Tag Archives: anticoagulants

Introduction Atrial fibrillation (AF) presents as an abnormal cardiac rhythm characterised by an irregular or abnormally fast (>100 bpm) resting heart rate (HR). AF risk factors include increasing age, diabetes, hypertension and coronary artery disease.1 AF increases stroke risk by roughly fivefold, greater than the risk elicited by hypertension, coronary artery disease or previous heart failure.2 AF-related stroke patients experience greater mortality rates, disability, hospitalisation time and healthcare costs relative to non-AF stroke patients.3 The East Midlands primary healthcare services comprise 19 Clinical Commissioning Groups (CCG

Introduction Atrial fibrillation (AF) is a common arrhythmia affecting approximately 1% of the general population, this rises to 18% in those aged 85 years and above.1 The most effective method for correcting persistent AF is direct current cardioversion (DCCV). However, DCCV is associated with an increased risk of thromboembolic events.2 Anticoagulation with warfarin reduces the risk of thromboembolism from approximately 6% to less than 1%.3 The current recommendations advise therapeutic anticoagulation for at least three weeks prior to, and four weeks after cardioversion.4 A nurse-led elective DCCV service at Raigmore Hospital was establish

With the number of patients with atrial fibrillation (AF) set to double by 2050, appropriate anticoagulation for this growing condition was highlighted in a special session at the meeting – a ‘State of The Art Lecture’. Professor Stefan H Hohnloser (JW Goethe University, Frankfurt, Germany) described how stroke in Europe costs an estimated €38 billion per year, with 20% attributable to AF. Yet a decade ago, around 40% of AF patients did not receive appropriate anticoagulation. Of those receiving therapy, only around 50% of time in therapeutic range (TTR) is seen. With this in mind, novel oral anticoagulants (NOACs) are non-inferior to

The guide, which has been published online in the European Heart Journal and Europace, covers four new oral anticoagulants: dabigatran, rivaroxaban and apixaban (which are all now on the market for AF), and edoxaban, which is included provisionally, as it is not yet approved. The guide notes that: “Both physicians and patients will have to learn how to use these drugs effectively and safely in clinical practice,” and “Many unresolved questions on how to optimally use these drugs in specific clinical situations remain”. It sets out 15 clinical scenarios and gives “as practical answers as possible” for each one. The topics are: Pra

Stroke risk assessment in AF New insights on stroke risk assessment were provided by Dr Ami Banerjee (University of Birmingham), in a session supported by the Atrial Fibrillation Association. Table 1. CHADS2 score The CHADS2 risk stratification scoring system (table 1) is currently the indicator for the Quality and Outcomes (QoF) framework used to determine whether an atrial fibrillation (AF) patient warrants anticoagulation. It may underestimate risk and those with a score of zero may actually be at substantial stroke risk. He also pointed out that the system has inherent disadvantages. It does not include many of the risk factors for stroke

Of the three new drugs, the paper appears to particularly highlight apixaban saying it “is currently the best-documented alternative to both warfarin and aspirin for stroke prevention in a broad population with AF”. It adds that “apixaban has been shown to be superior compared with warfarin concerning the reduction of stroke and mortality in combination with a reduction in major bleeding, with a bleeding risk similar to that of low-dose aspirin, and with better tolerability than both these alternatives, albeit with no reduction in ischaemic stroke compared with warfarin”. The paper says dabigatran 150 mg is also a well-documented alte

Mechanisms Figure 1. Platelet-fibrin thrombus in a coronary artery of a patient with acute coronary syndrome The mechanism of action of aspirin differs from that of other antiplatelet agents. Aspirin irreversibly acetylates platelet cyclooxygenase-1 (COX-1), completely inhibiting COX-1- dependent synthesis of thromboxane A2 (TXA2), a substance which is a potent vasoconstrictor and promoter of platelet aggregation. Whether low-dose aspirin also exerts a significant anti-inflammatory effect is uncertain: a retrospective sub-analysis suggested that it was more effective in primary prevention in individuals who had high levels of C-reacti