Clopidogrel versus ticagrelor in chronic kidney disease patients presenting with acute coronary syndrome: A retrospective evaluation

Aim: To compare the efficacy and bleeding risk of clopidogrel versus ticagrelor in patients presenting with the acute coronary syndrome (ACS). Method: This was a single-center retrospective comparison of in-hospital and 1-year major advance cardiovascular events (MACE) in patients with ACS and reduced estimated glomerular filtration rate (eGFR <60 mL/min) who were treated with clopidogrel or ticagrelor in addition to aspirin. Clinicodemographic features, medication use, and laboratory values were recorded. eGFR was calculated by means of the modification of diet in renal disease (MDRD) equation. The Killip classification was used to quantify the severity of heart failure. The primary outcome measures were in-hospital and 1-year MACEs and major and minor bleeding. MACE definition included recurrent myocardial infarction, stroke, and cardiovascular death. Results: In total, 235 patients (40.9% female, mean age 67.8 ± 12.4 years) were included. Of all patients, 56% presented with ST-elevation myocardial infarction (STEMI), whereas 44% had a non-ST-elevation myocardial infarction. Sixty-eight patients were treated with ticagrelor, while 167 patients were administered clopidogrel. The groups were comparable in terms of in-hospital mortality, cerebrovascular accident (CVA), and re-infarction rates. There was no statistical difference between the mortality, CVA and re-infarction rates between the groups at 12-month. In-hospital minor bleedings were more common among ticagrelor users. In-hospital major bleeding frequencies were similar in both groups. There was no statistical difference in terms of major or minor bleeding rates at 12 months. Conclusion: The findings of the present study showed comparable efficacy and bleeding risk in ACS patients who were treated clopidogrel or ticagrelor

Prevalence of Subclinical Hypothyroidism among Patients with Acute Myocardial Infarction

Introduction. Subclinical hypothyroidism (SCH) is defined as a serum thyroid-stimulating hormone (TSH) level above the upper limit of normal despite normal levels of serum free thyroxine. There is growing evidence that SCH is associated with increased cardiovascular risk. We tried to investigate prevalence of SCH in acute myocardial infarction patients. Methods and Results. We evaluate free T3, free T4, and TSH levels of 604 patients (age 58.4) retrospectively, who have been admitted to the coronary intensive care unit between years 2004–2009 with the diagnosis of ST elevation (STEMI) or non-ST elevation acute myocardial infarction (NSTEMI). Mild subclinical hypothyroidism (TSH 4.5 to 9.9 mU/l) was present in 54 (8.94%) participants and severe subclinical hypothyroidism (TSH 10.0 to 19.9 mU/l) in 11 (1.82%). So 65 patients (10.76%) had TSH levels between 4.5 and 20. Conclusions. In conclusion, 65 patients (10.76%) had TSH levels between 4.5 and 20 in our study, and it is a considerable amount. Large-scale studies are needed to clarify the effects of SCH on myocardial infarction both on etiologic and prognostic grounds

DOKUZ EYLÜL ÜNİVERSİTESİ TIP FAKÜLTESİ' NDE MESLEKSEL DEĞERLER VE ETİK EĞİTİMİ : ÜÇ YILLIK DENEYİM, SORUNLAR VE ÖNERİLER

Dokuz Eylül Üniversitesi Tıp Fakültesi' nde 1997-1998 eğitim yılında eğitim sistemi yapısal bir değişiklik geçirmiş ve eğitim yöntemleri probleme dayalı öğrenim sistemi ile uyumlu hale getirilmiştir