Anticoagulant Therapy Research Articles

Efficacy and safety of anticoagulant and antiplatelet therapies in the medical management of carotid free-floating thrombus: A systematic review.

The optimal treatment for carotid free-floating thrombus (CFFT) remains uncertain due to limited evidence, with no randomized clinical trials and scarce guidelines, such as ESVS 2023, favoring conservative management. Anticoagulation (ACT) and antiplatelet (APT) therapies are emerging as promising alternatives to high-risk surgical interventions. This systematic review aimed to evaluate the safety and efficacy of ACT and APT therapies for CFFT. A systematic search was performed across PubMed, Embase, Web of Science, and Cochrane databases. Safety and efficacy endpoints were assessed. A two-sample t-test compared baseline characteristics between groups, and a Chi-square test evaluated differences in categorical variables. Statistical significance was set at p < 0.05. Data were analyzed using R 4.3.0 with the meta package v.7.0-0. Four studies met the inclusion criteria, involving 170 patients diagnosed with CFFT. The APT group included 96 patients (mean age 55.35 ± 13.52 years; 56.25% male), and the ACT group included 74 patients (mean age 58.57 ± 14.28 years; 51.35% male). Thrombus regression was slightly lower in APT (42%) compared to ACT (48%). Both groups showed similar rates of residual stenosis. Antiplatelet had fewer ischemic events within 30 days (none vs. 4% in ACT) and lower intracranial hemorrhage rates (3.3% vs. 5.4% in ACT) but higher mortality (6.3% vs. none in ACT). Both ACT and APT are effective for managing CFFT, each with distinct efficacy and safety profiles. However, randomized trials are necessary to better assess these therapies in CFFT management.

Spontaneous Intramuscular Haematomas: A Single-Centre Retrospective Study and Proposed Management Algorithm.

Spontaneous intramuscular haematomas by definition are haematomas without known etiology and exclude those caused by trauma, surgery, and muscular disease. This is a rare condition which has been increasing in incidence lately largely due to anticoagulant therapy use and currently, there is no level 1 evidence with regards to the best management of these patients, with different institutions using different approaches to treatment. We retrospectively analyzed 31 patients who were treated with the diagnosis of spontaneous intramuscular haematoma in our center, in the years between 2013 and 2017. Patient information was recorded including patient characteristics, vital parameters, biochemical data, imaging data, risk stratification scores, and patient outcomes. We observed that on average males had longer hospitalizations and a higher baseline platelet count was a protective factor against haemorrhage. On temporal evaluation of haemoglobin levels, we saw an important drop of haemoglobin at T6 for the transfused patients. The majority of patients (61.29%) were treated with arterial embolization, with great technical and clinical success (94% and 81% respectively). There was also a very strong association between patients treated with non-operative therapy (NOT) and shorter hospitalization. Conclusion: NOT and embolization therapy are very effective treatments for spontaneous haematomas in the appropriate patient and should be included in the protocol. The small sample size was a very large limitation for the study, and a multicentric study is needed to further strengthen any associations we saw between risk factors and outcomes. We propose the need to perform a prospective study to ascertain the appropriate follow-up times for such investigations.

Bicuspid Aortic Valve – Therapeutic Options Today and Tomorrow

Bicuspid Aortic Valve (BAV) is the most common congenital heart defect, characterized by the presence of two cusps of the valve instead of three. This defect leads to hemodynamic and morphological disturbances, potentially resulting in serious health complications. BAV often remains asymptomatic for a long time, with symptoms eventually arising from valve degeneration along with the remodeling of the heart and aortic root, which are consequences of the initial condition. The aim of this study is to compile information regarding the defect, current treatment options, and potential new therapeutic directions. The classical approach for treatment is surgical aortic valve replacement (SAVR), which involves replacing the abnormal valve with either a mechanical or biological prosthesis through access via sternotomy. Mechanical valves are characterized by their longer lifespan but require ongoing anticoagulant therapy, whereas biological valves do not necessitate anticoagulation, although they tend to have a shorter durability. An alternative to SAVR is minimally invasive transcatheter aortic valve replacement (TAVR), which offers a shorter recovery time but limited long-term durability data restricts its use in younger patients. Other treatment options include the Ross procedure and valvuloplasty procedures, which may serve as viable solutions for pediatric patients. Despite the availability of different treatment methods, the selection of an appropriate therapeutic strategy remains a challenge, as each option carries distinct benefits and risks. Patient education plays a crucial role in the decision-making process, helping to alleviate anxiety and improve treatment outcomes. Emerging fields such as medical bioengineering might offer promising solutions in the future for patients with BAV.

Evaluation of older patients with minor blunt head trauma to identify those who do not have clinically important traumatic brain injury and can be safely managed without cranial computed tomography.

Our primary aim was to identify a low-risk subgroup of older adults (aged 65 and older) presenting to ED with minor head trauma which can be safely managed without a cranial CT (cCT). This was a single-site, prospective, observational, cohort study conducted at a major-referral ED. Alert, haemodynamically stable, older adults with suspected head trauma were eligible. This included both community dwellers and residential aged care facility (RACF) residents. Primary outcome was the proportion of patients who had a clinically important traumatic brain injury (ciTBI) within 42 days of index ED presentation. Secondary outcomes included proportion investigated with a cCT, and proportion needing neurosurgical intervention. Two hundred seventy-six patients (mean age 80.5 years; 53.6% female) were enrolled. The most common mechanism of injury was ground-level fall (93.8%). One in four patients was from RACFs, 30.1% had dementia and 52.2% were on blood thinners. 80.8% had a cCT during the index ED visit. Seven (2.5%) patients had ciTBI within 42 days of index ED presentation. Patients with ciTBI had either external signs of head injury or abnormal neurological exam. All patients with ciTBI were treated conservatively after shared decision-making. Alert, haemodynamically stable, older ED adults with suspected head trauma had a low incidence of ciTBI in the present study. Abnormal physical examination findings were consistently present in patients with ciTBI. Shared decision-making prior to cCT may be the pragmatic way ahead in the management of this patient cohort, especially among those from RACFs.

Novel anticoagulation therapy using apple watch after catheter ablation for atrial fibrillation—Up to AF trial: Design and rationale

Novel anticoagulation therapy using apple watch after catheter ablation for atrial fibrillation—Up to <scp>AF</scp> trial: Design and rationale

Effect of direct oral anticoagulants compared to enoxaparin on objective response to immune checkpoint inhibitors in patients with lung cancer.

A hypoxic tumor microenvironment inhibits the normal functioning of immune cells. Studies have hypothesized that anticoagulants that can penetrate and bind to factor Xa in the tumor microenvironment, can enhance T-cell function and augment immunotherapy activity. This study compared objective response rate and progression-free survival of lung cancer patients on concomitant immunotherapy treated with direct-acting oral anticoagulants versus enoxaparin. This single-center retrospective study included 73 adults with stage-IV lung cancer who received at least two cycles of immunotherapy and one month of anticoagulant therapy with direct-acting oral anticoagulants (Arm A) versus enoxaparin (Arm B) between June 1, 2016, to September 30, 2022. Primary endpoint was objective response rate, and secondary endpoints were rates of complete response, progression-free survival, incidence of thrombotic events, and major bleeding. Objective response rate at 6 months was 24.5% versus 25% while progression-free survival at 6 months was 54.7% versus 45% in Arm A versus Arm B, respectively. Complete response rates at 6 months were 7.5% in Arm A versus 0% in Arm B. One patient in Arm A and two in Arm B had a recurrent deep vein thrombosis. Nine patients in Arm A and two in Arm B were diagnosed with new deep vein thrombosis. One patient in Arm B was diagnosed with new pulmonary embolism. Two major bleeding events occurred in Arm B. Our study suggests a trend toward improved progression-free survival at 6 months with no new safety concerns in lung cancer patients on concurrent immunotherapy and direct-acting oral anticoagulants.

Comparison of outcomes between anticoagulation and antiplatelet therapies for intracranial arterial dissections

BackgroundThis study aimed to evaluate real-world data on the differences in outcomes between antiplatelet (AP) and anticoagulation (AC) therapies for intracranial arterial dissection (IAD).MethodsThis study included patients with symptomatic unruptured IAD between 2010 and 2021 that were treated with anti-thrombotics. Patients were dichotomized to AC and AP based on a treatment policy analysis. Primary endpoints were a composite of ischemic early neurological deterioration, recurrent ischemic or hemorrhagic stroke, or 3-month mortality. Arterial changes were evaluated both in the early (during admission) and late (after discharge) periods. A treatment effectiveness analysis was also performed with AC, AP and a third group of antithrombotic cross-overs. Propensity score matching (PSM) was used to adjust significant baseline differences.ResultsIn unruptured IAD patients (N = 311), the AC group (N = 211) presented with a higher rate of ischemic stroke or TIA (74.4% vs. 51.0%, p &amp;lt; 0.001) and steno-occlusive morphology (vs. dilatation, 63.0% vs. 39.0%, p &amp;lt; 0.001) compared to AP group (N = 100). After PSM, there was no difference in rates of primary endpoint (9.4% vs. 6.5%, p = 0.470). The results of the treatment effectiveness analysis resembled that of the treatment policy analysis. However, there was a high rate of cross-overs from AC to AP (57/211 [27.0%]). In this group, there was a higher rate of early arterial changes (26.8% vs. 13.1%, p = 0.019) compared to the AC group.ConclusionIn patients with unruptured IAD, this study did not show differences in primary endpoints according to antithrombotic regimen, while there was a high rate of cross-overs from AC to AP.

Risk of Intracranial Hemorrhage Associated With Direct Oral Anticoagulation vs Antiplatelet Therapy

For patients with atrial fibrillation, clinicians often prescribe antiplatelet therapy rather than oral anticoagulation, which may be related to a concern that direct oral anticoagulants (DOACs) are associated with a higher risk of intracranial bleeding, despite being less effective for stroke prevention. To determine whether DOAC therapy, compared with single-agent antiplatelet therapy, was associated with an increased risk of intracranial and major hemorrhage. A systematic search of PubMed and Embase databases from inception to February 7, 2024, was performed. Randomized clinical trials that compared DOAC therapy with single-agent antiplatelet therapies were included. Trials with active follow-up of less than 30 days or a sample size less than 200 were excluded. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Data were extracted independently by 2 researchers. A random-effects meta-analysis model was used to report pooled treatment effects and 95% CIs. The primary outcome was occurrence of intracranial hemorrhage. A total of 9 randomized clinical trials were included (45 494 participants). DOAC therapy was not associated with significantly higher odds of intracranial hemorrhage compared with antiplatelet therapy (0.55% vs 0.48% over a mean trial follow-up of 17.1 months; odds ratio [OR], 1.15; 95% CI, 0.71-1.88), but there was heterogeneity among trials (I2 = 53.7%). In an analysis by DOAC agent, the respective estimates for intracranial hemorrhage risk were as follows: rivaroxaban, OR, 2.09 (95% CI, 1.20-3.64); dabigatran, OR, 1.00 (95% CI, 0.61-1.64); and apixaban, OR, 0.72 (95% CI, 0.44-1.17). Overall, DOAC therapy was associated with higher odds of major hemorrhage compared with antiplatelet therapy (2.41% vs 1.76% over a mean trial follow-up of 15.5 months; OR, 1.39; 95% CI, 1.07-1.80), with the following estimates by agent: rivaroxaban, OR, 1.91 (95% CI, 1.22-3.00); dabigatran; OR, 1.21 (95% CI, 0.86-1.69); and apixaban, OR, 1.09 (95% CI, 0.73-1.63). In this systematic review and meta-analysis, DOAC therapy was not associated with a significantly higher risk of intracranial hemorrhage compared with antiplatelet therapy, but was associated with a higher risk of major hemorrhage. These findings support the safety of DOAC compared with antiplatelet therapy with respect to risk of ICH and reinforce adherence with current atrial fibrillation guidelines.

Endovascular treatment of upper limb phlegmasia cerulea dolens in a hemodialysis patient

Phlegmasia cerulea dolens (PCD) is a rare but limb-threatening complication of deep vein thrombosis. A 72-year-old hemodialysis male patient presented with upper limb PCD. The patient underwent hemodialysis via a permanent hemodialysis central venous catheter (HD-CVC) while a new brachial-cephalic AVF was created 1 month ago. Computed tomography revealed extensive thrombosis of right subclavian and brachiocephalic vein. The HD-CVC was removed and patient was treated with anticoagulation therapy. However, his clinical condition was worsening and he was transferred to IR department. The patient underwent successful percutaneous pharmacomechanical thrombectomy (PMT) of the right subclavian and brachiocephalic vein followed by percutaneous angioplasty (PTA) with significant flow restoration and no signs of pulmonary embolization. PCD may also be developed in hemodialysis patients with well-functioned AVF. Effective and rapid revascularization is important to prevent serious complications such as venous gangrene and limb ischemia. Endovascular treatment with PMT and PTA can be a limb-saving procedure for rapid recanalization in patients with PCD.

Uncommon presentation of left main congenital coronary aneurysm: a rare case report

Coronary aneurysm, a dilated segment of the coronary artery, is a rare condition with a prevalence ranging from 0.02% to 0.2%. According to the current literature, reports of large aneurysms in the left main artery are extremely rare. We present a case of a 43-year-old male patient presenting with cough, wheezing, and dyspnea after a cold. Initial examinations suggested viral myocarditis, but further evaluation revealed a giant aneurysm in the left main coronary artery. Due to the high surgical risk, conservative treatment was chosen. Follow-up assessments showed no significant changes in the coronary aneurysm, with slight improvement in dyspnea. This rare case of a left main congenital coronary aneurysm suggests that treatment should consider the patient's overall condition, thrombosis presence, suitability for anticoagulant therapy, and aneurysm location and size.

Real-World Safety Profile of Direct Oral Anticoagulants (DOACs): Disproportionality Analysis of Major Bleeding Events

BackgroundDirect Oral Anticoagulants (DOACs) have revolutionized the management of thrombotic conditions, providing more predictable and manageable anticoagulation compared to traditional vitamin K antagonists. Despite their success, major bleeding events remain a significant concern. This study aims to assess and compare the haemorrhagic risks associated with various DOACs using data from the FDA's Adverse Event Reporting System (FAERS). MethodsA retrospective disproportionality analysis of the FAERS database was conducted, covering the period from January 1, 2015, to December 31, 2023. The study focused on adverse bleeding events reported for DOACs. The Proportional Reporting Ratio (PRR) was calculated for each DOAC to identify disproportionate reporting of haemorrhagic events. Major haemorrhagic events were classified as those leading to hospitalization. The analysis also utilized the Medicare Part D dataset to estimate the usage of specific DOACs from 2015 to 2021. ResultsA total of 353,188 haemorrhagic events were identified, with 17,236 (4.9%) attributed to DOACs. The PRR for major haemorrhagic events was highest for Edoxaban at 14.1 (95% CI 13.93-14.85), followed by Dabigatran at 4.0 (95% CI 3.81-4.20), Apixaban at 3.53 (95% CI 3.47-3.61), and Rivaroxaban at 2.11 (95% CI 2.05-2.18). Edoxaban also had the highest PRR for cerebral haemorrhages. Medicare data indicated that Apixaban was the most commonly used DOAC (58.3%), followed by Rivaroxaban (34.5%). ConclusionsEdoxaban shows a significantly higher risk of major and cerebral haemorrhages compared to other DOACs, while Rivaroxaban demonstrates a lower overall risk of haemorrhage. These findings emphasize the need for careful consideration of bleeding risks in DOAC therapy. Continuous post-marketing surveillance is crucial for understanding the safety profiles of DOACs in real-world clinical settings, aiding clinicians and patients in making informed decisions about anticoagulant therapy.

Association of care specialty with anticoagulant prescription and clinical outcomes in newly diagnosed atrial fibrillation: Results from the GARFIELD-AF registry

ObjectiveTo determine whether stroke prevention strategy, comorbidity management, and clinical outcome risks differ across atrial fibrillation (AF) care specialties. MethodsNewly diagnosed non-valvular AF patients enrolled in the international, prospective GARFIELD-AF registry (enrolment: 2010–2016) were analysed. Prescription of oral anticoagulation (OAC) therapy and select comorbidities was assessed by baseline care specialty: cardiology, primary care, or other specialties (internist/neurologist/geriatrician). Associations between care specialty and 2-year clinical outcomes were evaluated using multivariable Cox frailty models to account for within-country homogeneity. ResultsIn 52,011 patients, 34,172 (65.7 %) were diagnosed and initially managed in cardiology care, 7396 (14.2 %) in primary care, and 10,443 (20.1 %) in other specialties. The inter-country care specialty distribution varied considerably. Non-vitamin K OAC (NOAC) therapy among CHA2DS2-VASc ≥2 patients was more common in cardiology care (31.0 %) than primary care (19.8 %) and other specialty care (24.9 %), but comorbidity management was similar across specialties. Compared to cardiology care, primary care was associated with greater non-cardiovascular mortality (1.21 [1.01–1.45]), major bleeding (1.31 [1.05–1.62]), and new/worsening heart failure risk (2.09 [1.69–2.59]). Care in other specialties was associated with greater all-cause (adjusted hazard ratio, 1.19 [95 % CI, 1.09–1.29]), cardiovascular (1.15 [1.01–1.31]), and non-cardiovascular mortality (1.29 [1.13–1.47]), as well as non-haemorrhagic stroke/systemic embolism (1.48 [1.26–1.73]), major bleeding (1.21 [1.02–1.43]), and new/worsening heart failure risk (1.45 [1.21–1.75]) than cardiology care. ConclusionComorbidity management was similar across AF care specialties, but patients outside of cardiology care had fewer NOAC prescriptions and greater risk for most clinical endpoints. Cardiology expertise may have important implications for AF prognosis.Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF: NCT01090362

Left atrial appendage closure in patients with failure of anticoagulation therapy: A multicenter comparative study between DOACs and VKAs.

Patients with non-valvular atrial fibrillation (nvAF) who experienced a cardioembolic (CE) event despite adequate oral anticoagulation (OAC) are at high risk of recurrence and the combination between percutaneous left atrial appendage closure (LAAC) and long-term OAC may be a valuable option. The aim of this study was to compare the safety and the efficacy of post-LAAC long-term assumption of direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKAs) in this population. Consecutive nvAF patients who experienced OAC failure despite adequate OAC therapy and underwent LAAC were retrospectively enrolled from three Italian centers. Patients were divided according to the anticoagulation strategy following LAAC: DOAC group and VKA group. The primary endpoint was a composite of all-cause death, CE event, and major bleeding, while secondary endpoint was a composite of CE event and major bleeding. Overall, 132 patients (39 % females; mean age 69 ± 11 years), including 73 patients on DOAC and 59 patients on VKA, were enrolled. At a median follow up of 61 ± 23 months, the DOAC group reported lower rate of primary endpoint (HR 0.42, 95 %CI 0.18-0.99, p = 0.038) and lower rate of secondary endpoint (HR 0.28, 95 %CI 0.09-0.89, p = 0.02). No significant differences were detected regarding the type of DOAC assumed. Previous cerebrovascular events, CHA2DS2-VASc, CHADS2, HAS-BLED, and renal dysfunction were predictors of the primary endpoint. Long-term DOAC assumption was associated with higher free from primary and secondary endpoint with respect to VKA in nvAF patients undergoing LAAC for OAC failure.

Physician and Patient Preferences for Oral Anticoagulation Therapy Decision Making in Atrial Fibrillation: Results From a National Best-Worst Scaling Survey in Türkiye.

Atrial fibrillation (AF) is the most common cardiac dysrhythmia and a common cause of ischemic stroke. Stroke prevention with oral anticoagulation (OAC) is the cornerstone of AF management. Patients and their treating physicians may have different views on different attributes of OACs. The objective of this study was to quantify the relative importance that patients and physicians in Turkey place on different OAC attributes when making treatment decisions in AF. A cross-sectional survey was administered to AF patients (≥ 50 years) receiving OAC and practising cardiologists, including residents with ≥ 2 years of experience in Turkey. For both patients (N = 230; 50% male) and physicians (N = 194; 74% male), the most important attributes for OAC treatment decision making in AF were "success in preventing stroke" (57% and 73.9% or overall importance, respectively) and "risk of major bleeding" (20% and 23.4%, respectively). For patients, other attributes were much less important, but not altogether unimportant: reversal agent availability (7%), monitoring (5%), food or drug interactions (3%), minor bleeding (3%), and ease of swallowing (2%). For physicians, among the other attributes, only the need for monitoring (1.3%) had a relative importance of > 1%. For all Turkish participants, efficacy and safety were found to be the most important attributes influencing OAC choice in AF with these two attributes accounting for 77% and 97.3% of overall importance for patients and physicians, respectively. Certain considerations, especially reversal agent availability and monitoring appear to be more important to patients than to physicians This is the first study to use BWS to quantify patient and physician preferences for OAC treatments in AF in Turkey.

Rationale and Design of the PE-TRACT Trial - A Multicenter Randomized Trial to Evaluate Catheter-Directed Therapy for the Treatment of Intermediate-Risk Pulmonary Embolism

The optimal management of patients with intermediate-risk pulmonary embolism (PE), who have right heart dysfunction (determined by a combination of imaging and cardiac biomarkers) but a normal blood pressure, is uncertain. These patients suffer from reduced functional capacity and a lower quality of life over the long-term, despite use of anticoagulant therapy. Catheter-directed therapy (CDT) is a promising treatment for acute PE that rapidly removes thrombus and potentially improves cardiac dysfunction. However, CDT has risk and is costly, and it is not known whether it improves long-term cardiorespiratory fitness and/or quality of life compared with anticoagulation alone. We are therefore conducting an open-label, assessor-blinded, multicenter randomized trial, the Pulmonary Embolism: Thrombus Removal with Catheter-Directed Therapy (PE-TRACT) Study, to compare CDT plus anticoagulation (CDT group) with anticoagulation alone (No-CDT group) in 500 patients with intermediate-risk PE. The primary study hypothesis is that CDT will increase the peak oxygen uptake (peak VO2) with cardiopulmonary exercise testing at 3 months and reduce New York Heart Association (NYHA) Class at 12 months compared with No-CDT. These two primary efficacy outcomes will be analyzed sequentially using a "gatekeeping" procedure; for NYHA class to be compared, peak oxygen consumption must first be shown to be significantly increased by CDT. Safety and cost-effectiveness will also be assessed. When completed, PE-TRACT will provide important evidence regarding the benefits and risks of CDT to treat intermediate-risk PE compared with anticoagulation alone.

Prévention du risque thromboembolique de la fibrillation atriale dans le service de cardiologie d'Abidjan

IntroductionAtrial fibrillation is the most common cardiac rhythm disorder whose incidence with age and which is responsible for high morbidity and mortality. ObjectiveEvaluate the thromboembolic risk of patients with atrial fibrillation and analyze the quality of the oral anticoagulation therapy at the Abidjan cardiology institute. MethodsThis was a multicenter, retrospective and prospective cross-sectional study, with descriptive and analytical aims in 332 patients followed for atrial fibrillation diagnosed on the electrocardiogram. ResultsAverage age of 61 years (standard deviation = 16), with a female predominance with a sex ratio (M/F) of 0.93. The circumstances of discovery of atrial fibrillation were mainly palpitations (58.1%). Hypertension (57.8%). was the most frequently encountered comorbidity Underlying heart diseases were dominated by dilated cardiomyopathy (26.8%) and hypertensive heart disease (18.1%). The average CHA2DS2-VASc score was = 3.1 (standard deviation = 1.5) revealing a high level of thromboembolic risk (CHA2DS2-VASc score ≥2) in 76% of cases. The mean HAS-BLED score was =1.9 (SD =1.2).VKA were the main antithrombotic therapy prescribed in our patients and appeared of poor quality with a TTR <65% in the great majority of patients (93,75%) ConclusionAtrial fibrillation is a condition responsible for the occurrence of thromboembolic complications when antithrombotic management is not correct. In this instance good oral anticoagulation is the best treatment to instaure. VKA are the most prescribed OAC in our context.The evaluation of the quality of anticoagulation by vitamin K antagonist is essential by one of its most used indices is the time spent in the therapeutic zone (TTR).

Assessment of medication literacy of anticoagulation therapy in hospitalized orthopedic patients

Assessment of medication literacy of anticoagulation therapy in hospitalized orthopedic patients

Evaluation of patient and encounter decision aid interventions for atrial fibrillation: Baseline characteristics of the RED-AF study - A Randomized Controlled Trial

BackgroundThe Randomized Evaluation of Decision Support Interventions for Atrial Fibrillation (RED-AF) trial is a multi-site, randomized controlled clinical trial examining the effectiveness of a patient decision aid and an encounter decision aid in promoting shared decision-making (SDM) during a clinical encounter for patients with atrial fibrillation (AF). We sought to describe baseline characteristics of patients and clinicians in the trial and compare them to the demographics of the larger AF population. We also conducted an analysis of possible predictors of attrition rates at baseline, 6 and 12 months. MethodsThis study was a multi-center randomized controlled trial conducted at six academic centers across the U.S. Patients with non-valvular AF who qualify for anticoagulation therapy were eligible for enrollment. Patient demographics and characteristics were evaluated via questionnaires after their baseline clinical encounter. Participating clinicians completed demographic surveys, reporting educational background, specialty, and years of experience. Patient characteristics were analyzed via univariate logistic regression to identify potential trends among those lost to follow-up at each timepoint. FindingsA total of 1117 patients were enrolled in the RED-AF trial, with an average age of 69 (SD 9.3). Patients were predominantly male (61.7 %) and white (89.1 %), with 33.7 % reporting graduate or professional education. Clinicians (N = 107) were enrolled from specialties including cardiology (68.2 %), internal medicine (13.1 %), and pharmacy (14.0 %). No significant associations were found between any measured patient characteristics with survey completion at baseline, 6 or 12 months. ConclusionThe baseline demographics of the RED-AF trial reflect that patient participants were largely similar to prior studies investigating shared-decision making in patients with AF. The lack of association between patient demographics and attrition rates may highlight equity across the tested subgroups for survey completion for the study as a whole.

Unusual presentation of Evans syndrome with hypokalemic paralysis during pregnancy, management and outcome

Background: Evans Syndrome (ES) is a rare autoimmune disorder characterized by autoimmune hemolytic anemia (AIHA) and immune thrombocytopenic purpura (ITP). Its occurrence in association with Sjögren’s Syndrome (SS) during pregnancy, compounded by hypokalemic paralysis, is exceedingly rare. Case Description: A 24-year-old primigravida at 17 weeks of gestation presented with limb weakness due to hypokalemic paralysis. She had a history of ES and SS diagnosed prior to conception, managed initially with corticosteroids and vitamin B12 supplementation. During pregnancy, she experienced hypokalemia, renal tubular acidosis, and moderate anemia, which were managed effectively with potassium, bicarbonate, prednisolone, and hydroxychloroquine. The pregnancy was monitored closely, culminating in a cesarean delivery of a healthy baby at 39 weeks. Postpartum care included transfusions and anticoagulation therapy. Both mother and baby showed favorable outcomes without major complications. Conclusion: The coexistence of ES and SS during pregnancy, further complicated by hypokalemic paralysis, presents unique challenges. Early diagnosis, multidisciplinary management, and close monitoring are pivotal in achieving successful maternal and neonatal outcomes.

Safety and Efficacy of Left Atrial Appendage Closure Devices: In-Vitro Controlled Simulations and In-Vivo Correlations

The "Left Atrial Appendage Closure (LAAC) Device" is specifically designed to address the problem of stroke prevention in patients with atrial fibrillation (AF). In individuals with AF, the heart's atria (upper chambers) do not beat effectively, allowing blood to pool and potentially form clots, particularly in the left atrial appendage (LAA). These clots can then travel to the brain, causing a stroke. The purpose of the Left Atrial Appendage Closure Device is to mechanically seal off the left atrial appendage, preventing blood clots from forming there and reducing the risk of stroke in patients with atrial fibrillation who are at high risk of stroke but cannot tolerate long-term anticoagulation therapy. Hence Patients with atrial fibrillation frequently develop thrombus in the Left Atrial Appendage (LAA), which significantly increases their risk of stroke. LAA closure devices block the appendage, providing a percutaneous method of lowering this risk. With an emphasis on current developments, this research article examines the history, development effectiveness, delivery &amp; deployment and safety of LAA closure devices via in-vitro simulation testing with controlled conditions.