Objectives To investigate the rate of anticoagulant use,the reasons for not prescribing anticoagulant,and the factors associated with non-prescription of anticoagulant in older Thai adults with non-valvular atrial fib...Objectives To investigate the rate of anticoagulant use,the reasons for not prescribing anticoagulant,and the factors associated with non-prescription of anticoagulant in older Thai adults with non-valvular atrial fibrillation.Methods A multicenter registry of patients with non-valvular atrial fibrillation was conducted during 2014 to 2017 in Thailand.Demographic,medical history,antithrombotic medication,non-antithrombotic medication,and laboratory data were collected and analyzed.Data were compared between the older adult (≥ 65 years) and younger adult (< 65 years) groups.The reasons why anticoagulant was not prescribed were collected,and predictive factors were identified.Results A total of 3218 patients (1873 males) with an average age of 67.3 ± 11.3 years were included.Almost two-thirds (61.0%) of patients were in the older adult group.Anticoagulant was prescribed in 2422 patients (75.3%): 81.4% in the older adult group and 65.7% in the younger adult group.The three main reasons for not prescribing anticoagulant were already taking antiplatelets,patient refusal,and bleeding risk.These reasons were more common in older adults as compared to younger adults.Multivariate analysis revealed current use of antiplatelets to be the most important factor that predict the non-prescription of anticoagulant in older population.Conclusions The prevalence of anticoagulant prescription among older Thai adults with atrial fibrillation is 81.4%.Taking antiplatelet drugs was found to be the strongest reason that predicts the non-prescription of anticoagulant in this patient population.A guideline should be developed to optimize the use of anticoagulant and antiplatelet in older adults.展开更多
Objective Elevated serum uric acid predicts poor outcomes in patients with cardiovascular disease.We aimed to examine associations between hyperuricemia and clinical outcomes among very elderly patients with non-valvu...Objective Elevated serum uric acid predicts poor outcomes in patients with cardiovascular disease.We aimed to examine associations between hyperuricemia and clinical outcomes among very elderly patients with non-valvular atrial fibrillation(NVAF).Methods Elderly patients(≥80 years)with NVAF admitted to our hospital from January 2009 to December 2015 were retrospectively studied and were followed up until April 2017.展开更多
Purpose: The aim of this study was to investigate non-genetic and genetic factors contributing to stable warfarin dose change in the extreme elderly patients with non-valvular atrial fibrillation. Methods: A total of ...Purpose: The aim of this study was to investigate non-genetic and genetic factors contributing to stable warfarin dose change in the extreme elderly patients with non-valvular atrial fibrillation. Methods: A total of 40 elderly patients with stable warfarin doses were included in this study. Clinical basic data, such as age, sex, body mass index, basic disease like hypertension, diabetes and coronary heart disease had been recorded. Two nucleotide polymorphisms about VKORC1-1639G^A and CYP2C9 1075A^C genes were detected via sequencing by hybridization. Results: The elderly patients with CYP2C9 1075A^C (CA) genotype needed less warfarin daily doses than those?with CYP2C9 1075A^C (AA) genotype (1.93 ± 0.79 mg/d VS 2.15 ± 0.64 mg/d), but there was no significant difference (p = 0.601). While the daily warfarin dose required for patients with VKORC1-1639G^A (AA) genotype was significantly lower than that for patients with VKORC1-1639G^A (GA) genotype (2.00 ± 0.67 mg/d VS 2.63 ± 0.38 mg/d, p = 0.012). VKORC1-1639G^A together with age and diabetes status accounted 41.7% for dose variability. The new algorithm was developed using multivariate linear regression analysis;the model was developed for: Dose = 7.731 – 0.056 * age + 0.527 * DM - 0.785 * VKORC1. Conclusions: VKORC1-1639G^A together with age and diabetes status might predict warfarin doses in age ≥ 80 years patients with non-valvularatrial fibrillation. In contrast, the polymorphism of CYP2C9 1075A^C was not associated with dose variability.展开更多
Objective:To explore the relationship between polymorphisms in rs1800807 and rs1800808 locies of P-selectin gene and plasma concentrations of soluble P-selectin(sPs)and non-valvular atrial fibrillation(Af)coupled with...Objective:To explore the relationship between polymorphisms in rs1800807 and rs1800808 locies of P-selectin gene and plasma concentrations of soluble P-selectin(sPs)and non-valvular atrial fibrillation(Af)coupled with thrombosis in Kazakh ethnicity.Methods:This was a case-control study,enrolling hospitalized Kazakh Af patients with and without thrombosis and healthy subjects.PCR-RFLP method was used to analyze the polymorphisms of the locies,and ELISA method was to measure plasma sPs concentrations.Subjects were divided into Af thrombosis,only Af and control groups.Results:We enrolled 42 Af thrombosis,156 only Af and 307 control subjects.Carriers of GG genotype of the loci rs1800807 was the highest in Af thrombosis,followed by only Af and the lowest in the control groups(69 vs 23.7 vs 18.2%,P<0.001).Carriers of TT genotype of the loci rs1800808 was the highest in Af thrombosis,followed by only Af and the lowest in the control groups(31.0 vs 13.5 vs 8.1%,P<0.001).Plasma sPs concentrations was the highest in Af thrombosis group,followed by only Af group and the lowest in the control(52.20 vs 34.04 vs 35.85pg/mL,P<0.001).Plasma sPs concentrations were significantly higher in the carriers of GG genotypes of the loci rs1800807 than in those of CC and CG genotypes(45.75 vs 33.86 vs 39.26pg/mL,P<0.001)and also significantly higher in the carries of TT of the loci rs1800808 than in those of CC and CT(43.16 vs 36.74 vs 39.08pg/mL,P<0.001).GG type of rs1800807 loci(OR=3.35,95%CI:2.03-5.55)and TT type of rs1800808(OR=2.19,95%CI:1.65-2.90)showed significantly higher odd's ratio for Af thrombosis,compared with the wild genotype and the highest tertile of plasma sPs aslo showed higher odd's ratio(OR=1.31,95CI%:1.12-1.93),compared with the lowest tertile.Conclusion:polymorphisms of the locies of the PS gene were observed to exist in Af patients with thrombosis and with higher concentrations of plamsa sPs,suggesting their involvement in Af and thrombosis in Kazakh subjects.展开更多
<strong>Background:</strong> <span style="white-space:normal;"><span style="font-family:;" "="">Atrial fibrillation (AF) is the most common cardiac arrhythmia...<strong>Background:</strong> <span style="white-space:normal;"><span style="font-family:;" "="">Atrial fibrillation (AF) is the most common cardiac arrhythmia. It increases cardiovascular morbidity, especially embolic stroke and mortality. Two-dimensional speckle tracking echocardiography (2D STE) is a useful method that has been used to detect changes in atrial myocardial deformation in AF patients.</span></span><span style="white-space:normal;"><span style="font-family:;" "=""> </span></span><span style="white-space:normal;"><b><span style="font-family:;" "="">Objectives:</span></b></span><span style="white-space:normal;"><span style="font-family:;" "=""> To study atrial myocardial deformation changes in patient with non</span></span><span style="white-space:normal;"><span style="font-family:;" "="">-</span></span><span style="white-space:normal;"><span style="font-family:;" "="">valvular AF using 2D STE.<b> Patients and Methods: </b>This study included 25 patients with non</span></span><span style="white-space:normal;"><span style="font-family:;" "="">-</span></span><span style="white-space:normal;"><span style="font-family:;" "="">valvular AF and 25 normal healthy controls. 2D STE was used for assessment of strain and strain rate of septal and free walls of both right atrium (RA) and LA and left ventricle (LV). <b>Results:</b> Mean LA septal and lateral strain and strain rate were significantly reduced in the AF group compared to the control group (-7.2% ± 5.2% vs. -20.4% ± 3.9%, -8.7% ± 8.8% vs. -21.7% ± 3.4%) and (-0.9 ± 0.5 S<sup>-1</sup> vs. -1.9 ± 0.4 S<sup>-1</sup>, –1.1 ± 0.6 S<sup>-1</sup> vs. -2.04 ± 0.3 S<sup>-1</sup>) respectively. Mean RA septal and lateral strain and strain rate were significantly reduced in the AF group compared to the control group (-5.9% ± 6.1% vs. -23.4% ± 4.5%, -8.9% ± 9.3% vs. -21.7% ± 3.4%) and (-0.98 ± 0.6 S<sup>-1</sup> vs. -1.9 ± 0.3 S<sup>-1</sup>, -1.3 ± 0.9 S<sup>-1</sup> vs. -2.1 ± 0.5 S<sup>-1</sup>) respectively. Mean LV global longitudinal strain (GLS) and strain rate were significantly reduced in the AF group compared to the control group (-8.8% ± 4.6% vs -19.6% ± 2.4%) and (-0.8 ± 0.3 S<sup>-1</sup> vs -1.5 ± 0.4 S<sup>-1</sup>) respectively (P <</span></span><span style="white-space:normal;"><span style="font-family:;" "=""> </span></span><span style="white-space:normal;"><span style="font-family:;" "="">0.001 for all). <b>Conclusion:</b> AF is a bi-atrial disease, LA and RA myocardial deformation properties as well as LV GLS and strain rate measured by 2D STE were significantly impaired in AF patients compared to healthy controls.</span></span>展开更多
Objective:To summarize the use rate,safety,efficacy of antithrombotics in stroke/transient ischemic attack (TIA) prevention,and reasons for not using dabigatran etexilate (DE) in Shanghai,China.Methods:Non-valvular at...Objective:To summarize the use rate,safety,efficacy of antithrombotics in stroke/transient ischemic attack (TIA) prevention,and reasons for not using dabigatran etexilate (DE) in Shanghai,China.Methods:Non-valvular atrial fibrillation (NVAF)-associated stroke patients were prospectively registered as an electronic database.Use rate of antithrombofics and reasons for not using DE were extracted during follow-up.Patients' baseline characteristics,recurrent ischemic stroke/TIA events and bleeding complications were analyzed.Patients:From April 2012 to August 2014,110 inpatients with NVAF-associated stroke were studied in our hospital.NVAF was diagnosed by 12-lead electrocardiogram,24 h Holter and echocardiography.Results:Before introduction of DE (April 2013),use rates of warfarin and antiplatelets were 28.9％ (11/38) and 60.5％ (23/38)respectively; after that,use rates of warfarin,DE,and antiplatelets were 20.8％ (15/72),12.5％ (9/72),and 43.1％ (31/72).The DE did not improve use of anticoagulants (P =0.639).There were 19 (17.3％) recurrent ischemic stroke events up to October 2015; two (9.5％) in the non-user group,10 (18.5％) in the antiplatelet group,and seven (20.0％) in the anticoagulants group (P =0.570).Furthermore,recurrence rates were similar between the DE group (20.0％) and the Warfarin group (20.0％,P =1.000).The most common reason for not using DE was financial concerns (61.0％),followed by inconvenience to purchase (14.0％) and hemorrhage concerns (11.0％).Two patients using warfarin found fecal occult blood so they stopped warfarin and began to use antiplatelet drugs.No bleeding event occurred in the other groups.Only one patient had side effects (dyspepsia and gastroesophageal reflux)from DE.Conclusion:The use rate of either DE or warfarin in Shanghai was low; DE had not improved anticoagulation therapy for NVAF patients in Shanghai mainly because DE had not been covered by health insurance.展开更多
基金funded by the Health Systems Research Institute (HSRI), Nonthaburi, Thailand (grant no. 59-053)the Heart Association of Thailand under the Royal Patronage of H.M. the King, Bangkok, ThailandThe Royal College of Physicians of Thailand, Bangkok, Thailand
文摘Objectives To investigate the rate of anticoagulant use,the reasons for not prescribing anticoagulant,and the factors associated with non-prescription of anticoagulant in older Thai adults with non-valvular atrial fibrillation.Methods A multicenter registry of patients with non-valvular atrial fibrillation was conducted during 2014 to 2017 in Thailand.Demographic,medical history,antithrombotic medication,non-antithrombotic medication,and laboratory data were collected and analyzed.Data were compared between the older adult (≥ 65 years) and younger adult (< 65 years) groups.The reasons why anticoagulant was not prescribed were collected,and predictive factors were identified.Results A total of 3218 patients (1873 males) with an average age of 67.3 ± 11.3 years were included.Almost two-thirds (61.0%) of patients were in the older adult group.Anticoagulant was prescribed in 2422 patients (75.3%): 81.4% in the older adult group and 65.7% in the younger adult group.The three main reasons for not prescribing anticoagulant were already taking antiplatelets,patient refusal,and bleeding risk.These reasons were more common in older adults as compared to younger adults.Multivariate analysis revealed current use of antiplatelets to be the most important factor that predict the non-prescription of anticoagulant in older population.Conclusions The prevalence of anticoagulant prescription among older Thai adults with atrial fibrillation is 81.4%.Taking antiplatelet drugs was found to be the strongest reason that predicts the non-prescription of anticoagulant in this patient population.A guideline should be developed to optimize the use of anticoagulant and antiplatelet in older adults.
文摘Objective Elevated serum uric acid predicts poor outcomes in patients with cardiovascular disease.We aimed to examine associations between hyperuricemia and clinical outcomes among very elderly patients with non-valvular atrial fibrillation(NVAF).Methods Elderly patients(≥80 years)with NVAF admitted to our hospital from January 2009 to December 2015 were retrospectively studied and were followed up until April 2017.
文摘Purpose: The aim of this study was to investigate non-genetic and genetic factors contributing to stable warfarin dose change in the extreme elderly patients with non-valvular atrial fibrillation. Methods: A total of 40 elderly patients with stable warfarin doses were included in this study. Clinical basic data, such as age, sex, body mass index, basic disease like hypertension, diabetes and coronary heart disease had been recorded. Two nucleotide polymorphisms about VKORC1-1639G^A and CYP2C9 1075A^C genes were detected via sequencing by hybridization. Results: The elderly patients with CYP2C9 1075A^C (CA) genotype needed less warfarin daily doses than those?with CYP2C9 1075A^C (AA) genotype (1.93 ± 0.79 mg/d VS 2.15 ± 0.64 mg/d), but there was no significant difference (p = 0.601). While the daily warfarin dose required for patients with VKORC1-1639G^A (AA) genotype was significantly lower than that for patients with VKORC1-1639G^A (GA) genotype (2.00 ± 0.67 mg/d VS 2.63 ± 0.38 mg/d, p = 0.012). VKORC1-1639G^A together with age and diabetes status accounted 41.7% for dose variability. The new algorithm was developed using multivariate linear regression analysis;the model was developed for: Dose = 7.731 – 0.056 * age + 0.527 * DM - 0.785 * VKORC1. Conclusions: VKORC1-1639G^A together with age and diabetes status might predict warfarin doses in age ≥ 80 years patients with non-valvularatrial fibrillation. In contrast, the polymorphism of CYP2C9 1075A^C was not associated with dose variability.
基金National Natural Science Foundation China(No.81760062)
文摘Objective:To explore the relationship between polymorphisms in rs1800807 and rs1800808 locies of P-selectin gene and plasma concentrations of soluble P-selectin(sPs)and non-valvular atrial fibrillation(Af)coupled with thrombosis in Kazakh ethnicity.Methods:This was a case-control study,enrolling hospitalized Kazakh Af patients with and without thrombosis and healthy subjects.PCR-RFLP method was used to analyze the polymorphisms of the locies,and ELISA method was to measure plasma sPs concentrations.Subjects were divided into Af thrombosis,only Af and control groups.Results:We enrolled 42 Af thrombosis,156 only Af and 307 control subjects.Carriers of GG genotype of the loci rs1800807 was the highest in Af thrombosis,followed by only Af and the lowest in the control groups(69 vs 23.7 vs 18.2%,P<0.001).Carriers of TT genotype of the loci rs1800808 was the highest in Af thrombosis,followed by only Af and the lowest in the control groups(31.0 vs 13.5 vs 8.1%,P<0.001).Plasma sPs concentrations was the highest in Af thrombosis group,followed by only Af group and the lowest in the control(52.20 vs 34.04 vs 35.85pg/mL,P<0.001).Plasma sPs concentrations were significantly higher in the carriers of GG genotypes of the loci rs1800807 than in those of CC and CG genotypes(45.75 vs 33.86 vs 39.26pg/mL,P<0.001)and also significantly higher in the carries of TT of the loci rs1800808 than in those of CC and CT(43.16 vs 36.74 vs 39.08pg/mL,P<0.001).GG type of rs1800807 loci(OR=3.35,95%CI:2.03-5.55)and TT type of rs1800808(OR=2.19,95%CI:1.65-2.90)showed significantly higher odd's ratio for Af thrombosis,compared with the wild genotype and the highest tertile of plasma sPs aslo showed higher odd's ratio(OR=1.31,95CI%:1.12-1.93),compared with the lowest tertile.Conclusion:polymorphisms of the locies of the PS gene were observed to exist in Af patients with thrombosis and with higher concentrations of plamsa sPs,suggesting their involvement in Af and thrombosis in Kazakh subjects.
文摘<strong>Background:</strong> <span style="white-space:normal;"><span style="font-family:;" "="">Atrial fibrillation (AF) is the most common cardiac arrhythmia. It increases cardiovascular morbidity, especially embolic stroke and mortality. Two-dimensional speckle tracking echocardiography (2D STE) is a useful method that has been used to detect changes in atrial myocardial deformation in AF patients.</span></span><span style="white-space:normal;"><span style="font-family:;" "=""> </span></span><span style="white-space:normal;"><b><span style="font-family:;" "="">Objectives:</span></b></span><span style="white-space:normal;"><span style="font-family:;" "=""> To study atrial myocardial deformation changes in patient with non</span></span><span style="white-space:normal;"><span style="font-family:;" "="">-</span></span><span style="white-space:normal;"><span style="font-family:;" "="">valvular AF using 2D STE.<b> Patients and Methods: </b>This study included 25 patients with non</span></span><span style="white-space:normal;"><span style="font-family:;" "="">-</span></span><span style="white-space:normal;"><span style="font-family:;" "="">valvular AF and 25 normal healthy controls. 2D STE was used for assessment of strain and strain rate of septal and free walls of both right atrium (RA) and LA and left ventricle (LV). <b>Results:</b> Mean LA septal and lateral strain and strain rate were significantly reduced in the AF group compared to the control group (-7.2% ± 5.2% vs. -20.4% ± 3.9%, -8.7% ± 8.8% vs. -21.7% ± 3.4%) and (-0.9 ± 0.5 S<sup>-1</sup> vs. -1.9 ± 0.4 S<sup>-1</sup>, –1.1 ± 0.6 S<sup>-1</sup> vs. -2.04 ± 0.3 S<sup>-1</sup>) respectively. Mean RA septal and lateral strain and strain rate were significantly reduced in the AF group compared to the control group (-5.9% ± 6.1% vs. -23.4% ± 4.5%, -8.9% ± 9.3% vs. -21.7% ± 3.4%) and (-0.98 ± 0.6 S<sup>-1</sup> vs. -1.9 ± 0.3 S<sup>-1</sup>, -1.3 ± 0.9 S<sup>-1</sup> vs. -2.1 ± 0.5 S<sup>-1</sup>) respectively. Mean LV global longitudinal strain (GLS) and strain rate were significantly reduced in the AF group compared to the control group (-8.8% ± 4.6% vs -19.6% ± 2.4%) and (-0.8 ± 0.3 S<sup>-1</sup> vs -1.5 ± 0.4 S<sup>-1</sup>) respectively (P <</span></span><span style="white-space:normal;"><span style="font-family:;" "=""> </span></span><span style="white-space:normal;"><span style="font-family:;" "="">0.001 for all). <b>Conclusion:</b> AF is a bi-atrial disease, LA and RA myocardial deformation properties as well as LV GLS and strain rate measured by 2D STE were significantly impaired in AF patients compared to healthy controls.</span></span>
基金the 'prevention and control of chronic diseases project' of Shanghai Hospital Development Center [No.SHDC12015310,to J.R.Liu],early development program from Clinical Research Center of Brain Disease [No.2015NKX006,to J.R.Liu],the National Natural Science Foundation of China [No 81271302 to J.R.Liu],the 'Science and Technology Project' of the Shanghai Pudong New Area Health Bureau (Pudong New Area Population and Family Planning Commission) [No.PW 2013D-4,to J.R.Liu],research innovation project from Shanghai Municipal Science and Technology Commission [No.14JC1404300,to J.R.Liu],and State Key Laboratory of Medical Neurobiology,Fudan University
文摘Objective:To summarize the use rate,safety,efficacy of antithrombotics in stroke/transient ischemic attack (TIA) prevention,and reasons for not using dabigatran etexilate (DE) in Shanghai,China.Methods:Non-valvular atrial fibrillation (NVAF)-associated stroke patients were prospectively registered as an electronic database.Use rate of antithrombofics and reasons for not using DE were extracted during follow-up.Patients' baseline characteristics,recurrent ischemic stroke/TIA events and bleeding complications were analyzed.Patients:From April 2012 to August 2014,110 inpatients with NVAF-associated stroke were studied in our hospital.NVAF was diagnosed by 12-lead electrocardiogram,24 h Holter and echocardiography.Results:Before introduction of DE (April 2013),use rates of warfarin and antiplatelets were 28.9％ (11/38) and 60.5％ (23/38)respectively; after that,use rates of warfarin,DE,and antiplatelets were 20.8％ (15/72),12.5％ (9/72),and 43.1％ (31/72).The DE did not improve use of anticoagulants (P =0.639).There were 19 (17.3％) recurrent ischemic stroke events up to October 2015; two (9.5％) in the non-user group,10 (18.5％) in the antiplatelet group,and seven (20.0％) in the anticoagulants group (P =0.570).Furthermore,recurrence rates were similar between the DE group (20.0％) and the Warfarin group (20.0％,P =1.000).The most common reason for not using DE was financial concerns (61.0％),followed by inconvenience to purchase (14.0％) and hemorrhage concerns (11.0％).Two patients using warfarin found fecal occult blood so they stopped warfarin and began to use antiplatelet drugs.No bleeding event occurred in the other groups.Only one patient had side effects (dyspepsia and gastroesophageal reflux)from DE.Conclusion:The use rate of either DE or warfarin in Shanghai was low; DE had not improved anticoagulation therapy for NVAF patients in Shanghai mainly because DE had not been covered by health insurance.
