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Vrátná E, Husáková J, Králová K, Kratochvílová S, Girman P, Saudek F, Dubský M, Bém R, Wosková V, Jirkovská A, Dad'ová K, Vařeková J, Lánská V, Fejfarová V. Incidence and Risk Factors of Diabetic Foot Syndrome in Patients Early After Pancreas or Kidney/Pancreas Transplantation and its Association with Preventive Measures. INT J LOW EXTR WOUND 2024; 23:283-290. [PMID: 34723678 DOI: 10.1177/15347346211052155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diabetic foot (DF) can develop in diabetic patients after organ transplantation (Tx) due to several factors including peripheral arterial disease (PAD), diabetic neuropathy and inappropriate DF prevention. Aim: To assess the occurrence of DF and associated risk factors in transplant patients. Methods: Fifty-seven diabetic patients were enrolled as part of this prospective study. All patients underwent organ Tx (01/2013-12/2015) and were followed up for minimum of 12 months up to a maximum of 50 months. Over the study period we evaluated DF incidence and identified a number of factors likely to influence DF development, including organ function, presence of late complications, PAD, history of DF, levels of physical activity before and after Tx, patient education and standards of DF prevention. Results: Active DF developed in 31.6% (18/57) of patients after organ Tx within 11 months on average (10.7 ± 8 months). The following factors significantly correlated with DF development: diabetes control (p = .0065), PAD (p<0.0001), transcutaneous oxygen pressure (TcPO2;p = .01), history of DF (p = .0031), deformities (p = .0021) and increased leisure-time physical activity (LTPA) before Tx (p = .037). However, based on logistic stepwise regression analysis, the only factors significantly associated with DF during the post-transplant period were: PAD, deformities and increased LTPA. Education was provided to patients periodically (2.6 ± 2.5 times) during the observation period. Although 94.7% of patients regularly inspected their feet (4.5 ± 2.9 times/week), only 26.3% of transplant patients used appropriate footwear. Conclusions: Incidence of DF was relatively high, affecting almost 1/3 of pancreas and kidney/pancreas recipients. The predominant risk factors were: presence of PAD, foot deformities and higher LTPA before Tx. Therefore, we recommend a programme involving more detailed vascular and physical examinations and more intensive education focusing on physical activity and DF prevention in at-risk patients before transplantation.
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Affiliation(s)
- E Vrátná
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
- Division of Clinical Rehabilitation, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - J Husáková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - K Králová
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - S Kratochvílová
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - P Girman
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - F Saudek
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - M Dubský
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - R Bém
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - V Wosková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - A Jirkovská
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - K Dad'ová
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - J Vařeková
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - V Lánská
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - V Fejfarová
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Second Faculty of Medicine, Charles University, Prague, Czech Republic
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Lee I, Suarez S, Hall R, Majumdar M, Bellomo T, Jessula S, Nuzzolo K, Jefferson DM, Zacharias N, Dua A. Optimizing platelet inhibition in peripheral artery disease: A comparison of mono-antiplatelet therapy and dual-antiplatelet therapy using thromboelastography. Vascular 2024:17085381241237005. [PMID: 38441042 DOI: 10.1177/17085381241237005] [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: 03/06/2024]
Abstract
BACKGROUND Antiplatelet therapy is used to prevent thrombosis in patients with peripheral artery disease (PAD) following revascularization. However, the current standard of care for these patients remains at the physician's discretion, varying from mono-antiplatelet therapy (MAPT) to dual-antiplatelet therapy (DAPT). Viscoelastic assays such as Thromboelastography with Platelet Mapping (TEG-PM) provide insight into individual coagulation profiles and measure real-time platelet function. This prospective, observational study looks at the differences in platelet function for patients on MAPT versus DAPT using TEG-PM. METHODS Patients with PAD undergoing revascularization were prospectively evaluated between December 2020 and June 2023. TEG-PM analysis compared platelet function for patients prescribed MAPT (aspirin or clopidogrel) at the initial encounter and DAPT (aspirin and clopidogrel) at the next visit. Platelet function measured in percent inhibition was evaluated at these visits, and within-group t-tests were performed. RESULTS Of the 195 patients enrolled, 486 samples were analyzed by TEG-PM. Sixty-four patients met the study criteria. At the initial visit, 52 patients had been prescribed aspirin, and 12 patients had been prescribed clopidogrel. For patients initially prescribed aspirin MAPT, an increase of 96.8%in the mean ADP platelet inhibition was exhibited when transitioning to DAPT [22.0% vs. 43.3%, p < .01], as well as an increase of 34.6%in the mean AA platelet inhibition when transitioning to DAPT [60.9% vs. 82.0%, p < .01]. For patients prescribed initial clopidogrel MAPT, an increase of 100% in AA platelet inhibition was exhibited on DAPT compared to the MAPT state [42.3% vs. 84.6%, p < .01]. CONCLUSIONS Patients on DAPT showed a significant increase in platelet inhibition when compared to initial aspirin MAPT. A significant difference in AA %platelet inhibition was shown for patients on DAPT when compared to initial clopidogrel MAPT. The results show that patients may benefit from DAPT post-revascularization. Personalizing antiplatelet therapy with objective viscoelastic testing to confirm adequate treatment may be the next step in optimizing patient outcomes to reduce thrombosis in PAD patients.
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Affiliation(s)
- Ivy Lee
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Sasha Suarez
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Ryan Hall
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Monica Majumdar
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Tiffany Bellomo
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Samuel Jessula
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kathryn Nuzzolo
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - Nikolaos Zacharias
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
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Qamar SUR, Spahić L, Benolić L, Zivanovic M, Filipović N. Treatment of Peripheral Artery Disease Using Injectable Biomaterials and Drug-Coated Balloons: Safety and Efficacy Perspective. Pharmaceutics 2023; 15:1813. [PMID: 37514000 PMCID: PMC10385947 DOI: 10.3390/pharmaceutics15071813] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/01/2023] [Accepted: 06/15/2023] [Indexed: 07/30/2023] Open
Abstract
The possibility of injectable biomaterials being used in the therapy of peripheral artery disease (PAD) is investigated in this article. We conducted a thorough review of the literature on the use and efficacy of biomaterials (BMs) and drug-coated balloons (DCBs). These BMs included hydrogels, collagen scaffolds, and nanoparticles. These BMs could be used alone or in combination with growth factors, stem cells, or gene therapy. The treatment of peripheral artery disease with DCBs is increasingly common in the field of interventional angiology. Studies have been carried out to examine the effectiveness of paclitaxel-coated balloons such as PaccocathTM in lowering the frequency with which further revascularization operations are required. PCB angioplasty and angioplasty without paclitaxel did not significantly vary in terms of mortality, according to the findings of a recent meta-analysis that included the results of four randomized controlled studies. On the other hand, age was found to be a factor that predicted mortality. There was a correlation between the routine utilization of scoring balloon angioplasty along with DCBs and improved clinical outcomes in de novo lesions. In both preclinical and clinical testing, the SelutionTM DCB has demonstrated efficacy and safety, but further research is required to determine whether or not it is effective and safe over the long term. In addition, we reviewed the difficulties involved in bringing injectable BMs-based medicines to clinical trials, including the approval processes required by regulatory bodies. Injectable BMs have a significant amount of therapeutic promise for PAD, which highlights the need for more research and clinical studies to be conducted in this field. In conclusion, this research focuses on the potential of injectable BMs and DCBs in the treatment of PAD as well as the hurdles that must be overcome in order to translate these treatments into clinical trials. In this particular field, there is a demand for further research as well as clinical trials.
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Affiliation(s)
- Safi Ur Rehman Qamar
- Bioengineering Research and Development Centre (BioIRC), Prvoslava Stojanovića 6, 34000 Kragujevac, Serbia; (L.S.); (L.B.); (N.F.)
- Faculty of Engineering, University of Kragujevac, Sestre Janjić 6, 34000 Kragujevac, Serbia
| | - Lemana Spahić
- Bioengineering Research and Development Centre (BioIRC), Prvoslava Stojanovića 6, 34000 Kragujevac, Serbia; (L.S.); (L.B.); (N.F.)
- Faculty of Engineering, University of Kragujevac, Sestre Janjić 6, 34000 Kragujevac, Serbia
| | - Leo Benolić
- Bioengineering Research and Development Centre (BioIRC), Prvoslava Stojanovića 6, 34000 Kragujevac, Serbia; (L.S.); (L.B.); (N.F.)
- Faculty of Engineering, University of Kragujevac, Sestre Janjić 6, 34000 Kragujevac, Serbia
| | - Marko Zivanovic
- Institute for Information Technologies Kragujevac, University of Kragujevac, Jovana Cvijića бб, 34000 Kragujevac, Serbia;
| | - Nenad Filipović
- Bioengineering Research and Development Centre (BioIRC), Prvoslava Stojanovića 6, 34000 Kragujevac, Serbia; (L.S.); (L.B.); (N.F.)
- Faculty of Engineering, University of Kragujevac, Sestre Janjić 6, 34000 Kragujevac, Serbia
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Shih PK, Chen JX, Lin MC, Wu SC. Risk of peripheral artery occlusive disease in patients with lower leg fracture who received fixation and non-fixation treatments: A population cohort study. PLoS One 2022; 17:e0272068. [PMID: 35925984 PMCID: PMC9352030 DOI: 10.1371/journal.pone.0272068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022] Open
Abstract
Background The risk of peripheral artery occlusive disease (PAOD) in patients with lower leg fracture who underwent fixation procedures is not yet completely understood. Therefore, the current study aimed to examine the risk of subsequent PAOD in patients with lower leg fracture who received fixation and non-fixation treatments. Methods We included 6538 patients with lower leg fracture who received non-fixation treatment and a matched cohort comprising 26152 patients who received fixation treatment from the National Health Insurance Database. Patients were frequency matched according to age, sex, and index year. The incidence and risk of PAOD in patients with lower leg fracture who received fixation and non-fixation treatments were evaluated via the stratification of different characteristics and comorbidities. Results Non-fixation treatment, male sex, older age (≥ 50 years old), diabetes mellitus, and gout were associated with a significantly higher risk of lower extremity PAOD compare to each comparison group, respectively. Moreover, there was a significant correlation between fixation treatment and a lower risk of lower extremity PAOD in women (adjusted hazard ratio [aHR] = 0.58, 95% confidence interval [CI] = 0.38–0.90), women aged > 50 years (aHR = 0.61, 95% CI = 0.38–0.96), and patients with coronary artery disease (aHR = 0.43, 95% CI = (0.23–0.81). Further, patients with fixation treatment had a significantly lower risk of lower extremity PAOD within 2 years after trauma (aHR = 0.57, 95% CI = 0.34–0.97). The Kaplan–Meier analysis showed that the cumulative incidence of PAOD was significantly higher in the non-fixation treatment group than in the fixation treatment group at the end of the 10-year follow-up period (log-rank test: P = 0.022). Conclusion Patients with lower leg fracture who received non-fixation treatment had a significantly higher risk of PAOD than those who received fixation treatment. Moreover, the risk of PAOD was higher in women aged > 50 years, as well as in coronary artery disease patients who received non-fixation treatment than in those who received fixation treatment. Therefore, regular assessment of vessel patency are recommended for these patients. Nevertheless, further studies must be conducted to validate the results of our study.
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Affiliation(s)
- Pin-Keng Shih
- School of medicine, China Medical University, Taichung, Taiwan
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Jian-Xun Chen
- School of medicine, China Medical University, Taichung, Taiwan
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Mei-Chen Lin
- School of medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University and Hospital, Taichung, Taiwan
| | - Shih-Chi Wu
- School of medicine, China Medical University, Taichung, Taiwan
- Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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Xu Z, Miao Y, Wu T, Chen L, Gao M, Sun Y, Liu Y, Niu J, Cai D, Li X, Chen C, Liu S, Gu J, Cao X. Evaluation of efficacy and safety after replacement of methyl hydrogen with deuterium at methyl formate of Clopidogrel. Eur J Pharm Sci 2022; 172:106157. [DOI: 10.1016/j.ejps.2022.106157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/03/2022]
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Extracorporeal Shock Wave Therapy Salvages Critical Limb Ischemia in B6 Mice through Upregulating Cell Proliferation Signaling and Angiogenesis. Biomedicines 2022; 10:biomedicines10010117. [PMID: 35052796 PMCID: PMC8773589 DOI: 10.3390/biomedicines10010117] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 02/01/2023] Open
Abstract
(1) This study tests hypothesis whether extracorporeal shock wave (ECSW) therapy effectively salvages mouse critical limb ischemia (CLI). In vitro result demonstrated that the angiogenesis parameters (i.e., tubular length/cluster/network formation) and protein expressions of EGFR/VEGFR2/RAS/c-Raf/MEK/ERK/VEGF/p-PI3K/p-Akt/p-m-TOR were significantly and progressively increased with stepwise augmentation of ECSW energy (0.1/0.14/0.20 mJ/mm2/140 impulses). On the other hand, they were suppressed by administration of Avastin (20 μM). Adult male B6 mice (n = 24) were equally categorized into group 1 (sham-operated control), group 2 (CLI), group 3 [CLI + ECSW (0.12 mJ/mm2/120 impulses/at days 1/3/7 after CLI induction)] and group 4 [CLI + ECSW (0.12 mJ/mm2/120 impulses) + Avastin (1 mg/intramuscular-injection)] at days 1/3/7 after CLI induction] and quadriceps were harvested by day 14. The laser Doppler result showed that the ratio of left (ischemia) to right (normal) limb blood flow was highest in group 1, lowest in group 2, and significantly higher in group 3 than in group 4 by days 7/14 after the CLI procedure (p < 0.0001). The protein expressions of cell proliferation/migration/angiogenesis receptors (EGFR/VEGFR2), angiogenesis biomarkers (VEGF/CXCR4/SDF-1) and cell proliferation/growth/survival (Ras/c-Raf/MEK/ERK)/(PI3K/Akt/m-TOR) and cell motility/proliferation (p-FAK/p-Scr) signaling biomarkers were significantly higher in group 3 than in groups 1/2/4, and significantly lower in group 1 than in groups 2/4, but they did not show a difference between groups 2 and 4 (all p < 0.001). The small vessel density and cellular levels of endothelial cell surface marker (CD31+) exhibited an identical pattern of blood flow, whereas the angiogenesis (CXCR4+/VEGF+) displayed an identical pattern of VEGFR2 among the groups (all p < 0.0001). The in vitro and in vivo studies found ECSW salvaged the CLI mainly through upregulating Ras-Raf-MEK/ERK/cell motility, cell proliferation/growth pathways and angiogenesis.
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Nasr AO, Al-Harbi TM, AlRamadan FS. Case report; successful treatment of traumatic ischaemic hemiplegia secondary to blunt carotid injury associating high grade liver trauma. Int J Surg Case Rep 2021; 88:106547. [PMID: 34753099 PMCID: PMC8581270 DOI: 10.1016/j.ijscr.2021.106547] [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: 09/16/2021] [Revised: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Blunt carotid injury (BCI) injury is a rare sequel of trauma and could result in ischemic complication if not detected and treated early. The presence of high-grade solid organ injury with ongoing bleeding represents additional challenge in treating BCI. CASE PRESENTATION A 25-year-old victim of motor vehicle collision resulted in grade IV liver, grade III left kidney and grade I spleen injury. He underwent an urgent laparotomy with transient liver packing at local hospital. A full body Contrast-Enhanced Computer Tomography (CECT) upon arrival revealed right internal carotid intimal tear with intra and extra-cranial thrombosis and a 3 cm aneurysm. With a decreased level of consciousness, the patient showed a GCS of 13 and left-sided hemiplegia. After complex multidisciplinary treatment sessions, patient recovered with a partial regain of left-sided muscle power. CLINICAL DISCUSSION Selective embolization of active liver bleeding was a turning point in the management of our patient as it deferred the need for a second operative intervention. It was a necessary step before endovascular stenting and recanalization of the BCI to restore the circulation to the right cerebral hemisphere. Dual anti-platelet therapy (DAPT) was necessary to prevent thrombosis of the stent and continuity of carotid recanalization. CONCLUSION BCI with traumatic ischaemic hemiplegia associating a sum of life-threatening multiple injuries including high grade liver trauma with ongoing bleeding could still be managed non-operatively with acceptable outcome in the presence of a comprehensive specialized multidisciplinary service.
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Affiliation(s)
- Ayman O Nasr
- Department of Surgery, King Fahad Hospital Of University-Collage of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia.
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Kalinin RE, Suchkov IA, Mzhavanadze ND, Zhurina ON, Klimentova EA, Povarov VO. Coagulation Factor Activity and Hemostatic Markers of Endothelial Dysfunction in Patients with Peripheral Arterial Disease. Vasc Specialist Int 2021; 37:26. [PMID: 34349046 PMCID: PMC8339417 DOI: 10.5758/vsi.210010] [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: 02/03/2021] [Revised: 06/14/2021] [Accepted: 07/05/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose We aimed to evaluate the impact of intrinsic coagulation factors and hemostatic markers of endothelial dysfunction on complications in patients with atherosclerotic peripheral arterial disease (PAD). Methods Materials and This prospective study enrolled 120 PAD patients at Fontaine stages 2b to 3 who underwent open surgical, endovascular, or conservative treatment. Coagulation factors (FVIII, FIX, and FXI) and endothelial hemostatic markers, including von Willebrand factor (vWF) activity and level, soluble endothelial protein C receptor, and plasminogen activator inhibitor-1 (PAI-1) levels, were assessed. Results At 3 months after open bypass grafting, activity of FVIII significantly increased from a median of 175% to 233% (P<0.001). At 3 months after endovascular treatment, the activities of FVIII, FIX, and FXI significantly increased from medians of 157%, 180%, and 156% to 184%, 218%, and 181%, respectively (P<0.05). Six patients with increased FVIII activity developed bypass graft thrombosis. Four patients in the endovascular group and three patients in the conservative treatment group with increased activity of vWF developed myocardial infarction (P=0.049). The subjects who developed restenosis had increased vWF activity (P=0.023) and decreased nitric oxide metabolite levels (P=0.003). Three subjects who received conservative treatment and developed PAD progression at 12 months had increased PAI-1 activity (P=0.028). Conclusion Patients with advanced PAD had a hypercoagulable status, and performance of open or endovascular revascularization was associated with further hypercoagulability. Increased activity of coagulation factors and altered levels of hemostatic markers of endothelial dysfunction were associated with PAD complications such as graft thrombosis, myocardial infarction, disease progression, and restenosis.
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Affiliation(s)
- Roman E Kalinin
- Department of Cardiovascular, Endovascular, Operative Surgery, and Topographic Anatomy, Ryazan State Medical University, Ryazan, Russia
| | - Igor A Suchkov
- Department of Cardiovascular, Endovascular, Operative Surgery, and Topographic Anatomy, Ryazan State Medical University, Ryazan, Russia
| | - Nina D Mzhavanadze
- Department of Cardiovascular, Endovascular, Operative Surgery, and Topographic Anatomy, Ryazan State Medical University, Ryazan, Russia
| | - Olga N Zhurina
- Clinical Research Center for Hematology, Oncology and Immunology, Ryazan State Medical University, Ryazan, Russia
| | - Emma A Klimentova
- Department of Cardiovascular, Endovascular, Operative Surgery, and Topographic Anatomy, Ryazan State Medical University, Ryazan, Russia
| | - Vladislav O Povarov
- Department of Cardiovascular, Endovascular, Operative Surgery, and Topographic Anatomy, Ryazan State Medical University, Ryazan, Russia
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Hoffman ME, Hamandi M, Lanfear AT, Shutze W. Rare Etiology of Ischemic Steal Syndrome in the Left Peroneal Artery. Ann Vasc Surg 2021; 75:533.e11-533.e14. [PMID: 33945860 DOI: 10.1016/j.avsg.2021.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/25/2021] [Accepted: 03/20/2021] [Indexed: 11/18/2022]
Abstract
Ischemic steal syndrome (ISS) secondary to an arteriovenous fistula (AVF) in the lower extremity (LE) is a rare occurrence. Herein, we report a case of symptomatic ISS in an adult male due to an iatrogenic AVF in the left LE, which was surgically repaired by placing an arterial stent across the acquired AVF of the peroneal artery to the peroneal vein.
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Affiliation(s)
- Mary E Hoffman
- Baylor Scott and White Research Institute at The Heart Hospital Baylor Plano, Plano, TX
| | - Mohanad Hamandi
- Baylor Scott and White Research Institute at The Heart Hospital Baylor Plano, Plano, TX.
| | - Allison T Lanfear
- Baylor Scott and White Research Institute at The Heart Hospital Baylor Plano, Plano, TX
| | - William Shutze
- Baylor Scott and White Research Institute at The Heart Hospital Baylor Plano, Plano, TX
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Lushchak O, Piskovatska V, Strilbytska O, Kindrat I, Stefanyshyn N, Koliada A, Bubalo V, Storey KB, Vaiserman A. Aspirin as a Potential Geroprotector: Experimental Data and Clinical Evidence. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1286:145-161. [PMID: 33725352 DOI: 10.1007/978-3-030-55035-6_11] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aging is a biological process with effects at the molecular, cellular, tissue, organ, system, and organismal levels and is characterized by decline in physical function and higher risks of age-related diseases. The use of anti-aging drugs for disease prevention has become a high priority for science and is a new biomedicine trend. Geroprotectors are compounds which slow aging and increase lifespan of the organism in question. The common painkiller aspirin, a member of the non-steroidal anti-inflammatory drug (NSAID) family, is one of the potential geroprotective agents. Aspirin is often used in treatment of mild to moderate pain. It has anti-inflammatory and anti-pyretic properties and acts as an inhibitor of cyclooxygenase which results in inhibition of prostaglandin. Acetylsalicylic acid as an active compound of aspirin also inhibits platelet aggregation and is used in the prevention of arterial and venous thrombosis. Aspirin has shown life-extending effects in numerous model organisms. This chapter reviews the evidence for clinical efficacy of aspirin including cardiovascular disease prevention, anti-cancer effects, and improvement of cognitive function. However, there are some limitations of these therapies, including the risk of excessive bleeding. We have also summarized numerous experimental and analytical data that support health and longevity benefits of aspirin treatment by affecting pro-longevity pathways.
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Affiliation(s)
- Oleh Lushchak
- Department of Biochemistry and Biotechnology, Vasyl Stefanyk Precarpathian National University, Ivano-Frankivsk, Ukraine.
| | - Veronika Piskovatska
- Clinic for Heart Surgery, University clinic of Martin Luther University, Halle, Germany
| | - Olha Strilbytska
- Department of Biochemistry and Biotechnology, Vasyl Stefanyk Precarpathian National University, Ivano-Frankivsk, Ukraine
| | | | - Nadya Stefanyshyn
- Department of Biochemistry and Biotechnology, Vasyl Stefanyk Precarpathian National University, Ivano-Frankivsk, Ukraine
| | - Alexander Koliada
- Laboratory of Epigenetics, D.F. Chebotarev Institute of Gerontology, NAMS, Kyiv, Ukraine
| | - Volodymyr Bubalo
- Laboratory of Experimental Toxicology and Mutagenesis L.I. Medved's Research Center of Preventive Toxicology, Food and Chemical Safety, MHU, Kyiv, Ukraine
| | | | - Alexander Vaiserman
- Laboratory of Epigenetics, D.F. Chebotarev Institute of Gerontology, NAMS, Kyiv, Ukraine
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Hernandez L, Shah A, Zhao Q, Milentijevic D, Kharat A. Economic Implications of Preventing Major Cardiovascular and Limb Events with Rivaroxaban plus Aspirin in Patients with Coronary or Peripheral Artery Disease in the United States. AMERICAN HEALTH & DRUG BENEFITS 2020; 13:184-190. [PMID: 33343818 PMCID: PMC7741174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/30/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Patients with chronic coronary artery disease (CAD) and/or peripheral artery disease (PAD) have increased risks for cardiovascular (CV)-related morbidity and mortality. In the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) clinical trial of such patients, rivaroxaban plus aspirin demonstrated a significant reduction in major adverse CV events (MACE), a composite of stroke, myocardial infarction, and CV death, and major adverse limb events (MALE), a composite of chronic and acute limb ischemia, and major amputation resulting from vascular events, versus aspirin alone. OBJECTIVE To estimate the 1-year economic implications of preventing MACE and MALE with the use of rivaroxaban plus aspirin versus aspirin alone among patients with chronic CAD and/or PAD in a US commercial health plan. METHOD A cost-consequence model was developed to evaluate the economic impact of rivaroxaban plus aspirin in a hypothetical 1-million-member health plan. The model inputs were taken from the COMPASS study (ie, the efficacy and safety of rivaroxaban plus aspirin vs aspirin), Optum Integrated Database (ie, the prevalence of chronic CAD and/or PAD, incidence rates, and healthcare costs of MACE, MALE, and major bleeding), and the RED BOOK (ie, wholesale drug acquisition costs). The cost inputs were in 2019 US dollars. One-way sensitivity analyses and subgroup analyses were conducted. RESULTS A 1-year treatment with rivaroxaban plus aspirin resulted in reductions of MACE and MALE, which balance the increased risk for bleeding versus aspirin alone and indicate a net health benefit for this drug regimen. These reductions were achieved at an incremental per-member per-month (PMPM) cost of $0.16, mainly because of rivaroxaban's acquisition cost. In patients with ≥2 MACE or MALE risk factors, the incremental PMPM cost was $0.09, given the increased offset in rivaroxaban's acquisition cost by reduced rates of MACE or MALE. CONCLUSIONS In an era of emerging thrombocardiology, treatment with rivaroxaban plus aspirin offers an effective thrombotic risk management strategy for healthcare stakeholders in the management of chronic CAD and/or PAD. The contribution of rivaroxaban would be greater in patients with ≥2 risk factors for MACE or MALE.
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Affiliation(s)
- Luis Hernandez
- Senior Research Scientist, Evidera, Waltham, MA, during this study, and is Director of Health Economics, Takeda, Cambridge, MA
| | - Anshul Shah
- Senior Research Associate, Evidera, Waltham, MA
| | - Qi Zhao
- Associate Director, Janssen Scientific Affairs, Titusville, NJ, during this study, and is Director, Global Value and Access, Eisai, Woodcliff Lake, NJ
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12
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Marone EM, Rinaldi LF, Chierico S, Marazzi G, Palmieri P, Lovotti M, Klersy C. Optimal duration of dual antiplatelet therapy following PTA of the superficial femoral artery: the DAPT-SFA protocol. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:380-381. [PMID: 32668890 DOI: 10.23736/s0021-9509.20.11268-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Enrico M Marone
- Unit of Vascular Surgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy - .,Unit of Vascular Surgery, Department of Surgical Sciences, San Matteo Polyclinic IRCCS, Pavia, Italy -
| | - Luigi F Rinaldi
- Unit of Vascular Surgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Simona Chierico
- Unit of Vascular Surgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giulia Marazzi
- Unit of Vascular Surgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Piernicola Palmieri
- Unit of Vascular Surgery, Department of Surgical Sciences, San Matteo Polyclinic IRCCS, Pavia, Italy
| | - Maurizio Lovotti
- Unit of Vascular Surgery, Department of Surgical Sciences, San Matteo Polyclinic IRCCS, Pavia, Italy
| | - Catherine Klersy
- Unit of Clinical Epidemiology and Biometrics, Scientific Direction, San Matteo Polyclinic IRCCS, Pavia, Italy
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13
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Ambler GK, Waldron CA, Contractor UB, Hinchliffe RJ, Twine CP. Umbrella review and meta-analysis of antiplatelet therapy for peripheral artery disease. Br J Surg 2019; 107:20-32. [DOI: 10.1002/bjs.11384] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/31/2019] [Accepted: 09/05/2019] [Indexed: 12/11/2022]
Abstract
Abstract
Background
The literature on antiplatelet therapy for peripheral artery disease has historically been summarized inconsistently, leading to conflict between international guidelines. An umbrella review and meta-analysis was performed to summarize the literature, allow assessment of competing safety risks and clinical benefits, and identify weak areas for future research.
Methods
MEDLINE, Embase, DARE, PROSPERO and Cochrane databases were searched from inception until January 2019. All meta-analyses of antiplatelet therapy in peripheral artery disease were included. Quality was assessed using AMSTAR scores, and GRADE analysis was used to quantify the strength of evidence. Data were pooled using random-effects models.
Results
Twenty-eight meta-analyses were included. Thirty-three clinical outcomes and 41 antiplatelet comparisons in 72 181 patients were analysed. High-quality evidence showed that antiplatelet monotherapy reduced non-fatal strokes (3 (95 per cent c.i. 0 to 6) fewer per 1000 patients), In symptomatic patients, it reduced cardiovascular deaths (8 (0 to 16) fewer per 1000 patients), but increased the risk of major bleeding (7 (3 to 14) more events per 1000). In asymptomatic patients, monotherapy reduced non-fatal strokes (5 (0 to 8) fewer per 1000), but had no other clinical benefit. Dual antiplatelet therapy caused more major bleeding after intervention than monotherapy (37 (8 to 102) more events per 1000), with very low-quality evidence of improved endovascular patency (risk ratio 4·00, 95 per cent c.i. 0·91 to 17·68).
Conclusion
Antiplatelet monotherapy has minimal clinical benefit for asymptomatic peripheral artery disease, and limited benefit for symptomatic disease, with a clear risk of major bleeding. There is a lack of evidence to guide antiplatelet prescribing after peripheral endovascular intervention.
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Affiliation(s)
- G K Ambler
- Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol, Bath and Weston Vascular Network, North Bristol NHS Trust, Bristol, UK
| | - C-A Waldron
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - U B Contractor
- Bristol, Bath and Weston Vascular Network, North Bristol NHS Trust, Bristol, UK
| | - R J Hinchliffe
- Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol, Bath and Weston Vascular Network, North Bristol NHS Trust, Bristol, UK
| | - C P Twine
- Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol, Bath and Weston Vascular Network, North Bristol NHS Trust, Bristol, UK
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14
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Yu Z, Witman N, Wang W, Li D, Yan B, Deng M, Wang X, Wang H, Zhou G, Liu W, Sahara M, Cao Y, Fritsche-Danielson R, Zhang W, Fu W, Chien KR. Cell-mediated delivery of VEGF modified mRNA enhances blood vessel regeneration and ameliorates murine critical limb ischemia. J Control Release 2019; 310:103-114. [PMID: 31425721 DOI: 10.1016/j.jconrel.2019.08.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/05/2019] [Accepted: 08/15/2019] [Indexed: 01/20/2023]
Abstract
Synthetic chemically modified mRNAs (modRNA) encoding vascular endothelial growth factor (VEGF) represents an alternative to gene therapy for the treatment of ischemic cardiovascular injuries. However, novel delivery approaches of modRNA are needed to improve therapeutic efficacy in the diseased setting. We hypothesized that cell-mediated modRNA delivery may enhance the in vivo expression kinetics of VEGF protein thus promoting more potent angiogenic effects. Here, we employed skin fibroblasts as a "proof of concept" to probe the therapeutic potential of a cell-mediated mRNA delivery system in a murine model of critical limb ischemia (CLI). We show that fibroblasts pre-treated with VEGF modRNA have the potential to fully salvage ischemic limbs. Using detailed molecular analysis we reveal that a fibroblast-VEGF modRNA combinatorial treatment significantly reduced tissue necrosis and dramatically improved vascular densities in CLI-injured limbs when compared to control and vehicle groups. Furthermore, fibroblast-delivered VEGF modRNA treatment increased the presence of Pax7+ satellite cells, indicating a possible correlation between VEGF and satellite cell activity. Our study is the first to demonstrate that a cell-mediated modRNA therapy could be an alternative advanced strategy for cardiovascular diseases.
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Affiliation(s)
- Ziyou Yu
- Department of Plastic and Reconstructive Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai 200011, China
| | - Nevin Witman
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Wenbo Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai 200011, China
| | - Dong Li
- Department of Plastic and Reconstructive Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai 200011, China
| | - Bingqian Yan
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai 200127, China; Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai 200127, China
| | - Mingwu Deng
- Department of Plastic and Reconstructive Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai 200011, China
| | - Xiangsheng Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai 200011, China
| | - Huijing Wang
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai 200127, China; Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai 200127, China
| | - Guangdong Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai 200011, China
| | - Wei Liu
- Department of Plastic and Reconstructive Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai 200011, China
| | - Makoto Sahara
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Yilin Cao
- Department of Plastic and Reconstructive Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai 200011, China
| | - Regina Fritsche-Danielson
- Research and Early Clinical Development, Cardiovascular, Renal and Metabolism, Biopharmaceuticals R&D, AstraZeneca, Pepparedsleden 1, Gothenburg, 43183, Sweden
| | - Wenjie Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai 200011, China.
| | - Wei Fu
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai 200127, China; Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dong Fang Road, Shanghai 200127, China.
| | - Kenneth R Chien
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden.
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15
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Doshi R, Patel K, Desai R, Patel P, Grines C, Meraj P. Differences in risk factors and resource utilization for women undergoing percutaneous coronary intervention and lower extremity peripheral vascular intervention. Catheter Cardiovasc Interv 2019; 96:136-142. [PMID: 31400070 DOI: 10.1002/ccd.28431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/30/2019] [Accepted: 07/27/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the differences in risk factors and in-hospital outcomes for women undergoing percutaneous coronary intervention (PCI) and peripheral vascular intervention (PVI). BACKGROUND The clinical impact of coronary artery disease (CAD) and peripheral artery disease (PAD) is well characterized and is associated with high morbidity and mortality. There is lack of data comparing risk factors and in-hospital outcomes for PCI and PVI, particularly in women. METHODS Only female hospitalizations (age ≥ 18 years) who underwent PCI or PVI from 2005 to 2014 were identified using appropriate International Classification of Diseases-Ninth Revision, Clinical Modification codes from the National Inpatient Sample database. Charlson's Comorbidity Index (CCI) was selected as the primary endpoint of the study. Coprimary endpoint was the cost of hospitalizations associated with PCI or PVI. RESULTS Of the 2,461,328 female hospitalizations that were included, 85.6% (N = 2,105,236) underwent PCI and 14.4% (N = 356,092) received PVI. Compared to PCI, PVI hospitalizations were 3.2 years older (p < .001) and consisted of significantly more hospitalizations above 80 years of age (26.5% vs. 18.6%; p < .001). Hospitalizations with CCI ≥3 were significantly higher in the PVI cohort (29.1% vs. 24%; p < .001). CCI in women increased during the study period for both groups. PVI hospitalizations had a significantly longer length of stay (3 days vs. 2 days; p < .001) and cost of hospitalization ($23,610 vs. $20,571; p < .001), compared to PCI. Finally, the mean cost of hospitalizations increased during the study period for PCI and PVI. CONCLUSION Women hospitalized for PVI had a greater risk-profile and resource utilization as demonstrated by the longer length of stay and higher cost compared to PCI.
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Affiliation(s)
- Rajkumar Doshi
- Department of Internal Medicine, University of Nevada School of Medicine, Nevada
| | - Krunalkumar Patel
- Department of Cardiology, North Shore University Hospital, Northwell Health, New York
| | - Rupak Desai
- Department of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Palakkumar Patel
- Department of Internal Medicine, Nassau University Medical Center, New York
| | - Cindy Grines
- Department of Cardiology, North Shore University Hospital, Northwell Health, New York
| | - Perwaiz Meraj
- Department of Cardiology, North Shore University Hospital, Northwell Health, New York
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Watts MM. Pharmacology of Peripheral Arterial Disease in the Angio Suite: What Every Interventionalist Should Know. Semin Intervent Radiol 2019; 35:393-398. [PMID: 30728655 DOI: 10.1055/s-0038-1676329] [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: 10/27/2022]
Abstract
Safe and effective treatment of peripheral arterial disease (PAD) and critical limb ischemia can be routinely performed in the angiography suite. A systematic understanding of the medications commonly used during these procedures is essential. This review discusses the traditional roles of the medications used in PAD procedures, the existing evidence basis for those roles, potential alternatives, and evolving techniques. Developing a familiarity with these medications can help improve outcomes and safety for the patients being treated.
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Affiliation(s)
- Micah M Watts
- Pennsylvania Vascular Institute, Philadelphia, Pennsylvania
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17
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Yu G, Chen J, Li S, Pu P, Huang W, Zhao Y, Peng X, Wang R, Lei H. RING finger protein 10 prevents neointimal hyperplasia by promoting apoptosis in vitro and in vivo. Life Sci 2018; 208:325-332. [DOI: 10.1016/j.lfs.2018.04.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 04/19/2018] [Accepted: 04/28/2018] [Indexed: 12/23/2022]
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On-Treatment Platelet Reactivity is a Predictor of Adverse Events in Peripheral Artery Disease Patients Undergoing Percutaneous Angioplasty. Eur J Vasc Endovasc Surg 2018; 56:545-552. [PMID: 30025662 DOI: 10.1016/j.ejvs.2018.06.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 06/13/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Few data are available on the association between a different entity of platelet inhibition on antiplatelet treatment and clinical outcomes in patients with peripheral artery disease (PAD). The aim of this study was to evaluate the degree of on-treatment platelet reactivity, and its association with ischaemic and haemorrhagic adverse events at follow up in PAD patients undergoing percutaneous transluminal angioplasty (PTA). METHODS In this observational, prospective, single centre study, 177 consecutive patients with PAD undergoing PTA were enrolled, and treated with dual antiplatelet therapy with aspirin and a P2Y12 inhibitor. Platelet function was assessed on blood samples obtained within 24 h from PTA by light transmission aggregometry (LTA) using arachidonic acid (AA) and adenosine diphosphate (ADP) as agonists of platelet aggregation. High on-treatment platelet reactivity (HPR) was defined by LTA ≥ 20% if induced by AA, and LTA ≥ 70% if induced by ADP. Follow up was performed to record outcomes (death, major amputation, target vessel re-intervention, acute myocardial infarction and/or myocardial revascularisation, stroke/TIA, and bleeding). RESULTS HPR by AA and HPR by ADP were found in 45% and 32% of patients, respectively. During follow up (median duration 23 months) 23 deaths (13%) were recorded; 27 patients (17.5%) underwent target limb revascularisation (TLR), two (1.3%) amputation, and six (3.9%) myocardial revascularisation. Twenty-four patients (15.6%) experienced minor bleeding. On multivariable analysis, HPR by AA and HPR by ADP were independent predictors of death [HR 3.8 (1.2-11.7), p = .023 and HR 4.8 (1.6-14.5), p = .006, respectively]. The median value of LTA by ADP was significantly lower in patients with bleeding complications than in those without [26.5% (22-39.2) vs. 62% (44.5-74), p < .001). LTA by ADP ≤ 41% was independently associated with bleeding HR 14.6 (2.6-24.0), p = .001] on multivariable analysis. CONCLUSIONS In this study a high prevalence of on-clopidogrel and aspirin high platelet reactivity was found, which was significantly associated with the risk of death. Conversely, a low on-clopidogrel platelet reactivity was associated with a higher risk of bleeding. These results document that the entity of platelet inhibition is associated with both thrombotic and bleeding complications in PAD patients.
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Divanji P, Shunk K. Modern Antiplatelet Therapy: When Is Clopidogrel the Right Choice? CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2018. [DOI: 10.15212/cvia.2017.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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20
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Li H, Gui H, Yuan G, Zheng X, Gao C, Yuan H. Increased plasma olfactomedin 2 after interventional therapy is a predictor for restenosis in lower extremity arteriosclerosis obliterans patients. Scandinavian Journal of Clinical and Laboratory Investigation 2018; 78:269-274. [PMID: 29553861 DOI: 10.1080/00365513.2018.1452287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Animal studies have indicated that olfactomedin 2 (OLFM2) is involved in the process of vascular remolding. The aim of the present study was to investigate circulating OLFM2 levels in lower extremity arteriosclerosis obliterans (LEASO) patients and the association of OLFM2 with postoperative restenosis in patients. A total of 203 LEASO patients were enrolled in the present study. Plasma OLFM2 was measured before and 6 h after interventional therapy. After 6 months, patients were divided into a restenosis group and a non-restenosis group. Inter-group and intra-group differences in plasma OLFM2 were compared. The correlation between plasma OLFM2 and the severity of restenosis was analyzed by Spearman's correlation analysis. An receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of plasma OLFM2 on restenosis. Logistic regression was used to determine the risk factors for restenosis. Postoperative OLFM2 in the restenosis group was significantly higher compared with the non-restenosis group (34.07 ± 5.76 ng/mL vs. 19.53 ± 2.99 ng/mL). No significant difference in preoperative plasma OLFM2 levels was identified between the two groups (10.92 ± 2.49 ng/mL vs. 11.54 ± 3.18 ng/mL). Postoperative OLFM2 levels were positively correlated with the severity of restenosis (r = 0.728, p < .001). The area under the ROC curve was 0.902 (95% confidence interval (CI): 0.874-0.965), with a cutoff value of 26.91 ng/mL (95% CI: 26.16-28.32). Plasma OLFM2 was an independent risk factor for restenosis. Our results suggest that plasma OLFM2 is a potential biomarker for restenosis and may be a novel target for the treatment of restenosis.
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Affiliation(s)
- Hongbo Li
- a Department of Vascular Surgery , People's Hospital of Shouguang , Weifang , Shandong , China.,b Department of Vascular Surgery , Shandong Provincial Hospital , Jinan , Shandong , China
| | - Hua Gui
- c Department of Surgery , People's Hospital of Shouguang , Weifang , Shandong , China
| | - Guohong Yuan
- c Department of Surgery , People's Hospital of Shouguang , Weifang , Shandong , China
| | - Xiaomei Zheng
- a Department of Vascular Surgery , People's Hospital of Shouguang , Weifang , Shandong , China
| | - Changkuan Gao
- d Department of Clinical Laboratory , Qilu Hospital , Jinan , Shandong , China
| | - Hai Yuan
- b Department of Vascular Surgery , Shandong Provincial Hospital , Jinan , Shandong , China
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