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Source: The American Journal of Medicine
Condition: Atrial Fibrillation
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Total 96 results found since Jan 2013.
On Hoofs and Zebras – Struma Ovarii
A 75-year-old mother of ten suffering from a urinary tract infection developed macrohematuria and therefore an abdominal ultrasound was performed, followed by a CT scan when an unexpected large pelvic mass was discovered. Past history included hypertension, paroxysmal atrial fibrillation, and remote history of minor stroke (on candesartan, dabigatran, bisoprolol); bilateral chronic lymphedema; and hysterectomy due to prolapse at the age of 40. Imaging revealed nephrolithiasis and a prominent left adnexal mass suspected as ovarian cancer.
Source: The American Journal of Medicine - July 20, 2023 Category: General Medicine Authors: Ami Schattner, Ina Dubin, Livnat Uliel, Daniela Dick-Necula Tags: Clinical Communication to the Editor Source Type: research
Racial and Ethnic Disparities in Stroke Prevention for Atrial Fibrillation
Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting around 2% of the population (1,2) and increasing the risk of stroke by 4 to 5 times (3). Anticoagulation with Vitamin K antagonists (VKAs) such as Warfarin (4) or the newer Direct Oral Anticoagulants (DOACs) (4,5) reduces this risk by up to 60%. AF-related strokes also tend to be more severe and disabling (6).
Source: The American Journal of Medicine - December 7, 2022 Category: General Medicine Authors: Peter Calvert, Kamala Tamirisa, Amin Al-Ahmad, Gregory Y H Lip, Dhiraj Gupta Tags: Review Source Type: research
Integrated care for atrial fibrillation management: The role of the pharmacist
Within Europe and the Asia-Pacific, the Atrial Fibrillation Better Care (ABC) pathway is the gold standard integrated care strategy for atrial fibrillation management. Atrial fibrillation diagnosis should be Confirmed and Characterized (CC) before implementation of ABC pathway components: (1) ‘A’- Anticoagulation/Avoid stroke; (2) ‘B’- Better symptom management and (3) ‘C’- Cardiovascular and other co-morbidity optimization. Pharmacists have the potential to expedite integrated care for atrial fibrillation across the healthcare continuum -hospital, community pharmacy and gene ral practice.
Source: The American Journal of Medicine - August 20, 2022 Category: General Medicine Authors: Leona A Ritchie, Peter E Penson, Asangaedem Akpan, Gregory YH Lip, Deirdre A Lane Tags: Review Source Type: research
Long-term cardiac monitoring after embolic stroke of undetermined source. Search longer – look harder
Ischemic stroke is a heterogeneous syndrome which may result from several causes such as atherosclerosis, small vessel disease and atrial fibrillation.1 Despite an extensive diagnostic work-up during the acute or chronic phase of the ischemic stroke, the cause of ischemic stroke remains unexplained for 20% of patients, termed cryptogenic stroke. 2 3
Source: The American Journal of Medicine - May 14, 2022 Category: General Medicine Authors: Dimitrios Sagris, Stephanie L Harrison, Benjamin J.R Buckley, George Ntaios, Gregory Y.H Lip Source Type: research
Long-Term Cardiac Monitoring After Embolic Stroke of Undetermined Source: Search Longer, Look Harder
Embolic stroke of undetermined source (ESUS) represents a heterogeneous subgroup of patients with cryptogenic stroke, in which despite an extensive diagnostic workup the cause of stroke remains uncertain. Identifying covert atrial fibrillation among patients with ESUS remains challenging. The increasing use of cardiac implanted electronic devices (CIED), such as pacemakers, implantable defibrillators, and implantable loop recorders (ILR), has provided important information on the burden of subclinical atrial fibrillation.
Source: The American Journal of Medicine - May 14, 2022 Category: General Medicine Authors: Dimitrios Sagris, Stephanie L. Harrison, Benjamin J.R. Buckley, George Ntaios, Gregory Y.H. Lip Tags: Review Source Type: research
Frank's sign in a double stroke patient
A 72-year-old male, non-smoker, with a medical history of hypertension, hypercholesterolemia, atrial fibrillation and a past myocardial infarction 15 years ago, presented to the emergency department complaining about difficulty of speaking and left-hand weakness of 6-hour duration. Apart from an elevated blood pressure, at 170/100 mmHg, physical examination revealed dysarthria, accompanied by left brachial monoplegia and hypoesthesia. A bilateral earlobe wrinkle extending obliquely and backward, at a 45o angle, from the tragus to the edge of the auricle (Frank's sign) was observed (Figure 1A).
Source: The American Journal of Medicine - April 23, 2022 Category: General Medicine Authors: Konstantinos C. Christodoulou, Ioannis Stouras, Xafnoula Zlatidou, Despoina Kakagia Tags: Clinical Communication to the Editor Source Type: research
Oral Anticoagulant Use for Patients with Atrial Fibrillation with Concomitant Anemia and/or Thrombocytopenia
Atrial fibrillation is the most common sustained cardiac arrhythmia in clinical practice, which is associated with an increased risk of thromboembolism, heart failure and mortality.1 Previous studies in atrial fibrillation patients have reported that abnormal hemoglobin and platelet counts may be associated with adverse events. However, these studies that specifically examined the associations between hemoglobin and platelet levels and adverse outcomes reported conflicting data.2-5 Although warfarin effectively reduces the risk of ischemic stroke by 64% compared to placebo/control,6 and non-vitamin K antagonist oral antico...
Source: The American Journal of Medicine - April 2, 2022 Category: General Medicine Authors: Yung-Hsin Yeh, Yi-Hsin Chan, Shao-Wei Chen, Shang-Hung Chang, Chun-Li Wang, Chi-Tai Kuo, Gregory Y.H. Li, Shih-Ann Chen, Tze-Fan Chao Tags: Clinical Research Study Source Type: research
Peripheral Arterial Disease, Stroke, and Mortality in Patients with Atrial Fibrillation
I read the paper by Vitalis et al1 with great interest. The authors assessed the impact of peripheral arterial disease on mortality and stroke in patients with atrial fibrillation. The adjusted hazard ratio (HR) (95% confidence interval [CI]) of peripheral arterial disease in patients with atrial fibrillation for all-cause mortality was 1.34 (1.06-1.70). In addition, the adjusted HR (95% CI) of peripheral arterial disease in patients with nonanticoagulated atrial fibrillation for ischemic stroke was 3.37 (1.25-9.09).
Source: The American Journal of Medicine - February 1, 2022 Category: General Medicine Authors: Tomoyuki Kawada Tags: Letter Source Type: research
Non-Vitamin K Antagonists versus Warfarin in Patients with Atrial Fibrillation and Bioprosthetic Valves: a Systematic Review and Meta-Analysis
Patients with bioprosthetic heart valves and valve repair with concomitant atrial fibrillation are at an increased risk of thromboembolic events.1-5 Until recently, there was a paucity of randomized data to guide the optimal anticoagulation strategy in this patient population. In a prior meta-analysis of 4 randomized studies in patients with atrial fibrillation and valvular heart disease, excluding significant mitral stenosis and mechanical valves, there was a significant reduction in the risk of stroke or systemic embolism with non-vitamin K antagonist oral anticoagulants (NOACs) vs.
Source: The American Journal of Medicine - October 7, 2021 Category: General Medicine Authors: Rhanderson Cardoso, Caique M.P. Ternes, Gustavo B. Justino, Amanda Fernandes, Ana Vitoria Rocha, Leonardo Knijnik, Andre d'Avila, Renato D. Lopes Tags: Clinical Research Study Source Type: research
Effects of Anticoagulation on Low-Density Lipoprotein-Cholesterol and Ischemic Stroke in Patients with Nonvalvular Atrial Fibrillation
The study by Omelchenko et al1 concluded that, unlike the general population, low-density lipoprotein-cholesterol (LDL-C) levels were not associated with ischemic stroke risk among patients with atrial fibrillation treated with direct oral anticoagulants (DOACs). To arrive at this conclusion, they retrospectively analyzed data of 21,229 patients with a first-time diagnosis of nonvalvular atrial fibrillation treated with DOACs categorized according to the congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack (TIA), vascular disease, age 65 to 74 years, sex category, ...
Source: The American Journal of Medicine - September 28, 2021 Category: General Medicine Authors: Zeeshan H. Ismail, Zekarias T. Asnake, Joshua K. Salabei Tags: Letter Source Type: research
Impact of Atrial Fibrillation on In-Hospital Mortality and Stroke in Acute Aortic Syndromes
Acute aortic syndromes may present with a number of cardiovascular complications, including atrial fibrillation. We assessed the prevalence of atrial fibrillation in patients presenting with acute aortic syndromes and evaluated atrial fibrillation's association with in-hospital mortality and stroke.
Source: The American Journal of Medicine - July 6, 2021 Category: General Medicine Authors: Umberto Campia, Samantha M. Rizzo, Julia E. Snyder, Mariana A. Pfefferman, Ruth B. Morrison, Gregory Piazza, Samuel Z. Goldhaber Source Type: research
The impact of strong inducers on direct oral anticoagulant levels
Direct oral anticoagulants (DOAC) are widely used in clinical practice. They are now recommended over warfarin in eligible patients, for stroke prevention in atrial fibrillation (SPAF) or the treatment of venous thromboembolism1,2. Given their predictable dose response, DOAC have a fixed-dose regimen and do not require routine laboratory monitoring. However, inter-individual variability in DOAC plasma concentrations has been described. In phase 3 trials and registries, low and high DOAC levels were shown to correlate with thromboembolic and bleeding events respectively3,4.
Source: The American Journal of Medicine - June 24, 2021 Category: General Medicine Authors: Anne-Laure Sennesael, Anne-Sophie Larock, Philippe Hainaut, Sarah Lessire, Michael Hardy, Jonathan Douxfils, Anne Spinewine, Fran çois Mullier Tags: Brief Observation Source Type: research
Long-term Clinical Outcomes of Underdosed Direct Oral Anticoagulants in patients with Atrial Fibrillation and Atrial Flutter
Although direct oral anticoagulants (DOACs) have been shown to be effective at reducing the risk of stroke in patients with atrial fibrillation/flutter (AF), they are sometimes underdosed off-label to mitigate their associated higher bleeding risk. We sought to evaluate frequency and clinical outcomes of inappropriate underdosing of DOACS in patients with AF.
Source: The American Journal of Medicine - January 11, 2021 Category: General Medicine Authors: Hasan Ashraf, Pradyumna Agasthi, Anusha Shanbhag, Ramila A. Mehta, Pattara Rattanawong, Mohamed Allam, Sai Harika Pujari, Farouk Mookadam, William K. Freeman, Komandoor Srivathsan, Dan Sorajja, Win-Kuang Shen, Peter A. Noseworthy, Eric H. Yang, Hicham Z. Tags: Clinical Research Study Source Type: research
Oral Anticoagulation Use in High-Risk Patients Is Improved by Elimination of False-Positive and Inactive Atrial Fibrillation Cases
Multiple registries have reported that>40% of high-risk atrial fibrillation patients are not taking oral anticoagulants. The purpose of our study was to determine the presence or absence of active atrial fibrillation and CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥75 y, Diabetes mellitus, prior Stroke [or transient ischemic attack or thromboembolism], Vascular disease, Age 65-74 y, Sex category) risk factors to accurately identify high-risk atrial fibrillation (CHA2DS2-VASc ≥2) patients requiring oral anticoagulants and the magnitude of the anticoagulant treatment gap.
Source: The American Journal of Medicine - December 23, 2020 Category: General Medicine Authors: Gerald V. Naccarelli, Mohammed Ruzieh, Deborah L. Wolbrette, Mauricio Sendra-Ferrer, John van Harskamp, Barbara Bentz, Gregory Caputo, Nathan McConkey, Kevin Mills, Stephen Wasemiller, Jovan Plamenac, Douglas Leslie, Frendy D. Glasser, Thomas W. Abendroth Tags: Clinical Research Study Source Type: research
High-Grade Carotid Artery Stenosis and Atrial Fibrillation
The disclosure of a higher rate of stroke among patients with the association of nonvalvular atrial fibrillation and peripheral vascular disease1 is entirely predictable given the fact that Kanter et al2 have shown that, among patients with nonvalvular atrial fibrillation, high-grade carotid artery stenosis (a risk factor for stroke)3 had a prevalence of 12% among men aged>70 years, and a prevalence of 11% among women of that age group. Furthermore, in their systematic review of 9 studies (2611 patients) reporting presumed pathophysiological stroke mechanisms in patients with atrial fibrillation, Katsi et al4 showed that 1...
Source: The American Journal of Medicine - December 1, 2020 Category: General Medicine Authors: Oscar M.P. Jolobe Tags: Letter Source Type: research
