In Paris, during the European Society of Cardiology (ESC) Congress 2019 Scientific Sessions, new guidelines for the diagnosis and treatment of chronic coronary syndromes were presented. This document, simultaneously published in Euro Heart J, updates the 2013 guidelines on stable ischemic heart disease and takes out the word “stable” so as to emphasize that the<a href="https://solaci.org/en/2019/09/05/esc-2019-new-european-guidelines-on-chronic-coronary-syndromes/" title="Read more" >...</a>
Courtesy of Dr. Carlos Fava. The benefit of dual antiplatelet therapy in acute coronary syndromes (ACS) has been proven long ago, and both prasugrel and ticagrelor have offered best results than clopidogrel. However, nowadays, it is unclear which of them is superior in the long term, taking into account the fact that one starts to<a href="https://solaci.org/en/2019/09/05/esc-2019-isar-react-5-which-is-better-in-acs-prasugrel-or-ticagrelor/" title="Read more" >...</a>
This is a sub-study of the THEMIS presented during the ESC 2019 scientific sessions in Paris, and simultaneously published in Lancet. They were all diabetics with stable coronary artery disease, but in this sub-study patients also had prior PCI. It included over 11000 patients with prior PCI for whom the combination of ticagrelor and aspirin<a href="https://solaci.org/en/2019/09/03/esc-2019-themis-pci-unlike-in-the-main-study-here-ticagrelor-is-indeed-effective/" title="Read more" >...</a>
The use of ticagrelor in patients with stable coronary artery disease significantly reduces the rate of major cardiovascular events when compared against aspirin, according to this study presented on Sunday at ESC 2019 simultaneously published in NEJM, though the cost in terms of major bleeding seems unacceptable. Primary end point rate (composite of cardiovascular death,<a href="https://solaci.org/en/2019/09/03/esc-2019-themis-ticagrelor-in-diabetics-with-stable-coronary-artery-disease/" title="Read more" >...</a>
This new strategy to reduce the risk of stroke in patients with atrial fibrillation is technically feasible and safe, even though long-term outcomes are yet to be seen and despite the evidence available, for instance, left atrial appendage closure devices. It is true that they could be used simultaneously, but its synergy and cost have<a href="https://solaci.org/en/2019/08/29/permanent-carotid-coil-filters-in-patients-with-atrial-fibrillation/" title="Read more" >...</a>
The antiplatelet treatment strategy providing optimal balance between thrombotic and bleeding risks in patients undergoing myocardial revascularization surgery is unclear. What does seem somewhat certain is that some antiplatelet therapy is necessary to prevent early thrombosis, mainly in vein grafts, but (as opposed to what happens with angioplasty) there are other relevant factors such as<a href="https://solaci.org/en/2019/08/19/can-antiplatelet-therapy-affect-the-life-of-coronary-grafts/" title="Read more" >...</a>
Most patients with atrial fibrillation require anticoagulation to reduce the risk of stroke or systemic embolization. Today, this is achieved with the new direct oral anticoagulants, which present lower intracranial bleeding risk compared against the old vitamin K antagonists. On the other hand, approximately between 5% to 10% of patients receiving PCI also present atrial<a href="https://solaci.org/en/2019/08/14/pci-and-anticoagulation-what-is-the-best-strategy/" title="Read more" >...</a>
The American College of Cardiology/American Heart Association (ACC/AHA) have recently published primary prevention cardiovascular disease guidelines. They were originally considered very useful for general practitioners who had no choice but to review separately expert consensus or clinical practice guidelines for hypertension, cholesterol, diabetes, etc. Now, everything is concentrated in a single reference document. But is<a href="https://solaci.org/en/2019/08/13/primary-prevention-guidelines-published-for-the-first-time-are-they-useful-for-all-patients/" title="Read more" >...</a>
Several clinical guidelines differ in their recommendation regarding the prescription of proton pump inhibitors to patients being treated with dual antiplatelet therapy after infarction. In 2015, the European Society of Cardiology (ESC) recommended their use in patients with high bleeding risk; however, in the 2017 update that recommendation became general after the assumption that, for<a href="https://solaci.org/en/2019/07/14/after-much-toing-and-froing-gastrointestinal-protection-is-back-to-the-forefront/" title="Read more" >...</a>
What is the most appropriate antithrombotic strategy for a patient with atrial fibrillation and coronary artery disease, particularly when admitted with acute coronary syndrome or undergoing coronary angioplasty? This is a question whose answer is still in the works and that literature is addressing dynamically. Whatever we read yesterday may already be out of date<a href="https://solaci.org/en/2019/06/26/antithrombotic-strategies-in-atrial-fibrillation-and-angioplasty/" title="Read more" >...</a>