The Experts below are selected from a list of 21801 Experts worldwide ranked by ideXlab platform
Alexander Battler - One of the best experts on this subject based on the ideXlab platform.
-
short term triple therapy with aspirin warfarin and a thienopyridine among patients undergoing percutaneous coronary intervention
Catheterization and Cardiovascular Interventions, 2006Co-Authors: Avital Porter, Yuval Konstantino, Zaza Iakobishvili, Leeor Shachar, Alexander BattlerAbstract:Objectives: To assess Bleeding Complications among patients undergoing percutaneous coronary intervention (PCI) and receiving triple therapy of warfarin, aspirin, and a thienopyridine. Background: Triple therapy of warfarin, aspirin, and a thienopyridine is strongly discouraged, given the potential risk of Bleeding Complications. Methods and Results: Post-PCI patients receiving triple therapy thereafter underwent assessment for Bleeding Complications. Continuous variables are presented as median (25th–75th percentiles). The study group included 180 patients (80% males; age 65 (52, 75.5)). PCI was on an urgent/emergent basis in 86.6%. The main indications for warfarin use were left ventricular mural thrombus and atrial fibrillation (46.9 and 36.9% respectively). Glycoprotein IIb/IIIa receptor antagonists were used in 47.7%. Post-PCI triple therapy duration was 30 days (30, 30). During the post-triple therapy, 104 patients (57.8%) continued treatment with warfarin and aspirin for 376 days (150, 775). During the triple therapy period, 20 patients developed Bleeding Complications, (mean INR 2.1 ± 0.7 at 7 (6, 8.5) days post-PCI): 2 major groin hematoma (initial phase of warfarin treatment during overlap with heparin) and 18 minor. During post-triple therapy, primarily under warfarin and aspirin, 19 patients developed Bleeding Complications: 1 major and 18 minor. Conclusion: Short-term triple therapy after PCI was not associated with prohibitively high Bleeding Complication rates, and thus should be favorably considered in patients with a clear indication for warfarin use. © 2006 Wiley-Liss, Inc.
Robert G Hart - One of the best experts on this subject based on the ideXlab platform.
-
vitamin k antagonists and risk of subdural hematoma meta analysis of randomized clinical trials
Stroke, 2014Co-Authors: Ben J Connolly, Lesly A Pearce, Robert G HartAbstract:Background and Purpose—Subdural hematomas are an important Bleeding Complication of anticoagulation. We quantify the risk of subdural hematoma associated with anticoagulation with vitamin K antagonists (VKAs) compared with other oral antithrombotic therapies. Methods—Randomized trials were identified from the Cochrane Central Register of Controlled Trials and were included if published since 1980 and compared oral VKAs with antiplatelet therapy or with direct-acting oral anticoagulants. Two reviewers independently extracted data with differences resolved by joint review. Results—Nineteen randomized trials were included that involved 92 156 patients and 275 subdural hematomas. By meta-analysis, VKAs were associated with a significantly increased risk of subdural hematoma (odds ratios, 3.0; 95% confidence interval, 1.5–6.1) compared with antiplatelet therapy (9 trials, 11 603 participants). The risk of subdural hematoma was also significantly higher with VKAs versus factor Xa inhibitors (meta-analysis odds ...
-
aspirin therapy and risk of subdural hematoma meta analysis of randomized clinical trials
Journal of Stroke & Cerebrovascular Diseases, 2013Co-Authors: Ben J Connolly, Lesly A Pearce, Tobias Kurth, Carlos S Kase, Robert G HartAbstract:Background Subdural hematomas are an important Bleeding Complication of antithrombotic therapies. We sought to characterize the risk of subdural hematoma associated with antiplatelet therapy. Methods Trials were gathered from the Cochrane Central Register of Controlled Trials and from recent meta-analyses of trials regarding antiplatelet therapy for the primary prevention of stroke. Randomized trials published since 1980 comparing antiplatelet therapy with placebo or control and reporting subdural hematoma were included in the analysis. For recent large trials that did not report subdural hematomas, unpublished results were sought. Two reviewers independently extracted data on study design and subdural hematomas, with differences resolved by joint review and consensus. Results Four published trials were identified that compared aspirin with placebo/control involving 6565 participants (mean age 66 years) with 8 total subdural hematomas. Unpublished data from 5 aspirin trials with 90,689 participants reported 18 total subdural hematomas. The incidence of subdural hematomas varied from 0.02 per 1000 patient-years for primary prevention trials of middle-aged health professionals to 1 to 2 per 1000 patient-years for older patients with atrial fibrillation. Pooled data from all 9 trials revealed an odds ratio of 1.6 (95% confidence interval 0.8-3.5; heterogeneity P = .8; I 2 index 0%) for antiplatelet therapy and risk of subdural hematoma. Conclusions Based on the limited available data, it is uncertain whether aspirin therapy increases the risk of subdural hematoma: the observed 1.6-fold increased risk was not statistically significant. The incidence of subdural hematoma during aspirin therapy is low but varies widely depending upon the age of the patient population.
Jeanmarc Regimbeau - One of the best experts on this subject based on the ideXlab platform.
-
gastrointestinal Bleeding Complication of gastric fistula after sleeve gastrectomy consider pseudoaneurysms
Surgical Endoscopy and Other Interventional Techniques, 2013Co-Authors: Lionel Rebibo, David Fuks, Christelle Blot, Brice Robert, Pierreolivier Boulet, Abdennaceur Dhahri, P Verhaeghe, Jeanmarc RegimbeauAbstract:Background Gastric fistula (GF) is the most serious Complication after longitudinal sleeve gastrectomy (LSG), with an incidence ranging from 0 to 5 %. In this context, concomitant upper gastrointestinal Bleeding (UGIB) has never been described. Here, we describe our experience of this situation and suggest a procedure for the standardized management of this life-threatening Complication.
-
gastrointestinal Bleeding Complication of gastric fistula after sleeve gastrectomy consider pseudoaneurysms
Surgical Endoscopy and Other Interventional Techniques, 2013Co-Authors: Lionel Rebibo, David Fuks, Christelle Blot, Brice Robert, Pierreolivier Boulet, Abdennaceur Dhahri, P Verhaeghe, Jeanmarc RegimbeauAbstract:Gastric fistula (GF) is the most serious Complication after longitudinal sleeve gastrectomy (LSG), with an incidence ranging from 0 to 5 %. In this context, concomitant upper gastrointestinal Bleeding (UGIB) has never been described. Here, we describe our experience of this situation and suggest a procedure for the standardized management of this life-threatening Complication. We retrospectively analyzed all patients having been treated for post-LSG UGIB in our university medical center between November 2004 and February 2012. Data on GF and UGIB (time to onset, diagnosis and management) were assessed. Forty patients were treated for post-LSG GF in our institution, 18 of whom (45 %) had been referred by tertiary centers. Four patients presented UGIB (10 %): two had undergone primary LSG, one had undergone simultaneous gastric band removal and LSG, and one had undergone repeat LSG. The median time interval between GF and UGIB was 15 days. The four cases of UGIB included three pseudoaneurysms (75 %, with two affecting the left gastric artery and one affecting the upper pole of the splenic artery) and one case of Bleeding related to stent-induced gastric ulceration. Computed tomography enabled diagnosis of the pseudoaneurysm in all cases. Two of the four patients (50 %) were treated with selective embolization during arteriography, and two (50 %) were treated surgically with arterial ligation. One of the surgically treated patients died during follow-up. UGIB after LSG was investigated in the context of a postoperative GF and was found to have been caused by a pseudoaneurysm in 75 % of cases. When looking for a pseudoaneurysm, a primary angiography should be preferred to endoscopy allowing selective arterial embolization in hemodynamically stable patients, whereas surgery should be reserved for treatment failures or hemodynamically instability.
Kayleigh M Litton - One of the best experts on this subject based on the ideXlab platform.
-
rectus sheath hematoma with low molecular weight heparin administration a case series
BMC Research Notes, 2014Co-Authors: Laura E J Sullivan, Dale C Wortham, Kayleigh M LittonAbstract:Background Rectus sheath hematoma is an uncommon but potentially serious Bleeding Complication that can occur spontaneously or as a result of anticoagulation administration.
Suresh R Mulukutla - One of the best experts on this subject based on the ideXlab platform.
-
relationship between predicting Bleeding Complication in patients undergoing stent implantation and subsequent dual antiplatelet therapy precise dapt score and mortality among patients with atrial fibrillation undergoing percutaneous coronary intervention
Catheterization and Cardiovascular Interventions, 2020Co-Authors: Anum Asif, Ahmet Sezer, Floyd Thoma, Catalin Toma, John Schindler, Jeffrey Fowler, Conrad Smith, Oscar C Marroquin, Suresh R MulukutlaAbstract:BACKGROUND The predicting Bleeding Complication in patients undergoing stent implantation and subsequent dual antiplatelet therapy, PRECISE-DAPT (P-DAPT) score has been validated in large cohorts as an effective tool in predicting Bleeding Complication after dual antiplatelet therapy (DAPT) as well as in predicting in-hospital mortality. The implication of using this score to predict outcomes, including mortality in patients with atrial fibrillation (AF) undergoing PCI is unknown. OBJECTIVE Role of P-DAPT score to study clinical outcomes, including mortality, hospitalization, and major Bleeding, particularly among patients with AF. METHODS This is a retrospective observational study of 18,850 consecutive patients who underwent percutaneous coronary intervention (PCI) across a large multihospital healthcare system from 2010 to 2019. Patients were stratified into four groups depending on the presence or absence of AF and P-DAPT score, with score ≥ 25 defined as high risk. The primary outcome was all-cause mortality. The secondary outcomes evaluated were hospitalization and major Bleeding. RESULTS In the unadjusted analyses, a P-DAPT score ≥ 25, in both AF and non-AF population, was associated with increased mortality, hospitalization, and Bleeding. After adjusting for baseline covariates, no significant differences in major Bleeding risk were found across the four groups. However, a P-DAPT score of ≥25 in AF patients was associated with a higher risk for hospitalizations related to cardiovascular causes (HR: 2.15 95% CI 2.00-2.3, p < .0001). Among AF patients, P-DAPT score ≥ 25 was found to be strongly associated with mortality (HR 3.5; 95% CI 2.95-4.25, p < .0001) as compared with AF patients with score < 25 (HR 1.18, 95% CI 0.88-1.54, p = .26). CONCLUSION In this large cohort of patients undergoing PCI, the P-DAPT score can help to identify patients at high risk for long-term mortality, particularly among those with atrial fibrillation.