Venous thromboembolism in patients hospitalized in internal medicine wards.

Minerva Med. 2011 Feb;102(1):93-101

Authors: Campanini M, Lunati F, Dugnani M, Re R

Venous thromboembolism (VTE) is one of the main causes of morbility and mortality in the ospedalized patients. Epidemiologist studies have also demonstrated that VTE is an important and frequent problems in medical patients. In surgical patients is done with greater frequency, but in medical patients prophylaxis is not completely codified and less often less practiced. This review shows epidemiological data, risk factors and classification of the risk of VTE in patients with medical pathologies. Then meta-analyses studies and main studies such as Medenox, Prevent and Artemis, that have examined the prophylaxis of VTE in medical patients are described and discussed, along with their results concerning morbility and mortality. The current problems of prophylaxis in medical patients are reviewed , such as duration of treatment, optimal dosage of the low molecular weight heparin (LMWH) and the correct risk assessment of VTE. EXCLAIM Study has showed the benefit of extended prophylaxis with statistically significant reduction in VTE events.

PMID: 21317851 [PubMed - indexed for MEDLINE]

Atrial fibrillation in the elderly.

Minerva Med. 2009 Apr;100(2):145-50

Authors: Wetzel U, Hindricks G, Piorkowski C

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and its prevalence is increasing with age. With aging of the population treatment of atrial fibrillation especially in elderly population is a growing task for all medical staff working with elderly patients. Treatment of atrial fibrillation especially in elderly patients has to focus on prevention of thromboembolism as well as symptom relief with rate or rhythm control. This review article will focus on medical and non-pharmacological treatment options for the treatment of atrial fibrillation in elderly patients.

PMID: 19390500 [PubMed - indexed for MEDLINE]

Management of atrial fibrillation in the elderly.

Minerva Med. 2009 Feb;100(1):3-24

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 (DC) 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, diltiazem, or verapamil may be administered to slow immediately 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. Nondrug therapies should be performed in patients with symptomatic AF in whom a rapid ventricular rate cannot be slowed by drugs. Paroxysmal AF associated with the tachycardia-bradycardia syndrome should be treated with a permanent pacemaker in combination with drugs. A permanent pacemaker should be implanted in patients with AF and symptoms such as dizziness or syncope associated with ventricular pauses greater than 3 seconds which are not drug-induced. Elective 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 DC 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 antiar-rhythmic 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 to 3.0. Patients with AF at low risk for stroke or with contraindications to warfarin should be treated with aspirin 325 mg daily.

PMID: 19182738 [PubMed - indexed for MEDLINE]