Clinical utility of dabigatran in United Arab Emirates. A pharmacovigilance study.

OBJECTIVES: To provide early data regarding clinical utility of dabigatran in Al-Ain, United Arab Emirates (UAE). METHODS: This was an ethics approved retrospective cross sectional study. We retrieved a total of 76 patients who were using dabigatran from September to December 2014 in the Cardiology Clinic at Al-Ain Hospital, Al-Ain, UAE. The primary analysis was designed to test the frequency of bleeding events (rate) with dabigatran 75, 110, and 150 mg. RESULTS: The mean age ± standard deviation of cohort was 67.9 ± 1.5 years (range; 29-98 years), composed of males (52.6%) with mean age of 66.3 ± 1.7 years, and females (47.4%) with mean age of 69.6 ± 1.1 years. The highest age group was those between 61-80 years (60.5%). Most comprised the age strata of ≤75 years (73.7%). The main indication for dabigatran use was atrial fibrillation. The rate of bleeding with dabigatran was 18/76 (23.7%), and melena was the leading cause of bleeding 8/76 (10.7%). The hospitalization rate was 67.1%, dabigatran withdrawal rate was 0.01%, and mortality rate was 6.5%. The cohort had exhibited incidences of minor bleeding with one fatal major bleeding, high co-morbidities, admission, and readmission, which was not directly linked to dabigatran. We did not identify any relation of death due to dabigatran. CONCLUSION: Dabigatran is a suitable alternative to warfarin obviating the need for repetitive international normalized ratio monitoring, however, it may need plasma drug monitoring.

Cutting balloon in reverse CART technique for recanalization of chronic coronary total occlusion.

Chronic coronary total occlusion (CTO) is still one of the last frontiers for myocardial revascularization by percutaneous coronary interventions (PCI). New devices (microcatheters, dedicated tools, guidewires), new techniques, and retrograde approach increase success rate of CTOPCI. The reverse controlled anterograde and retrograde subintimal tracking (CART) technique can be an option to succeed. Sometimes the retrograde guidewire fails to cross the calcified proximal cap into the antegrade space, despite several standard balloon inflations. In our case, we describe the first case of CTO-PCI by the reverse CART technique using a cutting balloon to facilitate the retrograde connection with the antegrade space in case of failure with conventional balloon.