Abstract WP414: Dabigatran Has the Lowest Risk of Hemorrhage and Death Among Patients Taking SSRI/SNRIs That Require Anticoagulation

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Salman Al Jerdi ◽  
Mary Sarrazin ◽  
Enrique Leira
Keyword(s):  
Vital Role ◽  
Major Hemorrhage ◽  
Stroke Incidence ◽  
Risk Of Death ◽  
Post Stroke Depression ◽  
Artery Disease ◽  
New Diagnosis ◽  
Risk Of Hemorrhage ◽  
The Impact ◽  
Matched Samples

Introduction: Antidepressants have a vital role in treating post-stroke depression and improving motor recovery. SSRI/SNRI’s have antiplatelet effects, possibly increasing the risk of hemorrhage when taken with anticoagulants. The impact of concomitant SSRI/SNRI use on patients taking different anticoagulants for atrial fibrillation is not known. Methods: Data included Medicare Part A, B, and D claims for 2010-2013. Patients 66 years or older, with a new diagnosis of AF who initiated warfarin, dabigatran (150 mg bid) or rivaroxaban (20 mg od) within 90 days of diagnosis were included. SSRI/SNRI use was identified using prescription claims within +/- 90 days of anticoagulation initiation. Patients taking warfarin, dabigatran, and rivaroxaban with concurrent SSRI/SNRI were matched using a 3-way propensity algorithm. The relative hazards of death, stroke, GI hemorrhage, and other major hemorrhage were compared between anticoagulants. Results: We identified10,773 patients with SSRI/SNRI use, and 37,278 without SSRI/SNRI use. At baseline, patients who received SSRI/SNRIs were more likely than other patients to have several comorbid conditions, including coronary artery disease, liver disease, kidney disease, previous hemorrhage, and previous stroke. In matched samples of patients taking SSRI/SNRI, dabigatran users had the lowest incidence of any hemorrhage, with Hazard Ratio [HR]=0.78 (p=0.07) relative to warfarin; 0.68 (p=0.01) relative to rivaroxaban. Non-GI-hemorrhage was less likely with both dabigatran and rivaroxaban, compared to warfarin, while GI hemorrhage was most likely with rivaroxaban. The risk of death was significantly lower with dabigatran (HR 0.60; p<0.001) and rivaroxaban (HR 0.67; p=0.007), compared to warfarin. There was no difference in stroke incidence by anticoagulant type. Conclusion: In patients with AF and concomitant SSRI/SNRI use, dabigatran has the lowest risk of hemorrhage and mortality.

scholarly journals Impact of Coronary Artery Disease and Diabetes Mellitus on the Long-Term Follow-Up in Patients after Retrograde Recanalization of the Femoropopliteal Arterial Region

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Joanna Wojtasik-Bakalarz ◽  
Zoltan Ruzsa ◽  
Tomasz Rakowski ◽  
Andreas Nyerges ◽  
Krzysztof Bartuś ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Risk Of Death ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Artery Disease ◽  
The Impact

The most relevant comorbidities in patients with peripheral artery disease (PAD) are coronary artery disease (CAD) and diabetes mellitus (DM). However, data of long-term follow-up of patients with chronic total occlusion (CTO) are scarce. The aim of the study was to assess the impact of CAD and DM on long-term follow-up patients after superficial femoral artery (SFA) CTO retrograde recanalization. In this study, eighty-six patients with PAD with diagnosed CTO in the femoropopliteal region and at least one unsuccessful attempt of antegrade recanalization were enrolled in 2 clinical centers. Mean time of follow-up in all patients was 47.5 months (±40 months). Patients were divided into two groups depending on the presence of CAD (CAD group: n=45 vs. non-CAD group: n=41) and DM (DM group: n=50 vs. non-DM group: n=36). In long-term follow-up, major adverse peripheral events (MAPE) occurred in 66.6% of patients with CAD vs. 36.5% of patients without CAD and in 50% of patients with DM vs. 55% of non-DM subjects. There were no statistical differences in peripheral endpoints in both groups. However, there was a statistically significant difference in all-cause mortality: in the DM group, there were 6 deaths (12%) (P value = 0.038). To conclude, patients after retrograde recanalization, with coexisting CTO and DM, are at higher risk of death in long-term follow-up.

scholarly journals Quantification of Death Risk in Relation to Sex, Pre-Existing Cardiovascular Diseases and Risk Factors in COVID-19 Patients: Let’s Take Stock and See Where We Are

2020 ◽  
Vol 9 (9) ◽  
pp. 2685
Author(s):  
Amalia Ioanna Moula ◽  
Linda Renata Micali ◽  
Francesco Matteucci ◽  
Fabiana Lucà ◽  
Carmelo Massimiliano Rao ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Mortality Rates ◽  
Cerebrovascular Diseases ◽  
Continuous Variables ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Increase Risk ◽  
Artery Disease ◽  
Dichotomous Variables ◽  
The Impact

Patients with pre-existing cardiovascular disease (CVD) might be more susceptible to infection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and have higher mortality rates. Nevertheless, the risk of mortality has not been previously quantified. The aim of this meta-analysis is to quantify the risk of mortality in coronavirus disease 2019 (COVID-19) patients. A meta-analysis was conducted analyzing the impact of (1) sex, (2) age, (3) CVD with coronary artery disease (CAD), (4) CAD alone, (5) CVD without CAD, (6) hypertension, (7) cerebrovascular diseases, and (8) diabetes on mortality. Relative risk was assessed for dichotomous variables, mean difference for continuous variables. Twenty-six studies were included, encompassing 8497 patients. Males had 16% higher risk of mortality than females (p < 0.05) and elderly patients had higher chance of dying than younger patients (p < 0.0001). Patients with overall CVD have a 1.96-fold higher mortality risk (p < 0.0001). CAD increases risk of mortality by 1.90-fold (p < 0.05). CVD-CAD were found to increase risk up to 2.03-fold (p < 0.05). Hypertension, cerebrovascular disease and diabetes increase the risk of death up to 1.73-fold, 1.76-fold and 1.59-fold, respectively (p < 0.0001, p < 0.0001, p < 0.05, respectively). Sex, age, presence of CAD and/or other types of CVD, hypertension, cerebrovascular diseases and diabetes mellitus increase mortality in patients with COVID-19.

scholarly journals Impact of Splanchnic Vein Thrombosis on Mortality in Patients with Advanced Pancreatic Cancer

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4685-4685 ◽  
Author(s):  
Amber Afzal ◽  
Suhong Luo ◽  
Theodore S. Thomas ◽  
Kristen M. Sanfilippo
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Patients ◽  
Advanced Pancreatic Cancer ◽  
Stage Iv ◽  
Cancer Stage ◽  
Vein Thrombosis ◽  
Risk Of Death ◽  
Increased Risk ◽  
Risk Of Hemorrhage ◽  
The Impact

Abstract BACKGROUND: The incidence of venous thromboembolism in pancreatic cancer is high. Pancreatic cancer patients who develop deep venous thrombosis (DVT) or pulmonary embolism (PE) have increased mortality compared to those without. Pharmacological anticoagulation mitigates the increased mortality in these patients thus providing rationale for treatment. The incidence of splanchnic vein thrombosis (SVT) in pancreatic cancer is also high ~8% (Pachon JCO 2015, Sogaard Blood 2015). However, the correlation between SVT and mortality in pancreatic cancer is not well established. Current guidelines recommend anticoagulation for SVT on a case-to-case basis, assessing the risk-benefit of treatment and patient prognosis (Khorana J Thromb Thrombolysis 2016). Hence, we conducted the largest study to date to evaluate the impact of SVT on mortality in a cohort of United States Veterans with advanced pancreatic cancer. METHODS: Study Population: We identified patients in the Veterans Administration Central Cancer Registry (VACCR) diagnosed with unresectable or metastatic pancreatic cancer (stage II, III, IV) between October 1st, 1998 and December 31st, 2014 using ICD-O3 codes. We then identified the pancreatic cancer patients who developed SVT using ICD-9/10 codes and the CPT codes for relevant diagnostic imaging. Patients with DVT, PE and atrial fibrillation were excluded. Statistical Analyses: We compared baseline patient characteristics between pancreatic cancer patients with SVT and those without using Chi-square and Cochrane-Mantel-Haenszel tests for categorical variables, and unpaired Student's t-tests for continuous variables. Using Cox proportional hazard models, we assessed the association between SVT and overall survival in patients with pancreatic cancer while adjusting for significant prognostic indicators including: age, gender, body mass index (BMI), Charlson comorbidity index, stage of cancer (stage IV vs. stage II/III), white blood cell count (WBC), estimated glomerular filtration rate (eGFR), use of radiation or chemotherapy. A two-tailed alpha significance level of 0.05 was used for all analyses. Statistical analyses were performed using SAS version 9.2 (SAS Institute, Cary, NC). RESULTS: We identified 6296 patients with unresectable or metastatic pancreatic cancer within the VACCR, of whom 170 were diagnosed with SVT. Baseline demographics of patients with and without SVT are shown in Table 1. The median OS of the patients with SVT was 140 days as compared to 92 days for those without SVT, Figure 1. After adjusting for potential confounders, patients with SVT had a 16% reduction in mortality compared to those without (HR 0.84, p = 0.03). In addition, increasing age, male gender, BMI < 18.5, increasing comorbidities, eGFR < 45 mL/min, WBC > 10 x 109/L, metastatic disease (stage IV) were associated with increased risk of death, while receipt of chemo or radiation therapy and BMI ≥ 25 were associated with a reduced risk of death. DISCUSSION/CONCLUSION: In this large retrospective study of patients with advanced pancreatic cancer, we found no association between SVT and increased mortality in patients with pancreatic cancer. A significant number of SVTs are detected incidentally on surveillance scans, and are thus asymptomatic at diagnosis. Anticoagulation is associated with an increased risk of hemorrhage which can be fatal in some cases. Given the lack of association between SVT and death in pancreatic cancer, future studies should assess the impact of anticoagulation on outcomes in this population with consideration given to observation only to reduce the risk of hemorrhage. Disclosures Sanfilippo: BMS/Pfizer: Speakers Bureau.

The Impact Of Emotional Intelligence On Leadership Excellence Of Executive Empoloyees In Public Sector Organizationin Ampara District Of Sri Lanka

2019 ◽  
Vol 118 (9) ◽  
pp. 52-60
Author(s):  
Dr.S. Gunapalan ◽  
Dr.K. Maran
Keyword(s):  
Emotional Intelligence ◽  
Public Sector ◽  
Vital Role ◽  
Public Organization ◽  
Self Awareness ◽  
Public Sector Organization ◽  
Expression Of Emotion ◽  
Asking Questions ◽  
Private Sector Organizations ◽  
The Impact

Emotional Intelligence is play a vital role to decide  leadership excellence. So this paper to study the  impact of emotional intelligence on leadership excellence of executive employee in public sector organization.Hence the objective of this  research   is to identify the  impact of emotional intelligence on leadership excellence of executive employee in Public Sector Organization in Ampara districtof Sri Lanka.emotional intelligence includes the verbal and non-verbal appraisal and expression of emotion, the regulation of emotion in the self and others, and the utilization of emotional content in problem solving. Cook (2006)[1]. Emotional intelligence is one of the  essential skill for leaders to manage their subordinate. Accordingly although there is some research done under “Emotional intelligence on leadership excellence of the executive employee in the public organization in Ampara district so this study full filed the gap. Based on the analysis, Self-awareness, Self-management, Social-awareness and Relationship management are the positively affect to the Leadership excellence. So, executive employees should consider about the Emotions of their subordinators when they completing their targets. leaders should pay the attention for recognize the situation, hove to impact their feelings for the performance & recognized their own feelings. Leaders should consider and see their own emotions when they work with others by listening carefully, understand the person by asking questions, identifying non-verbal expressions and solving problems without helming someone’s. Leadersshould consider their subordinators emotions when they find a common idea, government should give to moderate freedom to executive employees in public organization to take the decision with competing the private sector organizations.

Understanding the role of Inflammasome in Angina Pectoris

2020 ◽  
Vol 21 ◽  
Author(s):  
Ishita Sharma ◽  
Tapan Behl ◽  
Simona Bungau ◽  
Monika Sachdeva ◽  
Arun Kumar ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Angina Pectoris ◽  
Nlrp3 Inflammasome ◽  
Vital Role ◽  
Death Process ◽  
Cell Death Process ◽  
Artery Disease ◽  
Species Production ◽  
Pro Inflammatory Cytokines

Abstract:: Angina pectoris, associated with coronary artery disease, a cardiovascular disease where, pain is caused by adverse oxygen supply in myocardium, resulting in contractility and discomfort in chest. Inflammasomes, triggered by stimuli due to infection and cellular stress have identified to play a vital role in the progression of cardiovascular disorders and thus, causing various symptoms like angina pectoris. Nlrp3 inflammasome, a key contributor in the pathogenesis of angina pectoris, requires activation and primary signaling for the commencement of inflammation. Nlrp3 inflammasome elicit out an inflammatory response by emission of pro inflammatory cytokines by ROS (reactive oxygen species) production, mobilization of K+ efflux and Ca2+ and by activation of lysosome destabilization that eventually causes pyroptosis, a programmed cell death process. Thus, inflammasome are considered to be one of the factors involved in the progression of coronary artery diseases and have an intricate role in development of angina pectoris.

The Impact of Smoking on Cardiovascular Outcomes and Comorbidities in Statin-treated Patients with Coronary Artery Disease: A Post hoc Analysis of the GREACE Study

2013 ◽  
Vol 11 (5) ◽  
pp. 779-784 ◽  
Author(s):  
Vasilios G. Athyros ◽  
Konstantinos Tziomalos ◽  
Niki Katsiki ◽  
Thomas D. Gossios ◽  
Olga Giouleme ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Outcomes ◽  
Post Hoc Analysis ◽  
Artery Disease ◽  
Post Hoc ◽  
The Impact

scholarly journals Association between Intraoperative Blood Transfusion and Mortality and Morbidity in Patients Undergoing Noncardiac Surgery

2011 ◽  
Vol 114 (2) ◽  
pp. 283-292 ◽  
Author(s):  
Laurent G. Glance ◽  
Andrew W. Dick ◽  
Dana B. Mukamel ◽  
Fergal J. Fleming ◽  
Raymond A. Zollo ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Noncardiac Surgery ◽  
Pulmonary Complications ◽  
Wound Complications ◽  
Severe Anemia ◽  
Thromboembolic Complications ◽  
Mortality And Morbidity ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

Background The impact of intraoperative erythrocyte transfusion on outcomes of anemic patients undergoing noncardiac surgery has not been well characterized. The objective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severe anemia (hematocrit less than 30%) who are exposed to one or two units of erythrocytes intraoperatively. Methods This was a retrospective analysis of the association of blood transfusion and 30-day mortality and 30-day morbidity in 10,100 patients undergoing general, vascular, or orthopedic surgery. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications. Results Intraoperative blood transfusion was associated with an increased risk of death (odds ratio [OR], 1.29; 95% CI, 1.03-1.62). Patients receiving an intraoperative transfusion were more likely to have pulmonary, septic, wound, or thromboembolic complications, compared with patients not receiving an intraoperative transfusion. Compared with patients who were not transfused, patients receiving one or two units of erythrocytes were more likely to have pulmonary complications (OR, 1.76; 95% CI, 1.48-2.09), sepsis (OR, 1.43; 95% CI, 1.21-1.68), thromboembolic complications (OR, 1.77; 95% CI, 1.32-2.38), and wound complications (OR, 1.87; 95% CI, 1.47-2.37). Conclusions Intraoperative blood transfusion is associated with a higher risk of mortality and morbidity in surgical patients with severe anemia. It is unknown whether this association is due to the adverse effects of blood transfusion or is, instead, the result of increased blood loss in the patients receiving blood.

scholarly journals Impact of Coronary CT angiography in combination with CAD-RADS on the management of coronary artery disease patients

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
F Andre ◽  
S Seitz ◽  
P Fortner ◽  
R Sokiranski ◽  
F Gueckel ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Risk Stratification ◽  
Coronary Ct Angiography ◽  
Patient Management ◽  
Male Gender ◽  
Coronary Ct ◽  
History Of ◽  
Artery Disease ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Siemens Healthineers Introduction Coronary CT angiography (CCTA) plays an increasing role in the detection and risk stratification of patients with coronary artery disease (CAD). The Coronary Artery Disease – Reporting and Data System (CAD-RADS) allows for standardized classification of CCTA results and, thus, may improve patient management. Purpose Aim of this study was to assess the impact of CCTA in combination with CAD-RADS on patient management and to identify the impact of cardiovascular risk factors (CVRF) on CAD severity. Methods CCTA was performed on a third-generation dual-source CT scanner in patients, who were referred to a radiology centre by their attending physicians. In a total of 4801 patients, CVRF were derived from medical reports and anamnesis. Results The study population consisted of 4770 patients (62.0 (54.0-69.0) years, 2841 males) with CAD (CAD-RADS 1-5), while 31 patients showed no CAD and were excluded from further analyses. Age, male gender and the number of CVRF were associated with more severe CAD stages (all p &lt; 0.001). 3040 patients (63.7 %) showed minimal or mild CAD requiring optimization of CVRF i.e. medical therapy but no further assessment at his time. A group of 266 patients (5.6 %) had a severe CAD defined as CAD-RADS 4B/5. In the multivariate regression analysis, age, male gender, history of smoking, diabetes mellitus and hyperlipidaemia were significant predictors for severe CAD, whereas arterial hypertension and family history of CAD did not reach significance. Of note, a subgroup of 28 patients (10.5 %) with a severe CAD (68.5 (65.5-70.0) years, 26 males, both p = n.s.) had no CVRF. Conclusions CCTA in combination with the CAD-RADS allowed for effective risk stratification of CAD patients. The majority of the patients showed non-obstructive CAD and, thus, could be treated conservatively without the need for further CAD assessment. CVRF out of arterial hypertension and family history had an impact on CAD severity reflected in higher CAD-RADs gradings. Of note, a relevant fraction of patients with CAD did not have any CVRF and, thus, may not be covered by risk stratification models. CAD-RADS n Age (years) Males (%) 1 1453 56.0 (50.0-62.0) 623 (42.9 %) 2 1587 62.0 (55.0-69.0) 918 (57.8 %) 3 1067 66.0 (59.0-71.0) 749 (70.2 %) 4A 397 66.0 (59.0-72.0) 317 (79.8 %) 4B 162 67.0 (61.0-74.0) 139 (85.8 %) 5 104 66.0 (58.5.0-77.0) 95 (91.3 %)

scholarly journals High Expression of KLF10 Is Associated with Favorable Survival in Patients with Oral Squamous Cell Carcinoma

Medicina ◽  
2020 ◽  
Vol 57 (1) ◽  
pp. 17
Author(s):  
Chung-Min Yeh ◽  
Yi-Ju Lee ◽  
Po-Yun Ko ◽  
Yueh-Min Lin ◽  
Wen-Wei Sung
Keyword(s):  
Survival Rate ◽  
Oral Cancer ◽  
Cancer Patients ◽  
Protective Factor ◽  
Female Gender ◽  
Vital Role ◽  
Cancer Stage ◽  
Independent Prognostic Marker ◽  
Oral Cancer Patients ◽  
The Impact

Background and objectives: Krüppel-like transcription factor 10 (KLF10) plays a vital role in regulating cell proliferation, including the anti-proliferative process, activation of apoptosis, and differentiation control. KLF10 may also act as a protective factor against oral cancer. We studied the impact of KLF10 expression on the clinical outcomes of oral cancer patients to identify its role as a prognostic factor in oral cancer. Materials and Methods: KLF10 immunoreactivity was analyzed by immunohistochemical (IHC) stain analysis in 286 cancer specimens from primary oral cancer patients. The prognostic value of KLF10 on overall survival was determined by Kaplan–Meier analysis and the Cox proportional hazard model. Results: High KLF10 expression was significantly associated with male gender and betel quid chewing. The 5-year survival rate was greater for patients with high KLF10 expression than for those with low KLF10 expression (62.5% vs. 51.3%, respectively; p = 0.005), and multivariate analyses showed that high KLF10 expression was the only independent factor correlated with greater overall patient survival. The significant correlation between high KLF10 expression and a higher 5-year survival rate was observed in certain subgroups of clinical parameters, including female gender, non-smokers, cancer stage T1, and cancer stage N0. Conclusions: KLF10 expression, detected by IHC staining, could be an independent prognostic marker for oral cancer patients.

scholarly journals The Influence of COVID-19-Induced Daily Activities on Health Parameters—A Case Study in Malaysia

2021 ◽  
Vol 13 (13) ◽  
pp. 7465
Author(s):  
Mujahid Ali ◽  
Afonso R. G. de Azevedo ◽  
Markssuel T. Marvila ◽  
Muhammad Imran Khan ◽  
Abdul Muhaimin Memon ◽  
...  
Keyword(s):  
Structural Equation ◽  
Linear Regression Analysis ◽  
Daily Activities ◽  
Social Health ◽  
Coefficient Of Determination ◽  
Equation Modeling ◽  
Risk Of Death ◽  
Unit Increase ◽  
The Impact ◽  
Health Parameters

Since December 2019, the COVID-19 epidemic has been spreading all over the world. This epidemic has brought a risk of death in the daily activity (physical and social) participation that influences travellers’ physical, social, and mental health. To analyze the impact of the COVID-19-induced daily activities on health parameters of higher education institutes, 150 students of the Universiti Teknologi PETRONAS, Perak, Malaysia, were surveyed through an online web survey using random sampling techniques. The data were analyzed through RStudio and SPSS using multilevel linear regression analysis and Hierarchical Structural Equation Modeling. The estimated results indicate that restricting individuals from doing out-of-home activities negatively influences physical and social health. A unit increase in the in-home maintenance activities during the COVID-19 pandemic introduced a daily increase of 0.5% in physical health. Moreover, a unit increase in the in-home activities at leisure time represents a 1% positive improvement in social health. Thus, physical activity has proven to be beneficial in improving physical and social health with severe COVID-19. In contrast, the coefficient of determination (R2) for all endogenous variables ranges from 0.148 to 0.227, which is incredibly acceptable in psychological research. For a healthier society with a better quality of life, this study adopted multidisciplinary approaches that are needed to be designed.

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