Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Jan 2025
ReviewAnticoagulation in patients with a history of heparin-induced thrombocytopenia who require cardiovascular surgery: is it okay to use heparin?
Heparin‑induced thrombocytopenia (HIT) is an adverse drug reaction with significant thromboembolic risk. Though there are models for use of nonheparin anticoagulants, heparin remains the preferred anticoagulant in many operative settings, especially cardiovascular surgery and percutaneous cardiac intervention. ⋯ If procedures cannot be delayed, approaches include intraoperative bivalirudin or intraoperative heparin with pre- or intraoperative plasma exchange or a potent antiplatelet agent, sometimes in combination with intravenous immunoglobulin. In subacute HIT B (immunoassay positive, functional assay negative) and remote HIT (immunoassay negative, functional assay negative), brief exposure to heparin in the intraoperative setting with close monitoring postoperatively is suggested due to the low risk of recurrent HIT.
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Pol. Arch. Med. Wewn. · Jan 2025
Prognostic significance of anti-gliadin and anti-F-actin IgA antibodies in primary sclerosing cholangitis.
Primary sclerosing cholangitis (PSC) is a biliary disorder associated with a high risk of end‑stage liver disease and cholangiocarcinoma (CCA). Currently, prediction of unfavorable outcomes is hindered by a lack of valuable prognostic biomarkers. ⋯ Anti‑gliadin and anti‑F‑actin IgA identify the subgroup of PSC patients with a more severe disease and at a risk of shortened transplantation‑free survival.
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Pol. Arch. Med. Wewn. · Jan 2025
Association between standardized management algorithm and outcomes of patients undergoing high-risk percutaneous coronary interventions in the IMPELLA-PL registry.
Impella CP is a percutaneous left ventricular assist device used in selected patients undergoing high‑risk percutaneous coronary interventions (HR‑PCIs). To improve outcomes of Impella‑supported HR‑PCI, institutional Impella programs have been developed. ⋯ Implementation of a dedicated management algorithm might improve outcomes of Impella‑assisted HR‑PCI, especially in low‑volume centers.
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Pol. Arch. Med. Wewn. · Jan 2025
Application of the TRI-SCORE to predict long-term mortality in acute heart failure patients with moderate-severe tricuspid regurgitation.
Moderate‑to‑severe tricuspid regurgitation (TR) in the setting of acute heart failure (AHF) has been found to be associated with worse clinical outcomes. Recently, the TRI‑SCORE model was developed to predict clinical outcomes after isolated tricuspid surgery. ⋯ The AHF patients with moderate‑to‑severe TR have a poor prognosis during follow‑up. TRI‑SCORE can predict all‑cause mortality in these patients.