Revue médicale de Liège
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Revue médicale de Liège · Oct 2013
Randomized Controlled Trial Multicenter Study Comparative Study[Hokusai-VTE: edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism].
Currently venous thromboembolic disease (VTE), i.e. deep venous thrombosis and pulmonary embolism, remains a major cause of morbidity and mortality all around the world. The Hokusai-VTE study is a randomized, double-blind trial to evaluate whether initial heparin (5 days) followed by the oral Xa factor inhibitor edoxaban (60 mg once daily) may be an alternative to the standard therapy, i.e. heparin (5 days) followed by warfarin (INR of 2.0-3.0) for the prevention of recurrent thromboembolism in patients with acute symptomatic VTE. In patients with VTE, including pulmonary embolism with right ventricular dysfunction, treatment with heparin followed by oral edoxaban 60 mg once daily was non inferior to the standard treatment with respect to efficacy and superior with respect to bleeding (fewer fatal and intracranial bleeds, but no statistical significance regarding major bleeding). Reducing the dosage of edoxaban to 30 mg once daily is safe in case of renal impairment and low body weight.
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The 2013 guidelines for arterial hypertension have just been released by the European Societies of Cardiology and Hypertension. As already discussed in earlier versions, the decision to treat must be based on the assessment of the cardiovascular risk. ⋯ A novelty, however, consists in the simplification of the blood pressure target under treatment, which must be < 140/90 mmHg in the vast majority of patients, except for octogenerians whose systolic blood pressure target should be < 150 mmHg. For resistant hypertension, renal denervation and carotid baroreceptor stimulation are proposed as new invasive modes of therapy; their clinical values, however, remain to be confirmed.