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Antithrombotic treatment after stroke due to intracerebral haemorrhage
CONCLUSIONS: We did not identify beneficial or hazardous effects of short-term prophylactic dose parenteral anticoagulation and long-term oral antiplatelet therapy after ICH on important outcomes. Although there was a significant reduction in MACE and all major occlusive vascular events after long-term treatment with therapeutic dose oral anticoagulation for atrial fibrillation after ICH, the pooled estimates were imprecise, the certainty of evidence was only moderate, and effects on other important outcomes were uncertain. Large RCTs with a low risk of bias are required to resolve the ongoing dilemmas about antithrombotic...
Source: Cochrane Database of Systematic Reviews - January 26, 2023 Category: General Medicine Authors: Alexia Cochrane Chen Chen Jacqueline Stephen Ole Morten R ønning Craig S Anderson Graeme J Hankey Rustam Al-Shahi Salman Source Type: research

Anticoagulants for people hospitalised with COVID-19
CONCLUSIONS: When compared to a lower-dose regimen, higher-dose anticoagulants result in little to no difference in all-cause mortality and increase minor bleeding in people hospitalised with COVID-19 up to 30 days. Higher-dose anticoagulants possibly reduce pulmonary embolism, slightly increase major bleeding, may result in little to no difference in hospitalisation time, and may result in little to no difference in deep vein thrombosis, stroke, major adverse limb events, myocardial infarction, atrial fibrillation, or thrombocytopenia. Compared with no treatment, anticoagulants may reduce all-cause mortality but the evide...
Source: Cochrane Database of Systematic Reviews - March 4, 2022 Category: General Medicine Authors: Ronald Lg Flumignan Vinicius T Civile J éssica Dantas de Sá Tinôco Patricia If Pascoal Libnah L Areias Charbel F Matar Britta Tendal Virginia Fm Trevisani Álvaro N Atallah Luis Cu Nakano Source Type: research

Interrupted versus uninterrupted anticoagulation therapy for catheter ablation in adults with arrhythmias
CONCLUSIONS: This meta-analysis showed that the evidence is uncertain to inform the decision to either interrupt or continue anticoagulation therapy around CA procedure in adults with arrhythmia on outcomes of thromboembolic events, major and minor bleeding, all-cause mortality, asymptomatic thromboembolic events, and a composite endpoint of thromboembolic events (stroke, systemic embolism, major bleeding, and all-cause mortality). Most studies in the review adopted a minimal interruption strategy which has the advantage of reducing the risk of bleeding while maintaining a lower level of anticoagulation to prevent periproc...
Source: Cochrane Database of Systematic Reviews - October 21, 2021 Category: General Medicine Authors: Ghada A Bawazeer Hadeel A Alkofide Aya A Alsharafi Nada O Babakr Arwa M Altorkistani Tarek S Kashour Michael Miligkos Khalid M AlFaleh Lubna A Al-Ansary Source Type: research

Anticoagulation versus placebo for heart failure in sinus rhythm
CONCLUSIONS: Based on the three RCTs, there is no evidence that oral anticoagulant therapy modifies mortality in people with HF in sinus rhythm. The evidence is uncertain if warfarin has any effect on all-cause death compared to placebo or no treatment, but it may increase the risk of major bleeding events. There is no evidence of a difference in the effect of rivaroxaban on all-cause death compared to placebo. It probably reduces the risk of stroke, but probably increases the risk of major bleedings. The available evidence does not support the routine use of anticoagulation in people with HF who remain in sinus rhythm.PMI...
Source: Cochrane Database of Systematic Reviews - May 18, 2021 Category: General Medicine Authors: Eduard Shantsila Monika Kozie ł Gregory Yh Lip Source Type: research

Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis in people with low surgical risk.
CONCLUSIONS: Our meta-analysis indicates that, in the short term, TAVI probably has little or no mortality difference compared to SAVR for severe AS in individuals with low surgical risk. Similarly, there is probably little or no difference in risk of stroke, MI, and cardiac death between the two approaches. TAVI may reduce the risk of rehospitalisation, but we are uncertain about the effects on LOS. TAVI reduces the risk of atrial fibrillation, AKI, and bleeding. However, this benefit is offset by the increased risk of PPM implantation. Long-term follow-up data are needed to further assess and validate these outcomes, esp...
Source: Cochrane Database of Systematic Reviews - December 19, 2019 Category: General Medicine Authors: Kolkailah AA, Doukky R, Pelletier MP, Volgman AS, Kaneko T, Nabhan AF Tags: Cochrane Database Syst Rev Source Type: research

Non-vitamin K antagonist oral anticoagulants (NOACs) post-percutaneous coronary intervention: a network meta-analysis.
CONCLUSIONS: Very low- to moderate-certainty evidence suggests no meaningful difference in efficacy outcomes between non-vitamin K antagonist oral anticoagulants (NOAC) and vitamin K antagonists following percutaneous coronary interventions (PCI) in people with non-valvular atrial fibrillation. NOACs probably reduce the risk of recurrent hospitalisation for adverse events compared with vitamin K antagonists. Low- to moderate-certainty evidence suggests that dabigatran may reduce the rates of major and non-major bleeding, and apixaban and rivaroxaban probably reduce the rates of non-major bleeding compared with vitamin K an...
Source: Cochrane Database of Systematic Reviews - December 18, 2019 Category: General Medicine Authors: Al Said S, Alabed S, Kaier K, Tan AR, Bode C, Meerpohl JJ, Duerschmied D Tags: Cochrane Database Syst Rev Source Type: research

Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation.
CONCLUSIONS: There is high-certainty evidence of increased mortality associated with sotalol treatment, and low-certainty evidence suggesting increased mortality with quinidine, when used for maintaining sinus rhythm in people with atrial fibrillation. We found few data on mortality in people taking disopyramide, flecainide and propafenone, so it was not possible to make a reliable estimation of the mortality risk for these drugs. However, we did find moderate-certainty evidence of marked increases in proarrhythmia and adverse effects with flecainide.Overall, there is evidence showing that antiarrhythmic drugs increase adv...
Source: Cochrane Database of Systematic Reviews - September 3, 2019 Category: General Medicine Authors: Valembois L, Audureau E, Takeda A, Jarzebowski W, Belmin J, Lafuente-Lafuente C Tags: Cochrane Database Syst Rev Source Type: research

Polyunsaturated fatty acids for the primary and secondary prevention of cardiovascular disease.
CONCLUSIONS: This is the most extensive systematic review of RCTs conducted to date to assess effects of increasing PUFA on cardiovascular disease, mortality, lipids or adiposity. Increasing PUFA intake probably slightly reduces risk of coronary heart disease and cardiovascular disease events, may slightly reduce risk of coronary heart disease mortality and stroke (though not ruling out harms), but has little or no effect on all-cause or cardiovascular disease mortality. The mechanism may be via TG reduction. PMID: 30484282 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - November 27, 2018 Category: General Medicine Authors: Abdelhamid AS, Martin N, Bridges C, Brainard JS, Wang X, Brown TJ, Hanson S, Jimoh OF, Ajabnoor SM, Deane KH, Song F, Hooper L Tags: Cochrane Database Syst Rev Source Type: research

Factor Xa inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in patients with atrial fibrillation.
CONCLUSIONS: Treatment with factor Xa inhibitors significantly reduced the number of strokes and systemic embolic events compared with warfarin in people with AF. The absolute effect of factor Xa inhibitors compared with warfarin treatment was, however, rather small. Factor Xa inhibitors also reduced the number of ICHs, all-cause deaths and major bleedings compared with warfarin, although the evidence for a reduction in the latter is less robust. PMID: 29509959 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - March 6, 2018 Category: General Medicine Authors: Bruins Slot KM, Berge E Tags: Cochrane Database Syst Rev Source Type: research

WITHDRAWN: Pharmacological cardioversion for atrial fibrillation and flutter.
CONCLUSIONS: There is no evidence that pharmacological cardioversion of atrial fibrillation to sinus rhythm is superior to rate control. Rhythm control is associated with more adverse effects and increased hospitalisation. It does not reduce the risk of stroke. The conclusions cannot be generalised to all people with atrial fibrillation. Most of the patients included in these studies were relatively older (>60 years) with significant cardiovascular risk factors. PMID: 29140557 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - November 15, 2017 Category: General Medicine Authors: Cordina J, Mead GE Tags: Cochrane Database Syst Rev Source Type: research

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