PMID- 29089455
OWN - NLM
STAT- MEDLINE
DCOM- 20171219
LR  - 20180308
IS  - 1524-4628 (Electronic)
IS  - 0039-2499 (Linking)
VI  - 48
IP  - 12
DP  - 2017 Dec
TI  - Echocardiographic Risk Factors for Stroke and Outcomes in Patients With Atrial
      Fibrillation Anticoagulated With Apixaban or Warfarin.
PG  - 3266-3273
LID - 10.1161/STROKEAHA.117.017574 [doi]
AB  - BACKGROUND AND PURPOSE: Few data exist on the long-term outcomes of patients with
      spontaneous echo contrast (SEC), left atrial/left atrial appendage (LA/LAA)
      thrombus, and complex aortic plaque (CAP), in patients with atrial fibrillation
      receiving oral anticoagulation. We explored the relationship between these 3
      echocardiographic findings and clinical outcomes, and the comparative efficacy
      and safety of apixaban and warfarin for each finding. METHODS: Patients from the 
      ARISTOTLE trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events
      in Atrial Fibrillation) with SEC, LA/LAA thrombus, or CAP diagnosed by either
      transthoracic or transesophageal echocardiography were compared with patients
      with none of these findings on transesophageal echocardiography. RESULTS: A total
      of 1251 patients were included: 217 had SEC, 127 had LA/LAA thrombus, 241 had
      CAP, and 746 had none. The rates of stroke/systemic embolism were not
      significantly different among patients with and without these echocardiographic
      findings (hazard ratio, 0.96; 95% confidence interval, 0.25-3.60 for SEC; hazard 
      ratio, 1.27; 95% confidence interval, 0.23-6.86 for LA/LAA thrombus; hazard
      ratio, 2.21; 95% confidence interval, 0.71-6.85 for CAP). Rates of ischemic
      stroke, myocardial infarction, cardiovascular death, and all-cause death were
      also not different between patients with and without these findings. For patients
      with either SEC or CAP, there was no evidence of a differential effect of
      apixaban over warfarin. For patients with LA/LAA thrombus, there was also no
      significant interaction, with the exception of all-cause death and any bleeding
      where there was a greater benefit of apixaban compared with warfarin among
      patients with no LA/LAA thrombus. CONCLUSIONS: In anticoagulated patients with
      atrial fibrillation and risk factors for stroke, echocardiographic findings do
      not seem to add to the risk of thromboembolic events. CLINICAL TRIAL
      REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00412984.
CI  - (c) 2017 American Heart Association, Inc.
FAU - Vinereanu, Dragos
AU  - Vinereanu D
AD  - From the University of Medicine and Pharmacy Carol Davila, University and
      Emergency Hospital, Bucharest, Romania (D.V.); Duke Clinical Research Institute
      (C.B.G., J.H.A.), Duke University School of Medicine, Durham, NC (R.D.L., H.M.); 
      Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, 
      MN (B.J.G.); Bristol-Myers Squibb, Princeton, NJ (M.H.); Brazilian Clinical
      Research Institute, Sao Paulo, Brazil (P.G.M.d.B.e.S.); Oslo University Hospital,
      Norway (D.A.); and Uppsala Clinical Research Institute, Uppsala University,
      Sweden (L.W.). vinereanu@gmail.com.
FAU - Lopes, Renato D
AU  - Lopes RD
AD  - From the University of Medicine and Pharmacy Carol Davila, University and
      Emergency Hospital, Bucharest, Romania (D.V.); Duke Clinical Research Institute
      (C.B.G., J.H.A.), Duke University School of Medicine, Durham, NC (R.D.L., H.M.); 
      Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, 
      MN (B.J.G.); Bristol-Myers Squibb, Princeton, NJ (M.H.); Brazilian Clinical
      Research Institute, Sao Paulo, Brazil (P.G.M.d.B.e.S.); Oslo University Hospital,
      Norway (D.A.); and Uppsala Clinical Research Institute, Uppsala University,
      Sweden (L.W.).
FAU - Mulder, Hillary
AU  - Mulder H
AD  - From the University of Medicine and Pharmacy Carol Davila, University and
      Emergency Hospital, Bucharest, Romania (D.V.); Duke Clinical Research Institute
      (C.B.G., J.H.A.), Duke University School of Medicine, Durham, NC (R.D.L., H.M.); 
      Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, 
      MN (B.J.G.); Bristol-Myers Squibb, Princeton, NJ (M.H.); Brazilian Clinical
      Research Institute, Sao Paulo, Brazil (P.G.M.d.B.e.S.); Oslo University Hospital,
      Norway (D.A.); and Uppsala Clinical Research Institute, Uppsala University,
      Sweden (L.W.).
FAU - Gersh, Bernard J
AU  - Gersh BJ
AD  - From the University of Medicine and Pharmacy Carol Davila, University and
      Emergency Hospital, Bucharest, Romania (D.V.); Duke Clinical Research Institute
      (C.B.G., J.H.A.), Duke University School of Medicine, Durham, NC (R.D.L., H.M.); 
      Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, 
      MN (B.J.G.); Bristol-Myers Squibb, Princeton, NJ (M.H.); Brazilian Clinical
      Research Institute, Sao Paulo, Brazil (P.G.M.d.B.e.S.); Oslo University Hospital,
      Norway (D.A.); and Uppsala Clinical Research Institute, Uppsala University,
      Sweden (L.W.).
FAU - Hanna, Michael
AU  - Hanna M
AD  - From the University of Medicine and Pharmacy Carol Davila, University and
      Emergency Hospital, Bucharest, Romania (D.V.); Duke Clinical Research Institute
      (C.B.G., J.H.A.), Duke University School of Medicine, Durham, NC (R.D.L., H.M.); 
      Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, 
      MN (B.J.G.); Bristol-Myers Squibb, Princeton, NJ (M.H.); Brazilian Clinical
      Research Institute, Sao Paulo, Brazil (P.G.M.d.B.e.S.); Oslo University Hospital,
      Norway (D.A.); and Uppsala Clinical Research Institute, Uppsala University,
      Sweden (L.W.).
FAU - de Barros E Silva, Pedro G M
AU  - de Barros E Silva PGM
AD  - From the University of Medicine and Pharmacy Carol Davila, University and
      Emergency Hospital, Bucharest, Romania (D.V.); Duke Clinical Research Institute
      (C.B.G., J.H.A.), Duke University School of Medicine, Durham, NC (R.D.L., H.M.); 
      Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, 
      MN (B.J.G.); Bristol-Myers Squibb, Princeton, NJ (M.H.); Brazilian Clinical
      Research Institute, Sao Paulo, Brazil (P.G.M.d.B.e.S.); Oslo University Hospital,
      Norway (D.A.); and Uppsala Clinical Research Institute, Uppsala University,
      Sweden (L.W.).
FAU - Atar, Dan
AU  - Atar D
AD  - From the University of Medicine and Pharmacy Carol Davila, University and
      Emergency Hospital, Bucharest, Romania (D.V.); Duke Clinical Research Institute
      (C.B.G., J.H.A.), Duke University School of Medicine, Durham, NC (R.D.L., H.M.); 
      Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, 
      MN (B.J.G.); Bristol-Myers Squibb, Princeton, NJ (M.H.); Brazilian Clinical
      Research Institute, Sao Paulo, Brazil (P.G.M.d.B.e.S.); Oslo University Hospital,
      Norway (D.A.); and Uppsala Clinical Research Institute, Uppsala University,
      Sweden (L.W.).
FAU - Wallentin, Lars
AU  - Wallentin L
AD  - From the University of Medicine and Pharmacy Carol Davila, University and
      Emergency Hospital, Bucharest, Romania (D.V.); Duke Clinical Research Institute
      (C.B.G., J.H.A.), Duke University School of Medicine, Durham, NC (R.D.L., H.M.); 
      Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, 
      MN (B.J.G.); Bristol-Myers Squibb, Princeton, NJ (M.H.); Brazilian Clinical
      Research Institute, Sao Paulo, Brazil (P.G.M.d.B.e.S.); Oslo University Hospital,
      Norway (D.A.); and Uppsala Clinical Research Institute, Uppsala University,
      Sweden (L.W.).
FAU - Granger, Christopher B
AU  - Granger CB
AD  - From the University of Medicine and Pharmacy Carol Davila, University and
      Emergency Hospital, Bucharest, Romania (D.V.); Duke Clinical Research Institute
      (C.B.G., J.H.A.), Duke University School of Medicine, Durham, NC (R.D.L., H.M.); 
      Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, 
      MN (B.J.G.); Bristol-Myers Squibb, Princeton, NJ (M.H.); Brazilian Clinical
      Research Institute, Sao Paulo, Brazil (P.G.M.d.B.e.S.); Oslo University Hospital,
      Norway (D.A.); and Uppsala Clinical Research Institute, Uppsala University,
      Sweden (L.W.).
FAU - Alexander, John H
AU  - Alexander JH
AD  - From the University of Medicine and Pharmacy Carol Davila, University and
      Emergency Hospital, Bucharest, Romania (D.V.); Duke Clinical Research Institute
      (C.B.G., J.H.A.), Duke University School of Medicine, Durham, NC (R.D.L., H.M.); 
      Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, 
      MN (B.J.G.); Bristol-Myers Squibb, Princeton, NJ (M.H.); Brazilian Clinical
      Research Institute, Sao Paulo, Brazil (P.G.M.d.B.e.S.); Oslo University Hospital,
      Norway (D.A.); and Uppsala Clinical Research Institute, Uppsala University,
      Sweden (L.W.).
CN  - ARISTOTLE Investigators
LA  - eng
SI  - ClinicalTrials.gov/NCT00412984
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20171031
PL  - United States
TA  - Stroke
JT  - Stroke
JID - 0235266
RN  - 0 (Anticoagulants)
RN  - 0 (Pyrazoles)
RN  - 0 (Pyridones)
RN  - 3Z9Y7UWC1J (apixaban)
RN  - 5Q7ZVV76EI (Warfarin)
SB  - IM
MH  - Aged
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Atrial Fibrillation/*complications/*drug therapy/mortality
MH  - Brain Ischemia/epidemiology/mortality
MH  - Cardiovascular Diseases/epidemiology/mortality
MH  - Double-Blind Method
MH  - Echocardiography
MH  - *Electrocardiography
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/complications/mortality
MH  - Plaque, Atherosclerotic/epidemiology/mortality
MH  - Pyrazoles/adverse effects/*therapeutic use
MH  - Pyridones/adverse effects/*therapeutic use
MH  - Risk Factors
MH  - Stroke/*epidemiology/etiology/mortality
MH  - Thromboembolism/epidemiology
MH  - Treatment Outcome
MH  - Warfarin/*adverse effects/therapeutic use
OTO - NOTNLM
OT  - *apixaban
OT  - *atrial fibrillation
OT  - *echocardiography
OT  - *risk factors
OT  - *warfarin
EDAT- 2017/11/02 06:00
MHDA- 2017/12/20 06:00
CRDT- 2017/11/02 06:00
PHST- 2017/04/03 00:00 [received]
PHST- 2017/08/25 00:00 [revised]
PHST- 2017/09/18 00:00 [accepted]
PHST- 2017/11/02 06:00 [pubmed]
PHST- 2017/12/20 06:00 [medline]
PHST- 2017/11/02 06:00 [entrez]
AID - STROKEAHA.117.017574 [pii]
AID - 10.1161/STROKEAHA.117.017574 [doi]
PST - ppublish
SO  - Stroke. 2017 Dec;48(12):3266-3273. doi: 10.1161/STROKEAHA.117.017574. Epub 2017
      Oct 31.