Cardiovascular Journal of Africa: Vol 32 No 1 (JANUARY/FEBRUARY 2021)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 1, January/February 2021 4 AFRICA
Trust the ! Original
S3 ISMO-20 R/7.1.4/136. Isosorbide-5-mononitrate 20 mg/tablet.
For full prescribing information, please refer to package insert.
Pharmaco Distribution (Pty) Ltd. 3 Sandown Valley Crescent, South Tower, 1st Floor, Sandton, 2196; PO Box 786522, Sandton, 2146, South Africa. Tel: + 27 11 784 0077.
Website:
1 Long-term prophylaxis and management of Angina Pectoris
2,3 = 100% bioavailability No first-pass metabolism
4 Twice daily dosage regimen shown to avoid withdrawal and tolerance
References: 1. South African approved ISMO package insert. 2. Ismo 20 Product Monograph (2015). 3. Abshagen, U., 1992. Pharmacokinetics of isosorbide mononitrate.
The American Journal of Cardiology,[online] 70(17), pp.G61-G66. 4. Thadani U, Maranda CR, Amsterdam E, et al. Lack of Pharmacological Tolerance and Rebound
Angina Pectoris during Twice-daily Therapy with Isosorbide-5-Mononitrate. Annals of Internal Medicine. 1994; 120:353-359. IS_0120.
indicating that the approach is achievable. Bleeding was avoided
despite the high risk, but it is important that if bleeding were
to occur, there was the option to discontinue DAPT without
incurring major risk.
Both studies included appropriate cases and had a high rate of
procedural success. Outcomes of the procedures were good and
in line with literature published in other geographical regions. It
is important that local datasets confirm the ability to replicate
published outcomes in our region and the authors are to be
commended for these efforts. Both studies are limited by their
observational nature and small numbers, but the publications are
nonetheless of value.
Bleeding avoidance is a major focus of current cardiovascular
research. Newer anticoagulant drugs with lower bleeding risk and
a change in antiplatelet monotherapy to non-aspirin alternatives
are the focus of current investigations. These, together with
procedural enhancements, such as seen in these two publications,
will hopefully successfully reduce bleeding risk going forward,
while continuing to prevent stroke and myocardial infarction.
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ence of left atrial appendage occlusion: patient characteristics, procedur-
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