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Related Concept Videos

Aneurysm IV: Nursing Management01:22

Aneurysm IV: Nursing Management

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Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
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Aneurysm III: Interprofessional Care01:26

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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Aortic Regurgitation III: Medical Management01:25

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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
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Aneurysm II: Clinical Manifestations and Diagnostic Studies01:21

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Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
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Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
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ORal anticoagulation risks late aortic intervention in Conservatively managed type B Aortic dissection (ORCA study).

Katarzyna Jesse1,2, Lorenz Meuli1, Reinhard Kopp1

  • 1Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|October 6, 2022
PubMed
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Oral anticoagulation (OAC) therapy in patients with acute type B aortic dissection was linked to a higher risk of late aortic interventions. Patients on OAC require close monitoring for aortic events.

Keywords:
Anticoagulant drugsAnticoagulationAntiplatelet therapyAortic dissectionConservative managementEndovascular therapy

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Area of Science:

  • Cardiovascular Medicine
  • Vascular Surgery
  • Medical Research

Background:

  • Acute type B aortic dissection (TBAD) is a serious condition requiring careful management.
  • The role of oral anticoagulation (OAC) in TBAD patients managed conservatively is not well-defined.
  • Understanding OAC's impact is crucial for optimizing long-term patient outcomes.

Purpose of the Study:

  • To evaluate the long-term effects of oral anticoagulation (OAC) on outcomes in patients with acute type B aortic dissection (TBAD).
  • To determine if OAC influences the risk of late aortic events in conservatively managed TBAD patients.

Main Methods:

  • Retrospective cohort study analyzing data from 69 patients with conservatively managed TBAD.
  • Patients receiving OAC were compared to those not on OAC regarding late aortic events.
  • Multivariable Cox proportional hazard models were used to analyze time-to-event data, adjusting for confounders.

Main Results:

  • A total of 69 patients were included, with 68% receiving OAC during follow-up.
  • 41% of patients experienced late aortic events, primarily interventions (39%).
  • OAC was associated with a significantly increased risk of late aortic events (HR 3.94, P=0.040).

Conclusions:

  • Oral anticoagulation therapy is associated with an increased risk of late aortic interventions in patients with type B aortic dissection.
  • OAC should not be initiated solely for TBAD.
  • Patients with TBAD on OAC for other indications necessitate vigilant follow-up imaging.