Methodist DeBakey cardiovascular journal
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Methodist Debakey Cardiovasc J · Apr 2012
Cytomegalovirus localization in atherosclerotic plaques is associated with acute coronary syndromes: report of 105 patients.
It has been shown that cytomegalovirus (CMV) is present in coronary atherosclerotic plaques, but the clinical relevance of this presence remains to be elucidated. In this study we sought to examine CMV infection in atherosclerosis patients defined by different methods and to identify the clinical significance of CMV replication in the atherosclerotic plaques. The study included 105 consecutive patients who were admitted to our department and underwent coronary artery bypass grafting (CABG) surgical interventions. ⋯ They were also more likely to have a positive family history for cardiovascular diseases (CVD). This study confirms previous evidence about the replication of CMV virus in the atherosclerotic plaques of coronary arteries and brings clinical significance to this observation by showing a higher prevalence of acute coronary syndromes in those patients with CMV-infected plaques. Our study also suggests a familial vulnerability to CMV replication in the coronary artery walls.
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Methodist Debakey Cardiovasc J · Oct 2011
Review Case ReportsPerioperative management of antithrombotic therapy in cardiovascular patients.
Many patients with underlying cardiovascular disease require long-term anticoagulation. The perioperative or periprocedural management of patients who require temporary interruption of anticoagulant or antiplatelet medications is a common and often challenging clinical problem. It requires a fine balance between the risk of thromboembolic events during anticoagulant interruption and the risk of bleeding in the setting of antithrombotic therapy administered around the time of surgery. ⋯ Bridging anticoagulation, generally with low-molecular-weight heparin (LMWH), is often an integral part of perioperative thrombosis risk reduction. Perioperative anticoagulation management varies depending on the indication for anticoagulation and the anticoagulant or antiplatelet agent being used by the patient. In this article, we review some of the general principles involved with perioperative anticoagulation and discuss the perioperative management of patients taking vitamin K antagonists (VKAs), bridging regimens for anticoagulants and antiplatelet agents, and strategies for managing patients on the newer oral anticoagulants.
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Methodist Debakey Cardiovasc J · Oct 2011
ReviewEnhanced strategies for prevention and management of blood loss in special, unusual, and unexpected surgical situations.
Typically, surgical and anesthesia teams work together in the operating room to control blood loss by thoroughly evaluating bleeding risk preoperatively and by using their training in the treatment of intraoperative blood loss. As a result, most bleeding is usually well controlled. ⋯ In the end, however, it is usually the surgeons and anesthesiologists making decisions about how best to control bleeding. What follows is an update on currently available options in the management of surgical bleeding (Table 1).