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Meta-Analysis of Effectiveness and Safety of Oral Anticoagulants in Atrial Fibrillation with Focus on Apixaban
We performed a meta-analysis of data on the effectiveness and safety of apixaban compared with other oral anticoagulants (OACs, warfarin or rivaroxaban or dabigatran or edoxaban) for stroke prevention in atrial fibrillation (AF) in different settings of randomized controlled trials (RCTs), real-world studies, and radiofrequency ablation (RFA). 30 studies were searched in PubMed, the Cochrane Library and Clinicaltrials.gov databases reporting comparative effectiveness and safety of apixaban with warfarin (n=23), rivaroxaban (n=12) or dabigatran (n=13) or edoxaban (2) for stroke prevention in AF.
Source: The American Journal of Cardiology - August 1, 2017 Category: Cardiology Authors: Ying Bai, Xu-Bo Shi, Chang-Sheng Ma, Gregory Y H Lip Source Type: research

Anticoagulation Control in Warfarin-Treated Patients Undergoing Cardioversion of Atrial Fibrillation (from the Edoxaban Versus Enoxaparin –Warfarin in Patients Undergoing Cardioversion of Atrial Fibrillation Trial)
In the Edoxaban Versus Enoxaparin –Warfarin in Patients Undergoing Cardioversion of Atrial Fibrillation (ENSURE-AF) study (NCT 02072434), edoxaban was compared with enoxaparin–warfarin in 2,199 patients undergoing electrical cardioversion of nonvalvular atrial fibrillation (AF). In this multicenter prospective randomized open bl inded end-point trial, we analyzed patients randomized to enoxaparin–warfarin. We determined time to achieve therapeutic range (TtTR); time in therapeutic range (TiTR); their clinical determinants; relation to sex, age, medical history, treatment, tobacco use, race risk (SAMe-TT2R2) score; an...
Source: The American Journal of Cardiology - June 15, 2017 Category: Cardiology Authors: Gregory Y.H. Lip, Naab Al-Saady, James Jin, Ming Sun, Michael Melino, Shannon M. Winters, Dmitry Zamoryakhin, Andreas Goette Tags: Arrhythmias and Conduction Disturbances Source Type: research

Anticoagulation Control in Warfarin Treated Patients Undergoing Cardioversion for Atrial Fibrillation (From the ENSURE-AF Trial)
In the ENSURE-AF study (NCT 02072434), edoxaban was compared to enoxaparin –warfarin in 2199 patients undergoing electrical cardioversion of non-valvular atrial fibrillation (AF). In this multicenter PROBE trial, we analyzed patients randomized to enoxaparin–warfarin. We determined time to achieve therapeutic range (TtTR), time in therapeutic range (TiTR), their clinic al determinants, relation to SAMe-TT2R2 score, and impact on primary endpoints (composite of stroke, systemic embolic event [SEE], myocardial infarction [MI], and cardiovascular death [CVD] and composite of major + clinically relevant non-major [CRNM] bleeding).
Source: The American Journal of Cardiology - June 15, 2017 Category: Cardiology Authors: Gregory Y H Lip, Naab Al-Saady, James Jin, Ming Sun, Michael Melino, Shannon M Winters, Dmitry Zamoryakhin, Andreas Goette Source Type: research

Efficacy and Safety of Rivaroxaban Versus Warfarin in Patients Taking Nondihydropyridine Calcium Channel Blockers for Atrial Fibrillation (from the ROCKET AF Trial)
Non-dihydropyridine calcium channel blockers (non-DHP CCBs) possess combined P-glycoprotein and moderate CYP3A4 inhibition, which may lead to increased exposure of medications that are substrates for these metabolic pathways, such as rivaroxaban. We evaluated the use and outcomes of non-DHP CCBs in patients with atrial fibrillation (AF) in 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).
Source: The American Journal of Cardiology - May 29, 2017 Category: Cardiology Authors: Jeffrey B. Washam, Anne S. Hellkamp, Yuliya Lokhnygina, Jonathan P. Piccini, Scott D. Berkowitz, Christopher C. Nessel, Richard C. Becker, G ünter Breithardt, Keith A.A. Fox, Jonathan L. Halperin, Graeme J. Hankey, Kenneth W. Mahaffey, Daniel E. Singer, Tags: Arrhythmias and Conduction Disturbances Source Type: research

Safety and Efficacy of Uninterrupted Apixaban Therapy Versus Warfarin During Atrial Fibrillation Ablation
Thromboembolic cerebrovascular accident remains a rare but potentially devastating complication of catheter based atrial fibrillation (AF) ablation. Uninterrupted oral anticoagulant (OAC) therapy with warfarin has become the standard of care when performing catheter based AF ablation. Compared with warfarin, apixaban, a factor Xa inhibitor, has been shown to reduce the risk of stroke and major bleeding in non-valvular AF. With an increase in apixaban use for stroke prophylaxis in AF patients there is an increased interest in the safety and efficacy of uninterrupted apixaban therapy during AF ablation.
Source: The American Journal of Cardiology - May 10, 2017 Category: Cardiology Authors: Ruchit R. Shah, Ajay Pillai, Pascha Schafer, David Meggo, Tom McElderry, Vance Plumb, Takumi Yamada, Vineet Kumar, Harish Doppalapudi, Alicia Gunter, Emily Pentecost, William R. Maddox Source Type: research

Effect of Addition of a Statin to Warfarin on Thromboembolic Events in Japanese Patients With Nonvalvular Atrial Fibrillation and Diabetes Mellitus
Statins have been shown to decrease stroke risk in patients with cardiovascular risk factors, but not to prevent recurrence of ischemic stroke in patients with atrial fibrillation (AF). The present subanalysis aimed to clarify the efficacy of combined use of warfarin and statins in nonvalvular AF (NVAF) patients with coronary artery disease (CAD), diabetes mellitus (DM) or hypertension. The effects of adding statins to warfarin were compared with those of warfarin alone in NVAF patients with the data set of J-RHYTHM Registry, a prospective, observational study with a 2-year follow-up.
Source: The American Journal of Cardiology - April 26, 2017 Category: Cardiology Authors: Naoko Kumagai, John A. Nusser, Hiroshi Inoue, Ken Okumura, Takeshi Yamashita, Toru Kubo, Hiroaki Kitaoka, Hideki Origasa, Hirotsugu Atarashi, J-RHYTHM Registry Investigators Source Type: research

Relation of Risk of Stroke in Patients With Atrial Fibrillation to Body Mass Index (From Patients Treated With Rivaroxaban and Warfarin in the ROCKET AF Trial)
We investigated stroke outcomes in normal weight (body mass index [BMI] 18.50-24.99 kg/m2), overweight (BMI 25.00-29.99 kg/m2), and obese (BMI ≥30 kg/m2) patients with AF treated with rivaroxaban and warfarin. We compared the incidence of stroke and systemic embolic events (SEE) as well as bleeding events in normal weight (n=3289), overweight (n=5535), and obese (n=5206) patients in a post-hoc analysis of the ROCKET AF trial. Stroke and SEE rates per 100 patient-years were 2.93 in the normal weight group (reference group), 2.28 in the overweight group (adjusted hazard ratio [HR] 0.81, 95% confidence interval [CI]: 0.66-0...
Source: The American Journal of Cardiology - March 28, 2017 Category: Cardiology Authors: Somasekhara R. Balla, Derek D. Cyr, Yuliya Lokhyngina, 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, Danie Source Type: research

Management of Major Bleeding in Patients With Atrial Fibrillation Treated With Non –Vitamin K Antagonist Oral Anticoagulants Compared With Warfarin in Clinical Practice (from Phase II of the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation ORBIT-AF II)
Non –vitamin K antagonist oral anticoagulants (NOACs) are effective at preventing stroke in patients with atrial fibrillation (AF). However, little is known about the management of bleeding in contemporary, clinical use of NOACs. We aimed to assess the frequency, management, and outcomes of major blee ding in the setting of community use of NOACs. Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II registry, we analyzed rates of International Society on Thrombosis and Haemostasis major bleeding and subsequent outcomes in patients treated with NOACs versus warfarin.
Source: The American Journal of Cardiology - February 28, 2017 Category: Cardiology Authors: Benjamin A. Steinberg, DaJuanicia N. Simon, Laine Thomas, Jack Ansell, Gregg C. Fonarow, Bernard J. Gersh, Peter R. Kowey, Kenneth W. Mahaffey, Eric D. Peterson, Jonathan P. Piccini, Outcomes Registry for Better Informed Treatment of Atrial Fibrillation ( Tags: Arrhythmias and Conduction Disturbances Source Type: research

How Well Do Stroke Risk Scores Predict Hemorrhage in Patients With Atrial Fibrillation?
The decision to use anticoagulants for atrial fibrillation depends on comparing a patient's estimated risk of stroke to their bleeding risk. Several of the risk factors in the stroke risk schemes overlap with hemorrhage risk. We compared how well 2 stroke risk scores (CHADS2 and CHA2DS2-VASc) and 2 hemorrhage risk scores (the ATRIA bleeding score and the HAS-BLED score) predicted major hemorrhage on and off warfarin in a cohort of 13,559 community-dwelling adults with AF. Over a cumulative 64,741 person-years of follow-up, we identified a total of 777 incident major hemorrhage events.
Source: The American Journal of Cardiology - June 13, 2016 Category: Cardiology Authors: Gene R. Quinn, Daniel E. Singer, Yuchiao Chang, Alan S. Go, Leila H. Borowsky, Margaret C. Fang Tags: Arrhythmias and Conduction Source Type: research

How Well do Stroke Risk Scores Predict Hemorrhage in Patients with Atrial Fibrillation?
The decision to use anticoagulants for atrial fibrillation depends on comparing a patient’s estimated risk of stroke to their bleeding risk. Several of the risk factors in the stroke risk schemes such as overlap with hemorrhage risk. We compared how well two stroke risk scores (CHADS2 and CHA2DS2-VASc) and two hemorrhage risk scores (the ATRIA bleeding score and the HAS-BLED score) predicted major hemorrhage on and off warfarin in a cohort of 13,559 community-dwelling adults with AF. Over a cumulative 64,741 person-years of follow up, we identified a total of 777 incident major hemorrhage events.
Source: The American Journal of Cardiology - June 13, 2016 Category: Cardiology Authors: Gene R. Quinn, Daniel E. Singer, Yuchiao Chang, Alan S. Go, Leila H. Borowsky, Margaret C. Fang Source Type: research

Long-Term Population-Based Cerebral Ischemic Event and Cognitive Outcomes of Direct Oral Anticoagulants Compared to Warfarin among Long-Term Anticoagulated Patients for Atrial Fibrillation
Direct oral anticoagulants (DOACs) have been used in clinical practice in the US for the last 4-6 years. While DOACs may be an attractive alternative to warfarin among many patients, long-term outcomes of use of these medications are unknown. We performed a propensity-matched analysis to report patient important outcomes of death, stroke/TIA, bleeding, major bleeding and dementia among patients taking a DOAC or warfarin. Patients receiving long-term anticoagulation between June 2010-December 2014 for thromboembolism prevention with either warfarin or a DOAC were matched 1:1 by index date and propensity score.
Source: The American Journal of Cardiology - May 4, 2016 Category: Cardiology Authors: Victoria Jacobs, Heidi T. May, Tami L. Bair, Brian G. Crandall, Michael J. Cutler, John D. Day, Charles Mallender, Jeffrey S. Osborn, Scott M. Stevens, J. Peter Weiss, Scott C. Woller, T. Jared Bunch Source Type: research

Relation of Non-Valvular Atrial Fibrillation to Body Mass Index (From the SPORTIF Trials)
Obesity is well-established as a major cardiovascular (CV) risk factor. Obesity confers a higher risk for developing atrial fibrillation (AF), but the relation between obesity and established non-valvular AF (NVAF) for stroke and all-cause death is still unclear. To ascertain the prevalence of overweight and obesity in NVAF patients, their influence on adverse events and the relation with anticoagulation control we performed this post-hoc analysis of the pooled SPORTIF III and V datasets. For this study, we analysed all patients assigned to the warfarin arm with data on body mass index(BMI).
Source: The American Journal of Cardiology - April 19, 2016 Category: Cardiology Authors: Marco Proietti, Deirdre A. Lane, Gregory Y.H. Lip Source Type: research

Cost-Effectiveness of Dabigatran (150 mg Twice Daily) and Warfarin in Patients ≥65 Years With Nonvalvular Atrial Fibrillation
Dabigatran has been shown to be superior to warfarin for stroke prevention in nonvalvular atrial fibrillation (NVAF) but with higher out-of-pocket costs for patients. Although dabigatran has been shown to be cost effective from a societal perspective, cost implications for individual patients and insurers are not well described. We aimed to assess cost perspectives of each payer (Medicare and patient) in relation to administration, monitoring, and adverse outcomes for dabigatran and warfarin in patients with and without prescription drug coverage.
Source: The American Journal of Cardiology - October 16, 2015 Category: Cardiology Authors: Brian M. Salata, David W. Hutton, Deborah A. Levine, James B. Froehlich, Geoffrey D. Barnes Tags: Arrhythmias and Conduction Disturbances Source Type: research

Cost-Effectiveness of Dabigatran (150 mg Twice Daily) and Warfarin in Patients ≥ 65 Years with Non-Valvular Atrial Fibrillation
Dabigatran has been shown to be superior to warfarin for stroke prevention in non-valvular atrial fibrillation (NVAF) but with higher out-of-pocket costs for patients. Although dabigatran has been shown to be cost-effective from a societal perspective, cost implications for individual patients and insurers are not well-described. We aimed to assess cost perspectives of each payer (Medicare and patient) in relation to administration, monitoring and adverse outcomes for dabigatran and warfarin in patients with and without prescription drug coverage.
Source: The American Journal of Cardiology - October 16, 2015 Category: Cardiology Authors: Brian M. Salata, David W. Hutton, Deborah A. Levine, James B. Froehlich, Geoffrey D. Barnes Source Type: research

Meta-Analysis of Renal Function on the Safety and Efficacy of Novel Oral Anticoagulants for Atrial Fibrillation
Novel oral anticoagulants (NOACs) are safe and effective for the prevention of stroke or systemic embolism (S/SE) in atrial fibrillation (AF). The efficacy and safety of NOACs compared to warfarin has not been systematically assessed in subjects with mild or moderate renal dysfunction. We performed a meta-analysis of the randomized clinical trials that compared efficacy and safety (major bleeding) outcomes of NOACs compared to warfarin for the treatment of nonvalvular AF and had available data on renal function.
Source: The American Journal of Cardiology - October 16, 2015 Category: Cardiology Authors: Freddy Del-Carpio Munoz, S. Michael Gharacholou, Thomas M. Munger, Paul A. Friedman, Samuel J. Asirvatham, Douglas L. Packer, Peter A. Noseworthy Source Type: research

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