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Vrachatis DA, Papathanasiou KA, Giotaki SG, Iliodromitis KE, Papaioannou TG, Stefanini GG, Cleman M, Siasos G, Reimers B, Lansky A, Tardif JC, Deftereos SG, Giannopoulos G. Repurposing colchicine's journey in view of drug-to-drug interactions. A review. Toxicol Rep 2021; 8:1389-93. [PMID: 34285885 DOI: 10.1016/j.toxrep.2021.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/10/2021] [Accepted: 07/08/2021] [Indexed: 12/15/2022] Open
Abstract
Colchicine's medical evolution is historically bound to the Mediterranean basin, since remarkable researchers from this region underscored its valuable properties. With the passing of years colchicine became an essential pharmaceutical substance for the treatment of rheumatologic and cardiovascular diseases. In light of recent findings, the therapeutic value of colchicine has grown. In clinical practice, colchicine remains underutilized in view of its proven efficacy and safety. Its complex pharmacokinetics and multifaceted anti-inflammatory role remain under investigation. The current review addresses the safe administration of colchicine in view of key drug to drug interactions. Finally, we are briefly presenting colchicine's future potential applications.
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Kim AT, Iwata S, Ishikawa S, Tamura S, Matsuo M, Yoshiyama T, Nonin S, Ito A, Izumiya Y, Yoshiyama M. Difference in risk factors of silent brain infarction between paroxysmal and persistent atrial fibrillation. Int J Cardiol Heart Vasc 2021; 33:100753. [PMID: 33778153 DOI: 10.1016/j.ijcha.2021.100753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/21/2021] [Accepted: 02/27/2021] [Indexed: 01/28/2023]
Abstract
Differences in risk factors for SBI between paroxysmal and persistent AF was studied. NVAF patients (119 paroxysmal, 71 persistent) underwent brain MRI, TTE, and TEE. DM and CKD, which represents microvascular disease, predicted SBI in paroxysmal AF. There was no obvious therapeutic target for SBI after progression to persistent NVAF. Intervention for DM and CKD from paroxysmal NVAF may prevent SBI and future stroke.
Background Although silent brain infarction is an independent risk factor for subsequent symptomatic stroke and dementia in patients with nonvalvular atrial fibrillation, little is known regarding differences in risk factors for silent brain infarction between patients with paroxysmal and persistent nonvalvular atrial fibrillation. Methods This study population consisted of 190 neurologically asymptomatic patients (mean age, 64 ± 11 years) with nonvalvular atrial fibrillation (119 paroxysmal, 71 persistent) who were scheduled for catheter ablation. All patients underwent brain magnetic resonance imaging to screen for silent brain infarction prior to ablation. Transthoracic and transesophageal echocardiography was performed to screen for left atrial abnormalities (left atrial enlargement, spontaneous echo contrast, or left atrial appendage emptying velocity) and complex plaques in the aortic arch. Results Silent brain infarction was detected in 50 patients (26%) [26 patients (22%) in paroxysmal vs. 24 patients (34%) in persistent, p = 0.09]. Multiple logistic regression analysis indicated that age and diabetes mellitus or chronic kidney disease (estimated glomerular filtration rate < 60 mL/min/1.73 m2) were associated with silent brain infarction in patients with paroxysmal nonvalvular atrial fibrillation (p < 0.05), whereas no modifiable risk factors of silent brain infarction were observed in patients with persistent nonvalvular atrial fibrillation. Conclusions These findings suggest that intensive intervention for diabetes mellitus and renal impairment from the paroxysmal stage or ablation therapy at the time of paroxysmal stage to prevent progression to persistent nonvalvular atrial fibrillation may prevent silent brain infarction and consequently reduce the risk of future symptomatic stroke.
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Al-Subaie AM. Coagulopathies in novel coronavirus (SARS-CoV-2) pandemic: Emerging evidence for hematologists. Saudi J Biol Sci 2021; 28:956-961. [PMID: 33169062 PMCID: PMC7642728 DOI: 10.1016/j.sjbs.2020.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 01/22/2023] Open
Abstract
The coronavirus disease (COVID-19), which is also known as acute respiratory syndrome coronavirus-2 (SARS-CoV2) is a transmissible disease, has phenotypes varying from asymptomatic to Acute Respiratory Distress Syndrome (ARDS) or multiple organ dysfunction syndrome (MODS) and ultimately death in certain cases. Coagulation disorders are being frequently reported amongst these patients and the pathogenesis is still not completely understood. Proposed mechanisms for these coagulopathies comprise a hypercoagulable state with micro- and/or macro-thrombosis in the vessels. A number of changes have been reported or proposed in circulating prothrombotic factors in COVID-19 patients and includes elevation in both factor VIII and fibrinogen, circulating prothrombotic microparticles and hyperviscosity. The COVID-19 patients are showing varied coagulopathies and are at high risk for venous thromboembolism (VTE) which demands an early intervention. This paper reviews the evolving data regarding the evaluation and managing of coagulopathies in patients with COVID-19.
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Affiliation(s)
- Abeer M. Al-Subaie
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Imam AbdulRahman bin Faisal University, P.O. Box: 1982, Dammam 31441, Saudi Arabia
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Meinig R, Jarvis S, Orlando A, Nwafo N, Banerjee R, McNair P, Woods B, Harrison P, Nentwig M, Kelly M, Smith W, Bar-Or D. Is anticoagulation reversal necessary prior to surgical treatment of geriatric hip fractures? J Clin Orthop Trauma 2020; 11:S93-S99. [PMID: 31992926 PMCID: PMC6977537 DOI: 10.1016/j.jcot.2019.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Hip fracture surgery in geriatric patients on anticoagulants may increase the risk for blood loss. Anticoagulation reversal may lower these risks; however, data on blood loss and transfusions are limited. The study purpose was to compare outcomes between hip fracture patients 1) not on anticoagulants 2) whose anticoagulants were reversed, and 3) whose anticoagulants were not reversed. METHODS This four-year retrospective cohort study at six Level 1 Trauma Centers enrolled geriatric patients (≥65) with isolated hip fractures. The primary outcome was total hospital blood loss (ml). Secondary outcomes: hospital length of stay (HLOS) and volume of packed red blood cells (pRBC) transfusions (ml). Statistical analyses included: Fisher's, chi-squared, Kruskal-Wallis, linear mixed-effect and logistic regression. Bonferroni adjusted alpha = 0.025. RESULTS Of the 459 patients, 189 (41%) were not on anticoagulants, 186 (41%) were reversed, and 84 (18%) were not reversed. The LS mean (SE) blood loss was 134 ml (12) for not reversed patients and 159 (17) for reversed patients; no significant difference compared to those not on anticoagulants [138 (12)], p-diff = 0.14 and 0.83, respectively. The LS mean (SE) HLOS was significantly longer for the reversed patients, 7.7 (0.4) days, when compared to those not on anticoagulants, 6.8 (0.4), p = 0.02, and when compared to those not reversed, 6.3 (0.6), p = 0.01. There was no significant difference in pRBC transfusions. CONCLUSION Not reversing anticoagulants for geriatric hip fractures was not associated with increased volume of blood loss or transfusions when compared to those reversed. Delayed surgery for anticoagulant reversal may be unnecessary and contributing to an increased HLOS.
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Affiliation(s)
- Rick Meinig
- Orthopedic Trauma, Penrose Hospital, 2222 North Nevada Ave, Colorado Springs, CO, 80907, USA
| | - Stephanie Jarvis
- Trauma Department, ION Research, 383 Corona St. #319, Denver, CO, 80218, USA
| | - Alessandro Orlando
- Trauma Department, ION Research, 383 Corona St. #319, Denver, CO, 80218, USA
| | - Nnamdi Nwafo
- Internal Medicine, Swedish Medical Center, 501 E Hampden Ave, Englewood, CO, 80113, USA
| | - Rahul Banerjee
- Orthopedic Surgery, Medical City Plano, 3901 West 15th Street, Plano, TX, 75075, USA
| | - Patrick McNair
- Orthopedic Trauma, St. Anthony’s Hospital, 11600 West 2nd Place, Lakewood, CO, 80228, USA
| | - Bradley Woods
- Surgery Research Medical Center, 2316 East Meyer Blvd, Kansas City, MO, 64132, USA
| | - Paul Harrison
- Trauma Surgery, Wesley Medical Center, 550 N. Hillside St., Wichita, KS, 67214, USA
| | - Michelle Nentwig
- Orthopedic Surgery, Wesley Medical Center, 550 N. Hillside St., Wichita, KS, 67214, USA
| | - Michael Kelly
- Orthopedic Trauma, Penrose Hospital, 2222 North Nevada Ave., Colorado Springs, CO, 80907, USA
| | - Wade Smith
- Orthopedic Trauma, Swedish Medical Center, 501 E Hampden Ave., Englewood, CO, 80113, USA
| | - David Bar-Or
- Trauma Department, ION Research, 383 Corona St. #319, Denver, CO, 80218, USA
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