The safety and efficacy of direct oral anticoagulants (DOACs) in patients with left ventricular assist devices (LVADs) remain uncertain because of limited comparative data with warfarin. Are DOACs a safe and effective alternative to warfarin in patients with durable LVADs? A retrospective cohort study using the TriNetX database was conducted. Adults with LVADs prescribed DOACs or warfarin were included. Propensity score matching (1:1) was performed to balance baseline characteristics. The primary outcome was all-cause mortality. Secondary outcomes included thromboembolic events, major bleeding, and blood transfusion requirements. Among 3726 patients with LVAD, 79 received DOACs and 3647 received warfarin. After matching, 77 patients remained in each group. At 5 years, all-cause mortality was significantly lower in the DOAC group compared to warfarin (13% vs. 30%, P < 0.001). Rates of thromboembolism and major bleeding were similar, while blood transfusion needs were lower in the DOAC group (13% vs. 22.1%). In this multicenter cohort, DOACs were associated with improved long-term survival and comparable safety outcomes relative to warfarin in LVAD patients. These findings suggest DOACs may be a viable alternative, but larger prospective studies are warranted.

Adjustment disorder with mixed anxiety and depressed mood lacks established treatment protocols, despite its clinical significance. Repetitive transcranial magnetic stimulation (rTMS) has demonstrated efficacy in stress-related conditions, yet its application in adjustment disorder remains limited. This retrospective chart review examined the safety and clinical benefit of rTMS for this condition in a Romanian health care context. Sixty adults with adjustment disorder with mixed anxiety and depressed mood were identified from outpatient clinic records and grouped by treatment received: rTMS alone (n = 20), rTMS with medication (n = 10), or medication only (n = 30). Low-frequency 1-Hz stimulation at 110% of the motor threshold was applied to the right dorsolateral prefrontal cortex in 10 sessions over 2 weeks. Depressive and anxiety symptoms were measured at baseline and at day 30 using the Hamilton Depression Rating Scale and the Hamilton Anxiety Scale. Logistic regression analysis was used to identify factors associated with treatment outcomes. Significant symptom improvements occurred across all groups ( P < 0.001). Complete remission rates varied substantially: rTMS monotherapy achieved 80% remission, medication alone 40%, and combined treatment 20% (χ 2 = 13.714, P = 0.008). Sixty percent of participants showed clinical response. Treatment modality predicted response, with rTMS monotherapy increasing odds of improvement 5.7-fold versus medication alone ( P = 0.017). Lower baseline anxiety predicted combined remission (OR = 0.779, P = 0.001), while demographic factors showed no predictive value. Adverse events were mild and transient, with no serious complications or discontinuations. Urban residence significantly influenced rTMS uptake ( P = 0.011). rTMS seems effective and may be considered alongside conventional pharmacotherapy for adjustment disorder with mixed anxiety and depressed mood. The intervention showed good tolerability. Geographic barriers to access warrant attention in service planning. Larger randomized controlled trials with extended follow-up are needed to confirm these findings and establish optimal protocols.