A 64-year-old man manifested a stroke two years after restoration of sinus rhythm through a radiofrequency catheter ablation. Transesophageal echocardiography demonstrated the presence of a thrombus in the left atrial appendage. Left atrial volumes and different parameters of atrial emptying showed that, despite the persistence of the sinus rhythm, atrial mechanical function was severely impaired. After atrial ablation procedures echocardiography can be useful to stratify patients according to their risk of developing embolic events and hence be of help in deciding whether or not discontinuation of anticoagulant therapy is the appropriate choice.
BackgroundAngiodysplasia (AD) is the most common vascular malformation of the gastrointestinal (GI) tract and causes significant morbidity. Long-acting octreotide, administered intramuscularly once per month might be useful for controlling chronic bleeding from angiodysplasia as an off-label use. Some case reports have demonstrated a significant benefit.PurposeTo evaluate the effectiveness and safety of long-acting octreotide as an off-label use in patients suffering from chronic GI bleeding from AD.Material and methodsA retrospective observational study of all patients treated in our hospital with long-acting octreotide for chronic GI bleeding because of AD was performed. We analysed three time periods: one year before starting long-acting octreotide (t0), one year after (t1) and two years after (t2) starting long-acting octreotide treatment. Data, collected from the patient’s medical record, included: demographic data, treatment-related data, haemoglobin levels and number of hospitalizations as efficacy data, and side effects. The statistical analysis was performed with SPSS.ResultsTwenty five patients were included, 85% men with a mean age of 76.1 years [58.7–91.7]. Dosage pattern used was: 10 mg (48%), 20 mg (40%) and 30 mg (12%). Mean treatment duration was 31.1 months [3.2–97.4]. The mean of haemoglobin levels was: t0 9.14 (Standard deviation (SD): 1.12), t1 10.37 (SD: 1.69) and t2 10.37 (SD: 2.02). There was statistical differences in haemoglobin levels between t1-t0 (p = 0.001) and between t2-t0 (p = 0.05). Furthermore, hospitalizations decreased when compared at t1 (3.61 ± 2.69) to t0 (5.29 ± 4.26), p = 0.028; and t2 (2.43 ± 2.44) to t0 (5.29), p = 0.042. No major adverse events were recorded; two patients experienced cholelithiasis and another two glycaemic alteration.ConclusionPatients treated with long-acting octreotide had a significant reduction in hospitalizations and higher mean haemoglobin concentrations after treatment, with an acceptable safety profile. Besides, case reports by Bon et al. 2012, Scaglione et al. 2007 and Molina Infante et al. 2009, showed a significant reduction in transfusion requirements and iron supplementations.References and/or AcknowledgementsNo conflict of interest.
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