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Aspirin versus vitamin K antagonist treatment guided by transoesophageal echocardiography in patients with atrial fibrillation: a pilot study
Conclusions This hypothesis-generating pilot trial has found that TEE may be used for refinement of stroke risk in paroxysmal atrial fibrillation patients. A larger trial is needed to confirm these data. (ClinicalTrials.gov number NTC00224757).
Source: Heart - March 5, 2014 Category: Cardiology Authors: Dinh, T., Baur, L. H. B., Pisters, R., Kamp, O., Verheugt, F. W. A., Smeets, J. L. R. M., Cheriex, E. C., Lindeboom, J.-E., Heesen, W. F., Tieleman, R. G., Prins, M. H., Crijns, H. J. G. M., for the TIARA investigators, Dinh, Pisters, Tieleman, Prins, Cri Tags: Drugs: cardiovascular system, Echocardiography, Clinical diagnostic tests, Epidemiology Cardiac risk factors and prevention Source Type: research

Two-year clinical outcome from the Iberian registry patients after left atrial appendage closure
Conclusions LAA closure with an occlusion device in patients contraindicated for oral anticoagulants is a therapeutic option associated with fewer thromboembolic and haemorrhagic events than expected from risk scores, particularly in the second year postimplantation.
Source: Heart - May 12, 2015 Category: Cardiology Authors: Minguez, J. R. L., Asensio, J. M. N., Gragera, J. E., Costa, M., Gonzalez, I. C., de Carlos, F. G., Diaz, J. A. F., Yuste, V. M., Gonzalez, R. M., Dominguez-Franco, A., Buendia, A. B., Garibi, J. H., Hernandez, F. H., Ribeiro, V. G. Tags: Congenital heart disease in adult patients, Editor's choice, Drugs: cardiovascular system, Heart failure, Hypertension, Epidemiology Arrhythmias and sudden death Source Type: research

Combined anticoagulation and antiplatelet therapy in AF patients: why do we not follow guidelines?
While current European guidelines recommend oral anticoagulation treatment over antiplatelet therapy for the prevention of ischaemic stroke in patients with non-valvular atrial fibrillation (AF) with a 64% stroke risk reduction by warfarin treatment versus placebo and a 39% risk reduction versus aspirin,1 single or dual antiplatelet therapy is the guideline recommended first-line treatment strategy for patients with peripheral and/or coronary artery disease with and without intervention to prevent recurrences and major adverse cardiac events.2–7 Antiplatelet therapy is also recommended in patients with ischaemic stro...
Source: Heart - September 23, 2014 Category: Cardiology Authors: Brandes, A. Tags: Drugs: cardiovascular system, Acute coronary syndromes, Venous thromboembolism Editorials Source Type: research

Effect of prior clopidogrel use on outcomes in medically managed acute coronary syndrome patients
Conclusions Patients receiving clopidogrel before admission for ACS and subsequently treated only medically are at higher risk for CV events versus those not previously receiving clopidogrel. More potent antiplatelet inhibition with prasugrel versus clopidogrel did not significantly reduce this risk. Trial registration number NCT00699998.
Source: Heart - July 10, 2016 Category: Cardiology Authors: Chin, C. T., Boden, W. E., Roe, M. T., Neely, B., Neely, M. L., Leiva-Pons, J. L., Corbalan, R., Gottlieb, S., Dalby, A. J., Armstrong, P. W., Prabhakaran, D., Fox, K. A. A., White, H. D., Ohman, E. M., Winters, K. J., Schiele, F. Tags: Drugs: cardiovascular system, Acute coronary syndromes Special populations Source Type: research

Prevalence and antithrombotic management of atrial fibrillation in hospitalised patients
Conclusions This hospital-based study revealed high AF prevalence rates (16.8%). Patients with AF were present in all hospital zones and almost all patients were at high risk for stroke. Anticoagulation management was likely inappropriate in 48.7%, indicating the need for better guideline implementation initiatives to guarantee hospital-wide optimised care for patients with AF.
Source: Heart - May 12, 2015 Category: Cardiology Authors: Berti, D., Moors, E., Moons, P., Heidbuchel, H. Tags: Drugs: cardiovascular system, Hypertension Arrhythmias and sudden death Source Type: research

Antiplatelet therapy following transcatheter aortic valve implantation
Conclusions No difference in 30-day NACE rate was observed between ASA-only or DAPT following TAVI. Moreover, a trend towards less life-threatening and major bleeding was observed in favour of ASA. Consequently the additive value of clopidogrel warrants further investigation.
Source: Heart - June 25, 2015 Category: Cardiology Authors: Hassell, M. E. C. J., Hildick-Smith, D., Durand, E., Kikkert, W. J., Wiegerinck, E. M. A., Stabile, E., Ussia, G. P., Sharma, S., Baan, J., Eltchaninoff, H., Rubino, P., Barbanti, M., Tamburino, C., Poliacikova, P., Blanchard, D., Piek, J. J., Delewi, R. Tags: Drugs: cardiovascular system, Epidemiology Valvular heart disease Source Type: research

Cochrane corner: vitamin K for improved anticoagulation control in patients receiving warfarin
There has been a substantial increase in the use of oral anticoagulants, notably in the ageing population. This is primarily driven by the use of warfarin in people with atrial fibrillation (AF) in order to reduce the risks of thromboembolic events such as stroke.1 In elderly patients with AF, warfarin use has been shown to reduce the relative risk of stroke by >50% compared with aspirin alone.2 Warfarin is also used to treat patients with deep vein thrombosis, mechanical heart valve replacement, cardioversion, cardiomyopathy and antiphospholipid syndrome.1 The clinical benefits of warfarin must also be balanced with po...
Source: Heart - October 11, 2015 Category: Cardiology Authors: Mahtani, K. R., Nunan, D., Heneghan, C. Tags: Drugs: cardiovascular system, Cochrane Corner, Venous thromboembolism, Epidemiology Editorials Source Type: research

Cardiovascular highlights from non-cardiology journals
Pre-operative aspirin does not influence CABG outcomes Aspirin is a common therapy for risk reduction among patients with coronary artery disease. However, among patients undergoing coronary artery bypass surgery, the benefits of aspirin on the risk of myocardial infarction and stroke may be outweighed by perioperative bleeding risk. To address this question, the ATACAS trial randomized 2100 patients to either receive 100 mg aspirin daily or matching placebo for 4 days immediately prior to the operation with all patients resuming aspirin within 24 hours of their bypass surgery. The primary outcome was a composite of d...
Source: Heart - June 5, 2016 Category: Cardiology Authors: Bradley, S. M. Tags: Journal scan Source Type: research

Cochrane corner: self-monitoring and self-management of oral anticoagulation
Background Use of oral anticoagulants such as warfarin is increasing. Part of the reason for this is the rising prevalence of atrial fibrillation, an ageing population and the widening indications for treatment based on evidence of benefit in reducing risk of stroke. A meta-analysis of 29 randomised trials including 28 044 participants with atrial fibrillation found that warfarin decreased the absolute risk of stroke by 2.7% per year (the number needed to treat (NNT) 37) compared with placebo or no treatment and by 0.7% per year (NNT=143) compared with aspirin.1 Management of warfarin, however, is challenging bec...
Source: Heart - May 31, 2017 Category: Cardiology Authors: Heneghan, C. J., Spencer, E. A., Mahtani, K. R. Tags: Editorials Source Type: research

Aspirin use in women for primary prevention
At present, there is no consensus on antiplatelet treatments in primary prevention, particularly for women. European guidelines on cardiovascular disease (CVD) prevention1 do not recommend antiplatelet therapy, while the American Heart Association guidelines for primary prevention2 support a daily treatment of low-dose aspirin in women aged >65 years. The US Food and Drug Administration at the beginning of this year stated that the agency "does not believe the evidence supports the general use of aspirin for primary prevention of a heart attack or stroke. In fact, there are serious risks associated with the use of ...
Source: Heart - February 12, 2015 Category: Cardiology Authors: Ferrario, M. M., Veronesi, G. Tags: Press releases, Drugs: cardiovascular system, Acute coronary syndromes, Epidemiology Editorials Source Type: research

Cardiovascular highlights from non-cardiology journals
Antiplatelet therapy in long-term risk reduction after myocardial infarction The activated platelet is central to development of ischemic cardiovascular events. Guidelines recommend treatment with a P2Y12 receptor antagonist for 1-year after myocardial infarction (MI) to reduce the risk of recurrent events. The PEGASUS trial sought to determine the impact of using the P2Y12 antagonist ticagrelor as part of long-term therapy after MI. In this trial, a total of 21,162 clinically stable patients with a MI in the prior 1 to 3 years (median 18 months) were randomized in a 1:1:1 fashion to either placebo, ticagrelor 90mg twice d...
Source: Heart - June 10, 2015 Category: Cardiology Authors: Bradley, S. M. Tags: Journal scan Source Type: research

Antithrombotic therapy after transcatheter aortic valve implantation
In their Heart paper, Hassell et al1 present an original analysis of four studies comparing single and dual antiplatelet therapy after transcatheter aortic valve implantation (TAVI). There was no difference in the primary endpoint of net adverse clinical and cerebral events combining 30-day rates of mortality, acute coronary syndrome, stroke and major bleeding. However, there was a strong trend, although not statistically significant, towards less major or life-threatening bleeding at 30 days in patients receiving aspirin alone as compared with those treated using the usual combination of aspirin and clopidogrel early...
Source: Heart - June 25, 2015 Category: Cardiology Authors: Iung, B. Tags: Drugs: cardiovascular system, Interventional cardiology, Clinical diagnostic tests, Epidemiology Editorials Source Type: research

Ischaemic stroke after ST-elevation myocardial infarction
Clinical introduction A 67-year-old Hispanic man presented with 5-h history of typical chest pain and an ECG consistent with inferior ST-elevation myocardial infarction (STEMI). Coronary angiography revealed an occluded proximal right coronary artery, and a percutaneous intervention with drug eluting stent was performed. He was started on aspirin and clopidogrel. Two weeks later, he was admitted with loss of consciousness, tonic-clonic seizure and urinary incontinence. On physical examination, he was unresponsive to tactile stimuli. Cardiac examination revealed a prominent left ventricular heave. Neurological examination s...
Source: Heart - December 11, 2015 Category: Cardiology Authors: Al-Ansari, Y., Otalvaro, L., Damluji, A. A. Tags: Drugs: cardiovascular system, Echocardiography, Image challenges, Acute coronary syndromes, Clinical diagnostic tests Source Type: research

Ticagrelor and aspirin for the prevention of cardiovascular events after coronary artery bypass graft surgery
Conclusions Ticagrelor added to aspirin after CABG reduced the proportion of patients with graft occlusion, and was a significant univariate and multivariable predictor of graft occlusion. These results are hypothesis-generating and should be confirmed in larger studies. Trial registration number NCT01373411: Results.
Source: Heart - April 24, 2016 Category: Cardiology Authors: Saw, J., Wong, G. C., Mayo, J., Bernstein, V., Mancini, G. B. J., Ye, J., Skarsgard, P., Starovoytov, A., Cairns, J. Tags: Drugs: cardiovascular system, Interventional cardiology, Acute coronary syndromes, Clinical diagnostic tests, Epidemiology Coronary artery disease Source Type: research

Antithrombotic drug use: scientific breakthroughs, biological limits and physician behaviour
During the past 25 years, there has been a dramatic surge in the use of antithrombotic drugs as documented in the Heart paper by Adelborg et al.1 The authors derived their findings from the Danish drug utilisation database, which is unique in its comprehensiveness and ability to capture over-the-counter aspirin. The increased prescription of antithrombotic drugs is fuelled by a better understanding of disease and risk, population growth, ageing societies, improved methods of detection, and rising global rates of obesity, a recognised risk factor for atrial fibrillation (AF), venous thromboembolic (VTE) disease, and ca...
Source: Heart - November 10, 2016 Category: Cardiology Authors: Hylek, E. M. Tags: Drugs: cardiovascular system, Venous thromboembolism, Epidemiology Editorials Source Type: research

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