Antithrombotic Therapy Prescribed for Patients with Non-Rheumatic Atrial Fibrillation

1994 ◽  
Vol 39 (4) ◽  
pp. 110-111 ◽  
Author(s):  
A. Hendry ◽  
A.M. Campbell ◽  
G. Campbell ◽  
J.B. Macdonald ◽  
B.O. Williams
Keyword(s):  
Atrial Fibrillation ◽  
Geriatric Assessment ◽  
Antithrombotic Therapy ◽  
Current Practice ◽  
Retrospective Case ◽  
Case Record ◽  
Medical Unit ◽  
Increased Risk ◽  
Assessment Unit

Patients with non-rheumatic atrial fibrillation have a fivefold increased risk of stroke. Warfarin reduces this risk by approximately two thirds, but evidence for benefit from aspirin is less compelling. We assessed whether our current practice reflects the message of the trials. In a retrospective case record study we reviewed notes of 131 patients with atrial fibrillation (AF), mean age 79 (range 53–95) years, admitted to a medical unit (72) or geriatric assessment unit (59). Thirty-two patients had paroxysmal AF. Of 115 patients with nonrheumatic AF, 36 (31%) had one or more recorded contraindication to anti-coagulation. Although 79 patients (69%) had no recorded contraindication to warfarin, only 2 took warfarin and 15 aspirin prior to admission. Ten patients commenced warfarin and 8 aspirin before discharge. Thirty-nine patients (53%) without contraindication, were discharged without antithrombotic therapy. Despite evidence to support anticoagulating patients with non-rheumatic AF, this rarely occurs.

scholarly journals Prevalence, Epidemiological Characteristics, and Pharmacotherapy of Coronary Artery Disease among Patients with Atrial Fibrillation: Data from Jo-Fib Study

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 605
Author(s):  
Hanna K. Al-Makhamreh ◽  
Mohammed Q. Al-Sabbagh ◽  
Ala’ E. Shaban ◽  
Abdelrahman F. Obiedat ◽  
Ayman J. Hammoudeh
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Antiplatelet Agents ◽  
Retrospective Case ◽  
Increased Risk ◽  
Artery Disease ◽  
Epidemiological Characteristics ◽  
Cad Risk

Background and Objectives: Patients with AF are at increased risk for Coronary Artery Disease (CAD) owing to their shared etiologies and risk factors. This study aimed to assess the prevalence, cardiovascular risk factors, and used medications of CAD in AF patients. Materials and Methods: This retrospective, case-control study utilized data from the Jordanian Atrial Fibrillation (Jo-Fib) registry. Investigators collected clinical features, history of co-existing comorbidities, CHA2DS2-VASc, and HAS BLED scores for all AF patients aged >18 visiting 19 hospitals and 30 outpatient cardiology clinics. A multivariable binary logistic regression was used to asses for factors associated with higher odds of having CAD. Results: Out of 2000 patients with AF, 227 (11.35%) had CAD. Compared to the rest of the sample, those with CAD had significantly higher prevalence of hypertension (82.38%; p < 0.01), hypercholesterolemia (66.52%, p < 0.01), diabetes (56.83%, p < 0.01), and smoking (18.06%, p = 0.04). Patients with AF and CAD had higher use of anticoagulants/antiplatelet agents combination (p < 0.01) compared to the rest of the sample. Females had lower CAD risk than males (OR = 0.35, 95% CI: 0.24–0.50). AF Patients with dyslipidemia (OR = 2.5, 95% CI: 1.8–3.4), smoking (OR = 1.7, 95% CI: 1.1–2.6), higher CHA2DS2-VASc score (OR = 1.5, 95% CI: 1.4–1.7), and asymptomatic AF (OR = 1.9, 95% CI: 1.3–2.6) had higher risk for CAD. Conclusions: Owing to the increased prevalence of CAD in patients with AF, better control of cardiac risk factors is recommended for this special group. Future studies should investigate such interesting relationships to stratify CAD risk in AF patients. We believe that this study adds valuable information regarding the prevalence, epidemiological characteristics, and pharmacotherapy of CAD in patients with AF.

Preoperative CHA2DS2-VASc Score Predicts Postoperative Atrial Fibrillation after Lobectomy

2018 ◽  
Vol 67 (02) ◽  
pp. 125-130 ◽  
Author(s):  
Charles Lee ◽  
David Strauss ◽  
Lauren Stone ◽  
Jill Stoltzfus ◽  
Matthew Puc ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Nonsmall Cell Lung Cancer ◽  
Postoperative Atrial Fibrillation ◽  
Multivariable Logistic Regression Analysis ◽  
Cutoff Score ◽  
Pulmonary Lobectomy ◽  
Retrospective Case ◽  
Chi Square ◽  
Significant Independent Predictor ◽  
Increased Risk

Background Postoperative atrial fibrillation (POAF) affects 10 to 20% of noncardiac thoracic surgeries and increases patient morbidity and costs. The purpose of this study is to determine if preoperative CHA2DS2-VASc score can predict POAF after pulmonary lobectomy for nonsmall cell lung cancer. Methods Patients with complete CHA2DS2-VASc data who underwent lobectomies from January 2007 to January 2016 at a single institution were analyzed in a retrospective case–control study using a prospective database. An independent samples t-test was used to compare the mean CHA2DS2-VASc scores of POAF and non-POAF groups. A multivariable logistic regression analysis (MVA) evaluated the independent contribution of variables of the CHA2DS2-VASc score in predicting POAF. Chi-square test with univariate odds ratios (ORs) was used to determine a statistically significant cutoff score for predicting POAF. Results Of 525 total patients, 82 (15.6%) developed POAF (mean CHA2DS2-VASc score: 2.7) and 443 (84.4%) did not develop POAF (mean score: 2.3). Mean difference between these groups was significant at 0.43 (p = 0.01; 95% confidence interval [CI]: 0.09–0.76). In the MVA, significant predictors of POAF were age 65 to 74 years (adjusted OR [aOR] = 2.45; 95% CI: 1.31–4.70; p = 0.006) and age ≥75 years (aOR = 3.11; 95% CI: 1.62–5.95; p = 0.0006). Patients with CHA2DS2-VASc scores ≥5 had significantly increased OR for POAF (OR = 2.59; 95% CI: 1.22–5.50). Conclusions Preoperatively calculated CHA2DS2-VASc score can predict POAF in patients undergoing pulmonary lobectomy. Age is the most statistically significant independent predictor, and patients with scores ≥5 have significantly increased risk. Trials for POAF prophylaxis should target this population.

scholarly journals Antithrombotic therapy according to baseline bleeding risk in patients with atrial fibrillation undergoing percutaneous coronary intervention: applying the PRECISE-DAPT score in RE-DUAL PCI

2020 ◽  
Author(s):  
Francesco Costa ◽  
Marco Valgimigli ◽  
Philippe Gabriel Steg ◽  
Deepak L Bhatt ◽  
Stefan H Hohnloser ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Antithrombotic Therapy ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Event Analysis ◽  
Increased Risk ◽  
Safety Endpoint ◽  
High Bleeding Risk ◽  
The Impact

Abstract Aims Patients with atrial fibrillation undergoing coronary intervention are at higher bleeding risk due to the concomitant need for oral anticoagulation and antiplatelet therapy. The RE-DUAL PCI trial demonstrated better safety with dual antithrombotic therapy (DAT: dabigatran 110 or 150 mg b.i.d., clopidogrel or ticagrelor) compared to triple antithrombotic therapy (TAT: warfarin, clopidogrel or ticagrelor, and aspirin). We explored the impact of baseline bleeding risk based on the PRECISE-DAPT score for decision-making regarding DAT vs. TAT. Methods and results A score ≥25 points qualified high bleeding risk (HBR). Comparisons were made for the primary safety endpoint International Society of Thrombosis and Haemostasis major or clinically relevant non-major bleeding, and the composite efficacy endpoint of death, thrombo-embolic events, or unplanned revascularization, analysed by time-to-event analysis. PRECISE-DAPT was available in 2336/2725 patients, and 37.9% were HBR. Compared to TAT, DAT with dabigatran 110 mg reduced bleeding risk both in non-HBR [hazard ratio (HR) 0.42, 95% confidence interval (CI) 0.31–0.57] and HBR (HR 0.70, 95% CI 0.52–0.94), with a greater magnitude of benefit among non-HBR (Pint = 0.02). Dual antithrombotic therapy with dabigatran 150 mg vs. TAT reduced bleeding in non-HBR (HR 0.60, 95% CI 0.45–0.80), with a trend toward less benefit in HBR patients (HR 0.92, 95% CI 0.63–1.34; Pint = 0.08). The risk of ischaemic events was similar on DAT with dabigatran (both 110 and 150 mg) vs. TAT in non-HBR and HBR patients (Pint = 0.45 and Pint = 0.56, respectively). Conclusions PRECISE-DAPT score appeared useful to identify AF patients undergoing PCI at further increased risk of bleeding complications and may help clinicians identifying the antithrombotic regimen intensity with the best benefit–risk ratio in an individual patient.

Coagulation and thrombosis

2017 ◽  
Author(s):  
Kurt Huber ◽  
Joao Morais
Keyword(s):  
Atrial Fibrillation ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Antithrombotic Therapy ◽  
Antiplatelet Agents ◽  
Thromboembolic Events ◽  
Efficacy And Safety ◽  
Antithrombotic Treatment ◽  
Bleeding Events ◽  
Increased Risk

Antithrombotic therapy consisting of antiplatelet agents and/or anticoagulants is an important way to avoid atherothrombotic complications, especially in secondary prevention. Primary prevention by antithrombotic measures usually refers to the prevention of stroke in patients with atrial fibrillation and an increased risk for stroke or peripheral thromboembolic events by the use of anticoagulants. In certain situations a combination of anticoagulants and antiplatelet agents is mandatory. This chapter provides the pathophysiological background of coagulation and thrombosis, reports on the epidemiology of antithrombotic treatment, and describes the efficacy and safety of preventive antithrombotic measures in different cardiovascular indications. A short paragraph summarizes the current discussion of skipping aspirin in order to reduce the rate and severity of bleeding events.

Pulmonary Embolism and Atrial Fibrillation: Two Sides of the Same Coin? A Systematic Review

2017 ◽  
Vol 43 (08) ◽  
pp. 849-863 ◽  
Author(s):  
Maen Abou Ziki ◽  
Gregory Lip ◽  
Behnood Bikdeli
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Embolism ◽  
Antithrombotic Therapy ◽  
Pressure Overload ◽  
Epidemiological Studies ◽  
Right Atrial ◽  
Related Factors ◽  
Increased Risk ◽  
Bidirectional Association ◽  
Pubmed Search

AbstractPulmonary embolism (PE) is a common, potentially fatal thrombotic disease. Atrial fibrillation (AF), the most common arrhythmia, may also lead to thromboembolic complications. Although initially appearing as distinct entities, PE and AF may coexist. The direction and extent of this association has not been well characterized. We performed a search of PubMed, Scopus, and the Cochrane Database of Systematic Reviews for publications that reported coexisting AF in patients with PE, or vice versa, to provide a systematic overview of pathophysiological and epidemiological aspects of this association (last search: October 13, 2016). We screened 650 articles following the PubMed search, and 697 through Scopus. PE and AF share many common risk factors, including old age, obesity, heart failure, and inflammatory states. In addition, PE may lead to AF through right-sided pressure overload or inflammatory cytokines. AF, in turn, might lead to right atrial appendage clot formation and thereby PE. Epidemiological studies indicate that AF can be seen as a presenting sign, during the early phase, or later in the course of recovery from PE. Patients with AF are also at increased risk of developing PE, a risk that correlates with the CHA2DS2-VASc score. For the choice of antithrombotic therapy, PE-related factors (provoked or unproved, active cancer, and prior recurrence) and AF-related factors (CHA2DS2-VASc score), risk of bleeding, and patient preferences should be considered. In conclusion, PE and AF may coexist, with an understudied bidirectional association. Prognostication and choice of antithrombotic therapy in patients with both PE and AF might be different compared with those who present with only one of the two and warrants further investigation.

Antithrombotic therapy and the risk of new-onset dementia in elderly patients with atrial fibrillation

2020 ◽  
pp. postgradmedj-2020-137916
Author(s):  
Chun Ka Wong ◽  
Duo Huang ◽  
Mi Zhou ◽  
JoJo Hai ◽  
Wen Sheng Yue ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Antithrombotic Therapy ◽  
Lower Risk ◽  
Female Gender ◽  
Increased Risk ◽  
The Mean ◽  
Relationship Of ◽  
The Relationship ◽  
New Onset

BackgroundAtrial fibrillation (AF) is associated with an increased risk of dementia. Little is known about the relationship of antithrombotic therapy and the risk of dementia in patients with AF without clinical stroke.MethodThis was an observational study based on a hospital AF registry. Patients aged 65–85 years at the time of AF diagnosis were identified via the computerised database of the clinical management system. Patients with prior stroke or known cognitive dysfunction were excluded. The primary outcome was newly diagnosed dementia during the follow-up period.Results3284 patients (mean age 76.4±5.3 years, 51.6% male) were included for analysis. The mean CHA2DS2-VASc score was 3.94±1.44. 18.5% patients were prescribed warfarin, 39.8% were prescribed aspirin and 41.7% were prescribed no antithrombotic therapy. After a mean follow-up of 3.6 years, 71 patients (2.2%) developed dementia, giving rise to an incidence of 0.61%/year. The incidence of dementia were 1.04%/year, 0.69%/year and 0.14%/year for patients on no therapy, aspirin and warfarin, respectively. Both univariate and multivariate analyses showed that age ≥75 years, female gender and high CHA2DS2-VASc score were associated with significantly higher risk of dementia; warfarin use was associated with significantly lower risk of dementia (HR: 0.14%, 95% CI 0.05 to 0.36, p<0.001). Patients on warfarin with time in therapeutic range (TTR) ≥65% had a non-significant trend towards a lower risk of dementia compared with those with TTR <65%.ConclusionIn elderly AF patients, warfarin therapy was associated with a significantly lower risk of new-onset dementia compared those with no therapy or aspirin.

Coagulation and thrombosis

2015 ◽  
Author(s):  
Kurt Huber ◽  
Joao Morais
Keyword(s):  
Atrial Fibrillation ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Antithrombotic Therapy ◽  
Antiplatelet Agents ◽  
Thromboembolic Events ◽  
Efficacy And Safety ◽  
Antithrombotic Treatment ◽  
Bleeding Events ◽  
Increased Risk

Antithrombotic therapy consisting of antiplatelet agents and/or anticoagulants is an important way to avoid atherothrombotic complications, especially in secondary prevention. Primary prevention by antithrombotic measures usually refers to the prevention of stroke in patients with atrial fibrillation and an increased risk for stroke or peripheral thromboembolic events by the use of anticoagulants. In certain situations a combination of anticoagulants and antiplatelet agents is mandatory. This chapter provides the pathophysiological background of coagulation and thrombosis, reports on the epidemiology of antithrombotic treatment, and describes the efficacy and safety of preventive antithrombotic measures in different cardiovascular indications. A short paragraph summarizes the current discussion of skipping aspirin in order to reduce the rate and severity of bleeding events.

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