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Outcomes and costs of left atrial appendage closure from randomized controlled trial and real-world experience relative to oral anticoagulation
Conclusion</strong> Left atrial appendage closure in NVAF in a real-world setting may result in lower stroke and major bleeding rates than reported in LAAC clinical trials. Left atrial appendage closure in both settings achieves cost parity in a relatively short period of time and may offer substantial savings compared with current therapies. Savings are most pronounced among higher risk patients and those unsuitable for anticoagulation.</span>
Source: European Heart Journal - February 29, 2016 Category: Cardiology Source Type: research

Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 2
<span class="paragraphSection">The choice of oral anticoagulant (OAC) for patients with atrial fibrillation (AF) may be influenced by individual clinical features or by patterns of risk factors and comorbidities. We reviewed analyses of subgroups of patients from trials of vitamin K antagonists vs. non-vitamin K oral anticoagulants (NOACs) for stroke prevention in AF with the aim to identify patient groups who might benefit from a particular OAC more than from another. In addition, we discuss the timing of initiation of anticoagulation. In the second of a two-part review, we discuss the use of NOAC for stroke prevent...
Source: European Heart Journal - February 4, 2016 Category: Cardiology Source Type: research

Stopping or continuing clopidogrel 12 months after drug-eluting stent placement: the OPTIDUAL randomized trial
Conclusions Extended DAPT did not achieve superiority in reducing net adverse clinical events compared to 12 months of DAPT after DES placement. The power of the OPTIDUAL trial was however low and reduced by premature termination of enrolment. ClinicalTrials.gov number NCT00822536.
Source: European Heart Journal - January 21, 2016 Category: Cardiology Authors: Helft, G., Steg, P. G., Le Feuvre, C., Georges, J.-L., Carrie, D., Dreyfus, X., Furber, A., Leclercq, F., Eltchaninoff, H., Falquier, J.-F., Henry, P., Cattan, S., Sebagh, L., Michel, P.-L., Tuambilangana, A., Hammoudi, N., Boccara, F., Cayla, G., Douard, Tags: ESC Hot Line Source Type: research

Long-term dual antiplatelet therapy for secondary prevention of cardiovascular events in the subgroup of patients with previous myocardial infarction: a collaborative meta-analysis of randomized trials
Conclusion Compared with aspirin alone, DAPT beyond 1 year among stabilized high-risk patients with prior MI decreases ischaemic events, including significant reductions in the individual endpoints of cardiovascular death, recurrent MI, and stroke. Dual antiplatelet therapy beyond 1 year increases major bleeding, but not fatal bleeding or non-cardiovascular death.
Source: European Heart Journal - January 21, 2016 Category: Cardiology Authors: Udell, J. A., Bonaca, M. P., Collet, J.-P., Lincoff, A. M., Kereiakes, D. J., Costa, F., Lee, C. W., Mauri, L., Valgimigli, M., Park, S.-J., Montalescot, G., Sabatine, M. S., Braunwald, E., Bhatt, D. L. Tags: Coronary artery disease Source Type: research

Efficacy and safety of ticagrelor for long-term secondary prevention of atherothrombotic events in relation to renal function: insights from the PEGASUS-TIMI 54 trial
Conclusion In patients with a history of MI, patients with renal dysfunction are at increased risk of MACE and consequently experience a particularly robust absolute risk reduction with long-term treatment with ticagrelor.
Source: European Heart Journal - January 21, 2016 Category: Cardiology Authors: Magnani, G., Storey, R. F., Steg, G., Bhatt, D. L., Cohen, M., Kuder, J., Im, K., Aylward, P., Ardissino, D., Isaza, D., Parkhomenko, A., Goudev, A. R., Dellborg, M., Kontny, F., Corbalan, R., Medina, F., Jensen, E. C., Held, P., Braunwald, E., Sabatine, Tags: Thrombosis and antithrombotic therapy Source Type: research

Ascertainment, classification, and impact of neoplasm detection during prolonged treatment with dual antiplatelet therapy with prasugrel vs. clopidogrel following acute coronary syndrome
Conclusions Neoplasm events were infrequent during long-term DAPT after ACS, were associated with differential cancer-screening practices across regions, and the frequency of neoplasm detection was similar with prasugrel vs. clopidogrel. Trial registration ClinicalTrials.gov identifier: NCT00699998.
Source: European Heart Journal - January 21, 2016 Category: Cardiology Authors: Roe, M. T., Cyr, D. D., Eckart, D., Schulte, P. J., Morse, M. A., Blackwell, K. L., Ready, N. E., Zafar, S. Y., Beaven, A. W., Strickler, J. H., Onken, J. E., Winters, K. J., Houterloot, L., Zamoryakhin, D., Wiviott, S. D., White, H. D., Prabhakaran, D., Tags: Acute coronary syndromes Source Type: research

Clinical outcomes in patients with atrial fibrillation according to sex during anticoagulation with apixaban or warfarin: a secondary analysis of a randomized controlled trial
Conclusion In the ARISTOTLE trial, women had a similar rate of stroke or systemic embolism but a lower risk of mortality and less clinically relevant bleeding than men. The efficacy and safety benefits of apixaban compared with warfarin were consistent in men and women. Trial registration ARISTOTLE ClinicalTrials.gov number, NCT00412984.
Source: European Heart Journal - December 7, 2015 Category: Cardiology Authors: Vinereanu, D., Stevens, S. R., Alexander, J. H., Al-Khatib, S. M., Avezum, A., Bahit, M. C., Granger, C. B., Lopes, R. D., Halvorsen, S., Hanna, M., Husted, S., Hylek, E. M., Mărgulescu, A. D., Wallentin, L., Atar, D. Tags: Atrial fibrillation Source Type: research

The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation
Conclusions The five-element ORBIT bleeding risk score had better ability to predict major bleeding in AF patients when compared with HAS-BLED and ATRIA risk scores. The ORBIT risk score can provide a simple, easily remembered tool to support clinical decision making.
Source: European Heart Journal - December 7, 2015 Category: Cardiology Authors: O'Brien, E. C., Simon, D. N., Thomas, L. E., Hylek, E. M., Gersh, B. J., Ansell, J. E., Kowey, P. R., Mahaffey, K. W., Chang, P., Fonarow, G. C., Pencina, M. J., Piccini, J. P., Peterson, E. D. Tags: Atrial fibrillation Source Type: research

Edoxaban vs. warfarin in patients with atrial fibrillation on amiodarone: a subgroup analysis of the ENGAGE AF-TIMI 48 trial
Conclusions Patients randomized to the LDE treated with amiodarone at the time of randomization demonstrated a significant reduction in ischaemic events vs. warfarin when compared with those not on amiodarone, while preserving a favourable bleeding profile. In contrast, amiodarone had no effect on the relative efficacy and safety of HDE.
Source: European Heart Journal - September 1, 2015 Category: Cardiology Authors: Steffel, J., Giugliano, R. P., Braunwald, E., Murphy, S. A., Atar, D., Heidbuchel, H., Camm, A. J., Antman, E. M., Ruff, C. T. Tags: Thrombosis and anti-thrombotic therapy Source Type: research

A prospective randomized evaluation of the TriGuard™ HDH embolic DEFLECTion device during transcatheter aortic valve implantation: results from the DEFLECT III trial
Conclusion TriGuard cerebral protection during TAVI is safe and complete cerebral vessel coverage was achieved in 89% of subjects. In this exploratory study, subjects undergoing protected TAVI had more freedom from ischaemic brain lesions, fewer neurologic deficits, and improved cognitive function in some domains at discharge and 30 days compared with controls.
Source: European Heart Journal - August 14, 2015 Category: Cardiology Authors: Lansky, A. J., Schofer, J., Tchetche, D., Stella, P., Pietras, C. G., Parise, H., Abrams, K., Forrest, J. K., Cleman, M., Reinohl, J., Cuisset, T., Blackman, D., Bolotin, G., Spitzer, S., Kappert, U., Gilard, M., Modine, T., Hildick-Smith, D., Haude, M., Tags: FASTTRACK EuroPCR Source Type: research

Uninterrupted rivaroxaban vs. uninterrupted vitamin K antagonists for catheter ablation in non-valvular atrial fibrillation
Conclusion In patients undergoing CA for AF, the use of uninterrupted oral rivaroxaban was feasible and event rates were similar to those for uninterrupted VKA therapy. Name of the Trial Registry Clinicaltrials.gov trial registration number is NCT01729871.
Source: European Heart Journal - July 21, 2015 Category: Cardiology Authors: Cappato, R., Marchlinski, F. E., Hohnloser, S. H., Naccarelli, G. V., Xiang, J., Wilber, D. J., Ma, C.-S., Hess, S., Wells, D. S., Juang, G., Vijgen, J., Hugl, B. J., Balasubramaniam, R., De Chillou, C., Davies, D. W., Fields, L. E., Natale, A., on behalf Tags: Atrial fibrillation Source Type: research

Randomized trial of atrial arrhythmia monitoring to guide anticoagulation in patients with implanted defibrillator and cardiac resynchronization devices
Conclusion In patients with implanted defibrillators, the strategy of early initiation and interruption of anticoagulation based on remotely detected AT did not prevent thromboembolism and bleeding. Clinical trial registration IMPACT ClinicalTrials.gov identifier: NCT00559988 http://clinicaltrials.gov/ct2/show/NCT00559988?term=NCT00559988&rank=1.
Source: European Heart Journal - July 7, 2015 Category: Cardiology Authors: Martin, D. T., Bersohn, M. M., Waldo, A. L., Wathen, M. S., Choucair, W. K., Lip, G. Y. H., Ip, J., Holcomb, R., Akar, J. G., Halperin, J. L., on behalf of the IMPACT Investigators Tags: Atrial fibrillation Source Type: research

Edoxaban vs. warfarin in vitamin K antagonist experienced and naive patients with atrial fibrillation
Conclusion In patients with AF, edoxaban appeared to demonstrate greater efficacy compared with warfarin in patients who were VKA naive than VKA experienced. Edoxaban significantly reduced major bleeding compared with warfarin regardless of prior VKA exposure.
Source: European Heart Journal - June 14, 2015 Category: Cardiology Authors: O'Donoghue, M. L., Ruff, C. T., Giugliano, R. P., Murphy, S. A., Grip, L. T., Mercuri, M. F., Rutman, H., Shi, M., Kania, G., Cermak, O., Braunwald, E., Antman, E. M. Tags: Atrial fibrillation Source Type: research

ISAR-SAFE: a randomized, double-blind, placebo-controlled trial of 6 vs. 12 months of clopidogrel therapy after drug-eluting stenting
Conclusions In the present trial, characterized by low event rates, we did not observe a significant difference in net clinical outcome between 6 and 12 months of clopidogrel therapy after DES implantation. However, the results of the trial must be considered in view of its premature termination and lower than expected event rates. The trial is registered with ClinicalTrials.gov, Identifier: NCT00661206.
Source: European Heart Journal - May 21, 2015 Category: Cardiology Authors: Schulz-Schupke, S., Byrne, R. A., ten Berg, J. M., Neumann, F.-J., Han, Y., Adriaenssens, T., Tolg, R., Seyfarth, M., Maeng, M., Zrenner, B., Jacobshagen, C., Mudra, H., von Hodenberg, E., Wohrle, J., Angiolillo, D. J., von Merzljak, B., Rifatov, N., Kufn Tags: Thrombosis and antithrombotic therapy Source Type: research

Clinical outcomes and management associated with major bleeding in patients with atrial fibrillation treated with apixaban or warfarin: insights from the ARISTOTLE trial
Conclusion Major bleeding was associated with substantially increased risk of death, ischaemic stroke, or MI, especially following ICH, and this risk was similarly elevated regardless of treatment with apixaban or warfarin. These results underscore the importance of preventing bleeding in anti-coagulated patients. Clinical Trials.gov identifier NCT00412984.
Source: European Heart Journal - May 21, 2015 Category: Cardiology Authors: Held, C., Hylek, E. M., Alexander, J. H., Hanna, M., Lopes, R. D., Wojdyla, D. M., Thomas, L., Al-Khalidi, H., Alings, M., Xavier, D., Ansell, J., Goto, S., Ruzyllo, W., Rosenqvist, M., Verheugt, F. W. A., Zhu, J., Granger, C. B., Wallentin, L. Tags: Thrombosis and antithrombotic therapy Source Type: research

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