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1. Definition and Implications of the Preventable Stroke

Author

Fisher, Mark, Moores, Lisa, Alsharif, Mohamad N, and Paganini-Hill, Annlia

Subjects
Biomedical and Clinical Sciences, Neurosciences, Clinical Sciences, Clinical Research, Stroke, Aging, Prevention, Brain Disorders, Cardiovascular, Good Health and Well Being, Aged, Brain Ischemia, Female, Fibrinolytic Agents, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Thrombolytic Therapy, Treatment Outcome, United States, anticoagulant agent, antihypertensive agent, antilipemic agent, antithrombocytic agent, fibrinolytic agent, adult, aged, Article, atrial fibrillation, brain ischemia, cardiovascular disease, cerebrovascular disease, data analysis, demography, disease severity, female, health care delivery, hospital discharge, human, hyperlipidemia, hypertension, major clinical study, male, medical record review, National Institutes of Health Stroke Scale, patient compliance, priority journal, rating scale, risk assessment, risk factor, university hospital, very elderly, fibrinolytic therapy, middle aged, procedures, retrospective study, treatment outcome, Cognitive Sciences, Neurology & Neurosurgery, Clinical sciences
Abstract

ImportanceAlthough patients with acute stroke are routinely evaluated for potential treatment (ie, treatability of the stroke), preventability of the presenting stroke is generally not seriously considered.ObjectiveTo systematically analyze stroke preventability.Design, setting, and participantsWe evaluated medical records of 274 consecutive patients discharged with a diagnosis of ischemic stroke between December 2, 2010, and June 11, 2012, at the University of California Irvine Medical Center. Mean (SE) patient age was 67.2 (0.8) years. Data analysis was conducted from July 3, 2014, to August 4, 2015.ExposuresMedical records were systematically examined for demographic information, stroke risk factors, stroke severity, and acute stroke treatment.Main outcomes and measuresWe defined stroke preventability as the degree to which the patient's presenting stroke was preventable. Using variables easily determined at onset of stroke, we developed a 10-point scale (0, not preventable; 10, most preventable) to classify the degree of stroke preventability. Our focus was effectiveness of treatment of hypertension (0-2 points), hyperlipidemia (0-2 points), and atrial fibrillation (0-4 points), as well as use of antithrombotic treatment for known prior cerebrovascular and cardiovascular disease (0-2 points).ResultsTotal risk scores ranged from 0 to 8 (mean [SE], 2.2 [0.1]), with 207 patients (75.5%) exhibiting some degree of preventability (score of 1 or higher). Seventy-one patients (25.9%) had scores of 4 or higher, indicating that the stroke was highly preventable. Severity of stroke as determined by the National Institutes of Health Stroke Scale score was not related to preventability of stroke. However, 21 of 71 patients (29.6%) whose stroke was highly preventable were treated with intravenous or intra-arterial acute stroke therapy while these treatments were provided for only 13 of 67 patients (19.4%) with scores of 0 (no preventability) and 19 of 136 patients (14.0%) with scores of 1 to 3 (low preventability) (P = .03).Conclusions and relevanceMost patients with acute stroke exhibited some degree of preventability. Preventability and treatment of stroke were significantly associated, indicating that the most preventable strokes paradoxically were more likely to receive acute treatment.

Published
2016

2. Frequency, Predictors, Etiology, and Outcomes for Deep Intracerebral Hemorrhage without Hypertension

Author

Prats-Sánchez L., Iruzubieta P., Vesperinas A., Collet R., Martínez-Domeño A., Guisado-Alonso D., Camps-Renom P., Delgado-Mederos R., Guasch-Jiménez M., Ramos-Pachón A., Rodríguez-Antigüedad J., Campo-Caballero D., Equiza J., de la Riva P., Martínez-Zabaleta M., de Arce A., and Martí-Fàbregas J.

Subjects
retrospective study, clinical outcome, thrombocytopenia, heparin, anticoagulant agent, middle aged, echocardiography, atrial fibrillation, nuclear magnetic resonance imaging, drug abuse, leukoaraiosis, antithrombocytic agent, neurological deficit score, aged, female, risk factor, brain angiography, frequency, diabetes mellitus, antihypertensive agent, brain hemorrhage, end stage liver disease, tertiary care center, adrenergic receptor stimulating agent, hospitalization, prospective study, hypertension, diagnostic imaging, alcohol consumption, brain, electrocardiography, congenital blood vessel malformation, tobacco use, electrocardiogram, Article, transthoracic echocardiography, male, blood clotting disorder, Rankin scale, ischemic stroke, follow up, controlled study, human, deterioration, dyslipidemia, international normalized ratio, platelet count, major clinical study, blood pressure monitoring, hospital discharge, age, treatment outcome
Abstract

Objectives: Some patients with deep intracerebral hemorrhage (ICH) have a transient hypertensive response and they may be erroneously classified as secondary to hypertension. We investigated frequency, risk factors, and outcomes for patients with deep ICH without hypertension. Materials and methods: We consecutively recruited patients with spontaneous ICH attending two Spanish stroke centers (January 2015-June 2019). Excluded were patients with lobar/infratentorial ICH and patients who died during hospitalization. We defined deep ICH without hypertension when the bleeding was in a deep structure, no requirement for antihypertensive agents during follow-up and no evident chronic hypertension markers evaluated by transthoracic echocardiography, 24 h ambulatory blood pressure monitoring and/or electrocardiography. We compared clinical, radiological, and 3-month functional outcome data for deep-ICH patients with hypertension versus those without hypertension. Results: Of 759 patients with ICH, 219 (mean age 69.6 ± 15.4 years, 54.8% men) met the inclusion criteria and 36 (16.4%) did not have hypertension. Of these 36 patients, 19 (52.7%) had a transient hypertensive response. Independent predictors of deep ICH without hypertension were age (adjusted OR:0.94;95%CI:0.91–0.96) and dyslipidemia (adjusted OR:0.27;95% CI:0.08–0.85). One third of deep ICH without hypertension were secondary to vascular malformations. Favorable outcomes (modified Rankin Scale 0–2) were more frequent in patients with deep ICH without hypertension compared to those with hypertension (70.9% vs 33.8%; p < 0.001). Conclusion: Of patients with deep ICH, 16.4% were unrelated with hypertension, around half showed hypertensive response, and around a third had vascular malformations. We suggest studying hypertension markers and performing a follow-up brain MRI in those patients with deep ICH without prior hypertension. © 2021 Elsevier Inc.

Published
2022

3. Antiplatelet Drugs for Neurointerventions: Part 2 Clinical Applications.

Author

Brooks M., Jhamb A., Thijs V., Asadi H., Pearce S., Maingard J.T., Kuan Kok H., Barras C.D., Russell J.H., Hirsch J.A., Chandra R.V., Brooks M., Jhamb A., Thijs V., Asadi H., Pearce S., Maingard J.T., Kuan Kok H., Barras C.D., Russell J.H., Hirsch J.A., and Chandra R.V.

Abstract

Endovascular techniques have expanded to include balloon and stent-assistance, flow diversion and individualized endovascular occlusion devices, to widen the treatment spectrum for more complex aneurysm morphologies. While usually well-tolerated by patients, endovascular treatment of intracranial aneurysms carries the risk of complications, with procedure-related ischemic complications being the most common. Several antiplatelet agents have been studied in a neurointerventional setting for both prophylaxis and in the setting of intraprocedural thrombotic complications. Knowledge of these antiplatelet agents, evidence for their use and common dosages is important for the practicing neurointerventionist to ensure the proper application of these agents. Part one of this two-part review focused on basic platelet physiology, pharmacology of common antiplatelet medications and future directions and therapies. Part two focuses on clinical applications and evidence based therapeutic regimens.Copyright © 2021, Springer-Verlag GmbH, DE part of Springer Nature.

Published
2021

4. Factors predicting positive CT mesenteric angiography results in lower gastrointestinal haemorrhage prior to consideration of intra-arterial angio-embolisation.

Author

Tan S.W.J., Buckenham T., Smith R.S., Heath-Kalgutkar G.A., Rajagopalan A., Tran V.H., Tan S.W.J., Buckenham T., Smith R.S., Heath-Kalgutkar G.A., Rajagopalan A., and Tran V.H.

Abstract

Introduction: Lower gastrointestinal haemorrhage (LGIH) is a challenging phenomenon in a comorbid, elderly population. CT mesenteric angiography (CTMA) allows localisation of the site of haemorrhage, and provides a target for interventional techniques, but the intermittent nature of LGIH makes it challenging to reliably demonstrate extravasation. This study aimed to identify objective factors that may predict scan outcomes. Method(s): In this retrospective cohort study, all patients undergoing CTMA for LGIH at Monash Health from January 2011 to December 2019 (n = 854) were included. Baseline patient characteristics included age, bowel resection/endoscopic intervention within the past 14 days, known bowel malignancy, anticoagulant/antiplatelet use, duration of symptoms, vital signs, transfusion requirements in the past 24 h and investigation results (recent haemoglobin levels, platelet count, international normalised ratio and creatinine levels). Univariate analysis was performed, and significant factors were entered into a multivariate model. Result(s): The final multivariate model was statistically significant (P < 0.001) and consisted of bowel resection/endoscopic intervention within the past 14 days (OR = 2.15), use of antiplatelet agents (OR = 2.03), blood transfusion requirement greater than 3 units per 24 h (OR = 1.79), systolic blood pressure less than 100 mmHg (OR = 1.56) and heart rate greater than 100 beats per minute (OR = 1.52). Conclusion(s): The factors identified above are objective, independently associated with positive scan outcomes, readily available to radiologists and are useful for more judicious patient selection.Copyright © 2021 The Royal Australian and New Zealand College of Radiologists

Published
2021

5. The use of warfarin in patients with atrial fibrillation and end stage kidney disease.

Author

Kerr P., Hong J., Damasiewicz M., Kerr P., Hong J., and Damasiewicz M.

Abstract

Aim: To examine prescriber characteristics and reasoning for selection of stroke prevention therapy for dialysis patients with atrial fibrillation (AF). Background(s): Warfarin therapy in dialysis patients with AF remains controversial especially for primary stoke prevention. Method(s): Utilising scanned medical records, dialysis patients with AF at Monash Health were identified. Patient demographics, therapeutic agent for AF, prescriber characteristics and reasoning were then assessed. Result(s): Of 575 dialysis patients, 100 (17.4%) were identified as having AF. Of those, 31 patients received warfarin, 46 received antiplatelet therapy, 21 did not receive stroke prevention therapy and 2 received other forms of stroke prevention therapy (clexane non-dialysis days, apixaban). Of the 31 patients on warfarin, 15 were placed on warfarin for primary prevention, 13 for secondary prevention and 3 were unknown. The AF cohort was generally older compared to the cohort without AF (71.9 vs 61.2 years, p < 0.001). Demographically, patient subgroups on warfarin, antiplatelet agents and no stroke prevention therapy were similar. 16 of 31 patients were commenced on warfarin by cardiology, predominantly for primary stroke prevention (81%). Neurology commenced warfarin in 9 of 31 patients, in all instances for secondary stroke prevention (100%). 16 patients were previously on warfarin. Most cases of warfarin cessation were instigated by nephrology (63%) with major reasons including conflicting evidence regarding warfarin use in dialysis patients, bleeding complications, bleed risk greater than stroke risk, and dialysis commencement. Conclusion(s): Further research is required to provide an evidence-based approach to primary stroke prevention therapy in dialysis patients with AF. Presently, with limited evidence and differences in clinical practice between the various specialties, a multidisciplinary approach is necessary for the individualized management of AF in dialysis patients.

Published
2021

6. Urinary Tartaric Acid, a Biomarker of Wine Intake, Correlates with Lower Total and LDL Cholesterol

Author

Universitat Rovira i Virgili, Dominguez-Lopez, Ines; Parilli-Moser, Isabella; Arancibia-Riveros, Camila; Tresserra-Rimbau, Anna; Martinez-Gonzalez, Miguel Angel; Ortega-Azorin, Carolina; Salas-Salvado, Jordi; Castaner, Olga; Lapetra, Jose; Aros, Fernando; Fiol, Miquel; Serra-Majem, Lluis; Pinto, Xavier; Gomez-Gracia, Enrique; Ros, Emilio; Lamuela-Raventos, Rosa M.; Estruch, Ramon, Universitat Rovira i Virgili, and Dominguez-Lopez, Ines; Parilli-Moser, Isabella; Arancibia-Riveros, Camila; Tresserra-Rimbau, Anna; Martinez-Gonzalez, Miguel Angel; Ortega-Azorin, Carolina; Salas-Salvado, Jordi; Castaner, Olga; Lapetra, Jose; Aros, Fernando; Fiol, Miquel; Serra-Majem, Lluis; Pinto, Xavier; Gomez-Gracia, Enrique; Ros, Emilio; Lamuela-Raventos, Rosa M.; Estruch, Ramon

Abstract

Postmenopausal women are at higher risk of developing cardiovascular diseases due to changes in lipid profile and body fat, among others. The aim of this study was to evaluate the association of urinary tartaric acid, a biomarker of wine consumption, with anthropometric (weight, waist circumference, body mass index (BMI), and waist-to-height ratio), blood pressure, and biochemical variables (blood glucose and lipid profile) that may be affected during the menopausal transition. This sub-study of the PREDIMED (Prevencion con Dieta Mediterranea) trial included a sample of 230 women aged 60-80 years with high cardiovascular risk at baseline. Urine samples were diluted and filtered, and tartaric acid was analyzed by liquid chromatography coupled to electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS). Correlations between tartaric acid and the study variables were adjusted for age, education level, smoking status, physical activity, BMI, cholesterol-lowering, antihypertensive, and insulin treatment, total energy intake, and consumption of fruits, vegetables, and raisins. A strong association was observed between wine consumption and urinary tartaric acid (0.01 mu g/mg (95% confidence interval (CI): 0.01, 0.01), p-value < 0.001). Total and low-density lipoprotein (LDL) cholesterol were inversely correlated with urinary tartaric acid (-3.13 mu g/mg (-5.54, -0.71), p-value = 0.016 and -3.03 mu g/mg (-5.62, -0.42), p-value = 0.027, respectively), whereas other biochemical and anthropometric variables were unrelated. The results suggest that wine consumption may have a positive effect on cardiovascular health in postmenopausal women, underpinning its nutraceutical properties.

Published
2021

7. Mediterranean Diet Maintained Platelet Count within a Healthy Range and Decreased Thrombocytopenia-Related Mortality Risk: A Randomized Controlled Trial

Author

Universitat Rovira i Virgili, Hernaez, Alvaro; Lassale, Camille; Castro-Barquero, Sara; Ros, Emilio; Tresserra-Rimbau, Anna; Castaner, Olga; Pinto, Xavier; Vazquez-Ruiz, Zenaida; Sorli, Jose, V; Salas-Salvado, Jordi; Lapetra, Jose; Gomez-Gracia, Enrique; Alonso-Gomez, Angel M.; Fiol, Miquel; Serra-Majem, Lluis; Sacanella, Emilio; Razquin, Cristina; Corella, Dolores; Guasch-Ferre, Marta; Cofan, Montserrat; Estruch, Ramon, Universitat Rovira i Virgili, and Hernaez, Alvaro; Lassale, Camille; Castro-Barquero, Sara; Ros, Emilio; Tresserra-Rimbau, Anna; Castaner, Olga; Pinto, Xavier; Vazquez-Ruiz, Zenaida; Sorli, Jose, V; Salas-Salvado, Jordi; Lapetra, Jose; Gomez-Gracia, Enrique; Alonso-Gomez, Angel M.; Fiol, Miquel; Serra-Majem, Lluis; Sacanella, Emilio; Razquin, Cristina; Corella, Dolores; Guasch-Ferre, Marta; Cofan, Montserrat; Estruch, Ramon

Abstract

There is little information on the dietary modulation of thrombosis-related risk factors such as platelet count. We aimed to assess the effects of Mediterranean diet (MedDiet) on platelet count and related outcomes in an older population at high cardiovascular risk. In participants of the PREDIMED (PREvencion con DIeta MEDiterranea) study, we assessed whether an intervention with a MedDiet enriched with extra-virgin olive oil or nuts, relative to a low-fat control diet, modulated platelet count (n = 4189), the risk of developing thrombocytosis and thrombocytopenia (n = 3086), and the association between these alterations and all-cause mortality (median follow-up time: 3.0 years). Although platelet count increased over time (+0.98 center dot 10(9) units/L center dot year [95% confidence interval: 0.12; 1.84]), MedDiet interventions moderated this increase, particularly in individuals with near-high baseline count (both MedDiets combined: -3.20 center dot 10(9) units/L center dot year [-5.81; -0.59]). Thrombocytopenia incidence was lower in the MedDiet interventions (incidence rates: 2.23% in control diet, 0.91% in MedDiets combined; hazard ratio: 0.44 [0.23; 0.83]). Finally, thrombocytopenia was associated with a higher risk of all-cause mortality (hazard ratio: 4.71 [2.69; 8.24]), but this relationship was attenuated in those allocated to MedDiet (p-interaction = 0.018). In brief, MedDiet maintained platelet counts within a healthy range and attenuated platelet-related mortality in older adults at high cardiovascular risk.

Published
2021

8. Aggregometry Response to Half-dose Prasugrel in Flow-diverting Stent Implantation

Author

Fatih Düzgün, Ismail Oran, Mustafa Gök, Celal Cinar, Department of Radiology, Ege University Medical School, Izmir, 35100, Turkey, Department of Radiology, Adnan Menderes University Medical School, Aydin, Turkey, Department of Radiology, Celal Bayar University Medical School, Manisa, Turkey, and Ege Üniversitesi

Subjects
Male, loading drug dose, Prasugrel, retrospective study, medicine.medical_treatment, morbidity, mortality rate, 030218 nuclear medicine & medical imaging, 0302 clinical medicine, P2Y12, middle aged, Occlusion, implantation, Aspirin, medicine.diagnostic_test, adult, Antiplatelet agents, antithrombocytic agent, female, brain angiography, Anesthesia, Stents, medicine.drug, diagnostic imaging, maintenance therapy, Loading dose, Article, 03 medical and health sciences, Aneurysm, thrombocyte function, medicine, Humans, controlled study, Radiology, Nuclear Medicine and imaging, human, Retrospective Studies, Platelet function test, business.industry, Flow diversion, Stent, Intracranial Aneurysm, acetylsalicylic acid, medicine.disease, purinergic P2Y12 receptor, major clinical study, brain ischemia, prasugrel, Cerebral Angiography, impedance aggregometry, transient ischemic attack, impedance, Angiography, stent, Neurology (clinical), business, Prasugrel Hydrochloride, subdural hematoma, Platelet Aggregation Inhibitors, 030217 neurology & neurosurgery
Abstract

EgeUn###, Purpose: The aim of this study was to determine whether half-dose loading (30?mg) of prasugrel is sufficient to achieve adequate platelet inhibition, and whether such a loading dose of prasugrel together with aspirin followed by a 10?mg/day prasugrel maintenance, could serve as a first-line antiplatelet strategy for patients undergoing flow-diverting stent (FDS) implantation. Methods: Data from a group of consecutive patients treated for intracranial aneurysm with FDS were retrospectively collected. Platelet P2Y12 receptor responsiveness was assessed by a rapid platelet function test just prior to the procedure. All ischemic and hemorrhagic complications as well as morbidity and mortality rates were documented. Results: A total of 138 patients with 153 aneurysms (32 were symptomatic and 121 were incidental) underwent FDS treatment in a total of 147 loading sessions. Adequate platelet inhibition was obtained in 136/138 (98.5%) patients and 145/147 (98.6%) loading sessions. Overall, there was one case of (hemorrhagic) mortality (0.7%), one of (ischemic) morbidity (0.7%), one of symptomatic (hemorrhagic) clinical complications without permanent deficits (0.7%), and six transient ischemic attacks (4.1%). The 6-month control angiography, available for all patients, revealed a 95.4% aneurysm occlusion rate. Conclusion: Half-dose (30?mg) prasugrel loading results in effective platelet P2Y12 receptor inhibition in more than 98% of patients. Dual antiaggregant loading with half dose prasugrel followed by prasugrel maintenance as a first-line therapy appears to be feasible in patients treated with FDS implantation for intracranial aneurysm. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.

Published
2019

9. The incidence and natural history of dasatinib complications in the treatment of chronic myeloid leukemia.

Author

Costello B., Cleary R., McQuillan A., Schwarer A., Harrup R., Holmes A., Ratnasingam S., Chan K.-L., Hsu W.-H., Ashraf A., Putt F., Grigg A., Fox L.C., Cummins K.D., Yeung D., Forsyth C., Tatarczuch M., Burbury K., Motorna O., Shortt J., Fleming S., Costello B., Cleary R., McQuillan A., Schwarer A., Harrup R., Holmes A., Ratnasingam S., Chan K.-L., Hsu W.-H., Ashraf A., Putt F., Grigg A., Fox L.C., Cummins K.D., Yeung D., Forsyth C., Tatarczuch M., Burbury K., Motorna O., Shortt J., and Fleming S.

Abstract

Dasatinib has shown superiority over imatinib in achieving molecular responses (MRs) in chronic phase chronic myeloid leukemia but with a different toxicity profile, which may impact its overall benefit. Reported toxicities include pleural effusions and pulmonary hypertension, and although the incidence of these events is well described, response to therapy and impact of dose modifications on toxicity has not been comprehensively characterized in a real-world setting. We retrospectively reviewed the incidence of dasatinib adverse events in 212 chronic phase chronic myeloid leukemia patients at 17 Australian institutions. Adverse events were reported in 116 patients (55%), most commonly pleural effusions (53 patients, 25%), which was the predominant cause of permanent drug cessation. Age and dose were risk factors for pleural effusion (P < .01 and .047, respectively). Recurrence rates were higher in those who remained on 100 mg compared with those who dose reduced (P = .041); however, recurrence still occurred at 50 mg. Patients who developed pleural effusions were more likely to have achieved MR4.5 after 6 months of dasatinib than those without effusions (P = .008). Pulmonary hypertension occurred in 5% of patients, frequently in association with pleural effusion, and was reversible upon dasatinib cessation in 6 of 7 patients. Dose reductions and temporary cessations had minimal impact on MR rates. Our observations suggest that by using the lowest effective dose in older patients to minimize the effusion risk, dose modification for cytopenias, and care with concomitant antiplatelet therapy, the necessity for permanent dasatinib cessation due to toxicity is likely to be minimal in immunologically competent patients.

Published
2020

10. Incidence and risk factors for stroke following percutaneous coronary intervention.

Author

Chan W., Andrianopoulos N., Thrift A.G., Clark D.J., Brennan A.L., Freeman M., O'Brien J., Sebastian M., Shaw J.A., Duffy S.J., Reid C.M., Dinh D., Dawson L.P., Cole J.A., Lancefield T.F., Ajani A.E., Chan W., Andrianopoulos N., Thrift A.G., Clark D.J., Brennan A.L., Freeman M., O'Brien J., Sebastian M., Shaw J.A., Duffy S.J., Reid C.M., Dinh D., Dawson L.P., Cole J.A., Lancefield T.F., and Ajani A.E.

Abstract

Background: Stroke rates and risk factors may change as percutaneous coronary intervention practice evolves and no data are available comparing stroke incidence after percutaneous coronary intervention to the general population. Aim(s): This study aimed to identify the incidence and risk factors for inpatient and subsequent stroke following percutaneous coronary intervention with comparison to age-matched controls. Method(s): Data were prospectively collected from 22,618 patients undergoing percutaneous coronary intervention in the Melbourne Interventional Group registry (2005-2015). The cohort was compared to the North-East Melbourne Stroke Incidence Study population-based cohort (1997-1999) and predefined variables assessed for association with inpatient or outpatient stroke. Result(s): Inpatient stroke occurred in 0.33% (65.3% ischemic, 28.0% haemorrhagic, and 6.7% cause unknown), while outpatient stroke occurred in 0.55%. Inpatient and outpatient stroke were associated with higher rates of in-hospital major adverse cardiovascular outcomes (p < 0.0001) and mortality (p < 0.0001), as well as 12-month mortality (p < 0.0001). Factors independently associated with inpatient stroke were renal impairment, ST-elevation myocardial infarction, previous stroke, left ventricular ejection fraction 30-45%, and female sex, while those associated with outpatient stroke were previous stroke, chronic lung disease, previous myocardial infarction, rheumatoid arthritis, female sex, and older age. Compared to the age-standardized population-based cohort, stroke rates in the 12 months following discharge were higher for percutaneous coronary intervention patients <65 years old, but lower for percutaneous coronary intervention patients >=65 years old. Conclusion(s): Risk of inpatient stroke following percutaneous coronary intervention appears to be largely associated with clinical status at presentation, while outpatient stroke relates more to age and chronic disease. Compared to the g

Published
2020

11. Risk stratification in acute variceal bleeding: Comparison of the AIMS65 score to established upper gastrointestinal bleeding and liver disease severity risk stratification scoring systems in predicting mortality and rebleeding.

Author

Huynh A., Angus P., Skardoon G., Deshpande S., Sievert W., Low Z.Y., Robertson M., Ng J., Abu Shawish W., Swaine A., Huynh A., Angus P., Skardoon G., Deshpande S., Sievert W., Low Z.Y., Robertson M., Ng J., Abu Shawish W., and Swaine A.

Abstract

Background and Aim: Risk stratification is recommended in all patients with acute variceal bleeding (AVB). It remains unclear whether liver disease severity or upper gastrointestinal bleeding (UGIB) scoring algorithms offer superior predictive ability. We aimed to validate the AIMS65 score as a predictor of mortality in AVB, and to compare AIMS65 with established UGIB and liver disease severity risk stratification scores. Method(s): International Classification of Diseases, Tenth Revision codes identified patients presenting with AVB to three tertiary centers over a 48-month period. Patients were risk-stratified using AIMS65, Rockall, pre-endoscopy Rockall, Child-Pugh, Model for End-stage Liver Disease (MELD) and United Kingdom MELD (UKELD) scores. Primary outcomes were inpatient and 6-week mortality and inpatient rebleeding. Result(s): Two hundred and twenty-three patients were included. Inpatient and 6-week mortality were 13.9% and 15.5% respectively. Prediction of inpatient mortality by AIMS65 (area under the receiver-operating characteristic curve [AUROC: 0.84]) was equivalent to UGIB (Rockall: 0.79, pre-Rockall: 0.78) and liver risk scores (MELD: 0.81, UKELD: 0.79, Child-Pugh: 0.78). AIMS65 score >=3 best defined high- and low-risk groups for inpatient mortality (mortality 37.7% vs 4.9%). AIMS65 (AUROC: 0.62) was equivalent to UGIB risk scores (pre-Rockall: 0.64, Rockall: 0.70) in predicting inpatient rebleeding and superior to liver risk scores (MELD: 0.56, UKELD: 0.57, Child-Pugh: 0.60). Conclusion(s): AIMS65 is equivalent to established UGIB and liver disease severity risk stratification scores in predicting mortality, and superior to liver scores in predicting rebleeding.Copyright © 2019 Japan Gastroenterological Endoscopy Society

Published
2020

12. Effect of Glomerular Filtration Rates on Outcomes Following Percutaneous Left Atrial Appendage Closure

Author

Faroux L., Cruz-González I., Arzamendi D., Freixa X., Nombela-Franco L., Peral V., Caneiro-Queija B., Mangieri A., Trejo-Velasco B., Asmarats L., Regueiro A., McInerney A., Mas-Lladó C., Estevez-Loureiro R., Laricchia A., O'Hara G., and Rodés-Cabau J.

Subjects
glomerulus filtration rate, estimated glomerular filtration rate, very elderly, Embolism, clinical outcome, complication, Comorbidity, left atrial appendage closure, anticoagulant agent, Article, male, Kidney Failu, heart atrium appendage, Atrial Fibrillation, severity of illness index, Humans, Atrial Appendage, postoperative complication, human, Cardiac Surgical Procedures, thrombosis, Ischemic Stroke, Aged, 80 and over, hemodialysis, Anticoagulants, antithrombocytic agent, postoperative hemorrhage, chronic kidney failure, bleeding, major clinical study, interventional cardiovascular procedure, brain ischemia, heart surgery, Cardiac Tamponade, aged, multicenter study, female, priority journal, Ischemic Attack, Transient, transient ischemic attack, mortality risk, disease severity, cerebrovascular accident, heart tamponade, prospective study, Glomerular Filtration Rate
Abstract

Scarce data support the prescription of oral anticoagulation in patients with concomitant advanced chronic kidney disease (CKD) and atrial fibrillation, and left atrial appendage closure (LAAC) may provide a favorable risk-benefit ratio in this population. However, outcomes of LAAC in CKD patients are unknown. We aimed to investigate the impact of moderate-to-severe CKD on clinical outcomes following percutaneous LAAC. This was a multicenter study including 1094 patients who underwent LAAC. Moderate-to-severe CKD was defined as an eGFR

Published
2021

13. Direct oral anticoagulant use does not affect clinical outcomes in acute non-variceal upper gastrointestinal bleeding.

Author

Be K., Hui S., Rajadurai A., Bohra A., Lovett G., Romero S., Ling S., McNamara L., Batt N., Nguyen P., Chung W., Robertson M., Be K., Hui S., Rajadurai A., Bohra A., Lovett G., Romero S., Ling S., McNamara L., Batt N., Nguyen P., Chung W., and Robertson M.

Abstract

Background and Aim: Upper gastrointestinal bleeding (UGIB) remains the most common gastrointestinal emergency and is associated with substantial morbidity and mortality. In recent years, the use of direct oral anticoagulants (DOACs) has dramatically increased, with studies suggesting DOAC use is associated with an increased risk of UGIB. It remains unclear whether DOAC use at the time of UGIB translates into higher morbidity and mortality. We aimed to evaluate the prevalence of DOAC use in patients presenting with non-variceal UGIB and to compare their clinical outcomes with those on therapeutic anticoagulation, antiplatelet therapy, or no antithrombotic therapy. Method(s): Data on all adult patients presenting with UGIB requiring endoscopy to three metropolitan hospitals (two tertiary referral centers and a secondary center) were prospectively collected using a purpose-built smartphone app over a 34-month period from January 2016 to October 2018. Patients with variceal or portal hypertensive bleeding were excluded. Patient cohort demographics, as well as clinical and endoscopic data, were collected. Patients were classified into four groups for analysis: DOACs alone or in combination with antiplatelet therapy; anticoagulant agents (warfarin or therapeutic low molecular weight heparin) alone or in combination with antiplatelet therapy; antiplatelet agents (combination or singleagent therapy); or no antithrombotic therapy. The primary endpoints were 30-day all-cause mortality and a composite clinical endpoint of mortality, rebleeding, and need for re-endoscopy, surgery, or radiological embolization. Secondary endpoints were hospital length of stay (LOS), intensive care unit (ICU) admission, hemoglobin level on admission, and blood transfusion requirements. Result(s): A total of 875 patients were included (median age, 69 years; IQR, 54-80; 64% male). Eighty-one patients (9.2%) presented on a DOAC, 83 (9.5%) on anticoagulation, 284 (32.5%) on antiplatelet therapy, and

Published
2019

14. Carotid artery stenting: Current state of evidence and future directions.

Author

Brooks D.M., Kok H.K., Handelman G., Chandra R.V., Thijs V., Asadi H., Lamanna A., Maingard J., Barras C.D., Brooks D.M., Kok H.K., Handelman G., Chandra R.V., Thijs V., Asadi H., Lamanna A., Maingard J., and Barras C.D.

Abstract

Both carotid endarterectomy (CEA) and carotid artery stenting (CAS) are common treatments for carotid artery stenosis. Several randomized controlled trials (RCTs) have compared CEA to CAS in the treatment of carotid artery stenosis. These studies have suggested that CAS is more strongly associated with periprocedural stroke; however, CEA is more strongly associated with myocardial infarction. Published long-term outcomes report that CAS and CEA are similar. A reduction in complications associated with CAS has also been demonstrated over time. The symptomatic status of the patient and history of previous CEA or cervical radiotherapy are significant factors when deciding between CEA or CAS. Numerous carotid artery stents are available, varying in material, shape and design but with minimal evidence comparing stent types. The role of cerebral protection devices is unclear. Dual antiplatelet therapy is typically prescribed to prevent in-stent thrombosis, and however, evidence comparing periprocedural and postprocedural antiplatelet therapy is scarce, resulting in inconsistent guidelines. Several RCTs are underway that will aim to clarify some of these uncertainties. In this review, we summarize the development of varying techniques of CAS and studies comparing CAS to CEA as treatment options for carotid artery stenosis.Copyright © 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Published
2019

15. KHA-CARI Guideline recommendations for renal biopsy.

Author

Champion De Crespigny P.J., Manera K., Gutman T., Menahem S., Saunders J., See E., Voss D., Wong J., Lopez-Vargas P., MacGinley R., Champion De Crespigny P.J., Manera K., Gutman T., Menahem S., Saunders J., See E., Voss D., Wong J., Lopez-Vargas P., and MacGinley R.

Published
2019

16. Sub-Tenon anesthesia, maintained oral anticoagulant and antiplatelet therapies and vitreoretinal surgery: About 68 cases [Anesthésie sous-ténonienne, traitements anticoagulants et antiagrégants plaquettaires oraux et chirurgie vitréorétinienne: à propos de 68 cas]

Author

Rezkallah, A., Didier, C., Denis, P., Mathis, T., Kodjikian, L., Ecosystèmes méditerranéens et risques (UR EMAX), Centre national du machinisme agricole, du génie rural, des eaux et forêts (CEMAGREF), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Matériaux, ingénierie et science [Villeurbanne] (MATEIS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Letter, retrospective study, very elderly, apixaban, postoperative thrombosis, heart arrhythmia, lymphoma, anesthesia, postoperative period, artery disease, [SPI.MAT]Engineering Sciences [physics]/Materials, intraoperative period, dabigatran, human, rivaroxaban, pars plana vitrectomy, vitreous hemorrhage, anticoagulant therapy, acenocoumarol, ischemic cardiomyopathy, adult, international normalized ratio, patient care, epiretinal membrane, antithrombocytic agent, fluindione, retina macula hole, postoperative hemorrhage, thromboembolism, major clinical study, vitreoretinal surgery, risk benefit analysis, warfarin, aged, valvular heart disease, heart graft, proliferative diabetic retinopathy
Abstract

cited By 0

Published
2019

17. Plasma microRNA profiling reveals novel biomarkers of epicardial adipose tissue: A multidetector computed tomography study

Author

de Gonzalo-Calvo D., Vilades D., Martínez-Camblor P., Vea À., Ferrero-Gregori A., Nasarre L., Bornachea O., Vega J.S., Leta R., Puig N., Benítez S., Sanchez-Quesada J.L., Carreras F., and Llorente-Cortés V.

Subjects
hypertension, epicardial fat, phenotype, polymerase chain reaction, microRNA 590 5p, dipeptidyl carboxypeptidase, multidetector computed tomography, microRNA 22, immunoturbidimetry, Article, hydroxymethylglutaryl coenzyme A reductase inhibitor, microRNA 148a 3p, RNA fingerprinting, male, cardiometabolic risk, heart rate, human, microRNA 15b 3p, computed tomographic angiography, receiver operating characteristic, C reactive protein, microRNA, screening, dyslipidemia, risk assessment, beta adrenergic receptor blocking agent, antithrombocytic agent, microRNA 15b, biological marker, major clinical study, body mass, human tissue, unclassified drug, heart surgery, microRNA 148b 3p, aged, RNA isolation, female, risk factor, plasma protein, RNA purification, diabetes mellitus, microRNA 22 3p, gene expression, blood sampling, coronary angiography, prospective study
Abstract

Epicardial adipose tissue (EAT) constitutes a novel parameter for cardiometabolic risk assessment and a target for therapy. Here, we evaluated for the first time the plasma microRNA (miRNA) profile as a source of biomarkers for epicardial fat volume (EFV). miRNAs were profiled in plasma samples from 180 patients whose EFV was quantified using multidetector computed tomography. In the screening study, 54 deregulated miRNAs were identified in patients with high EFV levels (highest tertile) compared with matched patients with low EFV levels (lowest tertile). After filtering, 12 miRNAs were selected for subsequent validation. In the validation study, miR-15b-3p, miR-22-3p, miR-148a-3p miR-148b-3p and miR-590-5p were directly associated with EFV, even after adjustment for confounding factors (p value < 0.05 for all models). The addition of miRNA combinations to a model based on clinical variables improved the discrimination (area under the receiver-operating-characteristic curve (AUC) from 0.721 to 0.787). miRNAs correctly reclassified a significant proportion of patients with an integrated discrimination improvement (IDI) index of 0.101 and a net reclassification improvement (NRI) index of 0.650. Decision tree models used miRNA combinations to improve their classification accuracy. These results were reproduced using two proposed clinical cutoffs for epicardial fat burden. Internal validation corroborated the robustness of the models. In conclusion, plasma miRNAs constitute novel biomarkers of epicardial fat burden. © 2019 by the authors. Licensee MDPI, Basel, Switzerland.

Published
2019

18. Percutaneous left atrial appendage closure with the watchman device: 12 month outcomes from the wasp asia-pacific registry.

Author

Al Ghamdi M., Omar R., Chandavimol M., Stein K., Shanker A., Phillips K., Santoso T., Sanders P., Alison J., Leung Kwai Chan J., Pak H., Al Ghamdi M., Omar R., Chandavimol M., Stein K., Shanker A., Phillips K., Santoso T., Sanders P., Alison J., Leung Kwai Chan J., and Pak H.

Abstract

Background: Left atrial appendage closure is a non-pharmacological alternative for stroke prevention in high-risk patients with non-valvular atrial fibrillation. Method(s): The objective of the multicentre WASP registry was to obtain clinical data on procedural success and complications, and long-term patient outcomes during real world clinical use in patients across the Asia-Pacific region. Result(s): 201 patients were enrolled in 2014-2015 from 9 centres in Australia, Indonesia, Malaysia, Hong Kong, South Korea, Thailand and Kingdom of Saudi Arabia. Subjects were at high risk of stroke (average CHA2DS2-VASc: 3.9 +/-1.6) and moderate-to-high risk of bleeding (average HAS-BLED score: 2.1 +/-1.2). More than one third of subjects (37.6%) had a history of TIA, ischaemic or haemorrhagic stroke; 71% of patients were deemed unsuitable for long-term oral anticoagulant. Post-implant 57% of patients were prescribed a short-term oral anticoagulant, 38% antiplatelet therapy and 5% no therapy. The device was successfully deployed in 98.5% of patients with no or minimal residual flow achieved in 100% of patients studied at follow-up. The 7-day device or procedure-related SAE rate was 2.0%. There were no peripro-cedural stroke/TIAs or device embolisation. Two patients (1%) required pericardiocentesis. The 12-month mortality rate was 5.2% with 1 procedure/device-related death at 32 days due to oesophageal tear. The 12-month stroke rate was 1.8%. Conclusion(s): Real world experience of left atrial appendage closure with the WATCHMAN device has demonstrated a high successful implant rate and low peri-procedural risk in an Asia-Pacific registry. Long-term outcomes show effi-cacious stroke prevention and are consistent with other WATCHMAN studies.

Published
2018

19. Prevention of stroke: a global perspective.

Author

Gandhi D.B.C., Silva G.S., Akinyemi R.O., Ovbiagele B.I., Lavados P.M., Thrift A.G., Pandian J.D., Gall S.L., Kate M.P., Gandhi D.B.C., Silva G.S., Akinyemi R.O., Ovbiagele B.I., Lavados P.M., Thrift A.G., Pandian J.D., Gall S.L., and Kate M.P.

Abstract

Along with the rising global burden of disability attributed to stroke, costs of stroke care are rising, providing the impetus to direct our research focus towards effective measures of stroke prevention. In this Series paper, we discuss strategies for reducing the risk of the emergence of disease (primordial prevention), preventing the onset of disease (primary prevention), and preventing the recurrence of disease (secondary prevention). Our focus includes global strategies and campaigns, and measurements of the effectiveness of worldwide preventive interventions, with an emphasis on low-income and middle-income countries. Our findings reveal that effective tobacco control, adequate nutrition, and development of healthy cities are important strategies for primordial prevention, whereas polypill strategies, use of mobile technology (mHealth), along with salt reduction and other dietary interventions, are effective in the primary prevention of stroke. An effective collaboration between various health-care sectors, government policies, and campaigns can successfully implement secondary prevention strategies, through surveillance and registries, such as the WHO's non-communicable diseases programmes, across high-income and low-income countries.Copyright © 2018 Elsevier Ltd

Published
2018

20. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial

Author

Gaziano J.M., Brotons C., Coppolecchia R., Cricelli C., Darius H., Gorelick P.B., Howard G., Pearson T.A., Rothwell P.M., Ruilope L.M., Tendera M., and Tognoni G.

Subjects
unstable angina pectoris, Male, double blind procedure, proportional hazards model, heart infarction, Myocardial Infarction, intention to treat analysis, gastrointestinal hemorrhage, risk management, Article, cause of death, Double-Blind Method, cardiovascular disease, Risk Factors, middle aged, follow up, Humans, controlled study, human, Longitudinal Studies, risk reduction, Aged, Proportional Hazards Models, Aspirin, adult, practice guideline, longitudinal study, clinical trial, antithrombocytic agent, acetylsalicylic acid, major clinical study, Stroke, female, multicenter study, priority journal, risk factor, transient ischemic attack, randomized controlled trial, incidence, chemically induced, cerebrovascular accident, Platelet Aggregation Inhibitors
Abstract

Background: The use of aspirin in the primary prevention of cardiovascular events remains controversial. We aimed to assess the efficacy and safety of aspirin versus placebo in patients with a moderate estimated risk of a first cardiovascular event. Methods: ARRIVE is a randomised, double-blind, placebo-controlled, multicentre study done in seven countries. Eligible patients were aged 55 years (men) or 60 years (women) and older and had an average cardiovascular risk, deemed to be moderate on the basis of the number of specific risk factors. We excluded patients at high risk of gastrointestinal bleeding or other bleeding, or diabetes. Patients were randomly assigned (1:1) with a computer-generated randomisation code to receive enteric-coated aspirin tablets (100 mg) or placebo tablets, once daily. Patients, investigators, and others involved in treatment or data analysis were masked to treatment allocation. The primary efficacy endpoint was a composite outcome of time to first occurrence of cardiovascular death, myocardial infarction, unstable angina, stroke, or transient ischaemic attack. Safety endpoints were haemorrhagic events and incidence of other adverse events, and were analysed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT00501059. Findings: Between July 5, 2007, and Nov 15, 2016, 12 546 patients were enrolled and randomly assigned to receive aspirin (n=6270) or placebo (n=6276) at 501 study sites. Median follow-up was 60 months. In the intention-to-treat analysis, the primary endpoint occurred in 269 (4·29%) patients in the aspirin group versus 281 (4·48%) patients in the placebo group (hazard ratio [HR] 0·96; 95% CI 0·81–1·13; p=0·6038). Gastrointestinal bleeding events (mostly mild) occurred in 61 (0·97%) patients in the aspirin group versus 29 (0·46%) in the placebo group (HR 2·11; 95% CI 1·36–3·28; p=0·0007). The overall incidence rate of serious adverse events was similar in both treatment groups (n=1266 [20·19%] in the aspirin group vs n=1311 [20·89%] in the placebo group. The overall incidence of adverse events was similar in both treatment groups (n=5142 [82·01%] vs n=5129 [81·72%] in the placebo group). The overall incidence of treatment-related adverse events was low (n=1050 [16·75%] vs n=850 [13·54%] in the placebo group; p

Published
2018

21. Diffuse alveolar hemorrhage associated with ticagrelor therapy after percutaneous coronary intervention

Author

Oguz Kilic, Samet Yilmaz, and Yalin Tolga Yaylali

Subjects
Lung Diseases, Male, Ticagrelor, lung disease, loading drug dose, medicine.medical_treatment, Case Report, oxygen therapy, 030204 cardiovascular system & hematology, amlodipine, heparin, anterior myocardial infarction, computer assisted tomography, 0302 clinical medicine, Postoperative Complications, middle aged, differential diagnosis, Medicine, coronary artery occlusion, postoperative complication, thrombocyte aggregation, thorax radiography, clinical article, adult, ST segment elevation, Diffuse alveolar hemorrhage, antithrombocytic agent, Middle Aged, drug substitution, drug withdrawal, Cardiology, chemically induced, revascularization, Acute coronary syndrome, Cardiology and Cardiovascular Medicine, Alveolar hemorrhage, medicine.drug, medicine.medical_specialty, Chest Pain, diagnostic imaging, electrocardiography, Kalp ve Kalp Damar Sistemi, complication, Hemorrhage, Article, hemoptysis, Diagnosis, Differential, 03 medical and health sciences, Text mining, Percutaneous Coronary Intervention, Internal medicine, x-ray computed tomography, case report, Humans, human, clopidogrel, ST segment elevation myocardial infarction, business.industry, ST segment depression, thorax pain, Percutaneous coronary intervention, acetylsalicylic acid, bleeding, lung hemorrhage, 030228 respiratory system, ST Elevation Myocardial Infarction, coronary angiography, business, Tomography, X-Ray Computed, Platelet Aggregation Inhibitors
Abstract

Not Available

Published
2018

22. Sources and biological activities of marine sulfated steroids

Author

Carvalhal F., Correia-da-Silva M., Sousa E., Pinto M., Kijjoa A., and CIIMAR - Centro Interdisciplinar de Investigação Marinha e Ambiental

Subjects
antivirus agent, guanosine diphosphate, antiproliferative activity, marine environment, protein tyrosine kinase inhibitor, microtubule assembly, biological activity, antineoplastic activity, Review, protein kinase C inhibitor, antiparasitic agent, pregnane X receptor, angiogenesis, antibacterial activity, antibiotic agent, antifungal agent, human, antineoplastic agent, structure activity relation, nonhuman, steroid, antifungal activity, apoptosis, protein tyrosine kinase, antiinflammatory activity, clinical trial, antithrombocytic agent, protein kinase C delta, antifouling agent, beta secretase 1, priority journal, antihypertensive activity, cardiovascular agent, antiviral activity, osteoblast, matrix metalloproteinase 14, hemolysis, antiinflammatory agent, farnesoid X receptor
Abstract

Marine environment is rich in structurally unique molecules and can be an inspiring source of novel drugs. Currently, six marine-derived drugs are in the market with FDA approval and several more are in the clinical pipeline. Structurally diverse and complex secondary metabolites have been isolated from the marine world and these include sulfated steroids. Biological activities of nearly 150 marine sulfated steroids reported from 1978 to 2017 are compiled and described, namely antimicrobial, antitumor, cardiovascular and antifouling activities. Structure–activity relationship for each activity is discussed. © 2018 Society for Endocrinology. This work was supported through national funds provided by FCT/MCTES – Foundation for Science and Technology from the Minister of Science, Technology and Higher Education (PIDDAC) and European Regional Development Fund (ERDF) through the COMPETE – Programa Operacional Factores de Competitividade (POFC) programme, under the projects PTDC/ MAR-BIO/4694/2014 (reference POCI-01-0145-FEDER-016790; Project 3599 PPCDT – Promover a Produção Científica e Desenvolvimento Tecnológico e a Constituição de Redes Temáticas) and PTDC/AAG-TEC/0739/2014 (reference POCI-01-0145-FEDER-016793; Project 9471 RIDTI – Reforçar a Investigação, o Desenvolvimento Tecnológico e a Inovação) in the framework of the programme PT2020. The author acknowledges the Strategic Funding UID/Multi/04423/2013 provided by FCT – Foundation for Science and Technology and European Regional Development Fund (ERDF), in the framework of the programme PT2020.

Published
2018

23. Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation: A Report from the REPOSI Study

Author

Paciullo, Francesco, Proietti, Marco, Bianconi, Vanessa, Nobili, Alessandro, Pirro, Matteo, Mannucci, Pier Mannuccio, Lip, Gregory Y. H., Lupattelli, Graziana, Tettamanti, Mauro, Pasina, Luca, Franchi, Carlotta, Perticone, Francesco, Salerno, Francesco, Corrao, Salvatore, Marengoni, Alessandra, Licata, Giuseppe, Violi, Francesco, Corazza, Gino Roberto, Marcucci, Maura, Eldin, Tarek Kamal, Di Blanca, Maria Pia Donatella, Lanzo, Giovanna, Astuto, Sarah, Ardoino, Ilaria, Cortesi, Laura, Prisco, Domenico, Silvestri, Elena, Cenci, Caterina, Emmi, Giacomo, Biolo, Gianni, Guarnieri, Gianfranco, Zanetti, Michela, Fernandes, Giovanni, Chiuch, Massimiliano, Vanoli, Massimo, Grignani, Giulia, Casella, Gianluca, Pulixi, Edoardo Alessandro, Bernardi, Mauro, Bassi, Silvia Li, Santi, Luca, Zaccherini, Giacomo, Mannarino, Elmo, Nuti, Ranuccio, Valenti, Roberto, Ruvio, Martina, Cappelli, Silvia, Palazzuoli, Alberto, Salvatore, Teresa, Sasso, Ferdinando Carlo, Girelli, Domenico, Olivieri, Oliviero, Matteazzi, Thomas, Barbagallo, Mario, Plances, Lidia, Alcamo, Roberta, Calvo, Luigi, Valenti, Maria, Zoli, Marco, Arnò, Raffaella, Pasini, Franco Laghi, Capecchi, Pier Leopoldo, Bicchi, Maurizio, Palasciano, Giuseppe, Modeo, Maria Ester, Peragine, Maria, Pappagallo, Fabrizio, Pugliese, Stefania, Di Gennaro, Carla, Postiglione, Alfredo, Barbella, Maria Rosaria, de Stefano, Francesco, Cappellini, Maria Domenica, Fabio, Giovanna, Seghezzi, Sonia, de Amicis, Margherita Migone, Mancarella, Marta, Mari, Daniela, Rossi, Paolo Dionigi, Damanti, Sarah, Ottolini, Barbara Brignolo, Bonini, Giulia, Miceli, Emanuela, Lenti, Marco Vincenzo, Padula, Donatella, Murialdo, Giovanni, Marra, Alessio, Cattaneo, Federico, Secchi, Maria Beatrice, Ghelfi, Davide, Anastasio, Luigi, Sofia, Lucia, Carbone, Maria, Davì, Giovanni, Guagnano, Maria Teresa, Sestili, Simona, Mancuso, Gerardo, Calipari, Daniela, Bartone, Mosè, Meroni, Maria Rachele, Perin, Paolo Cavallo, Lorenzati, Bartolomeo, Gruden, Gabriella, Bruno, Graziella, Amione, Cristina, Fornengo, Paolo, Tassara, Rodolfo, Melis, Deborah, Rebella, Lara, Delitala, Giuseppe, Pretti, Vincenzo, Masala, Maristella Salvatora, Pes, Chiara, Bolondi, Luigi, Rasciti, Leonardo, Serio, Ilaria, Fanelli, Filippo Rossi, Amoroso, Antonio, Molfino, Alessio, Petrillo, Enrico, Zuccalà, Giuseppe, Franceschi, Francesco, de Marco, Guido, Chiara, Cordischi, Marta, Sabbatini, D’Aurizio, Gabriella, Romanelli, Giuseppe, Amolini, Claudia, Chiesa, Deborah, Picardi, Antonio, Gentilucci, Umberto Vespasiani, Gallo, Paolo, Annoni, Giorgio, Corsi, Maurizio, Zazzetta, Sara, Bellelli, Giuseppe, Szabo, Hajnalka, Arturi, Franco, Succurro, Elena, Rubino, Mariangela, Sesti, Giorgio, Loria, Paola, Becchi, Maria Angela, Martucci, Gianfranco, Fantuzzi, Alessandra, Maurantonio, Mauro, Serra, Maria Grazia, Bleve, Maria Antonietta, Gasbarrone, Laura, Sajeva, Maria Rosaria, Brucato, Antonio, Ghidoni, Silvia, Di Corato, Paola, Agnelli, Giancarlo, Marchesini, Emanuela, Fabris, Fabrizio, Carlon, Michela, Turatto, Francesca, Baritusso, Aldo, Amabile, Annalisa, Omenetto, Elisabetta, Scarinzi, Paolo, Manfredini, Roberto, Molino, Christian, Pala, Marco, Fabbian, Fabio, Boari, Benedetta, de Giorgi, Alfredo, Paolisso, Giuseppe, Rizzo, Maria Rosaria, Laieta, Maria Teresa, Rini, Giovanbattista, Mansueto, Pasquale, Pepe, Ilenia, Borghi, Claudio, Strocchi, Enrico, de Sando, Valeria, Pareo, Ilaria, Sabbà, Carlo, Vella, Francesco Saverio, Suppressa, Patrizia, Valerio, Raffaella, Agosti, Pasquale, Fontana, Flavia, Loparco, Francesca, Capobianco, Caterina, Fenoglio, Luigi, Bracco, Christian, Giraudo, Alessia Valentina, Testa, Elisa, Serraino, Cristina, Fargion, Silvia, Bonara, Paola, Periti, Giulia, Porzio, Marianna, Tiraboschi, Slivia, Peyvandi, Flora, Tedeschi, Alberto, Rossio, Raffaella, Ferrari, Barbara, Monzani, Valter, Savojardo, Valeria, Folli, Christian, Magnini, Maria, Conca, Alessio, Gobbo, Giulia, Pallini, Giada, Valenti, Miriam, Balduini, Carlo L., Bertolino, Giampiera, Provini, Stella, Quaglia, Federica, Dallegri, Franco, Ottonello, Luciano, Liberale, Luca, Chin, Wu Sheng, Carassale, Laura, Caporotundo, Silvia, Traisci, Giancarlo, de Feudis, Lucrezia, Di Carlo, Silvia, Liberato, Nicola Lucio, Buratti, Alberto, Tognin, Tiziana, Bianchi, Giovanni Battista, Giaquinto, Sabrina, Purrello, Francesco, Di Pino, Antonino, Piro, Salvatore, Rozzini, Renzo, Falanga, Lina, Spazzini, Elena, Montrucchio, Giuseppe, Greco, Elisabetta, Tizzani, Pietro, Petitti, Paolo, Perciccante, Antonio, Coralli, Alessia, Salmi, Raffaella, Gaudenzi, Piergiorgio, Gamberini, Susanna, Semplicini, Andrea, Gottardo, Lucia, Vendemiale, Gianluigi, Serviddio, Gaetano, Forlano, Roberta, Masala, Cesare, Mammarella, Antonio, Raparelli, Valeria, Basili, Stefania, Perri, Ludovica, Landolfi, Raffaele, Montalto, Massimo, Mirijello, Antonio, Vallone, Carla, Bellusci, Martino, Setti, Donatella, Pedrazzoli, Filippo, Guasti, Luigina, Castiglioni, Luana, Maresca, Andrea, Squizzato, Alessandro, Molaro, Marta, Bertolotti, Marco, Mussi, Chiara, Libbra, Maria Vittoria, Miceli, Andrea, Pellegrini, Elisa, Carulli, Lucia, Veltri, Francesca, Sciacqua, Angela, Quero, Michele, Bagnato, Chiara, Colangelo, Lidia, Falbo, Tania, de Giorgio, Roberto, Serra, Mauro, Grasso, Valentina, Ruggeri, Eugenio, Ilaria, Benzoni, Salvi, Andrea, Leonardi, Roberto, Grassini, Chiara, Mascherona, Ilenia, Minelli, Giorgio, Maltese, Francesca, Damiani, Giampaolo, Capeci, William, Mattioli, Massimo, Martino, Giuseppe Pio, Biondi, Lorenzo, Ormas, Monica, Pettinari, Pietro, Romiti, Roberto, Messina, Silvia, Cavallaro, Federica, Ghio, Riccardi, Favorini, Serena, Col, Anna Dal, Minisola, Salvatore, Colangelo, Luciano, Afeltra, Antonella, Alemanno, Pamela, Marigliano, Benedetta, Pipita, Maria Elena, Castellino, Pietro, Blanco, Julien, Zanoli, Luca, Cattaneo, Marco, Fracasso, Paola, Amoruso, Maria Valentina, Saracco, Valter, Fogliati, Marisa, Bussolino, Carlo, Durante, Vittorio, Eusebi, Giovanna, Tirotta, Daniela, Mete, Francesca, Gino, Miriam, Cittadini, Antonio, Vigorito, Carlo, Arcopinto, Michele, Salzano, Andrea, Bobbio, Emanuele, Marra, Alberto Maria, Sirico, Domenico, Moreo, Guido, Scopelliti, Francesco, Gasparini, Francesca, Cocca, Melissa, Ballestrero, Alberto, Ferrando, Fabio, Berra, Sergio, Dassi, Simonetta, Nava, Maria Cristina, Graziella, Bruno, Baldassarre, Stefano, Fragapani, Salvatore, Galanti, Giorgio, Mascherini, Gabriele, Petri, Cristian, Stefani, Laura, Girino, Margherita, Piccinelli, Valeria, Nasso, Francesco, Gioffrè, Vincenza, Pasquale, Maria, Scattolin, Giuseppe, Martinelli, Sergio, Turrin, Mauro, Sechi, Leonardo, Catena, Cristina, Colussi, Gianluca, Nieves, Ramirez Duque, Alberto, Muela Molinero, Pedro, Abad Requejo, Vanessa, Lopez Pelaez, Lara, Tamargo, Xavier, Corbella Viros, Francesc, Formiga, Jesus, Diez Manglano, Esperanza, Bejarano Tello, Esther, Del Corral Behamonte, Maria, Sevil Puras, Romero, Manuel, Blanca, Pinilla Llorente, Cristina, Lopez Gonzalez-Cobos, Victoria, Villalba Garcia M., Saez, Lopez, Bosco, Juan, Susana, Sanz Baena, Marta, Arroyo Gallego, Concepcion, Gonzalez Becerra, Antonio, Fernandez Moyano, Hernandez, Mercedes Gomez, Borrego, Manuel Poyato, Raquel, Pacheco Cuadros, Florencia, Perez Rojas, Beatriz, Garcia Olid, Sara, Carrascosa Garcia, Alfonso, Gonzalez-Cruz Cervellera, Marta, Peinado Martinez, Garcia, Sara Carrascosa, Alberto, Ruiz Cantero, Antonio, Albarracín Arraigosa, Montserrat, Godoy Guerrero, Ángel, Barón Ramos Miguel, Manuel, Machin Jose, Ignacio, Novo Veleiro, Lucía, Alvela Suarez, Alfonso, Lopez, David, Rubal Bran, Iria, Iñiguez Vazquez, Monica, Rios Prego, Paciullo F., Proietti M., Bianconi V., Nobili A., Pirro M., Mannucci P.M., Lip G.Y.H., Lupattelli G., Tettamanti M., Pasina L., Franchi C., Perticone F., Salerno F., Corrao S., Marengoni A., Licata G., Violi F., Corazza G.R., Marcucci M., Eldin T.K., Di Blanca M.P.D., Lanzo G., Astuto S., Ardoino I., Cortesi L., Prisco D., Silvestri E., Cenci C., Emmi G., Biolo G., Guarnieri G., Zanetti M., Fernandes G., Chiuch M., Vanoli M., Grignani G., Casella G., Pulixi E.A., Bernardi M., Bassi S.L., Santi L., Zaccherini G., Mannarino E., Nuti R., Valenti R., Ruvio M., Cappelli S., Palazzuoli A., Salvatore T., Sasso F.C., Girelli D., Olivieri O., Matteazzi T., Barbagallo M., Plances L., Alcamo R., Calvo L., Valenti M., Zoli M., Arno R., Pasini F.L., Capecchi P.L., Bicchi M., Palasciano G., Modeo M.E., Peragine M., Pappagallo F., Pugliese S., Di Gennaro C., Postiglione A., Barbella M.R., De Stefano F., Cappellini M.D., Fabio G., Seghezzi S., De Amicis M.M., Mancarella M., Mari D., Rossi P.D., Damanti S., Ottolini B.B., Bonini G., Miceli E., Lenti M.V., Padula D., Murialdo G., Marra A., Cattaneo F., Secchi M.B., Ghelfi D., Anastasio L., Sofia L., Carbone M., Davi G., Guagnano M.T., Sestili S., Mancuso G., Calipari D., Bartone M., Meroni M.R., Perin P.C., Lorenzati B., Gruden G., Bruno G., Amione C., Fornengo P., Tassara R., Melis D., Rebella L., Delitala G., Pretti V., Masala M.S., Pes C., Bolondi L., Rasciti L., Serio I., Fanelli F.R., Amoroso A., Molfino A., Petrillo E., Zuccala G., Franceschi F., De Marco G., Chiara C., Marta S., D'Aurizio G., Romanelli G., Amolini C., Chiesa D., Picardi A., Gentilucci U.V., Gallo P., Annoni G., Corsi M., Zazzetta S., Bellelli G., Szabo H., Arturi F., Succurro E., Rubino M., Sesti G., Loria P., Becchi M.A., Martucci G., Fantuzzi A., Maurantonio M., Serra M.G., Bleve M.A., Gasbarrone L., Sajeva M.R., Brucato A., Ghidoni S., Di Corato P., Agnelli G., Marchesini E., Fabris F., Carlon M., Turatto F., Baritusso A., Amabile A., Omenetto E., Scarinzi P., Manfredini R., Molino C., Pala M., Fabbian F., Boari B., De Giorgi A., Paolisso G., Rizzo M.R., Laieta M.T., Rini G., Mansueto P., Pepe I., Borghi C., Strocchi E., De Sando V., Pareo I., Sabba C., Vella F.S., Suppressa P., Valerio R., Agosti P., Fontana F., Loparco F., Capobianco C., Fenoglio L., Bracco C., Giraudo A.V., Testa E., Serraino C., Fargion S., Bonara P., Periti G., Porzio M., Tiraboschi S., Peyvandi F., Tedeschi A., Rossio R., Ferrari B., Monzani V., Savojardo V., Folli C., Magnini M., Conca A., Gobbo G., Pallini G., Balduini C.L., Bertolino G., Provini S., Quaglia F., Dallegri F., Ottonello L., Liberale L., Chin W.S., Carassale L., Caporotundo S., Traisci G., De Feudis L., Di Carlo S., Liberato N.L., Buratti A., Tognin T., Bianchi G.B., Giaquinto S., Purrello F., Di Pino A., Piro S., Rozzini R., Falanga L., Spazzini E., Montrucchio G., Greco E., Tizzani P., Petitti P., Perciccante A., Coralli A., Salmi R., Gaudenzi P., Gamberini S., Semplicini A., Gottardo L., Vendemiale G., Serviddio G., Forlano R., Masala C., Mammarella A., Raparelli V., Basili S., Perri L., Landolfi R., Montalto M., Mirijello A., Vallone C., Bellusci M., Setti D., Pedrazzoli F., Guasti L., Castiglioni L., Maresca A., Squizzato A., Molaro M., Bertolotti M., Mussi C., Libbra M.V., Miceli A., Pellegrini E., Carulli L., Veltri F., Sciacqua A., Quero M., Bagnato C., Colangelo L., Falbo T., De Giorgio R., Serra M., Grasso V., Ruggeri E., Ilaria B., Salvi A., Leonardi R., Grassini C., Mascherona I., Minelli G., Maltese F., Damiani G., Capeci W., Mattioli M., Martino G.P., Biondi L., Ormas M., Pettinari P., Romiti R., Messina S., Cavallaro F., Ghio R., Favorini S., Col A.D., Minisola S., Afeltra A., Alemanno P., Marigliano B., Pipita M.E., Castellino P., Blanco J., Zanoli L., Cattaneo M., Fracasso P., Amoruso M.V., Saracco V., Fogliati M., Bussolino C., Durante V., Eusebi G., Tirotta D., Mete F., Gino M., Cittadini A., Vigorito C., Arcopinto M., Salzano A., Bobbio E., Marra A.M., Sirico D., Moreo G., Scopelliti F., Gasparini F., Cocca M., Ballestrero A., Ferrando F., Berra S., Dassi S., Nava M.C., Graziella B., Baldassarre S., Fragapani S., Galanti G., Mascherini G., Petri C., Stefani L., Girino M., Piccinelli V., Nasso F., Gioffre V., Pasquale M., Scattolin G., Martinelli S., Turrin M., Sechi L., Catena C., Colussi G., Nieves R.D., Alberto M.M., Pedro A.R., Vanessa L.P., Lara T., Xavier C.V., Francesc F., Jesus D.M., Esperanza B.T., Esther D.C.B., Maria S.P., Romero M., Blanca P.L., Cristina L.G.-C., Victoria V.G.M., Saez L., Bosco J., Susana S.B., Marta A.G., Concepcion G.B., Antonio F.M., Hernandez M.G., Borrego M.P., Raquel P.C., Florencia P.R., Beatriz G.O., Sara C.G., Alfonso G.-C.C., Marta P.M., Garcia S.C., Alberto R.C., Antonio A.A., Montserrat G.G., Angel B.R.M., Manuel M.J., Ignacio N.V., Lucia A.S., Alfonso L., David R.B., Iria I.V., Monica R.P., Paciullo, Francesco, Proietti, Marco, Bianconi, Vanessa, Nobili, Alessandro, Pirro, Matteo, Mannucci, Pier Mannuccio, Lip, Gregory Y. H., Lupattelli, Graziana, Tettamanti, Mauro, Pasina, Luca, Franchi, Carlotta, Perticone, Francesco, Salerno, Francesco, Corrao, Salvatore, Marengoni, Alessandra, Licata, Giuseppe, Violi, Francesco, Corazza, Gino Roberto, Marcucci, Maura, Eldin, Tarek Kamal, Di Blanca, Maria Pia Donatella, Lanzo, Giovanna, Astuto, Sarah, Ardoino, Ilaria, Cortesi, Laura, Prisco, Domenico, Silvestri, Elena, Cenci, Caterina, Emmi, Giacomo, Biolo, Gianni, Guarnieri, Gianfranco, Zanetti, Michela, Fernandes, Giovanni, Chiuch, Massimiliano, Vanoli, Massimo, Grignani, Giulia, Casella, Gianluca, Pulixi, Edoardo Alessandro, Bernardi, Mauro, Bassi, Silvia Li, Santi, Luca, Zaccherini, Giacomo, Mannarino, Elmo, Nuti, Ranuccio, Valenti, Roberto, Ruvio, Martina, Cappelli, Silvia, Palazzuoli, Alberto, Salvatore, Teresa, Sasso, Ferdinando Carlo, Girelli, Domenico, Olivieri, Oliviero, Matteazzi, Thoma, Barbagallo, Mario, Plances, Lidia, Alcamo, Roberta, Calvo, Luigi, Valenti, Maria, Zoli, Marco, Arnò, Raffaella, Pasini, Franco Laghi, Capecchi, Pier Leopoldo, Bicchi, Maurizio, Palasciano, Giuseppe, Modeo, Maria Ester, Peragine, Maria, Pappagallo, Fabrizio, Pugliese, Stefania, Di Gennaro, Carla, Postiglione, Alfredo, Barbella, Maria Rosaria, de Stefano, Francesco, Cappellini, Maria Domenica, Fabio, Giovanna, Seghezzi, Sonia, de Amicis, Margherita Migone, Mancarella, Marta, Mari, Daniela, Rossi, Paolo Dionigi, Damanti, Sarah, Ottolini, Barbara Brignolo, Bonini, Giulia, Miceli, Emanuela, Lenti, Marco Vincenzo, Padula, Donatella, Murialdo, Giovanni, Marra, Alessio, Cattaneo, Federico, Secchi, Maria Beatrice, Ghelfi, Davide, Anastasio, Luigi, Sofia, Lucia, Carbone, Maria, Davì, Giovanni, Guagnano, Maria Teresa, Sestili, Simona, Mancuso, Gerardo, Calipari, Daniela, Bartone, Mosè, Meroni, Maria Rachele, Perin, Paolo Cavallo, Lorenzati, Bartolomeo, Gruden, Gabriella, Bruno, Graziella, Amione, Cristina, Fornengo, Paolo, Tassara, Rodolfo, Melis, Deborah, Rebella, Lara, Delitala, Giuseppe, Pretti, Vincenzo, Masala, Maristella Salvatora, Pes, Chiara, Bolondi, Luigi, Rasciti, Leonardo, Serio, Ilaria, Fanelli, Filippo Rossi, Amoroso, Antonio, Molfino, Alessio, Petrillo, Enrico, Zuccalà, Giuseppe, Franceschi, Francesco, de Marco, Guido, Chiara, Cordischi, Marta, Sabbatini, D’Aurizio, Gabriella, Romanelli, Giuseppe, Amolini, Claudia, Chiesa, Deborah, Picardi, Antonio, Gentilucci, Umberto Vespasiani, Gallo, Paolo, Annoni, Giorgio, Corsi, Maurizio, Zazzetta, Sara, Bellelli, Giuseppe, Szabo, Hajnalka, Arturi, Franco, Succurro, Elena, Rubino, Mariangela, Sesti, Giorgio, Loria, Paola, Becchi, Maria Angela, Martucci, Gianfranco, Fantuzzi, Alessandra, Maurantonio, Mauro, Serra, Maria Grazia, Bleve, Maria Antonietta, Gasbarrone, Laura, Sajeva, Maria Rosaria, Brucato, Antonio, Ghidoni, Silvia, Di Corato, Paola, Agnelli, Giancarlo, Marchesini, Emanuela, Fabris, Fabrizio, Carlon, Michela, Turatto, Francesca, Baritusso, Aldo, Amabile, Annalisa, Omenetto, Elisabetta, Scarinzi, Paolo, Manfredini, Roberto, Molino, Christian, Pala, Marco, Fabbian, Fabio, Boari, Benedetta, de Giorgi, Alfredo, Paolisso, Giuseppe, Rizzo, Maria Rosaria, Laieta, Maria Teresa, Rini, Giovanbattista, Mansueto, Pasquale, Pepe, Ilenia, Borghi, Claudio, Strocchi, Enrico, de Sando, Valeria, Pareo, Ilaria, Sabbà, Carlo, Vella, Francesco Saverio, Suppressa, Patrizia, Valerio, Raffaella, Agosti, Pasquale, Fontana, Flavia, Loparco, Francesca, Capobianco, Caterina, Fenoglio, Luigi, Bracco, Christian, Giraudo, Alessia Valentina, Testa, Elisa, Serraino, Cristina, Fargion, Silvia, Bonara, Paola, Periti, Giulia, Porzio, Marianna, Tiraboschi, Slivia, Peyvandi, Flora, Tedeschi, Alberto, Rossio, Raffaella, Ferrari, Barbara, Monzani, Valter, Savojardo, Valeria, Folli, Christian, Magnini, Maria, Conca, Alessio, Gobbo, Giulia, Pallini, Giada, Valenti, Miriam, Balduini, Carlo L., Bertolino, Giampiera, Provini, Stella, Quaglia, Federica, Dallegri, Franco, Ottonello, Luciano, Liberale, Luca, Chin, Wu Sheng, Carassale, Laura, Caporotundo, Silvia, Traisci, Giancarlo, de Feudis, Lucrezia, Di Carlo, Silvia, Liberato, Nicola Lucio, Buratti, Alberto, Tognin, Tiziana, Bianchi, Giovanni Battista, Giaquinto, Sabrina, Purrello, Francesco, Di Pino, Antonino, Piro, Salvatore, Rozzini, Renzo, Falanga, Lina, Spazzini, Elena, Montrucchio, Giuseppe, Greco, Elisabetta, Tizzani, Pietro, Petitti, Paolo, Perciccante, Antonio, Coralli, Alessia, Salmi, Raffaella, Gaudenzi, Piergiorgio, Gamberini, Susanna, Semplicini, Andrea, Gottardo, Lucia, Vendemiale, Gianluigi, Serviddio, Gaetano, Forlano, Roberta, Masala, Cesare, Mammarella, Antonio, Raparelli, Valeria, Basili, Stefania, Perri, Ludovica, Landolfi, Raffaele, Montalto, Massimo, Mirijello, Antonio, Vallone, Carla, Bellusci, Martino, Setti, Donatella, Pedrazzoli, Filippo, Guasti, Luigina, Castiglioni, Luana, Maresca, Andrea, Squizzato, Alessandro, Molaro, Marta, Bertolotti, Marco, Mussi, Chiara, Libbra, Maria Vittoria, Miceli, Andrea, Pellegrini, Elisa, Carulli, Lucia, Veltri, Francesca, Sciacqua, Angela, Quero, Michele, Bagnato, Chiara, Colangelo, Lidia, Falbo, Tania, de Giorgio, Roberto, Serra, Mauro, Grasso, Valentina, Ruggeri, Eugenio, Ilaria, Benzoni, Salvi, Andrea, Leonardi, Roberto, Grassini, Chiara, Mascherona, Ilenia, Minelli, Giorgio, Maltese, Francesca, Damiani, Giampaolo, Capeci, William, Mattioli, Massimo, Martino, Giuseppe Pio, Biondi, Lorenzo, Ormas, Monica, Pettinari, Pietro, Romiti, Roberto, Messina, Silvia, Cavallaro, Federica, Ghio, Riccardi, Favorini, Serena, Col, Anna Dal, Minisola, Salvatore, Colangelo, Luciano, Afeltra, Antonella, Alemanno, Pamela, Marigliano, Benedetta, Pipita, Maria Elena, Castellino, Pietro, Blanco, Julien, Zanoli, Luca, Cattaneo, Marco, Fracasso, Paola, Amoruso, Maria Valentina, Saracco, Valter, Fogliati, Marisa, Bussolino, Carlo, Durante, Vittorio, Eusebi, Giovanna, Tirotta, Daniela, Mete, Francesca, Gino, Miriam, Cittadini, Antonio, Vigorito, Carlo, Arcopinto, Michele, Salzano, Andrea, Bobbio, Emanuele, Marra, Alberto Maria, Sirico, Domenico, Moreo, Guido, Scopelliti, Francesco, Gasparini, Francesca, Cocca, Melissa, Ballestrero, Alberto, Ferrando, Fabio, Berra, Sergio, Dassi, Simonetta, Nava, Maria Cristina, Graziella, Bruno, Baldassarre, Stefano, Fragapani, Salvatore, Galanti, Giorgio, Mascherini, Gabriele, Petri, Cristian, Stefani, Laura, Girino, Margherita, Piccinelli, Valeria, Nasso, Francesco, Gioffrè, Vincenza, Pasquale, Maria, Scattolin, Giuseppe, Martinelli, Sergio, Turrin, Mauro, Sechi, Leonardo, Catena, Cristina, Colussi, Gianluca, Nieves, Ramirez Duque, Alberto, Muela Molinero, Pedro, Abad Requejo, Vanessa, Lopez Pelaez, Lara, Tamargo, Xavier, Corbella Viro, Francesc, Formiga, Jesus, Diez Manglano, Esperanza, Bejarano Tello, Esther, Del Corral Behamonte, Maria, Sevil Pura, Romero, Manuel, Blanca, Pinilla Llorente, Cristina, Lopez Gonzalez-Cobo, Victoria, Villalba Garcia M., Saez, Lopez, Bosco, Juan, Susana, Sanz Baena, Marta, Arroyo Gallego, Concepcion, Gonzalez Becerra, Antonio, Fernandez Moyano, Hernandez, Mercedes Gomez, Borrego, Manuel Poyato, Raquel, Pacheco Cuadro, Florencia, Perez Roja, Beatriz, Garcia Olid, Sara, Carrascosa Garcia, Alfonso, Gonzalez-Cruz Cervellera, Marta, Peinado Martinez, Garcia, Sara Carrascosa, Alberto, Ruiz Cantero, Antonio, Albarracín Arraigosa, Montserrat, Godoy Guerrero, Ángel, Barón Ramos Miguel, Manuel, Machin Jose, Ignacio, Novo Veleiro, Lucía, Alvela Suarez, Alfonso, Lopez, David, Rubal Bran, Iria, Iñiguez Vazquez, Monica, Rios Prego, De Stefano, Francesco, De Amicis, Margherita Migone, De Marco, Guido, De Giorgi, Alfredo, De Sando, Valeria, De Feudis, Lucrezia, De Giorgio, Roberto, Mannucci, Pm, Nobili, A, Tettamanti, M, Pasina, L, Franchi, C, Perticone, F, Salerno, F, Corrao, S, Marengoni, A, Licata, G, Violi, F, Corazza, Gr, Marcucci, M, Eldin, Tk, Di Blanca, Mpd, Lanzo, G, Astuto, S, Ardoino, I, Cortesi, L, Prisco, D, Silvestri, E, Cenci, C, Emmi, G, Biolo, G, Guarnieri, G, Zanetti, M, Fernandes, G, Chiuch, M, Vanoli, M, Grignani, G, Casella, G, Pulixi, Ea, Bernardi, M, Bassi, Sl, Santi, L, Zaccherini, G, Mannarino, E, Lupattelli, G, Bianconi, V, Paciullo, F, Nuti, R, Valenti, R, Ruvio, M, Cappelli, S, Palazzuoli, A, Salvatore, T, Sasso, Fc, Girelli, D, Olivieri, O, Matteazzi, T, Barbagallo, M, Plances, L, Alcamo, R, Calvo, L, Valenti, M, Zoli, M, Arnò, R, Pasini, Fl, Capecchi, Pl, Bicchi, M, Palasciano, G, Modeo, Me, Peragine, M, Pappagallo, F, Pugliese, S, Di Gennaro, C, Postiglione, A, Barbella, Mr, De Stefano, F, Cappellini, Md, Fabio, G, Seghezzi, S, De Amicis, Mm, Mancarella, M, Mari, D, Rossi, Pd, Damanti, S, Ottolini, Bb, Bonini, G, Miceli, E, Lenti, Mv, Padula, D, Murialdo, G, Marra, A, Cattaneo, F, Secchi, Mb, Ghelfi, D, Anastasio, L, Sofia, L, Carbone, M, Davì, G, Guagnano, Mt, Sestili, S, Mancuso, G, Calipari, D, Bartone, M, Meroni, Mr, Perin, Pc, Lorenzati, B, Gruden, G, Bruno, G, Amione, C, Fornengo, P, Tassara, R, Melis, D, Rebella, L, Delitala, G, Pretti, V, Masala, M, Pes, C, Bolondi, L, Rasciti, L, Serio, I, Fanelli, Fr, Amoroso, A, Molfino, A, Petrillo, E, Zuccalà, G, Franceschi, F, De Marco, G, Chiara, C, Marta, S, D'Aurizio, G, Romanelli, G, Amolini, C, Chiesa, D, Picardi, A, Gentilucci, Uv, Gallo, P, Annoni, G, Corsi, M, Zazzetta, S, Bellelli, G, Szabo, H, Arturi, F, Succurro, E, Rubino, M, Sesti, G, Loria, P, Becchi, Ma, Martucci, G, Fantuzzi, A, Maurantonio, M, Serra, Mg, Bleve, Ma, Gasbarrone, L, Sajeva, Mr, Brucato, A, Ghidoni, S, Di Corato, P, Agnelli, G, Marchesini, E, Fabris, F, Carlon, M, Turatto, F, Baritusso, A, Amabile, A, Omenetto, E, Scarinzi, P, Manfredini, R, Molino, C, Pala, M, Fabbian, F, Boari, B, De Giorgi, A, Paolisso, G, Rizzo, Mr, Laieta, Mt, Rini, G, Mansueto, P, Pepe, I, Borghi, C, Strocchi, E, De Sando, V, Pareo, I, Sabbà, C, Vella, F, Suppressa, P, Valerio, R, Agosti, P, Fontana, F, Loparco, F, Capobianco, C, Fenoglio, L, Bracco, C, Giraudo, Av, Testa, E, Serraino, C, Fargion, S, Bonara, P, Periti, G, Porzio, M, Tiraboschi, S, Peyvandi, F, Tedeschi, A, Rossio, R, Ferrari, B, Monzani, V, Savojardo, V, Folli, C, Magnini, M, Conca, A, Gobbo, G, Pallini, G, Balduini, Cl, Bertolino, G, Provini, S, Quaglia, F, Dallegri, F, Ottonello, L, Liberale, L, Chin, W, Carassale, L, Caporotundo, S, Traisci, G, De Feudis, L, Di Carlo, S, Liberato, Nl, Buratti, A, Tognin, T, Bianchi, Gb, Giaquinto, S, Purrello, F, Di Pino, A, Piro, S, Rozzini, R, Falanga, L, Spazzini, E, Montrucchio, G, Greco, E, Tizzani, P, Petitti, P, Perciccante, A, Coralli, A, Salmi, R, Gaudenzi, P, Gamberini, S, Semplicini, A, Gottardo, L, Vendemiale, G, Serviddio, G, Forlano, R, Masala, C, Mammarella, A, Raparelli, V, Basili, S, Perri, L, Landolfi, R, Montalto, M, Mirijello, A, Vallone, C, Bellusci, M, Setti, D, Pedrazzoli, F, Guasti, L, Castiglioni, L, Maresca, A, Squizzato, A, Molaro, M, Bertolotti, M, Mussi, C, Libbra, Mv, Miceli, A, Pellegrini, E, Carulli, L, Veltri, F, Sciacqua, A, Quero, M, Bagnato, C, Colangelo, L, Falbo, T, De Giorgio, R, Serra, M, Grasso, V, Ruggeri, E, Ilaria, B, Salvi, A, Leonardi, R, Grassini, C, Mascherona, I, Minelli, G, Maltese, F, Damiani, G, Capeci, W, Mattioli, M, Martino, Gp, Biondi, L, Ormas, M, Pettinari, P, Romiti, R, Messina, S, Cavallaro, F, Ghio, R, Favorini, S, Col, Ad, Minisola, S, Afeltra, A, Alemanno, P, Marigliano, B, Pipita, Me, Castellino, P, Blanco, J, Zanoli, L, Cattaneo, M, Fracasso, P, Amoruso, Mv, Saracco, V, Fogliati, M, Bussolino, C, Durante, V, Eusebi, G, Tirotta, D, Mete, F, Gino, M, Cittadini, A, Vigorito, C, Arcopinto, M, Salzano, A, Bobbio, E, Marra, Am, Sirico, D, Moreo, G, Scopelliti, F, Gasparini, F, Cocca, M, Ballestrero, A, Ferrando, F, Berra, S, Dassi, S, Nava, Mc, Graziella, B, Baldassarre, S, Fragapani, S, Galanti, G, Mascherini, G, Petri, C, Stefani, L, Girino, M, Piccinelli, V, Nasso, F, Gioffrè, V, Pasquale, M, Scattolin, G, Martinelli, S, Turrin, M, Sechi, L, Catena, C, Colussi, G, Nieves, Rd, Alberto, Mm, Pedro, Ar, Vanessa, Lp, Lara, T, Xavier, Cv, Francesc, F, Jesus, Dm, Esperanza, Bt, Esther, Dcb, Maria, Sp, Romero, M, Blanca, Pl, Cristina, Lg, Victoria, Vgm, Saez, L, Bosco, J, Susana, Sb, Marta, Ag, Concepcion, Gb, Antonio, Fm, Hernandez, Mg, Borrego, Mp, Raquel, Pc, Florencia, Pr, Beatriz, Go, Sara, Cg, Alfonso, Gc, Marta, Pm, Garcia, Sc, Alberto, Rc, Antonio, Aa, Montserrat, Gg, Ángel, Brm, Manuel, Mj, Ignacio, Nv, Lucía, A, Alfonso, L, David, Rb, Iria, Iv, Monica, Rp., Paciullo, F., Proietti, M., Bianconi, V., Nobili, A., Pirro, M., Mannucci, P. M., Lip, G. Y. H., Lupattelli, G., Tettamanti, M., Pasina, L., Franchi, C., Perticone, F., Salerno, F., Corrao, S., Marengoni, A., Licata, G., Violi, F., Corazza, G. R., Marcucci, M., Eldin, T. K., Di Blanca, M. P. D., Lanzo, G., Astuto, S., Ardoino, I., Cortesi, L., Prisco, D., Silvestri, E., Cenci, C., Emmi, G., Biolo, G., Guarnieri, G., Zanetti, M., Fernandes, G., Chiuch, M., Vanoli, M., Grignani, G., Casella, G., Pulixi, E. A., Bernardi, M., Bassi, S. L., Santi, L., Zaccherini, G., Mannarino, E., Nuti, R., Valenti, R., Ruvio, M., Cappelli, S., Palazzuoli, A., Salvatore, T., Sasso, F. C., Girelli, D., Olivieri, O., Matteazzi, T., Barbagallo, M., Plances, L., Alcamo, R., Calvo, L., Valenti, M., Zoli, M., Arno, R., Pasini, F. L., Capecchi, P. L., Bicchi, M., Palasciano, G., Modeo, M. E., Peragine, M., Pappagallo, F., Pugliese, S., Di Gennaro, C., Postiglione, A., Barbella, M. R., De Stefano, F., Cappellini, M. D., Fabio, G., Seghezzi, S., De Amicis, M. M., Mancarella, M., Mari, D., Rossi, P. D., Damanti, S., Ottolini, B. B., Bonini, G., Miceli, E., Lenti, M. V., Padula, D., Murialdo, G., Marra, A., Cattaneo, F., Secchi, M. B., Ghelfi, D., Anastasio, L., Sofia, L., Carbone, M., Davi, G., Guagnano, M. T., Sestili, S., Mancuso, G., Calipari, D., Bartone, M., Meroni, M. R., Perin, P. C., Lorenzati, B., Gruden, G., Bruno, G., Amione, C., Fornengo, P., Tassara, R., Melis, D., Rebella, L., Delitala, G., Pretti, V., Masala, M. S., Pes, C., Bolondi, L., Rasciti, L., Serio, I., Fanelli, F. R., Amoroso, A., Molfino, A., Petrillo, E., Zuccala, G., Franceschi, F., De Marco, G., Chiara, C., Marta, S., D'Aurizio, G., Romanelli, G., Amolini, C., Chiesa, D., Picardi, A., Gentilucci, U. V., Gallo, P., Annoni, G., Corsi, M., Zazzetta, S., Bellelli, G., Szabo, H., Arturi, F., Succurro, E., Rubino, M., Sesti, G., Loria, P., Becchi, M. A., Martucci, G., Fantuzzi, A., Maurantonio, M., Serra, M. G., Bleve, M. A., Gasbarrone, L., Sajeva, M. R., Brucato, A., Ghidoni, S., Di Corato, P., Agnelli, G., Marchesini, E., Fabris, F., Carlon, M., Turatto, F., Baritusso, A., Amabile, A., Omenetto, E., Scarinzi, P., Manfredini, R., Molino, C., Pala, M., Fabbian, F., Boari, B., De Giorgi, A., Paolisso, G., Rizzo, M. R., Laieta, M. T., Rini, G., Mansueto, P., Pepe, I., Borghi, C., Strocchi, E., De Sando, V., Pareo, I., Sabba, C., Vella, F. S., Suppressa, P., Valerio, R., Agosti, P., Fontana, F., Loparco, F., Capobianco, C., Fenoglio, L., Bracco, C., Giraudo, A. V., Testa, E., Serraino, C., Fargion, S., Bonara, P., Periti, G., Porzio, M., Tiraboschi, S., Peyvandi, F., Tedeschi, A., Rossio, R., Ferrari, B., Monzani, V., Savojardo, V., Folli, C., Magnini, M., Conca, A., Gobbo, G., Pallini, G., Balduini, C. L., Bertolino, G., Provini, S., Quaglia, F., Dallegri, F., Ottonello, L., Liberale, L., Chin, W. S., Carassale, L., Caporotundo, S., Traisci, G., De Feudis, L., Di Carlo, S., Liberato, N. L., Buratti, A., Tognin, T., Bianchi, G. B., Giaquinto, S., Purrello, F., Di Pino, A., Piro, S., Rozzini, R., Falanga, L., Spazzini, E., Montrucchio, G., Greco, E., Tizzani, P., Petitti, P., Perciccante, A., Coralli, A., Salmi, R., Gaudenzi, P., Gamberini, S., Semplicini, A., Gottardo, L., Vendemiale, G., Serviddio, G., Forlano, R., Masala, C., Mammarella, A., Raparelli, V., Basili, S., Perri, L., Landolfi, R., Montalto, M., Mirijello, A., Vallone, C., Bellusci, M., Setti, D., Pedrazzoli, F., Guasti, L., Castiglioni, L., Maresca, A., Squizzato, A., Molaro, M., Bertolotti, M., Mussi, C., Libbra, M. V., Miceli, A., Pellegrini, E., Carulli, L., Veltri, F., Sciacqua, A., Quero, M., Bagnato, C., Colangelo, L., Falbo, T., De Giorgio, R., Serra, M., Grasso, V., Ruggeri, E., Ilaria, B., Salvi, A., Leonardi, R., Grassini, C., Mascherona, I., Minelli, G., Maltese, F., Damiani, G., Capeci, W., Mattioli, M., Martino, G. P., Biondi, L., Ormas, M., Pettinari, P., Romiti, R., Messina, S., Cavallaro, F., Ghio, R., Favorini, S., Col, A. D., Minisola, S., Afeltra, A., Alemanno, P., Marigliano, B., Pipita, M. E., Castellino, P., Blanco, J., Zanoli, L., Cattaneo, M., Fracasso, P., Amoruso, M. V., Saracco, V., Fogliati, M., Bussolino, C., Durante, V., Eusebi, G., Tirotta, D., Mete, F., Gino, M., Cittadini, A., Vigorito, C., Arcopinto, M., Salzano, A., Bobbio, E., Marra, A. M., Sirico, D., Moreo, G., Scopelliti, F., Gasparini, F., Cocca, M., Ballestrero, A., Ferrando, F., Berra, S., Dassi, S., Nava, M. C., Graziella, B., Baldassarre, S., Fragapani, S., Galanti, G., Mascherini, G., Petri, C., Stefani, L., Girino, M., Piccinelli, V., Nasso, F., Gioffre, V., Pasquale, M., Scattolin, G., Martinelli, S., Turrin, M., Sechi, L., Catena, C., Colussi, G., Nieves, R. D., Alberto, M. M., Pedro, A. R., Vanessa, L. P., Lara, T., Xavier, C. V., Francesc, F., Jesus, D. M., Esperanza, B. T., Esther, D. C. B., Maria, S. P., Romero, M., Blanca, P. L., Cristina, L. G. -C., Victoria, V. G. M., Saez, L., Bosco, J., Susana, S. B., Marta, A. G., Concepcion, G. B., Antonio, F. M., Hernandez, M. G., Borrego, M. P., Raquel, P. C., Florencia, P. R., Beatriz, G. O., Sara, C. G., Alfonso, G. -C. C., Marta, P. M., Garcia, S. C., Alberto, R. C., Antonio, A. A., Montserrat, G. G., Angel, B. R. M., Manuel, M. J., Ignacio, N. V., Lucia, A. S., Alfonso, L., David, R. B., Iria, I. V., Monica, R. P., Proietti, M, Pirro, M, Mannucci, P, Lip, G, Corazza, G, Eldin, T, Di Blanca, M, Pulixi, E, Bassi, S, Sasso, F, Pasini, F, Capecchi, P, Modeo, M, Barbella, M, de Stefano, F, Cappellini, M, de Amicis, M, Rossi, P, Ottolini, B, Lenti, M, Secchi, M, Guagnano, M, Meroni, M, Perin, P, Fanelli, F, de Marco, G, D’Aurizio, G, Gentilucci, U, Becchi, M, Bleve, M, Sajeva, M, de Giorgi, A, Rizzo, M, Laieta, M, de Sando, V, Giraudo, A, Balduini, C, de Feudis, L, Liberato, N, Bianchi, G, Libbra, M, de Giorgio, R, Martino, G, Col, A, Pipita, M, Amoruso, M, Nava, M, Nieves, R, Alberto, M, Pedro, A, Vanessa, L, Xavier, C, Jesus, D, Esperanza, B, Esther, D, Maria, S, Blanca, P, Cristina, L, Victoria, V, Susana, S, Marta, A, Concepcion, G, Antonio, F, Hernandez, M, Borrego, M, Raquel, P, Florencia, P, Beatriz, G, Sara, C, Alfonso, G, Marta, P, Garcia, S, Alberto, R, Antonio, A, Montserrat, G, Ángel, B, Manuel, M, Ignacio, N, David, R, Iria, I, and Monica, R

Subjects
Male, Anti-Arrhythmia Agents/therapeutic use, antiarrhythmic agent, Comorbidity, Aged, Aged, 80 and over, Anti-Arrhythmia Agents, Atrial Fibrillation, Diabetes Mellitus, Female, Heart Failure, Heart Rate, Hospitalization, Humans, Odds Ratio, Polypharmacy, Prevalence, Geriatrics and Gerontology, Pharmacology (medical), 030204 cardiovascular system & hematology, anticoagulant agent, Diabetes Mellitus/drug therapy, 0302 clinical medicine, 80 and over, 030212 general & internal medicine, LS4_4, antiarrhythmic agent, anticoagulant agent, antithrombocytic agent, calcium channel blocking agent, digoxin, Heart Rate/drug effects, Diabetes Mellitu, Atrial fibrillation, antithrombocytic agent, digoxin, Anti-Arrhythmia Agent, Human, medicine.medical_specialty, Socio-culturale, 03 medical and health sciences, Internal medicine, Diabetes mellitus, Heart rate, calcium channel blocking agent, medicine, business.industry, Atrial Fibrillation/drug therapy, Odds ratio, medicine.disease, Heart Failure/drug therapy, Confidence interval, Heart failure, business
Abstract

Background: Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients. Design: We performed an ancillary analysis from the ‘Registro Politerapie SIMI’ study, enrolling elderly inpatients from internal medicine and geriatric wards. Methods: We considered patients enrolled from 2008 to 2014 with an AF diagnosis at admission, treated with a rate-control-only or rhythm-control-only strategy. Results: Among 1114 patients, 241 (21.6%) were managed with observation only and 122 (11%) were managed with both the rate- and rhythm-control approaches. Of the remaining 751 patients, 626 (83.4%) were managed with a rate-control-only strategy and 125 (16.6%) were managed with a rhythm-control-only strategy. Rate-control-managed patients were older (p=0.002), had a higher Short Blessed Test (SBT; p=0.022) and a lower Barthel Index (p=0.047). Polypharmacy (p=0.001), heart failure (p=0.005) and diabetes (p=0.016) were more prevalent among these patients. Median CHA2DS2-VASc score was higher among rate-control-managed patients (p=0.001). SBT [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94–1.00, p=0.037], diabetes (OR 0.48, 95% CI 0.26–0.87, p=0.016) and polypharmacy (OR 0.58, 95% CI 0.34–0.99, p=0.045) were negatively associated with a rhythm-control strategy. At follow-up, no difference was found between rate- and rhythm-control strategies for cardiovascular (CV) and all-cause deaths (6.1 vs. 5.6%, p=0.89; and 15.9 vs. 14.1%, p=0.70, respectively). Conclusion: A rate-control strategy is the most widely used among elderly AF patients with multiple comorbidities and polypharmacy. No differences were evident in CV death and all-cause death at follow-up.

Published
2018

24. Long-term antithrombotic treatment in intracranial hemorrhage survivors with atrial fibrillation

Author

Roland Veltkamp, Joan Martí-Fàbregas, Celine S. Gathier, Hagen B. Huttner, Eleni Korompoki, Angela Del Giudice, Filippos T. Filippidis, Joji B. Kuramatsu, Jiming Fang, Alessandro Biffi, Peter Brønnum Nielsen, Anand Viswanathan, Daniela Poli, Peter U. Heuschmann, Uwe Malzahn, Sam Schulman, Christian Weimar, and Gregory Y.H. Lip

Subjects
Vitamin K, Medizin, 030204 cardiovascular system & hematology, Cochrane Library, THERAPY, law.invention, RESUMPTION, Brain Ischemia, 0302 clinical medicine, Randomized controlled trial, law, Antithrombotic, Atrial Fibrillation, ORAL ANTICOAGULANTS, RISK, fibrinolytic agent, vitamin K group, Atrial fibrillation, antithrombocytic agent, ASSOCIATION, Stroke, Meta-analysis, brain hemorrhage, Cardiology, cerebrovascular accident, Life Sciences & Biomedicine, Intracranial Hemorrhages, medicine.drug, medicine.medical_specialty, Clinical Neurology, WARFARIN, Article, 03 medical and health sciences, Fibrinolytic Agents, Internal medicine, medicine, MANAGEMENT, Journal Article, Humans, human, SPONTANEOUS INTRACEREBRAL HEMORRHAGE, antagonists and inhibitors, METAANALYSIS, Science & Technology, Neurology & Neurosurgery, business.industry, STROKE PREVENTION, Warfarin, 1103 Clinical Sciences, 1702 Cognitive Science, medicine.disease, brain ischemia, Confidence interval, Clinical trial, Neurology (clinical), Neurosciences & Neurology, business, 1109 Neurosciences, 030217 neurology & neurosurgery, Platelet Aggregation Inhibitors, meta analysis
Abstract

Objective:To perform a systematic review and meta-analysis of studies reporting recurrent intracranial hemorrhage (ICH) and ischemic stroke (IS) in ICH survivors with atrial fibrillation (AF) during long-term follow-up.Methods:A comprehensive literature search including MEDLINE, EMBASE, Cochrane library, clinical trials registry was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We considered studies capturing outcome events (ICH recurrence and IS) for ≥3 months and treatment exposure to vitamin K antagonists (VKAs), antiplatelet agents (APAs), or no antithrombotic medication (no-ATM). Corresponding authors provided aggregate data for IS and ICH recurrence rate between 6 weeks after the event and 1 year of follow-up for each treatment exposure. Meta-analyses of pooled rate ratios (RRs) were conducted with the inverse variance method.Results:Seventeen articles met inclusion criteria. Seven observational studies enrolling 2,452 patients were included in the meta-analysis. Pooled RR estimates for IS were lower for VKAs compared to APAs (RR = 0.45, 95% confidence interval [CI] 0.27–0.74, p = 0.002) and no-ATM (RR = 0.47, 95% CI 0.29–0.77, p = 0.002). Pooled RR estimates for ICH recurrence were not significantly increased across treatment groups (VKA vs APA: RR = 1.34, 95% CI 0.79–2.30, p = 0.28; VKA vs no-ATM: RR = 0.93, 95% CI 0.45–1.90, p = 0.84).Conclusions:In observational studies, anticoagulation with VKA is associated with a lower rate of IS than APA or no-ATM without increasing ICH recurrence significantly. A randomized controlled trial is needed to determine the net clinical benefit of anticoagulation in ICH survivors with AF.

Published
2017

25. Scorpion-related cardiomyopathy and acute pulmonary edema in a child who is stung by Leiurus abdullahbayrami

Author

Mehmet Dokur, Ersen Aydın Yağmur, Mustafa Doğan, Necip Fazil City Hospital, Department of Emergency Medicine, Dulkadiroglu, Kahramanmaras, 46050, Turkey, Pamukkale University School of Medicine, Department of Pediatrics, Kinikli Campus, Denizli, 20070, Turkey, and Manisa Celal Bayar University Alasehir Vocational High School, Alaşehir, Manisa, 45600, Turkey

Subjects
Inotrope, hypotension, leukocyte count, Cardiomyopathy, heart failure, Case Report, oxygen therapy, tachycardia, enalapril, 0302 clinical medicine, aspartate aminotransferase, Pulmonary edema, medical examination, Edema, cardiogenic pulmonary edema, echocardiography, tricuspid valve regurgitation, 030212 general & internal medicine, heart ejection fraction, thorax radiography, child, clinical article, emergency ward, Acrocyanosis, biology, scorpion related cardiomyopathy, Scorpionism, mitral valve regurgitation, lcsh:Medical emergencies. Critical care. Intensive care. First aid, artery flow rate, single drug dose, enoxaparin, antithrombocytic agent, digoxin, hallucination, inotropic agent, Doppler ultrasonography, confusion, fractional shortening, Anesthesia, dextran, Leiurus abdullahbayrami, Cardiology, morphine sulfate, flow rate, medicine.symptom, dopamine, acrocyanosis, pediatric intensive care unit, medicine.medical_specialty, Leiurus, animal structures, alanine aminotransferase, 030231 tropical medicine, complex mixtures, Article, 03 medical and health sciences, male, Internal medicine, respiratory distress, medicine, cardiovascular parameters, furosemide, human, Envenomation, outcome assessment, lung edema, envenomation, business.industry, diuretic agent, cyanosis, dobutamine, Glasgow coma scale, lcsh:RC86-88.9, dyspnea, biology.organism_classification, medicine.disease, school child, clinical feature, crystalloid, scorpion sting, Heart failure, pupil reflex, business
Abstract

Venom of Leiurus abdullahbayrami (Scorpiones: Buthidae) is an extremely toxic one and it stimulates voltage-gated sodium and potassium channels. In case of a stung by this scorpion; excessive catecholamine release occur and it impairs left ventricle contractility and consequently a heart failure occurs (scorpion sting-related cardiomyopathy). In addition to this cardiac-induced acute pulmonary, edema may occur in severe cases too. An 11-year-old male child who was stung by a scorpion (species: Leiurus abdullahbayrami) consulted to the Emergency Room. Even after 7 h of scorpion envenomation he was confused and having hallucinations. Besides he was dyspneic, tachycardic, hypotensive and got worse in overall situation due to cardiogenic pulmonary edema. These clinical findings are concordant with the Level III scorpion envenomation (major systemic manifestations). Positive inotropic agents, diuretics and antiagregant agents used on supportive therapy in his treatment. After 2 weeks he get recovered and discharged from the pediatric intensive care unit. This research is conducted by thinking emergency physicians should learn that Leiurus abdullahbayrami envenomation can cause scorpion-related cardiomyopathy and acute pulmonary edema especially in children. Keywords: Leiurus, Scorpionism, Cardiomyopathy, Pulmonary edema

Published
2017

26. Effect of the P2Y12antagonist ticagrelor on neointimal hyperplasia in a rabbit carotid anastomosis model

Author

Ahmet Hakan Vural, Tamer Turk, Ulviye Yalcinkaya, Suleyman Surer, Cuneyt Eris, Nihal Y. Gul, Senol Yavuz, Mehmet Tuğrul Göncü, Faruk Toktaş, Derih Ay, Uludağ Üniversitesi/Veterinerlik Fakültesi/Klinik Bilimler Bölümü., Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Patoloji Anabilim Dalı., Gül, Nihal Yaşar, Yalçınkaya, Ulviye, and AAH-8924-2021

Subjects
Single drug dose, Ticagrelor, Antithrombocytic agent, Adenosine, Intimal hyperplasia, Cardiac & cardiovascular systems, Unclassified drug, Biopsy, Purinergic P2Y receptor antagonists, medicine.medical_treatment, Injury, Rabbit, Disease models, animal, Artery intima proliferation, Animal tissue, Receptors, purinergic P2Y12, Purinergic P2Y12 receptor, Restenosis, Recurrence, Pathology, Recurrent disease, Carotid Stenosis, Common carotid artery, Saline, Priority journal, Neointimal hyperplasia, Analogs and derivatives, Purinergic P2Y12 receptor antagonist, Purinergic P2 receptor antagonist, Tunica intima, Immunohistochemistry, Clopidogrel, Carotid arteries, Blood, medicine.anatomical_structure, Dose-response relationship, drug, Female, Rabbits, Anastomosis, surgical, Cardiology and Cardiovascular Medicine, medicine.drug, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Anastomosis, Urology, Respiratory system, Article, Neointima, Platelet aggregation inhibitors, medicine.artery, Dose response, medicine, Animals, Animal model, Drug dose comparison, Animal experiment, New Zealand white (rabbit), Rabbit model, Hyperplasia, Drug effects, Animal, Disease model, business.industry, Artery anastomosis, Platelet Aggregation Inhibitors, Purinergic P2Y receptor antagonist, Thrombosis, Nonhuman, medicine.disease, Surgery, Drug efficacy, Cardiovascular system & cardiology, Metabolism, Transforming growth factor beta, business, Controlled study, Carotid artery
Abstract

OBJECTIVES: In the present study, we aimed to deterimine the dose-related effects of ticagrelor, the first reversible inhibitor of the P2Y(12) receptor, found in smooth muscle cells as well as platelets, during neointimal hyperplasia in a rabbit carotid anastomosis model. METHODS: This study was an experimental, prospective, randomized controlled study including 20 New Zealand white female rabbits (6-months old; weighing 2300 +/- 300 g). Under general anaesthesia, the rabbits underwent transection of the right carotid artery and subsequent anastomosis of both ends. The study animals were divided into the following 4 groups: T1 (ticagrelor 5 mg/kg, orally, daily), T2 (ticagrelor 10 mg/kg, orally, daily), T3 (ticagrelor 20 mg/kg, orally, daily) and control (no ticagrelor treatment). The single oral doses were administered in phosphate-buffered saline. The control group received sterile phosphate-buffered saline (2 ml/kg/day, orally) for 3 weeks postoperatively. At the end of the study, the animals were killed, and the anastomosed segment of the right carotid artery and part of the left carotid artery were excised from each animal. Antibodies against transforming growth factor-beta were used in staining of arterial sections, which was followed by histomorphological and immunohistochemical studies. RESULTS: The median intimal thickness (2.0 +/- 0.14 m left vs 73.4 +/- 35.8 m anastomosed right arteries; P

Published
2014

27. EPITOME-2: An open-label study assessing the transition to a new formulation of intravenous epoprostenol in patients with pulmonary arterial hypertension

Author

Thomas Pfister, Emmanuel Bergot, John Granton, David Langleben, Jean-Christophe Lemarié, Anco Boonstra, Olivier Sitbon, Gérald Simonneau, Marion Delcroix, Pilar Escribano Subías, Nazzareno Galiè, Olivier Sitbon, Marion Delcroix, Emmanuel Bergot, Anco B. Boonstra, John Granton, David Langleben, Pilar Escribano Subía, Nazzareno Galiè, Thomas Pfister, Jean-Christophe Lemarié, Gérald Simonneau, Pulmonary medicine, and ICaR - Heartfailure and pulmonary arterial hypertension

Subjects
Adult, Male, Cardiac Catheterization, Continuous infusion, Hypertension, Pulmonary, Hemodynamics, arginine, Young Adult, Open label study, Quality of life, Surveys and Questionnaires, pulmonary hypertension, Medicine, Humans, In patient, Familial Primary Pulmonary Hypertension, Single-Blind Method, Prospective Studies, Adverse effect, Infusions, Intravenous, Antihypertensive Agents, Aged, Exercise Tolerance, Dose-Response Relationship, Drug, business.industry, Walk distance, antithrombocytic agent, Middle Aged, Epoprostenol, respiratory tract diseases, Treatment Outcome, Tolerability, Patient Satisfaction, Anesthesia, Female, PROSTACYCLIN SYNTHASE, business, Cardiology and Cardiovascular Medicine, Follow-Up Studies
Abstract

Background Continuous infusion of epoprostenol is the treatment of choice in patients with pulmonary arterial hypertension in functional classes III to IV. However, this treatment's limitations include instability at room temperature. A new epoprostenol formulation offers improved storage conditions and patient convenience. Methods The EPITOME-2 trial was an open-label, prospective, multicenter, single-arm, phase IIIb study. Patients with pulmonary arterial hypertension on long-term, stable epoprostenol therapy were transitioned from epoprostenol with glycine and mannitol excipients (Flolan; GlaxoSmithKline, Durham, NC) to epoprostenol with arginine and sucrose excipients (Veletri; Actelion Pharmaceuticals Ltd, Allschwil, Switzerland). Patients were followed up for 3 months, and dose adjustments were recorded. Efficacy measures included the 6-minute walk distance, hemodynamics assessed by right heart catheterization, and New York Heart Association functional class. Safety and tolerability of the transition were also evaluated. Quality of life was assessed using the Treatment Satisfaction Questionnaire for Medication. Results Forty-two patients enrolled in the study, and 1 patient withdrew consent before treatment; thus, 41 patients received treatment and completed the study. Six patients required dose adjustments. There were no clinically relevant changes from baseline to month 3 in any of the efficacy end points. Adverse events were those previously described with intravenous prostacyclin therapy. Treatment Satisfaction Questionnaire for Medication scores showed an improvement from baseline to month 3 in the domain of treatment convenience. Conclusions Transition from epoprostenol with glycine and mannitol excipients to epoprostenol with arginine and sucrose excipients did not affect treatment efficacy, raised no new safety or tolerability concerns, and provided patients with an increased sense of treatment convenience.

Published
2014
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28. Crosslinked acellular saphenous vein for small-diameter vascular graft

Author

Soma Guhathakurta, Satish Galla, Kotturathu Mammen Cherian, Balasundari Ramesh, and Santosh Mathapati

Subjects
Hot Temperature, Small diameter, acellular dermal matrix, animal cell, Mice, saphenous vein graft, venous circulation, Materials Testing, Spectroscopy, Fourier Transform Infrared, Biocompatible materials, infrared spectroscopy, cell count, Decellularization, Calorimetry, Differential Scanning, Tissue Scaffolds, Enzymatic digestion, blood compatibility, biomaterial, scleroprotein, vascular disease, antithrombocytic agent, General Medicine, Cross-Linking Reagents, medicine.anatomical_structure, protein stability, deoxycholic acid, immunohistochemistry, Models, Animal, protein degradation, Tissue and Organ Harvesting, cytotoxicity, decellularization, Collagen, differential scanning calorimetry, Cardiology and Cardiovascular Medicine, Vascular graft, Pulmonary and Respiratory Medicine, cross linking, medicine.medical_specialty, in vitro study, porosity, animal experiment, small diameter vascular graft, biomechanics, animal tissue, in vivo study, biocompatibility, detergent, male, enthalpy, Blood vessel prosthesis, Cadaver, medicine, Animals, Humans, cadaver donor, controlled study, Saphenous Vein, human, mechanical stimulation, Vein, reproducibility, thrombogenicity, cell viability, mouse, thrombosis, dye, nonhuman, Sheep, Tissue Engineering, business.industry, animal model, human cell, photooxidation, Biocompatible material, human tissue, thermostability, Blood Vessel Prosthesis, Surgery, tensile strength, blood vessel diameter, validation process, vascular diseases, vein graft, business, Biomedical engineering, Large animal
Abstract

Objective: Patients with congenital and acquired heart diseases or arteriopathy require small-diameter vascular grafts for arterial reconstruction. Autologous veins are the most suitable graft, but when absent, an alternative is necessary. This work addresses the issue. Background: Tissue-engineering efforts to create such grafts by modifications of acellular natural scaffolds are considered a promising area. Methods: Homologous saphenous veins harvested from cadavers and organ donors were processed by decellularization with detergent and enzymatic digestion, followed by crosslinking by dye-mediated photooxidation. They were validated for acellularity, mechanical strength, and crosslink stability. In-vitro and in-vivo cytotoxicity and hemocompatibility studies were conducted. Collagen conformity was studied by Fourier transform infrared spectroscopy, and heat stability by differential scanning calorimetry. A limited large animal study was performed. Results: The processing method delivered biocompatible, hemocompatible, effectively crosslinked grafts, with high heat stability of 126 ℃, an enthalpy value of 183.5 J·g−1, and collagen conformity close to that of the native vein. The mechanical strength was 250% better than the native vein. The presence of extracellular matrix proteins allowed the acellular vein to become a triple-layered vascular structure in the sheep venous system. Conclusion: Crosslinking after decellularization by the dye-mediated photooxidation method could be reproduced in any human vein to obtain a small-diameter vascular grafts.

Published
2013

29. Utilization of Evidence-Based Secondary Prevention Medications at the Time of Discharge in Patients with Acute Coronary Syndrome (ACS) in Qatar

Author

Dana H. Elkhalifa, Ziyad Mahfoud, Wafa Z. Al-Marridi, Maguy El-Hajj, Ahmed A. Saad, Jassim Al-Suwaidi, and Alaa A. Mohamed

Subjects
Male, 030213 general clinical medicine, obesity, evidence based medicine, retrospective study, Angiotensin-Converting Enzyme Inhibitors, hydroxymethylglutaryl coenzyme A reductase inhibitor, 0302 clinical medicine, angiotensin 1 receptor antagonist, Risk Factors, dipeptidyl carboxypeptidase inhibitor, middle aged, Odds Ratio, Secondary Prevention, simvastatin, Practice Patterns, Physicians', Aspirin, pravastatin, Evidence-Based Medicine, thienopyridine derivative, adult, lisinopril, mevinolin, beta adrenergic receptor blocking agent, atorvastatin, antithrombocytic agent, Middle Aged, Clopidogrel, metoprolol, Patient Discharge, clinical practice, aged, female, multivariate analysis, risk factor, 030220 oncology & carcinogenesis, diabetes mellitus, Practice Guidelines as Topic, Platelet aggregation inhibitor, Female, Guideline Adherence, Cardiology and Cardiovascular Medicine, Ticagrelor, medicine.drug, medicine.medical_specialty, Acute coronary syndrome, hypertension, Adrenergic beta-Antagonists, valsartan, Article, ticagrelor, acute coronary syndrome, 03 medical and health sciences, Internal medicine, medicine, Humans, Rosuvastatin, cardiovascular diseases, human, procedures, Acute Coronary Syndrome, outcome assessment, Qatar, Retrospective Studies, Pharmacology, clopidogrel, prescription, business.industry, practice guideline, percutaneous coronary intervention, statistical model, fluindostatin, Cardiovascular Agents, Odds ratio, acetylsalicylic acid, medicine.disease, ischemic heart disease, major clinical study, body mass, hospital discharge, angiotensin receptor antagonist, pitavastatin, Logistic Models, protocol compliance, cardiovascular agent, Cardiovascular agent, Multivariate Analysis, Physical therapy, Hydroxymethylglutaryl-CoA Reductase Inhibitors, business, rosuvastatin, Angiotensin II Type 1 Receptor Blockers, chronic kidney disease, Platelet Aggregation Inhibitors
Abstract

Background and Objectives: In Qatar, ACS (Acute Coronary Syndrome) has become the leading cause of morbidity and mortality. Guidelines recommend that ACS patients should receive indefinite treatment with antiplatelets, β-blockers, angiotensin converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) and statins. The study objectives were to assess the use of evidence-based secondary prevention medication at discharge among ACS patients in Qatar and to determine the clinical and demographic characteristics associated with the use of these medications. Setting and Methods: A retrospective medical record review was conducted at the Heart Hospital in Qatar. A random sample of 1068 ACS patients was selected. Patient characteristics were summarized. Prevalence of medications at discharge were computed for each medication as well as for medication combinations. Multiple logistic regression was used to detect patient variables that were associated with the outcomes. A p≤0.05 was considered significant. Main Outcome Measures: -Percentage of ACS patients discharged on each of the following medications: antiplatelets (aspirin, clopidogrel), β-blockers, ACEI or ARBs and statins and on the combination of these medications-Association between the use of these medications and patient characteristics. Results: In total, 1064 records were reviewed. The majority were males (85.3%) and about 1 in 5 (18.7%) were Qatari. At discharge, patients were prescribed the following: aspirin (96.0%), clopidogrel (92.0%), -blockers (90.6%) and statins (97.7%). ACEI and ARBs were prescribed to 63.5 and 11.3%, respectively. The concurrent 4 medications (aspirin or clopidogrel, statins or other lowering cholesterol medication, β-blockers and ACEI or ARB) were prescribed to 773 patients (77.8%; 95% confidence interval: 75.2-80.4%). Being overweight or obese, and having PCI (percutaneous coronary intervention) or hypertension were associated with higher prescription of the concurrent medications. Those with diabetes had a 52% increase in the odds of prescribing the 4 medications. Those with kidney disease had a 67% reduction in the odds of prescribing. Conclusion: Most ACS patients were prescribed antiplatelets, β-blockers and statins, but the use of ACEIs or ARBs was suboptimal. Strategies are needed to enhance ACEI or ARB prescribing, especially for high risk patients who would have the greatest therapeutic benefit from these drugs. Scopus

Published
2015

30. Does high serum uric acid level cause aspirin resistance?

Author

Ahmet Ergin, Harun Evrengul, Emel Ozkan, Fatma Esin, Ismail Dogu Kilic, Murat Bilgin, Havane Asuman Kaftan, Yusuf Izzettin Alihanoglu, Bekir Serhat Yildiz, and Hayrettin Ozkan

Subjects
Blood Glucose, Male, leukocyte count, Neutrophils, Drug Resistance, Drug resistance, hyperuricemia, dose calculation, Coronary Artery Disease, 030204 cardiovascular system & hematology, Gastroenterology, hydroxymethylglutaryl coenzyme A reductase inhibitor, Coronary artery disease, chemistry.chemical_compound, 0302 clinical medicine, dipeptidyl carboxypeptidase inhibitor, middle aged, Medicine, coronary artery occlusion, Platelet, Drug Dosage Calculations, Hyperuricemia, Lymphocytes, Stroke, Aspirin, receiver operating characteristic, C reactive protein, adult, neutrophil, beta adrenergic receptor blocking agent, Hematology, General Medicine, antithrombocytic agent, Middle Aged, serum uric acid level, biological marker, stable angina pectoris, aged, aspirin resistance, trombocyte, female, C-Reactive Protein, priority journal, Aged, Angina Pectoris/blood/complications/diagnosis/*drug therapy, Aspirin/*therapeutic use, Biomarkers, Blood Cell Count, Blood Glucose/metabolism, C-Reactive Protein/metabolism, Coronary Artery Disease/blood/complications/diagnosis/*drug therapy, Female, Humans, Hyperuricemia/blood/complications/diagnosis/*drug therapy, Lymphocytes/metabolism/pathology, Neutrophils/metabolism/pathology, Platelet Aggregation Inhibitors/*therapeutic, medicine.drug, uric acid blood level, medicine.medical_specialty, insulin, complication, lymphocyte, Sensitivity and Specificity, Article, Angina Pectoris, 03 medical and health sciences, uric acid, blood, Internal medicine, coronary artery disease, Platelet activation, human, drug sensitivity, business.industry, neutrophil count, antidiabetic agent, acetylsalicylic acid, medicine.disease, major clinical study, Surgery, Uric Acid, neutrophil lymphocyte ratio, angiotensin receptor antagonist, glucose blood level, chemistry, calcium channel blocking agent, ROC Curve, Uric acid, pathology, coronary angiography, business, metabolism, 030217 neurology & neurosurgery, Platelet Aggregation Inhibitors
Abstract

In patients with coronary artery disease (CAD), though aspirin inhibits platelet activation and reduces atherothrombotic complications, it does not always sufficiently inhibit platelet function, thereby causing a clinical situation known as aspirin resistance. As hyperuricemia activates platelet turnover, aspirin resistance may be specifically induced by increased serum uric acid (SUA) levels. In this study, we thus investigated the association between SUA level and aspirin resistance in patients with CAD. We analyzed 245 consecutive patients with stable angina pectoris (SAP) who in coronary angiography showed more than 50% occlusion in a major coronary artery. According to aspirin resistance, two groups were formed: the aspirin resistance group (Group 1) and the aspirin-sensitive group (Group 2). Compared with those of Group 2, patients with aspirin resistance exhibited significantly higher white blood cell counts, neutrophil counts, neutrophil-to-lymphocyte ratios, SUA levels, high-sensitivity C-reactive protein levels, and fasting blood glucose levels. After multivariate analysis, a high level of SUA emerged as an independent predictor of aspirin resistance. The receiver-operating characteristic analysis provided a cutoff value of 6.45 mg/dl for SUA to predict aspirin resistance with 79% sensitivity and 65% specificity. Hyperuricemia may cause aspirin resistance in patients with CAD and high SUA levels may indicate aspirin-resistant patients. Such levels should thus recommend avoiding heart attack and stroke by adjusting aspirin dosage. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

Published
2015

31. The leaders free trial: A double blind randomized comparison of a BMS and a polymer-free Drug Coated Stent (DCS) in 2,466 patients at high bleeding risk and treated with one month DAPT only.

Author

Urban P., Garot P., Berland J., Abdellaoui M., Morice M.-C., Abizaid A., Greene S., Pocock S., Meredith I., Lipiecki J., Carrie D., Urban P., Garot P., Berland J., Abdellaoui M., Morice M.-C., Abizaid A., Greene S., Pocock S., Meredith I., Lipiecki J., and Carrie D.

Abstract

Background A sizeable proportion of patients treated with PCI are unable to take dual antiplatelet therapy (DAPT) for the guideline-recommended time period of 6-12 months. Optimal treatment of pts at high bleeding risk thus remains uncertain. The BioFreedomTM DCS (Biosensors, Europe SA, Morges, Switzerland) is polymer- and carrier-free, releases Biolimus A9 into the vessel wall over a period of 4 weeks, and then technically becomes a BMS. Methods 2,466 pts at high bleeding risk from 68 centers in Europe, Asia, and Canada were enrolled over an 18 months period in a doubleblinded randomized 1:1 comparison of the GazelleTM BMS vs. the BioFreedom DCS (both Biosensors, Morges, CH) with a 1 month course of DAPT only in both arms. At 1 year, the primary endpoints are: safety: a composite of cardiovascular death, MI and stent thrombosis, and efficacy: the rate of ci-TLR. Current results In the trial population, the most frequently used inclusion criteria were: advanced age (64%), need for long term oral anticoagulation (36%), anemia, recent bleeding or transfusion (20%), renal insufficiency (18%), planned surgery (15%) and concomitant cancer (9%). When compared to those included in 'all-comer' trials, pts were markedly older (75 years) and had more co-morbidiites (diabetes 33%, atrial fibrillation 33%, peripheral vascular disease 15%, heart failure 13%, prior stroke 9% and COPD 11%) 1.5 lesions/pts were treated and 1.7 stents/pts were implanted for a total stent length of 32mm/patient. Technical procedure success was 95%. 71% of pts were discharged on DAPT alone, 27% of DAPT+oral anticoagulation and 2% on a single antiplatelet agent + oral anticoagulation. Conclusion The trial focuses on a never previously studied high bleeding risk population characterized by advanced age and more comorbid conditions. It is the 1st evaluation of a DCS with clinical endpoints and comprises the shortest ever DAPT course with an active stent to be evaluated for both safety and efficacy.

Published
2016

32. Stroke in people with atrial fibrillation: Is the treatment gap improving?.

Author

Jannes J., Thrift A.G., Ben Freedman S., Leyden J.M., Sturm J.W., Kleinig T., Gall S.L., Jannes J., Thrift A.G., Ben Freedman S., Leyden J.M., Sturm J.W., Kleinig T., and Gall S.L.

Abstract

Objectives: Atrial fibrillation (AF) is a major risk factor for stroke. The proportion of AF-related stroke is likely to grow as the population ages. We aimed to determine the treatment gap of AF over time in two large population-based studies of stroke. Method(s): We used data from the North East Melbourne Stroke Incidence Study, NEMESIS, 1996-99; and Adelaide Stroke Incidence Study, ASIS, 2009-10 to determine the change in proportion of strokes attributable to previously known and newly diagnosed AF. In those with previously known AF we also determined the CHADS2 score (a score >=2 is indicative of a high risk of stroke, and warfarin is recommended), and the proportion on antithrombotic treatment. Result(s): In total, 411 (27%) of 1511 people in NEMESIS had stroke attributable to AF, and 92 (33%) of 275 in ASIS (p = 0.03). In those with previously known AF, warfarin therapy rose from 13% to 44% (p < 0.001), but many had an INR <2 on admission (37% in NEMESIS and 44% in ASIS). Few with known AF were on adequate anticoagulant therapy with INR >=2 (8% in NEMESIS and 25% in ASIS). The proportion of patients with known AF on antiplatelet agents rose from 46% to 94% over time (p < 0.001), with most having a CHADS2 score >=2 (94% in NEMESIS; 100% in ASIS). This demonstrates a large treatment gap. Conclusion(s): A large proportion of patients with AF were on inadequate therapy. Reducing the treatment gap in AF is essential to reduce the occurrence of stroke, particularly as the population ages.

Published
2016

33. The potential economic impact of improving acute stroke care standards for Australia.

Author

Thrift A., Bernhardt J., Cadilhac D., Kim J., Lindley R., Thrift A., Bernhardt J., Cadilhac D., Kim J., and Lindley R.

Abstract

Background: Providing hospital care for stroke in accordance with evidence-based practice prevents death and disability. However, performance monitoring data provides evidence that many patients are not receiving recommended treatments. Aim(s): To approximate gaps between Australia and other countries in the hospital management of stroke and to estimate the potential cost savings in Australia from improving treatment rates to that of international benchmarks. Method(s): We compared treatment in stroke units, use of thrombolysis (tPA) within 4.5 hours and use of secondary prevention agents as published in the 2013 Australian national audit with published international benchmarks. Percentage differences in treatment rates were applied to a standardized economic simulation model that comprised attack rates and resource use estimates from the North East Melbourne Stroke Incidence Study, to estimate stroke occurrence and cost savings from achieving international benchmarks (2010 reference year). Result(s): In Australia in 2010, 44164 people were expected to be hospitalized with stroke. If international benchmarks were attained, annually an additional 8391 patients would access stroke units, 2109 would receive tPA, 7004 with atrial fibrillation would be anticoagulated, 6625 would be prescribed antihypertensive medications, 5335 would be prescribed antiplatelet agents, and 1475 would be prescribed cholesterol-lowering medications. With these improvements, it is estimated that more than 785 strokes could be prevented each year with potential cost savings of $17.5 million. This outweighs the $17.1 million in providing more thrombolysis or care in stroke units. Conclusion(s): Potential cost savings from filling evidence-practice gaps in Australia are considerable.

Published
2016

34. Antiplatelet and anticoagulation therapy post-transcatheter aortic valve implantation in patientswith andwithout atrial fibrillation.

Author

Gooley R., Meredith I., Zaman S., Hui S., McCormick L., Gooley R., Meredith I., Zaman S., Hui S., and McCormick L.

Abstract

Objectives: To compare antiplatelet and anticoagulation use following transcatheter aortic valve replacement (TAVR) in patients with and without Atrial Fibrillation (AF) and the impact on clinical outcome. Background(s): Presently there are no guidelines for antiplatelet or anticoagulation therapy in AF patients undergoing TAVR. Method(s): Consecutive patients (n=104) undergoing TAVR with the Lotus Valve were prospectively recruited. Demographics, discharge medication and 30-day outcomes (defined according to VARC-2) were obtained. Patients with pre-existing AF or new AF during the index admission were compared to patients without AF. Result(s): 35% of patients had a history of AF. Baseline CHADS-VASC was 3.9 and 3.8 in the AF versus non-AF groups respectively (p=0.7). The AF group were more likely to be discharged on anticoagulation (70% versus 4% in the non-AF group; p=<0.01). In the AF group, 5.5%, 25%, 11%, 53% and 5.5% were on single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), anticoagulation, SAPT+anticoagulation and DAPT+anticoagulation, respectively. In the non-AF group, 1.5%, 14.5%, 81%, 0%, 1.5%, 1.5% were on no medication, SAPT, DAPT, anticoagulation, SAPT+anticoagulation and DAPT+anticoagulation respectively. Overall 30-day incidence of life threatening or disabling stroke was 2% with no difference between groups (p=0.8). There was no difference in major or life-threatening bleeds in AF versus non-AF patients (17% versus 21%; p=0.63), nor in patients on anticoagulation versus no anticoagulation (18% versus 20%; p=0.83). Conclusion(s): AF occurred in over a third of our TAVR cohort with 70% receiving anticoagulation therapy. Patients with AF had comparable rates of stroke and bleeding to those without AF.

Published
2016

35. Concurrent use of DOACs and pharmacodynamic interacting drugs is associated with an increased risk of major bleeding compared with patients using DOACs alone: Nested case-control study in UK CPRD

Subjects
conference abstract, side effect, diagnosis, adult, human cell, adverse drug reaction, apixaban, risk assessment, antithrombocytic agent, case control study, bleeding, cohort analysis, major clinical study, clinical practice, drug therapy, female, male, risk factor, Taverne, serotonin uptake inhibitor, dabigatran, controlled study, human, rivaroxaban, pharmacokinetics
Abstract

Background: Although many studies on bleeding risk associated with use of direct oral anticoagulants (DOACs) are conducted, the effect of concurrent use of potentially interacting drugs on this risk is not well studied. Objectives: To evaluate the association between concurrent use of DOACs with concurrent use of potential pharmacokinetic or pharmacodynamic interacting drugs on major bleeding. Methods: We used data from the UK Clinical Practice Research Datalink (period 2008-2015) to conduct a nested case-control study in a cohort of new users of DOACs (dabigatran, apixaban, and rivaroxaban). Cases were patients who were hospitalized with a primary discharge diagnosis of major bleeding while taking DOACs. Up to four controls were matched to each case on age, sex, and index date. Controls also had to be a current user of a DOAC on the index date. Conditional logistic regression analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI) to estimate the risk of major bleeding associated with concurrent use (30 days prior to the index date) of potential pharmacokinetic or pharmacodynamic interacting drugs. The analysis was adjusted for well-known risk factors for bleeding Results: We identified 393 cases from 29 120 new users of DOACs and 1494 controls. Most subjects were current users of rivaroxaban (58.8%). The concurrent use of DOACs and pharmacokinetic interacting drugs did not increase the risk of major bleeding vs use of DOACs alone (45.0% vs 51.2%, adjusted OR 0.90; 95% CI 0.60-1.36). However, concurrent use of pharmacodynamic interacting drugs was associated with an increased risk of major bleeding (21.6% vs 13.5%, adjusted OR, 1.91; 95% CI, 1.39-2.62). This effect was mainly driven by selective serotonin reuptake inhibitors (SSRIs, adjusted OR, 1.73; 95% CI, 1.12-2.65) and antiplatelet drugs (adjusted OR, 1.90; 95% CI, 1.23-2.93), respectively. Conclusions: Among patients taking a DOAC, concurrent use of an SSRIs or antiplatelet drug was associated with increased risk of major bleeding compared with DOAC use without these drugs.

Published
2018

36. Bleeding in patients using new anticoagulants or antiplatelet agents: Risk factors and management

Subjects
desmopressin, idraparinux, drug megadose, heart atrium fibrillation, orthopedic surgery, treatment indication, thrombosis prevention, heparin, allergic reaction, high risk patient, anticoagulant agent, hemodynamics, protamine sulfate, geriatric patient, heparanase, cardiovascular disease, drug binding, single nucleotide polymorphism, dose response, nonsteroid antiinflammatory agent, genetic variability, melagatran, dabigatran, heart death, anticoagulation, rivaroxaban, disease transmission, disseminated intravascular clotting, prothrombin complex, low molecular weight heparin, vitamin K group, drug effect, ST segment elevation, Cangrelor, enoxaparin, antithrombocytic agent, thrombocyte factor 4, risk benefit analysis, Clopidogrel, antithrombin, comorbidity, risk factor, brain hemorrhage, cerebrovascular accident, Prasugrel, coronary artery disease, side effect, heredity, vasectomy, heart infarction, venous thromboembolism, apixaban, review, gastrointestinal hemorrhage, Pentasaccharides, acute coronary syndrome, respiratory tract disease, thrombin time, coronary artery bypass graft, unindexed drug, hirudin, recombinant blood clotting factor 7a, drug screening, human, occlusive cerebrovascular disease, prothrombin, Aspirin, drug absorption, drug potentiation, acenocoumarol, drug bioavailability, drug half life, international normalized ratio, liver failure, percutaneous coronary intervention, fondaparinux, Anticoagulants, acetylsalicylic acid, case control study, blood clotting factor 10a inhibitor, bleeding, prothrombin time, drug metabolism, kidney failure, warfarin, Haemorrhage, Vitamin K antagonists, phenprocoumon, nanofiltration, hemostasis, incidence
Abstract

The most important adverse effect of antithrombotic treatment is the occurrence of bleeding. in case of serious or even life-threatening bleeding in a patient who uses anticoagulant agents or when patient on anticoagulants needs to undergo an urgent invasive procedure, anticoagulant treatment can be reversed by various specific strategies. heparin and heparin derivatives can be counteracted by protamine sulphate, whereas the anticoagulant effect of vitamin K antagonists may be neutralised by administration of vitamin K or prothrombin complex concentrates. the antihaemostatic effect of aspirin and other antiplatelet strategies can be corrected by the administration of platelet concentrate and/or desmopressin, if needed. recently, a new generation of anticoagulants with a greater specificity towards activated coagulation factors has been introduced and most of these agents are currently being evaluated in clinical studies, showing promising results. the new-generation anticoagulants include specific inhibitors of factor iia or factor Xa (including pentasaccharides) and antiplatelet agents belonging to the class of thienopyridine derivatives. a limitation of the new class of anti-iia and anti-Xa agents may be the lack of an appropriate strategy to reverse the effect if a bleeding event occurs, although in some cases the administration of recombinant factor VIIa may be an option. © Van Zuiden Communications B.V. All rights reserved.

Published
2010

37. Perioperatieve onderbreking van antistollingsmiddelen: Praktische aanbevelingen

Subjects
desmopressin diacetate, heart atrium fibrillation, perioperative period, venous thromboembolism, dipyridamole, heparin, anticoagulant agent, deep vein thrombosis, coronary stent, controlled study, human, thrombocyte aggregation, thrombosis, clopidogrel, thienopyridine derivative, controlled clinical trial, acenocoumarol, low molecular weight heparin, article, clinical trial, antithrombocytic agent, acetylsalicylic acid, postoperative hemorrhage, warfarin, drug contraindication, risk factor, phenprocoumon, randomized controlled trial, heart valve prosthesis, hemostasis, antivitamin K, prospective study, transluminal coronary angioplasty
Abstract

If patients being treated with anticoagulants need to undergo an operation then physicians need to consider whether to suspend the use of this medication or to allow its use to be continued. Suspending the use of anticoagulants increases the risk of thrombosis, whereas continued use may cause bleeding complications. No evidence-based scientific research has been carried out regarding best practice for the perioperative use of anticoagulants.Antithrombotic drugs are vitamin K antagonists and platelet aggregation inhibitors. For daily practice, appropriate bridging strategies can be used for perioperative anticoagulant policy for various risk groups, such as patients with venous thromboembolism, atrial fibrillations, mechanical heart valves and coronary heart diseases (including coronary stents) and patients who have experienced a cerebrovascular accident. In the vast majority of cases the treating physician must carefully consider each individual case in order to realise the best policy.

Published
2009

38. Profile of cardiovascular risk factors and mortality in patients with symptomatic peripheral arterial disease

Author

Beatriz Bojikian Matsubara, Mariângela Giannini, Silméia Garcia Zanati, Luiz Shiguero Matsubara, Guilherme Grisi Mouraria, and Universidade Estadual Paulista (Unesp)

Subjects
Male, Kaplan Meier method, Coronary Artery Disease, Kaplan-Meier Estimate, Coronary artery disease, Elderly, Risk Factors, Prospective Studies, Prospective cohort study, Peripheral Vascular Diseases, Aspirin, Univariate analysis, lcsh:R5-920, Smoking, antithrombocytic agent, General Medicine, female, risk factor, peripheral vascular disease, Hypertension, Platelet aggregation inhibitor, Female, lcsh:Medicine (General), Brazil, prospective study, medicine.drug, medicine.medical_specialty, hypertension, Clinical Sciences, survival, Internal medicine, Diabetes mellitus, medicine, Humans, human, Risk factor, Kaplan-Meiers Estimate, Aged, business.industry, acetylsalicylic acid, medicine.disease, Cardiovascular risk, mortality, Survival Analysis, Surgery, Vascular surgery, business, Dyslipidemia, Platelet Aggregation Inhibitors
Abstract

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:23:56Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:35:29Z : No. of bitstreams: 1 2-s2.0-67650607185.pdf: 152240 bytes, checksum: 36723a0a5b4e601dd9df536a326572ea (MD5) Made available in DSpace on 2014-05-27T11:23:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-07-22 Introduction: The present study examines cardiovascular risk factor profiles and 24-month mortality in patients with symptomatic peripheral arterial disease. Design Study: Prospective observational study including 75 consecutive patients with PAD (67 ± 9.7 years of age; 52 men and 23 women) hospitalized for planned peripheral vascular reconstruction. Doppler echocardiograms were performed before surgery in 54 cases. Univariate analyses were performed using Student's t-test or Fisher's exact test. Survival analysis at 24-month follow-up was performed using the Cox regression model and Kaplan-Meier method including age and chronic use of aspirin as covariates. Survival curves were compared using the log-rank test. Results: Hypertension and smoking were the most frequent risk factors (52 cases and 51 cases, respectively), followed by diabetes (32 cases). Undertreated dyslipidemia was found in 26 cases. Fasting glycine levels (131 ± 69.1 mg/dl) were elevated in 29 cases. Myocardial hypertrophy was found in 18 out of 54 patients. Thirty-four patients had been treated with aspirin. Overall mortality over 24 months was 24% and was associated with age (HR: 0.064; CI95: 0.014-0.115; p=0.013) and lack of use of aspirin, as no deaths occurred among those using this drug (p

Published
2009

39. Comparison among patients ≥75 years having percutaneous coronary angioplasty using drug-eluting stents versus bare metal stents

Author

Fabio Mangiacapra, Giuseppe Patti, Giuseppe Di Gioia, Emanuele Barbato, Elisabetta Ricottini, Bernard De Bruyne, Aaron Peace, William Wijns, Germano Di Sciascio, Mangiacapra, Fabio, Ricottini, Elisabetta, Di Gioia, Giuseppe, Peace, Aaron, Patti, Giuseppe, De Bruyne, Bruyne, Wijns, William, Barbato, Emanuele, and Di Sciascio, Germano

Subjects
Male, Bare-metal stent, Time Factors, Percutaneous, medicine.medical_treatment, Myocardial Infarction, Myocardial Ischemia, paclitaxel, Immunosuppressive Agent, device safety, Drug-Eluting Stent, Stent, Clinical endpoint, Myocardial infarction, Angioplasty, Balloon, Coronary, device, comparative study, time, very elderly, Age Factor, media_common, Aged, 80 and over, Incidence (epidemiology), Age Factors, Drug-Eluting Stents, antithrombocytic agent, female, Treatment Outcome, priority journal, Cardiology, Stents, revascularization, Cardiology and Cardiovascular Medicine, drug eluting stent, Immunosuppressive Agents, transluminal coronary angioplasty, Human, Drug, medicine.medical_specialty, bare metal stent, Time Factor, media_common.quotation_subject, heart infarction, stable angina pectori, zotarolimu, Article, Follow-Up Studie, stent thrombosi, adverse effect, Internal medicine, Angioplasty, medicine, Humans, follow up, outcome assessment, Aged, ST segment elevation myocardial infarction, treatment duration, anticoagulant therapy, rapamycin, business.industry, Platelet Aggregation Inhibitor, everolimu, non ST segment elevation myocardial infarction, bleeding, medicine.disease, ischemic heart disease, major clinical study, Surgery, clinical effectivene, comparative effectivene, age, immunosuppressive agent, aged, Conventional PCI, business, Platelet Aggregation Inhibitors, Follow-Up Studies
Abstract

Limited data are available on long-term efficacy and safety of drug-eluting stents (DES) in elderly patients who underwent PCI. A total of 635 consecutive patients aged ≥75 years who underwent PCI were enrolled at 2 European centers. Of these, 170 patients received at least 1 DES, whereas 465 patients received bare metal stent (BMS) only. Primary end point was the incidence of net adverse clinical events (NACE), defined as the occurrence of ischemic events or bleeding events, and was compared at a median follow-up of 31.2 months. Clinical follow-up information was available in 593 patients (93.4%). The duration of dual antiplatelet therapy was 12.3 ± 5.1 months in the DES group and 3.8 ± 7.4 months in the BMS group. The Kaplan-Meier estimate of NACE at 5 years was significantly lower in DES-treated patients (40.5%) than in BMS-treated patients (55.7%; p = 0.009). This benefit was driven by a significant reduction in myocardial infarction (8.6% vs 16.6%; p = 0.038) and target vessel revascularization rates (7.9% vs 21.9%; p = 0.003) in the DES group, with no significant increase in the incidence of bleeding events (13.8% vs 12.2%; p = 0.882). These results were confirmed at propensity score-adjusted Cox proportional hazard analysis. In conclusion, in patients ≥75 years, the use of DES compared with BMS seems to reduce myocardial infarction and repeat revascularization rates at long-term follow-up, without an increase in bleeding despite longer duration of dual antiplatelet therapy. This net clinical benefit, resulting from persistent efficacy and safety over time, may support the use of DES as a reasonable option in patients ≥75 years. © 2015 Elsevier Inc. All rights reserved.

Published
2015

40. QSAR studies of paeonol analogues for inhibition of platelet aggregation

Author

P.A. Padmaswar, Mukesh Doble, K.G. Akamanchi, and S. Karthikeyan

Subjects
Quantitative structure–activity relationship, Platelet Aggregation, Molecular model, Stereochemistry, Clinical Biochemistry, Quantitative Structure-Activity Relationship, Pharmaceutical Science, Biochemistry, antithrombocytic agent, cyclooxygenase 1, peonol, article, calculation, correlation coefficient, drug activity, drug structure, drug synthesis, energy, hydration, hydrophilicity, in vitro study, linear regression analysis, model, nerve cell network, nonlinear regression analysis, quantitative structure activity relation, structure activity relation, structure analysis, thrombocyte aggregation inhibition, Acetophenones, Cyclooxygenase 1, Cyclooxygenase Inhibitors, Molecular Structure, chemistry.chemical_compound, Computational chemistry, Drug Discovery, Molecular Biology, chemistry.chemical_classification, Organic Chemistry, Interaction energy, Enzyme, chemistry, Lipophilicity, Molecular Medicine, Paeonol, Hydration energy, Nonlinear regression
Abstract

Various paeonol analogues were synthesized and tested in vitro as inhibitors of platelet aggregation. Structural properties (or descriptors) of paeonol analogues were calculated and the structure-activity relationships were determined. Several multiple linear and nonlinear regression models and back-propagation neural network model were tested and the latter using relative positive charge, hydration energy, and hydrophilic factor as inputs gave the best data fitting with R2 = 0.89 and qpre2=0.66. The correlation coefficient between antiplatelet inhibition activity with an interaction energy between the paeonol compounds with COX-1 enzyme is only 0.39. ? 2005 Elsevier Ltd. All rights reserved.

Published
2005

41. Comparative performance of the wells and amuse scores for excluding DVT in emergency department patients.

Author

Wells G., Blecher G.E., Stiell I., Woo M.Y., Pageau P., Wells P., McInnes M., Wells G., Blecher G.E., Stiell I., Woo M.Y., Pageau P., Wells P., and McInnes M.

Abstract

Background: The Wells clinical decision rule can risk stratify patients with potential lower limb deep vein thrombosis (DVT). Recently another rule was developed to address the reported lowered sensitivity amongst primary care patients. Objective(s): We evaluated the test characteristics of both the Wells and AMUSE decision rules in a cohort of emergency department (ED) patients with suspected DVT. Method(s): We conducted a prospective cohort study on a sample of adult patients who presented to an academic ED with suspected acute lower limb DVT. Demographic and clinical data were collected and ddimer was measured on all patients, allowing calculation of the Wells and AMUSE scores. The primary outcome was any venous thromboembolism or death at 90 days, as determined by radiology database and medical record review, and structured telephone interview. The sensitivity, specificity, positive and negative likelihood ratios were calculated for patients classified as high-risk for DVT by the rules. Result(s): The 197 study patients had these characteristics: mean age 60 and male sex 46%; 1.0% had congestive heart failure, 2.0% peripheral vascular disease and 0.5% systemic lupus erythematosis. 19.3% were taking antiplatelet agents and 5.6% anticoagulants. 41.2% had elevated d-dimer levels and 32.6% were classified as high-risk by the Wells score and 43.3% by the AMUSE score. 14.2% were positive for the primary outcome and 3.0% died. The Wells score had a sensitivity of 82.1% (95% CI 62.4 - 93.2) and specificity of 76.3%, (95% CI 68.7 - 82.6) whereas the AMUSE score had a sensitivity of 92.9%, (95% CI 75.0 - 98.8) and specificity of 65.8% (95% CI 57.6 - 73.2). (See Table 452) Conclusion(s): The AMUSE score was more sensitive, but the Wells score was more specific for acute lower limb DVT in this cohort. The AMUSE instrument may be more useful for ruling out suspected DVT in ED patients, but this needs confirmation on a larger sample. (Table presented) .

Published
2014

42. Myocardial infarction in a 17-year-old patient due to neurofibromatosis- associated coronary aneurysm

Author

Mustafa Zungur, Yusuf Izzettin Alihanoglu, Doğu İsmail Kılıç, Halil Tanriverdi, and Harun Evrengul

Subjects
angiocardiography, coronary thrombus, Myocardial Infarction, anticoagulant agent, Coronary Angiography, protein C, neurofibroma, hypokinesia, Electrocardiography, Myocardial infarction, heart ejection fraction, medicine.diagnostic_test, subacute myocardial infarction, heart electrophysiology, article, Coronary Aneurysm, Electrocardiography in myocardial infarction, beta adrenergic receptor blocking agent, General Medicine, antithrombocytic agent, coronary artery aneurysm, antithrombin, medicine.anatomical_structure, female, akinesia, Cardiology, cardiovascular system, Cardiology and Cardiovascular Medicine, protein S, Artery, medicine.medical_specialty, Adolescent, Neurofibromatoses, heart infarction, Young, vasodilator agent, Aneurysm, angina pectoris, nitrate, coronary artery bypass graft, Internal medicine, medicine, case report, Humans, artery thrombosis, cardiovascular diseases, human, Neurofibromatosis, Thrombus, clopidogrel, prothrombin, neurofibromatosis, business.industry, activated protein C, disease association, homocysteine, acetylsalicylic acid, medicine.disease, blood clotting factor 5 Leiden, Pediatrics, Perinatology and Child Health, fibrinogen, business
Abstract

Neurofibromatosis is an autosomal dominant multi-system genetic disorder. Extra-cardiac vascular manifestations of neurofibromatosis have been previously described in many reports. However, coronary arterial involvements have been rarely described. A 17-year-old girl with neurofibromatosis presented to our institute with subacute myocardial infarction. Coronary angiogram revealed an aneurysm with thrombus in the left anterior descending artery.

Published
2013

43. Effectiveness of recommended drug classes in secondary prevention of acute coronary syndrome in France

Subjects
endogenous compound, proportional hazards model, morbidity, hydroxymethylglutaryl coenzyme A reductase inhibitor, acute coronary syndrome, cause of death, hazard ratio, male, prevention, data base, dipeptidyl carboxypeptidase inhibitor, follow up, controlled study, human, adult, beta adrenergic receptor blocking agent, clinical trial, antithrombocytic agent, cohort analysis, major clinical study, angiotensin receptor antagonist, aged, comorbidity, female, confidence interval, exposure, transient ischemic attack, cardiovascular system, young adult, France, secondary prevention, insurance
Abstract

Background: Guidelines for cardiovascular secondary prevention are based on evidence from relatively old clinical trials and need to be evaluated in daily clinical practice. Objectives: To evaluate effectiveness of the recommended drug classes after an acute coronary syndrome (ACS) for secondary prevention of cardiovascular diseases and all-cause mortality. Methods: This cohort study used data from a representative sample of the French national healthcare insurance system database (EGB). Patients hospitalised for an incident ACS between 2006 and 2011, and aged ≥ 20 years at time of ACS were included in the study. Patients non-exposed to any of the four recommended drug classes (beta-blockers, antiplatelet agents, statins, and angiotensin-converting-enzyme inhibitors, ACEI, or angiotensin II receptor blockers, ARB) in the first 3 months following ACS or who died during this period were not included in the cohort. Exposure status was determined daily during follow-up. Effectiveness of the four therapeutic classes in preventing the composite outcome ACS, transient ischemic attack, ischemic stroke, or all-cause-death was estimated using a time-dependent Cox proportional hazards model, which was adjusted for time-fixed confounders measured at baseline (general characteristics and characteristics of the initial ACS) and time-dependent confounders during follow-up (co-morbidities and co-medications). Results: Of the 2874 patients included in the study, 33.9% were women and the median age was 67 years (interquartile range, IQR: 56-77). The median time of follow-up was 3.6 years (IQR: 2.2-5.3). The risk of the composite outcome decreased with use of antiplatelet agents (adjusted hazard ratio (aHR) 0.76, 95% confidence interval (CI) 0.63; 0.91), use of statins (aHR 0.71, 95%CI 0.57; 0.87), and use of ACEI/ARB (aHR 0.67, 95%CI 0.57; 0.80). Use of beta-blockers was not associated with a lower risk of the composite outcome (aHR, 0.90, 95%CI 0.74; 1.09]). Conclusions: Use of antiplatelet agents, statins, and ACEI/ARB after an ACS, but not beta-blockers, was associated with a lower risk of cardiovascular morbidity and all-cause mortality.

Published
2016

44. Definition and Implications of the Preventable Stroke

Author

Annlia Paganini-Hill, Lisa Moores, Mohamad N. Alsharif, and Mark Fisher

Subjects
Male, health care delivery, Aging, demography, very elderly, retrospective study, data analysis, 030204 cardiovascular system & hematology, Cardiovascular, anticoagulant agent, medical record review, Brain Ischemia, 0302 clinical medicine, Risk Factors, cardiovascular disease, middle aged, hyperlipidemia, Thrombolytic Therapy, atrial fibrillation, Myocardial infarction, Stroke, fibrinolytic agent, adult, Medical record, risk assessment, Atrial fibrillation, antithrombocytic agent, Middle Aged, National Institutes of Health Stroke Scale, cerebrovascular disease, aged, Treatment Outcome, female, priority journal, risk factor, antihypertensive agent, Female, disease severity, Cognitive Sciences, medicine.medical_specialty, hypertension, Clinical Sciences, university hospital, patient compliance, Article, 03 medical and health sciences, Fibrinolytic Agents, Clinical Research, Severity of illness, medicine, Humans, human, procedures, cardiovascular diseases, antilipemic agent, Aged, Retrospective Studies, Neurology & Neurosurgery, business.industry, Prevention, Neurosciences, Retrospective cohort study, medicine.disease, major clinical study, Comorbidity, United States, Brain Disorders, hospital discharge, Good Health and Well Being, Emergency medicine, Physical therapy, Neurology (clinical), fibrinolytic therapy, business, 030217 neurology & neurosurgery, Fibrinolytic agent, rating scale
Abstract

Importance Although patients with acute stroke are routinely evaluated for potential treatment (ie, treatability of the stroke), preventability of the presenting stroke is generally not seriously considered. Objective To systematically analyze stroke preventability. Design, Setting, and Participants We evaluated medical records of 274 consecutive patients discharged with a diagnosis of ischemic stroke between December 2, 2010, and June 11, 2012, at the University of California Irvine Medical Center. Mean (SE) patient age was 67.2 (0.8) years. Data analysis was conducted from July 3, 2014, to August 4, 2015. Exposures Medical records were systematically examined for demographic information, stroke risk factors, stroke severity, and acute stroke treatment. Main Outcomes and Measures We defined stroke preventability as the degree to which the patient’s presenting stroke was preventable. Using variables easily determined at onset of stroke, we developed a 10-point scale (0, not preventable; 10, most preventable) to classify the degree of stroke preventability. Our focus was effectiveness of treatment of hypertension (0-2 points), hyperlipidemia (0-2 points), and atrial fibrillation (0-4 points), as well as use of antithrombotic treatment for known prior cerebrovascular and cardiovascular disease (0-2 points). Results Total risk scores ranged from 0 to 8 (mean [SE], 2.2 [0.1]), with 207 patients (75.5%) exhibiting some degree of preventability (score of 1 or higher). Seventy-one patients (25.9%) had scores of 4 or higher, indicating that the stroke was highly preventable. Severity of stroke as determined by the National Institutes of Health Stroke Scale score was not related to preventability of stroke. However, 21 of 71 patients (29.6%) whose stroke was highly preventable were treated with intravenous or intra-arterial acute stroke therapy while these treatments were provided for only 13 of 67 patients (19.4%) with scores of 0 (no preventability) and 19 of 136 patients (14.0%) with scores of 1 to 3 (low preventability) ( P = .03). Conclusions and Relevance Most patients with acute stroke exhibited some degree of preventability. Preventability and treatment of stroke were significantly associated, indicating that the most preventable strokes paradoxically were more likely to receive acute treatment.

Published
2016

45. Anti-platelet activity of infusion of Tithonia diversifolia's leaves

Author

Soares, V. C. G., Baldissera Jr, L., Diz-Filho, E. B. S., EDSON ANTUNES, Toyamam, M. H., Universidade Estadual de Campinas (UNICAMP), UNIP, and Universidade Estadual Paulista (Unesp)

Subjects
venous blood, thrombocyte count, Tithonia diversifolia extract, incubation time, drug activity, medicinal plant, antiplatelet activity, Tithonia diversifolia, Platelet aggregation, analytical equipment, human, glucose, citrate sodium, plant leaf, centrifugation, pH, human cell, drug infusion, informed consent, potassium chloride, sucrose, thrombocyte aggregation inhibition, antithrombocytic agent, thrombin, unclassified drug, Aqueous extract, acid citrate dextrose, concentration response, thrombocyte rich plasma, sodium chloride, plant extract, polypropylene
Abstract

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:26:56Z No. of bitstreams: 0 Made available in DSpace on 2014-05-27T11:26:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-08-20 Tithonia diversifolia, also known as Mexican arnica, has been used in traditional medicine to treat inflammatory refractory with absence of citotoxicity. The possible health risks associated with the consumption of ingestion of the infusion (tea) plant makes it is necessary to identify the potential pharmacological activity or toxicity to prove certain plants that are acclimated in Brazil. Considering the limited number of pharmacological studies regarding the Tithonia diversifolia, the aim of this study was evaluate the effects of this infusion in platelet aggregation. Venous blood was collected with informed consent from healthy volunteers who denied taking any medication in the previous 14 days. Whole blood was transferred into polypropylene tubes containing one-tenth of final volume of acid citrate dextrose (ACD-C; citric acid 3%, trisodium citrate 4%, glucose 2%; 1:9 v/v) and centrifuged at 200g for 15 min. Platelet rich plasma was added of wash buffer solution (NaCl 140mM, KCl 5mM, sodium citrate 12mM, glucose 10mM and saccharose 12mM; pH 6; 5:7 v/v) and centrifuged at 800g for 12 min at 20°C. Platelet pellet was gently resuspended in Krebs-Ringer solution and counts were performed on a Neubauer chamber. Aggregation assay was carried out with 400 μL of platelet suspension (1.2x10 8 platelets/mL) in a cuvette at 37°C with constant stirring. Platelet suspension was incubated for 3 min with aqueous extract infusion (0.6-20μg/mL) prior to addition of thrombin (100 mU/mL). Percentage of platelet aggregation was recorded with an aggregometer (Chrono-log Lumi-Aggregometer model 560-Ca, USA). Our results show an inhibition of thrombin induced platelet aggregation in the presence of 0.6-20 ug/mL Tithonia diversifolia infusion leaves. The Tithonia diversifolia infusion leaves inhibits thrombin induced washed platelet aggregation. Department of Biochemistry Institute of Biology UNICAMP, Campinas, SP Institute of Health Sciences College of Pharmacy UNIP, Jundiai, SP Department of Pharmacology Faculty of Medical Sciences UNICAMP, Campinas, SP Experimental Paulista Campus UNESP, Sao Vicente, SP Experimental Paulista Campus UNESP, Sao Vicente, SP

Published
2012

46. Monocyte chemotactic protein-1 as a potential biomarker for early anti-thrombotic therapy after ischemic stroke

Author

Helmut Schumacher, Ralf Lichtinghagen, Hans Worthmann, Reinhard Dengler, A. Schwartz, Karin Weissenborn, and Wolfgang G. Eisert

Subjects
Male, Dewey Decimal Classification::500 | Naturwissenschaften::540 | Chemie, Acetylsalicylic acid (ASA), Time Factors, Dewey Decimal Classification::500 | Naturwissenschaften::570 | Biowissenschaften, Biologie, very elderly, antithrombotic therapy, Gastroenterology, law.invention, Brain Ischemia, lcsh:Chemistry, Brain ischemia, Randomized controlled trial, law, monocyte chemoattractant protein-1 (MCP-1), middle aged, lcsh:QH301-705.5, Stroke, Spectroscopy, time, Chemokine CCL2, Aged, 80 and over, Aspirin, Ischemic stroke, predictive value, adult, ischemic stroke, neuroprotection, dipyridamole, acetylsalicylic acid (ASA), article, General Medicine, Dipyridamole, antithrombocytic agent, Middle Aged, Monocyte chemoattractant protein-1 (MCP-1), biological marker, National Institutes of Health Stroke Scale, Neuroprotection, Computer Science Applications, aged, female, monotherapy, ddc:540, Biomarker (medicine), Platelet aggregation inhibitor, Female, disease severity, Biological Markers, Drug Therapy, Combination, monocyte chemotactic protein 1, medicine.drug, Adult, medicine.medical_specialty, drug combination, Article, Catalysis, Inorganic Chemistry, open study, blood, Internal medicine, ddc:570, medicine, follow up, Humans, controlled study, human, Physical and Theoretical Chemistry, Molecular Biology, Aged, Antithrombotic therapy, business.industry, Organic Chemistry, acetylsalicylic acid, medicine.disease, major clinical study, Surgery, early intervention, multicenter study, lcsh:Biology (General), lcsh:QD1-999, protein blood level, transient ischemic attack, CCL2 protein, human, randomized controlled trial, prognosis, business, Biomarkers, Platelet Aggregation Inhibitors, Follow-Up Studies
Abstract

Inflammation following ischemic brain injury is correlated with adverse outcome. Preclinical studies indicate that treatment with acetylsalicylic acid + extended-release dipyridamole (ASA + ER-DP) has anti-inflammatory and thereby neuroprotective effects by inhibition of monocyte chemotactic protein-1 (MCP-1) expression. We hypothesized that early treatment with ASA + ER-DP will reduce levels of MCP-1 also in patients with ischemic stroke. The EARLY trial randomized patients with ischemic stroke or TIA to either ASA + ER-DP treatment or ASA monotherapy within 24 h following the event. After 7 days, all patients were treated for up to 90 days with ASA + ER-DP. MCP-1 was determined from blood samples taken from 425 patients on admission and day 8. The change in MCP-1 from admission to day 8 did not differ between patients treated with ASA + ER-DP and ASA monotherapy (p > 0.05). Comparisons within MCP-1 baseline quartiles indicated that patients in the highest quartile (>217–973 pg/mL) showed improved outcome at 90 days if treated with ASA + ER-DP in comparison to treatment with ASA alone (p = 0.004). Our data does not provide any evidence that treatment with ASA + ER-DP lowers MCP-1 in acute stroke patients. However, MCP-1 may be a useful biomarker for deciding on early stroke therapy, as patients with high MCP-1 at baseline appear to benefit from early treatment with ASA + ER-DP.

Published
2012

47. Thrombin-receptor antagonist vorapaxar in acute coronary syndromes

Author

Tricoci, P, Huang, Z, Held, C, Moliterno, Dj, Armstrong, Pw, Van de Werf, F, White, Hd, Aylward, Pe, Wallentin, L, Chen, E, Lokhnygina, Y, Pei, J, Leonardi, S, Rorick, Tl, Kilian, Am, Jennings, Lh, Ambrosio, G, Bode, C, Cequier, A, Cornel, Jh, Diaz, R, Erkan, A, Huber, K, Hudson, Mp, Jiang, L, Jukema, Jw, Lewis, Bs, Lincoff, Am, Montalescot, G, Nicolau, Jc, Ogawa, H, Pfisterer, M, Prieto, Jc, Ruzyllo, W, Sinnaeve, Pr, Storey, Rf, Valgimigli, M, Whellan, Dj, Widimsky, P, Strony, J, Harrington, Ra, Mahaffey, Kw, Huo, Y, Lixin, J, Isaza, D, Grande, P, Laine, M, Wong, L, Ofner, P, Yamaguchi, T, Park, Sj, Nordrehaug, Je, Providencia, L, Cheem, Th, Dalby, A, Betriu, A, Chen, Mf, Verheugt, F, Frye, Rl, Hochman, J, Steg, Pg, Bailey, Kr, Easton, Jd, Lincoff, A, Underwood, Fd, Wrestler, J, Larson, D, Vandyne, B, Kilian, A, Harmelin-Kadouri, R, Layton, L, Lipka, L, Petrauskas, S, Qidwai, M, Sorochuck, C, Temple, T, Mason, D, Sydlowski, D, Gallagher, B, Villasin, A, Beernaert, A, Douglas, S, Garrett, J, Wiering, J, Adriaenssens, T, Ganame, J, Hulselmans, M, Katz, Jn, Kayaert, P, La Gerche, A, Onsea, K, Zalewski, J, Johnson, A, O'Briant, J, Smith, M, Akerblom, A, Armaganijan, L, Bertolami, A, Brennan, M, da Ponte Nacif SA, de Campos Gonzaga, C, Dequadros, A, Déry, Jp, Dev, S, Ducrocq, G, Eapen, Zp, Echenique, L, Eggers, K, Garcia, H, Guimaraes, Hp, Hagstrom, E, Hanet, C, James, S, Jonelid, B, Kolls, Bj, Leiria, T, Leite, R, Lombardi, C, Lopes, Rd, Malagutti, P, Mathews, R, Mehta, Rh, Melloni, C, Piccini, Jp, Rodriques Soares, P, Roe, Mt, Shah, Br, Stashenko, G, Szczech, La, Truffa, A, Varenhorst, C, Vranckx, P, Williams, J, Kilaru, R, White, Ja, Binkowitz, B, He, W, Ramos, Ms, Hasbani, E, Farras, Ha, Luz del Valle, L, Zapata, G, Centeno, Ep, Hominal, M, Beloscar, J, Panno, M, Berli, M, Carlevaro, O, Wasserman, T, Lembo, L, Diez, F, Bettinotti, M, Allall, O, Macin, S, Hii, C, Bett, N, Aroney, C, Roberts-Thomson, P, Arstall, M, Horowitz, J, Prasan, A, Farshid, A, Rankin, J, Duffy, S, Sinhal, A, Hendricks, R, Waites, J, Hill, A, French, J, Adams, M, Soward, A, Dick, R, Jepson, N, Nelson, G, Thompson, P, Neunteufl, T, Pachinger, O, Leisch, F, Siostrzonek, P, Roithinger, F, Pieske, B, Weber, H, Eber, B, Zenker, G, Sinnaeve, P, Roosen, J, Vervoort, G, Coussement, P, Striekwold, H, Boland, J, Van Dorpe, A, Dujardin, K, Mertens, D, Vanneste, L, Celen, H, Lesseliers, H, Vrolix, M, Leone, A, De Maeseneire, S, Hellemans, S, Silva, Fa, Franken, M, Moraes JB Jr, Mora, R, Michalaros, Y, Perin, M, Guimaraes, Ae, da Silva DG, Mattos, Ma, Alves AR Jr, Hernandes, Me, Golin, V, da Silva SA, Ardito, W, Dery, Jp, Mukherjee, A, Tanguay, Jf, Kornder, J, Lutchmedial, S, Degrace, M, Klinke, P, Constance, C, Nogareda, G, Wong, G, Macdonald, P, Senaratne, M, Rupka, D, Halperin, F, Ramanathan, K, Natarajan, M, Lai, C, Brossoit, R, Tymchak, W, Rose, B, Dupuis, R, Mansour, S, Bata, I, Zadra, R, Turek, M, Madan, M, Le May, M, Leon, L, Perez, L, Yovaniniz, P, Pedemonte, O, Campos, P, Pincetti, C, Sepulveda, P, Li, W, Zhao, R, Li, Z, Yang, Y, Chen, J, Li, H, Jiang, Y, Li, D, Qu, P, Sun, Y, Zheng, Y, Zhou, C, Zhang, F, Wei, M, Wang, D, Lemus, J, Fernandez, Rl, Jaramillo, C, Ochoa, J, Velez, S, Cano, N, Lutz, J, Botero, R, Jaramillo, M, Saaib, J, Sanchez, G, Hernandez, H, Mendoza, F, Rizcala, A, Urina, M, Polasek, R, Motovska, Z, Zemanek, D, Ostransky, J, Kettner, J, Spinar, J, Groch, L, Ramik, C, Stumar, J, Linhart, A, Pleva, L, Niedobova, E, Macha, J, Vojacek, J, Stipal, R, Galatius, S, Eggert, S, Mickley, H, Egstrup, K, Pedersen, O, Hvilsted, L, Sykulski, R, Skagen, K, Dodt, K, Klarlund, K, Husted, S, Jensen, G, Melchior, T, Sjoel, A, Steffensen, Fh, Airaksinen, Ke, Laukkanen, Ja, Syvanne, Ms, Kotila, Mj, Mikael, K, Naveri, Hk, Hekkala, Am, Mustonen, Jn, Halkosaari, M, Ohlmann, P, Khalife, K, Dibon, O, Hirsch, Jl, Furber, A, Nguyen-Khac, Jo, Delarche, N, Probst, V, Lim, P, Bayet, G, Dauphin, R, Levai, L, Galinier, M, Belhassane, A, Wiedemann, Jy, Fouche, R, Coisne, D, Henry, P, Schiele, F, Boueri, Z, Vaquette, B, Davy, Jm, Cottin, Y, D'Houdain, F, Danchin, N, Cassat, C, Messner, P, Elbaz, M, Coste, P, Zemour, G, Maupas, E, Feldman, L, Soto, Fx, Ferrari, E, Haltern, G, Heuer, H, Genth-Zotz, S, Loges, C, Stellbrink, C, Terres, W, Ferrar, M, Zeymer, U, Brachmann, J, Mudra, H, Vohringer, Hf, vom Dah, J, Kreuzer, J, Hill, S, Kleinertz, K, Kadel, C, Appel, Kf, Nienabe, C, Behrens, S, Frantz, S, Mehrhof, F, Krings, P, Hengstenberg, C, Lueders, S, Hanefel, C, Krulls-Munch, J, Dorse, T, Leschke, M, Nogai, K, Butter, C, Darius, H, Fichtlscherer, Hp, Schmitt, C, Kasisk, Hp, Dorr, M, Fran, N, Jereczek, M, Wiemer, M, Nickenig, G, Boudriot, E, Werner, G, Altila, T, Strasser, R, Baldus, S, Desaga, M, Buerke, M, Land, S, Schunkert, H, Schulze, Ho, Holmer, S, Sohn, Hy, Burkhardt, W, Lauer, B, Schwimmbeck, P, Schoeller, R, Lapp, H, Gross, M, Kindermann, I, Schuster, P, Yu, Cm, Lee, S, Merkely, B, Apro, D, Lupkovics, G, Edes, I, Ungi, I, Piroth, Z, Csapo, K, Dezsi, Ca, Herczeg, B, Sereg, M, Butnaru, A, Lewis, B, Rosenschein, U, Mosseri, M, Turgeman, Y, Pollak, A, Shotan, A, Hammerman, H, Rozenman, Y, Gottlieb, S, Atar, S, Weiss, A, Marmor, A, Iakobishvili, Z, Mascia, F, De Cesare, N, Piovaccari, G, Ceravolo, R, Fiscella, A, Salvioni, A, Silvestri, O, Moretti, L, Severi, S, Carmina, Mg, De Caterina, R, Fattore, L, Terrosu, P, Trimarco, B, Ardissino, D, Uguccioni, L, Auguadro, C, Gregorio, G, De Ferrari, G, Testa, R, Evola, R, De Servi, S, Sganzerla, P, Vassanelli, C, Brunelli, C, Scherillo, M, Tamburino, C, Limido, A, Luzza, F, Percoco, Gf, Sinagra, G, Volpe, M, Crea, F, Fedele, F, Rasetti, G, Cinelli, F, Merlini, P, Sisto, F, Biancoli, S, Fresco, C, Corrada, E, Casolo, G, Santini, M, D'Alessandro, B, Antoniucci, D, Tuccillo, B, Assennato, P, Puccioni, E, Pasquetto, G, Perna, Gp, Morgagni, G, Takizawa, K, Kato, K, Oshima, S, Yagi, M, Asai, T, Kamiya, H, Hirokami, M, Sakota, S, Sueyoshi, A, Shimomura, H, Hashimoto, T, Miyahara, M, Matsumura, T, Nakao, K, Kakuta, T, Nakamura, S, Nishi, Y, Kawajiri, K, Nagai, Y, Takahashi, A, Ikari, Y, Hara, K, Koga, T, Fujii, K, Tobaru, T, Tsunoda, R, Uchiyama, T, Hirayama, H, Fujimoto, K, Sakurai, S, Tanigawa, T, Ohno, M, Yamamoto, E, Ikuta, S, Kato, A, Kikuta, K, Takami, A, Chong, Wp, Ong, Tk, Yusof, A, Maskon, O, Kahar, A, Breedveld, Rw, Bendermacher, Pe, Hamer, Bj, Oude Ophuis AJ, Nierop, Pr, Westendorp, Ic, Beijerbacht, Hp, Herrman, Jp, van 't Hof AW, Troquay, Rp, van der Meer, P, Peters, Rh, van Rossum, P, Liem, A, Pieterse, Mg, van Eck JW, van der Zwaan, C, Pasupati, S, Elliott, J, Tisch, J, Hart, H, Luke, R, Scott, D, Ternouth, I, White, H, Hamer, A, Harding, S, Wilkins, G, O'Meeghan, T, Harrison, N, Nilsen, D, Thalamus, J, Aaberge, L, Brunvand, H, Lutterbey, G, Omland, Tm, Eritsland, J, Wiseth, R, Aase, O, Campos, C, Horna, M, Toce, L, Salazar, M, Przewlocki, T, Ponikowski, P, Kasprzak, J, Kopaczewski, J, Musial, W, Mazurek, W, Kawecka-Jaszcz, K, Pluta, W, Dobrzycki, S, Loboz-Grudzien, K, Lewczuk, J, Karwowski, D, Grajek, S, Dudek, D, Trusz-Gluza, M, Kornacewicz-Jach, Z, Gil, R, Ferreira, J, Gavina, C, Ferreira, R, Martins, D, Garcia-Rinaldi, R, Ufret, R, Vazquez-Tanus, J, Banchs, H, Wong, A, Tan, Hc, Guerra, M, Ebrahim, I, Roux, J, Blomerus, P, Saaiman, A, Corbett, C, Pillay, T, Freeman, V, Horak, A, Zambakides, C, Burgess, L, Yoon, Jh, Ahn, Th, Gwon, Hc, Seong, Iw, Kim, Hs, Jeong, Mh, Kim, Yd, Chae, Sc, Hernandez, Jm, Pique, M, Fernandez Portales, J, Paz, Ma, Lopez Palop, R, Iniguez, A, Diaz Fernandez, J, Alvarez, P, Sanz, E, Heras, M, Sala, J, Goicolea, J, Cruz Fernandez, J, Serra, A, Fernandez Ortiz, A, Calle, G, Barriales, V, Albarran, A, Curos, A, Molano Casimiro FJ, Suarez, Ma, Franco, Sn, Bayon, J, Suarez, J, Belchi, J, Moreu, J, San Martin, M, Melgares Moreno, R, Aguirre Salcedo, J, Gonzalez Juanatey JR, Martinez Romero, P, Galache Osuna JG, Albertsson, P, Diderholm, E, Lycksell, M, Rasmanis, G, Swahn, E, Cherfan, P, Christensen, K, Lundman, P, Larson, Le, Vasko, P, Pripp, Cm, Johansson, A, Moccetti, T, Corti, R, Pieper, M, Mach, F, Eberli, F, Jeger, R, Rickli, H, Vogt, P, Windecker, S, Wu, Cj, Kao, Hl, Charng, Mj, Chang, Kc, Chen, Zc, Tsa, Cd, Shyu, Kg, Lai, Wt, Hsieh, Ic, Hou, Jy, Yeh, Hi, Ueng, Kc, Yin, Wh, Timurkaynak, T, Yigit, Z, Yilmaz, M, Boyaci, A, Sahin, M, Goktekin, O, Bozkurt, E, Ercan, E, Yildirir, A, Muthusamy, R, Keeling, P, Levy, T, Zaman, A, Cohen, A, Gorog, D, Baumbach, A, Oldroyd, K, Kadr, H, Tait, G, Bellenger, N, Davis, G, Shakespeare, C, Senior, R, Bruce, D, Uren, N, Trouton, T, Ahsan, A, Hamed, A, Malik, I, Sarma, J, Millar-Craig, M, Robson, H, Kennon, S, Sprigings, D, Brodie, B, Kang, Gs, Thomas, G, Cheng, Sc, Espinoza, A, Kassas, S, Jafar, Z, Kumar, P, Izzo, M, Wiseman, A, Chandna, H, Felten, W, D'Urso, M, Gudipati, Cr, Coram, R, Gill, S, Bengtson, J, Chang, M, Raisinghani, A, Blankenship, J, Harbor, Wf, Kraft, P, Ashraf, R, Chambers, J, Albirini, A, Malik, A, Ziada, K, Slepian, M, Taussig, A, Vernon, H, Jetty, P, Islam, Ma, Canaday, D, Martin, T, Burchenal, Jj, Gencheff, N, Nygaard, T, Panchal, V, Merritt, R, Abrahams, L, Lambert, C, Reyes, P, Leimbach, W, Chhabra, A, Caputo, R, Imburgia, M, Erickson, B, Kleiman, N, Hunter, J, Dehning, M, Graham, B, Strain, J, White, Jk, Mcgarvey, J Jr, Henderson, D, Treasure, C 2nd, Mirro, M, Pancholy, S, Helmy, T, Westerhausen, D, Dib, N, Penny, W, Kim, H, Degregorio, M, Jay, D, Kmonicek, J, Berlowitz, M, Starling, M, Langevin, E, Nelson, R, Singer, A, Siachos, A, Gibson, G, Parrott, C, Held, J, Puleo, P, Wolford, T, Omar, B, Brilakis, E, Lewis, S, Heller, L, Brener, S, Addo, T, Lieberman, S, Eisenberg, D, Feldman, R, Waksman, R, Waltman, J, Schulman, S, Bounds, C, Voyce, S, Batchelor, W, Dobies, D, Pasnoori, V, Chandrashekhar, Y, Vetrovec, G, Azrin, M, Spriggs, D, Hirsch, C, Smucker, M, Chetcuti, S, Stella, R, Levite, H, Shoukfeh, M, Vidovich, M, Saucedo, J, Fintel, D, Low, R, Gellman, J, Ahsan, C, Unks, Dm, Tolleson, T, Ceccoli, H, Aggarwal, K, Bhaktaram, V, Olson, C, Decaro, M, Kaluski, E, Mehta, V, Puma, J, Singh, V, Fulmer, J, Lewis, D, Khadra, S, Staniloae, C, East, M, Sundram, Ps, Anderson, J, Wasserman, H, Guy, D, Brill, D, Kruse, K, Ebrahimi, R, Nguyen, T, Keating, F, Srivastava, R, Wassmer, P, Todd, J 3rd, Stein, M, Hamzeh, I, Laxson, D, Hodson, R, Puri, S, Vijayaraghavan, K, Gazmuri, R, Chu, A, Vijay, N, Rabinowitz, A, Block, T, Agarwal, H, Martin, J, Zetterlund, P, Fortuin, D, Macdonell, A 3rd, Zouzoulas, S, Chepuri, V, Schmalfuss, C, Karve, M, Aviles, R, Lieberman, E, Amlani, M, Murphy, S, Shapiro, T, Herzog, E, Ariani, K, Bhagwat, R, Hockstad, E, Kai, W, Saririan, M, Roth, R, Weiland, F, Atassi, K, Harjai, K, Muhlestein, J, Marsh, R, Shokooh, S, Nahhas, A, Labroo, A, Mayor, M, Koshy, S, Tariq, M, Rayos, G, Jones, S, Klugherz, B, Dewey, R, Rashid, Hu, Wohns, D, Feiring, A, Bowles, M, Rohrbeck, S, Monroe, Vs, De Gottlieb, A, Gumm, D, Brown, C 3rd, Chang, D, Kalaria, V, Minisi, A, Joumaa, M, Josephson, R, Kleczka, J, Silver, K, Coleman, P, Brachfeld, C, Saltiel, F, Reiner, J, Carell, E, Hanovich, G, Rosenberg, M, Das, G, Blick, D, and Universitat de Barcelona

Subjects
Male, Pyridines, medicine.medical_treatment, Kaplan-Meier Estimate, law.invention, Lactones, Randomized controlled trial, law, Thrombin receptor antagonist, clopidogrel, placebo, thienopyridine derivative, vorapaxar, antithrombocytic agent, lactone, proteinase activated receptor 1, pyridine derivative, Coronary Artery Bypass, Vorapaxar, Cardiovascular diseases [NCEBP 14], Drugs, General Medicine, Middle Aged, Combined Modality Therapy, Cardiovascular diseases, Cardiovascular Diseases, Cardiology, Platelet aggregation inhibitor, Drug Therapy, Combination, Female, Plaquetes sanguínies, Intracranial Hemorrhages, Major bleeding, Medicaments, medicine.drug, medicine.medical_specialty, Acute coronary syndrome, Bypass cardiopulmonary, Hemorrhage, Pharmacotherapy, Blood platelets, Double-Blind Method, Angioplasty, Internal medicine, medicine, Humans, Receptor, PAR-1, Acute Coronary Syndrome, Aged, business.industry, Malalties cardiovasculars, medicine.disease, Surgery, Bypass cardiopulmonar, business, Platelet Aggregation Inhibitors, Follow-Up Studies
Abstract

Item does not contain fulltext BACKGROUND: Vorapaxar is a new oral protease-activated-receptor 1 (PAR-1) antagonist that inhibits thrombin-induced platelet activation. METHODS: In this multinational, double-blind, randomized trial, we compared vorapaxar with placebo in 12,944 patients who had acute coronary syndromes without ST-segment elevation. The primary end point was a composite of death from cardiovascular causes, myocardial infarction, stroke, recurrent ischemia with rehospitalization, or urgent coronary revascularization. RESULTS: Follow-up in the trial was terminated early after a safety review. After a median follow-up of 502 days (interquartile range, 349 to 667), the primary end point occurred in 1031 of 6473 patients receiving vorapaxar versus 1102 of 6471 patients receiving placebo (Kaplan-Meier 2-year rate, 18.5% vs. 19.9%; hazard ratio, 0.92; 95% confidence interval [CI], 0.85 to 1.01; P=0.07). A composite of death from cardiovascular causes, myocardial infarction, or stroke occurred in 822 patients in the vorapaxar group versus 910 in the placebo group (14.7% and 16.4%, respectively; hazard ratio, 0.89; 95% CI, 0.81 to 0.98; P=0.02). Rates of moderate and severe bleeding were 7.2% in the vorapaxar group and 5.2% in the placebo group (hazard ratio, 1.35; 95% CI, 1.16 to 1.58; P

Published
2012

48. Türk hipertansiyon hastalarında mikroalbuminüri sıklığı ve ilişkili kardiyovasküler risk faktörleri

Author

V Çam, M Etemoglu, Sebahattin Ateşal, E Koçak, Bulent Polat, Meral Kayıkçıoğlu, Yekta Gürlertop, Cem Köz, Ö Özbek, H Yegin, Ceyhun Ceyhan, K Dönmez, B Tosun, H Atmaca, G Dönmez, B. ilerigelen, H Bozdemir, I Biyik, A Sökmen, F Koca, Kenan Övünç, Ramazan Topsakal, Sadi Gulec, O Tartanoglu, Kurtulus Ozdemir, A Fiskeci, E Akarca, Ahmet Sakalli, A Yavuz, M Bilaloglu, Giray Kabakci, T Keleş, F K Inceer, H Tunar, Ş Coşkun, M Şan, S C Turan, Serkan Topaloglu, Irem Dincer, S Yorganci, R Yoldaş, Ömer Kozan, I T Kurt, Mehmet İlker Gökçe, Hakan Kültürsay, A Yilmaz, C Genç, M Ö Sunay, K Tigen, A Sinci, T Ulusoy, Şükrü Ünal, Filiz Özerkan, Sinan Aydoğdu, H Bozkurt, N S Aran, Ercan Varol, O Sancaktar, A Delice, H Tikiz, Emin Evren Özcan, Fatih Sinan Ertaş, H Kaymak, E Semiz, C Rezzagil, I Susal, N Çam, F Özmen, Vedat Aytekin, S Çolak, A Keskin, E Acartürk, N Ata, Oben Döven, H Boga, H Vural, E Şensoy, A Lazoglu, I Özdogru, Y Balbay, Dursun Aras, J Jordan, Dilek Yeşilbursa, H Akgöz, E Onrat, Y Selçoki, Dilek Ural, R Uçar, Sinan Kahraman, H Gök, M T Sirkeci, T Peker, M Bilge, Mehmet Metin Seker, C Agçal, D Aytekin, S Toktaş, A Birdane, Y Yakar, A H Sözcüer, U Sümerkan, S Sakalli, Mehmet Oc, N Sönmez, M Bostan, A Akyüz, Adnan Abaci, V Koca, K Şahna, K Aytemir, Yuksel Cavusoglu, M Tahtasiz, Adalet Gürlek, O Ergene, V Gökçe, I Dogru, M Dagalp, Cuneyt Turkoglu, Ramazan Akdemir, C Uyan, Ahmet Vural, R Kargin, Enver Atalar, A Ünsal, A Bitigen, T T Gündogdu, Kaan Kulan, B Erol, A U Gülmez, Merih Kutlu, K Öztaş, I Tandogan, A Karanfil, Mustafa Polat, S Cinsoy, A Sert, M Çakmak, Ali Ergin, T Durmaz, A Aydinlar, P Pinar, A Kerpeten, Serdar Sevimli, Saide Aytekin, C Nazli, T Kirat, Zeynep Tartan, H Atasever, A Çamsari, A Aribaş, N Keser, Aydan Ongun Ozdemir, N Coşkun, Mehmet Yazici, Y Erzurum, Nevrez Koylan, Mustafa Yilmaz, M Ş Güçel, A E Kiliçoglu, O H Elönü, A Köşüş, G Topkara, G Daş, L Saraç, M Melek, D Gaffari, A Bayram, Z Tosun, K Kaya, Mahmut Şahin, Z Işilak, A Içli, Necla Ozer, Mustafa Kılıçkap, E Aygün, H Gündüz, H Öney, A Daver, Z Kaplan, M Gürsürer, Huseyin Arinc, A Irmak, Osman Alper Onbasili, F V Ulusoy, Mehmet Ridvan Yalcin, M Şerifi, Ahmet Temizhan, Ahmet Çelik, C Kirdar, S Mecit, Cihan Örem, A Güven, Kozan, Ö., Dokuz Eylül University Medical Faculty, Department of Cardiology, Izmir, Turkey -- Özcan, E.E., Izmir Hospital, Izmir, Turkey -- Sancaktar, O., Istanbul Şafak Hospital, Istanbul, Turkey, Akdeniz University Medical Faculty, Department of Cardiology, Antalya, Turkey -- Kabakci, G., Hacettepe University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Sözcüer, A.H., Merkez Efendi State Hospital, Cardiology Clinic, Manisa, Turkey -- Kerpeten, A., Kütahya State Hospital, Cardiology Clinic, Kütahya, Turkey -- Delice, A., Kizilay Health Center, Cardiology Polyclinic, Kayseri, Turkey -- Içli, A., Konya Municipality Hospital, Cardiology Clinic, Konya, Turkey -- Sökmen, A., Sütçü Imam University Medical Faculty, Department of Cardiology, Kahramanmaraş, Turkey -- Gürlek, A., Ankara University Medical Faculty, Department of Cardiology, Ibn-i Sina Hospital, Ankara, Turkey -- Abaci, A., Gazi University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Bayram, A., Erzurum Numune State Hospital, Cardiology Clinic, Erzurum, Turkey -- Köşüş, A., Ordu Medical Center, 19 Eylül Internal Diseases Polyclinic, Ordu, Turkey -- Çamsari, A., Mersin University Medical Faculty, Department of Cardiology, Mersin, Turkey -- Sakalli, A., Afyon State Hospital, Cardiology Clinic, Afyon, Turkey -- Sert, A., Beypazari State Hospital, Cardiology Clinic, Ankara, Turkey -- Temizhan, A., Ankara Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey -- Yilmaz, A., Cumhuriyet University Medical Faculty, Department of Cardiology, Sivas, Turkey -- Daver, A., Antalya State Hospital, Cardiology Clinic, Antalya, Turkey -- Aydinlar, A., Uludag University Medical Faculty, Department of Cardiology, Bursa, Turkey -- Ergin, A., Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey -- Kiliçoglu, A.E., Elazig State Hospital, Cardiology Clinic, Elazig, Turkey -- Birdane, A., Osmangazi University Medical Faculty, Department of Cardiology, Eskişehir, Turkey -- Aribaş, A., Konya Numune State Hospital, Cardiology Clinic, Konya, Turkey -- Lazoglu, A., Intermed Medical Center, Cardiology Clinic, Alanya, Antalya, Turkey -- Özdemir, A., 1 Eylül State Hospital, Cardiology Clinic, Uşak, Turkey -- Fiskeci, A., Balikesir State Hospital, Cardiology Clinic, Balikesir, Turkey -- Çelik, A., Afyon Kocatepe University Medical Faculty, Department of Cardiology, Afyon, Turkey -- Bitigen, A., Kartal Koşuyolu Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey -- Keskin, A., Akhisar State Hospital, Cardiology Clinic, Manisa, Turkey -- Yavuz, A., Kartal Koşuyolu Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey -- Akyüz, A., Sultan 1. Izzettin Keykavuş State Hospital, Cardiology Clinic, Sivas, Turkey -- Karanfil, A., Fatih University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Ünsal, A., Gölcük State Hospital, Cardiology Clinic, Kocaeli, Turkey -- Sinci, A., Bilecik State Hospital, Cardiology Clinic, Bilecik, Turkey -- Gülmez, A.U., Pamukkale State Hospital, Cardiology Clinic, Denizli, Turkey -- Irmak, A., Ankara Training and Research Hospital, Cardiology Clinic, Ankara, Turkey -- Vural, A., Toros State Hospital, Cardiology Clinic, Mersin, Turkey -- Güven, A., Sütçü Imam University Medical Faculty, Department of Cardiology, Kahramanmaraş, Turkey -- Ilerigelen, B., Istanbul University Cerrahpaşa Medical Faculty, Department of Cardiology, Istanbul, Turkey -- Erol, B., Giresun State Hospital, Cardiology Clinic, Giresun, Turkey -- Polat, B., Polatli Duatepe State Hospital, Cardiology Clinic, Ankara, Turkey -- Tosun, B., Aydin 82. Yil State Hospital, Cardiology Clinic, Aydin, Turkey -- Agçal, C., Isparta State Hospital, Cardiology Clinic, Isparta, Turkey -- Genç, C., Gülhane Military Medical Academy, Department of Cardiology, Ankara, Turkey -- Kirdar, C., Eskişehir State Hospital, Cardiology Clinic, Eskişehir, Turkey -- Rezzagil, C., Şevket Yilmaz State Hospital, Cardiology Clinic, Bursa, Turkey -- Köz, C., Gülhane Military Medical Academy, Department of Cardiology, Ankara, Turkey -- Nazli, C., Atatürk Training and Research Hospital, Cardiology Clinic, Izmir, Turkey -- Ceyhan, C., Adnan Menderes University Medical Faculty, Department of Cardiology, Aydin, Turkey -- Örem, C., Karadeniz Technical University Medical Faculty, Department of Cardiology, Trabzon, Turkey -- Uyan, C., Abant Izzet Baysal University Medical Faculty, Department of Cardiology, Bolu, Turkey -- Türkoglu, C., Ege University Medical Faculty, Department of Cardiology, Izmir, Turkey -- Gaffari, D., Kizilay Health Center, Cardiology Polyclinic, Üsküdar, Istanbul, Turkey -- Aytekin, D., Salihli Public Hospital, Cardiology Clinic, Manisa, Turkey -- Ural, D., Kocaeli University Medical Faculty, Department of Cardiology, Kocaeli, Turkey -- Yeşilbursa, D., Uludag University Medical Faculty, Department of Cardiology, Bursa, Turkey -- Aras, D., Ankara Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey -- Semiz, E., Pamukkale University Medical Faculty, Department of Cardiology, Denizli, Turkey -- Koçak, E., Evliya Çelebi State Hospital, Cardiology Clinic, Kütahya, Turkey -- Atalar, E., Hacettepe University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Varol, E., Süleyman Demirel University Medical Faculty, Department of Cardiology, Isparta, Turkey -- Onrat, E., Afyon Kocatepe University Medical Faculty, Department of Cardiology, Afyon, Turkey -- Şensoy, E., Ankara Training and Research Hospital, Cardiology Clinic, Ankara, Turkey -- Acartürk, E., Çukurova University Medical Faculty, Department of Cardiology, Adana, Turkey -- Akarca, E., Nazilli State Hospital, Cardiology Clinic, Aydin, Turkey -- Aygün, E., Bafra State Hospital, Cardiology Clinic, Samsun, Turkey -- Ertaş, F.S., Ankara University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Koca, F., Alsancak State Hospital, Cardiology Clinic, Izmir, Turkey -- Özmen, F., Hacettepe University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Ulusoy, F.V., Ankara Numune Hospital, 2nd Cardiology Clinic, Ankara, Turkey -- Özerkan, F., Ege University Medical Faculty, Department of Cardiology, Izmir, Turkey -- Inceer, F.K., Çorum State Hospital, Cardiology Clinic, Çorum, Turkey -- Dönmez, G., Bakirköy Dr. Sadi Konuk Training and Research Hospital, Department of Cardiology, Istanbul, Turkey -- Topkara, G., Bandirma State Hospital, Cardiology Clinic, Balikesir, Turkey -- Daş, G., 82. Yil State Hospital, Cardiology Clinic, Adiyaman, Turkey -- Bozkurt, H., Antakya State Hospital, Cardiology Clinic, Antakya, Turkey -- Kültürsay, H., Ege University Medical Faculty, Department of Cardiology, Izmir, Turkey -- Tikiz, H., Celal Bayar University Medical Faculty, Department of Cardiology, Manisa, Turkey -- Akgöz, H., Siyami Ersek Hospital, Cardiology Clinic, Istanbul, Turkey -- Kaymak, H., Tarsus State Hospital, Cardiology Clinic, Mersin, Turkey -- Öney, H., Artvin State Hospital, Cardiology Clinic, Artvin, Turkey -- Yegin, H., Antalya State Hospital, Cardiology Clinic, Antalya, Turkey -- Boga, H., Adana Numune Training and Research Hospital, Fatma Timurçin Heart Center, Adana, Turkey -- Gök, H., Selçuk State Hospital, Cardiology Clinic, Izmir, Turkey -- Vural, H., Vedat Ali Özkan State Hospital, Cardiology Clinic, Kayseri, Turkey -- Atasever, H., Adapazari State Hospital, Cardiology Clinic, Adapazari, Turkey -- Arinç, H., Izzet Baysal University Medical Faculty, Department of Cardiology, Düzce, Turkey -- Bozdemir, H., Buca Seyfi Demirsoy State Hospital, Cardiology Clinic, Izmir, Turkey -- Gündüz, H., Izzet Baysal University Medical Faculty, Department of Cardiology, Düzce, Turkey -- Tunar, H., Salihli State Hospital, Cardiology Clinic, Manisa, Turkey -- Atmaca, H., Siyami Ersek Hospital, Cardiology Clinic, Istanbul, Turkey -- Dogru, I., Çukurova State Hospital, Cardiology Clinic, Adana, Turkey -- Özdogru, I., Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey -- Susal, I., Karşiyaka State Hospital, Cardiology Clinic, Izmir, Turkey -- Kurt, I.T., Atakalp Heart Hospital, Cardiology Clinic, Izmir, Turkey -- Dinçer, I., Ankara University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Biyik, I., Uşak State Hospital, Cardiology Clinic, Uşak, Turkey -- Tandogan, I., Cumhuriyet University Medical Faculty, Department of Cardiology, Sivas, Turkey -- Jordan, J., Uludag University Medical Faculty, Department of Cardiology, Bursa, Turkey -- Kulan, K., Trabzon Numune State Hospital, Cardiology Clinic, Trabzon, Turkey -- Şahna, K., Ordu State Hospital, Cardiology Clinic, Ordu, Turkey -- Öztaş, K., Samsun State Hospital, Cardiology Clinic, Samsun, Turkey -- Dönmez, K., Manavgat State Hospital, Cardiology Clinic, Antalya, Turkey -- Övünç, K., Hacettepe University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Kaya, K., Bursa State Hospital, Cardiology Clinic, Bursa, Turkey -- Aytemir, K., Hacettepe University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Özdemir, K., Selçuk University Medical Faculty, Department of Cardiology, Konya, Turkey -- Tigen, K., Ümraniye State Hospital, Cardiology Clinic, Istanbul, Turkey -- Saraç, L., Istinye State Hospital, Cardiology Clinic, Istanbul, Turkey -- Sirkeci, M.T., Kizilay Health Center, Cardiology Polyclinic, Erzincan, Turkey -- Çakmak, M., Ümraniye State Hospital, Cardiology Clinic, Istanbul, Turkey -- Şahin, M., Ondokuz Mayis University Medical Faculty, Department of Cardiology, Samsun, Turkey -- Kutlu, M., Harput State Hospital, Cardiology Clinic, Elazig, Turkey -- Bilge, M., Ankara Atatürk Training and Research Hospital, Cardiology Clinic, Ankara, Turkey -- Bostan, M., Rize State Hospital, Cardiology Clinic, Rize, Turkey -- Melek, M., Afyon Kocatepe University Medical Faculty, Department of Cardiology, Afyon, Turkey -- Sunay, M.Ö., Balikesir State Hospital, Cardiology Clinic, Balikesir, Turkey -- Şeker, M., Meram State Hospital, Cardiology Clinic, Konya, Turkey -- Güçel, M.Ş., Adana Numune Training and Research Hospital, Fatma Timurçin Heart Center, Adana, Turkey -- Yazici, M., Düzce University Medical Faculty, Department of Cardiology, Düzce, Turkey -- Kayikçioglu, M., Ege University Medical Faculty, Department of Cardiology, Izmir, Turkey -- Öç, M., Ümraniye State Hospital, Cardiology Clinic, Istanbul, Turkey -- Gürsürer, M., Karaelmas University Medical Faculty, Department of Cardiology, Zonguldak, Turkey -- Dagalp, M., Ziraat Bank Hospital, Cardiology Clinic, Ankara, Turkey -- Bilaloglu, M., Erzurum Numune State Hospital, Cardiology Clinic, Erzurum, Turkey -- Yalçin, M., GATA Haydarpaşa Training and Research Hospital, Department of Cardiology, Istanbul, Turkey -- Şerifi, M., Izmit State Hospital, Cardiology Clinic, Kocaeli, Turkey -- Gökçe, M., Karadeniz Technical University Medical Faculty, Department of Cardiology, Trabzon, Turkey -- Kiliçkap, M., Ankara University Medical Faculty, Department of Cardiology, Heart Center, Ankara, Turkey -- Polat, M., Ceyhan State Hospital, Cardiology Clinic, Adana, Turkey -- Şan, M., Çukurova University Medical Faculty, Department of Cardiology, Adana, Turkey -- Tahtasiz, M., Eşrefpaşa Municipality Hospital, Cardiology Clinic, Izmir, Turkey -- Yilmaz, M., Kayseri State Hospital, Cardiology Clinic, Kayseri, Turkey -- Etemoglu, M., Izmir Training and Research Hospital, Cardiology Clinic, Izmir, Turkey -- Coşkun, N., Harput State Hospital, Cardiology Clinic, Elazig, Turkey -- Aran, N.S., Istanbul University Cerrahpaşa Medical Faculty, Department of Cardiology, Istanbul, Turkey -- Ata, N., Osmangazi University Medical Faculty, Department of Cardiology, Eskişehir, Turkey -- Sönmez, N., Bodrum State Hospital, Cardiology Clinic, Mugla, Turkey -- Çam, N., Siyami Ersek Hospital, Cardiology Clinic, Istanbul, Turkey -- Koylan, N., Istanbul University Istanbul Medical Faculty, Department of Cardiology, Istanbul, Turkey -- Özer, N., Iskenderun State Hospital, Cardiology Clinic, Hatay, Turkey -- Keser, N., Maltepe University Medical Faculty, Department of Cardiology, Istanbul, Turkey -- Döven, O., Mersin University Medical Faculty, Department of Cardiology, Mersin, Turkey -- Tartanoglu, O., Karaman State Hospital, Cardiology Clinic, Karaman, Turkey -- Ergene, O., Atatürk Training and Research Hospital, Cardiology Clinic, Izmir, Turkey -- Elönü, O.H., Melikgazi Hospital, Cardiology Clinic, Kayseri, Turkey -- Onbaşili, O.A., Adnan Menderes University Medical Faculty, Department of Cardiology, Aydin, Turkey -- Özbek, Ö., Marmara University Medical Faculty, Department of Cardiology, Istanbul, Turkey -- Pinar, P., Manisa State Hospital, Cardiology Clinic, Manisa, Turkey -- Akdemir, R., Düzce University Medical Faculty, Department of Cardiology, Düzce, Turkey -- Kargin, R., Kartal Koşuyolu Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey -- Topsakal, R., Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey -- Yoldaş, R., Konya Numune State Hospital, Cardiology Clinic, Konya, Turkey -- Uçar, R., Giresun State Hospital, Cardiology Clinic, Giresun, Turkey -- Ateşal, S., Atatürk University Medical Faculty, Department of Cardiology, Erzurum, Turkey -- Toktaş, S., Adana Numune Training and Research Hospital, Fatma Timurçin Heart Center, Adana, Turkey -- Cinsoy, S., Sabuncuoglu Şerafeddin State Hospital, Cardiology Clinic, Amasya, Turkey -- Güleç, S., Ankara University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Aytekin, S., Kadir Has University Medical Faculty, Department of Cardiology, Istanbul, Turkey -- Çolak, S., Kizilay Health Center, Cardiology Polyclinic, Sivas, Turkey -- Mecit, S., Çanakkale Şehitlik State Hospital, Cardiology Clinic, Çanakkale, Turkey -- Sakalli, S., Siyami Ersek Hospital, Cardiology Clinic, Istanbul, Turkey -- Sevimli, S., Atatürk University Medical Faculty, Department of Cardiology, Erzurum, Turkey -- Topaloglu, S., Ankara Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey -- Aydogdu, S., Ankara Numune Hospital, Cardiology Clinic, Ankara, Turkey -- Turan, S.C., Fatih Sultan Mehmet State Hospital, Cardiology Clinic, Istanbul, Turkey -- Kahraman, S., Nigde State Hospital, Cardiology Clinic, Nigde, Turkey -- Yorganci, S., Atatürk State Hospital, Cardiology Clinic, Antalya, Turkey -- Coşkun, Ş., Bursa State Hospital, Cardiology Clinic, Bursa, Turkey -- Ünal, Ş., Nevşehir State Hospital, Cardiology Clinic, Nevşehir, Turkey -- Durmaz, T., Ankara Atatürk Training and Research Hospital, Cardiology Clinic, Ankara, Turkey -- Ulusoy, T., Aksaray State Hospital, Cardiology Clinic, Aksaray, Turkey -- Keleş, T., Ankara Atatürk Training and Research Hospital, Cardiology Clinic, Ankara, Turkey -- Kirat, T., Mugla State Hospital, Cardiology Clinic, Mugla, Turkey -- Gündogdu, T.T., Gebze Fatih Hospital, Cardiology Clinic, Kocaeli, Turkey -- Peker, T., Gemlik State Hospital, Cardiology Clinic, Bursa, Turkey -- Sümerkan, U., Marmara University Medical Faculty, Department of Cardiology, Istanbul, Turkey -- Aytekin, V., Kadir Has University Medical Faculty, Department of Cardiology, Istanbul, Turkey -- Koca, V., Bursa Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Bursa, Turkey -- Çam, V., Fethiye State Hospital, Cardiology Clinic, Mugla, Turkey -- Gökçe, V., Konya Numune State Hospital, Cardiology Clinic, Konya, Turkey -- Gürlertop, Y., Atatürk University Medical Faculty, Department of Cardiology, Erzurum, Turkey -- Balbay, Y., Ankara Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey -- Çavuşoglu, Y., Osmangazi University Medical Faculty, Department of Cardiology, Eskişehir, Turkey -- Erzurum, Y., Eskişehir Yunus Emre State Hospital, Cardiology Clinic, Eskişehir, Turkey -- Selçoki, Y., Fatih University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Yakar, Y., Tokat State Hospital, Cardiology Clinic, Tokat, Turkey -- Işilak, Z., GATA Haydarpaşa Training and Research Hospital, Department of Cardiology, Istanbul, Turkey -- Tosun, Z., Antalya State Hospital, Cardiology Clinic, Antalya, Turkey -- Kaplan, Z., Ankara Training and Research Hospital, Cardiology Clinic, Ankara, Turkey -- Tartan, Z., Siyami Ersek Hospital, Cardiology Clinic, Istanbul, Turkey, Zonguldak Bülent Ecevit Üniversitesi, 0-Belirlenecek, Ondokuz Mayıs Üniversitesi, BAİBÜ, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, Uyan, Cihangir, Aytekin, Saide, Aytekin, Vedat, Kozan, Ö., Dokuz Eylül University Medical Faculty, Department of Cardiology, Izmir, Turkey -- Özcan, E.E., Izmir Hospital, Izmir, Turkey -- Sancaktar, O., Istanbul Şafak Hospital, Istanbul, Turkey, Akdeniz University Medical Faculty, Department of Cardiology, Antalya, Turkey -- Kabakci, G., Hacettepe University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Sözcüer, A.H., Merkez Efendi State Hospital, Cardiology Clinic, Manisa, Turkey -- Kerpeten, A., Kütahya State Hospital, Cardiology Clinic, Kütahya, Turkey -- Delice, A., Kizilay Health Center, Cardiology Polyclinic, Kayseri, Turkey -- Içli, A., Konya Municipality Hospital, Cardiology Clinic, Konya, Turkey -- Sökmen, A., Sütçü Imam University Medical Faculty, Department of Cardiology, Kahramanmaraş, Turkey -- Gürlek, A., Ankara University Medical Faculty, Department of Cardiology, Ibn-i Sina Hospital, Ankara, Turkey -- Abaci, A., Gazi University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Bayram, A., Erzurum Numune State Hospital, Cardiology Clinic, Erzurum, Turkey -- Köşüş, A., Ordu Medical Center, 19 Eylül Internal Diseases Polyclinic, Ordu, Turkey -- Çamsari, A., Mersin University Medical Faculty, Department of Cardiology, Mersin, Turkey -- Sakalli, A., Afyon State Hospital, Cardiology Clinic, Afyon, Turkey -- Sert, A., Beypazari State Hospital, Cardiology Clinic, Ankara, Turkey -- Temizhan, A., Ankara Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey -- Yilmaz, A., Cumhuriyet University Medical Faculty, Department of Cardiology, Sivas, Turkey -- Daver, A., Antalya State Hospital, Cardiology Clinic, Antalya, Turkey -- Aydinlar, A., Uluda? University Medical Faculty, Department of Cardiology, Bursa, Turkey -- Ergin, A., Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey -- Kiliço?lu, A.E., Elazi? State Hospital, Cardiology Clinic, Elazi?, Turkey -- Birdane, A., Osmangazi University Medical Faculty, Department of Cardiology, Eskişehir, Turkey -- Aribaş, A., Konya Numune State Hospital, Cardiology Clinic, Konya, Turkey -- Lazo?lu, A., Intermed Medical Center, Cardiology Clinic, Alanya, Antalya, Turkey -- Özdemir, A., 1 Eylül State Hospital, Cardiology Clinic, Uşak, Turkey -- Fiskeci, A., Balikesir State Hospital, Cardiology Clinic, Balikesir, Turkey -- Çelik, A., Afyon Kocatepe University Medical Faculty, Department of Cardiology, Afyon, Turkey -- Bitigen, A., Kartal Koşuyolu Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey -- Keskin, A., Akhisar State Hospital, Cardiology Clinic, Manisa, Turkey -- Yavuz, A., Kartal Koşuyolu Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey -- Akyüz, A., Sultan 1. Izzettin Keykavuş State Hospital, Cardiology Clinic, Sivas, Turkey -- Karanfil, A., Fatih University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Ünsal, A., Gölcük State Hospital, Cardiology Clinic, Kocaeli, Turkey -- Sinci, A., Bilecik State Hospital, Cardiology Clinic, Bilecik, Turkey -- Gülmez, A.U., Pamukkale State Hospital, Cardiology Clinic, Denizli, Turkey -- Irmak, A., Ankara Training and Research Hospital, Cardiology Clinic, Ankara, Turkey -- Vural, A., Toros State Hospital, Cardiology Clinic, Mersin, Turkey -- Güven, A., Sütçü Imam University Medical Faculty, Department of Cardiology, Kahramanmaraş, Turkey -- Ilerigelen, B., Istanbul University Cerrahpaşa Medical Faculty, Department of Cardiology, Istanbul, Turkey -- Erol, B., Giresun State Hospital, Cardiology Clinic, Giresun, Turkey -- Polat, B., Polatli Duatepe State Hospital, Cardiology Clinic, Ankara, Turkey -- Tosun, B., Aydin 82. Yil State Hospital, Cardiology Clinic, Aydin, Turkey -- A?çal, C., Isparta State Hospital, Cardiology Clinic, Isparta, Turkey -- Genç, C., Gülhane Military Medical Academy, Department of Cardiology, Ankara, Turkey -- Kirdar, C., Eskişehir State Hospital, Cardiology Clinic, Eskişehir, Turkey -- Rezzagil, C., Şevket Yilmaz State Hospital, Cardiology Clinic, Bursa, Turkey -- Köz, C., Gülhane Military Medical Academy, Department of Cardiology, Ankara, Turkey -- Nazli, C., Atatürk Training and Research Hospital, Cardiology Clinic, Izmir, Turkey -- Ceyhan, C., Adnan Menderes University Medical Faculty, Department of Cardiology, Aydin, Turkey -- Örem, C., Karadeniz Technical University Medical Faculty, Department of Cardiology, Trabzon, Turkey -- Uyan, C., Abant Izzet Baysal University Medical Faculty, Department of Cardiology, Bolu, Turkey -- Türko?lu, C., Ege University Medical Faculty, Department of Cardiology, Izmir, Turkey -- Gaffari, D., Kizilay Health Center, Cardiology Polyclinic, Üsküdar, Istanbul, Turkey -- Aytekin, D., Salihli Public Hospital, Cardiology Clinic, Manisa, Turkey -- Ural, D., Kocaeli University Medical Faculty, Department of Cardiology, Kocaeli, Turkey -- Yeşilbursa, D., Uluda? University Medical Faculty, Department of Cardiology, Bursa, Turkey -- Aras, D., Ankara Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey -- Semiz, E., Pamukkale University Medical Faculty, Department of Cardiology, Denizli, Turkey -- Koçak, E., Evliya Çelebi State Hospital, Cardiology Clinic, Kütahya, Turkey -- Atalar, E., Hacettepe University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Varol, E., Süleyman Demirel University Medical Faculty, Department of Cardiology, Isparta, Turkey -- Onrat, E., Afyon Kocatepe University Medical Faculty, Department of Cardiology, Afyon, Turkey -- Şensoy, E., Ankara Training and Research Hospital, Cardiology Clinic, Ankara, Turkey -- Acartürk, E., Çukurova University Medical Faculty, Department of Cardiology, Adana, Turkey -- Akarca, E., Nazilli State Hospital, Cardiology Clinic, Aydin, Turkey -- Aygün, E., Bafra State Hospital, Cardiology Clinic, Samsun, Turkey -- Ertaş, F.S., Ankara University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Koca, F., Alsancak State Hospital, Cardiology Clinic, Izmir, Turkey -- Özmen, F., Hacettepe University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Ulusoy, F.V., Ankara Numune Hospital, 2nd Cardiology Clinic, Ankara, Turkey -- Özerkan, F., Ege University Medical Faculty, Department of Cardiology, Izmir, Turkey -- Inceer, F.K., Çorum State Hospital, Cardiology Clinic, Çorum, Turkey -- Dönmez, G., Bakirköy Dr. Sadi Konuk Training and Research Hospital, Department of Cardiology, Istanbul, Turkey -- Topkara, G., Bandirma State Hospital, Cardiology Clinic, Balikesir, Turkey -- Daş, G., 82. Yil State Hospital, Cardiology Clinic, Adiyaman, Turkey -- Bozkurt, H., Antakya State Hospital, Cardiology Clinic, Antakya, Turkey -- Kültürsay, H., Ege University Medical Faculty, Department of Cardiology, Izmir, Turkey -- Tikiz, H., Celal Bayar University Medical Faculty, Department of Cardiology, Manisa, Turkey -- Akgöz, H., Siyami Ersek Hospital, Cardiology Clinic, Istanbul, Turkey -- Kaymak, H., Tarsus State Hospital, Cardiology Clinic, Mersin, Turkey -- Öney, H., Artvin State Hospital, Cardiology Clinic, Artvin, Turkey -- Ye?in, H., Antalya State Hospital, Cardiology Clinic, Antalya, Turkey -- Bo?a, H., Adana Numune Training and Research Hospital, Fatma Timurçin Heart Center, Adana, Turkey -- Gök, H., Selçuk State Hospital, Cardiology Clinic, Izmir, Turkey -- Vural, H., Vedat Ali Özkan State Hospital, Cardiology Clinic, Kayseri, Turkey -- Atasever, H., Adapazari State Hospital, Cardiology Clinic, Adapazari, Turkey -- Arinç, H., Izzet Baysal University Medical Faculty, Department of Cardiology, Düzce, Turkey -- Bozdemir, H., Buca Seyfi Demirsoy State Hospital, Cardiology Clinic, Izmir, Turkey -- Gündüz, H., Izzet Baysal University Medical Faculty, Department of Cardiology, Düzce, Turkey -- Tunar, H., Salihli State Hospital, Cardiology Clinic, Manisa, Turkey -- Atmaca, H., Siyami Ersek Hospital, Cardiology Clinic, Istanbul, Turkey -- Do?ru, I., Çukurova State Hospital, Cardiology Clinic, Adana, Turkey -- Özdo?ru, I., Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey -- Susal, I., Karşiyaka State Hospital, Cardiology Clinic, Izmir, Turkey -- Kurt, I.T., Atakalp Heart Hospital, Cardiology Clinic, Izmir, Turkey -- Dinçer, I., Ankara University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Biyik, I., Uşak State Hospital, Cardiology Clinic, Uşak, Turkey -- Tando?an, I., Cumhuriyet University Medical Faculty, Department of Cardiology, Sivas, Turkey -- Jordan, J., Uluda? University Medical Faculty, Department of Cardiology, Bursa, Turkey -- Kulan, K., Trabzon Numune State Hospital, Cardiology Clinic, Trabzon, Turkey -- Şahna, K., Ordu State Hospital, Cardiology Clinic, Ordu, Turkey -- Öztaş, K., Samsun State Hospital, Cardiology Clinic, Samsun, Turkey -- Dönmez, K., Manavgat State Hospital, Cardiology Clinic, Antalya, Turkey -- Övünç, K., Hacettepe University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Kaya, K., Bursa State Hospital, Cardiology Clinic, Bursa, Turkey -- Aytemir, K., Hacettepe University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Özdemir, K., Selçuk University Medical Faculty, Department of Cardiology, Konya, Turkey -- Tigen, K., Ümraniye State Hospital, Cardiology Clinic, Istanbul, Turkey -- Saraç, L., Istinye State Hospital, Cardiology Clinic, Istanbul, Turkey -- Sirkeci, M.T., Kizilay Health Center, Cardiology Polyclinic, Erzincan, Turkey -- Çakmak, M., Ümraniye State Hospital, Cardiology Clinic, Istanbul, Turkey -- Şahin, M., Ondokuz Mayis University Medical Faculty, Department of Cardiology, Samsun, Turkey -- Kutlu, M., Harput State Hospital, Cardiology Clinic, Elazi?, Turkey -- Bilge, M., Ankara Atatürk Training and Research Hospital, Cardiology Clinic, Ankara, Turkey -- Bostan, M., Rize State Hospital, Cardiology Clinic, Rize, Turkey -- Melek, M., Afyon Kocatepe University Medical Faculty, Department of Cardiology, Afyon, Turkey -- Sunay, M.Ö., Balikesir State Hospital, Cardiology Clinic, Balikesir, Turkey -- Şeker, M., Meram State Hospital, Cardiology Clinic, Konya, Turkey -- Güçel, M.Ş., Adana Numune Training and Research Hospital, Fatma Timurçin Heart Center, Adana, Turkey -- Yazici, M., Düzce University Medical Faculty, Department of Cardiology, Düzce, Turkey -- Kayikçio?lu, M., Ege University Medical Faculty, Department of Cardiology, Izmir, Turkey -- Öç, M., Ümraniye State Hospital, Cardiology Clinic, Istanbul, Turkey -- Gürsürer, M., Karaelmas University Medical Faculty, Department of Cardiology, Zonguldak, Turkey -- Da?alp, M., Ziraat Bank Hospital, Cardiology Clinic, Ankara, Turkey -- Bilalo?lu, M., Erzurum Numune State Hospital, Cardiology Clinic, Erzurum, Turkey -- Yalçin, M., GATA Haydarpaşa Training and Research Hospital, Department of Cardiology, Istanbul, Turkey -- Şerifi, M., Izmit State Hospital, Cardiology Clinic, Kocaeli, Turkey -- Gökçe, M., Karadeniz Technical University Medical Faculty, Department of Cardiology, Trabzon, Turkey -- Kiliçkap, M., Ankara University Medical Faculty, Department of Cardiology, Heart Center, Ankara, Turkey -- Polat, M., Ceyhan State Hospital, Cardiology Clinic, Adana, Turkey -- Şan, M., Çukurova University Medical Faculty, Department of Cardiology, Adana, Turkey -- Tahtasiz, M., Eşrefpaşa Municipality Hospital, Cardiology Clinic, Izmir, Turkey -- Yilmaz, M., Kayseri State Hospital, Cardiology Clinic, Kayseri, Turkey -- Etemo?lu, M., Izmir Training and Research Hospital, Cardiology Clinic, Izmir, Turkey -- Coşkun, N., Harput State Hospital, Cardiology Clinic, Elazi?, Turkey -- Aran, N.S., Istanbul University Cerrahpaşa Medical Faculty, Department of Cardiology, Istanbul, Turkey -- Ata, N., Osmangazi University Medical Faculty, Department of Cardiology, Eskişehir, Turkey -- Sönmez, N., Bodrum State Hospital, Cardiology Clinic, Mu?la, Turkey -- Çam, N., Siyami Ersek Hospital, Cardiology Clinic, Istanbul, Turkey -- Koylan, N., Istanbul University Istanbul Medical Faculty, Department of Cardiology, Istanbul, Turkey -- Özer, N., Iskenderun State Hospital, Cardiology Clinic, Hatay, Turkey -- Keser, N., Maltepe University Medical Faculty, Department of Cardiology, Istanbul, Turkey -- Döven, O., Mersin University Medical Faculty, Department of Cardiology, Mersin, Turkey -- Tartano?lu, O., Karaman State Hospital, Cardiology Clinic, Karaman, Turkey -- Ergene, O., Atatürk Training and Research Hospital, Cardiology Clinic, Izmir, Turkey -- Elönü, O.H., Melikgazi Hospital, Cardiology Clinic, Kayseri, Turkey -- Onbaşili, O.A., Adnan Menderes University Medical Faculty, Department of Cardiology, Aydin, Turkey -- Özbek, Ö., Marmara University Medical Faculty, Department of Cardiology, Istanbul, Turkey -- Pinar, P., Manisa State Hospital, Cardiology Clinic, Manisa, Turkey -- Akdemir, R., Düzce University Medical Faculty, Department of Cardiology, Düzce, Turkey -- Kargin, R., Kartal Koşuyolu Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey -- Topsakal, R., Erciyes University Medical Faculty, Department of Cardiology, Kayseri, Turkey -- Yoldaş, R., Konya Numune State Hospital, Cardiology Clinic, Konya, Turkey -- Uçar, R., Giresun State Hospital, Cardiology Clinic, Giresun, Turkey -- Ateşal, S., Atatürk University Medical Faculty, Department of Cardiology, Erzurum, Turkey -- Toktaş, S., Adana Numune Training and Research Hospital, Fatma Timurçin Heart Center, Adana, Turkey -- Cinsoy, S., Sabuncuo?lu Şerafeddin State Hospital, Cardiology Clinic, Amasya, Turkey -- Güleç, S., Ankara University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Aytekin, S., Kadir Has University Medical Faculty, Department of Cardiology, Istanbul, Turkey -- Çolak, S., Kizilay Health Center, Cardiology Polyclinic, Sivas, Turkey -- Mecit, S., Çanakkale Şehitlik State Hospital, Cardiology Clinic, Çanakkale, Turkey -- Sakalli, S., Siyami Ersek Hospital, Cardiology Clinic, Istanbul, Turkey -- Sevimli, S., Atatürk University Medical Faculty, Department of Cardiology, Erzurum, Turkey -- Topalo?lu, S., Ankara Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey -- Aydo?du, S., Ankara Numune Hospital, Cardiology Clinic, Ankara, Turkey -- Turan, S.C., Fatih Sultan Mehmet State Hospital, Cardiology Clinic, Istanbul, Turkey -- Kahraman, S., Ni?de State Hospital, Cardiology Clinic, Ni?de, Turkey -- Yorganci, S., Atatürk State Hospital, Cardiology Clinic, Antalya, Turkey -- Coşkun, Ş., Bursa State Hospital, Cardiology Clinic, Bursa, Turkey -- Ünal, Ş., Nevşehir State Hospital, Cardiology Clinic, Nevşehir, Turkey -- Durmaz, T., Ankara Atatürk Training and Research Hospital, Cardiology Clinic, Ankara, Turkey -- Ulusoy, T., Aksaray State Hospital, Cardiology Clinic, Aksaray, Turkey -- Keleş, T., Ankara Atatürk Training and Research Hospital, Cardiology Clinic, Ankara, Turkey -- Kirat, T., Mu?la State Hospital, Cardiology Clinic, Mu?la, Turkey -- Gündo?du, T.T., Gebze Fatih Hospital, Cardiology Clinic, Kocaeli, Turkey -- Peker, T., Gemlik State Hospital, Cardiology Clinic, Bursa, Turkey -- Sümerkan, U., Marmara University Medical Faculty, Department of Cardiology, Istanbul, Turkey -- Aytekin, V., Kadir Has University Medical Faculty, Department of Cardiology, Istanbul, Turkey -- Koca, V., Bursa Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Bursa, Turkey -- Çam, V., Fethiye State Hospital, Cardiology Clinic, Mu?la, Turkey -- Gökçe, V., Konya Numune State Hospital, Cardiology Clinic, Konya, Turkey -- Gürlertop, Y., Atatürk University Medical Faculty, Department of Cardiology, Erzurum, Turkey -- Balbay, Y., Ankara Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey -- Çavuşo?lu, Y., Osmangazi University Medical Faculty, Department of Cardiology, Eskişehir, Turkey -- Erzurum, Y., Eskişehir Yunus Emre State Hospital, Cardiology Clinic, Eskişehir, Turkey -- Selçoki, Y., Fatih University Medical Faculty, Department of Cardiology, Ankara, Turkey -- Yakar, Y., Tokat State Hospital, Cardiology Clinic, Tokat, Turkey -- Işilak, Z., GATA Haydarpaşa Training and Research Hospital, Department of Cardiology, Istanbul, Turkey -- Tosun, Z., Antalya State Hospital, Cardiology Clinic, Antalya, Turkey -- Kaplan, Z., Ankara Training and Research Hospital, Cardiology Clinic, Ankara, Turkey -- Tartan, Z., Siyami Ersek Hospital, Cardiology Clinic, Istanbul, Turkey, Maltepe Üniversitesi, and Çukurova Üniversitesi

Subjects
Male, heart atrium fibrillation, Turkey, Cross-sectional study, urinalysis, anticoagulant agent, Coronary artery disease, Turkey (republic), hydroxymethylglutaryl coenzyme A reductase inhibitor, low density lipoprotein cholesterol, sedentary lifestyle, Risk Factors, high density lipoprotein cholesterol, cardiovascular disease, middle aged, dipeptidyl carboxypeptidase inhibitor, Albuminuria/complications/epidemiology, Cardiovascular diseases, Hypertension/complications, Prevalence, Risk factors, Turkey/epidemiology, Medicine, Family history, family history, education.field_of_study, C reactive protein, adult, creatinine, article, beta adrenergic receptor blocking agent, clinical trial, antithrombocytic agent, Middle Aged, urine, comorbidity, ComputingMilieux_MANAGEMENTOFCOMPUTINGANDINFORMATIONSYSTEMS, female, congestive heart failure, risk factor, laboratory test, diabetes mellitus, Hypertension, antihypertensive agent, Female, triacylglycerol, InformationSystems_MISCELLANEOUS, Cardiology and Cardiovascular Medicine, cardiovascular risk, Adult, disease control, medicine.medical_specialty, microalbuminuria, heart infarction, Population, Urinalysis, albuminuria, smoking, Young Adult, blood, Internal medicine, cross-sectional study, Albuminuria, Humans, human, Risk factor, Intensive care medicine, education, Triglycerides, concentration (parameters), business.industry, screening, dyslipidemia, Cholesterol, HDL, ComputerSystemsOrganization_COMPUTER-COMMUNICATIONNETWORKS, cholesterol, Cholesterol, LDL, medicine.disease, major clinical study, Comorbidity, brain ischemia, predictor variable, multicenter study, Cross-Sectional Studies, ComputingMethodologies_PATTERNRECOGNITION, transient ischemic attack, observational study, Microalbuminuria, disease duration, business, Dyslipidemia, peripheral occlusive artery disease
Abstract

PubMed ID: 22257801, Objectives: A growing body of data illustrates the importance of microalbuminuria (MAU) as a strong predictor of cardiovascular risk in the hypertensive population. The present study was designed to define the prevalence of MAU and associated cardiovascular risk factors among Turkish hypertensive outpatients. Study design: Representing the Turkish arm of the multinational i-SEARCH study involving 1,750 sites in 26 countries around the world, a total of 1,926 hypertensive patients from different centers were included in this observational and cross-sectional survey study. Patients with reasons for a false-positive MAU test were excluded. The prevalence of MAU was assessed using a dipstick test, and patients were inquired about comorbidities, comedication, and known cardiovascular risk factors. Results: The overall prevalence of MAU was 64.7% and there was no difference between genders. Most of the patients (82.5%) had uncontrolled hypertension, 35.6% had dyslipidemia, and 35.5% had diabetes, predominantly type 2. Almost one-third of the patients (26.4%) had at least one cardiovascular-related comorbidity, with 20.3% having documented coronary artery disease (CAD). Almost all patients (96.8%) had one or more risk factors for cardiovascular disease in addition to hypertension, including family history of myocardial infarction or CAD, diabetes, dyslipidemia, lack of physical exercise, and smoking. A trend towards higher MAU values in the presence of CAD was determined. Conclusion: Microalbuminuria tests should be routinely used as a screening and monitoring tool for the assessment of subsequent cardiovascular morbidity and mortality among hypertensive patients. © 2011 Turkish Society of Cardiology.

Published
2011

49. Antiplatelets treatment in atherosclerotic renal artery stenosis: need of consensus-based recommendations

Author

Martino F. Pengo, Fabio Ragazzo, Lorenzo A. Calò, Paola Caielli, Gian Paolo Rossi, Caielli, P, Pengo, M, Ragazzo, F, Rossi, G, and Calo, L

Subjects
Blood Platelets, Risk, medicine.medical_specialty, Physiology, Cardiology, ticlopidine, Guidelines as Topic, Constriction, Pathologic, Renin-Angiotensin System, Text mining, Renal Artery, Internal medicine, Atherosclerotic renal artery stenosis, dipeptidyl carboxypeptidase inhibitor, Internal Medicine, medicine, Humans, Clinical Trials as Topic, clopidogrel, business.industry, antithrombocytic agent, acetylsalicylic acid, Atherosclerosis, angiotensin receptor antagonist, Radiology, Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors
Published
2011

50. 21e journée de cardiologie octobre 2013 : le syndrome coronarien aigu du patient diabétique

Author

UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service de pathologie cardiovasculaire, Beauloye, Christophe, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service de pathologie cardiovasculaire, and Beauloye, Christophe

Abstract

Le diabète assombrit le pronostic des patients souffrant d’un syndrome coronarien aigu. La présence du diabète est souvent ignorée par le patient et doit être systématiquement recherchée lors d’un événement coronarien aigu que ce soit à l’hôpital ou après le séjour hospitalier. Le diabète influence la prise en charge des patients pour la rapidité de réalisation d’une angiographie chez les patients avec un syndrome coronarien sans sus-décalage persistant du segment ST, pour la stratégie de revascularisation pour ces mêmes patients et pour le choix des antiagrégants plaquettaires. Le traitement de prévention secondaire chez le patient diabétique associe un traitement antihypertenseur, une statine à haute dose et une double antiagrégation plaquettaire. L’intensité du contrôle glycémique doit être nuancé en fonction du type de patient

Published
2013

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