Интересные ссылки

[Dr.Vad]

4 публикации в нейме про аспирин:

Aspirin use prevented serious vascular events in persons who had diabetes and no evident cardiovascular disease at trial entry, but it also caused major bleeding events. The absolute benefits were largely counterbalanced by the bleeding hazard.
[Ссылки доступны только зарегистрированным пользователям ]

Higher all-cause mortality was observed among apparently healthy older adults who received daily aspirin than among those who received placebo and was attributed primarily to cancer-related death. In the context of previous studies, this result was unexpected and should be interpreted with caution.
[Ссылки доступны только зарегистрированным пользователям ]

Тhe use of low-dose aspirin as a primary prevention strategy in older adults resulted in a significantly higher risk of major hemorrhage and did not result in a significantly lower risk of cardiovascular disease than placebo.
[Ссылки доступны только зарегистрированным пользователям ]

Aspirin use in healthy elderly persons did not prolong disability-free survival over a period of 5 years but led to a higher rate of major hemorrhage than placebo.
[Ссылки доступны только зарегистрированным пользователям ]

[BMB]

Гайдлайн по профилактике и лечению ассоциированной с раком ТЭЛА от американских онкологов (NCCN) 2018 г. [Ссылки доступны только зарегистрированным пользователям ]
в лечении появилась схема дальтепарин 5 дней затем эдоксабан (категория рекомендаций I, Hokusai VTE-Cancer trial) и ривароксабан по обычной для ТЭЛА схеме (категория IIa, SELECT D trial).

[BMB]

AVERT trial. Apixaban therapy resulted in a significantly lower rate of venous thromboembolism than did placebo among intermediate-to-high-risk ambulatory patients with cancer who were starting chemotherapy. The rate of major bleeding episodes was higher with apixaban than with placebo. [Ссылки доступны только зарегистрированным пользователям ]

[Korzun]

Дополнения 2019 к гайдлану по ФП:
[Ссылки доступны только зарегистрированным пользователям ]
В основном по антикоагулянтам.

[Dr.Vad]

Reexamining Recommendations for Treatment of Hypercholesterolemia in Older Adults [Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

In patients with atrial fibrillation and a recent acute coronary syndrome or PCI treated with a P2Y12 inhibitor, an antithrombotic regimen that included 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, aspirin, or both.
---
Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation//AUGUSTUS Investigators//NEJM 2019
[Ссылки доступны только зарегистрированным пользователям ]

[Korzun]

[Ссылки доступны только зарегистрированным пользователям ]

Conclusions and Relevance In patients undergoing ablation for NVAF, anticoagulation with minimally interrupted dabigatran therapy did not increase thromboembolic events and was associated with fewer bleeding complications than uninterrupted warfarin therapy.

[Ссылки доступны только зарегистрированным пользователям ]

Conclusions The implantable cardiac system detects early ST-segment deviation and alerts patients of a potential occlusive event. Although the trial did not meet its pre-specified primary efficacy endpoint, results suggest that the device may be beneficial among high-risk subjects in potentially identifying asymptomatic events.
This study adds to a growing trend in real-time monitoring of patients. Although the study did not meet the efficacy endpoint, the rates of ACS in this population were low. Findings from this study, including lower rates of false positives and lower rates of new-onset LVEF <40% with these alarms, support the need for further studies.

[Korzun]

Про фибрилляцию предсердий.
1. Чем выше гликемия и хуже контроль гликозилированного гемоглобина, тем чаще рецидивы ФП после РЧА. О как!

Results:
Recurrent AF occurred in 133 patients (44.6%) during a mean follow-up of 26 months. The AF recurrence rates were 32.4%, 53.4%, and 68.8% among the patients with an HbA1c <7%, 7-9%, and >9%, respectively. The recurrence rate was 91% among the patients in whom glycemic control worsened during the 12 months before ablation, compared to 2% among the patients whose HbA1c improved by >10% during the same time period. After adjustment for multiple potential confounding variables, an improvement or worsening in HbA1c during the 12 months before CA remained independent predictors of a lower or higher AF recurrence rate, respectively.
[Ссылки доступны только зарегистрированным пользователям ]

2. Нормальная функция ушка ЛП = меньше риск инсульта. Можно даже ОАК отменить, если CHA2DS2-VASc позволяет. Хотя это больше генетика, чем то, на что можно повлиять. Т.к. 82% после электрической изоляции ушка ЛП остаются с дисфункцией ушка.

Methods:
This is a prospective study of consecutive AF patients who underwent LAA electrical isolation at a single center. Patients with AF recurrence within 6 months of the isolation procedure were excluded. Each patient underwent 6-month transesophageal echocardiography (TEE) and was classified into one of two groups. Patients in Group 1 had normal LAA function: preserved LAA velocity, contractility, and consistent A waves. These patients had oral anticoagulation (OAC) discontinued regardless of CHA2DS2-VASc score. Patients in Group 2 had abnormal LAA function: impaired velocity, contractility, or A-wave consistency. These patients were asked to continue OAC indefinitely. After LAA electrical isolation, all patients had: 1) 5 months of event recorder monitoring; 2) electrocardiograms at 1, 3, 6, and 12 months, and thereafter biannually; and 3) 7-day Holter monitoring at 1, 6, and 12 months. Group 2 patients also underwent a 12-month TEE to assess for LAA thrombus. The authors do not describe how the primary endpoint, incident TIA/stroke, was defined, identified, or adjudicated.
Results:
Of 2,726 patients who underwent LAA electrical isolation, 1,854 (68%) were in sinus rhythm at the 6-month follow-up and were included in this study. Of these, 336 (18%) patients were included in Group 1 and 1,518 (82%) patients were included in Group 2. After a median follow-up of 2.3 years (interquartile range, 1.5-4.2 years), no patients in Group 1 had an incident stroke/TIA, whereas 90 (5.9%) Group 2 patients had TIA/stroke. In Group 2, the incidence of stroke/TIA for patients on OAC was 1.7% (18 of 1,086), and off OAC was 16.7% (72 of 432); p < 0.001.
[Ссылки доступны только зарегистрированным пользователям ]

[Korzun]

Нужно высыпаться, но не пересыпать сильно! Меньше риск инфаркта! Недосып лучше большого пересыпа. Меньше 7 часов и больше 9 часов - плохо. Немного дополнительного сна - хорошо.
[Изображения доступны только зарегистрированным пользователям]
[Ссылки доступны только зарегистрированным пользователям ]

[Korzun]

[Ссылки доступны только зарегистрированным пользователям ]

Снижение потребления алкоголя уменьшает число рецидивов фибрилляции предсердий.

[Korzun]

[Ссылки доступны только зарегистрированным пользователям ]

The patient population consisted of 11,185 individuals who underwent PCI (median [interquartile range] age, 61 [54-71] years). The minority of patients were women (n = 2,760 [24.7%]). Ticagrelor users (4,076 [36.4%]) were generally younger and had fewer cardiac and noncardiac comorbidities than clopidogrel users. Ticagrelor was not associated with a lower risk of MACE (adjusted hazard ratio [aHR], 0.97; 95% confidence interval [CI], 0.85-1.10); however, it was associated with an increased risk of major bleeding (aHR, 1.51; 95% CI, 1.29-1.78) and dyspnea (aHR, 1.98; 95% CI, 1.47-2.65).

[Abugov]

Сообщение от Korzun

[Ссылки доступны только зарегистрированным пользователям ]

Да, над этим уже все угорали. Этакое антиПлато! Сейчас ещё Празугрел немного пригасят и будем опять сравнивать Клопи с Тиклопидином

[Korzun]

Еще один шаг назад от агрессивности к консервативному аспирину:

[Ссылки доступны только зарегистрированным пользователям ]
Aspirin for VTE Prophylaxis After Hip and Knee Surgery
Feb 04, 2020

Results:
The authors identified 13 randomized clinical trials inclusive of 6,060 patients. The overall relative risk for postoperative VTE was 1.12 (95% confidence interval [CI], 0.78-1.62) for aspirin compared to anticoagulation therapy. Similar risk was seen for deep vein thrombosis (relative risk [RR], 1.04; 95% CI, 0.72-1.51) and pulmonary embolism (RR, 1.01; 95% CI, 0.68-1.48). The risk of adverse events was not different between aspirin and anticoagulation therapy.

Conclusions:
The authors concluded that aspirin did not differ significantly from anticoagulation therapy for the prevention of postoperative VTE following THR or TKR.

Perspective:
Orthopedic surgery, especially THR and TKR, are known to be significant risk factors for VTE. While aspirin has long been known to reduce VTE risk in both primary and secondary prevention, anticoagulation therapy has generally shown better efficacy. However, given concerns about bleeding risk in the postoperative population, surgeons have long advocated for the use of aspirin over anticoagulants (e.g., low molecular weight heparin, rivaroxaban). Of note, the most recent randomized clinical trial including more than half of the total patients did utilize an initial 5-day course of rivaroxaban in all patients before randomizing to aspirin or continued rivaroxaban. All other trials were relatively small or had moderate-high potential for bias. This meta-analysis confirms recent guidelines recommending that aspirin be considered for VTE prophylaxis following THR/TKR in standard-risk patients. Patients at high risk for VTE, including those with prior VTE, likely benefit from anticoagulation prophylaxis.

[Korzun]

[Ссылки доступны только зарегистрированным пользователям ]

Клинические рекомендации
Артериальная гипертензия у взрослых
МКБ 10: I10/ I11/ I12/ I13/ I15
Год утверждения (частота пересмотра):2020
ID: КР62
URL
Профессиональные ассоциации
Российское кардиологическое общество
Одобрено Научно-практическим Советом Минздрава РФ

На сайте МЗ РФ.
Сам пока не смотрел.

[Korzun]

[Ссылки доступны только зарегистрированным пользователям ]
Руководство по диагностике и лечению болезней системы
кровообращения (БСК) в контексте пандемии COVID-19