Discontinuation of anticoagulant therapy for a month in a patient with HeartMate III continuous-flow left ventricular assist device without thromboembolic events

The recommended anticoagulation regimen for continuous-flow left ventricular assist device (LVAD) systems is warfarin and aspirin with a targeted international normalized ratio (INR) of 2.0–3.0. Our patient is a 58-year-old male who underwent surgical HeartMate III continuous-flow LVAD implantation 3?months ago outside the country. The patient mistakenly stopped taking warfarin for 1?month prior to presenting to our center for a routine visit. Luckily, the patient was doing very well without any complication despite the fact that his INR was 1.0.     

Endovascular treatment of aneurisms: Pre,intra and post operative management

The most frequent risk in endovascular aneurysm treatment is thromboembolic complications. Thus adjuvant pharmaceuticals are largely focused on preventing and treating these latter. Additionally symptomatic treatment of subarachnoid hemorrhage (SAH) and treatments to avoid vasospasm will enter into play in cases of ruptured aneurisms.     

《2020 ESC心房颤动诊断和管理指南》 更新要点解读

作为临床上常见的心律失常类型之一,心房颤动在人群中的患病率逐渐增加,因此不断优化心房颤动的诊断管理十分重要。2020年欧洲心脏病协会联合心胸外科协会发布的心房颤动管理指南是2016年ESC房颤指南的进一步更新,新指南对房颤的定义、诊断、危险因素、临床结局、综合管理、治疗、预防等方面进行了更新。本文重点对指南的更新处进行解读,尤其是整合管理方法（即ABC途径）进行解读,旨在为临床工作者管理房颤病人提供最新思路。     

Warfarin and intracranial haemorrhage

SUMMARY: Spontaneous intracerebral haemorrhage is one of the most feared complications of long-term anticoagulation. Warfarin therapy not only increases the likelihood of suffering an intracranial haemorrhage, but also increases the mortality associated with it. This review aims to examine the incidence, pathogenesis, and outcome following a warfarin associated intracranial haemorrhage. It also evaluates the available evidence regarding optimal management of these patients, including timing and strategies for reversal of the coagulopathy, the role of neurocritical care and surgery, and indications for re-anticoagulation once the acute phase has past. The specific management of patients with prosthetic heart valves is also discussed. A summary of current societal guidelines is also included, as are some key practice points.     

Antithrombotic therapy in elderly patients with atrial fibrillation: effects and bleeding complications: a stratified analysis of the NASPEAF randomized trial.

AIMS: Atrial fibrillation patients with prior embolism have a high risk of vascular events in spite of anticoagulant therapy and elderly patients carry an additional risk. We analysed and compared vascular events-rate between older and younger than 75 years atrial fibrillation patients randomized to anticoagulant-alone or combined antiplatelet plus moderate-level anticoagulant therapy. METHODS AND RESULTS: A total of 967 patients stratified by age and the history of prior embolism were randomized to therapeutic doses of anticoagulant-alone or combined antithrombotic therapy. Primary events were fatal and non-fatal ischaemic or haemorrhagic stroke/transient ischaemic attack, systemic embolism and myocardial infarction, sudden death and death from bleeding. The elderly, compared with the younger patients, had higher event-rate [hazard ratio 2.31 (95% confidence interval 1.37-3.90), P < 0.003]. The elderly suffered higher severe bleeding event-rate during anticoagulant therapy. The combined, compared with the anticoagulant therapy, reduced the vascular events-rate in the elderly (P = 0.012) and caused less intracranial haemorrhages and less bleeding mortality, although more non-fatal gastric bleeding. CONCLUSION: The elderly with AF had a higher event-rate than the younger patients. A higher severe bleeding event-rate was also registered in elderly patients receiving anticoagulant therapy. Combined, compared with anticoagulant therapy, significantly reduced vascular events and bleeding mortality in elderly patients.     

二尖瓣狭窄伴房颤球囊扩张术术前抗凝及术后复律探讨

对 2 6例二尖瓣狭窄 (MS)合并心房颤动 (Af)患者 ,在行经皮球囊二尖瓣扩张术 (PBMV)前给大剂量肝素短程抗凝 ,并对其中 1 9例在术后即给予同步直流电复律。结果　二尖瓣口面积 (MVA)由 0 92± 0 2cm2 扩大至 1 95± 0 3 7cm2 ,左房平均压 (LAP)由 3 1 2± 1 2 7kPa降至 1 4 2± 0 85kPa,而左房内径 (LAD)由 52 7± 8 1mm缩小至 4 2 5± 5 9mm。 2 6例均无血栓栓塞并发症及出血并发症 ;1 9例术后即刻行同步电复律者 1 5例 ( 78 9% )复律成功。     

Periprocedural antithrombotic medication in acute ischemic stroke treated by catheter-based thrombectomy. A review

This review summarized limited information known about periprocedural antithrombotic therapy before, during and immediately after percutaneous catheter-based thrombectomy for acute ischemic stroke. Very few data on this topic were published so far. In general, rtPA should be used upfront whenever clinically clearly indicated (0–3 h from stroke onset, absence of contraindications) irrespective of subsequent mechanical thrombectomy. If mechanical treatment follows after thrombolysis, neither anticoagulation, nor antiplatelet agents should be used in the acute phase. No data exist about the periprocedural use of anticoagulation or antiplatelet therapy in patients who cannot receive fibrinolysis and undergo direct mechanical thrombectomy alone. Most centers use no or very low dose heparin and a single dose of aspirin.     

冠脉内支架植入术及联合抗凝治疗急性心肌梗死的临床研究

目的探讨冠脉内支架植入术及联合抗凝治疗急性心肌梗死的临床效果.方法自2001年3月至2003年10月在我院就诊的急性心肌梗死病人156例,随机分为治疗组79例(男62例,女17例),给予冠脉内支架植入及联合抗凝治疗;对照组77例(男59例,女18例),给予静脉溶栓.所有病人均行冠脉造影,进行两组间比较.结果治疗组在冠脉再通率、恢复TIMI3级血流、心功能改善方面显著优于对照组(P＜0.01);而大出血、病死率明显低于对照组(P＜0.05).结论冠脉内支架植入术及联合抗凝治疗急性心肌梗死是有效、安全的,可减少并发症的发生.