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Lee S, Lee S, Kim S, Yoon CH, Park HJ, Kim JY, Choi H. Fabrication and Characterization of a Magnetic Drilling Actuator for Navigation in a Three-dimensional Phantom Vascular Network. Sci Rep 2018; 8:3691. [PMID: 29487359 PMCID: PMC5829245 DOI: 10.1038/s41598-018-22110-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/16/2018] [Indexed: 01/28/2023] Open
Abstract
Intravascular microrobots have emerged as a promising tool for vascular diseases. They can be wirelessly and precisely manipulated with a high degree of freedom. Previous studies have evaluated their drilling performance and locomotion, and showed the feasibility of using microrobots for biomedical applications in two-dimensional space. However, it is critical to validate micro-drillers in a three-dimensional (3D) environment because gravity plays an important role in a 3D environment and significantly affects the performance of the micro-drillers in vascular networks. In this work, we fabricated magnetic drilling actuators (MDAs) and characterized their locomotion and drilling performance in vascular network-mimicking fluidic channels. The MDAs were precisely manipulated in the fluidic channel network in both horizontal and vertical planes, selecting and moving through the desired path via the junctions of multiple channels. The MDAs also accurately navigated an artificial thrombosis in an artificial 3D vascular network and successfully drilled through it. The results obtained here confirmed the precise manipulation and drilling performance of the developed MDAs in 3D. We think that the MDAs presented in this paper have great potential as intravascular drillers for precise thrombus treatment.
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Affiliation(s)
- Sunkey Lee
- Department of Robotics Engineering, DGIST, Daegu, 42988, Republic of Korea
- DGIST-ETH Microrobot Research Center, DGIST, Daegu, 42988, Republic of Korea
| | - Seungmin Lee
- Department of Robotics Engineering, DGIST, Daegu, 42988, Republic of Korea
- DGIST-ETH Microrobot Research Center, DGIST, Daegu, 42988, Republic of Korea
| | - Sangwon Kim
- Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, CH-8092, Switzerland
| | - Chang-Hwan Yoon
- Cardiovascular Center & Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Hun-Jun Park
- Cardiology Division, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Jin-Young Kim
- Department of Robotics Engineering, DGIST, Daegu, 42988, Republic of Korea.
- DGIST-ETH Microrobot Research Center, DGIST, Daegu, 42988, Republic of Korea.
| | - Hongsoo Choi
- Department of Robotics Engineering, DGIST, Daegu, 42988, Republic of Korea.
- DGIST-ETH Microrobot Research Center, DGIST, Daegu, 42988, Republic of Korea.
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2
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Crespo A, Meyers C, Coelho A, Yáñez M, Fraiz N, Sotelo E, Maes BUW, Laguna R, Cano E, Lemière GLF, Raviña E. Pyridazines part 41: Synthesis, antiplatelet activity and SAR of 2,4,6-substituted 5-(3-oxo-3-phenylprop-1-en-1-yl)- or 5-(3-phenylprop-2-enoyl)pyridazin-3(2H)-ones. Bioorg Med Chem Lett 2006; 16:1080-3. [PMID: 16290144 DOI: 10.1016/j.bmcl.2005.10.073] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Revised: 10/19/2005] [Accepted: 10/20/2005] [Indexed: 11/20/2022]
Abstract
As part of the optimization process of the lead compound I a focussed library of diversely substituted pyridazin-3(2H)-ones containing a 3-oxo-3-phenylprop-1-en-1-yl or 3-phenylprop-2-enoyl fragment at position 5 has been obtained and evaluated as antiplatelet agents. The structural modification at positions 2, 6 and 4 of the heterocyclic moiety allowed us to obtain preliminary information on the structure-activity relationship in this family.
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Affiliation(s)
- Abel Crespo
- Departamento de Química Orgánica, Laboratorio de Química Farmacéutica, Universidad de Santiago de Compostela, 15782-Santiago de Compostela, España, Spain
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3
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van der Elst ME, Cisneros-Gonzalez N, de Blaey CJ, Buurma H, de Boer A. Oral antithrombotic use among myocardial infarction patients. Ann Pharmacother 2003; 37:143-6. [PMID: 12503950 DOI: 10.1345/aph.1c038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine the use of oral antithrombotics (i.e., antiplatelet agents, oral anticoagulants) after myocardial infarction (MI) in the Netherlands from 1988 to 1998. METHODS Retrospective follow-up of 3800 patients with MI, using data from the PHARMO Record Linkage System. RESULTS From 1988 to 1998, oral antithrombotic treatment increased significantly from 54.0% to 88.9%. In 1998, only 75.8% of patients who experienced a MI in the late 1980s received oral antithrombotic treatment compared with 94.4% of those who experienced a recent MI. CONCLUSIONS Oral antithrombotics were considerably underused in patients with a past history of MI. Therefore, these patients should be reviewed for antithrombotic therapy to assess whether their failure to use oral antithrombotics was right or wrong, and whether treatment should be initiated if possible.
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Affiliation(s)
- Menno E van der Elst
- Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.
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4
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Pilote L, Tager IB. Outcomes research in the development and evaluation of practice guidelines. BMC Health Serv Res 2002; 2:7. [PMID: 11914163 PMCID: PMC102335 DOI: 10.1186/1472-6963-2-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2001] [Accepted: 03/25/2002] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Practice guidelines have been developed in response to the observation that variations exist in clinical medicine that are not related to variations in the clinical presentation and severity of the disease. Despite their widespread use, however, practice guideline evaluation lacks a rigorous scientific methodology to support its development and application. DISCUSSION Firstly, we review the major epidemiological foundations of practice guideline development. Secondly, we propose a chronic disease epidemiological model in which practice patterns are viewed as the exposure and outcomes of interest such as quality or cost are viewed as the disease. Sources of selection, information, confounding and temporal trend bias are identified and discussed. SUMMARY The proposed methodological framework for outcomes research to evaluate practice guidelines reflects the selection, information and confounding biases inherent in its observational nature which must be accounted for in both the design and the analysis phases of any outcomes research study.
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Affiliation(s)
- Louise Pilote
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Canada
| | - Ira B Tager
- Division of Public Health Biology & Epidemiology, School of Public Health, University of California at Berkeley, Berkeley, USA
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5
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Abstract
The risk of thromboembolic complications in patients with heart failure and/or chronic left-ventricular systolic dysfunction is increased. Nevertheless, anticoagulant therapy in these patients is still a subject of debate. Atrial fibrillation is the only prospectively evaluated, proven thromboembolic risk factor and patients with atrial fibrillation benefit from long term anticoagulant therapy. The significance of other proposed thromboembolic risk factors in heart failure and/or chronic left-ventricular dysfunction such as gender, cause of myocardial disease, severity of heart failure, left-ventricular ejection fraction, left-ventricular thrombus, left ventricular aneurysm and history of previous thromboembolic event is less clear. This article summarizes key studies, assesses the incidence of thromboembolism, evaluates risk factors and proposes guidelines for anticoagulation of patients with heart failure and/or left ventricular systolic dysfunction.
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Affiliation(s)
- F Diet
- Klinik III für Innere Medizin, Universität zu Köln, Joseph-Stelzmann-Str. 9, 50924 Köln, Germany.
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6
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Therapie mit oralen Antikoagulanzien. Hamostaseologie 1999. [DOI: 10.1007/978-3-662-07673-6_92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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7
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Jaffy MB, Meischke H, Eisenberg MS. Prevalence of aspirin use among patients calling 9-1-1 for chest pain. Acad Emerg Med 1998; 5:1146-9. [PMID: 9864126 DOI: 10.1111/j.1553-2712.1998.tb02686.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Early aspirin administration during an acute myocardial infarction (AMI) decreases morbidity and mortality. This investigation examined the extent to which patients with a complaint of chest pain, the symptom most identified with AMI by the general population, self-administer aspirin before the arrival of emergency medical services (EMS) personnel. METHODS In this prospective, cross-sectional prevalence study, data were derived through the analysis of EMS incident reports for patients with a complaint of chest pain from June 1, 1997, to August 31, 1997. RESULTS The study included 694 subjects. One hundred two (15%) took aspirin for their chest pain before the arrival of EMS personnel. Of the 322 subjects who reported taking aspirin on a regular basis, 82 (26%) took additional aspirin for their acute chest pain. Only 20 (5%) of the 370 patients who were not using regular aspirin therapy self-administered aspirin acutely (p<0.001). In addition, patients with lower intensity of chest pain (p = 0.03) were more likely to take aspirin for their chest pain. CONCLUSION Only a relatively small fraction of individuals calling 9-1-1 with acute chest pain take aspirin prior to the arrival of EMS personnel. These individuals are more likely to self-administer aspirin if they are already taking it on a regular basis. It is also possible that they are less likely to take aspirin if their chest pain is more severe.
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Affiliation(s)
- M B Jaffy
- University of Washington School of Medicine, Seattle, USA.
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8
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Baker WF. Thrombosis and Hemostasis in Cardiology: Review of Pathophysiology and Clinical Practice (Part I). Clin Appl Thromb Hemost 1998. [DOI: 10.1177/107602969800400107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The adverse consequences of thrombosis are per haps nowhere more evident than in clinical cardiology. Throm bosis and hemostasis are primary issues in the management of patients with atrial fibrillation, prosthetic heart valves, severe left ventricular dysfunction, and coronary artery disease. Clini cal trials have defined a crucial role for anticoagulation with warfarin in patients with atrial fibrillation to reduce the inci dence of stroke. Anticoagulation with warfarin and aspirin in combination offers significant protection from systemic emboli in patients with mechanical prosthetic valves, without a sub stantial increased risk of hemorrhage. The risk of systemic emboli may also be reduced by anticoagulation in patients with severe left ventricular dysfunction. Disturbance of the normal balance of hemostasis is a major factor in the pathophysiology of coronary artery disease. Antiplatelet therapy, antithrombin agents, anticoagulants, and fibrinolytic agents have been used to prevent and treat acute coronary thrombosis and to prevent reocclusion following thrombolysis and interventional therapy. Guidelines are presented for antithrombotic therapy in the prac tice of clinical cardiology.
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Affiliation(s)
- William F. Baker
- Central California Heart Institute, Bakersfield, California and Department of Medicine, Center for Health Sciences, University of California at Los Angeles, Los Angeles, California, U.S.A
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9
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Kondo NI, Maddi R, Ewenstein BM, Goldhaber SZ. Anticoagulation and hemostasis in cardiac surgical patients. J Card Surg 1994; 9:443-61. [PMID: 7949674 DOI: 10.1111/j.1540-8191.1994.tb00875.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Optimizing anticoagulation and hemostasis during cardiopulmonary bypass and perioperatively helps to ensure the best possible clinical outcome. This article reviews the pharmacology of unfractionated and low-molecular weight heparin, aprotinin, desmopressin, dextran, antiplatelet agents, warfarin, and direct thrombin inhibitors. Their use is discussed in the context of coronary artery surgery, valvular surgery, and mechanical cardiac support devices, as well as in the management of acute ischemic syndromes, atrial fibrillation, and prevention and treatment of venous thromboembolism. Progress in the development and utilization of these anticoagulants and antiplatelet agents has supported the major advances that have been achieved in cardiac surgery.
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Affiliation(s)
- N I Kondo
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
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10
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Nuovo J. Ischemic Heart Disease. Fam Med 1994. [DOI: 10.1007/978-1-4757-4005-9_77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Condorelli M, Chiariello M, Dagianti A, Penco M, Dalla Volta S, Pengo V, Schivazappa L, Mattioli G, Mattioli AV, Brusoni B. IPO-V2: a prospective, multicenter, randomized, comparative clinical investigation of the effects of sulodexide in preventing cardiovascular accidents in the first year after acute myocardial infarction. J Am Coll Cardiol 1994; 23:27-34. [PMID: 8277091 DOI: 10.1016/0735-1097(94)90498-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES This study was conducted to assess the efficacy of sulodexide, a glycosaminoglycan compound with antithrombotic properties, in preventing death and thromboembolic events after acute myocardial infarction. BACKGROUND Antithrombotic therapy has been found to play an important role in the prevention of cardiovascular events and death after acute myocardial infarction. Glycosaminoglycan-containing compounds, including sulodexide, show profibrinolytic and antithrombotic properties that render them suitable for use in patients after infarction. METHODS A total of 3,986 patients who had recovered from acute myocardial infarction were randomized to receive either the standard therapy routinely administered at each study center, excluding antiplatelet and anticoagulant drugs (control group, 1,970 patients), or the standard therapy plus sulodexide (treated group, 2,016 patients). Between 7 and 10 days after the episode of acute myocardial infarction, sulodexide was administered as a single daily 600-lipoprotein-lipase-releasing unit (LRU) intramuscular injection for the 1st month, followed by oral capsules of 500 LRU twice daily. Patients were evaluated for > or = 12 months. RESULTS At the end of the study, 140 deaths (7.1%) were recorded in the control group and 97 (4.8%) in the sulodexide group (32% risk reduction, p = 0.0022, chi-square test). A total of 90 patients (4.6%) in the control group had a further infarction, compared with 66 (3.3%) in the sulodexide group (28% risk reduction, p = 0.035). Furthermore, a reduction in left ventricular thrombus formation (evaluated by echocardiography) was observed in the sulodexide group (n = 12; 0.6%), compared with values in the control group (n = 25; 1.3%) (53% risk reduction, p = 0.027). Sulodexide was well tolerated and devoid of significant adverse events. All significant results were confirmed by "actual treatment" analyses. CONCLUSIONS The study provides evidence that long-term therapy with sulodexide started early after an episode of acute myocardial infarction is associated with reductions in total mortality, rate of reinfarction and mural thrombus formation.
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Affiliation(s)
- M Condorelli
- Department of Medicine, School of Medicine, Federico II University, Naples, Italy
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12
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Saour J, Gallus A. Warfarin: is it time to reduce target ranges again? AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1993; 23:692-6. [PMID: 8141700 DOI: 10.1111/j.1445-5994.1993.tb04729.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- J Saour
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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14
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Dunn SM, Senerchia CB. Bleeding Complications in the Patient with Cardiac Disease Following Thrombolytic and Anticoagulant Therapies. Crit Care Nurs Clin North Am 1993. [DOI: 10.1016/s0899-5885(18)30555-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Affiliation(s)
- R L Soutar
- McMaster University Medical Centre, Hamilton, Ontario
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16
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Complications of acute myocardial infraction. Curr Probl Cardiol 1993. [DOI: 10.1016/0146-2806(93)90002-j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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18
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Abstract
Left ventricular (LV) thrombi are responsible for significant morbidity and mortality in our society. Twenty-five percent of cardiogenic emboli are associated with acute and chronic myocardial infarction. With the development of noninvasive imaging techniques LV thrombi have been increasingly recognized as an important clinical entity; the imaging method of choice is two-dimensional echocardiography. LV mural thrombi occur in one third of Q wave anterior myocardial infarctions; their occurrence in patients with non-Q wave infarction and inferior Q wave myocardial infarction is less than 5%. More than half of all LV thrombi are formed within 48 hours of acute myocardial infarction, and nearly all thrombi have been formed within a week of infarction. The development of an LV thrombus is associated with some risk of systemic embolization. To prevent LV thrombosis and systemic embolism, full-dose heparin followed by warfarin therapy for at least 3 months is indicated for patients with large anterior infarctions and those with heart failure. The use of thrombolytic therapy does not reduce the risk of LV thrombus formation; few data exist on whether early coronary angioplasty reduces the risk of LV thrombus formation and the risk of embolization. The proper treatment for patients with chronic LV thrombi remains unknown.
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Affiliation(s)
- L L Cregler
- Department of Medicine, Mt. Sinai School of Medicine, CUNY
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Vanscoy GJ, Krause JR. Warfarin and the international normalized ratio: reducing interlaboratory effects. DICP : THE ANNALS OF PHARMACOTHERAPY 1991; 25:1190-2. [PMID: 1763536 DOI: 10.1177/106002809102501108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In North America, the dose of warfarin has been unintentionally increased during the past two decades because of failure to recognize the effect on the anticoagulation test of less sensitive tissue thromboplastins. Although there still is some controversy, the suggested dose of warfarin has now been adjusted downward to reduce the risk of bleeding. These revised dosing recommendations incorporate the international normalized ratio (INR), which takes into account the source of thromboplastin. However, there is considerable variability in the sensitivities of thromboplastin from manufacturer to manufacturer and lot to lot. Therefore, prothrombin times (PTs) are not comparable from laboratory to laboratory without knowing the sensitivity of the thromboplastin. Unless laboratories adopt a standardized tissue thromboplastin, the PT should be reported as an INR.
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Affiliation(s)
- G J Vanscoy
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh Medical Center, PA 15261
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Dhami MS, Bona RD. Using anticoagulants safely. Guidelines for therapeutic and prophylactic regimens. Postgrad Med 1991; 90:121-2, 127-32. [PMID: 1883410 DOI: 10.1080/00325481.1991.11700985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Heparin and warfarin sodium (Coumadin, Panwarfin, Sofarin) are used most often to treat acute and recurrent venous thromboembolic disease, arterial disease, valvular heart disease, and atrial fibrillation. These agents along with dextran, pneumatic compression devices, and gradient stockings are also used to prevent deep venous thrombosis and pulmonary embolism in patients at high risk (eg, those with venous stasis, lower limb or spinal cord trauma, clotting abnormalities). Anticoagulation therapy is monitored by maintaining the activated partial thromboplastin time and the prothrombin time in the therapeutic range.
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Affiliation(s)
- M S Dhami
- University of Connecticut School of Medicine, Famington
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22
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Manson JE, Grobbee DE, Stampfer MJ, Taylor JO, Goldhaber SZ, Gaziano JM, Ridker PM, Buring JE, Hennekens CH. Aspirin in the primary prevention of angina pectoris in a randomized trial of United States physicians. Am J Med 1990; 89:772-6. [PMID: 2252045 DOI: 10.1016/0002-9343(90)90220-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The objective of this study was to examine the effect of low-dose aspirin (325 mg on alternate days) on the primary prevention of angina pectoris in the United States Physicians' Health Study. Despite a postulated role of platelets in atherogenesis and myocardial ischemia, the effect of chronic platelet inhibition on the development of clinical angina pectoris is unknown. SUBJECTS AND METHODS The Physicians' Health Study is a randomized, double-blind, placebo-controlled trial among 22,071 male physicians aged 40 to 84 years, free from previous myocardial infarction, stroke, and transient cerebral ischemia at entry, and followed for an average of 60.2 months. The 21,738 physicians who were also free from angina pectoris at baseline constituted the study population for the present analyses. RESULTS During 106,652 person-years of follow-up, 331 patients with confirmed angina pectoris were diagnosed, 194 of whom underwent a coronary revascularization procedure (coronary artery bypass graft surgery or coronary angioplasty). As compared to participants assigned placebo, the relative risk of confirmed angina pectoris in the aspirin group was 1.10 (95% confidence interval [CI], 0.88 to 1.38). For coronary revascularization, the relative risk was 1.19 (95% CI, 0.88 to 1.59). After simultaneous control for other coronary risk factors in a proportional-hazards model, these relative risks remained near unity at 1.07 (95% CI, 0.84 to 1.36) and 1.11 (95% CI, 0.81 to 1.52), respectively. When the risks of angina pectoris were examined according to year of randomization in the trial, there was no pattern of increasing benefit with longer duration of treatment. CONCLUSION These randomized trial data indicate that chronic platelet inhibition with low-dose aspirin for an average duration of 60.2 months does not reduce the incidence of angina pectoris.
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Affiliation(s)
- J E Manson
- Channing Laboratory, Department of Medicine, Harvard Medical School
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23
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Abstract
Myocardial salvage can be maximized by the early institution of thrombolytic therapy and aspirin. Certain patients may benefit from the administration of intravenous heparin, beta blockers, or nitroglycerin. The routine use of percutaneous transluminal coronary angioplasty (PTCA) or calcium-channel blockers does not appear to be warranted. Recurrent myocardial ischemia should be vigorously treated with medical therapy and there may be value in cardiac catheterization, followed by PTCA or bypass surgery, depending upon the extent of myocardium at risk and the underlying coronary anatomy. Long-term morbidity and mortality may be reduced by instituting aspirin and beta blockers as well as by modifying risk factors. There is no evidence for the long-term benefit from any calcium-channel blocker. Oral anticoagulation may be warranted in those patients with a mural thrombus, congestive heart failure, or atrial fibrillation. ACE inhibitors may be of value in the presence of left ventricular dysfunction and certainly in the presence of symptomatic congestive heart failure. Antiarrhythmic therapy is generally indicated only for symptomatic or life-threatening arrhythmias. Residual myocardial ischemia should be sought by exercise testing, and those patients with poor exercise tolerance generally warrant cardiac catheterization in consideration for revascularization.
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Affiliation(s)
- D Massel
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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24
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Gunnar RM, Bourdillon PD, Dixon DW, Fuster V, Karp RB, Kennedy JW, Klocke FJ, Passamani ER, Pitt B, Rapaport E. ACC/AHA guidelines for the early management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (subcommittee to develop guidelines for the early management of patients with acute myocardial infarction). Circulation 1990; 82:664-707. [PMID: 2197021 DOI: 10.1161/01.cir.82.2.664] [Citation(s) in RCA: 139] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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25
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Gunnar RM, Passamani ER, Bourdillon PD, Pitt B, Dixon DW, Rapaport E, Fuster V, Reeves TJ, Karp RB, Russell RO. Guidelines for the early management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee to Develop Guidelines for the Early Management of Patients with Acute Myocardial Infarction). J Am Coll Cardiol 1990; 16:249-92. [PMID: 2197309 DOI: 10.1016/0735-1097(90)90575-a] [Citation(s) in RCA: 273] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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26
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Stratton JR, Ritchie JL. 111In platelet imaging of left ventricular thrombi. Predictive value for systemic emboli. Circulation 1990; 81:1182-9. [PMID: 2317901 DOI: 10.1161/01.cir.81.4.1182] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
To determine whether a positive indium 111 platelet image for a left ventricular thrombus, which indicates ongoing thrombogenic activity, predicts an increased risk of systemic embolization, we compared the embolic rate in 34 patients with positive 111In platelet images with that in 69 patients with negative images during a mean follow-up of 38 +/- 31 (+/- SD) months after platelet imaging. The positive and negative image groups were similar with respect to age (59 +/- 11 vs. 62 +/- 10 years), prevalence of previous infarction (94% vs. 78%, p less than 0.05), time from last infarction (28 +/- 51 vs. 33 +/- 47 months), ejection fraction (29 +/- 14 vs. 33 +/- 14), long-term or paroxysmal atrial fibrillation (15% vs. 26%), warfarin therapy during follow-up (26% vs. 20%), platelet-inhibitory therapy during follow-up (50% vs. 33%), injected 111In dose (330 +/- 92 vs. 344 +/- 118 microCi), and latest imaging time (greater than or equal to 48 hours in all patients). During follow-up, embolic events occurred in 21% (seven of 34) of patients with positive platelet images for left ventricular thrombi as compared with 3% (two of 69) of patients with negative images (p = 0.002). By actuarial methods, at 42 months after platelet imaging, only 86% of patients with positive images were embolus free as compared with 98% of patients with negative images (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J R Stratton
- Department of Medicine, Seattle Veterans Administration Medical Center, Washington 98108
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27
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Vandenberg BF. 111In platelet scintigraphy and risk stratification for embolization from chronic left ventricular thrombi. Circulation 1990; 81:1419-21. [PMID: 2317918 DOI: 10.1161/01.cir.81.4.1419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- B F Vandenberg
- Department of Internal Medicine, University of Iowa, Iowa City 52242
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Guidelines on oral anticoagulation: second edition. British Society for Haematology. British Committee for Standards in Haematology. Haemostasis and Thrombosis Task Force. J Clin Pathol 1990; 43:177-83. [PMID: 2185281 PMCID: PMC502325 DOI: 10.1136/jcp.43.3.177] [Citation(s) in RCA: 96] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Stein B, Fuster V, Halperin JL, Chesebro JH. Antithrombotic therapy in cardiac disease. An emerging approach based on pathogenesis and risk. Circulation 1989; 80:1501-13. [PMID: 2688970 DOI: 10.1161/01.cir.80.6.1501] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- B Stein
- Mount Sinai Medical Center, New York, New York 10029
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Halperin JL, Fuster V. Left ventricular thrombus and stroke after myocardial infarction: toward prevention or perplexity? J Am Coll Cardiol 1989; 14:912-4. [PMID: 2794277 DOI: 10.1016/0735-1097(89)90464-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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