scholarly journals Oral anticoagulant use for stroke prevention in atrial fibrillation patients with difficult scenarios

2018 ◽  
Vol 20 ◽  
pp. 56-62 ◽  
Author(s):  
Ting-Yung Chang ◽  
Jo-Nan Liao ◽  
Tze-Fan Chao ◽  
Jennifer Jeanne Vicera ◽  
Chin-Yu Lin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Prevention ◽  
Oral Anticoagulant

scholarly journals Stroke Prevention in Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (24) ◽  
pp. 2371-2388
Author(s):  
Aristeidis H Katsanos ◽  
Hooman Kamel ◽  
Jeff S. Healey ◽  
Robert G. Hart
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trials ◽  
High Risk ◽  
Vitamin K ◽  
Stroke Prevention ◽  
Oral Anticoagulant ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Bleeding Complications ◽  
Secondary Stroke Prevention

Ischemic strokes related to atrial fibrillation are highly prevalent, presenting with severe neurologic syndromes and associated with high risk of recurrence. Although advances have been made in both primary and secondary stroke prevention for patients with atrial fibrillation, the long-term risks for stroke recurrence and bleeding complications from antithrombotic treatment remain substantial. We summarize the major advances in stroke prevention for patients with atrial fibrillation during the past 30 years and focus on novel diagnostic and treatment approaches currently under investigation in ongoing clinical trials. Non–vitamin K antagonist oral anticoagulants have been proven to be safer and equally effective compared with warfarin in stroke prevention for patients with nonvalvular atrial fibrillation. Non–vitamin K antagonist oral anticoagulants are being investigated for the treatment of patients with atrial fibrillation and rheumatic heart disease, for the treatment of patients with recent embolic stroke of undetermined source and indirect evidence of cardiac embolism, and in the prevention of vascular-mediated cognitive decline in patients with atrial fibrillation. Multiple clinical trials are assessing the optimal timing of non–vitamin K antagonist oral anticoagulant initiation after a recent ischemic stroke and the benefit:harm ratio of non–vitamin K antagonist oral anticoagulant treatment in patients with atrial fibrillation and history of previous intracranial bleeding. Ongoing trials are addressing the usefulness of left atrial appendage occlusion in both primary and secondary stroke prevention for patients with atrial fibrillation, including those with high risk of bleeding. The additive value of prolonged cardiac monitoring for subclinical atrial fibrillation detection through smartphone applications or implantable cardiac devices, together with the optimal medical management of individuals with covert paroxysmal atrial fibrillation, is a topic of intensive research interest. Colchicine treatment and factor XIa inhibition constitute 2 novel pharmacologic approaches that might provide future treatment options in the secondary prevention of cardioembolic stroke attributable to atrial fibrillation.

Persistence with Dabigatran Therapy for Stroke Prevention in Patients with Non-Valvular Atrial Fibrillation: The Gloria-AF Registry

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2616-2616 ◽  
Author(s):  
Christine Teutsch ◽  
Menno V Huisman ◽  
Gregory Y.H. Lip ◽  
Hans-Christoph Diener ◽  
Sergio J Dubner ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Prevention ◽  
Oral Anticoagulant ◽  
Research Funding ◽  
Stroke Risk ◽  
Committee Member ◽  
Global Perspective ◽  
Newly Diagnosed ◽  
Kaplan Meier ◽  
Grant Support

Abstract Purpose/Background : Oral anticoagulation is recommended for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) and stroke risk factors, but discontinuation rates are high among those treated with vitamin K antagonists (VKA). After the first year of treatment, about half of patients permanently stop taking VKA therapy. We examined persistence to therapy with dabigatran etexilate (DE) in patients enrolled in the global, prospective GLORIA-AF Registry Program. Methods: GLORIA-AF collects data in three phases from routine clinical practice in 44 countries worldwide. Enrollment in Phase II was initiated following approval of DE, the first non-VKA oral anticoagulant (NOAC) available. During this phase, all patients with newly diagnosed NVAF at risk for stroke starting DE are followed for 2 years. This analysis is based on a pre-specified interim analysis once follow-up of the first 3000 DE patients was completed. Patients were recruited between November 2011 and December 2013 at nearly 1,000 sites worldwide, by cardiologists, neurologists and general practitioners. To reduce selection bias, patients were recruited consecutively, irrespective of antithrombotic therapy. Persistence was defined as time from initiation to discontinuation of therapy for >30 days or substitution of initial treatment by another oral anticoagulant. Persistence rates were analyzed on the basis of a time-to-event analysis using the Kaplan Meier method. Results: Among eligible patients, 2,937 were prescribed DE; 823 (27.4%) in North America, 1,503 (50.1%) in Europe, 194 (6.5%) in Latin America, 54 (1.8%) in Africa/Middle East and 363 (12.1%) in Asia. Overall, 55.3% were male, the median age was 71.0 (range 23-98) years; 36.7% were ≥75 years old. The CHA2DS2VASc score was ≥2 in 88.2%, 78.9% had hypertension, 22.7% diabetes mellitus, 10.1% prior stoke and 24.9% heart failure. All but 5 eligible patients took at least one dose of DE. The probability of remaining on DE treatment was 76.6% at 1 year and 69.2% at 2 years (based on Kaplan-Meier method). At the 2 years visit, half of the permanently discontinued patients (418 out of 828) had switched to another oral anticoagulant. Characteristics of patients discontinuing vs. sustaining therapy and relationships to stroke risk and geographical region will be presented. Conclusions: In this global, prospective, cohort of patients newly diagnosed with NVAF and treated with DE, persistence on therapy was high through 2 years of treatment, with an estimated probability of remaining on treatment of about 77% after 1 year and 70% after 2 years. The detailed results will provide a global perspective on the factors that influence treatment persistence in patients prescribed a NOAC for stroke prophylaxis. Disclosures Teutsch: Boehringer Ingelheim: Employment. Huisman:Boehringer Ingelheim Pharma GmbH & Co.KG: Other: Grant support; GlaxoSmithKline: Other: Grant support; Bayer HealthCare: Other: Grant support; Pfizer: Other: Grant support; Actelion: Other: Grant support. Lip:Bayer, BMS/Pfizer, Boehringer Ingelheim and Sanofi Aventis: Speakers Bureau; Bayer, Astellas, Merck, Sanofi, Bristol-Myers Squibb (BMS)/Pfizer, Daiichi-Sankyo, Biotronik, Portola and Boehringer Ingelheim: Consultancy. Diener:AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Janssen-Cilag, Lundbeck, Novartis, Sanofi Aventis, Syngis and Talecris: Research Funding; Abbott, Allergan, AstraZeneca, Bayer Vital, BMS, Boehringer Ingelheim, CoAxia, Corimmun, Covidien, Daiichi-Sankyo, D-Pharm, Fresenius, GlaxoSmithKline, Janssen-Cilag, Johnson & Johnson, Knoll, Lilly, Medtronic, MindFrame, MSD, Neurobiological Technologies: Honoraria; The Department of Neurology at the University Duisburg-Essen received research grants from the German Research Council (DFG), German Ministry of Education and Research (BMBF), European Union, National Institutes of Health, Bertelsmann Foundation and Heinz: Research Funding. Dubner:steering committee member for Boehringer Ingelheim: Consultancy; St Jude Medical: Research Funding. Changsheng:steering committee member for Boehringer Ingelheim: Consultancy. Rothman:RTI Health Solutions: Employment. Zint:Boehringer Ingelheim: Employment. Elsaesser:Boehringer Ingelheim: Employment. Paquette:Boehringer Ingelheim: Employment. Bartels:Boehringer Ingelheim: Employment. Halperin:Bayer HealthCare: Consultancy; Boehringer Ingelheim: Consultancy.

scholarly journals Traumatic events involving elderly patients treated with anticoagulants for atrial fibrillation: the downside of stroke prevention

2016 ◽  
Vol 12 (2) ◽  
Author(s):  
Alessandro Riccardi ◽  
Pierangela Minuto ◽  
Maria Ghinatti ◽  
Grazia Guiddo ◽  
Alessandro Calvia ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Elderly Patients ◽  
Emergency Room ◽  
Stroke Prevention ◽  
Oral Anticoagulant ◽  
Traumatic Event ◽  
Risk Of Falling ◽  
Very Elderly ◽  
Permanent Atrial Fibrillation

A group of oral anticoagulant-treated patients affected by permanent atrial fibrillation was evaluated after their access to the emergency room as a result of a traumatic accident. In these patients, the re-evaluation of their risk of thromboembolism and bleeding was performed together with the evaluation of their risk of falling and institutionalization. Results show that the emergency department identifies a cohort of very elderly frail patients, who should be carefully reconsidered for anticoagulant therapy after a traumatic event.

Non-Vitamin K Oral Anticoagulant Drugs for Stroke Prevention in Patients with Atrial Fibrillation and Chronic Kidney Disease

2016 ◽  
Vol 23 (19) ◽  
pp. 2055-2069 ◽  
Author(s):  
Tatjana S. Potpara ◽  
Vera Jokic ◽  
Nikolaos Dagres ◽  
Torben B. Larsen ◽  
Deirdre A. Lane ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vitamin K ◽  
Stroke Prevention ◽  
Oral Anticoagulant ◽  
Anticoagulant Drugs

scholarly journals Patients’ perspectives on factors affecting their involvement in decision-making on oral anticoagulant therapy for stroke prevention in non-valvular atrial fibrillation

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i25-i26
Author(s):  
K Medlinskiene ◽  
S Richardson ◽  
D Petty ◽  
K Stirling ◽  
M Rattray ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Stroke Prevention ◽  
Oral Anticoagulant ◽  
Patient Involvement ◽  
Oral Anticoagulant Therapy ◽  
Pharmacy Practice ◽  
Medical Decision ◽  
Factors Affecting ◽  
Therapy Options

Abstract Introduction Acknowledging patients’ preferences and addressing their concerns is thought to improve patients’ satisfaction with consultations, resulting in improved adherence and health benefits [1]. Adherence to oral anticoagulant (OA) therapy in non-valvular atrial fibrillation (NVAF) is crucial to prevent AF-related strokes. Previous research on anticoagulation in NVAF indicated that decision-making was dominated by prescribers, but patients offered several therapy options reported being involved [2]. Identifying the patient’s perspective on factors affecting their involvement could help to deliver more patient-centred care in the management of AF. Aim To explore patients’ perspectives and experiences concerning factors affecting their involvement in decision-making about OA therapy for stroke prevention in NVAF. Methods Semi-structured face-to-face interviews were conducted with patients in three health economies in the North of England between August 2018 and April 2019. An interview topic guide based on narrative review findings [2] was developed and refined by a Patient and Public Involvement (PPI) group to ensure clarity. Theoretical sampling was used to recruit adults (>18 years) diagnosed with NVAF, prescribed OA (vitamin K antagonist or direct oral anticoagulant (DOAC)), and able to give written consent. Up to 30 potential participants were approached by a member of their direct care team (nurse or pharmacist) in secondary and primary care anticoagulation or arrhythmia clinics. PPI members recruited patients from a local patient support group. Data collection continued until data saturation was achieved. Audio recorded interviews were transcribed verbatim and analysed using the Framework method. Results A total of 21 patient with median (IQR) age of 73 years (65–78 years) were interviewed. Eleven patients took DOACs. The median (IQR) time of taking OA was 3 years (4 weeks-7 years), warfarin 7 years (3–9 years) and DOAC 1 year (4 weeks-4 years). Interviews lasted between 15 and 48 minutes (average 27 minutes). Three themes were identified during analysis (Figure 1). Patients described therapy decisions being made by just the clinician, jointly with the clinician, and in few cases by the patient alone. The lack of involvement resulted from patients perceiving that there was only a choice between accepting and refusing the therapy, and clinician’s role was to make decisions. Limited consultation times, lack of continuous relationship with a clinician and knowledge about OAs options discouraged patients from being involved and some patients reported difficulties with the prescribed therapy. Patients that were involved considered safety of therapy options and impact on daily life. Conclusions Limited consultation time, patient’s perception of clinician’s role, quality of patient-clinician relationship, and patients’ awareness of therapy options were main factors influencing the level of patient involvement in the decision-making. Support from both organisation and clinicians (e.g., longer consultations, availability of different therapy options) is needed to facilitate greater patient involvement, which could prevent difficulties encountered by some patients. The main strength of this study was recruitment of participants from three health economies differing in anticoagulation service provision models, which enabled greater insight into potential barriers. However, the sample was lacking ethnic diversity and could have potential of recall bias. References 1. Shay LA and Lafata JE. (2015). Where is the evidence? A systematic review of shared decision making and patient outcomes. Medical Decision Making. 35 (1): 114–131. 2. Medlinskiene K, Petty D, Richardson S and Stirling K. (2018) Are patients with non-valvular atrial fibrillation involved in decision-making about oral anticoagulants? A literature review. International Journal of Pharmacy Practice. 26 (Suppl. 1): 42–43.

scholarly journals Dabigatran for Stroke Prevention in Nonvalvular Atrial Fibrillation: Answers to Challenging “Real-World” Questions

Thrombosis ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Jorge Ferreira ◽  
Daniel Ferreira ◽  
Miguel Viana-Baptista ◽  
Paulo Bettencourt ◽  
Rui Cernadas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Real World ◽  
Stroke Prevention ◽  
Oral Anticoagulant ◽  
Dabigatran Etexilate ◽  
Direct Thrombin Inhibitor ◽  
Thrombin Inhibitor ◽  
Joint Effort ◽  
Nonvalvular Atrial Fibrillation ◽  
New Oral Anticoagulant

Dabigatran etexilate is a novel, oral, reversible, direct thrombin inhibitor that constitutes a major breakthrough for stroke prevention in patients with nonvalvular atrial fibrillation (AF). Dabigatran was the first new oral anticoagulant approved in Europe and became available in Portugal, for stroke prevention in nonvalvular AF, earlier than in most European countries. This paper is the joint effort of a panel of experts from different specialties and provides information on the use of dabigatran, in anticipation of the challenges that will come with increased usage.

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