1
|
Araki T, Hayashi K, Sonoda Y, Honda T, Imamura Y, Koide Y, Hamada H, Nakao K. Dabigatran-induced esophagitis with full circumferential blue pigmentation. DEN Open 2024; 4:e271. [PMID: 37469668 PMCID: PMC10352591 DOI: 10.1002/deo2.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/23/2023] [Accepted: 07/02/2023] [Indexed: 07/21/2023]
Abstract
Dabigatran is a useful and widely used drug for stroke prevention in patients with atrial fibrillation. However, it has been reported to cause esophagitis. Herein, we report the case of a 77-year-old man with dabigatran-induced esophagitis with blue pigmentation, which is known to be a rare adverse effect. The patient presented to our hospital with a tightness of the chest and anorexia. Computed tomography revealed a thickening of the entire esophageal wall, with an upper esophageal predominance. Esophagogastroduodenoscopy was performed, which showed that the cervical and upper thoracic esophagus had blue pigmentation with edematous changes, partial narrowing, and longitudinal sloping. We replaced dabigatran with edoxaban, a similar anticoagulation medication. The patient was closely monitored for 1 month after switching to edoxaban. The follow-up esophagogastroduodenoscopy showed marked improvements, revealing resolution of the bluish discoloration and edematous changes, and the patient's complaints regarding the tightness of the chest and anorexia were also resolved. It is important to recognize that such side effects can occur with dabigatran, a drug that is frequently used in daily practice. Considering the fact that strong edematous changes can cause indigo carmine pigmentation associated with dabigatran stagnation, we recommend switching to another anticoagulant if esophagitis occurs during dabigatran administration.
Collapse
Affiliation(s)
- Tomonori Araki
- Department of Gastroenterology and HepatologyGraduate School of Biomedical Sciences, Nagasaki UniversityNagasakiJapan
- Medical Education Development CenterNagasaki University HospitalNagasakiJapan
- Nagasaki Memorial HospitalNagasakiJapan
| | - Kohei Hayashi
- Department of Gastroenterology and HepatologyGraduate School of Biomedical Sciences, Nagasaki UniversityNagasakiJapan
| | - Yuki Sonoda
- Department of Gastroenterology and HepatologyGraduate School of Biomedical Sciences, Nagasaki UniversityNagasakiJapan
| | - Takuya Honda
- Department of Gastroenterology and HepatologyGraduate School of Biomedical Sciences, Nagasaki UniversityNagasakiJapan
| | - Yoshifumi Imamura
- Medical Education Development CenterNagasaki University HospitalNagasakiJapan
- Nagasaki Memorial HospitalNagasakiJapan
| | - Yuji Koide
- Medical Education Development CenterNagasaki University HospitalNagasakiJapan
- Nagasaki Memorial HospitalNagasakiJapan
| | - Hisayuki Hamada
- Medical Education Development CenterNagasaki University HospitalNagasakiJapan
| | - Kazuhiko Nakao
- Department of Gastroenterology and HepatologyGraduate School of Biomedical Sciences, Nagasaki UniversityNagasakiJapan
| |
Collapse
|
2
|
Chan SHK, Sin PSL, Lee MKY, Fong WC, Cheung CY, Lee CP, Leung WYS, Chu KKY, Cheung YT. Development and validation of the Chinese oral anticoagulants knowledge tool (C-OAKT): A pilot study. PEC Innov 2023; 3:100210. [PMID: 37727699 PMCID: PMC10505667 DOI: 10.1016/j.pecinn.2023.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 08/27/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
Objective To develop and validate an oral anticoagulant knowledge tool for Chinese-speaking patients treated with warfarin or direct oral anticoagulants (DOACs) in Hong Kong. Method This pilot validation study consisted of the following three phases: (1) the development of a knowledge tool and content validity assessment; (2) a pilot study of 200 participants, consisting of 100 patients taking warfarin or DOACs, 50 pharmacists, and 50 members of the general public; and (3) known-group validity and reliability assessments. Results A 19-item "Chinese Oral Anticoagulants Knowledge Tool (C-OAKT)" was developed with a scale content validity index of 0.95. The mean score for known-group validity was significantly higher in the pharmacist group than the patient groups, and the patient groups scored significantly higher than the general public (mean ± standard deviation [SD] = 90.00 ± 7.11 vs. 51.55 ± 17.49 vs. 19.0 ± 15.42, respectively; p < 0.001). The mean score was higher for patients who attended a pharmacist-managed anticoagulant therapy management clinic (PAC) than for non-PAC patients (mean ± SD = 56.80 ± 13.60 vs. 46.30 ± 9.43; p = 0.004). An analysis of internal consistency showed a Cronbach's alpha value of 0.86. Conclusion The results of the pilot validation study suggested that the C-OAKT is a valid and reliable instrument for assessing patients' knowledge of oral anticoagulants in ambulatory care settings. Innovations This is the first validated Chinese version of an anticoagulant knowledge assessment tool. This tool will be utilized in public hospitals in Hong Kong, and will facilitate future research exploring the relationship between anticoagulant knowledge and patient-related outcomes.
Collapse
Affiliation(s)
- Serena Hiu Kwan Chan
- Department of Pharmacy, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - Phoebe Sze Lam Sin
- Department of Pharmacy, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - Michael Kang Yin Lee
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - Wing Chi Fong
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - Chi Yuen Cheung
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - Chui Ping Lee
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Wilson Yun Shing Leung
- Department of Pharmacy, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - Kitty Kit Yee Chu
- Department of Pharmacy, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| |
Collapse
|
3
|
Hengstenberg C, Van Mieghem NM, Wang R, Ye X, Shi L, Guo S, Chen C, Jin J, Ye X, Dangas G, Unverdorben M. Treatment Satisfaction and Convenience for Patients With Atrial Fibrillation on Edoxaban or Vitamin K Antagonists After Transcatheter Aortic Valve Replacement: A Post Hoc Analysis from the ENVISAGE-TAVI AF Trial. Am J Cardiol 2023; 209:212-219. [PMID: 37848174 DOI: 10.1016/j.amjcard.2023.09.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/14/2023] [Accepted: 09/24/2023] [Indexed: 10/19/2023]
Abstract
ENVISAGE-TAVI AF (Edoxaban versus Standard of Care and Their Effects on Clinical Outcomes in Patients Having Undergone Transcatheter Aortic Valve Implantation-Atrial Fibrillation; NCT02943785) was a prospective, randomized, open-label trial comparing non-vitamin K oral anticoagulant (NOAC) edoxaban with vitamin K antagonists (VKAs) in patients with atrial fibrillation after successful transcatheter aortic valve replacement (TAVR). The effect of edoxaban- or VKA-based therapy on patient-reported outcomes remains unknown, as most studies focus on efficacy and safety. Pre-TAVR patient-reported expectations and post-TAVR Treatment Satisfaction and Convenience with edoxaban or VKA treatment (at months 3 and 12) were analyzed using the Perception of Anticoagulation Treatment Questionnaire (PACT-Q). This analysis included randomized and dosed patients with an evaluable PACT-Q1 assessment at baseline and ≥1 postbaseline assessment (PACT-Q2). Subanalyses included patients stratified by pre-TAVR anticoagulant (NOAC, VKA, no NOAC/VKA). Edoxaban- (n = 585) and VKA-treated (n = 522) patients had similar baseline characteristics and treatment expectations. Pre-TAVR anticoagulant use did not affect treatment expectations. After TAVR, edoxaban-treated patients had significantly higher Treatment Satisfaction and Convenience scores compared with VKA-treated patients at all time points (p <0.001 for all). Among edoxaban-treated patients, those who received VKAs pre-TAVR were significantly more satisfied with treatment than those who received NOACs (p <0.001) or no NOACs/VKAs (p = 0.003); however, there was no significant difference in the perception of convenience (p = 0.927 and p = 0.092, respectively). Conversely, among VKA-treated patients, the type of anticoagulant used pre-TAVR did not affect Treatment Satisfaction or Convenience scores post-TAVR. In conclusion, patients with atrial fibrillation who received edoxaban post-TAVR reported significantly higher Treatment Satisfaction and Convenience scores compared with those who received VKAs, resulting in a clinically meaningful difference between treatment groups.
Collapse
Affiliation(s)
- Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University, Vienna, Austria.
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands
| | - Rosa Wang
- Daiichi Sankyo, Inc., Basking Ridge, New Jersey
| | - Xiaomei Ye
- Clinical Outcomes Analytics, Evidera PPD, LLC, Bethesda, Maryland
| | - Ling Shi
- Clinical Outcomes Analytics, Evidera PPD, LLC, Bethesda, Maryland
| | - Shien Guo
- Clinical Outcomes Analytics, Evidera PPD, LLC, Bethesda, Maryland
| | - Cathy Chen
- Daiichi Sankyo, Inc., Basking Ridge, New Jersey
| | - James Jin
- Daiichi Sankyo, Inc., Basking Ridge, New Jersey
| | - Xin Ye
- Daiichi Sankyo, Inc., Basking Ridge, New Jersey
| | - George Dangas
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York; School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | |
Collapse
|
4
|
Grosse GM, Hüsing A, Stang A, Kuklik N, Brinkmann M, Nabavi D, Sparenberg P, Weissenborn K, Gröschel K, Royl G, Poli S, Michalski D, Eschenfelder CC, Weimar C, Diener HC. Early or late initiation of dabigatran versus vitamin-K-antagonists in acute ischemic stroke or TIA: The PRODAST study. Int J Stroke 2023; 18:1169-1177. [PMID: 37306492 PMCID: PMC10676026 DOI: 10.1177/17474930231184366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/07/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND The optimal timing of initiating or resuming anticoagulation after acute ischemic stroke (AIS) or transient ischemic attack (TIA) in patients with atrial fibrillation (AF) is debated. Dabigatran, a non-vitamin K oral anticoagulant (NOAC), has shown superiority against vitamin K antagonists (VKA) regarding hemorrhagic complications. AIMS In this registry study, we investigated the initiation of dabigatran in the early phase after AIS or TIA. METHODS PRODAST (Prospective Record of the Use of Dabigatran in Patients with Acute Stroke or TIA) is a prospective, multicenter, observational, post-authorization safety study. We recruited 10,039 patients at 86 German stroke units between July 2015 and November 2020. A total of 3,312 patients were treated with dabigatran or VKA and were eligible for the analysis that investigates risks for major hemorrhagic events within 3 months after early (⩽ 7 days) or late (> 7 days) initiation of dabigatran or VKA initiated at any time. Further endpoints were recurrent stroke, ischemic stroke, TIA, systemic embolism, myocardial infarction, death, and a composite endpoint of stroke, systemic embolism, life-threatening bleeding and death. RESULTS Major bleeding event rates per 10,000 treatment days ranged from 1.9 for late administered dabigatran to 4.9 for VKA. Early or late initiation of dabigatran was associated with a lower hazard for major hemorrhages as compared to VKA use. The difference was pronounced for intracranial hemorrhages with an adjusted hazard ratio (HR) of 0.47 (95% confidence interval (CI): 0.10-2.21) for early dabigatran use versus VKA use and an adjusted HR of 0.09 (95% CI: 0.00-13.11) for late dabigatran use versus VKA use. No differences were found between early initiation of dabigatran versus VKA use regarding ischemic endpoints. CONCLUSIONS The early application of dabigatran appears to be safer than VKA administered at any time point with regards to the risk of hemorrhagic complications and in particular for intracranial hemorrhage. This result, however, must be interpreted with caution in view of the low precision of the estimate.
Collapse
Affiliation(s)
- Gerrit M Grosse
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Anika Hüsing
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Andreas Stang
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - Nils Kuklik
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Marcus Brinkmann
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- Center for Clinical Trials Essen, University Hospital Essen, Essen, Germany
| | - Darius Nabavi
- Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Paul Sparenberg
- Department of Neurology, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | | | - Klaus Gröschel
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Georg Royl
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Sven Poli
- Department of Neurology and Stroke, University of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | | | | | - Christian Weimar
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- BDH-Klinik Elzach, Elzach, Germany
| | - Hans-Christoph Diener
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | | |
Collapse
|
5
|
Genovesi S, Porcu L, Rebora P, Slaviero G, Casu G, Bertoli S, Airoldi F, Buskermolen M, Gallieni M, Pieruzzi F, Rovaris G, Montoli A, Piccaluga E, Molon G, Alberici F, Adamo M, Gaspardone A, D'Angelo G, Merella P, Vezzoli G, Trezzi B, Mazzone P. Long-term safety and efficacy of left atrial appendage occlusion in dialysis patients with atrial fibrillation: a multi-center, prospective, open label, observational study. Clin Kidney J 2023; 16:2683-2692. [PMID: 38046009 PMCID: PMC10689152 DOI: 10.1093/ckj/sfad221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Indexed: 12/05/2023] Open
Abstract
Background The prevalence of atrial fibrillation (AF) in end stage kidney disease (ESKD) patients undergoing dialysis is high, however, the high risk of bleeding often hampers with a correct anticoagulation in ESKD patients with AF, despite high thromboembolic risk. Left atrial appendage (LAA) occlusion is a anticoagulation (OAT) for thromboembolism prevention in AF populations with high hemorrhagic risk. Methods and Results The purpose of the study was to evaluate the efficacy and safety of LAA occlusion in a cohort of dialysis patients undergoing the procedure (LAA occlusion cohort, n = 106), in comparison with two other ESKD cohorts, one taking warfarin (Warfarin cohort, n = 114) and the other without anticoagulation therapy (No-OAT cohort, n = 148). After a median follow-up of 4 years, a Cox regression model, adjusted for possible confounding factors, showed that the hazard ratios (HRs) of thromboembolic events in the LAA occlusion cohort were 0.19 (95%CI 0.04-0.96; p = 0.045) and 0.16 (95%CI 0.04-0.66; p = 0.011) as compared with Warfarin and No-OAT cohorts, respectively. The HR of bleeding in the LAA occlusion cohort was 0.37 (95%CI 0.16-0.83; p = 0.017) compared to Warfarin cohort, while there were no significant differences between the LAA occlusion and the No-OAT cohort (HR 0.51; 95%CI 0.23-1.12; p = 0.094). Adjusted Cox regression models showed lower mortality in patients undergoing LAA occlusion as compared with both the Warfarin cohort (HR 0.60; 95%CI 0.38-0.94; p = 0.027) and no-OAT cohort (HR 0.52; 95%CI 0.34-0.78; p = 0.002). Thromboembolic events in the LAA occlusion cohort were lower than expected according to the CHA2DS2VASc score (1.7 [95%CI 0.3-3.0] vs 6.7 events per 100 person/years, p < 0.001). Conclusion In ESKD patients with AF, LAA occlusion is safe and effective and is associated with reduced mortality compared with OAT or no therapy.
Collapse
Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Luca Porcu
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Paola Rebora
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Gavino Casu
- Cardiology Unit, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy
| | - Silvio Bertoli
- Dialysis and Nephrology Unit-IRCCS-Multimedica, Sesto S.Giovanni, Italy
| | - Flavio Airoldi
- Electrophysiology Unit-IRCCS-Multimedica, Sesto S.Giovanni, Italy
| | | | - Maurizio Gallieni
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milano, Italy
- Department of Biomedical and Clinical Sciences, University of Milano, Milano, Italy
| | - Federico Pieruzzi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giovanni Rovaris
- Interventional Electrophysiology Unit, San Gerardo Hospital, Monza, Italy
| | | | | | - Giulio Molon
- Cardiology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Federico Alberici
- Nephrology Unit, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology Unit, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | | | | | - Pierluigi Merella
- Cardiology Unit, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy
| | | | - Barbara Trezzi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Patrizio Mazzone
- Cardiology 3, “A. De Gasperis” Cardio Center, ASST GOM Niguarda Ca' Granda, Milan, Italy
| |
Collapse
|
6
|
Gruwez H, Verbrugge FH, Proesmans T, Evens S, Vanacker P, Rutgers MP, Vanhooren G, Bertrand P, Pison L, Haemers P, Vandervoort P, Nuyens D. Smartphone-based atrial fibrillation screening in the general population: feasibility and impact on medical treatment. Eur Heart J Digit Health 2023; 4:464-472. [PMID: 38045439 PMCID: PMC10689910 DOI: 10.1093/ehjdh/ztad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/04/2023] [Indexed: 12/05/2023]
Abstract
Aims The aim of this study is to determine the feasibility, detection rate, and therapeutic implications of large-scale smartphone-based screening for atrial fibrillation (AF). Methods and results Subjects from the general population in Belgium were recruited through a media campaign to perform AF screening during 8 consecutive days with a smartphone application. The application analyses photoplethysmography traces with artificial intelligence and offline validation of suspected signals to detect AF. The impact of AF screening on medical therapy was measured through questionnaires. Atrial fibrillation was detected in the screened population (n = 60.629) in 791 subjects (1.3%). From this group, 55% responded to the questionnaire. Clinical AF [AF confirmed on a surface electrocardiogram (ECG)] was newly diagnosed in 60 individuals and triggered the initiation of anti-thrombotic therapy in 45%, adjustment of rate or rhythm controlling strategies in 62%, and risk factor management in 17%. In subjects diagnosed with known AF before screening, a positive screening result led to these therapy adjustments in 9%, 39%, and 11%, respectively. In all subjects with clinical AF and an indication for oral anti-coagulation (OAC), OAC uptake increased from 56% to 74% with AF screening. Subjects with clinical AF were older with more co-morbidities compared with subclinical AF (no surface ECG confirmation of AF) (P < 0.001). In subjects with subclinical AF (n = 202), therapy adjustments were performed in only 7%. Conclusion Smartphone-based AF screening is feasible at large scale. Screening increased OAC uptake and impacted therapy of both new and previously diagnosed clinical AF but failed to impact risk factor management in subjects with subclinical AF.
Collapse
Affiliation(s)
- Henri Gruwez
- Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
- Department of Cardiology, Hospital East-Limburg, Genk, Belgium
| | - Frederik H Verbrugge
- Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Centre for Cardiovascular Diseases, University Hospital Brussels, Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | | | | | - Peter Vanacker
- Department of Neurology, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
- Department of Neurology, Groeninge Hospital, Kortrijk, Belgium
| | | | - Geert Vanhooren
- Department of Neurology, Sint-Jan Hospital Brugge-Oostende, Bruges, Belgium
| | - Philippe Bertrand
- Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Cardiology, Hospital East-Limburg, Genk, Belgium
| | - Laurent Pison
- Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Cardiology, Hospital East-Limburg, Genk, Belgium
| | - Peter Haemers
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Pieter Vandervoort
- Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Cardiology, Hospital East-Limburg, Genk, Belgium
| | - Dieter Nuyens
- Department of Cardiology, Hospital East-Limburg, Genk, Belgium
| |
Collapse
|
7
|
Hsieh MT, Liu CH, Lin SH, Lin PY, Chang YM, Wang CM, Chen CH, Sung PS. Comparing Efficacy and Safety Between Patients With Atrial Fibrillation Taking Direct Oral Anticoagulants or Warfarin After Direct Oral Anticoagulant Failure. J Am Heart Assoc 2023:e029979. [PMID: 38038171 DOI: 10.1161/jaha.123.029979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/19/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND An increased risk of recurrent stroke is noted in patients with atrial fibrillation despite direct oral anticoagulant (DOAC) use. We investigated the efficacy and safety of treatment with each of 4 different DOACs or warfarin after DOAC failure. METHODS AND RESULTS We retrospectively analyzed patients with atrial fibrillation with ischemic stroke despite DOAC treatment between January 2002 and December 2016. The different outcomes of patients with DOAC failure were compared, including recurrent ischemic stroke, major cardiovascular events, intracranial hemorrhage and subarachnoid hemorrhage, mortality, and net composite outcomes according to switching to different DOACs or vitamin K antagonist after index ischemic stroke. We identified 3759 patients with DOAC failure. A total of 84 patients experienced recurrent ischemic stroke after switching to different oral anticoagulants, with a total follow-up time of 14 years. Using the vitamin K antagonist group as a reference, switching to any of the 4 DOACs was associated with a 69% to 77% reduced risk of major cardiovascular events (adjusted hazard ratio [aHR], 0.25 [95% CI, 0.16-0.39] for apixaban, 0.23 [95% CI, 0.14-0.37] for dabigatran, 0.23 [95% CI, 0.09-0.60] for edoxaban, and 0.31 [95% CI, 0.21-0.45] for rivaroxaban), and a 69% to 83% reduced risk of net composite outcomes (aHR, 0.25 [95% CI, 0.18-0.35] for apixaban, 0.17 [95% CI, 0.11-0.25] for dabigatran, 0.31 [95% CI, 0.17-0.56] for edoxaban, and 0.31 [95% CI, 0.23-0.41] for rivaroxaban). CONCLUSIONS In Asian patients with DOAC failure, continuing DOACs after index stroke was associated with fewer undesirable outcomes than switching to a vitamin K antagonist. Alternative pharmacologic and nonpharmacologic strategies warrant investigation.
Collapse
Affiliation(s)
- Meng-Tsang Hsieh
- Stroke Center and Department of Neurology Chi-Mei Medical Center Tainan Taiwan
- Institute of Clinical Medicine, College of Medicine National Cheng Kung University Tainan Taiwan
| | - Chi-Hung Liu
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine Chang Gung University Taoyuan Taiwan
- Institute of Health Policy and Management, College of Public Health National Taiwan University Taipei Taiwan
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, College of Medicine National Cheng Kung University Tainan Taiwan
- Department of Public Health, College of Medicine National Cheng Kung University Tainan Taiwan
- Biostatistics Consulting Center National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University Tainan Taiwan
| | - Po-Yu Lin
- Department of Neurology National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University Tainan Taiwan
| | - Yu-Ming Chang
- Department of Neurology National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University Tainan Taiwan
| | - Chun-Min Wang
- Department of Neurology National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University Tainan Taiwan
| | - Chih-Hung Chen
- Department of Neurology National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University Tainan Taiwan
| | - Pi-Shan Sung
- Department of Neurology National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University Tainan Taiwan
| |
Collapse
|
8
|
Kumar N, Iyer MH, Dalia A, Bardia A. The Price of Keeping the Rhythm: Increased Bleeding Risk in Patients With Atrial Fibrillation Concurrently Prescribed Amiodarone and Factor Xa Inhibitors. J Cardiothorac Vasc Anesth 2023; 37:2416-2418. [PMID: 37657997 DOI: 10.1053/j.jvca.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] |