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Cosentino F, Verma S, Ambery P, Treppendahl MB, van Eickels M, Anker SD, Cecchini M, Fioretto P, Groop PH, Hess D, Khunti K, Lam CSP, Richard-Lordereau I, Lund LH, McGreavy P, Newsome PN, Sattar N, Solomon S, Weidinger F, Zannad F, Zeiher A. Cardiometabolic risk management: insights from a European Society of Cardiology Cardiovascular Round Table. Eur Heart J 2023; 44:4141-4156. [PMID: 37448181 DOI: 10.1093/eurheartj/ehad445] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/20/2022] [Revised: 04/24/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Metabolic comorbidities are common in patients with cardiorenal disease; they can cause atherosclerotic cardiovascular disease (ASCVD), speed progression, and adversely affect prognosis. Common comorbidities are Type 2 diabetes mellitus (T2DM), obesity/overweight, chronic kidney disease (CKD), and chronic liver disease. The cardiovascular system, kidneys, and liver are linked to many of the same risk factors (e.g. dyslipidaemia, hypertension, tobacco use, diabetes, and central/truncal obesity), and shared metabolic and functional abnormalities lead to damage throughout these organs via overlapping pathophysiological pathways. The COVID-19 pandemic has further complicated the management of cardiometabolic diseases. Obesity, T2DM, CKD, and liver disease are associated with increased risk of poor outcomes of COVID-19 infection, and conversely, COVID-19 can lead to worsening of pre-existing ASCVD. The high rates of these comorbidities highlight the need to improve recognition and treatment of ASCVD in patients with obesity, insulin resistance or T2DM, chronic liver diseases, and CKD and equally, to improve recognition and treatment of these diseases in patients with ASCVD. Strategies to prevent and manage cardiometabolic diseases include lifestyle modification, pharmacotherapy, and surgery. There is a need for more programmes at the societal level to encourage a healthy diet and physical activity. Many pharmacotherapies offer mechanism-based approaches that can target multiple pathophysiological pathways across diseases. These include sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, selective mineralocorticoid receptor antagonists, and combined glucose-dependent insulinotropic peptide/glucagon-like peptide-1 receptor agonist. Non-surgical and surgical weight loss strategies can improve cardiometabolic disorders in individuals living with obesity. New biomarkers under investigation may help in the early identification of individuals at risk and reveal new treatment targets.
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Affiliation(s)
- Francesco Cosentino
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Solna, 171 76 Stockholm, Sweden
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Philip Ambery
- Late-stage Development, CVRM, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | | | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), and German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Michele Cecchini
- Health Division, Organisation for Economic Co-operation and Development (OECD), Paris, France
| | - Paola Fioretto
- Department of Medicine, University of Padova, Padova, Italy
| | - Per-Henrik Groop
- Department of Nephrology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Institute of Genetics, Helsinki, Finland
- Department of Diabetes, Monash University, Melbourne, Australia
| | - David Hess
- Department of Physiology and Pharmacology, University of Western Ontario, Robarts Research Institute, London, ON, Canada
- Department of Pharmacology, University of Toronto, Division of Vascular Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore, Duke-National University of Singapore, Singapore
| | | | - Lars H Lund
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | | | - Philip N Newsome
- National Institute for Health Research, Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Liver & Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Scott Solomon
- Harvard Medical School, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Franz Weidinger
- 2nd Medical Department with Cardiology and Intensive Care Medicine, Klinik Landstrasse, Vienna, Austria
| | - Faiez Zannad
- Université de Lorraine, Inserm Clinical Investigation Center at Institut Lorrain du Coeur et des Vaisseaux, University Hospital of Nancy, Nancy, France
| | - Andreas Zeiher
- Cardio Pulmonary Institute, Goethe University of Frankfurt, Frankfurt, Germany
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Camm CF, Virdone S, Goto S, Bassand JP, van Eickels M, Haas S, Gersh BJ, Pieper K, Fox KAA, Misselwitz F, Turpie AGG, Goldhaber SZ, Verheugt F, Camm J, Kayani G, Panchenko E, Oh S, Luciardi HL, Sawhney JPS, Connolly SJ, Angchaisuksiri P, ten Cate H, Eikelboom JW, Kakkar AK. Association of body mass index with outcomes in patients with newly diagnosed atrial fibrillation: GARFIELD-AF. Open Heart 2022. [PMCID: PMC9362832 DOI: 10.1136/openhrt-2022-002038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective While greater body mass index (BMI) is associated with increased risk of developing atrial fibrillation (AF), the impact of BMI on outcomes in newly diagnosed AF is unclear. We examine the influence of BMI on outcomes and whether this is modified by sex and evaluate the effect of non-vitamin K oral anticoagulants (NOACs) in patients with high BMI. Methods GARFIELD-AF is a prospective registry of 52 057 newly diagnosed AF patients. The study population comprised 40 482 participants: 703 underweight (BMI <18.5 kg/m2), 13 095 normal (BMI=18.5–24.9 kg/m2), 15 043 overweight (BMI=25.0–29.9 kg/m2), 7560 obese (BMI=30.0–34.9 kg/m2) and 4081 extremely obese (BMI ≥35.0 kg/m2). Restricted cubic splines quantified the association of BMI with outcomes. Comparative effectiveness of NOACs and vitamin K antagonists (VKAs) by BMI was performed using propensity score overlap-weighted Cox models. Results The median age of participants was 71.0 years (Q1; Q3 62.0; 78.0), and 55.6% were male. Those with high BMI were younger, more often had vascular disease, hypertension and diabetes. Within 2-year follow-up, a U-shaped relationship between BMI and all-cause mortality was observed, with BMI of ~30 kg/m2 associated with the lowest risk. The association with new/worsening heart failure was similar. Only low BMI was associated with major bleeding and no association emerged for non-haemorrhagic stroke. BMI was similarly associated with outcomes in men and women. BMI did not impact the lower rate of all-cause mortality of NOACs compared with VKAs. Conclusions In the GARFIELD-AF registry, underweight and extremely obese AF patients have increased risk of mortality and new/worsening heart failure compared with normal or obese patients.
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Kirchhof P, Haas S, Amarenco P, Hess S, Lambelet M, van Eickels M, Turpie AGG, Camm AJ. Impact of Modifiable Bleeding Risk Factors on Major Bleeding in Patients With Atrial Fibrillation Anticoagulated With Rivaroxaban. J Am Heart Assoc 2020; 9:e009530. [PMID: 32079476 PMCID: PMC7335544 DOI: 10.1161/jaha.118.009530] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Reducing major bleeding events is a challenge when managing anticoagulation in patients with atrial fibrillation. This study evaluated the impact of modifiable and nonmodifiable bleeding risk factors in patients with atrial fibrillation receiving rivaroxaban and estimated the impact of risk factor modification on major bleeding events. Methods and Results Modifiable and nonmodifiable risk factors associated with major bleeding events were identified from the XANTUS (Xarelto for Prevention of Stroke in Patients With Atrial Fibrillation) prospective registry data set (6784 rivaroxaban-treated patients). Parameters showing univariate association with bleeding were used to construct a multivariable model identifying independent risk factors. Modeling was used to estimate attributed weights to risk factors. Heavy alcohol use (hazard ratio [HR]=2.37; 95% CI 1.24-4.53); uncontrolled hypertension (HR after parameter-wise shrinkage=1.79; 95% CI 1.05-3.05); and concomitant treatment with antiplatelets, nonsteroidal anti-inflammatory drugs, or paracetamol (HR=1.80; 95% CI 1.24-2.61) were identified as modifiable, independent bleeding risk factors. Increasing age (HR=1.25 [per 5-year increment]; 95% CI 1.12-1.38); heart failure (HR=1.97; 95% CI 1.36-2.86); and vascular disease (HR=1.91; 95% CI 1.32-2.77) were identified as nonmodifiable bleeding risk factors. Overall, 128 (1.9%) patients experienced major bleeding events; of these, 11% had no identified bleeding risk factors, 50% had nonmodifiable bleeding risk factors only, and 39% had modifiable bleeding risk factors (with or without nonmodifiable risk factors). The presence of 1 modifiable bleeding risk factor doubled the risk of major bleeding. Conclusions Elimination of modifiable bleeding risk factors is a potentially effective strategy to reduce bleeding risk in atrial fibrillation patients receiving rivaroxaban. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01606995.
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Affiliation(s)
- Paulus Kirchhof
- Institute of Cardiovascular Sciences UHB and Sandwell & West Birmingham Hospitals NHS Trusts University of Birmingham United Kingdom.,University Heart and Vascular Center Hamburg Hamburg Germany
| | - Sylvia Haas
- Formerly Technical University of Munich Munich Germany
| | - Pierre Amarenco
- Department of Neurology and Stroke Centre Paris-Diderot-Sorbonne University Paris France
| | - Susanne Hess
- Medical Affairs Bayer AG Berlin Germany.,Chrestos Concept GmbH & Co KG Essen Germany
| | | | | | | | - A John Camm
- Cardiovascular and Cell Sciences Research Institute and Cardiology Clinical Academic Group St George's, University of London London United Kingdom
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Hacke W, Bassand JP, Virdone S, Camm AJ, Fitzmaurice DA, Fox KA, Goldhaber SZ, Goto S, Haas S, Kayani G, Mantovani LG, Misselwitz F, Pieper KS, Turpie AG, van Eickels M, Verheugt FW, Kakkar AK. Prior stroke and transient ischemic attack as risk factors for subsequent stroke in atrial fibrillation patients: A report from the GARFIELD-AF registry. Int J Stroke 2019; 15:308-317. [PMID: 31847794 DOI: 10.1177/1747493019891516] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It is not always possible to verify whether a patient complaining of symptoms consistent with transient ischemic attack has had an actual cerebrovascular event. RESEARCH QUESTION To characterize the risk of cardiovascular events associated with a history of stroke/transient ischemic attack in patients with atrial fibrillation. STUDY DESIGN AND METHODS This study investigated the clinical characteristics and outcomes of patients with a history of stroke/transient ischemic attack among 52,014 patients enrolled prospectively in GARFIELD-AF registry. The diagnosis of stroke or transient ischemic attack was not protocol defined but based on physicians' assessment. Patients' one-year risk of death, stroke/systemic embolism, and major bleeding was assessed by multivariable Cox regression. RESULTS At enrollment, 5617 (10.9%) patients were reported to have a history of stroke or transient ischemic attack. Patients with stroke or transient ischemic attack were older and had a greater burden of diabetes, moderate-to-severe kidney disease, and atherothrombosis and higher median CHA2DS2-VASc and HAS-BLED scores than those without history of stroke or transient ischemic attack. After adjustment, prior stroke/transient ischemic attack was associated with significantly higher risk for all-cause mortality (hazard ratio (HR), 1.26; 95% confidence interval (CI), 1.12-1.42), cardiovascular death (HR, 1.22; 95% CI, 1.01-1.48), non-cardiovascular death (HR, 1.39; 95% CI, 1.15-1.68), and stroke/systemic embolism (HR, 2.17; 95% CI, 1.80-2.63) than patients without history of stroke/transient ischemic attack. In patients with a prior stroke alone higher risk was observed for all-cause mortality (HR, 1.29; 95% CI, 1.11-1.50), non-cardiovascular death (HR, 1.39; 95% CI, 1.10-1.77), and stroke/systemic embolism (HR, 2.29; 95% CI, 1.83-2.86). No significantly elevated risk of adverse events was seen for patients with history of transient ischemic attack alone. INTERPRETATION A history of prior stroke or transient ischemic attack is a strong independent risk factor for mortality and stroke/systemic embolism. This excess risk is mainly attributed to a history of stroke (with or without transient ischemic attack), whereas history of transient ischemic attack is a weaker predictor. Clinical trial registration: NCT01090362.
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Affiliation(s)
- Werner Hacke
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | | | - Saverio Virdone
- Department of Clinical Research, Thrombosis Research Institute, London, UK
| | - A John Camm
- Molecular and Clinical Sciences Institute, St. George's University of London, London, UK
| | | | - Keith Aa Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Samuel Z Goldhaber
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Shinya Goto
- Department of Medicine (Cardiology), Tokai University School of Medicine, Kanagawa, Japan
| | - Sylvia Haas
- Formerly Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gloria Kayani
- Department of Clinical Research, Thrombosis Research Institute, London, UK
| | - Lorenzo G Mantovani
- Center for Public Health Research, University of Milan Bicocca, and IRCCS Multimedica Milan, Italy
| | - Frank Misselwitz
- Therapeutic areas Thrombosis & Hematology, Bayer AG Pharmaceuticals, Berlin, Germany
| | - Karen S Pieper
- Department of Clinical Research, Thrombosis Research Institute, London, UK
| | | | - Martin van Eickels
- Therapeutic areas Thrombosis & Hematology, Bayer AG Pharmaceuticals, Berlin, Germany
| | - Freek Wa Verheugt
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - Ajay K Kakkar
- Department of Clinical Research, Thrombosis Research Institute, London, UK.,Department of Surgery, University College London, London, UK
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Bassand JP, Virdone S, Goldhaber SZ, Camm AJ, Fitzmaurice DA, Fox KAA, Goto S, Haas S, Hacke W, Kayani G, Mantovani LG, Misselwitz F, Pieper KS, Turpie AGG, van Eickels M, Verheugt FWA, Kakkar AK. Early Risks of Death, Stroke/Systemic Embolism, and Major Bleeding in Patients With Newly Diagnosed Atrial Fibrillation. Circulation 2019; 139:787-798. [PMID: 30586740 DOI: 10.1161/circulationaha.118.035012] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial fibrillation is associated with increased risks of death, stroke/systemic embolism, and bleeding (incurred by antithrombotic therapy), which may occur early after diagnosis. METHODS We assessed the risk of early events (death, stroke/systemic embolism, and major bleeding) over 12 months and their relation to the time after diagnosis of atrial fibrillation in 52 014 patients prospectively enrolled in the GARFIELD-AF registry (Global Anticoagulant Registry in the FIELD-Atrial Fibrillation) between March 2010 and August 2016. RESULTS Over 12 months, 2140 patients died (mortality rate, 4.3; 95% CI, 4.2-4.5 per 100 person-years), of whom 288 (13.5%) died in the first month (6.8; 95% CI, 6.1-7.6). Over 12 months, 657 patients had a stroke/systemic embolism (1.3; 95% CI, 1.2-1.4) and 411 had a major bleeding (0.8; 95% CI, 0.8-0.9). During the first month, the rates (per 100 person-years) of stroke/systemic embolism and major bleed were 2.3 (95% CI, 1.9-2.8) and 1.5 (95% CI, 1.2-1.9), respectively. The elevated 1-month mortality rate was mostly attributable to cardiovascular mortality (3.5; 95% CI, 3.0-4.1), in particular, heart failure, sudden death, and acute coronary syndromes (1.0 [95% CI, 0.8-1.4], 0.6 [95% CI, 0.4-0.8], and 0.5 [95% CI, 0.3-0.8], respectively). Age, heart failure, prior stroke, history of cirrhosis, vascular disease, moderate-to-severe kidney disease, diabetes mellitus, and living in North or Latin America were independent predictors of a higher risk of early death, whereas anticoagulation and living in Europe or Asia were independent predictors of a lower risk of early death. A predictive model developed for the 1-month risk of death had a C-statistic of 0.81 (95% CI, 0.78-0.83). CONCLUSIONS The increased hazard of early events, in particular, cardiovascular mortality, in newly diagnosed atrial fibrillation points to the importance of comprehensive care for such patients and should alert clinicians to detect warning signs of possible early mortality. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT01090362.
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Affiliation(s)
- Jean-Pierre Bassand
- University of Besançon, France (J.-P.B.).,Thrombosis Research Institute, London, UK (J.-P.B., S.V., G.K., K.S.P., A.K.K.)
| | - Saverio Virdone
- Thrombosis Research Institute, London, UK (J.-P.B., S.V., G.K., K.S.P., A.K.K.)
| | - Samuel Z Goldhaber
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.Z.G.)
| | - A John Camm
- St George's University of London, UK (A.J.C.)
| | | | - Keith A A Fox
- Centre for Cardiovascular Science, University of Edinburgh, UK (K.A.A.F.)
| | - Shinya Goto
- Tokai University School of Medicine, Kanagawa, Japan (S.G.)
| | - Sylvia Haas
- Formerly Klinikum rechts der Isar, Technical University of Munich, Germany (S.H.)
| | | | - Gloria Kayani
- Thrombosis Research Institute, London, UK (J.-P.B., S.V., G.K., K.S.P., A.K.K.)
| | - Lorenzo G Mantovani
- Center for Public Health Research, University of Milan Bicocca, Monza, Italy (L.G.M.)
| | | | - Karen S Pieper
- Thrombosis Research Institute, London, UK (J.-P.B., S.V., G.K., K.S.P., A.K.K.).,Duke Clinical Research Institute, Durham, NC (K.S.P.)
| | | | | | | | - Ajay K Kakkar
- Thrombosis Research Institute, London, UK (J.-P.B., S.V., G.K., K.S.P., A.K.K.).,University College London, UK (A.K.K.)
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Kerneis M, Yee MK, Mehran R, Nafee T, Bode C, Halperin JL, Peterson ED, Verheugt FWA, Wildgoose P, van Eickels M, Lip GYH, Cohen M, Fox KAA, Gibson CM. Novel Oral Anticoagulant Based Versus Vitamin K Antagonist Based Double Therapy Among Stented Patients With Atrial Fibrillation: Insights From the PIONEER AF-PCI Trial. Circ Cardiovasc Interv 2019; 12:e008160. [PMID: 31707805 DOI: 10.1161/circinterventions.119.008160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Among stented patients with atrial fibrillation, double therapy with a novel oral anticoagulant plus single antiplatelet therapy (SAPT) reduces bleeding or cardiovascular rehospitalizations compared with a vitamin K antagonist (VKA) based triple therapy regimen. A recent study demonstrated that apixaban based double therapy reduced bleeding compared with VKA based double therapy. However, it remains unknown whether rivaroxaban based double therapy is superior to a VKA based double therapy. METHODS Patient with stented atrial fibrillation (n=2124) were randomized to 3 groups: rivaroxaban 15 mg od plus a P2Y12 inhibitor (Group 1, n=709); rivaroxaban 2.5 mg bid plus dual antiplatelet therapy (DAPT; Group 2, n=709); and warfarin plus DAPT (Group 3, n=706). Before randomization, subjects were stratified according to a prespecified duration of DAPT (1, 6, or 12 months). After the prespecified DAPT duration, subjects in Group 2 were switched to rivaroxaban 15 mg plus low dose aspirin, and those in Group 3 were switched to VKA plus low dose aspirin. The Wei, Lin, and Weissfeld time to multiple events method was used to compare the occurrence of all bleeding and cardiovascular rehospitalizations among subjects on a novel oral anticoagulant versus VKA based double therapy. RESULTS A total of 906 subjects were prespecified to a 1 or 6 months DAPT duration and received at least one dose of study drug. Twenty subjects (3.3%) assigned to novel oral anticoagulant+SAPT, and 15 (5.1%) subjects assigned to VKA+SAPT experienced multiple rehospitalizations. In total, 124 (20.3%) events occurred among subjects on novel oral anticoagulant+SAPT compared with 87 (29.6%) among subjects on VKA+SAPT (hazard ratio=0.65 [95% CI, 0.45-0.93], P=0.008). CONCLUSIONS Among stented patients with atrial fibrillation, rivaroxaban plus SAPT was superior to warfarin plus SAPT in lowering total bleeding and cardiovascular rehospitalization. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01830543.
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Affiliation(s)
- Mathieu Kerneis
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (M.K., M.K.Y., T.N., C.M.G.)
| | - Megan K Yee
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (M.K., M.K.Y., T.N., C.M.G.)
| | - Roxana Mehran
- Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, NY (R.M., J.L.H.)
| | - Tarek Nafee
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (M.K., M.K.Y., T.N., C.M.G.)
| | - Christoph Bode
- Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Germany (C.B.)
| | - Jonathan L Halperin
- Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, NY (R.M., J.L.H.)
| | | | - Freek W A Verheugt
- Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, the Netherlands (F.W.A.V.)
| | - Peter Wildgoose
- Janssen Pharmaceuticals, Inc, Beerse, Belgium, Inc, Titusville, NJ (P.W.)
| | | | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
| | - Marc Cohen
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.)
| | - Keith A A Fox
- Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, United Kingdom (K.A.A.F.)
| | - C Michael Gibson
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (M.K., M.K.Y., T.N., C.M.G.)
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Mantovani LG, Haas S, Kreutz R, Folkerts K, Gebel M, Monje D, Schneider J, van Eickels M, Sahin K, Zell E, Ageno W, Turpie AGG. Healthcare resource use in XALIA: A subgroup analysis of a non-interventional study of rivaroxaban versus standard anticoagulation for deep vein thrombosis. Eur J Intern Med 2019; 61:29-33. [PMID: 30342973 DOI: 10.1016/j.ejim.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 06/22/2018] [Revised: 09/25/2018] [Accepted: 10/08/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The non-interventional XALIA study compared the safety and effectiveness of rivaroxaban with standard anticoagulation for the treatment of venous thromboembolism in routine clinical practice. This substudy assessed the effect of treatment with rivaroxaban on healthcare resource use, hospital length of stay (LOS) and frequency of hospitalisation. METHODS In XALIA, patients aged ≥18 years scheduled to receive ≥3 months of rivaroxaban or standard anticoagulation treatment for deep vein thrombosis (DVT) were eligible. Treatment decisions were at the physician's discretion. Healthcare resource use, including hospital admission for the index DVT and initial LOS, was documented. The main analyses in this substudy were conducted in a 1:1 propensity score-matched set (PMS) of patients, with adjustment for cancer at baseline. RESULTS In the PMS analysis, 1124 rivaroxaban-treated patients and 1124 standard anticoagulation-treated patients were included. Baseline characteristics were similar between groups (mean age 60.8 years vs. 61.2 years, DVT only rates of 89.7% vs. 90.2% and cancer rates of 8.4% vs. 8.5%, respectively). Of these, 433/1124 (38.5%) rivaroxaban-treated patients and 438/1124 (39.0%) standard anticoagulation-treated patients were hospitalised. Index event LOS in the PMS analysis was a least-squares mean of 2.6 days shorter with rivaroxaban vs. standard anticoagulation (5.4 vs. 8.0 days; geometric means ratio = 0.67 [95% confidence interval 0.61-0.74, P < 0.001]). CONCLUSIONS In XALIA, hospital LOS was shorter with rivaroxaban than with standard anticoagulation, consistent with the phase III study results. DVT treatment with rivaroxaban in routine clinical practice may reduce the cost per patient vs. standard anticoagulation.
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Affiliation(s)
- Lorenzo G Mantovani
- Center for Public Health Research, School of Medicine, University of Milano-Bicocca, Via Cadore 48, I-20900 Monza, Italy.
| | - Sylvia Haas
- Formerly Technical University, Munich, Germany
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin; corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | | | | | | | | | | | | | - Elizabeth Zell
- Stat-Epi Associates Inc., Ponte Vedra Beach, Florida, USA
| | - Walter Ageno
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
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Goto S, Angchaisuksiri P, Bassand J, Camm AJ, Dominguez H, Illingworth L, Gibbs H, Goldhaber SZ, Goto S, Jing Z, Haas S, Kayani G, Koretsune Y, Lim TW, Oh S, Sawhney JPS, Turpie AGG, van Eickels M, Verheugt FWA, Kakkar AK. Management and 1-Year Outcomes of Patients With Newly Diagnosed Atrial Fibrillation and Chronic Kidney Disease: Results From the Prospective GARFIELD - AF Registry. J Am Heart Assoc 2019; 8:e010510. [PMID: 30717616 PMCID: PMC6405596 DOI: 10.1161/jaha.118.010510] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 12/24/2018] [Indexed: 01/11/2023]
Abstract
Background Using data from the GARFIELD - AF (Global Anticoagulant Registry in the FIELD -Atrial Fibrillation), we evaluated the impact of chronic kidney disease ( CKD ) stage on clinical outcomes in patients with newly diagnosed atrial fibrillation ( AF ). Methods and Results GARFIELD - AF is a prospective registry of patients from 35 countries, including patients from Asia (China, India, Japan, Singapore, South Korea, and Thailand). Consecutive patients enrolled (2013-2016) were classified with no, mild, or moderate-to-severe CKD , based on the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative guidelines. Data on CKD status and outcomes were available for 33 024 of 34 854 patients (including 9491 patients from Asia); 10.9% (n=3613) had moderate-to-severe CKD , 16.9% (n=5595) mild CKD , and 72.1% (n=23 816) no CKD . The use of oral anticoagulants was influenced by stroke risk (ie, post hoc assessment of CHA 2 DS 2- VAS c score), but not by CKD stage. The quality of anticoagulant control with vitamin K antagonists did not differ with CKD stage. After adjusting for baseline characteristics and antithrombotic use, both mild and moderate-to-severe CKD were independent risk factors for all-cause mortality. Moderate-to-severe CKD was independently associated with a higher risk of stroke/systemic embolism, major bleeding, new-onset acute coronary syndrome, and new or worsening heart failure. The impact of moderate-to-severe CKD on mortality was significantly greater in patients from Asia than the rest of the world ( P=0.001). Conclusions In GARFIELD - AF , moderate-to-severe CKD was independently associated with stroke/systemic embolism, major bleeding, and mortality. The effect of moderate-to-severe CKD on mortality was even greater in patients from Asia than the rest of the world. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 01090362.
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Affiliation(s)
- Shinya Goto
- Tokai University School of MedicineKanagawaJapan
| | | | - Jean‐Pierre Bassand
- University of BesançonFrance
- Thrombosis Research InstituteLondonUnited Kingdom
| | - A. John Camm
- St. George's University of LondonLondonUnited Kingdom
| | - Helena Dominguez
- Bispebjerg‐Frederiksberg HospitalCopenhagenDenmark
- Faculty of Health SciencesUniversity of CopenhagenCopenhagenDenmark
| | | | | | | | | | - Zhi‐Cheng Jing
- Fu Wai HospitalState Key Lab of Cardiovascular DiseaseNational Center for Cardiovascular DiseasePUMC & CAMSBeijingChina
| | - Sylvia Haas
- Formerly Klinikum rechts der IsarTechnical University of MunichGermany
| | | | | | | | - Seil Oh
- Seoul National University HospitalSeoulKorea
| | | | | | | | | | - Ajay K. Kakkar
- Thrombosis Research InstituteLondonUnited Kingdom
- University College LondonLondonUnited Kingdom
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9
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Kerneis M, Yee MK, Mehran R, Nafee T, Bode C, Halperin JL, Peterson ED, Verheugt FW, Wildgoose P, van Eickels M, Lip GY, Cohen M, Fox KA, Gibson CM. Association of International Normalized Ratio Stability and Bleeding Outcomes Among Atrial Fibrillation Patients Undergoing Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2019; 12:e007124. [DOI: 10.1161/circinterventions.118.007124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mathieu Kerneis
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (M.K., M.K.Y., T.N., C.M.G.)
| | - Megan K. Yee
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (M.K., M.K.Y., T.N., C.M.G.)
| | - Roxana Mehran
- Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY (R.M., J.L.H.)
| | - Tarek Nafee
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (M.K., M.K.Y., T.N., C.M.G.)
| | - Christoph Bode
- Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Germany (C.B.)
| | - Jonathan L. Halperin
- Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY (R.M., J.L.H.)
| | | | | | - Peter Wildgoose
- Janssen Pharmaceuticals, Inc, Beerse, Belgium, Inc, Titusville, NJ (P.W.)
| | | | - Gregory Y.H. Lip
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (G.Y.H.L.)
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
| | - Marc Cohen
- Division of Cardiology, Newark Beth Israel Medical Center, NJ (M.C.)
| | - Keith A.A. Fox
- Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, United Kingdom (K.A.A.F.)
| | - C. Michael Gibson
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (M.K., M.K.Y., T.N., C.M.G.)
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10
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Miyazawa K, Pastori D, Hammerstingl C, Cappato R, Meng IL, Kramer F, Cohen A, Schulz A, Eickels MV, Lip GYH, Marin F. Left atrial thrombus resolution in non-valvular atrial fibrillation or flutter: biomarker substudy results from a prospective study with rivaroxaban (X-TRA). Ann Med 2018; 50:511-518. [PMID: 29956554 DOI: 10.1080/07853890.2018.1495337] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Non-vitamin K antagonist oral anticoagulants including rivaroxaban are widely used for stroke prevention in patients with atrial fibrillation (AF). We investigated the relationship between plasma biomarkers (indicative of thrombogenesis, fibrinolysis and inflammation) and left atrial thrombus resolution after rivaroxaban treatment. METHODS This was an ancillary analysis of the X-TRA study, which was a prospective interventional study evaluating the use of rivaroxaban for left atrial/left atrial appendage (LA/LAA) thrombus resolution in AF patients. We assessed various biomarkers of thrombogenesis/fibrinolysis [D-dimer, plasminogen activator inhibitor-1 (PAI-1), prothrombin fragment 1 + 2 (F1,2), thrombin-antithrombin (TAT) complexes, von Willebrand factor (vWF)] and inflammation [high-sensitivity interleukin-6 (hsIL-6), and high-sensitivity C-reactive protein (hsCRP)], measured at baseline and after 6 weeks' of rivaroxaban treatment. RESULTS There was a significant decrease in the mean levels of hsCRP, D-dimer, vWF, and TAT from baseline to end of treatment with rivaroxaban. Although none of the thrombogenesis/fibrinolysis biomarkers showed a significant relationship with thrombus resolution, high inflammatory biomarkers at baseline were significantly associated with an increased chance of the thrombus being completely resolved (hsIL-6) or reduced/resolved (hsCRP). CONCLUSIONS Biomarkers of inflammation are significantly associated with LA/LAA thrombus outcomes in AF patients prospectively treated with rivaroxaban.
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Affiliation(s)
- Kazuo Miyazawa
- a Institute of Cardiovascular Sciences , University of Birmingham , Birmingham , UK
| | - Daniele Pastori
- a Institute of Cardiovascular Sciences , University of Birmingham , Birmingham , UK.,b Department of Internal Medicine and Medical Specialties, I Clinica Medica, Atherothrombosis Centre , Sapienza University of Rome , Rome , Italy
| | - Christoph Hammerstingl
- c Department of Medicine II , Heart Centre Bonn, University Hospital Bonn , Bonn , Germany
| | | | | | - Frank Kramer
- e Global Medical Affairs, Bayer AG , Berlin , Germany
| | - Ariel Cohen
- f Cardiology Department , Assistance publique-Hôpitaux de Paris and Université Pierre-et-Marie-Curie, Saint-Antoine University and Medical School , Paris , France
| | - Anke Schulz
- g Research and Clinical Sciences Statistics, Bayer AG , Berlin , Germany
| | | | - Gregory Y H Lip
- a Institute of Cardiovascular Sciences , University of Birmingham , Birmingham , UK.,h Aalborg Thrombosis Research Unit, Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
| | - Francisco Marin
- i Department of Cardiology , Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV , Murcia , Spain
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11
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Chi G, Kerneis M, Kalayci A, Liu Y, Mehran R, Bode C, Halperin JL, Verheugt FW, Wildgoose P, van Eickels M, Lip GY, Cohen M, Peterson ED, Fox KA, Gibson CM. Safety and efficacy of non-vitamin K oral anticoagulant for atrial fibrillation patients after percutaneous coronary intervention: A bivariate analysis of the PIONEER AF-PCI and RE-DUAL PCI trial. Am Heart J 2018; 203:17-24. [PMID: 30015064 DOI: 10.1016/j.ahj.2018.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 06/05/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND The tradeoff in safety versus efficacy in substituting a non-vitamin K antagonist oral anticoagulant for a vitamin K antagonist (VKA) in the stented atrial fibrillation patient has not been quantitatively evaluated. METHODS Based on summary data from the PIONEER AF-PCI and RE-DUAL PCI trials, 4 antithrombotic regimens were compared with VKA-based triple therapy: (1) rivaroxaban (riva) 15 mg daily + P2Y12 inhibitor, (2) riva 2.5 mg twice daily + P2Y12 inhibitor + aspirin, (3) dabigatran (dabi) 110 mg twice daily + P2Y12 inhibitor, and (4) dabi 150 mg twice daily + P2Y12 inhibitor. A bivariate model with a noninferiority margin of 1.38 was used to simultaneously assess safety and efficacy. The safety end point was major or clinically relevant nonmajor bleeding by International Society on Thrombosis and Haemostasis definitions. The efficacy end point was a thromboembolic event (myocardial infarction, stroke, or systemic embolism), death, or urgent revascularization. The bivariate outcome, a measure of risk difference in the net clinical outcome, was compared between antithrombotic regimens. RESULTS All 4 non-vitamin K antagonist oral anticoagulant regimens were superior in bleeding and noninferior in efficacy compared with triple therapy with VKA. Riva 15 mg daily and 2.5 mg twice daily were associated with bivariate combined risk reductions of 5.6% (2.3%-8.8%) and 5.5% (2.1%-8.7%), respectively, and dabi 110 mg twice daily and 150 mg twice daily reduced the bivariate risk by 3.8% (0.5%-7.0%) and 6.3% (2.4%-9.8%), respectively. CONCLUSIONS A bivariate analysis that simultaneously characterizes both risk and benefit demonstrates that riva- and dabi-based regimens were both favorable over VKA plus dual antiplatelet therapy among patients with atrial fibrillation undergoing PCI.
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12
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Cano S, Mantovani L, Folkerts K, Gebel M, Sahin K, Zell E, Monje D, Schneider J, Eickels MV, Haas S, Kreutz R, Ageno W, Turpie AGG. Patient-Reported Treatment Experience with Oral Rivaroxaban: Results from the Noninterventional XALIA Study of Deep-Vein Thrombosis. TH Open 2018; 2:e139-e146. [PMID: 31249937 PMCID: PMC6524861 DOI: 10.1055/s-0038-1641679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 02/19/2018] [Indexed: 10/24/2022] Open
Abstract
For venous thromboembolism (VTE) treatment, patient satisfaction was shown to improve with rivaroxaban versus standard anticoagulation in the phase III EINSTEIN DVT and EINSTEIN PE trials. This substudy of the prospective, noninterventional XALIA study of rivaroxaban for deep-vein thrombosis treatment assessed if this was also observed in routine clinical practice. Patients enrolled in XALIA who received rivaroxaban or standard anticoagulation treatment were eligible for inclusion in this substudy. Treatment decisions were at the physician's discretion. Patients completed the 17-item Anti-Clot Treatment Scale (ACTS, comprising a 12-item Burdens subscale, a 3-item Benefits subscale and one global item per subscale) during follow-up. The propensity score-matched set (PMS) was used for the main analysis; the adjusted safety analysis (ASAF) set was used for confirmatory purposes. Analyses by follow-up visit and subgroup, including age, sex, and previous VTE, were also conducted. The PMS-ACTS analysis included 458 rivaroxaban-treated and 434 standard anticoagulation-treated patients. Baseline demographic and clinical characteristics were generally similar across treatment arms. ACTS Burdens scores significantly improved with rivaroxaban versus standard anticoagulation (least-squares mean difference of 2.4 ± 0.4 points; p < 0.0001); ACTS Benefits scores were numerically higher with rivaroxaban (least-squares mean difference of 0.2 ± 0.1 points; p = 0.2). Similar findings occurred across follow-up visits and subgroups. Results were confirmed in the ASAF-ACTS analysis. Consistent with phase III analyses, rivaroxaban was associated with improved ACTS Burdens scores; ACTS Benefits scores numerically favored rivaroxaban, although without reaching statistical significance.
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Affiliation(s)
- Stefan Cano
- Modus Outcomes, Letchworth Garden City, United Kingdom
| | - Lorenzo Mantovani
- CESP-Center for Public Health Research, University of Milan Bicocca, Monza, Italy
| | | | | | | | - Elizabeth Zell
- Stat-Epi Associates, Inc., Ponte Vedra Beach, Florida, United States
| | | | | | | | | | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Walter Ageno
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
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13
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Kerneis M, Gibson CM, Chi G, Mehran R, AlKhalfan F, Talib U, Pahlavani S, Mir M, Bode C, Halperin JL, Nafee T, Peterson ED, Verheugt FW, Wildgoose P, van Eickels M, Lip GY, Fox KA, Cohen M. Effect of Procedure and Coronary Lesion Characteristics on Clinical Outcomes Among Atrial Fibrillation Patients Undergoing Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2018; 11:626-634. [DOI: 10.1016/j.jcin.2017.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 12/19/2022]
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14
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Bassand JP, Accetta G, Al Mahmeed W, Corbalan R, Eikelboom J, Fitzmaurice DA, Fox KAA, Gao H, Goldhaber SZ, Goto S, Haas S, Kayani G, Pieper K, Turpie AGG, van Eickels M, Verheugt FWA, Kakkar AK. Risk factors for death, stroke, and bleeding in 28,628 patients from the GARFIELD-AF registry: Rationale for comprehensive management of atrial fibrillation. PLoS One 2018; 13:e0191592. [PMID: 29370229 PMCID: PMC5784935 DOI: 10.1371/journal.pone.0191592] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 01/08/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The factors influencing three major outcomes-death, stroke/systemic embolism (SE), and major bleeding-have not been investigated in a large international cohort of unselected patients with newly diagnosed atrial fibrillation (AF). METHODS AND RESULTS In 28,628 patients prospectively enrolled in the GARFIELD-AF registry with 2-year follow-up, we aimed at analysing: (1) the variables influencing outcomes; (2) the extent of implementation of guideline-recommended therapies in comorbidities that strongly affect outcomes. Median (IQR) age was 71.0 (63.0 to 78.0) years, 44.4% of patients were female, median (IQR) CHA2DS2-VASc score was 3.0 (2.0 to 4.0); 63.3% of patients were on anticoagulants (ACs) with or without antiplatelet (AP) therapy, 24.5% AP monotherapy, and 12.2% no antithrombotic therapy. At 2 years, rates (95% CI) of death, stroke/SE, and major bleeding were 3.84 (3.68; 4.02), 1.27 (1.18; 1.38), and 0.71 (0.64; 0.79) per 100 person-years. Age, history of stroke/SE, vascular disease (VascD), and chronic kidney disease (CKD) were associated with the risks of all three outcomes. Congestive heart failure (CHF) was associated with the risks of death and stroke/SE. Smoking, non-paroxysmal forms of AF, and history of bleeding were associated with the risk of death, female sex and heavy drinking with the risk of stroke/SE. Asian race was associated with lower risks of death and major bleeding versus other races. AC treatment was associated with 30% and 28% lower risks of death and stroke/SE, respectively, compared with no AC treatment. Rates of prescription of guideline-recommended drugs were suboptimal in patients with CHF, VascD, or CKD. CONCLUSIONS Our data show that several variables are associated with the risk of one or more outcomes, in terms of death, stroke/SE, and major bleeding. Comprehensive management of AF should encompass, besides anticoagulation, improved implementation of guideline-recommended therapies for comorbidities strongly associated with outcomes, namely CHF, VascD, and CKD. TRIAL REGISTRATION ClinicalTrials.gov NCT01090362.
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Affiliation(s)
- Jean-Pierre Bassand
- Department of Cardiology–EA 3920, University of Besançon, Besançon, France
- Thrombosis Research Institute, London, United Kingdom
- * E-mail:
| | | | - Wael Al Mahmeed
- Cardiology, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Ramon Corbalan
- Department of Cardiology, Catholic University School of Medicine, Santiago, Chile
| | - John Eikelboom
- Department of Medicine, McMaster University, Hamilton, Canada
| | | | - Keith A. A. Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Haiyan Gao
- Thrombosis Research Institute, London, United Kingdom
| | - Samuel Z. Goldhaber
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Shinya Goto
- Department of Medicine (Cardiology), Tokai University School of Medicine, Kanagawa, Japan
| | - Sylvia Haas
- Formerly Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gloria Kayani
- Thrombosis Research Institute, London, United Kingdom
| | - Karen Pieper
- Thrombosis Research Institute, London, United Kingdom
- Duke Clinical Research Institute, Durham, North Carolina, United States of America
| | | | | | - Freek W. A. Verheugt
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Ajay K. Kakkar
- Thrombosis Research Institute, London, United Kingdom
- University College London, London, United Kingdom
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15
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Verheugt FWA, Gao H, Al Mahmeed W, Ambrosio G, Angchaisuksiri P, Atar D, Bassand JP, Camm AJ, Cools F, Eikelboom J, Kayani G, Lim TW, Misselwitz F, Pieper KS, van Eickels M, Kakkar AK. Characteristics of patients with atrial fibrillation prescribed antiplatelet monotherapy compared with those on anticoagulants: insights from the GARFIELD-AF registry. Eur Heart J 2017; 39:464-473. [DOI: 10.1093/eurheartj/ehx730] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/23/2017] [Indexed: 12/27/2022] Open
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Camm AJ, Turpie AGG, Hess S, Amarenco P, Lambelet M, Haas S, van Eickels M, Kirchhof P. Outcomes after catheter ablation and cardioversion in patients with non-valvular atrial fibrillation: results from the prospective, observational XANTUS study. Europace 2017; 20:e87-e95. [DOI: 10.1093/europace/eux127] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 06/05/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
- A John Camm
- Cardiovascular and Cell Sciences Research Institute, St George’s, University of London and Imperial College, Cranmer Terrace, London SW17 0RE, UK
| | | | | | - Pierre Amarenco
- Department of Neurology and Stroke Center, Paris-Diderot-Sorbonne University, Paris, France
| | | | | | | | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Sandwell and West Birmingham Hospitals and UHB NHS Trusts, Birmingham, UK
- Department of Cardiovascular Medicine, University of Münster, Münster, Germany
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Ageno W, Mantovani LG, Haas S, Kreutz R, Monje D, Schneider J, van Eickels M, Gebel M, Turpie AGG. Subgroup Analysis of Patients with Cancer in XALIA: A Noninterventional Study of Rivaroxaban versus Standard Anticoagulation for VTE. TH Open 2017; 1:e33-e42. [PMID: 31259294 PMCID: PMC6598195 DOI: 10.1055/s-0037-1603924] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background
The noninterventional XALIA study compared rivaroxaban with standard anticoagulation for deep vein thrombosis treatment. This substudy describes the demographics, clinical characteristics, and outcomes of the patients with cancer.
Methods
Therapy type, dose, and duration were at the physician's discretion. The cohorts identified were rivaroxaban (rivaroxaban alone or after heparin or fondaparinux for ≤48 hours); early switchers (rivaroxaban after heparin or fondaparinux for >48 hours to 14 days and/or a vitamin K antagonist [VKA] for 1–14 days); standard anticoagulation (heparin or fondaparinux and a VKA); low-molecular-weight heparin (LMWH) alone; and miscellaneous (other heparins, fondaparinux alone, VKA alone). Primary outcomes were major bleeding, recurrent venous thromboembolism, and all-cause mortality.
Results
In XALIA, 587 patients (11.4% of the XALIA cohort) were with cancer: 146 (24.9%) rivaroxaban, 30 (5.1%) early switchers, 141 (24.0%) standard anticoagulation, 223 (38.0%) LMWH, and 47 (8.0%) miscellaneous. Patients with gastrointestinal or lung cancer more commonly received LMWH than rivaroxaban; the opposite occurred in patients with breast or genitourinary cancer. Rates of primary outcome in the rivaroxaban group were as follows: major bleeding, 1.4% (
n
= 2); recurrent venous thromboembolism, 3.4% (
n
= 5); and all-cause mortality, 4.8% (
n
= 7).
Conclusion
In XALIA, physicians treated cancer-associated thrombosis with various anticoagulant regimens, most commonly LMWH. In addition, the choice of anticoagulant varied with cancer type. In rivaroxaban-treated patients, rates for the primary outcomes were low, suggesting that patients administered rivaroxaban were a good prognosis group.
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Affiliation(s)
- Walter Ageno
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - Lorenzo G Mantovani
- CESP-Center for Public Health Research, University of Milan Bicocca, Monza, Italy
| | - Sylvia Haas
- Technical University of Munich, Munich, Germany
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité Universitätsmedizin, Berlin, Germany
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Turpie AGG, Mantovani LG, Haas S, Kreutz R, Monje D, Schneider J, van Eickels M, Gebel M, Ageno W. Analysis of patients with deep vein thrombosis switched from standard therapy to rivaroxaban in the non-interventional XALIA study. Thromb Res 2017; 155:23-27. [PMID: 28477534 DOI: 10.1016/j.thromres.2017.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/29/2017] [Accepted: 04/02/2017] [Indexed: 11/15/2022]
Abstract
INTRODUCTION XALIA assessed the safety and effectiveness of rivaroxaban for deep vein thrombosis (DVT) treatment in routine clinical practice. This substudy describes the clinical characteristics and outcomes of 'early switchers' - patients who received heparin or fondaparinux for >2-14days and/or a vitamin K antagonist (VKA) for 1-14days before switching to rivaroxaban. MATERIALS AND METHODS Patients with DVT (latterly with concomitant pulmonary embolism) received rivaroxaban or standard anticoagulation (initial treatment with heparin or fondaparinux, usually overlapping with and followed by a VKA). Patients administered rivaroxaban alone, or heparin or fondaparinux for ≤48h pre-enrollment were included in the rivaroxaban cohort. Therapy type, dose, and duration were at the physician's discretion. Primary outcomes were major bleeding, recurrent venous thromboembolism (VTE), and all-cause mortality. RESULTS In 368 early switchers, recurrence or bleeding risk factors were more prevalent versus the rivaroxaban cohort, including creatinine clearance<50mL/min (6.5% vs. 3.9%), previous major bleeding (4.6% vs. 1.4%), active cancer (8.2% vs. 5.6%), and concomitant pulmonary embolism (20.9% vs. 8.4%). Crude incidence rates were numerically higher versus the rivaroxaban cohort for major bleeding (1.4% vs. 0.7%), recurrent VTE (2.2% vs. 1.4%), and all-cause mortality (0.8% vs. 0.5%). CONCLUSIONS Patients who switched to rivaroxaban early in the treatment process had a higher frequency of risk factors for bleeding and recurrent VTE than patients treated with rivaroxaban; reflected by the higher risk of adverse events in that group during follow-up.
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Affiliation(s)
| | - Lorenzo G Mantovani
- CESP-Center for Public Health Research, University of Milan Bicocca, Monza, Italy
| | | | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité Universitätsmedizin, Berlin, Germany
| | | | | | | | | | - Walter Ageno
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
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Camm AJ, Accetta G, Al Mahmeed W, Ambrosio G, Goldhaber SZ, Haas S, Jansky P, Kayani G, Misselwitz F, Oh S, Oto A, Raatikainen P, Steffel J, van Eickels M, Kakkar AK. Impact of gender on event rates at 1 year in patients with newly diagnosed non-valvular atrial fibrillation: contemporary perspective from the GARFIELD-AF registry. BMJ Open 2017; 7:e014579. [PMID: 28264833 PMCID: PMC5353285 DOI: 10.1136/bmjopen-2016-014579] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) explored the impact of gender, risk factors and anticoagulant (AC) treatment on 1-year outcomes in patients with non-valvular atrial fibrillation (NVAF). DESIGN GARFIELD-AF is a prospective non-interventional registry. SETTING Investigator sites (n=1048) are representative of the care settings/locations in each of the 35 countries. PARTICIPANTS Patients ≥18yrs with newly diagnosed (≤6 weeks' duration) NVAF and ≥1 investigator-determined stroke risk factors. MAIN OUTCOME MEASURES Event rates per 100 person-years were estimated from the Poisson model and HRs and 95% CIs calculated. RESULTS Of 28 624 patients (women 44.4%; men 55.6%) enrolled, there were more elderly (≥75 years) women (46.9%) than men (30.4%). All-cause mortality rates per 100 person-years (95% CI) for women and men were 4.48 (4.12 to 4.87) and 4.04 (3.74 to 4.38), respectively, stroke/systemic embolism (SE) (1.62 (1.41 to 1.87) and 1.17 (1.01 to 1.36)) and major bleeding (0.93 (0.78 to 1.13) and 0.79 (0.66 to 0.95)). After adjustment for baseline risk factors in treated and untreated patients, HRs (95% CI) for women (relative to men) for stroke/SE rates were 1.3-fold higher in women (HR 1.30 (1.04 to 1.63)), and similar for major bleeding (1.13 (0.85 to 1.50)) and all-cause mortality (1.05 (0.92 to 1.19)). Antithrombotic treatment patterns in men and women were almost identical. 63.8% women and 62.9% men received AC± antiplatelets. Relative to no AC treatment, the reduction in stroke/SE rates with AC treatment was greater (p=0.01) in men (HR 0.45 (0.33 to 0.61)) than women 0.77 (0.57 to 1.03). All-cause mortality reduction with AC treatment was similar (women: 0.65 (0.54 to 0.77); men: 0.57 (0.48 to 0.68)). The risk of major bleeding when treated with AC versus no AC was 2.33 (1.41 to 3.84) in men and 1.86 (1.16 to 2.99) in women (p value=0.53). CONCLUSIONS Women have a higher risk of stroke/SE and the reduction in stroke/SE events rates with AC treatment is less in women than in men. TRIAL REGISTRATION NUMBER NCT01090362.
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Affiliation(s)
- A John Camm
- St George's University of London, and Imperial College, London, UK
| | | | - Wael Al Mahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | | | | | - Sylvia Haas
- Formerly Technical University of Munich, Munich, Germany
| | - Petr Jansky
- Motol University Hospital, Prague, Czech Republic
| | | | | | - Seil Oh
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ali Oto
- Hacettepe University, Ankara, Turkey
| | | | - Jan Steffel
- University Hospital Zurich, Zurich, Switzerland
| | | | - Ajay K Kakkar
- Thrombosis Research Institute, London, UK
- University College London, London, UK
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Verheugt FW, Al Mahmeed W, Ambrosio G, Angchaisuksiri P, Atar D, Bassand JP, Camm AJ, Cools F, Eikelboom JW, Gao H, Kayani G, Lim TW, Misselwitz F, van Eickels M, Kakkar A. THE PRESCRIBING OF ANTIPLATELET THERAPY ONLY IN PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION: RESULTS FROM THE GARFIELD-AF REGISTRY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33715-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Camm AJ, Amarenco P, Haas S, Hess S, Kirchhof P, Kuhls S, Lambelet M, van Eickels M, Turpie A, AG B. REAL-WORLD VERSUS RANDOMIZED TRIAL OUTCOMES IN SIMILAR POPULATIONS OF RIVAROXABAN-TREATED PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION IN ROCKET AF AND XANTUS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33827-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Camm AJ, Accetta G, Agnelli G, Bassand JP, Goldhaber S, Kayani G, Misselwitz F, Oh S, Raatikainen P, Turpie A, van Eickels M, Kakkar A. TREATMENT AND OUTCOMES OF PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION ACCORDING TO GUIDELINE-DEFINED ANTICOAGULATION THRESHOLDS: RESULTS FROM THE GARFIELD-AF REGISTRY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33753-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gibson CM, Mehran R, Bode C, Halperin J, Verheugt FW, Wildgoose P, Birmingham M, Ianus J, Burton P, van Eickels M, Korjian S, Daaboul Y, Lip GYH, Cohen M, Husted S, Peterson ED, Fox KA. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med 2016; 375:2423-2434. [PMID: 27959713 DOI: 10.1056/nejmoa1611594] [Citation(s) in RCA: 1024] [Impact Index Per Article: 128.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) with placement of stents, standard anticoagulation with a vitamin K antagonist plus dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor and aspirin reduces the risk of thrombosis and stroke but increases the risk of bleeding. The effectiveness and safety of anticoagulation with rivaroxaban plus either one or two antiplatelet agents are uncertain. METHODS We randomly assigned 2124 participants with nonvalvular atrial fibrillation who had undergone PCI with stenting to receive, in a 1:1:1 ratio, low-dose rivaroxaban (15 mg once daily) plus a P2Y12 inhibitor for 12 months (group 1), very-low-dose rivaroxaban (2.5 mg twice daily) plus DAPT for 1, 6, or 12 months (group 2), or standard therapy with a dose-adjusted vitamin K antagonist (once daily) plus DAPT for 1, 6, or 12 months (group 3). The primary safety outcome was clinically significant bleeding (a composite of major bleeding or minor bleeding according to Thrombolysis in Myocardial Infarction [TIMI] criteria or bleeding requiring medical attention). RESULTS The rates of clinically significant bleeding were lower in the two groups receiving rivaroxaban than in the group receiving standard therapy (16.8% in group 1, 18.0% in group 2, and 26.7% in group 3; hazard ratio for group 1 vs. group 3, 0.59; 95% confidence interval [CI], 0.47 to 0.76; P<0.001; hazard ratio for group 2 vs. group 3, 0.63; 95% CI, 0.50 to 0.80; P<0.001). The rates of death from cardiovascular causes, myocardial infarction, or stroke were similar in the three groups (Kaplan-Meier estimates, 6.5% in group 1, 5.6% in group 2, and 6.0% in group 3; P values for all comparisons were nonsignificant). CONCLUSIONS In participants with atrial fibrillation undergoing PCI with placement of stents, the administration of either low-dose rivaroxaban plus a P2Y12 inhibitor for 12 months or very-low-dose rivaroxaban plus DAPT for 1, 6, or 12 months was associated with a lower rate of clinically significant bleeding than was standard therapy with a vitamin K antagonist plus DAPT for 1, 6, or 12 months. The three groups had similar efficacy rates, although the observed broad confidence intervals diminish the surety of any conclusions regarding efficacy. (Funded by Janssen Scientific Affairs and Bayer Pharmaceuticals; PIONEER AF-PCI ClinicalTrials.gov number, NCT01830543 .).
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Affiliation(s)
- C Michael Gibson
- From the Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (C.M.G., S.K., Y.D.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg (C.B.), and Bayer Pharmaceuticals, Leverkusen (M.E.) - both in Germany; Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam (F.W.V.); Janssen Pharmaceuticals, Titusville (P.W., M.B., J.I., P.B.), and the Division of Cardiology, Newark Beth Israel Medical Center, Newark (M.C.) - both in New Jersey; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Aarhus University Hospital, Medical Department, Hospital Unit West, Herning, Denmark (S.H.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and the Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh (K.A.F.)
| | - Roxana Mehran
- From the Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (C.M.G., S.K., Y.D.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg (C.B.), and Bayer Pharmaceuticals, Leverkusen (M.E.) - both in Germany; Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam (F.W.V.); Janssen Pharmaceuticals, Titusville (P.W., M.B., J.I., P.B.), and the Division of Cardiology, Newark Beth Israel Medical Center, Newark (M.C.) - both in New Jersey; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Aarhus University Hospital, Medical Department, Hospital Unit West, Herning, Denmark (S.H.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and the Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh (K.A.F.)
| | - Christoph Bode
- From the Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (C.M.G., S.K., Y.D.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg (C.B.), and Bayer Pharmaceuticals, Leverkusen (M.E.) - both in Germany; Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam (F.W.V.); Janssen Pharmaceuticals, Titusville (P.W., M.B., J.I., P.B.), and the Division of Cardiology, Newark Beth Israel Medical Center, Newark (M.C.) - both in New Jersey; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Aarhus University Hospital, Medical Department, Hospital Unit West, Herning, Denmark (S.H.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and the Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh (K.A.F.)
| | - Jonathan Halperin
- From the Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (C.M.G., S.K., Y.D.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg (C.B.), and Bayer Pharmaceuticals, Leverkusen (M.E.) - both in Germany; Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam (F.W.V.); Janssen Pharmaceuticals, Titusville (P.W., M.B., J.I., P.B.), and the Division of Cardiology, Newark Beth Israel Medical Center, Newark (M.C.) - both in New Jersey; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Aarhus University Hospital, Medical Department, Hospital Unit West, Herning, Denmark (S.H.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and the Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh (K.A.F.)
| | - Freek W Verheugt
- From the Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (C.M.G., S.K., Y.D.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg (C.B.), and Bayer Pharmaceuticals, Leverkusen (M.E.) - both in Germany; Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam (F.W.V.); Janssen Pharmaceuticals, Titusville (P.W., M.B., J.I., P.B.), and the Division of Cardiology, Newark Beth Israel Medical Center, Newark (M.C.) - both in New Jersey; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Aarhus University Hospital, Medical Department, Hospital Unit West, Herning, Denmark (S.H.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and the Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh (K.A.F.)
| | - Peter Wildgoose
- From the Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (C.M.G., S.K., Y.D.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg (C.B.), and Bayer Pharmaceuticals, Leverkusen (M.E.) - both in Germany; Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam (F.W.V.); Janssen Pharmaceuticals, Titusville (P.W., M.B., J.I., P.B.), and the Division of Cardiology, Newark Beth Israel Medical Center, Newark (M.C.) - both in New Jersey; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Aarhus University Hospital, Medical Department, Hospital Unit West, Herning, Denmark (S.H.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and the Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh (K.A.F.)
| | - Mary Birmingham
- From the Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (C.M.G., S.K., Y.D.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg (C.B.), and Bayer Pharmaceuticals, Leverkusen (M.E.) - both in Germany; Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam (F.W.V.); Janssen Pharmaceuticals, Titusville (P.W., M.B., J.I., P.B.), and the Division of Cardiology, Newark Beth Israel Medical Center, Newark (M.C.) - both in New Jersey; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Aarhus University Hospital, Medical Department, Hospital Unit West, Herning, Denmark (S.H.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and the Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh (K.A.F.)
| | - Juliana Ianus
- From the Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (C.M.G., S.K., Y.D.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg (C.B.), and Bayer Pharmaceuticals, Leverkusen (M.E.) - both in Germany; Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam (F.W.V.); Janssen Pharmaceuticals, Titusville (P.W., M.B., J.I., P.B.), and the Division of Cardiology, Newark Beth Israel Medical Center, Newark (M.C.) - both in New Jersey; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Aarhus University Hospital, Medical Department, Hospital Unit West, Herning, Denmark (S.H.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and the Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh (K.A.F.)
| | - Paul Burton
- From the Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (C.M.G., S.K., Y.D.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg (C.B.), and Bayer Pharmaceuticals, Leverkusen (M.E.) - both in Germany; Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam (F.W.V.); Janssen Pharmaceuticals, Titusville (P.W., M.B., J.I., P.B.), and the Division of Cardiology, Newark Beth Israel Medical Center, Newark (M.C.) - both in New Jersey; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Aarhus University Hospital, Medical Department, Hospital Unit West, Herning, Denmark (S.H.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and the Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh (K.A.F.)
| | - Martin van Eickels
- From the Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (C.M.G., S.K., Y.D.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg (C.B.), and Bayer Pharmaceuticals, Leverkusen (M.E.) - both in Germany; Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam (F.W.V.); Janssen Pharmaceuticals, Titusville (P.W., M.B., J.I., P.B.), and the Division of Cardiology, Newark Beth Israel Medical Center, Newark (M.C.) - both in New Jersey; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Aarhus University Hospital, Medical Department, Hospital Unit West, Herning, Denmark (S.H.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and the Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh (K.A.F.)
| | - Serge Korjian
- From the Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (C.M.G., S.K., Y.D.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg (C.B.), and Bayer Pharmaceuticals, Leverkusen (M.E.) - both in Germany; Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam (F.W.V.); Janssen Pharmaceuticals, Titusville (P.W., M.B., J.I., P.B.), and the Division of Cardiology, Newark Beth Israel Medical Center, Newark (M.C.) - both in New Jersey; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Aarhus University Hospital, Medical Department, Hospital Unit West, Herning, Denmark (S.H.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and the Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh (K.A.F.)
| | - Yazan Daaboul
- From the Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (C.M.G., S.K., Y.D.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg (C.B.), and Bayer Pharmaceuticals, Leverkusen (M.E.) - both in Germany; Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam (F.W.V.); Janssen Pharmaceuticals, Titusville (P.W., M.B., J.I., P.B.), and the Division of Cardiology, Newark Beth Israel Medical Center, Newark (M.C.) - both in New Jersey; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Aarhus University Hospital, Medical Department, Hospital Unit West, Herning, Denmark (S.H.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and the Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh (K.A.F.)
| | - Gregory Y H Lip
- From the Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (C.M.G., S.K., Y.D.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg (C.B.), and Bayer Pharmaceuticals, Leverkusen (M.E.) - both in Germany; Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam (F.W.V.); Janssen Pharmaceuticals, Titusville (P.W., M.B., J.I., P.B.), and the Division of Cardiology, Newark Beth Israel Medical Center, Newark (M.C.) - both in New Jersey; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Aarhus University Hospital, Medical Department, Hospital Unit West, Herning, Denmark (S.H.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and the Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh (K.A.F.)
| | - Marc Cohen
- From the Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (C.M.G., S.K., Y.D.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg (C.B.), and Bayer Pharmaceuticals, Leverkusen (M.E.) - both in Germany; Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam (F.W.V.); Janssen Pharmaceuticals, Titusville (P.W., M.B., J.I., P.B.), and the Division of Cardiology, Newark Beth Israel Medical Center, Newark (M.C.) - both in New Jersey; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Aarhus University Hospital, Medical Department, Hospital Unit West, Herning, Denmark (S.H.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and the Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh (K.A.F.)
| | - Steen Husted
- From the Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (C.M.G., S.K., Y.D.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg (C.B.), and Bayer Pharmaceuticals, Leverkusen (M.E.) - both in Germany; Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam (F.W.V.); Janssen Pharmaceuticals, Titusville (P.W., M.B., J.I., P.B.), and the Division of Cardiology, Newark Beth Israel Medical Center, Newark (M.C.) - both in New Jersey; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Aarhus University Hospital, Medical Department, Hospital Unit West, Herning, Denmark (S.H.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and the Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh (K.A.F.)
| | - Eric D Peterson
- From the Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (C.M.G., S.K., Y.D.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg (C.B.), and Bayer Pharmaceuticals, Leverkusen (M.E.) - both in Germany; Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam (F.W.V.); Janssen Pharmaceuticals, Titusville (P.W., M.B., J.I., P.B.), and the Division of Cardiology, Newark Beth Israel Medical Center, Newark (M.C.) - both in New Jersey; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Aarhus University Hospital, Medical Department, Hospital Unit West, Herning, Denmark (S.H.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and the Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh (K.A.F.)
| | - Keith A Fox
- From the Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (C.M.G., S.K., Y.D.); the Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg (C.B.), and Bayer Pharmaceuticals, Leverkusen (M.E.) - both in Germany; Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam (F.W.V.); Janssen Pharmaceuticals, Titusville (P.W., M.B., J.I., P.B.), and the Division of Cardiology, Newark Beth Israel Medical Center, Newark (M.C.) - both in New Jersey; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Aarhus University Hospital, Medical Department, Hospital Unit West, Herning, Denmark (S.H.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and the Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh (K.A.F.)
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Gibson CM, Pinto DS, Chi G, Arbetter D, Yee M, Mehran R, Bode C, Halperin J, Verheugt FWA, Wildgoose P, Burton P, van Eickels M, Korjian S, Daaboul Y, Jain P, Lip GYH, Cohen M, Peterson ED, Fox KAA. Recurrent Hospitalization Among Patients With Atrial Fibrillation Undergoing Intracoronary Stenting Treated With 2 Treatment Strategies of Rivaroxaban or a Dose-Adjusted Oral Vitamin K Antagonist Treatment Strategy. Circulation 2016; 135:323-333. [PMID: 27881555 PMCID: PMC5266420 DOI: 10.1161/circulationaha.116.025783] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/24/2016] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Patients with atrial fibrillation who undergo intracoronary stenting traditionally are treated with a vitamin K antagonist (VKA) plus dual antiplatelet therapy (DAPT), yet this treatment leads to high risks of bleeding. We hypothesized that a regimen of rivaroxaban plus a P2Y12 inhibitor monotherapy or rivaroxaban plus DAPT could reduce bleeding and thereby have a favorable impact on all-cause mortality and the need for rehospitalization. Methods: Stented subjects with nonvalvular atrial fibrillation (n=2124) were randomized 1:1:1 to administration of reduced-dose rivaroxaban 15 mg daily plus a P2Y12 inhibitor for 12 months (group 1); rivaroxaban 2.5 mg twice daily with stratification to a prespecified duration of DAPT of 1, 6, or 12 months (group 2); or the reference arm of dose-adjusted VKA daily with a similar DAPT stratification (group 3). The present post hoc analysis assessed the end point of all-cause mortality or recurrent hospitalization for an adverse event, which was further classified as the result of bleeding, a cardiovascular cause, or another cause blinded to treatment assignment. Results: The risk of all-cause mortality or recurrent hospitalization was 34.9% in group 1 (hazard ratio=0.79; 95% confidence interval, 0.66–0.94; P=0.008 versus group 3; number needed to treat=15), 31.9% in group 2 (hazard ratio=0.75; 95% confidence interval, 0.62–0.90; P=0.002 versus group 3; number needed to treat=10), and 41.9% in group 3 (VKA+DAPT). Both all-cause death plus hospitalization potentially resulting from bleeding (group 1=8.6% [P=0.032 versus group 3], group 2=8.0% [P=0.012 versus group 3], and group 3=12.4%) and all-cause death plus rehospitalization potentially resulting from a cardiovascular cause (group 1=21.4% [P=0.001 versus group 3], group 2=21.7% [P=0.011 versus group 3], and group 3=29.3%) were reduced in the rivaroxaban arms compared with the VKA arm, but other forms of rehospitalization were not. Conclusions: Among patients with atrial fibrillation undergoing intracoronary stenting, administration of either rivaroxaban 15 mg daily plus P2Y12 inhibitor monotherapy or 2.5 mg rivaroxaban twice daily plus DAPT was associated with a reduced risk of all-cause mortality or recurrent hospitalization for adverse events compared with standard-of-care VKA plus DAPT. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01830543.
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Affiliation(s)
- C Michael Gibson
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.).
| | - Duane S Pinto
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Gerald Chi
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Douglas Arbetter
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Megan Yee
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Roxana Mehran
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Christoph Bode
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Jonathan Halperin
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Freek W A Verheugt
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Peter Wildgoose
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Paul Burton
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Martin van Eickels
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Serge Korjian
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Yazan Daaboul
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Purva Jain
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Gregory Y H Lip
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Marc Cohen
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Eric D Peterson
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Keith A A Fox
- From Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (C.M.G., D.S.P., G.C., D.A., M.Y., S.K., Y.D., P.J.); Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York (R.M., J.H.); Heart Center, Department for Cardiology and Angiology I, University of Freiburg, Freiburg, Germany (C.B.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.); Janssen Pharmaceuticals, Inc, Beerse, Belgium (P.W., P.B.); Bayer Pharmaceuticals, Inc, Berlin, Germany (M.v.E.); University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ (M.C.); Duke Clinical Research Institute, Durham, NC (E.D.P.); and Centre for Cardiovascular Science, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
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Oh S, Goto S, Accetta G, Angchaisuksiri P, Camm AJ, Cools F, Haas S, Kayani G, Koretsune Y, Lim TW, Misselwitz F, van Eickels M, Kakkar AK. Vitamin K antagonist control in patients with atrial fibrillation in Asia compared with other regions of the world: Real-world data from the GARFIELD-AF registry. Int J Cardiol 2016; 223:543-547. [DOI: 10.1016/j.ijcard.2016.08.236] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/18/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
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Ageno W, Mantovani LG, Haas S, Kreutz R, Monje D, Schneider J, van Eickels M, Gebel M, Zell E, Turpie AGG. Real life studies and good clinical practice - Authors' reply. Lancet Haematol 2016; 3:e160-1. [PMID: 27063973 DOI: 10.1016/s2352-3026(16)00027-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 02/19/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Walter Ageno
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy.
| | - Lorenzo G Mantovani
- CESP-Center for Public Health Research, University of Milan Bicocca, Milan, Italy
| | | | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin, Berlin, Germany
| | | | | | | | | | | | - Alexander G G Turpie
- Department of Medicine, Hamilton Health Sciences, General Division, Hamilton, ON, Canada
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Lip GYH, Hammerstingl C, Marin F, Cappato R, Meng IL, Kirsch B, van Eickels M, Cohen A. Left atrial thrombus resolution in atrial fibrillation or flutter: Results of a prospective study with rivaroxaban (X-TRA) and a retrospective observational registry providing baseline data (CLOT-AF). Am Heart J 2016; 178:126-34. [PMID: 27502860 DOI: 10.1016/j.ahj.2016.05.007] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/05/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Data on left atrial/left atrial appendage (LA/LAA) thrombus resolution after non-vitamin K antagonist (VKA) oral anticoagulant treatment are scarce. The primary objective of X-TRA was to explore the use of rivaroxaban for the resolution of LA/LAA thrombi in patients with nonvalvular atrial fibrillation (AF) or atrial flutter, with the CLOT-AF registry providing retrospective data after standard-of-care therapy in this setting. METHODS X-TRA was a prospective, single-arm, open-label, multicenter study that investigated rivaroxaban treatment for 6 weeks for LA/LAA thrombus resolution in patients with nonvalvular AF or atrial flutter and LA/LAA thrombus confirmed at baseline on a transesophageal echocardiogram (TEE). CLOT-AF retrospectively collected thrombus-related patient outcome data after standard-of-care anticoagulant treatment for 3 to 12 weeks in patients with nonvalvular AF or atrial flutter who had LA/LAA thrombi on TEE recorded in their medical file. RESULTS In X-TRA, patients were predominantly (95.0%) from Eastern European countries. The adjudicated thrombus resolution rate was 41.5% (22/53 modified intention-to-treat [mITT] patients, 95% CI 28.1%-55.9%) based on central TEE assessments. Resolved or reduced thrombus was evident in 60.4% (32/53 mITT patients, 95% CI 46.0%-73.6%) of patients. In CLOT-AF, the reported thrombus resolution rate was 62.5% (60/96 mITT patients, 95% CI 52.0%-72.2%) and appeared better in Western European countries (34/50; 68.0%) than in Eastern European countries (26/46; 56.5%). CONCLUSION X-TRA is the first prospective, multicenter study examining LA/LAA thrombus resolution with a non-VKA oral anticoagulant in VKA-naïve patients or in patients with suboptimal VKA therapy. Rivaroxaban could be a potential option for the treatment of LA/LAA thrombi.
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Affiliation(s)
- Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | | | - Francisco Marin
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | | | | | - Bodo Kirsch
- Global Research and Development Statistics, Bayer Pharma AG, Berlin, Germany
| | | | - Ariel Cohen
- Cardiology Department, Assistance publique-Hôpitaux de Paris and université Pierre-et-Marie-Curie, Saint-Antoine University and Medical School, Paris, France
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Camm AJ, Amarenco P, Haas S, Hess S, Kirchhof P, Kuhls S, van Eickels M, Turpie AGG. XANTUS: a real-world, prospective, observational study of patients treated with rivaroxaban for stroke prevention in atrial fibrillation. Eur Heart J 2016; 37:1145-53. [PMID: 26330425 PMCID: PMC4823634 DOI: 10.1093/eurheartj/ehv466] [Citation(s) in RCA: 321] [Impact Index Per Article: 40.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 08/11/2015] [Accepted: 08/20/2015] [Indexed: 12/16/2022] Open
Abstract
AIMS Although non-vitamin K antagonist oral anticoagulants are recommended for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) based on clinical trial results, there is a need for safety and efficacy data from unselected patients in everyday clinical practice. XANTUS investigated the safety and efficacy of the Factor Xa inhibitor rivaroxaban in routine clinical use in the NVAF setting. METHODS AND RESULTS Consecutive consenting patients with NVAF newly started on rivaroxaban were eligible and were followed up at ∼3-month intervals for 1 year, or for at least 30 days after permanent discontinuation. All adverse events (AEs) were recorded as AEs or serious AEs; major outcomes (including major bleeding, symptomatic thromboembolic events [stroke, systemic embolism, transient ischaemic attack, and myocardial infarction], and all-cause death) were centrally adjudicated. There were 6784 patients treated with rivaroxaban at 311 centres in Europe, Israel, and Canada. Mean patient age was 71.5 years (range 19-99), 41% were female, and 9.4% had documented severe or moderate renal impairment (creatinine clearance <50 mL/min). The mean CHADS2 and CHA2DS2-VASc scores were 2.0 and 3.4, respectively; 859 (12.7%) patients had a CHA2DS2-VASc score of 0 or 1. The mean treatment duration was 329 days. Treatment-emergent major bleeding occurred in 128 patients (2.1 events per 100 patient-years), 118 (1.9 events per 100 patient-years) died, and 43 (0.7 events per 100 patient-years) suffered a stroke. CONCLUSION XANTUS is the first international, prospective, observational study to describe the use of rivaroxaban in a broad NVAF patient population. Rates of stroke and major bleeding were low in patients receiving rivaroxaban in routine clinical practice. TRIAL REGISTRATION NUMBER Clinicaltrials.gov: NCT01606995.
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Affiliation(s)
- A John Camm
- Cardiovascular and Cell Sciences Research Institute, St George's, University of London, Cranmer Terrace, SW170RE London, UK
| | - Pierre Amarenco
- Department of Neurology and Stroke Center, Paris-Diderot-Sorbonne University, Paris, France
| | | | - Susanne Hess
- Global Medical Affairs, Bayer HealthCare Pharmaceuticals, Berlin, Germany
| | - Paulus Kirchhof
- Centre for Cardiovascular Sciences, University of Birmingham and Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - Silvia Kuhls
- Global Integrated Analysis, Bayer HealthCare Pharmaceuticals, Wuppertal, Germany
| | - Martin van Eickels
- Global Medical Affairs, Bayer HealthCare Pharmaceuticals, Berlin, Germany
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Hohnloser SH, Cappato R, Ezekowitz MD, Evers T, Sahin K, Kirchhof P, Meng IL, van Eickels M, Camm AJ. Patient-reported treatment satisfaction and budget impact with rivaroxaban vs. standard therapy in elective cardioversion of atrial fibrillation: a post hoc analysis of the X-VeRT trial. Europace 2015; 18:184-90. [PMID: 26487668 PMCID: PMC4767121 DOI: 10.1093/europace/euv294] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 08/03/2015] [Indexed: 11/23/2022] Open
Abstract
Aims We compared patient-reported treatment satisfaction and the economic impact of anticoagulation therapy with rivaroxaban vs. vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation undergoing elective cardioversion procedures. Methods and results The current study is a post hoc analysis of the prospective, multicentre X-VeRT (EXplore the efficacy and safety of once-daily oral riVaroxaban for the prevention of caRdiovascular events in subjects with non-valvular aTrial fibrillation scheduled for cardioversion) trial. Patient-reported treatment satisfaction with anticoagulation therapy was assessed using the Treatment Satisfaction Questionnaire for Medication version II in seven countries (US, UK, Canada, Germany, France, Italy, and the Netherlands). An economic model was also developed to estimate the impact of postponed cardioversions for two countries (UK and Italy). This model estimated the total costs of cardioversion, taking into consideration the costs for drug therapy (including extended treatment duration due to cardioversion postponement), international normalized ratio monitoring of VKAs, the cardioversion procedure, and rescheduling the procedure. These costs were linked to the respective X-VeRT study data to estimate the total costs. Patients receiving rivaroxaban in the delayed cardioversion group had significantly higher scores for Convenience, Effectiveness, and Global satisfaction (81.74 vs. 65.78; 39.41 vs. 32.95; and 82.07 vs. 66.74, respectively; P < 0.0001). Based on the total patient population included in the treatment satisfaction substudy (n = 632) in the delayed cardioversion group in X-VeRT, the use of rivaroxaban was estimated to result in a saving of £421 and €360 per patient in UK and Italian settings, respectively. Conclusion The use of rivaroxaban in the setting of cardioversion resulted in greater patient satisfaction and cost savings, compared with that of VKA.
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Affiliation(s)
- Stefan H Hohnloser
- Department of Cardiology, Division of Clinical Electrophysiology, J.W. Goethe University, Frankfurt, Germany
| | - Riccardo Cappato
- Arrhythmia and Electrophysiology Center, IRCCS Humanitas Research Hospital, Milan, Italy Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Michael D Ezekowitz
- The Sidney Kimell Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Kurtulus Sahin
- ClinStat GmbH, Statistics and Health Economics, Cologne, Germany
| | - Paulus Kirchhof
- Centre for Cardiovascular Sciences, School of Clinical and Experimental Medicine, University of Birmingham, SWBH and UHB NHS Trusts, Birmingham, UK Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany
| | | | | | - A John Camm
- Division of Clinical Sciences, St George's, University of London, London, UK
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Jackson N, Atar D, Borentain M, Breithardt G, van Eickels M, Endres M, Fraass U, Friede T, Hannachi H, Janmohamed S, Kreuzer J, Landray M, Lautsch D, Le Floch C, Mol P, Naci H, Samani NJ, Svensson A, Thorstensen C, Tijssen J, Vandzhura V, Zalewski A, Kirchhof P. Improving clinical trials for cardiovascular diseases: a position paper from the Cardiovascular Round Table of the European Society of Cardiology. Eur Heart J 2015; 37:747-54. [PMID: 26077039 DOI: 10.1093/eurheartj/ehv213] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 05/04/2015] [Indexed: 12/12/2022] Open
Abstract
AIMS Cardiovascular disease is the most common cause of mortality and morbidity in the world, but the pharmaceutical industry's willingness to invest in this field has declined because of the many challenges involved with bringing new cardiovascular drugs to market, including late-stage failures, escalating regulatory requirements, bureaucracy of the clinical trial business enterprise, and limited patient access after approval. This contrasts with the remaining burden of cardiovascular disease in Europe and in the world. Thus, clinical cardiovascular research needs to adapt to address the impact of these challenges in order to ensure development of new cardiovascular medicines. METHODS AND RESULTS The present paper is the outcome of a two-day workshop held by the Cardiovascular Round Table of the European Society of Cardiology. We propose strategies to improve development of effective new cardiovascular therapies. These can include (i) the use of biomarkers to describe patients who will benefit from new therapies more precisely, achieving better human target validation; (ii) targeted, mechanism-based approaches to drug development for defined populations; (iii) the use of information technology to simplify data collection and follow-up in clinical trials; (iv) streamlining adverse event collection and reducing monitoring; (v) extended patent protection or limited rapid approval of new agents to motivate investment in early phase development; and (vi) collecting data needed for health technology assessment continuously throughout the drug development process (before and after approval) to minimize delays in patient access. Collaboration across industry, academia, regulators, and payers will be necessary to enact change and to unlock the existing potential for cardiovascular clinical drug development. CONCLUSIONS A coordinated effort involving academia, regulators, industry, and payors will help to foster better and more effective conduct of clinical cardiovascular trials, supporting earlier availability of innovative therapies and better management of cardiovascular diseases.
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Affiliation(s)
| | - Dan Atar
- Oslo University Hospital Ulleval and University of Oslo, Oslo, Norway
| | | | - Günter Breithardt
- Department of Cardiovascular Medicine, Universitätsklinikum Münster, Münster, Germany Centre for Cardiovascular Sciences, School of Clinical and Experimental Medicine, University of Birmingham and Sandwell and West Birmingham Hospitals National Health Service Trust, Wolfson Drive, Birmingham B15 2TT, UK
| | | | | | | | - Tim Friede
- Department of Medical Statistics, University Medical Center, Göttingen, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | | | | | - Jörg Kreuzer
- Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
| | | | | | | | - Peter Mol
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | - Huseyin Naci
- London School of Economics and Political Science, London, UK
| | | | | | | | - Jan Tijssen
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Paulus Kirchhof
- Centre for Cardiovascular Sciences, School of Clinical and Experimental Medicine, University of Birmingham and Sandwell and West Birmingham Hospitals National Health Service Trust, Wolfson Drive, Birmingham B15 2TT, UK Atrial Fibrillation Competence NETwork (AFNET) e.V., Münster, Germany
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van Eickels M. Rivaroxaban – größtes Studienprogramm aller neuen direkten oralen Antikoagulanzien. Dtsch Med Wochenschr 2015; 140 Suppl 1:S27. [DOI: 10.1055/s-0041-101776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lip GYH, Hammerstingl C, Marin F, Cappato R, Meng IL, Kirsch B, Morandi E, van Eickels M, Cohen A. Rationale and design of a study exploring the efficacy of once-daily oral rivaroxaban (X-TRA) on the outcome of left atrial/left atrial appendage thrombus in nonvalvular atrial fibrillation or atrial flutter and a retrospective observational registry providing baseline data (CLOT-AF). Am Heart J 2015; 169:464-71.e2. [PMID: 25819852 DOI: 10.1016/j.ahj.2014.12.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/04/2014] [Indexed: 12/24/2022]
Abstract
There are still many unresolved issues concerning patient outcomes and prognostic factors in patients with atrial fibrillation (AF) and left atrial/left atrial appendage (LA/LAA) thrombi. Rivaroxaban (Xarelto®), a potent and highly selective oral, direct factor Xa inhibitor, is a new therapeutic option in this setting. The planned study program will consist of a prospective interventional study (X-TRA) and a retrospective observational registry (CLOT-AF). The primary objective of the X-TRA study is to explore the efficacy of rivaroxaban in the treatment of LA/LAA thrombi in patients with nonvalvular AF or atrial flutter, scheduled to undergo cardioversion or AF ablation, in whom an LA/LAA thrombus has been found on transesophageal echocardiography (TEE) before the procedure. The primary end point is the complete LA/LAA thrombus resolution rate at 6 weeks of end of treatment confirmed by TEE. The secondary objectives are to describe categories of thrombus outcome in patients (resolved, reduced, unchanged, larger, or new) confirmed on TEE at the end of treatment (after 6 weeks of treatment), incidence of the composite of stroke and noncentral nervous system systemic embolism at the end of treatment and during follow-up, and incidence of all bleeding at the end of treatment and during follow-up. The objective of the CLOT-AF registry is to provide retrospective thrombus-related patient outcome data after standard-of-care anticoagulant treatment in patients with nonvalvular AF or atrial flutter, who have TEE-documented LA/LAA thrombi. The data will be used as a reference for the prospective X-TRA study. In conclusion, X-TRA and CLOT-AF will provide some answers to the many unresolved issues concerning patient outcomes and prognostic factors in patients with AF and LAA thrombi. Results from this study program would provide the first prospective interventional study (X-TRA) and a large international retrospective observational registry (CLOT-AF) on the prevalence and natural history of LA/LAA thrombi. Unique data on clot resolution with rivaroxaban in a prospective cohort would be obtained in X-TRA.
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Affiliation(s)
- Gregory Y H Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
| | | | - Francisco Marin
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - Riccardo Cappato
- Arrhythmia and Electrophysiology Center, University of Milan, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Bodo Kirsch
- Global Research and Development Statistics, Bayer HealthCare, Berlin, Germany
| | - Eolo Morandi
- Therapeutic Cardiovascular and Coagulation, Global Development, Bayer HealthCare, São Paulo, Brazil
| | | | - Ariel Cohen
- Cardiology Department, Assistance Publique-Hôpitaux de Paris and Université Pierre-et-Marie-Curie, Saint-Antoine University and Medical School, Paris, France
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Gibson CM, Mehran R, Bode C, Halperin J, Verheugt F, Wildgoose P, van Eickels M, Lip GY, Cohen M, Husted S, Peterson E, Fox K. An open-label, randomized, controlled, multicenter study exploring two treatment strategies of rivaroxaban and a dose-adjusted oral vitamin K antagonist treatment strategy in subjects with atrial fibrillation who undergo percutaneous coronary intervention (PIONEER AF-PCI). Am Heart J 2015; 169:472-8.e5. [PMID: 25819853 DOI: 10.1016/j.ahj.2014.12.006] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 12/17/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Guidelines recommendations regarding anticoagulant therapy after percutaneous coronary intervention (PCI) among patients with atrial fibrillation (AF) rely on retrospective, nonrandomized observational data. Currently, patients are treated with triple-therapy (dual antiplatelet therapy [DAPT] + oral anticoagulation therapy), but neither the duration of DAPT nor the level of anticoagulation has been studied in a randomized fashion. Recent studies also suggest dual pathway therapy with clopidogrel plus oral anticoagulation therapy may be superior, and other studies suggest that novel oral anticoagulants such as rivaroxaban may further improve patient outcomes. DESIGN PIONEER AF-PCI (ClinicalTrials.gov NCT01830543) is an exploratory, open-label, randomized, multicenter clinical study assessing the safety of 2 rivaroxaban treatment strategies and 1 vitamin K antagonist (VKA) treatment strategy in subjects who have paroxysmal, persistent, or permanent nonvalvular AF and have undergone PCI with stent placement. Approximately 2,100 subjects will be randomized in a 1:1:1 ratio to receive either rivaroxaban 15 mg once daily plus clopidogrel 75 mg daily for 12 months (a WOEST trial-like strategy), or rivaroxaban 2.5 mg twice daily (with stratification to a prespecified duration of DAPT 1, 6, or 12 months, an ATLAS trial-like strategy), or dose-adjusted VKA once daily (with stratification to a prespecified duration of DAPT 1, 6, or 12 months, traditional triple therapy). All patients will be followed up for 12 months for the primary composite end point of Thrombolysis in Myocardial Infarction major bleeding, bleeding requiring medical attention, and minor bleeding (collectively, clinically significant bleeding). CONCLUSION The PIONEER AF-PCI study is the first randomized comparison of VKA vs novel oral anticoagulant therapy in patients with NVAF receiving antiplatelet therapy after PCI to assess the relative risks of bleeding complications.
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Lip GYH, Rushton-Smith SK, Goldhaber SZ, Fitzmaurice DA, Mantovani LG, Goto S, Haas S, Bassand JP, Camm AJ, Ambrosio G, Janský P, Al Mahmeed W, Oh S, van Eickels M, Raatikainen P, Steffel J, Oto A, Kayani G, Accetta G, Kakkar AK. Does sex affect anticoagulant use for stroke prevention in nonvalvular atrial fibrillation? The prospective global anticoagulant registry in the FIELD-Atrial Fibrillation. Circ Cardiovasc Qual Outcomes 2015; 8:S12-20. [PMID: 25714828 DOI: 10.1161/circoutcomes.114.001556] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Among patients with atrial fibrillation (AF), women are at higher risk of stroke than men. Using prospective cohort data from a large global population of patients with nonvalvular AF, we sought to identify any differences in the use of anticoagulants for stroke prevention in women and men. METHODS AND RESULTS This was a prospective multicenter observational registry with 858 randomly selected sites in 30 countries. A total of 17 184 patients with newly diagnosed (≤6 weeks) nonvalvular AF and ≥1 additional investigator-defined stroke risk factor(s) were recruited (March 2010 to June 2013). The main outcome measure was the use of anticoagulants (vitamin K antagonists, factor Xa inhibitors, and direct thrombin inhibitors) for stroke prevention at AF diagnosis. Of 17 184 patients enrolled, 43.8% were women. More women than men were at moderate-to-high risk of stroke (CHADS2 score ≥2: 65.1% versus 54.7%). Rates of anticoagulant use were not different overall (60.9% of men versus 60.8% of women) and in patients with a CHADS2 score ≥2 (adjusted odds ratio for women versus men, 1.00; 95% confidence interval, 0.92-1.09). In patients at low risk (CHA2DS2-VASc of 0 in men and 1 in women), 41.8% of men and 41.1% of women received an anticoagulant. In patients at high risk (CHA2DS2-VASc score ≥2), 35.4% of men and 38.4% of women did not receive an anticoagulant. CONCLUSIONS These contemporary global data show that anticoagulant use for stroke prevention is no different in men and women with nonvalvular AF. Thromboprophylaxis was, however, suboptimal in substantial proportions of men and women, with underuse in those at moderate-to-high risk of stroke and overuse in those at low risk. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT01090362.
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Cappato R, Ezekowitz MD, Klein AL, Camm AJ, Ma CS, Le Heuzey JY, Talajic M, Scanavacca M, Vardas PE, Kirchhof P, Hemmrich M, Lanius V, Meng IL, Wildgoose P, van Eickels M, Hohnloser SH. Rivaroxaban vs. vitamin K antagonists for cardioversion in atrial fibrillation. Eur Heart J 2014; 35:3346-55. [DOI: 10.1093/eurheartj/ehu367] [Citation(s) in RCA: 292] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Camm AJ, Amarenco P, Haas S, Hess S, Kirchhof P, van Eickels M, Turpie AGG. XANTUS: rationale and design of a noninterventional study of rivaroxaban for the prevention of stroke in patients with atrial fibrillation. Vasc Health Risk Manag 2014; 10:425-34. [PMID: 25083135 PMCID: PMC4108256 DOI: 10.2147/vhrm.s63298] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Atrial fibrillation (AF) is associated with a fivefold increase in the risk of stroke. The Phase III ROCKET AF (Rivaroxaban Once-Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation) trial showed that rivaroxaban, an oral, direct Factor Xa inhibitor, was noninferior to warfarin for the reduction of stroke or systemic embolism in patients with AF. Compared with warfarin, rivaroxaban significantly reduced rates of intracranial and fatal hemorrhages, although not rates of bleeding overall. XANTUS (Xarelto(®) for Prevention of Stroke in Patients with Atrial Fibrillation) is a prospective, international, observational, postauthorization, noninterventional study designed to collect safety and efficacy data on the use of rivaroxaban for stroke prevention in AF in routine clinical practice. The key goal is to determine whether the safety profile of rivaroxaban established in ROCKET AF is also observed in routine clinical practice. XANTUS is designed as a single-arm cohort study to minimize selection bias, and will enroll approximately 6,000 patients (mostly from Europe) with nonvalvular AF prescribed rivaroxaban, irrespective of their level of stroke risk. Overall duration of follow-up will be 1 year; the first patient was enrolled in June 2012. Similar studies (XANTUS-EL [Xarelto(®) for Prevention of Stroke in Patients with Nonvalvular Atrial Fibrillation, Eastern Europe, Middle East, Africa and Latin America] and XANAP [Xarelto(®) for Prevention of Stroke in Patients with Atrial Fibrillation in Asia-Pacific]) are ongoing in Latin America and Asia-Pacific. Data from these studies will supplement those from ROCKET AF and provide practical information concerning the use of rivaroxaban for stroke prevention in AF.
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Affiliation(s)
- A John Camm
- Division of Clinical Sciences, St George's, University of London, London, UK
| | - Pierre Amarenco
- Department of Neurology and Stroke Center, Paris-Diderot-Sorbonne University, Paris, France
| | | | - Susanne Hess
- Medical Affairs, Bayer HealthCare Pharmaceuticals, Berlin, Germany
| | - Paulus Kirchhof
- Centre for Cardiovascular Sciences, University of Birmingham and Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK ; Department of Cardiovascular Medicine, University of Münster, Münster, Germany
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Turpie AGG, Haas S, Kreutz R, Mantovani LG, Pattanayak CW, Holberg G, Jamal W, Schmidt A, van Eickels M, Lassen MR. A non-interventional comparison of rivaroxaban with standard of care for thromboprophylaxis after major orthopaedic surgery in 17,701 patients with propensity score adjustment. Thromb Haemost 2013; 111:94-102. [PMID: 24154549 DOI: 10.1160/th13-08-0666] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 09/17/2013] [Indexed: 11/05/2022]
Abstract
Rivaroxaban demonstrated superior efficacy and a similar safety profile to enoxaparin for the prevention of venous thromboembolism in the phase III RECORD programme in patients undergoing elective hip or knee replacement surgery. The XAMOS study investigated adverse events, including bleeding and thromboembolic events, in patients receiving rivaroxaban for thromboprophylaxis in routine clinical practice. XAMOS was a non-interventional, open-label cohort study in patients undergoing major orthopaedic surgery of the hip or knee (predominantly elective arthroplasty), in which rivaroxaban was compared with other pharmacological thromboprophylaxis. All adverse events were documented, including symptomatic thromboembolic and bleeding events. Crude and adjusted incidences based on propensity score subclasses were calculated and compared between the rivaroxaban and standard-of-care groups. A total of 17,701 patients were enrolled from 252 centres in 37 countries. Crude incidences of symptomatic thromboembolic events three months after surgery in the safety population were 0.89% in the rivaroxaban group (n=8,778) and 1.35% in the standard-of-care group (n=8,635; odds ratio [OR] 0.65; 95% confidence interval [CI] 0.49-0.87), and 0.91% and 1.31% (weighted) in the propensity score-adjusted analysis (OR 0.69; 95% CI 0.56-0.85), respectively. Treatment-emergent major bleeding events (as defined in the RECORD studies) occurred in 0.40% and 0.34% of patients in the rivaroxaban and standard-of-care groups in the safety population (OR 1.19; 95% CI 0.73-1.95), and in 0.44% versus 0.33% (weighted) in the propensity score-adjusted analysis (OR 1.35; 95% CI 0.94-1.93), respectively.This study in unselected patients confirmed the favourable benefit-risk profile of rivaroxaban seen in the RECORD programme.
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Affiliation(s)
- Alexander G G Turpie
- Alexander G. G. Turpie, MD, Department of Medicine, Hamilton Health Sciences, General Division, 237 Barton Street East, Hamilton, Ontario, Canada, Tel.: +1 905 929 4385, Fax: +1 905 628 9505, E-mail:
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Kakkar AK, Mueller I, Bassand JP, Fitzmaurice DA, Goldhaber SZ, Goto S, Haas S, Hacke W, Lip GYH, Mantovani LG, Turpie AGG, van Eickels M, Misselwitz F, Rushton-Smith S, Kayani G, Wilkinson P, Verheugt FWA. Risk profiles and antithrombotic treatment of patients newly diagnosed with atrial fibrillation at risk of stroke: perspectives from the international, observational, prospective GARFIELD registry. PLoS One 2013; 8:e63479. [PMID: 23704912 PMCID: PMC3660389 DOI: 10.1371/journal.pone.0063479] [Citation(s) in RCA: 341] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 04/02/2013] [Indexed: 11/18/2022] Open
Abstract
Background Limited data are available on the characteristics, clinical management, and outcomes of patients with atrial fibrillation at risk of stroke, from a worldwide perspective. The aim of this study was to describe the baseline characteristics and initial therapeutic management of patients with non-valvular atrial fibrillation across the spectrum of sites at which these patients are treated. Methods and Findings The Global Anticoagulant Registry in the FIELD (GARFIELD) is an observational study of patients newly diagnosed with non-valvular atrial fibrillation. Enrollment into Cohort 1 (of 5) took place between December 2009 and October 2011 at 540 sites in 19 countries in Europe, Asia-Pacific, Central/South America, and Canada. Investigator sites are representative of the distribution of atrial fibrillation care settings in each country. Cohort 1 comprised 10,614 adults (≥18 years) diagnosed with non-valvular atrial fibrillation within the previous 6 weeks, with ≥1 investigator-defined stroke risk factor (not limited to those in existing risk-stratification schemes), and regardless of therapy. Data collected at baseline included demographics, medical history, care setting, nature of atrial fibrillation, and treatments initiated at diagnosis. The mean (SD) age of the population was 70.2 (11.2) years; 43.2% were women. Mean±SD CHADS2 score was 1.9±1.2, and 57.2% had a score ≥2. Mean CHA2DS2-VASc score was 3.2±1.6, and 8,957 (84.4%) had a score ≥2. Overall, 38.0% of patients with a CHADS2 score ≥2 did not receive anticoagulant therapy, whereas 42.5% of those at low risk (score 0) received anticoagulant therapy. Conclusions These contemporary observational worldwide data on non-valvular atrial fibrillation, collected at the end of the vitamin K antagonist-only era, indicate that these drugs are frequently not being used according to stroke risk scores and guidelines, with overuse in patients at low risk and underuse in those at high risk of stroke. Trial Registration ClinicalTrials.gov TRI08888
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Affiliation(s)
- Ajay K. Kakkar
- Thrombosis Research Institute, London, United Kingdom
- University College London, London, United Kingdom
- * E-mail:
| | - Iris Mueller
- Thrombosis Research Institute, London, United Kingdom
| | | | - David A. Fitzmaurice
- Primary Care Clinical Sciences, The University of Birmingham, Birmingham, United Kingdom
| | - Samuel Z. Goldhaber
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, and Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Shinya Goto
- Department of Medicine, Tokai University, Kanagawa, Japan
| | - Sylvia Haas
- Department of Medicine, Technical University of Munich, Munich, Germany
| | - Werner Hacke
- Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Gregory Y. H. Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
| | - Lorenzo G. Mantovani
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Napoli, Italy
| | | | | | | | | | - Gloria Kayani
- Thrombosis Research Institute, London, United Kingdom
| | | | - Freek W. A. Verheugt
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
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Tiyerili V, Mueller CFH, Becher UM, Czech T, van Eickels M, Daiber A, Nickenig G, Wassmann S. Stimulation of the AT2 receptor reduced atherogenesis in ApoE(-/-)/AT1A(-/-) double knock out mice. J Mol Cell Cardiol 2011; 52:630-7. [PMID: 22230040 DOI: 10.1016/j.yjmcc.2011.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 11/21/2011] [Accepted: 12/10/2011] [Indexed: 11/24/2022]
Abstract
AT1 receptor blockers (ARB) and in part ACE inhibitors (ACI) potentially exert beneficial effects on atherogenesis independent of AT1 receptor inhibition. These pleiotropic effects might be related to angiotensin II mediated activation of the AT2 receptor. To analyze this hypothesis we investigated the development of atherosclerosis and the role of ACIs and ARBs in apolipoprotein E-deficient (ApoE(-/-)) mice and in ApoE/AT1A receptor double knockout mice (ApoE(-/-)/AT1A(-/-)). ApoE(-/-) mice and ApoE(-/-)/AT1A(-/-) mice were fed cholesterol-rich diet for 7 weeks. Vascular oxidative stress, endothelial dysfunction, and atherosclerotic lesion formation were evident in ApoE(-/-) mice, but were markedly reduced in ApoE(-/-)/AT1A(-/-) mice. Concomitant treatment of ApoE(-/-)/AT1A(-/-) mice with either telmisartan or ramipril had no additional effect on blood pressure, vascular oxidative stress, AT2 receptor expression, and endothelial function. Remarkably, atherosclerotic lesion formation was increased in ramipril treated ApoE(-/-)/AT1A(-/-) mice compared to untreated ApoE(-/-)/AT1A(-/-) mice whereas pharmacological AT1 receptor inhibition with telmisartan had no additional effect on atherogenesis. Moreover, chronic AT2 receptor inhibition with PD123,319 significantly increased plaque development in ApoE(-/-)/AT1A(-/-) mice. In additional experiments, direct AT2 receptor stimulation reduced atherogenesis in ApoE(-/-)/AT1A(-/-) mice. Taken together, our data demonstrate a relevant antiatherosclerotic role of the AT2 receptor in atherosclerotic mice and provide novel insight in RAS-physiology.
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Affiliation(s)
- Vedat Tiyerili
- Medizinische Klinik und Poliklinik II, University of Bonn, Germany
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Hohnloser SH, Crijns HJGM, van Eickels M, Gaudin C, Page RL, Torp-Pedersen C, Connolly SJ. Dronedarone in patients with congestive heart failure: insights from ATHENA. Eur Heart J 2010; 31:1717-21. [PMID: 20436046 PMCID: PMC2903712 DOI: 10.1093/eurheartj/ehq113] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aims Dronedarone is a new multichannel blocking antiarrhythmic drug for treatment of atrial fibrillation (AF). In patients with recently decompensated congestive heart failure (CHF) and depressed LV function, the drug was associated with excess mortality compared with a placebo group. The present study aimed to analyse in detail the effects of dronedarone on mortality and morbidity in AF patients CHF. Methods and results We performed a post hoc analysis of ATHENA, a large placebo-controlled outcome trial in 4628 patients with paroxysmal or persistent AF, to evaluate the relationship between clinical outcomes and dronedarone therapy in patients with stable CHF. The primary outcome was time to first cardiovascular (CV) hospitalization or death. There were 209 patients with NYHA class II/III CHF and a left ventricular ejection fraction ≤0.40 at baseline (114 placebo, 95 dronedarone patients). A primary outcome event occurred in 59/114 placebo patients compared with 42/95 dronedarone patients [hazard ratio (HR) 0.78, 95% CI = 0.52–1.16]. Twenty of 114 placebo patients and 12/95 dronedarone patients died during the study (HR 0.71, 95% CI = 0.34–1.44). Fifty-four placebo and 42 dronedarone patients were hospitalized for an intermittent episode of NYHA class IV CHF (HR = 0.78, 95% CI = 0.52–1.17). Conclusion In this post-hoc analysis of ATHENA patients with AF and stable CHF, dronedarone did not increase mortality and showed a reduction of CV hospitalization or death similar to the overall population. However, in the light of the ANtiarrhythmic trial with DROnedarone in Moderate to severe CHF Evaluating morbidity DecreAse study, dronedarone should be contraindicated in patients with NYHA class IV or unstable NYHA classes II and III CHF.
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Affiliation(s)
- Stefan H Hohnloser
- Division of Clinical Electrophysiology, Department of Cardiology, J. W. Goethe University, Theodor-Stern-Kai 7, D 60590 Frankfurt, Germany.
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Connolly SJ, Crijns HJ, Torp-Pedersen C, van Eickels M, Gaudin C, Page RL, Hohnloser SH. Analysis of Stroke in ATHENA: A Placebo-Controlled, Double-Blind, Parallel-Arm Trial to Assess the Efficacy of Dronedarone 400 mg BID for the Prevention of Cardiovascular Hospitalization or Death From Any Cause in Patients With Atrial Fibrillation/Atrial Flutter. Circulation 2009; 120:1174-80. [PMID: 19752319 DOI: 10.1161/circulationaha.109.875252] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Many patients with atrial fibrillation are at high risk for stroke and require antithrombotic therapy. Antiarrhythmic drugs have not previously been shown to reduce the risk of stroke in atrial fibrillation. The effect of dronedarone, a new multichannel-blocking antiarrhythmic drug, on stroke has been evaluated in a randomized, double-blind clinical trial, ATHENA (A placebo-controlled, double-blind, parallel-arm Trial to assess the efficacy of dronedarone 400 mg BID for the prevention of cardiovascular Hospitalization or death from any cause in patiENts with Atrial fibrillation/atrial flutter).
Methods and Results—
Patients with persistent or paroxysmal atrial fibrillation and at least 1 risk factor for cardiovascular hospitalization were randomized to receive dronedarone (400 mg BID) or double-blind matching placebo and followed up for a minimum of 1 year to a common termination at 30 months. All strokes that occurred during the study were included in the present post hoc analysis. There were 4628 patients randomized to placebo or dronedarone. The baseline risk factors for stroke were well balanced between the 2 groups, and the baseline mean CHADS
2
score was 2. The baseline use of either oral anticoagulant therapy or antiplatelet agent alone was 60%. Dronedarone reduced the risk of stroke from 1.8% per year to 1.2% per year (hazard ratio 0.66, 95% confidence interval 0.46 to 0.96,
P
=0.027). The effect of dronedarone was similar whether or not patients were receiving oral anticoagulant therapy, and there was a significantly greater effect of dronedarone in patients with higher CHADS
2
scores.
Conclusions—
In this post hoc analysis, a reduction in stroke was observed in patients with atrial fibrillation who were receiving usual care, which included antithrombotic therapy and heart rate control, who were randomized to dronedarone. Further studies to investigate the effect of dronedarone and other antiarrhythmic agents on stroke are indicated.
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Affiliation(s)
- Stuart J. Connolly
- From the Population Health Research Institute (S.J.C.), McMaster University, Hamilton, Ontario, Canada; Department of Cardiology (H.J.G.M.C.), University Hospital Maastricht, Maastricht, Netherlands; Department of Cardiology (C.T.-P.), Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; sanofi-aventis (M.v.E., C.G.), Research and Development, Frankfurt, Germany; Department of Cardiology (R.L.P.), University of Washington, Seattle, Wash; and Department of Cardiology (S.H.H.), J.W. Goethe
| | - Harry J.G.M. Crijns
- From the Population Health Research Institute (S.J.C.), McMaster University, Hamilton, Ontario, Canada; Department of Cardiology (H.J.G.M.C.), University Hospital Maastricht, Maastricht, Netherlands; Department of Cardiology (C.T.-P.), Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; sanofi-aventis (M.v.E., C.G.), Research and Development, Frankfurt, Germany; Department of Cardiology (R.L.P.), University of Washington, Seattle, Wash; and Department of Cardiology (S.H.H.), J.W. Goethe
| | - Christian Torp-Pedersen
- From the Population Health Research Institute (S.J.C.), McMaster University, Hamilton, Ontario, Canada; Department of Cardiology (H.J.G.M.C.), University Hospital Maastricht, Maastricht, Netherlands; Department of Cardiology (C.T.-P.), Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; sanofi-aventis (M.v.E., C.G.), Research and Development, Frankfurt, Germany; Department of Cardiology (R.L.P.), University of Washington, Seattle, Wash; and Department of Cardiology (S.H.H.), J.W. Goethe
| | - Martin van Eickels
- From the Population Health Research Institute (S.J.C.), McMaster University, Hamilton, Ontario, Canada; Department of Cardiology (H.J.G.M.C.), University Hospital Maastricht, Maastricht, Netherlands; Department of Cardiology (C.T.-P.), Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; sanofi-aventis (M.v.E., C.G.), Research and Development, Frankfurt, Germany; Department of Cardiology (R.L.P.), University of Washington, Seattle, Wash; and Department of Cardiology (S.H.H.), J.W. Goethe
| | - Christophe Gaudin
- From the Population Health Research Institute (S.J.C.), McMaster University, Hamilton, Ontario, Canada; Department of Cardiology (H.J.G.M.C.), University Hospital Maastricht, Maastricht, Netherlands; Department of Cardiology (C.T.-P.), Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; sanofi-aventis (M.v.E., C.G.), Research and Development, Frankfurt, Germany; Department of Cardiology (R.L.P.), University of Washington, Seattle, Wash; and Department of Cardiology (S.H.H.), J.W. Goethe
| | - Richard L. Page
- From the Population Health Research Institute (S.J.C.), McMaster University, Hamilton, Ontario, Canada; Department of Cardiology (H.J.G.M.C.), University Hospital Maastricht, Maastricht, Netherlands; Department of Cardiology (C.T.-P.), Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; sanofi-aventis (M.v.E., C.G.), Research and Development, Frankfurt, Germany; Department of Cardiology (R.L.P.), University of Washington, Seattle, Wash; and Department of Cardiology (S.H.H.), J.W. Goethe
| | - Stefan H. Hohnloser
- From the Population Health Research Institute (S.J.C.), McMaster University, Hamilton, Ontario, Canada; Department of Cardiology (H.J.G.M.C.), University Hospital Maastricht, Maastricht, Netherlands; Department of Cardiology (C.T.-P.), Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; sanofi-aventis (M.v.E., C.G.), Research and Development, Frankfurt, Germany; Department of Cardiology (R.L.P.), University of Washington, Seattle, Wash; and Department of Cardiology (S.H.H.), J.W. Goethe
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Kuhn M, Schwarz K, Hartmann M, Carbajo-Lozoya J, Flögel U, Stypmann J, van Eickels M, Gambaryan S, Wieland T, Baba HA. The natriuretic peptide/guanylyl cyclase-A system functions as a stress-responsive regulator of angiogenesis in mice. BMC Pharmacol 2009. [PMCID: PMC3313414 DOI: 10.1186/1471-2210-9-s1-s23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kuhn M, Völker K, Schwarz K, Carbajo-Lozoya J, Flögel U, Jacoby C, Stypmann J, van Eickels M, Gambaryan S, Hartmann M, Werner M, Wieland T, Schrader J, Baba HA. The natriuretic peptide/guanylyl cyclase--a system functions as a stress-responsive regulator of angiogenesis in mice. J Clin Invest 2009; 119:2019-30. [PMID: 19487812 DOI: 10.1172/jci37430] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Accepted: 04/08/2009] [Indexed: 12/22/2022] Open
Abstract
Cardiac atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) modulate blood pressure and volume by activation of the receptor guanylyl cyclase-A (GC-A) and subsequent intracellular cGMP formation. Here we report what we believe to be a novel function of these peptides as paracrine regulators of vascular regeneration. In mice with systemic deletion of the GC-A gene, vascular regeneration in response to critical hind limb ischemia was severely impaired. Similar attenuation of ischemic angiogenesis was observed in mice with conditional, endothelial cell-restricted GC-A deletion (here termed EC GC-A KO mice). In contrast, smooth muscle cell-restricted GC-A ablation did not affect ischemic neovascularization. Immunohistochemistry and RT-PCR revealed BNP expression in activated satellite cells within the ischemic muscle, suggesting that local BNP elicits protective endothelial effects. Since within the heart, BNP is mainly induced in cardiomyocytes by mechanical load, we investigated whether the natriuretic peptide/GC-A system also regulates angiogenesis accompanying load-induced cardiac hypertrophy. EC GC-A KO hearts showed diminished angiogenesis, mild fibrosis, and diastolic dysfunction. In vitro BNP/GC-A stimulated proliferation and migration of cultured microvascular endothelia by activating cGMP-dependent protein kinase I and phosphorylating vasodilator-stimulated phosphoprotein and p38 MAPK. We therefore conclude that BNP, produced by activated satellite cells within ischemic skeletal muscle or by cardiomyocytes in response to pressure load, regulates the regeneration of neighboring endothelia via GC-A. This paracrine communication might be critically involved in coordinating muscle regeneration/hypertrophy and angiogenesis.
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Affiliation(s)
- Michaela Kuhn
- Institute of Physiology, University of Würzburg, Würzburg, Germany.
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Weissmann N, Hackemack S, Dahal BK, Pullamsetti SS, Savai R, Mittal M, Fuchs B, Medebach T, Dumitrascu R, Eickels MV, Ghofrani HA, Seeger W, Grimminger F, Schermuly RT. The soluble guanylate cyclase activator HMR1766 reverses hypoxia-induced experimental pulmonary hypertension in mice. Am J Physiol Lung Cell Mol Physiol 2009; 297:L658-65. [PMID: 19617308 DOI: 10.1152/ajplung.00189.2009] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Severe pulmonary hypertension (PH) is a disabling disease with high mortality, characterized by pulmonary vascular remodeling and right heart hypertrophy. In mice with PH induced by chronic hypoxia, we examined the acute and chronic effects of the soluble guanylate cyclase (sGC) activator HMR1766 on hemodynamics and pulmonary vascular remodeling. In isolated perfused mouse lungs from control animals, HMR1766 dose-dependently inhibited the pressor response of acute hypoxia. This dose-response curve was shifted leftward when the effects of HMR1766 were investigated in isolated lungs from chronic hypoxic animals for 21 days at 10% oxygen. Mice exposed for 21 or 35 days to chronic hypoxia developed PH, right heart hypertrophy, and pulmonary vascular remodeling. Treatment with HMR1766 (10 mg x kg(-1) x day(-1)), after full establishment of PH from day 21 to day 35, significantly reduced PH, as measured continuously by telemetry. In addition, right ventricular (RV) hypertrophy and structural remodeling of the lung vasculature were reduced. Pharmacological activation of oxidized sGC partially reverses hemodynamic and structural changes in chronic hypoxia-induced experimental PH.
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Affiliation(s)
- Norbert Weissmann
- Univ. of Giessen Lung Center Medical Clinic II/V, Klinikstr. 36, 35392 Giessen, Germany
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Abstract
BACKGROUND Dronedarone is a new antiarrhythmic drug that is being developed for the treatment of patients with atrial fibrillation. METHODS We conducted a multicenter trial to evaluate the use of dronedarone in 4628 patients with atrial fibrillation who had additional risk factors for death. Patients were randomly assigned to receive dronedarone, 400 mg twice a day, or placebo. The primary outcome was the first hospitalization due to cardiovascular events or death. Secondary outcomes were death from any cause, death from cardiovascular causes, and hospitalization due to cardiovascular events. RESULTS The mean follow-up period was 21+/-5 months, with the study drug discontinued prematurely in 696 of the 2301 patients (30.2%) receiving dronedarone and in 716 of the 2327 patients (30.8%) receiving placebo, mostly because of adverse events. The primary outcome occurred in 734 patients (31.9%) in the dronedarone group and in 917 patients (39.4%) in the placebo group, with a hazard ratio for dronedarone of 0.76 (95% confidence interval [CI], 0.69 to 0.84; P<0.001). There were 116 deaths (5.0%) in the dronedarone group and 139 (6.0%) in the placebo group (hazard ratio, 0.84; 95% CI, 0.66 to 1.08; P=0.18). There were 63 deaths from cardiovascular causes (2.7%) in the dronedarone group and 90 (3.9%) in the placebo group (hazard ratio, 0.71; 95% CI, 0.51 to 0.98; P=0.03), largely due to a reduction in the rate of death from arrhythmia with dronedarone. The dronedarone group had higher rates of bradycardia, QT-interval prolongation, nausea, diarrhea, rash, and an increased serum creatinine level than the placebo group. Rates of thyroid- and pulmonary-related adverse events were not significantly different between the two groups. CONCLUSIONS Dronedarone reduced the incidence of hospitalization due to cardiovascular events or death in patients with atrial fibrillation. (ClinicalTrials.gov number, NCT00174785.)
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Zhou Z, Pyriochou A, Kotanidou A, Dalkas G, van Eickels M, Spyroulias G, Roussos C, Papapetropoulos A. Soluble guanylyl cyclase activation by HMR-1766 (ataciguat) in cells exposed to oxidative stress. Am J Physiol Heart Circ Physiol 2008; 295:H1763-71. [PMID: 18757489 DOI: 10.1152/ajpheart.51.2008] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Many vascular diseases are characterized by increased levels of ROS that destroy the biological activity of nitric oxide and limit cGMP formation. In the present study, we investigated the cGMP-forming ability of HMR-1766 in cells exposed to oxidative stress. Pretreatment of smooth muscle cells with H(2)O(2) reduced cGMP production stimulated by sodium nitroprusside (SNP) or BAY 41-2272. However, pretreatment with H(2)O(2) significantly increased HMR-1766 responses. Similar results were obtained with SIN-1, menadione, and rotenone. In addition, HMR-1766 was more effective in stimulating heme-free sGC compared with the wild-type enzyme. Interestingly, in cells expressing heme-free sGC, H(2)O(2) inhibited instead of potentiated HMR-1766 responses, suggesting that the ROS-induced enhancement of cGMP formation was heme dependent. Moreover, using truncated forms of sGC, we observed that the NH(2)-terminus of the beta(1)-subunit is required for the action of HMR-1766. Finally, to study tolerance development to HMR-1766, cells were pretreated with this sGC activator and reexposed to HMR-1766 or SNP. Results from these experiments demonstrated lack of tolerance development to HMR-1766 as well as lack of cross-tolerance with SNP. We conclude that HMR-1766 is an improved sGC activator as it has the ability to activate oxidized/heme-free sGC and is resistant to the development of tolerance; these observations make HMR-1766 a promising agent for treating diseases associated with increased vascular tone combined with enhanced ROS production.
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Affiliation(s)
- Zongmin Zhou
- George P. Livanos and Marianthi Simou Laboratories, Department of Critical Care and Pulmonary Services, Evangelismos Hospital, University of Athens, Athens, Greece
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Frank D, Kuhn C, van Eickels M, Gehring D, Hanselmann C, Lippl S, Will R, Katus HA, Frey N. Calsarcin-1 Protects Against Angiotensin-II–Induced Cardiac Hypertrophy. Circulation 2007; 116:2587-96. [DOI: 10.1161/circulationaha.107.711317] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Derk Frank
- From the Department of Internal Medicine III (D.F., C.K., C.H., S.L., R.W., H.A.K., N.F.), University of Heidelberg, Germany; Medizinische Universitäts-Poliklinik (M.v.E.), Universitätsklinikum Bonn, Germany; and Sanofi-Aventis Pharma (D.G.), Frankfurt, Germany
| | - Christian Kuhn
- From the Department of Internal Medicine III (D.F., C.K., C.H., S.L., R.W., H.A.K., N.F.), University of Heidelberg, Germany; Medizinische Universitäts-Poliklinik (M.v.E.), Universitätsklinikum Bonn, Germany; and Sanofi-Aventis Pharma (D.G.), Frankfurt, Germany
| | - Martin van Eickels
- From the Department of Internal Medicine III (D.F., C.K., C.H., S.L., R.W., H.A.K., N.F.), University of Heidelberg, Germany; Medizinische Universitäts-Poliklinik (M.v.E.), Universitätsklinikum Bonn, Germany; and Sanofi-Aventis Pharma (D.G.), Frankfurt, Germany
| | - Doris Gehring
- From the Department of Internal Medicine III (D.F., C.K., C.H., S.L., R.W., H.A.K., N.F.), University of Heidelberg, Germany; Medizinische Universitäts-Poliklinik (M.v.E.), Universitätsklinikum Bonn, Germany; and Sanofi-Aventis Pharma (D.G.), Frankfurt, Germany
| | - Christiane Hanselmann
- From the Department of Internal Medicine III (D.F., C.K., C.H., S.L., R.W., H.A.K., N.F.), University of Heidelberg, Germany; Medizinische Universitäts-Poliklinik (M.v.E.), Universitätsklinikum Bonn, Germany; and Sanofi-Aventis Pharma (D.G.), Frankfurt, Germany
| | - Stefanie Lippl
- From the Department of Internal Medicine III (D.F., C.K., C.H., S.L., R.W., H.A.K., N.F.), University of Heidelberg, Germany; Medizinische Universitäts-Poliklinik (M.v.E.), Universitätsklinikum Bonn, Germany; and Sanofi-Aventis Pharma (D.G.), Frankfurt, Germany
| | - Rainer Will
- From the Department of Internal Medicine III (D.F., C.K., C.H., S.L., R.W., H.A.K., N.F.), University of Heidelberg, Germany; Medizinische Universitäts-Poliklinik (M.v.E.), Universitätsklinikum Bonn, Germany; and Sanofi-Aventis Pharma (D.G.), Frankfurt, Germany
| | - Hugo A. Katus
- From the Department of Internal Medicine III (D.F., C.K., C.H., S.L., R.W., H.A.K., N.F.), University of Heidelberg, Germany; Medizinische Universitäts-Poliklinik (M.v.E.), Universitätsklinikum Bonn, Germany; and Sanofi-Aventis Pharma (D.G.), Frankfurt, Germany
| | - Norbert Frey
- From the Department of Internal Medicine III (D.F., C.K., C.H., S.L., R.W., H.A.K., N.F.), University of Heidelberg, Germany; Medizinische Universitäts-Poliklinik (M.v.E.), Universitätsklinikum Bonn, Germany; and Sanofi-Aventis Pharma (D.G.), Frankfurt, Germany
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van Eickels M, Wassmann S, Schäfer A, Bauersachs J, Strobel H, Rütten H. Role of the sGC activator ataciguat sodium (HMR1766) in cardiovascular disease. BMC Pharmacol 2007. [DOI: 10.1186/1471-2210-7-s1-s4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Eder E, van Eickels M, Frantz S, Völker K, Baba HA, Kuhn M. Chronic inhibition of cyclic GMP phosphodiesterase 5A may promote pressure overload-induced chamber dilatation in mice. BMC Pharmacol 2007. [DOI: 10.1186/1471-2210-7-s1-p17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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50
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Kuhn M, Schwarz K, Völker K, Gaßner B, Gambaryan S, Baba HA, van Eickels M. Guanylyl cyclase-A mediated endothelial actions of natriuretic peptides are critically involved in postischemic reperfusion. BMC Pharmacol 2007. [DOI: 10.1186/1471-2210-7-s1-s17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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