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Thaarup M, Jacobsen S, Nielsen PB, Nicolajsen CW, Eldrup N, Petersen CN, Behrendt CA, Dahl M, Højen AA, Søgaard M. Adherence and Persistence to Antiplatelet Therapy in Lower Extremity Peripheral Arterial Disease: A Danish Population Based Cohort Study. Eur J Vasc Endovasc Surg 2024; 67:948-957. [PMID: 38341174 DOI: 10.1016/j.ejvs.2024.02.002] [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: 09/08/2023] [Revised: 01/25/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Adherence to antiplatelet therapy is recommended but unexplored in patients with symptomatic lower extremity peripheral arterial disease (PAD). Therefore, this study aimed to determine adherence and persistence to antiplatelet therapy in patients with PAD, defined as intermittent claudication and chronic limb threatening ischaemia. DESIGN Population based nationwide cohort study. METHODS This study included all Danish citizens aged ≥ 40 years with a first inpatient or outpatient diagnosis of symptomatic PAD between 2010 - 2017, and who had at least one prescription claim for aspirin and/or clopidogrel within 90 days after diagnosis. Adherence was determined by the proportion of days covered (PDC) during the first year after diagnosis. Persistence was defined as no treatment gap ≥ 30 days between prescription renewals over three year follow up. RESULTS A total of 39 687 patients were eligible for inclusion, of whom 23 279 (58.7%) claimed a prescription for aspirin and/or clopidogrel within 90 days of diagnosis. Among these, 12 898 (55.4%) were prevalent users, while the remainder comprised new users who initiated the therapy after the index PAD diagnosis. The mean PDC was 74.5% (SD 35.0%) for prevalent users and 60.5% (SD 30.5%) for new users. Adherence increased with age and number of concomitant drugs. The overall one year cumulative incidence treatment discontinuation was 13.0% (95% CI 12.5 - 13.4%) overall, 17.2% (CI 16.6 - 17.9%) for prevalent users, and 7.9% (CI 7.4 - 8.4%) for new users. At three year follow up, the cumulative incidence of discontinuation was 31.5% (CI 30.9 - 32.2%) overall, 44.6% (CI 43.7 - 45.4%) for prevalent users, and 14.6% (CI 13.9 - 15.3) for new users. CONCLUSION Less than 60% of patients with newly diagnosed symptomatic PAD claimed a prescription for antiplatelet therapy within 90 days of diagnosis, and both adherence and persistence were moderate during the first year after diagnosis. These findings underscore the importance of efforts to improve the initiation and continuation of antiplatelet therapy in patients with PAD.
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Affiliation(s)
- Maja Thaarup
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Sara Jacobsen
- Danish Centre for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Denmark
| | - Peter Brønnum Nielsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Danish Centre for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Denmark
| | | | - Nikolaj Eldrup
- Department of Vascular Surgery, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | | | - Christian-Alexander Behrendt
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Hamburg, Germany
| | - Marie Dahl
- Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Research Unit of Cardiac, Thoracic, and Vascular Surgery, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Anette Arbjerg Højen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Danish Centre for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Denmark
| | - Mette Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Danish Centre for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Denmark.
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Treffalls JA, Treffalls RN, Harbin Z, Clothier W, Tolbert PH, Yan Q, Davies MG. Quality Analysis of Online Resources for Patients with Peripheral Artery Disease. Ann Vasc Surg 2022; 83:1-9. [DOI: 10.1016/j.avsg.2021.12.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/11/2021] [Accepted: 12/19/2021] [Indexed: 11/15/2022]
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Chan SL, Rajesh R, Tang TY. Evidence-based medical treatment of peripheral arterial disease:
A rapid review. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021. [DOI: 10.47102/annals-acadmedsg.2020649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
ABSTRACT
Introduction: Peripheral arterial disease (PAD) treatment guidelines recommend the use of statins
and antiplatelets in all PAD patients to reduce adverse cardiovascular and limb-related outcomes. In
addition, hypertension and diabetes should be treated to reach recommended targets. The aim of this
rapid review was to evaluate the level of adherence to evidence-based medical therapy (EBMT)
recommended by PAD treatment guidelines in the real-world setting.
Methods: We searched PubMed and Embase using keywords, MeSH and Emtree terms related to the
population, exposure and outcomes from their inception to 22 September 2020. We included randomised
controlled trials, non-randomised studies, and observational studies reporting adherence to at least 1 of
these 4 drug classes: (1) statins, (2) antiplatelets, (3) antihypertensives and (4) antidiabetic drugs.
Non-English articles, abstracts, dissertations, animal studies and case reports or series were excluded.
A narrative summary of the results was performed.
Results: A total of 42 articles were included in the review. The adherence to lipid-lowering drugs/statins
ranged from 23.5 to 92.0% and antiplatelets from 27.5 to 96.3%. Only 7 and 5 studies reported use of
“any anti-hypertensive” and “any anti-diabetic” medications, respectively, and the proportion of the cohort
treated were generally close to the proportion with hypertension and/or diabetes. Adherence in studies
published in 2016–2020 ranged from 52.4–89.6% for lipid-lowering drugs and 66.2–96.3% for antiplatelets.
Conclusion: EBMT adherence in PAD patients was highly variable and a substantial proportion in
many settings were undertreated. There was also a notable lack of studies in Asian populations.
Keywords: Evidence-practice gap, medication adherence, pharmacoepidemiology
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Affiliation(s)
- Sze Ling Chan
- Health Services Research Centre, SingHealth, Singapore
| | - Revvand Rajesh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Kim C, Yang YS, Ryu GW, Choi M. Risk factors associated with amputation-free survival for patients with peripheral arterial disease: a systematic review. Eur J Cardiovasc Nurs 2021; 20:295-304. [PMID: 33786599 DOI: 10.1093/eurjcn/zvaa022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/01/2020] [Accepted: 11/09/2020] [Indexed: 12/24/2022]
Abstract
AIMS Peripheral arterial disease (PAD) is associated with morbidity and mortality, comprising a significant percentage of amputations. As it affects the quality of life of patients with PAD, it is an important health issue. Therefore, the risk factors affecting the outcomes of limb salvage after revascularization should be well investigated. The aim of this review is to summarize risk factors of amputation-free survival (AFS) after interventions targeting patients with PAD to develop evidence-based intervention for improving patient outcomes. METHODS AND RESULTS A systematic review following PRISMA guidelines was conducted, and the protocol was registered on PROSPERO (CRD42020183076). PubMed, CINAHL, EMBASE, Cochrane Library, and Web of Science were searched for observational studies published between 2008 and 2019. Search terms included 'peripheral arterial disease', 'risk factors', and 'amputation-free survival'. The quality of the studies was evaluated using the Joanna Briggs Institute's Critical Appraisal Tools. Seventeen cohort studies were included in our study, and 16 risk factors were identified. Risk factors exemplifying a significant influence on decreased AFS were divided into three categories: sociodemographic (e.g. older age, male gender, African-American race, low body mass index, high nutritional risk, frailty), disease-related characteristics (e.g. severity of the disease, intervention site), and comorbidities (e.g. cardiovascular disease, kidney disease, diabetes mellitus, chronic obstructive pulmonary disease, dementia, wide pulse pressure). CONCLUSION We found that managing modifiable risk factors, as well as addressing high-risk populations, has the potential to improve outcomes of PAD interventions. More high-quality cohort studies are needed to confirm these findings.
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Affiliation(s)
- Changhwan Kim
- Department of Critical Care Nursing, Samsung Medical Center, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Yong Sook Yang
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1 Yonsei-ro, College of Nursing Yonsei University, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Gi Wook Ryu
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1 Yonsei-ro, College of Nursing Yonsei University, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Mona Choi
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1 Yonsei-ro, College of Nursing Yonsei University, Seodaemun-gu, Seoul 03722, Republic of Korea.,Yonsei Evidence Based Nursing Centre of Korea, JBI Centre of Excellence, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
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Hua S, Isasi CR, Kizer JR, Matsushita K, Allison MA, Tarraf W, Qi Q, Ponce SG, Daviglus M, Kaplan RC. Underuse of Cardiovascular Medications in Individuals With Known Lower Extremity Peripheral Artery Disease: HCHS/SOL. J Am Heart Assoc 2020; 9:e015451. [PMID: 32752978 PMCID: PMC7660818 DOI: 10.1161/jaha.119.015451] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Underuse of cardiovascular medications for secondary prevention among individuals with peripheral artery disease (PAD) has been reported. Little is known about PAD treatment status in the Hispanic/Latino population in the United States, who may have limited access to health care and who have worse clinical outcomes than non‐Hispanic individuals. Methods and Results We studied the use of cardiovascular therapies in 1244 Hispanic/Latino individuals recruited from 4 sites in the United States, including 826 individuals who reported diagnosis of PAD by physician and 418 individuals with coronary artery disease alone, in the Hispanic Community Health Study/Study of Latinos. We compared the prevalence of using antiplatelet therapy, lipid‐lowering therapy and antihypertensive therapy by PAD and coronary artery disease status. Among those with PAD, we studied factors associated with taking cardiovascular medications, including demographic and socioeconomic factors, acculturation, access to health care and comorbidities, using multivariable regression models. The overall prevalence for individuals with PAD taking antiplatelet therapy, lipid‐lowering therapy and, among hypertensive individuals, antihypertensive therapy was 31%, 26% and 57%, respectively. Individuals of Mexican background had the lowest use for all classes of cardiovascular medications. Older age, number of doctor visits and existing hypertension and diabetes mellitus were significantly associated with taking cardiovascular therapies in adjusted models. Compared with those with PAD alone, individuals with PAD and concurrent coronary artery disease were 1.52 (95% CI, 1.20–1.93) and 1.74 (1.30–2.32) times more likely to use antiplatelet agents and statins according to multivariable analysis. No significant difference of antihypertensive medication use was found among PAD patients with or without coronary artery disease. Conclusions Hispanic/Latino individuals with known PAD underuse cardiovascular medications recommended in clinical guidelines. More efforts should be directed to improve treatment in this important group.
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Affiliation(s)
- Simin Hua
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNY
| | - Carmen R. Isasi
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNY
| | - Jorge R. Kizer
- Cardiology SectionSan Francisco Veterans Affairs Health Care SystemSan FranciscoNYUSA
- Departments of Medicine, and Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCA
| | - Kunihiro Matsushita
- Department of EpidemiologyJohns Hopkins University Bloomberg School of Public HealthBaltimoreMD
| | - Matthew A. Allison
- Department of Family Medicine and Public HealthUniversity of CaliforniaSan DiegoCA
| | - Wassim Tarraf
- Department of Healthcare SciencesWayne State UniversityDetroitMI
- Institute of GerontologyWayne State UniversityDetroitMI
| | - Qibin Qi
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNY
| | - Sonia G. Ponce
- Department of Family Medicine and Public HealthUniversity of CaliforniaSan DiegoCA
| | - Martha Daviglus
- Institute for Minority Health ResearchUniversity of Illinois at ChicagoIL
- Department of MedicineUniversity of Illinois at ChicagoIL
- Department of Preventive MedicineNorthwestern UniversityChicagoIL
| | - Robert C. Kaplan
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNY
- Public Health Sciences DivisionFred Hutchinson Cancer Research CenterSeattleWA
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Ambrosetti M, Abreu A, Corrà U, Davos CH, Hansen D, Frederix I, Iliou MC, Pedretti RF, Schmid JP, Vigorito C, Voller H, Wilhelm M, Piepoli MF, Bjarnason-Wehrens B, Berger T, Cohen-Solal A, Cornelissen V, Dendale P, Doehner W, Gaita D, Gevaert AB, Kemps H, Kraenkel N, Laukkanen J, Mendes M, Niebauer J, Simonenko M, Zwisler ADO. Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2020; 28:460-495. [PMID: 33611446 DOI: 10.1177/2047487320913379] [Citation(s) in RCA: 352] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/26/2020] [Indexed: 12/24/2022]
Abstract
Secondary prevention through comprehensive cardiac rehabilitation has been recognized as the most cost-effective intervention to ensure favourable outcomes across a wide spectrum of cardiovascular disease, reducing cardiovascular mortality, morbidity and disability, and to increase quality of life. The delivery of a comprehensive and 'modern' cardiac rehabilitation programme is mandatory both in the residential and the out-patient setting to ensure expected outcomes. The present position paper aims to update the practical recommendations on the core components and goals of cardiac rehabilitation intervention in different cardiovascular conditions, in order to assist the whole cardiac rehabilitation staff in the design and development of the programmes, and to support healthcare providers, insurers, policy makers and patients in the recognition of the positive nature of cardiac rehabilitation. Starting from the previous position paper published in 2010, this updated document maintains a disease-oriented approach, presenting both well-established and more controversial aspects. Particularly for implementation of the exercise programme, advances in different training modalities were added and new challenging populations were considered. A general table applicable to all cardiovascular conditions and specific tables for each clinical condition have been created for routine practice.
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Affiliation(s)
- Marco Ambrosetti
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Italy
| | - Ana Abreu
- Serviço de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Italy
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Greece
| | - Dominique Hansen
- REVAL and BIOMED-Rehabilitation Research Centre, Hasselt University, Belgium
| | | | - Marie C Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Publique Hopitaux de Paris Centre-Universite de Paris, France
| | | | | | | | - Heinz Voller
- Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf and Centre of Rehabilitation Medicine, University Potsdam, Germany
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Italy
| | - Birna Bjarnason-Wehrens
- Department of Preventive and Rehabilitative Sport Medicine and Exercise Physiology, Institute for Cardiology and Sports Medicine, German Sport University Cologne, Germany
| | | | - Alain Cohen-Solal
- Cardiology Department, Hopital Lariboisiere, Paris University, France
| | | | - Paul Dendale
- Heart Centre, Jessa Hospital Campus Virga Jesse, Belgium
| | - Wolfram Doehner
- Department of Cardiology (Virchow Klinikum), German Centre for Cardiovascular Research (DZHK), Germany.,BCRT - Berlin Institute of Health Centre for Regenerative Therapies, and Centre for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Germany
| | - Dan Gaita
- University of Medicine & Pharmacy 'Victor Babes' Cardiovascular Prevention & Rehabilitation Clinic, Romania
| | - Andreas B Gevaert
- Heart Centre, Jessa Hospital Campus Virga Jesse, Belgium.,Research group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Belgium
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, The Netherlands
| | - Nicolle Kraenkel
- Charité - University Medicine Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Germany
| | - Jari Laukkanen
- Central Finland Health Care District Hospital District, Finland
| | - Miguel Mendes
- Cardiology Department, CHLO-Hospital de Santa Cruz, Portugal
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Austria
| | - Maria Simonenko
- Physiology Research and Blood Circulation Department, Cardiopulmonary Exercise Test SRL, Heart Transplantation Outpatient Department, Federal State Budgetary Institution, 'V.A. Almazov National Medical Research Centre' of the Ministry of Health of the Russian Federation, Russian Federation
| | - Ann-Dorthe Olsen Zwisler
- REHPA-Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Odense University Hospital, Denmark
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Lower Socioeconomic Status Is Associated with Groin Wound Complications after Revascularization for Peripheral Artery Disease. Ann Vasc Surg 2020; 62:76-82. [DOI: 10.1016/j.avsg.2019.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/19/2019] [Accepted: 05/25/2019] [Indexed: 11/22/2022]
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CHANGES IN THE HEMOSTATIC SYSTEM AGAINST THE BACKGROUND OF VARIOUS TREATMENT REGIMENS IN PATIENTS WITH ATHEROSCLEROSIS OF LOWER EXTREMITIES. EUREKA: HEALTH SCIENCES 2019. [DOI: 10.21303/2504-5679.2019.001084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
About 2–3 % of the population and about 35–50 % of people over 65 years suffer from obliterating atherosclerosis of the main arteries of the lower extremities. There are many known factors that potentiate atherosclerosis. Some of them are referred to as leading, such as hyperlipoproteinemia or hypertension, others to concomitant contributing to the defeat of the arteries. According to J.S.A. Fuchs include hypertension, hypercholesterolemia and smoking as major risk factors for atherosclerosis. They are less affected by obesity, diabetes, hypertriglyceridemia, sedentary lifestyle, stress
Objective of the study. The purpose of this study is to evaluate the functional status of the vascular – platelet, coagulation and fibrinolysis of the hemostasis system and their disorders using low – frequency piezoelectric thromboelastography (LPTEG) in patients with obliterating atherosclerosis of the lower extremities on the background of treatment.
Materials and methods. The initial state of the hemostasis system was evaluated in 90 patients undergoing treatment for obliterating atherosclerosis of the lower extremities in the Odessa Regional Clinical Hospital and MD Odreks. All patients underwent surgery in the amount of femoral-popliteal autologous bypass grafting. Patients in the control (1st) group (45 patients) received analgesia during surgery and in the postoperative period based on epidural administration of bupivacaine, and their treatment regimen included enoxaparin 0.4 ml (40,000 anti-XA ME) 2 times a day subcutaneously into the anterolateral surface of the abdominal wall from the first postoperative day and pentoxifylline IV 200 mg twice a day for 7 days. Patients of the studied (2nd) group (45 patients) received analgesia during surgery and in the postoperative period on the basis of epidural administration of bupivacaine, also rivaroxaban 15 mg 2 times a day oraly on the first postoperative day was included in their treatment regimen.
The dynamics of the state of the hemostatic system in both groups of patients with OA was evaluated using LPTEG in the first day before surgery and on the 3rd, 5th and 7th postoperative days.
Results and conclusions. Before surgery and the start of treatment in patients with OA, against the background of activation of the vascular - platelet link of hemostasis, significant structural and chronometric hypercoagulation with increased thrombin generation and activation of blood fibrinolytic activity are noted. Against the background of treatment in the 1st group, platelet aggregation tends to normalize and there are significant differences compared with the indicators before treatment in the 1st group, the vascular-platelet and fibrinolytic systems did not reach normal values before 7 days, but showed a significant downward trend the degree of manifestation of their violations. Against the background of treatment of the 2nd group, significant changes were observed towards normalization in all components of the hemostatic system according to the LPTEG technique. The state of the coagulation unit of the hemostasis system in patients with OA on the 7th day of therapy does not significantly differ from the norm, it is possible to note significant shifts towards hypocoagulation within the normal range. The fibrinolytic system on the 7th day of treatment does not statistically differ from normal indicators, it has significant positive dynamics compared to 1 day. The second group revealed a statistically significant normalization of all indicators characterizing the blood coagulation potential of the blood and the aggregation ability of platelets, as well as the indicator that is responsible for changes in the fibrinolytic blood system.
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Li S, Cui L, Anderson C, Gao C, Yu C, Shan G, Wang L, Peng B. Cardiovascular surgery experience does not significantly improve patients' response to stroke. Brain Behav 2019; 9:e01405. [PMID: 31515973 PMCID: PMC6790311 DOI: 10.1002/brb3.1405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/09/2019] [Accepted: 08/11/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Patients with a history of cardiovascular surgery are at risk of stroke, and immediately calling emergency medical services (EMS) after stroke onset is crucial to receiving effective reperfusion therapy. We aimed to determine the effect of a history of cardiovascular surgery on patients' ability to recognize stroke and intent to call EMS. METHODS We performed a cross-sectional community-based study from January 2017 to May 2017. A total population of 186,167 individuals, recruited from 69 administrative areas across China, was analyzed. Different multivariable logistic regression models were performed to identify the associations between cardiovascular surgical history and stroke recognition or intent to call EMS, respectively. RESULTS 0.1% of the total population had a history of cardiovascular surgery. In the surgery group, the estimated stroke recognition rate (SRR) and correct action rate (CAR) were 84.9% and 74.7%, respectively. The prevalence of cardiovascular risk factors was significantly higher in the surgery group. Cardiovascular surgical history was not associated with recognition of stroke across different models. The surgery group was more likely to call EMS, but the difference was not significant after full adjustment (OR: 1.40, 95% CI: 0.99-1.98, p = .0572). CONCLUSIONS Cardiovascular surgical history does not influence patients' likelihood of calling EMS more often at stroke onset. Patients receiving cardiovascular surgeries should be counseled regarding stroke recognition, proper response to stroke, and the importance of controlling risk factors.
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Affiliation(s)
- Shengde Li
- Department of NeurologyPeking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical SciencesBeijingChina
| | - Li‐Ying Cui
- Department of NeurologyPeking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical SciencesBeijingChina
| | - Craig Anderson
- Neurological and Mental Health DivisionThe George Institute for Global HealthFaculty of MedicineUniversity of New South WalesSydneyAustralia
- The George Institute for Global HealthPeking University Health Science CenterBeijingChina
| | - Chunpeng Gao
- Disease Control and Prevention OfficeDalian Municipal Central HospitalLiaoningChina
| | - Chengdong Yu
- Department of Epidemiology and StatisticsInstitute of Basic Medical SciencesChinese Academy of Medical SciencesBeijingChina
| | - Guangliang Shan
- Department of Epidemiology and StatisticsInstitute of Basic Medical SciencesChinese Academy of Medical SciencesBeijingChina
| | - Longde Wang
- Stroke Control Project CommitteeThe National Health CommissionBeijingChina
| | - Bin Peng
- Department of NeurologyPeking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical SciencesBeijingChina
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Abstract
PURPOSE OF REVIEW This paper provides a concise update on the management of peripheral artery disease (PAD). RECENT FINDINGS PAD continues to denote a population at high risk for mortality but represents a threat for limb loss only when associated with foot ulcers, gangrene, or infections. Performing either angiogram or non-invasive testing for all patients with foot ulcers, gangrene, or foot infections will help increase the detection of PAD, and refined revascularization strategies may help optimize wound healing in this patient group. Structured exercise programs are becoming available to more patients with claudication as methods to improve adherence to community-based exercise programs will improve. Finally, ensuring more patients with PAD receive aspirin therapy and statins may improve long-term survival, while further research will help determine if adding newer antiplatelet or anticoagulant medications may reduce leg amputations in selected patients. Clinicians should have a low threshold to obtain an angiogram and to pursue revascularization in patients with foot ulcers, gangrene, or foot infections. In patients with claudication, clinicians should maximize the benefits derived from exercise therapy and medical management before offering percutaneous or surgical revascularization.
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Affiliation(s)
- Neal R Barshes
- Division of Vascular Surgery and Endovascular Therapy, Michael E. Debakey Department of Surgery, Baylor College of Medicine/Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard (OCL 112),, Houston, TX, 77030, USA.
| | - Courtney L Grant
- Division of Vascular Surgery and Endovascular Therapy, Michael E. Debakey Department of Surgery, Baylor College of Medicine/Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard (OCL 112),, Houston, TX, 77030, USA
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Affiliation(s)
- Neal R Barshes
- 1 Division of Vascular Surgery and Endovascular Therapy Michael E. DeBakey Department of Surgery Baylor College of Medicine/Michael E. DeBakey Veterans Affairs Medical Center Houston TX
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