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Mechanical Valve Thrombosis With Dabigatran. J Am Coll Cardiol 2012; 60:1710-1. [DOI: 10.1016/j.jacc.2012.06.039] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 06/25/2012] [Accepted: 06/28/2012] [Indexed: 11/21/2022]
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52
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53
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Lazar HL. The year in review: the surgical treatment of valvular disease-2011. J Card Surg 2012; 27:493-510. [PMID: 22784204 DOI: 10.1111/j.1540-8191.2012.01494.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This review highlights important advances in techniques, guidelines, outcomes and innovations in valve surgery during 2011.
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Affiliation(s)
- Harold L Lazar
- Department of Cardiothoracic Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
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54
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Emery RW, Cooper MM, Joyce DL. Over the Next Hill. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012. [DOI: 10.1177/155698451200700302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Robert W. Emery
- HealthEast Care System, Saint Joseph's Hospital, St Paul, MN USA
| | | | - David L. Joyce
- HealthEast Care System, Saint Joseph's Hospital, St Paul, MN USA
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55
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Alberts MJ, Bernstein RA, Naccarelli GV, Garcia DA. Response to Letters Regarding Article, “Using Dabigatran in Patients With Stroke: A Practical Guide for Clinicians”. Stroke 2012. [DOI: 10.1161/strokeaha.112.652800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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56
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Huisman MV, Lip GYH, Diener HC, Brueckmann M, van Ryn J, Clemens A. Dabigatran etexilate for stroke prevention in patients with atrial fibrillation: resolving uncertainties in routine practice. Thromb Haemost 2012; 107:838-47. [PMID: 22318514 DOI: 10.1160/th11-10-0718] [Citation(s) in RCA: 167] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 01/29/2011] [Indexed: 12/15/2022]
Abstract
Dabigatran etexilate is a new oral anticoagulant recently approved in Europe for the prevention of stroke or systemic embolism in adult patients with non-valvular atrial fibrillation (AF) and at least one risk factor for stroke. With a fast onset of action and a predictable anticoagulant effect obviating the need for coagulation monitoring, dabigatran etexilate offers practical advantages over vitamin K antagonists in clinical practice. However, clinicians may have questions about practical aspects of dabigatran etexilate use including monitoring anticoagulant efficacy, interruption for surgical or invasive procedures and management of bleeding. This review article aims to address these concerns and provide guidance on the use of dabigatran etexilate in special situations, such as acute coronary syndromes and cardiac revascularisation. In addition, cut-off values for different coagulation assay results associated with an increased risk of bleeding are given.
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Affiliation(s)
- Menno V Huisman
- Department of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands.
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57
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Die Arbeitsgemeinschaft Aortenklappenchirurgie stellt sich vor. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2012. [DOI: 10.1007/s00398-011-0888-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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58
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Alberts MJ, Bernstein RA, Naccarelli GV, Garcia DA. Using Dabigatran in Patients With Stroke. Stroke 2012; 43:271-9. [DOI: 10.1161/strokeaha.111.622498] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Mark J. Alberts
- From the Northwestern University Feinberg School of Medicine (M.J.A., R.A.B.), Chicago, IL; Penn State Heart and Vascular Institute (G.V.N.), Hershey, PA; and the University of New Mexico School of Medicine (D.A.G.), Albuquerque, NM
| | - Richard A. Bernstein
- From the Northwestern University Feinberg School of Medicine (M.J.A., R.A.B.), Chicago, IL; Penn State Heart and Vascular Institute (G.V.N.), Hershey, PA; and the University of New Mexico School of Medicine (D.A.G.), Albuquerque, NM
| | - Gerald V. Naccarelli
- From the Northwestern University Feinberg School of Medicine (M.J.A., R.A.B.), Chicago, IL; Penn State Heart and Vascular Institute (G.V.N.), Hershey, PA; and the University of New Mexico School of Medicine (D.A.G.), Albuquerque, NM
| | - David A. Garcia
- From the Northwestern University Feinberg School of Medicine (M.J.A., R.A.B.), Chicago, IL; Penn State Heart and Vascular Institute (G.V.N.), Hershey, PA; and the University of New Mexico School of Medicine (D.A.G.), Albuquerque, NM
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59
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Stewart RA, Astell H, Young L, White HD. Thrombosis on a Mechanical Aortic Valve whilst Anti-coagulated With Dabigatran. Heart Lung Circ 2012; 21:53-5. [DOI: 10.1016/j.hlc.2011.08.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 08/19/2011] [Accepted: 08/19/2011] [Indexed: 10/17/2022]
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60
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Mair H, Sachweh J, Sodian R, Brenner P, Schmoeckel M, Schmitz C, Reichart B, Daebritz S. Long-term self-management of anticoagulation therapy after mechanical heart valve replacement in outside trial conditions. Interact Cardiovasc Thorac Surg 2011; 14:253-7. [PMID: 22159262 DOI: 10.1093/icvts/ivr088] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this investigation, we hypothesize that quality of oral anticoagulation (OA) and long-term outcome after mechanical heart valve (MHV) replacement with self-management (Self-M) of OA is superior to conventional anticoagulation treatment (Conv-T), even in outside trial conditions. One hundred sixty patients (78.8% aortic valve replacements) were trained in international normalized ratio Self-M and 260 patients (86.2% aortic valve replacements) preferred Conv-T. Mean follow-up was 8.6 ± 2.1 years, representing 3612 patient-years. During follow-up, 37.2% bleedings and 10.6% thromboembolic events were recorded in the Self-M group versus 39.6% bleedings (P = 0.213) and 15.4% thromboembolic events (P = 0.064) in the Conv-T group. Serious adverse events were significantly lower in the Self-M group [grade III bleeding events causing disability or death: 0 versus 4.6% (P = 0.03); grade III thromboembolic events: 0.6 versus 5.0% (P = 0.011)]. Patients with Self-M were significantly more satisfied with their OA management and their quality of life (P < 0.001). Actuarial survival after 1, 5 and 10 years was 100, 99 and 97 with Self-M and 100, 95 and 81% with Conv-T, respectively (P < 0.001). Univariate risk factors for mortality were age (P = 0.008), type of operation (P = 0.021) and conventional OA (P < 0.001). In multivariate analysis, only conventional OA reached significance (P < 0.001). We conclude that in a routine setting under outside trial conditions Self-M of OA improves long-term outcome and treatment quality.
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Affiliation(s)
- Helmut Mair
- Department of Cardiac Surgery, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
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61
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McKellar SH, Schaff HV. Reply to the Editor. J Thorac Cardiovasc Surg 2011. [DOI: 10.1016/j.jtcvs.2011.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Argiriou ME. Dabigatran etexilate in mechanical valve thromboprophylaxis. J Thorac Cardiovasc Surg 2011; 142:1591. [PMID: 22093722 DOI: 10.1016/j.jtcvs.2011.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 05/20/2011] [Indexed: 11/24/2022]
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Kulik A, Saltzman MB, Morris JJ. Dabigatran after cardiac surgery: Caution advised. J Thorac Cardiovasc Surg 2011; 142:1288. [DOI: 10.1016/j.jtcvs.2011.05.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 05/05/2011] [Indexed: 11/30/2022]
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Augoustides JGT. Advances in anticoagulation: focus on dabigatran, an oral direct thrombin inhibitor. J Cardiothorac Vasc Anesth 2011; 25:1208-12. [PMID: 21982327 DOI: 10.1053/j.jvca.2011.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Indexed: 11/11/2022]
Abstract
Dabigatran is an oral direct thrombin inhibitor with a rapid onset. Patients on dabigatran do not require coagulation monitoring. Recent prospective randomized trials have shown the efficacy of dabigatran for the prevention of venous thromboembolism after knee or hip arthroplasty and for the prevention of stroke and systemic embolism in nonvalvular atrial fibrillation. Because dabigatran is cleared principally by the kidneys, dosage adjustments are required in the setting of renal dysfunction. There currently is no reversal agent for dabigatran although hemodialysis can facilitate its rapid removal in life-threatening circumstances. The management of severe bleeding associated with dabigatran also may include the administration of a procoagulant, such as recombinant activated factor VII. Based on recent guidelines, regional anesthesia should be used cautiously in patients taking this novel oral thrombin inhibitor.
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Affiliation(s)
- John G T Augoustides
- Cardiovascular and Thoracic Anesthesiology and Critical Care Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Abstract
Heparins and vitamin K antagonists have been the primary agents used for anticoagulation in certain cardiovascular and thromboembolic diseases for over 50 years. However, they can be difficult to administer and are fraught with limitations. In response to the need for new anticoagulants, direct thrombin inhibitors (DTIs) have been developed and investigated for their utility in prophylaxis and treatment of venous thromboembolism (VTE), heparin-induced thrombocytopenia (HIT), acute coronary syndromes (ACS), secondary prevention of coronary events after ACS, and nonvalvular atrial fibrillation. Currently, four parenteral direct inhibitors of thrombin activity are FDA-approved in North America: lepirudin, desirudin, bivalirudin and argatroban. Of the new oral DTIs, dabigatran etexilate is the most studied and promising of these agents. This review discusses the clinical indications and efficacy of these direct thrombin inhibitors as well as future directions in anticoagulant therapy.
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Affiliation(s)
- Catherine J Lee
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA.
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