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Advanced age is one of the major determinants of frailty in patients with cancer-associated thrombosis. However, multiple other factors contribute to frailty in these patients. The identification of frailty in patients with cancer-associated thrombosis is critical as it influences the complexity of the anticoagulant treatment in this population at high risk of venous thromboembolism and bleeding. Factors that contribute to frailty in patients with cancer-associated thrombosis include age, type of cancer, comorbidities such as chronic kidney disease, poly-pharmacotherapy, treatment compliance, cognitive impairment, anemia, thrombocytopenia, mobility, nutritional status, Eastern Cooperative Oncology Group grade, risk of falls, and reduced life expectancy. In the absence of specific clinical studies current anticoagulant treatment guidelines for the management are not fully applicable to frail patients with cancer. The anticoagulant treatment should therefore benefit from a tailored approach based on an algorithm that takes into account the specificities of the malignant disease.

Elevated resting heart rate is linked to an increase in both cardiovascular and all-cause mortality, and agents that reduce heart rate have obvious applications in improving the prognosis of coronary artery disease and heart failure. In this short review, we examine the pathophysiological grounds for the original clinical benefits of pure heart rate lowering through the development of a new class of heart-rate-reducing agents. Ivabradine, a novel selective and specific inhibitor of the I_f pacemaker current in the sinoatrial node cells, is the prototype of this pharmacological class. It has shown anti-ischemic and antianginal efficacy superior to placebo and comparable to β-blockers and calcium channel blockers. In early clinical pharmacological studies, ivabradine was shown to reduce heart rate in a dose-dependent manner without modifying other cardiac parameters such as conduction, contractility, and ventricular repolarization. Ivabradine improves myocardial oxygen delivery and decreases oxygen consumption. Together, these properties make ivabradine a valuable alternative to existing drug therapies for stable angina and other myocardial conditions.

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