المؤلفون: Cafaro, Teresa, Allwood, Melissa, McIntyre, William F., Park, Lily J., Daza, Julian, Ofori, Sandra N., Ke Wang, Michael, Borges, Flavia K., Conen, David, Marcucci, Maura, Healey, Jeff S., Whitlock, Richard P., Lamy, Andre, Belley-Côté, Emilie P., Spence, Jessica D., McGillion, Michael, Devereaux, P. J.

المساهمون: Trimedic Therapeutics

المصدر: Canadian Journal of Anesthesia/Journal canadien d'anesthésie ; volume 70, issue 11, page 1828-1838 ; ISSN 0832-610X 1496-8975

مصطلحات موضوعية: Anesthesiology and Pain Medicine, General Medicine

الإتاحة: https://doi.org/10.1007/s12630-023-02586-0Test

المؤلفون: Devereaux, P.J., Marcucci, Maura, Painter, Thomas W., Conen, David, Lomivorotov, Vladimir, Sessler, Daniel I., Chan, Matthew T.V., Borges, Flavia K., Martínez-Zapata, María J., Wang, Chew Yin, Xavier, Denis, Ofori, Sandra N., Wang, Michael K., Efremov, Sergey, Landoni, Giovanni, Kleinlugtenbelt, Ydo V., Szczeklik, Wojciech, Schmartz, Denis, Garg, Amit X., Short, Timothy G., Wittmann, Maria, Meyhoff, Christian S., Amir, Mohammed, Torres, David, Patel, Ameen, Duceppe, Emmanuelle, Ruetzler, Kurt, Parlow, Joel L., Tandon, Vikas, Fleischmann, Edith, Polanczyk, Carisi A., Lamy, Andre, Astrakov, Sergey V., Rao, Mangala, Wu, William K.K., Bhatt, Keyur, de Nadal, Miriam, Likhvantsev, Valery V., Paniagua, Pilar, Aguado, Hector J., Whitlock, Richard P., McGillion, Michael H., Prystajecky, Michael, Vincent, Jessica, Eikelboom, John, Copland, Ingrid, Balasubramanian, Kumar, Turan, Alparslan, Bangdiwala, Shrikant I., Stillo, David, Gross, Peter L., Cafaro, Teresa, Alfonsi, Pascal, Roshanov, Pavel S., Belley-Côté, Emilie P., Spence, Jessica, Richards, Toby, VanHelder, Tomas, McIntyre, William, Guyatt, Gordon, Yusuf, Salim, Leslie, Kate

المساهمون: UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire

المصدر: New England Journal of Medicine, Vol. 386, no.21, p. 1986-1997 (2022)

مصطلحات موضوعية: General Medicine

الوصف: BACKGROUND Perioperative bleeding is common in patients undergoing noncardiac surgery. Tranexamic acid is an antifibrinolytic drug that may safely decrease such bleeding. METHODS We conducted a trial involving patients undergoing noncardiac surgery. Patients were randomly assigned to receive tranexamic acid (1-g intravenous bolus) or placebo at the start and end of surgery (reported here) and, with the use of a partial factorial design, a hypotension-avoidance or hypertension-avoidance strategy (not reported here). The primary efficacy outcome was life-threatening bleeding, major bleeding, or bleeding into a critical organ (composite bleeding outcome) at 30 days. The pri- mary safety outcome was myocardial injury after noncardiac surgery, nonhemor- rhagic stroke, peripheral arterial thrombosis, or symptomatic proximal venous thromboembolism (composite cardiovascular outcome) at 30 days. To establish the noninferiority of tranexamic acid to placebo for the composite cardiovascular out- come, the upper boundary of the one-sided 97.5% confidence interval for the hazard ratio had to be below 1.125, and the one-sided P value had to be less than 0.025. RESULTS A total of 9535 patients underwent randomization. A composite bleeding outcome event occurred in 433 of 4757 patients (9.1%) in the tranexamic acid group and in 561 of 4778 patients (11.7%) in the placebo group (hazard ratio, 0.76; 95% confi- dence interval [CI], 0.67 to 0.87; absolute difference, −2.6 percentage points; 95% CI, −3.8 to −1.4; two-sided P<0.001 for superiority). A composite cardiovascular outcome event occurred in 649 of 4581 patients (14.2%) in the tranexamic acid group and in 639 of 4601 patients (13.9%) in the placebo group (hazard ratio, 1.02; 95% CI, 0.92 to 1.14; upper boundary of the one-sided 97.5% CI, 1.14; absolute difference, 0.3 per- centage points; 95% CI, −1.1 to 1.7; one-sided P=0.04 for noninferiority). CONCLUSIONS Among patients undergoing noncardiac surgery, the incidence of the composite bleed- ing outcome was ...

العلاقة: boreal:262972; http://hdl.handle.net/2078.1/262972Test; urn:ISSN:0028-4793; urn:EISSN:1533-4406

الإتاحة: https://doi.org/10.1056/nejmoa2201171Test
http://hdl.handle.net/2078.1/262972Test

المؤلفون: McEwen, Charlotte C., Amir, Takhliq, Qiu, Yuan, Young, Jack, Kennedy, Kevin, Grocott, Hilary P., Kashani, Hessam, Mazer, David, Brudney, Scott, Kavosh, Morvarid, Jacobsohn, Eric, Vedel, Anne, Wang, Eugene, Whitlock, Richard P., Belley-Coté, Emilie P., Spence, Jessica

المصدر: Canadian Journal of Anesthesia/Journal canadien d'anesthésie ; volume 69, issue 6, page 799-800 ; ISSN 0832-610X 1496-8975

مصطلحات موضوعية: Anesthesiology and Pain Medicine, General Medicine

الإتاحة: https://doi.org/10.1007/s12630-022-02205-4Test

المؤلفون: McIntyre, William F., Vadakken, Maria E., Rai, Anand S., Thach, Terry, Syed, Wajahat, Um, Kevin J., Ibrahim, Omar, Dalmia, Shreyash, Bhatnagar, Akash, Mendoza, Pablo A., Benz, Alexander P., Bangdiwala, Shrikant I., Spence, Jessica, McClure, Graham R., Huynh, Jessica T., Zhang, Tianyi, Inami, Toru, Conen, David, Devereaux, P. J., Whitlock, Richard P., Healey, Jeff S., Belley-Côté, Emilie P.

المساهمون: Canadian Stroke Prevention Intervention Network, Canadian Cardiovascular Society (CA) -Bayer Vascular Awards program

المصدر: Canadian Journal of Anesthesia/Journal canadien d'anesthésie ; volume 68, issue 7, page 1045-1056 ; ISSN 0832-610X 1496-8975

مصطلحات موضوعية: Anesthesiology and Pain Medicine, General Medicine

الإتاحة: https://doi.org/10.1007/s12630-021-01944-0Test

المؤلفون: Gupta, Saurabh, Belley-Cote, Emilie P., Eqbal, Adam, McEwen, Charlotte, Basha, Ameen, Wu, Nicole, Cerasuolo, Joshua O., Mehta, Shamir, Schwalm, Jon-David, Whitlock, Richard P.

المساهمون: Hamilton Health Sciences

المصدر: Implementation Science ; volume 16, issue 1 ; ISSN 1748-5908

مصطلحات موضوعية: Public Health, Environmental and Occupational Health, Health Informatics, Health Policy, General Medicine

الوصف: Background Guidelines recommend both acetylsalicylic acid and ticagrelor following acute coronary syndrome (ACS), but appropriate prescription practices lag. We analyzed the impact of government medication approval, national guideline updates, and publicly funded drug coverage plans on P2Y12 inhibitor utilization. Methods Accessing provincial databases, we obtained data for elderly ACS patients in Ontario, Canada, between 2008 and 2018. Using interrupted-time series with descriptive statistics and segmented regression analysis, we evaluated types of P2Y12 inhibitors prescribed at discharge and changes to their utilization in patients managed with percutaneous intervention (PCI), coronary artery bypass grafting (CABG) or medically, following national antiplatelet therapy guidelines (by the Canadian Cardiovascular Society), ticagrelor’s national approval by Health Canada, and ticagrelor’s coverage by a publicly funded medication plan. Results We included 114,142 patients (49.4%-PCI; mean age 75.71±6.94 and 62.3% male and 7.7%-CABG; mean age 74.11±5.63 and 73.5% male). Among PCI patients, clopidogrel utilization declined monthly after 2010 national guidelines were published ( p <0.0001) and within the first month after ticagrelor’s national approval by Health Canada ( p =0.03). Among PCI patients, ticagrelor utilization increased within the first month ( p <0.0001) and continued increasing monthly ( p <0.0001) after its coverage by a publicly funded medication plan. Among PCI patients, clopidogrel utilization declined within the first month ( p =0.003) and ticagrelor utilization increased monthly ( p =0.05) after 2012 CCS guidelines. Among CABG patients, ticagrelor’s coverage was associated with a monthly increase in its utilization ( p <0.0001). Conclusion National guideline updates and drug coverage by a publicly funded medication plan significantly improved P2Y12 inhibitor utilization. Barriers to appropriate antiplatelet therapy in the surgical population must be explored.

الإتاحة: https://doi.org/10.1186/s13012-021-01117-zTest

المؤلفون: Eikelboom, Rachel, Whitlock, Richard P, Muzaffar, Raveen, Lopes, Renato D, Siegal, Deborah, Schulman, Sam, Belley-Côté, Emilie P

المصدر: European Journal of Cardio-Thoracic Surgery ; volume 63, issue 4 ; ISSN 1873-734X

مصطلحات موضوعية: Cardiology and Cardiovascular Medicine, Pulmonary and Respiratory Medicine, General Medicine, Surgery

الوصف: OBJECTIVES We conducted a systematic review and meta-analysis of randomized controlled trials comparing direct oral anticoagulants (DOACs) to vitamin K antagonists (VKAs) in the first 90 days after bioprosthetic valve implantation. METHODS We systematically searched Embase, Medline and CENTRAL. We screened titles, abstracts and full texts, extracted data and assessed the risk of bias in duplicate. We pooled data using the Mantel–Haenzel method and random effects modelling. We conducted subgroup analyses based on the type of valve (transcatheter versus surgical) and timing of initiation of anticoagulation (<7 vs >7 days after valve implantation). We assessed the certainty of evidence using the Grading of Recommendations, Assessments, Development and Evaluation approach. RESULTS We included 4 studies of 2284 patients with a median follow-up of 12 months. Two studies examined transcatheter valves (1877/2284 = 83%) and 2 examined surgical valves (407/2284 = 17%). We found no statistically significant differences between DOACs and VKAs with regard to thrombosis, bleeding, death or subclinical valve thrombosis. However, there was a subgroup trend towards more bleeding with DOACs when initiated within 7 days of valve implantation. CONCLUSIONS In the existing randomized literature on DOACs versus VKAs in the first 90 days after bioprosthetic valve implantation, there appears to be no difference with regard to thrombosis, bleeding or death. Interpretation of the data is limited by small numbers of events and wide confidence intervals. Future studies should focus on surgical valves and should include long-term follow-up to assess any potential impact of randomized therapy on valve durability.

الإتاحة: https://doi.org/10.1093/ejcts/ezad110Test
https://academic.oup.com/ejcts/article-pdf/63/4/ezad110/49871587/ezad110.pdfTest

المؤلفون: Belley-Cote, Emilie P., Whitlock, Richard P., Ulic, Diana V., Honarmand, Kimia, Khalifa, Abubaker, McClure, Graham R., Gibson, Andrew, Alshamsi, Fayez, D’Aragon, Frederick, Rochwerg, Bram, Duan, Erick, Savija, Nevena, Karachi, Tim, Lamontagne, François, Kavsak, Peter, Cook, Deborah J.

المساهمون: Physicians' Services Incorporated Foundation, Hamilton Health Sciences

المصدر: Canadian Journal of Anesthesia/Journal canadien d'anesthésie ; volume 66, issue 6, page 648-657 ; ISSN 0832-610X 1496-8975

مصطلحات موضوعية: Anesthesiology and Pain Medicine, General Medicine

الإتاحة: https://doi.org/10.1007/s12630-019-01375-yTest

المؤلفون: Belley-Cote, Emilie P, Lamy, André, Devereaux, P J, Kavsak, Peter, Lamontagne, François, Cook, Deborah J, Kennedy, Kevin, Vincent, Jessica, Ou, Yongning, Tagarakis, George, Whitlock, Richard P

المساهمون: Canadian Institutes of Health Research, Canada Research Chairs

المصدر: European Journal of Cardio-Thoracic Surgery ; volume 57, issue 1, page 168-175 ; ISSN 1010-7940 1873-734X

مصطلحات موضوعية: Cardiology and Cardiovascular Medicine, Pulmonary and Respiratory Medicine, General Medicine, Surgery

الوصف: OBJECTIVES Using data from the CORONARY trial (n = 4752), we evaluated the incidence and prognostic significance of myocardial infarction (MI) applying different definitions based on peak postoperative creatine kinase-MB isoenzyme and cardiac troponin levels. We then aimed to identify the peak cardiac troponin during the first 3 postoperative days that was independently associated with a 2-fold increase in 30-day mortality. METHODS To combine different assays, we analysed cardiac troponins in multiples of their respective upper limit of normal (ULN). We identified the lowest threshold with a hazard ratio (HR) >2 for 30-day mortality independent of EuroSCORE and on- versus off-pump surgery. RESULTS Depending on the definition used based on creatine kinase-MB, the incidence of MI after coronary artery bypass grafting (CABG) ranged from 0.6% to 19% and the associated HRs for 30-day mortality ranged from 2.7 to 6.9. Using cardiac troponin (1528 patients), the incidence of MI ranged from 1.7% to 13% depending on the definition used with HRs for 30-day mortality ranging from 5.1 to 7.2. The first cardiac troponin threshold we evaluated, 180xULN, was associated with an adjusted HR for 30-day mortality of 7.6 [95% confidence interval (CI) 3.4–17.1] when compared to <130xULN. The next independent threshold was 130xULN with an adjusted HR for 30-day mortality of 7.8 (95% CI 2.3–26.1). The next cardiac troponin tested threshold (70xULN) did not meet criteria for significance. CONCLUSIONS Our results illustrate that the incidence and prognosis of a post-CABG MI varies based on the definition used. Validated post-CABG MI diagnostic criteria formulated from their independent association with important clinical outcomes are needed.

الإتاحة: https://doi.org/10.1093/ejcts/ezz161Test
http://academic.oup.com/ejcts/article-pdf/57/1/168/31496347/ezz161.pdfTest

المؤلفون: McClure, Graham R., Belley-Cote, Emilie P., Harlock, John, Lamy, Andre, Stacey, Michael, Devereaux, P. J., Whitlock, Richard P.

المصدر: Canadian Journal of Anesthesia/Journal canadien d'anesthésie ; volume 66, issue 2, page 182-192 ; ISSN 0832-610X 1496-8975

مصطلحات موضوعية: Anesthesiology and Pain Medicine, General Medicine

الإتاحة: https://doi.org/10.1007/s12630-018-1253-5Test

المؤلفون: McIntyre, William F, Um, Kevin J, Cheung, Christopher C, Belley-Côté, Emilie P, Dingwall, Orvie, Devereaux, Philip J, Wong, Jorge A, Conen, David, Whitlock, Richard P, Connolly, Stuart J, Seifer, Colette M, Healey, Jeff S

المصدر: European Heart Journal: Acute Cardiovascular Care ; volume 8, issue 2, page 130-141 ; ISSN 2048-8726 2048-8734

مصطلحات موضوعية: Cardiology and Cardiovascular Medicine, Critical Care and Intensive Care Medicine, General Medicine

الوصف: Objective: There is uncertainty about the incidence of and prognosis associated with atrial fibrillation that is documented for the first time in the setting of an acute stressor, such as surgery or medical illness. Our objective was to perform a systematic review of the incidence and long-term recurrence rates for atrial fibrillation occurring transiently with stress in the setting of acute medical illness. Data sources: Medline, Embase and Cochrane Central to September 2017. Study selection: We included retrospective and prospective observational studies, and randomised controlled trials. The population of interest included patients hospitalised for medical (i.e. non-surgical) illness who developed newly diagnosed atrial fibrillation. Studies were included if they included data on either the incidence of atrial fibrillation or the rate of atrial fibrillation recurrence in atrial fibrillation occurring transiently with stress patients following hospital discharge. Data extraction: Two reviewers collected data independently and in duplicate. We characterised each study’s methodology for ascertainment of prior atrial fibrillation history, atrial fibrillation during hospitalisation and atrial fibrillation recurrence after hospital discharge. Data synthesis: Thirty-six studies reported the incidence of atrial fibrillation. Ten used a prospective design and included a period of continuous electrocardiographic (ECG) monitoring. Atrial fibrillation incidence ranged from 1% to 44%, which was too heterogeneous to justify meta-analysis ( I 2 =99%). In post-hoc meta-regression models, the use of continuous ECG monitoring explained 13% of the variance in atrial fibrillation incidence, while care in an intensive care unit explained none. Two studies reported the long-term rate of atrial fibrillation recurrence following atrial fibrillation occurring transiently with stress. Neither of these studies used prospective, systematic monitoring. Recurrence rates at 5 years ranged from 42% to 68%. Conclusions: The incidence of ...

الإتاحة: https://doi.org/10.1177/2048872618799748Test