- Prof. Aldo P. Maggioni
- Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Heart Care Foundation, Florence, Italy.
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- Prof. Felicita Andreotti
- Fondazione Policlinico Universitario Gemelli IRCCS and Catholic University, Rome, Italy.
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Special Issue Introduction
This special issue of Vessel Plus aims to provide an updated framework for the practical use of oral anticoagulation (OAC) in patients with atrial fibrillation (AF). It includes clinical conditions in which OAC use may be uncertain for lack of evidence or for elevated bleeding risk.
To assess whether the increased use of OAC for AF – secondary to guideline recommendations and to the introduction of direct OAC - may have determined a measurable impact on patient outcomes, temporal patterns of antithrombotic therapy will be described in relation to the rates of ischemic stroke and major bleeds.
Ischemic strokes of undetermined nature remain an open problem. Appropriate management and drug therapy are conditional to identifying the aetiology of these cerebral events through traditional or new technologies. Another open issue is how to better measure the risk of ischemic stroke in patients with or without atrial fibrillation. A review of prediction models and methods to improve the identification of risk factors and causes of ischemic stroke will be provided. Echocardiographic characteristics, including left atrial appendage morphology, will be discussed in the context of finding predictors of ischemic stroke, irrespective of the presence or absence of atrial fibrillation.
Several clinical conditions, such as renal dysfunction, cancer or the post-cardiac surgery period, will be examined as potential obstacles to the use of OAC; the potential benefits of OAC, even when the risk of adverse reactions is high, will be considered. Elderly patients receiving OAC who are poly-treated for comorbidities will be analysed in relation to functional status, risk of drug-drug interactions, and mortality.
In conclusion, the main objective of this special issue is to offer concrete and practical information to clinicians, including cardiologists, geriatricians, internists and neurologists, to help daily decision making on challenging aspects that are still controversial because of current insufficient evidence from randomized clinical trials and consequently lack of strong guideline recommendations.
Submission Deadline15 Aug 2021