Perioperative bridging therapy in patients with atrial fibrillation on Warfarin: Examining current practice and implementing evidence based changes

2016 ◽  
Vol 07 (04) ◽  
Author(s):  
Helen Bartlett
Keyword(s):  
Atrial Fibrillation ◽  
Current Practice ◽  
Evidence Based ◽  
Bridging Therapy

scholarly journals Use of Guidelines for Reducing Stroke Risk in Patients With Nonvalvular Atrial Fibrillation: A Review From a Latin American Perspective

2017 ◽  
Vol 24 (1) ◽  
pp. 22-32 ◽  
Author(s):  
Carlos Cantú-Brito ◽  
Gisele Sampaio Silva ◽  
Sebastián F. Ameriso
Keyword(s):  
Atrial Fibrillation ◽  
Latin America ◽  
Latin American ◽  
Stroke Risk ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Evidence Based ◽  
Scoring Methods ◽  
Essential Components ◽  
Evidence Based Guidelines

Atrial fibrillation (AF) is a prominent risk factor for stroke and a leading cause of death and disability throughout Latin America. Contemporary evidence-based guidelines for the management of AF and stroke incorporate the use of practical and relatively simple scoring methods to estimate both stroke and bleeding risk, in order to assist in matching patients with appropriate interventions. This review examines consistencies and differences among guidelines for reducing stroke risk in patients with AF, assessing the role of user-friendly scoring methods to determine appropriate patients for anticoagulation and other treatment options. Current options include warfarin and direct oral anticoagulants such as dabigatran, rivaroxaban, apixaban, and edoxaban. These agents have been found to be superior or noninferior to standard vitamin K antagonist anticoagulation in large randomized trials. Potential benefits of these agents mainly include lower ischemic stroke rates, reduced intracranial bleeding, no need for regular monitoring, and fewer drug–drug and drug–food interactions. Expert opinions regarding clinical situations for which data are presently lacking, such as emergency bleeding and stroke in anticoagulated patients, are also provided. Enhanced attention and adherence to evidence-based guidelines are essential components for a strategy to reduce stroke morbidity and mortality across Latin America.

scholarly journals Evidence-Based Case Report: The Use of D-Dimer Assay to Exclude Left Atrial Thrombus in Patient with Atrial Fibrillation >48 Hours

2019 ◽  
Vol 11 (6) ◽  
Author(s):  
Raymond Pranata ◽  
Emir Yonas ◽  
Veresa Chintya ◽  
Alexander Edo Tondas ◽  
Sunu Budhi Raharjo
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Left Atrial ◽  
Evidence Based ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
D Dimer

scholarly journals Electronic Record Linkage cohort study of evidence-based management and outcomes in patients with ischaemic heart disease and atrial fibrillation

2021 ◽  
Author(s):  
◽  
Edward Daniel Harris
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Evidence Based Medicine ◽  
Lipid Lowering ◽  
Evidence Based ◽  
Lipid Lowering Therapy ◽  
Lipid Levels ◽  
Increased Risk ◽  
Based Medicine

BACKGROUND Implementation of evidence-based medicine is often suboptimal. The objectives of this thesis are to explore the delivery of evidence-based medicine and outcomes in patients with ischaemic heart disease (IHD) and atrial fibrillation (AF). METHODS Retrospective observational cohort studies were conducted using linked anonymised data from the secure anonymised information linkage (SAIL) databank. Patients included (i) those undergoing percutaneous coronary intervention, (ii) patients prescribed vitamin K antagonist (VKA) for AF, and (iii) patients with AF who had undergone successful PCI. RESULTS Amongst patients directed to take clopidogrel for one-year post-PCI, discontinuation was far lower (~6%) than in previous studies where the treatment duration was not known. Despite this, early discontinuation and/or bleeding was associated with an increased risk of adverse events. In a national cohort of PCI patients, we observed a low rate of achievement of international guideline target lipid levels (<25%) and low prescribing of intensive lipid lowering therapy amongst those not at target. Females and patients who had undergone elective PCI were least likely to have their lipid levels documented and be at target. In patients prescribed VKA for AF guideline defined poor anticoagulation control was common and associated with significantly higher bleeding event rates, independent of common comorbidities that are recognised as risk factors for stroke and bleeding. In patients with AF who had undergone PCI outcomes were poor: approximately 1 in 5 had either a stroke, acute coronary syndrome (ACS) or died in the year follow-up. Bleeding events were also common and associated with a five, three and four-fold increased risk of stroke, ACS, and death. CONCLUSION This thesis has characterised the nature of multiple therapeutic gaps and associated adverse outcomes with common clinical conditions. Thus, identifying opportunities to improve outcomes in individual patients and at population level.

scholarly journals Current practice of Dutch cardiologists in detecting and diagnosing atrial fibrillation: results of an online case vignette study

2017 ◽  
Vol 25 (10) ◽  
pp. 567-573 ◽  
Author(s):  
N. Verbiest-van Gurp ◽  
P. J. M. van Bladel ◽  
H. A. M. van Kesteren ◽  
P. M. Erkens ◽  
H. E. J. H. Stoffers
Keyword(s):  
Atrial Fibrillation ◽  
Current Practice ◽  
Case Vignette ◽  
Vignette Study
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