Incidence and outcomes of patients with atrial fibrillation and major bleeding complications: from the TREAT-AF study

AbstractPurposeOptimal stroke prevention strategies for patients with atrial fibrillation (AF) who experience a major bleed are poorly defined. We sought to estimate the effectiveness and safety of oral anticoagulation (OAC) represcription after an OAC contraindication.MethodsTREAT-AF is a retrospective cohort study of patients with newly diagnosed AF (2004 –2012), treated in the Veterans Health Administration. From this cohort, we identified patients with a contraindication to OAC after AF diagnoses, defined as incident intracranial bleeding, non-intracranial bleeding requiring hospitalization, or unrepaired cerebral aneurysm or aortic dissection. W e used multivariate Cox proportional hazards to estimate the association of OAC prescription in the 90 days following OAC contraindication to ischemic stroke and rebleeding.ResultsAmong 167,190 patients with newly diagnosed AF (70  ± 11 years, 1.7% female, CHA2DS2-VASc 2.7  ± 1.7), 19,285 patients (11.5%) had an incident bleed (n = 18,342) or an unrepaired cerebral aneurysm or aortic dissection (n = 943). For OAC-contraindicated patients with a CHA2DS2-VASc ≥2 (N = 16,194), OAC was represcribed in 4075 patients (25%) and was associated with a higher risk of non-intracranial bleeding (HR 1.49; 95% CI 1.37–1.61;p 
Source: Journal of Interventional Cardiac Electrophysiology - Category: Cardiology Source Type: research

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CONCLUSIONS: In highly selected patients at very HBR, discontinuation of any antithrombotic therapy after LAAC appears safe and feasible. PMID: 32999093 [PubMed - in process]
Source: The Journal of Invasive Cardiology - Category: Cardiology Tags: J Invasive Cardiol Source Type: research
ConclusionsIn the treatment of AF, CA appeared to be superior to AADs, decreasing the risk of all-cause death and cardiovascular hospitalization and improving the long-term QoL of patients with AF. CA was better tolerated and more effective than pharmacological therapy and allowed for improved QoL.
Source: American Journal of Cardiovascular Drugs - Category: Cardiology Source Type: research
ConclusionIn NVAF patients of all ages initiating either apixaban or warfarin for stroke prevention in the Sentinel System, apixaban was associated with a decreased risk of GI bleeding, ICH, and ischemic stroke compared with warfarin. Among patients less than 65  years of age, apixaban use was associated with a decreased risk of GI bleeding and ischemic stroke.
Source: Journal of General Internal Medicine - Category: Internal Medicine Source Type: research
AbstractBackgroundWomen undergoing atrial fibrillation catheter ablation (AFCA) have higher rates of vascular complications and major bleeding. However, most studies have been underpowered to detect differences in rarer complications such as stroke/transient ischemic attack (TIA) and procedural mortality.MethodsWe performed a systematic review of databases (PubMed, World of Science, Embase) to identify studies published since 2010 reporting AFCA complications by sex. Six complications of interest were: 1) vascular/groin complications; 2) pericardial effusion/tamponade; 3) stroke/TIA; 4) permanent phrenic nerve injury; 5) m...
Source: Journal of Cardiovascular Electrophysiology - Category: Cardiology Authors: Tags: ORIGINAL ‐ ELECTROPHYSIOLOGY Source Type: research
AbstractPurposeThe purpose of the present study was to compare the long-term effectiveness and safety of newly initiated anticoagulation with edoxaban (EDO) versus uninterrupted vitamin K antagonist (VKA) therapy in patients with atrial fibrillation (AF) scheduled for transesophageal echocardiogram (TEE)-guided direct electrical current cardioversion (DCC).MethodsA propensity score-matched cohort observational study was performed comparing the safety and effectiveness of edoxaban versus well-controlled VKA therapy among a cohort of consecutive non-valvular AF patients scheduled for DCC. The primary safety outcome was major...
Source: Cardiovascular Drugs and Therapy - Category: Cardiology Source Type: research
ConclusionsConcurrent LAA exclusion during MVR is a safe and effective way to reduce postoperative ischemic stroke, particularly in patients with AF.
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: ORIGINAL ARTICLE Source Type: research
Left atrial appendage closure (LAAC) is an alternative to oral anticoagulation therapy in patients with non-valvular atrial fibrillation for the prevention of embolic stroke and systemic embolism. Although elderly patients (>75 years) have both higher ischemic and bleeding risk as compared to younger patients, they benefit from optimal anticoagulation. The sub-analysis aimed to assess the indications, the safety, efficacy, and 1-year outcomes of interventional LAAC in elderly patients ( ≥ 75 years) compared to younger (
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
Left atrial appendage closure (LAAC) is an alternative to oral anticoagulation therapy in patients with non-valvular atrial fibrillation for the prevention of embolic stroke and systemic embolism. Although elderly patients (>75 years) have both higher ischemic and bleeding risk as compared with younger patients, they benefit from optimal anticoagulation. The subanalysis aimed to assess the indications, the safety, efficacy, and 1-year outcomes of interventional LAAC in elderly patients ( ≥ 75 years) compared with younger (
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
AbstractAimsMajor bleeding events in heart failure (HF) patients are poorly described. We sought to investigate the importance of major bleeding and its impact on outcomes in HF patients.Methods and resultsWe analysed incident bleeding and ischaemic events during a 3  year follow‐up in 2910 HF outpatients included in a prospective multicentre registry. Major bleeding was defined as a Type ≥3 bleed using the Bleeding Academic Research Consortium definition. Ischaemic event was a composite of ischaemic stroke and myocardial infarction. Events were adjudicated by a blinded committee. At inclusion, most patients (89%...
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Original Research Article Source Type: research
AbstractObjectivesThe OVID study will demonstrate whether prophylactic-dose enoxaparin improves survival and reduces hospitalizations in symptomatic ambulatory patients aged 50 or older diagnosed with COVID-19, a novel viral disease characterized by severe systemic, pulmonary, and vessel inflammation and coagulation activation.Trial designThe OVID study is conducted as a multicentre open-label superiority randomised controlled trial.ParticipantsInclusion Criteria1. Signed patient informed consent after being fully informed about the study ’s background.2. Patients aged 50 years or older with a positive test for SARS-...
Source: Trials - Category: Research Source Type: clinical trials
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