Atrial Fibrillation Discussion

Atrial Fibrillation Discussion
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Atrial Fibrillation Discussion
Reference:  Steinberg, B., Simon, D., Thomas, L., Ansell, J., Fonarow, G., & Gersh, B. et al. (2017). Management of Major Bleeding in Patients With Atrial Fibrillation Treated With Non–Vitamin K Antagonist Oral Anticoagulants Compared With Warfarin in Clinical Practice (from Phase II of the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation [ORBIT-AF II]). The American Journal of Cardiology 119(10), 1590-1595. doi: 10.1016/j.amjcard.2017.02.015
Summary: This article details a study that was carried out among the US adults aged 18years and above who suffered from AF. The study participants were outpatients from cardiologists, primary care clinicians, and electrophysiologists. All the events that took place in the clinical setup were recorded as well as monitoring information. Also, during follow-up, clinical activities were also recorded. According to the article, analysis WAS mainly targeted at patients that were treated with OAC and showed significant bleeding on follow-ups. On the other hand, the analysis was constrained to those patients who received OAC treatment during major bleedings, and only for those whose, monitoring data was available. According to the article, the results showed that during a median monitoring of 360 days on the patients, 3.3 major bleeding was recorded per a hundred patient-years in the patients that were received NOACs whereas 3.5 among those that were treated with warfarin.

Apparently, according to the article, those patients that received NOAC who had bleeding events were easily managed without and interventions, reversal agents or any blood products. On the other hand, those who were treated with warfarin were managed with administration of blood products and the reversal agents. Coagulation reversal strategies were used inconsistently in for both groups, those treated with warfarin and NOAC. After bleeding event, no major differences were seen in the adverse events in both groups of patients. According to the results, it is argued that it is a concern to many clinicians about the extensive use of the NOACs in the society since the drugs lack correctional agents. Therefore, patients who receive NOACs during major bleeding events do not require the administration of correctional agents and PCCs. It is cautioned in the article that comparisons between the patients on warfarin and those on NOACs should be made with care because the treatment was not randomly assigned and no multivariable adjustment was performed due to limited power. It is concluded that NOAC dosing has a potential of impacting on bleeding risk.
Clinical Application: The article is significant in clinical practices as it compares the managing of major bleeding events in the patients suffering from Atrial Fibrillation. Through the comparison, clinicians can evaluate the best treatment to use on their patients and hence provide the best management.
URL: https://www.ajconline.org/article/S0002-9149(17)30201-1/fulltext