Importance of Risk Reassessment in Patients With Atrial Fibrillation in Guidelines: Assessing Risk as a Dynamic Process

Chang, Ting‐Yung; Lip, Gregory Y.H.; Chen, Shih‐Ann; Chao, Tze‐Fan

doi:10.1016/j.cjca.2019.01.018

Cited by 38 publications

(33 citation statements)

References 31 publications

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“…Importantly, many biomarkers are non-specific, more likely reflecting a patient with significant comorbidities and significant underlying heart disease, and are predictive of various endpoints apart from death, including stroke, heart failure, etc. 306 , 307 Indeed, biomarker-based scores like ABC-death were derived from a highly selected clinical trial cohort which was anticoagulated, and values were determined at study entry (baseline). Many biomarkers also have a diurnal variation and inter/intra laboratory variability and are predictive of non-cardiovascular outcomes.…”

Section: How To Assess Risk For Adverse Outcomes In Patients With Atrmentioning

confidence: 99%

European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population

et al. 2020

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Section: How To Assess Risk For Adverse Outcomes In Patients With Atrmentioning

confidence: 99%

European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population

et al. 2020

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“…Importantly, many biomarkers are non‐specific, more likely reflecting a patient with significant comorbidities and significant underlying heart disease, and are predictive of various endpoints apart from death, including stroke, heart failure, etc 307,308 . Indeed, biomarker‐based scores like ABC‐death were derived from a highly selected clinical trial cohort which was anticoagulated, and values were determined at study entry (baseline).…”

Section: How To Assess Risk For Adverse Outcomes In Patients With Atrmentioning

confidence: 99%

European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population

Nielsen

Lin

Figueiredo

et al. 2020

Journal of Arrhythmia

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“…Accordingly, OACs could be prescribed based on a specified timing, for example, once patients are no longer at low risk, modifiable risk factors for bleeding have been corrected. 49…”

Section: Risk Scores For Bleedingmentioning

confidence: 99%

Combination of Oral Anticoagulants and Single Antiplatelets versus Triple Therapy in Nonvalvular Atrial Fibrillation and Acute Coronary Syndrome: Stroke Prevention among Asians

Santoso

Raharjo

2020

Int J Angiol

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Atrial fibrillation (AF), the most prevalent arrhythmic disease, tends to foster thrombus formation due to hemodynamic disturbances, leading to severe disabling and even fatal thromboembolic diseases. Meanwhile, patients with AF may also present with acute coronary syndrome (ACS) and coronary artery disease (CAD) requiring stenting, which creates a clinical dilemma considering that majority of such patients will likely receive oral anticoagulants (OACs) for stroke prevention and require additional double antiplatelet treatment (DAPT) to reduce recurrent cardiac events and in-stent thrombosis. In such cases, the gentle balance between bleeding risk and atherothromboembolic events needs to be carefully considered. Studies have shown that congestive heart failure, hypertension, age ≥ 75 years (doubled), diabetes mellitus, and previous stroke or transient ischemic attack (TIA; doubled)–vascular disease, age 65 to 74 years, sex category (female; CHA2DS2-VASc) scores outperform other scoring systems in Asian populations and that the hypertension, abnormal renal/liver function (1 point each), stroke, bleeding history or predisposition, labile international normalized ratio (INR), elderly (>65 years), drugs/alcohol concomitantly (1 point each; HAS-BLED) score, a simple clinical score that predicts bleeding risk in patients with AF, particularly among Asians, performs better than other bleeding scores. A high HAS-BLED score should not be used to rule out OAC treatment but should instead prompt clinicians to address correctable risk factors. Therefore, the current review attempted to analyze available data from patients with nonvalvular AF who underwent stenting for ACS or CAD and elaborate on the direct-acting oral anticoagulant (DOAC) and antiplatelet management among such patients. For majority of the patients, “triple therapy” comprising OAC, aspirin, and clopidogrel should be considered for 1 to 6 months following ACS. However, the optimal duration for “triple therapy” would depend on the patient's ischemic and bleeding risks, with DOACs being obviously safer than vitamin-K antagonists.

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Importance of Risk Reassessment in Patients With Atrial Fibrillation in Guidelines: Assessing Risk as a Dynamic Process

Cited by 38 publications

References 31 publications

European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population

European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population

European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population

Combination of Oral Anticoagulants and Single Antiplatelets versus Triple Therapy in Nonvalvular Atrial Fibrillation and Acute Coronary Syndrome: Stroke Prevention among Asians

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