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Is Transcatheter Aortic Valve Implantation as Cost-effective as Surgical Aortic Valve Replacement?
Transcatheter aortic valve implantation (TAVI) has emerged as an efficacious and cost-effective treatment for inoperable patients with severe aortic stenosis.1 For high-risk patients, existing evidence suggests that TAVI has similar peri-procedural mortality and stroke outcomes compared to surgical aortic valve replacement (AVR), with higher incidences of paravalvular leak, permanent pacemaker requirement and vascular injuries after TAVI and higher incidences of major bleeding after AVR.2 Regarding the cost-effectiveness of TAVI, a recent systematic review examining its incremental cost effectiveness ratio in relation to A...
Source: The American Journal of Cardiology - July 16, 2015 Category: Cardiology Authors: Christopher Cao Source Type: research

Meta-Analysis of Renal Function on the Safety and Efficacy of Novel Oral Anticoagulants for Atrial Fibrillation
Novel oral anticoagulants (NOACs) are safe and effective for the prevention of stroke or systemic embolism (S/SE) in atrial fibrillation (AF). The efficacy and safety of NOACs compared to warfarin has not been systematically assessed in subjects with mild or moderate renal dysfunction. We performed a meta-analysis of the randomized clinical trials that compared efficacy and safety (major bleeding) outcomes of NOACs compared to warfarin for the treatment of nonvalvular AF and had available data on renal function.
Source: The American Journal of Cardiology - October 16, 2015 Category: Cardiology Authors: Freddy Del-Carpio Munoz, S. Michael Gharacholou, Thomas M. Munger, Paul A. Friedman, Samuel J. Asirvatham, Douglas L. Packer, Peter A. Noseworthy Source Type: research

Meta-analysis of Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement in patients with Severe Aortic Valve Stenosis Patients
Transcatheter aortic valve replacement (TAVR) is a viable option in the treatment of severe aortic stenosis in patients at high risk for surgery. We sought to further investigate outcomes in low-to-intermediate-risk patients with aortic stenosis undergoing surgical aortic valve replacement (SAVR) versus TAVR. We systematically searched the electronic databases, MEDLINE, PUBMED, EMBASE and Cochrane for prospective cohort studies of the effects of TAVR vs SAVR on clinical outcomes (30-day mortality, all cause mortality, stroke and myocardial infarction [MI], major vascular complications, paravalvular regurgitation, permanent...
Source: The American Journal of Cardiology - November 5, 2015 Category: Cardiology Authors: Ashok Kondur, Alexandros Briasoulis, Mohan Palla, Anirudh Penumetcha, Sagar Mallikethi-Reddy, Apurva Badheka, Theodore Schreiber 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

Long-Term Population-Based Cerebral Ischemic Event and Cognitive Outcomes of Direct Oral Anticoagulants Compared to Warfarin among Long-Term Anticoagulated Patients for Atrial Fibrillation
Direct oral anticoagulants (DOACs) have been used in clinical practice in the US for the last 4-6 years. While DOACs may be an attractive alternative to warfarin among many patients, long-term outcomes of use of these medications are unknown. We performed a propensity-matched analysis to report patient important outcomes of death, stroke/TIA, bleeding, major bleeding and dementia among patients taking a DOAC or warfarin. Patients receiving long-term anticoagulation between June 2010-December 2014 for thromboembolism prevention with either warfarin or a DOAC were matched 1:1 by index date and propensity score.
Source: The American Journal of Cardiology - May 4, 2016 Category: Cardiology Authors: Victoria Jacobs, Heidi T. May, Tami L. Bair, Brian G. Crandall, Michael J. Cutler, John D. Day, Charles Mallender, Jeffrey S. Osborn, Scott M. Stevens, J. Peter Weiss, Scott C. Woller, T. Jared Bunch Source Type: research

Usefulness of Palliative Care to Complement the Management of Patients on Left Ventricular Assist Devices
Within the last decade, advancements in left ventricular assist device (LVAD) therapy have allowed end-stage heart failure patients to live longer and with better quality of life. Like other life-saving interventions, however, there remains the risk of complications including infections, bleeding episodes, and stroke. The candidate for LVAD therapy faces complex challenges going forward, both physical and psychological, many of which may benefit from the application of palliative care principles by trained specialists.
Source: The American Journal of Cardiology - June 20, 2016 Category: Cardiology Authors: Nancy Luo, Joseph G. Rogers, Gwen C. Dodson, Chetan B. Patel, Anthony N. Galanos, Carmelo A. Milano, Christopher M. O’Connor, Robert J. Mentz Source Type: research

Comparison of the Incidence of Major Bleeding with Rivaroxaban Use among Nonvalvular Atrial Fibrillation Patients With versus Without Diabetes Mellitus
Diabetes mellitus (DM) is a common comorbidity in those with nonvalvular atrial fibrillation (NVAF). Most patients with DM and NVAF have a CHA2DS2-VASc score of ≥1 and should be considered for oral anticoagulation therapy for stroke prevention per treatment guidelines. The most important risk associated with anticoagulation is bleeding, which may be higher in those with NVAF plus DM. Our objective was to evaluate the incidence and characteristics of major bleeding (MB) in rivaroxaban users diagnosed with NVAF, further comparing those with DM versus those without DM, in a real-world clinical setting.
Source: The American Journal of Cardiology - December 7, 2016 Category: Cardiology Authors: W. Frank Peacock, Sally Tamayo, Nicholas Sicignano, Kathleen P. Hopf, Zhong Yuan, Manesh Patel 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

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

Anticoagulation Control in Warfarin Treated Patients Undergoing Cardioversion for Atrial Fibrillation (From the ENSURE-AF Trial)
In the ENSURE-AF study (NCT 02072434), edoxaban was compared to enoxaparin –warfarin in 2199 patients undergoing electrical cardioversion of non-valvular atrial fibrillation (AF). In this multicenter PROBE trial, we analyzed patients randomized to enoxaparin–warfarin. We determined time to achieve therapeutic range (TtTR), time in therapeutic range (TiTR), their clinic al determinants, relation to SAMe-TT2R2 score, and impact on primary endpoints (composite of stroke, systemic embolic event [SEE], myocardial infarction [MI], and cardiovascular death [CVD] and composite of major + clinically relevant non-major [CRNM] bleeding).
Source: The American Journal of Cardiology - June 15, 2017 Category: Cardiology Authors: Gregory Y H Lip, Naab Al-Saady, James Jin, Ming Sun, Michael Melino, Shannon M Winters, Dmitry Zamoryakhin, Andreas Goette Source Type: research

Anticoagulation Control in Warfarin-Treated Patients Undergoing Cardioversion of Atrial Fibrillation (from the Edoxaban Versus Enoxaparin –Warfarin in Patients Undergoing Cardioversion of Atrial Fibrillation Trial)
In the Edoxaban Versus Enoxaparin –Warfarin in Patients Undergoing Cardioversion of Atrial Fibrillation (ENSURE-AF) study (NCT 02072434), edoxaban was compared with enoxaparin–warfarin in 2,199 patients undergoing electrical cardioversion of nonvalvular atrial fibrillation (AF). In this multicenter prospective randomized open bl inded end-point trial, we analyzed patients randomized to enoxaparin–warfarin. We determined time to achieve therapeutic range (TtTR); time in therapeutic range (TiTR); their clinical determinants; relation to sex, age, medical history, treatment, tobacco use, race risk (SAMe-TT2R2) score; an...
Source: The American Journal of Cardiology - June 15, 2017 Category: Cardiology Authors: Gregory Y.H. Lip, Naab Al-Saady, James Jin, Ming Sun, Michael Melino, Shannon M. Winters, Dmitry Zamoryakhin, Andreas Goette Tags: Arrhythmias and Conduction Disturbances Source Type: research

Effect of Bleeding Risk on Type of Stent Used in Patients Presenting with Acute Coronary Syndrome
Patients at high bleeding risk (HBR) are at increased risk of bleeding following percutaneous coronary intervention (PCI) with drug-eluting stent (DES) due to the need for longer dual antiplatelet duration. We sought to evaluate the likelihood of receiving DES during PCI in HBR populations and to characterize DES utilization trends over time. Consecutive patients who underwent PCI from April 2003 to September 2015 were identified. HBR is defined as patients fulfilling one or more of the HBR criteria: age ≥75 years, anticoagulation use at discharge, history of stroke, cancer in previous 3 years, glucocorticoid use, hemoglobin (Hgb)
Source: The American Journal of Cardiology - July 24, 2017 Category: Cardiology Authors: M. Chadi Alraies, Sang Yeub Lee, Michael J. Lipinski, Kyle Buchanan, Arie Steinvil, Toby Rogers, Edward Koifman, Jiaxiang Gai, Rebecca Torguson, Itsik Ben-Dor, Lowell F. Satler, Augusto D. Pichard, Ron Waksman Source Type: research

Outcome of Patients Receiving Thrombolytic Therapy While on Rivaroxaban for Non-Valvular Atrial Fibrillation (From ROCKET AF)
The safety of intravenous thrombolysis in patients taking rivaroxaban has not been well established. We retrospectively analyzed the outcomes of all patients who received thrombolytic therapy in the ROCKET AF trial. Review of medical and adverse event records for patients receiving thrombolytic therapy while enrolled in ROCKET AF was performed to determine their baseline characteristics, indications for thrombolysis, and type of agent used. Safety endpoints were 30-day post-thrombolytic rates of stroke, bleeding, and mortality.
Source: The American Journal of Cardiology - August 7, 2017 Category: Cardiology Authors: Sean T Chen, Anne S Hellkamp, Richard C Becker, Scott D Berkowitz, G ünter Breithardt, Keith AA Fox, Werner Hacke, Jonathan L Halperin, Graeme J Hankey, Kenneth W Mahaffey, Christopher C Nessel, Jonathan P Piccini, Daniel E Singer, Manesh R Patel 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

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