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Is left atrial appendage closure useful for stroke prevention in atrial fibrillation patients with renal failure?
With great interest we read the article by Kefer et al. about the impact of chronic kidney disease on left atrial appendage (LAA) occlusion with the ACP device for stroke prevention in patients with atrial fibrillation (AF) [1]. We agree with the authors that stroke prevention in AF patients with chronic kidney disease is a problem due to increased bleeding complications during oral anticoagulant therapy with vitamin K antagonists. Furthermore, the use of non-vitamin K-antagonist oral anticoagulants (NOACs) is dangerous or contraindicated in these patients.
Source: International Journal of Cardiology - April 14, 2016 Category: Cardiology Authors: Claudia Stöllberger, Josef Finsterer, Birke Schneider Source Type: research

A Case of Transient Global Amnesia: A Review and How It May Shed Further Insight into the Neurobiology of Delusions
Conclusion In closing, our patient’s episode of TGA combined with her emotional and perceptual response lends credence to the proposal of a “fear/paranoia” circuit in the genesis of paranoid delusions—a circuit incorporating amygdala, frontal, and parietal cortices. Here, neutral or irrelevant stimuli, thoughts, and percepts come to engender fear and anxiety, while dysfunction in frontoparietal circuitry engenders inappropriate social predictions and maladaptive inferences about the intentions of others.[54] Hippocampus relays information about contextual information based on past experiences and the current situat...
Source: Innovations in Clinical Neuroscience - April 1, 2016 Category: Neuroscience Authors: ICN Online Editor Tags: Anxiety Disorders Behavioral and Cognitive Neurology Case Report Cognition Current Issue Dementia Medical Issues Neurologic Systems and Symptoms Psychiatry Schizophrenia delusions hippocampus neurobiology Transient global amnesia Source Type: research

Altered lipid metabolism in the aging kidney identified by three layered omic analysis.
Abstract Aging-associated diseases and their comorbidities affect the life of a constantly growing proportion of the population in developed countries. At the center of these comorbidities are changes of kidney structure and function as age-related chronic kidney disease predisposes to the development of cardiovascular diseases such as stroke, myocardial infarction or heart failure. To detect molecular mechanisms involved in kidney aging, we analyzed gene expression profiles of kidneys from adult and aged wild-type mice by transcriptomic, proteomic and targeted lipidomic methodologies. Interestingly, transcriptome...
Source: Aging - February 16, 2016 Category: Biomedical Science Authors: Braun F, Rinschen MM, Bartels V, Frommolt P, Habermann B, Hoeijmakers JH, Schumacher B, Dollé ME, Müller RU, Benzing T, Schermer B, Kurschat CE Tags: Aging (Albany NY) Source Type: research

Non-vitamin K oral anticoagulant drugs for stroke prevention in patients with atrial fibrillation and chronic kidney disease.
Abstract Atrial fibrillation (AF) and chronic kidney disease (CKD) are disorders with increasing prevalence. The presence of CKD increases the risk of incident AF and vice versa, and the presence of AF may accelerate CKD progression. Nearly a third of patients with established CKD also have AF, whilst half of AF patients may have some degree of renal dysfunction. Both AF and CKD are associated with increased cardiovascular morbidity and mortality, including significantly increased risk of stroke or systemic embolism. Oral anticoagulant therapy (OAC), either with vitamin K antagonists or with non-vitamin K oral ant...
Source: Current Medicinal Chemistry - February 10, 2016 Category: Chemistry Authors: Potpara TS, Jokic V, Dagres N, Larsen TB, Lane DA, Hindricks G, Lip GY Tags: Curr Med Chem Source Type: research

Decision-making about the use of non-vitamin K oral anticoagulant therapies for patients with atrial fibrillation
Abstract Until recently, vitamin K antagonists, warfarin being the most commonly used agent in the United States, have been the only oral anticoagulant therapies available to prevent stroke in patients with atrial fibrillation (AF). In the last 5 years four new, non-vitamin K oral anticoagulants, the so-called NOACs or novel oral anticoagulants, have come to market and been approved by the Federal Drug Administration. Despite comparable if not superior efficacy in preventing AF-related stroke, and generally lower risks of major hemorrhage, particularly intracranial bleeding, the uptake of these agents has been s...
Source: Journal of Thrombosis and Thrombolysis - February 1, 2016 Category: Hematology Source Type: research

Management of atrial fibrillation in patients with chronic kidney disease in Europe Results of the European Heart Rhythm Association Survey
The purpose of this European Heart Rhythm (EHRA) Scientific Initiatives Committee EP Wire Survey was to assess ‘real-world’ practice in the management of patients with atrial fibrillation (AF) and chronic kidney disease (CKD) in the European Eelectrophysiology centres. Of 41 responding centres, 39 (95.1%) and 37 (90.2%) routinely evaluated renal function in AF patients at first presentation and during follow-up, respectively, but 13 centres (31.7%) re-assessed advanced CKD only at ≥1-year intervals. While the use of oral anticoagulants (OACs) in mild-to-moderate CKD patients was mostly guided by individual p...
Source: Europace - January 4, 2016 Category: Cardiology Authors: Potpara, T. S., Lenarczyk, R., Larsen, T. B., Deharo, J.-C., Chen, J., Dagres, N., Conducted by the Scientific Initiatives Committee, European Heart Rhythm Association, Conducted by the Scientific Initiatives Committee, European Heart Rhythm Association, Tags: EP WIRE Source Type: research

Atrial fibrillation and chronic kidney disease: focus on rivaroxaban.
Authors: Barrios V, Górriz JL Abstract Renal insufficiency increases the risk of stroke and bleeding in atrial fibrillation patients. Although vitamin K antagonists reduce the risk of stroke in patients with moderate renal dysfunction, this observation is less clear in patients with renal impairment. Moreover, the risk of bleeding with vitamin K antagonists increases as renal function worsens. Maintaining international normalized ratio values within therapeutic targets is more difficult in patients with renal dysfunction, and those agents may cause warfarin-related nephropathy and vascular calcification. Rivaroxa...
Source: Journal of Comparative Effectiveness Research - December 2, 2015 Category: Journals (General) Tags: J Comp Eff Res Source Type: research

A Probable Life-Saving Switch from Apixaban to Phenprocoumon.
Abstract The direct oral anticoagulants (DOAC) dabigatran, rivaroxaban, and apixaban are increasingly prescribed in atrial fibrillation (AF) patients, although dosage in elderly patients, safety in chronic kidney disease, food- and drug-interactions, laboratory tests for monitoring, and antidote are not clarified. In a 78-year-old man with an acute stroke, paroxysmal AF and sick-sinus-syndrome were detected as he received a DDD-pacemaker and 5 mg apixaban/bid. He had a history of hypertension, hypothyroidism, diabetes mellitus, hyperlipidemia, sleep apnea, lumbar discopathy, and nephropathy. Renal function deterio...
Source: The Heart Surgery Forum - October 30, 2015 Category: Cardiovascular & Thoracic Surgery Authors: Stöllberger C, Finsterer J Tags: Heart Surg Forum Source Type: research

Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation
The current manuscript is an update of the original Practical Guide, published in June 2013[Heidbuchel H, Verhamme P, Alings M, Antz M, Hacke W, Oldgren J, et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013;15:625–51; Heidbuchel H, Verhamme P, Alings M, Antz M, Hacke W, Oldgren J, et al. EHRA practical guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation: executive summary. Eur Heart J 2013;34:2094–106]. Non-vitamin K antagonist oral anticoagulants (NOACs) are an ...
Source: Europace - October 23, 2015 Category: Cardiology Authors: Heidbuchel, H., Verhamme, P., Alings, M., Antz, M., Diener, H.-C., Hacke, W., Oldgren, J., Sinnaeve, P., Camm, A. J., Kirchhof, P., Advisors:, Ahmad, Heinrich-Nols, Hess, Muller, Munzel, Schwertfeger, Van Eickels, Richard-Lordereau, Document reviewers:, L Tags: EHRA PRACTICAL GUIDE Source Type: research

Oral anticoagulants for stroke prevention in atrial fibrillation: current status, special situations, and unmet needs
Publication date: Available online 14 March 2015 Source:The Lancet Author(s): Freek W A Verheugt , Christopher B Granger In patients with non-valvular atrial fibrillation, oral anticoagulation with vitamin K antagonists reduces the risk of stroke by more than 60%. But vitamin K antagonists have limitations, including causing serious bleeding such as intracranial haemorrhage and the need for anticoagulation monitoring. In part related to these limitations, they are used in only about half of patients who should be treated according to guideline recommendations. In the past decade, oral agents have been developed that dire...
Source: The Lancet - March 14, 2015 Category: Journals (General) Source Type: research

Non-vitamin K antagonist oral anticoagulation agents in anticoagulant naive atrial fibrillation patients: Danish nationwide descriptive data 2011-2013
Conclusion Among oral anticoagulation-naïve AF patients initiated on oral anticoagulation in Denmark, warfarin initiation has declined since the introduction of dabigatran in August 2011. Dabigatran is the most frequently used alternative option to warfarin; however, use of rivaroxaban and apixaban is increasing. Patients initiated with rivaroxaban or apixaban in general have a higher predicted stroke and bleeding risks compared with warfarin or dabigatran initiators.
Source: Europace - January 29, 2015 Category: Cardiology Authors: Olesen, J. B., Sorensen, R., Hansen, M. L., Lamberts, M., Weeke, P., Mikkelsen, A. P., Kober, L., Gislason, G. H., Torp-Pedersen, C., Fosbol, E. L. Tags: Atrial fibrillation Source Type: research

Prognosis and treatment of atrial fibrillation patients by European cardiologists: One Year Follow-up of the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot registry)
Conclusion In this 1-year follow-up analysis of the EORP-AF pilot general registry, we provide data on the first contemporary registry focused on management practices among European cardiologists, conducted since the publication of the new ESC guidelines. Overall OAC use remains high, although persistence with therapy may be problematic. Nonetheless, continued OAC use was more common than in prior reports. Despite the high prescription of OAC, 1-year mortality and morbidity remain high in AF patients, particularly from heart failure and hospitalizations.
Source: European Heart Journal - December 14, 2014 Category: Cardiology Authors: Lip, G. Y. H., Laroche, C., Ioachim, P. M., Rasmussen, L. H., Vitali-Serdoz, L., Petrescu, L., Darabantiu, D., Crijns, H. J. G. M., Kirchhof, P., Vardas, P., Tavazzi, L., Maggioni, A. P., Boriani, G. Tags: Fast Track ESC Clinical Trial and Registry Update Source Type: research

Novel oral Anticoagulants in Non-Valvular Atrial Fibrillation.
This article is a review of the major studies of the NOACs. The clinical use of these drugs in patients with non-valvular atrial fibrillation is presented. PMID: 25470147 [PubMed - in process]
Source: Cardiovascular and Hematological Agents in Medicinal Chemistry - December 5, 2014 Category: Cardiology Tags: Cardiovasc Hematol Agents Med Chem Source Type: research

Atrial Fibrillation and Chronic Kidney Disease in Hypertension: A Common and Dangerous Triad.
Abstract Hypertension (HTN) and chronic kidney disease (CKD) often coexist sharing common pathophysiological factors that both in combination and separately induce fibrotic changes in the heart provoking atrial fibrillation (AF). AF, per se, is associated with a 4- to 5-fold increased risk of stroke and a 2-fold increased risk of all-cause death. The co-existence of AF with HTN and renal dysfunction considerably increases morbidity and mortality. Management of AF in hypertensive patients with CKD is complex and multidisciplinary, since these patients have both a prothrombotic state and a coagulopathy with an incre...
Source: Current Vascular Pharmacology - May 19, 2014 Category: Drugs & Pharmacology Authors: Tsiachris D, Tsioufis C, Mazzone P, Katsiki N, Stefanadis C Tags: Curr Vasc Pharmacol Source Type: research

Metabolic Syndrome and Non-Cardiac Vascular Diseases: an Update from Human Studies.
Abstract The metabolic syndrome (MetS) is characterized by a cluster of risk factors including central obesity, hypertension, dyslipidemia and insulin resistance, The MetS is associated with an increased risk for cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Several international organizations have defined MetS using different diagnostic criteria that produced discrepancies in the results of previous studies, thus leading to the latest Joint Interim Societies (JIS) MetS definition. Other risk factors than the diagnostic criteria that have been associated with MetS include lipid abnormalities, u...
Source: Current Pharmaceutical Design - December 5, 2013 Category: Drugs & Pharmacology Authors: Katsiki N, Athyros VG, Karagiannis A, Mikhailidis DP Tags: Curr Pharm Des Source Type: research

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