Risk Of Bleeding Research Articles

Hemodynamic evaluation of endovascular techniques of stenting and coiling for the treatment of internal carotid artery aneurysm: a computational study

The selection optimum endovascular method for the treatment of different cerebral aneurysms has been the main challenge for surgeons. In the present article, the computational technique is used for the hemodynamic evaluation of two main endovascular techniques of stent and coiling for the reduction of the hemorrhage risk of ICA aneurysms. Comprehensive analyses of the blood flow are performed to detect potential regions with high risk at critical stages of the cardiac cycle. Two coiling porosity conditions and stent deformation have been investigated via computational study to reveal the main change related to hemodynamics when these techniques are implemented. The hemodynamic results of this study show that the endovascular technique is more efficient in small aneurysms rather than giant ones. Meanwhile, the stent treatment of the giant saccular aneurysm is effective when the parent vessel of this type of aneurysm is fully aligned and limited blood flow enters the sac area.

Spotting the scurvy’s sight: Spontaneous intraorbital hematomas causing bilateral acute proptosis

Spontaneous intraorbital hematomas in a child with no history of malignancy, coagulopathy, or child abuse can have nutritional deficiency leading to increased risk of bleeding. Children with neurological impairment are more prone to develop scurvy. Scurvy in a child presents with both musculoskeletal findings and bleeding diathesis and, therefore, a radiologist should be well-versed with the classical osseous changes on radiographs and with unusual, yet important radiological clues of intraorbital and intracranial hematomas on computed tomography.

NSAIDs increase risk of haemorrhage in patients on oral anticoagulants

NSAIDs increase risk of haemorrhage in patients on oral anticoagulants

The application of hepatopancreatoduodenectomy in advanced gallbladder carcinoma: Patients’ selection, surgical outcome and influence on survival compared to radical cholecystectomy

Aimto investigate hepatopancreatoduodenectomy (HPD) application in gallbladder carcinoma (GBC) and compare it to radical cholecystectomy (RC) regarding patients’ characteristics, surgical outcome and survival. MethodsPatients treated in our center were included. Three groups (HPD, RC, no-surgery) were compared. Comparisons included basic characteristics, liver function, tumor biomarkers, surgical complications, outcome, and survival. Differences in severity, surgical risks and survival were investigated. ResultsIn total, 19 patients in HPD, 89 in RC and 20 in no-surgery groups were included. Median follow-up was 42.0 months. Compared to RC, HPD group revealed increased severity represented by significantly higher rates of elevated ALT, AST, TB, DB, preoperative biliary decompression, T3/4, N1/2, stage III/IV, and MVI. Similar severity was observed between HPD and no-surgery groups. Additionally, HPD presented higher risks of perioperative bleeding, transfusion and complications (grade III/IV). Pancreatic fistula and delayed gastric emptying were most encountered in HPD and only one mortality was recorded. Although HPD had shorter survival in general population (HPD: 17 ± 5.804, RC: 49 ± 11.433,P < 0.001); however, in matched (PSM) advanced stages, its benefits matched RC (HPD: 17 ± 4.793, RC: 11 ± 1.169, P = 0.966). Significant survival advantages were observed when comparing HPD to no-surgery group (HPD: 17 ± 5.804, no-surgery: 7 ± 0.836, P = 0.013). ConclusionCases benefiting from HPD are usually severe and comparable to unresectable cases. Although HPD complexity and complication risks are higher than RC, the survival benefits of HPD in advanced GBC stages are not inferior. Thus, HPD is a valuable option in such patients and can be the only approach to achieve R0 resection.

Outcomes of Adjunct Emergent Stenting Versus Mechanical Thrombectomy Alone: The RESCUE-ICAS Registry.

Underlying intracranial stenosis is the most common cause of failed mechanical thrombectomy in acute ischemic stroke patients with large vessel occlusion. Adjunct emergent stenting is sometimes performed to improve or maintain reperfusion, despite limited data regarding its safety or efficacy. We conducted a prospective multicenter observational international cohort study. Patients were enrolled between January 2022 and December 2023 at 25 thrombectomy capable centers in North America, Europe, and Asia. Consecutive patients treated with mechanical thrombectomy were included if they were identified as having underlying intracranial stenosis, defined as 50-99% residual stenosis of the target vessel or intra-procedural re-occlusion. The primary outcome was functional independence, defined as modified Rankin Scale of 0-2 at 90 days. After applying inverse probability of treatment weighting (IPTW) based on propensity scores, we compared outcomes among patients who underwent adjunct emergent intracranial stenting (stenting) versus those who received mechanical thrombectomy alone. A total of 417 patients were included; 218 patients treated with mechanical thrombectomy alone (168 anterior circulation) and 199 with mechanical thrombectomy plus stenting (144 anterior circulation). Patients in the stenting group were less likely to be non-Hispanic White (51.8% vs 62.4%, p=0.03), and less likely to have diabetes (33.2% vs 43.1%, p=0.037) or hyperlipidemia (43.2% vs 56%, p= 0.009). In addition, there was a lower rate of IV thrombolysis use in the stenting group (18.6% vs 27.5%, p=0.03). There was a higher rate of successful reperfusion (modified Treatment In Cerebral Infarction score ≥ 2B) in the stenting versus mechanical thrombectomy alone group (90.9% vs 77.9%, p<0.001) and a higher rate of a 24-hour infarct volume of <30 mL (n=260, 67.9% vs 50.3%, p=0.005). The overall complication rate was higher in the stenting group (12.6% vs 5%, p=0.006), but there was not a significant difference in the rate of symptomatic hemorrhage (9% vs 5.5%, p=0.162). Functional independence at 90 days was significantly higher in the stenting group (42.2% vs. 28.4%, adjusted odds ratio 2.67; 95% CI, 1.66-4.32). In patients with underlying stenosis who achieved reperfusion with mechanical thrombectomy, adjunct emergent stenting was associated with better functional outcome without a significantly increased risk of symptomatic hemorrhage. https://clinicaltrials.gov/study/NCT05403593.

MANAGEMENT OF ANTICOAGULATION IN ATRIAL FIBRILLATION: MINIMIZING DRUG INTERACTIONS WITH DOACS

Introduction: Atrial fibrillation (AF) is a common cardiac arrhythmia that elevates the risk of thromboembolic events, necessitating effective anticoagulation strategies. Direct oral anticoagulants (DOACs) have become the preferred choice due to their safety profiles; however, drug interactions can compromise their efficacy and safety. Objective: This study aims to assess the impact of drug interactions on the efficacy and safety of DOACs in patients with AF. Method: A literature review was conducted using databases such as the Virtual Health Library, LILACS Plus, and Medline, focusing on articles published from 2019 to 2024. Inclusion criteria emphasized studies related to drug interactions involving DOACs and AF, resulting in the selection of 13 relevant articles. Results: The analysis revealed a significant prevalence of drug interactions among patients treated with DOACs. Co-prescription with CYP3A4 inhibitors and P-glycoprotein modulators was linked to increased bleeding risks. Factors such as age, renal function, and the presence of comorbidities were crucial in determining appropriate dosing and the risk of adverse events. Conclusion: Careful management of AF patients on DOACs is vital to mitigate risks associated with drug interactions. Personalized treatment approaches that consider individual clinical profiles and ongoing education for healthcare providers are essential to optimize anticoagulation therapy.

Manajemen Anestesi Gravida dengan Plasenta Akreta yang dilakukan Seksio Sesarea dengan Transarterial Ballooning

Bleeding before (antepartum) and after (postpartum) delivery remains a major contributor to perinatal mortality and maternal morbidity worldwide. Placenta accreta is a cause of maternal morbidity and mortality, recently becoming the most common reason for emergency postpartum hysterectomy. A 35-year-old woman weighing 55 kg, height 151 cm, G3P1101Ab000 at a gestational age of 34-36 weeks, with a history of antepartum bleeding and suspicion of placenta accreta from the ultrasound, is scheduled for pregnancy termination via cesarean section. Before the surgery, a transarterial balloon catheter is inserted, and the estimated blood loss during the operation is around 10,000 ml. In this patient, the choice of general anesthesia is made considering the history of third-trimester bleeding, a high probability index score of 51% for accreta, and the plan for hysterectomy, leading to an anticipated prolonged operation time. Additionally, the risk of significant bleeding during the surgery prompts the selection of general anesthesia for hemodynamic management, and the placement of a catheter balloon is done to anticipate massive bleeding. To obtain a more comprehensive comparison and understanding of estimated blood loss, a comparison with other cases involving catheter balloon procedures before or after surgery is needed.

Programmed cell death-related ABI1 is a critical mediator of abdominal aortic aneurysm

Abdominal aortic aneurysm (AAA) is a life-threatening condition characterized by localized dilation of the abdominal aorta, posing a significant risk of rupture and fatal hemorrhage. While surgical and endovascular repair techniques have advanced, the underlying mechanisms driving AAA development remain unclear, hindering the development of effective preventive and therapeutic strategies. Using bioinformatics analysis of publicly available data sets, the study identified a strong correlation between cell death (CD) score and different types of programmed cell death scores in AAA samples. WGCNA analysis revealed a module enriched in genes related to proteasome-mediated protein degradation, nuclear envelope, and endocytosis, significantly correlated with CD score. Further analysis identified ABI1 as a dominant feature gene, highlighting its potential role in AAA pathogenesis. In vitro validation using an Angiotensin II-induced AAA model in human aortic smooth muscle cells demonstrated that siRNA-mediated knockdown of ABI1 significantly reduced cell apoptosis, migration, and the expression of pro-apoptotic proteins, confirming ABI1's crucial role in promoting CD and AAA progression. The findings suggest that ABI1 may represent a promising therapeutic target for the prevention and treatment of AAA. Further research is warranted to fully understand the role of ABI1 in AAA and to develop targeted therapies based on this promising target.

Study of Iron Deficiency Anemia in First Three Trimesters of Pregnant Women During in RAMADAN: A Prospective Study

Background: Iron deficiency is defined as a condition in which Hemoglobin (Hb) level in the body is lower than normal, which results in decreased oxygen-carrying capacity of red blood cells to tissues, Pregnant women with Iron Deficiency Anemia are at a higher risk of postpartum hemorrhage. Methods: This study was a prospective analytical study conducted at the Sabratha Laboratory from RAMADAN 2021 to 2023. This study was conducted on all pregnant women with hemoglobin level less than 11 gm/dl in the first trimester and less than 10 gm/dl in the second and third trimesters. Data were 30 cases collected by studying from the Sabratha Laboratory in Libya. A self-designed questionnaire was used. The questionnaire was translated into the Arabic language for ease of understanding and administration to study the population. Conclusion: To improve maternal and fetal outcomes, it is recommended that primary health care has to be strengthened and high priority has to be given to aspects such as prevention, early diagnosis, and treatment of anemia in pregnancy before Fasting Ramadan.

Determination of the optimal obesity-adjusted dosing weight for enoxaparin.

The ideal dosing weight metric for enoxaparin remains elusive. Dosing remains focused on actual body weight, which may inadvertently increase the risk of bleeding in those with obesity, or ideal weight, which may underdose those with obesity. Our aim was to determine the optimal obesity-adjusted enoxaparin dosing weight. Multisite retrospective data were collected over a 2.0-year period for those with minimum 48 h of in-hospital twice-daily enoxaparin and factor anti-Xa level 3-5h postdose (n= 220). Multiple linear regression calculated the associated variance between a range of nominal dosing weights and factor anti-Xa levels, adjusted for renal function. Dosing weights were calculated as ideal body weight (IBW) and then adjusted for increasing percentages of weight above IBW, i.e. IBW +10% above IBW, IBW + 20% etc. up to actual body weight. A similar approach was used for lean body weight (LBW). For body mass index ≥30 kg/m2 optimal variance explained by dosing weight metrics was at IBW + 40% (23%) and similarly for LBW + 40% (23%). Using actual body weight (ABW) had lowest associated variance with factor anti-Xa levels (18%) followed by unadjusted IBW (13%) or unadjusted LBW (19%). In those with body mass index <30 kg/m2 there was similar associated variance in the ranges of IBW + 20-50% and LBW 10-40% (21%). Compared to IBW + 40% or LBW + 40% use of ABW to calculate dose was poorly associated with factor anti-Xa levels, as was IBW or LBW. IBW + 40% and LBW + 40% require further study as a dosing weight metric and may provide a more consistent factor anti-Xa response in those with obesity.

The Bleeding Edge: Managing Coagulation and Bleeding Risk in Patients with Cirrhosis Undergoing Interventional Procedures.

This review addresses the peri-procedural bleeding risks in patients with cirrhosis, emphasizing the need for careful coagulation assessment and targeted correction strategies. Liver disease presents a unique hemostatic challenge, where traditional coagulation tests may not accurately predict bleeding risk, complicating the management of procedures like paracentesis, endoscopic therapy, and various interventional procedures. As such, this paper aims to provide a comprehensive analysis of current data, guidelines, and practices for managing coagulation in cirrhotic patients, with a focus on minimizing bleeding risk while avoiding unnecessary correction with blood products. The objectives of this review are threefold: first, to outline the existing evidence on bleeding risks associated with common invasive procedures in cirrhotic patients; second, to evaluate the efficacy and limitations of standard and advanced coagulation tests in predicting procedural bleeding; and third, to examine the role of blood product transfusions and other hemostatic interventions, considering potential risks and benefits in this delicate population. In doing so, this review highlights patient-specific and procedure-specific factors that influence bleeding risk and informs best practices to optimize patient outcomes. This review progresses through key procedures often performed in cirrhotic patients. The discussion begins with paracentesis, a low-risk procedure, followed by endoscopic therapy for varices, and concludes with high-risk interventions requiring advanced hemostatic considerations. Each chapter addresses procedural techniques, bleeding risk assessment, and evidence-based correction approaches. This comprehensive structure aims to guide clinicians in making informed, evidence-backed decisions in managing coagulation in cirrhosis, ultimately reducing procedural complications and improving care quality for this high-risk population.

External validation of the OAC3-PAD risk score after endovascular revascularisation.

Background: The OAC3-PAD bleeding risk score was developed to assess the bleeding risk in patients with peripheral arterial disease (PAD), however its performance in patients treated exclusively with endovascular revascularisation has not yet been tested. We aimed to externally validate the bleeding risk score for this patient cohort. Patients and methods: A retrospective observational study, analysing the data of all PAD patients successfully treated with endovascular revascularisation in a single centre within a five-year period. The performance of the Cox proportional hazards (CPH) model, upon which the OAC3-PAD bleeding risk score is based, was tested using calibration methods, discrimination, and a scaled Brier score for overall performance. The OAC3-PAD bleeding risk score was calculated for all patients, classifying them into the four respective risk groups. Kaplan-Meier curves were plotted for all risk groups and discrimination was tested using log-rank tests. Results: While discrimination of the CPH model was adequate, calibration of the model was poor and the scaled Brier score was 3.27% (95% CI 0.65%-4.40%). Of the 1,434 patients, 33(2.3%) experienced a major bleeding event. The frequency of bleeding was 0.4% in the low risk group (3/736 patients), 0.8% in the low-to-moderate risk group (2/243 patients), 5.8% in the moderate-to-high risk group (15/258 patients), and 6.6% in the high risk group (13/197 patients). The OAC3-PAD score successfully discriminated each of the two lower bleeding risk groups from one of the two higher risk groups, but failed to discriminate among the two lower risk groups and the two higher risk groups, respectively. Conclusions: Although the OAC3-PAD score did not stratify patients into the four respective risk groups, it allowed discrimination between the low risk patients and the high risk patients. It could therefore become a useful tool for predicting major bleeding events in patients with PAD after endovascular revascularisation.

Population pharmacokinetics of unfractionated heparin and multivariable analysis of activated clotting time in patients undergoing radiofrequency ablation of atrial fibrillation

IntroductionAtrial fibrillation (AF) increases cardiovascular morbidity and mortality. To reduce thrombosis and bleeding risks, and due to high variability of unfractionated heparin (UFH) effect, activated clotting time (ACT) is used during radiofrequency catheter ablation (RFCA) of AF to guide UFH dose. This study aimed to develop a population PK-PD model and perform multivariable analysis in order to identify the most significant covariates associated with interindividual variability of UFH. MethodsElectronic medical records from 668 patients undergoing RFCA were analyzed, including relevant covariates. The relationship between UFH dose and ACT and the impact of the main covariates were characterized using a mixed-effect PK-PD model. Multivariable analysis was then used to identify predictors of ACT 15 minutes after UFH administration (ACT15). ResultsA two-compartment PK model with linear elimination and a direct Emax PD model with a baseline and sigmoidicity best described the observed ACT values. Pretreatment with dabigatran, warfarin, or fluindione significantly influenced baseline ACT. Pretreatment with vitamin K antagonists or low molecular weight heparin explained Emax variability. The multivariable model identified baseline ACT, initial UFH dose, and previous anticoagulant as the main predictors of ACT15. Model evaluation through resampling and external validation showed accurate ACT15 predictions. ConclusionThis study presents the first population PK-PD model characterizing the relationship between UFH doses and ACT during RFCA, along with multivariable analysis. Additionally, predictive calculators for ACT15 and UFH dose based on patient and procedural characteristics were developed, enhancing personalized anticoagulation management during RFCA.

Safety of direct oral anticoagulants in patients with atrial fibrillation aged 80 years and older: clinical risk factors

BACKGROUND: Direct oral anticoagulants (DOACs) are associated with bleeding, particularly in the geriatric population. Most studies focus on predicting major bleeding, but clinically relevant non-major bleeding (CRNMB) is equally important in practice. АIM: To assess the ability of clinical factors to predict the risk of CRNMB with the use of DOACs in patients with atrial fibrillation (AF) aged 80 years and older. MATERIALS AND METHODS: A total of 367 patients on DOACs with non-valvular AF aged 80 years and older were evaluated; the median age was 84 [82; 88] years. Key characteristics of the groups were analyzed, including gender, age, and body mass index. CHA2DS2-VASc and HAS-BLED scales were used to assess the risk of ischemic stroke and bleeding, respectively. Comorbidities, Charlson Comorbidity Index, and risk factors of chronic non-communicable diseases were considered. In addition, number of medications taken, physical examination data, history of atherosclerosis, and laboratory test results were collected. RESULTS: In univariate analysis, significant risk factors for the development of CRNMB with all DOACs included higher walking frequency (p=0.022), lower heart rate (p=0.08), and history of gastric and duodenal ulcer [odds ratio 5.34; 95% confidence interval (CI) 2.31–12.0; p 0.001]. In multivariate analysis, a model for predicting CRNMB was developed using age, type of DOAC, liver disease, acute cerebrovascular accident, history of gastric and duodenal ulcer as predictors. The resulting model had a predictive accuracy of 62.6% (95% CI 57.4–67.6), a sensitivity of 66.5% (95% CI 59.4–73.1), and a specificity of 58.2% (95% CI 50.4–65.7). CONCLUSION: The study identified specific modifiable, potentially modifiable, and non-modifiable risk factors for developing CRNMB in AF patients aged 80 years and over taking DOACs. An electronic system to support medical decision making, risk factor management, and public quality of life can be created using results of the study.

Supportive care strategies in myelodysplastic syndromes and acute myeloid leukemia in older adults: a national survey of Canadian hematologists.

Myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) are severe myeloid disorders associated with significant morbidity and mortality. Because of patient and disease factors, many older adults are treated as outpatients with less-intensive therapy. Optimal supportive care strategies to minimize bleeding and infectious complications in this patient population have not been systematically evaluated. We conducted a survey of Canadian hematologists to explore current practice in the use of tranexamic acid (TXA) and prophylactic antimicrobials in patients with MDS/AML treated with less-intensive therapy, and to evaluate equipoise for future trials. Survey items were generated through a combination of literature review and discussion with content experts. The survey was disseminated to 304 potential respondents with a response rate of 52%. Prophylactic platelet transfusions were used by 95%, while prophylactic TXA was used by 57%; the most frequent reason for not using TXA was uncertainty about benefit or harm. Use of prophylactic antimicrobials varied by chemotherapy regimen. If antimicrobial prophylaxis was used, the most frequently prescribed antibacterials were fluroquinolones (90%) and trimethoprim/sulfamethoxazole (21%); the most commonly used antifungals were fluconazole (66%) and voriconazole (36%). The most common reason for not using prophylactic antimicrobials was insufficient evidence of benefit. Most respondents agreed that clinical trials are needed to define the use of TXA and prophylactic antimicrobials in this patient population. Among survey respondents, there was variation in the use of supportive care strategies to address bleeding and infection risk in older adults with MDS/AML. The results of this survey will help to inform clinical trials to assess the benefits and risks of these prophylactic strategies.

Artificial intelligence systems for predicting chronic ischemic heart disease outcomes in cardiac surgery patients based on presence of anemia: a literature review

BACKGROUND: In Russia, the number of people undergoing heart surgery exceeds 600 thousand annually. These include anemia in 30–70% of patients with a 4-fold increased risk of one-year death, a 5-fold increased risk of stent thrombosis, a 1.3-fold increased risk of recurrent acute coronary events, and a 2-fold increased risk of bleeding. However, among the prognostic systems developed using artificial intelligence (AI) technologies, few take the presence of anemia into account. Existing digital platforms are not designed to support clinical decision making. AIM: The review aimed to evaluate existing AI platforms for predicting the course of ischemic heart disease (IHD) and systems that take into account the presence of anemia. MATERIALS AND METHOD: The PubMed and Russian Science Citation Index databases from 2000 to January 2024 were analyzed. Using Keywords of “artificial intelligence”, “anemia”, “coronary heart disease”, “hemoglobin”, and “cardiac surgery”, 906 articles were found, of which 38 met the inclusion criteria for analysis. RESULTS: In some countries, AI platforms have been created to predict the course of IHD. This review analyzes published data on the development and use of AI-based digital products for the management of patients with IHD, including those that take into account key hemodynamic parameters. CONCLUSION: Analysis of existing developments revealed a focus on solving prognostic problems. However, in our opinion, the range of parameters analyzed is not wide enough. For example, anemia, which plays a key role in modifying the risk of adverse outcomes in IHD, has not been considered as a factor.

Risk of bleeding after retrograde intrarenal surgery vs miniaturised percutaneous nephrolithotomy for 10-20 mm renal stones: a not so different safety profile.

To assess differences in bleeding risk between retrograde intrarenal surgery (RIRS) and minimally invasive miniaturised percutaneous nephrolithotomy (mini-PCNL) for 10-20 mm renal stones. A total of 176 patients with a renal stone between 10 and 20 mm were treated. For all patients the Stone Management According to Size-Hardness (SMASH) score was calculated: Hounsfield units × stone maximum size (cm)/100. Patients with score of <15 underwent RIRS (90 patients, Group A), whereas patients with score ≥15 underwent mini-PCNL (86 patients, Group B). In both groups the Cyber Ho laser was used. A statistical analysis was carried out to assess differences in the risk of bleeding. Preoperative features were comparable. The mean maximum stone diameter was 17.1 and 16.8 mm in Groups A and B, respectively (P = 0.13). The stone-free rate was comparable (87.8% vs 95.3%, P = 0.07). The overall complication rate was 14.4% and 18.6% in Groups A and B, respectively (P = 0.09). Gross haematuria was observed in five cases (5.5%) after RIRS and seven (8.1%) after mini-PCNL (P = 0.07). The mean haemoglobin drop was 12 and 2 g/L at the first and third postoperative day after RIRS vs 17 and 3 g/L after mini-PCNL (P = 0.06 and P = 0.21, respectively). Blood transfusions and renal embolisation were never necessary. When managing renal stones between 10 and 20 mm taking into account both size and hardness with the application of the SMASH score, RIRS and mini-PCNL show comparable efficacy. A higher bleeding risk has been expected with percutaneous approaches; however, in our cohort the incidence of clinically significant bleeding was low and comparable between the two groups when adopting mini-PCNL.

Left atrial appendage occlusion in patients with non-valvular atrial fibrillation and cerebral amyloid angiopathy: insights from the LOGIC (Left atrial appendage Occlusion in patients with Gastrointestinal or IntraCranial bleeding) international multicenter registry.

Oral anticoagulation therapy (OAC) is often contraindicated in patients with atrial fibrillation (AF) and cerebral amyloid angiopathy (CAA) because of the high hemorrhagic risk. Left atrial appendage occlusion (LAAO) can prevent thromboembolic events while avoiding long-term anticoagulation. However, a short period of antithrombotic therapy (AT) is still recommended after LAAO, and, therefore, it is unclear whether patients with CAA can be candidates for LAAO. The aim of the study was to investigate the safety and efficacy of LAAO in patients with CAA and AF. In this sub-study of the LOGIC (Left atrial appendage Occlusion in patients with Gastrointestinal or IntraCranial bleeding) registry, the authors considered only patients with previous intracranial (IC) bleeding, and patients with CAA were compared with patients who did not have CAA. Outcomes of interest were death from any causes and cardiovascular death, ischemic stroke, transient ischemic attack and systemic embolization, and any bleeding and major bleeding at 12 months. The analysis included 270 patients, 49 (18%) of whom had CAA. Patients with CAA were more frequently discharged without AT after LAAO compared with patients who did not have CAA (36.7% vs 6.8%, P less than .001), and this was confirmed at the 1-year follow-up (30.4% vs 14.1%, P = .001). There were no significant differences in all-cause or cardiovascular mortality, or ischemic or hemorrhagic endpoints at 1 and 12 months. LAAO seems to be safe and effective in reducing both ischemic and hemorrhagic risk in patients with AF and CAA. Although patients with CAA are more likely to be discharged without AT after LAAO, there are no significant differences in ischemic and hemorrhagic outcomes compared with patients with a history of IC bleeding from other causes.

Device-Related Adverse Events and Flow Capacity of Percutaneous Ventricular Assist Devices.

Complication management is crucial in patients receiving mechanical circulatory devices. However, there are limited data on the association between the risks of complications and device type in patients with percutaneous ventricular assist devices (PVAD). The Japanese registry for PVAD (J-PVAD) is a nationwide ongoing registry that enrolls consecutive patients with cardiogenic shock treated with PVAD. We analyzed 5717 patients in the J-PVAD from February 1, 2020, to December 31, 2022, to compare the incident risks of device-related problems and all-cause mortality within 30 days after PVAD introduction based on flow capacities of first-line PVAD (low: Impella 2.5/CP, n=5375; high: Impella 5.0/5.5, n=342). The overall incidence of major device-related problems, including hemolysis, major bleeding, kidney injury, sepsis, and pump stop were 13%, 21%, 7%, 3%, and 1%, respectively. The all-cause mortality rate was 34%. The incident risks of hemolysis (hazard ratio [HR] 0.38, 95% confidence interval [CI] 0.24-0.58), kidney injury (HR 0.32, 95%CI 0.18-0.57), and pump stop (HR 0.38, 95%CI 0.16-0.91) were lower in patients with high-flow PVAD compared with those with low-flow PVAD. The risks of major bleeding or sepsis did not differ significantly between groups. The risk of all-cause mortality was lower in patients with high-flow PVAD compared with those with low-flow PVAD (HR 0.79, 95%CI 0.65-0.96). Compared with those with low-flow PVAD, patients with high-flow PVAD had lower incident risks of device-related problems, including hemolysis, kidney injury, and pump stop, as well as lower risk of all-cause mortality.

Postpartum Hemorrhagic Morbidity with Scheduled versus Unscheduled Cesarean Delivery at Term.

This study aimed to compare the composite maternal hemorrhagic outcomes (CMHOs) among term (≥37 weeks) singletons who had scheduled versus unscheduled cesarean deliveries (CDs). A subgroup analysis was done for those without prior uterine surgeries. Retrospectively, we identified all singletons at term who had CDs. The unscheduled CDs included individuals admitted with a plan for vaginal delivery with at least 1 hour of attempted labor. CMHOs included any of the following: estimated blood loss of ≥1,000 mL, use of uterotonics (excluding prophylactic oxytocin) or Bakri balloon, surgical management of hemorrhage, blood transfusion, hysterectomy, thromboembolism, admission to intensive care unit, or maternal death. Multivariable Poisson regression models with robust error variance were used to estimate adjusted relative risks (aRRs) with 95% confidence intervals (CIs). Of 8,623 deliveries in the study period, 2,691 (31.2%) had CDs at term, with 1,709 (67.3%) scheduled CDs, and 983 (36.5%) unscheduled CDs. Overall, the rate of CMHO was 23.3%, and the rate of blood transfusion was 4.1%. CMHOs were two-fold higher among unscheduled (34.5%) than scheduled CDs (16.9%; aRR = 2.18; 95% CI: 1.81-2.63). The aRRs for blood transfusion and surgical interventions to manage postpartum hemorrhage were three times higher with unscheduled than scheduled CDs. The subgroup analysis indicated that among the cohorts without prior uterine surgery, the rate of the CMHOs was significantly higher when the CD was unscheduled versus scheduled (aRR 1.85; 95% CI 1.45-2.37). Compared to scheduled CDs, the composite hemorrhagic adverse outcomes were significantly higher with unscheduled CDs. · Unscheduled cesareans are at higher risk of hemorrhage.. · Unscheduled cesareans are at higher risk of transfusion.. · Atony treatment is higher in unscheduled cesareans..