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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAtrial fibrillation (AF) is a worldwide public health problem, with a prevalence of 10% to 15% after 80 years of age. The morbidity and mortality secondary to AF is high. With regard to the outcomes of stroke, the attributable risk of AF increases sharply from 1.5% to 23.5% for ages 50 to 59 years and 80 to 89 years, respectively. AF-related stroke is particularly concerning as it carries a high mortality, with 1 in 4 patients dying within 30 days. This article discusses stroke prevention in elderly patients with AF, including data on the advances in pharmacological therapeutic and agent selection that are used to balance thromboembolic risk with bleeding risk in patients with AF.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECerebrovascular Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECerebrovascular Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAtrial fibrillation (AF) is a worldwide public health problem, with a prevalence of 10% to 15% after 80 years of age. The morbidity and mortality secondary to AF is high. With regard to the outcomes of stroke, the attributable risk of AF increases sharply from 1.5% to 23.5% for ages 50 to 59 years and 80 to 89 years, respectively. AF-related stroke is particularly concerning as it carries a high mortality, with 1 in 4 patients dying within 30 days. Much of AF may be caused by the underlying processes contributing to aging of the vasculature, including a decreased ability to manage the oxidative stress caused by pro-inflammatory insults. Many of the risk factors that predict stroke in these patients also predict bleeding when antiplatelet agents or anticoagulants (AC) are used.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EIn her State of the Art lecture on preventing stroke in elderly patients with AF, Elaine M. Hylek, MD, Boston University Medical Center, Boston, Massachusetts, USA, discussed data on the advances in pharmacological therapeutic and agent selection that are used to balance thromboembolic risk with bleeding risk in patients with AF. Beyond appropriate drug selection, treatment barriers, such as gender bias, adherence factors (eg, perception of bleeding risk) and polypharmacy, were reviewed. Other strategies to reduce stroke, such LAA occlusion, were also discussed. Finally, she highlighted the need for the prevention of AF by treatment of its underlying causes, including obesity.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EUndertreatment of thromboembolic risk in patients with AF has been demonstrated. In an analysis of primary care practices in the UK [Freedman SB et al. \u003Cem\u003EEur Heart J.\u003C\/em\u003E 2014 (abstr 4183)], 30% of all patients with AF were being treated with only an antiplatelet (AP) drug, despite a mean CHA\u003Csub\u003E2\u003C\/sub\u003EDS\u003Csub\u003E2\u003C\/sub\u003E-VASc score of 2.9. The data also illustrated a persistent gender bias, as seen across the spectrum of cardiovascular disease (CVD), with 43% of women receiving only an AP drug. The international GARFIELD and GLORIA-AF registries have shown that utilization of AC therapy does not increase with higher CHADS\u003Csub\u003E2\u003C\/sub\u003E scores, demonstrating that those with the highest stroke risk are inadequately treated [Kakkar AJ et al. \u003Cem\u003EPLoS One.\u003C\/em\u003E 2013 and Huisman MV et al. \u003Cem\u003EEur Heart J.\u003C\/em\u003E 2014 (abstr P4394)]. Dr Hylek stated these data reinforce the need for better education of physicians and patients and the need to identify healthcare system barriers to adequate anticoagulation in certain countries.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAspirin should not have a significant role in the prevention of AF-related stroke, stated Dr Hylek. The BAFTA study [Mant J et al. \u003Cem\u003ELancet.\u003C\/em\u003E 2007] showed in patients aged \u0026gt; 75 years that warfarin reduced the risk of fatal or nonfatal disabling stroke or significant arterial embolism by 47% as compared with aspirin (HR, 0.48; 95% CI, 0.28 to 0.80). The reduced efficacy of aspirin was not accompanied by a more benign bleeding profile (as commonly believed); the bleeding risk was similar between warfarin and aspirin for major extracranial hemorrhages (HR, 0.87; 95% CI, 0.43 to 1.73) and all major hemorrhages (HR, 0.96; 95% CI, 0.53 to 1.75). Supporting data from a meta-analysis showed a 64% versus 22% risk reduction in stroke with adjusted-dose warfarin as compared to AP [Hart RG et al. \u003Cem\u003EAnn Intern Med.\u003C\/em\u003E 2007]. The AVERROES trial demonstrated that the rates of major bleeding are similar between apixiban and aspirin (RR, 1.18; 95% CI, 0.77 to 1.80; \u003Cem\u003EP\u003C\/em\u003E = .76) [Connolly SJ, et al. \u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2011], again suggesting no significant safety benefit of aspirin over AC, especially in an older population.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ENovel oral anticoagulants (NOACs) provided a greater reduction in the combined end point of ischemic and hemorrhagic stroke as compared with warfarin, according to a meta-analysis of 4 phase 3 trials (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Ruff CT et al. \u003Cem\u003ELancet.\u003C\/em\u003E 2014]. Importantly, NOACs reduce the risk of intracerebral hemorrhage (ICH) by 60% compared to vitamin K antagonists [Debette S, Markus HS. \u003Cem\u003EBMJ.\u003C\/em\u003E 2010], possibly due to a lack of Factor VII suppression. ICH is a rare (approximately 1 in 250 patients), but it is a devastating complication of AC therapy, often stemming from the increase in white matter disease with age, hypertension, diabetes, and amyloidosis.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/27\/7\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Efficacy of NOACS Versus Warfarin in Clinical Trials\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-705244147\u0022 data-figure-caption=\u0022Efficacy of NOACS Versus Warfarin in Clinical Trials\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/27\/7\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/27\/7\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/27\/7\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15000\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EEfficacy of NOACS Versus Warfarin in Clinical Trials\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EOn December 11, 2014, this figure was changed to the correct figure. Data are n\/N, unless otherwise indicated. Heterogeneity: \u003Cem\u003EI\u003C\/em\u003E\n            \u003Csup\u003E2\u003C\/sup\u003E = 47%; \u003Cem\u003EP\u003C\/em\u003E = .13. NOAC, novel oral anticoagulant. *Dabigatran 150 mg twice daily. \u2020 Rivaroxaban 20 mg once daily. \u2021 Apixaban 5 mg twice daily. \u222b Edoxaban 60 mg once daily.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReprinted from Ruff CT et al, Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. \u003Cem\u003EThe Lancet.\u003C\/em\u003E 2014;383:955\u2013962. Copyright \u00a9 2014, with permission from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EAlthough the overall risk of major bleeding was reduced by 14% with NOACS as compared warfarin for the combined trials in this meta-analysis, gastrointestinal (GI) bleeding remains a prominent concern, especially for an elderly population. The incidence of upper and lower GI bleeding increases with age, with 70% of acute upper GI bleeding occurring in persons aged \u0026gt; 60 years. The reasons for this high risk of GI bleeding in older patients includes concomitant aspirin use; changes in GI physiology, such as luminal effects, mucosal protection, and reparative capacity [Newton JL. \u003Cem\u003EClin Interv Aging.\u003C\/em\u003E 2006]; and a prevalence of \u003Cem\u003EHelicobacter pylori\u003C\/em\u003E in up to 80% of patients aged \u0026gt; 80 years in some countries. Dr Hylek stated that these factors help to explain some of the difficulty in maintaining older patients on an AC. The added risk of GI bleeding with concomitant AP, warfarin, and nonsteroidal anti-inflammatory drugs (NSAIDs) is shown in \u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E [Delaney JA et al. \u003Cem\u003ECMAJ\u003C\/em\u003E. 2007]. The addition of AP or NSAIDs to a treatment regimen that included a NOAC would also likely increase the risk of GI bleeding, noted Dr Hylek.\u003C\/p\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/27\/7\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Risk of GI Bleeding With Antithrombotics or NSAIDs\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-705244147\u0022 data-figure-caption=\u0022Risk of GI Bleeding With Antithrombotics or NSAIDs\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/27\/7\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/27\/7\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/27\/7\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15001\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003ERisk of GI Bleeding With Antithrombotics or NSAIDs\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EASA, aspirin; NSAID, nonsteroidal anti-inflammatory drug.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-4\u0022\u003EReproduced from Delaney JA et al. Drug\u2014drug interactions between antithrombotic medications and the risk of gastrointestinal bleeding. \u003Cem\u003ECMAJ\u003C\/em\u003E. 2007;177:347\u201351. With permission from Canadian Medical Association.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EFollowing a GI bleed, re-challenging patients with AC therapy is often difficult. The need to resume treatment is supported by a study demonstrating that, in patients with a prior GI bleed, the resumption of warfarin led to a reduction in thrombotic events (HR, 0.05; 95% CI; 0.01 to 0.58) and death (HR, 0.31; 95% CI, 0.15 to 0.62), and was not accompanied by a significant increase in recurrent GI bleeding (HR, 1.32; 95% CI, 0.50 to 3.57) [Witt DM et al. \u003Cem\u003EArch Intern Med\u003C\/em\u003E. 2012].\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EAn adherence to AC may be compromised by polypharmacy, with the number of drugs being the strongest predictor of nonadherence. About 75% of patient nonadherence is intentional to decrease the burden of taking pills, reduce adverse effects, or decrease costs [Wu JY et al. \u003Cem\u003EBMJ\u003C\/em\u003E. 2006]. One study showed that persistence in taking a vitamin K antagonist was only about 30% at 360 days [Simonyi G, Molnar MP. \u003Cem\u003EESC\u003C\/em\u003E 2014; (abstr 4184)].\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EIntervention-based strategies that are being developed to prevent stroke in AF include catheter-based, left atrial appendage closure [Tzikas A, et al. \u003Cem\u003EESC\u003C\/em\u003E 2014; (abstr 4185)] as well as possible pharmaceutical strategies, which include different targets for thrombus that result in reduced bleeding. A recent study showed that paroxysmal AF is associated with a lower level of risk for stroke versus persistent or permanent AF [Vanassche T, et al. \u003Cem\u003EESC\u003C\/em\u003E 2014; (abstr 4182)], and this may provide some clues for new approaches, stated Dr Hylek.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EThe prevention of AF may be the most important goal if the burden of AF is to be reduced. A recent study demonstrated a linear increase between the CHA\u003Csub\u003E2\u003C\/sub\u003EDS\u003Csub\u003E2\u003C\/sub\u003E-VASc score and the risk of new AF, underscoring the effect of the aging vasculature on AF risk [Fauchier L et al. \u003Cem\u003EEur Heart J.\u003C\/em\u003E 2014 (abstr P4229)]. It is possible to reduce the burden and severity of AF by addressing obesity and other cardiometabolic risk factors [Abed HS et al. \u003Cem\u003EJAMA.\u003C\/em\u003E 2013]. It is likely that much of the improvement is mediated by a reduction in inflammation; one study showed that a decrease in body mass index was associated with significant reductions in C-reactive protein and AF burden and symptoms. Scientific work is exploring the link between inflammation and thrombosis. It has been shown that, in the presence of inflammation, there is an upregulation in genes that stimulate the coagulation cascade. Additionally, investigators have shown that neutrophils activation results in a release of myeloperoxidase, which in turn leads to endothelial damage, increased fibrosis, and the development of tissue that is conducive to AF. MR imaging has demonstrated that left atrial fibrosis is associated with an increased risk of stroke in patients with AF and with recurrent AF after ablation [Daccarett M et al. \u003Cem\u003EJ Am Coll Cardiol.\u003C\/em\u003E 2011]. The different stages of fibrosis may provide an opportunity to disrupt these pathways, alter the substrate, and prevent or reverse fibrosis.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EIn addressing obesity and other cardiometabolic risk factors, it is possible to reduce the burden and severity of AF [Abed HS et al. \u003Cem\u003EJAMA.\u003C\/em\u003E 2013] by reducing inflammation caused by the presence of these risk factors, stated Dr Hylek. Although these findings await further validation, Dr Hylek stated that weight reduction strategies should be part of the initial education that is provided by cardiovascular intervention laboratories.\u003C\/p\u003E\u003Cdiv id=\u0022F3\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/27\/7\/F3.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022The editors would like to thank the many members of the 2014 European Society of Cardiology presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-705244147\u0022 data-figure-caption=\u0022The editors would like to thank the many members of the 2014 European Society of Cardiology presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure3\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/27\/7\/F3.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/27\/7\/F3.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure3\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/27\/7\/F3.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15002\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\n            \u003Cp id=\u0022p-15\u0022 class=\u0022first-child\u0022\u003EThe editors would like to thank the many members of the 2014 European Society of Cardiology presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/27\/7.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzotwd\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzotwd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}