Abstract:
:The best strategy in atrial fibrillation (AF) after > 12 months after an acute coronary syndrome or in patients with chronic coronary syndrome without an indication for interventional revascularization remains unclear. European guidelines generally recommend therapy with oral anticoagulation (OAC) alone, whereas North American guidelines advise combination therapy consisting of OAC plus antiplatelet therapy in some patients. We performed a meta-analysis of available trials comparing these treatment strategies. The primary endpoint was major adverse cardiac events (MACE), secondary endpoints included major bleeding, ischemic and hemorrhagic stroke, myocardial infarction (MI), all-cause mortality, and cardiovascular mortality. Study level data were analyzed. Heterogeneity was assessed using the I2 statistic. risk rates (RR) were calculated using a random-effects model (DerSimonian and Laird). Two randomized trials evaluating 1905 patients were included in this meta-analysis. Rates of MACE (RR 0.91 95% CI 0.58-1.41; p = 0.66; I2 75%), MI (RR 1.75 95% CI 0.87-3.55; p = 0.12; I2 0%) and ischemic stroke (RR 0.83 95% CI 0.53-1.31; p = 0.42; I2 0%) did not differ between the OAC monotherapy and the OAC combination therapy. With regards to safety, rates of major bleeding (RR 0.66 95% CI 0.49-0.91; p = 0.01; I2 0%), and of hemorrhagic stroke (RR 0.43 95% CI 0.19-1.00; p = 0.05; I2 0%) were lower in patients on OAC monotherapy. Based on available evidence summarized in this meta-analysis, we think that primum non nocere still stands true: unless future randomized evidence suggests otherwise, most AF patients should be on OAC monotherapy.
journal_name
J Thromb Thrombolysisjournal_title
Journal of thrombosis and thrombolysisauthors
Wernly B,Bhatt DL,Polzin A,Jung Cdoi
10.1007/s11239-019-02007-4subject
Has Abstractpub_date
2020-02-01 00:00:00pages
321-324issue
2eissn
0929-5305issn
1573-742Xpii
10.1007/s11239-019-02007-4journal_volume
49pub_type
杂志文章,meta分析abstract::D-Dimer is a biomarker of fibrin formation and degradation. While a D-dimer within normal limits is used to rule out the diagnosis of deep venous thrombosis and pulmonary embolism among patients with a low clinical probability of venous thromboembolism (VTE), the prognostic association of an elevated D-dimer with adve...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章,评审
doi:10.1007/s11239-014-1101-6
更新日期:2015-01-01 00:00:00
abstract::Direct oral anticoagulants are associated with rates of major bleeding which are not negligible, albeit lower than those associated with vitamin K antagonists. No specific reversal agent for factor Xa (FXa) direct inhibitors is currently available for clinical use. A modified activated human FXa decoy protein, andexan...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章,评审
doi:10.1007/s11239-018-1617-2
更新日期:2018-04-01 00:00:00
abstract::Although clinical evidence supports a plausible association between thyroid disorders and venous thrombosis, reliable evidence is so far lacking on the potential biological mechanisms and neither temporary nor permanent thromboembolic risk factors were constantly identified. We performed a 2-years retrospective analys...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-008-0269-z
更新日期:2009-10-01 00:00:00
abstract::The current, global situation regarding the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic and its potentially devastating clinical manifestations, i.e. coronavirus disease 2019 (COVID-19), took the world by storm, as millions of people have been infected worldwide and more than 1,600,000 patien...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章,评审
doi:10.1007/s11239-020-02374-3
更新日期:2021-01-15 00:00:00
abstract::Patients with established coronary heart disease (CHD) have a high risk of subsequent cardiovascular events, including myocardial infarction (MI), stroke, and death from cardiovascular disease. Adherence to evidence-based secondary prevention therapies for CHD has improved in recent years but still remains suboptimal....
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章,评审
doi:10.1007/s11239-009-0381-8
更新日期:2010-01-01 00:00:00
abstract::Increased level of soluble cell adhesion molecules may be a marker for atherosclerosis and/or reflect complication of the atherosclerotic plaque. To test whether expression of cell adhesion molecules is more pronounced in unstable versus stable coronary plaques, we measured the serum level of soluble E-selectin (sE-se...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1023/a:1018656530541
更新日期:2000-01-01 00:00:00
abstract::The objective was to compare the pharmacodynamic (PD) and pharmacokinetic (PK) effects of ticagrelor with clopidogrel among subjects of Hispanic ethnicity, as the PD and PK effects of antiplatelet agents among Hispanics are not specifically known. This was a randomised, open-label, crossover PD/PK study of 40 Hispanic...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1007/s11239-014-1135-9
更新日期:2015-01-01 00:00:00
abstract:INTRODUCTION:While the CURE trial demonstrated the benefits of clopidogrel in acute coronary syndromes, patients receiving glycoprotein IIb/IIIa antagonists were excluded. Given the frequent coadministration of these two medications, we sought to examine their interaction and their combined effect on platelet inhibitio...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-004-0170-3
更新日期:2004-08-01 00:00:00
abstract::Patients with COVID-19 are known to be at risk of developing both venous, arterial and microvascular thrombosis, due to an excessive immuno-thrombogenic response to the SARS-CoV-2 infection. Overlapping syndromes of COVID-19 associated coagulopathy with consumptive coagulopathy and microangiopathy can be seen in criti...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-020-02318-x
更新日期:2020-10-24 00:00:00
abstract:AIMS:Cancer patients have an increased risk for thromboembolism (TE). Factor V 1691 G-A(Leiden) (FVL) and prothrombin (PT) G20210A mutation are common inherited risk factor for TE. The aim of the study is to evaluate the prevalence of FVL and PT G20210A polymorphism in cancer patients with and without TE as compared to...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-006-9001-z
更新日期:2007-02-01 00:00:00
abstract::Drug-eluting stents (DES) reduce the incidence of in-stent restenosis (ISR) after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Whether the use of biomarkers might be of utility to identify patients who remain at risk for DES ISR after primary PCI has never been exami...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1007/s11239-012-0706-x
更新日期:2012-08-01 00:00:00
abstract:BACKGROUND:Antithrombin (AT) drop during cardiac surgery has been described. The causes and the effects of this phenomenon are not clear. The objective of the study is to evaluate the relationship of AT postoperative values on short and mid-term outcome after cardiac surgery. METHODS:Between January and June 2005, 405...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-007-0191-9
更新日期:2009-01-01 00:00:00
abstract::Factor Xa (FXa) inhibitors are recommended for use in fixed doses without laboratory monitoring. However, prior studies reported the importance of establishing biomarkers representing anticoagulation intensity related to bleeding or thrombotic events. To test the hypothesis that prothrombin activation fragment 1 and 2...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-020-02079-7
更新日期:2020-08-01 00:00:00
abstract::Associations of Raynaud's phenomenon (RP) with venous thromboembolism (VTE) are unclear. We investigated the occurrence of RP together with prothrombotic state markers and fibrin clot properties in VTE patients. In this prospective cohort study we enrolled 360 patients free of known autoimmune disease. D-dimer, von Wi...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-019-01805-0
更新日期:2019-02-01 00:00:00
abstract::Inherited afibrinogenemia and hypofibrinogenemia are rare bleeding disorders characterized by markedly reduced levels of fibrinogen in blood. Thrombotic complications in these disorders have been rarely described. We performed a multicenter retrospective study and reviewed the occurrence of thrombotic complications am...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章,多中心研究
doi:10.1007/s11239-015-1325-0
更新日期:2016-08-01 00:00:00
abstract::Thrombotic thrombocytopenic purpura (TTP) is a life-threatening thrombotic microangiopathy caused by severely reduced activity of the von-Willebrand factor-cleaving protease ADAMTS13, mainly caused by anti-ADAMTS-13 antibodies. Although several test systems for ADAMTS13 measurement exist, long turn-around times hamper...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-020-02086-8
更新日期:2020-10-01 00:00:00
abstract::Background: Renal vein thrombosis (RVT) complicating the nephrotic syndrome is associated with a poor prognosis. Methods/Results: RVT was diagnosed in 12 of 60 patients with a diagnosis of nephrotic syndrome suggested by computed tomography (CT) and subsequently confirmed by selective renal angiography. Fifty patients...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/BF00226414
更新日期:1996-01-01 00:00:00
abstract::Hyperhomocysteinemia (HHcy) affects haemostasis and shifts its balance in favour of thrombosis. In vitro and in vivo studies suggested that HHcy may impair fibrinolysis either by influencing the plasma levels of fibrinolytic factors or by altering the fibrinogen structure. We investigated the influence of mild HHcy le...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 临床试验,杂志文章
doi:10.1007/s11239-013-0981-1
更新日期:2014-07-01 00:00:00
abstract::Infarct artery stenting with adjunctive abciximab therapy is widely used treatment for patients with acute myocardial infarction (AMI). However, bleeding complications have been associated with a worse clinical outcome. Randomized trials in elective patients have shown that postprocedural protamine administration is s...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-010-0481-5
更新日期:2010-11-01 00:00:00
abstract::Warfarin is the most widely prescribed oral anticoagulant, but large interindividual variations exist in the dose required to achieve comparable therapeutic effects. Several clinical and genetic variables have been identified that influence warfarin dosing. However, interactions between genotype and nutrition remain u...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 临床试验,杂志文章
doi:10.1007/s11239-013-0978-9
更新日期:2014-07-01 00:00:00
abstract:OBJECTIVE:The -5T/C polymorphism in the Kozak sequence of glycoprotein Ibalpha, a component of the platelet glycoprotein Ib-IX-V receptor complex, is associated with an increase in this receptor density on the surface of the platelet. This study was designed to investigate the effect of platelet glycoprotein Ibalpha Ko...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-008-0204-3
更新日期:2009-04-01 00:00:00
abstract:BACKGROUND:The missed diagnosis of acute myocardial infarction has been studied in the Emergency Department, but few studies have investigated how often coronary ischemia is correctly identified in the outpatient setting. METHODS:This was a single center retrospective observational study of patients with Health Allian...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-007-0153-2
更新日期:2009-01-01 00:00:00
abstract::We report a case of infective endocarditis (IE) involving the posterior mitral leaflet (PML) with calcific embolization in a patient with hypertrophic obstructive cardiomyopathy (HOCM). Amongst HOCM patients with IE, the anterior mitral leaflet and basal septal myocardium are almost always involved due to the endocard...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-014-1111-4
更新日期:2015-02-01 00:00:00
abstract::Little is known about the impact of thrombolytic agents on in-hospital outcomes in the Middle East. The objective of this study was to evaluate the impact of thrombolytic agents on in-hospital outcomes in ST-segment elevation myocardial infarction (STEMI) patients in six Middle Eastern countries. Gulf Registry of Acut...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章,多中心研究
doi:10.1007/s11239-012-0698-6
更新日期:2012-04-01 00:00:00
abstract::Objective: To define the changing incidence, risk, and therapy of acute myocardial infarction (A311). Data sources: Review of contemporary AMI data from the University of Alberta Hospitals, six other sites of the Clinical Quality Improvement Network (CQIN), and other Canadian and international centers. Data synthesis:...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/BF00132402
更新日期:1996-01-01 00:00:00
abstract::Asymmetric dimethylarginine (ADMA) typically accumulates in the plasma of patients with chronic renal failure. Moreover, its plasma levels are raised in the presence of virtually all of the traditional cardiovascular risk factors. ADMA inhibits the three isoforms of nitric oxide (NO) synthase, thereby blunting the kno...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-007-0181-y
更新日期:2009-02-01 00:00:00
abstract::The predictive value of and the influencing factors associated with early neurological improvement (ENI) among patients with acute basilar artery occlusion (BAO) have not been well studied. The present study aimed to evaluate whether ENI predicted a better functional outcome and to identify the influencing factors of ...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-020-02153-0
更新日期:2021-01-01 00:00:00
abstract:BACKGROUND:Venous thromboembolism (VTE) is a significant cause of mortality and morbidity in medical patients. Although thromboprophylaxis with enoxaparin reduces the risk of VTE in these patients, the optimal duration of therapy is not currently known. The EXCLAIM (EXtended CLinical prophylaxis in Acutely Ill Medical ...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11239-006-7732-5
更新日期:2006-08-01 00:00:00
abstract::Monocytes and monocyte-derived microparticles (MMPs) play a major role in acute coronary syndrome (ASC). Activated monocytes (ac-M) and MMPs support thrombin generation via tissue factor (TF). The aim of this study was to evaluate the inhibitory effect of fondaparinux, a selective Xa inhibitor, on thrombin generation ...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-010-0490-4
更新日期:2010-11-01 00:00:00
abstract::Cardiac disease following radiation therapy represents a major consideration in the treatment of a variety of malignancies. Damage to the heart can manifest in a variety of pathologies including ischemic cardiac disease, cardiomyopathy, valvular dysfunction, arrhythmias, and pericarditis. This damage has been shown to...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章,评审
doi:10.1007/s11239-020-02303-4
更新日期:2020-10-08 00:00:00