Tag Archives: rivaroxaban

Introduction Bleeding post cardiac surgery carries significant patient mortality and morbidity including resternotomy, increased hospital stays, and blood product transfusion.1,2 Bleeding is more severe in patients who are taking pre-operative antiplatelet or anticoagulation medications that have not been stopped sufficiently in advance to minimise such risks. Current guidelines across Europe recommend stopping such agents at least two to five days prior to surgery; they also recommend delaying urgent surgery so that the risk of perioperative bleeding is minimised.3 However, this is not always possible in the setting of urgent and emergency c

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

Mike is a Professor of Medicine at Harvard Medical School, and an interventional cardiologist at the Beth Israel Deaconess in Boston, USA. He is the founder and director of the academic research organization PERFUSE and has been principal investigator or has led core services for over 120 clinical trials, the results of which have been published in leading journals. Mike is also an active user of Twitter (@CMichaelGibson). Amar is a Consultant in Diabetes and Endocrinology at the Good Hope Hospital, Sutton Coldfield, West Midlands. A regular contributor to the journal, Amar has previously been very active in the Young Diabetologists and Endoc

Self-monitoring of type 2 diabetes cuts costs Self-monitoring of type 2 diabetes used in combination with an electronic feedback system results in considerable savings on health care costs and also travel costs for patients, especially in sparsely populated areas, a new study shows. The study, carried out in Northern Karelia by the University of Eastern Finland, found that by replacing half of the required follow-up visits for type 2 diabetes with self-measurements and electronic feedback, total costs of glycated haemoglobin monitoring were reduced by nearly 60%. The annual per-patient cost was down from 280 euros to 120 euros. Fewer follow-u

European Society of Cardiology congress 2018, held in Munich This was the key finding from COMMANDER HF (A Study to Assess the Effectiveness and Safety of Rivaroxaban in Reducing the Risk of Death, Myocardial Infarction, or Stroke in Participants with Heart Failure and Coronary Artery Disease Following an Episode of Decompensated Heart Failure) presented in a Hot Line Session and also published in The New England Journal of Medicine (DOI: 10.1056/NEJMoa1808848). Patients with worsening heart failure experience high rates of hospital readmission, and death. Previous studies have suggested that the enzyme thrombin may contribute to these poor o

European Society of Cardiology congress 2018, held in Munich The principal safety outcome of major bleeding also showed no significant difference between the rivaroxaban and placebo groups. Rivaroxaban, however, did reduce the rate of symptomatic VTE only, and symptomatic VTE and all-cause mortality, compared to placebo. On leaving hospital, the rate of symptomatic VTE more than doubles over the first 21 days and is associated with a five-fold increased risk of fatal pulmonary embolism (PE) within 30 days post-discharge. The MARINER trial investigated whether continuing thromboprophylaxis with an oral anticoagulant after discharge could reduc

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

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

Landmark trials in heart failure – 30 years from CONSENSUS With 2017 marking the 30th year since the publication of CONSENSUS,1 which first reported a reduction in mortality with enalapril versus placebo in patients with advanced heart failure (HF), the BCS held a dedicated session to review the seminal clinical trials and advances in chronic heart failure management in this period. Dr Rosita Zakeri (Royal Brompton Hospital, London) reviewed this session for us and spoke to the BJC afterwards. Rosita Zakeri The era of vasodilator therapy for heart failure began in the 1990s. Professor Karl Swedberg (University of Gothenberg, Sweden) began