BACKGROUND It is unknown whether warfarin or aspirin therapy is superior for patients with heart failure who are in sinus rhythm. METHODS We designed this trial to determine whether warfarin (with a target international normalized ratio of 2.0 to 3.5) or aspirin (at a dose of 325 mg per day) is a better treatment for patients in sinus rhythm who have a reduced left ventricular ejection fraction (LVEF). We followed 2305 patients for up to 6 years (mean [±SD], 3.5±1.8). The primary outcome was the time to the first event in a composite end point of ischemic stroke, intracerebral hemorrhage, or death from any cause. RESULTS The rates of the primary outcome were 7.47 events per 100 patient-years in the warfarin group and 7.93 in the aspirin group (hazard ratio with warfarin, 0.93; 95% confidence interval [CI], 0.79 to 1.10; P = 0.40). Thus, there was no significant overall difference between the two treatments. In a time-varying analysis, the hazard ratio changed over time, slightly favoring warfarin over aspirin by the fourth year of follow-up, but this finding was only marginally significant (P = 0.046). Warfarin, as compared with aspirin, was associated with a significant reduction in the rate of ischemic stroke throughout the follow-up period (0.72 events per 100 patient-years vs. 1.36 per 100 patient-years; hazard ratio, 0.52; 95% CI, 0.33 to 0.82; P = 0.005). The rate of major hemorrhage was 1.78 events per 100 patient-years in the warfarin group as compared with 0.87 in the aspirin group (P<0.001). The rates of intracerebral and intracranial hemorrhage did not differ significantly between the two treatment groups (0.27 events per 100 patient-years with warfarin and 0.22 with aspirin, P = 0.82). CONCLUSIONS Among patients with reduced LVEF who were in sinus rhythm, there was no significant overall difference in the primary outcome between treatment with warfarin and treatment with aspirin. A reduced risk of ischemic stroke with warfarin was offset by an increased risk of major hemorrhage. The choice between warfarin and aspirin should be individualized.

BackgroundDengue fever, a major public health problem throughout tropical and subtropical regions, has often unpredictable clinical evolution and outcomes. Thrombocytopenia is a common laboratory finding in dengue fever and severe dengue during the dengue critical phase. To the best of our knowledge, there is no clinical data about patient and disease factors that could predict in a short time the platelet recovery. Mean platelet volume (MPV), a measurement of platelet size, has a strong inverse correlation with platelet count and could indirectly reflect bone marrow activity. The aim of this study was to describe the behavior of MPV during the platelet count nadir and recovery.MethodsAn observational prospective study was conducted. We included patients with confirmed dengue virus infection with SD BIOLINE Dengue Duo kit (Abbott, Santa Clara, USA; former Alere Inc., Waltham, USA) attended at Fundación Valle del Lili, Cali - Colombia. Blood count was analyzed by xn-3000 system impedance method (Sysmex, Kobe, Japan). Laboratory and clinical data were recollected from clinical charts and clinical laboratory database. Platelet count (PC) and MPV were measured repeatedly during clinical management. Time was measured from the first blood count. A non-parametric analysis with a cubic smoothing spline was performed for platelet count and MPV.ResultsA total of 54 patients were analyzed from April 2016 to January 2016. 50% of patients had at least three blood counts. The median of the lowest PC was 112,500/L (IQR = 67,000–148,500), and the median of the highest MPV was 11. 25 fL (IQR = 10. 42–12. 15). MPV increased from the first blood count until day six, while platelets presented slight fluctuations. On the sixth day after first blood count, MPV presented a high peak that suggests an inverse relationship with a platelets decrease (Figure 1).ConclusionMPV increased with thrombocytopenia during the critical period and its decline precedes platelet count recovery. MPV could be useful to predict the platelet count recovery. Disclosures All authors: No reported disclosures.

Background: COVID-19 is a global disease caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Patients with a severe or critical illness can develop respiratory and cardiovascular complications. This study aimed to describe a Latin American and Caribbean (LA&C) population with COVID-19 to provide information related to this disease, in-hospital cardiovascular complications and in-hospital mortality. Methods: The CARDIO COVID-19-20 Registry is an observational, multicenter, ambispective, and hospital-based registry of patients with confirmed COVID-19 infection that required in-hospital treatment in LAC. Enrollment of patients started on May 01, 2020, and ended on June 30, 2021. Results: The CARDIO COVID-19-20 Registry included 3260 patients from 44 institutions of 14 LA&C countries. 63.2% patients were male and median age was 61.0 years old. Most common comorbidities were overweight/obesity (49.7%), hypertension (49.0%), and diabetes mellitus (26.7%). Most frequent cardiovascular complications were cardiac arrhythmia (9.1%), decompensated heart failure (8.5%), and pulmonary embolism (3.9%). 53.5% of patients were admitted to Intensive Care Unit (ICU), and median length of stay at the ICU was 10.0 days. Support required in ICU included invasive mechanical ventilation (34.2%), vasopressors (27.6%), inotropics (10.3%) and vasodilators (3.7%). Rehospitalization after 30-day post discharge was 7.3%. In-hospital mortality and 30-day post discharge was 25.5% and 2.6%, respectively. Conclusions: The LA&C population with COVID-19 patients and hospitalization, has a considerable burden of cardiovascular diseases related to a worse prognosis. It is necessary to carry out a more specific analysis to determine risk factors for cardiovascular outcome.

Las oclusiones coronarias crónicas se asocian con un impacto negativo en el pronóstico a largo plazo. Objetivos: Conocer si existe diferencia en los eventos cardiovasculares mayores en pacientes sometidos a revascularización exitosa vs revascularización fallida de lesiones de oclusión total crónica en angina estable. Material y métodos: Estudio correlacional, transversal, con dos grupos independientes. Resultados: Se evaluaron 71 pacientes, en un contexto de angina crónica estable, en la Unidad Médica de Alta Especialidad del Bajío, del periodo de enero de 2013 a febrero de 2020, se obtuvieron 41 pacientes con revascularización exitosa (RE) y 30 con revascularización fallida (RF). La tasa de éxito de revascularización fue de 57.7%. La tasa de eventos cardiovasculares mayores encontrados entre pacientes con RE vs RF en este estudio fueron: eventos de angina inestable postrevascularización en 12.5% del grupo RE y en 13.3% del grupo RF (p = 0.918). El grupo de revascularización exitosa tuvo ausencia de infartos agudos al miocardio y en 3.3% del grupo RF (p = 0.245) sí hubo. Ocurrió muerte de origen cardiaco en 0% del grupo RE y en 3.3% del grupo RF (p = 0.245). Mientras que tuvieron necesidad de nueva vascularización el 0% del grupo RE y el 6.7% de los pacientes del grupo RF. La tasa de supervivencia de pacientes con RF fue de 96.7% y en pacientes con RE fue de 100%. Conclusiones: La revascularización exitosa vs fallida no demostró diferencias estadísticamente significativas en la tasa de eventos cardiovasculares mayores aBSTRaCT Introduction: Chronic coronary occlusions are associated with a negative impact on long-term prognosis. Objectives: To know if there is a difference in major cardiovascular events in patients undergoing successful revascularization versus failed revascularization of chronic total occlusion lesions instable angina. Material and methods: Cross-sectional, correlational study with two independent groups. Results: 71 patients were evaluated, in a context of stable chronic angina, in the High Specialty Medical Unit of Bajio, from January 2013 to February 2020; 41 patients with successful revascularization (RE) and 30 with revascularization was failed (RF). The revascularization success rate was 57.7%. The rate of major cardiovascular events found among patients with RE vs RF in this study were: unstable angina events post-revascularization in 12.5% of the RE group and in 13.3% of the RF group (p = 0.918). AMI (acute myocardial infarction) occurred in 0% of the RE group and in 3.3% of the RF group (p = 0.245). Death of cardiac origin occurred in 0% of the RE group and in 3.3% of the RF group (p = 0.245). In contrast 0% of the RE group and 6.7% of the RF group patients needed new vascularization. The survival rate in RF patients was 96.7%, and in RE patients, it was 100%. Conclusions: Successful versus failed revascularization did not show statistically significant differences in the rate of major cardiovascular events.