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Uninterrupted NOAC therapy in patients undergoing catheter ablation of atrial fibrillation: “Dual anticoagulant therapy” ready for primetime or systematic overtreatment?
Catheter ablation of atrial fibrillation (AF) appears as a very promising technique to reduce arrhythmia episodes in patients with AF [1]. The major adverse events of such procedures are bleeding complications and stroke. Therefore, several studies were performed to assess efficacy and safety of different oral anticoagulants like warfarin (VKA) and non-VKA oral anticoagulants (NOAC). NOAC therapy has been explored in patients with chronic AF and in patients undergoing antiarrhythmic procedures [2, 3].
Source: International Journal of Cardiology - June 13, 2018 Category: Cardiology Authors: Andreas Goette Tags: Editorial Source Type: research

Percutaneous left atrial appendage closure versus oral anticoagulant: A bird in the hand is worth two in the bush?
Since the technology of percutaneous left atrial closure (LAAC) was developed to prevent thromboembolic events in non-valvular atrial fibrillation (AF) patients, debate continues over its risks and benefits. Some support LAAC as it significantly reduces bleeding and all-cause mortality and is non-inferior, if not superior, to warfarin in terms of stroke prevention [1,2]; however, others question the data retrieved from the LAAC-related trials and argue the efficacy and safety of LAAC devices. The more the device is used, the stronger the voice from both camps.
Source: International Journal of Cardiology - November 30, 2017 Category: Cardiology Authors: Rong Bai Tags: Editorial Source Type: research

Left atrial appendage closure in a patient with left atrial appendage thrombus using a novel fish ball technique
We report on a 47-year-old (body-mass-index 24, 8), male patient who was scheduled for percutaneous left atrial appendage (LAA) closure at our hospital. In this patient permanent atrial fibrillation was known since 2010 with a CHA2DS2-Vasc-score of 3, because of arterial hypertension, diabetes mellitus type II and coronary heart disease). The Hasbled-score was 4, because of arterial hypertension, bleeding and stroke in his history and labile INR values under anticoagulation with warfarin therapy.
Source: International Journal of Cardiology - December 26, 2016 Category: Cardiology Authors: Barbara Bellmann, Andreas Rillig, David Leistner, Mario Kasner, Carsten Skurk, Ulf Landmesser, Jai-Wun Park Source Type: research

Efficacy and safety of novel anticoagulants versus vitamin K antagonists in patients with mild and moderate to severe renal insufficiency: Focus on apixaban
The high risk of both stroke and major bleeding in atrial fibrillation (AF) patients with chronic kidney disease (CKD) defines an important population for whom the assessment of the balance between the risk of ischemic stroke and of bleeding is essential. The use of novel oral anticoagulants (NOACs) may be a viable option in this population due to their greater net clinical benefit than warfarin, as demonstrated by the results of the clinical phase III trials. NOACs have been found to have a greater net clinical benefit than warfarin in patients at high risk of either stroke (CHADS2 ≥1 or CHA2DS2-VASc score≥2) or bleeding (HAS-BLED≥3).
Source: International Journal of Cardiology - September 30, 2016 Category: Cardiology Authors: Francesco Pelliccia, Salvatore Rosanio, Giuseppe Marazzi, Sara Poggi, Alessandra Tanzilli, Cesare Greco, Carlo Gaudio, Giuseppe Rosano Tags: Review Source Type: research

The C of CHADS: Historical Perspective and Clinical Applications for Anticoagulation in patients with Non Valvular Atrial Fibrillation and Congestive Heart Failure
The risk stratification of patients with coexisting non valvular atrial fibrillation and congestive heart failure, is often a clinical challenge, as the definitions of congestive heart failure in the popular CHADS2 and CHA2DS2VASc scoring systems, and amongst major clinical trials on Warfarin and Novel Oral Anticoagulants (NOAC) have heterogeneity. Available evidence reveals that any heart failure and/or left ventricular systolic dysfunction is associated with higher rates of stroke/systemic embolism and bleeding in patients with non valvular atrial fibrillation compared to patients without heart failure and normal left ventricular function.
Source: International Journal of Cardiology - September 16, 2016 Category: Cardiology Authors: Y Chugh, RT Faillace Tags: Editorial Source Type: research

Corrigendum to “Dabigatran in clinical practice: Contemporary overview of the evidence” Int. J. Cardiol. 220 (2016) 417–428
The authors regret errors in the presentation of data in Figs. 2, 3 and 4 for the stroke or systemic embolism and major bleeding outcomes for dabigatran vs warfarin in subgroups with age ≥75years and
Source: International Journal of Cardiology - September 6, 2016 Category: Cardiology Authors: Walter Ageno, John Eikelboom, Gregory Y.H. Lip Tags: Corrigendum Source Type: research

Fatal stroke following treatment with apixaban in a patient with atrial fibrillation and left atrial appendage thrombus
Atrial fibrillation increases the risk of ischemic stroke 4–5 fold [1] and doubles the mortality independently of other vascular risk factors [2]. The vast majority (>90%) of thrombi associated with atrial fibrillation originate from the left atrial appendage [3]. The direct factor Xa inhibitor apixaban is superior to warfarin in terms of stroke prevention with a lower risk of bleeding and mortality [4].
Source: International Journal of Cardiology - March 23, 2016 Category: Cardiology Authors: Ashkan Eftekhari, Dorte Damgaard, Erik L. Grove Tags: Correspondence Source Type: research

Comparative effectiveness and safety of non-vitamin K Antagonist oral anticoagulants versus warfarin in patients with atrial fibrillation and valvular heart disease
Non-vitamin K antagonist oral anticoagulants (NOACs) are approved for prevention of stroke in patients with nonvalvular atrial fibrillation (NVAF). These agents are as effective as warfarin and are associated with less intracranial bleeding and may be preferable for many patients with NVAF [1]. However, the term non-valvular AF remains a source of confusion because clinical trials and guidelines have adopted variable definitions.
Source: International Journal of Cardiology - February 2, 2016 Category: Cardiology Authors: Peter A. Noseworthy, Xiaoxi Yao, Nilay D. Shah, Bernard J. Gersh Source Type: research

‘Real-world’ haemorrhagic rates for warfarin and dabigatran using population-level data in New Zealand
Anticoagulants such as warfarin and dabigatran can significantly reduce the risk of stroke in individuals with atrial fibrillation that may lead to increased risk of bleeding, especially in older people. Evidence for bleeding risks with anticoagulants within the context of doses, multimorbidity and impaired renal function in real world setting is lacking.
Source: International Journal of Cardiology - November 9, 2015 Category: Cardiology Authors: Prasad S. Nishtala, Danijela Gnjidic, Hamish Jamieson, H. Carl Hanger, Chanaka Kaluarachchi, Sarah N. Hilmer Source Type: research

Time to use mobile health devices to diagnose paroxysmal atrial fibrillation
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice. It is a global healthcare problem with evidence suggesting an increasing prevalence and incidence worldwide. All AF patients whose risk of embolization exceeds the risk of bleeding are candidates for long-term oral anticoagulation (OAC) therapy. In recently published manuscript Konstantinos et al. reported significant underuse of OAC in AF patients presented with stroke; only 37% of high risk AF patients were taking warfarin at the time of stroke.
Source: International Journal of Cardiology - October 21, 2015 Category: Cardiology Authors: Hilal Olgun Kucuk, Ugur Kucuk, Murat Yalcin, Zafer Isilak Tags: Correspondence Source Type: research

Meta-analysis of Major bleeding with uninterrupted warfarin compared to interrupted warfarin and heparin bridging in ablation of atrial fibrillation
The role of catheter ablation procedures of Atrial fibrillation are increasing in importance and recent AHA/ACC guidelines give a class I recommendation for ablation in symptomatic paroxysmal atrial fibrillation who are intolerant or refractory to at least one antiarrhythmic medication [1]. Anticoagulation strategies peri-ablation are of extreme importance as it relates to both thrombo-embolic and bleeding complications. A strategy of stopping warfarin and bridging with heparin was widely adopted however a strategy of performing ablation on continued therapeutic warfarin is gaining traction as it was shown in a recent meta...
Source: International Journal of Cardiology - March 27, 2015 Category: Cardiology Authors: Ramez Nairooz, Partha Sardar, Jason Payne, Wilbert S. Aronow, Hakan Paydak Tags: Letter to the Editor Source Type: research

Meta-analysis of Risk of Stroke and Thrombo-Embolism with Rivaroxaban versus Vitamin K antagonists in ablation and cardioversion of atrial fibrillation
: Anticoagulation in cardioversion and ablation of atrial fibrillation is imperative for reducing thrombo-embolic events. Ample information is available about use of warfarin and vitamin K antagonists (VKA) but few trials examine safety and efficacy of rivaroxaban in these procedures. We aim to explore the hypothesis that rivaroxaban causes equal thrombo-embolic and bleeding events when used in atrial fibrillation patients undergoing ablation or cardioversion compared to VKA.
Source: International Journal of Cardiology - March 25, 2015 Category: Cardiology Authors: Ramez Nairooz, Partha Sardar, Maria Pino, Wilbert S. Aronow, Asif Sewani, Debabrata Mukherjee, Hakan Paydak, Waddah Maskoun Source Type: research

Antithrombotic therapy for atrial fibrillation in patients with acute ischemic stroke or transient ischemic attack
Although warfarin is more effective than are antiplatelet drugs for preventing stroke in patients with atrial fibrillation (AF), it is usually underutilized after stroke for various reasons. A global AF registry study indicated that warfarin was prescribed even less frequently for stroke prevention in Asia than in the West [1]. The major problem of using warfarin in Asian populations is the increased risk of intracranial bleeding. The purpose of this study was to evaluate the use of antithrombotic therapy at discharge in a consecutive cohort of patients with acute ischemic stroke or transient ischemic attack (TIA) and AF.
Source: International Journal of Cardiology - November 13, 2014 Category: Cardiology Authors: Poh-Shiow Yeh, Chun-Ming Yang, Sheng-Hsiang Lin, Wei-Ming Wang, Po-Sheng Chen, Huey-Juan Lin, Kao-Chang Lin, Chia-Yu Chang, Tain-Junn Cheng, Yi-Heng Li Tags: Letter to the editor Source Type: research

Dual antiplatelet therapy versus warfarin anticoagulation in patients undergoing catheter ablation of atrial fibrillation
Radio frequency catheter ablation (RFCA) has become a standard treatment for patients with atrial fibrillation (AF) . Anticoagulation in patients undergoing AF ablation is crucial to minimize the risk of thromboembolic complications. Although warfarin is effective in reducing stroke, its chronic use has many disadvantages including frequent international normalized ratio (INR)/prothrombin, attention to numerous dietary and medication interactions, and risk of serious bleeding including intracranial hemorrhage . Novel oral anticoagulants provide a reasonable alternative; however, they cannot yet be reversed, are expensive, ...
Source: International Journal of Cardiology - March 28, 2014 Category: Cardiology Authors: Zhiyu Ling, Fengpeng Jia, Yanping Xu, Li Su, Zengzhang Liu, Huaan Du, Xiaoyu Yang, Xianbin Lan, Peilin Xiao, Weijie Chen, Jinqi Fan, Suxin Luo, Yuehui Yin, Saman Nazarian Tags: Letters to the Editor Source Type: research

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