scholarly journals Not-high before-treatment platelet reactivity in patients with STEMI:prevalence, clinical characteristics, response to therapy and outcomes

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M E Canonico ◽  
G D Sanna ◽  
R Siciliano ◽  
S Guarino ◽  
B Bellandi ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Platelet Reactivity ◽  
Significant Proportion ◽  
Kidney Injury ◽  
Male Gender ◽  
Response To Therapy ◽  
P2y12 Inhibitor ◽  
Young Males ◽  
High Platelet Reactivity ◽  
Funding Sources

Abstract Background Platelet reactivity (PR) has been indicated as a pathophysiological key element for ST-Elevation Myocardial Infarction (STEMI) development. In STEMI patients, PR following pharmacological treatment has been extensively studied with focus on patients with on-treatment high platelet reactivity (HPR). Patients with before-treatment not-high platelet reactivity (NHPR) have been poorly studied so far. Purpose Aim of the study is to investigate the prevalence, clinical characteristics, response to therapy and outcomes of baseline prior to treatment NHPR among patients with STEMI undergoing primary PCI. Methods We analysed the data from 358 STEMI patients with assessment of PR by VerifyNowbefore P2Y12 inhibitor loading dose (LD). All patients received a P2Y12 inhibitor (ticagrelor or prasugrel) LDafter baseline PR assessment. Blood samples were obtained at baseline (T0), and after 1 hour (T1), 2 hours (T2), 4–6 hours (T3) and 8–12 hours (T4) after LD. HPR was defined as Platelet Reactivity Unit values ≥208, while patients with values <208 at baseline were defined as having NHPR. Results Overall, 20% patients had NHPR. Patients with before-treatment NHPR values were more frequently young, of male gender and more frequently smokers (p=0.005), overweight or obese (p=0.009), affected by dyslipidemia (p=0.03) and with a family history of coronary artery disease (p=0.04). Age and male gender resulted both independent predictors of NHPR, even after propensity score adjustment. The percentage of inhibition of PR after ticagrelor or prasugrel LD was similar between HPR and NHPR patients at each time point (figure 1) and residual PR was constantly lower in patients with before-treatment PRU <208 from baseline to 8–12 hours from LD (figure 2). However, patients with HPR showed worse in-hospital clinical outcomes, and the composite adverse outcome endpoint of death, reinfarction, stroke, acute kidney injury or heart failure was significantly higher (10.0% vs 1.4%; p=0.017) as compared with the NHPR group. Conclusions A significant proportion of patients presenting with STEMI has a baseline NHPR; they are predominantly young males with a high-risk cardiovascular profile. NHPR is associated with better in-hospital outcomes as compare with patients with HPR. Further studies are needed to better understand the underlying pathophysiology in order to find out potential personalized treatments in this setting. FUNDunding Acknowledgement Type of funding sources: None.

Not-high before-treatment platelet reactivity in patients with STEMI: prevalence, clinical characteristics, response to therapy and outcomes

Platelets ◽  
2021 ◽  
pp. 1-8
Author(s):  
Mario E. Canonico ◽  
Giuseppe D. Sanna ◽  
Roberta Siciliano ◽  
Simona Guarino ◽  
Benedetta Bellandi ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Platelet Reactivity ◽  
Response To Therapy

scholarly journals 211 Impact of smoking habits on baseline and on-treatment platelet reactivity in STEMI patients treated with third generation P2Y12

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Mario Enrico Canonico ◽  
Fernando Scudiero ◽  
Giuseppe Damiano Sanna ◽  
Marisa Avvedimento ◽  
Attilio Leone ◽  
...  
Keyword(s):  
Adverse Event ◽  
Platelet Reactivity ◽  
Smoking Habit ◽  
Kidney Injury ◽  
Left Ventricular ◽  
Smoking Habits ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
P2y12 Inhibitor ◽  
The Impact

Abstract Aims Smoking habit is a well-known risk factor for cardiovascular disease. High on-treatment platelet reactivity has been associated with high risk of ischaemic events in STEMI patients. The relationship between platelet reactivity and smoking habit was investigated only in few studies, and the impact of smoke on platelet reactivity in STEMI patients treated with 3rd generation P2Y12 inhibitor is still lacking. This study aim to assess the impact of smoking habits on baseline and on-treatment platelet reactivity in STEMI patients treated with 3rd generation P2Y12 inhibitor. Methods Overall, 429 STEMI patients were enrolled in this study. Patients were divided into two groups according to smoking habit. Platelet reactivity was assessed by VerifyNow at baseline and after 3rd generation P2Y12 inhibitor (ticagrelor or prasugrel) loading dose (LD). Blood samples were obtained at baseline (T0), and after 1 h (T1), 2 h (T2), 4w6 h (T3) and 8–12 h (T4) after LD. Results The mean age of the enrolled population was 62 ± 12 and male rate was 75%. Patients with smoking habit were younger (75.8% vs. 38.9%, P < 0.001 for age <65 years), with higher prevalence of family history of CAD, while with a lower rate hypertension (43.4% vs. 65.9%, P < 0.001) and previous myocardial infarction (5.3% vs. 11.4%, P = 0.022). Smoker patients had lower platelet reactivity either at baseline [T0: 249 (205–285) vs. 284 (230–324), P < 0.001] or at 2 h after the LD [T2: 107 (18–279) vs. 136 (51–260), P = 0.003]. Similarly, Smoker patients experienced a lower rate of in-hospital composite adverse event of death, Re-infarction, stroke or acute kidney injury (1.6% vs. 12.4%; P≤0.001). Multivariate analysis demonstrated that left ventricular ejection fraction at admission (OR = 0.916, 95% CI 0.865–0.969; P = 0.002), and platelet reactivity at baseline (OR = 1.013, 95% CI 1.002–1.024; P = 0.024) were independent predictors of in-hospital composite adverse event. Conclusions Smoker status is associated with lower platelet reactivity either at baseline or after LD and with a better short-term prognosis in STEMI patients treated by dual antiplatelet therapy with ticagrelor or prasugrel.

scholarly journals Drug-Induced Acute Kidney Injury: A Study from the French Medical Administrative and the French National Pharmacovigilance Databases Using Capture-Recapture Method

2021 ◽  
Vol 10 (2) ◽  
pp. 168
Author(s):  
Anne-Lise Rolland ◽  
Anne-Sophie Garnier ◽  
Katy Meunier ◽  
Guillaume Drablier ◽  
Marie Briet
Keyword(s):  
Acute Kidney Injury ◽  
Medical Information ◽  
Significant Proportion ◽  
Kidney Injury ◽  
International Classification Of Diseases ◽  
Administrative Databases ◽  
Health Concern ◽  
Medical Information System ◽  
Drug Induced ◽  
Capture Recapture

Background: Acute kidney injury (AKI) is a public health concern. Among the pathological situations leading to AKI, drugs are preventable factors but are still under-notified. We aimed to provide an overview of drug-induced AKI (DIAKI) using pharmacovigilance and medical administrative databases Methods: A query of the PMSI database (French Medical Information System Program) of adult inpatient hospital stays between 1 January 2017 and 31 December 2018 was performed using ICD-10 (International Classification of Diseases 10th revision) codes to identify AKI cases which were reviewed by a nephrologist and a pharmacovigilance expert to identify DIAKI cases. In parallel, DIAKIs notified in the French Pharmacovigilance Database (FPVDB) were collected. A capture-recapture method was performed to estimate the total number of DIAKIs. Results: The estimated total number of DIAKIs was 521 (95%CI 480; 563), representing 20.0% of all AKIs. The notification was at a rate of 12.9% (95%CI 10.0; 15.8). According to the KDIGO classification, 50.2% of the DIAKI cases were stage 1 and 49.8% stage 2 and 3. The mortality rate was 11.1% and 9.6% required hemodialysis. Conclusion: This study showed that drugs are involved in a significant proportion of patients developing AKI during a hospital stay and emphasizes the severity of DIAKI cases.

scholarly journals Clinical characteristics and prognosis of postpartum acute kidney injury

2021 ◽  
Vol 49 (2) ◽  
pp. 030006052098838
Author(s):  
Hong Shu ◽  
Fang Nie
Keyword(s):  
Acute Kidney Injury ◽  
Clinical Characteristics ◽  
Survival Rates ◽  
Kidney Injury ◽  
Renal Recovery ◽  
Replacement Treatment ◽  
Elevated Liver Enzymes ◽  
Recovery Times ◽  
Low Platelet Count ◽  
Lost To Follow Up

Objective To investigate the clinical characteristics and prognoses of patients with postpartum acute kidney injury (PPAKI). Methods We retrospectively reviewed the clinical presentations, laboratory examinations, treatments, and outcomes of patients with PPAKI admitted to our hospital from January 2013 to December 2017. We then analyzed the clinical characteristics and prognoses of the mothers and their infants. Results Of 37 patients diagnosed with PPAKI, 26 (70.3%) received treatment in the intensive care unit, mainly for hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome (28/37, 75.7%), pre-eclampsia (26/37, 70.3%), and postpartum hemorrhage (22/37, 59.5%). Twenty patients required renal replacement treatment (RRT), but renal recovery times were similar in the RRT and non-RRT groups. Renal function recovered completely in 30 patients (81.1%) and partially in one patient (2.7%), and was not re-examined in two patients (5.4%). Three patients (8.1%) were lost to follow-up. Only one patient (2.7%) remained dialysis-dependent, and no maternal deaths occurred. The preterm birth, low birth weight, and infant survival rates were 70.7% (29/41), 68.3% (28/41), and 78.0% (32/41), respectively. Conclusion RRT does not reduce renal recovery time compared with non-RRT. Overall, the prognoses of both mothers and their fetuses are good following treatment for PPAKI.

Myositis-associated Interstitial Lung Disease: Predictors of Failure of Conventional Treatment and Response to Tacrolimus in a US Cohort

2017 ◽  
Vol 44 (11) ◽  
pp. 1612-1618 ◽  
Author(s):  
Niharika Sharma ◽  
Michael S. Putman ◽  
Rekha Vij ◽  
Mary E. Strek ◽  
Anisha Dua
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Clinical Characteristics ◽  
Conventional Treatment ◽  
Case Reports ◽  
Response To Therapy ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Small Series ◽  
The Mean

Objective.Patients with myositis-associated interstitial lung disease (MA-ILD) are often refractory to conventional treatment, and predicting their response to therapy is challenging. Recent case reports and small series suggest that tacrolimus may be useful in refractory cases.Methods.A retrospective cohort study of patients with MA-ILD comparing clinical characteristics between those who responded to or failed conventional treatment. In those who failed conventional treatment and received adjunctive tacrolimus, response to tacrolimus was measured by the improvement in myositis, ILD, and change in the dose of glucocorticoids.Results.Thirty-one of 54 patients (57%) responded to conventional treatment based on the predefined variables of improvement in myositis and/or ILD. Patients with polymyositis (PM)-ILD were more likely to respond to conventional treatment than those with dermatomyositis (DM)-ILD (67% vs 35%, p = 0.013). Twenty-three patients failed conventional treatment, 18 of whom subsequently received adjunctive tacrolimus. Ninety-four percent had improvements in ILD and 72% showed improvement in both myositis and ILD. The mean doses of prednisone decreased from baseline by 65% at 3–6 months (p = 0.002) and 81% at 1 year (p < 0.001).Conclusion.Patients with PM-ILD were more likely to respond to conventional treatment than patients with DM-ILD, but clinical characteristics and serology did not otherwise predict response to therapy. A majority of patients with MA-ILD refractory to conventional therapy improved while receiving tacrolimus and were able to decrease their dose of both glucocorticoids and other disease-modifying antirheumatic drugs.

scholarly journals Clinical outcomes in patients treated for coronary in-stent restenosis with drug-eluting balloons: Impact of high platelet reactivity

PLoS ONE ◽  
2017 ◽  
Vol 12 (12) ◽  
pp. e0188493 ◽  
Author(s):  
Adrienn Tornyos ◽  
Dániel Aradi ◽  
Iván G. Horváth ◽  
Attila Kónyi ◽  
Balázs Magyari ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Platelet Reactivity ◽  
High Platelet Reactivity ◽  
Stent Restenosis ◽  
Drug Eluting ◽  
In Stent Restenosis

scholarly journals Morphological and immunohistochemical predictors of renal response to therapy patients with myeloma cast nephropathy and dialysis-dependent acute kidney injury

2020 ◽  
Vol 92 (7) ◽  
pp. 63-69
Author(s):  
I. G. Rekhtina ◽  
E. V. Kazarina ◽  
E. S. Stolyarevich ◽  
A. M. Kovrigina ◽  
V. N. Dvirnyk ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Prognostic Value ◽  
Interstitial Fibrosis ◽  
Kidney Injury ◽  
Response To Therapy ◽  
Tubular Damage ◽  
Renal Response ◽  
Cast Nephropathy ◽  
Myeloma Cast Nephropathy ◽  
E Cadherin

Aim.Reveal morphological and immunohistochemical predictors of reversibility of dialysis-dependent acute kidney injury (AKI) in patients with myeloma cast nephropathy (MCN) based on the study of kidney biopsy. Materials and methods.Renal pathological findings were studied in 36 patients with MCN and dialysis-dependent stage 3 AKI (AKIN, 2012). The study of biopsy samples was performed by a semi-quantitative and quantitative analysis using computer morphometry. The expression of E-cadherin, vimentin and-smooth muscle actin was determined immunohistochemically in the tubular cells and interstitium. Induction therapy for 26 patients was carried out to bortezomib-based programs; in 10 patients other schemes were used. A comparative analysis of morphological changes in nephrobiopathy depending on the renal response was performed in patients with achieved hematologic remission. Results.Improved renal function was observed only in patients with hematologic response to therapy. There were no differences in the number of sclerotic glomeruli, protein casts, the area of inflammatory interstitial infiltration, and the degree of acute tubular damage in patients with and without renal response. In patients with renal response compared with patients without improving renal function, the area of interstitial fibrosis was less (24.9% and 45.9%, respectively;p=0.001), and the area of E-cadherin expression was larger (15.9% and 7.1%, respectively;p=0.006). Interstitial fibrosis of 40% or more and/or the area of expression of E-cadherin less than 10% of the area of tubulo-interstitium have an unfavorable prognostic value in achieving a renal response in MCN. Conclusion.If the interstitial fibrosis area is 40% or more and the expression area of E-cadherin is less than 10%, the probability of the absence of a renal response is 93.3% (OR=24.5) even when a hematological response to induction therapy is achieved. The number of protein casts, the prevalence of acute tubular damage and inflammatory interstitial infiltration have not prognostic value.

scholarly journals Erythroderma caused by vancomycin in children: concentration and speed of infusion

2013 ◽  
Vol 1 (2) ◽  
Author(s):  
José F. Luna Álvarez ◽  
Mónica Gómez Vázquez ◽  
Ana L. Moreno González ◽  
Aldo Melchor Hernández ◽  
Marco A. Escamilla-Acosta ◽  
...  
Keyword(s):  
Adverse Reaction ◽  
Clinical Practice ◽  
Retrospective Study ◽  
Clinical Characteristics ◽  
Male Gender ◽  
The Other ◽  
Paediatric Hospital ◽  
Other Hand ◽  
Red Man Syndrome ◽  
Main Factors

Vancomycin is an antibiotic glycopeptide that was isolated of the Streptomyces orientalis. It was introduced in the clinical practice for treatment of infections caused by staphylococcus in which other antibiotics were proving to be ineffective. In this retrospective study, we determine its prescription, clinical characteristics as well as the factors that favor the apparition of the erythroderma or red-man syndrome in a paediatric hospital. Forty patients to which physicians administer vancomycin and presented erythroderma were evaluated. Male gender was more predominated, with a total of 25 cases (62.5 %). The average age was of 12 ± 6 years. We identified two main factors that are directly related to the appearance of erythroderma. On one hand, the "concentration of the drug", which is related to the dilution that it is realized when a dose of vancomycin is going to be administered to the patient and on the other hand the “time or speed of infusion”. In the present study, it was found a low incident of this adverse reaction and few cases of complications.

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