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Thromboembolic, Bleeding, and Mortality  Risks of Rivaroxaban and Dabigatran in Asians With Nonvalvular Atrial Fibrillation
BackgroundIt is unclear whether the non –vitamin K antagonist oral anticoagulant agents rivaroxaban and dabigatran are superior to warfarin for efficacy and safety outcomes in Asians with nonvalvular atrial fibrillation (NVAF).ObjectivesThe aim of this study was to compare the risk for thromboembolic events, bleeding, and mortality associated with rivaroxaban and dabigatran versus warfarin in Asians with NVAF.MethodsA nationwide retrospective cohort study was conducted of consecutive patients with NVAF taking rivaroxaban (n  = 3,916), dabigatran (n = 5,921), or warfarin (n = 5,251) using data collected from the Taiwan...
Source: Journal of the American College of Cardiology - September 20, 2016 Category: Cardiology Source Type: research

Aspirin Instead of Oral Anticoagulant Prescription in Atrial Fibrillation Patients at Risk for Stroke
ConclusionsIn a large, real-world cardiac outpatient population of AF patients with a moderate to high risk of stroke, more than 1 in 3 were treated with aspirin alone without OAC. Specific patient characteristics predicted prescription of aspirin therapy over OAC.
Source: Journal of the American College of Cardiology - June 21, 2016 Category: Cardiology Source Type: research

Stroke and Bleeding Risks in NOAC- and Warfarin-Treated Patients With Hypertrophic Cardiomyopathy and Atrial Fibrillation
Hypertrophic cardiomyopathy (HCM) affects>600,000 patients in the United States, and approximately 1 in 5 of them have atrial fibrillation (AF) (1). The incidence of stroke in patients with HCM is markedly increased when complicated by AF, with an annualized risk of nearly 4% (2). AF is an indication for warfarin in nearly all patients with HCM (3,4). Non–vitamin K antagonist oral anticoagulants (NOACs) may be reasonable alternatives to warfarin, but there are no explicit data to support their use (3,4).
Source: Journal of the American College of Cardiology - June 21, 2016 Category: Cardiology Source Type: research

CHA 2 DS 2 -VASc Score for Predicting Stroke and Thromboembolism in Patients With AF and Biological Valve Prosthesis
Patients with valvular atrial fibrillation (AF), as defined in the 2012 European Society of Cardiology guidelines (those with a valvular prosthesis or rheumatic mitral disease) should receive anticoagulation regardless of the CHA2DS2-VASc score, with vitamin K antagonist being recommended (1–3). Whether thromboembolic risk related to bioprosthetic valve implantation differs from other forms of AF is not established with certainty. We evaluated the prognostic value of the CHA2DS2-VASc score for thromboembolic in AF patients with aortic or mitral bioprosthesis.
Source: Journal of the American College of Cardiology - January 19, 2016 Category: Cardiology Source Type: research

Matching the NOAC to the Patient Remember the Modifiable Bleeding Risk Factors ∗
Approximately 5 years ago, when deciding on oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF), we did not have a choice; only the vitamin K antagonists (VKA; e.g., warfarin) were available. In 2015, in addition to VKAs, we currently have 4 licensed non-VKA oral anticoagulants (NOACs), and therefore have the opportunity to fit the most appropriate drug to the patient’s risk profile, and vice versa.
Source: Journal of the American College of Cardiology - November 23, 2015 Category: Cardiology Source Type: research

Gastrointestinal Bleeding in Patients With Atrial Fibrillation Treated With Rivaroxaban or Warfarin ROCKET AF Trial
ConclusionsIn the ROCKET AF trial, rivaroxaban increased GI bleeding compared with warfarin. The absolute fatality rate from GI bleeding was low and similar in both treatment arms. Our results further illustrate the need for minimizing modifiable risk factors for GI bleeding in patients on oral anticoagulation.
Source: Journal of the American College of Cardiology - November 23, 2015 Category: Cardiology Source Type: research

Stroke Risk Stratification in Patients With Atrial Fibrillation Comme Ci, Comme Ça, Plus Ça Change… ∗
There has been a huge increase in academic interest in atrial fibrillation (AF) and particularly its major complication: thromboembolism. This sustained flurry of activity is fueled by the development of better thromboprophylaxis with well-controlled vitamin K antagonist (VKA) anticoagulation rather than antiplatelet therapy or poorly controlled management with VKAs. The emergence of new therapies, such as non-VKA oral anticoagulant agents and left atrial appendage occlusion devices with better net clinical benefit (less strokes, fewer intracranial or life-threatening bleeds, and reduced mortality) than with warfarin or as...
Source: Journal of the American College of Cardiology - October 19, 2015 Category: Cardiology Source Type: research

Atrial Fibrillation and Renal Function How High Is the Price of Anticoagulation? ∗
For over a half century, vitamin K antagonists, chiefly warfarin, were the exclusive oral anticoagulants available for long-term anticoagulation. Being “the only game in town,” the emphasis of the accompanying clinical research was focused on determining the most appropriate method to measure anticoagulant effects, define the most efficacious and safe target range for anticoagulation, and identify strategies to maintain and reverse therapeutic anticoagulation. This emphasis came at the expense of turning a blind eye to rare concerns raised about the potential for warfarin to cause or worsen renal dysfunction (1,2). Th...
Source: Journal of the American College of Cardiology - June 8, 2015 Category: Cardiology Source Type: research

Reply One More “C” for CHA 2 DS 2 -VASc Score
We thank Dr. Siu for his comments regarding our recently published paper (1) about the usefulness of the CHA2DS2-VASc score for refining stroke risk stratification among patients with atrial fibrillation (AF) having an ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) score of 0 to 5. We agree that the risk of ischemic stroke for Chinese AF patients with a CHA2DS2-VASc score of 0 is higher than that of Caucasians. However, it does not mean that non-vitamin K antagonist oral anticoagulants (NOACs) should be routinely prescribed for these patients. Our previous study demonstrated that the risk of ischemic strok...
Source: Journal of the American College of Cardiology - April 13, 2015 Category: Cardiology Source Type: research

Antithrombotic Regimens in Patients With Atrial Fibrillation and Coronary Disease: Optimizing Efficacy and Safety∗
Clear evidence supports the value of oral anticoagulation (OAC) with vitamin K antagonists in preventing stroke and thromboembolism in patients with atrial fibrillation (AF) who have well-established risk factors. For this indication, vitamin K antagonists have been shown to be superior to single or dual antiplatelet agents in reducing thromboembolic complications . Yet, up to 30% of patients with AF also have indications for antiplatelet therapy because of coronary artery disease . Dual antiplatelet therapy with aspirin and a P2Y12 receptor inhibitor (e.g., clopidogrel) is usually recommended after stent implantation or a...
Source: Journal of the American College of Cardiology - June 10, 2013 Category: Cardiology Authors: Steven M. Markowitz Tags: Coronary Artery Disease: Editorial Comment Source Type: research

Triple Therapy With Aspirin, Prasugrel, and Vitamin K Antagonists in Patients With Drug-Eluting Stent Implantation and an Indication for Oral Anticoagulation
This study sought to evaluate whether prasugrel may serve as an alternative to clopidogrel in patients with triple therapy. Background: Approximately 10% of patients who receive dual antiplatelet therapy after percutaneous coronary intervention have an indication for oral anticoagulation and are thus treated with triple therapy. The standard adenosine diphosphate receptor blocker in this setting is clopidogrel. Data regarding prasugrel as part of triple therapy are not available. Methods: We analyzed a consecutive series of 377 patients who underwent drug-eluting stent implantation and had an indication for oral antico...
Source: Journal of the American College of Cardiology - March 25, 2013 Category: Cardiology Authors: Nikolaus Sarafoff, Amadea Martischnig, Jill Wealer, Katharina Mayer, Julinda Mehilli, Dirk Sibbing, Adnan Kastrati Tags: Interventional Cardiology Source Type: research

Outcomes of Discontinuing Rivaroxaban Compared With Warfarin in Patients With Nonvalvular Atrial Fibrillation: Analysis From the ROCKET AF Trial (Rivaroxaban Once-Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation)
Conclusions: In atrial fibrillation patients who temporarily or permanently discontinued anticoagulation, the risk of stroke or non-CNS embolism was similar with rivaroxaban or warfarin. An increased risk of stroke and non-CNS embolism was observed in rivaroxaban-treated patients compared with warfarin-treated patients after the end of the study, underscoring the importance of therapeutic anticoagulation coverage during such a transition.
Source: Journal of the American College of Cardiology - February 6, 2013 Category: Cardiology Authors: Manesh R. Patel, Anne S. Hellkamp, Yuliya Lokhnygina, Jonathan P. Piccini, Zhongxin Zhang, Surya Mohanty, Daniel E. Singer, Werner Hacke, Günter Breithardt, Jonathan L. Halperin, Graeme J. Hankey, Richard C. Becker, Christopher C. Nessel, Scott D. Berkow Tags: Heart Rhythm Disorders Source Type: research

Discontinuation of Rivaroxaban: Filling in the Gaps⁎
Late in 2011, rivaroxaban became the first factor Xa inhibitor to receive regulatory approval for the prevention of stroke in patients with atrial fibrillation (AF), based largely on the results of the phase III 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 (), which enrolled 14,264 patients in a double-blind, double-dummy design. The ROCKET AF trial clearly established the noninferiority of rivaroxaban compared with warfarin for the primary endpoint of stroke or systemic embolism. The superio...
Source: Journal of the American College of Cardiology - February 6, 2013 Category: Cardiology Authors: Matthew R. Reynolds Tags: Heart Rhythm Disorders: Editorial Comment Source Type: research

Lack of Stroke Subtype Information May Hinder Indirect Comparison Between the ROCKET-AF and Other Trials of New Oral Anticoagulants
Although we agree with Lip et al. () on the limitation of their study, we argue that lack of stroke subtype information may hinder scientific conclusion by including 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) in any indirect comparison of new oral anticoagulants (NOA).
Source: Journal of the American College of Cardiology - January 30, 2013 Category: Cardiology Authors: Hai-feng Li, Ren-liang Zhao Tags: Letters to the Editor Source Type: research

Reply
We thank Drs. Li and Zhao for their interest in our paper (). 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 patients...
Source: Journal of the American College of Cardiology - January 30, 2013 Category: Cardiology Authors: Gregory Y.H. Lip, Torben Bjerregaard Larsen, Flemming Skjøth, Lars Hvilsted Rasmussen Tags: Letters to the Editor Source Type: research