Medical Bulletin 9/November/2022

Medications to follow to treat cardiovascular diseases are ineffective as clinicians are rightly concerned that there are too many guidelines with too many individual recommendations to be practical and useful for daily use, particularly in primary care. Typical patients with multiple illnesses require the access to many guidelines at the same time, and some recommendations are not harmonized and often seem contradictory.

A new one-stop guideline takes a 360-degree approach to managing heart disease in Canadian patients, with 83 recommendations in one easy-to-use reference. The guideline is published in CMAJ Canadian Medical Association Journal.

Reference:

New one-stop guideline for cardiovascular health in Canada; CANADIAN MEDICAL ASSOCIATION JOURNAL, DOI:10.1503/cmaj.220138.

Clinical trial finds novel therapy markedly reduced lipoprotein(a) levels in people with cardiovascular disease

Lipoprotein(a) is a special type of bad cholesterol that is believed to contribute to heart disease, but there are no approved pharmacological therapies to decrease its concentration in the bloodstream. Olpasiran is an investigational drug that reduces lipoprotein(a) concentration by degrading the RNA that codes for a protein that is an essential part of the molecule.

Researchers at Brigham and Women's Hospital conducted a phase 2, randomized, placebo-controlled clinical trial of olpasiran in patients with established cardiovascular disease to evaluate its safety and tolerability and to identify an optimal dose of olpasiran for reducing lipoprotein(a) levels.

Reference:

Clinical trial finds novel therapy markedly reduced lipoprotein(a) levels in people with cardiovascular disease; BRIGHAM AND WOMEN'S HOSPITAL, JOURNAL: New England Journal of Medicine

Bivalirudin found to be safer and more effective than heparin for treating heart attack patients undergoing percutaneous coronary intervention

The most common anticoagulant used during primary percutaneous coronary intervention is heparin. However, its effects can be somewhat unpredictable, leading to higher-than-desirable rates of bleeding and blood clots. Bivalirudin is a newer anticoagulant that has more predictable "blood thinning" effects.

Bivalirudin is a safer and more effective anticoagulant than heparin for treating patients with the most serious type of heart attacks who undergo urgent percutaneous coronary intervention (PCI), and can lower the risk of death or major bleeding by 31 percent finds a study, study was a Late Breaking Clinical Trial presentation at the American Heart Association's Scientific Sessions (AHA 22) in Chicago, and published in The Lancet.

Reference:

Bivalirudin found to be safer and more effective than heparin for treating heart attack patients undergoing percutaneous coronary intervention; THE MOUNT SINAI HOSPITAL / MOUNT SINAI SCHOOL OF MEDICINE; JOURNAL-The Lancet.

Lucid dying: Patients recall death experiences during CPR

One in five people who survive cardiopulmonary resuscitation (CPR) after cardiac arrest may describe lucid experiences of death that occurred while they were seemingly unconscious and on the brink of death, a new study shows. This study was presented during the resuscitation science symposium at the American Heart Association's Scientific Sessions 2022 on Sunday, Nov. 6.

Survivors reported having unique lucid experiences, including a perception of separation from the body, observing events without pain or distress, and a meaningful evaluation of life, including of their actions, intentions and thoughts toward others. The researchers found these experiences of death to be different from hallucinations, delusions, illusions, dreams or CPR-induced consciousness.

Reference:

Lucid dying: Patients recall death experiences during CPR; JOURNAL- Circulation MEETING; American Heart Association Scientific Sessions.