CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

November 17th, 2014

Selection from Richard Lehman’s Literature Review: November 17th

CardioExchange is pleased to reprint this selection from Dr. Richard Lehman’s weekly journal review blog at BMJ.com. Selected summaries are relevant to our audience, but we encourage members to engage with the entire blog.

The BMJ 15 November 2014 Vol 349

Anticoagulant Therapy During Primary PCI for Acute MI: A confession: these reviews are there to point you to the evidence, but do not constitute proof that I know much. For someone who never does percutaneous coronary interventions, there is simply no use in taking up brain space to try and remember which is the latest anticoagulant regimen to come up top in the meta-analysis stakes. Reporting the trials over the last 16+ years has been fun at times (this is a lie), but you can’t really expect me to remember my dabigatran from my enoxaparin. All it has done is give me a healthy scepticism about the possibility of a truly definitive and up to date meta-analysis. But here is the conclusion of the latest one: “In patients undergoing primary PCI, unfractionated heparin plus GpIIb/IIIa inhibitor and LMWH plus GpIIb/IIIa inhibitor were most efficacious, with the lowest rate of major adverse cardiovascular events, whereas bivalirudin was safest, with the lowest bleeding.” I’m a firm believer in shared decision making, but if I was about to undergo PCI, I think my eyes would just glaze over and I’d find myself saying “Just do whatever you think best, doctor.”

 

Categories: General


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