Low cardiovascular event rate and high atrial fibrillation recurrence rate one year after electrical cardioversion

Publisher Copyright: © 2017 The Czech Society of CardiologyBackground: Electrical cardioversion is widely used to restore sinus rhythm in patients with atrial fibrillation. However, the long term clinical event and sinus rhythm maintenance rates following electrical cardioversion still remains unclear. This study evaluated one year incidence and risk factors for cardiovascular events and atrial fibrillation recurrence in a single center clinical practice. Methods: In a prospective study 188 patients with atrial fibrillation who underwent electrical cardioversion were enrolled. Patients and their primary care physicians were followed up one year after cardioversion and patient clinical and arrhythmic event rate was evaluated. Data obtained from patients and general practitioners were combined and the results were analyzed with PSPP 0.8.5 software. Results: Electrical cardioversion success rate was 90.4%. Within a year after cardioversion one patient (0.6%) suffered myocardial infarction, three patients (1.9%) had a stroke/transitory ischemic attack (TIA), three patients (1.6%) died and three patients (1.9%) had a bleeding event that required hospitalization. The presence of diabetes mellitus was the only factor with a tendency to increase the risk of combined event of myocardial infarction, stroke/TIA and bleeding (P = 0.096). At follow up 30.0% of patients reported having atrial fibrillation and within a year 62.2% had suffered at least one atrial fibrillation paroxysm. The proportion of patients who underwent additional cardioversions after the initial hospitalization was 32.5%. The factors that significantly increased the risk of atrial fibrillation recurrence were history of stroke/TIA (P = 0.014) and increased left atrial volume index on echocardiography (P = 0.039). Greater left atrial diameter had a tendency toward an increased risk (P = 0.087). Conclusions: Cardiovascular event rate one year after electrical cardioversion was low. Electrical cardioversion had a high immediate success rate, however, maintenance of stable sinus rhythm in the long term was low.publishersversionPeer reviewe

Problems of Cardioembolic Stroke Primary and Secondary Prevention in the Latvian Population

Publisher Copyright: © 2015 by Kristaps Jurjns.Atrial fibrillation is one of major risk factors of cerebral infarction. The use of oral anticoagulants is the only evidence-based method of reducing the risk of cardioembolic accidents. The guidelines of oral anticoagulant admission and usage have been available since 2012. The results of this study show that of 550 stroke patients that were admitted to Pauls Stradiņš Clinical University Hospital, Riga, Latvia, from 1 January 2014 until 1 July 2014, atrial fibrillation was diagnosed in 247 (45%) cases, and of these patients, only 8.5% used oral anticoagulants before the onset of stroke. Six months after discharge of 111 (44.9%) stroke survivors, five (4.5%) used no secondary prevention medication, 27 (24.3%) used antiplatelet agents, 54 (48.6%) warfarin, and 25 (22.5%) used target specific oral anticoagulants (TSOACs). The mortality rate was significantly higher in the patient group that used no secondary prevention medication or antiplatelet agents compared to the patient group that used oral anticoagulants. The use of oral anticoagulants for primary stroke prevention in Latvia is insufficient. The mortality of cardioembolic stroke in 180 days is very high-40.4%. Secondary prevention is essential to prevent recurrent cardioembolic accidents.publishersversionPeer reviewe

CARDIOEMBOLIC STROKE IN LATVIA : PREVENTION AND LONG-TERM OUTCOME

NTRODUCTION:Untreated non-valvular atrial fibrillation is one of major causes of stroke. The goalof the study was to evaluate the use of antithrombotic medication stroke prevention and assess long-term stroke outcome.METHODS:This study involved 531 cardio embolicstroke patients of thePaul’sStradins Clinical University Hospital, Riga, Latvia,in 2014. After dischargethe patients or their relatives were interviewed by phone after 30, 90, 180, and 365 days. Standardized questions were asked about the patients’abilities and use of prescribed secondary prevention medication. Theresults were compared between patient groups, assigned according to prescribed medications. RESULTS:Of all the patients included in the study,8.9% were using oral anticoagulants before stroke onset. One year after discharge,1.44% of patients were not using any preventivemedication, 23.56%were using antiplatelet agents, 43.27% warfarin,and 31.73% target-specificoralanticoagulants. The one-year mortality ratewas 40.7%. The mortality rate was significantly higher in the patient group using no secondary preventivemedication or antiplatelet agents compared to the patient group that used oral anticoagulants. CONCLUSION:Cardio embolicstroke primary and secondary prevention in Latvia islacking. The study outcomes suggest that action is neededto increase the use of oral anticoagulants in primary stroke prevention in patients with atrial fibrillation. Poor function outcomes, dementia,and patients’incompliance limits the use of oral anticoagulants in secondary preventionpublishersversionPeer reviewe

Potential drug-drug interactions between oral anticoagulants for high-risk patients with atrial fibrillation in Latvia

Publisher Copyright: © 2019 Elsevier Science B.V.. All rights reserved.Introduction: Atrial fibrillation (AFib) is a disease that affects many people, especially elderly ones. All of these persons have an increased risk of thromboembolic event. For lowering the risk these patients use anticoagulation therapy. There are two types of oral anticoagulants – vitamin K antagonist warfarin and new, known also as direct oral anticoagulants, dabigatran and rivaroxaban. Due to several comorbidities and other complications, e.g. the risk of bleeding and thromboembolism, AFib patients are using different medication simultaneously, therefore increasing the risk of drug-drug interactions because of one metabolism path through P-glycoprotein and CYP450. Monitoring of medical therapy and patient education about most frequent drug-drug interactions using oral anticoagulants could raise attention of health care professionals to the possible drug-drug interactions and promote safe and effective anticoagulation therapy. Aim: To define and analyze the most common potential drug-drug interactions for most frequent used oral anticoagulants – warfarin, dabigatran, rivaroxaban – in patients with high-risk AFib in Latvia. Materials and methods: Quantitative analytic cross-section research was made in time period from October 2016 till June 2017 in Pauls Stradins clinical university hospital, Center of Cardiology in Latvia. The data about patients with high-risk AFib who used oral anticoagulants daily were selected. After signed patients consent form the demographic data, regularly and frequently used medication and food supplements were obtained. Laboratory analysis and echocardiography data were specified with the help of case anamnesis. For statistical data analysis were used SPSS Statistics database. Results: Altogether 143 patients were enrolled in this study, from which 46.2% were male, 53.8% female, with the mean age 69.7 (SD 9.9) years. 53.8% used warfarin, 16.1% dabigatran and 33.6% used rivaroxaban. 49.7% of patients had increased risk of possible drug-drug interactions. For warfarin users the most frequent potential interactions were with omega-3 supplements (20.8%), amiodarone (16.7%) and proton pump inhibitors (13.8%). For dabigatran users the most frequent potential interaction was with proton pump inhibitors (26.1%), amiodarone (17.4%) and omega-3 supplements (13.0%). For rivaroxaban users the most frequent potential drug interaction was with amiodarone (29.2%), omega-3 supplements (16.7%) and non-steroidal anti-inflammatory drugs (4.2%). Conclusion: From all high-risk AFib patients 47.7% had potentially moderate or major risk of drug interactions, most frequently with food supplements. 50.3% patients used warfarin, K vitamin antagonist. The most frequent potential drug interaction in warfarin group was with omega-3 supplements (20.8%) and amiodarone (16.7%), in dabigatran group with proton pump inhibitors (26.1%) and amiodarone (17.4%), in rivaroxaban group with amiodarone (29.2%) and omega-3 supplements (16.7%). Awareness of these interactions between health care professionals could promote the safety and effectiveness of anticoagulation therapy for high-risk atrial fibrillation patients.publishersversionPeer reviewe