Prospektivní registr všech konsekutivních kardiaků, postupujících nekardiální chirurgický výkon: pacienti musí splnit všechna tři vstupní kriteria: (1) Jakákoli operace (elektivní nebo akutní) v celkové nebo v neuroaxiální anestezii, prováděná na Chirurgické, Ortopedické nebo Neurochirurgické klinice. (2) Anamneza kardiovaskulárního onemocnění s rizikem arteriální, intrakardiální či žilní trombozy nebo embolie. (3) Podepsaný informovaný souhlas. Zařazeni budou všichni nemocní, splňující vstupní kriteria, tj. všichni operovaní kardiaci, kteří podepsali informovaný souhlas. Předpokládáme zařazení 2000 až 3000 nemocných. Budou sledovány základní klinické ukazatele, chronická i perioperační medikace, EKG, echokardiografie, laboratoř a samozřejmě veškeré komplikace (zejména ischemické a krvácivé). Ve 2. fázi (randomizovaná studie) předpokládáme zařazení cca 1000 nemocných. Vstupní / vylučovací kriteria pro tuto fázi budou definována na základě výsledků 1. fáze.; Prospective registry of all consecutive cardiac patients undergoing non-cardiac surgery. Patients have to meet all three inclusion criteria: (1) Any kind of non-cardiac surgery (acute or elective) performed under general or neuroaxial anaesthesia in three surgical departments - General surgery, Orthopedics-Trauma and Neurosurgery. (2) History of cardiac disease with risk of arterial, intracardiac or vein thrombosis or embolism. (3) Signed Informed consent. All operated patients who meet the inclusion criteria will be enrolled, i.e. all consecutive cardiacs, who signed Informed consent. Inclusion of cca 2000 - 3000 patients is expected. Baseline clinical indicators, chronic and perioperative medication, ECG, echocardiography, laboratory tests and all complications (especially ischemic and bleeding) will be registered. The second phase (randomized study) will include cca 1000 patients. Inclusion/exclusion criteria will be defined on the basis of results of the first phase.

• MeSH
• inhibitory agregace trombocytů MeSH
• kardiovaskulární nemoci MeSH
• koronární trombóza MeSH
• krvácení při operaci MeSH
• multivariační analýza MeSH
• nemoci koronárních tepen MeSH
• onemocnění periferních arterií komplikace   MeSH
• peroperační komplikace MeSH
• rizikové faktory MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• chirurgie
• kardiologie
• farmacie a farmakologie
• NLK Publikační typ
• závěrečné zprávy o řešení grantu IGA MZ ČR

INTRODUCTION: The study objective was to ascertain the incidence of bleeding and ischemic complications related to acute and planned orthopedic surgery in patients with known cardiovascular diseases. MATERIALS AND METHODS: The study conducted between 2010 and 2013 enrolled 477 patients (289 women, 188 men) with a diagnosed cardiovascular disease or a history of thromboembolic event. Aside from gender, age, height and weight, the study observed other anamnestic data and perioperative laboratory test results that may impact on a bleeding or ischemic event. RESULTS: Two hundred seventy-two (57 %) patients had acute surgery, and 205 (43 %) patients had elective surgery. Complications arose in 55 (11.6 %) patients, 32 (6.9 %) had bleeding complications, 19 (4.0 %) ischemic complications, and both complications were experienced by 4 (0.8 %) patients. Bleeding developed in 14 (5.1 %) patients who had acute surgery, and in 22 (10.7 %) who had elective surgery. Twenty-two (8.1 %) patients having acute surgery and one (0.1 %) undergoing elective surgery suffered from ischemic complications. The incidence of bleeding complications was significantly higher in elective surgery (p = 0.026, OR 2.22), and when adjusted (general anaesthesia, gender, and use of warfarin), the difference was even higher (p = 0.015, OR 2.44), whereas the occurrence of ischemic complications was significantly higher in acute surgery (p = 0.005, OR 18.0), and when adjusted (age), the difference remained significant (p = 0.044, OR 8.3). CONCLUSIONS: The study noted a significantly higher incidence of bleeding complications in elective orthopedic surgery when compared with acute surgery. Conversely, the incidence of ischemic complications was significantly higher in patients having acute orthopedic surgery when compared with those operated on electively.

• MeSH
• dospělí MeSH
• elektivní chirurgické výkony škodlivé účinky   MeSH
• incidence MeSH
• ischemie epidemiologie   etiologie   MeSH
• kardiovaskulární nemoci komplikace   chirurgie   MeSH
• krvácení epidemiologie   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• ortopedické výkony škodlivé účinky   MeSH
• pooperační komplikace epidemiologie   MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH

BACKGROUND: Interruption of antithrombotic treatment before surgery may prevent bleeding, but at the price of increasing cardiovascular complications. This prospective study analysed the impact of antithrombotic therapy interruption on outcomes in non-selected surgical patients with known cardiovascular disease (CVD). METHODS: All 1200 consecutive patients (age 74.2 ± 10.2 years) undergoing major non-cardiac surgery (37.4 % acute, 61.4 % elective) during a period of 2.5 years while having at least one CVD were enrolled. Details on medication, bleeding, cardiovascular complications and cause of death were registered. RESULTS: In-hospital mortality was 3.9 % (versus 0.9 % mortality among 17,740 patients without CVD). Cardiovascular complications occurred in 91 (7.6 %) patients (with 37.4 % case fatality). Perioperative bleeding occurred in 160 (13.3 %) patients and was fatal in 2 (1.2 % case fatality). Multivariate analysis revealed age, preoperative anaemia, history of chronic heart failure, acute surgery and general anaesthesia predictive of cardiovascular complications. For bleeding complications multivariate analysis found warfarin use in the last 3 days, history of hypertension and general anaesthesia as independent predictive factors. Aspirin interruption before surgery was not predictive for either cardiovascular or for bleeding complications. CONCLUSIONS: Perioperative cardiovascular complications in these high-risk elderly all-comer surgical patients with known cardiovascular disease are relatively rare, but once they occur, the case fatality is high. Perioperative bleeding complications are more frequent, but their case fatality is extremely low. Patterns of interruption of chronic aspirin therapy before major non-cardiac surgery are not predictive for perioperative complications (neither cardiovascular, nor bleeding). Simple baseline clinical factors are better predictors of outcomes than antithrombotic drug interruption patterns.

• Publikační typ
• časopisecké články MeSH

OBJECTIVE: The purpose of the present study was to investigate the association between left ventricular systolic function and the response to clopidogrel. METHODS: The efficacy of clopidogrel was measured by the vasodilator-stimulated phosphoprotein phosphorylation 20 ± 4 h after 600 mg of clopidogrel. High on-clopidogrel platelet reactivity (HCPR) was defined as a platelet reactivity index (PRI) ≥50%. The 30-day combined incidence of death, non-fatal acute coronary syndrome, re-percutaneous coronary intervention (PCI), stent thrombosis, and stroke was also investigated. RESULTS: The study group consisted of 519 patients undergoing PCI. The values (mean and 95% confidence interval) of the PRI were as follows: 40.4% (37.8-43.0) in patients with left ventricular ejection fraction (LVEF) >50%, 42.4% (39.3-45.6) in patients with LVEF 35-50%, and 46.7% (40.6-52.9) in patients with LVEF <35% (p = 0.013). The proportions of patients with HCPR were 35.9% in patients with LVEF ≥35 and 51.9% in patients with LVEF <35% (p = 0.022). After adjustment for variables that significantly influenced clopidogrel efficacy, LVEF <35% was found to be independently associated with HCPR (p = 0.039). The 30-day combined clinical endpoint occurred in 18% of patients with LVEF <35% and in 7.3% of patients with LVEF ≥35% (p = 0.026). The 30-day incidence of all-cause mortality was 14% in patients with LVEF <35 and 1.0% in patients with LVEF ≥35% (p < 0.001). CONCLUSION: An LVEF <35% was found to be independently associated with HCPR.

• MeSH
• akutní koronární syndrom epidemiologie   MeSH
• cévní mozková příhoda epidemiologie   MeSH
• dysfunkce levé srdeční komory farmakoterapie   epidemiologie   patofyziologie   MeSH
• fosfoproteiny metabolismus   MeSH
• inhibitory agregace trombocytů farmakologie   terapeutické užití   MeSH
• koronární angioplastika MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikrofilamentové proteiny metabolismus   MeSH
• molekuly buněčné adheze metabolismus   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• stenty MeSH
• tepový objem MeSH
• tiklopidin analogy a deriváty   farmakologie   terapeutické užití   MeSH
• trombocyty metabolismus   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Renal dysfunction is a strong independent predictor of stent thrombosis. The aim of the present study was to evaluate the strength and direction of the association between kidney function and clopidogrel efficacy. The study group consisted of consecutive patients (n = 275) who underwent stent implantation. Drug efficacy was measured using the vasodilator-stimulated phosphoprotein (VASP) index 20 ± 4 hours after clopidogrel 600 mg. Nonresponse was defined as an VASP index ≥50%. Renal function was determined using serum cystatin C. The upper reference levels are 1.12 mg/L for ≤65 years of age and 1.21 mg/L for >65 years of age. Estimated glomerular filtration was calculated using cystatin C. The median value of cystatin C was 1.16 mg/L (twenty-fifth and seventy-fifth percentiles 0.96 and 1.43); 47.63% of the study population had cystatin C above reference levels and 33.1% of patients were nonresponders to clopidogrel. No correlation was found between clopidogrel efficacy assessed with the VASP index and kidney function assessed with cystatin C (Spearman r = -0.070, p = 0.248). Based on cystatin C the proportion of nonresponders to clopidogrel was 34.4% versus 31.9% (p = 0.702) in patients with impaired renal function compared to normal renal function, respectively. The proportion of clopidogrel nonresponders did not differ (p = 0.902) among groups with normal (28.8%), mildly impaired (34.8%), moderately impaired (32.9%), and severely impaired (34.8%) renal function. In conclusion, renal function assessed by cystatin C does not predict clopidogrel efficacy. Renal dysfunction is a complex entity and its significant relation to stent thrombosis cannot be explained simply by a decrease in clopidogrel efficacy.

• MeSH
• balónková koronární angioplastika metody   MeSH
• cystatin C krev   MeSH
• fosfoproteiny krev   MeSH
• hodnoty glomerulární filtrace účinky léků   fyziologie   MeSH
• imunoanalýza MeSH
• inhibitory agregace trombocytů aplikace a dávkování   MeSH
• koronární trombóza krev   patofyziologie   prevence a kontrola   MeSH
• krevní proteiny MeSH
• lidé MeSH
• mikrofilamentové proteiny krev   MeSH
• molekuly buněčné adheze krev   MeSH
• následné studie MeSH
• nemoci koronárních tepen patofyziologie   terapie   MeSH
• prognóza MeSH
• senioři MeSH
• stenty MeSH
• tiklopidin aplikace a dávkování   analogy a deriváty   MeSH
• vyšetření funkce ledvin MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

Percutaneous coronary interventions (PCIs) have become the most commonly performed coronary revascularization procedures. At the same time, there is an increased likelihood that patients with intracoronary stents will need to undergo surgery. Two serious consequences emerge from this situation: (i) stent thrombosis in relation to discontinuation of antiplatelet therapy, and (ii) major bleeding in relation to continuation of antiplatelet therapy. The best solution to overcome the risks resulting from surgery performed in patients after stent implantation is to postpone the operation until after re-endothelialization of the vessel surface is completed. Expert recommendations advise that patients can be sent for non-cardiac surgery 3 months after bare-metal stent PCI and 12 months after drug-eluting stent PCI, with continuation of aspirin therapy. Difficult decisions regarding antiplatelet management arise when a patient that is still receiving dual antiplatelet therapy with aspirin and a thienopyridine has to undergo surgery that cannot be postponed. Discussions between the treating cardiologist, the surgeon and the anaesthesiologist about this situation are recommended in order to achieve a reasonable expert consensus.

• MeSH
• Aspirin aplikace a dávkování   MeSH
• časové faktory MeSH
• cévní protézy škodlivé účinky   MeSH
• chirurgie operační MeSH
• hospitalizovaní pacienti MeSH
• inhibitory agregace trombocytů aplikace a dávkování   MeSH
• kombinovaná farmakoterapie MeSH
• koronární trombóza etiologie   terapie   MeSH
• lidé MeSH
• pyridiny aplikace a dávkování   MeSH
• rizikové faktory MeSH
• stenty škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH