Assessment of immunosuppression induction with basiliximab compared to antithymocyte-globulin in adult heart transplant patients.

BACKGROUND: Patients undergoing heart transplants are at risk of rejection which can have significant morbidity and mortality. Induction immunosuppression at the time of transplant reduces the early risk and has additional benefits. The induction agent of choice within our program was changed from rabbit antithymocyte-globulin (rATG) to basiliximab, so it was necessary to evaluate whether this had any impact on patient outcomes. OBJECTIVES: Our primary objective was to describe rejection, infection, and other outcomes in adult heart transplant patients at the University of Alberta Hospital in Edmonton, Canada. METHODS: This study was a nonrandomized, retrospective cohort study. RESULTS: Sixty-three patients were included with median ages 50 years versus 54 years. More female patients received rATG (20% vs. 42.4%). The most common indication for transplant in both cohorts was ICM (63.3% vs. 57.6%). Patients who received rATG had significantly higher PRA (0% vs. 43%, p < .001). Acute rejection episodes were similar between basiliximab and rATG at 3 months (16.7% vs. 15.1%; p = 1.0) and 6-months (30.0% vs. 18.1%; p = .376). Infections were not statistically different with basiliximab compared to rATG at 3-months, 43.3% vs. 63.6% and at 6-months 60.0% vs. 66.7%). There were no fatalities in either group. CONCLUSIONS: Our study did not demonstrate differences in rejection with basiliximab compared to rATG. Mortality did not differ, but basiliximab-treated patients had fewer infections and infection-related hospitalizations than those treated with rATG. Larger studies with longer durations are needed to more completely describe the differences in rejection and infectious outcomes.

Effect of New Evidence on Antithrombotic Therapies in Atrial Fibrillation Patients Who Undergo Percutaneous Coronary Intervention in Alberta, Canada.

Background: Trials have addressed the combined use of direct oral anticoagulants (DOACs) and antiplatelets in atrial fibrillation (AF) patients undergoing percutaneous coronary intervention (PCI). These trials may have changed prescribing patterns. Methods: This administrative audit of Albertans with AF undergoing PCI described antithrombotic therapy before vs after publication of the PIONEER AF-PCI (An Open-label, Randomized, Controlled, Multicenter Study Exploring Two Treatment Strategies of Rivaroxaban and a Dose-Adjusted Oral Vitamin K Antagonist Treatment Strategy in Patients With Atrial Fibrillation Who Undergo Percutaneous Coronary Intervention) trial results. Results: Cohorts were similar before (n = 597) and after (n = 708) trial publication: median age 72 years; 23% female; 63% with acute coronary syndrome; and 22% with bleeding history. Anticoagulant use increased by 7.0% (P = 0.01) after; with DOAC use increasing by 24.9% and warfarin use decreasing by 17.5% (P < 0.0001). DOAC use was associated with being in the "after" cohort (odds ratio 5.42, 95% confidence interval 3.75-7.82, P < 0.0001). Conclusions: Significantly more patients were prescribed anticoagulation therapy after the publication of the results of the PIONEER AF-PCI trial than before, and the choice of agent favoured DOAC over warfarin. Almost half of patients were not on anticoagulants, a situation that requires further investigation, to ensure that AF patients are being optimally managed post-PCI.

Contexte: Des essais se sont penchés sur l'utilisation combinée d'anticoagulants oraux directs (AOD) et d'antiplaquettaires chez les patients atteints de fibrillation auriculaire (FA) qui subissent une intervention coronarienne percutanée (ICP). Il est possible que ces essais aient donné lieu à des modifications des habitudes de prescription. Méthodologie: Cet audit interne portant sur des Albertains atteints de FA subissant une ICP fournit une description des traitements antithrombotiques prescrits avant et après la publication des résultats de l'essai PIONEER AF-PCI (An O p en-label, Randomized, Controlled, Multicenter Study Explor i ng Tw o Treatme n t Strat e gi e s of R ivaroxaban and a Dose-Adjusted Oral Vitamin K Antagonist Treatment Strategy in Patients With A trial F ibrillation Who Undergo P ercutaneous C oronary I ntervention). Résultats: Les caractéristiques des cohortes étudiées avant (n = 597) et après (n = 708) la publication étaient semblables : âge médian, 72 ans; 23 % des femmes; 63 % ayant des antécédents de syndrome coronarien aigu; 22 % ayant des antécédents de saignements. Après la publication, on a observé une augmentation de 7,0 % (p = 0,01) de l'utilisation d'anticoagulants, dont une augmentation de 24,9 % de l'utilisation d'AOD et une diminution de 17,5 % de l'utilisation de warfarine (p < 0,0001). Une corrélation a été établie entre le recours aux AOD et l'appartenance à la cohorte prise en charge « après ¼ la publication des résultats de l'essai (rapport de cotes : 5,42; intervalle de confiance à 95 % : 3,75 ­ 7,82; p < 0,0001). Conclusions: Après la publication des résultats de l'essai PIONEER AF-PCI, les prescriptions d'anticoagulants ont sensiblement augmenté, et ce, en faveur des AOD plutôt que de la warfarine. Près de la moitié des patients ne prenaient pas d'anticoagulants, une situation qui nécessite un examen plus approfondi afin de s'assurer que les patients atteints de FA sont pris en charge de manière optimale après une ICP.