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BackgroundStandard Modifiable Cardiovascular Risk Factors (SMurfs) influence Atrial fibrillation (AF). However, data on their cumulative prognostic effect in Asian non-valvular AF (NVAF) patients receiving oral anticoagulants (OACs) remain limited. This study investigated the association between the cumulative burden of SMurfs and the prognosis of these NVAF patients on oral anticoagulation (OAC) therapy.MethodsThis retrospective cohort study used Tianjin Health and Medical Data Platform (THMDP) data on 20 782 NVAF patients on OACs between 2015 and 2020. Patients were categorized into groups by the number of baseline SMurfs (0, 1-2, or 3-4: hypertension, diabetes, hyperlipidemia, smoking). Cox proportional hazards models assessed the association between SMurf burden group and the primary outcome (all-cause mortality) and secondary outcomes. Subgroup and sensitivity analyses were performed to evaluate the consistency and robustness of the findings.ResultsAfter adjusting for confounders, compared to the SMurf-less group, the hazard ratios (HRs) for all-cause mortality were 1.20 (95% confidence interval [CI]: 1.01-1.44) for the SMurf (1-2) group and 1.67 (95% CI: 1.33-2.08) for the SMurf (3-4) group. For ischemic stroke, the hazard ratio (HR) was 1.44 (95% CI: 1.03-1.99) for the SMurf (3-4) group, while the association was not significant for the SMurf (1-2) group. A more pronounced association between SMurfs and all-cause mortality was observed in patients with an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m .ConclusionIn Asian NVAF patients receiving OACs, a higher SMurf burden is significantly associated with an increased risk of all-cause mortality and ischemic stroke.

Deep vein thrombosis (DVT) poses a significant global health challenge that affects patients’ physical function and symptom burden. Evidence on the health-related quality of life (HRQoL) of patients with DVT remains scarce in Ethiopia. This study aimed to assess DVT-specific quality of life and associated factors among patients with DVT. A hospital-based cross-sectional study was conducted at Tikur Anbessa Specialized Hospital, Ethiopia, in which 123 adults with confirmed DVT were recruited. Data were collected using the Amharic version of the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms (VEINES-QOL/Sym) questionnaire, supplemented with clinical and demographic data. VEINES-QOL/Sym scores were standardized to T-scores (mean = 50, SD = 10), with raw scores scaled 0-100 (higher values indicated better HRQoL). Data were analyzed using Statistical Package for the Social Sciences version 28. Binary logistic regression was used to identify factors associated with HRQoL, with statistical significance set at P < .05. Among 123 patients (73.2% provoked, 93.5% unilateral DVT), VEINES-QOL ranged 33.4-59.6 and VEINES-Sym 26.7-58.7, both with a mean value of 50. Longer time since diagnosis was significantly associated with improved QoL (AOR = 1.922; 95% CI 1.155-3.199; P = .012), while proximal DVT (AOR = 0.240; P = .008), combined proximal/distal DVT (AOR = 0.136; P = .014), and post-thrombotic syndrome (PTS) (AOR = 0.108; P = .017) predicted poorer outcomes. In conclusion, VEINES-QOL/Sym scores indicated average QoL with modest improvement over time. Routine HRQoL assessment, PTS prevention, and improved monitoring, adherence, and patient education are recommended to strengthen DVT care in Ethiopia.

Background Venous thromboembolism (VTE) often necessitates extended anticoagulation to reduce the risk of recurrence. While direct oral anticoagulants (DOACs) have largely replaced vitamin K antagonists due to their improved safety and convenience, the optimal long-term dosing strategy (reduced vs full dose) remains uncertain. This systematic review assesses the efficacy and safety outcomes of reduced-dose DOACs compared with full-dose therapy for extended VTE treatment. Methods We conducted a systematic review of randomized controlled trials (RCTs) comparing reduced-dose and full-dose DOACs in patients with VTE. Due to heterogeneity in study designs and outcomes, a narrative synthesis was performed. Results Three RCTs were included. In AMPLIFY-EXT, recurrent VTE or death occurred in 1.7% of patients receiving apixaban (both 2.5 mg and 5 mg) versus 8.8% with placebo. In EINSTEIN CHOICE, recurrent VTE occurred in 1.2% and 1.5% of patients receiving rivaroxaban 10 mg and 20 mg, respectively, compared with 4.4% with aspirin. The safety outcomes were comparable between the two DOAC doses in AMPLIFY-EXT and EINSTEIN CHOICE. RENOVE reported 5-year cumulative incidences of recurrent VTE of 2.2% with reduced-dose and 1.8% with full-dose DOACs (hazard ratio 1.32, 95% confidence interval [CI]: 0.67-2.60; P = .23 for non-inferiority). Major or clinically relevant non-major bleeding events occurred in 9.9% patients in the reduced-dose group and 15.2% patients in the full-dose group (HR 0.61; 95% CI 0.48-0.79). Conclusion Current evidence suggest that reduced-dose DOACs provide efficacy comparable to full-dose regimens without a corresponding increase in bleeding events in the extended treatment of VTE.

AimsThis study compared the effectiveness and safety of direct oral anticoagulants (DOACs) versus aspirin for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) and intermediate stroke risk, defined by a CHA DS -VASc score of 1 in men and 2 in women.MethodThis retrospective cohort study used Korean Health Insurance Review and Assessment Service claims data. Patients diagnosed with NVAF between January 1, 2017, and December 31, 2019, who initiated DOACs or aspirin, were included. Eligibility was restricted by CHA DS -VASc score, and patients were matched by age and sex to reduce confounding. The observation period extended until November 30, 2021. The primary outcomes were the incidence of ischemic stroke (effectiveness) and major bleeding events (safety).ResultsOf the 2234 patients included, 977 (43.7%) were treated with DOACs, and 1257 (56.3%) received aspirin. After matching, no statistically significant differences were observed between the DOAC and aspirin groups in ischemic stroke incidence (1.46 vs 0.92 per 100 person-years,  = .060) or major bleeding events (2.26 vs 2.10 per 100 person-years,  = .100). Notably, rheumatic disease was associated with an increased risk of ischemic stroke, while liver disease was linked to a higher risk of major bleeding.ConclusionIn NVAF patients with intermediate stroke risk, no statistically significant differences were observed in ischemic stroke or major bleeding between DOACs and aspirin. These results should not be interpreted as therapeutic equivalence but highlight the need for further real-world research, particularly in Asian populations, to inform optimal antithrombotic strategies in this subgroup.

Research shows Black African communities in the UK maintain bicultural dietary patterns combining Westernised and African practices. However, limited research exists on older African adults, who face complex nutrition challenges owing to interacting social and cultural factors affecting health in later life. This study explored factors influencing food choices among older African adults. Using Photovoice, an innovative community-based participatory research method, 12 purposively sampled participants were given cameras to photograph their thoughts on eating well and older adults' health. Semi-structured interviews explored the photos, with thematic analysis conducted on photos and transcripts using an inductive approach. Participants averaged 62 ± 5.4 years; 75% were female, 58.3% married, 41.7% lived with family, 50% held postgraduate degrees, and 66.7% were fully employed. Key determinants included social, emotional, cultural, age-related health conditions, knowledge, accessibility, nutrition perceptions, creativity, adaptation, technology use, convenience, cost, and time. This research provides new insights into how older African adults manage the rich, complicated intersection of cultural identity, health needs to support nutrition in ageing. Further research into adaptive strategies, intersectional solutions on culture, health, sociality and technological innovation is warranted to inform culturally tailored age-sensitive interventions for older African adults.

The management of device-detected atrial fibrillation in patients with a history of stroke or transient ischemic attack remains a clinical dilemma, balancing the potential benefits of stroke prevention against the risks of anticoagulant-related bleeding. This review synthesizes evidence from the NOAH-AFNET 6 and ARTESIA trials, which evaluated the efficacy and safety of direct oral anticoagulants in this population. Collectively, randomized evidence regarding the use of direct oral anticoagulants in patients with device-detected atrial fibrillation and a history of stroke or transient ischemic attack remains limited and internally discordant. In ARTESIA, apixaban was associated with a reduction in ischemic stroke accompanied by an increase in major bleeding, yielding a relatively coherent benefit–risk signal in this high-risk subgroup. In contrast, NOAH-AFNET 6 demonstrated a modest and statistically non-significant reduction in ischemic stroke alongside a substantial increase in major bleeding. Further research is still needed to refine patient selection and optimize therapeutic strategies.

Background There is no cumulative evidence supporting the role of coagulation indices in mortality among the critically ill patients with atrial fibrillation (AF). Methods The data were derived from the MIMIC-III database, which included a total of 2284 individuals. We explored the association between coagulation indices and mortality using multivariable correction analysis. Results 2284 participants were included in the study with a median age of 71.29, and 1476 participants were male (64.62%). The median levels of coagulation indices -PTT, PT, INR PT and fibrinogen were 44.14 s, 16.95 s, 1.67 and 277.8 mg/dL, respectively. After adjusting for confounding factors, there were still strong positive correlations between coagulation indices and mortality (hospital mortality, 7-day mortality, 30-day mortality, and 1-year mortality), (all P < 0.001). In addition, stratified analysis showed that gender as a covariate affected the association between PTT and mortality; age, valvular disease, statins, heparin and aspirin were covariates that affected the association between fibrinogen and mortality Conclusions Our study is the first to indicate that there is a positive correlation between coagulation indices (PTT, PT/INR PT, fibrinogen) and mortality in critically ill patients with AF.

The optimal timing for initiating direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) following acute ischemic stroke (AIS) remains a critical clinical question. This review evaluates findings from three pivotal randomized controlled trials—TIMING, ELAN, and OPTIMAS—comparing early versus delayed DOAC initiation in AF patients with AIS. Collectively, these trials provide strong evidence supporting the safety and efficacy of early initiation of DOACs in patients with AIS and AF. The TIMING trial demonstrated the non-inferiority of early DOAC initiation (≤4 days) compared to delayed initiation (5-10 days), with numerically lower rates of ischemic stroke and no cases of symptomatic ICH. The ELAN trial further corroborated these findings, showing no significant difference in the composite outcome of recurrent ischemic stroke, systemic embolism, or major hemorrhage between early initiation (≤48 h for minor/moderate strokes; days 6-7 for major strokes) and later initiation (days 3-4 to 12-14). OPTIMAS, the largest trial to date, confirmed the non-inferiority of early initiation (≤4 days) versus delayed initiation (7-14 days), without an increased risk of symptomatic ICH and with comparable rates of recurrent ischemic events.

Background This systematic review aimed to evaluate the comparative effectiveness and safety of direct oral anticoagulants (DOACs) versus traditional anticoagulants, including vitamin K antagonists (VKAs) and low-molecular-weight heparins (LMWHs), in the treatment of Budd-Chiari Syndrome (BCS). Methods A comprehensive literature search was conducted in the PubMed and Embase databases up to July 2025. Studies were selected based on predefined inclusion criteria, focusing on patients with BCS who received DOACs (specifically dabigatran, rivaroxaban, apixaban, or edoxaban) compared to those treated with VKAs or LMWHs. Results Of 68 identified records, two retrospective studies met the inclusion criteria. Sharma et al (India, n = 98) compared dabigatran with VKAs after percutaneous endovascular intervention. Stent patency and major bleeding rates were similar between groups, with no difference in mortality, suggesting that dabigatran was noninferior to VKAs. Semmler et al (Austria, n = 43) compared DOACs with VKAs/LMWH in primary BCS patients, many with underlying myeloproliferative neoplasms. Over a median follow-up of 82.5 months, DOACs demonstrated comparable complete response rates and major bleeding risks. Both studies emphasized the convenience of DOACs due to oral administration and lack of INR monitoring. Conclusion Current evidence, though limited to small retrospective cohorts, suggests that DOACs may be as effective and safe as traditional anticoagulants in BCS management. DOACs offer practical advantages, particularly in patients with difficulties maintaining therapeutic INR or requiring long-term anticoagulation. Larger prospective studies and randomized controlled trials are warranted to validate these findings.

Background Due to age-related immunosenescence, the efficacy of unfractionated heparin (UFH) in geriatric sepsis populations remains unclear. The aim of this study was to investigate the efficacy of UFH in geriatric sepsis patients, providing a basis for the design of interventional randomized controlled trials. Methods We identified geriatric sepsis patients (aged ≥65 years) from the Medical Information Mart for Intensive Care (MIMIC-IV) database, Propensity score matching (PSM) and marginal structural Cox model (MSCM) were used to adjust for both baseline and time varying confounding. The primary endpoint was intensive care unit (ICU) mortality, while secondary outcomes included 28-day, 90-day, and in-hospital mortality, along with haemorrhage occurrence. Results A total of 3866 geriatric sepsis patients were enrolled in the study, with 1434 patients receiving UFH therapy. UFH therapy significantly reduced in-ICU mortality (hazard ratio [HR] 0.64, 95% confidence interval [CI] 0.48-0.81) and haemorrhage occurrence (HR 0.43, 95% CI 0.33-0.56) with PSM. However,UFH therapy did not significantly improve 28-day, 90-day, or in-hospital mortality. MSCMs further confirmed that UFH administration reduced ICU mortality (HR 0.58, 95% CI: 0.44-0.75) in the general population. Stratification analysis using MSCMs indicated that UFH administration was associated with a reduced ICU mortality rate among patients on ventilation (HR 0.55, 95% CI 0.41-0.74) and with acute kidney injury (AKI) (HR 0.59, 95% CI 0.45-0.78) (P < .001). Conclusions Early administration UFH to geriatric patients with sepsis was associated with reducing ICU mortality, without increasing the risk of bleeding. Subgroup analysis further suggested that UFH therapy conferred organ protective effects, particularly pronounced in patients requiring mechanical ventilation and those with AKI.