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zondag 12 november 2017

The Lancet: [Articles] Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disea...

[Articles] Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial
Low-dose rivaroxaban taken twice a day plus aspirin once a day reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb events and increased major bleeding.
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[Articles] Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial
In patients with stable coronary artery disease, addition of rivaroxaban to aspirin lowered major vascular events, but increased major bleeding. There was no significant increase in intracranial bleeding or other critical organ bleeding. There was also a significant net benefit in favour of rivaroxaban plus aspirin and deaths were reduced by 23%. Thus, addition of rivaroxaban to aspirin has the potential to substantially reduce morbidity and mortality from coronary artery disease worldwide.
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[Comment] Secondary prevention shifts into second gear
Aspirin has been a mainstay in the secondary prevention of cardiovascular events since the 1990s.1 In the mid-1990s, the antiplatelet clopidogrel was tested against aspirin in patients with atherosclerotic vascular disease and was found to reduce vascular death, ischaemic stroke, and myocardial infarction by 8·7%.2 The combination of clopidogrel and aspirin for secondary prevention to reduce cardiovascular events was tested in patients with symptomatic atherothrombosis; however, no benefit was observed.
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[Comment] Antithrombotic therapy in peripheral artery disease
Peripheral artery disease is a systemic atherothrombotic disease in which plaque builds up in the arteries that carry blood to the limbs. If severe enough, impaired blood flow can cause critical limb ischaemia, which presents as resting pain, ulceration, or gangrene, and might require a limb amputation in the most extreme cases.1 People with peripheral artery disease often have plaque in other arterial beds, and thus are at increased risk for myocardial infarction, ischaemic stroke, and cardiovascular death.
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[Review] What works in inclusion health: overview of effective interventions for marginalised and excluded populations
Inclusion health is a service, research, and policy agenda that aims to prevent and redress health and social inequities among the most vulnerable and excluded populations. We did an evidence synthesis of health and social interventions for inclusion health target populations, including people with experiences of homelessness, drug use, imprisonment, and sex work. These populations often have multiple overlapping risk factors and extreme levels of morbidity and mortality. We identified numerous interventions to improve physical and mental health, and substance use; however, evidence is scarce for structural interventions, including housing, employment, and legal support that can prevent exclusion and promote recovery.
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