BACKGROUND: Subclinical atrial fibrillation is short-lasting and asymptomatic and can usually be detected only by long-term continuous monitoring with pacemakers or defibrillators. Subclinical atrial fibrillation is associated with an increased risk of stroke by a factor of 2.5; however, treatment with oral anticoagulation is of uncertain benefit. METHODS: We conducted a trial involving patients with subclinical atrial fibrillation lasting 6 minutes to 24 hours. Patients were randomly assigned in a double-blind, double-dummy design to receive apixaban at a dose of 5 mg twice daily (2.5 mg twice daily when indicated) or aspirin at a dose of 81 mg daily. The trial medication was discontinued and anticoagulation started if subclinical atrial fibrillation lasting more than 24 hours or clinical atrial fibrillation developed. The primary efficacy outcome, stroke or systemic embolism, was assessed in the intention-to-treat population (all the patients who had undergone randomization); the primary safety outcome, major bleeding, was assessed in the on-treatment population (all the patients who had undergone randomization and received at least one dose of the assigned trial drug, with follow-up censored 5 days after permanent discontinuation of trial medication for any reason). RESULTS: We included 4012 patients with a mean (±SD) age of 76.8±7.6 years and a mean CHA2DS2-VASc score of 3.9±1.1 (scores range from 0 to 9, with higher scores indicating a higher risk of stroke); 36.1% of the patients were women. After a mean follow-up of 3.5±1.8 years, stroke or systemic embolism occurred in 55 patients in the apixaban group (0.78% per patient-year) and in 86 patients in the aspirin group (1.24% per patient-year) (hazard ratio, 0.63; 95% confidence interval [CI], 0.45 to 0.88; P = 0.007). In the on-treatment population, the rate of major bleeding was 1.71% per patient-year in the apixaban group and 0.94% per patient-year in the aspirin group (hazard ratio, 1.80; 95% CI, 1.26 to 2.57; P = 0.001). Fatal bleeding occurred in 5 patients in the apixaban group and 8 patients in the aspirin group. CONCLUSIONS: Among patients with subclinical atrial fibrillation, apixaban resulted in a lower risk of stroke or systemic embolism than aspirin but a higher risk of major bleeding. (Funded by the Canadian Institutes of Health Research and others; ARTESIA ClinicalTrials.gov number, NCT01938248.).
- MeSH
- antikoagulancia * škodlivé účinky terapeutické užití MeSH
- Aspirin * škodlivé účinky terapeutické užití MeSH
- cévní mozková příhoda * etiologie prevence a kontrola MeSH
- dvojitá slepá metoda MeSH
- embolie * etiologie prevence a kontrola MeSH
- fibrilace síní * komplikace diagnóza MeSH
- inhibitory faktoru Xa škodlivé účinky terapeutické užití MeSH
- krvácení chemicky indukované MeSH
- lidé MeSH
- pyridony škodlivé účinky MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
- Geografické názvy
- Kanada MeSH
Kontext: Antiagregační terapie sice představuje základní způsob léčby pacientů s akutním koronárním syndromem, avšak vzhledem k tomu, že již byl popsán případ hypersenzitivity na kyselinu acetylsalicylovou, může být léčba pacienta s akutním koronárním syndromem problematická. Popis případu: Na oddělení urgentního příjmu byla přepravena 65letá Jávanka s dyspnoe přetrvávající po dobu tří dní a s ortopnoe. Na základě fyzikálního vyšetření a výsledků pomocných testů byla pacientce stanovena diagnóza akutní dekompenzace srdečního selhání. Třetí den léčby byla na EKG záznamu pozorována nová inverze vlny T ve svodech V 1 až V 6 , I a aVL, prokazující akutní koronární syndrom bez elevace úseku ST. Byla podána nasycovací dávka antiagregancií (clopidogrelu a kyseliny acetylsalicylové). Tři dny po podání léčiv si pacientka stěžovala na náhlé zhoršení dušnosti; současně byly slyšet hvízdavé zvuky. Vzniklo tak podezření na alergickou reakci, a vzhledem k četným alergickým reakcím na nesteroidní antiflogistika v anamnéze pacientky se předpokládalo, že tentokrát reakci vyvolala kyselina acetylsalicylová. Diskuse: Kyselina acetylsalicylová se jako inhibitor COX-1 často podílí na vyvolání hypersenzitivních reakcí. V takových případech je léčebnou strategií podání silnějšího antagonisty receptoru P2Y12 a rychlá perorální desenzibilizace ihned po stabilizaci pacientova stavu.
Background: Antiplatelet therapy is an essential treatment for patients with acute coronary syndrome. But a history of aspirin hypersensitivity has been reported and it might be challenging to treat a patient with this case. Case: A 65-year-old Javanese woman came to the emergency department and presented with dyspnea for three days and with orthopnea. Based on physical and supporting examination, the patient was diagnosed with ADHF. However, on the 3rd day of treatment, ECG showed new T wave inversion at lead V1 to V6, I, and aVL lead to NSTEACS. Loading doses of antiplatelets (clopidogrel and aspirin) were administered. Three hours after the drug administration, the patient complained of sudden worsening shortness of breath with pronounced wheezing. Allergic reaction was suspected and due to the patient's history of multiple NSAIDs allergies, aspirin was suspected as the culprit. Discussion: Aspirin as a COX-1 inhibitor, is often implicated with hypersensitivity reactions. Using a more potent P2Y12 receptor antagonist and performing rapid oral desensitization once the patient has stabilized is a strategy in this kind of case.
- MeSH
- akutní koronární syndrom diagnóza farmakoterapie komplikace MeSH
- alergie MeSH
- anafylaxe etiologie MeSH
- Aspirin * aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- inhibitory agregace trombocytů aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- lidé MeSH
- senioři MeSH
- srdeční selhání diagnóza terapie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Cíl: Zhodnocení laboratorní účinnosti námi nejčastěji používaných protidestičkových léčiv: kyseliny acetylsalicylové (ASA), clopidogrelu a ticagreloru. Posouzení efektivity ticagreloru jako alternativní léčby u pacientů, kterým jsme zjistili in vitro rezistenci, neboli HTPR (high on-treatment platelet reactivity) na clopidogrel. Metodika: V našem souboru byla testována účinnost protidestičkových léčiv metodou light transmission aggregometry (LTA) od 16. září 2020 do 5. prosince 2022. Byla sledována účinnost léčby u pacientů převedených na alternativní léčivo a byla hodnocena úspěšnost změny terapie. Výsledky: Ve sledovaném období bylo otestováno celkem 529 krevních vzorků, v případě clopidogrelu (n = 216), ticagreloru (n = 59) a ASA (n = 254). Účinnost léčby clopidogrelem byla 45,4 %, resp. ticagrelorem 93,2 % (p < 0,000). V případě převedení z clopidogrelu na ticagrelor byla léčba úspěšná u 49 z 54 pacientů (90,7 %). Závěr: U testovaných protidestičkových léčiv byly prokázané statisticky významné rozdíly v dosažené účinnosti. V případě clopidogrelu je ticagrelor vhodnou alternativou statisticky významně redukující výskyt HTPR. Zařazením testování účinnosti protidestičkové léčby do algoritmu endovaskulárních výkonů lze významně snížit počet pacientů s HTPR podstupujících implantaci stentů/flow-diverterů.
Purpouse: Evaluation of the laboratory effectiveness of the antiplatelet drugs we use: clopidogrel, ticagrelor, aspirin. Assessment of the effectiveness of ticagrelor as an alternative treatment in patients with in vitro resistance, or HTPR (high on-treatment platelet reactivity) to clopidogrel. Methods: In our set of patients, the effectiveness of antiplatelet drugs was tested using the light transmission aggregometry (LTA) method from 16. 9. 2020 to 5. 12. 2022. The effectiveness of treatment in patients switched to an alternative medicine was monitored and the success of the change in therapy was evaluated. Results: In the monitored period, a total of 529 blood samples were tested for clopidogrel (n = 216), ticagrelor (n = 59) and aspirin (n = 254). The efficacy of clopidogrel treatment was 45.4 %. On the other hand, the efficacy of ticagrelor was 93.2 %, statistically significantly higher (p < 0.000). In case of conversion from clopidogrel to ticagrelor, treatment was successful in 49 of 54 patients (90.7 %). Conclusion: For the antiplatelet drugs tested, statistically significant differences in the effectiveness were demonstrated. In the case of clopidogrel, ticagrelor is a suitable alternative, significantly reducing incidence of HTPR. The number of patients with HTPR undergoing stent/flow diverter implantation can be significantly reduced by including platelet function testing in the algorithm of endovascular procedures.
- MeSH
- Aspirin aplikace a dávkování MeSH
- inhibitory agregace trombocytů * aplikace a dávkování MeSH
- klopidogrel aplikace a dávkování MeSH
- léková rezistence MeSH
- lidé MeSH
- statistika jako téma MeSH
- techniky in vitro MeSH
- ticagrelor aplikace a dávkování MeSH
- tromboembolie prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- hodnotící studie MeSH
AIM: This study aimed to analyze the influence of the hospital admitting department on adherence to the Guidelines of European Society of Cardiology for management of acute coronary syndromes in patients after out-of-hospital cardiac arrest (OHCA) of coronary etiology. METHODS: We studied retrospective-prospective register of 102 consecutive patients with OHCA as a manifestation of acute coronary syndrome (ACS). Patients were admitted to the coronary care unit (CCU) 52, general intensive care unit (GICU) 21, or GICU after initial Cath lab treatment (CAG-GICU) 29. This study compared the differences in the management of ACS in patients with OHCA of coronary etiology based on the admitting department in a tertiary care institution. RESULTS: Twelve of the 21 (57.1%) patients admitted to the GICU were evaluated as having ACS on-site where they experienced OHCA. In the CCU group, 50 out of 52 (96.2%) and 28 of 29 (100%) patients in the CAG-GICU group (P<0.001). Coronary angiography was performed in 10 of 21 patients (48%) admitted to the GICU. It was performed in 49 out of 52 (94%) CCU patients and, in the CAG-GICU group, 28 out of 29 patients. The mean time to CAG differed significantly across groups (that is, GICU 200.7 min., CCU 71.2 min., and CAG-GICU 7.5 min. (P<0.001)). Aspirin was used in 48% of GICU, 96% of CCU, and 79% of CAG-GICU patients (P<0.001), while in the pre-hospital phase, aspirin was used in 9.5% of GICU, 71.2% of CCU, and 50% of CAG-GICU patients (P<0.001). P2Y12 inhibitor prescriptions were lower in patients admitted to the GICU (33% vs. 89% CCU and 57% CAG-GICU, P<0.001). The department's choice significantly affected the time to initiation of antithrombotics, which was the longest in the GICU. CONCLUSION: The choice of admission department for patients with OHCA caused by ACS was found to affect the extent to which the recommended treatments were used. An examination of OHCA patients by a cardiologist upon admission to the hospital increased the likelihood of an early diagnosis of ACS as the cause of OHCA.
- MeSH
- akutní koronární syndrom * komplikace terapie MeSH
- Aspirin terapeutické užití MeSH
- koronární angiografie škodlivé účinky MeSH
- koronární angioplastika * škodlivé účinky MeSH
- lidé MeSH
- přijímací oddělení nemocnice * MeSH
- retrospektivní studie MeSH
- zástava srdce mimo nemocnici * etiologie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
IMPORTANCE: Aspirin is an effective and low-cost option for reducing atherosclerotic cardiovascular disease (CVD) events and improving mortality rates among individuals with established CVD. To guide efforts to mitigate the global CVD burden, there is a need to understand current levels of aspirin use for secondary prevention of CVD. OBJECTIVE: To report and evaluate aspirin use for secondary prevention of CVD across low-, middle-, and high-income countries. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis using pooled, individual participant data from nationally representative health surveys conducted between 2013 and 2020 in 51 low-, middle-, and high-income countries. Included surveys contained data on self-reported history of CVD and aspirin use. The sample of participants included nonpregnant adults aged 40 to 69 years. EXPOSURES: Countries' per capita income levels and world region; individuals' socioeconomic demographics. MAIN OUTCOMES AND MEASURES: Self-reported use of aspirin for secondary prevention of CVD. RESULTS: The overall pooled sample included 124 505 individuals. The median age was 52 (IQR, 45-59) years, and 50.5% (95% CI, 49.9%-51.1%) were women. A total of 10 589 individuals had a self-reported history of CVD (8.1% [95% CI, 7.6%-8.6%]). Among individuals with a history of CVD, aspirin use for secondary prevention in the overall pooled sample was 40.3% (95% CI, 37.6%-43.0%). By income group, estimates were 16.6% (95% CI, 12.4%-21.9%) in low-income countries, 24.5% (95% CI, 20.8%-28.6%) in lower-middle-income countries, 51.1% (95% CI, 48.2%-54.0%) in upper-middle-income countries, and 65.0% (95% CI, 59.1%-70.4%) in high-income countries. CONCLUSION AND RELEVANCE: Worldwide, aspirin is underused in secondary prevention, particularly in low-income countries. National health policies and health systems must develop, implement, and evaluate strategies to promote aspirin therapy.
- MeSH
- Aspirin * terapeutické užití MeSH
- dospělí MeSH
- kardiovaskulární nemoci * prevence a kontrola MeSH
- lidé středního věku MeSH
- lidé MeSH
- průřezové studie MeSH
- sekundární prevence MeSH
- vyspělé země MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Research Support, N.I.H., Extramural MeSH
The process of platelet aggregation is often influenced by several factors including sex and age. A literature review confirmed the existence of sex-related differences in platelet aggregation. Although 68 out of 78 papers found such differences, there are still some controversies regarding these differences, which can be due to multiple factors (age, trigger, concomitant disease, sample handling, etc.). These outcomes are discussed in line with novel results obtained from a local study, in which blood samples from a total of 53 overall healthy women and men with ages ranging from 20 to 66 years were collected. Aggregation was induced with seven different triggers (ristocetin, thrombin receptor activating peptide 6 [TRAP-6], arachidonic acid [AA], platelet-activating factor 16 [PAF-16], ADP, collagen, or thromboxane A2 analog U-46619) ex vivo. In addition, three FDA-approved antiplatelet drugs (vorapaxar, ticagrelor, or acetylsalicylic acid [ASA]) were also tested. In general, women had higher aggregation responses to some agonists (ADP, TRAP), as well as lower benefit from inhibitors (ASA, vorapaxar). The aggregatory responses to AA and TRAP decreased with age in both sexes, while responses to ADP, U-46619, and PAF were affected by age only in women. In conclusion, more studies are needed to decipher the biological importance of sex-related differences in platelet aggregation in part to enable personalized antiplatelet treatment.
- MeSH
- adenosindifosfát farmakologie MeSH
- agregace trombocytů * MeSH
- Aspirin terapeutické užití MeSH
- inhibitory agregace trombocytů * terapeutické užití MeSH
- kyselina 15-hydroxy-11 alfa,9 alfa-(epoxymethano)prosta-5,13-dienová farmakologie MeSH
- kyselina arachidonová farmakologie MeSH
- laktony farmakologie MeSH
- lidé MeSH
- trombocyty MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
PURPOSE: To investigate the safety and efficacy of baseline antiplatelet treatment in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT). MATERIALS AND METHODS: Baseline use of antiplatelet medication before MT for (AIS) may provide benefit on reperfusion and clinical outcome but could also carry an increased risk of intracranial hemorrhage (ICH). All consecutive patients with AIS and treated with MT with and without intravenous thrombolysis (IVT) between January 2012 and December 2019 in all centers performing MT nationwide were reviewed. Data were prospectively collected in national registries (eg, SITS-TBY and RES-Q). Primary outcome was functional independence (modified Rankin Scale 0-2) at 3 months; secondary outcome was ICH. RESULTS: Of the 4,351 patients who underwent MT, 1,750 (40%) and 666 (15%) were excluded owing to missing data from the functional independence and ICH outcome cohorts, respectively. In the functional independence cohort (n = 2,601), 771 (30%) patients received antiplatelets before MT. Favorable outcome did not differ in any antiplatelet, aspirin, and clopidogrel groups when compared with that in the no-antiplatelet group: odds ratio (OR), 1.00 (95% CI, 0.84-1.20); OR, 1.05 (95% CI, 0.86-1.27); and OR, 0.88 (95% CI, 0.55-1.41), respectively. In the ICH cohort (n = 3,685), 1095 (30%) patients received antiplatelets before MT. The rates of ICH did not increase in any treatment options (any antiplatelet, aspirin, clopidogrel, and dual antiplatelet groups) when compared with those in the no-antiplatelet group: OR, 1.03 (95% CI, 0.87-1.21); OR, 0.99 (95% CI, 0.83-1.18); OR, 1.10 (95% CI, 0.82-1.47); and OR, 1.43 (95% CI, 0.87-2.33), respectively. CONCLUSIONS: Antiplatelet monotherapy before MT did not improve functional independence or increase the risk of ICH.
- MeSH
- Aspirin škodlivé účinky MeSH
- cévní mozková příhoda * diagnostické zobrazování terapie MeSH
- intrakraniální krvácení chemicky indukované MeSH
- ischemická cévní mozková příhoda * diagnostické zobrazování terapie MeSH
- ischemie mozku * diagnostické zobrazování terapie MeSH
- klopidogrel škodlivé účinky MeSH
- lidé MeSH
- mechanická trombolýza * škodlivé účinky MeSH
- trombektomie škodlivé účinky MeSH
- trombolytická terapie škodlivé účinky MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Kontext: V rámci pandemie nemoci covid-19 byl objeven život ohrožující syndrom postihující dominantně mladé dospělé, který přichází zpravidla do čtyř týdnů po primoinfekci virem SARS-CoV-2. Onemocnění bývá spojeno s postižením více orgánových soustav včetně srdce. Tato nová jednotka byla pojmenována jako multisystémový zánětlivý syndrom dospělých (běžně používaná anglická zkratka MIS-A). Kazuistika: Popisujeme případ mladého dospělého pacienta s MIS-A s predominantním kardiálním postižením, vstupně s horečkou a známkami akutního levostranného srdečního selhání v souvislosti s recentní infekcí virem SARS-CoV-2. Pacient byl léčen imunomudulační terapií methylprednisolonem a intravenózními imunoglobuliny s promptní úpravou stavu a rychlou normalizací ejekční frakce levé komory.
Background: As a part of world-wide spreading COVID-19 disease pandemic, a life-threatening syndrome affecting predominantly young adults was discovered. This entity usually occurs within 4 weeks after the onset of SARS-CoV-2 infection. The disease is often associated with several organ involvements, including the heart. This newly emerging unit is known as multisystem inflammatory syndrome in adults (MIS-A). Case presentation: We describe a case of a 29-year-old patient with MIS-A with predominant cardiac involvement. At admission the patient experienced fever and signs of acute left-sided heart failure, which was thought to be associated with recent SARS-CoV-2 infection as MIS-A. The patient was treated with immunomodulation therapy including methylprednisolone and intravenous immunoglobulins with prompt improvement of patient's condition and rapid normalization of the left ventricular ejection fraction.
- Klíčová slova
- multisystémový zánětlivý syndrom,
- MeSH
- Aspirin aplikace a dávkování MeSH
- COVID-19 komplikace MeSH
- dospělí MeSH
- gadolinium terapeutické užití MeSH
- intravenózní imunoglobuliny aplikace a dávkování MeSH
- kombinovaná farmakoterapie MeSH
- lidé MeSH
- methylprednisolon aplikace a dávkování MeSH
- postakutní syndrom COVID-19 * diagnostické zobrazování farmakoterapie patologie MeSH
- srdce diagnostické zobrazování MeSH
- srdeční selhání etiologie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- kazuistiky MeSH
- přehledy MeSH
BACKGROUND: Low dose rivaroxaban with aspirin reduced major cardiovascular events (MACE) compared to aspirin alone in patients with cardiovascular disease although effects on total events are unknown. METHODS: The COMPASS clinical trial randomized 27,395 participants with chronic coronary and/or peripheral artery disease to rivaroxaban 2.5 mg twice daily plus aspirin 100 mg daily, rivaroxaban 5 mg twice daily alone, or aspirin 100 mg daily. We analyzed total (first and recurrent) MACE outcomes of cardiovascular death, stroke, or myocardial infarction, and the primary safety outcome of major bleeding. Exploratory analyses included on-treatment and net clinical benefit. Total MACE and safety events were modeled for each treatment. RESULTS: MACE events were lowest in rivaroxaban with aspirin (379 first MACE, 432 total MACE) compared with rivaroxaban (448 first, 508 total) or aspirin alone (496 first, 574 total). Rivaroxaban and aspirin reduced total MACE events compared with aspirin alone [HR 0.75, 95% CI 0.66-0.85, P < .0001, number needed to treat for 2 years (NNT2y) of 63]. Total major bleeding was higher for rivaroxaban with aspirin compared to aspirin, but severe bleeding was not increased. The net clinical benefit of rivaroxaban plus aspirin was 20% higher compared with aspirin alone [HR 0.80 (95% CI 16.3%-31.6%)]. Rivaroxaban alone had no benefit on MACE outcomes compared with aspirin alone. MACE outcomes were similar for those on and off randomized treatment. CONCLUSIONS: Low dose rivaroxaban with aspirin significantly reduces first and total cardiovascular events compared with aspirin alone with a NNT2y of 63 and a 20% net clinical benefit. TRIAL REGISTRATION: NCT01776424. https://clinicaltrials.gov/ct2/show/NCT01776424.
- MeSH
- Aspirin MeSH
- inhibitory agregace trombocytů škodlivé účinky MeSH
- inhibitory faktoru Xa MeSH
- kombinovaná farmakoterapie MeSH
- krvácení chemicky indukované MeSH
- lidé MeSH
- nemoci koronárních tepen * farmakoterapie MeSH
- onemocnění periferních arterií * farmakoterapie MeSH
- rivaroxaban MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH