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Lindgren LH, Thomsen T, de Thurah A, Aadahl M, Hetland ML, Kristensen SD, Esbensen BA. Newly diagnosed with inflammatory arthritis (NISMA)-development of a complex self-management intervention. BMC Health Serv Res 2023; 23:123. [PMID: 36750937 PMCID: PMC9902823 DOI: 10.1186/s12913-022-09007-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/23/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Patients newly diagnosed with inflammatory arthritis (IA) request regular consultations and support from health professionals to manage physiological, emotional, and social challenges. Evidence suggests that providing a tailored multi-component self-management program may benefit disease management. However, there is a lack of evidence of effective interventions with multiple components targeting the needs of this group. Therefore, the aim of this study was to develop a self-management intervention targeting newly diagnosed patients with IA, following the Medical Research Council (MRC) framework for developing complex interventions. METHODS The development of the complex self-management intervention covered three steps. First, the evidence base was identified through literature reviews, in which we described a preliminary nurse-led intervention. Secondly, we chose Social Cognitive Theory as the underlying theory along with Acceptance and Commitment Theory to support our communication strategy. Thirdly, the preliminary intervention was discussed and further developed in workshops to ensure that the intervention was in accordance with patients' needs and feasible in clinical practice. RESULTS The developed intervention comprises a 9-month nurse-led intervention (four individual and two group sessions). A physiotherapist and an occupational therapist will attend the group sessions along with the nurse. All sessions should target IA-specific self-management with a particular focus on medical, role, and emotional management. CONCLUSION Through the workshops, we involved all levels of the organization to optimize the intervention, but also to create ownership and commitment, and to identify barriers and shortcomings of the preliminary intervention. As a result, from the existing evidence, we believe that we have identified effective mechanisms to increase self-management in people newly diagnosed with IA. Further, we believe that the involvement of various stakeholders has contributed significantly to developing a relevant and feasible intervention. The intervention is a nurse-led complex self-management intervention embedded in a multidisciplinary team (named NISMA). The intervention is currently being tested in a feasibility study.
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Affiliation(s)
- L. H. Lindgren
- grid.475435.4Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark
| | - T. Thomsen
- grid.475435.4Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark ,grid.512917.9Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - A. de Thurah
- grid.154185.c0000 0004 0512 597XDepartment of Rheumatology, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - M. Aadahl
- grid.512917.9Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M. L. Hetland
- grid.475435.4Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - B. A. Esbensen
- grid.475435.4Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Thrane P, Olesen KKW, Wurtz M, Gyldenkerne C, Mortensen MB, Kristensen SD, Maeng MB. Bleeding after percutaneous coronary intervention and selection of candidates for long-term dual antithrombotic treatment. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The European Society of Cardiology recommends addition of a second antithrombotic drug (a P2Y12 inhibitor or rivaroxaban 2.5 mg twice daily) on top of aspirin in selected patients with chronic coronary syndrome (CCS) at high residual risk of ischemic events. However, this treatment increases bleeding risk, and identifying subsets of patients with the most favorable trade-off between ischemic and bleeding risk thus is essential. We hypothesized that patients undergoing percutaneous coronary intervention (PCI) who tolerate subsequent dual antiplatelet therapy (aspirin plus a P2Y12 inhibitor) without any bleeding complications selected themselves as candidates for prolonged dual antithrombotic therapy.
Methods and results
We included 30,531 patients with CCS treated with dual antiplatelet therapy after first-time PCI with a drug-eluting stent in Western Denmark (3.5 million inhabitants) from 1999 to 2018. Of these, 1,220 (4%) were hospitalized for bleeding within one year after PCI (bleeders) and 29,311 (96%) were not (non-bleeders). Patients were followed for maximum nine years (median follow-up 5.4 years). Bleeders had an increased nine-year risk of death (adjusted hazard ratio [aHR] 1.54, 95% CI 1.37–1.73) and hospitalization for bleeding (aHR 2.53, 95% CI 2.20–2.90). These associations were particularly strong for women. Looking at types of bleeding, the strongest predictors of death were gastrointestinal bleeding, cerebral bleeding, and anemia due to bleeding. Risks of myocardial infarction and ischemic stroke did not differ between bleeders and non-bleeders (Table). We then stratified non-bleeders according to their thromboembolic risk using the CHADS-P2A2RC score – a validated clinical risk prediction model developed to estimate thromboembolic risk in patients without atrial fibrillation. Non-bleeders with a high estimated thromboembolic risk (CHADS-P2A2RC score ≥4) had higher nine-year risks of myocardial infarction (hazard ratio [HR] 1.88, 95% CI 1.78–2.07), ischemic stroke (HR 3.02, 95% CI 2.66–3.43), hospitalization for bleeding (HR 1.98, 95% CI 1.81–2.16) and, in particular, death (HR 4.48, 95% CI 4.21–4.77) than non-bleeders with a low-to-moderate predicted risk (CHADS-P2A2RC score <4).
Conclusions
Patients with CCS experiencing a bleeding event during the first year after first-time PCI had a substantially higher long-term risk of death and recurrent bleeding, but not a higher risk of ischemic events. Therefore, bleeding events during the first year after PCI may guide the preclusion of selected patients from long-term dual antithrombotic therapy. Among non-bleeders, the risk of ischemic events rose proportionately more than the risk of bleeding when comparing high-risk with low-risk patients. This is an important finding for clinicians, for whom accurate identification of patients at highest risk of ischemic events is an essential step in treatment allocation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Thrane
- Aarhus University Hospital , Aarhus , Denmark
| | | | - M Wurtz
- Aarhus University Hospital , Aarhus , Denmark
| | | | | | | | - M B Maeng
- Aarhus University Hospital , Aarhus , Denmark
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Thrane P, Olesen KKW, Thim T, Gyldenkerne C, Kristensen SD, Maeng M. Trends in mortality and ischemic outcomes in patients with ST-segment elevation myocardial infarction following implementation of a primary percutaneous coronary intervention strategy, 2003–2017. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
In Denmark, primary percutaneous coronary intervention (pPCI) has served as the national reperfusion strategy in ST-segment elevation myocardial infarction (STEMI) since 2003. Since then, extensive changes in management and treatment of patients with STEMI have been introduced. We investigated the temporal trends in one-year mortality and ischemic outcomes after STEMI.
Methods
We included all first-time STEMI patients treated with pPCI in Western Denmark from 2003 to 2017. Patients were categorized into four time periods based on year of pPCI treatment (2003–2006, 2007–2010, 2011–2014, 2015–2017) and followed for one year. Outcomes included all-cause death, recurrent myocardial infarction (MI: follow-up started after 30 days post-pPCI since the validity of recurrent MI is low in the first 30 days), and ischemic stroke. We also identified a sex and age matched comparison cohort without prior cardiovascular disease from the Western Denmark general population. Groups were compared using sex- and age-adjusted hazard ratios (aHRs) by Cox regression with the first period as reference.
Results
A total of 18,538 STEMI patients and 92,690 individuals from the general population were included. One-year mortality in STEMI patients decreased from 10.8% in 2003–2006 to 7.8% in 2015–2017 (aHR 0.70, 95% CI 0.60–0.80), while it was steady in the general population cohort (figure). The one-year risk of recurrent MI and ischemic stroke also decreased from 2003–2006 to 2015–2017 (MI: 3.5% vs. 2.4%, aHR: 0.66, 95% CI 0.51–0.86; ischemic stroke: 2.5% vs. 1.9%, aHR 0.58, 95% CI 0.42–0.80). These improvements coincided with increased up-take of evidence-based treatments, especially drug-eluting stents (39% vs. 90%), high-intensity statins (3% vs. 87%), and newer antiplatelet agents.
Conclusions
From 2003 to 2017, the one-year risk of death, recurrent MI, and ischemic stroke decreased substantially among patients with STEMI. These improvements occurred simultaneously with the gradual implementation of evidence-based guideline-directed treatments.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Aase and Ejnar Danielsen foundation
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Affiliation(s)
- P Thrane
- Aarhus University Hospital , Aarhus , Denmark
| | | | - T Thim
- Aarhus University Hospital , Aarhus , Denmark
| | | | | | - M Maeng
- Aarhus University Hospital , Aarhus , Denmark
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Kristiansen J, Grove EL, Sjurdarson T, Rasmussen J, Mohr M, Kristensen SD, Hvas AM. Effect of supervised high-intensity interval training on haemostasis in patients with coronary artery disease: a randomised controlled trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Regular exercise training is recommended for patients with stable coronary artery disease (CAD), because it improves quality of life and reduces cardiovascular mortality and hospital admissions. CAD patients benefit from anti-thrombotic therapy and may have a pro-coagulant condition compared to healthy individuals. Long-term exercise training may reduce platelet aggregation and coagulation and increase fibrinolysis.
Purpose
We aimed to investigate if supervised high-intensity interval training affects haemostasis in patients with stable CAD.
Methods
We randomised stable CAD patients to supervised high-intensity interval training or standard care. High-intensity exercise training was performed on rowing ergometers three times weekly for 12 weeks. Blood samples were obtained in all patients prior to randomisation (baseline) and after 6 and 12 weeks. We evaluated platelet aggregation with the Multiplate® Analyzer, thrombin generation using the Calibrated Automated Thrombogram and fibrinolysis employing an in-house clot lysis assay. Between group differences were evaluated with mixed model analysis using SPSS. According to our sample size calculation, we have a statistical power of 88% to detect a difference of 25% in clot lysis time.
Results
A total of 142 patients with stable CAD (mean age 67±9 years, 83% males) completed the study; 64 in the exercise group and 78 in the control group. The weekly average active training duration was 54 min, and adherence to training was 97%. When comparing the two groups (exercise vs. standard care) from baseline to post intervention, we found no significant changes in ADP-induced platelet aggregation (difference between baseline and 12 weeks (Δ) 11 AU·min, 95% confidence interval (CI): −46–68 in the exercise group and Δ24 AU·min, 95% CI: −28–77 in the standard care group, p=0.52), thrombin generation (endogenous thrombin potential Δ45 nM·min, 95% CI: −77–166 in the exercise group and Δ103 nM·min, 95% CI: −7–212 in the standard care group, p=0.18) or fibrinolysis (50% clot lysis time Δ62 sec, 95% CI: −136–261 in the exercise group and Δ215 sec, 95% CI: 38–391 in the standard care group, p=0.39).
Conclusion
High-intensity interval training did not have major effects on platelet aggregation, thrombin generation nor fibrinolysis in patients with stable CAD.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Aarhus UniversityThe Faroese Health Research Foundation (Sjúkrakassagrunnurin)
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Affiliation(s)
- J Kristiansen
- National Hospital of the Faroe Islands , Torshavn , Faroe Islands
| | - E L Grove
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - T Sjurdarson
- University of the Faroe Islands, Faculty of Health , Torshavn , Faroe Islands
| | - J Rasmussen
- National Hospital of the Faroe Islands , Torshavn , Faroe Islands
| | - M Mohr
- University of the Faroe Islands, Faculty of Health , Torshavn , Faroe Islands
| | - S D Kristensen
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - A M Hvas
- Aarhus University, Faculty of Health , Aarhus , Denmark
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Kristensen SD, Gormsen J, Naver L, Helgstrand F, Floyd AK. Randomized clinical trial on closure versus non-closure of mesenteric defects during laparoscopic gastric bypass surgery. Br J Surg 2021; 108:145-151. [PMID: 33711136 DOI: 10.1093/bjs/znaa055] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/24/2020] [Accepted: 09/28/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND Internal herniation is a well known and potentially life-threatening complication of laparoscopic Roux-en-Y gastric bypass (LRYGB). The aim of this study was to evaluate the benefit and harm of closing the mesenteric defects with clips during LRYGB to prevent internal herniation. METHODS This was a single-centre, single-blinded RCT. Patients eligible for LRYGB were randomized to surgery with or without closure of mesenteric defects with clips. The primary endpoint was the incidence of (intermittent) internal herniation after LRYGB with a minimum follow-up of 24 months. Secondary outcomes were duration of surgery, number of clips used, trocars and sutures used, postoperative pain measured by a visual analogue scale (VAS), and postoperative complications. RESULTS Between 13 August 2012 and 18 May 2017, 401 patients were randomized to closure (201) or non-closure (200) of mesenteric defects. Median follow-up for both groups was 59 months (range 8-67 and 16-67 months in non-closure and closure groups respectively). The cumulated risk of internal herniation after 2 years was 8.0 per cent in the non-closure group compared with 4.5 per cent in the closure group (hazard ratio (HR) 1.81, 95 per cent c.i. 0.80 to 4.12; P = 0.231). At 5 years, rates were 15.5 and 6.5 per cent respectively (HR 2.52, 1.32 to 4.81; P = 0.005). Closure of mesenteric defects increased operating time by a median of 4 min (95 per cent c.i. 52 to 56 min for the non-closure group and 56 to 60 min for the closure group; P = 0.002). There was no difference in postoperative blood transfusion rates and VAS scores between the groups. CONCLUSION Routine closure of the mesenteric defects in LRYGB with clips is associated with a lower rate of internal herniation. Registration number: NCT01595230 (http://www.clinicaltrials.gov).
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Affiliation(s)
- S D Kristensen
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - J Gormsen
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - L Naver
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - F Helgstrand
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - A K Floyd
- Department of Surgery, Hospital South West Jutland, University Hospital Southern Denmark, Esbjerg, Denmark
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Olesen KKW, Wurtz M, Gyldenkerne C, Thrane PG, Thim T, Kristensen SD, Botker HE, Eikelboom JW, Maeng M. P1527The applicability of the dual pathway approach criteria after coronary angiography. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The combination of aspirin and low-dose rivaroxaban (dual pathway approach, DPA) has been approved for high-risk patients with stable coronary artery disease (CAD) in the COMPASS trial. Patients with CAD combined with ≥1 DPA criteria, defined as peripheral artery disease, renal failure, heart failure, or diabetes, have been proposed as high-risk patients eligible for DPA.
Purpose
To determine the prevalence of patients meeting the DPA criteria and the association with major adverse cardiovascular events (MACE) in patients with stable CAD after coronary angiography (CAG). Further, to evaluate use of the DPA criteria in CAD patients meeting the inclusion criteria in the COMPASS trial.
Methods
We studied patients included in the Western Denmark Heart Registry after examination by CAD 2004–11. Patients without CAD or myocardial infarction (MI) <1 year before or 30 days after CAG were excluded. Patients were stratified according to 0 or ≥1 DPA criteria and being eligible/ineligible for the COMPASS trial. Event rates and incidence rate ratios (IRRs) of MACE (cardiac death, ischemic stroke, and MI) were estimated.
Results
Of 80,071 patients undergoing CAG, 18,689 (23%) patients had stable CAD. According to the DPA criteria, 7,730 patients (10%) were DPA eligible. Rates of MACE were 1.98 (95% CI 1.86–2.34) events per 100 person-years among DPA ineligible patients and 4.26 (95% CI 4.04–4.50) events per 100 person-years among DPA eligible patients (IRR 2.15, 95% CI 1.98–2.34). When stratifying patients according to eligibility in the COMPASS inclusion criteria, COMPASS eligible patients with 0 DPA criteria and COMPASS ineligible patients with ≥1 DPA criteria were at intermediate risk compared to patients meeting both (high risk) or none (low risk) of these criteria (Figure 1).
Figure 1
Conclusion
In a cohort of consecutive patients undergoing CAG, 1 in 10 patients would be eligible for DPA according to the DPA criteria. Patients with stable CAD and ≥1 DPA criteria had >2-fold higher rate of MACE than CAD patients without any DPA criteria.
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Affiliation(s)
- K K W Olesen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Wurtz
- Region Hospital Herning, Department of Cardiology, Herning, Denmark
| | - C Gyldenkerne
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - P G Thrane
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - T Thim
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - S D Kristensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - H E Botker
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - J W Eikelboom
- McMaster University, Population Health Research Institute, Hamilton, Canada
| | - M Maeng
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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Steensig K, Olesen KKW, Madsen M, Thim T, Jensen LO, Raungaard B, Kristensen SD, Boetker HE, Lip GYH, Eikelboom JW, Maeng M. 6152A novel model for prediction of ischemic stroke in patients without atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.6152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Steensig
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - K K W Olesen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Madsen
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - T Thim
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L O Jensen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - B Raungaard
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - S D Kristensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - H E Boetker
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - G Y H Lip
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
| | - J W Eikelboom
- McMaster University, Department of Medicine, Hamilton, Canada
| | - M Maeng
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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Wurtz M, Olesen KKW, Thim T, Kristensen SD, Eikelboom JW, Maeng M. P4204Applicability of the COMPASS trial in a Danish all-comers coronary angiography cohort: an analysis of the Western Denmark heart registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Wurtz
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - K K W Olesen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - T Thim
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - S D Kristensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | | | - M Maeng
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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Gleerup H, Dahm C, Thim T, Jensen SE, Jensen LO, Kristensen SD, Boetker HE, Maeng M. P792Smoking is the dominating modifiable risk factor in younger patients with STEMI. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Gleerup
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - C Dahm
- Aarhus University, Aarhus, Denmark
| | - T Thim
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - S E Jensen
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - L O Jensen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - S D Kristensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - H E Boetker
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Maeng
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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10
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Christiansen MK, Larsen SB, Nyegaard M, Neergaard-Petersen S, Wurtz M, Grove EL, Hvas AM, Jensen HK, Kristensen SD. P804The AB0 gene locus is associated with increased platelet aggregation in stable coronary artery disease patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M K Christiansen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - S B Larsen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Nyegaard
- Aarhus University, Department of Biomedicine, Aarhus, Denmark
| | | | - M Wurtz
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - E L Grove
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - A.-M Hvas
- Aarhus University Hospital, Department of Clinical Biochemistry, Aarhus, Denmark
| | - H K Jensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - S D Kristensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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11
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Pareek M, Jensen LO, Christiansen EH, Aaroe J, Jensen JS, Kristensen SD, Lassen JF, Thuesen L, Madsen M, Boetker HE, Maeng M. 146210-year outcomes from a randomized comparison of zotarolimus-eluting and sirolimus-eluting stents: the SORT OUT III study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Pareek
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L O Jensen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - E H Christiansen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - J Aaroe
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - J S Jensen
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - S D Kristensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - J F Lassen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - L Thuesen
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - M Madsen
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - H E Boetker
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Maeng
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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12
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Steensig K, Olesen KKW, Thim T, Nielsen JC, Madsen M, Jensen SE, Jensen LO, Kristensen SD, Boetker HE, Lip GYH, Maeng M. 2162Coronary artery disease is an independent risk factor for ischemic stroke among patients with atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Steensig
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - K K W Olesen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - T Thim
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - J C Nielsen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Madsen
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - S E Jensen
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - L O Jensen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - S D Kristensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - H E Boetker
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - G Y H Lip
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
| | - M Maeng
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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Husted SE, Kristensen SD, Vissinger H, Mørn B, Schmidt EB, Nielsen HK. Intravenous Acetylsalicylic Acid – Dose-Related Effects on Platelet Function and Fibrinolysis in Healthy Males. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1656353] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryLow-dose acetylsalicylic acid (ASA) has been shown to be beneficial in patients with acute myocardial infarction and unstable angina pectoris. Oral administration of ASA is difficult in the acute phase of these syndromes. In this study we evaluated the effect of 25 mg, 50 mg or 100 mg of ASA given as an intravenous bolus injection on platelet function and fibrinolysis in healthy males and related this to plasma concentrations of ASA. No adverse effects were found. A complete inhibition of serum thromboxane B2 synthesis was demonstrated 5 min after injection of 100 mg ASA intravenously. ASA disappeared from the circulation within 60 min after bolus injection and at this time thromboxane B2 synthesis was inhibited dose-dependently by 71%, 90% and 100% for doses of 25 mg, 50 mg and 100 mg, respectively. Inhibition of thromboxane B2 synthesis after 100 mg of intravenous ASA was still 96.5% at 24 h and 93.4% at 48 h after the injection. The bleeding time measured at 30 min after ASA administration was significantly prolonged on the average by 70 s, 144 s and 211 s after 25 mg, 50 mg and 100 mg of ASA, respectively. Minor, but significant changes were found in tissue plasminogen activator antigen and in plasminogen activator inhibitor within the first hour after injection of low dose ASA, but similar changes were found after injection of saline. No change in tissue plasminogen activator activity was found. We conclude, that intravenous administration of low dose ASA is safe and easy, and that almost immediate, complete blockage of serum thromboxane B2 synthesis can be obtained after a single intravenous bolus injection of 100 mg.
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Affiliation(s)
- S E Husted
- The University Department of Medicine and Cardiology, County Hospital of Aarhus, Tage Hansens Gade, Aarhus C, Denmark
| | - S D Kristensen
- The University Department of Medicine and Cardiology, County Hospital of Aarhus, Tage Hansens Gade, Aarhus C, Denmark
| | - H Vissinger
- The University Department of Medicine and Cardiology, County Hospital of Aarhus, Tage Hansens Gade, Aarhus C, Denmark
| | - B Mørn
- The University Department of Medicine and Cardiology, County Hospital of Aarhus, Tage Hansens Gade, Aarhus C, Denmark
| | - E B Schmidt
- The Department of Clinical Chemistry, Aalborg Hospital, Aalborg, Denmark
| | - H K Nielsen
- The University Department of Medicine and Cardiology, County Hospital of Aarhus, Tage Hansens Gade, Aarhus C, Denmark
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Kristensen SD, Grove EL, Maeng M. Coronary stents and non-cardiac surgery: to bridge or not to bridge? Thromb Haemost 2015; 114:211-3. [PMID: 26018636 DOI: 10.1160/th15-04-0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/13/2015] [Indexed: 11/05/2022]
Affiliation(s)
- S D Kristensen
- Prof. Steen Dalby Kristensen, Department of Cardiology, Aarhus University Hospital, DK-8200 Aarhus N, Denmark, E-mail:
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Kristensen SD, Laut KG, Fajadet J, Kaifoszova Z, Kala P, Di Mario C, Wijns W, Clemmensen P, Agladze V, Antoniades L, Alhabib KF, De Boer MJ, Claeys MJ, Deleanu D, Dudek D, Erglis A, Gilard M, Goktekin O, Guagliumi G, Gudnason T, Hansen KW, Huber K, James S, Janota T, Jennings S, Kajander O, Kanakakis J, Karamfiloff KK, Kedev S, Kornowski R, Ludman PF, Merkely B, Milicic D, Najafov R, Nicolini FA, No c M, Ostojic M, Pereira H, Radovanovic D, Sabate M, Sobhy M, Sokolov M, Studencan M, Terzic I, Wahler S, Widimsky P. Corrigendum to: Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011: current status in 37 ESC countries. Eur Heart J 2014. [DOI: 10.1093/eurheartj/ehu333] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Grove EL, Storey RF, Kristensen SD. Can we improve the efficacy of low-dose aspirin? Thromb Haemost 2014; 112:1077-8. [PMID: 25208629 DOI: 10.1160/th14-08-0702] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/25/2014] [Indexed: 11/05/2022]
Affiliation(s)
- E L Grove
- Erik L. Grove, MD, PhD, Department of Cardiology, Aarhus University Hospital, Brendstrupgaardsvej 100, 8200 Aarhus, Denmark, Tel.: +45 7845 2029, Fax: +45 7845 2260, E-mail:
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Neergaard-Petersen S, Hvas AM, Kristensen SD, Grove EL, Larsen SB, Phoenix F, Kurdee Z, Grant PJ, Ajjan RA. The influence of type 2 diabetes on fibrin clot properties in patients with coronary artery disease. Thromb Haemost 2014; 112:1142-50. [PMID: 25187394 DOI: 10.1160/th14-05-0468] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 07/22/2014] [Indexed: 01/06/2023]
Abstract
Type 2 diabetes mellitus (T2DM) increases the risk of coronary thrombosis and both conditions are associated with altered fibrin clot properties. However, the influence of T2DM on fibrin clot properties in patients with coronary artery disease (CAD) remains unclear. We aimed to investigate the influence of T2DM on fibrin clot properties in patients with CAD. Fibrin clot structure and fibrinolysis were investigated in 581 CAD patients (148 with T2DM) using turbidimetric assays, confocal and scanning electron microscopy. Clots made from plasma and plasma-purified fibrinogen were studied, and plasma levels of inflammatory markers were analysed. T2DM patients had increased clot maximum absorbance compared with non-diabetic patients (0.36 ± 0.1 vs 0.33 ± 0.1 au; p=0.01), displayed longer lysis time (804 [618;1002] vs 750 [624;906] seconds; p=0.03) and showed more compact fibrin structure assessed by confocal and electron microscopy. Fibrinogen levels were elevated in T2DM (p< 0.001), but clots made from purified fibrinogen showed no differences in fibrin properties in the two populations. Adjusting for fibrinogen levels, T2DM was associated with C-reactive protein and complement C3 plasma levels, with the former correlating with clot maximum absorbance (r=0.24, p< 0.0001) and the latter with lysis time (r=0.30, p< 0.0001). Independent of fibrinogen levels, females had more compact clots with prolonged lysis time compared with males (all p-values< 0.001). In conclusion, T2DM is associated with prothrombotic changes in fibrin clot properties in patients with CAD. This is related to quantitative rather than qualitative changes in fibrinogen with a possible role for inflammatory proteins.
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Affiliation(s)
| | | | | | | | | | | | | | | | - R A Ajjan
- Ramzi Ajjan, Division of Cardiovascular and Diabetes Research, Multidisciplinary Cardiovascular Research Centre, Leeds Institute for Genetics, Health and Therapeutics, LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds LS2 9JT, UK, E-mail:
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Neergaard-Petersen S, Ajjan R, Hvas AM, Hess K, Larsen SB, Kristensen SD, Grove EL. Platelet aggregation and fibrin clot structure in patients with coronary artery disease and previous myocardial infarction. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Laut KG, Gale CP, Pedersen AB, Fox KAA, Lash TL, Kristensen SD. Variation in access to primary percutaneous coronary intervention in 120 european regions: why do inequalities persist? Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Orhoj T, Holm NR, Dreyer R, Maeng M, Krusell LR, Dijkstra J, Kristensen SD, Botker HE, Lassen JF, Christiansen EH. Healing response after coronary stenting in diabetic versus non-diabetic patients assessed by optical coherence tomography: a matched analysis of baseline and 12-month follow-up. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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21
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Røpcke DM, Hjortdal VE, Toft GE, Jensen MO, Kristensen SD. Remote ischemic preconditioning reduces thrombus formation in the rat. J Thromb Haemost 2013. [DOI: 10.1111/j.1538-7836.2013.04914.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
| | - VE Hjortdal
- Department of Cardiothoracic Surgery; Aarhus University Hospital - Skejby; Brendstrupgaardsvej 100; 8200; Aarhus N; DK
| | - GE Toft
- Department of Plastic Surgery; Aarhus University Hospital - NBG; Nørrebrogade 44; 8000; Aarhus C; DK
| | - MO Jensen
- Department of Engineering; University of Aarhus; Dalgas Avenue 2; 8000; Aarhus C; DK
| | - SD Kristensen
- Department of Cardiology; Aarhus University Hospital - Skejby; Brendstrupgaardsvej 100; 8200; Aarhus N; DK
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Larsen SB, Grove EL, Kristensen SD, Hvas AM. Reduced antiplatelet effect of aspirin is associated with low-grade inflammation in patients with coronary artery disease. Thromb Haemost 2013; 109:920-9. [PMID: 23407706 DOI: 10.1160/th12-09-0666] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 01/23/2013] [Indexed: 01/01/2023]
Abstract
Inflammation has been proposed to modify platelet function. This may lead to increased platelet reactivity and reduced antiplatelet drug efficacy in patients with coronary artery disease (CAD). However, this hypothesis has not been investigated in stable CAD patients receiving aspirin as mono antiplatelet therapy. It was the objective of this study to investigate the association between platelet reactivity, the inflammatory markers high-sensitive C-reactive protein (hs-CRP) and interleukin-6 (IL-6), and platelet activation. We performed a cross-sectional study on 524 stable high-risk CAD patients. Among these, 91% had a history of myocardial infarction, 23% had type 2 diabetes, and 13% had both. All patients received 75 mg aspirin daily as mono antiplatelet therapy. Platelet reactivity was assessed by multiple electrode aggregometry (Multiplate®, MEA) and VerifyNow®. Inflammation was evaluated by hs-CRP and IL-6. Platelet activation was assessed by soluble P-selectin (sP-selectin), and cyclooxygenase-1 inhibition was evaluated by measurement of serum thromboxane B2. Hs-CRP levels were significantly higher in upper platelet reactivity tertile patients than in lower platelet reactivity tertile patients (p≤0.02). Similar results were obtained with IL-6, though not statististically significant (p≥0.15). Platelet activation evaluated by sP-selectin was significantly higher in patients with MEA reactivity levels in the upper tertile than in the lower tertile (p=0.0001). Optimal compliance was confirmed by low serum thromboxane B2 levels in all patients. In conclusion, increased levels of hs-CRP were associated with augmented platelet reactivity in stable high-risk CAD patients receiving aspirin as mono antiplatelet therapy. These findings may suggest that chronic low-grade inflammation reduce the antiplatelet effect of aspirin.
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Affiliation(s)
- S B Larsen
- Department of Clinical Biochemistry, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, Aarhus N, Denmark.
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Trenk D, Kristensen SD, Hochholzer W, Neumann FJ. High on-treatment platelet reactivity and P2Y12 antagonists in clinical trials. Thromb Haemost 2012; 109:834-45. [PMID: 23238773 DOI: 10.1160/th12-08-0588] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 11/07/2012] [Indexed: 12/18/2022]
Abstract
Dual antiplatelet therapy with aspirin and clopidogrel in patients undergoing percutaneous coronary intervention (PCI) and in patients with acute coronary syndromes (ACS) has substantially decreased the rate of cardiovascular events. Within the past decade, the variability in pharmacodynamic response as well as the moderate antiplatelet efficacy of clopidogrel has raised major concerns, since high on-clopidogrel platelet reactivity has consistently been associated with increased risk for ischaemic events in PCI patients. The variability in response could be linked to genetic polymorphisms impacting on activity of cytochrome P450 enzymes as well as clinical and demographic variables, but, taken together, factors identified so far can explain only up to approximately 12% of this variability in adenosine diphosphate-induced platelet aggregation on clopidogrel. Regulatory agencies as well as major cardiac societies suggest the use of other anti-platelet medications or alternative dosing strategies for clopidogrel in patients with reduced effectiveness of clopidogrel. This review will focus on the current status of alternate strategies for more sufficient suppression of high platelet reactivity.
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Affiliation(s)
- D Trenk
- Universitaets-Herzzentrum Freiburg-Bad Krozingen, Klinik für Kardiologie und Angiologie II, Bad Krozingen, Suedring 15, Bad Krozingen, Germany.
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Affiliation(s)
- D M Røpcke
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital - Skejby Department of Experimental and Clinical Research, Aarhus University Hospital - Skejby Department of Plastic Surgery, Aarhus University Hospital - NBG Department of Engineering, University of Aarhus Department of Cardiology, Aarhus University Hospital - Skejby, Denmark
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Kristensen SD. On the cutting edge of acute coronary syndromes: adding oral factor Xa-inhibition with darexaban to dual antiplatelet therapy: the RUBY-1 trial. Eur Heart J 2011; 32:2486-8. [DOI: 10.1093/eurheartj/ehr314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Grove EL, Hvas AM, Mortensen SB, Larsen SB, Kristensen SD. Effect of platelet turnover on whole blood platelet aggregation in patients with coronary artery disease. J Thromb Haemost 2011; 9:185-91. [PMID: 20955349 DOI: 10.1111/j.1538-7836.2010.04115.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Previous studies have demonstrated considerable variation in the antiplatelet effect of aspirin. OBJECTIVES To investigate the impact of platelet turnover on the antiplatelet effect of aspirin in patients with stable coronary artery disease (CAD) and to identify determinants of platelet turnover. METHODS Platelet turnover was evaluated by measurements of immature platelets and thrombopoietin in 177 stable CAD patients on aspirin monotherapy, including 85 type 2 diabetics and 92 non-diabetics. Whole blood platelet aggregation was determined using the VerifyNow(®) Aspirin test and multiple electrode aggregometry (MEA, Multiplate(®) ) induced by arachidonic acid (AA) (1.0 mm), adenosine diphosphate (ADP) (10 μm) and collagen (1.0 μg mL(-1) ). RESULTS Immature platelet levels significantly correlated with MEA (r = 0.31-0.36, P-values < 0.0001) and the platelet activation marker sP-selectin (r = 0.19, P = 0.014). Contrary to the VerifyNow(®) test, MEA significantly correlated with variations in platelet count (r = 0.45-0.68, P-values < 0.0001). Among patients with residual platelet reactivity according to AA, there were significantly more diabetics (61% vs. 41%, P = 0.027) and higher levels of sP-selectin (77.7 ± 29 vs. 70.2 ± 25 ng mL(-1) , P = 0.070) and serum thromboxane B(2) (0.81 [0.46; 1.70] vs. 0.56 [0.31; 1.12] ng mL(-1) , P = 0.034). In a multivariate regression analysis, immature platelet levels were determined by thrombopoietin levels (P < 0.001), smoking (P = 0.020) and type 2 diabetes (P = 0.042). CONCLUSIONS The antiplatelet effect of aspirin was reduced in CAD patients with an increased platelet turnover. Once-daily dosing of aspirin might not suffice to adequately inhibit platelet aggregation in patients with an increased platelet turnover.
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Affiliation(s)
- E L Grove
- Departments ofCardiology Clinical Biochemistry, Aarhus University Hospital, Skejby, Aarhus, Denmark
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Grove EL, Wurtz M, Gislason GH, Kristensen SD, Hvas AM. Aspirin and coronary artery disease. Heart 2010. [DOI: 10.1136/hrt.2010.201145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mortensen SB, Larsen SB, Grove EL, Kristensen SD, Hvas AM. Reduced platelet response to aspirin in patients with coronary artery disease and type 2 diabetes mellitus. Thromb Res 2010; 126:e318-22. [PMID: 20451957 DOI: 10.1016/j.thromres.2010.03.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 03/11/2010] [Accepted: 03/27/2010] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Diabetes mellitus is complicated by accelerated atherosclerosis, resulting in an increased risk of coronary artery disease (CAD) and thrombosis. Despite the proven benefits of aspirin, previous studies indicate a reduced cardiovascular protection from aspirin in diabetic patients. We aimed to investigate whether diabetes mellitus influenced the platelet response to aspirin in patients with CAD. MATERIALS AND METHODS Platelet aggregation and activation were evaluated during aspirin treatment in 85 diabetic and 92 non-diabetic patients with CAD. Adherence to aspirin was carefully controlled. All patients had CAD verified by coronary angiography and were taking 75 mg non-enteric coated aspirin daily. RESULTS Diabetic patients showed significantly higher levels of platelet aggregation compared to non-diabetic patients evaluated by VerifyNow® Aspirin (p=0.03) and Multiplate® aggregometry using arachidonic acid (AA) 0.5 mM (p=0.005) and 1.0 mM (p=0.009). In addition, platelet activation determined by soluble P-selectin was significantly higher in diabetics compared to non-diabetics (p=0.005). The higher AA-induced aggregation was associated with higher levels of HbA(1c). Compliance was confirmed by low levels of serum thromboxane B(2) (below 7.2 ng/mL). Diabetics had significantly higher levels of serum thromboxane B(2) (p<0.0001). CONCLUSIONS Diabetic patients with CAD had significantly higher levels of both platelet aggregation and activation compared to non-diabetic patients with CAD despite treatment with the same dosage of aspirin. These findings may partly explain the reduced cardiovascular protection from aspirin in diabetic patients.
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Affiliation(s)
- S B Mortensen
- Department of Cardiology, Aarhus University Hospital Skejby, Denmark.
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Authors/Task Force Members, Poldermans D, Bax JJ, Boersma E, De Hert S, Eeckhout E, Fowkes G, Gorenek B, Hennerici MG, Iung B, Kelm M, Kjeldsen KP, Kristensen SD, Lopez-Sendon J, Pelosi P, Philippe F, Pierard L, Ponikowski P, Schmid JP, Sellevold OF, Sicari R, Van den Berghe G, Vermassen F, Hoeks SE, Vanhorebeek I, Vahanian A, Auricchio A, Bax JJ, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, McGregor K, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas P, Widimsky P, De Caterina R, Agewall S, Al Attar N, Andreotti F, Anker SD, Baron-Esquivias G, Berkenboom G, Chapoutot L, Cifkova R, Faggiano P, Gibbs S, Hansen HS, Iserin L, Israel CW, Kornowski R, Eizagaechevarria NM, Pepi M, Piepoli M, Priebe HJ, Scherer M, Stepinska J, Taggart D, Tubaro M. Corrigendum to: 'Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery: The Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA)' [Eur Heart J 2009;30:2769-2812]. Eur Heart J 2010. [DOI: 10.1093/eurheartj/ehp593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Glud T, Schmidt EB, Kristensen SD, Arnfred T. Platelet number and volume during myocardial infarction in relation to infarct size. Acta Med Scand 2009; 220:401-5. [PMID: 3812027 DOI: 10.1111/j.0954-6820.1986.tb02787.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Platelet number and mean platelet volume (MPV) were measured in 100 patients with acute chest pain, 41 with acute myocardial infarction (AMI), 33 with angina pectoris (AP) and 26 with non-coronary event (NCE), and compared with 21 controls. We found no significant difference in platelet count on admission in the patient groups, but it was lower compared with controls. There were no significant differences in MPV between the patient groups nor between patients and controls. Thirty patients with AMI were followed for 10 days and showed an initial 12% fall in platelet count followed by a 36% increase. Initially there was an increase in MPV (2%) followed by a fall (8%). The fall in platelet count and increase in MPV correlated with infarct size (maximum activity of lactate dehydrogenase (LDH)) and might reflect consumption of platelets. The precise role of platelets in the process of infarction is still unknown.
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Busk M, Kaltoft A, Nielsen SS, Bottcher M, Rehling M, Thuesen L, Botker HE, Lassen JF, Christiansen EH, Krusell LR, Andersen HR, Nielsen TT, Kristensen SD. Infarct size and myocardial salvage after primary angioplasty in patients presenting with symptoms for <12 h vs. 12-72 h. Eur Heart J 2009; 30:1322-30. [DOI: 10.1093/eurheartj/ehp113] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJV, Ponikowski P, Poole-Wilson PA, Strömberg A, van Veldhuisen DJ, Atar D, Hoes AW, Keren A, Mebazaa A, Nieminen M, Priori SG, Swedberg K, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Tendera M, Auricchio A, Bax J, Bohm M, Corra U, della Bella P, Elliott PM, Follath F, Gheorghiade M, Hasin Y, Hernborg A, Jaarsma T, Komajda M, Kornowski R, Piepoli M, Prendergast B, Tavazzi L, Vachiery JL, Verheugt FWA, Zamorano JL, Zannad F. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 2008; 29:2388-442. [PMID: 18799522 DOI: 10.1093/eurheartj/ehn309] [Citation(s) in RCA: 1950] [Impact Index Per Article: 121.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Kenneth Dickstein
- University of Bergen, Cardiology Division, Stavanger University Hospital, Norway.
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Terkelsen CJ, Christiansen EH, Sorensen JT, Kristensen SD, Lassen JF, Thuesen L, Andersen HR, Vach W, Nielsen TT. Primary PCI as the preferred reperfusion therapy in STEMI: it is a matter of time. Heart 2008; 95:362-9. [DOI: 10.1136/hrt.2007.139493] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Daemen J, Simoons ML, Wijns W, Bagust A, Bos G, Bowen JM, Braunwald E, Camenzind E, Chevalier B, DiMario C, Fajadet J, Gitt A, Guagliumi G, Hillege HL, James S, Juni P, Kastrati A, Kloth S, Kristensen SD, Krucoff M, Legrand V, Pfisterer M, Rothman M, Serruys PW, Silber S, Steg PG, Tariah I, Wallentin L, Windecker SW, Aimonetti A, Allocco D, Baczynska A, Bagust A, Berenger M, Bos G, Boam A, Bowen J, Braunwald E, Calle J, Camenzind E, Campo G, Carlier S, Chevalier B, Daemen J, de Schepper J, Di Bisceglie G, DiMario C, Dobbels H, Fajadet J, Farb A, Ghislain J, Gitt A, Guagliumi G, Hellbardt S, Hillege H, ten Hoedt R, Isaia C, James S, de Jong P, Juni P, Kastrati A, Klasen E, Kloth S, Kristensen S, Krucoff M, Legrand V, Lekehal M, LeNarz L, Ni Mhullain F, Nagai H, Patteet A, Paunovic D, Pfisterer M, Potgieter A, Purdy I, Raveau-Landon C, Rothman M, Serruys P, Silber S, Simoons M, Steg P, Tariah I, Ternstrom S, Van Wuytswinkel J, Waliszewski M, Wallentin L, Wijns W, Windecker S. Meeting Report: ESC Forum on Drug Eluting Stents European Heart House, Nice, 27-28 September 2007. Eur Heart J 2008; 30:152-61. [DOI: 10.1093/eurheartj/ehn510] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Busk M, Maeng M, Rasmussen K, Kelbaek H, Thayssen P, Abildgaard U, Vigholt E, Mortensen LS, Thuesen L, Kristensen SD, Nielsen TT, Andersen HR. The Danish multicentre randomized study of fibrinolytic therapy vs. primary angioplasty in acute myocardial infarction (the DANAMI-2 trial): outcome after 3 years follow-up. Eur Heart J 2007; 29:1259-66. [DOI: 10.1093/eurheartj/ehm392] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
In the era of primary PCI, a strategy of admitting patients to the nearest hospital should be obsolete. Instead, a prehospital diagnostic strategy should be implemented in order to: (1) refer patients directly to interventional centres, thereby eliminating delay at local hospitals; (2) alert the interventional centre, thereby reducing door to balloon times; (3) initiate adjunctive medication in the prehospital phase.
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Affiliation(s)
- H R Andersen
- Department of Cardiology B, Skejby University Hospital, DK-8200 Aarhus N, Denmark.
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38
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Schmidt EB, Arnesen H, Christensen JH, Rasmussen LH, Kristensen SD, De Caterina R. Marine n−3 polyunsaturated fatty acids and coronary heart disease. Thromb Res 2005; 115:257-62. [PMID: 15668184 DOI: 10.1016/j.thromres.2004.09.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2004] [Accepted: 09/13/2004] [Indexed: 10/26/2022]
Affiliation(s)
- E B Schmidt
- Department of Preventive Cardiology, Aalborg Sygehus, Arhus University Hospitals, Denmark.
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Affiliation(s)
- S D Kristensen
- Department of Cardiology, Skejby Hospital, Aarhus University Hospital, Aarhus N, Denmark.
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40
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Abstract
OBJECTIVES Platelet glycoprotein (GP) receptor IIb/IIIa plays a key role in the development of myocardial infarction (MI), and Pl(A2) is a polymorphism in the gene encoding this receptor. The prevalence of Pl(A2) shows pronounced geographical variation and has to our knowledge not been presented for a Scandinavian population before. Platelets from Pl(A2)-positive individuals show increased aggregability compared with platelets from Pl(A2)-negative individuals, and Pl(A2) genotypes might be associated with MI. The purpose of this study was to investigate the relation between the Pl(A2) polymorphism and MI in a large Scandinavian population. DESIGN Case-control study. We included patients with angiographically verified CAD with and without previous MI and a group of healthy individuals matched for age, race, and sex. RESULTS We studied the frequency of Pl(A2) in 1191 healthy individuals and 1019 patients with coronary artery disease (CAD). Amongst these patients, 529 subjects had suffered an MI previously. Pl(A2) was present in 28% of healthy individuals, 28% of patients with CAD but no MI, and in 35% of patients with CAD and MI. The difference between healthy individuals and MI patients was significant (P = 0.002). Furthermore, a graded relationship between the number of Pl(A2) alleles and the risk of MI was seen (P = 0.011). Associations between Pl(A2) and traditional cardiovascular risk factors as well as mean platelet volume were investigated. We found a significant interaction between Pl(A2) and serum cholesterol. CONCLUSION In our Scandinavian study population the common platelet polymorphism Pl(A2) is significantly associated with an increased risk of MI, but not of CAD. Clinically, typing for Pl(A2) might have implications for antiplatelet therapy of patients with MI.
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Affiliation(s)
- E L Grove
- Department of Cardiology, Aarhus University Hospital, Skejby Sygehus, Denmark
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41
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Abstract
Studies of Greenland Eskimos showed that a very high intake of marine n-3 fatty acids markedly inhibited platelet reactivity and suggested that intake of these fatty acids might prevent coronary thrombosis. Later studies with lower, more practical doses of n-3 fatty acids also have shown a platelet inhibitory effect of n-3 fatty acids, albeit fairly marginal. Furthermore, n-3 fatty acids have little effect on measures of blood coagulability and may slightly decrease fibrinolysis. In animal models, n-3 fatty acids often have been shown to inhibit thrombosis, but again the doses have tended to be very high. Finally, there has been little effect of (low-dose) n-3 fatty acids in clinical trials in humans on the incidence of myocardial infarction. Overall, there is little evidence for a major antithrombotic effect of practical doses of n-3 fatty acids on coronary thrombosis. This does not exclude a beneficial effect of n-3 fatty acids on coronary heart disease as suggested from clinical trials, but the major effect may be antiarrhythmic rather than antithrombotic.
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Affiliation(s)
- S D Kristensen
- Department of Cardiology, Skejby Hospital, Aarhus N, Denmark.
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42
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Ziegler BK, Kristensen SD, Vissinger H, Jensen HK, Nielsen HK, Husted SE. Incomplete thromboxane inhibition with 100 mg of intravenous acetylsalicylic acid in patients with acute ST elevation myocardial infarction: a placebo-controlled pilot trial. Thromb Res 2001; 104:175-80. [PMID: 11672759 DOI: 10.1016/s0049-3848(01)00339-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acetylsalicylic acid (ASA) is now a standard treatment of acute myocardial infarction (AMI). ASA inhibits thromboxane A(2) (TXA(2)) production by blocking the constitutive cyclooxygenase (COX)-1 enzyme, but only to a small degree the inducible COX-2. COX-2 is induced by increased concentrations of cytokines, which is related to an enhanced inflammatory response. Previously, we have found a complete inhibition of TXA(2) synthesis in healthy volunteers after intravenous administration of 50 mg of ASA. We measured in a randomized, placebo-controlled pilot trial the effect of 100 mg of ASA injected intravenously on TXA(2) synthesis in AMI patients treated with streptokinase. METHODS AND RESULTS Nineteen patients with AMI treated with streptokinase were randomized to 100 mg of ASA or placebo injected intravenously. Se-TXB(2) and bleeding time were measured before and after drug administration. One hundred and eighty minutes after intravenous ASA administration, treatment with oral ASA was initiated. We found a significant decrease in serum concentrations of TXB(2) after 30, 60 and 180 min following ASA injection compared to placebo, but in none of the patients was complete inhibition of TXA(2) production achieved. No significant change in bleeding time could be demonstrated. CONCLUSION Intravenous ASA in a dosage of 100 mg did not completely prevent TXA(2) production in AMI patients treated with streptokinase. This may be due to synthesis of TXA(2) by the inducible COX-2 enzyme and/or to a transcellular metabolism in platelets of prostanoids generated by endothelial cells.
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Affiliation(s)
- B K Ziegler
- Department of Medicine and Cardiology, Aarhus Amtssygehus, University Hospital of Aarhus, Aarhus C 8000, Denmark.
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43
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Thuesen L, Andersen HR, Krusell LR, Kristensen SD. Six months' clinical and angiographic follow-up of a flexible, coiled stainless steel stent in long, native coronary artery lesions. SCAND CARDIOVASC J 2001; 34:182-5. [PMID: 10872707 DOI: 10.1080/14017430050142224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
This study was conducted to evaluate the short- and long-term clinical and angiographic results of implantation of a flexible, coiled stainless steel stent, the Freedom Coronary Stent. During the study period this stent was used as an alternative to the Palmaz-Schatz PS153 coronary stent in long or tortuous lesions. The study was designed as a prospectively planned outcome analysis. Implantation of Freedom stents was attempted in 62 consecutive patients (56% males, mean age 63+/-10 years) with a total of 65 coronary lesions. Indications for stent implantation were: restenosis, 8%; recoil, 26%; visible dissection, 32%; threatening occlusion, 15%; chronic total occlusion, 18%. The average stent length was 30+/-16 mm and 67% of the lesions were type C. Rate of successful stent implantation, acute complications, angiographic restenosis after 6 months and major cardiac events (death, myocardial infarction, target vessel revascularization) during follow-up were assessed. The success rate of stent implantation was 94%. One patient died after an emergency bypass operation and one patient suffered a subacute stent thrombosis, which was successfully treated with re-percutaneous transluminal coronary angioplasty (PTCA). There were no Q- or non-Q myocardial infarctions. Clinical follow-up was carried out in 56 patients (97%) and 57 vessels were assessed by angiography (93%). Mean length of the follow-up period was 6.8+/-2.3 months. During the 6 months' follow-up period, one patient died, two patients suffered an acute non-Q myocardial infarction and eight patients had revascularization of the target vessel. Major cardiac event rate for all patients where stent implantation was intended was 23%. Angina CCS class declined from 3.0+/-0.9 to 1.1+/-0.8 (p < 0.01) before PTCA to follow-up. Overall restenosis rate was 28%. In 14 lesions with a stented segment length of <20 mm, the restenosis rate was 21%; in 31 lesions with a stented segment length > or =20 and <30 mm, the restenosis rate was 26%; and in 13 lesions with a stented segment length of > or =30 mm, the restenosis rate was 42%. Although there was a high procedural success rate after implantation of the Freedom stent in long or tortuous lesions, problems with high restenosis rates in long lesions remain unresolved.
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Affiliation(s)
- L Thuesen
- Department of Cardiology, Skejby Sygehus, Aarhus University Hospital, Denmark.
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Rasmussen LH, Husted SE, Kassis E, Kastrup J, Kristensen SD, Pedersen KE, Grande P. [Abciximab (ReoPro) in the treatment of acute coronary syndromes]. Ugeskr Laeger 2001; 163:472-7. [PMID: 11218792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Platelet activation plays a major role in the pathophysiology of acute coronary syndromes (ACS). Inhibition of platelet function is the basic pharmacological treatment of ACS. Platelet membrane glycoprotein IIb/IIIa inhibitors, a new class of potent antiplatelet agents, have been used in the treatment of ACS and in the prevention of complications after percutaneous coronary interventions (PCI). Several large clinical trials have demonstrated the effectiveness of this class of agents. The first of these agents to show beneficial effects after coronary interventions was the mouse/human chimeric Fab fragment antibody c7E3 abciximab (ReoPro). The purpose of this article is to describe the pharmacology of abciximab and to review the results of the clinical trials carried out with the drug in patients with ACS, treated either with or without acute/elective PCI.
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45
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Rasmussen LH, Husted SE, Clemmensen PM, Gøtzsche CO, Helqvist S, Kristensen SD, Pedersen KE, Rasmussen K, Rasmussen S. [Clinical studies on glycoprotein IIb/IIIa receptor antagonist]. Ugeskr Laeger 2000; 162:5944-7. [PMID: 11094564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Platelet activation plays a major role in the pathophysiology of acute coronary syndromes (ACS), and inhibition of platelet function is the basic pharmacological treatment of ACS. Platelet membrane glycoprotein IIb/IIIa inhibitors, a new class of potent antiplatelet agents, have been used in the treatment of ACS, as well as in the prevention of complications after percutaneous coronary interventions. The aim of this article is to describe the potential possibilities of platelet inhibition and to review the pharmacology of glycoprotein IIb/IIIa inhibitors, the results of the clinical trials with these agents, and their current use in the pharmacological treatment of ACS and in relation to percutaneous coronary intervention.
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Affiliation(s)
- L H Rasmussen
- Hjertecentret, kardiologisk afdeling S, Aalborg Sygehus Syd
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46
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Kristensen SD, Lassen JF, Ravn HB. Pathophysiology of coronary thrombosis. Semin Interv Cardiol 2000; 5:109-115. [PMID: 11054908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Detailed knowledge of the pathophysiology as well as the dynamic nature of coronary thrombus formation provides a valuable tool for correct management and proper adjunctive therapy in patients with acute coronary syndromes. Coronary thrombosis is in the majority of cases caused by disruption or fissuring of an atherosclerotic plaque. At the lesion thrombogenic material will be exposed to the flowing blood leading to activation of platelets and the formation of a platelet clot. Simultaneously, the coagulation system is activated resulting in increased thrombin formation. Thrombin is a key mediator in arterial thrombosis, due to its effect on both platelets and fibrin generation. Thrombin contributes to the stabilization of an initially loose platelet clot by generating cross-bound fibrin within the thrombus. During the course of an acute coronary syndrome, the patient presents changing chest pain and dynamic ischaemic ECG findings. This is likely to be related to the dynamic nature of the pathophysiology. The presence of a non-occlusive coronary thrombus may deprive the myocardium its normal blood flow and oxygen supply, leading to ischaemic pain. During lysis or embolization, blood supply may be restored, but the presence of thrombus fragments in the microcirculation holds the potential to sustained interference with myocardial metabolism. The emboli contain activated platelets which release vasoconstrictors that may compromise the microcirculation. Recurrent thrombus formation at the lesion site may result in occlusion of the artery adding to the dynamic nature of the clinical presentation. In conclusion, platelets, the coagulation system, and the endothelium cause a dynamic process of intermittent occlusion, vasospasm and embolization of thrombus material.
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Affiliation(s)
- S D Kristensen
- Department of Cardiology B and Institute of Experimental Clinical Research, Aarhus University Hospital, Skejby Sygehus, Arhus N, Denmark.
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47
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Thorwest M, Balling E, Kristensen SD, Aagaard S, Hakami A, Husted SE, Marqversen J, Hjortdal VE. Dietary fish oil reduces microvascular thrombosis in a porcine experimental model. Thromb Res 2000; 99:203-8. [PMID: 10946095 DOI: 10.1016/s0049-3848(00)00233-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Microvascular thrombosis plays a significant role in the pathophysiology of ischaemic reperfusion injury. A fish oil-supplemented diet containing n-3 polyunsaturated fatty acids (PUFA) reduces thromboxane A(2) (TxA(2)) synthesis and, thus, vasoconstriction and platelet aggregation. The aim of this study was to elucidate whether n-3 PUFA in a porcine model of ischaemia and reperfusion injury 1) inhibit accumulation of platelets and fibrinogen in ischaemia-reperfusion injured tissue, 2) prolong the bleeding time, and 3) inhibit TxA(2) synthesis. Nine pigs were fed a standard diet supplemented with 7 g n-3 PUFA/day for 3 weeks. Nine pigs on the standard diet served as controls. Unilateral myocutaneous flaps were exposed to ischaemia for a period of 6 hours. Contralateral flaps were nonischaemic. Tissue contents of radioactive-labelled platelets and fibrinogen were measured after 4 hours of reperfusion. Platelet count, serum TxB(2), and the cutaneous bleeding time were measured before and after 3 weeks of diet. In the fish oil group, the accumulation of platelets was significantly reduced in all the myocutaneous flaps, except in the ischaemic skin part, when compared to control animals. Fibrinogen was significantly reduced in nonischaemic flaps, but not in ischaemic flaps. After the feeding period, the level of TxB(2) was significantly lowered in the fish oil group (p<0.01). No difference in the bleeding time was observed. Thus, dietary supplementation with n-3 PUFA inhibits the formation of microvasculatory thrombosis in this model.
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Affiliation(s)
- M Thorwest
- Institute of Experimental Clinical Research, University of Aarhus, Aarhus, Denmark
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48
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Kristensen SD, Andersen HR, Falk E. What an interventional cardiologist should know about the pathophysiology of acute myocardial infarction. Semin Interv Cardiol 1999; 4:11-6. [PMID: 10406063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Basic knowledge of the sequence of cellular events that change the relative benign disease coronary atherosclerosis into a life-threatening acute coronary syndrome is of great importance for the interventional cardiologist in order to understand and choose the correct pharmacological and interventional management in patients with acute myocardial infarction. Plaque disruption, or fissuring, with superimposed thrombosis frequently complicates the course of coronary atherosclerosis. Small ruptures often remain clinically silent, whereas more extensive plaque rupture may lead to the development of unstable angina, acute myocardial infarction, and sudden cardiac death. The risk of plaque disruption depends more on plaque composition than on plaque size and stenosis severity. Major determinants of a plaque's vulnerability to rupture are: the size and consistency of the lipid-rich atheromatous core, the thickness of the fibrous cap covering the core, and inflammation and repair within the cap. The elevation of fibrinogen and C-reactive protein in patients with unstable angina may be markers of ongoing plaque inflammation. Both plaque vulnerability and rupture triggers are important for plaque disruption. The resultant thrombotic response, which is important for the clinical presentation and outcome, is in part determined by the reactivity of the circulating platelets and the balance between the fibrinolytic and coagulation systems. New ways of identification and treatment of the dangerous vulnerable plaques responsible for infarction and death and optimization of anti-thrombotic treatment are highly warranted in order to prevent and treat life-threatening coronary thrombosis.
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Affiliation(s)
- S D Kristensen
- Department of Cardiology B, Skejby Hospital, Aarhus, Denmark
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49
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Ravn HB, Kristensen SD, Hjortdal VE, Thygesen K, Husted SE. Early administration of intravenous magnesium inhibits arterial thrombus formation. Arterioscler Thromb Vasc Biol 1997; 17:3620-5. [PMID: 9437213 DOI: 10.1161/01.atv.17.12.3620] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
An antiplatelet effect of magnesium has been demonstrated in vitro and ex vivo, and this effect may be advantageous in patients with acute myocardial infarction to inhibit reocclusion after coronary angioplasty or thrombolysis. We investigated the antithrombotic in vivo effect of intravenous magnesium in a placebo-controlled, blinded study in 46 male Wistar rats. Thrombus formation was induced by standardized arteriotomy of the femoral artery and partial inversion of the vessel wall to produce a thrombogenic area. The vessel was transilluminated and visualized dynamically by in vivo microscopy. Thrombus area was measured every minute for 30 minutes after removal of the vessel clamp by image analysis techniques, and the number of visible emboli was registered. Animals were randomized into three groups: groups 1 and 2 received saline (control group, n = 15) or MgSO4 (Mg-early group, n = 15), respectively, during the entire infusion period. In group 3 intravenous saline was given during preparation of the arteriotomy followed by infusion of MgSO4 (Mg-late group, n = 16) from 10 minutes after removal of the vessel clamp. Thrombus area was significantly reduced by 75% in the Mg-early group (P < .005) but not in the Mg-late group compared with the control group. Mean number of emboli was reduced during magnesium infusion. The serum magnesium level increased to 2.2 (2.1 to 2.5) and 3.5 (3.0 to 4.2) mmol/L after infusion in the Mg-late and the Mg-early group, respectively. In the present study, intravenous infusion of MgSO4 significantly reduced thrombus formation in vivo but only when it was given before reperfusion. The antithrombotic effect of magnesium may be utilized in patients with acute myocardial infarction to reduce the rate of reocclusion. Magnesium infusion may also be of value in elective arterial angioplasty, but this option has not been investigated in clinical trials. However, correct timing of magnesium administration is critical to obtain an efficient antithrombotic effect.
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Affiliation(s)
- H B Ravn
- Department of Medicine and Cardiology, Aarhus Amtssygehus, Aarhus University Hospital, Denmark.
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50
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Abstract
Coronary atherosclerosis without thrombosis is, in general, a benign disease. However, plaque disruption, or fissuring, with superimposed thrombosis, frequently complicates the course of coronary atherosclerosis. Small ruptures often remain clinically silent, whereas more extensive plaque rupture may cause the development of unstable angina, myocardial infarction, and sudden death. The risk of plaque disruption depends more on plaque type (composition) than on plaque size and stenosis severity. Major determinants of a plaque's vulnerability to rupture are: the size and consistency of the lipid-rich atheromatous core; the thickness of the fibrous cap covering the core; and ongoing inflammation and repair within the cap. Both plaque vulnerability (intrinsic disease) and rupture triggers (extrinsic forces) are important for plaque disruption. The former predisposes the plaque to rupture whereas the latter may precipitate it. The resultant thrombotic response, which is important for the clinical presentation and outcome, is portly determined by the reactivity of the circulating platelets and the balance between the fibrinolytic and coagulation systems. New ways of identification and treatment of the dangerous vulnerable plaques responsible for infarction and death, and optimization of antithrombotic treatment, are highly warranted in order to prevent and treat life-threatening coronary thrombosis.
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Affiliation(s)
- S D Kristensen
- Department of Cardiology and Institute of Experimental Clinical Research, Skejby Hospital, Aarhus N, Denmark
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