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What is the importance of calculating sample size?
Worldwide, venous thromboembolism (VTE) is among the leading causes of death from cardiovascular disease, surpassed only by acute myocardial infarction and stroke. The spectrum of VTE presentations ranges, by degree of severity, from deep vein thrombosis to acute pulmonary thromboembolism. Treatment is based on full anticoagulation of the patients. For many decades, it has been known that anticoagulation directly affects the mortality associated with VTE. Until the beginning of this century, anticoagulant therapy was based on the use of unfractionated or low-molecular-weight heparin and vitamin K antagonists, warfarin in p...
Source: Jornal Brasileiro de Pneumologia - May 6, 2016 Category: Respiratory Medicine Source Type: research

Recurrent infarctions due to a dome-shaped pannus above the mitral valve prosthesis.
This report describes a unique case of a 56-year-old female who suffered from recurrent stroke after double mechanical valve replacement. During the four years after the surgery, she remained in normal sinus rhythm, received adequate anticoagulation therapy, and no apparent left atrial thrombus was detected. She underwent redo surgery to prevent further stroke after fourth instance of cerebral infarction. Intraoperative findings revealed a 'dome-shaped' pannus formation covering the sewing ring of the mitral prosthesis circumferentially, probably leading to clot formation and repeated infarctions. She has been stroke free ...
Source: Journal of Thoracic Disease - February 25, 2016 Category: Respiratory Medicine Tags: J Thorac Dis Source Type: research

Dealing with surgical left ventricular assist device complications.
Authors: Kilic A, Acker MA, Atluri P Abstract Left ventricular assist devices (LVAD) will undoubtedly have an increasing role due to the aging population, anticipated concomitant increase in the prevalence of end-stage heart failure, and improvements in LVAD technology and outcomes. As with any surgical procedure, LVAD implantation is associated with an adverse event profile. Such complications of LVAD therapy include bleeding, infection, pump thrombosis, right heart failure, device malfunction, and stroke. Although each has a unique management, early recognition and diagnosis of these complications is uniformly pa...
Source: Journal of Thoracic Disease - January 24, 2016 Category: Respiratory Medicine Tags: J Thorac Dis Source Type: research

Rivaroxaban in non valvular atrial fibrillation: subgroups analysis.
Authors: Greco C Abstract After the ROCKET AF study main paper several subgroups analysis were recently published. These studies are useful to better evaluate the rivaroxaban efficacy and safety in different clinical conditions. Here the subgroup analysis of patients with moderate renal failure, heart failure and diabetes are presented. Post hoc data on patients who underwent an electrical or pharmacological cardioversion during ROKET AF follow up were available and here we analyze also the results of the first randomized study on electrical cardioversion in patients treated with new oral anticolagulants: the X-VeR...
Source: Monaldi Archives for Chest Disease - December 21, 2015 Category: Respiratory Medicine Tags: Monaldi Arch Chest Dis Source Type: research

The comparison of serum visfatin levels in patients with acute PTE and non-PTE independent of BMI
Conclusions: Although the serum visfatin levels were lower in the acute PTE group than in the non-PTE group both of which had similar BMI, the difference was not statistically significant. Further and larger studies are needed to evaluate the visfatin levels in acute PTE.
Source: European Respiratory Journal - October 30, 2015 Category: Respiratory Medicine Authors: Tutar, N., Dogan, S., Buyukoglan, H., Sen, A., Yilmaz, I., Yildirim, A., Dogan, A., Yetkin, A., Oymak, F. s., Gulmez, I., Demir, R. Tags: 4.3 Pulmonary Circulation and Pulmonary Vascular Disease Source Type: research

Cerebral air embolism during CT-guided lung biopsy
A patient with cirrhosis and hepatocellular carcinoma, on the waiting list for liver transplantation, presented with lung nodule during initial evaluation. A CT-guided core needle lung biopsy under general anaesthesia was performed. Pneumothorax (figure 1) and a large amount of gas within the left ventricle (figure 2) were identified during the procedure. Neurological focal signs (drowsiness, conjugate eye deviation and right hemiparesis) were observed in the anaesthesia-recovery period. A brain CT scan was immediately obtained, showing cerebral air embolism (figure 3). Initial resuscitation and hyperbaric oxygen therapy w...
Source: Thorax - October 14, 2015 Category: Respiratory Medicine Authors: Rocha, R. D., Azevedo, A. A., Falsarella, P. M., Rahal, A., Garcia, R. G. Tags: Images in Thorax, Journalology, Screening (oncology), Venous thromboembolism, Pulmonary embolism, Transplantation, Ethics Chest clinic Source Type: research

Oral anticoagulation and the risk of stroke or death in patients with atrial fibrillation and one additional stroke risk factor: the Loire Valley Atrial Fibrillation Project.
Conclusion: Among AF patients with one single additional stroke risk factor (CHA2DS2-VASc score = 1 in males, 2 in females), OAC use was associated with an improved prognosis for stroke/systemic thromboembolism/death. PMID: 26425935 [PubMed - as supplied by publisher]
Source: Chest - October 1, 2015 Category: Respiratory Medicine Authors: Fauchier L, Lecoq C, Clementy N, Bernard A, Angoulvant D, Ivanes F, Babuty D, Lip GY Tags: Chest Source Type: research

Stroke, Major Bleeding and Mortality Outcomes in Warfarin Users with Atrial Fibrillation and Chronic Kidney Disease: A Meta-analysis of Observational Studies.
Conclusions: Based on this meta-analysis, the use of warfarin for AF may have an unfavorable risk/benefit ratio in patients with end-stage CKD but not in those with non-end stage CKD. PMID: 26378611 [PubMed - as supplied by publisher]
Source: Chest - September 17, 2015 Category: Respiratory Medicine Authors: Dahal K, Kunwar S, Rijal J, Schulman P, Lee J Tags: Chest Source Type: research

Pulmonary Embolism Response to Fragmentation, Embolectomy, and Catheter Thrombolysis (PERFECT): Initial Results from a Prospective Multicenter Registry.
CONCLUSIONS: Catheter-directed therapy improves clinical outcomes in acute PE patients while minimizing the risk of major bleeding. At experienced centers, CDT is a safe and effective treatment for both acute massive and submassive PE. CLINICAL TRIAL REGISTRATION: NCT01097928, available at http://clinicaltrials.gov/show/NCT01097928. PMID: 25856269 [PubMed - as supplied by publisher]
Source: Chest - April 9, 2015 Category: Respiratory Medicine Authors: Kuo WT, Banerjee A, Kim PS, DeMarco FJ, Levy JR, Facchini FR, Unver K, Bertini MJ, Sista AK, Hall MJ, Rosenberg JK, DeGregorio MA Tags: Chest Source Type: research

The impact of associated diabetic retinopathy on stroke and severe bleeding risk in diabetic patients with atrial fibrillation: The Loire Valley Atrial Fibrillation Project.
ConclusionCrude rates of stroke/TE increased in a stepwise fashion when non-diabetic AF patients were compared to diabetics with no retinopathy and diabetics with retinopathy. However, we have shown for the first time that the presence of diabetic retinopathy did not emerge as an independent predictor for stroke/TE or severe bleeding on multivariate analysis. Background: Diabetes mellitus is recognized as a stroke risk factor in atrial fibrillation (AF). Diabetics with retinopathy have an increased risk of systemic cardiovascular complications, and also, severe diabetic retinopathy predisposes to ocular bleeds. We hyp...
Source: Chest - November 20, 2014 Category: Respiratory Medicine Authors: Lip GY, Clementy N, Pierre B, Boyer M, Fauchier L Tags: Chest Source Type: research

Patent foramen ovale and stroke in intermediate-risk pulmonary embolism.
CONCLUSIONS: PFO and related ischemic strokes are frequent in intermediate-risk pulmonary embolism. TEE is much more efficient than TTE for PFO diagnostic. Considering the high risk of intra-cranial bleeding with thrombolysis in PE, which in part may be due to haemorrhagic transformation of sub-clinical strokes, screening PFO with TEE should be considered in intermediate risk PE when a thrombolytic treatment is discussed. PMID: 24874409 [PubMed - as supplied by publisher]
Source: Chest - May 29, 2014 Category: Respiratory Medicine Authors: Doyen D, Castellani M, Moceri P, Chiche O, Lazdunski R, Bertora D, Cerboni P, Chaussade C, Ferrari E Tags: Chest Source Type: research

What's hot that the other lot got
Fibrinolysis for patients with intermediate-risk PE The use of fibrinolysis for normotensive patients with an intermediate risk of death after acute pulmonary embolism (PE) remains a controversial topic. The PIETHO trial (N Engl J Med 2014;370:1402–11) was a multicentre, double-blind trial, in which 1006 patients with acute PE and evidence of right ventricular dysfunction on echocardiography or CT, as well as positive cardiac troponin test, were randomly assigned to initial treatment with tenecteplase plus heparin, or placebo plus heparin. The primary outcome of death or haemodynamic compromise within 7 days of rando...
Source: Thorax - May 14, 2014 Category: Respiratory Medicine Authors: Rolin, S. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: infectious diseases, HIV/AIDS, Inflammation, Venous thromboembolism, Pulmonary embolism, Radiology (diagnostics) Chest clinic Source Type: research

Stroke/thromboembolism and intracranial hemorrhage in a 'real world' atrial fibrillation population: The CAFBO STUDY (Complications of Atrial Fibrillation in the BOlogna area).
CONCLUSION IEs occurred mainly in elderly patients who received ASA or no treatment. Half of anticoagulated patients with IEs had subtherapeutic INRs. Therapeutic approaches to elderly subjects with AF require an effective anticoagulant treatment strategy. PMID: 24810397 [PubMed - as supplied by publisher]
Source: Chest - May 8, 2014 Category: Respiratory Medicine Authors: Palareti G, Salomone L, Cavazza M, Guidi M, Muscari A, Boriani G, Di Micoli A, Guizzardi G, Procaccianti G, Guidetti A, Binetti N, Malservisi S, Masina M, Viola A, Bua V, Ongari M, Diaspri G, Lip GY Tags: Chest Source Type: research

Relationship of the SAME-TT2R2score to poor quality anticoagulation, stroke, clinically relevant bleeding and mortality in patients with atrial fibrillation.
CONCLUSION We demonstrate that the SAME-TT2R2 score was predictive for an increasing risk of stroke/TE, severe bleeding, major BARC bleeding and death, reflecting poor anticoagulation control (and labile INRs) on VKA amongst our patients with AF. PMID: 24722973 [PubMed - as supplied by publisher]
Source: Chest - April 10, 2014 Category: Respiratory Medicine Authors: Lip GY, Haguenoer K, Saint-Etienne C, Fauchier L Tags: Chest Source Type: research

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