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Atrial fibrillation prophylaxis in cardiac surgery

Jason W Greenberg, Timothy S Lancaster, Richard B Schuessler, Spencer J Melby
Postoperative atrial fibrillation (POAF) is a common, expensive and potentially morbid complication following cardiac surgery. POAF occurs in around 35% of cardiac surgery cases and has a peak incidence on postoperative day 2. Patients who develop POAF incur on average $10 000-$20 000 in additional hospital treatment costs, 12-24 h of prolonged ICU time, and an additional 2 to 5 days in the hospital. POAF has been identified as an independent predictor of numerous adverse outcomes, including a 2- to 4-fold increased risk of stroke, reoperation for bleeding, infection, renal or respiratory failure, cardiac arrest, cerebral complications, need for permanent pacemaker placement, and a 2-fold increase in all-cause 30-day and 6-month mortality...
March 27, 2017: European Journal of Cardio-thoracic Surgery
Zeyad Al-Shawabkeh, Khalid Al-Nawaesah, Razi Abu Anzeh, Hael Al-Odwan, Wasfi Azyoud Bashar Al-Rawashdeh, Haetham Altaani
OBJECTIVES: To assess the effectiveness of corticosteroids in the prophylaxis of postoperative atrial fibrillation (AF) in patients undergoing elective coronary artery bypass grafting or valvular heart surgery in terms of reducing its incidence and decreasing the length of hospital stay. METHODS: This prospective double blinded randomized study was conducted at Queen Alia Heart Institute (Amman, Jordan) from June 2014 to June 2015 on 340 patients who underwent their first on-pump elective coronary artery bypass grafting (CABG) alone or combined with valvular surgery...
January 2017: Journal of the Saudi Heart Association
Paria Habibollahi, Shahrzad Hashemi Jam, Samad Shams Vahdati, Hamidreza Morteza Baghi, Hassan Amiri
BACKGROUND: Atrial fibrilation (AF) is the most common complication following heart surgeries; it often occurs in patients after coronary artery bypass graft (CABG). The purpose of this review is to categorize prophylaxes or treatment by administration of Amiodaron in patients with CABG. DATA RESOURCES: We searched google scholar, pubmed, and Cochrane Library databases (the period 1970-2010) for articles on Amiodaron in CABG and cardiac surgery. A total of 1 561 articles were identified, and 30 articles met the criteria and were enrolled in this review...
2016: World Journal of Emergency Medicine
Amr S Omar, Hesham Ewila, Mahmoud Allam, Sameh Aboulnagah, Samy Hanoura, Praveen C Sivadasan, Ousama Bilal, Abdul Rasheed A Pattath, Abdulaziz AlKhulaifi
OBJECTIVES: Postoperative atrial fibrillation (POAF) remains a major risk after cardiac surgery. Twelve percent patients admitted to this unit postcardiac surgery experienced POAF, which led to hemodynamic instability, increased risk of stroke, and increased length of postoperative intensive care unit stay. Our aim was to decrease the incidence of POAF in the cardiothoracic intensive care unit by the end of April 2014. METHODS: Design-Retrospective data analysis...
December 8, 2016: Journal of Intensive Care Medicine
William L Baker, Craig I Coleman
PURPOSE: Results of a systematic review and meta-analysis of published data on use of ascorbic acid to prevent postoperative atrial fibrillation (POAF) after cardiac surgery are presented. METHODS: MEDLINE and other sources were searched for reports on trials evaluating the effects of preoperative and/or postoperative use of ascorbic acid in patients undergoing cardiac surgery. For each study selected for meta-analysis, an assessment for risks of methodological bias was performed...
December 15, 2016: American Journal of Health-system Pharmacy: AJHP
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...
November 2016: Archives of Cardiovascular Diseases
Evangelos Polymeropoulos, Pantelis Bagos, Maria Papadimitriou, Ioannis Rizos, Efstratios Patsouris, Ioannis Τoumpoulis
PURPOSE: Several studies have investigated the administration of vitamin C (vitC) for the prevention of postoperative atrial fibrillation (AF) after cardiac surgery. However, their findings were inconsistent. The purpose of this meta-analysis was to evaluate the efficacy of vitC as prophylaxis for the prevention of postoperative AF in cardiac surgery. METHODS: A systematic search of PubMed, EMBASE, Google Scholar, the Cochrane Library, and clinical trial registries, was performed...
June 2016: Advanced Pharmaceutical Bulletin
Yolanda Carrascal, Roman J Arnold, Luis De la Fuente, Ana Revilla, Teresa Sevilla, Nuria Arce, Gregorio Laguna, Pilar Pareja, Miriam Blanco
BACKGROUND: To evaluate the efficacy of perioperative atorvastatin administration for prophylaxis of postoperative atrial fibrillation (POAF) after heart valve surgery. METHODS: Our study included 90 patients with heart valve disease who were scheduled to undergo elective cardiac surgery. Cases with previous AF or preoperative beta-blocker therapy were excluded. Patients were randomized into the atorvastatin group, which included 47 patients who received 40 mg/day of atorvastatin 7 days before and after the surgery and the control group, which included 43 patients...
June 2016: Journal of Arrhythmia
Mohammad Hassan Nemati, Behrooz Astaneh
BACKGROUND: Atrial fibrillation (AF) is one of the most common complications after cardiac surgery. Several therapeutic and preventive strategies have been introduced for postoperative AF, but the treatment and prophylaxis of AF remain controversial. We aimed to compare the efficacy of intravenous amiodarone and oral propafenone in the treatment of AF after coronary artery bypass grafting (CABG). METHODS: This was a randomized controlled trial performed in two hospitals in Shiraz, Iran from 2009 to 2012...
June 2016: Korean Journal of Thoracic and Cardiovascular Surgery
Shobhit V Minhas, Preeya Goyal, Alpesh A Patel
BACKGROUND: Perioperative cerebrovascular accidents (CVAs) are one of the leading causes of patient morbidity, mortality, and medical costs. However, little is known regarding the rates of these events and risk factors for CVA after elective orthopaedic surgery. QUESTIONS/PURPOSES: Our goals were to (1) establish the national, baseline proportion of patients experiencing a 30-day CVA and the timing of CVA; and (2) determine independent risk factors for 30-day CVA rates after common elective orthopaedic procedures...
March 2016: Clinical Orthopaedics and related Research
Rustin G Kashani, Sohail Sareh, Bradley Genovese, Christina Hershey, Corrine Rezentes, Richard Shemin, Eric Buch, Peyman Benharash
BACKGROUND: Postoperative atrial fibrillation (POAF) is the most frequent complication of cardiac surgery and is associated with increased morbidity and mortality. Pharmacologic prophylaxis is the main method of preventing POAF but needs to be targeted to patients at high risk of developing POAF. The CHA2DS2-VASc scoring system is a clinical guideline for assessing ischemic stroke risk in patients with atrial fibrillation. The present study evaluated the utility of this scoring system in predicting the risk of developing de novo POAF in cardiac surgery patients...
October 2015: Journal of Surgical Research
Giuseppe Santarpia, Antonio Curcio, Gerolamo Sibilio, Ciro Indolfi
Atrial fibrillation (AF) is the most commonly observed rhythm disorder in clinical practice. It is associated with a high risk of thromboembolic stroke and increased cardiovascular mortality. Vitamin K antagonists (VKAs), the only oral anticoagulants used for thromboembolic prophylaxis in AF patients over the past 60 years, have been effective in reducing thromboembolic stroke, compared with placebo and aspirin, in this group of patients. However, VKAs have a very narrow therapeutic window, so regular monitoring of the therapeutic effect is obligatory for their use...
2015: Circulation Journal: Official Journal of the Japanese Circulation Society
Ebrahim Mansoor
Atrial fibrillation (AF) is the most common complication post cardiac surgery and results in elevated morbidity and mortality rates and healthcare costs. A pilot, retrospective study of the medical records of all adult patients developing de novo AF post surgery was undertaken at the cardiac surgical unit in Durban between 2009 and 2012. We aimed to describe the local experience of AF with a view to suggesting an adapted local treatment policy in relation to previously published data. Fifty-nine patients developed AF during the study period...
November 2014: Cardiovascular Journal of Africa
Krzysztof Kępa, Łukasz Krzych, Michał Krejca
INTRODUCTION: The majority of evidence for use of gentamicin-containing collagen implants (GCCI) demonstrates a positive impact on infection prophylaxis despite the equivocal results of a recently published large-scale study. The primary aim of the study was to evaluate the impact of prophylactic use of GCCI on SWI following cardiac surgery in a routine clinical setting. A secondary aim was to identify the risk factors for SWI among the patient cohort. METHODS: A consecutive series of patients who had undergone sternotomy were analysed on a retrospective basis...
January 2015: International Journal of Surgery
Xiao Dong Feng, Xue Ning Wang, Xin Hiu Yuan, William Wang
OBJECTIVE: Postoperative atrial fibrillation (POAF) is the most frequent complication arising after cardiac surgery, occurring in 30% of cases. Amiodarone is the most effective drug for prophylaxis and treatment. However, because of significant extracardiac side effects, only high-risk patients are eligible for prophylactic amiodarone therapy. We performed a randomized prospective study of 100 patients undergoing cardiac surgery with epicardial application of amiodarone-releasing hydrogel to determine the effectiveness of preventing POAF...
September 2014: Journal of Thoracic and Cardiovascular Surgery
Jia Hu, Ling Peng, Hong Qian, Ya-jiao Li, Wei Meng, Zheng-hua Xiao, Jing Janice Zhao, Jonathan Zhao Hu, Er-yong Zhang
OBJECTIVES: Recent studies suggested association between impaired left ventricular long-axis function and arrhythmic events early after open heart surgery. This prospective study investigated the predictive value of a depressed intraoperative global longitudinal strain (GLS) for postoperative atrial fibrillation after isolated aortic valve replacement in patients with preserved ejection fraction. METHODS: A total of 107 patients with ejection fraction ≥50% and moderate-to-severe aortic stenosis undergoing isolated aortic valve replacement were enrolled...
May 2015: European Journal of Cardio-thoracic Surgery
Daniel J Culkin, Emilio J Exaire, David Green, Mark S Soloway, Andreas J Gross, Maheshbhai R Desai, James R White, Deborah J Lightner
PURPOSE: Given the lack of urology specific directives for the periprocedural management of anticoagulant and antiplatelet medications, the AUA (American Urological Association) and ICUD (International Consultation on Urological Disease) named an international multidisciplinary panel to develop consensus based recommendations. MATERIALS AND METHODS: A systematic literature review was queried by a methodologist for 3 questions. 1) When and in whom can anticoagulant/antiplatelet prophylaxis be stopped in preparation for surgery? 2) What procedures can be safely performed without discontinuing anticoagulant/antiplatelet prophylaxis? 3) What periprocedural strategies can adequately balance the risk of major surgical bleeding vs the risk of major thrombotic event? Hematology and cardiology guidelines, and 79 articles were selected for full review...
October 2014: Journal of Urology
Hui-Shan Wang, Zeng-Wei Wang, Zong-Tao Yin
BACKGROUND: Postoperative atrial fibrillation (POAF) remains the most common complication after cardiac surgery. Current guidelines recommend β-blockers to prevent POAF. Carvedilol is a non-selective β-adrenergic blocker with anti-inflammatory, antioxidant, and multiple cationic channel blocking properties. These unique properties of carvedilol have generated interest in its use as a prophylaxis for POAF. OBJECTIVE: To investigate the efficacy of carvedilol in preventing POAF...
2014: PloS One
Sohail Sareh, William Toppen, Laith Mukdad, Nancy Satou, Richard Shemin, Eric Buch, Peyman Benharash
BACKGROUND: Atrial fibrillation (AF) following cardiac surgery portends higher morbidity and increased health expenditure. Although many anatomic and patient risk factors have been identified, a simple clinical scoring system to identify high-risk patients is lacking. The CHADS2 score is widely used to predict the risk of stroke in patients with AF. We assessed the utility of this scoring algorithm in predicting the development of de novo postoperative atrial fibrillation (POAF) in cardiac surgery patients...
August 2014: Journal of Surgical Research
Chao Liu, Jinghui Wang, Daofeng Yiu, Kunshen Liu
AIMS: cardiopulmonary bypass and cardiac surgery are associated with a significant systemic inflammatory response that has been suggested playing a causative role in the development of perioperative atrial fibrillation (POAF). The goal of this meta-analysis was to determine the efficacy of glucocorticoid prophylaxis in preventing POAF, or length of intensive care unite (ICU) or hospital stay. METHODS: A systematic electronic database literature search of Cochrane controlled trials register (2013, issue 4) and MEDLINE (1966 to April, 2013) was conducted using specific search terms for all relevant articles...
June 2014: Cardiovascular Therapeutics
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