Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain
the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in
Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles
and JavaScript.
The primary goals of antiplatelet therapy in peripheral artery disease are the prevention of cardiovascular ischaemic events and maintenance of revascularization patency. Vorapaxar is a novel agent that has a demonstrated clinical benefit in a broad population of patients, and also decreases the progression of limb ischaemia.
Wide variation exists in the use of inferior vena cava filters for the treatment of venous thromboembolism, possibly because of a deficit of evidence on the efficacy of these devices, and a lack of consensus on their use. Future guidelines should be evidence-based and account for the development of novel anticoagulants.
Areas of thinned myocardium (≤5.5 mm) were previously thought to be regions of transmural infarction, without remaining viable tissue. However, new data using late-enhancement cardiovascular magnetic resonance imaging now show that, in 18% of patients with ventricular wall thinning, substantial viable myocardium remains, which can improve in function after revascularization.
The therapeutic efficacy of bone-marrow-derived cells in patients with acute or chronic myocardial infarction has been a matter of intense debate. Three new clinical trials—the Swiss-AMI, CELLWAVE, and C-CURE studies—unfortunately do not resolve the controversy in the field of cell therapy for the damaged heart.
Tirone David expertly reviews the surgical repair and replacement of the aortic valve. Patient selection for aortic valve-sparing operations, bioprosthetic or mechanical valve insertion, pulmonary autograft, aortic valve homograft, and aortic root replacement is discussed. Finally, the author assesses the long-term clinical outcomes of these procedures.
Critical limb ischaemia (CLI) is the most-severe clinical manifestation of peripheral arterial disease (PAD), and is associated with a high risk of amputation and death. Therapeutic angiogenesis is an approach to stimulating blood vessel growth to improve tissue perfusion, and has the potential to benefit patients with CLI for whom revascularization is not an option. Here, Brian Annex reviews data from clinical trials of therapeutic angiogenesis in patients with PAD, and discusses how advances in systems biology, genetics, and gene therapy might be used in new approaches to this therapy.
The novel oral anticoagulants apixaban, dabigatran, edoxaban, and rivaroxaban have been examined for efficacy and safety in the prophylaxis and treatment of venous thromboembolism. In this Review, these clinical trials are summarized, and practical considerations in the use of these drugs are discussed.
Advanced vascular occlusion, a leading cause of death in Western countries, can be treated by CABG surgery. Autografts are the gold-standard treatment, but prosthetic grafts are under development as an alternative source of vessels. Vascular tissue engineering is a fast-moving area of research that promises soon to allow the synthesis of responsive, living conduits, with properties similar to those of native tissue.
Heart transplantation has become the treatment of choice for eligible patients with end-stage heart failure. In this Perspectives article, David Baran challenges the presupposed need for multidrug immunosuppression after transplantation, and draws on data and experience from the TICTAC randomized trial to explore the potential efficacy and benefits of monotherapy.
