Tag Archives: anticoagulation

Introduction Peripheral artery disease (PAD) refers to all arterial disease outside of the coronary arteries and the aorta.1 It is estimated that over 200 million individuals are living with PAD globally.2,3 In the Western world, one in five adults over the age of 75 has PAD, including over 40 million Europeans.3-6 Though the prevalence of PAD is already at endemic levels worldwide, ageing populations and the increasing burden of chronic disease (i.e. hypertension, dyslipidaemia, diabetes mellitus, smoking) will contribute to further increases in the incidence and prevalence of PAD in the coming decades.2,3 As a consequence, PAD is the third

Background, epidemiology and rationale for the COMPASS study One quarter of all deaths in the UK in 2017 occurred as a result of diseases of the heart and circulation.1 One in seven men and one in twelve women died from coronary heart disease (CHD).1 The presence of CHD doubles the risk of stroke,2 and more than 100,000 strokes occur in the UK each year.1 Although the mortality rate from circulatory diseases is declining due to advances in treatment,1,3 more than 100,000 deaths resulted from CHD or stroke combined in the UK each year.1 CHD and stroke are the two leading causes of death worldwide.4 Circulatory disease is also associated with a

Until recently, warfarin was the drug of choice for patients with atrial fibrillation. Data from the ROCKET-AF (Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation),1 ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation),2 RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy)3 and ENGAGE AF-TIMI 48 (Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48)4 trials demonstrated non-inferior or superior reduction in str

Background, epidemiology and rationale for study The PIONEER AF-PCI (Open-Label, Randomized, Controlled, Multicenter Study Exploring Two Treatment Strategies of Rivaroxaban and a Dose-Adjusted Oral Vitamin K Antagonist Treatment Strategy in Subjects with Atrial Fibrillation who Undergo Percutaneous Coronary Intervention) trial addressed an important medical question, which is potentially relevant for the 20–45% of atrial fibrillation (AF) patients who also have coronary artery disease and are likely to undergo percutaneous coronary intervention (PCI). Prior to the PIONEER AF-PCI trial, there was an unmet need for evidence-based recommendati

In the study, patients newly diagnosed with hip fracture from 2005 –2013 were followed until late 2016. Among 34,991 patients, 4602 (13%) received osteoporosis treatment during follow-up. Alendronate was associated with 67% and 45% lower risks of one-year CV death and heart attack, respectively. It was associated with an 18% reduced risk of stroke within five years and a 17% reduced risk of stroke within 10 years. Protective effects were not evident for other classes of osteoporosis treatments. “There is a world-wide crisis in the treatment of osteoporosis, due to patients’ awareness of the extremely rare side effects,” said senior au

Current treatment recommendation for the prevention of recurrent VTE is anticoagulation therapy for three months or longer, depending on the balance between the risk of recurrent VTE and the risk of bleeding. However, the risk of patients with unprovoked VTE or with ongoing risk factors experiencing a second event is up to 10% in the first year if treatment is stopped. More than 25,000 people in the UK die from VTE every year. More news in this issue: NICE publishes updated familial hypercholesterolaemia guidance REDUCE shows non-inferiority of short versus long DAPT in acute coronary syndrome Primary Care Cardiovascular Society announces it

Over a mean follow-up of 23 months, there was a marked decrease in the primary composite end point of cardiovascular death, stroke, or myocardial infarction in the combination therapy group by 24% (hazard ration [HR] 0.76; 95% CI 0.66-0.86; p<0.001) over aspirin monotherapy, and improved survival by 18%. The trial terminated prematurely by the data monitoring committee due to due to overwhelming efficacy. Rivaroxaban monotherapy showed no efficacy benefit. The anticipated trade-off was apparent with increased major bleeding in the combination therapy arm (HR 1.70, 95% CI 1.40–2.05; p<0.001), although fatal and intracranial bleeds wer

Case A 63-year-old woman presented with breathlessness for a week. She had had a right mastectomy and axillary node clearance three weeks previously for breast cancer. She was known to have rheumatic heart disease and mitral stenosis with history of balloon mitral valvuloplasty 12 years ago. An echocardiogram, which was performed four months before, showed moderate mitral stenosis with valve area of 1.2 cm2, moderate aortic stenosis with peak gradient across aortic valve of 42 mmHg and mean of 22 mmHg and mild tricuspid regurgitation with normal pulmonary artery pressure. She was also known to have permanent atrial fibrillation and was on w

Nanoparticles, inhaled from sources such as vehicle exhausts, have been shown to cross from the lungs into the blood stream. They can then accumulate in areas susceptible to heart problems, according to research part-funded by the British Heart Foundation.  Previous studies have identified a correlation but not a causal link between nanoparticles and strokes or cardiovascular disease. It is not currently possible to measure environmental nanoparticles in the blood. So, researchers from the University of Edinburgh, and the National Institute for Public Health and the Environment in the Netherlands, used a variety of specialist techniques to t

Tsimane people show healthiest arteries yet studied Indigenous South Americans from the Bolivian Amazon – the Tsimane people – have the lowest recorded levels of vascular ageing A South American Tsimane person of 80 years is estimated to have the same vascular age as an American person in their mid-50s, according to a study presented at the ACC. The Tsimane people – an indigenous forager-horticulturalist population of the Bolivian Amazon – have the lowest reported levels of vascular ageing for any population, with coronary atherosclerosis being five times less common than in the USA. This has led the researchers to propose that the lo