The Impact of Preoperative Clopidogrel on Outcomes After Coronary Artery Bypass Grafting

This study evaluated the impact of preoperative clopidogrel exposure on outcomes of coronary artery bypass grafting (CABG).MethodsPatients undergoing isolated CABG from January 2010 to February 2018 at a single institution were included. Primary stratification was based on exposure to clopidogrel within 5 days of CABG. Primary outcomes included blood product transfusion and mediastinal reexploration for bleeding. Secondary outcomes included early and late mortality, major postoperative complications, and hospital readmissions. Multivariable Cox regression was used to evaluate the risk-adjusted impact of preoperative clopidogrel on post-CABG mortality.ResultsIsolated CABG was performed in 7048 patients, including 1240 (18%) who had received clopidogrel within 5 days. Patients who received preoperative clopidogrel had higher rates of transfusions (53.4% vs 40.3%, P
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research

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In this study, we examined the safety of WATCHMAN implantation followed by 6 months of anti-thrombotic therapy in patients with a history of ICH.MethodsThis is a retrospective analysis of 63 patients with a history of ICH prior to WATCHMAN implantation (Group I) and 95 patients without a history of ICH who underwent WATCHMAN placement (Group II). The primary outcome was death, stroke, or major bleeding within 6  months of WATCHMAN placement.ResultsThe average CHA2DS2-VASc of Group I was 4.9  ± 1.7 vs 4.7 ± 1.4 for Group II (p = 0.34). The most common type of...
Source: Journal of Interventional Cardiac Electrophysiology - Category: Cardiology Source Type: research
Authors: Atzema CL, Jackevicius CA, Chong A, Dorian P, Ivers NM, Parkash R, Austin PC Abstract BACKGROUND: Patients with atrial fibrillation frequently seek emergency care. Rates of guideline-concordant oral anticoagulant therapy for stroke prevention are suboptimal in the community. We assessed the association between prescribing of oral anticoagulants in the emergency department (relative to referral to a longitudinal care provider for treatment initiation) and long-term use of oral anticoagulants. METHODS: This retrospective cohort study performed at 15 hospitals in Ontario, Canada, involved patients aged 65...
Source: Canadian Medical Association Journal - Category: General Medicine Tags: CMAJ Source Type: research
It’s fairly established medical science that people who have had heart attacks can take regular low doses of aspirin to significantly lower their risk of having another heart attack, or other heart problems including stroke. But it is still an open question whether or not people who haven’t had a heart event, but are at higher risk of one (because, for example) they have diabetes, high blood pressure, or elevated cholesterol levels), can also benefit from the over-the-counter painkiller and anti-inflammatory drug. A new study, published in the Journal of the American Heart Association, adds to that debate by ad...
Source: TIME: Health - Category: Consumer Health News Authors: Tags: Uncategorized aspirin Drugs Heart Disease Source Type: news
Conclusion/Clinical Relevance: The case demonstrated that refractory AD could be managed with ITB in an emergency. PMID: 31815605 [PubMed - as supplied by publisher]
Source: Journal of Spinal Cord Medicine - Category: Orthopaedics Tags: J Spinal Cord Med Source Type: research
This study proposes a multi-center RCT in order to compare outcomes of warmer hypothermic strategies during aortic hemiarch surgery on a composite endpoint of neurologic and acute kidney injury (AKI).Methods/designThis is a prospective multi-center, single-blind two-arm RCT comparing mild (32  °C) versus moderate (26 °C) hypothermic cardiac arrest in patients (n = 282) undergoing hemiarch surgery with antegrade cerebral perfusion (ACP). The primary endpoint is a composite of neurological injury (incidence of transient ischemic attack and/or stroke) and Kidney Disease Improving Global Out...
Source: Trials - Category: Research Source Type: clinical trials
Studies have indicated differences between Asians and Whites in their propensity for stroke, coronary artery disease, heart failure, bleeding and thrombosis. We investigated whether Asian-Americans on durable left ventricular assist devices (LVADs) exhibit differential morbidity and mortality when compared to Whites.
Source: Heart, Lung and Circulation - Category: Cardiology Authors: Tags: Original Article Source Type: research
Authors: Cohen AT, Hunt BJ Abstract The direct oral anticoagulants (DOACs) have transformed the management of thrombotic disorders. Large clinical trials have demonstrated that DOACs can replace vitamin K antagonists (VKAs) in the 2 existing major indications for anticoagulation: the prevention of stroke in atrial fibrillation and the acute treatment and secondary prevention of venous thromboembolism (VTE); this literature is widely known. In this article, we will concentrate on the less well-discussed benefits of the use of DOACs-using low doses as primary and secondary prophylaxis in both venous and arterial thro...
Source: Hematology ASH Education Program - Category: Hematology Tags: Hematology Am Soc Hematol Educ Program Source Type: research
Authors: Leebeek FWG, Muslem R Abstract Chronic heart failure (HF) is a growing health problem, and it is associated with high morbidity and mortality. Left ventricular assist devices (LVADs) are nowadays an important treatment option for patients with end-stage HF not only as a bridging tool to heart transplantation but also, as a permanent therapy for end-stage HF (destination therapy). The use of LVAD is associated with a high risk for bleeding complications and thromboembolic events, including pump thrombosis and ischemic stroke. Bleeding is the most frequent complication, occurring in 30% to 60% of patients, b...
Source: Hematology ASH Education Program - Category: Hematology Tags: Hematology Am Soc Hematol Educ Program Source Type: research
Authors: Kimpton M, Siegal DM Abstract A 77-year-old man with atrial fibrillation and a CHA2DS2Vasc score of 6 for hypertension, age, diabetes, and previous stroke is brought to the emergency department with decreased level of consciousness. He is anticoagulated with rivaroxaban (a direct oral factor Xa inhibitor [FXaI]) and received his last dose about 4 hours before presentation. Urgent computed tomography of the head shows intracerebral hemorrhage. Because of his previous stroke, the patient's family is concerned about treating the bleed with pharmacological agents that may increase the risk of stroke. What are ...
Source: Hematology ASH Education Program - Category: Hematology Tags: Hematology Am Soc Hematol Educ Program Source Type: research
Conclusions: Stroke is uncommon in cirrhotic patients. However, considering a positive relationship of liver cirrhosis with subarachnoid and intracranial hemorrhage, the prophylactic strategy may be selectively adopted in cirrhotic patients.
Source: Journal of Clinical Gastroenterology - Category: Gastroenterology Tags: LIVER, PANCREAS & BILIARY TRACT: Original Articles Source Type: research
More News: Bleeding | Blood Transusion | Cardiovascular & Thoracic Surgery | Clopidogrel | Coronary Artery Bypass Graft | Plavix | Stroke | Study