- Email: [email protected]
Is warfarin still underused in patients with atrial fibrillation? A major threat to treatment benefit
Letters to the Editor
439
Fig. 1. A: Echocardiography showing no antegrade flow crossing pulmonary valve; B: After operation, patent pulmonary valve confirmed by echocardiography (PA: pulmonary artery; PV: pulmonary valve; RVOT: right ventricular outflow tract).
[6] Cheatham JP. To perforate or not to perforate—that's the question…or is it? Just ask Richard! Cathet Cardiovasc Diagn 1997;42:403–4. [7] Asnes JD, Fahey JT. Novel catheter positioning technique for atretic pulmonary valve perforation. Catheter Cardiovasc Interv 2008;71: 850–2.
[8] McLean KM, Pearl JM. Pulmonary atresia with intact ventricular septum: initial management. Ann Thorac Surg 2006;82:2214–9 discussion 9–20. [9] Coats AJ. Ethical authorship and publishing. Int J Cardiol 2009;131: 149–50.
0167-5273/$ - see front matter © 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2009.03.083
Is warfarin still underused in patients with atrial fibrillation? A major threat to treatment benefit Oben Baysan, Mehmet Yokusoglu ⁎, Baris Bugan Gulhane Military Medical School, Department of Cardiology, Ankara, Turkey Received 13 March 2009; accepted 15 March 2009 Available online 5 April 2009
Keywords: Atrial fibrillation; Anticoagulant therapy; Thromboembolic event
Dear Editor, Atrial fibrillation patients have very significant thromboembolic event risk which increases with the number of ⁎ Corresponding author. Gulhane Military Medical School, Department of Cardiology 06018, Etlik, Ankara, Turkey. Tel.: +90 312 304 42 67; fax: +90 312 304 42 50. E-mail address: [email protected] (M. Yokusoglu).
clinical risk factors as determined by CHADS2 score [1]. Besides from these clinical factors, other factors reflecting intraatrial properties such as left atrial appendage peak emptying velocity and the presence of spontaneous echo contrast may also increase thrombus development [2] and thromboembolic event risk in patients with atrial fibrillation [3]. In this respect, we thought that Ohara et al.'s study may provide new opportunities in AF patient management by showing close relation between clinical and
440
Letters to the Editor
echocardiographic risk factors [4]. Furthermore, echocardiographic risk factors may provide better selection of the patients in whom anticoagulant therapy is most effective. However, we noticed in Ohara et al.'s study that 41% of the patients did not receive anticoagulant therapy. The absence of appropriate anticoagulant therapy may be related to various factors such as poor patient compliance or ignorance of the guidelines [5]. However, whatever the patient's reason for warfarin underutilisation, probably it is the main obstacle for reducing stroke risk in atrial fibrillation. Consequently, it makes the use of any risk factor calculation useless. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [6].
[2] Li YH, Lai LP, Shyu KG, Hwang JJ, Ma HM, Ko YL, et al. Clinical implications of left atrial appendage function: its influence on thrombus formation. Int J Cardiol 1994;43:61–6. [3] Dawn B, Varma J, Singh P, Longaker RA, Stoddard MF. Cardiovascular death in patients with atrial fibrillation is better predicted by left atrial thrombus and spontaneous echocardiographic contrast as compared with clinical parameters. J Am Soc Echocardiogr 2005;18:199–205. [4] Ohara K, Hirai T, Fukuda N, Sakurai K, Nakagawa K, Nozawa T, et al. Relation of left atrial blood stasis to clinical risk factors in atrial fibrillation. Int J Cardiol 2009;132:210–5. [5] Glazer NL, Dublin S, Smith NL, French B, Jackson LA, Hrachovec JB, et al. Newly detected atrial fibrillation and compliance with antithrombotic guidelines. Arch Intern Med 2007;167:246–52. [6] Coats AJ. Ethical authorship and publishing. Int J Cardiol 2009;131: 149–50.
References [1] Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001;285:2864–70.
0167-5273/$ - see front matter © 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2009.03.073
Comments on “Interatrial defect, ventricular septal defect and patent ductus arteriosus in a 2-day-old newborn infant” by Dattilo et al. Rana Olgunturk Serdar Kula ⁎ Gazi University School of Medicine, Department of Pediatric Cardiology, 06500, Besevler, Ankara, Turkey Received 18 March 2009; accepted 18 March 2009 Available online 5 April 2009
Keywords: Newborn; Patent ductus arteriosus; Atrial septal defect
Dear Sir,
In a recently published article entitled “Interatrial defect, ventricular septal defect and patent ductus arteriosus in a 2day-old newborn infant” by Dattilo et al. [1], there were conflicting data with regard to clinical diagnosis. The authors reported a 2-day-old newborn who had an interatrial defect with ventricular septal defect and patent ductus arteriosus. ⁎ Corresponding author. Tel.: +90 312 202 5626. E-mail addresses: [email protected], [email protected] (S. Kula).
Initially, there was a discrepancy within the patient's age which was 2-day-old in the title and 3-day-old in the text. The age of patient is very important for diagnosis of PDA. According to our knowledge, ductus arteriosus is functionally closed in about 90% of full term infants by 48 h of age. Persistent, patency for up to 10 days after birth is encountered in premature infants [2]. At this point we have no sufficient information about this baby whether is mature or not. Also, according to Fig. 2B, ductal shunt is lower than expected which pointed out that might be closing. Interatrial septal shunts in newborns are frequently encountered. Since there are no definitive diagnostic criteria
439
Fig. 1. A: Echocardiography showing no antegrade flow crossing pulmonary valve; B: After operation, patent pulmonary valve confirmed by echocardiography (PA: pulmonary artery; PV: pulmonary valve; RVOT: right ventricular outflow tract).
[6] Cheatham JP. To perforate or not to perforate—that's the question…or is it? Just ask Richard! Cathet Cardiovasc Diagn 1997;42:403–4. [7] Asnes JD, Fahey JT. Novel catheter positioning technique for atretic pulmonary valve perforation. Catheter Cardiovasc Interv 2008;71: 850–2.
[8] McLean KM, Pearl JM. Pulmonary atresia with intact ventricular septum: initial management. Ann Thorac Surg 2006;82:2214–9 discussion 9–20. [9] Coats AJ. Ethical authorship and publishing. Int J Cardiol 2009;131: 149–50.
0167-5273/$ - see front matter © 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2009.03.083
Is warfarin still underused in patients with atrial fibrillation? A major threat to treatment benefit Oben Baysan, Mehmet Yokusoglu ⁎, Baris Bugan Gulhane Military Medical School, Department of Cardiology, Ankara, Turkey Received 13 March 2009; accepted 15 March 2009 Available online 5 April 2009
Keywords: Atrial fibrillation; Anticoagulant therapy; Thromboembolic event
Dear Editor, Atrial fibrillation patients have very significant thromboembolic event risk which increases with the number of ⁎ Corresponding author. Gulhane Military Medical School, Department of Cardiology 06018, Etlik, Ankara, Turkey. Tel.: +90 312 304 42 67; fax: +90 312 304 42 50. E-mail address: [email protected] (M. Yokusoglu).
clinical risk factors as determined by CHADS2 score [1]. Besides from these clinical factors, other factors reflecting intraatrial properties such as left atrial appendage peak emptying velocity and the presence of spontaneous echo contrast may also increase thrombus development [2] and thromboembolic event risk in patients with atrial fibrillation [3]. In this respect, we thought that Ohara et al.'s study may provide new opportunities in AF patient management by showing close relation between clinical and
440
Letters to the Editor
echocardiographic risk factors [4]. Furthermore, echocardiographic risk factors may provide better selection of the patients in whom anticoagulant therapy is most effective. However, we noticed in Ohara et al.'s study that 41% of the patients did not receive anticoagulant therapy. The absence of appropriate anticoagulant therapy may be related to various factors such as poor patient compliance or ignorance of the guidelines [5]. However, whatever the patient's reason for warfarin underutilisation, probably it is the main obstacle for reducing stroke risk in atrial fibrillation. Consequently, it makes the use of any risk factor calculation useless. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [6].
[2] Li YH, Lai LP, Shyu KG, Hwang JJ, Ma HM, Ko YL, et al. Clinical implications of left atrial appendage function: its influence on thrombus formation. Int J Cardiol 1994;43:61–6. [3] Dawn B, Varma J, Singh P, Longaker RA, Stoddard MF. Cardiovascular death in patients with atrial fibrillation is better predicted by left atrial thrombus and spontaneous echocardiographic contrast as compared with clinical parameters. J Am Soc Echocardiogr 2005;18:199–205. [4] Ohara K, Hirai T, Fukuda N, Sakurai K, Nakagawa K, Nozawa T, et al. Relation of left atrial blood stasis to clinical risk factors in atrial fibrillation. Int J Cardiol 2009;132:210–5. [5] Glazer NL, Dublin S, Smith NL, French B, Jackson LA, Hrachovec JB, et al. Newly detected atrial fibrillation and compliance with antithrombotic guidelines. Arch Intern Med 2007;167:246–52. [6] Coats AJ. Ethical authorship and publishing. Int J Cardiol 2009;131: 149–50.
References [1] Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001;285:2864–70.
0167-5273/$ - see front matter © 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2009.03.073
Comments on “Interatrial defect, ventricular septal defect and patent ductus arteriosus in a 2-day-old newborn infant” by Dattilo et al. Rana Olgunturk Serdar Kula ⁎ Gazi University School of Medicine, Department of Pediatric Cardiology, 06500, Besevler, Ankara, Turkey Received 18 March 2009; accepted 18 March 2009 Available online 5 April 2009
Keywords: Newborn; Patent ductus arteriosus; Atrial septal defect
Dear Sir,
In a recently published article entitled “Interatrial defect, ventricular septal defect and patent ductus arteriosus in a 2day-old newborn infant” by Dattilo et al. [1], there were conflicting data with regard to clinical diagnosis. The authors reported a 2-day-old newborn who had an interatrial defect with ventricular septal defect and patent ductus arteriosus. ⁎ Corresponding author. Tel.: +90 312 202 5626. E-mail addresses: [email protected], [email protected] (S. Kula).
Initially, there was a discrepancy within the patient's age which was 2-day-old in the title and 3-day-old in the text. The age of patient is very important for diagnosis of PDA. According to our knowledge, ductus arteriosus is functionally closed in about 90% of full term infants by 48 h of age. Persistent, patency for up to 10 days after birth is encountered in premature infants [2]. At this point we have no sufficient information about this baby whether is mature or not. Also, according to Fig. 2B, ductal shunt is lower than expected which pointed out that might be closing. Interatrial septal shunts in newborns are frequently encountered. Since there are no definitive diagnostic criteria