This is the first report on a polysaccharide(RCJ2-Ib)isolated from Rosa Chinensis Flos.RCJ2-Ib was obtained through the extraction with water,precipitation with ethanol,separation with DEAE-52 column and purification ...This is the first report on a polysaccharide(RCJ2-Ib)isolated from Rosa Chinensis Flos.RCJ2-Ib was obtained through the extraction with water,precipitation with ethanol,separation with DEAE-52 column and purification with DEAE-Sepharose Fast Flow column and Sephadex G100 column.GC,FT-IR and NMR analyses revealed that RCJ2-Ib(3.3 k Da)was a 1,4-linked polymannuronic acid containing substantialβ-Danomers units.The anticoagulant effect of RCJ2-Ib evaluated by using rabbit ear venous blood and an acute blood stasis rat model showed that RCJ2-Ib had obvious anticoagulant activity in regulating endogenous and exogenous coagulation pathways and reducing serum thromboxane B2 and endothelin-1.In addition,RCJ2-Ib could also increase the number of Lactobacillus and Escherichia coli.As a result,RCJ2-Ib has the potential to inhibit thrombosis and maintain the intestinal environment.展开更多
Aspirin,other antiplatelet agents,and anticoagulant drugs are used across a wide spectrum of cardiovascular and cerebrovascular diseases.A concomitant proton pump inhibitor(PPI)treatment is often prescribed in these p...Aspirin,other antiplatelet agents,and anticoagulant drugs are used across a wide spectrum of cardiovascular and cerebrovascular diseases.A concomitant proton pump inhibitor(PPI)treatment is often prescribed in these patients,as gastrointestinal complications are relatively frequent.On the other hand,a potential increased risk of cardiovascular events has been suggested in patients treated with PPIs;in particular,it has been discussed whether these drugs may reduce the cardiovascular protection of clopidogrel,due to pharmacodynamic and pharmacokinetic interactions through hepatic metabolism.Previously,the concomitant use of clopidogrel and omeprazole or esomeprazole has been discouraged.In contrast,it remains less known whether PPI use may affect the clinical efficacy of ticagrelor and prasugrel,new P2Y12 receptor antagonists.Current guidelines recommend PPI use in combination with antiplatelet treatment in patients with risk factors for gastrointestinal bleeding,including advanced age,concurrent use of anticoagulants,steroids,or non-steroidal anti-inflammatory drugs,and Helicobacter pylori(H.pylori)infection.In patients taking oral anticoagulant with risk factors for gastrointestinal bleeding,PPIs could be recommended,even if their usefulness deserves further data.H.pylori infection should always be investigated and treated in patients with a history of peptic ulcer disease(with or without complication)treated with antithrombotic drugs.The present review summarizes the current knowledge regarding the widespread combined use of platelet inhibitors,anticoagulants,and PPIs,discussing consequent clinical implications.展开更多
Objective To describe the long-term antithrombotic management patterns(AMPs)and clinical outcomes of Chinese patients with acute coronary syndrome(ACS).Methods This was an observational,multicenter,longitudinal cohort...Objective To describe the long-term antithrombotic management patterns(AMPs)and clinical outcomes of Chinese patients with acute coronary syndrome(ACS).Methods This was an observational,multicenter,longitudinal cohort extension study of Chinese patients who had completed the EPICOR Asia 2-year follow-up study post-hospitalization for an ACS event.Changes in AMP and clinical outcomes for up to 5 years post-ACS event were evaluated.Results Overall,2334 patients with ACS were enrolled at 49 sites.The mean age was 61.6 years and 76.3%were men.By study end,2093 patients completed the 3-year follow-up.At baseline(2 years post-ACS event),72.4%of patents received one antiplatelet(AP)medication,with aspirin being the preferred one.A small proportion of patients(21.5%)was treated with two or more APs(2+AP),and even fewer patients(6.1%)did not receive any AP medication at baseline.Upon study completion,the proportion of patients without AP therapy increased to 13.6%,while the percentage of patients on one AP and 2+AP decreased to 69.3%and 17.1%,respectively.Numerically,a higher incidence of clinical events(composite of all-cause mortality,myocardial infarction,stroke)was observed for the 2+AP(13.2%)subgroup than for the no AP(10.5%)and one AP(8.6%)subgroups.Furthermore,the 2+AP subgroup exhibited the greatest number of bleeding events,outpatient visits,and hospitalization rates.Unlike myocardial infarction or stroke,bleeding events prompted an adjustment in AMP.Conclusion Most patients in China received at least one AP medication up to 5 years after an ACS event.展开更多
AIM To investigated the relationship between postoperative bleeding following gastric endoscopic submucosal dissection(ESD) and individual antithrombotic agents.METHODS A total of 2488 gastric neoplasms in 2148 consec...AIM To investigated the relationship between postoperative bleeding following gastric endoscopic submucosal dissection(ESD) and individual antithrombotic agents.METHODS A total of 2488 gastric neoplasms in 2148 consecutive patients treated between May 2001 and June 2016 were studied. The antithrombotic agents were categorized into antiplatelet agents, anticoagulants, and other antithrombotic agents, and we included combination therapies [e.g., dual antiplatelet therapy(DAPT)]. The risk factors associated with post-ESD bleeding, namely, antithrombotic agents overall, individual antithrombotic agents, withdrawal or continuation of antithrombotic agents, and bleeding onset period(during the first six days or thereafter), were analyzed using univariate and multivariate analyses.RESULTS The en bloc resection and complete curative resection rates were 99.2% and 91.9%, respectively. Postoperative bleeding occurred in 5.1% cases. Bleeding occurred in 10.3% of the patients administered antithrombotic agents. Being male(P = 0.007), specimen size(P < 0.001), and antithrombotic agent used(P < 0.001) were independent risk factors for postoperative bleeding. Heparin bridging therapy(HBT)(P = 0.002) and DAPT/multidrug combinations(P < 0.001) were independent risk factors associated with postoperative bleeding. The bleeding rate of the antithrombotic agent continuation group was significantly higher than that of the withdrawal group(P < 0.01). Bleeding within postoperative day(POD) 6 was significantly higher in warfarin(P = 0.015), and bleeding after POD 7 was significantly higher in DAPT/multidrug combinations(P = 0.007). No thromboembolic events were reported.CONCLUSION We must closely monitor patients administered HBT and DAPT/multidrug combinations after gastric ESD, particularly those administered multidrug combinations after discharge.展开更多
AIM: To evaluate the risk factors for postoperative bleeding after gastric endoscopic submucosal dissection(ESD) based on the latest guidelines.METHODS: A total of 262 gastric neoplasms were treated by ESD at our cent...AIM: To evaluate the risk factors for postoperative bleeding after gastric endoscopic submucosal dissection(ESD) based on the latest guidelines.METHODS: A total of 262 gastric neoplasms were treated by ESD at our center during a 2-year period from October 2012. We analyzed the data of these cases retrospectively to identify the risk factors for postESD bleeding.RESULTS: Of the 48(18.3%) cases on antithrombotic treatment, 10 were still receiving antiplatelet drugs perioperatively, 13 were on heparin replacement after oral anticoagulant withdrawal, and the antithrombotic therapy was discontinued perioperatively in 25 cases. Postoperative bleeding occurred in 23 cases(8.8%). The postoperative bleeding rate in the heparin replacement group was 61.5%, significantly higher than that in the non-antithrombotic therapy group(6.1%). Univariate analysis identified history of antithrombotic drug use, heparin replacement, hemodialysis, cardiovascular disease, diabetes mellitus, elevated prothrombin timeinternational normalized ratio, and low hemoglobin level on admission as risk factors for post ESD bleeding. Multivariate analysis identified only heparin replacement(OR = 13.7, 95%CI: 1.2-151.3, P = 0.0329) as a significant risk factor for post-ESD bleeding.CONCLUSION: Continued administration of antiplatelet agents, based on the guidelines, was not a risk factor for postoperative bleeding after gastric ESD; however, heparin replacement, which is recommended after withdrawal of oral anticoagulants, was identified as a significant risk factor.展开更多
AIM To investigate the long-term prognosis in peptic ulcer patients continuing taking antithrombotics after ulcer bleeding, and to determine the risk factors that influence the prognosis. METHODS All clinical data of ...AIM To investigate the long-term prognosis in peptic ulcer patients continuing taking antithrombotics after ulcer bleeding, and to determine the risk factors that influence the prognosis. METHODS All clinical data of peptic ulcer patients treated from January 1, 2009 to January 1, 2014 were retrospectively collected and analyzed. Patients were divided into either a continuing group to continue taking antithrombotic drugs after ulcer bleeding or a discontinuing group to discontinue antithrombotic drugs. The primary outcome of follow-up in peptic ulcer bleeding patients was recurrent bleeding, and secondary outcome was death or acute cardiovascular disease occurrence. The final date of follow-up was December 31, 2014. Basic demographic data, complications, and disease classifications were analyzed and compared by t- or χ2-test. The number of patients that achieved various outcomes was counted and analyzed statistically. A survival curve was drawn using the Kaplan-Meier method, and the differencewas compared using the log-rank test. COX regression multivariate analysis was applied to analyze risk factors for the prognosis of peptic ulcer patients. RESULTS A total of 167 patients were enrolled into this study. As for the baseline information, differences in age, smoking, alcohol abuse, and acute cardiovascular diseases were statistically significant between the continuing and discontinuing groups(70.8 ± 11.4 vs 62.4 ± 12.0, P < 0.001; 8(8.2%) vs 15(21.7%), P < 0.05; 65(66.3%) vs 13(18.8%), P < 0.001). At the end of the study, 18 patients had recurrent bleeding and three patients died or had acute cardiovascular disease in the continuing group, while four patients had recurrent bleeding and 15 patients died or had acute cardiovascular disease in the discontinuing group. The differences in these results were statistically significant(P = 0.022, P = 0.000). The Kaplan-Meier survival curve indicated that the incidence of recurrent bleeding was higher in patients in the continuing group, and the risk of death and developing acute cardiovascular disease was higher in patients in the discontinuing group(log-rank test, P = 0.000 for both). Furthermore, COX regression multivariate analysis revealed that the hazard ratio(HR) for recurrent bleeding was 2.986(95%CI: 067-8.356, P = 0.015) in the continuing group, while HR for death or acute cardiovascular disease was 5.216(95%CI: 1.035-26.278, P = 0.028).CONCLUSION After the occurrence of peptic ulcer bleeding, continuing antithrombotics increases the risk of recurrent bleeding events, while discontinuing antithrombotics would increase the risk of death and developing cardiovascular disease. This suggests that clinicians should comprehensively consider the use of antithrombotics after peptic ulcer bleeding.展开更多
Significant progress was achieved in the search of a thrombin receptor antagonist as a novel antithrombotic treatment since the thrombin receptor (protease-activated receptor-1, PAR-1) was cloned 20 years ago. Previou...Significant progress was achieved in the search of a thrombin receptor antagonist as a novel antithrombotic treatment since the thrombin receptor (protease-activated receptor-1, PAR-1) was cloned 20 years ago. Previous works have shown that it is possible to develop potent thrombin receptor antagonists to compete effectively with the receptor’s internal “tethered” ligand to block platelet activation. Vorapaxar (SCH 530348) from Schering-Plough (now Merck) and atopaxar (E5555) from Eisai have been advanced to human clinical trials. Recently, the pivotal phase III clinical trial results for vorapaxar were published. In this article we review these results plus the phase II results from atopaxar. Several newly described thrombin receptor antagonists from the literature will also be discussed. The phase III results from vorapaxar demonstrated that a thrombin receptor antagonist can achieve efficacy in addition to current standard- of-care in treating atherothrombotic patients, especially those with previous myocardial infarction (MI). However, the increased moderate and severe bleeding, especially intracranial bleeding, point to the limitations of current thrombin receptor antagonists. Future thrombin receptor antagonists that can improve on the efficacy and bleeding profile of current ones should have a promising place in meeting the unmet medical need in treating atherothrombotic patients using current standard therapy.展开更多
Endoscopic submucosal dissection(ESD) is minimally invasive and thus has become a widely accepted treatment for gastric neoplasms,particularly for patients with comorbidities.Antithrombotic agents are used to prevent ...Endoscopic submucosal dissection(ESD) is minimally invasive and thus has become a widely accepted treatment for gastric neoplasms,particularly for patients with comorbidities.Antithrombotic agents are used to prevent thrombotic events in patients with comorbidities such as cardio-cerebrovascular diseases and atrial fibrillation.With appropriate cessation,antithrombotic therapy does not increase delayed bleeding in low thrombosis-risk patients.However,high thrombosisrisk patients are often treated with combination therapy with antithrombotic agents and occasionally require the continuation of antithrombotic agents or heparin bridge therapy(HBT) in the perioperative period.Dual antiplatelet therapy(DAPT),a representative combination therapy,is frequently used after placement of drug-eluting stents and has a high risk of delayed bleeding.In patients receiving DAPT,gastric ESD may be postponed until DAPT is no longer required.HBT is often required for patients treated with anticoagulants and has an extremely high bleeding risk.The continuous use of warfarin or direct oral anticoagulants may be possible alternatives.Here,we show that some antithrombotic therapies in high thrombosis-risk patients increase delayed bleeding after gastric ESD,whereas most antithrombotic therapies do not.The management of high thrombosis-risk patients is crucial for improved outcomes.展开更多
BACKGROUND Postoperative delayed bleeding(PDB) after gastric endoscopic submucosal dissection(ESD) is the most common adverse event in patients receiving antithrombotics even with second-look endoscopy. Moreover, with...BACKGROUND Postoperative delayed bleeding(PDB) after gastric endoscopic submucosal dissection(ESD) is the most common adverse event in patients receiving antithrombotics even with second-look endoscopy. Moreover, with the increasing prevalence of cardiovascular and cerebrovascular diseases in an aging population with associated lifestyle-related diseases, an increasing number of patients receive antithrombotics. Several attempts have been made to prevent PDB in aging population;however, a consensus has yet to be reached.AIM To examine the efficacy of third-look endoscopy(TLE) for PDB prevention.METHODS One hundred patients with early gastric neoplasms receiving antithrombotics were prospectively enrolled and subjected to ESD with TLE between February 2017 and July 2019. The primary endpoint was PDB rate, which was compared with our preset threshold. Furthermore, we divided the bleeding period into early-and late-onset PDB(E-PDB and L-PDB, respectively) and analyzed its rate. As a secondary analysis, we compared PDB rates with those of a historical control group, using propensity score matching, and calculated the PDB rates per antithrombotic agent use in each group.RESULTS In total, 96 patients and 114 specimens were finally evaluated. The overall PDB rate was 7.9%(9/114) [90%CI: 4.7-13.1, P = 0.005], while the late-and early-onset PDB rates(L-PDB and E-PDB) were 5.3% [90%CI: 2.7-9.9, P < 0.0001] and 2.6% [90%CI: 1.1-6.4, P = 0.51], respectively. Propensity score matching generated 58 matched pairs for TLE and control groups. No differences were found in overall PDB incidence(10.3% vs 20.7%, P = 0.12), whereas L-PDB occurrence significantly differed(5.2% vs 17.2%, P = 0.04) between groups. Considering antithrombotics' use, the overall PDB rate was higher for direct oral anticoagulants and multiple antithrombotics in the control group, while L-PDB incidence was lower in the TLE group for these agents(8.7% vs 23.1% and 5.0% vs 29.4%, respectively).CONCLUSION TLE for gastric ESD reduces overall PDB, and especially L-PDB incidence, among patients receiving antithrombotics.展开更多
A new rapid and sensitive high performance liquid chromatography (HPLC) method has been developed for the simultaneous determination of atorvastatin-an antihyperlipidemic drug along with most commonly prescribed drugs...A new rapid and sensitive high performance liquid chromatography (HPLC) method has been developed for the simultaneous determination of atorvastatin-an antihyperlipidemic drug along with most commonly prescribed drugs (antihyperlipidemic, antihypertensive, antidiabetic, antithrombotic) in bulk and marketed combined formulations. The chromatographic separation was carried out by gradient elution mode with acetonitrile as organic modifier and 0.1% triethylamine acetate (TEAA) buffer pH 5 at a flow rate of 1 mL/min and a diode array detector at wavelength 230 nm was employed for detection of the analytes. Calibration curves were linear in the range of 5-150 mg/mL for all the drugs with correlation coefficients of determination (r 2 values)Z0.999. Limits of detection (LODs) and Limits of quantification (LOQs) ranged from 0.1 to 0.27 mg/mL and 0.3 to 0.89 mg/mL respectively. Intra-day and inter-day precision was studied at three concentration levels (20, 60 and 100 mg/mL). The intra-day and inter-day RSD for all compounds was less than 2.0%. The accuracy for all compounds was found to be between 98% and 102%. Thus, the performance of the method described allows its use in quantification of atorvastatin along with 9 most commonly prescribed drugs available in market as atorvastatin combined dosage forms.展开更多
BACKGROUND There are some studies investigating the relationship between antithrombotic medication and postoperative bleeding after endoscopic resection(ER)with controversial results.AIM To perform a meta-analysis eva...BACKGROUND There are some studies investigating the relationship between antithrombotic medication and postoperative bleeding after endoscopic resection(ER)with controversial results.AIM To perform a meta-analysis evaluating the effects of antithrombotic therapy on postoperative bleeding after ER.METHODS A systematic search was conducted on PubMed,Web of Science,Cochrane Library.The Newcastle-Ottawa scale was used to evaluate the quality of studies.Stata 12.0 was used for statistical analysis.The odds ratio(OR)and 95%CI were calculated and heterogeneity was quantified using Cochran’s Q test and I2.RESULTS Total 66 studies were included in the meta-analysis.Pooled data suggested that antithrombotic therapy was significantly associated with postoperative bleeding(OR=2.302,95%CI:2.057-2.577,P=0.000)after ER.The risk of postoperative bleeding after endoscopic submucosal dissection,endoscopic mucosal resection and polypectomy in the antithrombotic group was higher than the nonantithrombotic group(OR=2.439,95%CI:1.916-3.105;OR=2.688,95%CI:1.098-6.582;OR=2.112,95%CI:1.434-3.112).CONCLUSION The risk of postoperative bleeding after ER correlated with the types and management of antithrombotic agents by our meta-analysis.展开更多
BACKGROUND There are few reports on major gastrointestinal(GI)bleeding among patients receiving an antithrombotic.AIM To describe clinical characteristics,bleeding locations,management and inhospital mortality related...BACKGROUND There are few reports on major gastrointestinal(GI)bleeding among patients receiving an antithrombotic.AIM To describe clinical characteristics,bleeding locations,management and inhospital mortality related to these events.METHODS Over a three-year period,we prospectively identified 1080 consecutive adult patients admitted in two tertiary care hospitals between January 1,2013 and December 31,2015 for major GI bleeding while receiving an antithrombotic.The bleeding events were medically validated.Clinical characteristics,causative lesions,management and fatalities were described.The distribution of antithrombotics prescribed was compared across the bleeding lesions identified.RESULTS Of 576 patients had symptoms of upper GI bleeding and 504 symptoms of lower GI bleeding.No cause was identified for 383(35.5%)patients.Gastro-duodenal ulcer was the first causative lesion in the upper tract(209 out of 408)and colonic diverticulum the first causative lesion in the lower tract(120 out of 289).There was a larger proportion of direct oral anticoagulant use among patients with lower GI than among those with upper GI lesion locations(P=0.03).There was an independent association between gastro-duodenal ulcer and antithrombotic use(P=0.03),taking account of confounders and proton pump inhibitor coprescription.Pair wise comparisons pointed to a difference between vitamin K antagonist,direct oral anticoagulants,and antiplatelet agents in monotherapy vs dual antiplatelet agents.CONCLUSION We showed a higher rate of bleeding lesion identification and suggested a different pattern of antithrombotic exposure between upper and lower GI lesion locations and between gastro-duodenal ulcer and other identified upper GI causes of bleeding.Management was similar across antithrombotics and in-hospital mortality was low(5.95%).展开更多
BACKGROUND Since 2010,the European Society of Cardiology has extended prescription criteria for oral antithrombotic therapy(OAT)in atrial fibrillation(AF).Direct oral anticoagulants(DOACs)were upgraded from an IIAa re...BACKGROUND Since 2010,the European Society of Cardiology has extended prescription criteria for oral antithrombotic therapy(OAT)in atrial fibrillation(AF).Direct oral anticoagulants(DOACs)were upgraded from an IIAa recommendation in 2012 to an IA in 2016.In real-world scenarios,however,OAC prescription is still suboptimal,mainly for DOACs.AIM To evaluate OAT temporal prescription patterns in a cohort of patients hospitalized with AF in a Cardiology Department.METHODS A retrospective observational study was conducted on a cohort of hospitalized patients in a secondary setting(Trapani,Italy)from 2010 to 2021 with AF as the main or secondary diagnosis.For 4089 consecutive patients,the variables extracted from the Cardiology department database were:Sex,age,time of hospitalization,antithrombotic therapy(warfarin,acenocoumarol,apixaban,dabigatran,edoxaban,rivaroxaban,aspirin,clopidogrel,other antiplatelet agents,low molecular weight heparin,and fondaparinux),diagnosis at discharge and used resources.Basal features are presented as percentage values for categorized variables and as mean+/-SD for categorized once.RESULTS From January 1st,2010 to October 6th,2021,25132 patients were hospitalized in our department;4089(16.27%,mean age 75.59+/-10.82)were discharged with AF diagnosis;of them,2245 were males(54.81%,mean age 73.56+/-11.45)and 1851 females(45.19%,mean age 78.06+/-9.47).Average length of stay was 5.76+/-4.88 days;154 patients died and 88 were moved to other Departments/Structures.AF was the main diagnosis in 899 patients(21.94%).The most frequent main diagnosis in patients with AF was acute myocardial infarction(1973 discharges,48.19%).The most frequent secondary cardiac diagnosis was chronic coronary syndrome(1864 discharges,45.51%),and the most frequent secondary associated condition was arterial hypertension(1010 discharges,24.66%).For the analysis of antithrombotic treatments,the final sample included 3067 patients,after excluding in-hospital deaths,transferred out or self-discharged patients,as well as discharges lacking indications for prescribed treatments.OAC treatment increased significantly(35.63%in 2010-2012 vs 61.18%in 2019-2021,+25.55%,P<0.0001),in spite of any antiplatelet agent use.This rise was due to increasing use of DOACs,with or without antiplatelet agents,from 3.04%in 2013-2015 to 50.06%in 2019-2021(+47.02%,P<0.0001)and was greater for factor Xa inhibitors,especially apixaban.In addition,treatment with a vitamin K antagonist,in spite of any antiplatelet agent use,decreased from 35.63%in 2010-2012 to 11.12%in 2019-2021(-24.48%,P<0.0001),as well as any antiplatelet therapy,alone or in double combination,(49.18%in 2010-2012 vs 34.18%in 2019-2021,-15.00%,P<0.0001);and patients not receiving antithrombotic therapy declined with time(14.58%in 2010-2012 vs 1.97%in 2021,P<0.0001).CONCLUSION Real-world patients with AF are elderly and affected by cardiovascular and non-cardiovascular diseases.The percentage of patients on OAT and DOACs increased.These data suggest a slow,gradual guidelines implementation process.展开更多
AIM To assess the impact of laparoscopic liver resection(LLR) on surgical blood loss(SBL),especially in patients with antithrombotics for thromboembolic risks.METHODS Consecutive 258 patients receiving liver resection...AIM To assess the impact of laparoscopic liver resection(LLR) on surgical blood loss(SBL),especially in patients with antithrombotics for thromboembolic risks.METHODS Consecutive 258 patients receiving liver resection at our institution between 2010 and 2016 were retrospectively reviewed.Preoperative antithrombotic therapy(ATT;antiplatelets and/or anticoagulation) was regularly used in 100 patients(ATT group,38.8%) whereas not used in 158(non-ATT group,61.2%).Our perioperative management of high thromboembolic risk patients included maintenance of preoperative aspirin monotherapy for patients with antiplatelet therapy and bridging heparin for patients with anticoagulation.In both ATT and non-ATT groups,outcome variables of patients undergoing LLR were compared with those of patients receiving open liver resection(OLR),and the independent risk factors for increased SBL were determined by multivariate analysis.RESULTS This series included 77 LLR and 181 OLR.There were 3 thromboembolic events(1.2%) in a whole cohort,whereas increased SBL(≥500 mL) and postoperative bleeding complications(BCs) occurred in 66 patients(25.6%) and 8(3.1%),respectively.Both in the ATT and non-ATT groups,LLR was significantly related to reduced SBL and low incidence of BCs,although LLR was less performed as anatomical resection.Multivariate analysis showed that anatomical liver resection was the most significant risk factor for increased SBL [risk ratio(RR)=6.54,P<0.001] in the whole cohort,and LLR also had the significant negative impact(RR = 1/10.0,P<0.001).The same effects of anatomical resection(RR=15.77,P<0.001) and LLR(RR=1/5.88,P=0.019) were observed when analyzing the patients in the ATT group.CONCLUSION LLR using the two-surgeon technique is feasible and safely performed even in the ATT-burdened patients with thromboembolic risks.Independent from the extent of liver resection,LLR is significantly associated with reduced SBL,both in the ATT and non-ATT groups.展开更多
Background It’s essential to prevent from thrombosis on device without increasing the risk of bleeding complications after successfully implanted left atrial appendage device.At present,no guidelines recommend about ...Background It’s essential to prevent from thrombosis on device without increasing the risk of bleeding complications after successfully implanted left atrial appendage device.At present,no guidelines recommend about postoperative antithrombotic therapy of left atrial appendage closure(LAAC).The purpose of this study is to investigate the safety and efficacy of different antithrombotic therapies after LAAC.展开更多
Objective To determine the antiplatelet and antithrombotic efficacies of MV1 serine protease on coronary arterial thrombosis in a canine model of unstable angina.Methods Pentobarbital-anesthetized Beagles(total of 30)...Objective To determine the antiplatelet and antithrombotic efficacies of MV1 serine protease on coronary arterial thrombosis in a canine model of unstable angina.Methods Pentobarbital-anesthetized Beagles(total of 30)were used in which acute damage of the proximal left circumflex coronary artery,together with mechanical stenosis,produced the phenomenon of cyclic flow reduction(CFR)in the Folts model of unstable angina.When the platelet plug was removed by rubbing the vessel,the occlusion returned reproducibly for at least 3 hours in control studies.To evaluate the antithrombotic efficacy of MV1,CFR was first established over a period of one hour,thereafter,MV1(0.3,0.6 mg·kg-1 i.v.bolus),Batroxobin(0.3 BU·kg-1 i.v.bolus),Tirofiban(40 μg·kg-1,i.v.bolus),or vehicle was administered and observations continued for two additional hours.Platelet aggregation induced by adenosine diphosphate(ADP),arachidonic acid(AA),collagen(CG)was measured by the method of born,and thrombin time(TT),prothrombin time(PT),activated partial thromboplastin time(APTT)and fibrinogen(Fbg)were measured using coagulation methods,bleeding time was measured according to previous described methods.Results MV1 dramatically inhibited the frequency of CFR dose-dependently and the frequency of CFR decreased by 65%,80% respectively at 1 h than that in control group's after MV1 0.3,0.6 mg·kg-1 administration,further more the frequency decreased by 75%,90% respectively at 2 h.MV1 eliminated thrombus formation in 5 of 6 dogs at 0.6 mg·kg-1,and the time for CFR absolute disappearances of MV1 at a dose of 0.6 mg·kg-1 was shortened to 5±2 min(the time was more than 120 min in all dogs of control group).Platelet aggregation induced by ADP,AA,CG was inhibited effectively by MV1 0.3,0.6 mg·kg-1 TT,PT prolonged gently after MV1 administration,and MV1 produced an approximate 40% degradation of Fbg,but MV1 did not have any effects on APTT.There was a tendency for prolonged bleeding time with MV1 administration.Conclusions These studies showed that as a novel serine protease,MV1 provides favorable antithrombotic activity in vivo with inhibition of platelet aggregation and fibrinogenolytic activity.The results indicated that MV1 has reliable therapeutical efficacy on unstable angina pectoris.展开更多
OBJECTIVES Elderly patients show a higher incidence of ischemic and bleeding events after percutaneous transluminal coron-ary intervention(PCI).We sought to investigate outcomes in elderly patients treated with antith...OBJECTIVES Elderly patients show a higher incidence of ischemic and bleeding events after percutaneous transluminal coron-ary intervention(PCI).We sought to investigate outcomes in elderly patients treated with antithrombotic strategy guided by bleeding and ischemic risks after revascularization with last generation everolimus-eluting stent(EES).METHODS Prospective multicenter registry including patients over 75 years revascularized with EES and antithrombotic ther-apy guided by clinical presentation,PCI complexity and PRECISE DAPT score.Co-primary safety endpoints were:(1)composite of cardiac death,myocardial infarction and stent thrombosis and;(2)bleeding(BARC 2-5).Primary efficacy endpoint was target lesion revascularization.A matched group of patients revascularized with current drug-eluting stents and no such tailored antith-rombotic therapy was used as control.RESULTS Finally,1064 patients were included in SIERRA-75 cohort,80.8±4.2 years,36.6%women,71%acute coronary syn-dromes(ACS)and 53.6%complex PCI.Co-primary safety endpoint of major adverse cardiovascular events was met in 6.2%,co-primary safety endpoint of bleeding in 7.8%and primary efficacy endpoint of TKLR in 1.5%.The multivariable adjusted model showed no significant association of the prescribed short/long dual antiplatelet therapy(DAPT)durations with any endpoint suggesting a well tailored therapy.No stent thrombosis reported in the subgroup with 1-3 months DAPT duration.As compared to control group,bleeding BARC 2-5 was significantly lower in SIERRA-75 group(7.4%vs.10.2%,P=0.04)as well as the net safety-efficacy endpoint(14.3%vs.18.5%,P=0.02).CONCLUSIONS In elderly population,the application of this risks-adjusted antithrombotic protocol after revascularization with last generation EES seems to be associated with an improved prognosis in terms of ischemic and bleeding outcomes.展开更多
BACKGROUND Postpancreatectomy hemorrhage(PPH)is the most severe type of complication after pancreatic surgery,although the effect of antithrombotic therapy(ATT)on PPH is largely unknown.The safety and efficacy of chem...BACKGROUND Postpancreatectomy hemorrhage(PPH)is the most severe type of complication after pancreatic surgery,although the effect of antithrombotic therapy(ATT)on PPH is largely unknown.The safety and efficacy of chemical thromboprophylaxis for venous thromboembolism(VTE)remains controversial.AIM To elucidate the effect of ATT on PPH.METHODS Published articles between 2013 and 2020 were searched from PubMed and Google Scholar,and after careful reviewing of all studies,studies concerning ATT and pancreatic surgery were included.Data such as study design,type of surgical procedures,type of antithrombotic drugs,and surgical outcome were extracted from the studies.RESULTS Nineteen published articles with a total of 37863 patients who underwent pancreatic surgery were included in the systematic review.Fourteen were cohort studies,with only three being prospective in nature.Two studies demonstrated that in patients receiving chronic ATT,which were mostly managed by heparin bridging,the risk of PPH was higher compared with those without ATT,and one study showed that patients with direct-acting oral anticoagulants managed by heparin bridging had significantly higher postoperative bleeding rates than others.The remaining six studies reported that pancreatic surgery can be safely performed in patients receiving chronic ATT,even under preoperative aspirin continuation.Concerning chemical thromboprophylaxis for VTE,most studies have shown a potentially high risk of PPH in patients undergoing chemical thromboprophylaxis;however,its effectiveness against VTE has not been statistically demonstrated,particularly among Asian patients.CONCLUSION Pancreatic surgery in chronically ATT-received patients can be safely performed without an increase in the occurrence of PPH,although the safety and efficacy of chemical thromboprophylaxis for VTE during pancreatic surgery is still controversial.Further investigation using reliable studies with good design is required to establish definite protocols or guidelines.展开更多
BACKGROUND There is no consensus on the antithrombotic treatment strategy for patients with coronary artery ectasia(CAE).CASE SUMMARY This case reports the dynamic observation of a patient for 48 mo after a diagnosis ...BACKGROUND There is no consensus on the antithrombotic treatment strategy for patients with coronary artery ectasia(CAE).CASE SUMMARY This case reports the dynamic observation of a patient for 48 mo after a diagnosis of CAE with acute myocardial infarction(AMI).The first antithrombotic agents used were aspirin(100 mg/d)and clopidogrel(75 mg/d).During the sixth month of observation,a second AMI occurred involving the same culprit vessel;therefore,antithrombotic agents were changed to aspirin(100 mg/d)and ticagrelor(90 mg twice per day).Twelve months after the second AMI,an attempt to reduce the dosage ticagrelor failed;therefore the original dose was continued.The CAE was relatively stable during the following 4 years.CONCLUSION This case indicates that a combination of aspirin and ticagrelor may be more effective for CAE patients with AMI than aspirin and clopidogrel.展开更多
The treatment of elderly patients with acute coronary syndromes (ACS) remains challenging. About two thirds of patients with ACS and four fifth of patients who died from ACS are older than 65 years.
基金supported by Research on Precision Nutrition and Health Food,Department of Science and Technology of Henan Province(CXJD2021006)Key Project in Science and Technology Agency of Henan Province(202102110283 and 202102110149)。
文摘This is the first report on a polysaccharide(RCJ2-Ib)isolated from Rosa Chinensis Flos.RCJ2-Ib was obtained through the extraction with water,precipitation with ethanol,separation with DEAE-52 column and purification with DEAE-Sepharose Fast Flow column and Sephadex G100 column.GC,FT-IR and NMR analyses revealed that RCJ2-Ib(3.3 k Da)was a 1,4-linked polymannuronic acid containing substantialβ-Danomers units.The anticoagulant effect of RCJ2-Ib evaluated by using rabbit ear venous blood and an acute blood stasis rat model showed that RCJ2-Ib had obvious anticoagulant activity in regulating endogenous and exogenous coagulation pathways and reducing serum thromboxane B2 and endothelin-1.In addition,RCJ2-Ib could also increase the number of Lactobacillus and Escherichia coli.As a result,RCJ2-Ib has the potential to inhibit thrombosis and maintain the intestinal environment.
文摘Aspirin,other antiplatelet agents,and anticoagulant drugs are used across a wide spectrum of cardiovascular and cerebrovascular diseases.A concomitant proton pump inhibitor(PPI)treatment is often prescribed in these patients,as gastrointestinal complications are relatively frequent.On the other hand,a potential increased risk of cardiovascular events has been suggested in patients treated with PPIs;in particular,it has been discussed whether these drugs may reduce the cardiovascular protection of clopidogrel,due to pharmacodynamic and pharmacokinetic interactions through hepatic metabolism.Previously,the concomitant use of clopidogrel and omeprazole or esomeprazole has been discouraged.In contrast,it remains less known whether PPI use may affect the clinical efficacy of ticagrelor and prasugrel,new P2Y12 receptor antagonists.Current guidelines recommend PPI use in combination with antiplatelet treatment in patients with risk factors for gastrointestinal bleeding,including advanced age,concurrent use of anticoagulants,steroids,or non-steroidal anti-inflammatory drugs,and Helicobacter pylori(H.pylori)infection.In patients taking oral anticoagulant with risk factors for gastrointestinal bleeding,PPIs could be recommended,even if their usefulness deserves further data.H.pylori infection should always be investigated and treated in patients with a history of peptic ulcer disease(with or without complication)treated with antithrombotic drugs.The present review summarizes the current knowledge regarding the widespread combined use of platelet inhibitors,anticoagulants,and PPIs,discussing consequent clinical implications.
基金provided by Isuru Wijesoma from MediTech Media(Singapore),which was funded by AstraZeneca in accordance with Good Publication Practice(GPP3)guidelines。
文摘Objective To describe the long-term antithrombotic management patterns(AMPs)and clinical outcomes of Chinese patients with acute coronary syndrome(ACS).Methods This was an observational,multicenter,longitudinal cohort extension study of Chinese patients who had completed the EPICOR Asia 2-year follow-up study post-hospitalization for an ACS event.Changes in AMP and clinical outcomes for up to 5 years post-ACS event were evaluated.Results Overall,2334 patients with ACS were enrolled at 49 sites.The mean age was 61.6 years and 76.3%were men.By study end,2093 patients completed the 3-year follow-up.At baseline(2 years post-ACS event),72.4%of patents received one antiplatelet(AP)medication,with aspirin being the preferred one.A small proportion of patients(21.5%)was treated with two or more APs(2+AP),and even fewer patients(6.1%)did not receive any AP medication at baseline.Upon study completion,the proportion of patients without AP therapy increased to 13.6%,while the percentage of patients on one AP and 2+AP decreased to 69.3%and 17.1%,respectively.Numerically,a higher incidence of clinical events(composite of all-cause mortality,myocardial infarction,stroke)was observed for the 2+AP(13.2%)subgroup than for the no AP(10.5%)and one AP(8.6%)subgroups.Furthermore,the 2+AP subgroup exhibited the greatest number of bleeding events,outpatient visits,and hospitalization rates.Unlike myocardial infarction or stroke,bleeding events prompted an adjustment in AMP.Conclusion Most patients in China received at least one AP medication up to 5 years after an ACS event.
文摘AIM To investigated the relationship between postoperative bleeding following gastric endoscopic submucosal dissection(ESD) and individual antithrombotic agents.METHODS A total of 2488 gastric neoplasms in 2148 consecutive patients treated between May 2001 and June 2016 were studied. The antithrombotic agents were categorized into antiplatelet agents, anticoagulants, and other antithrombotic agents, and we included combination therapies [e.g., dual antiplatelet therapy(DAPT)]. The risk factors associated with post-ESD bleeding, namely, antithrombotic agents overall, individual antithrombotic agents, withdrawal or continuation of antithrombotic agents, and bleeding onset period(during the first six days or thereafter), were analyzed using univariate and multivariate analyses.RESULTS The en bloc resection and complete curative resection rates were 99.2% and 91.9%, respectively. Postoperative bleeding occurred in 5.1% cases. Bleeding occurred in 10.3% of the patients administered antithrombotic agents. Being male(P = 0.007), specimen size(P < 0.001), and antithrombotic agent used(P < 0.001) were independent risk factors for postoperative bleeding. Heparin bridging therapy(HBT)(P = 0.002) and DAPT/multidrug combinations(P < 0.001) were independent risk factors associated with postoperative bleeding. The bleeding rate of the antithrombotic agent continuation group was significantly higher than that of the withdrawal group(P < 0.01). Bleeding within postoperative day(POD) 6 was significantly higher in warfarin(P = 0.015), and bleeding after POD 7 was significantly higher in DAPT/multidrug combinations(P = 0.007). No thromboembolic events were reported.CONCLUSION We must closely monitor patients administered HBT and DAPT/multidrug combinations after gastric ESD, particularly those administered multidrug combinations after discharge.
文摘AIM: To evaluate the risk factors for postoperative bleeding after gastric endoscopic submucosal dissection(ESD) based on the latest guidelines.METHODS: A total of 262 gastric neoplasms were treated by ESD at our center during a 2-year period from October 2012. We analyzed the data of these cases retrospectively to identify the risk factors for postESD bleeding.RESULTS: Of the 48(18.3%) cases on antithrombotic treatment, 10 were still receiving antiplatelet drugs perioperatively, 13 were on heparin replacement after oral anticoagulant withdrawal, and the antithrombotic therapy was discontinued perioperatively in 25 cases. Postoperative bleeding occurred in 23 cases(8.8%). The postoperative bleeding rate in the heparin replacement group was 61.5%, significantly higher than that in the non-antithrombotic therapy group(6.1%). Univariate analysis identified history of antithrombotic drug use, heparin replacement, hemodialysis, cardiovascular disease, diabetes mellitus, elevated prothrombin timeinternational normalized ratio, and low hemoglobin level on admission as risk factors for post ESD bleeding. Multivariate analysis identified only heparin replacement(OR = 13.7, 95%CI: 1.2-151.3, P = 0.0329) as a significant risk factor for post-ESD bleeding.CONCLUSION: Continued administration of antiplatelet agents, based on the guidelines, was not a risk factor for postoperative bleeding after gastric ESD; however, heparin replacement, which is recommended after withdrawal of oral anticoagulants, was identified as a significant risk factor.
基金Supported by Shanghai Health and Family Planning Commission Foundation,No.201440430
文摘AIM To investigate the long-term prognosis in peptic ulcer patients continuing taking antithrombotics after ulcer bleeding, and to determine the risk factors that influence the prognosis. METHODS All clinical data of peptic ulcer patients treated from January 1, 2009 to January 1, 2014 were retrospectively collected and analyzed. Patients were divided into either a continuing group to continue taking antithrombotic drugs after ulcer bleeding or a discontinuing group to discontinue antithrombotic drugs. The primary outcome of follow-up in peptic ulcer bleeding patients was recurrent bleeding, and secondary outcome was death or acute cardiovascular disease occurrence. The final date of follow-up was December 31, 2014. Basic demographic data, complications, and disease classifications were analyzed and compared by t- or χ2-test. The number of patients that achieved various outcomes was counted and analyzed statistically. A survival curve was drawn using the Kaplan-Meier method, and the differencewas compared using the log-rank test. COX regression multivariate analysis was applied to analyze risk factors for the prognosis of peptic ulcer patients. RESULTS A total of 167 patients were enrolled into this study. As for the baseline information, differences in age, smoking, alcohol abuse, and acute cardiovascular diseases were statistically significant between the continuing and discontinuing groups(70.8 ± 11.4 vs 62.4 ± 12.0, P < 0.001; 8(8.2%) vs 15(21.7%), P < 0.05; 65(66.3%) vs 13(18.8%), P < 0.001). At the end of the study, 18 patients had recurrent bleeding and three patients died or had acute cardiovascular disease in the continuing group, while four patients had recurrent bleeding and 15 patients died or had acute cardiovascular disease in the discontinuing group. The differences in these results were statistically significant(P = 0.022, P = 0.000). The Kaplan-Meier survival curve indicated that the incidence of recurrent bleeding was higher in patients in the continuing group, and the risk of death and developing acute cardiovascular disease was higher in patients in the discontinuing group(log-rank test, P = 0.000 for both). Furthermore, COX regression multivariate analysis revealed that the hazard ratio(HR) for recurrent bleeding was 2.986(95%CI: 067-8.356, P = 0.015) in the continuing group, while HR for death or acute cardiovascular disease was 5.216(95%CI: 1.035-26.278, P = 0.028).CONCLUSION After the occurrence of peptic ulcer bleeding, continuing antithrombotics increases the risk of recurrent bleeding events, while discontinuing antithrombotics would increase the risk of death and developing cardiovascular disease. This suggests that clinicians should comprehensively consider the use of antithrombotics after peptic ulcer bleeding.
文摘Significant progress was achieved in the search of a thrombin receptor antagonist as a novel antithrombotic treatment since the thrombin receptor (protease-activated receptor-1, PAR-1) was cloned 20 years ago. Previous works have shown that it is possible to develop potent thrombin receptor antagonists to compete effectively with the receptor’s internal “tethered” ligand to block platelet activation. Vorapaxar (SCH 530348) from Schering-Plough (now Merck) and atopaxar (E5555) from Eisai have been advanced to human clinical trials. Recently, the pivotal phase III clinical trial results for vorapaxar were published. In this article we review these results plus the phase II results from atopaxar. Several newly described thrombin receptor antagonists from the literature will also be discussed. The phase III results from vorapaxar demonstrated that a thrombin receptor antagonist can achieve efficacy in addition to current standard- of-care in treating atherothrombotic patients, especially those with previous myocardial infarction (MI). However, the increased moderate and severe bleeding, especially intracranial bleeding, point to the limitations of current thrombin receptor antagonists. Future thrombin receptor antagonists that can improve on the efficacy and bleeding profile of current ones should have a promising place in meeting the unmet medical need in treating atherothrombotic patients using current standard therapy.
文摘Endoscopic submucosal dissection(ESD) is minimally invasive and thus has become a widely accepted treatment for gastric neoplasms,particularly for patients with comorbidities.Antithrombotic agents are used to prevent thrombotic events in patients with comorbidities such as cardio-cerebrovascular diseases and atrial fibrillation.With appropriate cessation,antithrombotic therapy does not increase delayed bleeding in low thrombosis-risk patients.However,high thrombosisrisk patients are often treated with combination therapy with antithrombotic agents and occasionally require the continuation of antithrombotic agents or heparin bridge therapy(HBT) in the perioperative period.Dual antiplatelet therapy(DAPT),a representative combination therapy,is frequently used after placement of drug-eluting stents and has a high risk of delayed bleeding.In patients receiving DAPT,gastric ESD may be postponed until DAPT is no longer required.HBT is often required for patients treated with anticoagulants and has an extremely high bleeding risk.The continuous use of warfarin or direct oral anticoagulants may be possible alternatives.Here,we show that some antithrombotic therapies in high thrombosis-risk patients increase delayed bleeding after gastric ESD,whereas most antithrombotic therapies do not.The management of high thrombosis-risk patients is crucial for improved outcomes.
文摘BACKGROUND Postoperative delayed bleeding(PDB) after gastric endoscopic submucosal dissection(ESD) is the most common adverse event in patients receiving antithrombotics even with second-look endoscopy. Moreover, with the increasing prevalence of cardiovascular and cerebrovascular diseases in an aging population with associated lifestyle-related diseases, an increasing number of patients receive antithrombotics. Several attempts have been made to prevent PDB in aging population;however, a consensus has yet to be reached.AIM To examine the efficacy of third-look endoscopy(TLE) for PDB prevention.METHODS One hundred patients with early gastric neoplasms receiving antithrombotics were prospectively enrolled and subjected to ESD with TLE between February 2017 and July 2019. The primary endpoint was PDB rate, which was compared with our preset threshold. Furthermore, we divided the bleeding period into early-and late-onset PDB(E-PDB and L-PDB, respectively) and analyzed its rate. As a secondary analysis, we compared PDB rates with those of a historical control group, using propensity score matching, and calculated the PDB rates per antithrombotic agent use in each group.RESULTS In total, 96 patients and 114 specimens were finally evaluated. The overall PDB rate was 7.9%(9/114) [90%CI: 4.7-13.1, P = 0.005], while the late-and early-onset PDB rates(L-PDB and E-PDB) were 5.3% [90%CI: 2.7-9.9, P < 0.0001] and 2.6% [90%CI: 1.1-6.4, P = 0.51], respectively. Propensity score matching generated 58 matched pairs for TLE and control groups. No differences were found in overall PDB incidence(10.3% vs 20.7%, P = 0.12), whereas L-PDB occurrence significantly differed(5.2% vs 17.2%, P = 0.04) between groups. Considering antithrombotics' use, the overall PDB rate was higher for direct oral anticoagulants and multiple antithrombotics in the control group, while L-PDB incidence was lower in the TLE group for these agents(8.7% vs 23.1% and 5.0% vs 29.4%, respectively).CONCLUSION TLE for gastric ESD reduces overall PDB, and especially L-PDB incidence, among patients receiving antithrombotics.
基金the Department of Pharmaceuticals (Ministry of Chemicals and Fertilizers),New Delhi,for grant of a MS(Pharm.) fellowship
文摘A new rapid and sensitive high performance liquid chromatography (HPLC) method has been developed for the simultaneous determination of atorvastatin-an antihyperlipidemic drug along with most commonly prescribed drugs (antihyperlipidemic, antihypertensive, antidiabetic, antithrombotic) in bulk and marketed combined formulations. The chromatographic separation was carried out by gradient elution mode with acetonitrile as organic modifier and 0.1% triethylamine acetate (TEAA) buffer pH 5 at a flow rate of 1 mL/min and a diode array detector at wavelength 230 nm was employed for detection of the analytes. Calibration curves were linear in the range of 5-150 mg/mL for all the drugs with correlation coefficients of determination (r 2 values)Z0.999. Limits of detection (LODs) and Limits of quantification (LOQs) ranged from 0.1 to 0.27 mg/mL and 0.3 to 0.89 mg/mL respectively. Intra-day and inter-day precision was studied at three concentration levels (20, 60 and 100 mg/mL). The intra-day and inter-day RSD for all compounds was less than 2.0%. The accuracy for all compounds was found to be between 98% and 102%. Thus, the performance of the method described allows its use in quantification of atorvastatin along with 9 most commonly prescribed drugs available in market as atorvastatin combined dosage forms.
基金Liaoning Science and Technology Foundation,No.20170541052.
文摘BACKGROUND There are some studies investigating the relationship between antithrombotic medication and postoperative bleeding after endoscopic resection(ER)with controversial results.AIM To perform a meta-analysis evaluating the effects of antithrombotic therapy on postoperative bleeding after ER.METHODS A systematic search was conducted on PubMed,Web of Science,Cochrane Library.The Newcastle-Ottawa scale was used to evaluate the quality of studies.Stata 12.0 was used for statistical analysis.The odds ratio(OR)and 95%CI were calculated and heterogeneity was quantified using Cochran’s Q test and I2.RESULTS Total 66 studies were included in the meta-analysis.Pooled data suggested that antithrombotic therapy was significantly associated with postoperative bleeding(OR=2.302,95%CI:2.057-2.577,P=0.000)after ER.The risk of postoperative bleeding after endoscopic submucosal dissection,endoscopic mucosal resection and polypectomy in the antithrombotic group was higher than the nonantithrombotic group(OR=2.439,95%CI:1.916-3.105;OR=2.688,95%CI:1.098-6.582;OR=2.112,95%CI:1.434-3.112).CONCLUSION The risk of postoperative bleeding after ER correlated with the types and management of antithrombotic agents by our meta-analysis.
基金National Clinical Research Hospital Program of the French Ministry of Health,No.PHRC-12-009-0243.
文摘BACKGROUND There are few reports on major gastrointestinal(GI)bleeding among patients receiving an antithrombotic.AIM To describe clinical characteristics,bleeding locations,management and inhospital mortality related to these events.METHODS Over a three-year period,we prospectively identified 1080 consecutive adult patients admitted in two tertiary care hospitals between January 1,2013 and December 31,2015 for major GI bleeding while receiving an antithrombotic.The bleeding events were medically validated.Clinical characteristics,causative lesions,management and fatalities were described.The distribution of antithrombotics prescribed was compared across the bleeding lesions identified.RESULTS Of 576 patients had symptoms of upper GI bleeding and 504 symptoms of lower GI bleeding.No cause was identified for 383(35.5%)patients.Gastro-duodenal ulcer was the first causative lesion in the upper tract(209 out of 408)and colonic diverticulum the first causative lesion in the lower tract(120 out of 289).There was a larger proportion of direct oral anticoagulant use among patients with lower GI than among those with upper GI lesion locations(P=0.03).There was an independent association between gastro-duodenal ulcer and antithrombotic use(P=0.03),taking account of confounders and proton pump inhibitor coprescription.Pair wise comparisons pointed to a difference between vitamin K antagonist,direct oral anticoagulants,and antiplatelet agents in monotherapy vs dual antiplatelet agents.CONCLUSION We showed a higher rate of bleeding lesion identification and suggested a different pattern of antithrombotic exposure between upper and lower GI lesion locations and between gastro-duodenal ulcer and other identified upper GI causes of bleeding.Management was similar across antithrombotics and in-hospital mortality was low(5.95%).
文摘BACKGROUND Since 2010,the European Society of Cardiology has extended prescription criteria for oral antithrombotic therapy(OAT)in atrial fibrillation(AF).Direct oral anticoagulants(DOACs)were upgraded from an IIAa recommendation in 2012 to an IA in 2016.In real-world scenarios,however,OAC prescription is still suboptimal,mainly for DOACs.AIM To evaluate OAT temporal prescription patterns in a cohort of patients hospitalized with AF in a Cardiology Department.METHODS A retrospective observational study was conducted on a cohort of hospitalized patients in a secondary setting(Trapani,Italy)from 2010 to 2021 with AF as the main or secondary diagnosis.For 4089 consecutive patients,the variables extracted from the Cardiology department database were:Sex,age,time of hospitalization,antithrombotic therapy(warfarin,acenocoumarol,apixaban,dabigatran,edoxaban,rivaroxaban,aspirin,clopidogrel,other antiplatelet agents,low molecular weight heparin,and fondaparinux),diagnosis at discharge and used resources.Basal features are presented as percentage values for categorized variables and as mean+/-SD for categorized once.RESULTS From January 1st,2010 to October 6th,2021,25132 patients were hospitalized in our department;4089(16.27%,mean age 75.59+/-10.82)were discharged with AF diagnosis;of them,2245 were males(54.81%,mean age 73.56+/-11.45)and 1851 females(45.19%,mean age 78.06+/-9.47).Average length of stay was 5.76+/-4.88 days;154 patients died and 88 were moved to other Departments/Structures.AF was the main diagnosis in 899 patients(21.94%).The most frequent main diagnosis in patients with AF was acute myocardial infarction(1973 discharges,48.19%).The most frequent secondary cardiac diagnosis was chronic coronary syndrome(1864 discharges,45.51%),and the most frequent secondary associated condition was arterial hypertension(1010 discharges,24.66%).For the analysis of antithrombotic treatments,the final sample included 3067 patients,after excluding in-hospital deaths,transferred out or self-discharged patients,as well as discharges lacking indications for prescribed treatments.OAC treatment increased significantly(35.63%in 2010-2012 vs 61.18%in 2019-2021,+25.55%,P<0.0001),in spite of any antiplatelet agent use.This rise was due to increasing use of DOACs,with or without antiplatelet agents,from 3.04%in 2013-2015 to 50.06%in 2019-2021(+47.02%,P<0.0001)and was greater for factor Xa inhibitors,especially apixaban.In addition,treatment with a vitamin K antagonist,in spite of any antiplatelet agent use,decreased from 35.63%in 2010-2012 to 11.12%in 2019-2021(-24.48%,P<0.0001),as well as any antiplatelet therapy,alone or in double combination,(49.18%in 2010-2012 vs 34.18%in 2019-2021,-15.00%,P<0.0001);and patients not receiving antithrombotic therapy declined with time(14.58%in 2010-2012 vs 1.97%in 2021,P<0.0001).CONCLUSION Real-world patients with AF are elderly and affected by cardiovascular and non-cardiovascular diseases.The percentage of patients on OAT and DOACs increased.These data suggest a slow,gradual guidelines implementation process.
文摘AIM To assess the impact of laparoscopic liver resection(LLR) on surgical blood loss(SBL),especially in patients with antithrombotics for thromboembolic risks.METHODS Consecutive 258 patients receiving liver resection at our institution between 2010 and 2016 were retrospectively reviewed.Preoperative antithrombotic therapy(ATT;antiplatelets and/or anticoagulation) was regularly used in 100 patients(ATT group,38.8%) whereas not used in 158(non-ATT group,61.2%).Our perioperative management of high thromboembolic risk patients included maintenance of preoperative aspirin monotherapy for patients with antiplatelet therapy and bridging heparin for patients with anticoagulation.In both ATT and non-ATT groups,outcome variables of patients undergoing LLR were compared with those of patients receiving open liver resection(OLR),and the independent risk factors for increased SBL were determined by multivariate analysis.RESULTS This series included 77 LLR and 181 OLR.There were 3 thromboembolic events(1.2%) in a whole cohort,whereas increased SBL(≥500 mL) and postoperative bleeding complications(BCs) occurred in 66 patients(25.6%) and 8(3.1%),respectively.Both in the ATT and non-ATT groups,LLR was significantly related to reduced SBL and low incidence of BCs,although LLR was less performed as anatomical resection.Multivariate analysis showed that anatomical liver resection was the most significant risk factor for increased SBL [risk ratio(RR)=6.54,P<0.001] in the whole cohort,and LLR also had the significant negative impact(RR = 1/10.0,P<0.001).The same effects of anatomical resection(RR=15.77,P<0.001) and LLR(RR=1/5.88,P=0.019) were observed when analyzing the patients in the ATT group.CONCLUSION LLR using the two-surgeon technique is feasible and safely performed even in the ATT-burdened patients with thromboembolic risks.Independent from the extent of liver resection,LLR is significantly associated with reduced SBL,both in the ATT and non-ATT groups.
文摘Background It’s essential to prevent from thrombosis on device without increasing the risk of bleeding complications after successfully implanted left atrial appendage device.At present,no guidelines recommend about postoperative antithrombotic therapy of left atrial appendage closure(LAAC).The purpose of this study is to investigate the safety and efficacy of different antithrombotic therapies after LAAC.
文摘Objective To determine the antiplatelet and antithrombotic efficacies of MV1 serine protease on coronary arterial thrombosis in a canine model of unstable angina.Methods Pentobarbital-anesthetized Beagles(total of 30)were used in which acute damage of the proximal left circumflex coronary artery,together with mechanical stenosis,produced the phenomenon of cyclic flow reduction(CFR)in the Folts model of unstable angina.When the platelet plug was removed by rubbing the vessel,the occlusion returned reproducibly for at least 3 hours in control studies.To evaluate the antithrombotic efficacy of MV1,CFR was first established over a period of one hour,thereafter,MV1(0.3,0.6 mg·kg-1 i.v.bolus),Batroxobin(0.3 BU·kg-1 i.v.bolus),Tirofiban(40 μg·kg-1,i.v.bolus),or vehicle was administered and observations continued for two additional hours.Platelet aggregation induced by adenosine diphosphate(ADP),arachidonic acid(AA),collagen(CG)was measured by the method of born,and thrombin time(TT),prothrombin time(PT),activated partial thromboplastin time(APTT)and fibrinogen(Fbg)were measured using coagulation methods,bleeding time was measured according to previous described methods.Results MV1 dramatically inhibited the frequency of CFR dose-dependently and the frequency of CFR decreased by 65%,80% respectively at 1 h than that in control group's after MV1 0.3,0.6 mg·kg-1 administration,further more the frequency decreased by 75%,90% respectively at 2 h.MV1 eliminated thrombus formation in 5 of 6 dogs at 0.6 mg·kg-1,and the time for CFR absolute disappearances of MV1 at a dose of 0.6 mg·kg-1 was shortened to 5±2 min(the time was more than 120 min in all dogs of control group).Platelet aggregation induced by ADP,AA,CG was inhibited effectively by MV1 0.3,0.6 mg·kg-1 TT,PT prolonged gently after MV1 administration,and MV1 produced an approximate 40% degradation of Fbg,but MV1 did not have any effects on APTT.There was a tendency for prolonged bleeding time with MV1 administration.Conclusions These studies showed that as a novel serine protease,MV1 provides favorable antithrombotic activity in vivo with inhibition of platelet aggregation and fibrinogenolytic activity.The results indicated that MV1 has reliable therapeutical efficacy on unstable angina pectoris.
基金The study was funded by an unrestricted grant from Abbott Laboratories(COR10620).
文摘OBJECTIVES Elderly patients show a higher incidence of ischemic and bleeding events after percutaneous transluminal coron-ary intervention(PCI).We sought to investigate outcomes in elderly patients treated with antithrombotic strategy guided by bleeding and ischemic risks after revascularization with last generation everolimus-eluting stent(EES).METHODS Prospective multicenter registry including patients over 75 years revascularized with EES and antithrombotic ther-apy guided by clinical presentation,PCI complexity and PRECISE DAPT score.Co-primary safety endpoints were:(1)composite of cardiac death,myocardial infarction and stent thrombosis and;(2)bleeding(BARC 2-5).Primary efficacy endpoint was target lesion revascularization.A matched group of patients revascularized with current drug-eluting stents and no such tailored antith-rombotic therapy was used as control.RESULTS Finally,1064 patients were included in SIERRA-75 cohort,80.8±4.2 years,36.6%women,71%acute coronary syn-dromes(ACS)and 53.6%complex PCI.Co-primary safety endpoint of major adverse cardiovascular events was met in 6.2%,co-primary safety endpoint of bleeding in 7.8%and primary efficacy endpoint of TKLR in 1.5%.The multivariable adjusted model showed no significant association of the prescribed short/long dual antiplatelet therapy(DAPT)durations with any endpoint suggesting a well tailored therapy.No stent thrombosis reported in the subgroup with 1-3 months DAPT duration.As compared to control group,bleeding BARC 2-5 was significantly lower in SIERRA-75 group(7.4%vs.10.2%,P=0.04)as well as the net safety-efficacy endpoint(14.3%vs.18.5%,P=0.02).CONCLUSIONS In elderly population,the application of this risks-adjusted antithrombotic protocol after revascularization with last generation EES seems to be associated with an improved prognosis in terms of ischemic and bleeding outcomes.
文摘BACKGROUND Postpancreatectomy hemorrhage(PPH)is the most severe type of complication after pancreatic surgery,although the effect of antithrombotic therapy(ATT)on PPH is largely unknown.The safety and efficacy of chemical thromboprophylaxis for venous thromboembolism(VTE)remains controversial.AIM To elucidate the effect of ATT on PPH.METHODS Published articles between 2013 and 2020 were searched from PubMed and Google Scholar,and after careful reviewing of all studies,studies concerning ATT and pancreatic surgery were included.Data such as study design,type of surgical procedures,type of antithrombotic drugs,and surgical outcome were extracted from the studies.RESULTS Nineteen published articles with a total of 37863 patients who underwent pancreatic surgery were included in the systematic review.Fourteen were cohort studies,with only three being prospective in nature.Two studies demonstrated that in patients receiving chronic ATT,which were mostly managed by heparin bridging,the risk of PPH was higher compared with those without ATT,and one study showed that patients with direct-acting oral anticoagulants managed by heparin bridging had significantly higher postoperative bleeding rates than others.The remaining six studies reported that pancreatic surgery can be safely performed in patients receiving chronic ATT,even under preoperative aspirin continuation.Concerning chemical thromboprophylaxis for VTE,most studies have shown a potentially high risk of PPH in patients undergoing chemical thromboprophylaxis;however,its effectiveness against VTE has not been statistically demonstrated,particularly among Asian patients.CONCLUSION Pancreatic surgery in chronically ATT-received patients can be safely performed without an increase in the occurrence of PPH,although the safety and efficacy of chemical thromboprophylaxis for VTE during pancreatic surgery is still controversial.Further investigation using reliable studies with good design is required to establish definite protocols or guidelines.
基金Supported by National Natural Science Foundation of China,No. 81600276
文摘BACKGROUND There is no consensus on the antithrombotic treatment strategy for patients with coronary artery ectasia(CAE).CASE SUMMARY This case reports the dynamic observation of a patient for 48 mo after a diagnosis of CAE with acute myocardial infarction(AMI).The first antithrombotic agents used were aspirin(100 mg/d)and clopidogrel(75 mg/d).During the sixth month of observation,a second AMI occurred involving the same culprit vessel;therefore,antithrombotic agents were changed to aspirin(100 mg/d)and ticagrelor(90 mg twice per day).Twelve months after the second AMI,an attempt to reduce the dosage ticagrelor failed;therefore the original dose was continued.The CAE was relatively stable during the following 4 years.CONCLUSION This case indicates that a combination of aspirin and ticagrelor may be more effective for CAE patients with AMI than aspirin and clopidogrel.
文摘The treatment of elderly patients with acute coronary syndromes (ACS) remains challenging. About two thirds of patients with ACS and four fifth of patients who died from ACS are older than 65 years.
