New Oral Anticoagulants
Warfarin has been the main anticoagulant for many years. The main problem has been the variability of anticoagulant control necessitating regular and sometimes frequent blood tests to monitor and control the anticoagulant action of warfarin.
New treatments have been developed and have now been approved by NICE as well as recommended by the European Society of Cardiology. They do not have the variation of action that is associated with warfarin and they do not require blood tests to monitor their effectiveness. They are generally associated with less serious bleeding than occurs with warfarin.
The main disadvantage is the cost - plus there is no specific antidote, but supportive measures are available and antidotes should be available soon.
Aortic Stenosis - Transcatheter Aortic Valve Implant (TAVI)
The Aortic valve sits at the exit of the main pumping chamber of the heart, the Left Venricle. As we age this valve can narrow and put a strain on the heart. Repair up to recently has been undertaken by cardiac surgery using heart-lung bypass. This is still the preferred option, but if you are not fit enough for surgery, TAVI enables the Aortic Valve to be replaced without major surgery.
Usually tubes/catheters are passed back into the heart from the groin (see coronary angiography) or other access sites. The new aortic valve is introduced through this tubing. This is a successful technique and is developing rapidly.