Gastrointestinal bleeding in patients with atrial fibrillation treated with Apixaban or warfarin: Insights from the ARISTOTLE trial

Publication date: Available online 31 October 2019Source: American Heart JournalAuthor(s): David A. Garcia, Deborah A. Fisher, Hillary Mulder, Lisa Wruck, Raffele De Caterina, Sigrun Halvorsen, Christopher B. Granger, Claes Held, Lars Wallentin, John H. Alexander, Renato D. LopesAbstractObjectivesA history of gastrointestinal bleeding (GIB) in patients with atrial fibrillation (AF) may impact decisions about anticoagulation treatment. To sought to determine whether prior GIB in patients with AF taking anticoagulants was associated with an increased risk of stroke or major hemorrhage.MethodsWe analyzed key efficacy and safety outcomes in patients with prior GIB in ARISTOTLE. Centrally adjudicated outcomes according to GIB history were analyzed using Cox proportional hazards models adjusted for randomized treatment and established risk factors.ResultsA total of 784 (4.3%) patients had prior GIB (321 [41%] lower, 463 [59%] upper); 215 (27%) occurred
Source: American Heart Journal - Category: Cardiology Source Type: research

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Authors: Kimpton M, Siegal DM Abstract A 77-year-old man with atrial fibrillation and a CHA2DS2Vasc score of 6 for hypertension, age, diabetes, and previous stroke is brought to the emergency department with decreased level of consciousness. He is anticoagulated with rivaroxaban (a direct oral factor Xa inhibitor [FXaI]) and received his last dose about 4 hours before presentation. Urgent computed tomography of the head shows intracerebral hemorrhage. Because of his previous stroke, the patient's family is concerned about treating the bleed with pharmacological agents that may increase the risk of stroke. What are ...
Source: Hematology ASH Education Program - Category: Hematology Tags: Hematology Am Soc Hematol Educ Program Source Type: research
Atrial fibrillation (AF) is associated with a substantially higher risk of thromboembolism, particularly stroke events, resulting in significant morbidity and mortality. Oral anticoagulation (OAC), while effective in reducing embolic events in AF patients, is associated with an increased bleeding risk. Thus, not all patients with AF are candidates for OAC and some are only candidates for OAC in the short term. Of the available nonpharmacologic strategies for the management of AF, left atrial appendage occlusion (LAAO) has emerged as a potential approach for reducing the risk of systemic thromboembolism in AF patients eligi...
Source: Cardiology in Review - Category: Cardiology Tags: Review Articles Source Type: research
CONCLUSIONS: Compared to warfarin, NOACs were associated with a significantly lower risk of adverse events, with heterogeneity in treatment effects among different age strata. Overall, the clear safety signal in favor of NOACs over warfarin was evident irrespective of age strata, being most marked in the most elderly. PMID: 31809694 [PubMed - as supplied by publisher]
Source: Chest - Category: Respiratory Medicine Authors: Tags: Chest Source Type: research
AbstractThe best strategy in atrial fibrillation (AF) after  >  12 months after an acute coronary syndrome or in patients with chronic coronary syndrome without an indication for interventional revascularization remains unclear. European guidelines generally recommend therapy with oral anticoagulation (OAC) alone, whereas North American guidelines advise com bination therapy consisting of OAC plus antiplatelet therapy in some patients. We performed a meta-analysis of available trials comparing these treatment strategies. The primary endpoint was major adverse cardiac events (MACE), secondary endp...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
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Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
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Source: Cardiovascular Drugs and Therapy - Category: Cardiology Source Type: research
In conclusion, current published data suggest that th e use of reduced-dose NOACs is non-inferior to warfarin in patients with AF (in particular Asians).
Source: Heart Failure Reviews - Category: Cardiology Source Type: research
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Source: American Journal of Therapeutics - Category: Drugs & Pharmacology Tags: Review Source Type: research
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Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
AbstractThe role of non-vitamin K antagonist oral anticoagulants (NOACs) in stroke prevention remains unclear in Asian patients with atrial fibrillation (AF). Therefore, we performed a meta-analysis to compare the efficacy and safety outcomes of NOACs in Asian patients with AF from the real-world settings. The PubMed and Embase databases were systematically searched to identify eligible observational studies until June 2019. The odds ratios (OR) and 95% confidence intervals (CIs) were calculated and then pooled by a random-effects model. A total of 18 observational studies were included. Compared with warfarin, dabigatran ...
Source: Heart Failure Reviews - Category: Cardiology Source Type: research
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