Investigation of Direct-Acting Oral Anticoagulants and the Incidence of Venous Thromboembolism in Patients Weighing ≥120 kg Compared to Patients Weighing <120 kg.

BACKGROUND: Direct oral anticoagulants (DOACs) present a favorable alternative to warfarin based on the decreased burden of monitoring and fewer drug and food interactions. Although studied in the general population, limited clinical data justifying efficacy in patients weighing ≥120 kg present concern for using DOACs in this specific population. OBJECTIVE: The purpose was to identify if a difference exists in incidence of recurrent thromboembolic events in patients receiving a DOAC for the indication of venous thromboembolism (VTE) weighing ≥120 kg compared to patients weighing <120 kg. METHODS: A retrospective database analysis was conducted with patients on apixaban, dabigatran, or rivaroxaban for treatment of VTE from the Veterans Integrated Service Network 8 between January 2012 and June 2017. The primary outcome was incidence of recurrent VTEs while on anticoagulation. Fisher's exact tests were used to evaluate difference in VTEs between the groups. RESULTS: There were 133 patients weighing ≥120 kg and 1063 patients weighing <120 kg identified within the 5-year time frame that met inclusion criteria. Although no statistically significant difference was found in incidence of recurrent VTEs between study groups (0.8% vs 1.1%; odds ratio: 0.66; 95% confidence interval: 0.09-5.14; P = .69) few events occurred limiting the power to be able to detect a difference. CONCLUSION: This study found no difference in VTE recurrence in patients weighing ≥120 kg compared to patients <120 kg with few events in either group. Although promising, additional studies are needed to confirm these findings.

Effects of oral Aloe vera on electrocardiographic and blood pressure measurements.

PURPOSE: The effects of oral aloe vera on electrocardiographic and blood pressure measurements were evaluated. METHODS: In this double-blind, placebo-controlled, crossover study, healthy volunteers over age 18 years received either 1200 mg of oral aloe vera powder or matching placebo on day 1 of the study and the treatment not received during the first phase on day 8. In each phase, electrocardiographic variables, systolic blood pressure, and diastolic blood pressure were evaluated at baseline and one, three, five, and eight hours after treatment. The primary endpoint was the maximum posttreatment Q-Tc interval over eight hours in both groups. RESULTS: Sixteen participants were enrolled in the study, with a mean ± S.D. age of 25 ± 5 years. No significant differences in electrocardiographic or blood pressure measurements were observed. The maximum Q-Tc interval was 419 ± 17 milliseconds in the placebo group and 422 ± 17 milliseconds in the aloe-treated group. The maximum P-R intervals in the placebo- and aloe-treated groups were 166 ± 22 and 169 ± 25 milliseconds, respectively. The maximum QRS complex duration did not significantly differ between the placebo- and aloe-treated groups (89.4 ± 9 and 89.3 ± 9 milliseconds, respectively). The maximum systolic blood pressures in the placebo- and aloe-treated groups were 120 ± 16 and 120 ± 14 milliseconds, respectively. The maximum diastolic blood pressures in the placebo- and aloe-treated groups were 74 ± 10 and 75 ± 9 milliseconds, respectively. CONCLUSION: A single dose of oral aloe vera had no effect on electrocardiographic or blood pressure measurements in young healthy volunteers.

Impact of enhanced external counterpulsation on Canadian Cardiovascular Society angina class in patients with chronic stable angina: a meta-analysis.

STUDY OBJECTIVE: To evaluate the true magnitude of benefit from enhanced external counterpulsation (EECP) by determining the effect of EECP on Canadian Cardiovascular Society (CCS) angina class in patients with chronic stable angina. DESIGN: Meta-analysis of 13 prospective studies that evaluated patients with stable angina and reported adequate data on CCS angina class. PATIENTS: A total of 949 adult patients with stable angina who underwent EECP treatment. MEASUREMENTS AND MAIN RESULTS: A systematic literature search of studies published between 1950 and February 2009 was performed. Studies were included for meta-analysis if they were reported in the English language, included human subjects, had a prospective study design, and reported adequate data on CCS angina class. The EECP treatment consisted of 35 sessions-1 hour/day, 5 days/week, for 7 weeks. Improvement in angina class was reported as the weighted proportion of patients improving by at least one CCS class from before to after EECP treatment. Heterogeneity was assessed by performing subgroup analyses and using the Cochran Q statistic. Publication bias was assessed by inspection of funnel plots and the Egger bias statistic. Among the 13 studies incorporating 949 patients, angina class was reduced by at least one CCS score in 86% of the patients (95% confidence interval 82-90%, Q statistic p=0.008]. Inspection of funnel plots showed some asymmetry, but the Egger bias statistic showed no publication bias (p=0.97). CONCLUSION: The results of our meta-analysis call for further long-term studies to determine the place of EECP therapy in the management of chronic stable angina. Currently, EECP therapy should be considered for patients with stable angina who are refractory to or not suitable for invasive therapy and/or medical management.