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Oral Anticoagulant Use for Patients with Atrial Fibrillation with Concomitant Anemia and/or Thrombocytopenia
Atrial fibrillation is the most common sustained cardiac arrhythmia in clinical practice, which is associated with an increased risk of thromboembolism, heart failure and mortality.1 Previous studies in atrial fibrillation patients have reported that abnormal hemoglobin and platelet counts may be associated with adverse events. However, these studies that specifically examined the associations between hemoglobin and platelet levels and adverse outcomes reported conflicting data.2-5 Although warfarin effectively reduces the risk of ischemic stroke by 64% compared to placebo/control,6 and non-vitamin K antagonist oral antico...
Source: The American Journal of Medicine - April 2, 2022 Category: General Medicine Authors: Yung-Hsin Yeh, Yi-Hsin Chan, Shao-Wei Chen, Shang-Hung Chang, Chun-Li Wang, Chi-Tai Kuo, Gregory Y.H. Li, Shih-Ann Chen, Tze-Fan Chao Tags: Clinical Research Study Source Type: research

The Reply
Dr. Jolobe, in his comments on our case study,1 is quite right in highlighting 2 pertinent examples of the potentially severe iatrogenic patient harm that may result from erroneous treatment of pauci-symptomatic acute type A aortic dissection masquerading and possibly misdiagnosed as an acute vascular event, be it ischemic stroke, acute myocardial infarction, or pulmonary thromboembolism.
Source: The American Journal of Medicine - August 1, 2021 Category: General Medicine Authors: Ami Schattner Tags: Letter Source Type: research

Oral Anticoagulation Use in High-Risk Patients Is Improved by Elimination of False-Positive and Inactive Atrial Fibrillation Cases
Multiple registries have reported that>40% of high-risk atrial fibrillation patients are not taking oral anticoagulants. The purpose of our study was to determine the presence or absence of active atrial fibrillation and CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥75 y, Diabetes mellitus, prior Stroke [or transient ischemic attack or thromboembolism], Vascular disease, Age 65-74 y, Sex category) risk factors to accurately identify high-risk atrial fibrillation (CHA2DS2-VASc ≥2) patients requiring oral anticoagulants and the magnitude of the anticoagulant treatment gap.
Source: The American Journal of Medicine - December 23, 2020 Category: General Medicine Authors: Gerald V. Naccarelli, Mohammed Ruzieh, Deborah L. Wolbrette, Mauricio Sendra-Ferrer, John van Harskamp, Barbara Bentz, Gregory Caputo, Nathan McConkey, Kevin Mills, Stephen Wasemiller, Jovan Plamenac, Douglas Leslie, Frendy D. Glasser, Thomas W. Abendroth Tags: Clinical Research Study Source Type: research

High Fluctuation Between Anticoagulants, Frequent Off-Label Dosing, and No Difference Concerning Outcomes: Results of a Real-Life Cohort Study
Recently published studies indicated a high proportion of patients taking direct oral anticoagulants (DOACs) are off-label under- or overdosed. The present study aimed at investigating whether off-label dosages are corrected over time and whether off-label doses are associated with differences in bleeding rates, ischemic stroke, or venous thromboembolism.
Source: The American Journal of Medicine - October 24, 2020 Category: General Medicine Authors: Corinne M. Eschler, Ana Antelo, Georg-Christian Funk, Aristomenis K. Exadaktylos, Gregor Lindner Tags: Clinical Research Study Source Type: research

Peripheral arterial disease in patients with atrial fibrillation: The Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study.
Atrial fibrillation and peripheral arterial disease are two conditions associated with high risk of cardiovascular and cerebrovascular complications and mortality.1 –5 There is evidence that coexistence of both these clinical conditions can result to an additive risk of adverse events.6 Indeed, atherosclerotic vascular disease has been linked with stroke, thromboembolism and death in subjects with atrial fibrillation and has been therefore included as one of the components of risk scores, such as the CHA2DS2-VASc score (Congestive Heart failure, Hypertension Age> 75 years, DM, Stroke, Vascular disease) in order to strati...
Source: The American Journal of Medicine - September 17, 2020 Category: General Medicine Authors: Antonios Vitalis, Alena Shantsila, Marco Proietti, Rajiv K. Vohra, Mark Kay, Brian Olshansky, Gregory Y.H. Lip Source Type: research

Contemporary Meta-Analysis of Extended Direct Acting Oral Anticoagulant Thromboprophylaxis to Prevent Venous Thromboembolism Among Hospitalized Patients
There are over 36 million medical hospitalizations each year in the United States, with the majority being for acute medical illness.1 Cancer, chronic obstructive pulmonary disease, congestive heart failure, stroke and myocardial infarction are some of the most common indications for hospitalization and are additionally risk factors for venous thromboembolism.2 With over 900,000 patients suffering from venous thromboembolism each year, excess thrombosis causes a large medical and financial burden to patients and the health care system.
Source: The American Journal of Medicine - March 5, 2020 Category: General Medicine Authors: Vikas Bhalla, Olivia F Lamping, Ahmed Abdel-Latif, Meenakshi Bhalla, Khaled Ziada, Susan S. Smyth Tags: Clinical Research Study Source Type: research

Predictors of not initiating anticoagulation after incident venous thromboembolism: a Danish nationwide cohort study
Venous thromboembolism, com prising deep vein thrombosis and pulmonary embolism, is the third most common cause of cardiovascular death after stroke and myocardial infarction.1 Anticoagulation is the keystone in venous thromboembolism treatment and prevention of venous thromboembolism morbidity, mortality, and recurrence. International guidelines mandate anticoagulant therapy for a minimum of 3 months after proximal deep vein thrombosis and/or pulmonary embolism.2,3
Source: The American Journal of Medicine - October 9, 2019 Category: General Medicine Authors: Ida Ehlers Albertsen, Samuel Zachary Goldhaber, Gregory Piazza, Thure Filskov Overvad, Peter Br ønnum Nielsen, Torben Bjerregaard Larsen, Mette Søgaard Tags: Clinical Research Study Source Type: research

Arterial Ischemic Events Are a Major Complication in Cancer Patients with Venous Thromboembolism
A number of studies revealed that patients with venous thromboembolism are at increased risk of developing subsequent arterial ischemic events, such as myocardial infarction or stroke.1 –8 Prevention of such arterial ischemic events in addition to treating venous thromboembolismmay warrant combination therapy with antiplatelets and anticoagulants. Recent studies suggested an increased risk of arterial ischemic events in cancer patients.9,10 Accurate identification of patients at increased risk for arterial ischemic events during the course of anticoagulation for venous thromboembolismmay help to select those who would po...
Source: The American Journal of Medicine - May 26, 2018 Category: General Medicine Authors: Benjamin Brenner, Behnood Bikdeli, Inna Tzoran, Olga Madridano, Raquel L ópez-Reyes, José María Suriñach, Ángeles Blanco-Molina, Antonella Tufano, Juan José López Núñez, Javier Trujillo-Santos, Manuel Monreal, for the RIETE Investigators Tags: Clinical Research Study Source Type: research

Severity of Gastrointestinal Bleeding in Patients Treated with Direct-Acting Oral Anticoagulants
Direct-acting oral anticoagulants (DOACs), which have gained approval for stroke prevention in non-valvular atrial fibrillation and treatment of venous thromboembolism, have become increasingly preferred over warfarin given their predictable pharmacodynamics, lack of required monitoring, and superior outcomes. DOACs have been shown to be associated with an increased frequency of gastrointestinal bleeding compared to warfarin, but the severity and characteristics of gastrointestinal bleeding in these patients is poorly understood.
Source: The American Journal of Medicine - November 22, 2017 Category: General Medicine Authors: Mark M. Brodie, Jill C. Newman, Tyler Smith, Don C. Rockey Tags: Clinical Research Study Source Type: research

Atrial Appendage Thrombosis Risk Is Lower for Atrial Flutter Compared with Atrial Fibrillation
The risk of stroke and thromboembolism in atrial fibrillation is established. However, the evidence surrounding the risk of thromboembolism in patients with atrial flutter is not as clear. We hypothesized that atrial flutter would have indicators of less risk for thromboembolism compared with atrial fibrillation on transesophageal echocardiography, thereby possibly leading to a lower stroke risk.
Source: The American Journal of Medicine - November 8, 2017 Category: General Medicine Authors: Jennifer J. Huang, Sridhar Reddy, Tam H. Truong, Prakash Suryanarayana, Joseph S. Alpert Tags: Clinical Research Study Source Type: research

Atrial Flutter Has Less Left Atrial Spontaneous Contrast and Higher Left Atrial Appendage Emptying Velocity Compared with Atrial Fibrillation
The risk of stroke and thromboembolism in atrial fibrillation is established. There are clear guidelines in anticoagulation management of patient's with atrial fibrillation, however, the evidence surrounding the risk of thromboembolism in patients with atrial flutter is not as clear. We hypothesized that atrial flutter would have indicators of less risk for thromboembolism compared with atrial fibrillation on transesophageal echocardiography (TEE); thereby possibly leading to a lower stroke risk.
Source: The American Journal of Medicine - November 8, 2017 Category: General Medicine Authors: Jennifer J. Huang, Sridhar Reddy, Tam H. Truong, Prakash Suryanarayana, Joseph S. Alpert Tags: Clinical Research Study Source Type: research

NSAID Use and Association with Cardiovascular Outcomes in Outpatients with Stable Atherothrombotic Disease
Abstract: Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) other than aspirin have been linked to heart failure, salt retention, adverse ventricular remodeling, and thrombosis. We therefore sought to assess their impact on cardiovascular events in outpatients with stable atherothrombotic disease.Methods: We analyzed 44,095 patients in the REduction of Atherothrombosis for Continued Health (REACH) registry with information on NSAID use and 4-year follow-up. Cox proportional hazard models, including NSAID use as a time-dependent covariate, were constructed and adjusted for key baseline characteristics. End points of...
Source: The American Journal of Medicine - November 25, 2013 Category: Journals (General) Authors: Payal Kohli, Ph. Gabriel Steg, Christopher P. Cannon, Sidney C. Smith, Kim A. Eagle, E. Magnus Ohman, Mark J. Alberts, Elaine Hoffman, Jianping Guo, Tabassome Simon, Emmanuel Sorbets, Shinya Goto, Deepak L. Bhatt, REACH Registry Investigators Tags: Clinical research studies Source Type: research

Venous and Arterial Viscosity-associated Thrombosis in Hemoglobin SC Disease
I read with interest the article of Naik et al highlighting the risk of venous thrombosis in patients suffering from sickle cell disease. However, the authors may have missed the opportunity to address an important issue by studying separately sickle cell anemia and hemoglobin SC patients whose clinical presentation, pathogenesis, treatment and evolution are quite different. Hemoglobin SC patients usually are not anemic or only mildly anemic, and hyperviscosity plays a key role in the pathogenesis of complications observed in this disease. We showed in a recent study that life-threatening complication observed in hemoglo...
Source: The American Journal of Medicine - September 25, 2013 Category: Journals (General) Authors: François Lionnet Tags: Letters Source Type: research