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
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
Nonalcoholic fatty liver disease(NAFLD)exhibits sexual dimorphism,with men being more exposed than women to the risk of simple steatosis,nonalcoholic steatohepatitis fibrosis,and hepatocellular carcinoma(HCC),while th...Nonalcoholic fatty liver disease(NAFLD)exhibits sexual dimorphism,with men being more exposed than women to the risk of simple steatosis,nonalcoholic steatohepatitis fibrosis,and hepatocellular carcinoma(HCC),while the protection conferred to women seemingly disappears with aging and reproductive senescence(i.e.,menopause).HCC,the most common primary liver cancer,which carries an ominous prognosis,may result from various genetic and non-genetic risk factors.NAFLD is now projected to become the most common cause of HCC.HCC also exhibits a definite sexual dimorphism in as much as it has a worldwide high male-to-female ratio.In this review article,we focus on sex differences in the epidemiological features of HCC.Moreover,we discuss sex differences in the clinical outcome and molecular pathobiology of NAFLD-HCC.By highlighting the research gaps to be filled,the aim of this review is to prompt future research of sex differences in HCC and facilitate developing personalized cancer prevention strategies,detection,and treatments to achieve better patient outcomes in NAFLD-HCC,considering sex differences in HCC pathobiology.展开更多
Introduction The hallmark of nonalcoholic fatty liver disease(NAFLD)is the intrahepatocyte accumulation of lipids with or without necro-inflammatory changes and ballooning[i.e.,steatohepatitis or nonalcoholic steatohe...Introduction The hallmark of nonalcoholic fatty liver disease(NAFLD)is the intrahepatocyte accumulation of lipids with or without necro-inflammatory changes and ballooning[i.e.,steatohepatitis or nonalcoholic steatohepatitis(NASH)],fibrosis,cirrhosis and hepatocellular carcinoma(HCC),which is observed in dysmetabolic individuals in the absence of competing causes of chronic liver disease such as excess alcohol consumption,viral infections,autoimmune or hereditary conditions and steatogenic medications(1).NAFLD represents an example of lipotoxicity caused by ectopic lipid accumulation.Even relatively modest amounts of ectopic lipid accumulation in normally lean organs(e.g.,liver,pancreas,heart,kidney and muscle)can trigger functional disturbance in the affected organs and a subsequent vicious circle of adverse metabolic consequences in predisposed individuals(1);this will eventually result in those hepatic and extra-hepatic manifestations and co-morbid conditions which are frequently observed in NAFLD patients.Under this perspective,NAFLD should be viewed as one of the systemic manifestations and consequences resulting from lipid overflow.展开更多
Background Nonalcoholic fatty liver disease(NAFLD),the spectrum of hepatic and extra-hepatic manifestations and complications resulting from the ectopic deposition of intra-hepatocyte fatty substrates,is a modern epid...Background Nonalcoholic fatty liver disease(NAFLD),the spectrum of hepatic and extra-hepatic manifestations and complications resulting from the ectopic deposition of intra-hepatocyte fatty substrates,is a modern epidemic(1,2).展开更多
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.
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Nonalcoholic fatty liver disease(NAFLD)exhibits sexual dimorphism,with men being more exposed than women to the risk of simple steatosis,nonalcoholic steatohepatitis fibrosis,and hepatocellular carcinoma(HCC),while the protection conferred to women seemingly disappears with aging and reproductive senescence(i.e.,menopause).HCC,the most common primary liver cancer,which carries an ominous prognosis,may result from various genetic and non-genetic risk factors.NAFLD is now projected to become the most common cause of HCC.HCC also exhibits a definite sexual dimorphism in as much as it has a worldwide high male-to-female ratio.In this review article,we focus on sex differences in the epidemiological features of HCC.Moreover,we discuss sex differences in the clinical outcome and molecular pathobiology of NAFLD-HCC.By highlighting the research gaps to be filled,the aim of this review is to prompt future research of sex differences in HCC and facilitate developing personalized cancer prevention strategies,detection,and treatments to achieve better patient outcomes in NAFLD-HCC,considering sex differences in HCC pathobiology.
文摘Introduction The hallmark of nonalcoholic fatty liver disease(NAFLD)is the intrahepatocyte accumulation of lipids with or without necro-inflammatory changes and ballooning[i.e.,steatohepatitis or nonalcoholic steatohepatitis(NASH)],fibrosis,cirrhosis and hepatocellular carcinoma(HCC),which is observed in dysmetabolic individuals in the absence of competing causes of chronic liver disease such as excess alcohol consumption,viral infections,autoimmune or hereditary conditions and steatogenic medications(1).NAFLD represents an example of lipotoxicity caused by ectopic lipid accumulation.Even relatively modest amounts of ectopic lipid accumulation in normally lean organs(e.g.,liver,pancreas,heart,kidney and muscle)can trigger functional disturbance in the affected organs and a subsequent vicious circle of adverse metabolic consequences in predisposed individuals(1);this will eventually result in those hepatic and extra-hepatic manifestations and co-morbid conditions which are frequently observed in NAFLD patients.Under this perspective,NAFLD should be viewed as one of the systemic manifestations and consequences resulting from lipid overflow.
文摘Background Nonalcoholic fatty liver disease(NAFLD),the spectrum of hepatic and extra-hepatic manifestations and complications resulting from the ectopic deposition of intra-hepatocyte fatty substrates,is a modern epidemic(1,2).
