- [Cardiovascular Medication in Elderly Patients]. [Journal Article]
- DMDtsch Med Wochenschr 2018; 143(4):236-243
- Elderly people show increased probability to develop atherosclerotic diseases; in consequence heart failure - most often following coronary heart disease - as well as atrial fibrillation is more comm...
Elderly people show increased probability to develop atherosclerotic diseases; in consequence heart failure - most often following coronary heart disease - as well as atrial fibrillation is more common. Following guidelines may lead to polypharmacy, i. e. use of more than 5 drugs daily. Thus, drug interactions as well as side effects become more likely; especially in elderly patients reduced kidney function has to be taken into account. Only drugs which have shown to prolong life or to reduce symptoms in controlled clinical trials should be used. There is little evidence to use low dose aspirin or lipid lowering agents in primary prevention especially in elderly. ACE inhibitors, β blocker and MRA are effective to improve symptoms and outcome in HFrEF but not in HFmEF or HFpEF. This also holds true for the elderly. Withdrawal of long term diuretic treatment in the elderly patients may lead to symptoms of heart failure or increase in blood pressure to hypertensive values often. In coronary heart disease β blocker may be used to control symptoms as well as to reduce the need for coronary intervention following 1 year after myocardial infarction. Because the risk of stroke increases with age more than the risk of bleeding, the absolute benefit of oral anticoagulation in atrial fibrillation patients is highest in the elderly. NOAK appear to be safer and at least as efficacious as warfarin.
- Peripheral artery disease and antiplatelet treatment. [Review]
- COCurr Opin Pharmacol 2018 Feb 19; 39:43-52
- Peripheral artery disease (PAD) is one of the most important causes of cardiovascular morbidity and mortality and its prevalence is alarmingly increasing in modern societies. PAD shares common charac...
Peripheral artery disease (PAD) is one of the most important causes of cardiovascular morbidity and mortality and its prevalence is alarmingly increasing in modern societies. PAD shares common characteristics with the other atherosclerotic diseases but involves specifically the arteries of the lower extremities. Apart from the changes in lifestyle, antiplatelet agents are the hallmark of the treatment and improve the symptoms as well as the progression of the disease. Aspirin is the cornerstone of treatment and is administrated in doses ranging from 75 to 325mg daily. Additionally, cilostazol and clopidogrel have an important therapeutic role too. Novel antiplatelet agents are the subject of research in both experimental and clinical studies in order to evaluate the efficacy and safety profile. The most important antiplatelet factors which are under investigation are the novel P2Y12 receptor inhibitors prasugrel and ticagrelor. Furthermore, vorapaxar, a protease-activated receptor inhibitor, exhibits antiplatelet properties and has been studied in PAD.
- Aspirin-induced attenuation of adipogenic differentiation of bone marrow mesenchymal stem cells is accompanied by the disturbed epigenetic modification. [Journal Article]
- IJInt J Biochem Cell Biol 2018 Feb 19
- Aspirin has positive effects on bone marrow mesenchymal stem cells (BMSCs) osteogenic differentiation. However, researchers did not give much thought to its effect on BMSCs adipogenic differentiation...
Aspirin has positive effects on bone marrow mesenchymal stem cells (BMSCs) osteogenic differentiation. However, researchers did not give much thought to its effect on BMSCs adipogenic differentiation. Here, we analyzed the effect of aspirin on the BMSCs adipogenic differentiation. To detect whether the effect of aspirin on the adipogenic differentiation of BMSCs is associated with the disturbed epigenetic modification, the expression of histone deacetylases (HDACs), activity of HDACs and HAT, global histone H3 acetylation and H3k9 acetylation alterations were investigated. Moreover, to further explore and understand the binding mode between aspirin and HDACs, an attempt was made to identify the interaction between aspirin and the HDACs with the aid of in silico docking study. The results showed that aspirin could induce inhibition of BMSCs adipogenesis. The level of HDAC activity, global histone H3 acetylation, and H3k9 acetylation were all down regulated during adipogenic differentiation, and aspirin can reverse these decreases. Furthermore, the HDAC isoforms have different expression patterns in those progresses. The expression of HDAC9 was increased in a does-dependent manner when aspirin was introduced during BMSCs adipogenic differentiation. Docking study showed that high affinity of HDAC9 to aspirin was existed, suggesting that HDAC9 may has an important role in the process of aspirin-induced suppression of adipogenesis. Further studies are needed to define the intricate mechanisms of the HDAC isoforms, and all of these enable us to understand aspirin and its efficacy of inhibition of adipogenic differentiation and pave the way to aspirin clinical using for the tissue regenerating.
- Impaired aspirin-mediated platelet function inhibition in resuscitated patients with acute myocardial infarction treated with therapeutic hypothermia: a prospective, observational, non-randomized single-centre study. [Journal Article]
- AIAnn Intensive Care 2018 Feb 21; 8(1):28
- The majority of resuscitated patients present with underlying cardiac disease, and out of these myocardial infarction is most common. Immediate interventional treatment is recommended and routinely r...
The majority of resuscitated patients present with underlying cardiac disease, and out of these myocardial infarction is most common. Immediate interventional treatment is recommended and routinely requires dual antiplatelet therapy including aspirin and a P2Y12-inhibitor. Therapeutic hypothermia or target temperature management is also recommended in these patients. Cardiogenic shock as well as reduced body temperature impacts platelet reactivity and its medical inhibition. The study aims to quantify aspirin- and P2Y12-mediated platelet inhibition in patients presenting with myocardial infarction and cardiopulmonary resuscitation. Twenty-five resuscitated patients were enrolled in this prospective, observational, non-randomized single-centre study. These patients were compared to 77 matched controls from the ATLANTIS-ACS database of non-resuscitated patients with myocardial infarction. Platelet function testing was performed by light transmittance aggregometry. Aspirin reactivity was monitored by inducing platelet aggregation with collagen and arachidonic acid, respectively. P2Y12 inhibition was recorded by stimulation of platelet aggregation with adenosine diphosphate. To quantify the overall platelet response, thrombin receptor-activated peptide was used. Aspirin-mediated platelet reactivity decreased significantly in resuscitated patients during the first days and was significantly weaker on day 3 (collagen AUC 253.8 (122.7-352.2) vs. 109.0 (73.0-182.0); p = 0.022). P2Y12-mediated platelet inhibition was also impaired in resuscitated patients on day 3 (mean ADP AUC (IQR): CPR 172.1 (46.7-346.5) vs. control 43.9 (18.9-115.2); p < 0.05). Aspirin- and P2Y12-mediated platelet inhibition is impaired in resuscitated patients treated with therapeutic hypothermia. On day 3, we recorded lowest inhibitory effects of both drug types and patients might be at particular risk at that time. Potentially, intravenous aspirin and P2Y12 inhibitors might still supply a more predictable and stable platelet inhibition.
- The association of aspirin use with severity of acute exacerbation of chronic obstructive pulmonary disease: a retrospective cohort study. [Journal Article]
- NPNPJ Prim Care Respir Med 2018 Feb 21; 28(1):7
- Little is known about the effect of long-term aspirin use on acute severity of COPD. We hypothesized that, in patients hospitalized for acute exacerbation of COPD (AECOPD), long-term aspirin use is a...
Little is known about the effect of long-term aspirin use on acute severity of COPD. We hypothesized that, in patients hospitalized for acute exacerbation of COPD (AECOPD), long-term aspirin use is associated with lower risks of disease severity (in-hospital death, mechanical ventilation use, and hospital length-of-stay). We conducted a retrospective cohort study using large population-based data from 2012 through 2013. Among 206,686 patients (aged ≥40 years) hospitalized for AECOPD, aspirin users had lower in-hospital mortality (1.0 vs. 1.4%; OR 0.60 [95% CI 0.50-0.72]; P < 0.001) and lower risk of invasive mechanical ventilation use (1.7 vs. 2.6%; OR 0.64 [95% CI 0.55-0.73]; P < 0.001) compared to non-users, while there was no significant difference in risks of non-invasive positive pressure ventilation use. Length-of-stay was shorter in aspirin users compared to non-users (P < 0.001). In sum, in patients with AECOPD, aspirin use was associated with lower rates of in-hospital mortality and invasive mechanical ventilation use, and shorter length-of-stay.
- Acute Respiratory Distress Syndrome: Advances in Diagnosis and Treatment. [Journal Article]
- JAMAJAMA 2018 02 20; 319(7):698-710
- CONCLUSIONS: The Berlin definition of acute respiratory distress syndrome addressed limitations of the American-European Consensus Conference definition, but poor reliability of some criteria may contribute to underrecognition by clinicians. No pharmacologic treatments aimed at the underlying pathology have been shown to be effective, and management remains supportive with lung-protective mechanical ventilation. Guidelines on mechanical ventilation in patients with acute respiratory distress syndrome can assist clinicians in delivering evidence-based interventions that may lead to improved outcomes.
- [Antiaggregants in Primary Prevention of Cardiovascular Diseases and Prevention of Atherothrombosis in Patients With Stable Ischemic Heart Disease: Aspects of Efficacy and Safety]. [Journal Article]
- KKardiologiia 2018; (2):55-67
- This review is devoted to the use of antiaggregants. We consider here pathogenesis of intraarterial thrombosis, mechanism of action of antiaggregants, and recommendations on the use of drugs of this ...
This review is devoted to the use of antiaggregants. We consider here pathogenesis of intraarterial thrombosis, mechanism of action of antiaggregants, and recommendations on the use of drugs of this class for primary prevention of cardiovascular diseases and prevention of atherothrombotic complications of stable ischemic heart disease. Information on mechanisms of development and causes of resistance to antiaggregants is also presented. Finally we discuss the problem of safety of therapy with antiaggregants, methods of lowering the risk of bleeding, and prevention of aspirin induced gastropathy.
- [Safety and efficacy of long-term treatment with different ASA forms in patients with stable IHD and a high risk for development of gastropathy by data from a cross-sectionals study]. [Journal Article]
- KKardiologiia 2017 SMar; 57(S3):24-31
- CONCLUSIONS: Aspirin-Cardio is characterized by better safety in respect of GI symptoms and better compliance with the treatment during long-term prophylactic therapy. The proposed questionnaire for evaluation of GI symptoms can be used for specifying indications and modifying the treatment tactics.
- Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty. [Journal Article]
- NEJMN Engl J Med 2018 02 22; 378(8):699-707
- CONCLUSIONS: Among patients who received 5 days of rivaroxaban prophylaxis after total hip or total knee arthroplasty, extended prophylaxis with aspirin was not significantly different from rivaroxaban in the prevention of symptomatic venous thromboembolism. (Funded by the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT01720108 .).
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- Preeclampsia induced by storkhead box 1 overexpression in mice induces intrauterine growth restriction, abnormal ultrasonography and blood oxygenation level-dependent MRI signatures. [Journal Article]
- JHJ Hypertens 2018 Feb 20
- CONCLUSIONS: These preliminary pre-clinical results suggest that BOLD MRI could be evaluated as a prognostic/diagnostic tool for preeclampsia.