Purpose: Apixaban is recommended for patients with atrial fibrillation. Although routine monitoring of plasma concentrations is not typically advised, factors such as ethnicity, sex, and comorbidities can influence these levels. Our study analyzed the plasma apixaban concentrations (PAC) in patients to explore whether these levels, along with underlying conditions, offer enhanced insights for risk stratification. Methods: This study analyzed 49 patients with atrial fibrillation who had been taking apixaban for over a month, examined factor Xa levels within 6 h post-administration, and correlated PAC with clinical characteristics such as age, body weight, estimated glomerular filtration rate (eGFR), presence of heart failure, and bleeding events. Results: The mean plasma concentration of apixaban in all patients was 160.3 ± 77.5 ng/mL. Those taking apixaban 5 mg twice daily had higher plasma concentrations than those taking 2.5 mg twice daily (191.2 ± 75.3 ng/mL vs.137.2 ± 72.0 ng/mL, p = 0.014). Among the patients receiving a reduced dose, renal function and heart failure were significantly associated with plasma concentrations. No factors were associated with the plasma concentrations in patients receiving the standard dose. Notably, reduced-dose patients with heart failure had plasma concentrations comparable to those of individuals receiving the standard dose and exhibited a higher incidence of bleeding than the other groups. Conclusions PAC measurement revealed that apixaban dosages, classified based on age, body weight, and eGFR, were generally effective. Nonetheless, heart failure may increase plasma levels and correlate with an increased bleeding risk in Korean patients on reduced doses. Therefore, tailoring apixaban prescriptions to account for heart failure and other comorbidities may enhance treatment efficacy.

Background: As the prevalence of hypertension increases with age and the proportion of the older population is also on the rise, research on the characteristics of older hypertensive patients and the importance of frailty is necessary. This study aimed to identify clinical characteristics of older hypertension in Korea and to investigate these characteristics based on frailty status. Methods: The HOW to Optimize eLDerly systolic BP (HOWOLD-BP) is a prospective, multicenter, open-label, randomized clinical trial that aims to compare intensive (target systolic blood pressure [SBP] ≤ 130 mmHg) with standard (target SBP ≤ 140 mmHg) treatment to reduce cardiovascular events in older hypertensive Korean patients aged ≥ 65 years. Data were analyzed through a screening assessment of 2,085 patients recruited from 11 university hospitals. Demographic, functional (physical and cognitive), medical history, laboratory data, quality of life, and medication history of antihypertensive drugs were assessed. Results: The mean age was 73.2 years (standard deviation ± 5.60), and 48.0% (n = 1,001) were male. Prevalent conditions included dyslipidemia (66.5%), obesity (body mass index ≥ 25 kg/m 2 , 53.6%), and diabetes (28.9%). Dizziness and orthostatic hypotension were self-reported by 1.6% (n = 33) and 1.2% (n = 24), respectively. The majority of patients were on two antihypertensive drugs (48.4%), while 27.5% (n = 574) and 20.8% (n = 433) were on 1 and 3 antihypertensive medications, respectively. Frail to pre-frail patients were older and also tended to have dependent instrumental activities of daily living, slower gait speed, weaker grip strength, lower quality of life, and lower cognitive function. The frail to pre-frail group reported more dizziness (2.6% vs. 1.2%, P < 0.001) and had concerning clinical factors, including lower glomerular filtration rate, more comorbidities such as diabetes, stroke, and a history of admission. Frail to pre-frail older hypertensive patients used slightly more antihypertensive medications than robust older hypertensive patients (1.95 vs. 2.06, P = 0.003). Pre-frail to frail patients often chose beta-blockers as a third medication over diuretics. Conclusion This study described the general clinical characteristics of older hypertensive patients in Korea. Frail hypertensive patients face challenges in achieving positive clinical outcomes because of multifactorial causes: they are older, have more morbidities, decreased function, lower quality of life and cognitive function, and take more antihypertensive medications. Therefore, it is essential to comprehensively evaluate and monitor diseaserelated or drug-related adverse events more frequently during regular check-ups, which is necessary for pre-frail to frail older patients with hypertension.

Background: The optimal duration and net clinical benefit of dual antiplatelet therapy (DAPT) after transcatheter aortic valve replacement (TAVR) have not been elucidated in realworld situations. Methods: Using nationwide claims data from 2013 to 2021, we selected patients who underwent TAVR and categorized them into two groups: short- and long-term (≤ 3 and > 3 months, respectively) DAPT group. Propensity score matching was used to balance baseline characteristics. The primary endpoint was the occurrence of net adverse clinical events (NACEs), including all-cause death, myocardial infarction, stroke, any coronary and peripheral revascularization, systemic thromboembolism, and bleeding events, at 1 year. Survival analyses were conducted using Kaplan-Meier estimation and Cox proportional hazards regression. Results: Patients who met the inclusion criteria (1,695) were selected. Propensity score matching yielded 1,215 pairs of patients: 416 and 799 in the short- and long-term DAPT groups, respectively. In the unmatched cohort, the mean ages were 79.8 ± 6.1 and 79.7 ± 5.8 years for the short- and long-term DAPT groups, respectively. In the matched cohort, the mean ages were 80.6 ± 5.9 and 79.9 ± 5.9 years for the short- and long-term DAPT groups, respectively. Over one year in the unmatched cohort, the NACE incidence was 11.9% and 11.5% in the short- and long-term DAPT groups, respectively (P = 0.893). The all-cause mortality rates were 7.4% and 4.7% (P = 0.042), composite ischemic event rates were 2.5% and 4.7% (P = 0.056), and bleeding event rates were 2.7% and 4.7% (P = 0.056) in the shortand long-term groups, respectively. In the matched cohort, the incidence of NACE was 9.6% in the short-term DAPT group and 11.6% in the long-term DAPT group, respectively (P = 0.329).The all-cause mortality rates were 6.5% and 4.9% (P = 0.298), composite ischemic event rates were 1.4% and 4.5% (P = 0.009), and bleeding event rates were 2.2% and 4.4% (P = 0.072) in the short- and long-term groups, respectively. Conclusion In patients who successfully underwent transfemoral TAVR, the short- and longterm DAPT groups exhibited similar one-year NACE rates. However, patients in the long-term DAPT group experienced more bleeding and ischemic events.

Background: The optimal duration and net clinical benefit of dual antiplatelet therapy (DAPT) after transcatheter aortic valve replacement (TAVR) have not been elucidated in realworld situations. Methods: Using nationwide claims data from 2013 to 2021, we selected patients who underwent TAVR and categorized them into two groups: short- and long-term (≤ 3 and > 3 months, respectively) DAPT group. Propensity score matching was used to balance baseline characteristics. The primary endpoint was the occurrence of net adverse clinical events (NACEs), including all-cause death, myocardial infarction, stroke, any coronary and peripheral revascularization, systemic thromboembolism, and bleeding events, at 1 year. Survival analyses were conducted using Kaplan-Meier estimation and Cox proportional hazards regression. Results: Patients who met the inclusion criteria (1,695) were selected. Propensity score matching yielded 1,215 pairs of patients: 416 and 799 in the short- and long-term DAPT groups, respectively. In the unmatched cohort, the mean ages were 79.8 ± 6.1 and 79.7 ± 5.8 years for the short- and long-term DAPT groups, respectively. In the matched cohort, the mean ages were 80.6 ± 5.9 and 79.9 ± 5.9 years for the short- and long-term DAPT groups, respectively. Over one year in the unmatched cohort, the NACE incidence was 11.9% and 11.5% in the short- and long-term DAPT groups, respectively (P = 0.893). The all-cause mortality rates were 7.4% and 4.7% (P = 0.042), composite ischemic event rates were 2.5% and 4.7% (P = 0.056), and bleeding event rates were 2.7% and 4.7% (P = 0.056) in the shortand long-term groups, respectively. In the matched cohort, the incidence of NACE was 9.6% in the short-term DAPT group and 11.6% in the long-term DAPT group, respectively (P = 0.329).The all-cause mortality rates were 6.5% and 4.9% (P = 0.298), composite ischemic event rates were 1.4% and 4.5% (P = 0.009), and bleeding event rates were 2.2% and 4.4% (P = 0.072) in the short- and long-term groups, respectively. Conclusion In patients who successfully underwent transfemoral TAVR, the short- and longterm DAPT groups exhibited similar one-year NACE rates. However, patients in the long-term DAPT group experienced more bleeding and ischemic events.

Background: The optimal duration and net clinical benefit of dual antiplatelet therapy (DAPT) after transcatheter aortic valve replacement (TAVR) have not been elucidated in realworld situations. Methods: Using nationwide claims data from 2013 to 2021, we selected patients who underwent TAVR and categorized them into two groups: short- and long-term (≤ 3 and > 3 months, respectively) DAPT group. Propensity score matching was used to balance baseline characteristics. The primary endpoint was the occurrence of net adverse clinical events (NACEs), including all-cause death, myocardial infarction, stroke, any coronary and peripheral revascularization, systemic thromboembolism, and bleeding events, at 1 year. Survival analyses were conducted using Kaplan-Meier estimation and Cox proportional hazards regression. Results: Patients who met the inclusion criteria (1,695) were selected. Propensity score matching yielded 1,215 pairs of patients: 416 and 799 in the short- and long-term DAPT groups, respectively. In the unmatched cohort, the mean ages were 79.8 ± 6.1 and 79.7 ± 5.8 years for the short- and long-term DAPT groups, respectively. In the matched cohort, the mean ages were 80.6 ± 5.9 and 79.9 ± 5.9 years for the short- and long-term DAPT groups, respectively. Over one year in the unmatched cohort, the NACE incidence was 11.9% and 11.5% in the short- and long-term DAPT groups, respectively (P = 0.893). The all-cause mortality rates were 7.4% and 4.7% (P = 0.042), composite ischemic event rates were 2.5% and 4.7% (P = 0.056), and bleeding event rates were 2.7% and 4.7% (P = 0.056) in the shortand long-term groups, respectively. In the matched cohort, the incidence of NACE was 9.6% in the short-term DAPT group and 11.6% in the long-term DAPT group, respectively (P = 0.329).The all-cause mortality rates were 6.5% and 4.9% (P = 0.298), composite ischemic event rates were 1.4% and 4.5% (P = 0.009), and bleeding event rates were 2.2% and 4.4% (P = 0.072) in the short- and long-term groups, respectively. Conclusion In patients who successfully underwent transfemoral TAVR, the short- and longterm DAPT groups exhibited similar one-year NACE rates. However, patients in the long-term DAPT group experienced more bleeding and ischemic events.

Background: The optimal duration and net clinical benefit of dual antiplatelet therapy (DAPT) after transcatheter aortic valve replacement (TAVR) have not been elucidated in realworld situations. Methods: Using nationwide claims data from 2013 to 2021, we selected patients who underwent TAVR and categorized them into two groups: short- and long-term (≤ 3 and > 3 months, respectively) DAPT group. Propensity score matching was used to balance baseline characteristics. The primary endpoint was the occurrence of net adverse clinical events (NACEs), including all-cause death, myocardial infarction, stroke, any coronary and peripheral revascularization, systemic thromboembolism, and bleeding events, at 1 year. Survival analyses were conducted using Kaplan-Meier estimation and Cox proportional hazards regression. Results: Patients who met the inclusion criteria (1,695) were selected. Propensity score matching yielded 1,215 pairs of patients: 416 and 799 in the short- and long-term DAPT groups, respectively. In the unmatched cohort, the mean ages were 79.8 ± 6.1 and 79.7 ± 5.8 years for the short- and long-term DAPT groups, respectively. In the matched cohort, the mean ages were 80.6 ± 5.9 and 79.9 ± 5.9 years for the short- and long-term DAPT groups, respectively. Over one year in the unmatched cohort, the NACE incidence was 11.9% and 11.5% in the short- and long-term DAPT groups, respectively (P = 0.893). The all-cause mortality rates were 7.4% and 4.7% (P = 0.042), composite ischemic event rates were 2.5% and 4.7% (P = 0.056), and bleeding event rates were 2.7% and 4.7% (P = 0.056) in the shortand long-term groups, respectively. In the matched cohort, the incidence of NACE was 9.6% in the short-term DAPT group and 11.6% in the long-term DAPT group, respectively (P = 0.329).The all-cause mortality rates were 6.5% and 4.9% (P = 0.298), composite ischemic event rates were 1.4% and 4.5% (P = 0.009), and bleeding event rates were 2.2% and 4.4% (P = 0.072) in the short- and long-term groups, respectively. Conclusion In patients who successfully underwent transfemoral TAVR, the short- and longterm DAPT groups exhibited similar one-year NACE rates. However, patients in the long-term DAPT group experienced more bleeding and ischemic events.

BACKGROUND: Accurate volume measurement is important in the management of patients with congestive heart failure or renal insufficiency. A bioimpedance analyser can estimate total body water in litres and has been widely used in clinical practice due to its non-invasiveness and ease of results interpretation. To change impedance data to volumetric data, bioimpedance analysers use equations derived from data from healthy subjects, which may not apply to patients with other conditions. Bioelectrical impedance vector analysis (BIVA) was developed to overcome the dependence on those equations by constructing vector plots using raw impedance data. BIVA requires normal reference plots for the proper interpretation of individual vectors. The aim of this study was to construct normal reference vector plots of bioelectrical impedance for Koreans. METHODS: Bioelectrical impedance measurements were collected from apparently healthy subjects screened according to a comprehensive physical examination and medical history performed by trained physicians. Reference vector contours were plotted on the RXc graph using the probability density function of the bivariate normal distribution. We further compared them with those of other ethnic groups. RESULTS: A total of 242 healthy subjects aged 22 to 83 were recruited (137 men and 105 women) between December 2015 and November 2016. The centers of the tolerance ellipses were 306.3 Ω/m and 34.9 Ω/m for men and 425.6 Ω/m and 39.7 Ω/m for women. The ellipses were wider for women than for men. The confidence ellipses for Koreans were located between those for Americans and Spaniards without overlap for both genders. CONCLUSION: This study presented gender-specific normal reference BIVA plots and corresponding tolerance and confidence ellipses on the RXc graph, which is important for the interpretation of BIA-reported volume status in patients with congestive heart failure or renal insufficiency. There were noticeable differences in reference ellipses with regard to gender and ethnic groups.
Adult ; Blood Volume ; Body Fluid Compartments ; Body Water ; Electric Impedance ; Ethnic Groups ; Female ; Healthy Volunteers ; Heart Failure ; Humans ; Male ; Physical Examination ; Renal Insufficiency

The present erratum notice corrects one figure of the article.

OBJECTIVE: To analyze the clinical characteristics and outcomes of ruptured distal anterior cerebral artery (DACA) aneurysms and to discuss optimal treatment strategy. METHODS: Out of 488 patients with ruptured intracranial aneurysms, 24 were treated for DACA aneurysms between February 2001 and January 2009. The medical records, radiological data and outpatient clinic charts of these patients were retrospectively reviewed. RESULTS: The 24 patients (6 men, 18 women) had a mean age of 52 years (range, 30-70). Among the 24 patients, 6 underwent coiling and 17 underwent clipping. Fifteen patients had a Hunt-Hess grade of II, 5 with III, 3 with IV and 1 had a grade of V. Nine patients had a Fisher grade of II, 1 with III and 14 had a grade of IV. Twenty-one (88%) patients had a good clinical course after treatment with endovascular (5 of 6 patients, 83%) or surgical (16 of 18 patients, 89%) treatments. Nineteen of 20 patients (95%) with good preoperative states (Hunt-Hess grade I-III) and 2 of the 4 patients (50%) with poor preoperative states (Hunt-Hess grade IV and V) demonstrated good clinical outcomes with Glasgow Outcome Scale (GOS) scores of 4-5. Two patients (8%) died due to pneumonia or preoperative severe brain damage. CONCLUSIONS: Acceptable and favorable outcomes were achieved in patients with good preoperative states who were treated with either clipping or coiling of ruptured DACA aneurysms. Immediate and active treatment should be mandatory for favorable outcomes.
Ambulatory Care Facilities ; Aneurysm ; Anterior Cerebral Artery ; Brain ; Glasgow Outcome Scale ; Humans ; Intracranial Aneurysm ; Male ; Medical Records ; Pneumonia ; Retrospective Studies

BACKGROUND: Combination treatment with all-trans-retinoic acid (ATRA) and anthracycline-based chemotherapy has led to major advances in the treatment of acute promyelocytic leukemia (APL). METHODS: In this study, we reviewed the outcome of pediatric APL patients treated using a modified AIDA protocol at our institution. RESULTS: Between May 1999 and December 2007, 23 patients were diagnosed with APL at the Department of Pediatrics, Saint Mary's Hospital, The Catholic University of Korea. Eleven patients were male (48%) (median age at diagnosis, 11 (range, 2-14) years). The treatment protocol consisted of remission induction (achieved by coadministration of ATRA and idarubicin), 3 courses of consolidation treatment, and 2 years of maintenance treatment during which ATRA was also administered. Three patients died early during remission induction due to CNS hemorrhage. The remaining 20 patients achieved complete remission (CR), with an overall CR rate of 87%. Two patients relapsed and died, and another patient died of pneumonia unrelated to APL. Four patients (17%) were diagnosed with ATRA syndrome, and all patients showed resolution of symptoms. The event-free survival (EFS) and overall survival (OS) of the cohort were 78.3+/-8.6% and 76.3+/-9.5%, respectively. Initial WBC count at diagnosis was the only significant prognostic factor for the rate of CR (P=0.039) and OS (P=0.039). CONCLUSION: A modified AIDA protocol for the treatment of childhood APL leads to improved EFS and OS, with limited ATRA syndrome-associated toxicity. Active monitoring and treatment of patients with high initial WBC counts may help in reducing mortality.
Antineoplastic Combined Chemotherapy Protocols ; Child ; Clinical Protocols ; Cohort Studies ; Disease-Free Survival ; Hemorrhage ; Humans ; Idarubicin ; Korea ; Leukemia, Promyelocytic, Acute ; Male ; Pediatrics ; Pneumonia ; Remission Induction ; Saints ; Tretinoin