Update on anti-coagulation in atrial fibrillation

Atrial fibrillation (AF), the most common clinically relevant arrhythmia, affects 2.2 million individuals in the USA and 4.5 million in Europe, resulting in significant morbidity and mortality. Pharmacotherapy aimed at controlling both heart rate and rhythm is employed to relieve AF symptoms, though debate continues about which approach is preferable. AF prevalence rises with age from 0.4% to 1% in the general population to 11% in those aged >70 years. AF is associated with a pro-thrombotic state and other comorbidities; age, hypertension, heart failure and diabetes mellitus all play a key role in AF pathogenesis. Anti-coagulation is essential for stroke prevention in patients with AF and is recommended for patients with one or more risk factors for stroke. Used within the recommended therapeutic range, warfarin and other vitamin K antagonists decrease the incidence of stroke and mortality in AF patients. Warfarin remains under-used, however, because of the perceived high risk of haemorrhage, narrow therapeutic window and need for regular monitoring. Several novel anti-coagulants show promise in AF-related stroke prevention. In particular, the novel, oral, direct thrombin inhibitor, dabigatran etexilate, recently licensed by the US Food and Drug Administration (FDA) and Health Canada has shown improved efficacy and safety compared with warfarin for stroke prevention in AF, and has the potential to replace warfarin in this indication. The increasing number of new therapeutic options, including improved anti-arrhythmic agents, novel anti-coagulants and more accessible ablation techniques, are likely to deliver better care for AF patients in the near future

Search for long-lived gravitational-wave transients coincident with long gamma-ray bursts

Long gamma-ray bursts (GRBs) have been linked to extreme core-collapse supernovae from massive stars. Gravitational waves (GW) offer a probe of the physics behind long GRBs. We investigate models of long-lived (~10–1000 s) GW emission associated with the accretion disk of a collapsed star or with its protoneutron star remnant. Using data from LIGO’s fifth science run, and GRB triggers from the Swift experiment, we perform a search for unmodeled long-lived GW transients. Finding no evidence of GW emission, we place 90% confidence-level upper limits on the GW fluence at Earth from long GRBs for three waveforms inspired by a model of GWs from accretion disk instabilities. These limits range from F<3:5 ergs cm⁻2 to F<1200 ergs cm⁻2, depending on the GRB and on the model, allowing us to probe optimistic scenarios of GW production out to distances as far as ≈ 33 Mpc. Advanced detectors are expected to achieve strain sensitivities 10× better than initial LIGO, potentially allowing us to probe the engines of the nearest long GRBs.J. Aasi ... D.J. Hosken ... W. Kim ... E.J. King ... J. Munch ... D. J. Ottaway ... P. J. Veitc