Nonsteroidal anti-inflammatory drug treatment for postoperative pericardial effusion: a multicenter randomized, double-blind trial.

BACKGROUND: The incidence of asymptomatic pericardial effusion is high after cardiac surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed in this setting, but no study has assessed their efficacy. OBJECTIVE: To assess whether the NSAID diclofenac is effective in reducing postoperative pericardial effusion volume. DESIGN: Multicenter randomized, double-blind, placebo-controlled study. (Clinical trials.gov registration number: NCT00247052) SETTING: 5 postoperative cardiac rehabilitation centers. PATIENTS: 196 patients at high risk for tamponade because of moderate to large persistent pericardial effusion (grade 2, 3, or 4 on a scale of 0 to 4, as measured by echocardiography) more than 7 days after cardiac surgery. INTERVENTION: Random assignment at each site in blocks of 4 to diclofenac, 50 mg, or placebo twice daily for 14 days. MEASUREMENTS: The main end point was change in effusion grade after 14 days of treatment. Secondary end points included frequency of late cardiac tamponade. RESULTS: The initial mean pericardial effusion grade was 2.58 (SD, 0.73) for the placebo group and 2.75 (SD, 0.81) for the diclofenac group. The 2 groups showed similar mean decreases from baseline after treatment (-1.08 grades [SD, 1.20] for the placebo group vs. -1.36 (SD, 1.25) for the diclofenac group). The mean difference between groups was -0.28 grade (95% CI, -0.63 to 0.06 grade; P = 0.105). Eleven cases of late cardiac tamponade occurred in the placebo group and 9 in the diclofenac group (P = 0.64). These differences persisted after adjustment for grade of pericardial effusion at baseline, treatment site, and type of surgery. LIMITATION: The sample was not large enough to find small beneficial effects of diclofenac or assess the cardiovascular tolerance of diclofenac. CONCLUSION: In patients with pericardial effusion after cardiac surgery, diclofenac neither reduced the size of the effusions nor prevented late cardiac tamponade. PRIMARY FUNDING SOURCE: French Society of Cardiology.

French registry of cases of type I acute aortic dissection admitted to a cardiac rehabilitation center after surgery.

BACKGROUND: After surgery for type I acute aortic dissection, the aorta remains partly dissected. This new population of patients is now referred to cardiac rehabilitation centers (CRCs). The feasibility of subsequent physical exercise is unknown. METHODS: Thirty-three consecutive patients (aged 55.1+/-9.3 years) were included in a prospective registry with clinical and radiological follow-up for 1 year after admission to a CRC. Twenty-six patients had undergone standard training sessions with exercise on a bicycle ergometer. Physical training programs included calisthenics, respiratory physiotherapy, walking, and cycling. Seven patients did not perform standard exercise training sessions but only walking and respiratory physiotherapy. RESULTS: For trained patients, the sessions (18+/-10) were carried out at 11.3+/-1.5 on the Borg scale ('light'), with blood pressure monitoring on exercise (<160 mmHg in 75% of patients). Maximum workload during exercise test (bicycle ergometer, 10 watts/min) increased from 62.7+/-11.8 to 91.6+/-16.5 watts (P=0.002). We identified three complications in two patients requiring further thoracic aorta surgery during follow-up. There was also one case of aortic valve replacement after 5 months and three cases of peripheral ischemia. No deaths, cerebral vascular accidents, or myocardial infarctions were recorded. Ten of the 19 patients of working age were able to return to work. CONCLUSION: Physical training of moderate intensity seems feasible and beneficial in postsurgical type I aortic dissection patients.

Management of intracranial hemorrhage in patients with mechanical circulatory support: a role for low-molecular-weight heparins?

Patients on mechanical circulatory support are at high risk of bleeding, particularly intracranial hemorrhage (ICH). The management of ICH in patients needing anticoagulation and antiplatelet therapies remains a challenge. We report our initial experience of ICH management with low-molecular-weight heparin in patients with mechanical circulatory support, without bleeding or thromboembolic complications.