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  1. Article ; Online: Association of sex with major bleeding risks in sub-Saharian anticoagulated patients with mechanical heart valves: A cohort study from the Khartoum Emergency Salam Centre.

    Erba, Nicoletta / Tosetto, Alberto / Abdallah, Suha Abdelwahab / Langer, Martin / Giovanella, Elena / Lentini, Salvatore / Masini, Franco / Mocini, Alessandro / Portella, Gennarina / Salvati, Alessandro Cristian / Squizzato, Alessandro / Testa, Sophie / Lip, Gregory Y H / Poli, Daniela

    International journal of cardiology

    2023  Volume 394, Page(s) 131398

    Abstract: Background: Rheumatic heart disease (RHD) with mechanical heart valve (MHV) replacement is common in Africa. However, MHV requires lifelong anticoagulation that could have a particular impact in women in reproductive age.: Methods: We report data of ... ...

    Abstract Background: Rheumatic heart disease (RHD) with mechanical heart valve (MHV) replacement is common in Africa. However, MHV requires lifelong anticoagulation that could have a particular impact in women in reproductive age.
    Methods: We report data of a prospective observational cohort study conducted between August 2018 and September 2019 in MHV patients in the Salam Centre for Cardiac Surgery built in Khartoum by Emergency, an Italian Non-Governmental Organization, to evaluate bleeding risk, its associated determinants, and the impact of lifelong anticoagulation in fertile women.
    Results: We studied 3647 patients (median age 25.1 years; 53.9% female). During follow-up [median time 1.1 (0.1-1.2) years], we recorded 85 major bleedings (rate 2.16 × 100 pt-years), Major bleedings occurred more frequently among women (64/85 cases, 75.3%; rate 3.0 × 100 pt-years), compared to men (21/85 cases, 24.7%; rate 1.16 × 100 pt-years) (RR 2.6; 95% CI 1.6-4.5; p = 0.0001). Multivariate analysis was performed to identify variables associated with major bleeding, and female sex was the only risk factor significantly associated, whereas aspirin treatment and higher INR target showed a non-significant trend for higher bleeding risk. Thirty-two/85 (37.6%) of major bleedings were metrorrhagias. When we calculate the incidence of major bleedings after the exclusion of gynecological events, no sex differences in the bleeding risk were found (HR 1.3, 95% CI 0.8-2.3; p = 0.3).
    Conclusions: Bleeding risk of young MHV patients on oral anticoagulant therapy is higher among women, mainly due to metrorrhagia. Women in the reproductive life are at high risk for gynecological bleeding when treated with anticoagulants.
    MeSH term(s) Male ; Humans ; Female ; Adult ; Warfarin/adverse effects ; Cohort Studies ; Prospective Studies ; Thromboembolism/epidemiology ; Anticoagulants/adverse effects ; Hemorrhage/chemically induced ; Hemorrhage/diagnosis ; Hemorrhage/epidemiology ; Heart Valve Prosthesis/adverse effects ; Risk Factors ; Heart Valves
    Chemical Substances Warfarin (5Q7ZVV76EI) ; Anticoagulants
    Language English
    Publishing date 2023-09-27
    Publishing country Netherlands
    Document type Observational Study ; Journal Article
    ZDB-ID 779519-1
    ISSN 1874-1754 ; 0167-5273
    ISSN (online) 1874-1754
    ISSN 0167-5273
    DOI 10.1016/j.ijcard.2023.131398
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    Zs.A 1673: Show issues Location:
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  2. Article ; Online: Oral anticoagulant management of patients with mechanical heart valves at the Salam Centre of Khartoum: Observations on quality of anticoagulation and thrombotic risk.

    Erba, Nicoletta / Tosetto, Alberto / Langer, Martin / Abdallah, Suha Abdelwahab / Giovanella, Elena / Lentini, Salvatore / Masini, Franco / Mocini, Alessandro / Portella, Gennarina / Salvati, Alessandro Cristian / Squizzato, Alessandro / Testa, Sophie / Lip, Gregory Y H / Poli, Daniela

    Thrombosis research

    2022  Volume 219, Page(s) 155–161

    Abstract: Introduction: Rheumatic heart disease with mechanical heart valve (MHV) replacement is common in Africa. However, MHV requires long-life anticoagulation and managing this can be challenging.: Methods and results: We report data of a prospective ... ...

    Abstract Introduction: Rheumatic heart disease with mechanical heart valve (MHV) replacement is common in Africa. However, MHV requires long-life anticoagulation and managing this can be challenging.
    Methods and results: We report data of a prospective observational study conducted between August 2018 and September 2019 in MHV patients in the Salam Centre for Cardiac Surgery built in Khartoum, by Emergency, an Italian Non-Governmental Organization, to evaluate the quality of anticoagulation control and the risk of thrombotic complications.
    Results: We studied 3647 patients (median age 25.1 years; 53.9 % female). Median Time in Therapeutic Range (TTR) was 53 % (interquartile range 37 % to 67 %) and 70 thrombotic events (rate 1.8 × 100 pt-years [95 % CI 1.38-2.23]) were recorded. Among patients in the first quartile of TTR (≤37 %), we recorded 34/70 (48.6 %) of all thrombotic events (rate 3.7 × 100 pt-years [95 % CI 2.5-5.1]), with a high mortality rate (2.2 × 100 pt-years [95 % CI 1.3-3.3]). In patients with guideline-recommended TTR (≥65 %) the event rate was 0.8 × 100 pt-years for thrombotic events [95 % CI 0.3-1.5] and 0.4 × 100 pt-years for mortality [95 % CI 0.1-0.9]. Multivariable analysis showed that having a TTR in the lowest quartile (≤37 %) and being noncompliant are significantly associated with increased thrombotic risk. Aspirin use or different valve type did not influence the thrombotic risk. Almost 40 % of all thromboembolic complications could have been potentially prevented by further improving VKA management to obtain a TTR > 37 %.
    Conclusion: The thrombotic risk of MHV patients on VKAs living in a low-income country like Sudan is associated with low quality of anticoagulation control. Efforts should be made to decrease the number of non-compliant patients and to reach a guideline-recommended TTR of ≥65 %.
    MeSH term(s) Adult ; Anticoagulants/adverse effects ; Aspirin/pharmacology ; Blood Coagulation ; Female ; Heart Valves ; Hemorrhage/chemically induced ; Humans ; Male ; Thrombosis/chemically induced ; Thrombosis/etiology
    Chemical Substances Anticoagulants ; Aspirin (R16CO5Y76E)
    Language English
    Publishing date 2022-09-21
    Publishing country United States
    Document type Journal Article ; Observational Study
    ZDB-ID 121852-9
    ISSN 1879-2472 ; 0049-3848
    ISSN (online) 1879-2472
    ISSN 0049-3848
    DOI 10.1016/j.thromres.2022.09.018
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 863: Show issues Location:
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  3. Article ; Online: Risk of syncope during work.

    Gaggioli, Germano / Laffi, Mattia / Montemanni, Massimo / Mocini, Alessandro / Rubartelli, Paolo / Brignole, Michele

    Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology

    2014  Volume 16, Issue 2, Page(s) 289–292

    Abstract: Aims: Little is known regarding the overall prevalence of syncope in a population of workers and the risk of occurrence during working time.: Methods and results: A total of 452 consecutive workers (mean age: 46 ± 9 years) were invited to answer an ... ...

    Abstract Aims: Little is known regarding the overall prevalence of syncope in a population of workers and the risk of occurrence during working time.
    Methods and results: A total of 452 consecutive workers (mean age: 46 ± 9 years) were invited to answer an anonymous questionnaire. They had been employed for 22 ± 10 years for a total of 9765 years worked. In the cohort, 160 subjects (35%) reported a total of 465 episodes of syncope during their lives; 64 (14%) suffered a syncopal episode after the start of employment, but only 26 (5.7%) reported syncope at work, 7 (1.5%) having had 2 episodes, and 1 (0.2%) 3 episodes (total: 36 episodes). The risk of syncope during work was 4.6 times higher for those who had a prior history of syncope [18 of 138 (13%)] than for those who did not [8 of 314 (3%), P = 0.001]. The occurrence of syncope during work for the patients with a history of syncope was one syncopal episode in every 99 years worked and for those who had already had an episode during work, one episode in every 16 years worked. Only one patient experienced minor trauma as a consequence of syncope during work and three were referred to the emergency department. All patients continued their employment without any problems.
    Conclusion: The prevalence of syncope during work is low and its impact is benign. The probability of syncope during work is higher for subjects with a history of syncope.
    MeSH term(s) Adult ; Cross-Sectional Studies ; Female ; Health Surveys ; Humans ; Incidence ; Italy/epidemiology ; Male ; Middle Aged ; Occupational Diseases/diagnosis ; Occupational Diseases/epidemiology ; Occupational Health ; Prevalence ; Risk Assessment ; Risk Factors ; Surveys and Questionnaires ; Syncope/diagnosis ; Syncope/epidemiology ; Time Factors
    Language English
    Publishing date 2014-02
    Publishing country England
    Document type Journal Article
    ZDB-ID 1449879-0
    ISSN 1532-2092 ; 1099-5129
    ISSN (online) 1532-2092
    ISSN 1099-5129
    DOI 10.1093/europace/eut247
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    Zs.A 5434: Show issues Location:
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  4. Article ; Online: An observational registry on efficacy and safety of the right ventricular outflow tract as a site for ICD leads: results of the EFFORT (EFFicacy Of Right ventricular outflow Tract as site for ICD leads) registry.

    Mascioli, Giosuè / Gelmini, Gianpaolo / Reggiani, Albino / Giudici, Vittorio / Spotti, Alfredo / Mocini, Alessandro / Marconi, Renato / Ruffa, Franco / Zanotto, Gabriele

    Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing

    2010  Volume 28, Issue 3, Page(s) 215–220

    Abstract: Background: Although pacing from the right ventricular outflow tract (RVOT) has been shown to be safe and feasible in terms of sensing and pacing thresholds, its use as a site for implantable cardioverter defibrillator (ICD) leads is not common. This is ...

    Abstract Background: Although pacing from the right ventricular outflow tract (RVOT) has been shown to be safe and feasible in terms of sensing and pacing thresholds, its use as a site for implantable cardioverter defibrillator (ICD) leads is not common. This is probably due to physicians' concerns about defibrillation efficacy. To date, only one randomized trial, involving 87 enrolled patients, has evaluated this issue.
    Objective: The aim of this observational study has been to compare safety (primary combined end point: efficacy of a 14-J shock in restoring sinus rhythm, R wave amplitude >4 mV and pacing threshold <1 V at 0.5 ms) and efficacy (in terms of effectiveness of a 14-J shock in restoring sinus rhythm after induction of VF, secondary end point) of two different sites for ICD lead positioning: RVOT and right ventricular apex (RVA).
    Methods: The study involved 185 patients (153 males; aged 67 ± 10 years; range, 28-82 years). Site of implant was left to physician's decision. After implant, VF was induced with a 1-J shock over the T wave or--if this method was ineffective--with a 50-Hz burst, and a 14-J shock was tested in order to restore sinus rhythm. If this energy was ineffective, a second shock at 21 J was administered and--eventually--a 31-J shock followed--in case of inefficacy--by a 360-J biphasic external DC shock. Sensing and pacing thresholds were recorded in the database at implant, together with acute (within 3 days of implant) dislodgement rate.
    Results: The combined primary end point was reached in 57 patients in the RVOT group (0.70%) and in 81 patients in the RVA group (0.79%). The 14-J shock was effective in 159 patients, 63 in the RVOT group (77%) and 86 in the RVA group (83%). Both the primary and the secondary end points are not statistically different. R wave amplitude was significantly lower in the RVOT group (10.9 ± 5.2 mV vs. 15.6 ± 6.4 mV, p < 0.0001), and pacing threshold at 0.5 ms was significantly higher (0.64 ± 0.25 V vs. 0.52 ± 0.20 V, p < 0.01), but these differences do not seem to have a clinical meaning, given that the lower values are well above the accepted limits in clinical practice.
    Conclusions: Efficacy and safety of ICD lead positioning in RVOT is comparable to RVA. Even if we observed statistically significant differences in sensing and pacing threshold, the clinical meaning of these differences is--in our opinion--irrelevant.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Cardiac Pacing, Artificial/methods ; Cardiomyopathies/physiopathology ; Cardiomyopathies/therapy ; Defibrillators, Implantable ; Electric Countershock/methods ; Equipment Design ; Female ; Heart Ventricles ; Humans ; Male ; Middle Aged ; Prospective Studies ; Registries ; Ventricular Function, Right
    Language English
    Publishing date 2010-06-25
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1329179-8
    ISSN 1572-8595 ; 1383-875X
    ISSN (online) 1572-8595
    ISSN 1383-875X
    DOI 10.1007/s10840-010-9489-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 5214: Show issues Location:
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