Current Issue : October - December Volume : 2017 Issue Number : 4 Articles : 7 Articles
Background: Large thrombus burdens in ectatic coronary arteries that remain after aspiration thrombectomy can\nnegatively impact outcomes following percutaneous coronary interventions in patients with acute myocardial\ninfarction.\nCase presentation: A 53-year-old man presented with ST-segment elevation myocardial infarction (STEMI).\nCoronary angiography revealed an ectatic right coronary artery (RCA) that was completely occluded in the mid\nportion by a large amount of thrombus. Catheter-directed intracoronary thrombolysis with alteplase led to recovery\nof coronary blood flow, which multiple attempts of aspiration thrombectomy had failed to achieve. Coronary\nangiography 9 days later showed good blood flow and insignificant stenosis remaining in the RCA; this had\ncompletely resolved in 6 months� follow-up coronary angiography.\nConclusion: Catheter-directed intracoronary thrombolysis can be performed effectively and safely when repeat\naspiration thrombectomy fails to produce satisfactory coronary reperfusion in STEMI patients with large thrombus\nburdens in ectatic coronary arteries....
Myriad surgical and medical remedies including Extracorporeal Membrane\nOxygenation (ECMO) are being employed for acute right ventricle with varying\nresults. Very few cases have been documented in literature regarding the\nrole of VA ECMO for right ventricular failure after open heart surgery. We\nretrospectively analyzed all cases eliciting VA ECMO for post-operative right\nheart failure over a period of 24 months. Data was completely delineated for\ndemography, pre-operative patient status at length, brief venipuncture course,\nindications for VA ECMO and its outcome after institution....
Background: High on-treatment platelet reactivity (HPR) represents a strong risk factor for thrombotic events after\nPCI. We aim to evaluate the efficacy and safety of individualizing intensified dual antiplatelet therapy (DAPT) in\nPCI-treated patients with HPR based on platelet function testing (PFT).\nMethods: Electronic databases were searched for randomized control trials that reported the clinical outcomes of\nusing an intensified antiplatelet protocol with P2Y12 receptor inhibitor comparing with standard maintenance dose\nof clopidogrel on the basis of platelet function testing. Clinical endpoints were assessed.\nResults: From 2005 to 2016, thirteen clinical studies comprising 7290 patients were included for analysis. Compared\nwith standard antiplatelet therapy with clopidogrel, the intensified protocol based on platelet function testing was\nassociated with a significant reduction in major adverse cardiovascular events (RR:0.55, 95% CI: 0.36ââ?¬â??0.84, p = 0.005),\ncardiovascular death (RR:0.60, 95% CI: 0.38ââ?¬â??0.96, p = 0.03), stent thrombosis (RR:0.58, 95% CI: 0.36ââ?¬â??0.93, p = 0.02) and\ntarget vessel revascularization (RR:0.33, 95% CI: 0.14ââ?¬â??0.76, p = 0.009). No significant difference was found in the rate\nof bleeding events between intensified and standard protocol.\nConclusions: Compared with standard clopidogrel therapy, individualized intensified antiplatelet therapy on the\nbasis of platelet reactivity testing reduces the incidence of cardiovascular events in patient undergoing PCI, without\nincreasing the risk of bleeding...
The aim of this study was to evaluate whether blood transfusions affect overall survival (OS) and progression-free survival (PFS)\nin newly diagnosed multiple myeloma (MM) patients without hematopoietic stem cell transplantation. A total of 181 patients were\nenrolled and divided into two groups: 68 patients in the transfused group and 113 patients in the nontransfused group. Statistical\nanalyses showed that there were significant differences in ECOG scoring, Ig isotype, platelet (Plt) counts, hemoglobin (Hb) level,\nserum creatinine (Scr) level, and ...
Aluminium phosphide (ALP) is widely used as a fumigant pesticide. In case of ALP poisoning, it is responsible formyocardial dysfunction,\nrelated to toxicmyocarditis, and hemodynamic disorders.We report a case of a 28-year-old female who had intentionally\ningested ALP and was admitted with cardiogenic shock.The transthoracic echocardiography (TTE) at the time of admission showed\nsevere global myocardial hypokinesia with the presence of a giant left ventricular thrombus. Cardiovascular magnetic resonance\n(CMR) revealed extensive toxic myocarditis with a left ventricular systolic dysfunction. All cardiac lesions were reversible after\nsymptomatic treatment, within 6 months. We aim, by reporting this case, to evidence the complete reversibility of cardiac injury\ndue to aluminium phosphide poisoning documented by transthoracic echocardiography and cardiovascular magnetic resonance....
Romiplostim, a thrombopoietin-receptor agonist (TPO-ra), is a highly effective option in primary immune thrombocytopenia\n(ITP), with 80ââ?¬â??90% of patients achieving platelet responses after few weeks of treatment. The evidence showing remissions, that\nis, sustained platelet counts after romiplostim discontinuation, in patients with ITP refractory to immunosuppressive therapy is\nsteadily increasing. However, there is a lack of guidelines or recommendations addressing how and when to taper romiplostim\nin clinical practice in patients maintaining elevated and stable platelet counts. Furthermore, given the high heterogeneity of ITP\npatients, no associated predictive factors have been currently identified. Here, we present 4 representative clinical cases of the daily\nclinical practice in Spain comprising newly diagnosed, persistent, and both splenectomized and nonsplenectomized chronic ITP\npatients treated with romiplostim, achieving and maintaining clinical remission (platelet count ââ?°Â¥ 50 Ã?â?? 109/L for 24 consecutive\nweeks in the absence of any treatment for ITP) after treatment tapering and discontinuation, without observed safety concerns.\nProspective studies identifying clinical and biological predictive factors of sustained response are warranted....
Background: Patients with atrial fibrillation (AF) routinely undergo different imaging modalities for the evaluation of the\nleft atrial (LA) appendage to rule out thrombus prior to the AF ablation procedure. Recently, uninterrupted novel oral\nanticoagulants were introduced for patients undergoing atrial fibrillation (AF) ablation to minimize the peri-procedural\nthromboembolism risk. We performed a retrospective analysis to evaluate the safety of uninterrupted rivaroxaban and\nwhether transesophageal (TEE) or intracardiac echocardiography (ICE) is necessary for patients undergoing AF ablation.\nMethods: Data from 332 consecutive patients (42% females, aged 64 �± 11 years) with AF undergoing either TEE\n(n = 115) prior to catheter ablation or ICE (n = 217) for the detection of LA thrombus were analyzed. All patients were\non uninterrupted rivaroxaban during, and for at least, 4 weeks before the procedure. Heparin bolus was administered\nin all patients before transseptal puncture to maintain a target activated clotting time of >350 s.\nResults: A total of 277 patients (80.4%) had paroxysmal AF. The average CHA2DS2VASc score was 2.11 �± 0.91 in the\nTEE group and 2.46 �± 0.61 in the ICE group. The CHA2DS2VASc score was â�¥2 in 64 (55.7%) and 214 (98.6%) patients in\nthe TEE and ICE groups, respectively. The left atrial appendage was adequately visualized in all cases. None of the\npatients have an identifiable LA thrombus either in the TEE group or the ICE group. One (0.3%) thromboembolic\nperiprocedural stroke occurred in a patient with long-standing persistent AF in the TEE group.\nConclusions: This study illustrates that performing AF ablation with ICE guidance on uninterrupted rivaroxaban for at\nleast 4 weeks even without TEE is feasible and safe....
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