Introduction. Sepsis and its consequences such as metabolic acidosis are resulting in increased mortality. Although correction of metabolic acidosis with sodium bicarbonate seems a reasonable approach, there is ongoing debate regarding the role of bicarbonates as a therapeutic option. Methods. We conducted a PubMed literature search in order to identify published literature related to the effects of sodium bicarbonate treatment on metabolic acidosis due to sepsis. The search included all articles published in English in the last 35 years. Results. There is ongoing debate regarding the use of bicarbonates for the treatment of acidosis in sepsis, but there is a trend towards not using bicarbonate in sepsis patients with arterial blood gas pH > 7.15. Conclusions. Routine use of bicarbonate for treatment of severe acidemia and lactic acidosis due to sepsis is subject of controversy, and current opinion does not favor routine use of bicarbonates. However, available evidence is inconclusive, and more studies are required to determine the potential benefit, if any, of bicarbonate therapy in the sepsis patient with acidosis.
The most frequent arrhythmia treated is atrial fibrillation (AF), which necessitates the use of oral anticoagulants (OACs) to reduce the risk of thromboembolism and stroke. Patients with chronic kidney disease are more likely to develop AF, with a 10% frequency among those on chronic dialysis. Warfarin is the most widely prescribed OAC for individuals with end-stage kidney disease (ESKD). On the other hand, direct OACs (DOACs) are generally safer than warfarin, with fewer fatal bleeding events and a fixed dose that does not require close international normalized ratio (INR) monitoring. For those patients, warfarin and apixaban appear to be FDA-approved, whereas dabigatran, rivaroxaban, and edoxaban are not recommended yet. Due to a lack of large randomized studies, data from major trials cannot be extended to dialysis patients. In this review, we summarize the available data and literature referring to patients on chronic hemodialysis with concomitant AF. Due to the scarcity of data, we try to assist clinicians in selecting the appropriate therapy according to the specific characteristics of each patient. Finally, future directions are provided in two key areas of focus: left atrial appendage closure therapies and genetic research.
Introduction Coronary calcification impedes proper stent deployment and expansion leading to an increased risk of adverse outcomes. Coronary Intravascular Lithotripsy (IVL) technology uses localized pulsative sonic pressure waves to disrupt subendothelial calcification and constitutes a promising technique for patients with severe coronary calcification. Purpose Our aim was to systematically review and summarize available data regarding the safety and efficacy of IVL in preparing severely calcified coronary plaques before stenting. Methods This study was conducted according to the PRISMA guidelines. We systematically searched PubMed, SCOPUS and Cochrane databases, from their inception to February 20, 2021 for studies assessing characteristics and outcomes of patients undergoing IVL before stent implantation. A random effects model meta-analysis was performed to assess the diameter of the vessel lumen before and after IVL along with the presence of major adverse cardiac events (MACE). Results Eight studies comprising 971 patients were included in this meta-analysis. Mean age was 72.22±8.8 years and the majority of patients were males (78.4%). The overall success rate was 94% (95% CI: 90%-98%), while the in-hospital and 30-days incidence of MACE, MI and death were 8% (95% CI: 3%-14%), 10% (95% CI: 7%-14%), and 1% (95% CI: 0%-1%), respectively. There was a significant increase in the vessel diameter (SMD: 4.03, 95% CI: 3.32–4.74, I2=92%) and the lumen area (SMD: 1.17, 95% CI: 0.78–1.55, I2=84.7%), while decrease was observed in the diameter stenosis (SMD: −6.29, 95% CI: −7.65 to −4.92, I2=96.4%) post-IVL when compared to pre-IVL. Mean acute luminal gain following IVL was estimated to be 1.54±0.5mm. Conclusions IVL seems to be an effective and safe technique for preparing severely calcified lesions before PCI. Future prospective cohorts are needed to validate our results. FUNDunding Acknowledgement Type of funding sources: None.
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