International Journal of Cardiology 173 (2014) e23–e24
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Treatment failure of low molecular weight heparin bridging therapy after implantation of a permanent pacemaker V. Giugno a, F. Messina b, S. Crosca c,⁎ a b c
Emergency Medicine Unit, Hospital of Locri, Reggio Calabria, Italy Diagnostic Radiology Unit, Hospital of Locri, Reggio Calabria, Italy Internal Medicine Unit, Hospital of Lipari, ASP 5 Messina, Italy
a r t i c l e
i n f o
Article history: Received 14 January 2014 Accepted 18 January 2014 Available online 24 January 2014 Keywords: Atrial fibrillation Pulmonary embolism Thrombosis prevention Low molecular weight heparin Oral anticoagulant therapy
Low molecular weight heparin bridging therapy (LMWH-BT) has been considered in patients at high risk of thromboembolism during the start or temporary interruption of oral anticoagulation therapy (OAT). Several cases of treatment failure of LMWH-BT have been reported [1–11]. A 76-year-old man, hypertensive and diabetic with atrial fibrillation of many years, underwent a cardiologic check-up for total BAV. Therapy has been recommended with LMWH to prepare for implantation of a permanent pacemaker. Current therapy with LMWH was standardized according to body weight, and continuing supportive therapy [12–21]. 20 days after he was received in the emergency department with dyspnea, chest pain and desaturation of O2, ECG abnormality was not showed. The patient after 7 days of hospitalization was regularly discharged. Echocardiographic evaluation revealed right atrial and ventricular thrombus tied at catheter (Fig. 1). A computed tomography (CT) performed shows a massive pulmonary embolism [22–29]. Also this case focuses on the failure of treatment with LMWH-BT.
Author contributions Vincenza Giugno conducted the clinical diagnosis. Francesco Messina conceived the case study. Sergio Crosca wrote the work. ⁎ Corresponding author at: Unità Complessa di Medicina Interna, Ospedale di Lipari, Via Sant'Anna n.1, 98055 Messina, Italy. Tel.: +39 3356168172. E-mail address: [email protected] (S. Crosca). 0167-5273/$ – see front matter © 2014 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijcard.2014.01.094
Fig. 1. Thrombus in the right atrium and ventricle, anchored to the catheter.
Acknowledgments The authors of this manuscript have certified that they adhere to the statement of ethical publishing as appears in the International Journal of Cardiology.
References [1] Hendriks JM, Crijns HJ, Tieleman RG, Vrijhoef HJ. The atrial fibrillation knowledge scale: development, validation and results. Int J Cardiol Sep 30 2013;168(2):1422–8. [2] Chao TF, Liu CJ, Chen SJ, et al. CHADS(2) score and risk of new-onset atrial fibrillation: a nationwide cohort study in Taiwan. Int J Cardiol Dec 29 2012;168(2):1360–3. [3] Wu J, Wang J, Jiang S, et al. The efficacy and safety of low intensity warfarin therapy in Chinese elderly atrial fibrillation patients with high CHADS(2) risk score. Int J Cardiol Nov 28 2012. http://dx.doi.org/10.1016/j.ijcard.2012.11.078. [4] Guo Y, Pisters R, Apostolakis S, et al. Stroke risk and suboptimal thromboprophylaxis in Chinese patients with atrial fibrillation: would the novel oral anticoagulants have an impact? Int J Cardiol Sep 20 2013;168(1):515–22. [5] Gooshah Gir AA, Namdar H, Emaratkar E, et al. Avicenna's view on the prevention of thrombosis. Int J Cardiol Jun 5 2013;166(1):274–5. [6] Task Force for Preoperative Cardiac Risk Assessment, Perioperative Cardiac Management in Non-cardiac Surgery, European Society of Cardiology (ESC), Poldermans D, et al. Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. Eur Heart J Nov 2009;30(22):2769–812.
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V. Giugno et al. / International Journal of Cardiology 173 (2014) e23–e24
[7] Imbalzano E, Trapani G, Creazzo M, Lizio G, Saitta A. Coronary artery disease in radiotherapy. Int J Cardiol Oct 9 2013;168(4):e125–6. [8] Imbalzano E, Dattilo G, Scarpelli M, Lo Gullo A, Saitta A. Left coronary artery fistula to right ventricle complicated heart failure in a patient on hemodialysis. Intern Emerg Med Dec 2013;8(8):765–6. [9] Patanè S, Marte F, Risica G, et al. Treatment failure of low molecular weight heparin bridging therapy before a cardiac surgery intervention in a patient with atrial fibrillation. Int J Cardiol Nov 12 2009;137(3):e59–60. [10] Tulino D, Imbalzano E, Casale M, et al. Treatment failure of low molecular weight heparin in diabetic patient. Int J Cardiol Sep 30 2013;168(2):e63–4. [11] Dattilo G, Tulino D, Lamari A, Tulino V, Marte F, Patanè S. Treatment failure of low molecular weight heparin in a patient with an aortic mechanical prosthesis. Int J Cardiol Jan 21 2011;146(2):e30–2. [12] Mandraffino G, Sardo MA, Riggio S, et al. Circulating progenitor cells are increased in newly diagnosed untreated hypertensive patients with arterial stiffening but normal carotid intima-media thickness. Hypertens Res Jul 2011;34(7):876–83. [13] Sardo MA, Mandraffino G, Riggio S, et al. Effects of the angiotensin II receptor blocker losartan on the monocyte expression of biglycan in hypertensive patients. Clin Exp Pharmacol Physiol Sep 2010;37(9):933–8. [14] Tulino V, Cacace C, Tulino D, Imbalzano E, Dattilo G. Clinical variants in Ebstein's anomaly. Int J Cardiol Oct 12 2013;168(5):4969–70. [15] Sardo MA, Mandraffino G, Campo S, et al. Biglycan expression in hypertensive subjects with normal or increased carotid intima-media wall thickness. Clin Chim Acta Aug 2009;406(1–2):89–93. [16] Mandraffino G, Sardo MA, Riggio S, et al. Smoke exposure and circulating progenitor cells: evidence for modulation of antioxidant enzymes and cell count. Clin Biochem Dec 2010;43(18):1436–42. [17] Yu HI, Sheu WH, Lai CJ, Lee WJ, Chen YT. Endothelial dysfunction in type 2 diabetes mellitus subjects with peripheral artery disease. Int J Cardiol Mar 2001;78(1):19–25. [18] Dattilo G, Lamari A, Crosca S, et al. Correlation between insulin resistance and endothelial dysfunction assessed by flow-mediated dilation. Recenti Prog Med Sep 2012;103(9):328–32.
[19] Juhani Airaksinen KE, Korkeila Petri, Lund Juha, et al. Safety of pacemaker and implantable cardioverter–defibrillator implantation during uninterrupted warfarin treatment — the Fin PAC study. Int J Cardiol Oct 9 2013;168(4):3679–82. [20] Elshot Stephen RE, El Gamal Mamdouh IH, Tielen Karel HJ, van Gelder Berry M. Incidence of atrioventricular block and chronic atrial flutter/fibrillation after implantation of atrial pacemakers; follow-up of more than ten years. Int J Cardiol Mar 1993;38(3):303–8. [21] Goktekin Omer, Besoglu Yavuz, Dogan Sait M, et al. Permanent pacemaker lead implantation via azygous vein in a patient with silent superior vena cava syndrome. Int J Cardiol Apr 12 2007;117(1):e4–6. [22] Patanè S, Marte F, Dattilo G, Sturiale M. Changing axis deviation during atrial fibrillation. Int J Cardiol Jan 12 2012;154(1):e1–3. [23] Dattilo G, Patanè S, Zito C, et al. Handgrip exercise associated with dobutamine stress echocardiography. Int J Cardiol Sep 3 2010;143(3):298–301. [24] Imbalzano E, Saitta A, Lamari A, et al. Echo-doppler evaluation of recent onset chronic venous insufficiency in elderly patients: does the heart have a role? Recenti Prog Med Nov 2013;104(11):569–73. [25] Dattilo G, Lamari A, Messina F, et al. The chance finding at multislice computed tomography coronary angiography of an ectopic origin of the left circumflex coronary artery from the right sinus of Valsalva. Int J Cardiol Jun 2 2011;149(2):e43–6. [26] Dattilo G, Carerj S, Lamari A, et al. The chance finding at multislice computed tomography coronary angiography of myocardial bridging. Int J Cardiol Jan 26 2012;154(2):e21–3. [27] Imbalzano E, Creazzo M, Mandraffino G, Sardo MA, Saitta A. Treatment failure of low molecular weight heparin in post-surgery orthopedic case. Int J Cardiol Nov 5 2013;169(3):e36–7. [28] Imbalzano E, Ceravolo R, Di Stefano R, Vatrano M, Saitta A. Treatment failure of low molecular weight heparin bridging therapy in atrial fibrillation after acute coronary syndrome. Int J Cardiol 2014;171(2):289–91. [29] Dattilo G, Lamari A, Di Bella G, et al. Treatment failure of low molecular weight heparin bridging therapy. Int J Cardiol Aug 20 2013;167(4):e106–7.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Treatment failure of low molecular weight heparin bridging therapy after implantation of a permanent pacemaker V. Giugno a, F. Messina b, S. Crosca c,⁎ a b c
Emergency Medicine Unit, Hospital of Locri, Reggio Calabria, Italy Diagnostic Radiology Unit, Hospital of Locri, Reggio Calabria, Italy Internal Medicine Unit, Hospital of Lipari, ASP 5 Messina, Italy
a r t i c l e
i n f o
Article history: Received 14 January 2014 Accepted 18 January 2014 Available online 24 January 2014 Keywords: Atrial fibrillation Pulmonary embolism Thrombosis prevention Low molecular weight heparin Oral anticoagulant therapy
Low molecular weight heparin bridging therapy (LMWH-BT) has been considered in patients at high risk of thromboembolism during the start or temporary interruption of oral anticoagulation therapy (OAT). Several cases of treatment failure of LMWH-BT have been reported [1–11]. A 76-year-old man, hypertensive and diabetic with atrial fibrillation of many years, underwent a cardiologic check-up for total BAV. Therapy has been recommended with LMWH to prepare for implantation of a permanent pacemaker. Current therapy with LMWH was standardized according to body weight, and continuing supportive therapy [12–21]. 20 days after he was received in the emergency department with dyspnea, chest pain and desaturation of O2, ECG abnormality was not showed. The patient after 7 days of hospitalization was regularly discharged. Echocardiographic evaluation revealed right atrial and ventricular thrombus tied at catheter (Fig. 1). A computed tomography (CT) performed shows a massive pulmonary embolism [22–29]. Also this case focuses on the failure of treatment with LMWH-BT.
Author contributions Vincenza Giugno conducted the clinical diagnosis. Francesco Messina conceived the case study. Sergio Crosca wrote the work. ⁎ Corresponding author at: Unità Complessa di Medicina Interna, Ospedale di Lipari, Via Sant'Anna n.1, 98055 Messina, Italy. Tel.: +39 3356168172. E-mail address: [email protected] (S. Crosca). 0167-5273/$ – see front matter © 2014 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijcard.2014.01.094
Fig. 1. Thrombus in the right atrium and ventricle, anchored to the catheter.
Acknowledgments The authors of this manuscript have certified that they adhere to the statement of ethical publishing as appears in the International Journal of Cardiology.
References [1] Hendriks JM, Crijns HJ, Tieleman RG, Vrijhoef HJ. The atrial fibrillation knowledge scale: development, validation and results. Int J Cardiol Sep 30 2013;168(2):1422–8. [2] Chao TF, Liu CJ, Chen SJ, et al. CHADS(2) score and risk of new-onset atrial fibrillation: a nationwide cohort study in Taiwan. Int J Cardiol Dec 29 2012;168(2):1360–3. [3] Wu J, Wang J, Jiang S, et al. The efficacy and safety of low intensity warfarin therapy in Chinese elderly atrial fibrillation patients with high CHADS(2) risk score. Int J Cardiol Nov 28 2012. http://dx.doi.org/10.1016/j.ijcard.2012.11.078. [4] Guo Y, Pisters R, Apostolakis S, et al. Stroke risk and suboptimal thromboprophylaxis in Chinese patients with atrial fibrillation: would the novel oral anticoagulants have an impact? Int J Cardiol Sep 20 2013;168(1):515–22. [5] Gooshah Gir AA, Namdar H, Emaratkar E, et al. Avicenna's view on the prevention of thrombosis. Int J Cardiol Jun 5 2013;166(1):274–5. [6] Task Force for Preoperative Cardiac Risk Assessment, Perioperative Cardiac Management in Non-cardiac Surgery, European Society of Cardiology (ESC), Poldermans D, et al. Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. Eur Heart J Nov 2009;30(22):2769–812.
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V. Giugno et al. / International Journal of Cardiology 173 (2014) e23–e24
[7] Imbalzano E, Trapani G, Creazzo M, Lizio G, Saitta A. Coronary artery disease in radiotherapy. Int J Cardiol Oct 9 2013;168(4):e125–6. [8] Imbalzano E, Dattilo G, Scarpelli M, Lo Gullo A, Saitta A. Left coronary artery fistula to right ventricle complicated heart failure in a patient on hemodialysis. Intern Emerg Med Dec 2013;8(8):765–6. [9] Patanè S, Marte F, Risica G, et al. Treatment failure of low molecular weight heparin bridging therapy before a cardiac surgery intervention in a patient with atrial fibrillation. Int J Cardiol Nov 12 2009;137(3):e59–60. [10] Tulino D, Imbalzano E, Casale M, et al. Treatment failure of low molecular weight heparin in diabetic patient. Int J Cardiol Sep 30 2013;168(2):e63–4. [11] Dattilo G, Tulino D, Lamari A, Tulino V, Marte F, Patanè S. Treatment failure of low molecular weight heparin in a patient with an aortic mechanical prosthesis. Int J Cardiol Jan 21 2011;146(2):e30–2. [12] Mandraffino G, Sardo MA, Riggio S, et al. Circulating progenitor cells are increased in newly diagnosed untreated hypertensive patients with arterial stiffening but normal carotid intima-media thickness. Hypertens Res Jul 2011;34(7):876–83. [13] Sardo MA, Mandraffino G, Riggio S, et al. Effects of the angiotensin II receptor blocker losartan on the monocyte expression of biglycan in hypertensive patients. Clin Exp Pharmacol Physiol Sep 2010;37(9):933–8. [14] Tulino V, Cacace C, Tulino D, Imbalzano E, Dattilo G. Clinical variants in Ebstein's anomaly. Int J Cardiol Oct 12 2013;168(5):4969–70. [15] Sardo MA, Mandraffino G, Campo S, et al. Biglycan expression in hypertensive subjects with normal or increased carotid intima-media wall thickness. Clin Chim Acta Aug 2009;406(1–2):89–93. [16] Mandraffino G, Sardo MA, Riggio S, et al. Smoke exposure and circulating progenitor cells: evidence for modulation of antioxidant enzymes and cell count. Clin Biochem Dec 2010;43(18):1436–42. [17] Yu HI, Sheu WH, Lai CJ, Lee WJ, Chen YT. Endothelial dysfunction in type 2 diabetes mellitus subjects with peripheral artery disease. Int J Cardiol Mar 2001;78(1):19–25. [18] Dattilo G, Lamari A, Crosca S, et al. Correlation between insulin resistance and endothelial dysfunction assessed by flow-mediated dilation. Recenti Prog Med Sep 2012;103(9):328–32.
[19] Juhani Airaksinen KE, Korkeila Petri, Lund Juha, et al. Safety of pacemaker and implantable cardioverter–defibrillator implantation during uninterrupted warfarin treatment — the Fin PAC study. Int J Cardiol Oct 9 2013;168(4):3679–82. [20] Elshot Stephen RE, El Gamal Mamdouh IH, Tielen Karel HJ, van Gelder Berry M. Incidence of atrioventricular block and chronic atrial flutter/fibrillation after implantation of atrial pacemakers; follow-up of more than ten years. Int J Cardiol Mar 1993;38(3):303–8. [21] Goktekin Omer, Besoglu Yavuz, Dogan Sait M, et al. Permanent pacemaker lead implantation via azygous vein in a patient with silent superior vena cava syndrome. Int J Cardiol Apr 12 2007;117(1):e4–6. [22] Patanè S, Marte F, Dattilo G, Sturiale M. Changing axis deviation during atrial fibrillation. Int J Cardiol Jan 12 2012;154(1):e1–3. [23] Dattilo G, Patanè S, Zito C, et al. Handgrip exercise associated with dobutamine stress echocardiography. Int J Cardiol Sep 3 2010;143(3):298–301. [24] Imbalzano E, Saitta A, Lamari A, et al. Echo-doppler evaluation of recent onset chronic venous insufficiency in elderly patients: does the heart have a role? Recenti Prog Med Nov 2013;104(11):569–73. [25] Dattilo G, Lamari A, Messina F, et al. The chance finding at multislice computed tomography coronary angiography of an ectopic origin of the left circumflex coronary artery from the right sinus of Valsalva. Int J Cardiol Jun 2 2011;149(2):e43–6. [26] Dattilo G, Carerj S, Lamari A, et al. The chance finding at multislice computed tomography coronary angiography of myocardial bridging. Int J Cardiol Jan 26 2012;154(2):e21–3. [27] Imbalzano E, Creazzo M, Mandraffino G, Sardo MA, Saitta A. Treatment failure of low molecular weight heparin in post-surgery orthopedic case. Int J Cardiol Nov 5 2013;169(3):e36–7. [28] Imbalzano E, Ceravolo R, Di Stefano R, Vatrano M, Saitta A. Treatment failure of low molecular weight heparin bridging therapy in atrial fibrillation after acute coronary syndrome. Int J Cardiol 2014;171(2):289–91. [29] Dattilo G, Lamari A, Di Bella G, et al. Treatment failure of low molecular weight heparin bridging therapy. Int J Cardiol Aug 20 2013;167(4):e106–7.
