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Systematic Review and Meta-Analysis of Direct Oral Anticoagulants Versus Warfarin in Atrial Fibrillation With Low Stroke Risk
Oral anticoagulation (OAC) in patients with atrial fibrillation (AF) has been shown to prevent thromboembolic complications, but concerns about the increased risk of major bleeding warrant judicious consideration of the risks and benefits.1 Current guidelines recommend OAC prescription for patients with AF at high risk of stroke, as measured by CHA2DS2-VASc scores of ≥2 and ≥3 in men and women respectively.2–4 Men and women with scores of 1 and 2 respectively (i.e., a single nongender-related stroke risk factor) are deemed to be at low-moderate risk of stroke and OAC prescription may be considered to reduce thromboem...
Source: The American Journal of Cardiology - August 11, 2023 Category: Cardiology Authors: Khi Yung Fong, Yiong Huak Chan, Colin Yeo, Gregory Y.H. Lip, Vern Hsen Tan 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

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

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

Meta-Analysis of Risk of Stroke or Transient Ischemic Attack With Dabigatran for Atrial Fibrillation Ablation
In conclusion, periprocedural use of dabigatran for AF ablation was related to a higher risk of thromboembolic complications including stroke and transient ischemic attack.
Source: The American Journal of Cardiology - January 16, 2014 Category: Cardiology Authors: Partha Sardar, Ramez Nairooz, Saurav Chatterjee, Jørn Wetterslev, Joydeep Ghosh, Wilbert S. Aronow Tags: Arrhythmias and Conduction Disturbances 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

Effect of Dabigatran on Referrals to and Switching From Warfarin in Two Academic Anticoagulation Management Services
Dabigatran was expected to replace warfarin for stroke prevention in patients with nonvalvular atrial fibrillation (AF) who are warfarin naive, difficult to maintain in therapeutic range, or at risk of warfarin-related bleeding complications. We hypothesized that the number of patients with nonvalvular AF referred to Anticoagulation Management Services would decrease sharply and that most would switch from warfarin to dabigatran. We evaluated the number of patients with nonvalvular AF referred to 2 large services, Anticoagulation Management Service 1 and Anticoagulation Management Service 2, 12 months before and after mark...
Source: The American Journal of Cardiology - May 6, 2013 Category: Cardiology Authors: Julie K. Atay, John Fanikos, Geoffrey D. Barnes, Michael Ehle, John Coatney, Gregory Piazza, James B. Froehlich, Samuel Z. Goldhaber Tags: Arrhythmias and Conduction Disturbances Source Type: research

Comparison of Characteristics and Outcomes of Dabigatran versus Warfarin in Hypertensive Patients with Atrial Fibrillation (From the RE-LY® Trial)
Hypertension is frequent among patients with atrial fibrillation (AF) and is an independent risk factor for stroke. The Randomized Evaluation of Long Term Anticoagulant TherapY (RE-LY) trial found dabigatran 110 mg bid (D 110) and 150 mg bid (D 150) non-inferior or superior to warfarin for stroke reduction in patients with AF, with either a reduction (D 110) or similar rates (D150) of major bleeding. Baseline characteristics and outcomes were compared in patients with and without hypertension. The quality of blood pressure control was also assessed.
Source: The American Journal of Cardiology - July 28, 2015 Category: Cardiology Authors: Rangadham Nagarakanti, Lars Wallentin, Herbert Noack, Martina Brueckmann, Paul Reilly, Andreas Clemens, Stuart J. Connolly, Salim Yusuf, Michael D. Ezekowitz Source Type: research

Comparison of Characteristics and Outcomes of Versus in Hypertensive Patients With Atrial Fibrillation (from the RE-LY Trial)
Hypertension is frequent in patients with atrial fibrillation (AF) and is an independent risk factor for stroke. The Randomized Evaluation of Long Term Anticoagulant TherapY (RE-LY) trial found dabigatran 110 mg (D110) and 150 mg twice daily (D150) noninferior or superior to warfarin for stroke reduction in patients with AF, with either a reduction (D110) or similar rates (D150) of major bleeding. Baseline characteristics and outcomes were compared in patients with and without hypertension. The quality of blood pressure control was also assessed.
Source: The American Journal of Cardiology - July 28, 2015 Category: Cardiology Authors: Rangadham Nagarakanti, Lars Wallentin, Herbert Noack, Martina Brueckmann, Paul Reilly, Andreas Clemens, Stuart J. Connolly, Salim Yusuf, Michael D. Ezekowitz 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

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

Quest for the Perfect Anticoagulant
The current referenced meta-analysis study by Selvaraj et al1 examines the relative merits of anticoagulation with a direct oral anticoagulant (DOAC) versus vitamin K antagonist (VKA) after transcatheter aortic valve implantation (TAVI) in patients meeting the indications for anticoagulation because of atrial fibrillation (AF). Although guidelines vary, the general consensus appears to indicate noninferiority to superiority of DOACs in the treatment of nonvalvular AF. In the landmark Apixiban for Reduction In Stroke and Other Thromboemoblic Events in Atrial Fibrillation trial comparing apixaban to warfarin in patients with...
Source: The American Journal of Cardiology - July 27, 2023 Category: Cardiology Authors: Bryant Fisher, Danny Chu Source Type: research

Safety of Continuous Anticoagulation With Dabigatran During Implantation of Cardiac Rhythm Devices
In conclusion, although no thromboembolic or major bleeding events were observed, additional studies are required to define the optimal antithrombotic management in the perioperative period.
Source: The American Journal of Cardiology - January 28, 2013 Category: Cardiology Authors: Christopher P. Rowley, Michael L. Bernard, William W. Brabham, Peter C. Netzler, Darren S. Sidney, Frank Cuoco, J. Lacy Sturdivant, Robert B. Leman, J. Marcus Wharton, Michael R. Gold Tags: Arrhythmias and Conduction Disturbances Source Type: research

Meta-Analysis of Gender Differences in Residual Stroke Risk and Major Bleeding in Patients With Nonvalvular Atrial Fibrillation Treated With Oral Anticoagulants
In conclusion, women with AF treated with warfarin have a greater residual risk of CVA/SE and an equivalent major bleeding risk, whereas those treated with NOAC agents deemed superior to warfarin are at equivalent residual risk of CVA/SE and less major bleeding risk compared with men. These results suggest an increased net clinical benefit of NOAC agents compared with warfarin in treating women with AF.
Source: The American Journal of Cardiology - November 14, 2013 Category: Cardiology Authors: Samir B. Pancholy, Parikshit S. Sharma, Dipti S. Pancholy, Tejas M. Patel, David J. Callans, Francis E. Marchlinski Tags: Arrhythmias and Conduction Disturbances Source Type: research

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