Outcomes in a Warfarin-Treated Population With Atrial Fibrillation

Björck, Fredrik; Renlund, Henrik; Lip, Gregory Y.H.; Wester, Per; Svensson, Peter; Själander, Anders

doi:10.1001/jamacardio.2016.0199

Cited by 134 publications

(106 citation statements)

References 38 publications

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“…9.5.3. Chwiejne wartości międzynarodowego wskaźnika znormalizowanego oraz odpowiednie dawkowanie doustnych leków przeciwzakrzepowych niebędących antagonistami witaminy K Ważnym wskaźnikiem predykcyjnym poważnych krwawień jest TTR podczas stosowania VKA [432,441,494]. U pacjentów otrzymujących VKA zaleca się więc dążenie do INR w przedziale 2,0-3,0, utrzymywane dużego TTR (np.…”

Section: Uprzednio Przebyte Krwawienieunclassified

“…U pacjentów otrzymujących VKA zaleca się więc dążenie do INR w przedziale 2,0-3,0, utrzymywane dużego TTR (np. ≥ 70%) [494] oraz rozważenie zamiany na NOAC, jeżeli nie udaje się utrzymać dużego TTR [444]. Dawkowanie NOAC powinno być zgodne z kryteriami zmniejszania dawki ocenianymi w próbach klinicznych, z uwzględnieniem czynności nerek, wieku i masy ciała.…”

Section: Uprzednio Przebyte Krwawienieunclassified

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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,401

4,206

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Section: Uprzednio Przebyte Krwawienieunclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,401

4,206

View full text Add to dashboard Cite

“…460,484 9.5.3 Labile international normalized ratio and adequate non-vitamin K antagonist oral anticoagulant dosing TTR on VKA therapy is an important predictor of major haemorrhage. 432,441,494 Therefore, we recommend targeting the INR between 2.0 and 3.0 in patients on VKAs, maintaining a high TTR (e.g. ≥70% 494 ), and to consider switching to a NOAC when a high TTR cannot be sustained.…”

Section: Previous Bleeding Eventmentioning

confidence: 99%

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof¹,

Benussi²,

Kotecha³

et al. 2016

Eur J Cardiothorac Surg

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“…Furthermore, the rate of any ICH (traumatic or nontraumatic) is like that of the rate of ischaemic stroke [55]. These data highlight the difficulties of VKAs management in the elderly patients with AF, although it is important to note that, when they are treated in a setting of Anticoagulation Clinics, the bleeding risk is low [56] as well as the rate of thromboembolic events [57].…”

Section: Dabigatran In the Elderly Elderly Atrial Fibrillation And Amentioning

confidence: 98%

Dabigatran etexilate: appropriate use in patients with chronic kidney disease and in the elderly patients

Molteni

Minno

et al. 2017

Intern Emerg Med

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Dabigatran etexilate (DE) is a direct thrombin inhibitor, which has been approved for the treatment of non-valvular atrial fibrillation (AF), and for the prevention and treatment of venous thromboembolism (VTE). Despite large randomized clinical trials and independent observational studies providing robust data concerning DE safety and efficacy, some physicians still perceive mild-to-moderate renal impairment and old age as a relative contraindication to its use. In this article, we review the available scientific evidence supporting the use of DE in these clinical situations. Patients with AF and chronic kidney disease (CKD) are per se at high risk of stroke, bleeding and mortality. Although there is evidence of clinical benefit of anticoagulation in these patients, anticoagulant therapy requires caution and demands careful clinical monitoring, regardless of the drug used. In patients with no contraindication to its use, the clinical benefit of DE versus warfarin is independent of renal function. The elderly with AF are frequently undertreated because of the perception of high bleeding risk and limited clinical benefit. However, the clinical benefit of anticoagulation is independent of patient age, and age per se should not represent a contraindication to anticoagulation. DE has been extensively studied in the elderly, both in randomized clinical trials and in observational studies: DE 150 mg BID should not be used in patients 80 years of age or older, while DE 110 mg BID is as safe as warfarin. Intracranial haemorrhages reduction by DE compared with warfarin is preserved in the elderly. Therefore, mild and moderate CKD and being elderly should not deter physicians from prescribing DE. Furthermore, the availability of a specific antidote is expected to improve the safety of the use of DE in clinical practice.

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Outcomes in a Warfarin-Treated Population With Atrial Fibrillation

Abstract: Well-managed warfarin therapy is associated with a low risk of complications and is still a valid alternative for prophylaxis of AF-associated stroke. Therapy should be closely monitored for patients with renal failure, concomitant aspirin use, and poor INR control.

Cited by 134 publications

References 38 publications

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Dabigatran etexilate: appropriate use in patients with chronic kidney disease and in the elderly patients

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