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…
RE-DUAL PCI: Anti-Thrombotic Management in Patients with Atrial Fibrillation and PCI
RE-DUAL PCI outcomes have been published by the New England Journal of Medicine along with their presentation at ESC 2017. The traditional triple anti-thrombotic scheme with dual antiplatelet therapy and warfarin for patients with atrial fibrillation undergoing coronary angioplasty seems to have been left behind. This new study showed that the combination of dabigatran with a P2Y12…
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…
Apixaban: An Alternative for Patients with Atrial Fibrillation Undergoing TAVR?
Courtesy of Dr. Carlos Fava. The prevalence of atrial fibrillation in patients undergoing transcatheter aortic valve replacement (TAVR) is high (32.9%, according to the PARTNER Trial, and 46.8%, according to the CoreValve High-Risk Study), and is associated with thromboembolic events (as in all other populations). Apixaban has shown to benefit patients with nonvalvular atrial fibrillation,…
Anticoagulated Patients with Atrial Fibrillation Undergoing Angioplasty: How to Treat Them
In patients with atrial fibrillation undergoing coronary angioplasty with stents, standard anticoagulation with vitamin K antagonists plus dual antiplatelet therapy with a P2Y12 inhibitor and aspirin reduces the risk of stent thrombosis and stroke, but increases the risk of bleeding. The effectiveness and safety of anticoagulation with rivaroxaban plus one or two antiplatelet agents…
Cardiovascular Events Reduction: Bivalirudin or Heparin?
The MATRIX study did not find a clear advantage of bivalirudin over unfractioned heparin to reduce major adverse cardiovascular events (MACE) or net cardiovascular adverse events (NCAE) in patients undergoing acute coronary syndrome receiving PCI. This new analyzis confirms there is no difference in ischemic and thrombotic events in patients with acute coronary syndrome…
Anticoagulation and PCI: How Long Should Triple Therapy Last?
The aim of this study was to compare clinical outcomes in relation to the duration of triple antithrombotic therapy in patients with indications for oral anticoagulation undergoing coronary angioplasty. The optimal period for the prescription of these three drugs has not been studied. Between 2009 and 2013, 8772 consecutive patients undergoing coronary angioplasty were included…
No Extra Benefit for Combined Use of Bivalirudin and Transradial Approach
The aim of this meta-analyzis was to study the relation between bivalirudin and access site in patients undergoing acute coronary syndrome (ACS). Both bivalirudin and the transradial access site are strategies aiming at reducing bleeding complication in patients with ACS undergoing invasive approaches. The interaction of both strategies and the potential benefits of their combined use…
Vorapaxar in Acute Limb Ischemia
Original Title: Acute Limb Ischemia and Outcomes With Vorapaxar in Patients with Peripheral Artery Disease: Results From TRA2°P-TIMI 50. Reference: Marc P. Bonaca et al. Circulation. 2016 Mar 8;133(10):997-1005. Patients with peripheral artery disease have a high risk of acute limb ischemia, an event that may result in the loss of the affected limb. This…