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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

Meta-Analysis of Anticoagulation Use, Stroke, Thromboembolism, Bleeding and Mortality in Patients with Atrial Fibrillation on Dialysis
Atrial fibrillation (AF) is common in patients on dialysis. While randomized trials of anticoagulation for AF have demonstrated striking reductions in stroke, these trials did not recruit dialysis patients. We thus undertook this systematic review and meta-analysis of observational studies. Electronic databases were searched for studies including AF patients on dialysis that reported observational associations of anticoagulation use. Twenty-one studies involving 530,031 individuals and 31,611 AF patients on dialysis were identified.
Source: The American Journal of Cardiology - April 12, 2016 Category: Cardiology Authors: Christopher X. Wong, Ayodele Odutayo, Connor A. Emdin, Ned J. Kinnear, Michelle T. Sun Source Type: research

Meta-Analysis of Anticoagulation Use, Stroke, Thromboembolism, Bleeding, and Mortality in Patients With Atrial Fibrillation on Dialysis
Atrial fibrillation (AF) is common in patients on dialysis. Although randomized trials of anticoagulation for AF have demonstrated striking reductions in stroke, these trials did not recruit patients on dialysis. We thus undertook this systematic review and meta-analysis of observational studies including patients with AF on dialysis that reported associations of anticoagulation use. Twenty studies involving 529,741 subjects and 31,321 patients with AF on dialysis were identified. Anticoagulation was associated with a 45% (95% CI 13% to 88%) increased risk of any stroke, reflecting a nonsignificant 13% (95% CI −4% to 34...
Source: The American Journal of Cardiology - April 12, 2016 Category: Cardiology Authors: Christopher X. Wong, Ayodele Odutayo, Connor A. Emdin, Ned J. Kinnear, Michelle T. Sun Tags: Arrhythmias and Conduction Disturbances Source Type: research

Assessment of Device-Related Thrombus and Associated Clinical Outcomes With the WATCHMAN Left Atrial Appendage Closure Device for Embolic Protection in Patients With Atrial Fibrillation (from the PROTECT-AF Trial)
Left atrial appendage closure with the WATCHMAN device is an alternative to anticoagulation for stroke prevention in selected patients with atrial fibrillation (AF). LA device-related thrombus (DRT) is poorly defined and understood. We aimed to (1) develop consensus echocardiographic diagnostic criteria for DRT; (2) estimate the incidence of DRT; and (3) determine clinical event rates in patients with DRT. In phase 1 (training), a training manual was developed and reviewed by 3 echocardiographers with left atrial appendage closure device experience.
Source: The American Journal of Cardiology - February 1, 2016 Category: Cardiology Authors: Michael L. Main, Dali Fan, Vivek Y. Reddy, David R. Holmes, Nicole T. Gordon, Tina R. Coggins, John A. House, Lawrence Liao, Dawn Rabineau, George G. Latus, Kenneth C. Huber, Horst Sievert, Richard F. Wright, Shephal K. Doshi, Pamela S. Douglas Tags: Arrhythmias and Conduction Disturbances Source Type: research

Assessment of Device Related Thrombus and Associated Clinical Outcomes with the WATCHMAN Left Atrial Appendage Closure Device for Embolic Protection in Patients with Atrial Fibrillation (From the PROTECT-AF Trial)
Left atrial appendage (LAA) closure with the WATCHMAN device is an alternative to anticoagulation for stroke prevention in selected patients with atrial fibrillation (AF). LA device related thrombus (DRT) is poorly defined and understood. We aimed to 1) develop consensus echocardiographic diagnostic criteria for DRT 2) estimate the incidence of DRT and 3) determine clinical event rates in patients with DRT. In Phase 1 (Training), a training manual was developed and reviewed by 3 echocardiographers with LAA closure device experience.
Source: The American Journal of Cardiology - February 1, 2016 Category: Cardiology Authors: Michael L. Main, Dali Fan, Vivek Y. Reddy, David R. Holmes, Nicole T. Gordon, Tina R. Coggins, John A. House, Lawrence Liao, Dawn Rabineau, George G. Latus, Kenneth C. Huber, Horst Sievert, Richard F. Wright, Shephal K. Doshi, Pamela S. Douglas Source Type: research

Treatment of Massive or Submassive Acute Pulmonary Embolism with Catheter Directed Thrombolysis
The presentation of acute pulmonary thromboembolism (PE) can be highly variable resulting in diagnostic challenges and management difficulties. Current guidelines suggest that therapy must be adjusted based on the severity of PE presentation. Systemic thrombolysis is the standard therapy for acute massive pulmonary embolism (PE), however systemic thrombolysis carries an estimated 20% risk of major hemorrhage, including a 3%-5% risk of hemorrhagic stroke. There are data supporting the use of catheter directed therapy (CDT) in massive and sub-massive PE, but past studies have limited its use to patients in whom systemic thro...
Source: The American Journal of Cardiology - December 31, 2015 Category: Cardiology Authors: Ashraf Mostafa, Alexandros Briasoulis, Tesfaye Telila, Kevin Belgrave, Cindy Grines Source Type: research

Gender Differences of Thromboembolic Events in Atrial Fibrillation
Atrial fibrillation (AF) is the most common clinically relevant arrhythmia and increases the risk of thromboembolism and stroke; however, these risks are not the same for women and men. This review examines the evidence and clinical significance of increased thromboembolic risk in women with AF. The balance of results from over thirty recent studies suggests that female gender is an independent stroke risk factor in AF, and the inclusion of female gender in stroke risk stratification models, such as CHA2DS2-VASc, has improved risk assessment.
Source: The American Journal of Cardiology - December 31, 2015 Category: Cardiology Authors: Emily Y. Cheng, Melissa H. Kong Source Type: research

Treatment of Massive or Submassive Acute Pulmonary Embolism With Catheter-Directed Thrombolysis
The presentation of acute pulmonary thromboembolism (PE) can be highly variable resulting in diagnostic challenges and management difficulties. Current guidelines suggest that therapy must be adjusted based on the severity of PE presentation. Systemic thrombolysis is the standard therapy for acute massive PE; however, systemic thrombolysis carries an estimated 20% risk of major hemorrhage, including a 3% to 5% risk of hemorrhagic stroke. There are data supporting the use of catheter-directed therapy (CDT) in massive and submassive PE, but past studies have limited its use to patients in whom systemic thrombolysis has eithe...
Source: The American Journal of Cardiology - December 31, 2015 Category: Cardiology Authors: Ashraf Mostafa, Alexandros Briasoulis, Tesfaye Telila, Kevin Belgrave, Cindy Grines Tags: Review Source Type: research

Prevalence and Clinical Determinants of Left Atrial Appendage Thrombus in Patients with Atrial Fibrillation Prior to Pulmonary Vein Isolation
The CHADS2 score is considered a reliable predictor of stroke/thromboembolism risk in patients with atrial fibrillation (AF). However, thromboembolism can occasionally occur even in AF patients with low CHADS2 score (CHADS2 score = 0 or 1). To investigate the incidence and predictors of left atrial appendage (LAA) thrombus (LAAT) formation in patients with AF, we studied consecutive 543 Japanese AF patients who underwent transesophageal echocardiography before pulmonary vein isolation from 2008 to 2012.
Source: The American Journal of Cardiology - August 13, 2015 Category: Cardiology Authors: Makiko Nishikii-Tachibana, Nobuyuki Murakoshi, Yoshihiro Seo, DongZhu Xu, Masayoshi Yamamoto, Tomoko Ishizu, Akiko Atsumi, Tomoko Machino-Ohtsuka, Kenji Kuroki, Hiro Yamasaki, Miyako Igarashi, Yukio Sekiguchi, Kazutaka Aonuma 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 Randomized Controlled Trials and Adjusted Observational Results Of Use Of Clopidogrel, Aspirin and Oral Anti-coagulants In Patients Undergoing Percutaneous Coronary Intervention
The optimal antiaggregant therapy after coronary stenting in patients receiving oral anticoagulation (OAC) is currently debated. Medline and Cochrane Library were searched for studies reporting outcomes of patients undergoing PCI and who were on triple therapy (TT)or dual antiplatelet therapy (DAPT) with aspirin and clopidogrel or dual therapy(DT) with OAC and clopidogrel. Major bleeding was the primary end point, while all-cause death, myocardial infarction (MI), stent thrombosis and stroke were secondary ones.
Source: The American Journal of Cardiology - February 11, 2015 Category: Cardiology Authors: Fabrizio D’Ascenzo, Salma Taha, Claudio Moretti, Pierluigi Omedè, Walter Grossomarra, Jonas Persson, Morten Lamberts, Willem Dewilde, Andrea Rubboli, Sergio Fernández, Enrico Cerrato, Ilaria Meynet, Flavia Ballocca, Umberto Barbero, Giorgio Quadri, Fr 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

Perioperative Complications After Noncardiac Surgery in Patients With Insertion of Second-Generation Drug-Eluting Stents
In conclusion, the incidence of perioperative complications with noncardiac surgery after second-generation DES implantation was 11% and consisted mainly of bleeding (5.8%). The incidence of definite stent thrombosis was 0.7%.
Source: The American Journal of Cardiology - May 5, 2014 Category: Cardiology Authors: Nathan Lo, Anna Kotsia, George Christopoulos, Michele Roesle, Bavana V. Rangan, Bryant J. Kim, Alexandra Webb, Subhash Banerjee, Emmanouil S. Brilakis Tags: Coronary Artery Disease 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

Unanswered Questions in Patients With Concurrent Atrial Fibrillation and Acute Coronary Syndrome
In conclusion, until the results of additional ongoing or planned randomized trials are known, clinicians must continue to rely on expert opinion and their own clinical judgment when treating these patients.
Source: The American Journal of Cardiology - December 16, 2013 Category: Cardiology Authors: Daniel S. Ice, Timothy A. Shapiro, Eric M. Gnall, Peter R. Kowey Tags: Review Source Type: research

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