Increased risk of myocardial infarction with dabigatran: fact or fiction?

Dabigatran is a direct, competitive inhibitor of thrombin recently approved for the prophylaxis of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. In some of the clinical trials evaluating the efficacy and safety of dabigatran in different clinical settings [i.e., prevention of venous thromboembolism (VTE) after orthopedic surgery, secondary prevention of VTE, and acute coronary syndromes (ACS)], a trend toward an increase in acute coronary events among patients receiving dabigatran has been reported, thus raising concerns of a possible relationship between dabigatran and myocardial infarction, especially in high-risk patients. However, as shown in our article, current evidence is inconclusive on this topic; more data are needed to detail this hypothetical association, and other considerations, such as the well-known protective effect of warfarin against ACS, should be taken into account as a possible explanation.
Source: Journal of Cardiovascular Medicine - Category: Cardiology Tags: Reviews: Antithrombotic treatment Source Type: research

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This study aimed to capture the evolving OAC patterns of patients with known non-valvular AF at high risk for stroke (CHA2DS2-Vasc score  ≥ 2 for males and ≥ 3 for females) during hospitalization. A total of 561 eligible patients who were admitted to the cardiology ward of a tertiary hospital were studied. Pre- and post-hospitalization OAC patterns [vitamin-K antagonist (VKA), non-vitamin K oral anticoagulants (NOAC), no OA C], changes between these patterns (initiation, switch, discontinuation, no change) and the respective patient profiles and discharge diagnoses were assessed. During hospitali...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
Abstract Oral anticoagulants (OAC) are widely used for prevention of systemic thromboembolism, including the reduction of the risk of stroke in patients with atrial fibrillation (AF) and prosthetic heart valves. There is also an increasing population of patients who require not only OACs, but also double antiplatelet therapy (DAPT). A typical example is a patient with AF and stable coronary artery disease or acute coronary syndrome (ACS), treated by percutaneous coronary intervention (PCI). In recent years, with the introduction of NOACs, triple or dual therapy has become safer. Regardless of these indications for...
Source: Polish Heart Journal - Category: Cardiology Authors: Tags: Kardiol Pol Source Type: research
Conclusion In real-life conditions, NVAF patients treated with apixaban show rates of treatment discontinuation and major bleedings, which are comparable to those found in the ARISTOTLE pivotal study, thus supporting its external validity.
Source: Journal of Cardiovascular Medicine - Category: Cardiology Tags: Research articles: Arrhythmias Source Type: research
This study details the design of the Edoxaban Treatment in routiNe clinical prActice for patients with Atrial Fibrillation in Europe (ETNA-AF-Europe) study – a postauthorization observational study, which is part of the postapproval plan for edoxaban agreed with the European Medicines Agency. Methods The ETNA-AF-Europe study ( NCT02944019) is a multicenter, prospective, observational study that enrolled 13 980 patients with atrial fibrillation treated with edoxaban from 852 sites across 10 European countries (Austria, Belgium, Germany, Ireland, Italy, the Netherlands, Portugal, Spain, Switzerl...
Source: Journal of Cardiovascular Medicine - Category: Cardiology Tags: Research articles: Trial design Source Type: research
A 60-something presented with hypotension, bradycardia, chest pain and back pain.She had a h/o aortic aneurysm, aortic insufficiency, peripheral vascular disease, and hypertension.  She had a mechanical aortic valve.  She was on anti-hypertensives including atenolol, and on coumadin, with an INR of 2.3. She was ill appearing.  BP was 70/49, pulse 60.A bedside echo showed good ejection fraction and normal right ventricle and no pericardial fluid. Here is the initial ECG:What do you think?This ECG actually looks like a left main occlusion (which rarely presents to the ED alive):  ST Elevation in...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
The management of antithrombotic therapy in patients with atrial fibrillation (AF) presenting an acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) is particularly complex. Oral anticoagulation (OAC) is superior to single or dual antiplatelet therapy (DAPT) for the prevention of thromboembolic complications (stroke and systemic embolism) due to AF, whereas DAPT with low-dose aspirin and a P2Y12 inhibitor is the recommended antithrombotic treatment to prevent ischemic events (myocardial infarction and stent thrombosis) in patients with ACS or undergoing PCI.
Source: International Journal of Cardiology - Category: Cardiology Authors: Tags: Editorial Source Type: research
Discussion: Our limited data suggests that use of DOACs in patients with MPN is feasible with an acceptable balance between risk of hemorrhage and recurrent thrombosis. Additional data on long term outcomes of DOACs in MPNs are needed.DisclosuresNo relevant conflicts of interest to declare.
Source: Blood - Category: Hematology Authors: Tags: 332. Antithrombotic Therapy Source Type: research
Introduction: Arterial and venous thromboembolic events, including stroke and myocardial infarction, are a leading cause of morbidity and mortality in the United States. Anticoagulation therapies are critical in preventing such morbidity and/or mortality. Vitamin K antagonist (VKA) such as warfarin has been the standard therapy for decades until recently with the advent of direct oral anticoagulants (DOACs). These newer agents offer important advantages over warfarin however, the risk of bleeding with these drugs as with all anticoagulants remains an ongoing safety concern. Among the most serious adverse events are intracr...
Source: Blood - Category: Hematology Authors: Tags: 332. Antithrombotic Therapy: Poster I Source Type: research
ConclusionsIn older adults treated with direct-acting oral anticoagulants after ischemic stroke, outcome rates varied considerably by drug and dosage.
Source: Drugs and Aging - Category: Geriatrics Source Type: research
CONCLUSION:  Presence, but not extent, of CAD was an independent risk factor of the composite thromboembolic endpoint beyond the components already included in the CHA2DS2-VASc score. Consequently, we suggest that significant angiographically proven CAD should be included in the vascular disease criterion in the CHA2DS2-VASc score. PMID: 30419601 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - Category: Hematology Authors: Tags: Thromb Haemost Source Type: research
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