301
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Pediatric Cardiac Intensive Care Society 2014 Consensus Statement: Pharmacotherapies in Cardiac Critical Care Anticoagulation and Thrombolysis. Pediatr Crit Care Med 2016; 17:S77-88. [PMID: 26945332 DOI: 10.1097/pcc.0000000000000623] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Thrombotic complications are increasingly being recognized as a significant cause of morbidity and mortality in pediatric and congenital heart disease. The objective of this article is to review the medications currently available to prevent and treat such complications. DATA SOURCES Online searches were conducted using PubMed. STUDY SELECTION Studies were selected for inclusion based on their scientific merit and applicability to the pediatric cardiac population. DATA EXTRACTION Pertinent information from each selected study or scientific review was extracted for inclusion. DATA SYNTHESIS Four classes of medications were identified as potentially beneficial in this patient group: anticoagulants, antiplatelet agents, thrombolytic agents, and novel oral anticoagulants. Data on each class of medication were synthesized into the follow sections: mechanism of action, pharmacokinetics, dosing, monitoring, reversal, considerations for use, and evidence to support. CONCLUSIONS Anticoagulants, antiplatelet agents, and thrombolytic agents are routinely used successfully in the pediatric patient with heart disease for the prevention and treatment of a wide range of thrombotic complications. Although the novel oral anticoagulants have been approved for a limited number of indications in adults, studies on the safety and efficacy of these agents in children are pending.
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302
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Di Biase L. Use of Direct Oral Anticoagulants in Patients With Atrial Fibrillation and Valvular Heart Lesions. J Am Heart Assoc 2016; 5:JAHA.115.002776. [PMID: 26892528 PMCID: PMC4802477 DOI: 10.1161/jaha.115.002776] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Luigi Di Biase
- Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY Department of Biomedical Engineering, University of Texas at Austin, TX Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX Department of Cardiology, University of Foggia, Foggia, Italy
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303
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Thrombus formation following transcatheter aortic valve replacement. JACC Cardiovasc Interv 2016; 8:728-39. [PMID: 25946447 DOI: 10.1016/j.jcin.2015.03.005] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 02/13/2015] [Accepted: 03/03/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVES This paper reviews the published data and reports 3 cases of thrombosis involving CoreValve (Medtronic, Minneapolis, Minnesota) and 1 involving Edward Sapien (Edwards Lifesciences, Irvine, California) devices. Three of these cases had pathological findings at autopsy. BACKGROUND Only a limited number of cases of valve dysfunction with rapid increase of transvalvular aortic gradients or aortic insufficiency post-transcatheter aortic valve replacement (TAVR) have been described. This nonstructural valvular dysfunction has been presumed to be because of early pannus formation or thrombosis. METHODS Through reviews of the published reports and 4 clinical cases, pathological and clinical findings of early valve thrombosis are examined to elucidate methods for recognition and identifying potential causes and treatments. RESULTS This paper presents 4 cases, 2 of which had increasing gradients post-TAVR. All 3 pathology cases showed presence of a valve thrombosis in at least 2 TAV leaflets on autopsy, but were not visualized by transthoracic echocardiogram or transesophageal echocardiogram. One case was medically treated with oral anti coagulation with normalization of gradients. The consequence of valve thrombosis in all 3 pathology patients either directly or indirectly played a role in their early demise. At least 18 case reports of early valve thrombosis have been published. In 12 of these cases, the early treatment with anticoagulation therapy resolved the thrombus formation and normalized aortic pressures gradients successfully. CONCLUSIONS These 4 cases elucidate the occurrence of valve thrombosis post-TAVR. Consideration should be given to treatment with dual antiplatelet therapy and oral anticoagulation in patients post-TAVR with increasing mean pressure gradients and maximum aortic valve velocity. Further research should be conducted to create guidelines for antithrombotic therapy following TAVR procedure.
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304
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Sternik L. Warfarin or aspirin after mitral valve repair: Why work harder? J Thorac Cardiovasc Surg 2016; 151:1309-10. [PMID: 26832210 DOI: 10.1016/j.jtcvs.2015.12.044] [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: 12/29/2015] [Accepted: 12/30/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Leonid Sternik
- Department of Cardiac Surgery, Sheba Medical Center, Tel-Hashomer, Israel.
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305
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Homma S, Messé SR, Rundek T, Sun YP, Franke J, Davidson K, Sievert H, Sacco RL, Di Tullio MR. Patent foramen ovale. Nat Rev Dis Primers 2016; 2:15086. [PMID: 27188965 DOI: 10.1038/nrdp.2015.86] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Patent foramen ovale (PFO) is the most common congenital heart abnormality of fetal origin and is present in approximately ∼25% of the worldwide adult population. PFO is the consequence of failed closure of the foramen ovale, a normal structure that exists in the fetus to direct blood flow directly from the right to the left atrium, bypassing the pulmonary circulation. PFO has historically been associated with an increased risk of stroke, the mechanism of which has been attributed to the paradoxical embolism of venous thrombi that shunt through the PFO directly to the left atrium. However, several studies have failed to show an increased risk of stroke in asymptomatic patients with a PFO, and the risk of stroke recurrence is low in patients who have had a stroke that may be attributed to a PFO. With the advent of transoesophageal and transthoracic echocardiography, as well as transcranial Doppler, a PFO can be routinely detected in clinical practice. Medical treatment with either antiplatelet or anticoagulation therapy is recommended. At the current time, closure of the PFO by percutaneous interventional techniques does not appear to reduce the risk of stroke compared to conventional medical treatment, as shown by three large clinical trials. Considerable controversy remains regarding the optimal treatment strategy for patients with both cryptogenic stroke and PFO. This Primer discusses the epidemiology, mechanisms, pathophysiology, diagnosis, screening, management and effects on quality of life of PFO.
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Affiliation(s)
- Shunichi Homma
- Department of Medicine, Columbia University, College of Physicians and Surgeons, 630 West 168th Street, New York 10032, USA
| | - Steven R Messé
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tatjana Rundek
- Department of Neurology, University of Miami School of Medicine, Miami, Florida, USA
| | - Yee-Ping Sun
- Department of Medicine, Columbia University, College of Physicians and Surgeons, 630 West 168th Street, New York 10032, USA
| | | | - Karina Davidson
- Department of Medicine, Columbia University, College of Physicians and Surgeons, 630 West 168th Street, New York 10032, USA
| | | | - Ralph L Sacco
- Department of Neurology, University of Miami School of Medicine, Miami, Florida, USA
| | - Marco R Di Tullio
- Department of Medicine, Columbia University, College of Physicians and Surgeons, 630 West 168th Street, New York 10032, USA
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306
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Tanaka KA, Mazzeffi MA, Strauss ER, Szlam F, Guzzetta NA. Computational simulation and comparison of prothrombin complex concentrate dosing schemes for warfarin reversal in cardiac surgery. J Anesth 2016; 30:369-76. [DOI: 10.1007/s00540-015-2128-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022]
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307
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Furie K, Khan M. Secondary Prevention of Cardioembolic Stroke. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00062-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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308
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Taherkhani M, Hashemi SR, Hekmat M, Safi M, Taherkhani A, Movahed MR. Thrombolytic Therapy for Right-Sided Mechanical Pulmonic and Tricuspid Valves: The Largest Survival Analysis to Date. Tex Heart Inst J 2015; 42:543-7. [PMID: 26664307 DOI: 10.14503/thij-14-4659] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Data regarding thrombolytic treatment of right-sided mechanical valve thrombosis are almost nonexistent, and all current guidelines arise from very small case series. We retrospectively studied the in-hospital and long-term outcome data of a larger series of patients who had received, from September 2005 through June 2012, thrombolytic therapy for right-sided mechanical pulmonary valve or tricuspid valve thrombosis. We identified 16 patients aged 8-67 years who had undergone thrombolytic therapy for definite thrombotic mechanical valve obstruction in the tricuspid or pulmonary valve position (8 in each position). All study patients except one had subtherapeutic international normalized ratios. The 8 patients with pulmonary mechanical valve thrombosis had a 100% response rate to thrombolytic therapy, and their in-hospital survival rate was also 100%. The 8 patients with tricuspid mechanical valve thrombosis had a 75% response rate to thrombolytic therapy, with an in-hospital survival rate of 87.5%. The one-year survival rate for mechanical valve thrombosis treated with thrombolytic therapy (whether pulmonary or tricuspid) was 87.5%. On the basis of our data, we recommend that thrombolytic therapy remain the first-line therapy for right-sided mechanical valve thrombosis in adults or children-including children with complex congenital heart disease and patients with mechanical pulmonary valve thrombosis. Surgery should be reserved for patients in whom this treatment fails.
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309
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Werlang ME, Palmer WC, Boyd EA, Cangemi DJ, Harnois DM, Taner CB, Stancampiano FF. Patent foramen ovale in liver transplant recipients does not negatively impact short-term outcomes. Clin Transplant 2015; 30:26-32. [PMID: 26448343 DOI: 10.1111/ctr.12643] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2015] [Indexed: 11/28/2022]
Abstract
AIM Patent foramen ovale (PFO) is a common atrial septal defect that is largely asymptomatic and often undiagnosed. The impact of a PFO in patients undergoing liver transplantation (LT) is unknown. OBJECTIVE Assess the impact of PFO and physiologic intrapulmonary shunt (IPS) on the perioperative outcomes of patients who underwent LT. METHODS We performed a retrospective, intention-to-treat analysis of patients with PFO and controls without PFO who underwent LT at Mayo Clinic in Florida between 2008 and 2013. Patients with physiologic IPS were also analyzed. The cohorts were compared for baseline characteristics, length of stay in the intensive care unit (ICU), postoperative oxygen requirements, 30-d cerebrovascular accidents, and mortality. RESULTS Of the 935 patients who underwent LT, 10.4% had proven PFO by pre-LT echocardiogram. Control patients (n = 101) were statistically older than PFO and IPS (n = 56) patients, but similar in sex, BMI, Model for End-stage Liver Disease score, American Society of Anesthesiologist score, and left ventricular ejection fraction. PFO and IPS patients had similar length of stay in the ICU, mechanical ventilation times, post-LT oxygen requirements, and 30-d mortality compared to controls. Subgroup analysis showed similar outcomes for large PFO and IPS patients to controls. CONCLUSIONS The presence of PFO did not have a negative impact on perioperative LT outcomes.
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Affiliation(s)
- Monia E Werlang
- Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - William C Palmer
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA
| | | | - David J Cangemi
- Department of Digestive and Liver Diseases, Gastroenterology, University of Texas Southwestern, Dallas, TX, USA
| | - Denise M Harnois
- Division of Transplant Hepatology, Department of Transplantation, Mayo Clinic College of Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Cemal B Taner
- Division of Transplant Hepatology, Department of Transplantation, Mayo Clinic College of Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
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310
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Wei M, Wang CT, Li DM, Song XJ. Prolonged use of fondaparinux for perioperative bridging: a case report of a patient with mechanical heart valve and heparin-induced thrombocytopenia. J Clin Pharm Ther 2015; 40:702-5. [PMID: 26573868 DOI: 10.1111/jcpt.12333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 10/08/2015] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Current guidelines provide no recommendations on perioperative bridging for patients after mechanical heart valve replacement (MHVR) who also have a history of heparin-induced thrombocytopenia (HIT). We present a successful case of prolonged bridging with fondaparinux in a 69-year-old Chinese woman. CASE SUMMARY The patient presented to our department with the aim for radical resection of oesophageal cancer. Fondaparinux has been administered alone at 2·5 mg subcutaneously once daily for 24 days during the interruption of warfarin perioperatively. There were no signs or symptoms of thromboembolic or bleeding throughout and after her hospitalization. WHAT IS NEW AND CONCLUSION Fondaparinux may offer an option for management of the patients with MHVR who cannot use heparin products, but further clinical investigations are warranted.
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Affiliation(s)
- M Wei
- Department of Pharmacy, Jinling Hospital, Nanjing, Jiangsu, China
| | - C T Wang
- Department of Cardio-thoracic Surgery, Jinling Hospital, Nanjing, Jiangsu, China
| | - D M Li
- Department of Cardio-thoracic Surgery, Jinling Hospital, Nanjing, Jiangsu, China
| | - X J Song
- Department of Pharmacy, Jinling Hospital, Nanjing, Jiangsu, China
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311
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Garcez JDS, Rosa VEE, Lopes ASDSA, Accorsi TAD, Fernandes JRC, Pomerantzeff PM, Avila WS, Tarasoutchi F. Patient Management with Metallic Valve Prosthesis during Pregnancy and Postpartum Period. Arq Bras Cardiol 2015; 105:426-9. [PMID: 26559990 PMCID: PMC4633007 DOI: 10.5935/abc.20150130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 08/27/2015] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Vitor Emer Egypto Rosa
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | - Walkiria Samuel Avila
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Flavio Tarasoutchi
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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312
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De Langhe E, Seghers A, Demaerel P, Verschueren P, Lemmens R. Non-infective endocarditis with systemic embolization and recurrent stroke in systemic sclerosis. Rheumatology (Oxford) 2015; 55:589-91. [PMID: 26546023 DOI: 10.1093/rheumatology/kev381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ellen De Langhe
- Department of Rheumatology, University Hospitals Leuven, Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Laboratory of Tissue Homeostasis and Disease, KU Leuven
| | | | | | | | - Robin Lemmens
- Department of Neurology and Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease, KU Leuven and VIB, Vesalius Research Center, Laboratory of Neurobiology, Leuven, Belgium
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313
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Ji J, Zöller B, Giaccia A, Haile R, Sundquist J, Sundquist K. Risk of breast cancer among patients with bioprosthetic or mechanical valve replacement: a population-based study in Sweden. Breast Cancer Res Treat 2015; 154:369-75. [PMID: 26476725 DOI: 10.1007/s10549-015-3607-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 10/13/2015] [Indexed: 02/03/2023]
Abstract
The association between breast cancer and warfarin is inconclusive as most previous studies examined their association using patients with thromboembolism, whereas thromboembolism itself is a risk factor for cancer. We explored this issue using patients received mechanical heart valves replacement as a proxy for warfarin exposure as these patients need a lifelong warfarin treatment, and compared them with patients received bioprosthesis valves replacement (short-term warfarin treatment) in Sweden between 1987 and 2010. Patients who were operated on for valve replacement were identified from the Swedish Hospital Discharge Registry and linked to the Swedish Cancer Registry to examine the hazard ratios of subsequent breast cancer. A total of 12,242 women were operated on for valve replacement (5481 with mechanical valve and 6401 with bioprosthetic valve). For the entire cohort, the HR of breast cancer was 1.49 (95 % CI 1.09-2.02) among patients with mechanical valve replacement compared to those with bioprosthetic valve replacement. After controlling for a number of confounding factors using propensity score weighting, the HR was 1.69 (95 % CI 1.15-2.47). Our study found that patients with mechanical valve replacement have an increased risk of breast cancer compared to those with bioprosthetic valve replacement. If confirmed, this increased risk should be considered when recommending breast cancer screening for women with mechanical valve replacement. Long-term use of warfarin may explain the observed increase. If so, patients who have used warfarin long-term for other reasons should be studied for a possible increased risk of breast cancer.
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Affiliation(s)
- Jianguang Ji
- Center for Primary Health Care Research, CRC, Lund University/Region Skåne, Skåne University Hospital, Building 28, Floor 11, Jan Waldenströms gata 35, 205 02, Malmö, Sweden.
| | - Bengt Zöller
- Center for Primary Health Care Research, CRC, Lund University/Region Skåne, Skåne University Hospital, Building 28, Floor 11, Jan Waldenströms gata 35, 205 02, Malmö, Sweden
| | - Amato Giaccia
- Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
| | - Robert Haile
- Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
| | - Jan Sundquist
- Center for Primary Health Care Research, CRC, Lund University/Region Skåne, Skåne University Hospital, Building 28, Floor 11, Jan Waldenströms gata 35, 205 02, Malmö, Sweden
- Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
| | - Kristina Sundquist
- Center for Primary Health Care Research, CRC, Lund University/Region Skåne, Skåne University Hospital, Building 28, Floor 11, Jan Waldenströms gata 35, 205 02, Malmö, Sweden
- Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
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314
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Carpentier A, Latrémouille C, Cholley B, Smadja DM, Roussel JC, Boissier E, Trochu JN, Gueffet JP, Treillot M, Bizouarn P, Méléard D, Boughenou MF, Ponzio O, Grimmé M, Capel A, Jansen P, Hagège A, Desnos M, Fabiani JN, Duveau D. First clinical use of a bioprosthetic total artificial heart: report of two cases. Lancet 2015; 386:1556-63. [PMID: 26231456 DOI: 10.1016/s0140-6736(15)60511-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The development of artificial hearts in patients with end-stage heart disease have been confronted with the major issues of thromboembolism or haemorrhage. Since valvular bioprostheses are associated with a low incidence of these complications, we decided to use bioprosthetic materials in the construction of a novel artificial heart (C-TAH). We report here the device characteristics and its first clinical applications in two patients with end-stage dilated cardiomyopathy. The aim of the study was to evaluate safety and feasibility of the CARMAT TAH for patients at imminent risk of death from biventricular heart failure and not eligible for transplant. METHODS The C-TAH is an implantable electro-hydraulically actuated pulsatile biventricular pump. All components, batteries excepted, are embodied in a single device positioned in the pericardial sac after excision of the native ventricles. We selected patients admitted to hospital who were at imminent risk of death, having irreversible biventricular failure, and not eligible for heart transplantation, from three cardiac surgery centres in France. FINDINGS The C-TAH was implanted in two male patients. Patient 1, aged 76 years, had the C-TAH implantation on Dec 18, 2013; patient 2, aged 68 years, had the implantation on Aug 5, 2014. The cardiopulmonary bypass times for C-TAH implantation were 170 min for patient 1 and 157 min for patient 2. Both patients were extubated within the first 12 postoperative hours and had a rapid recovery of their respiratory and circulatory functions as well as a normal mental status. Patient 1 presented with a tamponade on day 23 requiring re-intervention. Postoperative bleeding disorders prompted anticoagulant discontinuation. The C-TAH functioned well with a cardiac output of 4·8-5·8 L/min. On day 74, the patient died due to a device failure. Autopsy did not detect any relevant thrombus formation within the bioprosthesis nor the different organs, despite a 50-day anticoagulant-free period. Patient 2 experienced a transient period of renal failure and a pericardial effusion requiring drainage, but otherwise uneventful postoperative course. He was discharged from the hospital on day 150 after surgery with a wearable system without technical assistance. After 4 months at home, the patient suffered low cardiac output. A change of C-TAH was attempted but the patient died of multiorgan failure. INTERPRETATION This preliminary experience could represent an important contribution to the development of total artificial hearts using bioprosthetic materials. FUNDING CARMAT SA.
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Affiliation(s)
- Alain Carpentier
- Department of Cardiovascular Surgery, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes-Sorbonne Paris Cité, Paris, France.
| | - Christian Latrémouille
- Department of Cardiovascular Surgery, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Bernard Cholley
- Department of Anaesthesiology and Intensive Care, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - David M Smadja
- Department of Haematology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | | | - Elodie Boissier
- Institut du Thorax, Hôpital Guillaume et René Laënnec, Université de Nantes, France
| | - Jean-Noël Trochu
- Institut du Thorax, Hôpital Guillaume et René Laënnec, Université de Nantes, France
| | - Jean-Pierre Gueffet
- Institut du Thorax, Hôpital Guillaume et René Laënnec, Université de Nantes, France
| | - Michèle Treillot
- Institut du Thorax, Hôpital Guillaume et René Laënnec, Université de Nantes, France
| | - Philippe Bizouarn
- Institut du Thorax, Hôpital Guillaume et René Laënnec, Université de Nantes, France
| | - Denis Méléard
- Department of Anaesthesiology and Intensive Care, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Marie-Fazia Boughenou
- Department of Anaesthesiology and Intensive Care, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Olivier Ponzio
- Department of Cardiovascular Surgery, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | | | | | | | - Albert Hagège
- Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Michel Desnos
- Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Jean-Noël Fabiani
- Department of Cardiovascular Surgery, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Daniel Duveau
- Institut du Thorax, Hôpital Guillaume et René Laënnec, Université de Nantes, France
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315
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Early Bioprosthetic Valve Failure: Mechanistic Insights via Correlation between Echocardiographic and Operative Findings. J Am Soc Echocardiogr 2015; 28:1131-48. [DOI: 10.1016/j.echo.2015.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Indexed: 11/22/2022]
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316
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Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NAM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2015; 67:e27-e115. [PMID: 26409259 DOI: 10.1016/j.jacc.2015.08.856] [Citation(s) in RCA: 239] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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317
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Mekaj YH, Daci FT, Mekaj AY. New insights into the mechanisms of action of aspirin and its use in the prevention and treatment of arterial and venous thromboembolism. Ther Clin Risk Manag 2015; 11:1449-56. [PMID: 26445544 PMCID: PMC4590672 DOI: 10.2147/tcrm.s92222] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The antithrombotic action of aspirin has long been recognized. Aspirin inhibits platelet function through irreversible inhibition of cyclooxygenase (COX) activity. Until recently, aspirin has been mainly used for primary and secondary prevention of arterial antithrombotic events. The aim of this study was to review the literature with regard to the various mechanisms of the newly discovered effects of aspirin in the prevention of the initiation and development of venous thrombosis. For this purpose, we used relevant data from the latest numerous scientific studies, including review articles, original research articles, double-blinded randomized controlled trials, a prospective combined analysis, a meta-analysis of randomized trials, evidence-based clinical practice guidelines, and multicenter studies. Aspirin is used in the prevention of venous thromboembolism (VTE), especially the prevention of recurrent VTE in patients with unprovoked VTE who were treated with vitamin K antagonists (VKAs) or with non-vitamin K antagonist oral anticoagulants (NOACs). Numerous studies have shown that aspirin reduces the rate of recurrent VTE in patients, following cessation of VKAs or NOACs. Furthermore, low doses of aspirin are suitable for long-term therapy in patients recovering from orthopedic or other surgeries. Aspirin is indicated for the primary and secondary prevention as well as the treatment of cardiovascular diseases, including acute coronary syndrome, myocardial infarction, peripheral artery disease, acute ischemic stroke, and transient ischemic attack (especially in atrial fibrillation or mechanical heart valves). Aspirin can prevent or treat recurrent unprovoked VTEs as well as VTEs occurring after various surgeries or in patients with malignant disease. Recent trials have suggested that the long-term use of low-dose aspirin is effective not only in the prevention and treatment of arterial thrombosis but also in the prevention and treatment of VTE. Compared with VKAs and NOACs, aspirin has a reduced risk of bleeding.
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Affiliation(s)
- Ymer H Mekaj
- Institute of Pathophysiology, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo ; Department of Hemostasis and Thrombosis, National Blood Transfusion Center of Kosovo, University of Prishtina, Prishtina, Kosovo
| | - Fetije T Daci
- Department of Hemostasis and Thrombosis, National Blood Transfusion Center of Kosovo, University of Prishtina, Prishtina, Kosovo
| | - Agon Y Mekaj
- Clinic of Neurosurgery, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
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318
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Guidelines for the use of echocardiography as a monitor for therapeutic intervention in adults: a report from the American Society of Echocardiography. J Am Soc Echocardiogr 2015; 28:40-56. [PMID: 25559474 DOI: 10.1016/j.echo.2014.09.009] [Citation(s) in RCA: 285] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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319
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Min X, Zhu T, Han J, Li Y, Meng X. Left atrial appendage obliteration in atrial fibrillation patients undergoing bioprosthetic mitral valve replacement. Herz 2015; 41:87-94. [DOI: 10.1007/s00059-015-4350-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/26/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
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320
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Passaglia LG, de Barros GM, de Sousa MR. Early postoperative bridging anticoagulation after mechanical heart valve replacement: a systematic review and meta-analysis. J Thromb Haemost 2015; 13:1557-67. [PMID: 26178802 DOI: 10.1111/jth.13047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 06/30/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To perform a systematic review and meta-analysis of studies evaluating anticoagulation during the early postoperative period following mechanical heart valve implantation. METHODS Five literature databases were searched to assess the rates of bleeding and thromboembolic events among patients receiving oral anticoagulation (OAC), both with and without bridging anticoagulation therapy with unfractionated heparin (UFH) or subcutaneous low molecular weight heparin (LMWH). The studies' results were pooled via a mixed effects meta-analysis. Heterogeneity (I(2) ) and publication bias were both evaluated. RESULTS Twenty-three studies including 9534 patients were included. The bleeding rates were 1.8% (95% confidence interval CI 1.0-3.3) in the group receiving OAC, 2.2% (95% CI 0.9-5.3) in the OAC + UFH group, and 5.5% (95% CI 2.9-10.4) in the OAC + LMWH group (P = 0.042). The thromboembolic event rate was 2.1% (95% CI 1.5-2.9) in the group receiving OAC, as compared with 1.1% (95% CI 0.7-1.8) when the bridging therapy groups were combined as follows: OAC + UFH and OAC + LMWH (P = 0.035). Most of the analyses showed moderate heterogeneity and negative test results for publication bias. CONCLUSIONS Bridging therapy following cardiac valve surgery was associated with a lower thromboembolic event rate, although the difference was small, with considerable overlap of the CIs. Direct comparisons are missing. Bridging therapy with UFH appears to be safe; however, this observation has a risk of bias. Early bridging therapy with LMWH appears to be associated with consistently high bleeding rates across multiple analyses. On the basis of the quality of the included studies, more trials are necessary to establish the clinical relevance of bridging therapy and the safety of LMWH.
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Affiliation(s)
- L G Passaglia
- School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- Postgraduate Program in Adult Health Sciences, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - G M de Barros
- School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - M R de Sousa
- School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- Postgraduate Program in Adult Health Sciences, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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321
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Hsueh WD, Hwang PH, Abuzeid WM. Perioperative Management of Antithrombotic Therapy in Common Otolaryngologic Surgical Procedures: State of the Art Review. Otolaryngol Head Neck Surg 2015; 153:493-503. [PMID: 26307580 DOI: 10.1177/0194599815600409] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 07/23/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The perioperative management of patients undergoing otolaryngologic procedures is increasingly complicated by the use of newer antithrombotic agents. Furthermore, with advances in anesthesia and surgical technique, otolaryngologists are presented with the challenge of operating on patients with advanced comorbid diseases. The objective of this review is to provide evidence-based recommendations on perioperative antithrombotic management for common otolaryngologic procedures. DATA SOURCES PubMed/MEDLINE. REVIEW METHODS Selected literature on patient-specific thromboembolic risk, rate of bleeding complications in otolaryngologic procedures, and the interruption of antithrombotic therapy is reviewed and interpreted by expert opinion. CONCLUSIONS By stratifying patients into either low thromboembolic risk (≤ 5%) or high thromboembolic risk (> 5%) and interpreting this in the context of procedural bleed risk and potential clinical consequences in the event of a bleed, otolaryngologists can make evidence-based decisions to determine the appropriate perioperative management of antithrombotic therapy. IMPLICATIONS FOR PRACTICE When the perioperative management of antithrombotic therapy is being decided, 3 critical factors must be considered systematically: the patient's inherent thromboembolic risk, the risk and potential consequences of bleeding related to the procedure, and the timing of interruption of thromboembolic therapy.
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Affiliation(s)
- Wayne D Hsueh
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Waleed M Abuzeid
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, USA
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322
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Jaffer IH, Stafford AR, Fredenburgh JC, Whitlock RP, Chan NC, Weitz JI. Dabigatran is Less Effective Than Warfarin at Attenuating Mechanical Heart Valve-Induced Thrombin Generation. J Am Heart Assoc 2015; 4:e002322. [PMID: 26304938 PMCID: PMC4599481 DOI: 10.1161/jaha.115.002322] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Patients with mechanical heart valves (MHV) require warfarin to prevent thromboembolism. Although dabigatran was as effective as warfarin for stroke prevention in atrial fibrillation when compared with warfarin in patients with MHV, the study was stopped early because of more strokes and bleeding with dabigatran. To determine why dabigatran was less effective than warfarin, we compared their effects on thrombin generation induced by MHV. Methods and Results Thrombin generation in the absence or presence of valve leaflets or sewing ring segments (SRS) was quantified. Studies were done in control plasma, plasma depleted of factors (F) XII, XI, or VII, plasma containing varying concentrations of dabigatran, or plasma from patients on dabigatran or warfarin with varying dabigatran concentrations or international normalized ratio (INR) values. Mean endogenous thrombin potential (ETP) increased 1.2-, 1.5-, and 1.8-fold in the presence of leaflets, Teflon SRS, and Dacron SRS, respectively. Whereas ETP in FVII-depleted and control plasma was similar, ETP was reduced to background levels in FXII-depleted plasma and abrogated in FXI-depleted plasma. Dabigatran had little effect on ETP at concentrations below 400 ng/mL, whereas in plasma from warfarin-treated patients, ETP was suppressed with INR values over 1.5. Conclusions MHV induce thrombin generation via the intrinsic pathway and generate sufficient thrombin to overwhelm clinically relevant dabigatran concentrations. In contrast, warfarin is more effective than dabigatran at suppressing MHV-induced thrombin generation. These data explain why dabigatran failed in MHV patients and suggest that strategies targeting FXII or FXI may suppress the root cause of thrombosis in such patients.
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Affiliation(s)
- Iqbal H Jaffer
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada (I.H.J., A.R.S., J.C.F., J.I.W.) Department of Surgery, McMaster University, Hamilton, Ontario, Canada (I.H.J., R.P.W.) Department of Medical Sciences, McMaster University, Hamilton, Ontario, Canada (I.H.J., J.I.W.)
| | - Alan R Stafford
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada (I.H.J., A.R.S., J.C.F., J.I.W.) Department of Medicine, McMaster University, Hamilton, Ontario, Canada (A.R.S., J.C.F., J.I.W.)
| | - James C Fredenburgh
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada (I.H.J., A.R.S., J.C.F., J.I.W.) Department of Medicine, McMaster University, Hamilton, Ontario, Canada (A.R.S., J.C.F., J.I.W.)
| | - Richard P Whitlock
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (R.P.W., N.C.C.) Department of Surgery, McMaster University, Hamilton, Ontario, Canada (I.H.J., R.P.W.)
| | - Noel C Chan
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (R.P.W., N.C.C.)
| | - Jeffrey I Weitz
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada (I.H.J., A.R.S., J.C.F., J.I.W.) Department of Medical Sciences, McMaster University, Hamilton, Ontario, Canada (I.H.J., J.I.W.) Department of Medicine, McMaster University, Hamilton, Ontario, Canada (A.R.S., J.C.F., J.I.W.) Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada (J.I.W.)
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323
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Diffuse Alveolar Hemorrhage Associated with Warfarin Therapy. Case Rep Med 2015; 2015:350532. [PMID: 26347781 PMCID: PMC4549538 DOI: 10.1155/2015/350532] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 06/18/2015] [Accepted: 06/21/2015] [Indexed: 11/18/2022] Open
Abstract
Diffuse alveolar hemorrhage (DAH) is a life-threatening clinical pathologic syndrome caused by a variety of diseases. We report a case of DAH related to therapy of warfarin use. In this case report, we present the diffuse alveolar hemorrhage case as a rare and life-threatening complication of warfarin.
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324
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Effects of NAD(P)H quinone oxidoreductase 1 polymorphisms on stable warfarin doses in Korean patients with mechanical cardiac valves. Eur J Clin Pharmacol 2015; 71:1229-36. [PMID: 26257249 DOI: 10.1007/s00228-015-1915-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/23/2015] [Indexed: 01/21/2023]
Abstract
PURPOSE NAD(P)H dehydrogenase, encoded by NAD(P)H quinone oxidoreductase 1 (NQO1), is an enzyme that catalyzes the reduction of quinones, including vitamin K. Given its potential role in vitamin K metabolism, this study aimed to investigate the effects of NQO1 polymorphisms on stable warfarin doses. METHODS We tested a possible effect of gene polymorphisms on variability in warfarin response using 206 Korean patients with mechanical cardiac valves. Single nucleotide polymorphisms (SNPs) of NQO1 with a minor allele frequency of at least 15% were included. Also, genotypes of vitamin K epoxide reductase complex subunit 1 (VKORC1), cytochrome P450 (CYP) 2C9, CYP4F2, gamma-glutamyl carboxylase (GGCX), and GATA4 were determined. RESULTS NQO1 rs1800566 (C>T) and rs10517 (C>T) were significantly associated with stable warfarin doses. Variant homozygote carriers required lower stable warfarin doses than those with wild-type C allele in rs1800566 (4.85 ± 1.61 vs. 5.61 ± 1.94 mg; p = 0.033), whereas patients with wild homozygote required lower doses than those with T allele in rs10517 (5.11 ± 1.73 vs. 5.75 ± 1.98 mg; p = 0.017). Similar results were obtained from stratified analysis using VKORC1 variant homozygote carriers in both SNPs. Multivariate analysis showed that rs10517 (C>T) increased contribution of gene variations to the overall warfarin dose variability from 42.5 to 43.8%. CONCLUSION Our results demonstrate that NQO1 gene polymorphisms influence stable warfarin doses in Korean patients.
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325
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Lee KE, Chang BC, Park S, Gwak HS. Effects of single nucleotide polymorphisms in c-Myc on stable warfarin doses in patients with cardiac valve replacements. Pharmacogenomics 2015; 16:1101-8. [PMID: 26249541 DOI: 10.2217/pgs.15.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM This study aimed to investigate an association between c-Myc SNPs and stable warfarin doses. MATERIALS & METHODS The influences of genetic polymorphisms on dose requirements were investigated by genotyping ten SNPs in 201 patients with stable warfarin doses; VKORC1 (rs9923231), CYP2C9 (rs1057910), CYP4F2 (rs2108622), GATA4 (rs10090884), c-Myc (rs4645962, rs4645943, rs4645948 and rs4645974) and 8q24 (rs1447295 and rs16901979). RESULTS Around 44.3% of the overall interindividual variability in warfarin dose requirements was explained by the multivariate regression model; VKORC1 genotype accounted for 26.4%, CYP2C9 genotype for 4.9%, age for 3.4%, c-Myc genotypes for 5.2% (rs4645974 for 2.4% and rs4645943 for 2.8%), CYP4F2 genotype for 2.9% and diuretic use for 1.5%. CONCLUSION Our results revealed that c-Myc could be a determinant of stable warfarin doses.
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Affiliation(s)
- Kyung E Lee
- College of Pharmacy & Division of Life & Pharmaceutical Sciences, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 120-750, South Korea.,College of Pharmacy, Chungbuk National University, 1 Chungdae-ro, Seowon-gu, Cheongju, Chungbuk 361-763, South Korea
| | - Byung C Chang
- Department of Thoracic & Cardiovascular Surgery, Yonsei University Medical Center, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, South Korea
| | - Sunny Park
- College of Pharmacy & Division of Life & Pharmaceutical Sciences, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 120-750, South Korea
| | - Hye S Gwak
- College of Pharmacy & Division of Life & Pharmaceutical Sciences, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 120-750, South Korea
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326
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Turgeon RD, Barry AR. Single vs Dual Antiplatelet Therapy Following Transcatheter Aortic Valve Implantation: A Systematic Review. Clin Cardiol 2015; 38:629-34. [PMID: 26239886 DOI: 10.1002/clc.22426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/24/2015] [Indexed: 11/12/2022] Open
Abstract
There is wide variability in prescribing of antiplatelet regimens following transcatheter aortic valve implantation (TAVI). The objective of this review was to evaluate published and unpublished reports regarding the efficacy and safety of dual antiplatelet therapy (DAPT) compared with a single antiplatelet agent in patients undergoing TAVI. We searched MEDLINE, CENTRAL, Embase, and unpublished sources of literature from inception to December 2014 using terms synonymous with TAVI and DAPT. We included randomized controlled trials (RCTs) and cohort or case-control studies that compared DAPT with a single antiplatelet agent post-TAVI. Four articles met the inclusion criteria (2 RCTs, 2 cohort studies), of which all were deemed to be at high risk of bias, for a total of 662 patients. Compared with a single antiplatelet agent, DAPT did not significantly reduce all-cause mortality (risk ratio: 1.22, 95% confidence interval: 0.72-2.09, I(2) = 0%). Due to selective outcome reporting and variable follow-up, other outcomes of interest could not be meta-analyzed; however, evaluation of individual studies demonstrated no significant reduction in thrombotic events with DAPT and a similar or higher risk of bleeding. Current evidence, though limited by low methodological quality, suggests a lack of benefit and potential harm with DAPT compared with a single antiplatelet agent in patients post-TAVI. Therefore, clinicians should evaluate the use of DAPT in patients post-TAVI on a case-by-case basis until more robust evidence is available to guide practice.
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Affiliation(s)
- Ricky D Turgeon
- Doctor of Pharmacy Student, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arden R Barry
- Clinical Academic Colleague, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, and Clinical Pharmacist and Practice Leader, Pharmacy Services, Mazankowski Alberta Heart Institute, Alberta Health Services, Edmonton, Alberta, Canada
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327
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van der Wall SJ, Umans VA, Schotten J, Keijzers M, Wolterbeek R, Jansen EK, Huisman MV, Vonk AB. Antithrombotic strategy after bioprosthetic aortic valve replacement in patients in sinus rhythm: evaluation of guideline implementation. Eur J Cardiothorac Surg 2015; 49:1157-63. [DOI: 10.1093/ejcts/ezv254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/18/2015] [Indexed: 11/13/2022] Open
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328
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Fauchier L, Philippart R, Clementy N, Bourguignon T, Angoulvant D, Ivanes F, Babuty D, Bernard A. How to define valvular atrial fibrillation? Arch Cardiovasc Dis 2015; 108:530-9. [PMID: 26184867 DOI: 10.1016/j.acvd.2015.06.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 06/08/2015] [Indexed: 12/21/2022]
Abstract
Atrial fibrillation (AF) confers a substantial risk of stroke. Recent trials comparing vitamin K antagonists (VKAs) with non-vitamin K antagonist oral anticoagulants (NOACs) in AF were performed among patients with so-called "non-valvular" AF. The distinction between "valvular" and "non-valvular" AF remains a matter of debate. Currently, "valvular AF" refers to patients with mitral stenosis or artificial heart valves (and valve repair in North American guidelines only), and should be treated with VKAs. Valvular heart diseases, such as mitral regurgitation, aortic stenosis (AS) and aortic insufficiency, do not result in conditions of low flow in the left atrium, and do not apparently increase the risk of thromboembolism brought by AF. Post-hoc analyses suggest that these conditions probably do not make the thromboembolic risk less responsive to NOACs compared with most forms of "non-valvular" AF. The pathogenesis of thrombosis is probably different for blood coming into contact with a mechanical prosthetic valve compared with what occurs in most other forms of AF. This may explain the results of the only trial performed with a NOAC in patients with a mechanical prosthetic valve (only a few of whom had AF), where warfarin was more effective and safer than dabigatran. By contrast, AF in the presence of a bioprosthetic heart valve or after valve repair appears to have a risk of thromboembolism that is not markedly different from other forms of "non-valvular" AF. Obviously, we should no longer consider the classification of AF as "valvular" (or not) for the purpose of defining the aetiology of the arrhythmia, but for the determination of a different risk of thromboembolic events and the need for a specific antithrombotic strategy. As long as there is no better new term or widely accepted definition, "valvular AF" refers to patients with mitral stenosis or artificial heart valves. Patients with "non-valvular AF" may have other types of valvular heart disease. One should emphasize that "non-valvular AF" does not exclude patients with some types of valvular heart disease from therapy with NOACs.
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Affiliation(s)
- Laurent Fauchier
- Service de cardiologie, faculté de médecine, université François-Rabelais, CHU Trousseau, Tours, France.
| | - Raphael Philippart
- Service de cardiologie, faculté de médecine, université François-Rabelais, CHU Trousseau, Tours, France
| | - Nicolas Clementy
- Service de cardiologie, faculté de médecine, université François-Rabelais, CHU Trousseau, Tours, France
| | - Thierry Bourguignon
- Service de cardiologie, faculté de médecine, université François-Rabelais, CHU Trousseau, Tours, France
| | - Denis Angoulvant
- Service de cardiologie, faculté de médecine, université François-Rabelais, CHU Trousseau, Tours, France
| | - Fabrice Ivanes
- Service de cardiologie, faculté de médecine, université François-Rabelais, CHU Trousseau, Tours, France
| | - Dominique Babuty
- Service de cardiologie, faculté de médecine, université François-Rabelais, CHU Trousseau, Tours, France
| | - Anne Bernard
- Service de cardiologie, faculté de médecine, université François-Rabelais, CHU Trousseau, Tours, France
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329
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Sterling LH, Windle SB, Filion KB, Eisenberg MJ. Pharmacological management strategies for stroke prevention following transcatheter aortic valve replacement: A systematic review. Int J Cardiol 2015; 191:303-11. [DOI: 10.1016/j.ijcard.2015.04.226] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 04/01/2015] [Accepted: 04/29/2015] [Indexed: 11/30/2022]
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330
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Forsberg P, DeSancho MT. Role of novel anticoagulants for patients with mechanical heart valves. Curr Atheroscler Rep 2015; 16:448. [PMID: 25172513 DOI: 10.1007/s11883-014-0448-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The introduction of the target-specific oral anticoagulants (TSOACs) has led to a major shift in the management of patients at risk for thrombosis. The landscape continues to evolve as the evidence regarding their efficacy and safety in various clinical situations emerges. Antithrombotic therapy for thromboprophylaxis in patients with mechanical heart valves is challenging. To date, the RE-ALIGN trial comparing dabigatran etexilate to warfarin is the only randomized controlled study in this patient population. The higher risk of thromboembolic and bleeding events in the group of patients who received dabigatran compared with warfarin reinforced current guidelines recommending against the use of TSOACs in patients with mechanical heart valves. However, additional studies are needed to find suitable alternatives to vitamin K antagonists in this unique patient population.
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Affiliation(s)
- Peter Forsberg
- Weill Cornell Medical College, Weill Greenberg Pavilion, 1305 York Avenue, 7th Floor Room 51, New York, NY, 10021, USA,
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331
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Tellor KB, Patel S, Armbruster AL, Daly MW. Evaluation of the appropriateness of dosing, indication and safety of rivaroxaban in a community hospital. J Clin Pharm Ther 2015; 40:447-51. [DOI: 10.1111/jcpt.12288] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/29/2015] [Indexed: 02/05/2023]
Affiliation(s)
| | - S. Patel
- St. Louis College of Pharmacy; St. Louis MO USA
| | | | - M. W. Daly
- Saint Louis University Hospital; St. Louis MO USA
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332
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Philippart R, Brunet-Bernard A, Clementy N, Bourguignon T, Mirza A, Babuty D, Angoulvant D, Lip GY, Fauchier L. Prognostic value of CHA2DS2-VASc score in patients with ‘non-valvular atrial fibrillation’ and valvular heart disease: the Loire Valley Atrial Fibrillation Project. Eur Heart J 2015; 36:1822-30. [DOI: 10.1093/eurheartj/ehv163] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 04/21/2015] [Indexed: 02/03/2023] Open
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333
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Iung B. Antithrombotic therapy after transcatheter aortic valve implantation. Heart 2015; 101:1089-90. [PMID: 25953968 DOI: 10.1136/heartjnl-2015-307762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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334
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Elboudwarej O, Wei J, Siegel R. Diagnosis of an aortic valvular lesion. BRITISH HEART JOURNAL 2015; 101:719, 726. [DOI: 10.1136/heartjnl-2014-306723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 12/16/2014] [Indexed: 11/04/2022]
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335
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Wei W, Dong T, Zheng Z, Huang S. Effect of a combined anti-thrombotic therapy of thrombosis on prosthetic heart valves. J Thorac Dis 2015; 7:288-94. [PMID: 25922705 DOI: 10.3978/j.issn.2072-1439.2015.01.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 01/05/2015] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate the curative effects and risks of a medical therapy with combined anti-thrombotic agents for thrombosis on prosthetic heart valves. METHODS Twenty-two patients who suffered from thrombosis on prosthetic valves with stable hemodynamics were divided into the inpatient group and the outpatient group. Thrombosis on the valves were demonstrated by transesophageal echocardiographies (TEE). A combined anti-thrombotic therapy with clopidogrel and warfarin were prescribed for all the patients during the whole treatment. Low molecular weight heparin (LMWH) was given twice daily during the first 5 days for the inpatients. The patients accepted regular follow-ups for observation of the functions of prosthetic valves, changes of thrombi, coagulation status and general clinical status. RESULTS There were 5 men and 17 women. Thirteen patients suffered from thrombosis on the mechanical mitral valves (MVs), five on the mechanical tricuspid valves (TVs), one on the mechanical aortic valve and tricuspid bio-prosthetic valve, one on the mechanical aortic valve, one on the mitral bio-prosthetic valve, and one on the tricuspid bio-prosthetic valve. After an average of 36.4±23.1 days' observation, 16 (73%) patients' valvular function recovered normal without TTE detectable thrombi, 6 (27%) patients' valvular function remained abnormal including three patients without TTE detectable thrombi during follow-ups. No significant differences of thrombi changes and period of thrombi disappearance were observed between the inpatient group and the outpatient group. For patients with mitral thrombosis, sizes of the left atriums (LAs) decreased an average of 4.1 mm after treatment (95% CI, 1.2-6.9 mm). No significant changes of other chambers and left ventricular ejection fractions (LVEF) were observed. For patients with tricuspid thrombosis, LVEF improved an average of 10.5% after treatment (95% CI, 0.1-17.9%). No significant changes of chambers were observed. None experienced major bleedings except for two cases of mild subcutaneous ecchymoses. CONCLUSIONS The combined anti-thrombotic therapy based on clopidogrel and warfarin is a feasible treatment for thrombosis on prosthetic heart valves under a close monitoring.
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Affiliation(s)
- Wei Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Taiming Dong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Zhichao Zheng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Shuping Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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336
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Nguyen N, Sharathkumar A. Current Perioperative Anticoagulation Practices in Children with Prosthetic Mechanical Heart Valves. CONGENIT HEART DIS 2015; 10:E210-5. [DOI: 10.1111/chd.12268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Nguyenvu Nguyen
- Division of Cardiology; Department of Pediatrics; Northwestern University Feinberg School of Medicine; Ann & Robert H. Lurie Children's Hospital of Chicago; Chicago Ill USA
| | - Anjali Sharathkumar
- Division of Hematology and Oncology; Department of Pediatrics; Northwestern University Feinberg School of Medicine; Ann & Robert H. Lurie Children's Hospital of Chicago; Chicago Ill USA
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337
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Turan B, Demir H, Mutlu A, Daşlı T, Erkol A, Erden İ. Inappropriate combination of warfarin and aspirin. Anatol J Cardiol 2015; 16:189-96. [PMID: 26467380 PMCID: PMC5336805 DOI: 10.5152/akd.2015.6050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: A combination of warfarin and aspirin is associated with increased bleeding compared with warfarin monotherapy. The aim of the study was to investigate the incidence and appropriateness of the combination of warfarin and aspirin in patients with atrial fibrillation (AF) or mechanical heart valve (MHV). Methods: This cross-sectional study included consecutive patients with AF or MHV on chronic warfarin therapy (>3 months) without acute coronary syndrome or have not undergone a revascularization procedure in the preceding year. Medical history, concomitant diseases, and treatment data were acquired through patient interviews and from hospital records. Results: Three hundred and sixty patients (213 with AF, 147 with MHV) were included. In those with AF, a significantly higher warfarin-aspirin combination was observed with concomitant vascular disease (38.8% vs. 14.6%), diabetes (36.6% vs. 16.3%), statin therapy (40% vs. 16.9%), left ventricular systolic dysfunction (33.3% vs. 17.5%) (p<0.05 for all). The use of combination therapy was similar between different CHADS-VASc scores. In patients with MHV, higher combination therapy was observed in males (41% vs. 26.7% in females; p=0.070), concomitant vascular disease (47.8% vs. 29.8%; p=0.091), and AF (56.3% vs. 29.8%; p=0.033). Independent predictors of warfarin-aspirin combination were concomitant vascular disease, diabetes, and (younger) age in patients with AF and were concomitant AF and male sex in patients with MHV. Interestingly, the incidence of combination therapy was found to increase with a higher HAS-BLED score in both patients with AF and MHV (p<0.001). Conclusion: The combination of warfarin and aspirin was found to be prescribed to patients with AF mainly for the prevention of cardiovascular events, for which warfarin monotherapy usually suffices. On the other hand, co-treatment with aspirin appeared to be underused in patients with MHV. (Anatol J Cardiol 2016; 16: 189-96)
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Affiliation(s)
- Burak Turan
- Department of Cardiology, Kocaeli Derince Training and Research Hospital; Kocaeli-Turkey.
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338
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Abstract
Management of patients with an indication for long-term oral antithrombotic therapy who have an intracerebral hemorrhage (ICH) presents a therapeutic dilemma. Should antithrombotic therapy be resumed, and if so, when, using what agent, and for whom? There is no consensus for answers to these questions. In the absence of randomized trials, management of antithrombotic therapy after ICH is based on a combination of observational data, pathophysiologic concepts, and decision analysis. At the heart of the decision is an assessment of the individual patient's risk of thromboembolism off antithrombotic therapy versus risk of ICH recurrence on antithrombotic therapy.
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Affiliation(s)
- Allyson Zazulia
- Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St Louis, MO 63110, USA.
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339
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Sharma A, Sidhu RS, Paterson DI. Right atrial mass in a 23-year-old woman with molar pregnancy. CMAJ 2015; 187:350-4. [PMID: 25602006 DOI: 10.1503/cmaj.140889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Abhinav Sharma
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alta
| | - Robinder S Sidhu
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alta
| | - D Ian Paterson
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alta.
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340
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Davis EM, Friedman SK, Baker TM. A Review of Antithrombotic Therapy for Transcatheter Aortic Valve Replacement. Postgrad Med 2015; 125:59-72. [DOI: 10.3810/pgm.2013.01.2625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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341
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Amin H, Nowak RJ, Schindler JL. Cardioembolic Stroke: Practical Considerations for Patient Risk Management and Secondary Prevention. Postgrad Med 2015; 126:55-65. [DOI: 10.3810/pgm.2014.01.2725] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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342
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Roth C, Alli O. Role of occlusive devices to prevent thromboembolism among persons with a patent foramen ovale and prior stroke. Curr Treat Options Neurol 2015; 17:337. [PMID: 25744863 DOI: 10.1007/s11940-014-0337-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OPINION STATEMENT Patent foramen ovale (PFO) has been linked to stroke, presumably through the mechanism of paradoxical embolism; however, data is confusing regarding the causal relationship between PFO and embolic stroke. What has come to light in the past decade of research is that PFO closure with devices that achieve a high rate of closure may reduce the risk of recurrent stroke compared with medical therapy, but this benefit has not been shown in the general population with a PFO and cryptogenic stroke. The important question now is which patient will benefit from PFO closure for stroke risk reduction. A validated risk prediction tool is needed to help physicians determine those patients who will derive benefit from closure of PFO to prevent recurrent stroke. It is clear that even in studies with a small number of individuals and a very small number of events, there is some benefit to closure. Furthermore, improvements in closure devices and techniques have made percutaneous device closure both safe and efficacious. As such, it is not necessary to wait for a patient to have two strokes prior to serious consideration of PFO closure. We would advocate that the decision to close a PFO in the setting of a cryptogenic stroke be made at an individual level, on a case-by-case basis. Patients with high-risk features may be more likely to benefit, though who exactly comprises this population is still being elucidated. The most difficult aspect of managing this disease is the substantial number of individuals with incidental PFOs, as well as the prevalence of stroke due to other etiologies. When treating this disease, the physician must be able to weigh the likelihood of benefit versus the risk of the procedure, as well as patient preference.
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Affiliation(s)
- Christopher Roth
- Fellow, Division of Cardiovascular Disease, The University of Alabama at Birmingham, 201 Boshell Diabetes Building 1720 2nd Avenue South, Birmingham, AL, 35294-0012, USA,
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343
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Abstract
Many cardiac disorders and their treatment are associated with an increased risk for ischemic or hemorrhagic stroke, so it is important for cardiologists to be aware of recent advances in the field of stroke prevention. Atrial fibrillation (AF) is the most common cardiac disorder associated with a substantial risk for ischemic stroke (IS). The availability of implantable cardiac monitoring devices has substantially increased the detection rate of occult AF after IS. The 4 new oral anticoagulants have advantages when compared with warfarin, the standard therapy in AF to prevent IS, demonstrating a reduced risk for IS or intracerebral hemorrhage. Patients with cardiomyopathy, cardiac valve replacement, recent myocardial infarction, larger aortic arch atheroma and patent foramen ovale all have some level of increased risk for IS. The best approach for IS prevention in these disorders remains unsettled and varying approaches are recommended.
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Affiliation(s)
- Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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344
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Cafolla A, Manisco L, Baldacci E, Porcu A, Campanelli M, Cursano MC, Rossi E, Dragoni F, Foà R. Effectiveness and Safety of Therapy with Vitamin K Antagonists in Italian Patients Aged 80 Years or Older: a Multicentre Retrospective Study Comparing the Zeus Algorithm with the PARMA Algorithm or Manual Therapy. Drugs Aging 2015; 32:235-41. [DOI: 10.1007/s40266-015-0247-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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345
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Dental surgery in anticoagulated patients—stop the interruption. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:136-57. [DOI: 10.1016/j.oooo.2014.10.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/06/2014] [Accepted: 10/15/2014] [Indexed: 01/12/2023]
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346
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Carnahan L, Steven Block H, Biller J. Eleven Commonly Asked Questions About Ischemic Stroke. Top Stroke Rehabil 2015; 20:93-100. [DOI: 10.1310/tsr2002-93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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347
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Moser M. Peri- and postinterventional antithrombotic therapy in TAVI. Do we need antiplatelet therapy? Hamostaseologie 2015; 36:44-5. [PMID: 25564383 DOI: 10.5482/hamo-14-11-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/09/2014] [Indexed: 11/05/2022] Open
Abstract
Interventional treatment of aortic valve stenosis by transcatheter aortic valve replacement (TAVR) has become routine practice in elderly and high risk patients in recent years. Similar to other vascular interventional or surgical procedures TAVR carries thrombotic risks such as stroke, myocardial infarction or systemic embolism as well as peri-procedural bleeding risks. These risks comprise the access site, the type of prosthesis, and the individual risk profile of the patient. Not only during the peri-procedural period but also during longterm follow-up the current target population for TAVR procedures carries a high risk for thrombotic events in particular if atrial fibrillation is present. On the other hand side the bleeding risk is also increased in these patients. Thus, to provide the optimal strategy of antithrombotic therapy during and after TAVR remains a clinical challenge.
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Affiliation(s)
- M Moser
- Martin Moser, Heart Center, University of Freiburg, Department of Cardiology and Angiology I, Südring 15, 79189 Bad Krozingen, Germany, Tel. + 49/(0)76 33/402 32 10, E-mail:
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348
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Jones BM, Tuzcu EM, Krishnaswamy A, Kapadia SR. Neurologic Events After Transcatheter Aortic Valve Replacement. Interv Cardiol Clin 2015; 4:83-93. [PMID: 28582124 DOI: 10.1016/j.iccl.2014.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Early trials involving transcatheter aortic valve replacement raised concerns for an elevated risk of neurologic events compared to surgical AVR. Contemporary studies suggest declining rates with better patient selection, improved operator experience, and newer generation devices. Events are usually embolic in nature, occur in the periprocedural period, and can lead to increased morbidity and mortality. Current investigations are focused on developing embolic protection devices for intraprocedural use and optimizing antiplatelet and anticoagulant regimens. These efforts aim to further reduce the incidence of stroke, which is particularly important as the technology expands to include intermediate and possibly low surgical risk populations.
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Affiliation(s)
- Brandon M Jones
- Sones Cardiac Catheterization Laboratory, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk J2-3, Cleveland, OH 44195, USA
| | - E Murat Tuzcu
- Sones Cardiac Catheterization Laboratory, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk J2-3, Cleveland, OH 44195, USA
| | - Amar Krishnaswamy
- Sones Cardiac Catheterization Laboratory, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk J2-3, Cleveland, OH 44195, USA
| | - Samir R Kapadia
- Sones Cardiac Catheterization Laboratory, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk J2-3, Cleveland, OH 44195, USA.
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349
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Tosello F, Florens E, Caruba T, Lebeller C, Mimoun L, Milan A, Fabiani JN, Boutouyrie P, Menasché P, Lillo-Lelouet A. Atrial fibrillation at mid-term after bioprosthetic aortic valve replacement – implications for anti-thrombotic therapy. Circ J 2014; 79:70-6. [PMID: 25482295 DOI: 10.1253/circj.cj-14-0684] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Little is known about mid-term (3-month) postoperative atrial fibrillation (MT-POAF) in patients treated with bioprosthetic aortic valve replacement (BAVR). The aim of this study was to describe the natural history, identify the predictors and investigate the potential consequences in terms of anti-thrombotic therapy. METHODS AND RESULTS During a longitudinal, prospective study, 219 patients were treated with BAVR early (7 days) and at mid-term postoperatively (30 and 90 days). POAF was monitored and risk factors were identified on logistic regression analysis. History of previous AF (OR, 3.08; 95% CI: 1.35-6.98), early POAF (OR, 5.93; 95% CI: 2.96-11.8), and BMI (per 5 kg/m(2): OR, 1.46; 95% CI: 1.03-2.09), were independent predictors for MT-POAF whereas sex, age and Euroscore were not. Results were identical when restricted to the 176 patients free from preoperative AF. In this subgroup, 36 patients (20.4%) had MT-POAF; 33 out of 174 (18.7%) would have required anticoagulation (CHA2DS2VASc score ≥ 1). Conversely, patients with BMI <27.7 and sinus rhythm at early follow-up had a very low risk of MT-POAF (OR, 0.16; 95% CI: 0.06-0.42). CONCLUSIONS There was a higher than expected occurrence of MT-POAF in patients treated with BAVR, particularly in overweight patients with early POAF. This raises the question of implementing an anti-thrombotic therapy in these patients at higher risk of delayed atrial arrhythmia.
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350
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Bekker MWA, Noyez L, van Swieten HA. Anticoagulation therapy after bioprosthetic aortic valve replacement in Dutch cardiothoracic centres: acceptance of guidelines does not lead to overall implementation. Interact Cardiovasc Thorac Surg 2014; 20:395-8. [DOI: 10.1093/icvts/ivu392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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