Surgical bleeding after pre-operative unfractionated heparin and low molecular weight heparin for coronary bypass surgery

Background and Objectives Since the impairment of platelet function may cause excess peri-operative bleeding, pre-operative discontinuation of aspirin and heparin bridging are common for cardiac surgery. We evaluated the impact of pre-operative administration of enoxaparin and unfractionated heparin (UFH) on coagulation parameters and peri-operative bleeding in patients undergoing elective coronary artery bypass grafting (CABG) surgery after discontinuation of aspirin. Design and Methods Forty-three patients with three-vessel coronary artery disease undergoing elective CABG surgery discontinued aspirin and were randomized to receive either UFH 180 UI/Kg × 2/day s.c. or enoxaparin 100 UI/Kg × 2/day s.c. until 12 h before surgery (median pre-operative treatment 8 days, range 6–12 days). Surgery was performed as usual with UFH. Neither UFH nor any low molecular weight heparin was given in the immediate post-operative period. The effects of UFH and enoxaparin were monitored by the activated partial thromboplastin time (aPTT) and the Enox-test (sensitive to factor Xa inhibition) using a Rapidpoint® Coagulation Analyzer. aPTT and factor Xa activity were also measured by standard methods. Peri-operative bleeding and the nadirs of hemoglobin concentration, hematocrit and platelet count were monitored post-operatively. Results Patients in the two groups were similar for number of bypasses, on-pump time, total surgery time, and time from the last heparin administration. Coagulation parameters increased significantly and similarly at 30 min and 6 h with both treatments, but returned within the normal range at 12 h. Hemoglobin, hematocrit and platelet counts significantly decreased to the same extent after CABG and re-normalized at the same time. Transfusional requirements of blood and plasma units were similar in the two groups. Interpretation and Conclusions From the kinetics of coagulation parameters and the evaluation of bleeding, enoxaparin is a safe alternative to UFH as a bridging therapy to CABG after discontinuation of aspirin

Clinical discussions in antithrombotic therapy management in patients with atrial fibrillation: a delphi consensus panel

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Aspectos impositivos relacionados a la producción de carne aviar

Uno de los sectores de mayor crecimiento desde el año 1960 hasta la actualidad es el avícola. La producción aviar tiene dos componentes bien diferenciados, la de la carne y la del huevo. En la presente investigación se trabajará sólo con la producción cárnica. La cercanía de su producción, la variación en los gustos de los consumidores y su precio, son algunos de los factores que favorecen el incremento de la demanda. La cantidad producida, consumida y exportada, se incrementó desde los años 60 hasta la actualidad. Las provincias que componen la Región Centro, faenan aproximadamente el 61% de la producción aviar. Por lo que podemos decir que se produce en una provincia y su comercialización se realiza en otras de la República Argentina o se exporta. Esta situación presenta una serie de dificultades al momento de analizar los tributos que afectan al sector tanto a nivel provincial como al nacional. Este contexto se complica si se considera que la República Argentina no posee sus leyes tributarias en un código único.One of the fastest growing sectors from 1960 to the present is poultry. Avian production has two distinct components: meat and eggs. In the present investigation we will work only with meat production. The proximity of its production, the variation in consumer tastes and its price, are some of the factors that favor the increase on demand. The quantity produced, consumed and exported, increased from the 60s to the present. The provinces that make up the Central Region work approximately 61% of avian production. So we can say that it is produced in one province and its marketing is carried out in others in the Argentine Republic or exported. This situation presents a series of difficulties when analyzing the taxes that affect the sector both at the provincial and national levels. This context is complicated if we considered that the Argentine Republic does not have its tax laws in a unique code.Fil: D'Alleva, Mónica María, Facultad de Ciencias Económicas y Estadística. Universidad Nacional de Rosario. ArgentinaFil: Di Paolo, Horacio . Facultad de Ciencias Económicas y Estadística. Universidad Nacional de Rosario. ArgentinaFil: Goytia, Marisa Daniela. Facultad de Ciencias Económicas y Estadística. Universidad Nacional de Rosario. ArgentinaFil: Matich, Cecilia Carolina . Facultad de Ciencias Económicas y Estadística. Universidad Nacional de Rosario. ArgentinaFil: Ranieri, Rubén Alberto. Facultad de Ciencias Económicas y Estadística. Universidad Nacional de Rosario. Argentin

Secondary prevention and follow-up of patients with ACS and not-at-target LDL: An Italian real-world retro-prospective analysis by the inertia group

Background: In patients with recent ACS, the latest ESC/EAS guidelines for management of dyslipidaemia recommend intensification of LDL-C-lowering therapy. Objective: Report a real-world picture of lipid-lowering therapy prescribed and cholesterol targets achieved in post-ACS patients before and after a specific educational program. Methods: Retrospective data collection prior to the educational course and prospective data collection after the course of consecutive very high-risk patients with ACS admitted in 2020 in 13 Italian cardiology departments, and with a non-target LDL-C level at discharge. Results: Data from 336 patients were included, 229 in the retrospective phase and 107 in the post-course prospective phase. At discharge, statins were prescribed in 98.1% of patients, alone in 62.3% of patients (65% of which at high doses) and in combination with ezetimibe in 35.8% of cases (52% at high doses). A significant reduction was obtained in total and LDL cholesterol (LDL-C) from discharge to the first control visit. Thirty-five percent of patients achieved a target LDL-C <55 mg/dL according to ESC 2019 guidelines. Fifty percent of patients achieved the <55 mg/dL target for LDL-C after a mean of 120 days from the ACS event. Conclusions: Our analysis, though numerically and methodologically limited, suggests that management of cholesterolaemia and achievement of LDL-C targets are largely suboptimal and need significant improvement to comply with the lipid-lowering guidelines for very high CV risk patients. Earlier high intensity statin combination therapy should be encouraged in patients with high residual risk

Efficacy, safety, adherence and persistence of PCSK9 inhibitors in clinical practice: A single country, multicenter, observational study (AT-TARGET-IT)

Background and aims: Proprotein Convertase Subtilisin/Kexin type 9 inhibitors (PCSK9i) are recommended in patients at high and very-high cardiovascular (CV) risk, with documented atherosclerotic CV disease (ASCVD), and for very-high risk patients with familial hypercholesterolaemia not achieving LDL-cholesterol (LDL-C) goal while receiving maximally tolerated dose of lipid-lowering therapy (LLT). However, single country real-life data, reporting the use of PCSK9i in clinical practice, are limited. Therefore, we designed AT-TARGET-IT, an Italian, multicenter, observational registry on the use of PCSK9i in clinical practice. Methods: All data were recorded at the time of the first prescription and at the latest observation preceding inclusion in the study. Results: 798 patients were enrolled. The median reduction in LDL-C levels was 64.9%. After stratification for CV risk, 63.8% achieved LDL-C target; of them, 83.3% took LLTs at PCSK9i initiation and 16.7% did not. 760 patients (95.2%) showed high adherence to therapy, 13 (1.6%) partial adherence, and 25 (3.1%) poor adherence. At 6 months, 99.7% of patients enrolled in the study remained on therapy; there were 519 and 423 patients in the study with a follow-up of at least 12 and 18 months, respectively. Persistence in these groups was 98.1% and 97.5%, respectively. Overall, 3.5% of patients discontinued therapy. No differences in efficacy, adherence, and persistence were found between alirocumab and evolocumab. Conclusions: PCSK9i are safe and effective in clinical practice, leading to very high adherence and persistence to therapy, and achievement of recommended LDL-C target in most patients, especially when used as combination therapy