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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

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

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

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

Frequency, Trend, Predictors, and Impact of Gastrointestinal Bleeding in Atrial Fibrillation Hospitalizations
Atrial fibrillation (AF) is associated with a five-fold increased risk of stroke 1. Anticoagulation alone or in combination with other treatment strategies are implemented to reduce the risk of stroke in patients with AF. Gastrointestinal bleeding (GIB) is a common complication of oral anticoagulation (OAC) with a prevalence of 1%-3% in patients on long term OAC2. GIB in AF patients leads to discontinuation of anticoagulation, which can increase the risk of ischemic stroke, subject patients to endoscopic procedures, blood transfusions, and related side effects.
Source: The American Journal of Cardiology - January 30, 2021 Category: Cardiology Authors: Mihir Dav, Ashish Kumar, Monil Majmundar, Devina Adalja, Mariam Shariff, Palak Shah, Rupak Desai, Krunalkumar Patel, Gowthami Sai Kogilathota Jagirdhar, Saraschandra Vallabhajosyula, Nageshwara Gullapalli, Rajkumar Doshi 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

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

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

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

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

Comparison in Patients < 75 Years of Age - vs – Those > 75 Years on One-Year-Events with Atrial Fibrillation and Left Atrial Appendage Occluder (From the Prospective Multicenter German LAARGE Registry)
Left atrial appendage closure (LAAC) is an alternative to oral anticoagulation therapy in patients with non-valvular atrial fibrillation for the prevention of embolic stroke and systemic embolism. Although elderly patients (>75 years) have both higher ischemic and bleeding risk as compared to younger patients, they benefit from optimal anticoagulation. The sub-analysis aimed to assess the indications, the safety, efficacy, and 1-year outcomes of interventional LAAC in elderly patients ( ≥ 75 years) compared to younger (
Source: The American Journal of Cardiology - September 13, 2020 Category: Cardiology Authors: Aref El Nasasra, Johannes Brachmann, Thorsten Lewalter, Ibrahim Akin, Horst Sievert, Christoph A. Nienaber, Christian Wei ß, Sven T. Pleger, Hüseyin Ince, Jens Maier, Stephan Achenbach, Holger H. Sigusch, Matthias Hochadel, Steffen Schneider, Jochen Sen Source Type: research

Comparison in Patients < 75 Years of Age - Versus – Those > 75 Years on One-year-Events With Atrial Fibrillation and Left Atrial Appendage Occluder (From the Prospective Multicenter German LAARGE Registry)
Left atrial appendage closure (LAAC) is an alternative to oral anticoagulation therapy in patients with non-valvular atrial fibrillation for the prevention of embolic stroke and systemic embolism. Although elderly patients (>75 years) have both higher ischemic and bleeding risk as compared with younger patients, they benefit from optimal anticoagulation. The subanalysis aimed to assess the indications, the safety, efficacy, and 1-year outcomes of interventional LAAC in elderly patients ( ≥ 75 years) compared with younger (
Source: The American Journal of Cardiology - September 13, 2020 Category: Cardiology Authors: Aref El Nasasra, Johannes Brachmann, Thorsten Lewalter, Ibrahim Akin, Horst Sievert, Christoph A. Nienaber, Christian Wei ß, Sven T. Pleger, Hüseyin Ince, Jens Maier, Stephan Achenbach, Holger H. Sigusch, Matthias Hochadel, Steffen Schneider, Jochen Sen 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

Effects of Atrial Fibrillation and Chronic Kidney Disease on Major Adverse Cardiovascular Events
Atrial fibrillation (AF) is strongly linked to chronic kidney disease (CKD) and both of these conditions contribute to poor cardiovascular outcomes. We evaluated the impact of renal failure on major adverse cardiovascular events (MACE) in AF, and predictive value of the 2MACE score in this post-hoc analysis of the AMADEUS trial. The primary endpoint was MACE (composite of myocardial infarction, cardiac revascularisation and cardiovascular mortality). Secondary endpoints included the composite of stroke, major bleeding and non-cardiovascular mortality, and each of the specific outcomes separately.
Source: The American Journal of Cardiology - July 10, 2020 Category: Cardiology Authors: Wern Yew Ding, Gregory Y.H. Lip, Daniele Pastori, Alena Shantsila 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

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