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An evidence-based review of edoxaban and its role in stroke prevention in patients with nonvalvular atrial fibrillation
Tushar Acharya, Prakash Deedwania Division of Cardiology, Department of Internal Medicine, University of California, San Francisco, Fresno, CA, USA Abstract: Atrial fibrillation is the most common arrhythmia in the elderly. It is responsible for significant morbidity and mortality from cardioembolic complications like stroke. As a result, atrial fibrillation patients are risk-stratified using the CHADS2 or CHA2DS2-VASc scoring systems. Those at intermediate-to-high risk have traditionally been treated with therapeutic anticoagulation with warfarin for stroke prevention. Although effective, warfarin use is fraught with mult...
Source: Core Evidence - April 27, 2015 Category: Drugs & Pharmacology Tags: Core Evidence Source Type: research

Uninterrupted Dabigatran versus Warfarin in the Treatment of Intracardiac Thrombus in Patients with non-Valvular Atrial Fibrillation
Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice and increases the risk of thrombus in the left atrial appendage (LAA) which is strongly associated with an increased risk of ischemic stroke [1, 2]. Embolic strokes caused by AF are typically severe, more commonly disabling and fatal compared with strokes not associated with AF [1, 3]. Transesophageal echocardiography (TEE) is a sensitive method for intracardiac thrombus identification. When AF lasts for 2 days, atrial thrombi may take place in up to 14% patients on TEE examination; the prevalence of thrombus in AF patients varies from 10% ...
Source: International Journal of Cardiology - April 15, 2015 Category: Cardiology Authors: Li Hao, Jing-quan Zhong, Wei Zhang, Bing Rong, Fei Xie, Jun-tao Wang, Xin Yue, Zhao-tong Zheng, Qing Zhu, Yun Zhang Tags: Letter to the Editor Source Type: research

Case 4–2015
ATRIAL FIBRILLATION (AF) is the most common cardiac arrhythmia in the world and is estimated to affect more than 3 million people in the United States, with a projected increase to more than 5 million people in the US by the year 2050.1 AF is an independent risk factor for stroke and is associated with a four- to five-fold increased risk of embolic stroke compared with those individuals without AF. Oral anticoagulation therapy with warfarin or other agents (dabigatran, apixaban) significantly reduces the risk of stroke in this population; however, anticoagulation carries inherent risks.
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 18, 2015 Category: Anesthesiology Authors: Megan J. Lanigan, Mark A. Chaney, Sandeep Nathan, Atman P. Shah, Andrew J. Feider Tags: Case Conference Source Type: research

Left atrial thrombus formation and resolution during dabigatran therapy: A Japanese Heart Rhythm Society report
Conclusions LA thrombus developed in 4% of patients with AF receiving Dabi. Older patients with a higher CHADS2 score receiving a lower Dabi dosage were more likely to develop LA thrombus, which was resolved with a prolonged or increased dosage. A higher Dabi dosage may be more beneficial before ECV but prospective randomized studies would be needed to confirm these results.
Source: Journal of Arrhythmia - March 14, 2015 Category: Cardiology Source Type: research

Prevalence of Intracardiac Thrombi Under Phenprocoumon, Direct Oral Anticoagulants (Dabigatran and Rivaroxaban), and Bridging Therapy in Patients With Atrial Fibrillation and Flutter
Direct oral anticoagulants (DOACs) are effective for stroke prevention in nonvalvular atrial fibrillation (AF). Cardioversion (CV) is frequently performed in patients with AF or flutter. To further explore the safety profile of DOACs in the context of CV, we sought to assess the prevalence of intracardiac thrombi under DOAC therapy in comparison with treatment with vitamin K antagonists. A total of 672 transesophageal echocardiograms performed in 643 patients with a history of nonvalvular AF were analyzed.
Source: The American Journal of Cardiology - December 17, 2014 Category: Cardiology Authors: Maura M. Zylla, Mara Pohlmeier, Alexander Hess, Derliz Mereles, Meinhard Kieser, Thomas Bruckner, Eberhard Scholz, Edgar Zitron, Patrick A. Schweizer, Hugo A. Katus, Dierk Thomas Tags: Arrhythmias and Conduction Disturbances Source Type: research

Novel oral Anticoagulants in Non-Valvular Atrial Fibrillation.
This article is a review of the major studies of the NOACs. The clinical use of these drugs in patients with non-valvular atrial fibrillation is presented. PMID: 25470147 [PubMed - in process]
Source: Cardiovascular and Hematological Agents in Medicinal Chemistry - December 5, 2014 Category: Cardiology Tags: Cardiovasc Hematol Agents Med Chem Source Type: research

Apixaban exerts anti-inflammatory effects in mesangial cells by blocking thrombin/protease-activated receptor-1 system
Atrial fibrillation (AF) is most frequent arrhythmia in patients with chronic kidney disease (CKD) [1,2]. Since diabetes and hypertension are risk components of CHADS2 score and also risk factors for CKD, CKD could affect cardiovascular outcomes in patients with AF [2–5]. Indeed, several papers have shown that renal dysfunction increases the risk of thromboembolic events, stroke and all-cause mortality in AF patients [2–5]. In randomized trials of AF patients with stage III CKD, novel oral anticoagulant, dabigatran 150mg twice daily was superior to warfarin for stroke prevention, while apixaban was superior in regard t...
Source: Thrombosis Research - September 25, 2014 Category: Hematology Authors: Yuji Ishibashi, Takanori Matsui, Sho-ichi Yamagishi Tags: Letter to the Editor-in-Chief Source Type: research

Non-vitamin-K oral anticoagulants reduce mortality, stroke and intracranial haemorrhage when compared with warfarin in randomised trials of patients with non-valvular atrial fibrillation
Commentary on: Ruff CT, Giugliano RP, Braunwald E, et al.. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 2014;383:955–62. Context Historically, the standard medication for stroke prevention in atrial fibrillation (AF) has been a vitamin-K antagonist (warfarin). However, several non-vitamin-K oral anticoagulants (NOACs) have been developed and shown to be at least as effective as dose-adjusted warfarin in their respective phase-3 clinical trials.1–4 These include the direct thrombin inhibitor dabig...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Steinberg, B. A. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Connective tissue disease, Musculoskeletal syndromes, Diabetes, Arrhythmias Therapeutics Source Type: research

New oral anticoagulants in the prevention of thromboembolic complications in atrial fibrillation - a single-center experience.
Abstract Introduction:The prevention of thromboembolic complications in patients with atrial fibrillation(AF) takes priority in this group. In light of applicable guidelines, thesignificance of vitamin K antagonists (VKA) in stroke prevention decreased in favorofan ever more important role of new oral anticoagulants (nOAC). Theobjectives of this study are: theevaluation of the frequency of nOAC recommendations, the comparison between thepopulation of patients treatedwith VKA and those receiving nOAC, as well as theidentification of factors predisposing to the administration of nOAC to AF patients ondischarge.Metho...
Source: Polish Heart Journal - September 2, 2014 Category: Cardiology Authors: Gorczyca-Michta I, Wożakowska-Kapłon B Tags: Kardiol Pol Source Type: research

Novel oral anticoagulants: too good to be true?
It is fair to say that the pharmacological therapy of cardiovascular disease has not been an area of spectacular growth in recent years. Little has happened in the treatment of hypertension and heart failure. There has been interest in the development of antiplatelet drugs in acute coronary syndromes and percutaneous interventions, but not in long-term cardiovascular prevention to compete with aspirin and clopidogrel. The one major area of intense interest has been the novel oral anticoagulants (NOACs), dabigatran, rivaroxaban and apixaban. The first of these is a direct thrombin inhibitor, while the other two are blockers...
Source: Postgraduate Medical Journal - August 18, 2014 Category: Journals (General) Authors: Schachter, M. Tags: Editor's choice, Drugs: cardiovascular system, Stroke, Hypertension, Ischaemic heart disease, Arrhythmias Editorials Source Type: research

Intracranial Hemorrhage Mortality in Atrial Fibrillation Patients Treated With Dabigatran or Warfarin Clinical Sciences
Conclusions— In this sample of AF patients with ICB on oral anticoagulants, dabigatran was not associated with higher in-hospital mortality compared with warfarin. Hence, reluctance to use dabigatran because of a lack of approved reversal agents is not supported by our results.
Source: Stroke - July 28, 2014 Category: Neurology Authors: Alonso, A., Bengtson, L. G. S., MacLehose, R. F., Lutsey, P. L., Chen, L. Y., Lakshminarayan, K. Tags: Cerebrovascular disease/stroke, Coumarins, Other anticoagulants, Arrhythmias, clinical electrophysiology, drugs, Anticoagulants Clinical Sciences 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

Abstract 161: Atrial Fibrillation in India: Insights from the PINNACLE India Outpatient Registry Session Title: Poster Session I
Conclusion: AF is tough to diagnose since it is often asymptomatic and clinicians need many tests to confirm diagnosis. Lack of documentation or detection of AF and its associated conditions is a concern. AF can lead to life threatening problems such as stroke and heart failure. The surveillance of AF in India is important in order to identify opportunities for intervention. Continued data collection through the use of a cardiovascular registry can improve the understanding of AF in India.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Glusenkamp, N. T., Risch, S. A., Kerkar, P., Kumar, G., Oetgen, W. J. Tags: Session Title: Poster Session I Source Type: research

Direct Oral Anticoagulants in Atrial Fibrillation
Atrial fibrillation (AF), the most frequent sustained arrhythmia, is associated with an increased risk of thromboembolic events. The risk of stroke depends on risk factors such as age, hypertension, heart failure, and vascular disease. Thus, antithrombotic therapy is a cornerstone in the management of AF. Warfarin is successfully used to reduce thromboembolic events. More recently, direct thrombin (dabigatran) and factor Xa (apixaban, edoxaban, rivaroxaban) inhibitors have been compared to warfarin in large randomized trials. All new substances have been shown to be non-inferior to warfarin concerning thromboembolic events...
Source: Seminars in Hematology - April 9, 2014 Category: Hematology Authors: Georg Noll, Sarah Noll, David Hürlimann Source Type: research

Current and new oral antithrombotics in non-valvular atrial fibrillation: a network meta-analysis of 79 808 patients
Conclusions In this network meta-analysis, novel oral anticoagulants were the most promising treatments to reduce stroke, stroke or systemic embolism, and all-cause mortality in patients with AF.
Source: Heart - February 10, 2014 Category: Cardiology Authors: Dogliotti, A., Paolasso, E., Giugliano, R. P. Tags: Drugs: cardiovascular system, Epidemiology Arrhythmias and sudden death Source Type: research

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