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Source: JAMA
Condition: Bleeding

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Total 14 results found since Jan 2013.

Benefits of Pulmonary Vein Isolation Beyond Rhythm Control
The prevalence of atrial fibrillation (AF) is continually increasing, with major implications for patients and health care systems given the increased morbidity and mortality. Approximately one-third of patients with AF additionally are affected by mental health conditions (notably depression, anxiety, and perceived stress). Psychological distress conditions are independent risk factors for adverse cardiovascular outcomes (including stroke and major bleeding) in patients with AF and promote AF recurrence. Without doubt, these associations add more complexity to comprehensive treatment decisions for patients with AF.
Source: JAMA - September 12, 2023 Category: General Medicine Source Type: research

Rivaroxaban vs Apixaban and Ischemic or Hemorrhagic Events in Patients With Atrial Fibrillation —Reply
In Reply Dr Gu questions whether the differences in outcomes reported in our study of rivaroxaban vs apixaban are clinically significant. A widely accepted measure of clinical impact is the number needed to harm, estimated as the reciprocal of the rate difference. We found 1 additional major ischemic or hemorrhagic event for every 370 patients treated with rivaroxaban compared with apixaban. Given the severity of the study events —stroke, other intracranial hemorrhage, and fatal bleeding—we disagree with the contention that the difference is not clinically important. Furthermore, the number needed to harm for nonfatal ...
Source: JAMA - April 5, 2022 Category: General Medicine Source Type: research

Informing the Choice of Direct Oral Anticoagulant Therapy in Patients With Atrial Fibrillation
Anticoagulation is the fundamental priority for the prevention of stroke in patients with atrial fibrillation, yet enthusiasm for use among patients at highest thromboembolic risk is often tempered by concern for increased bleeding. In one of the earliest studies evaluating vitamin K antagonists (VKA) in atrial fibrillation, Askey and Cherry noted in 1950 that anticoagulant use for thromboembolic prophylaxis requires “a reasonable assurance that the benefit will justify the bother and expense of control and the dangers of the drug,” and predicted that “safer anticoagulant drugs will be available eventually.” It wou...
Source: JAMA - December 21, 2021 Category: General Medicine Source Type: research

Net Adverse Clinical Events With Antiplatelet Therapy in Acute Coronary Syndromes
Clopidogrel, prasugrel, and ticagrelor are oral platelet P2Y12 receptor inhibitors that decrease the risk of platelet-mediated coronary artery thrombosis. Clinical guidelines have recommended ticagrelor or prasugrel over clopidogrel in combination with aspirin as dual antiplatelet therapy (DAPT) for 1 year after acute coronary syndrome (ACS), whether or not percutaneous coronary intervention (PCI) is performed. The ticagrelor recommendation was based on the Study of Platelet Inhibition and Patient Outcomes (PLATO) trial, which enrolled 18  624 patients with ACS and randomized them to receive DAPT with either clopidogrel ...
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research

How Effective and Safe Is Factor XI Inhibition in Preventing Venous Thrombosis?
The introduction of the direct oral anticoagulants for stroke prevention in atrial fibrillation and the management of thromboembolism has transformed the care of patients with these disorders. These drugs, which selectively and reversibly inhibit factor Xa or thrombin in the common pathway of the coagulation cascade, have a wide therapeutic window; this allows for simplified dosing regimens without laboratory monitoring of most adult patients as contrasted to vitamin K antagonists. This class of drug is also associated with a lower bleeding risk than vitamin K antagonists, which has been most clearly demonstrated by a 50% ...
Source: JAMA - January 14, 2020 Category: General Medicine Source Type: research

Catheter Ablation Compared With Drug Therapy for Atrial Fibrillation
To the Editor Dr Packer and colleagues for the CABANA Investigators demonstrated no significant difference between catheter ablation and antiarrhythmic drug therapy in patients with paroxysmal and persistent atrial fibrillation on the composite primary end point of death, disabling stroke, serious bleeding, or cardiac arrest. For the composite secondary end point of death or CV hospitalization, patients randomized to catheter ablation had better event-free survival than those randomized to antiarrhythmic drugs.
Source: JAMA - September 17, 2019 Category: General Medicine Source Type: research

Association of Aspirin Use for Primary Prevention of CVD With Cardiovascular Events and Bleeding
This meta-analysis estimates the association between use of aspirin for primary prevention of cardiovascular disease and the rate of cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, and bleeding.
Source: JAMA - January 22, 2019 Category: General Medicine Source Type: research

Clinical Considerations for Aspirin Use for Primary Prevention in 2019
Reducing platelet activity with aspirin and other antiplatelet agents is an important factor in the prevention and management of atherothrombotic vascular events. For this indication, aspirin has both beneficial and potentially harmful effects; it can diminish or reverse thrombus formation (eg, in the setting of acute myocardial infarction or stroke), but it also increases the risk of bleeding.
Source: JAMA - January 22, 2019 Category: General Medicine Source Type: research

Mixing Study for Evaluation of Abnormal Coagulation Testing
An 84-year-old woman with a history of chronic kidney disease, prior stroke, and hypertension but no personal or family history of bleeding disorders was admitted with a 2-week history of spontaneous subcutaneous ecchymoses and hematomas. She had normal vital signs, laboratory results showing isolated severe anemia but unremarkable for other causes of anemia, and a large soft-tissue hematoma in the left chest wall without evidence of internal hemorrhage. How do you interpret these test results?
Source: JAMA - November 22, 2016 Category: Journals (General) Source Type: research

Adverse Events Linked With LVADs
The 2 FDA-approved implantable left ventricular assist devices (LVADs) currently on the market have been linked with serious adverse events, including stroke and bleeding complications (http://1.usa.gov/1OQwgwX).
Source: JAMA - September 15, 2015 Category: Journals (General) Source Type: research

Antiplatelet Therapy Duration Following Bare Metal or Drug-Eluting Coronary Stents The Dual Antiplatelet Therapy Randomized Clinical Trial
ImportanceDespite antirestenotic efficacy of coronary drug-eluting stents (DES) compared with bare metal stents (BMS), the relative risk of stent thrombosis and adverse cardiovascular events is unclear. Although dual antiplatelet therapy (DAPT) beyond 1 year provides ischemic event protection after DES, ischemic event risk is perceived to be less after BMS, and the appropriate duration of DAPT after BMS is unknown.ObjectiveTo compare (1) rates of stent thrombosis and major adverse cardiac and cerebrovascular events (MACCE; composite of death, myocardial infarction, or stroke) after 30 vs 12 months of thienopyridine in pati...
Source: JAMA - March 17, 2015 Category: Journals (General) Source Type: research

Association of NSAID Use With Risk of Bleeding and Cardiovascular Events in Patients Receiving Antithrombotic Therapy After Myocardial Infarction
Conclusions and RelevanceAmong patients receiving antithrombotic therapy after MI, the use of NSAIDs was associated with increased risk of bleeding and excess thrombotic events, even after short-term treatment. More research is needed to confirm these findings; however, physicians should exercise appropriate caution when prescribing NSAIDs for patients who have recently experienced MI.
Source: JAMA - February 24, 2015 Category: Journals (General) Source Type: research

Association Between the Use of Fondaparinux vs Low-Molecular-Weight Heparin and Clinical Outcomes in Patients With Non–ST-Segment Elevation Myocardial Infarction
Conclusions and RelevanceIn routine clinical care of patients with NSTEMI, fondaparinux was associated with lower odds than LMWH of major bleeding events and death both in-hospital and up to 180 days afterward.
Source: JAMA - February 17, 2015 Category: Journals (General) Source Type: research

Association of the 2011 ACGME Resident Duty Hour Reforms With Mortality and Readmissions Among Hospitalized Medicare Patients
Conclusions and RelevanceAmong Medicare beneficiaries, there were no significant differences in the change in 30-day mortality rates or 30-day all-cause readmission rates for those hospitalized in more intensive relative to less intensive teaching hospitals in the year after implementation of the 2011 ACGME duty hour reforms compared with those hospitalized in the 2 years before implementation.
Source: JAMA - December 10, 2014 Category: Journals (General) Source Type: research