European Heart Journal

Thomas F LÃ¼scher, Allan Davies, Juerg H Beer, Marco Valgimigli, Christoph A Nienaber, John A Camm, Iris Baumgartner, Hans-Christoph Diener, Stavros V Konstantinides

doi : 10.1093/eurheartj/ehab642

European Heart Journal, Volume 43, Issue 10, 7 March 2022, Pages 940â€“958

Intravascular thrombus formation and embolization are among the most frequent events leading to a number of cardiovascular conditions with high morbidity and mortality. The underlying causes are stasis of the circulating blood, genetic and acquired coagulation disorders, and reduced antithrombotic or prothrombotic properties of the vascular wall (Virchowâ€™s triad). In the venous system, intravascular thrombi can cause venous thrombosis and pulmonary and even peripheral embolism including ischaemic stroke [through a patent foramen ovale (PFO)]. Thrombi in the left atrium and its appendage or ventricle form in the context of atrial fibrillation and infarction, respectively. Furthermore, thrombi can form on native or prosthetic aortic valves, within the aorta (in particular at sites of ulcers, aortic dissection, and abdominal aneurysms), and in cerebral and peripheral arteries causing stroke and critical limb ischaemia, respectively. Finally, thrombotic occlusion may occur in arteries supplying vital organs such the heart, brain, kidney, and extremities. Thrombus formation and embolization can be managed with anticoagulants and devices depending on where they form and embolize and on patient characteristics. Vitamin K antagonists are preferred in patients with mechanical valves, while novel oral anticoagulants are first choice in most other cardiovascular conditions, in particular venous thromboembolism and atrial fibrillation. As anticoagulants are associated with a risk of bleeding, devices such as occluders of a PFO or the left atrial appendage are preferred in patients with an increased bleeding risk. Platelet inhibitors such as aspirin and/or P2Y12 antagonists are preferred in the secondary prevention of coronary artery disease, stroke, and peripheral artery disease either alone or in combination depending on the clinical condition. A differential and personalized use of anticoagulants, platelet inhibitors, and devices is recommended and reviewed in this article.

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Comparative effects of guided vs. potent P2Y12 inhibitor therapy in acute coronary syndrome: a network meta-analysis of 61 898 patients from 15 randomized trials

Mattia Galli, Stefano Benenati, Francesco Franchi, Fabiana Rollini, Davide Capodanno, Giuseppe Biondi-Zoccai, Giovanni Maria Vescovo, Larisa H Cavallari, Behnood Bikdeli, Jurrien ten Berg, Roxana Mehran, Charles Michael Gibson, Filippo Crea, Naveen L Pereira, Dirk Sibbing, Dominick J Angiolillo

doi : 10.1093/eurheartj/ehab836

European Heart Journal, Volume 43, Issue 10, 7 March 2022, Pages 959â€“967

Guidelines recommend the use of potent P2Y12 inhibitors over clopidogrel for the reduction of ischaemic events in patients with acute coronary syndrome (ACS). However, this comes at the expense of increased bleeding. A guided selection of P2Y12 inhibiting therapy has the potential to overcome this limitation. We aimed at evaluating the comparative safety and efficacy of guided vs. routine selection of potent P2Y12 inhibiting therapy in patients with ACS.

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Time for a paradigm shift? Making the case for tailored selection of antiplatelet therapy

Michelle L. Oâ€™Donoghue, Nicholas A. Marston

doi : 10.1093/eurheartj/ehac046

European Heart Journal, Volume 43, Issue 10, 7 March 2022, Pages 968â€“970

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Atherothrombotic factors and atherosclerotic cardiovascular events: the multi-ethnic study of atherosclerosis

Andrew P DeFilippis, Patrick J Trainor, George Thanassoulis, Lyndia C Brumback, Wendy S Post, Michael Y Tsai, Sotirios Tsimikas

doi : 10.1093/eurheartj/ehab600

European Heart Journal, Volume 43, Issue 10, 7 March 2022, Pages 971â€“981

Traditional atherosclerotic cardiovascular disease (ASCVD) risk factors fail to address the full spectrum of the complex interplay of atherosclerotic and atherothrombotic factors integral to ASCVD events. This study sought to examine the association between atherothrombotic biomarkers and ASCVD events.

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Thrombosis and fibrinolysis in atherosclerotic cardiovascular disease: it takes two to tango

Artur Fedorowski, Jolanta M Siller-Matula, Giuseppe Patti

doi : 10.1093/eurheartj/ehab710

European Heart Journal, Volume 43, Issue 10, 7 March 2022, Pages 982â€“984

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Ciraparantag reverses the anticoagulant activity of apixaban and rivaroxaban in healthy elderly subjects

Jack Ansell, Sasha Bakhru, Bryan E Laulicht, Gregory Tracey, Stephen Villano, Daniel Freedman

doi : 10.1093/eurheartj/ehab637

European Heart Journal, Volume 43, Issue 10, 7 March 2022, Pages 985â€“992

Ciraparantag is a reversal agent for anticoagulants including direct oral anticoagulants. The aim was to evaluate the efficacy and safety of ciraparantag to reverse anticoagulation induced by apixaban or rivaroxaban in healthy elderly adults.

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Ciraparantag as a potential universal anticoagulant reversal agent

Noel C Chan, Jeffrey I Weitz

doi : 10.1093/eurheartj/ehab706

European Heart Journal, Volume 43, Issue 10, 7 March 2022, Pages 993â€“995

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Dual antithrombotic treatment in chronic coronary syndrome: European Society of Cardiology criteria vs. CHADS-P2A2RC score

Morten WÃ¼rtz, Kevin Kris Warnakula Olesen, Martin BÃ¸dtker Mortensen, John W Eikelboom, Moman Aladdin Mohammad, David Erlinge, Steen Dalby Kristensen, Michael Maeng

doi : 10.1093/eurheartj/ehab785

European Heart Journal, Volume 43, Issue 10, 7 March 2022, Pages 996â€“1004

According to the 2019 European Society of Cardiology (ESC) guidelines on chronic coronary syndromes (CCS), adding a P2Y12 inhibitor or rivaroxaban to aspirin should be considered in high-risk patients. We estimated the proportion of patients eligible for treatment with the ESC criteria and examined if a recently validated risk score (CHADS-P2A2RC) could improve risk prediction.

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