Cardiology Digest podcast: Episode #7

Study #1

Have you ever wondered about the optimal timing for introducing direct-acting oral anticoagulants (DOACs) after strokes due to atrial fibrillation? This New England Journal of Medicine study dives into the potential advantages of early DOAC introduction. You might be surprised at the rates of symptomatic intracranial hemorrhage. But remember, patient profiles vary—for example, what works for those with mild neurologic deficits might not hold true for everyone.

"The 5 primary outcomes they were looking at included vascular death, major extracranial bleeding, symptomatic intracranial hemorrhage, systemic embolism, and recurrent ischemic stroke, within 30 days of randomizing the treatment."

Fischer, U, Koga, M, Strbian, D, et al. 2023. Early versus later anticoagulation for stroke with atrial fibrillation. N Engl J Med. 26: 2411–2421. (https://doi.org/10.1056/NEJMoa2303048)

Study #2

Next, we’ll take a look at the curious case of rising hematocrit in certain chronic kidney disease patients who have anemia and were treated with SGLT-2 inhibitors. Did they have a genuine improvement in anemia or was it merely an illusion? SGLT-2 inhibitors are the focal point, and we'll dissect their multifaceted effects that may be at play here.

"Now, while the diuretic properties of SGLT-2 inhibitors could mean that this rise in hematocrit might simply be due to reduced blood volume and hemoconcentration, there's another angle to this."

Koshino, A, Schechter, M, Chertow, GM, et al. 2023. Dapagliflozin and anemia in patients with chronic kidney disease. NEJM Evid.  6. (https://doi.org/10.1056/EVIDoa2300049)

Study #3

Hospitalization due to COVID-19 has presented a conundrum regarding post-discharge thromboprophylaxis. With the pandemic making such profound impacts on global health, it's crucial to address these concerns. See how new findings align with prior observational studies, and where rivaroxaban fits into all of this.

"Clinicians don't necessarily have to jump to prescribing preventive treatments for all patients discharged after a stint in the hospital for COVID-19. However, a noteworthy exception pertains to higher-risk patients post-discharge."

Wang, TY,  Wahed, AS, Morris, A, et al. 2023. Effect of thromboprophylaxis on clinical outcomes after COVID-19 hospitalization. Ann Intern Med. 4: 515–523. (https://doi.org/10.7326/M22-3350)

Study #4

Cholesterol management remains pivotal in cardiac care. But the question our fourth study poses is this: do age differences impact the effectiveness of statins, particularly in lowering LDL cholesterol? A dive into this study could reshape perceptions on dosage recommendations for certain patient demographics.

"That approach could be particularly relevant for older folks taking them for primary prevention or those juggling multiple medications, as they have a higher risk for unexpected drug interactions."

Corn, G, Melbye, M, Hlatky, MA, et al. 2023. Association between age and low-density lipoprotein cholesterol response to statins: A Danish nationwide cohort study. Ann Intern Med. 8: 1017–1026. (https://doi.org/10.7326/M22-2643)

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