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Reply to the Comment on “Comparison of Dabigatran Versus Warfarin Treatment for Prevention of New Cerebral Lesions in Valvular Atrial Fibrillation”

Published:October 10, 2022DOI:https://doi.org/10.1016/j.amjcard.2022.09.006
      We thank Dr. Abrahim et al for their interest and valuable comment on our study.
      • Cho MS
      • Kim M
      • Lee SA
      • Lee S
      • Kim DH
      • Kim J
      • Song JM
      • Nam GB
      • Kim SJ
      • Kang DH
      • Choi KJ.
      Comparison of dabigatran versus warfarin treatment for prevention of new cerebral lesions in valvular atrial fibrillation.
      In the methodology section, we intended to recruit stable patients who were able to use the standard anticoagulation in the outpatient setting. Therefore, we excluded the patients with acute stroke within 2 weeks or patients with high-bleeding risk. All the patients received standard rate control therapy according to the relevant guideline.
      • Hindricks G
      • Potpara T
      • Dagres N
      • Arbelo E
      • Bax JJ
      • Blomström-Lundqvist C
      • Boriani G
      • Castella M
      • Dan G-A
      • Dilaveris PE.
      2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC.
      The proportion of medications for rate control such as β blocker (56% of overall patients), calcium channel blocker (24%), or digitalis (31%) were already presented, and the mean heart rate was 74.1 ± 14.2 beats/min. As the present study is fundamentally a prospective randomized controlled trial, patients were randomly assigned to the study groups (dabigatran vs conventional treatment group), not based on specific selection criteria. In the dabigatran group, all 59 patients with previous use of warfarin (n = 52, including 4 combination therapy with antiplatelets), antiplatelet (n = 5), or no therapy (n = 2) were changed to the dabigatran. In the conventional treatment group, 60 patient used warfarin (n = 51), antiplatelet (n = 8), or no therapy (n = 1) before enrollment and changed to warfarin (n = 53) and antiplatelet (n = 7). Overall, 5 antiplatelet users used aspirin and 2 used clopidogrel. We are sorry that the number 19 was typographic error and the correct number of patients using antiplatelets is 17 (14%) including 9 patients of dabigatran group and 8 of conventional group. There was no episode of clinical ischemic stroke throughout the study period, and therefore no Magnetic Resonance Imaging scans were performed based on patients’ symptoms.
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      References

        • Cho MS
        • Kim M
        • Lee SA
        • Lee S
        • Kim DH
        • Kim J
        • Song JM
        • Nam GB
        • Kim SJ
        • Kang DH
        • Choi KJ.
        Comparison of dabigatran versus warfarin treatment for prevention of new cerebral lesions in valvular atrial fibrillation.
        Am J Cardiol. 2022; 175: 58-64
        • Hindricks G
        • Potpara T
        • Dagres N
        • Arbelo E
        • Bax JJ
        • Blomström-Lundqvist C
        • Boriani G
        • Castella M
        • Dan G-A
        • Dilaveris PE.
        2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC.
        Eur Heart J. 2021; 42: 373-498