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1.
Am J Cardiol ; 96(4): 512-4, 2005 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-16098302

RESUMO

We report on the incidence of adverse cardiac events in 350 patients who underwent noncardiac surgery within 2 months of successful balloon angioplasty (BA) at our institution between 1988 and 2001. Three patients died perioperatively (n = 1) or had myocardial infarction (n = 2) (0.9%, 95% confidence interval [CI] 0.2% to 2.5%), which is a lower incidence than that reported for patients undergoing noncardiac surgery after stenting (3.9% to 32%). One patient died, and 2 had a nonfatal myocardial infarction. All 3 (1.6%, 95% CI 0.3% to 4.6%) were among the 188 patients who underwent surgery within 2 weeks of BA. Repeat target vessel revascularization was performed in 10 patients (2.9%, 95% CI 1.4% to 5.2%): in 3 (1.6%, 95% CI 0.3% to 4.6%) of 188 patients who underwent surgery within 2 weeks of BA and in 7 (5.1%, 95% CI 2.1% to 10.2%) of 138 patients who underwent surgery within 3 to 7 weeks of BA. Therefore, in patients in whom percutaneous coronary revascularization is required before noncardiac surgery, BA appears to be safe, especially in patients who need to undergo surgery early after percutaneous coronary intervention.


Assuntos
Angioplastia Coronária com Balão , Procedimentos Cirúrgicos do Sistema Digestório , Isquemia Miocárdica/terapia , Procedimentos Ortopédicos , Procedimentos Cirúrgicos Urogenitais , Idoso , Angiografia Coronária , Endossonografia , Feminino , Seguimentos , Humanos , Masculino , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/mortalidade , Assistência Perioperatória/métodos , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
2.
Am Heart J ; 147(3): 463-7, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-14999195

RESUMO

BACKGROUND: Dual antiplatelet therapy with aspirin and clopidogrel has replaced aspirin and systemic anticoagulation with warfarin as the preferred antithrombotic therapy after percutaneous coronary intervention (PCI) with stent placement. However, a number of patients have indications for all 3 drugs. We sought to determine the frequency and type of hemorrhagic complications in patients who undergo systemic anticoagulation with warfarin while receiving aspirin and clopidogrel after a PCI with stent placement. METHODS: We performed a retrospective analysis of the Mayo Clinic PCI database and identified 66 consecutive patients who were discharged from hospital after PCI between January 2000 and August 2002 (inclusive) receiving a combination of dual antiplatelet therapy (aspirin and clopidogrel) and systemic anticoagulation (warfarin) to determine the incidence of bleeding and other clinical events during the treatment period. RESULTS: Six patients (9.2%; 95% CI, 3.5-19.0) reported a bleeding event; 2 patients required a blood transfusion. No patient died or sustained a myocardial infarction or stent thrombosis. CONCLUSIONS: The risk of bleeding may be increased in patients treated with aspirin, a thienopyridine, and warfarin early after PCI with stent placement.


Assuntos
Anticoagulantes/uso terapêutico , Aspirina/uso terapêutico , Doença das Coronárias/tratamento farmacológico , Inibidores da Agregação Plaquetária/uso terapêutico , Stents , Ticlopidina/análogos & derivados , Ticlopidina/uso terapêutico , Varfarina/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Angina Instável/terapia , Angioplastia Coronária com Balão , Anticoagulantes/efeitos adversos , Aspirina/efeitos adversos , Clopidogrel , Doença das Coronárias/terapia , Quimioterapia Combinada , Feminino , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/terapia , Inibidores da Agregação Plaquetária/efeitos adversos , Estudos Retrospectivos , Ticlopidina/efeitos adversos , Varfarina/efeitos adversos
3.
J Am Coll Cardiol ; 42(2): 234-40, 2003 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-12875757

RESUMO

OBJECTIVES: We sought to determine the frequency and timing of complications at our institution when surgery was performed within two months of coronary stent placement. BACKGROUND: The optimal delay following coronary stent placement prior to non-cardiac surgery is unknown. METHODS: We analyzed the Mayo Clinic Percutaneous Coronary Intervention and Surgical databases between 1990 and 2000 and identified 207 patients who underwent surgery in the two months following successful coronary stent placement. RESULTS: Eight patients (4.0%) died or suffered a myocardial infarction or stent thrombosis. All 8 patients were among the 168 patients (4.8%, 95% confidence interval [CI] 2.1 to 9.2) undergoing surgery six weeks after stent placement; the frequency of these events ranged from 3.8% to 7.1% per week during each of the six weeks. No events occurred in the 39 patients undergoing surgery seven to nine weeks after stent placement (0%, 95% CI 0.0 to 9.0). CONCLUSIONS: These data suggest that, whenever possible, non-cardiac surgery should be delayed six weeks after stent placement, by which time stents are generally endothelialized, and a course of antiplatelet therapy to prevent stent thrombosis has been completed.


Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Doença das Coronárias/complicações , Doença das Coronárias/terapia , Trombose Coronária/etiologia , Infarto do Miocárdio/etiologia , Hemorragia Pós-Operatória/etiologia , Stents/efeitos adversos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Idoso , Anticoagulantes/uso terapêutico , Aspirina/uso terapêutico , Transfusão de Sangue/estatística & dados numéricos , Angiografia Coronária , Trombose Coronária/epidemiologia , Trombose Coronária/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/prevenção & controle , Inibidores da Agregação Plaquetária/uso terapêutico , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/prevenção & controle , Piridinas/uso terapêutico , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Varfarina/uso terapêutico
4.
J Am Coll Cardiol ; 40(9): 1567-72, 2002 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-12427407

RESUMO

OBJECTIVES: The study examined the frequency, correlates, and outcome of patients with stent thrombosis within 30 days of stent placement. BACKGROUND: Patients in trials evaluating stents or dual antiplatelet therapy to prevent coronary stent thrombosis have generally had narrow inclusion criteria; the extent to which stent thrombosis rates in such trials represent current practice, particularly with the availability of newer stents, is unclear. METHODS: We performed a retrospective analysis of the Mayo Clinic Percutaneous Coronary Intervention database and identified all patients who received at least one coronary stent and dual antiplatelet therapy (aspirin and ticlopidine or clopidogrel for two to four weeks). RESULTS: Four thousand five hundred nine patients underwent successful coronary stent implantation and were treated with dual antiplatelet therapy between July 1, 1994, and April 30, 2000. Stent thrombosis occurred in 23 patients (0.51%; 95% confidence interval 0.32%, 0.76%) within 30 days of stent placement. Multivariate analysis using bootstrap model selection to avoid over-fitting the model indicated that only the number of stents placed was an independent correlate of stent thrombosis (odds ratio 1.80, p < 0.001). The frequency of death and frequency of nonfatal myocardial infarction (MI) among the 23 patients with stent thrombosis were 48% and 39%, respectively. CONCLUSIONS: Stent thrombosis is even more rare in the current era than in earlier trials. Number of stents placed was an independent correlate of stent thrombosis. Most patients who suffer stent thrombosis either die or suffer MI.


Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Trombose Coronária/epidemiologia , Inibidores da Agregação Plaquetária/uso terapêutico , Stents/efeitos adversos , Ticlopidina/análogos & derivados , Idoso , Idoso de 80 Anos ou mais , Angina Instável/terapia , Aspirina/administração & dosagem , Clopidogrel , Angiografia Coronária , Trombose Coronária/etiologia , Trombose Coronária/prevenção & controle , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Inibidores da Agregação Plaquetária/administração & dosagem , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Ticlopidina/administração & dosagem , Resultado do Tratamento
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