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Specialty: Cardiology
Condition: Bleeding

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Total 3637 results found since Jan 2013.

Improving Anticoagulation Measurement: Novel Warfarin Composite Measure Original Articles
Conclusions— WCM produces the largest range of risk for warfarin complications, widening the floor ceiling effects that limit the use of TTR and INR variability as separate measures. Anticoagulation clinics ranking changed considerably according to the anticoagulation measure that was selected.
Source: Circulation: Cardiovascular Quality and Outcomes - November 17, 2015 Category: Cardiology Authors: Razouki, Z., Burgess, J. F., Ozonoff, A., Zhao, S., Berlowitz, D., Rose, A. J. Tags: Anticoagulants, Ethics and Policy, Cerebrovascular Disease/Stroke, Thrombosis Original Articles Source Type: research

The Indian consensus guidance on stroke prevention in atrial fibrillation: An emphasis on practical use of nonvitamin K oral anticoagulants.
Abstract The last ten years have seen rapid strides in the evolution of nonvitamin K oral anticoagulants (NOACs) for stroke prevention in patients with atrial fibrillation (AF). For the preparation of this consensus, a comprehensive literature search was performed and data on available trials, subpopulation analyses, and case reports were analyzed. This Indian consensus document intends to provide guidance on selecting the right NOAC for the right patients by formulating expert opinions based on the available trials and Asian/Indian subpopulation analyses of these trials. A section has been dedicated to the curren...
Source: Indian Heart J - December 1, 2015 Category: Cardiology Authors: Dalal J, Bhave A, Oomman A, Vora A, Saxena A, Kahali D, Poncha F, Gambhir DS, Chaudhuri JR, Sinha N, Ray S, Iyengar SS, Banerjee S, Kaul U, SPAF Academy India experts Tags: Indian Heart J Source Type: research

Cost-Effectiveness of Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation Patients with Contraindications to Anticoagulation
Conclusions LAAC is a novel stroke preventative therapy for non-valvular AF and is a cost-effective alternative to aspirin in patients with contraindications to OAC. Teaser We sought to evaluate the cost-effectiveness of left atrial appendage closure (LAAC) compared to aspirin in atrial fibrillation patients with contraindications to oral anticoagulation (OAC). A probabilistic patient-level Markov microsimulation model with lifetime horizon was performed. Aspirin was less effective than LAAC, with average discounted lifetime cost of $38,974±18,783 for aspirin and $30,748±11,600 for LAAC. LAAC was dominant, being more eff...
Source: Canadian Journal of Cardiology - February 25, 2016 Category: Cardiology Source Type: research

Dabigatran Versus Warfarin for Atrial Fibrillation in Real-World Clinical Practice: A Systematic Review and Meta-Analysis Original Articles
Conclusions— In real-world clinical practice, dabigatran is comparable with warfarin in preventing ischemic stroke among patients with nonvalvular atrial fibrillation. However, dabigatran is associated with a lower risk for intracranial bleeding relative to warfarin, but—particularly among the elderly—a greater risk for gastrointestinal bleeding. Bleeding outcomes from observational studies are consistent with those from the pivotal Randomized Evaluation of Long-Term Anticoagulation Therapy trial.
Source: Circulation: Cardiovascular Quality and Outcomes - March 15, 2016 Category: Cardiology Authors: Romanelli, R. J., Nolting, L., Dolginsky, M., Kym, E., Orrico, K. B. Tags: Meta Analysis, Ischemic Stroke Original Articles 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

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

Combined administration of the GPVI-Fc fusion protein Revacept with low-dose thrombolysis in the treatment of stroke.
CONCLUSIONS: In contrast to using the equally effective full dose of rtPA, intracranial bleeding was not increased by low-dose rtPA combined with Revacept. Therefore, addition of Revacept to low-dose rtPA does not incur safety risks, but improves efficacy of treatment. PMID: 27924212 [PubMed - in process]
Source: Heart International - December 9, 2016 Category: Cardiology Tags: Heart Int Source Type: research

To occlude or not? Left atrial appendage occlusion for stroke prevention in atrial fibrillation
The cornerstone of atrial fibrillation (AF) management is effective stroke prevention, which by now remains the only proven method of improved survival in patients with AF. Oral anticoagulation with the use of vitamin K antagonists (eg, warfarin) or non-vitamin K antagonist oral anticoagulants (NOACs) has been shown to substantially reduce the risk of AF-related strokes and thus is presently the standard of care for stroke prevention in non-valvular AF. Approximately 90% of thrombi being formed in AF are localised in left atrial appendage (LAA).1 Thus, LAA exclusion seems a tempting method of prophylaxis against stroke, pa...
Source: Heart - January 4, 2017 Category: Cardiology Authors: Mazurek, M., Lip, G. Y. H. Tags: Drugs: cardiovascular system, Epidemiology Editorials 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

Oral anticoagulation for stroke prevention amongst atrial fibrillation patients with valvular heart disease: an update
This article will review current knowledge, areas of uncertainty and controversy, and ongoing research on oral anticoagulation for stroke prevention amongst patients with valvular heart disease. Recent findings: The rates of stroke, systemic embolism, and major bleeding were similar for patients with and without significant native valvular disease when treated with direct oral anticoagulants (DOACs) or vitamin K antagonists. There are very limited prospective data on the safety and efficacy of DOAC use for patients with bioprosthetic valves or rheumatic mitral stenosis. Summary: Atrial fibrillation patients with concomit...
Source: Current Opinion in Cardiology - February 10, 2017 Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma 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

Sex-Specific Comparative Effectiveness of Oral Anticoagulants in Elderly Patients With Newly Diagnosed Atrial Fibrillation Original Articles
Conclusions— The reduced risk of ischemic stroke in patients taking rivaroxaban, compared with dabigatran and warfarin, seems to be limited to men, whereas the higher risk of bleeding seems to be limited to women.
Source: Circulation: Cardiovascular Quality and Outcomes - April 13, 2017 Category: Cardiology Authors: Palamaner Subash Shantha, G., Bhave, P. D., Girotra, S., Hodgson-Zingman, D., Mazur, A., Giudici, M., Chrischilles, E., Vaughan Sarrazin, M. S. Tags: Anticoagulants, Cerebrovascular Disease/Stroke Original Articles Source Type: research

Dealing With the Left Atrial Appendage for Stroke Prevention: Devices and Decision-Making
Left atrial appendage (LAA) device occlusion represents a major evolution in stroke prevention for atrial fibrillation (AF). Left atrial appendage device occlusion is now a proven strategy which provides long-term thromboembolic stroke prevention for patients with non-rheumatic AF. Evidence supports its benefit as an alternative to long-term anticoagulation while mitigating long-term bleeding risks and improving cardiovascular mortality. The therapy offers expanded options to physicians and patients negotiating stroke prevention (both primary and secondary prevention), but a good understanding of the risks and benefits is ...
Source: Heart, Lung and Circulation - May 16, 2017 Category: Cardiology Authors: Karen P. Phillips, Vince Paul Source Type: research

CHADS2 risk score and rate of stroke or systemic embolism and major bleeding in patients with non-valvular atrial fibrillation receiving non-vitamin K antagonist oral anticoagulants.
Authors: VAN Mieghem W, Lancellotti P Abstract Randomized trials showed non-inferior or superior results of the non-vitamin K antagonist oral anticoagulants (NOACs) compared with warfarin in patients with non-valvular atrial fibrillation (AF). Despite the absence of direct head-to-head comparisons between the different NOACs, certain molecules have been proposed for subgroups of patients based mainly on the perception of different bleeding risks. The CHADS2 score has been uniformly used in the inclusion criteria of these studies and shared similar risk factors as the haemorrhagic risk score HAS-BLED. The aim of the...
Source: Acta Cardiologica - July 8, 2017 Category: Cardiology Tags: Acta Cardiol 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