In 1992, Kiemeneij performed the first transradial coronary procedure, following Campeau’s description of that access in 1989. It’s been 30 years since that milestone in interventional cardiology. Over time, the number of procedures conducted with this approach has increased exponentially, and it is the main approach in most centers in different clinical scenarios. Historically, the…
Results of Zotarolimus-Eluting Stents vs Biolimus-Eluting Polymer-Free Stents After 2 Years. Are They Safe in Patients at High Risk for Bleeding?
The proportion of patients treated with coronary angioplasty who are at a high risk for bleeding is increasing. In this population, extended dual antithrombotic therapy increases the risk of bleeding. The 1-year randomized Onyx one study has demonstrated the non-inferiority of zotarolimus-eluting stents (ZES) vs. biolimus-coated polymer-free stent BioFreedom (DCS). Patients received dual-antiplatelet therapy (DAPT)…
Should We Use Left Atrial Appendage Occlusion More Frequently? What Real-Life Data Are Available?
Left atrial appendage occlusion (LAAO) is an alternative to prevent atrial fibrillation stroke mainly used in patients at high risk for bleeding. One of the most widely used devices in randomized trials is the Watchman, which yielded promising results. However, its real-life performance had yet to be analyzed. Researchers conducted an analysis of the National…
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…
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…
Post-PCI Ticagrelor Monotherapy in High-Risk Bleeding
In patients at high risk of bleeding undergoing coronary PCI and after completing 3-month DAPT with no events, you may discontinue aspirin and follow up with ticagrelor monotherapy. This will significantly reduce bleeding without increasing ischemic events. With this strategy, the greater the risk of bleeding, the greater the absolute reduction of bleeding. Patients at…
AFIRE Study | Hidden Risks After Bleeding in Coronary Disease and Atrial Fibrillation
Patients with atrial fibrillation (AF) and stable coronary disease who suffer from major bleeding present an extremely high risk of subsequent cardiovascular events. Preventing bleeding is necessary, and so is preventing the risk of subsequent cardiovascular events and death. The association between coronary angioplasty, early bleeding, and an increase in death and infarction rates after…
AMULET IDE: New Research Compares WatchMan and Amulet Devices Providing New Evidence
Recently, at the TCT Congress results from the SWISS-APERO study comparing Watchman and Amulet devices were presented. Now, a new study, Amulet IDE—published in Circulation—, compared both devices on a large number of patients. Amulet IDE was designed to evaluate the safety and efficacy of dual-seal mechanism device Amulet compared with the Watchman (a widely…