1,721,022 research outputs found
The possible clinical impact of a threshold left atrial diameter associated with new AF in ESUS patients
No full textThe possible clinical impact of a threshold left atrial diameter associated with new AF in ESUS patient
Ten questions on venous thromboembolism
No full textVenous thromboembolism (VTE), which includes pulmonary embolism and deep vein thrombosis, is a leading cause of morbidity and mortality worldwide. Based on new evidence, the management and treatment of VTE have changed over the years. For several decades, low molecular weight heparin and vitamin K antagonists have been the two cornerstones of anticoagulant therapy for VTE. Recently, the introduction in clinical practice of the new oral anticoagulants has radically changed the management of VTE for their easy use and their better efficacy and safety profile. Here, we report on recent evidence of 10 still controversial clinical questions concerning common diagnostic and therapeutic aspects of VTE
Venous thromboembolism and COVID-19: Mind the gap between clinical epidemiology and patient management
No full textPatients with Atrial Fibrillation receiving NOACs: The boundary between appropriate and inappropriate dose
No full textSince their introduction in 2010, non-vitamin K oral anticoagulants
(NOACs) changed the landscape of stroke prevention in patients with
atrial fibrillation (AF). Because of their favorable benefit-harm profile,
the fixed dose administration, the no need for laboratory monitoring and
dose adjustment, NOAC prescription increased rapidly and overcome
the use of vitamin K antagonists (VKAs
Beyond the guidelines: Novelties, changes and unsolved issues from the 2019 ESC guidelines on pulmonary embolism
No full textShock and diffuse ST-elevation in a patient with coronavirus disease-2019 disease
No full textThe infection by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with significant cardiovascular morbidity and mortality. Cardiac events require prompt diagnosis and management, also in the SARS-CoV-2 era. A 58-year-old male, heavy smoker and with known SARS-CoV-2 infection, abruptly developed severe hypotension and asthenia. At patients' home, emergency physicians found hemodynamic compromise with diffuse ST-elevation at electrocardiography. The patient was rapidly moved to the cardiac catheterization laboratory, and any contact with other health-care workers was avoided. Coronary angiography excluded coronary artery disease. At admission to the coronavirus disease-2019 unit, an increase in inflammatory markers and liver enzymes with normal troponin levels were observed. Bedside lung ultrasonography showed interstitial syndrome and bilateral pleural effusion, whereas echocardiography showed large and diffuse pericardial effusion with a swinging heart. The hemodynamic status improved after gentle fluid therapy such suggesting potential concomitant sepsis and pericardiocentesis was not performed. At this time, a computed tomography scan showed a widespread neoplasm in the right lung involving the subclavian artery and vein and the thoracic lymph nodes. The histology confirmed the diagnosis of a locally advanced pulmonary adenocarcinoma. One week after admission, the patient died for worsening respiratory failure. Not delayed primary PCI remains the standard of care for patients with suspected ST-elevation myocardial infarction (STEMI) in the SARS-CoV-2 era. A diagnostic deepening for potential STEMI-mimicker (known to be associated with SARS-CoV-2 infection and to patients' comorbidities) should be considered, and a multidisciplinary approach is needed in these patients
Management of Anticoagulant Treatment and Anticoagulation-Related Complications in Nonagenarians
No full textGiven the aging population, the burden of age-dependent diseases is growing. Despite this, elderly patients are often underrepresented in clinical trials and little data are available on current anticoagulant management and outcomes in this unique population, especially those aged 90 years or older. There is uncertainty, and a fear of doing harm, that often leads to de-prescription of antithrombotic agents in nonagenarian patients. Decision-making concerning the use of anticoagulant treatment needs to balance the risk of thrombotic events against the risk of major bleeding, especially intracranial hemorrhage. In this perspective, the development of direct oral anticoagulants (DOACs), acting as direct and selective inhibitors of a specific step or enzyme of the coagulation cascade, has dramatically changed oral anticoagulant treatment. In fact, given the lower incidence of intracranial hemorrhage, the favorable overall efficacy and safety, and the lack of routine monitoring, DOACs are the currently recommended anticoagulant agents for the treatment of both atrial fibrillation and venous thromboembolism even in very elderly patients. However, given the limited data available on the management of anticoagulation in nonagenarians, a few unanswered questions remain. In this review, we focused on recent evidence for anticoagulant treatment in atrial fibrillation and venous thromboembolism along with management of anticoagulation-related bleeding in nonagenarians
Anticoagulation for atrial fibrillation in patients with active cancer: Reply to the ‘Letter to the Editor’ from Dr. Sorigue et al
No full textHistory of cardiac embolism
No full textFrom 1742, the first time Gerhard van Swieten postulated that embolism might arise inside the heart chambers and great vessels, another century was needed before that clinicians became accustomed to the concept that an embolism can lead to an occlusion of a brain artery. In fact, in 1875, Gowers described a case of blindness and contralateral hemiplegia in a patient with mitral stenosis. At autopsy, emboli were found in the middle cerebral artery and in the central retinal artery. Specifically, the emboli were found to originate from clots on the auricular appendices. Subsequently, in 1954, Fisher demonstrated that a thromboembolic mechanism underlies most ischemic strokes and that the source of thrombus might be the heart rather than a proximal arterial lesion. He suggested that the embolus might have arisen after myocardial infarction, in the fibrillating atrial appendage.
In 1977, a necropsy study provided additional evidence supporting the role of atrial fibrillation as a crucial cause of cerebral embolism which was later confirmed by large epidemiological studies. Finally, in the first part of the 1990’s, several studies reported that oral anticoagulants consistently reduced the risk of stroke in patients with atrial fibrillation. Oral anticoagulants currently remain the most powerful stroke prevention strategy available for patients with atrial fibrillation
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