Thromboembolic and Bleeding Risk in Atrial Fibrillation Patients with Chronic Kidney Disease: Role of Anticoagulation Therapy

Magnocavallo, Michele; Bellasi, Antonio; Mariani, Marco Valerio; Fusaro, Maria; Ravera, Maura; Paoletti, Ernesto; Iorio, Biagio Di; Barbera, Vincenzo; Rocca, Domenico G. Della; Palumbo, Roberto; Severino, Paolo; Lullo, Luca Di

doi:10.3390/jcm10010083

Cited by 29 publications

(27 citation statements)

References 136 publications

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“…This is contrary to other studies in which obesity paradox was observed, potentially because of differences in the adopted adjustment for risk factors [24,25]. The vital impact of impaired renal function, as an independent variable, on outcomes in AF, as in many other diseases, explains these findings [26][27][28][29][30].…”

Section: Discussioncontrasting

confidence: 64%

Impact of Weight on Clinical Outcomes of Edoxaban Therapy in Atrial Fibrillation Patients Included in the ETNA-AF-Europe Registry

Boriani

Caterina

Manu

et al. 2021

JCM

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Background: Extremes of body weight may alter exposure to non-vitamin K antagonist oral anticoagulants and thereby impact clinical outcomes. This ETNA-AF-Europe sub-analysis assessed 1-year outcomes in routine care patients with atrial fibrillation across a range of body weight groups treated with edoxaban. Methods: ETNA-AF-Europe is a multinational, multicentre, observational study conducted in 825 sites in 10 European countries. Overall, 1310, 5565, 4346 and 1446 enrolled patients were categorised into ≤60 kg, >60–≤80 kg (reference weight group), >80–≤100 kg and >100 kg groups. Results: Patients weighing ≤60 kg were older, more frail and had a higher CHA2DS2-VASc score vs. the other weight groups. The rates of stroke/systemic embolism, major bleeding and ICH were low at 1 year (0.82, 1.05 and 0.24%/year), with no significant differences among weight groups. The annualised event rates of all-cause death were 3.50%/year in the overall population. After adjustment for eGFR and CHA2DS2-VASc score, the risk of all-cause death was significantly higher in extreme weight groups vs. the reference group. Conclusions: Low rates of stroke and bleeding were reported with edoxaban, independent of weight. The risk of all-cause death was higher in extremes of weight vs. the reference group after adjustment for important risk modifiers, thus no obesity paradox was observed.

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Section: Discussioncontrasting

confidence: 64%

Impact of Weight on Clinical Outcomes of Edoxaban Therapy in Atrial Fibrillation Patients Included in the ETNA-AF-Europe Registry

Boriani

Caterina

Manu

et al. 2021

JCM

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“… 55 , 56 Given the remarkable safety profile of DOACs compared with VKAs, emerging evidence supports their use in high‐risk populations such as elderly, renal impairment, peripheral artery disease, and AF in the context of congenital heart disease and cardiomyopathies. 57 , 58 Similarly, several case reports have demonstrated that DOACs could be at least as effective and safe as warfarin in preventing cardioembolic events in NCCM patients. 59 , 60 Skidan et al .…”

Section: Stroke Prevention In Noncompaction Cardiomyopathymentioning

confidence: 99%

“…Well‐known therapeutic advantages of DOACs, including improved safety, reduced risk of bleeding, increased adherence to therapy, and convenience during long life oral therapy, could be preciously useful in young NCCM patients, especially in children. 54 , 58 , 64 The latter category is the most challenging one because no randomized trials on DOACs have been published for paediatric patients and VKAs still represent the first‐choice anticoagulation therapy. Unfortunately, VKAs have numerous drug interactions, as well as their efficacy can be influenced by the vitamin K intake from the diet.…”

Section: Stroke Prevention In Noncompaction Cardiomyopathymentioning

confidence: 99%

A proposed strategy for anticoagulation therapy in noncompaction cardiomyopathy

et al. 2021

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Noncompaction cardiomyopathy (NCCM) is a rare condition characterized by prominent trabeculae, deep intertrabecular recesses, and a left ventricular myocardium with a two-layered structure, characterized by a spongy endocardial layer and a thinner and compacted epicardial one. NCCM can be isolated or associated with other congenital heart diseases and complex syndromes involving neuromuscular disorders and facial dysmorphisms. To date, more than 40 genes coding for sarcomeric, cytoskeletal, ion channels, and desmosomal proteins have been identified. Clinical presentation is also highly variable, ranging from no symptoms to end-stage heart failure (HF), lethal arrhythmias, sudden cardiac death, or thromboembolic events. In particular, the prevalence of thromboembolism in NCCM patients appears to be higher than that of a similar, age-matched population without NCCM. Thromboembolism has a multifactorial aetiology, which is linked to genetic, as well as traditional cardiovascular risk factors. In previous studies, atrial fibrillation (AF) was observed in approximately 25-30% of adult NCCM patients and embolism had a cardiac source in ~63-69% of cases; therefore, AF represents a strong predictor of adverse events, especially if associated to HF and neuromuscular disorders. Left ventricular dysfunction is another risk factor for thromboembolism, as a result of blood stagnation and local myocardial injury. Moreover, it is not completely clarified if the presence of deep intertrabecular recesses causing stagnant blood flow can constitute per se a thrombogenic substrate even in absence of ventricular dysfunction. For the clinical management of NCCM patients, an appropriate stratification of the thromboembolic risk is of utmost importance for a timely initiation of anticoagulant therapy. The aim of the present study is to review the available literature on NCCM with particular attention on thromboembolic risk stratification and prevention and the current evidence for oral anticoagulation therapy. The use of direct oral anticoagulants vs. vitamin K antagonists is also discussed with important implications for patient treatment and prognosis.

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“…The ventricular myocardium involvement is associated with hampered left ventricle filling and diastolic stiffness [ 119 , 121 ], mainly determined by inflammation related titin phosphorylation [ 122 ]. The atrial myocardium involvement is associated with fibrosis and atrial fibrillation [ 119 , 123 , 124 , 125 , 126 ]. Inflammatory-metabolic HFpEF is typical phenotype of aged women with many cardiovascular comorbidities.…”

Section: The Pathophysiology Of Heart Failure With Preserved Ejection Fractionmentioning

confidence: 99%

Myocardial Tissue Characterization in Heart Failure with Preserved Ejection Fraction: From Histopathology and Cardiac Magnetic Resonance Findings to Therapeutic Targets

Severino¹,

D’Amato²,

Prosperi³

et al. 2021

IJMS

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Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome responsible for high mortality and morbidity rates. It has an ever growing social and economic impact and a deeper knowledge of molecular and pathophysiological basis is essential for the ideal management of HFpEF patients. The association between HFpEF and traditional cardiovascular risk factors is known. However, myocardial alterations, as well as pathophysiological mechanisms involved are not completely defined. Under the definition of HFpEF there is a wide spectrum of different myocardial structural alterations. Myocardial hypertrophy and fibrosis, coronary microvascular dysfunction, oxidative stress and inflammation are only some of the main pathological detectable processes. Furthermore, there is a lack of effective pharmacological targets to improve HFpEF patients’ outcomes and risk factors control is the primary and unique approach to treat those patients. Myocardial tissue characterization, through invasive and non-invasive techniques, such as endomyocardial biopsy and cardiac magnetic resonance respectively, may represent the starting point to understand the genetic, molecular and pathophysiological mechanisms underlying this complex syndrome. The correlation between histopathological findings and imaging aspects may be the future challenge for the earlier and large-scale HFpEF diagnosis, in order to plan a specific and effective treatment able to modify the disease’s natural course.

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Thromboembolic and Bleeding Risk in Atrial Fibrillation Patients with Chronic Kidney Disease: Role of Anticoagulation Therapy

Cited by 29 publications

References 136 publications

Impact of Weight on Clinical Outcomes of Edoxaban Therapy in Atrial Fibrillation Patients Included in the ETNA-AF-Europe Registry

Impact of Weight on Clinical Outcomes of Edoxaban Therapy in Atrial Fibrillation Patients Included in the ETNA-AF-Europe Registry

A proposed strategy for anticoagulation therapy in noncompaction cardiomyopathy

Myocardial Tissue Characterization in Heart Failure with Preserved Ejection Fraction: From Histopathology and Cardiac Magnetic Resonance Findings to Therapeutic Targets

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