Thrombosis - the central problem in clinical cardiology

Petr Widimský

Cor Vasa 2013, 55(2):e85 | DOI: 10.1016/j.crvasa.2013.03.008  

Patency of infarct-related artery and platelet reactivity in patients with ST-segment elevation myocardial infarction

Łukasz A. Małek, Mariusz Kłopotowski, Mateusz Śpiewak, Joanna Waś, Paweł K. Kunicki, Witold Rużyłło, Adam Witkowski

Cor Vasa 2013, 55(2):e126-e130 | DOI: 10.1016/j.crvasa.2012.12.005  

Background: Outcome in ST-segment elevation myocardial infarction (STEMI) is affected by patency of the infarct-related artery (IRA) on the initial angiogram. There is a controversy if preloading with antiplatelet drugs affects initial IRA patency in case of shortening transportation time for primary percutaneous coronary intervention (PCI). The aim of the study was to assess the relation between IRA patency and platelet reactivity on admission after preloading with aspirin and clopidogrel within 2 h to primary PCI.Methods: The study included 49 subjects who received 600 mg of clopidogrel and 300 mg of aspirin and underwent primary PCI within 120...

Pulmonary thromboembolism in congenital heart defects with severe pulmonary arterial hypertension

Monika Kaldarárová, Iveta Šimková, Tatiana Valkovičová, Anna Remková, Vladimír Neuschl

Cor Vasa 2013, 55(2):e170-e175 | DOI: 10.1016/j.crvasa.2013.03.006  

Introduction: Congenital heart defect (CHD) with shunt can lead to severe, even irreversible pulmonary arterial hypertension (PAH); in extreme form to Eisenmenger syndrome (ES). Despite relatively good long-term survival, these patients often suffer from cyanosis and multisystemic dysfunction; where pulmonary artery thrombosis can be a potentially fatal complication. Together with bleeding these are the most frequent causes of non-cardiac death in patients with severe PAH due to CHD.Patients and methods: Prospective study of 40 patients with severe PAH due to CHD (28 female/12 male, median age 41.5 years) was performed, with the aim to analyze...

Topical use of tranexamic acid in cardiac surgery - a review and meta-analysis of four randomized controlled trials

Tomáš Vaněk, Zbyněk Straka

Cor Vasa 2013, 55(2):e184-e189 | DOI: 10.1016/j.crvasa.2012.10.002  

The article deals with the issue of topical use of tranexamic acid in cardiac surgery. Four randomized, double--blind trials comparing tranexamic acid vs. placebo were identified in the available literature (371 patients in total). In all of these studies the topical application of tranexamic acid significantly reduced postoperative blood loss, whereas a significant reduction of transfusion requirements was only described in one of these studies. A meta-analytic approach confirmed a significant reduction in blood loss (in 24 hours) by 321.6 mL on average (95% confidence interval -530.3 mL, -112.9 mL; p = 0.003). Another trial was performed to examine...

Antiplatelet therapy - a pharmacologist's perspective

Jan Bultas

Cor Vasa 2013, 55(2):e86-e94 | DOI: 10.1016/j.crvasa.2013.03.003  

There are only few areas of cardiology that have witnessed such dramatic innovations as that occurring in the treatment and prophylaxis of thrombotic events. Antithrombotic (i.e., antiplatelet and anticoagulation) therapy plays a pivotal role in the prophylaxis of the pandemic of cardiovascular disease. Given the host of triggers activating primary hemostasis, various therapeutic strategies are currently available. The current approach, monotherapy or dual therapy or, possibly, combination therapy with antiplatelet and anticoagulant agents is selected based on the risk of a thrombotic event, dominant disease, and the risk of bleeding.The main problem...

Stroke prevention in patients with atrial fibrillation - anticoagulation strategy 2012

Marcin Syzdół, Michał Tendera

Cor Vasa 2013, 55(2):e95-e100 | DOI: 10.1016/j.crvasa.2013.03.002  

Vitamin K antagonists have been recommended as the only available oral anticoagulants for stroke prevention in patients with atrial fibrillation for many years. Despite their proved effectiveness, there are several limitations and drawbacks of this therapy. Recently three major clinical trials of novel oral anticoagulants clinical trials have been published. Dabigatran, a direct thrombin inhibitor, as well as rivaroxaban and apixaban, direct Xa factor inhibitors, were found to have at least non-inferior efficacy and safety in comparison to vitamin K antagonists for stroke prevention in patients with non-valvular fibrillation. These novel oral anticoagulants...

Oral anticoagulation during atrial fibrillation ablation: Facts and controversies

Maria Dorobantu, Radu Vatasescu

Cor Vasa 2013, 55(2):e101-e106 | DOI: 10.1016/j.crvasa.2012.12.002  

On the background of population ageing atrial fibrillation (AF) has reached epidemic dimensions in deve-loped countries. This condition is associated with major cardiovascular morbidity and mortality mainly due to its thrombo-embolic and heart failure related complications. Left atrial (LA) catheter ablation has emerged as a suitable alternative to antiarrhythmic drugs for sinus rhythm maintenance at least for paroxysmal atrial fibrillation in the settings of no/mild LA dilatation. Chronic oral anticoagulation (OAC) is helpful to prevent AF thromboembolic complications in high-risk patients. OAC is also protective around ablation procedures in patients...

Acute myocardial infarction and acute stroke: what are the differences? Focus on reperfusion therapy

Petr Widimský, Boris Kožnar, Peter Vaško, Tomáš Peisker, Ivana Štětkářová

Cor Vasa 2013, 55(2):e111-e116 | DOI: 10.1016/j.crvasa.2013.02.002  

This review compares acute myocardial infarction and acute stroke - their similarities and differences. The focus is given on reperfusion therapy: pharmacologic, mechanical or combined. The key trials and metaanalyses are described.The published data on iv. thrombolysis show, that even among a subgroup of patients treated within 90 min from stroke onset the trend to lower mortality is not significant and in all other subgroups (i.e. treated after > 90 min) there is a trend towards increased mortality with thrombolytic treatment.The data on combined therapy demonstrate, that there is no benefit from facilitated intervention (iv. thrombolysis...

Novel anti-thrombotic therapy in acute coronary syndromes

Amir Aziz, Shabeena Aziz, Stephen B. Wheatcroft

Cor Vasa 2013, 55(2):e117-e125 | DOI: 10.1016/j.crvasa.2013.01.005  

Despite recent developments in revascularisation, anti-platelet and anti-thrombotic therapies, patients with acute coronary syndromes (ACS) remain at increased risk of recurrent atherothrombotic events. Dual anti-platelet therapy comprising aspirin and platelet P2Y12 receptor inhibition has become the cornerstone of therapy in ACS. However, thrombin-mediated pathways, which contribute to platelet activation and are responsible for the formation of fibrin clot, remain active following initial plaque rupture. Recently, orally administered drugs which directly target thrombin, factor Xa or thrombin-mediated platelet activation have been developed. Efficacy...

Dual platelet inhibition in ACS - The Styrian consensus

Dirk von Lewinski, Herwig Schuchlenz, Reinhard Doppler, Markus Wallner, Burkert Pieske

Cor Vasa 2013, 55(2):e131-e134 | DOI: 10.1016/j.crvasa.2012.11.017  

Dual antiplatelet therapy facilitated treatment of acute coronary syndromes and enabled the wide use of stents after clopidogrel emerged on the market about twenty years ago. Although this was a milestone in cardiology, clopidogrel inherits several disadvantages which are likely to reduce clinical benefit of its use and a new generation of drugs including prasugrel and ticagrelor is now available. One megatrial was done for each substance and various publications regarding subgroups have been published. Since these broad data is difficult to overview, especially for clinicians not focused on cardiology patients, the invasive centers of Styria aimed...

STEMI - The importance of balance between antithrombotic treatment and bleeding risk

Jan Pospíšil, Milan Hromádka, Ivo Bernat, Richard Rokyta

Cor Vasa 2013, 55(2):e135-e146 | DOI: 10.1016/j.crvasa.2013.02.004  

The incidence of ST elevation myocardial infarction (STEMI) is around 66 STEMI per 100,000 of population/year, with 6-12% hospital mortality in unselected patients [1]. Modern treatment strategies for STEMI are based on immediate antithrombotic treatment and primary percutaneous coronary intervention (PCI) with stent implantation. Therapy with combination of two or even three more potent antiplatelet and anticoagulant agents reduces both short-term and long-term ischemic risk, morbidity and mortality; on the other hand it is associated with higher risks of bleeding. The first part of this review is focused on the pathogenesis of thrombi in STEMI patients...

Stent thrombosis and platelet reactivity

Elisabetta Ricottini, Fabio Mangiacapra, Germano Di Sciascio

Cor Vasa 2013, 55(2):e151-e157 | DOI: 10.1016/j.crvasa.2013.03.005  

Stent thrombosis (ST) is a rare but potentially life-threatening event that can follow percutaneous coronary intervention (PCI) with stent implantation. Several factors related to procedure or patient features can favor thrombus formation and development of ST. Dual antiplatelet therapy (DAPT) with aspirin and P2Y12 inhibitors is the cornerstone of strategy for reducing incidence of ST. Two main causes of DAPT failure have been identified: the inappropriately premature antiplatelet therapy discontinuation and hyporesponsiveness to antiplatelet drugs. There is growing evidence that a residual high on-treatment platelet reactivity (HPR) is associated...

Antithrombotic therapy in valvular heart disease and artificial valves

Hana Línková, Róbert Petr

Cor Vasa 2013, 55(2):e158-e163 | DOI: 10.1016/j.crvasa.2013.01.008  

The article summarizes the current recommendations and knowledge for the treatment of patients with artificial valves. The attention is focused on antithrombotic therapy after valve replacement, including possible complications of the treatment, particularly thromboembolic and bleeding complications. We review the procedures when the anticoagulation must be interrupted. The possibilities of improving therapy in patients that require permanent anticoagulation and the outlook for the future are discussed.

Antithrombotic therapy in patients after valve surgery with special attention to the combination of anticoagulant and antiplatelet therapy

Miroslav Brtko, Jaroslav Dušek

Cor Vasa 2013, 55(2):e164-e169 | DOI: 10.1016/j.crvasa.2013.01.009  

Patients after implantation of mechanical valves need life-long anticoagulant therapy. Nearly 30% of these patients have also indication for antiplatelet therapy because of concomitant ischemic heart disease or peripheral arterial disease. Combined anticoagulant and dual antiplatelet therapy (so called triple therapy - aspirin, clopidogrel and vitamin K antagonists) is indicated in patients with acute coronary syndrome and after percutaneous coronary intervention (PCI) for a different time according to the type of stent used during the procedure. Triple therapy is substantially more efficacious in reducing the occurrence of cardiovascular events and...

Imaging of intracardiac thrombus

Sibel Turhan, Ozgur Ulas Ozcan, Cetin Erol

Cor Vasa 2013, 55(2):e176-e183 | DOI: 10.1016/j.crvasa.2013.02.005  

Intracardiac thrombus is an important clinical condition because of its potential complications. Detection of ventricular thrombi is generally performed by transthoracic echocardiography while atrial thrombi are generally evaluated by transesophageal echocardiography. Contrast-enhanced computerized tomography is more sensitive for detecting ventricular and atrial thrombi than transthoracic echocardiography, but the technique has been demonstrated to be inferior to transesophageal echocardiography for displaying atrial thrombi. Cardiac magnetic resonance imaging provides superior specificity for evaluation of tissue characteristics and helps to differentiate...

Current opinion on aspirin in primary prevention of atherosclerotic cardiovascular diseases. Is there any difference between diabetic and non-diabetic patients?

Barbora Nussbaumerová, Hana Rosolová

Cor Vasa 2013, 55(2):e190-e195 | DOI: 10.1016/j.crvasa.2012.11.019  

Aspirin reduces vascular death by approximately 15% and nonfatal vascular events by about 30% in secondary prevention. The evidence in primary prevention in non-diabetic subjects is not so powerful. The benefit of aspirin primary prevention in type 2 diabetes remains to be advocated definitely.

Prevention of arterial and venous thrombosis in cancer patients

Michael Aschermann

Cor Vasa 2013, 55(2):e196-e200 | DOI: 10.1016/j.crvasa.2013.03.001  

Patients with cancer have prothrombotic and hypercoagulable state, which leads to higher risk for venous thromboembolism and other clinical manifestations of thromboses. Pathophysiology of thrombosis in cancer patients is influenced by many factors, different from patients without malignancy. Tumor cells express tissue factor and other procoagulant factors and during tumors invasive growth, dissemination and metastasis process tumor cells interact with endothelial cells, leukocytes, monocytes and platelets. Increased platelet activation and aggregability as well as changes in coagulation and fibrinolysis are present in cancer and especially in metastatic...

Protocols of antithrombotic therapy in a University Cardiocenter

Petr Widimský, Zuzana Moťovská, Tomáš Vaněk, Hana Línková, Viktor Kočka

Cor Vasa 2013, 55(2):e201-e206 | DOI: 10.1016/j.crvasa.2013.02.006  

This article presents local protocols for antithrombotic therapy used in a tertiary care institution - the cardiocenter of a university hospital. The protocols were discussed in detail among the whole team of physicians of the cardiocenter. This article addresses cardiac conditions requiring hospitalization whenever antithrombo-tic therapy is indicated. These protocols do not include antithrombotic therapy in other medicinal disciplines (e.g., orthopedics, surgery). These protocols are mostly based on the current guidelines of the European Society of Cardiology (ESC). The partial differences between the ESC guidelines and this text are usually based...

Acute stroke in a young healthy woman with hormonal contraception: Direct percutaneous thrombectomy with stent-retriever followed by full neurologic recovery

Peter Vaško, Boris Kožnar, Ivana Štětkářová, Tomáš Peisker, Petr Widimský

Cor Vasa 2013, 55(2):e107-e110 | DOI: 10.1016/j.crvasa.2013.02.001  

Healthy 46-year old woman with hormonal contraception suffered from severe acute hemispheral stroke caused by occlusion of medial cerebral artery. Percutaneous intervention using Solitaire® stent-retriever was started within 30 min of arrival. Complete thrombectomy was followed by full recovery of neurological deficit within several hours. Neither thrombolysis nor general anesthesia was used.

Stent thrombosis due to stent fracture in heavily calcified right coronary artery

Zoltán Ruzsa, György Szabó, Zoltán Jambrik, Balázs Berta, Levente Molnár, István Édes, Béla Merkely

Cor Vasa 2013, 55(2):e147-e150 | DOI: 10.1016/j.crvasa.2012.12.006  

Coronary stent fracture is an often unrecognized cause of target vessel failure, however, it has been reported more frequently in the drug-eluting stent era. Clinical presentation of stent fracture may range from benign in-stent restenosis to potentially fatal acute stent thrombosis. Interventional treatment of stent thrombosis can be carried out by high pressure balloon dilatation or second stent implantation into the stented segment after thrombus aspiration. Intravascular ultrasound is mandatory in order to exclude mechanical problems in the background of the stent thrombosis and to achieve good final stent apposition and expansion. We report on...

Výhody fixní kombinace telmisartan/amlodipin v léčbě hypertenze

Jiří Widimský jr.

Cor Vasa 2013, 55(2):255-257  

Zápis ze schůze výboru ČKS konané dne 8. 1. 2013 v Brně

P. Widimský, I. Pavézková

Cor Vasa 2013, 55(2):261-262  

Zpráva z VI. kongresu kardiologických sester s mezinárodní účastí v Ostravě 18.-19. října 2012

Mgr. Ludmila Klemsová, Mgr. Margita Mikátová

Cor Vasa 2013, 55(2):263-264  

VI. edukačně-odborná konference kardiologických sester a spřízněných profesí České kardiologické společnosti, o. s., z pohledu dvou účastnic

Jitka Panská, Radka Trčková

Cor Vasa 2013, 55(2):264  

Prof. MUDr. Vladimír Staněk, CSc., FESC, 80 let

prof. MUDr. Jiří Widimský, DrSc., FESC

Cor Vasa 2013, 55(2):247-248  

Prof. MUDr. Vladimír Staněk, CSc., FESC - k 80. narozeninám

Doc. MUDr. Ivan Málek, CSc.

Cor Vasa 2013, 55(2):249-250  

Významné životní jubileum prof. MUDr. Vladimíra Staňka, CSc., FESC

Prof. MUDr. Michael Aschermann, DrSc., FESC

Cor Vasa 2013, 55(2):251  

Významné životní jubileum prof. MUDr. Karla Horkého, DrSc.

Prof. MUDr. Michael Aschermann, DrSc.

Cor Vasa 2013, 55(2):252  

Významné výročí prof. MUDr. Františka Kölbela, DrSc., FACC

Prof. MUDr. Jaromír Hradec, CSc., FESC

Cor Vasa 2013, 55(2):253-254  

Zemřel prof. Alexander Schirger, MD

Prof. MUDr. Jiří Vítovec, CSc., FESC, doc. MUDr. Tomáš Kára, Ph.D.

Cor Vasa 2013, 55(2):259-260  

Editorial Board

Editorial board

Cor Vasa 2013, 55(2):i | DOI: 10.1016/S0010-8650(13)00045-3