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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 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

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

Bleeding Risk Scores in Atrial Fibrillation and Venous Thromboembolism
Patients receiving oral anticoagulant (OAC) therapy for stroke prevention in atrial fibrillation (AF) and prevention of venous thromboembolism (VTE) face an increased risk of bleeding with OAC treatment. Clinicians need to weigh-up the benefits of OAC treatment against the risk of bleeding. To help formalise bleeding risk assessment, various bleeding risk scores have been developed to help predict the risk of bleeding in AF and VTE patients receiving anticoagulant therapy. This review summarises the literature involving original studies deriving bleeding risk scores and validation studies of these scores for stroke prevent...
Source: The American Journal of Cardiology - July 14, 2017 Category: Cardiology Authors: Hanis Zulkifly, Gregory Yoke Hong Lip, Deirdre Anne Lane 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

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

Safety and Efficacy of Uninterrupted Apixaban Therapy Versus Warfarin During Atrial Fibrillation Ablation
Thromboembolic cerebrovascular accident remains a rare but potentially devastating complication of catheter based atrial fibrillation (AF) ablation. Uninterrupted oral anticoagulant (OAC) therapy with warfarin has become the standard of care when performing catheter based AF ablation. Compared with warfarin, apixaban, a factor Xa inhibitor, has been shown to reduce the risk of stroke and major bleeding in non-valvular AF. With an increase in apixaban use for stroke prophylaxis in AF patients there is an increased interest in the safety and efficacy of uninterrupted apixaban therapy during AF ablation.
Source: The American Journal of Cardiology - May 10, 2017 Category: Cardiology Authors: Ruchit R. Shah, Ajay Pillai, Pascha Schafer, David Meggo, Tom McElderry, Vance Plumb, Takumi Yamada, Vineet Kumar, Harish Doppalapudi, Alicia Gunter, Emily Pentecost, William R. Maddox Source Type: research

Relation of Risk of Stroke in Patients With Atrial Fibrillation to Body Mass Index (From Patients Treated With Rivaroxaban and Warfarin in the ROCKET AF Trial)
We investigated stroke outcomes in normal weight (body mass index [BMI] 18.50-24.99 kg/m2), overweight (BMI 25.00-29.99 kg/m2), and obese (BMI ≥30 kg/m2) patients with AF treated with rivaroxaban and warfarin. We compared the incidence of stroke and systemic embolic events (SEE) as well as bleeding events in normal weight (n=3289), overweight (n=5535), and obese (n=5206) patients in a post-hoc analysis of the ROCKET AF trial. Stroke and SEE rates per 100 patient-years were 2.93 in the normal weight group (reference group), 2.28 in the overweight group (adjusted hazard ratio [HR] 0.81, 95% confidence interval [CI]: 0.66-0...
Source: The American Journal of Cardiology - March 28, 2017 Category: Cardiology Authors: Somasekhara R. Balla, Derek D. Cyr, Yuliya Lokhyngina, Richard C. Becker, Scott D. Berkowitz, G ünter Breithardt, Keith A.A. Fox, Werner Hacke, Jonathan L. Halperin, Graeme J. Hankey, Kenneth W. Mahaffey, Christopher C. Nessel, Jonathan P. Piccini, Danie 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

Comparison of HAS-BLED and HAS-BED versus CHADS2 and CHA2DS2VASC Stroke and Bleeding Scores in Patients with Atrial Fibrillation
Anticoagulation is recommended in Atrial Fibrillation (AF) patients for stroke prevention, and the bleeding risk associated suggests the need for a bleeding risk stratification. HAS-BLED score includes ‘labile INR’ referred to quality of anticoagulation. However, in naïve patients this item is not available. In addition, stroke and bleeding risk prediction scores shared several risk factors. Aims of our study were: 1) to evaluate if the HAS-BLED score in its refined form excluding ‘labile I NR’ (HAS-BED) is still associated with bleeding risk; and 2) to evaluate the predictive ability for bleeding of both stroke a...
Source: The American Journal of Cardiology - January 24, 2017 Category: Cardiology Authors: Daniela Poli, Emilia Antonucci, Vittorio Pengo, Sophie Testa, Gualtiero Palareti 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

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 therapy have allowed patients with end-stage heart failure (HF) 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 left ventricular assist device 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 Tags: Heart Failure Source Type: research

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