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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

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

Aspirin Instead of Oral Anticoagulant Prescription in Atrial Fibrillation Patients at Risk for Stroke
ConclusionsIn a large, real-world cardiac outpatient population of AF patients with a moderate to high risk of stroke, more than 1 in 3 were treated with aspirin alone without OAC. Specific patient characteristics predicted prescription of aspirin therapy over OAC.
Source: Journal of the American College of Cardiology - June 21, 2016 Category: Cardiology Source Type: research

Better than Aspirin for Your Heart
If you’ve been diagnosed with heart disease, the chances are you’ve been told to take low-dose aspirin every day as a preventative measure against heart attack and stroke. It’s most commonly prescribed for patients with congestive heart failure. This is the inability of your heart to pump as much blood as your body needs. And this is a big worry to me, because there is very little evidence that aspirin helps. In fact, regular use of aspirin — even baby aspirin — can do you more harm than good. Common Aspirin Beliefs The idea is that aspirin thins the blood, making it easier to pump.  It is also s...
Source: Al Sears, MD Natural Remedies - April 1, 2016 Category: Complementary Medicine Authors: Al Sears Tags: Heart Health Source Type: news

Clinical and Economic Implications of Apixaban Versus Aspirin in the Low-Risk Nonvalvular Atrial Fibrillation Patients Clinical Sciences
Conclusions— Anticoagulant treatment with apixaban versus aspirin in low-risk patients, as identified using CHADS2 or CHA2DS2–VASc, is projected to increase life expectancy and provide clinical benefits that are cost effective.
Source: Stroke - September 28, 2015 Category: Neurology Authors: Lip, G. Y. H., Lanitis, T., Mardekian, J., Kongnakorn, T., Phatak, H., Dorian, P. Tags: Primary prevention, Cerebrovascular disease/stroke, Anticoagulants, Antiplatelets Clinical Sciences Source Type: research

Study On Drug Utilization And Assessment Of Stroke Risk Using Chads2 And Cha2ds2-Vasc Scoring In Elderly Patients With Non-Valvular Atrial Fibrillation
Stroke Risk Stratification in AF patients of can be done using CHADS2 (Congestive heart failure, Hypertension, Age ≥75, DM, prior Stroke/TIA [2 points] ); or CHA2DS2VASc2 (Congestive heart failure/left ventricular ejection fraction ≤35%, Hypertension, Age ≥75 [2 points], DM, prior Stroke/TIA/thromboembolism [2 points], Vascular disease, Age 65–74, Sex- female). Treatment options for Prevention of stroke includes Anti-coagulants (Vitamin K Antagonist-Warfarin, Acenocoumarol; and Newer Oral Anticoagulant- Dabigatran) and anti-platelets (Aspirin and Clopidogrel).
Source: Value in Health - November 1, 2014 Category: Global & Universal Authors: T. Raj, S. Bonthu, S.R. Mallayasamy Source Type: research

Triple Therapy for Atrial Fibrillation and Percutaneous Coronary Intervention A Contemporary Review
Chronic oral anticoagulant therapy is recommended (class I) in patients with mechanical heart valves and in patients with atrial fibrillation with a CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, prior Stroke or transient ischemic attack or thromboembolism, Vascular disease, Age 65 to 74 years, Sex category) score ≥1. When these patients undergo percutaneous coronary intervention with stenting, treatment with aspirin and a P2Y12 receptor inhibitor also becomes indicated. Before 2014, guidelines recommended the use of triple therapy (vitamin K antagonists, aspirin, and clopidog...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - September 15, 2014 Category: Cardiology Source Type: research

Modification of Outcomes With Aspirin or Apixaban in Relation to Female and Male Sex in Patients With Atrial Fibrillation: A Secondary Analysis of the AVERROES Study Brief Reports
Conclusions— Female patients with atrial fibrillation had higher ischemic stroke rates compared with male patients, but the relative effects of apixaban compared with aspirin on both ischemic stroke and bleeding were similar in men and women.
Source: Stroke - June 23, 2014 Category: Neurology Authors: Lip, G. Y. H., Eikelboom, J., Yusuf, S., Shestakovska, O., Hart, R. G., Connolly, S., on behalf of the AVERROES Investigators Tags: Other anticoagulants, Thrombosis risk factors Brief Reports Source Type: research