A nomogram to predict unfavourable outcome in patients receiving oral anticoagulants for atrial fibrillation after stroke

Introduction It is unknown whether the type of treatment (direct oral anticoagulant versus vitamin K antagonist) and the time of treatment introduction (early versus late) may affect the functional outcome in stroke patients with atrial fibrillation. We aimed to develop and validate a nomogram model including direct oral anticoagulant/vitamin K antagonist and early/late oral anticoagulant introduction for predicting the probability of unfavourable outcome after stroke in atrial fibrillation-patients. Patients and Methods We conducted an individual patient data analysis of four prospective studies. Unfavourable functional outcome was defined as three-month modified Rankin Scale score 3 -6. To generate the nomogram, five independent predictors including age (<65 years, reference; 65--79; or 80), National Institutes of Health Stroke Scale score (0--5 points, reference; 6--15; 16--25; or >25), acute revascularisation treatments (yes, reference, or no), direct oral anticoagulant (reference) or vitamin K antagonist, and early (7 days, reference) or late (8--30) anticoagulant introduction entered into a final logistic regression model. The discriminative performance of the model was assessed by using the area under the receiver operating characteristic curve. Results A total of 2102 patients with complete data for generating the nomogram was randomly dichotomised into training ( n = 1553) and test ( n = 549) sets. The area under the receiver operating characteristic curve was 0.822 (95% confidence interval, CI: 0.800--0.844) in the training set and 0.803 (95% CI: 0.764--0.842) in the test set. The model was adequately calibrated (9.852; p = 0.276 for the Hosmer--Lemeshow test). Discussion and Conclusion Our nomogram is the first model including type of oral anticoagulant and time of treatment introduction to predict the probability of three-month unfavourable outcome in a large multicentre cohort of stroke patients with atrial fibrillation.

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Continuous and minimally-interrupted direct oral anticoagulant are both safe compared with vitamin K antagonist for atrial fibrillation ablation: An updated meta-analysis

International Journal of Cardiology ◽

10.1016/j.ijcard.2018.03.095 ◽

2018 ◽

Vol 262 ◽

pp. 51-56 ◽

Cited By ~ 13

Author(s):

Francis J. Ha ◽

Sergio Barra ◽

Adam J. Brown ◽

David A. Begley ◽

Andrew A. Grace ◽

...

Keyword(s):

Atrial Fibrillation ◽

Vitamin K ◽

Oral Anticoagulant ◽

Meta Analysis ◽

Vitamin K Antagonist ◽

Atrial Fibrillation Ablation ◽

Direct Oral Anticoagulant

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META-ANALYSIS OF DIRECT ORAL ANTICOAGULANT VERSUS VITAMIN K ANTAGONIST IN PATIENTS WITH ATRIAL FIBRILLATION AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)02529-8 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1170

Author(s):

Waiel Abusnina ◽

Ahmad Al-Abdouh ◽

Gauravpal S. Gill ◽

Anas Bizanti ◽

Abdelrazeg Houssein ◽

...

Keyword(s):

Atrial Fibrillation ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Vitamin K ◽

Oral Anticoagulant ◽

Transcatheter Aortic Valve Replacement ◽

Meta Analysis ◽

Vitamin K Antagonist ◽

Direct Oral Anticoagulant ◽

Transcatheter Aortic Valve

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The Complication Rates of Oral Anticoagulation Therapy in Deep Venous Thrombosis

Acta Medica Marisiensis ◽

10.2478/amma-2019-0012 ◽

2019 ◽

Vol 65 (3) ◽

pp. 87-90

Author(s):

Ionela Silivastru Cozlea ◽

Arthur-Atilla Keresztesi ◽

Gabriela Asofie Keresztesi ◽

Daniel Cozlea ◽

Daniela Ecaterina Dobru

Keyword(s):

Atrial Fibrillation ◽

Vitamin K ◽

Oral Anticoagulation ◽

Oral Anticoagulant ◽

Anticoagulation Therapy ◽

Vitamin K Antagonist ◽

Complication Rates ◽

Direct Oral Anticoagulant ◽

Oral Anticoagulation Therapy ◽

Hemorrhagic Events

AbstractThe objective of the current study is to evaluate the complication rates (embolic and hemorrhagic events) in deep venous thrombosis (DVT) patients on different types of oral anticoagulation therapy (OAC): direct oral anticoagulant therapy and vitamin K antagonist therapy.Methods: A number of 62 DVT patients were included and divided in two groups, depending on the type of oral anticoagulation therapy administered. The first group was composed of patients treated with direct oral anticoagulant treatment (Dabigatran, Rivaroxaban) and the second group was composed of patients treated with vitamin K antagonist (Acenocumarol). General data, including BMI and comorbidities were noted. Embolic and hemorrhagic events were noticed.Results: in the first group of patients (DOAC therapy), a number of 34 patients were included (14 of them with BMI higher than 25 kg/m2 and 14 with concomitant atrial fibrillation), while the second group comprised of 28 patients treated with VKA (21 of them with a high BMI and only 3 of them with atrial fibrillation). After a mean period of 36 months of anticoagulant therapy, complications were present in 17 patients, hematuria (8 episodes) and pulmonary embolism (4 cases) were the most frequent, with no difference regarding the treatment applied.Conclusion: No statistically significant difference was encountered regarding embolic and hemorrhagic event rates in our deep vein thrombosis patients.

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Persistence of non-vitamin K antagonist oral anticoagulant use in Japanese patients with atrial fibrillation: A single-center observational study

Journal of Arrhythmia ◽

10.1016/j.joa.2015.04.004 ◽

2015 ◽

Vol 31 (6) ◽

pp. 339-344 ◽

Cited By ~ 34

Author(s):

Tsuyoshi Shiga ◽

Miyoko Naganuma ◽

Takehiko Nagao ◽

Kenji Maruyama ◽

Atsushi Suzuki ◽

...

Keyword(s):

Atrial Fibrillation ◽

Observational Study ◽

Vitamin K ◽

Oral Anticoagulant ◽

Japanese Patients ◽

Vitamin K Antagonist ◽

Single Center ◽

Single Center Observational Study

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A New Measure of Pulse Rate Variability and Detection of Atrial Fibrillation Based on Improved Time Synchronous Averaging

Computational and Mathematical Methods in Medicine ◽

10.1155/2021/5597559 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Xiaodong Ding ◽

Yiqin Wang ◽

Yiming Hao ◽

Yi Lv ◽

Rui Chen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulse Rate ◽

Euclidean Distance ◽

Operating Characteristic ◽

Pulse Wave ◽

Characteristic Curve ◽

Signal Quality ◽

Training Set ◽

Pulse Rate Variability ◽

Operating Characteristic Curve

Background. Pulse rate variability monitoring and atrial fibrillation detection algorithms have been widely used in wearable devices, but the accuracies of these algorithms are restricted by the signal quality of pulse wave. Time synchronous averaging is a powerful noise reduction method for periodic and approximately periodic signals. It is usually used to extract single-period pulse waveforms, but has nothing to do with pulse rate variability monitoring and atrial fibrillation detection traditionally. If this method is improved properly, it may provide a new way to measure pulse rate variability and to detect atrial fibrillation, which may have some potential advantages under the condition of poor signal quality. Objective. The objective of this paper was to develop a new measure of pulse rate variability by improving existing time synchronous averaging and to detect atrial fibrillation by the new measure of pulse rate variability. Methods. During time synchronous averaging, two adjacent periods were regarded as the basic unit to calculate the average signal, and the difference between waveforms of the two adjacent periods was the new measure of pulse rate variability. 3 types of distance measures (Euclidean distance, Manhattan distance, and cosine distance) were tested to measure this difference on a simulated training set with a capacity of 1000. The distance measure, which can accurately distinguish regular pulse rate and irregular pulse rate, was used to detect atrial fibrillation on the testing set with a capacity of 62 (11 with atrial fibrillation, 8 with premature contraction, and 43 with sinus rhythm). The receiver operating characteristic curve was used to evaluate the performance of the indexes. Results. The Euclidean distance between waveforms of the two adjacent periods performs best on the training set. On the testing set, the Euclidean distance in atrial fibrillation group is significantly higher than that of the other two groups. The area under receiver operating characteristic curve to identify atrial fibrillation was 0.998. With the threshold of 2.1, the accuracy, sensitivity, and specificity were 98.39%, 100%, and 98.04%, respectively. This new index can detect atrial fibrillation from pulse wave signal. Conclusion. This algorithm not only provides a new perspective to detect AF but also accomplishes the monitoring of PRV and the extraction of single-period pulse wave through the same technical route, which may promote the popularization and application of pulse wave.

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