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2021 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: comment
We have read with keen interest the updated practical guide by Steffelet al.1 For safer decision-making, we share the authors ’ view on the need for rapid assessment of anticoagulation in patients under non-vitamin K antagonist oral anticoagulant (NOAC) during emergencies such as bleeding and urgent surgical intervention. Our group has been involved in studies on point-of-care coagulation testing (POCT) in acute stroke p atients where rapid decision-making with respect to thrombolysis and anticoagulation reversal is vital.
Source: Europace - September 4, 2021 Category: Cardiology Source Type: research

Atrial high-rate episodes: prevalence, stroke risk, implications for management, and clinical gaps in evidence
AbstractSelf-terminating atrial arrhythmias are commonly detected on continuous rhythm monitoring, e.g. by pacemakers or defibrillators. It is unclear whether the presence of these arrhythmias has therapeutic consequences. We sought to summarize evidence on the prevalence of atrial high-rate episodes (AHREs) and their impact on risk of stroke. We performed a comprehensive, tabulated review of published literature on the prevalence of AHRE. In patients with AHRE, but without atrial fibrillation (AF), we reviewed the stroke risk and the potential risk/benefit of oral anticoagulation. Atrial high-rate episodes are found in 10...
Source: Europace - August 3, 2019 Category: Cardiology Source Type: research

Challenges in comparing the non-vitamin K antagonist oral anticoagulants for atrial fibrillation-related stroke prevention
AbstractThe aim of this review is to provide context for meta-analyses interpreting data from phase III stroke prevention studies of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with non-valvular atrial fibrillation (NVAF). Differences between the four phase III NOAC stroke prevention studies in patients with NVAF (ROCKET AF, ARISTOTLE, RE-LY, and ENGAGE AF), their potential impact on outcomes, and inter-study differences were evaluated, as well as the potential role of real-world evidence in evaluating NOACs in this setting. Study design differences included blinding strategy, dose-reduction options, a...
Source: Europace - October 13, 2017 Category: Cardiology Source Type: research

124 GP-led anticoagulation counselling for non-valvular atrial fibrillation (AF) in the community is neither comprehensive nor accurate: Results from a service improvement project.
Background: Stroke risk in NVAF can be reduced significantly by anticoagulation with either warfarin or the non- vitamin K antagonist (NOACs). NICE recommendations state that NOACs are as efficacious but also associated with significantly less intracranial bleeding compared to Warfarin and in this sense are safer than warfarin. Additionally NOACs do not require regular monitoring of their anticoagulant effects and therefore offer convenience to the patient. However they are not as tried and tested as warfarin and at the time of our study, did not have an available agent to reverse their effects in the event of a bleeding c...
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

Non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients undergoing elective cardioversion
ConclusionThrombotic and bleeding complications related to NOACs were uncommon (<0.5%) in real life AF patients undergoing elective cardioversion.
Source: Europace - July 10, 2017 Category: Cardiology Source Type: research

Shifting to a non-vitamin K antagonist oral anticoagulation agent from vitamin K antagonist in atrial fibrillation
ConclusionIn a contemporary setting among VKA-experienced NVAF patients; VKA is still prevalent although about 30% by December 2015 had shifted to a NOAC.
Source: Europace - June 28, 2017 Category: Cardiology Source Type: research

Stroke and bleeding with non-vitamin K antagonist oral anticoagulant or warfarin treatment in patients with non-valvular atrial fibrillation: a population-based cohort study
ConclusionThis population-based cohort study of routine care indicates similar or better effectiveness and safety with NOAC compared with warfarin treatment. NOACs were associated with fewer intracranial bleeds, but more gastrointestinal bleeds.
Source: Europace - February 10, 2017 Category: Cardiology Source Type: research

Rationale and design of AXAFA-AFNET 5: an investigator-initiated, randomized, open, blinded outcome assessment, multi-centre trial to comparing continuous apixaban to vitamin K antagonists in patients undergoing atrial fibrillation catheter ablation
Conclusion</div>The results of AXAFA-AFNET 5 will provide evidence informing about the safety of apixaban in ablation patients and on its efficacy including effects on silent brain lesions. AXAFA – AFNET 5 is an investigator-initiated trial sponsored by AFNET. The trial is supported by the DZHK (German Centre for Cardiovascular Research) and by the BMBF (German Ministry of Education and Research) and by Bristol-Myers Squibb/Pfizer Alliance.</span>
Source: Europace - October 13, 2016 Category: Cardiology Source Type: research

Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation
The current manuscript is an update of the original Practical Guide, published in June 2013[Heidbuchel H, Verhamme P, Alings M, Antz M, Hacke W, Oldgren J, et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013;15:625–51; Heidbuchel H, Verhamme P, Alings M, Antz M, Hacke W, Oldgren J, et al. EHRA practical guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation: executive summary. Eur Heart J 2013;34:2094–106]. Non-vitamin K antagonist oral anticoagulants (NOACs) are an ...
Source: Europace - October 23, 2015 Category: Cardiology Authors: Heidbuchel, H., Verhamme, P., Alings, M., Antz, M., Diener, H.-C., Hacke, W., Oldgren, J., Sinnaeve, P., Camm, A. J., Kirchhof, P., Advisors:, Ahmad, Heinrich-Nols, Hess, Muller, Munzel, Schwertfeger, Van Eickels, Richard-Lordereau, Document reviewers:, L Tags: EHRA PRACTICAL GUIDE Source Type: research

Non-vitamin K antagonist oral anticoagulation agents in anticoagulant naive atrial fibrillation patients: Danish nationwide descriptive data 2011-2013
Conclusion Among oral anticoagulation-naïve AF patients initiated on oral anticoagulation in Denmark, warfarin initiation has declined since the introduction of dabigatran in August 2011. Dabigatran is the most frequently used alternative option to warfarin; however, use of rivaroxaban and apixaban is increasing. Patients initiated with rivaroxaban or apixaban in general have a higher predicted stroke and bleeding risks compared with warfarin or dabigatran initiators.
Source: Europace - January 29, 2015 Category: Cardiology Authors: Olesen, J. B., Sorensen, R., Hansen, M. L., Lamberts, M., Weeke, P., Mikkelsen, A. P., Kober, L., Gislason, G. H., Torp-Pedersen, C., Fosbol, E. L. Tags: Atrial fibrillation Source Type: research

Major bleeding in patients with atrial fibrillation receiving vitamin K antagonists: a systematic review of randomized and observational studies
Conclusion The median rate of major bleeding in observational studies and RCTs is similar. The larger heterogeneity in bleeding rates observed in a real-life setting could reflect a high variability in standard of care of patients on VKAs and/or methodological differences between observational studies and/or variability in data sources.
Source: Europace - May 24, 2013 Category: Cardiology Authors: Roskell, N. S., Samuel, M., Noack, H., Monz, B. U. Tags: Atrial Fibrillation Source Type: research