American heart journal
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American heart journal · Jan 2004
ReviewPeriprocedural thromboprophylaxis in patients receiving chronic anticoagulation therapy.
Patients receiving chronic anticoagulation therapy pose a clinical challenge when therapy needs to be interrupted for surgical or invasive procedures. Maintaining anticoagulation places them at risk for serious bleeding complications, whereas discontinuing anticoagulation puts them at risk of thromboembolic complications. Most patients can undergo dental procedures, cataract surgery, and diagnostic endoscopy without discontinuing anticoagulation. ⋯ As with the use of UFH, there are reports of maternal thromboembolic complications with LMWHs in pregnant women with mechanical heart valves. This review brings together the available data on periprocedural bridging to assess the available options for patients on long-term warfarin therapy who are undergoing surgical procedures. It provides a rationale for using LMWHs while individualizing the risks versus benefits in a given patient population.
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American heart journal · Jan 2004
Randomized Controlled Trial Multicenter Study Clinical TrialPatients with chest pain calling 9-1-1 or self-transporting to reach definitive care: which mode is quicker?
We examined differences in transport times for patients with chest pain who used private transportation compared with patients who used emergency medical services (EMS) to reach definitive medical care. ⋯ Although private transportation results in a faster trip to the ED, quicker care is obtained with the use of EMS.
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American heart journal · Dec 2003
Randomized Controlled Trial Clinical TrialAcetylcysteine in the prevention of contrast-induced nephropathy after coronary angiography.
Contrast-induced nephropathy (CIN) after coronary angiography is associated with increased morbidity and mortality rates. Preliminary studies with N-acetylcysteine (NAC) have found conflicting results in the prevention of CIN in patients undergoing coronary angiography. This study was designed to evaluate the efficacy and safety of NAC in the prevention of CIN in patients undergoing coronary angiography. ⋯ In patients with reduced renal function undergoing elective coronary angiography, NAC does not reduce the risk of CIN.
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American heart journal · Dec 2003
Randomized Controlled Trial Clinical TrialA randomized, placebo-controlled trial of early eptifibatide for non-ST-segment elevation acute coronary syndromes.
The acute benefits of platelet glycoprotein IIb/IIIa inhibitors for non-ST-segment elevation acute coronary syndromes (NSTE ACS) remain unclear. ⋯ In this pilot trial, early administration of eptifibatide in the emergency department did not modulate serologic measurements of infarct size in patients with NSTE ACS.
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American heart journal · Nov 2003
Randomized Controlled Trial Multicenter Study Clinical TrialInfluence of thrombolytic therapy, with or without intra-aortic balloon counterpulsation, on 12-month survival in the SHOCK trial.
The enhancement of diastolic coronary blood flow by the combination of thrombolytic therapy (TT) and intra-aortic balloon counterpulsation (IABP) in experimental studies provides a rationale for their combined use in acute myocardial infarction (MI) complicated by cardiogenic shock. We examined the relation between TT (with and without IABP) and 12-month survival in the SHould We Emergently Revascularize Occluded Coronaries for Cardiogenic ShocK (SHOCK) Trial. ⋯ Among patients randomly assigned to IMS in the SHOCK Trial, TT was associated with improved 12-month survival and did not significantly increase the risk of severe bleeding.