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Safety and Efficacy of Direct Oral Anticoagulants Versus Warfarin in Patients with Chronic Kidney Disease and Atrial Fibrillation
This study evaluated and compared the safety outcomes of DOACs versus warfarin in patients with non-valvular AF and concomitant CKD. Patients in our health system with AF prescribed oral anticoagulants during 2010 to 2017 were identified. All-cause mortality, bleeding, and hemorrhagic and ischemic stroke were evaluated based on degree of renal impairment and method of anticoagulation.
Source: The American Journal of Cardiology - October 30, 2019 Category: Cardiology Authors: Amber Makani, Samir Saba, Sandeep K. Jain, Aditya Bhonsale, Michael S. Sharbaugh, Floyd Thoma, Yisi Wang, Oscar C. Marroquin, Joon S. Lee, N.A. Mark Estes, Suresh R. Mulukutla Source Type: research

Thoracoscopic Left Atrial Appendage Occlusion for Stroke Prevention Compared with Long-Term Warfarin Therapy in Patients With Nonvalvular Atrial Fibrillation
In their recent paper, Fu et al. conclude that thoracoscopic left atrial appendage (LAA) occlusion is superior to warfarin for a composite outcome of stroke, systemic embolism and mortality.1 We suggest considering their results with caution.
Source: The American Journal of Cardiology - February 8, 2019 Category: Cardiology Authors: Sophie Weiwei Gao, Emilie Prudence Belley-C ôté, Kevin John Um, Richard Paul Whitlock Tags: Reader's Comments Source Type: research

Relation of Race, Apparent Disability, and Stroke Risk With Warfarin Prescribing for Atrial Fibrillation in Patients Receiving Maintenance Hemodialysis
We examined patterns of warfarin use, and associated factors, after AF diagnosis. This retrospective cohort analysis studied US Medicare patients receiving maintenance dialysis January 1, 2008-June 30, 2010. Demographics, comorbidity, and a durable medical equipment claims-based disability proxy score predicted warfarin prescription after AF diagnosis. The analysis included 8964 patients with non-valvular AF.
Source: The American Journal of Cardiology - November 24, 2018 Category: Cardiology Authors: James B. Wetmore, Yi Peng, David T. Gilbertson, Jiannong Liu Source Type: research

Impact of Body Mass Index on Outcomes in the Edoxaban Versus Warfarin Therapy Groups in Patients Undergoing Cardioversion of Atrial Fibrillation (From ENSURE-AF)
In the EdoxabaN versus warfarin in subjectS UndeRgoing cardiovErsion of Atrial Fibrillation (ENSURE-AF) study (NCT 02072434), edoxaban showed similar efficacy and safety vs enoxaparin –warfarin in patients undergoing electrical cardioversion of nonvalvular atrial fibrillation. In this ancillary analysis, we compared the primary efficacy (composite of stroke, systemic embolic event, myocardial infarction, and cardiovascular [CV] death, overall study period) and safety (composite of major and clinically relevant nonmajor [CRNM] bleeding, on-treatment) endpoints in relation to body mass index (BMI;
Source: The American Journal of Cardiology - November 24, 2018 Category: Cardiology Authors: Gregory Y.H. Lip, Jose L. Merino, Maciej Banach, Joris R. de Groot, Lars S. Maier, Sakis Themistoclakis, Giuseppe Boriani, James Jin, Michael Melino, Shannon M. Winters, Andreas Goette Source Type: research

Relation of the CHA2DS2-VASc Score to Risk of Thrombotic and Embolic Stroke in Community-Dwelling Individuals Without Atrial Fibrillation (From The Atherosclerosis Risk in Communities ARIC Study)
Recent hospital-based cohort studies found the CHA2DS2-VASc score to be associated with ischemic stroke in individuals without atrial fibrillation (AF). Our aim was to determine the distribution of embolic and thrombotic strokes and association with the CHA2DS2-VASc score, among community-dwelling individuals without AF. We included participants from the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 4 (1996-98) and had no prior AF, stroke, or anticoagulant use (n=10,671). During follow-up through 2008, incident AF cases (n=760) and participants who started warfarin were censored.
Source: The American Journal of Cardiology - November 6, 2018 Category: Cardiology Authors: Ryan J. Koene, M. Chadi Alraies, Faye L. Norby, Elsayed Z. Soliman, Ankit Maheshwari, Gregory Y.H. Lip, Alvaro Alonso, Lin Y. Chen Source Type: research

Thoracoscopic Left Atrial Appendage Occlusion for Stroke Prevention Compared with Long-Term Warfarin Therapy in Patients With Nonvalvular Atrial Fibrillation
Thoracoscopic left atrial appendage (LAA) occlusion is an alternative treatment for stroke prevention in patients with atrial fibrillation. Prospective study comparing thoracoscopic LAA occlusion and warfarin therapy is still lacking. The goal of this prospective cohort study was to assess the safety and efficacy of thoracoscopic LAA occlusion for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF) compared with long-term warfarin therapy. 492 NVAF Patients were enrolled. 257 patients were treated with thoracoscopic LAA occlusion and 235 with long-term warfarin therapy.
Source: The American Journal of Cardiology - September 26, 2018 Category: Cardiology Authors: Mingjie Fu, Zheng Qin, Shuai Zheng, Yueping Li, Shiwei Yang, Yingxin Zhao, Chengping Hu, Kuo Zhou, Yujie Zhou, Xu Meng Source Type: research

Outcomes With Novel Oral Anticoagulants in Obese Patients who Underwent Electrical Cardioversion for Atrial Tachyarrhythmias
The efficacy of novel oral anticoagulants (NOACs) in severely obese patients is uncertain as volume of distribution is related to weight, and few such patients were enrolled in the pivotal trials. As the month after direct-current cardioversion (DCCV) for atrial fibrillation and atrial flutter is a high-risk period for stroke, we sought to evaluate the safety of performing DCCV in obese patients on NOAC. All patients who underwent DCCV after ≥3 weeks of NOAC or therapeutic warfarin treatment without a previous transesophageal echocardiogram over a 3-year period at a single center were included.
Source: The American Journal of Cardiology - July 4, 2018 Category: Cardiology Authors: Rachel M. Kaplan, Celso L. Diaz, Theresa Strzelczyk, Cindy You, Basil Saour, Michelle Fine, Amar Trivedi, Mark J. Shen, Prasongchai Sattayaprasert, Alexandru B. Chicos, Rishi Arora, Susan Kim, Albert Lin, Nishant Verma, Bradley P. Knight, Rod S. Passman Source Type: research

Outcomes with Novel Oral Anticoagulants in Obese Patients Undergoing Electrical Cardioversion for Atrial Tachyarrhythmias
The efficacy of novel oral anticoagulants (NOACs) in severely obese patients is uncertain as volume of distribution is related to weight and few such patients were enrolled in the pivotal trials. As the month following direct-current cardioversion (DCCV) for atrial fibrillation and atrial flutter (AF/AFL) is a high-risk period for stroke, we sought to evaluate the safety of performing DCCV in obese patients on NOAC. All patients who underwent DCCV after ≥ 3 weeks of NOAC or therapeutic warfarin treatment without a prior transesophageal echocardiogram (TEE) over a 3-year period at a single center were included.
Source: The American Journal of Cardiology - July 4, 2018 Category: Cardiology Authors: Rachel M. Kaplan, Celso L. Diaz, Theresa Strzelczyk, Cindy You, Basil Saour, Michelle Fine, Amar Trivedi, Mark J. Shen, Prasongchai Sattayaprasert, Alexandru B. Chicos, Rishi Arora, Susan Kim, Albert Lin, Nishant Verma, Bradley P. Knight, Rod S. Passman Source Type: research

Effectiveness and Safety of Direct Oral Anticoagulants and Warfarin, Stratified by Stroke Risk in Patients With Atrial Fibrillation
The objective of the study was to examine how the comparative effectiveness and safety of direct oral anticoagulants (DOACs) and warfarin differ across subgroups of patients with atrial fibrillation defined by stroke risk (CHA2DS2-VASc score ≤3, 4 to 5, ≥6). Using Medicare claims data, we identified patients newly diagnosed with atrial fibrillation in 2013 to 2014 who initiated warfarin (n=12,354), apixaban (n=2,358), dabigatran (n=1,415), or rivaroxaban (n=5,139), and categorized them according to their CHA2DS2-VASc score (≤3, 4 to 5, ≥6).
Source: The American Journal of Cardiology - March 28, 2018 Category: Cardiology Authors: Inmaculada Hernandez, Yuting Zhang, Samir Saba Source Type: research

Effectiveness and Safety of Direct Oral Anticoagulants and Warfarin, Stratified by Stroke Risk in Patients with Atrial Fibrillation
The objective of the study was to examine how the comparative effectiveness and safety of direct oral anticoagulants (DOACs) and warfarin differ across subgroups of atrial fibrillation (AF) patients defined by stroke risk (CHA2DS2-VASc score ≤3, 4-5, ≥6). Using claims data from a 5% random sample of Medicare beneficiaries, we identified patients newly diagnosed with AF in 2013-2014 who initiated warfarin (n=12,354), apixaban (n=2,358), dabigatran (n=1,415) or rivaroxaban (n=5,139), and categorized them according to their CHA2DS2-VAS c score (≤3, 4-5, ≥6).
Source: The American Journal of Cardiology - March 28, 2018 Category: Cardiology Authors: Inmaculada Hernandez, Yuting Zhang, Samir Saba Source Type: research

Relation of Stroke and Bleeding Risk Profiles to Efficacy and Safety of Edoxaban for Cardioversion of Atrial Fibrillation (From the Edoxaban Versus Warfarin in Subjects Undergoing Cardioversion of Atrial Fibrillation ENSURE-AF Study)
In the ENSURE-AF study, edoxaban was compared to enoxaparin –warfarin in patients undergoing electrical cardioversion of nonvalvular atrial fibrillation, showing comparable low rates of bleeding and thromboembolism. This ancillary analysis investigated differences in relation to stroke and bleeding risk profiles. Secondly, we determined clinical risk profi les to quality of anticoagulation control in the warfarin arm. Primary efficacy (composite of stroke, systemic embolic event, myocardial infarction, and cardiovascular death) and safety (composite of major and clinically relevant nonmajor bleeding) outcomes and time to...
Source: The American Journal of Cardiology - October 26, 2017 Category: Cardiology Authors: Gregory Y.H. Lip, Jose L. Merino, G. Andrei Dan, Sakis Themistoclakis, Kenneth A. Ellenbogen, Raffaele De Caterina, Assen Goudev, James Jin, Michael Melino, Shannon M. Winters, Andreas Goette 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

Comparison of the Effectiveness and Safety of Apixaban, Dabigatran, Rivaroxaban and Warfarin in Newly Diagnosed Atrial Fibrillation
No studies have performed direct pairwise comparisons of the effectiveness and safety of warfarin and the new oral anticoagulants (NOACs) apixaban, dabigatran and rivaroxaban in atrial fibrillation (AF). Using 2013-2014 claims from a 5% random sample of Medicare beneficiaries, we identified patients newly diagnosed with AF who initiated apixaban, dabigatran, rivaroxaban, warfarin or no oral anticoagulation therapy in 2013-2014. Outcomes included the composite of ischemic stroke, systemic embolism (SE) and death, any bleeding event, gastrointestinal bleeding, intracranial bleeding, and treatment persistence.
Source: The American Journal of Cardiology - August 8, 2017 Category: Cardiology Authors: Inmaculada Hernandez, Yuting Zhang, Samir Saba Source Type: research

Comparison of the Effectiveness and Safety of Apixaban, Dabigatran, Rivaroxaban, and Warfarin in Newly Diagnosed Atrial Fibrillation
No studies have performed direct pairwise comparisons of the effectiveness and safety of warfarin and the new oral anticoagulants (NOACs) apixaban, dabigatran, and rivaroxaban. Using 2013 to 2014 claims from a 5% random sample of Medicare beneficiaries, we identified patients newly diagnosed with atrial fibrillation who initiated apixaban, dabigatran, rivaroxaban, warfarin, or no oral anticoagulation therapy in 2013 to 2014. Outcomes included the composite of ischemic stroke, systemic embolism (SE) and death, any bleeding event, gastrointestinal bleeding, intracranial bleeding, and treatment persistence.
Source: The American Journal of Cardiology - August 8, 2017 Category: Cardiology Authors: Inmaculada Hernandez, Yuting Zhang, Samir Saba Source Type: research

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