Thomas A Hennebry

Oklahoma Heart Hospital, Oklahoma City, Oklahoma, United States

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Publications (59)169.79 Total impact

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    ABSTRACT: The increasing prevalence of cardiovascular disease (CVD) has prompted leading cardiovascular organizations to advocate utilization of a team approach to patient care that includes nonphysician providers. In spite of that, the American College of Cardiology reported that nonphysician providers are underutilized in the management of patients with CVD. A survey of cardiologists revealed that the underutilization is a result of lack of understanding of how best to involve nonphysician providers in the health care team. Clinical pharmacists are one category of nonphysician providers that have recognized effectiveness in managing patients with CVD. No example of a comprehensive model of collaboration between cardiologists and clinical pharmacists is described in the literature that could serve to close this gap in understanding. The objective of this report is to describe a model of cardiologist-clinical pharmacist collaboration in the longitudinal management of patients with CVD that has been successfully implemented in 2 diverse settings. The implementation, evolution, scope of practice, required pharmacist training, logistical elements needed for success, and implementation barriers are reviewed. A summary of the patients referred to the clinic are examined as well.
    Annals of Pharmacotherapy 12/2013; 48(3). DOI:10.1177/1060028013515432 · 2.06 Impact Factor
  • Muhammad A Chaudhry · Reji Pappy · Thomas A Hennebry ·
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    ABSTRACT: The Trellis thrombectomy system (Covidien) is one of the newer devices that incorporates isolated pharmacomechanical thrombectomy and thrombolysis (PMT) for treatment of deep venous thrombosis (DVT). We conducted a retrospective review of patients with upper- and lower-extremity DVT managed with the Trellis thrombectomy system at our center. All patients with symptomatic DVT who presented to our center between April 2010 and April 2011 who underwent PMT by the Trellis device were included in this retrospective review. Twenty-eight patients (mean age, 46.4 ± 21.2 years) presented with symptoms with a mean duration of 1.3 ± 1.8 months. Eighty-six percent had 100% occlusion on admission, while 14.3% had 70%-90% stenosis. The mean lytic dose used was tPA 20.7 ± 12 mg. The mean Trellis treatment time was 25.1 ± 11.5 minutes. Grade 3 lysis was achieved in 23 of 28 patients (85.8%), while grade 2 lysis was achieved in 14.2%. Mean total hospital stay was 2.6 ± 2.7 days. Postprocedure symptom resolution was 100%, and there was no reocclusion in 78.6% of patients at 1 year. At 12 months, the patency rate (primary or secondary) was 80% as determined by Doppler ultrasound. In patients with DVT involving the ilio-femoral and the upper-extremity vessels, the use of the Trellis device was associated with a high technical success rate as well as a satisfactory 12-month patency rate. Moreover, this strategy was associated with reduced lytic dose, shorter treatment time and hospital stay, and no bleeding complications.
    The Journal of invasive cardiology 06/2013; 25(6):296-9. · 0.95 Impact Factor
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    ABSTRACT: Background: The direct thrombin inhibitor, bivalirudin, is associated with similar efficacy and superior safety in patients undergoing percutaneous coronary intervention. However, the role of direct thrombin inhibitors in carotid artery stenting is not well defined. The objective of this study was to compare the safety and effectiveness of bivalirudin and unfractionated heparin (UFH) for carotid artery stenting. We hypothesized that bivalirudin would be associated with less in-hospital postprocedure bleeding than UFH but similar rates of in-hospital and 30-day ischemic outcomes. Methods and results: We compared the incidence of in-hospital hemorrhagic and in-hospital/30-day ischemic outcomes among patients in the CARE Registry who underwent carotid artery stenting between May 2005 and March 2012 using bivalirudin or UFH. Propensity score matching was used to obtain a balanced cohort of 3555 patients in each treatment group. Patients treated with bivalirudin had a significantly lower incidence of bleeding or hematoma requiring red blood cell transfusions (0.9% versus 1.5%; odds ratio, 0.57 [0.36-0.89]; P=0.01) when compared with UFH-treated patients. The incidence of in-hospital and 30-day ischemic outcomes, including death, myocardial infarction, stroke, transient ischemic attack, and the composite outcome, death/myocardial infarction/stroke, did not differ significantly between groups. Conclusions: Bivalirudin was associated with lower rates of hemorrhagic outcomes compared with UFH during the index hospitalization for carotid artery stenting. In-hospital and 30-day ischemic events were similar between the 2 groups. Randomized comparisons of these agents are needed to confirm these findings.
    Circulation Cardiovascular Interventions 03/2013; 6(2). DOI:10.1161/CIRCINTERVENTIONS.112.974857 · 6.22 Impact Factor
  • Siddharth Wayangankar · Jigar Patel · Thomas A Hennebry ·
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    ABSTRACT: Since the long-term patency of axillofemoral (AXF) grafts is inferior to aorto-bifemoral (ABF) grafts, limb salvage procedures are crucial in this group of patients. Emerging endovascular devices have helped in the successful restoration of flow for acute limb ischemia in both native arteries as well as bypass grafts. One such device, the Trellis™ thrombectomy system is being used more frequently in this setting. The device has previously been used in veins, native arteries, and rarely in aortofemoral grafts. We present its first successful use for the treatment of occluded AXF bypass graft. The use of this device helped to isolate the treatment zone in the occluded graft, which allowed the use of a lower dose of thrombolytics, less systemic release of thrombolytics, and less distal embolization. Resolution of extensive clot burden was achieved and, with subsequent stenting of the graft at the distal anastomotic site, arterial flow to the leg through the AXF graft was restored and a revision surgery was avoided.
    Vascular Medicine 02/2013; 18(1):27-31. DOI:10.1177/1358863X13477233 · 1.79 Impact Factor
  • Raghav Gupta · Thomas A Hennebry ·
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    ABSTRACT: To study the efficacy of isolated pharmaco-mechanical thrombolysis-thrombectomy (IPMT) by Trellis™ device (Covidien, Mansfield, MA) in managing acute limb ischemic (ALI). ALI is both life and limb threatening disease with a reported 9-15% mortality and 15-25% limb loss in the first month after presentation. Pitfalls of current endovascular techniques include major bleeding, distal embolism, and prolonged thrombolytic infusion. IPMT isolates the thrombus between two balloons and utilizes wire oscillation to increase the thombus-lytic exposure surface area followed by aspiration. It decreases systemic lytic exposure, procedure time, and distal embolism. Technical aspects, success, and bleeding complications in 24 consecutive patients with ALI treated with IPMT between October 2009 and September 2010 were analyzed. In-hospital and 30-day mortality, amputation rates and treatment success rates were determined. 24 patients constituted 32 arteries; 18 (56.25%) were suprainguinal including 3 grafts (9.4%) and 14 (43.75%) were infrainguinal native arteries. Substantial or complete response was seen in >90% vessels with 87.5% patients revealing TIMI three flow while none demonstrated TIMI 2 or 3 pretreatment. Only three patients required adjunctive post-IPMT thrombolysis. In-hospital and 30-day all cause mortality was 4.16%. One patient died in-hospital and no patient underwent amputation. Besides being the largest series of ALI patients treated with IPMT, this is the first and largest series including 14 native infrainguinal arteries. These results suggest IPMT to be a promising and safer therapeutic option in ALI, likely due to its site-specific nature and limited thrombolysis exposure time. © 2012 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 10/2012; 80(4):636-43. DOI:10.1002/ccd.24283 · 2.11 Impact Factor
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    ABSTRACT: Utilizing a multidisciplinary approach to management of patients with certain chronic cardiovascular diseases (CVD) has been shown to improve treatment outcomes. The role of clinical pharmacists in comprehensive outpatient CVD management has not been evaluated. The objective of this pilot study was to evaluate the impact of a clinical pharmacist added to cardiologist care on blood pressure (BP), a key surrogate marker of CVD, in outpatients with CVD compared to cardiologist care alone. A retrospective, matched-control study was conducted in patients established in a cardiovascular clinic. The intervention was referral to a pharmacist clinic; control was usual care from the cardiologist. The surrogate marker evaluated was the change in BP. Patients in the pharmacist-intervention (n=57) experienced significant reductions in diastolic BP (-2.6 mmHg, p=0.05) and non-significant reductions in systolic BP (-4.3 mmHg, p=0.16) compared to baseline, whereas patients in the control group experienced non-significant increases in both systolic and diastolic BP (+1.6/+0.7 mmHg, p=NS). Similarly, there were significant reductions in diastolic BP and non-significant reductions in systolic BP for the intervention group when compared to controls (difference 3.3 mmHg, p=0.04 and 5.9 mmHg, p=0.1, respectively). Lastly, the proportion of patients categorized as having Stage 2 BP was significantly reduced in the intervention group (p=0.02), but not in the controls (p=0.5). The multidisciplinary model of care that included a clinical pharmacist reduced BP more than usual care by a cardiologist alone. This benefit was demonstrated in complex patients with CVD who were already receiving specialized care. The impact of this model on clinical outcomes requires further evaluation and should be a high priority given the burden of CVD in the population.
    07/2012; 10(3):173-9. DOI:10.4321/S1886-36552012000300008
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    ABSTRACT: Prior to June 2011, carotid artery stenting (CAS) had been limited to patients deemed high risk for surgical revascularization due to medical or anatomic reasons. Intraprocedural anticoagulation for CAS has traditionally been carried out with unfractionated heparin (UFH). The direct thrombin inhibitor bivalirudin has emerged as a possible alternative choice for anticoagulation in this patient population. In patients undergoing coronary interventions, bivalirudin has been shown in large prospective analysis to reduce major adverse events and hemorrhagic complications (TIMI major bleeding rates, 0.6%-3.1%; TIMI minor bleeding rates, 1.3%-3.7%). As of now, the safety and efficacy of bivalirudin for use during carotid stenting has not been rigorously evaluated. To date, the published evidence in favor of bivalirudin for CAS exists in small retrospective analyses and two prospective studies. We present a retrospective analysis of 331 patients with a total of 365 carotid artery lesions undergoing CAS between February 2007 and September 2010. The procedures were performed by five experienced operators from four separate sites within the same metropolitan area. Patients were included who received bivalirudin as the anticoagulation strategy and underwent CAS. The primary endpoints of the study were 30-day incidence of death, stroke, TIMI major bleeding (defined as ≥5 g/dL Hgb drop or intracranial hemorrhage), TIMI minor bleeding (defined as ≥3 g/dL Hgb drop), and blood transfusion. All data were collected by retrospective chart review. A total of 365 CAS procedures were performed. There were no deaths, strokes, or TIMI major bleeds. There was a 2.19% incidence of TIMI minor bleeding (8/365) and a 1.64% rate of blood transfusion (6/365). In our patient population, the major endpoints of stroke, death, MI, major and minor bleeding rates were well within those previously reported overall for carotid artery revascularization. Hence, we conclude that bivalirudin may be safe for use in CAS procedures with a safety profile similar to that validated in percutaneous coronary interventions.
    The Journal of invasive cardiology 05/2012; 24(5):202-5. · 0.95 Impact Factor
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    Journal of the American College of Cardiology 03/2012; 59(13):E255. DOI:10.1016/S0735-1097(12)60256-3 · 16.50 Impact Factor
  • Chadi Dib · Thomas A Hennebry ·
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    ABSTRACT: We report 2 cases of superior vena cava (SVC) syndrome treated using isolated pharmacomechanical thrombolysis with angioplasty alone. We also propose a new staged treatment strategy to optimally manage such patients, taking into consideration both cost-effectiveness and the ultimate prognosis.
    The Journal of invasive cardiology 03/2012; 24(3):E50-3. · 0.95 Impact Factor
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    Tarun W Dasari · Thomas A Hennebry ·

    Catheterization and Cardiovascular Interventions 02/2012; 79(3):497. DOI:10.1002/ccd.23294 · 2.11 Impact Factor
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    ABSTRACT: In patients with ST-elevation myocardial infarction, delay in door-to-balloon time strongly increases mortality rates. To our knowledge, no randomized studies to date have focused on reducing delays within the catheterization laboratory.We performed a retrospective analysis of all patients who presented with ST-elevation myocardial infarction at our institution from July 2006 through June 2010, looking primarily at time differences between percutaneous coronary intervention in the culprit vessel on the basis of ECG criteria, followed by contralateral angiography (Group 1), versus complete coronary angiography followed by culprit-vessel percutaneous intervention (Group 2).There were 49 patients in Group 1 and 57 patients in Group 2. No major differences in baseline characteristics were observed between the groups, except a higher prevalence of diabetes mellitus in Group 2. There was a statistically significant difference between Groups 1 and 2 in door-to-balloon time (median and interquartile range, 75 min [61-89] vs 87 min [70-115], P=0.03, respectively) and access-to-balloon time (12 min [9-18] vs 21 min [11-33], P=0.0006, respectively). Five Group 1 patients (10%) with inferior myocardial infarction had a contralateral culprit vessel. There were no differences in mortality rate or ejection fraction at the median 1-year follow-up. Four patients in Group 1 and 3 patients in Group 2 were referred for coronary artery bypass grafting after percutaneous intervention.This study suggests that performing culprit-vessel percutaneous intervention on the basis of electrocardiographic criteria, followed by angiography in patients with anterior ST-elevation myocardial infarction, might be the preferred approach, given the door-to-balloon time that is saved.
    Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 01/2012; 39(3):359-64. · 0.65 Impact Factor
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    Ripley TL · Hennebry TA · Sanders TN · Harrison DL · Rathbun RC ·

    Pharmacy Practice 01/2012; Pharm Pract(10):173-179.
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    ABSTRACT: Our goal was to describe a single-center's experience in managing acute and chronic mesenteric ischemia with endovascular therapies. Open surgical revascularization has been considered the historical gold standard treatment for mesenteric ischemia though it poses considerable morbidity and mortality risk. An aging population with increased comorbidities makes endovascular treatment a more attractive treatment option. Consecutive subjects receiving percutaneous mesenteric interventions for acute and chronic mesenteric ischemia from 2004 to 2010 were identified retrospectively. Information on comorbidities, symptoms, screening tests, procedural outcomes, and follow up was obtained. Thirty-one patients received percutaneous mesenteric interventions during this period. The mean age of the population was 65.0 years with roughly equal proportions of males (48.4%) and females (51.6%). Traditional cardiovascular risk factors were highly prevalent (hypertension 45.2%, diabetes 25.8%, dyslipidemia 38.7%, nicotine use 45.2%). Procedural success was 93.5%; no periprocedural complications were reported. During a mean follow up of 13 months, 16.1% required repeat revascularization and 22.6% died. Endovascular treatment of acute mesenteric ischemia was successful (n = 8) and no patient required open surgical revascularization acutely or during follow-up. Endovascular treatment of mesenteric ischemia is a safe and effective therapy with acceptable long-term results. Our experience with acute mesenteric ischemia suggests that percutaneous treatment may be an effective alternative to surgical revascularization in appropriately selected patients.
    Catheterization and Cardiovascular Interventions 11/2011; 78(6):948-52. DOI:10.1002/ccd.23098 · 2.11 Impact Factor
  • Reji Pappy · Thomas A Hennebry · Mazen S Abu-Fadel ·
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    ABSTRACT: Subintimal recanalization is beneficial in selected patients with peripheral chronic total occlusions (CTO). However, in complex cases, re-entry into the true arterial lumen may prove to be unsuccessful with a conventional guidewire or a re-entry catheter when using standard femoral artery access. Our case series describes these technical dilemmas along with strategies that can be utilized to overcome these challenges.
    Catheterization and Cardiovascular Interventions 10/2011; 78(4):625-31. DOI:10.1002/ccd.23039 · 2.11 Impact Factor
  • Beau M Hawkins · Thomas A Hennebry ·

    Circulation Cardiovascular Interventions 06/2011; 4(3):297-302. DOI:10.1161/CIRCINTERVENTIONS.110.961052 · 6.22 Impact Factor
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    Reji M. Pappy · Stavros Stavrakis · Thomas A Hennebry · Mazen S Abu-Fadel ·
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    ABSTRACT: Although the pleiotropic effects of statins are postulated to be renoprotective, clinical studies have demonstrated conflicting results. We undertook a meta-analysis of published trials to evaluate the impact of statin therapy on the incidence of contrast-induced nephropathy (CIN) in patients undergoing coronary angiography. We searched MEDLINE and EMBASE databases through December 2010 for articles evaluating the effect of statins on the incidence of CIN in patients undergoing coronary angiography. Odds ratios (OR) with 95% confidence intervals (CI) were calculated using random effects modeling. Three randomized controlled trials involving 770 patients (330 in the statin group and 340 in the control group) and 7 non-randomized studies involving 31,959 patients (11,936 statin-pretreated and 20,023 statin-naïve). The definition of CIN varied somewhat among the studies. Based on the pooled estimate across the 3 randomized controlled trials, statin therapy did not significantly reduce the incidence of CIN compared to control (OR=0.76, 95% CI: 0.41-1.41, p=0.39). No significant heterogeneity was found in the randomized studies (I(2)=0%, p=0.48). The pooled analysis of the non-randomized studies showed a marginally significant benefit associated with statin therapy (OR=0.60, 95% CI: 0.36-1.00, p=0.05). There was significant heterogeneity among the non-randomized studies (I(2)=88%, p<0.00001). Our meta-analysis suggests that statin therapy might be associated with a significant reduction in the incidence of CIN in patients undergoing coronary angiography. Further studies are warranted to clarify this issue.
    International journal of cardiology 05/2011; 151(3):348-53. DOI:10.1016/j.ijcard.2011.05.045 · 4.04 Impact Factor
  • Tarun W Dasari · Reji Pappy · Thomas A Hennebry ·
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    ABSTRACT: Pharmacomechanical thrombolysis (PMT) is an emerging treatment option for symptomatic deep vein thrombosis (DVT). This may obviate the need for systemic or catheter-directed thrombolysis. PubMed, EMBASE, and Cochrane database search of PMT in acute and chronic symptomatic DVT was undertaken. Baseline demographic and clinical characteristics, procedural details, DVT characteristics, and procedural and clinical outcomes are presented. A total of 8 case series (n = 2528; 1998-2009) qualified for inclusion. Lower extremity symptomatic DVTs constituted the majority of the cases (>80%). Both acute (<14 days) and chronic (>14 days) DVTs were included. Procedural success was 59% to 100% and catheter-directed thrombolysis was used as an adjunct in 16% to 53%. No deaths or major bleeding complications were reported. Pharmacomechanical thrombolysis leads to the immediate resolution of clinical symptoms of DVT in the majority of patients. Pharmacomechanical thrombolysis may be a safe and novel method, when appropriate expertise and resources are available, for the treatment of symptomatic acute and chronic DVT.
    Angiology 05/2011; 63(2):138-45. DOI:10.1177/0003319711410050 · 2.97 Impact Factor
  • Raghav Gupta · Siddharth A Wayangankar · Ira N Targoff · Thomas A Hennebry ·
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    ABSTRACT: Idiopathic inflammatory myopathies (IIM) presenting with diffuse skeletal muscular inflammation and cardiac involvement is one of the major causes of clinical deterioration. Our purpose was to observe the frequency of various reported clinical cardiac afflictions, cardiovascular mortality and its most important contributors in the IIM population. MEDLINE database was searched from 1977 through 2009. Articles reporting objective evidence of cardiac involvement were assessed. Patients were included if they satisfied Bohan and Peter criteria for definite or probable diagnosis of IIM. The review conforms to the criteria of the new PRISMA statement of preferred reporting items for systematic reviews and meta-analyses. Thirty-three out of 90 articles reported cardiac data. Twelve were case reports, while 21 articles were either cohort studies or case series. Angina was reported in 7% of cumulative prospective cohort. Dysrhythmias were seen in 31.8% of electrocardiograms. Diastolic dysfunction was the most common echocardiographic finding. Congestive heart failure was reported in 5.6% of the prospective cohort and was the most common cause of death accounting for 21% of total cardiac mortality. Myocarditis was the most common feature in reported pathology literature (38%), followed by focal myocardial fibrosis (22%). Cardiac involvement is an important cause of morbidity and mortality in patients with IIM. Myocardial fibrosis puts the patient at risk for systolic or diastolic heart failure and dysrhythmias. This review, therefore, suggests the importance of early and comprehensive cardiac evaluation in IIM population. Confirmation of these findings will require prospective studies of consecutive patients with long-term follow-up.
    International journal of cardiology 05/2011; 148(3):261-70. DOI:10.1016/j.ijcard.2010.08.013 · 4.04 Impact Factor
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    Raghav Gupta · Thomas A. Hennebry ·

    Journal of the American College of Cardiology 04/2011; 57(14). DOI:10.1016/S0735-1097(11)61963-3 · 16.50 Impact Factor
  • Elias B Hanna · Tarun W Dasari · Thomas A Hennebry ·
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    ABSTRACT: Difficulty in stent delivery is frequently encountered in cases of tortuous or calcified coronary arteries. Chronic total occlusion interventions often require extra back-up that may not be adequately provided by guiding catheters, even the most supportive guiding catheters. We report the first successful stenting of a complex native coronary artery occlusion through an angulated bypass graft with the support of a GuideLiner catheter.
    The Journal of invasive cardiology 03/2011; 23(3):E40-2. · 0.95 Impact Factor

Publication Stats

458 Citations
169.79 Total Impact Points


  • 2013
    • Oklahoma Heart Hospital
      Oklahoma City, Oklahoma, United States
  • 2008-2012
    • Oklahoma City University
      Oklahoma City, Oklahoma, United States
  • 2004-2012
    • University of Oklahoma Health Sciences Center
      • • Section of Molecular Medicine
      • • Section of Cardiovascular Diseases
      • • Department of Internal Medicine
      Oklahoma City, Oklahoma, United States