Secondary prevention of acute coronary syndrome with antiplatelet agents in real life: a high-dimensional propensity score matched cohort study in the French National claims database
This study was done in a newly available large-scale claims database, which may differ from other population databases, by it size and exhaustiveness•The methods elaborate on standard high-dimensional propensity scores as adapted to this claims databaseGraphical abstract
The prevalence of heart failure is rising1, 2 thus constantly widening the gap between donor hearts and patients listed for transplantation3. For an increasing number of patients with advanced heart failure, durable ventricular assist devices (VAD) prolong survival and improve quality of life4 by serving as bridge to transplant, or, for those not eligible for heart transplantation, as destination therapy, i.e. as a life-long support4, 5. Their long-term use, however, is hampered by stroke, bleeding, and infection.
Taking this pill every day to prevent a heart attack or stroke can cause brain and stomach bleeding. → Support PsyBlog for just $5 per month. Enables access to articles marked (M) and removes ads. → Explore PsyBlog's ebooks, all written by Dr Jeremy Dean: Accept Yourself: How to feel a profound sense of warmth and self-compassion The Anxiety Plan: 42 Strategies For Worry, Phobias, OCD and Panic Spark: 17 Steps That Will Boost Your Motivation For Anything Activate: How To Find Joy Again By Changing What You Do
Alteplase is the only Food and Drug Administration-approved intravenous (IV) thrombolytic medication for acute ischemic stroke. However, multiple recent studies comparing tenecteplase and alteplase suggest that tenecteplase is at least as efficacious as alteplase with regards to neurologic improvement. When given at 0.25 milligrams per kilogram (mg/kg), tenecteplase may have less bleeding complications than alteplase as well. This narrative review evaluates the literature and addresses the practical issues with regards to the use of tenecteplase versus alteplase for acute ischemic stroke, and it recommends that physicians ...
The antiplatelet landscape for the secondary prevention of ischemic stroke has changed significantly over the past decade. Poststroke dual antiplatelet regimens are becoming increasingly routine as supported by recent literature and guideline recommendations. Dual antiplatelet therapy after stroke generally consists of aspirin and clopidogrel and is considered in the short term after stroke in select populations including those with mild stroke or transient ischemic attack and in patients with severe intracranial atherosclerosis. When initiating dual antiplatelet therapy, factors that may increase a patient's risk of bleed...
FRIDAY, Feb. 21, 2020 (American Heart Association News) -- Nearly two-thirds of people who survive an often-deadly type of stroke caused by bleeding in the brain continue to experience high blood pressure because they aren't taking enough...
(American Heart Association) The blood thinner apixaban, which treats and prevents blood clots in some people with irregular heart rhythm, is safe and effective in stroke patients. Apixaban is associated with less bleeding, death and hospitalization than warfarin.
(American Heart Association) There are few treatment options for bleeding stroke.There was a trend towards reduced growth of brain bleeds in those treated with the antifibrinolytic agent tranexamic acid within 4.5 hours of stroke onset, compared to those treated with placebo.
(American Heart Association) Mechanical clot removal alone may be as effective as combining it with intravenous (IV) clot-busting medications for stroke patients. Mechanical clot removal alone reduced the risk of brain bleeding in this Japanese study.
In conclusion, the effects of 1-month DAPT for the primary and major secondary endpoints were consistent in HBR and non-HBR patients without any significant interactions. The benefit of 1-month DAPT in reducing major bleeding was numerically greater in HBR patients.Clinical trial registration Short and optimal duration of dual antiplatelet therapy after everolimus-eluting cobalt –chromium stent-2 [STOPDAPT-2]; NCT02619760.
CONCLUSIONS: We found a strong association between a low benefit satisfaction and increased stroke risk. We should follow patients carefully to educate them on treatment importance for patients unsatisfied with the benefits of DOACs for stroke prevention. PMID: 32089481 [PubMed - as supplied by publisher]