scholarly journals Clinical Significance of Thrombin Blockade with Low Doses (2.5 mg) of Rivaroxaban in Ischemic Heart Disease Patients

2020 ◽  
Vol 16 (1) ◽  
pp. 99-107
Author(s):  
A. B. Sumarokov ◽  
L. I. Buryachkovskaya ◽  
Y. V. Docenko ◽  
M. S. Kurochkin ◽  
N. V. Lomakin
Keyword(s):  
Myocardial Infarction ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Ischemic Heart Disease ◽  
Antiplatelet Therapy ◽  
Ischemic Heart ◽  
Low Doses ◽  
Antithrombotic Effect ◽  
Coronary Syndrome ◽  
Stable Ischemic Heart Disease

Arterial thrombosis is a result of complex interaction between blood cells, soluble coagulation factors in plasma and vessel wall. Antiplatelet drugs do not always provide the necessary antithrombotic effect of sufficient strength, because their influence does not extend to all three factors involved in this process. Low doses of direct oral inhibitors of thrombin are able to potentiate antithrombotic effect of antiplatelet therapy. The combination of rivaroxaban in a dose of 2.5 mg and standard double antiplatelet therapy turned out to be the most promising for clinical use, since studies with dabigatran and apixaban at the II and III stages of the trials were found to be unsuccessful due to the unacceptably high frequency of bleeding. Studies of the combination of rivaroxaban at a dose of 2.5 mg and standard antiplatelet therapy conducted in previous years among patients with acute myocardial infarction showed a decrease in the frequency of complications of atherothrombosis associated with their ischemic nature, while at the same time there was a slight increase in hemorrhagic complications. In the COMPASS study the combination of rivaroxaban (2.5 mg) plus aspirin reduced the risk of the primary endpoint (myocardial infarction, ischemic stroke, cardiovascular death) more significantly than aspirin alone in patients with stable ischemic heart disease and ischemic brain disease. The pathophysiological rationales for the use of low doses of rivaroxaban when added to dual antiplatelet therapy are considered, and the significance of recent studies in patients with acute coronary syndrome, stable ischemic heart disease and in the prevention of ischemic stroke is discussed.

scholarly journals Initial Invasive Versus Conservative Management of Stable Ischemic Heart Disease in Patients With a History of Heart Failure or Left Ventricular Dysfunction

Circulation ◽  
2020 ◽  
Vol 142 (18) ◽  
pp. 1725-1735
Author(s):  
Renato D. Lopes ◽  
Karen P. Alexander ◽  
Susanna R. Stevens ◽  
Harmony R. Reynolds ◽  
Gregg W. Stone ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Primary Outcome ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Ischemic Heart ◽  
Conservative Strategy ◽  
Stable Ischemic Heart Disease ◽  
History Of

Background: Whether an initial invasive strategy in patients with stable ischemic heart disease and at least moderate ischemia improves outcomes in the setting of a history of heart failure (HF) or left ventricular dysfunction (LVD) when ejection fraction is ≥35% but <45% is unknown. Methods: Among 5179 participants randomized into ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches), all of whom had left ventricular ejection fraction (LVEF) ≥35%, we compared cardiovascular outcomes by treatment strategy in participants with a history of HF/LVD at baseline versus those without HF/LVD. Median follow-up was 3.2 years. Results: There were 398 (7.7%) participants with HF/LVD at baseline, of whom 177 had HF/LVEF >45%, 28 HF/LVEF 35% to 45%, and 193 LVEF 35% to 45% but no history of HF. HF/LVD was associated with more comorbidities at baseline, particularly previous myocardial infarction, stroke, and hypertension. Compared with patients without HF/LVD, participants with HF/LVD were more likely to experience a primary outcome composite of cardiovascular death, nonfatal myocardial infarction, or hospitalization for unstable angina, HF, or resuscitated cardiac arrest (4-year cumulative incidence rate, 22.7% versus 13.8%; cardiovascular death or myocardial infarction, 19.7% versus 12.3%; and all-cause death or HF, 15.0% versus 6.9%). Participants with HF/LVD randomized to the invasive versus conservative strategy had a lower rate of the primary outcome (17.2% versus 29.3%; difference in 4-year event rate, −12.1% [95% CI, −22.6 to −1.6%]), whereas those without HF/LVD did not (13.0% versus 14.6%; difference in 4-year event rate, −1.6% [95% CI, −3.8% to 0.7%]; P interaction = 0.055). A similar differential effect was seen for the primary outcome, all-cause mortality, and cardiovascular mortality when invasive versus conservative strategy–associated outcomes were analyzed with LVEF as a continuous variable for patients with and without previous HF. Conclusions: ISCHEMIA participants with stable ischemic heart disease and at least moderate ischemia with a history of HF or LVD were at increased risk for the primary outcome. In the small, high-risk subgroup with HF and LVEF 35% to 45%, an initial invasive approach was associated with better event-free survival. This result should be considered hypothesis-generating. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01471522.

scholarly journals The Risk of Developing Ischemic Stroke in Patients After Exacerbation of Ischemic Heart Disease

Kardiologiia ◽  
2020 ◽  
Vol 60 (8) ◽  
pp. 46-53
Author(s):  
V. A. Brazhnik ◽  
L. O. Minushkina ◽  
N. R. Khasanov ◽  
E. D. Kosmacheva ◽  
M. A. Chichkova ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischemic Stroke ◽  
Ischemic Heart Disease ◽  
Roc Curve ◽  
Prognostic Model ◽  
External Validation ◽  
Diagnostic Value ◽  
Ischemic Heart ◽  
Blood Pressure Goal ◽  
Coronary Syndrome

Aim      To develop a model for evaluating the risk of stroke in patients after exacerbation of ischemic heart disease who were admitted to the hospitals included into a vascular program.Materials and methods This study included 1803 patients with acute coronary syndrome (ACS) from four institutions of Moscow, Kazan, Astrakhan, and Krasnodar where the vascular program was established. Mean age of patients was 64.9±12.78 years, 62,1 % of them were men. The patients were followed up for one year after the discharge from the hospital. External validation of the developed prognostic model was performed on a cohort of patients with ACS included into the RECORD-3 study.Results During the follow-up period, 42 cases of ischemic stroke were observed. The risk of ischemic stroke was associated with the presence of atrial fibrillation (odd ratio (OR) 2.640; р=0.037), diabetes mellitus (OR 2.718; р=0.041), and chronic heart failure (OR 7.049; р=0.011). Protective factors were high-density lipoprotein cholesterol >1 mmol/l (OR 0.629; р=0.041), percutaneous coronary intervention during an index hospitalization (OR 0.412; р=0.042), anticoagulant treatment (OR 0.670; р=0.049), and achieving the blood pressure goal (OR 0.604; р=0.023). The prognostic model developed on the basis of regression analysis showed a good predictive value (area under the ROC curve, 0.780), sensitivity of 80 %, and specificity of 64.6 %. The diagnostic value of other scales for risk assessment was somewhat lower. The area under the ROC curve was 0.692±0.0245 for the GRACE scale and 0.708±0.0334 for CHA2DS2‑VASc. In the external validation of the scale based on data of the RECORD-3 study, the diagnostic value was lower although satisfactory as well (area under the ROC curve, 0.651); sensitivity was 78.9 %, and specificity was 52.3 %.Conclusion      The study resulted in development of a simple clinical scale, which will probably allow identifying groups at risk of stroke more precisely than with standard scales. 

Correlations Between Acute Ischemic Stroke And Its Associated Cardiovascular Diseases

2014 ◽  
Vol 7 (2) ◽  
pp. 105-109
Author(s):  
Daniela Y. Arabadzhieva ◽  
Ara G. Kaprelyan ◽  
Zdravko D. Slavov ◽  
Zhaneta T. Georgieva ◽  
Aleksandra Zh. Tsukeva
Keyword(s):  
Myocardial Infarction ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Cardiovascular Diseases ◽  
Angina Pectoris ◽  
Ischemic Heart Disease ◽  
Acute Ischemic Stroke ◽  
Coronary Atherosclerosis ◽  
Ischemic Heart ◽  
Effort Angina

Summary The objective of this study was to analyze the association between some cardiovascular diseases and acute ischemic stroke. A total of 258 acute ischemic stroke patients (mean age 70.59±7.22 years) were examined. The presence of eight cardiovascular diseases and pathological conditions was analyzed: arterial hypertension, hypertensive heart, atrial fibrillation, myocardial infarction, ischemic heart disease, effort angina pectoris, coronary atherosclerosis, and heart failure. Data were statistically processed by variation and correlation analysis. Most male and female patients presented with four accompanying cardiovascular diseases (27 or 20.93% and 31 or 24.03% of the cases, respectively). There were two groups of four variables each - with a relatively strong and a moderate, as well as with a weak correlation (r<0.4), to the presence of acute ischemic stroke in the corresponding patients. Ischemic heart disease was strongly associated with effort angina pectoris (r=0.667) and to a lesser extent - with coronary atherosclerosis (r=0.470), whereas myocardial infarction was associated with coronary atherosclerosis (r=0.604) and ischemic heart disease (r=0.378), respectively. Arterial hypertension was moderately related to hypertensive heart (r=0.300). In conclusion, there were relatively close associations between acute ischemic stroke and these heart diseases. These patients should strictly and regularly be followed up by general practitioners.

scholarly journals Selected risk factors for ischemic heart disease and the success of treatment in patients with STEMI myocardial infarction treated with percutaneous coronary

2020 ◽  
Vol 14 (2) ◽  
pp. 1-8
Author(s):  
Piotr Jerzy Gurowiec
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Acute Coronary Syndromes ◽  
Ischemic Heart ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Coronary Syndromes ◽  
Success Of Treatment

Background: Coronary heart disease is one of the most common causes of hospitalization and premature deaths in Europe. ST segment elevation myocardial infarction (STEMI) has been a clinical problem for many years, particularly in the aspect of choosing the optimal treatment method. The success of treatment is determined by many factors, including: risk factors for ischemic heart disease, time between onset of symptoms and initiation of treatment, number and degree of coronary stenosis, and many more. Aim of the study: The aim of the study was to identify risk factors for ischemic heart disease affecting the success of STEMI patients treated with percutaneous coronary intervention (PCI). Material and method: The applied research method was a retrospective analysis of medical records of patients treated in the Department of Acute Coronary Syndromes of St Hedvig Provincial Hospital No. 2 in Rzeszow in 2009-2014. The research tool used in this paper was the author's questionnaire. A retrospective study included a total of 508 patients with STEMI myocardial infarction treated in the Department of Acute Coronary Syndromes (ACS) in 2009-2013. The inclusion criteria were the complete and clear files of patient treatment in the ACS department in 2009-2013 due to acute coronary syndrome treated invasively by the PCI method. Results: Hypertension dominated in the study group of patients - 334 subjects (65.7%). The most commonly found risk factors for ischemic heart disease were: dyslipidemia - 176 subjects (34.6%) and smoking - 163 (32.1%). This paper presents the results of the analysis of the success of treatment in relation to risk factors for ischemic heart disease. There was a statistically significant relation of hypertension with successful treatment. The success of treatment in the group of patients diagnosed with hypertension was p = 0.0425. More cases in which treatment was unsuccessful were observed in the group of patients who had no previous treatment for lipid disorders (20.2% vs 4.0%) (p = 0.0000). Significantly more cases of treatment failure were found among people who denied smoking (17.4% vs 8.6%). P value = 0.0087. Conclusions: Among the analyzed behavioral and somatic risk factors for failure in patients subjected to treatment were: untreated hypertension, hyperlipidemia and a negative history of cigarette smoking

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