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Tang Y, Qi L, Xu L, Lin L, Cai J, Shen W, Liu Y, Li M. Atrial giant cell myocarditis with preserved left ventricular function: a case report and literature review. J Cardiothorac Surg 2023; 18:232. [PMID: 37452361 PMCID: PMC10347761 DOI: 10.1186/s13019-023-02316-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
Giant cell myocarditis (GCM) is a rare and fatal inflammatory disorder induced by T-lymphocytes, typically affecting young adults. Generally, this disease presents with a rapidly progressive course and a very poor prognosis. In recent years, atrial GCM (aGCM) has been recognized as a clinicopathological entity distinct from classical GCM. As described by retrievable case reports, although its histopathological manifestations are highly similar to those of classical GCM, this entity is characterized by preserved left ventricular function and atrial arrhythmias, without ventricular arrhythmias. aGCM tends to show benign disease progression with a better clinical prognosis compared with the rapid course and poor prognosis of vGCM. We report a patient with aGCM with a history of renal abscess whose persistent myocardial injury considered to be associated with a history of renal abscess. Infection could be a potential trigger for the development of aGCM in this patient. An extensive literature review was also performed and the following three aspects were summarized: (1) Epidemiology and histopathological characteristics of aGCM; (2) The role of imaging in the evaluation of aGCM; (3) Diagnostic points and therapeutic decisions in aGCM.
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Affiliation(s)
- Yilin Tang
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, No. 221 West Yanan Road, Shanghai, 200040, China
| | - Lin Qi
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, No. 221 West Yanan Road, Shanghai, 200040, China.
| | - Ling Xu
- Department of Cardiovascular Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Lei Lin
- Department of Cardiovascular Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Junfeng Cai
- Department of Cardiovascular Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Wei Shen
- Department of Cardiovascular Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yang Liu
- Department of Cardiovascular Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Ming Li
- Department of Radiology, Huadong Hospital Affiliated to Fudan University, No. 221 West Yanan Road, Shanghai, 200040, China.
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Lindhoff-Last E, Birschmann I, Bidenharn AJ, Kuhn J, Lindau S, Konstantinides S, Grottke O, Nowak-Göttl U, Lucks J, Zydek B, von Heymann C, Sümnig A, Beyer-Westendorf J, Schellong S, Meybohm P, Greinacher A, Herrmann E. Pharmacokinetics of Phenprocoumon in Emergency Situations-Results of the Prospective Observational RADOA-Registry (Reversal Agent Use in Patients Treated with Direct Oral Anticoagulants or Vitamin K Antagonists Registry). Pharmaceuticals (Basel) 2022; 15:ph15111437. [PMID: 36422567 PMCID: PMC9692621 DOI: 10.3390/ph15111437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/03/2022] [Accepted: 11/11/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Phenprocoumon has been used as an oral anticoagulant in patients with thromboembolic disease for more than 40 years. So far its pharmacokinetics have not been analyzed in emergency situations. Methods: Phenprocoumon-treated patients with major bleeding or urgent surgery were included in a prospective, observational registry. Phenprocoumon drug concentrations were analyzed in samples, collected as part of routine care using ultraperformance liquid chromatography tandem mass spectrometry. Moreover, anticoagulant intensity and drug half-life (t1/2) were calculated. Results: 115 patients were included. Phenprocoumon levels declined over time with a half-life of 5.27 and 5.29 days in patients with major bleedings (n = 82) and with urgent surgery (n = 33). Baseline phenprocoumon levels were 2.2 times higher in the bleeding group compared to the surgery group (1.92 vs. 0.87 ng/mL, p < 0.0001). International normalized ratio (INR) values decreased rapidly during the first 24 h. In 27.6% of patients a rebound of INR (recurrent increase > 1.5) was observed which was associated with significantly increased bleeding rates (22% vs. 4.2% in patients with or without INR rebound, p = 0.012). Conclusions: In emergency situations, the long half-life of phenprocoumon may cause INR rebound and associated recurrent bleedings. Optimal management may need to include repeated vitamin K supplementation over days.
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Affiliation(s)
- Edelgard Lindhoff-Last
- Coagulation Centre, Cardiology Angiology Centre Bethanien Hospital (CCB), 60389 Frankfurt, Germany
- Coagulation Research Centre, Cardiology Angiology Centre Bethanien Hospital (CCB), 60389 Frankfurt, Germany
- Correspondence: (E.L.-L.); (I.B.); Tel.: +49-69-9450280 (E.L.-L.); +49-5731-973819 (I.B.); Fax: +49-69-461613 (E.L.-L.); +49-5731-972307 (I.B.)
| | - Ingvild Birschmann
- Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Centre, Ruhr University, 44789 Bochum, Germany
- Correspondence: (E.L.-L.); (I.B.); Tel.: +49-69-9450280 (E.L.-L.); +49-5731-973819 (I.B.); Fax: +49-69-461613 (E.L.-L.); +49-5731-972307 (I.B.)
| | - Antonia J. Bidenharn
- Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt, 60590 Frankfurt, Germany
| | - Joachim Kuhn
- Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Centre, Ruhr University, 44789 Bochum, Germany
| | - Simone Lindau
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany
| | - Oliver Grottke
- Department of Anaesthesiology, RWITH Aachen University Hospital, 52074 Aachen, Germany
| | - Ulrike Nowak-Göttl
- Institute of Clinical Chemistry, Thrombosis & Haemostasis Treatment Centre, University Hospital, 24105 Kiel-Lübeck, Germany
| | - Jessica Lucks
- Coagulation Research Centre, Cardiology Angiology Centre Bethanien Hospital (CCB), 60389 Frankfurt, Germany
| | - Barbara Zydek
- Coagulation Research Centre, Cardiology Angiology Centre Bethanien Hospital (CCB), 60389 Frankfurt, Germany
| | - Christian von Heymann
- Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, 10249 Berlin, Germany
| | - Ariane Sümnig
- Department of Immunology and Transfusion Medicine, Universitätsmedizin, 17475 Greifswald, Germany
| | - Jan Beyer-Westendorf
- Department of Medicine 1, Division of Thrombosis & Hemostasis, Dresden University Clinic, 01307 Dresden, Germany
| | | | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, 60590 Frankfurt, Germany
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Andreas Greinacher
- Department of Immunology and Transfusion Medicine, Universitätsmedizin, 17475 Greifswald, Germany
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt, 60590 Frankfurt, Germany
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Qian M, Zhao H, Lou Y, Wang J, Wang S, Wang Z, Ou H, Li J, Yang F, Bai L, Lv H, Peng X, Chen X, Yang X. Establishment of prediction algorithm for the Honghe minority group based on warfarin maintenance dose. Pharmacogenomics 2022; 23:619-626. [PMID: 35880564 DOI: 10.2217/pgs-2022-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: CYP2C9 and VKORC1 are important factors in warfarin metabolism. The authors explored the effects of these genetic polymorphisms and clinical factors on a warfarin maintenance dose and then established the prediction algorithm for Honghe minorities in China. Materials & methods: Quantitative fluorescence PCR determined the mutation frequency of CYP2C9 and VKORC1-1639 G>A alleles. The authors collected the relevant clinical factors, including age, gender, body surface area (BSA), international normalized ratio value, daily warfarin dose, comorbidity and concomitant prescriptions. Results: The mean values of BSA and international normalized ratio in Honghe minorities were lower than in Han Chinese (p = 0.00). The genotype of CYP2C9*1/*1 and VKORC1-1639 AA was the main allele, the mutationfrequency of VKORC1-1639 AA and the number of male of Honghe minorities were lower than that of Han Chinese (p = 0.013 and p = 0.04). The significances of the effect on actual warfarin dose value were gender, VKORC1 AA mutant, CYP2C9*1/*1, age, hypertension and BSA sequentially. Conclusion: By multiple linear regression analysis with genetic and clinical factors, the authors determined a prediction algorithm for adjusting individual dosing of warfarin in this population. Clinical trial registration number: ChiCTR2100051778.
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Affiliation(s)
- Mengjiao Qian
- Department of Cardiothoracic Surgery, The Yunnan South Central Hospital (The First People's Hospital of Honghe Prefecture), Mengzi, Yunnan, 661100, PR China
| | - Huan Zhao
- Department of Neurology, The Yunnan South Central Hospital (The First People's Hospital of Honghe Prefecture), Mengzi, Yunnan, 661100, PR China
| | - Yunli Lou
- Department of Medical Records & Statistics, The Yunnan South Central Hospital (The First People's Hospital of Honghe Prefecture), Mengzi, Yunnan, 661100, PR China
| | - Jing Wang
- Department of Cardiothoracic Surgery, The Yunnan South Central Hospital (The First People's Hospital of Honghe Prefecture), Mengzi, Yunnan, 661100, PR China
| | - Sibo Wang
- Department of Cardiothoracic Surgery, The Yunnan South Central Hospital (The First People's Hospital of Honghe Prefecture), Mengzi, Yunnan, 661100, PR China
| | - Zhongyin Wang
- Department of Cardiothoracic Surgery, The Yunnan South Central Hospital (The First People's Hospital of Honghe Prefecture), Mengzi, Yunnan, 661100, PR China
| | - Haibo Ou
- Department of Cardiothoracic Surgery, The Yunnan South Central Hospital (The First People's Hospital of Honghe Prefecture), Mengzi, Yunnan, 661100, PR China
| | - Jun Li
- Department of Cardiothoracic Surgery, The Yunnan South Central Hospital (The First People's Hospital of Honghe Prefecture), Mengzi, Yunnan, 661100, PR China
| | - Fajian Yang
- Clinical Pharmacy Laboratory, Department of Pharmacy, The Yunnan South Central Hospital (The First People's Hospital of Honghe Prefecture), Mengzi, Yunnan, 661100, PR China
| | - Lingying Bai
- Clinical Pharmacy Laboratory, Department of Pharmacy, The Yunnan South Central Hospital (The First People's Hospital of Honghe Prefecture), Mengzi, Yunnan, 661100, PR China
| | - Hong Lv
- Clinical Pharmacy Laboratory, Department of Pharmacy, The Yunnan South Central Hospital (The First People's Hospital of Honghe Prefecture), Mengzi, Yunnan, 661100, PR China
| | - Xuguan Peng
- Department of Cardiothoracic Surgery, The Yunnan South Central Hospital (The First People's Hospital of Honghe Prefecture), Mengzi, Yunnan, 661100, PR China
| | - Xiao Chen
- Department of Cardiothoracic Surgery, The Yunnan South Central Hospital (The First People's Hospital of Honghe Prefecture), Mengzi, Yunnan, 661100, PR China
| | - Xiubing Yang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Bejing, 100029, PR China
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Arai H, Ueda S, Uchida K, Sakakibara F, Kinjo N, Nezu M, Morimoto T. Effect of current smoking on ischemic events in patients with atrial fibrillation taking vitamin K antagonist. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2022; 14:200135. [PMID: 36703862 PMCID: PMC9871989 DOI: 10.1016/j.ijcrp.2022.200135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 01/29/2023]
Abstract
Purpose We investigated the association between current smoking and clinical outcomes in patients with atrial fibrillation (AF) prescribed vitamin K antagonist (VKA). Methods We conducted a retrospective study at 71 centers in Japan. The inclusion criterion was taking a VKA for AF. Exclusion criteria were mechanical heart valves or history of pulmonary thrombosis or deep vein thrombosis. Consecutive patients were registered in February 2013 and followed until February 2017. The primary outcomes included ischemic events and major bleedings. The secondary outcomes were ischemic stroke, hemorrhagic stroke, and all-cause mortality. Results A total of 7826 patients were included, with a mean age of 73 years; 5274 (67%) were men. The adjusted hazard ratios (HRs; 95% confidence intervals [CIs]) of current smokers relative to non-current smokers for ischemic events and major bleedings were 1.64 (1.05-2.57) and 1.09 (0.72-1.65), respectively. The adjusted HRs (95% CIs) of current smokers relative to non-current smokers for ischemic stroke, hemorrhagic stroke, and all-cause mortality were 1.65 (1.03-2.64), 0.52 (0.12-2.15), and 1.26 (0.83-1.92), respectively. Conclusions There were significant associations between current smoking and ischemic events or ischemic stroke in patients with AF on VKA.
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Affiliation(s)
- Hideki Arai
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan,Department of Internal Medicine, Toyonaka Heisei Hospital, Toyonaka, Japan
| | - Shinichiro Ueda
- Department of Clinical Pharmacology and Therapeutics, University of the Ryukyus, Okinawa, Japan
| | - Kazutaka Uchida
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan,Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Fumihiro Sakakibara
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan,Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Norito Kinjo
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan,Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Mari Nezu
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan,Corresponding author. Professor of Medicine, Department of Clinical Epidemiology, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan.
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Association between Severe SARS-CoV-2 Infection and Severe Acute Pancreatitis in Pregnancy and Postpartum. J Clin Med 2022; 11:jcm11092554. [PMID: 35566679 PMCID: PMC9102136 DOI: 10.3390/jcm11092554] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION SARS-CoV-2 infection (COVID-19) affects the respiratory system but is not limited to it. The gastrointestinal symptoms are polymorphic, including diarrhea, vomiting, abdominal pain, and even acute pancreatitis (AP). Pregnant women are more vulnerable to SARS-CoV-2 infection and have a higher risk of severe outcomes of COVID-19. CASE REPORT We present a case report of a 31-year-old primigravid patient at 30 weeks of gestation, unvaccinated, with a medical history of thrombophilia, chronic nephropathy of unknown origin, hypertension, and optic neuropathy with left eye hemianopsia. She was diagnosed with moderate-to-severe COVID-19 and respiratory failure, with indication for cesarean section. Postpartum, she developed severe acute pancreatitis, complicated by peripancreatic and supradiaphragmatic abscesses. After 3 months of hospitalization and eight surgical interventions, the patient was discharged. A short mini-review of the literature is introduced. CONCLUSION Pregnant women with cardiovascular comorbidities are prone to severe complications of SARS-CoV-2 infection. Clinicians should be aware of the association of SARS-CoV-2 and AP in pregnant women.
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Wang S, Liu Y, Wang L, Zuo H, Tian Y, Wang Y, Yin D, Zhang H, Tian Y. Optimisation of oral anticoagulants for patients with atrial fibrillation within 12 months after percutaneous coronary intervention: A meta-analysis and systematic review. IJC HEART & VASCULATURE 2021; 36:100850. [PMID: 34401468 PMCID: PMC8349768 DOI: 10.1016/j.ijcha.2021.100850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The optimal antithrombotic strategy, especially regarding oral anticoagulants (OACs) for atrial fibrillation (AF) patients with bleeding and thrombosis risk after percutaneous coronary intervention (PCI), remains unknown. This study explored the optimal oral anticoagulants for AF patients after PCI using a meta-analysis. METHODS Randomised controlled trials were identified from PubMed, Embase, and the Cochrane Library through December 2020. Risk ratios, 95% confidence intervals, and random-effects models were used to compare different antithrombotic strategies through network meta-analysis, and the combination of antithrombotic agents was ranked according to the surface under the cumulative ranking curve and rankograms. Interval plots were drawn to observe pairwise comparisons between the different strategies. RESULTS Five studies of 11,532 patients were included. Factor IIa inhibitor 110 mg bid plus a P2Y12 inhibitor had the greatest advantage for reducing Thrombolysis In Myocardial Infarction (TIMI) major or minor bleeding; Factor Xa inhibitor plus a P2Y12 inhibitor had the greatest advantage for reducing International Society on Thrombosis and Hemostasis major bleeding. For patients at risk of stroke plus all-cause death, factor IIa inhibitor 150 mg bid plus a P2Y12 inhibitor should be prioritised, and for those at risk of myocardial infarction and stent thrombosis, vitamin K antagonists plus a P2Y12 inhibitor were preferred. CONCLUSION Factor IIa inhibitor 110 mg, factor IIa inhibitor 150 mg, factor Xa inhibitor and vitamin K antagonists should be selected in different situations.
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Key Words
- 95% CI, 95% confidence intervals
- AF, Atrial fibrillation
- Antithrombotic therapy
- Atrial fibrillation
- DAT, Oral anticoagulants plus single antiplatelet therapy
- IIa, Factor IIa
- ISTH, International Society on Thrombosis and Hemostasis
- MI, Myocardial infarction
- NOACs, Novel oral anticoagulants
- OACs, Oral anticoagulants
- Oral anticoagulant
- PCI, Percutaneous coronary intervention
- Percutaneous coronary intervention
- RR, Risk ratios
- SD, Standard deviation
- SUCRA, Surface under the cumulative ranking curve
- TAT, Vitamin K antagonist plus a P2Y12 inhibitor and aspirin
- TIMI, Thrombolysis In Myocardial Infarction
- VKA, Vitamin K antagonist
- Xa, Factor Xa
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Affiliation(s)
- Shuo Wang
- Department of Pathophysiology and Key Laboratory of Cardiovascular Pathophysiology, Harbin Medical University, Key Laboratory of Cardiovascular Research (Harbin Medical University), Ministry of Education, Harbin 150086, PR China
- Heilongjiang Academy of Medical Sciences, Harbin, China
| | - Ying Liu
- Heilongjiang Academy of Medical Sciences, Harbin, China
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, PR China
| | - Linxin Wang
- Heilongjiang Academy of Medical Sciences, Harbin, China
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, PR China
| | - Haiqi Zuo
- Heilongjiang Academy of Medical Sciences, Harbin, China
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, PR China
| | - Yanfeng Tian
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, PR China
| | - Yimeng Wang
- Department of Pathophysiology and Key Laboratory of Cardiovascular Pathophysiology, Harbin Medical University, Key Laboratory of Cardiovascular Research (Harbin Medical University), Ministry of Education, Harbin 150086, PR China
- Heilongjiang Academy of Medical Sciences, Harbin, China
| | - Dechun Yin
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, PR China
| | - Haiyu Zhang
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, PR China
| | - Ye Tian
- Department of Pathophysiology and Key Laboratory of Cardiovascular Pathophysiology, Harbin Medical University, Key Laboratory of Cardiovascular Research (Harbin Medical University), Ministry of Education, Harbin 150086, PR China
- Heilongjiang Academy of Medical Sciences, Harbin, China
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, PR China
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Chiorescu RM, Mocan M, Stoia MA, Barta A, Goidescu CM, Chiorescu S, Farcaş AD. Arguments for Using Direct Oral Anticoagulants in Cancer-Related Venous Thromboembolism. Healthcare (Basel) 2021; 9:1287. [PMID: 34682967 PMCID: PMC8535422 DOI: 10.3390/healthcare9101287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 12/18/2022] Open
Abstract
(1) Background: Patients with cancer with a hypercoagulable state present an increased incidence of venous thromboembolism (VTE). Neoplastic patients with concurrent VTE undergoing anticoagulant treatment face a series of issues. (2) The aim of the present paper is to systematically summarize current VTE management in patients with neoplasia and to review the current clinical evidence from meta-analyses of randomized controlled trials and guidelines regarding the administration of direct oral anticoagulants (DOACs) for cancer-associated VTE. (3) Search Strategy: We performed a review on meta-analyses of randomized controlled trials and guidelines in favor of the administration of DOACs in patients with cancer-associated VTE published in the last 6 years in the Medline (PubMed) and Embase databases. (4) Results: 21 meta-analyses, 14 randomized controlled studies comparing DOACs to VKAs and LMWH, and 7 national and international guidelines were identified. We identified five studies that show the antineoplastic effect of DOAC on experimental models. (5) Conclusions: DOACs can be seen as the first choice for VTE treatment in neoplastic patients who have a low risk of bleeding, who do not have severe renal impairment, and who are not undergoing treatments that could interact with DOAC's mechanism of action.
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Affiliation(s)
- Roxana Mihaela Chiorescu
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.M.C.); (M.A.S.); (A.B.); (C.M.G.); (A.D.F.)
- Department of Internal Medicine, Emergency Clinical County Hospital, 400006 Cluj-Napoca, Romania
| | - Mihaela Mocan
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.M.C.); (M.A.S.); (A.B.); (C.M.G.); (A.D.F.)
- Department of Internal Medicine, Emergency Clinical County Hospital, 400006 Cluj-Napoca, Romania
| | - Mirela Anca Stoia
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.M.C.); (M.A.S.); (A.B.); (C.M.G.); (A.D.F.)
- Department of Cardiology, Emergency Clinical County Hospital, 400006 Cluj-Napoca, Romania
| | - Anamaria Barta
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.M.C.); (M.A.S.); (A.B.); (C.M.G.); (A.D.F.)
- Department of Cardiology, “Nicolae Stăncioiu” Heart Institute, 400001 Cluj-Napoca, Romania
| | - Cerasela Mihaela Goidescu
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.M.C.); (M.A.S.); (A.B.); (C.M.G.); (A.D.F.)
- Department of Cardiology, Military Emergency Hospital “C. Papilian”, 400132 Cluj-Napoca, Romania
| | - Stefan Chiorescu
- Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Anca Daniela Farcaş
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.M.C.); (M.A.S.); (A.B.); (C.M.G.); (A.D.F.)
- Department of Cardiology, Emergency Clinical County Hospital, 400006 Cluj-Napoca, Romania
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Velizarova M, Hristova J, Svinarov D, Ivanova S, Jovinska S, Abedinov P. The impact of CYP2C9 and VKORC1 genetic polymorphisms in anticoagulant therapy management after cardiac surgery with extracorporeal circulation. PHARMACIA 2021. [DOI: 10.3897/pharmacia.68.e63409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Extracorporeal circulation during cardiac surgery is characterized with increased risk for hypercoagulation because blood is exposed to foreign, nonendothelial cell surfaces. Thus, the usage of extracorporeal circulation is essentially not possible without anticoagulation. Open-heart surgery as well as many perioperative factors, such as acidosis, hypocalcemia, hypothermia, and hemodilution, might affect hemostasis and lead to coagulopathy and bleeding. A new insight into the effectiveness of anticoagulant therapy is applied to modify the dosing regimen with respect to the genetic CYP2C9 and VKORC1allelic variants. A systematic literature search was performed for VKORC1 and CYP2C9 and their association with coumarin anticoagulant therapy and bleeding risk in postoperative period of cardiac surgery with extracorporeal circulation.
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Criado PR, Pagliari C, Carneiro FRO, Quaresma JAS. Lessons from dermatology about inflammatory responses in Covid-19. Rev Med Virol 2020; 30:e2130. [PMID: 32656939 PMCID: PMC7404593 DOI: 10.1002/rmv.2130] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 02/06/2023]
Abstract
The SARS‐Cov‐2 is a single‐stranded RNA virus composed of 16 non‐structural proteins (NSP 1‐16) with specific roles in the replication of coronaviruses. NSP3 has the property to block host innate immune response and to promote cytokine expression. NSP5 can inhibit interferon (IFN) signalling and NSP16 prevents MAD5 recognition, depressing the innate immunity. Dendritic cells, monocytes, and macrophages are the first cell lineage against viruses' infections. The IFN type I is the danger signal for the human body during this clinical setting. Protective immune responses to viral infection are initiated by innate immune sensors that survey extracellular and intracellular space for foreign nucleic acids. In Covid‐19 the pathogenesis is not yet fully understood, but viral and host factors seem to play a key role. Important points in severe Covid‐19 are characterized by an upregulated innate immune response, hypercoagulopathy state, pulmonary tissue damage, neurological and/or gastrointestinal tract involvement, and fatal outcome in severe cases of macrophage activation syndrome, which produce a ‘cytokine storm’. These systemic conditions share polymorphous cutaneous lesions where innate immune system is involved in the histopathological findings with acute respiratory distress syndrome, hypercoagulability, hyperferritinemia, increased serum levels of D‐dimer, lactic dehydrogenase, reactive‐C‐protein and serum A amyloid. It is described that several polymorphous cutaneous lesions similar to erythema pernio, urticarial rashes, diffuse or disseminated erythema, livedo racemosa, blue toe syndrome, retiform purpura, vesicles lesions, and purpuric exanthema or exanthema with clinical aspects of symmetrical drug‐related intertriginous and flexural exanthema. This review describes the complexity of Covid‐19, its pathophysiological and clinical aspects.
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Affiliation(s)
- Paulo Ricardo Criado
- Dermatology Department, Centro Universitário Saúde ABC, Santo André, Brazil.,Dermatology Department, Faculdade de Medicina, Centro Universitário Saúde ABC, Santo André, Brazil
| | - Carla Pagliari
- Pathology Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Anghel L, Sascău R, Trifan A, Zota IM, Stătescu C. Non-Vitamin K Antagonist Oral Anticoagulants and the Gastrointestinal Bleeding Risk in Real-World Studies. J Clin Med 2020; 9:E1398. [PMID: 32397355 PMCID: PMC7290290 DOI: 10.3390/jcm9051398] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/12/2020] [Accepted: 05/07/2020] [Indexed: 02/05/2023] Open
Abstract
In the present study, we aimed to provide evidence from high-quality real world studies for a comprehensive and rigorous analysis on the gastrointestinal bleeding (GIB) risk for non-vitamin K antagonist oral anticoagulants (NOACs). We performed a systematic search of MEDLINE, EMBASE and PUBMED, and of 286 records screened, we included data from 11 high-quality real-world studies, coordinated by independent research groups over the last 3 years, that reported major GIB events in patients given NOACs or vitamin K antagonists for patients with nonvalvular atrial fibrillation. The lowest risk of gastrointestinal bleeding was with apixaban compared with warfarin (hazard ratio (HR) for GIB for apixaban ranging between 0.45 (95% confidence interval (CI) 0.34 to 0.59) and 1.13 (95% CI 0.79 to 1.63)). Apixaban was associated with a lower risk of GI bleeding than dabigatran ((HR ranging between 0.39 (95% CI 0.27 to 0.58) and 0.95 (95% CI 0.65 to 1.18)) or rivaroxaban ((HR ranging between 0.33 (95% CI 0.22 to 0.49) and 0.82 (95% CI 0.62 to 1.08)). The results of our study confirm a low or a similar risk for major GIB between patients receiving apixaban or dabigatran compared with warfarin, and apixaban appears to be associated with the lowest risk of GIB.
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Affiliation(s)
- Larisa Anghel
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (L.A.); (A.T.); (I.M.Z.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute, “Prof. Dr. George I.M. Georgescu”, 700503 Iași, Romania
| | - Radu Sascău
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (L.A.); (A.T.); (I.M.Z.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute, “Prof. Dr. George I.M. Georgescu”, 700503 Iași, Romania
| | - Anca Trifan
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (L.A.); (A.T.); (I.M.Z.); (C.S.)
- Gastroenterology and Hepatology Department, Gastroenterology and Hepatology Institute, 700019 Iași, Romania
| | - Ioana Mădălina Zota
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (L.A.); (A.T.); (I.M.Z.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute, “Prof. Dr. George I.M. Georgescu”, 700503 Iași, Romania
| | - Cristian Stătescu
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (L.A.); (A.T.); (I.M.Z.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute, “Prof. Dr. George I.M. Georgescu”, 700503 Iași, Romania
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