{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,22]],"date-time":"2025-02-22T00:28:12Z","timestamp":1740184092483,"version":"3.37.3"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T00:00:00Z","timestamp":1719273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>This study evaluated the feasibility of the intermittent use of direct oral anticoagulants (DOACs) guided by continuous rhythm monitoring via a clinically validated wearable smart device in high-bleeding risk (HBR) patients with symptomatic paroxysmal atrial fibrillation (AF) otherwise subjected to chronic anticoagulation after percutaneous coronary intervention (PCI).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>The INTERMITTENT registry was a 3-year prospective observational study at eight Italian centres. Inclusion criteria were elective or urgent PCI, Academic Research Consortium HBR criteria, history of symptomatic 12-lead ECG detected paroxysmal AF episodes, indication to DOACs, and use of a wearable smart device (Apple Watch\u2122). Thirty days after PCI, patients free of AF episodes discontinued DOAC. However, if an AF episode lasting &amp;gt;6 min or a total AF burden &amp;gt; 6 h over 24 h was detected, DOAC was initiated for 30 consecutive days, and withdrawn afterwards if no further AF episodes occurred. At the discretion of the referring physician, intermittent anticoagulation was offered to 89 patients, whereas continuous treatment with DOACs was prescribed to 151 patients. During a follow-up of 298 \u00b1 87 days, the average duration of oral anticoagulation was significantly shorter in the intermittent anticoagulation group (176 \u00b1 43 days, P = 0.0001), representing a 40% reduction in anticoagulation time compared to the continuous group. Ischaemic and bleeding endpoints were not significantly different between the two groups. Propensity score-matching resulted in a total of 69 matched patients with intermittent vs. continuous anticoagulation, respectively. During a follow-up of 291 \u00b1 63 days, there was a significant 46% reduction in anticoagulation time in the intermittent compared to the continuous group (P = 0.0001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In HBR patients with a history of paroxysmal AF episodes who underwent PCI, intermittent anticoagulation guided by continuous rhythm monitoring with a wearable device was feasible and decreased significantly the duration of anticoagulation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjdh\/ztae046","type":"journal-article","created":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T13:56:58Z","timestamp":1719323818000},"page":"637-642","source":"Crossref","is-referenced-by-count":0,"title":["Feasibility of anticoagulation on demand after percutaneous coronary intervention in high-bleeding risk patients with paroxysmal atrial fibrillation: the INTERMITTENT registry"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1260-1308","authenticated-orcid":false,"given":"Francesco","family":"Pelliccia","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Sciences, La Sapienza University , Viale del Policlinico 155, 00161 Rome , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5455-6010","authenticated-orcid":false,"given":"Marco","family":"Zimarino","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Imaging and Clinical Sciences, \u2018Gabriele D'Annunzio\u2019 University of Chieti-Pescara , Chieti , Italy"},{"name":"Department of Cardiology, \u2018SS. Annunziata Hospital\u2019, ASL 2 Abruzzo , Chieti , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melania","family":"Giordano","sequence":"additional","affiliation":[{"name":"IRCCS San Raffaele, IJC Milan Srls , Meina, Novara , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4612-117X","authenticated-orcid":false,"given":"Dobromir","family":"Dobrev","sequence":"additional","affiliation":[{"name":"Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen , Essen , Germany"},{"name":"Montr\u00e9al Heart Institute, Universit\u00e9 de Montr\u00e9al , Montr\u00e9al, Qu\u00e9bec , Canada"},{"name":"Department of Integrative Physiology, Baylor College of Medicine , Houston, TX , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,6,25]]},"reference":[{"key":"2024092309045887800_ztae046-B1","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"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","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur Heart J"},{"key":"2024092309045887800_ztae046-B2","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur Heart J"},{"key":"2024092309045887800_ztae046-B3","doi-asserted-by":"crossref","first-page":"e36","DOI":"10.1177\/2047487320937846","article-title":"Predictive ability of longitudinal changes in PRECISE-DAPT score in patients on dual antiplatelet therapy: the RE-SCORE multicentre prospective registry","volume":"28","author":"Pelliccia","year":"2021","journal-title":"Eur J Prev Cardiol"},{"key":"2024092309045887800_ztae046-B4","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1111\/jce.12864","volume":"27","author":"Passman","year":"2016","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2024092309045887800_ztae046-B5","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1007\/s10840-016-0192-8","article-title":"Intermittent vs. Continuous Anticoagulation theRapy in patiEnts with Atrial Fibrillation (iCARE-AF): a randomized pilot study","volume":"48","author":"Stavrakis","year":"2017","journal-title":"J Interv Card Electrophysiol"},{"key":"2024092309045887800_ztae046-B6","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1016\/j.hrthm.2018.06.027","article-title":"Intermittent anticoagulation guided by continuous atrial fibrillation burden monitoring using dual-chamber pacemakers and implantable cardioverter-defibrillators: results from the Tailored Anticoagulation for Non-Continuous Atrial Fibrillation (TACTIC-AF) pilot study","volume":"15","author":"Waks","year":"2018","journal-title":"Heart Rhythm"},{"key":"2024092309045887800_ztae046-B7","first-page":"232","article-title":"Clinical validation of 5 direct-to-consumer wearable smart devices to detect atrial fibrillation: BASEL wearable study","volume":"9","author":"Mannhart","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"2024092309045887800_ztae046-B8","doi-asserted-by":"crossref","first-page":"2736","DOI":"10.1161\/CIRCULATIONAHA.110.009449","article-title":"Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium","volume":"1","author":"Mehran","year":"2011","journal-title":"Circulation"},{"key":"2024092309045887800_ztae046-B9","doi-asserted-by":"crossref","first-page":"2211","DOI":"10.1161\/CIRCULATIONAHA.121.053170","article-title":"\u201cPill-in-pocket\u201d anticoagulation for atrial fibrillation: fiction, fact, or foolish?","volume":"143","author":"Passman","year":"2021","journal-title":"Circulation"},{"key":"2024092309045887800_ztae046-B10","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1056\/NEJMoa1105575","article-title":"Subclinical atrial fibrillation and the risk of stroke","volume":"366","author":"Healey","year":"2012","journal-title":"N Engl J Med"}],"container-title":["European Heart Journal - 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