Distribution of patterns of healthcare provider selection: stratified by residence area and income level.

<p>Distribution of patterns of healthcare provider selection: stratified by residence area and income level.</p

Mortality rate among patterns of healthcare provider selection stratified by residence area and income level.

<p>Mortality rate among patterns of healthcare provider selection stratified by residence area and income level.</p

Preferences of patients’ selection.

<p>Preferences of patients’ selection.</p

Descriptive Analysis.

<p>Descriptive Analysis.</p

Travelling distance to different level of provider performance: stratified by residence area and income level.

<p>Travelling distance to different level of provider performance: stratified by residence area and income level.</p

Results of Multilevel Analysis: Mediation Effect Examination.

<p>Results of Multilevel Analysis: Mediation Effect Examination.</p

Risk of Bleeding and Stroke with Oral Anticoagulation and Antiplatelet Therapy in Patients with Atrial Fibrillation in Taiwan: A Nationwide Cohort Study

<div><p>Background</p><p>Data on the use of oral anticoagulation (OAC) and antiplatelet therapy and the risk of bleeding and stroke amongst Asian patients with atrial fibrillation (AF) are limited. We investigated the risks of bleeding and stroke with use of oral anticoagulation (OAC) and antiplatelet therapy as mono- or combination therapy, in patients with AF from a Chinese nationwide cohort study.</p><p>Methods</p><p>We studied a cohort of 10384 patients (57.2% men, age 67.8 ± 13.2 yrs) between 1999 and 2010 from the National Health Insurance Research Database in Taiwan. Records of prescriptions were obtained during follow-up. The main outcome was a recurrent stroke during the follow-up period. Time-dependent Cox proportional hazards models were used for this analysis.</p><p>Results</p><p>We documented 1009 events for bleeding, as well as 224 hemorrhagic stroke and 1642 ischemic stroke events during a median 3.2 (interquartile range, 1.05-6.54) years’ follow-up. Compared with warfarin users, patients with antiplatelet therapy had a lower risk of bleeding (adjusted relative risk [RR], 0.59, 95% confidence interval [CI], 0.49-0.71, p<0.001) whilst combination therapy had a non-statistically significant higher bleeding risk (RR, 1.33, 95%, 0.91-1.94, p = 0.20). Patients on antiplatelet monotherapy had a similar risk for ischemic stroke compared with OAC (RR 1.05, 95% CI, 0.89-1.25, p = 0.50), whilst those on combination therapy had a significantly higher risk (RR 1.90, 95% CI, 1.34-2.70, p<0.001).</p><p>Conclusion</p><p>In a national representative cohort, antiplatelet therapy had no significant difference in ischemic stroke risk to warfarin. For bleeding, aspirin had a lower risk compared to warfarin. This may reflect poor anticoagulation control, highlighting important missed opportunities for improved stroke prevention, especially in countries where anticoagulation management is suboptimal.</p></div

Common pathology of the long head biceps tendons associated with rotator cuff tears: (A) biceps tendinopathy (B) biceps tendon medial subluxation (C) biceps tendon dislocation and (D) biceps tendon tear with an empty bicipital groove.

<p>Common pathology of the long head biceps tendons associated with rotator cuff tears: (A) biceps tendinopathy (B) biceps tendon medial subluxation (C) biceps tendon dislocation and (D) biceps tendon tear with an empty bicipital groove.</p

Relative risks for the risk of bleeding (A), hemorrhagic stroke (B), and ischemic stroke (C), associated with the use of warfarin, aspirin, clopidogrel, and combinations of these drugs in the study patients.

<p>CI indicates confidence interval.</p

Study cohort and comorbidities at 2 years before index AF.

<p>a: Comorbidities(Acute MI, Ischemic heart ^b Heart failure ^c, Hypertension, Ischemic stroke, Diabetes, Liver disease, Renal failure, Malignancy, Bleeding, Gastrointestinal bleeding ^d, Gastrointestinal bleeding ^e, Intracranial bleeding, Urinary tract bleeding and Airway bleeding) were defined before index AF (including index admission date) were defined 2 years before index AF (including index admission date).</p><p>b: Ischemic heart disease was defined as having treatments of treadmill exercise and coronary angioplasty, or nuclear medicine image and coronary angioplasty.</p><p>c: Included hospitalized patients only.</p><p>d: Gastrointestinal bleeding was defined as having operations of panendoscopy.</p><p>e: Non-specific type of operations on gastrointestinal bleeding.</p><p>f: Previous antithrombotic treatment was defined 90 days before index AF (including index admission date).</p><p>Study cohort and comorbidities at 2 years before index AF.</p