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Cost-Effectiveness of Left Atrial Appendage Closure With the WATCHMAN Device Compared With Warfarin or Non-Vitamin K Antagonist Oral Anticoagulants for Secondary Prevention in Nonvalvular Atrial Fibrillation Clinical Sciences
Conclusions—Upfront procedure costs initially make LAAC higher cost than warfarin and the non–vitamin K antagonist oral anticoagulants, but within 10 years, LAAC delivers more quality-adjusted life years and has lower total costs, making LAAC the most cost-effective treatment strategy for secondary prevention of stroke in atrial fibrillation.
Source: Stroke - May 25, 2018 Category: Neurology Authors: Vivek Y. Reddy, Ronald L. Akehurst, Stacey L. Amorosi, Meghan B. Gavaghan, Deanna S. Hertz, David R. Holmes Jr Tags: Atrial Fibrillation, Cost-Effectiveness Original Contributions Source Type: research

Real-World Use of Apixaban for Stroke Prevention in Atrial Fibrillation Clinical Sciences
Background and Purpose—The use of oral anticoagulant therapy for stroke prevention in atrial fibrillation has been transformed by the availability of the nonvitamin K antagonist oral anticoagulants. Real-world studies on the use of nonvitamin K antagonist oral anticoagulants would help elucidate their effectiveness and safety in daily clinical practice. Apixaban was the third nonvitamin K antagonist oral anticoagulants introduced to clinical practice, and increasing real-world studies have been published. Our aim was to summarize current evidence about real-world studies on apixaban for stroke prevention in atrial fibril...
Source: Stroke - December 22, 2017 Category: Neurology Authors: Marco Proietti, Imma Romanazzi, Giulio Francesco Romiti, Alessio Farcomeni, Gregory Y.H. Lip Tags: Atrial Fibrillation, Anticoagulants, Quality and Outcomes Original Contributions Source Type: research

Echocardiographic Risk Factors for Stroke and Outcomes in Patients With Atrial Fibrillation Anticoagulated With Apixaban or Warfarin Clinical Sciences
Conclusions—In anticoagulated patients with atrial fibrillation and risk factors for stroke, echocardiographic findings do not seem to add to the risk of thromboembolic events.Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00412984.
Source: Stroke - November 27, 2017 Category: Neurology Authors: Dragos Vinereanu, Renato D. Lopes, Hillary Mulder, Bernard J. Gersh, Michael Hanna, Pedro G.M. de Barros e Silva, Dan Atar, Lars Wallentin, Christopher B. Granger, John H. Alexander Tags: Arrhythmias, Echocardiography, Intracranial Hemorrhage, Ischemic Stroke Original Contributions Source Type: research

Predicting Major Bleeding in Ischemic Stroke Patients With Atrial Fibrillation Brief Report
Conclusions—Performance of prediction models for major bleeding in patients with cerebral ischemia and atrial fibrillation is modest but comparable with performance in patients with only atrial fibrillation. Bleeding risk scores cannot guide treatment decisions for oral anticoagulants but may still be useful to identify modifiable risk factors for bleeding. Clinical usefulness may be best for ORBIT, which is based on a limited number of easily obtainable variables and showed reasonable performance.
Source: Stroke - October 23, 2017 Category: Neurology Authors: Nina A. Hilkens, Ale Algra, Jacoba P. Greving Tags: Atrial Fibrillation, Secondary Prevention, Ischemic Stroke Brief Reports Source Type: research

Effectiveness and Safety of Apixaban, Dabigatran, and Rivaroxaban Versus Warfarin in Patients With Nonvalvular Atrial Fibrillation and Previous Stroke or Transient Ischemic Attack Clinical Sciences
Conclusions—Results from our study of the 3 NOACs versus warfarin in nonvalvular atrial fibrillation patients with a previous history of stroke/transient ischemic attack are relatively consistent with their respective phase III trials and previous stroke/transient ischemic attack subgroup analyses. All NOACs seemed no worse than warfarin in respect to ischemic stroke, ICH, or major bleeding risk.
Source: Stroke - July 24, 2017 Category: Neurology Authors: Craig I. Coleman, W. Frank Peacock, Thomas J. Bunz, Mark J. Alberts Tags: Arrhythmias, Quality and Outcomes, Intracranial Hemorrhage, Ischemic Stroke Original Contributions Source Type: research

Is There an Obesity Paradox for Outcomes in Atrial Fibrillation? Clinical Sciences
Conclusions—There may be an obesity paradox in atrial fibrillation patients, particularly for all-cause and cardiovascular death outcomes. An obesity paradox was also evident for stroke/systemic embolic event outcome in NOAC trials, with a treatment effect favoring NOACs over warfarin for both efficacy and safety that was significant only for normal weight patients.
Source: Stroke - March 27, 2017 Category: Neurology Authors: Marco Proietti, Elisa Guiducci, Paola Cheli, Gregory Y.H. Lip Tags: Catheter Ablation and Implantable Cardioverter-Defibrillator, Obesity, Anticoagulants, Quality and Outcomes Original Contributions Source Type: research

Rivaroxaban Versus Dabigatran or Warfarin in Real-World Studies of Stroke Prevention in Atrial Fibrillation Clinical Sciences
Conclusions—In this systematic review and meta-analysis, rivaroxaban was as effective as dabigatran, but was more effective than warfarin for the prevention of stroke/thromboembolism in atrial fibrillation patients. Major bleeding risk was significantly higher with rivaroxaban than with dabigatran, as was all-cause mortality and gastrointestinal bleeding. Rivaroxaban was comparable to warfarin for major bleeding, with an increased risk in gastrointestinal bleeding and decreased risk of intracranial hemorrhage.
Source: Stroke - March 27, 2017 Category: Neurology Authors: Ying Bai, Hai Deng, Alena Shantsila, Gregory Y.H. Lip Tags: Meta Analysis, Quality and Outcomes Original Contributions Source Type: research

Anticoagulation Use and Clinical Outcomes After Major Bleeding on Dabigatran or Warfarin in Atrial Fibrillation Clinical Sciences
Conclusions—Dabigatran was associated with a superior benefit/risk ratio than warfarin and anticoagulation discontinuation in the treatment of atrial fibrillation patients who have survived a major bleed.
Source: Stroke - December 22, 2016 Category: Neurology Authors: Inmaculada Hernandez, Yuting Zhang, Maria M. Brooks, Paul K.L. Chin, Samir Saba Tags: Atrial Fibrillation, Quality and Outcomes, Intracranial Hemorrhage, Ischemic Stroke Original Contributions Source Type: research

Renal Function and the Risk of Stroke and Bleeding in Patients With Atrial Fibrillation Clinical Sciences
Background and Purpose—We sought to determine the risk of stroke/thromboembolism and bleeding associated with reduced renal function in patients with atrial fibrillation and the risk of stroke and bleeding associated with warfarin treatment in specific estimated glomerular filtration rate (eGFR) groups.Methods—We conducted a register-based cohort study and included patients discharged with nonvalvular atrial fibrillation from 1997 to 2011 with available eGFR.Results—A total of 17 349 patients were identified with eGFR available at baseline. All levels of lower eGFR were associated with higher risk of stroke/thrombo...
Source: Stroke - October 23, 2016 Category: Neurology Authors: Bonde, A. N., Lip, G. Y. H., Kamper, A.–L., Fosbol, E. L., Staerk, L., Carlson, N., Torp–Pedersen, C., Gislason, G., Olesen, J. B. Tags: Atrial Fibrillation Original Contributions Source Type: research

Outcomes With Edoxaban Versus Warfarin in Patients With Previous Cerebrovascular Events: Findings From ENGAGE AF-TIMI 48 (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48) Clinical Sciences
Conclusions— Patients with atrial fibrillation with previous IS/TIA are at high risk of recurrent thromboembolism and bleeding. HDER is at least as effective and is safer than warfarin, regardless of the presence or the absence of previous IS or TIA. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00781391.
Source: Stroke - July 24, 2016 Category: Neurology Authors: Rost, N. S., Giugliano, R. P., Ruff, C. T., Murphy, S. A., Crompton, A. E., Norden, A. D., Silverman, S., Singhal, A. B., Nicolau, J. C., SomaRaju, B., Mercuri, M. F., Antman, E. M., Braunwald, E., on behalf of the ENGAGE AF-TIMI 48 Investigators Tags: Atrial Fibrillation, Anticoagulants, Ischemic Stroke Clinical Sciences Source Type: research

Female Sex, Time in Therapeutic Range, and Clinical Outcomes in Atrial Fibrillation Patients Taking Warfarin Brief Reports
Conclusion— Anticoagulated female patients with atrial fibrillation had a similar rate of cardiovascular death and SSE, but a lower risk of major bleeding, compared with males. TTR (but not female sex) was an independent predictor for combined cardiovascular death and SSE and clinically relevant bleeding events.
Source: Stroke - May 22, 2016 Category: Neurology Authors: Senoo, K., Lip, G. Y. H. Tags: Quality and Outcomes Brief Reports Source Type: research

Cardiovascular, Bleeding, and Mortality Risks of Dabigatran in Asians With Nonvalvular Atrial Fibrillation Clinical Sciences
Conclusions— In real-world practice, dabigatran was associated with a reduced risk of ischemic stroke, intracranial hemorrhage, all hospitalized major bleeding, and all-cause mortality compared with warfarin in Asian patients with nonvalvular atrial fibrillation. Dabigatran did not increase the risk of major gastrointestinal bleeding or myocardial infarction compared with warfarin.
Source: Stroke - January 25, 2016 Category: Neurology Authors: Chan, Y.-H., Yen, K.-C., See, L.-C., Chang, S.-H., Wu, L.-S., Lee, H.-F., Tu, H.-T., Yeh, Y.-H., Kuo, C.-T. Tags: Atrial Fibrillation, Cardiovascular Disease, Race and Ethnicity, Intracranial Hemorrhage, Ischemic Stroke Clinical Sciences Source Type: research

Use of Warfarin at Discharge Among Acute Ischemic Stroke Patients With Nonvalvular Atrial Fibrillation in China Clinical Sciences
Conclusions— The rate of warfarin use remains low among patients with ischemic stroke and known nonvalvular atrial fibrillation in China. Hospital size and academic status together with patient age, heart failure, heavy alcohol drinking, international normalized ratio in hospital, and stroke severity on admission were each independently associated with the use of warfarin at discharge. There is much room for improvement for secondary stroke prevention in nonvalvular atrial fibrillation patients in China.
Source: Stroke - January 25, 2016 Category: Neurology Authors: Yang, X., Li, Z., Zhao, X., Wang, C., Liu, L., Wang, C., Pan, Y., Li, H., Wang, D., Hart, R. G., Wang, Y., Wang, Y., on behalf of the China National Stroke Registry II Investigators Tags: Anticoagulants, Treatment, Quality and Outcomes, Ischemic Stroke Clinical Sciences Source Type: research

Relationship of Age With Stroke and Death in Anticoagulated Patients With Nonvalvular Atrial Fibrillation: AMADEUS Trial Clinical Sciences
Conclusions— Elderly patients with atrial fibrillation have higher absolute risks of cardiovascular death, SSE, and bleeding, but relative risks of clinically relevant bleeding are not significantly different with increasing age strata. A significant inverse relationship between time in therapeutic range and bleeding and cardiovascular death/SSE emphasizes the importance of good quality anticoagulation control.
Source: Stroke - October 26, 2015 Category: Neurology Authors: Senoo, K., Lip, G. Y. H. Tags: Coumarins, Anticoagulants Clinical Sciences Source Type: research

Ischemic Stroke and Intracranial Hemorrhage With Aspirin, Dabigatran, and Warfarin: Impact of Quality of Anticoagulation Control Clinical Sciences
Conclusions— In Chinese patients with atrial fibrillation, the benefits of warfarin therapy for stroke prevention and ICH risk are closely dependent on the quality of anticoagulation, as reflected by TTR. Even at the top TTR quartile, warfarin was associated with a higher stroke and ICH risk than dabigatran.
Source: Stroke - December 22, 2014 Category: Neurology Authors: Ho, C.-W., Ho, M.-H., Chan, P.-H., Hai, J.-J., Cheung, E., Yeung, C.-Y., Lau, K.-K., Chan, K.-H., Lau, C.-P., Lip, G. Y. H., Leung, G. K.-K., Tse, H.-F., Siu, C.-W. Tags: Coumarins, Other anticoagulants, Anticoagulants Clinical Sciences Source Type: research

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