2011 March 23

Novel oral anticoagulants: focus on stroke prevention and treatment of venous thrombo-embolism.

Mar 232011

Novel oral anticoagulants: focus on stroke prevention and treatment of venous thrombo-embolism.

Eur Heart J. 2011 Mar 18;

Authors: Steffel J, Braunwald E

Anticoagulation for the long-term treatment and prevention of thrombo-embolic diseases as well as for stroke prevention in atrial fibrillation (AF) has been accomplished by vitamin K antagonists for the last half century. Although effective under optimal conditions, the imminent risk of a recurrent event vs. the risk of bleeding due to the narrow therapeutic window, numerous food- and drug interactions, and the need for regular monitoring complicate the long-term use of these drugs and render treatment with these agents complicated. As a result, novel anticoagulants which selectively block key factors in the coagulation cascade are being developed. The efficacy and safety of the direct thrombin inhibitor dabigatran etexilate, as well as of the selective factor Xa inhibitors rivaroxaban and apixaban, have been demonstrated in Phase III trials for stroke prevention in AF and the treatment and secondary prophylaxis of venous thrombo-embolism. This review summarizes the results from recently published pivotal clinical trials and discusses the opportunities as well as uncertainties in the clinical applications of these novel agents.

PMID: 21421599 [PubMed - as supplied by publisher]

Link to Article at PubMed

Outcomes and Safety of Antithrombotic Treatment in Patients Aged 80 Years or Older With Nonvalvular Atrial Fibrillation.

Am J Cardiol Start a Discussion »

Mar 232011

Outcomes and Safety of Antithrombotic Treatment in Patients Aged 80 Years or Older With Nonvalvular Atrial Fibrillation.

Am J Cardiol. 2011 Mar 18;

Authors: Ruiz Ortiz M, Romo E, Mesa D, Delgado M, Ibáñez CL, Anguita M, Castillo JC, Arizón JM, de Lezo JS

Our aim was to evaluate the effectiveness of oral anticoagulation (OAC) in patients aged ?80 years with nonvalvular atrial fibrillation in daily clinical practice. From February 1, 2000 to June 30, 2009, we enrolled all patients aged ?80 years with nonvalvular atrial fibrillation attended at 2 outpatient cardiology clinics of a tertiary care university hospital. The patients received antithrombotic treatment according to the recommendations from scientific societies and were prospectively followed, with major events (i.e., all-cause death, stroke, transient ischemic attack, peripheral embolism, severe bleeding) analyzed according to the treatment group (OAC vs no OAC). Of 269 patients included in the present study (87 men, mean age 83 ± 3 years), 164 received OAC (61%). After 2.8 ± 1.9 years of follow-up, the raw rates (per 100 patient-years) of embolic events (1.52% vs 8.30%, p <0.0001) and mortality (6.67% vs 10.94%, p = 0.04) were lower for patients receiving OAC, with a nonsignificant greater rate of severe bleeding (3.03% vs 1.25%, p = 0.14). The probability of survival free of major embolic or hemorrhagic events at the mean follow-up was greater for patients receiving OAC (82.27% vs 66.10%, p = 0.004). After adjustment for age, gender, coronary heart disease, and embolic risk, evaluated using the CHADS(2) score (congestive heart failure, 1 point; hypertension [blood pressure consistently >140/90 mm Hg or hypertension medication], 1 point; age ?75 years, 1 point; diabetes mellitus, 1 point; previous stroke or transient ischemic attack, 2 points), only OAC was an independent predictor of embolic events (hazard ratio 0.17, 95% confidence interval 0.07 to 0.41, p <0.001). The CHADS(2) score (hazard ratio 1.32, 95% confidence interval 1.01 to 1.73, p = 0.04) and OAC (hazard ratio 0.52, 95% confidence interval 0.31 to 0.88, p = 0.01) were independent predictors of mortality. In conclusion, OAC according to the scientific societies' recommendations is effective and safe in daily clinical practice, even in patients aged ?80 years.

PMID: 21420049 [PubMed - as supplied by publisher]

Link to Article at PubMed

A New Protocol Using Sodium Bicarbonate for the Prevention of Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography.

Am J Cardiol Start a Discussion »

Mar 232011

A New Protocol Using Sodium Bicarbonate for the Prevention of Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography.

Am J Cardiol. 2011 Mar 18;

Authors: Motohiro M, Kamihata H, Tsujimoto S, Seno T, Manabe K, Isono T, Sutani Y, Yuasa F, Iwasaka T

Contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality rates. Although a previous study reported that pretreatment with sodium bicarbonate is more effective than sodium chloride for prophylaxis of CIN, this has not been a universal finding. We performed a prospective randomized trial to investigate whether CIN can be avoided using sodium bicarbonate. In total 155 patients with a glomerular filtration rate (GFR) <60 ml/min/1.73 m(2) who were undergoing coronary angiography were enrolled. We assigned patients to sodium chloride plus sodium bicarbonate (bicarbonate group, n = 78) or sodium chloride alone (chloride group, n = 77). Infusion of sodium bicarbonate at 1 ml/kg/hour continued from 3 hours before to 6 hours after coronary angiography. CIN was defined as a 25% increase in serum creatinine from baseline value or an absolute increase of ?0.5 mg/dl, which appeared within 2 days of contrast. Baseline GFR was not significantly different between the 2 groups. Patients in the bicarbonate group had a higher GFR than those in the chloride group on day 2 (45.8 ± 13.4 vs 40.9 ± 14.6 ml/min/1.73 m(2), p = 0.031) and at 1 month (49.5 ± 14.7 vs 43.7 ± 15.5 ml/min/1.73 m(2), p = 0.019). CIN occurred in 10 patients (13%) in the chloride group but in only 2 patients (2.6%) in the bicarbonate group (p = 0.012). Sodium chloride plus sodium bicarbonate is more effective than sodium chloride alone for prophylaxis of CIN and can lead to retention of better long-term renal function.

PMID: 21420053 [PubMed - as supplied by publisher]

Link to Article at PubMed

Serological responses following influenza a h1n1 2009 infection in adults.

J Infect Start a Discussion »

Mar 232011

Serological responses following influenza a h1n1 2009 infection in adults.

J Infect. 2011 Mar 17;

Authors: Tan S, Gordon DL, Honda-Okubo Y, Petrovsky N, Phillips P, Huddleston S, Sadlon TA

OBJECTIVE: : The aim of this study was to determine the humoral immune response to influenza A H1N1 2009 and cross reactivity against seasonal H1N1 and H3N2 strains. Methods: Baseline and convalescent sera from 88 subjects with confirmed H1N1 2009 was screened for serological responses by HAI assay. RESULTS: : Protective antibody titres to H1N1 2009 were present in 87% post-infection, but varied with age, sex and pregnancy. Some cross reactivity with seasonal influenza strains was observed. CONCLUSIONS: : Females and pregnant subjects had an attenuated immune response to H1N1 2009 in comparison to the rest of the study population. Antibodies from the serum of H1N1 2009 infected subjects cross reacted with seasonal H1N1 and H3N2 influenza viruses.

PMID: 21420426 [PubMed - as supplied by publisher]

Link to Article at PubMed

Biological markers and diagnosis of ventilator-associated pneumonia.

Crit Care Start a Discussion »

Mar 232011

Biological markers and diagnosis of ventilator-associated pneumonia.

Crit Care. 2011 Mar 9;15(2):130

Authors: Fagon JY

ABSTRACT: Evaluation of a new biomarker from bronchoalveolar fluid, the Clara cell protein 10, adds data to the search for a diagnostic marker for ventilator-associated pneumonia (VAP). For more than 15 years, investigators tried to identify such a marker for predicting or diagnosing VAP. Unfortunately, the results of a number of these studies are disappointing. For optimal management of critically ill, ventilated patients with clinical suspicion of VAP, clinicians need accurate microbiological information to decide to treat in case of confirmed infection and to guide the initial choice of antibiotic therapy with identification of the responsible pathogen(s). Thus, today, the potential advantages of biomarkers are to improve the rapidity and performance of current diagnostic procedures and to reduce antibiotic exposure and selective pressure.

PMID: 21418551 [PubMed - as supplied by publisher]

Link to Article at PubMed

Acquired bloodstream infection in the intensive care unit: incidence and attributable mortality.

Crit Care Start a Discussion »

Mar 232011

Acquired bloodstream infection in the intensive care unit: incidence and attributable mortality.

Crit Care. 2011 Mar 21;15(2):R100

Authors: Prowle JR, Echeverri JE, Ligabo EV, Sherry N, Taori GC, Crozier TM, Hart GK, Korman TM, Mayall BC, Johnson PD, Bellomo R

ABSTRACT: INTRODUCTION: To estimate the incidence of intensive care unit (ICU)-acquired bloodstream infection (BSI) and its independent effect on hospital mortality. METHODS: We retrospectively studied acquisition of BSI during admissions of >72 hours to adult ICUs from two university-affiliated hospitals. We obtained demographics, illness severity and co-morbidity data from ICU databases and microbiological diagnoses from departmental electronic records. We assessed survival at hospital discharge or at 90 days if still hospitalized. RESULTS: We identified 6339 ICU admissions, 330 of which were complicated by BSI (5.2%). Median time to first positive culture was 7 days (IQR 5-12). Overall mortality was 23.5%, 41.2% in patients with BSI and 22.5% in those without. Patients who developed BSI had higher illness severity at ICU admission (median APACHE III score: 79 vs. 68, P<0.001). After controlling for illness severity and baseline demographics by Cox proportional-hazard model, BSI remained independently associated with risk of death (hazard ratio from diagnosis 2.89; 95% confidence interval 2.41-3.46; P<0.001). However, only 5% of the deaths in this model could be attributed to acquired-BSI, equivalent to an absolute decrease in survival of 1% of the total population. When analyzed by microbiological classification, Candida, Staphylococcus aureus and gram-negative bacilli infections were independently associated with increased risk of death. In a sub-group analysis intravascular catheter associated BSI remained associated with significant risk of death (hazard ratio 2.64; 95% confidence interval 1.44-4.83; P=0.002). CONCLUSIONS: ICU-acquired BSI is associated with greater in-hospital mortality, but complicates only 5% of ICU admissions and its absolute effect on population mortality is limited. These findings have implications for the design and interpretation of clinical trials.

PMID: 21418635 [PubMed - as supplied by publisher]

Link to Article at PubMed

Older Entries

March 2011
M	T	W	T	F	S	S
« Feb				Apr »
	1	2	3	4	5	6
7	8	9	10	11	12	13
14	15	16	17	18	19	20
21	22	23	24	25	26	27
28	29	30	31