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Qin R, Liang X, Yang Y, Chen J, Huang L, Xu W, Qin Q, Lai X, Huang X, Xie M, Chen L. Exploring cuproptosis-related molecular clusters and immunological characterization in ischemic stroke through machine learning. Heliyon 2024; 10:e36559. [PMID: 39295987 PMCID: PMC11408831 DOI: 10.1016/j.heliyon.2024.e36559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/15/2024] [Accepted: 08/19/2024] [Indexed: 09/21/2024] Open
Abstract
Objective Ischemic stroke (IS) is a significant health concern with high disability and fatality rates despite available treatments. Immune cells and cuproptosis are associated with the onset and progression of IS. Investigating the interaction between cuproptosis-related genes (CURGs) and immune cells in IS can provide a theoretical basis for IS treatment. Methods We obtained IS datasets from the Gene Expression Omnibus (GEO) and employed machine learning to identify CURGs. The diagnostic efficiency of the CURGs was evaluated using receiver operating characteristic (ROC) curves. KEGG and gene set enrichment analysis (GSEA) were also conducted to identify biologically relevant pathways associated with CURGs in IS patients. Single-cell analysis was used to confirm the expression of 19 CURGs, and pathway activity calculations were performed using the AUCell package. Additionally, a risk prediction model for IS patients was developed, and core modules and hub genes related to IS were identified using weighted gene coexpression network analysis (WGCNA). We classified IS patients using a method of consensus clustering. Results We established a precise diagnostic model for IS. Enrichment analysis revealed major pathways, including oxidative phosphorylation, the NF-kappa B signaling pathway, the apoptosis pathway, and the Wnt signaling pathway. At the single-cell level, compared to those in non-IS samples, 19 CURGs were primarily overexpressed in the immune cells of IS samples and exhibited high activity in natural killer cell-mediated cytotoxicity, steroid hormone biosynthesis, and oxidative phosphorylation. Two clusters were obtained through consensus clustering. Notably, immune cell types including B cells, plasma cells, and resting NK cells, varied between the two clusters. Furthermore, the red module and hub genes associated with IS were uncovered. The expression patterns of CURGs varied over time. Conclusion This study developed a precise diagnostic model for IS by identifying CURGs and evaluating their interaction with immune cells. Enrichment analyses revealed key pathways involved in IS, and single-cell analysis confirmed CURG overexpression in immune cells. A risk prediction model and core modules associated with IS were also identified.
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Affiliation(s)
- Rongxing Qin
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, China
| | - Xiaojun Liang
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, China
| | - Yue Yang
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, China
- National Center for International Research of Biological Targeting Diagnosis and Therapy (Guangxi Key Laboratory of Biological Targeting Diagnosis and Therapy Research), Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Jiafeng Chen
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, China
- National Center for International Research of Biological Targeting Diagnosis and Therapy (Guangxi Key Laboratory of Biological Targeting Diagnosis and Therapy Research), Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Lijuan Huang
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, China
- National Center for International Research of Biological Targeting Diagnosis and Therapy (Guangxi Key Laboratory of Biological Targeting Diagnosis and Therapy Research), Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Wei Xu
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, China
- National Center for International Research of Biological Targeting Diagnosis and Therapy (Guangxi Key Laboratory of Biological Targeting Diagnosis and Therapy Research), Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Qingchun Qin
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, China
- National Center for International Research of Biological Targeting Diagnosis and Therapy (Guangxi Key Laboratory of Biological Targeting Diagnosis and Therapy Research), Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Xinyu Lai
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, China
| | - Xiaoying Huang
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, China
| | - Minshan Xie
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, China
| | - Li Chen
- Department of Neurology, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, China
- National Center for International Research of Biological Targeting Diagnosis and Therapy (Guangxi Key Laboratory of Biological Targeting Diagnosis and Therapy Research), Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, 530021, China
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Massmann A, Heukelom JV, Weaver M, Schultz A, Figueroa DM, Stys A, Stys TP, Christensen KD. Evaluation of pharmacogenetic automated clinical decision support for clopidogrel. Pharmacogenomics 2024; 25:391-399. [PMID: 39258919 PMCID: PMC11418215 DOI: 10.1080/14622416.2024.2394014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 08/15/2024] [Indexed: 09/12/2024] Open
Abstract
Aim: Clopidogrel requires CYP2C19 activation to have antiplatelet effects. Pharmacogenetic testing to identify patients with impaired CYP2C19 function can be coupled with clinical decision support (CDS) alerts to guide antiplatelet prescribing. We evaluated the impact of alerts on clopidogrel prescribing.Materials & methods: We retrospectively analyzed data for 866 patients in which CYP2C19-clopidogrel CDS was deployed at a single healthcare system during 2015-2023.Results: Analyses included 2,288 alerts. CDS acceptance rates increased from 24% in 2015 to 63% in 2023 (p < 0.05). Adjusted analyses also showed higher acceptance rates when clopidogrel had been ordered for a percutaneous intervention (OR: 28.7, p < 0.001) and when cardiologists responded to alerts (OR: 2.11, p = 0.001).Conclusion: CDS for CYP2C19-clopidogrel was effective in reducing potential drug-gene interactions. Its influence varied by clinician specialty and medication indications.
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Affiliation(s)
- Amanda Massmann
- Sanford Imagenetics, Sioux Falls, SD57105, USA
- Department of Internal Medicine, University of South Dakota School of Medicine, Vermillion, SD57069, USA
| | - Joel Van Heukelom
- Sanford Imagenetics, Sioux Falls, SD57105, USA
- Department of Internal Medicine, University of South Dakota School of Medicine, Vermillion, SD57069, USA
| | - Max Weaver
- Sanford Imagenetics, Sioux Falls, SD57105, USA
| | - April Schultz
- Sanford Imagenetics, Sioux Falls, SD57105, USA
- Department of Internal Medicine, University of South Dakota School of Medicine, Vermillion, SD57069, USA
| | - Debbie M Figueroa
- Department of Internal Medicine, University of South Dakota School of Medicine, Vermillion, SD57069, USA
- Sanford Medical Genetics Laboratory, Sioux Falls, SD57105, USA
| | - Adam Stys
- Department of Internal Medicine, University of South Dakota School of Medicine, Vermillion, SD57069, USA
- Sanford Cardiovascular Institute, Sioux Falls, SD57105, USA
| | - Tomasz P Stys
- Department of Internal Medicine, University of South Dakota School of Medicine, Vermillion, SD57069, USA
- Sanford Cardiovascular Institute, Sioux Falls, SD57105, USA
| | - Kurt D Christensen
- Precision Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, MA02215, USA
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Qin M, Liu T, Shi X, Feng L, Li T, Cheng Z, Cheng S, Zhou C, Zou M, Jia Q, Zhang C, Gao Y. Antiplatelet therapy versus intravenous thrombolysis for mild acute ischaemic stroke: a living systematic review and meta-analysis. Stroke Vasc Neurol 2024:svn-2024-003097. [PMID: 39134430 DOI: 10.1136/svn-2024-003097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 07/16/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Previous studies have shown contradictory results between early application of antiplatelet therapy and intravenous thrombolysis (IVT) for mild acute ischaemic stroke (AIS), with National Institutes of Health Stroke Scale score 0-5. OBJECTIVE To compare the benefits and risks of antiplatelet therapy and IVT in patients with mild AIS. METHODS A systematic search of MEDLINE, Embase and Cochrane Library was conducted from database inception until July 2023, without language restriction. Randomised clinical trials (RCTs) or observational studies were selected. The primary outcomes were 90-day functional outcomes, measured by the modified Rankin Scale (mRS) score. The protocol has been registered before data collection. RESULTS Two RCTs and four observational studies with relatively low risk of bias that enrolled 3975 patients were analysed (2454 in antiplatelet therapy and 1521 in IVT therapy). There were no significant differences between antiplatelet therapy and IVT in 90-day functional outcomes (mRS 0-1, OR 1.08 (95% CI 0.73 to 1.58); mRS 0-2, OR, 1.04 (95% CI 0.63 to 1.73)), death (OR, 0.64 (95% CI 0.19 to 2.13)) and stroke recurrence (OR, 0.71 (95% CI 0.28 to 1.79)). Antiplatelet therapy was associated with a reduced risk of symptomatic intracranial haemorrhage (sICH) compared with IVT (OR, 0.20 (95% CI 0.06 to 0.69)). CONCLUSIONS Among patients with mild AIS, compared with IVT, early application of antiplatelet therapy was not significantly associated with improved functional outcomes, reduced death or stroke recurrence, but was significantly associated with a reduced risk of sICH. PROSPERO REGISTRATION NUMBER CRD42023447862.
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Affiliation(s)
- Mingzhen Qin
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tingting Liu
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Xinyi Shi
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Luda Feng
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tingting Li
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zixin Cheng
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Sisong Cheng
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Congren Zhou
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Mingrun Zou
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qi Jia
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chi Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ying Gao
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
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Wu Q, Yao J, Qi J, Bi Y, Chen A, Yang Z, Ai C, Chen L, Zhang B, Xu S, Li Z, Shi H, Wu P. Microsurgical clipping versus endovascular therapy for treating patients with middle cerebral artery aneurysms presenting with neurological ischemic symptoms. Neurosurg Rev 2024; 47:318. [PMID: 38995460 DOI: 10.1007/s10143-024-02559-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 05/05/2024] [Accepted: 07/07/2024] [Indexed: 07/13/2024]
Abstract
Studies comparing different treatment methods in patients with middle cerebral artery (MCA) aneurysms in different subgroups of onset symptoms are lacking. It is necessary to explore the safety and efficacy of open surgical treatment and endovascular therapy in patients with MCA aneurysms in a specific population. This study aimed to compare microsurgical clipping versus endovascular therapy regarding complication rates and outcomes in patients with MCA aneurysms presenting with neurological ischemic symptoms. This was a retrospective cohort study in which 9656 patients with intracranial aneurysms were screened between January 2014 and July 2022. Further, 130 eligible patients were enrolled. The primary outcome was the incidence of serious adverse events (SAEs) within 30 days of treatment, whereas secondary outcomes included postprocedural target vessel-related stroke, disabling stroke or death, mortality, and aneurysm occlusion rate. Among the 130 included patients, 45 were treated with endovascular therapy and 85 with microsurgical clipping. The primary outcome of the incidence of SAEs within 30 days of treatment was significantly higher in the clipping group [clipping: 23.5%(20/85) vs endovascular: 8.9%(4/45), adjusted OR:4.05, 95% CI:1.20-13.70; P = 0.024]. The incidence of any neurological complications related to the treatment was significantly higher in the clipping group [clipping:32.9%(28/85) vs endovascular:15.6%(7/45); adjusted OR:3.49, 95%CI:1.18-10.26; P = 0.023]. Postprocedural target vessel-related stroke, disabling stroke or death, mortality rate, and complete occlusion rate did not differ significantly between the two groups. Endovascular therapy seemed to be safer in treating patients with MCA aneurysms presenting with neurological ischemic symptoms compared with microsurgical clipping, with a significantly lower incidence of SAEs within 30 days of treatment and any neurological complications related to the treatment during follow-up.
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Affiliation(s)
- Qiaowei Wu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Youzheng Road No.23, Harbin, 150000, Heilongjiang, China
| | - Jinbiao Yao
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Youzheng Road No.23, Harbin, 150000, Heilongjiang, China
| | - Jingtao Qi
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Youzheng Road No.23, Harbin, 150000, Heilongjiang, China
| | - Yuange Bi
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Aixia Chen
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Youzheng Road No.23, Harbin, 150000, Heilongjiang, China
| | - Zhonghui Yang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Youzheng Road No.23, Harbin, 150000, Heilongjiang, China
| | - Changsi Ai
- Department of Neurosurgery, Hongda Hospital of Jiamusi University, Jiamusi, Heilongjiang, China
| | - Lining Chen
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Youzheng Road No.23, Harbin, 150000, Heilongjiang, China
| | - Bohan Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Youzheng Road No.23, Harbin, 150000, Heilongjiang, China
| | - Shancai Xu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Youzheng Road No.23, Harbin, 150000, Heilongjiang, China
| | - Zhentao Li
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Youzheng Road No.23, Harbin, 150000, Heilongjiang, China
| | - Huaizhang Shi
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Youzheng Road No.23, Harbin, 150000, Heilongjiang, China.
| | - Pei Wu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Youzheng Road No.23, Harbin, 150000, Heilongjiang, China.
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Tan S, Liu Y, Li F, Han M, Ye M. The impact of various antiplatelet strategies on the incidence of gouty arthritis in hospitalized patients with acute cerebral infarction. Clin Neurol Neurosurg 2024; 242:108326. [PMID: 38772278 DOI: 10.1016/j.clineuro.2024.108326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVES 1.To explore the incidence of concurrent gouty arthritis (GA) during hospitalization in patients with different subtypes of acute stroke. 2.To investigate disparities in acute cerebral infarction patients with coexisting GA undergoing various antiplatelet strategies. MATERIALS AND METHODS Data from acute stroke patients admitted to the Affiliated Panyu Central Hospital of Guangzhou Medical University, from January 2019 to December 2021, underwent screening. The incidence of GA in acute stroke patients of various subtypes were analyzed. Subsequently, we divided cerebral infarction cases into three cohorts based on distinct antiplatelet therapies: the aspirin group, the dual antiplatelet therapy group (DAPT,aspirin plus clopidogrel), and the clopidogrel group. Investigate disparities in acute cerebral infarction patients with coexisting GA undergoing various antiplatelet strategies. RESULTS A total of 12,381 patients with acute stroke were screened in this study. The incidence of GA in various subtypes of acute stroke was as follows: cerebral infarction (3.56 %, n = 9890), TIA (1.81 %, n = 443), cerebral hemorrhag (0.64 %, n = 1713), and SAH (0.30 %, n = 335). The incidence of GA in patients with ischemic stroke is higher than that of hemorrhagic stroke (χ2 = 49.258, p<0.001). No significant differences were observed in the incidence of GA among three different antiplatelet therapy groups. But there was marginal statistical difference in the incidence of GA between the aspirin group and the DAPT group (P = 0.051), as well as between the clopidogrel group and the DAPT group (P = 0.059). CONCLUSIONS The incidence of GA in patients with ischemic stroke is higher than that of hemorrhagic stroke. No significant differences were observed in the incidence of GA in acute cerebral infarction across various antiplatelet Strategies. The marginal statistical difference in the incidence of GA between the single antiplatelet group and the DAPT group requires further investigation.
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Affiliation(s)
- Shaohua Tan
- Department of Neurology, The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Yuanting Liu
- Department of Information and Statistics Center, The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, China
| | - Futao Li
- Department of Neurology, The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, China
| | - Meng Han
- Department of Neurology, The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mingxin Ye
- Department of Neurology, The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, China
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Yang J, Wu C, Jin Y, Hu M, Lin Y, Yao Q, Zhu C. Long-term outcomes among ischemic stroke TOAST subtypes: A 12-year Cohort study in China. J Stroke Cerebrovasc Dis 2024; 33:107783. [PMID: 38896973 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/12/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Disparities in short-term ischemic stroke (IS) prognosis among Trial of Org 10172 in Acute Stroke Treatment (TOAST) subtypes were observed. Notably, little is known about the long-term prognosis of different subtypes in China. We aim to investigate the long-term outcome in IS patients and try to explore the potential interactive effects between IS subtypes and antithrombotic therapy. METHODS This is a prospective cohort of stroke survivors. Patients diagnosed with first-ever IS at the Department of Neurology, West China Hospital, Sichuan University from January 2010 to December 2019 were recruited. They were followed until September 2022 to assess recurrence, mortality, and functional recovery. The multivariate Fine-Gray model assessed stroke recurrence, while Cox regression estimated hazard ratios. Modified Rankin Scale scores(mRS) were analyzed using the generalized linear mixed effects model. RESULTS At baseline, 589 of 950 participants (62.00 %) were male. The longest follow-up was 150 months, the shortest was 1.5 months, and the median follow-up was 81.0 months. Cardio-embolism (CE) bore the highest mortality risk compared to large artery atherosclerosis (LAA) (HR=4.43,95 %CI 1.61-12.23). Among survivors on anticoagulant therapy, CE exhibited a reduced risk of mortality (HR = 0.18, 95 % CI 0.04-0.80). In function recovery, small artery occlusion (SAO) demonstrated more favorable prognostic outcomes (β=-2.08, P<0.01, OR=0.13,95 %CI 0.03-0.47). Among survivors taking antiplatelet drugs, SAO demonstrated a slower pace of functional recovery compared to LAA (β=1.39, P=0.05, OR=3.99,95 %CI 1.01-15.74). CONCLUSIONS Long-term outcomes post-first IS vary among TOAST subtypes. Anticoagulant therapy offers long-term benefits among patients of the CE. However, prolonged administration of antiplatelet drugs among SAO patients may be limited in improving function recovery. Physicians should carefully consider treatment options for different IS subtypes to optimize patient outcomes and stroke care effectiveness.
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Affiliation(s)
- Jing Yang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China
| | - Chenyao Wu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China; Public Health Center, Tianfu New Area Disease Prevention and Control Center, Sichuan, PR China
| | - Yu Jin
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China
| | - Meijing Hu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China
| | - Yidie Lin
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China
| | - Qiang Yao
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China
| | - Cairong Zhu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China.
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Shao H, He S, Ni P, Zheng D, Yu N, Chen Q, Leng X, Lin Y, Li S, Yang J, Wang X. Dual antiplatelet therapy for ischemic stroke with intracranial arterial stenosis: a systematic review and meta-analysis. Front Neurol 2024; 15:1411669. [PMID: 38915797 PMCID: PMC11194412 DOI: 10.3389/fneur.2024.1411669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/29/2024] [Indexed: 06/26/2024] Open
Abstract
Background The safety and efficacy of dual antiplatelet therapy (DAPT) in ischemic stroke patients with intracranial artery stenosis (ICAS) remain contentious. Aims This study evaluates DAPT's effectiveness and safety for these patients. Methods This review was reported following PRISMA 2020 guidelines. A comprehensive search was conducted in PubMed, Embase, Cochrane Library, ClinicalTrials.gov, CNKI, WanFang, VIP, and SinoMed up to June 20, 2023, for randomized controlled trials comparing efficacy and safety of DAPT against single antiplatelet therapy (SAPT) in ischemic stroke patients with ICAS. The primary outcome was a composite of ischemic and bleeding events. Secondary outcomes included stroke (cerebral infarction and hemorrhage), ischemic events, and cerebral infarction. Safety outcomes assessed were bleeding events, cerebral hemorrhage, and mortality. Risk ratios (RRs) with 95% confidence intervals (CIs) were synthesized using Review Manager 5.4. Results Analysis of 21 randomized controlled trials involving 3,591 patients revealed that DAPT significantly lowered the rate of ischemic and bleeding events (RR = 0.52; 95% CI: 0.46-0.59, p < 0.001) and recurrent stroke (RR = 0.37; 95% CI: 0.30-0.44, p < 0.001) compared to SAPT. There was no significant increase in bleeding events (RR = 1.34; 95% CI: 0.97-1.85, p = 0.07) or cerebral hemorrhage (RR = 0.47; 95% CI: 0.17-1.31, p = 0.15). Conclusion DAPT proveed to be effective and safe for ischemic stroke patients with ICAS and significantly reduced stroke and the composite endpoint of ischemic and bleeding events without elevating bleeding risks.
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Affiliation(s)
- Haifeng Shao
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Song He
- Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Ping Ni
- Department of Neurology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Danni Zheng
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Nengwei Yu
- Department of Neurology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiao Chen
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xinyi Leng
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Yan Lin
- Department of Neurology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Suping Li
- Department of Neurology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jie Yang
- Department of Neurology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xia Wang
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Zapata-Arriaza E, Medina-Rodríguez M, Moniche Álvarez F, de Albóniga-Chindurza A, Aguilar-Pérez M, Ainz-Gómez L, Baena-Palomino P, Zamora A, Pardo-Galiana B, Delgado-Acosta F, Valverde Moyano R, Jiménez-Gómez E, Bravo Rey I, Oteros Fernández R, Escudero-Martínez I, Vielba-Gomez I, Morales Caba L, Díaz Pérez J, García Molina E, Mosteiro S, Castellanos Rodrigo MDM, Amaya Pascasio L, Hidalgo C, Freijo Guerrero MDM, González Díaz E, Ramírez Moreno JM, Fernández Prudencio L, Terceño Izaga M, Bashir Viturro S, Gamero-García MÁ, Jiménez Jorge S, Rosso Fernández C, Montaner J, González García A. Statistical analysis plan for the multicenter, open, randomized controlled clinical trial to assess the efficacy and safety of intravenous tirofiban vs aspirin in acute ischemic stroke due to tandem lesion, undergoing recanalization therapy by endovascular treatment (ATILA trial). Trials 2024; 25:35. [PMID: 38195586 PMCID: PMC10775524 DOI: 10.1186/s13063-023-07817-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/21/2023] [Indexed: 01/11/2024] Open
Abstract
RATIONALE In-stent reocclusion after endovascular therapy has a negative impact on outcomes in acute ischemic stroke (AIS) due to tandem lesions (TL). Optimal antiplatelet therapy approach in these patients to avoid in-stent reocclusion is yet to be elucidated. AIMS To assess efficacy and safety of intravenous tirofiban versus intravenous aspirin in patients undergoing MT plus carotid stenting in the setting of AIS due to TL. SAMPLE SIZE ESTIMATES Two hundred forty patients will be enrolled, 120 in every treatment arm. METHODS AND DESIGN A multicenter, prospective, randomized, controlled (aspirin group), assessor-blinded clinical trial will be conducted. Patients fulfilling the inclusion criteria will be randomized at MT onset to the experimental or control group (1:1). Intravenous aspirin will be administered at a 500-mg single dose and tirofiban at a 500-mcg bolus followed by a 200-mcg/h infusion during the first 24 h. All patients will be followed for up to 3 months. STUDY OUTCOMES Primary efficacy outcome will be the proportion of patients with carotid in-stent thrombosis within the first 24 h after MT. Primary safety outcome will be the rate of symptomatic intracranial hemorrhage. DISCUSSION This will be the first clinical trial to assess the best antiplatelet therapy to avoid in-stent thrombosis after MT in patients with TL. TRIAL REGISTRATION The trial is registered as NCT05225961. February, 7th, 2022.
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Affiliation(s)
- Elena Zapata-Arriaza
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain.
- Interventional Neuroradiology Department, Virgen del Rocío University Hospital, Neurovascular Research Laboratory, Institute of Biomedicine of Seville (IBIS), Av Manuel Siurot sn, Seville, 41013, Spain.
| | - Manuel Medina-Rodríguez
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Neurology Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | - Francisco Moniche Álvarez
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Neurology Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | - Asier de Albóniga-Chindurza
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Neurology Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | - Marta Aguilar-Pérez
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Interventional Neuroradiology Department, Virgen del Rocío University Hospital, Neurovascular Research Laboratory, Institute of Biomedicine of Seville (IBIS), Av Manuel Siurot sn, Seville, 41013, Spain
| | - Leire Ainz-Gómez
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Neurology Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | - Pablo Baena-Palomino
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Neurology Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | - Aynara Zamora
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
| | - Blanca Pardo-Galiana
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Neurology Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | | | | | - Elvira Jiménez-Gómez
- Interventional Neuroradiology Department, Reina Sofía University Hospital, Córdoba, Spain
| | - Isabel Bravo Rey
- Interventional Neuroradiology Department, Reina Sofía University Hospital, Córdoba, Spain
| | | | | | - Isabel Vielba-Gomez
- Interventional Neuroradiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Lluis Morales Caba
- Interventional Neuroradiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Jose Díaz Pérez
- Interventional Neuroradiology Department, Virgen de la Arrixaca University Clinical Hospital, Murcia, Spain
| | | | - Sonia Mosteiro
- Interventional Neuroradiology Department, A Coruña University Hospital Complex, Coruña, Spain
| | | | | | - Carlos Hidalgo
- Interventional Neuroradiology Department, Torrecardenas University Hospital, Almería, Spain
| | | | - Eva González Díaz
- Interventional Neuroradiology Department, Cruces University Hospital, Vizcaya, Spain
| | | | | | - Mikel Terceño Izaga
- Department of Neurology, Doctor Josep Trueta Hospital, Girona, Spain
- Interventional Neuroradiology Unit, Doctor Josep Trueta Hospital, Girona, Spain
| | - Saima Bashir Viturro
- Department of Neurology, Doctor Josep Trueta Hospital, Girona, Spain
- Interventional Neuroradiology Unit, Doctor Josep Trueta Hospital, Girona, Spain
| | - Miguel Ángel Gamero-García
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Neurology Department, Virgen Macarena University Hospital, Seville, Spain
| | - Silvia Jiménez Jorge
- Clinical Research and Clinical Trials Unit (CTU), Virgen del Rocío Hospital, Seville, Spain
| | - Clara Rosso Fernández
- Clinical Research and Clinical Trials Unit (CTU), Virgen del Rocío Hospital, Seville, Spain
| | - Joan Montaner
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Neurology Department, Virgen Macarena University Hospital, Seville, Spain
| | - Alejandro González García
- Stroke Unit, Neurovascular Research Program, Seville Biomedical Research Institute, Seville, Spain
- Interventional Neuroradiology Department, Virgen del Rocío University Hospital, Neurovascular Research Laboratory, Institute of Biomedicine of Seville (IBIS), Av Manuel Siurot sn, Seville, 41013, Spain
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9
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Wu P, Liu Z, Tian Z, Wu B, Shao J, Li Q, Geng Z, Pan Y, Lu K, Wang Q, Xu T, Zhou K. CYP2C19 Loss-of-Function Variants Associated With Long-Term Ischemic Stroke Events During Clopidogrel Treatment in the Chinese Population. Clin Pharmacol Ther 2023; 114:1126-1133. [PMID: 37607302 DOI: 10.1002/cpt.3028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/12/2023] [Indexed: 08/24/2023]
Abstract
This study aims to determine whether CYP2C19 loss-of-function (LoF) variants were associated with long-term ischemic stroke risk in Chinese primary care patients treated with clopidogrel. Patients treated with clopidogrel were ascertained from Chinese electronic medical records linked with a biobank for a retrospective cohort study. Their medical information was examined for the period from January 2018 to December 2021. Two CYP2C19 major loss of function variants (*2:rs4244285 and *3: rs4986893) were genotyped. The clinical outcome was ischemic stroke event. Cox regression analysis was used to evaluate the association between the occurrence of ischemic stroke events and CYP2C19 LoF variants. Covariates included age, gender, body mass index, prior ischemic stroke, transient ischemic attack, hypertension, diabetes mellitus, hyperlipoidemia, smoke status, aspirin use, proton-pump inhibitor use, and statin use. Of the 1,141 patients included in the clopidogrel therapy cohort, 61.9% carried at least one CYP2C19 LoF variant. During a median follow-up period of 12 months, 103 patients (9.0%) had an ischemic stroke. After adjusting for other risk factors, carriers of CYP2C19 LoF variants had significantly higher risk of ischemic stroke compared with non-carriers (hazard ratio: 1.64, 95% confidence interval: 1.06-2.53, P = 0.025). This pharmacogenetic study of clopidogrel provides novel insights into the association between the CYP2C19 LoF variant and long-term stroke risk. We established that there is still a need for CYP2C19 genotype-guided personalized antiplatelet therapy in those who have returned to the primary care setting for clopidogrel prescription.
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Affiliation(s)
- Peng Wu
- Guangzhou Laboratory, Guangzhou International Bio Island, Guangzhou, China
| | - Ziqing Liu
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Zijian Tian
- Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Benrui Wu
- Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Jian Shao
- Guangzhou Laboratory, Guangzhou International Bio Island, Guangzhou, China
| | - Qian Li
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Zhaoxu Geng
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
- Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Ying Pan
- Department of General Practice, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, China
| | - Ke Lu
- Department of General Practice, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, China
| | - Qiang Wang
- Department of General Practice, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, China
| | - Tao Xu
- Guangzhou Laboratory, Guangzhou International Bio Island, Guangzhou, China
- Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Kaixin Zhou
- Guangzhou Laboratory, Guangzhou International Bio Island, Guangzhou, China
- College of Public Health, Guangzhou Medical University, Guangzhou, China
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10
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Ayass MA, Griko N, Pashkov V, Tripathi T, Zhang J, Ramankutty Nair R, Okyay T, Zhu K, Abi-Mosleh L. New High-Affinity Thrombin Aptamers for Advancing Coagulation Therapy: Balancing Thrombin Inhibition for Clot Prevention and Effective Bleeding Management with Antidote. Cells 2023; 12:2230. [PMID: 37759453 PMCID: PMC10526462 DOI: 10.3390/cells12182230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Thrombin is a key enzyme involved in blood clotting, and its dysregulation can lead to thrombotic diseases such as stroke, myocardial infarction, and deep vein thrombosis. Thrombin aptamers have the potential to be used as therapeutic agents to prevent or treat thrombotic diseases. Thrombin DNA aptamers developed in our laboratory exhibit high affinity and specificity to thrombin. In vitro assays have demonstrated their efficacy by significantly decreasing Factor II activity and increasing PT and APTT times in both plasma and whole blood. Aptamers AYA1809002 and AYA1809004, the two most potent aptamers, exhibit high affinity for their target, with affinity constants (Kd) of 10 nM and 13 nM, respectively. Furthermore, the in vitro activity of these aptamers displays dose-dependent behavior, highlighting their efficacy in a concentration-dependent manner. In vitro stability assessments reveal that the aptamers remain stable in plasma and whole blood for up to 24 h. This finding is crucial for their potential application in clinical settings. Importantly, the thrombin inhibitory activity of the aptamers can be reversed by employing reverse complement sequences, providing a mechanism to counteract their anticoagulant effects when necessary to avoid excessive bleeding. These thrombin aptamers have been determined to be safe, with no observed mutagenic or immunogenic effects. Overall, these findings highlight the promising characteristics of these newly developed thrombin DNA aptamers, emphasizing their potential for therapeutic applications in the field of anticoagulation therapy. Moreover, the inclusion of an antidote in the coagulation therapy regimen can improve patient safety, ensure greater therapeutic efficacy, and minimize risk during emergency situations.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lina Abi-Mosleh
- Ayass Bioscience LLC, 8501 Wade Blvd, Building 9, Frisco, TX 75034, USA
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11
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Jyotsna F, Mahfooz K, Sohail H, Kumar S, Adeeb M, Anand D, Kumar R, Rekha F, Varrassi G, Khatri M, Kumar S. Deciphering the Dilemma: Anticoagulation for Heart Failure With Preserved Ejection Fraction (HFpEF). Cureus 2023; 15:e43279. [PMID: 37692595 PMCID: PMC10492587 DOI: 10.7759/cureus.43279] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Impairment in ventricular relaxation and preserved left ventricular ejection fraction are the two main features of heart failure with preserved ejection fraction (HFpEF) a difficult clinical condition. Therapeutic choices for HFpEF patients are still scarce despite its rising frequency and negative effects on morbidity and mortality, necessitating creative methods to enhance results. The increased thromboembolic risk seen in these individuals raises questions about the relevance of anticoagulation in the therapy of HFpEF. Although anticoagulation has been shown to be beneficial in heart failure with decreased ejection fraction (HFrEF) and other high-risk cardiovascular disorders, its efficacy and safety in HFpEF present a challenging therapeutic challenge. Anticoagulants have been the subject of clinical trials in HFpEF, but the results have been conflicting, giving clinicians only a little information with which to make decisions. The decision-making process is made more difficult by worries about potential bleeding hazards, particularly in susceptible elderly HFpEF patients with other comorbidities. The link between heart failure and anticoagulant medication in HFpEF is thoroughly analyzed in this narrative review. In HFpEF, cardiac fibrosis and endothelial dysfunction create a prothrombotic milieu, as is highlighted in this passage. Also covered are recent developments in innovative biomarker research and cutting-edge imaging techniques, which may provide ways to spot HFpEF patients who might benefit from anticoagulation. This therapeutic conundrum may be resolved by using precision medicine strategies based on risk classification and individualized therapy choices. This review emphasizes the need for more research to establish the best use of anticoagulation in HFpEF within the framework of personalized therapy and shared decision-making. To successfully manage thromboembolic risk and reduce bleeding consequences in HFpEF patients, it is essential to perform well-designed clinical studies and advance our understanding of the pathophysiology of HFpEF. These developments may ultimately improve the prognosis and quality of life for people who suffer from this difficult and mysterious ailment.
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Affiliation(s)
- Fnu Jyotsna
- Medicine, Dr. Bhim Rao Ambedkar Medical College and Hospital, Sahibzada Ajit Singh Nagar, IND
| | - Kamran Mahfooz
- Internal Medicine, Lincoln Medical Center, New York City, USA
| | - Haris Sohail
- Medicine, Lincoln Medical Center, New York City, USA
| | - Sumeet Kumar
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Maham Adeeb
- Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Dev Anand
- Medicine, Bahria University Medical and Dental College, Karachi, USA
| | - Rahul Kumar
- Medicine, Liaquat University of Medical and Health Sciences, Karachi, PAK
| | - Fnu Rekha
- Medicine, Liaquat University of Medical and Health Sciences, Karachi, PAK
| | | | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
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