BackgroundPeriprocedural heparin bridging therapy aims to reduce the risk of thromboembolic events in patients requiring an interruption in their anticoagulation therapy for the purpose of an elective procedure. The efficacy and safety of heparin bridging therapy has not been well established.ObjectivesTo compare through meta-analysis the effects of heparin bridging therapy on the risk of major bleeding and thromboembolic events of clinical significance among patients taking oral anticoagulants.MethodsWe searched PubMed, EMBASE and the Cochrane library from January 2005 to July 2016. Studies were included if they reported clinical outcomes of patients receiving heparin bridging therapy during interruption of oral anticoagulant for operations. Data were pooled using random-effects modeling.ResultsA total of 25 studies, including 6 randomized controlled trials and 19 observational studies, were finally included in this analysis. Among all the 35,944 patients, 10,313 patients were assigned as heparin bridging group, and the other 25,631 patients were non-heparin bridging group. Overall, compared with patients without bridging therapy, heparin bridging therapy increased the risk of major bleeding (OR = 3.23, 95%CI: 2.06–5.05), minor bleeding (OR = 1.52, 95%CI: 1.06–2.18) and overall bleeding (OR = 2.83, 95%CI: 1.86–4.30).While there was no significant difference in thromboembolic events (OR = 0.99,95%CI: 0.49–2.00), stroke or transient ischemic attack(OR = 1.45, 95%CI: 0.93–2.26,) or all-cause mortality (OR = 0.71, 95%CI: 0.31–1.65).ConclusionsHeparin-bridging therapy increased the risk of major and minor bleeding without decreasing the risk of thromboembolic events and all cause death compared to non-heparin bridging.
Although Coronary Microvascular Dysfunction (CMVD) is clinically prevalent, its therapeutic efficacy data remains uncertain. We report a 62-year-old female CMVD patients whose condition improved after Shexiang Tongxin dropping pill treatment, as confirmed by stress perfusion cardiac MRI. This case emphasizes that Shexiang Tongxin dropping pill is typically effective in the treatment of CMVD. It can not only alleviate symptoms, but also ameliorate microvascular function. Traditional Chinese medicine is a good choice for the treatment of microvascular angina.
Background: Recent evidence indicates a link between depression and microvascular dysfunction, which may affect therapy options and prognosis. Case summary: We described two young depressed patients with angina. No obstructive coronary heart disease was detected by computed tomography coronary angiography or invasive coronary angiography. Determined by stress perfusion cardiac MRI, these two patients were diagnosed with microvascular angina. Discussion: The two cases emphasized that depression and microvascular angina can coexist inyoung patients. Negligence of mental disorder may cause insufficient treatments. Both psycho-regulatory interventions and heart disease medicine should be options for these patients. Keywords: Microvascular angina; Depression; Stress perfusion cardiac magnetic resonance; Case report.
Previous studies reported regional variations in in-hospital acute coronary syndrome (ACS) mortality, but the reasons for that were not clearly defined. We explored whether differences in patient characteristics could explain regional variation. The Improving Care for Cardiovascular Disease in China (CCC)-ACS project is an ongoing national registry and quality improvement project, involving 150 tertiary hospitals from 30 provinces across China. We applied a prediction model that included patient-specific variables to calculate the expected in-hospital mortality. For each province, we reported the observed, expected in-hospital mortality and the risk-adjusted ratio which is based on the observed divided by the expected mortality. From 2014 to 2018, 79 585 ACS patients were enrolled. The average in-hospital mortality was 1.8%. There was a wide variation in the in-hospital mortality among different provinces (0.2-3.9%). Patient characteristics explained part of this variation because of differences in the expected in-hospital mortality (0.7-2.8%). There was a substantial variation in the risk-adjusted ratio among provinces (0.2-3.5), which suggests that the variations in the mortality cannot be completely explained by the differences in patient characteristics. In conclusion, we observed a wide regional variation in mortality for ACS, part of which could be explained by the difference in patient characteristics.
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