scholarly journals Impact of intra-operative cell salvage on blood coagulation in high-bleeding-risk patients undergoing cardiac surgery with cardiopulmonary bypass: a prospective randomized and controlled trial

2016 ◽  
Vol 14 (1) ◽  
Author(s):  
Sheliang Shen ◽  
Jun Zhang ◽  
Wenyuan Wang ◽  
Jiayin Zheng ◽  
Yihong Xie
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Coagulation ◽  
Controlled Trial ◽  
Bleeding Risk ◽  
Cell Salvage ◽  
Risk Patients ◽  
High Bleeding Risk

scholarly journals Sex-based outcomes in contemporary antiplatelet therapy trials

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001761
Author(s):  
Mirvat Alasnag ◽  
Tara L Jones ◽  
Yasmin Hanfi ◽  
Nicola Ryan
Keyword(s):  
High Risk ◽  
Antiplatelet Therapy ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Representation Of Women ◽  
Percutaneous Coronary ◽  
Risk Patients ◽  
High Risk Populations ◽  
High Bleeding Risk ◽  
Randomised Controlled

Balancing ischaemic and bleeding risks in high-risk populations undergoing percutaneous coronary interventions has become an everyday dilemma for clinicians. It is particularly difficult to make decisions concerning combinations and duration of antiplatelet regimens in women given the poor representation of women in trials that have shaped current practice. Several contemporary landmark trials have recently been presented at the American College of Cardiology. The trials included the Harmonising Optimal Strategy for Treatment of coronary artery diseases-EXtended Antiplatelet Monotherapy, Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention and the TicAgrelor versus CLOpidogrel in Stabilised Patients With Acute Myocardial Infarction. In this article, we summarise the main findings of these trials and include the The Polymer-free Drug-Coated Coronary Stents in Patients at High Bleeding Risk (LEADERS FREE) in search for evidence based best practices for women patients. Although some of these trials had prespecified a subanalysis of sex differences, women constituted only 17%–30% of participants making sex-specific analyses challenging. Data suggest that women benefit from de-escalation to both ticagrelor and clopidogrel monotherapy. However, given the increased bleeding risks observed in women further randomised controlled trials are necessary to determine the most appropriate combination and duration of dual antiplatelet therapy as well as maintenance single antiplatelet therapy.

scholarly journals FINAL TWO-YEAR RESULTS FROM THE RANDOMIZED ONYX ONE TRIAL IN HIGH BLEEDING RISK PATIENTS TREATED WITH 1-MONTH DAPT

2021 ◽  
Vol 77 (18) ◽  
pp. 899
Author(s):  
Stephan Windecker ◽  
Elvin Kedhi ◽  
Azeem Latib ◽  
David Kandzari ◽  
Ajay Kirtane ◽  
...  
Keyword(s):  
Bleeding Risk ◽  
Risk Patients ◽  
High Bleeding Risk

scholarly journals Effect of sevoflurane on the inflammatory response during cardiopulmonary bypass in cardiac surgery: the study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Thiago Augusto Azevedo Maranhão Cardoso ◽  
Gudrun Kunst ◽  
Caetano Nigro Neto ◽  
José de Ribamar Costa Júnior ◽  
Carlos Gustavo Santos Silva ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Inflammatory Response ◽  
Controlled Trial ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Volatile Anesthetic ◽  
Serum Levels ◽  
Randomized Controlled

Abstract Background Recent experimental evidence shows that sevoflurane can reduce the inflammatory response during cardiac surgery with cardiopulmonary bypass. However, this observation so far has not been assessed in an adequately powered randomized controlled trial. Methods We plan to include one hundred patients undergoing elective coronary artery bypass graft with cardiopulmonary bypass who will be randomized to receive either volatile anesthetics during cardiopulmonary bypass or total intravenous anesthesia. The primary endpoint of the study is to assess the inflammatory response during cardiopulmonary bypass by measuring PMN-elastase serum levels. Secondary endpoints include serum levels of other pro-inflammatory markers (IL-1β, IL-6, IL-8, TNFα), anti-inflammatory cytokines (TGFβ and IL-10), and microRNA expression in peripheral blood to achieve possible epigenetic mechanisms in this process. In addition clinical endpoints such as presence of major complications in the postoperative period and length of hospital and intensive care unit stay will be assessed. Discussion The trial may determine whether adding volatile anesthetic during cardiopulmonary bypass will attenuate the inflammatory response. Trial registration ClinicalTrials.gov NCT02672345. Registered on February 2016 and updated on June 2020.

Thromboprophylaxis in Patients with COVID-19: Systematic Review of National and International Clinical Guidance Reports

2021 ◽  
Vol 19 ◽  
Author(s):  
Konstantinos G Kyriakoulis ◽  
Anastasios Kollias ◽  
Ioannis G Kyriakoulis ◽  
Ioanna A Kyprianou ◽  
Chrysso Papachrysostomou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Dose Intensity ◽  
Treatment Decision ◽  
Bleeding Risk ◽  
Post Discharge ◽  
Risk Patients ◽  
Guidance Documents ◽  
Current Guidance ◽  
High Bleeding Risk ◽  
Pharmacological Thromboprophylaxis

Background: Venous thromboembolism (VTE) is common among patients with severe coronavirus disease 2019 (COVID-19). Anticoagulation in hospitalized COVID-19 patients has been associated with survival benefit; however, the optimal thromboprophylaxis strategy has not yet been defined. Objective: To identify published guidance reports by national and international societies regarding thromboprophylaxis strategies in COVID-19 patients in different settings (outpatients, hospitalized, post-discharge). Methods: A systematic review of the literature (Pubmed/EMBASE) was conducted independently by two investigators. Results: Among 1942 initially identified articles, 33 guidance documents were included: 20 published by national and 13 by international societies. These documents provide recommendations mainly for hospitalized (97% of reports) and post-discharge (75%) COVID-19 patients, and less so for outpatients (34%). Thrombotic and bleeding risk stratification prior to any treatment decision is the cornerstone of all suggested thromboprophylaxis strategies; 81% of the documents recommend thromboprophylaxis for all hospitalized patients with a prophylactic dosage of low molecular weight heparin irrespective of VTE risk. Intermediate or therapeutic dose intensity is recommended in high VTE risk patients by 56% and 28% of documents, respectively. Mechanical thromboprophylaxis is suggested in case of high bleeding risk or contraindication to pharmacological thromboprophylaxis (59% of documents). Extended pharmacological thromboprophylaxis is recommended for patients with high VTE risk after hospital discharge (63% of documents). For non-hospitalized outpatients, 28% of documents recommend pharmacological thromboprophylaxis for high VTE risk. Conclusion: The current guidance identifies thromboprophylaxis in COVID-19 patients, especially during hospitalization, as of major importance for the prevention of VTE. Recommendations are derived from limited evidence from observational studies.

scholarly journals TCT CONNECT-64 Impact of DAPT Cessation in High Bleeding-Risk Patients Undergoing PCI: Insights From the PARIS Registry

2020 ◽  
Vol 76 (17) ◽  
pp. B27-B28
Author(s):  
Davide Cao ◽  
George Dangas ◽  
Samantha Sartori ◽  
Zhongjie Zhang ◽  
Cono Ariti ◽  
...  
Keyword(s):  
Bleeding Risk ◽  
Risk Patients ◽  
High Bleeding Risk

Drug-coated balloons for coronary artery disease: current concepts and controversies

2019 ◽  
Vol 15 (6) ◽  
pp. 437-454 ◽  
Author(s):  
Dario Buccheri ◽  
Renzo M Lombardo ◽  
Bernardo Cortese
Keyword(s):  
Bleeding Risk ◽  
Coronary Intervention ◽  
Side Branch ◽  
Bioresorbable Vascular Scaffold ◽  
Total Occlusion ◽  
Small Vessels ◽  
Stent Restenosis ◽  
Risk Patients ◽  
Artery Disease ◽  
High Bleeding Risk

Drug-coated balloons (DCBs) are a novel development for percutaneous coronary intervention. The first successful application was in-stent restenosis but in recent years, strong evidence has been released for its use in native small-vessels disease. Additional applications such as acute myocardial infarction, chronic total occlusion and bifurcation lesions are still under investigation. This article reviews the key studies evaluating the role of DCBs in several settings and reports on interesting cases where DCBs showed positive results for high-risk patients with neoplasm, as well as with high bleeding risk, planned surgery or renal injury. We also highlight a new biodegradable therapy for coronary bifurcation treatment, in which a bioresorbable vascular scaffold is implanted in the main branch, completed with a DCB angioplasty in the side branch when a treatment is deemed necessary.

Sign in / Sign up

Export Citation Format

Share Document