A strategy for addressing aspirin hypersensitivity in patients requiring urgent PCI.

Aspirin is key to the treatment of acute myocardial infarction, particularly if stent implantation is considered. In patients with a history of hypersensitivity to aspirin, the optimal management of ST-segment elevation acute myocardial infarction is unclear. We suggest a strategy for addressing this problem by performing percutaneous coronary intervention with antiplatelet therapy by intravenous glycoprotein IIb/IIIa receptor blockers and performing rapid oral desensitization in the ensuing hours, once the patient has stabilized.

In flight auscultation: comparison of electronic and conventional stethoscopes.

OBJECTIVES: The ability to auscultate during air medical transport is compromised by high ambient noise levels. The aim of this study was to assess the capabilities of a traditional and an amplified stethoscope (which is expected to reduce background and ambient noise) to assess heart and breath sounds during medical transport in a Falcon 50 plane. METHODS: A prospective, double-blind, randomized study was performed. We tested 1 model of traditional stethoscope (Littman cardiology III) and 1 model of amplified stethoscope (Littman 3100). We studied heart and lung auscultation during real medical evacuations aboard Falcon 50 (medically configured). For each, the quality of auscultation was described using a numeric rating scale (ranging from 0 to 10, with 0 corresponding to "I hear nothing" and 10 corresponding to "I hear perfectly"). Comparisons were accomplished using a t test for paired values. RESULTS: A total of 32 comparative evaluations were performed. For cardiac auscultation, the value of the rating scale was 5.8 ± 1.5 and 6.4 ± 1.9, respectively, for the traditional and amplified stethoscope (P = .018). For lung sounds, quality of auscultation was estimated at 3.3 ± 2.4 for traditional stethoscope and at 3.7 ± 2.9 for amplified stethoscope (P = .15). CONCLUSIONS: Practicians in Falcon 50 are more able to hear cardiac sounds with an amplified than with a traditional stethoscope, whereas there is no significant difference concerning breath sounds auscultation.

Adjusted weight anticoagulation for radial approach in elective coronarography: the AWARE coronarography study.

AIMS: To evaluate the feasibility and safety of an anticoagulation adapted regimen for transradial coronary angiography. METHODS AND RESULTS: We randomly assigned 162 consecutive patients who benefited from an elective transradial approach for coronarography to receive either a standard dose of 5,000 IU heparin or 50 IU/kg with an upper limit of 5,000 IU. Patients under anti-vitamin K therapy were excluded. The TRband compression system was employed for the entire population after the procedure. Radial artery patency, the primary endpoint, was evaluated with Doppler before discharge from the hospital. Secondary endpoints were: ACT level immediately before sheath removal, compression length and bleeding complications. Both groups were well matched. ACT level is significantly lower in the adjusted anticoagulation group (231.4 min, vs. 265.6 min, p<10-4). Radial compression time was higher in the standard protocol group (235.5 min, vs. 204.5 min, p<10-5). No radial occlusion was noted, whatever the group considered. Local haematoma is less frequent in the 50 IU/kg group, with no statistical difference. CONCLUSIONS: A weight-adjusted heparin dose allows for lower ACT levels and decreases in radial compression time without increase in radial artery occlusion. The impact on bleeding complication needs further evaluation in larger series.