Direct anticoagulant agents were associated with lower long-term mortality in patients with atrial fibrillation (AF) discharged after transcatheter aortic valve replacement (TAVR), compared with classic vitamin K antagonists. The purpose of this paper published in JACC Interv was to compare long-term results between classic vitamin K antagonists and novel direct anticoagulant agents in patients with…
Major Cause of Myocardial Injury by COVID-19
The most common cause of myocardial necrosis in patient undergoing COVID-19 infection is microthrombi. These microthrombi resulted quite different in composition vs. thrombi obtained from COVID-19 negative patients and thrombi obtained from infected patients with ACS. Myocardial injury is common in patients hospitalized for COVID-19 and has worse prognosis. Regardless its frequency, the mechanism and…
AAS vs Warfarin in Low Risk TAVR
We are still discussing the adequate antithrombotic scheme after transcatheter aortic valve replacement (TAVR). Additionally, we are treating a much wider array of patients ranging from low risk to inoperable. And there is yet one more important point: hypo-attenuated leaflet thickening diagnosed by CT. We are still unaware of the impact they have on device…
AHA 2020 | RIVER: Rivaroxaban as Alternative to Warfarin in Patients with Atrial Fibrillation and Bioprosthetic Mitral Valve
Rivaroxaban seems to be a reasonable alternative to warfarin in patients with atrial fibrillation and bioprosthetic mitral valve. These results arise from the RIVER Study presented at the American Heart Association (AHA) 2020 Congress and simultaneously published in the New England Journal of Medicine (NEJM). After 5 years of follow-up, rivaroxaban reached the non-inferiority criterion…
ESC 2020 | Rivaroxaban Might Reduce Cardiac Cerebral and Peripheral Events
Adding rivaroxaban to the standard treatment might reduce events incidence in lower limbs, heart, and brain, in patients with peripheral vascular disease undergoing revascularization. These new data resulted from the analysis of the VOYAGER PAD subgroups and were presented at the virtual ESC 2020. The COMPASS study had reached similar conclusions using 2.5 mg rivaroxaban…
Impact on Mortality with Rivaroxaban after Discharge
Extending thromboembolic prophylaxis with rivaroxaban in patients hospitalized for heart conditions reduce fatal and thromboembolic events by 28% without major bleeding payback. Patients hospitalized for heart conditions are at risk of thromboembolic events, and this is why inhospital prophylaxis (in general with low molecular weight heparin) is within the standard treatment. It was not…
Antiaggregation vs. Anticoagulation after Peripheral PCI
The truth is this question has no clear answer and what with do with peripheral stenting is transfer the evidence we have on coronary stenting, given the lack of standards and poor reporting on antithrombotic therapy outcomes in randomized studies on endovascular intervention. Heterogeneity is worse when it comes to venous territory. Some time ago…
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 | 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…