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  • 1
    Online Resource
    Online Resource
    Conversion to tacrolimus alone compared to full immunosuppression following cardiac transplantation (TACTFUL)
    Wiley ; 2023
    In:  Clinical Transplantation
    Details
    In: Clinical Transplantation, Wiley
    Abstract: Cardiac transplantation requires lifelong immunosuppressant medications to prevent rejection. However, some patients may not tolerate multiple immunosuppressants due to adverse effects. At our institution, patients may be converted to monotherapy with tacrolimus if unable to tolerate a combination regimen. This study evaluated the outcomes among patients converted to tacrolimus monotherapy compared with those maintained on combination immunosuppression. Methods This single‐center, retrospective cohort study included patients who received heart transplants at Sentara Norfolk General Hospital between January 2015 and July 2021. Patients were classified as receiving tacrolimus monotherapy (Mono) or combination immunosuppression (Combo). The primary outcome was all‐cause mortality with key secondary outcomes including incidence of 2R/3R rejection, necessity for renal replacement therapy, and infection. Results 112 patients were included (Mono = 25, Combo = 87). Median age at transplant was 53.8 years (Mono) and 52.1 years (Combo). The most common reasons for conversion to monotherapy were leukopenia, infection, and gastrointestinal (GI) distress. There was no difference in mortality (0 in Mono, 11 in Combo; p  = .09) or percentage of patients with 2R/3R rejection (24% in Mono, 32.2% in Combo; p  = .43). No Mono group patients experienced rejection after converting from combination therapy. 24% of Mono group patients resumed at least one additional immunosuppressive medication during the study period. Median time to monotherapy was 9.0 months, with a total median duration on monotherapy of 16.0 months. A median of 3.3 years of follow‐up was observed for patients in Mono and 3.4 years in Combo ( p  = .29). Conclusion Selected patients who do not tolerate combination immunosuppression can be safely transitioned to tacrolimus monotherapy as a means of controlling adverse events without an increased risk of mortality or rejection.
    Type of Medium: Online Resource
    ISSN: 0902-0063 , 1399-0012
    URL: Article
    DOI: 10.1111/ctr.15140
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2739458-X
    detail.hit.zdb_id: 2004801-4
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  • 2
    Online Resource
    Online Resource
    Gastrointestinal Bleeding Rates in Left Ventricular Assist Device Population Reduced with Octreotide Utilization
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  ASAIO Journal Vol. 67, No. 9 ( 2021-09), p. 989-994
    Details
    In: ASAIO Journal, Ovid Technologies (Wolters Kluwer Health), Vol. 67, No. 9 ( 2021-09), p. 989-994
    Abstract: Patients with continuous-flow left ventricular assist devices have a high risk of gastrointestinal bleeding (GIB) and recurrent bleeding. Studies have shown octreotide can reduce the risk of GIB. This retrospective, case-crossover study, evaluated the efficacy of octreotide for the prevention of recurrent GIB in patients with left ventricular assist devices between August 2008 and October 2018. A total of 32 patients received octreotide and were included in the study. Hospital admission for GIB was evaluated before and after the initiation of octreotide. Each case served as his/her own control. Most patients were on a reduced aspirin dose (56.2%) and had a reduced international normalized ratio goal (59.4%) before starting monthly octreotide. The most common dose of long-acting octreotide was 30 mg every 28 days. Overall, octreotide decreased the frequency of GIB (4.3 vs. 0.9 events/year, p 〈 0.001). Nineteen (59.4%) patients did not have a subsequent gastrointestinal bleed. Of the 13 patients who rebled after initiation of octreotide, the frequency of events decreased by 2.6 bleeds per patient per year (4.8 vs. 2.2; p = 0.043). In high-risk patients who have failed conventional therapy, octreotide can be useful for the prevention of recurrent GIB.
    Type of Medium: Online Resource
    ISSN: 1058-2916
    URL: Article
    DOI: 10.1097/MAT.0000000000001342
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2083312-X
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  • 3
    Online Resource
    Online Resource
    Protocol-based anticoagulation management for mechanical circulatory support patients can be safe and efficient
    SAGE Publications ; 2022
    In:  The International Journal of Artificial Organs Vol. 45, No. 6 ( 2022-06), p. 564-570
    Details
    In: The International Journal of Artificial Organs, SAGE Publications, Vol. 45, No. 6 ( 2022-06), p. 564-570
    Abstract: Achieving optimal anticoagulation remains a significant challenge in managing patients on left ventricular assist device (LVAD) support. Maintaining tight control of anticoagulation can be time-consuming but essential in preventing serious complications such as pump thrombosis and bleeding. Objectives: The efficacy and safety of a nurse coordinator-driven outpatient protocol (NCDOP) was evaluated for managing anticoagulation for LVAD patients. Methods: A retrospective analysis was performed as part of a single-center quality improvement project. The primary outcome was time in therapeutic range (TTR), a measure of anticoagulation target efficacy before and after the implementation of the protocol. Results: Among 47 patients, who served as their own control, there was no significant change in TTR or proportion of hospitalizations following institution of the protocol. Pre-NCDOP, there were six major bleeding and two thrombotic events, and none during the post-NCDOP period. Conclusions: A NCDOP is a reliable method to manage anticoagulation in LVAD patients and facilitates efficient care delivery. Future multicenter studies with larger patient cohorts are warranted to expand on the findings outlined in this manuscript.
    Type of Medium: Online Resource
    ISSN: 0391-3988 , 1724-6040
    URL: Article
    DOI: 10.1177/03913988221093089
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 1474999-3
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  • 4
    Online Resource
    Online Resource
    Intoxicated Donors and Heart Transplant Outcomes: Long-Term Safety
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation: Heart Failure Vol. 14, No. 8 ( 2021-08)
    Details
    In: Circulation: Heart Failure, Ovid Technologies (Wolters Kluwer Health), Vol. 14, No. 8 ( 2021-08)
    Abstract: The opioid crisis has led to an increase in available donor hearts, although questions remain about the long-term outcomes associated with the use of these organs. Prior studies have relied on historical information without examining the toxicology results at the time of organ offer. The objectives of this study were to examine the long-term survival of heart transplants in the recent era, stratified by results of toxicological testing at the time of organ offer as well as comparing the toxicology at the time of donation with variables based on reported history. Methods: The United Network for Organ Sharing database was requested as well as the donor toxicology field. Between 2007 and 2017, 23 748 adult heart transplants were performed. United Network for Organ Sharing historical variables formed a United Network for Organ Sharing Toxicology Score and the measured toxicology results formed a Measured Toxicology Score. Survival was examined by the United Network for Organ Sharing Toxicology Score and Measured Toxicology Score, as well as Cox proportional hazards models incorporating a variety of risk factors. Results: The number and percent of donors with drug use has significantly increased over the study period ( P 〈 0.0001). Cox proportional hazards modeling of survival including toxicological and historical data did not demonstrate differences in post-transplant mortality. Combinations of drugs identified by toxicology were not associated with differences in survival. Lower donor age and ischemic time were significantly positively associated with survival ( P 〈 0.0001). Conclusions: Among donors accepted for transplantation, neither history nor toxicological evidence of drug use was associated with significant differences in survival. Increasing use of such donors may help alleviate the chronic donor shortage.
    Type of Medium: Online Resource
    ISSN: 1941-3289 , 1941-3297
    URL: Article
    DOI: 10.1161/CIRCHEARTFAILURE.120.007433
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2428100-1
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  • 5
    Online Resource
    Online Resource
    The utilization and safety of apixaban for therapeutic anticoagulation in heart transplant population requiring routine endomyocardial biopsies
    Wiley ; 2022
    In:  Clinical Transplantation Vol. 36, No. 12 ( 2022-12)
    Details
    In: Clinical Transplantation, Wiley, Vol. 36, No. 12 ( 2022-12)
    Abstract: Routine endomyocardial (EM) biopsies pose a challenge in the management of heart transplant recipients requiring anticoagulation. Apixaban is a direct‐acting oral anticoagulant (DOAC) with a short half‐life allowing for brief interruptions of anticoagulation for procedures. The study objective was to determine the safety and efficacy of apixaban in heart transplant patients undergoing EM biopsies. Methods This retrospective case series evaluated patients with a heart transplant from April 1, 2017 to July 30, 2020 who were treated with apixaban within 90 days post‐transplant. The primary outcome was the occurrence of a bleeding or thrombotic event. Results A total of 12 patients with 〉 100 biopsies were included. The median age was 54 years (IQR 37–59) with a mean weight of 91 ± 20 kg. There were no bleeding or thrombotic events. During therapy, patients underwent an average of eight biopsies. The median time from transplant to initiation of apixaban was 39.5 days (range 9–77). Therapy was maintained without any need for reversal for a median of 276 days (IQR 45–245). Conclusions Apixaban is safe to use for anticoagulation of heart transplant recipients undergoing routine biopsies. Using apixaban allows for a short interruption of therapeutic anticoagulation to accommodate a biopsy without increased risk of bleeding.
    Type of Medium: Online Resource
    ISSN: 0902-0063 , 1399-0012
    URL: Issue
    URL: Article
    DOI: 10.1111/ctr.v36.12
    DOI: 10.1111/ctr.14828
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2739458-X
    detail.hit.zdb_id: 2004801-4
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  • 6
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    Online Resource
    Describing and Classifying Shock: Recent Insights
    Radcliffe Media Media Ltd ; 2021
    In:  US Cardiology Review Vol. 15 ( 2021-9-15)
    Details
    In: US Cardiology Review, Radcliffe Media Media Ltd, Vol. 15 ( 2021-9-15)
    Abstract: Cardiogenic shock continues to present a daunting challenge to clinicians, despite an increasing array of percutaneous mechanical circulatory support devices. Mortality for cardiogenic shock has not changed meaningfully in more than 20 years. There have been many attempts to generate risk scores or frameworks to evaluate cardiogenic shock and optimize the use of resources and assist with prognostication. These include the Intra-Aortic Balloon Pump in Cardiogenic Shock (IABP-SHOCK) II risk score, the CardShock score and the new CLIP biomarker score. This article reviews the Society for Cardiac Angiography and Interventions (SCAI) classification of cardiogenic shock and subsequent validation studies. The SCAI classification is simple for clinicians to use as it is based on readily available information and can be adapted depending on the data set that can be accessed. The authors consider the future of the field. Underlying all these efforts is the hope that a better understanding and classification of shock will lead to meaningful improvements in mortality rates.
    Type of Medium: Online Resource
    ISSN: 1758-390X , 1758-3896
    URL: Issue
    URL: Journal
    URL: Article
    DOI: 10.15420/usc.2021.vol15
    DOI: 10.15420/usc
    DOI: 10.15420/usc.2021.09
    Language: English
    Publisher: Radcliffe Media Media Ltd
    Publication Date: 2021
    detail.hit.zdb_id: 3017967-1
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  • 7
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    Online Resource
    Clinical outcomes of ventricular assist device support by HIV infection status: An STS-INTERMACS analysis
    Elsevier BV ; 2023
    In:  The Journal of Heart and Lung Transplantation Vol. 42, No. 9 ( 2023-09), p. 1185-1193
    Details
    In: The Journal of Heart and Lung Transplantation, Elsevier BV, Vol. 42, No. 9 ( 2023-09), p. 1185-1193
    Type of Medium: Online Resource
    ISSN: 1053-2498
    URL: Article
    DOI: 10.1016/j.healun.2023.04.014
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
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