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  • Bay, Curt  (21)
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  • 1
    Language: English
    In: The American Journal of Cardiology, 15 January 2013, Vol.111(2), pp.273-277
    Description: The role of low-dose thrombolysis in the reduction of pulmonary artery pressure in moderate pulmonary embolism (PE) has not been investigated. Because the lungs are very sensitive to thrombolysis, we postulated that effective and safe thrombolysis might be achieved by a lower dose of tissue plasminogen activator. The purpose of the present study was to evaluate the role of this “safe dose” thrombolysis in the reduction of pulmonary artery pressure in moderate PE. During a 22-month period, 121 patients with moderate PE were randomized to receive a “safe dose” of tissue plasminogen activator plus anticoagulation (thrombolysis group [TG], n = 61 patients) or anticoagulation alone (control group [CG], n = 60). The primary end points consisted of pulmonary hypertension and the composite end point of pulmonary hypertension and recurrent PE at 28 months. Pulmonary hypertension and the composite end point developed in 9 of 58 patients (16%) in the TG and 32 of 56 patients (57%) in the CG (p 〈0.001) and 9 of 58 patients (16%) in the TG and 35 of 56 patients (63%) in the CG (p 〈0.001), respectively. The secondary end points were total mortality, the duration of hospital stay, bleeding at the index hospitalization, recurrent PE, and the combination of mortality and recurrent PE. The duration of hospitalization was 2.2 ± 0.5 days in the TG and 4.9 ± 0.8 days in the CG (p 〈0.001). The combination of death plus recurrent PE was 1 (1.6%) in TG and 6 (10%) in the CG (p = 0.0489). No bleeding occurred in any group, and despite a positive trend in favor of a “safe dose” thrombolysis, no significant difference was noted in the rate of individual outcomes of death and recurrent PE when assessed independently. In conclusion, the results from the present prospective randomized trial suggests that “safe dose” thrombolysis is safe and effective in the treatment of moderate PE, with a significant immediate reduction in the pulmonary artery pressure that was maintained at 28 months.
    Keywords: Medicine
    ISSN: 0002-9149
    E-ISSN: 1879-1913
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  • 2
    Language: English
    In: Journal of the American College of Cardiology, 17 March 2015, Vol.65(10), pp.A2130-A2130
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0735-1097(15)62130-1 Byline: Mohsen Sharifi, Wilbur Freeman, Curt Bay, Mirali Sharifi, Jean Chatham, Frederic Schwartz Author Affiliation: Arizona Cardiovascular Consultants & Vein Clinic, Mesa, AZ, USA A.T. Still University, Mesa, AZ, USA Article Note: (footnote) Poster Contributions Poster Hall B1 Monday, March 16, 2015, 9:45 a.m.-10:30 a.m. Session Title: Advanced in Pharmacomechanical Therapy for Deep Vein Thrombosis Abstract Category: 46. Vascular Medicine: Venous Disease Presentation Number: 1258-333
    Keywords: Medicine
    ISSN: 0735-1097
    E-ISSN: 1558-3597
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  • 3
    Language: English
    In: Journal of the American College of Cardiology, 27 March 2012, Vol.59(13), pp.E1700-E1700
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0735-1097(12)61701-X Byline: Mohsen Sharifi, Curt Bay, Todd Schuster, Navid Mehdipour Author Affiliation: Arizona Cardiovascular Consultants, Mesa, AZ, USA, A.T. Still University, Mesa, AZ, USA Article Note: (footnote) ACC Moderated Poster Contributions McCormick Place South, Hall A Sunday, March 25, 2012, 9:30 a.m.-10:30 a.m. Session Title: Prevention: Clinical Current Topics in Anticoagulation/Antiplatelet Therapies Abstract Category: 9. Prevention: Clinical Presentation Number: 1192-603
    Keywords: Medicine
    ISSN: 0735-1097
    E-ISSN: 1558-3597
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  • 4
    Language: English
    In: Journal of the American College of Cardiology, 29 October 2013, Vol.62(18), pp.B157-B157
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jacc.2013.08.1262 Byline: Mohsen Sharifi, Wilbur K. Freeman, Jean Chatham, Tahereh Emami, Curt Bay, Frederic Schwartz Author Affiliation: (1) Arizona Cardiovascular Consultants & A.T. Still University, Mesa, AZ (2) A.T.Still University, Mesa, AZ (3) Arizona Cardiovascular Consultants, Mesa, AZ (4) A.T.Still University, Mesa, AZ
    Keywords: Medicine
    ISSN: 0735-1097
    E-ISSN: 1558-3597
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  • 5
    Language: English
    In: Journal of the American College of Cardiology, 23 October 2012, Vol.60(17), pp.B221-B221
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jacc.2012.08.798 Byline: Mohsen Sharifi, Curt Bay, Suzanne Bentz, Mahshid Mehdipour, Pamela Eden, Sasan Nowroozi Author Affiliation: (1) Arizona Cardiovascular Consultants & A.T. Still University, Mesa, AZ (2) A.T.Still University, Mesa, AZ (3) Arizona Cardiovascular Consultants, Mesa, AZ
    Keywords: Medicine
    ISSN: 0735-1097
    E-ISSN: 1558-3597
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  • 6
    Language: English
    In: Journal of Vascular Surgery, 2011, Vol.53(1), pp.147-149
    Description: A growing number of patients who are on systemic anticoagulation with warfarin require endovenous thermal ablation for reflux disease in the great saphenous vein (GSV). Little is known about the effects of anticoagulation on periprocedural bleeding and long-term closure rates of the treated veins. This study evaluated the effects of uninterrupted anticoagulation in patients undergoing endovenous thermal ablation. In this prospective observational study, 88 limbs of patients on warfarin (anticoagulation group [AG]) who underwent endovenous thermal ablation for GSV reflux disease were compared with 92 limbs in patients receiving no anticoagulation or antiplatelet agents (control group [CG]). Forty percent of AG patients were also receiving antiplatelet therapy. Periprocedural bleeding and closure rate at 1 year were evaluated. No major bleeding occurred in either group. Minor bleeding was noted in 8 of 88 procedures in the AG vs 4 of 92 in the CG ( = 0.24); all in patients receiving radiofrequency ablation. Four of the eight minor bleeds in the AG were noted in patients receiving “triple therapy” with warfarin, aspirin, and clopidogrel or ticlopidine. Triple therapy in the AG was associated with a higher risk of minor bleeding compared with the CG (relative risk, 13.0; 95% confidence interval, 4.10-41.19, 〈 .001). All treated venous segments remained closed at the 1-year follow-up in both groups. In this relatively small, nonrandomized study comparing endovenous thermal ablation in patients with and without warfarin, no differences were found in periprocedural risk of major bleeding or closure rate of the treated venous segments. Minor bleeding was increased in patients receiving triple therapy with warfarin, aspirin, and a thienopyridine who underwent radiofrequency ablation.
    Keywords: Medicine
    ISSN: 0741-5214
    E-ISSN: 1097-6809
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  • 7
    Language: English
    In: Journal of the American College of Cardiology, 01 April 2014, Vol.63(12), pp.A2096-A2096
    Keywords: Medicine
    ISSN: 0735-1097
    E-ISSN: 1558-3597
    Source: ScienceDirect Journals (Elsevier)
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  • 8
    Language: English
    In: Journal of the American College of Cardiology, 01 April 2014, Vol.63(12), pp.A1475-A1475
    Keywords: Medicine
    ISSN: 0735-1097
    E-ISSN: 1558-3597
    Source: ScienceDirect Journals (Elsevier)
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  • 9
    In: Clinical Cardiology, February 2014, Vol.37(2), pp.78-82
    Description: Byline: Mohsen Sharifi, Curt Bay, Frederic Schwartz, Laura Skrocki ABSTRACT Background Thrombolysis, though very effective, has not been embraced as routine therapy for symptomatic pulmonary embolism (PE) except in very severe cases. Rivaroxaban recently has been approved for the treatment of venous thromboembolism (VTE). There are no data on the combined use of thrombolysis and rivaroxaban in PE. Hypothesis "Safe dose" thrombolysis (SDT) plus new oral anticoagulants are expected to become an appealing, safe and effective approach in the treatment of moderate and severe PE in the near future, thereby drastically reducing hospitalization time. Methods Over a 12-month period, 98 consecutive patients with symptomatic PE were treated by a combination of SDT and rivaroxaban. The SDT was started in parallel with unfractionated heparin and given in 2 hours. Heparin was given for a total of 24 hours and rivaroxaban started at 15 or 20 mg daily 2 hours after termination of heparin infusion. Results There was no bleeding due to SDT. Recurrent VTE occurred in 3 patients who had been switched to warfarin. No patient on rivaroxaban developed VTE. Two patients died of cancer at a mean follow-up of 12 [+ or -] 2 months. The pulmonary artery systolic pressure dropped from 52.8 [+ or -] 3.9 mm Hg before to 32 [+ or -] 4.4 mm Hg within 36 hours of SDT (P 0.001). The duration of hospitalization for patients presenting primarily for PE was 1.9 [+ or -] 0.2 days. Conclusions "Safe dose" thrombolysis plus rivaroxaban is highly safe and effective in the treatment of moderate and severe PE, leading to favorable early and intermediate-term outcomes and early discharge. Author Affiliation: Arizona Cardiovascular Consultants and Vein Clinic, Mesa, Arizona A. T. Still University, Mesa, Arizona
    Keywords: Pulmonary Embolism -- Drug Therapy ; Thromboembolism -- Drug Therapy ; Heparin ; Warfarin;
    ISSN: 0160-9289
    E-ISSN: 1932-8737
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  • 10
    Language: English
    In: CardioVascular and Interventional Radiology, 2013, Vol.36(6), pp.1586-1590
    Description: Byline: Mohsen Sharifi (1,2), Curt Bay (2), Sasan Nowroozi (1), Suzanne Bentz (1), Gayle Valeros (1), Sara Memari (1) Keywords: Argatroban; Deep vein thrombosis; Infusion catheter; Percutaneous endovenous intervention; Thrombolysis; tPA Abstract: Purpose Catheter-directed thrombolysis (CDT) is a highly effective approach in the treatment of deep venous thrombosis (DVT). There are no data on the primary use of CDT with argatroban and tissue plasminogen activator (tPA) in patients without heparin-induced thrombocytopenia (HIT). The aim of this study was to evaluate the efficacy and safety of the combined administration of argatroban and tPA during CDT for massive DVT in patients without HIT. Methods Thirty-three patients with massive symptomatic iliac and femoropopliteal DVT underwent CDT with tPA and argatroban within 28 +- 6 h of presentation. The dose of tPA was 0.75--1 mg/h through the infusion port and that of argatroban at 0.3--1 ug/kg/min through the side port of the sheath. The patients were evaluated for the efficacy and safety of CDT and recurrent symptomatic venous thromboembolism (VTE) at a mean follow-up of 22 months. Results There was no bleeding or iatrogenic pulmonary embolism with the CDT regimen we used. Grade III lysis (complete resolution of thrombus on venography) was achieved in 30 patients (91 %). In 3 patients with additional inferior vena cava filter thrombosis, further thrombectomy of the filter was required. No patient developed recurrent VTE. Conclusion Concomitant administration of argatroban and tPA is a highly safe and effective regimen for CDT for massive DVT. Author Affiliation: (1) Arizona Cardiovascular Consultants, 3850 E Baseline Road, Bldg1, Suite 102, Mesa, AZ, 85206, USA (2) A. T. Still University, 5850 East Still Circle, Mesa, AZ, 85206, USA Article History: Registration Date: 17/01/2013 Received Date: 25/09/2012 Accepted Date: 10/01/2013 Online Date: 02/02/2013
    Keywords: Argatroban ; Deep vein thrombosis ; Infusion catheter ; Percutaneous endovenous intervention ; Thrombolysis ; tPA
    ISSN: 0174-1551
    E-ISSN: 1432-086X
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