The American journal of medicine
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Multicenter Study
Oral Anticoagulant Use for Patients with Atrial Fibrillation with Concomitant Anemia and/or Thrombocytopenia.
Hemoglobin levels and platelet counts have been associated with adverse clinical outcomes in patients with cardiovascular conditions. We aimed to assess the impact of oral anticoagulant use for patients with atrial fibrillation and concomitant anemia or thrombocytopenia. ⋯ Patients with atrial fibrillation with anemia or thrombocytopenia were a high-risk population. Compared with no OAC use, NOACs were associated with better clinical outcomes for patients with atrial fibrillation and advanced anemia (hemoglobin <10g/dL) or thrombocytopenia (platelet <100 K/µL) but not for those with both conditions.
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Differentiating patients with type 1 and type 2 myocardial infarction (MI) and acute non-ischemic myocardial injury continues to be a problem for many clinicians. Type 1 MI is the most easily defined. It involves the rise and fall of blood troponin measurements (only falling values if the patient arrives late) with an appropriate clinical observation consistent with myocardial ischemia. ⋯ The clinical scenarios leading to type 2 MI and non-ischemic myocardial injury are, however, often fraught with greater degrees of uncertainty. In addition, therapy for these latter 2 entities is poorly defined. This review will present 3 patient scenarios that should help clinicians understand the difference between these 3 entities as well as possible therapeutic interventions.
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We aim to describe reporting and representation of minority patient populations in immune checkpoint inhibitor (ICI) clinical trials and assess predictors of enrollment disparity. ⋯ The reporting of participation by racial or ethnic subgroup categories is inadequate. Women, older adults, as well as Black and Hispanic participants are significantly underrepresented in ICI clinical trials.
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Sickle cell trait is typically considered benign. Although evidence remains inconsistent, recent studies suggest that it is associated with several common diseases. We systematically assessed associations of sickle cell trait with reported diseases in a large population-based cohort. ⋯ Sickle cell trait is significantly associated with increased risk for diabetes and diabetes-related complications/comorbidities.
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Anemia is common in older individuals, but it is not known whether the prognostic impact of transfusion differs according to cardiac troponin concentration. ⋯ This pilot study suggests that transfusion could be associated with better 30-day outcomes in older anemic patients with anemia-related myocardial injury. Thus, troponin levels could be involved in decision-making relative to transfusion in anemic older patients. Clinical trials are needed to establish the benefit of transfusion in patients with elevated troponins.