The Canadian journal of cardiology
-
Multicenter Study Comparative Study
Managing novel oral anticoagulants in patients with atrial fibrillation undergoing device surgery: Canadian survey.
Approximately 10% of patients who undergo surgical procedures require chronic oral anticoagulation. Physicians must balance the thromboembolic and bleeding risks to make informed decisions on whether to continue anticoagulant medication. Evidence is lacking regarding the perioperative management of novel oral anticoagulant (NOAC) agents. This survey aims to describe the management of perioperative NOAC use during device implantation by Canadian centres. ⋯ Most Canadian centres perform device implantation with NOAC interruption without the use of bridging. The timing of stopping and restarting anticoagulation and incidence of bleeding complications is variable. These findings emphasize the need for randomized controlled studies to guide the optimal approach to management of NOACs during device implantation.
-
Comparative Study
Predictors of radial artery size in patients undergoing cardiac catheterization: insights from the Good Radial Artery Size Prediction (GRASP) study.
Radial artery occlusion occurs after transradial cardiac catheterization or percutaneous coronary intervention. Although use of a sheath larger than the artery is a risk factor for radial artery occlusion, radial artery size is not routinely measured. We aimed to identify bedside predictors of radial artery diameter. ⋯ Wrist circumference, male sex, and non-South Asian ancestry are independent predictors of increased radial artery diameter. A risk score using these variables can identify patients with small radial arteries.
-
Comparative Study
Duration of preoperative β-blockade and outcomes after major elective noncardiac surgery.
Although practice guidelines recommend that perioperative β-blockade be initiated at least several days to weeks before noncardiac surgery is performed, the minimum required period of preoperative therapy is unclear. ⋯ Initiation of β-blocker therapy 1-7 days before noncardiac surgery is associated with increased 30-day mortality. The findings merit further evaluation by randomized trials.
-
Spontaneous chest wall hematoma is rare and has been associated with neoplasms and arteriovenous malformations. However, the increasing use of anticoagulant and antiplatelet agents has increased the clinical presentation of spontaneous hematomas. ⋯ Although bleeding is a known adverse effect, only a small number of cases of hematomas associated with antiplatelet agents have been described. We report a case of a large spontaneous latissimus dorsi hematoma in a patient receiving clopidogrel and aspirin therapy.
-
Renal denervation is a novel catheter-based, percutaneous procedure using radiofrequency energy to ablate nerves within the renal arteries. This procedure might help to significantly lower blood pressure (BP) in patients with resistant hypertension, defined as BP > 140/90 mm Hg (> 130/80 mm Hg for those with diabetes) despite use of ≥ 3 optimally dosed antihypertensive agents, ideally including 1 diuretic agent. The Canadian Hypertension Education Program Recommendations Task Force reviewed the current evidence on safety and efficacy of this procedure. ⋯ Although early results on short-term safety and blood pressure-lowering are encouraging, there are no long-term efficacy and safety data, or hard cardiovascular end point data. The discrepancy between office BP reductions and 24-hour ambulatory BP monitor reductions needs to be further investigated. Until more data are available, renal sympathetic denervation should be considered as a treatment option of last resort for patients with resistant hypertension who have exhausted all other available medical management options.