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Quality of Life Assessment in the Randomized PROTECT AF (Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapy for Prevention of Stroke in Patients With Atrial Fibrillation) Trial of Patients at Risk for Stroke With Nonvalvular Atrial Fibrillation
ConclusionsPatients with nonvalvular AF at risk for stroke treated with left atrial appendage closure have favorable QOL changes at 12 months versus patients treated with warfarin. (WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation [WATCHMAN PROTECT]; NCT00129545)
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - April 22, 2013 Category: Cardiology Source Type: research

Pre-Operative Risk Factors of Bleeding and Stroke During Left Ventricular Assist Device Support An Analysis of More Than 900 HeartMate II Outpatients
ConclusionsThe risk of bleeding and thrombotic events during LVAD support differs by patient demographics, including sex, age, body mass index, and etiology of heart failure. Further studies should focus on the potential of tailored anticoagulation strategies in these subgroups.
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - March 3, 2014 Category: Cardiology Source Type: research

Renal Impairment and Ischemic Stroke Risk Assessment in Patients With Atrial Fibrillation The Loire Valley Atrial Fibrillation Project
ConclusionsRenal impairment was not an independent predictor of IS/TE in patients with AF and did not significantly improve the predictive ability of the CHADS2 or CHA2DS2-VASc scores.
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - May 13, 2013 Category: Cardiology Source Type: research

Major Bleeding in Patients With Atrial Fibrillation Receiving Apixaban or Warfarin The ARISTOTLE Trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation): Predictors, Characteristics, and Clinical Outcomes
This study sought to characterize major bleeding on the basis of the components of the major bleeding definition, to explore major bleeding by location, to define 30-day mortality after a major bleeding event, and to identify factors associated with major bleeding.BackgroundApixaban was shown to reduce the risk of major hemorrhage among patients with atrial fibrillation in the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial.MethodsAll patients who received at least 1 dose of a study drug were included. Major bleeding was defined according to the criteria of the Inte...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - May 19, 2014 Category: Cardiology Source Type: research

Percutaneous Left Atrial Appendage Suture Ligation Not Ready for Prime Time ∗
Novel approaches to reduce stroke risk with oral anticoagulant medications or interventions are of the utmost importance to improve the quality of care for patients with atrial fibrillation (AF). Oral anticoagulation with vitamin K antagonists and, more recently, with novel oral anticoagulants (NOACs) has led to a remarkable reduction of stroke risk; however, some of the benefits with NOACs are counterbalanced by increased bleeding risks. The idea of developing interventions that reduce stroke risk but avoid long-term oral anticoagulation and thereby avoid increasing the bleeding risk appears very reasonable and attractive...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - August 4, 2014 Category: Cardiology Source Type: research

Atrial Fibrillation and Thrombosis: The Missing Molecular Links ⁎ ⁎
Nonvalvular atrial fibrillation (AF) confers a 5-fold increased risk of stroke and systemic thromboembolism (TE), especially in the presence of stroke risk factors (1). AF is common, and the TE manifestations are evident in many diverse cardiovascular conditions. For example, transient new-onset AF in acute myocardial infarction is a risk factor for stroke (2). Also, patients with left ventricular systolic impairment with associated AF are at high risk of TE (3). Fortunately, the use of anticoagulation therapy reduces the risk of stroke and/or TE (by 64%) as well as all-cause mortality (by 26%), whereas aspirin results in ...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - February 18, 2013 Category: Cardiology Source Type: research

The HAS-BLED Score Has Better Prediction Accuracy for Major Bleeding Than CHADS 2 or CHA 2 DS 2 -VASc Scores in Anticoagulated Patients With Atrial Fibrillation
ObjectivesThe aim of this study was to test the hypothesis that a specific bleeding risk score, HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly), was better at predicting major bleeding compared with CHADS2 (congestive heart failure, hypertension, 75 years of age or older, diabetes mellitus, and previous stroke or transient ischemic attack) and CHA2DS2-VASc (congestive heart failure, hypertension, 75 years of age and older, diabetes mellitus, previous stroke or transient ischemic attack, vascular d...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - December 2, 2013 Category: Cardiology Source Type: research

Shared Risk Factors for Anticoagulation in Nonvalvular Atrial Fibrillation A Dilemma in Clinical Decision Making ∗
Atrial fibrillation (AF) is the most common cardiac rhythm disorder (1) and can result in negative cardiovascular outcomes such as stroke and mortality, especially in patients with cardiovascular morbidities (2,3). AF also contributes substantially to the cost of medical care (4), of which stroke-related care is a large component. Clinical trials have fundamentally supported the concepts used by clinicians in the management of AF including rate and rhythm control, use of interventional procedures such as ablation, and anticoagulation for the prevention of stroke and thromboembolism (5,6). Despite these guidelines, there is...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - May 19, 2014 Category: Cardiology Source Type: research

Left Atrial Appendage Thrombus in Transcatheter Aortic Valve Replacement: Incidence, Clinical Impact, and the Role of Cardiac Computed Tomography
Conclusions The incidence of LAAT in patients considered for TAVR is high, and LAAT embolization may represent a clinically relevant cause of periprocedural stroke. Dual-phase CCT is an accurate modality for the diagnosis of LAAT. It may obviate the need for pre-procedural TEE. The presence of LAAT should be examined in all patients undergoing TAVR and strategies developed for those patients in whom LAAT is identified.
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - January 15, 2017 Category: Cardiology Authors: Palmer, S., Child, N., de Belder, M. A., Muir, D. F., Williams, P. Tags: Structural Source Type: research

Reply
We thank Drs. Li and Zhao for their interest in our paper (1). They are correct that indirect comparisons cannot address all the heterogeneity between trials, as well as the underlying pathogenic mechanisms that they allude to. However, it is not very likely that there would be major differences in stroke subtypes among the 3 studies. Also, the inclusion and exclusion criteria are broadly the same in the 3 trials, except for the ROCKET-AF (Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation) trial, wherein more patient...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - January 28, 2013 Category: Cardiology Source Type: research

Ankle-Brachial Index in Patients With Nonvalvular Atrial Fibrillation
Violi et al. (1) are to be commended for their large study on the prevalence of subclinical peripheral artery disease (PAD) among patients with nonvalvular atrial fibrillation. Indeed, the ankle-brachial index (ABI) enables the detection of a substantial subset of individuals with asymptomatic (or with atypical symptoms of) PAD in diverse populations, and beyond its diagnostic interest, a low ABI is predictive for stroke, as highlighted recently in a meta-analysis (2). Violi et al. (1) reported an even higher than expected 21% prevalence of PAD detected by an ABI ≤0.90, almost doubling the proportion of patients with ...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - April 7, 2014 Category: Cardiology Source Type: research

Second-Generation Drug-Eluting Stent Implantation Followed by 6- Versus 12-Month Dual Antiplatelet Therapy The SECURITY Randomized Clinical Trial
BackgroundThe optimal duration of dual antiplatelet therapy (DAPT) following second-generation drug-eluting stent (DES) implantation is still debated.ObjectivesThe aim of this study was to test the noninferiority of 6 versus 12 months of DAPT in patients undergoing percutaneous coronary intervention with second-generation DES.MethodsThe SECURITY (Second Generation Drug-Eluting Stent Implantation Followed by Six- Versus Twelve-Month Dual Antiplatelet Therapy) trial was a 1:1 randomized, multicenter, international, investigator-driven, noninferiority study conducted from July 2009 to June 2014. Patients with a stable or unst...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - November 10, 2014 Category: Cardiology Source Type: research

Outcomes in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction Via Radial Access Anticoagulated With Bivalirudin Versus Heparin: A Report From the National Cardiovascular Data Registry
Conclusions In patients undergoing primary PCI via transradial access anticoagulated with bivalirudin or heparin, there was no difference in the composite endpoint of death, myocardial infarction, or stroke.
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - June 5, 2017 Category: Cardiology Authors: Jovin, I. S., Shah, R. M., Patel, D. B., Rao, S. V., Baklanov, D. V., Moussa, I., Kennedy, K. F., Secemsky, E. A., Yeh, R. W., Kontos, M. C., Vetrovec, G. W. Tags: Coronary Source Type: research

Percutaneous Left Atrial Appendage Closure With the AMPLATZER Cardiac Plug Device in Patients With Nonvalvular Atrial Fibrillation and Contraindications to Anticoagulation Therapy
ConclusionsIn patients with nonvalvular atrial fibrillation at high risk of cardioembolic events and absolute contraindications to anticoagulation, LAAC using the ACP device followed by dual-/single-antiplatelet therapy was associated with a low rate of embolic and bleeding events after a mean follow-up of 20 months. No cases of severe residual leak or device thrombosis were observed at the 6-month follow-up.
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - July 1, 2013 Category: Cardiology Source Type: research

Switching Patients From Blinded Study Drug to Warfarin at the End of the ENGAGE AF–TIMI 48 Trial Setting a New Standard ∗
Interruption of warfarin treatment is associated with an increased risk of thromboembolic events (1). Among patients with atrial fibrillation (AF) receiving warfarin for stroke prevention, as many as 1 in 10 temporarily interrupt treatment each year, most commonly for invasive procedures (1,2). Because of its long half-life, warfarin is usually stopped 4 to 5 days before a procedure, and it takes another 4 to 5 days after restarting treatment before a therapeutic anticoagulant effect is regained. In order to minimize the time off treatment and thereby reduce the risk of thromboembolism around the time of the procedure, t...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - August 4, 2014 Category: Cardiology Source Type: research

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