Atrial fibrillation is the most common arrhythmia and its combination with a history of acute myocardial infarction or coronary angioplasty is quite frequent. According to this study (recently published in JACC), in a real-world population, the combination of direct anticoagulant agents and dual antiplatelet therapy reduces significantly the risk of bleeding and provides similar thromboembolic…
New Anticoagulant Agents in Atrial Fibrillation in Latin American Patients, Specifically
There is limited information on the use of antithrombotic therapies and their outcomes in Latin American patients with atrial fibrillation. This stands true in almost all aspects of medicine: large multicenter randomized studies rarely include Latin American countries, and when they do, the population included is not representative of the overall population. The only exception…
Galileo: Rivaroxaban After TAVR Stopped Due to Early Event Rates
Patients undergoing transcatheter aortic valve replacement (TAVR) randomized to rivaroxaban in the GALILEO trial experienced higher risk of all-cause death, thromboembolic events, and bleeding compared with patients who received antiplatelet therapy. The GALILEO trial was halted after an early peek of events at the data from the rivaroxaban (Xarelto; Bayer/Janssen) arm. These events included higher…
TCT 2018 | OAC-ALONE: Anticoagulation Alone 1 Year After Stenting in Patients with Atrial Fibrillation
Up to now, there had been no randomized controlled trial assessing oral anticoagulation alone vs. oral anticoagulation plus antiplatelet therapy in patients with atrial fibrillation 1 year after stenting in a setting of stable coronary disease. Such was the vacuum that this work, presented at TCT 2018 and published simultaneously in Circulation, attempted to fill. This trial…
ESC 2018 | MATRIX: 1-Year Superiority of Transradial Access
Transradial access should be the access of choice in patients with acute coronary syndrome, while bivalirudin has not shown any benefit for this population. The long-term follow-up from the MATRIX (Minimizing Adverse Hemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox) trial confirms the results at 30 days: transradial access is here to stay…
ESC 2018 | MARINER: Rivaroxaban as Thromboprophylaxis after Hospitalization
For acute patients hospitalized for a clinical disease (e.g.: heart failure), indicating rivaroxaban for 6.5 weeks after discharge did not significantly reduce the risk of symptomatic venous thromboembolism. Efficacy primary end point rate was low, with 0.83% in patients treated with rivaroxaban vs 1.1% of patients receiving placebo. This work presented at ESC and…
NSAIDs and Risk of Bleeding in Patients with Atrial Fibrillation
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is very frequent and many of these medications are sold over-the-counter, but they can expose patients with atrial fibrillation using warfarin or dabigatran to potentially dangerous bleeding. Such a combination is a “perfect storm” of sorts, since atrial fibrillation is the most frequent type of arrhythmia and its…
NCDR ACTION Registry: Anticoagulated Patients with No Higher Risk of Bleeding in Emergency Procedures
Patients with a history of atrial fibrillation treated with warfarin or any of the new direct oral anticoagulants undergoing acute myocardial infarction do not present higher risk of bleeding when receiving angiography or angioplasty. In fact, this subgroup of anticoagulated patients showed lower in-hospital mortality than the control group. After analyzing 6471 patients undergoing ST elevation MI…
The End of Aspirin for Anticoagulated Patients Undergoing PCI
The discussion about the best anti-thrombotic strategy for patients with atrial fibrillation undergoing PCI seemed never-ending until the RE-DUAL PCI trial was published in the New England Journal of Medicine (NEJM). This study has arrived to simplify the tough choice between the risk of a thrombotic event vs. the risk of bleeding with a simpler scheme, without…
COMPASS: A New Place for Rivaroxaban in Chronic Ischemic Heart Disease
Combining low doses of rivaroxaban and aspirin seems to be the best strategy for patients with stable chronic ischemic heart disease, according to this new study presented at the European Society of Cardiology Congress 2017, which was published simultaneously in the New England Journal of Medicine. Compared with low-dose aspirin alone, the combination of aspirin…
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…