Roughly 50% of hypertrophic cardiomyopathies (HCM) are obstructive, and of this percentage, most of symptoms can be attributed to this condition. Historically, it has been treated with non-specific drugs such as betablockers or calcium blockers. There is an alternative treatment, septal reduction therapy (SRT), done either by surgery myectomy and alcohol septal ablation, both normally done in…
ACC 2022 – POISE-3: Tranexamic Acid, Bleeding and Cardiovascular Events in Non-Cardiac Surgeries
Tranexamic Acid is an antifibrinolytic which has been shown to reduce bleeding in orthopedic patients and cardiac surgery. But evidence for its use in non-cardiac surgery is still limited. The aim of this study was to assess whether tranexamic acid reduces the incidence of bleeding events, which include life threatening bleeding, major bleeding, or bleeding…
REVERSE-IT | Bentracimab: Progress on the Antidote for Ticagrelor in Emergency Scenarios
Optimizing an antiplatelet therapy after an acute coronary syndrome (ACS) aims at reducing the major adverse cardiac events (MACE) caused by atherosclerotic disease. Ticagrelor is a potent P2Y12 inhibitor that directly prevents platelet activation. It is characterized by a rapid and consistent onset of action throughout its administration (twice daily) and its proven pleiotropic effects,…
Ticagrelor Monotherapy after 3 Months: Is the Current Strategy Worth Changing?
Dual antiplatelet therapy (DAPT) after PCI with DES has shown noticeable reduction of thrombotic events, especially in acute coronary syndromes (ACS). However, this therapy encompasses increased bleeding, especially in elderly patients increasingly undergoing percutaneous intervention. Even though most bleeding events might not be fatal (many of them are mostly digestive) they do involve higher hospitalization…
Abbreviated DAPT in ACS: The End of Clopidogrel Monotherapy?
Compared with patients with chronic coronary syndromes, patients with acute coronary syndromes (ACS) are more likely to suffer from long term major adverse cardiac events (MACE). To prevent this, both the American and the European guidelines recommend prolonging dual antiplatelet therapy (DAPT) in this population for at least 12 months. However, in patients with certain clinical…
Acute Coronary Syndrome: What Is Safer, Antiaggregant Monotherapy or De-Escalation?
For several years it has been shown that 12-month dual antiplatelet therapy (DAPT) is mandatory for patients undergoing left main PCI for acute coronary syndrome (ACS). However, though this strategy does reduce thrombotic events and mortality, it also causes undesirable bleeding events followed by hospitalization and antiaggregation interruption for a period of time. A feasible…
Cangrelor: Additional Research Findings Not Translating into Clinical Practice
The potent and fast endovenous platelet inhibition provided by Cangrelor reduces ischemic events early in the course of acute coronary syndrome. However, and despite mounting evidence, the drug is not reaching the clinical practice. This is a sub-analysis of the CHAMPION PHOENIX, which sought the timing, number and type of early events that could be…
Clnical Practice Dissociated from Study Outcomes: Bad News for Our Patients?
Differences in patient characteristics, changes in treatment algorithms, and advances in device technology, together or separately, might limit the applicability of older randomized trials to contemporary clinical practice. In this case, we look at patients and devices used in the contemporary clinical practice vs. those in the EXTEND DAPT. These differences were associated with attenuated…
Left Atrial Appendage Closure vs Direct Anticoagulants at Long Term
The PRAGUE-17 has shown that left atrial appendage closure is not inferior to direct anticoagulants at long term to prevent major cardiovascular, neurological, or bleeding events. Moreover, procedures not related to prosthesis implantation saw significant reduction. The PRAGUE-17 was a randomized non-inferiority study comparing left atrial appendage closure (Watchman or Amulet) with direct anticoagulants (95%…
TICO: Age Impacts the Effect of Antiplatelet Monotherapy
The higher the age, the greater the benefit of ticagrelor monotherapy vs. dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome. This post hoc sub-analysis of the TICO study goes along the same lines as the TWILIGHT study (which we recently discussed), given that age is the most common reason for considering that a…
The Most Relevant Articles of 2021 in Pharmacology
This last year, new data in pharmacology gave way to changes in practices and new hypotheses, when not simply further justified the already existing evidence. In this new editorial section, we share the most relevant of last year’s works to keep you up to speed on the main topics in the field. The Most Relevant…