Use of vitamin K antagonists for secondary stroke prevention depends on the treating healthcare provider in Germany – results from the German AFNET registry

Background Anticoagulation using vitamin K antagonists (VKAs) significantly reduces the risk of recurrent stroke in stroke patients with atrial fibrillation (AF) and is recommended by guidelines. Methods The German Competence NETwork on Atrial Fibrillation established a nationwide prospective registry including 9,574 AF patients, providing the opportunity to analyse AF management according to German healthcare providers. Results On enrolment, 896 (9.4 %) patients reported a prior ischaemic stroke or transient ischaemic attack. Stroke patients were significantly older, more likely to be female, had a higher rate of cardiovascular risk factors, and more frequently received anticoagulation (almost exclusively VKA) than patients without prior stroke history. Following enrolment, 76.4 % of all stroke patients without VKA contraindications received anticoagulation, which inversely associated with age (OR 0.95 per year; 95 % CI 0.92–0.97). General practitioners/internists (OR 0.40; 95 % CI 0.21–0.77) and physicians working in regional hospitals (OR 0.47; 95 % CI 0.29–0.77) prescribed anticoagulation for secondary stroke prevention less frequently than physicians working at university hospitals (reference) and office-based cardiologists (OR 1.40; 95 % CI 0.76–2.60). The impact of the treating healthcare provider was less evident in registry patients without prior stroke. Conclusions In the AFNET registry, anticoagulation for secondary stroke prevention was prescribed in roughly three-quarters of AF patients, a significantly higher rate than in primary prevention. We identified two factors associated with withholding oral anticoagulation in stroke survivors, namely higher age and—most prominently—treatment by a general practitioner/internist or physicians working at regional hospitals

Allergic respiratory disease care in the COVID-19 era : a EUFOREA statement

Spring and Summer 2020 are unique in that the challenges of care for those suffering from pollen allergy coincide with the COVID-19 pandemic. Several considerations are important to allow optimal care of allergic rhinitis (AR) and asthma and hence prevention of coronavirus spread through sneezing, rhinorrhoea, and coughing. This compact overview of recommendations by the EUFOREA expert teams on allergic airway diseases and allergen-specific immunotherapy (AIT) is based on investigation of the current COVID-19 literature in association with the key words above and shared clinical experience of the experts involved. It deals with similarities and differences between AR and coronavirus infection, specific recommendations for allergic disease care in the COVID-19 era, including guidance on AIT

Recombinant hirudin (lepirudin) for the improvement of thrombolysis with streptokinase in patients with acute myocardial infarction Results of the HIT-4 trial

AbstractOBJECTIVESThe purpose of this study was to compare recombinant hirudin and heparin as adjuncts to streptokinase thrombolysis in patients with acute myocardial infarction (AMI).BACKGROUNDExperimental studies and previous small clinical trials suggest that specific thrombin inhibition improves early patency rates and clinical outcome in patients treated with streptokinase.METHODSIn a randomized double-blind, multicenter trial, 1,208 patients with AMI ≤6 h were treated with aspirin and streptokinase and randomized to receive recombinant hirudin (lepirudin, IV bolus of 0.2 mg/kg, followed by subcutaneous (SC) injections of 0.5 mg/kg b.i.d. for 5 to 7 days) or heparin (IV placebo bolus, followed by SC injections of 12,500 IU b.i.d. for 5 to 7 days). A total of 447 patients were included in the angiographic substudy in which the primary end point, 90-min Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 of the infarct-related artery, was evaluated, while the other two-thirds served as “safety group” in which only clinical end points were evaluated. As an additional efficacy parameter the ST-segment resolution at 90 and 180 min was measured in all patients.RESULTSTIMI flow grade 3 was observed in 40.7% in the lepirudin and in 33.5% in the heparin group (p = 0.16), respectively. In the entire study population the proportion of patients with complete ST resolution at 90 min (28% vs. 22%, p = 0.05) and at 180 min (52% vs. 48%, p = 0.18) after start of therapy tended to be higher in the lepirudin group. There was no significant difference in the incidence of hemorrhagic stroke (0.2% vs. 0.3%) or total stroke (1.2% vs. 1.5%), reinfarction rate (4.6% vs. 5.1%) and total mortality rate (6.8% vs. 6.4%) at 30 days, as well as the combined end point of death, nonfatal stroke, nonfatal reinfarction, rescue-percutaneous transluminal coronary angioplasty and refractory angina (22.7 vs. 24.3%) were not statistically different between the two groups.CONCLUSIONSLepirudin as adjunct to thrombolysis with streptokinase did not significantly improve restoration of blood flow in the infarct vessel as assessed by angiography, but was associated with an accelerated ST resolution. There was no increase in the risk of major bleedings with lepirudin compared to heparin

Rezensionsteil aus der Zeitschrift Nordelbingen 89.2023

Sammlung von Rezensionen zu folgenden Titeln: Karen Asmussen-Stratmann: Das Neue Werk von Gottorf. Rekonstruktion, Geschichte und Bedeutung eines norddeutschen Terrassengartens des 17. Jahrhunderts, Imhof Verlag: Petersberg 2022 (ISBN 978-3-7319-1165-4); Hans Apengeter. Norddeutscher Bronzeguss des 14. Jahrhunderts im Kontext, hg. v. Klaus Gereon Beuckers und Jochen Hermann Vennebusch unter Mitarbeit von Anna Kajsa Hill (Opera Borealia 1), Schnell & Steiner: Regensburg 2022 (ISBN 978-3-7954-3603-2); Die Kirche in Flintbek und ihre Kunstwerke, hg. v. Vivien Bienert, Verlag Ludwig: Kiel 2023 (ISBN 978-3-86935-456-9); Franziska Böhmer, Jarich Hoekstra, Claas Riecken, Wendy Vanselow: Die nordfriesische Literatur. En Uuning fuar di Taachten, Verlag Nordfriisk Instituut: Bräist/Bredstedt 2022 (ISBN: 978-3-88007-443-9); Licht – Mitte – Raum. Die Arbeiten des Bildhauers Hans Kock im Greifswalder Dom 1982–1989, hg. v. Antonia Gottwald und Holger Zaborowski, Schnell und Steiner: Regensburg 2017 (ISBN 978-3-7954-3265-2); Hans Kock. Bild des Glaubens. Die Neugestaltung der Feldsteinkirche St. Cyriacus in Kellinghusen 1974/75 und 1993, hg. v. Antonia Gottwald und Holger Zaborowski, Schnell und Steiner: Regensburg 2020 (ISBN 978-3-7954-3464-9); Hans Kock. Skulptur und Raum. Gespräche, Vorträge und Essays zu Kunst und Architektur 1972–2007, hg. v. Antonia Gottwald und Holger Zaborowski, Schnell und Steiner: Regensburg 2023 (ISBN: 978-3-7954-3710-7); Joachim Heisel: Tradition und Modernität. Reformarchitektur in Lübeck, wbg Academic: Darmstadt 2021 (ISBN 978-3-534-40591-6); Mehr als nur Sailing City! Kiel im Spiegel archäologischer Quellen, hg. v. Fritz Jürgens und Ulrich Müller (Sonderveröffentlichungen der Gesellschaft für Kieler Stadtgeschichte 98), Verlag Ludwig: Kiel 2022 (ISBN 978-3-86935-435-4); Vierstimmige Choräle mit Vorspielen. Zum allgemeinen sowohl, als zum besonderen Gebrauch für die Schleswig-Holsteinischen Kirchen gesetzt von Johann Christian Kittel (1732–1809), hg. und eingel. v. Matthias Kirsch (Denkmäler Norddeutscher Musik 7), Musikverlag Bernd Katzbichler: München und Salzburg 2021 (ISBN 978-3-87397-288-9); Anna-Sophie Laug: Oskar Schwindrazheim (1865–1952). Ein Künstler, Pädagoge und Kunstschriftsteller zwischen Tradition und Reform (Beiträge zur Geschichte Hamburgs 69), Wallstein: Göttingen 2020 (ISBN 978-3-8353-3733-6); Christian G. Schulz: Gottes Wort und fürstliche Macht. Silberaltäre des 17. Jahrhunderts zwischen München und Stockholm, Schnell & Steiner: Regensburg 2021 (ISBN 978-3-7954-3565-3); Heiko K. L. Schulze: Arthur Bock (1875–1957). Ein Hamburger Bildhauer (Hamburg-Inventar, Themenreihe 13), Verlag Ludwig: Kiel 2022 (ISBN 978-3-86935-430-9).Collection of reviews of the following titles: Karen Asmussen-Stratmann: Das Neue Werk von Gottorf. Rekonstruktion, Geschichte und Bedeutung eines norddeutschen Terrassengartens des 17. Jahrhunderts, Imhof Verlag: Petersberg 2022 (ISBN 978-3-7319-1165-4); Hans Apengeter. Norddeutscher Bronzeguss des 14. Jahrhunderts im Kontext, ed. by Klaus Gereon Beuckers and Jochen Hermann Vennebusch in collaboration with Anna Kajsa Hill (Opera Borealia 1), Schnell & Steiner: Regensburg 2022 (ISBN 978-3-7954-3603-2); Die Kirche in Flintbek und ihre Kunstwerke, ed. by Vivien Bienert, Verlag Ludwig: Kiel 2023 (ISBN 978-3-86935-456-9); Franziska Böhmer, Jarich Hoekstra, Claas Riecken, Wendy Vanselow: Die nordfriesische Literatur. En Uuning fuar di Taachten, Verlag Nordfriisk Instituut: Bräist/Bredstedt 2022 (ISBN: 978-3-88007-443-9); Licht – Mitte – Raum. Die Arbeiten des Bildhauers Hans Kock im Greifswalder Dom 1982–1989, ed. by Antonia Gottwald and Holger Zaborowski, Schnell und Steiner: Regensburg 2017 (ISBN 978-3-7954-3265-2); Hans Kock. Bild des Glaubens. Die Neugestaltung der Feldsteinkirche St. Cyriacus in Kellinghusen 1974/75 und 1993, ed. by Antonia Gottwald and Holger Zaborowski, Schnell und Steiner: Regensburg 2020 (ISBN 978-3-7954-3464-9); Hans Kock. Skulptur und Raum. Gespräche, Vorträge und Essays zu Kunst und Architektur 1972–2007, ed. by Antonia Gottwald and Holger Zaborowski, Schnell und Steiner: Regensburg 2023 (ISBN: 978-3-7954-3710-7); Joachim Heisel: Tradition und Modernität. Reformarchitektur in Lübeck, wbg Academic: Darmstadt 2021 (ISBN 978-3-534-40591-6); Mehr als nur Sailing City! Kiel im Spiegel archäologischer Quellen, ed. by Fritz Jürgens and Ulrich Müller (Sonderveröffentlichungen der Gesellschaft für Kieler Stadtgeschichte 98), Verlag Ludwig: Kiel 2022 (ISBN 978-3-86935-435-4); Vierstimmige Choräle mit Vorspielen. Zum allgemeinen sowohl, als zum besonderen Gebrauch für die Schleswig-Holsteinischen Kirchen gesetzt von Johann Christian Kittel (1732–1809), ed. and introduced by Matthias Kirsch (Denkmäler Norddeutscher Musik 7), Musikverlag Bernd Katzbichler: München und Salzburg 2021 (ISBN 978-3-87397-288-9); Anna-Sophie Laug: Oskar Schwindrazheim (1865–1952). Ein Künstler, Pädagoge und Kunstschriftsteller zwischen Tradition und Reform (Beiträge zur Geschichte Hamburgs 69), Wallstein: Göttingen 2020 (ISBN 978-3-8353-3733-6); Christian G. Schulz: Gottes Wort und fürstliche Macht. Silberaltäre des 17. Jahrhunderts zwischen München und Stockholm, Schnell & Steiner: Regensburg 2021 (ISBN 978-3-7954-3565-3); Heiko K. L. Schulze: Arthur Bock (1875–1957). Ein Hamburger Bildhauer (Hamburg-Inventar, Themenreihe 13), Verlag Ludwig: Kiel 2022 (ISBN 978-3-86935-430-9)

Heparin based prophylaxis to prevent venous thromboembolic events and death in patients with cancer - a subgroup analysis of CERTIFY

<p>Abstract</p> <p>Background</p> <p>Patients with cancer have an increased risk of VTE. We compared VTE rates and bleeding complications in 1) cancer patients receiving LMWH or UFH and 2) patients with or without cancer.</p> <p>Methods</p> <p>Acutely-ill, non-surgical patients ≥70 years with (n = 274) or without cancer (n = 2,965) received certoparin 3,000 UaXa o.d. or UFH 5,000 IU t.i.d. for 8-20 days.</p> <p>Results</p> <p>1) Thromboembolic events in cancer patients (proximal DVT, symptomatic non-fatal PE and VTE-related death) occurred at 4.50% with certoparin and 6.03% with UFH (OR 0.73; 95% CI 0.23-2.39). Major bleeding was comparable and minor bleedings (0.75 vs. 5.67%) were nominally less frequent. 7.5% of certoparin and 12.8% of UFH treated patients experienced serious adverse events. 2) Thromboembolic event rates were comparable in patients with or without cancer (5.29 vs. 4.13%) as were bleeding complications. All cause death was increased in cancer (OR 2.68; 95%CI 1.22-5.86). 10.2% of patients with and 5.81% of those without cancer experienced serious adverse events (OR 1.85; 95% CI 1.21-2.81).</p> <p>Conclusions</p> <p>Certoparin 3,000 UaXa o.d. and 5,000 IU UFH t.i.d. were equally effective and safe with respect to bleeding complications in patients with cancer. There were no statistically significant differences in the risk of thromboembolic events in patients with or without cancer receiving adequate anticoagulation.</p> <p>Trial Registration</p> <p>clinicaltrials.gov, <a href="http://www.clinicaltrials.gov/ct2/show/NCT00451412">NCT00451412</a></p

Промыслово-геофизические исследования с целью оценки эффективности ГТМ (ГРП) в эксплуатационных скважинах Хандинского лицензионного участка (Иркутская область)

Объектом исследования является эксплуатационная скважина Хандинского лицензионного участка Ковыктинской группы месторождений. Цель работы – составление проекта на проведение комплекса промыслово-геофизических работ в эксплуатационной скважине. В процессе проектирования проводится качественный анализ предыдущих промыслово-геофизических исследований в скважине, в которой выполнялись мероприятия по интенсификации притока – гидравлический разрыв пласта. В результате анализа запроектирован комплекс промыслово-геофизических исследований в добывающей газовой скважине при соблюдении требований подготовки скважины к проведению геофизических работ.Final qualifying work includes 85 pages, 13 pictures, 10 tables, 25 sources. The object of study is production well of Khandinsky license area, Kovykta group of fields. Purpose – creation of a project for the well logging complex in a production well. The design process is conducted a qualitative analysis of the previous logging, which carried out fluid intensification activities – hydraulic fracturing. The analysis is projected complex geophysical studies in extracting gas well, subject to the requirements of the well preparation for the geophysical survey