Antithrombotic Therapy in Atrial Fibrillation

Singer, Daniel E.; Albers, Gregory W.; Dalen, James E.; Go, Alan S.; Halperin, Jonathan L.; Manning, Warren J.

doi:10.1378/chest.126.3_suppl.429s

Cited by 498 publications

(87 citation statements)

References 184 publications

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“…Specifically, useful predictors may help identify the best candidates for preventive therapies, and/or identify patients who will benefit the most from more‐careful monitoring (such as with continuous or implantable monitors) to determine appropriate candidacy for stroke prevention using anticoagulation 2, 25. If a causal relationship between either PACs and AF or PVCs and HF does indeed exist, ultimately these findings may also help inform trials investigating prophylactic interventions, such as catheter ablation, to prevent AF and/or HF or pharmacological therapy, such as with beta‐blockers, to prevent systolic dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Ectopy on a Single 12‐Lead ECG, Incident Cardiac Myopathy, and Death in the Community

Nguyen

Vittinghoff

Dewland

et al. 2017

JAHA

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BackgroundAtrial fibrillation and heart failure are 2 of the most common diseases, yet ready means to identify individuals at risk are lacking. The 12‐lead ECG is one of the most accessible tests in medicine. Our objective was to determine whether a premature atrial contraction observed on a standard 12‐lead ECG would predict atrial fibrillation and mortality and whether a premature ventricular contraction would predict heart failure and mortality.Methods and ResultsWe utilized the CHS (Cardiovascular Health) Study, which followed 5577 participants for a median of 12 years, as the primary cohort. The ARIC (Atherosclerosis Risk in Communities Study), the replication cohort, captured data from 15 792 participants over a median of 22 years. In the CHS, multivariable analyses revealed that a baseline 12‐lead ECG premature atrial contraction predicted a 60% increased risk of atrial fibrillation (hazard ratio, 1.6; 95% CI, 1.3–2.0; P<0.001) and a premature ventricular contraction predicted a 30% increased risk of heart failure (hazard ratio, 1.3; 95% CI, 1.0–1.6; P=0.021). In the negative control analyses, neither predicted incident myocardial infarction. A premature atrial contraction was associated with a 30% increased risk of death (hazard ratio, 1.3; 95% CI, 1.1–1.5; P=0.008) and a premature ventricular contraction was associated with a 20% increased risk of death (hazard ratio, 1.2; 95% CI, 1.0–1.3; P=0.044). Similarly statistically significant results for each analysis were also observed in ARIC.ConclusionsBased on a single standard ECG, a premature atrial contraction predicted incident atrial fibrillation and death and a premature ventricular contraction predicted incident heart failure and death, suggesting that this commonly used test may predict future disease.

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Section: Discussionmentioning

confidence: 99%

Ectopy on a Single 12‐Lead ECG, Incident Cardiac Myopathy, and Death in the Community

Nguyen

Vittinghoff

Dewland

et al. 2017

JAHA

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“…Metaná-lise realizada por Linkins et al 27 , reunindo 10.757 pacientes (4.374 pacientes/ano) tratados com AVK por TEV, em ensaios randomizados ou coortes prospectivos, mostrou uma incidência de 1,15 casos por 100 pacientes/ano de hemorragia intracraniana. Essa incidência parece ser maior ainda em pacientes com fibrilação atrial, infarto do miocárdio, válvulas prostéticas cardíacas e acidente vascular encefálico, onde tem variado de 0,2 a 2,9% [39][40][41][42] .…”

Section: Discussionunclassified

Complicações da terapia anticoagulante com warfarina em pacientes com doença vascular periférica: estudo coorte prospectivo

et al. 2006

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194 ResumoObjetivo: Estudar prospectivamente a freqüência de complicações em pacientes tratados com warfarina e acompanhados no Ambulatório de Anticoagulação da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista.Métodos: Pacientes sorteados entre os agendados para consulta de junho de 2002 a fevereiro de 2004. Na primeira consulta, foi preenchida ficha com dados de identificação e clínicos. A cada retorno, ou quando o paciente procurou o hospital por intercorrência, foi preenchida ficha com a razão normatizada internacional, existência e tipo de intercorrência e condições de uso dos antagonistas da vitamina K.Resultados: Foram acompanhados 136 pacientes (61 homens e 75 mulheres), 99 com tromboembolismo venoso e 37 com doença arterial; 59 pacientes eram de Botucatu, e 77, de outros municípios. Foram registradas 30 intercorrências: nove não relacionadas ao uso da warfarina e 21 complicações hemorrágicas (38,8 por 100 pacientes/ ano). Uma hematêmese foi considerada grave (1,9 por 100 pacientes/ ano). As demais foram consideradas moderadas ou leves. Não houve óbitos, hemorragia intracraniana ou necrose cutânea. A única associação significante foi da freqüência de hemorragia com nível médio de razão normatizada internacional.Conclusão: Nossos resultados mostram a viabilidade desse tratamento em pacientes vasculares em nosso meio, mesmo em população de baixo nível socioeconômico, quando tratados em ambulatório especializado.Palavras-chave: Anticoagulantes, warfarina, efeitos adversos, doenças vasculares, trombose venosa, embolia pulmonar. AbstractObjective: To prospectively study the frequency of complications in patients treated with warfarin followed at Botucatu Medical School.Methods: Patients randomly selected among those with appointments scheduled from June 2002 to February 2004. At the first appointment, a protocol was filled with identification and clinical data. At every return or when the patient went to the hospital due to clinical events, another form was filled with the international normalized ratio, existence and type of clinical event and the conditions of use of vitamin K antagonists.Results: A total of 136 patients (61 men and 75 women), were followed; 99 patients with venous thromboembolism and 37 with arterial disease; 59 were from Botucatu and 77 were from other municipalities. Thirty clinical events were registered: nine of them were not related to the use of warfarin and 21 were hemorrhagic complications (38.8 per 100 patients-year). One hematemesis was considered severe (1.9 per 100 patients-year). The others were considered moderate or mild. There were no deaths, intracranial hemorrhage or cutaneous necrosis. The only significant association was frequency of hemorrhage and average international normalized ratio level.Conclusion: Our results demonstrate the feasibility of this treatment in vascular patients in our country, even in socially and economically poor populations, when treated in specialized clinics.

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“…The CHADS 2 score ranges from 0 to 6 and is calculated by adding 1 point for each of the following risk factors: recent congestive heart failure, hypertension, age N 75 years, or diabetes mellitus, and adding 2 points for having had a previous stroke or TIA. For the sake of simplicity the scale was collapsed into high (4,5,6), medium (2,3), and low risk of stroke (1).…”

Section: Outcome Measuresmentioning

confidence: 99%

“…The narrow therapeutic window of warfarin and the difficulties related to its management raise concerns on a widespread prescription of this drug [2]. Several international and national scientific societies [3,4] have produced guidelines to help physicians to stratify the risk of stroke according to the presence of different risk factors. In particular, a score has been recently proposed and validated to obtain an easy and practical stratification (CHADS 2 ) [5].…”

Section: Introductionmentioning

confidence: 99%

Risk of bleeding in very old atrial fibrillation patients on warfarin: Relationship with ageing and CHADS2 score

Poli

Antonucci

Marcucci

et al. 2007

Thrombosis Research

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Aims: In atrial fibrillation (AF) patients, age z75 years is one of the major risk factors for stroke. However, it is not clear if an upper limit for the indication to OAT exists. Methods and results: For this reason, we performed a prospective study on 290 AF patients on OAT aged z75 years (median age 82 years, total follow-up period 814 pt/ years) followed by our Anticoagulation Clinic. Seventeen major bleeding events were recorded (rate 2.1 × 100 pt/years), 11 of which cerebral (1.35 × 100 pt/years). The occurrence of major bleedings was associated with history of previous TIA or stroke [OR 3.4 (1.1-12.5), p = 0.01] and with diabetes .7) p = 0.01]. We found a trend to a progressive increase in the rate of bleeding risk with the increase of the CHADS 2 score: patients with score 4-6 showed a rate of 3.4 × 100 pt/years with respect to 1.5 × 100 pt/years of patients with lower score. Number Needed to Harm (NNH) was calculated in relation to different classes of age (75-89, 80-84, z85 years) and to CHADS 2 score. For patients in CHADS 2 score 1-3 NNH remained stable across the different age classes. Instead for patients in CHADS 2 score 4-6, NNH varied among the 3 groups of ages, reaching a value of 10 in patients ≥ 85 years. Conclusion: Our data suggest that: 1) in AF patients older than 75 years with CHADS 2 score 1-3 the risk of bleeding is low, 2) in AF patients N85 years with CHADS 2 4-6 the risk of bleeding is high so that the use of OAT should be highly individualised.

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Antithrombotic Therapy in Atrial Fibrillation

Cited by 498 publications

References 184 publications

Ectopy on a Single 12‐Lead ECG, Incident Cardiac Myopathy, and Death in the Community

Ectopy on a Single 12‐Lead ECG, Incident Cardiac Myopathy, and Death in the Community

Complicações da terapia anticoagulante com warfarina em pacientes com doença vascular periférica: estudo coorte prospectivo

Risk of bleeding in very old atrial fibrillation patients on warfarin: Relationship with ageing and CHADS2 score

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