Switching to ticagrelor monotherapy after 3 months of dual antiplatelet therapy reduces major bleeding without paying a price in terms of ischemic events, compared with dual antiplatelet therapy for a year, in patients who had acute coronary syndrome and underwent angioplasty with a second-generation drug-eluting stent. Interrupting aspirin at 3 months and switching it for ticagrelor reduces…
Virtual ACC 2020 | PRONOMOS: Rivaroxaban Superior to Enoxaparin in Orthopedic Surgery
According to this new study presented virtually at the suspended American College of Cardiology (ACC) 2020 Scientific Session and published simultaneously in the New England Journal of Medicine (NEJM), rivaroxaban is more effective than enoxaparin in preventing venous thromboembolism during a period of immobilization after nonmajor orthopedic surgery of a lower limb. After an orthopedic…
Virtual ACC 2020 | TWILIGHT-COMPLEX: Ticagrelor Monotherapy in the Most “Dangerous” Angioplasties
The original TWILIGHT findings in more than 9000 patients who underwent angioplasty were presented last year at TCT and showed a 3.1% absolute risk reduction in BARC 2, 3, or 5 bleeding with no increase in death, infarction, or stroke in patients who received ticagrelor and placebo compared with patients who received ticagrelor and aspirin. All patients…
Virtual ACC 2020 | TWILIGHT-DM: Ticagrelor Monotherapy in Diabetic Patients
In parallel to the TWILIGHT in patients with complex PCI, Dr. Angiolillo virtually presented the sub-study in diabetic patients, and it was published simultaneously in J Am Coll Cardiol. This study focuses on the clinical complexity of patients, rather than the technical complexity of the procedure itself. The TWILIGHT-DM analyzed 2620 diabetic patients from the…
Virtual ACC 2020 | POPULAR TAVR: Post TAVR Anticoagulation without Clopidogrel?
In patients undergoing transcatheter aortic valve replacement (TAVR) that also required anticoagulation for another indication (mostly atrial fibrillation), the incidence of major bleeding between month 1 and 12 was lower in those receiving only anticoagulation instead of anticoagulation + clopidogrel. The present study presented as part of the scientific sessions at the virtual ACC 2020,…
Virtual ACC 2020 | Antidote for Life-Threatening Bleeding with New Anticoagulant Agents
Among patients hospitalized with life-threatening or uncontrolled bleeding under treatment with direct factor Xa inhibition, anticoagulation reversal with andexanet alfa (Andexxa) was associated with low mortality rates. These promising results have multiple limitations, particularly the lack of definition on bleeding severity. One of the studies testing the new antidote used propensity-score matching, and there were lower…
Virtual ACC 2020 | TAILOR-PCI: Gene-Based Prescribing of Clopidogrel Does Not Change Outcomes
This very interesting work leaves us with a sour taste in our mouth, as it failed to meet its primary endpoint. Using genotype to individualize treatment with a P2Y12 inhibitor in patients with acute coronary syndrome or stable patients after a scheduled angioplasty compared with conventional treatment with clopidogrel does not reduce the risk of…
Virtual ACC 2020 | Vericiguat: New Hope in Chronic Cardiac Failure
Treatment with the new drug called Vericiguat (acting on guanosine monophosphate receptors GMP) might reduce cardiovascular mortality or hospitalizations due to heart failure in a high-risk population with reduced ejection fraction. The VICTORIA trial (Vericiguat Global Study in Subjects with Heart Failure with Reduced Ejection Fraction) was presented virtually at the ACC 2020 scientific sessions…
Virtual ACC 2020 | VOYAGER PAD: Rivaroxaban Superior to Aspirin in Preventing Events
In patients with peripheral artery disease undergoing revascularization, the combination of rivaroxaban (Xarelto) and low doses of aspirin are superior to aspirin alone in the prevention of acute low limb ischemic events, amputation, cardiovascular events and strokes. The outcomes of VOYAGER PAD add to the COMPASS outcomes, showing the combination of therapies can benefit risk…
Virtual ACC 2020 | COMPASS Sub-Analysis: Diabetes Increases the Benefit of Rivaroxaban Combined with AAS
In patients with stable coronary or peripheral artery disease, diabetes increases the benefit of combining low doses of rivaroxaban and aspirin vs. aspirin alone. This analysis was pre-specified in the COMPASS protocol and was presented virtually for the ACC 2020 and simultaneously published in Circulation. Patients with diabetes, showed numerically greater reduction in terms of…
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