1,721,233 research outputs found
[The HEAT-PPCI study]
No full textBackground. La bivalirudina, in associazione con l’uso selettivo degli inibitori della glicoproteina (GP) IIb/IIIa, rappresenta uno standard di cura riconosciuto nell’angioplastica coronarica primaria (PPCI). Scopo dello studio è stato quello di confrontare la terapia antitrombotica con bivalirudina o eparina non frazionata nel corso di tale procedura.
Metodi e risultati. Tra il 7 febbraio 2012 e il 20 novembre 2013, sono stati randomizzati 1829 pazienti su un totale di 1917 pazienti sottoposti ad angiografia d’emergenza presso il nostro centro (pari al 97% dei pazienti afferiti consecutivamente), di cui 1812 inclusi nell’analisi finale. 751 pazienti (83%) dei 905 inclusi nel gruppo bivalirudina e 740 pazienti (82%) dei 907 inclusi nel gruppo eparina sono stati sottoposti ad angioplastica coronarica. Il tasso di utilizzo degli inibitori della GP IIb/IIIa era sostanzialmente simile nei due gruppi (122 pazienti [13%] nel gruppo bivalirudina e 140 pazienti [15%] nel gruppo eparina). L’endpoint primario di efficacia si è verificato in 79/905 pazienti (8.7%) del gruppo bivalirudina e in 52/907 pazienti (5.7%) del gruppo eparina (differenza di rischio assoluto 3.0%; rischio relativo [RR] 1.52, IC 95% 1.09-2.13, p=0.01). L’endpoint primario di sicurezza si è verificato in 32/905 pazienti (3.5%) del gruppo bivalirudina e in 28/907 pazienti (3.1%) del gruppo eparina (differenza di rischio assoluto 0.4%; RR 1.15, IC 95% 0.70-1.89, p=0.59).
Conclusioni. Rispetto alla bivalirudina, l’eparina riduce l’incidenza degli eventi ischemici avversi maggiori nel contesto della PPCI, a fronte di nessun incremento delle complicanze emorragiche. L’uso sistematico di eparina, invece che di bivalirudina, si tradurrebbe in una sostanziale riduzione dei costi correlati al farmaco. [Lancet 2014;384:1849-58
Innovative transcatheter procedures for the treatment of heart failure
Full text linkThe prevalence of heart failure (HF) continues to rise over time, with aging of the population and increased survival of incident cases. Major improvements occurred in drug therapy but morbidity and mortality of HF patients remain high. Some non-pharmacologic approaches to HF are already part of standard treatment for HF, including implantable cardioverter-defibrillators, cardiac resynchronization therapy (CRT) and left ventricular assist devices (LVADs). A number of transcatheter treatments and devices have been developed to improve management of valvular heart diseases (VHD), and some of them are being used or tested in specific HF conditions. For example, transcatheter aortic valve implantation (TAVI) to unload the left ventricle in patients with moderate aortic stenosis (AS) and HF or TAVI for severe aortic regurgitation (AR) in patients with LVADs. Similarly, percutaneous mitral valve repair can be used to improve prognosis and quality of life in patients with functional mitral valve regurgitation, and has been proposed as a bridge-to-LVAD or to heart transplant in selected patients. Other devices have been specifically developed for the treatment of chronic HF. In this review we describe the main devices used in the treatment of HF associated with aortic and mitral valve disease, as well as novel transcatheter interventions for chronic HF with different pathophysiologic targets
Ruolo attuale dell'utilizzo di tirofiban come inibitore del recettore piastrinico glicoproteico IIb/IIIa
No full textRuolo attuale dell'utilizzo di tirofiban come inibitore del recettore piastrinico glicoproteico IIb/III
Management and outcome of major bleeding in patients on triple therapy after coronary stenting. Clues from the warfarin and coronary STENTing (WAR-STENT) registry
No full textIliac “paving & cracking” technique for transcatheter aortic valve implantation
No full textChallenging femoral/iliac access (CA) can lead to vascular complications which can hamper the clinical benefit of transfemoral (TF) transcatheter aortic valve implantation (TAVI). In this sense, iliac artery rupture is a severe complication associated with significant morbidity and mortality. We report a case of TF-TAVI managed with the "paving and cracking technique" to overcome CA
Antithrombotic Management during Percutaneous Mitral Valve Repair with the Mitraclip System in a Patient with Heparin-Induced Thrombocytopenia
No full textInterventional cardiology procedures require full anticoagulation to prevent thrombus formation on catheters and devices with potential development of embolic complications. Bivalirudin, a short half-life direct thrombin inhibitor, has been largely used during percutaneous coronary interventions and represents the preferred alternative to heparin in patients with heparin-induced thrombocytopenia (HIT). However, few data are available about intraprocedural use of bivalirudin during transcatheter structural heart disease interventions. Activated clotting time (ACT) monitoring during bivalirudin infusion pre- sents some limitations and it is not mandatory. We report a case of bivalirudin use in a patient with type-2 HIT during percutaneous mitral valve repair with the Mitraclip system (Abbott, Abbott Park, Illinois, United States). Despite use of standard bivalirudin dose (0.75 mg/kg bolus and 1.4 mg/kg/min infusion—reduced infusion rate was motivated by a glomerular filtration rate of 37 mL/min), the patient developed a large thrombus on the second clip during its orientation toward the mitral orifice. ACT was measured at that time and was suboptimal (240 seconds). The case was successfully managed with clip and thrombus retrieval, adjunctive 0.3 mg/kg bivalirudin bolus and increased infusion rate, and clip repositioning with ACT monitoring. This report makes the case for mandatory ACT checking and drug titration during high-risk catheter–based structural heart disease interventions, even when thromboprophylaxis is performed with bivalirudin. Additional coagulation tests may be useful to monitor bivalirudin response in similar cases
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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