Oral anticoagulants and antiplatelet treatment in different settings

The evidence for beta-blocker therapy after myocardial infarction ( MI) is from randomized trials conducted more than 30 years ago, and its continued efficacy has been questioned. 1 -3 Kristensen et al. present a trial design study.An event-driven trial will randomize ∼5700 patients and continue until 950 primary endpoints have occurred.The ongoing Danish ( DANBLOCK) and Norwegian ( BETAMI) randomized betablocker trials are joined to evaluate the effectiveness and risks of longterm beta-blocker therapy after MI.Patients with normal or mildly reduced left ventricular ejec tion frac tion ≥40%, will be randomized to open-label treatment with beta-blockers or no such therapy.Atrial arrhythmia is the most common complication of patent foramen ovale ( PFO) closure. 4In another trial design paper, DrMontalescot and co-workers perform a prospective, national, multicentre, randomized, open-label, superiority trial with a blind evaluation of all the endpoints ( PROBE design) .A total of 186 patients are randomized in a 1:1:1 ratio immediately after PFO closure to receive Flecainide ( 150 mg per day in a single sustained-release dose) for 6 months ( Group 1) , Flecainide ( 150 mg per day in a single sustained-release dose) for 3 months ( Group 2) , or no additional treatment ( standard of care) for 6 months ( Group 3) .Ticagrelor improves clinical outcomes in patients with acute coronary syndrome compared with clopidogrel. 5 , 6 Dr D'Amario and co-workers from Italy sought to investigate the potential cardioprotective effects of ticagrelor, as compared with clopidogrel, in stable patients undergoing percutaneous coronary intervention.In this randomized study, the authors concluded that Ticagrelor enhances the cardioprotective effects of ischaemic pre-conditioning compared with clopidogrel in stable patients with CAD undergoing PCI.Guidelines recommend extended dual pathway inhibition ( DPI) with aspirin and rivaroxaban in patients with chronic coronary syndrome ( CCS) at high ischaemic risk. 7 -10Dr Würtz et al. from Denmark evaluated the net clinical benefit of DPI treatment according to baseline risk as classified by the CHADS-P2A2RC score 11 in patients with CCS included in the COMPASS trial. 12 -15 In the COMPASS study, 14 670 patients with CCS were randomized to aspirin alone or DPI, stratified according to cardiovascular risk using the CHADS-P2A2RC score.The authors concluded that in this COMPASS substudy of patients with CCS, DPI substantially reduced