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.

Introduction: Left main coronary artery (LMCA) revascularization has been indicated when the mean luminal area (MLA) measured by intravascular ultrasound (IVUS) is 50%), calcification prevent clear measurement of LM artery media layer or any LMCA previous stents, and poor IVUS acquisition were excluded. The LMCA area measured by IVUS at the mid-shaft of the artery was investigated for correlation with patients’ height, weight, body mass index (BMI), and body surface area (BSA). Results: A total of 242 patients were included (20.2% of females with a mean age of 59.3 ± 12.1 years). The mean LMCA minimum luminal area (MLA) is 22.2 ± 5.51 mm². There is no significant difference between gender (female MLA 21.2041 mm² vs. male MLA 22.4021 mm² (P = 0.174). There is a significant correlation between LMCA area and height, with a correlation coefficient of 0.21 and P = 0.0008; by simple linear regression, there is a 1.38 mm² increase in LMCA area for every 10 cm increase in height. There is also a significant correlation between LMCA area and weight with a correlation coefficient of 0.19 and P = 0.0025; by simple linear regression, there is a 0.7 mm² increase in LMCA area for every 10 kg increase in weight. Conclusion: The diameter values of the LM in our population sample aligned with those of other populations. There was no statistically significant correlation to age, gender, BMI, or BSA. However, we discovered a weak but statistically significant correlation between height and weight. The clinical importance of the correlation needs to be further investigated in a larger population-based study.

To assess the feasibility and effectiveness of valve-in-valve caval implantation using a balloon-expandable valve after AndraStent prestenting for bioprosthetic dysfunction in challenging venous anatomy. Computed tomography showed a 34-mm inferior vena cava (IVC), exceeding available balloon-expandable valve sizes. A 39-mm Andra XXL stent was used for IVC downsizing, enabling successful implantation of a 30-mm balloon-expandable valve, with postprocedural transesophageal echocardiography confirming optimal positioning and no regurgitation. Valve-in-valve caval implantation after prior caval valve implantation is technically challenging. Accurate imaging and sizing are critical to avoid malapposition, migration, or caval injury. Landing-zone selection must preserve hepatic venous inflow. Controlled Andra XXL expansion with fluoroscopy and transesophageal echocardiography optimizes alignment, while vigilant anticoagulation and follow-up mitigate thrombosis risk. Comprehensive multimodality imaging is critical to identify prosthetic dysfunction and guide safe reintervention after prior caval valve implantation. Stent-assisted IVC downsizing can enable successful valve-in-valve caval implantation, with durable outcomes dependent on accurate sizing and precise deployment.

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.