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Healthcare costs of stroke and major bleeding in patients with atrial fibrillation treated with non-vitamin K antagonist oral anticoagulants.
CONCLUSIONS: The incremental healthcare costs incurred by patients with versus without stroke/SE was nearly twice as high as those of patients with versus without MB. Moreover, each additional year up to 4 years after the first event was associated with an incremental cost for patients with a stroke/SE or MB event compared to those without an event. PMID: 30939954 [PubMed - as supplied by publisher]
Source: Journal of Medical Economics - April 5, 2019 Category: Health Management Tags: J Med Econ Source Type: research

Stroke Prevention in Atrial Fibrillation: Looking Forward.
Abstract Ischemic strokes related to atrial fibrillation are highly prevalent, presenting with severe neurologic syndromes and associated with high risk of recurrence. Although advances have been made in both primary and secondary stroke prevention for patients with atrial fibrillation, the long-term risks for stroke recurrence and bleeding complications from antithrombotic treatment remain substantial. We summarize the major advances in stroke prevention for patients with atrial fibrillation during the past 30 years and focus on novel diagnostic and treatment approaches currently under investigation in ongoing cl...
Source: Circulation - December 15, 2020 Category: Cardiology Authors: Katsanos AH, Kamel H, Healey JS, Hart RG Tags: Circulation Source Type: research

Atrial Fibrillation and Ischemic Stroke: A Clinical Review
Semin Neurol DOI: 10.1055/s-0041-1726332Atrial fibrillation (AF) is an important risk factor for ischemic stroke resulting in a fivefold increased stroke risk and a twofold increased mortality. Our understanding of stroke mechanisms in AF has evolved since the concept of atrial cardiopathy was introduced as an underlying pathological change, with both AF and thromboembolism being common manifestations and outcomes. Despite the strong association with stroke, there is no evidence that screening for AF in asymptomatic patients improves clinical outcomes; however, there is strong evidence that patients with embolic stroke of ...
Source: Seminars in Neurology - April 13, 2021 Category: Neurology Authors: Migdady, Ibrahim Russman, Andrew Buletko, Andrew B. Tags: Review Article Source Type: research

Outcomes of Discontinuing Rivaroxaban Compared With Warfarin in Patients With Nonvalvular Atrial Fibrillation: Analysis From the ROCKET AF Trial (Rivaroxaban Once-Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation)
Conclusions: In atrial fibrillation patients who temporarily or permanently discontinued anticoagulation, the risk of stroke or non-CNS embolism was similar with rivaroxaban or warfarin. An increased risk of stroke and non-CNS embolism was observed in rivaroxaban-treated patients compared with warfarin-treated patients after the end of the study, underscoring the importance of therapeutic anticoagulation coverage during such a transition.
Source: Journal of the American College of Cardiology - February 6, 2013 Category: Cardiology Authors: Manesh R. Patel, Anne S. Hellkamp, Yuliya Lokhnygina, Jonathan P. Piccini, Zhongxin Zhang, Surya Mohanty, Daniel E. Singer, Werner Hacke, Günter Breithardt, Jonathan L. Halperin, Graeme J. Hankey, Richard C. Becker, Christopher C. Nessel, Scott D. Berkow Tags: Heart Rhythm Disorders Source Type: research

Preventing stroke and systemic embolism in renal patients with atrial fibrillation: focus on anticoagulation.
Abstract Chronic kidney disease and atrial fibrillation (AF) commonly coexist, and data suggest that renal patients have AF rates in excess of double that encountered in the general population. These patients are at increased risk of stroke, regardless of the presence or absence of AF. Furthermore, a lower GFR causes increased thromboembolic risk in patients with AF - independent of other risk factors. The dilemma facing clinicians treating this cohort of patients is that renal insufficiency confers both a thromboembolic and a bleeding risk. Renal disease also commonly coexists with other risk factors for stroke a...
Source: Contributions to Nephrology - May 26, 2013 Category: Urology & Nephrology Authors: Ahmad Y, Lip GY Tags: Contrib Nephrol Source Type: research

Percutaneous Left Atrial Appendage Occlusion with a Watchman Device Following Recurrent Stroke on Warfarin and Rivaroxaban in Patient with Paroxysmal Atrial Fibrillation
We present the case of a 66 year-old male with paroxysmal atrial fibrillation who experienced recurrent stroke despite treatment with warfarin initially, and rivaroxaban subsequently. After excluding non-cardioembolic causes of recurrent stroke, we proceeded with percutaneous occlusion of the LAA with a Watchman device. Nine months post-procedure he has not experienced recurrence of neurological symptoms. Our case provides anectodal evidence that catheter-based LAA occlusion can be beneficial in secondary stroke prevention where oral anticoagulation has been problematic.
Source: Heart, Lung and Circulation - September 30, 2013 Category: Cardiology Authors: Roberto Spina, Rajesh Subbiah, Romesh Markus, Brendan Gunalingam Tags: Brief Communications Source Type: research

Abstract 271: Anti-coagulation and Ischemic Stroke Risk in Patients with Chronic Kidney Disease and Atrial Fibrillation: Insights from the Kaiser Permanente Colorado Atrial Fibrillation Registry Session Title: Poster Session II
Conclusion: 1 in 3 patients with atrial fibrillation have CKD. There were similar reductions in the risk of stroke associated with warfarin use for CKD and non-CKD patients. These findings reinforce current clinical practice guidelines, which recommend warfarin use based on thromboembolic risk without consideration for CKD status.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Schneider, P. M., Tavel, H. M., Witt, D. M., Kauffman, Y. S., Shetterly, S. M., Go, A. S., Ho, P. M., Magid, D. J. Tags: Session Title: Poster Session II Source Type: research

Medical Costs of Oral Anticoagulants vs Warfarin for Atrial Fibrillation Patients with Different Stroke Risks
Conclusions Medical cost differences associated with OACs vs. warfarin vary according to stroke risk. Of the three OACs, apixaban demonstrated consistent medical cost reductions vs. warfarin for NVAF patients with moderate and high stroke risks.
Source: Cardiology and Therapy - December 1, 2013 Category: Cardiology Source Type: research

Time trends of aspirin and warfarin use on stroke and bleeding events in Chinese patients with new-onset atrial fibrillation.
Conclusion: Aspirin use increased amongst newly diagnosed Chinese AF patients with no relationship to the patient's stroke or bleeding risk. Warfarin use was very low. Given the healthcare burden of AF and its complications, our study has major implications for healthcare systems in non-Western countries, given the global burden of this common arrhythmia. PMID: 25501045 [PubMed - as supplied by publisher]
Source: Chest - December 11, 2014 Category: Respiratory Medicine Authors: Guo Y, Wang H, Tian Y, Wang Y, Lip GY Tags: Chest Source Type: research

Oral Anticoagulation, Aspirin, or No Therapy in Patients With Nonvalvular AF With 0 or 1 Stroke Risk Factor Based on the CHA 2 DS 2 -VASc Score
ConclusionsLow-risk patients (CHA2DS2-VASc = 0 [male], 1 [female]) have a truly low risk for stroke and bleeding. With 1 additional stroke risk factor (CHA2DS2-VASc = 1 [male], = 2 [female]), there was a significant increase in event rates (particularly mortality) if nonanticoagulated.
Source: Journal of the American College of Cardiology - April 6, 2015 Category: Cardiology Source Type: research

The Risk Stratification and Stroke Prevention Therapy Care Gap in Canadian Atrial Fibrillation Patients
Conclusions In a large Canadian AF population, primary care physicians did not provide a stroke or bleeding risk in a substantial proportion of their AF patients. When estimates were provided, they were on the basis of a predictive stroke and bleeding risk index in less than half of the patients. Furthermore, there was under- and overestimation of stroke and bleeding risk in a substantial proportion of patients. As many as 1 in 3 patients receiving warfarin have their TTR < 60%. These findings suggest an opportunity to enhance knowledge translation to primary care physicians.
Source: Canadian Journal of Cardiology - October 23, 2015 Category: Cardiology 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

A tailored treatment strategy: a modern approach for stroke prevention in patients with atrial fibrillation
The objective of this review is to provide an overview of modern AF stroke prevention with a focus on tailored treatment strategies. Biomarkers and genetic factors have been proposed to help identify ‘high‐risk’ patients to be targeted for oral anticoagulation, but ultimately their use must be balanced against that of more simple and practical considerations for everyday use. Current guidelines have directed focus on initial identification of ‘truly low‐risk’ patients with AF, that is those patients with a CHA2DS2‐VASc [congestive heart failure, hypertension, age ≥75 years (two points), diabetes mellitus, ...
Source: Journal of Internal Medicine - March 21, 2016 Category: Internal Medicine Authors: G. Y. H. Lip, T. Potpara, G. Boriani, C. Blomström‐Lundqvist Tags: Review Source Type: research

Thoracoscopic Ablation With Appendage Ligation Versus Medical Therapy for Stroke Prevention: A Proof-of-Concept Randomized Trial
Conclusions: This small proof-of-concept study showed that TPVIAL improved QOL on two subscores and restored normal sinus rhythm in all but one patient, and it showed the potential to prevent secondary stroke. A larger study will be needed.
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - March 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Stroke in a Young Woman as a Presenting Manifestation of Membranous Nephropathy
Stroke is one of the most severe complications of nephrotic syndrome (NS), only a few cases have been reported in previous literature. Some of those cases are not clear about whether the stroke was purely caused by NS because they also had other risk factors for stroke, such as old age, hypertension. A recent study showed that serum albumin less than 2.8 g/dL is a risk factor for thromboembolic events (venous thromboembolic events). Anticoagulation is suggested for patients with NS with low albumin by KIDIGO guideline 2012. Here, we describe a case in which a young patient presented with stroke as an initial symptom of mem...
Source: American Journal of Therapeutics - May 1, 2016 Category: Drugs & Pharmacology Tags: Case Reports Source Type: research