Tag Archives: ENGAGE AF-TIMI 48

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

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

Anticoagulant treatment after intracerebral haemorrhage in patients with AF Anticoagulant treatment may be initiated seven to eight weeks after intracerebral haemorrhage (ICH) in patients with atrial fibrillation (AF), to optimise the benefit from treatment and minimise risk, according to a nationwide observational study published recently in Stroke.1 The study aimed to provide observational data on the relationship between the timing of antithrombotic treatment and the competing risks of severe thrombotic and haemorrhagic events in a cohort of Swedish patients with AF and ICH. Patients with AF and a first-ever ICH were identified in the Swed

Drug therapies include anticoagulants to reduce the risk of stroke and anti-arrhythmics to restore/maintain the normal heart rhythm or slow the heart rate in patients who remain in AF. Non-pharmacological management options include electrical cardioversion, which may be used to ‘shock’ the heart back to its normal rhythm. The high risk of stroke associated with electrical cardioversion can be reduced by oral anticoagulation. Although effective in reducing the risk of thromboembolism, the limitations of warfarin present considerable challenges for its use in clinical practice. The challenges of maintaining warfarin within an appropriate th

Understanding the mechanisms of AF lies at the heart of its treatment. AF occurs when structural and/or electrophysiological abnormalities alter atrial tissue to promote abnormal impulse formation and/or propagation (figure 1).3 Multiple clinical risk factors, electrocardiographic/echocardiographic features and biochemical markers are associated with an increased risk of AF (table 1), and, AF can be described in terms of the duration of episodes using a simplified scheme (table 2).3 Figure 1. Mechanisms of atrial fibrillation Table 1. Risk factors3 The aim of treatment is to prevent stroke and alleviate symptoms.4 Drug therapies include antic

Obstructive sleep apnoea and neurovascular disease The association between obstructive sleep apnoea (OSA) and neurovascular disease was discussed by Dr David Hargroves (British Association of Stroke Physicians Education and Training Chair) and colleagues from East Kent during the training day at the conference. Dr Hargroves presented previously published data which shows that OSA is not uncommon: 24% of men and 9% of women in the general population may have OSA, 3−4% with clinically ‘obvious’ sequelae, and 60% of older and obese people may have OSA.1 Clinicians treating patients with neurological presentations should have a high index o

X-VERT: rivaroxaban▼ an alternative to VKA in cardioversion for AF Watch Professor Keith Fox, Chairman of the ESC programme committee discussing the relevance of X-VERT and other studies for UK practice in our podcast from the ESC Oral anticoagulant therapy with rivaroxaban is an alternative to vitamin K antagonists (VKAs) in patients with AF who are undergoing elective cardioversion according to the results of the X-VERT study.1 In addition, rivaroxaban may potentially have one important advantage over VKAs, with a shorter time to cardioversion, the study suggests. Professor Riccardo Cappato (University of Milan, Italy), the co-principal

ENGAGE AF-TIMI 48: success for edoxaban in AF The new factor Xa inhibitor, edoxaban (Daiichi-Sankyo), was as effective in preventing strokes and safer than warfarin in patients with atrial fibrillation (AF) in the ENGAGE AF-TIMI 48 trial. The ENGAGE AF-TIMI 48 (Effective AnticoaGulation with Factor XA Next Generation in Atrial Fibrillation – Thrombolysis In Myocardial Infarction 48) trial included more than 21,000 AF patients from 46 countries who were randomised to edoxaban at one of two doses (60 mg or 30 mg per day) or warfarin. Results (table 1) showed that both edoxaban doses were associated with significantly less major bleeding than