Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
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Catheter Cardiovasc Interv · Jul 2009
ReviewPrevention and treatment of venous thromboembolism during pregnancy.
Women who are pregnant or have recently given birth are at significantly increased risk of venous thromboembolism (VTE) compared with the general population. Furthermore, the issues surrounding the appropriate prevention, diagnosis, and treatment of VTE are more complex in pregnancy, where not only the effects on the mother, but also the effects on the fetus need to be considered. Although guidelines provide recommendations for the optimal management of these patients, most of these guidelines are based on evidence from observational studies, or on data extrapolated from a nonpregnant population. Randomized clinical trials are needed to identify the optimal strategies for prevention and treatment of VTE in pregnancy.
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Catheter Cardiovasc Interv · Jul 2009
ReviewDeep-vein thrombosis in malignancy: how long should patients be treated, and with what?
Cancer patients are at high-risk of venous thromboembolism (VTE). However, the optimal VTE prophylaxis and treatment options for this population are currently unclear. ⋯ In cancer patients with confirmed VTE, questions remain over the most effective long-term treatment regimen. Further trials are required to help physicians to make evidence-based choices for the management of VTE in these patients.
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Catheter Cardiovasc Interv · Jul 2009
ReviewChronically anticoagulated patients who need surgery: can low-molecular-weight heparins really be used to "bridge" patients instead of intravenous unfractionated heparin?
Patients at high risk of arterial or venous thromboembolic events often receive chronic treatment with long-term oral anticoagulants such as warfarin. However, if these patients require an invasive procedure, they may require a temporary interruption of their warfarin therapy to minimize their bleeding risk during the procedure. As warfarin has a long half-life and an unpredictable pharmacokinetic profile, short-acting parenteral anticoagulants, such as unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH), may be of benefit in protecting the patient from thromboemboli while their warfarin dose is withheld. Such "bridging therapy" has traditionally been provided in-hospital with intravenous UFH; however, recent data have suggested that LMWH may be an effective alternative, with potential cost-savings due to the ability to provide bridging therapy in the outpatient setting.
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Catheter Cardiovasc Interv · Apr 2009
Comparative StudyFunnel plots for comparing performance of PCI performing hospitals and cardiologists: demonstration of utility using the New York hospital mortality data.
The New York State Department of Health collects and reports outcome data on the hospitals and cardiologists who perform percutaneous coronary intervention (PCI) to allow them to examine their quality of care. Results are provided in tabular form. However funnel plots are the display method of choice for comparison of institutions and operators, using the principles of statistical process control (SPC). We aimed to demonstrate that funnel plots, which aid a meaningful interpretation of the results, can be derived from the New York PCI dataset. ⋯ The SPC funnel plot is an easy-to-interpret, risk-adjusted means of identifying units whose performance, in terms of mortality, diverges significantly from the population mean. Funnel plots may be applied to a complex dataset and allow a visual comparison of data derived from multiple healthcare units. Variation is readily identified permitting hospitals and cardiologists to appraise their practices so that effective quality improvement may take place.