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  1. Article ; Online: Cierre de la orejuela izquierda frente a anticoagulantes orales en FA e implante de stents coronarios. Registro DESAFIO

    José Ramón López-Mínguez / Estrella Suárez-Corchuelo / Sergio López-Tejero / Luis Nombela-Franco / Xavier Freixa-Rofastes / Guillermo Bastos-Fernández / Xavier Millán-Álvarez / Raúl Moreno-Gómez / José Antonio Fernández-Díaz / Ignacio Amat-Santos / Tomás Benito-Gonzále / Fernando Alfonso-Manterola / Pablo Salinas-Sanguino / Pedro Cepas-Guillén / Dabit Arzamendi / Ignacio Cruz-González / Juan Manuel Nogales-Asensio

    REC: Interventional Cardiology, Vol 5, Iss 4, Pp 287-

    2023  Volume 296

    Abstract: RESUMEN Introducción y objetivos: El tratamiento de los pacientes con fibrilación auricular no valvular (FANV) que requieren implante de stents coronarios es un desafío. El objetivo del estudio fue investigar si el cierre de la orejuela izquierda (COI) ... ...

    Abstract RESUMEN Introducción y objetivos: El tratamiento de los pacientes con fibrilación auricular no valvular (FANV) que requieren implante de stents coronarios es un desafío. El objetivo del estudio fue investigar si el cierre de la orejuela izquierda (COI) podría ser una opción posible y beneficiosa para estos pacientes. Para ello, se analiza el impacto del COI más tratamiento antiagregante plaquetario (AP) en comparación con la combinación de anticoagulantes orales (ACO), incluidos los ACO directos, y tratamiento AP en los resultados a largo plazo de estos pacientes Métodos: Se analizaron los resultados de 207 pacientes con FANV sometidos consecutivamente a implante de stents coronarios. Recibieron ACO 146 pacientes (74 acenocumarol, 71 ACO de acción directa) y en 61 se realizó COI. La mediana de seguimiento fue de 35 meses. Los pacientes también recibieron tratamiento AP por prescripción de su cardiólogo. El estudio recibió la debida supervisión ética. Resultados: La edad (media: 75,7 años) y el antecedente de accidente vascular cerebral fueron similares en ambos grupos, aunque el grupo de COI presentó más características desfavorables (antecedente de enfermedad de las arterias coronarias [CHA2DS2-VASc], antecedente de hemorragias significativas [BARC ≥ 2] y HAS-BLED). La aparición de acontecimientos adversos graves (muerte, accidente vascular cerebral, accidente isquémico transitorio, hemorragia grave) y cardiovasculares graves (muerte de causa cardiaca, acciden-te vascular cerebral, accidente isquémico transitorio, infarto de miocardio) fue significativamente mayor en el grupo de ACO que en el de COI: 19,75 frente a 9,06% (HR = 2,18; p = 0,008) y 6,37 frente a 1,91% (HR =3,34; p = 0,037), respectivamente. Conclusiones: La ...
    Keywords Stent ; Orejuela ; Fibrilación auricular ; Anticoagulantes ; Internal medicine ; RC31-1245
    Language English
    Publishing date 2023-11-01T00:00:00Z
    Publisher Permanyer
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Left atrial appendage occlusion vs oral anticoagulants in AF and coronary stenting. The DESAFIO registry

    José Ramón López-Mínguez / Estrella Suárez-Corchuelo / Sergio López-Tejero / Luis Nombela-Franco / Xavier Freixa-Rofastes / Guillermo Bastos-Fernández / Xavier Millán-Álvarez / Raúl Moreno-Gómez / José Antonio Fernández-Díaz / Ignacio Amat-Santos / Tomás Benito-González / Fernando Alfonso-Manterola / Pablo Salinas-Sanguino / Pedro Cepas-Guillén / Dabit Arzamendi / Ignacio Cruz-González / Juan Manuel Nogales-Asensio

    REC: Interventional Cardiology (English Ed.), Vol 5, Iss 4, Pp 287-

    2023  Volume 296

    Abstract: ABSTRACT Introduction and objectives: The treatment of patients with non-valvular atrial fibrillation (NVAF) who need coronary stenting is challenging. The objective of the study was to determine whether left atrial appendage occlusion (LAAO) could be a ... ...

    Abstract ABSTRACT Introduction and objectives: The treatment of patients with non-valvular atrial fibrillation (NVAF) who need coronary stenting is challenging. The objective of the study was to determine whether left atrial appendage occlusion (LAAO) could be a feasible option and benefit these patients. To this end, we studied the impact of LAAO plus antiplatelet drugs vs oral anticoagulants (OAC) (including direct OAC) plus antiplatelet drugs in these patients’ long-term outcomes. Methods: The results of 207 consecutive patients with NVAF who underwent coronary stenting were analyzed. A total of 146 patients were treated with OAC (75 with acenocoumarol, 71 with direct OAC) while 61 underwent LAAO. The median follow-up was 35 months. Patients also received antiplatelet therapy as prescribed by their cardiologist. The study received the proper ethical oversight. Results: Age (mean 75.7 years), and the past medical history of stroke were similar in both groups. However, the LAAO group had more unfavorable characteristics (history of coronary artery disease [CHA2DS2-VASc], and significant bleeding [BARC ≥ 2] and HAS-BLED). The occurrence of major adverse events (death, stroke/transient ischemic events, major bleeding) and major cardiovascular events (cardiac death, stroke/transient ischemic attack, and myocardial infarction) were significantly higher in the OAC group compared to the LAAO group: 19.75% vs 9.06% (HR, 2.18; P.= .008) and 6.37% vs 1.91% (HR, 3.34; P.= .037), respectively. Conclusions: In patients with NVAF undergoing coronary stenting, LAAO plus antiplatelet therapy produced better long-term outcomes compared to treatment with OAC plus antiplatelet therapy despite the unfavorable baseline characteristics of the LAAO group.
    Keywords Stents ; Atrial appendage ; Atrial fibrillation ; Anticoagulants ; Medicine ; R
    Subject code 610
    Language English
    Publishing date 2023-11-01T00:00:00Z
    Publisher Permanyer
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

    Full text online

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    Inter-library loan at ZB MED

    Your chosen title can be delivered directly to ZB MED Cologne location if you are registered as a user at ZB MED Cologne.

  3. Article ; Online: Major Bleeding Predictors in Patients with Left Atrial Appendage Closure

    José Ramón López-Mínguez / Juan Manuel Nogales-Asensio / Eduardo Infante De Oliveira / Lino Santos / Rafael Ruiz-Salmerón / Dabit Arzamendi-Aizpurua / Marco Costa / Hipólito Gutiérrez-García / Jose Antonio Fernández-Díaz / Xavier Freixa / Ignacio Cruz-González / Raúl Moreno / Andrés Íñiguez-Romo / Fernando Alfonso-Manterola

    Journal of Clinical Medicine, Vol 9, Iss 2295, p

    The Iberian Registry II

    2020  Volume 2295

    Abstract: Introduction and objective: Major bleeding events in patients undergoing left atrial appendage closure (LAAC) range from 2.2 to 10.3 per 100 patient-years in different series. This study aimed to clarify the bleeding predictive factors that could ... ...

    Abstract Introduction and objective: Major bleeding events in patients undergoing left atrial appendage closure (LAAC) range from 2.2 to 10.3 per 100 patient-years in different series. This study aimed to clarify the bleeding predictive factors that could influence these differences. Methods: LAAC was performed in 598 patients from the Iberian Registry II (1093 patient-years; median, 75.4 years). We conducted a multivariate analysis to identify predictive risk factors for major bleeding events. The occurrence of thromboembolic and bleeding events was compared to rates expected from CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes, stroke history, vascular disease, sex) and HAS-BLED (hypertension, abnormal renal and liver function, stroke, bleeding, labile INR, elderly, drugs or alcohol) scores. Results: Cox regression analysis revealed that age ≥75 years (HR: 2.5; 95% CI: 1.3 to 4.8; p = 0.004) and a history of gastrointestinal bleeding (GIB) (HR: 2.1; 95% CI: 1.1 to 3.9; p = 0.020) were two factors independently associated with major bleeding during follow-up. Patients aged <75 or ≥75 years had median CHA2DS2-VASc scores of 4 (IQR: 2) and 5 (IQR: 2), respectively ( p < 0.001) and HAS-BLED scores were 3 (IQR: 1) and 3 (IQR: 1) for each group ( p = 0.007). Events presented as follow-up adjusted rates according to age groups were stroke (1.2% vs. 2.9%; HR: 2.4, p = 0.12) and major bleeding (3.7 vs. 9.0 per 100 patient-years; HR: 2.4, p = 0.002). Expected major bleedings according to HAS-BLED scores were 6.2% vs. 6.6%, respectively. In patients with GIB history, major bleeding events were 6.1% patient-years (HAS-BLED score was 3.8 ± 1.1) compared to 2.7% patients-year in patients with no previous GIB history (HAS-BLED score was 3.4 ± 1.2; p = 0.029). Conclusions: In this high-risk population, GIB history and age ≥75 years are the main predictors of major bleeding events after LAAC, especially during the first year. Age seems to have a greater influence on major bleeding events than on thromboembolic ...
    Keywords atrial fibrillation ; bleeding risk ; age ; left atrial appendage closure ; Medicine ; R
    Subject code 610 ; 616
    Language English
    Publishing date 2020-07-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

    Full text online

    More links

    Kategorien

    Inter-library loan at ZB MED

    Your chosen title can be delivered directly to ZB MED Cologne location if you are registered as a user at ZB MED Cologne.

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