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Series Stroke prevention in atrial fibrillation
Atrial fibrillation is found in a third of all ischaemic strokes, even more after post-stroke atrial fibrillation monitoring. Data from stroke registries show that both unknown and untreated or under treated atrial fibrillation is responsible for most of these strokes, which are often fatal or debilitating. Most could be prevented if efforts were directed towards detection of atrial fibrillation before stroke occurs, through screening or case finding, and treatment of all patients with atrial fibrillation at increased risk of stroke with well-controlled vitamin K antagonists or non-vitamin K antagonist anticoagulants.
Source: LANCET - August 19, 2016 Category: Journals (General) Authors: Ben Freedman, Tatjana S Potpara, Gregory Y H Lip Tags: Series Source Type: research

Comment Stroke and mortality after atrial fibrillation —a global struggle
Atrial fibrillation is a widely recognised health-care challenge with increasing prevalence across the world. Epidemiological observations mainly attribute this increase to an ageing population and better prognosis in distinguishing it from other cardiac disorders such as myocardial infarction.1 Research into atrial fibrillation has focused on antithrombotic management for stroke prevention and mortality, in the era of non-vitamin K antagonist oral anticoagulants.2 However, although these large, phase 3 trials enrolled patients from many centres in different countries and included broad populations, regional differences an...
Source: LANCET - August 7, 2016 Category: Journals (General) Authors: Torben Bjerregaard Larsen, Peter Br ønnum Nielsen Tags: Comment Source Type: research

Correspondence Intracerebral haemorrhage, atrial fibrillation, and anticoagulation
The Review by Freek Verheugt and colleagues (July 18, p 303)1 provides an excellent overview of non-vitamin K antagonist oral anticoagulants (NOACs) and stroke prevention in atrial fibrillation. However, we emphasise another factor that was omitted: survivors of intracranial haemorrhage who also have atrial fibrillation. Observational studies show up to 37% of patients with an intracerebral haemorrhage have concurrent atrial fibrillation,2 with absolute numbers of patients who have anticoagulant-related intracranial haemorrhage expected to increase because of the increased use of oral anticoagulation and an ageing population.
Source: LANCET - October 30, 2015 Category: Journals (General) Authors: Duncan Wilson, Rustam Al-Shahi Salman, Catharina J M Klijn, Gregory Y H Lip, David J Werring Tags: Correspondence Source Type: research

Correspondence Intracerebral haemorrhage, atrial fibrillation, and anticoagulation – Authors' reply
We thank Duncan Wilson and colleagues for their comments about our Review.1 These authors discuss an important issue and suggest that non-vitamin K antagonist oral anticoagulants might provide a strong option to reduce ischaemic stroke in patients who have atrial fibrillation and have suffered an intracranial haemorrhage. A fundamental advantage of non-vitamin K antagonist oral anticoagulants over warfarin is the substantially lower risk of intracranial haemorrhage,2 and this feature might be particularly important for patients at high risk of intracranial haemorrhage, including those with previous history of this disorder.
Source: LANCET - October 30, 2015 Category: Journals (General) Authors: Freek W A Verheugt, Christopher B Granger Tags: Correspondence Source Type: research

Series Oral anticoagulants for stroke prevention in atrial fibrillation: current status, special situations, and unmet needs
In patients with non-valvular atrial fibrillation, oral anticoagulation with vitamin K antagonists reduces the risk of stroke by more than 60%. But vitamin K antagonists have limitations, including causing serious bleeding such as intracranial haemorrhage and the need for anticoagulation monitoring. In part related to these limitations, they are used in only about half of patients who should be treated according to guideline recommendations. In the past decade, oral agents have been developed that directly block the activity of thrombin (factor IIa), as well as drugs that directly inhibit activated factor X (Xa), which is ...
Source: LANCET - March 14, 2015 Category: Journals (General) Authors: Freek W A Verheugt, Christopher B Granger Tags: Series Source Type: research

Articles Digoxin use in patients with atrial fibrillation and adverse cardiovascular outcomes: a retrospective analysis of the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF)
Digoxin treatment was associated with a significant increase in all-cause mortality, vascular death, and sudden death in patients with AF. This association was independent of other measured prognostic factors, and although residual confounding could account for these results, these data show the possibility of digoxin having these effects. A randomised trial of digoxin in treatment of AF patients with and without heart failure is needed.
Source: LANCET - March 6, 2015 Category: Journals (General) Authors: Jeffrey B Washam, Susanna R Stevens, Yuliya Lokhnygina, Jonathan L Halperin, Günter Breithardt, Daniel E Singer, Kenneth W Mahaffey, Graeme J Hankey, Scott D Berkowitz, Christopher C Nessel, Keith A A Fox, Robert M Califf, Jonathan P Piccini, Manesh R Pa Tags: Articles Source Type: research

Comment Warfarin or novel oral anticoagulants for atrial fibrillation?
Stroke prevention is central to the management of atrial fibrillation and, until recently, the focus was to identify high-risk patients who would be given a so-called inconvenient drug, warfarin. Nowadays, the landscape for stroke prevention has changed with the availability of novel oral anticoagulants, and an increased appreciation that vitamin K antagonists (eg, warfarin) work best with high-quality anticoagulation control (shown by the average individual time in therapeutic range at an international normalised ratio of 2·0–3·0).
Source: LANCET - March 14, 2014 Category: Journals (General) Authors: Torben Bjerregaard Larsen, Gregory Y H Lip Tags: Comment Source Type: research