Tag Archives: acute coronary syndrome

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Introduction The low molecular weight heparin (LMWH) enoxaparin is recommended by the European Society of Cardiology as an antithrombotic agent for the treatment of acute coronary syndromes (ACS) (class I level A indication in the treatment of acute ST-elevation myocardial infarction [MI] along with thrombolytic therapy and class IIa level B recommendation in the treatment of ACS without ST elevation).1,2 A dosing strategy of 1 mg/kg twice daily is recommended as higher doses have been shown to result in increased bleeding without further clinical benefit.3 Weight-adjusted dose reduction is advised in patients >75 years and in those with

Highlights of this year’s European Society of Cardiology Congress, held in Stockholm, Sweden, from August 28th to September 1st included a new drug which benefits heart failure by slowing heart rate, and more exciting results from oral compounds that could replace warfarin in various indications. Highlights of this year’s European Society of Cardiology Congress, held in Stockholm, Sweden, from August 28th to September 1st included a new drug which benefits heart failure by slowing heart rate, and more exciting results from oral compounds that could replace warfarin in various indications. SHIFT: ivabradine shows benefit in heart failure

Introduction Developments along the way have included better patient selection, improved peri-procedural management of patients and, with newer-generation drugs and devices, better results. Recent hurdles have been confronted, including left main stem disease, complex bifurcation lesions and total chronic occlusions. Similarly, primary percutaneous coronary intervention (PCI) has become the treatment of choice in acute myocardial infarction. Challenges remain, however, including restenosis. The fine balance between thrombosis and haemostasis demands that we provide more effective and predictable antiplatelet strategies to optimise risk reduct

Introduction While primary PCI, rather than thrombolysis, is now the reperfusion treatment of choice for STEMI, the majority of patients coming for revascularisation in the UK have stable coronary disease or NSTE-ACS. In the treatment of NSTE-ACS, first principles involve the selection of patients for diagnostic angiography followed by either PCI or coronary artery bypass grafting (CABG). Rates of PCI are increasing annually in the UK, which, in part, is a reflection of greater awareness of coronary artery disease, its earlier diagnosis and treatment in the ageing population. This section looks at coronary intervention in general, how PCI act

Introduction The discovery of the thienopyridines, or ADP receptor antagonists, led to the development of more effective oral antiplatelet agents. Trials assessed dual antiplatelet therapy in high-risk patients versus aspirin alone and the significant benefits observed have resulted in dual antiplatelet therapy becoming a mainstay of treatment. As expected with more potent dual therapy, there is always a fine balance between prevention of thrombosis and bleeding risk. There are still many challenges to overcome. Many patients, such as those with diabetes or with a previous stent thrombosis, are at high risk for further infarction, indicating

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Missing data Figure 1. Computed tomography (CT) sagittal reconstruction, two-chamber view. The subepicardial myocardium is thin and normally compacted with a thicker non-compacted subendocardial layer in the anterior wall and apex. Note the artefact from the right ventricular (RV) pacemaker tip There are, however, justified concerns with regard to MINAP data relating to data quality and completeness of ascertainment. These concerns reflect, in some cases, difficulties experienced by some hospitals with data collection. Systematic differences between patients with and without information recorded may bias the estimated performance of a hospita

Prasugrel, which will be marketed in Europe as Efient“, will be the first major competitor to clopidogrel, which has a much broader range of indications and is one of the world’s best selling pharmaceuticals. Prasugrel is a more potent antiplatelet agent than clopidogrel and is not thought to be associated with so much variability as clopidogrel. The increased antiplatelet potency of prasugrel would be expected to translate into a higher efficacy in preventing ischaemic events, but also a higher risk of bleeding. This is exactly what was seen in the large-scale TRITON-TIMI 38 trial, on which the approval of prasugrel is based. In the

PPIs are often prescribed for patients treated with clopidogrel and aspirin following ACS to reduce the risk of gastrointestinal bleeding. But it is thought that they can inhibit the cytochrome P450 isoenzymes that convert clopidogrel to its active metabolite, and these latest results suggest that such prophylactic prescribing of PPIs in this group of patients is not recommended, and that other gastro-protective agents may be preferable, the study authors comment. For their study, they identified 8,205 patients with ACS taking clopidogrel after hospital discharge, of whom 64% were prescribed a PPI. The primary end point, the risk of death or