Antiaggregational Therapy

Patofiziološko obrazloženje značenja antiagregacijske terapije leži u središnjoj ulozi trombocita pri aterotrombotskoj bolesti koja se nalazi u osnovi akutne i kronične koronarne bolesti, bolesti perifernih arterija i arterija mozga. Danas su dostupni brojni lijekovi kojima se mogu različitim mehanizmima mijenjati svojstva trombocita. Postoje brojna klinička istraživanja u kojima je dokazana učinkovitost antiagregacijske terapije pri različitim aterotrombotskim bolestima, premda neka pitanja ostaju još neodgovorena. U ovom pregledu antiagregacijske terapije bit će ukratko opisana dosadašnja saznanja o acetilsalicilnoj kiselini, tienopiridinima (tiklopidin, klopidogrel, prasugrel, tikagrelor), antagonistima glikoproteinskih receptora IIb/IIIa i kombinacijskom liječenju.Pathophysiological explanation of the antiplatelet therapy importance lies in the central role of platelets in atherothrombotic disease, which is in the very foundations of both acute and chronic coronary artery disease, peripheral arterial disease and cerebral arteries disease. Today, many medications are available that change the properties of platelets using different mechanisms. Numerous clinical trials have demonstrated the effectiveness of antiplatelet therapy in various atherothrombotic diseases, although some questions still remain unanswered. This review of antiplatelet therapy will briefly describe current knowledge about acetylsalicylic acid, thienopyridines (ticlopidine, clopidogrel, prasugrel, ticagrelor), glycoprotein IIb/IIIa receptor antagonists and the combination treatment

Arrhythmology and cardiac pacing – an overview of the situation in Croatia.

Unazad nekoliko godina prisutan je značajan napredak u zbrinjavanju bolesnika s poremećajima srčanog ritma, kako u svijetu, tako i u Republici Hrvatskoj. Ovaj pregledni članak prikazuje postojeće stanje u području aritmologije i elektrostimulacije u Republici Hrvatskoj. Najveći napredak vidljiv je u području elektrofiziologije značajnim povećanjem broja učinjenih kateterskih ablacija aritmija, a osobito ablacije fibrilacije atrija. Prisutni su i znatni pomaci u novim spoznajama u području elektrostimulacije, daljnji porast u brojnu centara gdje se takvi postupci provode, kao i u broju učinjenih postupaka, pri čemu edukacija prati nove spoznaje i trendove, sve s ciljem kako bi našim bolesnicima omogućili dulje preživljenje i bolju kvalitetu života. Međutim, glavni izazovi koji ostaju pred nama nisu se bitno promijenili u odnosu na prijašnje godine, a osnovno je pronalazak dodatnih sredstava koji bi osigurali bolju prevenciju nagle srčane smrti neophodnim povećanjem broja ugradnje implantabilnih kardioverter defibrilatora i uređaja za resinkronizacijsku terapiju. Prostor za poboljšanje je znatan, pri čemu se ne može dovoljno naglasiti važnost ustrajne aktivnosti stručnog društva u ovom području.In the past few years there has been a significant progress in the management of patients with heart rhythm disorders both in the world and in Croatia. This review article summarizes the current situation in the area of arrhythmology and cardiac pacing in the Republic of Croatia. The greatest improvement is seen in the field of electrophysiology due to a significant increase in the number of performed electrophysiological procedures, particularly catheter ablation of atrial fibrillation. There are also significant advancements in new insights in the field of electrical stimulation, a further increase in a number of centers where such procedures are performed, as well as in the number of performed procedures where education follows new insights and trends, all with an aim to enable our patients to have prolonged survival and a better quality of life. However, some major challenges we are facing have not significantly changed compared to the previous year, and the basic one is finding additional resources to ensure better prevention of sudden cardiac death by necessary increasing the implantation rate of implantable cardioverter defibrillators and cardiac resynchronization therapy devices. The room for improvement is great, whereas we can not sufficiently emphasize the importance of persistent activities of the professional society in this area

EUROPEAN GUIDELINES ON THE DIAGNOSIS AND MANAGEMENT OF PULMONARY EMBOLISM

Suglasnost ispitanika za sudjelovanje u medicinskim istraživanjima standard je zaštite svih sudionika u biomedicinskim istraživanjima koji je potvrđen i u međunarodnim dokumentima vezanim uz područje istraživanja na ljudima i u hrvatskom zakonodavstvu. Neka pitanja međutim ostaju otvorena. Jedno od njih, s kojim se susreću brojna etička povjerenstva u svijetu i Republici Hrvatskoj, jest i je li potrebno tražiti suglasnost pacijenata kod istraživanja u kojima se rabe pohranjeni biološki materijali pacijenata i njihovi medicinski podatci dobiveni tijekom dijagnostičkih i/ili terapijskih zahvata. U radu je dan pregled hrvatskih i međunarodnih pravnih dokumenata i smjernica te znanstvenih istraživanja koja se bave ovim pitanjem. Budući da za sada ne postoji zakonska regulativa u Hrvatskoj vezana uz ovaj tip istraživanja, autori ovog rada daju preporuke za istraživače i etička povjerenstva kako postupati u takvim slučajevima. Njihovo prihvaćanje olakšalo bi znanstvena istraživanja i međunarodnu suradnju hrvatskih znanstvenih institucija.Informed consent represents the standard for adequate protection of all participants in biomedical research. This standard is affirmed in international legal documents concerning biomedical research, as well as in Croatian legislation. However, some questions regarding informed consent remain open. One of such questions that research ethics committees around the world and in the Republic of Croatia often deal with, is the question of whether to obtain informed consent for the research on archived material or previously collected research data taken from the patients during diagnostic or therapeutic procedures. This contribution provides an overview of both Croatian and international legal documents and guidelines that deal with this issue, together with an overview of the literature concerning this issue. Since in the Republic of Croatia there are no regulations regarding this type of research, the authors of this contribution are presenting conduct guidelines for researchers and ethics committees in such cases. The implementation of the proposed guidelines would facilitate scientific research and international cooperation for Croatian scientific institutions

Increased plasma level of lipoprotein(a) and homocysteine is a marker of increased cardiovascular risk

Introduction. Recent molecular research regards Lp(a) as the “third cholesterol” which should be treated in the same way like the total and LDL-cholesterol in reduction of total cardiovascular risk. Although early data on the relationship between elevated blood homocysteine concentrations and CAD and stroke have been somewhat inconsistent, hyperhomocystinemia has been suggested as an indicator of an increased risk of cardiovascular disease. In light of this, our study objective was to provide answers to the following questions: 1. Is serum Lp(a) concentration a risk factor for coronary artery disease in Croatian population; 2. What are the frequencies of various apo(a) isoforms in elevated serum Lp(a) concentrations; 3. Is there a relation between elevated serum homocysteine and Lp(a) concentration; 4. Investigate the relation of Lp(a) to other lipid disorders and other cardiovascular risk factors. Methods. This study was performed in Dubrava University Hospital in Zagreb, Croatia. 87 patients participated with no known preliminary coronary or peripheral vascular disease. The patient groups were stratified according to increased and normal Lp(a) levels measured from serum. Extensive medical history was obtained, blood biochemistry was evaluated and all patients underwent exercise stress testing. Results. In the group with increased concentration of Lp(a) in serum (> 0.30 g/L) there were 53 patients (average age 55 years, 32 males and 21 females), and normal concentration of Lp(a) in serum (< 0.30 g/L) was found in 34 patients (average age 52 years, 20 males and 14 females). The patients with increased Lp(a) levels were significantly older than the patients with normal Lp(a) levels (p = 0.020). The average concentration of Lp(a) in patients with negative exercise stress testing results was 0.38g/L, and in those with positive exercise stress testing results it was 0.51 g/L, with this difference among groups being significant (p = 0.049). The correlation of homocysteine and Lp(a) levels was statistically significant (r = 0.57, p < 0.01). Frequencies of phenotype Lp(a) were determined with the predominance of S4 phenotype (in 34 patients, 39.10%). Conclusions. Lp(a) concentration is a statistically significant risk factor for coronary artery disease. Homocysteine and Lp(a) seem to interact to increase the risk of CAD. No significant association was observed between Lp(a) levels and conventional risk factors for CAD

The prevalence of smoking among Croatian hospitalized coronary heart disease patients [Prevalencija pušenja u hospitaliziranih bolesnika u Hrvatskoj]

The aim of this paper was to investigate the prevalence of smoking using selected anthropometric variables in a sample of hospitalized coronary heart disease (CHD) patients in Croatia (N = 1,298). A total of 444 subjects (34.6%) were non-smokers, 548 (42.6%) were smokers and 293 (22.8%) were ex-smokers. Men, on average, smoked more cigarettes per day than women (22.62 vs. 19.84 cigarettes, p < 0.001) and they also had bigger index "pack-years" than women (36.96 vs. 33.91, p = 0.024). Men were more often smokers and ex-smokers than women (47.4% vs. 30.8% for smokers and 25.0% vs. 22.8% for ex-smokers, p < 0.001). In this study a high prevalence of smoking was found among CHD patients in Croatia. Unless it is decreased, it can be expected that CHD patients in Croatia will continue to experience adverse effects more often than other CHD patients in the rest of Europe