No abstract

No abstract

The aim of our study was to evaluate implantation efficacy and safety across various occluder types and to identify factors determining device selection.Methods. This single-site prospective observational study included patients above the age of 40 years with non-valvular atrial fibrillation (AF) and high thromboembolic risk, undergoing endovascular isolation of the left atrium appendage (LAA) with Watchman or Amplatzer Cardiac Plug/Amulet devices. Occluders were implanted to patients without either had contraindications to anticoagulant therapy (ACT) or refused ACT. We evaluated technical aspects of device implantation, short- and long-term outcomes of the intervention over 3 years of follow-up.Results. 90 patients were enrolled in the study (62 into the Watchman arm and 28 into the Amplatzer arm). Interventions were technically successful in 89 cases. In 1 patient (1/90, 1.1%) technical success was not achieved due to device migration (Amplatzer Amulet). The incidence of early (occurring within˂ 24 hours) implantation complications was 0% in the Watchman arm, and 3.6% in the Amplatzer arm (1/28) (р=0.135) (device migration). The cumulative incidence of all in-hospital complications was 11.3% and 14.3%, respectively (р=0.734). No significant differences between arms were found in the incidence of device thrombosis within 90 days post-implantation (3.3% in the Watchman’s arm and 8.3% in the Amplatzer arm, р=0.316). During the observation period, there were no significant differences in comparison groups in the incidence of net clinical efficacy endpoint events (р=0.58). The bleeding rate was 17.7% and 14.3%, respectively, р=0.769. No factors influencing the choice of the device could be identified reliably; however, there was a trend towards Watchman preference for appendage anatomic variants such as broccoli and cactus. Amplatzer was preferred in patients with contraindications to ACT.Conclusion. Implantation of Watchman and Amplatzer Amulet occluders is equally effective and safe in preventing thromboembolism in patients with AF not receiving ACT for various reasons. The individual choice of a device may be influenced by appendage anatomy and indications to occluder implantation.

Thromboembolic complications (TEC) remain a significant problem in modern surgery, worsening the prognosis and reducing the effectiveness of the operation performed. The increase in the number of venous thromboembolisms (VTE) is determined by the severity of the initial injuries, the volume and traumatic nature of the surgical intervention, as well as the increase in the number of elderly patients with multiple comorbidities. Patients in orthopedic departments who have undergone major surgeries such as total hip arthroplasty (THA) or total knee arthroplasty (TKA) are at increased risk of VTE, leading to significant postoperative morbidity and mortality. Thromboses in extensive orthopedic surgery are caused by several prothrombotic mechanisms, such as venous injury, activation of procoagulation factors due to massive bone and tissue damage, and prolonged postoperative immobilization. The most common potential thrombotic complications after arthroplasty are deep vein thrombosis (DVT) of the lower extremities and pulmonary embolism (PE).In the absence of prophylaxis in the postoperative period of major orthopedic surgeries, TECs develop in most patients.To date, the issue of primary prevention of VTE in orthopedic patients remains relevant, and there is still no consensus on the best way to prevent thrombosis after THA and TKA.Risk assessment is the first step in preventing death and disability from VTE. Currently, mechanical and pharmacological methods are used for primary prevention in orthopedics, often in combination. Certainly, the use of antithrombotic drugs in the postoperative period is an effective way to prevent thrombosis. When prescribing antithrombotic drugs, it is also important to minimize the risk of bleeding, including in the area of postoperative wounds. Various antithrombotic drugs are used as pharmacological prophylaxis for TEC. The literature on the dosage, duration, efficacy, and safety of their use varies considerably. Our review assessed published literature on the efficacy and safety of antiplatelet agents for VTE prophylaxis.

Background and Aims Contrast-induced acute kidney injury (CI-AKI) remains one of the major obstacles to perform percutaneous coronary interventions (PCI), especially in older patients and in patients with comorbidities. The number of cases of stable coronary artery disease (CAD) requiring such kind of interventions, in spite of optimal medical treatment received, remains high. Diabetes, hyperuricemia and other components of metabolic syndrome, as well as heart failure, are well known risk factors predisposing to the development of CI-AKI after contrast exposure. Anaemia is diagnosed in a number of patients without underlying chronic kidney disease (CKD), when they seek for medical help due to CAD. The aim of our study was to assess the prevalence of CI-AKI (primary outcome) and the prognostic significance of anaemia as a its possible risk factor (secondary outcome) in different groups of patients with stable CAD requiring PCI using the contrast media. Method We conducted a single-centre prospective observational cohort study. 561 patients aged 18-89 with stable CAD undergoing PCI were enrolled from June 2012 until October 2013. The CI-AKI was defined as a rise in serum creatinine of ≥0,5 mg/dl (≥44μmol/l) or a 25% increase from baseline value, assessed at 48-72 hours after PCI. Anaemia was defined according to the WHO definition – haemoglobin level <12,0 g/dl in women and <13,0 g/dl in men. The contrast media used was either iodixanol (iso-osmolar contrast) or iopromide (low-osmolar contrast), which are both known to cause less adverse events than high-osmolar types of contrast. Nephrotoxic drugs were stopped 48 hours before PCI. The 5-year prognosis including all-cause and cardiovascular mortality, myocardial infarction, stroke, gastrointestinal bleeding, decompensation of chronic heart failure, repeat revascularizations (PCI and coronary artery bypass grafting), end-stage renal disease (ESRD) development, was assessed via phone calls and appointments according to the clinical situation and severity of the condition. Results The prevalence of CI-AKI in this group of patients was 104 cases (18,5%) (primary outcome). The number of patients with anaemia was higher in the group of patients who developed CI-AKI after PCI (6% [7/104] vs 4,4% [20/457]). The female patients with anaemia were more likely to develop CI-AKI (71% [5/7] vs 35% [7/20]). The number of patients who suffered from MI having anaemia at the inclusion date was 2 (28,6%) vs 6 (30%) in patients with and without CI-AKI respectively. Acute heart failure decompensation in patients with anaemia was significantly higher in patients with CI-AKI (43% [3/7] vs 10% [2/20]). This fact needs further evaluation in larger studies but anaemia may be one of the prognostic factors, worsening the kidney damage and leading to worse cardiorenal outcomes. Conclusion Patients with stable CAD suffering from anaemia are more likely to develop CI-AKI even without underlying CKD or ESRD. Female patients with anaemia and stable CAD have higher risk of development of CI-AKI. The combination of CI-AKI and anaemia may lead to a higher 5-year risk of acute heart failure decompensation.