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Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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Scooped by Seth Bilazarian, MD
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Patient Guide for Bood Thinners for Atrial Fibrillation

Patient Guide for Bood Thinners for Atrial Fibrillation | Heart and Vascular Health | Scoop.it

Having atrial fibrillation, an irregular heart rhythm, increases your risk of having a stroke. This irregular beating of the heart affects blood flow in the top chambers of the heart and can cause blood cells to collect and stick together, which increases the risk of a blood clot forming. These blood clots may then be carried in the bloodstream to the brain and, if large enough, can block an artery in the brain, resulting in a stroke. Oral anticoagulant drugs (commonly called blood thinners) are used to help prevent strokes by causing the blood to take longer to clot. Two groups of oral anticoagulant drugs are used, vitamin K antagonists (warfarin/Coumadin) and non–vitamin K antagonist oral anticoagulants (NOACs). This Cardiology Patient Page focuses on NOACs.

Seth Bilazarian, MD's insight:

These four new drugs called NOACs  (novel oral anticoagulants) or now being called DOACs (direct oral anticoagulants) or TSOACs (Target Specific Oral Anticoagulants) are alternatives to the older anticoagulant warfarin or Coumadin.  The use of blood thinners is recommended for atrial fibrillation and this patient page from circulation is a great resource.

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It's official: New Oral Antithrombotic Agents in Nonvalvular AF now in guidelines

It's official: New Oral Antithrombotic Agents in Nonvalvular AF now in guidelines | Heart and Vascular Health | Scoop.it

The new oral anticoagulants (NOAC): dabigatran (Pradaxa) and rivaroxaban (Xarelto), both FDA approved, and apixaban (Eliquis), which has not been approved, can all be considered for stroke prevention in nonvalvular atrial fibrillation, a science advisory from AHA/ ASA stated.

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Heart-Rhythm Monitoring for Evaluation of Cryptogenic Stroke

Heart-Rhythm Monitoring for Evaluation of Cryptogenic Stroke | Heart and Vascular Health | Scoop.it

Observational studies suggest that we often fail to detect paroxysmal atrial fibrillation as the cause of ischemic stroke. However, owing to the limitations of existing studies, guidelines have yet to endorse specific strategies for detecting atrial fibrillation in patients with a new stroke. The results of two studies published in this issue of the Journal indicate that prolonged monitoring of heart rhythm should now become part of the standard care of patients with cryptogenic stroke.leaving it unclear whether monitoring improves diagnosis as compared with routine follow-up. 

Seth Bilazarian, MD's insight:

Our patients want to avoid stroke because of the debilitating effects it can have on functional status and quality of life.  Efforts to prevent a second stroke are enthusiastically embraced by patients.

Cryptogenic is stroke that a cause cannot be determined (about 1/3 of strokes).  Treatment with anticoagulants in this patient population is not recommended UNLESS the cause of the stroke is from the common irregular heart rhythm atrial fibrillation (AF).  

On the other hand if atrial fibrillation is NOT detected treatment with aspirin or other anti-platelet drugs are used and these drugs are inferior to anticoagulants if AF is the cause.

Two studies in NEJM showed that prolonged monitoring (30 days or 6 months)  increased the detection of AF and allowed more patients to be started on anticoagulants for stroke prevention.

In the trial of 30 days of recording with an external (carried) monitor was 16.1%.

In the trial of the implanted recorder detection of AF was 

at 6 months 8.9%

at 12 months 12%

at 36 months 36%

 The strategy of prolonged monitoring with an external device  for 1 month or 6 months with an implanted device is an unresolved question and adoption of the small subcutaneous device pictured above, will be limited by its cost, until further studies showing stroke reduction can be completed justifying its cost.

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