Questionable levels of evidence in new atrial fibrillation guidelines? Reply

Camm, A. John; Lip, G. Y.; Caterina, R De; Savelieva, Irina; Atar, Dan; Hohnloser, Stefan H.; Hindricks, Gerhard; Kirchhof, Paulus

doi:10.1093/europace/eus394

Cited by 53 publications

(86 citation statements)

References 10 publications

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“…6,22 Guidelines reflect this uncertainty and either do not mention patients with ESRD or make no recommendation. [24][25][26] There is unease about using vitamin K antagonists in ESRD not only because of the increased risk of bleeding but also the association with vascular calcification inducing cardiovascular disease or calciphylaxis. 27,28 Unfortunately, no suitable alternative currently exists.…”

Section: Anticoagulation In Esrdmentioning

confidence: 99%

Risk Factors of Ischemic Stroke and Subsequent Outcome in Patients Receiving Hemodialysis

Findlay

Thomson

Fulton

et al. 2015

Stroke

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Background and Purpose— End-stage renal disease (ESRD) requiring hemodialysis carries up to a 10-fold greater risk of stroke than normal renal function. Knowledge on risk factors and management strategies derived from the general population may not be applicable to those with ESRD. We studied a large ESRD population to identify risk factors and outcomes for stroke. Methods— All adult patients receiving hemodialysis for ESRD from January 1, 2007, to December 31, 2012, were extracted from the electronic patient record. Variables associated with stroke were identified by survival analysis; demographic, clinical, imaging, and dialysis-related variables were assessed, and case-fatality was determined. Follow-up was until December 31, 2013. Results— A total of 1382 patients were identified (mean age, 60.5 years; 58.5% men). The prevalence of atrial fibrillation was 21.2%, and 59.4% were incident hemodialysis patients. One hundred and sixty patients (11.6%) experienced a stroke during 3471 patient-years of follow-up (95% ischemic). Stroke incidence was 41.5/1000 patient-years in prevalent and 50.1/1000 patient-years in incident hemodialysis patients. Factors associated with stroke on regression analysis were prior stroke, diabetes mellitus, and age at starting renal replacement therapy. Atrial fibrillation was not significantly associated with stroke, and warfarin did not affect stroke risk in warfarin-treated patients. Fatality was 18.8% at 7 days, 26.9% at 28 days, and 56.3% at 365 days after stroke. Conclusions— Incidence of stroke is high in patients with ESRD on hemodialysis with high case-fatality. Incident hemodialysis patients had the highest stroke incidence. Many, but not all, important risk factors commonly associated with stroke in the general population were not associated with stroke in patients receiving hemodialysis.

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Section: Anticoagulation In Esrdmentioning

confidence: 99%

Risk Factors of Ischemic Stroke and Subsequent Outcome in Patients Receiving Hemodialysis

Findlay

Thomson

Fulton

et al. 2015

Stroke

View full text Add to dashboard Cite

show abstract

“…In non-anticoagulated patients the periprocedure risk of ischemic event associated with ECV is between 5 and 7%, but warfarin treatment reduces the incidence of thromboembolic events between 0.5 and 1.6% [6]. International guidelines recommend at least 3 consecutive weeks of effective anticoagulation prior to cardioversion, followed by at least another 4 weeks of anticoagulation thereafter [5,7].…”

Section: Discussionmentioning

confidence: 99%

“…All patients received anticoagulant treatment before ECV for at least 3 weeks, as indicated by clinical practice guidelines [5]. The choice of the type of anticoagulant treatment was decided by the responsible physician before the patient was referred to the Arrhythmia Unit for ECV.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness and Safety of Direct Oral Anticoagulants Compared With Vitamin K Antagonists in Non-Valvular Atrial Fibrillation Patients Undergoing Electrical Cardioversion

Carrillo-Aleman¹,

Candela-Sanchez²,

Lozano³

et al. 2017

JCTCD

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“…The prevalence tends to increase with aging from 0.5% in 40-50 year old patients till 5-17% in 80-85 year old patients (Camm et al, 2012;European Heart Rhythm et al, 2010;Go et al, 2001;Stewart, Hart, Hole, & McMurray, 2001). The possibility of developing AF at the age of 55 in the European population is 23.8% for men and 22.2% for women (Heeringa et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

“…As for the male patients with CHA2DS2-VASc a score of one, the benefit of oral anticoagulants must be compared with possible bleeding risk as assessed by the HAS-BLED score, with oral anticoagulants prescribed where the stroke risk outweighs the risk of bleeding. Stroke and bleeding risks should be re-evaluated at least once a year, coinciding with change of age category new hypertension, and certain other categories (Camm et al, 2012;Hobbs et al, 2015).…”

Section: Introductionmentioning

confidence: 99%