scholarly journals Bleeding and Thrombotic Risk in Low Dose Heparin Infusion As Compared to Standard Dose Heparin Infusion

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1251-1251
Author(s):  
Forat Lutfi ◽  
Rohit Boshnoi ◽  
Vikas Patel ◽  
Aisha Alfasi ◽  
Michael Setteducato ◽  
...  
Keyword(s):  
Activity Level ◽  
Patient Specific ◽  
Heparin Infusion ◽  
Thrombotic Risk ◽  
Coronary Syndrome ◽  
Risk Of Bleeding ◽  
Low Intensity ◽  
Dose Heparin ◽  
Standard Intensity ◽  
Significant Difference

Abstract Introduction: At our institution, therapeutic use of unfractionated heparin (UFH) is administered by standard (target anti-Xa activity level 0.30 to 0.70 IU/mL) and low intensity (target anti-Xa activity level 0.25 to 0.35 IU/mL) protocols. In patients deemed high-risk for hemorrhage, the low intensity protocol is often employed. However, to date, there has been little study of differences in adverse events, namely hemorrhage, and efficacy between intensity protocols. Furthermore, identifying the effect of patient specific factors (e.g. age, indication for UFH, anticoagulant and antiplatelet use, medical, and surgical history) on outcomes has the potential to assist in determining the most optimal protocol. Methods: A total of 377 adult patients receiving therapeutic UFH from July 2011 to July 2017 at a single institution were retrospectively studied. Patients receiving UFH by acute coronary syndrome protocol and those receiving thrombolytics were excluded. IRB approval was obtained prior to collection of data. Results: Of the 377 patients, 42.0% (158/377) and 58.0% (219/377) were on low and standard intensity protocols, respectively. The majority of patients 76.1% (287/377) received an initial bolus. Patients were predominately Caucasian 74.0% (279/377), with median age of 63 years-old, and near equal gender distribution. The main indications for therapeutic UFH were venous thromboembolism VTE 46.9% (177/377) and atrial fibrillation 18.6% (70/377.) The indication for UFH was comparable between both groups with the exception of a higher percentage of those on full intensity protocol being treated for VTE (53.4% vs 38.0%.) Many patients were on home antiplatelet 35.0% (132/377) and anticoagulant 33.2% (125/377) therapy. The percentage of patients on aspirin, antiplatelet, and injectable anticoagulants was similar in both groups. A higher percentage of patients on low intensity protocol were on oral anticoagulants (36.1% vs 24.2%.) The median HAS-BLED score was two in both groups. Low intensity protocol patients were more likely to have had a history of previous bleeding (24.1% vs 12.8%) and had higher incidence of bleeding (10.8% vs 7.8%) than patients receiving standard intensity protocol. Transfusion requirement was greater in the low intensity protocol (29.7% vs 16.4%.) Both groups had similar risk of developing new thrombi (3.2% vs 3.7%) during the study period. All-cause mortality at three-months was higher in the low intensity group (19.6% vs 15.1%.) However, only 3.1% (2/64) of deaths within three-months were due to hemorrhage while on UFH and both were on the standard intensity protocol. Conclusion: Low intensity UFH infusion is used in patients in whom there is clinical concern for increased risk of bleeding. Bleeding rates with both low and standard intensity protocols was comparable (10.8% vs 7.8%), although patients on the low intensity protocol had notably higher transfusion rates (29.7% vs 16.4%.) Rates of new or worsening thrombi were comparable (3.2% vs 3.7%.) Initial analysis of our data suggests that there is not a clinically significant difference in studied outcomes between standard and low intensity protocols. Furthermore, in patients where this is high clinical risk of bleeding, a low intensity protocol can be utilized with similar therapeutic efficacy as a standard intensity protocol. Table Table. Disclosures No relevant conflicts of interest to declare.

scholarly journals Perioperative Management of Chronic Antithrombotic Agents in Elective Hip and Knee Arthroplasty

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 188
Author(s):  
Daniel C. Santana ◽  
Matthew J. Hadad ◽  
Ahmed Emara ◽  
Alison K. Klika ◽  
Wael Barsoum ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Perioperative Management ◽  
Recent Literature ◽  
Patient Specific ◽  
Antithrombotic Agents ◽  
Coronary Syndrome ◽  
Risk Of Bleeding ◽  
Post Operative Period ◽  
Number Of Patients ◽  
Hip And Knee Arthroplasty

Total hip and knee arthroplasty are common major orthopedic operations being performed on an increasing number of patients. Many patients undergoing total joint arthroplasty (TJA) are on chronic antithrombotic agents due to other medical conditions, such as atrial fibrillation or acute coronary syndrome. Given the risk of bleeding associated with TJAs, as well as the risk of thromboembolic events in the post-operative period, the management of chronic antithrombotic agents perioperatively is critical to achieving successful outcomes in arthroplasty. In this review, we provide a concise overview of society guidelines regarding the perioperative management of chronic antithrombotic agents in the setting of elective TJAs and summarize the recent literature that may inform future guidelines. Ultimately, antithrombotic regimen management should be patient-specific, in consultation with cardiology, internal medicine, hematology, and other physicians who play an essential role in perioperative care.

scholarly journals Dual therapy in a patient with atrial fibrillation at high risk of bleeding

ABOUTOPEN ◽  
2018 ◽  
Vol 4 (1) ◽  
pp. 104-109
Author(s):  
Andrea Rolandi
Keyword(s):  
Atrial Fibrillation ◽  
Triple Therapy ◽  
Oral Anticoagulant Therapy ◽  
Dual Therapy ◽  
Thrombotic Risk ◽  
Coronary Syndrome ◽  
Risk Of Bleeding ◽  
Hemorrhagic Events ◽  
The Individual ◽  
The Right

In patients with atrial fibrillation (AF) undergoing coronary angioplasty (PCI) the guidelines recommend the use of triple therapy (oral anticoagulant therapy in addition to dual antiplatelet therapy) for varying periods depending on the individual patient's risk profile, limiting the possibility of starting immediately with dual antithrombotic therapy to patients with relevant haemorrhagic risk. Triple therapy is associated with a high frequency of major bleeding; in recent years there have been several studies investigating new therapeutic strategies attempting to reduce the risk of bleeding without increasing the thrombotic risk. We report the case of an elderly patient suffering from hypertension, a previous acute coronary syndrome with anterior descending stenting and permanent AF treated with dabigatran 110 mg bid for 2 years. The patient is admitted to hospital for syncope with facio-brachio-crural hemiparesis associated with myocardial infarction; she is treated with idarucizumab and coronary angiography shows trivessel disease with acute occlusion of the right proximal coronary arteru. This case is an example of how in a patient with AF, in which the risk of bleeding increases 4-fold, the adoption of the dual therapy rather than the triple therapy immediately after the acute event (according to data from the RE-DUAL PCI) or after 1 month (according to the guidelines), can prove effective over the long term, ensuring adequate protection both from hemorrhagic events and from the risk of stent thrombosis (Cardiology).

scholarly journals Comparison of Clinical Outcomes Between Ticagrelor and Clopidogrel in Acute Coronary Syndrome: an Updated Meta-Analysis

2021 ◽  
Author(s):  
Mengyi Sun ◽  
Weichen Cui ◽  
Linping Li
Keyword(s):  
Clinical Trials ◽  
Acute Coronary Syndrome ◽  
Clinical Outcomes ◽  
Observational Studies ◽  
Meta Analysis ◽  
Therapeutic Effects ◽  
Minor Bleeding ◽  
Coronary Syndrome ◽  
Risk Of Bleeding ◽  
Significant Difference

Abstract Background: Ticagrelor is currently recommended for patients with acute coronary syndrome (ACS). However, recent studies have yielded controversial results. Objective: To compare the clinical outcomes of ticagrelor and clopidogrel in ACS patients.Methods: Three electronic databases were queried until April 1, 2021. Major adverse cardiovascular event (MACE) was the primary efficacy endpoint. The secondary efficacy endpoints included stroke, stent thrombosis (ST), cardiovascular (CV) death, all-cause death, and myocardial infarction (MI). The safety endpoints were (major and minor) bleeding. Odds ratios (ORs) and 95% confidence intervals (CIs) and were calculated to represent the estimated effect sizes.Results: Nine clinical trials and 18 observational studies with 269,935 ACS patients were included. No significant difference was detected in MACE (OR 0.76, 95% CI 0.54-1.06, p = 0.11, I² = 66.74%), but ticagrelor introduced a higher risk of bleeding (1.49, 1.14-1.94, 0.00, 63.97%) and minor bleeding (1.57, 1.08-2.30, 0.02, 59.09%) in clinical trials. The secondary efficacy endpoints differed between clinical trials and observational studies. Subgroup analysis demonstrated that ticagrelor showed better therapeutic effects in patients underwent PCI (0.38, 0.23-0.63, 0.00, 0) than those intended for PCI (1.02, 0.70-1.49, 0.93, 68.99%). Meanwhile ticagrelor showed different therapeutic effects on ACS patients of different ethnicities and from different countries.Conclusion:This meta-analysis demonstrated that ticagrelor is not superior to clopidogrel in MACE but is associated with a higher risk of bleeding in ACS patients. Different PCI strategies, ethnicities, and countries may be the factors that contribute to different therapeutic efficacy of ticagrelor.

scholarly journals Bleeding and Thrombotic Risk in Low Dose Heparin Infusion as Compared to Standard Dose Heparin Infusion

Cureus ◽  
2020 ◽  
Author(s):  
Forat Lutfi ◽  
Rohit Bishnoi ◽  
Vikas Patel ◽  
Aisha Elfasi ◽  
Michael Setteducato ◽  
...  
Keyword(s):  
Low Dose ◽  
Standard Dose ◽  
Heparin Infusion ◽  
Thrombotic Risk ◽  
Dose Heparin ◽  
Low Dose Heparin

Physical Activity Level and Motor Aptitude: Motor Domains and Identification Capacity of Brazilian Insufficiently Active Older Adults

2020 ◽  
Vol 13 ◽  
Author(s):  
Lucia Maria Andreis ◽  
Fernando de Aguiar Lemos ◽  
Lorenna Walesca de Lima Silva ◽  
Cassiana Luiza Pistorello Garcia ◽  
Gabrielli Veras ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Physical Activity Level ◽  
Area Under The Curve ◽  
The Elderly ◽  
Activity Level ◽  
General Motor ◽  
Body Scheme ◽  
Significant Difference ◽  
Global Coordination

Background: A decrease in the physical activity level in old age is common, which results in an increase in the number of falls and chronic conditions. Associated with that occurs the decline in motor skills as a result of the deficit in the interaction of cognitive and motor processes. Physical activity level can be associated differently with each motor domains. Objective: We analyzed the relationship between physical activity level and motor aptitude, and to identify which motor domains were most sensitive to detect insufficiently active level in older adults. Methods: Participated in the study 385 elderly people of both sexes. For the evaluation of the subjects were adopted the International Questionnaire on Physical Activity and the Motor Scale for Older Adults. Results: The majority of the elderly were active. In the comparison of motor aptitude between active and insufficiently active (IAC) elders a significant difference was found in the Global Coordination, Balance, Body Scheme and General Motor Aptitude. From the analysis of the area under the curve (AUC), we verified that these domains also were the ones that presented adequate diagnostic accuracy to identify IAC elderly. Besides that active elderly have presented the General Motor Aptitude classified within normality while the IAC below the normal. Conclusion: Our data suggest that IAC older adults present lower motor aptitude than the active elderly, especially in the domains of Global Coordination, Balance, Body Scheme and General Motor Aptitude, and that these domains were sensitive to indicate IAC older adults.

Quality of Life, Physical Activity Level and Psychological Profile of Nigerians with Serious Mental Illness and Healthy Psychotropic Naive Subjects (Preprint)

2020 ◽  
Author(s):  
Christian Arinze Okonkwo ◽  
Peter Olarenwaju Ibikunle ◽  
Izuchukwu Nwafor ◽  
Andrew Orovwigho
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Mental Illness ◽  
Serious Mental Illness ◽  
Activity Level ◽  
Psychological Profile ◽  
Cross Sectional Survey ◽  
Significant Difference ◽  
Apparently Healthy

BACKGROUND Quality of life (QoL), physical activity (PA) level and psychological profile (PF) of patients with serious mental illness have been neglected during patient’s management OBJECTIVE The purpose of this study was to determine the effect of selected psychotropic drugs on the QoL, PA level and PF of patients with serious mental illness METHODS A cross sectional survey involving one hundred and twenty-four subject [62 Serious Mental Illness (SMI) and 62 apparently healthy subjects as control] using purposive and consecutive sampling respectively .Questionnaires for each of the constructs were administered to the participants for data collation. Analysis of the data was done using non parametric inferential statistics of Mann-Whitney U independent test and Spearman’s rho correlation with alpha level set as 0.05. RESULTS Significant difference was recorded in the QoL (p<0.05) of patient with SMI and apparently healthy psychotropic naive participants. There was a significant correlation between the QoL (p<0.05) and PF of participants with SMI. Participants with SMI had significantly lower QoL than apparently healthy psychotropic naive subject. QoL of the healthy psychotropic naive group was better than those of the participants with SMI. Female participants with SMI had higher PA than their male counterparts CONCLUSIONS Psychological profiles of male participants with SMI were lower than male healthy psychotropic naive participants. Clinicians should take precaution to monitor the QoL, PA level and PF because the constructs are relevant in evaluation of treatment outcome.

Effects of Low-Dose Heparin Infusion on Arterial Endothelin-1 Release in Humans

Circulation ◽  
1996 ◽  
Vol 94 (11) ◽  
pp. 2703-2707 ◽  
Author(s):  
P.M. Piatti ◽  
L.D. Monti ◽  
G. Valsecchi ◽  
M. Conti ◽  
R. Nasser ◽  
...  
Keyword(s):  
Low Dose ◽  
Heparin Infusion ◽  
Endothelin 1 ◽  
Dose Heparin ◽  
Low Dose Heparin

scholarly journals The effect of obstructive sleep apnoea on timing of acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.H Muhmad Hamidi ◽  
H Sani ◽  
M.A Ibrahim ◽  
K.S Ibrahim ◽  
A.B Md Radzi ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
High Risk ◽  
Systolic Function ◽  
Strong Association ◽  
Multiple Logistic Regression Analysis ◽  
Sleep Apnoea ◽  
Neck Circumference ◽  
Coronary Syndrome ◽  
Obstructive Sleep ◽  
Significant Difference

Abstract Background and objective Acute coronary syndrome (ACS) remains the principal cause of death in Malaysia. It is estimated about 20% of ACS occurs at nighttime during sleep between 12am to 6am. Factors associated with nocturnal ACS are unknown. Acute nocturnal pathophysiological response to obstructive sleep apnea (OSA) may increase risk of nocturnal ACS. We hypothesized that OSA risk is associated with timing of ACS onset. Methodology This study included 200 patients with ACS who underwent coronary angiogram for which the time of chest pain onset was clearly identified and divided into 2 groups; nocturnal ACS (12am-5.59am) and non-nocturnal ACS (6am–11.59pm). Two validated questionnaires, STOP-BANG and Epworth Sleepiness Scale (ESS) were self-administered by subjects to determine OSA risk. All subjects timing of ACS onset, OSA risk, demography, anthropometric measurements, comorbidities and echocardiographic characteristics were analyzed. Results Acute coronary syndrome occurs nocturnally in 19% of ACS patients. The prevalence of high risk OSA individuals among ACS patients is 43%. There is significantly higher prevalence of high risk OSA individuals in nocturnal ACS group of 95% compared to 30% of high risk OSA individuals in non-nocturnal ACS group (p=0.001). Nocturnal ACS patients was significantly younger (50.1±8.7yrs, p=0.001), had higher BMI (33.9±4.3kg/m2, p=0.005), waist circumference (106.7±10.3cm, p=0.003) and larger neck circumference (44.6±3.3cm, p=0.001) compared to non-nocturnal ACS group. These groups had similar prevalence of other comorbidities for ACS and showed no significant difference between left and right ventricular systolic function. In multiple logistic regression analysis, the most significant predictors for nocturnal ACS are OSA risk, neck circumference and age. Conclusion There is a strong association between high risk OSA individuals and nocturnal ACS onset. Patient with nocturnal ACS onset should be screened for OSA and prioritized for polysomnography. OSA prevalence according to ACS onset Funding Acknowledgement Type of funding source: None

An evaluation of a shoulder rehabilitation class in a UK hospital following evidence-based modifications

2021 ◽  
pp. 1-8
Author(s):  
Emily Kell ◽  
John A. Hammond ◽  
Sophie Andrews ◽  
Christina Germeni ◽  
Helen Hingston ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Shoulder Pain ◽  
Management Strategies ◽  
Cost Effective ◽  
Rehabilitation Programme ◽  
Patient Specific ◽  
Satisfaction Survey ◽  
Evidence Based ◽  
Patient Satisfaction Survey ◽  
Significant Difference

OBJECTIVES: Shoulder pain is a common musculoskeletal disorder, which carries a high cost to healthcare systems. Exercise is a common conservative management strategy for a range of shoulder conditions and can reduce shoulder pain and improve function. Exercise classes that integrate education and self-management strategies have been shown to be cost-effective, offer psycho-social benefits and promote self-efficacy. This study aimed to examine the effectiveness of an 8-week educational and exercise-based shoulder rehabilitation programme following the introduction of evidence-based modifications. METHODS: A retrospective evaluation of a shoulder rehabilitation programme at X Trust was conducted, comparing existing anonymised Shoulder Pain and Disability Index (SPADI) and Patient-Specific Functional Scale (PSFS) scores from two cohorts of class participants from 2017-18 and 2018-19 that were previously collected by the physiotherapy team. Data from the two cohorts were analysed separately, and in comparison, to assess class efficacy. Descriptive data were also analysed from a patient satisfaction survey from the 2018-19 cohort. RESULTS: A total of 47 patients completed the 8-week shoulder rehabilitation programme during the period of data collection (2018-2019). The 2018-19 cohort showed significant improvements in SPADI (p 0.001) and PSFS scores (p 0.001). No significant difference was found between the improvements seen in the 2017-18 cohort and the 2018-19 cohort. 96% of the 31 respondents who completed the patient satisfaction survey felt the class helped to achieve their goals. CONCLUSION: A group-based shoulder rehabilitation class, which included loaded exercises and patient education, led to improvements in pain, disability and function for patients with rotator cuff related shoulder pain (RCRSP) in this outpatient setting, but anticipated additional benefits based on evidence were not observed.

Comparison of prasugrel and ticagrelor for patient with acute coronary syndrome: a systematic review and meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L.C.W Fong ◽  
N Lee ◽  
A.T Yan ◽  
M.Y Ng
Keyword(s):  
Acute Coronary Syndrome ◽  
Stent Thrombosis ◽  
Meta Analysis ◽  
Composite Endpoint ◽  
Cardiovascular Death ◽  
Coronary Syndrome ◽  
Primary Composite Endpoint ◽  
Significant Difference ◽  
St Elevation

Abstract Background Prasugrel and ticagrelor are both effective anti-platelet drugs for patients with acute coronary syndrome. However, there has been limited data on the direct comparison of prasugrel and ticagrelor until the recent ISAR-REACT 5 trial. Purpose To compare the efficacy of prasugrel and ticagrelor in patients with acute coronary syndrome with respect to the primary composite endpoint of myocardial infarction (MI), stroke or cardiac cardiovascular death, and secondary endpoints including MI, stroke, cardiovascular death, major bleeding (Bleeding Academic Research Consortium (BARC) type 2 or above), and stent thrombosis within 1 year. Methods Meta-analysis was performed on randomised controlled trials (RCT) up to December 2019 that randomised patients with acute coronary syndrome to either prasugrel or ticagrelor. RCTs were identified from Medline, Embase and ClinicalTrials.gov using Cochrane library CENTRAL by 2 independent reviewers with “prasugrel” and “ticagrelor” as search terms. Effect estimates with confidence intervals were generated using the random effects model by extracting outcome data from the RCTs to compare the primary and secondary clinical outcomes. Cochrane risk-of-bias tool for randomised trials (Ver 2.0) was used for assessment of all eligible RCTs. Results 411 reports were screened, and we identified 11 eligible RCTs with 6098 patients randomised to prasugrel (n=3050) or ticagrelor (n=3048). The included trials had a follow up period ranging from 1 day to 1 year. 330 events on the prasugrel arm and 408 events on the ticagrelor arm were recorded. There were some concerns over the integrity of allocation concealment over 7 trials otherwise risk of other bias was minimal. Patients had a mean age of 61±4 (76% male; 50% with ST elevation MI; 35% with non-ST elevation MI; 15% with unstable angina; 25% with diabetes mellitus; 64% with hypertension; 51% with hyperlipidaemia; 42% smokers). There was no significant difference in risk between the prasugrel group and the ticagrelor group on the primary composite endpoint (Figure 1) (Risk Ratio (RR)=1.17; 95% CI=0.97–1.41; p=0.10, I2=0%). There was no significant difference between the use of prasugrel and ticagrelor with respect to MI (RR=1.24; 95% CI=0.81–1.90; p=0.31); stroke (RR=1.05; 95% CI=0.66–1.67; p=0.84); cardiovascular death (RR=1.01; 95% CI=0.75–1.36; p=0.95); BARC type 2 or above bleeding (RR=1.17; 95% CI =0.90–1.54; p=0.24); stent thrombosis (RR=1.58; 95% CI =0.90–2.76; p=0.11). Conclusion Compared with ticagrelor, prasugrel did not reduce the primary composite endpoint of MI, stroke and cardiovascular death within 1 year. There was also no significant difference in the risk of MI, stroke, cardiovascular death, major bleeding and stent thrombosis respectively. Figure 1. Primary Objective Funding Acknowledgement Type of funding source: None

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