ABSTRACT
ABSTRACT: Spontaneous coronary artery dissection (SCAD) is an underrecognized form of nonatherosclerotic acute coronary syndrome, mostly occurring in younger female patients. The knowledge base about the diagnosis and management of SCAD has grown over the past decade, but gaps remain in how best to approach this disease. This article reviews the research on the prevalence, presentation, and management of SCAD.
Subject(s)
Acute Coronary Syndrome , Vascular Diseases , Humans , Female , Coronary Vessels/diagnostic imaging , Coronary Angiography/adverse effects , Vascular Diseases/complications , Vascular Diseases/diagnosis , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/etiologyABSTRACT
BACKGROUND: Direct oral anticoagulants (DOACs) are often used in patients with atrial fibrillation or flutter instead of warfarin and although supporting evidence is limited, available studies suggest this may be an acceptable route of care. Our study assessed the question: are DOACs as effective and safe as warfarin in patients with atrial fibrillation and class III obesity specifically in a rural population? METHODS: A retrospective analysis was conducted by examining the first 6-12 months of therapy with a DOAC (apixaban or rivaroxaban) or warfarin in patients with weight >120kg or class III obesity. Events of interest, thrombosis and bleeding, were documented for analysis. The risk and odds of events of interest for both groups were calculated and compared. RESULTS: Characteristics of both arms were similar (DOAC n=42; warfarin n=43). A lack of thrombosis events limited efficacy analysis. A total of 22 bleeds occurred with 8 in patients prescribed a DOAC (7 minor; 1 major) and 14 in those prescribed warfarin (12 minor; 2 major). Weight in kg (p<0.001), BMI (p=0.013) and HAS-BLED score (p=0.035) were predictive of a first bleeding event in patients prescribed warfarin. The odds ratio for any type of bleed on DOAC vs warfarin was 0.55 (0.180-1.681; 95% CI). CONCLUSIONS: In patients with atrial fibrillation and class III obesity, regarding safety, DOACs appear to be non-inferior to warfarin during the first six to 12 months of therapy in our rural population - consistent with other analyses; however, the lack of thrombosis events limited the efficacy analysis.
