Phenprocoumon

Data regarding uninterrupted oral anticoagulation in patients with chronic kidney disease (CKD) during catheter ablation for left atrial arrhythmias is limited. This study aimed to evaluate the safety and efficacy of periprocedural uninterrupted direct oral anticoagulants (DOAC) compared with uninterrupted phenprocoumon in patients with CKD undergoing left atrial catheter ablation.

We conducted a retrospective single-center study of patients who underwent left atrial catheter ablation between 2016 and 2019 with underlying chronic kidney disease (glomerular filtration rate (GFR) between 15 and 45 ml/min). The primary objective of this study was to investigate whether direct oral anticoagulant (DOAC) therapy or warfarin presents a superior safety profile in patients with chronic kidney disease (CKD) undergoing left atrial catheter ablation. We compared periprocedural complications (arteriovenous fistula, aneurysm, significant hematoma (> 5 cm)) and/or bleeding (drop in hemoglobin of >2 g/dl, pericardial effusion, retroperitoneal bleeding, other bleeding, stroke) between patients receiving either uninterrupted DOAC or warfarin therapy. Secondary analysis included patient baseline characteristics as well as procedural data. A total of 188 patients (female n = 108 (57%), mean age 75.3 ± 8.1 years, mean GFR 36.8 ± 6 ml/min) were included in this study. Underlying arrhythmias were atrial fibrillation (n = 104, 55.3%) and atypical atrial flutter (n = 84, 44.7%). Of these, n = 132 patients (70%) were under a DOAC medication, and n = 56 (30%) were under phenprocoumon. Major groin complications including pseudoaneurysm and/or AV fistula occurred in 8.9% of patients in the phenprocoumon group vs. 11.3% of patients in the DOAC group, which was not statistically significant (p = 0.62). Incidence of cardiac tamponade (2.3% vs. 0%; p = 0.55) and stroke (0% vs. 0%) were low in both DOAC and phenprocoumon groups with similar post-procedural drops in hemoglobin levels (1.1±1 g/dl vs 1.1±0.9 g/dl; p = 0.71).

The type of anticoagulation had no significant influence on bleeding or thromboembolic events as well as groin complications in this retrospective study. Despite observing an increased rate of groin complications, the uninterrupted use of DOAC or phenprocoumon during left atrial catheter ablation in patients with CKD appears to be feasible and effective.

Hydrophobic organic contaminants (HOCs) are conventionally screened by matching electron ionization (EI) mass spectra acquired using gas chromatography-mass spectrometry (GC-MS) to reference spectra. However, extensive in-source fragmentation hampers de novo structure elucidation of novel substances that are absent from EI databases. To address this problem, a new method based on GC-atmospheric pressure chemical ionization (APCI) coupled to ion mobility-high resolution mass spectrometry (IM-HRMS) was developed for simultaneous target, suspect, and nontarget screening of HOCs. Of 102 target chemicals, 85.3% produced (quasi-)molecular ions as base peaks, while 71.6% displayed method detection limits lower than those of GC-EI-low resolution MS. The optimized method was applied to standard reference sediment and sediments from the Baltic Sea, an Arctic shelf, and a Norwegian lake. In total, we quantified 56 target chemicals with concentrations ranging from 4.86 pg g^-1 to 124 ng g^-1 dry weight. Further, using a combination of full scan mass spectrum, retention time, collision cross section (CCS), and fragmentation spectrum, a total of 54 suspects were identified at Confidence Level (CL) 2. Among the remaining features, 169 were prioritized using a halogen-selective CCS cutoff (100 Ų + 20% mass), leading to annotation of 54 substances (CL ≤ 3). Notably, a suite of fluorotelomer thiols, disulfides, and alkyl sulfones were identified in sediment (CL 1-2) for the first time. Overall, this work demonstrates the potential of GC-APCI-IM-HRMS as a next-generation technique for resolving complex HOC mixtures in environmental samples through exploitation of molecular ions.