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How to define valvular atrial fibrillation?
Abstract Atrial fibrillation (AF) confers a substantial risk of stroke. Recent trials comparing vitamin K antagonists (VKAs) with non-vitamin K antagonist oral anticoagulants (NOACs) in AF were performed among patients with so-called "non-valvular" AF. The distinction between "valvular" and "non-valvular" AF remains a matter of debate. Currently, "valvular AF" refers to patients with mitral stenosis or artificial heart valves (and valve repair in North American guidelines only), and should be treated with VKAs. Valvular heart diseases, such as mitral regurgitation, aortic stenosis (AS) and aortic insufficiency, do...
Source: Archives of Cardiovascular Diseases - July 13, 2015 Category: Cardiology Authors: Fauchier L, Philippart R, Clementy N, Bourguignon T, Angoulvant D, Ivanes F, Babuty D, Bernard A Tags: Arch Cardiovasc Dis Source Type: research

Apixaban Compared with Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease: Findings From the ARISTOTLE Trial.
CONCLUSIONS: -More than a quarter of the patients in ARISTOTLE with "nonvalvular" atrial fibrillation had moderate or severe valvular heart disease. There was no evidence of a differential effect of apixaban over warfarin in reducing stroke or systemic embolism, causing less bleeding, and reducing death in patients with and without valvular heart disease. Clinical Trial Registration Information-clinicaltrials.gov. Identifier: NCT00412984. PMID: 26106009 [PubMed - as supplied by publisher]
Source: Circulation - June 23, 2015 Category: Cardiology Authors: Avezum A, Lopes RD, Schulte PJ, Lanas F, Gersh BJ, Hanna M, Pais P, Erol C, Diaz R, Bahit MC, Bartunek J, De Caterina R, Goto S, Ruzyllo W, Zhu J, Granger CB, Alexander JH Tags: Circulation Source Type: research

Abstract 234: Comparison of Hospital Length of Stay and Costs between Non-valvular Atrial Fibrillation Patients Treated with Either Apixaban or Warfarin Session Title: Poster Session II
Conclusions: NVAF patients treated with apixaban had significantly shorter hospital LOS and lower index hospitalization costs compared to those treated with warfarin. Costs remained significantly lower for apixaban patients across all CHADS2 scores.
Source: Circulation: Cardiovascular Quality and Outcomes - April 29, 2015 Category: Cardiology Authors: Xie, L., Vo, L., Keshishian, A., Price, K., Singh, P., Mardekian, J., Bruno, A., Baser, O., Kim, J., Tan, W., Trocio, J. Tags: Session Title: Poster Session II Source Type: research

Premature Ventricular Complexes on Screening Electrocardiogram and Risk of Ischemic Stroke Brief Reports
Conclusions— PVCs are common on routine screening ECGs and are associated with an increased risk of ischemic stroke.
Source: Stroke - April 27, 2015 Category: Neurology Authors: Agarwal, S. K., Chao, J., Peace, F., Judd, S. E., Kissela, B., Kleindorfer, D., Howard, V. J., Howard, G., Soliman, E. Z. Tags: Electrocardiology, Embolic stroke, Epidemiology Brief Reports Source Type: research

Anticoagulant Prescription in Patients With AF
In patients with atrial fibrillation (AF) who are at risk for thromboembolism, anticoagulation therapy with warfarin or the newer novel anticoagulants reduces morbidity and mortality. Because oral anticoagulant use carries a risk of bleeding, the drugs are not recommended in patients with AF who are at a particularly low risk for stroke. Specifically, previous AF guidelines recommend against the use of oral anticoagulation in patients younger than 60 years without heart disease or other known risk factors for thromboembolism, and more recently updated guidelines do not recommend the use of oral anticoagulation in patients ...
Source: JAMA Internal Medicine - April 13, 2015 Category: Internal Medicine Source Type: research

Oral anticoagulants for stroke prevention in atrial fibrillation: current status, special situations, and unmet needs
Publication date: Available online 14 March 2015 Source:The Lancet Author(s): Freek W A Verheugt , Christopher B Granger In patients with non-valvular atrial fibrillation, oral anticoagulation with vitamin K antagonists reduces the risk of stroke by more than 60%. But vitamin K antagonists have limitations, including causing serious bleeding such as intracranial haemorrhage and the need for anticoagulation monitoring. In part related to these limitations, they are used in only about half of patients who should be treated according to guideline recommendations. In the past decade, oral agents have been developed that dire...
Source: The Lancet - March 14, 2015 Category: Journals (General) Source Type: research

An Aspirin a Day: Is the Benefit Worth the Risk?
Studies have shown that aspirin, the age old remedy for pain and fever, also thins the blood. Because of this property, it can also help to lower the chances of a heart attack or a stroke caused by a blood clot in the brain. And, although research has found that it only works in certain people (specifically, those with a history of heart attack or stroke) many Americans are inappropriately taking daily, low doses of aspirin as a preventative measure. In fact, researchers have found that about 12 percent of the of nearly 69,000 U.S. adults taking aspirin on a long-term basis should not have received the prescription in the ...
Source: Healthy Living - The Huffington Post - March 13, 2015 Category: Consumer Health News Source Type: news

Novel oral anticoagulants and valvular atrial fibrillation: are they always contraindicated?
Abstract Atrial fibrillation (AF) is the most common sustained cardiac dysrhythmia, and is associated with an increased risk of death, stroke, and other thromboembolic events. Valvular heart disease (VHD) frequently coexists with AF, mostly in elderly patients. After the introduction of novel oral anticoagulants (NOACs) approved for the prevention of stroke in non-valvular atrial fibrillation (NVAF) on the basis of recent trials, the importance of a universal definition of NVAF was raised in clinical practice. In the most recent guidelines, the term valvular AF is used to imply that AF is related to rheumatic valv...
Source: Internal and Emergency Medicine - January 15, 2015 Category: Emergency Medicine Source Type: research

Utility of a Dedicated Pediatric Cardiac Anticoagulation Program: The Boston Children’s Hospital Experience
Abstract Congenital heart disease is the leading cause of stroke in children. Warfarin therapy can be difficult to manage safely in this population because of its narrow therapeutic index, multiple drug and dietary interactions, small patient size, high-risk cardiac indications, and lack of data to support anticoagulation recommendations. We sought to describe our institution’s effort to develop a dedicated cardiac anticoagulation service to address the special needs of this population and to review the literature. In 2009, in response to Joint Commission National Patient Safety Goals for Anticoagulation, Boston...
Source: Mammalian Genome - January 8, 2015 Category: Genetics & Stem Cells Source Type: research

Thrombosis in Fontan patient on apixaban
We report a case of large thrombus in a 24-year-old male born with double inlet left ventricle in the lateral tunnel Fontan while on apixaban.
Source: International Journal of Cardiology - December 27, 2014 Category: Cardiology Authors: Candida Pinto, Bennett P. Samuel, Christopher Ratnasamy, Joseph J. Vettukattil Source Type: research

Antithrombotic Therapy After Acute Ischemic Stroke in Patients With Atrial Fibrillation Clinical Sciences
Conclusions— Contrary to current guidelines, 30% of patients with atrial fibrillation and recent IS are not prescribed any OAC therapy on discharge, whereas a further 30% are prescribed combination OAC and antiplatelet therapy. Combination OAC and antiplatelet therapy in patients at high cardiovascular risk requires evaluation in clinical trials, particularly with the newer OACs, given their more favorable risk–benefit ratio compared with warfarin.
Source: Stroke - November 24, 2014 Category: Neurology Authors: McGrath, E. R., Kapral, M. K., Fang, J., Eikelboom, J. W., Conghaile, A. O., Canavan, M., O'Donnell, M. J., on behalf of the Investigators of the Ontario Stroke Registry Tags: Secondary prevention, Acute Cerebral Infarction, Arrhythmias, clinical electrophysiology, drugs Clinical Sciences Source Type: research

Approach to the new oral anticoagulants in family practice: Part 2: addressing frequently asked questions.
CONCLUSION: Management of "what if" scenarios for patients taking NOACs have been proposed, but additional study is needed to address these issues, especially periprocedural management and bleeding. PMID: 25392439 [PubMed - as supplied by publisher]
Source: Canadian Family Physician Medecin de Famille Canadien - November 1, 2014 Category: Primary Care Authors: Douketis J, Bell AD, Eikelboom J, Liew A Tags: Can Fam Physician Source Type: research

Non-vitamin-K oral anticoagulants reduce mortality, stroke and intracranial haemorrhage when compared with warfarin in randomised trials of patients with non-valvular atrial fibrillation
Commentary on: Ruff CT, Giugliano RP, Braunwald E, et al.. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 2014;383:955–62. Context Historically, the standard medication for stroke prevention in atrial fibrillation (AF) has been a vitamin-K antagonist (warfarin). However, several non-vitamin-K oral anticoagulants (NOACs) have been developed and shown to be at least as effective as dose-adjusted warfarin in their respective phase-3 clinical trials.1–4 These include the direct thrombin inhibitor dabig...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Steinberg, B. A. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Connective tissue disease, Musculoskeletal syndromes, Diabetes, Arrhythmias Therapeutics Source Type: research

Relation of Left Atrial Dysfunction to Ischemic Stroke in Patients With Coronary Heart Disease (from the Heart and Soul Study)
In conclusion, LA dysfunction is an independent risk factor for stroke or TIA, even in patients without baseline AF.
Source: The American Journal of Cardiology - March 5, 2014 Category: Cardiology Authors: Jonathan M. Wong, Christine C. Welles, Farnaz Azarbal, Mary A. Whooley, Nelson B. Schiller, Mintu P. Turakhia Tags: Arrhythmias and Conduction Disturbances Source Type: research

Cardiac Surgery in Indigenous Australians: Early Onset Cardiac Disease with follow-up Challenges
Conclusions: The mean age of 52 years at which Indigenous patients have cardiac surgery is significantly low compared to non-Indigenous patients. Indigenous patients have multiple risk factors for cardiac disease and with a large number requiring emergency surgery. Although surgical outcome in the short term is favourable, a large number of patients are lost to follow-up. The use of mechanical valve and warfarin should be individualised. Strategic post-operative follow-up mechanisms are needed to address these issues.
Source: Heart, Lung and Circulation - February 24, 2014 Category: Cardiology Authors: M.P. Matebele, S. Rohde, A. Clarke, J.F. Fraser Tags: Original Articles Source Type: research

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