Canadian Cardiovascular Society Atrial Fibrillation Guidelines 2010: Prevention of Stroke and Systemic Thromboembolism in Atrial Fibrillation and Flutter

Cairns, John A.; Connolly, Stuart J.; McMurtry, Sean; Stephenson, Michael; Talajic, Mario

doi:10.1016/j.cjca.2010.11.007

Cited by 260 publications

(180 citation statements)

References 105 publications

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“…This could be explained by limited evidence on the safety of the DOAC-clopidogrel association. Furthermore, at the beginning of the study period, the 2010 Canadian Cardiovascular Society Atrial Fibrillation Guidelines recommended warfarin over dabigatran in patients with AF and coronary artery disease requiring an OAC and antiplatelet therapy 15 , while more recent guidelines favors DOACs based on limited evidence. 16 This result suggests that clinicians are cautious about the use of DOACs in subjects on antiplatelet therapy.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Direct Oral Anticoagulants Utilization for Thromboembolism Prevention in Atrial Fibrillation

et al. 2017

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-PURPOSE:Several factors have been associated with the prescription of direct oral anticoagulants (DOAC) over warfarin such as younger age, fewer concomitant medications, and lower CHADS 2 or bleeding scores. The primary objective of this study was to identify predictors of DOAC choice compared with warfarin for patients who are starting a new oral anticoagulant (OAC) for atrial fibrillation (AF). The secondary objective was to describe the proportion of DOAC prescriptions in new users of OAC for AF. METHODS: A retrospective cross-sectional study was conducted in a teaching hospital in Canada. Medical records of adult patients hospitalized in any medical units between October 1 st , 2011 and October 1 st , 2014, who were newly prescribed an OAC for non valvular AF were systematically reviewed. Baseline characteristics of warfarin and DOAC users were compared and a multivariate logistic regression analysis was completed to identify predictors of DOAC use. Variables included in the multiple regression analysis were: age, hypertension, diabetes, history of stroke or transient ischemic attack, coronary artery disease, peripheral arterial disease, CHADS 2 score of 2 or more, creatinine clearance 30mL/min or more, polypharmacy, concomitant use of ASA or clopidogrel, and prescription by a neurologist. RESULTS: Among OAC users (144 patients To the best of our knowledge, this is the first observational study finding that concomitant use of clopidogrel reduced the likelihood of DOAC utilization while prescription by a neurologist increased the probability of receiving a DOAC over warfarin in patients with AF.

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Section: Discussionmentioning

confidence: 99%

Predictors of Direct Oral Anticoagulants Utilization for Thromboembolism Prevention in Atrial Fibrillation

et al. 2017

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“…One in five strokes is caused by atrial fibrillation [2], and patients with atrial fibrillation have a five-fold increased risk of stroke [3]. Strokes in patients with atrial fibrillation are associated with higher mortality and cause more severe disability -thus, stroke prevention in patients with atrial fibrillation is an essential part of management [2,4].…”

Section: Introductionmentioning

confidence: 99%

“…Strokes in patients with atrial fibrillation are associated with higher mortality and cause more severe disability -thus, stroke prevention in patients with atrial fibrillation is an essential part of management [2,4].…”

Section: Introductionmentioning

confidence: 99%

Retinal vein and artery occlusions: a risk factor for stroke in atrial fibrillation

Christiansen

Lip

Lamberts

et al. 2013

Journal of Thrombosis and Haemostasis

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Summary. Background: Retinal vascular occlusions may constitute an independent risk factor for stroke in patients with atrial fibrillation. Methods: We performed a retrospective study on a nationwide cohort with atrial fibrillation from 1997 to 2008. The rate of stroke/systemic thromboembolism (TE)/transitory ischemic attack (TIA) was determined for atrial fibrillation patients with and without a history of retinal vascular occlusion. A Cox regression analysis, adjusted for risk factors and medications, was performed to determine the independent predictive value of retinal arterial or venous occlusion for the risk of ischemic stroke, TE or TIA in atrial fibrillation patients. Results: We included 87 202 patients with nonvalvular atrial fibrillation. At baseline, a history of retinal arterial occlusion was diagnosed in 224 patients (0.26%) and a history of retinal venous occlusion in 361 (0.41%). Patients without retinal occlusion had a rate of stroke/TE/ TIA of 4.52 (95% confidence interval [CI] 4.44-4.60). For patients with retinal arterial occlusion, the rate of stroke/ TE/TIA was 8.16 (95% CI 6.35-10.49) per 100 personyears, and for patients with retinal venous occlusion it was 7.28 (95% CI 5.93-8.94) per 100 person-years. In multivariate analysis, both retinal arterial occlusions (hazard ratio [HR] 1.39, 95% CI 1.08-1.79) and retinal venous occlusions (HR 1.26, 95% CI 1.02-1.54) were associated with an increased risk of future stroke/TE/TIA. Conclusions: A history of retinal arterial or retinal venous occlusion is associated with an increased risk of stroke/TE/TIA in patients with atrial fibrillation. Thus, prior retinal vascular occlusion may be considered as a previous thromboembolic event when evaluating stroke risk in patients with atrial fibrillation.

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“…[1][2][3][4] Its presence increases 2-7-fold the risk of ischemic stroke and systemic embolism compared to patients in sinus rhythm, showing a mean incidence of new embolic events of approximately 5% per year. [5][6][7][8] The magnitude of AF embolic risk is influenced by the presence of additional prognostic factors: age over 65 years, congestive heart failure, blood hypertension, diabetes, history of previous transient ischemic attack (TIA) or stroke, history of vascular diseases, female sex. Their weight in predicting embolic risk has been codified in practical scales such as the CHADS 2 and the most recently released CHA 2 DS 2 -VASC.…”

Section: Introductionmentioning

confidence: 99%

“…9 The most recent guidelines suggest as a possible alternative the combination acetylsalicylic acid (ASA)/clopidogrel to oral anticoagulants in patients at low bleeding risk or ASA alone in patients at high bleeding risk when oral anticoagulants are contraindicated because of limitations or when not accepted by the patient. [5][6][7][8]10 In patients at low embolic risk, no antithrombotic therapy is recommended. However, where the physicians are inclined to recommend antithrombotic prevention therapy, the guidelines suggest the use of ASA alone [5][6][7][8]10 ( Figure 1).…”

Section: Introductionmentioning

confidence: 99%

Direct oral anticoagulants for secondary prevention in patients with non-valvular atrial fibrillation

Masotti¹,

Napoli

Ageno

et al. 2013

Ital J Med

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The patients with non-valvular atrial fibrillation (NVAF), both permanent and paroxysmal, and history of previous transient ischemic attack (TIA) or stroke represent a category of patients at high risk of new embolic events, independently of the presence of other risk factors. In these patients, national and international guidelines recommend oral anticoagulants as first choice for antithrombotic prevention. Direct oral anticoagulants (DOACs) have been demonstrated to be not inferior to warfarin for many end points in NVAF patients in terms of efficacy and safety. The post hoc analysis in selected subgroups of patients enrolled in the three mega trials of phase III comparing DOACs (RE-LY, ROCKET-AF and ARISTOTLE) with warfarin help to evaluate whether superiority and non-inferiority persist in these subgroups. Here, patients with NVAF and history of previous TIA/stroke receiving DOACs as secondary prevention are compared with patients with the same characteristics receiving warfarin. An analysis of these patients has been recently published (separately for each of three DOACs). This analysis shows that DOACs maintain their non-inferiority when compared with warfarin in secondary prevention, representing a real alternative in this context of patients at high risk for ischemic and bleeding events.

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Canadian Cardiovascular Society Atrial Fibrillation Guidelines 2010: Prevention of Stroke and Systemic Thromboembolism in Atrial Fibrillation and Flutter

Cited by 260 publications

References 105 publications

Predictors of Direct Oral Anticoagulants Utilization for Thromboembolism Prevention in Atrial Fibrillation

Predictors of Direct Oral Anticoagulants Utilization for Thromboembolism Prevention in Atrial Fibrillation

Retinal vein and artery occlusions: a risk factor for stroke in atrial fibrillation

Direct oral anticoagulants for secondary prevention in patients with non-valvular atrial fibrillation

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