Replacing warfarin with a novel oral anticoagulant: Risk of recurrent bleeding and stroke in patients with warfarin ineligible or failure in patients with atrial fibrillation (The ROAR study)

Journal of Cardiovascular Electrophysiology
Mohit K TuragamDhanunjaya Lakkireddy

Abstract

A significant proportion of patients treated with warfarin for atrial fibrillation (AF) become warfarin ineligible (WI) due to major bleeding events (MBE) or systemic thromboembolism (STE). We report a large multicenter real-world experience of the use of direct oral antagonists (DOACs) in these WI patients. We report the outcomes of 263 WI patients treated with DOACs. The primary objective was to evaluate clinical outcomes of STE and MBE with DOACs. Secondary objective was to assess clinical predictors of repeat MBE and STE on DOACs. Note that 63% (166 of 263) patients had a repeat MBE on DOACs. Repeat MBE was significantly higher in patients with prior gastrointestinal bleeding (74.5% vs. 30%, P < 0.0001). Five percent (12 of 263) developed repeat STE. Higher mean CHA2DS2VASC (6.5 ± 1.7 vs. 3.3 ± 1.6 = 0.001) score was associated with repeat STE. About 34% (57 of 166) of patients had an intervention to manage repeat MBE. LAAO devices were successfully used in 67% (12 of 18) high-risk patients who underwent major interventions to manage MBE. In WI patients rechallenged with DOACs, a significant proportion developed repeat MBE. LAAO devices seem reasonable in those patients who undergo major interventions to manage MBE with cau...Continue Reading

References

Jul 1, 1995·Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis·Y Stirling
Apr 18, 2009·Anesthesia and Analgesia·Nigel Mackman
Apr 28, 2009·Pharmacology & Therapeutics·Sara EyalJashvant D Unadkat
Sep 1, 2009·The New England Journal of Medicine·Stuart J ConnollyUNKNOWN RE-LY Steering Committee and Investigators
Nov 3, 2009·The Journal of Thoracic and Cardiovascular Surgery·Sacha P SalzbergMichele Genoni
Aug 13, 2011·The New England Journal of Medicine·Manesh R PatelUNKNOWN ROCKET AF Investigators
Aug 30, 2011·The New England Journal of Medicine·Christopher B GrangerUNKNOWN ARISTOTLE Committees and Investigators
Jan 8, 2013·Clinical Pharmacokinetics·Francesco Scaglione
Nov 21, 2013·The New England Journal of Medicine·Robert P GiuglianoUNKNOWN ENGAGE AF-TIMI 48 Investigators
Nov 17, 2014·JAMA : the Journal of the American Medical Association·Vivek Y ReddyUNKNOWN PROTECT AF Steering Committee and Investigators
Dec 19, 2014·Circulation·Dariush MozaffarianUNKNOWN American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Jan 22, 2015·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Apostolos TzikasJai-Wun Park
Dec 25, 2015·Circulation·John W EikelboomJeffrey I Weitz
Feb 14, 2016·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Dhanunjaya LakkireddyDavid Wilber
Oct 25, 2016·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Yoshinari EnomotoVivek Y Reddy

❮ Previous
Next ❯

Citations

Nov 11, 2017·Journal of Cardiovascular Electrophysiology·Mohit K Turagam, Dhanunjaya Lakkireddy
Mar 15, 2018·Heart·Dhiraj GuptaStefano Bartoletti
Dec 1, 2020·The Journal of International Medical Research·Shu-Yue LiHang Xu
Apr 11, 2020·Journal of the American College of Cardiology·Mina K ChungUNKNOWN ACC Electrophysiology Section Leadership Council

❮ Previous
Next ❯

Related Concepts

Related Feeds

Atrial Fibrillation

Atrial fibrillation is a common arrhythmia that is associated with substantial morbidity and mortality, particularly due to stroke and thromboembolism. Here is the latest research.

Atrial Filbrillation

Atrial fibrillation refers to the abnormal heart rhythm characterized by rapid and irregular beating of the atria. Here is the latest research.

Arrhythmia

Arrhythmias are abnormalities in heart rhythms, which can be either too fast or too slow. They can result from abnormalities of the initiation of an impulse or impulse conduction or a combination of both. Here is the latest research on arrhythmias.