PubMed Health⌕ Search

Biomedical subjects

Italo de Luca

Publications and source records attributed to Italo de Luca.

11 recordsLinked to original sources
PubMed2006

Antithrombotic therapy in atrial fibrillation: beyond the AFFIRM study.

In the last few decades several clinical studies evaluated the efficacy and safety of different strategies for antithrombotic prophylaxis to prevent thromboembolic events in patients with atrial fibrillation (AF). Nowadays, a frequently debated point is related to the high embolic risk deriving from the asymptomatic and symptomatic AF recurrence after cardioversion or in paroxysmal AF, especially in patients with a large number of prolonged episodes of AF. In fact, after the recent AFFIRM and RACE trials, patients after successful cardioversion at risk for thromboembolism could also need lifelong anticoagulation. Considering this, should we anticoagulate all patients with clinical risk factors for thromboembolism with a single episode of AF, without considering the hemorrhagic risk? Based on recent trials, it is reasonable to hypothesize that long AF recurrences (> 48 h), both symptomatic and asymptomatic, are present mostly (if not exclusively) in patients with structural left atrial appendage (LAA) dysfunction and remodeling. Conversely, AF recurrences in patients without LAA dysfunction and remodeling, could be too short to allow thrombi formation in the LAA, and the anticoagulation could also be avoided. Once other clinical and echocardiographic determinants of stroke have been excluded, the LAA velocity could select patients with a normal appendage function at low embolic risk who could benefit from anti-aggregation and patients with irreversible appendage dysfunction, at high embolic risk, who need lifelong anticoagulation.

Anticoagulants↗
PubMed2005

The emerging role of echocardiography in the screening of patients at risk of heart failure.

A large number of patients without symptoms of heart failure (HF) have asymptomatic left ventricular (LV) dysfunction owing to the compensatory mechanisms acting through the autonomic nervous system and neurohormones. In the setting of screening for prevention, one must identify the subgroup of these patients at high risk for symptomatic HF to establish appropriate therapy. As a first step to identify the subgroup of patients at high risk, clinical screening scores and natriuretic peptide measurements are used. Second, the definite diagnosis of asymptomatic LV dysfunction must be confirmed with echocardiography, occasionally with the help of new technologic developments to establish prompt, appropriate treatment to prevent disease progression. Therefore, the screening role of echocardiography is the early identification of patients with structural cardiopathy who are at risk of developing symptomatic HF and detection of those without LV dysfunction (diabetic and hypertensive) whose condition is prone to advance rapidly to structural cardiopathy or to symptomatic HF.

Echocardiography↗
PubMed2005

Pre- and post-cardioversion transesophageal echocardiography for brief anticoagulation therapy with enoxaparin in atrial fibrillation patients: a prospective study with a 1-year follow-up.

BACKGROUND: In patients with atrial fibrillation (AF) eligible for electrical cardioversion (C), the guided approach with transesophageal echocardiography (TEE) allows to avoid the 3 weeks of recommended precardioversion anticoagulation therapy. However, after sinus rhythm restoration, at least other 4 weeks of oral anticoagulation therapy are indicated, due to the postcardioversion thromboembolic risk related to left atrial (LA) and left atrial appendage (LAA) stunning. The aim of this study was to prospectively assess the effectiveness and the safety of anticoagulation therapy discontinuation 7 days after C using low-molecular-weight heparins (LMWH) in a selected group of patients who underwent a pre-C and 7 days post-C TEE evaluation. METHODS: One hundred one patients (74 patients with nonvalvular AF and 27 patients with atrial flutter lasting >48 h and history of AF) were enrolled into the study. Two patients refused the TEE, therefore, in 99/101, we performed a first TEE and, within 24 h, a C if there were no LAA thrombi, complex aortic plaques or severe spontaneous echocontrast. After C and 7 days of home-administered enoxaparin, a second TEE was carried out. In the absence of any new thrombi, severe spontaneous echocontrast and/or low emptying velocity of LAA, the therapy with enoxaparin was stopped; otherwise, anticoagulation therapy with enoxaparin was overlapped with oral anticoagulation and continued for at least 3 weeks. All patients were clinically followed at 1, 6 and 12 months after C. RESULTS: Sinus rhythm was restored in 68/99 patients after successful C. The second TEE was carried out in 53 patients. At 1 month follow-up, no thromboembolic events were recorded either in patients at risk who had continued the oral anticoagulant therapy for at least 3 weeks or in those who suspended LMWH after 7 days post-C TEE. Between the 2nd and 12th month, three ischemic strokes occurred, all in the group of patients who had anticoagulation therapy for at least 3 weeks and had shown LAA velocity <25 cm/s at first or second TEE. No thromboembolic events were recorded in patients with normal LAA velocity; conversely, among the patients who had shown low LAA velocity at either TEE, three suffered from ischemic stroke. In two of these three patients, low LAA velocity was detected only at post-C TEE. CONCLUSIONS: A brief anticoagulation therapy using LMWH appears to be safe and feasible. The 7 days post-C TEE can well-define patients without LAA stunning at low thromboembolic risk, who may take advantage of an early interruption of enoxaparin as an alternative to long oral anticoagulation. The LAA stunning, even in the absence of other thromboembolic risk factors, could select a group of patients at high risk who should continue oral anticoagulation indefinitely or until signs of LAA dysfunction disappear.

Aged↗
PubMed2004

Which is the best reperfusion strategy for patients with high-risk myocardial infarction?

Systemic thrombolysis and primary percutaneous coronary intervention (PCI) are both effective treatments for acute ST-elevation myocardial infarction. Several randomized trials have shown that primary PCI is superior to thrombolytic therapy in acute myocardial infarction (AMI). Despite these findings, thrombolytic therapy remains an acceptable alternative for most patients, yet it may not be ideal for higher-risk AMI patients. Advanced age, diabetes mellitus, anterior infarction, severe tachycardia, shock and comorbidities are associated with early mortality rates ranging from 10 to 58% in patients treated with thrombolytic agents. This review will examine the data comparing primary PCI and systemic thrombolysis in the different clinical conditions which identify patients at high risk in the setting of AMI.

Age Factors↗
PubMed2004

Primary angioplasty of an anomalous right coronary artery complicated by an acute thrombotic occlusion.

A right coronary artery (RCA) arising from the left main is a very uncommon congenital defect. We report on a 69-year-old patient with an acute myocardial infarction submitted to primary percutaneous coronary intervention (PCI) for an anomalous RCA. The PCI procedure was complicated by an acute thrombotic occlusion, successfully treated by an intracoronary bolus of abciximab.

Abciximab↗
PubMed2003

Introduction.

Explore the source record for details and available documents.

Cardiology↗
PubMed2003

Nonpharmacologic care of heart failure: counseling, dietary restriction, rehabilitation, treatment of sleep apnea, and ultrafiltration.

The prognosis of patients with chronic congestive heart failure (CHF) depends not only on pharmacologic therapy but also on nonpharmacologic aspects. A complete and ongoing education program for treating CHF includes an understanding of the causes of CHF, symptoms, diet, salt and fluid restriction, drug regimen, compliance, physical and work activities, lifestyle changes, and measures of self-control. Moreover, the nonpharmacologic treatment (dietary modifications, lifestyle, physical exercise, and health care education) must be inserted in a multidisciplinary program organized by the physician in conjunction with the health system, the nurses, and, especially, the patients themselves, who must understand their disease and the many therapeutic options. Cardiologists should treat patients in a clear and comprehensible way, and other specialists (dietitians, physiotherapists, psychologists, nurses, and social workers), together with the patient's family, should strive for the best living conditions for the patient. In this way, the treatment of CHF can improve the quantity and quality of life and save a significant amount in health care costs.

Counseling↗
PubMed2003

[Quality system in cardiology: practical example to develop an organizational model for management certification without bureaucracy].

It is a difficult task to define practical guidelines and a pragmatic achievement for the new document of the Italian Ministry of Health for structures of the national health system obtaining a quality system according to the ISO 9000 standard. The present article illustrates the different steps to accomplish the quality management in our cardiology department, recently internationally certified, and it gives several practical examples of the path followed in the different sections of the department to obtain the best management of all the Operative Units, identifying customer requests and measuring customer satisfaction.

Cardiology↗
PubMed2003

Abciximab for the treatment of an acute thrombotic coronary occlusion during stent implantation in a patient with severe hemophilia B.

Hemophilia B is a severe inherited coagulopathy caused by mutations in the gene that encodes factor IX. Surgical and invasive procedures in patients suffering from this congenital disease are to be considered as being at high risk of hemorrhage. We describe a case of a patient with unstable angina who suffered from severe hemophilia B, pre-treated with plasma purified factor IX concentrate and not on antithrombotic therapy, in whom the use of abciximab induced the complete lysis of an acute thrombus complicating the implantation of a stent on the left anterior descending coronary artery.

Abciximab↗
PubMed2002

[Quality system Vision 2000].

A recent document of the Italian Ministry of Health points out that all structures which provide services to the National Health System should implement a Quality System according to the ISO 9000 standards. Vision 2000 is the new version of the ISO standard. Vision 2000 is less bureaucratic than the old version. The specific requests of the Vision 2000 are: a) to identify, to monitor and to analyze the processes of the structure, b) to measure the results of the processes so as to ensure that they are effective, d) to implement actions necessary to achieve the planned results and the continual improvement of these processes, e) to identify customer requests and to measure customer satisfaction. Specific attention should be also dedicated to the competence and training of the personnel involved in the processes. The principles of the Vision 2000 agree with the principles of total quality management. The present article illustrates the Vision 2000 standard and provides practical examples of the implementation of this standard in cardiological departments.

Italy↗