Background/Objectives: The use of direct oral anticoagulants (DOACs) in obese patients is scarcely studied despite having many advantages over warfarin. Consequently, this study aims to assess the real-world safety and effectiveness of apixaban compared to warfarin in treating atrial fibrillation (AF) in obese patients. Methods: A retrospective cohort study examined consecutive AF patients with a BMI of ≥ 30 kg/m² treated with apixaban or warfarin. Patients were started on these medications between January 2015 and December 2021. Efficacy outcomes included ischemic stroke and venous thromboembolism (VTE) occurrences, while safety outcomes encompassed bleeding incidents and mortality rates. Outcomes were assessed following propensity score matching. Results: We identified 876 patients treated with either apixaban (414) or warfarin (462). Their mean age was 76.9, with a mean CHA₂DS₂VASc score of 4.9 ± 1.97. After matching and compared to warfarin, apixaban was correlated with a lower incidence of all-cause mortality (19.7% vs. 33.7%, p < 0.001). The incidences of stroke, venous thromboembolism (VTE), and bleeding events were (4.7% vs. 4.7%, p = 1.000), (1.0% vs. 2.6%, p = 0.107), and (3.9% vs. 6.2%, p = 0.139), respectively. Using Cox-regression model, apixaban was associated with lower mortality risk (HR = 0.728, 95% CI: 0.55–0.97; p = 0.030) which remained significant after adjusting for the conventional cardiovascular risk factors and BMI values. Conclusions: Apixaban is associated with a trend of reduced incidence of thromboembolism among obese patients with atrial fibrillation and significantly lowers all-cause mortality. Despite earlier concerns, the use of apixaban is an effective and safe alternative to warfarin among obese patients with AF.

(1) Background: Home health care (HHC) services guarantee good patient care and family support. Understanding how we can better help our informal caregivers (ICs) by understanding their needs and the burden they experience is crucial. (2) Methods: A cross-sectional study was conducted from June to September 2024 at an HHC facility in Riyadh, Saudi Arabia. The 22-item Zarit Burden Interview (ZBI-22) was used to assess the caregiver burden (CB). ICs of patients with specific diseases (palliative, cancer, chronic, and dementia patients) and other factors were studied to identify any association with informal caregiver burden (ICB). (3) Results: Significant CB was defined as ZBI ≥ 21. The IC (384) participants comprised 119 caregivers of dementia patients, 104 caregivers of chronic patients, 83 caregivers of palliative patients, and 78 caregivers of cancer patients. The total mean of the ZBI-22 score among ICs was 31.66, representing a significant CB. The means by groups were as follows: chronic patients, 38.28; dementia patients, 34.97; cancer patients, 25.21; and palliative patients, 22.94. Other variables, such as the duration of care, education level, relationship with the patient, and unemployment, were associated with CB (p-value < 0.05). (4) Conclusions: The caregivers’ characteristics and the patients’ disease were associated with significant CB. More interventions from healthcare workers to support ICs are essential to release their burden.

OBJECTIVES: To evaluate the safety and efficacy of an early chest tube removal protocol in reducing tube duration without increasing complications following pediatric cardiac surgery. DESIGN: A single-center, randomized controlled trial. SETTING: Pediatric cardiac ICU. PATIENTS: Two hundred fifteen pediatric patients with chest tubes after cardiac surgery. INTERVENTIONS: Patients were randomized to early removal (drainage threshold < 6 mL/kg over 8 hr) or late removal (24-hr assessment) groups. Primary outcomes included chest tube duration, whereas secondary outcomes encompassed ICU stay, ventilation time, hospital stay, and complication rates. MEASUREMENTS AND MAIN RESULTS: Median chest tube duration was significantly shorter in the early removal group (3 d) compared with the late removal group (4.9 d; p < 0.0001). Rates of fluid reaccumulation and pneumothorax were low and comparable between groups. Notably, no patients in either group required tube reinsertion. ICU and total hospital stay durations were similar across groups. CONCLUSIONS: An early chest tube removal protocol following pediatric cardiac surgery suggests a reduction in chest tube duration without increasing the risk of complications. These findings support the adoption of an evidence-based early removal approach to enhance patient comfort and optimize ICU resource utilization in pediatric cardiac surgery patients.

Background/Objectives: The use of direct oral anticoagulants (DOACs) in obese patients is scarcely studied despite having many advantages over warfarin. Consequently, this study aims to assess the real‐world safety and effectiveness of DOACs compared to warfarin in treating atrial fibrillation (AF) and venous thromboembolism (VTE) in obese patients. Methods: A brief description of the main methods or treatments applied. This can include any relevant preregistration or specimen information. Results: We identified 959 patients treated with either a direct oral anticoagulant (DOAC) (519) or warfarin (440). Their average age was 76, with a mean CHA2DS2‐VASc score of 4.9 ± 1.97. Compared to warfarin, DOAC therapy was correlated with a lower incidence of all‐cause mortality (21.2% vs. 32.9%, p<0.001). The incidence of stroke (4.0% vs. 4.9%, p=0.507), venous thromboembolism (VTE) (1.9% vs. 3.1%, p=0.269), and a trend to lower bleeding events (4.2% vs. 6.8%, p=0.099). Even when adjusting for additional risk factors, there is a trend to a lower risk of mortality associated with DOAC usage compared to warfarin, though the adjusted hazard ratio was statistically insignificant (0.780; 95% CI = 0.60 to 1.02; p=0.069). Conclusions: Compared to warfarin, the efficacy of DOAC therapy was similar, while its safety wasoutstanding in obese patients with non‐valvular AF or VTE. Therefore, considering DOACs as analternative to warfarin in obese patients would be logical.

(1) Background: Home health care (HHC) services guarantee good patient care and family support. Understanding how we can better help our informal caregivers (IC) by understanding their needs and the burden they experience is crucial; (2) Methods: A cross-sectional study was conducted from June to September 2024 at (HHC) facility in Riyadh, Saudi Arabia. The 22-item Zarit Burden Interview (ZBI-22) was used to assess the caregiver burden (CB). IC from patients with specific diseases (palliative, cancer, chronic, and dementia) and other factors were studied to identify any association with informal caregiver burden (ICB); (3) Results: Significant CB was defined as ZBI ≥ 21. Total IC (384) participants: 119 (dementia) patients, 104 (chronic), 83 (palliative) and 78 (cancer). The total mean of the ZBI-22 score among IC was 31.66, representing a significant CB. The mean by groups was chronic (38.28), dementia (34.97), cancer (25.21), and palliative patients (22.94). Other variables, such as the duration of care, education level, relationship with the patient, and unemployment, were associated with CB (p-value < 0.05); (4) Conclusions: The caregivers' characteristics and the patient’s disease were associated with significant CB. More interventions from healthcare workers to support the IC are essential to release their burden.