The enthusiasm for direct oral anticoagulants after transcatheter aortic valve replacements (TAVR) is waning. At least, when it combines with atrial fibrillation. The ENVISAGE-TAVI AF has shown excessive bleeding with endoxaban vs. the classical vitamin K antagonists. Endoxaban resulted non-inferior to vitamin K antagonists in terms of net clinical adverse events, but major bleeding events...
Antiaggregation indication after peripheral intervention (PVI) can vary up to 50% depending on center, operator, and procedure. This highlights the huge variation in indication and the scarce evidence there is on this matter. Most cardiologists would like to simply transfer the information from the coronaries to the superficial femoral, but we can confirm this does...
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...
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...
According to this study, presented during the ESC 2019 scientific sessions, non-ST acute coronary syndrome (NSTE-ACS) patients treated with ticagrelor presented a significantly higher risk of bleeding than patients treated with clopidogrel, with no counterbalance by higher benefit in thrombotic events. Researchers suggest clopidogrel might be the gold standard for this elderly NSTE-ACS population, though...
Polymer persistence in 1st and 2nd generation DES meant to allow drug release has been associated with a chronic inflammatory response that might be associated to restenosis, neo atherosclerosis and stent thrombosis. This is the rationale behind the development of polymer free and bioresorbable polymer-based DES. They have both been compared against permanent polymer DES,...
These new hypertension guidelines (which were as long-awaited as the American ones, back then) finally emerged in Barcelona, at the European Society of Hypertension (ESH) Congress. The document was issued jointly with the European Society of Cardiology (ESC). These guidelines provide recommendations for physicians to diagnose hypertension, evaluate risk, and determine when and how to...
As regards the use of antithrombotic agents, the risk of bleeding will always be an issue, and in the case of aspirin this risk is twice as big: it does have the desired antiaggregation effect, but on top of the increased bleeding risk, it has a damaging effect on stomach lining that increases the risk...
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...
So far, the main controlled randomized studies have almost exclusively been aimed at comparing the efficacy and safety of carotid artery stenting vs. endarterectomy. Almost all of them have left at operator discretion the choice of the devices to be used during the procedure, which is why there is few direct information to help us...