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Novel oral anticoagulants: too good to be true?
It is fair to say that the pharmacological therapy of cardiovascular disease has not been an area of spectacular growth in recent years. Little has happened in the treatment of hypertension and heart failure. There has been interest in the development of antiplatelet drugs in acute coronary syndromes and percutaneous interventions, but not in long-term cardiovascular prevention to compete with aspirin and clopidogrel. The one major area of intense interest has been the novel oral anticoagulants (NOACs), dabigatran, rivaroxaban and apixaban. The first of these is a direct thrombin inhibitor, while the other two are blockers...
Source: Postgraduate Medical Journal - August 18, 2014 Category: Journals (General) Authors: Schachter, M. Tags: Editor's choice, Drugs: cardiovascular system, Stroke, Hypertension, Ischaemic heart disease, Arrhythmias Editorials Source Type: research

Abstract 132: The POWR Survey: Patient and Physician Perspectives on Outcomes Weighting in Revascularization. Session Title: Poster Session I
Conclusions: Patients and physicians agree on which outcomes are most (death and stroke)and least impactful (incision scar), but there is a lot of variability in between supporting the reporting of more adverse outcomes and not just those included in MACE.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Pandit, J. A., Gupta, V., Boyer, N., Ports, T. A., Yeghiazarians, Y., Boyle, A. J. Tags: Session Title: Poster Session I Source Type: research

Meta-analysis finds benefit for dual antiplatelet therapy but limitations preclude changing standard mono antiplatelet therapy approach for acute non-cardioembolic ischaemic stroke or transient ischaemic attack
Commentary on: Wong KSL, Wang Y, Leng X, et al.. Early dual versus mono antiplatelet therapy for acute non-cardioembolic ischemic stroke or transient ischemic attack. An updated systematic review and meta-analysis. Circulation 2013;128:1656–66. Context Current guidelines recommend aspirin, aspirin plus clopidogrel or aspirin plus extended-release dipyridamole for treatment of acute ischaemic stroke (IS) or transient ischaemic attack (TIA) to prevent recurrent stroke, myocardial infarction and cardiovascular death.1 The Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial ra...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Aronow, W. S. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease Therapeutics Source Type: research

Extent of coronary artery disease and outcomes after ticagrelor administration in patients with an acute coronary syndrome: Insights from the PLATelet inhibition and patient Outcomes (PLATO) trial
Background: Extensive coronary artery disease (CAD) is associated with higher risk. In this substudy of the PLATO trial, we examined the effects of randomized treatment on outcome events and safety in relation to the extent of CAD.Methods: Patients were classified according to presence of extensive CAD (defined as 3-vessel disease, left main disease, or prior coronary artery bypass graft surgery). The trial's primary and secondary end points were compared using Cox proportional hazards regression.Results: Among 15,388 study patients for whom the extent of CAD was known, 4,646 (30%) had extensive CAD. Patients with extensiv...
Source: American Heart Journal - April 14, 2014 Category: Cardiology Authors: Anna Kotsia, Emmanouil S. Brilakis, Claes Held, Christopher Cannon, Gabriel P. Steg, Bernhard Meier, Frank Cools, Marc J. Claeys, Jan H. Cornel, Philip Aylward, Basil S. Lewis, Douglas Weaver, Gunnar Brandrup-Wognsen, Susanna R. Stevens, Anders Himmelmann Tags: Acute Ischemic Heart Disease Source Type: research

Early Clopidogrel Versus Prasugrel Use Among Contemporary STEMI and NSTEMI Patients in the US: Insights From the National Cardiovascular Data Registry Coronary Heart Disease
Conclusions With prasugrel as an antiplatelet treatment option, contemporary practice shows low uptake of prasugrel and delays in P2Y12 antagonist initiation among NSTEMI patients. We also note concerning evidence of inappropriate use of prasugrel, and inadequate targeting of this more potent therapy to maximize the benefit/risk ratio.
Source: JAHA:Journal of the American Heart Association - April 14, 2014 Category: Cardiology Authors: Sherwood, M. W., Wiviott, S. D., Peng, S. A., Roe, M. T., DeLemos, J., Peterson, E. D., Wang, T. Y. Tags: Coronary Heart Disease Source Type: research

Clopidogrel Use Is Associated With an Increased Prevalence of Cerebral Microbleeds in a Stroke-Free Population: The Rotterdam Study Stroke
Conclusions In stroke-free individuals, clopidogrel use was associated with a higher prevalence and higher number of CMBs. Whether this association is causal requires confirmation in prospective studies, especially given the small number of participants taking clopidogrel and the possibility of residual confounding in this study.
Source: JAHA:Journal of the American Heart Association - September 26, 2013 Category: Cardiology Authors: Darweesh, S. K. L., Leening, M. J. G., Akoudad, S., Loth, D. W., Hofman, A., Arfan Ikram, M., Vernooij, M. W., Stricker, B. H. Tags: Stroke Source Type: research

Effect of ticagrelor on the outcomes of patients with prior coronary artery bypass graft surgery: Insights from the PLATelet inhibition and patient outcomes (PLATO) trial
Conclusions: Prior-CABG patients presenting with acute coronary syndrome are a high-risk cohort for death and recurrent cardiovascular events but have a lower risk for major bleeding. Similar to the results in no-prior-CABG patients, ticagrelor was associated with a reduction in ischemic events without an increase in major bleeding.
Source: American Heart Journal - July 29, 2013 Category: Cardiology Authors: Emmanouil S. Brilakis, Claes Held, Bernhard Meier, Frank Cools, Marc J. Claeys, Jan H. Cornel, Philip Aylward, Basil S. Lewis, Douglas Weaver, Gunnar Brandrup-Wognsen, Susanna R. Stevens, Anders Himmelmann, Lars Wallentin, Stefan K. James Tags: Acute Ischemic Heart Disease Source Type: research

Lack of association between proton pump inhibitors and adverse events in patients taking clopidogrel and aspirin
Commentary on Douglas IJ, Evans SJ, Hingorani AD, et al.. Clopidogrel and interaction with proton pump inhibitors: comparison between cohort and within person study designs. BMJ 2012;345:e4388 Context Clopidogrel inhibits the P2Y12 platelet receptor and is used in patients with acute coronary syndromes or ischaemic stroke to prevent recurrent vascular events. Proton pump inhibitors (PPIs), however, have been shown to reduce the pharmacodynamic effect of clopidogrel upon platelet inhibition, and have been linked in retrospective studies to a higher rate of ischaemic outcomes in patients taking clopidogrel. Methods A total o...
Source: Evidence-Based Medicine - May 15, 2013 Category: Internal Medicine Authors: Waksman, R., Gaglia, M. A. Tags: Smoking and tobacco, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Health education, Smoking Aetiology Source Type: research

Thromboprophylaxis in heart failure patients with sinus rhythm: aspirin and warfarin lead to similar cardiovascular outcomes
Commentary on: Homma S, Thompson JL, Pullicino PM, et al.. WARCEF Investigators. Warfarin and aspirin in patients with heart failure and sinus rhythm. N Engl J Med 2012;366:1859–69. Context Chronic heart failure (CHF) is common, affecting 1–2% of the population and 10% of people >70 years. Patients with CHF have an increased risk of thromboembolism. Those with atrial fibrillation (AF) should receive warfarin but whether CHF patients with sinus rhythm (SR), whose risk is 1.5–3.5%,1 should receive thromboprophylaxis is unclear. Previous studies, Warfarin/Aspirin Study in Heart failure (warfarin, asp...
Source: Evidence-Based Medicine - March 19, 2013 Category: Internal Medicine Authors: Witte, K. K. A., Jamil, H. A. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Diabetes, Arrhythmias Therapeutics Source Type: research

Impact of Proton Pump Inhibitor Therapy on the Efficacy of Clopidogrel in the CAPRIE and CREDO Trials Coronary Heart Disease
Conclusions In CREDO, the efficacy of clopidogrel was not significantly affected by PPI use. However, in CAPRIE, clopidogrel was beneficial to non-PPI users while apparently harmful to PPI users. Whether this negative interaction is clinically important for patients receiving clopidogrel without aspirin needs further study.
Source: JAHA:Journal of the American Heart Association - January 15, 2013 Category: Cardiology Authors: Dunn, S. P., Steinhubl, S. R., Bauer, D., Charnigo, R. J., Berger, P. B., Topol, E. J. Tags: Coronary Heart Disease Source Type: research

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