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Managing Anticoagulation in LVAD Patients: The Harefield Experience
Anticoagulation management in patients with Left Ventricular Assist devices (LVAD) continues to be a challenge. Patients and their clinicians are faced with the daily challenge of needing adequate anticoagulation versus the bleeding risks that are associated with anticoagulation.Warfarin is the recommended oral anticoagulant for all currently available LVAD devices.Warfarin is known to be a difficult medication to manage due to its narrow therapeutic window, and its many interactions .Dlott et al (2014) describe in Circulation the overall time in therapeutic range for patients on warfarin as 53.7%, Time in therapeutic rang...
Source: The Journal of Heart and Lung Transplantation - March 25, 2017 Category: Transplant Surgery Authors: R. Hards, G. Edwards, C. Kavanagh, M. Hedger, A.R. Simon Source Type: research

Pre-treatment clinical assessment in head and neck cancer: United Kingdom National Multidisciplinary Guidelines.
Authors: Robson A, Sturman J, Williamson P, Conboy P, Penney S, Wood H Abstract This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides recommendations on the pre-treatment clinical assessment of patients presenting with head and neck cancer. Recommendations • Comorbidity data should be collected as it is important in the analysis of survival, quality of life and functional outcomes after treatment as well as for comparing results of different treatment regimens and different centres. (R) • Patients with hypertens...
Source: Journal of Laryngology and Otology - November 15, 2016 Category: ENT & OMF Tags: J Laryngol Otol Source Type: research

Thrombosis at the Site of Pulmonary Venous Anastomosis Following Lung Transplantation Presenting with Multiple, Bilateral, Supra- and Infra-Tentorial Ischemic Strokes in the Setting of a Known Patent Foramen Ovale (P4.355)
CONCLUSIONS: PFO-related stroke risk over time remains a controversial matter and so does its prevention by closure, as there is no current evidence-based data to justify this procedure except on anecdotal basis. LT patients may represent a subset population who could benefit from pre-operative PFO screening and closure, especially if they have a history of prior strokes.Disclosure: Dr. Yeung has nothing to disclose. Dr. Bakhos has nothing to disclose. Dr. Biller has received personal compensation in an editorial capacity for the Journal of Stroke and Cerebrovascular Diseases, Frontier in Neurology and Up-To-Date.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Yeung, S., Bakhos, M., Biller, J. Tags: Cerebrovascular Case Reports Source Type: research

Left Ventricular Assist Devices vs. the Total Artificial Heart: Which Causes More Cerebrovascular Accidents?
More recently, the continuous flow left ventricular assist devices (LVADs) have been more commonly used in patients (pts) with severe left heart failure. However, these devices also have risk for strokes, both ischemic and hemorrhagic. The Total Artificial Heart (TAH) has also been used in patients with biventricular heart failure at our single institution. Both continuous flow LVADs and TAH patients are systemically anti-coagulated with warfarin and aspirin. We sought to compare stroke rates between the LVAD patients and TAH pts.
Source: The Journal of Heart and Lung Transplantation - April 1, 2015 Category: Transplant Surgery Authors: C. Runyan, F. Arabia, L. Czer, M. Kittleson, E. Passano, F. Liou, J. Yabuno, H. Henry, D.H. Chang, J. Kobashigawa, J. Moriguchi Source Type: research

Gastrointestinal bleeding and subsequent risk of thromboembolic events during support with a left ventricular assist device
Background: Modern left ventricular assist devices (LVAD) require anti-coagulation (AC) with warfarin and anti-platelet therapy to prevent thromboembolic complications in patients. Gastrointestinal bleeding (GI) is a significant adverse event in these patients and treatment typically requires reduction or elimination of AC or anti-platelet therapy. It is not known whether alterations in AC to treat GI bleeding influence subsequent risk of thromboembolic (TE) events during LVAD support.Methods: Between July 2003 and September 2011, 389 patients (308 male) underwent implantation of a continuous-flow LVAD at the University of...
Source: The Journal of Heart and Lung Transplantation - September 9, 2013 Category: Transplant Surgery Authors: John M. Stulak, Dustin Lee, Jonathon W. Haft, Matthew A. Romano, Jennifer A. Cowger, Soon J. Park, Keith D. Aaronson, Francis D. Pagani Tags: Featured Articles Source Type: research

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