The individual approach to management of patients with atrial fibrillation and its influence on patient adherence to anticoagulant therapy

Abstract Background The key points in the treatment of patients with atrial fibrillation (AF) with the ABC (Atrial Fibrillation Better Care) pathway are the prevention of stroke and increasing patient adherence to therapy. The basis for increasing adherence to therapy is regular communication between medical staff and the patients. Purpose To assess the effect of telephone contact (TC) frequency on patient adherence to anticoagulant therapy (ACT). Methods A prospective, non-interventional observational study was carried out, during which 84 patients with non-valvular AF were observed remotely after being discharged from the hospital. Patient education was provided in the hospital, which included an explanation of the importance of ACT. The observation period was 12 months. All enrolled patients were 18 years of age or older; AF was documented before enrolment on the basis of objective electrocardiographic evaluation; all patients had indications for taking anticoagulants (AC) for stroke prevention. Adherence to therapy was assessed using the Morisky-Green test. Results The patients were randomized into 2 groups: group 1 – TC monthly, group 2 – TC every 6 months. In the first group, 85.7% of patients received the non–vitamin K antagonist oral anticoagulants (NOAC), and 14.3% received warfarin; in the 2nd group, 92.9% of patients received NOAC, and 7.1% received warfarin. The mean score of the adherence to therapy according to the Morisky-Green test was initially 3.3±0.8 in group 1, and 3.3±0.7 in group 2, p=0.78. After 12 months: in group 1, 14.6% of patients refused to take AC; and in group 2, 25.0% did the same. The mean value score of the adherence to therapy in group 1 underwent a statistically insignificant change over time (from 3.3±0.8 to 3.1±1.5, p=0.48). In group 2, after 12 months, the mean score of adherence to therapy saw a significant decrease from 3.3±0.7 to 2.7±1.6, p=0.03. Both in group 1 and in group 2, the decrease in the mean score of adherence to therapy occurred mainly due to patients with an initially insufficient level of adherence. Conclusions The results of our study confirm the need for individual strategy for managing patients through the ABC pathway. In most cases, face-to-face or telephone contact with medical staff once every six months is sufficient for patients who are initially adherent to therapy, after receiving an introductory briefing. Patients with insufficient level of adherence require more frequent contact. FUNDunding Acknowledgement Type of funding sources: None.

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P318 Left atrial dysfunction assessed by echocardiography in relation to left atrial fibrosis in patients undergoing ablation for atrial fibrillation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.171 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

E Pilichowska ◽

J Baran ◽

P Kulakowski ◽

B Zaborska

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Systolic Function ◽

Electrophysiological Study ◽

Stiffness Index ◽

P Value ◽

Group 2 ◽

Left Atrial Dysfunction ◽

Left Atrial Fibrosis ◽

Group 1

Abstract PURPOSE Left atrial (LA) fibrosis is the hallmark of LA remodeling in atrial fibrillation (AF), alters LA function and may predict poor catheter ablation (CA) outcome. LA fibrosis may be assessed invasively using electroanatomical mapping (EAM) during electrophysiological study. The aim was to assess LA function parameters in relation to degree of LA fibrosis derived from EAM in patients with AF. METHODS Patients (pts) n = 39 (79% males, mean age 56+/-10) with non-valvular AF were studied with TTE and TEE before first CA during sinus rhythm. LA strain (LAS) and strain rate (LASR) were analyzed in reservoir (r), conduit (cd) and contractile (ct) phases. The velocities of mitral A, E" and A" were measured with Doppler. E/E" and LA stiffness index - the ratio of E/E" to LASr were assessed. LA appendage flow velocity (LAAv) was measured in TEE. LA volume using biplane area-length method was calculated. The EAM of LA was build using Carto System before CA. Low amplitude potentials area (LAPA) was quantitatively analyzed and expressed as a percentage of LA surface using the cut-off <0.5 mV to detect sites of fibrosis. LA parameters were compared between mild (LAPA <10%) moderate (LAPA 10-40%) and extensive degree of LA fibrosis (LAPA >40%) (table). RESULTS The mean LA volume was 35 ± 11 mL/m². The LAPA ranged from 2 to 78 % of LA surface. Reduced LA function was observed in the LAPA >40% group. Extensive LAPA altered mainly LA compliance parameters. Traditional LA systolic function parameters did not differ in relation to degree of LAPA. CONCLUSION LA compliance is mostly affected by LA fibrosis, thus LA diastolic parameters may be useful in the noninvasive assessment of LA fibrosis. Whether these parameters should be a part of the proper selection of candidates for CA requires further studies. LA function parameters LA parameters Group 1 LAPA <10% n = 13 Group 2 LAPA >10% <40% n = 13 Group 3 LAPA >40% n = 13 P-value Group 1 + 2 vs 3 Mitral A 0.55 ± 0.10 0.55 ± 0.24 0.73 ± 0.32 0.077 A" 9.19 ± 1.74 7.85 ± 1.43 7.92 ± 2.40 0.376 LASr 31.48 ± 4.52 26.48 ± 8.79 19.63 ± 6.76 <0.001 LAScd 17.30 ± 3.05 15.44 ± 6.93 10.91 ± 4.04 0.003 LASct 14.18 ± 5.36 11.05 ± 3.67 8.72 ± 4.78 0.024 LASRr 1.22 ± 0.19 1.24 ± 0.21 0.92 ± 0.20 <0.001 LASRct -1.71 ± 0.46 -1.37 ± 0.34 -1.04 ± 0.33 <0.001 LA stiffness 0.20 ± 0.07 0.34 ± 0.17 0.63 ± 0.29 <0.001 LAAv 0.83 ± 0.18 0.55 ± 0.17 0.60 ± 0.16 0.178

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Creation of physiologic rhythm by closed loop stimulation in heart failure patients with severe chronotropic incompetence: worldwide first results of a pilot study

European Heart Journal ◽

10.1093/ehjci/ehaa946.0803 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Proff ◽

B Merkely ◽

R Papp ◽

C Lenz ◽

P.J Nordbeck ◽

...

Keyword(s):

Heart Rate ◽

Closed Loop ◽

Funding Source ◽

Chronotropic Incompetence ◽

First Results ◽

The Mean ◽

Group 2 ◽

Group 1

Abstract Background The prevalence of chronotropic incompetence (CI) in heart failure (HF) population is high and negatively impacts prognosis. In HF patients with an implanted cardiac resynchronisation therapy (CRT) device and severe CI, the effect of rate adaptive pacing on patient outcomes is unclear. Closed loop stimulation (CLS) based on cardiac impedance measurement may be an optimal method of heart rate adaptation according to metabolic need in HF patients with severe CI. Purpose This is the first study evaluating the effect of CLS on the established prognostic parameters assessed by the cardio-pulmonary exercise (CPX) testing and on quality of life (QoL) of the patients. Methods A randomised, controlled, double-blind and crossover pilot study has been performed in CRT patients with severe CI defined as the inability to achieve 70% of the age-predicted maximum heart rate (APMHR). After baseline assessment, patients were randomised to either DDD-CLS pacing (group 1) or DDD pacing at 40 bpm (group 2) for a 1-month period, followed by crossover for another month. At baseline and at 1- and 2-month follow-ups, a CPX was performed and QoL was assessed using the EQ-5D-5L questionnaire. The main endpoints were the effect of CLS on ventilatory efficiency (VE) slope (evaluated by an independent CPX expert), the responder rate defined as an improvement (decrease) of the VE slope by at least 5%, percentage of maximal predicted heart rate reserve (HRR) achieved, and QoL. Results Of the 36 patients enrolled in the study, 20 fulfilled the criterion for severe CI and entered the study follow-up (mean age 68.9±7.4 years, 70% men, LVEF=41.8±9.3%, 40%/60% NYHA class II/III). Full baseline and follow-up datasets were obtained in 17 patients. The mean VE slope and HRR at baseline were 34.4±4.4 and 49.6±23.8%, respectively, in group 1 (n=7) and 34.5±12.2 and 54.2±16.1% in group 2 (n=10). After completing the 2-month CPX, the mean difference between DDD-CLS and DDD-40 modes was −2.4±8.3 (group 1) and −1.2±3.5 (group 2) for VE slope, and 17.1±15.5% (group 1) and 8.7±18.8% (group 2) for HRR. Altogether, VE slope improved by −1.8±2.95 (p=0.31) in DDD-CLS versus DDD-40, and HRR improved by 12.9±8.8% (p=0.01). The VE slope decreased by ≥5% in 47% of patients (“responders to CLS”). The mean difference in the QoL between DDD-CLS and DDD-40 was 0.16±0.25 in group 1 and −0.01±0.05 in group 2, resulting in an overall increase by 0.08±0.08 in the DDD-CLS mode (p=0.13). Conclusion First results of the evaluation of the effectiveness of CLS in CRT patients with severe CI revealed that CLS generated an overall positive effect on well-established surrogate parameters for prognosis. About one half of the patients showed CLS response in terms of improved VE slope. In addition, CLS improved quality of life. Further clinical research is needed to identify predictors that can increase the responder rate and to confirm improvement in clinical outcomes. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Biotronik SE & Co. KG

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Anxiety-depressive disorders and quality of life in patients with atrial fibrillation

European Heart Journal ◽

10.1093/ehjci/ehaa946.0384 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Demenko ◽

G.A Chumakova

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Atrial Fibrillation ◽

Correlation Analysis ◽

Depressive Disorders ◽

Life Assessment ◽

Mild Depression ◽

Group 2 ◽

Group 1

Abstract Background Mental disorders in patients with cardiovascular disease have a significant impact on the course, the prognosis of the underlying disease and quality of life (QOL). Objective We aimed to examine the prevalence of anxiety and depressive disorders and their impact on the quality of life in patients with atrial fibrillation (AF). Materials and methods In 52 with permanent AF and 50 with paroxysmal AF patients, we administered the depression scale Tsung, the scale of situational anxiety (SA) and personal anxiety (PA) Spielberger-Hanin; QOL was assessed the SF-36 quality of life assessment scale. Correlation analysis using Spearman's rank correlation coefficient. Results The prevalence symptoms mild depression situational or neurotic genesis was 21.1% (12 patients) in Group 1 and 12.0% (6 patients) in Group 2 (p>0.05). Subdepressive state was two percents of patients in Group 1 and Group 2. The incidence SA was 59.6% (31 patients) in Group 1 and 52.0% (26 patients) in Group 2. The incidence PA was 74.0% (37 patients) in Group 2 and 67.3% (35 patients) in Group 1. The average score the physical component of health (PCH) was 29,8±4,3 in Group 1, the mental component of health (MCH) – 49.5±7.4 points; p<0.05. In Group 2: PCH – 44.8±6.6 points, MCH – 26.6±7.5 points; p<0.05. Correlation analysis showed negative strong correlations between SA and MCH (r=−0.64, p=0.0005) and between PA and MCH (r=−0.69, p<0.0001), between SA and PCH (r=−0.71, p=0.0001), between depression and PCH (r=−0.69, p=0.023). Negative statistically significant correlation between depression and MCH (r=−0.69, p=0.54) and negative medium correlation between depression and PCH (r=−0.64, p=0.23). Conclusion These findings suggest that we did not identify patients with symptoms of a true depressive (that can cause pseudodementia and influenced to complete tests). 16.5% patients with AF had mild depression of situational or neurotic genesis. Depression may be a pathogenetic factor of AF or develop because of paroxysms AF – psychological stress. More than 50% patients in Group 1 and Group 2 had an increased anxiety score. SA is more common in patients with permanent AF, probably because older people difficult to adapt to a new situation. PA is more common in patient with paroxysmal AF, probably because disease is sudden and causes anxiety. The PCH of QOL is more impairment in patients with permanent AF, because complications (for example heart failure) impairment physical activity. However, PCH also reduced in patient with paroxysmal AF, because disease is sudden may occur during physical activity. The MCH of QOL is more impairment in patients with paroxysmal AF, because waiting attack effect on mental health and social functioning. An increased level of anxiety and depression negatively affected the mental and physical health of patients with AF. Funding Acknowledgement Type of funding source: None

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Real-time local impedance monitoring to assess tissue lesion during pulmonary vein isolation: a new tool for AF ablation

European Heart Journal ◽

10.1093/ehjci/ehaa946.0562 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Di Cori ◽

L Segreti ◽

G Zucchelli ◽

S Viani ◽

F Tarasco ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Contact Force ◽

Vascular Complications ◽

Lesion Formation ◽

Tissue Impedance ◽

Af Ablation ◽

Group 2 ◽

Group 1

Abstract Background Contact force catheter ablation is the gold standard for treatment of atrial fibrillation (AF). Local tissue impedance (LI) evaluation has been recently studied to evaluate lesion formation during radiofrequency ablation. Purpose Aim of the study was to assess the outcomes of an irrigated catether with LI alghorithm compared to contact force (CF)-sensing catheters in the treatment of symptomatic AF. Methods A prospective, single-center, nonrandomized study was conducted, to compare outcomes between CF-AF ablation (Group 1) and LI-AF ablation (Group 2). For Group 1 ablation was performed using the Carto 3© System with the SmartTouch SF catheter and, as ablation target, an ablation index value of 500 anterior and 400 posterior. For Group 2, ablation was performed using the Rhythmia™ System with novel ablation catheter with a dedicated algorithm (DirectSense) used to measure LI at the distal electrode of this catheter. An absolute impedance drop greater than 20Ω was used at each targeted. According to the Close Protocol, ablation included a point by point pulmonary vein isolation (PVI) with an Inter-lesion space ≤5 mm in both Groups. Procedural endpoint was PVI, with confirmed bidirectional block. Results A total of 116 patients were enrolled, 59 patients in Group 1 (CF) and 57 in Group 2 (LI), 65 (63%) with a paroxismal AF and 36 (37%) with a persistent AF. Baseline patients features were not different between groups (P=ns). LI-Group showed a comparable procedural time (180±89 vs 180±56, P=0.59) but with a longer fluoroscopy time (20±12 vs 13±9 min, P=0.002). Wide antral isolation was more often observed in CF-Group (95% vs 80%, P=0.022), while LI-Group 2 required frequently additional right or left carina ablation (28% vs 14%, P=0.013). The mean LI was 106±14Ω prior to ablation and 92.5±11Ω after ablation (mean LI drop of 13.5±8Ω) during a median RF time of 26 [19–34] sec for each ablation spot. No steam pops or complications during the procedures were reported. The acute procedural success was 100%, with all PVs successfully isolated in all study patients. Regarding safety, only minor vascular complications were observed (5%), without differences between groups (p=0.97). During follow up, 9-month freedom from atrial fibrillation/atrial flutter/atrial tachycardia recurrence was 86% in Group 1 and 75% in Group 2 (P=0.2). Conclusions An LI-guided PV ablation strategy seems to be safe and effective, with acute and mid-term outcomes comparable to the current contact force strategy. LI monitoring could be a promising complementary parameter to evaluate not only wall contact but also lesion formation during power delivery. Procedural Outcomes Funding Acknowledgement Type of funding source: None

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Comparison of the ATRIA, CHA2DS2-VASc, and Modified Scores ATRIA-HSV, CHA2DS2-VASc-HS, for the Prediction of Coronary Artery Disease Severity

Angiology ◽

10.1177/0003319721991410 ◽

2021 ◽

pp. 000331972199141

Author(s):

Arafat Yildirim ◽

Mehmet Kucukosmanoglu ◽

Fethi Yavuz ◽

Nermin Yildiz Koyunsever ◽

Yusuf Cekici ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Vascular Disease ◽

Operating Characteristics ◽

Coronary Artery Disease Severity ◽

Group 3 ◽

The Mean ◽

Group 2 ◽

Artery Disease ◽

Group 1

Many parameters included in the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke, vascular disease, age 65-74 years, sex category) scores also predict coronary artery disease (CAD). We modified the ATRIA score (ATRIA-HSV) by adding hyperlipidemia, smoking, and vascular disease and also male sex instead of female. We evaluated whether the CHA2DS2-VASc, CHA2DS2-VASc-HS, ATRIA, and ATRIA-HSV scores predict severe CAD. Consecutive patients with coronary angiography were prospectively included. A ≥50% stenosis in ≥1epicardial coronary artery (CA) was defined as severe CAD. Patient with normal CA (n = 210) were defined as group 1, with <50% CA stenosis (n = 178) as group 2, and with ≥50% stenosis (n = 297) as group 3. The mean ATRIA, ATRIA-HSV, CHA2DS2-VASc, and CHA2DS2VASc-HS scores increased from group 1 to group 3. A correlation was found between the Synergy between PCI with Taxus and Cardiac Surgery score and ATRIA ( r = 0.570), ATRIA-HSV ( r = 0.614), CHA2DS2-VASc ( r = 0.428), and CHA2DS2-VASc-HS ( r = 0.500) scores ( Ps < .005). Pairwise comparisons of receiver operating characteristics curves showed that ATRIA-HSV (>3 area under curve [AUC]: 0.874) and ATRIA (>3, AUC: 0.854) have a better performance than CHA2DS2-VASc (>1, AUC: 0.746) and CHA2DS2-VASc-HS (>2, AUC: 0.769). In conclusion, the ATRIA and ATRIA-HSV scores are simple and may be useful to predict severe CAD.

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Does Presurgical Nasoalveolar Molding Have a Long-Term Effect on Nasal and Upper Airway Dimensions?

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620980234 ◽

2020 ◽

pp. 105566562098023

Author(s):

Ashwina S. Banari ◽

Sanjeev Datana ◽

Shiv Shankar Agarwal ◽

Sujit Kumar Bhandari

Keyword(s):

Upper Airway ◽

P Value ◽

Airway Patency ◽

The Mean ◽

Group 2 ◽

Acoustic Pharyngometry ◽

Nasoalveolar Molding ◽

Area And Volume ◽

Group 1

Objectives: To compare nasal and upper airway dimensions in patients with cleft lip and palate (CLP) who underwent nasoalveolar molding (NAM) with those without NAM during infancy using acoustic pharyngometry and rhinometry. Materials and Methods: Eccovision acoustic pharyngometry and rhinometry (Sleep Group Solutions) was used for assessment of mean area and volume of nasal and upper airway in patients with complete unilateral CLP (age range 16-21 years) treated with NAM (group 1, n = 19) versus without NAM (group 2, n = 22). Results: The mean nasal cross-sectional areas and volume were higher in group 1 compared to group 2 on both cleft ( P value <.001) and noncleft side ( P value >.05). The mean area and volume of upper airway were also significantly higher in group 1 compared to group 2 ( P value <.05). Conclusions: Nasoalveolar molding being one of the first interventions in chronology of treatment of patients with CLP, its long-term outcome on nasal and upper airway patency needs to be ascertained. The results of the present study show that the patients with CLP who have undergone NAM during infancy have better improvement in nasal and upper airway patency compared with those who had not undergone NAM procedure. The basic advantages of being noninvasive, nonionizing and providing dynamic assessment of nasal and upper airway patency make acoustic pharyngometry and rhinometry a diagnostic tool of choice to be used in patients with CLP.

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Comparison of Bite Force in Patients After Treatment of Mandibular Fractures With 3-Dimensional Locking Miniplate and Standard Miniplates

The Traumaxilla ◽

10.1177/2632327319881058 ◽

2019 ◽

Vol 1 (1) ◽

pp. 7-10

Author(s):

Gaurav Singh ◽

Madan Mishra ◽

Amit Gaur ◽

Dhritiman Pathak

Keyword(s):

Treatment Strategies ◽

Bite Force ◽

Mandibular Fractures ◽

Time Intervals ◽

Experimental Conditions ◽

3 Dimensional ◽

The Mean ◽

Group 2 ◽

Drilling Conditions ◽

Group 1

Background: Fractures of the mandible can be studied and described in anatomic terms, functional considerations, treatment strategies, and outcome measures. The performance of any fixation system depends on multiple factors including plate adaptation, screw placement, bone quality, drilling conditions, and postoperative patient compliance. Bite force assesses masticatory muscle function under clinical and experimental conditions. Method: 30 patients with isolated, noncomminuted mandibular fractures were randomly divided into two equal groups. Group 1 patients were treated using 3-dimensional locking miniplates and group 2 patients were treated with standard miniplates. The bite forces were recorded at definite time intervals: preoperatively, and second week, sixth week, third month, and sixth month postoperatively. Result: At 6 weeks postoperative, 3 month postoperative, and 6 month postoperative, the mean bite force was found to be significantly higher among group 1 patients as compared to those in group 2 in all the sites. While at 2 week postoperative, the mean bite force was found to be significantly higher in Group 2 as compared to Group 1 at incisor region. Conclusion: The overall results of the present study show better performance in bite force for the 3-dimensional locking miniplate when compared with standard miniplates.

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Repair Integrity and Functional Outcomes Between Knot-Tying and Knotless Suture-Bridge Arthroscopic Rotator Cuff Repair: A Prospective Randomized Clinical Trial

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211002482 ◽

2021 ◽

Vol 9 (4) ◽

pp. 232596712110024

Author(s):

Koray Şahin ◽

Fatih Şentürk ◽

Mehmet Ersin ◽

Ufuk Arzu ◽

Mechmet Chodza ◽

...

Keyword(s):

Rotator Cuff ◽

Constant Score ◽

Knot Tying ◽

Suture Bridge ◽

Significant Difference ◽

The Mean ◽

Group 2 ◽

Cuff Repair ◽

Group 1

Background: Knot-tying suture-bridge (SB) rotator cuff repair may compromise the vascularity of the repaired tendon, causing tendon strangulation and medial repair failure. The knotless SB repair technique has been proposed to overcome this possibility and decrease retear rates. Purpose: To compare clinical and structural outcomes and retear patterns between the knot-tying and knotless SB techniques. We hypothesized that the knotless technique would result in lower retear rates owing to the preservation of intratendinous vascularity. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 104 patients with full-thickness rotator cuff tears were randomly and prospectively allocated to undergo knot-tying (group 1) or knotless (group 2) SB repair. Clinical outcome measures included range of motion, the visual analog scale (VAS) for pain, and the Constant score for function. Repair integrity was evaluated on magnetic resonance imaging scans using the Sugaya classification. Retears were also classified according to their pattern as type 1 (lateral) or type 2 (medial). Results: Overall, 88 patients (group 1: n = 42 [mean ± SD age, 54.3 ± 9.8 years]; group 2: n = 46 [mean ± SD age, 55.8 ± 8.2 years]) were included in the final analysis. The mean ± SD follow-up period was 25.4 ± 8.3 and 23.3 ± 7.2 months for groups 1 and 2, respectively. From preoperatively to postoperatively, the mean VAS pain score improved significantly in both groups (group 1: from 7.4 ± 1.7 to 1.0 ± 1.7; group 2: from 7.1 ± 1.9 to 1.3 ± 2.0; P < .0001 for both), as did the mean ± SD Constant score (group 1: from 51.7 ± 13.4 to 86.0 ± 11.5; group 2: from 49.4 ± 18.4 to 87.2 ± 14.8; P < .0001 for both). There was no significant difference between the groups for the postoperative VAS or Constant score. The retear rate was not significantly different between the groups (19.0% [8/42] in group 1 and 28.3% [13/46] in group 2; P > .05). There was a significant difference in the type 2 failure rate (75.0% [6/8] in group 1 and 23.1% [3/13] in group 2; P = .03). Conclusion: Both techniques showed excellent improvement and comparable clinical outcomes, and there was no significant difference in retear rates. Consistent with previously published data, the type 2 failure rate was significantly higher with the knot-tying technique. Registration: NCT03982108 ( ClinicalTrials.gov identifier).

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TO ASSESS THE IDEAL TIME OF LAPAROSCOPIC CHOLECYSTECTOMY AFTER ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN CASES OF CHOLELITHIASIS WITH CHOLEDOCHOLITHIASIS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i4.1865 ◽

2021 ◽

Vol 5 (4) ◽

Author(s):

Dhirendra Godara ◽

Vineet Choudhary ◽

Nitish Soni

Keyword(s):

Laparoscopic Cholecystectomy ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Medical Sciences ◽

Early Recovery ◽

Endoscopic Retrograde ◽

The Mean ◽

Group 2 ◽

Late Group ◽

Group 1 ◽

The Ideal

Background: Aims of this study was assess the ideal time of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography in cases of cholelithiasis with Choledocholthiasis Methods: The present study was carried out on 150 patients admitted in Department of General surgery National Institute of Medical Sciences and Research, Jaipur, diagnosed with cholelithiasis along with choledocholithiasis from 1stJanuary 2019 to 30thJune, 2020. Results: In group 1 out of 75 patients 7 patients developed complications in post operative period compared to 35 patients out of 75 patients developed complications in group 2. The The mean hospital stay (in day) in group 1 patients was 2.26, median 2 and the mean of group 2 was 5.26, median 5. Conclusion: To conclude in our study there has been found significant advantage of early laparoscopic cholecystecomy following ERCP over the late group to minimize complications and promote early recovery of the patients. Keywords: ERCP, Cholecystectomy, Endoscopic retrograde cholangiopancreatography

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Factors That Determine the Prothrombin Time in Patients With Atrial Fibrillation Receiving Rivaroxaban

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029618800830 ◽

2018 ◽

Vol 24 (9_suppl) ◽

pp. 188S-193S

Author(s):

Jen-Hung Huang ◽

Yung-Kuo Lin ◽

Cheng-Chih Chung ◽

Ming-Hsiung Hsieh ◽

Wan-Chun Chiu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Prothrombin Time ◽

Factor Xa ◽

International Normalized Ratio ◽

Biochemical Properties ◽

Study Patient ◽

Group 3 ◽

Multiple Variables ◽

Group 2 ◽

Group 1

Rivaroxaban, a direct factor Xa inhibitor, is widely used to reduce the chance of stroke in patients with atrial fibrillation (AF). It is not clear why the prothrombin time (PT) of the international normalized ratio (INR) fails to correlate with treatment using rivaroxaban in patients with AF. In this study, patient characteristics, the rivaroxaban dosage, AF type, drug history, biochemical properties, and hematological profiles were assessed in patients treated with rivaroxaban. In 69 patients with AF receiving rivaroxaban, 27 (39.1%) patients had a normal INR (≤1.1, group 1), 27 (39.1%) patients had a slightly prolonged INR (1.1∼1.5, group 2), and 15 (21.7%) patients had a significantly prolonged INR (>1.5, group 3). Group 1 patients had a higher incidence of a stroke history than did patients in group 2 ( P = .026) and group 3 ( P = .032). We scored patients with a persistent AF pattern (1 point), paroxysmal AF pattern (0 point), renal function (ie, the creatinine clearance rate in mL/min/1.73 m2 of >60 as 0 points, of 30∼60 as 1 point, and of <30 as 2 points), and no history of stroke (1 point), and we found that group 3 had a higher score than groups 2 or 1 (2.9 ± 0.8, 2.4 ± 0.7, and 2 ± 0.7, respectively; P < .05). There were similar incidences of bleeding, stroke, and unexpected hospitalizations among the 3 groups. The PT of the INR is determined by multiple variables in patients with AF receiving rivaroxaban. Rivaroxaban-treated patients with AF having different INR values may have similar clinical outcomes.

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