Oral Anticoagulation Therapy and Progression of Calcific Aortic Valve Stenosis: Factor Xa versus Factor IIa Inhibition?

Abstract Background Recently, there are some reports that hypo-attenuated leaflet thickening (HALT) following transcatheter aortic valve implantation (TAVI) is incidentally detected by multi-slice computed tomography. It is believed that valve thrombosis causes HALT, because oral anticoagulation therapy (OAC) is effective for HALT regression. Furthermore, it is reported that d-dimer level increases in patients with HALT, and might be a key biomarker to detect HALT. Purpose We sought to investigate the predictors related to increased d-dimer level at 6 months after follow-up TAVI. Methods We enrolled 124 consecutive patients who underwent successful TAVI between 2016 and 2018. Study patients were classified into two groups according to antithrombotic therapy resume (OAC therapy or anti-platelet therapy).We set the primary endpoint as the d-dimer levels at 6 months after TAVI. To evaluate the risks of the primary endpoint, we employed a multivariable linear regression model, setting the primary endpoint as an objective variable and patient and clinical backgrounds as explanatory variables. Furthermore, we set the secondary endpoint as one-year bleeding event. Results The median age of patients was 83 years old (quartile 80-87). Patients who had taken OAC at 6 months follow-up after TAVI were 29.8%. The median d-dimer level at 6 months after TAVI was 1.3 (1.0-2.2) µg/ml, and OAC group had statistically lower d-dimer level at 6 months follow-up than those in non-OAC group (p = 0.020). Uni-variable liner regression model demonstrated that increased d-dimer level at follow-up had significant relationship with large effective orifice area (EOA) (p = 0.002) and low left ventricular ejection fraction (LVEF) (p = 0.048) after TAVI. Furthermore, large EOA (p = 0.003) and OAC therapy (p = 0.027) were independently associated with increased d-dimer level in multivariate analysis. Kaplan-Meier estimates revealed that there were no significant difference regarding one-year bleeding event between OAC group and non-OAC group (long-rank p = 0.167). Conclusions This study suggests that large EOA after TAVI is associated with increased d-dimer levels at 6 months after TAVI, and OAC therapy might have a potential to decrease d-dimer level after TAVI without increase of bleeding events. Abstract P107 Figure: One-year bleeding event

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B-PO05-141 ASSESSMENT OF CLOT KINETICS IN PATIENTS ON UNINTERRUPTED ORAL ANTICOAGULATION THERAPY WITH FACTOR XA INHIBITORS

Heart Rhythm ◽

10.1016/j.hrthm.2021.06.1060 ◽

2021 ◽

Vol 18 (8) ◽

pp. S429

Author(s):

Carola Gianni ◽

Domenico G. Della Rocca ◽

Chintan Trivedi ◽

Sanghamitra Mohanty ◽

Amin Al-Ahmad ◽

...

Keyword(s):

Oral Anticoagulation ◽

Anticoagulation Therapy ◽

Factor Xa ◽

Factor Xa Inhibitors ◽

Oral Anticoagulation Therapy

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Ervaringen tijdens de "Belgian Improvement Study on Oral Anticoagulation Therapy" (BISOAT)

Tijdschrift voor Geneeskunde ◽

10.2143/tvg.61.11.5002197 ◽

2005 ◽

Vol 61 (11) ◽

pp. 841-847 ◽

Cited By ~ 1

Author(s):

CLAES N ◽

BUNTINX F ◽

VIJGEN J ◽

ARNOUT J ◽

VERMYLEN J ◽

...

Keyword(s):

Oral Anticoagulation ◽

Anticoagulation Therapy ◽

Oral Anticoagulation Therapy

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Depression and Uptake of Oral Anticoagulation Therapy in Patients With Atrial Fibrillation

Medical Care ◽

10.1097/mlr.0000000000001268 ◽

2020 ◽

Vol 58 (3) ◽

pp. 216-224 ◽

Cited By ~ 1

Author(s):

Morten Fenger-Grøn ◽

Claus H. Vestergaard ◽

Lars Frost ◽

Dimitry S. Davydow ◽

Erik T. Parner ◽

...

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulation ◽

Anticoagulation Therapy ◽

Oral Anticoagulation Therapy

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Oral Anticoagulation Therapy for Venous Thromboembolism in Norway: Time Trends and Treatment Patterns

Clinical Therapeutics ◽

10.1016/j.clinthera.2021.04.017 ◽

2021 ◽

Author(s):

Waleed Ghanima ◽

Anna Schultze ◽

Robert Donaldson ◽

Ellen Brodin ◽

Sigrun Halvorsen ◽

...

Keyword(s):

Venous Thromboembolism ◽

Oral Anticoagulation ◽

Time Trends ◽

Anticoagulation Therapy ◽

Treatment Patterns ◽

Oral Anticoagulation Therapy

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Consideration of non-valvular atrial fibrillation with left atrial appendage thrombus formation despite under appropriate oral anticoagulation therapy

European Heart Journal ◽

10.1093/ehjci/ehaa946.0071 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

H Shiraki ◽

H Tanaka ◽

K Yamashita ◽

Y Tanaka ◽

K Sumimoto ◽

...

Keyword(s):

Atrial Fibrillation ◽

Logistic Regression ◽

Regression Analysis ◽

Oral Anticoagulation ◽

Left Atrial ◽

Thrombus Formation ◽

Anticoagulation Therapy ◽

Left Ventricular ◽

Volume Index ◽

Oral Anticoagulation Therapy

Abstract Background Atrial fibrillation (AF) is the most frequently sustained cardiac arrhythmia, with a prevalence of about 2–3% in the general population. In accordance with CHADS2 or CHA2DS2-VASc score, appropriate oral anticoagulation therapy such as warfarin or direct oral anticoagulants (DOAC) significantly reduced the risk of thromboembolic events. However, left atrial (LA) thrombus can be detected in the LA appendage (LAA) in AF patients despite appropriate oral anticoagulation therapy. Purpose Our purpose was to investigate the associated factors of LAA thrombus formation in non-valvular atrial fibrillation (NVAF) patients despite under appropriate oral anticoagulation therapy. Methods We retrospectively studied consecutive 286 NVAF patients for scheduled catheter ablation or electrical cardioversion for AF in our institution between February 2017 and September 2019. Mean age was 67.1±9.4 years, 79 patients (29.5%) were female, and 140 (52.2%) were paroxysmal AF. All patients underwent transthoracic and transesophageal echocardiography before catheter ablation or electrical cardioversion. All patients received appropriate oral anticoagulation therapy including warfarin or DOAC for at least 3 weeks prior to transesophageal echocardiography based on the current guidelines. LAA thrombus was defined as an echodense intracavitary mass distinct from the underlying endocardium and not caused by pectinate muscles by at least three senior echocardiologists. Results Of 286 NVAF patients with under appropriate oral anticoagulation therapy, LAA thrombus was observed in 9 patients (3.3%). Univariate logistic regression analysis showed that age, paroxysmal AF, CHADS2 score ≥3, left ventricular end-diastolic volume index (LVEDVI), left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), LA volume index (LAVI), mitral inflow E and mitral e' annular velocities ratio (E/e'), and LAA flow were associated with LAA thrombus formation. It was noteworthy that multivariate logistic regression analysis showed that LAA flow was independent predictor of LAA thrombus (OR: 0.72, 95% CI: 0.59–0.89, p<0.005) as well as LVEF. Furthermore, receiver operating characteristic (ROC) curve analysis identified the optimal cutoff value of LAA flow for predicting LAA thrombus as ≤15cm/s, with a sensitivity of 88%, specificity of 93%, and area under the curve (AUC) of 0.95. Conclusions LAA flow was strongly associated with LAA thrombus formation even in NVAF patients with appropriate oral anticoagulation therapy. According to our findings, further strengthen of oral anticoagulation therapy or percutaneous transcatheter closure of the LAA may be considered in NVAF patients with appropriate oral anticoagulation therapy but low LAA flow, especially <15cm/s. Funding Acknowledgement Type of funding source: None

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Management of Oral Anticoagulation Therapy After Gastrointestinal Bleeding: Whether to, When to, and How to Restart an Anticoagulation Therapy

Annals of Pharmacotherapy ◽

10.1177/1060028017717019 ◽

2017 ◽

Vol 51 (11) ◽

pp. 1000-1007 ◽

Cited By ~ 9

Author(s):

Kazuhiko Kido ◽

Michael J. Scalese

Keyword(s):

Gastrointestinal Bleeding ◽

Cohort Studies ◽

Oral Anticoagulation ◽

Retrospective Cohort ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Anticoagulation Therapy ◽

Cochrane Library ◽

Oral Anticoagulation Therapy ◽

Retrospective Cohort Studies

Objective: To evaluate current clinical evidence for management of oral anticoagulation therapy after gastrointestinal bleeding (GIB) with an emphasis on whether to, when to, and how to resume an anticoagulation therapy. Data Sources: Relevant articles from MEDLINE, Cochrane Library, and EMBASE databases were identified from 1946 through May 20, 2017, using the keywords: gastrointestinal hemorrhage or gastrointestinal bleeding and antithrombotic therapy or anticoagulation therapy or warfarin or dabigatran or rivaroxaban or apixaban or edoxaban.Study Selection and Data Extraction: All English-language studies assessing management of oral anticoagulation therapy after GIB were evaluated. Data Synthesis: A total of 9 studies were identified. Four retrospective cohort studies showed that resuming anticoagulation therapy was associated with significantly lower rate of thromboembolism (TE) in the general population. Meta-analyses and prospective cohort studies also supported this finding. Two retrospective cohort studies indicated an increase in GIB when anticoagulation reinitiation occurred in less than 7 days without a decrease in TE. Resuming therapy between 7 and 15 days did not demonstrate a significant increase in GIB or TE. A large retrospective study showed that apixaban was associated with the significantly lowest risk of GIB compared with both rivaroxaban and dabigatran. Conclusion: Anticoagulation therapy resumption is recommended, with resumption being considered between 7 and 14 days following GIB regardless of the therapy chosen. Data for warfarin management after GIB should be applied with caution to direct oral anticoagulants (DOACs) because of the quicker onset and experimental nature of reversal agents. Apixaban may be a preferred option when restarting a DOAC therapy.

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