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Short-Term Risk of Bleeding During Heparin Bridging at Initiation of Vitamin K Antagonist Therapy in More Than 90 000 Patients With Nonvalvular Atrial Fibrillation Managed in Outpatient Care Epidemiology
BackgroundSeveral studies have recently examined the risks of bleeding and of ischemic stroke and systemic embolism associated with perioperative heparin bridging anticoagulation in patients with nonvalvular atrial fibrillation. However, few studies have investigated bridging risks during vitamin K antagonist initiation in outpatient settings.Methods and ResultsA retrospective cohort study was conducted on individuals starting oral anticoagulation between January 2010 and November 2014 for nonvalvular atrial fibrillation managed in outpatient care and identified from French healthcare insurance. Bleeding and ischemic strok...
Source: JAHA:Journal of the American Heart Association - October 30, 2016 Category: Cardiology Authors: Bouillon, K., Bertrand, M., Boudali, L., Ducimetiere, P., Dray-Spira, R., Zureik, M. Tags: Atrial Fibrillation, Epidemiology Original Research Source Type: research

Early Adoption of Dabigatran and Its Dosing in US Patients With Atrial Fibrillation: Results From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation Health Services and Outcomes Research
Conclusions Patients receiving dabigatran were younger and at a lower risk of stroke and bleeding. Patients appeared to drive switching from warfarin, whereas clinical characteristics influenced de novo start of dabigatran. These data suggest cautious early uptake of dabigatran, and more careful attention to dosing adjustments is warranted. Clinical Trial Registration URL: Clinicaltrials.gov. Unique identifier: NCT01165710.
Source: JAHA:Journal of the American Heart Association - November 25, 2013 Category: Cardiology Authors: Steinberg, B. A., Holmes, D. N., Piccini, J. P., Ansell, J., Chang, P., Fonarow, G. C., Gersh, B., Mahaffey, K. W., Kowey, P. R., Ezekowitz, M. D., Singer, D. E., Thomas, L., Peterson, E. D., Hylek, E. M., The Outcomes Registry for Better Informed Treatme Tags: Health Services and Outcomes Research Source Type: research

Concomitant Use of Single Antiplatelet Therapy With Edoxaban or Warfarin in Patients With Atrial Fibrillation: Analysis From the ENGAGE AF-TIMI48 Trial Arrhythmia and Electrophysiology
Conclusions Patients with AF who were selected by their physicians to receive SAPT in addition to an anticoagulant had a similar risk of stroke/SEE and higher rates of bleeding than those not receiving SAPT. Edoxaban exhibited similar relative efficacy and reduced bleeding compared to warfarin, with or without concomitant SAPT. Clinical Trial Registration URL: http://www.clinicaltrials.gov/. Unique identifier: NCT00781391.
Source: JAHA:Journal of the American Heart Association - February 23, 2016 Category: Cardiology Authors: Xu, H., Ruff, C. T., Giugliano, R. P., Murphy, S. A., Nordio, F., Patel, I., Shi, M., Mercuri, M., Antman, E. M., Braunwald, E. Tags: Platelets, Chronic Ischemic Heart Disease, Anticoagulants, Acute Coronary Syndromes Arrhythmia and Electrophysiology Source Type: research

Stability of High-Quality Warfarin Anticoagulation in a Community-Based Atrial Fibrillation Cohort: The Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study Epidemiology
Conclusions Nearly 60% of AF patients with high-quality TTR1 on warfarin maintained TTR ≥70% over the next 6 months. A minority deteriorated to very poor TTR. Patient features did not strongly predict TTR in the second 6-month period. Our analyses support watchful waiting for AF patients with initial high-quality warfarin anticoagulation before considering alternative anticoagulants.
Source: JAHA:Journal of the American Heart Association - July 21, 2016 Category: Cardiology Authors: Dallalzadeh, L. O., Go, A. S., Chang, Y., Borowsky, L. H., Fang, M. C., Singer, D. E. Tags: Atrial Fibrillation, Epidemiology, Primary Prevention, Anticoagulants Source Type: research

Early Clopidogrel Versus Prasugrel Use Among Contemporary STEMI and NSTEMI Patients in the US: Insights From the National Cardiovascular Data Registry Coronary Heart Disease
Conclusions With prasugrel as an antiplatelet treatment option, contemporary practice shows low uptake of prasugrel and delays in P2Y12 antagonist initiation among NSTEMI patients. We also note concerning evidence of inappropriate use of prasugrel, and inadequate targeting of this more potent therapy to maximize the benefit/risk ratio.
Source: JAHA:Journal of the American Heart Association - April 14, 2014 Category: Cardiology Authors: Sherwood, M. W., Wiviott, S. D., Peng, S. A., Roe, M. T., DeLemos, J., Peterson, E. D., Wang, T. Y. Tags: Coronary Heart Disease Source Type: research

Outcome Reporting in Cardiac Surgery Trials: Systematic Review and Critical Appraisal Cardiovascular Surgery
Conclusions Outcome reporting in the cardiac surgery literature is heterogeneous, and efforts should be made to standardize the outcomes reported and the definitions used to ascertain them. The development of standardizing outcome reporting is an essential step toward strengthening the process of evidence-based care in cardiac surgery.
Source: JAHA:Journal of the American Heart Association - August 17, 2015 Category: Cardiology Authors: Goldfarb, M., Drudi, L., Almohammadi, M., Langlois, Y., Noiseux, N., Perrault, L., Piazza, N., Afilalo, J. Tags: Cardiovascular Surgery Source Type: research

Dabigatran is Less Effective Than Warfarin at Attenuating Mechanical Heart Valve-Induced Thrombin Generation Valvular Heart Disease
Conclusions MHV induce thrombin generation via the intrinsic pathway and generate sufficient thrombin to overwhelm clinically relevant dabigatran concentrations. In contrast, warfarin is more effective than dabigatran at suppressing MHV-induced thrombin generation. These data explain why dabigatran failed in MHV patients and suggest that strategies targeting FXII or FXI may suppress the root cause of thrombosis in such patients.
Source: JAHA:Journal of the American Heart Association - August 24, 2015 Category: Cardiology Authors: Jaffer, I. H., Stafford, A. R., Fredenburgh, J. C., Whitlock, R. P., Chan, N. C., Weitz, J. I. Tags: Valvular Heart Disease Source Type: research

Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndromes and Chronic Obstructive Pulmonary Disease: An Analysis From the Platelet Inhibition and Patient Outcomes (PLATO) Trial Coronary Heart Disease
Conclusions In this post-hoc analysis, COPD patients experienced high rates of ischemic events. Ticagrelor versus clopidogrel reduced and substantially decreased the absolute risk of ischemic events (5.8%) in COPD patients, without increasing overall major bleeding events. The benefit-risk profile supports the use of ticagrelor in patients with ACS and concomitant COPD. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00391872.
Source: JAHA:Journal of the American Heart Association - October 9, 2015 Category: Cardiology Authors: Andell, P., James, S. K., Cannon, C. P., Cyr, D. D., Himmelmann, A., Husted, S., Keltai, M., Koul, S., Santoso, A., Steg, P. G., Storey, R. F., Wallentin, L., Erlinge, D., the PLATO Investigators Tags: Coronary Heart Disease Source Type: research

Incremental Value of the CRUSADE, ACUITY, and HAS-BLED Risk Scores for the Prediction of Hemorrhagic Events After Coronary Stent Implantation in Patients Undergoing Long or Short Duration of Dual Antiplatelet Therapy Coronary Heart Disease
Conclusions Our analysis suggests that the CRUSADE score predicts major bleeding similarly to ACUITY and better than HAS BLED in an all-comer population with percutaneous coronary intervention and potentially identifies patients at higher risk of hemorrhagic complications when treated with a long-term dual antiplatelet therapy regimen. Clinical Trial Registration URL: http://clinicaltrials.gov. Unique identifier: NCT00611286.
Source: JAHA:Journal of the American Heart Association - December 7, 2015 Category: Cardiology Authors: Costa, F., Tijssen, J. G., Ariotti, S., Giatti, S., Moscarella, E., Guastaroba, P., De Palma, R., Ando, G., Oreto, G., Zijlstra, F., Valgimigli, M. Tags: Coronary Heart Disease Source Type: research

Comparison of Approaches to Revascularization in Patients With Multivessel Coronary Artery Disease Presenting With ST-Segment Elevation Myocardial Infarction: Meta-analyses of Randomized Control Trials Interventional Cardiology
Conclusion Results suggest that CR and SR compared with CL reduce major adverse cardiovascular event and revascularization rates primarily by lowering repeated percutaneous coronary intervention rates. We did not observe any increase in the rate of adverse events while using a CR or SR strategy compared with a CL approach. Current guidelines discouraging CR need to be reevaluated, and clinical judgment should prevail in treating multivessel coronary artery disease patients with ST-segment elevation myocardial infarction as data from larger RCTs accumulate.
Source: JAHA:Journal of the American Heart Association - December 14, 2015 Category: Cardiology Authors: Bajaj, N. S., Kalra, R., Aggarwal, H., Ather, S., Gaba, S., Arora, G., McGiffin, D. C., Ahmed, M., Aslibekyan, S., Arora, P. Tags: Interventional Cardiology Source Type: research

Off-Hour Admission and Mortality Risk for 28 Specific Diseases: A Systematic Review and Meta-Analysis of 251 Cohorts Epidemiology
Conclusions Off-hour admission is associated with increased mortality risk, and the associations varied substantially for different diseases. Specialists, nurses, as well as hospital administrators and health policymakers can take these findings into consideration to improve the quality and continuity of medical services.
Source: JAHA:Journal of the American Heart Association - March 17, 2016 Category: Cardiology Authors: Zhou, Y., Li, W., Herath, C., Xia, J., Hu, B., Song, F., Cao, S., Lu, Z. Tags: Epidemiology, Risk Factors, Health Services, Meta Analysis, Mortality/Survival Source Type: research

Incidence and Predictors of Complications During Cryoballoon Pulmonary Vein Isolation for Atrial Fibrillation Arrhythmia and Electrophysiology
Conclusions In a large contemporary cohort, cryoballoon PVI is associated with low procedural risk, including lower rates of PNI than previously reported. Older age and 23-mm balloon use were associated with PNI. Our low rate of PNI may reflect more sensitive detection methods, including compound motor action potential monitoring and forced double-deflation.
Source: JAHA:Journal of the American Heart Association - July 20, 2016 Category: Cardiology Authors: Guhl, E. N., Siddoway, D., Adelstein, E., Bazaz, R., Mendenhall, G. S., Nemec, J., Saba, S., Schwartzman, D., Voigt, A., Wang, N. C., Jain, S. K. Tags: Arrhythmias, Catheter Ablation and Implantable Cardioverter-Defibrillator, Electrophysiology, Atrial Fibrillation Arrhythmia and Electrophysiology Source Type: research

Factors Associated With Initial Prasugrel Versus Clopidogrel Selection for Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention: Insights From the Treatment With ADP Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) Study Coronary Heart Disease
Conclusions In community practice, prasugrel use may be driven more by bleeding risk rather than ischemic benefit. This may result in underutilization of higher potency ADP receptor inhibitor among patients more likely to derive ischemic benefit.
Source: JAHA:Journal of the American Heart Association - September 22, 2016 Category: Cardiology Authors: Vora, A. N., Peterson, E. D., McCoy, L. A., Effron, M. B., Anstrom, K. J., Faries, D. E., Zettler, M. E., Fonarow, G. C., Baker, B. A., Stone, G. W., Wang, T. Y. Tags: Acute Coronary Syndromes, Coronary Artery Disease Coronary Heart Disease Source Type: research

Impact of Proton Pump Inhibitor Use on the Comparative Effectiveness and Safety of Prasugrel Versus Clopidogrel: Insights From the Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) Study Health Services and Outcomes Research
ConclusionsPPIs did not significantly affect the MACE and bleeding risk associated with prasugrel use, relative to clopidogrel.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT01088503.
Source: JAHA:Journal of the American Heart Association - September 27, 2016 Category: Cardiology Authors: Jackson, L. R., Peterson, E. D., McCoy, L. A., Ju, C., Zettler, M., Baker, B. A., Messenger, J. C., Faries, D. E., Effron, M. B., Cohen, D. J., Wang, T. Y. Tags: Quality and Outcomes Original Research Source Type: research

Factors Associated With Initial Prasugrel Versus Clopidogrel Selection for Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention: Insights From the Treatment With ADP Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) Study Coronary Heart Disease
We examined patients presenting with acute myocardial infarction treated with percutaneous coronary intervention at 233 US hospitals in the TRANSLATE‐ACS observational study from April 2010 to October 2012. We developed a multivariable logistic regression model to identify factors associated with prasugrel selection. Prasugrel use rates and associated 1‐year risk‐adjusted major adverse cardiovascular events and Global Utilization of Streptokinase and t‐PA for Occluded Coronary Arteries (GUSTO) moderate/severe bleeding outcomes were also examined in relation to predicted mortality and bleeding using the validated Ac...
Source: JAHA:Journal of the American Heart Association - September 22, 2016 Category: Cardiology Authors: Vora, A. N., Peterson, E. D., McCoy, L. A., Effron, M. B., Anstrom, K. J., Faries, D. E., Zettler, M. E., Fonarow, G. C., Baker, B. A., Stone, G. W., Wang, T. Y. Tags: Acute Coronary Syndromes, Coronary Artery Disease Original Research Source Type: research

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