Thromboembolic Complications After Receipt of Prothrombin Complex Concentrate

Purpose: Patients presenting with life-threatening bleeding associated with oral anticoagulants (OACs) are challenging with few available treatments. Prothrombin complex concentrate (PCC) is an option for OAC reversal in the setting of life-threatening bleeding with a relatively benign safety profile. Little is known about the risk of developing thromboembolic complications (TEC) in patients receiving PCC who were previously anticoagulated. The aim of this study is to characterize the rate of TEC after receipt of PCC. Methods: All adult patients who received 4-Factor PCC for life-threatening bleeding were retrospectively evaluated over a 2-year time period. Data collected included anticoagulant and indication, bleeding source, PCC dose, INR, and TEC within 14 days of PCC dose, including venous thromboembolism (VTE), acute myocardial infarction, and ischemic stroke. Results: Three hundred thirty-three patients received 383 PCC doses. Of these, 55 (16.5%) patients developed TEC, including VTE, ischemic stroke, and acute myocardial infarction. There was increased rivaroxaban use in patients who developed TEC (25.4% vs 12.2%; P = .011). Additionally, there were more patients who had anticoagulation for a previous TEC in those who developed a new TEC (38.2% vs 23.4%; P = .022). Lastly, there was a higher rate of TEC in those who received >1 dose of PCC (21.8% vs 7.9%; P = .002). Conclusion: PCC administration in the setting of life-threatening bleeding is not benign. Risk of TEC increases in patients who have rivaroxaban reversal, receive a repeat dose of PCC, and have a TEC indication for their anticoagulation and these factors should be further investigated.

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Complications of thrombolysis in an intensive care unit

Acta medica Lituanica ◽

10.6001/actamedica.v19i3.2460 ◽

2012 ◽

Vol 19 (3) ◽

pp. 251-254

Author(s):

Živilė Deimantavičienė ◽

Nerijus Klimas ◽

Aurimas Pečkauskas ◽

Giedrė Bakšytė ◽

Andrius Macas ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Pulmonary Embolism ◽

Intensive Care ◽

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Injection Site ◽

Acute Ischemic Stroke ◽

Vaginal Bleeding ◽

Life Threatening

Background. Thrombolysis is often the only way in treating people with life-threatening conditions, like acute myocardial infarction (AMI), pulmonary embolism (PE) and acute ischemic stroke (AIS). Complications of thrombolytic therapy are not rare and have clear influence in the quality of life, hospital stay, outcomes and mortality. Most common complications are intracranial hemorrhage, severe injection site, nose, vaginal bleeding and peripheral hematomas. Methods and materials. A retrospective study took place in the Department of Intensive Care, Hospital of Lithuanian University of Health Sciences Kaunas Clinics. Medical data of 83 patients, who underwent treatment with thrombolytic drugs in the period of 2007–2011, were analyzed. All patients were treated with intravenous infusion of Alteplase. Inclusion criteria were as follows: • AMI, AIS or PE treatable with thrombolytic therapy. Results. 72.3% (n = 60) of patients experienced massive PE, 13.3% (n = 11) AMI and 14.4% (n = 12) AIS. There were 8.43% (n = 7) of patients who had bleeding complications – 2.4% (n = 2) experienced nose bleed during or shortly after thrombolytic therapy, 3.6% (n = 3) had injection site bleeding and 1.2% (n = 1) experienced multiple skin hemorrhages. 11.7% (n = 7) of patients in the group of massive PE were thrombolised during CPR and only one of them experienced bleeding to the pleural cavity. There were no internal or external bleeding observed neither in AMI nor in AIS groups. In-hospital mortality after thrombolytic therapy was 20.5% (n = 17). Conclusions. Thrombolytic therapy very often is the only way in treating acute, life-threatening diseases, like acute myocardial infarction, pulmonary embolism or acute ischemic stroke. Intracranial hemorrhage, injection site, nose, vaginal bleeding and peripheral hematomas are the most common complications of thrombolysis. Risk factors should be evaluated before starting the thrombolytic therapy. Data of our hospital experience do not dramatically differ from worldwide data.

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Thrombolytic Therapy in the Current ERA: Myocardial Infarction and Beyond

Current Pharmaceutical Design ◽

10.2174/1381612824666171227211623 ◽

2018 ◽

Vol 24 (4) ◽

pp. 414-426 ◽

Cited By ~ 3

Author(s):

Patrick Proctor ◽

Massoud A. Leesar ◽

Arka Chatterjee

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Disease ◽

Acute Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Coronary Intervention ◽

Evidence Base ◽

Primary Pci ◽

Percutaneous Coronary

Thrombolytic therapy kick-started the era of modern cardiology but in the last few decades it has been largely supplanted by primary percutaneous coronary intervention (PCI) as the go-to treatment for acute myocardial infarction. However, these agents remain important for vast populations without access to primary PCI and acute ischemic stroke. More innovative uses have recently come up for the treatment of a variety of conditions. This article summarizes the history, evidence base and current use of thrombolytics in cardiovascular disease.

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Mortality of major cardiovascular emergencies among patients admitted to hospitals on weekends as compared with weekdays in Taiwan

BMC Health Services Research ◽

10.1186/s12913-021-06553-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chao-Lun Lai ◽

Raymond Nien-Chen Kuo ◽

Ting-Chuan Wang ◽

K. Arnold Chan

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Pulmonary Embolism ◽

Ischemic Stroke ◽

Aortic Aneurysm ◽

Hospital Mortality ◽

Weekend Effect ◽

Claims Database ◽

Ruptured Aortic Aneurysm ◽

Incident Cases

Abstract Background Several studies have found a so-called weekend effect that patients admitted at the weekends had worse clinical outcomes than patients admitted at the weekdays. We performed this retrospective cohort study to explore the weekend effect in four major cardiovascular emergencies in Taiwan. Methods The Taiwan National Health Insurance (NHI) claims database between 2005 and 2015 was used. We extracted 3811 incident cases of ruptured aortic aneurysm, 184,769 incident cases of acute myocardial infarction, 492,127 incident cases of ischemic stroke, and 15,033 incident cases of pulmonary embolism from 9,529,049 patients having at least one record of hospitalization in the NHI claims database within 2006 ~ 2014. Patients were classified as weekends or weekdays admission groups. Dates of in-hospital mortality and one-year mortality were obtained from the Taiwan National Death Registry. Results We found no difference in in-hospital mortality between weekend group and weekday group in patients with ruptured aortic aneurysm (45.4% vs 45.3%, adjusted odds ratio [OR] 1.01, 95% confidence interval [CI] 0.87–1.17, p = 0.93), patients with acute myocardial infarction (15.8% vs 16.2%, adjusted OR 0.98, 95% CI 0.95–1.00, p = 0.10), patients with ischemic stroke (4.1% vs 4.2%, adjusted OR 0.99, 95% CI 0.96–1.03, p = 0.71), and patients with pulmonary embolism (14.6% vs 14.6%, adjusted OR 1.02, 95% CI 0.92–1.15, p = 0.66). The results remained for 1 year in all the four major cardiovascular emergencies. Conclusions We found no difference in either short-term or long-term mortality between patients admitted on weekends and patients admitted on weekdays in four major cardiovascular emergencies in Taiwan.

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Sample Timing, Diagnosis of Subclinical Thyroid Dysfunction and Mortality in Acute Myocardial Infarction: ThyrAMI1 Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgz143 ◽

2019 ◽

Vol 105 (4) ◽

pp. e1299-e1306 ◽

Cited By ~ 3

Author(s):

Salman Razvi ◽

Owain Leng ◽

Avais Jabbar ◽

Arjola Bano ◽

Lorna Ingoe ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Thyroid Function ◽

Thyroid Dysfunction ◽

Reference Interval ◽

Reference Ranges ◽

Diagnosis And Prognosis ◽

Time Period ◽

All Cause Mortality ◽

The Impact

Abstract Objective The objective of this study was to determine the impact of blood sample timing on the diagnosis of subclinical thyroid dysfunction (SCTD) and mortality in patients with acute myocardial infarction (AMI). Patients, Design, and Main Outcome Measures Patients with AMI had thyroid function evaluated on admission between December 2014 and December 2016 and those with abnormal serum thyrotropin (TSH) had repeat thyroid function assessed at least a week later. The association between sample timing and SCTD was evaluated by logistic regression analysis. Secondary outcomes were confirmation of SCTD on repeat testing and all-cause mortality up to June 2018. Results Of the 1806 patients [29.2% women, mean (± standard deviation) age of 64.2 (±12.1) years] analyzed, the prevalence of subclinical hypothyroidism (SCH) was 17.2% (n = 311) and subclinical hyperthyroidism (SHyper) was 1.2% (n = 22) using a uniform TSH reference interval. The risk of being diagnosed with SCTD varied by sample timing in fully-adjusted models. The risk of SCH was highest between 00.01 and 06.00 hours and lowest between 12.01 and 18.00 hours, P for trend <.001, and risk of SHyper was highest between 12.01 hours and 18.00 hours and lowest between 00.01 hours and 06.00 hours. Furthermore, time of the initial sample was associated with the risk of remaining in a SCH state subsequently. Mortality in SCH patients was not elevated when a uniform TSH reference interval was utilized. However, when time period–specific TSH reference ranges were utilized, the mortality risk was significantly higher in SCH patients with HR (95% CI) of 2.26 (1.01–5.19), P = .04. Conclusions Sample timing impacts on the diagnosis and prognosis of SCH in AMI patients. If sample timing is not accounted for, SCH is systemically misclassified, and its measurable influence on mortality is lost.

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An unusual presentation of acute myocardial infarction in physiotherapy direct access: findings from a case report

Archives of Physiotherapy ◽

10.1186/s40945-021-00099-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Lorenzo Storari ◽

Valerio Barbari ◽

Fabrizio Brindisino ◽

Marco Testa ◽

Maselli Filippo

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Case Report ◽

Visceral Pain ◽

Signs And Symptoms ◽

Final Diagnosis ◽

Outpatient Setting ◽

Direct Access ◽

Life Threatening ◽

Medical Referral

Abstract Background Shoulder pain (SP) may originate from both musculoskeletal and visceral conditions. Physiotherapists (PT) may encounter patients with life-threatening pathologies that mimic musculoskeletal pain such as Acute Myocardial Infarction (AMI). A trained PT should be able to distinguish between signs and symptoms of musculoskeletal or visceral origin aimed at performing proper medical referral. Case presentation A 46-y-old male with acute SP lasting from a week was diagnosed with right painful musculoskeletal shoulder syndrome, in two successive examinations by the emergency department physicians. However, after having experienced a shift of the pain on the left side, the patient presented to a PT. The PT recognized the signs and symptoms of visceral pain and referred him to the general practitioner, which identified a cardiac disease. The final diagnosis was acute myocardial infarction. Conclusion This case report highlights the importance of a thorough patient screening examination, especially for patients treated in an outpatient setting, which allow distinguishing between signs and symptoms of musculoskeletal from visceral diseases.

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Abstract WMP51: Risk and Timing of of Ischemic Stroke Following Acute Myocardial Infarction

Stroke ◽

10.1161/str.48.suppl_1.wmp51 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Alexander E Merkler ◽

Gino Gialdini ◽

Santosh Murthy ◽

Shadi Yaghi ◽

Babak Navi ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Ischemic Stroke ◽

Stroke Risk ◽

Absolute Risk ◽

Absolute Increase ◽

Risk Increase ◽

Immortal Time Bias ◽

Acute Mi ◽

The Absolute

Background: Acute myocardial infarction (MI) has long been reported as a risk factor for ischemic stroke, but the magnitude and duration of risk remains uncertain. Methods: We performed a crossover-cohort study using inpatient and outpatient claims data from a nationally representative 5% sample of Medicare beneficiaries from 2008 through 2014. We identified all patients ≥66 years of age with a first-recorded hospitalization for acute MI. The primary outcome was ischemic stroke. All predictors and outcomes were defined using previously validated ICD-9-CM codes. To exclude stroke that may have been due to percutaneous coronary intervention, we included only cases of ischemic stroke that occurred after discharge from the MI hospitalization. We compared the risk of ischemic stroke in successive 4-week periods during the 12 weeks after MI versus the corresponding 4-week periods 1 year later. To avoid immortal time bias, we limited our cohort to patients who remained alive and insured throughout the 15 month study period. Odds ratios (OR) and absolute risk differences were calculated using the Mantel-Haenszel estimator for matched data. Results: We identified 22,798 patients with an acute MI in whom the mean age was 77.4 (±7.9) years and 50.3% were women. In the 12 weeks after discharge, 216 patients (0.95%) developed a stroke, as compared to 21 (0.09%) patients in the corresponding 12-week period 1 year later. The absolute increase in stroke risk was 0.45% (95% confidence interval [CI], 0.36-0.55%) in the first 4 weeks after acute MI compared to the 4-week time period 1 year later, corresponding to an OR of 18.2 (95% CI, 8.1-50.6). The absolute risk increase was 0.24% (95% CI, 0.16-0.31%) during weeks 5-8 (OR, 8.7; 95% CI, 4.0-22.6) and 0.17% (95% CI, 0.10-0.23%) during weeks 9-12 (OR, 5.8; 95% CI, 2.7-14.1). Conclusions: Acute MI is associated with a substantially elevated short-term risk of ischemic stroke. This risk was independent of periprocedural stroke risk in the setting of coronary reperfusion therapies.

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Association of preceding angina with in-hospital life-threatening ventricular tachyarrhythmias and late potentials in patients with a first acute myocardial infarction

American Heart Journal ◽

10.1016/s0002-8703(97)70223-0 ◽

1997 ◽

Vol 133 (3) ◽

pp. 297-301 ◽

Cited By ~ 22

Author(s):

Koji Tamura ◽

Hisako Tsuji ◽

Takashi Nishiue ◽

Satoshi Tokunaga ◽

Toshiji Iwasaka

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Late Potentials ◽

Ventricular Tachyarrhythmias ◽

Life Threatening

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Risk of Ischemic Stroke After Acute Myocardial Infarction in Patients Undergoing Coronary Artery Bypass Graft Surgery

Scientific Reports ◽

10.1038/s41598-020-60854-1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

André Åström ◽

Lars Söderström ◽

Thomas Mooe

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Ischemic Stroke ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

Incidence Rates ◽

P2y12 Inhibitors ◽

Over Time

AbstractOnly sparse epidemiological data are available regarding the risk of ischemic stroke (IS) after coronary artery bypass surgery (CABG). Here we aimed to describe the incidence and predictors of IS associated with CABG performed after acute myocardial infarction (AMI), as well as trends over time. We analyzed data for 248,925 unselected AMI patients. We separately analyzed groups of patients who underwent CABG early or late after the index infarction. IS incidence rates per year at risk were 15.8% (95% confidence interval, 14.5–17.1) and 10.9% (10.6–11.2), respectively, among patients with and without CABG in the early cohort, and 4.0% (3.5–4.5) and 2.3% (2.2–2.3), respectively, among patients with and without CABG in the late cohort. Predictors of post-AMI IS included prior IS, CABG, prior atrial fibrillation, prior hemorrhagic stroke, heart failure during hospitalization, older age, diabetes mellitus, and hypertension. Reduced IS risk was associated with use of statins and P2Y12 inhibitors. IS incidence markedly decreased among patients who did not undergo CABG, while no such reduction over time occurred among those who underwent CABG. This emphasizes the need to optimize modifiable risk factors and to consistently use treatments that may reduce IS risk among CABG patients.

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The use of novel oral anticoagulants compared to vitamin K antagonists (warfarin) in patients with left ventricular thrombus after acute myocardial infarction

European Heart Journal - Cardiovascular Pharmacotherapy ◽

10.1093/ehjcvp/pvaa096 ◽

2020 ◽

Cited By ~ 7

Author(s):

Daniel A Jones ◽

Paul Wright ◽

Momin A Alizadeh ◽

Sadeer Fhadil ◽

Krishnaraj S Rathod ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Vitamin K ◽

Oral Anticoagulants ◽

Left Ventricular ◽

Left Ventricular Thrombus ◽

Novel Oral Anticoagulants ◽

Secondary Outcome ◽

Ventricular Thrombus

Abstract Aim Current guidelines recommend the use of vitamin K antagonist (VKA) for up to 3–6 months for treatment of left ventricular (LV) thrombus post-acute myocardial infarction (AMI). However, based on evidence supporting non-inferiority of novel oral anticoagulants (NOAC) compared to VKA for other indications such as deep vein thrombosis, pulmonary embolism (PE), and thromboembolic prevention in atrial fibrillation, NOACs are being increasingly used off licence for the treatment of LV thrombus post-AMI. In this study, we investigated the safety and effect of NOACs compared to VKA on LV thrombus resolution in patients presenting with AMI. Methods and results This was an observational study of 2328 consecutive patients undergoing coronary angiography ± percutaneous coronary intervention (PCI) for AMI between May 2015 and December 2018, at a UK cardiac centre. Patients’ details were collected from the hospital electronic database. The primary endpoint was rate of LV thrombus resolution with bleeding rates a secondary outcome. Left ventricular thrombus was diagnosed in 101 (4.3%) patients. Sixty patients (59.4%) were started on VKA and 41 patients (40.6%) on NOAC therapy (rivaroxaban: 58.5%, apixaban: 36.5%, and edoxaban: 5.0%). Both groups were well matched in terms of baseline characteristics including age, previous cardiac history (previous myocardial infarction, PCI, coronary artery bypass grafting), and cardiovascular risk factors (hypertension, diabetes, hypercholesterolaemia). Over the follow-up period (median 2.2 years), overall rates of LV thrombus resolution were 86.1%. There was greater and earlier LV thrombus resolution in the NOAC group compared to patients treated with warfarin (82% vs. 64.4%, P = 0.0018, at 1 year), which persisted after adjusting for baseline variables (odds ratio 1.8, 95% confidence interval 1.2–2.9). Major bleeding events during the follow-up period were lower in the NOAC group, compared with VKA group (0% vs. 6.7%, P = 0.030) with no difference in rates of systemic thromboembolism (5% vs. 2.4%, P = 0.388). Conclusion These data suggest improved thrombus resolution in post-acute coronary syndrome (ACS) LV thrombosis in patients treated with NOACs compared to VKAs. This improvement in thrombus resolution was accompanied with a better safety profile for NOAC patients vs. VKA-treated patients. Thus, provides data to support a randomized trial to answer this question.

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