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Benefits and Harms of Oral Anticoagulant Therapy in Chronic Kidney Disease: A Systematic Review and Meta-analysis.
Conclusion: In early-stage CKD, NOACs had a benefit-risk profile superior to that of VKAs. For advanced CKD or ESKD, there was insufficient evidence to establish benefits or harms of VKAs or NOACs. Primary Funding Source: None. (PROSPERO: CRD42017079709). PMID: 31307056 [PubMed - as supplied by publisher]
Source: Annals of Internal Medicine - July 15, 2019 Category: Internal Medicine Authors: Ha JT, Neuen BL, Cheng LP, Jun M, Toyama T, Gallagher MP, Jardine MJ, Sood MM, Garg AX, Palmer SC, Mark PB, Wheeler DC, Jha V, Freedman B, Johnson DW, Perkovic V, Badve SV Tags: Ann Intern Med Source Type: research

Factors affecting the occurrence of gastrointestinal bleeding in acute ischemic stroke patients
In this study, we aimed to examine: (1) the risk factors of GIB in acute cerebral infarction patients; (2) association between GIB and 1-year mortality in patients with acute cerebral infarction. Patients with acute cerebral infarction were divided into 2 groups based on the occurrence of GIB during acute stroke stage. Patient characteristics, clinical presentation, stroke risk factors, comorbidities, laboratory data, medication, and outcomes were investigated to analyze the associations between the variables and the probability of having GIB. In addition, patients in the study were matched individually by age, gender. ...
Source: Medicine - July 1, 2019 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Net clinical benefit analysis of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation and chronic kidney disease: Protocol for a systematic review and meta-analysis
Conclusions: This study will provide new evidence for clinical profile of NOACs on SSE, major bleeding, all-cause death, and NCB in CKD patients. PROSPERO registration number: CRD42019116940.
Source: Medicine - June 1, 2019 Category: Internal Medicine Tags: Research Article: Study Protocol Systematic Review Source Type: research

Gender differences of in-hospital outcomes in patients undergoing percutaneous coronary intervention in the drug-eluting stent era
This study was performed to investigate whether gender influences the in-hospital outcome of PCI in the DES era. A total of 44,967 PCI procedure between January and December of 2014 from the nationwide PCI registry database in Korea were analyzed. The study population was male predominant (70.2%). We examined the association of gender with unadjusted and adjusted in-hospital mortality and composite events of PCI, including mortality, nonfatal myocardial infarction, stent thrombosis, stroke, urgent repeat PCI and bleeding requiring transfusion. Most of the study patients (91.3%) received DES. The incidence rates of in-hos...
Source: Medicine - May 1, 2019 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Comparison of 1-year clinical outcomes between prasugrel and ticagrelor versus clopidogrel in type 2 diabetes patients with acute myocardial infarction underwent successful percutaneous coronary intervention
Although the new oral P2Y12 inhibitors, prasugrel/ticagrelor have shown greater efficacy than clopidogrel in patients with the acute coronary syndrome, but they have not shown better efficacy in Korean patients. So we evaluated the efficacy of the prasugrel/ticagrelor in patients with myocardial infarction (MI) and diabetes, a more high-risk patients group. From the Korea Acute Myocardial Infarction Registry-National Institute of Health, 3985 patients with MI and diabetes who underwent PCI were enrolled between November 2011 and December 2015. The patients were divided into 2 groups: clopidogrel (n = 2985) and prasugr...
Source: Medicine - March 1, 2019 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Oral Anticoagulants in Japanese Patients with Atrial Fibrillation and Active Cancer.
Conclusion The rates of stroke or systemic embolism and major bleeding events were not negligible among Japanese cancer patients with AF receiving OACs. Further investigations on the optimal management of Japanese patients with AF and cancer are needed. PMID: 30799369 [PubMed - as supplied by publisher]
Source: Internal Medicine - February 26, 2019 Category: Internal Medicine Tags: Intern Med Source Type: research

Early versus late clinical outcomes following same day discharge after elective percutaneous coronary intervention: A systematic review and meta-analysis
Conclusions: In those patients who were discharged from the hospital on the same day following elective PCI, no significant difference was observed in the assessed early versus late clinical outcomes. However, late clinical outcomes resulted in a significantly higher rate of re-hospitalization. Larger studies should confirm this hypothesis.
Source: Medicine - January 1, 2019 Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research

Interventions for Preventing Thromboembolic Events in Patients With Atrial Fibrillation: A Systematic Review.
Conclusion: The available direct-acting oral anticoagulants (DOACs) are at least as effective and safe as warfarin for patients with nonvalvular AF. The DOACs had similar benefits across several patient subgroups and seemed safe and efficacious for a wide range of patients with nonvalvular AF. Primary Funding Source: Patient-Centered Outcomes Research Institute. (PROSPERO: CRD42017069999). PMID: 30383133 [PubMed - as supplied by publisher]
Source: Annals of Internal Medicine - October 30, 2018 Category: Internal Medicine Authors: Lowenstern A, Al-Khatib SM, Sharan L, Chatterjee R, LaPointe NMA, Shah B, Borre ED, Raitz G, Goode A, Yapa R, Davis JK, Lallinger K, Schmidt R, Kosinski AS, Sanders GD Tags: Ann Intern Med Source Type: research

Choosing between ticagrelor and clopidogrel following percutaneous coronary intervention: A systematic review and Meta-Analysis (2007–2017)
Conclusion: Ticagrelor and clopidogrel were comparable in terms of efficacy in these patients with ACS. However, the safety outcomes of ticagrelor should further be investigated.
Source: Medicine - October 1, 2018 Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research

Efficacy and safety of CYP2C19 genotype in stroke or transient ischemic attack patients treated with clopidogrel monotherapy or clopidogrel plus aspirin: Protocol for a systemic review and meta-analysis
Conclusions: The results will bring about vigorous evidence in this issue and guide both clinical decision-making and future research.
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Study Protocol Systematic Review Source Type: research

Observational study comparing pharmacoinvasive strategy with primary percutaneous coronary intervention in patients presenting with ST elevation myocardial infarction to a tertiary care centre in India
Conclusion: This observational study showed that pharmacoinvasive strategy was as good as primary PCI in STEMI, in our setting, where primary PCI may be delayed or not possible at all due to financial and logistic constraints.
Source: Journal of Postgraduate Medicine - April 23, 2018 Category: Internal Medicine Authors: AG Alex A Lahiri Devika T Geevar OK George Source Type: research

Atrial Fibrillation had Less Impact on the Risk of Ischemic Stroke in Non-anticoagulated Patients Undergoing Hemodialysis: Insight from the RAKUEN study.
Conclusion A great impact on death, but not ischemic stroke, was observed in non-anticoagulated hemodialysis patients with AF in comparison to those without AF from the analysis of the RAKUEN study. PMID: 29607945 [PubMed - as supplied by publisher]
Source: Internal Medicine - April 4, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Fitting the right non-vitamin K antagonist oral anticoagulant to the right patient with non-valvular atrial fibrillation: An evidence-based choice.
Authors: Li Y, Pastori D, Lip GY Abstract Atrial fibrillation (AF) is the most prevalent arrhythmia and is associated with an increased risk of ischemic stroke (IS) and systemic embolism (SE). Stroke prevention is a key element for the overall management of AF patients. The non-vitamin K antagonist oral anticoagulants (NOACs), such as dabigatran, rivaroxaban, apixaban and edoxaban, are at least as effective as warfarin in reducing IS/SE with a lower rate of major bleeding. Various analyses from the large Phase III randomised trials demonstrated different efficacy and safety of NOACs in specific subgroups of patient...
Source: Annals of Medicine - April 4, 2018 Category: Internal Medicine Tags: Ann Med Source Type: research

Over-the-counter analgesic powder use in patients presenting with intracerebral hemorrhage: A case series
Conclusions: Over-the-counter analgesic powders containing high doses of aspirin including BC Powder and Goody's Powder may contribute to ICH in patients with no or minimal risk factors. Providers should inquire about the use of these powders in ICH patients particularly among African Americans.
Source: Medicine - April 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

A clinical decision support tool for improving adherence to guidelines on anticoagulant therapy in patients with atrial fibrillation at risk of stroke: A cluster-randomized trial in a Swedish primary care setting (the CDS-AF study)
ConclusionsThe present study demonstrates that a CDS can increase guideline adherence for anticoagulant therapy in patients with AF. Even though the observed difference was small, this is the first randomized study to our knowledge indicating beneficial effects with a CDS in patients with AF. Trial registrationClinicalTrials.gov NCT02635685
Source: PLoS Medicine - March 13, 2018 Category: Internal Medicine Authors: Lars O. Karlsson Source Type: research

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