Gregory Y H Lip

University of Leipzig , Leipzig, Saxony, Germany

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Publications (763)3799.23 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: ABSTRACT BACKGROUND The efficacy and safety of anticoagulation with use of the Vitamin K antagonists(VKA) is highly dependent on the quality of anticoagulation control, as reflected by the average time in therapeutic range(TTR) in keeping within a therapeutic range of 2.0-3.0. A clinical dilemma is trying to predict which anticoagulation-naïve patients with atrial fibrillation(AF) would do well on a VKA(with a TTR>70%) whist those less likely to do well on VKA could be managed with novel oral anticoagulants. METHODS In our cohort of 4637 patients, we investigated whether the SAME-TT2R2 score could discriminate between patients with AF who were likely to have a labile INR during followup, as well as stroke/thromboembolism(TE), clinically relevant bleeding(defined as 'severe bleeding' and also as BARC-defined major bleeding) and mortality, whilst being treated with a VKA. RESULTS During a mean follow-up of 1016±1108 days, there was a significant increase in risk of severe bleeding events [RR(95%CI): 1.38(1.12-2.68), p=0.002] and a significant increase in risk of major BARC bleeding [RR 1.77(1.29-2.44), p=0.0005] in AF patients with a high (>2) SAME-TT2R2 score. Increasing SAME-TT2R2 score was associated with an increasing risk of labile INR(p=0.004), stroke/TE at followup(p=0.007), severe bleeding(p<0.0001), major BARC bleeding (p<0.0001) and death (p=0.002).Amongst the patients on VKA, the SAME-TT2R2 score was predictive of labile INR(c-statistic ∼0.58) as well as for stroke/TE, severe bleeding, major BARC bleeding and death(c-statistics ∼0.54 to 0.57 for events), reflecting the suboptimal TTR in such patients. This was not the case for those patients who were not on VKA. CONCLUSION We demonstrate that the SAME-TT2R2 score was predictive for an increasing risk of stroke/TE, severe bleeding, major BARC bleeding and death, reflecting poor anticoagulation control (and labile INRs) on VKA amongst our patients with AF.
    Chest 04/2014; · 5.85 Impact Factor
  • Leif Friberg, Lina Benson, Gregory Y H Lip
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    ABSTRACT: Patients who have both atrial fibrillation (AF) and renal failure have an increased risk of thrombo-embolism. Renal failure is also a risk factor for bleeding, which makes decisions regarding thromboprophylaxis complicated. Our aim was to determine risks for ischaemic stroke and bleeding in patients with AF and renal failure in relation to anticoagulant strategies. This is retrospective non-randomized study of Swedish health registers comprising 307 351 patients with AF, of whom 13 435 had a previous diagnosis of renal failure. Ischaemic stroke occurred more often in AF patients with renal failure (annual rate, 3.9% vs. no renal failure, 2.9%), but this was related to concomitant comorbidities [adjusted hazard ratio (HR) 1.02, 95% confidence interval (CI) 0.95-1.10].Adding renal failure to the established stroke risk stratification schemes (CHADS2 and CHA2DS2-VASc) did not improve their predictive value. Renal failure was an independent risk factor for intracranial bleeding [adjusted HR: 1.27 (1.09-1.49)]. Most patients with renal failure benefited from warfarin treatment, despite their high bleeding risk. The incidence of the combined endpoint ischaemic or haemorrhagic stroke or death was lower among those who used warfarin than among those who did not use warfarin (adjusted HR: 0.76, CI 0.72-0.80). Patients with both AF and renal failure will probably benefit most from having the same treatment as is recommended for other patients with AF, without setting a higher or lower threshold for treatment. Adding additional points for renal failure to the CHADS2 and CHA2DS2-VASc scores did not improve their predictive value.
    European Heart Journal 04/2014; · 14.10 Impact Factor
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    ABSTRACT: Atrial fibrillation is associated with decline of cognitive function. Observational evidence suggests that anticoagulation might protect against this decline. We report the first randomized controlled trial evidence on the effect of anticoagulation on cognitive function in elderly patients with atrial fibrillation. A total of 973 patients aged ≥75 years with atrial fibrillation were recruited from primary care and randomly assigned to warfarin (n=488; target international normalized ratio, 2-3) or aspirin (n=485; 75 mg/d). Neither participants nor investigators were masked to group assignment. Follow-up was for a mean of 2.7 years (SD, 1.2). Cognitive outcome was assessed using the Mini-Mental State Examination at 9-, 21-, and 33-month follow-up. Participants who had a stroke were censored from the analysis, which was by intention to treat with imputation for missing data. There was no difference between mean Mini-Mental State Examination scores in people assigned to warfarin or aspirin at 9 or 21 months. At 33-month follow-up, there was a nonsignificant difference of 0.56 in favor of warfarin that decreased to 0.49 (95% confidence interval, -0.01 to 0.98) after imputation. We found no evidence that anticoagulation confers clinically important protection over aspirin against cognitive decline as measured by the Mini-Mental State Examination in atrial fibrillation in the first 33 months of treatment other than that provided by preventing clinical stroke. http://www.controlled-trials.com. Unique identifier: ISRCTN89345269.
    Stroke 04/2014; · 6.16 Impact Factor
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    ABSTRACT: The risk of stroke and death in patients with atrial fibrillation is strongly associated with age and concomitant comorbidities. The aim of this study was to examine the age dependence of risk factors for stroke and mortality in young patients with atrial fibrillation. This study is a population-based cohort study of 30- to 65-year-old patients with atrial fibrillation and diagnosed during 2000 to 2011, identified by record linkage between nationwide Danish registries. Cox regression models were used to estimate the risk of stroke and mortality according to risk factors within age groups: 30 to 50, 50 to 65, and 65 to 75 years. We identified 73 799 nonvalvular atrial fibrillation patients, of which 37 782 (51.2%) were <65 years old (mean age 62.8). A higher modified cardiac failure or dysfunction, hypertension, age 75 (doubled), diabetes, stroke (doubled), vascular disease, age 65-74 and sex category (female) score (CHA2DS2-VASc score) was associated with decreased survival probability in all age groups. The overall incidence of stroke per year for 1 year (5 years) follow-up was 1.2% (0.6%), 3.5% (1.6%), and 5.6% (2.8%), respectively, for the age groups of 30 to 50, 50 to 65, and 65 to 75. Overall, risk factors such as previous stroke, heart failure, vascular disease, diabetes mellitus, and hypertension remained independent predictors of stroke and death in patients <65 years old with nonvalvular atrial fibrillation. The CHA2DS2-VASc score is an applicable tool for all age groups and in nonvalvular atrial fibrillation patients <65 years old, the same risk factors apply.
    Stroke 03/2014; · 6.16 Impact Factor
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    ABSTRACT: Atrial fibrillation (AF) increases the risk of stroke, but this risk is not homogenous. Many risk factors contribute to stroke risk however, the evidence for female sex as a risk factor is less well-established. To perform a systematic review and meta-analysis of the available evidence to establish if female sex is a risk factor for stroke/thromboembolism among patients with atrial fibrillation. A systematic literature search was conducted using Medline. The search term 'atrial fibrillation' was used in combination with 'stroke risk', 'thromboembolism' 'female' and 'gender differences' and returned 735 articles, of which 17 were appraised and included. Females with AF were compared with males with AF for the outcome of stroke/thromboembolism. Seventeen studies, five randomised-controlled trials and 12 prospective observational studies were included.; 10 demonstrated an increased risk of stroke in women. Meta-analysis of the 17 studies revealed a 1.31-fold (95% confidence intervals (CIs) 1.18-1.46) elevated risk of stroke in women with AF; the risk appearing greatest for women aged ≥75 years.Only three studies compared entirely anticoagulated populations; stroke rates among these patients varied from 1.2%-1.44% per-patient year for men and 2.08%-2.43% per-patient year for women. Risk of stroke in women appeared similar regardless of oral anticoagulation therapy [risk ratio (95% CI 1.29 (1.09-1.52) and 1.49 (1.17-1.90) in non-anticogulated vs. anticoagulated/mixed cohorts, respectively). Women with AF are at increased risk of stroke, particularly elderly women. Comprehensive stroke risk assessment, including sex as a risk factor, should be undertaken in all AF patients.
    QJM: monthly journal of the Association of Physicians 03/2014; · 2.36 Impact Factor
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    ABSTRACT: Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting 1% to 2% of the population and raising the risk of stroke 5-fold. Until recently, the only treatment choices for stroke prevention in patients with AF have been vitamin K antagonists (VKA) or antiplatelet drugs. With approval of novel oral anticoagulants (NOACs) antithrombotic treatment, patterns are changing. The Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation is designed to investigate patient characteristics influencing choice of antithrombotic treatment of stroke prevention in patients with nonvalvular AF and to collect data on outcomes of antithrombotic therapy in clinical practice. The GLORIA-AF is a large, international, observational registry involving patients with newly diagnosed nonvalvular AF at risk for stroke, enrolling up to 56,000 patients in nearly 50 countries. We will collect and analyze data from routine care using an inception cohort design. Phase I includes patients before approval of NOACs. Phase II, beginning early after approval of dabigatran, monitors dabigatran safety and addresses potential channeling across treatment options based on propensity scoring to assess comparability of baseline characteristics of patients treated with dabigatran or VKA. Phase III entails analysis of large treatment groups, adjusting for differences in propensity score, to provide information about the relative effectiveness and safety of NOACs and VKA in routine clinical care. Novel features of this registry program will add data from clinical practice to those from randomized trials to expand knowledge of antithrombotic treatment in patients with AF.
    American heart journal 03/2014; 167(3):329-34. · 4.65 Impact Factor
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    ABSTRACT: Atrial fibrillation (AF) is generally considered a progressive disease, typically evolving from paroxysmal through persistent to 'permanent' forms, a process attributed to electrical and structural remodelling related to both the underlying disease and AF itself. Medical treatment has yet to demonstrate clinical efficacy in preventing progression. Large clinical trials performed to date have failed to show benefit of rhythm control compared with rate control, but these trials primarily included patients at late stages in the disease process. One possible explanation is that intervention at only an early stage of progression may improve prognosis. Evolving observations about the progressive nature of AF, along with the occurrences of major complications such as strokes upon AF presentation, led to the notion that earlier and more active approaches to AF detection, rhythm-reversion, and maintenance of sinus rhythm may be a useful strategy in AF management. Approaches to early and sustained rhythm control include measures that prevent development of the AF substrate, earlier catheter ablation, and novel antiarrhythmic drugs. Improved classifications of AF mechanism, pathogenesis, and remodelling may be helpful to enable patient-specific pathophysiological diagnosis and therapy. Potential novel therapeutic options under development include microRNA-modulation, heatshock protein inducers, agents that influence Ca(2+) handling, vagal stimulators, and more aggressive mechanism-based ablation strategies. In this review, of research into the basis and management of AF in acute and early settings, it is proposed that progression from paroxysmal to persistent AF can be interrupted, with potentially favourable prognostic impact.
    European Heart Journal 02/2014; · 14.10 Impact Factor
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    ABSTRACT: Oral anticoagulation is highly effective in reducing stroke and mortality in atrial fibrillation (AF). Several risk stratification schemes have been developed using clinical characteristics. Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) are important markers of increased mortality and morbidity in congestive heart failure and general community population. The aim of our study was to assess the predictive value of NT-proBNP levels in an unselected real-world cohort of anticoagulated patients with AF. We studied 1172 patients (49% male; median age, 76 years) with permanent AF who were well stabilized on oral anticoagulation (international normalized ratio, 2.0-3.0). Plasma NT-proBNP levels were quantified at baseline. We recorded thrombotic and vascular events, mortality, and major bleeding. The best cutoff points were assessed by receiver-operating characteristic curves. Median levels (interquartile range) of NT-proBNP were 610 (318-1037) pg/mL. Median follow-up was 1007 (806-1279) days. On multivariate analysis, high NT-proBNP was significantly associated with the risk of stroke (hazards ratio, 2.71; P=0.001) and composite vascular events (acute coronary syndrome or acute heart failure; hazards ratio, 1.85; P=0.016), as well as a significant association with mortality (adjusted hazards ratio, 1.66; P=0.006). No association with bleeding was found (P=0.637). The integrated discrimination improvement (IDI) analysis demonstrated that NT-proBNP improved the Congestive heart failure, Hypertension, Age≥75 (doubled), Diabetes mellitus, Stroke (doubled)-Vascular disease and Sex category (female); CHA2DS2-VASc score for predicting embolic events (relative IDI, 2.8%; P=0.001) and all-cause death (relative IDI, 1.8%; P=0.001). In real-world cohort of anticoagulated patients with AF, NT-proBNP provided complementary prognostic information to an established clinical risk score (CHA2DS2-VASc) for the prediction of stroke/systemic embolism. NT-proBNP was also predictive of all-cause mortality, suggesting that this biomarker may potentially be used to refine clinical risk stratification in anticoagulated patients with AF.
    Stroke 02/2014; · 6.16 Impact Factor
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    ABSTRACT: Warfarin, a vitamin K antagonist (VKA), has been the standard of care for stroke prevention in patients with atrial fibrillation (AF). Aspirin is recommended for low-risk patients and those unsuitable for warfarin. Apixaban is an oral anticoagulant that has demonstrated better efficacy than warfarin and aspirin in the ARISTOTLE and AVERROES studies, respectively, and causes less bleeding than warfarin. We evaluated the potential cost-effectiveness of apixaban against warfarin and aspirin from the perspective of the UK payer perspective. A lifetime Markov model was developed to evaluate the pharmacoeconomic impact of apixaban compared with warfarin and aspirin in VKA suitable and VKA unsuitable patients, respectively. Clinical events considered in the model include ischaemic stroke, haemorrhagic stroke, intracranial haemorrhage, other major bleed, clinically relevant non-major bleed, myocardial infarction, cardiovascular hospitalization and treatment discontinuations; data from the ARISTOTLE and AVERROES trials and published mortality rates and event-related utility rates were used in the model. Apixaban was projected to increase life expectancy and quality-adjusted life years (QALYs) compared with warfarin and aspirin. These gains were expected to be achieved at a drug acquisition-related cost increase over lifetime. The estimated incremental cost-effectiveness ratio was £11 909 and £7196 per QALY gained with apixaban compared with warfarin and aspirin, respectively. Sensitivity analyses indicated that results were robust to a wide range of inputs. Based on randomized trial data, apixaban is a cost-effective alternative to warfarin and aspirin, in VKA suitable and VKA unsuitable patients with AF, respectively.
    European Heart Journal 02/2014; · 14.10 Impact Factor
  • Eduard Shantsila, Gregory Y H Lip
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    ABSTRACT: Pathophysiologically, there is a prothrombotic state evident in heart failure (HF). This is particularly evident within atria in patients whose course of the disease is complicated by concomitant atrial fibrillation (AF). A predisposition for thrombogenesis exists in patients with dilated dysfunctional cardiac chambers, such as those seen in patients with large myocardial infarction, left ventricular (LV) aneurysm or dilated cardiomyopathy. Based on subgroup analyses of recent phase 3 randomized trials, the novel oral anticoagulants are equally effective and safe in AF patients with HF or without HF. This appears to be true regarding both HF with systolic LV dysfunction and with preserved LVEF. However, patients with HF with preserved LVEF with more strict definition (ie, LVEF ≥ 55 %) have not been analyzed specifically. There is no information from clinical trial regarding possible utility of the novel oral anticoagulants in HF patients in sinus rhythm. Further research is required to cover gaps in knowledge on utility of these medications in a substantial proportion of HF patients not included in major clinical trials on novel oral anticoagulants.
    Current Treatment Options in Cardiovascular Medicine 02/2014; 16(2):285.
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    ABSTRACT: Optimal long-term antithrombotic treatment of patients with coexisting atrial fibrillation (AF) and stable coronary artery disease (CAD) is unresolved and commonly a single antiplatelet agent is added to oral anticoagulation. We investigated the effectiveness and safety of adding antiplatelet therapy to vitamin K antagonist (VKA) in AF patents with stable CAD. AF patients with stable CAD (defined as 12 months from an acute coronary event) between 2002-2011 were identified. Subsequent risk of cardiovascular events and serious bleeding (requiring hospitalization) events were examined with adjusted Cox regression models according to ongoing antithrombotic therapy. A total of 8,700 patients were included (mean age 74.2 years; 38% females). During a mean follow-up of 3.3 years, crude incidence rates were 7.2, 3.8 and 4.0 events per 100 person-years for myocardial infarction/coronary death, thromboembolism and serious bleeding, respectively. Relative to VKA monotherapy, the risk of myocardial infarction/coronary death was similar for VKA plus aspirin (HR 1.12 [0.94-1.34]) or VKA plus clopidogrel (HR 1.53 [0.93-2.52]). The risk of thromboembolism was comparable in all regimens including VKA, while the risk of bleeding increased when aspirin (HR 1.50 [1.23-1.82]) or clopidogrel (HR 1.84 [1.11-3.06]) was added to VKA. In AF patients with stable CAD, adding antiplatelet therapy on top of VKA is not associated with a reduction in risk of recurrent coronary events or thromboembolism, while risk of bleeding is significantly increased. The common practice of adding antiplatelet therapy to oral VKA anticoagulation in patients with AF and stable CAD warrants reassessment.
    Circulation 01/2014; · 15.20 Impact Factor
  • Yee C Lau, Deirdre A Lane, Gregory Y H Lip
    The American journal of cardiology 01/2014; · 3.58 Impact Factor
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    ABSTRACT: Background Apixaban (5 mg BID), dabigatran (available as 150 mg and 110 mg BID in Europe), and rivaroxaban (20 mg once daily) are 3 novel oral anticoagulants (NOACs) currently approved for stroke prevention in patients with atrial fibrillation (AF). Objective The objective of this study was to evaluate the cost-effectiveness of apixaban against other NOACs from the perspective of the United Kingdom National Health Services. Methods A Markov model was developed to evaluate the pharmacoeconomic impact of apixaban versus other NOACs over a lifetime. Pair-wise indirect treatment comparisons were conducted against other NOACs by using ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation), RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy), and ROCKET-AF (Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation) trial results for the following end points: ischemic stroke, hemorrhagic stroke, intracranial hemorrhage, other major bleeds, clinically relevant nonmajor bleeds, myocardial infarction, and treatment discontinuations. Outcomes were life-years, quality-adjusted life years gained, direct health care costs, and incremental cost-effectiveness ratios. Results Apixaban was projected to increase life expectancy versus other NOACs, including dabigatran (both doses) and rivaroxaban. A small increase in therapeutic management costs was observed with apixaban due to projected gains in life expectancy and lower discontinuation rates anticipated on apixaban versus other NOACs through lifetime. The estimated incremental cost-effectiveness ratio was £9611, £4497, and £5305 per quality-adjusted life-year gained with apixaban compared with dabigatran 150 mg BID, dabigatran 110 mg BID, and rivaroxaban 20 mg once daily, respectively. Sensitivity analyses indicated that results were robust over a wide range of inputs. Conclusions Although our analysis was limited by the absence of head-to-head trials, based on the indirect comparison data available, our model projects that apixaban may be a cost-effective alternative to dabigatran 150 mg BID, dabigatran 110 mg BID, and rivaroxaban 20 mg once daily for stroke prevention in AF patients from the perspective of the United Kingdom National Health Services.
    Clinical Therapeutics 01/2014; · 2.23 Impact Factor
  • Journal of the American College of Cardiology 01/2014; 63(14):1457–1458. · 14.09 Impact Factor
  • Deirdre A. Lane, Gregory Y.H. Lip
    Thrombosis Research 01/2014; · 3.13 Impact Factor
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    ABSTRACT: Aims The multiple roles of monocytes in atherogenesis, including inflammation, angiogenesis and repair are attributed to the existence of different monocyte sub-populations. Scarce data are available on changes in phenotype and functional status of human monocyte subsets in patients with coronary artery disease (CAD), especially when monocytes are evaluated as three distinct subsets. Methods and results Surface expression of receptors implicated in inflammation, repair and activation status (intracellular IKKβ) of monocyte subsets was assessed by flow cytometry in 53 patients with CAD and compared to 50 age- and sex-matched healthy controls. Monocyte subsets were defined as CD14++CD16−CCR2+ (Mon1), CD14++CD16+CCR2+ (Mon2), and CD14+CD16++CCR2− (Mon3). Plasma levels of inflammatory cytokines (FACSArray) and fibrinolytic factors (ELISA) were measured in CAD. CAD was associated with reduced expression of CD14 on Mon1 (p = 0.02) and Mon3 (p = 0.036), higher expression of IL6 receptor on Mon1 (p = 0.025) and Mon2 (p = 0.015), CXCR4 on Mon1 (p = 0.035) and Mon3 (p = 0.003), and CD34 on all subsets (all p < 0.007). Monocyte CD163 expression correlated negatively with interleukin (IL)-6 levels (p < 0.01 for all subsets). Expression of vascular endothelial growth factor receptor-1 correlated positively with plasminogen activator inhibitor (PAI)-1 antigen levels (r = 0.47, p = 0.006). In vitro, monocyte subsets derived from CAD patients showed significantly altered responses to endotoxin stimulation compared to monocytes from healthy controls. Conclusions There is a complex interplay between phenotype and activity of monocytes and plasma cytokines and fibrinolytic factors. These findings support the presence of unique roles for the three human monocyte subsets in atherogenesis and CAD pathogenesis.
    Atherosclerosis 01/2014; 234(1):4–10. · 3.71 Impact Factor
  • Article: Response.
    Chest 01/2014; 145(1):188-9. · 5.85 Impact Factor
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    ABSTRACT: ABSTRACT BACKGROUND Patients with chronic kidney disease (CKD) are more likely to develop atrial fibrillation(AF) than individuals with normal renal function, and are more likely to suffer ischaemic stroke(IS)/thromboembolism(TE). No prior study has considered the impact of eGFR on bleeding. We investigated the relationship of eGFR to IS/TE, mortality and bleeding in an AF population, unrestricted by age or comorbidity. METHODS Patients with non-valvular AF (NVAF) were stratified into five categories according to eGFR(ml/min/1.73 m2): ≥90,60-89,30-59,15-29 and <15, analysing risk factors, all-cause mortality, bleeding and IS/TE. Of 8962 eligible individuals, 5912 had NVAF and available serum creatinine data, with 14499 patient-years of follow-up. RESULTS In non-anticoagulated and anticoagulated individuals, the incidence rates of IS/TE were 7.4 and 7.2 per 1000 person-years, respectively. Rates of all-cause mortality were 13.4 and 9.4 per 1000 person-years, respectively, and of major bleeding, 6.2 and 9.0 per 1000 person-years, respectively.Rates increased with decreasing eGFR with IS/TE rates being lower in individuals receiving OAC. eGFR was not an independent predictor of IS/TE on multivariate analyses. When the benefit of IS reduction is balanced against the increased risk of haemorrhagic stroke, the net clinical benefit (NCB) was clearly positive in favour of OAC use. CONCLUSION Incidence rates of IS/TE, mortality and bleeding increased with reducing eGFR, across the whole range of renal function. OAC use was associated with a lower incidence of IS/TE and mortality at 1 year, compared with non-anticoagulated individuals in all categories of renal function as measured by eGFR. The NCB balancing IS against serious bleeding was positive, in favour of OAC use amongst patients with renal impairment.
    Chest 12/2013; · 5.85 Impact Factor
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    ABSTRACT: Given the advances in atrial fibrillation (AF) management and the availability of new European Society of Cardiology (ESC) guidelines, there is a need for the systematic collection of contemporary data regarding the management and treatment of AF in ESC member countries.METHODS AND RESULTS: We conducted a registry of consecutive in- and outpatients with AF presenting to cardiologists in nine participating ESC countries. All patients with an ECG-documented diagnosis of AF confirmed in the year prior to enrolment were eligible. We enroled a total of 3119 patients from February 2012 to March 2013, with full data on clinical subtype available for 3049 patients (40.4% female; mean age 68.8 years). Common comorbidities were hypertension, coronary disease, and heart failure. Lone AF was present in only 3.9% (122 patients). Asymptomatic AF was common, particularly among those with permanent AF. Amiodarone was the most common antiarrhythmic agent used (∼20%), while beta-blockers and digoxin were the most used rate control drugs. Oral anticoagulants (OACs) were used in 80% overall, most often vitamin K antagonists (71.6%), with novel OACs being used in 8.4%. Other antithrombotics (mostly antiplatelet therapy, especially aspirin) were still used in one-third of the patients, and no antithrombotic treatment in only 4.8%. Oral anticoagulants were used in 56.4% of CHA2DS2-VASc = 0, with 26.3% having no antithrombotic therapy. A high HAS-BLED score was not used to exclude OAC use, but there was a trend towards more aspirin use in the presence of a high HAS-BLED score.CONCLUSION: The EuroObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot Registry has provided systematic collection of contemporary data regarding the management and treatment of AF by cardiologists in ESC member countries. Oral anticoagulant use has increased, but novel OAC use was still low. Compliance with the treatment guidelines for patients with the lowest and higher stroke risk scores remains suboptimal.
    Europace 12/2013; · 2.77 Impact Factor
  • Philomena Z Y Lip, Gregory Y H Lip
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    ABSTRACT: Migraine headache and the presence of a patent foramen ovale have been associated with each other, although the precise pathophysiological mechanism(s) are uncertain. The purpose of this systematic review was to identify the extent of patent foramen ovale prevalence in migraineurs and to determine whether closure of a PFO would improve MH. An electronic literature search was performed to select studies between January 1980 and February 2013 that were relevant to the prevalence of patent foramen ovale and migraine, and the effects of intervention(s) on migraine attacks. Of the initial 368 articles presented by the initial search, 20 satisfied the inclusion criteria assessing patent foramen ovale prevalence in migraineurs and 21 presented data on patent foramen ovale closure. In case series and cohort studies, patent foramen ovale prevalence in migraineurs ranged from 14.6% to 66.5%. Case control studies reported a prevalence ranging from 16.0% to 25.7% in controls, compared to 26.8% to 96.0% for migraine with aura. The extent of improvement or resolution of migraine headache attack symptoms was variable. In case series, intervention ameliorated migraine headache attack in 13.6% to 92.3% of cases. One single randomised trial did not show any benefit from patent foramen ovale closure. The data overall do not exclude the possibility of a placebo effect for resolving migraine following patent foramen ovale closure. This systematic review demonstrates firstly that migraine headache attack is associated with a higher prevalence of patent foramen ovale than amongst the general population. Observational data suggest some improvement of migraine would be observed if the patent foramen ovale were to be closed. A proper assessment of any interventions for patent foramen ovale closure would require further large randomised trials to be conducted given uncertainties from existing trial data.
    The American journal of medicine 12/2013; · 4.47 Impact Factor

Publication Stats

10k Citations
3,799.23 Total Impact Points

Institutions

  • 2013
    • University of Leipzig
      Leipzig, Saxony, Germany
    • Queen Mary, University of London
      • Centre for Primary Care and Public Health
      London, ENG, United Kingdom
    • Aalborg University Hospital
      • Department of Cardiology
      Aalborg, Region North Jutland, Denmark
    • Attikon University Hospital
      Athínai, Attica, Greece
  • 2012–2013
    • Aalborg University
      • Faculty of Medicine
      Ålborg, North Denmark, Denmark
    • Chinese PLA General Hospital (301 Hospital)
      Peping, Beijing, China
    • University of Missouri
      Columbia, Missouri, United States
    • Boehringer Ingelheim
      Ingelheim, Rheinland-Pfalz, Germany
    • Università di Pisa
      Pisa, Tuscany, Italy
    • University of Iowa
      Iowa City, Iowa, United States
    • University of Belgrade
      • Chair of Pharmacology, Clinical Pharmacology and Toxicology
      Beograd, Central Serbia, Serbia
    • Copenhagen University Hospital Gentofte
      Hellebæk, Capital Region, Denmark
    • Hospital General Universitario Morales Meseguer
      Murcia, Murcia, Spain
    • University of Tours
      Tours, Centre, France
    • Vilnius University Hospital Santariškių Klinikos
      Vil'nyus, Vilniaus Apskritis, Lithuania
    • Universität Heidelberg
      • Department of Clinical Pharmacology and Pharmacoepidemiology
      Heidelberg, Baden-Wuerttemberg, Germany
  • 2011–2013
    • Aston University
      • School of Life and Health Sciences
      Birmingham, ENG, United Kingdom
    • University of Bologna
      • Institute of Cardiology
      Bologna, Emilia-Romagna, Italy
    • Centre Hospitalier Universitaire de Tours
      Tours, Centre, France
    • National Health Service
      Radditch, England, United Kingdom
    • Oulu University Hospital
      • Department of Surgery
      Oulu, Oulu, Finland
    • Universitätsklinikum Münster
      Muenster, North Rhine-Westphalia, Germany
    • Maastricht Universitair Medisch Centrum
      Maestricht, Limburg, Netherlands
    • ΓΕΝ.ΝΟΣΟΚΟΜΕΙΟ ΑΛΕΞΑΝΔΡΑ
      Athínai, Attica, Greece
    • Uppsala University
      • Department of Medical Sciences
      Uppsala, Uppsala, Sweden
    • Turku University Hospital
      • Turku PET Centre
      Turku, Province of Western Finland, Finland
  • 2008–2013
    • University of Murcia
      Murcia, Murcia, Spain
    • Royal College of Physicians
      Londinium, England, United Kingdom
    • Ilustre Colegio Oficial de Médicos de Alicante
      Alicante, Valencia, Spain
  • 2004–2013
    • Hospital General Universitario de Alicante
      • Departamento de Cardiología
      Alicante, Valencia, Spain
    • St. George's School
      Middletown, Rhode Island, United States
  • 2002–2013
    • Birmingham City University
      Birmingham, England, United Kingdom
    • McMaster University
      • Department of Medicine
      Hamilton, Ontario, Canada
  • 2001–2013
    • University Hospitals Birmingham NHS Foundation Trust
      • Department of Medicine
      Birmingham, ENG, United Kingdom
  • 1996–2013
    • University of Birmingham
      • • Centre for Cardiovascular Sciences
      • • School of Sport and Exercise Sciences
      • • Department of Primary Care Clinical Sciences
      Birmingham, England, United Kingdom
  • 2011–2012
    • Klinički centar Srbije
      • Institute for Cardiovascular Diseases
      Beograd, Central Serbia, Serbia
  • 2008–2012
    • Hospital Universitario Virgen de la Arrixaca
      • Departamento de Cardiología
      Murcia, Murcia, Spain
  • 2009–2011
    • Medical University of Gdansk
      • Department of Cardiology and Heart Electrotherapy
      Danzig, Pomeranian Voivodeship, Poland
    • University Hospitals Coventry and Warwickshire NHS Trust
      • Department of Cardiology
      Coventry, England, United Kingdom
    • University of Lodz
      Łódź, Łódź Voivodeship, Poland
    • AstraZeneca
      Tukholma, Stockholm, Sweden
  • 2007–2011
    • Maastricht University
      • Cardiologie
      Maastricht, Provincie Limburg, Netherlands
  • 2005–2011
    • Sandwell and West Birmingham Hospitals NHS Trust
      Birmingham, England, United Kingdom
    • Hospital Universitario San Juan De Alicante
      Alicante, Valencia, Spain
    • Otto-von-Guericke-Universität Magdeburg
      • Clinic for Cardiology, Angiology and Pneumology
      Magdeburg, Saxony-Anhalt, Germany
  • 2003–2011
    • Medical University of Vienna
      • Universitätsklinik für Klinische Pharmakologie
      Linz, Upper Austria, Austria
  • 2010
    • Baker IDI Heart and Diabetes Institute
      Melbourne, Victoria, Australia
  • 2008–2009
    • Justus-Liebig-Universität Gießen
      Gieben, Hesse, Germany
  • 2005–2009
    • Nottinghamshire Healthcare NHS Trust
      Nottigham, England, United Kingdom