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Source: Clinical Cardiology
Condition: Bleeding

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Total 38 results found since Jan 2013.

Advances in Stroke Prevention in Atrial Fibrillation: Enhanced Risk Stratification Combined With the Newer Oral Anticoagulants
Abstract Patients with atrial fibrillation (AF) have an increased stroke risk compared with those in sinus rhythm, although the absolute risk for individual patients is modulated by the presence of various additional risk factors. Patient selection for oral anticoagulation for stroke prevention is based on risks of stroke and bleeding. Although CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack) is the most widely used scheme for evaluating stroke risk in patients with AF, several other stroke risk factors are not included; therefore, many patients' strok...
Source: Clinical Cardiology - April 1, 2013 Category: Cardiology Authors: Freek W. A. Verheugt Tags: Review Source Type: research

Stroke and Bleeding Risk in Atrial Fibrillation: Navigating the Alphabet Soup of Risk‐Score Acronyms (CHADS2, CHA2DS2‐VASc, R2CHADS2, HAS‐BLED, ATRIA, and More)
ABSTRACT Stroke prevention is central to the management of patients with atrial fibrillation (AF). As effective stroke prophylaxis essentially requires oral anticoagulants, an understanding of the risks and benefits of oral anticoagulant therapy is needed. Although AF increases stroke risk 5‐fold, this risk is not homogeneous. Many stroke risk factors also confer an increased risk of bleeding. Various stroke and bleeding risk‐stratification schemes have been developed to help inform clinical decision‐making. These scores were derived and validated in different study cohorts, ranging from highly selected clinical‐tr...
Source: Clinical Cardiology - August 1, 2014 Category: Cardiology Authors: Mikhail S. Dzeshka, Deirdre A. Lane, Gregory Y. H. Lip Tags: Reviews Source Type: research

Cost‐Effectiveness of Dabigatran Compared With Warfarin for Stroke Prevention in Patients With Atrial Fibrillation—A Real Patient Data Analysis in a Hong Kong Teaching Hospital
ConclusionsThe study favored dabigatran for stroke prophylaxis in patients with nonvalvular AF in Hong Kong under the current hospital's perspective and provided a reference for further comparisons under patient and subsidization perspectives.
Source: Clinical Cardiology - March 14, 2013 Category: Cardiology Authors: Andy M. Chang, Jason C. S. Ho, Bryan P. Yan, Cheuk Man Yu, Yat Yin Lam, Vivian W. Y. Lee Tags: Clinical Investigation Source Type: research

Left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation
Atrial fibrillation (AF) is a commonly sustained atrial arrhythmia with associated morbidity and mortality. AF is associated with increased risk of thromboembolism and stroke, requiring use of anticoagulation. Anticoagulation decreases the risk of stroke but is associated with a higher risk of bleeding, necessitating discontinuation in some patients. The left atrial appendage is the likely source of thrombus in the majority of patients with AF. This has led to the development of left atrial appendage occlusion as a means to reduce stroke risk in patients who have a contraindication to long‐term anticoagulation. Multiple ...
Source: Clinical Cardiology - July 27, 2017 Category: Cardiology Authors: Rizma Jalees Bajwa, Lara Kovell, Jon R. Resar, Armin Arbab ‐Zadeh, Kaushik Mandal, Hugh Calkins, Ronald D. Berger Tags: REVIEW Source Type: research

Stroke prevention strategies in North American patients with atrial fibrillation: the GLORIA ‐AF registry program
ConclusionsIn GLORIA‐AF, 20% of the population comprising males with CHA2DS2‐VASc ≥1 and females with CHA2DS2‐VASc ≥2 did not receive oral anticoagulation therapy. Patient characteristics associated with a lower likelihood of OAC prescription were use of antiplatelet drugs, paroxysmal pattern of AF, a history of falls, and prior bleeding.
Source: Clinical Cardiology - February 1, 2018 Category: Cardiology Authors: William F. McIntyre, David Conen, Brian Olshansky, Jonathan L. Halperin, Emil Hayek, Menno V. Huisman, Gregory Y.H. Lip, Shihai Lu, Jeff S. Healey Tags: CLINICAL INVESTIGATIONS Source Type: research

Novel Oral Anticoagulants in Atrial Fibrillation: A Meta‐analysis of Large, Randomized, Controlled Trials vs Warfarin
Conclusions:Novel oral anticoagulants may be superior to warfarin in patients with atrial fibrillation, reducing the composite of stroke or systemic embolism and lowering all‐cause mortality. The benefit is largely due to fewer hemorrhagic strokes.Ernesto Paolasso, MD, is a national lead investigator for a clinical trial sponsored by Daiichi‐Sankyo investigating a novel oral anticoagulant. Robert Giugliano, MD, SM, is a member of the TIMI Study Group, which has received research grant support from Johnson & Johnson and from Daiichi‐Sankyo related to clinical trials of anticoagulants. Dr. Giugliano has received ho...
Source: Clinical Cardiology - January 1, 2013 Category: Cardiology Authors: Ariel Dogliotti, Ernesto Paolasso, Robert P. Giugliano Tags: Review Source Type: research

Efficacy and safety of rivaroxaban compared with warfarin in patients with carotid artery disease and nonvalvular atrial fibrillation: Insights from the ROCKET AF trial
ConclusionsPatients with CD in ROCKET AF had similar risk of stroke/SE compared with patients without CD. Additionally, there was no interaction between CD and the treatment effect of rivaroxaban or warfarin for stroke prevention or safety endpoints.
Source: Clinical Cardiology - December 1, 2017 Category: Cardiology Authors: Ajar Kochar, Anne S. Hellkamp, Yuliya Lokhnygina, W. Schuyler Jones, Richard C. Becker, Scott D. Berkowitz, G ünter Breithardt, Keith A.A. Fox, Jonathan L. Halperin, Graeme J. Hankey, Kenneth W. Mahaffey, Christopher C. Nessel, Daniel E. Singer, Jonathan Tags: CLINICAL INVESTIGATIONS Source Type: research

Postoperative Strokes and Intracranial Bleeds in Patients With Atrial Fibrillation: The FibStroke Study
ConclusionsPerioperative interruption of OAC is common in patients who suffer a postoperative stroke, even in patients with low‐bleeding‐risk procedures. Postoperative intracranial bleeding is frequently preceded by perioperative heparin bridging.
Source: Clinical Cardiology - April 30, 2016 Category: Cardiology Authors: Antti Palomäki, Tuomas Kiviniemi, Juha E.K. Hartikainen, Pirjo Mustonen, Antti Ylitalo, Ilpo Nuotio, Päivi Hartikainen, Jussi Jaakkola, Riho Luite, K.E. Juhani Airaksinen Tags: Clinical Investigations Source Type: research

Thromboembolic risk and effect of oral anticoagulation according to atrial fibrillation patterns: A systematic review and meta ‐analysis
The objectives of the meta‐analysis were to investigate different impact on outcomes of pxAF and non‐pxAF, with and without OAC. Two reviewers searched for prospective studies on risk of stroke and systemic embolism (SE) in pxAF and non‐pxAF, with and without OAC. Quality of evidence was assessed according to GRADE approach. Stroke combined with SE was the main outcome. Meta‐regression was performed to evaluate OAC effect on stroke and SE incidence rate. We identified 18 studies. For a total of 239 528 patient‐years of follow‐up. The incidence rate of stroke/SE was 1.6% (95% confidence interval [CI]: 1.3%‐2...
Source: Clinical Cardiology - April 1, 2017 Category: Cardiology Authors: Alessio Lilli, Andrea Di Cori, Valerio Zac à Tags: REVIEWS Source Type: research

Patterns of Long‐term Thienopyridine Therapy and Outcomes in Patients With Acute Coronary Syndrome Treated With Coronary Stenting: Observations From the TIMI‐38 Coronary Stent Registry
ConclusionsPatients stabilized for a year after ACS and stenting have low rates of ST relative to overall cardiovascular events. The decision to continue DAPT maybe associated with stent type (DES vs bare‐metal stent) and region.
Source: Clinical Cardiology - February 1, 2014 Category: Cardiology Authors: Marc P. Bonaca, Sabina A. Murphy, Debra Miller, Jean‐Paul R. Herrman, Shmuel Gottlieb, Matyas Keltai, Alberto Menozzi, José C. Nicolau, Petr Widimsky, Elliott M. Antman, Stephen D. Wiviott Tags: Clinical Investigation Source Type: research

Quality of Anticoagulation With Vitamin K Antagonists
ConclusionsPatients who receive VKA to prevent stroke for AF spend less than half the time within therapeutic range.
Source: Clinical Cardiology - May 11, 2015 Category: Cardiology Authors: Vicente Bertomeu‐González, Manuel Anguita, José Moreno‐Arribas, Ángel Cequier, Javier Muñiz, Jesús Castillo‐Castillo, Juan Sanchis, Inmaculada Roldán, Francisco Marin, Vicente Bertomeu‐Martínez, Tags: Clinical Investigations Source Type: research

Design and Rationale of the RE ‐DUAL PCI Trial: A Prospective, Randomized, Phase 3b Study Comparing the Safety and Efficacy of Dual Antithrombotic Therapy With Dabigatran Etexilate Versus Warfarin Triple Therapy in Patients With Nonvalvular Atrial Fibrillation Who Have Undergone Percutaneous Coronary Intervention With Stenting
Antithrombotic management of patients with atrial fibrillation (AF) undergoing coronary stenting is complicated by the need for anticoagulant therapy for stroke prevention and dual antiplatelet therapy for prevention of stent thrombosis and coronary events. Triple antithrombotic therapy, typically comprising warfarin, aspirin, and clopidogrel, is associated with a high risk of bleeding. A modest‐sized trial of oral anticoagulation with warfarin and clopidogrel without aspirin showed improvements in both bleeding and thrombotic events compared with triple therapy, but large trials are lacking. The RE‐DUAL PCI trial (NCT...
Source: Clinical Cardiology - July 31, 2016 Category: Cardiology Authors: Christopher P. Cannon, Savion Gropper, Deepak L. Bhatt, Stephen G. Ellis, Takeshi Kimura, Gregory Y.H. Lip, Ph. Gabriel Steg, Jurri ën M. Berg, Jenny Manassie, Jörg Kreuzer, Jon Blatchford, Joseph M. Massaro, Martina Brueckmann, Ernesto Ferreiros Ripoll Tags: Trial Designs Source Type: research

Cost ‐effectiveness analysis of 30‐month vs 12‐month dual antiplatelet therapy with clopidogrel and aspirin after drug‐eluting stents in patients with acute coronary syndrome
Continuation of dual antiplatelet therapy (DAPT) beyond 1 year reduces late stent thrombosis and ischemic events after drug‐eluting stents (DES) but increases risk of bleeding. We hypothesized that extending DAPT from 12 months to 30 months in patients with acute coronary syndrome (ACS) after DES is cost‐effective. A lifelong decision‐analytic model was designed to simulate 2 antiplatelet strategies in event‐free ACS patients who had completed 12‐month DAPT after DES: aspirin monotherapy (75–162 mg daily) and continuation of DAPT (clopidogrel 75 mg daily plus aspirin 75–162 mg daily) for 18 months. Clinical e...
Source: Clinical Cardiology - June 1, 2017 Category: Cardiology Authors: Minghuan Jiang, Joyce H.S. You Tags: QUALITY AND OUTCOMES Source Type: research

New Antithrombotics for Secondary Prevention of Acute Coronary Syndrome
This study was terminated early in patients with prior stroke owing to excess ICH, though an increased risk of ICH or fatal bleeding was not detected in patients with prior myocardial infarction. The Apixaban for Prevention of Acute Ischemic and Safety Events 2 (APPRAISE‐2) trial of standard‐dose apixaban added to standard care in patients with ACS was also stopped early owing to excess serious bleeding. However, in Rivaroxaban in Combination With Aspirin Alone or With Aspirin and a Thienopyridine in Patients With Acute Coronary Syndromes (ATLAS ACS 2 TIMI 51), fatal bleeding or fatal ICH did not increase with low‐do...
Source: Clinical Cardiology - January 22, 2014 Category: Cardiology Authors: Shinya Goto, Aiko Tomita Tags: Review Source Type: research

Antithrombotic Regimens for Patients Taking Oral Anticoagulation After Coronary Intervention: A Meta‐analysis of 16 Clinical Trials and 9185 Patients
This study sought to compare efficacy and safety outcomes of triple therapy (OAC, aspirin, and clopidogrel) vs dual therapy (clopidogrel with aspirin or OAC) in these patients. We hypothesize OAC plus clopidogrel could be the optimal regimen for patients with indications for OAC receiving stent implantation. Medline, the Cochrane Library, and other Internet sources were searched for clinical trials comparing the efficacy and safety of triple vs dual therapy for patients taking OAC after coronary stenting. Sixteen eligible trials including 9185 patients were identified. The risks of major adverse cardiac events (odds ratio ...
Source: Clinical Cardiology - May 12, 2015 Category: Cardiology Authors: Xiao‐Fei Gao, Yan Chen, Zhong‐Guo Fan, Xiao‐Min Jiang, Zhi‐Mei Wang, Bing Li, Wen‐Xing Mao, Jun‐Jie Zhang, Shao‐Liang Chen Tags: Reviews Source Type: research