Minerva cardioangiologica
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Minerva cardioangiologica · Jun 2018
Review Comparative StudyTranscatheter aortic valve implantation (TAVI) in 2018: recent advances and future development.
Transcather aortic valve implantation (TAVI) has become a safe and indispensable treatment option for patients with severe symptomatic aortic stenosis (AS) who are at high or prohibitive surgical risk. In the past years, outcomes after TAVI have improved significantly and TAVI has emerged as a qualified alternative to surgical aortic valve replacement (SAVR) in the treatment of intermediate risk patients. ⋯ Currently, several trials are investigating the role of TAVI in low surgical risk patients, novel indications and peri-operative management. In this review we give an overview on 1) current generation TAVI devices; on 2) recent clinical trial results and guidelines; and on 3) future trends and novel developments in the field of interventional treatment of AS.
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Minerva cardioangiologica · Jun 2018
ReviewDirect oral anticoagulants use in elderly patients with non valvular atrial fibrillation: state of evidence.
Non-valvular atrial fibrillation (NVAF) increases the risk of stroke by three- to five-fold, especially in elderly patients, creating a huge burden on medical system as well as a negative impact on patients' lives. Balancing efficacy and bleeding risk is a challenge when considering anticoagulation therapy in elderly patients, because of their frequent high risk of both stroke and bleeding. Real world data reveal the underuse of anticoagulation in the elderly, especially due to physicians' fear of bleeding, often neglecting the thromboembolic risk. ⋯ However, there are conflicting opinions on the absolute benefit of DOACs use in elderly patients. A key factor to consider is that elderly patients frequently suffer from renal impairment and therefore dose adjustments according to creatinine clearance are mandatory for DOACs. As each DOAC comes with its own unique advantages and safety profile, a personalized case by case approach should be adopted to decide on the appropriate anticoagulation regimen for elderly patients after weighing the overall risks and benefits of therapy.