Assuntos
Apêndice Atrial/cirurgia , Bacteriemia/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Próteses e Implantes/microbiologia , Infecções Estafilocócicas/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Ecocardiografia Transesofagiana/métodos , Feminino , Humanos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Resultado do TratamentoAssuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Estenose Coronária/cirurgia , Vasos Coronários/cirurgia , Intervenção Coronária Percutânea/métodos , Stents , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Estenose Coronária/complicações , Estenose Coronária/diagnóstico , Vasos Coronários/diagnóstico por imagem , Humanos , Masculino , Tomografia por Emissão de PósitronsRESUMO
Introduction: Non-vitamin-K oral anticoagulants (NOACs) are known to have advantages over vitamin K antagonists (VKAs) for patients with atrial fibrillation (AF). However, more than half of patients are still treated with VKAs. The absence of direct comparisons amongst NOACs and the insufficient evidence in some clinical situations could explain, at least in part, this predominance of VKAs. The aims of our study were: 1) to analyze the opinion of an expert panel on the role of NOACs in different clinical scenarios; 2) to elaborate specific consensus recommendations for the management of NOACs for each one of these situations.Patients and methods: An online survey was created covering distinct aspects of the use of oral anticoagulants in various clinical settings. A two-round modified Delphi approach was used.Results: Forty-eight experts responded to the survey. Consensus was reached on 58% (48/83) of the items. The panelists concluded that the term non-valvular AF should be avoided. In most clinical settings NOACs were preferred over VKAs. Once daily NOACs were preferred in elderly patients to improve therapeutic compliance and, in those over the age of 85, edoxaban could be the best choice. Edoxaban and apixaban were the favorites for patients with AF and moderate chronic kidney disease (CKD). In the case of patients on triple antithrombotic therapy due to AF and acute coronary syndrome (ACS) the lowest effective NOAC dose should be used.Conclusion: Our study emphasizes that there are several clinical circumstances in patients with AF requiring complex decisions about anticoagulation treatment and offers some recommendations based on the consensus reached by an expert panel.
Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Administração Oral , Idoso , Cardiologia , Consenso , Humanos , Pirazóis/uso terapêutico , Piridinas/uso terapêutico , Piridonas/uso terapêutico , Tiazóis/uso terapêutico , Vitamina K/antagonistas & inibidoresRESUMO
Radial artery catheterization is a common procedure performed in the cardiac catheterization laboratory. Transradial accesssing is becoming an increasingly widespread choice because of its lower complications compared with the transfemoral approach. Although complications related to this procedure are well established, troubles associated with the guide wire are rare. We present the first reported case of a percutaneous rescue of a wire during radial sheath insertion using the balloon entrapment technique to retrieve it without surgery.
