• Filter By:
• Specialty
• Source
• Condition
• Cancer
• Infectious Disease
• Drug
• Training
• Management
• Procedure
• Therapy
• Vaccine
• Nutrition
• Country

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

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

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 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