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Short-Term Versus Long-Term Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation in Elderly Patients: A Meta-Analysis of Individual Participant Data From 6 Randomized Trials
Conclusions Short-term DAPT after new-generation DES implantation may be more beneficial in elderly patients than in younger patients.
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - March 5, 2018 Category: Cardiology Authors: Lee, S.-Y., Hong, M.-K., Palmerini, T., Kim, H.-S., Valgimigli, M., Feres, F., Colombo, A., Gilard, M., Shin, D.-H., Kim, J.-S., Kim, B.-K., Ko, Y.-G., Choi, D., Jang, Y., Stone, G. W. Tags: Coronary Source Type: research

Risk of Early Adverse Events After Clopidogrel Discontinuation in Patients Undergoing Short-Term Dual Antiplatelet Therapy: An Individual Participant Data Analysis
Conclusions Among patients undergoing PCI with predominantly new-generation DES, discontinuation of clopidogrel after 3 or 6 months DAPT duration was not associated with an early increase in adverse clinical events. An early increase in MACCE was observed after long-term (≥12 months) DAPT exposure.
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - August 21, 2017 Category: Cardiology Authors: Piccolo, R., Feres, F., Abizaid, A., Gilard, M., Morice, M.-C., Hong, M.-K., Kim, H.-S., Colombo, A., Bhatt, D. L., Palmerini, T., Stone, G. W., Windecker, S., Valgimigli, M. Tags: Coronary: Focus on Antithrombotic Drugs Source Type: research

Outcomes in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction Via Radial Access Anticoagulated With Bivalirudin Versus Heparin: A Report From the National Cardiovascular Data Registry
Conclusions In patients undergoing primary PCI via transradial access anticoagulated with bivalirudin or heparin, there was no difference in the composite endpoint of death, myocardial infarction, or stroke.
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - June 5, 2017 Category: Cardiology Authors: Jovin, I. S., Shah, R. M., Patel, D. B., Rao, S. V., Baklanov, D. V., Moussa, I., Kennedy, K. F., Secemsky, E. A., Yeh, R. W., Kontos, M. C., Vetrovec, G. W. Tags: Coronary Source Type: research

Extended Duration Dual Antiplatelet Therapy After Coronary Stenting Among Patients With Peripheral Arterial Disease: A Subanalysis of the Dual Antiplatelet Therapy Study
Conclusions Among patients undergoing coronary stenting, those with PAD have more ischemic and bleeding events versus those without PAD. Extended duration dual antiplatelet therapy is associated with consistent ischemic benefit and bleeding harm among patients with and without PAD.
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - May 1, 2017 Category: Cardiology Authors: Secemsky, E. A., Yeh, R. W., Kereiakes, D. J., Cutlip, D. E., Steg, P. G., Massaro, J. M., Apruzzese, P. K., Mauri, L., Dual Antiplatelet Therapy Study Investigators Tags: Peripheral Source Type: research

Thromboembolic Risk Reduction Via Transseptal Thrombus Aspiration in a Patient With Spontaneous Left Atrial Thrombus and Stroke
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - March 19, 2017 Category: Cardiology Authors: Stimpfle, F., Müller, K., Geisler, T., Schreieck, J., Schlak, D., Ziemann, U., Gawaz, M., Seizer, P. Tags: Images in Intervention Source Type: research

Left Atrial Appendage Thrombus in Transcatheter Aortic Valve Replacement: Incidence, Clinical Impact, and the Role of Cardiac Computed Tomography
Conclusions The incidence of LAAT in patients considered for TAVR is high, and LAAT embolization may represent a clinically relevant cause of periprocedural stroke. Dual-phase CCT is an accurate modality for the diagnosis of LAAT. It may obviate the need for pre-procedural TEE. The presence of LAAT should be examined in all patients undergoing TAVR and strategies developed for those patients in whom LAAT is identified.
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - January 15, 2017 Category: Cardiology Authors: Palmer, S., Child, N., de Belder, M. A., Muir, D. F., Williams, P. Tags: Structural Source Type: research

Atrial Fibrillation and Transcatheter Aortic Valve Replacement: Implications of Pre-Procedural Identification of Left Atrial Appendage Thrombus for Stroke Prevention
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - January 15, 2017 Category: Cardiology Authors: Kapadia, S. R., Krishnaswamy, A., Tuzcu, E. M. Tags: Editorial Comment Source Type: research

Second-Generation Drug-Eluting Stent Implantation Followed by 6- Versus 12-Month Dual Antiplatelet Therapy The SECURITY Randomized Clinical Trial
BackgroundThe optimal duration of dual antiplatelet therapy (DAPT) following second-generation drug-eluting stent (DES) implantation is still debated.ObjectivesThe aim of this study was to test the noninferiority of 6 versus 12 months of DAPT in patients undergoing percutaneous coronary intervention with second-generation DES.MethodsThe SECURITY (Second Generation Drug-Eluting Stent Implantation Followed by Six- Versus Twelve-Month Dual Antiplatelet Therapy) trial was a 1:1 randomized, multicenter, international, investigator-driven, noninferiority study conducted from July 2009 to June 2014. Patients with a stable or unst...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - November 10, 2014 Category: Cardiology Source Type: research

Maybe Atrial Fibrillation DOES Matter in Ventricular Assist Device Patients? ∗
Atrial fibrillation (AF) management poses challenges that are typically distilled into a simple question: rate control or rhythm control? Do the benefits of full anticoagulation outweigh the potential risks in this patient? As an internal medicine resident, I found AF management much less anxiety provoking than acute coronary syndromes. Hours of pathophysiology and lurking in the back of the room on rounds reinforced the relatively “benign” nature of AF. The AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) study was published (1), I used the CHADS2 (congestive heart failure, hypertension, age...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - October 27, 2014 Category: Cardiology Source Type: research

Efficacy and Safety of Amiodarone in Patients With Atrial Fibrillation in the Era of Target-Specific Anticoagulants ∗
In patients with atrial fibrillation (AF), loss of organized atrial contraction and accelerated ventricular rate can have both immediate and long-term adverse consequences, including deterioration of hemodynamics, progressive atrial and ventricular dysfunction, and an ongoing risk of ischemic stroke and systemic embolic events (SEEs). The principal goals of therapy are control of symptoms and prevention of thromboembolism.
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - October 6, 2014 Category: Cardiology Source Type: research

Triple Therapy for Atrial Fibrillation and Percutaneous Coronary Intervention A Contemporary Review
Chronic oral anticoagulant therapy is recommended (class I) in patients with mechanical heart valves and in patients with atrial fibrillation with a CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, prior Stroke or transient ischemic attack or thromboembolism, Vascular disease, Age 65 to 74 years, Sex category) score ≥1. When these patients undergo percutaneous coronary intervention with stenting, treatment with aspirin and a P2Y12 receptor inhibitor also becomes indicated. Before 2014, guidelines recommended the use of triple therapy (vitamin K antagonists, aspirin, and clopidog...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - September 15, 2014 Category: Cardiology Source Type: research

Switching Patients From Blinded Study Drug to Warfarin at the End of the ENGAGE AF–TIMI 48 Trial Setting a New Standard ∗
Interruption of warfarin treatment is associated with an increased risk of thromboembolic events (1). Among patients with atrial fibrillation (AF) receiving warfarin for stroke prevention, as many as 1 in 10 temporarily interrupt treatment each year, most commonly for invasive procedures (1,2). Because of its long half-life, warfarin is usually stopped 4 to 5 days before a procedure, and it takes another 4 to 5 days after restarting treatment before a therapeutic anticoagulant effect is regained. In order to minimize the time off treatment and thereby reduce the risk of thromboembolism around the time of the procedure, t...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - August 4, 2014 Category: Cardiology Source Type: research

Percutaneous Left Atrial Appendage Suture Ligation Not Ready for Prime Time ∗
Novel approaches to reduce stroke risk with oral anticoagulant medications or interventions are of the utmost importance to improve the quality of care for patients with atrial fibrillation (AF). Oral anticoagulation with vitamin K antagonists and, more recently, with novel oral anticoagulants (NOACs) has led to a remarkable reduction of stroke risk; however, some of the benefits with NOACs are counterbalanced by increased bleeding risks. The idea of developing interventions that reduce stroke risk but avoid long-term oral anticoagulation and thereby avoid increasing the bleeding risk appears very reasonable and attractive...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - August 4, 2014 Category: Cardiology Source Type: research

Aspirin Therapy in Primary Cardiovascular Disease Prevention A Position Paper of the European Society of Cardiology Working Group on Thrombosis
Although the use of oral anticoagulants (vitamin K antagonists) has been abandoned in primary cardiovascular prevention due to lack of a favorable benefit-to-risk ratio, the indications for aspirin use in this setting continue to be a source of major debate, with major international guidelines providing conflicting recommendations. Here, we review the evidence in favor and against aspirin therapy in primary prevention based on the evidence accumulated so far, including recent data linking aspirin with cancer protection. While awaiting the results of several ongoing studies, we argue for a pragmatic approach to using low-do...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - July 14, 2014 Category: Cardiology Source Type: research

Shared Risk Factors for Anticoagulation in Nonvalvular Atrial Fibrillation A Dilemma in Clinical Decision Making ∗
Atrial fibrillation (AF) is the most common cardiac rhythm disorder (1) and can result in negative cardiovascular outcomes such as stroke and mortality, especially in patients with cardiovascular morbidities (2,3). AF also contributes substantially to the cost of medical care (4), of which stroke-related care is a large component. Clinical trials have fundamentally supported the concepts used by clinicians in the management of AF including rate and rhythm control, use of interventional procedures such as ablation, and anticoagulation for the prevention of stroke and thromboembolism (5,6). Despite these guidelines, there is...
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - May 19, 2014 Category: Cardiology Source Type: research

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