Conjugated acetyl Salicylic Acid [KLH]

Background: beta-blocker use has been associated with improved outcomes in a number of different malignancies; however, the impact of beta-blockade in esophageal cancer is not been well characterized. We compared the outcomes of esophageal cancer patients based on beta-blocker usage. Methods: The charts of all 418 patients treated with radiation for esophageal cancer at our institution from April 2010 to October 2018 were analyzed. Patients who underwent treatment with palliative intent or did not finish treatment were excluded. beta-blocker use was determined from the medication list at time of pretreatment consultation. Results: There were 291 esophageal cancer patients who received neoadjuvant/definitive chemoradiation therapy. The median follow-up for the cohort was 22.5 months (interquartile range: 9.6 to 41.0 mo). Within the cohort, 27.8% (n=81) of patients were taking beta-blockers at the time of treatment. Those taking beta-blockers had significantly improved distant control (22.2% vs. 37.9%; P=0.035). Concomitant beta-blocker use was significantly associated with improved progression-free survival (P<0.001, hazard ratio=0.42 [0.27-0.66]) and overall survival (P=0.002, hazard ratio=0.55 [0.38-0.81]) on Cox regression analysis. Propensity score-matched pairs were created using tumor stage, nodal stage, sex, neoadjuvant versus definitive therapy, Karnofsky Performance Status, and aspirin use. This matched-pair analysis showed a significant progression-free survival (P=0.005) benefit in esophageal cancer patients taking beta-blockers. Conclusions: Concurrent beta-blocker use is common within patients receiving concurrent chemoradiation for esophageal cancer. Esophageal cancer patients who received chemoradiation while taking beta-blockers demonstrated significant benefits in survival-based outcomes.

OBJECTIVES The aim of this study was to evaluate the impact of CHA(2)DS(2)-VASc and HAS-BLED scores on ischemic and bleeding events of patients enrolled in the Amplatzer Amulet Observational Study. BACKGROUND Baseline CHA(2)DS(2)-VASc and HAS-BLED scores have been validated in atrial fibrillation patients to guide about anticoagulation but not in patients treated by left atrial appendage occlusion (LAAO). METHODS Subjects were stratified according to CHA(2)DS(2)-VASc and HAS-BLED scores. Clinical outcomes were collected through 2 years and adjudicated by an independent committee. RESULTS Subjects were considered at low (n = 156), moderate (n 715), and high (n 215) risk for ischemic stroke, corresponding to CHA(2)DS(2)-VASc scores of <3, 3 to 5, and >= 6, respectively. The annual rates of ischemic stroke were 1.1%, 2.0%, and 3.5%, respectively. When compared with the predicted rate, LAAO reduced the risk of ischemic stroke by 56%, 69%, and 68%. Device-related thrombus occurred in 0.7%, 1.5%, and 3.0% of subjects at tow, moderate, and high risk for ischemic stroke, respectively. The HAS-BLED score was <= 3 in 629 subjects and >3 in 456 subjects, respectively. Non-peri-procedural major bleeding was reduced by 11% and 9% compared with predicted rates in the low and high bleeding risk groups, respectively. CONCLUSIONS LAAO with the Amplatzer Amulet reduced the risk of ischemic stroke compared with the predicted rate, with a greater magnitude among patients at high thromboembolic risk without increasing the bleeding risk. (C) 2020 by the American College of Cardiology Foundation.