1.
Effective practical management of patients with atrial fibrillation when using new oral anticoagulants.
Cox, JL
Annals of medicine. 2015;(4):278-88
Abstract
Practical management of stroke prevention in patients with non-valvular atrial fibrillation (AF) requires physicians to find the optimal balance between maximizing prevention of ischaemic stroke and minimizing the risk of bleeding. Vitamin K antagonists have traditionally been used for stroke prevention in patients with AF; however, they have been associated with increased risk of bleeding, particularly intracranial haemorrhage. New oral anticoagulants (OACs) have shown similar efficacy to the vitamin K antagonist warfarin but with a reduced risk of bleeding, particularly life-threatening bleeding such as intracranial haemorrhage. Decisions about which new OAC therapy to use may be influenced by patient characteristics such as age, renal function, co-medication use, and bleeding risk. This review uses a case-based approach to highlight the practical management issues to be considered by the physician when selecting a new OAC for stroke prevention in patients with non-valvular AF.
2.
NOAC and intracerebral bleeding--presentation of four cases and review of the literature.
Hana, A, Berthold, C, Gunness, VR, Hana, A, Dooms, G, Standhardt, H, Koy, J, Matgé, G, Boecher-Schwarz, H, Hertel, F
Bulletin de la Societe des sciences medicales du Grand-Duche de Luxembourg. 2014;(1):57-66
Abstract
AF might be a life threatening disease. Patients have been under oral antithrombotic treatment in order to avoid thrombotic events. Although this treatment proved to be effective in the last decades there was always the inconvenience of a regular blood control. In the last months NOACs have been flooding the market promising to be as effective as their older concurrents in certain circumstances and highlighting the fact that the control of INR has become obsolete. However, as there is no specific antidote up to date, NOACs might present a life threatening event in case of an intracerebral haemorrhage. The brain surgeons might find themselves in a difficult situation when they have to decide whether to operate on a patient with a compromised haemostasis or not. We present four patients who were treated with NOACs for AF. Three of them were admitted with intracerebral haemorrhage in our neurosurgical unit from January to October 2013. The fourth patient bled one week after stopping his treatment with NOAC. Furthermore we take a closer look to the existing literature and try to portray the issue from a neurosurgical point of view.
3.
Emergency reversal of vitamin-K antagonists related over-anticoagulation: case report and brief overview on the role of prothrombin complex concentrate.
Di Fusco, SA, Aspromonte, N, Aquilani, S, Mele, L, Colivicchi, F
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace. 2013;(4):184-8
Abstract
Oral anticoagulation is a widely used treatment and atrial fibrillation (AF) is the most frequent indication. We review the therapeutic options on an important clinical challenge: rapid reversal anticoagulation in the setting of an urgent invasive procedure. We report a case of a 71-year-old man treated with warfarin who was over-anticoagulated when presented to the emergency department for syncope due to severe bradiarrhythmia and needed temporary pacing. Intravenous infusion of vitamin-k was not adequate for rapid reversal over anticoagulation whereas the administration of a Prothrombin Complex Concentrate (PCC) was able to quickly reverse anticoagulant activity and allowed the performance of an urgent invasive procedure without hemorrhagic complication. The aim of this paper is to draw attention to possible therapeutic strategies to reduce the risk of bleeding related to over-anticoagulation with vitamin-K antagonists (VKAs) in case of urgent invasive procedure, emphasizing the role of PCC in keeping with national and international guidelines.
5.
[Coronary embolism with apical ballooning complicating electrical cardioversion--is it part of the apical ballooning syndrome? Case report and review of the literature].
Buchter, B, Khattab, AA, Richardt, G
Herz. 2006;(5):480-4
Abstract
CASE STUDY A case of thromboembolic left anterior descending artery occlusion following electrical cardioversion for atrial fibrillation is described. A 66-year-old female patient presenting with exertional angina pectoris and atrial fibrillation was subjected to coronary angiography, ventriculography and transesophageal echocardiography. No significant coronary stenoses were found, left ventricular systolic function and regional wall motion were normal, and she had no intracardiac thrombi. Direct-current cardioversion was complicated by asystole which was managed by cardiac massage and 1 mg atropine and 1 mg adrenaline intravenously. Shortly afterwards, the patient regained a normal sinus rhythm. She remained hypotensive and developed ST segment elevation over the chest leads. Angiography was repeated and showed apical ballooning and thromboembolic subtotal occlusion of the proximal LAD, which migrated to the periphery and subsequently disappeared with regain of TIMI 3 flow by the end of angiography. 4 months later, a normal left ventricular global and regional function was seen in echocardiography. HYPOTHESIS At least part of the apical ballooning syndrome patients are a sequel of transient thromboembolic occlusions. METHODS Therefore, all patients with the diagnosis of coronary embolism in the period from September 2004 to September 2005 were analyzed retrospectively. RESULTS Further three patients had coronary artery embolism (two females, one male; age 69-76 years). Two patients had apical ballooning, and one showed global hypokinesia (known dilated cardiomyopathy). Cardiac markers were slightly elevated. ST segment elevation was seen in two patients and T-wave inversion in one. All had risk factors for embolization and two had an additional triggering factor. Both cases with apical ballooning had regained a normal ejection fraction at follow-up. CONCLUSION This case series probably bridges the gap between two as yet separate disease entities, namely the apical ballooning syndrome and coronary emboli. The time factor probably plays the pivotal role in determining whether the apical ballooning alone or also an embolus is seen. It seems possible that some patients presenting with apical ballooning are unrecognized coronary thromboembolic cases.
6.
Atrial fibrillation during adjuvant chemotherapy with docetaxel: a case report.
Palma, M, Mancuso, A, Grifalchi, F, Lugini, A, Pizzardi, N, Cortesi, E
Tumori. 2002;(6):527-9
Abstract
A 46-year-old woman had an episode of atrial fibrillation during infusion of docetaxel as adjuvant chemotherapy for an infiltrating ductal carcinoma of the breast. All cardiological tests performed before treatment were normal and there was no evidence of thyroid dysfunction nor any objective or anamnestic data indicating acute or chronic cardiovascular disease. None of the drugs administered has ever shown any proarrhythmic activity. In controlled clinical trials docetaxel was found to have a very low cardiotoxicity.