Bleeding Outcomes Research Articles

Long-term outcomes of apixaban as main anticoagulant in patients with HeartMate 3 left ventricular assist devices.

HeartMate 3 (HM3) left ventricular assist devices (LVADs) offer improved haemocompatibility-related outcomes for end-stage heart failure patients, facilitating the exploration of alternative anticoagulation therapies beyond warfarin. This study presents a long-term evaluation of thrombotic and bleeding outcomes in HM3 LVAD patients transitioned from warfarin to apixaban. We retrospectively identified HM3 LVAD patients at our single centre who transitioned from warfarin to apixaban. Baseline characteristics were described at discharge from implant hospitalization and at the last follow-up on each anticoagulation regimen. We reported survival, thrombo-embolic events (including LVAD pump thrombosis, stroke, arterial thrombo-embolic events and pump exchange) and bleeding events on both warfarin and apixaban. Eight patients were identified between May 2018 and June 2022 who transitioned from warfarin to apixaban 5mg twice daily. Patients were followed for a mean of 1233days after LVAD implantation and 789days after transition to apixaban. All patients were transitioned due to difficulty maintaining a therapeutic international normalized ratio (INR), including five patients who experienced bleeding complications on warfarin. No patients encountered LVAD pump thrombosis, stroke events, arterial thrombo-embolic event, pump exchange or death. While on warfarin, five patients had eight bleeding events: one major [requiring 2units of packed red blood cells (pRBCs)] and seven minors (five gastrointestinal bleeds, one episode of haematuria and one episode of haemoptysis). After switching to apixaban, one patient with angioectasia had a major gastrointestinal bleed requiring two pRBCs and endoscopic clipping. Apixaban demonstrated safe and favourable long-term outcomes in a cohort of HM3 LVAD patients over a mean follow-up of more than 2years. To our knowledge, our report provides the longest follow-up duration for this patient population to date. Larger prospective studies are needed before this can be adopted as the standard of care.

Trends in antithrombotic therapy and clinical outcomes for percutaneous coronary intervention in Japan following the 2020 JCS guideline focused update: findings from the SAKURA PCI2 Antithrombotic Registry.

In April 2020, the Japanese Circulation Society updated guidelines recommending shortened dual antiplatelet therapy (DAPT) for patients at Japanese Version of the High Bleeding Risk (J-HBR), but the impact remains unclear. We conducted a prospective multicenter registry (SAKURA PCI2 Antithrombotic Registry) starting June 2020 (n = 1136), enrolling patients who underwent percutaneous coronary intervention (PCI). Planned DAPT duration, defined as short if less than 3months, was based on patient background post-PCI and physicians' discretion. Planned short DAPT was used in 55.2% of patients, with a similar incidence of J-HBR (68.3% vs. 66.6%, p = 0.55) and a shorter actual DAPT duration (97 vs. 229days, p < 0.001) compared with Planned non-short DAPT. Primary endpoints, major adverse cardiovascular and cerebrovascular events (MACCE) including all-cause death, non-fatal myocardial infarction, stent thrombosis, and stroke, and Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding (BARC-3/5), occurred similarly across groups (MACCE: 6.5% vs. 7.3%, p = 0.66; BARC-3/5: 3.7% vs. 2.2%, p = 0.14). Independent predictors of MACCE included age ≥ 75, Clinical Frailty Scale ≥ 4, and hemoglobin < 11. Age ≥ 75, severe chronic kidney disease, hemoglobin < 11, and platelets < 100,000 were linked to BARC-3/5. Among BARC 3/5 patients, 41.2% experienced bleeding after switching to single antiplatelet therapy. Planned short DAPT was implemented in 55.2% of patients, showing comparable thrombotic and bleeding outcomes to non-short DAPT.

Elevated serum and cerebrospinal fluid levels of Interleukin-4 related to poor outcome of Aneurysmal subarachnoid hemorrhage

Aneurysmal subarachnoid hemorrhage (aSAH) is a hemorrhagic cerebrovascular disease that seriously jeopardizes human life and health. Some studies have shown that although Interleukin-4 (IL-4) acts as an anti-inflammatory factor, IL-4 levels are elevated when the disease occurs. This study focuses on exploring the relationship between IL and 4 concentrations in the serum and cerebrospinal fluid (CSF) and poor outcome in patients with aSAH. This study was a prospective observational study and 210 aSAH patients who met the inclusion criteria were divided into two groups according to the mRS score at 3 months after discharge, and 210 healthy people were selected as controls. The IL-4 concentrations were quantitatively determined with enzyme-linked adsorption assay (ELISA). We can draw a conclusion that Serum and CSF IL-4 concentrations are generally elevated in patients with poor outcome(P < 0.05), and the CSF IL-4 concentration decreased gradually over the progress of time (P < 0.05). The IL-4 concentration in the CSF was positively correlated with age, platelet-lymphocyte ratio (PLR), C-reactive protein (CRP), Hunt-Hess grade, mRS score, and World Federation of Neurological Surgeons score (WFNS) (P < 0.0001). Additionally, IL-4 concentrations in the CSF were correlated with complications such as intracranial infection (P = 0.01), cerebral edema (P < 0.01), hydrocephalus (P = 0.02), and complications by DCI (P = 0.02). Elevated serum and CSF concentrations of IL-4 may associated with the outcome of aSAH and may be a candidate early biomarkers for outcome of aSAH.

Predicting Intracerebral Hemorrhage Outcomes Using Deep Learning Models to Extract Head CT Imaging Features

Predicting Intracerebral Hemorrhage Outcomes Using Deep Learning Models to Extract Head CT Imaging Features

The risk of upper gastrointestinal bleeding associated with concomitant proton pump inhibitor administration during dual antiplatelet therapy with aspirin and prasugrel: a retrospective single-center study

ObjectiveDual‐antiplatelet therapy (DAPT) and proton pump inhibitor (PPI) are frequently prescribed after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) placement. However, studies that evaluate the optimal PPI when used as primary prevention in patients without a history of peptic ulcer disease or upper gastrointestinal bleeding (UGIB), particularly in the context of DAPT involving prasugrel, are lacking. This study aimed to assess the efficacy and safety of PPI use in preventing UGIB in this patient population.MethodsThis study included patients who underwent PCI with coronary stent placement for acute coronary syndrome or stable angina at our institution from January 2015 to December 2020. Eligible patients started DAPT with aspirin and prasugrel and concomitantly received PPI therapy (lansoprazole or esomeprazole), with a follow-up period of two years. The primary endpoint was UGIB incidence, diagnosed during follow-up, serving as an efficacy measure. Secondary endpoints included the assessment of major bleeding (as defined by the Thrombolysis in Myocardial Infarction major bleeding criteria) and clinically relevant non-major bleeding events. Safety outcomes focused on adverse event incidence attributable to PPI use.ResultsAmong the 165 patients analyzed, 109 and 56 were included in the lansoprazole and esomeprazole groups, respectively, with cumulative incidence of UGIB at 96 weeks of 0.9% (1/109) and 3.6% (2/56). No significant differences in terms of major bleeding events or other bleeding outcomes were observed between the two groups. Adverse events related to PPI use were reported as diarrhea/soft stools in 7 (6%) cases and thrombocytopenia in 1 (1%) case in the lansoprazole group, whereas no such events were observed in the esomeprazole group. No clinically significant hematologic or biochemical abnormalities were reported.ConclusionThis study evaluated the efficacy and safety of PPIs in combination with DAPT, including prasugrel, following PCI, and suggests that lansoprazole and esomeprazole may offer comparable efficacy in preventing UGIB.

Efanesoctocog Alfa Versus Emicizumab in Adolescent and Adult Patients With HaemophiliaA Without Inhibitors.

The phase3 XTEND-1 trial (NCT04161495) demonstrated that efanesoctocog alfa prophylaxis provided superior bleed protection compared with pre-trial factorVIII (FVIII) prophylaxis in patients with severe haemophiliaA. The aim of this study was to indirectly compare the efficacy of efanesoctocog alfa with non-factor replacement therapy emicizumab in adolescent and adult patients with severe haemophiliaA without inhibitors. A systematic literature review was conducted to identify phase3 trials of emicizumab. Matching-adjusted indirect comparisons were used to compare annualised bleeding rates (ABRs) for any, treated, joint, and spontaneous bleeds, and joint health (measured using Hemophilia Joint Health Score [HJHS]), between efanesoctocog alfa and emicizumab. Estimated effects for different emicizumab regimens were pooled using random-effect meta-analysis to evaluate the overall difference in bleed outcomes between efanesoctocog alfa and emicizumab. One emicizumab trial was included (HAVEN3), which investigated three dosing regimens. In meta-analyses, efanesoctocog alfa once-weekly (Q1W) was associated with significantly lower ABRs for any (incidence rate ratio [95%CI] 0.33 [0.20; 0.53]), any treated (0.49 [0.30; 0.80]) and treated joint (0.51 [0.28; 0.91]) bleeds compared with emicizumab Q1W in non-inhibitor patients with prior prophylaxis or on-demand treatment. Efanesoctocog alfa Q1W was also associated with a significantly better improvement from baseline in HJHS Joint Score (mean difference [95%CI] -2.06 [-3.97; -0.14]) and Total Score (-2.37 [-4.36; -0.39]) versus emicizumab Q1W or every 2weeks. Efanesoctocog alfa prophylaxis was associated with significantly lower rates of any, treated, and joint bleeds and improved joint health compared with emicizumab in patients with severe haemophiliaA.

Efanesoctocog Alfa versus Standard and Extended Half-Life Factor VIII Prophylaxis in Adolescent and Adult Patients with Haemophilia A without Inhibitors.

In the Phase 3 XTEND-1 trial, (NCT04161495) efanesoctocog alfa prophylaxis provided superior bleed protection versus pre-study factor VIII (FVIII) replacement therapy in patients with severe haemophilia A. The aim of this study was to indirectly compare bleed outcomes between efanesoctocog alfa and standard/extended half-life (SHL and EHL) FVIII replacement therapies in adolescent and adult patients with severe haemophilia A without inhibitors. A systematic literature review was conducted to identify Phase 3 trials of EHL and SHL FVIII replacement therapies for comparison with efanesoctocog alfa data from XTEND-1. Matching-adjusted indirect comparisons were used to compare annualised bleeding rates (ABRs) for any, treated, joint, and spontaneous bleeds between efanesoctocog alfa and comparators. The estimates from respective comparisons were pooled using random-effect meta-analyses to evaluate the overall difference between efanesoctocog alfa and comparator therapies. Four EHL therapies (rurioctocog alfa pegol, efmoroctocog alfa, turoctocog alfa pegol, damoctocog alfa pegol) and two octocog alfa SHL therapies were included. In meta-analyses, efanesoctocog alfa was associated with significantly lower ABRs for any [mean difference (95% CI) -2.24 (-3.24; -1.25)], spontaneous [-1.52 (-2.33; -0.72)], and joint bleeds [-1.60 (-2.32; -0.88)] versus EHL therapies, and with significantly lower ABRs for any [-3.61 (-4.43; -2.79)], treated [-1.55 (-1.89; -1.20)], spontaneous [-2.52 (-3.31; -1.72)], and joint bleeds [-3.42 (-4.77; -2.08)] versus SHL therapies. Efanesoctocog alfa was associated with significantly lower ABRs (any, spontaneous and joint) compared with EHL or SHL prophylaxis therapies. Patients had, on average, 2.2 and 3.6 fewer bleeds per year versus EHL and SHL therapies, respectively.

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..

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.

Direct Oral Anticoagulants Versus Warfarin in Patients With Isolated Heparin-Induced Thrombocytopenia or Heparin-Induced Thrombocytopenia With Thrombosis.

No existing studies compare oral anticoagulants to treat heparin-induced thrombocytopenia with or without thrombosis (HIT/HITT). This retrospective study evaluated thrombotic and bleeding outcomes in adults treated for HIT/HITT with a direct oral anticoagulant (DOAC) or warfarin between 2012 and 2023 within the Ochsner Health System. Patients with mechanical heart valves, valvular atrial fibrillation, antiphospholipid syndrome, active malignancy, or venous thromboembolism (VTE) within the previous 6 months were excluded. The primary outcome was a composite of new or progressive VTE or arterial thromboembolism. Secondary outcomes included major and clinically relevant non-major bleeding, duration of hospitalization, time to platelet recovery, and incidence of skin necrosis, gangrene, and amputation. Forty-nine patients receiving a DOAC and 30 patients receiving warfarin were included. Baseline characteristics were similar between cohorts. There were non-statistically significant increased rates of both the primary outcome (8.9% vs. 4.3%, p = 0.65) and the composite bleeding outcome (32.7% vs. 23.3%, p = 0.37) in the DOAC cohort. Larger, prospective studies are needed to confirm these findings.

Use of Aspirin and Initial Cardiovascular and Bleeding Risk in Patients with Chronic Kidney Disease

Background: Despite the high cardiovascular risk in patients with chronic kidney disease (CKD), the role of aspirin in primary prevention remains unclear. This study aimed to investigate the association between aspirin initiation in adults with CKD without prior cardiovascular disease (CVD) and the first cardiovascular and bleeding events using Korean nationwide cohort data. Methods: Among individuals aged 40–79 years with an estimated glomerular filtration rate between 15 and 59 mL/min/1.73 m2 who underwent routine health examinations between 2011 and 2016, 15,861 individuals who were newly prescribed aspirin at a dose of 100 mg/day were matched with 79,305 aspirin non-users by propensity score matching. The primary efficacy outcome was a composite of nonfatal atherosclerotic CVD or cardiovascular death. The primary safety outcome was hospitalization due to intracranial or gastrointestinal bleeding. Results: During a mean follow-up of 6.9±2.9 years, the incidence rates for the primary efficacy outcome in aspirin users and non-users were 8.0 and 9.0 per 1,000 person-years, respectively. Aspirin therapy initiation was not associated with the primary efficacy outcome (hazard ratio [HR], 0.93; 95% confidence intervals [CI], 0.86-1.04). However, the primary safety outcome of major bleeding was more frequent in aspirin users than in non-users (6.7 versus 4.7 per 1,000 person-years). The HR for this outcome in aspirin users versus non-users was 1.45 (95% CI, 1.32-1.59). Conclusions: No association was observed between aspirin use and the risk of nonfatal atherosclerotic CVD or cardiovascular death in patients with CKD stages G3 and G4 without prior CVD. Aspirin use was associated with higher risk of major bleeding.

Abstract 4135791: Bleeding risk with non-vitamin K antagonist oral anticoagulants versus single antiplatelet therapy: A systematic review and meta-analysis of randomized controlled trials

Background: While non-vitamin K antagonist oral anticoagulants (NOACs) are more effective than single antiplatelets (mostly low-dose aspirin) at reducing stroke risk in patients with atrial fibrillation (AF), differences in bleeding risk between NOACs and single-dose antiplatelets across various populations remain unclear. Aim: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing bleeding outcomes of NOACs versus single antiplatelet therapy. Methods: We searched MEDLINE, EMBASE, and CENTRAL to June 2024 for RCTs that compared NOAC (therapeutic doses used for stroke prevention in AF patients) versus single antiplatelet therapy for a treatment duration of ≥3 months. For the meta-analyses, we used fixed-effects models and reported results as summary risk ratios (RRs). We used Risk of Bias 2 and GRADE to assess the quality and certainty of the evidence. Results: Eight RCTs with 26,194 participants were included. Mean follow-up time was 18 (±13) months. NOACs included in the studies were apixaban (4 studies), rivaroxaban (2 studies), and dabigatran (2 studies). All studies used low-dose aspirin as the comparator. When compared to aspirin, NOACs had a higher risk of major bleeding (326/13107 [2.5%] vs. 239/13087 [1.8%] events; RR 1.36 95% CI 1.15-1.60, I 2 =52%, 8 trials; high certainty) (Figure A), gastrointestinal bleeding (104/8803 [1.2%] vs. 74/8788 [0.8%] events; RR 1.39; 95%CI, 1.04-1.87; I 2 =0%; 5 trials; high certainty), and clinically relevant non-major bleeding (318/10397 [3.1%] vs. 230/10395 [2.2%] events; RR 1.38; 95%CI, 1.17-1.63; I 2 =16%; 5 trials; high certainty). There was no difference in the risk of intracranial hemorrhage (88/13107 [0.7%] vs. 84/13087 [0.6%] events; RR 1.04, 95%CI 0.78-1.41; I 2 =48%; 9 trials; high certainty) (Figure B) nor fatal bleeding (22/12412 [0.2%] vs. 28/12392 [0.2%] events; RR 0.78; 95%CI, 0.45-1.36; I 2 =8%; 6 trials; high certainty). Conclusion: When compared to aspirin, NOACs are associated with an increased risk of major bleeding and clinically relevant non-major bleeding, but not intracranial hemorrhage. These data are important to inform patients about the risks of antithrombotic treatment.

Predictors and Outcomes of Periprocedural Intracranial Hemorrhage after Stenting for Symptomatic Intracranial Atherosclerotic Stenosis.

Periprocedural intracranial hemorrhage is one of common complications after stent placement for symptomatic intracranial atherosclerotic stenosis. This study was conducted to demonstrate predictors and long-term outcomes of periprocedural intracranial hemorrhage after stent placement for symptomatic intracranial atherosclerotic stenosis. We retrospectively analyzed patients with symptomatic intracranial atherosclerotic stenosis stent placement in a prospective cohort at a high-volume stroke center. Clinical, radiologic, and periprocedural characteristics and long-term outcomes were reviewed. Periprocedural intracranial hemorrhage was classified as procedure-related hemorrhage (PRH) and non-procedure-related hemorrhage (NPRH). The long-term outcomes were compared between patients with PRH and NPRH, and the predictors of NPRH were explored. Among 1849 patients, 24 (1.3%) had periprocedural intracranial hemorrhage, including PRH (4) and NPRH (20). The postprocedural 30-day mRS was 0-2 in 9 (37.5%) cases, 3-5 in 5 (20.8%) cases, and 6 in 10 (41.7%) cases. For the 14 survivors, the long-term (median of 78 months) mRS were 0-2 in 10 (76.9%) cases and 3-5 in 3 (23.1%) cases. The proportion of poor long-term outcomes (mRS ≥3) in patients with NPRH was significantly higher than those with PRH (68.4% versus 0%, P = .024). Anterior circulation (P = .002), high preprocedural stenosis rate (P < .001), and cerebral infarction within 30 days (P = .006) were independent predictors of NPRH after stent placement. Patients with NPRH had worse outcomes than those with PRH after stent placement for symptomatic ICAS. Anterior circulation, severe preprocedural stenosis, and recent infarction are independent predictors of NPRH.

The Role of Systemic Inflammatory Indices in Predicting Composite Adverse Outcomes of Peripartum Hemorrhage Treated with Fibrinogen Concentrate

The Role of Systemic Inflammatory Indices in Predicting Composite Adverse Outcomes of Peripartum Hemorrhage Treated with Fibrinogen Concentrate

Postoperative bleeding outcome of fresh frozen plasma prime in pediatric cardiac surgery: A systematic review & meta-analysis.

Bleeding after cardiac surgeries holds risk of mortality and morbidity in pediatrics. This systematic review aimed to evaluate postoperative blood loss and blood transfusion requirements for pediatric patients undergoing cardiac surgery with fresh frozen plasma (FFP) priming. In 2024, the search reviewed four databases on randomized trials (RCTs) examining the impact of FFP prime intervention on 24-h postoperative blood loss and transfusion requirements in pediatric cardiac surgeries. The journals were appraised using Grading of Recommendation Assessment, Development, and Evaluation checklists, and random effects models estimated the effect size with a 95% confidence interval. Significance and study heterogeneity were indicated by p-values and I2. Of the screened 2070 articles, one high-quality and four moderate-quality RCTs involving 354 children were identified. No significant reduction in 24-h mean postoperative blood loss was found following FFP priming (mean difference MD: -0.78, 95% CI [-3.3 to 1.75], p = .55) in general pediatric cardiac surgeries. However, subgroup analysis showed significant decrease in blood loss for younger children (<7 months) or those with lower body weight (<6kg). There was no significant difference between groups in FFP (MD: -0.19, 95% CI [-0.42 to 0.05], p = .13) or red blood cell transfusion (MD: -0.25, 95% CI [-0.51 to 0.02], p = .07). Administering FFP as prime fluid in cardiac surgery did not reduce postoperative bleeding in general pediatric patients, but younger children (<7 months) and those with lower weight (<6kg) were the subjects who benefited from the FFP priming before surgery.

Revisiting the Efficacy and Safety of Bivalirudin in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: Insights From a Mixed Treatment Comparison Meta-Analysis of Randomized Trials.

Randomized trials of bivalirudin in patients with ST elevation myocardial infarction (STEMI) have yielded heterogeneous results. Our aim was to evaluate the efficacy and safety of four antithrombin regimens-unfractionated heparin (UFH), bivalirudin (stopped soon after percutaneous coronary intervention [PCI]), extended bivalirudin (continued for a few hours after PCI), and combined UFH and a Gp2b3a inhibitors (GPI) in patients who present with STEMI. A PubMed, EMBASE, and clinicaltrials.gov databases were searched for randomized clinical trials (RCTs) of the above antithrombin in patients with STEMI. The primary outcome was net adverse cardiovascular events (NACE). The primary ischemic endpoint was major adverse cardiovascular events (MACE), and the primary safety endpoint was major bleeding, and other endpoints included all-cause mortality and stent thrombosis. The primary analysis compared the effect of these antithrombin regimens in reference to UFH using a mixed treatment comparison meta-analysis. In the 14 RCTs evaluating 25,415 patients with STEMI, when compared to UFH monotherapy, extended bivalirudin lowered NACE (OR = 0.71 with 95% CI: 0.53-0.96; moderate level of confidence) driven by a significant decrease in major bleeding (OR = 0.42 with 95% CI: 0.26-0.68; high level of confidence) without any significant difference in MACE or all-cause mortality. When compared with UFH monotherapy, UFH+GPI reduced risk of MACE (OR = 0.76 with 95% CI: 0.60-0.97; high level of confidence) but at the expense of an increase in major bleeding (OR = 1.48 with 95% CI: 1.11-1.98; high level of confidence) with no difference in NACE or all-cause mortality. For major bleeding, extended bivalirudin infusion ranked #1, bivalirudin ranked #2, UFH monotherapy ranked #3, and combined UFH and GPI ranked #4. For NACE, extended bivalirudin infusion ranked #1, bivalirudin ranked #2, combined UFH and GPI ranked #3, and UFH monotherapy ranked #4. Cluster plots for MACE and major bleeding demonstrated that extended bivalirudin had the best balance for efficacy and safety. In patients undergoing PCI for STEMI, extended bivalirudin offers the best balance for primary ischemic (MACE) and safety (major bleeding) outcomes.

Sex Modifies the Severity and Outcome of Spontaneous Intracerebral Hemorrhage.

The limited existing evidence on sex differences in the clinical characteristics of patients with spontaneous, non-traumatic intracerebral hemorrhage (ICH) comes from small, single-center studies. Here, we performed an individual patient data meta-analysis of 3 randomized clinical trials and 1 multi-ethnic observational study of ICH to investigate the impact of sex on ICH severity and outcome. Inclusion criteria in our study were a neuroimaging-confirmed ICH. We evaluated whether sex was associated with ICH severity (hematoma volume and expansion) and poor functional outcomes (modified Rankin Scale >3) 3 or 6 months after the ICH. A total of 4,812 ICH patients were evaluated (mean age 62, 40% female). Males with ICH were younger, more likely to be smokers and have diabetes, and less likely to be on anticoagulants (all p < 0.05). In multivariable analyses, male sex was associated with non-lobar location (odds ratio [OR]: 1.63; 95% confidence interval [CI]: [1.39-1.92]; p < 0.001), larger hemorrhages (beta: 0.16 [0.08-0.23]; p < 0.001) and a higher risk of hematoma expansion (OR: 1.43 [1.20-1.71]; p < 0.001). Despite the larger hemorrhage volume and higher risk of expansion, male sex was associated with a 24% lower risk of poor outcomes (OR: 0.76 [0.64-0.90]; p = 0.002). Compared to females, males with ICH have larger bleeds and higher risk of hematoma expansion. Despite the larger bleeds and higher risk of hematoma expansion, males with ICH have lower risk of poor outcomes. Our results suggest that the biology and clinical trajectory are different in females and males with ICH, supporting sex-specific research in this condition. ANN NEUROL 2024.

Real-World Bleeding Risk, Outcomes and Treatment Patterns of Patients with CLL/SLL Receiving BTKi with or without Prescription Anticoagulants or Antiplatelets

Real-World Bleeding Risk, Outcomes and Treatment Patterns of Patients with CLL/SLL Receiving BTKi with or without Prescription Anticoagulants or Antiplatelets

Influencing Factors and Predictors for Bleeding Outcomes in Severe-Type People with Hemophilia a (PwHA) on Extended Half-Life rFVIII-Fc Prophylaxis

Influencing Factors and Predictors for Bleeding Outcomes in Severe-Type People with Hemophilia a (PwHA) on Extended Half-Life rFVIII-Fc Prophylaxis

Age-Related Differences in Clinical Characteristics and Outcomes of Aneurysmal Subarachnoid Hemorrhage: A Retrospective Study of 657 Patients

Aneurysmal subarachnoid hemorrhage (aSAH) has an incidence of 6-7 per 100,000 person-years. Despite advancements in treatment, 26% of patients die, and 19% remain dependent post-hemorrhage. Long-term neuropsychological sequelae affect about half of the survivors, significantly impacting their quality of life. This study aims to assess aSAH characteristics and identify predictive factors of clinical outcomes in young patients. A retrospective study analyzed 657 aSAH patients treated at two South Korean medical centers from January 2011 to December 2023. Data on demographics, comorbidities, smoking history, clinical grades, aneurysm size and location, and outcomes were collected. Outcomes were classified using the modified Rankin Scale (mRS), with scores ≤2 indicating good outcomes. The cohort included 233 men and 424 women (male-to-female ratio 1:1.8). Most patients were middle-aged (74.4%), followed by young (16.7%) and old (8.8%) groups. Young patients exhibited male predominance (56.8%), lower hypertension (12.7%) and diabetes (1.8%) rates, and higher smoking rates (39.6%). Older patients had higher hypertension (44.6%) and diabetes (23.3%) rates, and were predominantly female (69.1%). Aneurysms in young patients were smaller (p=0.04). Multivariate analysis identified poor Hunt-Hess grade, permanent cerebral infarction, and aneurysmal recurrence or rebleeding as predictors of poor outcomes in young patients. Middle-aged patients had additional predictors, including diabetes and hydrocephalus. In older patients, only poor Hunt-Hess grade was significant. Young aSAH patients exhibit distinct characteristics and prognostic factors compared to older patients. Despite higher post-operative complications, young patients generally have better outcomes, emphasizing the need for age-specific management strategies in aSAH.