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Pharmaco-Invasive Strategy With Half-Dose Tenecteplase in Patients With STEMI: Prespecified Pooled Analysis of Patients Aged ≥75 Years in STREAM-1 and 2.
Circ Cardiovasc Interv
December 2024
Canadian VIGOUR Centre (K.R.B., R.C.W., Y.Z., T.T., E.L., C.M.W., P.W.A.), University of Alberta, Edmonton, Canada.
Background: In STREAM-1 (Strategic Reperfusion Early After Myocardial Infarction), excess intracranial hemorrhage occurred in patients aged ≥75 years receiving full-dose tenecteplase as part of a pharmaco-invasive strategy, whereas no further intracranial hemorrhage occurred after halving the tenecteplase dose. In STREAM-2 (Second Strategic Reperfusion Early After Myocardial Infarction), half-dose tenecteplase was an effective and safe pharmaco-invasive strategy in older patients with ST-segment-elevation myocardial infarction presenting within <3 hours, compared with primary percutaneous coronary intervention (PCI). We prespecified evaluating the efficacy and safety of a half-dose versus full-dose pharmaco-invasive strategy and compared the half-dose pharmaco-invasive strategy to primary PCI in patients aged ≥75 years.
View Article and Find Full Text PDF4-Factor prothrombin complex concentrates and factor VIII inhibitor bypass activity use in cardiac surgery.
Blood Coagul Fibrinolysis
November 2024
Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA.
Article Synopsis
- The study aimed to compare the occurrence of thromboembolic complications between two treatments, 4-factor prothrombin complex concentrate (4F-PCC) and factor VIII inhibitor bypassing activity (FEIBA), during cardiac surgery.
- Data was retrospectively analyzed from a university hospital involving patients who underwent cardiac procedures with cardiopulmonary bypass, focusing on various medical outcomes.
- Results indicated no significant difference in thromboembolic events, acute kidney injuries, or hospital stays between the two treatment groups, although variations in blood product usage were noted.
Platelet-sparing properties of aprotinin: A scoping review on mechanisms and clinical effects.
Eur J Anaesthesiol
January 2025
From the Department of Cardiovascular Sciences, KU Leuven (LLWV, SR, RVdE), and the Department of Anesthesiology, University Hospital of the KU Leuven, Leuven, Belgium (LLWV, SR, RVdE).
Background: Cardiac surgery involving cardiopulmonary bypass (CPB) is associated with the risk of acquired coagulopathy, including dysregulated fibrinolysis, which can result in life-threatening bleeding complications. Aprotinin, an antifibrinolytic agent, has been recommended for the prevention of these complications. Its effectiveness has been attributed to its ability to nonspecifically inhibit various serine proteases involved in the coagulation and fibrinolysis cascade.
View Article and Find Full Text PDFVenous thromboembolism treatment failure during use of factor Xa inhibitors-association with thoracic outlet syndrome and development of chronic thromboembolic pulmonary hypertension.
Ann Med
December 2024
Heart and Lung Center, Cardiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Article Synopsis
- Factor Xa inhibitors are commonly used to treat venous thromboembolism (VTE), but a small percentage of patients experience treatment failure, prompting this study to explore the causes of recurrent VTE in those receiving FXaIs.
- The study included ten patients, mostly young adults with significant underlying VTE risk factors despite initial assessments suggesting unprovoked VTE, highlighting conditions like thoracic outlet syndrome contributing to their risks.
- Results indicated that treatment failure occurred within a few months, often leading to serious complications like chronic thromboembolic pulmonary hypertension, and emphasized the importance of tailored treatment strategies and careful risk evaluation for patients with recurrent VTE.
Sex differences in treatment strategies for pulmonary embolism in older adults: The SERIOUS-PE study of RIETE participants and US Medicare beneficiaries.
Vasc Med
November 2024
Faculty of Health Sciences, UCAM Universidad Católica San Antonio de Murcia, Murcia, Spain.
Article Synopsis
- The study investigates sex differences in treatment approaches for pulmonary embolism (PE) among older adults, revealing that existing evidence on disparities is limited and often inconclusive due to small sample sizes and inadequate methods.
- Analysis of data from a European PE registry and US Medicare beneficiaries shows no significant overall sex differences in the use of anticoagulation or advanced therapies, although fewer women received fibrinolytic therapy compared to men with intermediate-risk PE.
- The authors suggest that future research should explore whether the observed sex disparities in treatment correlate with different clinical outcomes, especially regarding fibrinolytic therapy and advanced treatment utilization in older adults in the US.
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