Tag Archives: atrial fibrillation

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We believe that the new guideline2 will be a major advance in stroke prevention in AF. We would suggest that Professor Brady and colleagues, in their focus on non-vitamin K oral anticoagulants (NOACs), have overlooked the importance of a number of crucial aspects of the guideline. It represents a paradigm change in stroke management. The GDG were very keen to promote the concept that, whereas previously risk assessment was undertaken to define patients at high risk of stroke requiring anticoagulation, under the new guideline anticoagulation has become the norm for all but the lowest-risk patients. It represents a considerable simplification

Introduction People with atrial fibrillation (AF) are five times more likely to have a stroke.1 AF is an increasing problem as our population gets older.2 It is, therefore, important to be able to identify this condition as early as possible, when intervention with anticoagulation can prevent stroke, as is recommended by the National Institute for Health and Care Excellence (NICE), in most cases.3 Several studies have attempted to identify the most effective way of screening for, or case-finding, AF.4-7 The gold standard for diagnosis of AF is a 12-lead electrocardiogram (ECG). However, the 12-lead ECG is an impractical diagnostic tool for a

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Introduction Atrial fibrillation is the most common arrhythmia, affecting 1–2% of the population.1 It is associated with an increased risk of stroke and death, heart failure, reduction in quality of life, mental health problems and cognitive impairment.2 Hospitalisation is common and costly.3 Dronedarone was first approved by the National Institute for Health and Care Excellence (NICE) in April 20104 for atrial fibrillation rhythm control, but following two fatal cases of liver toxicity it is contraindicated in patients with liver dysfunction, a creatinine clearance (CrCl) ≤30 ml/min, in permanent atrial fibrillation or congestive heart f

Introduction Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterised by uncoordinated activation of the atria. AF is a progressive disease and represents the most common serious disorder of cardiac rhythm. The incidence and prevalence of the disease increase progressively with age and is more common among men.1–5 AF is associated with higher mortality and cardiovascular (CV) morbidity.6–13 Specifically, AF is a recognised risk factor for stroke, with the proportion of strokes attributable to AF increasing exponentially with age.1,2,7,14–17 Although clinicians are most concerned about stroke risk among AF patients, c

When the NOACs (novel oral anticoagulants) were introduced over three years ago, they promised to revitalise the management of conditions such as atrial fibrillation (AF), venous thromboembolism (VTE) and thromboprophylaxis after major joint replacement surgery. Rivaroxaban is currently available in multiple indications, including (but not limited to): prevention of stroke and systemic embolism in adult patients with non-valvular AF, treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and the prevention of recurrent DVT and PE in adults. For decades anticoagulant therapy in these conditions had relied on the vitamin K antagon

ESC guidelines and differences between NOACs Following the roll-out of the novel oral anticoagulants (NOACs), the European Society of Cardiology (ESC) published in 2012 a focused update of its guidelines for the management of atrial fibrillation (AF). Since the NOACs tested in clinical trials all showed at least non-inferiority when compared with vitamin K antagonists (VKAs), with a better safety profile, particularly with reduction in intracranial haemorrhage (ICH), the ESC 2012 guideline recommended NOACs as broadly preferable to VKAs in the vast majority of patients with non-valvular AF (NVAF).1 In 2013, the European Heart Rhythm Associati

Introduction Vitamin K antagonists (VKAs) reduce the risk of stroke in patients with atrial fibrillation (AF). For more than five decades, they were the only available treatment. Novel oral anticoagulants (NOACs) have recently been approved for the prevention of non-valvular AF-related stroke. Dose-adjusted VKA therapy and NOACs are highly effective in AF patients. However, dabigatran, rivaroxaban and apixaban are more convenient, while at least equally effective and with a comparable safety profile (regarding bleeding complications) for stroke prevention compared with VKAs.1-3 Recent guidelines prefer treatment with NOACs over VKAs for most

The National Institute for Health and Care Excellence (NICE) has said that thousands of people with atrial fibrillation (AF) could be prevented from having strokes, disability or death if its new guidance is followed. It says many patients with AF are not being appropriately anticoagulated and highlights how there has not been widespread uptake of novel oral anticoagulant drugs (NOACs) which were approved by NICE in 2012. Clinical guideline 180 published in June 2014 updates and replaces the 2006 NICE clinical guideline 36. The full guidance can be found at http://www.nice.org.uk/guidance/CG180 NICE Chair, Professor David Haslam writes on the