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Gerardo Casucci
Unit of Internal Medicine, San Francesco Hospital, Viale Europa 21, 82037 Telese Terme, Italy

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Review
Published: 29 June 2021 in Journal of Clinical Medicine
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Diabetes mellitus (DM) represents an independent risk factor for chronic AF and is associated with unfavorable outcomes. We aimed to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF), with and without diabetes mellitus (DM), using a new risk index (RI) defined as: RI =Rate of EventsRate of Patients at Risk. In particular, an RI lower than 1 suggests a favorable treatment effect. We searched MEDLINE, MEDLINE In-Process, EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials. The risk index (RI) was calculated in terms of efficacy (rate of stroke/systemic embolism (stroke SEE)/rate of patients with and without DM; rate of cardiovascular death/rate of patients with and without DM) and safety (rate of major bleeding/rate of patients with and without DM) outcomes. AF patients with DM (n = 22,057) and 49,596 without DM were considered from pivotal trials. DM doubles the risk index for stroke/SEE, major bleeding (MB), and cardiovascular (CV) death. The RI for stroke/SEE, MB, and CV death was comparable in patients treated with warfarin or DOACs. The lowest RI was in DM patients treated with Rivaroxaban (stroke/SEE, RI = 0.08; CV death, RI = 0.13). The RIs for bleeding were higher in DM patients treated with Dabigatran (RI110 = 0.32; RI150 = 0.40). Our study is the first to use RI to homogenize the efficacy and safety data reported in the DOACs pivotal studies against warfarin in patients with and without DM. Anticoagulation therapy is effective and safe in DM patients. DOACs appear to have a better efficacy and safety profile than warfarin. The use of DOACs is a reasonable alternative to vitamin-K antagonists in AF patients with DM. The RI can be a reasonable tool to help clinicians choose between DOACs or warfarin in the peculiar set of AF patients with DM.

ACS Style

Domenico Acanfora; Marco Ciccone; Valentina Carlomagno; Pietro Scicchitano; Chiara Acanfora; Alessandro Bortone; Massimo Uguccioni; Gerardo Casucci. A Systematic Review of the Efficacy and Safety of Direct Oral Anticoagulants in Atrial Fibrillation Patients with Diabetes Using a Risk Index. Journal of Clinical Medicine 2021, 10, 2924 .

AMA Style

Domenico Acanfora, Marco Ciccone, Valentina Carlomagno, Pietro Scicchitano, Chiara Acanfora, Alessandro Bortone, Massimo Uguccioni, Gerardo Casucci. A Systematic Review of the Efficacy and Safety of Direct Oral Anticoagulants in Atrial Fibrillation Patients with Diabetes Using a Risk Index. Journal of Clinical Medicine. 2021; 10 (13):2924.

Chicago/Turabian Style

Domenico Acanfora; Marco Ciccone; Valentina Carlomagno; Pietro Scicchitano; Chiara Acanfora; Alessandro Bortone; Massimo Uguccioni; Gerardo Casucci. 2021. "A Systematic Review of the Efficacy and Safety of Direct Oral Anticoagulants in Atrial Fibrillation Patients with Diabetes Using a Risk Index." Journal of Clinical Medicine 10, no. 13: 2924.

Case report
Published: 01 June 2021 in Viruses
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In recent weeks, adverse reactions have been reported after administration of Oxford–AstraZeneca chimpanzee adenovirus vectored vaccine ChAdOx1 nCoV-19 (AZD1222), in particular thrombus formation, which has led several European Countries to discontinue administration of this vaccine. On March 8, 2021, the European Medicines Agency Safety Committee did not confirm this probable association. We report the case of a patient who developed disseminated intravascular coagulation after the first dose of Oxford-Astra Zeneca vaccine, which resolved in a few days with the administration of dexamethasone and enoxaparin. This work demonstrates the safety of the Oxford-Astra Zeneca vaccine and that any development of side effects can be easily managed with a prompt diagnosis and in a short time with a few commonly used drugs.

ACS Style

Gerardo Casucci; Domenico Acanfora. DIC-Like Syndrome Following Administration of ChAdOx1 nCov-19 Vaccination. Viruses 2021, 13, 1046 .

AMA Style

Gerardo Casucci, Domenico Acanfora. DIC-Like Syndrome Following Administration of ChAdOx1 nCov-19 Vaccination. Viruses. 2021; 13 (6):1046.

Chicago/Turabian Style

Gerardo Casucci; Domenico Acanfora. 2021. "DIC-Like Syndrome Following Administration of ChAdOx1 nCov-19 Vaccination." Viruses 13, no. 6: 1046.