Direct Oral Anticoagulants vs Warfarin in Older Patients With Atrial Fibrillation and Ischemic Stroke

This observational study examined 11,662 patients with atrial fibrillation who had had an ischemic stroke and were anticoagulation naïve, patients discharged while receiving:

1. Direct oral anticoagulants (DOACs) had more days at home post-discharge
2. Were less likely to experience major adverse cardiovascular events, all-cause mortality, all-cause readmissions, cardiovascular readmissions, or hemorrhagic strokes
3. Had a small but significant increase in gastrointestinal bleeding.

Overall, DOACs appear to be an effective and safe treatment option compared with warfarin for patients with atrial fibrillation who have ischemic stroke and may be even more beneficial despite a small in crease in gastrointestinal bleeding.

Perioperative Direct Oral Anticoagulant Use

This study of 3007 patients with atrial fibrillation who were undergoing surgery enrolled patients to have:

1. Direct Oral Anticoagulants (DOACs) were omitted 1-day before a low-bleeding-risk procedure
2. DOACs were omitted 2 days before a high-bleeding-risk procedure
3. Patients with renal impairment had the pre-operative omission duration readjusted

Study investigators found that the perioperative risk of bleeding and arterial thromboembolism were low with this simplified strategy. The 30-day postoperative rate of major bleeding was 1.35% (95% CI, 0%-2.00%) in the apixaban cohort, 0.90% (95% CI, 0%-1.73%) in the dabigatran cohort, and 1.85% (95% CI, 0%-2.65%) in the rivaroxaban cohort. The rate of arterial thromboembolism was 0.16% (95% CI, 0%-0.48%) in the apixaban cohort, 0.60% (95% CI, 0%-1.33%) in the dabigatran cohort, and 0.37% (95% CI, 0%-0.82%) in the rivaroxaban cohort.

DOACs	Bleeding Risk	Arterial Thromboembolism
Apixaban	1.35	0.16
Dabigatran	0.90	0.60
Rivaroxaban	1.85	0.37

Hospital Visits After Discharge in Readmission Reduction Program Era

This study raises interesting questions about the effectiveness of the Hospital Readmission Reduction Program. While readmissions are going down, the hospital ED visits and observation admits are going up. Are hospitals gaming the system?

A Case For More Vacations!

Vacationing more may reduce your risk of metabolic syndrome. So, don’t bypass your vacations and give sometime to yourself.

Here is the link

Longitudinal Study of Physician Burnout

Here is the study

The most interesting part is “burnout trends among staff tended to move in the opposite direction from trends among clinicians.”