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How Well Do Stroke Risk Scores Predict Hemorrhage in Patients With Atrial Fibrillation?
The decision to use anticoagulants for atrial fibrillation depends on comparing a patient's estimated risk of stroke to their bleeding risk. Several of the risk factors in the stroke risk schemes overlap with hemorrhage risk. We compared how well 2 stroke risk scores (CHADS2 and CHA2DS2-VASc) and 2 hemorrhage risk scores (the ATRIA bleeding score and the HAS-BLED score) predicted major hemorrhage on and off warfarin in a cohort of 13,559 community-dwelling adults with AF. Over a cumulative 64,741 person-years of follow-up, we identified a total of 777 incident major hemorrhage events.
Source: The American Journal of Cardiology - June 13, 2016 Category: Cardiology Authors: Gene R. Quinn, Daniel E. Singer, Yuchiao Chang, Alan S. Go, Leila H. Borowsky, Margaret C. Fang Tags: Arrhythmias and Conduction Source Type: research

How Well do Stroke Risk Scores Predict Hemorrhage in Patients with Atrial Fibrillation?
The decision to use anticoagulants for atrial fibrillation depends on comparing a patient’s estimated risk of stroke to their bleeding risk. Several of the risk factors in the stroke risk schemes such as overlap with hemorrhage risk. We compared how well two stroke risk scores (CHADS2 and CHA2DS2-VASc) and two hemorrhage risk scores (the ATRIA bleeding score and the HAS-BLED score) predicted major hemorrhage on and off warfarin in a cohort of 13,559 community-dwelling adults with AF. Over a cumulative 64,741 person-years of follow up, we identified a total of 777 incident major hemorrhage events.
Source: The American Journal of Cardiology - June 13, 2016 Category: Cardiology Authors: Gene R. Quinn, Daniel E. Singer, Yuchiao Chang, Alan S. Go, Leila H. Borowsky, Margaret C. Fang 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

Meta-Analysis of Anticoagulation Use, Stroke, Thromboembolism, Bleeding and Mortality in Patients with Atrial Fibrillation on Dialysis
Atrial fibrillation (AF) is common in patients on dialysis. While randomized trials of anticoagulation for AF have demonstrated striking reductions in stroke, these trials did not recruit dialysis patients. We thus undertook this systematic review and meta-analysis of observational studies. Electronic databases were searched for studies including AF patients on dialysis that reported observational associations of anticoagulation use. Twenty-one studies involving 530,031 individuals and 31,611 AF patients on dialysis were identified.
Source: The American Journal of Cardiology - April 12, 2016 Category: Cardiology Authors: Christopher X. Wong, Ayodele Odutayo, Connor A. Emdin, Ned J. Kinnear, Michelle T. Sun Source Type: research

Meta-Analysis of Anticoagulation Use, Stroke, Thromboembolism, Bleeding, and Mortality in Patients With Atrial Fibrillation on Dialysis
Atrial fibrillation (AF) is common in patients on dialysis. Although randomized trials of anticoagulation for AF have demonstrated striking reductions in stroke, these trials did not recruit patients on dialysis. We thus undertook this systematic review and meta-analysis of observational studies including patients with AF on dialysis that reported associations of anticoagulation use. Twenty studies involving 529,741 subjects and 31,321 patients with AF on dialysis were identified. Anticoagulation was associated with a 45% (95% CI 13% to 88%) increased risk of any stroke, reflecting a nonsignificant 13% (95% CI −4% to 34...
Source: The American Journal of Cardiology - April 12, 2016 Category: Cardiology Authors: Christopher X. Wong, Ayodele Odutayo, Connor A. Emdin, Ned J. Kinnear, Michelle T. Sun Tags: Arrhythmias and Conduction Disturbances Source Type: research

Drug-coated balloon for in-stent restenosis in high risk patients: Another brick in the wall of the challenging settings for interventionists
Recently Miglionico et al. published in this Journal an interesting prospective observational study regarding 82 high-risk patients with in-stent restenosis of bare metal stent (BMS), n=48 (59%) or drug-eluting stent (DES), n=34 (41%) .1 All patients had at least one of the following high-risk features: history of hemorrhagic stroke or gastrointestinal bleeding, ischemic stroke not longer of 3 months before, need for oral anticoagulation or non-cardiac surgery or recent surgery, chronic inflammatory disease or neoplasm.
Source: The American Journal of Cardiology - March 21, 2016 Category: Cardiology Authors: Dario Buccheri, Davide Piraino, Giuseppe Andolina, Bernardo Cortese Source Type: research

Drug-Coated Balloon for Instent Restenosis in Patients at High Risk: Another Brick in the Wall of the Challenging Settings for Interventionists
Recently, Miglionico et al1 published in this journal an interesting prospective observational study regarding 82 patients at high-risk with instent restenosis of bare-metal stent, n = 48 (59%) or drug-eluting stent (DES), n = 34 (41%). All patients had at least one of the following high-risk features: a history of hemorrhagic stroke or gastrointestinal bleeding, ischemic stroke not longer of 3 months before, need for oral anticoagulation or noncardiac surgery or recent surgery, chronic inflammatory disease, or neoplasm.
Source: The American Journal of Cardiology - March 20, 2016 Category: Cardiology Authors: Dario Bucchei, Davide Piraino, Giuseppe Andolina, Bernardo Cortese Tags: Readers' Comments 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

Effects of Oral Anticoagulant Therapy in Medical Inpatients ≥65 Years With Atrial Fibrillation
In this retrospective cohort observational study, we investigated mortality, ischemic, and hemorrhagic events in patients ≥65 years with atrial fibrillation consecutively discharged from an Acute Geriatric Ward in the period 2010 to 2013. Stroke and bleeding risk were evaluated using CHA2DS2-VASC (congestive heart failure/left ventricular dysfunction, hypertension, aged ≥75 years, diabetes mellitus, stroke/transient ischemic attack/systemic embolism, vascular disease, aged 65 to 74 years, gender category) and HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile in...
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 Tags: Arrhythmias and Conduction Disturbances Source Type: research

The Quandary of Oral Anticoagulation in Patients with Atrial Fibrillation and Chronic Kidney Disease
Compared to patients with normal renal function, the prevalence of atrial fibrillation (AF) in chronic kidney disease (CKD) is increased, as is consequently the stroke prevalence in these patients. This increased risk of stroke in CKD patients is caused not only by the increased prevalence of AF, but also by associated comorbidities, and inherent platelet and vascular dysfunction. Paradoxically, imbalance in the same factors also increases the bleeding risk, imposing a dilemma as to whether anticoagulation should be prescribed or deferred, particularly in patients with end stage renal disease (ESRD), in whom the bleeding d...
Source: The American Journal of Cardiology - November 18, 2015 Category: Cardiology Authors: Shmuel Schwartzenberg, Eli I. Lev, Alik Sagie, Asher Korzets, Ran Kornowski 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

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

Stroke Risk Factors Beyond the CHADS-VASc Score: Can We Improve Our Identification of “High Stroke Risk” Patients With Atrial Fibrillation?
The prevention of stroke and other thromboembolic events plays a crucial role in the management of patients with atrial fibrillation. Not all patients with atrial fibrillation are equal in terms of thromboembolic risk; therefore, not all will benefit from oral anticoagulation treatment. The general principle is that the expected benefit of anticoagulation in reduction of thromboembolic risk must exceed the expected harm caused by possible bleeding. Some guidelines have focused on a categorical approach to stroke prevention, with a focus on identifying patients at high risk for oral anticoagulation.
Source: The American Journal of Cardiology - September 11, 2015 Category: Cardiology Authors: Filip M. Szymanski, Gregory Y.H. Lip, Krzysztof J. Filipiak, Anna E. Platek, Anna Hrynkiewicz-Szymanska, Grzegorz Opolski Tags: Review Source Type: research

Stroke Risk Factors Beyond the CHADS-VASc Score: Can We Improve our Identification of ‘High Stroke Risk’ Patients with Atrial Fibrillation?
The prevention of stroke and other thromboembolic events plays a crucial role in the management of atrial fibrillation (AF) patients. Not all AF patients are equal in terms of thromboembolic risk, therefore not all will benefit from oral anticoagulation treatment. The general principle is that the expected benefit of anticoagulation in reduction of thromboembolic risk must exceed the expected harm caused by possible bleeding. Some guidelines have focused on a categorical approach to stroke prevention, with a focus on identifying high risk patients for oral anticoagulation (OAC).
Source: The American Journal of Cardiology - September 11, 2015 Category: Cardiology Authors: Filip M. Szymanski, Gregory Y.H. Lip, Krzysztof J. Filipiak, Anna E. Platek, Anna Hrynkiewicz-Szymanska, Grzegorz Opolski Source Type: research

Comparison of Characteristics and Outcomes of Dabigatran versus Warfarin in Hypertensive Patients with Atrial Fibrillation (From the RE-LY® Trial)
Hypertension is frequent among patients with atrial fibrillation (AF) and is an independent risk factor for stroke. The Randomized Evaluation of Long Term Anticoagulant TherapY (RE-LY) trial found dabigatran 110 mg bid (D 110) and 150 mg bid (D 150) non-inferior or superior to warfarin for stroke reduction in patients with AF, with either a reduction (D 110) or similar rates (D150) of major bleeding. Baseline characteristics and outcomes were compared in patients with and without hypertension. The quality of blood pressure control was also assessed.
Source: The American Journal of Cardiology - July 28, 2015 Category: Cardiology Authors: Rangadham Nagarakanti, Lars Wallentin, Herbert Noack, Martina Brueckmann, Paul Reilly, Andreas Clemens, Stuart J. Connolly, Salim Yusuf, Michael D. Ezekowitz Source Type: research

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