Original article Thierry Lefevre
Heparin Pretreatment in STEACS Treatment: A New Old Ally?
The treatment of ST-segment elevation acute coronary syndromes (STEACS) is undoubtedly reperfusion therapy with primary percutaneous coronary intervention. Similarly, nobody doubts that the pretreatment with more stronger antiplatelet agents has a role in such a treatment. In certain sites, unfractionated heparin (UFH) pretreatment is also administered before the patient enters the cath lab; its aim...
TAVR and Anticoagulation: Direct Anticoagulant Agents or Vitamin K Inhibitors?
In some patients, using an anticoagulant agent is not an option, it is just prescribed. Based on the French TAVR registry, this research compared long-term mortality, bleeding, and ischemic events after valve implantation. A comparison was made between TAVR and direct vs. classic anticoagulant agents—good old proven and reversible vitamin K inhibitors. Cardiologists, hematologists, clinicians, and...
Heparin Anticoagulation in Critically Ill COVID-19 Patients: Results that Differ from the Rest
In critically ill COVID-19 patients, an initial strategy of anticoagulation with heparin did not result in any benefit compared with standard prophylactic treatment. Thrombosis and inflammation are the main issues when discussing COVID-19 related morbidity. This led to testing whether an anticoagulation scheme could improve prognosis in critically ill COVID-19 patients. Given the dynamics of...
Surviving Covid-19 with Good Old Heparin?
Patients hospitalized for COVID-19 are at high risk for thrombosis, particularly venous thromboembolism. This information is not new: in a meta-analysis of 66 studies, the overall prevalence of venous thromboembolism among patients with COVID-19 admitted to intensive care units was between 14.1% and 22.7%. Hypercoagulability is an early-described feature of this new virus, and so is...
Anticoagulation with Heparin in Non-Critical COVID-19
In non-severe COVID-19 patients, an initial therapeutic strategy with heparin increases the chance of survival after discharge and reduces the need for respiratory and cardiovascular support compared against usual thromboprophylaxis doses. These data have been welcomed by a medical community eager to receive good news in terms of effective strategies to combat an already existing...
The Fellow’s Corner | 2nd Clinical Case: An Explosive Mission
Read the case presentation and join the conversation through the comments in this post! Case Introduction: An Explosive Mission! 56-year-old male patient Severe smoker Hypertension Dyslipidemia Sedentary lifestyle and stress A sibling suffered from an acute myocardial infraction Cardiac markers: Standard angina, intensity of 8-9/10, 3-to-4-h long, and dyspnea (on and off for the past...
Do NOACs Result in Any Benefit in TAVR?
Courtesy of Dr. Carlos Fava. The need for anticoagulation after transcatheter aortic valve replacement (TAVR) is over 15% according to different reports and, so far, no one has analyzed in depth whether new oral anticoagulant agents (non-vitamin K oral anticoagulants [NOACs]) result in superior benefit compared with classic vitamin K antagonists (VKAs). This study analyzed...
VALIDATE-SWEDEHEART: bivalirudin seems to be losing ground
Another important work that does not see the benefits of bivalirudin over heparin as monotherapy as regards both efficacy (death and MI) and safety end points (bleeding) in patients undergoing acute myocardial infarction with and without ST elevation. The study VALIDATE-SWEDEHEART, presented at ESC, simultaneously published in the New England Journal of Medicine, randomized 6000 patients...
Transradial access shows no benefit of bivalirudin
The aim of this study was to compare bivalirudin against heparin in patients with ST elevation acute myocardial infarction undergoing transradial primary PCI. Both bivalirudin and the transradial access are strategies aimed at reducing bleeding complications in patients undergoing acute MI. However, the benefit of their combined use is not year clear. Even though...
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