Stroke Prevention in Atrial Fibrillation
Literature review: stroke prevention in atrial fibrillation
The review includes the pivotal randomised controlled trials for warfarin and direct oral anticoagulants as well as relevant publications from the last 18 months. The following search terms were used: ‘stroke prevention’, ‘atrial fibrillation’, dabigatran, rivaroxaban, apixaban, edoxaban, warfarin, ‘oral anticoagulants’, ‘non-VKA oral anticoagulants’, novel oral anticoagulants’, ‘direct oral anticoagulants’, ‘reversal agents’
New This Month
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Calkins H, Willems S, Verma A, et al. EP Europace 2019;21:879–85
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Byrne RA, Colleran R, Kastrati A. EuroIntervention 2019;14:e1793–5.
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Chan NC, Eikelboom JW. Blood 2019;133:2269–78.
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Khaji A, Hanley C, Kowey PR. Cardiol Clin 2019;37:197–206.
Videos
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Webinars
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Dr Robert Byrne, Prof Georg Nickenig, Prof Stefan Hohnloser, Prof Georg Nickenig, Prof Pepe Zamorano, Dr Jose Lopez-Sendon. -
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Dr. Amit Mistri
Key Articles
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Andrade JG, Hawkins NM, Fordyce CB, al. Can J Cardiol 2018;34:1010–8.
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Lane DA, Meyerhoff J, Rohner U, Lip GYH. Clin Cardiol 2018;41:855–61.
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Lee CJ, Gerds TA, Carlson T, et al. J Am Coll Cardiol 2018;72:17–26.
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Hohnloser SH, Eikelboom JW. J Am Coll Cardiol 2018;72:27–8.
Independent Medical Education
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Byrne R, Hohnloser S, Nickenig G, Sendon JL and Zamarano JL, Radcliffe-CME, Feb 2018. -
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Hugh Calkins, A John Camm
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Richard Hobbs
Guidelines/ Expert Recommendations
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Dan GA, Iliodromitis K, Scherr D, et al. Europace 2018;20:1382–7.
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Steffel J, Verhamme P, Potpara TS, et al. Eur Heart J 2018;39:1330–93.
Randomised Controlled Trials
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Hohnloser SH, Eikelboom JW. J Am Coll Cardiol 2018;72:27–8.
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O’Brien EC, Holmes DN, Thomas L, et al. J Am Heart Assoc 2018;7:e006391.
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Di Biase L, Romero J. JACC Clin Electrophysiol 2018;4:601–3.
Post-Hoc/Subgroup Analysis Of Pivotal Trials - Dabigatran
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Hohnloser SH, Eikelboom JW. J Am Coll Cardiol 2018;72:27–8.
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Glund S, Gan G, Moschetti V, et al. Clin Appl Thromb Hemost 2018;24:724–33.
Post-Hoc/Subgroup Analysis Of Pivotal Trials - Edoxaban
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Med Lett Drugs Ther 2018;60:99–101.
Post-Hoc/Subgroup Analysis Of Pivotal Trials - Apixaban
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Med Lett Drugs Ther 2018;60:99–101.
Post-Hoc/Subgroup Analysis Of Pivotal Trials - Diabetes
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McAllister DA, Read SH, Kerssens J, et al. Circulation 2018;138:2774–86.
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Nassif ME, Kosiborod M. Circulation 2018;138:4–6.
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Shilpa Vijayakumar, Muthiah Vaduganathan, Javed Butler, et alVijaykumar S et al. Circulation. 2018;137:1060-1073.
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Seferović PM, Petrie MC, Filippatos GS, et al. Eur J Heart Fail 2018;20:853–72.
Post-Hoc/Subgroup Analysis Of Pivotal Trials - Elderly
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Patti G, Cavallari I, Hanon O, De Caterina R. Int J Cardiol 2018;265:118–24.
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Yanagisawa S, Inden Y, Fujii A, et al. JACC Clin Electrophysiol 2018;4:592–600.
Stroke prevention in atrial fibrillation
Despite the evidence-based guidelines for the management of atrial fibrillation (AF), serious gaps continue to exist between clinical knowledge and practice, leaving patients at risk for disabling strokes. It is estimated that up to 67% of AF-related strokes are preventable. The significant increase in mortality and functional impairment is even more alarming, compared to non-AF strokes.
Updated AF treatment guidelines recommend new oral anticoagulants (NOACs) over warfarin for stroke prevention except, in patients with moderate to severe mitral stenosis or a mechanical heart valve. Based on some recent trials, NOACs were superior to warfarin for the prevention of the composite of stroke and systemic embolism in patients with AF and an additional risk factor for stroke. Reversal agents are now also available for NOACs in patients for severe bleeding or emergency procedures.
With the increased utilization of NOACs, it is critical for the clinician to understand the clinical and practical usage of these agents in diverse patient populations and clinical situations.
Radcliffe Cardiology would like to thank Boehringer Ingelheim for their support in the development of this section.
Content on this section was partly provided by Boehringer Ingelheim. For any follow up questions please contact your local Boehringer Ingelheim representative.
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In this study, changes in hospitalisations for AF, AF-related stroke and treatment patterns between 2012 and 2016 were investigated using administrative data.
Maggioni AP, Dondi L, Andreotti F, et al. Am Heart J 2020;220:12–9. -
NAXOS aimed to compare the safety, effectiveness and mortality of apixaban with vitamin K antagonists, rivaroxaban and dabigatran, in oral anticoagulant-naïve patients with nonvalvular AF.
Van Ganse E, Danchin N, Mahé I, et al. Stroke 2020;51:2066–75. -
This review evaluated morbidly obese patients with AF or venous thromboembolism who received DOACs. Continued caution is recommended when considering DOAC use in these patients.
Kido K, Lee JC, Hellwig T, Gulseth MP. Pharmacotherapy 2020;40:72–83. -
In this article, current evidence on AF in the setting of acute heart failure is summarised. The recommendations on management of AF in the prehospital stage, the treatment of reversible causes, when and how to use rate or rhythm control,...
Gorenek B, Halvorsen S, Kudaiberdieva G, et al. Eur Heart J Acute Cardiovasc Care 2020; epub ahead of press. -
The objective was to assess recently published studies to examine the outcomes of the use of warfarin among patients with AF and end-stage renal disease.
Randhawa MS, Vishwanath R, Rai MP, et al. JAMA Netw Open 2020;3:e202175.
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Videos
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18 Nov 2020
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12 Oct 2020
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12 Oct 2020
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26 Jun 2020 -
26 Jun 2020
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Clinical publications
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Maggioni AP, Dondi L, Andreotti F, et al. Am Heart J 2020;220:12–9.
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Ma C, Riou França L, Lu S, et al. J Arrhythm 2020;36:408–16.
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Yasaka M, Uchiyama S, Atarashi H, et al. J Stroke Cerebrovasc Dis 2020;29:104717.
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Blin P, Dureau-Pournin C, Bénichou J, et al. Am J Cardiovasc Drugs 2020;20:81–103.
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Jansson M, Själander S, Sjögren V, et al. Thromb Res 2020;185:135–41.
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Trials
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Van Ganse E, Danchin N, Mahé I, et al. Stroke 2020;51:2066–75.
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Wongcharoen W, Pacharasupa P, Norasetthada L, et al. Circ J 2020;84:1075–82.
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Anguita Sánchez M, Bertomeu Martínez V, Ruiz Ortiz M, et al. Rev Esp Cardiol (Engl Ed) 2020;73:14–20.
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Russo V, Attena E, Rago A, et al. J Clin Med 2020;9:1621.
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Calkins H, Willems S, Verma A, et al. EP Europace 2019;21:879–85
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Opinion articles
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Mulder BA, ten Berg J, ten Cate H, et al. Neth Heart J 2020.
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Kawakami S, Yasuda S and Ogawa H. J Cardiol 2020;76:35–43.
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Brand-McCarthy SR, Delaney RK and Noseworthy PA. Circ Cardiovasc Qual Outcomes 2020;13:e006080.
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Potpara TS, Mujovic N and Lip GYH. Europace 2020;22:173–6.
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Packer M. Europace 2020;22:681–3.
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Review articles
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Jin H, Zhu K, Wang L, et al. Cardiovasc Ther 2020;2020:2683740.
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Xu D, Su C and Pan J. Curr Drug Metab 2020;21:106–11.
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Ferrari F, da Silveira AD, Martins VM, et al. Cardiol Rev 2020.
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Smythe MA, Parker D, Garwood CL, et al. Pharmacotherapy 2020;40:55–71.
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Liu X, Xu ZX, Yu P, et al. Cardiovasc Drugs Ther 2020;34:569–78.
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Guidelines
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Skurk C and Landmesser U. EuroIntervention 2020;15:1117–9.
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Messé SR, Gronseth GS, Kent DM, et al. Neurology 2020;94:876–85.
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Gorenek B, Halvorsen S, Kudaiberdieva G, et al. Eur Heart J Acute Cardiovasc Care 2020; epub ahead of press.
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Chung MK, Eckhardt LL, Chen LY, et al. Circulation 2020;141:e750–e772.
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Das SR, Everett BM, Birtcher KK, et al. J Am Coll Cardiol 2018;72:3200–23.
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Anticoagulation in AF following PCI: guideline updates and real-world evidence
PART 1: Managing AF following PCI: Interpreting ESC guideline updates
Learning objectives
- Summarise the recent updates to the European Society of Cardiology Atrial Fibrillation guidelines
- State the clinical studies that have influenced the recent guideline updates
- Recall the different study designs used in pivotal clinical trials assessing NOAC use post-PCI
PART 2: Real world outcomes in AF patients undergoing PCI
Dual antiplatelet therapy for acute stroke and TIA: Current best practice and emerging strategies
PART 1: Chairperson’s welcome and introduction
Learning Objectives:
- To highlight the continued high unmet need for strategies to prevent stroke or death for patients experiencing acute stroke or TIA
- To outline the guidelines on the use of dual antiplatelet therapy for patients presenting with acute stroke or TIA
- To examine recent evidence from clinical trials on novel strategies for improving outcomes for patients presenting with acute stroke or TIA and how these data and insights can be applied in clinical practice
PART 2: Secondary prevention after acute minor stroke or TIA: Understanding the ongoing risk
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