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Halperin JL, Chen H, Olin JW. Antithrombotic Therapy to Reduce Mortality in Patients With Atherosclerosis: 2 Pathways to a Single Goal. J Am Coll Cardiol 2021; 78:24-26. [PMID: 34210410 DOI: 10.1016/j.jacc.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Jonathan L Halperin
- Cardiovascular Institute, Mount Sinai Medical Center, New York, New York, USA.
| | - Huazhen Chen
- Cardiovascular Institute, Mount Sinai Medical Center, New York, New York, USA
| | - Jeffrey W Olin
- Cardiovascular Institute, Mount Sinai Medical Center, New York, New York, USA
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2
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Muruganantham S, Krishnaswami V, Alagarsamy S, Kandasamy R. Anti-platelet Drug-loaded Targeted Technologies for the Effective Treatment of Atherothrombosis. Curr Drug Targets 2021; 22:399-419. [PMID: 33109044 DOI: 10.2174/1389450121666201027125303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/13/2020] [Accepted: 08/27/2020] [Indexed: 11/22/2022]
Abstract
Atherothrombosis results from direct interaction between atherosclerotic plaque and arterial thrombosis and is the most common type of cardiovascular disease. As a long term progressive disease, atherosclerosis frequently results in an acute atherothrombotic event through plaque rupture and platelet-rich thrombus formation. The pathophysiology of atherothrombosis involves cholesterol accumulation endothelial dysfunction, dyslipidemia, immuno-inflammatory, and apoptotic aspects. Platelet activation and aggregation is the major cause for stroke because of its roles, including thrombus, contributing to atherosclerotic plaque, and sealing off the bleeding vessel. Platelet aggregates are associated with arterial blood pressure and cardiovascular ischemic events. Under normal physiological conditions, when a blood vessel is damaged, the task of platelets within the circulation is to arrest the blood loss. Antiplatelet inhibits platelet function, thereby decreasing thrombus formation with complementary modes of action to prevent atherothrombosis. In the present scientific scenario, researchers throughout the world are focusing on the development of novel drug delivery systems to enhance patient's compliance. Immediate responding pharmaceutical formulations become an emerging trend in the pharmaceutical industries with better patient compliance. The proposed review provides details related to the molecular pathogenesis of atherothrombosis and recent novel formulation approaches to treat atherothrombosis with particular emphasis on commercial formulation and upcoming technologies.
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Affiliation(s)
- Selvakumar Muruganantham
- Centre for Excellence in Nanobio Translational Research (CENTRE), Department of Pharmaceutical Technology, University College of Engineering, Anna University, BIT Campus, Tiruchirappalli, Tamil Nadu, India
| | - Venkateshwaran Krishnaswami
- Centre for Excellence in Nanobio Translational Research (CENTRE), Department of Pharmaceutical Technology, University College of Engineering, Anna University, BIT Campus, Tiruchirappalli, Tamil Nadu, India
| | - Shanmugarathinam Alagarsamy
- Centre for Excellence in Nanobio Translational Research (CENTRE), Department of Pharmaceutical Technology, University College of Engineering, Anna University, BIT Campus, Tiruchirappalli, Tamil Nadu, India
| | - Ruckmani Kandasamy
- Centre for Excellence in Nanobio Translational Research (CENTRE), Department of Pharmaceutical Technology, University College of Engineering, Anna University, BIT Campus, Tiruchirappalli, Tamil Nadu, India
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3
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Bereczky Z, Gindele R, Fiatal S, Speker M, Miklós T, Balogh L, Mezei Z, Szabó Z, Ádány R. Age and Origin of the Founder Antithrombin Budapest 3 (p.Leu131Phe) Mutation; Its High Prevalence in the Roma Population and Its Association With Cardiovascular Diseases. Front Cardiovasc Med 2021; 7:617711. [PMID: 33614741 PMCID: PMC7892435 DOI: 10.3389/fcvm.2020.617711] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/22/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Antithrombin (AT) is one of the most important regulator of hemostasis. AT Budapest 3 (ATBp3) is a prevalent type II heparin-binding site (IIHBS) deficiency due to founder effect. Thrombosis is a complex disease including arterial (ATE) and venous thrombotic events (VTE) and the Roma population, the largest ethnic minority in Europe has increased susceptibility to these diseases partly due to their unfavorable genetic load. We aimed to calculate the age and origin of ATBp3 and to explore whether the frequency of it is higher in the Roma population as compared with the general population from the corresponding geographical area. We investigated the association of ATBp3 with thrombotic events in well-defined patients' populations in order to refine the recommendation when testing for ATBp3 is useful. Methods and Results: Prevalence of ATBp3, investigated in large samples (n = 1,000 and 1,185 for general Hungarian and Roma populations, respectively) was considerably high, almost 3%, among Roma and the founder effect was confirmed in their samples, while it was absent in the Hungarian general population. Age of ATBp3—as calculated by analysis of 8 short tandem repeat sequences surrounding SERPINC1—was dated back to XVII Century, when Roma migration in Central and Eastern Europe occurred. In our IIHBS cohort (n = 230), VTE was registered in almost all ATBp3 homozygotes (93%) and in 44% of heterozygotes. ATE occurred with lower frequency in ATBp3 (around 6%); it was rather associated with AT Basel (44%). All patients with ATE were young at the time of diagnosis. Upon investigating consecutive young (<40 years) patients with ATE (n = 92) and VTE (n = 110), the presence of ATBp3 was remarkable. Conclusions: ATBp3, a 400-year-old founder mutation is prevalent in Roma population and its Roma origin can reasonably be assumed. By the demonstration of the presence of ATBp3 in ATE patients, we draw the attention to consider type IIHBS AT deficiency in the background of not only VTE but also ATE, especially in selected populations as young patients without advanced atherosclerosis. We recommend including the investigation of ATBp3 as part of thrombosis risk assessment and stratification in Roma individuals.
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Affiliation(s)
- Zsuzsanna Bereczky
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Réka Gindele
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Szilvia Fiatal
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Marianna Speker
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tünde Miklós
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Balogh
- Department of Cardiology and Cardiovascular Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Mezei
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsuzsanna Szabó
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Róza Ádány
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Magyar Tudományos Akadémia - Debrecen Public Health Research Group, University of Debrecen, Debrecen, Hungary
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4
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Mejorar la prevención de la trombosis y las complicaciones cardiovasculares durante la pandemia de COVID-19. REVISTA ESPAÑOLA DE CARDIOLOGÍA SUPLEMENTOS 2021. [PMCID: PMC8320271 DOI: 10.1016/s1131-3587(21)00001-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Las complicaciones cardiovasculares son frecuentes en el paciente con la enfermedad coronavírica de 2019 (COVID-19), y se asocian con una mayor mortalidad. Entre las complicaciones cardiovasculares, destacan el síndrome coronario agudo, el daño miocárdico agudo (elevación de troponinas con coronarias normales), arritmias (principalmente fibrilación auricular y arritmias ventriculares), insuficiencia cardiaca, pericarditis/derrame pericárdico y complicaciones tromboembólicas (tromboembolia arterial y venosa, trombosis microvascular, embolia pulmonar, ictus). Por lo tanto, uno de los objetivos del tratamiento del paciente con COVID-19, sobre todo en sus formas más graves, es la prevención de las complicaciones cardiovasculares y trombóticas, lo que sin duda tendría un impacto positivo en el pronóstico de estos pacientes. Fuera de este contexto, los resultados provenientes tanto de ensayos clínicos como de estudios en la práctica clínica muestran que el rivaroxabán es eficaz y seguro en todo el espectro de la enfermedad cardiovascular (fibrilación auricular, enfermedad tromboembólica venosa y enfermedad cardiovascular ateroesclerótica), por lo que podría aportar un valor añadido en la prevención de las complicaciones trombóticas y cardiovasculares durante la pandemia de COVID-19.
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Kubica J, Adamski P, Niezgoda P, Alexopoulos D, Badarienė J, Budaj A, Buszko K, Dudek D, Fabiszak T, Gąsior M, Gil R, Gorog DA, Grajek S, Gurbel PA, Gruchała M, Jaguszewski MJ, James S, Jeong YH, Jilma B, Kasprzak JD, Kleinrok A, Kubica A, Kuliczkowski W, Legutko J, Lesiak M, Siller-Matula JM, Nadolny K, Pstrągowski K, Di Somma S, Specchia G, Stępińska J, Tantry US, Tycińska A, Verdoia M, Wojakowski W, Navarese EP. Prolonged antithrombotic therapy in patients after acute coronary syndrome: A critical appraisal of current European Society of Cardiology guidelines. Cardiol J 2020; 27:661-676. [PMID: 33073857 DOI: 10.5603/cj.a2020.0132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/12/2020] [Indexed: 01/23/2023] Open
Abstract
The increased risk of non-cardiovascular death in patients receiving clopidogrel or prasugrel in comparison with the placebo group in the Dual Antiplatelet Therapy (DAPT) trial in contrast to the decreased risk of cardiovascular death and all-cause death seen in patients treated with low-dose ticagrelor in the EU label population of the PEGASUS-TIMI 54 trial, resulted in inclusion in the 2020 ESC NSTE-ACS guidelines the recommendation for use of clopidogrel or prasugrel only if the patient is not eligible for treatment with ticagrelor. The prevalence of the primary outcome composed of cardiovascular death, stroke, or myocardial infarction was lower in the low-dose rivaroxaban and acetylsalicylic acid (ASA) group than in the ASA-alone group in the COMPASS trial. Moreover, all-cause mortality and cardiovascular mortality rates were lower in the rivaroxaban-plus-ASA group. Comparison of the PEGASUS-TIMI 54 and COMPASS trial patient characteristics clearly shows that each of these treatment strategies should be addressed at different groups of patients. A greater benefit in post-acute coronary syndrome (ACS) patients with a high risk of ischemic events and without high bleeding risk may be expected with ASA and ticagrelor 60 mg b.i.d. when the therapy is continued without interruption or with short interruption only after ACS. On the other hand, ASA and rivaroxaban 2.5 mg b.i.d. seems to be a better option when indications for dual antithrombotic therapy (DATT) appear after a longer time from ACS (more than 2 years) and/or from cessation of DAPT (more than 1 year) and in patients with multiple vascular bed atherosclerosis. Thus, both options of DATTs complement each other rather than compete, as can be presumed from the recommendations. However, a direct comparison between these strategies should be tested in future clinical trials.
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Affiliation(s)
- Jacek Kubica
- Collegium Medicum, Nicolaus Copernicus University, Ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland.
| | - Piotr Adamski
- Collegium Medicum, Nicolaus Copernicus University, Ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Piotr Niezgoda
- Collegium Medicum, Nicolaus Copernicus University, Ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Dimitrios Alexopoulos
- National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Jolita Badarienė
- Clinic of Cardiac and Vascular diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Andrzej Budaj
- Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | | | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.,Maria Cecilia Hospital, GVM Care&Research, Cotignola (RA), Ravenna, Italy
| | - Tomasz Fabiszak
- Collegium Medicum, Nicolaus Copernicus University, Ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Mariusz Gąsior
- IIIrd Department of Cardiology, Silesian Center for Heart Diseases, Faculty of Medicine in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Robert Gil
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Central Hospital of the Internal Affairs and Administration Ministry, Warsaw, Poland
| | - Diana A Gorog
- Postgraduate Medicine, University of Hertfordshire, United Kingdom and Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Stefan Grajek
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Paul A Gurbel
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Marcin Gruchała
- 1st Department of Cardiology, Medical University of Gdańsk, Poland
| | | | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University Hospital, Uppsala, Sweden
| | - Young-Hoon Jeong
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | - Jarosław D Kasprzak
- 1st Department and Chair of Cardiology, Medical University of Lodz Bieganski Hospital, Lodz Poland
| | - Andrzej Kleinrok
- University of Information Technology and Management in Rzeszow, Poland.,Department of Cardiology The Pope John Paul II Hospital in Zamosc, Poland
| | - Aldona Kubica
- Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital in Krakow, Poland
| | - Maciej Lesiak
- Postgraduate Medicine, University of Hertfordshire, United Kingdom and Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Jolanta M Siller-Matula
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Poland.,Department of Cardiology, Medical University of Vienna, Austria
| | - Klaudiusz Nadolny
- Department of Emergency Medical Service, Strategic Planning University of Dabrowa Gornicza, Dabrowa Gornicza, Poland.,Faculty of Medicine, Katowice School of Technology, Katowice, Katowice, Poland
| | - Krzysztof Pstrągowski
- Collegium Medicum, Nicolaus Copernicus University, Ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Salvatore Di Somma
- Department of Medical-Surgery Sciences and Translational Medicine, University La Sapienza, Rome, Italy
| | | | - Janina Stępińska
- Department of Intensive Cardiac Therapy, National Institute of Cardiology, Warsaw, Poland
| | - Udaya S Tantry
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | | | - Monica Verdoia
- Division of Cardiology, Ospedale degli Infermi ASL Biella, Università del Piemonte Orientale, Italy
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Eliano P Navarese
- Collegium Medicum, Nicolaus Copernicus University, Ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
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6
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Liang Y, Zhu J, Liu L, Anand SS, Connolly SJ, Bosch J, Guzik TJ, O'Donnell M, Dagenais GR, Fox KA, Shestakovska O, Berkowitz SD, Muehlhofer E, Keller L, Yusuf S, Eikelboom JW. Efficacy and safety of rivaroxaban plus aspirin in women and men with chronic coronary or peripheral artery disease. Cardiovasc Res 2020; 117:942-949. [PMID: 32289159 DOI: 10.1093/cvr/cvaa100] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/17/2020] [Accepted: 04/08/2020] [Indexed: 12/27/2022] Open
Abstract
AIMS The COMPASS trial demonstrated that the combination of rivaroxaban 2.5 mg twice daily and aspirin 100 mg once daily compared with aspirin 100 mg once daily reduced major adverse cardiovascular events (MACE) in patients with chronic coronary artery disease or peripheral artery disease by 24% during a mean follow-up of 23 months. We explored whether this effect varies by sex. METHODS AND RESULTS The effects were examined in women and men using log-rank tests and Kaplan-Meier curve. Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were obtained from stratified Cox proportional hazards models to explore subgroup effects including subgroup of women and men according to baseline modified REACH risk score. Of 27 395 patients randomized, 18 278 were allocated to receive rivaroxaban plus aspirin (n = 9152) or aspirin alone (n = 9126), and of these, 22.1% were women. Women compared with men had similar incidence rates for MACE and major bleeding but borderline lower rates for myocardial infarction (1.7% vs. 2.2%, P = 0.05). The effect of combination therapy compared with aspirin in women and men was consistent for MACE (women: 3.8% vs. 5.2%, HR 0.72, 95% CI 0.54-0.97; men: 4.2% vs. 5.5%, HR 0.76, 95% CI 0.66-0.89; P interaction 0.75) and major bleeding (women: 3.1% vs. 1.4%, HR 2.22, 95% CI 1.42-3.46; men: 3.2% vs. 2.0%, HR 1.60, 95% CI 1.29-1.97; P interaction 0.19). There was no significant interaction between randomized treatment and baseline modified REACH score above or below the median for MACE or major bleeding. CONCLUSION In patients with stable coronary artery disease or peripheral artery disease, the combination of rivaroxaban (2.5 mg twice daily) and aspirin compared with aspirin alone appears to produce consistent benefits in women and men, independent of baseline cardiovascular risk.
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Affiliation(s)
- Yan Liang
- Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for Cardiovascular Diseases, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Jun Zhu
- Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for Cardiovascular Diseases, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Lisheng Liu
- Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for Cardiovascular Diseases, No. 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Sonia S Anand
- Department of Medicine, Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Department of Epidemiology, Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Stuart J Connolly
- Department of Medicine, Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Division of Cardiology, Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jackie Bosch
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Tomasz J Guzik
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Collegium Medicum, Jagiellonian University, Krakow, Poland
| | - Martin O'Donnell
- Department of Translational Medicine, NUI Galway and Saolta Hospital Group, HRB-Clinical Research Facility, Galway, Ireland
| | - Gilles R Dagenais
- Department of Medicine, Laval University and Quebec Heart and Lung Institute, Quebec City, Canada
| | - Keith Aa Fox
- Department of Cardiology, University of Edinburgh, Edinburgh, UK.,Department of Medical and Radiological Sciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Olga Shestakovska
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Scott D Berkowitz
- Clinical Development, Group Head Thrombosis, Bayer U.S. LLC, Research & Development, Pharmaceuticals, Thrombosis & Hematology Therapeutic Area, Whippany, NJ, USA
| | - Eva Muehlhofer
- Bayer AG, Research & Development, Pharmaceuticals, TA Thrombosis & Hematology, USA
| | - Lars Keller
- Bayer AG, Research & Development, Pharmaceuticals, Medical Experts Cardio & Coagulant, USA
| | - Salim Yusuf
- Department of Medicine, Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Heart and Stroke Foundation/Marion W. Burke Chair in Cardiovascular Disease, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - John W Eikelboom
- Department of Medicine, Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Hamilton General Hospital, Hamilton, Ontario, Canada
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