scholarly journals Atrial Fibrillation and Coronary Artery Disease: Deciding on The Best Antithrombotic Regimen

2018 ◽  
Vol 13 (SP1) ◽  
Author(s):  
Jason Andrade ◽  
Laurent Macle ◽  
Marc Dyall
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Antiplatelet Therapy ◽  
Treatment Strategies ◽  
Current Evidence ◽  
Systemic Embolism ◽  
Increased Risk ◽  
Coronary Events ◽  
Artery Disease

Atrial fibrillation (AF) is a chronic progressive disease characterized by exacerbations and remissions. Up to 20-30% of patients with AF also have coronary artery disease (CAD). In patients with concomitant AF and CAD, the management of antithrombotic therapy is challenging. Oral anticoagulation (OAC) is indicated for the prevention of AF-related stroke and systemic embolism, whereas antiplatelet therapy is indicated for the prevention of coronary events. Each of these therapeutic avenues offers a relative efficacy benefit (e.g. dual antiplatelet therapy [DAPT] is more effective than OAC alone in reducing cardiovascular death, myocardial infarction, stent thrombosis, and ischemic coronary events in an ACS population), but with a relative compromise (e.g. DAPT is significantly inferior to OAC for the prevention of stroke/systemic embolism in an AF population at increased risk of AF-related stroke). The purpose of this review is to explore the current evidence and rationale for antithrombotic treatment strategies in patients with both AF and CAD.

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.

Should the Presence or Extent of Coronary Artery Disease be Quantified in the CHA2DS2-VASc Score in Atrial Fibrillation? A Report from the Western Denmark Heart Registry

2018 ◽  
Vol 118 (12) ◽  
pp. 2162-2170 ◽  
Author(s):  
Kamilla Steensig ◽  
Kevin Olesen ◽  
Troels Thim ◽  
Jens Nielsen ◽  
Svend Jensen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Risk Factor ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Ischaemic Stroke ◽  
Independent Risk Factor ◽  
Oral Anticoagulants ◽  
Increased Risk ◽  
Artery Disease

Background Patients with atrial fibrillation (AF) have an increased risk of ischaemic stroke. The risk can be predicted by the CHA2DS2-VASc score, in which the vascular component refers to previous myocardial infarction, peripheral artery disease and aortic plaque, whereas coronary artery disease (CAD) is not included. Objectives This article explores whether CAD per se or extent provides independent prognostic information of future stroke among patients with AF. Materials and Methods Consecutive patients with AF and coronary angiography performed between 2004 and 2012 were included. The endpoint was a composite of ischaemic stroke, transient ischaemic attack and systemic embolism. The risk of ischaemic events was estimated according to the presence and extent of CAD. Incidence rate ratios (IRR) were calculated in reference to patients without CAD and adjusted for parameters included in the CHA2DS2-VASc score and treatment with anti-platelet agents and/or oral anticoagulants. Results Of 96,430 patients undergoing coronary angiography, 12,690 had AF. Among patients with AF, 7,533 (59.4%) had CAD. Mean follow-up was 3 years. While presence of CAD was an independent risk factor for the composite endpoint (adjusted IRR, 1.25; 1.06–1.47), extent of CAD defined as 1-, 2-, 3- or diffuse vessel disease did not add additional independent risk information. Conclusion Presence, but not extent, of CAD was an independent risk factor of the composite thromboembolic endpoint beyond the components already included in the CHA2DS2-VASc score. Consequently, we suggest that significant angiographically proven CAD should be included in the vascular disease criterion in the CHA2DS2-VASc score.

scholarly journals Clinical Applications of Natriuretic Peptides in Heart Failure and Atrial Fibrillation

2019 ◽  
Vol 20 (11) ◽  
pp. 2824 ◽  
Author(s):  
Masako Baba ◽  
Kentaro Yoshida ◽  
Masaki Ieda
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Natriuretic Peptides ◽  
Clinical Applications ◽  
Current Evidence ◽  
Clinical Prognosis ◽  
Diagnosis And Management ◽  
Artery Disease

Natriuretic peptides (NPs) have become important diagnostic and prognostic biomarkers in cardiovascular diseases, particularly in heart failure (HF). Diagnosis and management of coronary artery disease and atrial fibrillation (AF) can also be guided by NP levels. When interpreting NP levels, however, the caveat is that age, sex, body mass index, renal dysfunction, and race affect the clearance of NPs, resulting in different cut-off values in clinical practice. In AF, NP levels have been associated with incident AF in the general population, recurrences after catheter ablation, prediction of clinical prognosis, and the risk of stroke. In this article, we first review and summarize the current evidence and the roles of B-type NP and atrial NP in HF and coronary artery disease and then focus on the increasing utility of NPs in the diagnosis and management of and the research into AF.

Abstract 491: Detection of Subclinical Coronary Artery Disease by Calcium Score in Patients With Atrial Fibrillation: Potential Clinical Implications

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Kongkiat Chaikriangkrai ◽  
Miguel Valderrabano ◽  
Sayf Khaleel Bala ◽  
Sama Alchalabi ◽  
Edward Graviss ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Vascular Diseases ◽  
Calcium Score ◽  
Clinical Implications ◽  
Therapeutic Implications ◽  
Increased Risk ◽  
Original Definition ◽  
Artery Disease

Background: Clinical implications of detecting subclinical coronary artery disease (CAD) in patients with atrial fibrillation (AF) are unclear. Methods: A total of 430 AF patients (age 63 ± 10 y, 65% male, 62% hypertensive, 16% diabetic, 42% dyslipidemic) without known CAD undergoing pre-procedural CT for catheter ablation were included. We evaluated the change in: 1) numbers of patients with CACS-diagnosed CAD who could potentially be on statin. 2) CHA2DS2-VASc score after incorporating CACS>100 (related to increased risk of stroke) into the original definition of vascular diseases who could potentially be on anticoagulants. Results: 1) Prevalence of subclinical CAD (CACS>0) was 74% (319/430) and 25% (106/430) had CACS>100. There were 62% (267/430) who were not on statin. Of these patients, 71% (190/267) had subclinical CAD while 21% (34/163) of statin users had CACS of 0. 2) The median original CHA2DS2-VASc score was 2. After incorporating CACS>100 into the original score, 24% (18/75) with the original score of 0 had the score changed to 1 (7/35 in persistent AF [PST-AF] and 11/40 in paroxysmal AF [PRX-AF]) (figure A) and 17% (22/131) with the original score of 1 had the score changed to ≥ 2 (10/83 in PST-AF and 12/48 in PRX-AF) (figure B). PRX-AF had more frequent increase in CHA2DS2-VASc score than PST-AF (p=0.035)(figure C). Conclusion: In AF patients without known history of CAD, detecting subclinical CAD by CACS potentially has important therapeutic implications for prevention forprogression of CAD and stroke.

scholarly journals Antiplatelet Therapy for Stable Coronary Artery Disease in Atrial Fibrillation Patients Taking an Oral Anticoagulant

Circulation ◽  
2014 ◽  
Vol 129 (15) ◽  
pp. 1577-1585 ◽  
Author(s):  
Morten Lamberts ◽  
Gunnar H. Gislason ◽  
Gregory Y.H. Lip ◽  
Jens Flensted Lassen ◽  
Jonas Bjerring Olesen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Antiplatelet Therapy ◽  
Oral Anticoagulant ◽  
Stable Coronary Artery Disease ◽  
Artery Disease

Abstract 449: Increased Risk of Coronary Artery Disease in Patients with Persistent Type of Nonvalvular Atrial Fibrillation

2014 ◽  
Vol 34 (suppl_1) ◽  
Author(s):  
Kongkiat Chaikriangkrai ◽  
Sama Alchalabi ◽  
Sayf Khaleel bala ◽  
Su Min Chang
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiac Computed Tomography ◽  
Framingham Score ◽  
Nonvalvular Atrial Fibrillation ◽  
Increased Risk ◽  
Significant Difference ◽  
History Of ◽  
Artery Disease

Background: This study is to examine relationship between coronary artery disease (CAD) and types of atrial fibrillation (AF) Methods: A total of 403 nonvalvular atrial fibrillation patients without known history of CAD underwent coronary artery calcium score (CACS) evaluation by multi-detector cardiac computed tomography. Clinical characteristics and CACS were compared between patients with persistent type of AF and paroxysmal type of AF. Results: The cohort comprised of 65% (279 of 430) male with a mean (SD) age of 63(10) years. Prevalence of persistent AF was 60% (259 of 430). Mean (SD) 10-year risk of CAD by Framingham score was 14(7)%. Median CACS was 22 (range 0-5402) with 75% CACS>0 (321 of 430). Compared to paroxysmal type, those with persistent type had higher prevalence of CAC>0 as shown in Figure1 and more history of hypertension (p<0.001) but less history of smoking (p0.004), statins use (p0.018) and warfarin use (p<0.001). There was no statistically significant difference in mean age (p0.783) and CAD risk by Framingham score (p0.477) between two groups. In multivariate analysis, persistent type is an independent predictor for CACS>0 (OR 1.938; 95%CI 1.197, 3.138; p0.007). Conclusion: In patients with AF, persistent type of AF is independently associated with CACS>0. Our findings suggest potential benefit from evaluation of CAD in this population.

Antiplatelet for Coronary Artery Disease in Specific Condition “No Size Fits All”

2018 ◽  
Vol 24 (4) ◽  
pp. 478-495
Author(s):  
Benny M. Setiadi ◽  
Beny Hartono ◽  
Adhitia B. Prakoso ◽  
Anggia C. Lubis ◽  
Reza M. Munandar ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Platelet Reactivity ◽  
Antiplatelet Agent ◽  
Current Evidence ◽  
Efficacy And Safety ◽  
Current Recommendation ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Artery Disease

Antiplatelet is the cornerstone therapy for patient with coronary artery disease. Several comorbidities can influence the efficacy and safety of antiplatelet agent. Diabetes mellitus is characterized by increased platelet reactivity and reduced response to antiplatelet. Elderly patients have both reduced response to antiplatelet and increased risk of bleeding. Patients with renal dysfunction also had decreased efficacy of antiplatelet accompanied with increased risk of bleeding. In patients with atrial fibrillation, the concomitant use of anticoagulant with antiplatelet poses an increased risk of bleeding. In patients with these comorbidities, caution should be stressed in selecting the best regimen of antiplatelet which translates the most optimal efficacy while minimizing the risk of adverse events. In this review, we will discuss the platelet changes in these comorbidities, current evidence of antiplatelet usage in these group of patients and current recommendation.

Antithrombotic therapy: what the dental surgeon has to know

2010 ◽  
Vol 1 (3) ◽  
pp. 92-98
Author(s):  
Nadzeya Kuzniatsova ◽  
Gregory YH Lip
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Elective Surgery ◽  
Antiplatelet Agents ◽  
Invasive Procedures ◽  
Antithrombotic Drugs ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Artery Disease

Antithrombotic drugs are prescribed more and more often in medical practice. With a progressively aging population, the proportion of patients having prothrombotic medical conditions such as coronary artery disease, atrial fibrillation, venous thrombosis and many others increases dramatically. Anticoagulants or antiplatelet agents save thousands of lives annually but also introduce concerns of increased risk of bleeding, especially in the settings of elective surgery or invasive procedures.

scholarly journals The Role of Direct Oral Anticoagulants in Patients With Coronary Artery Disease

2018 ◽  
Vol 24 (2) ◽  
pp. 103-112 ◽  
Author(s):  
Ricky D. Turgeon ◽  
Margaret L. Ackman ◽  
Hazal E. Babadagli ◽  
Jade E. Basaraba ◽  
June W. Chen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Triple Therapy ◽  
Antiplatelet Therapy ◽  
Low Dose ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Artery Disease ◽  
Stable Cad

Despite contemporary management, patients with coronary artery disease (CAD) remain at high risk for thrombotic events. Several randomized controlled trials have evaluated the use of direct oral anticoagulants (DOACs) in patients with CAD, including in the setting of acute coronary syndrome (ACS) and stable CAD, and in patients with concomitant atrial fibrillation. Trials of apixaban and dabigatran in patients with ACS demonstrate no benefit with an increased risk of bleeding. Conversely, rivaroxaban at a reduced dose of 2.5 mg twice daily reduced thrombotic events and all-cause mortality when added to dual antiplatelet therapy in patients with ACS. Similarly, the addition of low-dose rivaroxaban to acetylsalicylic acid reduced the risk of thrombotic events in patients with stable CAD. However, the addition of a DOAC to antiplatelet therapy increased the risk of major bleeding. In patients with atrial fibrillation undergoing percutaneous coronary intervention, dual-pathway or low-dose triple therapy regimens including dabigatran or rivaroxaban reduced bleeding risk compared to traditional warfarin-based triple therapy, although it remains unclear whether these regimens preserve antithrombotic efficacy. DOAC–based antithrombotic regimens prove useful in patients with CAD in various settings; however, careful selection of patients and regimens per trial protocols are critical to achieving net benefit.

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