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Contemporary Antiplatelet and Anticoagulant Therapies for Secondary Stroke Prevention: A Narrative Review of Current Literature and Guidelines
Curr Neurol Neurosci Rep. 2023 Apr 11. doi: 10.1007/s11910-023-01266-2. Online ahead of print.ABSTRACTPURPOSE OF REVIEW: Stroke is a leading cause of death and disability worldwide. The annual incidence of new or recurrent stroke is approximately 795,000 cases per year in the United States, of which 87% are ischemic in nature. In addition to the management of modifiable high-risk factors to reduce the risk of recurrent stroke, antithrombotic agents (antiplatelets and anticoagulants) play an important role in secondary stroke prevention. This review will discuss the published literature on the use of antiplatelets and antic...
Source: Atherosclerosis - April 10, 2023 Category: Cardiology Authors: Kunal Bhatia Lindsey M Ladd Kelsey H Carr Mario Di Napoli Jeffrey L Saver Louise D McCullough Maryam Hosseini Farahabadi Diana L Alsbrook Archana Hinduja Jorge G Ortiz Garcia Sara Y Sabbagh Alibay Jafarli Afshin A Divani Source Type: research

Effect of Warfarin on Ischemic Stroke, Bleeding, and Mortality in Patients with Atrial Fibrillation Receiving Peritoneal Dialysis
ConclusionThere is no significant association between warfarin treatment with risks of mortality, ischemic stroke or bleeding in patients with atrial fibrillation receiving peritoneal dialysis.
Source: American Journal of Cardiovascular Drugs - April 22, 2019 Category: Cardiology Source Type: research

Predictors of Oral Anticoagulant Non-prescription in Patients with Atrial Fibrillation and Elevated Stroke Risk
Conclusions In this registry of AF patients, older patients at elevated stroke and low bleeding risk were commonly treated with OAC. However, a variety of factors were associated with OAC non-prescription. Specifically, antiplatelet use was prevalent and associated with the highest likelihood of OAC non-prescription. Future studies are warranted to understand provider and patient rationale that may underlie observed associations with OAC non-prescription.
Source: American Heart Journal - March 11, 2018 Category: Cardiology Source Type: research

New Data From Two Large Studies Reinforce Effectiveness of Dual Pathway Inhibition (DPI) with XARELTO ® (rivaroxaban) Plus Aspirin in Patients with Coronary Artery Disease (CAD) and/or Peripheral Artery Disease (PAD)
RARITAN, N.J., May 23, 2022 – Findings from the XARELTO® (rivaroxaban) Phase 3 COMPASS Long-Term Open Label Extension (LTOLE) study and the XARELTO® in Combination with Acetylsalicylic Acid (XATOA) registry have been published in the European Society of Cardiology’s (ESC) European Heart Journal, Cardiovascular Pharmacotherapy. Additionally, the XATOA registry was presented at the American Congress of Cardiology’s 71st Annual Scientific Session (ACC.22). These studies provide further evidence supporting the role of dual pathway inhibition (DPI) with the XARELTO® vascular dose (2.5 mg twice daily plus aspirin 100 mg...
Source: Johnson and Johnson - May 23, 2022 Category: Pharmaceuticals Source Type: news

Can I use DOAC in a patient with renal disease?
Case A 76-year-old man is diagnosed with non-valvular atrial fibrillation. His comorbid conditions are hypertension, diabetes complicated by neuropathy, and chronic kidney disease stage 3. His current medications include metformin, lisinopril, gabapentin, and aspirin. His most recent laboratories showed a creatinine 1.8, creatinine clearance (CrCl) 35 mL/min, hemoglobin 11g/dL, and international normalized ratio 1.0. His congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, and sex (CHADSVASc) score is 4. Which medication should we use to prevent stroke in this patient?  Brief overview of the is...
Source: The Hospitalist - February 3, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: Renal & Genitourinary Source Type: research

Outcomes Associated with Apixaban Use in End-Stage Kidney Disease Patients with Atrial Fibrillation in the United States.
Conclusions -Among ESKD patients with AF on dialysis, apixaban use may be associated with lower risk of major bleeding compared with warfarin, with a standard 5 mg twice a day dose also associated with reductions in thromboembolic and mortality risk. PMID: 29954737 [PubMed - as supplied by publisher]
Source: Circulation - June 28, 2018 Category: Cardiology Authors: Siontis KC, Zhang X, Eckard A, Bhave N, Schaubel DE, He K, Tilea A, Stack AG, Balkrishnan R, Yao X, Noseworthy PA, Shah ND, Saran R, Nallamothu BK Tags: Circulation Source Type: research

Dabigatran - the First Approved DTI for SPAF.
Authors: Trailokya A, Hiremath JS Abstract Atrial fibrillation (AF) is commonly occurring arrhythmia in clinical practice. AF is easy to recognize but difficult to treat. Stroke is the most devastating complication of AF and is associated with a huge disease burden on the society. Effective stroke prevention is a priority for patients with AF. Two-thirds of strokes due to AF are preventable with suitable anticoagulant therapy. VKA like warfarin, acenocoumarol remains the gold standard for stroke prevention in AF (SPAF). However, it is associated with numerous limitations such as a high risk of drug-drug, drug-food ...
Source: Journal of the Association of Physicians of India - October 25, 2018 Category: General Medicine Tags: J Assoc Physicians India Source Type: research

Comparative Effectiveness and Safety of Rivaroxaban and Warfarin Among Nonvalvular Atrial Fibrillation (NVAF) Patients with Obesity and Polypharmacy in the United States (US)
ConclusionsThese results suggest that rivaroxaban is an effective and safe treatment option among NVAF patients with obesity and polypharmacy in a commercially-insured US population.
Source: Advances in Therapy - May 25, 2021 Category: Drugs & Pharmacology Source Type: research

Oral anticoagulant underutilization among elderly patients with atrial fibrillation: insights from the United States Medicare database
ConclusionsAlthough OAC therapy prescription is the standard of care for stroke prevention in AF patients, its overall utilization is still low among Medicare patients  ≥ 65 years old, with specific patient characteristics that predict underutilization.
Source: Journal of Interventional Cardiac Electrophysiology - July 9, 2022 Category: Cardiology Source Type: research

Atrial Fibrillation Decision Support Tool: Population Perspective
Conclusions Availability of DOACs increases the proportion of patients for whom oral anticoagulation therapy is recommended in a real-world cohort of AF patients and increased projected QALYs by more than 1500 when all patients are receiving thromboprophylaxis as recommended by the AFDST compared with current treatment.
Source: American Heart Journal - August 23, 2017 Category: Cardiology Source Type: research

Safety and Effectiveness of Direct Oral Anticoagulants Versus Warfarin for Treating Left Ventricular Thrombus
ConclusionsIn this diverse population-based cohort of patients, DOAC treatment for left ventricular thrombus appears to be as safe and effective as warfarin treatment. These findings support the use of DOACs for patients with left ventricular thrombus.
Source: American Journal of Cardiovascular Drugs - March 29, 2022 Category: Cardiology Source Type: research

Comparative Effectiveness and Safety Between Apixaban, Dabigatran, Edoxaban, and Rivaroxaban Among Patients With Atrial Fibrillation : A Multinational Population-Based Cohort Study
CONCLUSION: Among patients with AF, apixaban use was associated with lower risk for GIB and similar rates of ischemic stroke or systemic embolism, ICH, and all-cause mortality compared with dabigatran, edoxaban, and rivaroxaban. This finding was consistent for patients aged 80 years or older and those with chronic kidney disease, who are often underrepresented in clinical trials.PRIMARY FUNDING SOURCE: None.PMID:36315950 | DOI:10.7326/M22-0511
Source: Annals of Internal Medicine - October 31, 2022 Category: Internal Medicine Authors: Wallis C Y Lau Carmen Olga Torre Kenneth K C Man Henry Morgan Stewart Sarah Seager Mui Van Zandt Christian Reich Jing Li Jack Brewster Gregory Y H Lip Aroon D Hingorani Li Wei Ian C K Wong Source Type: research

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