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Source: Journal of the American College of Cardiology
Condition: Bleeding

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Total 52 results found since Jan 2013.

Vorapaxar, Combination Antiplatelet Therapy, and Stroke ∗
Drugs that inhibit platelet activation and aggregation reduce vascular events, notably myocardial infarction (MI) and ischemic stroke, and are generally associated with low rates of bleeding (1). Available agents inhibit platelets via distinct mechanisms (Table 1) (2), and combining antiplatelet drugs with different mechanisms of action should enhance net antithrombotic activity. For over a decade, the standard of care in patients with acute coronary syndromes, particularly those undergoing coronary stent implantation, has been dual antiplatelet therapy with aspirin plus an adenosine diphosphate receptor antagonist. When ...
Source: Journal of the American College of Cardiology - December 1, 2014 Category: Cardiology Source Type: research

Coronary Stent Thrombosis With Vorapaxar Versus Placebo Results From the TRA 2°P-TIMI 50 Trial
BackgroundVorapaxar, a novel thrombin receptor antagonist, reduces cardiovascular death and recurrent thrombotic events when added to standard antiplatelet therapy in patients with stable atherosclerotic vascular disease.ObjectivesThe goal of this study was to test the hypothesis that treatment with vorapaxar reduces the rate of coronary stent thrombosis (ST) in stable patients with a history of coronary stenting.MethodsTRA 2°P-TIMI 50 (Trial to Assess the Effects of Vorapaxar in Preventing Heart Attack and Stroke in Patients With Atherosclerosis-Thrombolysis In Myocardial Infarction 50) was a multinational, randomized, d...
Source: Journal of the American College of Cardiology - December 1, 2014 Category: Cardiology Source Type: research

The Effect of Dabigatran Plasma Concentrations and Patient Characteristics on the Frequency of Ischemic Stroke and Major Bleeding in Atrial Fibrillation Patients: The RE-LY Trial (Randomized Evaluation of Long-Term Anticoagulation Therapy)
Objectives: The goal of this study was to analyze the impact of dabigatran plasma concentrations, patient demographics, and aspirin (ASA) use on frequencies of ischemic strokes/systemic emboli and major bleeds in atrial fibrillation patients.Background: The efficacy and safety of dabigatran etexilate were demonstrated in the RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) trial, but a therapeutic concentration range has not been defined.Methods: In a pre-specified analysis of RE-LY, plasma concentrations of dabigatran were determined in patients treated with dabigatran etexilate 110 mg twice daily (bid) ...
Source: Journal of the American College of Cardiology - September 30, 2013 Category: Cardiology Authors: Paul A. Reilly, Thorsten Lehr, Sebastian Haertter, Stuart J. Connolly, Salim Yusuf, John W. Eikelboom, Michael D. Ezekowitz, Gerhard Nehmiz, Susan Wang, Lars Wallentin, RE-LY Investigators Tags: Antithrombotic Therapy Source Type: research

High-Sensitivity Troponin T and Risk Stratification in Patients With Atrial Fibrillation During Treatment With Apixaban or Warfarin
Objectives: The aim of this study was to evaluate the prognostic value of high-sensitivity troponin T (hs-TnT) in addition to clinical risk factors and the CHA2DS2VASc (congestive heart failure, hypertension, 75 years of age and older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, 65 to 74 years of age, female) risk score in patients with atrial fibrillation (AF).Background: The level of troponin is a powerful predictor of cardiovascular events and mortality.Methods: A total of 14,897 patients with AF were randomized to treatment with apixaban or warfarin in the ARISTOTLE (Apixaban for...
Source: Journal of the American College of Cardiology - September 23, 2013 Category: Cardiology Authors: Ziad Hijazi, Lars Wallentin, Agneta Siegbahn, Ulrika Andersson, John H. Alexander, Dan Atar, Bernard J. Gersh, Michael Hanna, Veli Pekka Harjola, John D. Horowitz, Steen Husted, Elaine M. Hylek, Renato D. Lopes, John J.V. McMurray, Christopher B. Granger, Tags: Heart Rhythm Disorders Source Type: research

The HAS-BLED Score Has Better Prediction Accuracy for Major Bleeding Than CHADS2 or CHA2DS2-VASc Scores in Anticoagulated Patients With Atrial Fibrillation
Objectives: The aim of this study was to test the hypothesis that a specific bleeding risk score, HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly), was better at predicting major bleeding compared with CHADS2 (congestive heart failure, hypertension, 75 years of age or older, diabetes mellitus, and previous stroke or transient ischemic attack) and CHA2DS2-VASc (congestive heart failure, hypertension, 75 years of age and older, diabetes mellitus, previous stroke or transient ischemic attack, vascular...
Source: Journal of the American College of Cardiology - September 20, 2013 Category: Cardiology Authors: Vanessa Roldán, Francisco Marín, Sergio Manzano-Fernández, Pilar Gallego, Juan Antonio Vílchez, Mariano Valdés, Vicente Vicente, Gregory Y.H. Lip Tags: Heart Rhythm Disorders Source Type: research

Higher N-Terminal Pro–B-Type Natriuretic Peptide May Be Related to Very Different Conditions
We read the paper by Hijazi et al. with interest. The authors investigated the incremental value of measuring N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels in addition to established risk factors (including the CHA2DS2VASc [heart failure, hypertension, age 75 years and older, diabetes, and previous stroke or transient ischemic attack, vascular disease, age 65 to 74 years, sex category (female sex, respectively)] score) for the prediction of cardiovascular and bleeding events. They concluded that NT-proBNP levels are often elevated in atrial fibrillation (AF) and independently associated with an increased ...
Source: Journal of the American College of Cardiology - July 26, 2013 Category: Cardiology Authors: Sevket Balta, Sait Demirkol, Mehmet Aydogan, Turgay Celik Tags: Letters to the Editor Source Type: research

Balancing the Benefits and Risks of 2 Doses of Dabigatran Compared With Warfarin in Atrial Fibrillation
Conclusions: On a group level both doses of dabigatran as compared with warfarin have similar benefits when considering a weighted estimate including both efficacy and safety. The similar overall benefits of the 2 doses of dabigatran versus warfarin support individualizing the dose based on patient characteristics and physician and patient preferences. (Randomized Evaluation of Long Term Anticoagulant Therapy [RE-LY] With Dabigatran Etexilate; NCT00262600)
Source: Journal of the American College of Cardiology - June 14, 2013 Category: Cardiology Authors: John W. Eikelboom, Stuart J. Connolly, Robert G. Hart, Lars Wallentin, Paul Reilly, Jonas Oldgren, Sean Yang, Salim Yusuf Tags: Heart Rhythm Disorders Source Type: research

The ATLAS ACS 2–TIMI 51 Trial and the Burden of Missing Data: (Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects With Acute Coronary Syndrome ACS 2–Thrombolysis In Myocardial Infarction 51)
Rivaroxaban is a factor Xa inhibitor that was recently reviewed by the Food and Drug Administration as a potential therapy to reduce the risk of recurrent atherothrombotic events in patients with acute coronary syndromes. Approval of this drug would represent a paradigm shift away from dual antiplatelet therapy toward long-term triple antithrombotic therapy. However, to date, no other experimental anticoagulant agent has demonstrated a favorable risk-benefit profile in this population, in part because of the expected increased risk in major bleeding by combining aspirin, a P2Y12 receptor inhibitor, and an anticoagulant. Ap...
Source: Journal of the American College of Cardiology - June 10, 2013 Category: Cardiology Authors: Mori J. Krantz, Sanjay Kaul Tags: VIEWPOINT Source Type: research

Oral Anticoagulation and Antiplatelets in Atrial Fibrillation Patients After Myocardial Infarction and Coronary Intervention
Conclusions: In real-life AF patients with indication for multiple antithrombotic drugs after MI/PCI, OAC and clopidogrel was equal or better on both benefit and safety outcomes compared to triple therapy.
Source: Journal of the American College of Cardiology - June 10, 2013 Category: Cardiology Authors: Morten Lamberts, Gunnar H. Gislason, Jonas Bjerring Olesen, Søren Lund Kristensen, Anne-Marie Schjerning Olsen, Anders Mikkelsen, Christine Benn Christensen, Gregory Y.H. Lip, Lars Køber, Christian Torp-Pedersen, Morten Lock Hansen Tags: Coronary Artery Disease Source Type: research

Antithrombotic Regimens in Patients With Atrial Fibrillation and Coronary Disease: Optimizing Efficacy and Safety∗
Clear evidence supports the value of oral anticoagulation (OAC) with vitamin K antagonists in preventing stroke and thromboembolism in patients with atrial fibrillation (AF) who have well-established risk factors. For this indication, vitamin K antagonists have been shown to be superior to single or dual antiplatelet agents in reducing thromboembolic complications . Yet, up to 30% of patients with AF also have indications for antiplatelet therapy because of coronary artery disease . Dual antiplatelet therapy with aspirin and a P2Y12 receptor inhibitor (e.g., clopidogrel) is usually recommended after stent implantation or a...
Source: Journal of the American College of Cardiology - June 10, 2013 Category: Cardiology Authors: Steven M. Markowitz Tags: Coronary Artery Disease: Editorial Comment Source Type: research

Percutaneous Left Atrial Appendage Closure With the AMPLATZER Cardiac Plug Device in Patients With Nonvalvular Atrial Fibrillation and Contraindications to Anticoagulation Therapy
Conclusions: In patients with nonvalvular atrial fibrillation at high risk of cardioembolic events and absolute contraindications to anticoagulation, LAAC using the ACP device followed by dual-/single-antiplatelet therapy was associated with a low rate of embolic and bleeding events after a mean follow-up of 20 months. No cases of severe residual leak or device thrombosis were observed at the 6-month follow-up.
Source: Journal of the American College of Cardiology - May 13, 2013 Category: Cardiology Authors: Marina Urena, Josep Rodés-Cabau, Xavier Freixa, Jacqueline Saw, John G. Webb, Mélanie Freeman, Eric Horlick, Mark Osten, Albert Chan, Jean-Francois Marquis, Jean Champagne, Réda Ibrahim Tags: Mini-Focus: Left Atrial Closure in Atrial Fibrillation Source Type: research

Rivaroxaban in Patients Stabilized After a ST-Segment Elevation Myocardial Infarction: Results From the ATLAS ACS-2–TIMI-51 Trial (Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects with Acute Coronary Syndrome–Thrombolysis In Myocardial Infarction-51)
Objectives: The present analysis reports on the pre-specified subgroup of ST-elevation myocardial infarction (STEMI) patients, in whom anticoagulant therapy has been of particular interest. Background: In ATLAS ACS-2–TIMI-51 (Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects with Acute Coronary Syndrome–Thrombolysis In Myocardial Infarction-51), rivaroxaban reduced cardiovascular events across the spectrum of acute coronary syndrome (ACS). Methods: Seven thousand eight hundred seventeen patients in ATLAS ACS-2-TIMI 51 presented with a STEMI. After being stabilized (1 to 7 d...
Source: Journal of the American College of Cardiology - May 1, 2013 Category: Cardiology Authors: Jessica L. Mega, Eugene Braunwald, Sabina A. Murphy, Alexei N. Plotnikov, Paul Burton, Robert Gabor Kiss, Alexander Parkhomenko, Michal Tendera, Petr Widimsky, C. Michael Gibson Tags: Coronary Artery Disease Source Type: research

Left Atrial Appendage Closure With the Watchman Device in Patients With a Contraindication for Oral Anticoagulation: The ASAP Study (ASA Plavix Feasibility Study With Watchman Left Atrial Appendage Closure Technology)
Conclusions: LAA closure with the Watchman device can be safely performed without a warfarin transition, and is a reasonable alternative to consider for patients at high risk for stroke but with contraindications to systemic oral anticoagulation. (ASA Plavix Feasibility Study With Watchman Left Atrial Appendage Closure Technology [ASAP]; NCT00851578)
Source: Journal of the American College of Cardiology - April 12, 2013 Category: Cardiology Authors: Vivek Y. Reddy, Sven Möbius-Winkler, Marc A. Miller, Petr Neuzil, Gerhard Schuler, Jens Wiebe, Peter Sick, Horst Sievert Tags: Atrial Fibrillation Source Type: research

Antithrombotic Treatment in Transcatheter Aortic Valve Implantation: Insights for Cerebrovascular and Bleeding Events
Transcatheter aortic valve implantation (TAVI) has emerged as a therapeutic alternative for patients with symptomatic aortic stenosis at high or prohibitive surgical risk. However, patients undergoing TAVI are also at high risk for both bleeding and stroke complications, and specific mechanical aspects of the procedure itself can increase the risk of these complications. The mechanisms of periprocedural bleeding complications seem to relate mainly to vascular/access site complications (related to the use of large catheters in a very old and frail elderly population), whereas the pathophysiology of cerebrovascular events re...
Source: Journal of the American College of Cardiology - April 12, 2013 Category: Cardiology Authors: Josep Rodés-Cabau, Harold L. Dauerman, Mauricio G. Cohen, Roxana Mehran, Eric M. Small, Susan S. Smyth, Marco A. Costa, Jessica L. Mega, Michelle L. O'Donoghue, E. Magnus Ohman, Richard C. Becker Tags: STATE-OF-THE-ART PAPER Source Type: research

The Transaortic Approach for Transcatheter Aortic Valve Replacement: Initial Clinical Experience in the United States
Conclusions: TAVR via the TAO approach is technically feasible, seems to be associated with favorable outcomes, and expands the current alternative options for access sites in patients with inoperable aortic stenosis who are ineligible for TF TAVR.
Source: Journal of the American College of Cardiology - April 12, 2013 Category: Cardiology Authors: Joel A. Lardizabal, Brian P. O'Neill, Harit V. Desai, Conrad J. Macon, Alexis P. Rodriguez, Claudia A. Martinez, Carlos E. Alfonso, Martin S. Bilsker, Roger G. Carillo, Mauricio G. Cohen, Alan W. Heldman, William W. O'Neill, Donald B. Williams Tags: Interventional Cardiology Source Type: research