digoxin and Hemorrhage

The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.

Topics: Acute Coronary Syndrome; Algorithms; Anticoagulants; Atrial Appendage; Atrial Fibrillation; Cardiac Pacing, Artificial; Cardiotonic Agents; Catheter Ablation; Coronary Artery Disease; Digoxin; Drug Therapy, Combination; Factor Xa Inhibitors; Fibrinolytic Agents; Hemorrhage; Humans; Magnesium; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Postoperative Complications; ST Elevation Myocardial Infarction; Stroke

The VERDICT (Verapamil Versus Digoxin and Acute Versus Routine Serial Cardioversion Trial) is a prospective, randomized study to investigate whether: 1) acutely repeated serial electrical cardioversions (ECVs) after a relapse of atrial fibrillation (AF); and 2) prevention of intracellular calcium overload by verapamil, decrease intractability of AF.. Rhythm control is desirable in patients suffering from symptomatic AF.. A total of 144 patients with persistent AF were included. Seventy-four (51%) patients were randomized to the acute (within 24 h) and 70 (49%) patients to the routine serial ECVs, and 74 (51%) patients to verapamil and 70 (49%) patients to digoxin for rate control before ECV and continued during follow-up (2 x 2 factorial design). Class III antiarrhythmic drugs were used after a relapse of AF. Follow-up was 18 months.. At baseline, there were no significant differences between the groups, except for beta-blocker use in the verapamil versus digoxin group (38% vs. 60%, respectively, p = 0.01). At follow-up, no difference in the occurrence of permanent AF between the acute and the routine cardioversion groups was observed (32% [95% confidence intervals (CI)] 22 to 44) vs. 31% [95% CI 21 to 44], respectively, p = NS), and also no difference between the verapamil- and the digoxin-randomized patients (28% [95% CI 19 to 40] vs. 36% [95% CI 25 to 48] respectively, p = NS). Multivariate Cox regression analysis revealed that lone digoxin use was the only significant predictor of failure of rhythm control treatment (hazard ratio 2.2 [95% CI 1.1 to 4.4], p = 0.02).. An acute serial cardioversion strategy does not improve long-term rhythm control in comparison with a routine serial cardioversion strategy. Furthermore, verapamil has no beneficial effect in a serial cardioversion strategy.

Topics: Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Calcium; Digoxin; Electric Countershock; Female; Hemorrhage; Humans; Male; Middle Aged; Prospective Studies; Quality of Life; Recurrence; Thromboembolism; Treatment Outcome; Verapamil

Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes.. To assess the treatment strategies and 1-year clinical outcomes of antithrombotic and CHF therapies for patients with newly diagnosed AF with concomitant CHF stratified by etiology (ischemic cardiomyopathy [ICM] vs nonischemic cardiomyopathy [NICM]).. The GARFIELD-AF registry is a prospective, noninterventional registry. A total of 52 014 patients with AF were enrolled between March 2010 and August 2016. A total of 11 738 patients 18 years and older with newly diagnosed AF (≤6 weeks' duration) and at least 1 investigator-determined stroke risk factor were included. Data were analyzed from December 2017 to September 2018.. One-year follow-up rates of death, stroke/systemic embolism, and major bleeding were assessed.. Event rates per 100 person-years were estimated from the Poisson model and Cox hazard ratios (HRs) and 95% confidence intervals.. The median age of the population was 71.0 years, 22 987 of 52 013 were women (44.2%) and 31 958 of 52 014 were white (61.4%). Of 11 738 patients with CHF, 4717 (40.2%) had ICM and 7021 (59.8%) had NICM. Prescription of oral anticoagulant and antiplatelet drugs was not balanced between groups. Oral anticoagulants with or without antiplatelet drugs were used in 2753 patients with ICM (60.1%) and 5082 patients with NICM (73.7%). Antiplatelets were prescribed alone in 1576 patients with ICM (34.4%) and 1071 patients with NICM (15.5%). Compared with patients with NICM, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (72.6% [3439] vs 60.3% [4236]) and of β blockers (63.3% [2988] vs 53.2% [3737]) was higher in patients with ICM. Rates of all-cause and cardiovascular death per 100 patient-years were significantly higher in the ICM group (all-cause death: ICM, 10.2; 95% CI, 9.2-11.1; NICM, 7.0; 95% CI, 6.4-7.6; cardiovascular death: ICM, 5.1; 95% CI, 4.5-5.9; NICM, 2.9; 95% CI, 2.5-3.4). Stroke/systemic embolism rates tended to be higher in ICM groups compared with NICM groups (ICM, 2.0; 95% CI, 1.6-2.5; NICM, 1.5; 95% CI, 1.3-1.9). Major bleeding rates were significantly higher in the ICM group (1.1; 95% CI, 0.8-1.4) compared with the NICM group (0.7; 95% CI, 0.5-0.9).. Patients with ICM received oral anticoagulants with or without antiplatelet drugs less frequently and antiplatelets alone more frequently than patients with NICM, but they received angiotensin-converting enzyme inhibitors/angiotensin receptor blockers more often than patients with NICM. All-cause and cardiovascular death rates were higher in patients with ICM than patients with NICM.. ClinicalTrials.gov Identifier: NCT01090362.

Topics: Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Atrial Fibrillation; Cardiomyopathies; Cardiotonic Agents; Cardiovascular Diseases; Cohort Studies; Digoxin; Female; Guideline Adherence; Heart Failure; Hemorrhage; Humans; Male; Middle Aged; Mineralocorticoid Receptor Antagonists; Mortality; Myocardial Ischemia; Platelet Aggregation Inhibitors; Practice Guidelines as Topic; Proportional Hazards Models; Registries; Sodium Potassium Chloride Symporter Inhibitors; Stroke; Stroke Volume

This study aimed to reveal the incidence of clinical endpoints in elderly patients with atrial fibrillation (AF) during a 2-year follow-up and evaluate the related prognostic factors of these endpoints.In total, 200 elderly patients with AF and 400 age- and sex-matched patients without AF were enrolled in this prospective observational cohort study. The incidence of clinical endpoints, including thromboembolism, hemorrhage, and all-cause death, during the 2-year follow-up was analyzed. Other follow-up data, including disease history, laboratory examinations, medication status, and other clinical endpoints, were collected. The prognostic factors of these clinical endpoints were then evaluated by Cox-survival analysis. In addition, the predicative role of C-reactive protein (CRP) and platelet-activating factor (PAF) on these clinical endpoints was analyzed.The incidence of clinical endpoints, including thromboembolism, hemorrhage, and all-cause death, was significantly higher in patients with AF than in those without AF (27.8% vs 9.8%, 29.4% vs 12.7%, and 28.7% vs 11.6%, respectively; all P < .001). Antithrombotic therapy significantly reduced the incidences of all-cause deaths (P < .05). Body mass index (BMI) and digoxin were prognostic risk factors of thromboembolism; age, massive hemorrhage history, and digoxin were prognostic risk factors of hemorrhage and age, renal insufficiency history, massive hemorrhage history, and digoxin were prognostic risk factors of all-cause death (P < .05). Further, both CRP and PAF were prognostic risk factors of thromboembolism and massive hemorrhage (P < .05).Age, BMI, massive hemorrhage history, and digoxin appear to be prognostic risk factors of clinical endpoints in elderly patients with AF. Appropriate drug use during follow-up may be beneficial in preventing the occurrence of clinical endpoints in elderly patients with AF.. ChiCTR-OCH-13003479.

Topics: Age Factors; Aged; Aged, 80 and over; Atrial Fibrillation; Body Mass Index; C-Reactive Protein; Case-Control Studies; China; Digoxin; Female; Fibrinolytic Agents; Follow-Up Studies; Hemorrhage; Humans; Male; Platelet Activating Factor; Prognosis; Proportional Hazards Models; Prospective Studies; Thromboembolism

Our environment hosts a vast diversity of venomous and poisonous animals and plants. Clinical toxinology is devoted to understanding, preventing and treating their effects in humans and domestic animals. In Sri Lanka, yellow oleander (Thevetia peruviana, Sinhala 'kaneru'), a widespread and accessible ornamental shrub, is a popular means of self-harm. Its toxic glycosides resemble those of foxglove, against which therapeutic antibodies have been raised. A randomised placebo-controlled trial proved that this treatment effectively reversed kaneru cardiotoxicity. There are strong scientific grounds for the use of activated charcoal, but encouraging results with multiple-dose activated charcoal were not confirmed by a recent more powerful study. Venom of Russell's viper (Daboia siamensis) in Burma (Myanmar) produces lethal effects in human victims. The case of a 17-year-old rice farmer is described with pathophysiological interpretations. During the first 9 days of hospital admission he suffered episodes of shock, coagulopathy, bleeding, acute renal failure, local tissue necrosis, generally increased capillary permeability and acute symptomatic hypoglycaemia with evidence of acute pituitary/adrenal insufficiency. Antivenom rapidly restored haemostatic function but failed to correct other effects of venom toxins incurred during the 3h before he could be treated.

Topics: Adolescent; Animals; Antivenins; Charcoal; Child; Digitalis; Digoxin; Female; Hemorrhage; Humans; Male; Plant Poisoning; Plants, Toxic; Seeds; Snake Bites; Suicide, Attempted; Viper Venoms

Topics: Anticoagulants; Atrial Fibrillation; Azetidines; Benzylamines; Digitalis; Digoxin; Drug Combinations; Hemorrhage; Humans; Phytotherapy

To determine the prevalence of adverse drug reaction (ADR)-related hospital admissions in an older population, to describe the most common clinical manifestations and drugs most frequently responsible for ADR-related hospital admissions, and to identify independent factors predictive of these ADRs.. Multicenter pharmacoepidemiology survey conducted between 1988 and 1997.. Eighty-one academic hospitals throughout Italy.. Twenty-eight thousand four hundred eleven patients consecutively admitted to participating centers during the survey periods.. For each suspected ADR at admission, a physician, who coded description, severity, and potentially responsible drugs, completed a questionnaire.. Mean age +/- standard deviation of the patients was 70 +/- 16. One thousand seven hundred four ADRs were identified upon hospital admission. In 964 cases (3.4% of all admissions), ADRs were considered to be the cause of these hospital admissions. Of these, 187 ADRs were coded as severe. Gastrointestinal complaints (19%) represented the most common events, followed by metabolic and hemorrhagic complications (9%). The drugs most frequently responsible for these ADRs were diuretics, calcium channel blockers, nonsteroidal antiinflammatory drugs, and digoxin. Female sex (odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.10-1.54), alcohol use (OR = 1.39, 95% CI = 1.20-1.60), and number of drugs (OR = 1.24, 95% CI = 1.20-1.27 for each drug increase) were independent predictors of ADR-related hospital admissions. For severe ADRs, age (OR = 1.50, 95% CI = 1.01-2.23 for age 65-79 and OR = 1.53, 95% CI = 1.00-2.33 for age > or =80, respectively), comorbidity (OR = 1.12, 95% CI = 1.05-1.20 for each point in the Charlson Comorbidity Index), and number of drugs (OR = 1.18, 95% CI = 1.11-1.25 for each drug increase) were the only predisposing factors.. The most important determinant of risk for ADR-related hospital admissions in older patients is number of drugs being taken. When considering only severe ADRs, risk is also related to age and frailty.

Topics: Aged; Alcohol Drinking; Anti-Inflammatory Agents, Non-Steroidal; Calcium Channel Blockers; Comorbidity; Digoxin; Diuretics; Drug-Related Side Effects and Adverse Reactions; Female; Gastrointestinal Diseases; Hemorrhage; Humans; Male; Metabolic Diseases; Patient Admission; Risk Factors; Sex Factors; Surveys and Questionnaires

The current animal model generally accepted by the pharmaceutical industry and the FDA for assessment of muscle damage following intramuscular injection (IM) is the rabbit lesion volume model (RbLV). However, this model is resource intensive. The goal of this study was to find a resource sparing alternative to the rabbit lesion model for assessing injection site toleration in IM formulation screening.. Short term animal model alternatives to RbLV for evaluating IM formulations were examined. In addition to RbLV, myeloperoxidase (MPO), p-nitrophenyl N-acetyl-beta-glucosaminide (NA beta G) and/or plasma creatine phosphokinase (CK) activities were determined in rabbits (Rb) and rats (Rt) after injection of formulations (digoxin, azithromycin and danofloxacin). The edema from these formulations 24 hr after subcutaneous injection into the rat footpad (RFE) was also determined.. MPO and NA beta G were not considered very useful as biochemical predictors of muscle damage for these formulations. Histology generally correlated with RbLV values. Compared to saline, RbLV was marked for all formulations within 1-3 days of injection. After day 3, lesions quickly resolved, and no significant differences were found. For these formulations, all CK animal models and RFE were generally predictive of RbLV. A formulation with RtCK > 1000 U/L or RbCK > 3000 U/L, was predicted to be poorly, tolerated.. Due to ease, number of animals, time and intrinsic mechanism, we concluded that for most formulations, 2 and 4 hr RtCK data alone should be reasonably predictive of muscle damage.

Topics: Acetylglucosaminidase; Animals; Chemistry, Pharmaceutical; Creatine Kinase; Digoxin; Disease Models, Animal; Drug Evaluation, Preclinical; Edema; Evaluation Studies as Topic; Hemorrhage; Injections, Intramuscular; Male; Muscles; Peroxidase; Rabbits; Rats; Rats, Sprague-Dawley

Topics: Digoxin; Female; Heart Failure; Hemangioma; Hemorrhage; Humans; Infant; Skin Neoplasms; Subclavian Artery; Thoracic Neoplasms; Wound Infection

Topics: Animals; Blood Pressure; Digoxin; Dogs; Hemorrhage; Kidney; Regional Blood Flow; Strophanthins

Topics: Animals; Digoxin; Dogs; Dose-Response Relationship, Drug; Drinking Behavior; Electrocardiography; Feeding Behavior; Female; Heart Rate; Hemorrhage; Isosorbide Dinitrate; Leukocyte Count; Male; Osmolar Concentration; Poisoning; Time Factors

Topics: Arrhythmias, Cardiac; Child, Preschool; Digoxin; Female; Follow-Up Studies; Heart Arrest; Heart Block; Hemorrhage; Humans; Hypotension; Infant; Male; Methods; Postoperative Complications; Propranolol; Transposition of Great Vessels

Topics: Adult; Anticoagulants; Autopsy; Cardiac Catheterization; Digoxin; Female; Hematoma; Hemorrhage; Humans; Lung Diseases; Pulmonary Artery; Quinidine; Rupture; Warfarin

Topics: Adolescent; Cardiac Surgical Procedures; Child; Child, Preschool; Digoxin; Hemorrhage; Humans; Infant; Infant, Newborn; Isoproterenol; Methods; Postoperative Care; Postoperative Complications; Stimulation, Chemical; Tetralogy of Fallot

Topics: Animals; Arteries; Atropine; Blood Flow Velocity; Blood Pressure; Calcium Chloride; Carbon Dioxide; Cardiac Output; Cardiac Volume; Cardiovascular System; Coronary Vessels; Digoxin; Dogs; Electrocardiography; Epinephrine; Halothane; Heart Auscultation; Heart Rate; Hematocrit; Hemoglobins; Hemorrhage; Injections, Intravenous; Isoproterenol; Oxygen Consumption; Propranolol; Radioisotopes; Vagotomy; Xenon

Topics: Anti-Bacterial Agents; Antilymphocyte Serum; Arrhythmias, Cardiac; Australia; Azathioprine; Betamethasone; Blood Pressure; Blood Sedimentation; Digoxin; Edema; Electrocardiography; Furosemide; Glycosuria; Heart Auscultation; Heart Transplantation; Hemorrhage; Humans; Hydrocortisone; Hydroxybutyrate Dehydrogenase; Immunosuppressive Agents; Infections; Infusions, Parenteral; Injections, Intramuscular; Injections, Intravenous; Intensive Care Units; Isoproterenol; Male; Middle Aged; Postoperative Complications; Respiration; Transplantation Immunology; Transplantation, Homologous; Veins