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1.
Vasc Med ; 26(4): 426-433, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33818200

RESUMO

Coronavirus disease 2019 (COVID-19) may predispose patients to venous thromboembolism (VTE). Limited data are available on the utilization of the Pulmonary Embolism Response Team (PERT) in the setting of the COVID-19 global pandemic. We performed a single-center study to evaluate treatment, mortality, and bleeding outcomes in patients who received PERT consultations in March and April 2020, compared to historical controls from the same period in 2019. Clinical data were abstracted from the electronic medical record. The primary study endpoints were inpatient mortality and GUSTO moderate-to-severe bleeding. The frequency of PERT utilization was nearly threefold higher during March and April 2020 (n = 74) compared to the same period in 2019 (n = 26). During the COVID-19 pandemic, there was significantly less PERT-guided invasive treatment (5.5% vs 23.1%, p = 0.02) with a numerical but not statistically significant trend toward an increase in the use of systemic fibrinolytic therapy (13.5% vs 3.9%, p = 0.3). There were nonsignificant trends toward higher in-hospital mortality or moderate-to-severe bleeding in patients receiving PERT consultations during the COVID-19 period compared to historical controls (mortality 14.9% vs 3.9%, p = 0.18 and moderate-to-severe bleeding 35.1% vs 19.2%, p = 0.13). In conclusion, PERT utilization was nearly threefold higher during the COVID-19 pandemic than during the historical control period. Among patients evaluated by PERT, in-hospital mortality or moderate-to-severe bleeding were not significantly different, despite being numerically higher, while invasive therapy was utilized less frequently during the COVID-19 pandemic.


Assuntos
COVID-19/terapia , Recursos em Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Equipe de Assistência ao Paciente/tendências , Padrões de Prática Médica/tendências , Embolia Pulmonar/terapia , Terapia Trombolítica/tendências , Tromboembolia Venosa/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/mortalidade , Feminino , Hemorragia/etiologia , Hemorragia/mortalidade , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Embolia Pulmonar/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/mortalidade
2.
Curr Heart Fail Rep ; 15(3): 181-190, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29700697

RESUMO

PURPOSE OF REVIEW: Heart failure is associated with an enormous burden on both patients and health care systems in the USA. Several national policy initiatives have focused on improving the quality of heart failure care, including reducing readmissions following hospitalization, which are common, costly, and, at least in part, preventable. The transition from inpatient to ambulatory care setting and the immediate post-hospitalization period present an opportunity to further optimize guideline concordant medical therapy, identify reversible issues related to worsening heart failure, and evaluate prognosis. It can also provide opportunities for medication reconciliation and optimization, consideration of device-based therapies, appropriate management of comorbidities, identification of individual barriers to care, and a discussion of goals of care based on prognosis. RECENT FINDINGS: Recent studies suggest that attention to detail regarding patient comorbidities, barriers to care, optimization of both diuretic and neurohormonal therapies, and assessment of prognosis improve patient outcomes. Despite the fact that the transition period appears to be an optimal time to address these issues in a comprehensive manner, most patients are not referred to programs specializing in this approach post hospital discharge. The objective of this review is to provide an outline for early post discharge care that allows clinicians and other health care providers to care for these heart failure patients in a manner that is both firmly rooted in the guidelines and patient-centered. Data regarding which intervention is most likely to confer benefit to which subset of patients with this disease is lacking and warrants further study.


Assuntos
Assistência Ambulatorial/métodos , Insuficiência Cardíaca/terapia , Alta do Paciente , Humanos , Readmissão do Paciente/tendências
4.
Cardiovasc Revasc Med ; 46: 44-51, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-35961855

RESUMO

BACKGROUND: Increased bleeding risks have been documented in patients exposed to P2Y12 inhibitors within 5 days of coronary artery bypass surgery (CABG). This study aimed to determine the relative CABG bleeding risks of clopidogrel versus ticagrelor exposure and the proper time course of ticagrelor discontinuation prior to surgery. METHODS: Clinical outcomes were assessed in 2075 isolated CABG patients, including 375 who had received P2Y12 inhibitors within 5 days of surgery (155 clopidogrel, 213 ticagrelor, 7 prasugrel). BARC-4 CABG bleeding complications and perioperative blood product usage were assessed in propensity-matched P2Y12-inhibited and non-P2Y12-inhibited cohorts. RESULTS: P2Y12-inhibited patients (n = 375) in comparison to matched non-P2Y12-inhibited patients (n = 1138) had higher rates of re-operation for bleeding (3.8 % vs 1.3 %, p = 0.003), postoperative red blood cell transfusion ≥5 units (5.7 % vs 2.7 %, p = 0.007), and intraoperative and postoperative blood product utilization (42.3 % vs 27.1 %, p < 0.001; 41.8 % vs 32.2 %, p < 0.001, respectively). Univariate predictors of BARC-4 bleeding included clopidogrel (OR: 2.145, 95 % CI: 1.131-4.067, p = 0.019) and ticagrelor discontinued within 3 days of surgery (OR: 2.153, 95 % CI: 1.003-4.169, p = 0.049). Multivariate logistic regression demonstrated that only clopidogrel exposure was an independent BARC-4 bleeding predictor (OR: 1.850, 95 % CI: 1.007-3.398, p = 0.048). Unadjusted ticagrelor patients with drug discontinuation 4-5 days prior to CABG only demonstrated higher rates of perioperative platelet transfusion, without additional signs of excessive bleeding. CONCLUSIONS: Clopidogrel exposure within 5 days of CABG is an independent predictor of BARC-4 bleeding, whereas major ticagrelor bleeding effects are confined to drug exposure within 3 days of surgery.


Assuntos
Síndrome Coronariana Aguda , Inibidores da Agregação Plaquetária , Humanos , Ticagrelor/efeitos adversos , Clopidogrel/efeitos adversos , Inibidores da Agregação Plaquetária/efeitos adversos , Hemorragia Pós-Operatória/induzido quimicamente , Ponte de Artéria Coronária/efeitos adversos , Cloridrato de Prasugrel/efeitos adversos , Síndrome Coronariana Aguda/cirurgia , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Resultado do Tratamento
5.
Cureus ; 14(7): e26479, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35919216

RESUMO

Spontaneous coronary artery dissection (SCAD) is an underdiagnosed cause of acute coronary syndrome, myocardial infarction, and sudden cardiac death. During the coronavirus disease 2019 (COVID-19) pandemic, a multisystem inflammatory syndrome (MIS) emerged that is incompletely understood. While the involvement of numerous organ systems has been described, the potential cardiovascular manifestations, such as myocarditis, arterial thrombosis, or SCAD, are particularly worrisome. Here, we present a case of MIS that was preceded by an unremarkable case of COVID-19 and followed by the development of SCAD. This case highlights the importance of furthering our understanding of the potential sequelae of COVID-19 and of the potential relationship between SCAD and MIS.

6.
Interv Cardiol Clin ; 9(2): 125-137, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32147115

RESUMO

Plaque modification (PM) for atherosclerotic peripheral vascular lesions includes a variety of device types to alter the vessel structure with the aim of enhancing procedural success. PM device utilization has expanded significantly in the United States in recent years despite limited high-quality clinical trials. This article reviews societal guidelines for PM, evaluates currently available trial evidence, examines various pathologic subsets in which PM may be used, and discusses future areas for research.


Assuntos
Aterectomia/métodos , Procedimentos Endovasculares/métodos , Calcificação Vascular/cirurgia , Dispositivos de Oclusão Vascular , Desenho de Equipamento , Artéria Femoral , Humanos , Calcificação Vascular/diagnóstico
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