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Source: The Lancet
Condition: Bleeding
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Total 30 results found since Jan 2013.
Guided de-escalation of antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention (TROPICAL-ACS): a randomised, open-label, multicentre trial
This study is registered with ClinicalTrials.gov, number NCT01959451, and EudraCT, 2013-001636-22. Findings Between Dec 2, 2013, and May 20, 2016, 2610 patients were assigned to study groups; 1304 to the guided de-escalation group and 1306 to the control group. The primary endpoint occurred in 95 patients (7%) in the guided de-escalation group and in 118 patients (9%) in the control group (pnon-inferiority=0·0004; hazard ratio [HR] 0·81 [95% CI 0·62–1·06], psuperiority=0·12). Despite early de-escalation, there was no increase in the combined risk of cardiovascular death, myocardial infarction, or stroke in the de-es...
Source: The Lancet - August 29, 2017 Category: General Medicine Source Type: research
Age-specific risks, severity, time course, and outcome of bleeding on long-term antiplatelet treatment after vascular events: a population-based cohort study
Publication date: Available online 13 June 2017 Source:The Lancet Author(s): Linxin Li, Olivia C Geraghty, Ziyah Mehta, Peter M Rothwell Background Lifelong antiplatelet treatment is recommended after ischaemic vascular events, on the basis of trials done mainly in patients younger than 75 years. Upper gastrointestinal bleeding is a serious complication, but had low case fatality in trials of aspirin and is not generally thought to cause long-term disability. Consequently, although co-prescription of proton-pump inhibitors (PPIs) reduces upper gastrointestinal bleeds by 70–90%, uptake is low and guidelines are conflicti...
Source: The Lancet - June 15, 2017 Category: General Medicine Source Type: research
The future of atrial fibrillation management: integrated care and stratified therapy
Publication date: Available online 28 April 2017 Source:The Lancet Author(s): Paulus Kirchhof Atrial fibrillation is one of the major cardiovascular health problems: it is a common, chronic condition, affecting 2–3% of the population in Europe and the USA and requiring 1–3% of health-care expenditure as a result of stroke, sudden death, heart failure, unplanned hospital admissions, and other complications. Early diagnosis of atrial fibrillation, ideally before the first complication occurs, remains a challenge, as shown by patients who are only diagnosed with the condition when admitted to hospital for acute cardiac d...
Source: The Lancet - April 29, 2017 Category: Journals (General) Source Type: research
Thrombolytic removal of intraventricular haemorrhage in treatment of severe stroke: results of the randomised, multicentre, multiregion, placebo-controlled CLEAR III trial
This study is registered with ClinicalTrials.gov, NCT00784134. Findings Between Sept 18, 2009, and Jan 13, 2015, 500 patients were randomised: 249 to the alteplase group and 251 to the saline group. 180-day follow-up data were available for analysis from 246 of 249 participants in the alteplase group and 245 of 251 participants in the placebo group. The primary efficacy outcome was similar in each group (good outcome in alteplase group 48% vs saline 45%; risk ratio [RR] 1·06 [95% CI 0·88–1·28; p=0·554]). A difference of 3·5% (RR 1·08 [95% CI 0·90–1·29], p=0·420) was found after adjustment for intraventricular ...
Source: The Lancet - January 9, 2017 Category: Journals (General) Source Type: research
Edoxaban versus enoxaparin –warfarin in patients undergoing cardioversion of atrial fibrillation (ENSURE-AF): a randomised, open-label, phase 3b trial
Publication date: Available online 30 August 2016 Source:The Lancet Author(s): Andreas Goette, Jose L Merino, Michael D Ezekowitz, Dmitry Zamoryakhin, Michael Melino, James Jin, Michele F Mercuri, Michael A Grosso, Victor Fernandez, Naab Al-Saady, Natalya Pelekh, Bela Merkely, Sergey Zenin, Mykola Kushnir, Jindrich Spinar, Valeriy Batushkin, Joris R de Groot, Gregory Y H Lip Background Edoxaban, an oral factor Xa inhibitor, is non-inferior for prevention of stroke and systemic embolism in patients with atrial fibrillation and is associated with less bleeding than well controlled enoxaparin–warfarin therapy. Few safety d...
Source: The Lancet - August 30, 2016 Category: Journals (General) Source Type: research
Platelet function monitoring to adjust antiplatelet therapy in elderly patients stented for an acute coronary syndrome (ANTARCTIC): an open-label, blinded-endpoint, randomised controlled superiority trial
Publication date: Available online 28 August 2016 Source:The Lancet Author(s): Guillaume Cayla, Thomas Cuisset, Johanne Silvain, Florence Leclercq, Stephane Manzo-Silberman, Christophe Saint-Etienne, Nicolas Delarche, Anne Bellemain-Appaix, Grégoire Range, Rami El Mahmoud, Didier Carrié, Loic Belle, Geraud Souteyrand, Pierre Aubry, Pierre Sabouret, Xavier Halna du Fretay, Farzin Beygui, Jean-Louis Bonnet, Benoit Lattuca, Christophe Pouillot, Olivier Varenne, Ziad Boueri, Eric Van Belle, Patrick Henry, Pascal Motreff, Simon Elhadad, Joe-Elie Salem, Jérémie Abtan, Hélène Rousseau, Jean-Philippe Collet, Eric Vicaut, Gi...
Source: The Lancet - August 27, 2016 Category: Journals (General) Source Type: research
Stroke prevention in atrial fibrillation
Publication date: 20–26 August 2016 Source:The Lancet, Volume 388, Issue 10046 Author(s): Ben Freedman, Tatjana S Potpara, Gregory Y H Lip Atrial fibrillation is found in a third of all ischaemic strokes, even more after post-stroke atrial fibrillation monitoring. Data from stroke registries show that both unknown and untreated or under treated atrial fibrillation is responsible for most of these strokes, which are often fatal or debilitating. Most could be prevented if efforts were directed towards detection of atrial fibrillation before stroke occurs, through screening or case finding, and treatment of all patients wi...
Source: The Lancet - August 18, 2016 Category: Journals (General) Source Type: research
The novel biomarker-based ABC (age, biomarkers, clinical history)-bleeding risk score for patients with atrial fibrillation: a derivation and validation study
Publication date: Available online 4 April 2016 Source:The Lancet Author(s): Ziad Hijazi, Jonas Oldgren, Johan Lindbäck, John H Alexander, Stuart J Connolly, John W Eikelboom, Michael D Ezekowitz, Claes Held, Elaine M Hylek, Renato D Lopes, Agneta Siegbahn, Salim Yusuf, Christopher B Granger, Lars Wallentin Background The benefit of oral anticoagulation in atrial fibrillation is based on a balance between reduction in ischaemic stroke and increase in major bleeding. We aimed to develop and validate a new biomarker-based risk score to improve the prognostication of major bleeding in patients with atrial fib...
Source: The Lancet - April 4, 2016 Category: Journals (General) Source Type: research
Can biomarkers balance stroke and bleeding risk?
Publication date: Available online 4 April 2016 Source:The Lancet Author(s): Paulus Kirchhof, Larissa Fabritz
Source: The Lancet - April 4, 2016 Category: Journals (General) Source Type: research
Deferred versus conventional stent implantation in patients with ST-segment elevation myocardial infarction (DANAMI 3-DEFER): an open-label, randomised controlled trial
Publication date: Available online 3 April 2016 Source:The Lancet Author(s): Henning Kelbæk, Dan Eik Høfsten, Lars Køber, Steffen Helqvist, Lene Kløvgaard, Lene Holmvang, Erik Jørgensen, Frants Pedersen, Kari Saunamäki, Ole De Backer, Lia E Bang, Klaus F Kofoed, Jacob Lønborg, Kiril Ahtarovski, Niels Vejlstrup, Hans E Bøtker, Christian J Terkelsen, Evald H Christiansen, Jan Ravkilde, Hans-Henrik Tilsted, Anton B Villadsen, Jens Aarøe, Svend E Jensen, Bent Raungaard, Lisette O Jensen, Peter Clemmensen, Peer Grande, Jan K Madsen, Christian Torp-Pedersen, Thomas Engstrøm Background De...
Source: The Lancet - April 3, 2016 Category: Journals (General) Source Type: research
Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): an open-label randomised controlled trial
This study is registered with ClinicalTrials.gov, number NCT01255540. Findings During a median follow-up of 1·53 years of participants recruited between Dec 10, 2010, and Feb 21, 2014, the primary outcome occurred in 93 (40·6%) of 229 patients assigned to the invasive group and 140 (61·4%) of 228 patients assigned to the conservative group (hazard ratio [HR] 0·53 [95% CI 0·41–0·69], p=0·0001). Five patients dropped out of the invasive group and one from the conservative group. HRs for the four components of the primary composite endpoint were 0·52 (0·35–0·76; p=0·0010) for myocardial infarction, 0·19 (0·0...
Source: The Lancet - January 13, 2016 Category: Journals (General) Source Type: research
Effect of the REG1 anticoagulation system versus bivalirudin on outcomes after percutaneous coronary intervention (REGULATE-PCI): a randomised clinical trial
Publication date: Available online 5 November 2015 Source:The Lancet Author(s): A Michael Lincoff, Roxana Mehran, Thomas J Povsic, Steven L Zelenkofske, Zhen Huang, Paul W Armstrong, P Gabriel Steg, Christoph Bode, Mauricio G Cohen, Christopher Buller, Peep Laanmets, Marco Valgimigli, Toomas Marandi, Viliam Fridrich, Warren J Cantor, Bela Merkely, Jose Lopez-Sendon, Jan H Cornel, Jaroslaw D Kasprzak, Michael Aschermann, Victor Guetta, Joao Morais, Peter R Sinnaeve, Kurt Huber, Rod Stables, Mary Ann Sellers, Marilyn Borgman, Lauren Glenn, Arnold I Levinson, Renato D Lopes, Vic Hasselblad, Ri...
Source: The Lancet - November 6, 2015 Category: Journals (General) Source Type: research
Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial
Publication date: Available online 16 March 2015 Source:The Lancet Author(s): Marco Valgimigli , Andrea Gagnor , Paolo Calabró , Enrico Frigoli , Sergio Leonardi , Tiziana Zaro , Paolo Rubartelli , Carlo Briguori , Giuseppe Andò , Alessandra Repetto , Ugo Limbruno , Bernardo Cortese , Paolo Sganzerla , Alessandro Lupi , Mario Galli , Salvatore Colangelo , Salvatore Ierna , Arturo Ausiello , Patrizia Presbitero , Gennaro Sardella , Ferdinando Varbella , Giovanni Esposito , Andrea Santarelli , Simone Tresoldi , Marco Nazzaro , Antonio Zingarelli , Nicoletta de Cesare , Stefano Rigattieri , Paolo Tosi , Cataldo Palmieri ,...
Source: The Lancet - March 17, 2015 Category: Journals (General) Source Type: research
Oral anticoagulants for stroke prevention in atrial fibrillation: current status, special situations, and unmet needs
Publication date: Available online 14 March 2015 Source:The Lancet Author(s): Freek W A Verheugt , Christopher B Granger In patients with non-valvular atrial fibrillation, oral anticoagulation with vitamin K antagonists reduces the risk of stroke by more than 60%. But vitamin K antagonists have limitations, including causing serious bleeding such as intracranial haemorrhage and the need for anticoagulation monitoring. In part related to these limitations, they are used in only about half of patients who should be treated according to guideline recommendations. In the past decade, oral agents have been developed that dire...
Source: The Lancet - March 14, 2015 Category: Journals (General) Source Type: research
Association between edoxaban dose, concentration, anti-Factor Xa activity, and outcomes: an analysis of data from the randomised, double-blind ENGAGE AF-TIMI 48 trial
Publication date: Available online 11 March 2015 Source:The Lancet Author(s): Christian T Ruff , Robert P Giugliano , Eugene Braunwald , David A Morrow , Sabina A Murphy , Julia F Kuder , Naveen Deenadayalu , Petr Jarolim , Joshua Betcher , Minggao Shi , Karen Brown , Indravadan Patel , Michele Mercuri , Elliott M Antman Background New oral anticoagulants for stroke prevention in atrial fibrillation were developed to be given in fixed doses without the need for the routine monitoring that has hindered usage and acceptance of vitamin K antagonists. A concern has emerged, however, that measurement of drug concentration or ...
Source: The Lancet - March 12, 2015 Category: Journals (General) Source Type: research
