JAMA : the journal of the American Medical Association
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Randomized Controlled Trial Multicenter Study Comparative Study
Comparison of vascular closure devices vs manual compression after femoral artery puncture: the ISAR-CLOSURE randomized clinical trial.
The role of vascular closure devices (VCD) for the achievement of hemostasis in patients undergoing transfemoral coronary angiography remains controversial. ⋯ In patients undergoing transfemoral coronary angiography, VCDs were noninferior to manual compression in terms of vascular access-site complications and reduced time to hemostasis.
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Randomized Controlled Trial Multicenter Study
Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation: a randomized clinical trial.
While effective in preventing stroke in patients with atrial fibrillation (AF), warfarin is limited by a narrow therapeutic profile, a need for lifelong coagulation monitoring, and multiple drug and diet interactions. ⋯ After 3.8 years of follow-up among patients with nonvalvular AF at elevated risk for stroke, percutaneous LAA closure met criteria for both noninferiority and superiority, compared with warfarin, for preventing the combined outcome of stroke, systemic embolism, and cardiovascular death, as well as superiority for cardiovascular and all-cause mortality.
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Is fixed-dose combination therapy (polypill) that combines antiplatelet, blood pressure-lowering, and cholesterol-lowering medications into a single pill associated with improved cardiovascular disease (CVD) risk factors or reduced all-cause mortality or fatal and nonfatal CVD events? Is the polypill associated with an increase in adverse events? ⋯ Polypills are associated with greater reductions in systolic blood pressure and total cholesterol compared with usual care, placebo, or active comparators, but also with a 19% higher risk of any adverse event. Due to limited power from available evidence, the association of polypills with all-cause mortality or fatal and nonfatal CVD events is uncertain.