Type 2 Diabetes Mellitus and Nonvalvular Atrial Fibrillation in Mexico: National Registries Raise a Red Flag

ABSTRACT Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases worldwide and is highly prevalent in Mexico, as 10.2% of the adult population harbors this condition. T2DM is usually associated with cardiovascular comorbidities, including arrhythmias. Metabolic impairment is one of the mechanisms that contribute to tissue remodeling that affects atrial structure, and concomitant, the cardiac conduction system, both could result in atrial fibrillation (AF). AF is estimated to affect more than a half million Mexicans, and its incidence is expected to keep rising. According to national registries, T2DM is present in 28.4% of Mexican patients with AF and the coexistence of both diseases is associated with a higher risk of stroke. In clinical practice, the CHA2DS2-VASc risk score is useful for stroke risk stratification in patients with AF to facilitate the adequate use of anticoagulation therapy. T2DM is among the items of the CHA2DS2-VASc score because it correlates with an intrinsic prothrombotic state. In this narrative review, we present information that highlights the need for optimal glucose control and adequate anticoagulation in subjects with T2DM and AF.

Left atrial automated functional myocardial imaging to identify patients with paroxysmal atrial fibrillation at high risk of stroke / 中华超声影像学杂志

Objective:To investigate the risk factors of non-valvular paroxysmal atrial fibrillation (NVPAF) with cerebral ischemic stroke(CIS) and analyze NVPAF by using left atrial automatic imaging (AFILA). Logistic regression model was established for left atrial(LA) function parameters.Methods:A total of 205 patients with NVPAF were included in the study and divided into the NVPAF group without ischemic stroke (154 patients) and the CIS group (51 patients). The clinical baseline data, blood biochemical results and AFILA ultrasound data of all patients were collected. Univariate analysis was performed to compare the above data between the two groups of patients. The independent risk factors were obtained by multivariate logistic regression analysis. Logistic regression model was compared with CHA2DS2-VASc scoring system in terms of area under ROC curve, sensitivity and specificity.Results:There were significant differences in age, CHA2DS2-VASc score, taking anticoagulant drugs, history of hypertension, diabetes and coronary heart disease, LAEF, S_R, S_CT, WBC, NEUT, HCY, UREA, NDD, NT-proBNP, Fibrinogen(Fib), Cardiac troponin I(cTnI) and NLR between the two groups (all P<0.05). The results of multifactor analysis showed that: age, hypertension, S_ CT, UREA, NLR, Fib and cTnI were independent risk factors associated with CIS in patients with paroxysmal atrial fibrillation[ OR value: 1.608 ( P=0.003), 3.821 ( P=0.019), 1.259 ( P=0.001), 1.326( P=0.001), 1.352 ( P=0.011), 1.502 ( P=0.042), 7.651( P=0.001)]. After adjusting for the age, sex and history of hypertension included in CHA2DS2-VASc score, S_CT significantly led to NVPAF complicated with stroke[ OR value 1.259 (1.095-1.447), P=0.001]. The diagnostic efficacy of Logistic regression model is better than that of CHA2DS2-VASc scoring (AUC of 0.931 vs 0.717, 95% CI: 0.896-0.967 vs 0.634-0.799, sensitivity of 0.883 vs 0.755, specificity of 0.849 vs 0.713, all P<0.001). Conclusions:Age, hypertension, S_CT, UREA, NLR, fibrinogen, cTnI are independently associated risk factors for patients with combined CIS; The diagnostic efficacy of Logistic regression model is better than that of CHA2DS2-VASc scoring model.And the sensitivity and specificity are high.

Prognostic value of AST/ALT ratio combined with APTT regimen in NVAF patients receiving rivaroxaban anticoagulant therapy / 国际生物医学工程杂志

Objective:To investigate the prognostic value of the ratio of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) combined with activated partial thromboplastin time (APTT) in elderly patients with non-valvular atrial fibrillation (NVAF) treated with rivaroxaban.Methods:One hundred and twenty-two elderly patients with NVAF who were anticoagulated with rivaroxaban from June 2020 to June 2021 in the Third Central Hospital of Tianjin were enrolled and divided into four groups based on the median method. The patients in the Q1 group ( n = 32) have low AST/ALT/low APTT. The patients in the Q2 group ( n = 27) have low AST/ALT/high APTT. The patients in the Q3 group ( n = 29) have high AST/ALT/low APTT. The patients in the Q4 group ( n = 34) have high AST/ALT/high APTT. The efficacy endpoint events, and safety endpoint events were analyzed in the four groups, and univariate and multivariate Cox regression analyses were performed for the composite endpoint events. Results:The effectiveness endpoint events were mainly cardiovascular deaths, the number of which in the Q1 to Q4 groups was 0 (0), 1 (3.70%), 4 (13.79%), and 5 (14.71%), respectively. The safety endpoint events were mainly non-major bleeding events, the number of which in the Q1 to Q4 groups was 5 (15.62%), 2 (7.41%), 6 (20.69%), and 5 (14.71%), respectively. Compared to the Q1 group, the Q4 group had an increased risk of composite endpoint events after incorporating traditional risk factor correction ( HR: 3.851, 95% CI: 1.167 to 12.704). Conclusions:AST/ALT ratio combined with APTT can provide risk stratification for distant bleeding and cardiovascular adverse events in elderly NVAF patients treated with rivaroxaban anticoagulation and has some predictive value for their prognosis.

Efficacy and safety evaluation of dabigatran etexilate in the treatment of elderly non-valvular atrial fibrillation / 药学实践杂志

Objective To explore the efficacy and safety of dabigatran etexilate in the treatment of elderly patients with non-valvular atrial fibrillation (NVAF), so as to provide reference for clinical treatment and rational drug use. Methods Eighty elderly patients with NVAF in The Seventh People's Hospital of Shanghai from December 2020 to June 2021, aged 65 to 80 years, were enrolled in a self-controlled study. Dabigatran etexilate 110 mg was given orally, twice a day (one in the morning and one in the evening) for 6 months. During the follow-up visit, the coagulation function indexes including APTT, TT, FIB and D-D were observed in patients taking medicine for 1 month and 6 months. Liver function indexes including ALT, AST and TBIL, renal function indicators including UREA and eGFR, and blood routine indexes including HGB and ESR, also were observed in patients taking medicine for 1 month and 6 months. Results Patients were compared at 1 month and 6 months after treatment with dabigatran and before: the difference of coagulation function indexes as APTT and TT was statistically significant (P<0.05);There was no significant difference in liver function index, renal function index and blood routine index (P>0.05); A total of 25 adverse events occurred, and the incidence rate of adverse reactions was 31.25%, there was no adverse events such as serious hemorrhage，life threatening and organ failure hemorrhage occurred．Conclusion Dabigatran has good efficacy and safety in the treatment of the elderly NVAF.

Efficacy and safety of new oral anticoagulants in patients with nonvalvular atrial fibrillation after left atrial appendage occlusion：a meta-analysis / 中国药房

OBJECTIVE To systematically evaluate the efficacy and safety of new oral anticoagulants （NOACs） in patients with nonvalvular atrial fibrillation after left atrial appendage occlusion （LAAO）. METHODS Retrieved from PubMed， Embase， Web of Science， the Cochrane Library， CNKI and Wanfang data， randomized controlled trials （RCTs） and cohort studies about NOACs （trial group） versus warfarin or dual antiplatelet agents （control group） were collected during the inception and November 2022. After literature screening， data extraction and quality evaluation， meta-analysis was performed by using RevMan 5.4 software. RESULTS A total of 10 studies were included， involving 2 RCTs and 8 cohort studies， with a total of 2 653 patients. RCT results showed that there was no statistically significant difference in the incidence of device-related thrombosis （DRT）， stroke/ systemic embolism （SSE）， major bleeding events， total bleeding events or all-cause mortality between 2 groups （P＞0.05）. Results of cohort studies showed that compared with dual antiplatelet agents， there was no statistically significant difference in the incidence of DRT， stroke/SSE， major bleeding events or all-cause mortality in the trial group （P＞0.05）. Compared with warfarin， the incidence of DRT [RR＝0.40， 95%CI　（0.19，0.82）， P＝0.01] and total bleeding events [RR＝0.28， 95%CI　（0.18， 0.44）， P＜ 0.000 01] in the trial group were decreased significantly； there was no statistical significance in the incidence of stroke/SSE， major bleeding events or all-cause mortality （P＞0.05）. CONCLUSIONS For patients with nonvalvular atrial fibrillation after LAAO， NOACs have comparable antithrombotic efficacy and safety with dual antiplatelet agents， and the incidence of DRT and total bleeding events are lower than warfarin.

Study on population pharmacokinetics of dabigatran in elderly patients with non-valvular atrial fibrillation / 中国药房

OBJECTIVE To analyze influential factors for dabigatran exposure in elderly patients with non-valvular atrial fibrillation. METHODS The clinical information of 75 elderly patients diagnosed with non-valvular atrial fibrillation was collected from our hospital in Jan. 2019-Jun. 2020. One or two steady-state blood drug concentration samples were collected from each patient. NONMEM 7.2.0 software was used to establish a population pharmacokinetics model of dabigatran； the effects of different covariates on the apparent clearance of dabigatran were investigated， and the final model was verified by goodness of fit and Bootstrap method； NONMEM 7.2.0 software was used to analyze the drug exposure of ordinary elderly patients and elderly patients after taking dabigatran ester in different disease states. RESULTS Totally 122 blood concentration samples of dabigatran were collected. Advanced age， creatinine clearance and history of chronic heart failure were screened out as three significant covariates that influenced the clearance of dabigatran in elderly patients. The exposure of population with advanced age increased by about 50% compared with the general elderly， the exposure of population with history of chronic heart failure increased by nearly 30% compared with population without， and the exposure of population with moderate and severe renal injury increased by about 30% and 80% compared with mild. CONCLUSIONS Advanced age， renal injury and history of chronic heart failure are influential factors for elevated systemic exposure of dabigatran.

Research progress in atrial fibrillation with cerebral small vessel disease / 中南大学学报(医学版)

Non-valvular atrial fibrillation is a common arrhythmia and a major risk factor for cardioembolic stroke. Small cerebral vascular disease is a syndrome of clinical, cognitive, imaging, and pathological manifestations caused by intracranial small vascular lesions. The imaging findings on cranial magnetic resonance usually shows recent subcortical small infarction, vascularised lacunae, white matter hypersignal, perivascular space enlargement, cerebral microhemorrhage, and brain atrophy. It is a major cause of neurological loss and cognitive function decline in the elderly. Current studies suggest that atrial fibrillation may increase the imaging load of cerebral small vessel disease through a series of mechanisms such as microembolization, hypoperfusion, inflammation, endothelial dysfunction, and lymphoid system dysfunction. The imaging of cerebral small vessel disease with atrial fibrillation has a potential relationship with cognitive function decline and is related to the occurrence and prognosis of stroke, even more has a potential role in suggesting the etiology and secondary prevention strategies of ischemic stroke.

Evaluación del tratamiento de la fibrilación auricular valvular y no valvular y su relación con eventos adversos en pacientes hospitalizados en el servicio de urgencias de un hospital de tercer nivel / Evaluation of the treatment of valvular and non-valvular atrial fibrillation and its relationship with adverse events in patients admitted to the Emergency Department of a third level hospital

Resumen Introducción: La fibrilación auricular es la arritmia más frecuente, y a pesar de importantes avances en su tratamiento, sigue siendo una de las principales causas de accidente cerebrovascular, insuficiencia cardíaca, muerte súbita y morbimortalidad cardiovascular en el mundo (1,2). En Colombia se cuenta con muy pocos registros que determinen su prevalencia y patrón epidemiológico. Objetivo: Describir el tratamiento de los pacientes que ingresan al servicio de urgencias con diagnóstico de fibrilación auricular, así como establecer la prevalencia, epidemiología y eventos adversos asociados con el tratamiento. Materiales y método: Se utilizaron los programas EXCEL, para la organización de los datos, y SPSS versión 23, para el análisis. Resultados: Durante el periodo del estudio 105 pacientes fueron admitidos en el servicio de Urgencias con diagnóstico de fibrilación auricular. 58% eran hombres, con promedio de edad de 67.8 años. Las comorbilidades más asociadas a la fibrilación auricular fueron hipertensión arterial y falla cardiaca. El 35% de los pacientes habían tenido alguna complicación cardioembólica, principalmente ataque cerebrovascular, y 12% ingresaron por complicaciones derivadas de la anticoagulación. En la mayoría de los casos se prefirió una estrategia de control de frecuencia cardíaca y anticoagulación. En cuanto al manejo anticoagulante, el 45% fueron tratados con warfarina y el 37% con anticoagulantes orales directos. Se documentaron tres casos de sangrados mayores en pacientes tratados con warfarina y ninguno en pacientes tratados con anticoagulantes orales directos. Conclusión: La fibrilación auricular continúa siendo una de las principales causas de atención en el servicio de urgencias, así como una importante causa de accidente cerebrovascular. Las comorbilidades asociadas son hipertensión arterial y falla cardiaca. La estrategia terapéutica más utilizada es el control de la frecuencia cardiaca y la anticoagulación; adicionalmente, hay un porcentaje creciente de pacientes en tratamiento con anticoagulantes directos.

Abstract Introduction: Atrial fibrillation is the most common arrhythmia, and despite the significant advances in its treatment, it continues to be one of the main causes of cerebrovascular accident, heart failure, sudden death, and cardiovascular morbidity and mortality in the world. In Colombia, there are very few registers that help to determine its prevalence and epidemiological pattern. Objective: To describe the treatment of the patients admitted to the Emergency Department with a diagnosis of atrial fibrillation, as well as to establish the prevalence, epidemiology, and adverse events associated with the treatment. Materials and method: Excel programs were used for the organisation of the data, SPSS version 23, for the analysis. Results: During the study period, a total of 105 patients were admitted into the Emergency Department with a diagnosis of atrial defibrillation. The mean age was 67.8 years and the majority (58%) were males. Arterial hypertension and heart failure were comorbidities most associated with the atrial fibrillation. More than one-third (35%) of the patients had suffered some cardio-embolic complication, mainly a stroke, and 12% were admitted due to complications arising from anticoagulation. Monitoring heart rate and anticoagulation was the preferred strategy in the majority of patients. As regards anticoagulant management, 45% were treated with warfarin, and 37% with direct oral anticoagulants. Three cases of major bleeding were documented in patients on warfarin, and none in patients treated with direct oral anticoagulants. Conclusion: Atrial fibrillation continues to be one of the main causes in the Emergency Department, as well as a significant cause of cerebrovascular accident. Arterial hypertension and heart failure were the most associated comorbidities. The most used therapeutic strategy was monitoring of heart rate and the anticoagulation. Furthermore, there was an increasing percentage of patients on treatment with direct oral anticoagulants.

SAMe-TT2R2 score for prediction of suboptimal time in therapeutic range in a Thai population with atrial fibrillation

INTRODUCTION@#International normalised ratio (INR) control is an important factor in patients with non-valvular atrial fibrillation (NVAF) being treated with warfarin. INR control was previously reported to be poorer among Asians compared to Westerners. We aimed to validate the SAMe-TT2R2 score for prediction of suboptimal INR control (defined as time in therapeutic range [TTR] < 65% in the Thai population) and to investigate TTR among Thai NVAF patients being treated with warfarin.@*METHODS@#INR data from patients enrolled in a multicentre NVAF registry was analysed. Clinical and laboratory data was prospectively collected. TTR was calculated using the Rosendaal method. Baseline data was compared between patients with and without suboptimal INR control. Univariate and multivariate analyses were performed to identify variables independently associated with suboptimal INR control.@*RESULTS@#A total of 1,669 patients from 22 centres located across Thailand were included. The average age was 69.1 ± 10.7 years, and 921 (55.2%) were male. The mean TTR was 50.5% ± 27.5%; 1,125 (67.4%) had TTR < 65%. Univariate analysis showed hypertension, diabetes mellitus, heart failure, renal disease and SAMe-TT2R2 score to be significantly different between patients with and without optimal TTR. The SAMe-TT2R2 score was the only factor that remained statistically significant in multivariate analysis. The C-statistic for the SAMe-TT2R2 score in the prediction of suboptimal TTR was 0.54.@*CONCLUSION@#SAMe-TT2R2 score was the only independent predictor of suboptimal TTR in NVAF patients being treated with warfarin. However, due to the low C-statistic, the score may have limited discriminative power.

Pacientes con fibrilación auricular no valvular tratados con antivitamina K o anticoagulantes directos: perfil de paciente y efectos a largo plazo / Patients with non-valvular atrial fibrillation on vitamin k antagonists or direct-acting oral anticoagulants: patients profile and long-term follow up outcomes

Resumen Introducción: La llegada de los anticoagulantes directos (ACD) ha supuesto un cambio en el tratamiento de la fibrilación auricular no valvular (FANV) en los últimos años. Los objetivos de este estudio son determinar el grado de control de la anticoagulación con antivitamina K (AVK) y su posible implicación en efectos cardiovasculares adversos mayores (ECAM) y evaluar las diferencias entre el grupo en tratamiento con AVK respecto del grupo con ACD. Pacientes y métodos: Estudio de cohorte prospectivo que incluyó a pacientes consecutivos diagnosticados con FANV valorados en el Servicio de Cardiología con un seguimiento de 18 meses. Se analizaron diferencias demográficas, clínicas y analíticas entre grupos, incluido el grado de control de la anticoagulación del grupo AVK y su posible relación con ECAM. Resultados: Se incluyó a 273 pacientes: 46.5% tratados con AVK, 42.5% con ACD y 11% sin tratamiento anticoagulante. El control de la anticoagulación con AVK fue del 62.1%, sin diferencias en ECAM en función de control. El grupo ACD presentó menos ECAM que el grupo de AVK (13.4 vs. 4.3%; HR, 0.90; 0.83-0.98; p = 0.01), con una menor mortalidad cardiovascular (0.0 vs. 5.5%; HR, 0.94; 0.90-0.98; p = 0.01) y total (0.9 vs. 12.6%; HR, 0.88; 0.82-0.94; p menor que 0,01), aunque sin diferencias significativas en eventos hemorrágicos (0.9 vs. 4.7%; p = 0.07) ni isquémicos (2.6 vs. 0.8%; p = 0.27). Discusión: Los pacientes con AVK poseen un perfil clínico diferente en comparación con los que reciben ACD. El control de anticoagulación del grupo de AVK fue inadecuado en casi la mitad de los casos. El grupo de AVK presentó más ECAM que el grupo de ACD.

Abstract Introduction: The arrival of direct-acting oral anticoagulants (DOACs) has led to a change in the management of non-valvular atrial fibrillation (NVAF) in recent years. The objectives of this study are to determine the level of therapeutic control of anticoagulation with vitamin K antagonists (VKA) and its possible involvement in major adverse cardiovascular events (MACE) and to evaluate differences between the group on VKA with respect to the group on DOACs. Patients and methods: Prospective cohort study that included consecutive patients diagnosed with NVAF in Cardiology Consultations with a clinical follow-up of 18 months. Demographic, clinical and analytical differences between groups were analyzed, including the level of therapeutic control of anticoagulation on the VKA group and its association with MACE. Results: Overall, 273 patients were included: 46.5% on VKA, 42.5% on DOACs, 11% without antithrombotic treatment. Patients on VKA spent 62.1% of their time within therapeutic range (TTR by the Rosendaal formule). There were no differences in MACE depending on anticoagulation control. The DOACs group presented lesser MACE rate than the VKA group (13.4 vs. 4.3%; 0.90; HR 0.90; 0.83-0.98 p = 0.01) with lower cardiovascular mortality (0.0 vs. 5.5%; HR, 0.94; 0.90-0.98; p = 0.01) and total mortality (0.9 vs. 12.6%; HR, 0.88; 0.82-0.94; p less 0.01) although without significant differences in hemorrhagic (0.9 vs. 4.7 %; p = 0.07), or ischemic events (2.6 vs. 0.8%, p = 0.27). Conclusions: Patients on VKA have a different clinical profile than those who receive DOACs. Patients on VKA have an inadequate control of the anticoagulation in quite the half of the cases. The VKA group presented more MACE than the DOACs group.

Comparison between the different new anti-coagulants for non-valvular atrial fibrillation: network meta-analysis

Atrial fibrillation is associated with high risk of ischaemic stroke which is considered a major fatal complication in atrial fibrillation. That’s why, anticoagulants were used to prevent this major complication. However, anticoagulants themselves are associated with their own complications. A systematic search of Embase, Medline and Google scholar were conducted. The included papers were extracted for outcomes related to the complications of each drugs. A Bayesian network meta-analysis based on Markov chain Monte Carlo simulation (MCMC) with 10000 burn-in iterations and 50000 inference iterations. We found eighteen papers that fit our inclusion criteria. Apixaban had the least risk of major bleeding compared to Warfarin [HR = 0.536, 95% (0.448, 0.652)] and the least risk of gastrointestinal hemorrhage. For stroke risk, the Rivaroxaban had the least risk compared to Warfarin [HR = 1.05, 95% (0.98, 1.14)]. For intracranial hemorrhage, dabigatran had the least risk of intracranial haemorrhage compared to Warfarin [HR = 0.46, 95% CrI (0.36, 0.61)]. For the thromboembolism risk, other non-vitamin k antagonist had the least risk of intracranial haemorrhage compared to Warfarin [HR = 0.523, 95% (0.095, 2.85)]. There were no conclusive results about the best anticoagulant drugs for non-valvular atrial fibrillation. Apixaban was the least among them to be associated with major bleeding, while rivaroxaban was ranked the first with least stroke complications. Furthermore, dabigatran was associated with less risk of intracranial haemorrhage compared to other anticoagulants.

Cost-effective analysis of LAAC and oral anticoagulants in the prevention of stroke in patients with atrial fibrillation / 中国实用内科杂志

OBJECTIVE: To study the cost-effectiveness of left atrial appendage occlusion(LAAC), rivaroxaban and warfarin in the prevention of stroke in patients with atrial fibrillation, in order to explore the most appropriate economical medication model. METHODS: A total of 156 NVAF patients treated in the First Affiliated Hospital of Dalian Medical University from July2016 to June 2018 were studied; they were divided into group A(LAAC), group B(rivaroxaban)and group C(warfarin)by random digital method.Markov model was used to analyze the drug economy of three methods to prevent stroke in patients with atrial fibrillation within one year, and sensitivity analysis was conducted to verify the stability of the results. RESULTS: The total cost of treatment in group C was significantly lower than that in the other two groups, while in group A it was significantly higher than in the other two groups, with statistical significance(P<0.05). ICER(A vs. B)was 91242.31 yuan/QALY,ICER(B vs. C)was 96706.25 yuan/QALY, and ICER(A vs. C)was 93323.81 yuan/QALY. So the drug economy of group A was better than that of the other two groups, and group B was better than group C. When the sensitive indicators selected changed, there was still a statistical difference in the total cost among the three groups(P<0.05), which indicated that the results of this study were credible. CONCLUSION: Compared with warfarin and rivaroxaban, LAAC may have more pharmacoeco-nomic effects on preventing stroke in patients with atrial fibrillation, but further studies with large sample sizes and longer follow-up cycles are needed.

Peripheral leukocyte count and risk of bleeding in patients with non-valvular atrial fibrillation taking dabigatran: a real-world study / 中华医学杂志(英文版)

Background@#The association between peripheral leukocyte count and bleeding events in nonvalvular atrial fibrillation (NVAF) patients treated with dabigatran remains unclear. This study aimed to explore the association between leukocyte count and bleeding events after excluding other confounders in NVAF patients taking dabigatran.@*Methods@#A total of 851 NVAF patients treated with dabigatran (110 mg bid) were recruited from 12 centers in China from February 2015 to December 2017. Follow-up was completed by May 2018. The exposure and outcome variables were leukocyte count measured at baseline and the number of bleeding events within the subsequent 6 months. Multivariate Cox proportional hazards models were constructed to analyze independent associations, and a Cox proportional hazards regression with cubic spline functions and smooth curve fitting (penalized spline method) was used to address nonlinearity between leukocyte count and bleeding. The inflection point was calculated using a recursive algorithm, and then a two-piecewise Cox proportional hazards model for both sides of the inflection point was constructed.@*Results@#During 6-month follow-up, 87 participants occurred bleeding events. For every 1 × 109/L increase in leukocyte count, the risk of bleeding increased by 11% (hazard ratio [HR]: 1.11, 95% confidence interval [CI]: 0.99–1.25). The smooth curve showed nonlinear relationship between leukocyte count and bleeding events. The inflection point of the leukocyte count was 6.75 × 109/L. For leukocyte counts < 6.75 × 109/L, the HR (95% CI) was 0.88 (0.69–1.13), and for leukocyte counts ≥ 6.75 × 109/L, the HR (95% CI) was 1.28 (1.09–1.51).@*Conclusion@#This study found a J-shaped association between baseline leukocyte count and risk of bleeding in NVAF patients treated with dabigatran.@*Clinical trial registration@#NCT02414035, https://clinicaltrials.gov.

Analysis of the risk factors of intracranial hemorrhagic transformation in acute cerebral infarction with non-valvular atrial fibrillation patients within 14-days / 中国神经精神疾病杂志

Objective To investigate the risk factors of intracranial hemorrhagic (ICH) transformation within 14-days in acute cerebral infarction with non-valvular atrial fibrillation (NVAF) patients. Methods CT and/or MRI scans of the head were conducted within 14 days on patients with NVAF acute cerebral infarction who admitted to the Department of Neurology, Huizhou Municipal Central Hospital between January 2015 to March 2018. The baseline scan data were reviewed to determine whether ICH conversion occurred. Comparable risk assessment were based on stratification scores using HAS-BLED, ASPECTS, and pc-ASPECTS. Results There were 150 cases of acute cerebral infarction with NVAF, 126 patients were eligible for the analysis, with an ICH conversion rate of 27.0% (34/126). The following four risk factors were statistically significant among the ICH and non-ICH transformation groups: ①systolic blood pressure (SBP) >160 mmHg or diastolic blood pressure (DBP) >100 mmHg post-cerebral infarction, ②Severe cerebral infarction, progressing stroke, ③ASPECTS (pc-ASPECTS) score ≤7 points, and ④ HAS-BLED score ≥3 points (P<0.05). Conclusion Approximately 1/3 of NVAF acute cerebral infarction patients experience an ICH transformation within 14 days of their episode. The following indicators are independent risk factors of ICH transformation: SBP >160mmHg or DBP >100mmHg after cerebral infarction, severe cerebral infarction, progressing stroke, ASPECTS (pc-ASPECTS)≤7 points, and HAS-BLED score≥3 points.

Nonvalvular atrial fibrillation: a study of epidemiology, demography and clinicoetiological profile in Central India

Background: Atrial fibrillation (AF) is the most common sustained disorder of cardiac rhythm. To study the epidemiology, demography and clinicoetiological profile of nonvalvular atrial fibrillation, such studies are sparse in India.Methods: One hundred sixty-five patients of nonvalvular atrial fibrillation were enrolled prospectively in the study during the period February 2017 to May 2018. Patients with an electrocardiographic documentation of atrial fibrillation, either chronic or paroxysmal were enrolled in the study. Patients underwent thorough physical examination, routine laboratory testing, and other relevant investigations to assess the underlying etiology. Baseline characteristics of all the patients’ viz. type of AF, primary etiological diagnosis, and baseline clinical parameters were noted. Statistical analysis was done using percentage analysis.Results: A total of 165 patients were enrolled in the study. The vast majority of patients were elderly; with the majority being in the 56-65years age group (45.45%). AF was more common in men (56.3%). Systemic hypertension was the most common etiological association (80%).Conclusions: Present study found that advanced age and male gender are significant risk factors for AF. Systemic hypertension is the most common etiological association with nonvalvular AF.

Manejo perioperatorio del paciente anticoagulado con fibrilación auricular no valvular / Perioperative management of the anticoagulated patient with non-valvular atrial fibrillation

Resumen: La fibrilación auricular (FA) aumenta el riesgo de accidente cerebrovascular (ACV) y tromboembolia (TE) sistémica, por lo que resulta fundamental prevenir esta temible complicación a través del tratamiento anticoagulante. Al uso habitual de warfarina se agregaron en los últimos años los anticoagulantes orales directos (ACOD). Frente a una intervención, o procedimiento invasivo es necesario evaluar el riesgo embólico y el de sangrado para definir el manejo más adecuado de estos fármacos. En el presente artículo se proponen recomendaciones para el tratamiento anticoagulante periprocedimiento en la fibrilación auricular no valvular basadas en el consenso de expertos del American College of Cardiology.

Summary: Atrial fibrillation increases the risk of stroke and systemic embolism, so it is important to prevent this terrible complication with anticoagulant therapy. To the usual use of warfarin were added in recent years, direct anticoagulants. In front of an invasive procedure, it is necessary to evaluate embolism and bleeding risks to define the most appropriate management of these drugs. In the present article, recommendations based in expert consensus of American College of Cardiology are proposed, to periprocedural anticoagulation treatment in non-valvular atrial fibrillation.

Investigation and Analysis of the Anticoagulant Therapy for Patients with Non-valvular Atrial Fibrillation in Our Hospital / 中国药房

OBJECTIVE:To investigate the current situation of anticoagulant therapy for patients with non-valvular atrial fibril-lation,and to provide reference for standardized anticoagulant therapy. METHODS:A total of 1056 patients with non-valvular atri-al fibrillation were collected from our hospital during Jul. 2015-Jun. 2016. According to 2012 European Society of Cardiology Guide-lines for the Management of Atrial Fibrillation,the risks of thrombosis and hemorrhage were evaluated,and the standardized anti-coagulant therapy was also evaluated. RESULTS:Among 1056 patients with non-valvular atrial fibrillation,the number of patients with thrombosis risk score ≥1 was 1028,accounting for 97.3%. 763 patients received antithrombosis therapy,and only 139 pa-tients were given warfarin anticoagulant therapy. The international normalized ratio(INR)of prothrombin time in just 30.9% of pa-tients receiving warfarin was in line with the standard before discharge. CONCLUSIONS:The anticoagulant therapy for patients with non-valvular atrial fibrillation is still not optimistic,and effective measure should be adopted to improve the standardization of anticoagulant therapy in the patients with atrial fibrillation.

Analysis on IL-6-174G/C and-572C/G site gene polymorphism and non-valvular atrial fibrillation population in Xinjiang and national differences / 重庆医学

Objective To investigate the relationship between IL-6-174C/G and-572C/G site gene polymorphism with nonvalvular atrial fibrillation(NVAF) as well as the national differences of interleukin-gene polymorphism between Kazak and Han nationality in Xinjiang region.Methods Seventy-nine Kazak patients of NVAF(Kazak NVAF group),78 Han patients with NVFA (Han NVAF group),75 Han cases of non-AF and 79 Kazak cases of non-AF were selected in Xinjiang region.The venous bloods were collected from extracting DNA.IL-6 gene-174G/C and-572C/G polymorphism in various groups were analyzed by adopting the PCR-RFLP technique.Results The allele frequency of IL-6-572G/C site G in the NVAF group was significantly higher than that in the control group(x2 =4.076,P＜0.05).The allele frequency of IL-6 gene-572 G/C site G had statistical difference between the NVAF group and the control group(OR=1.519,95 ％CI:I.087-2.122,P＜0.05),but the distribution difference between the Han and Kazak control groups had no statistical significance(P＞0.05);the advanced age ≥75 years old)(OR=6.468,95 ％CI:2.427-17.240) and left atrial dimension(OR =1.053,95 ％ CI:1.022-1.085) were the independent factors of AF occurrence;the left ventricular ejection fraction was a protective factor for preventing AF occurrence.The allele frequency of IL-6 gene 174G/C site C and G had no statistical difference among various groups(P＞0.05).Conclusion The allele of IL-6-572 G/C site G is a risk factor of genetic predisposition in NVAF.IL-6-174G/C site gene polymorphism has no relation with the susceptibility of AF.

Comparison of Anticoagulant Efficacy and Safety of Dabigatran Etexilate and Warfarin in the Treatment of Non-valvular Atrial Fibrillation / 中国药房

OBJECTIVE:To compare anticoagulant efficacy and safety of dabigatran etexilate and warfarin in the treatment of non-valvular atrial fibrillation(NVAF). METHODS:In retrospective analysis,360 NVAF patients were divided into control group (180 cases)and observation group(180 cases)according to therapy plan. Control group was given Warfarin sodium tablet with ini-tial dose of 2.5 mg orally,once a day,adjusted dosage according to INR. Observation group was given Dabigatran etexilate cap-sule 150 mg with warm water,twice a day,during or after meal. The levels of ALT,AST and INR,the occurrence of ADR were observed in 2 groups before treatment and 1,3 month after treatment. RESULTS:There was no statistical significance in the levels of ALT or AST between 2 groups before and after treatment (P>0.05). Before treatment,there was no statistical significance in INR between 2 groups (P>0.05),1,3 months after treatment,INR in control group was significantly higher than before treat-ment,with statistical significance(P<0.05);there was no statistical significance in the INR of observation group before and after treatment(P>0.05);but INR of 2 groups ranged were in normal range. There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Anticoagnlant efficacy of dabigatran etexilate is significantly better than war-farin for NVAF. Both have similar safety.

Investigation and Analysis of Medication Compliance of Patients with Nonvalvular Atrial Fibrillation to Warfarin and Its Influential Factors / 中国药房

OBJECTIVE:To improve medication compliance of patients with nonvalvular atrial fibrillation (NVAF) to warfarin and its influential factors,and to provide reference for guaranteeing the safety and effectiveness of therapy.METHODS:A questionnaire survey was conducted among NVAF patients receiving warfarin anticoagulation in our hospital,MMAS-8 and WRKS were adopted to evaluate medication compliance of patients to warfarin and the understanding of patients to the knowledge of anticoagulation treatment.Related influential factors for medication compliance of patients to warfarin were investigated by x2 test,t test and Logistic multiple regression analysis.RESULTS:Totally 129 questionnaires were sent out,and 112 were effectively received with effective recovery of 86.82％.The mean score of MMAS was (6.54 ± 1.61),and 42.86％ patients had good medication compliance.The mean score of WRKS was (7.95 ± 1.65);that of patients with good medication compliance was (9.31 ± 0.83),and that of patients with poor medication compliance was (6.92 ± 1.34).Single factor analysis showed that there was statistical significance in gender,age,occupation,educational level,the number of compliance,WRKS score between patients with good medication compliance and those with poor medication compliance (P＜0.05).Multivariate Logistic regression analysis showed that WRKS score,gender,educational level and the number of compliance were significantly correlated with medication compliance (P＜0.05).CONCLUSIONS:Poor medication compliance of NVAF patients to warfarin is related to multiple influential factors.The knowledge of warfarin anticoagulation is an important factor.