Antithrombotic therapies in Canadian atrial fibrillation patients with concomitant coronary artery disease: Insights from the CONNECT AF + PCI-II program.

BACKGROUND: Selecting the appropriate antithrombotic regimen for patients with atrial fibrillation (AF) who have undergone percutaneous coronary intervention (PCI) or have had medically managed acute coronary syndrome (ACS) remains complex. This multi-centre observational study evaluated patterns of antithrombotic therapies utilized among Canadian patients with AF post-PCI or ACS. METHODS AND RESULTS: By retrospective chart audit, 611 non-valvular AF patients [median (interquartile range) age 76 (69-83) years, CHADS2 score 2 (1-3)] who underwent PCI or had medically managed ACS between August 2018 and December 2020 were identified by 68 cardiologists across eight provinces in Canada. Overall, triple antithrombotic therapy [TAT: combined oral anticoagulation (OAC) and dual antiplatelet therapy (DAPT)] was the most common initial antithrombotic strategy, with use in 53.8 % of patients, followed by dual pathway therapy (32.7 % received OAC and a P2Y12 inhibitor, and 4.1 % received OAC and aspirin) and DAPT (9.3 %). Median duration of TAT was 30 (7, 30) days. Compared to the previous CONNECT AF + PCI-I program, there was an increased use of dual pathway therapy relative to TAT over time (P-value <.0001). DOACs (direct oral anticoagulants) represented 90.3 % of all OACs used overall, with apixaban being the most utilized (50.5 %). Proton pump inhibitors were used in 57.0 % of all patients, and 70.1 % of patients on ASA. Planned antithrombotic therapies at 1 year were: 76.2 % OAC monotherapy, 8.3 % OAC + ASA, 7.9 % OAC + P2Y12 inhibitor, 4.3 % DAPT, 1.3 % ASA alone, and <1 % triple therapy. CONCLUSION: In accordance with recent Canadian Cardiovascular Society guideline recommendations, we observed an increased use of dual pathway therapy relative to TAT over time in both AF patients post-PCI (elective and emergent) and in those with medically managed ACS. Additionally, DOACs have become the prevailing form of anticoagulation across all antithrombotic regimens. Our findings suggest that Canadian physicians are integrating evidence-based approaches to optimally manage the bleeding and thrombotic risks of AF patients post-PCI and/or ACS.

Abordaje tipo keyhole transciliar supraorbitario. Criterio de seleccion de pacientes / Transciliar supraorbitary keyhole approach. Case selection guidelines

Objective: to describe our initial experience with the supraorbital transciliar keyhole approach with emphasis on patients selection criteria. Methods: between july 2003 to june 2004, 7 patients were operated through this approach. Diagnosis included 1 pituitary macroadenoma, 1 craniopharyngioma, 1 clinoidal meningioma, 1 olfactory tract meningioma, 2 ApCom aneurysms and 1 carotid-ophthalmic aneurysm. In all patients the surgical techniqued was similar. Results: many factors demonstrate the advantage of this technique: minimal brain exposure, and cerebral retraction, shortened surgical time and early hospital discharge. There were no approach-related complications. All the lesions were of less than 35mm of diameter and under the medial third of the third ventricle. Conclusion: the supraorbital transciliar keyhole approach, endoscope assisted, is a safe way to reach sellar and parasellar lesions when the lesion is of less than 30mm, without extension to posterior fossa