RESUMEN
Scarce data are available on the effects of hospitalization on oral anticoagulation (OAC) patterns in patients with atrial fibrillation (AF). This study aimed to capture the evolving OAC patterns of patients with known non-valvular AF at high risk for stroke (CHA2DS2-Vasc score ≥ 2 for males and ≥ 3 for females) during hospitalization. A total of 561 eligible patients who were admitted to the cardiology ward of a tertiary hospital were studied. Pre- and post-hospitalization OAC patterns [vitamin-K antagonist (VKA), non-vitamin K oral anticoagulants (NOAC), no OAC], changes between these patterns (initiation, switch, discontinuation, no change) and the respective patient profiles and discharge diagnoses were assessed. During hospitalization, OAC administration increased from 73.1 to 86.6% of patients (p for trend < 0.001). NOAC use increased significantly (42.2-56.1%, p for trend < 0.001), whereas VKA use remained stable (30.8-30.5%). Of patients, 17.3% initiated OAC, 7.1% switched between OACs, 3.7% discontinued OAC treatment, while the rest underwent no change in anticoagulation status. Bleeding risk, use of concomitant antiplatelet therapy and incidence of primary discharge diagnosis of AF or ST-elevation myocardial infarction differed significantly between groups of initiation, switch, discontinuation and no change in OAC therapy. In conclusion, in patients with known AF at high risk for stroke, hospitalization was associated with an increase in OAC uptake, driven mainly by NOAC initiation. Three out of 10 patients initiated, switched or discontinued OAC treatment during hospitalization and this was associated with discrete epidemiologic parameters.
Asunto(s)
Anticoagulantes/administración & dosificación , Fibrilación Atrial/tratamiento farmacológico , Hospitalización , Administración Oral , Adulto , Anciano , Anticoagulantes/uso terapéutico , Fibrilación Atrial/complicaciones , Sustitución de Medicamentos/estadística & datos numéricos , Femenino , Hospitalización/tendencias , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Accidente Cerebrovascular/prevención & controlRESUMEN
BACKGROUND: Proper anticoagulation is a crucial therapeutic regimen in atrial fibrillation (AF). OBJECTIVES: To evaluate the real-life anticoagulation prescriptions of AF patients upon hospital discharge. METHODS: We studied 768 patients with comorbid AF who were discharged from the cardiology ward of a tertiary hospital. We assessed the appropriateness of oral anticoagulation (OAC) regimens at discharge based on stroke risk (CHA2DS2-Vasc score), SAMe-TT2R2 (sex, age, medical history, treatment, tobacco, race) score for vitamin K antagonists (VKA), and European labeling for nonvitamin K oral anticoagulant (NOAC) dosing. Logistic regression identified factors associated with suboptimal OAC use. RESULTS: Of 734 patients at significant (moderate or high) stroke risk, 107 (14.6%) were not prescribed OAC, which was administered to 23 (67.6%) of 34 patients at low risk. Nonprescribing of OAC to high-risk patients was associated with paroxysmal AF (adjusted odds ratio [OR]: 2.42, 95% confidence interval [CI]: 1.47-3.99, P < .001), history of major bleeding (adjusted OR: 1.89, 95% CI: 1.03-3.47, P = .039), and concomitant antiplatelet use (adjusted OR: 5.78, 95% CI: 3.51-9.51, P < .001). Anticoagulation control was inadequate (SAMe-TT2R2 score > 2) in 102 (50.2%) VKA-treated patients. Off-label dosing was evident in 118 (28.9%) NOAC-treated patients and was associated with a prior stroke/transient ischemic attack (adjusted OR: 2.06, 95% CI: 1.10-3.85, P = .023). Both outcomes were independently associated with low creatinine clearance. CONCLUSIONS: One of 6 patients with AF newly discharged from the hospital was treated discordantly for the corresponding risk of stroke. Suboptimal OAC use was evident in half of VKA regimens, twice as common compared to NOACs, and could be predicted by several clinical parameters.
Asunto(s)
Anticoagulantes/administración & dosificación , Fibrilación Atrial/tratamiento farmacológico , Alta del Paciente , Pautas de la Práctica en Medicina , Accidente Cerebrovascular/prevención & control , Administración Oral , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/epidemiología , Comorbilidad , Estudios Transversales , Revisión de la Utilización de Medicamentos , Femenino , Grecia/epidemiología , Adhesión a Directriz , Hemorragia/inducido químicamente , Hemorragia/epidemiología , Humanos , Prescripción Inadecuada , Masculino , Persona de Mediana Edad , Uso Fuera de lo Indicado , Guías de Práctica Clínica como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Resultado del TratamientoRESUMEN
Heart failure is a life-limiting condition affecting over 40 million patients worldwide. Ischemic cardiomyopathy (ICM) is the most common cause. This study investigates in situ cardiac regeneration utilizing precision delivery of a novel mesenchymal precursor cell type (iMP) during coronary artery bypass surgery (CABG) in patients with ischemic cardiomyopathy (LVEF < 40 %). The phase IIa safety study was designed to enroll 11 patients. Preoperative scintigraphy imaging (SPECT) was used to identify hibernating myocardium not suitable for conventional myocardial revascularization for iMP implantation. iMP cells were implanted intramyocardially in predefined viable peri-infarct areas that showed poor perfusion, which could not be grafted due to poor target vessel quality. Postoperatively, SPECT was then used to identify changes in scar area. Intramyocardial implantation of iMP cells with CABG was safe with preliminary evidence of efficacy of improved myocardial contractility and perfusion of nonrevascularized territories resulting in a significant reduction in left ventricular scar area at 12 months after treatment. Clinical improvement was associated with a significant improvement in quality of life at 6 months posttreatment in all patients. The results suggest the potential for in situ myocardial regeneration in ischemic heart failure by delivery of iMP cells.
Asunto(s)
Cardiomiopatías/cirugía , Puente de Arteria Coronaria , Infarto del Miocardio/cirugía , Miocitos Cardíacos/trasplante , Regeneración , Cardiomiopatías/diagnóstico por imagen , Cardiomiopatías/metabolismo , Cardiomiopatías/fisiopatología , Células Cultivadas , Puente de Arteria Coronaria/efectos adversos , Circulación Coronaria , Femenino , Grecia , Humanos , Masculino , Trasplante de Células Madre Mesenquimatosas/efectos adversos , Trasplante de Células Madre Mesenquimatosas/métodos , Persona de Mediana Edad , Contracción Miocárdica , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/metabolismo , Infarto del Miocardio/fisiopatología , Miocitos Cardíacos/metabolismo , Miocitos Cardíacos/patología , Fenotipo , Calidad de Vida , Recuperación de la Función , Volumen Sistólico , Factores de Tiempo , Tomografía Computarizada de Emisión de Fotón Único , Trasplante Homólogo , Resultado del Tratamiento , Función Ventricular IzquierdaRESUMEN
BACKGROUND: The levels of interleukin-6 (IL-6), white blood cells (WBCs), and some inflammatory-sensitive proteins (ISPs), such as fibrinogen (FIB) and C-reactive protein (CRP), have been related to coronary stent restenosis. The aim was to investigate the time course of the levels of IL-6, WBC, and several ISPs, i.e. FIB, CRP, cerruloplasmin (CER), haptoglobin (HPT), alpha-1 antitrypsin (A1AT), and alpha-1 acid glycoprotein (A1GP), after successful coronary stenting in patients with stable angina and to relate them to prognosis. MATERIAL/METHODS: FIB, CRP, IL-6, CER, HPT, A1AT, A1GP, and WBC levels were measured in 40 patients with stable angina before, and 6, 12, 24, 48, and 72 hours and 6 months after successful coronary stenting. The patients were followed up for 12 months. RESULTS: FIB levels increased significantly (p<0.05) 48 hours, CRP and WBC count 24 hours, CER, HPT, A1AT, and A1GP 72 hours, and IL-6 6 hours after stenting. All the levels remained unchanged in 20 control patients undergoing coronary angiography. During follow-up, stent restenosis occurred in 7 patients. Time-course and mean values of all the studied substances did not significantly differ in patients with or without restenosis (p>0.05). CONCLUSIONS: FIB, CRP, IL-6, CER, HPT, A1AT, A1GP, and WBC levels increase significantly after stenting, but they are not related to prognosis.
Asunto(s)
Proteína C-Reactiva/metabolismo , Enfermedad Coronaria/cirugía , Fibrinógeno/metabolismo , Interleucina-6/sangre , Recuento de Leucocitos , Stents , Anciano , Angioplastia , Femenino , Humanos , Cinética , Masculino , Persona de Mediana Edad , Pronóstico , Estudios ProspectivosRESUMEN
BACKGROUND: We investigated the time course and prognostic value of fibrinogen (Fib), C-reactive protein (CRP), interleukin-6 (IL-6), and ceruloplasmin (CP) in patients with severe unstable angina. METHODS: All 4 substances were measured on admission and after 6, 12, 24, 48, and 72 hours, and after 7 days and 6 months in 40 patients with Braunwald's classification class IIIB unstable angina. RESULTS: All recorded substances increased significantly; 15 patients had cardiovascular events during hospitalization and 11 patients during follow-up. The time course and the mean values of Fib, CRP, and IL-6 were similar in patients with and without complications both during hospitalization and follow-up. However, CP levels from 6 hours until 6 months were significantly higher in patients with complications during follow-up (P < .05). CONCLUSIONS: Fib, CRP, IL-6, and CP levels alter in patients with severe unstable angina. However, only CP levels were related to 12-month follow-up prognosis.