Journal of thrombosis and thrombolysis
-
J. Thromb. Thrombolysis · Jul 2020
Comparison of warfarin versus DOACs in patients with concomitant indication for oral anticoagulation undergoing TAVI; results from the ATLAS registry.
The optimal antithrombotic therapy for patients undergoing TAVI with concomitant indication for oral anticoagulation remains unclear. In this high-risk population group, there is a paucity of data with regards to the use of DOACs. In the present study we compared long-term clinical outcomes of TAVI patients requiring anticoagulation, treated with warfarin versus DOACs. ⋯ At 30-days, all-cause mortality was found to be comparable between the two groups. With regards to BARC defined bleeding complications, major and life-threatening complications did not differ between the two anticoagulation groups (6% vs. 8% for warfarin and DOACs respectively, p = 0.857). DOACs seem to demonstrate a similar safety and efficacy profile compared to warfarin in TAVI patients with a concomitant indication for oral anticoagulation.
-
J. Thromb. Thrombolysis · Jul 2020
Initiation of a fixed-dose four-factor prothrombin complex concentrate protocol.
Patients who require urgent warfarin reversal often receive four-factor prothrombin complex concentrate (4F-PCC), which is traditionally dosed according to weight and initial INR. Our institution implemented a fixed-dose 4F-PCC strategy, using an initial dose of 1500 units. We evaluated the frequency with which the initial fixed dose 4F-PCC was inadequate, as defined by need for supplemental dosing. ⋯ Two of the 11 patients eligible for supplemental 4F-PCC dosing received the second dose, both with initial supratherapeutic INRs > 3.5. We found that most patients given an initial fixed-dose 4F-PCC achieved their INR goals, and of those who did not, most did not receive supplemental dosing, suggesting that clinical providers felt that adequate hemostasis had been achieved. In addition, fixed-dose 4F-PCC was able to be given rapidly, with few dosing errors, suggesting that this is a reasonable option for 4F-PCC delivery.
-
J. Thromb. Thrombolysis · Apr 2020
Randomized Controlled TrialThe impact of incidental pulmonary cement embolism on mortality risk.
The prognosis of pulmonary cement embolism found incidentally on chest radiography after vertebroplasty has been rarely investigated. This study was performed to elucidate the impact of incidentally found pulmonary cement embolism on all-cause mortality. Patients with pulmonary cement embolism diagnosed using chest radiography between 2008 and 2014 at one tertiary referral hospital were included. ⋯ Although the patients with pulmonary cement embolism were not treated, they did not show a higher mortality risk than did those without pulmonary cement embolism (adjusted hazard ratio, 1.10; 95% confidence interval, 0.43-2.85). Subgroup analyses showed similar results. Incidentally found pulmonary cement embolism had no significant impact on all-cause mortality.