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

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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Blood biochemistry changes in a minipig infarction model

IntroductionThe present study aimed to assess changes in biochemical parameters during the adaptation of the myocardial infarction model to a conventional Hungarian minipig breed. According to our hypothesis, changes in the blood level of the necroenzymes are not only related to the interventional procedure but are also influenced by peri-procedural animal keeping and treatment conditions.MethodsClosed chest acute myocardial infarction (AMI) was induced by balloon occlusion for 90 min in the left anterior descendent coronary artery (LAD) in 24 adult, female Pannon minipigs followed by reperfusion. Blood samples were taken before AMI, and immediately after the reperfusion, during the cardiac magnetic resonance imaging (cMRI) on days 3 and 30. Aspartate transaminase (AST), alanine aminotransferase (ALT), creatine kinase (CK), lactate dehydrogenase (LDH), and high-sensitivity troponin I were determined.ResultsWhile the parameters measured at baseline remained within physiological ranges, a notable elevation was seen in comparison with the results observed on day 30. This phenomenon was evident in all the laboratory parameters tested, except hs-troponin. The results for AST, ALT, LDH, and CK were statistically significant (p = 0.011, p = 0.001, p = 0.013, and p = 0.001, respectively). A statistically significant difference was observed between the baseline and 30-day AST/ALT ratio (p = 0.00514).DiscussionThe elevated levels of necroenzymes observed at baseline are likely to be a consequence of the physical and social stress imposed by the study design on the minipigs during the 72-h period prior to intervention. It is essential to define the optimal timing of baseline blood tests to ensure the reliability of the biochemical profile in a large animal infarction model

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)

Transradial Approach as a Default Route in Coronary Artery Interventions

Advances in percutaneous coronary intervention (PCI) and peri-procedural potent antithrombotic treatments during the past decade have dramatically improved the outcomes of ischemic heart disease. The femoral artery is the vascular route used in PCI in most catheterization labs. However, when the femoral artery is used as the approaching vessel, local hemorrhagic complication is not rare in the era of potent antithrombotics. Recent studies have suggested that peri-procedural bleeding complications after PCI are associated with increased short- and long-term morbidity and mortality. On the other hand, there has been growing interest in transradial PCI due to rare complications at the puncture site, patient conveniences, early discharge and shortened hospitalization periods. Furthermore, the indications of transradial PCI are expanding to the complex lesion subsets due to the miniaturization of devices used, improvement of devices and techniques, and accumulated experience with the use of transradial PCI. In this review, we discuss the data of transradial PCI as a potential default route in coronary artery interventions, as well as other issues that may raise concerns with transradial PCI

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