A randomized controlled trial to investigate the use of acute coronary syndrome therapy in patients hospitalized with COVID-19: the COVID-19 Acute Coronary Syndrome trial

BACKGROUND: patients hospitalised with covid-19 suffer thrombotic complications. risk factors for poor outcomes are shared with coronary artery disease. Objectives: to investigate efficacy of an acute coronary syndrome regimen in patients hospitalised with covid-19 and coronary disease risk factors. PATIENTS/METHODS: a randomised controlled open-label trial across acute hospitals (uk and brazil) added aspirin, clopidogrel, low-dose rivaroxaban, atorvastatin, and omeprazole to standard care for 28-days. primary efficacy and safety outcomes were 30-day mortality and bleeding. the key secondary outcome was a daily clinical status (at home, in hospital, on intensive therapy unit admission, death). RESULTS: 320 patients from 9 centres were randomised. the trial terminated early due to low recruitment. at 30 days there was no significant difference in mortality (intervention: 11.5% vs control: 15%, unadjusted or 0.73, 95%ci 0.38 to 1.41, p=0.355). significant bleeds were infrequent and not significantly different between the arms (intervention: 1.9% vs control 1.9%, p>0.999). using a bayesian markov longitudinal ordinal model, it was 93% probable that intervention arm participants were more likely to transition to a better clinical state each day (or 1.46, 95% cri 0.88 to 95 2.37, pr(beta>0) =93%; adjusted or 1.50, 95% cri 0.91 to 2.45, pr(beta>0) =95%) and median time to discharge home was two days shorter (95% cri -4 to 0, 2% probability that it was worse). CONCLUSIONS: acute coronary syndrome treatment regimen was associated with a 99 reduction in the length of hospital stay without an excess in major bleeding. a larger trial is needed to evaluate mortality.

Atualização do uso de anticoagulantes na síndrome coronariana aguda / Update the use of anticoagulants in acute coronary syndrome

O infarto agudo do miocárdio é a principal causa de óbito no Brasil. nas últimas décadas, houve queda significativa da mortalidade graças ao desenvolvimento de protocolos de dor torácica, novos medicamentos, intervenção coronária percutânea e criação das unidades coronárias. Entre os pilares do tratamento da síndrome coronariana aguda, encontra-se a terapia antitrombótica...

Atualização do uso de anticoagulantes na síndrome coronariana aguda / Update the use of anticoagulants in acute coronary syndrome

O infarto Agudo do Miocárdio é a principal causa de óbito no Brasil. nas últimas décadas, houve queda significativa da mortalidade graças ao desenvolvimento de protocolos de dor torácica, novas medicações, intervenção coronária percutânea e a criação das Unidades Coronarianas. Entre os pilares do tratamento da Síndrome Coronariana Aguda...

Complicações associadas a cirurgias de implante e troca de dispositivos cardíacos eletrônicos implantáveis (DCEI) em chagásicos / Complications associated with implant surgeries and change of implantable electronic cardiac devices (IECD) in chagas patients

O implante de DCEI endocárdicos é considerado atualmente um procedimento seguro e simples. Em centros de implantes que contam com especialistas experientes, o índice de complicações é muito baixo. A etiologia chagásica ainda é responsável por um número significativo das indicações de implante de DCEI na américa latina e está associada à maioria dos procedimentos realizados em nosso meio...