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bleeding in coronary syndroms

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https://www.readbyqxmd.com/read/28439617/-stroke-prophylaxis-in-atrial-fibrillation-when-how-and-for-whom
#1
T Maurer, C Sohns
In patients suffering from atrial fibrillation (AF), modern antithrombotic therapy and anticoagulation strategies should be individualized based on shared decision making including patient preferences and the absolute and relative risks of stroke and bleeding. Estimation of the individual risk for stroke is still based on the CHA2DS2-VASc score. Based on the most recent guidelines for the management of AF, oral anticoagulation therapy should be considered for men with a CHA2DS2-VASc score ≥1 and women with a score ≥2, balancing the expected stroke reduction, risk of bleeding and patient preference...
April 24, 2017: Herz
https://www.readbyqxmd.com/read/28438739/reporting-clinical-end-points-and-safety-events-in-an-acute-coronary-syndrome-trial-results-with-integrated-collection
#2
Patrícia O Guimarães, Renato D Lopes, Susanna R Stevens, André Zimerman, Lisa Wruck, Stefan K James, Ghazala Haque, Roberto Rocha C V Giraldez, John H Alexander, Karen P Alexander
BACKGROUND: End points and adverse events (AEs) are collected separately in clinical trials, yet regulatory requirements for serious AE reporting vary across regions, so classifying end points according to seriousness criteria can be useful in global trials. METHODS AND RESULTS: In the Apixaban for Prevention of Acute Ischemic Events 2 (APPRAISE-2) trial, patients with a recent acute coronary syndrome were randomized to apixaban or placebo for the prevention of recurrent ischemic events...
April 24, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28424434/high-dose-bolus-tirofiban-versus-low-dose-bolus-in-patients-with-acute-coronary-syndrome-undergoing-percutaneous-coronary-intervention
#3
Taner Ulus, Utku Şenol, Senan Tahmazov, Kemal Iskenderov, Fezan Mutlu, Yüksel Çavuşoğlu
OBJECTIVE: Aim of the present study was to determine effects of high-dose versus low-dose intravenous (IV) bolus tirofiban on angiographic measures, ST resolution, enzymatic infarct size, and clinical outcomes in patients with acute coronary syndrome (ACS) who were undergoing percutaneous coronary intervention (PCI) and received current pharmacoinvasive therapy. METHODS: Acute coronary syndrome patients (n=271, 85.6% male; mean age: 57.9±12.6 years) from between 2009 and 2015 who received IV tirofiban therapy following PCI were retrospectively analyzed...
March 2017: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
https://www.readbyqxmd.com/read/28420862/clinical-characteristics-treatment-and-prognosis-of-patients-with-acute-severe-heart-failure-of-ischemic-and-non-ischemic-etiology-analysis-from-the-commit-ahf-registry
#4
Mateusz Ostręga, Marek J Gierlotka, Grzegorz Słonka, Paweł Nadziakiewicz, Mariusz Gąsior
INTRODUCTION    There are limited data on the impact of ischemic etiology on clinical status and long-term prognosis among patients with acute severe heart failure (ASHF) not associated with acute coronary syndrome (ACS).  OBJECTIVES    To assess clinical characteristics, treatment and the 12-month mortality of patients with no-ACS ASHF according to etiology.  PATIENTS AND METHODS    The data from 112 patients with ASHF that was not associated with ACS were analyzed: 61 with ischemic (IASHF) and 51 with non-ischemic (NIASHF) etiology...
April 18, 2017: Polish Archives of Internal Medicine
https://www.readbyqxmd.com/read/28420804/contemporary-trends-and-outcomes-associated-with-the-preprocedural-use-of-oral-p2y12-inhibitors-in-patients-undergoing-percutaneous-coronary-intervention-insights-from-the-blue-cross-blue-shield-of-michigan-cardiovascular-consortium-bmc2
#5
Devraj Sukul, Milan Seth, Simon R Dixon, Akshay Khandelwal, Thomas A LaLonde, Hitinder S Gurm
OBJECTIVES: We sought to describe trends in the use of preprocedural P2Y12 inhibitors and their clinical impact in patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: Oral P2Y12 inhibitors are ubiquitously used medications; however, the specific timing of initial P2Y12 inhibitor administration remains intensely debated. METHODS: Our study population comprised 74,053 consecutive patients undergoing PCI at 47 hospitals in Michigan from January 2013 through June 2015...
April 15, 2017: Journal of Invasive Cardiology
https://www.readbyqxmd.com/read/28416248/contemporary-practice-and-outcomes-of-an-elderly-cohort-of-japanese-patients-with-non-st-elevation-acute-coronary-syndrome-in-the-era-of-routine-early-invasive-strategy
#6
Takuya Nagata, Yohei Hyakuna, Kenji Miyata, Masahiro Mohri
BACKGROUND: An early invasive strategy for patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) has been recommended. However, patients at greater risk including the elderly are more often managed conservatively. We aimed to elucidate contemporary practice and outcomes of patients with NSTE-ACS who were referred to our hospital located in Kitakyushu City, one of the most aging metropolises in Japan. METHODS: A total of 270 consecutive NSTE-ACS patients hospitalized between January 2012 and December 2014 were retrospectively studied...
March 30, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28411246/growth-differentiation-factor-15-at-1%C3%A2-month-after-an-acute-coronary-syndrome-is-associated-with-increased-risk-of-major-bleeding
#7
Daniel Lindholm, Emil Hagström, Stefan K James, Richard C Becker, Christopher P Cannon, Anders Himmelmann, Hugo A Katus, Gerald Maurer, José Luis López-Sendón, Philippe Gabriel Steg, Robert F Storey, Agneta Siegbahn, Lars Wallentin
BACKGROUND: Growth differentiation factor-15 (GDF-15) is related to major bleeding when measured at initial presentation in patients with acute coronary syndromes (ACSs) treated with dual antiplatelet therapy. It is unknown whether follow-up measurements provide additional information. The objective of this study was to investigate whether GDF-15 measured 1 month after an ACS provides additional information beyond the baseline levels with regard to the risk of major bleeding. METHODS AND RESULTS: GDF-15 was measured at baseline and at 1 month after an ACS in 4049 patients included in the PLATelet inhibition and patient Outcomes (PLATO) trial...
April 14, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28411029/clinical-and-economic-impact-of-a-multisciplinary-intervention-to-reduce-bleeding-risk-in-patients-with-acute-coronary-syndrome
#8
Ana de Lorenzo-Pinto, Ana Herranz-Alonso, Begoña Cuéllar-Basterrechea, José María Bellón-Cano, María Sanjurjo-Sáez, Héctor Bueno
INTRODUCTION AND OBJECTIVES: To evaluate the clinical and economic impact of a multidisciplinary program to reduce bleeding events in patients with acute coronary syndrome through optimization of antithrombotic therapy. METHODS: We designed a preintervention (PRE) and postintervention (POST) quasi-experimental study using a retrospective analysis of 2 cohorts. The first cohort was analyzed to detect correctable measures contributing to bleeding (PRE). Afterward, a quality improvement intervention with a bundle of recommendations was implemented...
April 11, 2017: Revista Española de Cardiología
https://www.readbyqxmd.com/read/28407126/mitral-valve-replacement-in-severely-calcified-mitral-valve-annulus-a-10-year-experience
#9
Kareem Salhiyyah, Hassan Kattach, Ahmed Ashoub, Diana Patrick, Szabolcs Miskolczi, Geoffrey Tsang, Sunil K Ohri, Clifford W Barlow, Theodore Velissaris, Steve Livesey
OBJECTIVES: Severe calcification in the mitral valve annulus is a challenging problem during mitral valve surgery. We describe our experience with mitral valve replacement in severely calcified mitral valve without decalcification of the annulus. METHODS: Between April 2001 and July 2011, 61 patients underwent mitral valve replacement with severe mitral annulus calcification without decalcification of the annulus. This retrospective study was performed to assess the surgical and the long-term postoperative outcomes in this group...
April 11, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28388994/relation-of-baseline-hemoglobin-levels-and-adverse-events-in-patients-with-acute-coronary-syndromes-from-the-acute-catheterization-and-urgent-intervention-triage-strategy-and-harmonizing-outcomes-with-revascularization-and-stents-in-acute-myocardial-infarction
#10
Sorin J Brener, Roxana Mehran, George D Dangas, Edwin Magnus Ohman, Bernhard Witzenbichler, Yiran Zhang, Rupa Parvataneni, Gregg W Stone
The association between anemia at admission and adverse outcomes in patients with acute coronary syndrome (ACS) has been incompletely studied. Anemia was defined as serum hemoglobin <12 g/dl in women or <13 g/dl in men in 2 large trials of patients with ACS. We plotted hazard functions for major bleeding at 30 days and all-cause mortality, myocardial infarction, and stent thrombosis at 1 year according to baseline hemoglobin. Among 16,318 patients, 3070 (18.8%) had anemia at baseline. All-cause death at 1 year (2...
March 16, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28385176/meta-analysis-of-the-relative-efficacy-and-safety-of-oral%C3%A2-p2y12-inhibitors-in-patients-with-acute-coronary%C3%A2-syndrome
#11
Rahman Shah, Abdul Rashid, Inyong Hwang, Tai-Hwang M Fan, Rami N Khouzam, Guy L Reed
A cornerstone of medical therapy for patients with acute coronary syndrome (ACS) is dual antiplatelet therapy, which includes aspirin and a P2Y12 inhibitor. Randomized controlled trials (RCTs) have shown that prasugrel and ticagrelor are superior to clopidogrel, but none directly compared these 3 commonly used oral P2Y12 inhibitors for safety and efficacy. Therefore, we performed a Bayesian network meta-analysis of RCTs to compare the efficacies and safeties of 3 commonly used oral P2Y12 inhibitors in patients with ACS...
March 16, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28381584/predicting-the-risk-of-bleeding-during-dual-antiplatelet-therapy-after-acute-coronary-syndromes
#12
Joakim Alfredsson, Benjamin Neely, Megan L Neely, Deepak L Bhatt, Shaun G Goodman, Pierluigi Tricoci, Kenneth W Mahaffey, Jan H Cornel, Harvey D White, Keith Aa Fox, Dorairaj Prabhakaran, Kenneth J Winters, Paul W Armstrong, E Magnus Ohman, Matthew T Roe
OBJECTIVES: Dual antiplatelet therapy (DAPT) with aspirin + a P2Y12 inhibitor is recommended for at least 12 months for patients with acute coronary syndrome (ACS), with shorter durations considered for patients with increased bleeding risk. However, there are no decision support tools available to predict an individual patient's bleeding risk during DAPT treatment in the post-ACS setting. METHODS: To develop a longitudinal bleeding risk prediction model, we analysed 9240 patients with unstable angina/non-ST segment elevation myocardial infarction (NSTEMI) from the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes (TRILOGY ACS) trial, who were managed without revascularisation and treated with DAPT for a median of 14...
April 5, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28377396/optimal-duration-of-dual-antiplatelet-therapy-following-percutaneous-coronary-intervention-protocol-for-an-umbrella-review
#13
Jesse Elliott, Shannon E Kelly, Zemin Bai, Wenfei Liu, Becky Skidmore, Michel Boucher, Derek Y F So, George A Wells
INTRODUCTION: Although dual antiplatelet therapy (DAPT) is routinely given to patients after percutaneous coronary intervention (PCI) with stenting, the optimal duration is unknown. Recent evidence indicates there may be benefits in extending the duration beyond 12 months but such decisions may increase the risk of bleeding. Our objective is to provide a comprehensive overview of the literature for clinicians and policymakers via an umbrella review assessing the optimal duration of DAPT...
April 4, 2017: BMJ Open
https://www.readbyqxmd.com/read/28377232/comparison-of-safety-and-efficacy-of-unfractionated-heparin-versus-bivalirudin-in-patients-undergoing-percutaneous-coronary-intervention
#14
Ahmed Rehmani, Chris Judkins, Alan Whelan, Michael Nguyen, Carl Schultz
BACKGROUND: Anti-platelet and anti-coagulant adjunctive therapies are associated with a clinically significant increased risk of major bleeding. We retrospectively assessed in hospital major adverse clinical events (MACE) and major bleeding in patients undergoing percutaneous coronary intervention (PCI) who received either unfractionated heparin (UFH) or bivalirudin. METHOD: Consecutive patients undergoing PCI for acute coronary syndrome (ACS) at Fremantle Hospital from August 2008 to December 2013 were identified...
February 28, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28377230/gpiib-iiia-receptor-inhibitors-in-acute-coronary-syndrome-patients-presenting-with-cardiogenic-shock-and-or-after-cardiopulmonary-resuscitation
#15
Vojko Kanic, Maja Vollrath, Meta Penko, Andrej Markota, Gregor Kompara, Zlatka Kanic
BACKGROUND: Data on the use of GPIIb-IIIa receptor inhibitors (GPI) in acute coronary syndrome (ACS) patients presenting with cardiogenic shock and/or after cardiopulmonary resuscitation is sparse. The aim of the study was to establish the possible influence of the adjunctive use of GPI on 30-day and 1-year mortality in these high-risk patients. METHODS: Acute coronary syndrome patients (261), who presented with cardiogenic shock and/or were cardiopulmonary resuscitated on admission, were analysed...
March 20, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28374678/incidence-and-outcome-of-switching-of-oral-platelet-p2y12-receptor-inhibitors-in-patients-with-acute-coronary-syndromes-undergoing-percutaneous-coronary-intervention-the-scope-registry
#16
Leonardo De Luca, Fabrizio D'Ascenzo, Giuseppe Musumeci, Francesco Saia, Guido Parodi, Ferdinando Varbella, Alfredo Marchese, Stefano De Servi, Sergio Berti, Leonardo Bolognese
AIMS: In patients with acute coronary syndromes (ACS) undergoing a percutaneous coronary intervention (PCI) switching of oral P2Y12 receptor inhibitors may frequently occur. METHODS AND RESULTS: The SCOPE registry was a multicenter, observational, prospective study aimed to evaluate the incidence and 1-month outcome of switching of oral P2Y12 receptor inhibitors in consecutive ACS patients undergoing PCI during a 3-month period. A total of 1363 consecutive patients have been enrolled in 39 PCI centers across Italy...
April 4, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28371905/the-quest-for-equilibrium-exploring-the-thin-red-line-between-bleeding-and-ischaemic-risks-in-the-management-of-acute-coronary-syndromes-in-chronic-kidney-disease-patients
#17
Alexandru Burlacu, Simonetta Genovesi, Alberto Ortiz, Mehmet Kanbay, Patrick Rossignol, Maciej Banach, Jolanta Malyszko, David Goldsmith, Adrian Covic
Coronary artery disease and acute coronary syndrome (ACS) are both common in patients with chronic kidney disease (CKD). CKD patients have higher risks of bleeding and thrombosis. However, they remain under-represented in major randomized clinical trials (RCTs), and there is no medical evidence-based foundation on which to issue specific recommendations about the management of ACS in CKD. CKD patients with ACS frequently are diagnosed later, receive fewer acute interventions and are at increased risk of over-dosage of medications and under-prescription/under-performance of interventional treatments than CKD patients without ACS...
March 27, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28363224/improving-outcome-in-acute-coronary-syndromes-ischaemic-conditioning-antithrombosis-and-bleeding-and-inflammasome-antagonism
#18
Thomas F Lüscher
No abstract text is available yet for this article.
March 14, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28363222/trade-off-of-myocardial-infarction-vs-bleeding-types-on-mortality-after-acute-coronary-syndrome-lessons-from-the-thrombin-receptor-antagonist-for-clinical-event-reduction-in-acute-coronary-syndrome-tracer-randomized-trial
#19
Marco Valgimigli, Francesco Costa, Yuliya Lokhnygina, Robert M Clare, Lars Wallentin, David J Moliterno, Paul W Armstrong, Harvey D White, Claes Held, Philip E Aylward, Frans Van de Werf, Robert A Harrington, Kenneth W Mahaffey, Pierluigi Tricoci
Aims: Dual antiplatelet therapy reduces non-fatal ischaemic events after acute coronary syndrome (ACS) but increases bleeding to a similar extent. We sought to determine the prognostic impact of myocardial infarction (MI) vs. bleeding during an extended follow-up period to gain insight into the trade-off between efficacy and safety among patients after ACS. Methods and results: In 12 944 patients with non-ST-segment elevation ACS from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) trial, we investigated the relative impact of MI and bleeding occurring >30 days post-ACS and subsequent all-cause mortality...
March 14, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28329389/radial-versus-femoral-access-in-patients-with-acute-coronary-syndromes-with-or-without-st-segment-elevation-a-pre-specified-analysis-from-the-randomized-minimizing-adverse-haemorrhagic-events-by-transradial-access-site-and-systemic-implementation-of-angiox
#20
Pascal Vranckx, Enrico Frigoli, Martina Rothenbühler, Francesco Tomassini, Stefano Garducci, Giuseppe Andò, Andrea Picchi, Paolo Sganzerla, Anita Paggi, Fabrizio Ugo, Arturo Ausiello, Gennaro Sardella, Nicoletta Franco, Marco Nazzaro, Nicoletta de Cesare, Paolo Tosi, Camillo Falcone, Carlo Vigna, Pietro Mazzarotto, Emilio Di Lorenzo, Claudio Moretti, Gianluca Campo, Carlo Penzo, Giampaolo Pasquetto, Dik Heg, Peter Jüni, Stephan Windecker, Marco Valgimigli
Aims: To assess whether radial compared with femoral access is associated with consistent outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods and results: In the Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX (MATRIX) programme patients were randomized to radial or femoral access, stratified by STEMI (2001 radial, 2009 femoral) and NSTE-ACS (2196 radial, 2198 femoral)...
February 28, 2017: European Heart Journal
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