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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

GARFIELD-AF: risk profiles, treatment patterns and 2-year outcomes in patients with atrial fibrillation in Germany, Austria and Switzerland (DACH) compared to 32 countries in other regions worldwide
ConclusionsSimilarities and dissimilarities in AF management and clinical outcomes are seen in DACH and ORW. The increased use of NOAC was associated with a mismatch of risk-adapted anticoagulation (over-and-undertreatment) in DACH. Suboptimal control of INR requires educational activities in both regional groups. Higher rates of cardiovascular death in DACH may reflect the higher risk profile of these patients and lower rates of non-haemorrhagic stroke could be associated with increased NOAC use.Graphical abstract
Source: Clinical Research in Cardiology - September 12, 2022 Category: Cardiology Source Type: research

Antiplatelet agents and anticoagulants for hypertension
CONCLUSIONS: There is no evidence that antiplatelet therapy modifies mortality in patients with elevated BP for primary prevention. ASA reduced the risk of cardiovascular events and increased the risk of major bleeding events. Antiplatelet therapy with ASA probably reduces the risk of non-fatal and all cardiovascular events when compared to clopidogrel. Clopidogrel increases the risk of major bleeding events compared to ASA in patients with elevated BP for secondary prevention. There is no evidence that warfarin modifies mortality in patients with elevated BP for secondary prevention. The benefits and harms of the newer dr...
Source: Cochrane Database of Systematic Reviews - July 28, 2022 Category: General Medicine Authors: Eduard Shantsila Monika Kozie ł-Siołkowska Gregory Yh Lip Source Type: research

COVID-19-Associated Coagulopathy: Role of Vitamins D and K
Curr Pharm Biotechnol. 2022 May 27. doi: 10.2174/1389201023666220527110455. Online ahead of print.ABSTRACTRecent reports show coagulopathy as a potential complication and poorer outcome of coronavirus disease 2019 (COVID-19), especially in those with comorbid conditions such as diabetes and hypertension as thrombosis could result in stroke and heart attacks. Indeed, cardiovascular complications in COVID-19 accounts for 40% of mortality. Although there is no standard treatment protocol or guidelines for COVID-19, it is a common practice to use anti-inflammatory corticosteroids and anti-coagulants, especially for severe COVI...
Source: Current Pharmaceutical Biotechnology - May 31, 2022 Category: Biotechnology Authors: Bruk Getachew Harold E Landis Kebreten F Menaye Yousef Tizabi 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

Novel bleeding prediction model in atrial fibrillation patients on new oral anticoagulants
Conclusions We present a novel and simple risk score for prediction of major bleeding in patients with non-valvular AF treated with NOACs. Validation in additional cohorts is warranted.
Source: Heart - January 28, 2022 Category: Cardiology Authors: Barnett-Griness, O., Stein, N., Kotler, A., Saliba, W., Gronich, N. Tags: Editor's choice Arrhythmias and sudden death 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

Maternal and neonatal complications in women with congenital heart disease: a nationwide analysis
ConclusionsThis population-based study illustrates a reassuringly low maternal mortality rate in a highly developed healthcare system. Nevertheless, maternal morbidity and neonatal morbidity/mortality were significantly increased in women with ACHD and their offspring compared to non-ACHD controls highlighting the need of specialized care and pre-pregnancy counselling.
Source: European Heart Journal - October 12, 2021 Category: Cardiology Source Type: research

Characteristics of Ischemic Versus Hemorrhagic Stroke in Patients Receiving Oral Anticoagulants: Results of the PASTA Study
Conclusion The presence of CMBs, a history of stroke, natriuretic peptide and D-dimer levels, and PT-INR may be useful for risk stratification of either IS/TIA or ICH development in patients with AF receiving OACs.PMID:34483213 | DOI:10.2169/internalmedicine.8113-21
Source: Internal Medicine - September 6, 2021 Category: Internal Medicine Authors: Satoshi Suda Arata Abe Yasuyuki Iguchi Yoshiki Yagita Takao Kanzawa Seiji Okubo Nobuyuki Ohara Takayuki Mizunari Mineo Yamazaki Nobuhito Nakajima Kimito Kondo Shigeru Fujimoto Takeshi Inoue Takeshi Iwanaga Yuka Terasawa Kensaku Shibazaki Yu Kono Makoto Na Source Type: research

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