Search Results for: Associazione FANS e Warfarin

Stroke, Volume 56, Issue Suppl_1, Page A40-A40, February 1, 2025. Introduction:Atrial fibrillation (AF) significantly elevates the risk of ischemic stroke and systemic embolism. Novel Oral Anticoagulants (NOACs) have improved stroke prevention in AF, offering superior efficacy and safety compared to warfarin. However, NOAC therapy can fail due to genetic variations, inappropriate dosing, non-adherence, renal dysfunction, hepatic impairment, and drug-drug interactions.This study investigates the potential determinants of NOAC failure, which refers to patients who experienced recurrent thromboembolic events despite being on NOAC therapy.Objectives:To determine the genetic factors (CES1, ABCB1, and ABCG2 polymorphisms) and other contributing factors associated with NOAC therapy failure.Methods:This six-month prospective observational study included adult patients on NOACs for AF, stroke, pulmonary embolism, and other thrombotic events. Exclusions were malignancy and pregnancy/lactation. Data on demographics, medical history, concurrent medications, and clinical outcomes were collected. Genetic polymorphisms were assessed using High-Resolution Melting (HRM)-PCR. Medication adherence was evaluated via the Medication Adherence Rating Scale (MARS), and drug-drug interactions were analyzed using UpToDate software. Statistical analysis was performed using chi-square tests, with a p-value

Stroke, Volume 56, Issue Suppl_1, Page AWP299-AWP299, February 1, 2025. Background:Newer Oral Anticoagulants (NOACs) offer potential advantages for patients with cerebral venous sinus thrombosis (CVST). However, there is a lack of evidence to evaluate the efficacy and safety of NOACs in CVST. The purpose of this study was to compare the benefit and safety between NOACs and warfarin in CVST patients based on propensity score matching.Methods:We performed a single-center prospective analysis including CVST patients from the First Affiliated Hospital of Zhengzhou University between January 1, 2018 and December 31, 2021. The primary outcome was recurrent thrombotic events during 6-month follow-up. Secondary outcomes included modified Rankin Scale (mRS), bleeding events, death and cerebral venous recanalization during anticoagulant therapy. Propensity score matching (PSM) was used to balance baseline bias.Results:A total of 650 patients were identified. NOACs were treated in 184 patients and 466 were used warfarin following hospitalization. After 1:2 and 1:3 PSM, there were no statistically significant differences between the two groups in recurrent CVST (odd ratio [OR], 0.543; 95% CI, 0.258-1.143; P=0.108), bleeding events (OR, 0.823; 95% CI, 0.074-9.143; P=0.874) and partial/complete recanalization (OR, 0.980; 95% CI, 0.546-1.760; P=0.946) in all patients. Similarly, there were no significant differences in patients received anticoagulation therapy group and patients who were performed endovascular therapy plus anticoagulation therapy regarding any of the clinical outcomes. However, there were a statistically significant differences between the two groups in death (2.2% vs 8.0%, P=0.014) and mRS≤2 (95.1% vs 88.7%, P=0.020) in all patients.Conclusions:Our study demonstrates that the use of NOACs in CVST has similar efficacy and safety compared to warfarin treatment. NOACs treatment may reduced mortality at six months and good functional outcome compared with warfarin.Keywords:new oral anticoagulants; cerebral venous sinus thrombosis; warfarin; propensity score matching

Stroke, Volume 56, Issue Suppl_1, Page ADP49-ADP49, February 1, 2025. Introduction:Intracerebral hemorrhage (ICH) is associated with poor outcomes in part due to a lack of perceived sense of urgency. In low to middle-income countries, a rapid approach including oral anticoagulation (OAC) reversal and intensive blood pressure (BP) reduction

Stroke, Volume 56, Issue Suppl_1, Page A145-A145, February 1, 2025. Background:Patients with atrial fibrillation (AF) and previous stroke or transient ischemic attack (TIA) are at high risk of recurrent stroke. Data regarding the efficacy and safety of new oral anticoagulant therapy (NOAC) compared to warfarin in patients with previous strokes are lacking.Method:PubMed, Scopus and Cochrane databases were searched for both randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) that compared NOAC to warfarin in patients with AF and previous stroke or TIA and that reported the outcomes of cardiovascular death, death from any cause, disabling or fatal stroke, gastrointestinal major bleeding, hemorrhagic stroke, intracranial bleeding, major bleeding, overall stroke etc. Heterogeneity was examined using I2statistics.Results:We included 7 RCTs and 2 non-RCTs comparing NOAC to warfarin in patients with atrial fibrillation and previous stroke or TIA. The pooled results showed that cardiovascular death (4.9% vs 5.2% respectively; OR = 0.92; 95% CI [0.78, 1.08]; I2= 34%; p = 0.298), death from any cause (6.7% vs 7.5% respectively; OR = 0.88; 95% CI [0.77, 1.01]; I2= 59%; p = 0.066), disabling or fatal stroke (2.4% vs 2.9% respectively; OR = 0.83; 95% CI [0.69, 1.01]; I2= 0%; p = 0.058), gastrointestinal major bleeding (2.4% vs 1.3% respectively; OR = 1.95; 95% CI [0.65, 5.83]; I2= 80%; p = 0.231), and ischemic or unknown type of stroke (RR = 0.86; 95% CI [0.69, 1.08]; I2= 48%; p = 0.200) are not statistically different between the NAOC group and warfarin group. However, hemorrhagic stroke (RR = 0.46; 95% CI [0.30, 0.69]; I2= 24%; p < 0.001), intracranial bleeding (0.82% vs 1.8% respectively; OR = 0.41; 95% CI [0.25, 0.66]; I2= 43%; p < 0.001), major bleeding (RR = 0.83; 95% CI [0.71, 0.98]; I2= 9%; p = 0.025), overall stroke (RR = 0.72; 95% CI [0.58, 0.89]; I2= 44%; p = 0.002) and stroke or systemic embolism (4.3% vs 5.0% respectively; OR = 0.84; 95% CI [0.73, 0.97]; I2= 0%; p = 0.015) are significantly reduced in the NAOC group compared to the warfarin group.Conclusion:In patients with atrial fibrillation and previous stroke or transient ischemic attack, treatment with NOAC did not show any significant difference compared with warfarin for outcomes of death from any cause, cardiovascular death, disabling or fatal stroke, and gastrointestinal major bleeding. NOAC reduces the risk of hemorrhagic stroke, intracranial bleeding, major bleeding, and overall stroke compared to warfarin.

Stroke, Volume 56, Issue Suppl_1, Page ATP23-ATP23, February 1, 2025. Background:Stroke is the second leading cause of death worldwide, with atrial fibrillation being a significant risk factor that substantially increases the likelihood of stroke. Although many observational studies have assessed the effectiveness of apixaban, a widely used direct oral anticoagulant (DOAC), in preventing stroke in atrial fibrillation, there is limited evidence from randomized controlled trials (RCTs).Objectives:We aimed to integrate findings from RCTs to compare the efficacy and safety of apixaban with the standard of care (SOC)—antiplatelet therapy (aspirin) or vitamin K antagonists (warfarin)—for stroke prevention in atrial fibrillation.Methods:We analyzed the data using RevMan 5.4 with a random effects model, pooling outcomes as hazard ratios (HR) with 95% confidence intervals (CI). The primary efficacy outcome of the study was the composite endpoint of either stroke or systemic embolism. The primary safety outcome was major bleeding. Our study protocol is registered in PROSPERO (CRD42024572983).Results:Our analysis included 6 RCTs involving 33,000 participants, an average age of 71.3 years, and follow-up periods ranging from 6 months to 3.5 years. The pooled analysis revealed a statistically significant reduction in the composite outcome of stroke or systemic embolism for patients on apixaban compared to SOC, with an HR of 0.62 (95% CI: 0.44 to 0.87, p = 0.005). No significant difference was observed in major bleeding events between apixaban and SOC, with an HR of 0.93 (95% CI: 0.63 to 1.38, p = 0.72). For secondary outcomes, apixaban did not show a significant impact on all-cause mortality (HR: 0.92; 95% CI: 0.83 to 1.03, p = 0.13) or cardiovascular mortality (HR: 0.92; 95% CI: 0.81 to 1.05, p = 0.22).Conclusion:In patients with atrial fibrillation, apixaban was superior to aspirin or warfarin in preventing stroke or systemic embolism. However, no significant differences were found in major bleeding, all-cause mortality, or cardiovascular mortality when comparing apixaban to standard of care. Further randomized controlled trials with longer follow-ups are needed to assess the potential long-term effects and benefits of apixaban.

Stroke, Volume 56, Issue Suppl_1, Page AWP273-AWP273, February 1, 2025. Introduction:Anticoagulation therapy plays a pivotal role in stroke prevention for people with atrial fibrillation. Despite its efficacy, some patients still have an ischemic stroke while on therapy. Since it remains unclear how best to modify risk in these cases and guidance for clinical decision-making is limited, understanding real-world patterns is crucial for improving outcomes.Methods:Using data from the Get With The Guidelines-Stroke Registry between 2016 and 2023, we assessed the real-world strategies clinicians use for ischemic stroke patients with atrial fibrillation who experience stroke despite being on anticoagulation therapy. Multivariate logistic regression models with generalized estimating equations were used to identify factors associated with changes in oral anticoagulants (OAC).Results:Of 60,334 ischemic stroke patients with atrial fibrillation who were taking OAC but were not on antiplatelet prior to stroke, 14.4% were taking warfarin with subtherapeutic INR, 8.9% therapeutic warfarin, and 76.7% direct oral anticoagulant (DOAC) prior to stroke (4.7% dabigatran, 20.4% rivaroxaban, and 51.6% apixaban). The distribution of discharge antithrombotics is shown in theFigure. Among patients taking DOAC prior to stroke, 83.3% remained on the same DOAC at discharge, of whom 45.5% added an antiplatelet agent. Among patients on warfarin, 37.0% switched to DOAC at discharge. For those who remained on warfarin, 47.8% added an antiplatelet agent. Patients on warfarin with subtherapeutic INR (aOR 1.86), dabigatran (aOR 1.58), or rivaroxaban (aOR 1.09) were more likely to switch OACs, while those on apixaban (aOR 0.27) were less likely to switch as compared with those on warfarin with therapeutic INR prior to stroke.Conclusion:Among people with AF who were anticoagulated prior to hospitalization for ischemic stroke, switching OACs or adding an antiplatelet agent is common. Understanding the factors influencing treatment selection after stroke underscores the need for a prospective study of treatment strategies and could support the development of personalized antithrombotic strategies to reduce recurrent stroke risk.

Stroke, Volume 56, Issue Suppl_1, Page ATP13-ATP13, February 1, 2025. Background:Atrial fibrillation (AF) patients carry a high risk of stroke, and treatment related bleeding complications. Evidence for the safety and efficacy of anticoagulation remains sparse with conflicting results.Objective:We sought to investigate the effectiveness and safety of direct oral anticoagulant (DOAC) versus warfarin in atrial fibrillation patients.Methods:We performed a systematic literature search on PubMed, EMBASE, and ClinicalTrials.gov for relevant randomized controlled trials (RCTs) from inspection until July 30th, 2024, without any language restrictions. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using a random-effect model, and a p-value of

Organizzato domani a Pesaro dall’associazione Afi Odv

This study assessed whether electric fans limit core temperature increases in adults aged 65 to 85 years exposed to conditions similar to those experienced in homes during heat waves in North America.

Fondi raccolti da 83 sezioni dell’associazione contro leucemie

Circulation, Volume 150, Issue Suppl_1, Page A4145883-A4145883, November 12, 2024. Introduction/Background:While the international normalized ratio (INR), a marker of functioning of the extrinsic and final common pathways of the coagulation cascade is associated with increased intracerebral hemorrhage (ICH) mortality for patients taking warfarin, it is not understood how it might be associated with outcomes in patients taking direct oral anticoagulants (DOACs), given the inconsistent and variable effect of DOACs on INR.Research Questions/Hypothesis:To determine whether INR is associated with increased ICH severity in patients with recent exposure to a DOAC.Methods/Approach:We included patients taking Apixaban or Rivaroxaban prior to acute presentation with ICH to hospitals participating in the Get With the Guidelines – Stroke registry, a nationwide quality improvement registry. The primary exposure was INR, which we modeled as a continuous variable with restricted cubic splines. The primary endpoint was stroke severity on presentation, measured by the National Institutes of Health Stroke Scale (NIHSS). Secondary endpoints included Glasgow Coma Scale (GCS) =21 (aOR 1.02 [95% CI 1.00-1.04, p=0.03] per 0.1 above 1.1) and in-hospital mortality (aOR 1.11 [95% CI 1.05-1.16, p

Circulation, Volume 150, Issue Suppl_1, Page A4142147-A4142147, November 12, 2024. Introduction:The utilization of direct oral anticoagulant (DOAC) agents for atrial fibrillation (AF) in individuals with end-stage renal disease (ESRD) has increased despite a lack of robust supportive data from randomized controlled trials. We planned to assess the outcomes associated with rivaroxaban versus warfarin in the ESRD population with AF.Methods:We utilized the TriNetX Global Collaborative Network, which includes 114 Healthcare organizations to perform a propensity-score matched retrospective cohort study. We used ICD-10 codes to identify individuals with ESRD and AF, over 18 years of age, excluding those with prosthetic valves and apixaban or edoxaban use. Data were collected from 2011 to 2024. We evaluated the incidence of ischemic stroke (I63), intracranial hemorrhage (I62.9), cardiac arrest (I46), mortality, gastrointestinal (GI) hemorrhage (K92.2), systemic embolism and thrombosis (I74.3, I74.2), and other cardiac arrythmias (I49). We performed propensity-score matching (PSM) on age, sex, race, BMI,hypertension, diabetes mellitus, tobacco use, heart failure, stroke, or acute myocardial infarction.Results:We identified 25,092 individuals in the warfarin group and 2,391 individuals in the rivaroxaban group. After PSM, 2,381 individuals remained in each group. The average age was 72.9, predominantly male (59.8%), with 62.9% white, 14.7% African American, and 6.5% Hispanic individuals. Compared to those treated with warfarin, individuals treated with rivaroxaban demonstrated a lower risk of a composite outcome (Infarct, intracranial hemorrhage, mortality) (RR 0.823, 95% CI 0.765-0.885), mortality (RR 0.830, 95% CI 0.775-0.888), GI hemorrhage (RR 0.566, 95% CI 0.439-0.730), and cardiac arrest (RR 0.696, 95% CI 0.531-0.911). We found no significant difference in the risk of ischemic stroke (RR 1.024, 95% CI 0.744-1.408), intracranial hemorrhage (RR 0.587, 95% CI 0.270-1.280), systemic embolism (RR 0.828 (95% CI 0.512-1.339), or other cardiac arrythmias (RR 0.973, 95% CI 0.804-1.179).Conclusion:In individuals with AF and ESRD the use of rivaroxaban, in comparison to warfarin, was associated with a reduction in the risk of mortality, gastrointestinal hemorrhage, and cardiac arrest. We found no difference in other clinically relevant outcomes, including ischemic stroke. These findings suggest an extension of the safety benefits previously observed with DOACs to the ESRD population, however further research is needed to guide management.

Circulation, Volume 150, Issue Suppl_1, Page A4147523-A4147523, November 12, 2024. Background:Pulmonary artery aneurysms (PAAs) are rare with an incidence of 1 in 14,000. While rare, they are very critical conditions with a mortality rate of 50-100%. PAAs may be congenital or acquired via infections, vasculitis, pulmonary arterial hypertension, chronic pulmonary embolism, inflammatory lung disease, neoplasm, or iatrogenic. The risk of PAA is due to respiratory compromise, compression of other structures, and dissection. We describe the rare presentation of a PAA with a concomitant ascending aortic aneurysm.Case Description:75-year-old woman with a PMH of hypertension, Group I pulmonary artery hypertension, HFpEF, non-obstructive CAD, aortic insufficiency s/p mechanical aortic valve replacement on warfarin since 02/2014, hyperlipidemia who was admitted due to altered mental status. Physical exam was remarkable for 4/6 diastolic murmur, 3/6 aortic murmur, prominent P2, and parasternal lift and no JVD or lower extremity edema. CXR incidentally showed enlarged pulmonary artery and CT chest showed PAA at 6.6 cm. Echocardiogram confirmed moderate to severe pulmonary hypertension and a markedly dilated PAA with pulmonary valvular insufficiency. In addition, she had an ascending aortic aneurysm with moderate aortic insufficiency. The two coinciding aneurysms could be distinct in etiology due to sequela of high pressure vessel wall degradation from pulmonary artery hypertension and systemic hypertension or related due to vasculitis or cystic medial necrosis/connective tissue disease. Due to multiple concomitant aneurysms, the patient is pending further workup.Discussion:Aneurysms are focal dilations with PAA larger than 29 mm and ascending aortic aneurysm larger than 44 mm. Common etiologies include vasculitis, connective tissue disease, and high vessel pressure. Due to the risk of fatal pulmonary hemorrhage, PAAs are critical. Diagnosis of PAA is via CTA and of aortic aneurysm is via TTE with annual monitoring. Surgical intervention is greater than 45-55 mm depending on risk factors for ascending aortic aneurysm and greater than 55 mm for PAA. Surgical interventions for PAAs include stent graft, aneurysmorrhaphy, lobectomy, aneurysmectomy, and pneumonectomy. Surgical resection comes with high risk in patients with severe pulmonary hypertension. Treating the underlying pulmonary artery hypertension is crucial to long term management along with determination and treatment of underlying cause.

Circulation, Volume 150, Issue Suppl_1, Page A4141690-A4141690, November 12, 2024. Background:Arterial calcification often occurs with bone mineral loss in osteoporosis, for which bisphosphonates are a standard therapy. Mice lacking the matrix GLA protein (Mgp) exhibit lethal arterial calcification and cranial bone formation deficits causing dental malocclusion. Mgp not only binds to hydroxyapatite but also inhibits the bone morphogenic protein activation of Runx2 transcription factor, which drives the osteogenic conversion of arterial smooth muscle cells (SMCs). Prior studies showed bisphosphate therapy ameliorates warfarin-induced arterial calcification in rats. This study investigated whether bisphosphonate (Alendronate,ALN) treatment could address bone deficits and arterial calcification in Mgp-null mice.Methods:Mgp-null mice were subjected to various doses of Alendronate therapy starting at weaning or postnatal day 3. Dental malocclusion severity was assessed by incisor trimming frequency. Arterial calcification was quantified by Alizarin red staining and µ-CT.Results:In Mgp-null mice, susceptibility to aortic artery calcification was not uniform but varied by location, with calcification highest at the proximal aorta. Of note, recurring nodes of calcification were found to correspond to branch points of vertebral arteries, with internodal regions showing less calcification. Alendronate therapy started at 3 weeks of age ameliorated dental malocclusion in Mgp-null mice of both sexes and improved but did not normalize body weight gain in males and females. However, no improvement in arterial calcification was observed at 7 weeks. Similarly, Alendronate therapy at lower doses from postnatal day 3 for 5 weeks ameliorated dental malocclusion and improved but did not normalize body weight gain in both sexes, while at higher doses, Alendronate prevented incisor development and caused growth retardation in both wild type and Mgp-null mice. However, Alendronate accelerated the appearance of Runx2 in SMCs of the aorta and worsened internodal arterial calcification in Mgp-null mice in a dose-dependent fashion, but not in Mgp-hemizygous or wild type mice.Conclusion:Our study reveals an important dichotomy in Mgp’s function in bone and arteries. The bone deficits in Mgp-null mice, highlighted by incisor malocclusion, could be rescued by bisphosphonate treatment, whereas the arterial calcification could not. Thus, Mgp performs an essential function to prevent arterial calcification that cannot be restored by bisphosphonate therapy.