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Antithrombotic Medication and Major Complications After Mechanical Aortic Valve Replacement
Patients with mechanical aortic valve replacement (AVR) require lifelong vitamin K antagonist (VKA) therapy for stroke and systemic embolism prevention. However, VKA treatment predisposes patients to various types of bleeding. In the present study, we sought to assess the success of antithrombotic therapy and the occurrence and timing of strokes and bleeding events after mechanical AVR. A total of 308 patients who underwent isolated mechanical AVR were included in the study, and follow-up data were completed for 306 patients (99.4%).
Source: The American Journal of Cardiology - August 5, 2023 Category: Cardiology Authors: Rikhard Bj örn, Joonas Lehto, Markus Malmberg, Vesa Anttila, K.E. Juhani Airaksinen, Jarmo Gunn, Tuomas Kiviniemi 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

Comparison of Stroke and Bleeding Risk Profile in Patients With Atrial Fibrillation and Chronic Kidney Disease
This study explores the impact of glomerular filtration rate (GFR) in the embolic-hemorrhagic balance among a large cohort of patients with AF. The study cohort included 15,457 patients diagnosed with AF between January 2014 and April 2020. The risk of ischemic stroke and major bleeding was determined by competing risk regression.
Source: The American Journal of Cardiology - April 12, 2023 Category: Cardiology Authors: Jos é Antonio Parada Barcia, Sergio Raposeiras Roubin, Emad Abu-Assi, Pablo Domínguez Erquicia, Andrea Lizancos Castro, Lucía Rioboo Lestón, Juan Ocampo Míguez, Inmaculada González Bermúdez, Andrés Íñiguez-Romo Source Type: research

Effect of Duration of Anticoagulation in the Incidence of Stroke in Patients With Left-Ventricular Thrombus
The optimal duration of anticoagulation in patients with left-ventricular thrombus (LVT) is unclear. In the present study, we aimed to analyze the effect of treatment duration ( ≤12 months [short-term anticoagulation, (STA)] versus>12 months [long-term anticoagulation, (LTA)]) in the incidence of stroke and other secondary outcomes (acute myocardial infarction, bleeding, and mortality). Multivariate Cox regression was used to determine the association between treatment duration and stroke, adjusted for baseline embolic risk.
Source: The American Journal of Cardiology - October 12, 2022 Category: Cardiology Authors: Álvaro Lorente-Ros, Gonzalo L. Alonso-Salinas, Juan M. Monteagudo Ruiz, María Abellás-Sequeiros, José M. Vieítez-Florez, Diego Sánchez Vega, Jesús Álvarez-Garcia, Marcelo Sanmartín-Fernández, Marta Lorente-Ros, Susana del Prado Díaz, Covadonga 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

Influence of the Danish Co-morbidity Index Score on the Treatment and Outcomes of 2.5 Million Patients Admitted With Acute Myocardial Infarction in the United States
This study aimed to determine the association between the Danish Co-morbidity Index for Acute Myocardial Infarction (DANCAMI) and restricted DANCAMI (rDANCAMI) scores and clinical outcomes in patients hospitalized with AMI. Using the National Inpatient Sample, all AMI hospitalizations were stratified into four groups based on their DANCAMI and rDANCAMI score (0; 1 to 3; 4 to 5; ≥6). The primary outcome was all-cause mortality, whereas secondary outcomes were major adverse cardiovascular/cerebrovascular events, major bleeding, ischemic stroke, and receipt of coronary angiography or percutaneous coronary intervention.
Source: The American Journal of Cardiology - July 14, 2022 Category: Cardiology Authors: Balamrit Singh Sokhal, Andrija Mateti ć, Abhishek, Philip Freeman, Jan Walter Dhillon Shanmuganathan, Mohamed O. Mohamed, Christian Mallen, Mamas A. Mamas Source Type: research

Meta-Analysis Comparing Apixaban Versus Rivaroxaban for Management of Patients With Nonvalvular Atrial Fibrillation
To compare the efficacy and safety of apixaban and rivaroxaban for the prevention of stroke in patients with nonvalvular atrial fibrillation (NVAF) by way of a meta-analysis informed by real-world evidence. Systematic review and meta-analysis of observational studies including patients with NVAF on apixaban and rivaroxaban, which reported stroke/systemic embolism and/or major bleeding. Prospero registration number: CRD42021251719. Estimates of relative treatment effect (based on hazard ratios[HRs]) were pooled using the inverse variance method.
Source: The American Journal of Cardiology - December 20, 2021 Category: Cardiology Authors: Mamas A. Mamas, Sarah Batson, Kevin G. Pollock, Sarah Grundy, Andrew Matthew, Chris Chapman, Joana Assis Manuel, Usman Farooqui, Stephen A. Mitchell 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

Ischemic and Bleeding Events After First Major Bleeding Event in Patients Undergoing Coronary Stent Implantation
There is a scarcity of data on ischemic and bleeding events in patients who experienced major bleeding after percutaneous coronary intervention (PCI). Moreover, there also is a shortage of data on comparative outcomes between patients with and without interruption of an antithrombotic drug after major bleeding. We evaluated the incidence and prognostic impacts of ischemic (myocardial infarction or ischemic stroke) and bleeding (Bleeding Academic Research Consortium type 3 or 5) events after major bleeding in 12,691 consecutive patients who underwent first PCI in the Coronary Revascularization Demonstrating Outcome Study in...
Source: The American Journal of Cardiology - October 24, 2021 Category: Cardiology Authors: Ko Yamamoto, Masahiro Natsuaki, Takeshi Morimoto, Hiroki Shiomi, Yusuke Yoshikawa, Junichi Tazaki, Takeshi Tada, Hirotoshi Watanabe, Eri Kato, Mamoru Toyofuku, Tsukasa Inada, Kazuhisa Kaneda, Teruki Takeda, Hiroshi Sakai, Takashi Yamamoto, Hiroshi Eizawa, Source Type: research

MAUDE Database Analysis of Post-Approval Outcomes following Left Atrial Appendage Closure with the Watchman Device
The objective of this study was to determine the frequency and timing of adverse events associated with Watchman LAAC device implants performed after FDA approval. Adverse events associated with Watchman LAAC implants performed between March 2015 and March 2019 were identified through a search of the FDA Manufacturer and User Facility Device Experience (MAUDE) database.
Source: The American Journal of Cardiology - June 8, 2021 Category: Cardiology Authors: Pablo A. Ledesma, Uwajachukwumma A. Uzomah, Xuejing Yu, Ayman Shaqdan, Pegah Khaloo, Jennifer Galvin, Moussa Mansour, Leon M. Ptaszek, Jeremy N. Ruskin Source Type: research

Inappropriate Dosing of Direct Oral Anticoagulants in Patients with Atrial Fibrillation
Direct Oral Anticoagulants (DOACs) require dose adjustment based on specific patient characteristics, making them prone to incorrect dosing. The current study aimed to evaluate the prevalence of inappropriate DOAC dosing, its predictors, and corresponding outcomes in a single-center cohort of AF patients. We reviewed all patients with AF treated at Mayo Clinic with a DOAC (Apixaban, Rivaroxaban, or Dabigatran) between 2010 and 2017. Outcomes examined were ischemic stroke /transient ischemic attack (TIA)/embolism and bleeding.
Source: The American Journal of Cardiology - December 28, 2020 Category: Cardiology Authors: Alan Sugrue, David Sanborn, Mustapha Amin, Medhat Farwati, Haarini Sridhar, Azza Ahmed, Ramila Mehta, Konstantinos C. Siontis, Siva K. Mulpuru, Abhishek J. Deshmukh, Bernard J. Gersh, Samuel J Asirvatham, Malini Madhavan Source Type: research

Outcomes of Transcatheter Aortic Valve Replacement with Percutaneous Coronary Intervention versus Surgical Aortic Valve Replacement with Coronary Artery Bypass Grafting
We aimed to compare the outcomes of combined surgical aortic valve replacement (SAVR) with coronary artery bypass grafting (CABG) to concurrent transcatheter aortic valve replacement (TAVR) with percutaneous coronary intervention (PCI) in a large U.S. population sample. The National Inpatient Sample (NIS) was queried for all patients diagnosed with aortic valve stenosis who underwent SAVR with CABG or TAVR with PCI during the years 2016-2017. Study outcomes included all-cause in-hospital mortality, acute stroke, pacemaker insertion, vascular complications, major bleeding, acute kidney injury, sepsis, non-home discharge, le...
Source: The American Journal of Cardiology - September 25, 2020 Category: Cardiology Authors: Ashraf Abugroun, Mohammed Osman, Saria Awadalla, Lloyd Klein Source Type: research

Meta-analysis Comparing Multiple Arterial Grafts versus Single Arterial Graft for Coronary-Artery Bypass Grafting
Observational studies and randomized controlled trials (RCTs) have shown conflicting outcomes for multiple arterial graft (MAG) coronary artery bypass graft surgery (CABG) compared to single arterial grafts (SAGs). The predominant evidence supporting the use of MAGs is observational. The aim of this meta-analysis of RCTs is to compare outcomes following MAG and SAG. We searched multiple databases for RCTs comparing MAG versus SAG. The clinical outcomes studied were all-cause mortality, cardiac mortality, myocardial infarction (MI), revascularization, stroke, sternal wound complications, and major bleeding.
Source: The American Journal of Cardiology - June 14, 2020 Category: Cardiology Authors: Khalid Changal, Saqib Masroor, Ahmed Elzanaty, Mitra Patel, Tanveer Mir, Shayan Khan, Salik Nazir, Ronak Soni, Carson Oostra, Sadik Khuder, Ehab Eltahawy Source Type: research

Observed versus Expected Ischemic and Bleeding Events Following Left Atrial Appendage Occlusion
Data on the efficacy of left atrial appendage occlusion (LAAO) in clinical practice are limited. We performed a systematic review and meta-analysis of observational studies that reported observed vs. expected rates of ischemic strokes and/or major bleeding following LAAO. Our primary end points were the pooled relative risk reduction (RRR) in ischemic stroke and major bleeding with corresponding 95% confidence intervals (CI) compared with what was expected by the CHA2DS2-VASc and HASBLED scores, respectively.
Source: The American Journal of Cardiology - March 13, 2020 Category: Cardiology Authors: Tatiana Busu, Safi U Khan, Muhammad Alhajji, Fahad Alqahtani, David R Holmes, Mohamad Alkhouli Source Type: research

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