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Tag Archives: atrial fibrillation

Introduction

July 2019 Br J Cardiol 2019;26(suppl 2):S3 doi:10.5837/bjc.2019.s07

Introduction

Khalid Khan

Abstract

Effective anticoagulation improves outcomes in patients with AF or VTE.4-7 Non-vitamin K antagonist oral anticoagulants (NOACs) have provided an alternative to warfarin for prevention of stroke or recurrent VTE in these patients in recent years. Compared with warfarin, NOACs have more predictable pharmacokinetics and pharmacodynamics, do not require monitoring of the international normalised ratio (INR), and have a wider therapeutic window that enables prescription at fixed daily doses over an extended period.8 Edoxaban, an inhibitor of Factor Xa is a member of the NOAC class. The accompanying articles summarise latest findings on the effect

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Insights in patients with atrial fibrillation and co-existing cardiovascular disease

July 2019 Br J Cardiol 2019;26(suppl 2):S4–S9 doi:10.5837/bjc.2019.s08

Insights in patients with atrial fibrillation and co-existing cardiovascular disease

Khalid Khan, Honey Thomas

Abstract

Introduction Atrial fibrillation (AF) is encountered with increasing frequency in clinical practice,1 and is associated strongly with adverse clinical outcomes, including stroke, cardiovascular events and death.2,3 Concomitant atherosclerotic disease may increase the risk of adverse outcomes in people with AF. For example, peripheral arterial disease was present in 11% of a large cohort of European patients with AF, and increased the risk of all-cause and cardiovascular death, compared with patients with AF but no peripheral arterial disease.4 In addition, AF is associated with adverse outcomes in a range of other subgroups of patients, inclu

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Insights in stroke prevention in patients with a prior history of stroke or transient ischaemic attack

July 2019 Br J Cardiol 2019;26(suppl 2):S10–S14 doi:10.5837/bjc.2019.s09

Insights in stroke prevention in patients with a prior history of stroke or transient ischaemic attack

Paul Guyler

Abstract

Introduction Atrial fibrillation (AF) more than doubles the five-year risk of stroke in middle-aged men and women.1 Prior cerebrovascular disease markedly amplifies the risk of recurrent stroke in patients with or without AF.1,2 Figure 1 shows the influence of AF and prior cerebrovascular disease (stroke or transient ischaemic attack [TIA]) on the estimated five-year risk of a composite of stroke, systemic thromboembolism, or TIA (most events were ischaemic strokes) for a 60-year-old individual, from a large cohort study conducted in the UK.1 These observations demonstrate the need for long-term treatment to reduce the risk of stroke in thes

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May 2019 Br J Cardiol 2019;26:50

Quick takes from ACC.19: The American College of Cardiology 68th Annual Scientific Sessions

Gerald Chi, Syed Hassan Abbas Kazmi, C. Michael Gibson

Abstract

ACC.19 was held in New Orleans, US PARTNER 3 and Evolut Low Risk add to evidence base for TAVR Prior literature suggests that transcatheter aortic-valve replacement (TAVR) is non-inferior or even superior to standard surgical aortic-valve replacement (SAVR) among high and intermediate surgical risk patients with aortic stenosis (AS). Two pivotal studies have now addressed the efficacy and safety of TAVR in AS patients at low mortality risk from surgery. PARTNER 3 (ClinicalTrials.gov: NCT02675114) was an open-label trial that randomised 1,000 subjects with severe AS at low mortality risk from surgery into either TAVR with a third-generation ba

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April 2019 Br J Cardiol 2019;26:48–9 doi:10.5837/bjc.2019.014 Online First

Should we be targeting people with diabetes when screening for atrial fibrillation?

Angela Hall, Andrew Mitchell

Abstract

Relationship between diabetes and AF Mass screening of AF in the STROKESTOP study2 discovered diabetes, heart failure and previous stroke/transient ischaemic attack (TIA) to be the strongest predictors for AF in multi-variate analysis. This confirms findings from the historical Framingham study, where diabetes conferred a 1.4-fold increased risk of stroke in men and a 1.6-fold increased risk in women.3 A recent review of the evidence from AF screening studies in those with perceived high risks, has demonstrated the prevalence of AF in people with diabetes ranges from 2.9%4 to 18.5%.2 Chan and Choy’s study (2016)5 did not find diabetes to be

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Non-prescription of anticoagulants in patients discharged with stroke and atrial fibrillation

February 2019 Br J Cardiol 2019;26:23–6 doi:10.5837/bjc.2019.007

Non-prescription of anticoagulants in patients discharged with stroke and atrial fibrillation

Calum Creaney, Karissa Barkat, Christopher Durey, Susan Gallagher, Linda Campbell, Ashish MacAden, Paul Findlay, Gordon F Rushworth, Stephen J Leslie

Abstract

Introduction Atrial fibrillation (AF) increases an individual’s risk of stroke fivefold.1 Oral anticoagulation (OAC) with warfarin reduces the risk of stroke by 64%.2 Novel or direct oral anticoagulants are non-inferior to warfarin in preventing stroke in non-valvular AF and have a similar bleeding profile, but with a lower risk of fatal intracranial haemorrhage and several practical advantages.3-7 While several antiplatelet agents have been shown to reduce the risk of recurrent stroke, they are considerably less effective than OAC, with a similar risk of major bleeding, and, therefore, are no longer recommended in national guidelines for

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The future of atrial fibrillation: does the answer lie in ablation or anti-arrhythmics?

February 2019 Br J Cardiol 2019;26:31–3 doi:10.5837/bjc.2019.009

The future of atrial fibrillation: does the answer lie in ablation or anti-arrhythmics?

Mark T Mills

Abstract

Dr Mark Mills The question: medicate, or ablate? To medicate (with anti-arrhythmics), or to ablate: that is the question. In the management of atrial fibrillation (AF), the answer, depending on those questioned and the evidence cited, might be one, the other, both, or neither. Anti-arrhythmic drugs, compared with rate-control drugs, confer no prognostic benefit.1 Furthermore, emerging evidence suggests that ablation confers no mortality benefit over drug therapy.2 This equivocality presents a challenge in clinical practice. Here, consideration is given to each of these standpoints, while highlighting gaps in current knowledge and future direc

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Introduction

August 2018 Br J Cardiol 2018;25(suppl 1):S3–S5 doi:10.5837/bjc.2018.s01

Introduction

Tarek Nafee,
 C Michael Gibson

Abstract

Until recently, warfarin was the drug of choice for patients with atrial fibrillation. Data from the ROCKET-AF (Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation),1 ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation),2 RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy)3 and ENGAGE AF-TIMI 48 (Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48)4 trials demonstrated non-inferior or superior reduction in str

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Anticoagulation in patients with non-valvular AF undergoing PCI: clinical evidence from PIONEER AF-PCI

August 2018 Br J Cardiol 2018;25(suppl 1):S6–S11 doi:10.5837/bjc.2018.s02

Anticoagulation in patients with non-valvular AF undergoing PCI: clinical evidence from PIONEER AF-PCI

Tarek Nafee, Gerald Chi, Fahad AlKhalfan, Serge Korjian, Yazan Daaboul, Seyedmahdi Pahlavani, Usama Talib, Aravind Reddy Kuchkuntla, Mahshid Mir, Mathieu Kerneis, C Michael Gibson

Abstract

Background, epidemiology and rationale for study The PIONEER AF-PCI (Open-Label, Randomized, Controlled, Multicenter Study Exploring Two Treatment Strategies of Rivaroxaban and a Dose-Adjusted Oral Vitamin K Antagonist Treatment Strategy in Subjects with Atrial Fibrillation who Undergo Percutaneous Coronary Intervention) trial addressed an important medical question, which is potentially relevant for the 20–45% of atrial fibrillation (AF) patients who also have coronary artery disease and are likely to undergo percutaneous coronary intervention (PCI). Prior to the PIONEER AF-PCI trial, there was an unmet need for evidence-based recommendati

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June 2018 Br J Cardiol 2018;25:52

General news

BJC Staff

Abstract

New practical NOACs guide A new version of EHRA Practical Guide on the use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) was launched at the congress. ESC guidelines state that NOACs should be preferred over vitamin K antagonists, such as warfarin, for stroke prevention in AF patients, except those with a mechanical heart valve or rheumatic mitral valve stenosis, and their use in clinical practice is increasing. The guide gives concrete, practical advice on how to use NOACs in specific clinical situations. The guide is published in European Heart Journal (doi: 10.1093/eurheartj/ehy136). Anti

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