Our mission is to become a worldwide reference for education in the field for all professionals involved in the process to disseminate knowledge & skills of Acute Cardiovascular Care.
Our mission is to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular imaging in Europe.
Our mission is to promote excellence in research, practice, education and policy in cardiovascular health, primary and secondary prevention.
Our mission is to reduce the burden of cardiovascular disease in Europe through percutaneous cardiovascular interventions.
Our mission is to improve the quality of life of the population by reducing the impact of cardiac rhythm disturbances and reduce sudden cardiac death.
Our mission is to improve quality of life and longevity, through better prevention, diagnosis and treatment of heart failure, including the establishment of networks for its management, education and research.
The ESC Working Groups' goal is to stimulate and disseminate scientific knowledge in different fields of cardiology.
The ESC Councils' goal is to share knowledge among medical professionals practising in specific cardiology domains.
OUR MISSION: TO REDUCE THE BURDEN OF CARDIOVASCULAR DISEASE
Dr. John Alexander
Presenter report:Alexander, John (United States of America)Webcast
Acute coronary syndrome (ACS) patients have recurrent ischemic events despite revascularization and antiplatelet therapy. Novel anticoagulants may reduce these events but also increase bleeding. APPRAISE-1 is a phase 2, dose-ranging study of the oral, direct factor Xa inhibitor, apixaban. Patients (n=1715) with recent ST-elevation or non-ST-elevation ACS were randomized to placebo (n=611) or one of 4 doses of apixaban – 2.5mg BID (n=317), 10mg QD (n=318), 10mg BID (n=248), or 20mg QD (n=221) for 6 months. All patients received aspirin. Use of clopidogrel was at the discretion of the treating physician.The primary outcome was major or clinically relevant non-major bleeding by International Society of Thrombosis and Hemostasis (ISTH) criteria. A secondary outcome was cardiovascular death, myocardial infarction, severe recurrent ischemia or stroke.The 10mg BID and 20mg QD apixaban arms were discontinued early due to excess bleeding. Results from the placebo and the two lower dose apixaban arms were presented.Compared to placebo (3.0%), apixaban 2.5mg BID (5.7%, HR 1.78, 95% CI 0.91 to 3.48, p = 0.09) and 10mg QD (7.9%, HR 2.45, 95% CI 1.31 to 4.61, p = 0.005) resulted in a dose dependent increase in ISTH major or clinically relevant non-major bleeding. In addition, apixaban 2.5mg BID (7.6%, HR 0.73, 95% CI 0.44 to 1.19, p=0.21) and 10mg QD (6.0%, HR 0.61, 95% CI 0.35 to 1.04, p=0.07) resulted in trends toward a reduction in clinically important recurrent ischemic events compared to placebo (8.7%).This is the first experience using a direct factor Xa inhibitor for secondary prevention in ACS patients treated with contemporary antiplatelet therapy. Apixaban, at a daily dose of between 5 and 10mg, appears promising and deserves further clinical investigation.
Discussant : Van de Werf, Frans (Belgium)
Hot Line Update III
© 2017 European Society of Cardiology. All rights reserved