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Secondary stroke prevention and guideline adherent antithrombotic treatment in patients with atrial fibrillation: Insights from the Gulf Survey of atrial fibrillation events (Gulf SAFE)

Published on Jan 1, 2019in International Journal of Cardiology3.471
· DOI :10.1016/j.ijcard.2018.07.120
Kazuo Miyazawa3
Estimated H-index: 3
(University of Birmingham),
Yan-Guang Li4
Estimated H-index: 4
(Chinese PLA General Hospital)
+ 4 AuthorsGregory Y.H. Lip141
Estimated H-index: 141
(University of Birmingham)
Abstract
Abstract Background Anticoagulation therapy in patients with atrial fibrillation (AF) is well established as effective thromboprophylaxis. However, AF patients with prior stroke are often treated with suboptimal antithrombotic treatment (ATT). In the present study, we investigated clinical characteristics and outcomes in AF patients with versus without prior stoke, in relation to guideline adherence in ATT. Methods We used data from the Gulf SAFE registry, which included patients with AF who presented to hospitals in Gulf countries of the Middle East. Adherence to guideline recommended ATT was assessed against the European Society of Cardiology guidelines. Results Of 1860 patients, 15.4% had a history of stroke (secondary stroke prevention). For secondary stroke prevention, 62.0% of patients were prescribed oral anticoagulants, while 27.9% were still prescribed antiplatelet therapy alone and 10.1% received no ATT. Overall, 49.0% were treated with guideline adherent ATT, 25.5% were undertreated, and 25.4% were overtreated. On multivariable logistic regression analysis, undertreatment (OR; 2.763, 95% CI; 1.426–5.352, p = 0.003) was significantly associated with an increased risk of 1-year stroke. On the other hand, overtreatment was significantly associated with an increased risk of 1-year bleeding (OR; 3.294, 95% CI; 1.517–7.152, p = 0.003). Conclusions Only half of the AF patients received optimal ATT for stroke prevention if we apply guideline recommendations. Guideline adherent ATT significantly reduced the risk of stroke and bleeding compared with non-guideline adherent ATT.
  • References (35)
  • Citations (2)
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References35
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#1Sylvie Perreault (UdeM: Université de Montréal)H-Index: 29
#2Payman Shahabi (UdeM: Université de Montréal)H-Index: 2
Last. Marie-Pierre Dubé (UdeM: Université de Montréal)H-Index: 39
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: Over- and undercoagulation with warfarin are associated with hemorrhagic and thromboembolic events, respectively. Genetic and clinical factors affect warfarin response, and the causes of this variability remain unclear. We present descriptive statistics and test for predictors of poor anticoagulation control. The Quebec Warfarin Cohort (QWC) comprises 1059 new warfarin users, with prospective follow-up using telephone questionnaires every 3 months for 1 year, and using healthcare administrativ...
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#1Parin J. PatelH-Index: 6
#2Ronit Katz (UW: University of Washington)H-Index: 58
Last. Rajat Deo (UPenn: University of Pennsylvania)H-Index: 30
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Background Stroke may be the initial manifestation of atrial fibrillation (AF). Limited studies, however, have evaluated racial differences in stroke before the diagnosis of AF. Objective We assessed racial differences in strokes that occurred before and after AF diagnosis in the Penn Atrial Fibrillation Free study. Methods The Penn Atrial Fibrillation Free study consists of 56,835 patients from the University of Pennsylvania Health System who were free of AF at the index visit. We developed an ...
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#1Hanis Zulkifly (University of Birmingham)H-Index: 3
#2Gregory Y.H. Lip (University of Birmingham)H-Index: 141
Last. Deirdre A. Lane (University of Birmingham)H-Index: 59
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BACKGROUND: The most common type of arrhythmia in the USA and in European countries is atrial fibrillation (AF). The prevalence of AF is increasing worldwide with advances in technology, better prediction methods and increased awareness among healthcare professionals and patients. METHODS: This article summarises the literature on the epidemiology of AF worldwide according to continents, age and ethnicity/race, and also includes the prevalence of AF in stroke patients. RESULTS: In Australia, Eur...
5 CitationsSource
The Atrial fibrillation Better Care (ABC) pathway for integrated management provides a simple strategy (Avoid stroke, Better symptom management, and Cardiovascular and comorbidity risk reduction) that helps to improve awareness and detection, and reminds clinicians of the simple decision-making steps for management of patients with atrial fibrillation in a holistic approach.
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Concepts 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 medic...
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Abstract Background Recent improvements in atrial fibrillation diagnosis and management have prompted the initiation of various registries, predominantly to assess adherence to new guidelines but also to address the pending questions of safety and effectiveness of newly introduced management options in "real-world" clinical practice settings. In this review, we appraise antithrombotic treatment patterns for stroke prevention in atrial fibrillation registries. Methods We searched PubMed, Science ...
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#1Valeria Raparelli (Sapienza University of Rome)H-Index: 17
#2Marco ProiettiH-Index: 20
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Oral anticoagulation is pivotal in the management of thromboembolic risk in non-valvular atrial fibrillation (NVAF) patients. Effective anticoagulation is important to avoid major adverse events and medication adherence is central to achieve good anticoagulation control. Non-vitamin K antagonist oral anticoagulants (NOACs) are as effective and safe as vitamin K antagonist (VKAs) in NVAF patients. Due to the absence of routine anticoagulation monitoring with NOACs treatment, concerns have been ra...
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#1Marco Proietti (University of Birmingham)H-Index: 20
#2Alessandro NobiliH-Index: 30
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Background Atrial fibrillation (AF) is associated with a substantial risk of thromboembolism and mortality, significantly reduced by oral anticoagulation. Adherence to guidelines may lower the risks for both all cause and cardiovascular (CV) deaths.
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#1Ziad Hijazi (Uppsala University)H-Index: 24
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Last. Lars Wallentin (Uppsala University)H-Index: 124
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Aims Atrial fibrillation (AF) is associated with an increased risk of stroke, which is currently estimated by clinical characteristics. The cardiac biomarkers N-terminal fragment B-type natriuretic peptide (NT-proBNP) and cardiac troponin high-sensitivity (cTn-hs) are independently associated with risk of stroke in AF. Our objective was to develop and validate a new biomarker-based risk score to improve prognostication of stroke in patients with AF. Methods and results A new risk score was devel...
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#1Gregory Y.H. Lip (AAU: Aalborg University)H-Index: 141
#2Cécile Laroche (European Society of Cardiology)H-Index: 22
Last. Giuseppe Boriani (UNIBO: University of Bologna)H-Index: 59
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Aims Guideline-adherent therapy for stroke prevention in atrial fibrillation has been associated with better outcomes, in terms of thromboembolism (TE) and bleeding. Methods and results In this report from the EuroObservational Research Programme-Atrial Fibrillation (EORP-AF) Pilot General Registry, we describe the associated baseline features of ‘high risk’ AF patients in relation to guideline-adherent antithrombotic treatment, i.e. whether they were adherent, over-treated, or under-treated bas...
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#1Kang-Ho ChoiH-Index: 12
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Background: We investigated the effect of D-dimer levels and efficacy of different antithrombotic therapies according to the baseline D-dimer levels on recurrent stroke in patients with atrial fibrillation (AF)-related stroke and atherosclerosis. Methods: We enrolled 1441 patients with AF-related stroke and atherosclerosis in this nationwide multicenter study. The primary outcome measure was the occurrence of recurrent ischemic stroke over a 3-year period. Results: High D-dimer levels (≥2 μg/mL)...
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