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Quest for the Perfect Anticoagulant
The current referenced meta-analysis study by Selvaraj et al1 examines the relative merits of anticoagulation with a direct oral anticoagulant (DOAC) versus vitamin K antagonist (VKA) after transcatheter aortic valve implantation (TAVI) in patients meeting the indications for anticoagulation because of atrial fibrillation (AF). Although guidelines vary, the general consensus appears to indicate noninferiority to superiority of DOACs in the treatment of nonvalvular AF. In the landmark Apixiban for Reduction In Stroke and Other Thromboemoblic Events in Atrial Fibrillation trial comparing apixaban to warfarin in patients with...
Source: The American Journal of Cardiology - July 27, 2023 Category: Cardiology Authors: Bryant Fisher, Danny Chu Source Type: research

Meta-Analysis of Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Bioprosthetic Valves
Valvular heart disease is frequently complicated by atrial fibrillation, which is associated with an increased risk of mortality. In the presence of a surgical or transcatheter bioprosthetic valve, patients with atrial fibrillation are at increased risks of systemic thromboembolism.1 Although direct oral anticoagulants (DOACs) have been shown to be non-inferior or superior to warfarin in preventing stroke or thromboembolism associated with nonvalvular atrial fibrillation, the utilization of DOACs in patients with prior bioprosthetic valves has been limited in randomized clinical trials (RCTs).
Source: The American Journal of Cardiology - December 3, 2020 Category: Cardiology Authors: Babikir Kheiri, Ryle Przybylowicz, Timothy F Simpson, Hani Alhamoud, Mohammed Osman, Khidir Dalouk, Babak Nazer, Charles A. Henrikson, Eric Stecker Source Type: research

Non-Vitamin K Antagonist Oral Anticoagulant for Atrial Fibrillation in Obese Patients
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. It affects 1 in 4 adults aged>40 years,1 and is associated with a 5-fold increased risk of stroke.1 Hence, anticoagulants are universally recommended to prevent stroke and systemic embolism in patients with AF.1 The non-vitamin K antagonist oral anticoagulants (NOACs) are important alternatives to warfarin for prevention of arterial thromboembolism in patients with AF. Currently, the FDA has approved four NOACs for use in patients with AF: dabigatran is a thrombin inhibitor, while rivaroxaban, apixaban, and edoxaban are factor Xa inhibitors.
Source: The American Journal of Cardiology - April 22, 2020 Category: Cardiology Authors: Stephen Y Wang, Robert P Giugliano Tags: Review Article Source Type: research

Relation of Stroke and Bleeding Risk Profiles to Efficacy and Safety of Edoxaban for Cardioversion of Atrial Fibrillation (From the Edoxaban Versus Warfarin in Subjects Undergoing Cardioversion of Atrial Fibrillation ENSURE-AF Study)
In the ENSURE-AF study, edoxaban was compared to enoxaparin –warfarin in patients undergoing electrical cardioversion of nonvalvular atrial fibrillation, showing comparable low rates of bleeding and thromboembolism. This ancillary analysis investigated differences in relation to stroke and bleeding risk profiles. Secondly, we determined clinical risk profi les to quality of anticoagulation control in the warfarin arm. Primary efficacy (composite of stroke, systemic embolic event, myocardial infarction, and cardiovascular death) and safety (composite of major and clinically relevant nonmajor bleeding) outcomes and time to...
Source: The American Journal of Cardiology - October 26, 2017 Category: Cardiology Authors: Gregory Y.H. Lip, Jose L. Merino, G. Andrei Dan, Sakis Themistoclakis, Kenneth A. Ellenbogen, Raffaele De Caterina, Assen Goudev, James Jin, Michael Melino, Shannon M. Winters, Andreas Goette Source Type: research

Management of Major Bleeding in Patients With Atrial Fibrillation Treated With Non –Vitamin K Antagonist Oral Anticoagulants Compared With Warfarin in Clinical Practice (from Phase II of the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation ORBIT-AF II)
Non –vitamin K antagonist oral anticoagulants (NOACs) are effective at preventing stroke in patients with atrial fibrillation (AF). However, little is known about the management of bleeding in contemporary, clinical use of NOACs. We aimed to assess the frequency, management, and outcomes of major blee ding in the setting of community use of NOACs. Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II registry, we analyzed rates of International Society on Thrombosis and Haemostasis major bleeding and subsequent outcomes in patients treated with NOACs versus warfarin.
Source: The American Journal of Cardiology - February 28, 2017 Category: Cardiology Authors: Benjamin A. Steinberg, DaJuanicia N. Simon, Laine Thomas, Jack Ansell, Gregg C. Fonarow, Bernard J. Gersh, Peter R. Kowey, Kenneth W. Mahaffey, Eric D. Peterson, Jonathan P. Piccini, Outcomes Registry for Better Informed Treatment of Atrial Fibrillation ( Tags: Arrhythmias and Conduction Disturbances Source Type: research

Long-Term Population-Based Cerebral Ischemic Event and Cognitive Outcomes of Direct Oral Anticoagulants Compared to Warfarin among Long-Term Anticoagulated Patients for Atrial Fibrillation
Direct oral anticoagulants (DOACs) have been used in clinical practice in the US for the last 4-6 years. While DOACs may be an attractive alternative to warfarin among many patients, long-term outcomes of use of these medications are unknown. We performed a propensity-matched analysis to report patient important outcomes of death, stroke/TIA, bleeding, major bleeding and dementia among patients taking a DOAC or warfarin. Patients receiving long-term anticoagulation between June 2010-December 2014 for thromboembolism prevention with either warfarin or a DOAC were matched 1:1 by index date and propensity score.
Source: The American Journal of Cardiology - May 4, 2016 Category: Cardiology Authors: Victoria Jacobs, Heidi T. May, Tami L. Bair, Brian G. Crandall, Michael J. Cutler, John D. Day, Charles Mallender, Jeffrey S. Osborn, Scott M. Stevens, J. Peter Weiss, Scott C. Woller, T. Jared Bunch Source Type: research

Reply
We appreciate the interest in our article, “Overview of the Food and Drug Administration Circulatory System Devices Panel Meetings on WATCHMAN Left Atrial Appendage Closure Therapy,” and that it stimulated provocative discussion in a letter to the editor. First, the WATCHMAN device was approved with the indication to reduce the risk of thromboembolism from the left atrial appendage (LAA) in patients with non-valvular atrial fibrillation, who are at an increased risk for stroke and systemic embolism based on CHADS2 or CHA2DS2-VASc scores; are deemed by their physicians to be suitable for warfarin; and have an appropriat...
Source: The American Journal of Cardiology - April 23, 2015 Category: Cardiology Authors: Ron Waksman Source Type: research

Meta-Analysis of Efficacy and Safety of Rivaroxaban Compared With Warfarin or Dabigatran in Patients Undergoing Catheter Ablation for Atrial Fibrillation
In conclusion, our study suggests that patients treated with rivaroxaban during periprocedural catheter ablation have similar rates of thromboembolic events and major hemorrhage. Similar results were seen in direct comparisons between dabigatran and rivaroxaban.
Source: The American Journal of Cardiology - June 9, 2014 Category: Cardiology Authors: Madan Raj Aryal, Anene Ukaigwe, Anil Pandit, Paras Karmacharya, Rajesh Pradhan, Naba Raj Mainali, Ranjan Pathak, Leena Jalota, Yashoda Bhandari, Anthony Donato Tags: Arrhythmias and Conduction Disturbances Source Type: research

Safety of Short-Term Use of Dabigatran or Rivaroxaban for Direct-Current Cardioversion in Patients With Atrial Fibrillation and Atrial Flutter
In conclusion, the use of short-term dabigatran or rivaroxaban therapy for DCCV of AF appears safe.
Source: The American Journal of Cardiology - February 3, 2014 Category: Cardiology Authors: Ajay Yadlapati, Christopher Groh, Rod Passman Tags: Arrhythmias and Conduction Disturbances Source Type: research

Dabigatran and Acute Coronary Syndromes
There has been considerable interest in the utility of newer oral anticoagulants for the secondary prevention of myocardial infarction (MI) and acute coronary syndromes (ACS). The direct thrombin inhibitor dabigatran has been approved for stroke prevention in patients with atrial fibrillation. However, as Verheugt discussed, when combined with dual antiplatelet therapy for secondary prevention in patients with ACS, no difference was found between the placebo and dabigatran groups for the composite end point of cardiovascular death, nonfatal MI, or stroke. However, it should also be noted that recent reports have actually ...
Source: The American Journal of Cardiology - May 1, 2013 Category: Cardiology Authors: John R. Kapoor Tags: Readers' Comments Source Type: research

Safety of Continuous Anticoagulation With Dabigatran During Implantation of Cardiac Rhythm Devices
In conclusion, although no thromboembolic or major bleeding events were observed, additional studies are required to define the optimal antithrombotic management in the perioperative period.
Source: The American Journal of Cardiology - January 28, 2013 Category: Cardiology Authors: Christopher P. Rowley, Michael L. Bernard, William W. Brabham, Peter C. Netzler, Darren S. Sidney, Frank Cuoco, J. Lacy Sturdivant, Robert B. Leman, J. Marcus Wharton, Michael R. Gold Tags: Arrhythmias and Conduction Disturbances Source Type: research