RESUMO
UNLABELLED: The aim of the study was to estimate the efficacy and safety of dabigatran in comparison with warfarin after atrial fibrillation (AF) catheter ablation (CA). METHODS: 228 consecutive patients, having undergone AF CA, were enrolled in retrospective trial. In group I (n=170) warfarin was administered by modified interrupted scheme, in group II (n=58) dabigatran was administered by 150 mg twice a day. The main clinical efficacy and safety indicators were evaluated during the procedure and within 12 months after the procedure. RESULTS: There was no statistically significant difference between patients taking warfarin and dabigatran (p>0,1) in all of the investigated parameters, including the amount of bleeding and thromboembolic events. Side effects of mild dyspepsia were observed in the dabigatran group in 2.7% of the observations and in the warfarin group in 2.4% (p = 0,589). None of them required discontinuation of the therapy. CONCLUSION: Dabigatran can be considered as an alternative to warfarin for anticoagulation in patients undergoing AF CA.
Assuntos
Fibrilação Atrial , Ablação por Cateter/métodos , Dabigatrana , Tromboembolia , Varfarina , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Fibrilação Atrial/terapia , Dabigatrana/administração & dosagem , Dabigatrana/efeitos adversos , Monitoramento de Medicamentos/métodos , Feminino , Hemorragia/induzido quimicamente , Hemorragia/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sibéria , Tromboembolia/etiologia , Tromboembolia/prevenção & controle , Resultado do Tratamento , Varfarina/administração & dosagem , Varfarina/efeitos adversosRESUMO
We analyzed clinical efficacy of a strategy of sinus rhythm (SR) restoration after single stage correction of mitral valve defect and failed radiofrequency maze procedure elaborated and realized in the Research Institute for Complex Issues of Cardiovascular Diseases, and assessed its value for increase of efficacy and safety of anticoagulant therapy. First stage of this strategy--cardiosurgical treatment with maze procedure--resulted in restoration of SR in 61.8% of cases. In case of persistence of tachyarrhythmia external elelectro-impulse therapy was used in 1-1.5 months after cardiac surgery as a second stage of our strategy. Third stage--catheter radiofrequency ablation--was applied to patients with implanted biological cardiac valves. Second and third stages facilitated restoration of SR in 84.8 and 93.2% of patients, respectively, and provided 100% SR restoration in patients with biological valve prostheses. The suggested strategy allowed to withdraw anticoagulant therapy in patients with biological valves and to reduce level of hypocoagulation to lower limit of target range in patients with mechanical prostheses.
Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial , Bioprótese , Ablação por Cateter , Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Complicações Pós-Operatórias/prevenção & controle , Adulto , Fibrilação Atrial/etiologia , Fibrilação Atrial/terapia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Feminino , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Recidiva , Resultado do TratamentoRESUMO
AIM: To evaluate the impact of a learning program on quality of life indicators in patients with prosthetic heart valves (PHV). SUBJECTS AND METHODS: One hundred and twenty-two patients with PHV were examined. A study group consisted of 72 patients who were trained at PHV school; a control group comprised 50 untrained patients. The comparison groups were matched for age, gender, education level, the underlying disease that had been a cause of heart disease, and the type of PHV. The SF-36 questionnaire assessing quality of life was used to evaluate the effectiveness of the learning program. RESULTS: At baseline, before cardiac surgery, the patients with PHV showed low physical and mental health indicators in both groups. At 6-month follow-up, the physical health component was increased by 23.8% in the control group and by 27.4% in the study group trained by the learning program (p < 0.05). Analysis of the scores of each scale of the questionnaire yielded significant results in both groups after 6 months of cardiac surgery (p < 0.05), which showed better quality of life. The comparison groups had significant differences only in the scores of the mental health component. Thus, following 6 months the mental health component was 24.1% higher in the learning program group than in the control one (p < 0.05). CONCLUSION: The learning program for patients with PHV, which is based on the principle of continuity of the in- and outpatient management, contributes to better quality of life mainly due to an improvement in the mental health component.
Assuntos
Implante de Prótese de Valva Cardíaca/psicologia , Próteses Valvulares Cardíacas/psicologia , Educação de Pacientes como Assunto/métodos , Qualidade de Vida , Estudos de Casos e Controles , Feminino , Seguimentos , Doenças das Valvas Cardíacas/patologia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
The study included 94 patients with artificial heart valves aged 55.5 +/- 68 years including 47 (50%) with rheumatic heart diseases, 26 (27.7%) with infectious endocarditis, 21 (22.3%) with connective tissue dysplasia. Compliance with the treatment was estimated by the method of S.V. Davydov before and after education. The leading causes of poor compliance was insufficient socio-medical knowledge and dissatisfaction with the prescribed therapeutic regimen. The education program permitted to achieve a 3-fold decrease in the incidence of negative factors affecting compliance and 1.5-fold increase in the frequency of positive factors; socio-medical awareness and satisfaction with the prescribed treatment increased by 45.8% and 37.1% respectively (p < 0.05). The integral index of compliance before education +4.39 +/- 0.09 characterized it as a moderately positive one. It increased to +8.11 +/- 1.23 after education (p < 0.01). It is concluded that the education program based on the principle of continuity of in- and out-patient treatment improved compliance and socio-medical awareness of the patients, promoted their medico-social adaptation, increased satisfaction with the prescribed treatment and its outcome.