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Anticoagulation cardiac surgery

Maral Ouzounian, Vivek Rao, Cedric Manlhiot, Nachum Abraham, Carolyn David, Christopher M Feindel, Tirone E David
BACKGROUND: Although aortic valve-sparing (AVS) operations are established alternatives to composite valve graft (CVG) procedures for patients with aortic root aneurysms, comparative long-term outcomes are lacking. OBJECTIVES: This study sought to compare the results of patients undergoing AVS procedures with those undergoing CVG operations. METHODS: From 1990 to 2010, a total of 616 patients age <70 years and without aortic stenosis underwent elective aortic root surgery (AVS, n = 253; CVG with a bioprosthesis [bio-CVG], n = 180; CVG with a mechanical prosthesis [m-CVG], n = 183)...
October 25, 2016: Journal of the American College of Cardiology
Keika Miyazawa, Yuji Otsuka, Yoshiki Ishiguro
INTRODUCTION: For a patient with lupus anticoagulant (LA), activated coagulation time (ACT) was measured with two different types of devices (HEMOCHRON(®) 801 and HEMOCHRON(®) Jr). CASE REPORT: ACTs during heparinization measured with the HEMOCHRON(®) 801 were over the range of measurement, while those with the HEMOCHRON(®) Jr. reflected an almost normal response to heparin. DISCUSSION: The phospholipid contained in an activating agent of the HEMOCHRON(®) Jr was suggested to have counteracted the effect of LA...
October 5, 2016: Perfusion
P Gueret, S Combe, C Krezel, E Fuseau, P L M van Giersbergen, M Petitou, E Neuhart
INTRODUCTION: EP217609 is a representative of a new class of synthetic parenteral anticoagulants with a dual mechanism of action. It combines in a single molecule a direct thrombin inhibitor and an indirect factor Xa inhibitor. EP217609 can be neutralized by a specific antidote avidin, which binds to the biotin moiety of EP217609. PURPOSE: The primary objective was to assess the neutralization of EP217609 by avidin in healthy subjects. Secondary objectives were to define the optimal avidin monomer/EP217609 molar ratio to achieve an adequate neutralization of EP217609 and to assess the safety and tolerability of EP217609 and avidin...
October 15, 2016: European Journal of Clinical Pharmacology
Mário Augusto Cray da Costa, Lucas Kraeski Krum, Juliana da Silva Geraldino, Marcelo Derbli Schafranski, Ricardo Zanetti Gomes, Elise Souza Dos Santos Reis
Introduction: In patients with mechanical prosthetic heart valves or atrial fibrillation requiring anticoagulation to prevent thromboembolic events, several factors influence adherence and anticoagulation complications. Objective: To evaluate the factors that interfere with the quality and complications of anticoagulation with vitamin K antagonists. Methods: A retrospective cohort study of 100 patients, in the period from 2011 to 2014, was performed...
May 2016: Brazilian Journal of Cardiovascular Surgery
Javier A Valle, Laura Graham, Aerin DeRussy, Kamal Itani, Mary T Hawn, Thomas M Maddox
BACKGROUND: Triple therapy, or the use of anticoagulants with dual antiplatelet therapy (DAPT), is often used to protect against ischemic events in post-percutaneous coronary intervention (PCI) patients with indications for anticoagulation, but is associated with increased bleeding. As both ischemic and bleeding risks increase in the perioperative period, the impact of triple therapy may be especially pronounced in patients undergoing surgery. Outcomes in this population are currently unknown...
October 12, 2016: World Journal of Surgery
Abhijit Trailokya, J S Hiremath, Jps Sawhney, Y K Mishra, Vivek Kanhere, R Srinivasa, Mangesh Tiwaskar
Anticoagulant treatment is required for the treatment and prevention of thromboembolic disorders. Vitamin K antagonists are commonly used oral anticoagulants worldwide. Acenocoumarol is mono-coumarin derivative with racemic mixture of R (+) and S (-) enantiomers. Efficacy and safety of acenocoumarol has been evaluated in atrial fibrillation, cardiac valve replacement, after myocardial infarction, treatment of deep vein thrombosis, after major surgeries and after critical illness requiring prolonged hospitalization...
February 2016: Journal of the Association of Physicians of India
Cécile Aubron, Joris DePuydt, François Belon, Michael Bailey, Matthieu Schmidt, Jayne Sheldrake, Deirdre Murphy, Carlos Scheinkestel, D Jamie Cooper, Gilles Capellier, Vincent Pellegrino, David Pilcher, Zoe McQuilten
BACKGROUND: Bleeding is the most frequent complication associated with extracorporeal membrane oxygenation (ECMO) support in critically ill patients. Nonetheless, risk factors for bleeding have been poorly described especially those associated with coagulation anomalies and anticoagulant therapy during ECMO support. The aim of this study is to describe bleeding complications in critically ill patients undergoing ECMO and to identify risk factors for bleeding events. METHODS: We retrospectively analysed ICU charts of adults who received either veno-venous (VV) or veno-arterial (VA) ECMO support in two participating ICUs between 2010 and 2013...
December 2016: Annals of Intensive Care
Dominique Stephan, Elena-Mihaela Cordeanu, Corina Mirea, Alix Faller, Anne Lejay, Sébastien Gaertner
Non-vitamin K antagonist oral anticoagulants are becoming increasingly important in the prophylaxis and treatment of thrombosis in atrial fibrillation and venous thromboembolism. Antiplatelets are widely prescribed in the primary and secondary prevention of cardiac and vascular diseases. There are potentially numerous situations where anticoagulants and antiplatelets may be combined; these combinations have been explored in coronary artery disease, and some have been included in updated recommendations. Is it legitimate to transpose these recommendations to the management of peripheral artery disease? The specific characteristics of the treated vessels, the stents used, the respective frequencies of stent thrombosis and its effect on the target organ are probably different, and explain why opinions differ...
September 28, 2016: Archives of Cardiovascular Diseases
Celine Detremerie, Frank Timmermans, Michel De Pauw, Peter Gheeraert, Dimitri Hemelsoet, Jonas Toeback, Thierry Bové, Els Vandecasteele
We present a case of a 71-year-old woman with recurrent stroke episodes due to non-bacterial thrombotic endocarditis (NBTE) leading to the diagnosis of an early-stage breast carcinoma. NBTE is associated with a variety of inflammatory states, including malignancy. NBTE presents itself with systemic embolization, mostly stroke. Treatment consists of treating the underlying condition and start of systemic anticoagulation therapy. Cardiac surgery is restricted to highly selected cases, since prognosis usually is limited by the neoplasm, which usually is in an advanced stage at time of diagnosis of NBTE...
August 12, 2016: Acta Clinica Belgica
Malcolm G Coulthard
Most babies with chronic renal failure are identified antenatally, and over half that are treated with peritoneal dialysis receive kidney transplants before school age. Most infants that develop acute renal failure have hypotension following cardiac surgery, or multiple organ failure. Sometimes the falls in glomerular filtration and urine output are physiological and reversible, and sometimes due to kidney injury, but (illogically) it is now common to define them all as having 'acute kidney injury'. Contrary to widespread opinion, careful interpretation of the plasma creatinine concentrations can provide sensitive evidence of early acute renal failure...
September 25, 2016: Early Human Development
Alain J Poncelet, Gébrine El Khoury, Laurent De Kerchove, Thierry Sluysmans, Stéphane Moniotte, Mona Momeni, Thierry Detaille, Jean E Rubay
OBJECTIVES: To analyse our institutional results in the setting of paediatric aortic valve (AV) repair. Primary end-points were overall survival, freedom from AV reoperation and freedom from AV replacement. METHODS: A retrospective analysis of all patients under 18 years of age operated on from 1977 to 2015 in a single tertiary care level institution. Patients were included if they benefited from any type of AV repair procedure, including commissurotomy, leaflet shaving or plication, or leaflet augmentation...
September 28, 2016: European Journal of Cardio-thoracic Surgery
Arman Qamar, Deepak L Bhatt
Thrombotic events such as myocardial infarction or stent thrombosis are the major cause of adverse outcomes in patients undergoing percutaneous coronary intervention (PCI). While current antiplatelet agents, anticoagulants, and PCI techniques have reduced the risk of thrombotic events in PCI-treated patients, a considerable hazard still remains. Cangrelor is an intravenous P2Y12 receptor antagonist that provides a rapid onset and maximal platelet inhibition, which is quickly reversible. In the large-scale CHAMPION PHOENIX trial, cangrelor was shown to reduce ischemic events significantly, including myocardial infarction and stent thrombosis, without increasing the risk of severe bleeding across the full spectrum of patients undergoing PCI, with substantial benefits in all patient subgroups examined...
September 27, 2016: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
Hyo Shik Kim, Kyung Eun Lee, Ji Hyun Oh, Chan Sung Jung, Dughyun Choi, Yunsuek Kim, Jin Seok Jeon, Dong Cheol Han, Hyunjin Noh
A 65-year-old man was transferred from the Department of Vascular Surgery to Nephrology because of cardiac arrest during hemodialysis. He underwent incision and drainage for treatment of a buttock abscess. Nafamostat mesilate was used as an anticoagulant for hemodialysis to address bleeding from the incision and drainage site. Sudden cardiac arrest occurred after 15 minutes of dialysis. The patient was treated in the intensive care unit for 5 days. Continuous veno-venous hemodiafiltration was started without any anticoagulant in the intensive care unit...
September 2016: Kidney Research and Clinical Practice
Cecilia Gutierrez, Daniel G Blanchard
Atrial fibrillation is a supraventricular arrhythmia that adversely affects cardiac function and increases the risk of stroke. It is the most common arrhythmia and a major source of morbidity and mortality; its prevalence increases with age. Pulse rate is sensitive, but not specific, for diagnosis, and suspected atrial fibrillation should be confirmed with 12-lead electrocardiography. Because normal electrocardiographic findings do not rule out atrial fibrillation, home monitoring is recommended if there is clinical suspicion of arrhythmia despite normal test results...
September 15, 2016: American Family Physician
Nathalie Costedoat-Chalumeau, Laetitia Coutte, Véronique Le Guern, Nathalie Morel, Gaelle Leroux, Romain Paule, Luc Mouthon, Jean-Charles Piette
The catastrophic antiphospholipid syndrome (CAPS) develops in at least 1% of patients with antiphospholipid syndrome, either primary or associated with systemic lupus erythematosus. CAPS reveals the antiphospholipid syndrome in about 50% of cases. The CAPS is characterized by rapidly-progressive widespread thromboses mainly affecting the microvasculature in the presence of antiphospholipid antibodies. In a few days, the patients develop multiorgan failure with renal insufficiency with severe hypertension, pulmonary, cerebral, cardiac, digestive and/or cutaneous involvement...
September 9, 2016: La Presse Médicale
Kurt D Piggott, Grace George, Harun Fakioglu, Carlos Blanco, Sukumar Saguna Narasimhulu, Kamal Pourmoghadam, Hamish Munroe, William Decampli
AIM: To investigate and describe our current institutional management protocol for single-ventricle patients who must undergo a Ladd's procedure. METHODS: We retrospectively reviewed the charts of all patients from January 2005 to March 2014 who were diagnosed with heterotaxy syndrome and an associated intestinal rotation anomaly who carried a cardiac diagnosis of functional single ventricle and were status post stage I palliation. A total of 8 patients with a history of stage I single-ventricle palliation underwent Ladd's procedure during this time period...
August 8, 2016: World Journal of Clinical Pediatrics
Laurent Macle, John Cairns, Kori Leblanc, Teresa Tsang, Allan Skanes, Jafna L Cox, Jeff S Healey, Alan Bell, Louise Pilote, Jason G Andrade, L Brent Mitchell, Clare Atzema, David Gladstone, Mike Sharma, Subodh Verma, Stuart Connolly, Paul Dorian, Ratika Parkash, Mario Talajic, Stanley Nattel, Atul Verma
The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery...
October 2016: Canadian Journal of Cardiology
M Khoury, A Pitsis, H Poumpouridou-Kioura, G Soufla, C Kanthou, N Matoula, A Angelidis, E Melissari
INTRODUCTION: Systemic anticoagulation is necessary during cardiac surgery. To date, the only well established anticoagulation protocol involves the use of heparin. However, heparin can cause heparin-induced thrombocytopenia (HIT) a potentially life threatening immune-mediated thromboembolic syndrome. Until now, devastating consequences of HIT syndrome in patients undergoing heart surgery have been described, but only postoperatively. Here we report the development of HIT syndrome during cardiac revascularization by intra-operative heparin administration in two patients previously exposed to LMWH...
October 2016: Thrombosis Research
Mikhael F El-Chami, Faisal M Merchant, Paige Smith, Mathew Levy, Angela Gill Nelms, John Merlino, John Puskas, Angel R Leon
BACKGROUND: New-onset postoperative atrial fibrillation (POAF) occurs in up to 30% of patients undergoing coronary artery bypass grafting (CABG). POAF is associated with short- and long-term mortality. METHODS: To identify the true incidence and time course of recurrent atrial fibrillation (AF) in patients with POAF, we prospectively assigned 23 patients with POAF to receive an implantable loop recorder (ILR; Medtronic Inc., Minneapolis, MN, USA) for the detection of recurrent AF...
October 2016: Pacing and Clinical Electrophysiology: PACE
Andreas Schaefer, Yvonne Schneeberger, Daniel Reichart, Alexander M Bernhardt, Mathias Kubik, Markus J Barten, Florian M Wagner, Stefan Kluge, Hermann Reichenspurner, Sebastian A Philipp
Over the last decade the number of heart transplantations declined and the number of implanted left ventricular assist devices (LVAD) markedly increased. Accordingly, common intensive care interventions rise and present their own challenges, especially due to the necessary anticoagulation regimen. One of these procedures is percutaneous dilatation tracheostomy (PDT). We herein report our experience with 34 patients with LVAD and established phrenprocoumon therapy (INR 2.1 ± 0.9, PTT 68.9 ± 19.0 sec...
August 22, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
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