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Stroke prevention of thoracoscopic left atrial appendage clipping in patients with non-valvular atrial fibrillation at high risk of stroke and bleeding: study protocol for a non-randomised controlled clinical trial
Introduction Non-valvular atrial fibrillation (NVAF) is a high-risk factor for ischaemic stroke. The 2016 European Society of Cardiology Atrial Fibrillation Management guidelines recommend oral anticoagulants (OACs) to prevent stroke in men with CHA2DS2-VASc scores ≥2 and women ≥3. However, in patients with a high risk of stroke and a high risk of bleeding (HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (> 65 years), Drugs/alcohol concomitantly) score≥3), OAC had a higher risk of bleeding. Left atrial appendage cl...
Source: BMJ Open - October 28, 2022 Category: General Medicine Authors: Ye, C., Han, X., Chen, Y., Liu, F., Ma, H., Yang, Y., Liu, Y., Hu, Q., Yao, Q., Xie, W., Xu, D. Tags: Open access, Surgery Source Type: research

Understanding clinicians' decisions to offer intravenous thrombolytic treatment to patients with acute ischaemic stroke: a protocol for a discrete choice experiment
Background Intravenous thrombolysis is an effective emergency treatment for acute ischaemic stroke for patients meeting specific criteria. Approximately 12% of eligible patients in England, Wales and Northern Ireland received thrombolysis in the first quarter of 2013, yet as many as 15% are eligible to receive treatment. Suboptimal use of thrombolysis may have been largely attributable to structural factors; however, with the widespread implementation of 24/7 hyper acute stroke services, continuing variation is likely to reflect differences in clinical decision-making, in particular the influence of ambiguous areas within ...
Source: BMJ Open - July 9, 2014 Category: Journals (General) Authors: De Brun,, A., Flynn, D., Joyce, K., Ternent, L., Price, C., Rodgers, H., Ford, G. A., Lancsar, E., Rudd, M., Thomson, R. G. Tags: Open access, Health services research Protocol Source Type: research

Stand-Alone Left Atrial appendage occlusion for throMboembolism prevention in nonvalvular Atrial fibrillatioN DiseasE Registry (SALAMANDER): protocol for a prospective observational nationwide study
Introduction Atrial fibrillation (AF) is a prevalent disease considerably contributing to the worldwide cardiovascular burden. For patients at high thromboembolic risk (CHA2DS2-VASc ≥3) and not suitable for chronic oral anticoagulation, owing to history of major bleeding or other contraindications, left atrial appendage occlusion (LAAO) is indicated for stroke prevention, as it lowers patient’s ischaemic burden without augmentation in their anticoagulation profile. Methods and analysis Stand-Alone Left Atrial appendage occlusion for throMboembolism prevention in nonvalvular Atrial fibrillatioN DiseasE Registry (S...
Source: BMJ Open - September 21, 2022 Category: General Medicine Authors: Kowalewski, M., Wanha, W., Litwinowicz, R., Kołodziejczak, M., Pasierski, M., Januszek, R., Kuzma, Łukasz, Grygier, M., Lesiak, M., Kapłon-Cieslicka, A., Reczuch, K., Gil, R., Pawłowski, T., Bartus, K., Dobrzycki, S., Lorusso, Tags: Open access, Cardiovascular medicine Source Type: research

Antithrombotic stewardship: a multidisciplinary team approach towards improving antithrombotic therapy outcomes during and after hospitalisation: a study protocol
In this study, the effect of the implementation of a multidisciplinary antithrombotic team is compared with usual care using a pre-post study design. The study is performed at the Erasmus University Medical Center Rotterdam and the Reinier de Graaf Hospital Delft. Patients who are or will be treated with antithrombotics are included in the study. We aim to include 1900 patients, 950 in each hospital. Primary outcome is the proportion of patients with a composite end point consisting of ≥1 bleeding or ≥1 thrombotic event from the beginning of antithrombotic therapy (or hospitalisation) until 3 months after hospit...
Source: BMJ Open - December 19, 2016 Category: Journals (General) Authors: Dreijer, A. R., Kruip, M. J. H. A., Diepstraten, J., Polinder, S., Brouwer, R., Leebeek, F. W. G., Vulto, A. G., van den Bemt, P. M. L. A. Tags: Open access, Epidemiology, Haematology (incl blood transfusion), Health economics Protocol Source Type: research

Optimal duration of dual antiplatelet therapy following percutaneous coronary intervention: protocol for an umbrella review
Introduction Although dual antiplatelet therapy (DAPT) is routinely given to patients after percutaneous coronary intervention (PCI) with stenting, the optimal duration is unknown. Recent evidence indicates there may be benefits in extending the duration beyond 12 months but such decisions may increase the risk of bleeding. Our objective is to provide a comprehensive overview of the literature for clinicians and policymakers via an umbrella review assessing the optimal duration of DAPT. Methods and analysis We will perform a comprehensive search of the published and grey literature for systematic reviews involving ra...
Source: BMJ Open - April 4, 2017 Category: Journals (General) Authors: Elliott, J., Kelly, S. E., Bai, Z., Liu, W., Skidmore, B., Boucher, M., So, D. Y. F., Wells, G. A. Tags: Open access, Cardiovascular medicine, Evidence based practice Protocol Source Type: research

Randomised controlled trial to investigate optimal antithrombotic therapy in patients with non-valvular atrial fibrillation undergoing percutaneous coronary intervention: a study protocol of the OPTIMA-AF trial
This study received approval from the Certified Review Board of Osaka University (a certified research ethics committee by the Japanese Clinical Research Act). The findings will be disseminated through peer-reviewed publications and conference presentations. Trial registration number Japan Registry of Clinical Trials: jRCTs051190053; Pre-results.
Source: BMJ Open - December 14, 2021 Category: General Medicine Authors: Sotomi, Y., Kozuma, K., Kashiwabara, K., Higuchi, Y., Ando, K., Morino, Y., Ako, J., Tanabe, K., Muramatsu, T., Nakazawa, G., Hikoso, S., Sakata, Y., on behalf of the OPTIMA-AF Investigators Tags: Open access, Cardiovascular medicine Source Type: research

Continuation versus discontinuation of aspirin-based antiplatelet therapy for perioperative bleeding and ischaemic events in adults undergoing neurosurgery: protocol for a systematic review and meta-analysis
Introduction Antiplatelet therapy is commonly used in primary or secondary prevention of atherosclerotic and thrombotic diseases, such as coronary artery disease, transient ischaemic attack or stroke. Recent studies noted that antiplatelet therapy should be continued perioperatively in patients at high risk of thrombosis and low bleeding risk in orthopaedic, spinal or urological surgery. However, evidence in neurosurgery is lacking. Thus, we aim to conduct a systematic review and meta-analysis to assess whether the continuous use of antiplatelet drugs in neurosurgery increases the risk of perioperative bleeding. Methods a...
Source: BMJ Open - September 30, 2021 Category: General Medicine Authors: Wang, X., Wang, X., Yu, Y., Han, R. Tags: Open access, Anaesthesia Source Type: research

Effect of aspirin in takotsubo syndrome: protocol of a systematic review and meta-analysis
This study aims to evaluate the impact of long-term maintenance treatment of aspirin in TTS and provides insights in clinical management. Methods and analysis After searching through electronic databases (PubMed, Embase, Cochrane Library, Web of Science, National Library of Medicine Gateway, CNKI, Wanfang and VIP), grey literatures, conference abstract and trial registries for clinical studies investigating the impact of aspirin on patients with TTS, a systemic review and meta-analysis will be conducted. The search will be limited from inception of each database to 1 August 2020. The outcomes including all-cause death, TT...
Source: BMJ Open - August 10, 2021 Category: General Medicine Authors: Lin, J., Wu, B., Lin, L., Ding, Y., Zhong, B., Huang, Z., Lin, M., Xu, D.-P. Tags: Open access, Cardiovascular medicine Source Type: research

Rationale and design for comparison of non-compliant balloon with drug-coating balloon angioplasty for side branch after provisional stenting for patients with true coronary bifurcation lesions: a prospective, multicentre and randomised DCB-BIF trial
Introduction Provisional stenting using drug-eluting stent is effective for simple coronary bifurcation lesions. Kissing balloon inflation using conventional non-compliant balloon is the primary treatment of side branch (SB) after main vessel (MV) stenting. Drug-coating balloon (DCB) is reported to be associated with less frequent clinical events in in-stent restenosis and small vessel disease. The importance of DCB in bifurcation treatment is understudied. Accordingly, this trial is designed to investigate the superiority of DCB to non-compliant balloon angioplasty for SB after provisional stenting in patients with true c...
Source: BMJ Open - March 11, 2022 Category: General Medicine Authors: Gao, X.-F., Ge, Z., Kan, J., Kong, X.-Q., Wang, Y., Qiu, C.-G., Tresukosol, D., He, Y.-Q., Wu, Q., Li, J.-F., Yuan, H.-T., Shen, C., Chen, X., Munawar, M., Hanif, B., Santoso, T., Shin, E.-S., Sheiban, I., Ye, F., Zhang, J.-J., Chen, S.-L., On behalf of t Tags: Open access, Cardiovascular medicine Source Type: research