RESUMEN
The number of patients taking dual antiplatelet therapy is growing with high cardiovascular risk associated with even short-time antiplatelets cessation in some clinical scenarios (e.g., after acute coronary syndrome or percutaneous coronary interventions). However, sometimes, it is required to hold antiplatelets particularly in the preoperative period of coronary artery bypass surgery (CABG). The article reviews the data on thienopyridine use before CABG, offers an algorithm of preoperative antiplatelet therapy depending on patient's cardiovascular risk.
Asunto(s)
Enfermedades Cardiovasculares , Puente de Arteria Coronaria , Complicaciones Posoperatorias/prevención & control , Tienopiridinas/farmacología , Algoritmos , Enfermedades Cardiovasculares/tratamiento farmacológico , Enfermedades Cardiovasculares/cirugía , Ensayos Clínicos como Asunto , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Humanos , Inhibidores de Agregación Plaquetaria/farmacología , Cuidados Preoperatorios/métodos , Ajuste de RiesgoRESUMEN
The number of patients with coronary artery disease undergoing percutaneous coronary interventions (PCI) with stenting is growing. Stenting is associated with dual antiplatelet given until endothelization of stent. In some clinical situations surgery is required, e.g. coronary bypass, before stent is endothelized or soon after acute coronary syndrome, while even short-time antiplatelet therapy cessation might result in fatal sequelae. Nevertheless, before major surgeries, including coronary artery bypass surgery, antiplatelets (particulary thyenopyridines and ticagrelor) sometimes need to be stopped and bridging therapy with short-acting antithrombotics started. The article reviews data on bridging therapy before coronary bypass surgery.
Asunto(s)
Puente de Arteria Coronaria , Intervención Coronaria Percutánea , Atención Perioperativa/métodos , Inhibidores de Agregación Plaquetaria , Complicaciones Posoperatorias/prevención & control , Contraindicaciones , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Humanos , Evaluación de Resultado en la Atención de Salud , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/métodos , Atención Perioperativa/efectos adversos , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/efectos adversos , Stents , Factores de TiempoRESUMEN
In a review of the literature describes the risks and benefits of surgical interventions, in particular, coronary artery bypass grafting in patients with coronary artery disease receiving antiplatelet therapy with no cancellation or late withdrawal of acetylsalicylic acid (ASA). The data supporting a moderate - without increasing the frequency of reoperation and blood transfusion - an increased risk of perioperative bleeding in cases where operations are conducted against a background of aspirin therapy. At the same time showed a significant reduction in the risk of perioperative cardiovascular complications and improve survival after intervention, which did not occur before the removal of the drug ASA.
Asunto(s)
Aspirina , Pérdida de Sangre Quirúrgica/prevención & control , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/terapia , Hemorragia Posoperatoria , Privación de Tratamiento , Aspirina/administración & dosificación , Aspirina/efectos adversos , Transfusión Sanguínea , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Humanos , Atención Perioperativa/métodos , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/efectos adversos , Hemorragia Posoperatoria/inducido químicamente , Hemorragia Posoperatoria/prevención & control , Reoperación , Ajuste de Riesgo , Medición de Riesgo , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
At present reperfusion therapy in ST-elevation (STE) acute coronary syndrome (ACS) is carried out in majority of countries not more than in 70% of cases. We analyzed predictors of non-fulfillment of reperfusion therapy in patients with STEACS included into ACS registry conducted in the Kemerovo cardiological dispensary. Reperfusion therapy was not carried out in 154 patients with STEACS (36.2%). Main predictors of non-fulfillment of reperfusion were age older than 75 years (odds ratio [OR] 47.97, 95% confidence interval [CI] 19.47-118.21), admission later than in 12 hours after onset of disease (OR 4.29, 95%CI 1.52-12.13), history of myocardial infarction (OR 2.68, 95%CI 1.11-6.48). Thus there are factors including subjective ones which preclude full-fledged use of contemporary recommendations on the management of patients with STEACS.
Asunto(s)
Síndrome Coronario Agudo , Manejo de Caso/normas , Reperfusión Miocárdica/estadística & datos numéricos , Negativa al Tratamiento/estadística & datos numéricos , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/epidemiología , Síndrome Coronario Agudo/terapia , Factores de Edad , Anciano , Intervalos de Confianza , Vías Clínicas/normas , Atención a la Salud/organización & administración , Electrocardiografía , Femenino , Necesidades y Demandas de Servicios de Salud , Estado de Salud , Humanos , Masculino , Reperfusión Miocárdica/métodos , Sistema de Registros , Factores de Riesgo , Siberia/epidemiología , Análisis de Supervivencia , Factores de TiempoRESUMEN
The aim of the study was to elucidate 7-day rhythms of general and cardiovascular mortality among the residents of Kemerovo. We analysed all registered cases of death in Kemerovo over the period from 01.01.98 to 31.12.01. The sample included 28 761 persons (15 454 men and 13 307 women). Cardiovascular mortality was distinguished from other causes of death. Analysis of distribution of lethal cases regardless of the cause by days of the weak showed that most of them fell on Fridays when their number was by 5.2% higher than on Thursdays when the mortality rate was minimal (p=0.02). Monday was the most unfavourable day in terms of mortality from cardiovascular diseases that was minimal on Sundays, the difference between the two days being 8% (p=0.02). The study revealed weekly rhythms of general and cardiovascular mortality most of which occurred on Fridays whereas the largest number of cardiovascular death fell on Mondays.
Asunto(s)
Enfermedades Cardiovasculares/mortalidad , Ritmo Circadiano , Femenino , Humanos , Masculino , Mortalidad/tendencias , Periodicidad , Federación de Rusia/epidemiología , Estaciones del AñoRESUMEN
We studied effect of the period of new year holydays on parameters of total and cardiovascular mortality. We analyzed all registered deaths in Kemerovo from 01.01.1998 to 31.12.2001 using data of the Kemerovo registry office (ZAGS). In time interval from 21 December to January 10 of each year there were 1830 deaths (968 men and 862 women). Between January 1 and 5 compared with preceding and subsequent days total and cardiovascular mortality were 27% (p = 0.003) and 25% (p = 0.024), high respectively. We also noted dependence of the parameter studied on age and sex. Thus the period of New Year holydays is associated with increased total and cardiovascular mortality and this association can not be explained by the effect of low temperatures.