1,721,017 research outputs found
Early risk of mortality, cardiovascular events, and bleeding in patients with newly diagnosed atrial fibrillation
No full textAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is independently associated with a 1.5- to 2.0-fold higher risk of all-cause death and increased morbidity, in particular for heart failure and stroke. Previous studies have shown that the annual rate of death in AF patients is 5%; however, emerging data indicate that the risk of death, but also of thromboembolic and bleeding complications, is highest early after the diagnosis, especially during the first month. In light of these observations, patients with newly diagnosed AF deserve close monitoring and may benefit from a comprehensive care targeting modifiable risk factors for death, such as heart failure, diabetes, renal impairment, and vascular disease. Aim of this report is to focus on timing and causes of death as well as on temporal trends of cardiovascular and bleeding complications in patients with newly diagnosed AF
Primum non nocere does not justify clinical inertia for stroke prevention in elderly patients with atrial fibrillation in the era of direct oral anticoagulants
No full textAggiornamenti in tema di terapia antitrombotica dopo chiusura percutanea dell’auricola sinistra
No full textPercutaneous left atrial appendage occlusion is a novel therapeutic option for stroke prevention in patients with atrial fibrillation and contraindication to oral anticoagulant therapy. However, after left atrial appendage occlusion with the most commonly used devices, a short period of antithrombotic therapy is indicated to allow complete endothelialization of the device and to prevent device thrombosis. Post-procedure antithrombotic strategies are often performed empirically, because of the lack of clear evidence. The present article summarizes the main evidence and recommendations of the scientific societies about antithrombotic therapy after percutaneous left atrial appendage occlusion, suggesting individualized antithrombotic strategies based on the patient's hemorrhagic and thrombotic risk
Clinical effects with inhibition of multiple coagulative pathways in patients admitted for acute coronary syndrome
No full textPlatelets and the coagulation cascade play key roles in initiation, amplification, and perpetuation of acute coronary syndromes (ACS). In the past few years, there has been great progress in ACS antithrombotic treatment with the introduction of novel anticoagulants (fondaparinux and bivalirudin), more potent P2Y12 inhibitors (prasugrel and ticagrelor) and protease-activated receptor antagonists (vorapaxar). Nonetheless, patients with ACS frequently have recurrent ischemic events despite the use of currently recommended dual antiplatelet therapy, revascularization procedures as appropriate, and other evidence-based secondary preventive measures. This is the rationale beyond intensification of antiplatelet therapy. However, the major downside of intensive antithrombotic therapy is bleeding. When treating ACS patients, clinicians should find the adequate balance between the reduction of thrombotic events by effective drug treatment and the induction of bleeding that is linked to the use of potent or multiple antithrombotic agents. Numerous antithrombotic cocktails including oral anticoagulants with or without aspirin have been tested in large clinical trials with the goal of further reduction of ischemia and bleeding risk. The aim of this review is to discuss clinical outcomes resulting from inhibition of multiple coagulative pathways in patients with ACS in light of evidence from large randomized controlled clinical trials
Cardiovascular effects of SGLT-2 inhibitors: what we have learned from cardiovascular outcome trials and what we still need to understand
No full textThe recent results of the DECLARE-TIMI 58 trial forces a profound reflection about the cardiovascular protection conferred by SGLT-2 inhibitors. DECLARE-TIMI 58, the largest cardiovascular outcome trial in diabetes, failed to show a significant reduction in the risk of major adverse cardiovascular events (MACEs) conferred by dapagliflozin compared with placebo. However, a lower rate of hospitalization for heart failure was reported. Whilst the lack of benefits on MACE may seem in contrast with the results of previous SGLT-2 inhibitors cardiovascular outcome trials, DECLARE clearly delineates the real cardiovascular effects of SGLT-2 inhibitors, which mainly tackle heart failure. Differences in study design and population enrolled are crucial to correctly value each molecule and to translate results of clinical trials in daily clinical practise
Editorial: Moving beyond the molecular mechanisms of malignant pleural mesothelioma: Cues for novel biomarkers and drug targets
Full text linkPost-transcriptional regulation of HTLV gene expression: Rex to the rescue
Full text linkHuman T-lymphotropic virus type 1 (HTLV-1) and other members of the Deltaretrovirus genus code for a regulatory protein named Rex that binds to the Rex-responsive element present on viral mRNAs. Rex rescues viral mRNAs from complete splicing or degradation and guides them to the cytoplasm for translation. The activity of Rex is essential for expression of viral transcripts coding for the virion components and thus represents a potential target for virus eradication. We present an overview of the functional properties of the HTLV-1 and HTLV-2 Rex proteins (Rex-1 and Rex-2), outline mechanisms controlling Rex function, and discuss similarities and differences in the sequences of Rex coded by HTLV-1, -2, -3, and -4 that may influence their molecular anatomy and functional properties
Efficacy and Safety of Nonvitamin K Oral Anticoagulants in Patients with Atrial Fibrillation and Cancer: A Study-Level Meta-Analysis
No full textIn this study-level meta-analysis, we evaluated the clinical outcome with nonvitamin K antagonist oral anticoagulants (NOACs) versus vitamin K antagonists (VKAs) in atrial fibrillation (AF) patients with cancer
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