RESUMEN
Permanently implantable hemodynamic monitors show great promise in providing personalized and cost-efficient care to heart failure patients by providing timely intracardiac pressure data under ambulatory conditions. The data may be used to titrate maintenance therapies and to monitor health status so that more intensive interventions can be planned and performed under optimal conditions. In this pilot study, we present the results of the implantation of a novel wireless, battery-less pressure sensor into the apex of the left ventricle of four dogs for a period of 8 weeks. All animals recovered to a normal state and did not show any clinical signs of cardiac insufficiency or any complications suggestive of thromboembolism. All sensors functioned throughout the implantation period and provided detailed waveforms of ventricular pressure.
Asunto(s)
Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/terapia , Hemodinámica , Implantación de Prótesis/métodos , Transductores de Presión , Animales , Cateterismo Cardíaco , Redes de Comunicación de Computadores , Computadores , Perros , Miniaturización , Proyectos Piloto , Presión , Tromboembolia/terapiaRESUMEN
Surgeons increasingly encounter patients on clopidogrel therapy who are preparing to undergo surgery. The goal of this study was to examine the change in platelet function after the common clinical scenario of discontinuing chronic clopidogrel therapy in those patients preparing to undergo an elective surgery, and the time course of platelet function recovery after clopidogrel discontinuation. Patients on clopidogrel therapy scheduled for an elective surgical procedure had their platelet function tested using a VerifyNow P2Y12 device (Accumetrics, San Diego, CA). Platelet inhibition was evaluated at baseline before clopidogrel discontinuation, and subsequently studied every other day in the week before their scheduled procedure. Mean platelet inhibition was 32.1 per cent on Day 0 (before clopidogrel discontinuation), decreasing to 3.7 per cent on Day 4. Platelet inhibition decreased significantly after discontinuation of clopidogrel in a time-dependent manner (P = 0.011), although a considerable interindividual variability of P2Y12 reaction units values was observed over the study period. Patients on concomitant proton pump inhibitors and clopidogrel demonstrated a decreased effect of clopidogrel. In conclusion, individual platelet function monitoring may assist the surgeon in perioperative decision-making in patients receiving clopidogrel therapy preparing to undergo elective surgery.