Warfarin and Aspirin Use for Stroke Prevention Among Patients With Atrial Fibrillation: The US National Health and Wellness Survey

This study examined VKA and ASA use and their clinical correlates, including CHADS2 stroke risk scores, among adult patients with AF in the general population. Participants included 1290 (1.72%) adults reporting diagnosis with AF (mean age, 64.9 years; 65% men) from the 2009 US National Health and Wellness Survey, an online, self-administered, nationwide, stratified random sample survey of 75,000 adults. Antithrombotic use patterns, including VKA, ASA, VKA+ASA, and non-VKA/ASA, and their correlates were examined using logistic regressions. Respondents with AF were treated with VKA (26.6%), ASA (34.5%), VKA+ASA (15.4%), or neither (23.5%). Among those with CHADS2 ≥1, 19.3% did not report use of VKA or ASA. Among those with CHADS2 ≥2, 35.7% were treated only with ASA. Adjusting for covariates in logistic regressions, CHADS2 ≥1 was associated with VKA and/or ASA (vs. non-VKA/ASA) use (P ≤ 0.02), but CHADS2 score did not differentiate VKA versus ASA use (P> 0.4). Comorbidities were associated with ASA versus VKA use (P ≤ 0.01). Older age, male gender, married status, and obesity were each associated with use of at least one of the treatments investigated (all P
Source: American Journal of Therapeutics - Category: Drugs & Pharmacology Tags: Original Articles Source Type: research

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Atrial fibrillation (AF) is a frequently identified arrhythmia during the course of sepsis. The aim of this narrative review is to assess the characteristics of patients with new-onset AF related to sepsis and the risk of stroke and death, to understand if there is a need for anticoagulation. We searched for studies on AF and sepsis on PubMed, the Cochrane database, and Web of Science, and 17 studies were included. The mean incidence of new-onset AF in patients with sepsis was 20.6% (14.7% in retrospective studies and 31.6% in prospective). Risk factors for new-onset AF included advanced age, white race, male sex, obesity,...
Source: Current Awareness Service for Health (CASH) - Category: Consumer Health News Source Type: news
The efficacy and safety of DOACs in morbidly obese patients have been well investigated over the last few years.1-4 Our recent meta-analysis showed that the DOAC group did not increase stroke or systemic embolism (SE) event rate compared to the warfarin group and the DOAC use was significantly associated with a lower major bleeding event rate compared to the warfarin group.5 However, it is still unknown which DOAC is more appropriate than others. Apixaban and rivaroxaban are the two most common DOACs prescribed in the U.S but there is no guidance on which agent should be selected in morbidly obese patients with AF.
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
Conclusion This is one of the few studies analyzing the association of recent cannabis use and AIS using admission urine toxicology test independent of polysubstance use. Although our study has limitations, we did not find an independent association between recent cannabis use and the incidence of AIS. Further studies using urine toxicology tests with larger sample size and including dosage of cannabis exposure should be conducted.
Source: Neurology Clinical Practice - Category: Neurology Authors: Tags: All Cerebrovascular disease/Stroke, Other toxicology Research Source Type: research
Atrial fibrillation (afib) is a common heart rhythm disorder in which the upper chambers of the heart (the atria) beat fast and irregularly. Afib commonly causes recurrent symptoms, usually palpitations and shortness of breath, and can negatively affect quality of life. Afib also substantially increases the risk of stroke, and is also associated with heart failure, high blood pressure, and diabetes. People with afib routinely require lifelong treatment with blood thinners, to prevent blood clots that can lead to strokes. Doctors are only recently understanding the importance of lifestyle factors in treating afib. Modifiabl...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Diabetes Diet and Weight Loss Exercise and Fitness Healthy Eating Heart Health Sleep Source Type: blogs
In conclusion, uric acid is emerging as a potentially treatable risk factor for cardiometabolic diseases, and more clinical trials investigating the potential benefit of lowering serum uric acid are recommended in individuals with hyperuricaemia with and without deposition and concomitant hypertension, metabolic syndrome or chronic kidney disease. PMID: 32739239 [PubMed - as supplied by publisher]
Source: European Journal of Internal Medicine - Category: Internal Medicine Authors: Tags: Eur J Intern Med Source Type: research
Abstract BACKGROUND: Post-operative atrial fibrillation (POAF) after cardiac surgery is associated with longer hospital stay and increased in-hospital stroke and mortality, but its longer-term implications remain incompletely understood. A systematic literature review was undertaken to investigate the impact of POAF on long-term mortality and stroke in adult cardiac surgery patients. METHODS: Electronic databases (Cochrane, EMBASE, Ovid Medline, PubMed) were queried from inception to October 2018. Included studies compared long-term outcomes in cardiac surgery patients with and without POAF. Adjusted and unad...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg Source Type: research
AbstractBackgroundOlder persons with atrial fibrillation (AF) experience significant impairment in quality of life (QoL), which may be partly attributable to their comorbid diseases. A greater understanding of the impact of comorbidities on QoL could optimize patient-centered care among older persons with AF.ObjectiveTo assess impairment in disease-specific QoL due to comorbid conditions in older adults with AF.MethodsPatients aged  ≥ 65 years diagnosed with AF were recruited from five medical centers in Massachusetts and Georgia between 2015 and 2018. At 1 year of follow-up, the Quality of Life Disea...
Source: Quality of Life Research - Category: Health Management Source Type: research
Abstract OBJECTIVE: Treatment of asymptomatic internal carotid artery (ICA) stenosis, particularly for moderate to severe (70%-80%) disease, is controversial. The goal was to assess the clinical course of patients with moderate to severe carotid stenosis. METHODS: A single institution retrospective analysis of patients with asymptomatic ICA stenosis identified on duplex ultrasound as moderate to severe (70%-80%) from 2003 to 2018 were analysed. Duplex criteria for 70%-80% stenosis was a systolic velocity of ≥325 cm/s or an ICA:common carotid artery ratio of ≥4, and an end diastolic velocity of 80%,...
Source: PubMed: Eur J Vasc Endovasc ... - Category: Surgery Authors: Tags: Eur J Vasc Endovasc Surg Source Type: research
I’ve been wearing my Fitbit for a couple of years and only remove it when I shower. I use it to track my sleep and its smart alarm wakes me up at the optimal time every morning. With the pocketable Kardia, I regularly check my ECG at home to detect any anomalies. For an in-depth analysis of what my genetic makeup predisposes me to, I had my whole genome sequenced. And I bring relevant data to my general practitioner during my checkups so that we can decide on preventive measures. In short, I’m trying to live like the patient of the future. However, posing as such a patient is not feasible for many among us. ...
Source: The Medical Futurist - Category: Information Technology Authors: Tags: Lifestyle medicine E-Patients Health Sensors & Trackers Healthcare Design Medical Education Personalized Medicine sleep stress food scanner sleep apnea Apple Watch Dr. Vernes Baylor ACLM Source Type: blogs
Conclusions: Evidence indicates that each DOAC may have differences in outcomes when used in patients with a high BW/BMI. Currently, low-quality data are available that support avoiding dabigatran and considering apixaban or rivaroxaban; lack of sufficient data preclude a recommendation for edoxaban use in this patient population. PMID: 32443941 [PubMed - as supplied by publisher]
Source: The Annals of Pharmacotherapy - Category: Drugs & Pharmacology Authors: Tags: Ann Pharmacother Source Type: research
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