This article contains the data showing the different characteristics of atrial fibrillation (AF) patients treated with vitamin K (VKAs) or non-vitamin K antagonist oral anticoagulants (NOACs) screened for the presence of liver fibrosis (LF) and followed to record the occurrence of bleeding and cardiovascular events (CVEs). A detailed description of major and minor bleedings is provided according to anticoagulant treatment (VKAs vs. NOACs) and to the presence of LF. Data here reported also show a higher incidence rate of CVEs in VKA-treated patients, but not in those on NOACs. The data are supplemental to our original research article titled "Incidence of bleeding in patients with atrial fibrillation and advanced liver fibrosis on treatment with vitamin K or non-vitamin K antagonists oral anticoagulants" (Pastori et al., 2018) [1].
A 60-year-old woman was admitted to the hospital with worsening dyspnoea, cough and chest pain. This was on a background of weight loss, decreased appetite, mononeuritis multiplex, chronic eosinophilia and a single episode of a non-blanching rash. Investigations demonstrated a raised troponin and ischaemic changes on ECG, and she was therefore initially treated for a presumed myocardial infarction. However, her symptoms failed to improve with treatment for the acute coronary syndrome. A coronary angiogram revealed no significant flow-limiting disease, and further investigations yielded confirmation of raised eosinophils and a positive perinuclear antineutrophil cytoplasmic antibody test. An echocardiogram demonstrated a pericardial effusion, and subsequent cardiac magnetic resonance features were compatible with myopericarditis. In light of these findings, the patient was diagnosed with eosinophilic granulomatous with polyangiitis and commenced on high-dose intravenous methylprednisolone and cyclophosphamide. She made an excellent recovery and remains in remission on azathioprine and a tapering dose of corticosteroids.
Incident AF in HF is associated with earlier hospital contact, more hospital contacts, and more hospital bed-days. More evidence on interventions that may prevent the risk and subsequent burden of AF in HF is urgently needed.
Stroke prevention is central to the management of patients with atrial fibrillation (AF) which has moved towards a more holistic or integrative care approach. The published evidence suggests that management of AF patients following such a holistic approach based on the Atrial fibrillation Better Care (ABC) pathway is associated with a lower risk of stroke and adverse events. Risk assessment, re-assessment and use of direct oral anticoagulants (DOACs) are important for stroke prevention in AF. The stroke and bleeding risks of AF patients are not static and should be re-assessed regularly. Bleeding risk assessment is to address and mitigate modifiable bleeding risk factors, and to identify high bleeding risk patients for early review and follow-up. Well-controlled comorbidities and healthy lifestyles also play an important role to achieve a better clinical outcome. Digital health solutions are increasingly relevant in the diagnosis and management of patients with AF, with the potential to improve stroke prevention. In this review, we provide an update on stroke prevention in AF, including importance of holistic management, risk assessment/re-assessment, and stroke prevention for special AF populations. Evidence-based and structured management of AF patients would reduce the risk of stroke and other adverse events.
ACP Journal Club21 April 2020In patients with no indication for anticoagulation after TAVR, rivaroxaban increased adverse events vs antiplateletsWern Yew Ding, MBChB, Mark Field, DPhil (Oxon), FRCS (C-Th), Gregory Y.H. Lip, MDWern Yew Ding, MBChBUniversity of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, England, UK (W.Y.D., M.F., G.Y.L.)Search for more papers by this author, Mark Field, DPhil (Oxon), FRCS (C-Th)University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, England, UK (W.Y.D., M.F., G.Y.L.)Search for more papers by this author, Gregory Y.H. Lip, MDUniversity of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, England, UK (W.Y.D., M.F., G.Y.L.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJ202004210-040 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationDangas GD, Tijssen JGP, Wöhrle J, et al. A controlled trial of rivaroxaban after transcatheter aortic-valve replacement. N Engl J Med. 2020;382:120-9. https://pubmed.ncbi.nlm.nih.gov/31733180Clinical Impact RatingsCardiology: Reference1 Siddamsetti S, Balasubramanian S, Yandrapalli S, et al. Meta-analysis comparing dual antiplatelet therapy versus single antiplatelet therapy following transcatheter aortic valve implantation. Am J Cardiol. 2018;122:1401-8. [PMID: 30340696] Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, England, UK (W.Y.D., M.F., G.Y.L.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-3041.This article was published at Annals.org on 7 April 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 21 April 2020Volume 172, Issue 8Page: JC40KeywordsAntiplatelet therapyAortic valve replacementAspirinAtrial fibrillationHazard ratioHemorrhageMortalityMyocardial infarctionSafetyVitamin K ePublished: 21 April 2020 Issue Published: 21 April 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
