Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Aug 2024
ReviewThe periprocedural management of patients on a direct oral anticoagulant undergoing an elective gastrointestinal endoscopic procedure.
This narrative review summarizes the current body of literature regarding periprocedural management of direct oral anticoagulant (DOAC)-treated patients undergoing digestive endoscopy since the publication of the 2022 American College of Gastroenterology - Canadian Association of Gastroenterology guidelines. We provide a detailed analysis of the thromboembolic risk, endoscopic procedure-specific bleeding risks, contemporary intraprocedural techniques to reduce the bleeding risk, and a summary of periprocedural DOAC guidelines developed by major gastrointestinal societies, including recommendations on procedure risk stratification. Despite data heterogeneity, the overall trend of the current literature supports the contemporary practice of a minimal DOAC interruption without the need for heparin bridging.
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Cardiovascular disease remains the leading global cause of mortality, requiring effective antithrombotic strategies to prevent thromboembolic events. Currently available therapies are effective but have inherent bleeding risks which may limit or preclude their use, particularly in patients at the highest risk of bleeding. Factor XI (FXI) inhibitors are a promising new class of anticoagulants which may mitigate the risk of bleeding while maintaining efficacy. ⋯ Ongoing phase III trials including OCEANIC‑STROKE (A Study to Test Asundexian for Preventing a Stroke Caused by a Clot in Participants After an Acute Ischemic Stroke or After a High‑risk Transient Ischemic Attack, a So‑called Mini Stroke) and LIBREXIA trials aim to further explore the efficacy of FXI inhibitors in stroke, acute coronary syndrome, and atrial fibrillation. In conclusion, FXI inhibitors hold promise as next‑generation anticoagulants, potentially addressing limitations of current therapies. Ongoing research is required to establish their place in clinical practice and address unresolved questions.
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Pol. Arch. Med. Wewn. · Aug 2024
ReviewNew diagnostic technologies in laboratory medicine: Potential benefits and challenges.
Laboratory tests play a central role in medicine, as they help to make diagnoses, assess prognosis and risk of disease, and monitor therapies, thus contributing to 70% of all medical decisions. This cross‑sectional function offers great potential for technologic and organizational innovation to influence health care as a whole. In recent years, a variety of technologies have emerged and entered the field of medical research, or even medical care. ⋯ However, this enormous diagnostic potential is far from being utilized and only very few applications have been implemented in clinical practice. Why is this the case? In this article, we describe the key technologic fields, discuss their medical potential, and list obstacles to their implementation. In addition, we present a methodologic framework to support researchers, clinicians, and authorities in development and implementation of novel diagnostic approaches.
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Pol. Arch. Med. Wewn. · Aug 2024
The Barcelona Bio-Heart Failure Risk Calculator may predict one-year mortality in patients with advanced heart failure.
Accurate risk assessment in patients with heart failure (HF) is crucial. Developing new models that combine biochemical and clinical variables with novel biomarkers is the best approach to improving the management and prognostic evaluation in this population. ⋯ The BCN Bio‑HF risk score had significantly better prognostic performance than HFSS or SHFM. Lower BCN and HFSS scores and a higher bilirubin concentration were independently associated with a higher risk of 1‑year death in patients with end‑stage HF.