Alcohol and illicit drugs are associated with atrial fibrillation. Avoidance of these substances can help prevent further paroxysms. Apart from avoidance, there are no existing guidelines on the management of lone atrial fibrillation, precipitated by alcohol/illicit drugs. “Real life” management varies widely.
Abstract
Background
Atrial fibrillation in young patients (≤45 years) is uncommon. There is the perception that the precipitant in such cases is alcohol, but we also have noted cases related to illicit drug abuse. There are no clear guidelines on the treatment of atrial fibrillation in patients presenting with “lone atrial fibrillation” precipitated by alcohol or illicit drugs.
Methods
We retrospectively analyzed young (defined as ≤45 years) patients with “lone” atrial fibrillation who were admitted to the hospital with electrocardiographically confirmed diagnosis of atrial fibrillation or atrial flutter, precipitated by either alcohol or illicit drugs, over a 6-year period.
Results
Eighty-eight patients aged ≤45 years were admitted with atrial fibrillation or atrial flutter. In 22 patients, (mean [SD] age 33.6 [8.4] years; 20 male), alcohol (n = 19) and/or illicit drugs (n = 3) were found to be the precipitant. One patient required electrical cardioversion, with the remaining patients cardioverting back to sinus rhythm either pharmacologically or spontaneously. Twelve (54.5%) were investigated for atrial fibrillation burden by 24-hour Holter monitoring and the majority also underwent a transthoracic echocardiogram (81.8%). At discharge, 14 (63.6%) patients were treated with anti-arrhythmic drugs and 10 received either antiplatelets or anticoagulants. Most (85%) patients were followed-up for at least 12 months, during which time 6 had further paroxysms; all of whom continued to abuse either alcohol or illicit drugs.
Conclusions
Alcohol and illicit drugs are arrhythmogenic and are associated with atrial fibrillation. Apart from abstinence, the optimal management of such patients and the long-term effects of these substances on the heart and atrial fibrillation recurrences are still unclear.
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-- Suresh Krishnamoorthy, MRCP, Gregory Y.H. Lip, MD, Deirdre A. Lane, PhD
This article was originally published in the September 2009 issue of The American Journal of Medicine.
Kamis, 01 Oktober 2009
Incidence of Thrombocytopenia in Hospitalized Patients with Venous Thromboembolism
Although heparin-associated thrombocytopenia is uncommon, the incidence can be minimized by use of low molecular weight heparin, particularly if extended prophylaxis or extended treatment is required.
Abstract
Purpose
To determine the incidence of heparin-associated thrombocytopenia in patients receiving prophylaxis or treatment for venous thromboembolism.
Methods
We assessed the database of the National Hospital Discharge Survey from 1979 through 2005 and complemented this with a meta-analysis of published literature.
Results
Among 10,554,000 patients discharged from short-stay hospitals throughout the US with venous thromboembolism during the 27 years of study, secondary thrombocytopenia was coded in 38,000 patients (0.36%). From 1979 through 1992, secondary thrombocytopenia was coded in only 0.15% of hospitalized patients with venous thromboembolism. The frequency increased sharply to 0.54% from 1993 through 2005. Secondary thrombocytopenia was rarely diagnosed among 1,446,000 patients aged <40 years and among 77,000 women who had venous thromboembolism with deliveries. Meta-analysis of published literature showed a higher incidence among patients who received unfractionated heparin (UFH) for prophylaxis than those who received low-molecular-weight heparin (LMWH) for prophylaxis. Treatment resulted in smaller differences of the incidence between UFH and LMWH.
Conclusion
Heparin-associated thrombocytopenia is rare among patients aged <40 years and women following delivery. The risk of heparin-associated thrombocytopenia is more duration-related than dose-related, and higher with UFH when used for an extended duration. Our findings and those of the literature suggest that although heparin-associated thrombocytopenia is uncommon, the incidence can be minimized by use of LMWH, particularly if extended prophylaxis or extended treatment is required.
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-- Paul D. Stein, MD, Russell D. Hull, MBBS, MSc, Fadi Matta, MD, Abdo Y. Yaekoub, MDc, Jane Liang, MSc
This article was originally published in the October 2009 issue of The American Journal of Medicine.
Abstract
Purpose
To determine the incidence of heparin-associated thrombocytopenia in patients receiving prophylaxis or treatment for venous thromboembolism.
Methods
We assessed the database of the National Hospital Discharge Survey from 1979 through 2005 and complemented this with a meta-analysis of published literature.
Results
Among 10,554,000 patients discharged from short-stay hospitals throughout the US with venous thromboembolism during the 27 years of study, secondary thrombocytopenia was coded in 38,000 patients (0.36%). From 1979 through 1992, secondary thrombocytopenia was coded in only 0.15% of hospitalized patients with venous thromboembolism. The frequency increased sharply to 0.54% from 1993 through 2005. Secondary thrombocytopenia was rarely diagnosed among 1,446,000 patients aged <40 years and among 77,000 women who had venous thromboembolism with deliveries. Meta-analysis of published literature showed a higher incidence among patients who received unfractionated heparin (UFH) for prophylaxis than those who received low-molecular-weight heparin (LMWH) for prophylaxis. Treatment resulted in smaller differences of the incidence between UFH and LMWH.
Conclusion
Heparin-associated thrombocytopenia is rare among patients aged <40 years and women following delivery. The risk of heparin-associated thrombocytopenia is more duration-related than dose-related, and higher with UFH when used for an extended duration. Our findings and those of the literature suggest that although heparin-associated thrombocytopenia is uncommon, the incidence can be minimized by use of LMWH, particularly if extended prophylaxis or extended treatment is required.
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-- Paul D. Stein, MD, Russell D. Hull, MBBS, MSc, Fadi Matta, MD, Abdo Y. Yaekoub, MDc, Jane Liang, MSc
This article was originally published in the October 2009 issue of The American Journal of Medicine.
The Patient–Physician–Industry–Government Partnership: A Societal Good
I recently celebrated the 40th anniversary of my graduation from medical school at a class reunion in Boston. While reminiscing with my former classmates about the joys and tribulations of living as a student during the 1960s, a discussion arose regarding what was available to us then in the area of pharmacotherapeutics compared with what is now available for practicing physicians. In regard to treatments for cardiovascular disease, my area of internal medicine subspecialty, we had nitrates for angina pectoris; digitalis preparations and furosemide for heart failure; hydrochlorothiazide, reserpine, guanethidine, hydralazine, and alpha-methyldopa for hypertension; quinidine, lidocaine, and procainamide for arrhythmias; and bile acid resins for hypercholesterolemia. Since 1969, with the advances in basic research supported by the National Institutes of Health (NIH) and the development of new drugs by the pharmaceutical industry, we now have available for clinical use the beta-adrenergic blockers and calcium-entry blockers for the treatment of angina pectoris; angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for heart failure; new drugs for systemic and pulmonary hypertension; thrombolytics for myocardial infarction; statins for hypercholesterolemia; and new antiplatelet drugs. These newer therapies have favorably affected both the prevention and treatment of cardiovascular disease.
As examples, over the past 40 years, major reductions have occurred in the numbers of acute myocardial infarctions, in part related to innovative drug therapies for cholesterol elevations, hypertension, and smoking addiction.
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- William H. Frishman, MD
This article was originally published in the October 2009 issue of The American Journal of Medicine.
As examples, over the past 40 years, major reductions have occurred in the numbers of acute myocardial infarctions, in part related to innovative drug therapies for cholesterol elevations, hypertension, and smoking addiction.
To read this article in its entirety, please visit our website.
- William H. Frishman, MD
This article was originally published in the October 2009 issue of The American Journal of Medicine.
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