Risultati per: Low Back Pain: raccomandazioni

Circulation, Volume 150, Issue Suppl_1, Page A4120657-A4120657, November 12, 2024. Introduction:Early prehospital chest pain assessment improves acute coronary syndrome (ACS) outcomes and can reduce unnecessary Emergency Room (ER) visits but requires medical personnel and electrocardiographic (ECG) equipment.Objective:To evaluate the feasibility of a personal credit-card sized chest pain self-assessment device (HeartBeam, Santa Clara, CA, USA) in diagnosing ACS.Methods:ACS risk was estimated by serial likelihood ratio analysis of 3 components: pre-existing coronary heart disease (CHD) risk (pre-calculated based on pooled ASCVD equation), chest pain characteristics (interactive proprietary questionnaire), and integrated near-orthogonal 3-lead self-recorded vectorcardiogram (VCG) with optional comparison to baseline using portable handheld HeartBeam recorder. Final ACS risk was graded High/Intermediate/Low by the cloud-based proprietary algorithm. High risk was considered positive for ACS.Results:184 ER patients with chest pain (Age 57 +/- 7years, 90 Male, 43 (23%) ACS) comprised learning (n=96) and test (n=88) sets. ACS sensitivity was 28/28 (100%) in learning and 15/16 (94%) in test set with specificity of 43% and 42% respectively. In the subset of patients with pain-free portable VCG recorded 9 months later used as a “reverse baseline” (n=110) sensitivity was 17/17 (100%) and 11/12 (92%), specificity 54% and 58% in learning and test set, respectively (p >0.1 with no baseline). Single patient missed by the analysis had known coronary disease with usual anginal episode resulting in minor troponin leak. In “reverse baseline” analysis 41/110 (37%) patients were classified as Low risk compared to 18/184 (10%) without baseline (p0.1 with HeartBeam device).Conclusion:HeartBeam chest pain self-assessment device provides accurate ACS detection comparable to expert ER physicians using 12 lead ECG. The presence of baseline recording reduces the number of false positive results. If confirmed in larger studies, it can be used to facilitate outpatient chest pain assessment and triage by remote physicians and patients themselves.

Circulation, Volume 150, Issue Suppl_1, Page A4144749-A4144749, November 12, 2024. Background:Although high rates of P2Y12 inhibitor pretreatment for non-ST-elevation acute coronary syndrome (NSTE-ACS) have been reported, contemporary practice pattern in the U.S. are not well studied.Objectives:To investigate the temporal trends, variability, and clinical outcomes of P2Y12 inhibitor pretreatment in NSTE-ACS across U.S.Methods:Consecutive patients that underwent early invasive strategy for NSTE-ACS (coronary angiogram ≤ 24 hours of arrival) in National Cardiovascular Data Registry (NCDR) Chest Pain-Myocardial Infarction (MI) registry was analyzed. Initially, a time-trend analysis was conducted on the complete cohort from January 1, 2013, to March 31, 2023. Subsequently, a more recent cohort (January 1, 2019, to March 31, 2023), with a complete set of variables, was used to construct a hierarchical regression model to quantify variability in the use of pretreatment among institutions and hospital regions. For this contemporary cohort, instrumental variable analysis was performed to compare in-hospital outcomes between patients who received pretreatment and those who did not.Results:Use of P2Y12 inhibitor pretreatment has decreased from 24.8% in 2013Q1 to 12.4% in 2023Q3. Among the contemporary cohort of 110,148 patients (2019-23; mean age, 63.9 [SD 12.5] years; 33.0% female), 17,509 (15.9%) received pretreatment. Significant variability in P2Y12 inhibitor pretreatment was observed (range: 0-100%): hierarchical regression model demonstrated that two identical patients would have more than a three-fold difference in the odds of pretreatment by changing institution or hospital region (OR 3.63; 95% CI, 3.51-3.74 and 3.21; 95% CI, 2.90-3.54, respectively). Instrumental variable analysis demonstrated no significant differences in in-hospital all-cause death (1.5% vs 1.7%; p=0.071), recurrent MI (0.56% vs 0.57%; p=0.98), or major bleeding (2.7% vs 2.8%; p=0.98) between the two groups. However, in patients who underwent coronary artery bypass surgery, pretreatment was associated with a longer length of stay (11.2 ± 5.1 days vs 9.8 ± 5.0 days; p < 0.001).Conclusions:Within the nationwide registry in the U.S., we observed a significant variability in the use of P2Y12 inhibitor pretreatment among NSTE-ACS patients in the U.S. Given the lack of clear advantages and the potential for prolonged hospital stays, our findings highlight the importance of efforts to improve standardization.

Circulation, Volume 150, Issue Suppl_1, Page A4141710-A4141710, November 12, 2024. Background:Stress perfusion CMR has excellent diagnostic and prognostic values in assessing chest pain syndromes. AI-guided methods may overcome complex scanning and increase clinical adaptation of stress CMR.Aim:To assess the benefits of AI-guided stress perfusion CMR.Methods:Consecutive patients with stable chest pain underwent stress CMR using either a standard scanning method (SOC) or an AI-assist (AIA) machine learning protocol to automate scan planning, plane prescription, sequence tuning, and image reconstruction. Scan duration, the ratio of scan preparation time over the entire scan duration, and scan quality using a 5-point scale were compared between AIA and SOC. Cox regression models were constructed to associate evidence of ischemia on stress CMR, by either scanning method, with composite endpoints including cardiovascular death, non-fatal MI, unstable angina hospitalization, and late CABG. A second composite endpoint included the performance of additional cardiac imaging tests (stress imaging and CCTA) and invasive coronary procedures after CMR.Results:Among 594 patients (62.8 ± 14 years), 29% underwent stress CMR with AIA. 26% had stress-perfusion ischemia, and 39% had LGE present. AIA stress CMR had lower scan duration (median 44.0 [IQR 40-47] vs. 52.5 min [IQR 46-60]; p

Circulation, Volume 150, Issue Suppl_1, Page A4144964-A4144964, November 12, 2024. Major adverse cardiovascular (CV) events (MACE) occur in a substantioal percentage of individuals following acute coronary syndromes (ACS), primarily driven by residual vascular inflammation. Anti-inflammatory drugs have improved CV outcomes but their use is limited by significant side-effects. Low-dose interleukin 2 (IL2) increases regulatory T (Treg) cells, which are powerful endogenous regulators of the immune response, and could provide a new, targeted anti-inflammatory strategy in high-risk ACS patients. In IVORY, we hypothesised that treatment with low-dose IL2 would reduce arterial inflammation measured by18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT), compared to placebo. In IVORY FINALE we hypothesised that low dose IL2 could reduce MACE compared to placebo at follow up (up to 5 years.)IVORY was a double-blind, placebo-controlled, Phase IIb trial randomising ACS patients with high-sensitivity CRP levels ≧ 2mg/L to receive either 1.5×106IU IL2 or placebo (1:1). Dosing consisted of a daily induction (5 days) and a weekly maintenance phase (7 weeks).18F-FDG-PET/CT imaging of the ascending aorta and carotid arteries was performed before and after treatment. The primary outcome was the difference in the mean maximum target-to-background ratio (TBRmax) in the index vessel on follow-up imaging between the groups.60 patients (IL2:placebo, n=31:29) completed the trial. Arterial inflammation in the index vessel was lower at the end of treatment in the IL2 group than in placebo (TBRmax = -0.171[-7.7%], 95% CI -0.308 to -0.034, p=0.015)[Fig1]. In more inflamed areas with a mean TBRmax ≧ 2 (active slices), the difference between the groups was greater (-0.185 [-8.3%], P=0.009, 95% CI -0.323 to -0.0478). Overall, the additive treatment effect of low-dose IL2 was greater at higher baseline inflammation [Fig 2]. Low-dose IL2 significantly increased circulating Tregs compared to placebo (p

Circulation, Volume 150, Issue Suppl_1, Page A4140089-A4140089, November 12, 2024. Background:Lipid-lowering therapy for patients with acute myocardial infarction (AMI) is highly recommended, however, a paradox may exist where lower low-density lipoprotein cholesterol (LDL-C) levels at myocardial infarction (MI) are associated with poorer prognoses.Aim:To evaluate the association between baseline LDL-C levels and cardiovascular events after MI.Methods:We studied 1,987 consecutive AMI patients who underwent primary percutaneous coronary intervention and who had available data on preprocedural LDL-C between 1999-2015 at Juntendo University Shizuoka Hospital. Patients were divided into quartiles based on their LDL-C levels. The incidence of major adverse cardiac events (MACE), including all-cause death and recurrent MI up to 5-year, were evaluated.Results:Patients in the lowest LDL-C group were older and had higher prevalence of hypertension, diabetes mellitus and chronic kidney disease. During follow-up, 455 (20.9%) MACE were identified. Cumulative incidence of MACE was significantly higher in the lowest LDL-C group than in other groups (p

Circulation, Volume 150, Issue Suppl_1, Page A4146364-A4146364, November 12, 2024. Background:According to the European Guidelines, “low-risk” pulmonary arterial hypertension (PAH) patients is defined as a risk of death < 5% within a year and represents a treatment-goal. However, the impact of morbidity (e.g. hospitalization and clinical worsening), were not included in this definition.Research Questions:Can REVEAL 2.0 risk score further identify low-risk PAH patients for both morbidity and mortality?Aims:Using the REVEAL 2.0 risk score, to propose a modified definition of “low-risk” to include the risk of both morbidity and mortality at 1- and 3-years, respectively.Methods:A harmonized dataset from 8 PAH randomized controlled trials from the FDA was used for this analysis and REVEAL 2.0 risk score was calculated for each patient. Modified low-risk was a priori defined by “risk of death ≤ 5% at 3-years and risk of clinical worsening ≤10% at 1-year”. Clinical worsening was defined as any of the following: lung transplantation or hospitalization due to PAH worsening, initiation of prostanoids/chronic oxygen, 15% decrease in 6-MWD from baseline, a worsening of NYHA, addition of a new PAH medication.Results:A total of 4,122 PAH patients were included: median age 49 (36, 62) yo, mPAP 50 (40, 60) mmHg, PVR 10 (7, 14) WU, 6MWD 375 (306, 423) m, NTproBNP 884 (230, 3010) pg/mL. Patients with a REVEAL 2.0 risk score ≤ 4 had a 1-year clinical worsening free-survival and 3-year survival rate of 92% and 95% (Figure 1). The 3-years survival was significantly better in patients with a REVEAL 2.0 ≤ 4 compared to 5-6: HR=0.47, 95%CI[0.27-0.84], p=0.01. Compared to patients with REVEAL 2.0 risk score of 5-6 (“classical” low-risk), those with a REVEAL 2.0 risk score ≤ 4 (“refined low-risk”) had a better clinical, biological, hemodynamic presentation, and outcomes (Table 1).Conclusion:This study is the first embedding both morbidity and mortality within the definition of low risk for PAH patients and suggests that PAH patients with REVEAL 2.0 risk score ≤ 4 meet this definition. This definition may be a promising new treatment-goal strategy in future randomized controlled trials but also for daily clinical practice.

Circulation, Volume 150, Issue Suppl_1, Page A4146790-A4146790, November 12, 2024. Introduction:Available data suggest there is some regularity in the time of the day when patients experience their first clinical symptoms (pain) of ST Elevation Myocardial Infarction (STEMI). It has been noticed that the largest number of cases of myocardial infarction are observed in the early morning. Some studies, especially in Asian populations, have found a shift into the afternoon hours. Additionally, some publications suggest the existence of secondary peaks of incidence in the evening hours. There also seems to be a relationship between night hours and the occurrence of myocardial infarctions in patients with sleep apnea. Although the risk of myocardial infarction is highest in the morning, there are differences depending on the region and population which might indicate the influence of local and individual factors on the circadian rhythm of the disease.Objective:To analyze circadian variation of STEMI first chest pain onset occurence on one of the largest populations tested so far and to see if there is an association with time delays to Percutaneous Coronary Intervention (PCI).Methods:Data from the Polish National PCI Registry (ORPKI Registry) on patients with confirmed STEMI diagnosis who underwent either coronary angiography and/or PCI from 2014 untill 2022 were analyzed.Results:There were 153 543 individual patients in the analyzed time period with 68% of males. Circadian variation in the probablity of STEMI occurence in both men and women is presented in Figure 1 (p >0.05). Median time from chest pain onset to first medical contact (FMC) was 180 minutes (60-260; 95% CI) at 3 am and 90 minutes (59-196; 95% CI) at 1 pm respectively (p

Circulation, Volume 150, Issue Suppl_1, Page A4143426-A4143426, November 12, 2024. Background:Massage therapy has been increasingly recognized as a complementary intervention that can help alleviate pain and anxiety in various clinical settings. However, the efficacy of this intervention in patients undergoing cardiac surgeries remains unclear. This systematic review and meta-analysis aims to evaluate the existing evidence of massage therapy for postoperative pain in cardiac surgery patients.Methods:We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) analyzing the efficacy of massage therapy in patients undergoing cardiac surgeries. We pooled standardized mean differences (SMD) for continuous outcomes with 95% confidence intervals (CI) with a random-effects model. We utilized mean change from baseline values and post intervention values in separated plots to preserve the weighting of this meta-analysis. We performed a trial sequential analysis (TSA) to assess the random risk of postoperative pain with mean change from baseline values. We used R version 4.3.2 and TSA version 0.9.5.10 for statistical analyses.Results:Our meta-analysis included 12 RCTs comprising 1015 patients, of whom 484 (47.7%) were randomized to massage therapy. Compared with control, massage significant reduced postoperative pain based on mean change from baseline values (SMD -0.47; 95% CI: -0.73 to -0.21; p

Circulation, Volume 150, Issue Suppl_1, Page A4135082-A4135082, November 12, 2024. Background:High levels of small dense low-density lipoprotein (sdLDL) is a hallmark of dyslipidemia; however, studies on sdLDL cholesterol levels and risk of peripheral artery disease are sparse and results inconclusive.Hypothesis:We tested the hypothesis that higher levels of sdLDL cholesterol are associated with increased risk of peripheral artery disease in a primary prevention setting.Methods:We studied 31,036 individuals free of lipid-lowering therapy, ischemic stroke, and myocardial infarction at study entry in 2013-2017. All had fresh sample measurements of sdLDL cholesterol. During a median follow-up on 6.2 years, 155 were diagnosed with peripheral artery disease. The association was confirmed using ankle-brachial index (ABI) ≤ 0.9 as endpoint. Lastly, as comparison across different vascular beds risk estimates for myocardial infarction and ischemic stroke were calculated.Results:Higher levels of sdLDL cholesterol were associated with higher risk of peripheral artery disease and an ABI ≤ 0.9 illustrated by cubic splines multivariable adjusted for sex, systolic blood pressure, education, body mass index (BMI), diabetes, large buoyant LDL cholesterol, and age. Per 1 mmol/L (37 mg/dL) higher sdLDL cholesterol hazard ratio for peripheral artery disease was 2.01 (95% CI: 1.41-2.85) and odds ratio for an ABI ≤ 0.9 was 1.51 (95% CI: 1.07-2.14) in multivariable adjusted models. The cumulative incidence of peripheral artery disease was respectively 1.5%, 2.5%, and 3.5% for individuals having a sdLDL cholesterol in the 1st-50th, 51st-90th, and the 91st-100thpercentiles at age 80. For the 91st-100thversus the 1st-50thpercentile a hazard ratio on 2.51 (95% CI: 1.50-4.20) for peripheral artery disease, 2.18 (95% CI: 1.58-3.01) for myocardial infarction, and 1.85 (95% CI: 1.37-2.49) for ischemic stroke was found. Furthermore, the association of higher sdLDL cholesterol with increased risk of peripheral artery disease was robust in sensitivity analyses.Conclusion:Higher levels of sdLDL cholesterol were robustly associated with increased risk of peripheral artery disease in a primary prevention setting.

Circulation, Volume 150, Issue Suppl_1, Page A4147770-A4147770, November 12, 2024. Background:Randomized control trials (RCTs) have compared transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis (AS) at low-intermediate surgical risk.Objective:To compare TAVR vs. SAVR for AS in low-intermediate surgical risk patients.Methods:We systematically searched PubMed, Scopus, and Cochrane Central databases for studies comparing TAVR with SAVR for AS in low-intermediate surgical risk. Outcomes included composite death or stroke, death, stroke, myocardial infarction (MI), cardiac death, new atrial fibrillation (AF), new pacemaker implantation, acute kidney injury (AKI), bleeding, major vascular complications, endocarditis, aortic valve reintervention, and rehospitalization at 1 year. Random effects models were used to generate risk ratios (RRs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I2statistics.Results:The systematic review identified 8 RCTs including 9,239 patients (TAVR n=4,695, 50.8%). Death or stroke (RR 0.78; 95%CI 0.62-0.98; p=0.033; I2=52%), cardiac death (RR 0.79; 95%CI 0.63-0.98; p=0.029; I2=1%), bleeding (RR 0.39; 95%CI 0.25-0.60; p

Circulation, Volume 150, Issue Suppl_1, Page A4140003-A4140003, November 12, 2024. Background:Hypertension is a major preventable risk factor for cardiovascular (CV) disease. Emerging evidence suggests that in addition to blood pressure (BP) levels, controlling the consistency of BP is a key determinant of clinical outcomes. We aimed to assess the effects of consistency of BP control on adverse CV and renal outcomes using two metrics: long-term variability of systolic BP (LT-BPV) and the degree at which BP control is achieved, known as cumulative systolic BP load (CBPL).Methods:We collected clinic systolic BP (SBP) measurements from UK Biobank primary care records in those diagnosed with hypertension (N=39,816), chronic kidney disease (CKD, N=8,062), and neither of these (N=17,702), including a per-participant mean of 21 SBP values over 6 years. Instances of the primary outcome, 4-point major adverse cardiovascular events (MACE; stroke, acute myocardial infarction, heart failure hospitalization, and cardiovascular-related death), were collected from hospital records. Per-standard deviation (SD) and per-quartile hazard ratios (HR) were used to estimate LT-BPV, CBPL, and mean SBP separately using adjusted Cox regression. Sensitivity analyses were used to determine the independence of BP consistency effects from mean BP levels.Results:In those with hypertension, each per-SD increase in LT-BPV was associated with increased risk for MACE (HR=1.12, p=4.4E-11), specifically CV-related death, stroke, and HF hospitalization. LT-BPV effect estimates were strongest in those with controlled SBP and the strongest predictors for all events in those without high-risk comorbidities (coronary artery disease, CKD, peripheral vascular disease, and diabetes). CBPL was similarly associated with MACE (HR=1.13, p=8.1E-13), specifically stroke and acute myocardial infarction, but not with fatal events or HF. In those with CKD, both LT-BPV and CBPL were associated with progression to renal failure (HR=1.31-1.33, p

Circulation, Volume 150, Issue Suppl_1, Page A4144944-A4144944, November 12, 2024. Background:The American Heart Association’s (AHA) Life’s Essential 8 (LE8) concept serves as a quantitative framework for assessing cardiovascular health (CVH). Post-operative coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) patients are at high-risk for subsequent cardiovascular events (CVE). However, LE8 scores for post-procedural CABG or PCI patients remain unknown.Methods:Isolated post-operative CABG (n=208) or PCI (n=739) non-institutionalized patients from the National Institutes of Health’s (NIH) All of Us (AoU) Research Program (2017-2022) were included. LE8 scores (range 0-100, higher = better CVH; excluding diet metric) were calculated using methods recommended by the AHA. Physical activity and sleep metrics were derived from patients’ Fitbit data, while all other metrics were sourced from electronic health records (EHR).Results:Overall LE8 scores for post-operative CABG (57.9 [95% CI: 56.6-59.2]) and PCI patients (55.3 [54.4-56.1]) were significantly lower than that of the general population (65.9 [65.1-66.7] (p

Circulation, Volume 150, Issue Suppl_1, Page A4141419-A4141419, November 12, 2024. Introduction:Many patients with heart failure with preserved ejection fraction (HFpEF) have relatively low natriuretic peptide (NP) levels, often related to obesity. The predictors of mortality and hospitalization (CV outcomes) within HFpEF patients with low NT-proBNP levels remain unclear. In this study, we examined these predictors, comparing HFpEF with low NT-proBNP (HFpEF-LoBNP) and high NT-proBNP (HFpEF-HiBNP) groups.Methods:Patients from the Johns Hopkins HFpEF Clinic (July 2014 – May 2024) were categorized into HFpEF-LoBNP (

Circulation, Volume 150, Issue Suppl_1, Page A4140382-A4140382, November 12, 2024. Introduction:Although an estimated 54% of patients with heart failure (HF) and chronic pain report high symptom-associated distress, it is unclear whether pain predicts reduced physical function, cognitive function, independent activities of daily living (IADL) or health-related quality of life (HRQL) over time. The aims were to evaluate baseline pain presence as a predictor of physical function, cognitive function, IADL, and HRQL at baseline, 10 weeks, 4 months, and 8 months after baseline.Methods:In a retrospective longitudinal secondary analysis, data were analyzed from 237 participants with HF enrolled in the Cognitive Intervention to Improve Memory in Heart Failure Patients study. Pain presence was measured with the Health Utilities Index Mark-3 Questionnaire (HUI-3), physical function was measured by the Timed Up and Go (TUG), cognitive function was measured with the Montreal Cognitive Assessment (MoCA), IADL was measured by the Everyday Problems Test (EPT), and HRQL was measured by the Minnesota Living with Heart Failure Questionnaire (LHFQ). Descriptive statistics, independent t-tests, and linear mixed models were used to achieve the aims while controlling for gender.Results:The demographics were mean age 66.31 ± 12.02 years, gender 46% men, 54% women, race 13.5% Black, 85.7% White, 0.8% Other, NYHA class I: 9.7% II: 37.6% III: 52.7%, average LVEF: 48.9%. A total of 160 (67.51%) reported pain.In independent t-tests, patients with pain experienced significantly longer (i.e., worse) TUG scores at all timepoints except 10 weeks, and significantly higher (i.e., worse) LHFQ scores at all timepoints (see Table 1). However, in linear mixed models, pain at baseline did not predict TUG scores (F = 1.239, p = .298), MoCA scores (F = 0.148, p = .931), EPT scores, (F = 0.522, p = .668), or LHFQ scores (F = 0.364, p = .779) over time – see Table 1.Conclusions:Patients with HF and pain experienced significantly worse LHFQ and TUG scores at multiple timepoints. However, pain did not significantly predict cognitive function, physical function, IADL, or HRQL over time. Future prospective studies are needed to examine other outcomes associated with pain in this population and utilize more robust pain instruments.

Circulation, Volume 150, Issue Suppl_1, Page A4124369-A4124369, November 12, 2024. Background:Several clinical trials have demonstrated non-inferiority of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis (AS) and low to intermediate surgical risk. However, mid-term results are still contentious.Question:Is TAVR superior to SAVR in the mid-term in terms of mortality outcomes or adverse cardiovascular events?Methods:We searched Embase, Pubmed and Cochrane databases for RCTs that compared TAVR with SAVR in patients with symptomatic severe AS with a follow-up of at least 4 years. Outcomes of interest were all-cause mortality and disabling stroke.Results:We included six RCTs involving 6,444 patients with severe AS, of whom 3,282 (50.9%) underwent TAVR. There was no difference in mortality from all causes (RR 1.08; 95%CI 0.94-1.25; p=0.30; I2=45%) and disabling stroke (RR 0.95; 95%CI 0.75-1.21; p=0.67; I2=9%) between groups. In the subgroup analysis, 5-year mortality (RR 1.28; 95%CI 1.10-1.49; I2=0%) was higher in the TAVI group. The new pacemaker implantation rate was higher in the TAVI group (RR 2.22; 95%CI 1.42-3.45; p=0.0004 ; I2=91%). However, new atrial fibrillation rate was higher in the SAVR group (RR 0.42; 95%CI 0.37-0.49; p=0.00001; I2=62%).Conclusion:Mid-term mortality and disabling stroke of patients with severe AS treated with TAVR or SAVR were similar.

Circulation, Volume 150, Issue Suppl_1, Page A4139970-A4139970, November 12, 2024. Introduction:Anticoagulation (AC) is the mainstay of thromboprophylaxis for stroke prevention in atrial fibrillation (AF) and is recommended. Gastrointestinal bleeding (GIB) is a common complication with varied severity and often poses a challenge for cardiologists and gastroenterologists. The decision of whether to continue anticoagulation, when to resume and at what dose is often the challenge. Our study assesses the safety and efficacy of low-dose apixaban compared to a full-dose in patients with AF who had GIB over the course of 5 years.Methods:We queried the US Collaborative Network (which contains 63 healthcare organizations) of TriNetX deidentified research database. Patients with atrial fibrillation who have history of gastrointestinal bleed who received apixaban were identified and divided into two cohorts; patients on low dose of 2.5mg and those on full dose of 5mg. We excluded patients with serum creatinine ≥ 1.5 mg/dL and patients with body weight ≤ 132 lbs.Two well-matched cohorts were created using a 1:1 propensity-score matching (PSM) model using patients’ baseline characteristics and comorbidities. PSM components were age, gender, race, PPI use, anti-platelets, hypertension, coronary artery disease, heart failure, COPD, and CKD. We compared the risk of stroke, GIB, and mortality in 5 years.Results:A total of 19,427 patients with UGIB who have AFIB received oral apixaban were identified. Of those, 19% (n=3,701) were on low dose of 2.5mg and 81% (n=15,726) were on full dose of 5mg of apixaban. After PSM, each cohort included 3,701 patients. There was no statistically significant difference in the risk of stroke in 5 years between the patients on low dose compared to those on full dose (10.9% vs 11.9%, p=0.3). However, patients on low dose had a statistically significant lower risk of GIB compared to those on full dose (30.4% vs 35.3%, p