Clinical profile of direct oral anticoagulants versus vitamin K anticoagulants in octogenarians with atrial fibrillation: a multicentre propensity score matched real-world cohort study
AbstractAtrial fibrillation (AF) is the most common arrhythmia in clinical practice and its prevalence increases with age. Few data are available about the clinical performance of direct oral anticoagulant (DOACs) in patients aged ≥ 80 years with AF. The aim of our propensity score matched cohort study was to compare the safety and efficacy of DOACs versus well-controlled VKA therapy among octogenarians with AF in real life setting. Data for this study were sourced from the multicenter prospectively maintained Atrial Fibrillation Research Database (NCT03760874), which includes all AF patients followed by the participating centers, through outpatient visits every 3 to 6 months. The database was queried for AF patients aged ≥ 80 years who received DOACs or VKAs treatment. The primary effectiveness endpoint was the occurrence of thromboembolic events (a composite of stroke, transient ischemic attack, systemic embolism); the primary safety endpoint was the occurrence of major bleeding; the secondary endpoint was all-cause mortality. The database query identified 774 AF patients aged ≥ 80 years t reated with VKAs and 279 with DOACs. Propensity score (2:1) matching selected 252 DOAC and 504 VKA recipients. The mean follow-up was 31.07 ± 14.09 months. The incidence rate of thromboembolic events was 13.79 per 1000 person-years [14.80 in DOAC vs 13.34 in VKA group, Hazard Ratio 1.10; 95% ...
This study aims to address this gap.MethodsThe study used data from the Nihon University Japanese Longitudinal Study of Aging (NUJLSOA) and incidence-based multistate life tables to estimate disabled and disability-free life expectancy based on the stroke status of Japanese residents aged 65 and older.ResultsJapanese stroke survivors aged 65 who experienced an initial disability-free state could expect to live approximately 3 fewer total years of life, 4 –5 fewer years in a disability-free state, and 1–2 more years in a disabled state compared to those without history of a stroke (p
The common femoral vein (CFV) and iliac veins compose the common channel for venous drainage of the lower extremity. Occlusive venous thrombosis of the CFV and iliac veins is associated with severe post-thrombotic syndrome and in some cases with nonhealing vein ulcers. After percutaneous intervention, relative obstruction of the CFV can persist, leading to incomplete drainage of the femoral and profunda femoris venous systems, thereby mitigating the benefit of iliac vein recanalization and risking rethrombosis; associated restenosis intrastent could occur, resulting in a great challenge for endovascular management.
Recent studies have expanded the window for the use of systemic and catheter-directed thrombolysis and mechanical thrombectomy for acute stroke management. The purpose of this review was to evaluate the impact that contemporary cerebral imaging has on the indications for emergent cervical carotid revascularization.
Intravenous thrombolysis for treatment of acute carotid-associated stroke can be combined with carotid endarterectomy (CEA) either simultaneously or in a staged procedure. The aim of this single-center retrospective study was to analyze the short-term and long-term results of sequential lysis with CEA.
We report a case in which 12 years after a successful left carotid endarterectomy, a carotid-cutaneous fistula resulted in pulsatile bleeding from the neck that necessitated urgent intervention and surgical reconstruction.
This study reviewed the outcome of patients subjected to thoracic endovascular aortic repair (TEVAR) under full, low-dose, and no intraoperative systemic heparinization.
Myocardial injury after noncardiac surgery (MINS) is prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery and is known to be independently associated with 30-day mortality after intervention. Nonetheless, the long-term prognostic importance of MINS in vascular surgery patients is poorly described, and the prevalence of MINS in endovascular aneurysm repair (EVAR) patients is unknown. Also, most studies use fourth-generation troponin T, which can have significant baseline increases in chronic kidney disease patients.
In this study, we analyzed our experience with endovascular therapy in the treatment of symptomatic and asymptomatic femoropopliteal artery aneurysms.
Synthetic marijuana use has been reported in the last years as a possible causative factor of different cardiovascular events, including myocardial infarction, ischemic stroke, intracranial bleeding, and cerebral vasospasm. One case of aortic thrombosis was also reported, but that was in a patient using cocaine and synthetic marijuana together. A case of lower limb thromboembolism and synthetic marijuana use has not been reported to date. Intoxication, material impurity, blood vessel reactivity, and chemical interaction with other drugs have been proposed as possible mechanisms of these events.
The incidence of chronic kidney disease (CKD) has reached pandemic proportions across the world. Critical limb ischemia (CLI) in the CKD patient is a huge clinical challenge often culminating in major amputation or mortality. Endovascular revascularization is sometimes not feasible because of potential contrast agent-induced damage to the residual renal function, whereas heavy calcification may limit the success of such interventions. Surgical revascularization in these patients also carries added challenges and risks with seemingly poor outcomes in terms of limb salvage.