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On Hoofs and Zebras – Struma Ovarii
A 75-year-old mother of ten suffering from a urinary tract infection developed macrohematuria and therefore an abdominal ultrasound was performed, followed by a CT scan when an unexpected large pelvic mass was discovered. Past history included hypertension, paroxysmal atrial fibrillation, and remote history of minor stroke (on candesartan, dabigatran, bisoprolol); bilateral chronic lymphedema; and hysterectomy due to prolapse at the age of 40. Imaging revealed nephrolithiasis and a prominent left adnexal mass suspected as ovarian cancer.
Source: The American Journal of Medicine - July 20, 2023 Category: General Medicine Authors: Ami Schattner, Ina Dubin, Livnat Uliel, Daniela Dick-Necula Tags: Clinical Communication to the Editor Source Type: research

Corrigendum to “Effectiveness and Safety of Oral Anticoagulants in Adults with Non-valvular Atrial Fibrillation Patients and Concomitant Coronary/Peripheral Artery Disease” American Journal of Medicine 131:09 (2018): 1074-1085.e4
There were 33,269 apixaban-warfarin, 9,345 dabigatran-warfarin, and 42,156 rivaroxaban-warfarin matched pairs, with a median follow-up of 4-5 months. Compared with warfarin, apixaban was associated with lower rates of stroke/systemic embolism (hazard ratio [HR] 0.52; 95% confidence interval [95% CI], 0.43-0.62), major bleeding (HR 0.60; 95% CI, 0.55-0.66) and stroke/myocardial infarction/all-cause mortality (HR 0.70; 95%CI, 0.66-0.74); dabigatran was associated with lower rates of major bleeding (HR: 0.73; 95% CI, 0.62-0.85); dabigatran and rivaroxaban were associated with lower rates of stroke/myocardial infarction/all-ca...
Source: The American Journal of Medicine - August 4, 2020 Category: General Medicine Authors: Renato D. Lopes, Jan Steffel, Manuela Di Fusco, Allison Keshishian, Xuemei Luo, Xiaoyan Li, Cristina Masseria, Melissa Hamilton, Keith Friend, Kiran Gupta, Jack Mardekian, Xianying Pan, Onur Baser, W. Schuyler Jones Tags: Corrigendum Source Type: research

Embolic stroke of undetermined source: Gateway to a new stroke entity?
Embolic stroke of unknown source is currently thought to represent a subpopulation of cryptogenic strokes defined by its embolic stroke pattern on imaging and if after a carefully performed diagnostic evaluation, a specific, well recognized cause of stroke has not been identified. The concept was primarily established to justify and enable the conduct of the Embolic Stroke of Unknown Source (ESUS)-trials, such as RESPECT-ESUS (Randomized, Double-Blind, Evaluation in Secondary Stroke Prevention Comparing the Efficacy and Safety of the Oral Thrombin Inhibitor Dabigatran Etexilate versus Acetylsalicylic Acid in Patients with ...
Source: The American Journal of Medicine - April 1, 2020 Category: General Medicine Authors: Wolf-R üdiger Schäbitz, Martin Köhrmann, Peter D. Schellinger, Jens Minnerup, Marc Fisher Tags: Review Source Type: research

Oral anticoagulation in emergency department patients: high rates of off-label doses,no difference in bleeding rates
Patients with oral anticoagulation constitute an increasing proportion in the present medical routine.1 The approval of the first direct oral anticoagulant (DOAC) dabigatran by the U.S. food and drug administration in 2010 for the purpose of stroke prevention in patients with non-valvular atrial fibrillation revolutionized the therapy strategies of this entity since the Vitamin-K antagonists (VKA) warfarin, phenprocoumon and acenocoumarol had been the only available oral anticoagulants for decades.
Source: The American Journal of Medicine - October 23, 2019 Category: General Medicine Authors: Corinne M. Eschler, Bertram K. Woitok, Georg-Christian Funk, Philipp Walter, Volker Maier, Aristomenis K. Exadaktylos, Gregor Lindner Tags: Clinical Research Study Source Type: research

Variation in the Use of Warfarin and Direct Oral Anticoagulants in Atrial Fibrillation and Associated Cost Implications
Atrial fibrillation is the most common arrhythmia in the United States and affects between 2.7 million and 6.1 million adults in the United States, with a lifetime risk of up to 1 in 4 adults over age 40 and a prevalence that is projected to double over the next 25 years.1,2 Though warfarin has long been the cornerstone of therapy to reduce the risk of stroke, several new direct oral anticoagulants (DOACs) have recently become available, beginning with FDA approval of dabigatran in October 2010, and followed by rivaroxaban in 2011, apixaban in 2014, and most recently edoxaban in 2015.
Source: The American Journal of Medicine - October 3, 2018 Category: General Medicine Authors: Benjamin A. Rodwin, Joseph A. Salami, Erica S. Spatz, Javier Valero-Elizondo, Salim S. Virani, Ron Blankstein, Michael J. Blaha, Khurram Nasir, Nihar R. Desai Tags: Clinical Research Study Source Type: research

Dabigatran and warfarin for secondary prevention of stroke in atrial fibrillation patients: A nationwide cohort study
This study revealed, that in clinical practice, vitamin K antagonist-experienced patients with a history of stroke or transient ischemic attack who switch to dabigatran therapy may have an increased rate of a recurrent stroke compared to patients persisting with vitamin K antagonist therapy.
Source: The American Journal of Medicine - September 1, 2014 Category: Journals (General) Authors: Torben Bjerregaard Larsen, Lars Hvilsted Rasmussen, Anders Gorst-Rasmussen, Flemming Skjøth, Deirdre A. Lane, Gregory Y.H. Lip Source Type: research