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  1. Iqbal Malik, Editor

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ISCHAEMIC HEART DISEASE

A “no touch” way to keep vein grafts patent ▸

Conventional harvesting of the saphenous vein during coronary artery bypass grafting surgery (CABG) causes damage to the vessel which has previously been shown to affect endothelial cell integrity and may therefore have an effect on the patency rate. To counteract this, a novel “no touch” technique has been engineered which involves harvesting the saphenous vein with its surrounding tissue. Souza et al assigned 52 patients to conventional CABG, while another 52 had their saphenous veins harvested using the “no touch” technique. Angiographic follow-up was performed at a mean time of 18 months after the operation in at least 45 patients from each group, and again at a mean time of 8.5 years in 37 patients from both groups. The recipient coronary arteries were similar in their size and quality in both groups. At 18 months 89% of conventional versus 95% of no-touch grafts were patent; at 8.5 years this difference widened to 76% and 90%, respectively (p  =  0.01). By comparison, the patency of thoracic artery grafts was 90%. Multivariate analysis revealed that the two most important factors for graft patency were the technique of harvesting and the vein quality before implantation.

Enoxaparin in PCI ▸

Despite its limitations, unfractionated heparin has been the standard anticoagulant used during percutaneous coronary intervention (PCI). Several small studies have suggested that intravenous enoxaparin may be a safe and effective alternative. In this prospective, open-label, multicentre, randomised trial, the investigators randomly assigned 3528 patients with PCI to receive enoxaparin (0.5 or 0.75 mg/kg body weight) or unfractionated heparin adjusted for activated clotting time, stratified according to the use or non-use of glycoprotein IIb/IIIa inhibitors. The primary end point was the incidence of major or minor bleeding that was not related to CABG. Enoxaparin at a dose of 0.5 mg/kg was associated with a significant reduction in the rate …

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