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Atrial fibrillation prophylaxis in cardiac surgery

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
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
George Tokmaji, R Scott McClure, Tsuyoshi Kaneko, Sary F Aranki
With more than a third of patients expected to endure the arrhythmia at any given time point, atrial fibrillation after cardiac surgery becomes a vexing problem in the postoperative care of cardiac surgery patients. The impact on patient care covers a spectrum from the more common clinically insignificant sequelae to debilitating embolic events. Despite this, postoperative atrial fibrillation generally masquerades as being insignificant, or at most as an anticipated inherent risk, merely extending one's hospital stay by a few days...
2013: Cardiology Research and Practice
Ahmet Feyzi Abacilar, Omer Faruk Dogan
BACKGROUND: Atrial fibrillation (AF) often occurs after coronary artery bypass grafting (CABG) and can result in increased morbidity and mortality due to complications. In the present study, our goal was to investigate whether the use of levosimendan can reduce the frequency of AF after coronary artery bypass grafting in patients with poor left ventricle function. MATERIAL AND METHODS: To investigate the effectiveness of levosimendan in the prophylaxis of AF, we conducted a prospective, randomized, placebo-controlled clinical study on 200 consecutive patients in whom we performed elective CABG operations...
October 2013: Heart Surgery Forum
Janina M Jeff, Brian S Donahue, Kristin Brown-Gentry, Dan M Roden, Dana C Crawford, C Michael Stein, Daniel Kurnik
BACKGROUND: Postoperative atrial fibrillation (PoAF) after cardiac surgery is common and associated with increased morbidity and mortality. Increased sympathetic activation after surgery contributes to PoAF, and β-blockers are the first-line recommendation for its prevention. We examined the hypothesis that common functional genetic variants in the β1-adrenoreceptor, the mediator of cardiac sympathetic activation and drug target of β-blockers, are associated with the risk for PoAF and with the protective effect of β-blockers...
January 2014: American Heart Journal
M Maaroos, R Tuomainen, J Price, F D Rubens, R L Jideus, J Halonen, J Hartikainen, T Hakala
BACKGROUND AND AIMS: Atrial fibrillation is a common arrhythmia after cardiac surgery. It increases morbidity, length of hospital stay, and costs of operative treatment. Beta-blockers, sotalol, amiodarone, corticosteroids, and biatrial pacing have been shown to be efficient in the prevention of postoperative atrial fibrillation. The aim of this study was to find out how widely different prophylactic strategies for postoperative atrial fibrillation are used in Scandinavian countries. MATERIAL AND METHODS: An online link for a questionnaire was emailed to (214) cardiac surgeons in Finland, Sweden, Norway, Denmark, and Estonia to assess the use of prophylactic methods for postoperative atrial fibrillation...
2013: Scandinavian Journal of Surgery: SJS
Brian J Potter, Peter Leong-Sit, Susan M Fernandes, Andrew Feifer, John E Mayer, John K Triedman, Edward P Walsh, Michael J Landzberg, Paul Khairy
BACKGROUND: Patients with univentricular hearts and Fontan palliation are at risk for thromboembolic complications. While aspirin and warfarin therapies are currently the mainstay of prophylaxis, controversy exists as to the optimal prevention strategy. METHODS: A cohort study was conducted on the New England registry of patients born in 1985 or earlier with Fontan surgery at Boston Children's Hospital, in order to assess and compare the effect of prophylactic aspirin and warfarin on incident thromboembolic events...
October 9, 2013: International Journal of Cardiology
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