Nedostatna primjena antagonista vitamina K u bolesnika s atrijskom fibrilacijom - prikaz rezultata iz kliničke prakse u Kliničkoj bolnici "Merkur", Zagreb

Atrial fibrillation is the most common cardiac arrhythmia. It increases the risk of death and thromboembolic events. Vitamin K antagonists reduce these risks. Disadvantages of vitamin K antagonist therapy are narrow therapeutic range and interactions with drugs and food. In a single center prospective study, we enrolled 249 patients with atrial fibrillation over a 12-month period. The aim of our study was to evaluate vitamin K antagonist use regarding the indication and adequate dose. Data on 249 consecutive patients with atrial fibrillation were collected before general availability of novel oral anticoagulants. Out of 249 patients, 160 (64.2%) had indication for oral anticoagulant therapy. Only 81 (50.6%) patients had vitamin K antagonist in therapy, 12 (14.8%) of them in adequate dose. We also analyzed 129 patients aged over 75, of which 109 (84.4%) had absolute indication for oral anticoagulant therapy. Only 34 (31.2%) patients aged over 75 had been receiving vitamin K antagonist therapy and 6 (17.6%) had the International Normalized Ratio values within the proposed therapeutic interval. We found a significantly higher rate of anticoagulant therapy introduction in patients under 75 years (p=0.03), but there were no significant differences in the adequacy of anticoagulant therapy (p=0.89) between these two populations. Our results showed clear inadequacies of vitamin K antagonist treatment with a growing need for a wider use of novel oral anticoagulants.Atrijska fibrilacija je najučestalija aritmija koja povećava rizik smrti i tromboembolijskih incidenata. Antagonisti vitamina K smanjuju taj rizik. Problem terapije s antagonistima vitamina K je uska terapijska širina i brojne interakcije s lijekovima i hranom. Cilj ovoga istraživanja bio je utvrditi dostatnost primjene antagonista vitamina K s obzirom na indikaciju i dozu. Prikupljeni su podaci 249 bolesnika s atrijskom fibrilacijom hospitaliziranih u Kliničkoj bolnici “Merkur” u razdoblju od 12 mjeseci i to prije šire dostupnosti novijih oralnih antiokoagulansa. Od svih bolesnika, 160 (64,2%) ih je imalo indikaciju za primjenu oralne antikoagulantne terapije, a tek je njih 81 (50,6%) imalo antagonist vitamina K u terapiji. Samo 12 (14,8%) bolesnika je uzimalo antagonist vitamina K u dostatnoj dozi, a 129 (51,8%) ih je bilo iznad 75 godina starosti. Njih 109 (84,4%) je imalo indikaciju za oralnu antikoagulantnu terapiju, a samo 34 (31,2%) ih je uzimalo antagonist vitamina K, od kojih je 6 (17,6%) imalo INR u terapijskim vrijednostima. Statistička analiza podataka pokazala je da su bolesnici mlađi od 75 godina češće uzimali indiciranu oralnu antikoagulantnu terapiju u odnosu na bolesnike starije od 75 godina (p=0,03), dok nije bilo statistički značajne razlike u dostatnoj primjeni antikoagulantne terapije između ovih dviju populacija (p=0,89). Naši rezultati jasno pokazuju nedostatnosti primjene antagonista vitamina K kao i potrebu bržeg prijelaza prema terapiji novijim oralnim antikoagulansima

AUTOLOGOUS STEM CELL TRANSPLANTATION IN REFRACTORY OR RELAPSED DIFFUSE LARGE B CELL LYMPHOMA – A SINGLE CENTRE EXPERIENCE

Autologna transplantacija perifernih matičnih stanica zlatni je standard u liječenju refraktornog ili relapsnoga kemosenzitivnog difuznog B-velikostaničnog limfoma u pogodnih bolesnika. Cilj je ovog rada prikazati ishode autologne transplantacije perifernih matičnih stanica u bolesnika s refraktornim ili relapsnim ne-Hodgkinovim limfomom difuznoga B-velikostaničnog tipa. Retrospektivno smo analizirali podatke 62-je bolesnika liječenih autolognom transplantacijom u našem centru u razdoblju od 2000. do 2013. godine. Većina bolesnika (71%) liječena je kemoterapijom miniBEAM, a svi su primili mijeloablativnu kemoterapiju BEAM s reinfuzijom vlastitih matičnih stanica. Ukupna stopa odgovora (kom­pletna i parcijalna remisija) nakon autologne transplantacije iznosila je 75,8%. Medijan ukupnog preživljenja iznosio je 37,2 mjeseca. Medijan preživljenja bez događaja vezanih uz bolest iznosio je 16,9 mjeseci. Čimbenici statistički značajno povezani s ukupnim preživljenjem bili su aktivnost bolesti prije visokodozne spasonosne terapije, odgovor na spasonosnu terapiju. Internacionalni prognostički indeks, stadij bolesti, odgovor na autolognu transplantaciju perifernih matičnih sta­nica te radioterapija nakon autologne transplantacije. Liječenje rituksimabom nije bilo statistički značajno povezano s ishodom. U ovoj skupini bolesnika autologna je transplantacija perifernih matičnih stanica bila učinkovita u postizanju remisije i preživljenja, što je dobar i očekivan ishod navedenog postupka. Naglašavamo da je i u skupini bolesnika s kemorezistentnom bolešću autologna transplantacija bila učinkovita u 32,5% bolesnika.Autologous stem cell transplantation represents the gold standard in chemosensitive diffuse B large cell lymphoma in relapse or in refractory setting. The aim of this study was to present the outcome of peripheral autologous stem cell transplantation in patients with refractory or relapsed diffuse large B cell lymphoma. We retrospectively analysed the data of 62 patients, who underwent this procedure for the period 2000–2013. The majority of patients (71%) were treated with miniBEAM salvage chemotherapy and all received BEAM myeloablative protocol followed by the stem cell reinfusion. The overall response rate for autologous transplantation was 75.8%. Median overall survival was 37.2 months. Median event-free survival was 16.9 months. Factors associated with overall survival were state of disease prior to salvage chemotherapy, chemosensitivity of disease, International prognostic index, disease activity at the relapse, response to autologous transplantation and post-transplantation radiotherapy. The use of rituximab was not significantly correlated to the outcome. In this patient group autologous stem cell transplantation was found to be effective in achieving remission and survival showing the adequate role of this procedure in this clinical setting. We stress out that autologous stem cell transplantation was effective in 32.5% patients with chemorefractory disease after salvage therapy