30-Second Takeaway
- Adding low-dose rivaroxaban to DAPT after anterior STEMI does not significantly reduce LV thrombus and increases minor bleeding.
- Diltiazem with apixaban or rivaroxaban increases serious bleeding versus metoprolol, especially at higher diltiazem doses.
- Colchicine reduces MACE and MI across CAD without excess serious adverse events but causes more gastrointestinal intolerance.
Week ending February 28, 2026
Targeted Updates in Coronary, Heart Failure, and Antithrombotic Management
Low-dose rivaroxaban on top of DAPT fails to reduce LV thrombus after anterior STEMI
In APERITIF, 560 patients with anterior STEMI were randomized to DAPT plus rivaroxaban 2.5 mg twice daily for 4 weeks versus DAPT alone. LV thrombus at 1 month occurred in 13.7% with rivaroxaban versus 16.6% with DAPT alone, a nonsignificant absolute difference of −2.9%. Major adverse cardiovascular events and major bleeding (BARC ≥2) were similar between groups. Minor bleeding (BARC 1) was more frequent with rivaroxaban (16.4% vs 7.2%), adding nuisance bleeding without clear thrombus prevention.
Diltiazem plus apixaban or rivaroxaban increases serious bleeding versus metoprolol in AF
This retrospective cohort compared AF patients on apixaban or rivaroxaban receiving diltiazem versus metoprolol for rate control. After propensity matching, 23,000 diltiazem users were compared with 23,000 metoprolol users. Diltiazem was associated with higher serious bleeding requiring hospitalization, with a rate difference of 5.4 per 1000 person-years. Bleeding risk rose with diltiazem doses >120 mg/day compared with ≤120 mg/day, indicating a dose–response relationship.
Colchicine lowers MACE and MI in CAD with more GI events but no excess serious harms
This meta-analysis pooled 20 randomized trials including 21,486 patients with coronary artery disease, 65% with acute presentations. Colchicine reduced trial-defined MACE versus control (IRR 0.70; 95% CI 0.55-0.87). Myocardial infarction and any revascularization were also reduced (IRR 0.81 and 0.71, respectively). Serious adverse events and serious infections or sepsis were not increased with colchicine versus control.
GLP-1 receptor agonists reduce HF hospitalization versus DPP-4 inhibitors and match SGLT2 inhibitors
This Swedish target-trial emulation compared new GLP-1RA initiators with DPP-4 inhibitors and SGLT2 inhibitors in type 2 diabetes. Versus DPP-4 inhibitors, GLP-1RAs lowered 3-year HHF risk (3.4% vs 4.3%; weighted HR 0.77; 95% CI 0.66-0.91). Versus SGLT2 inhibitors, GLP-1RAs had similar 3-year HHF risk (3.6% vs 3.3%; weighted HR 1.02; 95% CI 0.85-1.18). GLP-1RA use also reduced major adverse cardiovascular events compared with DPP-4 inhibitors (weighted HR 0.85; 95% CI 0.74-0.99).
References
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Additional Reads
Optional additional studies from this edition.