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Cardiology Countdown | Familial Afib, Peri-procedural Anticoagulation and CKD

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Familial Afib, Peri-procedural Anticoagulation and CKD

Well in this week’s cardiology countdown we have the genetics of atrial fibrillation how to manage anticoagulation and a new large study on the prognosis of chronic kidney disease so the first pick this week is a study of the genetics of atrial fibrillation to see is there hereditary influence of atrial fibrillation this was an analysis of the danish national registry

When they looked at patients born between 1950 and 2008 comprising 92 million patient years of follow-up i think this is about the largest study i’ve reported on and they looked and found just under 10,000 patients who had developed atrial fibrillation and looked at the risk of developing atrial fibrillation this is lone atrial fibrillation in first and second-degree

Relatives they found that the risk for the first and second-degree relatives was a hazard of 3.5 and 1.6 and thus they found that there was in fact an apparent familial component of development of lone atrial fibrillation suggesting we should potentially screen other family members of patients who present to us with lone atrial fibrillation the next up is a study

Of anticoagulation for atrial fibrillation and how to manage invasive procedures a vexing problem this was an analysis from the rely trial that looked at dabigatran at one of two doses or warfarin and uh looked at the 4,500 patients who underwent some type of procedure during the study period and these included a pacemaker defibrillator defibrillator implanted

Or work diagnostic procedures included cataracts colonoscopy and joint replacements and interestingly the protocol had said and was followed that for the stopping of this of the medication for dabigatran it was on average about two days before and for warfarin about four and a half to five days before the procedure and in that setting the rates of bleeding were

Actually similar between dabigatran and warfarin and so the dabigatran hundred and ten milligram dose the lower dose had a numerically lower rate three-point-eight percent versus five point one and four point six percent for the higher dose dabigatran and for warfarin then for urgent surgery needed within 24 hours the rates of bleeding were higher about seventeen

To twenty percent and similar between the three groups and the study highlights the fact that the pharmacokinetics of the new anticoagulants are very different that the drug levels wear off with the half-life about 12 hours and so stopping as was done in the trial about two days before a procedure is the way to help avoid bleeding whereas it’s about five days for

Warfarin the top pick is a study of the prognosis of chronic kidney disease this is a large study published in lancet that looked at a population-based analysis from alberta canada they had 1.2 million participants in this analysis and looked at the prognosis for all-cause mortality and development of myocardial infarction in patients who had prior mi is sort of

The control or reference prognostic marker those who had chronic kidney disease diabetes with or without chronic kidney disease and those without and so for development of myocardial infarction those who had had an mi before were at highest risk followed by patients who had chronic kidney disease and diabetes then chronic kidney disease then diabetics and then

Those without any of the three conditions for mortality the highest mortality were in diabetics with chronic kidney disease this was followed by patients with chronic kidney disease and then patients with prior myocardial infarction and finally diabetes and none of those risk factors and so this shows that between death and mi the chronic kidney disease patients

Are high risk and that combination with diabetes is a very potent combination for an adverse prognostic marker and so they argue that this could be added to our list as has recently be done an unstable antigen on stemi to the high risk features where we think about managing patients more aggressively so for this week’s cardiology countdown i’m chris cannon you

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Cardiology Countdown | Familial Afib, Peri-procedural Anticoagulation and CKD By American College of Cardiology Video Archive