Future cardiology
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Aim: We describe the real-world utilization and outcomes associated with managing oral factor Xa inhibitor (FXai)-related major bleeds. Materials & methods: Electronic records from 45 US hospitals were queried (ICD-10-CM billing codes D68.32, T45.515x or T45.525x) to identify major bleed hospitalizations related to FXai use. Patient demographics, bleed type (intracranial hemorrhage, gastrointestinal, critical compartment, traumatic, other), FXai taken, reversal or replacement agents administered (including andexanet alfa, four-factor prothrombin complex concentrate, fresh frozen plasma, others), in-hospital mortality and length of stay were recorded. ⋯ Median length of stay was 5 days across all agents, while ICU length of stay was shorter andexanet alfa (2 days) compared with other agents (3 days). Conclusion: In-hospital mortality differed by bleed type and agents administered. Andexanet alfa was associated with the lowest rate of in-hospital mortality across all bleed types.
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Randomized Controlled Trial Multicenter Study
Rivaroxaban in atrial fibrillation cardioversion: insights from the X-VeRT trial.
ABSTRACT Vitamin K antagonists (VKAs) have traditionally been the standard of care for the thromboprophylactic anticoagulation of patients with nonvalvular atrial fibrillation (NVAF) undergoing cardioversion. X-VeRT was the first prospective trial to explore the safety and efficacy of one of the non-VKA oral anticoagulants, rivaroxaban, compared with dose-adjusted VKA as thromboprophylaxis in patients with NVAF scheduled to undergo cardioversion. ⋯ Rivaroxaban use (20 mg once daily or 15 mg if creatinine clearance was 30-49 ml/min) was associated with a similar incidence of adverse cardiovascular events and bleeding as VKA use; however, rivaroxaban significantly reduced the time to cardioversion in those undergoing delayed cardioversion. Thus, rivaroxaban is a safe alternative to VKAs for thromboprophylaxis in patients with NVAF undergoing elective cardioversion.