{"markup":"\u003C?xml version=\u00221.0\u0022 encoding=\u0022UTF-8\u0022 ?\u003E\n    \u003Chtml version=\u0022HTML+RDFa+MathML 1.1\u0022\n    xmlns:content=\u0022http:\/\/purl.org\/rss\/1.0\/modules\/content\/\u0022\n    xmlns:dc=\u0022http:\/\/purl.org\/dc\/terms\/\u0022\n    xmlns:foaf=\u0022http:\/\/xmlns.com\/foaf\/0.1\/\u0022\n    xmlns:og=\u0022http:\/\/ogp.me\/ns#\u0022\n    xmlns:rdfs=\u0022http:\/\/www.w3.org\/2000\/01\/rdf-schema#\u0022\n    xmlns:sioc=\u0022http:\/\/rdfs.org\/sioc\/ns#\u0022\n    xmlns:sioct=\u0022http:\/\/rdfs.org\/sioc\/types#\u0022\n    xmlns:skos=\u0022http:\/\/www.w3.org\/2004\/02\/skos\/core#\u0022\n    xmlns:xsd=\u0022http:\/\/www.w3.org\/2001\/XMLSchema#\u0022\n    xmlns:mml=\u0022http:\/\/www.w3.org\/1998\/Math\/MathML\u0022\u003E\n  \u003Chead\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_itu2PgFdrjV-docKmLK8Jn5oXe_05RgvQh73eOhI_mE.js\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_at_symbol.js?nznbs1\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_article_reference_popup.js?nznbs1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_I8yX6RYPZb7AtMcDUA3QKDZqVkvEn35ED11_1i7vVpc.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\n(function(i,s,o,g,r,a,m){i[\u0022GoogleAnalyticsObject\u0022]=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)})(window,document,\u0022script\u0022,\u0022\/\/www.google-analytics.com\/analytics.js\u0022,\u0022ga\u0022);ga(\u0022create\u0022, \u0022UA-15605596-27\u0022, {\u0022cookieDomain\u0022:\u0022auto\u0022});ga(\u0022set\u0022, \u0022page\u0022, location.pathname + location.search + location.hash);ga(\u0022send\u0022, \u0022pageview\u0022);ga(\u0027create\u0027, \u0027UA-189672-26\u0027, \u0027auto\u0027, {\u0027name\u0027: \u0027hwTracker\u0027});\r\nga(\u0027hwTracker.send\u0027, \u0027pageview\u0027);\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\njQuery.extend(Drupal.settings, {\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;12\\\/13\\\/32\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;12\\\/13\\\/32\u0022}],\u0022ac\u0022:{\u0022spmdc;12\\\/13\\\/32\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;12\\\/13\\\/32\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink 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\u003EPatients with atrial fibrillation (AF) have a 5-fold risk of stroke and suffer more severe strokes compared with the general population [Camm AJ et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2010]. One-year mortality in stroke patients with AF is 63% versus 34% in those without AF (p\u0026lt;0.001) [Lin H-J et al. \u003Cem\u003EStroke\u003C\/em\u003E 1996]. The risk of stroke recurrence is slightly higher in patients with AF (6.9% vs 4.7% in those without AF; p=0.0398) [Marini C et al. \u003Cem\u003EStroke\u003C\/em\u003E 2005].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECerebrovascular Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EPatients with atrial fibrillation (AF) have a 5-fold risk of stroke and suffer more severe strokes compared with the general population [Camm AJ et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2010]. One-year mortality in stroke patients with AF is 63% versus 34% in those without AF (p\u0026lt;0.001) [Lin H-J et al. \u003Cem\u003EStroke\u003C\/em\u003E 1996]. The risk of stroke recurrence is slightly higher in patients with AF (6.9% vs 4.7% in those without AF; p=0.0398) [Marini C et al. \u003Cem\u003EStroke\u003C\/em\u003E 2005].\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EIs There a Role for Vitamin K Antagonists?\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EA meta-analysis of 5 randomized placebo-controlled trials found that the relative risk reduction with warfarin was 62%, but the incidence of cerebral hemorrhage was substantial in elderly patients taking warfarin [Hart RG et al. \u003Cem\u003EAnn Intern Med\u003C\/em\u003E 1999]. Jean-Yves Le Heuzey, MD, Georges Pompidou Hospital, Rene Descartes University, Paris, France, discussed the challenges of vitamin K antagonists (VKAs), including a narrow therapeutic window, complex kinetics, and multiple interactions. An estimated 50% of eligible patients receive no anticoagulation therapy because of the limitations of VKAs.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EOral anticoagulant (OAC) therapy with an adjusted-dose VKA, a direct thrombin inhibitor, or oral factor Xa inhibitor (is now recommended for patients with CHA\u003Csub\u003E2\u003C\/sub\u003EDS\u003Csub\u003E2\u003C\/sub\u003E-VASc score \u22651, with preference for a new NOAC over a VKA for most patients with nonvalvular AF [Class I, Level of Evidence A; Camm AJ et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2012].\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EVKAs still have a role in anticoagulation therapy for patients with AF. The main contraindications for the new anticoagulants are valvular AF, renal failure, and stable INRs in patients unwilling to switch.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EAre Trials Comparable?\u003C\/h2\u003E\n         \u003Cp id=\u0022p-6\u0022\u003ELars Wallentin, MD, Uppsala University, Uppsala, Sweden, reviewed the available efficacy and safety data for dabigatran, rivaroxaban, apixaban, and edoxaban in patients with AF (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). Analysis by quartiles of time in therapeutic range (TTR) showed that dabigatran and apixaban remained effective for stroke or systemic embolism (SE) reduction irrespective of centers\u0027 quality of INR control (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14224\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14224\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14224\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\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EOAC Study Results.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \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\/12\/13\/32\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022New OACs Compared with Warfarin, Stroke, or SE in Relation to Quartiles of Center\u0027s TTR.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1958540523\u0022 data-figure-caption=\u0022New OACs Compared with Warfarin, Stroke, or SE in Relation to Quartiles of Center\u0027s TTR.\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\/12\/13\/32\/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\/12\/13\/32\/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\/12\/13\/32\/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\/14223\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-8\u0022 class=\u0022first-child\u0022\u003ENew OACs Compared with Warfarin, Stroke, or SE in Relation to Quartiles of Center\u0027s TTR.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from The \u003Cem\u003ELancet\u003C\/em\u003E; Wallentin L et al. Efficacy and safety of dabigatran compared with warfarin at different levels of international normalised ratio control for stroke prevention in atrial fibrillation: An analysis of the RE-LY trial. 2010;376(9745):975\u201383.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EProf. Wallentin concluded that compared with warfarin, new NOACs provide a better antithrombotic effect, lower risk of bleeding, fewer unexpected side effects, oral bioavailability, fewer food or drug interactions, broad therapeutic window, predictable anticoagulation without laboratory monitoring, and better patient acceptance and long-term tolerance.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EBleeding Risk with Anticoagulant Drugs\u003C\/h2\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EMichael D. Ezekowitz, MD, Thomas Jefferson Medical College, Philadelphia, Pennsylvania, USA, discussed the bleeding risks with OACs in AF patients. According to Dr. Ezekowitz, the risk of intracranial bleeding can be reduced by following the inclusion and exclusion criteria used in the clinical trials, assessing renal function, implementing dose adjustment per the prescribing information, and following the presurgical and the missed-dose protocols. He emphasized that none of the trials were stopped early because of increased bleeding or adverse events.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003E\n            \u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E shows the annual bleeding event rates in the RE-LY, ROCKET-AF, and ARISTOTLE trials. Compared with warfarin, major bleeding rates were significantly lower with dabigatran 110 mg and also lower with apixaban. Major bleeding rates with dabigatran 150 mg and with rivaroxaban were noninferior to that observed with warfarin. Major bleeding and intracranial hemorrhage (ICH) with warfarin and dabigatran did not correlate with the center-based TTR, dose or anticoagulant, CHADS\u003Csub\u003E2\u003C\/sub\u003E, or CHA\u003Csub\u003E2\u003C\/sub\u003EDS\u003Csub\u003E2\u003C\/sub\u003E-VASc scores.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14226\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14226\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14226\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\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-12\u0022 class=\u0022first-child\u0022\u003EBleeding Event Rates.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EAnalysis of the RE-LY trial efficacy results showed that the stroke and SE rate reduction with dabigatran was independent of CHADS\u003Csub\u003E2\u003C\/sub\u003E score. However, lower major bleeding rates with dabigatran 150 mg versus warfarin were only observed in patients with CHADS\u003Csub\u003E2\u003C\/sub\u003E score 0 to 1, while the benefit with dabigatran 110 mg remained across all CHADS\u003Csub\u003E2\u003C\/sub\u003E scores.\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EDr. Ezekowitz concluded that physicians are more influenced by OAC-induced bleeding than by OAC benefits in stroke prevention. The decision to use warfarin for nonvalvular AF is primarily driven by perceived risks of ICH. Fortunately NOACs reduce ICH by approximately 50%.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EImpact of Renal Function on Antithrombotic Therapy\u003C\/h2\u003E\n         \u003Cp id=\u0022p-16\u0022\u003ELimited data are available on stroke prevention in AF patients with renal dysfunction. Current stroke risk stratification strategies are based on data excluding patients with severe renal dysfunction. The aim of the study presented by Shinya Goto, MD, Tokai University, Kanagawa, Japan, was to assess the impact of renal dysfunction on stroke thromboprophylaxis in AF patients.\u003C\/p\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EStudy data were obtained from Cohort 1 of the international Global Anticoagulant Registry in the FIELD (GARFIELD) Registry [Kakkar AK et al. \u003Cem\u003EAm Heart J\u003C\/em\u003E 2012] which included 55,000 patients stratified into prospective (AF diagnosis \u22646 weeks prior) and retrospective (diagnosis 6 to 24 months prior) groups with \u22651 additional stroke risk factors. Data for both groups were combined. Antithrombotic therapy (n=10,537) was analyzed according to kidney function stage.\u003C\/p\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EGlomerular filtration rate data were available for 72% of patients; 67% had Stage 1 kidney dysfunction. VKAs were taken by 57.4% of patients, with 48.2% receiving a VKA alone, 11.7% receiving both a VKA and an antiplatelet, and 26.7% receiving an antiplatelet only. The use of combination therapy increased as the level of kidney dysfunction increased.\u003C\/p\u003E\n         \u003Cp id=\u0022p-19\u0022\u003EIn this registry, AF patients with renal dysfunction were more likely to receive combination therapy with antiplatelet and VKA agents than VKA monotherapy.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-5\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EROCKET-AF Trial\u003C\/h2\u003E\n         \u003Cp id=\u0022p-20\u0022\u003EManesh R. Patel, MD, Duke Clinical Research Institute, Durham, North Carolina, USA, presented results of the ROCKET-AF trial related to inadequate anticoagulation during end-of-study transition to open-label VKA therapy and the relationship between center TTR (cTTR) and comparative efficacy of rivaroxaban and warfarin.\u003C\/p\u003E\n         \u003Cp id=\u0022p-21\u0022\u003EThe ROCKET-AF trial randomized about 14,000 patients to rivaroxaban 20 mg BID or warfarin (INR target 2.0\u20133.0). At the end of the blinded phase, study therapy was discontinued during transition to open-label VKA therapy. To maintain blinding, local unblinded INR measurements were discouraged for at least 3 days after the start of open-label VKA therapy.\u003C\/p\u003E\n         \u003Cp id=\u0022p-22\u0022\u003EThis analysis focused on events 3 to 30 days after the end-of-study visit in patients still on the study drug (n=9248; 65%). Of these patients, 92% were transitioned to open-label VKA within 30 days. The median time to therapeutic INR after end of study in these patients was 3 days in those assigned warfarin and 13 days in those assigned rivaroxaban. From Days 3 to 30, the stroke and SE rate\/100 patient-years was 6.42% with rivaroxaban versus 1.73% with warfarin (HR, 3.72; 95% CI, 1.51 to 9.16; p=0.004) [Johnson \u0026amp; Johnson. \u003Cem\u003EAdvisory Committee Briefing Document\u003C\/em\u003E, No. EDMS-ERI-24510755:2.0 2011]. The excess events with rivaroxaban likely were caused by inadequate rates of and delayed achievement of therapeutic warfarin levels during this time.\u003C\/p\u003E\n         \u003Cp id=\u0022p-23\u0022\u003EA second analysis explored the impact of the quality of warfarin therapy by analyzing cTTR and treatment effect. The median TTR (INR 2.0\u20133.0) among warfarin patients was 57.8%. The treatment effect with rivaroxaban on stroke plus SE was consistent across cTTR quartiles (p for interaction=0.73). Estimated HRs for rivaroxaban versus warfarin favored rivaroxaban over a wide range of cTTRs.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 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\/12\/13\/32.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?nznbs1\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?nznbs1\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_tables.js?nznbs1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}