1
|
Albabtain MA, Alanazi Z, Al Mutairi N, Al Hebaishi Y, Alyafi O, Alghasoon H, Arafat AA. Better survival in morbidly obese patients with atrial fibrillation treated with non-vitamin K-dependent oral anticoagulants. J Saudi Heart Assoc 2023; 35:7-15. [PMID: 37020973 PMCID: PMC10069674 DOI: 10.37616/2212-5043.1327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 03/13/2023] Open
Abstract
Background The efficacy and safety of non-vitamin K-dependent anticoagulants (NOAC) are not well investigated in the obese population, and fixed dosing could lead to under-anticoagulation. Our objective was to evaluate the effect of obesity on anticoagulation outcomes and survival in non-valvular atrial fibrillation (AF) patients. Methods We enrolled 755 patients who required anticoagulation for AF from 2015 to 2016. We grouped the patients into four groups. Group 1 (n = 297) included patients with BMI< 40 kg/m2 treated with NOACs, Group 2 (n = 358) included patients on warfarin with BMI< 40 kg/m2, Group 3 (n = 57) had patients on NOACs with BMI≥ 40 kg/m2 and Group 4 (n = 43) included patients on warfarin and BMI≥ 40 kg/m2. Study outcomes were the composite endpoint of stroke, bleeding, and survival. Results Competing risk regression showed that stroke and bleeding were not affected by obesity or treatment (SHR: 1.09 (95% CI: 0.79-1.51); P = 0.62). Older age was the predictor of stroke/bleeding (HR:1.03 (95% CI:1.01-1.06); P = 0.02). Predictors of mortality were heart failure (HR:2.23 (95% CI:1.25-3.97); P = 0.007), lower creatinine clearance (HR: 0.98 (95% CI:0.97-0.98): P < 0.001), non-obese patients on warfarin (HR:3.51 (95%CI:1.6-7.7): P = 0.002) and obese patients on warfarin (HR: 6.7 (95% CI:2.51-17.92); P < 0.001). Conclusion NOACs could have a similar risk profile to warfarin in obese and non-obese patients with non-valvular AF but could have better survival. Larger randomized trials are recommended.
Collapse
Affiliation(s)
- Monirah A. Albabtain
- Cardiology Clinical Pharmacy Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
- Corresponding author at: Pharmacy Department-Prince Sultan Cardiac Centre, Building 6, Makkah Al Mukarramah Branch Road, As-Sulaymaniyah district, Riyadh, 12233, Saudi Arabia. E-mail address: (M.A. Albabtain)
| | - Zaid Alanazi
- Cardiology Clinical Pharmacy Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Nawaf Al Mutairi
- Cardiology Clinical Pharmacy Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Yahya Al Hebaishi
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Ola Alyafi
- Clinical Pharmacy Department-College of Pharmacy, AlMaarefa University, Riyadh,
Saudi Arabia
| | - Haneen Alghasoon
- Cardiac Research Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Amr A. Arafat
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| |
Collapse
|
2
|
Alqahtani JS, Aldhahir AM, Alanazi Z, Alsulami EZ, Alsulaimani MA, Alqarni AA, Alqahtani AS, AlAyadi AY, Alnasser M, AlDraiwiesh IA, Alghamdi SM, Almarkhan HM, Alsulayyim AS, AlRabeeah SM, AlAhmari MD. Impact of Smoking Status and Nicotine Dependence on Academic Performance of Health Sciences Students. Subst Abuse Rehabil 2023; 14:13-24. [PMID: 36865699 PMCID: PMC9970882 DOI: 10.2147/sar.s393062] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
Background Smoking behavior has been associated with poor academic performance among adult students worldwide. However, the detrimental effect of nicotine dependence on several students' academic achievement indicators is still unclear. This study aims to assess the impact of smoking status and nicotine dependence on grade point average (GPA), absenteeism rate and academic warnings among undergraduate health sciences students in Saudi Arabia. Methods A validated cross-sectional survey was conducted, in which, participants responded to questions evaluated cigarette consumption, urge to consume and dependency, learning performance, days of absentees, and academic warnings. Results A total of 501 students from different health specialties have completed the survey. Of whom, 66% were male, 95% ranging between the age of 18-30 years old, and 81% reported no health issues or chronic diseases. Current smokers estimated to be 30% of the respondents, of which 36% revealed smoking history of 2-3 years. The prevalence of nicotine dependency (high to extremely high) was 50%. Overall, smokers had significantly lower GPA, higher absenteeism rate, and higher number of academic warnings when compared to nonsmokers (p<0.001). Heavy smokers demonstrated significantly less GPA (p=0.036), higher days of absences (p=0.017), and more academic warnings (p=0.021) compared to light smokers. The linear regression model indicated a significant association between smoking history (increased pack-per-year) and poor GPA (p=0.01) and increased number of academic warning last semester (p=0.01), while increased cigarette consumption was substantially linked with higher academic warnings (p=0.002), lower GPA (p=0.01), and higher absenteeism rate for last semester (p=0.01). Conclusion Smoking status and nicotine dependence were predictive of worsening academic performance, including lower GPA, higher absenteeism rate and academic warnings. In addition, there is a substantial and unfavorable dose-response association between smoking history and cigarette consumption with impaired academic performance indicators.
Collapse
Affiliation(s)
- Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia,Correspondence: Jaber S Alqahtani, Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia, Email
| | - Abdulelah M Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, 45142, Saudi Arabia
| | - Zaid Alanazi
- Family Medicine Department, Northern Area Armed Forces Hospital (NAAFH), Hafar Al Batin, Saudi Arabia
| | - Emad Zahi Alsulami
- Family Medicine Department, Armed Forces Hospital in King Abdulaziz Airbase, Dhahran, Saudi Arabia
| | - Mujahid A Alsulaimani
- Basic Medical Unit, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia
| | - Abdullah A Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Abdullah S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia
| | - Ayadh Yahya AlAyadi
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia
| | - Musallam Alnasser
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia
| | - Ibrahim A AlDraiwiesh
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia
| | - Saeed M Alghamdi
- Respiratory Care Program, College of Applied Medical Sciences, Umm Al-Qura University, Makkah, 24382, Saudi Arabia
| | - Hussam M Almarkhan
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia
| | - Abdullah S Alsulayyim
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, 45142, Saudi Arabia,National Heart and Lung Institute, Imperial College London, London, SW7 2BX, UK
| | - Saad M AlRabeeah
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia
| | - Mohammed D AlAhmari
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia
| |
Collapse
|
3
|
Alanazi Z, Almutairi N, AlDukkan L, Arafat AA, Albabtain MA. Time in therapeutic range for virtual anticoagulation clinic versus in-person clinic during the COVID-19 pandemic: a crossover study. Ann Saudi Med 2022; 42:305-308. [PMID: 36252144 PMCID: PMC9557787 DOI: 10.5144/0256-4947.2022.305] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND COVID-19 infection affects the quality of the medical services globally. The pandemic required changes to medical services in several institutions. We established a virtual clinic for anticoagulation management during the pandemic using the Whatsapp application. OBJECTIVES Compare anticoagulation management quality in virtual versus in-person clinics. DESIGN A retrospective crossover study SETTINGS: Specialized cardiac care center PATIENTS AND METHODS: The study included patients who presented to Prince Sultan Cardiac Center in Riyadh for anticoagulation management during the pandemic from March 2020 to January 2021. We compared time in therapeutic range (TTR) in the same patients during virtual and in-person clinics. All international normalized ratio (INR) measures during the virtual clinic visits and prior ten INR measures from the in-person clinic were recorded. Patients who had no prior follow-up in the in-person clinic were excluded. MAIN OUTCOME MEASURE TTR calculated using the Rosendaal method. SAMPLE SIZE 192 patients RESULTS: The mean age was 58.6 (16.6) years and 116 (60.4%) were males. Patients were diagnosed with atrial fibrillation (n=101, 52.6%), mechanical mitral valve (n=88, 45.8%), mechanical aortic valve (n=79, 41%), left ventricular thrombus (n=5, 2.6%) and venous thromboembolism (n=8, 4.2%). Riyadh residents represented 56.7% of the study population (n=93). The median (IQR) percent TTR was 54.6 (27.3) in the in-person clinic versus 50.0 (33.3) (P=.07). CONCLUSION Virtual clinic results were comparable to in-person clinics for anticoagulation management during the COVID-19 pandemic. LIMITATIONS Number of INR measures during the virtual clinic visits, retrospective nature and single-center experience. CONFLICT OF INTEREST None.
Collapse
Affiliation(s)
- Zaid Alanazi
- From the Department of Pharmacy, Clinical Pharmacy Division, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Nawaf Almutairi
- From the Department of Pharmacy, Clinical Pharmacy Division, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Latifah AlDukkan
- From the Department of Pharmacy, Clinical Pharmacy Division, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Amr A Arafat
- From the Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Gharbiya, Egypt.,From the Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Monirah A Albabtain
- From the Department of Pharmacy, Clinical Pharmacy Division, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| |
Collapse
|
4
|
Mohammed S, El-Menyar A, Al-Janubi H, Shabana A, Alanazi Z. Antithrombotic Therapy for Transcatheter Valvular Interventions: A Revisit. Curr Vasc Pharmacol 2019; 16:107-113. [PMID: 28393705 DOI: 10.2174/1570161115666170406105753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/26/2017] [Accepted: 03/27/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND The optimal antithrombotic therapies for transcatheter aortic valve implantation (TAVI) and MitraClip implantation have not been well established. We conducted a narrative review from currently available studies between January 2002 and May 2016 to highlight the advantages and disadvantages of antithrombotic therapy use in cardiac catheter-based therapeutic techniques. Recently, these techniques have dramatically altered the approach towards valvular heart diseases management. The introduction into clinical practice, of TAVI for severe aortic stenosis and MitraClip for mitral regurgitation, has revolutionized interventional cardiology. However, TAVI is associated with a risk of cerebral embolization and ischaemic vascular events leading to neurological impairment and even death. These ischaemic complications might occur perioperatively or much later, although the estimated rate of occurrence is variable. CONCLUSION We will discuss prior experience with MitraClip for antithrombotic use. It is imperative for patients undergoing transcatheter valvular interventions to have optimal antithrombotic therapy that balances between ischaemic and haemorrhagic complications. The appropriate timing, combination, and duration of antithrombotic medications need consensus to weigh between the efficacy, efficiency and adverse effects in patients with transcatheter valvular interventions.
Collapse
Affiliation(s)
- Shaban Mohammed
- Clinical Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.,Clinical Research, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Haifa Al-Janubi
- Clinical Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Adel Shabana
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Zaid Alanazi
- Clinical Pharmacy, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| |
Collapse
|
5
|
Alhwiesh AK, Alsharani H, Ibrahim EF, Alanazi Z, AlGhamdi BA, Alaudah N, Alzahrani F, Alsarawi A, Almohaws A, Abdurrahman IS. Recurrent syndrome of inappropriate antidiuretic hormone secretion due to tolterodine in an elderly male patient. Saudi J Kidney Dis Transpl 2017; 28:625-628. [PMID: 28540903 DOI: 10.4103/1319-2442.206471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hyponatremia is defined as serum sodium of <135 mmol/L and equates with a low serum osmolality once translocational hyponatremia and pseudohyponatremia are ruled out. True hyponatremia develops when normal urine-diluting mechanisms are disturbed. In elderly patients, this complication is not uncommon, especially in nursing homes and assisted living facilities. Medications are often the most common cause of hyponatremia in these patients. Herewith, we reported a 65-year-old Saudi male, a known case of benign prostatic hypertrophy and hypertension, who developed recurrent hyponatremia secondary to tolterodine. To our knowledge, this is the fifth case reported in literature of such association.
Collapse
Affiliation(s)
- Abdullah K Alhwiesh
- Department of Internal Medicine, Division of Nephrology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Husain Alsharani
- Department of Internal Medicine, Division of Nephrology, Security Force Hospital, Eastern Province, Dammam, Saudi Arabia
| | - Eman Fathi Ibrahim
- Department of Internal Medicine, Division of Nephrology, Security Force Hospital, Eastern Province, Dammam, Saudi Arabia
| | - Zaid Alanazi
- Department of Internal Medicine, Division of Nephrology, Security Force Hospital, Eastern Province, Dammam, Saudi Arabia
| | - Bushra Ahmed AlGhamdi
- Department of Internal Medicine, Division of Nephrology, Security Force Hospital, Eastern Province, Dammam, Saudi Arabia
| | - Nadia Alaudah
- Department of Pathology, Dammam Medical Complex, Dammam, Saudi Arabia
| | - Feras Alzahrani
- Department of Internal Medicine, Division of Nephrology, Security Force Hospital, Eastern Province, Dammam, Saudi Arabia
| | - Adnan Alsarawi
- Department of Internal Medicine, Division of Nephrology, Security Force Hospital, Eastern Province, Dammam, Saudi Arabia
| | - Ashwaqu Almohaws
- Department of Internal Medicine, Division of Nephrology, Security Force Hospital, Eastern Province, Dammam, Saudi Arabia
| | - Ibraheem Saeed Abdurrahman
- Department of Internal Medicine, Division of Nephrology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| |
Collapse
|