theHeart.org - Thrombosis Risk

Sen Grassley questions top medical schools about ghostwriting

Fri, 20 Nov 2009 13:15:28 EST

As part of his mission to see more financial transparency in medicine, Sen Grassley has asked eight top US medical schools about their policies on ghostwriting.

Oral anticoagulants REDEEMed? Daily dabigatran "safe" with dual antiplatelets after MI

Thu, 19 Nov 2009 11:00:11 EST

A dose-finding study saw what were characterized as low bleeding rates associated with triple-drug antithrombotic therapy that included the oral anticoagulant dabigatran in patients with a recent ACS event and other cardiovascular risk factors.

EFFECT: Public reporting of hospital performance improves quality of care?

Thu, 19 Nov 2009 10:00:55 EST

Publicly released report cards based on hospital performance did not result in a measurably greater systemwide improvement in two composite AMI or CHF process-of-care indicators in a Canadian study. But they did appear to stimulate some important changes in delivery of care that could have led to some better outcomes.

Ticagrelor effects unraveled in new phase 2 trials

Wed, 18 Nov 2009 15:00:52 EST

New and unique phase 2 data add to the growing body of evidence explaining the pharmacologic effects of the new antiplatelet agent ticagrelor.

ACC/AHA focused update of guidelines for STEMI, PCI

Wed, 18 Nov 2009 09:00:00 EST

The latest evidence for the treatment of STEMI and PCI has been incorporated into a fast-track update of US guidelines. But questions remain about the quality of some of the evidence informing the guidelines and about the composition of the writing committees.

CASCADE: No significant benefit of clopidogrel in reducing graft disease after CABG

Tue, 17 Nov 2009 09:00:24 EST

Dual antiplatelet therapy did not significantly reduce vein graft intimal hyperplasia compared with aspirin alone over 12 months.

Postop anemia in high-CV-risk patients: No CV gains from fixed hemoglobin target in trial

Mon, 16 Nov 2009 17:45:01 EST

A randomized trial found no protection from in-hospital cardiovascular events with a strategy of blood transfusions to maintain hemoglobin above 10 g/dL, compared with a more conservative approach to transfusion therapy, in patients with CV disease or risk factors who underwent hip surgery.

Cangrelor in CHAMPION: What went wrong?

Mon, 16 Nov 2009 15:15:27 EST

Discussion is abounding on why cangrelor did not show benefit over clopidogrel despite the fact that it did inhibit platelet activity more effectively.

Good news continues for ticagrelor in PLATO STEMI subanalysis

Sun, 15 Nov 2009 19:30:00 EST

Ticagrelor, an investigational antiplatelet agent, may become a new standard of care for the management of patients with STEMI heading for primary PCI, said the lead investigator of the STEMI subset of the PLATO trial. Reporting the new findings here today, he said they were consistent with the overall PLATO results.

PACE: BiV pacing protects against RV pacing's adverse ventricular effects in randomized trial

Sun, 15 Nov 2009 16:30:23 EST

In patients with conventional indications for pacing and normal systolic function, preservation of synchrony with biventricular pacing prevented the adverse remodeling effects of right-ventricular-only pacing. But some question the trial's methods.

POPULARity contest: For platelet function assays, what works, what doesn't

Sun, 15 Nov 2009 14:15:02 EST

None of the eight platelet assays studied were able to predict bleeding, but four of the eight, based on ADP-induced platelet aggregation, produced results that correlated with adverse CV outcomes. By contrast, four tests that use shear-stress-induced adhesion-based methods were not predictive.

PEPCAD-3: Paclitaxel-coated-balloon/stent system misses mark in de novo coronary lesions

Sun, 15 Nov 2009 10:30:25 EST

Inflation of the paclitaxel-delivering balloon followed by a bare-metal stent failed a randomized noninferiority test against the Cypher sirolimus-eluting stent in previously untreated coronary lesions.

Canadian confusion: Primary-care docs lack knowledge of CVD risk factors, prevention

Sun, 15 Nov 2009 09:00:30 EST

Family doctors and general practitioners in Canada are confused about cardiovascular risk assessment in primary prevention, a new survey reveals.

Two-year EXPIRA results suggest mechanical aspiration with primary PCI may reduce mortality

Sun, 15 Nov 2009 09:00:03 EST

Two-year follow-up results from the EXPIRA study show mechanical thrombectomy during primary PCI improves myocardial perfusion and may reduce mortality.

CHAMPION: Negative trials but some positive angles for cangrelor?

Sun, 15 Nov 2009 08:00:00 EST

Although neither CHAMPION-PCI nor CHAMPION-PLATFORM showed significant reductions in the primary end point with this new IV antiplatelet agent, some positive effects were seen, suggesting that the drug may yet have a future.

SGR repair bill failure could cool physician support for healthcare reform

Thu, 12 Nov 2009 15:00:58 EST

Now that the US House of Representatives has passed a healthcare reform bill, organized medicine anticipates another vote—possibly next week—on a second bill that would rewrite Medicare's controversial sustainable-growth-rate formula for physician reimbursement.

DES fractures occur more often than thought

Thu, 12 Nov 2009 13:15:57 EST

A new postmortem study using high-resolution imaging has found that fractures in drug-eluting stents may be more common than thought. However, the majority of such fractures appear to be low-grade and silent, with likely few clinical implications, say the researchers.

What's going to be hot at AHA 2009?

Wed, 11 Nov 2009 09:00:54 EST

Anticipation is building for full trial results from ARBITER 6-HALTS, plus a better understanding of what went wrong with cangrelor in the CHAMPION trials. Also in the lineup are updates from PLATO, RE-LY, ALLHAT, BARI 2D, STICH, CASCADE, POPULAR, HEARTMATE II, and many more. Indeed, this year's "late-breaking" sessions include more than 30 trials over five days.

Walking speed predicts CV mortality in older people

Tue, 10 Nov 2009 19:01:00 EST

Fast walkers should find themselves less likely to succumb to cardiovascular death, according to a new French study in older adults. Measuring general fitness in this way could easily be incorporated into a general global assessment of cardiovascular risk, say the researchers.

No benefits of aspirin for primary prevention in diabetics, meta-analysis suggests

Tue, 10 Nov 2009 17:15:54 EST

Most guideline documents recommend aspirin for primary prevention in people with diabetes, but a new meta-analysis has found no benefit of the widely used drug across a range of different cardiovascular end points. The results speak to the need for dedicated randomized trials, investigators say.

Clopidogrel effects in men vs women

Tue, 10 Nov 2009 16:15:59 EST

A new meta-analysis has suggested that clopidogrel reduces cardiovascular events and increases bleeding in both men and women, without significant differences between the sexes.

Obesity may top hypertension as risk factor for LA enlargement

Mon, 09 Nov 2009 17:00:00 EST

Obesity and hypertension were major independent risk factors for left atrial enlargement (itself a risk factor for atrial fibrillation) in an observational, population-based study, but obesity was the strongest predictor.

Latest European and US STEMI guidelines compared and contrasted

Fri, 06 Nov 2009 17:15:26 EST

The latest recommendations for the treatment of ST-elevation MI issued by American cardiology associations and the European Society of Cardiology are compared and contrasted in a new paper.

VELETI in print: Plaque sealing of SVGs a strategy "ahead of its time"?

Wed, 04 Nov 2009 15:30:23 EST

The imaging study was the first to show that stenting a non-flow-limiting stenosis of an SVG may help slow or halt the accelerated atherosclerosis that takes place in these vessels. An accompanying editorial cautions that the study does little more than "infer a trend toward anatomic benefit."

Adding fuel to the J-curve fire; debate is reignited

Wed, 04 Nov 2009 14:30:56 EST

More discussion about the J-curve in hypertension is published this week; one expert believes the undue attention being paid to this subject might discourage doctors from treating high blood pressure aggressively.

US updates advice on perioperative beta-blocker use in noncardiac surgery

Tue, 03 Nov 2009 14:30:32 EST

A US update on the perioperative use of beta blockers for noncardiac surgery is, says the lead author, "similar" to recent European guidance on this issue.

Combined home/GP hypertension control program successful in Pakistan

Mon, 02 Nov 2009 17:00:00 EST

A synergistic approach of educating general practitioners about hypertension control together with a program to send lay workers into people's homes to educate them about the management of high blood pressure has proven successful in low- to middle-income households in Pakistan.

Imaging study shows plaque regression with niacin vs placebo

Fri, 30 Oct 2009 16:00:00 EDT

Just weeks before ARBITER-HALTS�6 results come out at AHA 2009, an MRI study suggests that niacin is better than placebo in statin-treated patients with low HDL, at least for reducing carotid wall area. Experts say they'd also like to see insights into niacin effects on lipid-rich plaque volumes—the more commonly seen end point with MRI.

Distribution of body fat important in VTE

Mon, 26 Oct 2009 16:00:00 EDT

The distribution of body fat, as well as the amount, is important when it comes to the risk of venous thromboembolism, Danish researchers have discovered.

Cardiovascular disease increases risk of hip fracture

Tue, 20 Oct 2009 16:00:00 EDT

Swedish researchers have confirmed a link between stroke and subsequent hip fracture in older people and identified for the first time that a diagnosis of heart failure also increases the risk for this fracture. They also identify a large genetic component to this association, via their use of a twin registry.

ACE inhibitors of benefit in ischemic heart disease patients with preserved LV function

Mon, 19 Oct 2009 17:00:00 EDT

Patients with ischemic heart disease and preserved LV function on standard therapy will gain additional benefit from taking ACE inhibitors, a new review concludes. The same cannot be said for ARBs, a drug class for which the evidence is much weaker, but these are a good substitute in those who cannot tolerate ACE inhibitors, the authors say.

TYCOON: One year of dual-antiplatelet therapy with DES isn't enough

Mon, 19 Oct 2009 12:45:34 EDT

New results from an Italian registry reopen the question of how long drug-eluting stent recipients should stay on a dual antiplatelet regimen to prevent late thrombosis.

Transfusion in acute HF: No extra mortality risk

Mon, 19 Oct 2009 11:00:10 EDT

Blood transfusions for anemia in acute decompensated heart failure don't exacerbate outcomes, as may happen in some ACS cases, suggests a one-year experience of hospitals in Israel. On the contrary�.�.�.�

Zero CAC score not 100% reassuring in those presenting to ER with chest pain

Fri, 16 Oct 2009 12:45:08 EDT

In those presenting to the ER with chest pain, a prior zero calcium score cannot completely rule out a coronary obstruction, a new analysis of the MESA study has shown. This is likely due to the presence of soft plaques not detected by calcium screening, the researchers say.

Racial background woefully underreported in CV trials

Thu, 15 Oct 2009 13:15:10 EDT

Two-thirds of the 156 trials considered by the AHA in preparing a recent guideline failed to even record the ethnic backgrounds of participants, a new study has found. The researchers call for the reporting of race/ethnicity to be mandatory in all clinical trials, and they suggest medical journals should enforce this policy.

Scripps starts routine genetic testing for clopidogrel responsiveness

Wed, 14 Oct 2009 11:00:05 EDT

Scripps Health has announced that it is now offering patients undergoing elective stenting a test for the gene variants associated with an inability to convert clopidogrel to its active metabolite so that antiplatelet therapy can be individualized.

Diuretics effective as second-line therapy for hypertension

Tue, 13 Oct 2009 12:00:48 EDT

Diuretics, especially hydrochlorothiazide, are as effective when given as second-line therapy for high blood pressure as they are when used as initial treatment, according to the first review to look at this issue.

Hopes build for natriuretic-peptide risk stratification before noncardiac surgery

Tue, 13 Oct 2009 10:00:10 EDT

Could a preoperative blood assay take the place of imaging studies or other more costly assessments of cardiovascular risk? A meta-analysis suggests yes. A massive randomized trial is looking into it now.

Glucocorticoids seen to double risk of atrial arrhythmias

Mon, 12 Oct 2009 16:00:00 EDT

In a case-control study from Denmark, the risk of atrial fibrillation or flutter was significantly increased with current but not previous use of glucocorticoids for chronic obstructive pulmonary disease, rheumatoid arthritis, and other conditions.

Target HbA1c levels still the subject of much debate, but tailored therapy should be the aim

Fri, 09 Oct 2009 16:45:25 EDT

Diabetologists are trying to tease out the best message to convey when it comes to target HbA_1c levels for primary-care physicians and other nonspecialists who might be treating patients with type 2 diabetes.

Coronary thrombosis�the culprit is not just plaque rupture

Thu, 08 Oct 2009 17:45:48 EDT

Clots derived from a different source—erosions of the arterial wall—may be an important cause of MI and sudden death, particularly in younger women, who may need a different approach to treatment, new research suggests.

New review confirms homocysteine lowering does not prevent CVD events

Thu, 08 Oct 2009 15:30:45 EDT

The latest review to look at the effects of homocysteine lowering with vitamin-B supplementation has come to much the same conclusions as most other studies and analyses in this field.

Lupus anticoagulant a major risk factor for stroke and MI in young women

Wed, 07 Oct 2009 10:00:40 EDT

Results of the RATIO study suggest lupus anticoagulant, but not anticardiolipin or antiprothrombin antibodies, is associated with increased stroke risk and to a lesser extent MI.

China death toll due to hypertension worse than predicted

Tue, 06 Oct 2009 14:15:24 EDT

The first prospective study using real data to inform the number of people suffering from and dying due to high blood pressure in China finds the problem is much worse than previously thought. A number of initiatives are planned to try to tackle this crisis.

20�000-patient DAPT clinical trial starts enrolling with eight industry sponsors on board

Mon, 05 Oct 2009 16:45:09 EDT

The trial, rumored to cost more than $100 million, is a first for collaboration: eight drug and device companies are backing the trial, along with the FDA. The study is powered to detect a difference in stent thrombosis and major adverse events between patients taking 12 or 30 months of aspirin plus clopidogrel or prasugrel.

Hypoglycemia associated with increased risk of MI among US veterans with diabetes

Mon, 05 Oct 2009 13:45:19 EDT

Close attention should be paid to diabetes patients who experience an episode of hypoglycemia, because a new case-control study suggests a 65% increased risk of MI in the immediate two-week aftermath of such an event. Doctors should tailor diabetes therapies to minimize the risk of hypoglycemia occurring, say the researchers.

New "principles" on authorship and COI from PhRMA get mixed response

Fri, 02 Oct 2009 12:00:10 EDT

The "Principles on Conduct of Clinical Trials and Communication of Clinical Trial Results" echo recent standards set by medical journal editors, but some observers say the document, which has no penalty component, lacks real teeth.

HORIZONS analysis: 600-mg clopidogrel load preferable in primary PCI

Thu, 01 Oct 2009 16:00:46 EDT

The higher dose was associated with a reduced rate of ischemic events without an increase in bleeding in patients with STEMI undergoing primary PCI.

Early statin therapy in ACS: What's the level of evidence?

Mon, 28 Sep 2009 17:00:00 EDT

The use of high-dose statin therapy early in the course of acute coronary syndrome currently has the highest possible (class IA) recommendation in US guidelines, but a group of experts argues that this is inaccurate based on current evidence. However, they stress, they are not saying statins should not be used in this indication.

CHARISMA Genomics Substudy links loss-of-function allele and bleeding

Mon, 28 Sep 2009 14:15:11 EDT

Patients who are homozygous for the CYP2C19*2 allele are at increased risk of ischemia but less likely to bleed. Routine genotyping for the variant still isn't recommended.

Skin lesions from heparin more common than thought

Mon, 28 Sep 2009 12:00:00 EDT

A new prospective study has found the incidence of heparin-induced skin lesions to be around 7.5%. Women, the obese, and those on heparin therapy for longest are most at risk.

Reduced bleeding and comparable stent thrombosis with DES and bare-metal stents: HORIZONS-AMI at two years

Fri, 25 Sep 2009 17:55:17 EDT

Two-year data showed significant reductions in bleeding and cardiac mortality in patients treated with bivalirudin when compared with those treated with heparin plus a GP IIb/IIIa inhibitor. In the stent arm of the trial, researchers showed that stent thrombosis rates were equivalent between DES and bare-metal stents, although both rates were high, at 4.1%.

PLATO-Invasive: Impressive ticagrelor results mirror overall trial findings

Fri, 25 Sep 2009 17:30:21 EDT

The prespecified subset analysis helps clarify the performance of the drug in patients managed invasively, including adding new insights into its benefits over both the 300-mg and 600-mg loading doses of clopidogrel.

COMPARE: "Real-world" randomized trial favors Xience V over Taxus Libert�

Fri, 25 Sep 2009 08:30:19 EDT

COMPARE is the second of two large randomized controlled trials comparing a Taxus stent with Xience V to show a clear benefit of the newer stent.

COGENT: No CV events but significant GI benefits of PPI omeprazole

Thu, 24 Sep 2009 16:30:07 EDT

The randomized controlled trial results should put a stop to alarmist headlines about PPIs blunting efficacy of antiplatelet drugs, experts say. By withholding PPIs, physicians are doing more harm than good, the results suggest.

SIRTAX LATE: No differences in MACE for first-generation stents at five years

Thu, 24 Sep 2009 08:30:17 EDT

After one year, Cypher had lower rates of death, MI, or repeat PCIs than Taxus in the SIRTAX trial. But four years later, investigators say all differences between the two have disappeared, in part due to more late "catch-up" with the Cypher.

SPIRIT IV: Xience V trumps Taxus for clinically driven end points, although diabetic questions linger

Wed, 23 Sep 2009 16:15:24 EDT

UPDATED // Rates of target lesion failure were significantly lower for the everolimus-eluting Xience V stent for the trial as a whole. In diabetic patients only, however, no differences were seen between the two stents.