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
目的通过筛选真实世界中非瓣膜性房颤(NVAF)合并肾功能不全[15<肌酐清除率(CL_(cr))≤60 mL·min^(-1)]患者联用利伐沙班致出血风险增加的药代动力学相互作用(PK-DDI)药品,以促进临床合理用药。方法通过检索文献(PubMed、Web of ...目的通过筛选真实世界中非瓣膜性房颤(NVAF)合并肾功能不全[15<肌酐清除率(CL_(cr))≤60 mL·min^(-1)]患者联用利伐沙班致出血风险增加的药代动力学相互作用(PK-DDI)药品,以促进临床合理用药。方法通过检索文献(PubMed、Web of Science、中国知网、万方数据、维普网)、说明书、2021年欧洲心律协会指南、Lexicomp数据库总结利伐沙班PK-DDI目录;采用回顾性队列研究,收集2022年11月1日至2023年10月31日在首都医科大学宣武医院住院并服用利伐沙班的NVAF合并肾功能不全患者,根据是否使用利伐沙班PK-DDI药品分为PK-DDI组和非PK-DDI组。其中PK-DDI药品限定为P-gp和/或CYP3A4抑制剂,随访3个月,比较2组患者有效性和安全性结局。结果共计22类141种药品,根据是否需调整剂量分类,需要禁用、慎用药品65种和无需调整剂量药品76种。研究共纳入患者143例,PK-DDI组出血发生率高于非PK-DDI组(P<0.05),PK-DDI组与非PK-DDI组的缺血性卒中发生率差异无统计学意义(P>0.05)。PK-DDI组主要的出血性事件为临床相关非大出血(8例,61.5%),用药后30 d内出血发生率为38.7%,涉及药品包含胺碘酮、银杏叶提取物、氟康唑、伏立康唑、奥希替尼。结论利伐沙班PK-DDI涉及多种药品,主要靶点为P-gp和CYP3A4。肾功能不全患者服用利伐沙班时,联用P-gp和/或CYP3A4抑制剂增加出血风险。利伐沙班应避免与银杏叶提取物、伏立康唑联用。利伐沙班与胺碘酮、氟康唑、奥希替尼联用需严密监测,如凝血酶原时间、抗凝血(Xa)因子水平或利伐沙班血药浓度。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>
文摘目的通过筛选真实世界中非瓣膜性房颤(NVAF)合并肾功能不全[15<肌酐清除率(CL_(cr))≤60 mL·min^(-1)]患者联用利伐沙班致出血风险增加的药代动力学相互作用(PK-DDI)药品,以促进临床合理用药。方法通过检索文献(PubMed、Web of Science、中国知网、万方数据、维普网)、说明书、2021年欧洲心律协会指南、Lexicomp数据库总结利伐沙班PK-DDI目录;采用回顾性队列研究,收集2022年11月1日至2023年10月31日在首都医科大学宣武医院住院并服用利伐沙班的NVAF合并肾功能不全患者,根据是否使用利伐沙班PK-DDI药品分为PK-DDI组和非PK-DDI组。其中PK-DDI药品限定为P-gp和/或CYP3A4抑制剂,随访3个月,比较2组患者有效性和安全性结局。结果共计22类141种药品,根据是否需调整剂量分类,需要禁用、慎用药品65种和无需调整剂量药品76种。研究共纳入患者143例,PK-DDI组出血发生率高于非PK-DDI组(P<0.05),PK-DDI组与非PK-DDI组的缺血性卒中发生率差异无统计学意义(P>0.05)。PK-DDI组主要的出血性事件为临床相关非大出血(8例,61.5%),用药后30 d内出血发生率为38.7%,涉及药品包含胺碘酮、银杏叶提取物、氟康唑、伏立康唑、奥希替尼。结论利伐沙班PK-DDI涉及多种药品,主要靶点为P-gp和CYP3A4。肾功能不全患者服用利伐沙班时,联用P-gp和/或CYP3A4抑制剂增加出血风险。利伐沙班应避免与银杏叶提取物、伏立康唑联用。利伐沙班与胺碘酮、氟康唑、奥希替尼联用需严密监测,如凝血酶原时间、抗凝血(Xa)因子水平或利伐沙班血药浓度。
