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Short- and long-term outcome of patients with spontaneous echo contrast or thrombus in the left atrial appendage in the era of the direct acting anticoagulants
ConclusionEven in the DOAC era, the occurrence of thrombus or SEC in the LAA is associated with a high rate of MACCE. Our study suggests that the choice of DOAC therapy may have an impact on long-term survival.Graphic abstract
Source: Clinical Research in Cardiology - August 26, 2021 Category: Cardiology Source Type: research

Impact of atrial fibrillation pattern on outcomes after left atrial appendage closure: lessons from the prospective LAARGE registry
ConclusionAtrial fibrillation type did not impair periprocedural safety or in-hospital MACE patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality.Graphic abstract
Source: Clinical Research in Cardiology - May 27, 2021 Category: Cardiology Source Type: research

Continuation or discontinuation of oral anticoagulants after HAS-BLED scores increase in patients with atrial fibrillation
ConclusionsFor patients whose HAS-BLED scores increased to  ≥ 3, the continuation of OACs was associated with better clinical outcomes. An increased HAS-BLED score in anticoagulated AF patients may not be the only reason to withhold OACs, but reminds physicians to correct modifiable bleeding risk factors and follow up patients more closely.Graphical abstractAssociations between Continuation or Discontinuation of Oral Anticoagulants and Risks of Clinical Outcomes after HAS-BLED Scores IncreasedAF atrial fibrillation;aHR adjusted hazard ratio;ICH intra-cranial hemorrhage;OACs oral anticoagulants
Source: Clinical Research in Cardiology - March 11, 2021 Category: Cardiology Source Type: research

Antithrombotic therapy with or without clopidogrel after transcatheter aortic valve replacement. A meta-analysis of randomized controlled trials
ConclusionsIn patients receiving TAVR, a therapeutic strategy of aspirin or OAC with clopidogrel significantly increases the risk of major bleeding without impact on mortality and ischemic outcomes compared to aspirin or OAC without clopidogrel. The performance of different antithrombotic regimens in terms of long-term clinical outcomes and bioprosthesis valve function requires further investigation.Graphic abstractForest plots from pairwise and network meta-analyses associated with an antithrombotic therapy with or without clopidogrel Risk ratio for all outcomes of interest calculated with the pairwise meta-analysis (left...
Source: Clinical Research in Cardiology - December 23, 2020 Category: Cardiology Source Type: research

Clinical risk predictors in atrial fibrillation patients following successful coronary stenting: ENTRUST-AF PCI sub-analysis
ConclusionAfter PCI in AF patients, increasing CHA2DS2-VASc score was associated with increased bleeding rates and CHA2DS2-VASc score ( ≥ 5) predicted the occurrence of stent thrombosis. Paroxysmal AF was associated with MI. These findings may have important clinical implications in AF patients.
Source: Clinical Research in Cardiology - October 24, 2020 Category: Cardiology Source Type: research

Anti-thrombotic strategies in patients with atrial fibrillation undergoing PCI
AbstractTriple anti-thrombotic therapy combining oral anticoagulation and dual anti-platelet therapy following percutaneous coronary intervention in patients with atrial fibrillation was considered as standard and recommended by guidelines. While bleeding risk is considerable with that approach, data for efficacy are scare. Several trials assessed the possibility of reducing anti-thrombotic treatment by mainly shortening the exposure to acetylsalicylic acid. Dropping one of the anti-platelet components might increase the risk of stent thrombosis, myocardial infarction or stroke. Despite that fear, the recent trials ’ pri...
Source: Clinical Research in Cardiology - July 20, 2020 Category: Cardiology Source Type: research

Effect of concomitant antiplatelet agents on clinical outcomes in the edoxaban vs warfarin in subjects undergoing cardioversion of atrial fibrillation (ENSURE-AF) randomized trial
ConclusionIn ENSURE-AF, thromboembolic events were rare and absolute bleeding event rates were higher with concomitant APT. These findings may be relevant for AF-patients considered for dual therapy; even for a short treatment duration of 1  month.
Source: Clinical Research in Cardiology - March 30, 2020 Category: Cardiology Source Type: research

Impact of renal function on clinical outcomes after PCI in ACS and stable CAD patients treated with ticagrelor: a prespecified analysis of the GLOBAL LEADERS randomized clinical trial
ConclusionsIRF negatively impacted long-term prognosis after PCI. There were no differential treatment effects found with regard to all-cause death or new Q-wave MI after PCI in patients with IRF treated with ticagrelor monotherapy.Clinical trial registrationThe trial has been registered with ClinicalTrials.gov, number NCT01813435.Graphic abstract
Source: Clinical Research in Cardiology - January 9, 2020 Category: Cardiology Source Type: research

Prasugrel use and clinical outcomes by age among patients undergoing PCI for acute coronary syndrome: from the PROMETHEUS study
ConclusionsAge is a strong determinant of clinical risk as well as prasugrel prescription in ACS PCI with much lower use among older patients. Prasugrel did not have a differential treatment effect by age for MACE or bleeding.Graphic abstractFrequency of prasugrel use and age-related temporal risks of all-cause death and bleeding after ACS PCI.
Source: Clinical Research in Cardiology - January 7, 2020 Category: Cardiology Source Type: research

Edoxaban versus warfarin in vitamin K antagonist experienced and na ïve patients from the edoxaban versus warfarin in subjects undergoing cardioversion of atrial fibrillation (ENSURE-AF) randomised trial
ConclusionsEdoxaban had comparable efficacy and safety to optimized anticoagulation with enox –warf. The primary efficacy and safety endpoint outcomes were broadly similar between VKA experienced or naïve patients.
Source: Clinical Research in Cardiology - January 7, 2020 Category: Cardiology Source Type: research

Mechanical circulatory support with Impella versus intra-aortic balloon pump or medical treatment in cardiogenic shock —a critical appraisal of current data
ConclusionIn patients suffering from severe CS due to AMI, the use of Impella is not associated with improved short-time survival but with higher complications rates compared to IABP and medical treatment. Better patient selection avoiding Impella implantation in futile situations or in possible lower risk CS might be necessary to elucidate possible advantages of Impella in future studies.
Source: Clinical Research in Cardiology - March 20, 2019 Category: Cardiology Source Type: research

Digitalis therapy is associated with higher comorbidities and poorer prognosis in patients undergoing ablation of atrial arrhythmias: data from the German Ablation Registry
ConclusionIn the present study of patients undergoing catheter ablation of supraventricular arrhythmias, an association of digitalis therapy with increased mortality and an increased rate of other severe adverse events were observed. The results from this ‘real-life’ registry are consistent with previously published studies. However, whether digitalis therapy promotes a poorer prognosis or may just serve as a marker for this aspect cannot be thoroughly interpreted.
Source: Clinical Research in Cardiology - February 23, 2019 Category: Cardiology Source Type: research

Uptake in antithrombotic treatment and its association with stroke incidence in atrial fibrillation: insights from a large German claims database
ConclusionBetween 2011 and 2016, the use of guideline-conform antithrombotic therapy in Germany has significantly increased. This was associated with a significant decline in strokes without an increased incidence of bleeding complications.
Source: Clinical Research in Cardiology - February 15, 2019 Category: Cardiology Source Type: research

Transcatheter aortic valve replacement for pure aortic valve regurgitation: “on-label” versus “off-label” use of TAVR devices
ConclusionBased on this summary of available observational data TAVR for PAR is feasible and safe in patients deemed inoperable. First-generation TAVR devices are associated with inferior outcome and should be avoided. The “on-label” use of PAR-certified TAVR devices is associated with a significantly higher procedural success rate and might be favorable compared to other second-generation devices.
Source: Clinical Research in Cardiology - February 8, 2019 Category: Cardiology Source Type: research

Interventional closure vs. medical therapy of patent foramen ovale for secondary prevention of stroke: updated meta-analysis
ConclusionsInterventional closure of PFO resulted in significant reduction of stroke and stroke/TIA compared with antiplatelets/anticoagulants with comparable bleeding rates between the groups, whereas AF occurred more frequently in the intervention group. Patients with large shunts had more benefit from interventional closure.
Source: Clinical Research in Cardiology - February 1, 2019 Category: Cardiology Source Type: research

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