The safety and efficacy of vitamin K antagonist in atrial fibrillation patients with previous ulcer bleeding

Lee, Seung Jun; Sung, Jung Hoon; Kim, Jin Bae; Ahn, Min Soo; Lee, Hye Young; Uhm, Jae Sun; Pak, Hui Nam; Lee, Moon Hyoung; Kim, Jong Youn; Joung, Boyoung

doi:10.1097/md.0000000000005467

Cited by 10 publications

(6 citation statements)

References 31 publications

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“…In the present study, we found a rate of MACE of 5% per year, which is consistent with other reports 27, 28. This is in accordance with Gallego et al, who found in a cohort of 529 AF patients a rate of thrombotic/cardiovascular events of 5.17% per year in a median follow‐up of 28 months28.…”

Section: Discussionsupporting

confidence: 94%

“…In the subgroup of 458 patients treated with warfarin, the rate of MACE was 5.4% per year. 27 Our results are also in keeping with a prespecified analysis from the ROCKET-AF trial, which showed that AF patients with prior cardiac events are at higher risk of MACE than cardiovascularfree patients. 29 The novel finding of the present study is that patients experiencing MACE disclosed significantly higher values of LPS, as compared with patients free from events during follow-up.…”

Section: Discussionsupporting

confidence: 88%

“…Similar findings have been recently reported in a study including 754 AF patients restarting treatment with warfarin after gastric ulcer bleeding. In the subgroup of 458 patients treated with warfarin, the rate of MACE was 5.4% per year 27. Our results are also in keeping with a prespecified analysis from the ROCKET‐AF trial, which showed that AF patients with prior cardiac events are at higher risk of MACE than cardiovascular‐free patients 29…”

Section: Discussionsupporting

confidence: 85%

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Gut‐Derived Serum Lipopolysaccharide is Associated With Enhanced Risk of Major Adverse Cardiovascular Events in Atrial Fibrillation: Effect of Adherence to Mediterranean Diet

Pastori

Carnevale

Nocella

et al. 2017

JAHA

141

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BackgroundGut microbiota is emerging as a novel risk factor for atherothrombosis, but the predictive role of gut‐derived lipopolysaccharide (LPS) is unknown. We analyzed (1) the association between LPS and major adverse cardiovascular events (MACE) in atrial fibrillation (AF) and (2) its relationship with adherence to a Mediterranean diet (Med‐diet).Methods and ResultsThis was a prospective single‐center study including 912 AF patients treated with vitamin K antagonists (3716 patient‐years). The primary end point was a composite of MACE. Baseline serum LPS, adherence to Med‐diet (n=704), and urinary excretion of 11‐dehydro‐thromboxane B2 (TxB2, n=852) were investigated. Mean age was 73.5 years; 42.9% were women. A total of 187 MACE (5.0% per year) occurred: 54, 59, and 74 in the first, second, and third tertile of LPS, respectively (log‐rank test P=0.004). Log‐LPS (hazard ratio 1.194, P=0.009), age (hazard ratio 1.083, P<0.001), and previous cerebrovascular (hazard ratio 1.634, P=0.004) and cardiac events (hazard ratio 1.822, P<0.001) were predictors of MACE. In the whole cohort, AF (versus sinus rhythm) (β 0.087, P=0.014) and low‐density lipoprotein cholesterol (β 0.069, P=0.049) were associated with circulating LPS. Furthermore, Med‐diet score (β −0.137, P<0.001) was predictive of log‐LPS, with fruits (β −0.083, P=0.030) and legumes (β −0.120, P=0.002) negatively associated with log‐LPS levels. Log‐LPS and log‐TxB2 were highly correlated (r=0.598, P<0.001). Log‐LPS (β 0.574, P<0.001) and Med‐diet score (β −0.218, P<0.001) were significantly associated with baseline urinary excretion of TxB2.ConclusionsIn this cohort of AF patients, LPS levels were predictive of MACE and negatively affected by high adherence to Med‐diet. LPS may contribute to MACE incidence in AF by increasing platelet activation.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 85%

See 1 more Smart Citation

Gut‐Derived Serum Lipopolysaccharide is Associated With Enhanced Risk of Major Adverse Cardiovascular Events in Atrial Fibrillation: Effect of Adherence to Mediterranean Diet

Pastori

Carnevale

Nocella

et al. 2017

JAHA

141

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“…For instance, esophagogastroduodenoscopy confirmed ulcer healing before initiation of OAC significantly reduces the rate of major bleeding [ 44 ]. Also, good (>65%) opposed to poor (<65%) TTR did not increase the risk of a recurrent ulcer bleeding but provided better stroke prevention [ 42 ]. The optimal time window of reinitiating OAC following gastrointestinal bleeding remains unclear.…”

Section: Aspects Of Successful Long-term Antithrombotic Managementmentioning

confidence: 99%

Optimal long-term antithrombotic management of atrial fibrillation: life cycle management

et al. 2018

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Optimal antithrombotic management of atrial fibrillation equals balancing between prevention of arterial thromboembolism, predominantly ischaemic stroke, and haemorrhagic complications. Over time different antithrombotic agents and strategies have been developed. At present, non-vitamin K antagonist oral anticoagulants (NOACs) are the first-line therapy for stroke prevention in patients with non-valvular atrial fibrillation (i.e. without a mechanical valve prosthesis or rheumatic heart disease). Considering the impact of the suboptimal adoption of recommended oral anticoagulant therapy, as experienced with the previous first-line vitamin K antagonists, this review focuses on adequate use of NOACs. As such, we address the most important and clinically challenging issues in the antithrombotic life cycle management for long-term stroke prevention in atrial fibrillation.

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“…Among those with gastrointestinal bleeding, gastric and duodenal ulcers are the most common etiologies, accounting for approximately 45–70% of total cases ( 4 , 5 ). A retrospective study in AF patients with a history of ulcer bleeding showed warfarin failed to improve outcomes, as the modest benefit in reducing major adverse cardiovascular events was offset by increased gastrointestinal bleeding ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Safety and Effectiveness of Direct Oral Anticoagulants vs. Warfarin in Patients With Atrial Fibrillation and Endoscopy-Diagnosed Peptic Ulcer

Wang

Huang

et al. 2021

Front. Cardiovasc. Med.

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Background: Patients with active peptic ulcer (PU) were excluded from direct oral anticoagulant (DOAC) trials for stroke prevention in patients with atrial fibrillation (AF). This study evaluated the safety and effectiveness of DOACs in AF patients with active, inactive and no peptic ulcer (PU).Methods: This study accessed electronic medical records from January 1, 2009 to May 31, 2019 at a multi-center healthcare provider in Taiwan and involved 2,955 AF patients who had undergone esophagogastroduodenoscopy ≤ 1 year before anticoagulation. Subjects were classified into 3 groups: active (n = 237), inactive (n = 828) and no-PU (n = 1,890) groups. We compared the risks of major bleeding, gastrointestinal bleeding, and ischemic stroke/systemic embolism (IS/SE) between DOACs and warfarin among the 3 groups.Results: In the active PU group, there were no significant differences in the risks of major bleeding [hazard ratio (HR) = 0.65, 95% confidence interval (CI) 0.08–4.98, p = 0.676], gastrointestinal bleeding (HR = 0.65, 95% CI 0.08–4.98, p = 0.676) and IS/SE (HR = 2.58; 95% CI 0.53–12.70, p = 0.243) between DOAC and warfarin (as the reference). In the inactive PU group, there were no significant differences in the risks of major bleeding (HR = 0.36, 95% CI 0.09–1.39, p = 0.138), gastrointestinal bleeding (HR = 0.21, 95% CI 0.02–1.80, p = 0.153), and IS/SE (HR = 1.04, 95% CI 0.39–2.82, p = 0.934) between DOAC and warfarin (as the reference). In the no-PU group, DOACs were associated with lower risk of major bleeding (HR = 0.26, 95% CI 0.12–0.53, p < 0.001), gastrointestinal bleeding (HR = 0.25, 95% CI 0.01–0.59, p = 0.002), and similar risk of IS/SE (HR = 0.92, 95% CI 0.55–1.54, p = 0.757) compared to warfarin.Conclusions: DOACs were as effective as warfarin in preventing IS/SE irrespective of PU status and safer than warfarin in reducing major bleeding in the no-PU group. In patients with active or inactive PUs, DOAC and warfarin were not significantly different in their effects on major bleeding or gastrointestinal bleeding.

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The safety and efficacy of vitamin K antagonist in atrial fibrillation patients with previous ulcer bleeding

Abstract: Supplemental Digital Content is available in the text

Cited by 10 publications

References 31 publications

Gut‐Derived Serum Lipopolysaccharide is Associated With Enhanced Risk of Major Adverse Cardiovascular Events in Atrial Fibrillation: Effect of Adherence to Mediterranean Diet

Gut‐Derived Serum Lipopolysaccharide is Associated With Enhanced Risk of Major Adverse Cardiovascular Events in Atrial Fibrillation: Effect of Adherence to Mediterranean Diet

Optimal long-term antithrombotic management of atrial fibrillation: life cycle management

Safety and Effectiveness of Direct Oral Anticoagulants vs. Warfarin in Patients With Atrial Fibrillation and Endoscopy-Diagnosed Peptic Ulcer

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