Clinical implications of assessment of apixaban levels in elderly atrial fibrillation patients: J-ELD AF registry sub-cohort analysis
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.
This study aimed to compare the outcomes between two minimally invasive approaches for AVR: mini ‐sternotomy (MS) and right anterior thoracotomy (RAT).Materials and MethodsA systematic search of MEDLINE, EMBASE, and OVID was conducted for the period 1990 ‐2019. Nine observational studies (n = 2926 patients) met the inclusion criteria.ResultsThere was no difference in operative mortality between MS and RAT (odds ratio [OR]: 0.87, 95% confidence interval [CI]: 0.41 ‐1.85;P = .709). Meta‐analyses favored MS over RAT in reoperation for bleeding (OR: 0.42, 95% CI: 0.28‐0.63;P
Atrial fibrillation (AF) is strongly linked to chronic kidney disease (CKD) and both of these conditions contribute to poor cardiovascular outcomes. We evaluated the impact of renal failure on major adverse cardiovascular events (MACE) in AF, and predictive value of the 2MACE score in this post-hoc analysis of the AMADEUS trial. The primary endpoint was MACE (composite of myocardial infarction, cardiac revascularisation and cardiovascular mortality). Secondary endpoints included the composite of stroke, major bleeding and non-cardiovascular mortality, and each of the specific outcomes separately.
Authors: Gunawardene MA, Hartmann J, Jularic M, Eickholt C, Gessler N, Willems S Abstract Atrial fibrillation (AF) is the most frequent persistent cardiac arrhythmia and is associated with an increased mortality. Therefore, an effective differential treatment of patients is mandatory. After a risk stratification oral anticoagulation (OAC) should be initiated depending on the individual stroke risk of each patient. Alternatively, in the presence of contraindications for OAC and an increased risk for bleeding and/or stroke, the implantation of a left atrial appendage closure device can be considered. Symptomatic pati...
Authors: Deltour S, Pautas E Abstract Primary and secondary prevention of stroke is often a challenge in elderly patients due to the increase in both thrombotic and hemorrhagic risks with age. In some cases, there is sufficient data in the elderly population to allow recommendations or anticoagulation decisions to be made, such as for the indication of anticoagulation to prevent stroke related to atrial fibrillation (AF) or the choice of oral anticoagulant therapy in this situation. In other situations, the less robust data leave some questions; this is the case for the delay to initiate an oral anticoagulant thera...
ConclusionsIn this prospective experience in unselected patients with atrial fibrillation, persistence to apixaban was high, and efficacy and safety were comparable to the results in clinical trials, supporting its use in clinical practice.
In this paper, the authors (Poole et al J Am Coll Cardiol. 2020;75:3105-3118. PMID 32586583) provide expanded results of an important secondary endpoint of the CABANA (Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation) trial, the recurrence of atrial fibrillation (AF). In the CABANA trial, 2204 patients with symptomatic AF and risk factors for stroke were randomized to catheter ablation or drug therapy with a primary endpoint was a composite of death, stroke, major bleeding or cardiac arrest during 5 years of follow-up.
rd A Abstract Using nationwide Danish registries, we conducted a population-based case-crossover study evaluating the association between switching from a vitamin K antagonist (VKA) to a direct oral anticoagulant (DOAC), and vice-versa, and 30-day risks of bleeding and arterial thromboembolism in atrial fibrillation (AF) patients. The case-crossover population was identified among oral anticoagulant users during 2011-2018 (n = 123,217), as AF patients with (a) a case-defining outcome and (b) an anticoagulant switch during the 180 days preceding the outcome. Odds Ratios were estimated using conditional lo...
Conclusion: In cancer patients with AF, NOAC were associated with significant reduced IS/SE, major bleeding, and ICH compared to warfarin.
ConclusionsPatients with AF and history of HF may have greater disease burden at AF diagnosis and increased mortality rates vs. patients without HF. Stroke and major bleeding rates were roughly comparable between groups confirming the long ‐term safety and effectiveness of dabigatran in patients with HF.
Atrial fibrillation (AF) patients with a previous stroke are often at a high risk of recurrent stroke and bleeding. Anticoagulation therapy in such patients is a challenging dilemma. Thoracoscopic left atrial appendage excision (LAAE) plus AF ablation is an interventional approach offered to some AF patients. We hypothesized that this approach may be suitable as a secondary stroke prevention strategy for these high-risk patients. Between January 2013 and December 2016, a total of 44 patients (26 male; mean age 65.0 ±9.1 years) with nonvalvular AF and a previous stroke or systemic thromboembolic event were enrolled.