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12 Aug 2019
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Stephen Padilla, 25 Jul 2019
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11 Aug 2019
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25 Jul 2019
Adding a third drug to achieve the target blood pressure (BP) seems to be more effective than increasing the dose of existing dual therapy without any increase in adverse events, suggest the results of a meta-analysis, adding that early use of triple therapy can help improve hypertension control.

Anticoagulation therapy lowers risk of BVD after TAVR

13 Jan 2019
A new synthetic heart has valves, arteries and veins made of polyvinyl alcohol hydrogel

Sex, renal failure and atrial fibrillation (AF) are most significantly associated with mortality at 3-year follow-up, whereas anticoagulation therapy, given mostly to AF patients, reduces the risk of bioprosthetic valve dysfunction (BVD) following transcatheter aortic valve replacement (TAVR), according to a recent study.

Overall, 12,804 patients were identified in the registry between 1 January 2013 and 31 December 2015, of whom 11,469 (mean age 82.8 years; logistic European System for Cardiac Operative Risk Evaluation, 17.8 percent; mean duration of follow-up, 495 days) were alive at discharge with known antithrombotic treatment and were included in the analysis for mortality.

There were 2,555 patients who had at least two echocardiographic assessments and were eligible for BVD evaluation. Of the patients, one-third had a history of AF and had oral anticoagulation at discharge (n=3,836).

Both aspirin and clopidogrel were not associated with mortality. The strongest independent predictors of death were male sex (adjusted hazard ratio [aHR], 1.63; 95 percent CI, 1.44–1.84; p<0.001), history of AF (aHR, 1.41; 1.23–1.62; p<0.001) and chronic renal failure (aHR, 1.37; 1.23–1.53; p<0.001).

Independently, anticoagulation at discharge (adjusted odds ratio [aOR], 0.54; 0.35–0.82; p=0.005) and a nonfemoral approach (aOR, 0.53; 0.28–1.02; p=0.49) correlated with lower BVD rates, while chronic renal failure (aOR, 1.46; 1.03–2.08; p=0.034) and prosthesis size 23 mm (aOR, 3.43; 2.41–4.89; p<0.001) were associated with increased BVD risk.

This study sought to identify independent correlates of long-term all-cause mortality and early BVD, defined as increased prosthetic gradient 10 mm Hg or new gradient ≥20 mm Hg, using FRANCE TAVI (French Transcatheter Aortic Valve Implantation), a prospective, multicentre nationwide registry.

The authors performed multiple imputations to account for missing values, as well as sensitivity analysis retaining only patients with complete data.

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Most Read Articles
12 Aug 2019
Treatment with nebivolol yields more favourable changes in 24-hour, intradialytic and daytime systolic and diastolic blood pressure variability in patients with intradialytic hypertension, a study has found.
Stephen Padilla, 25 Jul 2019
Nonvitamin K antagonist oral anticoagulants (NOACs) appear to confer more clinical benefits to elderly patients with atrial fibrillation (AF) than vitamin K antagonist anticoagulants (VKAs), suggests a study, adding that this is primarily driven by the lower rates of major bleeding.
11 Aug 2019
Intraoperative methylprednisolone does not appear to significantly prevent the incidence of death, cardiac arrest and other injuries in neonates undergoing cardiac surgery with cardiopulmonary bypass, according to a recent study.
25 Jul 2019
Adding a third drug to achieve the target blood pressure (BP) seems to be more effective than increasing the dose of existing dual therapy without any increase in adverse events, suggest the results of a meta-analysis, adding that early use of triple therapy can help improve hypertension control.