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Hummel T, Meves SH, Breuer-Kaiser A, Düsterwald JO, Mühlberger D, Mumme A, Neubauer H. Erratum zu: Evaluation einer Therapieanpassung bei ASS-Low-Response in der Gefäßchirurgie. Chirurg 2021; 92:1050. [PMID: 34618165 PMCID: PMC8536622 DOI: 10.1007/s00104-021-01526-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- T Hummel
- Klinik für Gefäßchirurgie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland.
| | - S H Meves
- Klinik für Neurologie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - A Breuer-Kaiser
- Klinik für Anästhesiologie und Intensivmedizin, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - J O Düsterwald
- Klinik für Gefäßchirurgie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - D Mühlberger
- Klinik für Gefäßchirurgie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - A Mumme
- Klinik für Gefäßchirurgie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - H Neubauer
- Klinik für Kardiologie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
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Hummel T, Meves SH, Breuer-Kaiser A, Düsterwald JO, Mühlberger D, Mumme A, Neubauer H. [Evaluation of treatment adaptation for low response to ASA in vascular surgery]. Chirurg 2021; 92:640-646. [PMID: 32945920 PMCID: PMC8484201 DOI: 10.1007/s00104-020-01280-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/29/2022]
Abstract
Hintergrund Eine verminderte antithrombozytäre Prophylaxe („Low-Response [LR]“/„high on-treatment platelet reactivity [HPR]“) mit Acetylsalicylsäure (ASS) ist mit einem erhöhten Risiko für thrombembolische Ereignisse assoziiert. Die Prävalenz einer Low-Response ist mit ca. 20 % häufig und ein Therapieregime wurde bisher noch nicht etabliert. Das Ziel dieser prospektiven Studie war es, die Effektivität eines Therapieschemas zur Therapieanpassung bei detektierter LR/HPR bei gefäßchirurgischen Patienten zu evaluieren. Methodik Insgesamt wurden 36 gefäßchirurgischen Patienten mit einer antithrombozytären Dauermedikation mit ASS 100 mg/Tag und einer nachgewiesenen ASS-Low-Response (ALR) in die Studie eingeschlossen. Entsprechend dem festgelegten Therapieplan wurde bei diesen Patienten eine Therapieanpassung durchgeführt und eine Kontrollaggregometrie zur Erfolgskontrolle durchgeführt. Das verwendete Therapieschema folgte dem Test-and-treat-Prinzip. Zur Beurteilung der Wirkung von ASS diente die Impedanzaggregometrie mittels Mehrelektrodenaggregometer (Multiplate). Ergebnisse Insgesamt konnten alle 36 Patienten erfolgreich in eine Response überführt werden. Bei 32 (88,89 %) Patienten erfolgte eine Dosiserhöhung auf 300 mg ASS, 2 (5,56 %) Patienten wurden von ASS auf Clopidogrel umgestellt. Bei weiteren 2 (5,56 %) Patienten wurde auf eine orale Antikoagulation mit Phenprocoumon aufgrund anderer Indikationen umgestellt. Blutungskomplikationen oder Nebenwirkungen traten nicht auf. Schlussfolgerung Das gewählte Therapieschema zur Behandlung einer Low-Response erwies sich als effektiv und sicher bei gefäßchirurgischen Patienten. Überwiegend führte eine leitliniengerechte Dosiserhöhung der Prophylaxe von 100 mg auf 300 mg ASS zu einer effektiven Thrombozytenaggregationshemmung in der Aggregometrie.
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Affiliation(s)
- T Hummel
- Klinik für Gefäßchirurgie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland.
| | - S H Meves
- Klinik für Neurologie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - A Breuer-Kaiser
- Klinik für Anästhesiologie und Intensivmedizin, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - J O Düsterwald
- Klinik für Gefäßchirurgie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - D Mühlberger
- Klinik für Gefäßchirurgie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - A Mumme
- Klinik für Gefäßchirurgie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - H Neubauer
- Klinik für Kardiologie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
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Hummel T, Meves SH, Rüdiger K, Mügge A, Mumme A, Burkert B, Mühlberger D, Neubauer H. [Prevalence of acetylsalicylic acid (ASA) - low response in vascular surgery]. Chirurg 2018; 87:446-54. [PMID: 27138269 DOI: 10.1007/s00104-016-0168-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Research has revealed that a decreased antiplatelet effect (low response [LR]/high on-treatment platelet reactivity [HPR]) of acetylsalicylic acid (ASA) and clopidogrel is associated with an increased risk of thromboembolic events. There are extensive ASA low response (ALR) and clopidogrel low response (CLR) prevalence data in the literature, but there are only a few studies concerning vascular surgical patients. The aim of this study was to examine the prevalence and risk factors of ALR and CLR in vascular surgical patients. MATERIALS AND METHODS We examined n = 154 patients with an antiplatelet long-term therapy, who were treated due to peripheral artery occlusive disease (PAD) and/or arteria carotis interna stenosis (CVD). To detect an ALR or CLR, we examined full blood probes with impedance aggregometry (ChronoLog® Aggregometer model 590). Risk factors were examined by acquisition of concomitant disease, severity of vascular disease, laboratory test results and medication. RESULTS We found a prevalence of 19.3 % in the ALR group and of 21.1 % in the CLR group. Risk factors for ALR were an increased platelet and leucocyte count and co-medication with pantoprazole. We found no significant risk factors for a decreased antiplatelet effect of clopidogrel treatment. CONCLUSION The investigated prevalence for ALR and CLR are in the range of other studies, particularly based on cardiological patients. More investigations are needed to gain a better evaluation of the risk factors for HPR and to develop an effective antiplatelet therapy regime to prevent cardiovascular complications.
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Affiliation(s)
- T Hummel
- Klinik für Gefäßchirurgie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland.
| | - S H Meves
- Klinik für Neurologie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - K Rüdiger
- Klinik für Gefäßchirurgie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - A Mügge
- Klinik für Kardiologie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - A Mumme
- Klinik für Gefäßchirurgie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - B Burkert
- Klinik für Gefäßchirurgie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - D Mühlberger
- Klinik für Gefäßchirurgie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - H Neubauer
- Klinik für Kardiologie, St. Josef Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
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Tsivgoulis G, Krogias C, Georgiadis GS, Mikulik R, Safouris A, Meves SH, Voumvourakis K, Haršány M, Staffa R, Papageorgiou SG, Katsanos AH, Lazaris A, Mumme A, Lazarides M, Vasdekis SN. Safety of early endarterectomy in patients with symptomatic carotid artery stenosis: an international multicenter study. Eur J Neurol 2014; 21:1251-7, e75-6. [DOI: 10.1111/ene.12461] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
Affiliation(s)
- G. Tsivgoulis
- Second Department of Neurology; ‘Attikon’ Hospital; University of Athens; School of Medicine; Athens Greece
- Department of Neurology; Democritus University of Thrace; School of Medicine; Alexandroupolis Greece
- International Clinical Research Center; St Anne's University Hospital in Brno; Brno Czech Republic
| | - C. Krogias
- Department of Neurology; St Josef Hospital; Ruhr University; Bochum Germany
| | - G. S. Georgiadis
- Department of Vascular Surgery; Democritus University of Thrace; School of Medicine; Alexandroupolis Greece
| | - R. Mikulik
- International Clinical Research Center; St Anne's University Hospital in Brno; Brno Czech Republic
- Department of Neurology; St Anne's University Hospital and Medical Faculty of Masaryk University; Brno Czech Republic
| | - A. Safouris
- Stroke Unit; Department of Neurology; Brugmann University Hospital; Brussels Belgium
| | - S. H. Meves
- Department of Neurology; St Josef Hospital; Ruhr University; Bochum Germany
| | - K. Voumvourakis
- Second Department of Neurology; ‘Attikon’ Hospital; University of Athens; School of Medicine; Athens Greece
| | - M. Haršány
- International Clinical Research Center; St Anne's University Hospital in Brno; Brno Czech Republic
- Department of Neurology; St Anne's University Hospital and Medical Faculty of Masaryk University; Brno Czech Republic
| | - R. Staffa
- 2nd Department of Surgery; St Anne's University Hospital, and Faculty of Medicine; Masaryk University; Brno Czech Republic
| | - S. G. Papageorgiou
- Second Department of Neurology; ‘Attikon’ Hospital; University of Athens; School of Medicine; Athens Greece
| | - A. H. Katsanos
- Department of Neurology; University of Ioannina; School of Medicine; Ioannina Greece
| | - A. Lazaris
- Vascular Unit; 3rd Surgical Department; ‘Attikon’ Hospital; University of Athens; School of Medicine; Athens Greece
| | - A. Mumme
- Department of Vascular Surgery; St Josef Hospital; Ruhr University; Bochum Germany
| | - M. Lazarides
- Department of Vascular Surgery; Democritus University of Thrace; School of Medicine; Alexandroupolis Greece
| | - S. N. Vasdekis
- Vascular Unit; 3rd Surgical Department; ‘Attikon’ Hospital; University of Athens; School of Medicine; Athens Greece
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Kerasnoudis A, Meves SH, Mumme A, Gold R, Krogias C. Präoperative Detektion von Mikroemboliesignalen und Impedanzaggregometrie bei Patienten mit akut-symptomatischen Carotis-Stenosen. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Meves SH, Overbeck U, Endres HG, Krogias C, Neubauer H. Dose-dependent effect of early antiplatelet therapy in acute ischaemic stroke*. Thromb Haemost 2011. [DOI: 10.1160/th-11-06-0436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Meves SH, Overbeck U, Kaiser A, Krogias C, Neubauer H. [Switching from clopidogrel hydrogen sulfate to clopidogrel besylate. Impaired antiplatelet effect in patients with ischemic stroke]. Nervenarzt 2010; 81:992-997. [PMID: 20517690 DOI: 10.1007/s00115-010-3028-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The use of antiplatelet medications, such as acetylsalicylic acid (ASA), a combination of dipyridamol with ASA and also clopidogrel, is of great importance for the secondary prevention of ischemic stroke or transient ischemic attacks. In addition to the known form of clopidogrel hydrogen sulfate (CHS) a further clopidogrel salt, clopidogrel besylate (CB), has also been available since May 2008. The presented case illustrates that in patients with a history of cerebrovascular disease the antiplatelet response of CB can be diminished in comparison to CHS. Therefore we recommend testing the antiplatelet effectiveness when changing patient medication from CHS to CB.
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Affiliation(s)
- S H Meves
- Klinikum für Neurologie, St. Josef-Hospital, Ruhr-Universität Bochum, Gudrunstrasse 56, 44791, Bochum, Deutschland.
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Abstract
BACKGROUND Little is known about the natural course of internal carotid artery (ICA) occlusion and its possible recanalization. The present study was designed to evaluate recanalization rates of extracranial ICA occlusions in acute stroke patients by means of color-coded duplex sonography (CCDS). METHODS 305 patients with acute ischemia in the territory of the middle cerebral artery were included in this study. All patients had a neurological examination on admission and on discharge and were rated by means of the European Stroke Scale (ESS). Extracranial color-coded duplexsonography, transcranial Doppler sonography and cranial computed tomography were immediately performed after admission and within 7 days. RESULTS 254 patients showed no sign of hemodynamic relevant stenosis greater than 70% of the ICA. 21 patients had symptomatic high grade ICA stenosis. 20 patients had an acute occlusion and 10 patients an old ICA occlusion as judged by duplex sonographic criteria. Six patients (5 male, 1 female; age range 57 to 77 years) with an acute atherothrombotic or cardioembolic occlusion showed a recanalization of the ICA in the follow-up ultrasonography. Two patients with cardiogenic embolic occlusion of the ICA had the most favorable outcome and these patients showed no residual stenosis. 4 patients who had ultrasound findings consistent with atherosclerosis on follow-up examination (2 high-grade stenosis, 2 with carotid plaques) did not show a notable improvement of their ESS-score. Patients with carotid plaques developed complete MCA infarctions; the other 4 patients had partial anterior circulation infarction on follow-up CT. CONCLUSIONS The present study showed that recanalization of the occluded ICA in acute stroke patients is more frequent than generally presumed. CCDS should be routinely performed in the follow-up of stroke patients as spontaneous recanalization may influence clinical outcome.
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Affiliation(s)
- S H Meves
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Germany
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Meves SH, Schröder A, Muhs A, Postert T, Federlein J, Büttner T. Distribution of artificially-produced microembolic signals into the cerebral circulation. Ultrasound Med Biol 2001; 27:285-287. [PMID: 11316538 DOI: 10.1016/s0301-5629(00)00343-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
According to clinical observations, cardiogenic embolism occurs more often in the anterior than in the posterior cerebral circulation. An ultrasound (US) contrast agent was used to artificially produce microembolic signals (MES) to imitate the intracranial distribution of systemic emboli. Systemic microemboli were simulated by IV administered US agent (Levovist(R) 300 mg/mL as bolus). A total of 20 patients were monitored by means of transcranial Doppler sonography (TCD), 3 min after the injection, with a 2-MHz transducer simultaneously at 50 mm (middle cerebral artery, MCA, on one side) and 90 mm (basilar artery, BA). Four 3-min recordings were done (two of the right MCA, two of the left MCA, with the BA, respectively). Three observers and an automatic detection system independently performed an off-line analysis. A total of 160 recordings were analyzed. The mean numbers of detected high-intensity transient signals (HITS) were 34.5 +/- 28.2 in the right MCA (simultaneously registered HITS in the BA: 9.4 +/- 16.8) and 39.1 +/- 34.2 in the left MCA (simultaneously registered HITS in the BA: 12.2 +/- 14.5). Only 21.4 to 23.7% of all HITS were recorded in the BA. Microembolic signals artificially produced by means of US contrast agent made it possible to mimic the physiologic distribution of small embolic particles. In future, these might help to investigate the distribution of systemic emboli in different vascular territories in various pathologic conditions of the cerebral blood flow.
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Affiliation(s)
- S H Meves
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstr. 56, D-44791 Bochum, Germany.
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Abstract
Syringomyelia classically presents with slowly progressing dissociated sensory and upper and lower motor deficits. Atypical and acute manifestations have rarely been described. We report here on 3 patients with syringomyelia, who had acute and atypical brainstem symptoms with regard to the underlying disease. These symptoms occurred after acute elevation of the intrathoracic and intra-abdominal pressure, respectively, and remitted subsequently. Vertebrobasilar ischemia was initially suspected.
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Affiliation(s)
- S H Meves
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, Germany.
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