The Indian consensus guidance on stroke prevention in atrial fibrillation: An emphasis on practical use of nonvitamin K oral anticoagulants

Dalal, Jamshed; Bhave, Abhay; Oomman, Abraham; Vora, Amit; Saxena, Anil; Kahali, Dhiman; Poncha, Fali; Gambhir, D S; Chaudhuri, Jaydip Ray; Sinha, Nakul; Ray, Saumitra; Iyengar, S. S.; Banerjee, Suvro; Kaul, Upendra

doi:10.1016/j.ihj.2015.10.380

Cited by 15 publications

(11 citation statements)

References 112 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…NOACs are more expensive in comparison with VKA; however, in the long term, NOACs might prove to be the more cost-effective treatment choice compared with VKA treatment, 23 primarily because of lower monitoring costs and reduced numbers of patients with stroke and SE 22 . Practical guidelines on the management of stroke prevention in AF (SPAF) with NOACs in Asians, including Indians, have been published recently by Dalal et al 24 for the SPAF Academy India experts. Unlike many countries, the GARFIELD-AF registry has not observed any definitive increase in NOACs prescribing in India over time (as shown in Fig.…”

Section: Discussionmentioning

confidence: 99%

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry

Investigators

2018

Indian Heart Journal

View full text Add to dashboard Cite

BackgroundThe Global Anticoagulant Registry in the FIELD–Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry.Methods and resultsA total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012–2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3–2.3) versus 2.3 (IQR 1.8–2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32–9.35) vs 4.34 (4.16–4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up.ConclusionCompared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF.Clinical trial registration—URLhttp://www.clinicaltrials.gov. Unique identifier: NCT01090362.

show abstract

Section: Discussionmentioning

confidence: 99%

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry

Investigators

2018

Indian Heart Journal

View full text Add to dashboard Cite

show abstract

“…2,23,32,35,38,42,43 As doses subsequentes de DOACs devem ser tomadas pelo menos 6h após o procedimento (Nível Ib, Classe I). 23,32,35,38,44 Pergunta 3: Em doentes adultos a fazer TAG e/ou TAC existem medidas pré-operatórias de relevo que modifiquem a incidência de FTE?…”

Section: Resultsunclassified

Normas de orientação clínica dos pacientes hipocoagulados em medicina dentária

Mata¹,

Mendonça²,

Caramês³

et al. 2018

j.rpemd

View full text Add to dashboard Cite

On-line a 12 de december de 2018 O aumento da prevalência de pacientes hipocoagulados recorrendo à consulta de Medicina Dentária pressiona a necessidade de consciencialização dos profissionais de saúde para uma abordagem correcta dos mesmos. Objetiva-se desta forma o desenvolvimento e disseminação de Normas de Orientação Clínica Nacionais, baseadas em evidência, para pacientes hipocoagulados, com indicação para cirurgia na cavidade oral. Foram criteriosamente focadas um número de perguntas visando classificar e avaliar procedimentos de risco em pacientes hipocoagulados no contexto pré, peri e pós-operatório. Efetuou-se uma pesquisa da literatura (Pu-bMed e Cochrane Library) com subsequente avaliação da qualidade da evidência (sistemas Robis e Agree II) por vários avaliadores e finalmente destilaram-se as devidas recomendações clínicas consubstanciadas pelo respetivo nível de evidência e classe de recomendação. (Rev

show abstract

“…This finding should prompt critical reevaluation of certain Asian guidelines which recommend lower INR ranges such as Japanese Circulation Society guidelines, the Asia Pacific Heart Rhythm Society, and Indian Consensus Guidance on Stroke Prevention in Atrial Fibrillation, which recommend INR ranges of 1.6 to 2.6 in elderly AF patients. [110][111][112] Despite many Asian guidelines recommending standard INR ranges, it has been reported that across Asia physicians often opt for lower INR targets as opposed to standard, especially in elderly patients. 5,113,114 In our sensitivity analysis evaluating studies that included patients at least 60 years of age, a lower INR target increased thromboembolism compared with standard INR ranges in East Asians.…”

Section: Discussionmentioning

confidence: 99%

Lower versus Standard INR Targets in Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Pandey

Zhang

et al. 2020

Thromb Haemost

View full text Add to dashboard Cite

Background Western guidelines recommend an international normalized ratio (INR) range of 2 to 3 when using warfarin for stroke prevention in atrial fibrillation (AF), but lower INR ranges are frequently used in East Asia. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) in AF patients comparing the effect of lower versus standard INR targets on thromboembolism, major bleeding, and mortality. Methods We searched Western databases including Cochrane CENTRAL, Medline, and Embase as well as Chinese databases including SinoMed, CNKI, and Wanfang Data. We pooled risk ratios (RRs) using random-effects model. We grouped INR targets in two ways: (1) any study-specific lower versus standard targets and (2) INR ranges of approximately 1.5 to 2 versus 2 to 3. Results Seventy-nine RCTs (n = 12,928) met eligibility criteria: 74 (n = 11,322) from East Asia and 5 (n = 1,606) from Western countries. Compared with standard targets, lower INR ranges were associated with higher rates of thromboembolism (76 RCTs, n = 12,577: 7.1% vs. 4.4%, RR 1.50, 95% confidence interval [CI] 1.29–1.74, I 2 = 0%), lower rates of major bleeding (61 RCTs, n = 10,815: 2.2% vs. 4.4%, RR 0.54, 95% CI 0.44–0.67, I 2 = 0%), and similar mortality (32 RCTs, n = 7,327: 4.8% vs. 5.2%, RR 1.00, 95% CI 0.85–1.19, I 2 = 0%). Results were similar when comparing target ranges of approximately 1.5 to 2 versus 2 to 3. Conclusion Moderate quality evidence suggests lower INR targets reduce bleeding but increase thromboembolism in AF. The data are dominated by East-Asian studies, limiting generalizability to Western populations. Until higher quality data demonstrate otherwise, an INR range of 2 to 3 should remain standard for thromboembolic prophylaxis in AF.

show abstract

The Indian consensus guidance on stroke prevention in atrial fibrillation: An emphasis on practical use of nonvitamin K oral anticoagulants

Cited by 15 publications

References 112 publications

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry

Normas de orientação clínica dos pacientes hipocoagulados em medicina dentária

Lower versus Standard INR Targets in Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Contact Info

Product

Resources

About