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Specialty: Internal Medicine
Condition: Bleeding

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Total 325 results found since Jan 2013.

Discontinuation of oral anticoagulation preceding acute ischemic stroke - prevalence and outcomes: Comprehensive chart review.
CONCLUSION: About 2.6% or 1 in every 38 of all ischemic stokes occurred after OAC discontinuation. Strokes occurring after OAC discontinuation also have higher mortality and morbidity. Our data suggest that any planned discontinuation of OAC, however brief, should be carefully considered. PMID: 26239873 [PubMed - as supplied by publisher]
Source: Postgraduate Medicine - August 5, 2015 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Use of non‐vitamin K antagonist oral anticoagulants in atrial fibrillation patients: insights from a specialist atrial fibrillation clinic
ConclusionIn this specialist AF clinic, patients prescribed NOACs had a favourable adverse event profile with good efficacy for stroke prevention, with a low rate of cessation or switch to warfarin.
Source: International Journal of Clinical Practice - August 3, 2015 Category: Internal Medicine Authors: S. I. Lee, M. Sayers, G. Y. H. Lip, D. A. Lane Tags: Original Paper Source Type: research

A Meta-Analysis of Randomized Controlled Trials on Antiplatelet Agents Versus Placebo/Control for Treating Peripheral Artery Disease
Abstract: Effect of aspirin (antiplatelet agents) in patients with peripheral artery disease (PAD) was still controversial. Varying studies reported varying results. Therefore, we did this meta-analysis to investigate if aspirin could reduce cardiovascular events in patients with PAD. A comprehensive literature search (PubMed, CCTR, Embase, Web of Science, CNKI, CBM-disc, and relevant websites) was conducted from 1990 to September 2014. The key search terms (“aspirin,” “PAD,” “peripheral arterial occlusive diseases,” and “claudication”) produced 9 high-quality randomized controlled trials (RCTs) of aspirin ...
Source: Medicine - August 1, 2015 Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research

Long-term ticagrelor therapy in patients with prior myocardial infarction significantly reduces ischaemic events, albeit with increased bleeding
Commentary on: Bonaca MP, Bhatt DL, Cohen M, et al., PEGASUS-TIMI 54 Steering Committee and Investigators. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med 2015;372:1791–800. Context Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor antagonist constitute the cornerstone of treatment in patients with acute coronary syndrome (ACS) with a recommended duration of 1 year.1 Nevertheless, high rates of atherothrombotic events, for which platelet activation is heavily implicated, still occur at later stages.2 Therefore, a longer duration of DAPT appears intuitive, a...
Source: Evidence-Based Medicine - July 24, 2015 Category: Internal Medicine Authors: Alexopoulos, D. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Diabetes Therapeutics/Prevention Source Type: research

Patient Characteristics and Risk of Bleeding With Dabigatran
To the Editor We appreciate the interesting study by Hernandez et al on the risk of bleeding with dabigatran in patients with atrial fibrillation. These are important data to an ongoing controversy. However, we would appreciate an author comment regarding the external validity of the study. To what extent is this sample of Medicare beneficiaries representative of the general population of patients with atrial fibrillation? Comparing the characteristics of patients in the RE-LY Study and the Danish population-based study, it seems that these are not effortlessly comparable. In the study by Hernandez et al, patients are cons...
Source: JAMA Internal Medicine - July 1, 2015 Category: Internal Medicine Source Type: research

Eicosapentaenoic Acid as long-term secondary prevention after ischemic stroke
Conclusion: Hemorrhagic stroke was not occurred in our observation of EPA prescribed patients. The clinical features of recurrent stroke patients were the existing complications of dyslipidemia and renal dysfunction.
Source: Clinical and Translational Medicine - June 11, 2015 Category: Internal Medicine Authors: Taizen NakaseMasahiro SasakiAkifumi Suzuki Source Type: research

Feasibility and safety of uninterrupted dabigatran therapy in patients undergoing ablation for atrial fibrillation.
Conclusion Uninterrupted dabigatran therapy in CA for AF thus may be a safe and effective anticoagulant therapy, and appears to be closely similar to continuous warfarin; however, it is essential to pay close attention to the APTT values when using dabigatran during CA. PMID: 25986252 [PubMed - in process]
Source: Internal Medicine - June 3, 2015 Category: Internal Medicine Tags: Intern Med Source Type: research

Intraaortic balloon pump in patients with cardiogenic shock complicating myocardial infarction: a systematic review and meta-analysis of randomized trials.
CONCLUSIONS: The use of IABP in patients with cardiogenic shock complicating myocardial ischemia does not reduce mortality (moderate confidence) and is not associated with a higher risk of complications (very low to low confidence). The results should be interpreted with caution owing to limitations such as imprecision, risk of bias, and clinical heterogeneity. PMID: 25698226 [PubMed - in process]
Source: Polskie Archiwum Medycyny Wewnetrznej - June 3, 2015 Category: Internal Medicine Tags: Pol Arch Med Wewn Source Type: research

Prolonged dual antiplatelet therapy after drug-eluting stent reduces the risk of stent thrombosis and major cardiovascular events but increases the rate of bleeding
This study is an international, randomised, placebo-controlled trial that was designed to determine the benefits and risks of continuing DAPT beyond 1 year after the placement of a coronary stent. The study enrolled 9961 patients. After 12 months of DAPT, patients were randomly assigned to continue thienopyridine treatment or to receive placebo for another 18 months, all...
Source: Evidence-Based Medicine - May 22, 2015 Category: Internal Medicine Authors: Helft, G. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Venous thromboembolism, Guidelines Therapeutics/Prevention Source Type: research

Using the Watchman device to close the left atrial appendage reduces risk of stroke in atrial fibrillation, compared to using warfarin
Commentary to: Reddy VY, Sievert H, Halperin J, et al.; PROTECT AF Steering Committee and Investigators. Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation: a randomized clinical trial. JAMA 2014;312:1988–98 . Context Atrial fibrillation (AF) is a common arrhythmia in clinical practice. The major complication of AF is thromboembolic stroke. Patients with AF have a fivefold higher risk of stroke and a twofold increase in mortality.1 As complete cure for AF is never certain, the aims of AF therapy are symptom relief and prevention of thromboembolic events. The latter can be managed by vitami...
Source: Evidence-Based Medicine - May 22, 2015 Category: Internal Medicine Authors: Swaans, M. J., Alipour, A., Boersma, L. V. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Arrhythmias Therapeutics/Prevention Source Type: research

Vitamin K antagonist-experienced patients with a history of stroke/transient ischaemic attack who switched from warfarin to dabigatran increased their rate of recurrent stroke/transient ischaemic attack compared with those on warfarin
Commentary on: Larsen TB, Rasmussen LH, Gorst-Rasmussen A, et al. Dabigatran and warfarin for secondary prevention of stroke in atrial fibrillation patients: a nationwide cohort study. Am J Med 2014;127:1172–8 . Context Randomised trials have shown that patients with atrial fibrillation (AF) who are treated with a non-vitamin K antagonist oral anticoagulant (NOAC), compared with warfarin, have similar or lower rates of stroke and major bleeding, markedly reduced rates of intracranial bleeding and a consistent pattern of reduced mortality.1 Dabigatran 150 mg two times a day is the only NOAC that can significantly...
Source: Evidence-Based Medicine - May 22, 2015 Category: Internal Medicine Authors: Eikelboom, J. W., Bosch, J. Tags: Epidemiologic studies, Time-to-event methods, Drugs: cardiovascular system, Stroke, Arrhythmias Aetiology/Harm Source Type: research

Anticoagulant Prescription in Patients With AF
In patients with atrial fibrillation (AF) who are at risk for thromboembolism, anticoagulation therapy with warfarin or the newer novel anticoagulants reduces morbidity and mortality. Because oral anticoagulant use carries a risk of bleeding, the drugs are not recommended in patients with AF who are at a particularly low risk for stroke. Specifically, previous AF guidelines recommend against the use of oral anticoagulation in patients younger than 60 years without heart disease or other known risk factors for thromboembolism, and more recently updated guidelines do not recommend the use of oral anticoagulation in patients ...
Source: JAMA Internal Medicine - April 13, 2015 Category: Internal Medicine Source Type: research

Stroke prevention with rivaroxaban in higher‐risk populations with atrial fibrillation
ConclusionsThese subgroup analyses demonstrate that the treatment effect for rivaroxaban vs. warfarin is broadly consistent across a wide range of patient groups, with respect to both efficacy and safety.
Source: International Journal of Clinical Practice - April 9, 2015 Category: Internal Medicine Authors: H.‐C. Diener, J. L. Halperin, K. Fox, G. J. Hankey Tags: Review Article Source Type: research

High rate of abnormal blood values and vascular complications before diagnosis of myeloproliferative neoplasms.
CONCLUSION: We therefore conclude that a large proportion of MPN patients suffer severe thromboembolic complications prior to diagnosis. If MPN were diagnosed earlier, a large proportion of these events might be prevented. An MPN should always be suspected and ruled out in patients with unexplained elevated hematocrit, leukocyte and/or platelet counts. PMID: 25863408 [PubMed - as supplied by publisher]
Source: European Journal of Internal Medicine - April 8, 2015 Category: Internal Medicine Authors: Enblom A, Lindskog E, Hasselbalch H, Hersby D, Bak M, Tetu J, Girodon F, Andréasson B Tags: Eur J Intern Med Source Type: research

Outcome of Frozen Elephant Trunk Technique for Acute Type A Aortic Dissection: As Systematic Review and Meta-Analysis
Abstract: Acute aortic dissections of Stanford type A require emergency surgery repair and present challenges to surgeons. The frozen elephant technique is one of several approaches used to treat aortic arch dissection. The purpose of this meta-analysis was to investigate the clinical effectiveness of the frozen elephant technique for treating acute type A aortic dissection. Medline, Cochrane, Google Scholar, and ClinicalTrials.gov databases were searched up to March 31, 2014, for studies that assessed the use of frozen elephant trunk technique for treating acute type A aortic dissection. The primary outcome was in-hospita...
Source: Medicine - April 1, 2015 Category: Internal Medicine Tags: Article: Systematic Review and Meta-Analysis Source Type: research