Comparison between prothrombin complex concentrate (PCC) and fresh frozen plasma (FFP) for the urgent reversal of warfarin in patients with mechanical heart valves in a tertiary care cardiac center

Fresh frozen plasma (FFP) and prothrombin complex concentrate (PCC) reverse oral anticoagulants such as Warfarin. We compared the standard dosage of FFP and PCC in terms of efficacy and safety for patients with mechanical heart valves undergoing interventional procedures while receiving Warfarin. Fifty patients were randomized (25 for each group) with mechanical heart valves international normalized ratio (INR) >2.5. FFP dosage was administered based on body weight (10-15 mL/Kg), while PCC dosage was administered based on both body weight and target INR. INR measurements were obtained at different time after PCC and FFP infusion. The mean ± SD of INR pre treatment was not significantly different between the PCC and FFP groups. However, over a 48-hour period following the administration of PCC and FFP, 76% of the patients in the PCC group and only 20% of the patients in the FFP group reached the INR target. Five (20%) patients in the PCC group received an additional dose of PCC, whereas 17 (68%) patients in the FFP group received a further dose of FFP (P=0.001). There was no significant difference between the two groups in Hb and Hct before and during a 48-hour period after PCC and FFP infusion. As regards safety monitoring and adverse drug reaction screening in the FFP group, the INR was high (INR > 2.5) in 86% of the patients. There was no report of hemorrhage in both groups. PCC reverses anticoagulation both effectively and safely while having the advantage of obviating the need to extra doses. © 2015 by School of Pharmacy Shaheed Beheshti University of Medical Sciences and Health Services

Localization of Japanese subsidiaries in the far east : organizational and environmental constraints

Includes bibliographical references

Prevalence and prognostic significance of pericardial effusion in native valve endocarditis based on data from the Iranian registry of infective endocarditis (IRIE)

Background: The presence of pericardial effusion (PE) in the setting of infective endocarditis (IE) may be a sign of more severe IE. In this study, we aimed to determine the prevalence and prognostic significance of PE in patients with native valve IE. Methods: The Iranian Registry of Infective Endocarditis (IRIE) is a single-center observational hospital-based study of patients with IE. Between 2002 and 2015, all patients with a diagnosis of IE who had been enrolled in the IRIE were evaluated. Results: A total of 445 patients (68.3 male) were enrolled in this registry, and 221 (49.7) patients had PE. PE was more prevalent in the patients with native valve IE and those with right-heart involvement (65 in right-heart IE vs 50 in left-heart IE; P=0.002). The rate of in-hospital mortality was 20 and 19.2 in the patients with and without PE, respectively, and the presence of PE was not a predictor of in-hospital death in our multivariate analyses. Additionally, there was no relationship between the rates of IE-related complications and the severity of PE. However, the prevalence of PE was higher in the patients with right-sided IE as well as in those with aortic root abscess and systemic emboli at presentation. Conclusions: The prevalence of PE in the setting of IE was relatively high in the present study. Most cases of PE had mild effusion, and there was no relationship between the severity of PE and IE-related complications as well as in-hospital mortality. © 2018, Iranian Heart Association. All rights reserved

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

Aims The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. Methods and results Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (inhospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, prehospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. Conclusion The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality