Adverse Effect of Antithrombotic Medications on Bleeding Events and Comparison of Antithrombotic Agents in Hemodialysis Patients

Effects of dynamic and isometric resistance training protocols on metabolic profile in hemodialysis patients: a randomized controlled trial

The aim of this study was to compare the effect of dynamic (DRT) and isometric (IRT) resistance training on glycemic homeostasis, lipid profile, and nitric oxide (NO) in hemodialysis (HD) patients. Patients were randomly distributed into 3 groups: control (n = 65), DRT (n = 65), and IRT (n = 67). Patients assessed before and after the intervention period were tested for fasting blood glucose, glycated hemoglobin, oral glucose tolerance test, insulin resistance, lipid profile, leptin, insulin, adiponectin, C-reactive protein, and NO . Patients underwent to strength and body composition assessments. Subjects allocated in both DRT and IRT groups took part in a 24-week resistance training program, 3 times per week. Each training session was approximately 1 hour before dialysis and consisted of 3 sets of 8-12 repetitions at low intensity. Total workload was higher in the DRT as compared with the IRT. This heightened workload related to better glycemic homeostasis in HD patients as measured by regulation of insulin, adiponectin, and leptin, while improveing triglycerides, free-fat mass, and muscle strength. Additionally, NO levels were increased in the DRT group. NO was significantly correlated with glucose intolerance (r = -0.42, p = 0.0155) and workload (r = 0.46, p = 0.0022). The IRT group only improved strength (p < 0.05). Twenty-four weeks of DRT improved glycemic homeostasis, lipid profile, and NO in HD patients. Although IRT seems to play an important role in increasing strength, DRT might be a better choice to promote metabolic adjustments in HD patients. Clinical trial: http://www.ensaiosclinicos.gov.br/rg/RBR-3gpg5w. Novelty: DRT might be a better choice for metabolic improvements in patients with chronic kidney disease (CKD). Exercise-training might treat metabolic imbalance in CKD patients.

Long term efficacy and safety of rivaroxaban plus cilostazol in the treatment of critical ischemia of the lower limbs in a frail, elderly patient with non valvular atrial fibrillation

Background

Many patients with critical lower limb ischemia are not eligible for revascularization procedures. Still, given the emerging role of both platelet and coagulation activation in the formation of arterial thrombi, they may benefit from the novel anticoagulant and antiplatelet drugs.

Case presentation

We describe the case of a male with critical lower limb ischemia complicated by older age, frailty, polymorbidity and non valvular atrial fibrillation, who was deemed as non eligible for surgery. The patient was successfully treated with the combination of rivaroxaban and cilostazol, and the clinical benefit was maintained throughout 32 months, with no occurrence of major or minor hemorrhagic or thrombotic events.

Conclusions

To our knowledge, this is the first report on the efficacy and safety of such a combination therapy in critical lower limb ischemia. In a clinical setting in which alternative pharmacological approaches are urgently needed, the association of rivaroxaban and cilostazol warrants further investigations.