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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

Rationale design and efficacy of a smartphone application for improving self-awareness of adherence to edoxaban treatment: study protocol for a randomised controlled trial (adhere app)
This study was approved by the Seoul National University Bundang Hospital Institutional Review Board and will be conducted according to the principles of the Declaration of Helsinki. The study results will be published in a reputable journal. Trial registration number KCT0004754.
Source: BMJ Open - April 27, 2022 Category: General Medicine Authors: Kim, I.-C., Lee, J. H., Choi, D.-J., Park, S.-J., Lee, J.-H., Park, S. M., Kim, M., Kim, H.-L., Lee, S., Kim, I. J., Choi, S., Bang, J., Ali, B., Hussain, M., Ali, T., Lee, S. Tags: Open access, Cardiovascular medicine 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

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

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

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

Disparities by sex in P2Y12 inhibitor therapy duration, or differences in the balance of ischaemic-benefit and bleeding-risk clinical outcomes in older women versus comparable men following acute myocardial infarction? A P2Y12 inhibitor new user retrospective cohort analysis of US Medicare claims data
Conclusions Risks for death/hospice and ischaemic events were lower among women still taking a P2Y12 inhibitor than comparable men, with no difference in bleeding risks. Shorter P2Y12 inhibitor durations in older women than comparable men observed between 12 and 24 months post-AMI may reflect a disparity that is not justified by differences in clinical need.
Source: BMJ Open - December 1, 2021 Category: General Medicine Authors: Hickson, R. P., Kucharska-Newton, A. M., Rodgers, J. E., Sleath, B. L., Fang, G. Tags: Open access, Cardiovascular medicine Source Type: research

Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database
Conclusions Surgical SAVR±CABG has low mortality risk and a low level of complications in the UK in people of all ages and risk factors. These results should inform consideration of treatment options in people with aortic valve disease.
Source: BMJ Open - October 28, 2021 Category: General Medicine Authors: Jahangiri, M., Bilkhu, R., Embleton-Thirsk, A., Dehbi, H.-M., Mani, K., Anderson, J., Avlonitis, V., Baghai, M., Birdi, I., Booth, K., Bose, A., Briffa, N., Buchan, K., Bhudia, S., Cale, A., Deglurkar, I., Farid, S., Hadjinikolaou, L., Jarvis, M., Javadpo Tags: Open access, Cardiovascular medicine 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

Prospective randomised trial examining the impact of an educational intervention versus usual care on anticoagulation therapy control based on an SAMe-TT2R2 score-guided strategy in anticoagulant-naïve Thai patients with atrial fibrillation (TREATS-AF): a study protocol
Introduction The burden of atrial fibrillation (AF) in Thailand is high and associated with increased morbidity, mortality and healthcare costs. Vitamin K antagonists (eg, warfarin), commonly used for stroke prevention in patients with AF in Thailand, are effective but are often suboptimally controlled. We aim to evaluate the impact of an SAMe-TT2R2 score-guided strategy and educational intervention compared to usual care on anticoagulation control expressed by the time in therapeutic range (TTR) at 12 months, in anticoagulant-naïve Thai patients with AF. Methods and analysis Multicentre, open-label, parallel-grou...
Source: BMJ Open - October 11, 2021 Category: General Medicine Authors: Phrommintikul, A., Nathisuwan, S., Gunaparn, S., Krittayaphong, R., Wongcharoen, W., Sehmi, S., Mehta, S., Winkles, N., Brocklehurst, P., Mathers, J., Jowett, S., Jolly, K., Lane, D., Thomas, G. N., Lip, G. Y. H., TREATS-AF Study Group, Prasertwitayakij, Tags: Open access, Medical management 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

In-hospital gastrointestinal bleeding in patients with acute myocardial infarction: incidence, outcomes and risk factors analysis from China Acute Myocardial Infarction Registry
Conclusions GIB is associated with both in-hospital and follow-up MACCEs. Gastrointestinal prophylactic treatment should be administered to patients with AMI who receive primary PCI, thrombolytic therapy or GPIIb/IIIa receptor inhibitor. Trial registration number NCT01874691.
Source: BMJ Open - September 7, 2021 Category: General Medicine Authors: Shi, W., Fan, X., Yang, J., Ni, L., Su, S., Yu, M., Yang, H., Yu, M., Yang, Y., On behalf of China Acute Myocardial Infarction(CAMI) Registry Study Group Tags: Open access, Cardiovascular medicine Source Type: research

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

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

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

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