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Clot lysis time predicts stroke during anticoagulant therapy in patients with atrial fibrillation
ConclusionsImpaired fibrinolysis may predict thromboembolic events in AF patients receiving VKA.
Source: Canadian Journal of Cardiology - August 8, 2019 Category: Cardiology Source Type: research

Anticoagulation in Patients with Advanced Chronic Kidney Disease: Walking the Fine Line between Benefit and Harm
Publication date: Available online 11 July 2019Source: Canadian Journal of CardiologyAuthor(s): Januvi Jegatheswaran, Gregory L. Hundemer, David Massicotte-Azarniouch, Manish M. SoodAbstractChronic kidney disease affects over 3 million Canadians and is highly associated with cardiovascular diseases that require anticoagulation, such as atrial fibrillation and venous thromboembolism. Patients with chronic kidney disease are at a problematic crossroads; they are at high risk of both thrombotic conditions requiring anticoagulation and bleeding complications due to anticoagulation. The limited high-quality clinical evidence to...
Source: Canadian Journal of Cardiology - July 12, 2019 Category: Cardiology Source Type: research

Periprocedural Anticoagulation for Cardioversion of Acute Onset Atrial Fibrillation and Flutter: Evidence Base for Current Guidelines
Publication date: Available online 12 June 2019Source: Canadian Journal of CardiologyAuthor(s): Jason G. Andrade, L. Brent MitchellABSTRACTThe practice of electrical or pharmacological cardioversion (CV) to restore sinus rhythm in patents with symptomatic atrial fibrillation (AF) or atrial flutter (AFL) has been a part of clinical practice for over 100 years. For almost as long as CV has been performed, it has been recognised that the act of restoring sinus rhythm is associated with an increased risk of stroke and systemic embolism, and that oral anticoagulation (OAC) therapy can be used to prevent peri-CV thromboembolism....
Source: Canadian Journal of Cardiology - June 13, 2019 Category: Cardiology Source Type: research

Outcome Of Patients Undergoing Transcatheter Implantation Of Aortic Valve With Previous Mitral Valve Prosthesis (OPTIMAL STUDY)
ConclusionsTAVR in patients with a previous mitral prosthesis appears safe and feasible, with good hemodynamic results at 30-day and at longer term follow-up.
Source: Canadian Journal of Cardiology - April 16, 2019 Category: Cardiology Source Type: research

Peridevice Leak After Left Atrial Appendage Closure: Incidence, Risk Factors, and Clinical Impact
ConclusionsThe PDL rate detected by CCTA after LAAC was high, especially in cases with a low device compression ratio (< 10%), but decreased over time. The incidence of MACE was quantitatively greater with PDL, but the difference was not statistically significant. Larger studies are needed to determine the clinical importance of PDL.RésuméIntroductionPeu d’études ont fait état des taux et des répercussions cliniques des fuites périprothétiques (FPP) après la fermeture de l’appendice auriculaire gauche (AAG) par voie percutanée.MéthodesNous avons inscrit de manière prospective tous les patients consécuti...
Source: Canadian Journal of Cardiology - March 30, 2019 Category: Cardiology Source Type: research

Optimal duration of dual antiplatelet therapy following percutaneous coronary intervention: An umbrella review
ConclusionsExtended DAPT may reduce the risk of MI and stent thrombosis but increase major bleeding and death. Whether the effects of extended DAPT are consistent across patient subgroups is unclear, and future SRs should address this knowledge gap. PROSPERO: CRD42016047735.
Source: Canadian Journal of Cardiology - February 6, 2019 Category: Cardiology Source Type: research

Peri-Device Leak after Left Atrial Appendage Closure: Incidence, Risk Factors and Clinical Impact
ConclusionsPDL rate detected by CCTA after LAAC is high, especially in cases with low device compression ratio (<10%), but decreased over time. The incidence of MACE was quantitatively greater with PDL, but the difference was not statistically significant. Larger studies are needed to determine the clinical importance of PDL.
Source: Canadian Journal of Cardiology - December 21, 2018 Category: Cardiology Source Type: research

Antithrombotic Therapy for Atrial Fibrillation and Coronary Disease Demystified
Publication date: November 2018Source: Canadian Journal of Cardiology, Volume 34, Issue 11Author(s): Jason G. Andrade, Marc W. Deyell, Graham C. Wong, Laurent MacleAbstractAtrial fibrillation (AF) is a progressive chronic disease characterized by exacerbations and periods of remission. It is estimated that up to 20% to 30% of those with AF also have coronary artery disease (CAD), and 5% to 15% will require percutaneous coronary intervention (PCI). In patients with concomitant AF and CAD, management remains challenging and requires a careful and balanced assessment of the risk of bleeding against the anticipated impact on i...
Source: Canadian Journal of Cardiology - November 6, 2018 Category: Cardiology Source Type: research

Antithrombotic Therapy for Atrial Fibrillation and Coronary Disease de-Mystified
Publication date: Available online 20 August 2018Source: Canadian Journal of CardiologyAuthor(s): Jason G. Andrade, Marc W. Deyell, Graham C. Wong, Laurent MacleABSTRACTAtrial fibrillation (AF) is a progressive chronic disease characterized by exacerbations and periods of remission. It is estimated that up to 20-30% of those with AF also have coronary artery disease (CAD), and 5-15% will require percutaneous coronary intervention (PCI). In patients with concomitant AF and CAD, management remains challenging and requires a careful and balanced assessment of the risk of bleeding against the anticipated impact on ischemic out...
Source: Canadian Journal of Cardiology - August 21, 2018 Category: Cardiology Source Type: research

Multiple thromboembolic events from a left atrial appendage occlusion device
We report a clinico-pathological case where thrombus adherent to an incompletely endothelialized Watchman® device resulted in multiple thromboembolic events, contributing to a fatal outcome. This case illustrates uncertainties regarding the device’s endothelialization process. Teaser Left atrial appendage occlusion devices are an alternative to oral anticoagulation in patients with nonvalvular atrial fibrillation at risk of ischemic stroke. Post-implantation thromboprophylaxis is recommended, but the optimal regimen is unknown. We report a clinico-pathological case where thrombus adherent to an incompletely endotheliali...
Source: Canadian Journal of Cardiology - December 27, 2017 Category: Cardiology Source Type: research

Assessment and management of the Left Atrial Appendage Thrombus in Patients with Nonvalvular Atrial Fibrillation
Conclusion Integration of clinical, biomarker, and imaging risk factors can improve overall prediction for the presence of LAA thrombi, translating into improved patient selection for imaging. The gold standard for the diagnosis of LAA thrombi remains TEE, although ICE, CCT, and CMR are promising alternative modalities. When LAA thrombi are discovered, the treatment regimen remains variable, although DOACs may have similar efficacy to VKA. Future trials will help further elucidate DOAC use for the treatment of LAA thrombi.
Source: Canadian Journal of Cardiology - December 15, 2017 Category: Cardiology Source Type: research

Transcatheter left atrial appendage closure using intracardiac echocardiographic guidance from the left atrium
Conclusion Initial experience suggests LAA occlusion with the Amplatzer Cardiac PlugTM under ICE guidance from the left atrium is feasible, reproducible and safe.
Source: Canadian Journal of Cardiology - May 18, 2015 Category: Cardiology Source Type: research

Atrial Fibrillation Patients Categorized as “Not for Anticoagulation” According to the 2014 Canadian Cardiovascular Society Algorithm Are Not “Low Risk”
Conclusions Based on the 2014 CCS algorithm, the “OAC not recommended” subgroup can have a high 1-year stroke rate overall, showing that such patients are not “low risk.” Use of the ESC guideline approach (based on the CHA2DS2-VASc) offers refinement of stroke risk stratification in such patients.
Source: Canadian Journal of Cardiology - January 17, 2015 Category: Cardiology Source Type: research

Serum Uric Acid and Risk of Left Atrial Thrombus in Patients With Nonvalvular Atrial Fibrillation
Conclusions Hyperuricemia was a modest risk factor for LA thrombus, which might refine stratification of LA thrombus in patients with nonvalvular AF.
Source: Canadian Journal of Cardiology - November 4, 2014 Category: Cardiology Source Type: research