Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
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Catheter Cardiovasc Interv · Jul 2009
ReviewPrevention and treatment of venous thromboembolism during pregnancy.
Women who are pregnant or have recently given birth are at significantly increased risk of venous thromboembolism (VTE) compared with the general population. Furthermore, the issues surrounding the appropriate prevention, diagnosis, and treatment of VTE are more complex in pregnancy, where not only the effects on the mother, but also the effects on the fetus need to be considered. Although guidelines provide recommendations for the optimal management of these patients, most of these guidelines are based on evidence from observational studies, or on data extrapolated from a nonpregnant population. Randomized clinical trials are needed to identify the optimal strategies for prevention and treatment of VTE in pregnancy.
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Catheter Cardiovasc Interv · Jul 2009
ReviewDeep-vein thrombosis in malignancy: how long should patients be treated, and with what?
Cancer patients are at high-risk of venous thromboembolism (VTE). However, the optimal VTE prophylaxis and treatment options for this population are currently unclear. ⋯ In cancer patients with confirmed VTE, questions remain over the most effective long-term treatment regimen. Further trials are required to help physicians to make evidence-based choices for the management of VTE in these patients.
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Catheter Cardiovasc Interv · Jul 2009
ReviewChronically anticoagulated patients who need surgery: can low-molecular-weight heparins really be used to "bridge" patients instead of intravenous unfractionated heparin?
Patients at high risk of arterial or venous thromboembolic events often receive chronic treatment with long-term oral anticoagulants such as warfarin. However, if these patients require an invasive procedure, they may require a temporary interruption of their warfarin therapy to minimize their bleeding risk during the procedure. As warfarin has a long half-life and an unpredictable pharmacokinetic profile, short-acting parenteral anticoagulants, such as unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH), may be of benefit in protecting the patient from thromboemboli while their warfarin dose is withheld. Such "bridging therapy" has traditionally been provided in-hospital with intravenous UFH; however, recent data have suggested that LMWH may be an effective alternative, with potential cost-savings due to the ability to provide bridging therapy in the outpatient setting.
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Catheter Cardiovasc Interv · Jan 2008
ReviewUse of multislice CT for the evaluation of emergency room patients with chest pain: the so-called "triple rule-out".
Recent advances in computed tomography (CT) technology have made high resolution noninvasive coronary angiograms possible. Multiple studies involving over 2,000 patients have established that coronary CT angiography (CCTA) is highly accurate for delineation of the presence and severity of coronary atherosclerosis. The high negative predictive value (>95%) found in these studies suggests that CCTA is an attractive option for exclusion of coronary artery disease in properly selected emergency department patients with acute chest pain. ⋯ Recent technical developments now permit acquisition of well-opacified images of the coronary arteries, thoracic aorta and pulmonary arteries from a single CT scan. While this so called "triple-rule out" scan protocol can potentially exclude fatal causes of chest pain in all three vascular beds, the attendant higher radiation dose of this method precludes its routine use except when there is sufficient support for the diagnosis of either aortic dissection or pulmonary embolism. This article provides an overview of CCTA, and reviews the clinical evidence supporting the use of this technique for triage of patients with acute chest pain.
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Advances in the identification of vulnerable plaque can be an important step in preventing myocardial infarction and sudden cardiac death. The recognition that non-flow-limiting plaques often produce cardiac events has led to the development of invasive and non-invasive methods to identify such plaques prospectively. This review will present the use of noninvasive imaging modalities for identifying vulnerable plaque such as computed tomography and magnetic resonance imaging. We will also review the different invasive modalities such as intravascular magnetic resonance imaging, intravascular ultrasound, coronary angioscopy, coronary thermography, optical coherence tomography, near-infrared spectroscopy, and palpography.