Viva Axadia, visca València y viva España! Y viva la gente alegre que no se busca enemigos

Axadia en realidad te incumbe, en la edad del hierro, éramos los Iberos, y lo conformábamos Cataluña, la C.Valenciana, Murcia y Andalucía. Ese es nuestro origen más primigenio, luego ya llegaron los romanos, visigodos, musulmanes, cristianos y Javier de Burgos con su división.

シンプルだけど回答が割れそうなclinical question（白背景がOpen Evidence, 黒背景がChatGPT for clinicians) 。あえて、ワーファリンとの比較、CHADsVAScスコア別、どのDOACとは指定せずに聞いてみました。両者とも、ガイドライン、RENAL-AF, AXADIA試験を参考に上手に回答してくれましたが、ChatGPTは全文引用できていない様子がありますね。 文章のまとめかたはChatGPTがよかったですが、今回はOEの方が信頼性が高いと感じました。 プロンプト：I am not sure if starting DOAC to prevent embolic stroke in patients with Atrial fibrillation and ESRD on HD is beneficial. Provide me evidence for the pros and cons and teach me the current landscape of recommendations. Open evidence回答： 最初に2023 ACC/AHA/ACCP/HRSガイドラインを要約してから、否定意見は2020 JACC reviewを根拠に、実際の図表を提示しながら説明。知り合いの @ToshikiKuno の総説も引用してくれているが、逆に 2022 circulation RENAL-AF trialのRCTは引用リストにない。不思議です。 ChatGPT for Clinicians回答：肯定と否定両者の意見、および主要な学会の推奨を簡潔にまとめてくれている。引用元の一つであるRENAL-AF試験の本文まで確認できているのかを追加質問してみましたが、どうもアブストラクトしか引用できていない様子。Limitationsなどへの回答は、ACCのsynthesisサイトから拾っている。

Looks as if LAAO may become the optimal option for stroke prevention for dialysis pat with AFib - after AXADIA, Valkyrie, RENAL-AF and SAFE-D all found a nearly prohibitively high bleeding rate with DOAC and particularly VKA. @IngoEitel @LukasUrbanek11 jamanetwork.com/journals/jam…

🧠 DOACs in CKD – Clinical Pearls for Everyday Practice 👨‍⚕️ Anticoagulation in CKD = Complex Balancing Act Here’s what latest data tells us 👇 🔷 Atrial Fibrillation CKD ✅ Moderate CKD (CrCl 30–50 ml/min) 🔹 Apixaban & Dabigatran 150 mg → Lower stroke/systemic embolism vs. warfarin 🔹 Apixaban & Edoxaban → Lower bleeding & mortality ⚠️ All DOACs need dose adjustment in CKD 💡 Prefer Apixaban when bleeding risk is high 🔶 Advanced CKD (CrCl <30 ml/min) 📊 Real-world observational data:  ☑️ DOACs = similar stroke/VTE protection  ⬇️ Numerically lower bleeding vs. warfarin  🧪 Therapeutic drug monitoring may help in select cases 🩺 Maintenance Dialysis AF 🔬 VALKYRIE Trial: ☑️ Rivaroxaban (10 mg) > VKA for preventing vascular events ❌ RENAL-AF & AXADIA trials inconclusive (low recruitment, low event rates) 🚨 BOTTOM LINE:  🛑 Oral anticoagulation in dialysis remains controversial  ❗ Both DOACs and warfarin carry high bleeding risk  👨‍⚕️ Shared decision-making essential 🔷 VTE CKD 🔹 In moderate CKD:  ▪ Edoxaban → ⬇️ VTE recurrence  ▪ Rivaroxaban → ⬇️ bleeding  ▪ Dabigatran → ⬆️ bleeding vs. warfarin 📌 Final Takeaways ✅ DOACs = Game changer in AF & VTE with CKD ⚠️ Caution in dialysis – Use only after case-by-case evaluation 🧮 Always check renal function & adjust dose 🧪 Consider drug level monitoring in fragile patients 📚 Source: PMC10994631 | Review of DOAC use in CKD 💬 pmc.ncbi.nlm.nih.gov/article…

via @brian_rifkin - slow or fast for hyponatremia correction? - AFib and anticoagulation (Renal AF, AXADIA published, SAFE-D at #kidneywk) #TopNephrology nominations

#WorldStrokeDay 2023 - Antikoagulation oder LAAO bei CKD & Vorhofflimmern? Unsere 2023 Diskussion zu AXADIA & LAA-Kidney - mit @IngoEitel Prof. Rupert Bauersachs @StephanSchirme2 @floriancustodis Partner @dgfn_ev @oegnephro @com_SFNDT youtu.be/rf3rIDVyWkA?si=hxmr… via @YouTube

Several indications w/ compelling evidence: 1) acute med Ill ext VTE ppx (MAGELLAN MARINER MICHELLE CORE-19 > ADOPT), 2) CAD/PAD (COMPASS VOYAGER-PAD > ?…AGRIPPA…?), 3) AF ESRD/HD (VALKYRIE > RENAL-AF AXADIA-AFNET-8), 4) biopisthetic MVR AFib (RIVER > …?…).

I am thrilled to announce my participation as a keynote speaker at the upcoming #MetaverseLeadersSummit on May 16th, 2023. 👋 Join me in person in Zurich or online in the metaverse @metabloqs @MetaverseAcademy @SwissMBAs #AXADIA @AXAFrance #PlayToGive

After RenalAF and AXADIA-AFNET, I feel DOAC does not seem that riskless as many of us hopped. For elderly CKD 5, if no clear indication (AF not always), seems safer not to anticoagulate at all

There is a big Ad of #axadia in the subway 👍🏻

🛡️ Have you already met #Papafitgym with the famous Axa shield 💫 from #Axadia in @LoveInParis2023 ? @AXAFrance @cyrillemagnetto @xsioroff @AXA @interactivestud

🧐 To understand everything about #Axadia @AXAFrance experience, meet @cyrillemagnetto @ParisBlockWeek @TheSandboxGame #web3 #metaverse

This Month, the trial of the month goes to the AXADIA-AFNET 8 Study, in which Apixaban demonstrated comparable safety and efficacy to vitamin K antagonism among hemodialysis patients. See the latest #ISNGTF summary for details. VA by @NephroSeeker from @NephJC @NSMCInternship

2/10 What did I miss? Two RCTs this #NephJC, both comparing apixaban to vitamin K antagonists, used for AF in patients on haemodialysis. Prior observational data indicated apixaban may be better choice. RENAL-AF pubmed.ncbi.nlm.nih.gov/3633… AXADIA-AFNET 8 pubmed.ncbi.nlm.nih.gov/3633…

Antikoagulation bei Dialysepatienten nach AXADIA, vor LAA-Kidney: MARKUS @ HOMe begrüßt morgen 19:15 Uhr Prof. Rupert Bauersachs & Prof. @IngoEitel Hosts: @StephanSchirme1 @floriancustodis Partner: @dgfn_ev @com_SFNDT @oegnephro youtu.be/rf3rIDVyWkA via @YouTube

AXA France débarque dans le métavers avec AXADIA ! Explorez, découvrez et inventez l'assurance de demain. #AXADIA #AXA #Métavers #ExpérienceVirtuelle #Innovation #Assurance

T2g: PK analysis of RENAL AF found AUC for 5mg bd comparable to ARISTOTLE for eCrCl 15-59 ml/min, but 2x higher than in normal renal function. 2.5mg bd in ESKD achieved similar AUC as 5mg in normal kidney function. Timely data to justify AXADIA AF NET 8 doing.. Phew #NephJC

T2c: Here is a summary of RENAL AF and AXADIA-AFNET 8 trials: low time in therapeutic range (TTR) for warfarin in ESKD seen in both. How can this affect safety outcomes? #NephJC

sorry late and lurking small trials I thought the NI design (esp for AXADIA) would require a much larger sample size - their calc seemed off Apixaban dose is all over the place...#NephJC