How to define valvular atrial fibrillation?

Autor: Laurent Fauchier, Thierry Bourguignon, Denis Angoulvant, Nicolas Clementy, Dominique Babuty, Raphael Philippart, Anne Bernard, Fabrice Ivanes
Přispěvatelé: Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Éducation Éthique Santé EA 7505 (EES), Université de Tours (UT), EA4245 - Transplantation, Immunologie, Inflammation [Tours] (T2i), Cellules Dendritiques, Immunomodulation et Greffes, Cellules Dendritiques, Immunomodulation et Greffes [Tours] (UFR de Médecine - EA4245), Université Francois Rabelais [Tours], Service de Cardiologie B, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Dorogoichenko, Aleksandra, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Rok vydání: 2015
Předmět:
medicine.medical_specialty
Heart Valve Diseases
Prosthesis Design
Risk Assessment
Accident vasculaire cérébral
Valve disease
Dabigatran
[SHS]Humanities and Social Sciences
Fibrinolytic Agents
Risk Factors
Terminology as Topic
Thromboembolism
Internal medicine
medicine
Fibrillation atriale
Humans
Heart valve
cardiovascular diseases
ComputingMilieux_MISCELLANEOUS
Bioprosthesis
Heart Valve Prosthesis Implantation
Mitral regurgitation
business.industry
valvular heart disease
Warfarin
Anticoagulants
Atrial fibrillation
General Medicine
medicine.disease
Thrombosis
Surgery
Stroke
Stenosis
Treatment Outcome
medicine.anatomical_structure
Heart Valve Prosthesis
Practice Guidelines as Topic
Valvulopathie
Cardiology
cardiovascular system
[SHS] Humanities and Social Sciences
business
Cardiology and Cardiovascular Medicine
medicine.drug
Zdroj: Archives of cardiovascular diseases
Archives of cardiovascular diseases, 2015, 108 (10), pp.530-539. ⟨10.1016/j.acvd.2015.06.002⟩
ISSN: 1875-2136
1875-2128
DOI: 10.1016/j.acvd.2015.06.002
Popis: SummaryAtrial fibrillation (AF) confers a substantial risk of stroke. Recent trials comparing vitamin K antagonists (VKAs) with non-vitamin K antagonist oral anticoagulants (NOACs) in AF were performed among patients with so-called “non-valvular” AF. The distinction between “valvular” and “non-valvular” AF remains a matter of debate. Currently, “valvular AF” refers to patients with mitral stenosis or artificial heart valves (and valve repair in North American guidelines only), and should be treated with VKAs. Valvular heart diseases, such as mitral regurgitation, aortic stenosis (AS) and aortic insufficiency, do not result in conditions of low flow in the left atrium, and do not apparently increase the risk of thromboembolism brought by AF. Post-hoc analyses suggest that these conditions probably do not make the thromboembolic risk less responsive to NOACs compared with most forms of “non-valvular” AF. The pathogenesis of thrombosis is probably different for blood coming into contact with a mechanical prosthetic valve compared with what occurs in most other forms of AF. This may explain the results of the only trial performed with a NOAC in patients with a mechanical prosthetic valve (only a few of whom had AF), where warfarin was more effective and safer than dabigatran. By contrast, AF in the presence of a bioprosthetic heart valve or after valve repair appears to have a risk of thromboembolism that is not markedly different from other forms of “non-valvular” AF. Obviously, we should no longer consider the classification of AF as “valvular” (or not) for the purpose of defining the aetiology of the arrhythmia, but for the determination of a different risk of thromboembolic events and the need for a specific antithrombotic strategy. As long as there is no better new term or widely accepted definition, “valvular AF” refers to patients with mitral stenosis or artificial heart valves. Patients with “non-valvular AF” may have other types of valvular heart disease. One should emphasize that “non-valvular AF” does not exclude patients with some types of valvular heart disease from therapy with NOACs.
Databáze: OpenAIRE
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