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T he use of oral anticoagulants (OACs), such as the vitamin K antagonists (eg, warfarin), in patients with atrial fibrillation (AF) results in a significant reduction in stroke, ischemic stroke (IS), and systematic thromboembolism (TE), as well as all-cause mortality, when compared with placebo or control.1 However, warfarin has many limitations, including the necessity for regular anticoagulation monitoring, dietary and drug interactions, and the potential for serious bleeding if anticoagulation is poorly controlled, as reflected by a poor time in therapeutic range. 2 The availability of the non-vitamin K antagonist oral anticoagulants (NOACs) has changed the landscape for stroke prevention in AF, and a meta-analysis of randomized clinical trials (RCTs) by Ruff et al 3 has shown that usual-dose NOACs result in a significant reduction in stroke/TE and mortality with NOACs compared with warfarin, with a trend toward less major bleeding and significantly lower intracranial hemorrhage (ICH). However, RCTs have specific inclusion/ exclusion criteria, have set protocol-based follow-up, and perhaps represent a highly selected and controlled scenario, but still represent the gold standard of testing the effectiveness and safety of an intervention. Based on RCT data, indirect comparisons have been published showing how the different NOACs may perform relative to each other, 4,5 but only a headto-head RCT can definitively assess the relative efficacy and safety of one NOAC against another.When a drug is licensed and used in everyday clinical practice, these drugs are then prescribed to a broad spectrum of Background and Purpose-This study was designed to evaluate the effectiveness and safety of rivaroxaban in real-world practice compared with effectiveness and safety of dabigatran or warfarin for stroke prevention in atrial fibrillation through meta-analyzing observational studies. Methods-Seventeen studies were included after searching in PubMed for studies reporting the comparative effectiveness and safety of rivaroxaban versus dabigatran (n=3), rivaroxaban versus Warfarin (n=11), or both (n=3) for stroke prevention in atrial fibrillation. Results-Overall, the risks of stroke/systematic thromboembolism with rivaroxaban were similar when compared with those with dabigatran (stroke/thromboembolism: hazard ratio, 1.02; 95% confidence interval, 0.91-1.13; I 2 =70.2%, N=5), but were significantly reduced when compared with those with warfarin (hazard ratio, 0.75; 95% confidence interval, 0.64-0.85; I 2 =45.1%, N=9). Major bleeding risk was significantly higher with rivaroxaban than with dabigatran (hazard ratio, 1.38; 95% confidence interval, 1.27-1.49; I 2 =26.1%, N=5), but similar to that with warfarin (hazard ratio, 0.99; 95% confidence interval, 0.91-1.07; I 2 =0.0%, N=6). Rivaroxaban was associated with increased all-cause mortality and gastrointestinal bleeding, but similar risk of acute myocardial infarction and intracranial hemorrhage when compared with dabigatran. When compared with warfarin, rivaroxaban was ass...

For those resectable tumors, the better choice for treatment of HCC with PVTT should be hepatectomy and removal of PVTT. For those unresectable tumors, TACE (especially the super-selective TACE) has been the preferred palliative treatment, the other regional interventional therapy and/or radiotherapy could improve the therapeutic effects. The multidisciplinary treatments may further improve the quality of life and prolong the survival period for the HCC patients associated with PVTT.

Patients with atrial fibrillation (AF) are commonly managed with rhythm control strategy, but the natural history of this common arrhythmia leads itself to progression from paroxysmal to persistent or permanent AF, and recurrences are evident despite rhythm control treatments using cardioversion or catheter ablation. Numerous clinical factors have been associated with outcomes of rhythm control or arrhythmia progression in patients with AF. The more common factors have been used to formulate risk stratification scores, to help predict the outcomes of rhythm control treatments or AF progression. This review article provides an overview on the published clinical risk scores related to outcomes of rhythm control strategy or AF progression.