Aspirin alone antiplatelet regimen after intracoronary placement of the Carbostent: the ANTARES study.

The effect of stent coatings in preventing early thrombotic occlusion remains to be proved. The purpose of this study was to evaluate the safety and efficacy of the Carbostent, a new coronary stent with a nonthrombogenic coating (Carbofilm), in 110 consecutive patients (73.6% men, mean age 61 +/- 9 years) who met prespecified clinical and angiographic inclusion criteria and were treated with aspirin monotherapy after stenting. Stable angina (75.5%), unstable angina (18.2%), and silent ischemia (6.3%) were clinical indications for coronary revascularization. Patients received 10,000 U of heparin and no IIb/IIIa inhibitors or postprocedural heparin. Complex lesion characteristics (B2, C) were present in 39 out of 129 (30.2%) lesions. Mean lesion length was 15.6 +/- 7.4 mm, and 32% of the lesions were >15 mm (range 16-52 mm). Small coronary vessels (<3.0 mm) were treated in 28% of the cases. A total of 165 Carbostent were used in 129 coronary lesions of the 110 patients. Single-vessel stenting was performed in 97 (88%) patients and multivessel stent placement in 13 (12%) patients. The mean length of the stented segment was 21 +/- 13 mm (range 9-95 mm). Procedural and clinical success was achieved in all patients. At 1-month follow-up, there were no stent thrombosis or other major adverse cardiac events. We observed 2 (1.8%) non-Q-wave myocardial infarctions and 2 (1.8%) vascular complications. This study indicates that the Carbostent may prevent stent thrombosis in selected patients treated with aspirin only. A randomized study comparing aspirin alone versus combined ticlopidine and aspirin after Carbostent implantation will be needed to confirm these results.     

Multivessel coronary thrombosis treated with abciximab (reopro®) in a patient with essential thrombocythemia

A 50-year-old man was admitted with acute inferior and anterior myocardial infarction. The patient was diagnosed with essential thrombocythemia (ET) based on the findings of marked thrombocytosis of 1,113 × 10³/mm³, splenomegaly, and numerous clumping megakaryocytes on bone marrow biopsy. Emergent coronary angiography revealed extensive multivessel thrombosis involving the left main coronary artery and completely occluding the proximal right coronary artery. In addition to standard therapy with aspirin, heparin, and primary angioplasty of the right coronary artery, the patient received additional antiplatelet therapy with ticlopidine, hydroxyurea, and the platelet glycoprotein IIb/IIIa receptor-inhibiting monoclonal antibody drug abciximab (ReoPro®). Serial coronary angiograms 1 and 5 days following the infarction showed progressive thrombus resolution. The pathophysiologic mechanisms and therapeutic challenges of ET-associated coronary thrombosis are discussed in this report.     

Treatment of venous thromboembolism with low-molecular-weight heparin

Summary There is now ample evidence to indicate that certain low-molecular-weight heparins given subcutaneously can replace continuous intravenous unfractionated heparin for the initial treatment of venous thromboembolism. The low-molecular-weight heparins have a predictably high absorption rate when given subcutaneously and a prolonged duration of action, permitting them to be given by a once or twice daily injection for the prevention or treatment of venous thrombosis. Furthermore, treatment does not require laboratory monitoring, thus eliminating the need for continuous IV infusion and permitting the early discharge of patients with venous thromboembolism. This should eventually lead to the outpatient treatment of venous thromboembolism. Studies to date indicate that low-molecular-weight heparin is more cost-effective than unfractionated heparin in the treatment of venous thromboembolism and the cost effectiveness will be increased by out-of-hospital treatment. At the present time, the findings associated with any individual lowmolecular-weight heparin preparation cannot be extrapolated to different low-molecular-weight heparins, and therefore each must be evaluated in separate clinical trials. The information to date is that low-molecular-weight heparin is safer and more effective than continuous intravenous unfractionated heparin in the treatment of proximal venous thrombosis. The decreased mortality rate seen in two clinical trials, particularly in patients with metastatic cancer, was quite unexpected. This requires further confirmation in larger prospective randomized trials.     

Cardiovascular ultrasound: expanding frontiers in vascular disease

Advances in cardiovascular ultrasound have included development of instrumentation providing outstanding images, as well as color spectral Doppler hemodynamic information. The increasing utilization of cardiovascular ultrasound has led to its increasing diagnostic application and accuracy in the evaluation of the patient with known or suspected cerebrovascular and peripheral vascular disease. The sensitivity of duplex ultrasound to detect carotid disease varies from 87% to 94% with a specificity of 88% to 93%. The accuracy of duplex examination for detection of peripheral venous disease, when compared to contrast venography, is high. A sensitivity of nearly 93% with a specificity of 98% has been noted. Cardiovascular ultrasound is a noninvasive technology with no known biological hazard that can be applied to the broad spectrum of patients including those who are critically ill. It is a relatively low-cost procedure when compared to other diagnostic procedures and can be performed on a serial basis. Since it provides anatomical and functional hemodynamic information, it is rapidly becoming the procedure of choice not only for diagnosis, but also for management.     

High incidence of recurrent in stent thrombosis after successful treatment of a first in stent thrombosis

Objectives: We attempted to investigate incidence and predictors of recurrent in stent thrombosis (IST) after successful treatment of a first IST. Background: The occurrence of recurrent IST after successful treatment of a first IST may be a decisive factor for patient clinical outcome. However, incidence and predictors of recurrent IST are currently poorly described in the literature. Methods: Between 2003 and 2005, 2,190 patients underwent a percutaneous coronary intervention in our center. During a median follow‐up of 19.4 months, 49 patients (2.24%) presented a first definite IST. Patients presenting with a first IST were followed during an additional median period of 40 months. Their baseline characteristics were listed and cardiovascular events especially recurrent IST as defined by the Academic Research Consortium definition were systematically indexed. Results: Altogether 39 (80%) patients were successfully treated with an effective reperfusion after percutaneous coronary intervention. Fourteen (36%) patients presented a recurrent IST and three presented multiple recurrent IST. The median occurrence time of recurrent IST was 5 days, range between 1 and 11 days. Multivariate analysis identified history of neoplasia (HR = 11.53, 95% CI 2.32–57.37, P = 0.003), residual diameter stenosis (HR = 1.15, 95% CI 1.02–1.29, P = 0.02), and residual dissection after treatment (HR = 8.78, 95% CI 1.85–41.62, P = 0.006), as independent predictors of recurrent IST. Conclusion: Recurrent IST is a frequent and early event after successful treatment of a first IST. Our results suggest that mechanical factors like residual dissection and residual diameter stenosis should be carefully tracked down. In addition, patients with multiple recurrent IST and the early time course of recurrent IST also suggest a potential role of inadequate antiplatelet therapy. © 2008 Wiley‐Liss, Inc.     

Elevated hepatic enzymes and incidence of venous thromboembolism: a prospective study

PurposeApproximately 10% of the general population has elevated blood concentrations of hepatic enzymes, which are linked to increased coagulation markers. We tested whether elevated hepatic enzymes are associated with increased risk of venous thromboembolism (VTE).MethodsWe followed 12,604 adults with measurements of alanine transaminase, aspartate aminotransferase (AST), and gamma-glutamyl transpeptidase (GGT) prospectively for VTE occurrence.ResultsAST and GGT above the laboratory normal values were associated over two decades of follow-up with increased risk of total (n = 532) and provoked VTE (n = 332), but with not unprovoked VTE (n = 200). In a model adjusted for age, race, sex, hormone replacement, alcohol intake, diabetes, body mass index, estimated glomerular filtration rate, and C-reactive protein, the hazard ratios (HR) (95% confidence interval) for high versus normal AST were 1.46 (1.00–2.11) for total VTE and 1.83 (1.21–2.79) for provoked VTE. For high GGT, the HR were 1.34 (1.06–1.69) for total VTE and 1.43 (1.07–1.91) for provoked VTE. When follow-up was limited to the first 10 years, associations were even stronger (HR ≈ 1.7 for total VTE).ConclusionsElevated concentrations of two hepatic enzymes (AST and GGT) in this general middle-aged population are associated with a modestly increased risk of VTE.     

中心静脉导管在胸腔积液治疗中的应用300例分析

目的：比较中心静脉导管行胸穿术与传统的胸穿针行胸穿术的疗效及安全性,为基层医院推广采用中心静脉导管取代传统胸穿针进行胸穿术治疗胸腔积液提供依据。方法：选取2010年3月－2013年3月在本院收治的300例胸腔积液患者,按照随机数字表法将其分为治疗组和对照组各150例,治疗组采用单腔中心静脉导管行胸穿术;对照组采用传统胸穿包的胸穿针行胸穿术。观察比较两组患者穿刺时间、气胸发生率、伤口感染率、住院期间穿刺次数、单次抽液成功率及结核性胸腔积液住院费用之间的差异。结果：两组患者的穿刺时间和伤口感染率比较差异均无统计学意义（P＞0.05）。但治疗组的气胸发生率和住院期间穿刺次数均明显少于对照组,差异均有统计学意义（P＜0.05）。且治疗组的单次抽液成功率明显高于对照组,结核性胸腔积液患者住院费用明显少于对照组,差异均有统计学意义（P＜0.05）。结论：中心静脉导管行胸腔穿刺抽液治疗可减少气胸发生率,减少抽液次数,单次成功率高,住院费用低,值得在基层医院推广应用。     

浅谈气压治疗对预防产妇产后下肢深静脉血栓形成的疗效观察

目的：探讨为预防产妇产后下肢深静脉血栓形成采用空气波压力治疗仪的临床治疗效果。方法：采集本院收治入院的围产期妇女120例,平均分为对照组和观察组,对照组在产妇产后采用常规临床治疗预防下肢深静脉血栓形成,观察组在常规临床治疗基础上给予空气波压力治疗仪治疗。观察两组临床效果。结果：观察组无一例引发下肢深静脉血栓及肺栓塞,有5例出现下肢肿胀、疼痛。对照组下肢深静脉血栓发生率13.33%,下肢疼痛、肿胀发生率31.66%,肺栓塞发生率6.66%,与观察组比较差异均有统计学意义（P〈0.05）。结论：空气波压力治疗仪对下肢静脉血栓有着明显的治疗效果,可有效降低产妇产后引发下肢深静脉血栓的发病率。     

罕见PICC继发性异位致深静脉血栓合并颅内静脉窦血栓形成

本文报告了1例因经外周静脉置入中心静脉导管（PICC）继发性异位致深静脉血栓合并颅内静脉窦血栓的罕见病例,通过积极正确救治,患者痊愈出院的原因分析,研究探讨如何规避及减少或者及早发现发生PICC继发性异位所致深静脉血栓合并颅内静脉窦血栓形成,以及一旦发生后并发症的治疗及护理对策。     

胸腔积液患者采用中心静脉导管置管引流治疗的疗效及安全性分析

目的：观察胸腔积液危重患者采用中心静脉导管置管引流治疗的疗效及安全性。方法：选取2010年3月-2013年3月在本院ICU接受治疗的胸腔积液患者56例,通过计算机随机将其分为试验组和对照组,每组均为28例,试验组患者给予中心静脉导管置管引流治疗,而对照组患者给予胸腔闭式引流。比较两组患者的术后并发症发生率、手术前后24 h的各项生化指标、胸腔引流量及所需的置管时间。结果：试验组患者的并发症发生率显著小于对照组（P〈0.05）,在手术前后24 h的各项生化指标比较中试验组C-反应蛋白的含量显著低于对照组患者（P〈0.05）,其他指标差异无统计学意义（P〉0.05）,两组患者在胸腔引流量及所需的置管时间上比较差异无统计学意义（P〉0.05）。结论：胸腔积液危重患者采用中心静脉导管置管引流治疗的疗效显著,安全性高。