Safety and Efficacy of Direct Oral Anticoagulants vs Warfarin in Patients With Obesity and Venous Thromboembolism: A Retrospective Analysis.

BACKGROUND: Current venous thromboembolism guidelines recommend using direct oral anticoagulants (DOACs) over warfarin regardless of obesity status; however, evidence remains limited for the safety and efficacy of DOAC use in patients with obesity. This retrospective analysis sought to demonstrate the safety and efficacy of DOACs compared with warfarin in a diverse population of patients with obesity in light of current prescribing practices. METHODS: A retrospective cohort study was conducted at a large academic health system between July 2014 and September 2019. Adults with an admission diagnosis of deep vein thrombosis (DVT) or pulmonary embolism, with weight greater than 120 kg or a body mass index greater than 40, and who were discharged on an oral anticoagulant were included. Outcomes included occurrence of a thromboembolic event (DVT, pulmonary embolism, or ischemic stroke), bleeding event requiring hospitalization, and all-cause mortality within 12 months following index admission. RESULTS: Out of 787 patients included, 520 were in the DOAC group and 267 were in the warfarin group. Within 12 months of index hospitalization, thromboembolic events occurred in 4.23% of patients in the DOAC group vs 7.12% of patients in the warfarin group (hazard ratio, 0.6 [95% CI, 0.32-1.1]; P = .082). Bleeding events requiring hospitalization occurred in 8.85% of DOAC patients vs 10.1% of warfarin patients (hazard ratio, 0.93 [95% CI, 0.57-1.5]; P = .82). A DVT occurred in 1.7% and 4.9% of patients in the DOAC and warfarin groups, respectively (hazard ratio, 0.35 [95% CI, 0.15-0.84]; P = .046). CONCLUSION: No significant differences could be determined between DOACs and warfarin for cumulative thromboembolic or bleeding events, pulmonary embolism, ischemic stroke, or all-cause mortality. The risk of DVT was lower with apixaban and rivaroxaban. Regardless of patient weight or body mass index, physicians prescribed DOACs more commonly than warfarin.

Quantitative Phase-Change Thermodynamics and Metastability of Perovskite-Phase Cesium Lead Iodide.

The perovskite phase of cesium lead iodide (α-CsPbI3 or "black" phase) possesses favorable optoelectronic properties for photovoltaic applications. However, the stable phase at room temperature is a nonfunctional "yellow" phase (δ-CsPbI3). Black-phase polycrystalline thin films are synthesized above 330 °C and rapidly quenched to room temperature, retaining their phase in a metastable state. Using differential scanning calorimetry, it is shown herein that the metastable state is maintained in the absence of moisture, up to a temperature of 100 °C, and a reversible phase-change enthalpy of 14.2 (±0.5) kJ/mol is observed. The presence of atmospheric moisture hastens the black-to-yellow conversion kinetics without significantly changing the enthalpy of the transition, indicating a catalytic effect, rather than a change in equilibrium due to water adduct formation. These results delineate the conditions for trapping the desired phase and highlight the significant magnitude of the entropic stabilization of this phase.