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A novel risk prediction score in atrial fibrillation for a net clinical outcome from the ENGAGE AF-TIMI 48 randomized clinical trial
Conclusion</div>In VKA naive patients with AF, the TIMI-AF score can assist in the prediction of a poor composite outcome and guide selection of anticoagulant therapy by identifying a differential clinical benefit with a NOAC or VKA.</span>
Source: European Heart Journal - January 7, 2017 Category: Cardiology 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

Comparison of the ATRIA, CHADS2, and CHA2DS2-VASc stroke risk scores in predicting ischaemic stroke in a large Swedish cohort of patients with atrial fibrillation
Conclusion In this SAF cohort, the ATRIA score predicted ischaemic stroke risk better than CHADS2 or CHA2DS2-VASc. However, relative performance of the categorical scores varied by population stroke rates. Score cut-points may need to be optimized to better fit local population stroke rates.
Source: European Heart Journal - November 16, 2016 Category: Cardiology Authors: Aspberg, S., Chang, Y., Atterman, A., Bottai, M., Go, A. S., Singer, D. E. Tags: Prevention and epidemiology Source Type: research

Ischaemic and haemorrhagic stroke associated with non-vitamin K antagonist oral anticoagulants and warfarin use in patients with atrial fibrillation: a nationwide cohort study
Conclusions</div>Among anticoagulant-naïve AF patients, treatment with NOACs was not associated with significantly lower risk of stroke/TE compared with VKA, but intracranial bleeding risk was significantly lower with dabigatran and apixaban.</span>
Source: European Heart Journal - October 14, 2016 Category: Cardiology Source Type: research

Antithrombotic therapy in heart failure patients with and without atrial fibrillation: update and future challenges
Atrial fibrillation (AF) and heart failure (HF) often coexist, and patients with AF and HF have a higher risk of thromboembolic events and overall mortality compared with those with AF without HF. Additionally, the prevalence of AF increases with the severity of HF. The use of vitamin K antagonists is more unstable in patients with concomitant AF and HF, which is an independent risk factor for reduced time under therapeutic range. More recently, non-vitamin K antagonists oral anticoagulants (NOACs) have emerged as therapeutic alternatives for stroke prevention in patients with non-valvular AF, as they have been shown to be...
Source: European Heart Journal - August 23, 2016 Category: Cardiology Authors: Ferreira, J. P., Girerd, N., Alshalash, S., Konstam, M. A., Zannad, F. Tags: Clinical update Source Type: research

Outcomes and costs of left atrial appendage closure from randomized controlled trial and real-world experience relative to oral anticoagulation
Conclusion</strong> 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.</span>
Source: European Heart Journal - February 29, 2016 Category: Cardiology Source Type: research

Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 1
<span class="paragraphSection">Patients with atrial fibrillation (AF) have a high risk of stroke and mortality, which can be considerably reduced by oral anticoagulants (OAC). Recently, four non-vitamin-K oral anticoagulants (NOACs) were compared with warfarin in large randomized trials for the prevention of stroke and systemic embolism. Today's clinician is faced with the difficult task of selecting a suitable OAC for a patient with a particular clinical profile or a particular pattern of risk factors and concomitant diseases. We reviewed analyses of subgroups of patients from trials of vitamin K antagonists vs. NOA...
Source: European Heart Journal - February 4, 2016 Category: Cardiology 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

Edoxaban vs. warfarin in patients with atrial fibrillation on amiodarone: a subgroup analysis of the ENGAGE AF-TIMI 48 trial
Conclusions Patients randomized to the LDE treated with amiodarone at the time of randomization demonstrated a significant reduction in ischaemic events vs. warfarin when compared with those not on amiodarone, while preserving a favourable bleeding profile. In contrast, amiodarone had no effect on the relative efficacy and safety of HDE.
Source: European Heart Journal - September 1, 2015 Category: Cardiology Authors: Steffel, J., Giugliano, R. P., Braunwald, E., Murphy, S. A., Atar, D., Heidbuchel, H., Camm, A. J., Antman, E. M., Ruff, C. T. Tags: Thrombosis and anti-thrombotic therapy 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

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

Higher risk of death and stroke in patients with persistent vs. paroxysmal atrial fibrillation: results from the ROCKET-AF Trial
Conclusion In patients with AF at moderate-to-high risk of stroke receiving anticoagulation, those with persistent AF have a higher risk of thrombo-embolic events and worse survival compared with paroxysmal AF.
Source: European Heart Journal - February 2, 2015 Category: Cardiology Authors: Steinberg, B. A., Hellkamp, A. S., Lokhnygina, Y., Patel, M. R., Breithardt, G., Hankey, G. J., Becker, R. C., Singer, D. E., Halperin, J. L., Hacke, W., Nessel, C. C., Berkowitz, S. D., Mahaffey, K. W., Fox, K. A. A., Califf, R. M., Piccini, J. P., on be Tags: Atrial fibrillation Source Type: research

Balancing stroke and bleeding risks in patients with atrial fibrillation and renal failure: the Swedish Atrial Fibrillation Cohort study
Conclusions Patients with both AF and renal failure will probably benefit most from having the same treatment as is recommended for other patients with AF, without setting a higher or lower threshold for treatment. Adding additional points for renal failure to the CHADS2 and CHA2DS2-VASc scores did not improve their predictive value.
Source: European Heart Journal - February 2, 2015 Category: Cardiology Authors: Friberg, L., Benson, L., Lip, G. Y. H. 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

CardioPulse Articles * New oral anticoagulants for non-valvular atrial fibrillation: harder to handle than expected * Once-daily edoxaban: a safer option than well-managed warfarin for patients with atrial fibrillation? * The Quick Test: 80 years on * Apixaban: a new direct oral anticoagulant for stroke prevention in atrial fibrillation * Novel oral anticoagulants in the emergency room
Source: European Heart Journal - July 21, 2014 Category: Cardiology Tags: CardioPulse Source Type: research

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