Minerva cardioangiologica
-
Minerva cardioangiologica · Dec 2008
ReviewPrevention of thromboembolic complications in patients with atrial fibrillation.
Atrial fibrillation (AF) is a major arrhythmia in clinical practice, and its frequency rises rapidly from the sixth decade onward. Its most serious clinical consequence is ischemic stroke. Patients with AF have a five-fold increased risk of stroke compared to those in sinus rhythm. ⋯ Inconvenience of monitoring and frequent dose adjustments, together with fear of major hemorrhage associated with oral anticoagulants, contribute to this underuse. In particular, conventional intensity of anticoagulation increases the risk of intracranial hemorrhage, and patients with advanced age are more prone to cerebral bleeding than younger patients. Up to date, the efficacy of aspirin, an antiplatelet agent, for stroke prevention in AF patients is less clear and remains controversial and alternative pharmacological treatment options have failed to demonstrate their superiority over vitamin K antagonists.
-
Minerva cardioangiologica · Dec 2008
Plasma NT-proBNP levels and the risk of atrial fibrillation after major lung resection.
Supraventricular tachyarrhythmias, most frequently atrial fibrillation (AF), occur in 8-30% of patients undergoing major pulmonary resection. The aim of this study was to characterize a biochemical marker in order to identify subjects at higher risk of postoperative AF. The authors tested the hypothesis that elevated preoperative plasma levels of N-terminal brain-type natriuretic peptide (NT-pro-BNP) may predict the occurrence of postoperative AF. ⋯ A preoperative elevated plasma NT-pro-BNP level was associated with the occurrence of AF in patient undergoing major thoracic surgery. Baseline NT-pro-BNP levels may be proposed as a biochemical marker to detect patients at higher risk of postoperative AF who could benefit from prophylactic therapeutic medication.