As dabigatran becomes more widely used in AF patients, electrophysiologists are trying to figure out how to handle anticoagulation in patients taking the drug and for whom AF ablation is planned. In a new study published in the Journal of the American College of Cardiology, Dhanunjaya Lakkireddy and colleagues report on a multicenter, observational study of 290 patients…

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A NEJM editorial fellow interviews a NEJM editorialist about subclinical AF and the risk of stroke.

A new study published in the New England Journal of Medicine sheds some much-needed light on the precise role of subclinical atrial fibrillation (AF) in the prognosis and development of ischemic stroke. ASSERT (Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial) followed 2580 patients with a newly implanted pacemaker or ICD…

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A new meta-analysis finds that dabigatran is associated with a higher risk of myocardial infarction and acute coronary syndromes. An editorial raises questions about the enthusiasm to embrace new drugs.

Based on the promising results of the recently published ATLAS ACS 2 TIMI 51 trial, Johnson & Johnson has submitted a supplemental new drug application to the FDA for the approval of rivaroxaban (Xarelto) to reduce the risk of thrombotic cardiovascular events in ACS patients. Following a succession of failed trials, ATLAS was the first trial…

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Although venous thromboembolism (VTE) is a serious problem for acutely ill patients in the hospital, a new study published in the New England Journal of Medicine failed to find any improvement in mortality associated with thromboprophylaxis. Ajay Kakkar and the LIFENOX investigators randomized 8307 acutely ill patients to receive enoxaparin or placebo for 10 days. All patients wore…

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The FDA announced today that it is initiating a safety review of dabigatran (Pradaxa, Boehringer Ingelheim). The review was prompted by reports of serious bleeding events in people taking the drug. Bleeding complications, the FDA acknowledges, are a “a well-recognized complication of all anticoagulant therapies.” The agency says it is “working to determine whether the reports of…

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Despite the advent of newer anticoagulants that don’t require monitoring, millions of people will continue to take warfarin for many years to come. Now a new meta-analysis published in the Lancet suggests that some of these patients may benefit from self-monitoring. Carl Heneghan and colleagues analyzed data from 11 trials with 6417 patients on oral anticoagulation and 12,800…

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Although medically ill patients remain at risk for VTE after hospital discharge, a strategy of extended oral anticoagulation with apixaban did not prove to be successful in the ADOPT (Apixaban Dosing to Optimize Protection from Thrombosis) trial, which was presented by Samuel Z. Goldhaber at the American Heart Association and published simultaneously in the New England…

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Results of the highly anticipated ATLAS-ACS 2–TIMI 51 trial demonstrate that ACS patients receiving standard therapy, including dual antiplatelet therapy, may benefit from the addition of the factor Xa inhibitor rivaroxaban, although at the cost of some additional bleeding complications. The Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects with Acute Coronary Syndrome  trial was…

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