Українська сангха японського Ордену Ніппондзан Мьоходзі

Стаття присвячена дослідженню історії української сангхи японського буддистського Ордену Ніппондзан Мьоходзі. Автор, враховуючи специфіку даної школи, намагався намітити загальний шлях для подальшого дослідження, виявити основні тенденції та періоди розвитку української сангхи Ніппондзан Мьоходзі. Значна увага приділяється діяльності членів української сангхи за межами України, що обумовлено світовими масштабами діяльності Дзюнсея Терасави, безпосереднього вчителя для українських монахів даного ОрденуСтатья посвящена исследованию истории украинской сангхи японского буддийского Ордена Ниппондзан Мёходзи. Автор, учитывая специфику данной школы, старался наметить общий путь для дальнейшего исследования, выявить основные тенденции и периоды развития украинской сангхи Ниппондзан Мёходзи. Значительное внимание уделяется деятельности членов украинской сангхи за пределами Украины, что обусловлено мировыми масштабами деятельности Дзюнсея Терасавы, непосредственного учителя монахов данного Ордена.This article is devoted to the history of Ukrainian Sangha of Japanese Buddhist Order Nippondzan Mehodzi. Taking into account the specificity of the school, the author trying to direct a common way for further research, to identify the key trends and periods of development of Ukrainian Sangha Nippondzan Mehodozi. Considerable attention has been given to the activities of the Ukrainian Sangha members outside of Ukraine, wich is caused by the global scale of Dzyunsey Terasava activity

Optimal antiplatelet and anticoagulant therapy in patients with oral anticoagulation in coronary stenting

Chronic oral anticoagulation (OAC) is necessary in patients with mechanical heart valves and in most patients with atrial fibrillation (AF). A large subgroup of these patients has concomitant coronary artery disease (CAD). When these patients have to undergo percutaneous coronary intervention (PCI), additional dual antiplatelet treatment (DAPT) with aspirin and a P2Y12 inhibitor becomes indicated to prevent stent thrombosis. In a rapidly ageing community, the number of patients suffering both AF and CAD is steadily increasing. Up to 2012 these patients were treated with the so-called triple therapy that is the combination of aspirin, clopidogrel and a vitamin K antagonist (VKA). However, this triple therapy also has its downsides. There is an association with an annual bleeding risk of up to 45% and bleeding is the Achilles-heel of triple therapy because it is the associated with an increased mortality risk. This thesis is based upon the clinical problem in this high-risk patient group (AF & PCI) that we encountered in 2007-2008 when patients had a high bleeding tendency when treated with triple therapy. We set out to decrease the bleeding risk without increasing the risk of stent thrombosis. Although triple therapy is still recommend by the guidelines, these recommendations are based on expert opinion and not on randomised trials. In this thesis we provide evidence that suggests that the increased bleeding risk outweighs the efficacy (preventing stent thrombosis, myocardial infarction (MI), stroke and thromboembolism) benefit of triple therapy in these patients and we present a possible new strategy of VKA and a P2Y12 inhibitor alone. The results of this randomised WOEST trial were presented in the hot line session of the 2012 annual meeting of the European Society of Cardiology in Munich and published in the Lancet. Second, we focus on the possible pitfall of VKA as it may modify the clopidogrel drug responsiveness and efficacy. However, the clinical impact of this finding on the risk of atherothrombotic events in patients on long term OAC undergoing PCI is unclear. Further investigation on this topic is needed. Third, the optimal peri-procedural PCI strategy in patients on OAC is highlighted. In a sub-analysis of the WOEST study, uninterrupted oral anticoagulation was not associated with an increase of bleeding or MACCE compared to bridging therapy. This study supports the current guidelines to adopt a peri-procedural uninterrupted oral anticoagulation strategy in patients on long term OAC who undergo PCI. Finally, we focus on stent choice in patients on OAC who undergo PCI. For patients on OAC who need to undergo PCI, guidelines (based on expert opinion) recommend the use of bare metal stents (BMS) but a sub-analysis of the WOEST trial showed that in patients treated with OAC who undergo PCI the implantation of DES was not associated with an increase of bleeding or ischemic events compared to BMS. The use of DES was associated with a significantly lower rate of TVR and therefore the use of DES seems a reasonable option in patients on long term OAC who undergo PCI

The WOEST 2 registry : a prospective registry on antithrombotic therapy in atrial fibrillation patients undergoing percutaneous coronary intervention

BACKGROUND: Patients on oral anticoagulants (OACs) undergoing percutaneous coronary intervention (PCI) also require aspirin and a P2Y12 inhibitor (triple therapy). However, triple therapy increases bleeding. The use of non-vitamin K antagonist oral anticoagulants (NOACs) and stronger P2Y12 inhibitors has increased. The aim of our study was to gain insight into antithrombotic management over time. METHODS: A prospective cohort study of patients on OACs for atrial fibrillation or a mechanical heart valve undergoing PCI was performed. Thrombotic outcomes were myocardial infarction, stroke, target-vessel revascularisation and all-cause mortality. Bleeding outcome was any bleeding. We report the 30-day outcome. RESULTS: The mean age of the 758 patients was 73.5 ± 8.2 years. The CHA(2)DS(2)-VASc score was ≥ 3 in 82% and the HAS-BLED score ≥ 3 in 44%. At discharge, 47% were on vitamin K antagonists (VKAs), 52% on NOACs, 43% on triple therapy and 54% on dual therapy. Treatment with a NOAC plus clopidogrel increased from 14% in 2014 to 67% in 2019. The rate of thrombotic (4.5% vs 2.0%, p = 0.06) and bleeding (17% vs. 14%, p = 0.42) events was not significantly different in patients on VKAs versus NOACs. Also, the rate of thrombotic (2.9% vs 3.4%, p = 0.83) and bleeding (18% vs 14%, p = 0.26) events did not differ significantly between patients on triple versus dual therapy. CONCLUSIONS: Patients on combined oral anticoagulation and antiplatelet therapy undergoing PCI are elderly and have both a high bleeding and ischaemic risk. Over time, a NOAC plus clopidogrel became the preferred treatment. The rate of thrombotic and bleeding events was not significantly different between patients on triple or dual therapy or between those on VKAs versus NOACs. SUPPLEMENTARY INFORMATION: The online version of this article (10.1007/s12471-022-01664-0) contains supplementary material, which is available to authorized users

Cost Effectiveness of a CYP2C19 Genotype-Guided Strategy in Patients with Acute Myocardial Infarction: Results from the POPular Genetics Trial

Introduction: The POPular Genetics trial demonstrated that a CYP2C19 genotype-guided P2Y12 inhibitor strategy reduced bleeding rates compared with standard treatment with ticagrelor or prasugrel without increasing thrombotic event rates after primary percutaneous coronary intervention (PCI). // Objective: In this analysis, we aimed to evaluate the cost effectiveness of a genotype-guided strategy compared with standard treatment with ticagrelor or prasugrel. // Methods: A 1-year decision tree based on the POPular Genetics trial in combination with a lifelong Markov model was developed to compare costs and quality-adjusted life-years (QALYs) between a genotype-guided and a standard P2Y12 inhibitor strategy in patients with myocardial infarction undergoing primary PCI. The cost-effectiveness analysis was conducted from a Dutch healthcare system perspective. Within-trial survival and utility data were combined with lifetime projections to evaluate lifetime cost effectiveness for a cohort of 1000 patients. Costs and utilities were discounted at 4 and 1.5%, respectively, according to Dutch guidelines for health economic studies. Besides deterministic and probabilistic sensitivity analyses, several scenario analyses were also conducted (different time horizons, different discount rates, equal prices for P2Y12 inhibitors, and equal distribution of thrombotic events between the two strategies). // Results: Base-case analysis with a hypothetical cohort of 1000 subjects demonstrated 8.98 QALYs gained and €725,550.69 in cost savings for the genotype-guided strategy (dominant). The deterministic and probabilistic sensitivity analysis confirmed the robustness of the model and the cost-effectiveness results. In scenario analyses, the genotype-guided strategy remained dominant. // Conclusion: In patients undergoing primary PCI, a CYP2C19 genotype-guided strategy compared with standard treatment with ticagrelor or prasugrel resulted in QALYs gained and cost savings