Discontinuation of oral anticoagulation preceding acute ischemic stroke--prevalence and outcomes: Comprehensive chart review.

INTRODUCTION: Oral anticoagulants (OAC) are the therapy of choice to prevent thromboembolism in patients at risk. Discontinuation of OAC prior to elective medical and surgical procedures may reduce the risk of bleeding, but may expose patients to increased risk of thromboembolism and ischemic stroke. The current public health burden of ischemic strokes associated with OAC discontinuation is unknown. We aimed to study the prevalence OAC discontinuation in patients who presented with acute ischemic stroke as well as the outcomes of these strokes. METHODS: Retrospective cross-sectional study by intensive chart review of all acute ischemic stroke patients over 6 months in a large tertiary care community hospital. RESULTS: A total of 431 patients with acute ischemic stroke were admitted during study period, of which 11 (2.6%) had OAC discontinuation within 120 days prior to the index admission. Several strokes occurred after relatively brief discontinuations. The patient group with discontinuation was older, had higher comorbidities and also had a clinically significant stroke and resulting higher mortality and morbidity. CONCLUSION: About 2.6% or 1 in every 38 of all ischemic stokes occurred after OAC discontinuation. Strokes occurring after OAC discontinuation also have higher mortality and morbidity. Our data suggest that any planned discontinuation of OAC, however brief, should be carefully considered.

Left Internal Mammary Artery Dissection: Use of Dual Balloon Angioplasty in Treatment of Ostial Dissection Involving Subclavian Artery.

The left internal mammary artery (LIMA) is the preferred arterial graft to be used for the left anterior descending (LAD) artery for coronary artery bypass graft (CABG) due to high graft patency rate. LIMA dissection is a rare, but dreadful complication of graft angiography and may lead to serious complications including death, myocardial infarction (MI), and re-do CABG. Transcatheter management of LIMA dissection involves multiple stenting. However, this may leave a dissection flap at the ostium of the LIMA that may extend to the left subclavian artery jeopardizing flow to the left arm and vertebral artery. We present a case of LIMA dissection where a dual balloon angioplasty was used for the first time offering better "sealing" of the dissection flap at the level of the ostium of the LIMA graft/subclavian artery.

TASER conducted electrical weapons and implanted pacemakers and defibrillators.

INTRODUCTION: Conducted electrical weapons (CEW) have generated controversy in recent years regarding their effect on heart rhythm and on their suspected interaction with implanted devices such as the pacemakers and ICDs (implantable cardioverter defibrillators). We review the current evidence available on device interactions and pre-sent a new case series of 6 patients. LITERATURE: We used the available case reports and animal studies on TASER or CEW related publications in PubMed. CONCLUSION: Oversensing of TASER CEW discharges may cause noise reversion pacing in pacemakers and inappropriate detection of VF in ICDs. The nominal 5-second discharge is sufficiently short that neither clinically significant inhibition of bradycardia pacing nor inappropriate ICD shocks have been reported. Current evidence indicates that CEW discharges do not have adverse effects on pacemakers and ICDs.