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Bangalore S, Barsness GW, Dangas GD, Kern MJ, Rao SV, Shore-Lesserson L, Tamis-Holland JE. Evidence-Based Practices in the Cardiac Catheterization Laboratory: A Scientific Statement From the American Heart Association. Circulation 2021; 144:e107-e119. [PMID: 34187171 DOI: 10.1161/cir.0000000000000996] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiac catheterization procedures have rapidly evolved and expanded in scope and techniques over the past few decades. However, although some practices have emerged based on evidence, many traditions have persisted based on beliefs and theoretical concerns. The aim of this review is to highlight common preprocedure, intraprocedure, and postprocedure catheterization laboratory practices where evidence has accumulated over the past few decades to support or discount traditionally held practices.
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Leslie-Mazwi T, Chen M, Yi J, Starke RM, Hussain MS, Meyers PM, McTaggart RA, Pride GL, Ansari AS, Abruzzo T, Albani B, Arthur AS, Baxter BW, Bulsara KR, Delgado Almandoz JE, Gandhi CD, Heck D, Hetts SW, Klucznik RP, Jayaraman MV, Lee SK, Mack WJ, Mocco J, Prestigiacomo C, Patsalides A, Rasmussen P, Sunenshine P, Frei D, Fraser JF. Post-thrombectomy management of the ELVO patient: Guidelines from the Society of NeuroInterventional Surgery. J Neurointerv Surg 2017; 9:1258-1266. [PMID: 28963364 DOI: 10.1136/neurintsurg-2017-013270] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/22/2017] [Accepted: 08/06/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Thabele Leslie-Mazwi
- Neurointerventional Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael Chen
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Julia Yi
- University Illinois at Chicago, Chicago, Illinois, USA
| | - Robert M Starke
- Department of Neurosurgery and Radiology, University of Miami, Miami, Florida, USA
| | | | | | - Ryan A McTaggart
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - G Lee Pride
- Department of Neuroradiology, University of Texas Southwestern, Dallas, Texas, USA
| | - A Sameer Ansari
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Todd Abruzzo
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Barbara Albani
- Department of Neurointerventional Surgery, Christiana Care Health Systems, Newark, Delaware, USA
| | | | - Blaise W Baxter
- Department of Radiology, Erlanger Medical Center, Chattanooga, Tennessee, USA
| | - Ketan R Bulsara
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Josser E Delgado Almandoz
- Department of Neurointerventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Chirag D Gandhi
- Department of Neurosurgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Don Heck
- Department of Radiology, Forsyth Medical Center, Winston Salem, North Carolina, USA
| | - Steven W Hetts
- Department of Radiology, University of California in San Francisco, San Francisco, California, USA
| | - Richard P Klucznik
- Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Mahesh V Jayaraman
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Seon-Kyu Lee
- The University of Chicago, Chicago, Illinois, USA
| | - William J Mack
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - J Mocco
- Mount Sinai School of Medicine, Mount Sinai Health System, New York, New York, USA
| | | | - Athos Patsalides
- New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York, USA
| | - Peter Rasmussen
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Donald Frei
- Swedish Medical Center, Denver, Colorado, USA
| | - Justin F Fraser
- Department of Neurological Surgery, University of Kentucky, Lexington, Kentucky, USA
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Wongcharoen W, Pinyosamosorn K, Gunaparn S, Boonnayhun S, Thonghong T, Suwannasom P, Phrommintikul A. Vascular access site complication in transfemoral coronary angiography between uninterrupted warfarin and heparin bridging. J Interv Cardiol 2017; 30:387-392. [DOI: 10.1111/joic.12403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 05/31/2017] [Accepted: 06/07/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Wanwarang Wongcharoen
- Department of Internal Medicine, Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
- Northern Cardiac Center, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University; Chiang Mai Thailand
| | - Kittipong Pinyosamosorn
- Department of Internal Medicine, Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Siriluck Gunaparn
- Department of Internal Medicine, Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
- Northern Cardiac Center, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University; Chiang Mai Thailand
| | - Suchada Boonnayhun
- Northern Cardiac Center, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University; Chiang Mai Thailand
| | - Tasalak Thonghong
- Northern Cardiac Center, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University; Chiang Mai Thailand
| | - Pannipa Suwannasom
- Northern Cardiac Center, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University; Chiang Mai Thailand
| | - Arintaya Phrommintikul
- Department of Internal Medicine, Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
- Northern Cardiac Center, Maharaj Nakorn Chiang Mai Hospital; Faculty of Medicine, Chiang Mai University; Chiang Mai Thailand
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Shammas NW, Shammas GA, Jones-Miller S, Gumpert MR, Gumpert MJ, Harb C, Chammas MZ, Shammas WJ, Khalafallah RA, Barzgari A, Bou Dargham B, Daher GE, Rachwan RJ, Shammas AN. Predictors of common femoral artery access site complications in patients on oral anticoagulants and undergoing a coronary procedure. Ther Clin Risk Manag 2017; 13:401-406. [PMID: 28408835 PMCID: PMC5384737 DOI: 10.2147/tcrm.s130624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background It is unclear whether patients on oral anticoagulants (OAC) undergoing a procedure using common femoral artery access have higher adverse events when compared to patients who are not anticoagulated at the time of the procedure. Methods We retrospectively reviewed data from consecutive patients who underwent a cardiac procedure at a tertiary medical center. Patients were considered (group A) fully or partially anticoagulated if they had an international normalized ratio (INR) ≥1.6 on the day of the procedure or were on warfarin or new OAC within 48 h and 24 h of the procedure, respectively. The nonanticoagulated group (group B) had an INR <1.6 or had stopped their warfarin and new OAC >48 h and >24 h preprocedure, respectively. The index primary end point of the study was defined as the composite end point of major bleeding, vascular complications, or cardiovascular-related death during index hospitalization. The 30-day primary end point was defined as the occurrence of the index primary end point and up to 30 days postprocedure. Results A total of 779 patients were included in this study. Of these patients, 27 (3.5%) patients were in group A. The index primary end point was met in 11/779 (1.4%) patients. The 30-day primary composite end point was met in 18/779 (2.3%) patients. There was no difference in the primary end point at index between group A (1/27 [3.7%]) and group B (10/752 [1.3%]; P=0.3155) and no difference in the 30-day primary composite end point between group A (2/27 [7.4%]) and group B (16/752 [2.1%]; P=0.1313). Multivariable analysis showed that a low creatinine clearance (odds ratio [OR] =0.56; P=0.0200) and underweight patients (<60 kg; OR =3.94; P=0.0300) were independent predictors of the 30-day primary composite end point but not oral anticoagulation (P=0.1500). Conclusion Patients on OAC did not have higher 30-day major adverse events than those who were not anticoagulated at index procedure.
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Affiliation(s)
- Nicolas W Shammas
- Midwest Cardiovascular Research Foundation.,Cardiology Division, Genesis Heart Institute, Davenport, IA, USA
| | | | - Susan Jones-Miller
- Midwest Cardiovascular Research Foundation.,Cardiology Division, Genesis Heart Institute, Davenport, IA, USA
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Kowalewski M, Suwalski P, Raffa GM, Słomka A, Kowalkowska ME, Szwed KA, Borkowska A, Kowalewski J, Malvindi PG, Undas A, Windyga J, Pawliszak W, Anisimowicz L, Carrel T, Paparella D, Lip GY. Meta-analysis of uninterrupted as compared to interrupted oral anticoagulation with or without bridging in patients undergoing coronary angiography with or without percutaneous coronary intervention. Int J Cardiol 2016; 223:186-194. [DOI: 10.1016/j.ijcard.2016.08.089] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
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Shahi V, Brinjikji W, Murad MH, Asirvatham SJ, Kallmes DF. Safety of Uninterrupted Warfarin Therapy in Patients Undergoing Cardiovascular Endovascular Procedures: A Systematic Review and Meta-Analysis. Radiology 2016. [DOI: 10.1148/radiol.2015142531] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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7
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Dewilde WJM, Janssen PW, Kelder JC, Verheugt FW, De Smet BJ, Adriaenssens T, Vrolix M, Brueren GB, Van Mieghem C, Cornelis K, Vos J, Breet NJ, ten Berg JM. Uninterrupted oral anticoagulation versus bridging in patients with long-term oral anticoagulation during percutaneous coronary intervention: subgroup analysis from the WOEST trial. EUROINTERVENTION 2015; 11:381-90. [DOI: 10.4244/eijy14m06_07] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Dunham CM, Hoffman DA, Huang GS, Omert LA, Gemmel DJ, Merrell R. Traumatic intracranial hemorrhage correlates with preinjury brain atrophy, but not with antithrombotic agent use: a retrospective study. PLoS One 2014; 9:e109473. [PMID: 25279785 PMCID: PMC4184859 DOI: 10.1371/journal.pone.0109473] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 09/01/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The impact of antithrombotic agents (warfarin, clopidogrel, ASA) on traumatic brain injury outcomes is highly controversial. Although cerebral atrophy is speculated as a risk for acute intracranial hemorrhage, there is no objective literature evidence. MATERIALS AND METHODS This is a retrospective, consecutive investigation of patients with signs of external head trauma and age ≥60 years. Outcomes were correlated with antithrombotic-agent status, coagulation test results, admission neurologic function, and CT-based cerebral atrophy dimensions. RESULTS Of 198 consecutive patients, 36% were antithrombotic-negative and 64% antithrombotic-positive. ASA patients had higher arachidonic acid inhibition (p = 0.04) and warfarin patients had higher INR (p<0.001), compared to antithrombotic-negative patients. Antithrombotic-positive intracranial hemorrhage rate (38.9%) was similar to the antithrombotic-negative rate (31.9%; p = 0.3285). Coagulopathy was not present on the ten standard coagulation, thromboelastography, and platelet mapping tests with intracranial hemorrhage and results were similar to those without hemorrhage (p≥0.1354). Hemorrhagic-neurologic complication (intracranial hemorrhage progression, need for craniotomy, neurologic deterioration, or death) rates were similar for antithrombotic-negative (6.9%) and antithrombotic-positive (8.7%; p = 0.6574) patients. The hemorrhagic-neurologic complication rate was increased when admission major neurologic dysfunction was present (63.2% versus 2.2%; RR = 28.3; p<0.001). Age correlated inversely with brain parenchymal width (p<0.001) and positively with lateral ventricular width (p = 0.047) and cortical atrophy (p<0.001). Intracranial hemorrhage correlated with cortical atrophy (p<0.001) and ventricular width (p<0.001). CONCLUSIONS Intracranial hemorrhage is not associated with antithrombotic agent use. Intracranial hemorrhage patients have no demonstrable coagulopathy. The association of preinjury brain atrophy with acute intracranial hemorrhage is a novel finding. Contrary to antithrombotic agent status, admission neurologic abnormality is a predictor of adverse post-admission outcomes. Study findings indicate that effective hemostasis is maintained with antithrombotic therapy.
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Affiliation(s)
- C. Michael Dunham
- Trauma/Critical Care Services, St. Elizabeth Health Center, Youngstown, Ohio, United States of America
- * E-mail:
| | - David A. Hoffman
- Division of Cardiology, St. Elizabeth Health Center, Youngstown, Ohio, United States of America
| | - Gregory S. Huang
- Trauma/Critical Care Services, St. Elizabeth Health Center, Youngstown, Ohio, United States of America
| | - Laurel A. Omert
- CSL Behring, King of Prussia, Pennsylvania, United States of America
| | - David J. Gemmel
- Medical Education and Statistics, St. Elizabeth Health Center, Youngstown, Ohio, United States of America
| | - Renee Merrell
- Trauma/Critical Care Services, St. Elizabeth Health Center, Youngstown, Ohio, United States of America
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Outcomes after arterial endovascular procedures performed in patients with an elevated international normalized ratio. Ann Vasc Surg 2014; 29:22-7. [PMID: 24930974 DOI: 10.1016/j.avsg.2014.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 04/17/2014] [Accepted: 05/18/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients treated with anticoagulants frequently require urgent vascular procedures and elevated prothrombin time/international normalized ratio (INR) is traditionally thought to increase access site bleeding complications after sheath removal. We aimed to determine the safety of percutaneous arterial procedures on patients with a high INR in the era of modern ultrasound-guided access and closure device use. METHODS Patients undergoing arterial endovascular procedures at a single institution between October 2010 and November 2012 were reviewed (n = 1,333). We retrospectively analyzed all patients with an INR > 1.5. Venous procedures, lysis checks, and cases with no documented INR within 24 hr were excluded. Sixty-five patients with 91 punctures were identified. A comparison group was then generated from the last 91 patients intervened on with INR < 1.6. Demographics, intraoperative data, and postoperative complications were compared. RESULTS The demographics were similar. More Coumadin use and higher INR were found in the study group (71/91 and 0/91, P = 0.001; 2.3 and 1.1 sec, P = 0.001, respectively), but there was more antiplatelet use in the control group (68/91 and 51/91, P = 0.01). Intraoperatively, the sheath sizes, protamine use, closure device use, ultrasound guidance, brachial access, and procedure types were not statistically different. Sheath sizes ranged from 4 to 22F in the study group and 4 to 20F in the control group. Paradoxically, heparin was administered more frequently in the study group (64/91 and 50/91, P = 0.046). Bleeding complications occurred more commonly in the study group (3/91 and 1/91, P = 0.62), but this failed to reach significance and the overall complication rate in both groups was low. CONCLUSIONS Endovascular procedures may be performed safely with a low risk of bleeding complications in patients with an elevated INR. Ultrasound guidance and closure device use may allow these cases to be performed safely, but a larger series may be needed to confirm this.
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Routine cardiac catheterization and angioplasty in anticoagulated patients: Does warfarin need to be discontinued? Int J Cardiol 2013; 168:2976-7. [DOI: 10.1016/j.ijcard.2013.04.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 04/04/2013] [Indexed: 01/20/2023]
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Kassem HH, Elmahdy MF, Ewis EB, Mahdy SG. Incidence and predictors of post-catheterization femoral artery pseudoaneurysms. Egypt Heart J 2013. [DOI: 10.1016/j.ehj.2012.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Faggioli G, Pini R, Rapezzi C, Mauro R, Freyrie A, Gargiulo M, Bacchi Reggiani L, Stella A. Carotid revascularization in patients with ongoing oral anticoagulant therapy: the advantages of stent placement. J Vasc Interv Radiol 2013; 24:370-7. [PMID: 23433413 DOI: 10.1016/j.jvir.2012.11.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 11/29/2012] [Accepted: 11/30/2012] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To assess the influence of oral anticoagulant therapy conversion to heparin (OAT-CH) on carotid endarterectomy (CEA) outcomes and the influence of unmodified oral anticoagulant therapy (OAT) on carotid artery stenting (CAS) and to compare the outcomes of CEA in OAT-CH with CAS in ongoing OAT. MATERIALS AND METHODS The 30-day results from all patients who underwent CEA and CAS in a 6-year period were analyzed for stroke, death, myocardial infarction (MI), and hematoma of the access site requiring surgical evacuation. We evaluated the influence of OAT-CH in CEA and the influence of OAT in CAS and compared CEA and CAS outcomes in patients receiving OAT-CH and OAT. RESULTS Among 1,222 carotid revascularizations, there were 711 CEAs (58.1%) and 511 CAS procedures (41.9%). In the CEA group, 31 (4.4%) patients were treated with OAT-CH, and these patients had a significantly higher complication rate compared with patients not receiving OAT, including death (1 [3.2%] vs 4 [0.6%]; P = .04), stroke (4 [12.9%] vs 10 [1.4%]; P = .001), and hematoma (3 [9.6%] vs 11 [1.6%]; P = .02). In CAS, the results were similar in patients receiving OAT (30 [5.8%]) and patients not receiving OAT. Patients receiving OAT who underwent CAS had better outcomes than patients receiving OAT-CH who underwent CEA, including stroke, death, MI, and hematoma combined (0 [0.0%] vs 7 [22.5%]; P =.01). CONCLUSIONS OAT management significantly influences the results of carotid revascularization. Because CAS with unmodified OAT had a significantly better outcome than CEA with OAT-CH, carotid revascularization strategies should favor CAS rather than CEA in this setting.
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Affiliation(s)
- Gianluca Faggioli
- Department of Vascular Surgery, University of Bologna, Via Massarenti 11, Bologna 40138, Italy
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Arbel J, Rozenbaum E, Reges O, Neuman Y, Levi A, Erel J, Haskia A, Caneti M, Sherf M, Mosseri M. USage of chitosan for Femoral (USF) haemostasis after percutaneous procedures: a comparative open label study. EUROINTERVENTION 2011; 6:1104-9. [DOI: 10.4244/eijv6i9a192] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ahmed I, Gertner E, Nelson WB, House CM, Zhu DW. Safety of coronary angiography and percutaneous coronary intervention in patients on uninterrupted warfarin therapy: a meta-analysis. Interv Cardiol 2011. [DOI: 10.2217/ica.10.94] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Jamula E, Lloyd NS, Schwalm JD, Airaksinen KJ, Douketis JD. Safety of Uninterrupted Anticoagulation in Patients Requiring Elective Coronary Angiography With or Without Percutaneous Coronary Intervention. Chest 2010; 138:840-7. [DOI: 10.1378/chest.09-2603] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Airaksinen K, Schlitt A, Rubboli A, Karjalainen P, Lip G. How to manage antithrombotic treatment during percutaneous coronary interventions in patients receiving long-term oral anticoagulation: to "bridge" or not to "bridge"? EUROINTERVENTION 2010; 6:520-6. [DOI: 10.4244/eij30v6i4a86] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lip GYH, Huber K, Andreotti F, Arnesen H, Airaksinen JK, Cuisset T, Kirchhof P, Marín F. Antithrombotic management of atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing coronary stenting: executive summary--a Consensus Document of the European Society of Cardiology Working Group on Thrombosis, endorsed by the European Heart Rhythm Association (EHRA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2010; 31:1311-8. [PMID: 20447945 DOI: 10.1093/eurheartj/ehq117] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
There remains uncertainty over optimal antithrombotic management strategy for patients with atrial fibrillation (AF) presenting with an acute coronary syndrome and/or undergoing percutaneous coronary intervention/stenting. Clinicians need to balance the risk of stroke and thromboembolism against the risk of recurrent cardiac ischaemia and/or stent thrombosis and the risk of bleeding. The full consensus document comprehensively reviews the published evidence and presents a consensus statement on a 'best practice' antithrombotic therapy guideline for the management of antithrombotic therapy in such AF patients. This executive summary highlights the main recommendations from the consensus document.
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Affiliation(s)
- Gregory Y H Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK.
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Periprocedural anticoagulation practices in warfarin-treated patients who require elective angiography with or without percutaneous coronary intervention: A retrospective chart review. Thromb Res 2010; 125:351-2. [DOI: 10.1016/j.thromres.2009.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 10/16/2009] [Accepted: 10/23/2009] [Indexed: 11/20/2022]
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Ziakas AG, Koskinas KC, Gavrilidis S, Giannoglou GD, Hadjimiltiades S, Gourassas I, Theofilogiannakos E, Economou F, Styliadis I. Radial versus femoral access for orally anticoagulated patients. Catheter Cardiovasc Interv 2010; 76:493-9. [DOI: 10.1002/ccd.22527] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Abstract
OBJECTIVE Since the previous comprehensive radiology review on coagulation concepts that was done in 1990, many studies have been published in the medical and surgical literature that can guide the approach of a radiology practice. The purpose of this article is to provide an analysis of these works, updating the radiologist on proper use and interpretation of coagulation assessment tools, medications that modify the hemostatic system, and the use of transfusions prior to interventions. CONCLUSION The basic tools for coagulation assessment have not changed; however, results from subspecialty research have suggested ways in which the use of these tools can be modified and streamlined to safely reduce time and expense for the patient and the health care system.
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Lesault PF, Teiger E. [Radial access and management of patients with long-term oral anticoagulation for cardiac catheterization]. Ann Cardiol Angeiol (Paris) 2009; 58:360-365. [PMID: 19875097 DOI: 10.1016/j.ancard.2009.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 09/26/2009] [Indexed: 05/28/2023]
Abstract
Patients with long-term oral anticoagulation are exposed to high bleeding risk and should be managed with care for invasive procedure. Angioplasty is assumed to increase bleeding and access site complications and it is often recommended to temporarily interrupt anticoagulation therapy. Moreover, due to the lack of recommendations, antithrombotic regimen adopted after stenting represents a substantial challenge for the physician who must balance the risk of ischemic and bleeding events. Nevertheless, approaches as uninterrupted therapeutic oral anticoagulation, transradial approach and a best knowledge of ischemic risk, haemorrhage risk and restenosis risk can limit long term complication. Herein, we review the currently available data assessing angioplasty and long-term antithrombotic therapy for stented patients with long-term oral anticoagulation and we propose a potential treatment paradigm to improve long-term prognosis.
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Affiliation(s)
- P-F Lesault
- Laboratoire d'hémodynamique et de cardiologie interventionnelle, service de physiologie et des explorations fonctionnelles, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
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Vinik R, Wanner N, Pendleton RC. Periprocedural antithrombotic management: a review of the literature and practical approach for the hospitalist physician. J Hosp Med 2009; 4:551-9. [PMID: 20013858 DOI: 10.1002/jhm.514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Many patients who are on long-term antithrombotic therapy (e.g. warfarin and/or antiplatelet agents) must be assessed for temporary discontinuation for a procedure or surgery, making this a salient topic for the hospitalist physician. Discontinuation of antithromhotic therapy can place patients at increased risk of thromboembolic complications while continuing antithrombotic therapy can increase procedure-related bleeding risk. Bridging anticoagulation with heparin or low molecular weight heparins is often used in the periprocedural period, but a great deal of uncertainty exists about how and when to use bridging anticoagulation. Because there is very little Level 1 evidence to define optimal care, both clinical practice and expert consensus guideline opinions vary. For the hospitalist, it is of critical importance to understand the available data, controversies, and management options in order to approach patient care rationally. This review provides a step-wise literature-based discussion addressing the following four questions: (1) What is the optimal management of antiplatelet therapy in the periprocedural period? (2) Are there very low bleeding risk procedures that do not require interruption of oral anticoagulation? (3) Are there low thromboembolic risk populations who do not require periprocedural bridging? (4) How do you manage patients who must discontinue anti-coagulants but are at an increased thrombotic risk?
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Affiliation(s)
- Russell Vinik
- Department of Internal Medicine, General Medicine Hospitalist Group, University of Utah, Salt Lake City, Utah 84132, USA.
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Affiliation(s)
- Angelos Sourgounis
- From the Department of Cardiology, University Hospital of Caen, Normandy (A.S., T.S.L., M.H.); Department of Cardiology, University Hospital of Clermont-Ferrand, Clermont-Ferrand (J.L.); and INSERM U744, Institute Pasteur de Lille (M.H.), Lille, France
| | - Janusz Lipiecki
- From the Department of Cardiology, University Hospital of Caen, Normandy (A.S., T.S.L., M.H.); Department of Cardiology, University Hospital of Clermont-Ferrand, Clermont-Ferrand (J.L.); and INSERM U744, Institute Pasteur de Lille (M.H.), Lille, France
| | - Ted S. Lo
- From the Department of Cardiology, University Hospital of Caen, Normandy (A.S., T.S.L., M.H.); Department of Cardiology, University Hospital of Clermont-Ferrand, Clermont-Ferrand (J.L.); and INSERM U744, Institute Pasteur de Lille (M.H.), Lille, France
| | - Martial Hamon
- From the Department of Cardiology, University Hospital of Caen, Normandy (A.S., T.S.L., M.H.); Department of Cardiology, University Hospital of Clermont-Ferrand, Clermont-Ferrand (J.L.); and INSERM U744, Institute Pasteur de Lille (M.H.), Lille, France
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Annala AP, Karjalainen PP, Porela P, Nyman K, Ylitalo A, Airaksinen KJ. Safety of diagnostic coronary angiography during uninterrupted therapeutic warfarin treatment. Am J Cardiol 2008; 102:386-90. [PMID: 18678292 DOI: 10.1016/j.amjcard.2008.04.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Revised: 04/02/2008] [Accepted: 04/02/2008] [Indexed: 10/22/2022]
Abstract
Long-term warfarin therapy is assumed to increase bleeding and access site complications after coronary angiography and it is often recommended to postpone invasive procedures to reach international normalized ratio (INR) levels <1.8. To assess the safety and feasibility of diagnostic coronary angiography during uninterrupted warfarin therapy, we retrospectively analyzed all consecutive patients (n = 258) on warfarin therapy referred for diagnostic coronary angiography in 2 centers with long experience in uninterrupted warfarin therapy during coronary angiography and in 1 center with a policy of preprocedural warfarin pause. An age- and gender-matched control group (n = 258) with similar disease presentation (unstable or stable symptoms) was collected from each center. Radial access was used in 56% of patients in the warfarin group and in 60% of controls (p = 0.21). There was no difference in access site and bleeding complications (1.9% vs 1.6%) or major adverse cardiovascular and cerebrovascular events (0.4% vs 0.8%) between the warfarin group and their controls. Warfarin was interrupted in 80 patients (31%), and bridging therapy was used in 24 of these patients (30%). INR levels were higher in the uninterrupted warfarin group (2.3 vs 1.9, p <0.001), but the incidence of access site complications was not higher (1.7%) than in patients (n = 80) with a warfarin pause (2.5%) or in patients with pause and bridging therapy (8.3%). Need for blood transfusions (n = 2) occurred only in patients with bridging therapy. Access site complications were more common in the 22 patients with supratherapeutic anticoagulation (INR >3) than in patients with therapeutic periprocedural INR (9.1% vs 1.5%, p <0.05). In conclusion, a simple strategy of performing coronary angiography during uninterrupted therapeutic warfarin anticoagulation is a tempting alternative to bridging therapy and is likely to lead to considerable cost savings.
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Abstract
PURPOSE OF REVIEW Plasma transfusion to correct abnormal coagulation test results prior to an invasive procedure is a common clinical practice; however, there are no evidence-based guidelines. This review aims to analyze the most recent publications to either support or disprove such practice. RECENT FINDINGS Due to heightened awareness of transfusion-related acute lung injury and volume overload in susceptible patients, clinicians are increasingly questioning the validity of prophylactic plasma transfusion. Recently, several articles, reviews and clinical studies (although small and poorly designed) have shown no benefit of prophylactic plasma transfusion in either correcting abnormal coagulation tests or reducing perceived risk of hemorrhage. SUMMARY The use of sensitive reagents (especially for prothrombin time) has resulted in increased incidence of abnormal preprocedure coagulation screening test results - tests that are not designed to assess risk of bleeding in patients without a history of bleeding. Transfusion of plasma prior to an invasive procedure to correct mild to moderate abnormal test results neither corrects the abnormality nor reduces the perceived bleeding risk.
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Affiliation(s)
- Lorne Holland
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-9073, USA
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