Long-term Oral Anticoagulation Reduces Bone Mass in Patients with Previous Hemispheric Infarction and Nonrheumatic Atrial Fibrillation

Due to heightened risk for thromboembolic complications, nonvalvular atrial fibrillation (NVAF) presents an absolute indication for long-term oral anticoagulation therapy. This was an observational, analytical, randomised, one-year clinical study, conducted in the Blood Transfusion Institute Sarajevo, Bosnia & Herzegovina. The aim of this study was to present the oral anticoagulation treatment in terms of International normalised ratio (INR) monitoring and warfarin/acenocoumarol dose titration in 117 patients with NVAF. INR values, the doses of warfarin and acenocoumarol, as well as the tendency and adequacy of their changes were monitored. Percentages of the therapeutic INR values were 51,77% and 53,62%, subtherapeutic 42,84% and 35,86%, and supratherapeutic 5,39% and 10,53% for the warfarin and acenocoumarol treatment, respectively. The average total weekly doses (TWD) which most frequently achieved the therapeutic INR values were 27,89±12,34 mg and 20,44±9,94 mg, for warfarin and aceno- coumarol, respectively. The dose changes with the INR values 1,7 or lower/3,3 or higher were omitted in 13,46% and 15,63%, and with the INR values 1,8-3,2 were noted in 8,62% and 13,48% of all the check-up visits in the warfarin and acenocoumarol group, respectively. The annual dose changes were noted in 24,65% and 31,41%, and the daily dose changes in 74,43% and 73,36% of all the check-up visits of warfarin and acenocoumarol group, respectively. We can conclude that the management of the oral anticoagulation treatment in our country is in accordance with the relevant recommendations, but with the present tendency toward underdosing and unnecessary frequent dose changing.

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Long-term oral anticoagulation for patients after successful catheter ablation of atrial fibrillation

Current Opinion in Cardiology ◽

10.1097/hco.0000000000000121 ◽

2015 ◽

Vol 30 (1) ◽

pp. 1-7 ◽

Cited By ~ 10

Author(s):

Andrew C.T. Ha ◽

Gerhard Hindricks ◽

David H. Birnie ◽

Atul Verma

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Oral Anticoagulation

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P4799Long-term thromboembolic risk in patients with postoperative atrial fibrillation after left-sided heart valve surgery

European Heart Journal ◽

10.1093/eurheartj/ehz745.1175 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J H Butt ◽

J B Olesen ◽

A Gundlund ◽

P S Olsen ◽

E Havers-Borgersen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Mitral Valve ◽

Heart Valve ◽

Oral Anticoagulation ◽

Anticoagulation Therapy ◽

Valve Surgery ◽

Heart Valve Surgery ◽

Oral Anticoagulation Therapy ◽

New Onset

Abstract Background New-onset postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery. However, data on the long-term risk of thromboembolism in patients who develop POAF after heart valve surgery are sparse. In addition, data on stroke prophylaxis in this setting are lacking. Objective To assess the long-term risk of thromboembolism in patients developing new-onset POAF following isolated left-sided heart valve surgery relative to patients with nonsurgical, nonvalvular atrial fibrillation (NVAF). Methods Using data from the Eastern Danish Heart Surgery Database and Danish nationwide registries, we identified patients who developed POAF following isolated left-sided heart valve surgery (i.e. biologic aortic/mitral valve replacement or aortic/mitral valve repair) from 2000 through 2015. These patients were matched with patients with nonsurgical NVAF in a 1:4 ratio by age, sex, heart failure, hypertension, diabetes, a history of thromboembolism, ischemic heart disease, and year of diagnosis. Long-term risk of thromboembolism was examined by the Aalen-Johansen estimator and cause-specific Cox regression models adjusted for comorbidities, concomitant pharmacotherapy, and oral anticoagulation therapy as a time-dependent covariate. Results A total of 1,539 patients undergoing isolated left-sided heart valve surgery were identified. Of these, 716 (46.5%) patients developed POAF after surgery. A total of 630 patients with POAF were matched with 2,520 patients with NVAF. In the matched study population, the median age was 71 years (25th-75th percentile 66–77 years) and 59.5% were men. Oral anticoagulation therapy was initiated within 30 days post-discharge in 62.7% and 51.4% of these patients, respectively. Compared with NVAF, POAF was not associated with a significantly different 5-year absolute risk of thromboembolism (10.7% [95% confidence interval [CI], 8.0%-13.9%] versus 8.9% [95% CI, 7.6%-10.2%] in the POAF and NVAF group, respectively) (Figure). In the adjusted analysis, the long-term risk of thromboembolism was similar in patients with POAF and NVAF (hazard ratio [HR] 1.01 [95% CI, 0.71–1.44]). Anticoagulation therapy during follow-up was associated with a lower risk of thromboembolic events in patients with POAF (HR 0.45 [95% CI, 0.18–0.99]) as well as NVAF (HR 0.58 [95% CI, 0.42–0.80]) compared with no anticoagulation therapy. Conclusions New-onset POAF following isolated left-sided heart valve surgery was associated with a similar long-term risk of thromboembolism compared with NVAF. Future studies addressing the role of oral anticoagulation therapy in POAF after heart valve surgery are warranted to examine the efficacy and safety as well as the timing and duration of anticoagulation therapy.

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TCT-97 Long term follow up of 134 patients with non valvular atrial fibrillation and contraindications to oral anticoagulation therapy, treated with the Ampatzer Cardiac Plug Device for left atrial appendage occlusion

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2013.08.824 ◽

2013 ◽

Vol 62 (18) ◽

pp. B32

Author(s):

Miroslava Stolcova ◽

Marco Rezzaghi ◽

Francesco Meucci ◽

Cataldo Palmieri ◽

Umberto Paradossi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Anticoagulation Therapy ◽

Oral Anticoagulation Therapy ◽

Left Atrial Appendage Occlusion ◽

Long Term Follow Up

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Abstract 12993: Oral Anticoagulation Prescription Depends on Both Atrial Fibrillation Duration and CHA 2 DS 2 -VASc Score

Circulation ◽

10.1161/circ.142.suppl_3.12993 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Rachel M Kaplan ◽

Paul D Ziegler ◽

Jodi L Koehler ◽

Sean Landman ◽

Shantanu Sarkar ◽

...

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulation ◽

Index Date ◽

Stroke Risk ◽

Data Availability ◽

Current Guideline ◽

Cardiac Implantable Electronic Devices ◽

Prescription Rates

Introduction: Current guideline recommendations for oral anticoagulation (OAC) in patients with atrial fibrillation (AF) are based on CHA 2 DS 2 -VASc score alone. In patients with cardiac implantable electronic devices (CIEDs), it is poorly understood how the interaction between AF duration and CHA 2 DS 2 -VASc score influence the decision to prescribe OAC. Methods: Data from the Optum® de-identified Electronic Health Record dataset were linked to the Medtronic CareLink database of CIEDs. An index date was assigned as the later of 6 months after device implant or 1 year after EHR data availability. CHA 2 DS 2 -VASc score was assessed via EHR data prior to the index date. Maximum daily AF burden (No AF, 6 minutes-23.5 hours, and >23.5 hours) was assessed over the 6 months prior to index date. OAC prescription rates were computed prior to the index date as a function of both AF duration and CHA 2 DS 2 -VASc score. Results: A total of 35,779 patients with CHA 2 DS 2 -VASc scores ≥1 were identified, including 8,581 who were prescribed OAC and 27,198 not prescribed OAC during the observation period. The overall OAC prescription rate among the subset of 12,938 patients with device-detected AF >6 minutes was 36.7% and the rate was nearly 60% higher for patients with a maximum daily AF burden >23.5 hours (45.4%) compared to those with 6 minutes-23.5 hours (28.7%). OAC prescription rates increased monotonically with both increasing AF duration and CHA 2 DS 2 -VASc score, reaching a maximum of 67.2% for patients with AF >23.5 hours and a CHA 2 DS 2 -VASc score ≥5 (Table). Conclusion: In contrast with guideline recommendations, real-world prescription of OAC increased with both increasing duration of AF and CHA 2 DS 2 -VASc score. This mirrors recent evidence demonstrating that stroke risk also increases with both of these features and highlights the need for further research into the role of AF duration, stroke risk, and the need for anticoagulation in patients with devices capable of long-term AF monitoring.

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