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Ethnicity and stroke risk in patients with atrial fibrillation
Conclusions Despite a reduced prevalence of AF among South Asian patients, their risk of stroke is higher than for white patients or black African/Caribbean patients in association with diabetes, cardiovascular disease, and hypertension. Under-prescription of anticoagulation persists in all ethnic groups, a deficit most pronounced in the elderly. Use of the CHA2DS2VASc score would enhance optimal management in primary care.
Source: Heart - July 5, 2013 Category: Cardiology Authors: Mathur, R., Pollara, E., Hull, S., Schofield, P., Ashworth, M., Robson, J. Tags: Drugs: cardiovascular system, Hypertension, Epidemiology Heart rhythm disorders Source Type: research

Rivaroxaban and other novel anticoagulants for stroke prevention in atrial fibrillation: time to embrace the future
Atrial fibrillation (AF) is now said to be at epidemic proportions.1 Although symptoms and heart failure are two of the main reasons that patients with AF suffer from reduced quality of life, thromboembolic complications, particularly stroke, remain the major determinant of significant morbidity and mortality.2 Importantly, the risk of thromboembolism (TE) is completely irrespective of symptoms, and hence the sad fact that people continue to present with catastrophic stroke in AF with no prior history of its detection.3 Appropriate anticoagulation is imperative to reduce the TE/stroke risk. Numerous large scale studies hav...
Source: Heart - February 18, 2013 Category: Cardiology Authors: Rajappan, K. Tags: Drugs: cardiovascular system, Epidemiology Editorials Source Type: research

To occlude or not? Left atrial appendage occlusion for stroke prevention in atrial fibrillation
The cornerstone of atrial fibrillation (AF) management is effective stroke prevention, which by now remains the only proven method of improved survival in patients with AF. Oral anticoagulation with the use of vitamin K antagonists (eg, warfarin) or non-vitamin K antagonist oral anticoagulants (NOACs) has been shown to substantially reduce the risk of AF-related strokes and thus is presently the standard of care for stroke prevention in non-valvular AF. Approximately 90% of thrombi being formed in AF are localised in left atrial appendage (LAA).1 Thus, LAA exclusion seems a tempting method of prophylaxis against stroke, pa...
Source: Heart - January 4, 2017 Category: Cardiology Authors: Mazurek, M., Lip, G. Y. H. Tags: Drugs: cardiovascular system, Epidemiology Editorials Source Type: research

Net clinical benefit of warfarin in individuals with atrial fibrillation across stroke risk and across primary and secondary care
Conclusions CHA2DS2-VASc accurately stratifies IS risk in individuals with AF across both primary and secondary care. However, the incidence rate of ischaemic stroke at CHA2DS2-VASc=1 are lower than previously reported, which may change the decision to start anticoagulation with warfarin in these individuals.
Source: Heart - January 12, 2017 Category: Cardiology Authors: Allan, V., Banerjee, A., Shah, A. D., Patel, R., Denaxas, S., Casas, J.-P., Hemingway, H. Tags: Open access, Drugs: cardiovascular system, Epidemiology Arrhythmias and sudden death Source Type: research

Efficacy and safety of left atrial appendage closure versus medical treatment in atrial fibrillation: a network meta-analysis from randomised trials
Conclusions The findings of this meta-analysis suggest that LAAC is superior to placebo and APT, and comparable to NOAC for preventing mortality and stroke or SE, with similar bleeding risk in patients with non-valvular AF. However, these results should be interpreted with caution and more studies are needed to further substantiate this advantage, in view of the wide CIs with some variables in the current meta-analysis.
Source: Heart - January 4, 2017 Category: Cardiology Authors: Sahay, S., Nombela-Franco, L., Rodes-Cabau, J., Jimenez-Quevedo, P., Salinas, P., Biagioni, C., Nunez-Gil, I., Gonzalo, N., de Agustin, J. A., del Trigo, M., Perez de Isla, L., Fernandez-Ortiz, A., Escaned, J., Macaya, C. Tags: Editor's choice, Drugs: cardiovascular system, Epidemiology Arrhythmias and sudden death Source Type: research

Biomarkers of inflammation and risk of cardiovascular events in anticoagulated patients with atrial fibrillation
Conclusions In patients with AF on anticoagulation, after accounting for clinical risk factors and other biomarkers, biomarkers of inflammation were significantly associated with an increased risk of mortality. However, there were no associations with the risk of stroke or major bleeding. Trial registration number ClinicalTrials.gov identifier: NCT00412984 post-results.
Source: Heart - March 11, 2016 Category: Cardiology Authors: Hijazi, Z., Aulin, J., Andersson, U., Alexander, J. H., Gersh, B., Granger, C. B., Hanna, M., Horowitz, J., Hylek, E. M., Lopes, R. D., Siegbahn, A., Wallentin, L., on behalf of the ARISTOTLE Investigators Tags: Editor's choice, Drugs: cardiovascular system, Acute coronary syndromes, Epidemiology Arrhythmias and sudden death Source Type: research

Effectiveness and safety of oral anticoagulants in elderly patients with atrial fibrillation
Conclusion In this nationwide cohort study of patients ≥75 years initiating oral anticoagulation for AF, standard and reduced dose NOACs were associated with similar risks of stroke/SE as warfarin and lower or similar risks of bleeding. The NOACs seem to be a safe option also in elderly patients.
Source: Heart - February 16, 2022 Category: Cardiology Authors: Rutherford, O.-C. W., Jonasson, C., Ghanima, W., Söderdahl, F., Halvorsen, S. Tags: Open access Arrhythmias and sudden death Source Type: research

Combined anticoagulation and antiplatelet therapy in AF patients: why do we not follow guidelines?
While current European guidelines recommend oral anticoagulation treatment over antiplatelet therapy for the prevention of ischaemic stroke in patients with non-valvular atrial fibrillation (AF) with a 64% stroke risk reduction by warfarin treatment versus placebo and a 39% risk reduction versus aspirin,1 single or dual antiplatelet therapy is the guideline recommended first-line treatment strategy for patients with peripheral and/or coronary artery disease with and without intervention to prevent recurrences and major adverse cardiac events.2–7 Antiplatelet therapy is also recommended in patients with ischaemic stro...
Source: Heart - September 23, 2014 Category: Cardiology Authors: Brandes, A. Tags: Drugs: cardiovascular system, Acute coronary syndromes, Venous thromboembolism Editorials Source Type: research

Not all thromboembolism comes from the left atrial appendage in atrial fibrillation
Atrial fibrillation (AF) confers a substantial risk of stroke and thromboembolism, which is effectively reduced by oral anticoagulation (OAC), whether as a vitamin K antagonist (VKA, eg, warfarin) or one of non-VKA oral anticoagulants (NOACs). With the use of OACs, the risk of bleeding remains a problem associated with these agents. Thus, a clinical dilemma remains in the optimal management of patients with AF who are at high risk of stroke but have a history of bleeding. Among patients with non-valvular AF, over 90% of the thrombus is formed in the left atrial appendage (LAA).1 Thus, the exclusion of LAA could greatly dec...
Source: Heart - May 12, 2015 Category: Cardiology Authors: Senoo, K., Lip, G. Y. H. Tags: Drugs: cardiovascular system, Heart failure, Hypertension, Epidemiology Editorials Source Type: research

Dabigatran and apolipoprotein B
Dabigatran is the first of a series of new direct acting oral anticoagulants that was clinically introduced for the prevention of ischaemic stroke in patients with atrial fibrillation (AF). In the randomized evaluation of long-term anticoagulation therapy (RE-LY) study, dabigatran was shown to be superior or non-inferior to warfarin in preventing ischaemic stroke, depending on the dose administered (150 or 110 mg twice daily, respectively).1 This phase III trial opened the door to the clinical introduction of this direct thrombin inhibitor, resulting in a swift clinical uptake around the globe. This was rapidly follow...
Source: Heart - December 11, 2015 Category: Cardiology Authors: ten Cate, H. Tags: Drugs: cardiovascular system Editorials Source Type: research

Close the appendage, open the future
Left atrial appendage closure is a proven method for prevention against stroke in patients with non-valvular atrial fibrillation. This method is proven for having clinical utility as well as safety. The need for coverage in this area is immense. Atrial fibrillation affects 1%–2% of the entire adult population.1 Of all ischaemic strokes, 15% are associated with atrial fibrillation. Both the CHADS2 and the CHA2DS2-VASc risk scores have been used for determining the level of anticoagulation in these patients. Multiple anticoagulants have been used for prevention of ischaemic stroke, including warfarin, dabigatran, rivar...
Source: Heart - May 12, 2015 Category: Cardiology Authors: Gafoor, S., Sievert, H., Matic, P. Tags: Drugs: cardiovascular system, Epidemiology Editorials Source Type: research

Cochrane corner: vitamin K for improved anticoagulation control in patients receiving warfarin
There has been a substantial increase in the use of oral anticoagulants, notably in the ageing population. This is primarily driven by the use of warfarin in people with atrial fibrillation (AF) in order to reduce the risks of thromboembolic events such as stroke.1 In elderly patients with AF, warfarin use has been shown to reduce the relative risk of stroke by >50% compared with aspirin alone.2 Warfarin is also used to treat patients with deep vein thrombosis, mechanical heart valve replacement, cardioversion, cardiomyopathy and antiphospholipid syndrome.1 The clinical benefits of warfarin must also be balanced with po...
Source: Heart - October 11, 2015 Category: Cardiology Authors: Mahtani, K. R., Nunan, D., Heneghan, C. Tags: Drugs: cardiovascular system, Cochrane Corner, Venous thromboembolism, Epidemiology Editorials Source Type: research

Heartbeat: Inflammatory biomarkers in atrial fibrillation
The association of systemic inflammation with atrial fibrillation and a pro-thrombotic state has received increasing attention recently, but whether this degree of inflammation provides additive value for prediction of clinical outcomes in adults with atrial fibrillation has not been established. In this issue of Heart, Hijazi and colleagues (see page 508) measured inflammatory biomarkers in over 14 thousand patients with atrial fibrillation in the Apixaban for Reduction In Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial. Cox regression was used to assess the relationship between outcomes at...
Source: Heart - March 11, 2016 Category: Cardiology Authors: Otto, C. M. Tags: Drugs: cardiovascular system, Echocardiography, Clinical diagnostic tests, Epidemiology Heartbeat Source Type: research

Native valve disease in patients with non-valvular atrial fibrillation on warfarin or rivaroxaban
Conclusions We found that patients with AF and AS on oral anticoagulants may have distinctly different efficacy and safety outcomes than patients with MR or AR or no SVD. Trial registration number NCT00403767; Post-results.
Source: Heart - June 9, 2016 Category: Cardiology Authors: Breithardt, G., Baumgartner, H., Berkowitz, S. D., Hellkamp, A. S., Piccini, J. P., Lokhnygina, Y., Halperin, J. L., Singer, D. E., Hankey, G. J., Hacke, W., Becker, R. C., Nessel, C. C., Mahaffey, K. W., Califf, R. M., Fox, K. A. A., Patel, M. R., for th Tags: Open access, Drugs: cardiovascular system, Interventional cardiology, Aortic valve disease, Mitral valve disease Valvular heart disease Source Type: research

Cochrane corner: self-monitoring and self-management of oral anticoagulation
Background Use of oral anticoagulants such as warfarin is increasing. Part of the reason for this is the rising prevalence of atrial fibrillation, an ageing population and the widening indications for treatment based on evidence of benefit in reducing risk of stroke. A meta-analysis of 29 randomised trials including 28 044 participants with atrial fibrillation found that warfarin decreased the absolute risk of stroke by 2.7% per year (the number needed to treat (NNT) 37) compared with placebo or no treatment and by 0.7% per year (NNT=143) compared with aspirin.1 Management of warfarin, however, is challenging bec...
Source: Heart - May 31, 2017 Category: Cardiology Authors: Heneghan, C. J., Spencer, E. A., Mahtani, K. R. Tags: Editorials Source Type: research

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