Koronária revaszkularizációs eljárásokat követő klinikai kimenetel a trombocita aggregáció gátló kezelés és a vérzéses szövődmények tükrében - a témában megjelent tanulmányok metaanalízise

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Apixaban and risk of myocardial infarction: meta-analysis of randomized controlled trials

The coagulation system contributes greatly to the evolution of myocardial infarction (MI). Anticoagulation may reduce the occurrence of MI as monotherapy or with con- comitant use of aspirin. Activated factor X antagonists (anti- Xa) and direct thrombin inhibitors have promising results in various indications in non-inferiority trials. However, results regarding their cardiovascular safety are heterogeneous. We systematically evaluated the risk of MI and mortality in patients receiving the new-generation oral anti-Xa agent apixaban. Electronic databases were searched to find pro- spective, randomized, controlled clinical trials (RCT) that evaluated the clinical impact of apixaban. Efficacy measures included frequency of MI, cardiovascular and overall mor- tality. Outcome parameters of RCTs were pooled with a ran- dom-effects model. Between January 2000 and December 2013, 12 RCTs comprising 54,054 patients were identified. Based on the pooled results, there was no increase in the risk of MI in patients treated with apixaban [odds ratio (OR) 0.90;95 % confidence interval (CI) 0.77–1.05; p = 0.17] com- pared to different controls. Cardiovascular and overall mor- tality with apixaban was comparable to the control groups (OR 0.88; 95 % CI 0.72–1.06; p = 0.18, OR 0.89; 95 % CI 0.77–1.03; p = 0.11, respectively). The pooled risk of major bleeding was lower in the apixaban treated groups (OR 0.84; 95 % CI 0.62–1.12; p = 0.23) however this reached signifi- cant level only in subgroup analysis of trials with anticoagu- lant regimes in the control (OR 0.66; 95 % CI 0.51–0.87; p = 0.003). In a broad spectrum of patients and compared to different controls apixaban treatment was not associated with an increase in MI or mortality

A Multicenter, Phase 2, Randomized, Placebo-Controlled, Double-Blind, Parallel-Group, Dose-Finding Trial of the Oral Factor XIa Inhibitor Asundexian to Prevent Adverse Cardiovascular Outcomes Following Acute Myocardial Infarction

Background: Oral factor XIa (FXIa) inhibitors may modulate coagulation to prevent thromboembolic events without significantly increasing bleeding. We explored the pharmacodynamics, safety, and efficacy of the oral FXIa inhibitor asundexian for secondary prevention after acute myocardial infarction (MI)

Clinical outcomes in patients treated for coronary in-stent restenosis with drug-eluting balloons: Impact of high platelet reactivity.

BACKGROUND: The impact of high platelet reactivity (HPR) on clinical outcomes after elective percutaneous coronary interventions (PCI) with drug-eluting balloons (DEB) due to in-stent restenosis (ISR) is unknown. OBJECTIVE: We sought to evaluate the prognostic importance of HPR together with conventional risk factors in patients treated with DEB. METHODS: Patients treated with DEB due to ISR were enrolled in a single-centre, prospective registry between October 2009 and March 2015. Only patients with recent myocardial infarction (MI) received prasugrel, others were treated with clopidogrel. HPR was defined as an ADP-test >46U with the Multiplate assay and no adjustments were done based on results. The primary endpoint of the study was a composite of cardiovascular mortality, MI, any revascularization or stroke during one-year follow-up. RESULTS: 194 stable angina patients were recruited of whom 90% were treated with clopidogrel. Clinical characteristics and procedural data were available for all patients; while platelet function testing was performed in 152 subjects of whom 32 (21%) had HPR. Patients with HPR had a higher risk for the primary endpoint (HR: 2.45; CI: 1.01-5.92; p = 0.03). The difference was primarily driven by a higher risk for revascularization and MI. According to the multivariate analysis, HPR remained a significant, independent predictor of the primary endpoint (HR: 2.88; CI: 1.02-8.14; p = 0.04), while total DEB length and statin treatment were other independent correlates of the primary outcome. CONCLUSION: HPR was found to be an independent predictor of repeat revascularization and MI among elective patients with ISR undergoing PCI with DEB

Különböző sertéstípusok az orvostudományi kardiovaszkuláris kutatásokban (Irodalmi áttekintés)

The swine is a well-known and frequently used animal in different research activities. They proved to have the most valuable role as model animals in the cardiovascular research field. However, the use of conventional meat-type hybrids is hampered by their high growth potential, which makes them unsuitable for long-term follow-up or adult research in modeling chronic diseases. In these cases, the use of minipig breeds is a solution for the researchers. The research results obtained using small-size pig varieties can be well adapted or extrapolated to the knowledge and treatment of similar diseases in the human population, on the understanding that researchers should strive for a deeper understanding of the biological characteristics of these varieties.A sertések régóta használt modellállatok a különböző kutatási tevékenységekben. Kifejezetten jól használhatók a kardiovaszkuláris betegségek vizsgálatában. A hagyományos húshibridek használatának azonban gátat szab nagy növekedési erélyük, amely miatt nem alkalmasak hosszú utánkövetési idejű vagy felnőtt szervezetben, krónikus betegségek modellezésére kialakított kutatási feladatokra. Ezekben az esetekben a törpe sertésfajták alkalmazása jelent megoldást a kutatók számára. A kisméretű fajták alkalmazásával nyert kutatási eredmények jól adaptálhatók, illetve extrapolálhatók a humán populáció hasonló betegségeinek megismerése és kezelése vonatkozásában azzal, hogy a kutatóknak törekedni kell ezen fajták biológiai sajátosságainak minél mélyebb megismerésére