Introduction. Atrial fibrillation leads to increased risk of systemic embolism and stroke. To decrease these adverse events, anticoagulation is routinely prescribed. Nonvitamin K anticoagulants like apixaban and rivaroxaban are becoming popular and being used more frequently nowadays. We here compare the efficacy and safety of apixaban with those of warfarin. Methods and Analysis. This systematic review aims to assess the efficacy and safety of apixaban compared to those of warfarin. Eligible participants were adults diagnosed with nonvalvular atrial fibrillation. The intervention was apixaban, and the comparator was warfarin. The primary efficacy endpoint is the first admission with systemic embolism or stroke, and the primary safety outcome is the occurrence of major bleeding. Relevant studies were searched in the Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, and clinicaltrials.gov. After being independently reviewed by two authors, five articles were included in the systematic review. The risk of bias of included studies was assessed using the Cochrane risk of bias tool and SIGN methodology. The RevMan software was used to assess the effect size and perform meta-analysis. Results. Apixaban was found to be superior to warfarin in terms of safety (RR 0.58; CI 0.52–0.66) but not superior to warfarin in terms of efficacy (RR 0.93; CI 0.70–1.24). Conclusion. Apixaban is superior to warfarin in terms of safety, but no difference in efficacy is noted. The choice of anticoagulation should be individualized based on the risk factor profile of the patient.

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Background Management of elderly patients with Non-ST Elevation Myocardial Infarction (NSTEMI) continues to be a source of controversy due to underrepresentation in large-scale clinical trials and the increased risk of adverse outcomes after both invasive (Percutaneous coronary intervention and Coronary artery bypass grafting) and non-invasive therapies. Recent randomized clinical trials have shown improved short term and intermediate term outcomes among high risk NSTEMI patients receiving early invasive management versus conservative medical management. However, how this is reflected in U.S. clinical practice for elderly patients has not been reported. Objective To identify the trend of invasive management in patients with NSTEMI, particularly among elderly population.

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Introduction Epoetin alfa is an erythrocyte-stimulating factor. We here present a case of an anemic patient, who was given epogen before a coronary artery bypass (CABG) surgery and developed periprocedural myocardial infarction. To our knowledge, there has been no previous case reported of epogen causing myocardial infarction. Case Presentation 66-year-old female presented with substernal chest pain. EKG showed ST segment elevations in aVf and L-III. Patient underwent left heart catheterization (LHC) and had triple vessel disease. A bare metal stent was placed in RCA. Patient continued to have symptoms after discharge and presented to the ED again with these complaints. She underwent coronary artery bypass surgery (CABG). Before the procedure, patient's hemoglobin was 11.1 grams/deciliter and was given epogen to raise hemoglobin level. Postoperative day (POD) #1 patient had ST elevations in inferior and anterolateral leads. She was diagnosed with periprocedural myocardial infarction. Patient underwent repeat LHC, which identified obstruction of saphenous vein graft (SVG). Hypercoagulable workup was negative for any disease and the patient was diagnosed with epogen induced early graft occlusion. Conclusion Epogen administration can cause myocardial infarction and coronary artery thrombosis. We suggest that physicians use epogen very cautiously, especially in population who has underlying coronary artery disease.