ABSTRACT
BACKGROUND: The optimal antithrombotic therapies for transcatheter aortic valve implantation (TAVI) and MitraClip implantation have not been well established. We conducted a narrative review from currently available studies between January 2002 and May 2016 to highlight the advantages and disadvantages of antithrombotic therapy use in cardiac catheter-based therapeutic techniques. Recently, these techniques have dramatically altered the approach towards valvular heart diseases management. The introduction into clinical practice, of TAVI for severe aortic stenosis and MitraClip for mitral regurgitation, has revolutionized interventional cardiology. However, TAVI is associated with a risk of cerebral embolization and ischaemic vascular events leading to neurological impairment and even death. These ischaemic complications might occur perioperatively or much later, although the estimated rate of occurrence is variable. CONCLUSION: We will discuss prior experience with MitraClip for antithrombotic use. It is imperative for patients undergoing transcatheter valvular interventions to have optimal antithrombotic therapy that balances between ischaemic and haemorrhagic complications. The appropriate timing, combination, and duration of antithrombotic medications need consensus to weigh between the efficacy, efficiency and adverse effects in patients with transcatheter valvular interventions.
Subject(s)
Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Cardiac Catheterization/methods , Fibrinolytic Agents/administration & dosage , Heart Valve Prosthesis Implantation/methods , Mitral Valve Insufficiency/surgery , Mitral Valve/surgery , Transcatheter Aortic Valve Replacement/methods , Aortic Valve/physiopathology , Aortic Valve Stenosis/physiopathology , Cardiac Catheterization/adverse effects , Cardiac Catheterization/instrumentation , Clinical Decision-Making , Fibrinolytic Agents/adverse effects , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/instrumentation , Hemorrhage/chemically induced , Humans , Mitral Valve/physiopathology , Mitral Valve Insufficiency/physiopathology , Patient Selection , Risk Factors , Transcatheter Aortic Valve Replacement/adverse effects , Transcatheter Aortic Valve Replacement/instrumentation , Treatment OutcomeABSTRACT
Owing to their immune modulatory, anti-inflammatory, antioxidant, antithrombotic, and endothelial action, statins are widely used in the critical care setting in several disease scenarios. The present review focuses on the evidence supporting an even wider utilization of statins in intensive care practice for diverse indications. A search of the literature was carried out in PubMed, Cochrane and EMBASE databases up to January 2016. Review articles, meta-analyses, and original trials on the effects of statin therapy in the intensive care unit (ICU) were included, by combining the following MeSH terms: "statins," "intensive care," "cardiac surgery," "sepsis," "acute respiratory distress syndrome," "pneumonia," "subarachnoid hemorrhage," "traumatic brain injury," and "critical illness." Case reports were excluded. No language restriction was applied. References were also searched for other potentially useful articles. It was concluded that beneficial effects of statins are observed in cardiac surgery; however, no robust evidence supports their effectiveness in diverse critical care settings. The decision to discontinue statins in native users should be taken in consideration of particular clinical circumstances.
