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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

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

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 CHA2DS2-VASc, CHADS2, HAS-BLED, ORBIT and ATRIA Risk Scores in Predicting Non-Vitamin K Antagonist Oral Anticoagulants-Associated Bleeding in Patients with Atrial Fibrillation
The increasing adoption of non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation (AF) necessitates a reassessment of bleeding risk scores. Because known risk factors for bleeding are largely the same as for stroke, we hypothesize that stroke risk scores could also be used to identify patients with high bleeding risks. We aimed to compare the performance of two stroke risk scores (CHA2DS2-VASc and CHADS2) and three bleeding risk scores (HAS-BLED, ORBIT, and ATRIA) in predicting major and intracranial bleeding.
Source: The American Journal of Cardiology - July 31, 2017 Category: Cardiology Authors: Xiaoxi Yao, Bernard J Gersh, Lindsey R Sangaralingham, David M Kent, Nilay D Shah, Neena S Abraham, Peter A Noseworthy Source Type: research

Comparison of the CHA2DS2-VASc, CHADS2, HAS-BLED, ORBIT, and ATRIA Risk Scores in Predicting Non –Vitamin K Antagonist Oral Anticoagulants-Associated Bleeding in Patients With Atrial Fibrillation
The increasing adoption of non –vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation (AF) necessitates a reassessment of bleeding risk scores. Because known risk factors for bleeding are largely the same as for stroke, we hypothesize that stroke risk scores could also be used to identify patients with high bleeding risks. We aimed to compare the performance of 2 stroke risk scores (Congestive Heart failure, hypertension, Age ≥75 [doubled], Diabetes, Stroke [doubled], Vascular disease, Age 65–74, and Sex [female] [CHA2DS2-VASc] and Cardiac failure, Hypertension, Age, Diabetes, ...
Source: The American Journal of Cardiology - July 31, 2017 Category: Cardiology Authors: Xiaoxi Yao, Bernard J. Gersh, Lindsey R. Sangaralingham, David M. Kent, Nilay D. Shah, Neena S. Abraham, Peter A. Noseworthy Source Type: research

Management of Major Bleeding in Patients With Atrial Fibrillation Treated With Non –Vitamin K Antagonist Oral Anticoagulants Compared With Warfarin in Clinical Practice (from Phase II of the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation ORBIT-AF II)
Non –vitamin K antagonist oral anticoagulants (NOACs) are effective at preventing stroke in patients with atrial fibrillation (AF). However, little is known about the management of bleeding in contemporary, clinical use of NOACs. We aimed to assess the frequency, management, and outcomes of major blee ding in the setting of community use of NOACs. Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II registry, we analyzed rates of International Society on Thrombosis and Haemostasis major bleeding and subsequent outcomes in patients treated with NOACs versus warfarin.
Source: The American Journal of Cardiology - February 28, 2017 Category: Cardiology Authors: Benjamin A. Steinberg, DaJuanicia N. Simon, Laine Thomas, Jack Ansell, Gregg C. Fonarow, Bernard J. Gersh, Peter R. Kowey, Kenneth W. Mahaffey, Eric D. Peterson, Jonathan P. Piccini, Outcomes Registry for Better Informed Treatment of Atrial Fibrillation ( Tags: Arrhythmias and Conduction Disturbances Source Type: research

Relation of Stroke and Major Bleeding to Creatinine Clearance in Patients With Atrial Fibrillation (From the Fushimi AF Registry)
Creatinine clearance (CrCl) has been widely used to adjust the dosage of non-vitamin K antagonist oral anticoagulants in atrial fibrillation (AF) patients and exclude contraindicated patients. However, there are few available real-world data on the relationship between CrCl and adverse clinical outcomes in AF patients. Therefore, we evaluated the clinical characteristics and adverse events in Japanese AF patients stratified by CrCl. We categorized patients in the Fushimi AF Registry, a large prospective community-based Japanese cohort of AF patients, into three groups as follows: (i) CrCl
Source: The American Journal of Cardiology - January 24, 2017 Category: Cardiology Authors: Mitsuru Abe, Hisashi Ogawa, Mitsuru Ishii, Nobutoyo Masunaga, Masahiro Esato, Yeong-Hwa Chun, Hikari Tsuji, Hiromichi Wada, Koji Hasegawa, Gregory Y.H. Lip, Masaharu Akao Source Type: research

Effects of Oral Anticoagulant Therapy in Medical In-patients ≥65 Years of Age with Atrial Fibrillation
In this retrospective cohort observational study we investigated mortality, ischemic and hemorrhagic events, in patients ≥65 years of age with atrial fibrillation (AF) consecutively discharged from an Acute Geriatric Ward in the period 2010-2013. Stroke and bleeding risk were evaluated using CHA2DS2-VASC and HAS-BLED scores. Comorbidity, cognitive status and functional autonomy were evaluated using standardized scales. Independent associations between clinical variables, including use of Vitamin K Antagonists (VKAs)-based oral anticoagulant therapy (OAT), and all-cause mortality, fatal and non-fatal ischemic and hemorrha...
Source: The American Journal of Cardiology - December 1, 2015 Category: Cardiology Authors: Mario Bo, Irene Sciarrillo, Federica Li Puma, Marco Badinella Martini, Yolanda Falcone, Marina Iacovino, Enrica Grisoglio, Elena Menditto, Gianfranco Fonte, Enrico Brunetti, Guido Maggiani, Giovanni Carlo Isaia, Fiorenzo Gaita Source Type: research

Unanswered Questions in Patients With Concurrent Atrial Fibrillation and Acute Coronary Syndrome
In conclusion, until the results of additional ongoing or planned randomized trials are known, clinicians must continue to rely on expert opinion and their own clinical judgment when treating these patients.
Source: The American Journal of Cardiology - December 16, 2013 Category: Cardiology Authors: Daniel S. Ice, Timothy A. Shapiro, Eric M. Gnall, Peter R. Kowey Tags: Review Source Type: research

Thrombocytopenia in Patients With Atrial Fibrillation on Oral Anticoagulation Undergoing Percutaneous Coronary Intervention
In conclusion, mild to moderate baseline thrombocytopenia does not seem to have a clinically significant effect on bleeding or thrombotic or thromboembolic complications after PCI in these frail patients receiving multiple antithrombotic drugs.
Source: The American Journal of Cardiology - May 13, 2013 Category: Cardiology Authors: Tuomas Kiviniemi, Pasi Karjalainen, Andrea Rubboli, Axel Schlitt, Petri Tuomainen, Matti Niemelä, Mika Laine, Fausto Biancari, Gregory Y.H. Lip, K.E. Juhani Airaksinen Tags: Coronary Artery Disease Source Type: research