The Canadian journal of cardiology
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Multicenter Study Comparative Study
Anticoagulation management pre- and post atrial fibrillation ablation: a survey of canadian centres.
Anticoagulation in patients undergoing atrial fibrillation (AF) ablation is crucial to minimize the risk of thromboembolic complications. There are broad ranges of approaches to anticoagulation management pre and post AF ablation procedures. The purpose of this study was to determine the anticoagulation strategies currently in use in patients peri- and post AF ablation in Canada. ⋯ Although guidelines recommend long-term anticoagulation in patients with CHADS(2) ≥ 2, 11% of physicians would discontinue warfarin in patients with no evidence of recurrent AF 1 year post successful ablation. Significant heterogeneity exists regarding periprocedural anticoagulation management in clinical practice. Clinical trial evidence is required to guide optimal periprocedural anticoagulation and therapeutic decisions regarding long-term anticoagulation after an apparently successful catheter ablation for AF.
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Multicenter Study Comparative Study
Survival from in-hospital cardiac arrest on the Internal Medicine clinical teaching unit.
There is a paucity of data on patient outcomes following in-hospital cardiac arrest (IHCA) on the Internal Medicine clinical teaching unit (CTU). Accurate outcome data enhances discussions between patients, surrogates, and physicians, and assists in their management. ⋯ IHCA in Internal Medicine CTU patients is characterized by a high rate of PEA/asystole and a minimal chance of survival to hospital discharge. Moreover, no patient with an unwitnessed arrest survived to hospital discharge. While these findings require confirmation in a larger study, they merit consideration in the context of code status discussions, particularly with respect to the response to unwitnessed arrests.
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Randomized Controlled Trial Multicenter Study Comparative Study
Reinitiation of anticoagulation after warfarin-associated intracranial hemorrhage and mortality risk: the Best Practice for Reinitiating Anticoagulation Therapy After Intracranial Bleeding (BRAIN) study.
While warfarin-related intracranial hemorrhage (ICH) occurs in 0.25%-1.1% patients per year, little is known about the practice and outcomes of anticoagulant reinitiation. ⋯ In selected patients at high thrombosis risk, reinitiation of warfarin after ICH did not confer increased mortality or bleeding events.
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Multicenter Study Comparative Study
A survey of standardized management protocols after coronary artery bypass grafting surgery in Canadian intensive care units.
Patients undergoing surgical coronary revascularization typically recover in an intensive care unit where many aspects of patient care are protocolized despite absence of widespread evidence-based guidelines on perioperative management. It was hypothesized that the postoperative management strategies varied significantly among units. ⋯ The majority of Canadian centres use at least 1 formal protocol for the care of the postoperative coronary revascularization patient. There is, however, significant variability in these management protocols. Future studies should examine whether implementation of standardized protocols improves outcomes and what treatment strategies are optimal in postoperative cardiac surgical patients.
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Multicenter Study Comparative Study
Microaxial devices for ventricular failure: a multicentre, population-based experience.
Impella microaxial devices provide circulatory assistance for patients with acute decompensated heart failure. This study reviews the population-based provincial experience in British Columbia. ⋯ Temporary support with Impella microaxial ventricular assist devices adds a valuable therapeutic option in selected patients with acute decompensated heart failure.