A national survey of antimicrobial prophylaxis in adult cardiac surgery across Canada.

Objective: To characterize national and regional patterns of antimicrobial prophylaxis in adult cardiac surgery across Canada.

Design: Retrospective, cross-sectional analysis.

Setting: Thirty-three adult cardiac surgical centres across Canada.

Comparison of enoxaparin versus heparin during elective percutaneous coronary intervention performed with either eptifibatide or tirofiban (the ACTION Trial).

Limited data are available with regard to the pharmacodynamics and safety of combining enoxaparin with glycoprotein IIb/IIIa inhibition during elective percutaneous coronary interventions (PCIs). We randomized 200 patients to receive open-label enoxaparin (0.75 mg/kg intravenous bolus) or unfractionated heparin (60 U/kg intravenous bolus) and eptifibatide or tirofiban during PCI.

High mortality with ST elevation myocardial infarction in a nontrial setting.

Background: Early mortality following ST elevation myocardial infarction (MI) is declining in trial and nontrial settings. Absolute rates in nontrial settings remain significantly higher than those seen in randomized controlled trials. It is unclear if this mortality difference is due to different patient characteristics or to less frequent use of reperfusion strategies.

Risk stratification, management and outcomes of patients with non-ST elevation acute coronary syndrome: a Canadian teaching hospital perspective.

Background: Current guidelines for non-ST elevation acute coronary syndromes (NSTACS) recommend tailoring the intensity of therapeutic management according to the baseline risk of the patient. Although the clinical characteristics, risk stratification and therapeutic management of contemporary patients with NSTACS have been reported for other geographical regions, this information has not been documented from a Canadian perspective.

Objectives: To describe the baseline clinical characteristics, therapeutic management and clinical outcomes of contemporary patients with NSTACS at a Canadian, tertiary care, teaching hospital, and to retrospectively risk stratify the patients with NSTACS according to the American College of Cardiology (ACC)/American Heart Association (AHA) and Thrombolysis in Myocardial Infarction (TIMI) risk guidelines to characterize management and outcomes according to the various risk classifications.

Acute thrombocytopenia associated with eptifibatide therapy.

Background: Platelet glycoprotein (GP) IIb/IIIa receptor blockade improves clinical outcomes in percutaneous coronary interventions and in acute coronary syndromes. Thrombocytopenia is a serious complication well described with the use of the prototype GPIIb/IIIa inhibitor abciximab. Its association with other agents of this class has been underemphasized.

Use of OTC and herbal products in patients with cardiovascular disease.

Background: The use of nonprescription and herbal products by the public is rising, resulting in an increased potential for adverse reactions or drug interactions in cardiac patients.

Objective: To describe the utilization patterns for nonprescription medications and herbal products in patients with cardiovascular disease across Canada.

Methods: Patients admitted to 8 teaching hospitals during the winter of 1998/1999 were interviewed by a pharmacist using a structured survey instrument.

The importance of in-hospital statin therapy for patients with acute coronary syndromes.

Starting lipid-lowering therapy in the hospital, especially with statins, has become an important component in the management of patients with acute coronary syndromes (ACS). It improves outcomes and increases patient motivation and long-term adherence. In addition, discontinuation of statin therapy in patients with ACS after hospital admission is associated with an increased risk of adverse outcomes.

Thrombotic thrombocytopenic purpura associated with clopidogrel: further evaluation.

Background: Eleven cases of thrombotic thrombocytopenic purpura (TTP) associated with clopidogrel therapy have been published.

Objectives: To perform a comprehensive causality assessment of the 11 published cases of TTP to assess quantitatively the extent to which clopidogrel was the causative factor.

Methods: The 11 reports of TTP were analyzed using the Bayesian Adverse Reaction Diagnostic Instrument to calculate the posterior probability (PsP) that clopidogrel caused the TTP based on epidemiological and clinical trials data (expressed as prior odds) and the clinical characteristics of each case (expressed as likelihood ratios).

Clopidogrel in interventional cardiology: questions answered and questions remaining.

Clopidogrel is appropriate as a replacement for ticlopidine when used in combination with acetylsalicylic acid in the setting of percutaneous coronary intervention (PCI). Compared with ticlopidine, clopidogrel has comparable efficacy in reducing adverse cardiac events and a lower risk of hematological toxicity; both medications have been associated with rare cases of the very serious syndrome of thrombotic thrombocytopenic purpura. Clopidogrel should preferably be initiated with a loading dose of 300 mg before PCI, because most cases of thrombotic stent occlusion occur shortly after stent implantation, and attainment of target platelet inhibition is delayed for several days if a loading dose is not given.