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Hassan H, Kallur KR, Chatterjee S, Bavishi C, Gongora C, Palazzo A, Herzog E, Mukherjee D, Sardar P, Kornberg R. ROLE OF EARLY CORONARY INTERVENTION IN IMPROVING IN-HOSPITAL MORTALITY IN COMATOSE CARDIAC ARREST PATIENTS WITHOUT ST ELEVATION MYOCARDIAL INFARCTION: A META-ANALYSIS OF OBSERVATIONAL STUDIES. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30298-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Chatterjee S, Chakraborty A, Sardar P, Giri J. DERIVATION AND VALIDATION OF A NOVEL RISK SCORE FOR PREDICTING INTRACRANIAL HEMORRHAGE IN PATIENTS WITH PULMONARY EMBOLISM TREATED WITH THROMBOLYTIC THERAPY: THE PE-ICH SCORE. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Krishnamoorthy P, Chatterjee S, Garg J, Sardar P, Bavishi C, Patel N, Giri J, Mukherjee D. CROSS SECTIONAL STUDY OF PATIENTS WITH ACUTE CORONARY SYNDROME REQUIRING LONG TERM ORAL ANTICOAGULATION THERAPY: RESULTS FROM NATIONAL INPATIENT SAMPLE. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30551-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kundu A, Sardar P, Ghosh S, Chatterjee S, McManus D. REMOTE ISCHEMIC PRECONDITIONING FOR PREVENTION OF POST-OPERATIVE ATRIAL FIBRILLATION IN PATIENTS UNDERGOING CARDIAC SURGERY: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30794-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kundu A, Sardar P, Ghosh S, Chatterjee S, Aronow W. EFFICACY AND SAFETY OF COLCHICINE FOR PREVENTION OF PERICARDITIS AND CARDIAC TAMPONADE: AN UPDATED META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31902-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Chatterjee S, Sardar P, Chakraborty A, Chatterjee S. ACP Journal Club. In patients with SBP ≥ 130 mm Hg and CV risk, intensive vs standard BP control reduced CV events and mortality. Ann Intern Med 2016; 164:JC15. [PMID: 26882300 DOI: 10.7326/acpjc-2016-164-4-015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Chatterjee S, Sardar P, Chakraborty A, Chatterjee S. ACP Journal Club. Review: More- vs less-intensive BP-lowering regimens reduce major CV events. Ann Intern Med 2016; 164:JC14. [PMID: 26882299 DOI: 10.7326/acpjc-2016-164-4-014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Chatterjee S, Tripathi B, Virk HUH, Ahmed M, Bavishi C, Krishnamoorthy P, Sardar P, Giri J, Omidvari K, Chikwe J. Does Surgical Repair of Moderate Ischemic Mitral Regurgitation Improve Survival? A Systematic Review. Curr Cardiol Rep 2016; 18:22. [DOI: 10.1007/s11886-016-0701-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sen P, Kundu A, Sardar P, Chatterjee S, Nairooz R, Amin H, Aronow WS. Outcomes After Cardioversion in Atrial Fibrillation Patients Treated with Non-Vitamin K Antagonist Oral Anticoagulants (NOACs): Insights from a Meta-Analysis. Am J Cardiovasc Drugs 2016; 16:33-41. [PMID: 26138204 DOI: 10.1007/s40256-015-0136-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are limited data on outcomes following cardioversion in atrial fibrillation (AF) patients treated with non-vitamin K antagonist oral anticoagulants (NOACs). A meta-analysis was performed to evaluate the efficacy and safety of NOACs in patients with AF undergoing cardioversion. METHODS PubMed, Cochrane Library, EMBASE, Web of Science and CINAHL databases were searched from January 1, 2001 through to October 30, 2014. Randomized controlled trials (RCTs) comparing NOACs (apixaban, rivaroxaban and dabigatran) with warfarin in AF patients undergoing cardioversion were selected. The primary efficacy outcome was stroke and systemic embolism, and the primary safety outcome was major or clinically relevant non-major (CRNM) bleeding. We used random-effects models. RESULTS Four RCTs were included, involving a total of 3635 randomized participants who underwent a total of 4257 cardioversions. A total of 12 events of stroke and systemic embolism were found in the NOAC group and ten events in the warfarin group [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.31-1.72]. Risk of major or CRNM bleeding was not different with NOACs, when compared with warfarin (OR 1.41, 95% CI 0.87-2.28). CONCLUSIONS Data from patients enrolled in RCTs, showed that NOACs are effective and safe for AF patients undergoing cardioversion.
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Kundu A, Sen P, Sardar P, Chatterjee S, Kapoor A, McManus DD. Intracranial hemorrhage with target specific oral anticoagulants in patients with atrial fibrillation: An updated meta-analysis of randomized controlled trials. Int J Cardiol 2016; 203:1000-2. [DOI: 10.1016/j.ijcard.2015.11.097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 11/16/2015] [Indexed: 11/29/2022]
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Nairooz R, Feldman DN, Rochlani Y, Aronow WS, Sardar P, Mukherjee D, Naidu SS, Patel P. Impact of intraprocedural thrombotic events on short- and long-term outcomes following percutaneous coronary intervention. Evidence from a meta-analysis. Int J Cardiol 2016; 202:469-76. [PMID: 26436676 DOI: 10.1016/j.ijcard.2015.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 09/09/2015] [Accepted: 09/19/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Data regarding the effects of intraprocedural thrombotic events (IPTE) are scarce. Hence we aim to perform a meta-analysis to examine the outcomes of IPTE compared to non-IPTE during PCI. METHODS We performed a literature search of all published full-length articles of studies that reported data on patients with IPTE compared with non-IPTE during PCI. We calculated odd ratios via random effects model. RESULTS A total of 26,697 patients, of which 1572 patients had IPTE, were included in this analysis. In-hospital, IPTE was associated with higher mortality (odds ratio (OR) 5.36, 95% confidence interval (CI) [2.31, 12.41]; p<0.0001), myocardial infarction (MI) and major bleeding compared to non-IPTE. At 30 days, IPTE was also associated with higher mortality (OR 4.57, 95% CI [2.43, 8.60]; p<0.0001), MI, repeat revascularization, stent thrombosis and major bleeding compared to non-IPTE group. IPTE was also associated with higher long-term mortality (OR 2.19, 95% CI [1.35, 3.53]; p=0.001). Among IPTE patients, intraprocedural stent thrombosis was associated with greater odds of MI compared to both no reflow and distal embolization events. CONCLUSION IPTE during PCI is associated with more adverse ischemic events, including mortality, during the index hospitalization, at 30 days and long-term.
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Kundu A, Sardar P, Sen P, Chatterjee S, Huston J, Nairooz R, Ryan JJ, Aronow WS. Patient Taking A Novel Oral Anticoagulant Presents With Major GI Bleeding. J Atr Fibrillation 2015; 8:1218. [PMID: 27957203 PMCID: PMC4955887 DOI: 10.4022/jafib.1218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 08/17/2015] [Accepted: 08/19/2015] [Indexed: 06/06/2023]
Abstract
Novel Oral Anticoagulants (NOACs) such as Dabigatran, Rivaroxaban, Apixaban and Edoxaban are becoming increasingly popular choices for anticoagulation in place of oral Vitamin K Antagonists in various clinical settings. However, they are thought to be associated with an increased risk of gastrointestinal bleeding. Moreover, no specific antidote is available which can rapidly reverse the anti-coagulant action of NOACs raising concern that gastrointestinal bleeding with NOACs could carry a worse prognosis than that associated with conventional agents. In this review, we describe a case of gastrointestinal bleeding in the setting of NOAC use, followed by a brief overview of the pivotal trials involving NOACs. Clinical issues such as pathophysiology, diagnosis and management of NOAC induced GI bleeding have been described. Future trials will help elucidate the true incidence, risk factors and preventive strategies for NOAC associated gastrointestinal bleeding.
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Sardar P, Chatterjee S, Giri J, Kundu A, Tandar A, Sen P, Nairooz R, Huston J, Ryan JJ, Bashir R, Parikh SA, White CJ, Meyers PM, Mukherjee D, Majersik JJ, Gray WA. Endovascular therapy for acute ischaemic stroke: a systematic review and meta-analysis of randomized trials. Eur Heart J 2015; 36:2373-80. [DOI: 10.1093/eurheartj/ehv270] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 05/27/2015] [Indexed: 11/12/2022] Open
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Sardar P, Udell JA, Chatterjee S, Bansilal S, Mukherjee D, Farkouh ME. Effect of Intensive Versus Standard Blood Glucose Control in Patients With Type 2 Diabetes Mellitus in Different Regions of the World: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Am Heart Assoc 2015; 4:e001577. [PMID: 25944874 PMCID: PMC4599400 DOI: 10.1161/jaha.114.001577] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 04/01/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Regional variation in type 2 diabetes mellitus care may affect outcomes in patients treated with intensive versus standard blood glucose control. We sought to evaluate these differences between North America and the rest of the world. METHODS AND RESULTS Databases were searched from their inception through December 2013. Randomized controlled trials comparing the effects of intensive therapy with standard therapy for macro- and microvascular complications in adults with type 2 diabetes mellitus were selected. We calculated summary odds ratios (ORs) and 95% CIs with the random-effects model. The analysis included 34 967 patients from 17 randomized controlled trials (7 in North America and 10 in the rest of the world). There were no significant differences between intensive and standard therapy groups for all-cause mortality (OR 1.03, 95% CI 0.93 to 1.13) and cardiovascular mortality (OR 1.09, 95% CI 0.90 to 1.32). For trials conducted in North America, intensive therapy compared with standard glycemic control resulted in significantly higher all-cause mortality (OR 1.21, 95% CI 1.05 to 1.40) and cardiovascular mortality (OR 1.41, 95% CI 1.05 to 1.90) than trials conducted in the rest of the world (all-cause mortality OR 0.93, 95% CI 0.85 to 1.03; interaction P=0.006; cardiovascular mortality OR 0.89, 95% CI, 0.79 to 1.00; interaction P=0.007). Analysis of individual macro- and microvascular outcomes revealed no significant regional differences; however, the risk of severe hypoglycemia was significantly higher in trials of intensive therapy in North America (OR 3.52, 95% CI 3.07 to 4.03) compared with the rest of the world (OR 1.45, 95% CI 0.85 to 2.47; interaction P=0.001). CONCLUSION Randomization to intensive glycemic control in type 2 diabetes mellitus patients was associated with increases in all-cause mortality, cardiovascular mortality, and severe hypoglycemia in North America compared with the rest of the world. Further investigation into the pathobiology or patient variability underlying these findings is warranted.
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Nairooz R, Sardar P, Payne J, Aronow WS, Paydak H. Meta-analysis of major bleeding with uninterrupted warfarin compared to interrupted warfarin and heparin bridging in ablation of atrial fibrillation. Int J Cardiol 2015; 187:426-9. [PMID: 25841141 DOI: 10.1016/j.ijcard.2015.03.376] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/22/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
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Nairooz R, Sardar P, Aronow WS. Not All NSTEMIs Are Created Equal. J Am Coll Cardiol 2015; 65:1718. [PMID: 25908087 DOI: 10.1016/j.jacc.2015.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 01/06/2015] [Indexed: 10/23/2022]
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Nairooz R, Sardar P, Amin H, Chatterjee S, Helmy T, Naidu SS. Short- and long-term outcomes in diabetes patients undergoing percutaneous coronary intervention with bivalirudin compared with heparin and glycoprotein IIb/IIIA inhibitors: A meta-analysis of randomized trials. Catheter Cardiovasc Interv 2015; 86:364-75. [PMID: 25914388 DOI: 10.1002/ccd.25952] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 03/15/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Diabetes patients undergoing percutaneous coronary intervention (PCI) have more complications than nondiabetes patients, including increased long-term mortality. Use of bivalirudin versus heparin and glycoprotein IIb/IIIa inhibitors (GPI) in diabetes patients undergoing PCI and its effect on long-term mortality were evaluated in few randomized trials, but with conflicting results. METHODS We searched the literature for randomized controlled trials that compared heparin and GPI therapy with bivalirudin in diabetes patients undergoing PCI. The incidence of major adverse cardiovascular events (MACE), death from any cause, myocardial infarction (MI), urgent revascularization, major and minor bleeding (at 30 days), as well as all-cause mortality at 1 year were included, and meta-analysis was performed. RESULTS A total of 5,137 patients with diabetes were included in four randomized trials. At 30 days, bivalirudin, compared with heparin and GPI, caused less major bleeding (odds ratio (OR), 0.68; 95% confidence interval (CI), 0.52-0.89; P = 0.005) and less minor bleeding (OR, 0.48; 95% CI, 0.41-0.57; P < 0.00001) and similar rates of MACE (OR, 0.87; 95% CI, 0.70-1.08; P = 0.21), MI (OR, 0.87; 95% CI, 0.68-1.10; P = 0.25), and urgent revascularization (OR, 1.12; 95% CI, 0.76-1.65; P = 0.57). Death from any cause at 30 day was numerically lower with bivalirudin use but not statistically significant (OR, 0.72; 95% CI, 0.46-1.13; P = 0.15). Mortality at 1 year was significantly lower in diabetes patients treated with bivalirudin compared with heparin and GPI (OR, 0.72; 95% CI, 0.52-0.99; P = 0.04). A secondary analysis suggests that the major bleeding benefit with bivalirudin may be driven by mandated use of GPI in heparin arm. CONCLUSION Among patients with diabetes undergoing PCI, bivalirudin caused less major and minor bleeding compared with heparin and GPI, with similar rates of MACE, death, MI, and urgent revascularization at 30 days, but significantly lower mortality rates at 1 year.
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Nairooz R, Sardar P, Pino M, Aronow WS, Sewani A, Mukherjee D, Paydak H, Maskoun W. Meta-analysis of risk of stroke and thrombo-embolism with rivaroxaban versus vitamin K antagonists in ablation and cardioversion of atrial fibrillation. Int J Cardiol 2015; 187:345-53. [PMID: 25839640 DOI: 10.1016/j.ijcard.2015.03.323] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 03/09/2015] [Accepted: 03/20/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anticoagulation in cardioversion and ablation of atrial fibrillation is imperative for reducing thrombo-embolic events. Ample information is available about the use of warfarin and vitamin K antagonists (VKA) but few trials examine safety and efficacy of rivaroxaban in these procedures. We aim to explore the hypothesis that rivaroxaban causes equal thrombo-embolic and bleeding events when used in atrial fibrillation patients undergoing ablation or cardioversion compared to VKA. METHODS We searched the online databases as well as conference abstracts till December 2014 for studies comparing rivaroxaban with VKA in atrial fibrillation patients undergoing catheter ablation or cardioversion. We report events as Odds ratio using random effects model except when event rates were less than 1% we used Peto Odds Ratio. RESULTS A total of 8872 atrial fibrillation patients in 15 studies undergoing either catheter ablation or cardioversion were included in this analysis. There were significantly lower stroke events with rivaroxaban compared with VKA (Peto Odds Ratio (POR) 0.33, 95% confidence interval (CI) [0.11, 0.95]; P=0.04), and significantly less thrombo-embolic events with rivaroxaban compared with VKA (POR 0.46, 95% CI [0.21, 0.97]; P=0.04). Major and minor bleeding were equal with rivaroxaban versus VKA (Odds Ratio (OR) 0.92, 95% CI [0.62, 1.36]; P=0.68) and (OR 0.81,95% CI [0.58, 1.11]; P=0.19) respectively. CONCLUSION The use of rivaroxaban in ablation and cardioversion of atrial fibrillation may be associated with decreased risk of stroke and thromboembolism with equal bleeding risk compared to VKA.
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Ranjan P, Chatterjee S, Gupta D, Sardar P, Giri J, Bhinder J, Mukherjee D, Kumbhani D. ASSOCIATIONS OF KNOWN COMPLICATIONS WITH TRANSCATHETER IMPLANTATION OF FIRST-GENERATION BALLOON EXPANDABLE EDWARDS-SAPIEN AORTIC VALVES WITH PERI-PROCEDURAL MORTALITY: AN INSIGHT FROM 2011-2014 REPORTS FROM THE FDA MAUDE DATABASE. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61766-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Nairooz RS, Sardar P, Pino M, Amin H, Sewani A, Maskoun W, Paydak H. META-ANALYSIS OF RISK OF STROKE AND THROMBO-EMBOLISM WITH RIVAROXABAN VERSUS VITAMIN K ANTAGONISTS IN ABLATION AND CARDIOVERSION OF ATRIAL FIBRILLATION. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60349-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nairooz RS, Ayoub KF, Sardar P, Ahmed Z, Helmy T, Anderson HV. PERCUTANEOUS CORONARY INTERVENTION WITH HALF DOSE FIBRINOLYSIS VERSUS PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN ST ELEVATION MYOCARDIAL INFARCTION: EVIDENCE FROM A META-ANALYSIS. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60067-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Koulova A, Chatterjee S, Sardar P, Giri J, DiNicolantonio J, Biondi-Zoccai G, Feldman D, Bangalore S. TRANSCATHETER VERSUS SURGICAL AORTIC VALVE REPLACEMENT IN END STAGE RENAL DISEASE: AN ANALYSIS OF THE NATIONWIDE INPATIENT SAMPLE DATABASE. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61948-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sardar P, Kundu A, Nairooz R, Chatterjee S, Ledley GS, Aronow WS. Health Resource Variability in the Achievement of Optimal Performance and Clinical Outcome in Ischemic Heart Disease. Curr Cardiol Rep 2015; 17:1. [PMID: 25612925 DOI: 10.1007/s11886-014-0551-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sardar P, Chatterjee S, Lavie CJ, Giri JS, Ghosh J, Mukherjee D, Lip GYH. Risk of major bleeding in different indications for new oral anticoagulants: insights from a meta-analysis of approved dosages from 50 randomized trials. Int J Cardiol 2014; 179:279-87. [PMID: 25464465 DOI: 10.1016/j.ijcard.2014.11.101] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 09/17/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND A meta-analysis was performed to evaluate the risk of major bleeding with the use of New Oral Anticoagulants (NOACs). METHODS Randomized controlled trials (RCTs) comparing NOACs (rivaroxaban, dabigatran, apixaban, edoxaban and darexaban) with comparators were selected. RESULTS Fifty trials included 155,537 patients. Pooled analysis of all NOACs for all indications together demonstrated no significant difference between NOACs and comparators for risk of major bleeding (odds ratio [OR] 0.93, 95% CI 0.79-1.09). Pooled analysis also showed that NOACs caused significantly less major bleeding compared to vitamin K antagonists (VKA) (0.77, 0.64-0.91). The analysis for individual NOACs showed risk of major bleeding were not different with rivaroxaban, apixaban or dabigatran compared to pharmacologically active comparators or VKA. Indication specific analysis showed that NOACs were associated with significantly higher major bleeding after hip surgery (1.43, 1.02-1.99), in patients with acute coronary syndrome (ACS), (compared against placebo) (2.89, 2.01-4.14), and for medically ill patients (2.79, 1.69-4.60). For the treatment of acute venous thromboembolism (VTE) or pulmonary embolism (PE), NOACs were associated with significantly less bleeding (0.63, 0.44-0.90). No significant difference was found between NOACs and comparators in treatment of atrial fibrillation and for extended treatment of VTE. CONCLUSIONS Risk of major bleeding with new oral anticoagulants varies with their indication for use. New agents may be associated with comparatively less major bleeding compared to VKA. NOAC may increase the risk of major bleeding after hip surgery, ACS and acute medically ill patients; but may be associated with less bleeding in treatment of acute VTE/PE.
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Sardar P, Nairooz R, Pekler G. Letter by Sardar et al regarding article, "optimal duration of dual antiplatelet therapy after drug-eluting stent implantation: a randomized, controlled trial". Circulation 2014; 130:e160. [PMID: 25462827 DOI: 10.1161/circulationaha.113.006936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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