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Stroke Prevention in Atrial Fibrillation

Stroke Prevention in Atrial Fibrillation Book
Author : Greg Flaker
Publisher : Elsevier Health Sciences
Release : 2018-05-24
ISBN : 032355430X
Language : En, Es, Fr & De

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Book Description :

Get a quick, expert overview of stroke risks among patients with treated and untreated atrial fibrillation, in addition to best practices for management and treatment of patients with atrial fibrillation to minimize stroke risks. This concise, clinically-focused resource by Dr. Greg Flaker consolidates today’s available information on this timely topic into one convenient resource, making it an ideal, easy-to-digest reference for practicing and trainee cardiologists as well as general practitioners treating and monitoring these patients. Covers a broad spectrum of management and treatment options for atrial fibrillation including anticoagulants, surgical and implanted devices. Presents information on recent drug trials to keep you up to date with the latest developments. Includes guidance on anticoagulation in special situations, such as cardioversion and ablation, in addition to atrial fibrillation treatment in patients with other medical conditions including cancer, major bleeding disorders, and renal or liver disease. Chapter on Risk Stratification assists in identifying patients with a high risk of stroke and predicting treatment outcomes. Chapter on The New Anticoagulation Clinic overviews best practices for patient education, compliance, follow-up monitoring, and quality assurance to aid in better patient outcomes.

Stroke Prevention in Atrial Fibrillation

Stroke Prevention in Atrial Fibrillation Book
Author : Jan Steffel
Publisher : Unknown
Release : 2014
ISBN : 9783837414578
Language : En, Es, Fr & De

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Quick Pocket Guide to New Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation

Quick Pocket Guide to New Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation Book
Author : Luca Masotti,Mario Di Napoli,Daniel A. Godoy,Roberto Cappelli
Publisher : SEEd
Release : 2012-06-05
ISBN : 8897419305
Language : En, Es, Fr & De

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Book Description :

Cardioembolic strokes account for one third of ischemic strokes and atrial fibrillation (AF) representing the main source of this stroke subtype. The rate of stroke is 5%/year in patients with AF. Patients with AF have a 2-7 fold increased risk of stroke compared to patients without. Stroke prevention in atrial fibrillation (SPAF) is therefore of utmost importance and represents a major point in the modern management of AF. This booklet provides an overview of new oral anticoagulants used, listing their pharmacokinetis profile, the evidence of efficacy and their clinical use.

Stroke Prevention in Atrial Fibrillation

Stroke Prevention in Atrial Fibrillation Book
Author : Harry J. Crijns
Publisher : Unknown
Release : 2012
ISBN : 9781780841182
Language : En, Es, Fr & De

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Left Atrial Appendage Closure

Left Atrial Appendage Closure Book
Author : Jacqueline Saw,Saibal Kar,Matthew J. Price
Publisher : Springer
Release : 2015-11-09
ISBN : 3319162802
Language : En, Es, Fr & De

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Book Description :

Percutaneous left atrial appendage (LAA) closure is an emerging technology for thromboembolic prevention in patients with atrial fibrillation (AF). The first human implantation of an LAA device occurred in 2001, and since then four devices have received CE mark approval. These devices are being widely used in Europe for LAA closure in patients who are poor candidates for long-term oral anticoagulation. In the US, the WATCHMAN device (Boston Scientific) is anticipated to receive FDA approval imminently for AF patients who are warfarin-eligible. This approval is projected to significantly expand the indications for LAA closures worldwide. Thus, the volume of procedures is anticipated to escalate. This book discusses the epidemiology of AF as a cause of stroke; the use of LAA closure in the reduction of thromboembolism with AF; early surgical approaches and novel surgical devices for LAA closure; and current percutaneous approaches and devices available for LAA closure. The emphasis of this book is on percutaneous technical approaches and contemporary trial results on the leading devices (PLAATO, WATCHMAN, Amplatzer Cardiac Plug, and LARIAT). It also reviews unapproved devices in development, in both clinical and pre-clinical phases.

Stroke Prevention in Atrial Fibrillation

Stroke Prevention in Atrial Fibrillation Book
Author : Renato D. Lopes,Duke University Evidence-based Practice Center
Publisher : Unknown
Release : 2013
ISBN : 0987650XXX
Language : En, Es, Fr & De

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Book Description :

OBJECTIVES: Oral anticoagulation with vitamin K antagonists (VKAs) has long been the gold standard therapy for stroke prevention in nonvalvular atrial fibrillation (AF). Limitations in monitoring and compliance of VKAs have fueled the development of new antithrombotic strategies, devices, and oral anticoagulants, including oral direct thrombin inhibitors and factor Xa inhibitors. This review updates previous reviews, particularly with regard to these newer treatment options and the optimal risk stratification tools for stroke and bleeding prediction. DATA SOURCES: We searched PubMed(r), Embase(r), and the Cochrane Database of Systematic Reviews for relevant English-language comparative studies published from January 1, 2000, to August 14, 2012. REVIEW METHODS: Two investigators screened each abstract and full-text article for inclusion, abstracted data, rated quality and applicability, and graded evidence. When possible, random-effects models were used to compute summary estimates of effects. RESULTS: Our review included 122 articles (92 unique studies), comprising 37 studies relevant to predicting thromboembolic risk, 17 relevant to predicting bleeding risk, 43 relevant to interventions for preventing thromboembolic events, 13 relevant to anticoagulation strategies in patients undergoing invasive procedures, and no studies relevant to strategies for switching between warfarin and novel oral anticoagulants or to stroke prevention after a hemorrhagic event. Across the Key Questions addressing prediction of stroke and bleeding risk, evidence was limited by variability in reporting and in underlying treatment of AF. Data suggest that the continuous CHADS2 (Congestive heart failure, Hypertension, Age e75, Diabetes mellitus, prior Stroke/transient ischemic attack [2 points]) and continuous CHA2DS2-VASc (Congestive heart failure/left ventricular ejection fraction d40%, Hypertension, Age e75 [2 points], Diabetes mellitus, prior Stroke/transient ischemic attack/thromboembolism [2 points], Vascular disease, Age 65-74, Sex category female) scores have the greatest discrimination for stroke risk (c-statistic 0.71 [95% confidence interval (CI), 0.66 to 0.75], and c-statistic 0.70 [95% CI 0.66 to 0.75], respectively; low strength of evidence for both scores) and that the HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly [>65 years], Drugs/alcohol concomitantly) score has the greatest discrimination for bleeding risk (moderate strength of evidence). Evidence evaluating interventions for stroke prevention was limited by the small number of studies for specific comparisons and lack of direct comparisons of novel anticoagulants, although many included studies were good-quality randomized controlled trials involving more than 5,000 patients. We found that a factor IIa inhibitor (dabigatran 150 mg) was superior to warfarin in reducing the incidence of stroke (including hemorrhagic) or systemic embolism (relative risk [RR] 0.66; 95% CI 0.53 to 0.82), with no significant difference in the occurrence of major bleeding (RR 0.93; 95% CI 0.81 to 1.07) (high strength of evidence for both outcomes). The Xa inhibitor rivaroxaban was noninferior to warfarin in preventing stroke or systemic embolism (moderate strength of evidence), with similar rates of major bleeding and death (high strength of evidence). The Xa inhibitor apixaban was superior to warfarin in reducing the incidence of stroke or systemic embolism (hazard ratio [HR] 0.79; 95% CI 0.66 to 0.95; high strength of evidence); major bleeding (HR 0.69; 95% CI 0.60 to 0.80; high strength of evidence); and all-cause mortality (HR 0.89; 95% CI 0.80 to 0.998; moderate strength of evidence). Apixaban was also superior to aspirin in reducing the incidence of stroke or systemic embolism (HR 0.45; 95% CI 0.32 to 0.62), with similar hemorrhagic events, including major bleeding (HR 1.13; 95% CI 0.74 to 1.75), in patients who are not suitable for oral anticoagulation (high strength of evidence for both outcomes). However, no studies directly compared the new therapies. Evidence for patients undergoing invasive procedures, switching among anticoagulant therapies, and starting or restarting anticoagulant therapy after previous major bleeding events was insufficient. CONCLUSIONS: Overall, we found that CHADS2 and CHA2DS2-VASc scores have the best discrimination ability for stroke events in patients with AF among the risk scores we reviewed, whereas HAS-BLED provides the best discrimination of bleeding risk. Imaging tools require further evidence in regard to their appropriate use in clinical decisionmaking. Improved evidence of the use of these scores among patients on therapy is also required. Newer anticoagulants show early promise of reducing stroke and bleeding events when compared with warfarin, and apixaban shows safety and efficacy in patients who are not candidates for warfarin. However, further studies are required for key clinical scenarios involving anticoagulation use and procedures, switching or bridging therapies, and when to start anticoagulation after a hemorrhagic event.

Stroke Prevention in Atrial Fibrillation

Stroke Prevention in Atrial Fibrillation Book
Author : U. S. Department Of Heal Human Services,Agency for Healthcare Resea And Quality
Publisher : CreateSpace
Release : 2013-09
ISBN : 9781492803485
Language : En, Es, Fr & De

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Book Description :

Atrial fibrillation (AF) is a common type of supraventricular tachyarrhythmia. While a supraventricular tachyarrhythmia is a tachycardic rhythm originating above the ventricular tissue, AF is characterized by uncoordinated atrial activation with consequent deterioration of mechanical function. AF is the most common cardiac arrhythmia in clinical practice, accounting for approximately one-third of hospitalizations for cardiac rhythm disturbances. The estimated prevalence of AF is 0.4% to1 % in the general adult population, occurring in about 2.2 million people in the U.S. The prevalence increases to about 6 % in people age 65 or older and to 10% in people age 80 or older. The burden of AF in the U.S. is increasing. It is estimated that by the year 2050 there will be 12.1 million Americans with AF, representing more than a twofold (240%) increase since 2000. However, this estimate assumes no further increase in the age-adjusted incidence of AF beyond 2000. If the incidence of AF increases at the same pace, then the projected number of adults with AF would be 15.9 million, a threefold increase from 2000. Although generally not as immediately life threatening as ventricular arrhythmias, AF is associated with significant morbidity and mortality. Patients with AF have increased risk of embolic stroke, heart failure, and cognitive impairment; reduced quality of life; and higher overall mortality. Patients with AF have a fivefold increased risk of stroke, and it is estimated that up to 25% of all strokes in the elderly are a consequence of AF.4 Furthermore, AF-related strokes are more severe, with patients twice as likely to be bedridden as patients with stroke from other etiologies, and are also more likely to result in death. Consistent with the nature of these events, AF-related stroke constitutes a significant economic burden, costing Medicare approximately $8 billion annually. Management of AF involves three distinct areas: rate control, rhythm control, and prevention of thromboembolic events. Strategies for preventing thromboembolic events can be categorized into (1) optimal risk stratification of patients and (2) prophylactic treatment of patients identified as being at risk. The KQs considered are as follows: KQ1: In patients with nonvalvular atrial fibrillation, what are the comparative diagnostic accuracy and impact on clinical decisionmaking (diagnostic thinking, therapeutic, and patient outcome efficacy) of available clinical and imaging tools for predicting thromboembolic risk? KQ2: In patients with nonvalvular atrial fibrillation, what are the comparative diagnostic accuracy and impact on clinical decisionmaking (diagnostic thinking, therapeutic, and patient outcome efficacy) of clinical tools and associated risk factors for predicting bleeding events? KQ3: What are the comparative safety and effectiveness of specific anticoagulation therapies, antiplatelet therapies, and procedural interventions for preventing thromboembolic events: a. In patients with nonvalvular atrial fibrillation? b. In specific subpopulations of patients with nonvalvular atrial fibrillation? KQ4: What are the comparative safety and effectiveness of available strategies for anticoagulation in patients with nonvalvular atrial fibrillation who are undergoing invasive procedures? KQ5: What are the comparative safety and effectiveness of available strategies for switching between warfarin and other, novel oral anticoagulants in patients with nonvalvular atrial fibrillation? KQ6: What are the comparative safety and effectiveness of available strategies for resuming anticoagulation therapy or performing a procedural intervention as a stroke prevention strategy following a hemorrhagic event (stroke, major bleed, or minor bleed) in patients with nonvalvular atrial fibrillation?

Stroke Prevention in Atrial Fibrillation

Stroke Prevention in Atrial Fibrillation Book
Author : 陳柏羲
Publisher : Unknown
Release : 2017
ISBN : 0987650XXX
Language : En, Es, Fr & De

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Book Description :

Download Stroke Prevention in Atrial Fibrillation book written by 陳柏羲, available in PDF, EPUB, and Kindle, or read full book online anywhere and anytime. Compatible with any devices.

Therapeutic Decision making Around Stroke Prevention in Atrial Fibrillation

Therapeutic Decision making Around Stroke Prevention in Atrial Fibrillation Book
Author : Yishen Wang
Publisher : Unknown
Release : 2016
ISBN : 0987650XXX
Language : En, Es, Fr & De

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Book Description :

Download Therapeutic Decision making Around Stroke Prevention in Atrial Fibrillation book written by Yishen Wang, available in PDF, EPUB, and Kindle, or read full book online anywhere and anytime. Compatible with any devices.

Improving Quality of Care and Patient Outcomes

Improving Quality of Care and Patient Outcomes Book
Author : Anonim
Publisher : Unknown
Release : 1997
ISBN : 0987650XXX
Language : En, Es, Fr & De

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Book Description :

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Stroke Prevention in Atrial Fibrillation 2012

Stroke Prevention in Atrial Fibrillation 2012 Book
Author : American College of Chest Physicians,International Guidelines Center (Igc)
Publisher : Unknown
Release : 2012-02-20
ISBN : 9780984899265
Language : En, Es, Fr & De

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Book Description :

GUIDELINES Pocketcards(tm) are multifold pocketcards containing society-endorsed, evidence-based treatment guidelines in a brief algorithmic format that is most preferred by practicing clinicians, quality managers, nurses, educators, and medical students. The Stroke Prevention in Atrial Fibrillation GUIDELINES Pocketcard(tm) is endorsed by the American College of Chest Physicians (ACCP) and based on the 9th Edition of Antithrombotic Therapy and Prevention of Thrombosis Evidence-Based Clinical Practice Guidelines. This practical quick-reference tool contains a CHADS2 risk assessment, detailed treatment recommendations and summary by risk, and drug therapy with a list of approved agents including dosing information. It provides all that is needed to make accurate clinical decisions at the point of care including key points; CHADS2 score; antithrombotic treatment for AF with ACS, intracoronary stent, stable coronary artery disease, and a rhythm control strategy; cardioversion; mitral stenosis; antithrombotic treatment for atrial flutter; current medication tables with brand and generic names; and detailed drug information. Applications include point of care, education, QI interventions, clinical trials, medical reference, and clinical research.

Dabigatran for Stroke Prevention in Atrial Fibrillation

Dabigatran for Stroke Prevention in Atrial Fibrillation Book
Author : Anonim
Publisher : Unknown
Release : 2012
ISBN : 0987650XXX
Language : En, Es, Fr & De

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Book Description :

Atrial fibrillation (AF) is a type of cardiac dysrhythmia that is estimated to affect between 200,000 and 250,000 Canadians. 1 Stroke is an important cause of disability and death from AF, where approximately 15% of strokes are caused by AF. A new class of oral anticoagulants, the direct thrombin inhibitors, has been developed. Dabigatran etexilate (Pradax) is the first of a new class of oral anticoagulants to reach the market. 5 With a more targeted mechanism of anticoagulation, dabigatran offers several potential clinical advantages over warfarin therapy, including obviating the need for routine monitoring; a faster onset and offset of action; no required dietary restrictions for patients; and few drug interactions. The purpose of this supplemental report is to summarize information retrieved from the literature, regarding adverse events associated with dabigatran, the first of this drug class to be marketed in Canada.

Stroke in Atrial Fibrillation An Issue of Cardiac Electrophysiology Clinics

Stroke in Atrial Fibrillation  An Issue of Cardiac Electrophysiology Clinics  Book
Author : Samuel J. Asirvatham
Publisher : Elsevier Health Sciences
Release : 2014-09-05
ISBN : 032328700X
Language : En, Es, Fr & De

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Book Description :

Because atrial fibrillation promotes the formation of blood clots that can travel to the brain and block an artery, atrial fibrillation independently increases the risk of ischemic stroke four-to-five-fold. In this issue expert authors review drug therapies for stroke prevention, use of the new anticoagulants, ablation strategies for stroke prevention, LAA closure for stroke prevention, stroke in heart rhythm device patients, transesophageal echo in atrial fibrillation, and other topics important to the management of this serious complication.

Stroke Prevention Through Management of Atrial Fibrillation

Stroke Prevention Through Management of Atrial Fibrillation Book
Author : Center for Clinical Quality Evaluation
Publisher : Unknown
Release : 1997*
ISBN : 0987650XXX
Language : En, Es, Fr & De

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Download Stroke Prevention Through Management of Atrial Fibrillation book written by Center for Clinical Quality Evaluation, available in PDF, EPUB, and Kindle, or read full book online anywhere and anytime. Compatible with any devices.

Stroke Prevention

Stroke Prevention Book
Author : John W. Norris,Vladimir Hachinski
Publisher : Oxford University Press
Release : 2001-04-12
ISBN : 0199761116
Language : En, Es, Fr & De

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Book Description :

The treatment of stroke remains ineffective, and prevention is the key issue for this common disease. Norris and Hachinski have recruited an international group of experts to provide a comprehensive, critical review of the evidence on the primary and secondary prevention of cerebrovascular disease and to translate this information into clinical practice. The authors present fresh information on established risk factors such as atrial fibrillation, smoking and hypertension and on new risk factors such as homocysteinemia and the paradoxical role of alcohol. They cover the protective effects of lifestyle changes, diet, exercise, and estrogen. Under secondary prevention, they deal with aspirin, antiplatelet therapy, surgical measures to prevent stroke, angioplasty and stenting, and the importance of cardiac anomalies increasingly revealed by high-definition imaging. While endarterectomy remains controversial for asymptomatic carotid stenosis, it has been clearly defined as the single most effective strategy in secondary prevention. In a concluding section that will be particularly valuable to clinical readers, the authors provide a lucid, balanced discussion of how the findings from clinical trials, where patients are highly selected, closely monitored, and given the highest standard of care, can be effectively applied in the everyday practice of medicine.

Improving Medical Decision Making

Improving Medical Decision Making Book
Author : Diederick Laurentius Arts
Publisher : Unknown
Release : 2016
ISBN : 0987650XXX
Language : En, Es, Fr & De

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Book Description :

This thesis consists of three parts. In part of A of this thesis we investigated guideline adherence to the guideline for atrial fibrillation (AF) of the Dutch College of General Practitioners (NHG) and appraised the guideline to identify barriers to adherence. We found low adherence to the guideline resulting in both over and under treatment. During our appraisal of the guideline we identified several potential improvements for the structure and contents of the guideline. Next we searched the literature and categorized reasons for intentional non-adherence in a systematic review. Reasons for guideline non-adherence were frequently and sometimes valid, pertaining to patient preferences and contra-indications. Part B presents the main study of this thesis: The Expert-AF trial. We implemented a clinical decision support system (CDSS) to improve adherence to the Dutch NHG AF guideline and evaluated its effectiveness in a cluster randomized trial. We could not show a significant increase in guideline adherence as a result of the implementation of the system. We did, however, identify valuable insights into barriers to usage in a mixed-methods evaluation of the system. In Part C we take a first step towards better prediction of stroke using complex prediction models, and show that these models hold promise for the future of stroke prediction. Chapter 10 contains a summary of each individual chapter.

Stroke Prevention in Clinical Practice

Stroke Prevention in Clinical Practice Book
Author : Daryll M. Baker
Publisher : Springer Science & Business Media
Release : 2007-12-10
ISBN : 1852339640
Language : En, Es, Fr & De

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Book Description :

Primary care physicians are the first to diagnose transient ischaemic attacks (TIAs), and are the doctors who can undertake a considerable amount of stroke prevention treatment. This book fills the primary care physician’s need for a short clear text explaining how to accurately diagnose a TIA, determine what investigations are indicated and how and when to intervene to reduce the risk of stroke. Short chapters are written in point form with clear diagrams and figures, each chapter written by an expert in the field. Stroke is a brain attack and a major cause of disability. Active intervention can prevent stroke especially in high risk groups.

Stroke Prevention in Patients with Atrial Fibrillation

Stroke Prevention in Patients with Atrial Fibrillation Book
Author : Gillian D. Sanders,Duke University Evidence-based Practice Center
Publisher : Unknown
Release : 2018
ISBN : 0987650XXX
Language : En, Es, Fr & De

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Book Description :

OBJECTIVE: This review updates previous reviews regarding the optimal risk stratification tools for stroke and bleeding prediction, and treatment options for stroke prevention in patients with atrial fibrillation. DATA SOURCES: We searched PubMed(r), Embase(r), and the Cochrane Database of Systematic Reviews for relevant English-language comparative studies published from January 1, 2000, to February 14, 2018. REVIEW METHODS: Two investigators screened each abstract and full-text article for inclusion, abstracted data, rated quality and applicability, and graded evidence. When possible, random-effects models were used to compute summary estimates of effects. RESULTS: Our review included 320 articles (185 unique studies). This included 61 studies relevant to predicting thromboembolic risk, 38 relevant to predicting bleeding risk, and 117 relevant to interventions for preventing thromboembolic (TE) events. Data suggest that the CHADS2, CHA2DS2-VASc, and ABC risk scores have the best evidence predicting TE risk (moderate strength of evidence [SOE] for limited prediction ability of each score) and that the HAS-BLED score has the best evidence to predict bleeding risk (moderate SOE). We found that a thrombin inhibitor (dabigatran 150 mg) was superior to warfarin in preventing stroke (including hemorrhagic) or systemic embolism (relative risk [RR] 0.66; 95% confidence interval [CI] 0.53 to 0.82), with no statistically significant difference in the occurrence of major bleeding (RR 0.93; 95% CI 0.81 to 1.07) (high SOE for both outcomes). The Xa inhibitor apixaban was superior to warfarin in preventing stroke or systemic embolism (hazard ratio [HR] 0.79; 95% CI 0.66 to 0.95; high SOE), major bleeding (HR 0.69; 95% CI 0.60 to 0.80; high SOE), and all-cause mortality (HR 0.89; 95% CI 0.80 to 0.998; low SOE) Apixaban was also superior to aspirin in preventing stroke or systemic embolism (HR 0.45; 95% CI 0.32 to 0.62), with similar risk for major bleeding (HR 1.13; 95% CI 0.74 to 1.75) in patients who are not suitable for warfarin (moderate SOE for both outcomes). The Xa inhibitor edoxaban reduced hemorrhagic stroke and major bleeding compared to warfarin (moderate SOE for both outcomes) but had no evidence of a difference in stroke or systemic embolism (moderate SOE) or myocardial infarction (moderate SOE). The Xa inhibitor rivaroxaban was similar to warfarin in preventing stroke or systemic embolism (HR 0.88, 95% CI 0.74 to 1.03; moderate SOE), with similar rates of major bleeding (low SOE) and death (moderate SOE). Low SOE for major bleeding was due to a trend toward an increase in risk of major bleeding with rivaroxaban seen in observational studies. Comparative effectiveness findings for stroke prevention were limited by the direct comparisons between individual direct oral anticoagulants. Evidence regarding nonpharmacologic interventions was sparse, but left atrial appendage (LAA) closure devices showed a trend toward benefit over warfarin for strokes, major bleeding, and all-cause mortality that did not reach statistical significance. Higher adverse events (excessive bleeding or procedure-related complications) were observed with LAA (low SOE). CONCLUSIONS: Overall, we found that CHADS2, CHA2DS2-VASc, and ABC scores have similar evidence regarding their ability to predict stroke risk in patients with atrial fibrillation, whereas HAS-BLED has the best evidence to predict bleeding risk. Direct oral anticoagulants (specifically apixaban and dabigatran) demonstrate reductions in stroke events and reductions (apixaban) or similar (dabigatran) rates in bleeding events when compared with warfarin, while rivaroxaban was similar in both benefits and harms to warfarin. Edoxaban reduced hemorrhagic stroke and major bleeding compared to warfarin but had no evidence of a difference in other outcomes. More studies are needed directly comparing oral anticoagulants, including thrombin inhibitors and individual Xa inhibitors.

                          Book
Author : Anonim
Publisher : Unknown
Release : 1989
ISBN : 0987650XXX
Language : En, Es, Fr & De

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