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Source: BMJ Open
Condition: Bleeding

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Total 38 results found since Jan 2013.

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

Antiplatelet regimens in the long-term secondary prevention of transient ischaemic attack and ischaemic stroke: an updated network meta-analysis
Conclusions Cilostazol was significantly more effective than aspirin and clopidogrel alone in the long-term prevention of serious vascular events in patients with prior non-cardioembolic ischaemic stroke or transient ischaemic attack. Cilostazol was associated with a significantly lower bleeding risk than low-dose aspirin (75–162 mg daily) and aspirin (50 mg daily) plus dipyridamole (400 mg daily). Low-dose aspirin was as effective as higher daily doses. However, further large, randomised, controlled, head-to-head trials are needed, especially in non-Asian ethnic groups.
Source: BMJ Open - March 17, 2016 Category: Journals (General) Authors: Niu, P.-P., Guo, Z.-N., Jin, H., Xing, Y.-Q., Yang, Y. Tags: Open access, Evidence based practice, Neurology, Pharmacology and therapeutics Research Source Type: research

Renal safety evaluation of aspirin plus edaravone in patients with ischaemic stroke: a retrospective cohort study
Conclusions Our study indicated that edaravone in patients with ischaemic stroke didn’t increase the nephrotoxicity of aspirin, and even had a protective effect on mild renal deterioration. Nevertheless, there is a need to be cautious when patients are in bad pathophysiological conditions and at high risk of bleeding.
Source: BMJ Open - April 19, 2022 Category: General Medicine Authors: Yang, H.-q., Yin, W.-J., Liu, K., Liu, M.-C., Zuo, X.-c. Tags: Open access, Cardiovascular medicine Source Type: research

Incidence of stroke, systemic embolism and bleeding events in patients without anticoagulation based on real-world data in Japan: a retrospective cohort study
Conclusions Approximately one-third of the patients do not receive any anticoagulation in the modern DOAC era in Japan. The SSE rate increases by the CHADS2 score. The SSE rate is low in patients with a CHADS2 score <1, supporting no indication of anticoagulation in current guidelines. In patients with a CHADS2 score >1, the use of anticoagulant drug therapy is recommended because of a higher risk of stroke.
Source: BMJ Open - November 10, 2022 Category: General Medicine Authors: Tanizawa, K., Nishimura, Y., Sera, S., Yaguchi, D., Okada, A., Nishikawa, M., Tamaru, S., Nagai, N. Tags: Open access, Epidemiology Source Type: research

Early real-world evidence of persistence on oral anticoagulants for stroke prevention in non-valvular atrial fibrillation: a cohort study in UK primary care
Conclusions Observed differential prescribing of OACs can result in channelling bias in comparative effectiveness research. Persistence patterns changed over follow-up time, but there are indications of improved persistence rates with apixaban over other OACs in the UK. A larger study with longer follow-up is needed to corroborate findings. This study is registered on ClinicalTrials.gov (NCT02488421).
Source: BMJ Open - September 25, 2016 Category: Journals (General) Authors: Johnson, M. E., Lefevre, C., Collings, S.-L., Evans, D., Kloss, S., Ridha, E., Maguire, A. Tags: Open access, Cardiovascular medicine, Epidemiology, General practice / Family practice Research Source Type: research

Correction: 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
This article has been corrected since it was published online. The affiliation numbers 1 and 2 have been merged and updated to "Department of Cardiac Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China".
Source: BMJ Open - June 1, 2023 Category: General Medicine Tags: Open access Correction Source Type: research

Systematic review and network meta-analysis comparing antithrombotic agents for the prevention of stroke and major bleeding in patients with atrial fibrillation
Conclusions Compared with standard adjusted dose VKA, new oral anticoagulants were associated with modest reductions in the absolute risk of stroke and major bleeding. People on antiplatelet drugs experienced more strokes compared with anticoagulant drugs without any reduction in bleeding risk. To fully elucidate the comparative benefits and harms of antithrombotic agents across the various subpopulations, rigorously conducted comparative studies or network meta-regression analyses of patient-level data are required. Systematic review registration number PROSPERO registry—CRD42012002721.
Source: BMJ Open - June 2, 2014 Category: Journals (General) Authors: Cameron, C., Coyle, D., Richter, T., Kelly, S., Gauthier, K., Steiner, S., Carrier, M., Coyle, K., Bai, A., Moulton, K., Clifford, T., Wells, G. Tags: Open access, Cardiovascular medicine, Epidemiology, Health policy Research Source Type: research

Potential effects on cardiometabolic risk factors and body composition by short message service (SMS)-guided training after recent minor stroke or transient ischaemic attack: post hoc analyses of the STROKEWALK randomised controlled trial
Conclusions No clear effect of 3 months daily mobile phone delivered training instructions was detected on body composition, cardiovascular biochemical risk factors or self-perceived health. Further research is needed to evaluate secondary prevention efforts in larger populations after recent stroke. Trial registration number NCT02902367.
Source: BMJ Open - October 18, 2021 Category: General Medicine Authors: Vahlberg, B. M., Lundström, E., Eriksson, S., Holmback, U., Cederholm, T. Tags: Open access, Rehabilitation medicine Source Type: research

Impact of gender on event rates at 1 year in patients with newly diagnosed non-valvular atrial fibrillation: contemporary perspective from the GARFIELD-AF registry
Conclusions Women have a higher risk of stroke/SE and the reduction in stroke/SE events rates with AC treatment is less in women than in men. Trial registration number NCT01090362.
Source: BMJ Open - March 5, 2017 Category: Journals (General) Authors: Camm, A. J., Accetta, G., Al Mahmeed, W., Ambrosio, G., Goldhaber, S. Z., Haas, S., Jansky, P., Kayani, G., Misselwitz, F., Oh, S., Oto, A., Raatikainen, P., Steffel, J., van Eickels, M., Kakkar, A. K., for the GARFIELD-AF Investigators Tags: Open access, Cardiovascular medicine Research Source Type: research

Prediction of individual combined benefit and harm for patients with atrial fibrillation considering warfarin therapy: a study protocol
This study has been approved by the KPCO Institutional Review Board and the Hamilton Integrated Research Ethics Board. Results from this study will be published in a peer-reviewed journal electronically and in print. The prediction models may aid in patient-physician shared decision-making when they are considering warfarin therapy.
Source: BMJ Open - November 5, 2015 Category: Journals (General) Authors: Li, G., Holbrook, A., Delate, T., Witt, D. M., Levine, M. A., Thabane, L. Tags: Open access, Cardiovascular medicine, Epidemiology, Pharmacology and therapeutics, Public health Protocol Source Type: research

Using primary care data to assess comparative effectiveness and safety of apixaban and rivaroxaban in patients with nonvalvular atrial fibrillation in the UK: an observational cohort study
Conclusions Among patients with nonvalvular AFib, apixaban was as effective as rivaroxaban in reducing rate of stroke and safer in terms of major bleeding episodes. This head-to-head comparison supports conclusions drawn from indirect comparisons of DOAC trials against warfarin and demonstrates the potential for real-world evidence to fill evidence gaps and reduce uncertainty in both health technology assessment decision-making and clinical guideline development.
Source: BMJ Open - October 17, 2022 Category: General Medicine Authors: Jaksa, A., Gibbs, L., Kent, S., Rowark, S., Duffield, S., Sharma, M., Kincaid, L., Ali, A. K., Patrick, A. R., Govil, P., Jonsson, P., Gatto, N. Tags: Open access, Cardiovascular medicine Source Type: research

Cardiovascular effects of rivaroxaban in heart failure patients with sinus rhythm and coronary disease with and without diabetes: a retrospective international cohort study from COMMANDER-HF
Conclusions In COMMANDER-HF a diagnosis of diabetes conferred higher rates of cardiovascular events that, with exception of ischaemic stroke, was not substantially reduced by rivaroxaban. Rivaroxaban was associated with reduced risk of ischaemic stroke for patients with and without diabetes. Trial registration number NCT01877915; Post-results.
Source: BMJ Open - August 11, 2023 Category: General Medicine Authors: Sharma, A., Caldeira, D., Razaghizad, A., Pinto, F. J., van Veldhuisen, D. J., Mehra, M. R., Lam, C. S. P., Cleland, J., Anker, S. D., Greenberg, B., Ferreira, J. P., Zannad, F. Tags: Open access, Cardiovascular medicine Source Type: research

Effectiveness, safety and costs of thromboembolic prevention in patients with non-valvular atrial fibrillation: phase I ESC-FA protocol study and baseline characteristics of a cohort from a primary care electronic database
Purpose Atrial fibrillation is the most common arrhythmia. Its management aims to reduce symptoms and to prevent complications through rate and rhythm control, management of concomitant cardiac diseases and prevention of related complications, mainly stroke. The main objective of Effectiveness, Safety and Costs in Atrial Fibrillation (ESC-FA) study is to analyse the drugs used for the management of the disease in real-use conditions, particularly the antithrombotic agents for stroke prevention. The aim of this work is to present the study protocol of phase I of the ESC-FA study and the baseline characteristics of newly dia...
Source: BMJ Open - January 28, 2016 Category: Journals (General) Authors: Giner-Soriano, M., Vedia Urgell, C., Roso-Llorach, A., Morros, R., Capella, D., Castells, X., Ferreira-Gonzalez, I., Troncoso Marino, A., Diogene, E., Elorza, J. M., Casajuana, M., Bolibar, B., Violan, C. Tags: Open access, Cardiovascular medicine, Epidemiology, Health services research, Pharmacology and therapeutics Cohort profile Source Type: research

Transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis: a systematic review and meta-analysis
Conclusions No overall change in the risk of death from any cause or cardiovascular mortality was identified but 95% CIs were often wide, indicating uncertainty. TAVI may reduce the risk of certain side effects while SAVR may reduce the risk of others. Most long-term (5-year) results are limited to older patients at high surgical risk (ie, early trials), therefore more data are required for low risk populations. Ultimately, neither surgical technique was considered dominant, and these results suggest that every patient with SAS should be individually engaged in SDM to make evidence-based, personalised decisions around thei...
Source: BMJ Open - December 6, 2021 Category: General Medicine Authors: Swift, S. L., Puehler, T., Misso, K., Lang, S. H., Forbes, C., Kleijnen, J., Danner, M., Kuhn, C., Haneya, A., Seoudy, H., Cremer, J., Frey, N., Lutter, G., Wolff, R., Scheibler, F., Wehkamp, K., Frank, D. Tags: Open access, Cardiovascular medicine Source Type: research

Do baseline characteristics and treatments account for geographical disparities in the outcomes of patients with newly diagnosed atrial fibrillation? The prospective GARFIELD-AF registry
Conclusion The variability in outcomes across countries for patients with newly diagnosed AF is not accounted for by baseline characteristics and antithrombotic treatments. Residual mortality rates were correlated with Healthcare Access and Quality indices. The findings suggest the management of patients with AF needs to not only address guideline indicated and sustained anticoagulation, but also the treatment of comorbidities and lifestyle factors. Trial registration number NCT01090362.
Source: BMJ Open - January 7, 2022 Category: General Medicine Authors: Fox, K. A. A., Virdone, S., Bassand, J.-P., Camm, A. J., Goto, S., Goldhaber, S. Z., Haas, S., Kayani, G., Koretsune, Y., Misselwitz, F., Oh, S., Piccini, J. P., Parkhomenko, A., Sawhney, J. P. S., Stepinska, J., Turpie, A. G. G., Verheugt, F. W. A., Kakk Tags: Open access, Cardiovascular medicine Source Type: research