ABSTRACT
Background: warfarin was used for decades to prevent stroke in high risk AF patients, recent guidelines and published data is recommending use of NOACs like Rivaroxaban as an alternative to Warfarin, Its use is increasing world over because of its predictable action, less food and drug interaction and no need of monitoring for dose adjustments, considering these facts we planned to conduct a study to see the frequency of use of Rivaroxaban in our local population of AF patients with risk of stroke calculated by CHA2DS2-VASc score
Method: this cross-sectional study was done at National Institute of Cardiovascular disease [NICVD] from May 2017 to September 2017 included 137 non-valvular AF patients with high risk of stroke calculated by applying CHA2DS2-VASc score more than or equal to 2. Clinical details and information about anticoagulant medications prescribed to them was also obtained. SPSS 19 was used for the analysis, descriptive statistics such as mean +/-SD, frequency and percentages were calculated. Z-test, t-test, and chi-square test were used for the assessment and comparison of data. Two sided p-value of 0.05 was considered for statistical significance
Results: total 137 patient were included 50.4% [69] were male, 104 [75.91%] out of 137 were on Anticoagulant therapy, with 86 [62.77%] were on Warfarin and only 18 [13.14%] were taking Rivaroxaban
Conclusion: our study showed very small percentage of non valvular AF patients with risk of stroke were prescribed Rivaroxaban. It's important to update our treating Physicians about this novel agent which is shown to be equally effective and safe in comparison to warfarin, and easy to prescribe without monitoring to reduce stroke risk
ABSTRACT
DM is an established risk factor for congestive cardiac failure, in which the diastolic function is impaired. The majority of these patients may be asymptomatic without signs of overt heart failure. The aim of this study was to determine asymptomatic Left Ventricular Diastolic Dysfuction [LVDD] in Non-Insulin Dependent Diabetes Mellitus [NIDDM] in association with glycemic control and to assess the risk factors for the development of diastolic dysfunction. This cross sectional study was conducted at the Tabba Heart Institute, Karachi from Dec, 2011 to Nov 2012, 101 asymptomatic patients with type 2 diabetes without evidence of cardio-respiratory illness were enrolled. LVDD was evaluated by Doppler echocardiography, which included the valsalva manoeuvre. A total of 101 patients, LVDD was found in 67 subjects [66.34%] of whom 52 [51.48%] had impaired relaxation and 15 [14.85%] had a pseudonormal pattern of ventricular filling. The potential risk factors for the development of LVDD in type 2 diabetics were [a] age ?45 years was associated with an almost three times higher risk for LVDD, [b] females had almost two times a higher risk of LVDD as compared with men, and [c] Diabetic patients of more than two years' duration had a two times higher risk of LVDD. The study results also indicate that LVDD was significantly associated with increased age, longer duration of Diabetes and glycemic control [glycated HbA1c levels] and LVDD is found in diabetic patients before the onset of clinically detectable disease. The high prevalence of LVDD suggests that screening for LVDD should include procedures such as the valsalva manoeuvre