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Atrial Appendage Thrombosis Risk Is Lower for Atrial Flutter Compared with Atrial Fibrillation
The risk of stroke and thromboembolism in atrial fibrillation is established. 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, 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

Clinical Outcomes and History of Fall in Patients with Atrial Fibrillation Treated with Oral Anticoagulation: Insights From the ARISTOTLE Trial
We assessed outcomes among anticoagulated patients with atrial fibrillation (AF) and a history of falling, and whether the benefits of apixaban versus warfarin are consistent in this population.
Source: The American Journal of Medicine - November 6, 2017 Category: General Medicine Authors: Meena P. Rao, Dragos Vinereanu, Daniel M. Wojdyla, John H. Alexander, Dan Atar, Elaine M. Hylek, Michael Hanna, Lars Wallentin, Renato D. Lopes, Bernard J. Gersh, Christopher B. Granger, on behalf of the Apixaban for Reduction in Stroke and Other Thromboe Tags: Clinical Research Study Source Type: research

Selective Reporting: Silent Atrial Fibrillation and Cryptogenic Strokes
I read with interest the article by Dalen and Alpert.1 Bothersome to me was the selectiveness of the data reported and the somewhat biased resultant interpretation. Consider: they did not mention the pivotal Cryptogenic Stroke and Underlying AF trial,2 in which the unmonitored control group had atrial fibrillation detected in 3% by 36 months, versus 3.7%, 8.9%, 12.4%, and 30.0% at 1, 6, 12, and 36 months, respectively, in the implanted monitor group. Notably, not only was the detection rate frequent with the implanted monitor but also greater than could have occurred with any external monitoring.
Source: The American Journal of Medicine - August 22, 2017 Category: General Medicine Authors: James A. Reiffel Tags: AJM online Source Type: research

Efficacy and Safety of Apixaban Versus Warfarin in Patients with Atrial Fibrillation and a History of Cancer: Insights From the ARISTOTLE Trial
• Cancer and atrial fibrillation frequently coexist, yet there are few data to guide care in this population.• No significant associations between history of cancer and the risk of stroke/systemic embolism, major bleeding, or mortality were observed.• The safety and efficacy of apixaban versus warfarin appear to be preserved among patients with and without active cancer.
Source: The American Journal of Medicine - July 21, 2017 Category: General Medicine Authors: Chiara Melloni, Allison Dunning, Christopher B. Granger, Laine Thomas, Michel G. Khouri, David A. Garcia, Elaine M. Hylek, Michael Hanna, Lars Wallentin, Bernard J. Gersh, Pamela S. Douglas, John H. Alexander, Renato D. Lopes Tags: Clinical Research Study Source Type: research

Renal function considerations for stroke prevention in atrial fibrillation
Renal impairment increases risk of stroke and systemic embolic events and bleeding in patients with atrial fibrillation. Direct oral anticoagulants have varied dependence on renal elimination, magnifying the importance of appropriate patient selection, dosing, and periodic kidney function monitoring. In randomized controlled trials of nonvalvular atrial fibrillation, direct oral anticoagulants were at least as effective and associated with less bleeding compared with warfarin. Each direct oral anticoagulant was associated with reduced risk of stroke and systemic embolic events and major bleeding compared with warfarin in n...
Source: The American Journal of Medicine - May 11, 2017 Category: General Medicine Authors: John Fanikos, Allison E. Burnett, Charles E. Mahan, Paul P. Dobesh Tags: Review Source Type: research

Edoxaban: How Does the Newest Agent Fit into the DOAC Landscape?
Edoxaban is the most recently approved factor Xa inhibitor within the class of direct oral anticoagulants (DOACs). Like other DOACs, edoxaban was approved by the US Food and Drug Administration for treatment of venous thromboembolism and prevention of stroke in patients with nonvalvular atrial fibrillation. Similar to other DOACs, edoxaban has fewer drug –drug interactions than warfarin and does not require routine laboratory monitoring. Unlike other DOACs, edoxaban has yet to be approved for secondary or postoperative venous thromboembolism thromboprophylaxis.
Source: The American Journal of Medicine - April 5, 2017 Category: General Medicine Authors: Caitlin M. Gibson, Shannon W. Finks Tags: Review Source Type: research

Edoxaban: Defining place in therapy for the newest direct acting oral anticoagulant
Edoxaban is the most recently approved factor Xa inhibitor within the class of direct oral anticoagulants (DOACs). Like other DOACs, edoxaban was approved by the FDA for treatment of venous thromboembolism and prevention of stroke in patients with non-valvular atrial fibrillation. Similar to other DOACs, edoxaban has fewer drug-drug interactions than warfarin and does not require routine laboratory monitoring. Unlike other DOACs, edoxaban has yet to be approved for secondary or postoperative venous thromboembolism thromboprophylaxis.
Source: The American Journal of Medicine - April 5, 2017 Category: Journals (General) Authors: Caitlin M. Gibson, Shannon W. Finks Tags: Review Source Type: research

Viewpoint Stroke prevention in recent guidelines for the management of patients with atrial fibrillation: An appraisal
Formal guidelines play an important role in disseminating the best available evidence knowledge and are expected to provide simple and practical recommendations for the most optimal management of patients with various conditions. Such guidelines have important implications for many disease states, which thereby could be more professionally managed in everyday clinical practice by clinicians with divergent educational backgrounds, and also more easily implemented in wards or outpatient clinics eliminating inequalities in health care management.
Source: The American Journal of Medicine - March 23, 2017 Category: Journals (General) Authors: Tatjana S. Potpara, Gregory Y.H. Lip, Carina Blomstr öm Lundqvist, Chern-En Chiang, A. John Camm Tags: Review Source Type: research

Viewpoint: Stroke Prevention in Recent Guidelines for the Management of Patients with Atrial Fibrillation: An Appraisal
Formal guidelines play an important role in disseminating the best available evidence knowledge and are expected to provide simple and practical recommendations for the most optimal management of patients with various conditions. Such guidelines have important implications for many disease states, which thereby could be more professionally managed in everyday clinical practice by clinicians with divergent educational backgrounds, and also more easily implemented in wards or outpatient clinics, eliminating inequalities in health care management.
Source: The American Journal of Medicine - March 23, 2017 Category: Journals (General) Authors: Tatjana S. Potpara, Gregory Y.H. Lip, Carina Blomstr öm-Lundqvist, Chern-En Chiang, A. John Camm Tags: Review Source Type: research

Non-Vitamin K Antagonist Oral Anticoagulants for Cardioversion in Atrial Fibrillation: An Updated Meta-analysis
Non-vitamin K oral anticoagulants are now proven alternatives to vitamin K antagonists for stroke prevention in atrial fibrillation. However, there are few data on the efficacy and safety of their use for cardioversion, in which the risk of thromboembolic events is heightened.
Source: The American Journal of Medicine - October 13, 2016 Category: Journals (General) Authors: Giulia Renda, Fabrizio Ricci, Raffaele De Caterina Tags: Clinical research study Source Type: research

Preclinical and Clinical Data for Factor Xa and “Universal” Reversal Agents
Oral Factor Xa (FXa) inhibitors, a growing class of direct-acting anticoagulants, are frequently used to prevent stroke and systemic embolism in patients with atrial fibrillation and to prevent and treat venous thromboembolism. These drugs reduce the risk of clotting at the expense of increasing the risk of bleeding, and currently they have no specific reversal agent. However, andexanet  alfa, a recombinant modified FXa decoy molecule, is in a late-phase clinical trial in bleeding patients, and ciraparantag, a small molecule that appears to reverse many anticoagulants including the FXa inhibitors, is in development.
Source: The American Journal of Medicine - August 26, 2016 Category: Journals (General) Authors: Truman J. Milling, Scott Kaatz Tags: Review Source Type: research

Safety of Direct Oral Anticoagulants: Insights from Postmarketing Studies
Direct oral anticoagulants (DOACs) have been marketed in the United States since 2010. While numerous large-scale prospective phase 3 outcomes studies have documented the effectiveness of DOACs for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, the primary safety concern with all of these drugs —as it is with the more established oral anticoagulant warfarin—is the risk of major bleeding. Postmarketing surveillance studies (PMSS) provide the opportunity to evaluate the safety of these recently approved drugs across a spectrum of patients that may be broader than those in...
Source: The American Journal of Medicine - August 25, 2016 Category: Journals (General) Authors: Todd C. Villines, W. Frank Peacock Tags: Review Source Type: research

North American Thrombosis Forum, AF Action Initiative Consensus Document
The North American Thrombosis Forum Atrial Fibrillation Action Initiative consensus document is a comprehensive yet practical briefing document focusing on stroke and bleeding risk assessment in patients with atrial fibrillation, as well as recommendations regarding anticoagulation options and management. Despite the breadth of clinical trial data and guideline recommendation updates, many clinicians continue to struggle to synthesize the disparate information available. This problem slows the uptake and utilization of updated risk prediction tools and adoption of new oral anticoagulants.
Source: The American Journal of Medicine - April 26, 2016 Category: Journals (General) Authors: Christian T. Ruff, Jack E. Ansell, Richard C. Becker, Emelia J. Benjamin, David J. Deicicchi, N.A. Mark Estes, Michael D. Ezekowitz, John Fanikos, Jawed Fareed, David Garcia, Robert P. Giugliano, Samuel Z. Goldhaber, Christopher Granger, Jeff S. Healey, R Source Type: research

Major Outcomes in Atrial Fibrillation Patients with One Risk Factor: Impact of Time in Therapeutic Range Observations from the SPORTIF Trials
The benefits and harms of oral anticoagulation therapy in patients with only one stroke risk factor (ie, CHA2DS2-VASc  = 1 in males, or 2 in females) has been a subject of debate.
Source: The American Journal of Medicine - April 14, 2016 Category: Journals (General) Authors: Marco Proietti, Gregory Y.H. Lip Tags: Clinical research study Source Type: research

Major Outcomes in Atrial Fibrillation Patients with One Risk Factor: Impact of Time in Therapeutic Range
The benefits and harms of oral anticoagulation (OAC) therapy in patients with only one stroke risk factor (i.e. CHA2DS2-VASc= 1 in males, or 2 in females) has been subject of debate.
Source: The American Journal of Medicine - April 14, 2016 Category: Journals (General) Authors: Marco Proietti, Gregory Y.H. Lip Tags: Clinical Research Study Source Type: research

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