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Safety and Effectiveness of Long-term Anticoagulation for Atrial Fibrillation Among Nonagenarians: A Real-world Analysis
The prevalence of atrial fibrillation (AF) increases with age, reaching 10% among those over 80 years old (1). Long-term anticoagulation (AC) is effective in reducing strokes among patients with AF at increased risk of thromboembolic events (2). The safety and effectiveness of AC among nonagenarians are poorly understood, since these patients were underrepresented in the pivotal trials of AC.1 While age is an independent risk factor for stroke in patients with AF, the net clinical benefit of AC may be mitigated by an increased risk of bleeding (3,4).
Source: The American Journal of Cardiology - November 11, 2020 Category: Cardiology Authors: Ahmed Elkaryoni, Kirolos Barssoum, Amr F. Barakat, Islam Y. Elgendy, Mahmoud Elsayed, Adel Muhanna, Anne Arnason, Islam Shatla, Amir Darki, Alan P. Wimmer Source Type: research

Procedural and Short-Term Outcomes of Percutaneous Left Atrial Appendage Closure in Patients with Cancer
Percutaneous left atrial appendage closure (LAAC) with the Watchman device (Boston Scientific) has emerged as an alternative to anticoagulation in patients with atrial fibrillation (AF). Cancer is a common comorbidity in patients with AF (1,2). Also, AF patients with cancer reportedly have a higher bleeding risk with a similar or higher stroke risk than those without cancer (3). Thus, AF patients with cancer unsuitable for anticoagulation can be indicated for LAAC to prevent AF-related thromboembolism (2).
Source: The American Journal of Cardiology - December 3, 2020 Category: Cardiology Authors: Toshiaki Isogai, Anas M. Saad, Abdelrahman Ibrahim Abushouk, Shashank Shekhar, Shunsuke Kuroda, Mohamed M. Gad, Oussama M. Wazni, Amar Krishnaswamy, Samir R. Kapadia Source Type: research

Benefit of Single Antiplatelet Therapy Over Dual Antiplatelet Therapy After Transcatheter Aortic Valve Implantation
Current practice guidelines recommend dual antiplatelet therapy with aspirin and clopidogrel for 3-6 months followed by lifelong aspirin after transcatheter aortic valve implantation (TAVI). However, recently published POPular TAVI trial1 and other trials2 –4 that have compared dual antiplatelet therapy (DAPT) with single antiplatelet therapy (SAPT) have shown decreased bleeding events and non-inferiority with respect to ischemic stroke, all-cause mortality, and myocardial infarction (MI) amongst patients receiving SAPT.
Source: The American Journal of Cardiology - December 8, 2020 Category: Cardiology Authors: Agam Bansal, Ashish Kumar, Vardhmaan Jain, Grant W Reed, Amar Krishnaswamy, Ankur Kalra, Rishi Puri, Samir R. Kapadia 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

Aspirin for Primary Prevention of Cardiovascular Disease in the 21st Century: A Review of the Evidence
Aspirin (ASA) is the most commonly prescribed antiplatelet agent. Although the evidence for efficacy of aspirin for secondary prevention of ischemic events in patients with established cardiovascular disease is strong, its role in primary prevention has been subject of controversies over the past decades. In fact, historical trials have shown only modest benefit in terms of reduction of ischemic events, mostly myocardial infarction and to a lesser extent stroke, and only at the expense of an increased risk of bleeding.
Source: The American Journal of Cardiology - March 9, 2021 Category: Cardiology Authors: Dominick J Angiolillo, Davide Capodanno 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

Meta-analysis of Surgical Left Atrial Appendage Occlusion During Cardiac Surgery
Atrial fibrillation (AF) is a common arrhythmia in the elderly population and represents a significant risk for cardio-embolic stroke secondary to thrombi originating from the left atrial appendage.1,2 Although oral anticoagulation is considered the standard of care, numerous concerns exist. Patient noncompliance, intolerance, and subtherapeutic drug levels are examples.3 Moreover, the risk of bleeding poses a significant problem, especially in elderly, frail patients. Surgical-left atrial appendage occlusion (S-LAAO) has been considered an alternative strategy to reduce the risk of future cardioembolic events.
Source: The American Journal of Cardiology - July 24, 2021 Category: Cardiology Authors: Mohamed M.G. Mohamed, Mohammed Faisaluddin, Babikir Kheiri, Mohammed Osman 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

Outcomes of Direct Oral Anticoagulants Co-Prescribed with Common Interacting Medications
We examined the prevalence of co-prescription of DOACs with interacting medications and its impact on outcomes in patients with atrial fibrillation (AF). Patients with AF treated with a DOAC from 2010 to 2017 at the Mayo Clinic and co-prescribed medications that are inhibitors or inducers of the P-glycoprotein and/or Cytochrome P450 3A4 pathways were identified. The outcomes of stroke, transient ischemic attack, or systemic embolism, major bleeding, and minor bleeds were compared between patients with and without an enzyme inducer.
Source: The American Journal of Cardiology - October 27, 2021 Category: Cardiology Authors: David Sanborn, Alan Sugrue, Mustapha Amin, Ramila Mehta, Medhat Farwati, Abhishek J. Deshmukh, Haarini Sridhar, Azza Ahmed, Samuel J. Asirvatham, Narith N. Ou, Peter A. Noseworthy, Ammar M. Killu, Siva K. Mulpuru, Malini Madhavan 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

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

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

Impact of Frailty on In-Hospital Outcomes in Patients Who Underwent Percutaneous Left Atrial Appendage Occlusion
In patients with atrial fibrillation, frailty is associated with an increased risk of bleeding, especially if patients take oral anticoagulation for stroke prophylaxis.1 Left atrial appendage occlusion (LAAO) is an alternative in patients unable to tolerate anticoagulation. However, whether patients who are frail are more vulnerable to procedural complications associated with LAAO remains undefined.2 We therefore examined in-hospital outcomes in patients who undergo LAAO procedures using a nationally representative real-world cohort of patients.
Source: The American Journal of Cardiology - April 9, 2023 Category: Cardiology Authors: Siddharth Agarwal, Muhammad Bilal Munir, Agam Bansal, Christopher V. DeSimone, Usman Baber, Abhishek Deshmukh, Zain Ul Abideen Asad 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

Percutaneous Left Atrial Appendage Closure Among Patients With Diabetes (Insights from a National Database)
Atrial fibrillation is a major risk factor for stroke. Left atrial appendage closure (LAAC) has emerged as an alternative to anticoagulation for patients with high risk of bleeding. Diabetes mellitus (DM) is associated with adverse events after cardiac procedures. We sought to compare procedural and hospital outcomes in patients who underwent LAAC with and without DM. The Nationwide Inpatient Database was queried for patients with atrial fibrillation who underwent LAAC between January 1, 2016, and December 31, 2019.
Source: The American Journal of Cardiology - July 11, 2023 Category: Cardiology Authors: Mohamed Hamed, Ramez Morcos, Ayman Elbadawi, Ahmed Osman, Hani Jneid, Wissam Khalife, Brijeshwar Maini, Houman Khalili Source Type: research

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