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Long-term oral anticoagulation for atrial fibrillation in low and middle income countries
Discussions regarding oral anticoagulation (OAC) use in low and middle income countries (LMICs) have historicallybeendominated by severallong-held beliefs. The first is that the quality of vitamin K antagonist (VKA) based anticoagulation is poor in these countries. The veracity of this assumption is supported by a large number of studies documenting both lower prescription of OACs, and a lower proportion of international normalised ratio (INR) values in the therapeutic range.1The second is that a large proportion of patients receiving OAC in LMICs have atrial fibrillation (AF) related to valvular heart disease, and rheumat...
Source: Indian Heart J - April 18, 2021 Category: Cardiology Authors: Venkatakrishnan Ramakumar Alexander P Benz Ganesan Karthikeyan Source Type: research

Dual therapy with oral anticoagulation and single antiplatelet agent versus monotherapy with oral anticoagulation alone in patients with atrial fibrillation and stable ischemic heart disease: a systematic review and meta-analysis
ConclusionsIn patients with AF and stable ischemic heart disease, OAC  + SAPT as compared to OAC monotherapy is associated with a significant increase in bleeding events without a significant reduction in thrombotic events, cardiovascular mortality, and all-cause mortality.
Source: Journal of Interventional Cardiac Electrophysiology - September 9, 2022 Category: Cardiology Source Type: research

Utilization of triple antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention
ConclusionsThe utilization of TAT following PCI among high-stroke risk AF patients steadily increased from 2011 to 2020, reaching 65.4% by the end of the study period. However, in 2020, a significant proportion of 29.4% of patients still received DAPT, indicating that many AF patients undergoing PCI did not receive adequate antithrombotic therapy.
Source: European Journal of Clinical Pharmacology - February 24, 2023 Category: Drugs & Pharmacology Source Type: research

Is There a Role for Vitamin K Antagonist in the Management of Atrial Fibrillation in 2023?
AbstractPurpose of ReviewTo address the following question: Are vitamin K antagonists (VKA) obsolete as stroke prevention therapy for patients with atrial fibrillation (AF) and thromboembolic risk factors?Recent FindingsA patient-level meta-analysis of the pivotal phase III randomized trials confirmed the favorable treatment effect of direct oral anticoagulants (DOAC) over VKA in multiple key patient subgroups. Among patients with AF and rheumatic heart disease (85% of whom had mitral stenosis), a randomized trial showed that rivaroxaban was not superior to VKA for stroke prevention. Caution should be exercised when prescr...
Source: Current Cardiology Reports - March 30, 2023 Category: Cardiology Source Type: research

Non-vitamin K antagonist oral anticoagulants (NOACs) for the management of venous thromboembolism
Learning objectives Understand the importance of venous thrombosis in cardiovascular medicine. Appreciate the mode of action of different oral anticoagulants. Recall the uses, risks and benefits of each non-vitamin K antagonist oral anticoagulants. Introduction Thrombosis is the common pathophysiology responsible for ischaemic heart disease, ischaemic stroke and venous thromboembolism (VTE), and a major contributor to the global disease burden.1 This effect is markedly more pronounced by considering the view that cancer is also a thrombotic disease.2 3 Cardiovascular disease (CVD, manifesting as acute coronary syndromes, m...
Source: Heart - June 5, 2016 Category: Cardiology Authors: Blann, A. D., Lip, G. Y. H. Tags: Education in Heart, Drugs: cardiovascular system, Acute coronary syndromes, Venous thromboembolism, Epidemiology Source Type: research

Anticoagulation in Atherosclerotic Disease.
Abstract The prevention of atherothrombotic events is an essential therapeutic goal in the treatment of patients with arteriosclerotic diseases. After plaque rupture, a rapidly growing thrombus can lead to acute vascular occlusion and thus heart attack, stroke or limb ischaemia. The acute therapy combines anticoagulation and platelet inhibition. However, the only available therapy so far in the primary and secondary prevention of stable patients is the platelet inhibitors aspirin and clopidogrel. Despite the use of antiplatelet therapies, including aspirin and P2Y12-receptor antagonists, some patients with artery ...
Source: Hamostaseologie - October 17, 2018 Category: Hematology Authors: Al Said S, Bode C, Duerschmied D Tags: Hamostaseologie Source Type: research

Thromboembolic and haemorrhagic events in patients with atrial fibrillation: a prospective cohort study in UK primary and secondary care.
CONCLUSION: Anticoagulants are associated with lower risk of thromboembolic and haemorrhagic events among patients with AF than antiplatelets. More research is required on the risk associated with VKAs or NOACs. PMID: 31015222 [PubMed - as supplied by publisher]
Source: The British Journal of General Practice - April 22, 2019 Category: Primary Care Authors: Robson J, Mathur R, Priebe M, Ahmed Z, Ayerbe L Tags: Br J Gen Pract Source Type: research

Association of vitamin K with cardiovascular events and all-cause mortality: a systematic review and meta-analysis
ConclusionsOur findings showed that higher dietary vitamin K consumption was associated with a moderately lower risk of CHD, and higher plasma dp-ucMGP concentration, but not total circulating osteocalcin, was associated with increased risks of all-cause and CVD mortality. However, causal relations cannot be established because of limited number of available studies, and larger prospective studies and randomized clinical trials are needed to validate the findings.
Source: European Journal of Nutrition - May 21, 2019 Category: Nutrition Source Type: research

Direct oral anticoagulants compared to vitamin K antagonist for the management of left ventricular thrombus
ConclusionsOur data suggest that DOACs are likely to be at least as effective and safe as VKA for stroke prevention in patients with LV thrombus and, despite their lack of a licence for this indication, are therefore likely to represent a reasonable and more convenient option for this setting. The optimal timing and type of anticoagulation for LV thrombus, as well as the role of screening for high ‐risk patients, should be tested in prospective, randomized trials.
Source: ESC Heart Failure - June 24, 2020 Category: Cardiology Authors: Hansa Iqbal, Sam Straw, Thomas P. Craven, Katherine Stirling, Stephen B. Wheatcroft, Klaus K. Witte Tags: Original Research Article Source Type: research

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