- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
Narastajúci objem dát a skúseností s použitím priamych orálnych antikoagulancií (DOAK) v primárnej aj sekundárnej prevencii venózneho tromboembolizmu u onkologických pacientov (CAVTE) viedol ku zmenám v početných medzinárodných odporúčaniach. Reflektujeme tieto zmeny s ohľadom na podmienky v SR. V primárnej prevencii CAVTE rozlišujeme onkologických pacientov na tých, ktorí podstupujú v súvislosti s ochorením chirurgický zákrok a na nechirurgických pacientov: hospitalizovaných a ambulantne liečených. Za základné liečivá v primárnej prevencii naďalej považujeme heparíny s nízkou molekulovou hmotnosťou (LMWH). V liečbe a sekundárnej prevencii CAVTE odporúčame uvažovať vždy aj o možnosti použiť DOAKy ako z hľadiska účinnosti rovnocennú alternatívu LMWH. LMWH je potrebné preferovať pred DOAKmi aj warfarinom u všetkých pacientov s klinicky nestabilnou situáciou s vysokým rizikom krvácania a vysokým rizikom interakcie so systémovou liečbou. Predovšetkým ide o pacientov s intraluminálnymi nádormi hornej časti gastrointestinálneho traktu a urogenitálnymi malignitami s vysokým rizikom krvácania. Pre nedostatočný objem dát sú LMWH stále preferované aj u pacientov s primárnymi nádormi a metastatickým postihnutím centrálnej nervovej sústavy a u hematoonkologických pacientov.
The increasing volume of the data and experience with direct oral anticoagulants (DOACS) in the primary and secondary prevention of venous thromboembolism in oncologic patients (CAVTE) has recently lead to changes in several international guidelines. We reflect these changes within the conditions in Slovak republic. In the primary prevention of CAVTE we recognise oncosurgical patients and nonsurgical patients: hospitalised and out patients. Low molecular weight heparins are still dominant in the primary prevention of CAVTE. Regarding the treatment and the secondary prevention of CAVTE, we recommend always to consider the possibility to use DOACs as they proved to be non inferior to LMWH. However, LMWH should be prefered over DOACs as well as over warfarin (VKA) in all patients who are in a clinically unstable condition with the high risk of bleeding and/or interaction with the systemic treatment. Primarily in the patients with intraluminal tumours of the upper part of the gastrointestinal tract and genitourinary tumours with the high risk of bleeding. As for the lack of data, LMWH are still preferd also in patients with primary tumours and metastatic disease of the central nervous system and in hemato oncology.
- MeSH
- kardiologie * MeSH
- kurikulum MeSH
- lidé MeSH
- specializace MeSH
- studium lékařství specializační postgraduální MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
Secondary prevention of peripheral arterial disease (PAD) includes administration of antiplatelet agents, and adherence to medication is a requirement for an effective treatment. The aim of this study was to analyse adherence measured using the proportion of days covered (PDC) index separately in persistent and non-persistent patients, and to identify patient- and medication-related characteristics associated with non-adherence in these patient groups. The study cohort of 9178 patients aged ≥ 65 years in whom PAD was diagnosed in 1/-12/2012 included 6146 persistent and 3032 non-persistent patients. Non-adherence was identified as PDC < 80%. Characteristics associated with non-adherence were determined using the binary logistic regression model. In the group of persistent patients, 15.3% of subjects were identified as non-adherent, while among non-persistent patients, 26.9% of subjects were non-adherent to antiplatelet medication. Administration of dual antiplatelet therapy (aspirin and clopidogrel) and a general practitioner as index prescriber were associated with adherence in both patient groups. Our study revealed a relatively high proportion of adherent patients not only in the group of persistent patients but also in the group of non-persistent patients before discontinuation. These results indicate that most non-persistent PAD patients discontinue antiplatelet treatment rapidly after a certain period of adherence.
- Publikační typ
- časopisecké články MeSH
The relationship between baroreflex sensitivity (BRS) and inflammatory vascular biomarker Lipoprotein associated phospholipase A2 (Lp-PLA2) in subjects with high normal blood pressure (HNBP, prehypertensives) with a positive family history of hypertension (FHH+) and hypertension history free control subjects (FHH-) was evaluated. A total of 24 HNBP participants (age 39.5 ± 2.5 years, 18 male/ 6 female) were studied. 14 HNBP subjects FHH+ were compared to 10 HNBP participants FHH-, being of similar age and body mass index. BRS (ms/mmHg) was determined by the sequence and spectral methods (five-minute non-invasive beat-to-beat recording of blood pressure and RR interval, controlled breathing at a frequency of 0.33 Hz). Venous blood was analyzed for Lp-PLA2 biomarker of vascular inflammation and atherothrombotic activity. A significant negative correlation between spontaneous BRS obtained by both methods and systolic blood pressure (BP) was present (BRS spect r = -0.54, P<0.001, BRS seq r = -0.59, P<0.001). BRS obtained by sequence and spectral methods were reduced in HNBP FHH+ compared to the group of HNBP FHH- (P = 0.0317 BRS seq, P = 0.0395 BRS spect). Lp-PLA2 was significantly higher in HNBP FHH+ compared to FHH- controls (P<0.05). Lp-PLA2 was negatively correlated with BRS obtained by sequence method (r = -0.798, R2 = 0.636, P<0.001) in the HNBP FHH+ subjects. These findings demonstrate that reduced baroreflex sensitivity, as a marker of autonomic dysfunction, is associated with vascular inflammation, predominantly in otherwise healthy participants with a positive family history of hypertension who could predispose to increased risk of hypertension. We conclude that our transversal study suggests that a lowbaroreflex sensitivity could be an early sign of autonomic dysfunction even in the prehypertensive period, and to corroborate these findings, a longitudinal study is needed.
- MeSH
- 1-alkyl-2-acetylglycerofosfocholinesterasa krev MeSH
- anamnéza MeSH
- autonomní nervový systém patofyziologie MeSH
- baroreflex * MeSH
- biologické markery krev MeSH
- dospělí MeSH
- hypertenze krev diagnóza enzymologie patofyziologie MeSH
- krevní tlak * MeSH
- lidé středního věku MeSH
- lidé MeSH
- prediktivní hodnota testů MeSH
- rizikové faktory MeSH
- studie případů a kontrol MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Vaskulitídy predstavujú heterogénnu skupinu ochorení, ktoré sú charakterizované zá-palom a nekrózou cievnej steny. Vaskulitídy veľkých ciev – Takayasuova arteritída a ob-rovskobunková arteritída – sú charakterizované imunitne sprostredkovaným systémo-vým granulomatóznym zápalom aorty a jej vetiev. Tieto vaskulitídy pravdepodobnepredstavujú dve tváre jednej chorobnej jednotky, odlišujúce sa vekom pri nástupu cho-roby. V kazuistike popisujeme prípad 57-ročnej ženy bez závažnejších komorbidít,u ktorej bol prvotným stimulom pre zahájenie diferenciálno-diagnostického procesustranový rozdiel pri meraní tlaku krvi na horných končatinách. Vaskulitídy sú typickýmmultisystémovým ochorením, preto by pri ich diagnostike a liečbe mal spolupracovaťcelý tím rôznych medicínskych odborníkov.
Vasculitides represent a heterogenous group of disorders characterized by inflammationand necrosis of the vessel wall. Large vessel vasculitis (LVV)–Takayasu Arteritis andGiant Cell Arteritis–are characterized by immune-mediated granulomatous inflamma-tion predominantly of the aorta and its major branches. These arteritides are probablytwo faces of one disease, differing in the age of the onset. The case report describes a 57-year-old woman without any comorbidities with increased inter-arm blood pressure dif-ference as a stimulus for differential diagnosis. Vasculitis are typical multisystemic dis -eases with a need of medical specialists’ cooperation in the diagnosis and treatment.
- MeSH
- antirevmatika terapeutické užití MeSH
- diagnostické techniky kardiovaskulární MeSH
- digitální subtrakční angiografie metody MeSH
- glukokortikoidy aplikace a dávkování terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční angiografie metody MeSH
- obrovskobuněčná arteritida diagnostické zobrazování diagnóza patofyziologie MeSH
- Takayasuova arteriitida diagnostické zobrazování diagnóza patofyziologie MeSH
- vaskulitida * diagnostické zobrazování etiologie farmakoterapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- ateroskleróza diagnóza epidemiologie MeSH
- dyslipidemie epidemiologie komplikace MeSH
- kardiovaskulární nemoci epidemiologie etiologie MeSH
- komplikace diabetu epidemiologie etiologie MeSH
- kouření škodlivé účinky MeSH
- lidé MeSH
- onemocnění periferních arterií diagnóza epidemiologie etiologie MeSH
- rizikové faktory MeSH
- zdravotně rizikové chování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
