Tag Archives: venous thromboembolism

Introduction Anticoagulant therapy is an essential component in the treatment and prevention of venous and arterial thromboembolic events. In recent years, direct-acting oral anticoagulants (DOACs) have replaced vitamin K antagonists (VKAs) for many of these indications, due to their more favourable risk-benefit profile.1 Despite this, bleeding remains a significant concern with DOACs, especially in patients at high risk, such as those with an indication for concurrent antiplatelet therapy, and may lead to poor adherence or undertreatment.2–4 Safer anticoagulation that spares haemostasis without compromising efficacy is, therefore, desirab

Effective anticoagulation improves outcomes in patients with AF or VTE.4-7 Non-vitamin K antagonist oral anticoagulants (NOACs) have provided an alternative to warfarin for prevention of stroke or recurrent VTE in these patients in recent years. Compared with warfarin, NOACs have more predictable pharmacokinetics and pharmacodynamics, do not require monitoring of the international normalised ratio (INR), and have a wider therapeutic window that enables prescription at fixed daily doses over an extended period.8 Edoxaban, an inhibitor of Factor Xa is a member of the NOAC class. The accompanying articles summarise latest findings on the effect

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

New practical NOACs guide A new version of EHRA Practical Guide on the use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) was launched at the congress. ESC guidelines state that NOACs should be preferred over vitamin K antagonists, such as warfarin, for stroke prevention in AF patients, except those with a mechanical heart valve or rheumatic mitral valve stenosis, and their use in clinical practice is increasing. The guide gives concrete, practical advice on how to use NOACs in specific clinical situations. The guide is published in European Heart Journal (doi: 10.1093/eurheartj/ehy136). Anti

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

Introduction Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), causes considerable morbidity and mortality.1 VTE is associated with 370,000 deaths per year in the European Union (EU), an estimated 12% of annual deaths.1 The average incidence of VTE in Europe is approximately 160–180 per 100,000 person-years.1 Three large phase III trials with rivaroxaban, a direct factor Xa inhibitor approved for the treatment and prevention of VTE, have provided a strong safety and efficacy evidence base (table 1). The EINSTEIN-DVT study compared rivaroxaban (15 mg twice daily for 21 days, followed by 20 mg on

BSH Parliament day Professor Andrew Clark (President of the British Society for Heart Failure) is pictured here (centre) carrying out an echocardiogram in the House of Commons. He was at a BSH event to help raise awareness that a person diagnosed with heart failure is likely to have a worse prognosis than if they were diagnosed with most cancers. This is despite the availability of specialist heart failure services that can have a remarkable impact on a patient’s chance of survival, but for which there is inconsistent access over the UK leading to wide variations in care and outcomes. Over 60 MPs, Peers, and professional and patient groups

Navigating the changing landscape of cardiovascular commissioning A clear majority (58%) of GPs with a special interest in cardiology (GPSIs) feel unprepared to fulfill a commissioning role in the new NHS landscape, despite almost half of GPs being currently involved in commissioning, according to results from the REACCT (REAssessing Cardiology Commissioning and Treatment) report announced at the meeting. The report also reveals that a majority of cardiologists (57%) feel unprepared to take on new commissioning roles around the management of cardiovascular disease (CVD). The report (available from: www.pccs.org.uk/report) was written by the P

Controversial salt paper published A new European study has caused controversy by suggesting that lowering salt intake may not be beneficial. The study, published recently in JAMA (May 4th 2011 issue), was conducted by a team from the University of Leuven, Belgium. They followed 3,681 participants who were free of cardiovascular disease at baseline for a median of 7.9 years, and found an inverse relationship between cardiovascular deaths and 24-hour sodium excretion (which correlates to salt intake), although systolic blood pressure was higher with higher salt intake. But an editorial in the Lancet (May 12th 2011 issue) criticises the study,