![Decisions regarding thromboprophylaxis requires weighing the risk of stroke against the risk of bleeding in each patient.[3,4] Numerous risk assessment tools are available, including CHADS2, CHA2DS2-VASc, and HAS-BLED. American and European guidelines recommend the use of CHA2DS2-VASc, which considers sex, age, and history of congestive HF, hypertension, stroke/transient ischemic attack/thromboembolism, vascular disease, and diabetes mellitus.[3,4] Compared with other stroke risk assessment measures, this tool performed best in identifying patients at low risk of stroke who did not require anticoagulation therapy.[12] Oral anticoagulation is recommended in any patient with a score ≥2 on the CHA2DS2-VASc. In these patients, warfarin or the novel anticoagulants dabigatran, rivaroxaban, apixaban, or edoxaban can be considered, except in the setting of moderate to severe chronic kidney disease, where reduced doses of direct thrombin or factor Xa inhibitors are preferable.[4]](https://www.thecardiologyadvisor.com/wp-content/uploads/sites/17/2019/01/slideshowsizeatrialfibrillati_1061315-544x306.jpg)
Osteoporotic Fracture Risk in A-Fib Lower With DOAC vs Warfarin
For patients with atrial fibrillation, the risk for osteoporotic fracture appears to be lower with direct oral anticoagulant use, compared with warfarin use.
Arrythmia
Use of Pectoral Nerve Blocks for Pacemaker or ICD Placement in Pediatric Patients
Pectoral nerve blocks were found to diminish pain and opioid use following pacemaker or implantable cardioverter defibrillator placement in children.
Apixaban May Be Safer Than Rivaroxaban for Atrial Fibrillation
Among adults with atrial fibrillation, the rates for ischemic stroke or systemic embolism and bleeding are lower with apixaban compared with rivaroxaban.
Apixaban May Be Safer and More Effective Than Rivaroxaban for Nonvalvular Atrial Fibrillation
Patients with nonvalvular atrial fibrillation who were prescribed apixaban vs rivaroxaban had a lower rate of ischemic stroke or systemic embolism and bleeding.
Trial Evaluating At-Home PSVT Treatment With Etripamil Nasal Spray Misses Primary End Point
Topline results were announced from the phase 3 NODE-301 trial of etripamil nasal spray (Milestone Pharmaceuticals), a novel short-acting calcium channel blocker, being investigated for the at-home treatment of acute paroxysmal supraventricular tachycardia (PSVT).
Anti-IL-6 Monoclonal Antibodies as Antiarrhythmic Treatment for HF
The promotion of arrhythmias in myocytes by mesenchymal stromal cells isolated from failing human hearts, which were found to produce high levels of interleukin-6 (IL-6), was abated in the presence of anti-IL-6 monoclonal antibodies.
Novel Clinical and Genetic Score Can Identify High Risk for Atrial Fibrillation and Stroke
Researchers developed and validated a clinical and genetic score to identify individuals at high risk for atrial fibrillation and stroke.
Dual Therapy Linked to Lower Bleeding Risk in A-Fib After PCI
For patients with AF after PCI, dual therapy is associated with a reduced risk for bleeding compared with triple therapy.
ACC Issues COVID-19 Clinical Guidance for Cardiovascular Care Team
On March 6, 2020, the American College of Cardiology issued COVID-19 clinical guidance for the cardiovascular care team.
Risk for Incident AF Associated With Plasma Levels of Ceramides, Sphingomyelin
An increased risk for incident atrial fibrillation was found to be associated with plasma levels of ceramides and sphingomyelins with palmitic acid.
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