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Can I use DOAC in a patient with renal disease?
Case A 76-year-old man is diagnosed with non-valvular atrial fibrillation. His comorbid conditions are hypertension, diabetes complicated by neuropathy, and chronic kidney disease stage 3. His current medications include metformin, lisinopril, gabapentin, and aspirin. His most recent laboratories showed a creatinine 1.8, creatinine clearance (CrCl) 35 mL/min, hemoglobin 11g/dL, and international normalized ratio 1.0. His congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, and sex (CHADSVASc) score is 4. Which medication should we use to prevent stroke in this patient?  Brief overview of the is...
Source: The Hospitalist - February 3, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: Renal & Genitourinary Source Type: research

Effect of Variation in Published Stroke Rates on the Net Clinical Benefit of Anticoagulation for Atrial Fibrillation.
Conclusion: Variation in published AF stroke rates for patients not receiving anticoagulant therapy results in multifold variation in the net clinical benefit of anticoagulation. Guidelines should better reflect the uncertainty in current thresholds of stroke risk score for recommending anticoagulation. Primary Funding Source: None. PMID: 30264130 [PubMed - as supplied by publisher]
Source: Annals of Internal Medicine - September 25, 2018 Category: Internal Medicine Authors: Shah SJ, Eckman MH, Aspberg S, Go AS, Singer DE Tags: Ann Intern Med 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

How I use anticoagulation in atrial fibrillation
Atrial fibrillation is the most common cardiac arrhythmia and conveys a significant risk of morbidity and mortality due to related stroke and systemic embolism. Oral anticoagulation (OAC) is the mainstay of thromboembolism prevention, and management of anticoagulation can be challenging. For patients without significant valvular disease, decisions around anticoagulation therapy are first based on the presence of additional stroke risk factors, as measured by the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75, diabetes, prior stroke or transient ischemic attack, vascular disease, age 65–74, and sex c...
Source: Blood - December 21, 2016 Category: Hematology Authors: Steinberg, B. A. Tags: How I Treat, Free Research Articles, Thrombosis and Hemostasis Source Type: research

Is an Oral Anticoagulant Necessary for Young Atrial Fibrillation Patients With a CHA2DS2-VASc Score of 1 (Men) or 2 (Women)? Arrhythmia and Electrophysiology
ConclusionsFor atrial fibrillation patients aged 20 to 49 years with 1 risk factor in addition to sex, non–vitamin K antagonist OACs should be considered for stroke prevention to minimize the risk of a potentially fatal or disabling event.
Source: JAHA:Journal of the American Heart Association - October 3, 2016 Category: Cardiology Authors: Hung, Y., Chao, T.-F., Liu, C.-J., Tuan, T.-C., Lin, Y.-J., Chang, S.-L., Lo, L.-W., Hu, Y.-F., Liao, J.-N., Chung, F.-P., Lin, W.-Y., Lin, W.-S., Cheng, S.-M., Chen, T.-J., Lip, G. Y. H., Chen, S.-A. Tags: Atrial Fibrillation Original Research Source Type: research

Aspirin Instead of Oral Anticoagulant Prescription in Atrial Fibrillation Patients at Risk for Stroke
ConclusionsIn a large, real-world cardiac outpatient population of AF patients with a moderate to high risk of stroke, more than 1 in 3 were treated with aspirin alone without OAC. Specific patient characteristics predicted prescription of aspirin therapy over OAC.
Source: Journal of the American College of Cardiology - June 21, 2016 Category: Cardiology Source Type: research

Effect of Adherence to Oral Anticoagulants on Risk of Stroke and Major Bleeding Among Patients With Atrial Fibrillation Arrhythmia and Electrophysiology
Conclusions Adherence to anticoagulation is poor in practice and may be modestly improved with NOACs. Adherence to therapy appears to be most important in patients with CHA2DS2-VASc score ≥2, whereas the benefits of anticoagulation may not outweigh the harms in patients with CHA2DS2-VASc score 0 or 1.
Source: JAHA:Journal of the American Heart Association - February 23, 2016 Category: Cardiology Authors: Yao, X., Abraham, N. S., Alexander, G. C., Crown, W., Montori, V. M., Sangaralingham, L. R., Gersh, B. J., Shah, N. D., Noseworthy, P. A. Tags: Arrhythmias, Atrial Fibrillation, Secondary Prevention, Intracranial Hemorrhage, Ischemic Stroke Arrhythmia and Electrophysiology Source Type: research

Poor adherence to anticoagulation guidelines in patients with non-valvular atrial fibrillation treated in a tertiary cardiology unit
Conclusions Few patients who require anticoagulation receive it in accordance with the guidelines even in a tertiary cardiology unit. There are many impediments to the effective use of VKA for stroke prevention among patients with AF.
Source: Heart Asia - April 21, 2015 Category: Cardiology Authors: Kew, G. S., Tan, M., Lim, T. W. Tags: Original research Source Type: research

Study On Drug Utilization And Assessment Of Stroke Risk Using Chads2 And Cha2ds2-Vasc Scoring In Elderly Patients With Non-Valvular Atrial Fibrillation
Stroke Risk Stratification in AF patients of can be done using CHADS2 (Congestive heart failure, Hypertension, Age ≥75, DM, prior Stroke/TIA [2 points] ); or CHA2DS2VASc2 (Congestive heart failure/left ventricular ejection fraction ≤35%, Hypertension, Age ≥75 [2 points], DM, prior Stroke/TIA/thromboembolism [2 points], Vascular disease, Age 65–74, Sex- female). Treatment options for Prevention of stroke includes Anti-coagulants (Vitamin K Antagonist-Warfarin, Acenocoumarol; and Newer Oral Anticoagulant- Dabigatran) and anti-platelets (Aspirin and Clopidogrel).
Source: Value in Health - November 1, 2014 Category: Global & Universal Authors: T. Raj, S. Bonthu, S.R. Mallayasamy Source Type: research

Percutaneous Left Atrial Appendage Suture Ligation Not Ready for Prime Time ∗
Novel approaches to reduce stroke risk with oral anticoagulant medications or interventions are of the utmost importance to improve the quality of care for patients with atrial fibrillation (AF). Oral anticoagulation with vitamin K antagonists and, more recently, with novel oral anticoagulants (NOACs) has led to a remarkable reduction of stroke risk; however, some of the benefits with NOACs are counterbalanced by increased bleeding risks. The idea of developing interventions that reduce stroke risk but avoid long-term oral anticoagulation and thereby avoid increasing the bleeding risk appears very reasonable and attractive...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - August 4, 2014 Category: Cardiology Source Type: research

Rivaroxaban for Stroke Prevention in East Asian Patients From the ROCKET AF Trial Clinical Sciences
Conclusions— Observed relative efficacy and safety of rivaroxaban versus warfarin were similar among patients within and outside East Asia. Rivaroxaban, 20 mg once daily, is an alternative to warfarin for stroke prevention in East Asians with nonvalvular atrial fibrillation. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00123456.
Source: Stroke - May 27, 2014 Category: Neurology Authors: Wong, K. S. L., Hu, D. Y., Oomman, A., Tan, R.-S., Patel, M. R., Singer, D. E., Breithardt, G., Mahaffey, K. W., Becker, R. C., Califf, R., Fox, K. A. A., Berkowitz, S. D., Hacke, W., Hankey, G. J., on behalf of The Executive Steering Committee and the RO Tags: Other anticoagulants, Embolic stroke, Anticoagulants Clinical Sciences Source Type: research

Intracranial Hemorrhage Among Patients With Atrial Fibrillation Anticoagulated With Warfarin or Rivaroxaban: The Rivaroxaban Once Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation Clinical Sciences
Conclusions— Among patients with atrial fibrillation treated with anticoagulation, the risk of ICH was higher among Asians, blacks, the elderly, and in those with previous stroke or transient ischemic attack, increased diastolic blood pressure, and reduced platelet count or serum albumin at baseline. The risk of ICH was significantly lower in patients with heart failure and in those who were randomized to rivaroxaban instead of warfarin. The external validity of these findings requires testing in other atrial fibrillation populations.
Source: Stroke - April 28, 2014 Category: Neurology Authors: Hankey, G. J., Stevens, S. R., Piccini, J. P., Lokhnygina, Y., Mahaffey, K. W., Halperin, J. L., Patel, M. R., Breithardt, G., Singer, D. E., Becker, R. C., Berkowitz, S. D., Paolini, J. F., Nessel, C. C., Hacke, W., Fox, K. A. A., Califf, R. M., on behal Tags: Acute Cerebral Hemorrhage, Anticoagulants Clinical Sciences 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