ABSTRACT Background Left atrial appendage closure (LAAC) and direct oral anticoagulants (DOACs) have emerged as alternatives to warfarin for stroke prevention in atrial fibrillation (AF). However, recent trials have shown variable results igniting the debate on this topic. Methods We performed a systematic review and network meta-analysis (NMA) of RCTs comparing LAAC, DOACs, and warfarin in patients with AF. The primary efficacy outcome was ischemic stroke or systemic embolism (IS/SE) and the primary bleeding outcome was hemorrhagic stroke (HS). Secondary outcomes included net adverse clinical events (NACE) and major or clinically relevant bleeding (MCRB). Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using a random-effects model. Results Ten RCTs (LAAC: 6 trials; DOAC: 8 trials; warfarin: 6 trials) enrolling 78,594 patients fulfilled the inclusion criteria. There were no significant differences for the primary efficacy outcome of IS/SE among the 3 strategies. However, when compared with warfarin, both DOACs (OR 0·43, 95% CI 0·34–0·54) and LAAC (OR 0·34, 95% CI 0·18–0·63) reduced the primary safety outcome of HS, with no significant difference between them (OR 0·79, 95% CI 0·44–1·3). For NACE, both DOACs (OR 0·87, 95% CI 0·83–0·91) and LAAC (OR 0·85, 95% CI 0·73–0·99) were superior to warfarin, with similar performance between them (OR 0·98, 95% CI 0·84–1·13). For MCRB, DOACs were superior to warfarin (OR 0·79, 95% CI 0·63–0·99), while LAAC showed a non-significant trend towards benefit. Conclusion In this meta-analysis of RCTs with data from over 78,000 patients, LAAC and DOACs significantly reduced NACE driven by lower hemorrhagic stroke and provided equivalent IS/SE protection compared with warfarin, making LAAC a potential viable alternative to oral anticoagulation in appropriately selected AF patients. Funding None.
Out-of-hospital cardiac arrest (OHCA) is a major public health challenge in India. Cardiopulmonary resuscitation (CPR) awareness, training, and bystander response rates remain critically low across the country. OBJECTIVE:This Indian Society of Electrocardiology position statement aims to promote nationwide CPR awareness, strengthen community response to sudden cardiac arrest (SCA) and improve survival in OHCA, with measures adapted to India-specific systems of care and bystander training. MAIN THEMES:The statement highlights the SCA burden, early recognition, rapid response, barriers to community CPR training in India, dispatcher-assisted CPR, and public access defibrillation (PAD). It emphasizes school-based CPR education, corporate social responsibility partnerships, legislative support, and development of a national CPR ecosystem. Role of digital innovations, mobile applications, virtual reality, mobile CPR training units, psychological barriers and the bystander effect are emphasized. CONCLUSION:The position statement advocates transforming CPR from a medical skill into a societal responsibility and improve OHCA survival in India.
In dermatology clinics we routinely come across cases of lesions on the hands. Patients may present with papules, vesicles, nodules on the hands. Such lumps and bumps on hands can be a manifestation of various diseases, ranging from benign lesions to systemic conditions. Routinely the rash on hands indicates primary skin disease. But lesions on hands can be seen in inflammatory conditions like psoriasis, eczema, rheumatoid arthritis, gout or infective diseases like bacterial (folliculitis, anthrax), viral (pox virus, herpetic whitlow, molluscum, wart), mycobacterial (tuberculosis verrucose cutis, lupus vulgaris), fungal infections (sporotrichosis). Few benign lesions like keratoacanthoma, ganglion or malignant conditions like SCC, Melanoma may present. A thorough examination and diagnosis of these lesions can provide valuable insights into underlying conditions. Here I am sharing interesting clinical cases highlighting the significance of hand lesions in diagnosing diseases like infective (secondary syphilis) and inflammatory conditions (gout, psoriatic arthritis) as well as clues to variety of systemic diseases (leprosy, tuberous xanthoma). Lumps and bumps on hands can serve as a valuable diagnostic clue to various diseases. The diagnosis of hand lesions is mostly clinical and depends on the clinical history and exploratory objective findings. A proper history taking, thorough clinical and systemic examination, combined with laboratory tests can aid in accurate diagnosis and timely management. Hand lesions may be a window of systemic disease.
Cardiac catheterization through upper extremity arterial access has revolutionized percutaneous coronary interventions offering reduced bleeding complications and quicker recovery times. Evidence-based techniques such as patent hemostasis and newer approaches such as distal radial arterial access present opportunities and challenges. This article reviews the current techniques used for hemostasis after upper extremity arterial access, including traditional radial artery access, distal radial artery access, and hemostasis after alternative access sites such as the brachial, ulnar, and axillary arteries. Understanding the effectiveness and limitations of each hemostasis technique is essential for reducing complications such as radial artery occlusion and ensuring better patient outcomes.
11060 Background: Metabolic syndrome (MetS) is a known risk factor for developing at least 13 cancer types and adverse outcomes. However, the effects of MetS on their differential and cumulative impact on cardiovascular, renal, and mortality outcomes in cancer patients remains uncertain. We aimed to determine whether MetS components increase cancer patients' risk of adverse cardiorenal and all-cause mortality. Methods: This large retrospective cohort study used the TriNetX database between 2013 to 2024. Adults (>18 years) with new cancer diagnoses and ≥1 MetS trait (obesity, insulin resistance(IR), hypertension (HT), or dyslipidemia (DLD)) were compared with matched controls without MetS. We performed 1:1 propensity score matching to adjust for confounding factors (demographics, comorbidities, cancer type, and medications). The primary outcomes were new adverse cardiovascular events like heart failure (HF), major adverse cardiovascular events (MACE), and cerebrovascular events (CVE). The secondary outcomes were end-stage renal diseases (ESRD), the need for dialysis, and all-cause mortality. We conducted sensitivity analyses to assess the robustness of the findings. Hazard ratios(HR) were calculated using Cox regression models stratified by MetS traits. Results: In total, 204,297 patients were identified (median age 54 years) with a median follow-up of 7.8 years. Patients with ≥1 MetS trait had significantly increased risks of adverse cardiorenal events. HR for HF was 1.76; this risk increased to 2.54 with ≥3 MetS traits. The risk of MACE was HR of 2.34 in those with ≥1 trait and HR of 2.47 in those with 4 traits. CVE had an HR of 1.56, increasing to 2.38 with ≥3 traits. For secondary outcomes, the risk of ESRD was HR of 1.76 in patients with ≥1 MetS trait, rising to HR of 2.29 in those with ≥3 traits. The need for dialysis was significantly elevated (HR 1.86), and all-cause mortality was HR of 2.15 in patients with ≥1 trait, increasing to 3.10 with 4 traits. Stratified analyses revealed obesity increased HF risk (HR 1.58) and mortality (HR 1.75). IR was linked to higher risks of MACE (HR 1.88) and ESRD (HR 2.59). HT increased the risk of CVE (HR 2.16) and dialysis (HR 2.11). DLD moderately elevated the risk of IHD (HR 1.47) and mortality (HR 1.59). Sensitivity analyses confirmed these findings across cancer types and treatments. A cumulative relationship was observed, with the number of MetS traits correlating to higher risks of outcomes. Conclusions: Our study showed a differential effect of MetS components on cardiovascular, renal, and all-cause mortality outcomes in cancer patients, with a cumulative impact of multiple MetS on overall risk. Early intervention targeting MetS traits may reduce these risks and improve outcomes. Comprehensive metabolic management should be integrated into oncology care to mitigate these risks and improve patient outcomes.
