Article
Medicine, General & Internal
Gregory Y. H. Lip, Allison Keshishian, Yan Zhang, Amiee Kang, Amol D. Dhamane, Xuemei Luo, Christian Klem, Mauricio Ferri, Jenny Jiang, Huseyin Yuce, Steven Deitelzweig
Summary: In this study of patients with NVAF and high risk of GI bleed, NOACs were associated with lower rates of stroke and/or SE, but NOACs had varying risks of MB compared with warfarin. These results may help inform treatment options in this patient population.
Article
Cardiac & Cardiovascular Systems
Alan Sugrue, David Sanborn, Mustapha Amin, Medhat Farwati, Haarini Sridhar, Azza Ahmed, Ramila Mehta, Konstantinos C. Siontis, Siva K. Mulpuru, Abhishek J. Deshmukh, Bernard J. Gersh, Samuel J. Asirvatham, Malini Madhavan
Summary: In a cohort of atrial fibrillation patients, 15% were found to have inappropriate doses of direct oral anticoagulants. Patients with older age, female gender, and higher CHA2DS2-VASc scores were more likely to be underdosed, but these inappropriate doses did not lead to significant adverse outcomes such as stroke, transient ischemic attack, embolism, or bleeding.
AMERICAN JOURNAL OF CARDIOLOGY
(2021)
Article
Hematology
Christos Voukalis, Gregory Y. H. Lip, Eduard Shantsila
Summary: Patients with atrial fibrillation have more potent thrombogenesis and delayed clot dissolution compared to disease control groups. Apixaban is more effective in attenuating prothrombotic characteristics and reducing biomarkers associated with adverse cardiovascular events compared to warfarin and antiplatelets.
THROMBOSIS RESEARCH
(2021)
Review
Medical Laboratory Technology
David D. Berg, Christian T. Ruff, David A. Morrow
Summary: This review discusses the use of circulating biomarkers to predict the risks of AF and its complications. Biomarkers reflecting pathophysiologic mechanisms can identify patients at higher risk for developing AF, S/SEE, or major bleeding. Biomarker-based risk scores, like ABC-stroke and ABC-bleeding, improve risk stratification compared to traditional clinical risk scores.
CLINICAL CHEMISTRY
(2021)
Article
Multidisciplinary Sciences
Beom Joon Kim, Keon-Joo Lee, Eun Lyeong Park, Kanta Tanaka, Masatoshi Koga, Sohei Yoshimura, Ryo Itabashi, Jae-Kwan Cha, Byung-Chul Lee, Hisanao Akiyama, Yoshinari Nagakane, Juneyoung Lee, Kazunori Toyoda, Hee-Joon Bae
Summary: This study aimed to develop and validate a risk prediction model for stroke recurrence in AIS patients with AF, but the final model did not show better predictive ability than traditional risk scoring tools.
Article
Cardiac & Cardiovascular Systems
Malik Elharram, Michelle Samuel, Ahmed AlTurki, Michael Quon, Hassan Behlouli, Amal Bessissow, Louise Pilote
Summary: This study aimed to investigate the association between oral anticoagulation (OAC) use and thromboembolic events and major bleeding in patients with new postoperative atrial fibrillation (POAF) after noncardiac surgery. The results showed that OAC was not associated with a reduction in long-term thromboembolic events in these patients, but it did increase the risk for major bleeding. Future prospective clinical studies are needed to better understand the efficacy and safety of anticoagulation therapy in the setting of POAF after noncardiac surgery.
CANADIAN JOURNAL OF CARDIOLOGY
(2021)
Article
Cardiac & Cardiovascular Systems
Sean D. Pokorney, Glenn M. Chertow, Hussein R. Al-Khalidi, Dianne Gallup, Pat Dignacco, Kurt Mussina, Nisha Bansal, Crystal A. Gadegbeku, David A. Garcia, Samira Garonzik, Renato D. Lopes, Kenneth W. Mahaffey, Kelly Matsuda, John P. Middleton, Jennifer A. Rymer, George H. Sands, Ravi Thadhani, Kevin L. Thomas, Jeffrey B. Washam, Wolfgang C. Winkelmayer, Christopher B. Granger
Summary: This study evaluated the safety and efficacy of apixaban for stroke prevention in patients with end-stage kidney disease on hemodialysis and atrial fibrillation. The trial showed no significant difference in major or clinically relevant nonmajor bleeding between apixaban and warfarin, and there was overlap in apixaban blood concentration between patients with and without bleeding events. Future randomized studies are needed to assess the risks and benefits of anticoagulation in this population.
Article
Pharmacology & Pharmacy
Shin-Yi Lin, Sung-Chun Tang, Ching-Hua Kuo, Li-Ting Ho, Yen-Bin Liu, Yu-Fong Peng, Li-Kai Tsai, Chih-Fen Huang, Jiann-Shing Jeng
Summary: This study reports on the association between direct oral anticoagulant (DOAC) concentration and clinical outcomes in Asian patients with atrial fibrillation (AF). The proportion of DOAC concentrations falling outside the expected range was higher than reported in clinical trials. Low trough concentration was associated with increased risk of systemic thromboembolism (SSE), while high trough concentration was associated with major bleeding. Measurement of trough DOAC concentration should be considered for patients at risk of concentration deviations.
CLINICAL PHARMACOLOGY & THERAPEUTICS
(2023)
Article
Medicine, General & Internal
Yi-Hsin Chan, Tze-Fan Chao, Shao-Wei Chen, Hsin-Fu Lee, Wei-Min Chen, Pei-Ru Li, Yung-Hsin Yeh, Chi-Tai Kuo, Lai-Chu See, Gregory Y. H. Lip
Summary: This study suggests a higher risk of incident ILD associated with the use of FXa inhibitors in patients with NVAF. Physicians should be vigilant in monitoring potential adverse lung outcomes related to the use of these drugs.
Article
Medicine, General & Internal
Derek S. Chew, Ke Zhou, Sean D. Pokorney, David B. Matchar, Sreekanth Vemulapalli, Larry A. Allen, Kevin P. Jackson, Zainab Samad, Manesh R. Patel, James V. Freeman, Jonathan P. Piccini
Summary: Left atrial appendage occlusion (LAAO) is a potential alternative to oral anticoagulants in patients with atrial fibrillation (AF) to reduce major bleeding risk. However, there is uncertainty regarding the risk for ischemic stroke compared with anticoagulation. The overall benefit from LAAO depends on the combination of stroke and bleeding risks in individual patients.
ANNALS OF INTERNAL MEDICINE
(2022)
Article
Medicine, General & Internal
Gregory F. Michaud, William G. Stevenson
Summary: A 63-year-old healthy male with atrial fibrillation presents with symptoms of dyspnea and irregular heartbeat. Physical examination reveals high blood pressure, irregular pulse, and ECG confirms atrial fibrillation. Further evaluation and treatment plan are needed.
NEW ENGLAND JOURNAL OF MEDICINE
(2021)
Article
Medicine, General & Internal
Anneka Mitchell, Julia Snowball, Tomas J. Welsh, Margaret C. Watson, Anita McGrogan
Summary: The study found a significant increase in the prescribing of oral anticoagulants for atrial fibrillation patients aged 75 years and older, but disparities still exist based on age and comorbidities. Elderly patients and those with comorbidities such as dementia, history of falls, major bleeds, and fractures were less likely to be prescribed oral anticoagulants.
Article
Medicine, General & Internal
Woldesellassie M. Bezabhe, Jan Radford, Barbara C. Wimmer, Mohammed S. Salahudeen, Ivan Bindoff, Gregory M. Peterson
Summary: The use of DOACs is associated with a lower risk of osteoporosis compared to warfarin, with each individual DOAC having a significantly lower risk as well.
JOURNAL OF CLINICAL MEDICINE
(2022)
Article
Cardiac & Cardiovascular Systems
Chung-Ming Fu, Lung-Chih Li, Yueh-Ting Lee, Shih-Wei Wang, Chien-Ning Hsu
Summary: The study found that compared to warfarin, apixaban treatment in atrial fibrillation patients with chronic kidney disease resulted in a lower risk of stroke or systemic embolism and no increased risk of major bleeding. Stratified analyses based on initial apixaban dose and baseline estimated glomerular filtration rate were conducted, showing consistent results of reduced risk with apixaban treatment.
FRONTIERS IN CARDIOVASCULAR MEDICINE
(2021)
Article
Cardiac & Cardiovascular Systems
Pablo Dominguez-Erquicia, Sergio Raposeiras-Roubin, Emad Abu-Assi, Paula Bouzon-Iglesias, Jose A. Parada-Barcia, Andrea Lizancos-Castro, Andre Gonzalez-Garcia, Vanesa A. Noriega-Caro, Ana Ledo-Pineiro, Carla Iglesias-Otero, Inmaculada Gonzalez-Bermudez, Andres Iniguez-Remo
Summary: This study evaluated the performance of anticoagulated patients in terms of embolic, hemorrhagic, and mortality events based on different body weight categories. The results showed that weight was not associated with bleeding risk, but the low body weight group had an increased risk of stroke/systemic embolism, while the high body weight group had a reduced risk. However, no significant association was found between weight and these events in the multivariable model.
AMERICAN JOURNAL OF CARDIOLOGY
(2022)
Article
Cardiac & Cardiovascular Systems
Christina Christersson, Tomasz Baron, Frank Flachskampf, Lars Lindhagen, Bertil Lindahl, Agneta Siegbahn
Summary: A proportion of ACS patients will experience progressive remodeling of the LV. This study identified important biomarkers associated with reduced LV function early and 1 year after ACS, providing insights into the biological processes involved in long-term heart failure after ACS.
JOURNAL OF CARDIOVASCULAR TRANSLATIONAL RESEARCH
(2023)
Article
Cardiac & Cardiovascular Systems
Michael W. A. Chu, Marc Ruel, Allen Graeve, Marc W. Gerdisch, Ralph J. Damiano Jr, Robert L. Smith II, William Brent Keeling, Michael A. Wait, Robert C. Hagberg, Reed D. Quinn, Gulshan K. Sethi, Rosario Floridia, Christopher J. Barreiro, Andrew L. Pruitt, Kevin D. Accola, Francois Dagenais, Alan H. Markowitz, Jian Ye, Michael E. Sekela, Ryan Y. Tsuda, David A. Duncan, Daniel G. Swistel, Lacy E. Harville III, Joseph J. DeRose, Eric J. Lehr, John H. Alexander, John D. Puskas
Summary: This study aimed to assess the safety and efficacy of low-dose warfarin in patients with mechanical mitral valve replacement. The results showed that low-dose warfarin did not achieve noninferiority for the composite primary end point compared to standard-dose warfarin. The difference in the annual incidence rate between the two groups was very small during the 4.1 years of follow-up. Therefore, the current target international normalized ratio range (2.5-3.5) may still be the recommended treatment range for patients with mechanical mitral valve replacement.
ANNALS OF THORACIC SURGERY
(2023)
Article
Cardiac & Cardiovascular Systems
Ziad Hijazi, Alexander P. Benz, Johan Lindback, John H. Alexander, Stuart J. Connolly, John W. Eikelboom, Christopher B. Granger, Peter Kastner, Renato D. Lopes, Andre Ziegler, Jonas Oldgren, Agneta Siegbahn, Lars Wallentin
Summary: In this study, BMP10 may be a novel specific biomarker of ischaemic stroke in patients with atrial fibrillation, irrespective of oral anticoagulation.
EUROPEAN HEART JOURNAL
(2023)
Editorial Material
Cardiac & Cardiovascular Systems
Mario Gaudino, John Alexander, Umberto Benedetto, Andreas Boening, Arnaldo Dimagli, Stephen Fremes, Joanna Chikwe, Leonard Girardi, David Hare, Paul Kurlansky, Andre Lamy, Katia Audisio, Antonino Di Franco, P. J. Devereaux, Anno Diegeler, Marcus Flather, Jennifer S. Lawton, Derrick Y. Tam, Wilko Reents, Mohamed Rahouma
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
(2023)
Article
Cardiac & Cardiovascular Systems
Guillaume Marquis-Gravel, Laurie-Anne Boivin-Proulx, Zhen Huang, Steven L. Zelenkofske, A. Michael Lincoff, Roxana Mehran, P. Gabriel Steg, Christoph Bode, John H. Alexander, Thomas J. Povsic
Summary: This study compared the effectiveness of vascular closure devices (VCDs) with manual compression in reducing bleeding after transfemoral percutaneous coronary intervention. The results showed that there was no significant difference in bleeding rate between the two groups, but the VCD group had shorter recovery time. Further investigation is needed for high-bleeding risk populations.
JOURNAL OF THE AMERICAN HEART ASSOCIATION
(2023)
Article
Cardiac & Cardiovascular Systems
Eleonora Hamilton, Liyew Desta, Anna Lundberg, Joakim Alfredsson, Christina Christersson, David Erlinge, Thomas Kellerth, Krister Lindmark, Elmir Omerovic, Christian Reitan, Tomas Jernberg
Summary: The aim of this study was to describe the prevalence, characteristics, and outcome of patients with acute myocardial infarction (MI) developing left ventricular (LV) systolic dysfunction or pulmonary congestion by applying different criteria to define the population. Four different subsets of patients were created based on different criteria, and the prevalence of LV systolic dysfunction or pulmonary congestion varied between these subsets. The study found that LV systolic dysfunction or pulmonary congestion is present in 13-32% of all patients with MI and is associated with a higher risk of subsequent death or heart failure admission.
Article
Cardiac & Cardiovascular Systems
Jr Tuman J. Milling, Saskia Middeldorp, Lizhen Xu, Bruce Koch, Andrew Demchuk, John W. Eikelboom, Peter Verhamme, Alexander T. Cohen, Jan Beyer-Westendorf, C. Michael Gibson, Jose Lopez-Sendon, Mark Crowther, Ashkan Shoamanesh, Michiel Coppens, Jeannot Schmidt, Pierre Albaladejo, Stuart J. Connolly
Summary: This study evaluated the safety and efficacy of andexanet alfa in patients with major bleeding caused by factor Xa inhibitors. The results showed that the drug reduced anti-FXa activity and achieved good or excellent hemostatic efficacy in 80% of the patients.
Review
Cardiac & Cardiovascular Systems
Josephine Harrington, Jonathan P. Piccini, John H. Alexander, Christopher B. Granger, Manesh R. Patel
Summary: FXIa inhibitors have the potential to improve precision in anticoagulation by primarily targeting thrombus formation while sparing clotting and hemostasis. Observational data and small phase 2 trials have shown promising results in terms of bleeding, safety, and prevention of venous thromboembolism. Larger clinical trials are needed to determine the role of FXIa inhibitors in different patient populations.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
(2023)
Editorial Material
Medicine, General & Internal
John H. H. Alexander
NEW ENGLAND JOURNAL OF MEDICINE
(2023)
Article
Cardiac & Cardiovascular Systems
Dragos Vinereanu, Daniel M. Wojdyla, John H. Alexander, Renato D. Lopes, Sana M. Al-Khatib, Bernard J. Gersh, M. Cecilia Bahit, Stefan H. Hohnloser, Greg C. Flaker, Marten Rosenquist, Ziad Hijazi, Lars Wallentin, Christopher B. Granger
Summary: Rate control is crucial in treating patients with AF, but the association between heart rate and outcomes remains unclear. In the ARISTOTLE trial, we found that in patients with persistent or permanent AF, a higher heart rate is associated with a slight, but statistically significant increase in death and heart failure hospitalizations.
AMERICAN HEART JOURNAL
(2023)
