Cardiol Rev

Rivaroxaban: an oral direct factor Xa inhibitor for the prevention of thromboembolism.

Aug 252009

Rivaroxaban: an oral direct factor Xa inhibitor for the prevention of thromboembolism.

Cardiol Rev. 2009 Jul-Aug;17(4):192-7

Authors: Chen T, Lam S

Rivaroxaban is a novel oral direct factor Xa inhibitor. It is currently awaiting approval from the US Food and Drug Administration as a prophylaxis for venous thromboembolism in total knee and hip replacements. Based on phase II and III trials, rivaroxaban has been shown to be as efficacious, if not more, as traditional antithrombotic therapy with similar safety profiles. The Regulation of Coagulation in Major Orthopedic Surgery Reducing the Risk of Deep Vein Thrombosis and Pulmonary Embolism (RECORD) phase III trials have shown rivaroxaban 10 mg once daily to be superior to the low molecular weight heparin, enoxaparin, when used for prophylaxis of venous thromboembolism in orthopedic surgeries. Rivaroxaban has been shown to have tolerable adverse effects and a low potential for drug-drug or drug-food interactions. It has the major advantages of once daily oral dosing and no required laboratory monitoring, giving it the potential to replace current antithrombotics in the market today.

PMID: 19525681 [PubMed - indexed for MEDLINE]

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Evaluation of patients after coronary artery bypass grafting.

Cardiol Rev Start a Discussion »

Aug 252009

Evaluation of patients after coronary artery bypass grafting.

Cardiol Rev. 2009 Jul-Aug;17(4):176-80

Authors: Wann S, Balkhy H

Modern techniques for coronary artery bypass graft (CABG) are highly successful. Nevertheless, over time, grafts do fail and native coronary artery disease does progress. Follow-up of patients after CABG should focus on secondary prevention, including careful attention to all modifiable risk factors for cardiovascular disease. Routine stress testing with or without imaging is usually not necessary if the patient is asymptomatic and engaging in normal physical activities, including moderate exercise without difficulty. Stress testing with electrocardiographic monitoring alone or in conjunction with nuclear myocardial perfusion imaging or echocardiography is commonly used if a patient develops recurrent symptoms post-CABG or is at particular high risk for complications. Computed tomography coronary angiography is a new, very powerful, noninvasive technique that can directly visualize both CABG and the native coronary arteries. Computed tomography coronary angiography is complimentary to functional stress testing in that it provides anatomic information about graft patency and native coronary artery stenoses, but the functional significance of these findings may still require stress testing with nuclear or ultrasound imaging. Further technical improvements, both in surgical techniques and in imaging, and prospective multicenter trials, are needed to better define the best methods for following patients post-CABG.

PMID: 19525679 [PubMed - indexed for MEDLINE]

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Treatment of atrial fibrillation and atrial flutter: Part II.

Cardiol Rev 1 Response »

Nov 212008

Treatment of atrial fibrillation and atrial flutter: Part II.

Cardiol Rev. 2008 Sep-Oct;16(5):230-9

Authors: Aronow WS

Atrial fibrillation (AF) is often complicated by a life-threatening ventricular response, and emergency electrocardioversion and/or drug therapy to reduce the rapid ventricular rate may be necessary. However, patients with AF and Wolff-Parkinson-White syndrome should not be given digoxin or calcium channel blockers. Elective direct current (DC) cardioversion has a higher success rate and a lower incidence of cardiac adverse effects than does medical cardioversion in converting AF to sinus rhythm. Unless transesophageal echocardiography has shown no thrombus in the left atrial appendage before cardioversion, oral warfarin should be given for 3 weeks before elective direct current or drug cardioversion of AF and continued for at least 4 weeks after maintenance of sinus rhythm. Many cardiologists prefer, especially in older patients, ventricular rate control plus warfarin rather than maintaining sinus rhythm with antiarrhythmic drugs. Patients with chronic or paroxysmal AF at high risk for stroke should be treated with long-term warfarin to achieve an international normalized ratio of 2.0-3.0. Patients with AF at low risk for stroke or with contraindications to warfarin should be treated with aspirin 325 mg daily. Management of atrial flutter is similar to management of AF.

PMID: 18708824 [PubMed - indexed for MEDLINE]

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Etiology, pathophysiology, and treatment of atrial fibrillation: part 1.

Cardiol Rev Start a Discussion »

Aug 142008

Etiology, pathophysiology, and treatment of atrial fibrillation: part 1.

Cardiol Rev. 2008 Jul-Aug;16(4):181-8

Authors: Aronow WS

Atrial fibrillation (AF) is associated with a higher incidence of mortality, stroke, and coronary events than is sinus rhythm. AF with a rapid ventricular rate may cause a tachycardia-related cardiomyopathy. Immediate direct-current cardioversion should be performed in patients with AF and acute myocardial infarction, chest pain due to myocardial ischemia, hypotension, severe heart failure, or syncope. Intravenous beta blockers, verapamil, or diltiazem may be given to immediately slow a very rapid ventricular rate in AF. An oral beta blocker, verapamil, or diltiazem should be used in persons with AF if a fast ventricular rate occurs at rest or during exercise despite digoxin. Amiodarone may be used in selected patients with symptomatic life-threatening AF refractory to other drugs. Digoxin should not be used to treat patients with paroxysmal AF. Nonpharmacologic therapies should be used in patients with symptomatic AF in whom a rapid ventricular rate cannot be slowed by drugs. This is part 1 of a 2-part review of the etiology, pathophysiology, and treatment of atrial fibrillation. The second part will be published in the subsequent issue of Cardiology in Review.

PMID: 18562808 [PubMed - indexed for MEDLINE]

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Hypertrophic cardiomyopathy: etiology, diagnosis, and treatment.

Cardiol Rev Start a Discussion »

Aug 142008

Hypertrophic cardiomyopathy: etiology, diagnosis, and treatment.

Cardiol Rev. 2008 Jul-Aug;16(4):172-80

Authors: Ramaraj R

Hypertrophic cardiomyopathy (HCM) is a disease characterized by primary hypertrophy of the left (and sometimes right) ventricle. The clinical manifestations of the disease are dyspnea, angina, and a continuum encompassing lightheadedness, presyncope, syncope, and sudden death. Although HCM is often caused by an identifiable mutation in a gene coding for a sarcomeric protein and inherited in an autosomal-dominant pattern, many patients do not have any relatives in whom the disease is manifest. The prevalence of HCM is estimated to be 0.2%, with nearly 600,000 Americans affected. This limited exposure of clinicians to HCM understandably accounts for the uncertainty that prevails regarding this disease and its management.

PMID: 18562807 [PubMed - indexed for MEDLINE]

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Cardiovascular considerations in patients undergoing gastrointestinal endoscopy.

Cardiol Rev Start a Discussion »

Apr 112008

Cardiovascular considerations in patients undergoing gastrointestinal endoscopy.

Cardiol Rev. 2008 Mar-Apr;16(2):76-81

Authors: Ross C, Frishman WH, Peterson SJ, Lebovics E

Gastrointestinal endoscopies are common procedures for diagnosis and treatment. Patients with various cardiovascular conditions can undergo these procedures, including those patients with acute myocardial infarction, but appropriate precautions need to be maintained, especially with procedure-induced autonomic nervous system pertubations that can affect heart rate and blood pressure. In this article, treatment recommendations are included for those patients undergoing endoscopy who are receiving anticoagulation and for those who are at risk for bacterial endocarditis.

PMID: 18281909 [PubMed - indexed for MEDLINE]

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