10 powodów stosowania riwaroksabanu w terapii przeciwzakrzepowej u osób w podeszłym wieku

Doustne antykoagulanty niebędące antagonistami witaminy K (NOAC) są coraz częściej stosowane w polskiej populacji pacjentów z migotaniem przedsionków. Bardzo często są to osoby w podeszłym wieku, u których ryzyko zarówno udaru mózgu/zatorowości obwodowej, jak i krwawienia jest wyższe niż u młodszych osób. Leki z grupy NOAC stosowane u osób w podeszłym wieku cechują się zarówno skutecznością w zabezpieczaniu przed tymi incydentami, jak i odpowiednim profilem bezpieczeństwa w zakresie ryzyka krwawienia. Należy pamiętać, że skuteczność postępowania zależy od stosowania się pacjentów do zaleconej terapii. Wydaje się, że sposób dawkowania (raz/d.) może wpływać na poprawę adherencji do zaleceń lekarskich, zwłaszcza wśród starszych pacjentów, co w codziennej praktyce lekarskiej może się przekładać na poprawę rokowania i bezpieczeństwa

The analysis of antiplatelets activity of standardised tomato extract

Choroby układu sercowo-naczyniowego (CVD) są główną przyczyną zgonów. Nieprawidłowy styl życia, zła dieta i brak aktywności fizycznej prowadzą do wzrostu ryzyka zawału serca i udaru mózgu. Rozwój CVD zależy od interakcji zmian miażdżycowych i tworzenia się skrzeplin z udziałem płytek krwi. W zmienionych miażdżycowo naczyniach płytki krwi mogą przylegać do komórek śródbłonka i wpływać na gromadzenie się leukocytów, co indukuje lokalny odczyn zapalny. Ze względu na taką patofizjologię, wtórnych do procesu miażdżycowego, incydentów naczyniowych przewlekłe hamowanie aktywności płytek (obecnie głównie za pomocą kwasu acetylosalicylowego) stanowi podstawę postępowania zarówno w prewencji wtórnej, czyli u osób już po incydentach klinicznych, jak i w prewencji pierwotnej — u pacjentów z grupy wysokiego ryzyka takich zdarzeń w przyszłości. Z punktu widzenia specjalistów od zdrowia publicznego nakłady na służbę zdrowia powinny być skierowane na prewencję pierwotną, głównie na ograniczenie czynników ryzyka CVD, w tym odpowiednią dietę. Właściwości przeciwpłytkowe lub przeciwkrzepliwe owoców i warzyw są słabo zbadane, chociaż efekt przeciwpłytkowy obserwowano już w składnikach następujących owoców: czarnych winogron, ananasa, truskawek, melona i kiwi oraz warzyw: czosnku, szalotki, pomidorów. Natomiast efekt fibrynolityczny obserwowano w przypadku składników kiwi i ananasów. Znaczna część badań dotyczyła zdrowotnych działań pomidorów i ich pochodnych. Pomidory zawierają bioaktywne składniki w postaci karotenoidów, takich jak likopen, oraz fenoli i nukleotydów. Elementy fenolowe pomidorów to flawanony i flawonole. Poza tym są źródłem witaminy E, witaminy C, kwasu foliowego i potasu. Zawarty w pomidorach likopen i inne karotenoidy sprawiają, że są one źródłem przeciwutleniaczy. W badaniach dotyczących wpływu wystandaryzowanego ekstraktu z pomidorów na płytki krwi wykazano, że działa on przeciwagregacyjne. W 2009 roku Europejska Agencja do Spraw Bezpieczeństwa Żywnościi Żywienia (EFSA) zatwierdziła wystandaryzowany rozpuszczalny w wodzie ekstrakt z pomidorów jako środek dietetyczny, który utrzymuje prawidłową agregację trombocytów. Zgodnie z powyższą rejestracją populacją docelową są dorośli w wieku 35–70 lat.Cardiovascular diseases (CVD) are the leading cause of death. Improper lifestyle, poor diet and lackof physical activity lead to increased risk of myocardial infarction and stroke. The mechanisms of CVD depend on interaction of atherosclerosis and thrombus formation with the participation of platelets. In the atherosclerotic vessels, platelets may adhere to endothelial cells and affect the accumulation of leukocytes, which induces a local inflammatory reaction. Due to the pathophysiology of vascular events secondary to atherosclerosis, chronic inhibition of platelet activity (mainly using acetylsalicylic acid) is the basis of the both secondary prevention after coronary artery incidents and a primary prevention in high cardio-vascular risk patients. From the point of view of public health specialists, expenditures on health care should be directed on primary prevention, mainly on the reduction of risk factors of cardiovascular diseases including: proper diet or physical activity. Antiplatelet or anticoagulant properties of fruits and vegetables are poorly investigated, although the antiplatelet effect was observed already in the components of the following fruits: black grapes, pineapple, strawberries, melon and kiwi fruit and vegetables: garlic, shallots, tomatoes. In contrast, the fibrinolytic effect was observed in the case of ingredients of kiwi and pineapple. Tomatoes contain bioactive components like: carotenoids (lycopene), phenols and nucleotides. Phenolic components of tomatoes are: flavanones and flavonols. Tomatoes are also a source of vitamin E, vitamin C, folic acid and potassium. Included in the tomato lycopene and other carotenoids make them a source of antioxidants.Studies on the effect of a standardized extract of tomato on platelets activity have shown that it works antiaggregatory. In 2009 European Food Safety Authority (EFSA) has approved standardized water-soluble extract of tomato as a diet ingredient that maintains normal platelet aggregation. According to the registration the target population are adults aged 35–70 years.

Feasibility of sacubitril/valsartan initiation early after acute decompensated heart failure

Despite significant diagnostic and therapeutic advances, heart failure (HF) is linked with high mortality and morbidity. Hospitalization for decompensated HF is still the most common cause of hospitalization in adults. What is more, a particularly high risk of hospitalization (even up to 50% of patients) is observed within a few months after a previous HF hospitalization. Sacubitril/valsartan, a first-in-class drug, contains a neprilysin inhibitor (sacubitril) and an angiotensin II receptor blocker (valsartan). In PARADIGM-HF trial investigators showed, that sacubitril/valsartan significantly reduced primary endpoint combined with cardiovascular death or HF hospitalization in patients with chronic, symptomatic HF (New York Heart Association class II–IV) with reduced ejection fraction (left ventricular ejection fraction [LVEF] ≤ 35–40%). Recently, results of the PIONEER-HF trial, which included HF patients with LVEF ≤ 40% who were hospitalized for acute decompensated HF were also published. The study proved that early, in-hospital, implementation of sacubitril/valsartan in these patients resulted in a substantially greater reduction of N-terminal prohormone B-type natriuretic peptide concentration and a lower rate of HF rehospitalizations with similar safety profile for enalapril

Effectiveness of Medtronic CareLink Express System in identifying patients with high-energy electrotherapy devices requiring clinically significant intervention

   Background: The number of patients with implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy and defibrillator (CRT-D) is growing. This results in high workloads for centers performing standard controls (SC) of these systems. Medtronic CareLink Express® (MCLE) is a solution enabling remote controls (RC) of implantable devices. In cases of detecting arrhythmias or device malfunctioning, it automatically generates alarms transmitted to the controlling physician. The objective of the study was to evaluate the effectiveness of alarms generated by MCLE in identification of patients that require clinically significant intervention during SC. Methods: A total of 119 patients (age 64 ± 14, 17 women) implanted with ICD/CRT-D were included in the trial. Device reprogramming or pharmacological treatment modifications during SC were as­sessed as significant if they were required for optimal clinical management of the patient (effectiveness of antiarrhythmic and resynchronization therapy, also patient safety). Analysis of generated alarms was then performed to assess the effectiveness (sensitivity and specificity) of MCLE in identifying patients that require changes in therapy. Results: Data from 129 transmissions and 129 subsequent SCs were analyzed. 179 alarms were recorded during 96 (74%) transmissions. A total of 333 program changes of implanted devices took place during 107 (83%) SCs. Device reprogramming was considered clinically significant in 27 cases Additionaly, 13 pharmacological treatment modifications were performed. Sensitivity and specificity of alarms generated by MCLE with regards to identification of patients requiring clinically significant intervention was 87% and 31%, respectively. Finally, a statistically significant difference was observed in the number of clinically significant interventions among patients with and without MCLE alarms (33 [86.8%] vs. 5 [13.2%], p = 0.037). Conclusions: Medtronic CareLink Express® is an RC system enabling high-sensitivity supervision of patients with cardia

Success rate and safety of catheter ablation in preexcitation syndrome: A comparison between adult and pediatric patients

Background: In contrast to adults, in whom cardiac rhythm disorders are mainly conditioned by coronary artery disease, in children, arrhythmias are most often associated with inherited heart disorders. Catheter ablation (CA) has an important role in the management of cardiac arrhythmias, in adults and children. The aim of the study was to assess and compare the efficacy and safety of CA in children and adults with preexcitation syndrome. Methods: The study population comprised 43 adults and 43 children diagnosed with a Wolff-Parkinson-White syndrome (WPW). The mean age of the study population was 41 ± 15 years for adults and 14 ± 2.5 years for children. In all patients, an electrophysiological study and CA were performed. Analysis with respect to the procedure duration, fluoroscopy exposure time, location of accessory pathways (AP), immediate success rate and complications were performed. Results: Electrophysiological study revealed the most frequent presence of left-sided AP (56% in children and 70% in adults). The mean procedure duration was 96 ± 36 min and 106 ± 51 min in children and adults, respectively (p = NS). The mean fluoroscopy duration was 8.5 ± 4.3 min and 5.9 ± 5.8 min in children and adults, respectively p < 0.05. The CA procedure was successful in 40 out of 43 (93%) adults and in 36 out of 43 (83.7%) children (p = NS). In 2 (4%) children minor complications occurred. Conclusions: Ablation in children and adults are equally effective with respect to short-term clinical observation

Administration of oral anticoagulants in periprocedural complications based on case report series

The use of dabigatran, a non-vitamin K antagonist (VKA) oral anticoagulant, is still increasing. Dabigatran has a good efficacy and safety ratio, as well as a more predictable anticoagulation effect compared with VKA. On the other hand, there is acenocoumarol/warfarin, a VKA which was evaluated in numerous clinical trials and is a drug of choice in a valve-related atrial fibrillation (AF).Based on the real clinical cases, we attempted to summarize current recommendations on how to manage periprocedural complications on oral anticoagulant treatment.In the first case we presented a patient on dabigatran, undergoing pulmonary vein isolation (PVI) of AF, who developed a right groin hematoma after the procedure and hence required several blood transfusions. In the second case we showed a patient on acenocoumarol, with high bleeding risk, who developed a pocket hematoma after an implantable cardioverter-defibrillator (ICD) implantation. We also reported a patient on dabigatran, who developed a femoral artery pseudoaneurysm (FAP) following PVI of AF.Periprocedural oral anticoagulation depends on the anticoagulant type and requires individual assessment of thepatient’s thromboembolic and bleeding risk factors. Our case reports showed that in case of a bleeding, dabigatranmay be quickly stopped and then restarted recently after reaching hemostasis, in contrast to acenocoumarol. They also confirm a possibility of successful pseudoaneurysm closure without dabigatran suspension.The use of dabigatran, a non-vitamin K antagonist (VKA) oral anticoagulant, is still increasing. Dabigatran has a good efficacy and safety ratio, as well as a more predictable anticoagulation effect compared with VKA. On the other hand, there is acenocoumarol/warfarin, a VKA which was evaluated in numerous clinical trials and is a drug of choice in a valve-related atrial fibrillation (AF).Based on the real clinical cases, we attempted to summarize current recommendations on how to manage periprocedural complications on oral anticoagulant treatment.In the first case we presented a patient on dabigatran, undergoing pulmonary vein isolation (PVI) of AF, who developed a right groin hematoma after the procedure and hence required several blood transfusions. In the second case we showed a patient on acenocoumarol, with high bleeding risk, who developed a pocket hematoma after an implantable cardioverter-defibrillator (ICD) implantation. We also reported a patient on dabigatran, who developed a femoral artery pseudoaneurysm (FAP) following PVI of AF.Periprocedural oral anticoagulation depends on the anticoagulant type and requires individual assessment of thepatient’s thromboembolic and bleeding risk factors. Our case reports showed that in case of a bleeding, dabigatranmay be quickly stopped and then restarted recently after reaching hemostasis, in contrast to acenocoumarol. They also confirm a possibility of successful pseudoaneurysm closure without dabigatran suspension