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Dabigatran Versus Warfarin for Atrial Fibrillation in Real-World Clinical Practice: A Systematic Review and Meta-Analysis Original Articles
Conclusions— In real-world clinical practice, dabigatran is comparable with warfarin in preventing ischemic stroke among patients with nonvalvular atrial fibrillation. However, dabigatran is associated with a lower risk for intracranial bleeding relative to warfarin, but—particularly among the elderly—a greater risk for gastrointestinal bleeding. Bleeding outcomes from observational studies are consistent with those from the pivotal Randomized Evaluation of Long-Term Anticoagulation Therapy trial.
Source: Circulation: Cardiovascular Quality and Outcomes - March 15, 2016 Category: Cardiology Authors: Romanelli, R. J., Nolting, L., Dolginsky, M., Kym, E., Orrico, K. B. Tags: Meta Analysis, Ischemic Stroke Original Articles Source Type: research

Reimagining Anticoagulation Clinics in the Era of Direct Oral Anticoagulants Cardiovascular Perspective
Anticoagulation clinics were initially developed to provide safe and effective care for warfarin-treated patients with atrial fibrillation, venous thromboembolism, and mechanical valve replacement. Traditionally, these patients required ongoing laboratory monitoring and warfarin dose adjustment by expert providers. With the introduction of direct oral anticoagulants (dabigatran, rivaroxaban, apixaban, and edoxaban), many have questioned the need for anticoagulation clinic. However, we think that the growing number of oral anticoagulant choices creates an urgent need for expanding the traditional role of the anticoagulation...
Source: Circulation: Cardiovascular Quality and Outcomes - March 15, 2016 Category: Cardiology Authors: Barnes, G. D., Nallamothu, B. K., Sales, A. E., Froehlich, J. B. Tags: Atrial Fibrillation, Ethics and Policy, Health Services, Ischemic Stroke, Thrombosis Cardiovascular Perspective Source Type: research

Abstract 2: Comparative Effectiveness and Safety of Anticoagulant Therapy With Warfarin, Dabigatran, Apixaban, or Rivaroxaban in Patients With Nonvalvular Atrial Fibrillation Session Title: Abstract Oral Session: QCOR 2016 Young Investigator Awards
Conclusions: Our results demonstrated a lower risk of a thromboembolic event or stroke among dabigatran, apixaban, or rivaroxaban users compared to warfarin users. Among NOACs, risks of a thromboembolic event or stroke were similar. Further studies are needed to clarify the finding of a higher major bleeding risk in warfarin and rivaroxaban users.
Source: Circulation: Cardiovascular Quality and Outcomes - February 26, 2016 Category: Cardiology Authors: Adeboyeje, G., Sylwestrzak, G., White, J., Rosenberg, A., Abarca, J., Crawford, G., Barron, J. Tags: Session Title: Abstract Oral Session: QCOR 2016 Young Investigator Awards Source Type: research

Abstract 154: Estimating Treatment Effects in More Than Two Treatment Groups via Propensity Score Weighting: Practical Guidance and Application from Anticoagulant Therapy in Atrial Fibrillation Study Session Title: Abstract Poster Session I and Reception
Conclusions: Our results showed IPTW methods, correctly employed under certain assumptions, are practical and relatively simple tools to control for selection bias and other baseline differences in observational studies evaluating the comparative treatment effects of more than two treatment arms. When preserving sample size is important and in the presence of time-varying confounders, IPTW methods have distinct advantages over propensity matching or adjustment.
Source: Circulation: Cardiovascular Quality and Outcomes - February 26, 2016 Category: Cardiology Authors: Adeboyeje, G., Sylwestrzak, G., Barron, J. Tags: Session Title: Abstract Poster Session I and Reception Source Type: research

Abstract 201: Are Patients With Atrial Fibrillation Willing to Consider New Strategies to Prevent Stroke? A Qualitative Analysis of Community-Based Focus Groups Session Title: Abstract Poster Session II
Conclusion: Focus group participants expressed a fear of debilitating stroke, with varying levels of acceptance of inconveniences and potential bleeding associated with blood thinners. Among a subset of participants, there was willingness to consider new stroke prevention therapies; however, this was preferred with a known, trusted physician. Subspecialized clinicians offering new therapies may be challenged to establish perceived mutual respect with patients, traditionally built over time, and this may be required for patients to consider new therapies. Future research is needed to determine best practices for both establ...
Source: Circulation: Cardiovascular Quality and Outcomes - February 26, 2016 Category: Cardiology Authors: ONeill, E. S., Grande, S. W., Coylewright, M. Tags: Session Title: Abstract Poster Session II Source Type: research

Sex Differences in Dabigatran Use, Safety, And Effectiveness In a Population-Based Cohort of Patients With Atrial Fibrillation Original Articles
Conclusions— In real-life practice, women are more frequently treated with low-dose dabigatran, yet a trend toward lower stroke rates in women taking high-dose dabigatran was observed. Men benefit from lower bleeding rates with dabigatran compared with warfarin.
Source: Circulation: Cardiovascular Quality and Outcomes - November 17, 2015 Category: Cardiology Authors: Avgil Tsadok, M., Jackevicius, C. A., Rahme, E., Humphries, K. H., Pilote, L. Tags: Epidemiology, Anticoagulants, Ethics and Policy Original Articles Source Type: research

Improving Anticoagulation Measurement: Novel Warfarin Composite Measure Original Articles
Conclusions— WCM produces the largest range of risk for warfarin complications, widening the floor ceiling effects that limit the use of TTR and INR variability as separate measures. Anticoagulation clinics ranking changed considerably according to the anticoagulation measure that was selected.
Source: Circulation: Cardiovascular Quality and Outcomes - November 17, 2015 Category: Cardiology Authors: Razouki, Z., Burgess, J. F., Ozonoff, A., Zhao, S., Berlowitz, D., Rose, A. J. Tags: Anticoagulants, Ethics and Policy, Cerebrovascular Disease/Stroke, Thrombosis Original Articles Source Type: research

Novel Oral Anticoagulant Use Among Patients With Atrial Fibrillation Hospitalized With Ischemic Stroke or Transient Ischemic Attack Original Articles
Conclusions— NOACs have had modest but growing uptake over time among atrial fibrillation patients hospitalized with stroke or transient ischemic attack and are prescribed to patients with lower stroke risk compared with warfarin.
Source: Circulation: Cardiovascular Quality and Outcomes - July 21, 2015 Category: Cardiology Authors: Patel, P. A., Zhao, X., Fonarow, G. C., Lytle, B. L., Smith, E. E., Xian, Y., Bhatt, D. L., Peterson, E. D., Schwamm, L. H., Hernandez, A. F. Tags: Other anticoagulants, Embolic stroke, Anticoagulants Original Articles Source Type: research

Abstract 119: Daily Cardiac Catheterization Procedural Volume and Complications Session Title: Poster Session I
Conclusions: There is a U-shaped association between CC volume and rates of CC related complications. Unlike prior studies which identified high annual volumes were associated with lower complication rate, our study results suggests that this relationship does not hold true for daily volume. There appears to be a daily limit at which complication rates begin to rise in proportion to volume. Higher complication rates were seen on days with very low CC volume (<5 procedures) and days with very high CC volume (>12 procedures). It is important that individual high volume CC labs consider a quality control analysis of the...
Source: Circulation: Cardiovascular Quality and Outcomes - April 29, 2015 Category: Cardiology Authors: Slicker, K., Lane, W., Oyetayo, O., Zimmermann, J., Copeland, L. A., Stock, E. M., Erwin, J. Tags: Session Title: Poster Session I Source Type: research

Abstract 150: Antithrombotic Use in Nonvalvular Atrial Fibrillation (NVAF): Alignment between Guidelines and Emerging Evidence with Clinician Prescribing Preferences Session Title: Poster Session I
Conclusions: Similar to findings from indirect treatment comparison studies, physicians largely prefer NOACs_particularly apixaban_compared to warfarin or aspirin for stroke risk reduction in NVAF patients. Additional research is needed to determine why NOACs are underused in practice.
Source: Circulation: Cardiovascular Quality and Outcomes - April 29, 2015 Category: Cardiology Authors: Shafrin, J., Bruno, A., MacEwan, J. P., Campinha-Bacote, A., Trocio, J., Tan, W., Romley, J. A. Tags: Session Title: Poster Session I Source Type: research

Abstract 157: An Early Assessment of Hospital Readmissions Among Nonvalvular Atrial Fibrillation Treated with the New Oral Anticoagulants, Apixaban, Dabigatran, and Rivaroxaban Session Title: Poster Session I
Conclusion: In this early assessment, treatment with rivaroxaban vs. apixaban was associated with greater risk of all-cause or bleeding-related 1-month readmissions and higher hospital costs due to readmissions.
Source: Circulation: Cardiovascular Quality and Outcomes - April 29, 2015 Category: Cardiology Authors: Deitelzweig, S., Bruno, A., Trocio, J., Tate, N., Lin, J., Lingohr-Smith, M. Tags: Session Title: Poster Session I Source Type: research

Abstract 176: Variation in the Content and Timing of Informed Consent in Cardiovascular Procedures: An Opportunity to Improve Decision-making Session Title: Poster Session I
Conclusion: We observed notable variation in the content, legibility and timing of informed consent documents within and across procedures. These components are necessary, though may not be sufficient, to support a high-quality informed consent process. Our results highlight opportunities for improving informed consent. Standardization of content and increased time for patients to consider the risks, benefits, and alternatives of elective procedures may result in higher quality decision-making and facilitate patient autonomy.
Source: Circulation: Cardiovascular Quality and Outcomes - April 29, 2015 Category: Cardiology Authors: Shahu, A., Spatz, E. S., Schwartz, J., Searfoss, R., Perez, M., Eddy, E., Schroeder, L. M., Bernheim, S. M., Krumholz, H. M. Tags: Session Title: Poster Session I Source Type: research

Abstract 225: Frequency and Assessment of Poor Global Outcome in Patients with Left Ventricular Assist Devices Session Title: Poster Session II
Conclusion: In this large, single-center study assessing global outcome after LVAD implantation, we found that about a third of all patients had experienced a poor global outcome at 1 year. While LVAD therapy remains life-saving and the standard of care for many patients with advanced heart failure, these findings could help guide discussions with eligible patients and families. Future work should compare patients’ pre-LVAD expectations with likely outcomes and create risk models to estimate the probability of poorer outcomes for individual patients using pre-procedural factors.
Source: Circulation: Cardiovascular Quality and Outcomes - April 29, 2015 Category: Cardiology Authors: Fendler, T. J., Nassif, M. E., Kennedy, K. F., Spertus, J. A., LaRue, S. J., Vader, J. M., Silvestry, S. C., Joseph, S. M., Arnold, S. V. Tags: Session Title: Poster Session II Source Type: research

Abstract 245: Cost Effectiveness and Safety of Abbreviated Eptifibatide Infusion in Veterans Undergoing Percutaneous Coronary Intervention Session Title: Poster Session II
Conclusion: In this real world cohort of patients undergoing PCI, an abbreviated 2 hour eptifibatide infusion after PCI was safe and had a cost savings of greater than 50% per patient, when compared with a standard 18 hour infusion. This approach is more cost-effective and should be considered in patients undergoing PCI who are not pretreated with dual antiplatelet therapy.
Source: Circulation: Cardiovascular Quality and Outcomes - April 29, 2015 Category: Cardiology Authors: Ghadban, R., Shah, A., Ampadu, J., Linneman, T., Thomas, J.-A., Forsberg, M., Stolker, J., Klein, A. Tags: Session Title: Poster Session II Source Type: research

Abstract 104: Cost-Effectiveness of Edoxaban vs. Rivaroxaban for Stroke Prevention in Patients with Non-Valvular Atrial Fibrillation (NVAF) in the US Session Title: Poster Session I
Conclusions: These results showed that once-daily edoxaban (60mg/30mg dose-reduced) regimen is a highly cost-effective treatment relative to rivaroxaban (20mg/15mg dose-reduced) for stroke prevention in NVAF patients.
Source: Circulation: Cardiovascular Quality and Outcomes - April 29, 2015 Category: Cardiology Authors: Miller, J. D., Ye, X., Lenhart, G. M., Farr, A. M., Tran, O. V., Kwong, W. J., Magnuson, E., Weintraub, W. Tags: Session Title: Poster Session I Source Type: research

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