nejm journal discussion dr. j.a. coetser dr. j-m nel 24 february 2011

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NEJM journal discussion Dr. J.A. Coetser Dr. J-M Nel 24 February 2011

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  • NEJM journal discussion Dr. J.A. Coetser Dr. J-M Nel 24 February 2011
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  • What we already know Activation of mineralocorticoid receptors by aldosterone and corticosteroids have negative effects on the failing heart. Mineralocorticoid antagonism reduces the rate of all-cause mortality and hospitalization in NYHA class III-IV systolic heart failure RALES trial (NYHA class III-IV) EPHESUS trial (systolic dysfunction following MI) Current guidelines recommend adding spironolactone or eplerenone if patient has moderate to severe symptomatic systolic failure
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  • EMPHASIS-HF Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure Aim To assess the effect on clinical outcomes of adding eplerenone to evidence-based treatment for mildly symptomatic (NYHA class II) heart failure Method 2737 patients NYHA class II systolic heart failure, with LVEF
  • EMPHASIS-HF Eplerenone group Placebo Primary outcome18,3%25,9% (p 5,5mmol/L11,8%7,2% (P
  • Study design Primary end point incidences of treatment failure and splenectomy Secondary end points rate of a platelet response (a platelet count >5010 9 per liter at any scheduled visit) safety outcomes quality of life
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  • Results Standard Rx Romiplostim Treatment failure 30% 18% Need for splenectomy 36% 9% Serious adverse events 37% 23% Compared to standard Rx, romiplostim group had Fewer bleeding episodes Less need for transfusion Improved quality of life Slight increased thrombotic rate compared to standard treatment
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  • Worthwhile review articles
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  • Bibliography Bhatt et al. Clopidogrel with or without Omeprazole in Coronary Artery Disease. N Engl J Med 2010;363:1909-17. Kuter et al. Romiplostim or Standard of Care in Patients with Immune Thrombocytopenia. N Engl J Med 2010;363:1889-99. Pasternak et al. Use of Proton-Pump Inhibitors in Early Pregnancy and the Risk of Birth Defects. N Engl J Med 2010;363:2114-23. Zannad et al. Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms. N Engl J Med 2011;364:11-21.