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Beckmann C, Foster-Witassek F, Brutsche M, Maeder MT, Eberli F, Roffi M, Pedrazzini G, Radovanovic D, Rickli H. Treatment and outcomes of patients with chronic lung disease and acute myocardial infarction: Insights from the nationwide AMIS plus registry. Eur J Clin Invest 2024; 54:e14193. [PMID: 38481088 DOI: 10.1111/eci.14193] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/25/2024] [Accepted: 02/25/2024] [Indexed: 05/15/2024]
Abstract
BACKGROUND Limited data are available on patients with chronic lung disease (CLD) presenting with acute myocardial infarction (AMI). We aimed to analyse baseline characteristics, treatment and outcome of those patients enrolled in the Swiss nationwide prospective AMIS Plus registry. METHODS All AMI patients enrolled between January 2002 and December 2021 with data on CLD, as defined in the Charlson Comorbidity Index, were included. The primary endpoints were in-hospital mortality and major adverse cardiac and cerebrovascular events (MACCE), defined as all-cause death, reinfarction and cerebrovascular events. Baseline characteristics, in-hospital treatments and outcomes were analysed using descriptive statistics and logistic regression. RESULTS Among 53,680 AMI patients enrolled during this time, 5.8% had CLD. Compared with patients without CLD, CLD patients presented more frequently with non-ST-elevation myocardial infarction (MI) and type 2 MI (12.8% vs. 6.5%, p < 0.001). With respect to treatment, CLD patients were less likely to receive P2Y12 inhibitors (p < 0.001) and less likely to undergo percutaneous coronary interventions (68.7% vs. 82.5%; p < 0.001). In-hospital mortality declined in AMI patients with CLD over time (from 12% in 2002 to 7.3% in 2021). Multivariable regression analysis showed that CLD was an independent predictor for MACCE (adjusted OR was 1.28 [95% CI 1.07-1.52], p = 0.006). CONCLUSION Patients with CLD and AMI were less likely to receive evidence-based pharmacologic treatments, coronary revascularization and had a higher incidence of MACCE during their hospital stay compared to those without CLD. Over 20 years, in-hospital mortality was significantly reduced in AMI patients, especially in those with CLD.
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Affiliation(s)
- C Beckmann
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - F Foster-Witassek
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - M Brutsche
- Lung Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - M T Maeder
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - F Eberli
- Division of Cardiology, Triemli Hospital, Zurich, Switzerland
| | - M Roffi
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - G Pedrazzini
- Department of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - D Radovanovic
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - H Rickli
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Morici N, Di Lauro S, Cusmano I, Birocchi S, Torracca L, Rubboli A. Inpatient Cardiac Rehabilitation Following Heart Valve Surgey: A Setting for the Tailored Management of Antithrombotic Therapy. Eur J Prev Cardiol 2024:zwae154. [PMID: 38679602 DOI: 10.1093/eurjpc/zwae154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/23/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024]
Affiliation(s)
| | - Silvia Di Lauro
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- Università degli studi di Milano, Milan, Italy
| | | | - Simone Birocchi
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Lucia Torracca
- Cardiac Surgery Division, Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Andrea Rubboli
- Department of Emergency, Internal Medicine and Cardiology, Division of Cardiology, S. Maria delle Croci Hospital, Ravenna, Italy
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Strahnen D, Stathi A, Beck J, Roelz R, Vasilikos I. Case report: Concurrent low-volume subdural hematoma and ipsilateral ischemic stroke presenting as capsular warning syndrome: a complex case with anticoagulation dilemma and dual pathology. Front Neurol 2024; 15:1358237. [PMID: 38445261 PMCID: PMC10912296 DOI: 10.3389/fneur.2024.1358237] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/06/2024] [Indexed: 03/07/2024] Open
Abstract
Background The simultaneous emergence of low-volume subdural hematoma and ipsilateral ischemic stroke in an atrial fibrillation patient who is under anticoagulation therapy is a rare and intricate clinical case. This report accentuates the diagnostic and treatment complexities associated with these consecutive neurological conditions. Case presentation An 83 years-old male patient initially presented with acute dyspnea, raising the suspicion of pulmonary embolism. After exclusion of pulmonary embolism through CT angiography, the patient experienced a sudden onset of left-sided hemiparesis without prior history of head trauma but with chronic intake of apixaban due to atrial fibrillation. Subsequent cranial CT tomography revealed a small right parietal subdural hematoma. After reversal of the anticoagulation therapy, surgical evacuation of the subdural hematoma was successfully performed. However, in the postoperative period, the patient developed new neurological symptoms that could not be explained by the reduced size of the subdural hematoma on a follow-up CT scan. Cranial MRI revealed the coexistence of acute ischemic stroke in the right corona radiata. The recent surgical procedure precluded guideline-recommended stroke treatment. Discussion This case underscores the complexities of diagnosing and treating concomitant small volume subdural hematoma and ischemic stroke, especially if the latter occurs in the corona radiata resulting in fluctuating symptoms known as "capsular warning syndrome." Reversal and secondary discontinuation of anticoagulant therapy for surgical intervention highlight the inherent risk of thrombotic events in anticoagulated patients. The development of tailored treatment strategies requires a multidisciplinary approach, and further research and guidelines are required in similar complex scenarios. Conclusion The presence of both a small subdural hematoma and an ipsilateral ischemic stroke presenting as capsular warning syndrome in an anticoagulated patient highlights the intricacy of their care. This case calls for a comprehensive and collaborative strategy to address complicated clinical scenarios.
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Affiliation(s)
- Daniel Strahnen
- Department of Neurosurgery, University Medical Center Freiburg, Freiburg, Germany
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Ten Berg JM, Overduin DC, van Ginkel DJ. What Oral Anticoagulant Is Best After TAVR: Vitamin K Antagonists or Direct Oral Anticoagulants? JACC Cardiovasc Interv 2024; 17:419-421. [PMID: 38355270 DOI: 10.1016/j.jcin.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 02/16/2024]
Affiliation(s)
- Jurriën M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Cardiology, University Medical Center Maastricht, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
| | - Daniël C Overduin
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Dirk-Jan van Ginkel
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
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Maciorowska M, Uziębło-Życzkowska B, Gorczyca-Głowacka I, Wożakowska-Kapłon B, Jelonek O, Wójcik M, Błaszczyk R, Kapłon-Cieślicka A, Gawałko M, Tokarek T, Rajtar-Salwa R, Bil J, Wojewódzki M, Szpotowicz A, Krzciuk M, Bednarski J, Bakuła-Ostalska E, Tomaszuk-Kazberuk A, Szyszkowska A, Wełnicki M, Mamcarz A, Krzesiński P. Oral anticoagulation therapy in atrial fibrillation patients at high risk of bleeding: Clinical characteristics and treatment strategies based on data from the Polish multicenter register of atrial fibrillation (POL-AF). Kardiol Pol 2024; 82:37-45. [PMID: 38230462 DOI: 10.33963/v.kp.98356] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Despite its benefits, oral anticoagulant (OAC) therapy in patients with atrial fibrillation (AF) is associated with hemorrhagic complications. AIMS We aimed to evaluate clinical characteristics of AF patients at high risk of bleeding and the frequency of OAC use as well as identify factors that predict nonuse of OACs in these patients. METHODS Consecutive AF patients hospitalized for urgent or planned reasons in cardiac centers were prospectively included in the registry in 2019. Patients with HAS-BLED ≥3 (high HAS-BLED group) were assumed to have a high risk of bleeding. RESULTS Among 3598 patients enrolled in the study, 29.2% were at high risk of bleeding (44.7% female; median [Q1-Q3] age 72 [65-81], CHA2DS2-VASc score 5 [4-6], HAS-BLED 3 [3-4]). In this group, 14.5% of patients did not receive OACs, 68% received NOACs, and 17.5% VKAs. In multivariable analysis, the independent predictors of nonuse of oral OACs were as follows: creatinine level (odds ratio [OR], 1.441; 95% confidence interval [CI], 1.174-1.768; P <0.001), a history of gastrointestinal bleeding (OR, 2.918; 95% CI, 1.395-6.103; P = 0.004), malignant neoplasm (OR, 3.127; 95% CI, 1.332-7.343; P = 0.009), and a history of strokes or transient ischemic attacks (OR, 0.327; 95% CI, 0.166-0.642; P = 0.001). CONCLUSIONS OACs were used much less frequently in the group with a high HAS-BLED score than in the group with a low score. Independent predictors of nonuse of OACs were creatinine levels, a history of gastrointestinal bleeding, and malignant neoplasms. A history of stroke or transient ischemic attack increased the chances of receiving therapy.
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Affiliation(s)
- Małgorzata Maciorowska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine - National Research Institute, Warszawa, Poland.
| | - Beata Uziębło-Życzkowska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine - National Research Institute, Warszawa, Poland
| | | | - Beata Wożakowska-Kapłon
- Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland
| | - Olga Jelonek
- Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland
| | - Maciej Wójcik
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Robert Błaszczyk
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | | | - Monika Gawałko
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
- Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Essen, Germany
| | - Tomasz Tokarek
- Center for Invasive Cardiology, Electrotherapy and Angiology, Nowy Sącz, Poland
- Center for Innovative Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Renata Rajtar-Salwa
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Jacek Bil
- Centre of Postgraduate Medical Education, Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warszawa, Poland
| | - Michał Wojewódzki
- Centre of Postgraduate Medical Education, Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warszawa, Poland
| | - Anna Szpotowicz
- Department of Cardiology, Regional Hospital, Ostrowiec Świętokrzyski, Poland
| | - Małgorzata Krzciuk
- Department of Cardiology, Regional Hospital, Ostrowiec Świętokrzyski, Poland
| | - Janusz Bednarski
- Department of Cardiology, St John Paul II Western Hospital, Clinic of Cardiology, Grodzisk Mazowiecki, Poland
- Lazarski University, Warszawa, Poland
| | - Elwira Bakuła-Ostalska
- Department of Cardiology, St John Paul II Western Hospital, Clinic of Cardiology, Grodzisk Mazowiecki, Poland
| | | | - Anna Szyszkowska
- Department of Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Marcin Wełnicki
- 3rd Department of Internal Diseases and Cardiology, Warsaw Medical University, Warszawa, Poland
| | - Artur Mamcarz
- 3rd Department of Internal Diseases and Cardiology, Warsaw Medical University, Warszawa, Poland
| | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine - National Research Institute, Warszawa, Poland
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Droppa M, Geisler T. Optimal Antithrombotic Strategies in Cardiogenic Shock. J Clin Med 2024; 13:277. [PMID: 38202284 PMCID: PMC10779586 DOI: 10.3390/jcm13010277] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024] Open
Abstract
Cardiogenic shock (CS) represents a critical condition with a high mortality rate. The most common cause of CS is coronary artery disease, and patients typically present with myocardial infarction, necessitating immediate treatment through percutaneous coronary intervention (PCI) and often requiring mechanical circulatory support. CS is associated with a prothrombotic situation, while on the other hand, there is often a significant risk of bleeding. This dual challenge complicates the selection of an optimal antithrombotic strategy. The choice of antithrombotic agents must be personalized, taking into consideration all relevant conditions. Repeated risk assessment, therapeutic monitoring, and adjusting antithrombotic therapy are mandatory in these patients. This review article aims to provide an overview of the current evidence and practical guidance on antithrombotic strategies in the context of CS.
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Affiliation(s)
| | - Tobias Geisler
- Department of Cardiology and Angiology, University Hospital of Tuebingen, 72076 Tuebingen, Germany
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Papazachariou A, Papadakis JA, Malikides V, Theodorakopoulou V, Vougiouklakis G, Malikides O, Kofteridis DP. The importance of intensive follow-up and achieving optimal chronic antithrombotic treatment in hospitalized medical patients with anemia: A prospective cohort study. Hellenic J Cardiol 2024:S1109-9666(23)00232-4. [PMID: 38176585 DOI: 10.1016/j.hjc.2023.12.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/11/2023] [Accepted: 12/30/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Anemia is a global health concern, particularly among the elderly on chronic antithrombotic treatment. Close monitoring of hemoglobin (Hb) levels and achievement of an optimized treatment significantly enhance patients' quality of life. This study aimed to examine the impact of antithrombotic treatment on Hb levels and readmissions in hospitalized patients with anemia. METHODS This is a prospective cohort study of patients admitted to the Department of Internal Medicine of the University Hospital of Heraklion, Greece, from November 2021 to October 2022 with the diagnosis of anemia while receiving antithrombotic treatment. Data regarding demographics, past medical history, and laboratory and endoscopy findings were recorded. For those receiving inappropriate therapy according to international guidelines, antithrombotic treatment was optimized. Subsequent follow-ups occurred at one and six months post-discharge. Six- and twelve-month anemia-caused readmissions, as well as annual mortality, were evaluated. RESULTS In total, 104 patients were assessed. Among them, 34.6% were on antiplatelets, 56.7% were on anticoagulants, and 8.7% were on combination treatment. The mean age was 80 ± 8.2 years, and 54.8% were males. On admission, mean Hb levels were 6.86 ± 1.23 g/dL, while 56 (53.8%) patients had severe anemia. Gastroscopy and colonoscopy were performed in 75.0% and 41.4% of patients, respectively, confirming gastrointestinal bleeding in most of the cases. Treatment optimization was carried out for 56 patients. Follow-up revealed elevated Hb levels after one and six months post-discharge, while anemia-related readmissions stayed below 10%. CONCLUSIONS Most hospitalized anemic patients on antithrombotic treatment had endoscopic findings favoring gastrointestinal bleeding. Half received inappropriate antithrombotic therapy. Treatment optimization and regular follow-up improved Hb levels and reduced readmissions.
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Affiliation(s)
- Andria Papazachariou
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece.
| | - John A Papadakis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Vironas Malikides
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | | | - George Vougiouklakis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Onoufrios Malikides
- Department of Cardiology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Diamantis P Kofteridis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
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Yamamoto M, Hayashida K, Hengstenberg C, Watanabe Y, Van Mieghem NM, Jin J, Saito S, Valgimigli M, Nicolas J, Mehran R, Moreno R, Kimura T, Chen C, Unverdorben M, Dangas GD. Predictors of All-Cause Mortality After Successful Transcatheter Aortic Valve Implantation in Patients With Atrial Fibrillation. Am J Cardiol 2023; 207:150-158. [PMID: 37741105 DOI: 10.1016/j.amjcard.2023.08.067] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/13/2023] [Indexed: 09/25/2023]
Abstract
Prevalent and incident atrial fibrillation are common in patients who undergo transcatheter aortic valve implantation and are associated with impaired postprocedural outcomes, including mortality. We determined predictors of long-term mortality in patients with atrial fibrillation after successful transcatheter aortic valve implantation. The EdoxabaN Versus standard of care and theIr effectS on clinical outcomes in pAtients havinG undergonE Transcatheter Aortic Valve Implantation-Atrial Fibrillation (ENVISAGE-TAVI AF) trial (NCT02943785) was a multicenter, prospective, randomized controlled trial in patients with prevalent or incident atrial fibrillation after successful transcatheter aortic valve implantation who received edoxaban or vitamin K antagonists. A Cox proportional hazard model was performed to identify predictors of all-cause mortality using a stepwise approach for multiple regression analysis. In addition, we assessed the performance of different risk scores and prediction models using ENVISAGE-TAVI AF data. Of 1,426 patients in ENVISAGE-TAVI AF, 178 (12.5%) died during the follow-up period (median 548 days). Our stepwise approach identified greater risk of mortality with older age, impaired renal function, nonparoxysmal atrial fibrillation, excessive alcohol use, New York Heart Association heart failure class III/IV, peripheral artery disease, and history of major bleeding or predisposition to bleeding. The present model (concordance statistic [c-statistic] 0.67) was a better discriminator than were other frequently used risk scores, such as the Society of Thoracic Surgeons score (c-statistic 0.56); Congestive heart failure, Hypertension, Age ≥75, Diabetes, Stroke, Vascular disease, Age 65 to 74 years, and Sex category (CHA2DS2-VASc) score (c-statistic 0.54); or Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly, and Drugs/alcohol concomitantly (HAS-BLED) score (c-statistic 0.58). In ENVISAGE-TAVI AF, several modifiable and nonmodifiable clinical characteristics were significantly associated with greater long-term all-cause mortality. Improved risk stratification to estimate the probability of mortality after successful transcatheter aortic valve implantation in patients with atrial fibrillation may improve long-term patient prognosis.
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Affiliation(s)
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University, Vienna, Austria
| | - Yusuke Watanabe
- Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - James Jin
- Global Specialty Medical Affairs, Daiichi Sankyo, Inc., Basking Ridge, New Jersey
| | - Shigeru Saito
- Division of Cardiology & Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Marco Valgimigli
- Division of Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Università della Svizzera Italiana (USI), Lugano, Switzerland; Department of Cardiology, University of Bern, Bern, Switzerland
| | - Johny Nicolas
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York
| | - Raul Moreno
- Department of Cardiology, University Hospital La Paz, Madrid, Spain
| | - Tetsuya Kimura
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | - Cathy Chen
- Global Specialty Medical Affairs, Daiichi Sankyo, Inc., Basking Ridge, New Jersey
| | - Martin Unverdorben
- Global Specialty Medical Affairs, Daiichi Sankyo, Inc., Basking Ridge, New Jersey
| | - George D Dangas
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York.
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Mannucci PM, Agosti P, Lettino M. Guidance for the antithrombotic management of persons with haemophilia and cardiovascular disease. Haemophilia 2023; 29:1390-1393. [PMID: 37729476 DOI: 10.1111/hae.14874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Pier Mannuccio Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pasquale Agosti
- Department of Pathophysiology and Transplantation and Fondazione Luigi Villa, Università degli Studi di Milano, Milan, Italy
| | - Maddalena Lettino
- Department for Cardiac, Thoracic and Vascular Diseases, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Kovács KB, Bencs V, Hudák L, Oláh L, Csiba L. Hemorrhagic Transformation of Ischemic Strokes. Int J Mol Sci 2023; 24:14067. [PMID: 37762370 PMCID: PMC10531605 DOI: 10.3390/ijms241814067] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Ischemic stroke, resulting from insufficient blood supply to the brain, is among the leading causes of death and disability worldwide. A potentially severe complication of the disease itself or its treatment aiming to restore optimal blood flow is hemorrhagic transformation (HT) increasing morbidity and mortality. Detailed summaries can be found in the literature on the pathophysiological background of hemorrhagic transformation, the potential clinical risk factors increasing its chance, and the different biomarkers expected to help in its prediction and clinical outcome. Clinicopathological studies also contribute to the improvement in our knowledge of hemorrhagic transformation. We summarized the clinical risk factors of the hemorrhagic transformation of ischemic strokes in terms of risk reduction and collected the most promising biomarkers in the field. Also, auxiliary treatment options in reperfusion therapies have been reviewed and collected. We highlighted that the optimal timing of revascularization treatment for carefully selected patients and the individualized management of underlying diseases and comorbidities are pivotal. Another important conclusion is that a more intense clinical follow-up including serial cranial CTs for selected patients can be recommended, as clinicopathological investigations have shown HT to be much more common than clinically suspected.
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Affiliation(s)
| | | | | | | | - László Csiba
- Department of Neurology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (K.B.K.); (V.B.); (L.H.); (L.O.)
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Palaiodimou L, Papagiannopoulou G, Katsanos AH, Eleftheriou A, Karapanayiotides T, Mitsias PD, Lemmens R, Molina CA, Alexandrov A, Caso V, Shoamanesh A, Sharma M, Tsivgoulis G. Efficacy and Safety of Oral Factor XIa Inhibitors in Stroke Prevention: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5562. [PMID: 37685629 PMCID: PMC10488897 DOI: 10.3390/jcm12175562] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/02/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Despite preventive measures, stroke rates remain high in the primary and secondary prevention settings. Factor XIa inhibition may offer a novel, safe and effective antithrombotic option for stroke prevention. METHODS We conducted a systematic review and meta-analysis including all available randomized controlled clinical trials (RCTs) that investigated the efficacy and safety of factor XIa inhibitors versus controls in primary or secondary stroke prevention. The primary efficacy and safety outcomes of interest were symptomatic ischemic stroke (IS) and the composite of major bleeding and clinically relevant non-major bleeding. RESULTS Four phase II dose-finding RCTs were included, comprising a total of 4732 patients treated with factor XIa inhibitors versus 1798 controls. Treatment with factor XIa inhibitors did not reduce the risk of IS compared to controls (RR: 0.89; 95% CI: 0.67-1.17). The composite of symptomatic IS and covert infarcts on brain MRI (RR: 1.01; 95% CI: 0.87-1.18), the composite of symptomatic IS and transient ischemic attack (TIA; RR: 0.78; 95% CI: 0.61-1.01), and the composite of major adverse cardiovascular events (RR: 1.07; 95% CI: 0.87-1.31) did not differ between the treatment groups. Treatment with factor XIa inhibitors did not increase the risk of the composite of major bleeding and clinically relevant non-major bleeding (RR: 1.19; 95% CI: 0.65-2.16), major bleeding alone (RR: 1.19; 95% CI: 0.64-2.22), intracranial bleeding (RR: 0.91; 95% CI: 0.26-3.19) or all-cause mortality (RR: 1.21; 95% CI: 0.77-1.90). CONCLUSION This meta-analysis provides reassuring evidence regarding the safety of factor XIa inhibitors. These findings, coupled with potential signals of efficacy in reducing IS (and TIA), underscore the importance of ongoing phase III RCTs for providing definitive data regarding the effect of factor XIa inhibition on stroke prevention.
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Affiliation(s)
- Lina Palaiodimou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Georgia Papagiannopoulou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Aristeidis H. Katsanos
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON L8L2X2, Canada
| | - Andreas Eleftheriou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Theodore Karapanayiotides
- Second Department of Neurology, School of Medicine, Faculty of Health Sciences, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Panayiotis D. Mitsias
- Neurology Department, University General Hospital of Heraklion, 71500 Heraklion, Greece
| | - Robin Lemmens
- Experimental Neurology, Department of Neurosciences, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
- VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, 3001 Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Carlos A. Molina
- Vall d’Hebron Stroke Center, Department of Neurology, Hospital Universitari Vall d’Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Andrei Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Valeria Caso
- Stroke Unit, Santa Maria della Misericordia Hospital, University of Perugia, 06129 Perugia, Italy
| | - Ashkan Shoamanesh
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON L8L2X2, Canada
| | - Mukul Sharma
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON L8L2X2, Canada
| | - Georgios Tsivgoulis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
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12
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Valgimigli M, Aboyans V, Angiolillo D, Atar D, Capodanno D, Halvorsen S, James S, Jüni P, Kunadian V, Landi A, Leonardi S, Mehran R, Montalescot G, Navarese EP, Niebauer J, Oliva A, Piccolo R, Price S, Storey RF, Völler H, Vranckx P, Windecker S, Fox KAA. Antithrombotic treatment strategies in patients with established coronary atherosclerotic disease: 2022 joint clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), Association for Acute CardioVascular Care (ACVC) and European Association of Preventive Cardiology (EAPC). Eur Heart J Cardiovasc Pharmacother 2023:7147298. [PMID: 37120728 DOI: 10.1093/ehjcvp/pvad032] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Multiple guidelines and consensus papers have addressed the role of antithrombotic strategies in patients with established coronary artery disease (CAD). Since evidence and terminology continue to evolve, the European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Association for Acute Cardiovascular Care (ACVC) and European Association of Preventive Cardiology (EAPC) undertook a consensus initiative to guide clinicians to select the optimal antithrombotic regimen for each patient. The aim of this document is to provide an update for clinicians on best antithrombotic strategies in patients with established CAD, classifying each treatment option in relation to the number of antithrombotic drugs irrespective of whether the traditional mechanism of action is expected to mainly inhibit platelets or coagulation cascade. With the aim to reach comprehensiveness of available evidence, we systematically reviewed and performed meta-analyses by means of both direct and indirect comparisons to inform the present consensus document.
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Affiliation(s)
- Marco Valgimigli
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via tesserete 48, 6900 Lugano, Switzerland
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, and INSERM 1094 & IRD, University of Limoges, 2, Martin Luther King ave, 87042, Limoges, France
| | - Dominick Angiolillo
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL 32209, USA
| | - Dan Atar
- Oslo University Hospital Ulleval, Department of Cardiology, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Via Santa Sofia, 78, Catania 95123, Italy
| | - Sigrun Halvorsen
- Institute of Clinical Medicine, University of Oslo, Blindern, P.O. Box 1078, N-0316, Oslo, Norway and Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway
| | - Stefan James
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala 751 85, Sweden
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Vijay Kunadian
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Antonio Landi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via tesserete 48, 6900 Lugano, Switzerland
| | - Sergio Leonardi
- University of Pavia and Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, United States of America
| | - Gilles Montalescot
- ACTION Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Eliano Pio Navarese
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Angelo Oliva
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele-Milan, Italy
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy
| | - Susanna Price
- Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK
| | - Robert F Storey
- Cardiovascular Research Unit, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Science Brandenburg, University of Potsdam, Potsdam, Germany
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Keith A A Fox
- Centre for Cardiovascular Science, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh
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13
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Larsen KT, Sandset EC, Selseth MN, Jahr SH, Koubaa N, Hillestad V, Kristoffersen ES, Rønning OM. Antithrombotic Treatment, Prehospital Blood Pressure, and Outcomes in Spontaneous Intracerebral Hemorrhage. J Am Heart Assoc 2023; 12:e028336. [PMID: 36870965 PMCID: PMC10111438 DOI: 10.1161/jaha.122.028336] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Background In acute intracerebral hemorrhage, both elevated blood pressure (BP) and antithrombotic treatment are associated with poor outcome. Our aim was to explore interactions between antithrombotic treatment and prehospital BP. Methods and Results This observational, retrospective study included adult patients with spontaneous intracerebral hemorrhage diagnosed by computed tomography within 24 hours, admitted to a primary stroke center during 2012 to 2019. The first recorded prehospital/ambulance systolic and diastolic BP were analyzed per 5 mm Hg increment. Clinical outcomes were in-hospital mortality, shift on the modified Rankin Scale at discharge, and mortality at 90 days. Radiological outcomes were initial hematoma volume and hematoma expansion. Antithrombotic (antiplatelet and/or anticoagulant) treatment was analyzed both together and separately. Modification of associations between prehospital BP and outcomes by antithrombotic treatment was explored by multivariable regression with interaction terms. The study included 200 women and 220 men, median age 76 (interquartile range, 68-85) years. Antithrombotic drugs were used by 252 of 420 (60%) patients. Compared with patients without, patients with antithrombotic treatment had significantly stronger associations between high prehospital systolic BP and in-hospital mortality (odds ratio [OR], 1.14 versus 0.99, P for interaction 0.021), shift on the modified Rankin Scale (common OR, 1.08 versus 0.96, P for interaction 0.001), and hematoma volume (coef. 0.03 versus -0.03, P for interaction 0.011). Conclusions In patients with acute, spontaneous intracerebral hemorrhage, antithrombotic treatment modifies effects of prehospital BP. Compared with patients without, patients with antithrombotic treatment have poorer outcomes with higher prehospital BP. These findings may have implications for future studies on early BP lowering in intracerebral hemorrhage.
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Affiliation(s)
- Kristin Tveitan Larsen
- Department of Neurology Akershus University Hospital Lørenskog Norway.,Department of Geriatric Medicine Oslo University Hospital Oslo Norway.,University of Oslo, Institute of Clinical Medicine Oslo Norway
| | - Else Charlotte Sandset
- Department of Neurology Oslo University Hospital Oslo Norway.,The Norwegian Air Ambulance Foundation Oslo Norway
| | | | - Silje Holt Jahr
- Department of Neurology Akershus University Hospital Lørenskog Norway.,University of Oslo, Institute of Clinical Medicine Oslo Norway
| | - Nojoud Koubaa
- Department of Neurology Akershus University Hospital Lørenskog Norway
| | - Vigdis Hillestad
- Department of Diagnostic Imaging Akershus University Hospital Lørenskog Norway
| | - Espen Saxhaug Kristoffersen
- Department of Neurology Akershus University Hospital Lørenskog Norway.,Department of General Practice University of Oslo, Institute of Health and Society Oslo Norway
| | - Ole Morten Rønning
- Department of Neurology Akershus University Hospital Lørenskog Norway.,University of Oslo, Institute of Clinical Medicine Oslo Norway
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14
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Forfang E, Larsen KT, Salman RA, Bell SM, Wester P, Berge E, Wyller TB, Rønning OM. Antithrombotic treatment after intracerebral hemorrhage: Surveys among stroke physicians in Scandinavia and the United Kingdom. Health Sci Rep 2023; 6:e1059. [PMID: 36698713 PMCID: PMC9854165 DOI: 10.1002/hsr2.1059] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/09/2022] [Accepted: 01/03/2023] [Indexed: 01/21/2023] Open
Abstract
Background and Aims It is unclear whether patients with previous intracerebral hemorrhage (ICH) should receive antithrombotic treatment to prevent ischemic events. We assessed stroke physicians' opinions about this, and their views on randomizing patients in trials assessing this question. Methods We conducted three web-based surveys among stroke physicians in Scandinavia and the United Kingdom. Results Eighty-nine of 205 stroke physicians (43%) responded to the Scandinavian survey, 161 of 180 (89%) to the UK antiplatelet survey, and 153 of 289 (53%) to the UK anticoagulant survey. In Scandinavia, 19 (21%) stroke physicians were uncertain about antiplatelet treatment after ICH for ischemic stroke or transient ischemic attack (TIA) and 21 (24%) for prior myocardial infarction. In the United Kingdom, 116 (77%) were uncertain for ischemic stroke or TIA and 115 (717%) for ischemic heart disease. In Scandinavia, 32 (36%) were uncertain about anticoagulant treatment after ICH for atrial fibrillation, and 26 (29%) for recurrent deep vein thrombosis or pulmonary embolism. In the United Kingdom, 145 (95%) were uncertain about anticoagulants after ICH in at least some cases. In both regions combined, 191 of 250 (76%) would consider randomizing ICH survivors in a trial of starting versus avoiding antiplatelets, and 176 of 242 (73%) in a trial of starting versus avoiding anticoagulants. Conclusion Considerable proportions of stroke physicians in Scandinavia and the United Kingdom were uncertain about antithrombotic treatment after ICH. A clear majority would consider randomizing patients in trials assessing this question. These findings support the need for such trials.
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Affiliation(s)
- Elisabeth Forfang
- Institute of Clinical MedicineUniversity of OsloOsloNorway
- Department of Geriatric MedicineOslo University HospitalOsloNorway
| | - Kristin Tveitan Larsen
- Institute of Clinical MedicineUniversity of OsloOsloNorway
- Department of Geriatric MedicineOslo University HospitalOsloNorway
| | | | - Simon M. Bell
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
| | - Per Wester
- Department of Public Health and Clinical ScienceUniversity of UmeåUmeåSweden
- Department of Clinical ScienceKarolinska Institutet Danderyds HospitalStockholmSweden
| | - Eivind Berge
- Department of CardiologyOslo University HospitalOsloNorway
| | - Torgeir Bruun Wyller
- Institute of Clinical MedicineUniversity of OsloOsloNorway
- Department of Geriatric MedicineOslo University HospitalOsloNorway
| | - Ole Morten Rønning
- Institute of Clinical MedicineUniversity of OsloOsloNorway
- Department of NeurologyAkershus University HospitalNordbyhagenNorway
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15
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Stančiaková L, Žolková J, Vadelová Ľ, Hornáková A, Kolková Z, Vážan M, Dobrotová M, Hollý P, Jedináková Z, Grendár M, Bolek T, Samoš M, Biringer K, Danko J, Burjanivová T, Lasabová Z, Kubisz P, Staško J. DNA Polymorphisms in Pregnant Women with Sticky Platelet Syndrome. J Clin Med 2022; 11. [PMID: 36362759 DOI: 10.3390/jcm11216532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/25/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Sticky platelet syndrome (SPS) is a thrombophilia caused by the increased aggregability of platelets in response to the addition of low concentrations of epinephrine (EPI) and/or adenosine diphosphate (ADP). Some of the single nucleotide polymorphisms (SNP), alleles and haplotypes of platelet glycoprotein receptors were proved to have a role in the etiology of thrombotic episodes When comparing SPS and the control group, in VEGFA rs3025039, the p value for both CC vs. TT and CT vs. TT analyses was <0.001. Interestingly, no minor TT genotype was present in the SPS group, suggesting the thrombotic pathogenesis of recurrent spontaneous abortions (RSA) in these patients. Moreover, we found a significant difference in the presence of AT containing a risky A allele and TT genotype of ALPP rs13026692 (p = 0.034) in SPS patients when compared with the controls. Additionally, we detected a decreased frequency of the GG (CC) genotype of FOXP3 rs3761548 in patients with SPS and RSA when compared with the control group (p value for the CC (GG) vs. AA (TT) 0.021). This might indicate an evolutionary protective mechanism of the A (T) allele in the SPS group against thrombotic complications in pregnancy. These results can be used for antithrombotic management in such pregnant patients.
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16
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Komarov AL, Krivosheeva EN, Makeev MI, Merkulov EV, Tripoten MI, Panchenko EP. [Patent foramen ovale as the cause of recurrent embolic strokes. Case report]. TERAPEVT ARKH 2022; 94:1109-1114. [PMID: 36286763 DOI: 10.26442/00403660.2022.09.201842] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
А clinical case of a young patient with recurrent ischemic strokes is presented. The problems of diagnostic embolic strokes are discussed. We set out the algorithm for identifying patients, in whom patent foramen ovale is the most probable cause of embolic stroke. Detailed consideration of imaging diagnostic methods possibility is included. Hypothesis of probable source of cardioembolism from patent foramen ovale is presented. Recommendations for the secondary prevention of recurrent ischemic stroke, associated with patent foramen ovale, are provided. We also considered the issues of antithrombotic treatment.
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Affiliation(s)
- A L Komarov
- Chazov National Medical Research Center of Cardiology
| | | | - M I Makeev
- Chazov National Medical Research Center of Cardiology
| | - E V Merkulov
- Chazov National Medical Research Center of Cardiology
| | - M I Tripoten
- Chazov National Medical Research Center of Cardiology
| | - E P Panchenko
- Chazov National Medical Research Center of Cardiology
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17
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Masiliūnas R, Dapkutė A, Grigaitė J, Lapė J, Valančius D, Bacevičius J, Katkus R, Vilionskis A, Klimašauskienė A, Ekkert A, Jatužis D. High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort. Medicina (Kaunas) 2022; 58:medicina58060800. [PMID: 35744063 PMCID: PMC9230037 DOI: 10.3390/medicina58060800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/10/2022] [Accepted: 06/10/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a five-fold increased risk for acute ischemic stroke (AIS). We aimed to estimate the prevalence of AF in a Lithuanian cohort of stroke patients, and its impact on patients regarding case fatality, functional outcome, and health-related quality of life (HRQoL) at 90 days. Materials and Methods: A single-center prospective study was carried out for four non-consecutive months between December 2018 and July 2019 in one of the two comprehensive stroke centers in Eastern Lithuania. A telephone-based follow-up was conveyed at 90 days using the modified Rankin Scale (mRS) and EuroQoL five-dimensional three-level descriptive system (EQ-5D-3L) with a self-rated visual analog scale (EQ-VAS). One-year case fatality was investigated. Results: We included 238 AIS patients with a mean age of 71.4 ± 11.9 years of whom 45.0% were female. A striking 97 (40.8%) AIS patients had a concomitant AF, in 68 (70.1%) of whom the AF was pre-existing. The AIS patients with AF were at a significantly higher risk for a large vessel occlusion (LVO; odds ratio 2.72 [95% CI 1.38−5.49], p = 0.004), and had a more severe neurological impairment at presentation (median NIHSS score (interquartile range): 9 (6−16) vs. 6 (3−9), p < 0.001). The LVO status was only detected in those who had received computed tomography angiography. Fifty-five (80.9%) patients with pre-existing AF received insufficient anticoagulation at stroke onset. All patients received a 12-lead ECG, however, in-hospital 24-h Holter monitoring was only performed in 3.4% of AIS patients without pre-existing AF. Although multivariate analyses found no statistically significant difference in one-year stroke patient survival and favorable functional status (mRS 0−2) at 90 days, when adjusted for age, gender, reperfusion treatment, baseline functional status, and baseline NIHSS, stroke patients with AF had a significantly poorer self-perceived HRQoL, indicated by a lower EQ-VAS score (regression coefficient ± standard error: β = −11.776 ± 4.850, p = 0.017). Conclusions: In our single-center prospective observational study in Lithuania, we found that 40.8% of AIS patients had a concomitant AF, were at a higher risk for an LVO, and had a significantly poorer self-perceived HRQoL at 90 days. Despite the high AF prevalence, diagnostic tools for subclinical AF were greatly underutilized.
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Affiliation(s)
- Rytis Masiliūnas
- Center of Neurology, Vilnius University, 08661 Vilnius, Lithuania; (A.D.); (J.G.); (D.V.); (A.K.); (A.E.); (D.J.)
- Correspondence: ; Tel.: +370-688-62356
| | - Austėja Dapkutė
- Center of Neurology, Vilnius University, 08661 Vilnius, Lithuania; (A.D.); (J.G.); (D.V.); (A.K.); (A.E.); (D.J.)
| | - Julija Grigaitė
- Center of Neurology, Vilnius University, 08661 Vilnius, Lithuania; (A.D.); (J.G.); (D.V.); (A.K.); (A.E.); (D.J.)
| | - Jokūbas Lapė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania;
| | - Domantas Valančius
- Center of Neurology, Vilnius University, 08661 Vilnius, Lithuania; (A.D.); (J.G.); (D.V.); (A.K.); (A.E.); (D.J.)
| | - Justinas Bacevičius
- Center of Cardiology and Angiology, Vilnius University, 08661 Vilnius, Lithuania; (J.B.); (R.K.)
| | - Rimgaudas Katkus
- Center of Cardiology and Angiology, Vilnius University, 08661 Vilnius, Lithuania; (J.B.); (R.K.)
| | | | - Aušra Klimašauskienė
- Center of Neurology, Vilnius University, 08661 Vilnius, Lithuania; (A.D.); (J.G.); (D.V.); (A.K.); (A.E.); (D.J.)
| | - Aleksandra Ekkert
- Center of Neurology, Vilnius University, 08661 Vilnius, Lithuania; (A.D.); (J.G.); (D.V.); (A.K.); (A.E.); (D.J.)
| | - Dalius Jatužis
- Center of Neurology, Vilnius University, 08661 Vilnius, Lithuania; (A.D.); (J.G.); (D.V.); (A.K.); (A.E.); (D.J.)
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Pope MK, Atar D, Svilaas A, Hole T, Nielsen JD, Hintze U, Crisby M, Raatikainen P, Airaksinen KEJ, Virdone S, Pieper K, Kayani G, Le Heuzey JY, Steffel J, Stepinska J, Bassand JP, Camm AJ. Risk profile, antithrombotic treatment and clinical outcomes of patients in Nordic countries with atrial fibrillation - results from the GARFIELD-AF registry. Ann Med 2021; 53:485-494. [PMID: 33818226 PMCID: PMC8023647 DOI: 10.1080/07853890.2021.1893897] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/16/2021] [Indexed: 10/27/2022] Open
Abstract
AIMS The objective was to evaluate the clinical characteristics, management and two-year outcomes of patients with newly diagnosed non-valvular atrial fibrillation at risk for stroke in Nordic countries. METHODS We examined the baseline characteristics, antithrombotic treatment, and two-year clinical outcomes of patients from four Nordic countries. RESULTS A total of 52,080 patients were enrolled in the GARFIELD-AF. Out of 29,908 European patients, 2,396 were recruited from Nordic countries. The use of oral anticoagulants, alone or in combination with antiplatelet (AP), was higher in Nordic patients in all CHA2DS2-VASc categories: 0-1 (72.8% vs 60.3%), 2-3 (78.7% vs 72.9%) and ≥4 (79.2% vs 74.1%). In Nordic patients, NOAC ± AP was more frequently prescribed (32.0% vs 27.7%) and AP monotherapy was less often prescribed (10.4% vs 18.2%) when compared with Non-Nordic European patients. The rates (per 100 patient years) of all-cause mortality and non-haemorrhagic stroke/systemic embolism (SE) were similar in Nordic and Non-Nordic European patients [3.63 (3.11-4.23) vs 4.08 (3.91-4.26), p value = .147] and [0.98 (0.73-1.32) vs 1.02 (0.93-1.11), p value = .819], while major bleeding was significantly higher [1.66 (1.32-2.09) vs 1.01 (0.93-1.10), p value < .001]. CONCLUSION Nordic patients had significantly higher major bleeding than Non-Nordic-European patients. In contrast, rates of all-cause mortality and non-haemorrhagic stroke/SE were comparable. CLINICAL TRIAL REGISTRATION Unique identifier: NCT01090362. URL: http://www.clinicaltrials.gov. KEY MESSAGE Nordic countries had significantly higher major bleeding than Non-Nordic-European countries. Rates of mortality and non-haemorrhagic stroke/SE were similar .
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Affiliation(s)
- Marita Knudsen Pope
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Hamar Hospital, Innlandet Hospital Trust, Hamar, Norway
| | - Dan Atar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Arne Svilaas
- Nymoen Medical Centre, Kongsberg, Norway
- Lipid Clinic, Oslo University Hospital, Oslo, Norway
| | - Torstein Hole
- Clinic of Medicine and Rehabilitation, More and Romsdal Hospital Trust, Alesund, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Trondheim, Norway
| | - Jørn Dalsgaard Nielsen
- Department of Cardiology, Copenhagen University Hospital, Copenhagen University, Copenhagen, Denmark
| | - Ulrik Hintze
- Department of Cardiology, Hospital of South West Jutland, Esbjerg, University of Southern Denmark, Denmark
| | - Milita Crisby
- Department of Neurobiology, Care Science and Society, Karolinska University Hospital, Stockholm, Sweden
| | - Pekka Raatikainen
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Tampere, Finland
| | | | | | | | | | | | - Jan Steffel
- Division of Electrophysiology and Pacing, Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - Janina Stepinska
- Institute of Cardiology, Intensive Cardiac Therapy Clinic, Warsaw, Poland
| | - Jean-Pierre Bassand
- Thrombosis Research Institute, London, UK
- University of Besançon, Besancon, France
| | - A. John Camm
- Cardiology Clinical Academic Group Molecular & Clinical Sciences Research Institute, St. George’s University of London, London, UK
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19
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Douros A, Cui Y, Platt RW, Filion KB, Sebastiani G, Renoux C. Utilization and long-term persistence of direct oral anticoagulants among patients with nonvalvular atrial fibrillation and liver disease. Br J Clin Pharmacol 2021; 88:994-1009. [PMID: 34409636 DOI: 10.1111/bcp.15046] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 07/25/2021] [Accepted: 08/07/2021] [Indexed: 11/28/2022] Open
Abstract
AIMS We characterized the utilization and long-term treatment persistence of direct oral anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation (NVAF) and liver disease. METHOD Using the UK Clinical Practice Research Datalink, we assembled a population-based cohort of NVAF patients with liver disease initiating oral anticoagulants between 2011 and 2020. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) of the association between patient characteristics and initiation of DOACs vs vitamin K antagonists (VKAs). Cox proportional hazards models estimated hazard ratios (HRs) and 95% CIs of the association between patient characteristics and the switch from VKAs to DOACs vs remaining on VKAs. We also assessed the 5-year treatment persistence with DOACs vs VKAs, and whether ischemic stroke or bleeding preceded treatment discontinuation. RESULTS Our cohort included 3167 NVAF patients with liver disease initiating DOACs (n = 2247, 71%) or VKAs (n = 920, 29%). Initiators of DOACs were more likely to have prior ischemic stroke (OR 1.44, 95% CI 1.12-1.85) than VKA initiators but less likely to have used antiplatelet agents (OR 0.66, 95% CI 0.53-0.82). Patients switching to DOACs were more likely to have used selective serotonin reuptake inhibitors (HR 1.64, 95% CI 1.13-2.37) than those remaining on VKAs. At 5 years, 31% of DOAC initiators and 9% of VKA initiators remained persistent. Only few patients were diagnosed with ischemic stroke or bleeding prior to treatment discontinuation. CONCLUSION Most NVAF patients with liver disease initiated treatment with DOACs. Long-term persistence with DOACs was higher than with VKAs but remained relatively low.
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Affiliation(s)
- Antonios Douros
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, Quebec, Canada.,Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ying Cui
- Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, Quebec, Canada
| | - Robert W Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, Quebec, Canada.,Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Kristian B Filion
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, Quebec, Canada
| | - Giada Sebastiani
- Department of Medicine, McGill University, Montreal, Quebec, Canada.,Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Christel Renoux
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, Quebec, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
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20
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Didier R, Lhermusier T, Auffret V, Eltchaninoff H, Le Breton H, Cayla G, Commeau P, Collet JP, Cuisset T, Dumonteil N, Verhoye JP, Beurtheret S, Lefèvre T, Teiger E, Carrié D, Himbert D, Albat B, Cribier A, Sudre A, Blanchard D, Bar O, Rioufol G, Collet F, Houel R, Labrousse L, Meneveau N, Ghostine S, Manigold T, Guyon P, Delepine S, Favereau X, Souteyrand G, Ohlmann P, Doisy V, Beygui F, Gommeaux A, Claudel JP, Bourlon F, Bertrand B, Iung B, Gilard M. TAVR Patients Requiring Anticoagulation: Direct Oral Anticoagulant or Vitamin K Antagonist? JACC Cardiovasc Interv 2021; 14:1704-1713. [PMID: 34274294 DOI: 10.1016/j.jcin.2021.05.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Using French transcatheter aortic valve replacement (TAVR) registries linked with the nationwide administrative databases, the study compared the rates of long-term mortality, bleeding, and ischemic events after TAVR in patients requiring oral anticoagulation with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). BACKGROUND The choice of optimal drug for anticoagulation after TAVR remains debated. METHODS Data from the France-TAVI and FRANCE-2 registries were linked to the French national health single-payer claims database, from 2010 to 2017. Propensity score matching was used to reduce treatment-selection bias. Two primary endpoints were death from any cause (efficacy) and major bleeding (safety). RESULTS A total of 24,581 patients who underwent TAVR were included and 8,962 (36.4%) were treated with OAC. Among anticoagulated patients, 2,180 (24.3%) were on DOACs. After propensity matching, at 3 years, mortality (hazard ratio [HR]: 1.37; 95% confidence interval [CI]: 1.12-1.67; P < 0.005) and major bleeding including hemorrhagic stroke (HR: 1.64; 95% CI: 1.17-2.29; P < 0.005) were lower in patients on DOACs compared with those on VKAs. The rates of ischemic stroke (HR: 1.32; 95% CI: 0.81-2.15; P = 0.27) and acute coronary syndrome (HR: 1.17; 95% CI: 0.68-1.99; P = 0.57) did not differ among groups. CONCLUSIONS In these large multicenter French TAVR registries with an exhaustive clinical follow-up, the long-term mortality and major bleeding were lower with DOACs than VKAs at discharge. The present study supports preferential use of DOACs rather than VKAs in patients requiring oral anticoagulation therapy after TAVR.
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Affiliation(s)
- Romain Didier
- Department of Cardiology, Brest University Hospital, Brest, France
| | | | | | | | | | | | | | - Jean Philippe Collet
- Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | | | | | - Emmanuel Teiger
- University Hospital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Dominique Himbert
- Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Bernard Albat
- University Hospital of Montpellier, Montpellier, France
| | | | | | - Didier Blanchard
- University Hospital Paris Ouest, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | - Remi Houel
- Saint Joseph Hospital, Marseille, France
| | | | | | - Said Ghostine
- Hospital Marie Lannelongue, Le Plessis-Robinson, France
| | - Thibaut Manigold
- University of Nantes, Department of Cardiologie, Saint-Herblain, France
| | | | | | - Xavier Favereau
- Private Hospital of Parly II, Le Chesnay-Rocquencourt, France
| | | | | | | | | | | | | | | | - Bernard Bertrand
- Department of Cardiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Bernard Iung
- Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, Brest, France.
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21
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Häner JD, Fürholz M, Kleinecke C, Galea R, Streit SR, Fankhauser M, Cherni T, Valgimigli M, Windecker S, Meier B, Gloekler S. Impact of individual stroke risk on outcome after Amplatzer left atrial appendage closure in patients with atrial fibrillation. Catheter Cardiovasc Interv 2021; 97:E1002-E1010. [PMID: 33022121 DOI: 10.1002/ccd.29318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/26/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To investigate periprocedural and long-term outcome of left atrial appendage closure (LAAC) using Amplatzer occluders with respect to individual pre-procedural stroke risk. BACKGROUND LAAC is a proven strategy for prevention from stroke and bleeding in patients with nonvalvular atrial fibrillation not amenable to oral anticoagulation. Whether individual pre-procedural stroke risk may affect procedural and long-term clinical outcome after LAAC is unclear. METHODS Multicenter study of consecutive patients who underwent Amplatzer-LAAC. Using pre-procedural CHADS2 score, outcomes were compared between a low (0-2 points) and a high stroke risk group (3-6 points). RESULTS Five hundred consecutive patients (73.9 ± 10.1 years) who underwent Amplatzer-LAAC. Two hundred and forty eight had preprocedural CHADS2 score ≤ 2 points (low-risk group) and the remaining 252 patients had 3-6 points (high-risk group). Periprocedural complication rates (6.0% vs. 5.6%, p = .85), procedural success (LAAC without major periprocedural or device-related complications or major para-device leaks: 89.4% vs. 87.9%, p = .74), and 30-day-mortality (2.4% vs. 2.6%, p = .77) were comparable. After 1,346 patient-years (PY), the long-term composite efficacy endpoint (stroke, systemic embolism, cardiovascular, and unexplained death) was reached in 23/653 (3.5/100 PY) versus 52/693 (7.5/100 PY); HR = 2.13; 95%-CI, 1.28-3.65, p = .002) with stroke rates 67% and 68% lower than anticipated by preprocedural CHADS2 score. Combined safety endpoint (major periprocedural complications and major, life-threatening or fatal bleedings) occurred in 22/653 (3.4/100 PY) versus 28/693 (4.0/100 PY); HR = 1.20; 95%-CI, 0.66-2.20, p = .52). CONCLUSIONS Compared with patients at low risk of stroke, LAAC with Amplatzer devices is associated with similar safety and efficacy in high-risk patients in our study.
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Affiliation(s)
- Jonas D Häner
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Monika Fürholz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Roberto Galea
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Samuel R Streit
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mate Fankhauser
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Takwa Cherni
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.,Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bernhard Meier
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Steffen Gloekler
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
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22
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Chen J, Sun H, Wu M, Zhong X, Zhang Y. Spontaneous arterial thrombosis in a patient with advanced ovarian clear cell cancer: a case report and literature review. J Int Med Res 2021; 48:300060520926742. [PMID: 32485125 PMCID: PMC7273781 DOI: 10.1177/0300060520926742] [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: 11/16/2022] Open
Abstract
Patients with ovarian cancer are often in a hypercoagulable state and have a high
risk of venous thrombosis, including deep vein thrombosis and pulmonary
embolism. However, arterial thrombosis is relatively rare in ovarian cancer. We
report a case a 46-year-old woman with ovarian clear cell carcinoma who
developed arterial and venous thrombosis in the lower extremities as the first
manifestation. Her arterial thrombosis-related ischemic symptoms were not
responsive to anticoagulant treatment of low-molecular-weight heparin, but
improved after neoadjuvant chemotherapy and surgery. Therefore, we hypothesize
that the optimal therapy for arterial thrombosis in ovarian cancer is treatment
for the underlying disease (i.e., ovarian cancer). A thorough investigation is
required to determine the relationships between arterial thrombosis and ovarian
cancer and antithrombotic treatments for ovarian cancer related-arterial
thrombosis.
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Affiliation(s)
- Jing Chen
- Department of Gynecology & Obstetrics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huimin Sun
- Department of Pathology, Weifang People's Hospital, Weifang, China
| | - Minrong Wu
- Department of Radiology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Xiaolin Zhong
- Department of Gynecology & Obstetrics, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Yuqin Zhang
- Department of Gynecology & Obstetrics, Zhongshan Hospital, Fudan University, Shanghai, China
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23
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Guillet B, Cayla G, Lebreton A, Trillot N, Wibaut B, Falaise C, Castet S, Gautier P, Claeyssens S, Schved JF. Long-Term Antithrombotic Treatments Prescribed for Cardiovascular Diseases in Patients with Hemophilia: Results from the French Registry. Thromb Haemost 2021; 121:287-296. [PMID: 33099283 PMCID: PMC7895544 DOI: 10.1055/s-0040-1718410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/28/2020] [Indexed: 02/08/2023]
Abstract
Cardiovascular diseases (CVDs) are a major issue in aging patients with hemophilia (PWHs). Antithrombotic agents are widely used in the general population for CVD treatment, but this recommendation is not fully applicable to PWHs. To improve treatment strategies, a prospective case-control study (COCHE) that analyzed CVD management and follow-up (2 years/patient) in PWHs was performed in France from 2011 to 2018. In total, 68 PWHs (median age: 65 years [39-89]; 48 mild, 10 moderate, and 10 severe hemophilia) were included (n = 50 with acute coronary syndrome, n = 17 with atrial fibrillation, n = 1 with both). They were matched with 68 control PWHs without antithrombotic treatment. In our series, bleeding was significantly influenced by (1) hemophilia severity, with a mean annualized bleeding ratio significantly higher in COCHE patients than in controls with basal clotting factor level up to 20%, (2) antihemorrhagic regimen (on-demand vs. prophylaxis) in severe (hazard ratio [HR] = 16.69 [95% confidence interval, CI: 8.2-47.26]; p < 0.0001) and moderate hemophilia (HR = 42.43 [95% CI: 1.86-966.1]; p = 0.0028), (3) type of antithrombotic treatment in mild hemophilia, with a significantly higher risk of bleeding in COCHE patients than in controls for dual-pathway therapy (HR = 15.64 [95% CI: 1.57-115.8]; p = 0.019), anticoagulant drugs alone (HR = 9.91 [95% CI: 1.34-73.47]; p = 0.0248), dual antiplatelet therapy (HR = 5.31 [95% CI: 1.23-22.92]; p = 0.0252), and single antiplatelet therapy (HR = 3.76 [95% CI: 1.13-12.55]; p = 0.0313); and (4) HAS-BLED score ≥3 (odds ratio [OR] = 33 [95% CI: 1.43-761.2]; p = 0.0065). Gastrointestinal bleeding was also significantly higher in COCHE patients than in controls (OR = 15 [95% CI: 1.84-268]; p = 0.0141). The COCHE study confirmed that antithrombotic treatments in PWHs are associated with increased bleeding rates in function of hemophilia-specific factors and also of known factors in the general population.
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Affiliation(s)
- Benoît Guillet
- Centre Régional de Traitement des Maladies Hémorragiques, CHU de Rennes, et Université de Rennes 1, France
- CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), Univ Rennes, UMR_S 1085, Rennes, France
| | - Guillaume Cayla
- Service de Cardiologie CHU de Nîmes, Université de Montpellier, Nimes, France
| | - Aurélien Lebreton
- Centre Régional de Traitement des Hémophiles, CHU de Clermont-Ferrand, France
| | - Nathalie Trillot
- Centre Régional de Traitement des Hémophiles, CHU de Lille, France
| | - Bénédicte Wibaut
- Centre Régional de Traitement des Hémophiles, CHU de Lille, France
| | - Céline Falaise
- Centre Régional de Traitement des Hémophiles, CHU La Timone, Marseille, France
| | - Sabine Castet
- Centre Régional de Traitement des Hémophiles, CHU de Bordeaux, France
| | - Philippe Gautier
- Centre Régional de Traitement des Hémophiles, CHU de Caen, France
| | | | - Jean-François Schved
- Centre Régional de Traitement des Hémophiles, Hôpital Saint-Eloi, CHRU de Montpellier, Montpellier, France
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24
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Liu H, Wang Z, Sun H, Teng T, Li Y, Zhou X, Yang Q. Thrombosis and Coagulopathy in COVID-19: Current Understanding and Implications for Antithrombotic Treatment in Patients Treated With Percutaneous Coronary Intervention. Front Cardiovasc Med 2021; 7:599334. [PMID: 33537347 PMCID: PMC7847976 DOI: 10.3389/fcvm.2020.599334] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 08/27/2020] [Accepted: 12/10/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), a respiratory syndrome, is a global pandemic. Therefore, there is an urgent need to explore mechanisms implicated in the pathogenesis of the disease. Clinical and autopsy studies show a complex chain of events preceding COVID-19-related death. The disease is characterized by endothelial dysfunction, platelet activation, thrombosis, coagulopathy, and multiple organ failure. Globally, millions of patients with coronary heart disease undergo percutaneous coronary intervention (PCI) each year. These patients undergo high-intensity antithrombotic therapy during hospitalization and dual antiplatelet therapy (DAPT) for at least 6 months post PCI. COVID-19 is characterized by changes in platelet counts. Treatment of ischemic events that occur during stent implantation is associated with bleeding complications in patients following PCI complicated by COVID-19. This review summarizes recent progress in activation status and levels of COVID-19-related platelet changes. These findings will provide information on the effectiveness of antithrombotic therapy for the management of platelet changes in COVID-19 patients.
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Affiliation(s)
- Hangkuan Liu
- Graduate School of Tianjin Medical University, Tianjin, China
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhijia Wang
- Graduate School of Tianjin Medical University, Tianjin, China
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Haonan Sun
- Graduate School of Tianjin Medical University, Tianjin, China
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Tianming Teng
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yongle Li
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xin Zhou
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qing Yang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
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25
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Zhou P, Wan J, Ran F, Gao F, Yang D, Dai X, Sun Y, Wang P. Development and validation of a prognostic prediction model for antithrombotic-related chronic subdural hematoma in patients with recent acute myocardial infarction. Cardiovasc Diagn Ther 2020; 10:1770-1784. [PMID: 33381422 DOI: 10.21037/cdt-20-763] [Citation(s) in RCA: 1] [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: 11/06/2022]
Abstract
Background Antithrombotic therapy is a cornerstone of acute myocardial infarction (AMI) treatment and is thought to be associated with an increased risk of chronic subdural hematoma (CSDH). However, no well-established model exists to predict subsequent antithrombotic treatment outcomes after CSDH in patients with recent AMI. We aimed to identify a prognostic model to predict the 6-month outcome of treatment with antithrombotic therapy. Methods This multicenter retrospective analysis involved 553 patients with recent AMI with antithrombotic-related CSDH. Several candidate clinical variables and biomarkers were examined in the training cohort (Chengdu training cohort; n=368). Patients with unfavorable outcomes had experienced at least 1 of the following: major adverse cardiovascular events (MACE), recurrence, or a modified Rankin scale (mRS) score of 2 to 6. To develop a 6-month outcome prediction model, three approaches were used: (I) a demographic variable model, (II) a clinical marker model and (III) a decision-driven model. A clinical outcome prediction model based on the superior predictors was assessed by logistic regression analysis. The nomogram for the final model was internally validated using a bootstrap procedure and externally validated in an independent cohort (Anhui cohort; n=185). Results Model A produced 7 predictors of unfavorable outcomes, while models B and C yielded 2 and 1 predictors, respectively. The areas under the curve (AUC) increased from 0.743 [model A; 95% confidence interval (CI): 0.680-0.782] to 0.889 (model A + B + C; 95% CI: 0.851-0.916). The final prediction model included age, systolic blood pressure (SBP), body mass index (BMI), the Glasgow Coma Scale (GCS), the estimated glomerular filtration rate (eGFR), the early resumption of antithrombotic therapy, hematoma thickness and the presence of abdominal obesity, frailty and previous bleeding. Internal and external validation of the selected final model revealed adequate C-statistics and calibration slope values (internal validation: 0.81 and 0.78; external validation: 0.80 and 0.76, respectively). Conclusions This model provided a risk stratification tool to predict unfavorable outcomes in patients with recent AMI with antithrombotic-related CSDH. Because the study was based on ten readily practical and available variables, it may be widely applicable to guide management and complement clinical assessment.
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Affiliation(s)
- Peng Zhou
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, China.,Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, China
| | - Jindong Wan
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, China.,Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, China
| | - Fei Ran
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, China.,Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, China
| | - Feng Gao
- Department of Cardiology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Dachun Yang
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Xiaozhen Dai
- School of Biosciences and Technology, Chengdu Medical College, Chengdu, China
| | - Yun Sun
- Department of Party Secretary, The First Affiliated Hospital, Chengdu Medical College, Chengdu, China
| | - Peijian Wang
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, China.,Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, China
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26
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Larsen KT, Forfang E, Pennlert J, Glader EL, Kruuse C, Wester P, Ihle-Hansen H, Carlsson M, Berge E, Al-Shahi Salman R, Bruun Wyller T, Rønning OM. STudy of Antithrombotic Treatment after IntraCerebral Haemorrhage: Protocol for a randomised controlled trial. Eur Stroke J 2020; 5:414-422. [PMID: 33598560 PMCID: PMC7856578 DOI: 10.1177/2396987320954671] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 05/13/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022] Open
Abstract
Background and aims Many patients with prior intracerebral haemorrhage have indications for antithrombotic treatment with antiplatelet or anticoagulant drugs for prevention of ischaemic events, but it is uncertain whether such treatment is beneficial after intracerebral haemorrhage. STudy of Antithrombotic Treatment after IntraCerebral Haemorrhage will assess (i) the effects of long-term antithrombotic treatment on the risk of recurrent intracerebral haemorrhage and occlusive vascular events after intracerebral haemorrhage and (ii) whether imaging findings, like cerebral microbleeds, modify these effects. Methods STudy of Antithrombotic Treatment after IntraCerebral Haemorrhage is a multicentre, randomised controlled, open trial of starting versus avoiding antithrombotic treatment after non-traumatic intracerebral haemorrhage, in patients with an indication for antithrombotic treatment. Participants with vascular disease as an indication for antiplatelet treatment are randomly allocated to antiplatelet treatment or no antithrombotic treatment. Participants with atrial fibrillation as an indication for anticoagulant treatment are randomly allocated to anticoagulant treatment or no anticoagulant treatment. Cerebral CT or MRI is performed before randomisation. Duration of follow-up is at least two years. The primary outcome is recurrent intracerebral haemorrhage. Secondary outcomes include occlusive vascular events and death. Assessment of clinical outcomes is performed blinded to treatment allocation. Target recruitment is 500 participants. Trial status: Recruitment to STudy of Antithrombotic Treatment after IntraCerebral Haemorrhage is on-going. On 30 April 2020, 44 participants had been enrolled in 31 participating hospitals. An individual patient–data meta-analysis is planned with similar randomised trials.
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Affiliation(s)
- Kristin Tveitan Larsen
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | | | - Johanna Pennlert
- Department of Public Health and Clinical Medicine, Umeå University Hospital, Umeå, Sweden
| | - Eva-Lotta Glader
- Department of Public Health and Clinical Medicine, Umeå University Hospital, Umeå, Sweden
| | - Christina Kruuse
- Herlev Gentofte Hospital and University of Copenhagen, Herlev, Denmark
| | - Per Wester
- Department of Public Health and Clinical Medicine, Umeå University Hospital, Umeå, Sweden.,Department of Clinical Sciences, Karolinska Institute, Danderyds Hospital, Stockholm, Sweden
| | - Hege Ihle-Hansen
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Maria Carlsson
- Department of Neurology, Nordland Hospital Trust, Bodø, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Eivind Berge
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Torgeir Bruun Wyller
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Ole Morten Rønning
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway.,Department of Neurology, Akershus University Hospital, Lørenskog, Norway
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27
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Camaro C, Damman P. Antithrombotic PreTreatment and Invasive Strategies in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome. J Clin Med 2020; 9:jcm9082578. [PMID: 32784868 PMCID: PMC7464603 DOI: 10.3390/jcm9082578] [Citation(s) in RCA: 1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 11/16/2022] Open
Abstract
In the current era, the antithrombotic treatment of patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) includes standard aspirin, and one of the potent P2Y12 inhibitors ticagrelor or prasugrel. The optimal timing of ticagrelor has not been adequately studied, while prasugrel is only recommended after coronary angiography prior to PCI. The invasive strategy, including indication and timing of angiography, depends on risk stratification and a mortality benefit has been shown in selected high-risk NSTE-ACS undergoing early (<24 h) intervention.
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Seif S, Ayuna A, Kumar A, Macdonald J. Massive coronary thrombosis caused primary percutaneous coronary intervention to fail in a COVID-19 patient with ST-elevation myocardial infarction. Catheter Cardiovasc Interv 2020; 97:E667-E669. [PMID: 32473051 PMCID: PMC7300872 DOI: 10.1002/ccd.29050] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/14/2020] [Accepted: 05/16/2020] [Indexed: 11/12/2022]
Abstract
COVID-19 is a new viral infection that has a significant impact on global health and economy. Because of its rapid spread worldwide, it may influence the prognosis of other medical conditions, such as ST-segment elevation myocardial infarction (STEMI). We report a case of a 58-year female patient admitted with an infero-posterior STEMI on the background of recently positive COVID-19 swab. Reperfusion was attempted through primary PCI but unfortunately failed to restore coronary blood flow due to massive thrombotic burden despite several attempts of balloon dilatation and aspiration thrombectomy. She sadly died later on because of hemodynamic deterioration. This scenario raises concerns about Neutrophil Extracellular Traps (NETS) which might potentially have propagated inflammation and thrombosis via platelets' aggregation leading to enhanced coagulopathy and massive coronary thrombosis. Therefore, we suggest primary PCI as the first-choice of revascularization in patients with combined COVID-19 and STEMI. Additionally, we emphasize on the importance of using the potent new generation P2Y12 inhibitors along with GPIIb/IIIa inhibitors in every STEMI patient with COVID-19 to achieve favorable conditions for primary PCI as well as favorable outcomes after stent implantation.
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Affiliation(s)
- Sherif Seif
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.,Cardiology Department, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Ahmed Ayuna
- Cardiology Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - Abhishek Kumar
- Cardiology Department, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - John Macdonald
- Cardiology Department, Salford Royal NHS Foundation Trust, Salford, UK
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Lacour T, Semaan C, Genet T, Ivanes F. Insights for increased risk of failed fibrinolytic therapy and stent thrombosis associated with COVID-19 in ST-segment elevation myocardial infarction patients. Catheter Cardiovasc Interv 2020; 97:E241-E243. [PMID: 32352633 PMCID: PMC7267248 DOI: 10.1002/ccd.28948] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/18/2020] [Indexed: 11/16/2022]
Abstract
Important health resources are dedicated worldwide to the management of COVID‐19. This new disease, due to its large diffusion, may significantly hamper the prognosis of other pathologies, such as ST‐segment elevation myocardial infarction (STEMI) because of (a) a possible direct negative impact and (b) shortage of first response medical resources and increased delays to reperfusion. We report the case of a 68‐year‐old man admitted for anterior STEMI and asymptomatic COVID‐19. Due to extended transportation delays to a cathlab, he received intravenous fibrinolytic therapy, which failed. Reperfusion was achieved with rescue coronary angioplasty, but the patient experienced two episodes of acute stent thrombosis at 2‐ and 36‐hr following admission and despite optimal medical therapy. He finally died because of cardiogenic shock. This raises concerns about a possible increase in platelet aggregability associated with COVID‐19 leading to an increased risk of stent thrombosis, particularly in the context of STEMI. This pleads for the promotion of primary coronary angioplasty as the first‐choice revascularization technique in this population and the use of new generation P2Y12 inhibitors. In addition, the use of GPIIb/IIIa inhibitors may be considered in every STEMI patient with COVID‐19 to prevent the risk of acute stent thrombosis.
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Affiliation(s)
- Thibaud Lacour
- Centre Hospitalier Régional Universitaire de Tours, Service de Cardiologie, Tours, France
| | - Carl Semaan
- Centre Hospitalier Régional Universitaire de Tours, Service de Cardiologie, Tours, France.,Faculté de Médecine, Université de Tours, Tours, France
| | - Thibaud Genet
- Centre Hospitalier Régional Universitaire de Tours, Service de Cardiologie, Tours, France
| | - Fabrice Ivanes
- Centre Hospitalier Régional Universitaire de Tours, Service de Cardiologie, Tours, France.,Faculté de Médecine, Université de Tours, Tours, France
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Márquez MF, Baños-González MA, Guevara-Valdivia ME, Vázquez-Acosta J, de los Ríos Ibarra MO, Aguilar-Linares JA, Jiménez-Cruz M, Matadamas-Hernández N, Camacho-Casillas R, Magaña-Magaña R, Rojel-Martínez U, Alcocer-Gamba MA, Lara-Vaca S, Rodríguez-Reyes H, Islava-Gálvez MA, Betancourt-Hernández LE, Reyes-Reyes N, Beltrán-Gámez ME, Cantú-Brito C, Baños-Velasco AZ, del Rivero Morfin PJ, González-Hermosillo JA. Anticoagulation Therapy by Age and Embolic Risk for Nonvalvular Atrial Fibrillation in Mexico, an Upper-Middle-Income Country: The CARMEN-AF Registry. Glob Heart 2020; 15:32. [PMID: 32489805 PMCID: PMC7218765 DOI: 10.5334/gh.767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/23/2020] [Indexed: 11/20/2022] Open
Abstract
Background Documenting the patterns of oral anticoagulation therapy (OAT) is essential to prevent thromboembolic complications of nonvalvular atrial fibrillation (NVAF). Objective To report the patterns of OAT according to age and thromboembolic risk in patients included in CARMEN-AF, a nationwide registry of NVAF in Mexico, an upper middle-income country. Material and methods There were 1,423 consecutive patients ≥18 years old and with at least one thromboembolic risk factor enrolled in the CARMEN-AF Registry at their regular clinical visit during a three-year period. They were analyzed according to 1) age, 2) AF type, and 3) CHA2DS2-VASc score. Results Overall, 16.4% of patients did not receive antithrombotic treatment, 19.4% received antiplatelet drugs (APD), 29.2% vitamin K antagonists (VKA), and 34.6% direct oral anticoagulants (DOAC). With increasing age, the proportion of subjects treated with VKA decreased significantly from 36.2% in subjects <65 years to 22.5% in those ≥75 years old (P <0.0001). Concomitantly, an increase in both APD and no antithrombotic treatment was observed with increasing age. DOAC were prescribed equally among all age groups (34.2% in <65, 36.0% in 65-74, and 33.9% in ≥75). According to the type of AF, VKA use was more common in patients with permanent AF (32.7%). A lower use of DOAC was observed in high thromboembolic risk subjects (33.6% in CHA2DS2-VASc ≥2) compared with the moderate risk group (41% in CHA2DS2-VASc = 1). Conclusions VKA use for NVAF in Mexico decreased in relation to increasing age. The proportion of DOAC therapy was the same in all age groups. Nevertheless, elderly patients with high thromboembolic risk received a suboptimal thromboprophylaxis. These data could help to improve gaps in the implementation of global guidelines. Clinical trial registration http://www.clinicaltrials.gov. Unique identifier: NCT02334852. Highlights CARMEN-AF is a nationwide multi-centric registry seeking to bridge the data gap on anticoagulation therapy for NVAF in Mexico.Elderly patients are more prone to receive suboptimal OAT for NVAF.DOAC were less frequently used in high thromboembolic risk patients (CHA2DS2-VASc ≥2).
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Affiliation(s)
| | - Manuel A. Baños-González
- Centro de Investigación y Posgrado, División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco (UJAT), MX
| | - Milton E. Guevara-Valdivia
- Unidad Médica de Alta Especialidad del Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Centro Médico Nacional “La Raza”, Instituto Mexicano del Seguro Social, MX
| | | | | | | | - Marcelo Jiménez-Cruz
- Hospital de Cardiología, Centro Médico Nacional “Siglo XXI”, Instituto Mexicano del Seguro Social, MX
| | | | | | | | | | | | | | | | | | | | | | | | - Carlos Cantú-Brito
- Departamento de Neurología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, MX
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Christersson C, James SK, Lindhagen L, Ahlsson A, Friberg Ö, Jeppsson A, Ståhle E. Comparison of warfarin versus antiplatelet therapy after surgical bioprosthetic aortic valve replacement. Heart 2019; 106:838-844. [PMID: 31757813 PMCID: PMC7282554 DOI: 10.1136/heartjnl-2019-315453] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/19/2019] [Accepted: 10/25/2019] [Indexed: 11/13/2022] Open
Abstract
Objectives To compare effectiveness of warfarin and antiplatelet exposure regarding both thrombotic and bleeding events, following surgical aortic valve replacement with a biological prosthesis(bioSAVR). Methods The study included all patients in Sweden undergoing a bioSAVR during 2008–2014 who were alive at discharge from the index hospital stay. Exposure was analysed and defined as postdischarge dispension of any antithrombotic pharmaceutical, updated at each following dispensions and categorised as single antiplatelet (SAPT), warfarin, warfarin combined with SAPT, dual antiplatelet (DAPT) or no antithrombotic treatment. Exposure to SAPT was used as comparator. Outcome events were all-cause mortality, ischaemic stroke, haemorrhagic stroke, any thromboembolism and major bleedings. We continuously updated adjustments for comorbidities with any indication for antithrombotic treatment by Cox regression analysis. Results We identified 9539 patients with bioSAVR (36.8% women) at median age of 73 years with a mean follow-up of 3.13 years. As compared with SAPT, warfarin alone was associated with a lower incidence of ischaemic stroke (HR 0.49, 95% CI 0.35 to 0.70) and any thromboembolism (HR 0.75, 95% CI 0.60 to 0.94) but with no difference in mortality (HR 0.94, 95% CI 0.78 to 1.13). The incidence of haemorrhagic stroke (HR 1.94, 95% CI 1.07 to 3.51) and major bleeding (HR 1.67, 95% CI 1.30 to 2.15) was higher during warfarin exposure. As compared with SAPT, DAPT was not associated with any difference in ischaemic stroke or any thromboembolism. Risk-benefit analyses demonstrated that 2.7 (95% CI 1.0 to 11.9) of the ischaemic stroke cases could potentially be avoided per every haemorrhagic stroke caused by warfarin exposure instead of SAPT during the first year. Conclusion In patients discharged after bioSAVR, warfarin exposure as compared with SAPT exposure was associated with lower long-term risk of ischaemic stroke and thromboembolic events, and with a higher incidence of bleeding events but with similar mortality.
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Affiliation(s)
| | - Stefan K James
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Lars Lindhagen
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Anders Ahlsson
- Department of Thoracic and Cardiovascular Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine Sahlgrenska Academy, Gothenburg, Sweden
| | - Örjan Friberg
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
| | - Anders Jeppsson
- Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisabeth Ståhle
- Department of Surgical Sciences Thoracic Surgery, University Hospital Uppsala, Uppsala, Sweden
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Bae JS, Ahn JH, Tantry US, Gurbel PA, Jeong YH. Should Antithrombotic Treatment Strategies in East Asians Differ from Caucasians? Curr Vasc Pharmacol 2019; 16:459-476. [PMID: 29345591 DOI: 10.2174/1570161116666180117103238] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 05/03/2017] [Revised: 07/17/2017] [Accepted: 01/01/2018] [Indexed: 11/22/2022]
Abstract
With over 1.5 billion people, East Asians are the most populous race in the world. Health status in this population is an important global issue. In the contemporary trials of antithrombotic treatment, East Asian patients have a lower risk for atherothrombotic diseases (especially, Coronary Artery Disease [CAD]) and a higher risk for bleeding (especially, gastrointestinal bleeding and hemorrhagic stroke). Despite these observations, antithrombotic treatment strategies in East Asian patients are mainly based on the American or European guidelines that are derived from randomized, controlled trials including mostly Caucasians. Despite a low response to clopidogrel, East Asian patients with CAD show a similar or even a lower rate of ischemic event occurrence and higher bleeding risk compared with Caucasian patients. The latter is referred to as the "East Asian Paradox", suggesting a dissimilar therapeutic window for antiplatelet therapy than Caucasians. In addition, different net clinical benefits have been observed between the races with potent P2Y12 inhibitors that may be related to racial differences in pharmacokinetic and pharmacodynamic profiles. Furthermore, there is emerging concern regarding differences between East Asian vs. Western patients in pharmacodynamic and clinical efficacies of anticoagulant agents. We now summarize experimental and clinical evidence of the efficacy and safety of antithrombotic agents in the East Asian population. We suggest the concept of "race-tailored antithrombotic treatment" in CAD patients and/or in patients undergoing percutaneous coronary intervention.
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Affiliation(s)
- Jae S Bae
- Department of Internal Medicine, Gyeongsang National University, School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jong-Hwa Ahn
- Department of Internal Medicine, Gyeongsang National University, School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Udaya S Tantry
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Fairfax, Virginia, United States
| | - Paul A Gurbel
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Fairfax, Virginia, United States
| | - Young-Hoon Jeong
- Department of Internal Medicine, Gyeongsang National University, School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, Korea.,Institute of the Health Sciences, Gyeongsang National University, Jinju, Korea
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Jerjes-Sanchez C, Corbalan R, Barretto ACP, Luciardi HL, Allu J, Illingworth L, Pieper KS, Kayani G. Stroke prevention in patients from Latin American countries with non-valvular atrial fibrillation: Insights from the GARFIELD-AF registry. Clin Cardiol 2019; 42:553-560. [PMID: 30873623 PMCID: PMC6522993 DOI: 10.1002/clc.23176] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/01/2019] [Accepted: 03/14/2019] [Indexed: 01/03/2023] Open
Abstract
Background Atrial fibrillation (AF) is an important preventable cause of stroke. Anticoagulation (AC) therapy can reduce this risk. However, prescribing patterns and outcomes in patients with non‐valvular AF (NVAF) from Latin American countries are poorly described. Methods Using data from the Global Anticoagulant Registry in the FIELD‐AF (GARFIELD‐AF), we examined the stroke prevention strategies and the 1‐year outcomes in patients from four Latin American countries: Argentina, Brazil, Chile, and Mexico. Results A total of 4162 patients (2010‐2014) were included in this analysis. At the time of AF diagnosis, 39.9% of patients were prescribed vitamin K antagonists (VKA) ± antiplatelet (AP) therapy, 21.8% non‐VKA oral anticoagulant (NOAC) ± AP, 24.1% AP only and 14.1% no antithrombotic treatment. The proportion of moderate‐high risk patients receiving no AC therapy at participating centers was highest in Mexico (46.4%) and lowest in Chile (14.3%). During 1‐year follow‐up, the rates of all‐cause mortality, stroke/SE and major bleeding were: 5.77 (95% CI) (5.06‐6.56), 1.58 (1.23‐2.02), and 0.99 (0.72‐1.36) and per 100 person‐years, respectively, which are higher than the global rates across all countries in GARFIELD‐AF. Unadjusted rates of all‐cause mortality were highest in Argentina, 6.95 (5.43‐8.90), and lowest in Chile, 4.01 (2.92‐5.52). Conclusions GARFIELD‐AF results describes the marked variation in the baseline characteristics and patterns of antithrombotic treatments in patients with NVAF in four Latin American countries. Over one‐third of patients with a moderate‐to‐high risk of stroke received no AC therapy, highlighting the need for improved management of patients according to national guideline. Clinical Trial Registration—URL http://www.clinicaltrials.gov. Unique identifier: NCT01090362.
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Affiliation(s)
- Carlos Jerjes-Sanchez
- Instituto de Cardiologia y Medicina Vascular, TEC Salud, Tecnológico de Monterrey, Monterrey, Mexico
| | - Ramon Corbalan
- Cardiovascular Division, Pontificia Universidad Catolica, Santiago, Chile
| | | | | | - Jagan Allu
- Thrombosis Research Institute, London, UK
| | | | - Karen S Pieper
- Thrombosis Research Institute, London, UK.,Duke Clinical Research Institute, Durham, North Carolina
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Yamamiya A, Kitamura K, Ishii Y, Mitsui Y, Yoshida H. Safety of endoscopic sphincterotomy in patients undergoing antithrombotic treatment: a retrospective study. Ther Adv Gastrointest Endosc 2019; 12:2631774519846327. [PMID: 31192316 PMCID: PMC6537482 DOI: 10.1177/2631774519846327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 04/05/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study investigated the safety of endoscopic sphincterotomy in patients undergoing antithrombotic treatment. METHODS From January 2014 to December 2016, a single-center retrospective study was conducted. Of the 80 patients with naïve papilla receiving antithrombotic treatment who underwent endoscopic sphincterotomy, 76 patients were retrospectively analyzed. We divided the participants into two groups as follows: 45 patients who discontinued antithrombotic treatment (discontinuation group) and 31 patients who continued antithrombotic treatment (continuation group). We evaluated the safety of endoscopic sphincterotomy in patients with naïve papilla who received antithrombotic treatment. RESULTS The percentage of patients requiring emergency endoscopic retrograde cholangiopancreatography in the continuation group was significantly higher than that in the discontinuation group (55% vs 11%; p = 0.001). The incidence of adverse events did not differ significantly between the two groups. Neither bleeding nor perforation occurred in either group. The length of hospital stay did not differ significantly between the two groups. CONCLUSIONS Endoscopic sphincterotomy in patients undergoing antithrombotic treatment may be safe if the guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment are followed.
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Affiliation(s)
- Akira Yamamiya
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | | | - Yu Ishii
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yuta Mitsui
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hitoshi Yoshida
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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Yu LJ, Chen S, Xu Y, Zhang ZX. Clinical analysis of antithrombotic treatment and occurrence of stroke in elderly patients with nonvalvular persistent atrial fibrillation. Clin Cardiol 2018; 41:1353-1357. [PMID: 30141193 DOI: 10.1002/clc.23057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/16/2018] [Accepted: 08/21/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is common in elderly patients and is associated with ischemic stroke. We sought to explore the current status of antithrombotic therapy in elderly patients with nonvalvular persistent AF. METHODS This is a retrospective study and data were collected from the First Hospital of China Medical University. A total of 300 patients were enrolled from January 2015 to June 2017. Patients were divided into two groups: Group 1 (from 65-74) and Group 2 (older than 75). The status of antithrombotic treatment was recorded. Follow-ups were done at 7, 90 , 180, and 360 days after discharge. The occurrence of stroke was recorded. RESULTS For 287 patients with a CHA2 DS2 -VASc score ≥2, 41.10% received oral anticoagulants (OAC), 27.20% received new oral anticoagulants (NOAC), 42.20% received antiplatelet agents, 16.70% received no antithrombotic treatment. From 2015 to the first half 2017, the ratio of OAC was 25.90%, 51.89%, and 49.30%, respectively; ratio of NOAC were 16.90%, 30.19%, and 39.10%, respectively. During the four times follow-up, percentage of patients who had good treatment compliance was 65%, 49.2%, 38.5%, and 25% stroke rate was 6.7% in total 300 patients. Logistic regression analysis showed age older than 75 (odds ratio [OR] 4.812), prior stroke (OR 4.109) were risk factors of stroke, and OAC treatment (OR 0.021) could prevent stroke. CONCLUSION Ratio of antithrombotic therapy in elderly patients with nonvalvular persistent AF was low and drug compliance was poor. Age, prior history of stroke, and OAC treatment are the important predictive factors of stoke in elderly patients.
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Affiliation(s)
- Lu-Jiao Yu
- Department of Gerontology, The First Hospital of China Medical University, Shenyang, China
| | - Shuai Chen
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, China
| | - Yao Xu
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, China
| | - Zi-Xin Zhang
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, China
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Tokiwa S, Shimmura H, Nomura S, Watanabe R, Kurita M, Yoshida N, Yamashita K, Nishikawa Y, Kouzmenko A, Kato S. Degarelix treatment is compatible with diabetes and antithrombotic therapy in patients with prostate cancer. Res Rep Urol 2017; 9:225-232. [PMID: 29264358 PMCID: PMC5724412 DOI: 10.2147/rru.s146180] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction Therapeutically induced androgen deficiency (AD) is a standard treatment for patients with prostate cancer, but it is often associated with various adverse effects (AEs) that may lead to discontinuation. Some AEs may depend on the patient's health condition, while others may be due to complications of the drug delivery method. Degarelix is a gonadotropin-releasing hormone (GnRH) antagonist widely used for the treatment of androgen-dependent prostate cancer. This study aimed to ascertain the following: 1) the compatibility of degarelix treatment with diabetes and 2) any specific causal associations of degarelix injections with increased blood clotting and antithrombotic therapy requirements. Patients and methods The medical records of 162 patients with prostate cancer who had undergone degarelix treatment were retrospectively examined. The association of a medical history of diabetes and anticoagulant co-treatment with degarelix treatment discontinuation was analyzed statistically. Results Rapid and significant decreases in prostate-specific antigen (PSA) levels during the course of degarelix treatment were detected for patients with prostate cancer regardless of clinical state. During the 27 months of treatment, 68 subjects (48%) ceased degarelix treatment, owing to several reasons, mainly financial issues. Among these subjects, 19 had diabetes, while 35 were treated with antithrombotics. Extensive statistical analysis indicated that there were no causal associations between degarelix treatment discontinuation and preexisting diabetes or antithrombotic therapy. Conclusion Our study suggests that preexisting diabetes and antithrombotic therapy were not significant factors for the discontinuation of degarelix treatment in patients with prostate cancer.
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Affiliation(s)
- Suguru Tokiwa
- Department of Urology, Jyoban Hospital, Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Hiroaki Shimmura
- Department of Urology, Jyoban Hospital, Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Shuhei Nomura
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.,Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo.,Research Institute of Innovative Medicine, Tokiwa Foundation, Iwaki
| | - Ryota Watanabe
- Department of Urology, Jyoban Hospital, Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Minoru Kurita
- Department of Urology, Jyoban Hospital, Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Naoto Yoshida
- Department of Urology, Jyoban Hospital, Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Kaori Yamashita
- Department of Urology, Jyoban Hospital, Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Yoshitaka Nishikawa
- Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan
| | - Alexander Kouzmenko
- Department of Life Sciences, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Shigeaki Kato
- Research Institute of Innovative Medicine, Tokiwa Foundation, Iwaki
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Donnini I, Rinnoci V, Nannucci S, Valenti R, Pescini F, Mariani G, Bianchi S, Dotti MT, Federico A, Inzitari D, Pantoni L. Pregnancy in CADASIL. Acta Neurol Scand 2017; 136:668-671. [PMID: 28608406 DOI: 10.1111/ane.12784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited cerebral small vessel disease caused by NOTCH3 gene mutations. CADASIL women are frequently considered at high risk of systemic vascular events during pregnancy and often prescribed with antithrombotic drugs. This decision is not evidence-based considering the lack of data about pregnancy outcome in CADASIL. We describe our experience on pregnancy in CADASIL patients. MATERIALS AND METHODS We reviewed records of 50 CADASIL females followed in our center, and we collected prospective information in six patients for a total of 93 pregnancies. RESULTS No woman had the disease onset or suffered from cerebral vascular ischemic events during pregnancy. Sixteen miscarriages (17.2%) were recorded. There were 72 vaginal births, and five cesarean sections. Considering the six patients followed prospectively (for a total of eight pregnancies), data on fetal growth and newborns weight were in line with those from the general population. Considering gestational complications, we recorded mild proteinuria without hypertension in one patient and hyperinsulinemia and pre-eclampsia in another affected by a known nephropathy. Antithrombotic drugs were used in three patients, in one for an unrelated coexisting prothrombotic condition. CONCLUSIONS CADASIL does not seem to be associated with an unfavorable outcome of pregnancy either for women and fetuses. Patients and treating physicians should be reassured that pregnancy can be safely initiated in CADASIL, as there is no evidence to support a specific preventive antithrombotic treatment during pregnancy in CADASIL. Larger studies are needed to definitively confirm these conclusions.
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Affiliation(s)
- I. Donnini
- NEUROFARBA Department; University of Florence; Florence Italy
| | - V. Rinnoci
- NEUROFARBA Department; University of Florence; Florence Italy
| | - S. Nannucci
- NEUROFARBA Department; University of Florence; Florence Italy
- Department of Emergency Neurology; C. Mondino National Neurological Institute; Pavia Italy
| | - R. Valenti
- NEUROFARBA Department; University of Florence; Florence Italy
| | - F. Pescini
- Stroke Unit; Emergency Department; Azienda Ospedaliero Universitaria Careggi; Florence Italy
| | - G. Mariani
- Gynecology and Obstetrics Department; University of Florence; Florence Italy
| | - S. Bianchi
- Department of Medical Surgical and Neurological Sciences; University of Siena; Siena Italy
| | - M. T. Dotti
- Department of Medical Surgical and Neurological Sciences; University of Siena; Siena Italy
| | - A. Federico
- Department of Medical Surgical and Neurological Sciences; University of Siena; Siena Italy
| | - D. Inzitari
- NEUROFARBA Department; University of Florence; Florence Italy
| | - L. Pantoni
- NEUROFARBA Department; University of Florence; Florence Italy
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Esteve-Pastor MA, Marín F, Bertomeu-Martinez V, Roldán-Rabadán I, Cequier-Fillat Á, Badimon L, Muñiz-García J, Valdés M, Anguita-Sánchez M. Do physicians correctly calculate thromboembolic risk scores? A comparison of concordance between manual and computer-based calculation of CHADS2 and CHA2 DS2 -VASc scores. Intern Med J 2017; 46:583-9. [PMID: 26929032 DOI: 10.1111/imj.13048] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Clinical risk scores, CHADS2 and CHA2 DS2 -VASc scores, are the established tools for assessing stroke risk in patients with atrial fibrillation (AF). AIM The aim of this study is to assess concordance between manual and computer-based calculation of CHADS2 and CHA2 DS2 -VASc scores, as well as to analyse the patient categories using CHADS2 and the potential improvement on stroke risk stratification with CHA2 DS2 -VASc score. METHODS We linked data from Atrial Fibrillation Spanish registry FANTASIIA. Between June 2013 and March 2014, 1318 consecutive outpatients were recruited. We explore the concordance between manual scoring and computer-based calculation. We compare the distribution of embolic risk of patients using both CHADS2 and CHA2 DS2 -VASc scores RESULTS The mean age was 73.8 ± 9.4 years, and 758 (57.5%) were male. For CHADS2 score, concordance between manual scoring and computer-based calculation was 92.5%, whereas for CHA2 DS2 -VASc score was 96.4%. In CHADS2 score, 6.37% of patients with AF changed indication on antithrombotic therapy (3.49% of patients with no treatment changed to need antithrombotic treatment and 2.88% of patients otherwise). Using CHA2 DS2 -VASc score, only 0.45% of patients with AF needed to change in the recommendation of antithrombotic therapy. CONCLUSION We have found a strong concordance between manual and computer-based score calculation of both CHADS2 and CHA2 DS2 -VASc risk scores with minimal changes in anticoagulation recommendations. The use of CHA2 DS2 -VASc score significantly improves classification of AF patients at low and intermediate risk of stroke into higher grade of thromboembolic score. Moreover, CHA2 DS2 -VASc score could identify 'truly low risk' patients compared with CHADS2 score.
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Affiliation(s)
- M A Esteve-Pastor
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - F Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | | | - Á Cequier-Fillat
- Department of Cardiology, Hospital de Bellvitge, Barcelona, Spain
| | - L Badimon
- Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - J Muñiz-García
- Department of Cardiology, Hospital Universitario A Coruña, La Coruña and, Spain
| | - M Valdés
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - M Anguita-Sánchez
- Department of Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain
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Caro-Codón J, Galeote G, Álvarez-Ortega C, Moreno R, López-Sendón JL. A Marble in the Heart. JACC Cardiovasc Interv 2016; 9:2573-2574. [PMID: 27889346 DOI: 10.1016/j.jcin.2016.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/06/2016] [Accepted: 09/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Juan Caro-Codón
- Cardiology Department, La Paz University Hospital, Madrid, Spain.
| | | | | | - Raul Moreno
- Cardiology Department, La Paz University Hospital, Madrid, Spain
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Nahas R, Saliba W, Elias A, Elias M. The Prevalence of Thrombophilia in Women With Recurrent Fetal Loss and Outcome of Anticoagulation Therapy for the Prevention of Miscarriages. Clin Appl Thromb Hemost 2016; 24:122-128. [PMID: 27799457 DOI: 10.1177/1076029616675967] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 01/16/2023] Open
Abstract
OBJECTIVE To estimate the prevalence of thrombophilia in women with recurrent miscarriages and to assess the effect of antithrombotic therapy. DESIGN A retrospective cohort study between the years 2004 and 2010. SETTING A hypercoagulation community clinic in northern Israel. PATIENTS Four hundred ninety pregnant women referred for thrombophilia screening. MAIN OUTCOME MEASURES Screening results for thrombophilia and antithrombotic treatment with enoxaparin, aspirin, or both and pregnancy outcomes. RESULTS The most common thrombophilia in our study group was factor V Leiden mutation with a prevalence of 20.9% followed by protein S deficiency with a prevalence of 19%. Live birth rate was higher in the group of women who received enoxaparin regardless of whether a specific thrombophilia could be found. This finding was more pronounced in women who had ≥4 miscarriages. CONCLUSION The prevalence of thrombophilia was higher in our study group than in the general population. Furthermore, treatment with enoxaparin might improve the rate of live births in women with or without evidence of thrombophilia, especially in women with ≥4 miscarriages.
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Affiliation(s)
- Rawan Nahas
- 1 Department of Pedeiatrics, Mount Sinai Hospital, New York, NY, USA
| | - Walid Saliba
- 2 Department of Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Adi Elias
- 3 Department of Medicine H, Rambam Medical Center, Haifa, Israel
| | - Mazen Elias
- 4 Department of Internal Medicine C, Haemek Medical Center, Afula, Israel
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Lukács D, Stáczer N, Vajta L, Olasz L, Joób-Fancsaly Á, Szalma J. [Dental and oral surgical treatment of medication-induced bleeding patients: Audit of the national guideline in Hungary]. Orv Hetil 2016; 157:1722-1728. [PMID: 27774803 DOI: 10.1556/650.2016.30568] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In 2015 a new Hungarian guideline was published regarding dental treatment and management of anticoagulated patients in agreement of the Hungarian Association of Oral and Maxillofacial Surgeons and the Dental Implantology Association of Hungarian Dentists. AIM The aim of the authors was to evaluate the efficiency and safety of local hemostatic measures recommended by the guideline in anticoagulated patients. METHOD In these patients, postoperative bleeding episodes were examined after dental and oral surgical treatments, retrospectively. RESULTS Overall 263 bleeding risk cases were treated; 138 patients with vitamin K antagonists, 97 patients with antiplatelet therapy and 6 patients with novel oral anticoagulants. Six patients (2.3%) had minor postoperative bleeding after the "one hour control", while one patient needed a night duty support (0.5%). In contrast, 86 patients who were treated in rural practices neglecting the guideline attended the night duty with postoperative bleeding (3 patients treated with vitamin K antagonists, 24 patients taking low molecular weight heparin, 30 patients receiving antiplatelet therapy and one patient on novel oral anticoagulant therapy. CONCLUSIONS The Hungarian guideline can be applied safely, without increasing the risk of postoperative bleeding, however, rural dental practices are frequently unprepared for these treatments. Orv. hetil., 2016, 157(43), 1722-1728.
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Affiliation(s)
- Dénes Lukács
- Fogorvostudományi Kar, Klinikai Központ, Arc-, Állcsont- és Szájsebészeti Tanszék, Pécsi Tudományegyetem Pécs, Dischka Győző u. 5., 7621
| | - Nóra Stáczer
- Fogorvostudományi Kar, Klinikai Központ, Arc-, Állcsont- és Szájsebészeti Tanszék, Pécsi Tudományegyetem Pécs, Dischka Győző u. 5., 7621
| | - László Vajta
- Fogorvostudományi Kar, Klinikai Központ, Arc-, Állcsont- és Szájsebészeti Tanszék, Pécsi Tudományegyetem Pécs, Dischka Győző u. 5., 7621
| | - Lajos Olasz
- Fogorvostudományi Kar, Klinikai Központ, Arc-, Állcsont- és Szájsebészeti Tanszék, Pécsi Tudományegyetem Pécs, Dischka Győző u. 5., 7621
| | - Árpád Joób-Fancsaly
- Fogorvostudományi Kar, Arc-, Állcsont-, Szájsebészeti és Fogászati Klinika, Semmelweis Egyetem Budapest
| | - József Szalma
- Fogorvostudományi Kar, Klinikai Központ, Arc-, Állcsont- és Szájsebészeti Tanszék, Pécsi Tudományegyetem Pécs, Dischka Győző u. 5., 7621
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Zhao XN, Wang YT. [An analysis of the factors affecting the treatment of peripheral inserted central catheter associated upper extremity deep vein thrombosis in elderly patients]. Zhongguo Ying Yong Sheng Li Xue Za Zhi 2016; 32:124-7. [PMID: 29931862 DOI: 10.13459/j.cnki.cjap.2016.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the treatment effectiveness and affecting factors for peripherally inserted central catheter (PICC) associated upper extremity deep vein thrombosis (UEDVT) in elderly patients. METHODS Two hundred of thirty-three patients diagnosed as PICC catheter-related upper extremity deep venous thrombosis in our hospital was enrolled in this study. The patients were divided into two groups depending on whether a thrombus recanalization was achieved or not. Data of patients, including general information, past history of diseases, catheter-related information, thrombosis-related information, whether remove the catheter and antithrombotic treatment were recorded and analyzed. RESULTS Among all the 126 patients with upper extremity deep vein thrombosis, the ratio of patients receiving catheter removal and antithrombotic treatment to those without these treatments was obviously higher in the group where a thrombus recanalization was achieved, compared with the group where a thrombus recanalization wasn't achieved. A higher fraction of patients underwent complete recanalization by catheter removal and antithrombotic treatment compared with the reference group. CONCLUSIONS For patients with PICC-related upper extremity deep vein thrombosis, catheter removal and antithrombotic treatment were found to be more effective. For elderly patients diagnosed with PICC-related thrombosis, we suggest to keep the PICC for further treatment, as long as no infection occurs.
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De Stefano V, Qi X, Betti S, Rossi E. Splanchnic vein thrombosis and myeloproliferative neoplasms: molecular-driven diagnosis and long-term treatment. Thromb Haemost 2016; 115:240-9. [PMID: 26333846 DOI: 10.1160/th15-04-0326] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/15/2015] [Indexed: 02/07/2023]
Abstract
Splanchnic vein thrombosis (SVT) encompasses Budd-Chiari syndrome (BCS), extrahepatic portal vein obstruction (EHPVO), and mesenteric vein thrombosis. Philadelphia-negative myeloproliferative neoplasms (MPNS) are the leading systemic cause of non-cirrhotic and non-malignant SVT and are diagnosed in 40% of BCS patients and one-third of EHPVO patients. In SVT patients the molecular marker JAK2 V617F is detectable up to 87% of those with overt MPN and up to 26% of those without. In the latter, other MPN molecular markers, such as mutations in JAK2 exon 12, CALR and MPL genes, are extremely rare. Immediate anticoagulation with heparin is used to treat acute patients. Upon clinical deterioration, catheter-directed thrombolysis or a transjugular intrahepatic portosystemic shunt is used in conjunction with anticoagulation. Orthotopic liver transplantation is the only reliable option in BCS patients with a lack of a response to other treatments, without contraindication due to MPN. Long-term oral anticoagulation with vitamin K-antagonists (VKA) is recommended in all SVT patients with the MPN-related permanent prothrombotic state; the benefits of adding aspirin to VKA are uncertain. Cytoreduction is warranted in all SVT patients with an overt MPN, but its appropriateness is doubtful in those with molecular MPN without hypercythaemia.
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Affiliation(s)
- Valerio De Stefano
- Valerio De Stefano, MD, Institute of Hematology, Catholic University, Largo Gemelli 8, 00168 Rome, Italy, Tel.: +39 06 30154968, Fax: +39 06 30155209, E-mail:
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Rosa M, De Lucia S, Rinaldi VE, Le Gal J, Desmarest M, Veropalumbo C, Romanello S, Titomanlio L. Paediatric arterial ischemic stroke: acute management, recent advances and remaining issues. Ital J Pediatr 2015; 41:95. [PMID: 26631262 PMCID: PMC4668709 DOI: 10.1186/s13052-015-0174-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 09/21/2015] [Indexed: 01/06/2023] Open
Abstract
Stroke is a rare disease in childhood with an estimated incidence of 1-6/100.000. It has an increasingly recognised impact on child mortality along with its outcomes and effects on quality of life of patients and their families. Clinical presentation and risk factors of paediatric stroke are different to those of adults therefore it can be considered as an independent nosological entity. The relative rarity, the age-related peculiarities and the variety of manifested symptoms makes the diagnosis of paediatric stroke extremely difficult and often delayed. History and clinical examination should investigate underlying diseases or predisposing factors and should take into account the potential territoriality of neurological deficits and the spectrum of differential diagnosis of acute neurological accidents in childhood. Neuroimaging (in particular diffusion weighted magnetic resonance) is the keystone for diagnosis of paediatric stroke and other investigations might be considered according to the clinical condition. Despite substantial advances in paediatric stroke research and clinical care, many unanswered questions remain concerning both its acute treatment and its secondary prevention and rehabilitation so that treatment recommendations are mainly extrapolated from studies on adult population. We have tried to summarize the pathophysiological and clinical characteristics of arterial ischemic stroke in children and the most recent international guidelines and practical directions on how to recognise and manage it in paediatric emergency.
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Affiliation(s)
- Margherita Rosa
- Department of Translational Medicine-Section of Pediatrics, Federico II University, Naples, Italy.
| | - Silvana De Lucia
- Department of Paediatrics, Aldo Moro University of Bari, Bari, Italy.
| | | | - Julie Le Gal
- Paediatric Migraine & Neurovascular diseases Unit, Department of Paediatrics, Robert Debré Hospital, Paris Diderot University, Sorbonne Paris Cité, Paris, France.
| | - Marie Desmarest
- Paediatric Migraine & Neurovascular diseases Unit, Department of Paediatrics, Robert Debré Hospital, Paris Diderot University, Sorbonne Paris Cité, Paris, France.
| | - Claudio Veropalumbo
- Department of Translational Medicine-Section of Pediatrics, Federico II University, Naples, Italy.
| | - Silvia Romanello
- Paediatric Emergency Department, Robert Debré Hospital, Paris Diderot University, Sorbonne Paris Cité, Paris, France.
| | - Luigi Titomanlio
- Paediatric Migraine & Neurovascular diseases Unit, Department of Paediatrics, Robert Debré Hospital, Paris Diderot University, Sorbonne Paris Cité, Paris, France.
- Paediatric Emergency Department, Robert Debré Hospital, Paris Diderot University, Sorbonne Paris Cité, Paris, France.
- Pediatric Emergency Department, INSERM U-1141 AP-HP Robert Debré University Hospital, 48, Bld Sérurier, 75019, Paris, France.
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Alonso‐Coello P, Montori VM, Díaz MG, Devereaux PJ, Mas G, Diez AI, Solà I, Roura M, Souto JC, Oliver S, Ruiz R, Coll‐Vinent B, Gich I, Schünemann HJ, Guyatt G. Values and preferences for oral antithrombotic therapy in patients with atrial fibrillation: physician and patient perspectives. Health Expect 2015; 18:2318-27. [PMID: 24813058 PMCID: PMC5810657 DOI: 10.1111/hex.12201] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Exploration of values and preferences in the context of anticoagulation therapy for atrial fibrillation (AF) remains limited. To better characterize the distribution of patient and physician values and preferences relevant to decisions regarding anticoagulation in patients with AF, we conducted interviews with patients at risk of developing AF and physicians who manage patients with AF. METHODS We interviewed 96 outpatients and 96 physicians in a multicenter study and elicited the maximal increased risk of bleeding (threshold risk) that respondents would tolerate with warfarin vs. aspirin to achieve a reduction in three strokes in 100 patients over a 2-year period. We used the probabilistic version of the threshold technique. RESULTS The median threshold risk for both patients and physicians was 10 additional bleeds (10 P = 0.7). In both groups, we observed large variability in the threshold number of bleeds, with wider variability in patients than clinicians [patient range: 0-100, physician range: 0-50]. We observed one cluster of patients and physicians who would tolerate <10 bleeds and another cluster of patients, but not physicians, who would accept more than 35. CONCLUSIONS Our findings suggest wide variability in patient and physician values and preferences regarding the trade-off between strokes and bleeds. Results suggest that in individual decision making, physician and patient values and preferences will often be discordant; this mandates tailoring treatment to the individual patient's preferences.
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Affiliation(s)
- Pablo Alonso‐Coello
- Iberoamerican Cochrane CentreBiomedical Research Institute Sant Pau‐CIBER of Epidemiology and Public Health (CIBERESP‐ IIB Sant Pau)BarcelonaSpain
| | | | - M. Gloria Díaz
- Unidad Docente de Medicina Familiar y ComunitariaHospital DonostiaDonostiaSpain
| | - Philip J. Devereaux
- Department of Clinical Epidemiology & BiostatisticsCLARITY Research GroupMcMaster University Medical Centre 2C9HamiltonONCanada
| | - Gemma Mas
- Iberoamerican Cochrane CentreBiomedical Research Institute Sant Pau‐CIBER of Epidemiology and Public Health (CIBERESP‐ IIB Sant Pau)BarcelonaSpain
| | - Ana I. Diez
- Centro de Salud de BeraunErrenteriaSan SebastiánSpain
| | - Ivan Solà
- Iberoamerican Cochrane CentreBiomedical Research Institute Sant Pau‐CIBER of Epidemiology and Public Health (CIBERESP‐ IIB Sant Pau)BarcelonaSpain
| | | | - Juan C. Souto
- Unitat d'Hemostàsia i TrombosiHospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Sven Oliver
- Unidad Formadora de Medicina Familiar y Comunitaria de A CoruñaCoruñaSpain
| | | | | | - Ignasi Gich
- Iberoamerican Cochrane CentreBiomedical Research Institute Sant Pau‐CIBER of Epidemiology and Public Health (CIBERESP‐ IIB Sant Pau)BarcelonaSpain
| | - Holger J. Schünemann
- Department of Clinical Epidemiology & BiostatisticsCLARITY Research GroupMcMaster University Medical Centre 2C9HamiltonONCanada
| | - Gordon Guyatt
- Department of Clinical Epidemiology & BiostatisticsCLARITY Research GroupMcMaster University Medical Centre 2C9HamiltonONCanada
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Horstmann S, Möhlenbruch M, Wegele C, Rizos T, Laible M, Rauch G, Veltkamp R. Prevalence of atrial fibrillation and association of previous antithrombotic treatment in patients with cerebral microbleeds. Eur J Neurol 2014; 22:1355-62. [PMID: 25557113 DOI: 10.1111/ene.12608] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [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: 05/21/2014] [Accepted: 10/07/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral microbleeds (CMBs) are associated with an increased risk of intracerebral hemorrhage. The impact of oral anticoagulation (OAC) on CMBs is not well characterized. Our aim was to assess the prevalence of CMBs in stroke and transient ischaemic attack (TIA) patients with atrial fibrillation (AF) and to analyze the implications of previous treatment with OAC. METHODS In this retrospective analysis on data from a prospectively recruiting stroke registry, patients with ischaemic stroke or TIA with brain magnetic resonance imaging including susceptibility weighted imaging were consecutively enrolled during a 3-year period. For each patient cardiovascular risk factors, AF history and recent diagnosis of AF, present use of OAC and antiplatelets, the National Institute of Health Stroke Scale and the premorbid modified Rankin Scale score were recorded. Two independent raters identified CMBs according to consensus criteria. CMB location was classified as lobar, deep or in the posterior fossa. RESULTS In all, 785 patients (mean age 63.9 ± 14.2 years) were included. At least one CMB was detected in 186 (23.7%) patients. CMBs were significantly more frequent in patients with AF (30.5% vs. 22.4%). Patients with previous OAC treatment were more likely to have CMBs (36.7% vs. 22.8%, P = 0.03) and abundant CMBs (n > 10) were more frequent in anticoagulated patients even after adjustment for age. However, age was the only independent factor predicting CMBs (P = 0.001). CONCLUSIONS Cerebral microbleeds are common in elderly AF patients with acute ischaemic stroke. Previous OAC is associated with a higher number of CMBs predominantly in the lobar location. Establishing a causal relationship requires prospective longitudinal investigation.
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Affiliation(s)
- S Horstmann
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - M Möhlenbruch
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - C Wegele
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - T Rizos
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - M Laible
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - G Rauch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - R Veltkamp
- Department of Neurology, University of Heidelberg, Heidelberg, Germany.,Department of Stroke Medicine, Imperial College London, London, UK
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Gerotziafas GT, Mahé I, Elalamy I. New orally active anticoagulant agents for the prevention and treatment of venous thromboembolism in cancer patients. Ther Clin Risk Manag 2014; 10:423-36. [PMID: 24966680 PMCID: PMC4063799 DOI: 10.2147/tcrm.s49063] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Patients with cancer have a 6-7-fold higher risk of venous thromboembolism (VTE) as compared with non-cancer patients. Effective and safe anticoagulation for the prevention and treatment of VTE is the cornerstone of the management of patients with cancer, aiming to decrease morbidity and mortality and to improve quality of life. Unfractionated heparin, low molecular weight heparins, fondaparinux and vitamin K antagonists (VKAs) are used in the prevention and treatment of VTE in cancer patients. Heparins and fondaparinux are administered subcutaneously. VKAs are orally active, but they have a narrow therapeutic window, numerous food and drug interactions, and treatment requires regular laboratory monitoring and dose adjustment. These limitations among others have important negative impact on the quality of life of patients and decrease adherence to the treatment. New orally active anticoagulant (NOAC) agents are specific inhibitors of activated factor Xa (FXa) (rivaroxaban and apixaban) or thrombin (dabigatran). It is expected that NOACs will improve antithrombotic treatment. Cancer patients are a particular group that could benefit from treatment with NOACs. However, NOACs present some significant interactions with drugs frequently used in cancer patients, which might influence their pharmacokinetics, compromising their efficacy and safety. In the present review, we analyzed the available data from the subgroups of patients with active cancer who were included in Phase III clinical trials that assessed the efficacy and safety of NOACs in the prevention and treatment of VTE. The data from the Phase III trials in prophylaxis of VTE by rivaroxaban or apixaban highlight that these two agents, although belonging to the same pharmacological group (direct inhibitors of factor Xa), have substantially different profiles of efficacy and safety, especially in hospitalized acutely ill medical patients with active cancer. A limited number of patients with VTE and active cancer were included in the Phase III trials (EINSTEIN, AMPLIFY, and RE-COVER) which evaluated the efficacy and safety of NOACs in the acute phase and secondary prevention of VTE. Although, from a conceptual point of view, NOACs could be an attractive alternative for the treatment of VTE in cancer patients, the available data do not support this option. In addition, due to the elimination of the NOACs by the liver and renal pathway as well as because of their pharmacological interactions with drugs which are frequently used in cancer patients, an eventual use of these drugs in cancer patients should be extremely cautious and be restricted only to patients presenting with contraindications for low molecular weight heparins, fondaparinux, or VKAs. The analysis of the available data presented in this review reinforces the request for the design of new Phase III clinical trials for the assessment of the efficacy and safety of NOACs in specific populations of patients with cancer.
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Affiliation(s)
- Grigoris T Gerotziafas
- Service d'Hématologie Biologique, Hôpital Tenon, Hôpitaux Universitaires Est Parisien Assistance Publique Hôpitaux de Paris, Paris, France ; ER2UPMC, Faculté de Médecine Pierre et Marie Curie, Université Paris VI, Paris, France
| | - Isabelle Mahé
- Service de Médecine interne, Hôpital Louis Mourier, Université Paris 7, Assistance Publique Hôpitaux de Paris, EA REMES, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Ismail Elalamy
- Service d'Hématologie Biologique, Hôpital Tenon, Hôpitaux Universitaires Est Parisien Assistance Publique Hôpitaux de Paris, Paris, France ; ER2UPMC, Faculté de Médecine Pierre et Marie Curie, Université Paris VI, Paris, France
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Affiliation(s)
- Srijita Sen-Chowdhry
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Department of Epidemiology, Imperial College, St Mary's Campus, London, United Kingdom.
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Greer IA, Brenner B, Gris JC. Antithrombotic treatment for pregnancy complications: which path for the journey to precision medicine? Br J Haematol 2014; 165:585-99. [PMID: 24593333 DOI: 10.1111/bjh.12813] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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: 11/24/2013] [Accepted: 01/02/2014] [Indexed: 01/31/2023]
Abstract
Haemostatic and vascular biology mechanisms appear to play an important role in the pathogenesis of placenta-mediated pregnancy complications. Although low-dose aspirin (LDA) has a modest effect in preventing preeclampsia, antithrombotic interventions, LDA and low molecular weight heparin (LMWH) have not definitively proven their effectiveness in women with placenta-mediated pregnancy complications selected by previous pregnancy outcome alone. Given the heterogeneous aetiology of placenta-mediated pregnancy complications, it is critical to stratify patients according to maternal and fetal characteristics and disease mechanisms rather than simply by pregnancy outcome, such as miscarriage. Such stratification could identify those who could benefit from antithrombotic interventions in pregnancy. We lack data on genome-wide association studies, biomarkers and trials of interventions applied to specific homogeneous populations. Future studies should focus on elaborating different disease mechanisms and examining antithrombotic interventions in specific and more homogeneous groups, such as thrombophilic women with well-characterized placenta-mediated pregnancy complications, stratified by disease severity and pathological findings. Because of fetal safety concerns with new anticoagulants, the intervention should focus on heparins alone or in combination with LDA. Thus, placenta-mediated pregnancy complications deserve precision medicine, defining disease by mechanism rather than outcome with interventions focused on a more personalized approach.
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Affiliation(s)
- Ian A Greer
- Faculty of Health & Life Sciences, University of Liverpool, Liverpool, UK
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Liu B, Liu LZ, Xuan J, Luo M, Li Y, Duan C, Cheng H, Yang X. Treatment patterns associated with stroke prevention in patients with atrial fibrillation in three major cities in the People's Republic of china. Int J Gen Med 2014; 7:29-35. [PMID: 24379692 PMCID: PMC3872083 DOI: 10.2147/ijgm.s49477] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with an increased risk of stroke. This study assessed treatment patterns associated with stroke prevention among patients with AF in three major cities of the People's Republic of China. METHODS A random sample of 2,862 medical charts for patients with AF at six tertiary hospitals located in Beijing, Shanghai, and Guangzhou between 2003 and 2008 were reviewed. Patient demographics, clinical characteristics, and treatment patterns were extracted from medical charts. Antithrombotic regimens included antiplatelets, anticoagulants, and a combination of both. Descriptive analyses were performed to summarize basic antithrombotic patterns. A logistic regression model examined demographic and clinical factors associated with antithrombotic treatment patterns. RESULTS Of the patient sample, 55% were male, the average age was 72 years (49% ≥75 years), 15% had valvular AF, 78% had nonvalvular AF, and the remainder had unspecified AF. CHADS2 scores ≥2 were reported for 53% of patients. Antithrombotic treatment was not received by 17% of patients during hospitalization, and 66% did not receive warfarin. Among patients with valvular or nonvalvular AF, 33%, 30%, and 20% received antiplatelet, anticoagulation, and antiplatelet plus anticoagulation treatments, respectively. For patients with CHADS2 scores of 0, 1, 2, 3, and ≥4, 52%, 42%, 28%, 21%, and 21%, respectively, were treated with warfarin. Predictors of no antithrombotic treatment included age and hospital location. CONCLUSION Anticoagulation therapy was underused in Chinese patients with AF. Antithrombotic treatment was not associated with stroke risk. Further studies need to examine the clinical consequences of various antithrombotic treatment patterns in Chinese patients with AF.
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Affiliation(s)
- Bao Liu
- School of Public Health, Fudan University, shanghai, People's Republic of China
| | - Larry Z Liu
- Pfizer Inc, New York, NY, USA ; Weill Medical college of cornell University, new York, NY, USA
| | | | - Man Luo
- Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yansheng Li
- Renji Hospital Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Chaohui Duan
- The Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Hongqin Cheng
- Xuanwu Hospital, Beijing, People's Republic of China
| | - Xiaohui Yang
- Beijing Anzhen Hospital, Capital University of Medical Science, Beijing, People's Republic of China
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