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Gastrointestinal bleeding in patients with atrial fibrillation treated with Apixaban or warfarin: Insights from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial.

Author: AlexanderJohn H, De CaterinaRaffele, FisherDeborah A, GarciaDavid A, GrangerChristopher B, HalvorsenSigrun, HeldClaes, LopesRenato D, MulderHillary, WallentinLars, WruckLisa

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Overview

Patients with atrial fibrillation (AF) who have had a history of gastrointestinal bleeding (GIB) have an increased risk of subsequent major GIB. However, this history is not associated with an increased risk of stroke, intracranial bleeding, or all-cause mortality. The use of apixaban versus warfarin in patients with AF was not modified by a history of GIB.
Paper Details　
Original Abstract of the Article :
OBJECTIVES: A history of gastrointestinal bleeding (GIB) in patients with atrial fibrillation (AF) may impact decisions about anticoagulation treatment. We sought to determine whether prior GIB in patients with AF taking anticoagulants was associated with an increased risk of stroke or major hemorrh...See full text at original site
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引用元：
https://doi.org/10.1016/j.ahj.2019.10.013

データ提供：米国国立医学図書館（NLM）

Gastrointestinal Bleeding in Atrial Fibrillation: A Complex Challenge

The management of [atrial fibrillation (AF)] is a major focus in [Cardiology], with anticoagulation therapy playing a crucial role in preventing stroke. This study investigates the risk of [gastrointestinal bleeding (GIB)] in patients with AF taking either [apixaban] or [warfarin]. The researchers examined the association between prior GIB and the risk of stroke, major hemorrhage, and other adverse outcomes in patients enrolled in the [ARISTOTLE] trial.

Prior GIB and Anticoagulation Therapy

The study found that patients with a history of GIB were at an increased risk of subsequent major GIB but not stroke, intracranial bleeding, or all-cause mortality. Interestingly, the treatment effect of apixaban versus warfarin was not significantly modified by a history of GIB. This finding suggests that while prior GIB might increase the risk of future bleeding, it does not necessarily preclude the use of anticoagulants.

Weighing the Risks and Benefits of Anticoagulation

This study, like a compass guiding us through the complex landscape of AF management, provides valuable insights into the risks and benefits of anticoagulation therapy. It highlights the importance of careful patient selection and risk assessment, considering individual factors such as prior GIB. The study's findings underscore the need for a personalized approach to managing AF, balancing the risk of stroke with the risk of bleeding complications.

Dr.Camel's Conclusion

This study is like a camel caravan navigating a complex desert landscape, where each sand dune represents a different risk factor for patients with AF. The findings provide a roadmap for navigating the challenges of anticoagulation therapy, balancing the risk of stroke with the risk of bleeding complications. It's a reminder that even in the most complex situations, careful navigation and thoughtful decision-making can lead to the best outcomes.

Date :
  1. Date Completed 2020-04-28
  2. Date Revised 2020-04-28
Further Info :

Pubmed ID

31896036

DOI: Digital Object Identifier

10.1016/j.ahj.2019.10.013

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SNS
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in preparation
Languages

English

Positive IndicatorAn AI analysis index that serves as a benchmark for how positive the results of the study are. Note that it is a benchmark and requires careful interpretation and consideration of different perspectives.

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