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Concomitant Use of Direct Oral Anticoagulants with Antiplatelet Agents and the Risk of Major Bleeding in Patients with Nonvalvular Atrial Fibrillation

  Patients with nonvalvular atrial fibrillation commonly have comorbidities requiring concurrent use of oral anticoagulants and antiplatelets. There are no real-world data on the comparative safety of concomitant antithrombotic treatments in the era of direct oral anticoagulant (DOACs). Thus, we compared the incidence of intracranial hemorrhage, gastrointestinal bleeding, and other major bleeding between concomitant DOAC-antiplatelet […]

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Concomitant Use of Direct Oral Anticoagulants with Antiplatelet Agents and the Risk of Major Bleeding in Patients with Nonvalvular Atrial Fibrillation

Patients with nonvalvular atrial fibrillation commonly have comorbidities requiring concurrent use of oral anticoagulants and antiplatelets. There are no real-world data on the comparative safety of concomitant antithrombotic treatments in the era of direct oral anticoagulant (DOACs). Thus, we compared the incidence of intracranial hemorrhage, gastrointestinal bleeding, and other major bleeding between concomitant DOAC-antiplatelet use […]

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Monitoring of Apixaban in a Super Obese Patient

Direct oral anticoagulants (DOACs) are considered advantageous compared to vitamin K antagonists in eligible atrial fibrillation patients.1 Increased body weight is associated with 30% lower exposure to standard doses of DOACs, raising concerns about adequate dosing in obese patients.2, 3 Due to lack of sufficient clinical data, use of DOACs in patients with a body mass index (BMI) […]

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Variation in the Use of Warfarin and Direct Oral Anticoagulants in Atrial Fibrillation and Associated Cost Implications

Little is known about national patterns of anticoagulant use among patients with atrial fibrillation after the availability of direct oral anticoagulants (DOACs) and the associated implications for healthcare spending. Methods The Medical Expenditure Panel Survey, a nationally representative survey, collects detailed information about prescription drug use, cost, and medical diagnoses. Using International Classification of Disease […]

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Spectrum of cerebral injuries from atrial fibrillation and atrial fibrillation management. (A) Large right middle cerebral artery territorial infarction on diffusion-weighted magnetic resonance imaging (MRI; arrow). (B) Ischemic infarction in multiple vascular territories on diffusion-weighted MRI. Left frontal lobe (blue arrow), right occipital lobe (red arrow), left occipital lobe (yellow arrow) are involved in this image on cerebral MRI (arrows). (C) Multiple microbleeds (white arrows) along with a larger right frontal subcortical hemorrhage (blue arrow) on brain MRI with susceptibility images. (D) Large high convexity right frontal hematoma with surrounding vasogenic edema on noncontrast computed tomography of the head (arrow).

Dementia and Atrial Fibrillation: Pathophysiological Mechanisms and Therapeutic Implications

Atrial fibrillation increases the risk of stroke by a factor of four- to fivefold, and dementia is a common consequence of stroke. However, atrial fibrillation has been associated with cognitive impairment and dementia, even in patients without prior overt stroke. Nonischemic mechanisms include cerebral hypoperfusion, vascular inflammation, brain atrophy, genetic factors, and shared risk factors […]

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Should Atrial Fibrillation Patients Take Oral Anticoagulants? (video)

A majority of atrial fibrillation patients who have not been treated oral anticoagulants (OAC) meet guideline indications for treatment. Untreated patients are at increased risk for adverse outcomes. In this video, AJM editor-in-chief Dr. Joseph S. Alpert discusses this new research in the April 2017 issue of the American Journal of Medicine. Read the Research: […]

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