ABSTRACT
BACKGROUND: Contrasting evidence exists on the comparative efficacy and safety of bivalirudin and unfractionated heparin (UFH) in relation to the planned use of glycoprotein IIb/IIIa inhibitors (GPIs). OBJECTIVES: This study assessed the efficacy and safety of bivalirudin compared with UFH with or without GPIs in patients with acute coronary syndrome (ACS) who underwent invasive management. METHODS: In the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX) program, 7,213 patients were randomly assigned to receive either bivalirudin or UFH with or without GPIs at discretion of the operator. The 30-day coprimary outcomes were major adverse cardiovascular events (MACEs) (a composite of death, myocardial infarction, or stroke), and net adverse clinical events (NACEs) (a composite of MACEs or major bleeding). RESULTS: Among 3,603 patients assigned to receive UFH, 781 (21.7%) underwent planned treatment with GPI before coronary intervention. Bailout use of GPIs was similar between the bivalirudin and UFH groups (4.5% and 5.4%) (p = 0.11). At 30 days, the 2 coprimary endpoints of MACEs and NACEs, as well as individual endpoints of mortality, myocardial infarction, stent thrombosis or stroke did not differ among the 3 groups after adjustment. Compared with the UFH and UFH+GPI groups, bivalirudin reduced bleeding, mainly the most severe bleeds, including fatal and nonaccess site-related events, as well as transfusion rates and the need for surgical access site repair. These findings were not influenced by the administered intraprocedural dose of UFH and were confirmed at multiple sensitivity analyses, including the randomly allocated access site. CONCLUSIONS: In patients with ACS, the rates of MACEs and NACEs were not significantly lower with bivalirudin than with UFH, irrespective of planned GPI use. However, bivalirudin significantly reduced bleeding complications, mainly those not related to access site, irrespective of planned use of GPIs. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX [MATRIX]; NCT01433627).
Subject(s)
Acute Coronary Syndrome , Coronary Artery Bypass/adverse effects , Heparin , Hirudins , Peptide Fragments , Percutaneous Coronary Intervention/adverse effects , Postoperative Complications , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/drug therapy , Acute Coronary Syndrome/surgery , Aged , Coronary Artery Bypass/methods , Electrocardiography/methods , Female , Hematologic Agents/administration & dosage , Hematologic Agents/adverse effects , Hematologic Agents/classification , Hemorrhage/chemically induced , Hemorrhage/prevention & control , Heparin/administration & dosage , Heparin/adverse effects , Hirudins/administration & dosage , Hirudins/adverse effects , Humans , Intraoperative Care/methods , Male , Middle Aged , Peptide Fragments/administration & dosage , Peptide Fragments/adverse effects , Percutaneous Coronary Intervention/methods , Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors , Postoperative Complications/classification , Postoperative Complications/etiology , Recombinant Proteins/administration & dosage , Recombinant Proteins/adverse effects , Treatment OutcomeABSTRACT
Patients with myeloma are at high risk of venous thromboembolism (VTE). There is no consensus about what agent to use or what haematologists are doing in clinical practice. A survey was sent to haematologists treating patients with myeloma in Ireland. 32/45 (71%) responded. 13/28 (46%) felt that VTE affected < 5% of patients. However, 8/28 (29%) felt it affected 10-19%. Thromboprophylaxis was most commonly used in patients on lenalidomide; 25/28 (89%) and thalidomide; 23/28 (82%). 23/28 (82%) used LMWH and 20/28 (71%) used aspirin either very frequently or frequently. 3/28 (11%) had used dabigatran/rivaroxaban despite there being little evidence to support their use. Efficacy was the most important factor in choosing an agent for 25/28 (89%). Bleeding was not felt to be an issue 15/29 (52%) were not using thromboprophylaxis guidelines. This survey demonstrated wide variation in the beliefs and practices regarding the burden of VTE in patients with myeloma and the need for thromboprophylaxis.
Subject(s)
Hematologic Agents , Multiple Myeloma/complications , Practice Patterns, Physicians' , Preventive Health Services , Venous Thromboembolism , Attitude of Health Personnel , Health Care Surveys , Hematologic Agents/classification , Hematologic Agents/therapeutic use , Hematology/methods , Hematology/statistics & numerical data , Humans , Ireland , Patient Participation , Practice Patterns, Physicians'/standards , Practice Patterns, Physicians'/statistics & numerical data , Preventive Health Services/methods , Preventive Health Services/standards , Risk Assessment , Treatment Outcome , Venous Thromboembolism/etiology , Venous Thromboembolism/prevention & control , Venous Thromboembolism/psychologyABSTRACT
Post-operative haemorrhage is a recognized complication in dental practice. This may be more prevalent in patients taking antithrombotic medications. It is important that the dentist understands the mechanism of action of these drugs and how they may affect management of dental patients. Clinical Relevance: Dental professionals must be aware of those medications affecting haemostasis and how they may impact on management. The emergence of different therapeutic regimens has increased the number of such drugs.
Subject(s)
Hematologic Agents/therapeutic use , Hemostasis, Surgical/methods , Oral Hemorrhage/prevention & control , Postoperative Hemorrhage/prevention & control , Anticoagulants/therapeutic use , Antithrombins/therapeutic use , Benzimidazoles/therapeutic use , Dabigatran , Drug Interactions , Fibrinolytic Agents/therapeutic use , Hematologic Agents/classification , Heparin/therapeutic use , Humans , International Normalized Ratio , Platelet Aggregation Inhibitors/therapeutic use , Risk Assessment , Warfarin/therapeutic use , beta-Alanine/analogs & derivatives , beta-Alanine/therapeutic useABSTRACT
The article deals with the analysis of the results of randomized placebo-controlled studies of various therapeutic agents currently available in Russia, as well as the results of meta-analyses and Cochrane reviews of medicamentous treatment of patients with intermittent claudication. The results of these studies gave grounds to recommend the most efficient agents in the new edition of the "National Guidelines on management of patients with lower-limb arterial disease" (2013).
Subject(s)
Intermittent Claudication , Cardiovascular Agents/classification , Cardiovascular Agents/therapeutic use , Central Nervous System Stimulants/classification , Central Nervous System Stimulants/therapeutic use , Chelating Agents/therapeutic use , Enterosorption/methods , Hematologic Agents/classification , Hematologic Agents/therapeutic use , Humans , Intermittent Claudication/drug therapy , Intermittent Claudication/physiopathology , Meta-Analysis as Topic , Patient Acuity , Practice Guidelines as Topic , Randomized Controlled Trials as TopicABSTRACT
When a woman suffering from a hematological condition is contemplating pregnancy, she may need to continue the use of medications that do not have sufficient evidence of fetal safety. We discuss the evidence existing for some therapies of major hematological conditions in the context of major principles in clinical teratology. It is critical to always balance the potential fetal risks of the drug in question against the maternal and fetal risks of the untreated hematological condition.
