https://orcid.org/0000-0002-6942-6312
In this issue of the journal, Dr Lip and co-workers aimed to compare the effectiveness and safety for very low dose (VLD) non-vitamin K antagonist oral anticoagulants (NOACs) [edoxaban 15 mg o.d., dabigatran 110 or 150 o.d., apixaban 2.5 mg o.d., or rivaroxaban 10 mg (without the diagnosis of chronic kidney disease) or <10 mg o.d.] vs. regular-dosage (RD) NOACs (edoxaban 60/30 mg o.d. or other labelling-dosage NOACs) among a real-world cohort of elderly atrial fibrillation (AF) population similar to the ELDERCARE-AF cohort.1–6 The authors used a retrospective cohort study from Taiwan National Health Insurance.
They concluded that use of VLD NOACs was associated with a greater risk of arterial and venous thrombosis, death as well as the composite outcomes, when compared with that of RD NOAC in high-risk elderly AF patients at increased bleeding risk. Thromboprophylaxis with RD NOAC is still preferable over VLD NOAC for the majority of elderly AF patients at increased bleeding risk.
Morphine may reduce absorption and delays onset of action of oral P2Y12 receptor inhibitors in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention.7 Orodispersible Ticagrelor has been suggested to avoid this problem.8 Dr Parodi and co-workers from Italy, aimed to evaluate platelet inhibition with 180 mg ticagrelor loading dose (LD) administered as oral dispensable tablet (ODT) compared with standard coated tablet ticagrelor formulation in ACS patients undergoing percutaneous coronary intervention (PCI) according to morphine use. They found no difference between ODT and standard ticagrelor tablets in terms of post-LD residual platelet reactivity, percentage of platelet inhibition, or Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation safety regardless to morphine use.
Guidelines recommend extended dual antiplatelet therapy (DAPT), including ticagrelor 60 mg twice daily, in high-risk post myocardial infarction (MI) patients who have tolerated 12 months and are not at high bleeding risk.9,10 Dr Bonaca et al. used registries (n = 7035) from different countries. Patients initiating ticagrelor 60 mg ≥ 12 months after MI, meeting eligibility criteria for PEGASUS-TIMI 54 trial,11 were included. The cumulative incidence of the composite of MI, stroke, or all-cause mortality, and of bleeding requiring hospitalization were calculated. The observed event rates for ischemic events and bleeding generally align with those in the pivotal trials, support the established safety profile of ticagrelor, and highlight the significant residual ischemic risk in this population.
The PRECISE-DAPT (Predicting Bleeding Complication in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy) score is a five-item risk score that predicts out-of-hospital bleeding for patients receiving DAPT.12–15 Dr Costa and co-workers aimed to summarise the totality of evidence validating the Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score. In a meta-analysis, a total of 21 studies and 67 283 patients were included; 24.7% of patients (n = 16 603) were at high-bleeding risk (PRECISE-DAPT ≥ 25) and when compared to those at low-bleeding risk, they experienced a significantly higher rate of any out-of-hospital bleeding. They concluded that in this systematic review and meta-analysis confirms the external validity of the PRECISE-DAPT score in predicting out-of-hospital bleeding outcomes in patients on DAPT following PCI. The moderate discriminative ability highlights the need for future improved risk prediction tools in the field.
The clinical relevance of common pharmacokinetic interactions with non-vitamin K antagonist oral anticoagulants (NOACs) often remains unclear.16 Therefore, the impact of P-glycoprotein (P-gp) and CYP3A4 inhibitors and inducers on clinical outcomes in NOAC-treated patients with atrial fibrillation (AF) was investigated by Dr Lahousse et al. from Belgium. They examined AF patients from Belgian nationwide data. Among 193 072 NOAC-treated AF patients, 46 194 and 2903 subjects concomitantly used a P-gp/CYP3A4 inhibitor or inducer. They concluded that concomitant use of P-gp/CYP3A4 inhibitors was associated with higher bleeding and all-cause mortality risks in NOAC users, whereas the use of Pgp/CYP3A4 inducers was associated with higher stroke risks.
Statins are widely acknowledged for their application in patients with coronary heart disease. More recently, their potential to exert pleiotropic effects, particularly in impeding the proliferation of neoplastic cells. While some studies suggest a significant reduction in mortality among statin users,17 others have found no such association compared to non-users.18 Dr Jaiswal and co-workers from the US performed a meta-analysis to evaluate the impact of statin use following a breast cancer diagnosis on breast cancer recurrence and mortality. A total of 15 studies with 156 448 patients were included in the final analysis. The authors found that statin use was associated with a reduction in the recurrence of breast cancer.
The beneficial cardiovascular effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors irrespective of the presence of diabetes mellitus are nowadays well established and they already constitute a significant pillar for the management of heart failure, irrespective of the ejection fraction.19–22 The exact underlying mechanisms accountable for these effects, however, remain largely unknown. In this issue of the journal. Dr Dimitriadis et al. from Greece present a review paper entitled; ‘The Effect of SGLT2 Inhibitors on the Endothelium and the Microcirculation: From Bench to Bedside and Beyond’.
Dr Benincasa and co-workers present a review paper entitled ‘Bioinformatic platforms for clinical stratification of natural history of atherosclerotic cardiovascular diseases’.
