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<1>
Accession Number
2015199224
Authors
Comez M. Celik M. Dostbil A. Aksoy M. Ahiskalioglu A. Fuat Erdem A. Aydin
Y. Ince I.
Institution
(Comez) Department of Anaesthesiology, Erzurum Regional and Training
Hospital, Palandoken, Erzurum 25070, Turkey
(Celik, Dostbil, Aksoy, Ahiskalioglu, Ince) Department of Anaesthesiology
and Reanimation, Ataturk University School of Medicine, Palandoken,
Erzurum 25070, Turkey
(Fuat Erdem) Department of Anaesthesiology and Reanimation, Sakarya
University School of Medicine, Palandoken, Erzurum 25070, Turkey
(Aydin) Department of Thorax surgery, Ataturk University School of
Medicine, Palandoken, Erzurum 25070, Turkey
Title
The effect of pre-emptive intravenous Dexketoprofen + thoracal epidural
analgesia on the chronic post-thoracotomy pain.
Source
International Journal of Clinical and Experimental Medicine. 8 (5) (pp
8101-8107), 2015. Date of Publication: 30 May 2015.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Post thoracotomy chronic pain is a severe problem that affects the
majority of patients and decreases the quality of life. The purpose of
this study is to evaluate the long-term effects of thoracal epidural
levobupivacaine and intravenous dexketoprofen analgesia formed
pre-emptively on the wound site pain after major thoracotomy operations.
This randomised, prospective and double-blind study was performed with 60
patients undergoing thoracic surgery. Patients were divided into three
groups; Control Group (Group C), Pre-emptive Epidural Group (Group PE) and
Pre-emptive Dexketoprofen + Epidural Group (Group PED). Patients in the
Group C did not receive epidural analgesics and i.v. dexketoprofen before
and during the operation. 10-15 ml 0.125% levobupivacaine was given to
cases in Group PE pre-emptively through epidural catheter before the
anesthesia induction. The cases in Group PED were given 10-15 ml 0.125%
epidural levobupivacaine and 50 mg dexketoprofen with i.v. infusion
pre-emptively. The VAS score was found to be lower in Group PED during
postoperative 24 and 48 hours and before the discharge (P<0.05). The VAS
score was similar in all groups during the first and third months
(P>0.05). A statistically significant decrease was determined in the VAS
score in Group PED during the sixth month, compared to the other groups
(P<0.05). When the scores of Patient Satisfaction Scale (PSS) of the cases
were compared, they were found to be higher in Group PED as statistically
significant during the discharge period (P<0.001). Scores of PSS were
higher in Group PED as statistically significant during the postoperative
month 6 (P = 0.008). Combined application of pre-emptive intravenous
dexketoprofen and thoracal epidural analgesia reduce the chronic
post-thoracotomy pain.

<2>
Accession Number
2015196846
Authors
Wu W.-M. Yang Y. Gao Z.-L. Zhao T.-C. He W.-W.
Institution
(Wu, Yang, Gao, Zhao, He) Deparment of Thoracic Surgery, Shanghai Jiao
Tong Universtity Affiliated Sixth People's Hospital, Shanghai, China
Title
Which is better to multiple rib fractures, surgical treatment or
conservative treatment?.
Source
International Journal of Clinical and Experimental Medicine. 8 (5) (pp
7930-7936), 2015. Date of Publication: 30 May 2015.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
To compare the surgery and conservative treatment of multiple fractured
ribs, we designed a randomized controlled trial in the single center of
thoracic surgery ward. After admission condition assessment (general
clinical evaluation, operation condition assessment, the digital method of
pain assessment), the selected multiple fractured rib patients were told
to choose surgery or conservative treatment, according to the patient will
undergo surgery or conservative treatment. In the acute phase, compared
with conservative treatment, patients with mechanical ventilation in time
(mechanical ventilation time MV) (3.7 +/- 1.4 vs. 9.5 +/- 4.3), ICU stay
time (8.2 +/- 4.3 vs. 14.6 +/- 3.2), total hospitalization days (15.3 +/-
6.4 vs. 26.5 +/- 6.9), the incidence of pneumonia (6.7% vs. 19.1%),
mortality (1.3% vs. 5.3%) and pain score on patients (3.3 vs. 5.8) of
surgical treatment group were significant lower (P < 0.05). The number of
tracheostomy in surgical patients with conservative treatment (4 vs. 7)
was no statistically significant difference (P > 0.05). In chronic phase,
the surgical patients compared with patients with conservative treatment
in the chest wall pain (2.9 +/- 1.2 vs. 5.6 +/- 1.7), chest wall tension
(13.3% vs. 57.3%), dyspnea (5.3% vs. 22.4%) and chest wall deformity rate
(4% vs. 93.5%) were lower significantly (P < 0.05). In conclusion, the
surgical treatment of multiple fractured ribs could ease the acute chest
pain, reduce the mechanical ventilation time and incidence of pneumonia,
shorten the hospitalization days and total hospitalization days in the ICU
and alleviate the forward chest wall discomfort. The speedy recovery and
long-term quality of patients' life had improved significantly.

<3>
Accession Number
2015197051
Authors
Zhang E.-Y. Cui L. Li Z.-Y. Liu T. Li G.-P.
Institution
(Zhang, Cui, Li, Liu, Li) Tianjin Key Laboratory of Ionic-molecular
Function of Cardiovascular Disease, Department of Cardiology, Tianjin
Institute of Cardiology, Second Hospital of Tianjin Medical University,
Tianjin 300211, China
Title
High killips class as a predictor of new-onset atrial fibrillation
following acute myocardial infarction: Systematic review and
meta-analysis.
Source
Chinese Medical Journal. 128 (14) (pp 1964-1968), 2015. Date of
Publication: 07 Jan 2015.
Publisher
Chinese Medical Association
Abstract
Background: Recent observational studies have shown that patients with
higher Killips score (>I) have higher risk of new-onset atrial
fibrillation (NOAF) following acute myocardial infarction (AMI), while
others drew a neutral conclusion. The ultimate predictive value of high
Killips class on NOAF remained obscure. Methods: PubMed, Web of Science,
China National Knowledge Infrastructure, and the Cochrane Controlled
Trials Register Databases were searched until February 2015. Of the 3732
initially identified studies, 5 observational studies with 10,053 patients
were analyzed. Results: The meta-analysis of these studies showed that
higher Killips score on admission was associated with higher incidence of
NOAF following AMI (odds ratio = 2.29, 95% confidence interval 1.96-2.67,
P < 0.00001), while no significant differences exist among individual
trials (P = 0.14 and I² = 43%). Conclusions: Killips class >I
was associated with the higher opportunity of developing NOAF following
AMI.

<4>
Accession Number
2015197035
Authors
Wang Q. Li Y.-H. Wang T.-L. Feng H. Cai B.
Institution
(Wang, Li, Wang, Feng, Cai) Department of Anesthesiology, Xuan Wu
Hospital, Capital Medical University, Beijing 100053, China
Title
Protective effect of low-dose sevoflurane inhalation and propofol
anesthesia on the myocardium after carotid endarterectomy: A randomized
controlled trial.
Source
Chinese Medical Journal. 128 (14) (pp 1862-1866), 2015. Date of
Publication: 07 Jan 2015.
Publisher
Chinese Medical Association
Abstract
Background: Myocardial infarction is an important cause of mortality after
carotid endarterectomy (CEA). Sevoflurane provides myocardial protection
to patients undergoing coronary surgery, but whether it also reduces the
incidence of myocardial injury in CEA patients is unclear. In this study,
we evaluated the cardioprotective effect of low-dose sevoflurane with
propofol in patients undergoing CEA. Methods: This was a single-center,
prospective, randomized study conducted between November 2011 and December
2013. The study population of 122 patients who underwent CEA were randomly
assigned to two groups. Group A (n = 62) received propofol for anesthetic
maintenance, and Group B (n = 60) additionally received 0.8% end-tidal
sevoflurane. The bispectral index was kept at 40-60. Myocardial injury,
defined as cardiac troponin I (cTnI) levels >0.04 ng/ml, was the primary
end-point. Levels of cTnI were measured before anesthesia, and at 4, 24,
and 72 h after surgery. Perioperative hemodynamic parameters and adverse
cardiovascular events after surgery were also recorded. Results:
Myocardial injury was detected in 18 patients in Group A and 7 in Group B.
The difference was statistically significant (29.0% vs. 11.7%, P = 0.018).
The hemodynamic parameters were comparable between the groups, as were
adverse cardiovascular events (P = 0.619). Conclusions: Low-dose
sevoflurane inhalation along with propofol reduces the incidence of
myocardial injury in symptomatic patients after CEA.

<5>
Accession Number
2015195920
Authors
Carroll K.A. Early N.K. Tsu L.V.
Institution
(Carroll) Department of Pharmacy Practice, Shenandoah University Bernard
J. Dunn School of Pharmacy, Wincester, VA, United States
(Early, Tsu) Department of Pharmacy Practice, Midwestern University
College of Pharmacy-Glendale, 19555 N 59th Avenue, Glendale, AZ 85308,
United States
Title
Managing acute coronary syndromes in the elderly.
Source
Consultant Pharmacist. 30 (5) (pp 265-282), 2015. Date of Publication: 01
May 2015.
Publisher
American Society of Consultant Pharmacists (1321 Duke Street, Alexandria
VA 22314-3563, United States)
Abstract
Objective: To provide an up-to-date review of the available evidence
regarding treatment of acute coronary syndromes (ACS) in elderly patients.
Data Source: A PubMed search of articles published through January 2015
was done using a combination of the following words: acute coronary
syndrome, pharmacy, elderly, geriatric, myocardial infarction,
beta-blocker, statin, antiplatelet, antithrombin, angiotensin-converting
enzyme inhibitor, and aspirin. Study Selection/Data Extraction: Relevant
original research, review articles, and guidelines were assessed for the
management of elderly patients with ACS. References from the above
literature were also evaluated. Articles were selected for inclusion based
on relevance to the topic, detailed methods, and complete results. Data
Synthesis: Because of the high prevalence of ACS in elderly patients,
appropriate treatment is necessary to reduce morbidity and mortality;
however, these patients are often under-represented in trials. This
article provides a review of the current literature on treatment of ACS in
the elderly and provides guidance to pharmacists regarding optimal
pharmacotherapy for these patients. Conclusion: Appropriate treatment of
ACS can help improve outcomes in elderly patients, and the pharmacist can
provide guidance regarding evidence-based therapy.

<6>
Accession Number
2015195500
Authors
Weltert L. Rondinelli B. Bello R. Falco M. Bellisario A. Maselli D. Turani
F. De Paulis R. Pierelli L.
Institution
(Weltert, Bellisario, Maselli, De Paulis) Cardiac Surgery Department,
European Hospital, Italy
(Rondinelli, Pierelli) Transfusion Medicine Department, San
Camillo-Forlanini Hospital, Circonvallazione Gianicolense 87, Rome 00152,
Italy
(Bello) Montefiore-Einstein Heart Center, Albert Einstein College of
Medicine, Bronx, NY, United States
(Falco, Turani) Anaesthesiology Department, European Hospital, Italy
(Pierelli) Department of Experimental Medicine, Sapienza University, Rome,
Italy
Title
A single dose of erythropoietin reduces perioperative transfusions in
cardiac surgery: Results of a prospective single-blind randomized
controlled trial.
Source
Transfusion. 55 (7) (pp 1644-1654), 2015. Date of Publication: 01 Jul
2015.
Publisher
Blackwell Publishing Inc.
Abstract
BACKGROUND We conducted a prospective single-blind randomized study to
assess whether a single 80,000 IU dose of human recombinant erythropoietin
(HRE), given just 2 days before cardiac surgery, could be effective in
reducing perioperative allogeneic red blood cell transfusion (aRBCt).
STUDY DESIGN AND METHODS Six-hundred patients presenting with preoperative
hemoglobin (Hb) level of not more than 14.5 g/dL were randomly assigned to
either HRE or control. The primary endpoint was the incidence of
perioperative aRBCt. The secondary endpoints were mortality and the
incidence of adverse events in the first 45 days after surgery, Hb level
on Postoperative Day 4, and number of units of RBC transfusions in the
first 4 days after surgery. RESULTS A total of 17% (HRE) versus 39%
(control) required transfusion (relative risk, 0.436; p<0.0005). After
baseline Hb was controlled for, there was no difference in the incidence
of aRBCt between HRE (0%) and control (3.5%) among the patients with
baseline Hb of 13.0 g/dL or more, which included the nonanemic fraction of
the study population. The mean (range) Hb level on Postoperative Day 4 was
10.2 (9.9-10.6) g/dL (HRE) versus 8.7 (8.5-9.2) g/dL (control; p<0.0005).
The distribution of number of units transfused was shifted toward fewer
units in HRE (p<0.0005). The all-cause mortality at 45 days was 3.00%
(HRE) versus 3.33% (control). The 45-day adverse event rate was 4.33%
(HRE) versus 5.67% (control; both p=NS). CONCLUSION In anemic patients
(Hb<13 g/dL), a single high dose of HRE administered 2 days before cardiac
surgery is effective in reducing the incidence of aRBCt without increasing
adverse events.

<7>
Accession Number
2015193186
Authors
Huang K. Liu W. He D. Huang B. Xiao D. Peng Y. He Y. Hu H. Chen M. Huang
D.
Institution
(Huang, Liu, Huang, Xiao, Peng, He, Hu, Chen, Huang) Department of
Cardiology, West China Hospital, Sichuan University, Chengdu, No. 37, Guo
Xue Xiang, Chengdu, Sichuan Province 610041, China
(He) Emergency Department, People's Hospital of Deyang City, China
Title
Telehealth interventions versus center-based cardiac rehabilitation of
coronary artery disease: A systematic review and meta-analysis.
Source
European Journal of Preventive Cardiology. 22 (8) (pp 959-971), 2015. Date
of Publication: 11 Aug 2015.
Publisher
SAGE Publications Inc.
Abstract
Background: Cardiac rehabilitation (CR) is an evidence-based
recommendation for patients with coronary artery disease (CAD). However,
CR is dramatically underutilized. Telehealth interventions have the
potential to overcome barriers and may be an innovative model of
delivering CR. This review aimed to determine the effectiveness of
telehealth intervention delivered CR compared with center-based supervised
CR. Method: Medline, Embase, the Cochrane Central Register of Controlled
Trials (CENTRAL) in the Cochrane Library and the Chinese BioMedical
Literature Database (CBM), were searched to April 2014, without language
restriction. Existing randomized controlled trials, reviews, relevant
conference lists and gray literature were checked. Randomized controlled
trials that compared telehealth intervention delivered CR with traditional
center-based supervised CR in adults with CAD were included. Two reviewers
selected studies and extracted data independently. Main clinical outcomes
including clinical events, modifiable risk factors or other endpoints were
measured. Results: Fifteen articles reporting nine trials were reviewed,
most of which recruited patients with myocardial infarction or
revascularization. No statistically significant difference was found
between telehealth interventions delivered and center-based supervised CR
in exercise capacity (standardized mean difference (SMD) -0.01; 95%
confidence interval (CI) -0.12-0.10), weight (SMD -0.13; 95% CI
-0.30-0.05), systolic and diastolic blood pressure (mean difference (MD) -
1.27; 95% CI -3.67-1.13 and MD 1.00; 95% CI -0.42-2.43, respectively),
lipid profile, smoking (risk ratio (RR) 1.03; 95% CI 0.78-1.38), mortality
(RR 1.15; 95% CI 0.61-2.19), quality of life and psychosocial state.
Conclusions: Telehealth intervention delivered cardiac rehabilitation does
not have significantly inferior outcomes compared to center-based
supervised program in low to moderate risk CAD patients. Telehealth
intervention offers an alternative deliver model of CR for individuals
less able to access center-based cardiac rehabilitation. Choices should
reflect preferences, anticipation, risk profile, funding, and
accessibility to health service.

<8>
Accession Number
2015191163
Authors
Salluh J.I.F. Wang H. Schneider E.B. Nagaraja N. Yenokyan G. Damluji A.
Serafim R.B. Stevens R.D.
Institution
(Salluh, Serafim) D'Or Institute for Research and Education, Rio de
Janeiro, Brazil
(Wang, Schneider, Nagaraja) Department of Surgery, Johns Hopkins
University, School of Medicine, Baltimore, MD, United States
(Yenokyan) Department of Biostatistics, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, United States
(Damluji) Cardiovascular Division, University of Miami, Miller School of
Medicine, Miami, United States
(Serafim) Department of Internal Medicine, Federal University of Rio de
Janeiro, Rio de Janeiro, Brazil
(Stevens) Department of Anesthesiology and Critical Care Medicine,
Neurology, Neurosurgery, and Radiology, Johns Hopkins University, School
of Medicine, Baltimore, MD 21287, United States
Title
Outcome of delirium in critically ill patients: Systematic review and
meta-analysis.
Source
BMJ (Online). 350 (pp 1-10), 2015. Article Number: h2538. Date of
Publication: 03 Jun 2015.
Publisher
BMJ Publishing Group
Abstract
OBJECTIVES: To determine the relation between delirium in critically ill
patients and their outcomes in the short term (in the intensive care unit
and in hospital) and after discharge from hospital. DESIGN: Systematic
review and meta-analysis of published studies. DATA SOURCES: PubMed,
Embase, CINAHL, Cochrane Library, and PsychINFO, with no language
restrictions, up to 1 January 2015. ELIGIBILITY CRITERIA FOR SELECTION
STUDIES: Reports were eligible for inclusion if they were prospective
observational cohorts or clinical trials of adults in intensive care units
who were assessed with a validated delirium screening or rating system,
and if the association was measured between delirium and at least one of
four clinical endpoints (death during admission, length of stay, duration
of mechanical ventilation, and any outcome after hospital discharge).
Studies were excluded if they primarily enrolled patients with a
neurological disorder or patients admitted to intensive care after cardiac
surgery or organ/tissue transplantation, or centered on sedation
management or alcohol or substance withdrawal. Data were extracted on
characteristics of studies, populations sampled, identification of
delirium, and outcomes. Random effects models and metaregression analyses
were used to pool data from individual studies. RESULTS: Delirium was
identified in 5280 of 16 595 (31.8%) critically ill patients reported in
42 studies. When compared with control patients without delirium, patients
with delirium had significantly higher mortality during admission (risk
ratio 2.19, 94% confidence interval 1.78 to 2.70; P<0.001) as well as
longer durations of mechanical ventilation and lengths of stay in the
intensive care unit and in hospital (standard mean differences 1.79 (95%
confidence interval 0.31 to 3.27; P<0.001), 1.38 (0.99 to 1.77; P<0.001),
and 0.97 (0.61 to 1.33; P<0.001), respectively). Available studies
indicated an association between delirium and cognitive impairment after
discharge. CONCLUSIONS: Nearly a third of patients admitted to an
intensive care unit develop delirium, and these patients are at increased
risk of dying during admission, longer stays in hospital, and cognitive
impairment after discharge.

<9>
Accession Number
2015190705
Authors
Tie H.-T. Luo M.-Z. Lin D. Zhang M. Wan J.-Y. Wu Q.-C.
Institution
(Tie, Zhang, Wu) Department of Cardiothoracic Surgery, The First
Affiliated Hospital of Chongqing Medical University, Chongqing, China
(Luo, Lin, Wan) Chongqing Key Laboratory of Biochemistry and Molecular
Pharmacology, Chongqing Medical University, Chongqing, China
Title
Erythropoietin administration for prevention of cardiac surgery-associated
acute kidney injury: A meta-analysis of randomized controlled trials.
Source
European Journal of Cardio-thoracic Surgery. 48 (1) (pp 32-39), 2015.
Article Number: ezu378. Date of Publication: 01 Jul 2015.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
The effect of erythropoietin (EPO) on the prevention of cardiac
surgery-associated acute kidney injury (CSA-AKI) is controversial.
Therefore, we undertook the meta-analysis of randomized controlled trials
(RCTs) to assess the efficacy and safety of EPO on the prevention of
CSA-AKI in adult patients and to explore whether risk factors for AKI
could explain the inconsistent effects. PubMed and EMbase databases were
searched to identify eligible RCTs. The meta-analysis was performed with
fixed- or random-effects models according to the heterogeneity, and the
subgroup analysis stratified by risk factors for AKI was carried out. Five
RCTs involving 423 patients were included. Overall, EPO administration was
not associated with a reduced incidence of CSA-AKI [relative risk (RR):
0.64, 95% confidence interval (CI): 0.35-1.16], with a moderate
heterogeneity (I² = 67.4%, heterogeneity P = 0.02). Subgroup
analysis showed that, in patients without high risk factors for AKI, EPO
administration could significantly reduce the incidence of CSA-AKI (RR:
0.38, 95% CI: 0.24-0.61), intensive care unit length of stay [standardized
mean difference (SMD): -0.54, 95% CI: -1.05 to -0.04] and hospital length
of stay (SMD: -0.48, 95% CI: -0.94 to -0.02). The test of heterogeneity
was not significant in the two subgroups. EPO administration could
significantly reduce the incidence of CSA-AKI, but not in patients with
high risk factors for AKI. Substantial heterogeneity across trials could
be attributed to high risk factors for AKI. However, our findings should
be interpreted cautiously because of the limited studies included, and
high-quality RCTs are warranted.

<10>
Accession Number
2015190704
Authors
Sa M.P.B.O. Cavalcanti P.E.F. Santos H.J.D.A.C. Soares A.F. Miranda R.G.A.
Araujo M.L. Lima R.C.
Institution
(Sa, Cavalcanti, Santos, Soares, Miranda, Araujo, Lima) Division of
Cardiovascular Surgery of Pronto Socorro Cardiologico de Pernambuco,
PROCAPE, Recife, Brazil
(Sa, Cavalcanti, Santos, Soares, Miranda, Araujo, Lima) University of
Pernambuco, UPE, Recife, Brazil
(Sa, Cavalcanti, Lima) Nucleus of Postgraduate and Research in Health
Sciences, Faculty of Medical Sciences and Biological Sciences Institute
(FCM/ICB), Recife, Brazil
Title
Flow capacity of skeletonized versus pedicled internal thoracic artery in
coronary artery bypass graft surgery: Systematic review, meta-analysis and
meta-regression.
Source
European Journal of Cardio-thoracic Surgery. 48 (1) (pp 25-31), 2015.
Article Number: ezu344. Date of Publication: 01 Jul 2015.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Many surgeons are concerned about the flow capacity of a skeletonized
internal thoracic artery (ITA) in comparison with a pedicled ITA used
during coronary artery bypass graft (CABG). This work aims to summarize
the evidence comparing the flow capacity of a skeletonized versus pedicled
ITA during CABG. We performed systematic review and meta-analysis
according to the PRISMA statement based on a search in MEDLINE, EMBASE,
CENTRAL/CCTR, ClinicalTrials.gov, SciELO, LILACS, Google Scholar and
reference lists of relevant articles. Studies included were original
studies whose populations comprised patients undergoing CABG; compared
outcomes between skeletonized versus pedicled ITA; the outcomes included
data regarding intraoperative flow capacity of the grafts; the studies
were prospective or retrospective or non-randomized or randomized
controlled trials. In total, eight studies were identified and reviewed
for eligibility and data were extracted. Forest plots and the summarized
difference in means including 95% confidence intervals (CIs) were
estimated and meta-regressions were performed. There was a statistically
significant difference in favour of the skeletonized ITA compared with the
pedicled ITA in terms of flow capacity (random-effect model: additional
20.8 ml/min, 95% CI 6.6-35.0, P = 0.004), being the summary measures under
the influence of heterogeneity of the effects, but free from publication
bias. We observed a difference with regard to the type of study, since
non-randomized studies together demonstrated the superiority of a
skeletonized ITA (random-effect model: additional 32.3 ml/min, 95% CI
21.0-43.6, P < 0.001), but the randomized studies together did not show it
(random-effect model: additional 13.2 ml/min, 95% CI -1.1 to 27.6, P =
0.071). Meta-regression demonstrated some modulation influence by female
gender, age and diabetes on the flow capacity of grafts. In summary, in
terms of flow capacity, a skeletonized ITA appears to be superior in
comparison with a pedicled ITA during CABG.

<11>
Accession Number
2015189529
Authors
Gurbel P.A. Navarese E.P. Tantry U.S.
Institution
(Gurbel, Tantry) Sinai Center for Thrombosis Research, Cardiac
Catheterization Laboratory, 2401 W. Belvedere Ave, Baltimore, MD 21215,
United States
(Navarese) Department of Internal Medicine Pulmonology and Vascular
Medicine, Division of Cardiology, Heinrich-Heine-University, Dusseldorf,
Germany
Title
What is the best anticoagulant therapy during primary percutaneous
coronary intervention for acute myocardial infarction?.
Source
Polskie Archiwum Medycyny Wewnetrznej. 125 (6) (pp 461-470), 2015. Date of
Publication: 2015.
Publisher
Medycyna Praktyczna
Abstract
Both ST-segment elevation myocardial infarction and percutaneous coronary
intervention (PCI) are associated with a highly prothrombotic state, and
thrombin plays a critical role during occlusive clot generation and
subsequent occurrence of an ischemic event. Therefore, a strategy of
anticoagulation plus dual antiplatelet therapy has been regarded as de
facto standard therapy during primary PCI (pPCI). Recently, there has been
great controversy surrounding the role of bivalirudin versus
unfractionated heparin in pPCI. Earlier, the results of the HORIZONS-AMI
trial, particularly those regarding the long-lasting mortality benefit,
provided a strong rationale for recommending bivalirudin therapy in pPCI.
However, the mortality benefit of bivalirudin observed in HORIZONS-AMI has
not been repeated in more contemporary studies or demonstrated in recent
meta-analyses. The current report will provide a concise review of the
controversy surrounding the optimal anticoagulant therapy for pPCI. Recent
evidence suggests that unfractionated heparin deserves strong
reconsideration despite the reports of pharmacologic weaknesses,
particularly when used with a strategy of selective glycoprotein IIb/IIIa
therapy, and it appears that a strategy of bivalirudin therapy in pPCI
should be reserved for patients at high bleeding risk.

<12>
Accession Number
2015185964
Authors
Tempio D. Pruiti G.P. Conti S. Romano S.A. Tavano E. Capodanno D. Liotta
C. Di Grazia A. Tamburino C. Calvi V.
Institution
(Tempio, Pruiti, Conti, Romano, Tavano, Capodanno, Liotta, Di Grazia,
Tamburino, Calvi) Arrhythmology OU, Ferrarotto Hospital, University of
Catania, Catania, Italy
Title
Ventricular arrhythmias in aortic valve stenosis before and after
transcatheter aortic valve implantation.
Source
Europace. 17 (7) (pp 1136-1140), 2015. Date of Publication: 01 Jun 2015.
Publisher
Oxford University Press
Abstract
Aims Transcatheter aortic valve implantation (TAVI) is a therapeutic
treatment for patients with severe aortic stenosis (AS) at high surgical
risk. Although the procedure is associated with a reduction in total
mortality, there are no data regarding changing in the incidence of
premature ventricular contractions (PVCs) and ventricular arrhythmias
(VAs) after TAVI. The aim of this study was to assess the incidence of VAs
before and after TAVI. Methods and results We enrolled 237 patients who
underwent TAVI at our centre. Ninety-one patients were excluded for the
following reasons: presence of prior permanent pacemaker (PPM) (n = 20),
new PPM implant after TAVI (n = 48), death during the follow-up period (n
= 16), and lost at follow-up (n = 7). Finally, 146 patients were included
in our analysis. The presence of VAs was evaluated in all patients
recording a 24 h Holter monitoring before the procedure and after 1 and 12
months. Ventricular arrhythmias were classified according to a modified
Lown grading system. Before the procedure, isolates PVCs (grade 1-2 of
Lown grading system) were present in 34.9% of patients (n = 51). Complex
PVCs (grade 3-4a-4b of Lown grading system) were present in 48.6% of the
population (multifocal PVCs in 32 patients, 21.9%; pairs in 25 patients,
17.1%; ventricular tachycardia in 14 patients, 9.6%). One month after the
procedure, we observed statistically significant incidence decrease of
arrhythmias of grade 3 (from 21.9 to 17.1%) and grade 4 (pairs from 17.1
to 12.3%; ventricular tachycardia from 9.6 to 4.8%). After 12 months,
there was a further significant reduction in the frequency and severity of
PVCs. In particular, 45.8% of patients had isolates PVCs (<30 in all given
hours of monitoring in 45 patients, 30.8%; higher than 30 in any hour of
monitoring in 22 patients, 15%) while the frequency of complex arrhythmias
was reduced to 16.4% (multifocal PVCs in 13 patients, 9%; couplets 8
patients, 5.5% and ventricular tachycardia in 3 patients, 2.0%). The
difference was statistically significant (P < 0.01). Conclusion This study
indicates that VAs are common in patients with AS. We observed a
significant decrease in the incidence and severity of PVCs since the first
month after TAVI. Furthermore, after 1 year follow-up there was a further
and significant reduction in the frequency of complex PVCs. This may be
related to the benefits determined by valve replacement on left
ventricular function.

<13>
Accession Number
2015185647
Authors
Ozturk T. Topcu I. Tuncer B. Acikgoz B. Yildirim F. Iskesen I.
Institution
(Ozturk, Topcu, Acikgoz) Celal Bayar Universitesi, Tip Fakultesi,
Anesteziyoloji ve Reanimasyon Anabilim Dali, Manisa 45020, Turkey
(Tuncer, Yildirim, Iskesen) Celal Bayar Universitesi, Tip Fakultesi, Kalp
Damar Cerrahisi Anabilim Dali, Turkey
Title
Coagulation effects of hydroxyethylstarch versus modified fluid gelatin
when used as normovolemic hemodilution solutions during cardiac surgery.
Source
Gogus-Kalp-Damar Anestezi ve Yogun Bakim Dernegi Dergisi. 20 (3) (pp
141-148), 2014. Date of Publication: 01 Sep 2014.
Publisher
Turkish Anaesthesiology and Intensive Care Society (Yildiz Posta Caddesi,
Sinan Apt. No; 36 D: 66/67, Gayrettepe-Istanbul 34349, Turkey. E-mail:
tsisa@logos.com.tr)
Abstract
Objective: The aim of this study to examine the effects of hydroxyethyl
starch and gelatin solutions used for acute normovolemic hemodilution on
coagulation during coronary artery bypass surgery. Material and Method:
Seventy-two patients undergoing elective coronary artery bypass graft
surgery randomly received no hemodilution (control), or 6% HES 200/0.5
(n=24) or 4% gelatin solution (n=24) for acute normovolemic hemodilution
before cardiopulmonary bypass. Thromboelastography parameters were
measured before (T0) and after (T1) acute nor-movolemic hemodilution, and
one (T2) and four (T3) hours after separation from CPB. Results: The R
(reaction) time in HES was significantly longer than in controls at T(2)
(p=0.03). The K (coagulation) values in group HES and GEL were
significantly longer than in controls at T(2) and T(3) (p=0.02 and 0.03,
respectively). Rapidity of clot formation (alpha angle) was significantly
smaller in HES and GEL compared to controls (p=0.01 and p=0.02,
respectively). Maximum amplitudes in HES and GEL were not significantly
different than controls at T(2) (p=0.3 and 0.9, respectively). At T2,
three patients in GEL (but none in HES) showed clotlysis at 30 min
(p=0.1). GEL and HES received fewer units of erythrocyts compared to
controls(p<0.001); however, use of fresh frozen plasma was not
significantly different than in controls. Mediastinal blood loss was
greater in group HES than in controls (p<0.05). Conclusion: Performing
acute normovolemic hemodilution with HES and GEL solutions caused
significant change in coagulation state by thromboelastography, reduced
the need for errytrocyt. Regarding the increase in mediastinal chest
drainage, we concluded that HES may not be safety in patients undergoing
coronary surgery.

<14>
Accession Number
2015190746
Authors
Benedetto U. Raja S.G. Albanese A. Amrani M. Biondi-Zoccai G. Frati G.
Institution
(Benedetto, Raja, Albanese, Amrani) Department of Cardiac Surgery,
Harefield Hospital, London, United Kingdom
(Biondi-Zoccai, Frati) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Rome, Italy
(Frati) Department of AngioCardio Neurology, IRCCS NeuroMed, Pozzilli,
Italy
Title
Searching for the second best graft for coronary artery bypass surgery: A
network meta-analysis of randomized controlled trials.
Source
European Journal of Cardio-thoracic Surgery. 47 (1) (pp 59-65), 2014.
Article Number: ezu111. Date of Publication: 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: There is a lack of unequivocal evidence basis for selecting
the best second conduit in coronary artery bypass grafting (CABG). We thus
aimed to perform head-to-head relative effect estimate on angiographic
outcomes for second conduits, including the right internal mammary artery
(RIMA), radial artery (RA), right gastroepiploic artery (RGEA) and
saphenous vein graft (SVG) by means of network meta-analysis of randomized
controlled trials (RCTs). METHODS: Databases were searched for RCTs
comparing angiographic outcomes (>4 weeks) of second conduits in CABG.
Odds ratios (95% confidence intervals) were computed with Markov Chain
Monte Carlo simulation. RESULTS: A total of nine RCTs were identified,
including 2780 patients and 1620 angiographic results available for
analysis to compare RIMA (n = 145) versus RA (n = 871) versus RGEA (n =
92) versus SVG (n = 845). The mean time to angiographic follow-up ranged
from 1 to 7.7 years. An SVG was significantly associated with a 4-fold
(1.67-16.00) and 3-fold (0.78-22.20) increased risk of late (>4 years)
functional graft occlusion when compared with the RIMA and RA,
respectively. A RIMA was associated with a non-significant 27% absolute
risk reduction for functional graft occlusion when compared with the RA.
CONCLUSIONS: The present network meta-analysis consistently demonstrated
an angiographic superiority of RIMA and RA over SVG. The RIMA is expected
to achieve a better patency rate than the RA, but further studies are
needed.

<15>
Accession Number
2015190742
Authors
Sharma V. Deo S.V. Altarabsheh S.E. Cho Y.H. Erwin P.J. Park S.J.
Institution
(Sharma) Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN,
United States
(Deo) Adventist Wockhardt Heart Institute, Athawalines, Surat, India
(Altarabsheh) Division of Cardiovascular Surgery, Queen Alia Heart
Institute, Amman, Jordan
(Cho) Samsung Medical Center, Sungkyunkwan University School of Medicine,
Seoul, South Korea
(Erwin) Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, United States
(Deo, Park) Division of Cardiovascular Surgery, University Hospitals, Case
Western Reserve University, Cleveland, OH, United States
Title
Comparison of the early haemodynamics of stented pericardial and porcine
aortic valves.
Source
European Journal of Cardio-thoracic Surgery. 47 (1) (pp 4-10), 2014.
Article Number: ezu272. Date of Publication: 2014.
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Data comparing the haemodynamic performance of stented pericardial and
porcine aortic valves are conflicting. Hence, we performed a systematic
review and meta-analysis comparing the early haemodynamic parameters of
stented pericardial and porcine valves in patients undergoing isolated
aortic valve replacement. Medline, EMBASE and Web of Science were queried
for English language original publications from 2000 to 2013. Studies
comparing porcine (PoV) and pericardial (PeV) with regard to their
haemodynamic parameters were included in this review. Continuous data were
pooled using the mean difference (MD) or the standardized mean difference
(SMD). A random-effect inverse weighted analysis was conducted; a P-value
<0.05 is considered statistically significant. Results are presented with
95% confidence intervals. Thirteen studies (1265 PeV patients and 871 PoV
patients) were included in this analysis. The pooled transvalvular mean
gradient was lower for PeV [MD -4.6 (-6.45 to -2.77) mmHg; P < 0.01].
Limiting this analysis to small valves (19 and 21 mm; eight studies; 714
patients) revealed that the PeV gradients were significantly lower [MD
-4.5 (-5.7 to -3.2); P = 0.001]. The corresponding effective orifice area
of PeV was significantly larger than PoV [SMD 0.42 (0.15-0.69); P < 0.01].
A sensitivity analysis comprising only randomized controlled trials did
not significantly alter results. When compared with porcine valves,
stented pericardial aortic valves have lower mean transvalvular gradients
early after implant. Even pericardial valves in smaller sizes (19 and 21
mm) have a better haemodynamic profile when compared with their
counterparts.

<16>
Accession Number
71948562
Authors
Narula J. Kiran U. Kapoor P.M. Choudhury M. Chowdhury U.K.
Institution
(Narula, Kiran, Kapoor, Choudhury, Chowdhury) All India Institute of
Medical Sciences, New Delhi, India
Title
Intra-operative autologous donation regulates increase in thoracic fluid
content in patients undergoing heart valve replacement on cardiopulmonary
bypass.
Source
Vox Sanguinis. Conference: 25th Regional Congress of the International
Society of Blood Transfusion in Conjunction with the 33rd Annual
Conference of the British Blood Transfusion Society London United Kingdom.
Conference Start: 20150627 Conference End: 20150701. Conference
Publication: (var.pagings). 109 (pp 373-374), 2015. Date of Publication:
June 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Intraoperative autologous donation (IAD) forms the mainstay of
blood conservation strategy in cardiac surgery. Additional therapeutic
benefit derived from it includes a decrease in the circulatory overload
being handled by the compromised ventricles in volume loaded patients with
pulmonary hypertension secondary to left heart disease (PH-LHD).
Institution of cardiopulmonary bypass (CPB) in such patients is associated
with accumulation of extravascular lung water secondary to a multitude of
factors. Electrical cardiometry (EC) provides an accurate, noninvasive,
continuous measurements of thoracic fluid content (TFC) which is an
indicator of total thoracic fluid volume (intravascular, intra-alveolar
and interstitial). Aims: To evaluate the effect of perioperative volume
shifts induced by IAD as measured by variations in TFC in patients
undergoing heart valve replacement. Secondary goal of this study was to
correlate IAD induced changes in TFC to the perioperative fluid balances.
Methods: Prospective randomized controlled trial conducted in 50 patients
assigned to a control group (standard care, n = 25) or IAD group. 15% of
the estimated blood volume of the patient extracted in the IAD group was
simultaneously replaced with 1:1 colloid. TFC and other hemodynamic data
were recorded across 7 perioperative time frames and perioperative fluid
balances were calculated. All patients were managed according to a
standard anesthetic technique and a well defined blood transfusion, fluid
management and inotrope therapy protocol. Results: IAD resulted in a
significant reduction in TFC -10.1% (-15.0 to -6.1), right atrial pressure
(RAP) -23% (-26.6 to -17.6), mean arterial pressure -12.6% (-22.2 to
-3.8), peak -6.2% (-11.7 to -2.8) and mean -15.4% (-25.0 to -8.3) airway
pressures and oxygenation index (OI) -10.34%(-16.4 to -4.8). Linear
regression analysis showed good correlation between the amount of
autologous blood removed and percentage change in TFC (%TFC), RAP, peak
and mean airway pressures and OI. CPB induced increase TFC, airway
pressures and oxygen index were significantly lesser in those undergoing
IAD. IAD also ensured an early return of TFC to baseline values at 48 h
after cardiac surgery. All patients in control group received banked blood
transfusion in the operation theatre vs 16 (64%) in the IAD group. The
amount of allogenic blood transfused/kg of body weight was significantly
higher in the control group [13.63 (8.3-18.5) ml] than the IAD group [6.9
(4.4-11.4) ml, P = 0.003]. The control group patients also had a higher
blood component therapy requirement (P = 0.001) and greater incidence of
massive blood transfusion (P = 0.043). Linear regression analysis revealed
good correlation between %TFC and intra-operative and cumulative fluid
balance, CPB time, massive transfusion requirement and duration of
mechanical ventilation. Conclusions: Therapeutic benefits derived from IAD
by decreasing TFC and decongesting volume loaded patients further warrant
its routine use in patients with PHLHD. IAD associated reduced allogenic
blood transfusion requirement optimizes fluid balance during cardiac
surgery and causes an attenuated TFC increase. Alterations in TFC
correlate well with perioperative changes in body fluid balance secondary
to IAD and CPB. Addressing the deficiencies of the existing methods, this
non-invasive technology can be utilized during routine cardiac surgery to
reliably predict fluid status of the body.

<17>
Accession Number
71947731
Authors
Murphy G.J.
Institution
(Murphy) University of Leicester, Leicester, United Kingdom
Title
Titre2.
Source
Vox Sanguinis. Conference: 25th Regional Congress of the International
Society of Blood Transfusion in Conjunction with the 33rd Annual
Conference of the British Blood Transfusion Society London United Kingdom.
Conference Start: 20150627 Conference End: 20150701. Conference
Publication: (var.pagings). 109 (pp 49), 2015. Date of Publication: June
2015.
Publisher
Blackwell Publishing Ltd
Abstract
Strong associations between transfusion and adverse outcome in
observational studies and a causal relationship between more liberal
transfusion and death in RCTs of liberal vs restrictive transfusion
thresholds in non-cardiac surgery have led to recommendations that
restrictive transfusion thresholds be applied as the standard of care.
However, there is uncertainty as to whether this evidence is relevant to
cardiac surgery patients and this is reflected by wide variation in
clinical practice. To address this uncertainty we sought to test the
hypothesis that more liberal transfusion is harmful than more restrictive
transfusion in anaemic cardiac surgery patients in a pragmatic RCT. The
TITRe2 trial (http://www.controlled-trials.com/ISRCTN70923932), was a
multi-centre randomised controlled trial of Transfusion Indication
Threshold Reduction on transfusion rates, morbidity and healthcare
resource use following cardiac surgery. Two thousand patients in 16 UK
cardiac centres were randomised to either a restrictive transfusion
threshold of 7.5 g/dl or a liberal threshold of 9 g/dl with ischaemic and
septic complications as a co-primary endpoint. The trial design addressed
important sources of bias that have been identified in previous studies.
The results, along with those of other similar trials will be discussed.

<18>
Accession Number
71947681
Authors
Wozniak M.J. Sullo N. Qureshi S. Patel N. Dott W. Nielsen P. Kumar T.
Joel-David L. Mariani S. Wiltshire M. Cardigan R. Murphy G.J.
Institution
(Wozniak, Sullo, Qureshi, Dott, Nielsen, Kumar, Joel-David, Mariani,
Murphy) University of Leicester, Leicester, United Kingdom
(Patel) Imperial Colledge London, London, United Kingdom
(Wiltshire, Cardigan) NHS Blood and Transplant, Cambridge, United Kingdom
Title
Inflammation and organ injury following transfusion of red cells - The
role of microparticles and oxidative stress.
Source
Vox Sanguinis. Conference: 25th Regional Congress of the International
Society of Blood Transfusion in Conjunction with the 33rd Annual
Conference of the British Blood Transfusion Society London United Kingdom.
Conference Start: 20150627 Conference End: 20150701. Conference
Publication: (var.pagings). 109 (pp 30), 2015. Date of Publication: June
2015.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Allogeneic red blood cell (RBC) transfusion is associated with
an increase in pulmonary and renal morbidity after cardiac surgery.
Transfusion of RBC stored for longer periods increases the frequency of
both lung and kidney injury. It has been hypothesised that these
associations are attributable to the 'storage lesion' - accumulation of
metabolites in the supernatant that includes pro-inflammatory lyso-lipids,
high cell-free haemoglobin and depletion of cellular ATP and 2,3-DPG
during storage. Aims: The aims of this study were to identify components
of the storage lesion that lead to inflammatory events resulting in kidney
and lung damage using in vitro and porcine models, and in human subjects.
We aimed to analyse mechanisms underlying organ injury in response to
transfusion in cardiac surgery patients, and ways to improve patients'
outcomes. Methods: Samples from 60 patients participating in REDWASH trial
(a single blinded, randomised controlled trial of washing of allogeneic
RBC prior to transfusion vs standard care - no washing, ISRCTN27076315)
were analysed for inflammatory response markers. In a complementary study
28 pigs were randomised into 4 groups receiving crystalloid infusion,
14-day old, washed 14-day old, or rejuvenated- washed 14-day old RBC
transfusion. Inflammatory markers, free haemoglobin and iron levels were
measured in plasma and serum. Leukocyte invasion was determined by
immunohistochemistry. The results from REDWASH trial and porcine model
were verified and further analysed in an in vitro inflammatory models.
Results: Transfusion of stored RBC (~22 days old) into REDWASH patients
was associated with increased leucocyte and platelet activation as
compared to washed blood, and this effect was attenuated by washing. Our
observations were reproduced in pigs. Further analysis revealed that
oxidised lipids on the surface of microparticles transfused with unwashed
blood were associated with activation of platelets and monocytes and
depletion of either in an in vitro model reduced activation. Unexpectedly,
transfusion of washed blood reduced lung injury but affected kidney
function as indicated by serum creatinine levels. This was associated with
increased free haemoglobin levels in samples from patients and pigs
transfused with washed RBC, and with higher oxidative stress as indicated
by increased HMOX-1 levels in porcine tissues. Free haemoglobin also
increased endothelial permeability in vitro and led to non-standard
endothelial activation manifested by expression of VLA5 and fibronectin
retention. Lung and kidney injury following transfusion were alleviated in
vivo in pigs and in vitro by rejuvenation of blood prior to transfusion.
Conclusion: Our results identify two types of inflammatory events that may
be important in response to RBC transfusion. Oxidised lipids present in MP
generated during storage activate leukocytes while free haemoglobin
increases oxidative stress that can lead to endothelial activation. These
may contribute towards kidney and lung injury in recipients. The latter
can be attenuated by washing RBC, but is associated with increased kidney
injury. However, in the porcine model both kidney and lung injury can be
significantly reduced by rejuvenation and washing RBC prior transfusion.
These data suggest that there may be interventions that may reduce adverse
events following transfusion of RBC in cardiac surgery patients.

<19>
Accession Number
71947680
Authors
Sullo N.S. Wozniak M.W. Farha A.F. Dott W.D. Nielsen P.N. Murphy Gjm
Institution
(Sullo, Wozniak, Farha, Dott, Nielsen, Murphy Gjm) University of
Leicester, Leicester, United Kingdom
Title
Microvesicles as indicators and mediators of inflammatory reactions in
response to transfusion during cardiac surgery.
Source
Vox Sanguinis. Conference: 25th Regional Congress of the International
Society of Blood Transfusion in Conjunction with the 33rd Annual
Conference of the British Blood Transfusion Society London United Kingdom.
Conference Start: 20150627 Conference End: 20150701. Conference
Publication: (var.pagings). 109 (pp 29-30), 2015. Date of Publication:
June 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Background: The REDWASH trial was a single blinded, randomised controlled
trial that tested the hypotheses that removal of the red cell supernatant
from stored allogenic red cells would attenuate inflammatory responses in
recipients of large volume blood transfusions. A secondary hypotheses was
that recipients of washed and unwashed red cells would have different
levels of circulating microvesicles and that and these would underlie our
observed differences in inflammatory responses and organ injury within the
groups. Aims: The aim was to establish a relationship between
transfusion-delivered storage lesion intermediates (microvesiscles) in
cardiac surgery patients and inflammatory events that lead to MV
generation. We also tested whether MV could serve as potential organ
injury markers. Methods: The study was performed on stored donor blood and
blood and serum samples obtained from 40 cardiac surgery patients
participating in the REDWASH trial that received on average 3 units of red
cells with a mean storage age of 20 days. Complementary to that, samples
from leukodepleted blood packs stored for 42 days were analysed, as well.
Samples were analysed using nano-particle tracking technology and flow
cytometry. Data was analysed by ANCOVA and t-tests and is reported as
means +/- SE. Results: Two populations of MV were detected in stored blood
packs: 50-150 and 150-300 nm in size. The smaller MV were present
regardless of the blood pack age, and the larger MV increased in numbers
during storage time. The larger MV were positive for red cells biomarker
CD235a and phosphatidylserine (PS). Further analysis of REDWASH patients'
samples revealed that PS-positive MV were also higher in numbers in
patients transfused with standard (unwashed blood). That most likely led
to activation of platelets, which resulted in higher levels of
CD41-positive microparticles. We also detected higher levels of
pro-coagulatory MV positive for tissue factor (CD142). In contrast MV that
increased in samples from the washed group were of endothelial and
monocytic origin. Size analysis showed that MV 50-200 nm large increased
within the first 12 h after surgery in samples from washed group. Another
population of MP, 100-200 nm in size, increased 48 h after surgery in
samples from the standard group. [GRAPH PRESENTED] Conclusions:
Transfusion of washed and unwashed RBC in cardiac surgery patients
generates two distinctive populations of MV. That reflects different modes
of inflammatory events where PS-positive MV from stored blood packs
activate leukocytes and platelets while changes in red cells concentrates
during washing result in activation of endothelium and monocytes.

<20>
Accession Number
71946953
Authors
Paikin J.S. Hirsh J. Ginsberg J.S. Weitz J. Chan N. Whitlock R.P. Pare G.
Eikelboom J.W.
Institution
(Paikin) Medicine, Hamilton General Hospital, McMaster University,
Hamilton, ON, Canada
(Hirsh) Medicine, Population Health Research Institute, McMaster
University, Hamilton, ON, Canada
(Ginsberg, Weitz) Medicine, Thrombosis and Atherosclerosis Research
Institute, McMaster University, Hamilton, ON, Canada
(Chan, Whitlock, Pare) Population Health Research Institute, McMaster
University, Hamilton, ON, Canada
(Eikelboom) Population Health Research Institute, McMaster University,
Medicine, Canada
Title
Twice-daily dosing of ASA overcomes reduced platelet response to
once-daily ASA after coronary artery bypass graft surgery: A randomized
controlled trial.
Source
Journal of Thrombosis and Haemostasis. Conference: 25th Congress of the
International Society on Thrombosis and Haemostasis, ISTH 2015 Toronto, ON
Canada. Conference Start: 20150620 Conference End: 20150625. Conference
Publication: (var.pagings). 13 (pp 928-929), 2015. Date of Publication:
June 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Low-dose ASA (81 mg daily) is administered after coronary
artery bypass graft surgery (CABG) to prevent graft failure. ASA
hyporesponsiveness, defined as a failure to fully suppress thromboxane
(TX) production, occurs in the immediate postoperative period and may
compromise the effectiveness of ASA. In a recent randomized trial, we
tested the hypothesis that resistance to low-dose ASA after CABG is caused
by increased platelet turnover, and thus, is overcome by more frequent
(four-times daily) ASA dosing. Although the fourtimes daily regimen
successfully reduces ASA resistance in the postoperative period, this
regimen is inconvenient for patients and health care providers. Aims: We
performed a randomized trial to determine whether a simpler twice-daily
ASA dosing regimen overcomes the resistance observed with once
daily-dosing. Methods: Adults undergoing CABG with or without valve
surgery were randomized to: 81 mg once-daily, 325 mg once-daily, or 162 mg
twice-daily. ASA was started on post-operative day 1 and continued until
day 7 or hospital discharge. Serum TXB₂ levels were measured
daily before the first dose of daily ASA. The primary outcome was the
median TXB₂ level on postoperative day 4. Results: A total of
68 patients (mean age 65, females 12%) were randomized. On postoperative
day 4, median TXB₂ levels in the group receiving ASA 81 mg
once-daily was 4.2 ng mL^-1 (Q1, Q3; 1.5, 7.5 ng
mL^-1). The median TXB₂ levels were significantly
lower in the group randomized to ASA 162 mg twice-daily 1.1 ng
mL^-1 (Q1, Q3; 0.7, 2.7 ng mL^-1) and
non-significantly lower in the group randomized to ASA 325 mg once-daily
1.9 ng mL^-1 (Q1, Q3;0.9, 4.7 ng mL^-1), P = 0.02 and
P = 0.12, respectively. Conclusion: ASA hyporesponsiveness following CABG
is overcome by twice-daily ASA administration. Twice-daily ASA
administration post CABG provides a novel and convenient treatment regimen
to reduce ASA hyporesponsiveness. A trial powered for relevant clinical
outcomes is needed to assess the potential clinical benefit of the
twicedaily regimen.