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New Risk Factors for Afib, Duration of Anticoagulation for AVR

 We have two new risks for atrial fibrillation and an intriguing study on the duration of anticoagulation after bioprosthetic aortic valve. So first up is a study from the women's health initiative that, as we know, randomized women to receive estrogen, with or without progesterone, depending on whether they did or did not have had a hysterectomy.

And this analysis looked over about a six-year follow-up period. To see the incidence of new atrial fibrillation that they found was modestly increased by about twelve percent overall, and this sum is a new finding, combined with other risks that have previously been seen of pulmonary, embolism, VTE and indeed cardiovascular events and so another factor to consider.

When thinking about estrogen replacement therapy, next up is a study from the Framingham risk study looking at low magnesium, that was also seen to be a risk factor for incidence of atrial fibrillation looking at the lowest quartile.

That is less than one point: seven, seven milligrams per deciliter. They found about a one and a half fold higher risk of developing atrial fibrillation compared with the highest quartile, which was above to this, is something we've known about.

We check in hospital but looks like it may have some relevance and so something worth checking the number one pick this week is an intriguing registry study from the Danish national registry. Looking at patients who had undergone bioprosthetic a ortak valve replacement and looked at the duration of anticoagulation, often it's recommended for three months.

But they compared people getting six months or longer as compared with shorter durations and found that there was a a half the risk of cardiovascular death, thromboembolic event or stroke in those who had six months of anticoagulation as compared with shorter durations.

This is an observational study. They tried to adjust for the differences, it's a moderate-sized study, looking at about 4,500 4,000 patients and one that they argue should be looked at by the guidelines committee and other databases evaluated to see whether we should be extending the duration of anticoagulation. Following bioprosthetic.

A ortak valve implantation and this would of course be in patients without other indications such as atrial fibrillation. So for this week's cardiology countdown on Chris cannon, you

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