Jannik Pallisgaard - Academia.edu (original) (raw)
Papers by Jannik Pallisgaard
Ugeskrift For Laeger, Dec 15, 2014
Giant coronary aneurysms (GCA with a diameter > 20... more Giant coronary aneurysms (GCA with a diameter > 20 mm) are rare with a prevalence < 0.02%. A 62-year-old woman with no history of ischaemic heart disease was admitted to hospital with acute chest pain. A coronary angiography revealed a left an-terior descendent-associated GCA. A cardiac computed tomo-g-raphy demonstrated a "snake-pit"-like fistula connecting the GCA and the pulmonary artery. Atherosclerosis, connective tissue dis-orders, and previous coronary intervention will predispose to GCA. No evidence-based treatment regimen exists, but coiling, excision or a conservative approach, as in this case, is possible strategies.
Ugeskrift For Laeger, Mar 10, 2014
Scleroderma is a rare cause of myocarditis. We present a case of myocarditis due to scleroderma i... more Scleroderma is a rare cause of myocarditis. We present a case of myocarditis due to scleroderma in a 48-year-old man. The patient was eventually diagnosed with viral myocarditis, as his scleroderma was well controlled, and the clinical presentation did not match prior examples of myocarditis due to scleroderma. When treating scleroderma patients with myocarditis, scleroderma should always be considered as a possible cause, as the treatment differs from other types of myocarditis.
BMJ (Clinical research ed.), Jan 16, 2015
What are the risks of all cause mortality, thromboembolism, major bleeding, and recurrent gastroi... more What are the risks of all cause mortality, thromboembolism, major bleeding, and recurrent gastrointestinal bleeding associated with restarting antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation? This Danish cohort study (1996-2012) included all patients with atrial fibrillation discharged from hospital after gastrointestinal bleeding while receiving antithrombotic treatment. Restarted treatment regimens were single or combined antithrombotic drugs with oral anticoagulation and antiplatelets. Follow-up started 90 days after discharge to avoid confounding from use of previously prescribed drugs on discharge. Risks of all cause mortality, thromboembolism, major bleeding, and recurrent gastrointestinal bleeding were estimated with competing risks models and time dependent multiple Cox regression models. 4602 patients (mean age 78 years) were included. Within two years, 39.9% (95% confidence interval 38.4% to 41.3%, n=1745) of the patients had d...
BMC Neurology, 2015
Background: In patients with ischemic stroke of non-cardioembolic origin, acetylsalicylic acid, c... more Background: In patients with ischemic stroke of non-cardioembolic origin, acetylsalicylic acid, clopidogrel, or a combination of acetylsalicylic acid and dipyridamole are recommended for the prevention of a recurrent stroke. The purpose of this study was to examine the risk of bleeding or recurrent stroke associated with these three treatments. Methods: Patients who were discharged with first-time ischemic stroke from 2007-2010, with no history of atrial fibrillation were identified from Danish nationwide registries. Hazard ratios (HRs) and 1-year risks of recurrent ischemic stroke and bleeding were calculated for each antiplatelet regimen. Results: Among patients discharged after first-time ischemic stroke, 3043 patients were treated with acetylsalicylic acid, 12,295 with a combination of acetylsalicylic acid and dipyridamole, and 3885 with clopidogrel. Adjusted HRs for clopidogrel versus the combination of acetylsalicylic acid and dipyridamole were 1.02 (95 % confidence interval [CI]: 0.89-1.17) for ischemic stroke and 1.06 (95 % CI: 0.83-1.35) for bleeding. Adjusted HRs for acetylsalicylic acid versus the combination of acetylsalicylic acid and dipyridamole were 1.48 (95 % CI: 1.31-1.67) for stroke and 1.47 (95 % CI: 1.18-1.82) for bleeding. Clopidogrel versus acetylsalicylic acid yielded HRs of 0.69 (95 % CI: 0.59-0.81) and 0.72 (95 % CI: 0.55-0.96) for stroke and bleeding, respectively. The 1-year predicted risks associated with acetylsalicylic acid, the combination of acetylsalicylic acid and dipyridamole, and clopidogrel were 11.1 (95 %
PLOS ONE, 2015
Aim Cardioversion can rapidly and effectively restore sinus rhythm in patients with persistent at... more Aim Cardioversion can rapidly and effectively restore sinus rhythm in patients with persistent atrial fibrillation. Since 2011 dabigatran has been available as an alternative to warfarin to prevent thromboembolic events in patients with non-valvular atrial fibrillation undergoing cardioversion. We studied time to cardioversion, risk of adverse events, and risk of readmission with atrial fibrillation after cardioversion according to anticoagulation therapy. Methods and Results Through the nationwide Danish registries we included 1,230 oral anticoagulation naïve patients with first time non-valvular atrial fibrillation and first time cardioversion from 2011 to 2012; 37% in the dabigatran group (n = 456), and 63% in the warfarin group (n = 774). Median time to cardioversion was 4.0 (interquartile range [IQR] 2.9 to 6.5) and 6.9 (IQR 3.9 to 12.1) weeks in the dabigatran and warfarin groups respectively, and the adjusted odds ratio of cardioversion within the first 4 weeks was 2.3 (95% confidence interval [CI] 1.7 to 3.1) in favor of dabigatran. The cumulative incidence of composite endpoint of stroke, bleeding or death were 2.0% and 1.0% at 30 weeks in the warfarin and dabigatran groups respectively, with an adjusted hazard ratio of 1.33 (95% CI 0.33 to 5.42). Cumulative incidence of readmission with atrial fibrillation after 30 weeks were 9% and 11% in the warfarin and dabigatran groups, respectively, and an adjusted hazard ratio of 0.66 (95% CI 0.41 to 1.08). Conclusion Anticoagulation treatment with dabigatran allows shorter time to cardioversion for atrial fibrillation than warfarin, and appears to be an effective and safe alternative treatment strategy to warfarin.
European Journal of Preventive Cardiology, 2015
Diabetes has been associated with atrial fibrillation but the current evidence is conflicting. In... more Diabetes has been associated with atrial fibrillation but the current evidence is conflicting. In particular knowledge regarding young diabetes patients and the risk of developing atrial fibrillation is sparse. The aim of our study was to investigate the risk of atrial fibrillation in patients with diabetes compared to the background population in Denmark. Through Danish nationwide registries we included persons above 18 years of age and without prior atrial fibrillation and/or diabetes from 1996 to 2012. The study cohort was divided into a background population without diabetes and a diabetes group. The absolute risk of developing atrial fibrillation was calculated and Poisson regression models adjusted for sex, age and comorbidities were used to calculate incidence rate ratios of atrial fibrillation. The total study cohort included 5,081,087 persons, 4,827,713 (95%) in the background population and 253,374 (5%) in the diabetes group. Incidence rates of atrial fibrillation per 1000 person years were stratified in four age groups from 18 to 39, 40 to 64, 65 to 74 and 75 to 100 years giving incidence rates (95% confidence intervals) of 0.02 (0.02-0.02), 0.99 (0.98-1.01), 8.89 (8.81-8.98) and 20.0 (19.9-20.2) in the background population and 0.13 (0.09-0.20), 2.10 (2.00-2.20), 8.41 (8.10-8.74) and 20.1 (19.4-20.8) in the diabetes group, respectively. The adjusted incidence rate ratios in the diabetes group with the background population as reference were 2.34 (1.52-3.60), 1.52 (1.47-1.56), 1.20 (1.18-1.23) and 0.99 (0.97-1.01) in the four age groups, respectively. Diabetes is an independent risk factor for developing atrial fibrillation/flutter, most pronounced in young diabetes patients. Routine screening for atrial fibrillation/flutter in diabetes patients might be beneficial and have therapeutic implications, especially in younger diabetes patients. Diabetes increases the risk of developing atrial fibrillation and especially young diabetes patients have a high relative risk. Increased focus on detecting atrial fibrillation in young diabetes patients might prove beneficial, and both anticoagulation treatment and anti-arrhythmic treatment strategies should be considered as soon as possible.
European Heart Journal - Cardiovascular Pharmacotherapy, 2015
Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with increased risk of cardiovascul... more Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with increased risk of cardiovascular disease. Yet, the risk of atrial fibrillation (AF) associated with NSAIDs among patients with prior myocardial infarction (MI) has not been examined, and such data could contribute considerably to the risk-benefit assessment of NSAID use in this clinical context. Methods and results Using nationwide administrative registries in Denmark, we studied patients aged ≥30 years admitted with first-time MI and without prior AF in the period of 1997-2011. Risk of AF associated with NSAID use vs. no NSAID use was analysed by multivariable time-dependent Cox proportional hazard models. Of the 86 496 patients [mean age 66 (SD 13) years; 64% men] included in this study, 44.1% filled at least one NSAID prescription after discharge from MI. During a mean follow-up of 5.3 years, 7831 (8.9%) developed AF. The confidence intervals rate (95% CI) of AF per 100 person-years with NSAID treatment was 2.2 (2.0-2.4) compared with 1.7 (1.6-1.7) without NSAIDs. In the adjusted model, the risk of AF after NSAID treatment increased [Hazard ratio (HR) 1.27 (1.14-1.40)]. An increased risk of AF was seen regardless of the type of NSAID or with short-term (0-14 days) treatment [HR 1.45 (1.24-1.69)]. When the risk of death in patients exposed [crude rate 23.3 (19.7-27.5)] vs. not exposed [crude rate 17.4 (95% CI 16.8-18.1)] to NSAIDs at the time of AF was compared, NSAID use was associated with a poorer prognosis [HR 1.35 (1.14-1.60)]. Conclusion Our study suggests that the use of NSAIDs might be associated with the increased risk of AF in post-MI patients.
Thrombosis Research, 2015
To examine and compare the safety and efficacy of extended treatment with dabigatran, apixaban, r... more To examine and compare the safety and efficacy of extended treatment with dabigatran, apixaban, rivaroxaban and warfarin in patients with unprovoked venous thromboembolism. PubMed and Embase were searched for randomized clinical trials reporting on the use of direct oral anticoagulants (DOACs) and warfarin for the extended treatment of VTE. Meta-analysis was performed on studies reporting similar study design and comparator. A total of 729 articles were identified and 5 studies covering 6 randomized clinical trials met the eligibility criteria and were included in the study. 5 studies were included in the meta-analysis. Results from the meta-analysis showed that the extended use of DOACs and warfarin significantly decreased the risk of recurrent VTE with 83 % when compared placebo. Warfarin (RR: 0.03, CI: 0.00-0.49) and dabigatran (RR: 0.08, CI: 0.03-0.27) showed the largest relative risk reduction followed by apixaban 2.5mg (RR: 0.19, CI: 0.11-0.33), rivaroxaban (RR:0.19, CI: 0.09-0.40) and apixaban 5mg (RR: 0.20, CI: 0.11-0.34). No significant increased risk of major bleeding was observed with the extended use of any DOACs and warfarin compared to placebo (1.15, CI: 0.40-3.31), but an overall increased risk of non-major clinically relevant bleeding (NMCRB) was observed (RR: 2.12, CI: 1.55-2.90). Apixaban 2.5mg and warfarin was not individually associated with an increased risk of NMCRB. Furthermore, it was found from a study not included in the meta-analysis that dabigatran was non-inferior to VKA for the prevention of recurrent VTE (HR: 1.44, CI: 0.78-2.64, p=0.01 for noninferiority) and decreased the risk of NMCRB compared to VKA (RR: 0.58, CI: 0.43-0.77). Extended treatment with both warfarin and DOACs are effective in preventing recurrent VTE and does not increase the risk of major bleeding, but increases the risk of NMCRB.
Expert Review of Cardiovascular Therapy, 2015
The global burden of atrial fibrillation and diabetes mellitus (diabetes) is considerable, and pr... more The global burden of atrial fibrillation and diabetes mellitus (diabetes) is considerable, and prevalence rates are increasing. Diabetes is associated with an increased risk of developing atrial fibrillation; however, diabetes also influences the management and prognosis of atrial fibrillation. In the following article, the authors describe the association between diabetes and atrial fibrillation; specifically, the significance of diabetes on the risk of atrial fibrillation, ischemic stroke and bleeding complications associated with anticoagulation. In addition, the authors evaluate the risks and outcomes of heart failure and the success rates of both ablation and cardioversion in atrial fibrillation patients with diabetes. Finally, this article describes the association of HbA1c levels with the management and prognosis of atrial fibrillation patients.
Ugeskrift for laeger, Jan 10, 2014
Scleroderma is a rare cause of myocarditis. We present a case of myocarditis due to scleroderma i... more Scleroderma is a rare cause of myocarditis. We present a case of myocarditis due to scleroderma in a 48-year-old man. The patient was eventually diagnosed with viral myocarditis, as his scleroderma was well controlled, and the clinical presentation did not match prior examples of myocarditis due to scleroderma. When treating scleroderma patients with myocarditis, scleroderma should always be considered as a possible cause, as the treatment differs from other types of myocarditis.
Ugeskrift for laeger, Jan 15, 2014
Giant coronary aneurysms (GCA with a diameter > 20 mm) are rare with a prevalence < 0.02%. ... more Giant coronary aneurysms (GCA with a diameter > 20 mm) are rare with a prevalence < 0.02%. A 62-year-old woman with no history of ischaemic heart disease was admitted to hospital with acute chest pain. A coronary angiography revealed a left an-terior descendent-associated GCA. A cardiac computed tomo-g-raphy demonstrated a "snake-pit"-like fistula connecting the GCA and the pulmonary artery. Atherosclerosis, connective tissue dis-orders, and previous coronary intervention will predispose to GCA. No evidence-based treatment regimen exists, but coiling, excision or a conservative approach, as in this case, is possible strategies.
Ugeskrift for laeger, Jan 22, 2012
Calcified amorphoeus tumour of the heart (cardiac CAT) is a rare non-neoplastic tumour of the hea... more Calcified amorphoeus tumour of the heart (cardiac CAT) is a rare non-neoplastic tumour of the heart. To the best of our knowledge, this is the first case report of cardiac CAT in Scandinavia. The patient was a 55-year-old woman with obesity, hypertension, hyperlipidaemia, a history of smoking, and a family history of ischaemic heart disease. She presented with dyspnoea and near syncope. The tumour was resected, and cytopathology was preformed on its content. Based on the cytopathology, the pathologist concluded that the tumour most likely was cardiac CAT, though a calcified myxoma could not be excluded with certainty.
The American journal of case reports, Jan 16, 2014
Brugada syndrome (BrS) is a genetic arrhythmogenic disease characterized by ST-segment elevations... more Brugada syndrome (BrS) is a genetic arrhythmogenic disease characterized by ST-segment elevations in the right precordial leads of the electrocardiogram (ECG). These ECG changes may be concealed and BrS may present with electrical storm characterized by recurrent ventricular tachycardia and fibrillation. A 49-year-old previously healthy man was admitted with electrical storm. The patient received direct current (DC) cardioversion shocks and only after intravenous lidocaine did the electrical storm slowly subside with a total of 255 DC shocks administered during the first 24 h after admission. He fully recovered and received an implantable cardioverter-defibrillator. Subsequent drug challenge with flecainide revealed type 1 BrS. Massive electrical storm can be the first symptom of BrS and the diagnostic ECG changes may be concealed at presentation. Although hundreds of DC shocks may be required during initial treatment, full recovery can be achieved.
European Journal of Heart Failure, 2014
Heart failure is an established risk factor for poor outcomes in patients undergoing non-cardiac ... more Heart failure is an established risk factor for poor outcomes in patients undergoing non-cardiac surgery, yet risk stratification remains a clinical challenge. We developed an index for 30-day mortality risk prediction in this particular group.
Ugeskrift For Laeger, Dec 15, 2014
Giant coronary aneurysms (GCA with a diameter &amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 20... more Giant coronary aneurysms (GCA with a diameter &amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 20 mm) are rare with a prevalence &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.02%. A 62-year-old woman with no history of ischaemic heart disease was admitted to hospital with acute chest pain. A coronary angiography revealed a left an-terior descendent-associated GCA. A cardiac computed tomo-g-raphy demonstrated a &amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;snake-pit&amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;-like fistula connecting the GCA and the pulmonary artery. Atherosclerosis, connective tissue dis-orders, and previous coronary intervention will predispose to GCA. No evidence-based treatment regimen exists, but coiling, excision or a conservative approach, as in this case, is possible strategies.
Ugeskrift For Laeger, Mar 10, 2014
Scleroderma is a rare cause of myocarditis. We present a case of myocarditis due to scleroderma i... more Scleroderma is a rare cause of myocarditis. We present a case of myocarditis due to scleroderma in a 48-year-old man. The patient was eventually diagnosed with viral myocarditis, as his scleroderma was well controlled, and the clinical presentation did not match prior examples of myocarditis due to scleroderma. When treating scleroderma patients with myocarditis, scleroderma should always be considered as a possible cause, as the treatment differs from other types of myocarditis.
BMJ (Clinical research ed.), Jan 16, 2015
What are the risks of all cause mortality, thromboembolism, major bleeding, and recurrent gastroi... more What are the risks of all cause mortality, thromboembolism, major bleeding, and recurrent gastrointestinal bleeding associated with restarting antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation? This Danish cohort study (1996-2012) included all patients with atrial fibrillation discharged from hospital after gastrointestinal bleeding while receiving antithrombotic treatment. Restarted treatment regimens were single or combined antithrombotic drugs with oral anticoagulation and antiplatelets. Follow-up started 90 days after discharge to avoid confounding from use of previously prescribed drugs on discharge. Risks of all cause mortality, thromboembolism, major bleeding, and recurrent gastrointestinal bleeding were estimated with competing risks models and time dependent multiple Cox regression models. 4602 patients (mean age 78 years) were included. Within two years, 39.9% (95% confidence interval 38.4% to 41.3%, n=1745) of the patients had d...
BMC Neurology, 2015
Background: In patients with ischemic stroke of non-cardioembolic origin, acetylsalicylic acid, c... more Background: In patients with ischemic stroke of non-cardioembolic origin, acetylsalicylic acid, clopidogrel, or a combination of acetylsalicylic acid and dipyridamole are recommended for the prevention of a recurrent stroke. The purpose of this study was to examine the risk of bleeding or recurrent stroke associated with these three treatments. Methods: Patients who were discharged with first-time ischemic stroke from 2007-2010, with no history of atrial fibrillation were identified from Danish nationwide registries. Hazard ratios (HRs) and 1-year risks of recurrent ischemic stroke and bleeding were calculated for each antiplatelet regimen. Results: Among patients discharged after first-time ischemic stroke, 3043 patients were treated with acetylsalicylic acid, 12,295 with a combination of acetylsalicylic acid and dipyridamole, and 3885 with clopidogrel. Adjusted HRs for clopidogrel versus the combination of acetylsalicylic acid and dipyridamole were 1.02 (95 % confidence interval [CI]: 0.89-1.17) for ischemic stroke and 1.06 (95 % CI: 0.83-1.35) for bleeding. Adjusted HRs for acetylsalicylic acid versus the combination of acetylsalicylic acid and dipyridamole were 1.48 (95 % CI: 1.31-1.67) for stroke and 1.47 (95 % CI: 1.18-1.82) for bleeding. Clopidogrel versus acetylsalicylic acid yielded HRs of 0.69 (95 % CI: 0.59-0.81) and 0.72 (95 % CI: 0.55-0.96) for stroke and bleeding, respectively. The 1-year predicted risks associated with acetylsalicylic acid, the combination of acetylsalicylic acid and dipyridamole, and clopidogrel were 11.1 (95 %
PLOS ONE, 2015
Aim Cardioversion can rapidly and effectively restore sinus rhythm in patients with persistent at... more Aim Cardioversion can rapidly and effectively restore sinus rhythm in patients with persistent atrial fibrillation. Since 2011 dabigatran has been available as an alternative to warfarin to prevent thromboembolic events in patients with non-valvular atrial fibrillation undergoing cardioversion. We studied time to cardioversion, risk of adverse events, and risk of readmission with atrial fibrillation after cardioversion according to anticoagulation therapy. Methods and Results Through the nationwide Danish registries we included 1,230 oral anticoagulation naïve patients with first time non-valvular atrial fibrillation and first time cardioversion from 2011 to 2012; 37% in the dabigatran group (n = 456), and 63% in the warfarin group (n = 774). Median time to cardioversion was 4.0 (interquartile range [IQR] 2.9 to 6.5) and 6.9 (IQR 3.9 to 12.1) weeks in the dabigatran and warfarin groups respectively, and the adjusted odds ratio of cardioversion within the first 4 weeks was 2.3 (95% confidence interval [CI] 1.7 to 3.1) in favor of dabigatran. The cumulative incidence of composite endpoint of stroke, bleeding or death were 2.0% and 1.0% at 30 weeks in the warfarin and dabigatran groups respectively, with an adjusted hazard ratio of 1.33 (95% CI 0.33 to 5.42). Cumulative incidence of readmission with atrial fibrillation after 30 weeks were 9% and 11% in the warfarin and dabigatran groups, respectively, and an adjusted hazard ratio of 0.66 (95% CI 0.41 to 1.08). Conclusion Anticoagulation treatment with dabigatran allows shorter time to cardioversion for atrial fibrillation than warfarin, and appears to be an effective and safe alternative treatment strategy to warfarin.
European Journal of Preventive Cardiology, 2015
Diabetes has been associated with atrial fibrillation but the current evidence is conflicting. In... more Diabetes has been associated with atrial fibrillation but the current evidence is conflicting. In particular knowledge regarding young diabetes patients and the risk of developing atrial fibrillation is sparse. The aim of our study was to investigate the risk of atrial fibrillation in patients with diabetes compared to the background population in Denmark. Through Danish nationwide registries we included persons above 18 years of age and without prior atrial fibrillation and/or diabetes from 1996 to 2012. The study cohort was divided into a background population without diabetes and a diabetes group. The absolute risk of developing atrial fibrillation was calculated and Poisson regression models adjusted for sex, age and comorbidities were used to calculate incidence rate ratios of atrial fibrillation. The total study cohort included 5,081,087 persons, 4,827,713 (95%) in the background population and 253,374 (5%) in the diabetes group. Incidence rates of atrial fibrillation per 1000 person years were stratified in four age groups from 18 to 39, 40 to 64, 65 to 74 and 75 to 100 years giving incidence rates (95% confidence intervals) of 0.02 (0.02-0.02), 0.99 (0.98-1.01), 8.89 (8.81-8.98) and 20.0 (19.9-20.2) in the background population and 0.13 (0.09-0.20), 2.10 (2.00-2.20), 8.41 (8.10-8.74) and 20.1 (19.4-20.8) in the diabetes group, respectively. The adjusted incidence rate ratios in the diabetes group with the background population as reference were 2.34 (1.52-3.60), 1.52 (1.47-1.56), 1.20 (1.18-1.23) and 0.99 (0.97-1.01) in the four age groups, respectively. Diabetes is an independent risk factor for developing atrial fibrillation/flutter, most pronounced in young diabetes patients. Routine screening for atrial fibrillation/flutter in diabetes patients might be beneficial and have therapeutic implications, especially in younger diabetes patients. Diabetes increases the risk of developing atrial fibrillation and especially young diabetes patients have a high relative risk. Increased focus on detecting atrial fibrillation in young diabetes patients might prove beneficial, and both anticoagulation treatment and anti-arrhythmic treatment strategies should be considered as soon as possible.
European Heart Journal - Cardiovascular Pharmacotherapy, 2015
Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with increased risk of cardiovascul... more Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with increased risk of cardiovascular disease. Yet, the risk of atrial fibrillation (AF) associated with NSAIDs among patients with prior myocardial infarction (MI) has not been examined, and such data could contribute considerably to the risk-benefit assessment of NSAID use in this clinical context. Methods and results Using nationwide administrative registries in Denmark, we studied patients aged ≥30 years admitted with first-time MI and without prior AF in the period of 1997-2011. Risk of AF associated with NSAID use vs. no NSAID use was analysed by multivariable time-dependent Cox proportional hazard models. Of the 86 496 patients [mean age 66 (SD 13) years; 64% men] included in this study, 44.1% filled at least one NSAID prescription after discharge from MI. During a mean follow-up of 5.3 years, 7831 (8.9%) developed AF. The confidence intervals rate (95% CI) of AF per 100 person-years with NSAID treatment was 2.2 (2.0-2.4) compared with 1.7 (1.6-1.7) without NSAIDs. In the adjusted model, the risk of AF after NSAID treatment increased [Hazard ratio (HR) 1.27 (1.14-1.40)]. An increased risk of AF was seen regardless of the type of NSAID or with short-term (0-14 days) treatment [HR 1.45 (1.24-1.69)]. When the risk of death in patients exposed [crude rate 23.3 (19.7-27.5)] vs. not exposed [crude rate 17.4 (95% CI 16.8-18.1)] to NSAIDs at the time of AF was compared, NSAID use was associated with a poorer prognosis [HR 1.35 (1.14-1.60)]. Conclusion Our study suggests that the use of NSAIDs might be associated with the increased risk of AF in post-MI patients.
Thrombosis Research, 2015
To examine and compare the safety and efficacy of extended treatment with dabigatran, apixaban, r... more To examine and compare the safety and efficacy of extended treatment with dabigatran, apixaban, rivaroxaban and warfarin in patients with unprovoked venous thromboembolism. PubMed and Embase were searched for randomized clinical trials reporting on the use of direct oral anticoagulants (DOACs) and warfarin for the extended treatment of VTE. Meta-analysis was performed on studies reporting similar study design and comparator. A total of 729 articles were identified and 5 studies covering 6 randomized clinical trials met the eligibility criteria and were included in the study. 5 studies were included in the meta-analysis. Results from the meta-analysis showed that the extended use of DOACs and warfarin significantly decreased the risk of recurrent VTE with 83 % when compared placebo. Warfarin (RR: 0.03, CI: 0.00-0.49) and dabigatran (RR: 0.08, CI: 0.03-0.27) showed the largest relative risk reduction followed by apixaban 2.5mg (RR: 0.19, CI: 0.11-0.33), rivaroxaban (RR:0.19, CI: 0.09-0.40) and apixaban 5mg (RR: 0.20, CI: 0.11-0.34). No significant increased risk of major bleeding was observed with the extended use of any DOACs and warfarin compared to placebo (1.15, CI: 0.40-3.31), but an overall increased risk of non-major clinically relevant bleeding (NMCRB) was observed (RR: 2.12, CI: 1.55-2.90). Apixaban 2.5mg and warfarin was not individually associated with an increased risk of NMCRB. Furthermore, it was found from a study not included in the meta-analysis that dabigatran was non-inferior to VKA for the prevention of recurrent VTE (HR: 1.44, CI: 0.78-2.64, p=0.01 for noninferiority) and decreased the risk of NMCRB compared to VKA (RR: 0.58, CI: 0.43-0.77). Extended treatment with both warfarin and DOACs are effective in preventing recurrent VTE and does not increase the risk of major bleeding, but increases the risk of NMCRB.
Expert Review of Cardiovascular Therapy, 2015
The global burden of atrial fibrillation and diabetes mellitus (diabetes) is considerable, and pr... more The global burden of atrial fibrillation and diabetes mellitus (diabetes) is considerable, and prevalence rates are increasing. Diabetes is associated with an increased risk of developing atrial fibrillation; however, diabetes also influences the management and prognosis of atrial fibrillation. In the following article, the authors describe the association between diabetes and atrial fibrillation; specifically, the significance of diabetes on the risk of atrial fibrillation, ischemic stroke and bleeding complications associated with anticoagulation. In addition, the authors evaluate the risks and outcomes of heart failure and the success rates of both ablation and cardioversion in atrial fibrillation patients with diabetes. Finally, this article describes the association of HbA1c levels with the management and prognosis of atrial fibrillation patients.
Ugeskrift for laeger, Jan 10, 2014
Scleroderma is a rare cause of myocarditis. We present a case of myocarditis due to scleroderma i... more Scleroderma is a rare cause of myocarditis. We present a case of myocarditis due to scleroderma in a 48-year-old man. The patient was eventually diagnosed with viral myocarditis, as his scleroderma was well controlled, and the clinical presentation did not match prior examples of myocarditis due to scleroderma. When treating scleroderma patients with myocarditis, scleroderma should always be considered as a possible cause, as the treatment differs from other types of myocarditis.
Ugeskrift for laeger, Jan 15, 2014
Giant coronary aneurysms (GCA with a diameter > 20 mm) are rare with a prevalence < 0.02%. ... more Giant coronary aneurysms (GCA with a diameter > 20 mm) are rare with a prevalence < 0.02%. A 62-year-old woman with no history of ischaemic heart disease was admitted to hospital with acute chest pain. A coronary angiography revealed a left an-terior descendent-associated GCA. A cardiac computed tomo-g-raphy demonstrated a "snake-pit"-like fistula connecting the GCA and the pulmonary artery. Atherosclerosis, connective tissue dis-orders, and previous coronary intervention will predispose to GCA. No evidence-based treatment regimen exists, but coiling, excision or a conservative approach, as in this case, is possible strategies.
Ugeskrift for laeger, Jan 22, 2012
Calcified amorphoeus tumour of the heart (cardiac CAT) is a rare non-neoplastic tumour of the hea... more Calcified amorphoeus tumour of the heart (cardiac CAT) is a rare non-neoplastic tumour of the heart. To the best of our knowledge, this is the first case report of cardiac CAT in Scandinavia. The patient was a 55-year-old woman with obesity, hypertension, hyperlipidaemia, a history of smoking, and a family history of ischaemic heart disease. She presented with dyspnoea and near syncope. The tumour was resected, and cytopathology was preformed on its content. Based on the cytopathology, the pathologist concluded that the tumour most likely was cardiac CAT, though a calcified myxoma could not be excluded with certainty.
The American journal of case reports, Jan 16, 2014
Brugada syndrome (BrS) is a genetic arrhythmogenic disease characterized by ST-segment elevations... more Brugada syndrome (BrS) is a genetic arrhythmogenic disease characterized by ST-segment elevations in the right precordial leads of the electrocardiogram (ECG). These ECG changes may be concealed and BrS may present with electrical storm characterized by recurrent ventricular tachycardia and fibrillation. A 49-year-old previously healthy man was admitted with electrical storm. The patient received direct current (DC) cardioversion shocks and only after intravenous lidocaine did the electrical storm slowly subside with a total of 255 DC shocks administered during the first 24 h after admission. He fully recovered and received an implantable cardioverter-defibrillator. Subsequent drug challenge with flecainide revealed type 1 BrS. Massive electrical storm can be the first symptom of BrS and the diagnostic ECG changes may be concealed at presentation. Although hundreds of DC shocks may be required during initial treatment, full recovery can be achieved.
European Journal of Heart Failure, 2014
Heart failure is an established risk factor for poor outcomes in patients undergoing non-cardiac ... more Heart failure is an established risk factor for poor outcomes in patients undergoing non-cardiac surgery, yet risk stratification remains a clinical challenge. We developed an index for 30-day mortality risk prediction in this particular group.