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Local anaesthetics combined with vasoconstrictors in patients with cardiovascular disease undergoing dental procedures: systematic review and meta-analysis
Conclusions The results suggest that the use of LA with vasoconstrictors (epinephrine in low doses) is safe in patients with some types of CVD. However, the low quality of evidence demonstrated that literature needs further studies in order to confirm these results. Protocol registration PROSPERO (CRD42016045421).
Source: BMJ Open - July 15, 2021 Category: General Medicine Authors: Guimaraes, C. C., Lopes, L. C., Bergamaschi, C. d. C., Ramacciato, J. C., Silva, M. T., Araujo, J. d. O., de Andrade, N. K., Motta, R. H. L. Tags: Open access, Anaesthesia Source Type: research

Very early invasive angiography versus standard of care in higher-risk non-ST elevation myocardial infarction: study protocol for the prospective multicentre randomised controlled RAPID N-STEMI trial
Background There are a paucity of randomised data on the optimal timing of invasive coronary angiography (ICA) in higher-risk patients with non-ST elevation myocardial infarction (N-STEMI). International guideline recommendations for early ICA are primarily based on retrospective subgroup analyses of neutral trials. Aims The RAPID N-STEMI trial aims to determine whether very early percutaneous revascularisation improves clinical outcomes as compared with a standard of care strategy in higher-risk N-STEMI patients. Methods and analysis RAPID N-STEMI is a prospective, multicentre, open-label, randomised-controlled, pragmat...
Source: BMJ Open - May 3, 2022 Category: General Medicine Authors: Kite, T. A., Banning, A. S., Ladwiniec, A., Gale, C. P., Greenwood, J. P., Dalby, M., Hobson, R., Barber, S., Parker, E., Berry, C., Flather, M. D., Curzen, N., Banning, A. P., McCann, G. P., Gershlick, A. H. Tags: Open access, Cardiovascular medicine, COVID-19 Source Type: research

Safety and effectiveness of appropriately and inappropriately dosed rivaroxaban or apixaban versus warfarin in patients with atrial fibrillation: a cohort study with nested case-control analyses from UK primary care
Conclusions Dosing appropriateness in NVAF was not associated with a significant difference in IS/SE risk or increase in ICB risk versus warfarin. These findings may reflect residual confounding and biases that were difficult to control, as also seen in other observational studies. They should, therefore, be interpreted with caution, and prescribers should adhere to the dosing instructions in the respective Summary of Product Characteristics. Further studies on this topic from real-world populations are needed.
Source: BMJ Open - June 2, 2022 Category: General Medicine Authors: Gonzalez-Perez, A., Roberts, L., Vora, P., Saez, M. E., Brobert, G., Fatoba, S., Garcia Rodriguez, L. A. Tags: Open access, Cardiovascular medicine Source Type: research

Impact of multimorbidity on long-term outcomes in older adults with non-ST elevation acute coronary syndrome in the North East of England: a multi-centre cohort study of patients undergoing invasive care
Conclusions In older adults with NSTE-ACS referred for coronary angiography, the presence of multimorbidity is associated with an increased risk of long-term adverse cardiovascular events, driven by a higher risk of all-cause mortality. Trial registration number NCT01933581; ClinicalTrials.gov.
Source: BMJ Open - July 26, 2022 Category: General Medicine Authors: Beska, B., Mills, G. B., Ratcovich, H., Wilkinson, C., Damluji, A. A., Kunadian, V. Tags: Open access, Cardiovascular medicine Source Type: research

Temporal trends in anticoagulation management for US active duty personnel with atrial fibrillation
Conclusions This is the first report describing AC utilisation in US AD military members with AF. Young AD personnel with low stroke and bleeding risks do not commonly receive AC prescriptions. DOAC prescription rates are increasing and predominate over warfarin for AC indications.
Source: BMJ Open - November 29, 2022 Category: General Medicine Authors: Keithler, A. N., Wilson, A. S., Yuan, A., Sosa, J. M., Bush, K. N. V. Tags: Open access, Cardiovascular medicine Source Type: research

Vitamin-K-antagonist phenprocoumon versus direct oral anticoagulants in patients with atrial fibrillation: a real-world analysis of German claims data
Conclusions The small superiority or non-inferiority of DOACs over warfarin seen in the RCTs might not translate into relevant advantages of DOACs over phenprocoumon. To confirm the hypothesis, an RCT with phenprocoumon is needed. Next to the safety and effectiveness assessments other factors might also play a substantial role in the decision on the right OAC for stroke prevention.
Source: BMJ Open - January 2, 2023 Category: General Medicine Authors: Warkentin, L., Klohn, F., Deiters, B., Kühlein, T., Hueber, S. Tags: Open access, Pharmacology and therapeutics Source Type: research

Registry for Evaluating Healthy Life Expectancy and Long-Term Outcomes after Catheter Ablation of Atrial Fibrillation in the Very Elderly (REHEALTH AF) study: rationale and design of a prospective, multicentre, observational, comparative study
Introduction Data are lacking on the extent to which patients with non-valvular atrial fibrillation (AF) who are aged ≥80 years benefit from ablation treatment. The question pertains especially to patients’ postablation quality of life (QoL) and long-term clinical outcomes. Methods and analysis We are initiating a prospective, registry-based, multicentre observational study that will include patients aged ≥80 years with non-valvular AF who choose to undergo treatment by catheter ablation and, for comparison, such patients who do not choose to undergo ablation (either according to their physician’s advice...
Source: BMJ Open - February 15, 2023 Category: General Medicine Authors: Okumura, Y., Nagashima, K., Watanabe, R., Yokoyama, K., Kato, T., Fukaya, H., Hayashi, H., Nakahara, S., Shimizu, W., Iwasaki, Y.-k., Fujimoto, Y., Mukai, Y., Ejima, K., Otsuka, T., Suzuki, S., Murakami, M., Kimura, M., Harada, M., Koyama, J., Okamatsu, H Tags: Open access, Cardiovascular medicine Source Type: research

Screening over 100 000 patients in 39 general practices in the Netherlands for anticoagulation underprescription in atrial fibrillation: a descriptive, cross-sectional study
Conclusions In this large Dutch study among GPs, we observed 9.8% underprescription of OAC in AF patients. In 76% of the AF patients lacking a prescription for OAC, no documentation for deviating from the guidelines was found. Only in a minority of cases detection of OAC underprescription lead to OAC initiation.
Source: BMJ Open - August 18, 2023 Category: General Medicine Authors: Voorhout, L., Pisters, R., Geurts, C. H. P. H., Oostindjer, A., van Doorn, S., Rila, H., Fuijkschot, W. W., Verheugt, F., Hemels, M. E. W. Tags: Open access, Cardiovascular medicine Source Type: research

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