Ischemic stroke and dose adjustment of oral Factor Xa inhibitors in patients with atrial fibrillation

AbstractBackgroundOral Factor Xa inhibitors for the prevention of stroke in atrial fibrillation require dose adjustment based on certain clinical criteria, but the off-label use of the reduced doses is common.MethodsData from an observational registry including patients admitted with acute cerebral ischemia while taking oral Factor Xa inhibitors for atrial fibrillation between April 2016 and December 2018 were investigated. The dose regimen of the Xa inhibitor was classified as “appropriate”, “underdosed” and “overdosed” in conformity with the European Medicines Agency labelling. The effect of underdosing on the functional factor Xa plasma level on admission, the clinical stroke severity and the functional outcome after 3 months were investigated.Results254 patients with cerebral ischemia while on Factor Xa inhibitors were included. The dose regimen of the Factor Xa inhibitor was appropriate in 166 patients (65%), underdosed in 67 patients (26%) and overdosed in 21 patients (8%). Underdosing was associated with female sex, diabetes mellitus and higher CHA2DS2–Vasc scores. Underdosing independently predicted lower anti-Xa plasma levels on admission [median 69.4 ng/ml (IQR 0.0–121.6) vs. 129.2 ng/ml (65.5–207.2);p 
Source: Journal of Neurology - Category: Neurology Source Type: research

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Authors: Kleinaki Z, Kapnisi S, Theodorelou-Charitou SA, Nikas IP, Paschou SA Abstract Diabetes mellitus (DM) is a chronic multisystem disease. Diabetic nephropathy (DN) is one of its significant microvascular complications, associated with increased morbidity and mortality. The aim of this article is to review the literature regarding the latest advances in the management of type 2 DM (T2DM) in patients with chronic kidney disease (CKD). We initially refer to the screening guidelines, the diagnostic tests used, the need for novel biomarkers in DN, the recent advances in high-risk patient identification, the recomm...
Source: Hormones - Category: Endocrinology Tags: Hormones (Athens) Source Type: research
Background: Brachial plexus birth injury (BPBI) is a condition in which the brachial plexus is thought to be damaged during the birth process. Studies have cited a varying incidence rate ranging from 0.5 to 4.0 per 1000 live births. The purpose of this study is to evaluate birth claims data over a 15-year period to identify risk and protective factors for BPBI in the state of Colorado. Methods: A data request was made to the state hospital association for birth claims data. We requested all birth claims from the years 2000 to 2014. ICD9 codes for variables of interest included: BPBI, shoulder dystocia, heavy-for-dates...
Source: Journal of Pediatric Orthopaedics - Category: Orthopaedics Tags: Upper Extremity Source Type: research
Conclusion. The spontaneous incidence rate of vertebral body infection among OVF patients was 0.7%; however, the occurrence of this complication led to serious events. Clinicians should pay attention to the possibility of bacillemia in elderly or immunocompromised OVF patients. Level of Evidence: 4
Source: Spine - Category: Orthopaedics Tags: CLINICAL CASE SERIES Source Type: research
Conclusion. Although intent-to-treat analysis failed to show significant differences in patients treated surgically, results of the as-treated analysis determined statically greater improvements in those patients with spondylolisthesis who were treated surgically as compared to those treated nonoperatively. Level of Evidence: 2
Source: Spine - Category: Orthopaedics Tags: LITERATURE REVIEW Source Type: research
Purpose of review To give an updated review on the underlying mechanisms and clinical effects of improved glucose control after bariatric surgery. Recent findings The basic principles of the mechanism for the metabolic effects of bariatric surgery can be categorized into calorie restriction, deviation of nutrients, and reduced amounts of adipose tissue. Recent findings suggest the importance of early changes following deviation of nutrients to more distal parts of the small bowel resulting in altered release of gastrointestinal hormones, altered gut microbiota, and weight-reduction. In the long-term, loss of adipose t...
Source: Current Opinion in Clinical Nutrition and Metabolic Care - Category: Nutrition Tags: CARBOHYDRATES: Edited by Bettina Mittendorfer and Olle Ljungqvist Source Type: research
Background: Treatment with a duodenal-jejunal bypass sleeve (DJBS) induces clinically significant weight loss, but little is known about the mechanisms of action of this device. Aim: The aim of this study was to characterize the mechanisms of action of the DJBS and determine the durability of weight loss and metabolic improvements. Materials and Methods: We studied a cohort of 19 subjects with severe obesity and type 2 diabetes (baseline body mass index: 43.7±5.3 kg/m2). Anthropometry, body composition, blood pressure, biochemical measures, and dietary intake were monitored for 48 weeks after DJBS imp...
Source: Journal of Clinical Gastroenterology - Category: Gastroenterology Tags: ALIMENTARY TRACT: Original Articles Source Type: research
Publication date: Available online 6 June 2020Source: Canadian Journal of DiabetesAuthor(s): Jessie Benson, Cameron Severn, Julia Hudnut-Beumler, Stacey L. Simon, Natalie Abramson, Lauren B. Shomaker, Lauren D. Gulley, Anya Taylor, Megan M. Kelsey, Kristen J. Nadeau, Philip Zeitler, Laura Pyle, Melanie Cree-Green
Source: Canadian Journal of Diabetes - Category: Endocrinology Source Type: research
Publication date: 5 October 2020Source: Journal of Ethnopharmacology, Volume 260Author(s): Geisla Teles Vieira, Tânia Toledo de Oliveira, Marco Antonio Alves Carneiro, Silvia Dantas Cangussu, Gabriel Almeida Paes Humberto, Jason Guy Taylor, Jorge Luiz Humberto
Source: Journal of Ethnopharmacology - Category: Drugs & Pharmacology Source Type: research
Purpose of review Major studies in interventional cardiology in 2019 have added substantial new evidence for pharmaco-invasive management of coronary artery disease. The review highlights the main findings of a selection of these trials and summarizes their impact on clinical practice. Recent findings Recent randomized studies examining the efficacy of revascularization or medical treatment in stable ischemic heart disease (SIHD), treatment of acute coronary syndromes, emerging interventional devices, adjunctive pharmacotherapy, and intravascular imaging and physiology guidance have substantially advanced the evidence...
Source: Current Opinion in Cardiology - Category: Cardiology Tags: CLINICAL TRIALS: Edited by Neal S. Kleiman Source Type: research
This article will summarize the effects of more intensive blood pressure (BP) control on cardiovascular, cognitive, and renal outcomes among elderly (age ≥75 years) individuals at high risk for cardiovascular events. Subsets of patients who may not benefit and obstacles to implementation will be addressed. The authors’ insights will conclude the review. Recent findings A burst of new research regarding the effects of lower BP targets on cardiovascular, cognitive, and renal endpoints among the elderly has been published. Achieved values of 123 mmHg systolic in those without diabetes or prior stroke revealed st...
Source: Current Opinion in Cardiology - Category: Cardiology Tags: HYPERTENSION: Edited by Hector O. Ventura and Carl J. Lavie Source Type: research
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