Introduction:Noninvasive prenatal testing (NIPT) using cell-free fetal DNA has increasingly been adopted as a screening tool for fetal aneuploidies. Several studies have discussed benefits and limitations of NIPT compared with both ultrasound and invasive procedures, but in spite of some shortcomings NIPT has become extensively used within the last 5 years. This study aims to describe the current use of NIPT in Europe, Australia and the USA. Material and methods:We conducted a survey to describe the current use of NIPT.Colleagues filled in a simple email-based questionnaire on NIPT in their own country, providing information on (a) access to NIPT, (b) NIPT's chromosomal coverage, (c) financial coverage of NIPT for the patient and (d) the proportion of women using NIPT in pregnancy. Some data are best clinical estimates, due to a lack of national data. Results:In Europe, 14 countries have adopted NIPT into a national policy/program. Two countries (Belgium and the Netherlands) offer NIPT for all pregnant women, whereas most other European countries have implemented NIPT as an offer for higher risk women after first trimester screening. In Australia, either combined first trimester screening (cFTS) or NIPT is used as a primary prenatal screening test. In the USA, there are no national consensus policies on the use of NIPT; however, NIPT is widely implemented. In most European countries offering NIPT, the proportion of | 723 GADSBØLL et AL.

Since 2010, more incident AF patients in Denmark were initiated on OAC therapy with predominant NOAC prescription. The increase was pronounced among females, among patients at high risk of stroke, and among older patients.

Among atrial fibrillation (AF) patients, Danish nationwide registries (2011–2015) were used to examine temporal trends of initiation patterns of oral anticoagulation (OAC) treatment according to age. Overall, 43,299 AF patients initiating vitamin K antagonists (VKA) (42%), dabigatran (29%), rivaroxaban (13%), or apixaban (16%) were included with mean age (SD) 72.1 (11.3), 71.5 (11.0), 74.3 (11.1), and 75.3 (11.1) years, respectively. Patients aged ≥85 years comprised 15%. Trend tests showed increase in patients ≥85 years initiating OAC (p < 0.0001). VKA usage decreased from 92% to 24% (p < 0.0001). This decrease was independent of age. Dabigatran was the most common non-VKA OAC (NOAC) (40% users), but usage decreased from 2014 until study end (6%) (p < 0.0001). Apixaban was the most used OAC at study end (41%), in particular among those ≥85 years (44%). Compared with patients aged <65 years, the odds ratios associated with initiating VKA, dabigatran, rivaroxaban, or apixaban for patients aged ≥85 years were 0.81 (95% CI 0.75–0.86), 0.65 (95% CI 0.60–0.70), 1.52 (95% CI 1.38–1.67), and 2.09 (95% CI 1.89–2.30), respectively. In conclusion, substantial increase in NOAC usage has occurred. Increasing age was associated with upstart of rivaroxaban or apixaban with reference to age <65 within the specific agent.

In a contemporary setting among VKA-experienced NVAF patients; VKA is still prevalent although about 30% by December 2015 had shifted to a NOAC.

Key Points Question Is oral anticoagulation therapy used and effective for secondary stroke prophylaxis in patients with atrial fibrillation? Findings In this cohort study of 30 626 intermediate- to high-risk patients with atrial fibrillation having an ischemic stroke, 36.3% received oral anticoagulation therapy before their stroke, and 52.5% received oral anticoagulation therapy after their stroke. Oral anticoagulation therapy was associated with a statistically significant reduction in thromboembolic risk. Meaning There exists a major potential for optimization of both primary and secondary stroke prophylaxis in patients with atrial fibrillation.

Atrial fibrillation patients who were initiated on apixaban had higher stroke risk scores than patients initiated on VKAs. Interestingly, opposite results were found for dabigatran.

AF patients resuming VKA and NOAC treatment following traumatic injury have lower hazard of all-cause mortality and ischaemic stroke, increased hazard of major bleeding but without additional hazards of recurrent traumatic injury. Withholding OAC following a traumatic injury in AF patients may not be warranted.

What are the novel findings of this work?Even small errors in the first-trimester measurement of crown-rump length (CRL) significantly affect secondand third-trimester estimated fetal weight (EFW). A measurement error of −2 mm in first-trimester CRL shifts an EFW on the 10 th percentile at the 20-week scan to around the 20 th percentile. A measurement error of + 2 mm shifts an EFW on the 10 th percentile to around the 5 th percentile. What are the clinical implications of this work?Published data suggest that CRL measurement errors of 2 mm or more are common in clinical practice. Misclassification as small-, appropriate-or large-for-gestational age will commonly occur and affect clinical assessment, patient management and research results. Thus, there is a need to increase awareness of the importance of correct CRL measurement and to reduce measurement error variation through standardization and quality control.