50 related results for Doubled risk of acute MI in real world AF patients receiving DOACs or aspirin vs. VKA

Discontinuation of long-term aspirin use for CVD prevention associated with higher CV risk

Literature 3-10-2017 • Sundström J et al., Circulation. 2017
The discontinuation of low-dose long-term aspirin use for CVD prevention in the absence of major surgery or bleeding, was associated with a >30% increased CV risk, shortly after discontinuation.

Risk of atrial fibrillation increased in those who work over 55 hours per week

Literature 19-7-2017 • Kivimäki M et al., EHJ 2017
In a large-scale meta-analysis, participants working over 55 h/week were 40% more likely to develop AF compared with those working standard hours, independently of known AF risk factors.

NOACs confer lower bleeding risk than VKA in low-risk AF patients

Literature 21-6-2017 • Lip GYH et al., JAMA Cardiol. 2017
In AF patients with a single non-gender-related stroke risk factor, the risk of any bleeding was lower for apixaban and dabigatran compared with warfarin, while no difference in stroke prevention was seen.

Lean body mass only anthropometric risk factor for atrial fibrillation

Literature 23-5-2017 • Fenger-Grøn M, et al, JACC 2017
Compared to 8 other anthropometric risk factors, lean body mass was the predominant and independent anthropometric driver for AF risk.

FORTA classifies all DOACs and warfarin as beneficial for older AF patients

Literature 17-5-2017 • Wehling M, et al, Drugs & Aging 2017
Based on FORTA classification, all DOACs and warfarin were classified as beneficial or very beneficial for older AF patients, while there was lack of evidence for other vitamin K antagonists.

Significance and recommendations AF-screening

Literature 10-5-2017 • Freedman B, et al, Circulation, 2017
Expert members of AF-SCREEN propose systematic or opportunistic screening approaches for AF based on known published data, to reduce the number of strokes and death. 

Incidence atrial fibrillation increased over last decade, which is expected to continue

Literature 3-5-2017 • Lane DA, et al, J Am Heart Assoc. 2017
Using a primary care population, it was observed that the incidence of AF increased in patients >75 yrs during the last decade, whereas mortality in these patients did not decrease as it did in younger patients. 

Undercoagulation was common in AF patients who suffered from stroke and impacts outcome

Literature 5-4-2017 • Xian Y et L., JAMA. 2017
In a contemporary registry, 84% of patients with a history of AF received no or subtherapeutic anticoagulation, which affected severity of stroke and in-hospital mortality.

Gastrointestinal safety profiles differ among direct oral anticoagulants

Literature 28-3-2017 • Abraham NS, et al, Gastroenterology 2017
In a large population-based cohort of AF patients on DOACs, apixaban had most favourable gastrointestinal safety profile among all age groups, and rivaroxaban the least favourable. 

Reduced doses NOAC show similar efficacy and bleeding risk but possibly higher mortality risk

Literature 20-2-2017 • Nielsen PB et al., BMJ. 2017
Real-world data show lower dose NOACs associated with similar risk of thromboembolic events and similar or lower rates of bleeding as compared with warfarin in AF, but mortality risk seems higher with NOACs.

Lower risk of liver injury hospitalisation with DOACs as compared to warfarin

Literature 10-1-2017 • Alonso A et al., Heart. 2017
Dabigatran, rivaroxaban and apixaban users were less often associated with liver injury hospitalisation compared to warfarin and several variables could predict this.

Frequency of off-label dosing of NOACs and its consequences

Literature 22-12-2016 • Steinberg BA et al., JACC 2016
Many AF patients on NOAC therapy do not receive recommended doses for stroke prevention, and are at increased risk for CV hospitalisation and all-cause mortality.

Higher risk of developing atrial fibrillation with moderate alcohol consumption

Literature 19-12-2016 • Voskoboinik A et al., JACC 2016
The cardioprotective effects attributed to alcohol do not apply to AF, as regular moderate consumption (~7-21 drinks/week), predisposes to AF, with an increase in AF recurrence in those who continue to drink.

DOACs also beneficial for elderly AF and VTE patients

Literature 11-10-2016 • Sadlon AH, Swiss Med Wkly, 2016
Rivaroxaban, apixaban, dabigatran and edoxaban were superior to VKAs in a meta-analysis of 8 studies comprising elderly patients with atrial fibrillation or venous thromboembolism.

Real-world safety data show differences between anticoagulants in AF patients

Literature 23-8-2016 • Lip GYH et al., Thromb Haemost 2016
In a real-world observational study using propensity score matched cohorts, apixaban initiation was associated with significantly lower risk of major bleeding compared to warfarin and rivaroxaban.

Many AF patients inappropriately on aspirin monotherapy rather than on anticoagulation

Literature 1-7-2016 • Hsu JH et al., J Am Coll Cardiol 2016
Approximately one third of AF outpatients at moderate to high risk for stroke treated by a cardiovascular specialist, received aspirin monotherapy, in spite of the lack of data supporting this practice.

Using 5 or more drugs concomitantly increases risk for comorbidity and complications in AF

Literature 29-6-2016 • Jaspers Focks J et al., BMJ 2016
In the ARISTOTLE trial population, polypharmacy was common and associated with higher comorbidity, mortality, and higher event rates of thromboembolic complications and major bleeding.

Direct oral anticoagulants result in lower risk of dementia in atrial fibrillation patients

Literature 9-6-2016 • Jacobs V, et al. Am J Cardiol. 2016
Treatment with direct oral anticoagulants was associated with a lower risk of cerebral ischemic events and new-onset dementia, in a retrospective analysis of 5,254 patients with atrial fibrillation.

Lower-risk AF patients also benefit from oral anticoagulation, new data show

Literature 9-6-2016 • Fauchier L et al., Stroke. 2016
Among AF patients with only 1 nongender-related stroke risk factor, OAC was associated with a positive net clinical benefit for the prevention of stroke and thromboembolic events.

Lower absolute number of bleeding events in the elderly with NOAC than with warfarin

Literature 1-6-2016 • Kato S et al., J Am Heart Assoc. 2016
In a pre-specified analysis from the ENGAGE AF-TIMI 48 trial, given the higher rates of bleeding in the elderly, a greater absolute reduction in safety events was seen with edoxaban as compared with warfarin than in younger patients.

Underweight BMI independently predicts mortality post AMI

Literature 17-5-2016 • Bucholz EM et al., PLoS Med 2016
In a large cohort of AMI patients, underweight BMI was an important risk factor for mortality, independent of comorbidities, frailty measures, and laboratory markers of nutritional status.

Adherence to oral anticoagulation affects outcomes in AF patients at high stroke risk

Literature 29-2-2016 • Yao et al., J Am Heart Assoc. 2016
In patients with atrial fibrillation, adherence to oral anticoagulation for stroke prevention was modestly improved by the use of NOACs, which impacts mainly the outcomes of high-risk patients.

Women have worse outcomes associated with atrial fibrillation than men

Literature 9-2-2016 • Emdin CA, et al. BMJ 2016
A meta-analysis shows that atrial fibrillation is associated with an increased risk of morbidity and mortality in women compared with men.

Polypharmacy in patients with AF can increase bleeding risk

Literature 2-2-2016 • Piccini JP et al., Circulation 2016
The risk of major bleeding with rivaroxaban compared with warfarin was reduced in patients in ROCKET-AF taking fewer than 5 medications, but not in patients taking 5 or more medications, whereas the risk of stroke was not influenced by multiple medications.

High risk elderly AF patients benefit from good quality anticoagulation control

Literature 21-10-2015 • Senoo K and Lip GYH, Stroke 2015
Elderly patients are at high risk of CV death and stroke/systemic embolism, but age does not increase risk of any clinically relevant bleeding. High TTR negatively correlated with adverse outcomes.

Protection from stroke and ICH with edoxaban vs placebo, aspirin, or aspirin plus clopidogrel

Literature 4-8-2015 • Blann AD et al., Thromb Haemost. 2015
Network meta-analysis compared edoxaban with placebo, aspirin alone, or aspirin plus clopidogrel in AF in both clinical trial populations and unselected community populations.

Stroke detection and prevention in atrial fibrillation

Literature 23-7-2015 • Prof. Richard Hobbs - Br. J. Gen. Prac. 2015
Professor Richard Hobbs, Chairman of EPCCS Scientific Organising Committee, wrote an editorial in the July issue of Br J Gen Prac, in which three articles on stroke and its better prevention are published.

Digoxin treatment possibly harmful, particularly when used to treat atrial fibrillation

Literature 6-5-2015 • Vamos et al., Eur Heart J. 2015
Large meta-analysis indicates that digoxin treatment is associated with higher all-cause mortality risk in patients with atrial fibrillation and with congestive heart failure.

Incidence of major bleedings with rivaroxaban in real world similar to trial setting

Literature 28-1-2015 • Tamayo S et al., Clin Cardiol 2015
The incidence of major bleeding in patients with NVAF taking rivaroxaban in standard clinical practice was similar to randomised trials. Most bleedings were of gastrointestinal or intracranial origin and fatal bleedings were rare.

Safety and efficacy of dabigatran confirmed in elderly real-world atrial fibrillation patients

Literature 4-11-2014 • Graham DJ et al., Circulation. 2014
FDA analysis of over 67.000 Medicare patients with non-valvular AF receiving dabigatran confirms efficacy- and safety profile as observed in RE-LY trial, as compared with warfarin.

Anticoagulation superior to antiplatelets or no treatment for improving survival in elderly AF patients

Literature 22-10-2014 • Wändell PE et al., Age Ageing. 2014
Men and women with AF aged > 75 years show increased survival with anticoagulants as compared to no treatment or treatment with antiplatelets. Not all pharmaceutical groups were associated with lower mortality and some sex differences were observed.

Screening for atrial fibrillation in stroke patients may be done by self-monitoring of pulse

Literature 29-7-2014 • Kallmünzer B et al., Neurology. 2014 Jul 23
The majority of stroke patients or their relatives can be trained in self-measurement of peripheral pulse, which can be an effective screening tool if combined with subsequent ECG.

Higher risk of CHD and diabetes associated with wide range of chronic inflammatory disorders

Literature 1-7-2014 • Dregan A et al., Circulation. 2014
Population-based study shows that diverse chronic inflammatory disorders were associated with an increased risk of at least two of the CHD, stroke and diabetes outcomes, possibly in a dose-responsive fashion.

Rivaroxaban also effective at reducing stroke in AF patients over 75 years

Literature 16-6-2014 • Halperin JL et al., Circulation 2014
Factor Xa inhibition is as effective as adjusted-dose warfarin to anticoagulate patients of over 75 years old with nonvalvular AF, tor the prevention of stroke and systemic embolism.

Hospitalisation for atrial fibrillation increased in the USA between 2000 and 2010

Literature 26-5-2014 • Patel NJ et al., Circulation. 2014
While admissions for AF increased over time, as well as associated health care costs, AF-associated mortality decreased, except in patients with heart failure.

Time in therapeutic range does not affect treatment benefits of rivaroxaban vs. warfarin

Literature 28-4-2014 • Piccini JP, J Am Heart Assoc. 2014
A wide range of centre TTRs were seen in ROCKET-AF, but the relative efficacy of rivaroxaban over warfarin did not vary with cTTR, for stroke prevention in atrial fibrillation.

Higher bleeding risk even with brief use of NSAID or aspirin, when on anticoagulation

Literature 23-4-2014 • Davidson BL et al., JAMA Intern Med. 2014
A clinically important increase in bleedings was observed in patients treated for VTE, who are simultaneously using anticoagulation and NSAIDs or aspirin.

In patients with acute VTE, NOACs are equally effective, but with a more favourable bleeding profile than VKA

Literature 9-3-2014 • Van der Hulle T et al. J Thromb Haemost. 2013
Meta-analysis shows that NOACs are as effective in the prevention of recurrent VTE, and give a lower risk of most types of bleedings, in patients with acute VTE.

Also brief episodes of atrial fibrillation associated with increased risk of ischaemic stroke

Literature 19-2-2014 • Boriani G et al.Eur Heart J 2014
Measuring burden of atrial fibrillation with implanted device may be clinically relevant, and specific thresholds of daily AF burden may identify a substantial increase in the risk of ischaemic stroke.

Statin treatment often not intensive enough after acute myocardial infarction

Literature 12-2-2014 • Arnold SV et al. Circulation. 2014
Statin initiation after AMI in statin-naïve patients is uniformly prevalent across hospitals, while rates of statin intensification were low and variable among different sites.

No increased risk of drug-induced liver injury with NOACs

Literature 5-2-2014 • Caldeira D et al. Heart. 2014
Meta-analysis of large NOAC RCTs shows that NOACs are not associated with elevations of transaminases over 3x ULN and bilirubin >2x ULN.

Antiplatelet therapy is still too often, inappropriately given in atrial fibrillation

Literature 29-1-2014 • Lip GYH et al. The American Journal of Medicine 2014
Improved use of oral anticoagulation in atrial fibrillation since last EuroHeart Survey, although antiplatelet therapy is still too often prescribed, specifically in the elderly.

Starting warfarin treatment gives a higher ischaemic stroke risk in the first 30 days

Literature 8-1-2014 • Azoulay et al. Eur Heart J. 2013
AF patients who start warfarin initially have a nearly two-fold increased risk of ischaemic stroke, but after 30 days this risk is lower than in patients not on antithrombotics.

European label of dabigatran use gives better efficacy and safety

Literature 18-12-2013 • Lip et al. Thromb Haemost. 2013
The preferred dose of dabigatran is 150 mg bid, but in contrast with the FDA, the EU label recommends 110 mg bid for patients with high risk of bleeding, which proves to be a relevant alternative.

Efficacy of dabigatran vs. warfarin in stroke prevention maintained with renal dysfunction

Literature 16-12-2013 • Hijazi et al., Circulation. Dec 2013
Generally, renal function did not affect the relative safety of dabigatran over warfarin, although estimation of eGFR with CKD-EPI showed a larger reduction of major bleeding risk when eGFR > 80 ml/min.

Favourable risk/benefit ratio of NOACs over warfarin in meta-analysis of large trials

Literature 9-12-2013 • Ruff et al., The Lancet 2013
Combined data from RE-LY, ROCKET-AF, ARISTOTLE and ENGAGE AF-TIMI 48 showed that NOACs safely reduce stroke and systemic embolism in comparison with warfarin, in atrial fibrillation.

HAS-BLED score better predicts major bleeding in anticoagulated AF patients

Literature 3-10-2013 • Roldán V, Marín F, Manzano-Fernández S et al.
The HAS-BLED score better predicts major bleeding than stroke stratification scores CHADS2 and CHA2DS2-VASc, in atrial fibrillation patients on anticoagulants.

Antithrombotic therapy only modestly reduces mortality in AF, thus management of CV comorbidities may be more effective

Literature 25-9-2013 • Marijon E, Le Heuzey JY, Connolly S, et al.
RE-LY: Dabigatran reduced vascular, but not other causes of mortality as opposed to warfarin. However important, anti- thrombotic treatment only modestly reduces mortality.

Novel use for new anticoagulant dabigatran

Literature 22-2-2013 • Schulman S, Kearon O, Kakkar AK, et al
New information about the risks and benefits of extended prophylaxis with dabigatran in patients who have had venous thromboembolism (VTE)

Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing PCI

Literature 22-2-2013 • Dewilde WJ et al. for the WOEST study investigators
Omitting aspirin from antiplatelet regimen reduces the incidence of bleeding, without compromising safety in patients receiving oral anticoagulants undergoing PCI

Upcoming meetings

EPCCS Council Meeting December 6-7, 2017, Stratford Upon Avon, United Kingdom
10th EPCCS Annual CV Summit for Primary care March 15-16, 2018, Malaga, Spain
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Meeting reports & resources

EPCCS 2017 Report of the Cardiovascular Summit held in Dublin, Ireland
EPCCS Guidance Documents Evidence- and meeting-based guidance for primary care
EPCCS 2015 Report of 8th Annual EPCCS meeting held in Prague.
EPCCS 2014 Report of 7th Annual EPCCS meeting held in Brussels.
All meeting reports...