Revisiting the Association of ECOG Performance Status With Clinical Outcomes in Diverse Patients With Cancer.

BACKGROUND: The ECOG performance status (PS) scale was developed to support national clinical trials, but the degree to which ECOG PS predicts clinical outcomes in patient subgroups outside of clinical trials is relatively unknown. This study examined associations between ECOG PS and adverse outcomes in a diverse community oncology population. PATIENTS AND METHODS: In this retrospective cohort study, demographic and clinical characteristics, including the most recent ECOG PS between January 1, 2017, and December 31, 2019, were examined for patients receiving cancer treatment within Kaiser Permanente Northern California (KPNC). Proportional hazard models were used to evaluate the effect of ECOG PS on adverse outcomes. RESULTS: A total of 21,730 patients were identified. Overall, most patients had an ECOG PS of 0 (42.5%) or 1 (42.5%). In multivariable analysis, an ECOG PS of 3 or 4 was associated with higher risk of 30-day emergency department visits (adjusted hazard ratio [aHR], 3.85; 95% CI, 3.47-4.26), 30-day hospitalizations (aHR, 4.70; 95% CI, 4.12-5.36), and 6-month mortality (aHR, 7.34; 95% CI, 6.64-8.11) compared with an ECOG PS of 0. Additionally, we found that upper gastrointestinal and stage IV cancers were associated with a higher risk of adverse outcomes compared with breast and stage I cancers, respectively. When adjusted for ECOG PS, African American race, Asian race, and female sex were associated with a lower risk of mortality than White race and male sex. An ECOG PS of 3 or 4 was more predictive of mortality in younger patients and those with breast cancer (P<.001). CONCLUSIONS: ECOG PS and upper gastrointestinal and stage IV cancers were independently associated with increased risk of emergency department visits, hospitalizations, and mortality, whereas African American and Asian race and female sex were associated with decreased risk of mortality. An ECOG PS of 3 or 4 was more predictive of an increased risk of mortality in younger patients and patients with breast cancer. These findings can enhance the use of ECOG PS for clinical decision-making and defining eligibility for clinical trials.

The Effect of Frontal Deformity at the Ankle Joint on Total Ankle Arthroplasty Revision Rate.

The presence of severe coronal plane deformity in the ankle joint is widely recognized as challenging to correct by total ankle joint arthroplasty alone, necessitating additional rearfoot fusion. The primary aim of this retrospective study was to investigate the potential associations between the presence or severity of coronal tibiotalar deformities and adverse outcomes after isolated total ankle arthroplasty, such as revisions and complications. The secondary aim was to analyze the potential associations between comorbidities, demographics, and implant types, and adverse outcomes. Our study's distinctive feature was its exclusive concentration on patients with deformities centralized in the ankle joint. Chart review was performed on 496 ankles in 456 patients who had a total ankle arthroplasty by 5 surgeons from 1/1/2010 to 12/31/2019. After exclusion and inclusion criteria were applied, total of 214 ankles in 210 patients were included for data analysis. At a mean follow-up period of 3 ± 2.0 years, our cohort had 15 (7.0%) revisions and 15 (7.0%) complications. Multivariable logistic regression model showed that the presence or severity of the coronal deformity was not significantly associated with incidences of revisions or complications. Female patients had significantly lower revision rate. Otherwise, the differences in age, race, body mass index, tobacco use, presence of diabetes, chronic kidney disease, atrial fibrillation, length of surgery, or type of implant were not significantly associated with incidences of revisions or complications. Further study could be performed to analyze the extent and duration that the coronal deformity correction is maintained after total ankle arthroplasty as well as the effect of each soft tissue procedure performed with the total ankle arthroplasty.

Effect of Acetylation of Two Cellulose Nanocrystal Polymorphs on Processibility and Physical Properties of Polylactide/Cellulose Nanocrystal Composite Film.

Polylactide (PLA) has become a popular alternative for petroleum-based plastics to reduce environmental pollution. The broader application of PLA is hampered by its brittle nature and incompatibility with the reinforcement phase. The aim of our work was to improve the ductility and compatibility of PLA composite film and investigate the mechanism by which nanocellulose enhances PLA polymer. Here, we present a robust PLA/nanocellulose hybrid film. Two different allomorphic cellulose nanocrystals (CNC-I and CNC-III) and their acetylated products (ACNC-I and ACNC-III) were used to realize better compatibility and mechanical performance in a hydrophobic PLA matrix. The tensile stress of the composite films with 3% ACNC-I and ACNC-III increased by 41.55% and 27.22% compared to pure PLA film, respectively. Compared to the CNC-I or CNC-III enhanced PLA composite films, the tensile stress of the films increased by 45.05% with 1% ACNC-I and 56.15% with 1% ACNC-III. In addition, PLA composite films with ACNCs showed better ductility and compatibility because the composite fracture gradually transitioned to a ductile fracture during the stretching process. As a result, ACNC-I and ACNC-III were found to be excellent reinforcing agents for the enhancement of the properties of polylactide composite film, and the replacement some petrochemical plastics with PLA composites would be very promising in actual life.

P2Y12 Inhibitors in Acute Coronary Syndromes: A Real-World, Community-Based Comparison of Ischemic and Bleeding Outcomes.

Background: Randomized trials have shown superiority of the novel P2Y12 inhibitors over clopidogrel in patients with acute coronary syndrome (ACS), but clinical benefit in the community remains controversial. Our objective was to compare the safety and efficacy of clopidogrel to ticagrelor and prasugrel in patients with ACS undergoing percutaneous coronary intervention (PCI) in a real-world population. Methods: We conducted a retrospective cohort study of patients with ACS who underwent PCI and were discharged with clopidogrel, ticagrelor, or prasugrel from 2012 to 2018 within Kaiser Permanente Northern California. We used Cox proportional hazard models with propensity-score matching to evaluate the association of the P2Y12 agent with the primary outcomes of all-cause mortality, myocardial infarction (MI), stroke, and bleeding events. Results: The study included 15,476 patients (93.1% on clopidogrel, 3.6% on ticagrelor and 3.2% on prasugrel). Compared to the clopidogrel group, ticagrelorand prasugrel patients were younger with less comorbidities. In multivariable models with propensity-score matching, we found a lower risk of all-cause mortality in the ticagrelor vs the clopidogrel group (HR (95% CI) 0.43 (0.20-0.92)), but no differences in the other endpoints, and no difference between prasugrel and clopidogrel among any endpoints. A larger proportion of patients on ticagrelor or prasugrel switched to an alternative P2Y12 agent vs. clopidogrel (p < 0.01), and a higher level of persistence was seen among patients on clopidogrel vs. ticagrelor (p = 0.03) or prasugrel (p < 0.01). Conclusion: Among patients with ACS who underwent PCI, we observed a lower risk of all-cause mortality in patients treated with ticagrelor vs clopidogrel, but no difference in other clinical endpoints nor any differences in endpoints between prasugrel vs. clopidogrel users. These results suggest that further study is needed to identify an optimal P2Y12 inhibitor in a real-world population.

The Contemporary Probability of Occult Colorectal Cancer in Patients With Colitis-Related Dysplasia Undergoing Colectomy.

Occult colorectal cancer (CRC) has historically driven recommendations for colectomy in patients with inflammatory bowel disease with dysplasia . We defined the contemporary risk of occult CRC at colectomy among 93 patients with inflammatory bowel disease with dysplasia based on endoscopic appearance, resection, and concordance between site of cancer at colectomy and dysplasia at colonoscopy. Contrary to our hypothesis, we found that occult CRC at colectomy remains elevated in high-grade polypoid and invisible dysplasia. It was infrequent in other visible lesions. When present, occult cancer occurred in the same segment as dysplasia, suggesting the historic concern of missing a remote cancer is low.

Increased Risk of Hospitalization, Surgery, and Venous Thromboembolism Among Patients With Inflammatory Bowel Disease and Malnutrition in a Large, Community-Based Health Care System.

INTRODUCTION: Patients with inflammatory bowel disease (IBD) constitute a high-risk population for malnutrition. Routine screening with standardized tools is recommended but can be challenging. Outcome data specific to IBD are sparse. METHODS: We performed a retrospective cohort study (2009-2019) and electronically screened a large community-based population with IBD for malnutrition risk by extracting height and longitudinal weight, data elements used in the Malnutrition Universal Screening Tool (MUST). We used Cox proportional hazards regression to evaluate whether an electronic medical record-derived modified MUST malnutrition risk score was associated with IBD-related hospitalization, surgery, and venous thromboembolism. RESULTS: Malnutrition risk was categorized as low in 10,844 patients with IBD (86.5%), medium in 1,135 patients (9.1%), and high in 551 patients (4.4%). In the 1-year follow-up period, medium and high malnutrition risks, compared with low risk, were associated with IBD-related hospitalization (medium-risk adjusted hazard ratio [aHR] 1.80, 95% confidence interval [CI] 1.34-2.42; high-risk aHR 1.90, 95% CI 1.30-2.78) and IBD-related surgery (medium risk aHR 2.28, 95% CI 1.60-3.26; high risk aHR 2.38, 95% CI 1.52-3.73). Only high malnutrition risk was associated with venous thromboembolism (aHR 2.79, 95% CI 1.33-5.87). DISCUSSION: Malnutrition risk is significantly associated with IBD-related hospitalization, surgery, and venous thromboembolism. Application of the MUST score to the electronic medical record can efficiently identify patients at risk for malnutrition and adverse outcomes, permitting concentration of nutritional and nonnutritional resources to those at greatest risk.

Flexible biomimetic materials with excellent photothermal performance and superhydrophobicity.

Although thousands of superhydrophobic composites have been reported, it is still a challenge to develop eco-friendly superhydrophobic materials by a simple and low-cost strategy. Here, a paper-based superhydrophobic material was prepared by carbon fiber powders and polydimethylsiloxane through a facile spraying method. This obtained material has excellent liquid resistance and self-cleaning properties, whose contact angle reaches 155°. In addition, it possesses excellent photothermal conversion characteristics with a stable surface temperature of 73.4 °C and good water evaporation performance with an evaporation rate up to 1.08 kg/(m2·h) under one solar intensity (100 mW/cm2). Also, it has outstanding self-deicing performance, whose deicing time is 120 s earlier than that of the untreated surface under one solar intensity. An adaptability test shows this strategy of functional coatings can also be applied to other fiber substrates (coating paper, kraft paper, non-woven fabric, paulownia veneer, etc.). Overall, this superhydrophobic material has a promising application prospect in many fields such as waterproof packaging, deicing materials, water evaporation materials, etc.

Preparation, characterization of light-colored lignin from corn stover by new ternary deep eutectic solvent extraction.

The industrial lignin has shown great potential to replace some of petrochemical. But the deep color of lignin limits their application in high-value field. The extraction of light-colored lignin from lignocellulose still remains challenging. Here, we reported a strategy for rapid extraction of lignin from corn stover by using a new ternary deep eutectic solvent (TDES) composed of choline chloride (ChCl), formic acid (FA) and maleic acid (MA). The color feature and structural characterization of obtained lignin was comprehensively elucidated. The results revealed that the lignin streams had light color (brightness ISO 23.44 %) with a high yield (76.3 %), purity (93.5 %), low molecular weight (Mw 1544-2040 g/mol), and low polydispersity (PDI ≤ 1.76). The introduction of MA could reduce the destruction of lignin substructure during the treatment process and avoid the deepening of lignin color. Quantitative analysis of conjugated carbonyl and quinone carbonyl and semi-quantitative analysis of lignin by 2D NMR showed that temperature had a great influence on its structure.

Hereditary Breast and Ovarian Cancer Genetic Risk: Screening and Treatment Among Transgender and Gender Diverse Patients.

IntroductionTransgender and gender diverse (TGD) populations with hereditary cancer syndromes face unique barriers to care and thus may not be accessing appropriate cancer screening or risk-reducing procedures. Our objective was to evaluate health care utilization of TGD patients with hereditary cancer syndromes. This includes counseling received, cancer screenings conducted, and risk-reducing procedures performed. MethodsA case series of TGD patients (N = 11) with hereditary breast and ovarian cancer (n = 9) or Lynch syndrome (n = 2) who received care within Kaiser Permanente Northern California between 2009 and 2019. ResultsAll patients received counseling and prophylactic options. Three patients (27%) completed all recommended screening, 6 (54%) had partial screening, 1 (9%) received no screening, and 1 (9%) did not require any screening. Six (55%) underwent a risk-reducing procedure. DiscussionThis case series highlights that despite all the study participants being appropriately counseled by practitioners about their risk of cancer, screening, and prophylactic options, in many cases, the screening received was partial or absent. Relatively few completed all the recommended screenings based on their clinical risk factors. ConclusionMany of the TGD patients with hereditary cancer syndromes in this cohort did not complete all the recommended cancer screening. This can be an area of focus in order to improve the quality of care provided to this vulnerable population.

Highly efficient and rapid purification of organic dye wastewater using lignin-derived hierarchical porous carbon.

Coating manufacturing, textile processing, and plastic industry have led to dramatical release levels of hazardous organic dye pollutants threatening public health and the environment. To solve this problem, porous carbon materials are being developed following with the United Nations initiative on water purification. However, conventional porous carbon materials face many challenges, such as limited removal rates, low adsorption capacity, and high chemicals consumption, hampering their large-scale utilization in dye wastewater treatment. Herein, we demonstrate a high-performance lignin-derived hierarchical porous carbon (LHPC) material directly prepared from renewable lignin through a low-cost activation procedure. The large specific surface area (1824 m2/g) enables the rapid and effective adsorption of organic dyes. Therefore, the LHPC exhibits an ultrahigh adsorption ability (1980.63 mg/g) and removal rate (99.03% in 10 min) for Azure B, superior to that of other adsorbents. Additionally, the LHPC adsorbent, organic dyes, eluting agent, and water all can be recycled and reused in a designed close-looped system. Its high removal ability and rate, strong retrievability, low-cost and scalable production combined with high dyes adsorption universality, positions our LHPC as a promising commercial adsorbent candidate for the purification of harmful organic dye wastewater, especially for heavily polluted area with an insistent demand for clear water.

Physicochemical transformation and enzymatic hydrolysis promotion of reed straw after pretreatment with a new deep eutectic solvent.

This work proposed a promising biorefinery method for the deconstruction of reed straw by using a novel deep eutectic solvent (DES) consisted of benzyltriethylammonium chloride/formic acid (BTEAC/FA). BTEAC/FA showed significant delignification and xylan removal while preserving most of the cellulose. Under the optimum conditions (molar ratio: 1:6), the glucose yield of cellulose-rich substrates by enzymatic hydrolysis reached 76.64%, which was about 5.24-fold higher than that of raw reed straw. The removal of lignin and hemicellulose and the changes in the cellulose crystal structure were presumed to the reason for enhancing enzymatic hydrolysis efficiency. The highest lignin yield reached 78.34%. Moreover, the lignin exhibited high purity (84.25%-91.45%), medium molecular weight (3812-9918 g/mol), and low polydispersity (1.47-2.75) because of the cleavage of ß-O-4 and ß-ß linkages. Overall, this work provided a theoretical basis for the in-depth utilization of reed straw.

A design with natural polysaccharide particles and cationic conditioning agent as efficient emulsifier for hair care.

An ideal hair-care product can restore the hydrophobicity and neutralize the static electricity of hair. As an effective ingredient in hair-care products, silicone oil is difficult to form emulsions due to its hydrophobic and oleophobic properties. To overcome these issues, a new system with natural polysaccharide-based particles and cationic conditioning agent as efficient emulsifier for hair-care product has been designed. In this study, a facile emulsifier formed with cellulose nanocrystals (CNCs) and hexadecyltrimethylammonium chloride (CTAC) was prepared. Compared with commercial emulsifiers, the CNCs/CTAC complex showed significant synergetic effect in preparing and stabilizing silicone oil emulsion. The properties of the gained silicone oil emulsion, deposition of silicone oil onto hair and combing work of hair could be controlled depending on CTAC concentration. Considering the functional properties of CTAC, which can absorb onto the hair to neutralize negative charges, silicone oil emulsion stabilized by CNCs/CTAC complex would be applied to hair-care product.

Eco-Friendly Superhydrophobic Composites with Thermostability, UV Resistance, and Coating Transparency.

Despite the market demand for biofiber assemblies endowed with superhydrophobicity being huge, the current approaches to their production are complicated, time-consuming, and even pose a serious threat to the environment. Here, we report a simple surface treatment strategy to prepare environmentally friendly superhydrophobic biofiber composites. The obtained samples have certain UV resistance properties, which are mainly determined by the titanium dioxide (TiO2) dosage. Additionally, the sample has excellent thermal stability, and the contact angle is maintained at 153.26° after heat treatment at 140 °C for 1 h. Quite encouragingly, thermal annealing of samples can transform translucent coatings into transparent structures and increase the tensile strength. The results also showed that this strategy could be integrated into the mass production process of other biofiber components as coating, such as coated paper, pulp boards, cotton gauzes, tissues, and so forth. Due to the facile preparation and environment-friendliness, this sustainable paper-based product can be used in diversified applications: packaging and storage of liquid food, protection of ancient books, UV- and rain-proof materials, and teaching demonstrations relevant to bionics, among others.

Pretreatment of pine lignocelluloses by recyclable deep eutectic solvent for elevated enzymatic saccharification and lignin nanoparticles extraction.

This study investigated the process intensification strategies for the pretreatment of Radiata Pine with the green deep eutectic solvent (DES) system composed of benzyltrimethylammonium chloride/formic acid (BTMAC/FA). The results showed that DES pretreatment drastically improved the delignification and hemicelluloses-removal capacity. The conducted process acceptably remained most of the cellulose in pretreated biomass (88.3%-91.8%). Benefiting from the overcoming of recalcitrance, the enzymatic digestibility of pretreated residues reached 92.4%. The efficient conversion was mainly ascribed to the lignin and hemicelluloses co-extraction. Meanwhile, the lignin yield and enzymatic saccharification was still largely maintained after five reuses. Further structural characteristics of lignin nanoparticles revealed that the lignin possessed high purity (95.19-97.51%), medium molecular weight (9600 to 6495 g/mol), and low polydispersity (ca 2.0), which was attributed to cleavage of ether bonds in lignin as well as linkages between lignin and hemicelluloses. Overall, this study illustrated that DES pretreatment was promising to achieve an efficient fractionation of woody biomass into fermentable glucose and high-quality lignin.

Association of Positive Fluid Balance at Discharge After Sepsis Management With 30-Day Readmission.

Importance: Although early fluid administration has been shown to lower sepsis mortality, positive fluid balance has been associated with adverse outcomes. Little is known about associations in non-intensive care unit settings, with growing concern about readmission from excess fluid accumulation in patients with sepsis. Objective: To evaluate whether positive fluid balance among non-critically ill patients with sepsis was associated with increased readmission risk, including readmission for heart failure. Design, Setting, and Participants: This multicenter retrospective cohort study was conducted between January 1, 2012, and December 31, 2017, among 57 032 non-critically ill adults hospitalized for sepsis at 21 hospitals across Northern California. Kaiser Permanente Northern California is an integrated health care system with a community-based population of more than 4.4 million members. Statistical analysis was performed from January 1 to December 31, 2019. Exposures: Intake and output net fluid balance (I/O) measured daily and cumulatively at discharge (positive vs negative). Main Outcomes and Measures: The primary outcome was 30-day readmission. The secondary outcomes were readmission stratified by category and mortality after living discharge. Results: The cohort included 57 032 patients who were hospitalized for sepsis (28 779 women [50.5%]; mean [SD] age, 73.7 [15.5] years). Compared with patients with positive I/O (40 940 [71.8%]), those with negative I/O (16 092 [28.2%]) were older, with increased comorbidity, acute illness severity, preexisting heart failure or chronic kidney disease, diuretic use, and decreased fluid administration volume. During 30-day follow-up, 8719 patients (15.3%) were readmitted and 3639 patients (6.4%) died. There was no difference in readmission between patients with positive vs negative I/O (HR, 1.00; 95% CI, 0.95-1.05). No association was detected between readmission and I/O using continuous, splined, and quadratic function transformations. Positive I/O was associated with decreased heart failure-related readmission (HR, 0.80 [95% CI, 0.71-0.91]) and increased 30-day mortality (HR, 1.23 [95% CI, 1.15-1.31]). Conclusions and Relevance: In this large observational study of non-critically ill patients hospitalized with sepsis, there was no association between positive fluid balance at the time of discharge and readmission. However, these findings may have been limited by variable recording and documentation of fluid intake and output; additional studies are needed to examine the association of fluid status with outcomes in patients with sepsis to reduce readmission risk.

Source apportionment of pulping wastewater and application of mechanical vapor recompression: Environmental and economic analyses.

It is expected that low-energy and scientific zero discharge of chemical-mechanical pulping wastewater will be achieved by applying the mechanical vapor recompression (MVR) technology. In this paper, the equal-standard pollution load model was introduced into pulp and paper field to parse the pollution sources for the first time. The results from the source apportionment indicated that the screw press and concentrating were the major pollution unit operations, and their cumulative load ratio reached 92.92%. The further survey demonstrated that the dominating pollution factors in the traditional chemical-mechanical pulping process were Chemical Oxygen Demand (COD), Biochemical Oxygen Demand (BOD5), and Suspended Solids (SS), whose cumulative load ratio was 92.69%. The environmental analysis demonstrated the implementation of MVR technology significantly decreased the pollution load and reduce the pressure of subsequent wastewater treatment. In addition, a further economic performance indicated that the utilization of MVR technology possessed a smaller operating cost of 2.899 $/m3. The result of the given model provides a scientific gist and instruction for the future treatment of water pollutants in the chemical-mechanical pulping process. The MVR technology is conducive for wastewater treatment to minimize environmental effects and costs.

Outcomes Following Open Reduction Internal Fixation of Ankle Fractures (ORIF) By Podiatric Surgeons.

Open reduction internal fixation of closed ankle fractures is a common procedure performed by podiatric surgeons. This is the first study to specifically evaluate complication rates of this procedure among podiatric surgeons using a large patient cohort. The rates of podiatric surgical complications were also compared to the complication rates reported in the orthopedic literature. There was no significant difference between podiatric surgeons and orthopedic surgeons with regards to surgical site infection. However, complication rates, including 1-year postsurgery deep vein thrombosis (DVT), malunion, and unplanned revision surgery within 90-day, were lower in our study, compared to the average rates reported in the orthopedic literature. The authors believe that the most important determinant for post ankle surgical complications is related to surgical volume and experience, rather than professional degree type.

Success and Survivorship Following Charcot Reconstruction: A Review of 151 Cases.

Charcot neuroarthropathy is a debilitating condition that frequently leads to skeletal deformity and pedal ulceration in the insensate foot. Results are often poor and no clear guidelines for surgical management exist. Additionally, amputation rates vary widely making it difficult to accurately inform patients of risks. Few studies have assessed outcomes to identify patients for whom reconstruction is likely to fail. The literature is limited, with small sample sizes and mortality infrequently addressed. We performed a retrospective observational study of patients with Charcot neuroarthropathy to assess overall amputation and mortality rates at 30 days, 1 year, and 3 years postreconstruction and evaluated associated risk factors. Rates of infection, re-ulceration, and return to walking were also assessed. We identified 151 patients over a 5-year period. Demographic and clinical characteristics were collected. Descriptive statistics, Cox proportional hazard model, and logistic regression were used. Overall, 22 (14.6%) patients died, and 23 (15.2%) patients advanced to limb amputation postoperatively. End-stage renal disease, peripheral vascular disease, reconstruction during active phase Charcot process, and reconstruction at the ankle or subtalar joint were all associated with poor outcomes. The risk of mortality was 2.5 times higher in patients with end-stage renal disease, and 3.4 times higher among patients with peripheral vascular disease. Patients with ankle or subtalar joint reconstruction were 70% less likely to return to walking compared to medial column reconstruction. Due to these findings, we suggest that patients with such comorbidities be advised of increased risk for complications including failure to return to walking, amputation, and death.

Risks and benefits of concurrent treatment with antiplatelet and anticoagulation therapy in post-op bioprosthetic aortic valve replacement patients.

BACKGROUND AND AIM: Among patients receiving surgical bioprosthetic aortic valve replacement (bAVR), there is an elevated risk of thromboembolic events postoperatively. However, the risks and benefits of varying anticoagulation strategies remain controversial. The aim of this study is to compare the risks and benefits of aspirin monotherapy to aspirin plus warfarin ("concurrent therapy") in patients receiving bAVR. METHODS: A retrospective cohort study was conducted using patients' data from Kaiser Permanente Northern California, including those who underwent bAVR with or without coronary artery bypass grafting between 2009 and 2018. Patients were identified as having been discharged with aspirin only or concurrent therapy. The outcomes were mortality, thromboembolic events, and clinically relevant bleeding during a 6-month follow-up. The event rates were compared using the Kaplan-Meier method. Multivariable survival analysis, incorporating propensity scores, was used to estimate adjusted hazard ratios (aHRs) for each outcome. RESULTS: The cohort consisted of 3047 patients. Approximately 58% of patients received aspirin only and 42% received concurrent therapy. Patients who received concurrent therapy were more likely to be older, have hypertension, previous stroke, and longer hospital stays. After adjustment using multivariable analysis, concurrent therapy was associated with a higher risk of clinically relevant bleeding (aHR, 2.33; 95% confidence interval, 1.67-3.25). There was no significant difference in the risk of thromboembolic events or mortality between the two groups. CONCLUSION: Patients who underwent bAVR and were discharged on concurrent therapy compared to aspirin only had a significantly increased risk of bleeding without a significant difference in thromboembolic events.