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dinsdag 21 maart 2017

The Lancet: [Articles] Clinically significant bleeding with low-dose rivaroxaban versus aspirin, in addition to P2Y12...

[Articles] Clinically significant bleeding with low-dose rivaroxaban versus aspirin, in addition to P2Y12 inhibition, in acute coronary syndromes (GEMINI-ACS-1): a double-blind, multicentre, randomised trial
A dual pathway antithrombotic therapy approach combining low-dose rivaroxaban with a P2Y12 inhibitor for the treatment of patients with acute coronary syndromes had similar risk of clinically significant bleeding as aspirin and a P2Y12 inhibitor. A larger, adequately powered trial would be required to definitively assess the efficacy and safety of this approach.
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[Articles] Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study
Subclinical leaflet thrombosis occurred frequently in bioprosthetic aortic valves, more commonly in transcatheter than in surgical valves. Anticoagulation (both NOACs and warfarin), but not dual antiplatelet therapy, was effective in prevention or treatment of subclinical leaflet thrombosis. Subclinical leaflet thrombosis was associated with increased rates of TIAs and strokes or TIAs. Despite excellent outcomes after TAVR with the new-generation valves, prevention and treatment of subclinical leaflet thrombosis might offer a potential opportunity for further improvement in valve haemodynamics and clinical outcomes.
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[Comment] Bioprosthetic surgical and transcatheter heart valve thrombosis
Excellent outcomes of transcatheter aortic valve replacement (TAVR) have been experienced by patients with aortic stenosis at high and intermediate risk of surgery.1 Findings from large randomised trials1,2 have shown survival with TAVR that is similar to or improved compared with bioprosthetic surgical aortic valve replacement (SAVR), and very low stroke rates have been observed with new-generation devices. Investigators of echocardiographic follow-up studies3 have consistently reported low transvalvular gradients up to 5 years after TAVR and SAVR, with slightly greater aortic valve areas after TAVR than after SAVR.
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[Comment] Optimising care for children with kidney disease
The theme for World Kidney Day in 2016 was "kidney disease and children: act early to prevent it". Given the adverse effect of renal replacement therapy—dialysis and transplantation—on quality of life and health care resources, few would disagree with this ambition. For some children, however, end-stage kidney disease cannot be avoided and its effects have to be managed and outcomes optimised. With increasing fiscal pressures on health services in many settings around the world, the Article in The Lancet by Nicholas Chesnaye and colleagues looking at macroeconomics and survival on renal replacement therapy in Europe is timely.
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[Articles] Mortality risk disparities in children receiving chronic renal replacement therapy for the treatment of end-stage renal disease across Europe: an ESPN-ERA/EDTA registry analysis
Substantial international variation exists in paediatric renal replacement therapy mortality rates across Europe, most of which was explained by disparities in public health expenditure, which seems to limit the availability and quality of paediatric renal care. Differences between countries in their ability to accept and treat the youngest patients, who are the most complex and costly to treat, form an important source of disparity within this population. Our findings can be used by policy makers and health-care providers to explore potential strategies to help reduce these health disparities.
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