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Direct Oral Anticoagulants in the Setting of Percutaneous Coronary Intervention: “There Will Be Blood”
Direct oral anticoagulants (DOACs) are being increasingly used in clinical practice for various indications ranging from treatment of venous thromboembolism1 to stroke thromboprophylaxis in atrial fibrillation.2 Clinical practice guidelines now endorse DOACs in preference to vitamin K antagonists (VKAs) for thromboprophylaxis in patients with atrial fibrillation and after venous thromboembolism, reflecting the favorable efficacy and safety profile of this anticoagulant class compared with VKA.3 Despite increasing DOAC utilization, the optimal periprocedural antithrombotic management for patients treated with DOAC who under...
Source: The American Journal of Cardiology - August 12, 2023 Category: Cardiology Authors: Maximillian T. Bourdillon, Konstantinos Charitakis Tags: Editorial Source Type: research

Antithrombotic Medication and Major Complications After Mechanical Aortic Valve Replacement
Patients with mechanical aortic valve replacement (AVR) require lifelong vitamin K antagonist (VKA) therapy for stroke and systemic embolism prevention. However, VKA treatment predisposes patients to various types of bleeding. In the present study, we sought to assess the success of antithrombotic therapy and the occurrence and timing of strokes and bleeding events after mechanical AVR. A total of 308 patients who underwent isolated mechanical AVR were included in the study, and follow-up data were completed for 306 patients (99.4%).
Source: The American Journal of Cardiology - August 5, 2023 Category: Cardiology Authors: Rikhard Bj örn, Joonas Lehto, Markus Malmberg, Vesa Anttila, K.E. Juhani Airaksinen, Jarmo Gunn, Tuomas Kiviniemi Source Type: research

Quest for the Perfect Anticoagulant
The current referenced meta-analysis study by Selvaraj et al1 examines the relative merits of anticoagulation with a direct oral anticoagulant (DOAC) versus vitamin K antagonist (VKA) after transcatheter aortic valve implantation (TAVI) in patients meeting the indications for anticoagulation because of atrial fibrillation (AF). Although guidelines vary, the general consensus appears to indicate noninferiority to superiority of DOACs in the treatment of nonvalvular AF. In the landmark Apixiban for Reduction In Stroke and Other Thromboemoblic Events in Atrial Fibrillation trial comparing apixaban to warfarin in patients with...
Source: The American Journal of Cardiology - July 27, 2023 Category: Cardiology Authors: Bryant Fisher, Danny Chu Source Type: research

Left Atrial Appendage Occlusion Devices: Are We Isolating the Right Population?
Atrial fibrillation (AF) affects more than 37 million persons worldwide contributing to significant morbidity and mortality.1 Stroke prevention with vitamin K antagonists (VKAs) or non-VKA oral anticoagulants remains the mainstay of therapy in patients with AF because of the reduction of all-cause mortality in randomized clinical trials when compared with placebo. VKAs are necessary for those patients with valvular AF but carry a higher risk of stroke, intracranial hemorrhage, and mortality when compared with non-VKA oral anticoagulants.
Source: The American Journal of Cardiology - June 27, 2023 Category: Cardiology Authors: Navid Nafissi, Anita M. Kelsey Source Type: research

Comparison of Dabigatran Versus Warfarin Treatment for the Prevention of New Cerebral Lesions in Valvular Atrial Fibrillation
Atrial fibrillation is one of the most common arrhythmias in the United States and is associated with an increased risk of thromboembolic events.1 The American Heart Association/American College of Cardiology/Heart Rhythm Society guidelines recommend oral anticoagulation with either warfarin or oral non-vitamin K antagonists for patients diagnosed with atrial fibrillation with a high risk for ischemic stroke based on the CHA2DS2-VASc score.2 The recently published article “Comparison of Dabigatran Versus Warfarin Treatment for Prevention of New Cerebral Lesions in Valvular Atrial Fibrillation” discussed the efficacy of...
Source: The American Journal of Cardiology - October 7, 2022 Category: Cardiology Authors: Marwa S.H. Abrahim, Olufemi Sofola-James, Zeina Bani Hani Source Type: research

Direct Oral Anticoagulants in Cardiac Amyloidosis –Associated Heart Failure and Atrial Fibrillation
Atrial fibrillation (AF) is present in approximately 40% of patients with cardiac amyloidosis.1 AF in the setting of cardiac amyloidosis is associated with a significant risk of stroke and systemic thromboembolism regardless of the patient's CHA ₂DS₂-VASc (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65 to 74 years, sex category) score.2 Although current guidelines recommend anticoagulation therapy in all patients with cardiac amyloidosis and AF, data about the comparative effectiveness and safety of vitamin K antagonists (VKAs) ...
Source: The American Journal of Cardiology - November 27, 2021 Category: Cardiology Authors: Amgad Mentias, Paulino Alvarez, Pulkit Chaudhury, Michael Nakhla, Rohit Moudgil, Mohamad Kanj, Mazen Hanna, Milind Y. Desai Source Type: research

Risk of Intracranial Hemorrhage Caused by Direct Oral Anticoagulants for Stroke Prevention in Patients With Atrial Fibrillation (from a Network Meta-Analysis of Randomized Controlled Trials)
Patients with atrial fibrillation (AF) who take direct oral anticoagulants (DOACs) face the risk of intracranial hemorrhage (ICH), which can be serious and even life threatening, but the risk of ICH of anticoagulants is still controversial. In this meta-analysis, we compared the risk of ICH between vitamin K antagonists (VKAs) and DOACs. Furthermore, we also compared the risk of ICH in different DOACs. PubMed, Embase, Web of Science, and the Cochrane Library were searched for relevant randomized controlled trials.
Source: The American Journal of Cardiology - October 28, 2021 Category: Cardiology Authors: Meina Lv, Tingting Wu, Shaojun Jiang, Wenjun Chen, Jinhua Zhang Source Type: research

Non-Vitamin K Antagonist Oral Anticoagulant for Atrial Fibrillation in Obese Patients
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. It affects 1 in 4 adults aged>40 years,1 and is associated with a 5-fold increased risk of stroke.1 Hence, anticoagulants are universally recommended to prevent stroke and systemic embolism in patients with AF.1 The non-vitamin K antagonist oral anticoagulants (NOACs) are important alternatives to warfarin for prevention of arterial thromboembolism in patients with AF. Currently, the FDA has approved four NOACs for use in patients with AF: dabigatran is a thrombin inhibitor, while rivaroxaban, apixaban, and edoxaban are factor Xa inhibitors.
Source: The American Journal of Cardiology - April 22, 2020 Category: Cardiology Authors: Stephen Y Wang, Robert P Giugliano Tags: Review Article Source Type: research

Pattern and Impact of Off-label Underdosing of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation Who Are Indicated for Standard Dosing
With safety concerns about increasing bleeding, off-label underdosing of non-vitamin K antagonist anticoagulants (NOACs) is common in East Asian patients with atrial fibrillation (AF). We tried to investigate the pattern of NOAC underdosing and associated clinical outcomes in patients with AF who are indicated for standard dosing. Using the Korean National Health Insurance Service database, we evaluated 16568 patients with a new prescription of NOAC who are indicated for standard NOAC dosing and compared 4536 patients with warfarin with respect to thromboembolic events (ischemic stroke or systemic embolization), all-cause ...
Source: The American Journal of Cardiology - February 6, 2020 Category: Cardiology Authors: Min Soo Cho, Ji Eun Yun, Ji Jeong Park, Yun Jung Kim, Jessie Lee, Hyungmin Kim, Duk-Woo Park, Gi-Byoung Nam Source Type: research

Predictors of Mortality in Patients with Atrial Fibrillation (From the Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events ACTIVE a)
The mortality rate of most patients with atrial fibrillation (AF) exceeds the stroke rate, but predictors of mortality have not been well defined. The Atrial Fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE) recruited AF patients who were unsuitable to receive vitamin K-antagonists and were randomized to aspirin alone vs. aspirin plus clopidogrel. We investigated independent predictors of all-cause mortality by multivariable Cox regression analysis and explored interactions with assigned antiplatelet therapy.
Source: The American Journal of Cardiology - December 11, 2017 Category: Cardiology Authors: Kanjana S. Perera, Lesly A. Pearce, Mukul Sharma, Oscar Benavente, Stuart J. Connolly, Robert G. Hart, ACTIVE (Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events) Steering Committee and Investigators Source Type: research

Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation and End Stage Renal Disease
Over the last decade there have been tremendous advancements in anticoagulation therapies for stroke prevention in patients with atrial fibrillation (AF). Although the Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) demonstrated favorable clinical outcomes compared to warfarin overall, the decision to anticoagulate and the choice of appropriate agent in patients with AF and concomitant chronic kidney disease (CKD) or end-stage renal disease (ESRD) is a particularly complex issue. CKD and ESRD increase both the risk of stroke as well as bleeding, and since all of the NOACs undergo various level of renal clearance, rena...
Source: The American Journal of Cardiology - October 13, 2017 Category: Cardiology Authors: Marin Nishimura, Jonathan C. Hsu Source Type: research

Non –Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation and End-Stage Renal Disease
Over the past decade, there have been tremendous advancements in anticoagulation therapies for stroke prevention in patients with atrial fibrillation (AF). Although the non –vitamin K antagonist oral anticoagulants (NOACs) demonstrated favorable clinical outcomes compared with warfarin overall, the decision to anticoagulate and the choice of appropriate agent in patients with AF and concomitant chronic kidney disease (CKD) or end-stage renal disease (ESRD) are a part icularly complex issue. CKD and ESRD increase both the risk of stroke and bleeding, and since all of the NOACs undergo various levels of renal clearance, re...
Source: The American Journal of Cardiology - October 13, 2017 Category: Cardiology Authors: Marin Nishimura, Jonathan C. Hsu Tags: Review Source Type: research

Outcome of Patients Receiving Thrombolytic Therapy While on Rivaroxaban for Nonvalvular Atrial Fibrillation (from Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation)
The safety of intravenous thrombolysis in patients taking rivaroxaban has not been well established. We retrospectively analyzed the outcomes of all patients who received thrombolytic therapy in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF). A review of medical and adverse event records for patients receiving thrombolytic therapy while enrolled in ROCKET AF was performed to determine their baseline characteristics, indications for thrombolysis, and type of agent used.
Source: The American Journal of Cardiology - August 7, 2017 Category: Cardiology Authors: Sean T. Chen, Anne S. Hellkamp, Richard C. Becker, Scott D. Berkowitz, G ünter Breithardt, Keith A.A. Fox, Werner Hacke, Jonathan L. Halperin, Graeme J. Hankey, Kenneth W. Mahaffey, Christopher C. Nessel, Jonathan P. Piccini, Daniel E. Singer, Manesh R. Source Type: research

Comparison of the CHA2DS2-VASc, CHADS2, HAS-BLED, ORBIT and ATRIA Risk Scores in Predicting Non-Vitamin K Antagonist Oral Anticoagulants-Associated Bleeding in Patients with Atrial Fibrillation
The increasing adoption of non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation (AF) necessitates a reassessment of bleeding risk scores. Because known risk factors for bleeding are largely the same as for stroke, we hypothesize that stroke risk scores could also be used to identify patients with high bleeding risks. We aimed to compare the performance of two stroke risk scores (CHA2DS2-VASc and CHADS2) and three bleeding risk scores (HAS-BLED, ORBIT, and ATRIA) in predicting major and intracranial bleeding.
Source: The American Journal of Cardiology - July 31, 2017 Category: Cardiology Authors: Xiaoxi Yao, Bernard J Gersh, Lindsey R Sangaralingham, David M Kent, Nilay D Shah, Neena S Abraham, Peter A Noseworthy Source Type: research

Comparison of the CHA2DS2-VASc, CHADS2, HAS-BLED, ORBIT, and ATRIA Risk Scores in Predicting Non –Vitamin K Antagonist Oral Anticoagulants-Associated Bleeding in Patients With Atrial Fibrillation
The increasing adoption of non –vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation (AF) necessitates a reassessment of bleeding risk scores. Because known risk factors for bleeding are largely the same as for stroke, we hypothesize that stroke risk scores could also be used to identify patients with high bleeding risks. We aimed to compare the performance of 2 stroke risk scores (Congestive Heart failure, hypertension, Age ≥75 [doubled], Diabetes, Stroke [doubled], Vascular disease, Age 65–74, and Sex [female] [CHA2DS2-VASc] and Cardiac failure, Hypertension, Age, Diabetes, ...
Source: The American Journal of Cardiology - July 31, 2017 Category: Cardiology Authors: Xiaoxi Yao, Bernard J. Gersh, Lindsey R. Sangaralingham, David M. Kent, Nilay D. Shah, Neena S. Abraham, Peter A. Noseworthy Source Type: research

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