Prevalence and clinical predictors of inappropriate direct oral anticoagulant dosage in octagenarians with atrial fibrillation

Purpose: Older age is associated with inappropriate dose prescription of direct oral anticoagulants. The aim of our study was to describe the prevalence and the clinical predictors of inappropriate DOACs dosage among octogenarians in real-world setting. Methods: Data for this study were sourced from the multicenter prospectively maintained Atrial Fibrillation (AF) Research Database (NCT03760874). Of the AF patients aged ≥ 80 who received DOACs treatment, 253 patients were selected. Participants were categorized as appropriate dosage, overdosage, or underdosage. Underdosage and overdosage were, respectively, defined as administration of a lower or higher DOAC dose than recommended in the EHRA consensus. Results: A total of 178 patients (71%) received appropriate DOACs dose and 75 patients (29%) inappropriate DOACs dose; among them, 19 patients (25.6%) were overdosed and 56 (74.4%) were underdosed. Subgroup analysis demonstrated that underdosage was independently associated with male gender [OR = 3.15 (95% IC; 1.45–6.83); p < 0.001], coronary artery disease [OR = 3.60 (95% IC 1.45–9.10); p < 0.001] and body mass index [OR = 1.27 (1.14–1.41); p < 0.001]. Overdosage was independently associated with diabetes mellitus [OR = 18 (3.36–96); p < 0.001], with age [OR = 0.76 (95% IC; 0.61–0.96; p = 0.045], BMI [OR = 0.77 (95% IC; 0.62–0.97; p = 0.043] and with previous bleedings [OR = 6.40 (0.7; 1.43–28); p = 0.039]. There wasn’t significant difference in thromboembolic, major bleeding events and mortality among different subgroups. Underdosage group showed a significatively lower survival compared with appropriate dose group (p < 0.001). Conclusion: In our analysis, nearly one-third of octogenarians with AF received an inappropriate dose of DOAC. Several clinical factors were associated with DOACs’ overdosage (diabetes mellitus type II, previous bleeding) or underdosage (male gender, coronary artery disease, and higher body mass index). Octogenarians with inappropriate DOACs underdosage showed less survival

I puritani

Coreògraf i mestre de ball : Joan Magrinyà ; Mestre de cor : Riccardo Bottino ; Director d'escena : Diego MonjoDe cada obra s'ha digitalitzat un programa sencer. De la resta s'han digitalitzat les parts que són diferents.Empresa: Juan A. PamiasOrquestra del Gran Teatre del Liceu dirigida per Renato SabbioniÒpera de Bellini i llibret de Pepol

Direct Oral Anticoagulants for Stroke Prevention in Special Populations: Beyond the Clinical Trials

Currently, direct oral anticoagulants (DOACs) are the first-line anticoagulant strategy in patients with non-valvular atrial fibrillation (NVAF). They are characterized by a more favorable pharmacological profile than warfarin, having demonstrated equal efficacy in stroke prevention and greater safety in terms of intracranial bleeding. The study population in the randomized trials of DOACs was highly selected, so the results of these trials cannot be extended to specific populations such as obese, elderly, frail, and cancer patients, which, on the other hand, are sub-populations widely represented in clinical practice. Furthermore, due to the negative results of DOAC administration in patients with mechanical heart valves, the available evidence in subjects with biological heart valves is still few and often controversial. We sought to review the available literature on the efficacy and safety of DOACs in elderly, obese, underweight, frail, cancer patients, and in patients with bioprosthetic heart valves with NVAF to clarify the best anticoagulant strategy in these special and poorly studied subpopulations

TAKOTSUBO CARDIOMYOPATHY AS EPIPHENOMENON OF CARDIOTOXICITY IN CANCER PATIENTS

Many antitumoral drugs have been linked to takotsubo cardiomyopathy, with no clear pathogenetic mechanisms. Data about this condition are lacking in literature. The aim of this meta-summary is to summarize the characteristics of patients with anti-tumoral drug-induced takotsubo cardiomyopathy, described in case reports available in literature.We searched for published case reports in PubMed, Google Scholar, EMBASE, and Scopus from 2009 about stress cardiomyopathy and antiblastic drugs. We selected 41 case reports.All cases underwent chemotherapy/immunotherapy for different types of cancer. Median age was 58 years old, 61% of them were women. The most common comorbidities were hypertension (12,2%) and dyslipidemia (4,9%), but most of the population had no past cardiological clinical history. Takotsubo cardiomyopathy is associated to the 5-fluorouracil (36,5%), Capecitabine (9,7%), Trastuzumab (9,7%) and ICIs (9,7%) treatment. The median time of onset was 2 days (1-150). Cardiogenic shock was the first manifestation in 11 patients (26,8%). Left ventricle ejection fraction recovery was showed in 33 patients (89%) with mean EF 57,7±7 %, after a median of 30 days (4-300) follow-up.Cancer patients experienced takotsubo cardiomyopathy within few days from the beginning of therapy and the most of them normalized the heart function in few weeks. Cardiogenic shock showed high prevalence in this setting of patients. Larger studies are needed to better understand the pathological mechanisms of antiblastic drugs-induced stress cardiomyopathy, to find risk factors associated and preventive strategies for limit this type of cardiotoxicities

TAKOTSUBO CARDIOMYOPATHY AS EPIPHENOMENON OF CARDIOTOXICITY IN CANCER PATIENTS: A META SUMMARY OF CASE REPORTS

Many antitumoral drugs have been linked to takotsubo cardiomyopathy, with no clear pathogenetic mechanisms. Data about this condition are lacking in literature. The aim of this meta-summary is to summarize the characteristics of patients with anti-tumoral drug-induced takotsubo cardiomyopathy, described in case reports available in literature.We searched for published case reports in PubMed, Google Scholar, EMBASE, and Scopus from 2009 about stress cardiomyopathy and antiblastic drugs. We selected 41 case reports.All cases underwent chemotherapy/immunotherapy for different types of cancer. Median age was 58 years old, 61% of them were women. The most common comorbidities were hypertension (12,2%) and dyslipidemia (4,9%), but most of the population had no past cardiological clinical history. Takotsubo cardiomyopathy is associated to the 5-fluorouracil (36,5%), Capecitabine (9,7%), Trastuzumab (9,7%) and ICIs (9,7%) treatment. The median time of onset was 2 days (1-150). Cardiogenic shock was the first manifestation in 11 patients (26,8%). Left ventricle ejection fraction recovery was showed in 33 patients (89%) with mean EF 57,7±7 %, after a median of 30 days (4-300) follow-up.Cancer patients experienced takotsubo cardiomyopathy within few days from the beginning of therapy and the most of them normalized the heart function in few weeks. Cardiogenic shock showed high prevalence in this setting of patients. Larger studies are needed to better understand the pathological mechanisms of antiblastic drugs-induced stress cardiomyopathy, to find risk factors associated and preventive strategies for limit this type of cardiotoxicities

Optimal anticoagulation in patients with atrial fibrillation and bioprosthetic heart valves

The antithrombotic management of patients after surgical or transcatheter bioprosthetic heart valves (BHVs) replacement is still challenging. Our review aims to describe the current evidence on the best antithrombotic strategy among patients undergoing BHVs replacement (surgical or transcatheter) and/or valve repair, with particular attention to those with atrial fibrillation

Formation of Bi4Ti3O12 One-Dimensional Structures by Solid-State Reactive Diffusion. From Core−Shell Templates to Nanorods and Nanotubes

International audienceOne-dimensional nanostructures are usually fabricated using liquid-phase chemical methods or growth from the vapor phase. A different approach is proposed in this investigation. Using two different kinds of reactive templates with core−shell structure obtained using colloidal chemistry methods, we fabricated for the first time Bi4Ti3O12 nanorods and nanotubes by means of solid-state reactions. The intimate contact of the parent compounds in the core−shell template resulted in low reaction temperatures (500−600 °C), overcoming the morphological instability problem of one-dimensional (1D) templates. As the formation of bismuth titanate is dominated by the coupled ambipolar diffusion of Bi3+ and O2− ions through the titanate layer, the final morphology, nanorod or nanotube, is determined by the relative arrangement of the parent compounds in the core−shell template. When the bismuth precursor is located in the shell region and the core is a single-crystal TiO2 nanowire, formation of a single-crystal Bi4Ti3O12 nanorod occurs by a topochemical reaction. Opposite, when the shell corresponds to nanocrystalline TiO2 and the core to the bismuth precursor, the reaction leads to a porous nanorod or a nanotube depending on the template thickness. The development of the central cavity is ascribed to the coalescence of Kirkendall porosity and the effect of mechanical stresses accumulated during the reaction. The present results indicate that a careful control of the solid-state reactions at the nanoscale can be achieved by means of reactive templates with core−shell structure thus providing an effective tool for the design and the large-scale fabrication of a variety of nano-objects with different dimensionalities