Expert review of cardiovascular therapy
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Expert Rev Cardiovasc Ther · Apr 2014
ReviewFour factor prothrombin complex concentrate (human): review of the pharmacology and clinical application for vitamin K antagonist reversal.
Vitamin K antagonists (VKAs) have been used for decades for the treatment and prophylaxis of thromboembolic events. Due to their wide range of therapeutic indications, they are the most prescribed oral anticoagulant worldwide. ⋯ In 2013, a 4-factor prothrombin complex concentrate (4F-PCC) was approved in the USA for VKA reversal in patients with bleeding or requiring emergency surgery and invasive procedure. Recent randomized controlled clinical trials have shown that 4F-PCC (Kcentra™) is non-inferior for hemostatic efficacy and superior for international normalized ratio correction as compared to plasma and has a similar safety profile.
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Expert Rev Cardiovasc Ther · Apr 2014
ReviewThe usual suspects in sudden cardiac death of the young: a focus on inherited arrhythmogenic diseases.
Up to 14,500 young individuals die suddenly every year in Europe of cardiac pathologies. The majority of these tragic events are related to a group of genetic defects that predispose the development of malignant arrhythmias (inherited arrhythmogenic diseases [IADs]). ⋯ However; if a timely diagnosis is made, simple preventative measures may be applied. Genetic studies play a pivotal role in the diagnosis of IADs and may help in the management of patients and their relatives.
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Expert Rev Cardiovasc Ther · Apr 2014
ReviewImaging methods for detection of chemotherapy-associated cardiotoxicity and dysfunction.
Survival in cancer has improved, shifting some of the focus of care to minimizing the long term complications of cancer therapy. Cardiovascular disease is a leading long-term cause of morbidity and mortality in patients who survive cancer. ⋯ We will differentiate cardiotoxicity and cardiac injury from cardiac dysfunction and cardiomyopathy. We will discuss the current clinical measures that are used to monitor patients, the limitations of each technique, and then detail research into novel methods for tracking and detecting the cardiac toxicity and cardiac dysfunction that may occur as a result of chemotherapy.
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Expert Rev Cardiovasc Ther · Apr 2014
Editorial ReviewAtrial fibrillation and stroke prevention: brief observations on the last decade.
Atrial fibrillation (AF) results in a substantial risk of mortality and morbidity from stroke and thromboembolism, and thus, a cornerstone of AF management requires appropriate and effective stroke prevention, which is oral anticoagulation. In the last decade, substantial changes in the landscape of stroke prevention in AF are evident. New knowledge has led to improved treatment options and guidelines have evolved. ⋯ An important clinical practice shift is the initial identification of 'low-risk' patients, that is, CHA2DS2-VASc score = 0 (male) or 1 (females), who do not need any antithrombotic therapy. Subsequent to this step OAC can be offered to patients with ≥1 stroke risk factors. More recently, the SAMe-TT2R2 score has been proposed to aid decision-making, by using simple clinical variables by identifying those AF patients likely to do well on warfarin (SAMe-TT2R2 score 0-1) or those more likely to have poor anticoagulation control (SAMe-TT2R2 score >2), where a non-vitamin K antagonist oral anticoagulant may be a better option.