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<1>
Accession Number
2011158421
Authors
McHugh S.M. Collins C.J. Corrigan M.A. Hill A.D.K. Humphreys H.
Institution
(McHugh, Corrigan, Hill) Department of Surgery, Royal College of Surgeons
in Ireland, Dublin 2, Ireland
(McHugh, Corrigan, Hill) Department of Surgery, Beaumont Hospital, Dublin
9, Ireland
(Collins, Humphreys) Department of Microbiology, Beaumont Hospital, Dublin
9, Ireland
(Humphreys) Department of Clinical Microbiology, Royal College of Surgeons
in Ireland, Dublin 2, Ireland
Title
The role of topical antibiotics used as prophylaxis in surgical site
infection prevention.
Source
Journal of Antimicrobial Chemotherapy. 66 (4) (pp 693-701), 2011.
Article Number: dkr009. Date of Publication: April 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Compared with systemic antibiotic therapy, the topical or local delivery
of an antibiotic has many potential advantages. However, local antibiotics
at the surgical site have received very limited approval in any of the
surgical prophylaxis consensus guidelines that we are aware of. A review
of the literature was carried out through searches of peer-reviewed
publications in PubMed in the English language over a 30 year period
between January 1980 and May 2010. Both retrospective and prospective
studies were included, as well as meta-analyses. With regard to defining
'topical' or 'local' antibiotic application, the application of an
antibiotic solution to the surgical site intraoperatively or immediately
post-operatively was included. A number of surgical procedures have been
shown to significantly benefit from perioperative topical prophylaxis,
e.g. joint arthroplasty, cataract surgery and, possibly, breast
augmentation. In obese patients undergoing abdominal surgery, topical
surgical prophylaxis is also proven to be beneficial. The selective use of
topical antibiotics as surgical prophylaxis is justified for specific
procedures, such as joint arthroplasty, cataract surgery and, possibly,
breast augmentation. In selective cases, such as obese patients undergoing
abdominal surgery, topical surgical prophylaxis is also proven to be
beneficial. Apart from these specific indications, the evidence for use of
topical antibiotics in surgery is lacking in conclusive randomized
controlled trials. The Author 2011. Published by Oxford University Press
on behalf of the British Society for Antimicrobial Chemotherapy. All
rights reserved.

<2>
Accession Number
2011159799
Authors
Schramko A.A. Suojaranta-Ylinen R.T. Kuitunen A.H. Raivio P.M. Kukkonen
S.I. Niemi T.T.
Institution
(Schramko, Suojaranta-Ylinen, Kuitunen, Kukkonen, Niemi) Department of
Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital,
Meilahti Hospital, PO Box 340, Helsinki, FI-00029 Hus, Finland
(Raivio) Department of Cardiothoracic Surgery, Helsinki University Central
Hospital, Meilahti Hospital, Helsinki, Finland
Title
Comparison of the effect of 6% hydroxyethyl starch and gelatine on cardiac
and stroke volume index: A randomized, controlled trial after cardiac.
Source
Perfusion. 25 (5) (pp 283-291), 2010. Date of Publication: September
2010.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Background and aims: The objective of this study was to find out the
effect of various doses of hydroxyethyl starch (HES), gelatine or Ringer's
acetate on cardiac and stroke volume index after cardiac surgery. Material
and methods: Three consecutive boluses (each 7 mL.kg-1) of either 6% HES
130/0.4, 4% gelatine, or Ringer's acetate solutions were administered to
45 patients postoperatively. The rate of infusions was adjusted according
to haemodynamic measurements. Thereafter, infusion of the study solution
(7 mL.kg-1) was continued for the following 12 hours. The total dose of
study solution was 28 mL. kg-1. Results and conclusion: Mean (SD) cardiac
and stroke volume indices were greater in the HES group [2.8 L.min-1.m-2
(0.7), 34.1 (6.7) ml.m-2] than in the gelatine group [2.2 L. min-1.m-2
(0.6), 25.8 (7.2) ml.m-2] after completion of 7 mL. kg-1 of study
solution. At this stage, the effect of gelatine did not differ from
Ringer's acetate. After completion of 14 mL.kg-1 and 21 mL.kg-1 of
colloids, similar cardiac and stroke volume indices were observed and the
haemodynamic response was better in both colloid groups than in the
Ringer's acetate group. No differences between groups were detected on the
first postoperative morning. In the early postoperative phase after
cardiac surgery, the effect of a single dose of HES solution on the
haemodynamics was superior to the effect of gelatine or Ringer's acetate.
However, after repeated administration of the study solutions, the
haemodynamics in the two colloid groups appeared to be similar, but
superior to the Ringer's acetate group.

<3>
Accession Number
2011159801
Authors
Lund P.E. Wassback G. Thomas O. Carlsson T. Schott U.
Institution
(Lund, Wassback, Carlsson) Orebro University Hospital, Department of
Cardiothoracic Anaesthesiology and Intensive Care, Orebro, Sweden
(Thomas) Lund University Medical Faculty, Lund, Sweden
(Schott) Department of Anaesthesiology and Intensive Care, Lund University
Skane University Hospital, Lund, Sweden
Title
Comparison of two infusion rates of antithrombin concentrate in
cardiopulmonary bypass surgery.
Source
Perfusion. 25 (5) (pp 305-312), 2010. Date of Publication: September
2010.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Background: Antithrombin concentrate (AT) is used to treat heparin
resistance (HR) in cardiac surgery. It is usually given slowly due to the
fear of anaphylaxis. This may delay cardiac catheterisation and the start
of cardiopulmonary bypass (CPB). HR is often defined as the failure to
reach or maintain a target activated clotting time (ACT) despite a
standard dose of heparin. It is not generally possible to predict which
patients will display HR, although there are known risk factors. Routine
early administration of AT before heparinisation is probably not
cost-effective. Infusing AT relatively quickly after demonstrating HR may
be more cost-effective, while not delaying surgery. The aim of this study
is to investigate the safety and side effects of a faster infusion of AT.
Methods: Forty patients undergoing elective heart surgery were included
and randomised to two groups in a double-blind fashion. Each group
received 1000 IU of AT intravenously (IV). One group received a slow
infusion (100 IU/min) before full-dose heparinisation. The other group
received a fast infusion (250 IU/min). Haemodynamic and respiratory data
were recorded. Any adverse effects were noted. Thrombin-antithrombin,
anti-Xa and antithrombin levels in plasma were measured. Results: No
anaphylaxis occurred in either group. No differences were found regarding
haemodynamics, respiration or laboratory results. Two patients experienced
major haemorrhage and recovered; there were two deaths, thought to be
unrelated to the study drugs. Conclusion: AT can be infused at a rate of
250 IU/min. This is faster than the current recommendation of 100 IU/min.
This rate of infusion allows restricting AT infusion to those patients who
display HR, without delaying surgery. Optimal anticoagulant therapy for
CPB probably includes point-of-care measurement of ACT and plasma AT and
small, but rapid, infusions of AT in heparin-resistant patients. 2010 The
Author(s).

<4>
Accession Number
2011158368
Authors
Castillo R. Rodrigo R. Perez F. Cereceda M. Asenjo R. Zamorano J.
Navarrete R. Villalabeitia E. Sanz J. Baeza C. Aguayo R.
Institution
(Castillo, Rodrigo, Perez, Navarrete) Institute of Biomedical Sciences,
Faculty of Medicine, University of Chile, Santiago, Chile
(Cereceda, Asenjo, Zamorano) Cardiovascular Department, University of
Chile Clinical Hospital, Santiago, Chile
(Villalabeitia, Sanz, Baeza) Cardiothoracic Surgery Unit, San Juan de Dios
Hospital, Santiago, Chile
(Aguayo) Coronary Intensive Unit, San Juan de Dios Hospital, Santiago,
Chile
Title
Antioxidant Therapy Reduces Oxidative and Inflammatory Tissue Damage in
Patients Subjected to Cardiac Surgery with Extracorporeal Circulation.
Source
Basic and Clinical Pharmacology and Toxicology. 108 (4) (pp 256-262),
2011. Date of Publication: April 2011.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Ischaemia reperfusion injury is a pathophysiological event that occurs
after cardiac surgery with extracorporeal circulation. This clinical event
has been associated with the induction of oxidative and inflammatory
damage in atrial tissue. Here, we tested whether combined omega 3
polyunsaturated fatty acids (n-3 PUFA)-antioxidant vitamin protocol
therapy reduces oxidative and inflammatory cardiac tissue damage. This
trial assigned 95 either-sex patients to supplementation with n-3 PUFA
(2g/day), or matching placebo groups, 7days before on-pump surgery.
Antioxidant vitamins C (1g/day) and E (400IU/day) or placebo were added
from 2days before surgery until discharge. Blood and atrial tissue samples
were obtained during the intervention. Reduced/oxidized glutathione
(GSH/GSSG) ratio, malondialdehyde (MDA) and protein carbonylation were
determined in atrial tissue. Leucocyte count and high-sensitivity
C-reactive protein (hs-CRP) in blood plus nuclear factor (NF)-appaB
activation in atrial tissue served for inflammation assessment. Lipid
peroxidation and protein carbonylation were 27.5 and 24% lower in
supplemented patients (p<0.01). GSH/GSSG ratio was 38.1% higher in
supplemented patients compared with placebo (p<0.01). Leucocyte count and
serum hs-CRP levels were markedly lower throughout the protocol in
supplemented patients (p<0.01). Atrial tissue NF-B DNA activation in
supplemented patients was 22.5% lower than that in placebo patients
(p<0.05). The combined n-3 PUFA-antioxidant vitamin protocol therapy here
proposed reduced the oxidative stress and inflammation biomarkers, in
patients undergoing on-pump cardiac surgery. 2010 The Authors. Basic &
Clinical Pharmacology & Toxicology 2010 Nordic Pharmacological Society.

<5>
Accession Number
2011144484
Authors
Dodd K.S. Saczynski J.S. Zhao Y. Goldberg R.J. Gurwitz J.H.
Institution
(Dodd, Saczynski, Gurwitz) Department of Medicine, University of
Massachusetts, Medical School, Worcester, MA, United States
(Dodd, Saczynski, Gurwitz) Meyers Primary Care Institute, University of
Massachusetts, Medical School, Worcester, MA, United States
(Goldberg) Department of Quantitative Health Sciences, University of
Massachusetts, Medical School, Worcester, MA, United States
(Zhao) Duke Translational Nursing Institute, Duke University, Durham, NC,
United States
Title
Exclusion of older adults and women from recent trials of acute coronary
syndromes.
Source
Journal of the American Geriatrics Society. 59 (3) (pp 506-511), 2011.
Date of Publication: March 2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
OBJECTIVES: To determine whether the participation of older adults and
women in published clinical trials has increased during recent years.
DESIGN: Systematic review to identify clinical trials of acute coronary
syndromes (ACSs) published from May 2007 to May 2009. Trials were excluded
if they enrolled fewer than 50 participants, were substudies of previously
published trials, or initiated treatment more than 3 weeks after the acute
cardiac event. SETTING: A search of MEDLINE and the Cochrane Central
Register of Controlled Trials. PARTICIPANTS: Sixty-eight thousand sixteen
participants of 80 trials. MEASUREMENTS: Information on the age of trial
participants, percentage of participants who were female, and whether
there were specific exclusions based on age were abstracted from all
included trials. RESULTS: Twenty-three trials (29.7%) had explicit
exclusion criteria based on age. Only 13.8% of study participants were
aged 75 and older, and 27.7% were women. These percentages are below the
representation of all U.S. adults experiencing an ACS in recent years who
were aged 75 and older (41.9%) or female (41.5%). The average age of all
study participants was 61.6 +/- 3.8. There was a significant association
between the mean age of a study population and the proportion of women
enrolled in the trial. CONCLUSION: Older adults and women remain
under-represented in recent clinical trials of people hospitalized with an
ACS. These exclusions may hinder efforts to inform evidence-based clinical
decision-making in these high-risk populations. 2011, Copyright the
Authors Journal compilation 2011, The American Geriatrics Society.

<6>
Accession Number
2011152357
Authors
Protopapas A.D. Baig K. Mukherjee D. Athanasiou T.
Institution
(Protopapas, Mukherjee, Athanasiou) Department of Surgery and Cancer,
Imperial College London, United Kingdom
(Baig) Hammersmith Hospital, Imperial College Healthcare NHS Trust,
London, United Kingdom
Title
Pulmonary embolism following coronary artery bypass grafting.
Source
Journal of Cardiac Surgery. 26 (2) (pp 181-188), 2011. Date of
Publication: March 2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: Pulmonary embolism (PE) is a life-threatening complication,
with a deceptive clinical presentation following coronary artery bypass
grafting (CABG). Methods: We identified 13 studies on PE in post-CABG
patients, spanning a period of 34 years. Results: The overall cumulative
incidence of PE following CABG was 1.3% (111 PEs in 8553 CABGs).
Conclusion: We suggest further prospective randomized studies to examine
the effect of saphenous system vein grafting, and choice of low molecular
weight heparin prophylaxis on the incidence of post-CABG PE. 2011 Wiley
Periodicals, Inc.

<7>
Accession Number
2011152371
Authors
Moraca R.J. Wanamaker K.M. Bailey S.H. McGregor W.E. Benckart D.H. Maher
T.D. Magovern Jr. G.J.
Institution
(Moraca, Wanamaker, Bailey, McGregor, Benckart, Maher, Magovern Jr.)
Department of Cardiovascular and Thoracic Surgery, Allegheny General
Hospital, 320 East North Avenue, Pittsburgh, PA 15212, United States
Title
Strategies and outcomes of cardiac surgery in Jehovah's witnesses.
Source
Journal of Cardiac Surgery. 26 (2) (pp 135-143), 2011. Date of
Publication: March 2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: Jehovah's Witnesses (JW) are a Christian faith, with an
estimated 1.1 million members in the United States, well recognized for
their refusal of blood and blood products. JW may not be considered for
cardiac surgery due to perceived higher risks of morbidity and mortality.
This study reviews our contemporary strategies and experience with JW
undergoing routine and complex cardiac surgery. Methods: From November
2001 to April 2010, 40 JW were referred for cardiac surgery at a single
quaternary referral institution. A retrospective analysis of demographic
data, perioperative management, and clinical outcomes was examined.
Published validated clinical risk calculator and model for prediction of
transfusion were used to identify high-risk patients (risk of mortality
>6% or probability of transfusion >0.80). Results: The mean age was 70
(+/- 9.5) years with 21 men and 19 women. Patients were classified as high
risk (45%, n = 18) and low risk (55%, n = 22) with demographics and
comorbidities listed in Table 2. Operative procedures included: isolated
coronary artery bypass grafting (CABG) (n = 19), isolated valve
replacement/repair (n = 7), valve/CABG (n = 7), reoperative valve
replacement (n = 4), reoperative CABG (n = 2), valve/ascending aorta
replacement (n = 1), and CABG /ascending aorta replacement (n = 1). All JW
were evaluated by The Department of Bloodless Medicine to individually
define acceptable blood management strategies. The mean preoperative
hemoglobin was 14.1 g/dL (+/-1.6). Overall mortality was 5% (n = 2) all of
which were in the high-risk group. Discussion: Using a multidisciplinary
approach to blood management, JW can safely undergo routine and complex
cardiac surgery with minimal morbidity and mortality. 2011 Wiley
Periodicals, Inc.

<8>
Accession Number
2011152373
Authors
Chaudhuri K. Marasco S.F.
Institution
(Chaudhuri) Department of Cardiothoracic Surgery, Alfred Hospital,
Australia
(Marasco) Department of Surgery, Monash University, Australia
Title
The effect of carbon dioxide insufflation on cognitive function during
cardiac surgery.
Source
Journal of Cardiac Surgery. 26 (2) (pp 189-196), 2011. Date of
Publication: March 2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
The use of carbon dioxide (CO₂) insufflation into the
pericardial well has become widespread, and in some units routine. The
rationale behind this practice is the fact that CO₂ is more
soluble than air leading to fewer gaseous microemboli entering the
bloodstream and being transferred to the brain or heart. However, the
evidence that this reduces postoperative neurocognitive decline is scant.
Although CO₂ insufflation is generally a safe procedure there
are case reports of significant complications. The aim of this systematic
review is to analyze the current evidence for this practice. 2011 Wiley
Periodicals, Inc.

<9>
Accession Number
2011155390
Authors
Cleeland C.S. Wang X.S. Shi Q. Mendoza T.R. Wright S.L. Berry M.D.
Malveaux D. Shah P.K. Gning I. Hofstetter W.L. Putnam Jr. J.B. Vaporciyan
A.A.
Institution
(Cleeland, Wang, Shi, Mendoza, Wright, Berry, Malveaux, Shah, Gning,
Hofstetter, Putnam Jr., Vaporciyan) University of Texas, MD Anderson
Cancer Center, Department of Symptom Research, 1515 Holcombe Blvd, Box
1450, Houston, TX 77030, United States
Title
Automated symptom alerts reduce postoperative symptom severity after
cancer surgery: A randomized controlled clinical trial.
Source
Journal of Clinical Oncology. 29 (8) (pp 994-1000), 2011. Date of
Publication: 10 Mar 2011.
Publisher
American Society of Clinical Oncology (330 John Carlyle Street, Suite 300,
Alexandria VA 22314, United States)
Abstract
Purpose: Patients receiving cancer-related thoracotomy are highly
symptomatic in the first weeks after surgery. This study examined whether
at-home symptom monitoring plus feedback to clinicians about severe
symptoms contributes to more effective postoperative symptom control.
Patients and Methods: We enrolled 100 patients receiving thoracotomy for
lung cancer or lung metastasis in a two-arm randomized controlled trial;
79 patients completed the study. After hospital discharge, patients rated
symptoms twice weekly for 4 weeks via automated telephone calls. For
intervention group patients, an e-mail alert was forwarded to the
patient's clinical team for response if any of a subset of symptoms (pain,
disturbed sleep, distress, shortness of breath, or constipation) reached a
predetermined severity threshold. No alerts were generated for controls.
Group differences in symptom threshold events were examined by generalized
estimating equation modeling. Results: The intervention group experienced
greater reduction in symptom threshold events than did controls (19% v 8%,
respectively) and a more rapid decline in symptom threshold events. The
difference in average reduction in symptom interference between groups was
-0.36 (SE, 0.078; P = .02). Clinicians responded to 84% of e-mail alerts.
Both groups reported equally high satisfaction with the automated system
and with postoperative symptom control. Conclusion: Frequent symptom
monitoring with alerts to clinicians when symptoms became moderate or
severe reduced symptom severity during the 4 weeks after thoracic surgery.
Methods of automated symptom monitoring and triage may improve symptom
control after major cancer surgery. These results should be confirmed in a
larger study. 2011 by American Society of Clinical Oncology.

<10>
Accession Number
2011156729
Authors
Mariscalco G. Banach M. Bruno V.D. Borsani P. Sala A.
Institution
(Mariscalco, Bruno, Borsani, Sala) Department of Surgical Sciences,
Cardiac Surgery Unit, Varese University Hospital, Viale Guicciardini, 7,
I-21100, Varese, Italy
(Banach) Department of Hypertension, Medical University of Lodz, Lodz,
Poland
Title
Reply to preoperative n-3 polyunsatured fatty acids do not reduce
postoperative atrial fibrillation in cardiac surgery, by takagi i. and
umemoto t.
Source
Angiology. 62 (3) (pp 278-279), 2011. Date of Publication: April 2011.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)

<11>
Accession Number
2011156733
Authors
Takagi H. Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan
Title
Preoperative n-3 polyunsatured fatty acids do not reduce postoperative
atrial fibrillation in cardiac surgery.
Source
Angiology. 62 (3) (pp 276-277), 2011. Date of Publication: April 2011.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)

<12>
Accession Number
2011140534
Authors
Chittoodan S. Breen D. O'Donnell B.D. Iohom G.
Institution
(Chittoodan, Breen, O'Donnell, Iohom) Department of Anaesthesia, Cork
University Hospital, University College Cork, Cork, Ireland
Title
Long versus short axis ultrasound guided approach for internal jugular
vein cannulation: A prospective randomised controlled trial.
Source
Medical Ultrasonography. 13 (1) (pp 21-25), 2011. Date of Publication:
March 2011.
Publisher
Societatea Romana de Ultrasonografie in Medicina si Biologie (Str. Iosif
Bulbuca nr.10, Timisoara 300736, Romania)
Abstract
Aim: The aim of this study was to compare the short and long axis
approaches to ultrasound guided right internal jugular vein cannulation
with respect to indicators of success. Methods: Patients undergoing
cardiac surgery requiring central venous cannulation (99 patients) were
randomised to undergo either long or short axis ultrasound guided
cannulation of the right internal jugular vein by a skilled anaesthetist.
First pass success, number of needle passes, procedural taken and
complications were documented for each procedure. Results: The right
internal jugular vein was successfully cannulated in all 99 patients. The
first pass success rate was significantly higher in the short axis 98%
group compared to the long axis group 78% [48:1 (98%) versus 39:11 (78%) p
<0.006]. Procedural time was comparable in both the groups [39.6 (18.4)
versus 46.9 (42.4)]. Fewer needle redirections were required in the short
axis group [1.02 (0.02) versus 1.24 (0.56) p <0.004]. Carotid artery
puncture only occurred in the long axis group. Conclusions: We conclude
that anaesthetists with experience in ultrasound guided internal jugular
vein cannulation, have higher first pass success rate and less carotid
artery puncture when a short axis, rather than a long axis, approach is
employed.

<13>
Accession Number
2011145128
Authors
Hoole S.P. Hamburger J.N.
Institution
(Hoole, Hamburger) Vancouver General Hospital, Vancouver BC, Canada
(Hoole, Hamburger) University of British Columbia, 2775, Laurel Street,
V5Z 1M9 Vancouver BC, Canada
Title
Calculators of revascularization risk: Peering into the crystal ball.
Source
Interventional Cardiology. 3 (1) (pp 49-53), 2011. Date of Publication:
February 2011.
Publisher
Future Medicine Ltd. (2nd Albert Place, Finchley Central, London N3 1QB,
United Kingdom)
Abstract
Revascularization risk-assessment tools guide optimal management of
patients with coronary disease. However, until recently, percutaneous
coronary intervention risk-prediction models had lagged behind surgical
risk-prediction tools. Validated percutaneous coronary intervention risk
calculators are now available, which allow the comparison of predicted
30-day mortality with coronary artery bypass graft surgical data,
facilitating optimal treatment selection by both physicians and patients,
insuring valid, informed consent to potentially high-risk procedures.
2011 Future Medicine Ltd.

<14>
Accession Number
2011145132
Authors
Ahmed I. Gertner E. Nelson W.B. House C.M. Zhu D.W.
Institution
(Ahmed, Gertner, Nelson, House, Zhu) Regions Hospital and the University
of Minnesota Medical School, MN, United States
(Nelson, Zhu) Section of Cardiology 11102H, Department of Medicine,
Regions Hospital, 640 Jackson Street, Saint Paul, MN 55101, United States
Title
Safety of coronary angiography and percutaneous coronary intervention in
patients on uninterrupted warfarin therapy: A meta-analysis.
Source
Interventional Cardiology. 3 (1) (pp 101-109), 2011. Date of
Publication: February 2011.
Publisher
Future Medicine Ltd. (2nd Albert Place, Finchley Central, London N3 1QB,
United Kingdom)
Abstract
Objective: A systematic review of the literature was conducted relating to
the continuation of warfarin therapy at the time of coronary angiography,
with or without percutaneous coronary intervention, to determine the
bleeding risk of these patients. Methods: A search of a major electronic
database was independently conducted by two reviewers from 1960 to
December 2009. Studies were included if they met the following criteria:
were original; included patients who were undergoing coronary
angiography/catheterization with or without angioplasty/stent placement
and were receiving uninterrupted warfarin therapy throughout the
periprocedural period; and reported the number of bleeding events and
procedure related complications. Based on the inclusion and exclusion
criteria, a total of eight studies (one randomized, four cohort and three
case series) were included for analysis. Results: The pooled odds ratio
(95% CI) for procedure-related complications in continued warfarin versus
nonanticoagulated patients, in those studies that had comparison groups,
was 0.53 (0.29-0.94) and for combined major bleeding and procedure-related
complication was 1.01 (0.29-3.51). However, there was significant
heterogeneity (p = 0.001; I² = 81%) in retrospective studies
and no heterogeneity in prospective studies (I² = 25%). The
pooled incidence (95% CI) of major bleeding and periprocedural
complications for all studies, including case series, was 0.037
(0.024-0.057). There was no significant heterogeneity (p = 0.32;
I² = 14.1%). Discussion: Continuing warfarin therapy during
coronary angiography and percutaneous intervention appears to be safe,
with no increased incidence of major bleeding and periprocedural
complications. However, the quality of evidence is low due to several
limitations of a number of the studies included in our article. A
multicenter randomized trial is necessary to determine the optimal
periprocedral strategy for patients receiving uninterrupted warfarin
therapy undergoing coronary angiography and percutaneous coronary
intervention. 2011 Future Medicine Ltd.