Trends in the Utilization of Left Atrial Appendage Exclusion in the United States
Stroke prevention remains a cornerstone in the management of patients with non-valvular atrial fibrillation (NVAF)1. Oral anticoagulation (OAC) is the main method of stroke prevention in NVAF worldwide. However,>50% of high-risk NVAF patients are not maintained on OAC due to comorbidities, frailty, bleeding complications, or non-compliance2. In 1996, Blackshear proposed Left atrial appendage exclusion (LAAE) as an alternative stroke prevention strategy in NVAF3. Because no randomized data were available to support the routine use of LAAE, its utilization remained initially limited to selected patients undergoing a concomitant cardiac surgery.
ConclusionsIn Japanese NVAF patients undergoing CA, NOACs have similar effects to warfarin in the prevention of stroke and systemic embolism. Moreover, NOACs were associated with a lower incidence of bleeding complications.
ConclusionsGPs and patients are waiting for the other to mention issues surrounding AF treatment such as switching, use of thrombosis service, and number of pills to take first. The perceptions and experiences of patients with AF regarding their disease and treatment highly influence the decisions GPs make, together with these patients, as well as considerations that patients have regarding their treatment; GPs need to be aware of their AF patients ’ perceptions and experiences with their condition and medication’ in order to facilitate discussions with patients and improve clinical outcomes.
ConclusionsA high trough apixaban level in patients indicated for standard dose was not associated with adverse events, while a high apixaban level in patients indicated for a reduced dose was associated with bleeding requiring hospitalization.
CONCLUSIONS: In patients with kidney failure and nonvalvular atrial fibrillation, treatment with apixaban was not associated with a lower incidence of new stroke, transient ischemic attack, or systemic thromboembolism but was associated with a higher incidence of fatal or intracranial bleeding. PMID: 32444398 [PubMed - as supplied by publisher]
Authors: Kuronuma K, Okumura Y, Morikawa T, Yokoyama K, Matsumoto N, Tachibana E, Oiwa K, Matsumoto M, Kojima T, Haruta H, Nomoto K, Sonoda K, Arima K, Kogawa R, Takahashi F, Kotani T, Ohkubo K, Fukushima S, Itou S, Kondo K, Chiku M, Ohno Y, Onikura M, Hirayama A, SAKURA AF Registry Investigators Abstract Atrial fibrillation (AF) and heart failure (HF) often coexist. The aims of this study were to explore the factors associated with the serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), and the association between prognosis and a history of HF or the serum NT-proBNP level in Japanese patients wit...
Conclusion4FPCC appears to be an effective and safe option for FXaI-associated ICB with outcomes comparable to andexanet alfa. A formal prospective evaluation of this strategy versus andexanet alpha including cost analysis is warranted.
Authors: Zimmermann F, Landmesser U Abstract Atrial fibrillation (AF) is one of the most frequent causes of ischemic stroke. Without treatment the annual risk of ischemic stroke is on average approximately 5-6%/year in patients with atrial fibrillation, depending on the overall cardiovascular risk profile. Oral anticoagulation with new oral anticoagulants (NOAC) or vitamin K antagonists (VKA) is recommended for patients with AF and an elevated risk for stroke (CHA2DS2-VASc score ≥1); however, severe bleeding complications are potential reasons for discontinuation of this treatment. Overall, up to 30 % of the p...
This post introduces a column I wrote over at TheHeart.org | Medscape Cardiology — The good news is that most people infected with coronavirus don’t need a hospital or doctor. But some do. Some get very ill. The maddening thing is that doctors don’t have an effective treatment for the virus. There are no cures. The Worldmeter today shows nearly 5 million infections and more than 300,000 deaths. And no effective therapy. Excluding a possibly modest effect of Remdesivir, our care is supportive, which is medical jargon for giving simple things like oxygen, acetaminophen, IV fluids and letting ...
CONCLUSION: Compared with drug therapy, PFO closure reduced the risk of recurrent stroke among patients with a risk score of ≥2 and reduced the incidence of serious bleeding without increasing the risk of new-onset atrial fibrillation or atrial flutter. PMID: 32394019 [PubMed - as supplied by publisher]
In conclusion, more and more patients who suffer a hematuria while on oral anticoagulant therapy resume NOAC. Patients resuming NOAC have similar risks of ischemic stroke/systemic embolism and major bleeding compared with those resuming VKA.