1,721,068 research outputs found
Myocardial infarction and atrial fibrillation: different impact of anti-IIa vs anti-Xa new oral anticoagulants: a meta-analysis of the interventional trials.
No full textPURPOSE:
The aim of this study was to perform a meta-analysis, in patients with atrial fibrillation, to evaluate the impact of new oral anticoagulants (NOACs) anti-IIa and anti-Xa vs warfarin on myocardial infarction incidence.
METHODS:
A meta-analysis of double blind randomized controlled trials (RCTs) was performed.
RESULTS:
Four RCT studies including 84,439 patients were selected. Compared with warfarin, no significant reduction of myocardial infarction was observed with anti-Xa drugs; conversely, myocardial infarction was significantly increased with anti-IIa NOAC (1.45% vs 1.04% respectively; RR: 1.38; 95% CI, 1.1-1.7; p=0.005).
CONCLUSIONS:
This meta-analysis suggests that in patients with atrial fibrillation, compared to standard therapy with warfarin, treatment with anti-IIa NOAC is associated with a higher incidence of myocardial infarction
Should all acutely ill medical patients be treated with antithrombotic drugs? A review of the interventional trials
No full textAfter reports from observational studies suggesting an association between acutely ill medical patients and venous thromboembolism (VTE), interventional trials with anticoagulants drugs have demonstrated a significant reduction of VTE during and immediately after hospitalisation. Although several guidelines suggest the clinical relevance of reducing this outcome, there is a low tendency to use anticoagulants in patients hospitalised for acute medical illness. We speculated that such underuse may be dependent on a low perception that patients included in the trials are actually at risk of thromboembolism. Therefore, the aim of this study was to analyse the clinical settings included in the interventional trials and their relationship with thrombotic risk. Analysis of interventional trials revealed that the majority of patients included in the trials (about 80%) were affected by heart failure, acute respiratory syndrome or infections. Among these three illnesses, literature data shows an association with venous thrombosis only in patients with acute infections; this finding was, however, supported only by retrospective study. On the contrary, there is scarce or no evidence that heart failure and acute respiratory syndrome are associated with venous thrombosis. These data underscore the need of better defining the thrombotic risk profile of acutely ill medical patients included in interventional trials with anticoagulants.After reports from observational studies suggesting an association between acutely ill medical patients and venous thromboembolism (VTE), interventional trials with anticoagulants drugs have demonstrated a significant reduction of VTE during and immediately after hospitalisation. Although several guidelines suggest the clinical relevance of reducing this outcome, there is a low tendency to use anticoagulants in patients hospitalised for acute medical illness. We speculated that such underuse may be dependent on a low perception that patients included in the trials are actually at risk of thromboembolism. Therefore, the aim of this study was to analyse the clinical settings included in the interventional trials and their relationship with thrombotic risk. Analysis of interventional trials revealed that the majority of patients included in the trials (about 80%) were affected by heart failure, acute respiratory syndrome or infections. Among these three illnesses, literature data shows an association with venous thrombosis only in patients with acute infections; this finding was, however, supported only by retrospective study. On the contrary, there is scarce or no evidence that heart failure and acute respiratory syndrome are associated with venous thrombosis. These data underscore the need of better defining the thrombotic risk profile of acutely ill medical patients included in interventional trials with anticoagulants
Sex related differences in patients with acute venous thromboembolism treated with new oral anticoagulants. A meta-analysis of the interventional trials
No full textBACKGROUND:
Gender differences have been reported in patients with acute VTE treated with antithrombotic drugs.
OBJECTIVE:
To address the relationship between gender and new oral anticoagulants (NOACs), we performed a meta-analysis to evaluate the incidence of recurrent VTE and major plus clinically relevant non-major bleedings in males and females, with acute VTE, treated with NOACs over the treatment period.
DESIGN:
Systematic review and meta-analysis of double blind randomized controlled trials (RCTs).
DATA SOURCES:
MEDLINE, Cochrane Library of Clinical Trials (up to September 2015).
STUDY SELECTION:
RCTs that compared the beneficial and harmful effects of NOAC drugs (apixaban, dabigatran, edoxaban and rivaroxaban).
DATA EXTRACTION:
Three authors abstracted data. Study-specific risk ratios (RR) were combined using random-effects model.
RESULTS:
Nine studies including 16,372 patients were selected. No significant difference for the incidence of recurrent VTE was found between men and women. Compared to men, women had a higher incidence of major bleedings plus clinically relevant minor bleedings (5.3% and 7.9% respectively; RR: 0.635; 95% CI: 0.54-0.74; p<0.001). The subgroup analysis showed a significant gender difference in incidence of major bleedings and clinically relevant minor bleedings only for Edoxaban (RR: 0.52; 95% CI: 0.42-0.64; p<0.001).
CONCLUSIONS:
This meta-analysis showed, compared to men, a higher risk of bleeding in women with acute VTE treated with NOACs. Future trials should evaluate the effect of gender on bleeding in patients with acute VTE treated with NOACs
Impact of new oral anticoagulants on gastrointestinal bleeding in atrial fibrillation: A meta-analysis of interventional trials.
No full textBACKGROUND:
New oral anticoagulants represent an alternative to standard therapy with vitamin K antagonists but data regarding gastrointestinal bleeding are still unclear.
AIMS:
To investigate if new oral anticoagulants are associated with an enhanced risk of gastrointestinal bleeding vs warfarin in patients with atrial fibrillation.
METHODS:
Meta-analysis of phase three randomized controlled trials to compare the incidence of gastrointestinal bleeding in atrial fibrillation patients treated with new oral anticoagulants (apixaban, dabigatran, edoxaban and rivaroxaban) vs warfarin.
RESULTS:
Four studies including 71,302 patients were selected. Compared with warfarin, new oral anticoagulants significantly increased gastrointestinal bleeding (RR: 1.23; 95% CI 1.03-1.46; p=0.01). Rivaroxaban (RR: 1.46; 95% CI 1.2-1.8; p<0.001) and high dosages of edoxaban (RR: 1.22; 95% CI 1.01-1.47; p=0.038) and dabigatran (RR: 1.50; 95% CI 1.20-1.88; p<0.001) significantly increased gastrointestinal bleeding while a null effect was detected with apixaban.
CONCLUSIONS:
This meta-analysis suggests that rivaroxaban and high dosages of dabigatran and edoxaban should be avoided in patients at high risk of gastrointestinal bleeding
Antioxidant and antiplatelet activity by polyphenol-rich nutrients. focus on extra virgin olive oil and cocoa
No full textCardiovascular disease is the most common cause of death in the Western world. In the last decades nutraceutical approaches have been proposed to counteract atherosclerotic complications. In particular, polyphenols, a class of bio-active molecules prevalently contained in foods such as cocoa, fruits, vegetables, wine and tea, have been widely studied for their beneficial properties. Several epidemiological and interventional studies have shown that polyphenol-rich nutrients, as in extra virgin olive oil (EVOO) and cocoa, are associated with a risk reduction of cardiovascular events and/or modulation of cardiovascular risk factors. Definition of themechanisms accounting for this putative cardio-protective effect is still elusive. This review focuses on themechanisms thatmay be implicated in the beneficial effects of EVOO and cocoa, including down-regulation of oxidative stress and platelet aggregation, improvement of endothelial function and cardiovascular risk factor such as blood pressure, serum cholesterol and insulin sensitivity
The risk of myocardial infarction in patients with atrial fibrillation: an unresolved issue
No full text[No abstract available
Flow-mediated dilation is associated with cardiovascular events in non-valvular atrial fibrillation patients.
No full textBACKGROUND:
Atrial fibrillation is associated with multiple atherosclerotic risk factors and predisposes to cardiovascular events (CVE). Endothelial dysfunction is associated with atherosclerosis and independently predicts CVE. The aim of the study was to evaluate the association between endothelial dysfunction, as assessed by flow-mediated dilation (FMD), and CVE in AF patients.
METHODS:
We prospectively measured FMD in 514 non-valvular AF patients on anticoagulant treatment with vitamin K antagonists. Patients were followed-up for a mean time of 23.5 months. The main composite outcome of the study was the occurrence of stroke/TIA, myocardial infarction, urgent revascularization and cardiovascular death.
RESULTS:
Median value of FMD was 4.6% [IQR 1.46-8.00]. A CVE occurred in 44 patients (8.56%):non-fatal myocardial infarction (MI) in 7, fatal MI in 2, stent/coronary artery by-pass graft (CABG) in 10, ischemic non-fatal stroke in 10, fatal stroke in 3, transient ischemic attack (TIA) in 1, and cardiovascular death in 11 patients. Patients who experienced a CVE showed significantly reduced FMD compared to those who did not (3.06% [IQR 0.00-6.00] vs 4.67% [IQR 1.58-8.22], p=0.027). During a mean follow-up of 23.5 months, the rate of CVE was significantly higher in subjects with FMD below median (<4.6%) than in those with FMD above median (27 vs 17, log-rank test p=0.006). COX analysis demonstrated that low FMD (below median) (HR: 2.20, CI 95%:1.13-4.28, p=0.020), age (HR: 1.08, CI 95%: 1.03-1.12, p<0.001), smoking (HR: 4.15, CI 95%: 1.63-10.6, p=0.003) and history of stroke/TIA (HR: 2.38, CI 95%: 1.13-5.04, p=0.023) independently predicted CVE.
CONCLUSIONS:
In AF patients low FMD is associated with increased risk of CVE suggesting that impaired artery dilatation predisposes to atherosclerotic complications
Upstream therapy with statin and recurrence of atrial fibrillation after electrical cardioversion. Review of the literature and meta-analysis
Full text linkBackground: Atrial fibrillation (AF) is the most common sustained arrhythmia observed in clinical practice. Electrical cardioversion (EC) is commonly used to restore and maintain sinus rhythm but it is characterized by high rate of recurrences. Several trials analyzed the effects of statins to reduce the recurrences in AF with contradictory results. Methods: We performed a meta-analysis of the interventional trials with statins in patients with persistent AF to evaluate recurrences after EC. Only randomized controlled trials were included in the analysis. Data sources included: Medline, ISI Web of Science, SCOPUS and Cochrane database (up to June 2012). Data extraction was performed by three authors. Study-specific odds ratios (ORs) were combined using fixed-effects model. Results: Six studies with 515 patients were included in the analysis. Statins used in the selected trials were: atorvastatin (at dosages ranging from 10 to 80 mg/day), pravastatin (40 mg/day) and rosuvastatin (20 mg/day). AF recurrence after EC occurred in 108/258 (41.8%) of patients treated with statins and in 132/257 (51.3%) patients not on treatment with statins. Compared with control, recurrences were significantly reduced with statin treatment (O.R.: 0.662; 95% C.I., 0.45-0.96; p = 0.03); statin treatment was associated with an absolute risk reduction of 0.095 and a number needed to treat of 11. Conclusions: This review suggests that statin therapy was significantly associated with a decreased risk of recurrence in patients with persistent AF after EC
Chronic granulomatous disease as an SOS call for multicenter cooperative effort to prevent infections. a meta-analysis of the treatments
No full textBackground: Chronic granulomatous disease (CGD) is a rare primary immunodeficiency disease. Patients with CGD experience recurrent life-threatening infections. Lack of large interventional trials generated several doubts for the treatment of infections in CGD.
Objective: To evaluate the effect of interferon gamma, antifungal drugs, and antibiotics in patients with CGD undergoing prophylaxis of infections.
Methods: A meta-analysis of the interventional trials was performed. The studies were identified by searching MEDLINE, ISI Web of Science, SCOPUS, and Cochrane database. The last search was run on January 2016. Reference lists of all studies included in the present systematic review were screened for potential additional eligible studies.
Results: Two studies with 163 patients with CGD were included in the interferon gamma analysis. Severe infections occurred in 17 of 73 patients (23%) treated with interferon gamma and in 49 of 90 patients (54%) not undergoing treatment with interferon gamma. Compared with control, severe infections were significantly reduced in patients treated with interferon gamma (relative risk, 0.46; 95% confidence interval, 0.29-0.73; P = .001). Interferon gamma treatment was associated with an absolute risk reduction of 31% and a number needed to treat of 3. Furthermore, compared with control, interferon gamma treatment reduced pulmonary infections (relative risk, 0.43; 95% confidence interval, 0.19-0.96; P = .04). Two studies with 172 patients with CGD were included in the antifungal drug analysis. Infections occurred in 4 of 69 patients (6%) treated with antifungals and in 17 of 103 patients (16%) not receiving treatment with antifungals. Compared with control, Aspergillus infections were not significantly reduced in patients treated with antifungals. No randomized prospective clinical trials of antibacterial prophylaxis in patients with CGD have been performed.
Conclusion: Despite the fact that interferon gamma prophylaxis seems to have a positive effect on severe infections, small sample sizes preclude definite conclusions. Further trials with interferon gamma and/or antifungal and antibiotics are necessary to optimize the treatment of CG
New oral anticoagulants for the treatment of acute venous thromboembolism: are they safer than vitamin K antagonists? A meta-analysis of the interventional trials.
No full textNew oral anticoagulants (NOACs) may represent an alternative to standard therapy with vitamin K antagonists (VKA). However, up to the present, it is unknown whether these drugs are safer than VKA. The aim of this study was to perform a meta-analysis of the interventional trials with NOACs vs VKA in patients with acute venous thromboembolism (VTE) to obtain the balance between clinical efficacy and complications. A meta-analysis of double blind randomized controlled trials (RCTs) was performed. We included RCTs that compared, in acute VTE, the beneficial and harmful effects of NOACs (ximelagatran, apixaban, dabigatran, edoxaban and rivaroxaban) vs VKA (warfarin). Seven studies including 29,482 patients were selected. Compared with warfarin, recurrent VTE and death from any cause were not significantly reduced by NOACs. Myocardial infarction was significantly increased with NOACs compared with warfarin (RR 2.55; 95 % CI 1.1-5.6; p = 0.02). NOACs significantly reduced the major bleedings (RR 0.63; 95 % CI 0.47-0.83; p = 0.001). This meta-analysis suggests that treatment with NOACs in patients with acute VTE is not inferior to conventional therapy with warfarin for recurrent VTE and death from any cause, but there might be an increased incidence of myocardial infarction
- …
