乌鸦传媒

BARCELONA -- Can patient education be an effective tool to increase the use of anticoagulant therapy? The answer is yes, according to data from IMPACT-AF reported at the European Society of Cardiology meeting here.

Here are relevant findings from IMPACT-AF, and two other trials reported here.

Frequent educational communication with patients and providers can improve the use of oral anticoagulants in eligible patients with atrial fibrillation, according to an international study. One-, 3-, 6-, 9-, and 12-month check-ins got 48% of those not on oral anticoagulants to start them within a year (versus 18%, P<0.0001). Use of these drugs went from 68% to 80% of eligible patients. Results were seen in a year in the form of reduced stroke (1% versus 2% for controls, P=0.043).

The intervention was customized to each country studied. For example, non-physician health workers were part of the effort in India and in China, the messaging app WeChat played an important role.

Long-acting inclisiran, a liver-targeted short interfering RNA (siRNA), can lower LDL cholesterol with just one or two injections a year. By 60 days, that siRNA injection was associated with 45-55% reductions in LDL cholesterol, which slowly crept up over time to maintain a 15-22% reduction at 1 year. With a second injection at day 90, however, patients still showed a 32% reduction by 1 year with 300 mg dosing.

With no safety signals, inclisiran is now in phase III, with a large cardiovascular outcomes trial in preparation.

There were no benefits to pretreating ST-segment elevation MI with P2Y12 inhibitors in a Swedish registry. Of more than 40,000 consecutive STEMI patients who got stenting in 2005-2016, those who did and didn't get these drugs (mostly clopidogrel [Plavix] and ticagrelor [Brilinta]) before percutaneous coronary intervention shared similar rates of survival at 30 days.

That said, pretreatment was not associated with more bleeds or neurological complications, researchers showed in their propensity score-adjusted analysis. Their data confirm the ATLANTIC trial and support current ESC guidelines.

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