Dataset Information

Tailored Anticoagulation for Thromboembolic Risk Reduction in Paroxysmal Atrial Fibrillation.

ABSTRACT: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting up to six million people in the United States and more than 35 million individuals worldwide. Thromboembolism, including stroke, represents the most common AF-related morbidity and mortality and data indicate that anticoagulation can mitigate this risk by 65%. Our understanding of thromboembolism in AF, however, remains incomplete, and the mechanisms by which AF increases thromboembolic risk are areas of ongoing investigation and debate. Current guidelines do not differentiate between the frequency and duration of AF episodes (AF burden) when selecting which patients with AF should be treated with anticoagulation for thromboembolic risk reduction. Recent data, primarily using cardiac implantable electronic devices (CIEDs) such as pacemakers, implantable cardioverter-defibrillators, and implantable loop recorders, however, have challenged this longstanding notion that AF burden does not influence thromboembolic risk. Continuous and automated cardiac rhythm monitoring via CIEDs with accurate and rapid acquisition and transmission of rhythm data also affords the opportunity to study the relationship between AF burden and thromboembolism and novel ways to reduce thromboembolic risk while minimizing the risk associated with chronic anticoagulation use. This manuscript will review the associations between subclinical, CIED-detected atrial arrhythmias and thromboembolic events. It will also discuss the emergence of "tailored anticoagulation," an anticoagulation strategy wherein CIEDs and remote AF monitoring are employed to allow dynamic administration of oral anticoagulation only around episodes of AF, and the holding of anticoagulation during prolonged periods of sinus rhythm when the thromboembolic risk associated with AF is presumably very low.

SUBMITTER: Matos JD

PROVIDER: S-EPMC7252665 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Tailored Anticoagulation for Thromboembolic Risk Reduction in Paroxysmal Atrial Fibrillation.

Matos Jason D JD Waks Jonathan W JW Zimetbaum Peter J PJ

The Journal of innovations in cardiac rhythm management 20180415 4

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting up to six million people in the United States and more than 35 million individuals worldwide. Thromboembolism, including stroke, represents the most common AF-related morbidity and mortality and data indicate that anticoagulation can mitigate this risk by 65%. Our understanding of thromboembolism in AF, however, remains incomplete, and the mechanisms by which AF increases thromboembolic risk are areas of ongoing ...[more]

PMID: 32477807

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Project description:Few data on the thromboembolic (TE) risk of paroxysmal and persistent atrial fibrillation (AF) are available. This study aimed to assess the incidence of TE events in paroxysmal and persistent AF.We performed a subset post hoc analysis of 771 patients with paroxysmal and 463 with persistent AF enrolled in the multicenter, prospective, randomized, double-blind, placebo-controlled GISSI-AF trial - comparing the efficacy of valsartan versus placebo in preventing AF recurrences - where the choice of antithrombotic treatment was left to the judgment of the referring physician. TE and major outcome events were centrally validated. AF recurrences were detected by frequent clinic visits and a transtelephonic monitoring device with weekly and symptomatic transmissions.Eighty-five percent of patients had a history of hypertension, and the 7.7% had heart failure, left ventricular dysfunction, or both. The mean CHADS2 score was 1.41±0.84. TE and major bleeding events were observed at a low incidence among the overall population at 1-year follow-up (0.97% and 0.81%, respectively). The univariate and multivariable analyses revealed no statistically significant differences in the incidence of TE, major bleeding events or mortality in paroxysmal and persistent AF patients. TE events were more common among women than men (p=0.02). The follow-up examination showed under- or overtreatment with warfarin in many patients, according to guideline suggestions. Warfarin was more frequently prescribed to patients with persistent AF (p<0.0001) and patients with AF recurrences (p<0.0001). AF recurrences were noninvasively detected in 632 (51.2%) patients. In patients without AF recurrences, the TE event rate was 0.5% versus 1.74%, 1.28%, and 1.18% for those with only symptomatic, only asymptomatic or both symptomatic and asymptomatic AF recurrences, respectively, but the difference was not statistically significant, even after adjusting for warfarin treatment and the CHADS2 score (HR 2.93; CI 95%; 0.8-10.9; p=0.11).TE and major bleeding events showed a very low incidence in the GISSI-AF trial population, despite under- or overtreatment with warfarin in many patients. TE events had a similar rate in paroxysmal and persistent AF.NCT00376272.

Dataset Information

Tailored Anticoagulation for Thromboembolic Risk Reduction in Paroxysmal Atrial Fibrillation.

Publications

Tailored Anticoagulation for Thromboembolic Risk Reduction in Paroxysmal Atrial Fibrillation.

Similar Datasets

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