Corrigendum to: 2021 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation

Steffel, Jan; Collins, Rónán; Antz, Matthias; Cornu, Pieter; Desteghe, Lien; Hæusler, Karl Georg; Oldgren, Jonas; Reinecke, Holger; Roldán, Vanessa; Rowell, Nigel; Sinnaeve, Peter; Vanassche, Thomas; Potpara, Tatjana; Camm, A John; Heidbüchel, Hein

doi:10.1093/europace/euab157

Cited by 209 publications

(436 citation statements)

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“…The 2018 ACCP guidelines recommend label-adjusted NOAC dosing, which reflects the dose-reduction criteria of the pivotal RCTs [27]. This consensus on the use of NOACs is also followed by the 2021 EHRA practical guidelines [28]. However, in Japan, the standard rivaroxaban dose is 15 mg once daily, and 10 mg rivaroxaban once daily is prescribed for patients with renal impairment based on the pharmacokinetic data available for elderly Japanese patients with AF.…”

Section: Discussionmentioning

confidence: 99%

Impact of Reduced-Dose Nonvitamin K Antagonist Oral Anticoagulants on Outcomes Compared to Warfarin in Korean Patients with Atrial Fibrillation: A Nationwide Population-Based Study

Han

Kim

Lee

et al. 2021

JCM

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Reduced-dose nonvitamin K antagonist oral anticoagulants (NOACs) are commonly prescribed to Asian patients with nonvalvular atrial fibrillation (NVAF). We aimed to compare the risk of stroke/systemic embolism (S/SE) and major bleeding (MB) between patients treated with reduced-dose NOACs and those treated with warfarin, using the claims database in Korea. Patients with NVAF newly initiated on oral anticoagulants (OACs; apixaban, dabigatran, rivaroxaban, and warfarin) between 1 July 2015 and 30 November 2016 were included. Among all patients with NVAF treated with OACs, 5249, 6033, 7602, and 8648 patients were treated with reduced-dose apixaban, dabigatran, rivaroxaban, and warfarin, respectively. Patients treated with reduced-dose NOACs were older and had higher CHA2DS2-VASc and HAS-BLED scores than those treated with warfarin. Compared to warfarin, all reduced-dose NOACs showed significantly lower risk of S/SE (hazard ratios (95% confidence interval), 0.63 (0.52–0.75) for apixaban; 0.51 (0.42–0.61) for dabigatran; and 0.67 (0.57–0.79) for rivaroxaban) and MB (0.54 (0.45–0.65) for apixaban; 0.58 (0.49–0.69) for dabigatran; 0.73 (0.63–0.85) for rivaroxaban). In the real-world practice among Asians with NVAF, all reduced-dose NOACs were associated with a significantly lower risk of S/SE and MB compared to those of warfarin.

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Section: Discussionmentioning

confidence: 99%

Impact of Reduced-Dose Nonvitamin K Antagonist Oral Anticoagulants on Outcomes Compared to Warfarin in Korean Patients with Atrial Fibrillation: A Nationwide Population-Based Study

Han

Kim

Lee

et al. 2021

JCM

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“…The time of (re-)initiation of anticoagulation is predicated on the extent of the infarct and whether there is associated secondary hemorrhagic transformation of the infarct [125,126]. Current recommendations are based on consensus opinion [41,127], observational studies [128][129][130], and cohort studies [131].…”

Section: Anticoagulant Therapymentioning

confidence: 99%

“…However, a European Stroke Organization expert consensus reports that recommendations for the optimal timing for anticoagulation initiation in patients with AIS could not be made [133]. Moreover, the 2021 European Heart Rhythm Association practical guide provides timeframes of when to (re-)initiate anticoagulation based on expert opinions, such that after a transient ischemic attack, anticoagulation may be continued or started the next day after excluding ICH on imaging [126,127,134]. In patients with mild stroke, anticoagulation may be (re-)initiated ≥ 3 days after AIS, while in moderate and severe strokes, anticoagulation may be (re-)initiated ≥ 6-8 days and ≥12-14 days after AIS, respectively, once excluding secondary hemorrhagic transformation on repeat imaging [127,134].…”

Section: Anticoagulant Therapymentioning

confidence: 99%

Overview of Acute Ischemic Stroke Evaluation and Management

Hasan

Hasan²,

Kelley

2021

Biomedicines

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Stroke is a major contributor to death and disability worldwide. Prior to modern therapy, post-stroke mortality was approximately 10% in the acute period, with nearly one-half of the patients developing moderate-to-severe disability. The most fundamental aspect of acute stroke management is “time is brain”. In acute ischemic stroke, the primary therapeutic goal of reperfusion therapy, including intravenous recombinant tissue plasminogen activator (IV TPA) and/or endovascular thrombectomy, is the rapid restoration of cerebral blood flow to the salvageable ischemic brain tissue at risk for cerebral infarction. Several landmark endovascular thrombectomy trials were found to be of benefit in select patients with acute stroke caused by occlusion of the proximal anterior circulation, which has led to a paradigm shift in the management of acute ischemic strokes. In this modern era of acute stroke care, more patients will survive with varying degrees of disability post-stroke. A comprehensive stroke rehabilitation program is critical to optimize post-stroke outcomes. Understanding the natural history of stroke recovery, and adapting a multidisciplinary approach, will lead to improved chances for successful rehabilitation. In this article, we provide an overview on the evaluation and the current advances in the management of acute ischemic stroke, starting in the prehospital setting and in the emergency department, followed by post-acute stroke hospital management and rehabilitation.

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“…DOACs have become increasingly preferred over warfarin, given their fewer food-drug or drug-drug interactions, rapid onset and offset, and lack of the need for frequent monitoring ( 7 , 8 ). In AF patients without risk factors for major bleeding, DOACs are at least as effective as warfarin in preventing stroke and safer than warfarin in reducing major bleeding ( 8 – 10 ). However, patients with a recent history of active PU or gastrointestinal bleeding were mostly excluded from major DOAC trials for stroke prevention in AF ( 11 – 14 ).…”

Section: Introductionmentioning

confidence: 99%

“…However, patients with a recent history of active PU or gastrointestinal bleeding were mostly excluded from major DOAC trials for stroke prevention in AF ( 11 – 14 ). Furthermore, there is no specific recommendation on the use of anticoagulants in AF patients with a history of active PU or gastrointestinal bleeding in current guidelines ( 8 , 15 ). Therefore, this study aimed to compare the safety and effectiveness of DOAC vs. warfarin for stroke prevention in patients with AF and endoscopic findings of active, inactive, and no PU.…”

Section: Introductionmentioning

confidence: 99%

Safety and Effectiveness of Direct Oral Anticoagulants vs. Warfarin in Patients With Atrial Fibrillation and Endoscopy-Diagnosed Peptic Ulcer

Wang

Huang

et al. 2021

Front. Cardiovasc. Med.

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Background: Patients with active peptic ulcer (PU) were excluded from direct oral anticoagulant (DOAC) trials for stroke prevention in patients with atrial fibrillation (AF). This study evaluated the safety and effectiveness of DOACs in AF patients with active, inactive and no peptic ulcer (PU).Methods: This study accessed electronic medical records from January 1, 2009 to May 31, 2019 at a multi-center healthcare provider in Taiwan and involved 2,955 AF patients who had undergone esophagogastroduodenoscopy ≤ 1 year before anticoagulation. Subjects were classified into 3 groups: active (n = 237), inactive (n = 828) and no-PU (n = 1,890) groups. We compared the risks of major bleeding, gastrointestinal bleeding, and ischemic stroke/systemic embolism (IS/SE) between DOACs and warfarin among the 3 groups.Results: In the active PU group, there were no significant differences in the risks of major bleeding [hazard ratio (HR) = 0.65, 95% confidence interval (CI) 0.08–4.98, p = 0.676], gastrointestinal bleeding (HR = 0.65, 95% CI 0.08–4.98, p = 0.676) and IS/SE (HR = 2.58; 95% CI 0.53–12.70, p = 0.243) between DOAC and warfarin (as the reference). In the inactive PU group, there were no significant differences in the risks of major bleeding (HR = 0.36, 95% CI 0.09–1.39, p = 0.138), gastrointestinal bleeding (HR = 0.21, 95% CI 0.02–1.80, p = 0.153), and IS/SE (HR = 1.04, 95% CI 0.39–2.82, p = 0.934) between DOAC and warfarin (as the reference). In the no-PU group, DOACs were associated with lower risk of major bleeding (HR = 0.26, 95% CI 0.12–0.53, p < 0.001), gastrointestinal bleeding (HR = 0.25, 95% CI 0.01–0.59, p = 0.002), and similar risk of IS/SE (HR = 0.92, 95% CI 0.55–1.54, p = 0.757) compared to warfarin.Conclusions: DOACs were as effective as warfarin in preventing IS/SE irrespective of PU status and safer than warfarin in reducing major bleeding in the no-PU group. In patients with active or inactive PUs, DOAC and warfarin were not significantly different in their effects on major bleeding or gastrointestinal bleeding.

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Corrigendum to: 2021 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation

Cited by 209 publications

References 0 publications

Impact of Reduced-Dose Nonvitamin K Antagonist Oral Anticoagulants on Outcomes Compared to Warfarin in Korean Patients with Atrial Fibrillation: A Nationwide Population-Based Study

Impact of Reduced-Dose Nonvitamin K Antagonist Oral Anticoagulants on Outcomes Compared to Warfarin in Korean Patients with Atrial Fibrillation: A Nationwide Population-Based Study

Overview of Acute Ischemic Stroke Evaluation and Management

Safety and Effectiveness of Direct Oral Anticoagulants vs. Warfarin in Patients With Atrial Fibrillation and Endoscopy-Diagnosed Peptic Ulcer

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