Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation
Abstr Act,James D. Douketis,Alex C. Spyropoulos,Scott Kaatz,Richard C. Becker,Joseph A. Caprini,Andrew Dunn,David A. Garcia,Alan K. Jacobson,Amir K. Jaffer,David F. Kong,Sam Schulman,Thomas L. Ortel +12 more
TLDR
In patients with atrial fibrillation who had warfarin treatment interrupted for an elective operation or other elective invasive procedure, forgoing bridging anticoagulation was noninferior to perioperative bridging with low-molecular-weight heparin for the prevention of arterial thromboembolism and decreased the risk of major bleeding.Abstract:
BACKGROUND It is uncertain whether bridging anticoagulation is necessary for patients with atrial fibrillation who need an interruption in warfarin treatment for an elective operation or other elective invasive procedure. We hypothesized that forgoing bridging anticoagulation would be noninferior to bridging with low-molecularweight heparin for the prevention of perioperative arterial thromboembolism and would be superior to bridging with respect to major bleeding. METHODS We performed a randomized, double-blind, placebo-controlled trial in which, after perioperative interruption of warfarin therapy, patients were randomly assigned to receive bridging anticoagulation therapy with low-molecular-weight heparin (100 IU of dalteparin per kilogram of body weight) or matching placebo administered subcutaneously twice daily, from 3 days before the procedure until 24 hours before the procedure and then for 5 to 10 days after the procedure. Warfarin treatment was stopped 5 days before the procedure and was resumed within 24 hours after the procedure. Follow-up of patients continued for 30 days after the procedure. The primary outcomes were arterial thromboembolism (stroke, systemic embolism, or transient ischemic attack) and major bleeding. RESULTS In total, 1884 patients were enrolled, with 950 assigned to receive no bridging therapy and 934 assigned to receive bridging therapy. The incidence of arterial thromboembolism was 0.4% in the no-bridging group and 0.3% in the bridging group (risk difference, 0.1 percentage points; 95% confidence interval [CI], −0.6 to 0.8; P = 0.01 for noninferiority). The incidence of major bleeding was 1.3% in the no-bridging group and 3.2% in the bridging group (relative risk, 0.41; 95% CI, 0.20 to 0.78; P = 0.005 for superiority). CONCLUSIONS In patients with atrial fibrillation who had warfarin treatment interrupted for an elective operation or other elective invasive procedure, forgoing bridging anticoagulation was noninferior to perioperative bridging with low-molecular-weight heparin for the prevention of arterial thromboembolism and decreased the risk of major bleeding. (Funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health; BRIDGE ClinicalTrials.gov number, NCT00786474.)read more
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Paulus Kirchhof,Stefano Benussi,Dipak Kotecha,Anders Ahlsson,Dan Atar,Barbara Casadei,Manuel Castellá,Hans-Christoph Diener,Hein Heidbuchel,Jeroen M.L. Hendriks,Gerhard Hindricks,Antonis S. Manolis,Jonas Oldgren,Bogdan A. Popescu,Ulrich Schotten,Bart P. Van Putte,Panagiotis Vardas,Stefan Agewall,John Camm,Gonzalo Barón Esquivias,Werner Budts,Scipione Carerj,Filip Casselman,Antonio Coca,Raffaele De Caterina,Spiridon Deftereos,Dobromir Dobrev,José M. Ferro,Gerasimos Filippatos,Donna Fitzsimons,Bulent Gorenek,Maxine Guenoun,Stefan H. Hohnloser,Philippe Kolh,Gregory Y.H. Lip,Athanasios J. Manolis,John J.V. McMurray,Piotr Ponikowski,Raphael Rosenhek,Frank Ruschitzka,Irina Savelieva,Sanjay Sharma,Piotr Suwalski,Juan Tamargo,Clare J Taylor,Isabelle C. Van Gelder,Adriaan A. Voors,Stephan Windecker,José Luis Zamorano,Katja Zeppenfeld +49 more
TL;DR: The Task Force for the management of atrial fibrillation of the European Society of Cardiology has been endorsed by the European Stroke Organisation (ESO).
Journal ArticleDOI
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS: The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Endorsed by the European Stroke Organisation (ESO)
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2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Rick A. Nishimura,Catherine M Otto,Robert O. Bonow,Blase A. Carabello,John P. Erwin,Lee A. Fleisher,Hani Jneid,Michael J. Mack,Christopher J. McLeod,Patrick T. O'Gara,Vera H. Rigolin,Thoralf M. Sundt,Annemarie Thompson +12 more
TL;DR: In this article, Levine and O'Gara proposed a new chairperson for FAHA, who was elected by a majority of the FAHA board members, including Birtcher, Bozkurt and Halperin.
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2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society
Craig T. January,L. Samuel Wann,Hugh Calkins,Lin Y. Chen,Joaquin E. Cigarroa,Joseph C. Cleveland,Patrick T. Ellinor,Michael D. Ezekowitz,Michael E. Field,Karen L. Furie,Paul A. Heidenreich,Katherine T. Murray,Julie B. Shea,Cynthia M. Tracy,Clyde W. Yancy +14 more
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Dabigatran versus warfarin in patients with atrial fibrillation
Stuart J. Connolly,Michael D. Ezekowitz,John W. Eikelboom,Jonas Oldgren,Amit Parekh,Janice Pogue,Paul A. Reilly,Ellison Themeles,Jeanne Varrone,Susan Wang,Marco Alings,Denis Xavier,Jun Zhu,Rafael Diaz,Basil S. Lewis,Harald Darius,Hans-Christoph Diener,Campbell D. Joyner,Lars Wallentin +18 more
TL;DR: In patients with atrial fibrillation, dabigatran given at a dose of 110 mg was associated with rates of stroke and systemic embolism that were similar to those associated with warfarin, as well as lower rates of major hemorrhage.
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Apixaban versus Warfarin in Patients with Atrial Fibrillation
Christopher B. Granger,John H. Alexander,Renato D. Lopes,Elaine M. Hylek,Michael G. Hanna,Hussein R. Al-Khalidi,Jack Ansell,Dan Atar,Alvaro Avezum,M. Cecilia Bahit,Rafael Diaz,J. Donald Easton,Justin A. Ezekowitz,Greg C. Flaker,David A. Garcia,Margarida Geraldes,Bernard J. Gersh,Sergey P. Golitsyn,Shinya Goto,Antonio G. Hermosillo,Stefan H. Hohnloser,John D. Horowitz,Puneet Mohan,Petr Jansky,Basil S. Lewis,Jose Lopez-Sendon,Prem Pais,Alexander Parkhomenko,Jun Zhu,Lars Wallentin +29 more
TL;DR: In patients with atrial fibrillation, apixaban was superior to warfarin in preventing stroke or systemic embolism, caused less bleeding, and resulted in lower mortality.
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Edoxaban versus warfarin in patients with atrial fibrillation
Robert P. Giugliano,Christian T. Ruff,Eugene Braunwald,Sabina A. Murphy,Stephen D. Wiviott,Jonathan L. Halperin,Albert L. Waldo,Michael D. Ezekowitz,Jeffrey I. Weitz,Witold Rużyłło,Mikhail Ruda,Yukihiro Koretsune,Joshua Betcher,Minggao Shi,Laura T. Grip,Laura T. Grip,Shirali P. Patel,Indravadan Patel,James J. Hanyok,Michele Mercuri,Elliott M. Antman,Elliott M. Antman,Abstr Act,Abstr Act +23 more
TL;DR: Both once-daily regimens of edoxaban were noninferior to warfarin with respect to the prevention of stroke or systemic embolism and were associated with significantly lower rates of bleeding and death from cardiovascular causes.
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Dabigatran versus warfarin in patients with atrial fibrillation.
TL;DR: Dabigatran appeared to be more efficacious in patients who weighed less and in patients with impaired renal function (in whom the drug ac cumulates), pointing to significant interpatient variability in response.
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