Naproxen as prophylaxis against atrial fibrillation on postoperative of coronary artery bypass graft surgery u NAFARM study

Introdução: a fibrilacao atrial (FA) e uma complicacao comum no pos-operatorio de cirurgia cardiaca e e responsavel por aumento nos custos hospitalares e na mortalidade intra-hospitalar. Varios estudos clinicos propoem a inflamacao como um dos fatores envolvidos na sua genese. Um estudo observacional recente sugeriu que o uso de anti-inflamatorios nao esteroides poderia oferecer protecao contra a FA. Objetivo: avaliar o efeito de naproxeno versus placebo na prevencao de FA no pos-operatorio de cirurgia de revascularizacao miocardica (CRM). Metodos: delineado um ensaio clinico, randomizado, duplo-cego, placebo controlado, de centro unico, com 161 pacientes consecutivos submetidos a CRM. Estes receberam naproxeno 275mg, a cada 12 horas, ou placebo na mesma dosagem, durante 120 horas imediatamente apos a realizacao da cirurgia. O desfecho primario foi a ocorrencia de FA nos cinco primeiros dias de pos-operatorio. Resultados: a incidencia de FA pos-operatoria foi de 15.2% (12/79) no grupo placebo versus 7.3% (6/82) no grupo naproxeno (P = .11). A duracao dos episodios de FA foi significativamente menor no grupo naproxeno (0.35 horas) quando comparada com a do grupo placebo (3.74 horas; P = .04). Nao houve diferenca no numero de dias de hospitalizacao entre os grupos placebo (17.23  7.39) e naproxeno (18.33 9.59; P = .44). O tempo de internacao na unidade de terapia intensiva foi de 4.0  4.57 dias no grupo placebo e 3.23  1.25 dias no grupo naproxeno (P = .16). O estudo foi interrompido, pelo comite de monitoramento de dados, antes de atingir o numero inicial planejado de 200 pacientes devido a um aumento nos casos de insufiCiência renal no grupo naproxeno (7.3% versus 1.3%; P = .06). Conclusoes: o uso do Naproxeno no pos-operatorio nao reduziu significantemente a incidencia de FA, mas reduziu sua duracao em uma amostra limitada de pacientes submetidos a CRM. Houve um aumento significativo nos casos de insufiCiência renal nos pacientes que receberam naproxeno 275mg a cada 12 horas.O presente estudo nao suporta o uso rotineiro de naproxeno, apos CRM, para prevencao de FA. Registro do ensaio clinico: Controlled-trials.com ISRCTN 10318446; http://www.isrctn.orgBV UNIFESP: Teses e dissertaçõe

Sleep-disordered breathing and chronic atrial fibrillation

Background: Little has been known about the prevalence of sleep apnea in patients with atrial fibrillation (AF). Studies have suggested that the prevalence of AF is increasing in patients with sleep-disordered breathing. We hypothesize that the prevalence of OSA is higher in chronic persistent and permanent AF patients than a sub-sample of the general population without this arrhythmic disorder.Objective: Evaluate the frequency of Obstructive Sleep Apnea in a sample of chronic AF compared to a sub-sample of the general population.Methods: Fifty-two chronic AF patients aged (60.5 +/- 9.5, 33 males) and 32 control (aged 57.3 +/- 9.6, 15 males). All subjects were evaluated by a staff cardiologist for the presence of medical conditions and were referred for polysomnography. the differences between groups were analyzed by ANOVA for continuous variables, and by the Chi-square test for dichotomous variables. Statistical significance was established by alpha = 0.05.Results: There were no differences in age, gender, BMI, sedentarism, presence of hypertension, type 2 diabetes mellitus, abdominal circumference, systolic and diastolic blood pressure, and sleepiness scoring between groups. Despite similar BMI, AF patients had a higher neck circumference compared to control group (39.9 cm versus 37.7 cm, p = 0.01) and the AF group showed higher percentage time of stage 1 NREM sleep (6.4% versus 3.9%. p = 0.03).Considering a cut-off value for AHI >= 10 per hour of sleep, the AF group had a higher frequency of OSA compared to the control group (81.6%, versus 60%, p = 0.03). All the oxygen saturation parameters were significantly worse ill the AF group, which had lower SaO(2) nadir (81.9% versus 85.3%, p = 0.0 1) and mean SaO(2) (93.4% versus 94.3%, p = 0.02), and a longer period of time below 90% (26.4 min versus 6.7 min, p = 0.05).Conclusion: Sleep-disordered breathing is more frequent in chronic persistent and permanent AF patients than in age-matched community dwelling subjects. (c) 2007 Elsevier B.V. All rights reserved.AFIPFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Psychobiol, Sleep Inst, São Paulo, BrazilUniversidade Federal de São Paulo, Cardiol Sect, São Paulo, BrazilStanford Univ, Dept Psychiat, Sleep Disorders Ctr, Stanford, CA 94305 USAUniversidade Federal de São Paulo, Dept Psychobiol, Sleep Inst, São Paulo, BrazilUniversidade Federal de São Paulo, Cardiol Sect, São Paulo, BrazilWeb of Scienc

Naproxen as Prophylaxis against Atrial Fibrillation after Cardiac Surgery: the NAFARM Randomized Trial

PURPOSE: We sought to assess the effect of naproxen versus placebo on prevention of atrial fibrillation after coronary artery bypass graft (CABG) surgery.METHODS: in this randomized, double-blind, placebo-controlled, single-center trial of 161 consecutive patients undergoing CABG surgery, patients received naproxen 275 mg every 12 hours or placebo at the same dosage and interval over 120 hours immediately after CABG surgery. the primary outcome was the occurrence of atrial fibrillation in the first 5 postoperative days.RESULTS: the incidence of postoperative atrial fibrillation was 15.2% (12/79) in the placebo versus 7.3% (6/82) in the naproxen group (P = .11). the duration of atrial fibrillation episodes was significantly lower in the naproxen (0.35 hours) versus placebo group (3.74 hours; P = .04). There was no difference in the overall days of hospitalization between placebo (17.23 +/- 7.39) and naproxen (18.33 +/- 9.59) groups (P = .44). Intensive care unit length of stay was 4.0 +/- 4.57 days in the placebo and 3.23 +/- 1.25 days in the naproxen group (P = .16). the trial was stopped by the data monitoring committee before reaching the initial target number of 200 patients because of an increase in renal failure in the naproxen group (7.3% vs 1.3%; P = .06).CONCLUSIONS: Postoperative use of naproxen did not reduce the incidence of atrial fibrillation but decreased its duration, in a limited sample of patients after CABG surgery. There was a significant increase in acute renal failure in patients receiving naproxen 275 mg twice daily. Our study does not support the routine use of naproxen after CABG surgery for the prevention of atrial fibrillation. (C) 2011 Elsevier Inc. All rights reserved. . the American Journal of Medicine (2011) 124, 1036-1042Duke Univ, Duke Clin Res Inst, Med Ctr, Durham, NC 27705 USAUniversidade Federal de São Paulo, Div Invas Clin Electrophysiol, Dept Cardiol, São Paulo, BrazilPontificia Univ Catolica Rio Grande do Sul, Div Cardiol, Porto Alegre, RS, BrazilBrazilian Clin Res Inst, São Paulo, BrazilUniversidade Federal de São Paulo, Div Invas Clin Electrophysiol, Dept Cardiol, São Paulo, BrazilWeb of Scienc

Correction to: Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice: GLORIA-AF Registry

International audienceIn this article, the name of the GLORIA-AF investigator Anastasios Kollias was given incorrectly as Athanasios Kollias in the Acknowledgements. The original article has been corrected

Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry

Background: Previous studies suggested potential ethnic differences in the management and outcomes of atrial fibrillation (AF). We aim to analyse oral anticoagulant (OAC) prescription, discontinuation, and risk of adverse outcomes in Asian patients with AF, using data from a global prospective cohort study. Methods: From the GLORIA-AF Registry Phase II-III (November 2011-December 2014 for Phase II, and January 2014-December 2016 for Phase III), we analysed patients according to their self-reported ethnicity (Asian vs. non-Asian), as well as according to Asian subgroups (Chinese, Japanese, Korean and other Asian). Logistic regression was used to analyse OAC prescription, while the risk of OAC discontinuation and adverse outcomes were analysed through Cox-regression model. Our primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). The original studies were registered with ClinicalTrials.gov, NCT01468701, NCT01671007, and NCT01937377. Findings: 34,421 patients were included (70.0 ± 10.5 years, 45.1% females, 6900 (20.0%) Asian: 3829 (55.5%) Chinese, 814 (11.8%) Japanese, 1964 (28.5%) Korean and 293 (4.2%) other Asian). Most of the Asian patients were recruited in Asia (n = 6701, 97.1%), while non-Asian patients were mainly recruited in Europe (n = 15,449, 56.1%) and North America (n = 8378, 30.4%). Compared to non-Asian individuals, prescription of OAC and non-vitamin K antagonist oral anticoagulant (NOAC) was lower in Asian patients (Odds Ratio [OR] and 95% Confidence Intervals (CI): 0.23 [0.22-0.25] and 0.66 [0.61-0.71], respectively), but higher in the Japanese subgroup. Asian ethnicity was also associated with higher risk of OAC discontinuation (Hazard Ratio [HR] and [95% CI]: 1.79 [1.67-1.92]), and lower risk of the primary composite outcome (HR [95% CI]: 0.86 [0.76-0.96]). Among the exploratory secondary outcomes, Asian ethnicity was associated with higher risks of thromboembolism and intracranial haemorrhage, and lower risk of major bleeding. Interpretation: Our results showed that Asian patients with AF showed suboptimal thromboembolic risk management and a specific risk profile of adverse outcomes; these differences may also reflect differences in country-specific factors. Ensuring integrated and appropriate treatment of these patients is crucial to improve their prognosis. Funding: The GLORIA-AF Registry was funded by Boehringer Ingelheim GmbH