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Efficacy and safety of novel anticoagulants versus vitamin K antagonists in patients with mild and moderate to severe renal insufficiency: Focus on apixaban
The high risk of both stroke and major bleeding in atrial fibrillation (AF) patients with chronic kidney disease (CKD) defines an important population for whom the assessment of the balance between the risk of ischemic stroke and of bleeding is essential. The use of novel oral anticoagulants (NOACs) may be a viable option in this population due to their greater net clinical benefit than warfarin, as demonstrated by the results of the clinical phase III trials. NOACs have been found to have a greater net clinical benefit than warfarin in patients at high risk of either stroke (CHADS2 ≥1 or CHA2DS2-VASc score≥2) or bleeding (HAS-BLED≥3).
Source: International Journal of Cardiology - September 30, 2016 Category: Cardiology Authors: Francesco Pelliccia, Salvatore Rosanio, Giuseppe Marazzi, Sara Poggi, Alessandra Tanzilli, Cesare Greco, Carlo Gaudio, Giuseppe Rosano Tags: Review Source Type: research

Reversal agents for direct oral anticoagulants: A focused review
For several decades the vitamin K antagonist oral anticoagulants were the only outpatient therapy that existed to reduce the risk of stroke and thromboembolism. When the new direct oral anticoagulants were approved for use and addressed many of the issues associated with oral vitamin K antagonists, a new concern arose —the lack of rapid ability to reverse these agents. Physicians and patients were concerned that in cases of life-threatening bleeding or need for emergent surgery, an antidote to reverse the anticoagulation effect of these agents did not exist.
Source: International Journal of Cardiology - August 11, 2016 Category: Cardiology Authors: Boris Arbit, Marin Nishimura, Jonathan C. Hsu Tags: Review Source Type: research

Reduced dose and reduced exposure to non-vitamin K-antagonist oral anticoagulants: Some considerations on this relationship
For the prevention of stroke and/or systemic embolism (SSE) in non-valvular atrial fibrillation (NVAF), the four available non-vitamin K-antagonist oral anticoagulants (NOACs) are each marketed in a higher and a lower dose: 150 and 110mg for dabigatran, 20 and 15mg for rivaroxaban, 5 and 2.5mg for apixaban and 60 and 30mg for edoxaban. The lower dose is commonly used with the aim to reduce the patient's exposure to the drug (and its anticoagulant effect), thereby reducing the risk of bleeding. This however, may not always be true, depending on the NOAC used and the characteristics of the patients to whom the NOAC is given.
Source: International Journal of Cardiology - August 10, 2016 Category: Cardiology Authors: Andrea Rubboli, Freek W.A. Verheugt Tags: Correspondence Source Type: research

Non-vitamin K oral anticoagulant treatment in elderly patients with atrial fibrillation and coronary heart disease
Atrial fibrillation (AF) is the most frequent sustained arrhythmia. Overall prevalence is estimated to 5.5% and the incidence increases with age. As the population ages, the prevalence and costs of AF are expected to increase. AF is the most important cause of stroke in patients>75years. Until recently, Vitamin K antagonists (VKAs) were the only available oral anticoagulants (OACs) evaluated for long-term treatment of patients with AF with or without coronary heart disease (CHD). This situation was challenged by introduction of non-VKA oral anticoagulants (NOACs).
Source: International Journal of Cardiology - August 3, 2016 Category: Cardiology Authors: Xavier Humbert, Vincent Roule, Mathieu Chequel, Sophie Fedrizzi, Marie Brionne, V éronique Lelong-Boulouard, Paul Milliez, Joachim Alexandre Tags: Review Source Type: research

Dabigatran in clinical practice: Contemporary overview of the evidence
Oral anticoagulation is the cornerstone of stroke prevention in non-valvular atrial fibrillation (AF) and management of venous thromboembolism (VTE), resulting in a reduction in thrombotic complications and mortality. Benefit of vitamin K antagonists (VKAs) in such patients has been unambiguously confirmed, but VKA use is complicated by need for regular monitoring of the international normalized ratio and multiple drug and food interactions.Dabigatran is an oral direct thrombin inhibitor that can be used with fixed doses, without the need for routine anticoagulation laboratory monitoring and the advantage of few drug or diet interactions.
Source: International Journal of Cardiology - June 22, 2016 Category: Cardiology Authors: Walter Ageno, John Eikelboom, Gregory Y.H. Lip Source Type: research

Is left atrial appendage closure useful for stroke prevention in atrial fibrillation patients with renal failure?
With great interest we read the article by Kefer et al. about the impact of chronic kidney disease on left atrial appendage (LAA) occlusion with the ACP device for stroke prevention in patients with atrial fibrillation (AF) [1]. We agree with the authors that stroke prevention in AF patients with chronic kidney disease is a problem due to increased bleeding complications during oral anticoagulant therapy with vitamin K antagonists. Furthermore, the use of non-vitamin K-antagonist oral anticoagulants (NOACs) is dangerous or contraindicated in these patients.
Source: International Journal of Cardiology - April 14, 2016 Category: Cardiology Authors: Claudia Stöllberger, Josef Finsterer, Birke Schneider Source Type: research

Comparative effectiveness and safety of non-vitamin K Antagonist oral anticoagulants versus warfarin in patients with atrial fibrillation and valvular heart disease
Non-vitamin K antagonist oral anticoagulants (NOACs) are approved for prevention of stroke in patients with nonvalvular atrial fibrillation (NVAF). These agents are as effective as warfarin and are associated with less intracranial bleeding and may be preferable for many patients with NVAF [1]. However, the term non-valvular AF remains a source of confusion because clinical trials and guidelines have adopted variable definitions.
Source: International Journal of Cardiology - February 2, 2016 Category: Cardiology Authors: Peter A. Noseworthy, Xiaoxi Yao, Nilay D. Shah, Bernard J. Gersh Source Type: research

Bleeding risk in patients treated with dabigatran or vitamin K antagonist for atrial fibrillation: A meta analysis of adjusted analysis in routine practice settings
Large randomized controlled trials have found that in non-valvular atrial fibrillation (AF), non-vitamin K antagonist oral anticoagulants (NOACs) had a favorable risk–benefit profile, with significant reductions in stroke, mortality and intracranial hemorrhage, but possibly increased gastrointestinal bleeding [1]. After the approval of dabigatran, many agencies in different countries received reports of severe dabigatran related bleeding reports through their adverse event reporting system. Concurrently, several case reports of dabigatran induced bleeding were published in medical journals and discussed in the mainstream media.
Source: International Journal of Cardiology - January 6, 2016 Category: Cardiology Authors: Walid Darwiche, Theodora Bejan-Angoulvant, François Dievart, Dominique Babuty, Denis Angoulvant, Laurent Fauchier Tags: Correspondence Source Type: research

Usefulness of the SAME-TTR score to predict anticoagulation control on VKA in patients with atrial fibrillation and obstructive sleep apnea
The objective of this study was to establish if presence of OSA is associated with poor expected benefit from Vitamin K Antagonist (VKA) therapy as assessed using the SAMe-TT2R2 score.
Source: International Journal of Cardiology - November 23, 2015 Category: Cardiology Authors: Filip M. Szymanski, Gregory Y.H. Lip, Krzysztof J. Filipiak, Anna E. Platek, Grzegorz Karpinski Source Type: research

Relative efficacy and safety of non-Vitamin K oral anticoagulants for non-valvular atrial fibrillation: Network meta-analysis comparing apixaban, dabigatran, rivaroxaban and edoxaban in three patient subgroups
Stroke is the most serious clinical consequence of atrial fibrillation, which is the most common cardiac arrhythmia. Non-vitamin K antagonist oral anticoagulants (NOACs) have emerged as efficacious, safe and convenient stroke prevention agents. This updated network meta-analysis focused on the relative efficacy and safety of apixaban compared with dabigatran, rivaroxaban and edoxaban for stroke prevention in (i) patients with CHADS2 score ≥2, (ii) secondary stroke prevention, and (iii) patients with high quality anticoagulation control with warfarin.
Source: International Journal of Cardiology - November 17, 2015 Category: Cardiology Authors: Gregory Y.H. Lip, Stephen A. Mitchell, Xianchen Liu, Larry Z. Liu, Hemant Phatak, Sumesh Kachroo, Sarah Batson Source Type: research

Inadequate anticoagulation by Vitamin K antagonists and major adverse cardiovascular events other than stroke
I read the article by Pastori et al. [1] with great interest. In their artcile, the authors reported that inadequate anticoagulation by Vitamin K Antagonists was found to be associated with Major Adverse Cardiovascular Events (MACE) in patients with atrial fibrillation, and they concluded that time in therapeutic range (TTR) was an independent predictor of MACE in patients with atrial fibrillation. It is known that inadequate anticoagulation by Vitamin K Antagonists is a strong predictor of stroke.
Source: International Journal of Cardiology - October 30, 2015 Category: Cardiology Authors: Mehmet Eyuboglu Tags: Correspondence Source Type: research

REal-LIfe Evidence of stroke prevention in patients with atrial Fibrillation – the RELIEF study
The objective of the ‘REal-LIfe Evidence on stroke prevention in patients with atrial Fibrillation’ (RELIEF) study was to compare the effectiveness of newly-initiated rivaroxaban or VKA therapy among NVAF patients in Germany.
Source: International Journal of Cardiology - September 21, 2015 Category: Cardiology Authors: Craig I. Coleman, Matthias Antz, Birgit Ehlken, Thomas Evers Source Type: research

REal-LIfe Evidence of stroke prevention in patients with atrial Fibrillation — The RELIEF study
The objective of the ‘REal-LIfe Evidence on stroke prevention in patients with atrial Fibrillation’ (RELIEF) study was to compare the effectiveness of newly-initiated rivaroxaban or VKA therapy among NVAF patients in Germany.
Source: International Journal of Cardiology - September 21, 2015 Category: Cardiology Authors: Craig I. Coleman, Matthias Antz, Birgit Ehlken, Thomas Evers Tags: Correspondence Source Type: research

Antiplatelet Therapy in Japanese Patients with Atrial Fibrillation without Oral Anticoagulants: Pooled Analysis of Shinken Database, J-RHYTHM Registry and Fushimi AF Registry
Atrial fibrillation (AF) is the most common cardiac arrhythmia and increases the risk of ischemic stroke. Oral anticoagulants (OAC) are effective for stroke prevention in patients with AF, and recent evidences have revealed the efficacy and safety of non-vitamin K antagonist OAC (NOAC) as well as warfarin. Although aspirin was shown to be inferior to warfarin or apixaban in preventing stroke [1,2], it is still prescribed to many AF patients in clinical practice [3–5]. This may be because physicians perceived it to be a safer and more convenient alternative to OAC.
Source: International Journal of Cardiology - April 22, 2015 Category: Cardiology Authors: Hisashi Ogawa, Masaharu Akao, Shinya Suzuki, Takeshi Yamashita, Ken Okumura, Hirotsugu Atarashi, Hiroshi Inoue Tags: Letter to the Editor Source Type: research

Reply: Health status, geriatric syndromes and prescription of oral anticoagulant therapy in elderly medical in-patients with atrial fibrillation: A prospective observational study
We agree with the content of the letter from Dr Jolobe OMP and, specifically we concur with his conclusion, where he underlines the fragile evidence for aspirin use in the prevention of atrial fibrillation (AF)-related stroke. According to recent European guidelines [1], our study aimed to assess prevalence of and variables associated with under-prescription of currently recommended anticoagulant therapy for AF patients, including vitamin K antagonists (VKAs) and new direct oral anticoagulants (DOAs), but not those associated with use or under-use of aspirin, which is currently not recommended for prevention of AF-related stroke.
Source: International Journal of Cardiology - April 15, 2015 Category: Cardiology Authors: M. Bo, F. Li Puma, M. Badinella Martini, Y. Falcone, M. Iacovino, E. Grisoglio, M. Bonetto, G. Isaia, G. Ciccone, G.C. Isaia, F. Gaita Tags: Letters to the Editor Source Type: research

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