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Efficacy and safety of novel anticoagulants in the elderly

Journal of Geriatric Cardiology 2016年第8期13卷 718-723页

作者： Nikolaos Karamichalakis stamatis georgopoulos Konstantinos Vlachos Ioarmis Liatakis Michael Efremidis Antonios Sideris Konstantinos P Letsas Laboratory of Cardiac Electrophysiology 'Evangelismos' General Hospital of Athens Greece

Atrial fibrillation and venous thromboembolism （VTE） are common disorders associated with maleficent thrombotic events, particularly in the elderly patients. Polypharmacy, co-morbidities, and altered pharmacokinetics, often present in these patients, render the use of antico-agulants quite challenging. Novel oral anticoagulants （NOACs） have recently emerged as alternatives to Vitamin K Antagonists （VKAs） and are gradually increasing their popularity mainly because of their fewer drug and food interactions and ease of use. Their effectiveness and safety has been weU-established in the general population but the balance between benefit and harm in the elderly is still unclear. Routine use in these patients is uncommon. Accumulating data have shown that the benefit of NOACs is consistent among all age groups, featuring equal or greater efficacy in preventing thrombotic events. Excess bleedings were lower with NOACs in comparison to VKAs, but bleeding patterns were disparate among them and head to head comparison is not available. The present review highlights on the efficacy and safety of novel anticoagulants in the elderly population.

关键词： Atrial fibrillation Efficacy Novel oral anticoagulants Safety Venous thromboembolism

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Prediction of atrial fibrillation development and progression:current perspectives

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World Journal of Cardiology 2016年第3期8卷 267-276页

作者： Konstantinos Vlachos Konstantinos P Letsas Panagiotis Korantzopoulos Tong Liu stamatis georgopoulos Athanasios Bakalakos Nikolaos Karamichalakis Sotirios Xydonas Michael Efremidis Antonios Sideris Second Department of Cardiology Laboratory of Cardiac Electrophysiology"Evangelismos" General Hospital of Athens First Department of Cardiology University Hospital of Ioannina Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical University

Atrial fibrillation(AF) is the most common arrhythmia in clinical practice. Several conventional and novel predictors of AF development and progression(from paroxysmal to persistent and permanent types) have been reported. The most important predictor of AF progression is possibly the arrhythmia itself. The electrical, mechanical and structural remodeling determines the perpetuation of AF and the progression from paroxysmal to persistent and permanent forms. Common clinical scores such as the hypertension, age ≥ 75 years, transient ischemic attack or stroke, chronic obstructive pulmonary disease, and heart failure and the congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years, sex category scores as well as biomarkers related to inflammation may also add important information on this topic. There is now increasing evidence that even in patients with so-called lone or idiopathic AF, the arrhythmia is the manifestation of a structural atrial disease which has recently been defined and described as fibrotic atrial cardiomyopathy. Fibrosis results from a broad range of factors related to AF inducing pathologies such as cell stretch, neurohumoral activation, and oxidative stress. The extent of fibrosis as detected either by late gadolinium enhancement-magnetic resonance imaging or electroanatomic voltage mapping may guide the therapeutic approach based on the arrhythmia substrate. The knowledge of these risk factors may not only delay arrhythmia progression, but also reduce the arrhythmia burden in patients with first detected AF. The present review highlights on the conventional and novel risk factors of development and progression of AF.

关键词： Atrial fibrillation Development Progression Risk factors inflammation Fibrosis

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