| Impact of transesophageal echocardiography on the anticoagulation management of patients admitted with focal cerebral ischemia. | |
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MedLine Citation:
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PMID: 8249849 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Transesophageal echocardiography (TEE) improves the diagnostic accuracy of transthoracic echocardiography in the identification of potential cardiac sources of embolus. However, there are few studies of the impact of TEE on the medical management of patients with focal cerebral ischemia. The records of 52 consecutive, hospitalized patients undergoing both TEE and transthoracic echocardiography for suspected cardiac source of embolus were reviewed to determine the influence of TEE on the decision to anticoagulate patients. Of 52 patients, 39 had focal cerebral ischemia (transient ischemic attack, n = 9; acute cerebral infarction, n = 30). In 4 of these 39 patients (10%), the TEE results changed the management of anticoagulation. In 19 of 39 patients (49%), the TEE results helped confirm anticoagulation decisions, and in 16 (41%), the results had no effect on anticoagulation decisions, because of overriding clinical information. Ten of the latter 16 patients had TEE evidence for a possible source of an embolus, but were not anticoagulated; 5 of these were poor candidates for long-term anticoagulation, and the others had right-to-left shunting across a patent foramen ovale or an interatrial septal aneurysm. Clinical variables (atrial fibrillation, TEE findings and pre-TEE anticoagulation status) were considered as possible predictors of post-TEE anticoagulation status using logistic regression analysis; the strongest predictor of post-TEE anticoagulation status was pre-TEE anticoagulation status (p < 0.0005). Despite the selection of patients presumed to receive maximal benefit from TEE, this study suggests that TEE findings are not predictive of subsequent anticoagulation management. However, TEE is at least confirmatory of anticoagulation decisions in most cases. |
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Authors:
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J S Hata; R W Ayres; J Biller; H P Adams; J E Stuhlmuller; T L Burns; R E Kerber; B F Vandenberg |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The American journal of cardiology Volume: 72 ISSN: 0002-9149 ISO Abbreviation: Am. J. Cardiol. Publication Date: 1993 Sep |
Date Detail:
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Created Date: 1994-01-06 Completed Date: 1994-01-06 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0207277 Medline TA: Am J Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 707-10 Citation Subset: AIM; IM |
Affiliation:
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Department of Internal Medicine, University of Iowa, Iowa City. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Anticoagulants / administration & dosage, therapeutic use* Cerebral Infarction / drug therapy* Decision Making Diagnostic Imaging Echocardiography Echocardiography, Transesophageal* Female Forecasting Heart Diseases / ultrasonography* Heparin / administration & dosage, therapeutic use Humans Intracranial Embolism and Thrombosis / drug therapy*, prevention & control Ischemic Attack, Transient / drug therapy* Male Middle Aged Thrombosis / ultrasonography* Warfarin / administration & dosage, therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 81-81-2/Warfarin; 9005-49-6/Heparin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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