Hydroxychloroquine-Azithromycin Treatment For COVID-19 May Pose a Risk for Ventricular Arrhythmia
Based on the positive results from an in vitro and preliminary research study completed in France on a mere 26 patients, a number of clinicians have begun using hydroxychloroquine for the treatment of COVID-19. However, as noted in a recent article from the American college of Cardiology (ACD), " chloroquine, hydroxychloroquine and azithromycin all prolong QT interval, raising concerns about the risk of arrhythmic death from individual or concurrent use of these medications." Outside of a clinical trial--for which the ACD has provided recommended research protocols--Hydroxychloroquine or chloroquine use should only occur at the direction of an infectious disease or COVID-19 expert, with cardiology input regarding QT monitoring.
ORION-9 trial Exhibits Beneficial Results for the Treatment of Heterozygous Familial Hypercholesterolemia Using Inclisiran
Recently published results from the ORION-9 trial demonstrated positive findings for the use of Inclisiran for the treatments of heterozygous familial hypercholesterolemia. The double-blind trial monitored 482 adults, with a median age of 56 years, 47% men, and with a mean baseline level of LDL cholesterol at 153 mg per deciliter. The study found that those who received inclisiran had significantly lower levels of LDL cholesterol than those who received placebo, with an infrequent dosing regimen and an acceptable safety profile.
Trial finds Apixaban for The Treatment of Cancer-Related Thromboembolism Non-Inferior to Subcutaneous Dalteparin
While recent guidelines offer consideration of the use of oral edoxaban or rivaroxaban for the treatment of venous thromboembolism in patients with cancer, the benefit of these oral agents are limited by the increased risk of bleeding associated with their use. A recent trial examined the use of apixabanfor the treatment of venous thromboembolism in patients with cancer and found it to be noninferior to subcutaneous dalteparin for the treatment of cancer-associated venous thromboembolism without an increased risk of major bleeding.
COMPASS Trial Indicates the Benefits of Combination Antiplatelet and Anticoagulation Therapy in Diabetes and Cardiovascular Disease
A recently published study-- led by CMHC Senior Planning Committee Member Dr. Deepak L. Bhatt--has demonstrated that in "stable atherosclerosis, the combination of aspirin plus rivaroxaban 2.5 mg twice daily provided a similar relative degree of benefit on coronary, cerebrovascular, and peripheral endpoints in patients with and without diabetes." The trial observed 10,341 patients with diabetes and 17,054 without it, and found that the overall benefits appeared larger in those with diabetes, including a three-fold reduction in all cause-mortality.
In this podcast, CMHC chair Dr. Anne Peters, Professor of Medicine and Director of Clinical Diabetes Programs at the University of Southern California in LA, discusses the impact of COVID-19 in patients with diabetes (Recorded March 25, 2019)
The practice of cardiology is not immune to the repercussions of COVID-19 outbreak. As a result, professional associations – such as the American College of Cardiology and the American Heart Association – have issued statements with a focus on actionable solutions in hopes of providing clear guidance and helping providers navigate the changing clinical landscape.
