Contemporary use of anticoagulation in the cardiac catheterization laboratory: a review.

Anticoagulation during percutaneous coronary interventions has a rich history that has been shaped by several key clinical trials. The correct choice of anticoagulation during interventions can maximize patient outcomes and ensure a safe procedure. However, in some specific situations, anticoagulation may not be required at all. In this review article, we review the significant clinical trials and current guidelines regarding the use of anticoagulation in the catheterization laboratory and discuss the unique pharmacological aspects of the most commonly used agents, with an emphasis on the specific pharmacokinetic parameters that dictate how these agents are used and monitored. Finally, we discussed the future directions in anticoagulation therapy in coronary artery disease. This review serves as a robust synopsis of the clinical data for practicing clinicians and fellows in training.

The development or worsening of hypertension after transcatheter aortic valve replacement (TAVR) improves short-term and long-term patient outcomes.

OBJECTIVES: In patients with symptomatic aortic valve disease who are at intermediate to high risk for open surgical aortic valve replacement, transcatheter aortic valve replacement (TAVR) decreases overall mortality and improves quality of life. Hypertension (HTN) after TAVR has been associated with improved cardiac function and short-term survival but its effect on survival over 1 year is unclear. Our study aims to evaluate the effect of HTN following TAVR on short-term and long-term clinical and echocardiographic outcomes. METHODS: A retrospective chart review case-control study of 343 consecutive patients who underwent TAVR between August 2012 and November 2016 was performed to elucidate the relationship between HTN and post-TAVR outcomes. RESULTS: 193 patients who underwent TAVR (56.2%) developed or had a worsening of their HTN after TAVR. The development of post-TAVR HTN was associated with a significantly better overall survival at 1 year (89% vs 67%, p<0.001) and 2 years (72% vs 46%, p=0.002). Patients with increased blood pressure also had a significant lower in hospital cardiovascular mortality (1% vs 12%, p<0.001). However, the development or worsening of their HTN after TAVR was associated with an increase in heart failure (HF) exacerbations and diuretic use. CONCLUSIONS: The development or worsening of HTN after TAVR is associated with improved overall survival despite an increase in postprocedural HF exacerbations and antihypertensive medication utilisation. The outcomes of this study could be important in postoperative management of patients who underwent TAVR.