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Beyond Stroke Prevention in Atrial Fibrillation: Exploring Further Unmet Needs with Rivaroxaban.
This article provides an update on three randomized controlled trials of rivaroxaban, a direct, oral factor Xa inhibitor, that are complete or are ongoing, in these unmet areas of stroke prevention: oPen-label, randomized, controlled, multicentre study explorIng twO treatmeNt stratEgiEs of Rivaroxaban and a dose-adjusted oral vitamin K antagonist treatment strategy in patients with Atrial Fibrillation who undergo Percutaneous Coronary Intervention (PIONEER AF-PCI) trial; the New Approach riVaroxaban Inhibition of factor Xa in a Global trial vs Aspirin to prevenT Embolism in Embolic Stroke of Undetermined Source (NAVIGATE E...
Source: Thrombosis and Haemostasis - March 22, 2018 Category: Hematology Authors: Gibson CM, Hankey GJ, Nafee T, Welsh RC Tags: Thromb Haemost 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

Antithrombotic therapy after percutaneous coronary intervention in patients requiring oral anticoagulant treatment : A meta-analysis.
CONCLUSION: Our analysis found no statistically significant difference between TT and DT with regard to all-cause death and MACE/stroke risk. At the same time, the available data demonstrated that TT increased the risk of major bleeding. If the international normalized ratio is in the target range, the risk of bleeding may be lowered. The data from Asian countries were limited, and therefore we could not assess the difference between TT and DT in Asian populations. Finally,on the basis of our analysis, we do not recommend TT as conventional treatment for patients taking OACs and undergoing percutaneous coronary interventio...
Source: Herz - July 3, 2015 Category: Cardiology Tags: Herz Source Type: research

Antithrombotic treatment in acute coronary syndrome and atrial fibrillation.
Authors: Darius H, Görge G, Spiecker M, Schinzel H Abstract The number of patients with atrial fibrillation (AF) is increasing due to the aging of the population. In addition, the number of patients with AF and indications for oral anticoagulation (OAC) for the prevention of stroke, who need dual antiplatelet treatment (DAPT) with acetylsalicylic acid (ASA) plus a P2Y12 inhibitor because of an acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI) is also increasing. In the past these patients received a triple therapy (TT) for 3-12 months. This TT has never been studied for efficacy; how...
Source: Herz - January 30, 2019 Category: Cardiology Tags: Herz Source Type: research

The management of patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation: In‐hospital‐data from the Atrial Fibrillation undergoing Coronary Artery Stenting (AFCAS) study
ConclusionsThe majority of AF patients undergoing PCI‐S are at high stroke risk, and therefore VKA treatment should not be withdrawn and combined anticoagulant and antiplatelet treatment is warranted. Current management appears largely in accordance with current recommendations, whereby accounting for the limited occurrence of in‐hospital adverse ischemic and bleeding events. © 2013 Wiley Periodicals, Inc.
Source: Catheterization and Cardiovascular Interventions - June 13, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Axel Schlitt, Andrea Rubboli, Gregory H Lip, Heli Lahtela, Josè Valencia, Pasi P. Karjalainen, Michael Weber, Mika Laine, Paulus Kirchhof, Matti Niemelä, Saila Vikman, Michael Buerke, K.E. Juhani Airaksinen, Tags: Original Study Source Type: research

The management of patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation
Current recommendations on the management of patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention with stent (PCI‐S) essentially derive from small, single‐center, retrospective datasets. To obtain larger and better quality data, we carried out the prospective, multicenter Atrial Fibrillation undergoing Coronary Artery Stenting (AFCAS) study. Therefore, consecutive patients with history of or ongoing AF undergoing PCI‐S were enrolled, and occurrence of adverse ischemic and bleeding events recorded during 12 months follow‐up. In this article, we report the in‐hospital observations. O...
Source: Catheterization and Cardiovascular Interventions - August 28, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Axel Schlitt, Andrea Rubboli, Gregory Y.H. Lip, Heli Lahtela, Josè Valencia, Pasi P. Karjalainen, Michael Weber, Mika Laine, Paulus Kirchhof, Matti Niemelä, Saila Vikman, Michael Buerke, K.E. Juhani Airaksinen, Tags: Coronary Artery Disease Source Type: research

Oral Anticoagulation and Antiplatelets in Atrial Fibrillation Patients After Myocardial Infarction and Coronary Intervention
ConclusionsIn real-life AF patients with indication for multiple antithrombotic drugs after MI/PCI, OAC and clopidogrel was equal or better on both benefit and safety outcomes compared to triple therapy.
Source: Journal of the American College of Cardiology: Cardiovascular Imaging - September 3, 2013 Category: Radiology Source Type: research

Design and Rationale of the RE ‐DUAL PCI Trial: A Prospective, Randomized, Phase 3b Study Comparing the Safety and Efficacy of Dual Antithrombotic Therapy With Dabigatran Etexilate Versus Warfarin Triple Therapy in Patients With Nonvalvular Atrial Fibrillation Who Have Undergone Percutaneous Coronary Intervention With Stenting
Antithrombotic management of patients with atrial fibrillation (AF) undergoing coronary stenting is complicated by the need for anticoagulant therapy for stroke prevention and dual antiplatelet therapy for prevention of stent thrombosis and coronary events. Triple antithrombotic therapy, typically comprising warfarin, aspirin, and clopidogrel, is associated with a high risk of bleeding. A modest‐sized trial of oral anticoagulation with warfarin and clopidogrel without aspirin showed improvements in both bleeding and thrombotic events compared with triple therapy, but large trials are lacking. The RE‐DUAL PCI trial (NCT...
Source: Clinical Cardiology - July 31, 2016 Category: Cardiology Authors: Christopher P. Cannon, Savion Gropper, Deepak L. Bhatt, Stephen G. Ellis, Takeshi Kimura, Gregory Y.H. Lip, Ph. Gabriel Steg, Jurri ën M. Berg, Jenny Manassie, Jörg Kreuzer, Jon Blatchford, Joseph M. Massaro, Martina Brueckmann, Ernesto Ferreiros Ripoll Tags: Trial Designs Source Type: research

Antithrombotic therapy in patients with non-valvular atrial fibrillation undergoing percutaneous coronary intervention: should we change our practice after the PIONEER AF-PCI and RE-DUAL PCI trials?
AbstractThe number of patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) is increasing. Since these patients have a CHA2DS2-VASc score of 1 or higher, they should be treated with oral anticoagulation to prevent stroke. However, combination therapy with oral anticoagulation for prevention of embolic stroke and dual platelet inhibition for prevention of coronary thrombosis significantly increases bleeding complications. The optimal combination, intensity and duration of antithrombotic combination therapy is still not known. In the rather small randomized WOEST trial, the combination of a vi...
Source: Clinical Research in Cardiology - April 20, 2018 Category: Cardiology Source Type: research

Safety and Efficacy of Triple Antithrombotic Therapy with Dabigatran versus Vitamin K Antagonist in Atrial Fibrillation Patients: A Pilot Study.
Conclusion: Dabigatran at the dose used for stroke prevention appears safer than VKA and maintains a similar efficacy profile, when used with DAPT, in AF patients who have undergone PCI with stenting for ACS. PMID: 30895193 [PubMed - in process]
Source: Biomed Res - March 22, 2019 Category: Research Authors: Russo V, Rago A, Proietti R, Attena E, Rainone C, Crisci M, Papa AA, Calabrò P, D'Onofrio A, Golino P, Nigro G Tags: Biomed Res Int Source Type: research

Triple Therapy for Atrial Fibrillation and Percutaneous Coronary Intervention A Contemporary Review
Chronic oral anticoagulant therapy is recommended (class I) in patients with mechanical heart valves and in patients with atrial fibrillation with a CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, prior Stroke or transient ischemic attack or thromboembolism, Vascular disease, Age 65 to 74 years, Sex category) score ≥1. When these patients undergo percutaneous coronary intervention with stenting, treatment with aspirin and a P2Y12 receptor inhibitor also becomes indicated. Before 2014, guidelines recommended the use of triple therapy (vitamin K antagonists, aspirin, and clopidog...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - September 15, 2014 Category: Cardiology Source Type: research

Clinical Relevance of Anticoagulation and Dual Antiplatelet Therapy to the Outcomes of Patients With Atrial Fibrillation and Recent Percutaneous Coronary Intervention With Stent.
CONCLUSIONS: TT, DT and DAPT displayed similar efficacy and safety. Although the superiority of OAC vs. DAPT for stroke prevention in AF patients has been demonstrated by previous randomized trials, a smaller frequency of high thromboembolic risks' features in DAPT group of the present study may have prevented the observation of a higher incidence of ischemic stroke in this group. PMID: 26767085 [PubMed]
Source: Clin Med Res - January 18, 2016 Category: Research Authors: De Vecchis R, Cantatrione C, Mazzei D Tags: J Clin Med Res Source Type: research

Prevalence, Management, and Long-Term (6-Year) Outcomes of Atrial Fibrillation Among Patients Receiving Drug-Eluting Coronary Stents
Conclusions Among patients receiving DES implantation, AF was not rare and was associated with increased ischemic and bleeding risk. In patients with AF, triple therapy was not associated with decreased ischemic events but was associated with increased bleeding risk compared to DAPT.
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - June 5, 2017 Category: Cardiology Authors: Choi, H.-I., Ahn, J.-M., Kang, S. H., Lee, P. H., Kang, S.-J., Lee, S.-W., Kim, Y.-H., Lee, C. W., Park, S.-W., Park, D.-W., Park, S.-J. Tags: Coronary Source Type: research

The safety and efficacy of oral anticoagulants with dual versus single antiplatelet therapy in patients after percutaneous coronary intervention: A meta-analysis
Conclusion: In patients on OAC undergoing PCI with stent implantation, compared with DT, TT shows equal effectiveness in terms of MACE, stroke, all-cause mortality, and stent thrombosis and lower risks of myocardial infarction and major bleeding. However, similar efficacy and safety outcomes were observed between the TT group and the OAC along with clopidogrel group.
Source: Medicine - September 1, 2017 Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research

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