The Verdict Is In: Endoscopic Vein-Graft Harvest Is as Safe as Open Harvest
A large contemporary, observational study allays concerns about long-term safety.
Can We Safely and Effectively Vaccinate Patients Receiving Biologic Therapies for Immune-Mediated Disease?
Indications are promising but not definitive; nevertheless, we should discuss results with patients who request the herpes zoster vaccine.HAS-BLED for Assessing Bleeding Risk with Anticoagulation: Best of the Mediocre
Notwithstanding a lackluster performance, HAS-BLED beat two other scoring systems in a comparative analysis of trial data.
Bleeding continues to be the Achilles heel of systemic anticoagulation, whether the agent used is warfarin or any of the new anticoagulants entering the market. Predictive models for bleeding include the following:
HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol)
Warfarin plus Aspirin After Aortic Valve Prosthesis Placement?
An observational study suggests that the combination reduces mortality, at the cost of increased bleeding, when used in the 3 months after surgery.
Patients receiving an aortic bioprosthesis have a low overall risk for thromboembolism, but controversy surrounds whether they benefit from anticoagulation in the first months after surgery. To address this issue, researchers used the Society of Thoracic Surgeons Adult Cardiac Surgery Database to compare the effectiveness of the early use of aspirin alone, aspirin plus warfarin, and warfarin alone.A collaborative meta-analysis suggests that the effect is real but smaller than previously thought.
In a recent meta-analysis of published cohort studies, job strain was associated with about a 40% increase in risk for coronary heart disease. However, these studies are susceptible to publication bias and limited by methodological idiosyncrasies. To minimize these shortcomings, investigators conducted a participant-level meta-analysis of 13 published and unpublished European studies including 197,473 individuals (mean age, 42; 49% women). The same validated model was used in all of the studies to assess baseline job strain.The Latest and Greatest in Anticoagulation — Still Not a Good Idea After ACS
The newer oral anticoagulants are associated with increased rates of major bleeding that offset their antithrombotic benefit.
The burgeoning use of new oral anticoagulants (e.g., dabigatran, rivaroxaban, apixaban) has rekindled interest in whether these agents, combined with standard antiplatelet therapy, could reduce thrombotic events after acute coronary syndromes (ACS). To synthesize the current evidence base, researchers performed a meta-analysis of seven trials in which 31,286 ACS patients were randomized to placebo or a new oral anticoagulant, either an anti-Xa or direct thrombin inhibitor. All patients also received antiplatelet therapy, and most received dual antiplatelet therapy with aspirin and a thienopyridine.
