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Predictors of adverse outcomes after transcatheter mitral valve replacement.
Authors: Overtchouk P, Piazza N, Granada JF, Modine T Abstract Introduction: Transcatheter mitral valve replacement (TMVR) is still a recent technology with numerous unknowns but also great promises. The risk of complications reported in observational studies have limited its adoption by interventional cardiology and surgical communities. Areas covered: Some of the major setbacks of TMVR are complications related to the devices and those related to the pathway. Device-related complications include left ventricle outflow tract (LVOT) obstruction, transcatheter heart valve (THV) dislocation or embolization, thrombosi...
Source: Expert Review of Cardiovascular Therapy - August 15, 2019 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Organizing stroke systems in the field for patients with suspected large vessel occlusion acute stroke.
Authors: Almekhlafi MA, Holodinsky JK, Hill MD, Kamal N, Goyal M Abstract INTRODUCTION: The dawn of endovascular stroke therapy has reshaped stroke care. Eligible patients need to be rushed to capable centers for intervention. This may entail bypassing closer hospitals that could confirm the diagnosis, administer thrombolytic therapy, then transfer patients for intervention. This has created a set of challenges: identifying endovascular candidates in the field, determining the best transport destination, and getting patients there quickly. Areas covered: This review provides a context for these emerging challenges....
Source: Expert Review of Cardiovascular Therapy - November 20, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Neurological complications associated with left ventricular assist device therapy.
Authors: Goodwin K, Kluis A, Alexy T, John R, Voeller R Abstract INTRODUCTION: Associated with significant morbidity and mortality, neurological complications in adult patients with left ventricular assist devices (LVAD) approaches a prevalence as high as 25%. As the number of individuals using LVAD support grows, it is increasingly important for providers to understand the hematologic and hemodynamic changes associated with LVAD implantation, the risk factors for neurological complications and their mitigation strategies. Areas covered: PubMed searches were completed using the terms 'Left ventricular assist device...
Source: Expert Review of Cardiovascular Therapy - November 15, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Triple antithrombotic therapy in patients with atrial fibrillation undergoing PCI: Current evidence and practice.
Authors: Clarke A, Ibrahim A, Kiernan TJ Abstract INTRODUCTION: Patients with atrial fibrillation taking oral anticoagulation and undergoing percutaneous coronary intervention with stent insertion are recommended to receive antithrombotic therapy with aspirin and P2Y12 receptor antagonist. This combinatory regime encompasses triple therapy (TT). Although TT reduces the risk of ischaemic events such as stroke and stent thrombosis, it is associated with an increased bleeding risk. Areas covered: The efficacy and safety profile of TT is uncertain with undetermined optimal duration and therapeutic combination. This rev...
Source: Expert Review of Cardiovascular Therapy - September 16, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Antithrombotic strategies after interventional left atrial appendage closure: an update.
Authors: Chen S, Weise FK, Chun KJ, Schmidt B Abstract INTRODUCTION: Interventional left atrial appendage occlusion (LAAO) has emerged as a valid alternative to oral anticoagulation (OAC) therapy for the prevention of ischemic stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF). Areas covered: Antithrombotic therapy following interventional LAAO is critical in balancing the risk of thromboembolism and bleeding during the endothelialization of the implanted devices. In this article, the most recent clinical trials are reviewed and the current real-world antithrombotic strategies follo...
Source: Expert Review of Cardiovascular Therapy - August 11, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Rivaroxaban in the cardiovascular world: a direct anticoagulant useful to prevent stroke, and venous and arterial thromboembolism.
Authors: Seoane L, Cortés M, Aris Cancela ME, Furmento J, Baranchuk A, Conde D Abstract INTRODUCTION: Until recently, vitamin K antagonists were the only drugs available for long-term anticoagulation. The use of these drugs is laborious due to their variable pharmacokinetics and pharmacodynamics. The advent of direct oral anticoagulants has produced a paradigm shift due to their low incidence of drug interactions, their stable plasma levels and their lack of monitoring. Rivaroxaban, a factor Xa inhibitor, has been tested in different clinical scenarios and has proved to be effective and safe, even increasing the s...
Source: Expert Review of Cardiovascular Therapy - June 6, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients with bioprosthetic valves.
Authors: Andrade JG, Meseguer E, Didier R, Dussault C, Weitz JI Abstract INTRODUCTION: The non-vitamin K antagonist oral anticoagulants (NOACs), which include dabigatran, apixaban, edoxaban and rivaroxaban, are preferred over vitamin K antagonists for stoke prevention in most patients with non-valvular atrial fibrillation. The NOACs are contraindicated in atrial fibrillation patients with rheumatic mitral stenosis or mechanical heart valves. There is evidence that bioprosthetic heart valves are less thrombogenic than mechanical heart valves, but it is unknown whether the risk of thromboembolism in atrial fibrillati...
Source: Expert Review of Cardiovascular Therapy - May 25, 2018 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Vorapaxar in the secondary prevention of atherothrombosis.
Authors: Tantry US, Liu F, Chen G, Gurbel PA Abstract Dual antiplatelet therapy with aspirin, a platelet cyclooxygenase-1 inhibitor and P2Y12 receptor blockers, remains the major drug strategy to prevent ischemic event occurrence in patients with acute coronary syndromes and in patients undergoing coronary stenting, but there some limitations that can be overcome by targeting novel targets. Unlike direct thrombin inhibitors that bind directly to thrombin, targeting the platelet thrombin receptor, protease activated receptor (PAR)-1, may offer a better choice for the attenuation of atherosclerosis progression, throm...
Source: Expert Review of Cardiovascular Therapy - February 17, 2016 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

The potential role of the left atrial septal pouch in cryptogenic stroke.
Authors: Wong JM, Fisher M Abstract The left atrial septal pouch (LASP) is an anatomic variant of the atrial septum that forms a blind-ending pouch, communicating exclusively with the left atrium (LA). Case reports have demonstrated thrombus within LASP and in the setting of cryptogenic stroke. Initial epidemiologic results are mixed, one study showing and others not showing an association between LASP and cryptogenic stroke. Additional investigation should take place to determine the clinical significance of LASP and what interventions are required to prevent ischemic stroke in at-risk individuals. PMID: 2648...
Source: Expert Review of Cardiovascular Therapy - February 17, 2016 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

Evaluating coagulation tests in patients with atrial fibrillation using direct oral anticoagulants.
Authors: Chan NC, Bhagirath V, Dale BJ, Eikelboom JW Abstract Four direct oral anticoagulants (dabigatran, rivaroxaban, apixaban, edoxaban) have been shown to be at least as effective and safe as warfarin for the prevention of stroke in atrial fibrillation and the prevention and treatment of venous thromboembolism. Although they are administered in fixed doses without routine coagulation monitoring, measurement of anticoagulant effect or drug levels may be useful to determine if: anticoagulant effect is present in patients who are bleeding or require an urgent procedure or thrombolysis; levels are within usual on-t...
Source: Expert Review of Cardiovascular Therapy - February 17, 2016 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research

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