Clinical Cardiology
RSSArticles
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Anticoagulation Management After Intracerebral Hemorrhage in Mechanical Heart Valve Patients
An observational study of patients with mechanical heart valves on oral anticoagulants who had an intracranial hemorrhage demonstrates that it generally is safe to resume anticoagulants after 14 days. However, in high-risk-for-thromboembolism patients, such as those with atrial fibrillation, restarting anticoagulants six to 13 days postoperative may be considered.
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When Can Surgeons Perform Aortic Valve Replacement Safely After a Stroke?
Interrogation of Danish administrative registry data demonstrated that a stroke within three to four months of aortic valve surgery was associated with a higher rate of perioperative stroke.
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Tailored Anticoagulation for Paroxysmal Atrial Fibrillation
Intermittent anticoagulation guided by continuous assessment of arrhythmia status in patients with low-to-moderate risk did not result in any strokes or thromboembolic events over a relatively short follow-up period. Such a strategy may be an alternative to chronic anticoagulation but requires further study.
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Invasive Procedures and the Risk of Infective Endocarditis
This large study suggests that several invasive, nondental medical procedures may be triggers for subsequent infective endocarditis, reopening the debate regarding prevention and management.
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Choosing a Vasopressor in Cardiogenic Shock: Is There a Difference?
When studying cardiogenic shock after acute myocardial infarction, these investigators found using epinephrine compared to norepinephrine produced similar effects on blood pressure and cardiac index, but resulted in a higher incidence of refractory cardiogenic shock.
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Simple Prediction Tool Facilitates Diagnosis of Heart Failure With Preserved Ejection Fraction
In patients with unexplained dyspnea, a score based on six noninvasive criteria can predict the likelihood of heart failure with preserved ejection fraction.
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Mortality Risk Score for Degenerative Mitral Regurgitation
An international database of patients with significant degenerative mitral valve regurgitation was used to derive and test a score using clinical and echocardiographic data to estimate mortality with medical and surgical therapy. From seven weighted characteristics, investigators developed a 0-12 score that predicted medical and surgical long-term mortality with high discriminatory ability (C-statistic, 0.78 and 0.81, respectively). Investigators found the score added incremental information to surgical scores and believe that it will be useful for therapeutic decision-making.
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Long-term Risk of Transient Atrial Fibrillation After Coronary Artery Bypass Graft Surgery
Investigators compared post-coronary artery bypass graft (CABG) atrial fibrillation (AF) to non-surgical, non-valvular AF in a large cohort derived from the Danish health system database. Despite a lower rate of oral anticoagulant use compared to non-valvular AF patients and equivalent CHA2DS2-VASc scores, post-CABG AF demonstrated a lower risk of thromboembolism, death, and recurrent AF. These data do not support the concept that post-CABG AF is the same as traditional non-valvular AF regarding thromboembolic risk.
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Drug-eluting Stents Fare No Better Than Bare-metal Stents in Vein Graft Lesions
The two largest randomized trials to date have shown no advantage to drug-eluting stents compared to bare-metal stents in saphenous vein graft percutaneous interventions.
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CABANA Trial Reveals New Insights About Ablation for Atrial Fibrillation
Ablation for atrial fibrillation did not reduce the composite endpoint of death, disabling stroke, serious bleeding, or cardiac arrest compared with drug therapy, although adverse events were infrequent and arrhythmia recurrence was reduced significantly.