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...
Patients who receive chronic anticoagulation therapy and then undergo angioplasty are frequently discharged on a triple anti-thrombotic scheme that usually includes aspirin, clopidogrel, and warfarin. The optimal duration of this indication remains unclear, particularly for patients at high bleeding risk. According to expert consensus, patients receiving chronic anticoagulation may receive from 1 to 12 months of dual...
Transcatheter aortic valve replacement (TAVR) is much less invasive than surgical replacement. This is associated with a substantial reduction in bleeding events (up to 60% less). However, clinically relevant bleeding is still present in one every four patients who undergo TAVR, which is associated with morbidity and mortality. Cases of bleeding are not uniform: they may...
Peripheral artery disease (PAD) is no longer a systemic manifestation of atherosclerosis. In fact, 2 in 3 people with PAD have concomitant heart disease, and 1 in 3 people has concomitant PAD. To understand the real dimension of this problem, we should know that PAD patients have 60% more risk of acute myocardial infarction...
Courtesy of Dr. Carlos Fava Bivalirudin has been shown to reduce bleeding in carotid stenting and maintain its efficacy. Even though carotid stenting has shown benefits, these remain unclear. With this in mind, four studies were analyzed (one randomized) including 7,784 patients undergoing carotid stenting with unfractioned heparin vs. bivalirudin. No difference was...
Despite the fact that some randomized studies and meta-analyzis have suggested prolonged dual antiaggregation could be associated to increased death rate, the underlying mechanism remains unclear. It is only logical to assume that if there was an actual increase in mortality associated to prolonged antiaggregation, this should be due to bleeding; however, no studies have...
Patients with peripheral artery disease (PAD) have higher rates of cardiovascular events after DES implantation, which could be explained partly by higher platelet reactivity. The present work studies the relationship between platelet reactivity and clinical events after PCI in patients with and without a history of peripheral artery disease. The ADAPT-DES study (Assessment of...
Original Title: Biolimus A9 drug-coated stent vs. bare metal stent in patients presenting with ACS. A pre-specified LEADERS FREE ACS sub-study. Presenter: C.K. Naber. In ACS patients with high bleeding risk, guidelines recommend 3 to 6 months of dual ATP treatment for DES implantation or one month in case of conventional stenting. The...
Original Title: Is Bare-Metal Stent Implantation Still Justifiable in High Bleeding Risk Patients Undergoing Percutaneous Coronary Intervention? A Pre-Specified Analysis From the ZEUS Trial. Reference: Sara Ariotti et al. J Am Coll Cardiol Intv. 2016;9(5):426-436. This work studied ischemic and bleeding events in high bleeding risk patients randomized to the zotarolimus eluting stent (ZEZ) Endeavor...
Original Title: Bleeding Outcomes After Left Atrial Appendage Closure Compared With Long-Term Warfarin A Pooled, Patient-Level Analysis of the WATCHMAN Randomized Trial Experience. Reference: Matthew J. Price et al. J Am Coll Cardiol Intv. 2015. Online before print. The aim of this trial was to compare the relative risk of major bleeding after left atrial appendage closure...