Modifying effect of dual antiplatelet therapy on incidence of stent thrombosis according to implanted drug-eluting stent type

Aim To investigate the putative modifying effect of dual antiplatelet therapy (DAPT) use on the incidence of stent thrombosis at 3 years in patients randomized to Endeavor zotarolimus-eluting stent (E-ZES) or Cypher sirolimus-eluting stent (C-SES). Methods and results Of 8709 patients in PROTECT, 4357 were randomized to E-ZES and 4352 to C-SES. Aspirin was to be given indefinitely, and clopidogrel/ticlopidine for ≥3 months or up to 12 months after implantation. Main outcome measures were definite or probable stent thrombosis at 3 years. Multivariable Cox regression analysis was applied, with stent type, DAPT, and their interaction as the main outcome determinants. Dual antiplatelet therapy adherence remained the same in the E-ZES and C-SES groups (79.6% at 1 year, 32.8% at 2 years, and 21.6% at 3 years). We observed a statistically significant (P = 0.0052) heterogeneity in treatment effect of stent type in relation to DAPT. In the absence of DAPT, stent thrombosis was lower with E-ZES vs. C-SES (adjusted hazard ratio 0.38, 95% confidence interval 0.19, 0.75; P = 0.0056). In the presence of DAPT, no difference was found (1.18; 0.79, 1.77; P = 0.43). Conclusion A strong interaction was observed between drug-eluting stent type and DAPT use, most likely prompted by the vascular healing response induced by the implanted DES system. These results suggest that the incidence of stent thrombosis in DES trials should not be evaluated independently of DAPT use, and the optimal duration of DAPT will likely depend upon stent type (Clinicaltrials.gov number NCT00476957

Plants of Sabkha Ecosystems of the Arabian Peninsula.

Sabkhas are unique ecosystems that are highly saline and where specially adapted plants are able to grow, flower, and fruit. In general, saline environments are poor in species – for the Arabian Peninsula about 120 taxa are recorded as halophytes which constitute about 4% of the total flora of the Arabian Peninsula. Key halophytes of Arabia are nearly always perennial; predominant life-forms are somewhat succulent, semiwoody dwarf shrubs belonging to the families Amaranthaceae, Zygophyllaceae, and Plumbaginaceae and hemicryptophytes belonging to the Poaceae, Cyperaceae, and Juncaceae; annuals are exceptions. Coastal species are either obligate halophytes or salt-tolerant genera from unspecialized families, such as Sporobolus and Aeluropus (Poaceae), or salt-secreting species such as Avicennia (Acanthaceae) and Limonium (Plumbaginaceae). The submerged coastal vegetation, e.g., seagrasses, is one of the most important vegetation types of the Gulf coast and is of great importance to marine fauna. The north-south distribution of coastal species is more distinct on the Red Sea coast, with the border lying near Jeddah, than on the Persian Gulf coast where there is a broad transitional zone between Qatar and northern Oman. The east-west distribution of coastal species is not as distinct. The eastern elements are either restricted to the coasts around the Arabian Gulf or are Irano-Turanian species extending into the Gulf region. Several vicariant species groups of halophytes are represented in the Arabian Peninsula. Halophytes have developed strategies for seed germination such as high germination levels and fast germination speed. These traits are found in the sabkha plants of the Arabian Peninsula. Some halophytes have been investigated for their potential for phytoremediation in their ability to survive weathered oil-contaminated soils. They have been found to have a set of micoorganisms around their root system that are related to the degradation of oil in contaminated soils. Sabkha ecosystems are being degraded and altered throughout the Gulf countries as they appear to be nonproductive. Over the last two decades, there has been a growing concern in protecting and restoring mangroves, and programs do to so have seen promising results. But, on the whole, coastal and inland sabkhas are neglected, and these unique ecosystems require urgent protection