Cardiology News / Recent Literature Review / Second Quarter 2019
AbstractESC Meeting: Paris, 31/8-4/9/2019TCT Meeting: San Francisco, 25-28/9/2019HCS 40th Congress: Ioannina, 17-19/10/2019AHA Meeting: Philadelphia, PA, USA, 16-18/11/2019ACC Meeting: Chicago, IL, USA, 28-30/3/2020EHRA Meeting: Vienna, 29-31/3/2020Rhythmos 2019;14(3):58-65. AUGUSTUS Trial: In Patients With Atrial Fibrillation (AF) and a Recent Acute Coronary Syndrome (ACS) or PCI Treated With a P2Y12 Inhibitor, an Antithrombotic Regimen Including Apixaban, Without Aspirin, Resulted in Less Bleeding and Fewer Hospitalizations Without Significant Differences in the Incidence of Ischemic Events Than Regimens that Included a Vitamin K Antagonist (VKA), Aspirin, or Both Among 4614 AF patients with ACS or PCI, major or clinically relevant nonmajor bleeding was noted in 10.5% of the patients receiving apixaban, as compared with 14.7% of those receiving a VKA (hazard ratio-HR, 0.69; P<0.001 for both noninferiority and superiority), and in 16.1% of the patients receiving aspirin, as compared with 9.0% of those receiving placebo (HR, 1.89; P<0.001). Patients in the apixaban group had a lower incidence of death or hospitalization than those in the VKA group (23.5% vs. 27.4%; HR, 0.83; P=0.002) and a similar incidence of ischemic events. Patients in the aspirin group had an incidence of death or hospitalization and of ischemic events that was similar to that in the placebo group (Lopes RD et al, N Engl J Med 2019; 380:1509-24).COAPT Trial: Among Patients Successfully Resuscitated After Out-Of-Hospital Cardiac Arrest with no Signs of STEMI, a Strategy of Immediate Angiography Was Not Found to be Better Than a Strategy of Delayed Angiography With Respect to Overall Survival at 90 DaysAt 90 days, 176 of 273 patients (64.5%) in the immediate angiography group and 178 of 265 patients (67.2%) in the delayed (delayed until after neurologic recovery) angiography group were alive (odds ratio, 0.89; P=NS). The median time to target temperature was 5.4 h in the immediate angiography group and 4.7 h in the delayed angiography group. No significant differences between the groups were found in the remaining secondary end points (Lemkers JS et al, N Engl J Med 2019; 380:1397-1407).ANNEXA-4: In Patients With Acute Major Bleeding Associated With Use of a Factor Xa Inhibitor, Treatment With Andexanet Markedly Reduced Anti–Factor Xa Activity, and 82% of Patients Had Excellent or Good Hemostatic Efficacy at 12 Hours Among 352 patients (mean age 77 years, most with CV disease) who had acute major bleeding (64% intracranial and 26% gastrointestinal) within 18 h after a factor Xa inhibitor and received a bolus of andexanet, followed by a 2-hour infusion, in patients who had received apixaban, the median anti–factor Xa activity decreased from 149.7 ng/ml at baseline to 11.1 ng/ml after the andexanet bolus (92% reduction); in patients who had received rivaroxaban, the median value decreased from 211.8 ng/ml to 14.2 ng/ml (92% reduction). Excellent or good hemostasis occurred in 204 of 249 patients (82%) who could be evaluated. Within 30 days, death occurred in 49 patients (14%) and a thrombotic event in 34 (10%). Reduction in anti–factor Xa activity was not predictive of hemostatic efficacy overall but was modestly predictive in patients with intracranial hemorrhage (Connolly SJ et al, N Engl J Med2019; 380:1326-35)... (excerpt). Rhythmos 2019;14(3):58-65.
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