Document Detail


The role of antiplatelet agents in the management of patients receiving intracardiac closure devices.
MedLine Citation:
PMID:  16611113     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Transcatheter closure of septal defects has become a widely used alternative to surgery or life-long anticoagulant therapy especially in patients with atrial septal defects (ASD) and patent foramen ovale (PFO). Post-procedural complications include thrombus formation on the occluder in about 0-10% of all cases. Therefore antithrombotic prophylaxis after device implantation is believed to be necessary, but still is variable and remains controversial. To date no randomized studies have been published to assess the optimal anticoagulation strategy. Thus, therapy is based on empirical data, local experience and case reports from the literature. The present review tries to give an overview on most of these mainly retrospective single center studies and summarizes their results. Factors influencing the rate of thrombus formation may be device type, existence of thrombophilic disorders and prophylactic medication. Thrombus formation has been described for each of the existing occluder types without a significant difference between the devices. For antithrombotic prophylaxis, most centers at present use either acetyl salicylic acid alone (ASA; 81 to 325 mg) for 6 months or a combination of ASA and clopidogrel (75 mg) for 6 to 8 weeks followed by ASA for additional 4 to 8 months. Inherited thrombophilic disorders should be excluded before device implantation in order to adapt antithrombotic prophylaxis. Follow-up examinations after device implantation should be performed using TEE within the first 4 weeks after implantation. Thus, thrombi may be recognized early enough to extend the antithrombotic regimen in order to avoid surgical device explantation.
Authors:
Andreas Franke; Harald P Kühl
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current pharmaceutical design     Volume:  12     ISSN:  1381-6128     ISO Abbreviation:  Curr. Pharm. Des.     Publication Date:  2006  
Date Detail:
Created Date:  2006-04-13     Completed Date:  2006-06-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9602487     Medline TA:  Curr Pharm Des     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1287-91     Citation Subset:  IM    
Affiliation:
Medizinische Klinik I, RWTH University Hospital, Pauwelsstr. 30, D52057 Aachen, Germany. AFranke@ukaachen.de
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MeSH Terms
Descriptor/Qualifier:
Fibrinolytic Agents / therapeutic use
Heart Defects, Congenital / surgery*
Heart-Assist Devices* / adverse effects
Humans
Intraoperative Complications / prevention & control
Platelet Aggregation Inhibitors / therapeutic use*
Risk Factors
Thrombosis / diagnosis,  etiology*,  prevention & control*
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Platelet Aggregation Inhibitors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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