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Abstract
Anticoagulant agents, such as unfractionated heparin and warfarin, have been in use for roughly 50 years. Over the past decade, injectable agents such as low-molecular-weight heparins, pentasaccharide, and direct thrombin inhibitors have been major advances in preventing and treating thrombosis. Despite these somewhat recent additions, there is still enormous potential to improve on the pharmacokinetic and pharmacodynamic properties of these agents, as well as improve patient outcomes. There are currently a large number of anticoagulant agents (injectable and oral) that could be available for use in the next several years. Many of these new agents have unique mechanisms that may provide practitioners with anticoagulant alternatives. This review gives a detailed analysis of the anticoagulant agents that may add to our armamentarium in the management of thrombosis.
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Affiliation(s)
- Paul P. Dobesh
- Division of Pharmacy Practice, St. Louis College of Pharmacy, St. Louis, Missouri, St. Luke’s Hospital, Chesterfield, Missouri,
| | | | - Zachary Stacy
- Division of Pharmacy Practice, St. Louis College of Pharmacy, St. Louis, Missouri, St. Luke’s Hospital, Chesterfield, Missouri
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2
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Cohen M. The thrombin hypothesis in ACS: a disappointing disconnect between bench data and bedside clinical trials. Am J Med 2010; 123:103-10. [PMID: 20103015 DOI: 10.1016/j.amjmed.2009.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies have demonstrated the efficacy and safety of unfractionated heparin and low-molecular-weight heparin in the management of patients with acute coronary syndrome. However, a common limitation of unfractionated heparin and low-molecular-weight heparin is that neither can neutralize clot-bound thrombin. To overcome this limitation of the broad heparin-based anticoagulants, novel anticoagulants targeted for both the free and clot-bound forms of thrombin (direct thrombin inhibitors), or other individual components of the coagulation cascade (eg, direct and indirect factor Xa inhibitors), were developed. These targeted anticoagulation agents showed promising results in preclinical testing and have been evaluated in large-scale clinical acute coronary syndrome trials. This review discusses the disconnect between the excellent preclinical findings obtained with these novel, targeted agents and the efficacy and safety data observed in patients with acute coronary syndrome, compared with the broader-range heparin-based anticoagulants.
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Affiliation(s)
- Marc Cohen
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ; Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA.
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3
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Nørgaard BL, Sørensen C, Larsen T, Thygesen K, Dellborg M. Computerized vectorcardiography telemetry: a new device for continuous multilead ST-segment monitoring of ambulatory patients. A preliminary report. Ann Noninvasive Electrocardiol 2006; 7:204-10. [PMID: 12167180 PMCID: PMC7027704 DOI: 10.1111/j.1542-474x.2002.tb00164.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Continuous vectorcardiography ST-segment monitoring has become a well-established method in the surveillance of patients with acute myocardial ischemia. However, immobility of the vectorcardiography technique prevents monitoring of patients during ambulatory activities. Computerized vectorcardiography telemetry (CVT) with the capacity of real-time ST-segment analysis has been developed in an attempt to overcome this shortcoming. Recent data, however, indicate that changes in body position occasionally lead to pseudo-ischemic ST-segment changes during continuous ST-segment monitoring. AIMS This report describes the technical features of the CVT system, presents clinical examples using CVT, and assesses the influence of changes in body position on ST-vector magnitude (ST-VM) during CVT, respectively. METHODS Clinical cases involving CVT are presented. The influence of changing body position during CVT monitoring was evaluated on 24 patients with suspected acute coronary syndromes, i.e., unstable angina or acute myocardial infarction. Each patient performed a specific body positional schedule. RESULTS We present three discrete clinical cases where CVT provided early and valuable evidence of ongoing myocardial ischemia. The consequences of different recumbent and ambulatory body positions on ST-VM during CVT monitoring appear to be limited. CONCLUSION Computerized vectorcardiography telemetry is a promising new tool for disclosing residual myocardial ischemic activity during the mobilization phase of patients with acute coronary syndromes. The clinical value of CVT needs further investigation in future trials.
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Johanson P, Armstrong PW, Barbagelata NA, Chaitman BR, Clemmensen P, Dellborg M, French J, Goodman SG, Green CL, Krucoff MW, Langer A, Pahlm O, Reilly P, Wagner GS. An Academic ECG Core Lab Perspective of the FDA Initiative for Digital ECG Capture and Data Management in Large-Scale Clinical Trials. ACTA ACUST UNITED AC 2005. [DOI: 10.1177/009286150503900402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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5
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Lincoff AM. Direct thrombin inhibitors for non-ST-segment elevation acute coronary syndromes: what, when, and where? Am Heart J 2003; 146:S23-30. [PMID: 14564303 DOI: 10.1016/j.ahj.2003.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Unfractionated heparin has been the cornerstone of antithrombin therapy in the treatment of non-ST-segment elevation acute coronary syndromes for more than a decade. Several new anticoagulants have emerged in recent years and have been studied extensively in patients with unstable coronary syndromes and in the percutaneous coronary intervention setting. METHODS Direct thrombin inhibitors comprise a family of agents with promising properties that offer several potential advantages over unfractionated heparin. Hirudin has been studied in patients with ST-elevation myocardial infarction, non-ST-elevation coronary syndromes, and coronary angioplasty. Bivalirudin has been studied in patients undergoing percutaneous coronary revascularization, with very promising efficacy and safety profile compared with unfractionated heparin. RESULTS The clinical trials of direct thrombin inhibitors in non-ST-elevation acute coronary syndromes and coronary angioplasty are reviewed.
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Affiliation(s)
- A Michael Lincoff
- Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
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6
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Magee KD, Sevcik W, Moher D, Rowe BH. Low molecular weight heparins versus unfractionated heparin for acute coronary syndromes. Cochrane Database Syst Rev 2003:CD002132. [PMID: 12535430 DOI: 10.1002/14651858.cd002132] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Acute coronary syndromes (ACS) are an important source of morbidity and mortality. Despite weak evidence for the use of unfractionated heparin (UFH) for acute coronary syndromes it is considered an accepted treatment for unstable angina and non-ST segment elevation myocardial infarction (MI). However, evidence suggests low molecular weight heparins (LMWH) are safer and more effective than UFH in the treatment and prevention of other thrombotic disorders. OBJECTIVES To assess the effects of LMWH compared to UFH for acute coronary syndromes. SEARCH STRATEGY We searched the Cochrane Controlled Trials Register (the Cochrane Library issue 4, 2000), MEDLINE (January 1966 to December 2000), EMBASE (1980 to December 2000) and CINAHL (1982 to December 2000) and reference lists of articles. Authors of all include studies and pharmaceutical industry representatives were contacted to determine if unpublished studies which met the inclusion criteria were available. SELECTION CRITERIA Randomized controlled trials of subcutaneous LMWH versus intravenous UFH in people with acute coronary syndromes (unstable angina or non-ST segment elevation MI). DATA COLLECTION AND ANALYSIS Two reviewers independently assessed quality of studies. Data were extracted independently by two reviewers. Study authors were contacted to verify and clarify missing data. MAIN RESULTS We identified 27 potentially relevant studies, 7 studies (11,092 participants) were included in this review. We found no evidence for difference in overall mortality between the groups treated with LMWH and UFH (RR = 1.0; 95% CI: 0.69, 1.44). Some pooled outcomes showed some evidence of heterogeneity, few of the pooled outcomes were statistically heterogeneous most were homogeneous. LMWH reduced the occurrence of MI (RR = 0.83; 95% CI: 0.70, 0.99) and the need for revascularization procedures (RR = 0.88; 95% CI: 0.82, 0.95). We found no evidence for difference in occurrence of recurrent angina (RR = 0.83; 95% CI: 0.68, 1.02), major bleeds (RR = 1.00; 95% CI: 0.80, 1.24) or minor bleeds (RR = 1.40; 95% CI: 0.66, 2.90). A decrease in the incidence of thrombocytopenia (RR = 0.64; 95% CI: 0.44, 0.94) was observed for patients given LMWH. From these results, 125 patients need to be treated with LMWH to prevent 1 additional MI and 50 patients need to be treated to prevent 1 revascularization procedure. Insufficient data exist to compare different types of LMWH. REVIEWER'S CONCLUSIONS LMWH and UFH had similar risk of mortality, recurrent angina, and major or minor bleeding but LMWH had decreased risk of MI, revascularization and thrombocytopenia. New Trials with longer follow up are required.
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Affiliation(s)
- K D Magee
- Department of Emergency Medicine, Dalhousie University, Queen Elizabeth II Health Sciences Centre, The New Halifax Infirmary, 1796 Summer Street, Halifax, Nova Scotia, Canada, B3H 3A7.
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7
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Abstract
Thrombin plays a central role in thrombosis. Consequently, most current antithrombotic treatment strategies are aimed at blocking the activity of thrombin, or preventing its generation. Although heparin has been a cornerstone of treatment, it has limitations. Thus, the anticoagulant response to heparin is unpredictable, the heparin/antithrombin complex is unable to inhibit fibrin-bound thrombin, an important trigger of thrombus growth, and heparin is neutralized by platelet factor 4. Direct thrombin inhibitors were developed to overcome these limitations. Unlike heparin, direct thrombin inhibitors produce a predictable anticoagulant response that is unaffected by platelet factor 4, and they inhibit fibrin-bound thrombin. Three parenteral direct thrombin inhibitors--hirudin, bivalirudin and argatroban--are currently licensed for use in North America, and orally available direct thrombin inhibitors are under investigation. This review summarizes the clinical trial data with direct thrombin inhibitors and provides perspective on the role of direct thrombin inhibitors in the face of other new anticoagulants currently under development.
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Affiliation(s)
- Jeffrey I Weitz
- McMaster University and Henderson Research Centre, 711 Concession Street, Hamilton, Ontario, Canada, L8V 1C3.
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8
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Affiliation(s)
- Jeffrey I Weitz
- McMaster University and Henderson Research Centre, Hamilton, Ontario, Canada.
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9
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Bogaty P, Dumont S, O'Hara GE, Boyer L, Auclair L, Jobin J, Boudreault JR. Randomized trial of a noninvasive strategy to reduce hospital stay for patients with low-risk myocardial infarction. J Am Coll Cardiol 2001; 37:1289-96. [PMID: 11300437 DOI: 10.1016/s0735-1097(01)01131-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study evaluated the feasibility, pertinence and psychosocial repercussions of a noninvasive reduced hospital stay strategy (three days) for low-risk patients with acute myocardial infarction using simple clinical criteria and predischarge 24-h ambulatory ST-segment ischemic monitoring. BACKGROUND Previous studies evaluating shorter stays for uncomplicated myocardial infarction have been limited by retrospective or nonrandomized design and overdependence on invasive cardiac procedures. METHODS One-hundred twenty consecutive patients admitted with an acute myocardial infarction fulfilling low-risk criteria were randomized 2:1 to a short hospital stay (80 patients) or standard stay (40 patients). Short-stay patients with no ischemia on ST-segment monitoring were discharged on day 3, returning for exercise testing a week later. All analyses were on an intention-to-treat basis. RESULTS Forty-one percent of all screened patients with acute myocardial infarction would have been medically eligible for the short-stay strategy. Seventeen patients (21%) were not discharged early because of ischemia on ST-monitoring or angina. Median initial hospital stay was halved from 6.9 days in the standard stay to 3.5 days in the short-stay group. At six months, median total days hospitalized were 7.5 in the standard stay and 3.6 in the short-stay group (p < 0.0001). Adverse events and readmissions were low and not significantly different, and there were 25% fewer invasive cardiac procedures in the short-stay group. Psychosocial outcomes, risk factor changes and exercise test results were similar in the two groups. CONCLUSIONS This reduced hospital stay strategy for low-risk patients with acute myocardial infarction is feasible and worthwhile, resulting in a substantial and sustained reduction in days hospitalized. It is without unfavorable psychosocial consequences, appears safe and does not increase the number of invasive cardiac procedures.
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Affiliation(s)
- P Bogaty
- Quebec Heart Institute/Laval Hospital, Laval University, Ste-Foy, Canada.
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10
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Chi L, Mertz TE, Rogers KL, Janiczek N, Peng YW, Saganek L, Bousley RF, Juneau PL, Uprichard AC, Gallagher KP. Antithrombotic effect of LB-30057 (CI-1028), a new synthetic thrombin inhibitor, in a rabbit model of thrombosis: comparison with inogatran. J Thromb Thrombolysis 2001; 11:19-31. [PMID: 11248787 DOI: 10.1023/a:1008900109285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
LB-30057 (CI-1028) is a novel, orally bioavailable, direct thrombin inhibitor with a Ki of 0.38 nM against human thrombin. The effects of LB-30057 on thrombus formation and hemostasis were evaluated in a veno-venous shunt model of thrombosis in rabbits, and compared with inogatran, another direct inhibitor of thrombin. Each compound was studied at 5 or 6 different doses with 5 or 6 rabbits in each group. After administration as a bolus i.v. injection followed by continuous infusion, both LB-30057 and inogatran dose-dependently inhibited thrombus formation, which was measured as an increase in time to occlusion (TTO) and a decrease in thrombus weight. Both compounds also improved vena caval blood flow and reduced the overall incidence of thrombotic occlusion. LB-30057 significantly prolonged TTO from 23 +/- 4 min (before dose) to 110 +/- 10 min at the highest dose (0.7 mg/kg + 47 microg/kg/min) (p < 0.001), and reduced thrombus weight from 57 +/- 2 mg to 15 +/- 5 mg (p < 0.001). Occlusive thrombus formed in only one of six rabbits that received the highest dose of LB-30057 (vs. 13/13 in the control group, p < 0.01). At the dose that produced the maximum antithrombotic effect (0.7 mg/kg + 47 microg/kg/min), LB-30057 increased aPTT and bleeding time approximately 2-and 2.5-fold above baseline, respectively. On a gravimetric basis, LB-30057 and inogatran displayed comparable in vivo antithrombotic efficacy. When compared to equally effective anti thrombotic doses of inogatran, LB-30057 caused less prolongation in aPTT, had no effect on PT, and tended to have less of effect on bleeding time. These results indicate that LB-30057 is an effective antithrombotic compound and it appears to have a better benefit/risk profile than inogatran in this experimental model.
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Affiliation(s)
- L Chi
- Cardiovascular Therapeutics Section, Parke-Davis Pharmaceutical Research Division, Warner Lambert Company, Ann Arbor, Michigan 48105, USA.
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11
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Rocha E, Panizo C, Lecumberri R. [Direct thrombin inhibitors: their role in the treatment of arterial and venous thrombosis]. Med Clin (Barc) 2001; 116:63-74. [PMID: 11181274 DOI: 10.1016/s0025-7753(01)71721-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- E Rocha
- Servicio de Hematología y Hemoterapia. Clínica Universitaria. Facultad de Medicina. Universidad de Navarra. Pamplona.
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12
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Akkerhuis KM, Maas AC, Klootwijk PA, Krucoff MW, Meij S, Califf RM, Simoons ML. Recurrent ischemia during continuous 12-lead ECG-ischemia monitoring in patients with acute coronary syndromes treated with eptifibatide: relation with death and myocardial infarction. PURSUIT ECG-Ischemia Monitoring Substudy Investigators. Platelet glycoprotein IIb/IIIa in Unstable angina: Receptor Suppression Using Integrilin Therapy. J Electrocardiol 2000; 33:127-36. [PMID: 10819406 DOI: 10.1016/s0022-0736(00)80069-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Computer-assisted continuous monitoring of the ST-segment allows detection and quantification of recurrent ischemia in patients with acute coronary syndromes. In a substudy of the PURSUIT (Platelet glycoprotein IIb/IIIa in Unstable angina: Receptor Suppression Using Integrilin Therapy) trial, this technique was used to evaluate the effects of the glycoprotein IIb/IIIa inhibitor eptifibatide on the incidence and severity of recurrent ischemia, and to investigate the relationship between recurrent ischemia and the occurrence of subsequent death or myocardial (re)infarction. A total of 258 patients with unstable angina or evolving myocardial infarction without ST elevation were monitored for 24 hours during infusion with either eptifibatide or placebo with a computer-assisted 12-lead ECG-ischemia monitoring device. Recurrent ischemic episodes were identified by an automated computer algorithm. Two hundred and sixteen patients (84%) had ECG recordings suitable for analysis. Ischemic episodes were detected in 35 (33%) of the 105 eptifibatide patients and in 32 (29%) of the 111 placebo patients (not significant). No difference in ischemic burden was apparent between both treatment groups. Patients who exhibited 2 or more episodes of recurrent ischemia more frequently died or suffered a myocardial infarction, both at 7 and 30 days, as well as through the 6-month follow-up. A greater ischemic burden was significantly related to adverse outcome during the 6-month follow-up period. Real-time computer-assisted continuous multilead ECG-ischemia monitoring may help to identify patients with unstable coronary syndromes at increased risk of adverse outcome and, thus, allow for better prognostic triage and more appropriate selection of therapeutic strategies. Integration of these systems in coronary care units and emergency wards should, therefore, be recommended.
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Affiliation(s)
- K M Akkerhuis
- Thoraxcenter, Erasmus University and University Hospital Rotterdam, Rotterdam, The Netherlands.
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13
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Abstract
The aim of the acute treatment of myocardial infarction is to restore, as promptly as possible, blood flow in the culprit vessel. Thrombolysis is a cornerstone of treatment, and direct coronary angioplasty (PTCA) is emerging as a valuable or even better alternative reperfusion strategy. The activation of hemostasis after plaque disruption, thrombolysis, or PTCA represents a strong rationale for the use of antithrombotic drugs. The results of the ISIS-2 trial and the data from the Antiplatelet Trialists' Collaboration indicated that aspirin is mandatory in patients with acute myocardial infarction and for secondary prevention. Recently, the efficacy of abciximab and other glycoprotein IIb/IIIa inhibitors was proven in the treatment of acute coronary syndromes and after PTCA, and their early use in patients with acute myocardial infarction is presently under evaluation. Anticoagulation with heparin appears to be only slightly effective in acute myocardial infarction not treated with thrombolysis; however, a rationale exists for its use in patients undergoing percutaneous and/or surgical revascularization and in conjunction with fibrin-specific thrombolytic agents. Further studies are under way on the possible usefulness of low-molecular-weight heparin. Direct antithrombin agents (hirudin, hirulog, and others) have been recently studied as an adjunct to thrombolysis. The data from these studies indicate the presence of a narrow therapeutic window, with only marginal advantage over heparin; studies with newer compounds are ongoing. Aspirin is still a mandatory drug in patients with acute myocardial infarction; the most promising agents in this setting seem to be glycoprotein IIb/IIIa inhibitors. Heparin and low-molecular-weight heparins are indicated in selected cases, and further studies are needed to assess the value of newer direct thrombin inhibitors.
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Affiliation(s)
- G F Gensini
- Internal Medicine, Azienda Ospedaliera Careggi, University of Florence, Italy
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14
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Nørgaard BL, Andersen K, Dellborg M, Abrahamsson P, Ravkilde J, Thygesen K. Admission risk assessment by cardiac troponin T in unstable coronary artery disease: additional prognostic information from continuous ST segment monitoring. TRIM study group. Thrombin Inhibition in Myocardial Ischemia. J Am Coll Cardiol 1999; 33:1519-27. [PMID: 10334417 DOI: 10.1016/s0735-1097(99)00080-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We investigated whether the addition of 24 h of continuous vectorcardiography ST segment monitoring (cVST) for an early (within 24 h of the latest episode of angina) determination of cardiac troponin T (cTnT) could provide additional prognostic information in patients with unstable coronary artery disease (UCAD), i.e., unstable angina and non-Q wave myocardial infarction. BACKGROUND Determination of cTnT at admission and cVST are individually reported to be valuable techniques for the risk assessment of patients with UCAD. METHODS Two hundred and thirty-two patients suspected of UCAD were studied. Patients were followed for 30 days, and the occurrence of cardiac death or acute myocardial infarction (AMI) were registered. RESULTS One ST segment episode or more (relative risk [RR] 7.43, p = 0.012), a cTnT level > or = 0.20 microg/liter (RR 3.85, p = 0.036) or prestudy medication with calcium antagonists (RR 3.31, p = 0.041) were found to carry independent prognostic information after multivariate analysis of potential risk variables. By combining a cTnT determination and subsequent cVST for 24 h, subgroups of patients at high (25.8%) (n = 31), intermediate (3.1%) (n = 65) and low risk (1.7%) (n = 117) of death or AMI could be identified. CONCLUSIONS Twenty-four hours of cVST provides additional prognostic information to that of an early cTnT determination in patients suspected of having UCAD. The combination of biochemical and electrocardiographic methods provides powerful and accurate risk stratification in UCAD.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Angina, Unstable/blood
- Angina, Unstable/diagnosis
- Angina, Unstable/drug therapy
- Angina, Unstable/mortality
- Antithrombins/adverse effects
- Antithrombins/therapeutic use
- Coronary Disease/blood
- Coronary Disease/diagnosis
- Coronary Disease/drug therapy
- Coronary Disease/mortality
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/prevention & control
- Dose-Response Relationship, Drug
- Double-Blind Method
- Drug Administration Schedule
- Electrocardiography, Ambulatory/drug effects
- Female
- Glycine/adverse effects
- Glycine/analogs & derivatives
- Glycine/therapeutic use
- Humans
- Male
- Middle Aged
- Myocardial Infarction/blood
- Myocardial Infarction/diagnosis
- Myocardial Infarction/drug therapy
- Myocardial Infarction/mortality
- Patient Admission
- Piperidines/adverse effects
- Piperidines/therapeutic use
- Prognosis
- Prospective Studies
- Risk Assessment
- Troponin T/blood
- Vectorcardiography/drug effects
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Affiliation(s)
- B L Nørgaard
- Department of Medicine and Cardiology, Aarhus University Hospital, Denmark.
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15
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Nørgaard BL, Rasmussen BM, Dellborg M, Thygesen K. Temporal and positional variability of the ST segment during continuous vectorcardiography monitoring in healthy subjects. J Electrocardiol 1999; 32:149-58. [PMID: 10338033 DOI: 10.1016/s0022-0736(99)90093-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Continuous vectorcardiography ST-segment monitoring (cVST) is a well-established method in the diagnosis and risk evaluation of patients with acute myocardial ischemia. Previous investigations have demonstrated that electrocardiographic ST-segment changes are to be expected, during both repeated measurements and changes in body position. We prospectively analyzed the influence of spontaneous temporal variation (technical and biological noise) and changes in body position on the ST segment (ST-vector magnitude [ST-VM]) during cVST of 21 healthy human subjects. The 95% expectancy range of the spontaneous intraindividual ST-VM variation was found to be +/-8 microV for the error of measurement, and +/-14 and +/-24 microV during 24-hour and day-to-day cVST measurements, respectively. Positional ST-segment changes in the orthogonal leads were frequent, especially in leads X and Z, and in the left lateral position. Positional orthogonal ST-segment changes resulted in significant ST-VM changes in two of seven subjects. It is concluded that the low spontaneous temporal ST-VM variation must be considered as good reproducibility. Moreover, the present findings support currently used ST-VM ischemia criteria. However, the impact of positional changes on ST-VM seems to be of importance (with the possibility of false-positive results) and should be taken into account during cVST.
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Affiliation(s)
- B L Nørgaard
- Department of Medicine and Cardiology, Aarhus University Hospital, Denmark
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16
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Hauptmann J, Stürzebecher J. Synthetic inhibitors of thrombin and factor Xa: from bench to bedside. Thromb Res 1999; 93:203-41. [PMID: 10074907 DOI: 10.1016/s0049-3848(98)00192-3] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- J Hauptmann
- Centre for Vascular Biology and Medicine, Friedrich Schiller University Jena, Erfurt, Germany
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17
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Thiagarajan P, Wu KK. Mechanisms of antithrombotic drugs. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 1999; 46:297-324. [PMID: 10332506 DOI: 10.1016/s1054-3589(08)60474-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- P Thiagarajan
- Division of Hematology and Vascular Biology Research Center, University of Texas-Houston Medical School 77030, USA
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