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1.
Isr Med Assoc J ; 23(9): 580-583, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34472234

RESUMO

BACKGROUND: Oral anticoagulants (OAC) reduce the risk for stroke and death from all causes in patients with non-valvular atrial fibrillation (NVAF). OBJECTIVES: To explore adherence rates of OAC among patients with NVAF in long-term use in a real-world setting and to examine patient characteristics associated with good adherence. METHODS: We conducted a population-based cohort study with members of Clalit Health Services, Israel. All patients aged ≥ 30 years with a diagnosis of NVAF before 2016 who were treated with OAC were included. We included patients who filled at least one prescription per year in the three consecutive years 2016-2018. We analyzed all prescriptions that were filled for the medications from 1 January 2017 to 31 December 2017. We considered purchasing of at least nine monthly prescriptions during 2017 as good medication adherence. RESULTS: We identified 26,029 patients with NVAF who were treated with OAC; 10,284 (39.5%) were treated with apixaban, 6321 (24.3%) with warfarin, 6290 (24.1%) with rivaroxaban, and 3134 (12.0%) with dabigatran. Rates of good medication adherence were 88.9% for rivaroxaban, 84.9% for apixaban, 83.6% for dabigatran, and 55.8% for warfarin (P < 0.0001). Advanced age was associated with higher adherence rates (P < 0.001). Socioeconomic status was not associated with medication adherence. Good adherence with OAC was associated with lower low density lipoprotein (LDL) cholesterol and glucose levels. CONCLUSIONS: Adherence rates to OAC in chronic use among patients with chronic NAVF are high. Investing in OAC adherence may have a wider health impact than expected.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Adesão à Medicação , Acidente Vascular Cerebral/prevenção & controle , Administração Oral , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Estudos de Coortes , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/etiologia
2.
Ann Palliat Med ; 10(8): 8982-8990, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34488385

RESUMO

BACKGROUND: Traditional Chinese medicine (TCM) has shown excellent therapeutic effects in the treatment of heart diseases. This meta-analysis was to evaluate the therapeutic effects of TCM on patients with atrial fibrillation (AF). METHODS: Four databases were searched from their establishment to 1 April 2021 for randomized controlled trials (RCTs) on the treatment of AF using TCM. The Cochrane Handbook 5.0.2 was used to perform to bias risk assessment, and RevMan 5.3 was used for meta-analysis. RESULTS: A total of 7 references were included. It was found that compared with conventional Western medicine, the effective rate of TCM or the combined therapy of TCM and Western medicine was higher [mean difference (MD) =1.85; 95% confidence interval (CI): 1.28 to 2.68; Z=3.26; P=0.001]; the success rate of conversion was increased (MD =1.58; 95% CI: 1.02 to 2.44; Z=2.06; P=0.04), the conversion time was shortened (MD =-224.82; 95% CI: -262.56 to -187.08; Z=11.68; P<0.00001), the incidence of adverse reactions was reduced (MD =0.62; 95% CI: 0.40 to 0.97; Z=2.11; P=0.03). DISCUSSION: The use of TCM to treat AF can improve clinical treatment efficiency, increase the success rate of conversion, and shorten the conversion time. Compared with conventional Western medicine, the combined therapy demonstrated better therapeutic effects.


Assuntos
Fibrilação Atrial , Medicina Tradicional Chinesa , Fibrilação Atrial/tratamento farmacológico , Análise por Conglomerados , Humanos
3.
J Int Med Res ; 49(9): 3000605211041439, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34521238

RESUMO

OBJECTIVE: The effect of renin-angiotensin system inhibitors (RASIs) in patients with heart failure (HF) and atrial fibrillation (AF) remains unclear. This study aimed to investigate associations between RASI use and all-cause mortality and cardiovascular outcomes in patients with AF and HF. METHODS: Using data from the China Atrial Fibrillation Registry study, we included 938 patients with AF and HF with a left ventricular ejection fraction <50%. Cox regression models for RASIs vs. non-RASIs with all-cause mortality as the primary outcome were fitted in a 1:1 propensity score-matched cohort. A sensitivity analysis was performed by using a multivariable time-dependent Cox regression model. As an internal control, we assessed the relation between ß-blocker use and all-cause mortality. RESULTS: During a mean follow-up of 35 months, the risk of all-cause mortality was similar in RASI users compared with non-users (hazard ratio: 0.92; 95% confidence interval: 0.67-1.26). Similar results were obtained in the sensitivity analysis. In contrast, ß-blocker use was associated with significantly lower all-cause mortality in the same population. CONCLUSIONS: RASI use was not associated with better outcomes in patients with AF and HF in this prospective cohort, which raises questions about their value in this specific subset.Trail Registration: ChiCTR-OCH-13003729.


Assuntos
Fibrilação Atrial , Insuficiência Cardíaca , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , China , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Pontuação de Propensão , Estudos Prospectivos , Sistema de Registros , Sistema Renina-Angiotensina , Volume Sistólico , Função Ventricular Esquerda
4.
BMJ Open ; 11(8): e047642, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34373301

RESUMO

INTRODUCTION: Atrial fibrillation (AF) is associated with significantly impaired quality-of-life. Iron deficiency (ID) is prevalent in patients with AF. Correction of ID in other patient populations with intravenous iron supplementation has been shown to be a safe, convenient and effective way of improving exercise tolerance, fatigue and quality-of-life. The IRON-AF (Effect of Iron Repletion in Atrial Fibrillation) study is designed to assess the effect of iron repletion with intravenous ferric carboxymaltose in patients with AF and ID. METHODS AND ANALYSIS: The IRON-AF study is a double-blind, randomised controlled trial that will recruit at least 84 patients with AF and ID. Patients will be randomised to receive infusions of either ferric carboxymaltose or placebo, given in repletion and then maintenance doses. The study will have follow-up visits at weeks 4, 8 and 12. The primary endpoint is change in peak oxygen uptake from baseline to week 12, as measured by cardiopulmonary exercise testing (CPET) on a cycle ergometer. Secondary endpoints include changes in quality-of-life and AF disease burden scores, blood parameters, other CPET parameters, transthoracic echocardiogram parameters, 6-minute walk test distance, 7-day Holter/Event monitor burden of AF, health resource utilisation and mortality. ETHICS AND DISSEMINATION: The study protocol has been approved by the Central Adelaide Local Health Network Human Research Ethics Committee, Australia. The results of this study will be disseminated through publications in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12620000285954).


Assuntos
Anemia Ferropriva , Fibrilação Atrial , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Austrália , Método Duplo-Cego , Compostos Férricos , Humanos , Ferro , Maltose/análogos & derivados
8.
Zhonghua Nei Ke Za Zhi ; 60(9): 797-805, 2021 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-34445815

RESUMO

Objective: To investigate the long-term safety of digoxin in patients with coronary artery disease (CAD) and atrial fibrillation (AF). Methods: This was a prospective study, in which 25 512 AF patients were enrolled from China Atrial Fibrillation Registry Study. After exclusion of patients receiving ablation therapy at the enrollment, 1 810 CAD patients [age: (71.5±9.3)years] with AF were included. The subjects were grouped into the digoxin group and non-digoxin group, and were followed up for a period of 80 months. Long-term outcomes were compared between the groups and an adjusted Cox regression analysis was applied to evaluate the risk of digoxin on the long-term outcomes. The primary endpoint was all-cause mortality. Results: The patients were followed up for a median period of 3.05 years. After multivariable adjustment, the Cox regression analysis showed that digoxin significantly increased the risk of all-cause mortality (HR=1.28, 95%CI 1.01-1.61, P=0.038), cardiovascular mortality (HR=1.48,95%CI 1.10-2.00,P=0.010), cardiovascular hospitalization (HR=1.67,95%CI 1.35-2.07,P=0.008) and the composite endpoints (HR=2.02,95%CI 1.71-2.38,P<0.001). In the subgroup of patients with heart failure (HF), digoxin was not associated with the risk of all-cause mortality, but was still associated with the increased risk of cardiovascular mortality (HR=1.44,95%CI 1.05-1.98,P=0.025), cardiovascular hospitalization (HR=1.44,95%CI 1.09-1.90,P=0.010) and the composite endpoints (HR=1.37, 95%CI 1.01-1.70, P=0.004). However, in the subgroup of patients without HF, digoxin was only associated with all-cause mortality (HR=2.56,95%CI 1.44-4.54,P=0.001). Conclusion: Digoxin significantly increased the risk of all-cause mortality in CAD patients with AF, especially in patients without HF.


Assuntos
Fibrilação Atrial , Doença da Artéria Coronariana , Insuficiência Cardíaca , Idoso , Idoso de 80 Anos ou mais , Antiarrítmicos/efeitos adversos , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/tratamento farmacológico , Digoxina/efeitos adversos , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
9.
Medicine (Baltimore) ; 100(31): e26702, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397805

RESUMO

INTRODUCTION: Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) catheter ablation. However, a PVI alone has been considered insufficient for persistent AF. This study aimed to evaluate the efficacy of persistent AF ablation targeting complex fractionated atrial electrogram (CFAE) areas within low voltage zones identified by high-resolution mapping in addition to the PVI. METHODS: We randomized 50 patients (mean age 58.4 ±â€Š9.5 years old, 86.0% males) with persistent AF to a PVI + CFAE group and PVI only group in a 1:1 ratio. CFAE and voltage mapping was performed simultaneously using a Pentaray Catheter with the CARTO3 CONFIDENSE module (Biosense Webster, CA, USA). The PVI + CFAE group, in addition to the PVI, underwent ablation targeting low voltage areas (<0.5 mV during AF) containing CFAEs. RESULTS: The mean persistent AF duration was 24.0 ±â€Š23.1 months and mean left atrial dimension 4.9 ±â€Š0.5 cm. In the PVI + CFAE group, AF converted to atrial tachycardia (AT) or sinus rhythm in 15 patients (60%) during the procedure. The PVI + CFAE group had a higher 1-year AF free survival (84.0% PVI + CFAE vs 44.0 PVI only, P = .006) without antiarrhythmic drugs. However, there was no difference in the AF/AT free survival (60.0% PVI + CFAE vs 40.0% PVI only, P = .329). CONCLUSION: Persistent AF ablation targeting CFAE areas within low voltage zones using high-density voltage mapping had a higher AF free survival than a PVI only. Although recurrence with AT was frequent in the PVI+CFAE group, the sinus rhythm maintenance rate after redo procedures was 76%.


Assuntos
Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Técnicas Eletrofisiológicas Cardíacas , Idoso , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Intervalo Livre de Doença , Técnicas Eletrofisiológicas Cardíacas/métodos , Feminino , Átrios do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Veias Pulmonares/cirurgia , Recidiva , Cirurgia Assistida por Computador , Taquicardia/etiologia
10.
Harefuah ; 160(8): 501-504, 2021 08.
Artigo em Hebraico | MEDLINE | ID: mdl-34396724

RESUMO

INTRODUCTION: Guidelines recommend direct oral anticoagulants (DOACs) for the treatment of non-valvular atrial fibrillation. The heads of the medicine wards in Beilinson Hospital were nominated for regulatory approval of these agents for Clalit Health Services (CHS) patients. OBJECTIVES: To estimate the short and long term compliance and adherence to DOACs, and their association with the approval during hospitalization. METHODS: A retrospective study was conducted on patients hospitalized at the medical wards of Beilinson Hospital during 2017 and the first 6 months of 2018. Inclusion criteria: age>18 years, members of CHS, have non-valvular atrial fibrillation and DOACs were started during their hospitalization. Data was evaluated for: the rate of approvals during hospitalization, the time needed for it after discharge, the 30 days and 12 months compliance and adherence to DOACs agents and their association with approval during hospitalization. RESULTS: During the study period DOACs were started in 373 patients; 263 (71%) of them were included in the study: 59 patients (23%) received the approval during hospitalization, while 204 (77%) received it after discharge within a median of 3 days (range 1-10). There were no significant differences between the two groups concerning demographic, clinical parameters or length of stay. The DOACs 30-days compliance was 60% and 12-months adherence was 57%. There was a slight association between 30 days compliance and in-hospital approval (63% vs. 57%, p=0.3), while the 12 months adherence revealed the opposite (54% vs. 61%, p=0.5). CONCLUSIONS: The short and long term compliance and adherence to DOACs is poor, regardless of the timing of the regulatory approval. DISCUSSION: These findings represent the real world situation, other studies revealed different results according to the study populations and methods.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Administração Oral , Adolescente , Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Hospitalização , Humanos , Estudos Retrospectivos
11.
Medicine (Baltimore) ; 100(32): e26945, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397946

RESUMO

ABSTRACT: Globally, 32% to 70% patients with atrial fibrillation (AF) are prescribed oral anticoagulants (OACs) with warfarin for stroke prevention. However, patients with AF on OACs may experience intracranial hemorrhage (ICH), which presents a treatment dilemma. We therefore investigated whether resuming OACs in these patients is beneficial. Electronic medical records of patients with AF on OACs discharged with ICH between 2001 and 2013 were retrieved from the Taiwan National Health Insurance Research Database for analysis. We excluded patients who were <20 years old, who were not using OACs 6 months prior to ICH, or who had a CHA2DS2-VASc score of ≤1. We also excluded patients who died during admission for ICH, with follow-up for <6 weeks after discharge, or who started OAC >6 weeks after ICH diagnosis. The remaining patients were categorized into those who resumed OAC and those who discontinued OAC. Propensity score matching was performed between the 2 groups. Primary outcomes were mortality/ischemic stroke (IS)/systemic embolism (SE), IS/SE, and recurrent ICH at 6 months and 1 year. After the exclusion criteria were applied, 604 eligible patients (408 discontinued OAC and 196 resumed OAC within 6 weeks) were included in this study, and 186 patients in each group were 1:1 matched. Patients who resumed OAC had significantly lower mortality/IS/SE (hazard ratio [HR] = 0.39, 95% confidence interval [CI] = 0.20-0.76) and IS/SE (HR = 0.12, 95% CI = 0.03-0.53) at 6-month follow-up than patients who discontinued OAC. In addition, patients who resumed OAC had significantly lower mortality/IS/SE (HR = 0.56, 95% CI = 0.34-0.93) and IS/SE (HR = 0.26, 95% CI = 0.09-0.75) at 1-year follow-up. No difference in recurrent ICH was noted between the 2 groups. In conclusion, in patients with AF on OACs with ICH, resuming anticoagulant use was associated with significantly lower risks of composite outcomes of mortality/IS/SE and IS/SE than patients who discontinued OACs. No difference in recurrent ICH was observed between the 2 groups.


Assuntos
Fibrilação Atrial/complicações , Coagulação Sanguínea/efeitos dos fármacos , Hemorragias Intracranianas/etiologia , Varfarina/administração & dosagem , Administração Oral , Adolescente , Adulto , Idoso , Anticoagulantes/administração & dosagem , Fibrilação Atrial/sangue , Fibrilação Atrial/tratamento farmacológico , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Hemorragias Intracranianas/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
12.
Expert Opin Drug Metab Toxicol ; 17(9): 1091-1102, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34357838

RESUMO

INTRODUCTION: Although dabigatran is safer than vitamin K antagonists, bleeding still occurs. Bleeding is an important cause of short-term morbidity and rarely mortality and can also have long-term consequences that are often under-appreciated. After bleeding, patients often do not restart treatment or are poorly adherent, which is associated with increased thromboembolism and mortality. Consequently, we need strategies to prevent and treat bleeding in patients with atrial fibrillation treated with dabigatran. AREAS COVERED: We review a) relevant dabigatran pharmacology, b) the burden and consequences of bleeding, c) how to identify patients at high risk of bleeding; and d) existing and novel approaches to prevent and treat bleeding in dabigatran-treated patients. EXPERT OPINION: Concerns about the risk of bleeding associated with anticoagulant therapy and emerging evidence of increased risk of thromboembolism and mortality after bleeding highlight the need for improved approaches to prevention and treatment of bleeding. Future research priorities should focus on improving our ability to prevent bleeding by identifying modifiable risk factors and the development of safer agents. The current front runners include drugs that selectively target the contact pathway of coagulation (e.g. factor XI). Targeting upstream drivers of thrombosis (e.g. inflammation) could help to further reduce the risk of thromboembolism.


Assuntos
Antitrombinas/efeitos adversos , Dabigatrana/efeitos adversos , Hemorragia/induzido quimicamente , Antitrombinas/administração & dosagem , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Dabigatrana/administração & dosagem , Hemorragia/prevenção & controle , Humanos , Fatores de Risco , Tromboembolia/etiologia , Tromboembolia/prevenção & controle
13.
Cardiol J ; 28(5): 758-766, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34382204

RESUMO

The coronavirus pandemic disease 2019 (COVID-19) has changed the face of contemporary medicine. However, each and every medical practitioner must be aware of potential early and late complications of COVID-19, its impact on chronic diseases - especially ones as common as atrial fibrillation (AF) - and the possible interactions between patients' chronic medications and pharmacotherapy of COVID-19. Patients with AF due to comorbidities and, often, elderly age are assumed to be at a higher risk of a severe course of COVID-19. This expert consensus summarizes the current knowledge regarding the pharmacotherapy of AF patients in the setting of the COVID-19 pandemic. In general, anticoagulation principles in quarantined or asymptomatic individuals remain unchanged. Nevertheless, it is advisable to switch from vitamin K antagonists to non-vitamin K antagonist oral anticoagulants (NOACs) whenever possible due to their consistent benefits and safety with fixed dosing and no monitoring. Additionally, in AF patients hospitalized due to mild or moderate COVID-19 pneumonia, we recommend continuing NOAC treatment or to switching to low-molecular-weight heparin (LMWH). On the other hand, in severely ill patients hospitalized in intensive care units, intravenous or subcutaneous dosing is preferable to oral, which is why the treatment of choice is either LMWH or unfractionated heparin. Finally, particularly in critical scenarios, the treatment strategy in COVID-19 patients with AF should be individualized based on possible interactions between anticoagulants, antiarrhythmics, antivirals, and antibiotics. In this consensus, we also discuss how to safely perform COVID-19 vaccination in anticoagulated AF patients.


Assuntos
Fibrilação Atrial , COVID-19 , Acidente Vascular Cerebral , Administração Oral , Idoso , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Vacinas contra COVID-19 , Heparina , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Pandemias , SARS-CoV-2 , Vitamina K
14.
Adv Emerg Nurs J ; 43(3): 186-193, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34397493

RESUMO

Atrial fibrillation/flutter (AF) remains the most common rhythm disturbance in adult patients presenting to emergency departments (EDs). Although pharmacologic cardioversion has been established as safe and effective in recent-onset AF, its use in U.S. EDs is uncommon. The purpose of this study was to assess the safety and efficacy of intravenous (IV) procainamide for pharmacologic cardioversion in patients presenting to the ED with AF of <48-hr duration. Patients presenting to the ED with recent-onset AF (<48 hr) undergoing a cardioversion strategy with IV procainamide from 2017 to 2019 were reviewed. Clinical outcomes assessed included rates of cardioversion, hospital admission, stroke, and return ED visits for arrhythmia or serious adverse events. A total of 64 patients received procainamide therapy-60.9% achieved cardioversion and 35.9% were admitted to the hospital. The mean dose was 1062.4 mg (12.1 mg/kg). No patients returned to the ED secondary to stroke and 9.4% experienced complications attributed to procainamide, the most common being hypotension. Within 30 days of therapy, 20.3% of patients returned to the ED secondary to arrhythmia recurrence. Patients experiencing cardioversion with procainamide were less likely to be admitted to the hospital (25.6% vs. 52.0%; p = 0.04) or receive a rate control agent (17.9% vs. 64.0%; p = 0.001). There was no significant difference in the rate of 30-day return between those who experienced pharmacologic cardioversion and those who did not (p = 0.220). The implementation of a procainamide-based acute cardioversion strategy for patients presenting to the ED with recent-onset AF resulted in a 60% cardioversion rate, which was associated with a significantly higher rate of discharge from the ED. Transient hypotension was the most common adverse event. Further investigation into ED-based protocols for management of recent-onset AF is necessary to better understand their safety and efficacy.


Assuntos
Antiarrítmicos/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Serviço Hospitalar de Emergência , Procainamida/administração & dosagem , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
Kardiologiia ; 61(7): 55-59, 2021 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-34397342

RESUMO

Aim    The aim of this study was to investigate the short-term effect of the COVID-19 pandemic on the management of warfarin therapy used for atrial fibrillation (AF) and prosthetic valve disease.Material and methods    The study included 139 Atrial fibrillation (AF) patients and 173 prosthetic valve patients (PVP) who were using warfarin. The time in therapeutic range (TTR), International Normalized Ratio (INR) averages, the numbers of INR tests, and the non-adherence to INR monitoring (NIM) were compared for the pre-covid period (PCP) and the COVID-19 period (CP). Also, adherence to warfarin therapy was evaluated with a questionnaire.Results    For all patients, the INR values were higher in the CP (2.47 vs 2.60, p<0.001), and the NIM percentage was higher (19.2 % vs 71.5 %, p<0.001) in the CP. The number of INR tests was lower during the CP (p<0.001).The percentage of patients with TTR≥70 % was lower during the CP (41.7 % vs 33 % p=0.017). Subgroup analysis showed that for PVP, TTR values and the percentage of patients with TTR ≥70 % were similar in both the PCP and CP periods. The questionnaire showed that for 94.1 % of respondents, the major cause of NIM in the CP was the COVID-19 pandemic. However, during the CP, adherence to warfarin medication was high (95.5 %).Conclusion    Lower TTR during the COVID-19 pandemic can increase bleeding and thromboembolic cases.Therefore, patients taking warfarin should be followed more closely, and more practical ways should be considered for INR testing.


Assuntos
Fibrilação Atrial , COVID-19 , Acidente Vascular Cerebral , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Humanos , Coeficiente Internacional Normatizado , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Resultado do Tratamento , Varfarina/efeitos adversos
16.
Geriatr Gerontol Int ; 21(9): 802-809, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34268840

RESUMO

AIM: Polypharmacy is known to be a risk factor for falls or bone fracture (F/F) in elderly patients. However, this relationship is not fully described in patients with non-valvular atrial fibrillation (NVAF), for which F/F may lead to serious clinical outcomes, including major bleeding. METHODS: We analyzed 509 elderly (aged ≥75 years) patients with NVAF who had recently visited a hospital specializing in cardiology, of which 272 patients had paroxysmal atrial fibrillation (PAF) and 237 had persistent/permanent atrial fibrillation (PeAF). Patients were divided into four groups according to the number of medications: ≤3, 4-6, 7-9, and ≥10. The relationship between the number of medications and incidence rate of F/F in AF patients was analyzed. In addition, this relationship was analyzed in patients with each AF type. RESULTS: Cumulative incidence of F/F at 3 years in the respective categories was 3.7%, 5.4%, 4.3% and 5.7% for PAF, and 5.2%, 7.5%, 7.8% and 25.0% for PeAF (log-rank test, P = 0.930 and 0.003, respectively). In a multivariable model, patients with ≥10 medications showed a significantly higher risk for F/F compared with those with ≤3 medications as reference only in PeAF (adjusted hazard ratio 4.82, 95%CI 1.42-16.33), without significant interaction (P = 0.081). CONCLUSIONS: Elderly NVAF patients using ≥10 medications showed a higher risk for F/F. In subgroup analysis, this association was observed only in patients with PeAF, although there was no significant interaction between number of medications and AF type. Geriatr Gerontol Int 2021; 21: 802-809.


Assuntos
Fibrilação Atrial , Fraturas Ósseas , Acidentes por Quedas , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Bases de Dados Factuais , Fraturas Ósseas/epidemiologia , Humanos , Incidência
17.
Ther Umsch ; 78(6): 313-319, 2021 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-34291659

RESUMO

Atrial fibrillation and ischaemic stroke: current treatment and personalized risk prediction of intracerebral haemorrhage Abstract. Atrial fibrillation is a major cause of stroke. Management of patients with atrial fibrillation and stroke is challenging. In this review article, based on the most recent scientific literature, the following questions are discussed: 1) When is the optimal point in time to start anticoagulation after a recent stroke? 2) How to treat patients with atrial fibrillation that have a stroke despite anticoagulant therapy? 3) What is the added value of MRI for personalized risk-prediction of intracerebral hemorrhage? 4) How to treat patients with atrial fibrillation after intracerebral hemorrhage? We provide recommendations for daily clinical management.


Assuntos
Fibrilação Atrial , Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Anticoagulantes/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Isquemia Encefálica/diagnóstico , Hemorragia Cerebral , Humanos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/prevenção & controle
18.
Herz ; 46(4): 323-328, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34223913

RESUMO

Anticoagulation in patients with atrial fibrillation (AF) should be guided by considerations of the risk of thromboembolism, stroke, and bleeding as well as the patient's preference. Well-recognized scores have been developed to help the clinician in daily risk assessment, but there are several special patient populations for whom scores are not developed or validated. Furthermore, these patients were not adequately represented in the pivotal randomized trials for non-vitamin K antagonist oral anticoagulants (NOACs). In patients with cancer, the intrinsic hypercoagulable state has to be balanced against an increased risk of bleeding, and a dynamic concept should be applied, taking into account the cancer type, current disease state, therapeutic strategy, and patient-related factors, with NOACs playing an increasingly larger role. In women with planned pregnancy or already pregnant, NOACs should be avoided. However, accidental exposure during pregnancy should not lead to recommendations for pregnancy termination in view of current observational data. Whether patients on dialysis with AF benefit from anticoagulation at all is questionable. But if the decision for anticoagulation is made, NOACs may contribute to a more favorable risk-benefit profile than vitamin- K antagonists. Finally, patients on the ward deserve special considerations regarding periprocedural management of anticoagulation. Although for the majority of procedures a short discontinuation of oral anticoagulation seems appropriate, there are some low-bleeding-risk procedures that do not require cessation. The aim of the present review is to discuss the major particularities of these four patient subgroups and thus to facilitate the clinical decision-making.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Tromboembolia , Administração Oral , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Feminino , Humanos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Tromboembolia/etiologia , Tromboembolia/prevenção & controle
19.
Int J Clin Pract ; 75(10): e14597, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34228865

RESUMO

BACKGROUND: Although acetylsalicylic acid is the most commonly used antithrombotic agent for the secondary prevention of cardiovascular events, residual atherothrombotic risk has prompted a guideline recommendation for the addition of dual antiplatelet therapy (DAPT) or dual pathway inhibition (DPI) in high vascular risk patients. Accordingly, the CONNECT CVD quality enhancement initiative provides a contemporary "snapshot" of the clinical features and antithrombotic management of atherosclerotic cardiovascular disease (ASCVD) patients in Canada. METHODS: Canadian cardiologists (49 cardiologists from six provinces) undertook a retrospective chart audit of 10 ASCVD patients in their outpatient practice who met the Cardiovascular Outcomes for People Using Anticoagulation Strategy-like criteria from May 2018 to April 2019. RESULTS: Of the 492 (two cardiologists provided 11 patients) enroled, average age was 70 years, 25% were female, 39% had diabetes and 20% had atrial fibrillation. Prior revascularisation was common (percutaneous coronary artery intervention 61%, coronary artery bypass graft 39%), with 31% having multivessel disease. A total of 47% of patients had a Reduction of Atherothrombosis for Continued Health bleeding score of ≥11 (~2.8% risk of serious bleeding at 2 years). Single antiplatelet therapy (SAPT) alone was most commonly used (62%), while 22% were on DAPT alone. In total, 22% were on oral anticoagulation (OAC), with 16% being on non-vitamin K oral anticoagulant alone, 5% on DPI and 1% received triple therapy. CONCLUSIONS: In contemporary Canadian clinical practice of stable ASCVD patients, a large number of patients receive antithrombotic therapy other than SAPT. Further efforts are required to guide the appropriate selection of patients in whom more potent antithrombotic therapies may safely reduce residual risk.


Assuntos
Fibrilação Atrial , Cardiologistas , Doenças Cardiovasculares , Intervenção Coronária Percutânea , Idoso , Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Canadá , Doenças Cardiovasculares/tratamento farmacológico , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Inibidores da Agregação Plaquetária/uso terapêutico , Estudos Retrospectivos , Prevenção Secundária
20.
Rev Port Cardiol (Engl Ed) ; 40(7): 509-518, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34274099

RESUMO

Atrial fibrillation is the most common arrhythmia in adults and its prevalence is growing rapidly. It has been shown that AF is associated with increased risk of heart failure, ischemic and hemorrhagic stroke, and mortality. Hence, there is growing interest among researchers in seeking preventive and therapeutic interventions regarding AF. In recent decades, it has been suggested that statins may decrease the incidence of AF and may also decrease its recurrence after cardioversion and catheter ablation. These effects are thought to be mediated by different mechanisms such as modulating inflammation, altering the properties of transmembrane ion channels, interfering with activation of matrix metalloproteinases, and acting on endothelial function. In this article, we review and update current knowledge about the role of statins in primary and secondary prevention of AF in general and specific populations.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Inibidores de Hidroximetilglutaril-CoA Redutases , Adulto , Fibrilação Atrial/tratamento farmacológico , Cardioversão Elétrica , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Prevenção Secundária
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