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1.  Dabigatran, a direct thrombin inhibitor, can be a life-saving treatment in heparin-induced thrombocytopenia 
ARYA Atherosclerosis  2013;9(1):112-114.
BACKGROUND
Several studies have emphasized thrombosis associated with thrombocytopenia as a potentially fatal complication of heparin. A number of agents are used for this condition. As a new oral, reversible direct thrombin inhibitor, dabigatran has been approved for short-term thromboprophylaxis after elective hip and knee replacement surgery. We present a case of dabigatran administration in a patient with femoral fracture.
CASE REPORT
A 67-year-old woman referred to the orthopedic ward of Shariati Hospital (Isfahan, Iran) due to femoral fracture following an accident. Immediately after surgery, she was found to be suffering from deep vein thrombosis (DVT) in her lower extremity despite sufficient prophylaxis by enoxaparin. Laboratory data showed severe thrombocytopenia. Considering the clinical history, an initial diagnosis of heparin-induced thrombocytopenia was made. Doppler ultrasound confirmed the diagnosis. Heparin was thus replaced with dabigatran which increased platelet count to the normal range and improved DVT.
CONCLUSION
Dabigatran can be a life-saving treatment in heparin-induced thrombocytopenia. However, it is contraindicated in patients with renal dysfunction since it may cause potentially catastrophic results.
PMCID: PMC3653267  PMID: 23690810
Heparin Induced Thrombocytopenia; Heparin; Enoxaparin; Dabigatran
2.  Sinus of Valsalva aneurysm: An uncommon presentation 
ARYA Atherosclerosis  2012;8(3):164-166.
BACKGROUND
Sinus of Valsalva aneurysm (SVA) may be congenital or acquired. They could mimic ventricular tumor symptoms and cause signs and symptoms of ventricular outflow tract obstruction. They may also involve the conduction system and cause palpitations or syncopal episodes. Both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) serve as quick, noninvasive methods to provide information on size and location of aneurysmal dilatation and cardiac chamber involvement. These methods can identify any associated anomalies or complications. This study presents a patient with unruptured SVA.
CASE REPORT
A 46-year-old man, who had been suffering from nonspecific symptoms such as exercise intolerance and weakness for a few months, referred to our clinic in Isfahan (Iran). In TTE, a large mass was observed in the right ventricle. SVA was suspected after meticulous probing. This diagnosis was confirmed by TEE and computed tomography angiography. At open heart surgery, an SVA with a lot of clots it was removed.
CONCLUSION
SVA must be kept in mind when a tumor-like mass is observed in the right ventricle. Detailed evaluation would thus be necessary to rule out SVA and to prevent wrong diagnosis and treatment that can sometimes be catastrophic.
PMCID: PMC3557003  PMID: 23358699
Sinus Valsalva; Aneurysm; Cardiac Tumor
3.  Association Between Serum Homocysteine Concentration with Coronary Artery Disease in Iranian Patients 
ARYA Atherosclerosis  2011;7(2):63-67.
BACKGROUND
The role of novel biomarkers like homocystein as a risk factor of coronary artery disease (CAD) is being increasingly recognized. Since there is a marked geographical variation in plasma homocystein concentration and because of importance of hyperhomocysteinemia as a CAD risk factor and due to the paucity of studies in Iran evaluating this risk factor in our population, we evaluated the association between plasma total homocysteine (tHcy) concentration and CAD risk in Iranian population.
METHODS
In a case-control study, we compared the level of tHcy of forty five patients of angiographically proven CAD with forty five subjects without CAD as control group matched for age and gender. The patients with diabetes, hypertension, thyroid dysfunction, chronic renal failure, hyperlipidemia and obesity and other conventional CAD risk factors were excluded from the study. Plasma tHcy was measured using immunoturbidimetry. The results were compared between groups using student t test.
RESULTS
CAD patients had significantly higher mean plasma tHcy than control group (17.1±5.3 versus 14.2±3.8, P= 0.004).
CONCLUSION
This study denoted that high plasma homocysteine concentration was associated to CAD risk in Iranian people.
PMCID: PMC3347846  PMID: 22577448
Coronary Artery Disease; Homocysteine.

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