Future cardiology
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Mavacamten is an investigational therapy for the treatment of hypertrophic cardiomyopathy (HCM), a condition where the heart muscle wall thickens, becomes stiff, and makes it harder for the heart to pump blood. In obstructive HCM (sometimes referred to as oHCM or HOCM), the thickened muscle also blocks blood flow from the heart. The EXPLORER-HCM trial compared mavacamten to placebo (a pill with no medicine/active substances) in symptomatic people with obstructive HCM who had exercise limitations and suffered from shortness of breath, tiredness, palpitations, and chest pain. ⋯ Side effects, such as irregular heartbeat, palpitations, rapid heartbeat, and heart failure, were similar for people who received mavacamten or placebo. To read the full Plain Language Summary of this article, click on the View Article button above and download the PDF. Clinical Trial Registration: NCT03470545 (ClinicalTrials.gov).
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Wide-necked bifurcation aneurysms are common when evaluating both ruptured and unruptured intracranial aneurysms and can pose unique challenges. The Woven EndoBridge device (recently approved in the US) is specifically designed for the treatment of these aneurysms. This article serves to introduce the device to a wider audience with a thorough review of the literature, device design, indications, pre-operative evaluation, procedural usage and potential pitfalls.
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The COVID-19 infection adversely affects the cardiovascular system. Transthoracic echocardiography has demonstrated diagnostic, prognostic and therapeutic utility. We report biventricular myocardial strain in COVID-19. ⋯ Conclusion: Right ventricular strain was decreased in patients with poor outcomes and left ventricular strain was decreased regardless of outcome. Right ventricular strain measurements may be important for risk stratification and prognosis. Further studies are needed to confirm these findings.
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Aim: We describe the real-world utilization and outcomes associated with managing oral factor Xa inhibitor (FXai)-related major bleeds. Materials & methods: Electronic records from 45 US hospitals were queried (ICD-10-CM billing codes D68.32, T45.515x or T45.525x) to identify major bleed hospitalizations related to FXai use. Patient demographics, bleed type (intracranial hemorrhage, gastrointestinal, critical compartment, traumatic, other), FXai taken, reversal or replacement agents administered (including andexanet alfa, four-factor prothrombin complex concentrate, fresh frozen plasma, others), in-hospital mortality and length of stay were recorded. ⋯ Median length of stay was 5 days across all agents, while ICU length of stay was shorter andexanet alfa (2 days) compared with other agents (3 days). Conclusion: In-hospital mortality differed by bleed type and agents administered. Andexanet alfa was associated with the lowest rate of in-hospital mortality across all bleed types.
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Direct oral anticoagulants are associated with lower rates of bleeding than vitamin K antagonists, but life-threatening bleeding still occurs. Andexanet alfa is a catalytically inactive recombinant modified human factor Xa molecule that reverses the anticoagulant effect of direct and indirect acting factor Xa inhibitors. In the ANNEXA-4 study, treatment with andexanet was associated with a 92% reduction in median anti-Xa activity levels and excellent or good hemostasis in 82% of patients presenting with serious bleeding while receiving apixaban or rivaroxaban. In this review, we discuss the burden of bleeding in anticoagulated patients and the need for reversal agents, review the mechanism of action of andexanet and critically evaluate the evidence for its efficacy and safety.