Effect of Fixed Minidose Warfarin, Conventional Dose Warfarin and Aspirin on INR and Prothrombin Fragment 1 + 2 in Patients with Atrial Fibrillation

1997 ◽  
Vol 77 (05) ◽  
pp. 0845-0848 ◽  
Author(s):  
B G Koefoed ◽  
C Feddersen ◽  
A L Gulløv ◽  
P Petersen
Keyword(s):  
Atrial Fibrillation ◽  
International Normalized Ratio ◽  
Coagulation System ◽  
Nonvalvular Atrial Fibrillation ◽  
Treatment Groups ◽  
Prothrombin Fragment ◽  
Conventional Dose ◽  
Dose Warfarin ◽  
Significant Difference ◽  
Changes Over Time

SummaryThe efficacy of conventional dose adjusted oral anticoagulation for stroke prevention in patients with non-valvular atrial fibrillation is well- documented but not considered ideal as primary antithrombotic treatment in elderly patients. The antithrombotic effect of fixed minidose warfarin 1.25 mg/day alone or in combination with aspirin 300 mg/day, of conventional dose adjusted warfarin (INR 2.0-3.0), and of aspirin 300 mg/day have been investigated in outpatients with chronic nonvalvular atrial fibrillation in the second Copenhagen Atrial Fibrillation, Aspirin and Anticoagulant Therapy Study (AFASAK 2). In order to investigate the effect on the coagulation system of the treatments, the International Normalized Ratio of the prothrombin time (INR) and prothrombin fragment 1 + 2 (F1 +2) were monitored at baseline and after three months of treatment in 100 patients consecutively included in the trial. At baseline no differences in INR and F1+2 between the four treatment groups were present. After three months of therapy the level of INR increased significantly from baseline in patients receiving warfarin in any dose and the level of F1+2 decreased significantly by combined minidose warfarin-aspirin and by dose adjusted warfarin. When comparing the changes over time in FI +2 (three-month value minus baseline value) during therapy with fixed minidose warfarin, combined minidose warfarin-aspirin and aspirin alone no significant difference between the groups was found. In conclusion, INR was changed by all three warfarin regimens but only dose adjusted warfarin (INR 2.0-3.0) had a marked effect on F1+2.

scholarly journals The Comparison of Therapeutic Efficacy Between Dabigatran Versus Warfarin in Patients With Nonvalvular Atrial Fibrillation

2021 ◽  
Vol 27 ◽  
pp. 107602962110447
Author(s):  
Hongxia Li ◽  
Lei Zhang ◽  
Ming Xia ◽  
Chi Zhang ◽  
Tingbo Jiang
Keyword(s):  
Atrial Fibrillation ◽  
Dabigatran Etexilate ◽  
Oral Anticoagulants ◽  
International Normalized Ratio ◽  
Thrombin Time ◽  
Nonvalvular Atrial Fibrillation ◽  
Coagulation Assays ◽  
Warfarin Group ◽  
Dose Warfarin ◽  
Coagulation Status

Background Novel oral anticoagulants and warfarin are widely used for stroke prevention in patients with atrial fibrillation. The anticoagulation status of patients receiving warfarin or rivaroxaban has been studied. In this study, we aimed to evaluate the effect of dabigatran and warfarin on preventing thrombin generation (TG). Methods This retrospective study enrolled 237 nonvalvular atrial fibrillation (NVAF) subjects treated with 110 mg dabigatran etexilate twice daily and 224 NVAF patients received adjusted-dose warfarin (international normalized ratio [INR] of 2 to 3)). Coagulation assays, prothrombin fragment 1  +  2 (F1+2), calibrated automated thrombogram, and thrombin–antithrombin complex (TAT) were detected at the steady state. Results Activated partial thromboplastin time (APTT), antithrombin III activity, fibrinogen, and lag time showed no difference between the two groups. Compared to the dabigatran group, prothrombin time and INR values were higher in the warfarin group (all P < .001). Thrombin time, endogenous thrombin potential, peak TG (Cmax), F1+2, and TAT were lower in the warfarin group. The inhibition of TG was still stronger in the warfarin group when the patients were divided into subgroups. Conclusion Conventional coagulation assays are suboptimal for assessing the coagulation status of dabigatran. TG could be used as supplementary assays to evaluate the anticoagulation effect of oral anticoagulants. Our results suggest that warfarin may inhibit TG more aggressively than dabigatran in patients regardless of age and kidney function.

Abstract TP120: Plasma D-dimer Level and Cerebral Infarction Volume in Patients With Nonvalvular Atrial Fibrillation

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Mari Matsumoto ◽  
Manabu Sakaguchi ◽  
Shuhei Okazaki ◽  
Shigetaka Furukado ◽  
Masafumi Tagaya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Functional Outcome ◽  
National Institutes Of Health ◽  
Nonvalvular Atrial Fibrillation ◽  
Nihss Score ◽  
Significant Difference ◽  
Infarction Volume ◽  
D Dimer

Introduction and Hypothesis: The purpose of this study was to investigate the association between plasma D-dimer level at admission and infarct size in non-valvular atrial fibrillation (NVAF) patients. Methods: We identified 124 patients with consecutive ischemic stroke and NVAF who were admitted within 48 hours of symptom onset. We measured infarction volume from CT taken after 3±1 days from the onset. Relationships were analysed between infarction volume, risk factors, preadmission medications and admission conditions. We also assessed the functional outcome by tertile of D-dimer level (≦ 0.83, 0.83-2.16, ≧ 2.16 μg/mL) in patients with preadmission modified Rankin Scale (mRS) score of 0-1. Results: Infarction volume significantly correlated with D-dimer level (r=0.309, p < 0.001) (Figure 1), systolic blood pressure (r=0.201, p=0.026), diastolic blood pressure (r=0.283, p=0.002), National Institutes of Health Stroke Scale (NIHSS) score on admission (r=0.546, p < 0.001) and mRS score at discharge (r=0.557, p<0.001). Multivariate regression analyses showed that the D-dimer level was significantly associated with infarction volume (p=0.043) after adjustment with known risk factors. In patients with a preadmission mRS score of 0-1 patients (n=108), D-dimer level was significantly associated with NIHSS score at admission (r=0.318, p<0.001) and mRS score at discharge (r=0.310, p=0.001).Significant difference existed among tertiles (p = 0.003)(Figure 2). Conclusions: Plasma D-dimer level on admission is significantly related to infarction volume and functional outcome, following cardioembolic stroke in NVAF patients.

Association of arterial thromboembolism location with presence of nonvalvular atrial fibrillation

Vascular ◽  
2020 ◽  
Vol 28 (3) ◽  
pp. 325-328
Author(s):  
Feryaz Kızıltan ◽  
Emre Demir Benli ◽  
Seyhan Yılmaz ◽  
Mehmet Kalender ◽  
Serdar Gunaydin
Keyword(s):  
Atrial Fibrillation ◽  
Lower Extremity ◽  
Oral Anticoagulants ◽  
Life Time ◽  
Signs And Symptoms ◽  
Limb Ischemia ◽  
Nonvalvular Atrial Fibrillation ◽  
Arterial Thromboembolism ◽  
Significant Difference ◽  
Baseline Characteristics

Objectives Since nonvalvular atrial fibrillation is persistent in nature, patients with chronic nonvalvular atrial fibrillation are at life-time risk for development of thromboembolic events. Several novel oral anticoagulants have entered the market and there has been a growing body of evidence regarding their efficacy in prevention of ischemic stroke and arterial thromboembolism. The present study sought to compare the baseline characteristics between patients presenting with upper and lower extremity arterial thromboembolism developed secondary to nonvalvular atrial fibrillation. Methods This retrospective study was made up of patients presenting with acute upper or lower extremity arterial thromboembolism as the first presentation of atrial fibrillation. Patients were included if they had acute upper or lower critical limb ischemia symptoms lasting for less than one week. Patients in whom chronic peripheral artery disease was diagnosed were also excluded to prevent potential confounding. Results Overall, 46.9% of patients presented with upper extremity arterial thromboembolism and 53.1% of patients presented with lower extremity arterial thromboembolism. None of the baseline characteristics showed significant difference between patients with upper and lower extremity arterial thrombosis. Conclusion It was observed that there was no significant difference in the incidence of extremity involvement of acute arterial thromboembolism occurring in patients with nonvalvular atrial fibrillation in our study, and we think that acute arterial thromboembolism must be taken into consideration as one of the first signs and symptoms of atrial fibrillation.

Premature permanent discontinuation of apixaban or warfarin in patients with atrial fibrillation

Heart ◽  
2020 ◽  
pp. heartjnl-2020-317229 ◽  
Author(s):  
Anthony P Carnicelli ◽  
Sana M Al-Khatib ◽  
Denis Xavier ◽  
Frederik Dalgaard ◽  
Peter D Merrill ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Major Bleeding ◽  
Study Drug ◽  
Treatment Groups ◽  
Patient Request ◽  
Clinical Events ◽  
Significant Difference ◽  
Ischaemic Attack

AimsThe ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial randomised patients with atrial fibrillation at risk of stroke to apixaban or warfarin. We sought to describe patients from ARISTOTLE who prematurely permanently discontinued study drug.Methods/ResultsWe performed a posthoc analysis of patients from ARISTOTLE who prematurely permanently discontinued study drug during the study or follow-up period. Discontinuation rates and reasons for discontinuation were described. Death, thromboembolism (stroke, transient ischaemic attack, systemic embolism), myocardial infarction and major bleeding rates were stratified by ≤30 days or >30 days after discontinuation. A total of 4063/18 140 (22.4%) patients discontinued study drug at a median of 7.3 (2.2, 15.2) months after randomisation. Patients with discontinuation were more likely to be female and had a higher prevalence of cardiovascular disease, diabetes, renal impairment and anaemia. Premature permanent discontinuation was more common in those randomised to warfarin than apixaban (23.4% vs 21.4%; p=0.002). The most common reasons for discontinuation were patient request (46.1%) and adverse event (34.9%), with no significant difference between treatment groups. The cumulative incidence of clinical events ≤30 days after premature permanent discontinuation for all-cause death, thromboembolism, myocardial infarction, and major bleeding was 5.8%, 2.6%, 0.9%, and 3.0%, respectively. No significant difference was seen between treatment groups with respect to clinical outcomes after discontinuation.ConclusionPremature permanent discontinuation of study drug in ARISTOTLE was common, less frequent in patients receiving apixaban than warfarin and was followed by high 30-day rates of death, thromboembolism and major bleeding. Initiatives are needed to reduce discontinuation of oral anticoagulation.

P1440Left atrial appendage closure for stroke prevention in nonvalvular atrial fibrillation with Watchman device versus Amplatzer Cardiac Plug. Results of the multicenter Russian trial

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
K V Davtyan ◽  
G Simonyan ◽  
A A Kalemberg ◽  
A H Topchyan ◽  
D S Lebedev ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Survival Rate ◽  
Stroke Prevention ◽  
Atrial Appendage ◽  
Efficacy And Safety ◽  
Nonvalvular Atrial Fibrillation ◽  
Significant Difference ◽  
Watchman Device ◽  
Complications Rate

Abstract Background The data are limited on comparative efficacy and safety of the left atrial appendage occlusion (LAAO) using the Watchman device (WD) and Amplatzer Cardiac Plug (ACP) for stroke prevention in nonvalvular atrial fibrillation (AF) patients. Objective To assess the safety and efficacy of the WD compared with ACP for stroke prevention and adverse events in patients with AF. Methods 200 consecutive patients (median age 67.5yrs, 94 female, median CHA2DS2VASc score - 4, median HASBLED score 3) with nonvalvular AF and contraindications to oral anticoagulation therapy from 5 medical centers in Russia, who undergone LAAO implantation using WD (n = 108; WD group) and ACP (n = 92; ACP group) were enrolled into this study. The coprimary end point was the composite of TIA/stroke and procedure-related complications during follow up.  Secondary end points included successful LAA occluder implantation rate and incidence rates of significant leakage. Patients were followed at 45 days, 3, 6 and 12 months after enrollment. At each follow-up visit the data regarding clinical events and healthcare utilization were collected. Results During the follow-up TIA/stroke has occurred in 6.2% of patients in the WD group with no such events in ACP group (6.2% vs 0%, p = 0.012). The composite safety-efficacy survival rate in WD group was 91.7% versus 92.4% in ACP group (p = 0.85). The periprocedural major complications rate (pulmonary trunk perforation with fatal haemotamponade, nonfatal haemotamponade with pericardiocentesis, device embolisation) was significantly higher in ACP group compared with WD group (5.4% vs 0%, p = 0.005). There was no significant difference in overall events rate between groups (3.7% vs 7.6%, p = 0.2). Successful LAA occluder implantation was performed in all 92 (100%) patients with ACP and in 105 (97,2%) with WD (p = 0.053). The significant leakage (≥5mm) was 3.03% in WD group with no such events in ACP group (3.03% vs 0%, p = 0.059). Conclusion LAAO using ACP was associated with higher major procedure-related complications rate. Despite a higher TIA/stroke rate in WD group, the composite efficacy and safety survival rate of LAAO using the WD and ACP was comparable during 12 month follow up.

scholarly journals Continuous use of low-dose warfarin for gastric endoscopic submucosal dissection: a prospective study

2017 ◽  
Vol 05 (05) ◽  
pp. E348-E353 ◽  
Author(s):  
Hideaki Harada ◽  
Satoshi Suehiro ◽  
Daisuke Murakami ◽  
Takanori Shimizu ◽  
Ryotaro Nakahara ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Low Dose ◽  
Postoperative Bleeding ◽  
Warfarin Dose ◽  
International Normalized Ratio ◽  
Safety And Efficacy ◽  
Submucosal Dissection ◽  
Day Range ◽  
Dose Warfarin ◽  
Significant Difference

Abstract Background and study aims Patients who receive warfarin usually require heparin bridge therapy (HBT) to prevent thromboembolic events during endoscopic submucosal dissection (ESD); however, clinical evidence demonstrating the safety and efficacy of HBT during gastric ESD is limited. Conversely, warfarin can be continuously used as a substitute for HBT to endoscopic procedures which have a low risk of bleeding. This study aimed to clarify the safety and efficacy of continuous low-dose warfarin (LDW) for gastric ESD. Patients and methods This was a prospective observational study at a single institution. A total of 22 patients who received warfarin between December 2014 and January 2016 were enrolled. The patients were treated with gastric ESD with a low dose of warfarin ( ≤ 4 mg) at approximately 1.6 – 2.6 of the international normalized ratio (INR) levels. Furthermore, we analyzed a total of 23 patients with HBT who underwent gastric ESD between January 2011 and November 2014. Results The average of warfarin dose and the INR level on the day of gastric ESD in the continuous LDW group were 2.3 mg/day (range 0.5 – 4.0) and 1.87 (range 1.41 – 2.75), respectively. Two of the 22 patients (9.1 %) in the continuous LDW group and 5 of the 23 patients (21.7 %) in the HBT group had postoperative bleeding after gastric ESD. Although the postoperative bleeding rate in the continuous LDW group was lower than that in the HBT group, no significant difference was observed between the 2 groups (P = 0.414). Conclusions Gastric ESD with continuous LDW as a substitute for HBT was feasible and may be acceptable.

scholarly journals Effects of Rivaroxaban on Biomarkers of Coagulation and Inflammation: A Post Hoc Analysis of the X-VeRT Trial

TH Open ◽  
2020 ◽  
Vol 04 (01) ◽  
pp. e20-e32 ◽  
Author(s):  
Paulus Kirchhof ◽  
Michael D. Ezekowitz ◽  
Yanish Purmah ◽  
Sonja Schiffer ◽  
Isabelle L. Meng ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulant ◽  
Logistic Models ◽  
High Sensitivity ◽  
International Normalized Ratio ◽  
Nonvalvular Atrial Fibrillation ◽  
Oral Anticoagulant Treatment ◽  
Biomarker Analysis ◽  
Hs Crp ◽  
D Dimer

Abstract Introduction This X-VeRT (eXplore the efficacy and safety of once-daily oral riVaroxaban for the prevention of caRdiovascular events in patients with nonvalvular aTrial fibrillation scheduled for cardioversion) substudy evaluated the effects of treatment with rivaroxaban or a vitamin-K antagonist (VKA) on levels of biomarkers of coagulation (D-dimer, thrombin–antithrombin III complex [TAT] and prothrombin fragment [F1.2]) and inflammation (high sensitivity C-reactive protein [hs-CRP] and high-sensitivity interleukin-6 [hs-IL-6]) in patients with atrial fibrillation (AF) who were scheduled for cardioversion and had not received adequate anticoagulation at baseline (defined as, in the 21 days before randomization: no oral anticoagulant; international normalized ratio <2.0 with VKA treatment; or <80% compliance with non-VKA oral anticoagulant treatment). Methods Samples for biomarker analysis were taken at baseline (n = 958) and treatment completion (42 days after cardioversion; n = 918). The influence of clinical characteristics on baseline biomarker levels and the effect of treatment on changes in biomarker levels were evaluated using linear and logistic models. Results Baseline levels of some biomarkers were significantly associated with type of AF (D-dimer and hs-IL-6) and with history of congestive heart failure (hs-CRP, D-dimer, and hs-IL-6). Rivaroxaban and VKA treatments were associated with reductions from baseline in levels of D-dimer (−32.3 and −37.6%, respectively), TAT (−28.0 and −23.1%, respectively), hs-CRP (−12.5 and −17.9%, respectively), and hs-IL-6 (−9.2 and −9.8%, respectively). F1.2 levels were reduced from baseline in patients receiving a VKA (−53.0%) but not in those receiving rivaroxaban (2.7%). Conclusion Anticoagulation with rivaroxaban reduced levels of key inflammation and coagulation biomarkers to a similar extent as VKAs, with the exception of F1.2. Further investigation to confirm the value of these biomarkers in patients with AF is merited.

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