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Vitamin K antagonists for stroke prevention in hemodialysis patients with atrial fibrillation: a systematic review and meta-analysis
Conclusion Our meta-analysis revealed a trend for a reduction of the risk of ischemic stroke in hemodialysis patients with AF treated with VKA. The true protective effect may have been underestimated, owing to inclusion of low-risk patients not expected to benefit from anticoagulation and to suboptimal anticoagulation. However, assessment of the overall effect of VKA in hemodialysis patients should also take into account the increased risk of bleeding, in particular of hemorrhagic stroke. Whether new oral anticoagulants provide a better benefit–risk ratio in hemodialysis patients should be the subject of future trials.
Source: American Heart Journal - October 4, 2016 Category: Cardiology Source Type: research

Factors associated with non –vitamin K antagonist oral anticoagulants for stroke prevention in patients with new-onset atrial fibrillation: Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II (ORBIT-AF II)
Conclusions In contemporary clinical practice, up to three-fourths of patients with new-onset AF are now initially treated with a NOAC for stroke prevention. Those selected for NOAC treatment had lower stroke and bleeding risk profiles, were more likely treated by cardiologists, and had higher socioeconomic status. Trial registration clinicaltrials.gov Identifier: NCT01701817
Source: American Heart Journal - April 25, 2017 Category: Cardiology Source Type: research

Blood Pressure Control and Stroke or Bleeding Risk in Anticoagulated Patients with Atrial Fibrillation: Results from the ROCKET AF Trial
Conclusions In a trial of anticoagulated patients with AF, increasing screening SBP was independently associated with stroke and SE, and one-third of patients had uncontrolled hypertension. The relative effectiveness and safety of rivaroxaban versus warfarin was consistent across all levels of screening SBP. A single SBP may be an important factor in reducing the overall risk of stroke and SE in anticoagulated patients with AF.
Source: American Heart Journal - May 6, 2016 Category: Cardiology Source Type: research

How Well Does Physician Risk Assessment Predict Stroke and Bleeding in Atrial Fibrillation? Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF)
Conclusion Physician-assigned risk showed a graded relationship with outcomes and both physician-based and empirical scores yielded only moderate discrimination. While empirical scores provided valuable risk stratification information (with or without physician judgement), physician-assessment added little to existing scores. These data support the use of empirical scores for stroke and bleeding risk stratification, and the need for novel approaches to risk stratification in this population.
Source: American Heart Journal - August 26, 2016 Category: Cardiology Source Type: research

Factors Associated with Non-vitamin K Antagonist Oral Anticoagulants for Stroke Prevention in Patients with New-Onset Atrial Fibrillation: Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II (ORBIT-AF II)
Conclusions In contemporary clinical practice up to three-fourths of patients with new-onset AF are now initially treated with a NOAC for stroke prevention. Those selected for NOAC treatment had lower stroke and bleeding risk profiles, were more likely treated by cardiologists and had higher socioeconomic status. Trial Registration clinicaltrials.gov Identifier: NCT01701817
Source: American Heart Journal - April 4, 2017 Category: Cardiology Source Type: research

Two-year follow-up of patients treated with dabigatran for stroke prevention in atrial fibrillation: GLORIA-AF Registry
Conclusions These global data confirm the sustained safety and effectiveness of dabigatran over 2years of follow-up, consistent with the results from clinical trials as well as contemporary real-world studies. WHAT IS KNOWN • Non- vitamin K antagonist (VKA) anticoagulants (NOACs) are the preferred therapy for prevention of ischemic stroke based on phase 3 trials, but there is insufficient information on their efficacy and safety in daily practice, based on prospectively collected data WHAT IS NEW • This study shows that in non-valvular AF patient population, with up to 2years of follow-up, the use of dabigatran led to ...
Source: American Heart Journal - September 1, 2017 Category: Cardiology Source Type: research

Apixaban versus warfarin in patients with atrial fibrillation according to prior warfarin use: Results from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation trial
Background: Patients with atrial fibrillation who are vitamin K antagonist (VKA)-naive may have a higher risk of thrombosis and/or bleeding than VKA-experienced patients.Methods and results: Using data from ARISTOTLE, we assessed baseline characteristics and the treatment effect of apixaban versus warfarin in the VKA-naive and VKA-experienced cohorts. We compared rates of study drug discontinuation and time-in-therapeutic range. Overall, 7,800 (43%) were VKA naive, and 10,401 were VKA experienced. At baseline, both groups were similar with respect to age and congestive heart failure, hypertension, age, diabetes, stroke sco...
Source: American Heart Journal - July 26, 2013 Category: Cardiology Authors: David A. Garcia, Lars Wallentin, Renato D. Lopes, Laine Thomas, John H. Alexander, Elaine M. Hylek, Jack Ansell, Michael Hanna, Fernando Lanas, Greg Flaker, Patrick Commerford, Denis Xavier, Dragos Vinereanu, Hongqiu Yang, Christopher B. Granger Tags: Electrophysiology Source Type: research

Predictors of Oral Anticoagulant Non-prescription in Patients with Atrial Fibrillation and Elevated Stroke Risk
Conclusions In this registry of AF patients, older patients at elevated stroke and low bleeding risk were commonly treated with OAC. However, a variety of factors were associated with OAC non-prescription. Specifically, antiplatelet use was prevalent and associated with the highest likelihood of OAC non-prescription. Future studies are warranted to understand provider and patient rationale that may underlie observed associations with OAC non-prescription.
Source: American Heart Journal - March 11, 2018 Category: Cardiology Source Type: research

Relationship of stroke and bleeding risk profiles to efficacy and safety of dabigatran dual therapy versus warfarin triple therapy in atrial fibrillation after PCI: An ancillary analysis from the RE-DUAL PCI trial
ConclusionDabigatran dual therapy reduced bleeding events irrespective of bleeding risk category and demonstrated similar efficacy regardless of stroke risk category when compared with warfarin triple therapy.
Source: American Heart Journal - March 4, 2019 Category: Cardiology Source Type: research

Clinical events after transitioning from apixaban versus warfarin to warfarin at the end of the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial
Conclusions The excess in thrombotic and bleeding events in the apixaban group after study drug discontinuation appears to be related to an increased risk associated with the initiation of a VKA rather than a direct effect of apixaban. Whether ≥2 days of apixaban bridging improves outcomes during VKA transition is unknown and deserves further evaluation.
Source: American Heart Journal - December 9, 2014 Category: Cardiology Source Type: research

Gastrointestinal bleeding in patients with atrial fibrillation treated with Apixaban or warfarin: Insights from the ARISTOTLE trial
ConclusionsIn patients with AF on oral anticoagulants, prior GIB was associated with an increased risk of subsequent major GIB but not stroke, intracranial bleeding, or all-cause mortality. For the key outcomes of stroke, hemorrhagic stroke, death, and major bleeding, we found no evidence that the treatment effect (apixaban vs. warfarin) was modified by a history of GIB.
Source: American Heart Journal - November 2, 2019 Category: Cardiology Source Type: research

History of Bleeding and Outcomes with Apixaban versus Warfarin in Patients with Atrial Fibrillation in the ARISTOTLE Trial
Conclusion In patients with AF in a randomized clinical trial of oral anticoagulants, a history of bleeding is associated with several risk factors for stroke, and portends a higher risk of major—but not intracranial— bleeding, during anticoagulation. However, the beneficial effects of apixaban over warfarin for stroke, hemorrhagic stroke, death or major bleeding remains consistent regardless of history of bleeding.
Source: American Heart Journal - January 20, 2016 Category: Cardiology Source Type: research

Incidence and risk factors for thromboembolism and major bleeding in patients with mechanical valve prosthesis; a nationwide population-based study
Conclusions In a nationwide cohort study with MHV and high TTR, heart failure and atrial fibrillation did not appear as risk factors of stroke/TE.
Source: American Heart Journal - August 11, 2016 Category: Cardiology Source Type: research

Impact of atrial fibrillation on outcomes of patients treated by transcatheter aortic valve implantation: A systematic review and meta-analysis
Conclusions AF is associated with impaired outcomes after TAVI, including mortality, stroke and - limited to new-onset AF - major bleedings. Compared to pre-existing AF, new-onset AF correlates with higher risk of early stroke and major bleedings. Improved management of AF in the TAVI setting, including tailored antithrombotic treatment strategies, remain a relevant need.
Source: American Heart Journal - July 15, 2017 Category: Cardiology Source Type: research

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