Long-term Event Reduction After Left Atrial Appendage Closure. Results of the Iberian Registry II

This study aimed to establish the occurrence of stroke and major bleeding events in patients with nonvalvular atrial fibrillation and left atrial appendage closure with long-term follow-up and to explore the factors associated with higher long-term mortality.MethodsAnalysis of a multicenter single cohort prospectively recruited from 2009 to 2015. Thromboembolic and bleeding events were compared with those expected from CHA2DS2-VASc and HAS-BLED scores. Multivariate analysis examined variables associated with mortality during follow-up.ResultsA total of 598 patients (1093 patient-years) with a contraindication for anticoagulants were recruited (median 75.4 years). The success rate of left atrial appendage closure device implantation was 95.8%. Thirty patients (5%) experienced periprocedural complications. The rate of events (per 100 patient-years) during follow-up (mean 22.9 months; median 16.1 months) was as follows: death 7.0%; ischemic stroke 1.6% (vs 8.5% expected according to CHA2DS2-VASc; P 24 months (mean follow-up 46.6 months, 683 patient-years) for severe bleeding 2.6% (vs 6.3% expected by HAS-BLED, P
Source: Revista Espanola de Cardiologia - Category: Cardiology Source Type: research

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AbstractThe goal of this paper is to review literature on the topic of anticoagulation resumption after stroke from atrial fibrillation. Following ischemic stroke, the average annual risk of recurrent stroke in a patient with a CHADS2 score of 9 is 12.2%%, translating to an average daily risk of 0.03%%. Oral anticoagulant therapy provides a 75% relative risk reduction. However, in the 2-week period immediately following an acute stroke, this daily risk appears to be elevated. The same period is associated with an increased risk of hemorrhagic transformation of ischemic stroke due to reperfusion, impaired autoregulation, an...
Source: Current Atherosclerosis Reports - Category: Cardiology Source Type: research
ConclusionThe prescription of rivaroxaban in patients with NVAF and renal impairment was associated with a lower incidence of ischaemic stroke and intracranial haemorrhage versus phenprocoumon in patients without evidence of cancer.
Source: IJC Heart and Vasculature - Category: Cardiology Source Type: research
AbstractPatients with non-valvular atrial fibrillation (NVAF) and chronic kidney disease (CKD) are at increased risk of stroke and bleeding. Although direct oral anticoagulant (DOAC) trials excluded patients with severe CKD, a growing portion of CKD patients have been starting DOACs and limited data from real-world outcome in this high-risk setting are available. The INSigHT registry included 632 consecutive NVAF patients that started apixaban (256 patients, 41%), dabigatran (245, 39%) and rivaroxaban (131, 20%) between 2012 and 2015. Based on creatinine clearance, two sub-cohorts were defined: (1) non-CKD group (CrCl 60 &...
Source: Internal and Emergency Medicine - Category: Emergency Medicine Source Type: research
AbstractPurpose of reviewAs one of the fastest growing portions of the population, nonagenarians will constitute a significant percentage of the stroke patient population in the near future. Nonagenarians are nevertheless not specifically targeted by most clinical guidelines. In this review, we aimed to summarise the available evidence guiding stroke prevention and treatment in this age group.Recent findingsSeveral recent observational studies have shown that the benefits of anticoagulation for the oldest old patients with atrial fibrillation may outweigh the bleeding risk. A sub-analysis of the IST-3 trial has shown for t...
Source: Current Treatment Options in Neurology - Category: Neurology Source Type: research
ConclusionThere is no significant association between warfarin treatment with risks of mortality, ischemic stroke or bleeding in patients with atrial fibrillation receiving peritoneal dialysis.
Source: American Journal of Cardiovascular Drugs - Category: Cardiology Source Type: research
Emilio Rodríguez-Castro1,2, Manuel Rodríguez-Yáñez1,2, Susana Arias1,2, María Santamaría1,2, Iria López-Dequidt1,2, Ignacio López-Loureiro1, Manuel Rodríguez-Pérez1, Pablo Hervella1, Tomás Sobrino1, Francisco Campos1, José Castillo1* and Ramón Iglesias-Rey1* 1Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain2Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Johannes Schurig1,2*, Karl Georg Haeusler1,2,3, Ulrike Grittner4,5, Christian H. Nolte1,2, Jochen B. Fiebach1,2, Heinrich J. Audebert1,2, Matthias Endres1,2,5,6 and Andrea Rocco1,2 1Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Berlin, Germany 2Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany 3Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany 4Insitute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Berlin, Germany 5Berlin Institute of Heal...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
CONCLUSIONS: The NNT calculation, when approached and interpreted properly, is a practical measure of the effectiveness of a treatment. The calculation based on HRs showed that NOACs are safe and effective alternatives to VKAs in real life. PMID: 30969801 [PubMed - as supplied by publisher]
Source: Journal of Medical Economics - Category: Health Management Tags: J Med Econ Source Type: research
Conclusion: In ischemic stroke or TIA patients with platelet count within normal range, platelet count may be a qualified predictor for long-term recurrent stroke, mortality, and poor functional outcome. Introduction Platelets exert a critical role in the pathogenesis of atherosclerotic complications of cardio-cerebrovascular disease, contributing to thrombus formation, and embolism (1, 2). Previous literature reported that platelets of various size and density are produced by megakaryocytes of different size and stages of maturation in different clinical conditions, suggesting various platelet patterns in differen...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
This article gives an overview of the contemporary diagnosis and management of atrial fibrillation, and the associated evidence base. Where there is uncertainty, we describe our own approach to these areas, while highlighting ongoing research that will likely guide future practice. PMID: 30826740 [PubMed - as supplied by publisher]
Source: Practical Neurology - Category: Neurology Authors: Tags: Pract Neurol Source Type: research
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