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Concomitant use of direct oral anticoagulants with antiplatelet agents and the risk of major bleeding in patients with non-valvular atrial fibrillation
Direct oral anticoagulants (DOACs) are increasingly being used for ischemic stroke prevention among patients with non-valvular atrial fibrillation,1,2 partly because of their favorable efficacy and safety compared with vitamin K antagonists (VKAs).3 However, the safety of DOACs in patients with non-valvular atrial fibrillation requiring additional use of antiplatelet agents remains uncertain. This is important, as up to 30% of patients with non-valvular atrial fibrillation may receive concomitant treatments of oral anticoagulants with antiplatelets due to comorbid cardiovascular conditions.
Source: The American Journal of Medicine - October 25, 2018 Category: General Medicine Authors: Antonios Douros, Christel Renoux, Hui Yin, Kristian B. Filion, Samy Suissa, Laurent Azoulay Tags: Clinical Research Study Source Type: research

Variation in the Use of Warfarin and Direct Oral Anticoagulants in Atrial Fibrillation and Associated Cost Implications
Atrial fibrillation is the most common arrhythmia in the United States and affects between 2.7 million and 6.1 million adults in the United States, with a lifetime risk of up to 1 in 4 adults over age 40 and a prevalence that is projected to double over the next 25 years.1,2 Though warfarin has long been the cornerstone of therapy to reduce the risk of stroke, several new direct oral anticoagulants (DOACs) have recently become available, beginning with FDA approval of dabigatran in October 2010, and followed by rivaroxaban in 2011, apixaban in 2014, and most recently edoxaban in 2015.
Source: The American Journal of Medicine - October 3, 2018 Category: General Medicine Authors: Benjamin A. Rodwin, Joseph A. Salami, Erica S. Spatz, Javier Valero-Elizondo, Salim S. Virani, Ron Blankstein, Michael J. Blaha, Khurram Nasir, Nihar R. Desai Tags: Clinical Research Study Source Type: research

Improved Outcomes by Integrated Care of Anticoagulated Patients with Atrial Fibrillation Using the Simple ABC (Atrial Fibrillation Better Care) Pathway
Integrated care for the clinical management of atrial fibrillation patients is advocated as a holistic way to improve outcomes; the simple Atrial fibrillation Better Care (ABC) pathway has been proposed. The ABC pathway streamlines care as follows: ‘A’ Avoid stroke; ‘B’ Better symptom management; ‘C’ Cardiovascular and Comorbidity optimization.
Source: The American Journal of Medicine - August 25, 2018 Category: General Medicine Authors: Marco Proietti, Giulio Francesco Romiti, Brian Olshansky, Deirdre A. Lane, Gregory Y.H. Lip Tags: Clinical Research Study Source Type: research

Periprocedural Bridging Anticoagulation: Measuring the Impact of a Clinical Trial on Care Delivery
Warfarin remains the most commonly prescribed oral anticoagulant in North America for patients with atrial fibrillation.1 –3 Historically, when patients underwent surgical procedures, many clinicians chose to give shorter acting “bridging” anticoagulants to help reduce the risk of stroke while the effect of warfarin was wearing off before surgery or building back up after surgery. In response to observational stu dies, the BRIDGE trial was conducted to test the safety and efficacy of short acting low-molecular-weight heparin (LMWH) as a bridge before and after surgery in patients with atrial fibrillation treated with warfarin.
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Geoffrey D Barnes, Yun Li, Xiaokui Gu, Brian Haymart, Eva Kline-Rogers, Steven Almany, Jay Kozlowski, Gregory Krol, Michael McNamara, James B Froehlich, Scott Kaatz Tags: Clinical Research Study Source Type: research

Dementia and Atrial Fibrillation: Pathophysiological Mechanisms and Therapeutic Implications
Dementia and atrial fibrillation have several epidemiologic characteristics in common, including high overall prevalence, increasing incidence with aging, and an expected rise in incidence.1,2 Atrial fibrillation has been associated more closely with dementia3-18 than other potentially comorbid age-related conditions.19,20 However, while atrial fibrillation increases the risk of stroke by a factor of 4- to 5-fold,21 it is uncertain whether cognitive impairment in the context of atrial fibrillation is mediated by an increased risk of stroke or whether other factors are responsible.
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Romain Chopard, Gregory Piazza, Seth Alan Gale, Umberto Campia, Ida Ehlers Albertsen, Jisoo Kim, Samuel Z. Goldhaber Tags: Review The American Journal of Medicine Source Type: research

Effectiveness and Safety of Anticoagulants in Adults with Non-valvular Atrial Fibrillation and Concomitant Coronary/Peripheral Artery Disease
Atrial fibrillation increases the risk of stroke by five-fold and is associated with 15-20% of all strokes.1,2 Prior studies have shown that the prevalence of coronary artery disease and peripheral artery disease among atrial-fibrillation-diagnosed patients ranges from 18-45%, and 4-17%, respectively.3 –9 Coronary and peripheral artery disease patients are at high risk for stroke, myocardial infarction, and cardiovascular-related death.10–13 Concomitant atrial fibrillation with coronary artery disease is associated with all-cause mortality, coronary death, and major coronary events.
Source: The American Journal of Medicine - May 26, 2018 Category: General Medicine Authors: Renato D. Lopes, Jan Steffel, Manuela Di Fusco, Allison Keshishian, Xuemei Luo, Xiaoyan Li, Cristina Masseria, Melissa Hamilton, Keith Friend, Kiran Gupta, Jack Mardekian, Xianying Pan, Onur Baser, W. Schuyler Jones Tags: Clinical Research Study Source Type: research

To Reduce Stroke with PFO Closure, Respect the Shunt
We read with interest the very timely updated meta-analysis regarding closure of patent foramen ovale for cryptogenic stroke by Vaduganathan et  al.1 They suggest a marked benefit in stroke prevention with an increase in the incidence of atrial fibrillation. However, we would like to draw your attention to a few caveats that are important for clinicians dealing with this situation and expand on the pooled analysis using the same 5 trials i ncluded in the current paper.2-6
Source: The American Journal of Medicine - May 19, 2018 Category: General Medicine Authors: Arka Chatterjee, Mark A. Law Tags: Letter Source Type: research

Gender Differences in Antithrombotic Treatment for Newly Diagnosed Atrial Fibrillation: the GLORIA-AF Registry Program
• Effective stroke prevention in atrial fibrillation requires oral anticoagulation.• Globally, similar proportions of women and men were prescribed oral anticoagulation.• The decision to prescribe oral anticoagulation does not seem to be gender-dependant.• Other non-gender risk factors play a predominant role in anticoagulation decision making.
Source: The American Journal of Medicine - April 11, 2018 Category: General Medicine Authors: Micha ł Mazurek, Menno V. Huisman, Kenneth J. Rothman, Miney Paquette, Christine Teutsch, Hans-Christoph Diener, Sergio J. Dubner, Jonathan L. Halperin, Kristina Zint, Lionel Riou França, Shihai Lu, Gregory Y.H. Lip, GLORIA-AF Investigators Tags: Clinical Research Study Source Type: research

Impact of Atrial Fibrillation on Cognitive Function, Psychological Distress, Quality of Life, and Impulsiveness
Atrial fibrillation is the most common cardiac arrhythmia and a known risk factor for cerebrovascular stroke. Atrial fibrillation and longstanding hypertension may produce ischemic lesions leading to progressive cognitive impairment. The impact of atrial fibrillation alone on cognitive impairment has not been evaluated. Our objective was to compare cognitive function, quality of life, psychological distress, and impulsiveness in people with atrial fibrillation and a matched control group.
Source: The American Journal of Medicine - February 4, 2018 Category: General Medicine Authors: Rokas Serpytis, Aurelija Navickaite, Emilija Serpytiene, Jurate Barysiene, Germanas Marinskis, Dalius Jatuzis, Zaneta Petrulioniene, Aleksandras Laucevicius, Pranas Serpytis Tags: Clinical Research Study Source Type: research

Patent Foramen Ovale Closure for Secondary Prevention of Cryptogenic Stroke: Updated Meta-Analysis of Randomized Clinical Trials
• In patients with recent cryptogenic stroke, percutaneous closure of patent foramen ovale reduced recurrent stroke/transient ischemic attack compared with medical therapy, but was associated with higher risk of new-onset atrial fibrillation/flutter.• Select, young patients (≤60 years) present ing with recent cryptogenic stroke may benefit from percutaneous closure of patent foramen ovale at relatively low procedural risk.
Source: The American Journal of Medicine - December 8, 2017 Category: General Medicine Authors: Muthiah Vaduganathan, Arman Qamar, Ankur Gupta, Navkaranbir Bajaj, Harsh B. Golwala, Ambarish Pandey, Deepak L. Bhatt Tags: Brief Observation Source Type: research

Severity of Gastrointestinal Bleeding in Patients Treated with Direct-Acting Oral Anticoagulants
Direct-acting oral anticoagulants (DOACs), which have gained approval for stroke prevention in non-valvular atrial fibrillation and treatment of venous thromboembolism, have become increasingly preferred over warfarin given their predictable pharmacodynamics, lack of required monitoring, and superior outcomes. DOACs have been shown to be associated with an increased frequency of gastrointestinal bleeding compared to warfarin, but the severity and characteristics of gastrointestinal bleeding in these patients is poorly understood.
Source: The American Journal of Medicine - November 22, 2017 Category: General Medicine Authors: Mark M. Brodie, Jill C. Newman, Tyler Smith, Don C. Rockey Tags: Clinical Research Study Source Type: research

Atrial Flutter Has Less Left Atrial Spontaneous Contrast and Higher Left Atrial Appendage Emptying Velocity Compared with Atrial Fibrillation
The risk of stroke and thromboembolism in atrial fibrillation is established. There are clear guidelines in anticoagulation management of patient's with atrial fibrillation, however, the evidence surrounding the risk of thromboembolism in patients with atrial flutter is not as clear. We hypothesized that atrial flutter would have indicators of less risk for thromboembolism compared with atrial fibrillation on transesophageal echocardiography (TEE); thereby possibly leading to a lower stroke risk.
Source: The American Journal of Medicine - November 8, 2017 Category: General Medicine Authors: Jennifer J. Huang, Sridhar Reddy, Tam H. Truong, Prakash Suryanarayana, Joseph S. Alpert Tags: Clinical Research Study Source Type: research

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