Govinda Adhikari

Interests

Teaching

Teaching/mentoring in medicine and research

Research

Cardiovascular and critical care medicine, with a focus on large database analysis

Courses

No activities entered.

Scholarly Contributions

Journals/Publications

• Awad, A. K., Abuelazm, M., Adhikari, G., Amin, A. M., Elhady, M. M., Awad, A. K., Mahmoud, A., Gonnah, A. R., & Abdelazeem, B. (2024). Antithrombotic Strategies After Transcatheter Aortic Valve Replacement in Patients Without an Indication of Oral Anticoagulants: A Network Meta-Analysis of Randomized Controlled Trials. Cardiology in review.
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  Single-antiplatelet therapy (SAPT) has been a standard of care posttranscatheter aortic valve replacement with no clear evidence exist using direct oral anticoagulants (DOACs), vitamin K antagonists (VKA), or dual antiplatelet agents (DAPT); thus we aim to compare the safety and efficacy of the various antithrombotic strategies after transcatheter aortic valve replacement. We performed a network meta-analysis using a frequentist framework, pooling dichotomous outcomes using risk ratio (RR), and continuous data using mean difference, along with the corresponding 95% confidence interval (CI). Nine randomized controlled trials with 4193 patients were included, 567 patients were in the VKA group, 591 patients in the SAPT group, 1571 patients in the DAPT group, and 1464 patients in the DOACs group. Only DOAC showed a statistically significant higher risk of all-cause mortality [RR of 1.88 (95% CI: 1.07-3.28)] with no statistically significant difference between our arms in terms of mortality. For minor bleeding, DAPT had a significant higher risk with RR of 1.53 (95% CI: 1.04-2.25), while for major bleeding, DAPT and DOAC had a significant higher risk with RR of 2.36 (95% CI: 1.27-4.40) and 4.74 (95% CI: 2.05-10.92), respectively. There was no significant difference in terms of stroke and life-threatening bleeding. Moreover, only DOAC showed a significantly lower risk for valve thrombosis, when compared to other strategies [RR: 0.24 (95% CI: 0.13-0.46)]. Overall, SAPT had lower major bleeding events compared to other arms. There were no differences in the outcomes of stroke, myocardial infarction, or life-threatening bleeding outcomes. However, DOACs significantly reduced valve thrombosis compared to VKAs.
• Govinda, A., Mohamed, A., Ahmed, A., Mazen, A. A., M., E. M., K., A. A., Abdelrahman, M., & Basel, A. (2024). OUTCOMES OF STROKE WITH VARIOUS ANTICOAGULATION STRATEGIES AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT IN PATIENTS WITHOUT AN INDICATION OF ORAL ANTICOAGULANTS: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS. Journal of the American College of Cardiology, 83(13_Supplement), 922-922.
• Baral, N., Mitchell, J. D., Aggarwal, N. T., Paul, T. K., Seri, A., Arida, A. K., Sud, P., Kunadi, A., Bashyal, K. P., Baral, N., Adhikari, G., Tracy, M., & Volgman, A. S. (2023). Sex-based disparities and in-hospital outcomes of patients hospitalized with atrial fibrillation with and without dementia. American Heart Journal Plus: Cardiology Research and Practice, 26, 100266.
• Tse, G., Zhang, Q., Adhikari, G., Cheung, B., Basit, J., Zhou, J., Wong, W. T., Liu, T., Chou, O., Chung, C. T., Waleed, K. B., Lee, S., & Wong, I. (2023). 199 Alkaline phosphatase variability and heart failure in type 2 diabetes mellitus: the hong kong diabetes study. Heart, 109(Suppl 3), A234--A235.
• Abdelazeem, B., Shehata, J., Abbas, K. S., El-Shahat, N. A., Baral, N., Adhikari, G., Khan, H., & Hassan, M. (2022). De-escalation from Prasugrel or Ticagrelor to Clopidogrel in Patients with Acute Coronary Syndrome Managed with Percutaneous Coronary Intervention: An Updated Meta-analysis of Randomized Clinical Trials. American journal of cardiovascular drugs : drugs, devices, and other interventions, 22(3), 287-298.
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  We aimed to evaluate the clinical benefits of a de-escalation strategy from prasugrel or ticagrelor to clopidogrel versus continuation of prasugrel or ticagrelor along with aspirin in both strategies for patients presenting with acute coronary syndrome (ACS) and treated with percutaneous coronary intervention (PCI), and to analyze the effect of the recently published randomized clinical trial (RCT) by Park et al., which included the largest sample size ever and the largest switched number of patients, on current guidelines and practices.
• Adhikari, G., Baral, N., Rauniyar, R., Tse, G., Karki, S., Abdelazeem, B., Gergis, K., Savarapu, P., Isa, S., Sud, P., & Kunadi, A. (2022). Meta-analysis examining phosphodiesterase-5 inhibitors in heart failure with preserved ejection fraction. Proceedings (Baylor University. Medical Center), 35(5), 643-648.
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  Patients with heart failure with preserved ejection fraction have reduced cyclic guanosine 3',5'-monophosphate (cGMP) levels compared to those with reduced ejection fraction. Phosphodiesterase-5 inhibitors may play a cardioprotective role by potentiating the cGMP pathway. To address this question, we conducted a systematic search for randomized trials using the electronic databases of PubMed, Embase, and Google Scholar and used RevMan (version 5.4) for the data analysis. We included 221 subjects in the phosphodiesterase group (mean age 69.2 ± 3.43 years; 58.82% male) and 202 subjects in the control group (mean age 70.4 ± 4.96 years; 53.46% male). The mean follow-up duration was 5.85 ± 3.43 months. The pooled results showed no significant differences in peak oxygen consumption, 6-minute walking distance, mitral annular E/e' ratio, left ventricular ejection fraction, mean pulmonary artery pressure, pulmonary artery systolic pressure, and pulmonary vascular resistance between the phosphodiesterase group and the control group.
• Adhikari, G., Khan, A., Shams, N., Hassan, M. H., & Kunadi, A. (2022). A unique case of tachycardia-mediated cardiomyopathy in a patient misusing anabolic steroids. Clinical case reports, 10(6), e5976.
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  A 54-year-old male patient with history of anabolic androgenic steroid (AAS) misuse presented to the emergency department with new-onset atrial fibrillation and severely reduced ejection fraction. Cardiac catheterization revealed normal coronaries. He underwent cryo-balloon ablation with subsequent conversion to sinus rhythm. After appropriate guideline-directed medical management, ejection fraction improved on follow-up.
• AdhikariGovinda, ., BaralNischit, ., SeriAmith, R., KambalapalliSoumya, ., GhimireCalvin, ., PatelNeej, ., & KunadiArvind, . (2022). Abstract 14680: Outcomes of Coronary Artery Bypass Graft in Patients With Atrial Fibrillation - A Study From National Inpatient Database 2016-2019. Circulation, 146(Suppl_1), A14680-A14680.
• Ashiya, K., Nischit, B., Reddy, S. A., R., K. M., Hafiz, K., Basel, A., Govinda, A., Rohit, R., Khaing, H. K., Arvind, K., & U., C. H. (2022). TRENDS AND OUTCOMES OF ACUTE HEART FAILURE WITH UNDERLYING AMYLOIDOSIS - A RETROSPECTIVE COHORT STUDY FROM 2016-2019 NATIONAL INPATIENT SAMPLE DATABASE. Journal of the American College of Cardiology, 79(9_Supplement), 356-356.
• BaralNischit, ., Santos, V. S., parajuliprem, ., AdhikariGovinda, ., BashyalKrishna, ., OjhaNiranjan, ., SalehHassan, ., BalmuriShravya, ., KunadiArvind, ., AbdelazeemBasel, ., AridaAbdul, ., ObeidatIslam, ., SeriAmith, R., KambalapalliSoumya, ., & PaulTimir, K. (2022). Abstract 12160: Sex Differences in Outcomes of Percutaneous Coronary Intervention in Octogenarians: A Retrospective Cohort Study From National Inpatient Sample 2016-2019. Circulation, 146(Suppl_1), A12160-A12160.
• Nischit, B., Sri, J., Basel, A., Ashiya, K., Nagaraja, R. D., Prasad, B. K., Rohit, R., Govinda, A., Calvin, G., Khaing, H. K., Kazim, A., Arvind, K., Hafiz, K., & R., K. M. (2022). TELE-BASED VIRTUAL BP MANAGEMENT BY PHARMACIST OR NURSE PRACTITIONER VERSUS OFFICE-BASED PCP LED INTERVENTION IN MANAGEMENT OF SYSTOLIC BP. A SYSTEMATIC REVIEW AND META-ANALYSIS. Journal of the American College of Cardiology, 79(9_Supplement), 1579-1579.
• Soumya, K., Nischit, B., Reddy, S. A., R., K. M., Basel, A., Hafiz, K., Khaing, H. K., Rohit, R., Govinda, A., Ashiya, K., Arvind, K., U., C. H., & Ahmad, M. (2022). OUTCOMES OF HOSPITALIZED PATIENTS WITH ACUTE ISCHEMIC STROKE AND CONCOMITANT NSTEMI - ANALYSIS FROM 2016-2019 NATIONAL INPATIENT SAMPLE. Journal of the American College of Cardiology, 79(9_Supplement), 1081-1081.
• Abdelazeem, B., Gergis, K., Baral, N., Rauniyar, R., & Adhikari, G. (2021). Sudden Cardiac Death and Sudden Cardiac Arrest in Patients with Human Immunodeficiency Virus: A Systematic Review. Cureus, 13(3), e13764.
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  The importance of this review lies in its study of the risk of sudden cardiac death (SCD) and sudden cardiac arrest (SCA) in people living with the human immunodeficiency virus (PLWH). To the best of our knowledge, this is the first review investigating the effect of the human immunodeficiency virus (HIV) on SCD and SCA. The review's objective was to determine the risk of SCD and SCA in PLWH. To do this, the electronic databases Ovid MEDLINE, EMBASE, Cochrane Central, Scopus, and Google Scholar were systematically searched to identify eligible studies published before January 31, 2021. Reference lists of the included studies were searched for further identification of relevant studies. The search terms included: "Sudden Cardiac Death," "Sudden Cardiac Arrest," "Human Immunodeficiency virus," "HIV," "Acquired immunodeficiency syndrome," and "AIDS." Only observational studies that assessed the association between SCD and SCA in PWLH were selected.  Data were extracted by two independent authors who screened titles, abstracts, and articles to meet the inclusion criterion. Quality assessment was done by using modified Downs and Black checklist. A total of seven studies were included in this review. Five studies revealed a higher incidence of SCD in PLWH, two of which focused on patients with HIV and low left ventricular ejection fraction (LVEF). The other two studies were about the association of HIV and SCA. Studies reported that PLWH had a three- to five-fold higher incidence of SCD as compared to non-HIV patients. HIV patients with low LVEF had a higher incidence of SCD than HIV patients with normal LVEF. PLWH had a higher incidence of SCA and less successful cardiopulmonary resuscitation (CPR) as compared to patients without HIV. After adjusting for various confounders in multiple studies, all the studies reported a higher incidence of SCD in PLWH. To conclude, PLWH is at an increased risk of SCD and SCA. Some risk factors for this include LVEF, viral load (VL), and the cluster of differentiation 4 (CD4) count. There is a paucity of data on the mechanisms involved, although a higher prevalence of cardiac fibrosis and interstitial fibrosis in PLWH may play a role. Because of the general suboptimal quality of the heterogeneous nature of the current evidence, further, rigorous studies are needed to determine the association of increased risk of SCD and SCA in PLWH.
• Adhikari, G., Baral, N., Rauniyar, R., Karki, S., Abdelazeem, B., Savarapu, P., Isa, S., Khan, H. M., Khan, M. R., & Changezi, H. U. (2021). Systematic Review and Meta-Analysis: Can We Compare Direct Oral Anticoagulants to Warfarin in Patients With Atrial Fibrillation and Bio-Prosthetic Valves?. Cureus, 13(4), e14651.
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  Background There are no clear consensus guidelines on the indications and types of anticoagulation therapies in patients with bio-prosthetic valves either with concomitant atrial fibrillation (AF) or sinus rhythm. In our meta-analysis, we assessed the safety and efficacy of DOACs as compared to the standard treatment with warfarin in patients with AF and bioprosthetic valves. Methods We included randomized controlled trials (RCTs), cohort studies in the English language, and studies reporting patients with valvular heart disease that included bioprosthetic valvular disease. A systematic literature review using Embase, PubMed, and Web of Science was performed using the terms "Direct Acting Oral Anticoagulant," "Oral Anticoagulants," "Non-Vitamin K Antagonist Oral Anticoagulant," "Atrial Fibrillation," "Bioprosthetic Valve" for literature published prior to January 2021. Extraction of data from included studies was carried out independently by three reviewers from Covidence. We assessed the methodical rigor of the included studies using the modified Downs and Black checklist. Results Four RCTs and one observational study (n=1776) were included in our study. A random-effect model using RevMan (version 5.4; The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen) was used for data analysis. The pooled data showed that there was a non-significant reduction in the incidence of stroke and systemic embolism in the patients taking DOACs as compared to warfarin (HR 0.69; 95% CI, 0.29, 1.67; I = 50%). The incidence of major bleeding was lower in the DOACs group; the difference was statistically significant (HR 0.42; 95% CI, 0.26, 0.67; I = 7%). The difference was not statistically significant for all-cause mortality in both groups (HR 1.24; 95% CI, 0.91, 1.67; I = 0%). Conclusion Our results showed that there was no difference in the outcomes of stroke and systemic embolism between DOACs and warfarin but there were statistically significantly lower major bleeding events. We conclude that larger clinical trials are needed to assess the true safety and efficacy of DOACs in patients with AF and bioprosthetic valves.
• Adhikari, G., Santiago-Rivera, O., Baral, N., Rauniyar, R., Khan, M., Reddy, S., Sud, P., Kesari, K., Changezi, H., & Hassan, M. (2021). Abstract 14211: In-Hospital Mortality and Length of Stay Among Patients Hospitalized With Acute Heart Failure and Vitamin D Deficiency: A Study From National Inpatient Sample 2016-2017. Circulation, 144(Suppl\_1), A14211-A14211.
• Baral, N., Adhikari, G., Karki, S., Champine, A., & Sud, P. (2021). Does Social Stigma and Neglect Post-COVID-19 Matter? A Case Report on Brief Psychotic Disorder Post-COVID-19 and Self-Quarantine. Cureus, 13(1), e12973.
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  Social stigma and neglect post-coronavirus disease 2019 (COVID-19) and self-quarantine can be associated with a brief psychotic disorder (BPD). A 53-year-old African-American man with no significant past medical and psychiatric history was brought to the emergency department (ED) with symptoms of persecutory delusions post COVID-19 and self-quarantine. His symptoms included false beliefs that people were plotting to kill him which made him combative at work and home. As his symptoms worsened, his wife brought him to the hospital. He was given intramuscular haloperidol 5 mg one dose in the ED. The Clinical Health Psychology and Psychiatry team diagnosed the patient with BPD as per the Diagnostic and Statistical Method of Mental Disorder Fifth Edition (DSM-5). Over the next few days, his symptoms slowly improved. At follow-up visit in the outpatient clinic in a week, we found him back to his baseline without any delusional thoughts. Increased stressors post COVID-19, neglect at home, and social stigmata at work associated with COVID-19 along with his individual vulnerability appeared to be the cause of his delusions but various other mechanisms may exist. Our case raises the question: does social stigma and neglect post-COVID-19 and self-quarantine matter?
• Baral, N., Gautam, S., Yadav, S. A., Poudel, S., Adhikari, G., Rauniyar, R., Savarapu, P., Katel, A., Paudel, A. C., & Parajuli, P. R. (2021). Pharmacotherapies in Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Cureus, 13(2), e13604.
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  Heart failure (HF) with preserved ejection fraction (HFpEF) causes significant cardiovascular morbidity and mortality. It is a growing problem in the developed world, especially, in the aging population. There is a paucity of data on the treatment of patients with HFpEF. We aimed to identify pharmacotherapies that improve peak oxygen consumption (peak VO), cardiovascular mortality, and HF hospitalizations in patients with HFpEF.
• BaralNischit, ., Santiago-RiveraOlga, ., GuptaTripti, ., KhanMahin, ., KhanHafiz, ., GhatolAbhijeet, ., Mallikethi, L. R., AbdelazeemBasel, ., AdhikariGovinda, ., KunadiArvind, ., sudparul, ., & ChangeziHameem, U. (2021). Abstract 11689: Among Patients Hospitalized for Infective Endocarditis, There is No Association Between Solid Organ Transplant Recipient Status and In-Hospital Mortality: A Retrospective Cohort Study From National Inpatient Sample 2016-2017. Circulation, 144(Suppl_1), A11689-A11689.
• Isa, S. O., Buhari, O., Adeniran-Isa, M., Baral, N., Adhikari, G., AbdulAzeem, B., Savarapu, P., Adekolujo, O., Hassan, M., & Adeboye, A. (2021). Hypothyroidism Is Associated With Longer Hospital Stay Following Implantation Of Left Ventricular Assist Device. Clinical Medicine Insights. Cardiology, 15, 11795468211058761.
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  There has been a steady and consistent rise in the use of left ventricular assist devices in the management of patients with advanced heart failure. Hypothyroidism also remains one of the most common endocrine conditions with a significant impact on the development and overall outcomes of heart failure. The authors analyzed the National Inpatient Sample to evaluate the effect of hypothyroidism on the in-hospital outcomes of patients with end-stage heart failure following the placement of left ventricular assist device.
• Baral, N., Adhikari, P., Adhikari, G., & Karki, S. (2020). Influenza Myocarditis: A Literature Review. Cureus, 12(12), e12007.
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  Viral myocarditis is not uncommon but the role of the influenza virus in causing myocarditis is less studied. It is difficult to diagnose influenza myocarditis. Due to bacterial and viral co-infection during influenza outbreaks, it becomes more difficult to distinguish influenza myocarditis from other causes. Our article provides current information on influenza myocarditis. We did a literature search using appropriate terms and reviewed articles published by November 2020. Our study highlights the incidence of influenza myocarditis and the need to become aware of this condition, especially during epidemics and pandemics. Our study highlights that although influenza myocarditis is a rare condition, it can be fatal. There should be increased awareness about the condition. By the early diagnosis and treatment of influenza myocarditis, we can prevent fatal complications.
• Baral, N., Changezi, H. U., Khan, M. R., Adhikari, G., Adhikari, P., Khan, H. M., Poudyal, A., Abdelazeem, B., Sigdel, S., & Champine, A. (2020). Inspiratory Muscle Training in Patients With Heart Failure With Preserved Ejection Fraction: A Meta-Analysis. Cureus, 12(12), e12260.
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  Objectives To explore the role of inspiratory muscle training (IMT) in improving cardiorespiratory fitness of stable heart failure with preserved ejection fraction (HFpEF) patients. Background There is a paucity of data on the role of IMT in patients with HFpEF. HFpEF is a growing problem in the developed world, especially in the aging population. Methods We conducted a systematic literature search for English studies in PubMed, EMBASE, and Cochrane Central Register of Controlled Trials. We searched databases using terms relating to or describing breathing exercise, IMT, and HFpEF. RevMan 5.4 (The Cochrane Collaboration, 2020) was used for data analysis, and two independent investigators performed literature retrieval and data extraction. Results We identified three randomized controlled trials (RCTs) and one prospective study on the role of IMT in HFpEF. We calculated the pooled mean difference of peak oxygen consumption (Peak VO) and six-min walk distance (6MWD) between the IMT and standard care (SC) groups. Our meta-analysis showed that compared with SC, IMT could significantly improve peak VO with a mean difference (MD) of 2.82 ml/kg/min, 95% CI [1.90, 3.74] P < 0.00001 and improve 6MWD with MD of 83.97 meters, 95% CI [59.18, 108.76] P< 0.00001 to improve cardiorespiratory fitness at 12 weeks of IMT and improve peak VO with MD of 2.18 ml/kg/min, 95% CI [0.38, 3.99] P < 0.00001 at 24 weeks of therapy. Conclusion IMT should be further studied as a possible treatment option to improve cardiorespiratory fitness for patients with stable HFpEF.
• Khan, M. R., Adhikari, G., Khan, H., & Changezi, H. U. (2020). A case report of absolute thrombocytopenia with ticagrelor. European heart journal. Case reports, 4(4), 1-5.
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  We report a rare case of absolute thrombocytopenia with ticagrelor after 6 h of single loading dose of ticagrelor.