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Direct Oral Anticoagulants: Patients Benefit When Prescribers Get the Message
Direct oral anticoagulants (DOACs) have demonstrated similar or better efficacy to warfarin in reducing stroke and systemic embolic events in large-scale prospective trials.1 –4 In addition, these trials demonstrated either noninferiority or superiority in reducing bleeding events compared with warfarin. To treat high-risk patients with atrial fibrillation (AF) and avoid bleeding in low-risk patients, current guidelines recommend oral anticoagulants in high-risk patien ts with AF with CHA2DS2VASc scores of ≥2 in men and ≥3 in women.
Source: The American Journal of Cardiology - September 5, 2023 Category: Cardiology Authors: Gerald V. Naccarelli Tags: Editorial Source Type: research

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

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

An Updated Meta-Analysis on the Clinical Outcomes of Percutaneous Left Atrial Appendage Closure Versus Direct Oral Anticoagulation in Patients With Atrial Fibrillation
The availability of direct oral anticoagulants (DOACs) with known lower bleeding risk compared with warfarin have raised questions about the role of left atrial appendage closure (LAAC). We aimed to perform a meta-analysis to compare the clinical outcomes for LAAC versus DOACs. All studies directly comparing LAAC with DOACs up to January 2023 were included. The outcomes studied included the combined major adverse cardiovascular (CV) events outcomes, ischemic stroke and thromboembolic events, major bleeding, CV mortality, and all-cause mortality.
Source: The American Journal of Cardiology - June 13, 2023 Category: Cardiology Authors: Haowen Jiang, Tian Hai Koh, Vijay Vengkat, Gao Fei, Zee Pin Ding, See Hooi Ewe, Ignasius Jappar, Soo Teik Lim, Jonathan Yap Source Type: research

Reply to the Comment on “Comparison of Dabigatran Versus Warfarin Treatment for Prevention of New Cerebral Lesions in Valvular Atrial Fibrillation”
We thank Dr. Abrahim et al for their interest and valuable comment on our study.1 In the methodology section, we intended to recruit stable patients who were able to use the standard anticoagulation in the outpatient setting. Therefore, we excluded the patients with acute stroke within 2  weeks or patients with high-bleeding risk. All the patients received standard rate control therapy according to the relevant guideline.2 The proportion of medications for rate control such as β blocker (56% of overall patients), calcium channel blocker (24%), or digitalis (31%) were already prese nted, and the mean heart rate was 74.1 ± 14.2 beats/min.
Source: The American Journal of Cardiology - October 10, 2022 Category: Cardiology Authors: Min Soo Cho, Duk-Hyun Kang, Kee-Joon Choi Source Type: research

Effectiveness and Safety of Apixaban Versus Warfarin in Obese Patients with Nonvalvular Atrial Fibrillation Enrolled in Medicare and Veteran Affairs
Real-world studies have evaluated the use of anticoagulants in obese patients with nonvalvular atrial fibrillation (NVAF), but they have been limited by sample size or the use of diagnosis codes on claims to define obesity. This retrospective study used body weight data of ≥100 kg or a body mass index of ≥30 kg/m2 to identify elderly (aged ≥65 years) NVAF patients with obesity in dually enrolled Veterans Affairs and fee-for-service Medicare patients. It evaluated the risk of stroke/systemic embolism (SE) and major bleeding (MB) in patients that initiated apixaba n versus warfarin.
Source: The American Journal of Cardiology - December 18, 2021 Category: Cardiology Authors: Steve Deitelzweig, Janvi Sah, Amiee Kang, Cristina Russ, Madison Preib, Amol D. Dhamane, Anna Ratiu, Matthew Cato, Tamuno Alfred, Edi Levi, Manuela Di Fusco Source Type: research

Network Meta-analysis Comparing Apixaban versus Rivaroxaban in Morbidly Obese Patients with Atrial Fibrillation
The efficacy and safety of DOACs in morbidly obese patients have been well investigated over the last few years.1-4 Our recent meta-analysis showed that the DOAC group did not increase stroke or systemic embolism (SE) event rate compared to the warfarin group and the DOAC use was significantly associated with a lower major bleeding event rate compared to the warfarin group.5 However, it is still unknown which DOAC is more appropriate than others. Apixaban and rivaroxaban are the two most common DOACs prescribed in the U.S but there is no guidance on which agent should be selected in morbidly obese patients with AF.
Source: The American Journal of Cardiology - September 7, 2020 Category: Cardiology Authors: Kazuhiko Kido, Mikiko Shimizu, Tsuyoshi Shiga, Masayuki Hashiguchi Source Type: research

Pattern and Impact of Off-label Underdosing of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation Who Are Indicated for Standard Dosing
With safety concerns about increasing bleeding, off-label underdosing of non-vitamin K antagonist anticoagulants (NOACs) is common in East Asian patients with atrial fibrillation (AF). We tried to investigate the pattern of NOAC underdosing and associated clinical outcomes in patients with AF who are indicated for standard dosing. Using the Korean National Health Insurance Service database, we evaluated 16568 patients with a new prescription of NOAC who are indicated for standard NOAC dosing and compared 4536 patients with warfarin with respect to thromboembolic events (ischemic stroke or systemic embolization), all-cause ...
Source: The American Journal of Cardiology - February 6, 2020 Category: Cardiology Authors: Min Soo Cho, Ji Eun Yun, Ji Jeong Park, Yun Jung Kim, Jessie Lee, Hyungmin Kim, Duk-Woo Park, Gi-Byoung Nam Source Type: research

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

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 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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