Meta-analysis of Stroke and Bleeding Risk in Patients with Various Atrial Fibrillation Patterns Receiving Oral Anticoagulants

Zhang, Weifang; Xiong, You-Wen; Yu, Lingling; Xiong, Aizhen; Bao, Huihui; Cheng, Xiaoshu

doi:10.1016/j.amjcard.2018.11.055

Cited by 15 publications

(11 citation statements)

References 31 publications

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“…Abbreviations: see large randomized controlled trials on non -vitamin K antagonist oral anticoagulation demonstrated that patients with paroxysmal AF were more likely to be women compared with patients with persistent or permanent AF. 12 Surprisingly, we found that male sex was associated with increased risk of permanent AF development. Studies on non pacemaker populations have not identified sex-related differences with regard to permanent AF.…”

Section: Figure 3 Association Of Baseline Factors With Permanent Atrimentioning

confidence: 70%

“…11 An observation that patients with persistent or permanent AF have significantly higher risk of all -cause mortality compared with those with paroxysmal AF was validated in the recent meta -analysis involving 6 large -scale randomized controlled trials on oral anticoagulation therapy and a total of 70 447 patients with AF. 12 Study limitations Our observations should be interpreted in the context of limitations imposed by a retrospective study design. We did not take into account patients' comorbidities, medications, baseline echocardiographic parameters at index procedure and we did not track subsequent conducted cardioversions, AF ablations, and changes during follow -up in incident comorbidities, medicine prescribing, echocardiographic parameters, and device reprogramming, all of which might have influenced the permanent AF occurrence.…”

Section: Risk Factors For Permanent Atrial Fibrillationmentioning

confidence: 98%

“…10 On the other hand, a recent real -world community -based cohort study and a meta -analysis involving 6 large -scale randomized controlled trials on oral anticoagulation therapy demonstrated that patients with persistent or permanent AF compared with paroxysmal AF had significantly higher risk of all -cause mortality. 11,12 In addition, the associations between development of permanent AF and baseline variables such as pacing indication, sex, and position of the right ventricular (RV) lead remain unclear. Previous reports suggested that the natural history of AF was affected by the cumulative percentage of atrial and ventricular pacing, therefore, outcomes in general populations may not be applicable to DDD paced cohorts.…”

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confidence: 99%

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Permanent atrial fibrillation in patients with a dual‑chamber pacemaker

Dębski¹,

Ulman²,

Ząbek³

et al. 2019

Kardiol Pol

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BACKGROUND Atrial fibrillation (AF) is thought to be a progressive arrhythmia. The impact of sex and position of right ventricular lead is not well recognized. Whilst nonparoxysmal AF compared with paroxysmal AF has been associated with increased mortality in the general population, its prognostic significance in patients with a dual -chamber (DDD) pacemaker is less clear. AIMS The aim of the study was to determine the incidence of permanent AF in patients with a DDD pacemaker, analyze the effect of selected baseline characteristics on permanent AF development, and examine the impact of permanent AF on patient survival. METHODS A retrospective cohort study included 3932 consecutive patients who underwent DDD pacing system implantation between 1984 and 2014. Follow -up was completed in August 2016. We included 3771 patients (96%) with post -operative follow -up and known vital status. Occurrence of permanent AF and all -cause mortality were the study endpoints. RESULTS During mean follow -up of 6.5 years, permanent AF occurred in 717 patients (19%). Sex (hazard ratio [HR], 1.316; 95% CI, 1.134-1.528, for men), age at implant (HR, 1.041; 95% CI, 1.033-1.049, 1-year increase), history of AF (HR, 3.521; 95% CI, 3.002-4.128) were independently associated with permanent AF development, whereas position of right ventricular lead (apical versus nonapical) and primary pacing indication (atrioventricular block versus sick sinus syndrome) were not related to permanent AF. Permanent AF was a significant risk factor for increased mortality (age-and sex -adjusted HR, 1.475; 95% CI, 1.294-1.682). CONCLUSIONS Permanent AF occurrence was independently predicted by advanced age at implant, male sex, and preexisting AF and associated with worse survival.

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Section: Figure 3 Association Of Baseline Factors With Permanent Atrimentioning

confidence: 70%

Section: Risk Factors For Permanent Atrial Fibrillationmentioning

confidence: 98%

mentioning

confidence: 99%

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Permanent atrial fibrillation in patients with a dual‑chamber pacemaker

Dębski¹,

Ulman²,

Ząbek³

et al. 2019

Kardiol Pol

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“…The AHA/ACC/HRS guideline for the management of AF recommended that for patients with paroxysmal AF, the need for anticoagulant therapy should be determined based on the risk of stroke, same with persistent AF 1. However, studies have shown that the risk of stroke in patients with paroxysmal AF is lower than that those with persistent/permanent AF 31 32. The benefit of anticoagulation in new-onset AF, occurring in the setting of an acute attack with ACS, acute pulmonary disease or sepsis, is associated with a higher risk of bleeding, but not with a reduced risk of ischaemic stroke 33.…”

Section: Discussionmentioning

confidence: 99%

A retrospective cohort study of oral anticoagulant treatment in patients with acute coronary syndrome and atrial fibrillation

Mai

Luo

et al. 2019

BMJ Open

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ObjectiveTo examine the real-world patterns of oral anticoagulant (OAC) therapy in patients with acute coronary syndrome (ACS) and atrial fibrillation (AF) in Southern China undergoing percutaneous coronary intervention (PCI) and determine the clinical characteristics associated with OAC prescription.DesignA retrospective cohort study.SettingThis study was conducted in the Shunde Hospital, Southern Medical University and the second hospital of Zhaoqing, China, from January 2013 to 31 December 2018.ParticipantsPatients were aged ≥18 years, hospitalised for ACS and received PCI treatment.Outcome measuresAF was diagnosed based on an ECG recording or a Holter monitor. Prescription of OACs and antiplatelets were determined from the discharge medication list.ResultsA total of 3612 patients with ACS were included: 286 (7.9%) were diagnosed with AF, including 45 (1.2%) with paroxysmal AF, 227 (6.3%) with persistent/permanent AF and 14 (0.4%) with unclassified AF. Although 95.5% of patients with AF were at high risk (CHA2DS2-VASc score ≥2) of stroke, only 21.7% of them were discharged on OACs (10.5% received warfarin and 11.2% received non-vitamin K antagonist OACs). Patients with pre-admission use of OAC, a HAS-BLED score <3, with persistent/permanent AF were more likely to receive OAC treatment at discharge.ConclusionWe found that approximately 8% of patients who underwent PCI during ACS hospitalisation also demonstrated AF. Anticoagulant therapy was greatly underused. Patients with paroxysmal AF and an increased risk of bleeding were less likely to receive anticoagulant treatment. Further efforts should be made to increase the adherence to guideline recommendations for OACs.

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“…Additionally, NOACs provide a significant relative reduction in intracranial hemorrhage (ICH) by 52% with similar major bleeding compared to warfarin [14]. Similar to VKAs, the efficacy of NOACs is consistent across types of AF (paroxysmal, persistent, and permanent) [15].…”

Section: Introductionmentioning

confidence: 99%

Many Good Reasons to Switch from Vitamin K Antagonists to Non-Vitamin K Antagonists in Patients with Non-Valvular Atrial Fibrillation

Botto¹,

Ameri

Caterina

2021

JCM

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Non-vitamin K oral anticoagulants (NOACs) are the first choice for prophylaxis of cardioembolism in patients with non-valvular atrial fibrillation (AF) who are anticoagulant-naïve, as well as the preferable anticoagulation strategy in those who are on vitamin K antagonists (VKAs), but with a low time in therapeutic range (TTR). Nonetheless, there are many good reasons to consider switching from VKAs to NOACs also when TTR is >70%. From the pharmacological standpoint, anticoagulation with VKAs may remain erratic even in those patients who have high TTR values, owing to the mode of action of this drug class. Furthermore, experimental data suggest that, unlike VKAs, NOACs favorably modulate the effects of factor Xa and thrombin in the cardiovascular system through the protease-activated receptor family. Clinically, the most striking advantage provided by NOACs over VKAs, irrespective of the TTR, is the substantially lower risk of intracranial hemorrhage. NOACs have also been associated with less deterioration of renal function as compared with VKAs and may confer protection against cardiovascular events not strictly related to AF, especially the acute complications of peripheral artery disease. In this narrative review, we discuss the evidence according to which it is warranted to systematically substitute NOACs for VKAs for the prevention of AF-related stroke and systemic embolism.

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Meta-analysis of Stroke and Bleeding Risk in Patients with Various Atrial Fibrillation Patterns Receiving Oral Anticoagulants

Cited by 15 publications

References 31 publications

Permanent atrial fibrillation in patients with a dual‑chamber pacemaker

Permanent atrial fibrillation in patients with a dual‑chamber pacemaker

A retrospective cohort study of oral anticoagulant treatment in patients with acute coronary syndrome and atrial fibrillation

Many Good Reasons to Switch from Vitamin K Antagonists to Non-Vitamin K Antagonists in Patients with Non-Valvular Atrial Fibrillation

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