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Evaluation of antithrombotic use and COVID-19 outcomes in a nationwide atrial fibrillation cohort
Conclusions Pre-existing AT use may be associated with lower odds of COVID-19 death and, while not evidence of causality, provides further incentive to improve AT coverage for eligible individuals with AF.
Source: Heart - May 25, 2022 Category: Cardiology Authors: Handy, A., Banerjee, A., Wood, A. M., Dale, C., Sudlow, C. L. M., Tomlinson, C., Bean, D., Thygesen, J. H., Mizani, M. A., Katsoulis, M., Takhar, R., Hollings, S., Denaxas, S., Walker, V., Dobson, R., Sofat, R., on behalf of the CVD-COVID-UK Consortium Tags: Open access, COVID-19 Cardiac risk factors and prevention 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

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

Non-major bleeding with apixaban versus warfarin in patients with atrial fibrillation
Conclusions In ARISTOTLE, non-major bleeding was common and substantially less frequent with apixaban than with warfarin. CRNM bleeding was independently associated with a higher risk of death and subsequent major bleeding. Our results highlight the importance of any severity of bleeding in patients with AF treated with anticoagulation therapy and suggest that non-major bleeding, including minor bleeding, might not be minor. Trial registration number NCT00412984; post-results.
Source: Heart - March 28, 2017 Category: Cardiology Authors: Bahit, M. C., Lopes, R. D., Wojdyla, D. M., Held, C., Hanna, M., Vinereanu, D., Hylek, E. M., Verheugt, F., Goto, S., Alexander, J. H., Wallentin, L., Granger, C. B. Tags: Open access, Drugs: cardiovascular system Arrhythmias and sudden death 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

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

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

Antithrombotic drug use: scientific breakthroughs, biological limits and physician behaviour
During the past 25 years, there has been a dramatic surge in the use of antithrombotic drugs as documented in the Heart paper by Adelborg et al.1 The authors derived their findings from the Danish drug utilisation database, which is unique in its comprehensiveness and ability to capture over-the-counter aspirin. The increased prescription of antithrombotic drugs is fuelled by a better understanding of disease and risk, population growth, ageing societies, improved methods of detection, and rising global rates of obesity, a recognised risk factor for atrial fibrillation (AF), venous thromboembolic (VTE) disease, and ca...
Source: Heart - November 10, 2016 Category: Cardiology Authors: Hylek, E. M. Tags: Drugs: cardiovascular system, Venous thromboembolism, Epidemiology Editorials Source Type: research

Direct oral anticoagulants: unique properties and practical approaches to management
Since 2009, four direct oral anticoagulants (DOACs) have been introduced for treatment of venous thromboembolism and stroke prevention in non-valvular atrial fibrillation. While they are currently first-line therapy for a majority of patients, there are a number of clinical situations where warfarin is preferable. In both randomised trials and real-world populations, use of DOACs significantly reduces the risk of intracranial haemorrhage as compared with warfarin. While drug-specific reversal agents are currently only available for dabigatran, andexanet alpha is pending approval for reversal of factor Xa inhibitors, reduci...
Source: Heart - September 26, 2016 Category: Cardiology Authors: Barnes, G. D., Kurtz, B. Tags: Review articles Reviews 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

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

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

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

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

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

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