International journal of cardiology
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Dabigatran etexilate, a pro-drug of a direct thrombin inhibitor, was approved a few years ago for non-valvular atrial fibrillation and deep venous thrombosis. Rapid monitoring of the dabigatran level is essential in trauma and bleeding patients but the traditional plasma-based assays may not sufficiently display the effect. Furthermore, no antidote exists and reversal of the anticoagulant effect is impossible or difficult. The present study investigated the in vitro effect of dabigatran on whole blood thromboelastography (TEG) and its reversal by recombinant activated factor VII and prothrombin complex concentrate. ⋯ TEG displays the presence of dabigatran in whole blood in vitro and the anticoagulant effect of dabigatran is partly reversed by spiking with recombinant activated factor VII.
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Stress-induced cardiomyopathy (SIC) is a common syndrome with substantial morbidity and mortality. SIC is common in intensive care units' patients. No therapeutic intervention for SIC has been evaluated in randomized clinical trial so far. Our aim was to investigate whether isoflurane is cardioprotective in an experimental SIC model. ⋯ Isoflurane prevented SIC-like cardiac dysfunction in rats. This protection was not mediated via KATPm. Our study provides an experimental foundation for future clinical trials in SIC.
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Recent guidelines for treating ventricular fibrillation (VF) and ventricular tachycardia (VT) stress class III antiarrhythmic drugs, but some malignant arrhythmias refractory to these agents still occur in clinical practice. The possibility of a new treatment strategy involving lidocaine and amiodarone combination therapy was evaluated. ⋯ This retrospective study suggests that combination therapy with lidocaine and amiodarone can terminate most refractory ventricular arrhythmias. Even in patients with a sufficient LVEF not receiving amiodarone, it is possible that lidocaine can contribute to a favorable outcome.
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Despite the fact that recent evidence from meta-analysis of randomized trials indicates an increase in mortality, perioperative treatment with β-blockers is still widely advocated. We therefore performed a meta-analysis of cohort studies to evaluate the effects of perioperative β-blockers on mortality in patients undergoing non-cardiac surgery in the real world scenarios. ⋯ In the real world scenarios, for patients undergoing non-cardiac surgery, the routine use of β-blockers does not seem to reduce the risk of death. Moreover, those who are taking β-blockers on the day of surgery may have an increased risk of postoperative mortality. However, these results should be interpreted with caution because of the significant heterogeneity across the studies.