CardioExchange Archive

CardioExchange is pleased to reprint selections from Dr. Richard Lehman’s weekly journal review blog at BMJ.com. Selected summaries are relevant to our audience, but we encourage members to engage with the entire blog.

NEJM  30 May 2013  Vol 368

Pacemaker or Defibrillator Surgery without Interruption of Anticoagulation (pg. 2084):  A neat study from Canada seeks to discover whether patients who need to stay on anticoagulants should continue warfarin or change to heparin while having a pacemaker or implantable cardioverter-defibrillator fitted. The main outcome measure was clinically significant device-pocket haematoma. The heparin group had more than four times as many pocket bleeds as the continued-warfarin group. There’s more on the general issue of antithrombotic treatment during invasive procedures in a clinical review article on 2113.

BMJ  1 June 2013  Vol 346

Diagnostic Accuracy of Conventional or Age Adjusted D-dimer Cut-Off Values in Older Patients with Suspected VTE: A Dutch systematic review usefully confirms that the cut-off level of D-dimer for detecting venous thromboembolism in people at low and medium risk needs to be adjusted for age. “The application of age adjusted cut-off values for D-dimer tests substantially increases specificity without modifying sensitivity, thereby improving the clinical utility of D-dimer testing in patients aged 50 or more with a non-high clinical probability.”

JAMA Intern Med  27 May 2013  Vol 173

Implantable Cardioverter-Defibrillator Shocks (pg. 859): Implantable cardioverter-defibrillators stop some people from dying suddenly. The only other things they are capable of doing are (a) going wrong and/or (b) delivering inappropriate shocks. People who have these things fitted need to know their individual odds, as far as that is possible. I know several researchers who are trying to bring shared decision making into this difficult arena, and this descriptive review of the literature about outcomes by Fred Masoudi and colleagues will be useful to them. It should also be read by all interventional cardiologists. “Implantable cardioverter-defibrillators reduce the risk of sudden cardiac death and prolong life in selected populations; however, many patients will receive an ICD shock, either appropriate or inappropriate. It is imperative that patients be counseled regarding this risk and adverse outcomes associated with shocks. Reduction of ICD shock should be individualized to ensure that patients receiving these devices experience the maximal benefits of therapy while minimizing the adverse consequences.”