62 research outputs found
P9 23. Seudoaneurisma aórtico con infeción de prótesis en aorta ascendente. ¿Es necesario retirar siempre la prótesis? ¿Cuánto tiempo con tratamiento antibiótico?
IntroducciónEl seudoaneurisma aórtico con infección de prótesis en aorta ascendente (PIPAA) tras cirugía cardíaca es una entidad infrecuente (0,9-2%) pero grave (mortalidad intrahospitalaria > 40%). El tratamiento más extendido es la cirugía con recambio protésico y terapia antibiótica adecuada a antibiograma; pero el recambio protésico en ocasiones es técnicamente inviable e incluso puede aumentar la mortalidad perioperatoria. Existen casos en los que se ha preservado la prótesis infectada con éxito terapéutico, realizándose limpieza/reparación quirúrgica local apoyada con omentoplastia. No existe consenso en la duración de la terapia médica, y el tratamiento «supresor a largo plazo» en ocasiones se complica por efectos adversos de los antibióticos.ObjetivosAportar dos nuevos casos y evaluar el tratamiento realizado tras un seguimiento a largo plazo.MétodoAnálisis descriptivo de aspectos microbiológicos, farmacológicos y resultados de la terapia realizada, en dos casos de PIPAA de pacientes intervenidos por disección de aorta (prótesis de dacrón en posición supracoronariana) y por insuficiencia y anuloectasia aórtica (tubo valvulado). Se realiza tratamiento quirúrgico conservador de la prótesis aórtica (limpieza quirúrgica, reparación del seudoaneurisma y omentoplastia), asociándose terapia antibiótica prolongada ajustada a antibiograma.ConclusiónAmbos casos presentan, tras más de 1 año de seguimiento, según criterios clínicos, microbiológicos y pruebas de imagen, ausencia de signos de recidiva infecciosa, resultando la terapia adecuada. Aun sin poder establecer tiempo óptimo de tratamiento, serían razonables 6 semanas de tratamiento endovenoso seguidas de 24 semanas de terapia supresora, a ser posible oral, y valorar su retirada siempre que no existan signos de recidiva
Biological behavior of familial papillary thyroid microcarcinoma: Spanish multicenter study
Purpose Familial papillary thyroid microcarcinoma (FPTMC) can present a more aggressive behavior than the sporadic microcarcinoma. However, few studies have analyzed this situation. The objective is to analyze the recurrence rate of FPTMC and the prognostic factors which determine that recurrence in Spain. Methods Spanish multicenter longitudinal analytical observational study was conducted. Patients with FPTMC received treatment with curative intent and presented cure criteria 6 months after treatment. Recurrence rate and disease-free survival (DFS) were analyzed. Two groups were analyzed: group A (no tumor recurrence) vs. group B (tumor recurrence). Results Ninety-four patients were analyzed. During a mean follow-up of 73.3 +/- 59.3 months, 13 recurrences of FPTMC (13.83%) were detected and mean DFS was 207.9 +/- 11.5 months. There were multifocality in 56%, bilateral thyroid involvement in 30%, and vascular invasion in 7.5%; that is to say, they are tumors with histological factors of poor prognosis in a high percentage of cases. The main risk factors for recurrence obtained in the multivariate analysis were the tumor size (OR: 2.574, 95% CI 1.210-5.473; p = 0.014) and the assessment of the risk of recurrence of the American Thyroid Association (ATA), both intermediate risk versus low risk (OR: 125, 95% CI 10.638-1000; p < 0.001) and high risk versus low risk (OR: 45.454, 95% CI 5.405-333.333; p < 0.001). Conclusion FPTMC has a recurrence rate higher than sporadic cases. Poor prognosis is mainly associated with the tumor size and the risk of recurrence of the ATA
Efficacy and safety of preoperative preparation with Lugol''s iodine solution in euthyroid patients with Graves’ disease (LIGRADIS Trial): Study protocol for a multicenter randomized trial
Background: Currently, both the American Thyroid Association and the European Thyroid Association recommend preoperative preparation with Lugol''s Solution (LS) for patients undergoing thyroidectomy for Graves’ Disease (GD), but their recommendations are based on low-quality evidence. The LIGRADIS trial aims to provide evidence either to support or refute the systematic use of LS in euthyroid patients undergoing thyroidectomy for GD. Methods: A multicenter randomized controlled trial will be performed. Patients =18 years of age, diagnosed with GD, treated with antithyroid drugs, euthyroid and proposed for total thyroidectomy will be eligible for inclusion. Exclusion criteria will be prior thyroid or parathyroid surgery, hyperparathyroidism that requires associated parathyroidectomy, thyroid cancer that requires adding a lymph node dissection, iodine allergy, consumption of lithium or amiodarone, medically unfit patients (ASA-IV), breastfeeding women, preoperative vocal cord palsy and planned endoscopic, video-assisted or remote access surgery. Between January 2020 and January 2022, 270 patients will be randomized for either receiving or not preoperative preparation with LS. Researchers will be blinded to treatment assignment. The primary outcome will be the rate of postoperative complications: hypoparathyroidism, recurrent laryngeal nerve injury, hematoma, surgical site infection or death. Secondary outcomes will be intraoperative events (Thyroidectomy Difficulty Scale score, blood loss, recurrent laryngeal nerve neuromonitoring signal loss), operative time, postoperative length of stay, hospital readmissions, permanent complications and adverse events associated to LS. Conclusions: There is no conclusive evidence supporting the benefits of preoperative treatment with LS in this setting. This trial aims to provide new insights into future Clinical Practice Guidelines recommendations. Trial registration: ClinicalTrials.gov identifier: NCT03980132. © 202
Conversion of biomass platform molecules into fuel additives and liquid hydrocarbon fuels
[EN] In this work some relevant processes for the preparation of liquid hydrocarbon fuels and fuel additives
from cellulose, hemicellulose and triglycerides derived platform molecules are discussed. Thus, it is
shown that a series of platform molecules such as levulinic acid, furans, fatty acids and polyols can be
converted into a variety of fuel additives through catalytic transformations that include reduction, esterification,
etherification, and acetalization reactions. Moreover, we will show that liquid hydrocarbon fuels
can be obtained by combining oxygen removal processes (e.g. dehydration, hydrogenolysis, hydrogenation,
decarbonylation/descarboxylation etc.) with the adjustment of the molecular weight via C C coupling
reactions (e.g. aldol condensation, hydroxyalkylation, oligomerization, ketonization) of the reactive
platform molecules.This work has been supported by the Spanish Government-MINECO through Consolider Ingenio 2010-Multicat and CTQ.-2011-27550, ITQ thanks the "Program Severo Ochoa" for financial support.Climent Olmedo, MJ.; Corma Canós, A.; Iborra Chornet, S. (2014). Conversion of biomass platform molecules into fuel additives and liquid hydrocarbon fuels. Green Chemistry. 16(2):516-547. https://doi.org/10.1039/c3gc41492bS51654716
Estimating a threshold price for CO2 emissions of buildings to improve their energy performance level. Case study of a new Spanish home
Energy consumption in homes produces CO2. In many countries, building regulations are being set to enable energy efficiency performance levels to be issued. In Spain, there is a regulated procedure to certify the energy performance of buildings according to their CO2 emissions. Consequently, some software tools have been design to simulate buildings and to obtain their energy consumption and CO2 emissions. In this paper the investment, maintenance and energy consumption costs are calculated for different energy performance levels and for various climatic zones, in a single-family home. According to the results, more energy efficient buildings imply higher construction and maintenance costs, which are not compensated by lower energy costs. Therefore, under current conditions, economic criteria do not support the improvement of the energy efficiency of a dwelling. Among the possible measures to promote energy efficiency, a price on CO2 emissions is to be suggested, including the social cost in the analysis. For this purpose, the cost-optimal methodology is used. In different scenarios for the discount rate y energy prices, various prices for CO2 are obtained, depending on the climatic zone and energy performance level.Ruá Aguilar, MJ.; Guadalajara Olmeda, MN. (2015). Estimating a threshold price for CO2 emissions of buildings to improve their energy performance level. Case study of a new Spanish home. Energy Efficiency. 8(2):183-203. doi:10.1007/s12053-014-9286-2S18320382AICIA. (2009). Escala de calificación energética. Edificios de nueva construcción. Madrid: Instituto para la Diversificación y Ahorro de la Energía, Ministerio de Industria, Turismo y Comercio.Al-Homoud, M. S. (2005). Performance characteristics and practical applications of common building thermal insulation materials. Building and Environment, 40(3), 353–360.Amecke, H. (2012). The impact of energy performances certificates: a survey of German home owners. Energy Policy, 46, 4–14.Andaloro, A., Salomone, R., Ioppolo, G., & Andaloro, L. (2010). Energy certification of buildings: a comparative analysis of progress towards implementation in European countries. Energy Policy, 38(10), 5840–5866.Annunziata, E., Frey, M., & Rizzi, F. (2013). Towards nearly zero-energy buildings: the state-of-art of national regulations in Europe. Energy, 57, 125–133. doi: 10.1016/j.energy.2012.11.049 .Audenaert, A., De Boeck, L., & Roelants, K. (2010). Economic analysis of the profitability of energy-saving architectural measures for the achievement of the EPBD-standard. Energy, 35(7), 2965–2971.Bertrán, A. (2009). Las mediciones en las obras adaptadas al CTE (4th ed.). Granada: Editorial Jorge Loring S.I.Brathal, D., & Langemo, M. (2004). Facilities management: a guide for total workplace design and management. Grand Forks: Knight Printing.Brown, D. W. (1996). Facility maintenance: the manager’s practical guide and handbook. New York: AMACOM American Management Association. New York, NY 10019.Concerted Action EPBD (2008). Implementation of the energy performance of buildings directive. Country reports 2008. Brussels: Directorate General for Energy and Transport, European Commission (available at www.epbd.ca.eu and www.buildup.eu ).Concerted Action EPBD (2011). Implementing the energy performance of buildings directive. Country reports 2011. Brussels: European Union (available at www.epbd.ca.eu and www.buildup.eu ).Davies, H., & Wyatt, D. (2004). Appropriate use or method for durability and service life prediction. Building Research and Information, 32(6), 552–553.Dresner, S., & Ekins, P. (2006). Economic instruments to improve UK home energy efficiency without negative social impacts. Fiscal Studies, 27(1), 47–74.Drury, C. (2008). Management and cost accounting, 7th ed. London.Eurostat European Comission, Instituto de Diversificación y Ahorro de Energía (IDAE), Ministerio de Industria, Energía y Turismo (2011). Proyecto SECH-SPAHOUSEC. Análisis del consumo energético del sector residencial en España. Informe Final. Madrid.Fraunhofer Institute for Systems and Innovation Research ISI (Germany) (2012). Financing the energy efficient transformation of the building sector in the EU. Lessons from the ODYSSEE-MURE project.Garrido, N., Almecija, J. C., Folch, C., Martínez, I. (2011). Certificación energética de edificios. Grupo de Estudios de Energía para la Sostenibilidad (CEES). Cátedra Unesco Sostenibilidad, Universitat Politècnica de Catalunya. (Available at: upcommons.upc.edu/e-prints/bitstream/2117/11820/1/GAS Natural_090406.pdf).Gómez, J. M., & Esteban, M. A. (2010). Sostenibilidad en la edificación. Comparación de dos tipologías constructivas. Rendimiento de los recursos. Ingeniería de Edificación Universitat Politècnica de Catalunya. (Available at: upcommons.upc.edu/pfc/bitstream/2099.1/…/1/PFG_Completo.pdf).Gram-Hanssen, K., Bartiaux, F., Michael Jensen, O., & Cantaert, M. (2007). Do homeowners use energy labels? A comparison between Denmark and Belgium. Energy Policy, 35(5), 2879–2888.Institut de Tecnologia de la Construcció de Catalunya (ITEC) (1991a). Manual de uso y conservación de la vivienda. COAAT Principado de Asturias. Simancas Ediciones S.A. Valladolid.Institut de Tecnologia de la Construcció de Catalunya (ITEC). (1991b). Manteniment de l’edifici. Fitxes (1st ed.). Badalona: Gràfiques Pacífic.Institut de Tecnologia de la Construcció de Catalunya (ITEC). (1991c). Manteniment instal.lacions. Fitxes (1st ed.). Badalona: Gràfiques Pacífic.Institut de Tecnologia de la Construcció de Catalunya (ITEC). (1991d). Manteniment urbanització. Fitxes (1st ed.). Badalona: Gràfiques Pacífic.Institut de Tecnologia de la Construcció de Catalunya (ITEC). (1994). L’actualitat i el cost del manteniment en edificis d’habitatge. Guia pràctic (1st ed.). Barcelona: Gama S.L. Servicios editoriales.Institut de Tecnologia de la Construcció de Catalunya (ITEC). (1996). Ús i manteniment de l’habitatge. Quadern de l’usuari (1st ed.). Zaragoza: Gràfiques Cometa.Institut de Tecnologia de la Construcció de Catalunya (ITEC) (1997). La vivienda: Manual de uso y mantenimient, COAAT de Cantabria. 1ª ed.Institut de Tecnologia de la Construcció de Catalunya (ITEC) (1999). La vivienda: Manual de uso y mantenimiento, COAAT Principado de Asturias. 2ª ed. Simancas Edicionas S.A. Valladolid.Instituto de Diversificación y Ahorro de Energía (IDAE), Ministerio de Industria, Turismo y Comercio (MITYC) (2010). Guía Técnica: Condiciones climáticas exteriores de proyecto, (available at: http://www.minetur.gob.es/energia/desarrollo/eficienciaenergetica/rite/reconocidos/reconocidos/condicionesclimaticas.pdf ).Instituto Eduardo Torroja de Ciencias de la Construcción (IETCC) (2010). Catálogo de Elementos Constructivos del Código Técnico, versión CAT-EC-v06.3-MARZO10. Madrid.Jáber-López, J. T., Valencia-Salazar, I., Peñalvo-López, E., Álvarez-Bel, C., Rivera-López, R., Merino-Hernández, E. (2011). Are energy certification tools for buildings effective? A Spanish case study, Proceedings of the 2011 3rd International Youth Conference on Energetics. Leiria, July 7–9.Johnstone, I. M. (2001a). Energy and mass flows of housing: a model and example. Building and Environment, 36, 27–41.Johnstone, I. M. (2001b). Energy and mass flows of housing: estimating mortality. Building and Environment, 36, 43–51.Kaiser, H. H. (2001). The facilities audit. A process for improving facilities conditions. Arlington: Kirby Lithographic. APPA. The Association of Higher Education Facilities Officers.Kjaerbye, V. H. (2008). Does energy label on residential housing cause energy savings? AKF, Danish Institute of Governmental Research.La Roche, P. (2010). Calculating green house emissions for houses: analysis of the performance of several carbon counting tools in different climates. Informes de la Construcción, 62(517), 61–80.Larsen, B. M., & Nebakken, R. (1997). Norwegian emissions of CO2 1987–1994. Environmental and Resource Economics, 9, 275–290.Laustsen, J. (2008). Energy efficiency requirements in building codes, energy efficiency policies for new buildings. Paris: International Energy Agency information paper.Linares, P., & Labandeira, X. (2010). Energy efficiency: economics and policy. Journal of Economic Surveys, 24(3), 573–592.Liska, R. W. (2000). Means facilities maintenance standards. Kingston: R.S. Means Company, Inc. Construction Publishers & Consultants.Majcen, D., Itard, H., & Visscher, H. (2013). Theoretical vs. actual energy consumption of labelled dwellings in the Netherlands: discrepancies and policy implications. Energy Policy, 54, 125–136.Mercader, M. P., Olivares, M., & Ramírez de Arellano, A. (2012). Modelo de cuantificación del consumo energético en edificación. Informes de la Construcción, 62(308), 567–582.Ministry of Development of Spain. Directorate for Architecture, Housing and Planning. Report on cost optimal calculations and comparison with the current and future energy performance requirements of buildings in Spain. Version 1.1, 7th June 2013.Pérez-Lombard, L., Ortiz, J., & González, R. (2009). A review of benmarching, rating and labelling concepts within the framework of building energy certification schemes. Energy and Buildings, 41(3), 272–278.Piper, J. E. (1995). Handbook of facility management: tools and techniques, formulas and tables. Upper Saddle River: Prentice Hall Inc.Popescu, D., Bienert, S., Schützenhofer, C., & Boazu, R. (2012). Impact of energy efficiency measures on the economic value of buildings. Applied Energy, 89(1), 454–463.Ramírez de Arellano, A. (2004). Presupuestación de obras. 3ª ed. Universidad de Sevilla. Secretariado de Publicaciones. Colección Manuales Universitarios, 37.Rodríguez-González, A. B., Vinagre-Díaz, J. J., Caañamo, A. J., & Wilby, M. R. (2011). Energy and buildings, 43(4), 980–987.Ruá, M. J., & Guadalajara, N. (2013). Application of compromise programming to a semi-detached housing development in order to balance economic and environmental criteria. Journal of the Operational Research Society, 64, 459–468.Ruá, M. J., & Guadalajara, N. (2014). Using the building energy rating software for mathematically modelling operation costs in a simulated home. International Journal of Computer Mathematics. doi: 10.1080/00207160.2014.892588 .Ruá, M. J., & López-Mesa, B. (2012). Certificación energética de edificios en España y sus implicaciones económicas. Informes de la Construcción, 64(527), 307–318.Rudbeck, C. (2002). Service life of building envelope components: making it operational in economical assessment. Construction and Building Materials, 16(2), 83–89.Ruiz, M. C., & Romero, E. (2011). Energy saving in the conventional design of a Spanish house using thermal simulation. Energy and Building, 43(11), 3226–3235.Sanstad, A. H., Blumstein, C., & Stoff, S. E. (1995). How high are option values in energy-efficiency investments? Energy Policy, 23(9), 739–743.Sumner, J., Bird, L., Smith, H. (2009). Carbon taxes: a review of experience and policy design consideration. Technical Report NREL/TP-6A2-47312. National Renewable Energy Laboratory. US Department of Energy.Tuominen, P., Forsström, J., & Honkatukia, J. (2013). Economic effects of energy efficiency improvements in the Finnish building stock. Energy Policy, 52, 181–189.Ucar, A., & Balo, F. (2009). Effect of fuel type on the optimum thickness of selected insulation materials for the four different climatic regions of Turkey. Applied Energy, 86(5), 730–736.Universidad Politécnica De Madrid. Departamento de Construcción y Vías Rurales (2009). Evaluación de los costes constructivos y consumos energéticos derivados de la calificación energética de viviendas. Precost&E. Fase1.Uzsilaityte, L., & Martinaitis, V. (2010). Search for optimal solution of public building renovation in terms of life cycle. Journal of Environmental Engineering and Landscape Management, 18(2), 102–110.Verbruggen, A. (2012). Financial appraisal of efficiency investments: why the good may be the worst enemy of the best. Energy Efficiency, 5, 571–582
SARS-CoV-2 susceptibility and COVID-19 disease severity are associated with genetic variants affecting gene expression in a variety of tissues
Variability in SARS-CoV-2 susceptibility and COVID-19 disease severity between individuals is partly due to genetic factors. Here, we identify 4 genomic loci with suggestive associations for SARS-CoV-2 susceptibility and 19 for COVID-19 disease severity. Four of these 23 loci likely have an ethnicity-specific component. Genome-wide association study (GWAS) signals in 11 loci colocalize with expression quantitative trait loci (eQTLs) associated with the expression of 20 genes in 62 tissues/cell types (range: 1:43 tissues/gene), including lung, brain, heart, muscle, and skin as well as the digestive system and immune system. We perform genetic fine mapping to compute 99% credible SNP sets, which identify 10 GWAS loci that have eight or fewer SNPs in the credible set, including three loci with one single likely causal SNP. Our study suggests that the diverse symptoms and disease severity of COVID-19 observed between individuals is associated with variants across the genome, affecting gene expression levels in a wide variety of tissue types
Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice: GLORIA-AF Registry
Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice: GLORIA-AF Registry
Background and purpose: Prospectively collected data comparing the safety and effectiveness of individual non-vitamin K antagonists (NOACs) are lacking. Our objective was to directly compare the effectiveness and safety of NOACs in patients with newly diagnosed atrial fibrillation (AF). Methods: In GLORIA-AF, a large, prospective, global registry program, consecutive patients with newly diagnosed AF were followed for 3 years. The comparative analyses for (1) dabigatran vs rivaroxaban or apixaban and (2) rivaroxaban vs apixaban were performed on propensity score (PS)-matched patient sets. Proportional hazards regression was used to estimate hazard ratios (HRs) for outcomes of interest. Results: The GLORIA-AF Phase III registry enrolled 21,300 patients between January 2014 and December 2016. Of these, 3839 were prescribed dabigatran, 4015 rivaroxaban and 4505 apixaban, with median ages of 71.0, 71.0, and 73.0 years, respectively. In the PS-matched set, the adjusted HRs and 95% confidence intervals (CIs) for dabigatran vs rivaroxaban were, for stroke: 1.27 (0.79–2.03), major bleeding 0.59 (0.40–0.88), myocardial infarction 0.68 (0.40–1.16), and all-cause death 0.86 (0.67–1.10). For the comparison of dabigatran vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 1.16 (0.76–1.78), myocardial infarction 0.84 (0.48–1.46), major bleeding 0.98 (0.63–1.52) and all-cause death 1.01 (0.79–1.29). For the comparison of rivaroxaban vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 0.78 (0.52–1.19), myocardial infarction 0.96 (0.63–1.45), major bleeding 1.54 (1.14–2.08), and all-cause death 0.97 (0.80–1.19). Conclusions: Patients treated with dabigatran had a 41% lower risk of major bleeding compared with rivaroxaban, but similar risks of stroke, MI, and death. Relative to apixaban, patients treated with dabigatran had similar risks of stroke, major bleeding, MI, and death. Rivaroxaban relative to apixaban had increased risk for major bleeding, but similar risks for stroke, MI, and death. Registration: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01468701, NCT01671007. Date of registration: September 2013
Whole-genome sequencing reveals host factors underlying critical COVID-19
Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2–4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease
Anticoagulant selection in relation to the SAMe-TT2R2 score in patients with atrial fibrillation. the GLORIA-AF registry
Aim: The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores >2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores >2 than to patients with lower scores. Methods and results: We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ≥1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score >2 and ≤ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores >2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores >2 and 27.5% in those with scores ≤2. Conclusions: The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial. Clinical trial registration: URL: https://www.clinicaltrials.gov//Unique identifier: NCT01937377, NCT01468701, and NCT01671007
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