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Utilization of triple antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention
ConclusionsThe utilization of TAT following PCI among high-stroke risk AF patients steadily increased from 2011 to 2020, reaching 65.4% by the end of the study period. However, in 2020, a significant proportion of 29.4% of patients still received DAPT, indicating that many AF patients undergoing PCI did not receive adequate antithrombotic therapy.
Source: European Journal of Clinical Pharmacology - February 24, 2023 Category: Drugs & Pharmacology Source Type: research

Outcomes and drivers of inappropriate dosing of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation: a systematic review and meta-analysis
Conclusions Our analysis suggests that off-label underdosing of NOACs does not reduce bleeding outcomes. Patients prescribed off-label NOAC doses are at an increased risk of all-cause mortality. These data underscore the importance of prescriber adherence to NOAC dosing guidelines to achieve optimal clinical outcomes for patients with AF. PROSPERO registration number CRD42020219844.
Source: Heart - January 11, 2023 Category: Cardiology Authors: Caso, V., de Groot, J. R., Sanmartin Fernandez, M., Segura, T., Blomström-Lundqvist, C., Hargroves, D., Antoniou, S., Williams, H., Worsley, A., Harris, J., Caleyachetty, A., Vardar, B., Field, P., Ruff, C. T. Tags: Open access Systematic review Source Type: research

Can I use DOAC in a patient with renal disease?
Case A 76-year-old man is diagnosed with non-valvular atrial fibrillation. His comorbid conditions are hypertension, diabetes complicated by neuropathy, and chronic kidney disease stage 3. His current medications include metformin, lisinopril, gabapentin, and aspirin. His most recent laboratories showed a creatinine 1.8, creatinine clearance (CrCl) 35 mL/min, hemoglobin 11g/dL, and international normalized ratio 1.0. His congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, and sex (CHADSVASc) score is 4. Which medication should we use to prevent stroke in this patient?  Brief overview of the is...
Source: The Hospitalist - February 3, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: Renal & Genitourinary Source Type: research

Mendelian randomization analysis of vitamin D in the secondary prevention of hypertensive-diabetic subjects: role of facilitating blood pressure control
ConclusionsGenetically predicted increase in Vit-D status [25(OH)D] may confer secondary protection against incident combined CVD events and myocardial infarction in a hypertensive-diabetic population where serological 25(OH)D deficiency is common, through facilitating blood pressure control.
Source: Genes and Nutrition - January 29, 2022 Category: Nutrition Source Type: research

Direct Oral Anticoagulants in Cardiac Amyloidosis –Associated Heart Failure and Atrial Fibrillation
Atrial fibrillation (AF) is present in approximately 40% of patients with cardiac amyloidosis.1 AF in the setting of cardiac amyloidosis is associated with a significant risk of stroke and systemic thromboembolism regardless of the patient's CHA ₂DS₂-VASc (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65 to 74 years, sex category) score.2 Although current guidelines recommend anticoagulation therapy in all patients with cardiac amyloidosis and AF, data about the comparative effectiveness and safety of vitamin K antagonists (VKAs) ...
Source: The American Journal of Cardiology - November 27, 2021 Category: Cardiology Authors: Amgad Mentias, Paulino Alvarez, Pulkit Chaudhury, Michael Nakhla, Rohit Moudgil, Mohamad Kanj, Mazen Hanna, Milind Y. Desai Source Type: research

Combination of Oral Anticoagulants and Single Antiplatelets versus Triple Therapy in Nonvalvular Atrial Fibrillation and Acute Coronary Syndrome: Stroke Prevention among Asians
Int J Angiol DOI: 10.1055/s-0040-1708477Atrial fibrillation (AF), the most prevalent arrhythmic disease, tends to foster thrombus formation due to hemodynamic disturbances, leading to severe disabling and even fatal thromboembolic diseases. Meanwhile, patients with AF may also present with acute coronary syndrome (ACS) and coronary artery disease (CAD) requiring stenting, which creates a clinical dilemma considering that majority of such patients will likely receive oral anticoagulants (OACs) for stroke prevention and require additional double antiplatelet treatment (DAPT) to reduce recurrent cardiac events and in-stent th...
Source: International Journal of Angiology - May 5, 2020 Category: Cardiology Authors: Santoso, Anwar Raharjo, Sunu B. Tags: Invited Papers Source Type: research

Can echocardiography improve the prediction of thromboembolic risk in atrial fibrillation? Evidences and perspectives
AbstractAtrial fibrillation is the most common arrhythmia and its prevalence is expected to further increase. Patients with atrial fibrillation have an increased risk of stroke (fivefold increased risk), heart failure, and death. In patients with non-valvular atrial fibrillation, the most recent guidelines recommend the use of the CHA2DS2-VASc (congestive heart failure, arterial hypertension, age  >  75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65–74 years, sex category) scoring system to identify those who may benefit from oral anticoagulant treatment. Guidelines recommen...
Source: Internal and Emergency Medicine - March 1, 2020 Category: Emergency Medicine Source Type: research

Preoperative Vitamin D Concentration and Cardiac, Renal, and Infectious Morbidity after Noncardiac Surgery
Conclusions Preoperative vitamin D was not associated with a composite of postoperative 30-day cardiac outcomes. However, there was a significant association between vitamin D deficiency and a composite of infectious complications and decreased kidney function. While renal effects were not clinically meaningful, the effect of vitamin D supplementation on infectious complications requires further study.
Source: Anesthesiology - December 13, 2019 Category: Anesthesiology Source Type: research

Direct Oral Anticoagulants and Mortality in Atrial Fibrillation
ConclusionsIn this cohort of newly diagnosed NVAF patients treated in routine clinical practice, DOAC therapy was associated with a lower risk for death compared to no oral anticoagulation. Our findings provide further evidence for the importance of DOAC therapy in NVAF patients.DisclosuresNo relevant conflicts of interest to declare.
Source: Blood - November 21, 2018 Category: Hematology Authors: Ellis, M., Ruslan, S., Ariel, H., Greenberg-Dotan, S., Battat, E., Hamburger-Avnery, O., Greenberg, D., Ronen, A. Tags: 332. Antithrombotic Therapy Source Type: research

Effect of Variation in Published Stroke Rates on the Net Clinical Benefit of Anticoagulation for Atrial Fibrillation.
Conclusion: Variation in published AF stroke rates for patients not receiving anticoagulant therapy results in multifold variation in the net clinical benefit of anticoagulation. Guidelines should better reflect the uncertainty in current thresholds of stroke risk score for recommending anticoagulation. Primary Funding Source: None. PMID: 30264130 [PubMed - as supplied by publisher]
Source: Annals of Internal Medicine - September 25, 2018 Category: Internal Medicine Authors: Shah SJ, Eckman MH, Aspberg S, Go AS, Singer DE Tags: Ann Intern Med Source Type: research

Stroke prevention, 1-year clinical outcomes and healthcare resource utilization in patients with atrial fibrillation in France: Data from the GARFIELD-AF registry.
CONCLUSIONS: Patients enrolled in France had higher rates of mortality and stroke/systemic embolism than in GARFIELD-AF overall. Conversely, the risk of major bleeding was not higher. PMID: 29861295 [PubMed - as supplied by publisher]
Source: Archives of Cardiovascular Diseases - May 31, 2018 Category: Cardiology Authors: Le Heuzey JY, Bassand JP, Berneau JB, Cozzolino P, D'Angiolella L, Doucet B, Mantovani LG, Martelet M, Mouallem J, Muller JJ, Pieper K, GARFIELD-AF Investigators Tags: Arch Cardiovasc Dis Source Type: research

Effects of Sleepiness on Survival in Japanese Hemodialysis Patients: J-DOPPS Study
Sleep disorder and poor sleep quality are common in chronic hemodialysis (HD) patients. They have been claimed as a cause of morbidity and mortality. The relationship between the degree of sleepiness and survival has not been studied. We studied the degree of sleepiness in 1,252 adult HD patients (age ≥20 years) recruited into the Dialysis Outcomes Practice Pattern Study in Japan (J-DOPPS III), using the Japanese version of the Epworth Sleepiness Scale (JESS) questionnaire. Demographic data were presented for three subgroups: low, intermediate, and high JESS score. Cox proportional hazard regre ssion analysis was perform...
Source: Nephron Clinical Practice - October 25, 2017 Category: Urology & Nephrology Source Type: research

Comparison of the CHA2DS2-VASc, CHADS2, HAS-BLED, ORBIT, and ATRIA Risk Scores in Predicting Non –Vitamin K Antagonist Oral Anticoagulants-Associated Bleeding in Patients With Atrial Fibrillation
The increasing adoption of non –vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation (AF) necessitates a reassessment of bleeding risk scores. Because known risk factors for bleeding are largely the same as for stroke, we hypothesize that stroke risk scores could also be used to identify patients with high bleeding risks. We aimed to compare the performance of 2 stroke risk scores (Congestive Heart failure, hypertension, Age ≥75 [doubled], Diabetes, Stroke [doubled], Vascular disease, Age 65–74, and Sex [female] [CHA2DS2-VASc] and Cardiac failure, Hypertension, Age, Diabetes, ...
Source: The American Journal of Cardiology - July 31, 2017 Category: Cardiology Authors: Xiaoxi Yao, Bernard J. Gersh, Lindsey R. Sangaralingham, David M. Kent, Nilay D. Shah, Neena S. Abraham, Peter A. Noseworthy Source Type: research

Factors associated with non –vitamin K antagonist oral anticoagulants for stroke prevention in patients with new-onset atrial fibrillation: Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II (ORBIT-AF II)
Conclusions In contemporary clinical practice, up to three-fourths of patients with new-onset AF are now initially treated with a NOAC for stroke prevention. Those selected for NOAC treatment had lower stroke and bleeding risk profiles, were more likely treated by cardiologists, and had higher socioeconomic status. Trial registration clinicaltrials.gov Identifier: NCT01701817
Source: American Heart Journal - April 25, 2017 Category: Cardiology Source Type: research

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