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Elharram M, Samuel M, AlTurki A, Quon M, Behlouli H, Bessissow A, Pilote L. Anticoagulant Use and the Risk of Thromboembolism and Bleeding in Postoperative Atrial Fibrillation After Noncardiac Surgery. Can J Cardiol 2020; 37:391-399. [PMID: 32891728 DOI: 10.1016/j.cjca.2020.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/05/2020] [Accepted: 08/08/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND An effective and safe oral anticoagulation (OAC) strategy for patients with new postoperative AF (POAF) after noncardiac surgery remains unclear. We aimed to determine the association between OAC use and 1) thromboembolic events and 2) major bleeding in patients with POAF after noncardiac surgery. METHODS A retrospective cohort (1999-2015) was used to identify patients with new POAF after inpatient noncardiac surgery. Initiation of OAC was defined as prescription of an OAC within 30 days following hospital discharge. Times to first hospital admission or emergency department visit for a thromboembolic or major bleeding event were compared using Cox proportional hazards models. RESULTS We identified 22,007 patients with new POAF after inpatient noncardiac surgery. The majority of patients had intermediate (CHA2DS2-VASc 2-3: 45%) to high (CHA2DS2-VASc ≥ 4: 42%) thromboembolic risk. During a mean follow-up of 4 years, a total of 1099 (5%) thromboembolic and 3250 (15%) bleeding events occurred. Compared with patients not on anticoagulation, anticoagulation did not reduce the risk for thromboembolic events (adjusted hazard ratio [aHR] 0.89, 95% CI 0.73-1.07). In patients initiated on anticoagulation, there was an association with a higher risk for major bleeding (aHR 1.14, 95% CI 1.04-1.25). CONCLUSIONS In patients with new POAF after noncardiac surgery, anticoagulation was not associated with a reduction in long-term thromboembolic events; however, this was accompanied by an overall increased risk for major bleeding. Future prospective clinical studies are needed to better address the role for anticoagulation therapy in the setting of POAF after noncardiac surgery to understand the efficacy and safety of treatment.
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Affiliation(s)
- Malik Elharram
- Research Institute McGill University Health Centre, Montréal, Québec, Canada
| | - Michelle Samuel
- Research Institute McGill University Health Centre, Montréal, Québec, Canada
| | - Ahmed AlTurki
- Division of Cardiology, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Michael Quon
- Division of General Internal Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hassan Behlouli
- Research Institute McGill University Health Centre, Montréal, Québec, Canada
| | - Amal Bessissow
- Research Institute McGill University Health Centre, Montréal, Québec, Canada; Division of General Internal Medicine, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Louise Pilote
- Research Institute McGill University Health Centre, Montréal, Québec, Canada; Division of General Internal Medicine, Department of Medicine, McGill University, Montréal, Québec, Canada.
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Sy E, Luong M, Quon M, Kim Y, Sharifi S, Norena M, Wong H, Ayas N, Leipsic J, Dodek P. Implementation of a quality improvement initiative to reduce daily chest radiographs in the intensive care unit. BMJ Qual Saf 2015; 25:379-85. [PMID: 26350068 DOI: 10.1136/bmjqs-2015-004151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/17/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To reduce the number of routine chest radiographs (CXRs) done in a tertiary care intensive care unit (ICU). METHODS Using a quality improvement approach, we measured the number of CXRs done per patient-day before (15 June 2010-15 June 2011) and after (15 June 2011-15 June 2012) a multipronged intervention in a 15-bed medical-surgical ICU in a 350-bed tertiary care teaching hospital. We studied a total of 1492 patients who were admitted to this ICU-738 patients during the preintervention period and 754 patients during the postintervention period. Interventions were education for the ICU house staff, developing indications for routine CXRs on the computer order-entry system, and visual posters/signage to remind ICU staff that there were no indications for routine, daily CXRs. The primary outcome was the number of CXRs per patient-day, but we also measured CTs of the chest, mechanical ventilator days, length of ICU stay and ICU and hospital mortality. RESULTS There were 0.73 CXRs per patient-day done during the preintervention period and 0.54 CXRs per patient-day done during the postintervention period, a 26% reduction. There were no differences between the periods in age, sex or severity of illness (Acute Physiology and Chronic Health Evaluation (APACHE) II score) of the patients, number of chest CTs, mechanical ventilator days, length of ICU stay and ICU or hospital mortality. CONCLUSIONS A quality improvement that includes education, reminders of appropriate indications and computerised decision support can decrease the number of routine CXRs in an ICU.
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Affiliation(s)
- Eric Sy
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Luong
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Quon
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Young Kim
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sadra Sharifi
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Monica Norena
- Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Hubert Wong
- Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Najib Ayas
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Dodek
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Koh KK, Quon M. COMBINATION THERAPY WITH PRAVASTATIN AND VALSARTAN HAS ADDITIVE EFFECTS TO IMPROVE METABOLIC PHENOTYPES OVER MONOTHERAPY IN PATIENTS WITH HYPERCHOLESTEROLEMIA. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61402-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Koh KK, Quon M, Choi H. SIGNIFICANT DIFFERENTIAL EFFECTS OF OMEGA-3 FATTY ACIDS AND FENOFIBRATE IN PATIENTS WITH HYPERTRIGLYCERIDEMIA. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61695-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Koh KK, Quon M, Park Y, Han S, Shin E, Chung WJ, Lee K. EFFECTS OF FENOFIBRATE THERAPY ON CIRCULATING ADIPOCYTOKINES IN PATIENTS WITH PRIMARY HYPERTRIGLYCERIDEMIA. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)62024-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Koh KK, Quon M, Han SH, Lee K. ATORVASTATIN WORSENS GLUCOSE METABOLISM AND INSULIN SENSITIVITY IN HYPERCHOLESTEROLEMIC PATIENTS. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)60459-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Koh KK, Quon M, Han SH, Lee K. SIMVASTATIN IMPROVES ENDOTHELIUM-DEPENDENT DILATION, BUT REDUCES ADIPONECTIN LEVELS AND INSULIN SENSITIVITY IN HYPERCHOLESTEROLEMIC PATIENTS. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)61543-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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