scholarly journals PCV29 IMPROVING BLEEDING RISK ASSESSMENT FOR ANTICOAGULANT USE IN ATRIAL FIBRILLATION

2011 ◽  
Vol 14 (3) ◽  
pp. A37
Author(s):  
E.H. Lee ◽  
W.J. Kwong ◽  
J. Casciano ◽  
B. Martin
Keyword(s):  
Atrial Fibrillation ◽  
Risk Assessment ◽  
Bleeding Risk

scholarly journals An mHealth intervention to improve nurses’ atrial fibrillation and anticoagulation knowledge and practice: the EVICOAG study

2018 ◽  
Vol 18 (1) ◽  
pp. 7-15 ◽  
Author(s):  
Caleb Ferguson ◽  
Louise D Hickman ◽  
Jane Phillips ◽  
Phillip J Newton ◽  
Sally C Inglis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Assessment ◽  
Anticoagulation Therapy ◽  
Bleeding Risk ◽  
Assessment Tools ◽  
Future Research ◽  
Post Intervention ◽  
Mhealth Intervention ◽  
Quasi Experimental ◽  
Nurses Knowledge

Background: There is a need to improve cardiovascular nurses’ knowledge and practices related to stroke prevention, atrial fibrillation and anticoagulation therapy. Aims: The aim of this study was to evaluate the efficacy of EVICOAG – a novel mHealth, smartphone-based, spaced-learning intervention on nurses’ knowledge of atrial fibrillation and anticoagulation. Methods: Nurses employed in four clinical specialties (neuroscience, stroke, rehabilitation, cardiology) across three hospitals were invited to participate. In this quasi-experimental study, 12 case-based atrial fibrillation and anticoagulation learning scenarios (hosted by an mHealth platform) were delivered to participants’ smartphones over a 6-week period (July–December 2016) using a spaced timing algorithm. Electronic surveys to assess awareness and knowledge were administered pre (T1) and post (T2) intervention. Results: From 74 participants recruited to T1, 40 completed T2. There was a 54% mean improvement in knowledge levels post-intervention. The largest improvement was achieved in domains related to medication interaction and stroke and bleeding risk assessment. Post-intervention, those who completed T2 were significantly more likely to use CHA2DS2-VASc (2.5% vs. 37.5%) and HAS-BLED (2.5% vs. 35%) tools to assess stroke and bleeding risk, respectively ( P<0.01). Conclusion: The EVICOAG intervention improved nurses’ knowledge of atrial fibrillation and anticoagulation, and influenced their uptake and use of stroke and bleeding risk assessment tools in clinical practice. Future research should focus on whether a similar intervention might improve patient-centred outcomes such as patients’ knowledge of their condition and therapies, medication adherence, time in the therapeutic range and quality of life.

Stroke prevention in atrial fibrillation: Past, present and future

2017 ◽  
Vol 117 (07) ◽  
pp. 1230-1239 ◽  
Author(s):  
Gregory Y.H. Lip ◽  
Ben Freedman ◽  
Raffaele De Caterina ◽  
Tatjana S. Potpara
Keyword(s):  
Atrial Fibrillation ◽  
Risk Assessment ◽  
Stroke Prevention ◽  
Review Process ◽  
Treatment Options ◽  
Bleeding Risk ◽  
Review Article ◽  
Ongoing Debate ◽  
New Treatment ◽  
Future Concepts

SummaryConcepts and our approaches to stroke prevention in atrial fibrillation (AF) have changed markedly over the last decade. There has been an evolution over the approach to stroke and bleeding risk assessment, as well as new treatment options. An increasing awareness of AF has led to calls to improve the detection of and population screening for AF. Stroke and bleeding risk assessment continues to evolve, and the ongoing debate on balance between simplicity and practicality, against precision medicine will continue. In this review article, we provide an overview of past, present and the (likely) future concepts and approaches to stroke prevention in AF. We propose three simple steps (the Birmingham ‘3-step’) that offers a practical management pathway to help streamline and simplify decision-making for stroke prevention in patients with AF.Note: The review process for this paper was fully handled by Christian Weber, Editor in Chief.

scholarly journals RIVOROXABAN IN PATIENTS WITH TYPE I ATRIAL FLUTTER: EFFECTIVENESS, SAFETY AND COMPLIANCE

2018 ◽  
Vol 7 (3) ◽  
pp. 44-55
Author(s):  
A. V. Fedoseenko ◽  
S. A. Zenin ◽  
O. V. Kononenko ◽  
O. V. Pyataeva ◽  
Y. E. Voskoboyniokov
Keyword(s):  
Atrial Fibrillation ◽  
Risk Assessment ◽  
Atrial Flutter ◽  
Bleeding Risk ◽  
Control Group ◽  
Type I ◽  
Adherence To Treatment ◽  
High Adherence ◽  
Potential Benefits ◽  
Atrial Fibrillation Group

Aim. To assess effectiveness, safety and adherence to treatment of patients with type I atrial flutter who were previously excluded from the clinical trials evaluating the potential benefits of rivoroxaban for thromboembolism prevention.Methods. 27 medical records of patients with type I atrial flutter were retrospectively reviewed and assigned to the study group. The control group consisted of 100 patients with atrial fibrillation. Both groups received rivoroxaban. All patients underwent thromboembolism risk assessment with the CHA2DS2-VACs score, bleeding risk assessment with HAS-BLED score. Data were collected by telephone.Results. No thromboembolic events were registered in the atrial flutter group, whereas one case of ischemic stroke was in the atrial fibrillation group. There were no major bleedings in both groups. Four patients with atrial flutter and 2 patients with atrial fibrillation had hemorrhages. Patients’ adherence to rivoroxaban was 75–80%.Conclusion. Rivoroxaban therapy was found to be effective and safe in patients with type I atrial flutter including those who underwent cardioversion. High adherence to rivoroxaban therapy was demonstrated.

scholarly journals Major bleeding risk assessment in atrial fibrillation patients taking vitamin K antagonists

2015 ◽  
Vol 35 (2) ◽  
pp. 99-103
Author(s):  
Fernando Pivatto ◽  
André Luís Ferreira da Silva ◽  
Indira Valente Bezerra ◽  
Leonardo Martins Pires ◽  
Luís Carlos Amon ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Assessment ◽  
Vitamin K ◽  
Major Bleeding ◽  
Vitamin K Antagonists ◽  
Bleeding Risk

scholarly journals Stroke and Bleeding Risk Assessment in Atrial Fibrillation: Where Are We Now?

2021 ◽  
Vol 51 ◽  
Author(s):  
Ling Kuo ◽  
Yi-Hsin Chan ◽  
Jo-Nan Liao ◽  
Shih-Ann Chen ◽  
Tze-Fan Chao
Keyword(s):  
Atrial Fibrillation ◽  
Risk Assessment ◽  
Bleeding Risk

Comparison of the CHADS2, CHA2DS2 -VASc and HAS-BLED scores for the prediction of clinically relevant bleeding in anticoagulated patients with atrial fibrillation: The AMADEUS trial

2013 ◽  
Vol 110 (11) ◽  
pp. 1074-1079 ◽  
Author(s):  
Stavros Apostolakis ◽  
Deirdre A. Lane ◽  
Harry Buller ◽  
Gregory Y. H. Lip
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Risk Assessment ◽  
Risk Score ◽  
Stroke Risk ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Net Reclassification Improvement ◽  
Anticoagulated Patients ◽  
Discriminatory Performance

SummaryMany of the risk factors for stroke in atrial fibrillation (AF) are also important risk factors for bleeding. We tested the hypothesis that the CHADS2 and CHA2DS2-VASc scores (used for stroke risk assessment) could be used to predict serious bleeding, and that these scores would compare well against the HAS-BLED score, which is a specific risk score designed for bleeding risk assessment. From the AMADEUS trial, we focused on the trial’s primary safety outcome for serious bleeding, which was “any clinically relevant bleeding”. The predictive value of HAS-BLED/CHADS2/CHA2DS2-VASc were compared by area under the curve (AUC, a measure of the c-index) and the Net Reclassification Improvement (NRI). Of 2,293 patients on VKA, 251 (11%) experienced at least one episode of “any clinically relevant bleeding” during an average 429 days follow up period. Incidence of “any clinically relevant bleeding” rose with increasing HAS-BLED/CHADS2/CHA2DS2-VASc scores, but was statistically significant only for HAS-BLED (p<0.0001). Only HAS-BLED demonstrated significant discriminatory performance for “any clinically relevant bleeding” (AUC 0.60, p<0.0001). There were significant AUC-differences between HAS-BLED (which had the highest AUC) and both CHADS2 (p<0.001) and CHA2DS2VASc (p=0.001). The HAS-BLED score also demonstrated significant NRI for the outcome of “any clinically relevant bleeding” when compared with CHADS2 (p=0.001) and CHA2DS2-VASc (p=0.04). In conclusion, the HAS-BLED score demonstrated significant discriminatory performance for “any clinically relevant bleeding” in anticoagulated patients with AF, whilst the CHADS2 and CHA2DS2-VASc scores did not. Bleeding risk assessment should be made using a specific bleeding risk score such as HAS-BLED, and the stroke risk scores such as CHADS2 or CHA2DS2-VASc scores should not be used.

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