Background: Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) are increasingly used in clinica... more Background: Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) are increasingly used in clinical practice for patients with atrial fibrillation (AF) undergoing catheter ablation. Catheter ablation is an established treatment option for patients with AF, however, it is associated with significant complications such as ischemic stroke and bleeding. We aimed to compare by meta-analytical techniques, the safety and efficacy of NOACs vs. warfarin. Methods: PUBMED, EMBASE, CENTRAL and Scopus were searched for randomized trials comparing uninterrupted NOACs and warfarin in patients undergoing AF catheter ablation. Ischemic and hemorrhagic stroke, major and minor bleeding, cardiac tamponade and access related complications were compared between the two groups. Results: A total of 4 trials with 1173 patients were included in the meta-analysis. NOACs and warfarin, resulted in similar risk of ischemic stroke [Odds ratio (OR); 0.50; 95% confidence interval (CI): (0.12-2.08); P=0.34), major bleeding [0.33(0.09-1.13); P=0.08] including cardiac tamponade [0.54(0.03-9.05); P=0.67] and minor bleeding [1.13(0.80-1.59); P=0.48], and lower risk of access-related complications [0.56(0.31-1.00); P=0.05)]. The findings of this meta-analysis showed that compared to warfarin, periprocedural anticoagulation with NOACs, result in reduced access-related complications and the incidence of ischemic stroke and bleeding was similar in the two groups.
Background: The use of Direct Oral Anticoagulants (DOACs) in patients who have both atrial fibril... more Background: The use of Direct Oral Anticoagulants (DOACs) in patients who have both atrial fibrillation (AF) and end-stage renal disease (ESRD) requiring hemodialysis remains controversial, with warfarin remaining the mainstay of the treatment. As hemodialysis patients were excluded from most clinical DOACs trials, the evidence of their efficacy and safety is lacking in this cohort of patients. Aim: To review the current evidence investigating safety profile and the efficacy of DOACs in comparison with warfarin in patients with AF and end-stage renal disease (ESRD) requiring hemodialysis. We included five studies with a total of 34,516 patients in our meta-analysis. The outcomes were major bleeding, ischemic stroke, systemic embolization, hemorrhagic stroke, gastrointestinal bleeding, minor bleeding, and death. Of these patients, 31,472 (92.14%) received warfarin and 3,044 patients received DOACs (8.91%). No significant differences in the incidence of hemorrhagic stroke, major bleeding, hemodialysis access site bleeding, ischemic stroke, and GI bleeding were found between DOACs and warfarin. However, there were higher rates of systemic embolization, minor bleeding, and death events in patients who received DOACs than in the warfarin group (3.39% vs. 1.97%, P-value = 0.02), (6.78% vs. 2.2%, P-value 0.02), and (11.38% vs. 5.12%, P-value < 0.006) respectively. In patients on dialysis who require anticoagulation for AF, warfarin could be associated with a significant reduction in minor bleeding, systemic embolization, and death compared to DOACs. These findings need to be validated by further prospective studies to address the best strategy to deal with the increased thrombotic and bleeding risks in such patients.
Background: One of the limitations of the right radial access approach is complex vessel anatomy,... more Background: One of the limitations of the right radial access approach is complex vessel anatomy, such as subclavian tortuosity. Several clinical predictors have been proposed for tortuosities, such as older age, female sex and hypertension. In this study, we hypothesised that chest radiography would add predictive value to the traditional predictors. Methods: This prospective blinded study included patients who underwent transradial access coronary angiography. They were classified into four groups according to difficulty: Group I, Group II, Group III and Group IV. Different groups were compared according to clinical and radiographic characteristics. Results: The study included 108 patients (54, 27, 17 and 10 patients in Groups I, II, III and IV, respectively). The rate of crossover to transfemoral access was 9.26%. Age, hypertension and female sex were associated with a greater difficulty and failure rates. Regarding radiographic parameters, a higher failure rate was associated wi...
The degree of coronary collateral development influences the outcome after acute myocardial infar... more The degree of coronary collateral development influences the outcome after acute myocardial infarction and long -term survival. This study aims to assess the factors that influence the development of collaterals in patients with chronic total occlusion (CTO). The study included 70 patients with coronary CTO. The patients were classified according to the presence and the degree of collateral formation using the Rentrop classification. Collaterals were present in 54 patients (77.1%), and 16 patients had no collaterals (22.9%). Patients with collaterals were significantly younger (51.76 ± 7.94) than those without collaterals (59.44 ± 6.26) (P < 0.05). Smokers and diabetic patients had fewer collaterals, while those with hypertension and dyslipidemia had more collaterals (P < 0.05). The duration of angina pectoris was significantly lower in patients without collaterals (8.44 ± 6.562) compared to those having collaterals (11.87 ± 5.45) (P < 0.05). Beta blockers were the only medication that showed significant collateral formation, with 11 patients (68.8%) having faintly visible collaterals, 31 patients (96.9%) partially filling collaterals, and six patients (100%) complete collateral filling versus two patients (12.5%) with nonvisible collaterals. Conclusion: Beta blocker therapy, hypertension, and long duration of angina pectoris were associated with an increase in coronary collateral formation, while diabetes, dyslipidemia, advanced age, and previous MI were all associated with a decrease in collateral formation.
BackgroundThe use of Direct Oral Anticoagulants (DOACs) in patients who have both atrial fibrilla... more BackgroundThe use of Direct Oral Anticoagulants (DOACs) in patients who have both atrial fibrillation (AF) and end-stage renal disease (ESRD) requiring hemodialysis remains controversial, with warfarin remaining the mainstay of the treatment. As hemodialysis patients were excluded from most clinical DOACs trials, the evidence of their efficacy and safety is lacking in this cohort of patients.AimTo review the current evidence investigating safety profile and the efficacy of DOACs in comparison with warfarin in patients with AF and end-stage renal disease (ESRD) requiring hemodialysis.Methods and ResultsWe included five studies with a total of 34,516 patients in our meta-analysis. The outcomes were major bleeding, ischemic stroke, systemic embolization, hemorrhagic stroke, gastrointestinal bleeding, minor bleeding, and death. Of these patients, 31,472 (92.14%) received warfarin and 3,044 patients received DOACs (8.91%). No significant differences in the incidence of hemorrhagic stroke...
This study aims to detect the coronary angiographic predictors of POAF. Methods: This is a prospe... more This study aims to detect the coronary angiographic predictors of POAF. Methods: This is a prospective study that included 100 patients with CAD and sinus rhythm scheduled for CABG. Exclusion included abnormal rhythm, impaired LV systolic function, congenital heart diseases, concomitant valve replacement or previous cardiac operation. Results: Patients were classified into: group I included 22 patients (22%) who developed POAF and Group II: included 78 patients (78%) patients who remained in sinus rhythm. Group I were significantly older than group II (mean age of 65 ± 6.25 in group I versus 54.5 ± 6.7 in group II, p value = 0.001).Left main coronary artery (LM) involvement was higher in group I (50%) versus group II (23.07%), p value = 0.014. There was no significant difference between the two groups regarding number of grafts and echocardiographic data. Conclusion: In our study, patients with advanced age, and those with left main lesion had a higher rate of POAF.
Background: Pulmonary arterial hypertension in congenital heart disease (PAH CHD) is reversed by ... more Background: Pulmonary arterial hypertension in congenital heart disease (PAH CHD) is reversed by early shunt closure, but this potential is lost beyond a certain point of no return. this study was conducted to evaluate the results of simple cardiac shunt closure regarding right ventricular function using speckle tracking and reversibility of pulmonary hypertension, testing the ability of echocardiography to provide information with minimal risk,we aimed to detect right ventricular function in simple cardiac shunt patients before closure using longitudinal strain and to investigate its role in predicting reversibility of pulmonary hypertension after closure
Background: Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) are increasingly used in clinica... more Background: Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) are increasingly used in clinical practice for patients with atrial fibrillation (AF) undergoing catheter ablation. Catheter ablation is an established treatment option for patients with AF, however, it is associated with significant complications such as ischemic stroke and bleeding. We aimed to compare by meta-analytical techniques, the safety and efficacy of NOACs vs. warfarin. Methods: PUBMED, EMBASE, CENTRAL and Scopus were searched for randomized trials comparing uninterrupted NOACs and warfarin in patients undergoing AF catheter ablation. Ischemic and hemorrhagic stroke, major and minor bleeding, cardiac tamponade and access related complications were compared between the two groups. Results: A total of 4 trials with 1173 patients were included in the meta-analysis. NOACs and warfarin, resulted in similar risk of ischemic stroke [Odds ratio (OR); 0.50; 95% confidence interval (CI): (0.12-2.08); P=0.34), major bleeding [0.33(0.09-1.13); P=0.08] including cardiac tamponade [0.54(0.03-9.05); P=0.67] and minor bleeding [1.13(0.80-1.59); P=0.48], and lower risk of access-related complications [0.56(0.31-1.00); P=0.05)]. The findings of this meta-analysis showed that compared to warfarin, periprocedural anticoagulation with NOACs, result in reduced access-related complications and the incidence of ischemic stroke and bleeding was similar in the two groups.
Background: The use of Direct Oral Anticoagulants (DOACs) in patients who have both atrial fibril... more Background: The use of Direct Oral Anticoagulants (DOACs) in patients who have both atrial fibrillation (AF) and end-stage renal disease (ESRD) requiring hemodialysis remains controversial, with warfarin remaining the mainstay of the treatment. As hemodialysis patients were excluded from most clinical DOACs trials, the evidence of their efficacy and safety is lacking in this cohort of patients. Aim: To review the current evidence investigating safety profile and the efficacy of DOACs in comparison with warfarin in patients with AF and end-stage renal disease (ESRD) requiring hemodialysis. We included five studies with a total of 34,516 patients in our meta-analysis. The outcomes were major bleeding, ischemic stroke, systemic embolization, hemorrhagic stroke, gastrointestinal bleeding, minor bleeding, and death. Of these patients, 31,472 (92.14%) received warfarin and 3,044 patients received DOACs (8.91%). No significant differences in the incidence of hemorrhagic stroke, major bleeding, hemodialysis access site bleeding, ischemic stroke, and GI bleeding were found between DOACs and warfarin. However, there were higher rates of systemic embolization, minor bleeding, and death events in patients who received DOACs than in the warfarin group (3.39% vs. 1.97%, P-value = 0.02), (6.78% vs. 2.2%, P-value 0.02), and (11.38% vs. 5.12%, P-value < 0.006) respectively. In patients on dialysis who require anticoagulation for AF, warfarin could be associated with a significant reduction in minor bleeding, systemic embolization, and death compared to DOACs. These findings need to be validated by further prospective studies to address the best strategy to deal with the increased thrombotic and bleeding risks in such patients.
Background: One of the limitations of the right radial access approach is complex vessel anatomy,... more Background: One of the limitations of the right radial access approach is complex vessel anatomy, such as subclavian tortuosity. Several clinical predictors have been proposed for tortuosities, such as older age, female sex and hypertension. In this study, we hypothesised that chest radiography would add predictive value to the traditional predictors. Methods: This prospective blinded study included patients who underwent transradial access coronary angiography. They were classified into four groups according to difficulty: Group I, Group II, Group III and Group IV. Different groups were compared according to clinical and radiographic characteristics. Results: The study included 108 patients (54, 27, 17 and 10 patients in Groups I, II, III and IV, respectively). The rate of crossover to transfemoral access was 9.26%. Age, hypertension and female sex were associated with a greater difficulty and failure rates. Regarding radiographic parameters, a higher failure rate was associated wi...
The degree of coronary collateral development influences the outcome after acute myocardial infar... more The degree of coronary collateral development influences the outcome after acute myocardial infarction and long -term survival. This study aims to assess the factors that influence the development of collaterals in patients with chronic total occlusion (CTO). The study included 70 patients with coronary CTO. The patients were classified according to the presence and the degree of collateral formation using the Rentrop classification. Collaterals were present in 54 patients (77.1%), and 16 patients had no collaterals (22.9%). Patients with collaterals were significantly younger (51.76 ± 7.94) than those without collaterals (59.44 ± 6.26) (P < 0.05). Smokers and diabetic patients had fewer collaterals, while those with hypertension and dyslipidemia had more collaterals (P < 0.05). The duration of angina pectoris was significantly lower in patients without collaterals (8.44 ± 6.562) compared to those having collaterals (11.87 ± 5.45) (P < 0.05). Beta blockers were the only medication that showed significant collateral formation, with 11 patients (68.8%) having faintly visible collaterals, 31 patients (96.9%) partially filling collaterals, and six patients (100%) complete collateral filling versus two patients (12.5%) with nonvisible collaterals. Conclusion: Beta blocker therapy, hypertension, and long duration of angina pectoris were associated with an increase in coronary collateral formation, while diabetes, dyslipidemia, advanced age, and previous MI were all associated with a decrease in collateral formation.
BackgroundThe use of Direct Oral Anticoagulants (DOACs) in patients who have both atrial fibrilla... more BackgroundThe use of Direct Oral Anticoagulants (DOACs) in patients who have both atrial fibrillation (AF) and end-stage renal disease (ESRD) requiring hemodialysis remains controversial, with warfarin remaining the mainstay of the treatment. As hemodialysis patients were excluded from most clinical DOACs trials, the evidence of their efficacy and safety is lacking in this cohort of patients.AimTo review the current evidence investigating safety profile and the efficacy of DOACs in comparison with warfarin in patients with AF and end-stage renal disease (ESRD) requiring hemodialysis.Methods and ResultsWe included five studies with a total of 34,516 patients in our meta-analysis. The outcomes were major bleeding, ischemic stroke, systemic embolization, hemorrhagic stroke, gastrointestinal bleeding, minor bleeding, and death. Of these patients, 31,472 (92.14%) received warfarin and 3,044 patients received DOACs (8.91%). No significant differences in the incidence of hemorrhagic stroke...
This study aims to detect the coronary angiographic predictors of POAF. Methods: This is a prospe... more This study aims to detect the coronary angiographic predictors of POAF. Methods: This is a prospective study that included 100 patients with CAD and sinus rhythm scheduled for CABG. Exclusion included abnormal rhythm, impaired LV systolic function, congenital heart diseases, concomitant valve replacement or previous cardiac operation. Results: Patients were classified into: group I included 22 patients (22%) who developed POAF and Group II: included 78 patients (78%) patients who remained in sinus rhythm. Group I were significantly older than group II (mean age of 65 ± 6.25 in group I versus 54.5 ± 6.7 in group II, p value = 0.001).Left main coronary artery (LM) involvement was higher in group I (50%) versus group II (23.07%), p value = 0.014. There was no significant difference between the two groups regarding number of grafts and echocardiographic data. Conclusion: In our study, patients with advanced age, and those with left main lesion had a higher rate of POAF.
Background: Pulmonary arterial hypertension in congenital heart disease (PAH CHD) is reversed by ... more Background: Pulmonary arterial hypertension in congenital heart disease (PAH CHD) is reversed by early shunt closure, but this potential is lost beyond a certain point of no return. this study was conducted to evaluate the results of simple cardiac shunt closure regarding right ventricular function using speckle tracking and reversibility of pulmonary hypertension, testing the ability of echocardiography to provide information with minimal risk,we aimed to detect right ventricular function in simple cardiac shunt patients before closure using longitudinal strain and to investigate its role in predicting reversibility of pulmonary hypertension after closure
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