Association Between Ischemic and Bleeding Risk Scores and the Use of New P2Y12 Inhibitors in Patients With Acute Coronary Syndrome

Conclusions New P2Y12 inhibitors were more frequently prescribed among ACS patients with lower CRUSADE bleeding risk. However, an ischemic risk paradox was found, with higher use of these agents in patients with lower ischemic risk based on GRACE risk score estimates. These results underscore the importance of risk stratification to safely deliver optimal therapies.
Source: Revista Espanola de Cardiologia - Category: Cardiology Source Type: research

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Abstract BACKGROUND: Current guidelines recommend newer generation drug-eluting stents (DES) over bare-metal stents (BMS) in patients with ischemic heart disease. However, there is no age-specific recommendation in elderly patients. METHODS: Meta-analysis was performed of 6 randomized studies enrolling 5,042 elderly patients who underwent percutaneous coronary intervention (PCI) with stent implantation (DES, n = 2,579; BMS, n = 2,463). RESULTS: Combined data indicated a significant reduction in major adverse cardiovascular events (MACEs) with use of DES (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.44-0.71, p
Source: Cardiology Journal - Category: Cardiology Authors: Tags: Cardiol J Source Type: research
Conclusion:Transfer for PCI without thrombolytics is best if PCI at receiving facility can be done in less than 120 minutes from first medical contact, or less than 90 minutes from STEMI diagnosis in first ED.Thrombolytics prior to Transfer to a PCI capable facility, then rescue PCI if no reperfusion for STEMITRANSFER AMI(Cantor et al. 2009).High risk STEMI: BP less than 100, HR greater than 100 Killip class II, III, ST depression of at least 2 mm in precordial leads, ST elevation in right precordial leads (right ventricular MIAll patients get TNK-tPA.80-90% received clopidogrel 300 mg (75 mg for age over 75).Enox...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Conclusion: Interventional therapy is effective in acute portal vein thrombosis, but should only be performed at specialized centers and based on an individual treatment decision.
Source: European Journal of Gastroenterology and Hepatology - Category: Gastroenterology Tags: Original Articles: Hepatology Source Type: research
Deep vein thrombosis (DVT) is frequently treated by anticoagulation, which helps to prevent new thrombus formation, but to restore venous flow, additional efforts might be needed. Thrombolytic agents can help clear acute thrombus, but increased bleeding risk is a concern, frequent contraindications are another. One lesser discussed potential limitation is thrombus age, which can affect efficiency of treatment.
Source: Annals of Vascular Surgery - Category: Surgery Authors: Tags: Case Report Source Type: research
ConclusionHeartMate 3 has reduced the rate of disabling stroke and pump thrombosis. However, despite increased hemocompatibility due to specialized design features, the residual risk of both surgical, and gastrointestinal bleeding remains a major adverse outcome. Different anticoagulation management and surgical techniques have been evaluated to address the remaining complications.
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: REVIEW ARTICLE Source Type: research
AbstractEnd stage renal disease requiring hemodialysis (HD) is frequent and coronary artery disease (CAD) is a common comorbidity. It is associated with bleeding and ischemic events. Platelet reactivity is a well-known determinant of both. However, the impact of HD due to end stage chronic kidney disease (CKD) on platelet reactivity is unknown. Therefore in this study, we evaluated platelet reactivity during hemodialysis in patients with CKD and coronary artery disease. 22 patients with CKD, HD and CAD were included in this study. Light transmission aggregometry (LTA) and flow cytometry were used for evaluating platelet fu...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
Publication date: Available online 5 November 2019Source: The Lancet HaematologyAuthor(s): Christoph Male, Anthonie W A Lensing, Joseph S Palumbo, Riten Kumar, Ildar Nurmeev, Kerry Hege, Damien Bonnet, Philip Connor, Hélène L Hooimeijer, Marcela Torres, Anthony K C Chan, Gili Kenet, Susanne Holzhauer, Amparo Santamaría, Pascal Amedro, Elizabeth Chalmers, Paolo Simioni, Rukhmi V Bhat, Donald L Yee, Olga LvovaSummaryBackgroundTreatment of venous thromboembolism in children is based on data obtained in adults with little direct documentation of its efficacy and safety in children. The aim of our study was...
Source: The Lancet Haematology - Category: Hematology Source Type: research
Portal hypertension is associated with many of the known complications of cirrhosis and has an enormous impact on patients ’ prognosis. Ascites and hepatic encephalopathy represent the most common complications of cirrhosis; both are associated with a significantly worse prognosis, with 50% survival over 1–2 years. Acute variceal bleeding is a life-threatening complication, and despite significant improvements in th e management it remains a leading cause of death in patients with cirrhosis. Advances in variceal bleeding management, including empirical antibiotic use, vasoactive drugs, early endoscopy and thera...
Source: Medicine - Category: Internal Medicine Authors: Tags: Management problems in liver disease Source Type: research
Conclusion: We concluded that LAA occlusion using the Amulet ™ LAA occluder can be performed with high procedural success and acceptable outcomes.Resumo Fundamento: A oclus ão do apêndice atrial esquerdo (AAE) é uma terapia alternativa para pacientes com fibrilação atrial que tenham alto risco embólico e contraindicações à terapia anticoagulante. Objetivo: Avaliar a viabilidade, segurança e resultados de médio prazo da oclusão percutânea do AAE, incluindo a trombose relacionada à prótese. Métodos: Sessenta pa...
Source: Arquivos Brasileiros de Cardiologia - Category: Cardiology Source Type: research
Conclusion: We concluded that LAA occlusion using the Amulet ™ LAA occluder can be performed with high procedural success and acceptable outcomes.Resumo Fundamento: A oclus ão do apêndice atrial esquerdo (AAE) é uma terapia alternativa para pacientes com fibrilação atrial que tenham alto risco embólico e contraindicações à terapia anticoagulante. Objetivo: Avaliar a viabilidade, segurança e resultados de médio prazo da oclusão percutânea do AAE, incluindo a trombose relacionada à prótese. Métodos: Sessenta pa...
Source: Arquivos Brasileiros de Cardiologia - Category: Cardiology Source Type: research
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