Systematic DOACs oral anticoagulation in patients with atrial fibrillation and chronic kidney disease: the nephrologist's perspective.

Systematic DOACs oral anticoagulation in patients with atrial fibrillation and chronic kidney disease: the nephrologist's perspective. J Nephrol. 2020 Mar 21;: Authors: Ravera M, Bussalino E, Fusaro M, Di Lullo L, Aucella F, Paoletti E Abstract Atrial fibrillation (AF) is highly prevalent among patients with chronic kidney disease (CKD), and also associated with unfavorable outcome. Anticoagulant therapy is the mainstep of management in such patients, aimed at reducing the high risk of systemic thromboembolism and especially of ischemic stroke, which is reportedly associated with increased mortality in CKD patients. Even though new direct oral anticoagulant agents (DOACs) proved to be effective in patients with non valvular chronic AF, and are therefore recommended by recent guidelines for their treatment, warfarin is currently used in more than one-half of subjects needing oral anticoagulation, and only 30% of them are converted from a vitamin K antagonist- to a DOAC-based regimen. The main reason for not prescribing DOACs is often a reduction in renal function, even if mild. Aim of this review was therefore to evaluate the impact of DOAC therapy in the setting of CKD, from a nephrological perspective, by comparing available evidence on the role of DOACs in patients with CKD and AF with that emerging from traditional warfarin-based therapy. Both the pathogenesis of AF in CKD, and available findings of renal, cardiovascular and bone effects of DOACs in C...
Source: Journal of Nephrology - Category: Urology & Nephrology Authors: Tags: J Nephrol Source Type: research

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This study included 1962 patients who underwent transesophageal echocardiographic examination (TEE) prior to cardioversion or ablation in the years 2014-2018 in three cardiac centers. RESULTS: More than a quarter of AF patients had decreased eGFR (
Source: Cardiology Journal - Category: Cardiology Authors: Tags: Cardiol J Source Type: research
The objectives of the study were to examine the temporal trends and patient characteristics associated with prescription of thrombolytic, antithrombotic and statin medications among patients with first-ever stroke. MATERIALS AND METHODS: First-ever ischaemic and haemorrhagic stroke patients admitted to 2 Singapore tertiary hospitals between 2010‒2014 were included. Data were extracted from the National Healthcare Group Chronic Disease Management System. Association between drug utilisation and admission year, as well as characteristics associated with drug use, were explored using multivariable logistic regression. ...
Source: Ann Acad Med Singapo... - Category: General Medicine Authors: Tags: Ann Acad Med Singapore Source Type: research
AbstractAtrial fibrillation (AF) is the most common arrhythmia in clinical practice and its prevalence increases with age. Few data are available about the clinical performance of direct oral anticoagulant (DOACs) in patients aged  ≥ 80 years with AF. The aim of our propensity score matched cohort study was to compare the safety and efficacy of DOACs versus well-controlled VKA therapy among octogenarians with AF in real life setting. Data for this study were sourced from the multicenter prospectively maintained Atrial Fibrillation Research Database (NCT03760874), which includes all AF patients followe...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
ConclusionTTS has a good short- and medium-term prognosis. However, the rate of in-hospital complications is high and should not be overlooked. Dyspnea at presentation, CKD, CAD and lower LVEF on admission were independent predictors of in-hospital complications. Prolonged QTc on admission was associated with complications in follow-up.ResumoIntroduçãoA síndrome de Takotsubo (TTS) caracteriza-se por disfunção sistólica ventricular esquerda transitória.ObjetivoCaracterizar uma população portuguesa com TTS e determinar o seu prognóstico a curto e mé...
Source: Revista Portuguesa de Cardiologia - Category: Cardiology Source Type: research
CONCLUSIONS: In the largest real-world practice study among Asians with NVAF, four DOACs were associated with lower risks of thromboembolism and bleeding than warfarin. There was consistency even amongst high risk subgroups and whether standard dose or low dose regimes were compared. PMID: 31103697 [PubMed - as supplied by publisher]
Source: Chest - Category: Respiratory Medicine Authors: Tags: Chest Source Type: research
Giuseppe Ristagno1*, Francesca Fumagalli1, Barbara Bottazzi2, Alberto Mantovani2,3,4, Davide Olivari1, Deborah Novelli1 and Roberto Latini1 1Department of Cardiovascular Research, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy 2Humanitas Clinical and Research Center-IRCCS, Milan, Italy 3Humanitas University, Milan, Italy 4The William Harvey Research Institute, Queen Mary University of London, London, United Kingdom The long pentraxin PTX3 is a member of the pentraxin family produced locally by stromal and myeloid cells in response to proinflammatory signals and microbial moieties. The p...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
ConclusionsIncidence rates of IS/TE, mortality and bleeding increased with worsening eGFR. Worsening eGFR was an independent predictor of IS/TE and bleeding, and a better predictor of IS/TE than renal impairment in AF. We were able to identify predictors of worsening renal function, which may help to tag patients needing regular FU for appropriate adaptation of antithrombotic therapy.
Source: Archives of Cardiovascular Diseases Supplements - Category: Cardiology Source Type: research
Conclusions: During long-term FU of more than 2.5 years, this very old population of NOAC recipients demonstrated low rates of cardiovascular or major bleeding complications during active NOAC therapy. Approximately one quarter of the study population died during follow-up, with cardiovascular events being the leading cause of death. Only 11 fatal bleeding events were observed; however, most of the 58 fatal thromboembolic events occurred after anticoagulation was discontinued. This indicates that continued anticoagulation with NOACs may result in a beneficial risk-benefit ratio also in very old patients.DisclosuresBeyer-We...
Source: Blood - Category: Hematology Authors: Tags: 332. Antithrombotic Therapy: Management of Challenging Patients and Scenarios Source Type: research
Validation of Conventional Thromboembolic Risk Factors in a Korean Atrial Fibrillation Population - Suggestion for a Novel Scoring System, CHA2DS2-VAK. Circ J. 2018 Oct 04;: Authors: Cha MJ, Cho Y, Oh IY, Choi EK, Oh S Abstract BACKGROUND: There is little evidence that focuses on the ethnic variability of clinical risk factors for thromboembolism (TE) in atrial fibrillation (AF). We aimed to investigate the effect of each traditional risk factor in the Korean AF population. Methods and Results:Medical records of 12,876 consecutive patients (aged>18 years) newly diagnosed and followed up with ...
Source: Circulation Journal - Category: Cardiology Authors: Tags: Circ J Source Type: research
Abstract BACKGROUND: Because of a lack of comparative data on anticoagulant use in the advanced chronic kidney disease (CKD) population, guidelines recommend warfarin for atrial fibrillation and venous thromboembolism (VTE) treatment in these patients. However, apixaban has specific dosing recommendations in CKD leading to use in clinical practice. OBJECTIVE: To evaluate major bleeding, stroke, and thromboembolism rates in patients with CKD stage 4, stage 5, and dialysis on apixaban or warfarin therapy. METHODS: This was a retrospective cohort study of patients with advanced CKD receiving apixaban or war...
Source: The Annals of Pharmacotherapy - Category: Drugs & Pharmacology Authors: Tags: Ann Pharmacother Source Type: research
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