scholarly journals Risk of postpolypectomy bleeding in patients taking direct oral anticoagulants or clopidogrel

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Gwang-Un Kim ◽  
Sinwon Lee ◽  
Jaewon Choe ◽  
Sung Wook Hwang ◽  
Sang Hyoung Park ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Logistic Regression Analysis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Thromboembolic Events

AbstractThe usage of direct oral anticoagulants (DOACs) to prevent and treat thromboembolic events is gradually increasing. We aimed to evaluate the outcomes of patients taking DOACs after polypectomy. We retrospectively reviewed 131 patients taking DOACs and 270 taking clopidogrel who underwent polypectomy between November 2010 and December 2017. The risk of delayed postpolypectomy bleeding (PPB) was evaluated and compared. A total of 989 polyps were removed (320 polyps in the DOAC and 669 polyps in the clopidogrel group). DOACs and clopidogrel were discontinued for 2.8 ± 1.7 days and 5.8 ± 2.5 days before polypectomy, respectively. DOACs and clopidogrel were restarted on 1.6 ± 2.9 days and 1.7 ± 1.1 days after polypectomy, respectively. According to per polyp analysis, delayed PPB rate was 1.6% in both groups (p = 0.924). Logistic regression analysis was performed after propensity score matching and revealed that DOACs did not increase the delayed PPB risk compared to clopidogrel (OR 0.929, 95% CI 0.436–1.975, p = 0.847). With the majority following the antithrombotic discontinuation guidelines, the incidence of delayed PPB was 3.1% in the patients taking DOACs. The delayed PPB risk was not greater in those taking DOACs than in those taking clopidogrel.

scholarly journals Incidence and predictors of left atrial appendage thrombus on transoesophageal echocardiography before elective cardioversion

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
F Wegner ◽  
R Radke ◽  
C Ellermann ◽  
J Wolfes ◽  
A J Fischer ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Flow Velocity ◽  
Logistic Regression Analysis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Multivariate Logistic Regression Analysis ◽  
Transoesophageal Echocardiography ◽  
Multivariate Logistic Regression ◽  
Increased Risk

Abstract Introduction Guidelines recommend transoesophageal echocardiography (TOE) before cardioversion in thrombogenic arrhythmias when the requirement of ≥3 weeks of anticoagulation is not met. Current data to support this approach, especially with direct oral anticoagulants (DOAC), are scarce. Methods We analysed consecutive elective pre-cardioversion TOE in a high-volume electrophysiology centre for the occurrence of LAA thrombi or reduced LAA flow velocity. Possible predictors were recorded and compared in a multivariate logistic regression analysis. Results Consecutive pre-cardioversion TOE in 512 patients (148 female, median age 69 years) were included. In all patients, indication for TOE was either intake of anticoagulation <3 weeks before cardioversion or uncertain adherence to the prescribed anticoagulation regimen. Of the 512 TOE, 19 (3.7%) depicted a LAA thrombus. An additional 41 patients (8.0%) showed either a reduced LAA flow velocity (≤20cm/s), LAA sludge, or both (see figure). In a multivariate logistic regression analysis, QRS width on admission 12-lead ECG emerged as a possible predictor of LAA thrombus and reduced LAA flow (p=0.008). Noteworthy, a high CHA2DS2-VaSc-Score was not associated with an increased risk of reduced LAA emptying velocity and LAA thrombi were even found in patients with a CHA2DS2-VaSc-Score of 0 (n=1) and 1 (n=1). Conclusion The presence of LAA thrombus before an elective cardioversion is a rare event in the age of direct oral anticoagulants. However, LAA thrombi occurred even in supposed low-risk individuals according to the CHA2DS2-VaSc score. QRS width may aid in identifying patients at a high risk of a reduced LAA flow velocity. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. Representative images of a solid LAA thrombus (panel A), LAA sludge (panel B, not containing a solid thrombus on i.v. contrast imaging), and a LAA free of thrombus or sludge (panel C). Panel D shows the PW Doppler signal in a patient with LAA emptying velocity reduced ≤20cm/s while panel E shows a LAA with normal flow characteristics.

Is a small coil more effective as a finishing coil for the embolization of intracranial aneurysms? Outcomes using GALAXY G3™ MINI micro-coils as finishing coils in a single center

2021 ◽  
pp. 159101992110118
Author(s):  
Sang-Uk Kim ◽  
Joon Huh ◽  
Hyun-Goo Lee ◽  
Won-Joo Jeong ◽  
Dal-Soo Kim ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Logistic Regression Analysis ◽  
Packing Density ◽  
Coil Embolization ◽  
Odds Ratio ◽  
Total Population ◽  
Outer Diameter

Objective The purpose of this study was to compare the outcomes of coil embolization using a 0.009 inches primary outer diameter coil as finishing coil (FC) to that of 0.01 inches. Methods From February and August 2020, 131 aneurysms that performed coil embolization using FC with a second loop diameter of 1 mm, were reviewed retrospectively, conducting propensity score matching and logistic regression analysis. Angiographic results such as, occlusion grade, packing density, failure and event were compared between 0.009 inches coil of GALAXY G3™ MINI microcoil (n = 54) and 0.01 inches coils (n = 77). Results There were no statistically significant differences between two groups, but more events occurred in the 0.009 group. (Odds ratio, 3.65; 95% CI, 1.06-12.55; P = 0.031) In the results of coil embolization, successful occlusion occlusion (complete occlusion and residual neck) was identified more in the 0.01 group. After propensity score matching, the variables in each group were similar, but the successful occlusion was higher in the 0.01 group as in the total population. Events tended to occur more frequently in the 0.009 inch group, and logistic regression analysis showed slightly higher events in the angled microcatheter. (48.3% versus 76.9%., P = 0.075), Also, the 0.009 inch FC is an independent risk factor. (Odds ratio, 3.84; 95% CI, 1.07-13.80; P = 0.039) Conclusions Using 0.01 inches coils as FC increased the packing density after the procedure, and showed more successful occlusion than using a 0.009 inches coil. The probability of unexpected events was observed more than three times in the 0.009 inch group.

scholarly journals Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines – a retrospective observational study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Oliver Birkelbach ◽  
Rudolf Mörgeli ◽  
Claudia Spies ◽  
Maria Olbert ◽  
Björn Weiss ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Postoperative Complications ◽  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Logistic Regression Analysis ◽  
Frailty Status ◽  
Frailty Assessment ◽  
Care Facilities

Abstract Background Frailty is a frequent and underdiagnosed functional syndrome involving reduced physiological reserves and an increased vulnerability against stressors, with severe individual and socioeconomic consequences. A routine frailty assessment was implemented at our preoperative anaesthesia clinic to identify patients at risk. Objective This study examines the relationship between frailty status and the incidence of in-hospital postoperative complications in elderly surgical patients across several surgical disciplines. Design Retrospective observational analysis. Setting Single center, major tertiary care university hospital. Data collection took place between June 2016 and March 2017. Patients Patients 65 years old or older were evaluated for frailty using Fried’s 5-point frailty assessment prior to elective non-cardiac surgery. Patients were classified into non-frail (0 criteria, reference group), pre-frail (1–2 positive criteria) and frail (3–5 positive criteria) groups. Main outcome measures The incidence of postoperative complications was assessed until discharge from the hospital, using the roster from the National VA Surgical Quality Improvement Program. Propensity score matching and logistic regression analysis were performed. Results From 1186 elderly patients, 46.9% were classified as pre-frail (n = 556), and 11.4% as frail (n = 135). The rate of complications were significantly higher in the pre-frail (34.7%) and frail groups (47.4%), as compared to the non-frail group (27.5%). Similarly, length of stay (non-frail: 5.0 [3.0;7.0], pre-frail: 7.0 [3.0;9.0], frail 8.0 [4.5;12.0]; p < 0.001) and discharges to care facilities (non-frail:1.6%, pre-frail: 7.4%, frail: 17.8%); p < 0.001) were significantly associated with frailty status. After propensity score matching and logistic regression analysis, the risk for developing postoperative complications was approximately two-fold for pre-frail (OR 1.78; 95% CI 1.04–3.05) and frail (OR 2.08; 95% CI 1.21–3.60) patients. Conclusions The preoperative frailty assessment of elderly patients identified pre-frail and frail subgroups to have the highest rate of postoperative complications, regardless of age, surgical discipline, and surgical risk. Significantly increased length of hospitalisation and discharges to care facilities were also observed. Implementation of routine frailty assessments appear to be an effective tool in identifying patients with increased risk. Now future studies are needed to investigate whether patients benefit from optimization of patient counselling, process planning, and risk reduction protocols based on the application of risk stratification.

scholarly journals Effects of Anesthetic Technique on the Occurrence of Acute Kidney Injury after Spine Surgery: A Retrospective Cohort Study

2021 ◽  
Vol 10 (23) ◽  
pp. 5653
Author(s):  
Jiwon Han ◽  
Ah-Young Oh ◽  
Chang-Hoon Koo ◽  
Yu Kyung Bae ◽  
Yong-Tae Jeon
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Spine Surgery ◽  
Logistic Regression Analysis ◽  
Kidney Injury ◽  
Volatile Anesthetics

The effects of anesthetics on acute kidney injury (AKI) after spine surgery have not been evaluated fully. This study compared propofol-based total intravenous anesthesia (TIVA) and volatile anesthetics in the development of AKI after spine surgery. This retrospective study reviewed patients who underwent spine surgery between 2015 and 2019. A logistic regression analysis was performed to identify risk factors for AKI. Additionally, after propensity score matching, the incidence of AKI was compared between TIVA and volatile groups. Of the 4473 patients, 709 were excluded and 3764 were included in the logistic regression. After propensity score matching, 766 patients from each group were compared, and we found that the incidence of AKI was significantly lower in the TIVA group (1% vs. 4.2%, p < 0.001). In the multivariate logistic regression analysis, the risk factors for postoperative AKI were male sex (OR 1.85, 95% CI 1.18–3.06), hypertension (OR 2.48, 95% CI 1.56–3.94), anemia (OR 2.66, 95% CI 1.76–4.04), and volatile anesthetics (OR 4.69, 95% CI 2.24–9.84). Compared with volatile anesthetics, TIVA is associated with a reduced risk of AKI for patients who have undergone spine surgery.

scholarly journals Effect of Hypothermia in the Emergency Department on the Outcome of Trauma Patients: A Cross-Sectional Analysis

2018 ◽  
Vol 15 (8) ◽  
pp. 1769 ◽  
Author(s):  
Ting-Min Hsieh ◽  
Pao-Jen Kuo ◽  
Shiun-Yuan Hsu ◽  
Peng-Chen Chien ◽  
Hsiao-Yun Hsieh ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Body Temperature ◽  
Propensity Score ◽  
Logistic Regression Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Trauma Patients ◽  
Body Temperatures ◽  
Multivariate Logistic Regression ◽  
Mortality Outcome

This study aimed to assess whether hypothermia is an independent predictor of mortality in trauma patients in the condition of defining hypothermia as body temperatures of <36 °C. Data of all hospitalized adult trauma patients recorded in the Trauma Registry System at a level I trauma center between 1 January 2009 and 12 December 2015 were retrospectively reviewed. A multivariate logistic regression analysis was performed in order to identify factors related to mortality. In addition, hypothermia and normothermia were defined as temperatures <36 °C and from 36 °C to 38 °C, respectively. Propensity score-matched study groups of hypothermia and normothermia patients in a 1:1 ratio were grouped for mortality assessment after adjusting for potential confounders such as age, sex, preexisting comorbidities, and injury severity score (ISS). Of 23,705 enrolled patients, a total of 401 hypothermic patients and 13,368 normothermic patients were included in this study. Only 3.0% of patients had hypothermia upon arrival at the emergency department (ED). Compared to normothermic patients, hypothermic patients had a significantly higher rate of abbreviated injury scale (AIS) scores of ≥3 in the head/neck, thorax, and abdomen and higher ISS. The mortality rate in hypothermic patients was significantly higher than that in normothermic patients (13.5% vs. 2.3%, odds ratio (OR): 6.6, 95% confidence interval (CI): 4.86–9.01, p < 0.001). Of the 399 well-balanced propensity score-matched pairs, there was no significant difference in mortality (13.0% vs. 9.3%, OR: 1.5, 95% CI: 0.94–2.29, p = 0.115). However, multivariate logistic regression analysis revealed that patients with low body temperature were significantly associated with the mortality outcome. This study revealed that low body temperature is associated with the mortality outcome in the multivariate logistic regression analysis but not in the propensity score matching (PSM) model that compared patients with hypothermia defined as body temperatures of <36 °C to those who had normothermia. These contradicting observations indicated the limitation of the traditional definition of body temperature for the diagnosis of hypothermia. Prospective randomized control trials are needed to determine the relationship between hypothermia following trauma and the clinical outcome.

Which Patients Would Be Willing to Change Anticoagulation From Vitamin-K Antagonists to a New Oral Anticoagulant?

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4318-4318
Author(s):  
Job Harenberg ◽  
Svetlana Marx ◽  
Nadja Abou-Ayash ◽  
Christophe Kremer ◽  
Vera Hoeing ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Vitamin K ◽  
Logistic Regression Analysis ◽  
Oral Anticoagulant ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulant ◽  
Willingness To Change

Abstract Abstract 4318 New oral anticoagulants have generated promising data on the prophylaxis of systemic and non-systemic embolism in patients with atrial fibrillation and treatment of acute venous thromboembolism and prolonged prophylaxis of recurrent events. For patients on chronic treatment with vitamin-K antagonists (VKA) we analysed the motivation and willingness to change the anticoagulation from VKA to new oral anticoagulants. Patients (n=110) on stable treatment with VKA for at least 3 months (indication for anticoagulation: atrial fibrillation or VTE) completed a validated personality inventory (Freiburger Persönlichkeitsinventar FPI-R), and a self-developed questionnaire on general attitudes regarding anticoagulant therapy (Q1). Patients were divided in two groups according to the reply to the question weather they were willing to switch to a new oral anticoagulant. Out of these sets of questions 7 questions were identified by means of a logistic regression analysis for the willingness to change anticoagulation with VKA to a new oral anticoagulant. The same patients completed this shortened questionnaire (Q2) (n=85) thereafter. Logistic regression analysis defined the 7 items of the FPI and Q1 questionaires as relevant for willingness of patients to change the medication. The probability to change medication was 98% using the 7 questions (Q2) compared to the 2 comlete questionnaires. The items were: extraversion – introversion scale on the FPI-R consisting of 14 questions, and from Q1: hope for a better quality of life with a new anticoagulant, no scepticism for new drugs, wish of a lack of routine monitoring for dose adjustment, relevance of the practitioners opinion, thoughts in the past of alternatives for anticoagulation, and difficulty to adjust the prothrombin time. Using Q2 85% of patients confirmed to be willing to change the anticoagulant drug compared to Q1 (chi square test p<0.0001). Seven questions were identified and confirmed to identify patients for their willingness to change anticoagulation from VKA to a new oral anticoagulant. Disclosures: No relevant conflicts of interest to declare.

scholarly journals A Composite Index Predicts Disease Progression in Early Stages of COVID-19: a Propensity Score-matched Cohort Study

2020 ◽  
Author(s):  
Jianjun Xu ◽  
Shaobo Hu ◽  
Suzhen Li ◽  
Weimin Wang ◽  
Yuzhe Wu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Propensity Score ◽  
Disease Progression ◽  
Logistic Regression Analysis ◽  
Independent Predictor ◽  
Early Stage ◽  
Multivariable Logistic Regression Analysis ◽  
Matched Cohort ◽  
Early Stages

Abstract Background: Thus far, studies on COVID-19 have focused on the epidemiology of the disease and clinical characteristics of patients (14-19), as well as on the risk factors associated with mortality during hospitalization in critical COVID-19 cases. However, no research has been performed on the prediction of progression in patients in the early stages of the disease. The aim of this work was to identify the early predictors of COVID-19 progression.Methods: The study included 338 patients with COVID-19 treated at two hospitals in Wuhan, Chian, from December, 2019 to March, 2020. Predictors of the progression of COVID-19 from mild to severe stages were selected by the logistic regression analysis. The predictive accuracy was evaluated further in the propensity score-matched cohort.Results: COVID-19 progression to severe and critical stages was confirmed in 78(23.1%) patients. The average value of the neutrophil-to-lymphocyte ratio (NLR) was higher in patients in the disease progression group than in the improvement group. Multivariable logistic regression analysis revealed that elevated NLR, LDH, and IL-10, were independent predictors of disease progression. The optimal cut-off value of NLR for predicting the progression of COVID-19 was 3.75. In the propensity score-matched cohort, NLR ≥ 3.75 was still an independent predictor of COVID-19 progression after multivariate analysis.Conclusions: The performed analysis demonstrates that NLR qualifies as an independent predictor of disease progression in COVID-19 patients at the early stage of the disease. The combined evaluation of NLR and LDH improved the accuracy of the prediction of COVID-19 progression. Assessment of predictors might facilitate early identification of COVID-19 patients at high risk for disease progression and ensure timely administration of appropriate treatment to prevent mild cases from becoming severe.

scholarly journals Direct Oral Anticoagulants and Mortality in Atrial Fibrillation

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5061-5061
Author(s):  
Martin Ellis ◽  
Sergienko Ruslan ◽  
Hammerman Ariel ◽  
Sari Greenberg-Dotan ◽  
Erez Battat ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Stroke Prevention ◽  
Lower Risk ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Routine Practice ◽  
Newly Diagnosed ◽  
Overall Mortality

Abstract Background Direct oral anticoagulants (DOACs) are at least as effective as vitamin K antagonists (VKAs) for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). DOACs are associated with less intracranial hemorrhage and are easier to administer and therfore have become standard of care for stroke prevention in NVAF patients. Nevertheless, many eligible patients still receive no anticoagulation. The effect on overall mortality in routine practice of DOAC therapy compared to no anticoagulation in NVAF patients is unknown. Methods We identified all newly diagnosed, anticoagulant naive NVAF patients eligible for DOAC therapy from 2011 to 2016 in Clalit Health Services, the largest HMO in Israel. We created a matched cohort, using 1:1 propensity score matching of DOAC -treated versus non-anticoagulant treated NVAF patients. The primary outcome was overall mortality rate in the two cohorts. Secondary outcomes were rates of stroke, major cardiac and bleeding events. Results 28,195 newly diagnosed CHADS2 ≥2 NVAF patients were identified. Of these 8 298 received a DOAC and 10 603 received no anticaogulation. The remainder received a VKA and were not included in this study. Patients recieving DOAC therapy were younger (77.4 vs 78.0 years), had a higher socioeconomic status (5.6 vs. 5.3), had a female predominance (53.7% vs 52.0%), had a higher BMI (29.6 vs 28.3) and had a greater prevalance of accompanying cardiovascular morbidities namely congestive heart failure (CHF) (29% vs 27%) and stroke (33% vs 30%) (P<0.001 for all variables) . 5,657 patients who received DOAC therapy were matched with 5,657 patients not receiving an anticoagulant using propensity score matching. DOAC therapy was associated with significantly lower risk for death (hazard ratio 0.66, 95% CI 0.60-0.71, P<0.001). Rates of stroke and major cardiac were significantly lower in the DOAC-treated than in the non-anticoagulated patients. DOAC therapy was associated with a significant survival benefit across all patient subgroups. Conclusions In this cohort of newly diagnosed NVAF patients treated in routine clinical practice, DOAC therapy was associated with a lower risk for death compared to no oral anticoagulation. Our findings provide further evidence for the importance of DOAC therapy in NVAF patients. Disclosures No relevant conflicts of interest to declare.

Dexmedetomidine and Mortality From Sepsis Requiring Mechanical Ventilation: A Japanese Nationwide Retrospective Cohort Study

2020 ◽  
pp. 088506662094215
Author(s):  
Shotaro Aso ◽  
Hiroki Matsui ◽  
Kiyohide Fushimi ◽  
Hideo Yasunaga
Keyword(s):  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Propensity Score ◽  
Logistic Regression Analysis ◽  
Instrumental Variable ◽  
Diagnosis Procedure Combination ◽  
Instrumental Variable Analysis ◽  
Mechanically Ventilated ◽  
Variable Analysis

Background: Dexmedetomidine has a mild sedative effect and may reduce mortality in mechanically ventilated critically ill patients. However, few studies have examined the effects of dexmedetomidine in patients with sepsis who require mechanical ventilation. The aim of this study was to investigate the association between dexmedetomidine and mortality in patients with sepsis requiring mechanical ventilation, using a nationwide inpatient database in Japan. Methods: Using the Diagnosis Procedure Combination database from July 1, 2010, to March 31, 2016, we identified adult patients with sepsis who required mechanical ventilation for more than 2 days. Patients were divided into those who received dexmedetomidine and those who received midazolam or propofol within 1 day after admission. Logistic regression analysis, propensity score-matched analysis, and instrumental variable analysis were performed to compare all-cause 28-day mortality and duration of mechanical ventilation between the groups. Results: In total, 50 671 were eligible patients, including dexmedetomidine group (n = 13 759) and propofol or midazolam group (n = 36 912). The dexmedetomidine group had significantly lower all-cause 28-day mortality compared with the group receiving midazolam or propofol, as shown by the logistic regression analysis (odds ratio [OR]: 0.78; 95% confidence interval [CI]: 0.73-0.84), the propensity score–matched analysis (OR: 0.85; 95% CI: 0.80-0.91), and the instrumental variable analysis (OR: 0.64; 95% CI: 0.57-0.73). The duration of mechanical ventilation in the dexmedetomidine group was significantly shorter than that in the midazolam or propofol group. Conclusions: Dexmedetomidine was associated with a reduction in all-cause 28-day mortality and duration of mechanical ventilation.

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