Apixaban pips warfarin in extended use comparison

Extended-duration treatment with apixaban beyond 90 days significantly reduces hospitalisation for recurrent VTE rates compared to warfarin (HR 0.69).

A retrospective cohort study of 64,642 patients previously hospitalised for VTE compared outcomes for those on apixaban, rivaroxaban and warfarin.

The study found no difference in subsequent hospitalisation rates for recurrent VTE with rivaroxaban compared to warfarin (HR 0.87) or apixaban compared to rivaroxaban (HR 0.80).

There were no significant differences in rates of hospitalisation for major bleeding or all-cause mortality.

“Results from this investigation provide some evidence that extending treatment after 90 days with apixaban vs warfarin may be beneficial,” it said.

“More data are needed for definitive conclusions about the relative benefits and risks of apixaban compared with rivaroxaban and of rivaroxaban vs warfarin, because this study had limited statistical power to detect small, but clinically important, differences between these treatments.”

Read more in JAMA

Older athletes lack awareness of cardiac risk: cardiologist

Cardiovascular risk factors and cardiac symptoms are common among older athletes, a study of Australian participants in Masters footballers has found

In a review of 153 amateur players, mostly male, and average age 49 years more than one in three (37%), had hypercholesterolaemia 20%  had hypertension, 41% were overweight, 13% were obese 8% were smokers.

One-fifth (21.6%) reported more than one potential cardiac symptom during activity in the prior year, for which only a quarter  sought medical attention.

And while most players were aware of typical MI symptoms such as chest pain, fewer than 40% had knowledge of less typical symptoms or aware that warning signs might precede MI by days. Half of the players were not confident to recognise MI in themselves, and a similar proportion would remain on the field for 5–10 min with chest pain.

Professor Geoffrey Tofler, senior author of the paper, and Professor of Preventative Cardiology at Sydney Medical School noted that most participants supported training in automatic external defibrillators (AED) and cardiopulmonary resuscitation, having AED at games  and receiving cardiac education.

“Although regular exercise improves health, the temporary increase in cardiac risk during strenuous exercise reinforces that it is important to recognise the warning signs of an impending cardiac event.

The findings are published in the Internal Medicine Journal.

Mammogram calcification predicts cardiovascular risk

Routine mammograms may provide important information on a woman’s cardiovascular risk through detection of breast arterial calcifications, US researchers say

A study that reviewed breast screen mammogram images for more than 5,000 women between the ages of 60-79 years found that those who had breast arterial calcification present on their mammogram were 51% more likely to develop heart disease or have a stroke compared with women who did not have breast arterial calcification. Women with breast arterial calcification were 23% more likely to develop any type of cardiovascular disease, including heart disease, stroke, heart failure and diseases of the peripheral arteries.

The researchers noted that it was not current practice for radiologists to report breast arterial calcification visible on mammograms.

“We hope that our study will encourage an update of the guidelines for reporting breast arterial calcification from routine mammograms. Our study has moved the needle toward recommending routine assessment and reporting of breast arterial calcification in postmenopausal women. Integrating this information in cardiovascular risk calculators and using this new information can help improve cardiovascular risk reduction strategies,” they wrote in Circulation: Cardiovascular Imaging.