A prolonged time interval between an initial cerebrovascular event and cardiac myxoma surgery was significantly associated with cerebrovascular event recurrence (p=0.021).
Cohort (n=13)
No
Does delayed surgical excision with bridging antithrombotic therapy prevent recurrent cerebrovascular events in patients with cardiac myxoma?
Bridging antithrombotic therapy does not reliably prevent recurrent cerebrovascular events in patients with cardiac myxoma, suggesting surgical excision should be performed as early as possible.
p-value: p=0.021
Background: Cardiac myxoma (CM) is the most frequent, cardiac benign tumour and is associated with enhanced risk for cerebrovascular events (CVE). Although surgical CM excision is the only curative treatment to prevent CVE recurrence, in recent reports conservative treatment with antiplatelet or anticoagulant agents in high-risk patients with CM-related CVE has been discussed. Methods: Case records at the University Hospital of Tübingen between 2005 and 2017 were screened to identify patients with CM-related CVE. Clinical features, brain and cardiac imaging findings, histological reports, applied treatments and long-term neurological outcomes were assessed. Results: 52 patients with CM were identified and among them, 13 patients with transient ischemic attack, ischemic stroke or retinal ischemia were included to the (to our knowledge) largest reported retrospective study of CM-related CVE. In all identified patients, CVE was the first manifestation of CM; 61% suffered ischemic stroke, 23% transient ischemic attack and 15% retinal ischemia. In 46% of the patients, CVE occurred under antiplatelet or anticoagulation treatment, while 23% of the patients developed recurrent CVE under bridging-antithrombotic-therapy prior to CM surgical excision. Prolonged time interval between CVE and CM-surgery was significantly associated with CVE recurrence (p=0.021). One patient underwent i.v. thrombolysis, followed by thrombectomy, with good post-interventional outcome and no signs of hemorrhagic transformation. Discussion: Our results suggest that antiplatelet or anticoagulation treatment is no alternative to cardiac surgery in patients presenting with CM-related CVE. We found significantly prolonged time-intervals between CVE and CM surgery in patients with recurrent CVE. Therefore, we suggest that the waiting- or bridging-interval with antithrombotic therapy until curative CM excision should be kept as short as possible. Based on our data and review of the literature, we suggest that in patients with CM-related CVE, i.v. thrombolysis and/or endovascular interventions may present safe and efficacious acute treatments.
Stefanou et al. (Wed,) conducted a cohort in Cardiac myxoma with cerebrovascular events (n=13). Prolonged time interval to cardiac myxoma surgery was evaluated on Cerebrovascular event recurrence (p=0.021). A prolonged time interval between an initial cerebrovascular event and cardiac myxoma surgery was significantly associated with cerebrovascular event recurrence (p=0.021).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: