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Initiation of warfarin in patients with atrial fibrillation: early effects on ischaemic strokes
Conclusion Patients initiating warfarin may be at an increased risk of stroke during the first 30 days of treatment, supporting the biological plausibility of a transient hypercoagulable state at the start of the treatment, although additional studies are needed to confirm these findings.
Source: European Heart Journal - July 21, 2014 Category: Cardiology Authors: Azoulay, L., Dell'Aniello, S., Simon, T. A., Renoux, C., Suissa, S. Tags: Atrial fibrillation Source Type: research

Clinical outcomes and management associated with major bleeding in patients with atrial fibrillation treated with apixaban or warfarin: insights from the ARISTOTLE trial
Conclusion Major bleeding was associated with substantially increased risk of death, ischaemic stroke, or MI, especially following ICH, and this risk was similarly elevated regardless of treatment with apixaban or warfarin. These results underscore the importance of preventing bleeding in anti-coagulated patients. Clinical Trials.gov identifier NCT00412984.
Source: European Heart Journal - May 21, 2015 Category: Cardiology Authors: Held, C., Hylek, E. M., Alexander, J. H., Hanna, M., Lopes, R. D., Wojdyla, D. M., Thomas, L., Al-Khalidi, H., Alings, M., Xavier, D., Ansell, J., Goto, S., Ruzyllo, W., Rosenqvist, M., Verheugt, F. W. A., Zhu, J., Granger, C. B., Wallentin, L. Tags: Thrombosis and antithrombotic therapy Source Type: research

Outcomes of apixaban vs. warfarin by type and duration of atrial fibrillation: results from the ARISTOTLE trial
Conclusion The risks of stroke, mortality, and major bleeding were lower with apixaban than warfarin regardless of AF type and duration. Although the risk of stroke or systemic embolism was lower in paroxysmal than persistent or permanent AF, apixaban is an attractive alternative to warfarin in patients with AF and at least one other risk factor for stroke, regardless of the type or duration of AF.
Source: European Heart Journal - August 14, 2013 Category: Cardiology Authors: Al-Khatib, S. M., Thomas, L., Wallentin, L., Lopes, R. D., Gersh, B., Garcia, D., Ezekowitz, J., Alings, M., Yang, H., Alexander, J. H., Flaker, G., Hanna, M., Granger, C. B. Tags: Arrhythmia/electrophysiology Source Type: research

Efficacy and safety of rivaroxaban compared with warfarin in patients with peripheral artery disease and non-valvular atrial fibrillation: insights from ROCKET AF
Conclusion Patients with PAD in ROCKET AF did not have a statistically significant higher risk of stroke or systemic embolism than patients without PAD, and there were similar efficacy outcomes in patients treated with rivaroxaban and warfarin. In PAD patients, there was a higher risk of major bleeding or NMCR bleeding with rivaroxaban when compared with warfarin (interaction P = 0.037). Further investigation is warranted to validate this subgroup analysis and determine the optimal treatment in this high-risk cohort of AF patients with PAD.
Source: European Heart Journal - January 21, 2014 Category: Cardiology Authors: Jones, W. S., Hellkamp, A. S., Halperin, J., Piccini, J. P., Breithardt, G., Singer, D. E., Fox, K. A. A., Hankey, G. J., Mahaffey, K. W., Califf, R. M., Patel, M. R. Tags: Atrial fibrillation Source Type: research

Prognostic value of CHA2DS2-VASc score in patients with 'non-valvular atrial fibrillation' and valvular heart disease: the Loire Valley Atrial Fibrillation Project
Conclusion In patients with non-valvular AF, left-sided valvular heart disease (excluding mitral stenosis and protheses) was associated with an increased risk of stroke/TE events. A higher CHA2DS2VASc score in these patients is likely to explain these results.
Source: European Heart Journal - July 21, 2015 Category: Cardiology Authors: Philippart, R., Brunet-Bernard, A., Clementy, N., Bourguignon, T., Mirza, A., Babuty, D., Angoulvant, D., Lip, G. Y. H., Fauchier, L. Tags: CLINICAL RESEARCH Source Type: research

Clinical outcomes in patients with atrial fibrillation according to sex during anticoagulation with apixaban or warfarin: a secondary analysis of a randomized controlled trial
Conclusion In the ARISTOTLE trial, women had a similar rate of stroke or systemic embolism but a lower risk of mortality and less clinically relevant bleeding than men. The efficacy and safety benefits of apixaban compared with warfarin were consistent in men and women. Trial registration ARISTOTLE ClinicalTrials.gov number, NCT00412984.
Source: European Heart Journal - December 7, 2015 Category: Cardiology Authors: Vinereanu, D., Stevens, S. R., Alexander, J. H., Al-Khatib, S. M., Avezum, A., Bahit, M. C., Granger, C. B., Lopes, R. D., Halvorsen, S., Hanna, M., Husted, S., Hylek, E. M., Mărgulescu, A. D., Wallentin, L., Atar, D. Tags: Atrial fibrillation Source Type: research

Implant success and safety of left atrial appendage closure with the WATCHMAN device: peri-procedural outcomes from the EWOLUTION registry
Conclusion Left atrial appendage closure with the WATCHMAN device has a high success rate in complete LAAC with low peri-procedural risk, even in a population with a higher risk of stroke and bleeding, and multiple co-morbidities. Improvement in implantation techniques has led to a reduction of peri-procedural complications previously limiting the net clinical benefit of the procedure.
Source: European Heart Journal - August 23, 2016 Category: Cardiology Authors: Boersma, L. V. A., Schmidt, B., Betts, T. R., Sievert, H., Tamburino, C., Teiger, E., Pokushalov, E., Kische, S., Schmitz, T., Stein, K. M., Bergmann, M. W., on behalf of the EWOLUTION investigators, Nooryani, Meincke, Mobius-Winkler, Senatore, Foley, Sch Tags: Atrial fibrillation Source Type: research

Apixaban vs. warfarin with concomitant aspirin in patients with atrial fibrillation: insights from the ARISTOTLE trial
Conclusion Apixaban had similar beneficial effects on stroke or systemic embolism and major bleeding compared with warfarin, irrespective of concomitant aspirin use.
Source: European Heart Journal - January 21, 2014 Category: Cardiology Authors: Alexander, J. H., Lopes, R. D., Thomas, L., Alings, M., Atar, D., Aylward, P., Goto, S., Hanna, M., Huber, K., Husted, S., Lewis, B. S., McMurray, J. J. V., Pais, P., Pouleur, H., Steg, P. G., Verheugt, F. W. A., Wojdyla, D. M., Granger, C. B., Wallentin, Tags: Atrial fibrillation Source Type: research

Clinical characteristics and outcomes with rivaroxaban vs. warfarin in patients with non-valvular atrial fibrillation but underlying native mitral and aortic valve disease participating in the ROCKET AF trial
Conclusions Many patients with ‘non-valvular atrial fibrillation’ have significant valve lesions. Their risk of stroke is similar to that of patients without SVD after controlling for stroke risk factors. Efficacy of rivaroxaban vs. warfarin was similar in patients with and without SVD; however, the observed risk of bleeding was higher with rivaroxaban in patients with SVD but was the same among those without SVD. Atrial fibrillation patients with and without SVD experience the same stroke-preventive benefit of oral anticoagulants.
Source: European Heart Journal - December 14, 2014 Category: Cardiology Authors: Breithardt, G., Baumgartner, H., Berkowitz, S. D., Hellkamp, A. S., Piccini, J. P., Stevens, S. R., Lokhnygina, Y., Patel, M. R., Halperin, J. L., Singer, D. E., Hankey, G. J., Hacke, W., Becker, R. C., Nessel, C. C., Mahaffey, K. W., Fox, K. A. A., Calif Tags: Atrial fibrillation Source Type: research

Edoxaban vs. warfarin in vitamin K antagonist experienced and naive patients with atrial fibrillation
Conclusion In patients with AF, edoxaban appeared to demonstrate greater efficacy compared with warfarin in patients who were VKA naive than VKA experienced. Edoxaban significantly reduced major bleeding compared with warfarin regardless of prior VKA exposure.
Source: European Heart Journal - June 14, 2015 Category: Cardiology Authors: O'Donoghue, M. L., Ruff, C. T., Giugliano, R. P., Murphy, S. A., Grip, L. T., Mercuri, M. F., Rutman, H., Shi, M., Kania, G., Cermak, O., Braunwald, E., Antman, E. M. Tags: Atrial fibrillation Source Type: research

Outcomes and costs of left atrial appendage closure from randomized controlled trial and real-world experience relative to oral anticoagulation
Conclusion Left atrial appendage closure in NVAF in a real-world setting may result in lower stroke and major bleeding rates than reported in LAAC clinical trials. Left atrial appendage closure in both settings achieves cost parity in a relatively short period of time and may offer substantial savings compared with current therapies. Savings are most pronounced among higher risk patients and those unsuitable for anticoagulation.
Source: European Heart Journal - December 29, 2016 Category: Cardiology Authors: Panikker, S., Lord, J., Jarman, J. W. E., Armstrong, S., Jones, D. G., Haldar, S., Butcher, C., Khan, H., Mantziari, L., Nicol, E., Hussain, W., Clague, J. R., Foran, J. P., Markides, V., Wong, T. Tags: Thrombosis and antithrombotic therapy Source Type: research

Revisiting sex differences in outcomes in non-valvular atrial fibrillation: a population-based cohort study
ConclusionIn NVAF, women were not at higher risk of thromboembolic events than men in our study. The small increased risk reported in previous studies may be related to residual confounding, in particular from insufficient control for age.
Source: European Heart Journal - January 10, 2017 Category: Cardiology Source Type: research

‘Ten Commandments’ of the EHRA Guide for the Use of NOACs in AF
Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with atrial fibrillation (AF), and have emerged as the preferred choice, particularly in patients newly started on anticoagulation. Both physicians and patients are becoming more accustomed to the use of these drugs in clinical practice. However, many unresolved questions on how to optimally use these agents in specific clinical situations remain. In 2013, the first “EHRA Practical Guide” was published to provide practical guidance for situations; an update was published in 2015. Below ...
Source: European Heart Journal - April 21, 2018 Category: Cardiology Source Type: research

Randomized trial of atrial arrhythmia monitoring to guide anticoagulation in patients with implanted defibrillator and cardiac resynchronization devices
Conclusion In patients with implanted defibrillators, the strategy of early initiation and interruption of anticoagulation based on remotely detected AT did not prevent thromboembolism and bleeding. Clinical trial registration IMPACT ClinicalTrials.gov identifier: NCT00559988 http://clinicaltrials.gov/ct2/show/NCT00559988?term=NCT00559988&rank=1.
Source: European Heart Journal - July 7, 2015 Category: Cardiology Authors: Martin, D. T., Bersohn, M. M., Waldo, A. L., Wathen, M. S., Choucair, W. K., Lip, G. Y. H., Ip, J., Holcomb, R., Akar, J. G., Halperin, J. L., on behalf of the IMPACT Investigators Tags: Atrial fibrillation Source Type: research

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