International angiology : a journal of the International Union of Angiology
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Review Meta Analysis
Prophylaxis of venous thromboembolism: low molecular weight heparin compared to the selective anticoagulants rivaroxaban, dabigatran and fondaparinux.
Newer therapeutic options available in the prevention of postoperative thromboembolism, currently focused on fondaparinux, rivaroxaban and dabigatran warrant an overall therapeutic assessment. The constitutive comparisons with enoxaparin are based on a combined outcome measure solely driven by the incidence of "asymptomatic deep vein thrombosis". Its validity as a clinically relevant endpoint is missing if antithrombotics of different classes are compared. ⋯ Their class-specific limitations are compensated through more intensive dosage-regimens which result in accentuated bleeding complications. Connotatively the hypothesis emerged that antiXa- and IIa-effects interact synergistically which translates into enhanced efficacy and tolerance. Experimental studies on hirudin with pentasaccharide and hirudin with "lower low molecular weight heparin" (3KDA) support such rationale.
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Case Reports
Endovascular management of aortoenteric fistulas with aortic cuff extenders: report of two cases.
Despite immediate open surgery, aortoenteric fistula (AEF) remains a highly lethal condition. Endovascular management is widely employed, although there is no agreement on its role as a definite treatment or, because of a high incidence of recurrent bleeding and sepsis, as a bridge to open repair. Two cases of secondary AEFs after distant elective abdominal aortic aneurysm repair are presented. ⋯ The second patient remained asymptomatic until the 16th postoperative month when he developed lumbar spine osteomyelitis as a direct extension of graft infection and was deemed inoperable due to multiple comorbidities. Endovascular management of AEF can achieve satisfactory short-term results. Due to the high rate of recurrent bleeding and sepsis it should be used as a temporary measure and a bridge to open repair, whenever this is feasible.
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The aim of the study was to investigate the utility of NT-proBNP measurement for the stratification of presurgical cardiac risk. ⋯ Measuring NT-proBNP before non cardiac surgery in clinical practice could be useful to better stratify patients' risk.