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  • Mehdipour, Mahshid  (14)
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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, 05 April 2011, Vol.57(14), pp.E1669-E1669
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0735-1097(11)61669-0 Byline: Mohsen Sharifi, Tariq Niazi, Mahshid Mehdipour, Elnaz Emrani
    Keywords: Medicine
    ISSN: 0735-1097
    E-ISSN: 1558-3597
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  • 3
    Language: English
    In: Journal of the American College of Cardiology, 05 April 2011, Vol.57(14), pp.E1202-E1202
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0735-1097(11)61202-3 Byline: Mohsen Sharifi, Rima Patel, Tariq Niazi, Elnaz Emrani, Mahshid Mehdipour
    Keywords: Medicine
    ISSN: 0735-1097
    E-ISSN: 1558-3597
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  • 4
    Language: English
    In: Journal of the American College of Cardiology, 09 March 2010, Vol.55(10), pp.A180.E1686-A180.E1686
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0735-1097(10)61687-7 Byline: Mohsen Sharifi, Mahshid Mehdipour, Adam Berkovits, Gary Smith
    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: Catheterization and Cardiovascular Interventions, 01 April 2010, Vol.75(5), pp.685-689
    Description: Venous thromboembolic disease is an underdiagnosed disease spectrum with a high mortality and morbidity. Despite significant advances in cardiovascular interventions, venous occlusive disease has not received the attention it deserves from the interventional cardiology community. We describe an 82‐year‐old man with massive left lower extremity DVT who underwent successful percutaneous endovenous intervention (PEVI) with rapid resolution of symptoms. We like to use this case as a call to action and raise awareness of the importance of PEVI in the treatment of extensive venous occlusive disease. © 2009 Wiley‐Liss, Inc.
    Keywords: Deep Venous Thrombosis ; Thrombectomy ; Thrombolytic Therapy
    ISSN: 1522-1946
    E-ISSN: 1522-726X
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  • 8
    Language: English
    In: Journal of Endovascular Therapy, April 2012, Vol.19(2), pp.273-280
    Description: Purpose To present midterm results from a randomized study comparing the safety and efficacy of percutaneous endovenous intervention (PEVI) + anticoagulation vs. anticoagulation alone in the reduction of venous thromboembolism (VTE) and post-thrombotic syndrome (PTS) in acute symptomatic proximal deep venous thrombosis (DVT). Methods The TORPEDO trial was a randomized study to demonstrate superiority of PEVI in the reduction of the VTE and PTS at 6 months; in that trial, 183 patients (103 men; mean age 61±11 years) with symptomatic proximal DVT were randomized to receive PEVI + anticoagulation (n=91) or anticoagulation alone (n=92). PEVI consisted of one or more of a combination of thrombectomy, balloon venoplasty, stenting, and/or local low-dose thrombolytic therapy. Results At 6 months, recurrent VTE developed in 2.3% of the PEVI + anticoagulation group vs. 14.8% in the anticoagulation only group (p=0.003); PTS developed in 3.4% vs. 27.2% (p〈0.001), respectively. At a mean follow-up of 3065 months (range 12–41), 88 patients in the PEVI + anticoagulation group and 81 patients in the anticoagulation only group reached target follow-up. Recurrent VTE developed in 4 (4.5%) of the 88 PEVI + anticoagulation patients vs. 13 (16%) of the 81 patients receiving anticoagulation only (p=0.02). PTS developed in 6 (6.8%) of the PEVI + anticoagulation group vs. 24 (29.6%) of the anticoagulation only group (p〈0.001). Conclusion In patients with proximal DVT, PEVI is superior to anticoagulation alone in the reduction of VTE and PTS. This benefit, which appears early in the course of treatment, extends to 〉2.5 years.
    Keywords: Venous Thrombolysis ; Post-Thrombotic Syndrome ; Recurrent Deep Venous Thrombosis ; Venous Thromboembolism ; Percutaneous Endovenous Intervention ; Thrombectomy ; Venoplasty ; Anticoagulation ; Stent ; Thrombolysis
    ISSN: 1526-6028
    E-ISSN: 1545-1550
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  • 9
    Language: English
    In: Catheterization and Cardiovascular Interventions, 01 September 2010, Vol.76(3), pp.316-325
    Description: We compared the efficacy and safety of percutaneous endovenous intervention (PEVI) plus anticoagulation with anticoagulation alone in the reduction of venous thromboembolism (VTE) and post‐thrombotic syndrome (PTS) in acute proximal deep venous thrombosis (DVT). Recurrent VTE and PTS are common complications of DVT. There are no randomized trials investigating the efficacy of PEVI in the reduction of the above complications. Patients with symptomatic proximal DVT were randomized to receive PEVI plus anticoagulation or anticoagulation alone. Anticoagulation consisted of intravenous unfractionated heparin or subcutaneous low‐molecular weight heparin plus warfarin. PEVI consisted of one or more of a combination of thrombectomy, balloon venoplasty, stenting, or local low‐dose thrombolytic therapy. At 6 months follow‐up, recurrent VTE developed in 2 of 88 patients of the PEVI plus anticoagulation group versus 12 of 81of the anticoagulation‐alone group (2.3% vs. 14.8%, = 0.003). PTS developed in 3 of 88 patients of the PEVI plus anticoagulation Group and 22 of 81 of the anticoagulation‐alone group (3.4% vs. 27.2%, 〈 0.001). In patients with symptomatic proximal DVT, PEVI plus anticoagulation may be superior to anticoagulation—alone in the reduction of VTE and PTS at 6 months. © 2010 Wiley‐Liss, Inc.
    Keywords: Peripheral Vascular Disease ; Thrombosis ; Coagulation
    ISSN: 1522-1946
    E-ISSN: 1522-726X
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  • 10
    Language: English
    In: Cardiovascular Revascularization Medicine, 2010, Vol.11(4), pp.272-272
    Keywords: Medicine
    ISSN: 1553-8389
    E-ISSN: 1878-0938
    Source: ScienceDirect Journals (Elsevier)
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