Archives des maladies du coeur et des vaisseaux
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Arch Mal Coeur Vaiss · Nov 2001
Review[Fibrinolysis in myocardial infarction with EKG elevation. Optimization of myocardial reperfusion by treatment with antithrombotic agents].
In the case of acute coronary syndrome with prolonged ST elevation on ECG showing an acute coronary obstruction, the urgent institution of fibrinolysis is a widely validated treatment. Since the first placebo controlled studies with streptokinase until the development of bolus administration rt-PA varieties, fibrinolytic agents have lowered mortality. Associated anti-thrombotic drugs are multiplying in parallel. ⋯ Pentasaccharide seems attractive. The place of hirudine and its derivatives in the acute phase of MI appear limited after the results of the HERO-2 trial, associating hirulog and streptokinase, with the earlier studies also having been disappointing. The GPIIbIIIa blockers in association with a half dose of fibrinolysis do not aggravate the intracerebral haemorrhagic risk before 75 years old and clearly reduce hospital morbidity in infarction, at the price however of an increase in transfusions.
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Cardiac rupture is certainly unrecognised in the context of closed chest trauma. There have been few reports in the literature despite the fact that autopsy series show that it is the second cause of death after serious thoracic injury. The authors report three cases of traumatic rupture of the heart. ⋯ When the pericardium is intact, the diagnosis is suggested by the signs of tamponade: With earlier treatment of trauma by medical teams, this lesion should be diagnosed as soon as possible. Echocardiography has many indications in closed chest trauma. Early surgical intervention is the only treatment of these lesions.
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Arch Mal Coeur Vaiss · Nov 2001
Review[Antithrombotic treatment protocols in interventional cardiology].
The use of coronary stents has become routine in interventional cardiology, for which anti-platelet drugs are part of the daily antithrombotic routine. The association of ticlopidine and aspirin may be replaced definitively by that of clopidogrel and aspirin. ⋯ The anti-GP IIb/IIIa agents with an immediate onset of action are also widely used in the acute phase of MI and in acute coronary syndromes without ST elevation when the troponin levels could enable selection of high risk patients more likely to benefit from an aggressive antithrombotic strategy. Finally, the superiority of enoxaparin over unfractionated heparin must be emphasised in these same acute coronary syndromes.