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Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) Trial: Study Rationale and Design
Publication date: Available online 7 March 2018 Source:American Heart Journal Author(s): Douglas L. Packer, Daniel B. Mark, Richard A Robb, Kristi Monahan, Tristram Bahnson, Kathleen Moretz, Jeanne Poole, Alice Mascette, Yves Rosenberg, Neal Jeffries, Hussein R. Al-Khalidi, Kerry L. Lee The Catheter Ablation Versus Anti-arrhythmic Drug Therapy for Atrial Fibrillation (CABANA, NCT00911508)(1) trial is testing the hypothesis that the treatment strategy of percutaneous left atrial catheter ablation for the purpose of eliminating atrial fibrillation (AF) is superior to current state-of-the-art pharmacologic therapy. This inte...
Source: American Heart Journal - March 8, 2018 Category: Cardiology Source Type: research

Is there a role for pharmacokinetic/pharmacodynamic-guided dosing for novel oral anticoagulants?
Publication date: May 2018 Source:American Heart Journal, Volume 199 Author(s): Noel Chan, Philip T. Sager, Jack Lawrence, Thomas's Ortel, Paul Reilly, Scott Berkowitz, Dagmar Kubitza, John Eikelboom, Jeffry Florian, Norman Stockbridge, Martin Rose, Robert Temple, Jonathan H. Seltzer The novel direct oral anticoagulants (NOACs) represent a major advance in oral anticoagulant therapy and are replacing vitamin K antagonists as the preferred options for many indications. Given in fixed doses without routine laboratory monitoring, they have been shown to be at least as effective in reducing thromboembolic stroke as dose-adjus...
Source: American Heart Journal - February 23, 2018 Category: Cardiology Source Type: research

Risk of Cardiovascular Events and Incident Atrial Fibrillation in Patients without Prior Atrial Fibrillation: Implications for Expanding the Indications for Anticoagulation
Conclusions Patients without diagnosed AF but with certain risk factors were at a particularly high cardiovascular risk and may require new prevention approaches. In addition to the ongoing trials, future trials in other high-risk populations, e.g., diabetes and chronic kidney disease may be warranted.
Source: American Heart Journal - February 10, 2018 Category: Cardiology Source Type: research

Transcatheter closure of patent foramen ovale following cryptogenic stroke: An updated meta-analysis of randomized controlled trials
Conclusions Transcatheter closure is associated with a significant reduction in the risk of stroke compared to medical management at the expense of an increased risk of atrial arrhythmias.
Source: American Heart Journal - February 1, 2018 Category: Cardiology Source Type: research

Shared Decision-Making Tool for Thromboprophylaxis in Atrial Fibrillation – A Feasibility Study
Conclusions A shared decision-making interaction, facilitated by an AFSDM can significantly improve multiple measures of decision-making quality, leading to improved medication adherence and patient satisfaction.
Source: American Heart Journal - January 17, 2018 Category: Cardiology Source Type: research

The Optimal Anti-Coagulation for Enhanced-Risk Patients Post –Catheter Ablation for Atrial Fibrillation (OCEAN) trial
The objective was to assess whether rivaroxaban is superior to acetylsalicylic acid (ASA) in reducing the risk of clinically overt stroke, systemic embolism, or covert stroke among patients without apparent recurrent atrial arrhythmias for at least 1 year after their most recent AF ablation procedure. Methods/design A prospective, multicenter, open-label, randomized trial with blinded assessment of outcomes is under way (NCT02168829). Atrial fibrillation patients with at least 1 stroke risk factor (as defined by the CHA2DS2-VASc score) and without known atrial arrhythmia recurrences for at least 12 months after ablation ar...
Source: American Heart Journal - January 17, 2018 Category: Cardiology Source Type: research

Efficacy and Safety of Dabigatran Compared with Warfarin in Patients with Atrial Fibrillation in Relation to Renal Function Over Time – A RE-LY trial analysis
Conclusions In AF, WRF was associated with a higher risk of death and major bleeding. The efficacy and safety profile of dabigatran compared to warfarin was similar irrespective of renal function changes over time. Dabigatran 110 mg showed a greater relative risk reduction of major bleeding in patients with normal renal function during follow-up.
Source: American Heart Journal - January 6, 2018 Category: Cardiology Source Type: research

Changes in glomerular filtration rate and outcomes in patients with atrial fibrillation
Conclusions Rates of IS/TE, mortality and bleeding increased with worsening eGFR >4.81 ml/min/1.73 m2. Worsening eGFR was an independent predictor of IS/TE and of bleeding, and a better predictor of IS/TE than renal impairment in AF.
Source: American Heart Journal - December 31, 2017 Category: Cardiology Source Type: research

The Optimal Anti-Coagulation for Enhanced Risk Patients Post-Catheter Ablation for Atrial Fibrillation (OCEAN) trial
Discussion The OCEAN trial is a multicenter randomized controlled trial evaluating two antithrombotic treatment strategies for patients with risk factors for stroke after apparently successful AF ablation. We hypothesize that rivaroxaban will reduce the occurrence of clinically overt stroke, systemic embolism, and covert stroke when compared to ASA alone.
Source: American Heart Journal - December 9, 2017 Category: Cardiology Source Type: research

Prediction of long-term net clinical outcomes using the TIMI-AF score: Comparison with CHA2DS2-VASc and HAS-BLED
Conclusions In VKA-experienced AF patients, the TIMI-AF score has limited usefulness predicting NCOs over a long-term period of follow-up. This novel score was not superior to CHA2DS2-VASc and HAS-BLED identifying ‘low risk’ AF patients.
Source: American Heart Journal - November 10, 2017 Category: Cardiology Source Type: research

Percutaneous Coronary Intervention and Antiplatelet Therapy in Patients with Atrial Fibrillation Receiving Apixaban or Warfarin: Insights from the ARISTOTLE Trial
Conclusions PCI occurred infrequently during follow-up. The majority of patients on study drug at the time of PCI remained on study drug in the peri-PCI period; 19% continued the study drug without interruption. Antiplatelet therapy use post-PCI was variable, though the majority of patients received DAPT. Additional data are needed to guide the use of antithrombotics in patients undergoing PCI.
Source: American Heart Journal - November 10, 2017 Category: Cardiology Source Type: research

Evaluation of the Safety and Efficacy of an Edoxaban-based Antithrombotic Regimen in Patients with Atrial Fibrillation Following Successful Percutaneous Coronary Intervention (PCI) with Stent Placement: Rationale and Design of the ENTRUST-AF PCI Trial
Publication date: Available online 23 October 2017 Source:American Heart Journal Author(s): Pascal Vranckx, Thorsten Lewalter, Marco Valgimigli, Jan G. Tijssen, Paul-Egbert Reimitz, Lars Eckardt, Hans-Joachim Lanz, Wolfgang Zierhut, Rüdiger Smolnik, Andreas Goette Background The optimal antithrombotic treatment after percutaneous coronary intervention (PCI) with stenting in patients with atrial fibrillation (AF) is unknown. In the ENGAGE AF-TIMI 48 trial, edoxaban was non-inferior to a vitamin-K antagonist (VKA) with respect to the prevention of stroke or systemic embolism and was associated with significantly lower rate...
Source: American Heart Journal - October 23, 2017 Category: Cardiology Source Type: research

Is There A Role For Pharmacokinetic/Pharmacodynamic Guided Dosing For Novel Oral Anticoagulants?
Publication date: Available online 10 October 2017 Source:American Heart Journal Author(s): Noel Chan, Philip T. Sager, Jack Lawrence, Thomas's Ortel, Paul Reilly, Scott Berkowitz, Dagmar Kubitza, John Eikelboom, Jeffry Florian, Norman Stockbridge, Martin Rose, Robert Temple, Jonathan H. Seltzer The novel direct oral anticoagulants (NOACs) represent a major advance in oral anticoagulant therapy, and are replacing vitamin K antagonists as the preferred options for many indications. Given in fixed doses without routine laboratory monitoring, they have been shown to be at least as effective in reducing thromboembolic stroke ...
Source: American Heart Journal - October 10, 2017 Category: Cardiology Source Type: research

Two-year follow-up of patients treated with dabigatran for stroke prevention in atrial fibrillation: GLORIA-AF Registry
Conclusions These global data confirm the sustained safety and effectiveness of dabigatran over 2years of follow-up, consistent with the results from clinical trials as well as contemporary real-world studies. WHAT IS KNOWN • Non- vitamin K antagonist (VKA) anticoagulants (NOACs) are the preferred therapy for prevention of ischemic stroke based on phase 3 trials, but there is insufficient information on their efficacy and safety in daily practice, based on prospectively collected data WHAT IS NEW • This study shows that in non-valvular AF patient population, with up to 2years of follow-up, the use of dabigatran led to ...
Source: American Heart Journal - September 1, 2017 Category: Cardiology Source Type: research

International trends in clinical characteristics and oral anticoagulation treatment for patients with atrial fibrillation: Results from the GARFIELD, ORBIT-AF I, and ORBIT-AF II Registries
Conclusions Among new-onset AF patients, NOAC use has increased and antiplatelet monotherapy has decreased. However, anticoagulation is used frequently in low-risk patients and inconsistently in those at high-risk of stroke. Significant geographic variability in anticoagulation persists and represents an opportunity for improvement.
Source: American Heart Journal - August 24, 2017 Category: Cardiology Source Type: research

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