Prevention is the key

Should patients with acute coronary syndrome ( ACS) and a transient episode of new-onset atrial fibrillation ( AF) be given anticoagulant treatment? 1 , 2 AF is one of the most prevalent complications observed in patients with ACS. 3 -5 For this last issue of the year, Dr Sorrentino and co-workers from Italy have examined the overall risk of long-term adverse events of a transient episode of new-onset AF in patients with ACS.The authors used 7 observational studies, comprising 151 735 patients; 6597 experienced transient new-onset AF, which was associated with an increased risk of ischaemic stroke, recurrent AF, or all-cause mortality.The authors concluded that occurrence of transient new-onset AF is associated with an elevated long-term risk of stroke, recurrent AF, and all-cause mortality in patients with ACS.The paper is followed by an editorial by Dr Lip and co-workers, who concluded that future prospective studies should also include long-term monitoring to understand how AF relates to outcomes, and whether it is AF burden or AF density being the more important consideration.The clinical validation of wearable devices has the potential to see them being integrated into monitoring pathways.Cancer-associated thrombosis ( CAT) is a primary cardiovascular ( CV) complication encountered during cancer treatment, and venous thromboembolism ( VTE) could be the most prevalent CAT.The current guidelines in the field of oncology, including those laid by the National Comprehensive Cancer Net work , American Society of Clinical Oncology, and International Initiative on Thrombosis and Cancer, recommend providing anticoagulation therapy for a minimum of 6 months for cancer-associated VTE. 6 , 7 Incidence of arterial thromboembolism ( ATE) among ambulatory cancer patients varies by primary tumour site.In a paper from Canada, Dr Xu and coworkers conducted a systematic analysis, and included randomized trials comparing prophylactic anticoagulation to no anticoagulation among ambulatory cancer patients who initiated tumour-directed systemic therapy.The authors included 10 randomized controlled trials with 9875 patients with follow-up ranging from 3.3 to 68 ( median 6.6) months.While prophylactic anticoagulation did not reduce ATE risks overall, it conferred a protective effect among pancreatic cancer patients, without a detectable increase in major bleeding.The authors concluded that prophylactic anticoagulation did not reduce ATE risks among ambulatory cancer patients overall.However, we observed lower incidence of ATE among pancreatic cancer patients randomized to receive anticoagulation.All patients with an ACS should be treated with lipid-lowering therapy.Preferably with a high dose but we know that some patients