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Fixed dose combination therapies in primary cardiovascular disease prevention in different groups: an individual participant meta-analysis
Conclusions In participants with intermediate cardiovascular risk, FDCs produce larger cardiovascular benefits in older individuals, which appear greater with aspirin. Trial registration number HOPE-3, NCT00468923; TIPS-3, NCT016464137; PolyIran, NCT01271985.
Source: Heart - August 24, 2023 Category: Cardiology Authors: Dagenais, G. R., Pais, P., Gao, P., Roshandel, G., Malekzadeh, R., Joseph, P., Yusuf, S. Tags: Cardiac risk factors and prevention Source Type: research

Outcomes and drivers of inappropriate dosing of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation: a systematic review and meta-analysis
Conclusions Our analysis suggests that off-label underdosing of NOACs does not reduce bleeding outcomes. Patients prescribed off-label NOAC doses are at an increased risk of all-cause mortality. These data underscore the importance of prescriber adherence to NOAC dosing guidelines to achieve optimal clinical outcomes for patients with AF. PROSPERO registration number CRD42020219844.
Source: Heart - January 11, 2023 Category: Cardiology Authors: Caso, V., de Groot, J. R., Sanmartin Fernandez, M., Segura, T., Blomström-Lundqvist, C., Hargroves, D., Antoniou, S., Williams, H., Worsley, A., Harris, J., Caleyachetty, A., Vardar, B., Field, P., Ruff, C. T. Tags: Open access Systematic review Source Type: research

Sex-specific differences in adverse outcome events among patients with atrial fibrillation
Conclusion In this large study of patients with established AF, women had a lower risk of death than men, but there were no sex-specific differences in other adverse outcomes.
Source: Heart - August 25, 2022 Category: Cardiology Authors: Evers-Dörpfeld, S., Aeschbacher, S., Hennings, E., Eken, C., Coslovsky, M., Rodondi, N., Beer, J. H., Moschovitis, G., Ammann, P., Kobza, R., Ceylan, S., Krempke, M., Meyer-Zürn, C. S., Moutzouri, E., Springer, A., Sticherling, C., Bonati, Tags: Arrhythmias and sudden death Source Type: research

Management and outcomes of patients with left atrial appendage thrombus prior to percutaneous closure
Conclusion In the presence of LAA thrombus, IAT was the initial management strategy in half of our cohort, with initial thrombus resolution in 60% of these, but with a relatively high bleeding rate (~10%). Direct LAAC was feasible, with high procedural success and absence of periprocedural embolic complications. However, a high rate of device-related thrombosis was detected during follow-up.
Source: Heart - June 24, 2022 Category: Cardiology Authors: Marroquin, L., Tirado-Conte, G., Pracon, R., Streb, W., Gutierrez, H., Boccuzzi, G., Arzamendi-Aizpurua, D., Cruz-Gonzalez, I., Ruiz-Nodar, J. M., Kim, J.-S., Freixa, X., Lopez-Minguez, J. R., De Backer, O., Ruiz-Salmeron, R., Dominguez, A., McInerney, A. Tags: Open access Arrhythmias and sudden death Source Type: research

Effectiveness and safety of oral anticoagulants in elderly patients with atrial fibrillation
Conclusion In this nationwide cohort study of patients ≥75 years initiating oral anticoagulation for AF, standard and reduced dose NOACs were associated with similar risks of stroke/SE as warfarin and lower or similar risks of bleeding. The NOACs seem to be a safe option also in elderly patients.
Source: Heart - February 16, 2022 Category: Cardiology Authors: Rutherford, O.-C. W., Jonasson, C., Ghanima, W., Söderdahl, F., Halvorsen, S. Tags: Open access Arrhythmias and sudden death Source Type: research

Novel bleeding prediction model in atrial fibrillation patients on new oral anticoagulants
Conclusions We present a novel and simple risk score for prediction of major bleeding in patients with non-valvular AF treated with NOACs. Validation in additional cohorts is warranted.
Source: Heart - January 28, 2022 Category: Cardiology Authors: Barnett-Griness, O., Stein, N., Kotler, A., Saliba, W., Gronich, N. Tags: Editor's choice Arrhythmias and sudden death Source Type: research

Single direct oral anticoagulant therapy in stable patients with atrial fibrillation beyond 1 year after coronary stent implantation
Conclusions DOAC monotherapy showed similar efficacy in preventing ischaemic events and was associated with lower major bleeding events compared with combination therapy in patients with AF beyond 1 year after coronary stent implantation.
Source: Heart - January 28, 2022 Category: Cardiology Authors: Choi, Y., Lee, Y., Kim, S.-H., Kim, S., Kim, J. Y., Kim, T.-S., Hwang, Y., Kim, J.-H., Jang, S.-W., Lee, M. Y., Oh, Y.-S. Tags: Coronary artery disease Source Type: research

Oral anticoagulation in end-stage renal disease and atrial fibrillation: is it time to just say no to drugs?
Atrial fibrillation (AF) frequently complicates the management of chronic kidney disease, especially in patients with end-stage renal disease (ESRD). AF occurs in approximately one in five of the 650 000 patients with ESRD in the USA.1 ESRD confers increased risk for AF, while AF hastens progression to ESRD. The presence of chronic kidney disease in patients with AF is associated with an increased risk for ischaemic stroke independent of traditional risk factors. In addition, chronic kidney disease and particularly ESRD are associated with an increased risk of bleeding. Little is understood about how to safely reduce ...
Source: Heart - May 10, 2017 Category: Cardiology Authors: Black-Maier, E., Piccini, J. P. Tags: Editorials Source Type: research

Non-major bleeding with apixaban versus warfarin in patients with atrial fibrillation
Conclusions In ARISTOTLE, non-major bleeding was common and substantially less frequent with apixaban than with warfarin. CRNM bleeding was independently associated with a higher risk of death and subsequent major bleeding. Our results highlight the importance of any severity of bleeding in patients with AF treated with anticoagulation therapy and suggest that non-major bleeding, including minor bleeding, might not be minor. Trial registration number NCT00412984; post-results.
Source: Heart - March 28, 2017 Category: Cardiology Authors: Bahit, M. C., Lopes, R. D., Wojdyla, D. M., Held, C., Hanna, M., Vinereanu, D., Hylek, E. M., Verheugt, F., Goto, S., Alexander, J. H., Wallentin, L., Granger, C. B. Tags: Open access, Drugs: cardiovascular system Arrhythmias and sudden death Source Type: research

Cautious anticoagulation strategy in patients with dialysis-requiring end-stage kidney disease
To the Editor: We read with interest this manuscript which demonstrated in a large clinical registry that patients with chronic kidney disease with indications for anticoagulation were often treated subtherapeutically.1 A more aggressive approach was, therefore, advocated. We would like to point out that, while this study should be commended for including a large number of patients, it did not show data on the key clinical outcomes of stroke or bleeding. We feel, therefore, that a clear association cannot be made between low time in the therapeutic range (TTR) and any negative clinical outcome. In fact, paradoxically,...
Source: Heart - March 28, 2017 Category: Cardiology Authors: Behar, J. M., Forbes, S. H., Wragg, A., Sporton, S. Tags: Correspondence Source Type: research

Pre-procedural dual antiplatelet therapy in patients undergoing transcatheter aortic valve implantation increases risk of bleeding
Conclusions The current study demonstrated that DAPT before TF-TAVI increased the risk of bleeding compared with single or no antiplatelet therapy. Lower intensity antiplatelet therapy was not associated with thrombotic events. In modern practice, it might be reasonable to perform TAVI using single or no pre-procedural antiplatelet therapy with an expectation of no increase of adverse events. Trial registration number UMIN-ID; 000020423; Results.
Source: Heart - February 15, 2017 Category: Cardiology Authors: Hioki, H., Watanabe, Y., Kozuma, K., Nara, Y., Kawashima, H., Kataoka, A., Yamamoto, M., Takagi, K., Araki, M., Tada, N., Shirai, S., Yamanaka, F., Hayashida, K., And on behalf of OCEAN-TAVI investigators Tags: Valvular heart disease Source Type: research

To occlude or not? Left atrial appendage occlusion for stroke prevention in atrial fibrillation
The cornerstone of atrial fibrillation (AF) management is effective stroke prevention, which by now remains the only proven method of improved survival in patients with AF. Oral anticoagulation with the use of vitamin K antagonists (eg, warfarin) or non-vitamin K antagonist oral anticoagulants (NOACs) has been shown to substantially reduce the risk of AF-related strokes and thus is presently the standard of care for stroke prevention in non-valvular AF. Approximately 90% of thrombi being formed in AF are localised in left atrial appendage (LAA).1 Thus, LAA exclusion seems a tempting method of prophylaxis against stroke, pa...
Source: Heart - January 4, 2017 Category: Cardiology Authors: Mazurek, M., Lip, G. Y. H. Tags: Drugs: cardiovascular system, Epidemiology Editorials Source Type: research

Efficacy and safety of left atrial appendage closure versus medical treatment in atrial fibrillation: a network meta-analysis from randomised trials
Conclusions The findings of this meta-analysis suggest that LAAC is superior to placebo and APT, and comparable to NOAC for preventing mortality and stroke or SE, with similar bleeding risk in patients with non-valvular AF. However, these results should be interpreted with caution and more studies are needed to further substantiate this advantage, in view of the wide CIs with some variables in the current meta-analysis.
Source: Heart - January 4, 2017 Category: Cardiology Authors: Sahay, S., Nombela-Franco, L., Rodes-Cabau, J., Jimenez-Quevedo, P., Salinas, P., Biagioni, C., Nunez-Gil, I., Gonzalo, N., de Agustin, J. A., del Trigo, M., Perez de Isla, L., Fernandez-Ortiz, A., Escaned, J., Macaya, C. Tags: Editor's choice, Drugs: cardiovascular system, Epidemiology Arrhythmias and sudden death Source Type: research

Atrial appendage occlusion for stroke prevention in patients with atrial fibrillation
In the developed countries, stroke is an important cause of mortality and disability. Cardioembolism is the most frequent cause of ischaemic stroke, in the presence of atrial fibrillation (AF).1 AF is the most common cardiac arrhythmia in the general population and its prevalence increases with age; the lifetime risk of AF development is 25% in people over 40 years old.2 Anticoagulation has been established as an effective treatment strategy for stroke prevention in patients with AF and risk factors for stroke.3 The new oral anticoagulants (NOACs) seem to be similarly efficacious compared with vitamin K antagonists (V...
Source: Heart - November 24, 2016 Category: Cardiology Authors: Swaans, M. J., Boersma, L. V. A. Tags: Drugs: cardiovascular system, Echocardiography, Hypertension, Interventional cardiology, Clinical diagnostic tests, Epidemiology Editorials Source Type: research

Left atrial appendage occlusion in high-risk patients with non-valvular atrial fibrillation
Conclusions Our data suggest LAA occlusion in high-risk patients with NVAF not suitable for OACs is feasible and associated with low complication rates as well as low rates of stroke and major bleeding at long-term follow-up.
Source: Heart - November 24, 2016 Category: Cardiology Authors: Berti, S., Pastormerlo, L. E., Rezzaghi, M., Trianni, G., Paradossi, U., Cerone, E., Ravani, M., De Caterina, A. R., Rizza, A., Palmieri, C. Tags: Drugs: cardiovascular system, Echocardiography, Clinical diagnostic tests Cardiac risk factors and prevention Source Type: research

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