C0150 The features of antiplatelet therapy in inflammation
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C0159 β1 blockers, warfarin and rhythm conversion in atrial fibrillation Ruzan Durgaryan Yerevan No 13 Polyclinic - Nerqin Shengavit 9, 32 Building, Armenia Background: Atrial fibrillation(AF) is the most frequently encoun- tered sustained cardiac arrhythmia in clinical practice and a major cause of morbidity and mortality. Effective treatment of AF still remains an unmet medical need. Treatment of AF is based on drug therapy and ablative strategies. Antiarrhythmic drug therapy is limited by a relatively high recurrence rate and proarrhythmic side effects. Conversion to sinus rhythm(SR) with pharmacological intervention is an actual goal for clinicians though unfortunately not always successful. Methods: 19 female patients have been chosen for trial, all they in postmenopausal period, with previous history of arterial hyperten- sion without valve disease as well as with the first paroxysm of atrial fibrillation and haven't gone to sinus rhythm conversion just after paroxysm. They have been divided into 2 groups for pharmacological intervention either for rhythm control or rate control. 10 patients have been involved in Group1 and 9 patients in Group2. These 2 groups have been adjusted by age, BMI, cholesterol, blood pressure (BP), left ventricular systolic function estimated using left ventricular ejection fraction more than 50%, measured by Simpson and Teichholz method, left atrial diameter less than 50 mm. Group1 has been treated by biseprolol (Coronal), losartan (Sentor), hypochlorthiazide, warfarin with the following mean doses 7,5 mg, 100 mg, 12.5 mg, 3.75 mg respectively. Group2 has been treated by metoprolol tartrate(Egiloc), lisinopril(Diraton), hypochlorthiazide, warfarin with the following mean doses 100 mg, 15 mg, 12.5 mg, 3.75 mg respectively. Dose of warfarin has been chosen to keep INR between 2.0–2.5 before and between 1.5-2 after rhythm conversion, there were no thrombs according to data of transesophageal echocardiography. BP was controlled between normal rages. Results: It has been noticed conversion to SR in 8 patients from 10 in Group1 during 3rd- 4th week of treatment, after amiodaron has been added to treatment. Despite to it in Group2 conversion to SR has been noticed only in 2 patients although there was well rate control in other patients. Any thromboembolic comlication has been noticed neither in Group1 nor in Group2. Comment: In abmulatory practice selective β1 blocker biseprolol which has much less proarrhythmic side effects than other antiar- rhythmic drugs can be used for conversion to SR in patient with AF combined with losartan and warfarin, after rhythm conversion treatment can be continued added amiodaron to control the rhythm. INR between 2–2.5 range before and 1.5-2 after rhythm conver- sion is saved by mean of thromboembolic complications. Although another selective β1 blocker metoprolol can be used for successful rate control. doi:10.1016/j.thromres.2012.08.188 C0409 Prevalence of atrial fibrillation in patients presenting with stroke Uchenna Ozo 1 , Khalil Peroo 2 , Gemma Fitzpatrick 2 , Khalil Kawafi 2 1 Fairfield General Hospital, Stroke - FGH, Rochdale Road, Bury, UK; 2 FGH, UK Background: Atrial fibrillation (AF) is a major risk factor in the development of thromboembolic stroke. A significant proportion of these patients are not receiving optimum thromboprophylaxis. Risk stratification in AF and subsequent anticoaguation was audited against NICE, SIGN and ESC guidance. Aims/Objectives Identify the incidence of new AF in stroke patients Quantify the prevalence of AF in stroke patients Audit documentation of risk stratification Assess whether anti-coagulation was prescribed according to best practice Methods: All patients with a diagnosis of stroke to the Stroke Unit at Fairfield General Hospital during the period ranging from January to June 2011 (both inclusive) were surveyed.Case notes were reviewed retrospectively and data collected using a specifically designed proforma Results: 272 patients were admitted to the Stroke Unit during a six month. 44 patient (16.2%) met the inclusion criteria, 9 (3.3%) of which were of new onset AF. 42 patients (15.4%) had indications for anticoagulation, four of whom were already on warfarin. The rationale for the failure to anticoagulate was documented in 50% of cases, the commonest reasons being risk of falls and intracranial haemorrhage. A small proportion of patients (12.2%) however failed to receive the correct thrombo-prophylaxis, i.e. warfarin. Around one-fifth (18.2%) died following their stroke. Comment: Risk stratification was not consistently and systematically completed for every patient admitted with AF. CHADS scores were not always calculated, and certainly rarely documented. The development of a clinical pathway for Stroke patients in AF, detailing risk assessment, management and onward referral. Educate medical and nursing teams about risk assessments in AF patient. Re-audit in 6 months to ensure clinical pathway is being adhered to. doi:10.1016/j.thromres.2012.08.189 C0150 The features of antiplatelet therapy in inflammation Liudmila Buryachkovskaya 1 , Alexander Sumarokov 2 , Irina Uchitel 1 1 Russian Cardiology Research Complex, Department of Thrombosis - 3rd Cherepkovskaya, 15A, Moscow, Russia; 2 Russian Cardiology Research Complex, Department of Atherosclerosis - 3rd Cherepkovskaya, 15A, Moscow, Russia Background: Platelets are important link between inflammation, thrombosis and atherogenesis. The antiplatelet drugs wide used in order to reduce the risk of thrombotic complications have their own features in the case of accompanying inflammation. The participation of platelets from different platelets subpopulations is not well known yet. The aim of this study was to evaluate the effect of antiplatelet therapy on platelets in inflammation. Methods: In our study there were included 36 CHD patients (pts) 1 day after percutaneous coronary intervention (PCI), 12 from whom received GPIIb/IIIa inhibitors, 24 were on the loading dose of clopidogrel, also 11 CHD and pneumonia pts who were taking 75 mg aspirin a day, 14 pts with yersinious taking NAIDs and 18 healthy subjects (HS) free from medications. In all study groups platelets spontaneous and ADP 0.1, 1.0, 5.0 μM aggregation (PA) was measured by using an aggregation analyzer BIOLA (Russia). Platelet morphology and leukocyte-platelet aggregates (LPA) were assessed by scanning electron microscopy. Platelet mean volume (MPV) was estimated by thrombocytocrit method, serum high sensitive CRP (hs-CRP) level was analysed by using nephelometric method. Results: In all pts with inflammation there was 62.7 ± 12.4% of LPA and 4.7 ± 1.3% of large reticulated platelets (LRP), which are normally absent in HS. The presence of LPA and LRP is usual in pts with inflammation. At 64% pts the number of LRP was higher than 2% and that correlated with Abstracts / Thrombosis Research 130 (2012) S100–S202 S173
Transcript of C0150 The features of antiplatelet therapy in inflammation
C0159β1 blockers, warfarin and rhythm conversion in atrial fibrillation
Ruzan DurgaryanYerevan No 13 Polyclinic - Nerqin Shengavit 9, 32 Building, Armenia
Background: Atrial fibrillation(AF) is the most frequently encoun-tered sustained cardiac arrhythmia in clinical practice and a majorcause of morbidity and mortality. Effective treatment of AF stillremains an unmet medical need. Treatment of AF is based on drugtherapy and ablative strategies. Antiarrhythmic drug therapy islimited by a relatively high recurrence rate and proarrhythmic sideeffects. Conversion to sinus rhythm(SR) with pharmacologicalintervention is an actual goal for clinicians though unfortunately notalways successful.Methods: 19 female patients have been chosen for trial, all they inpostmenopausal period, with previous history of arterial hyperten-sion without valve disease as well as with the first paroxysm of atrialfibrillation and haven't gone to sinus rhythm conversion just afterparoxysm. They have been divided into 2 groups for pharmacologicalintervention either for rhythm control or rate control. 10 patientshave been involved in Group1 and 9 patients in Group2. These 2groups have been adjusted by age, BMI, cholesterol, blood pressure(BP), left ventricular systolic function estimated using left ventricularejection fraction more than 50%, measured by Simpson and Teichholzmethod, left atrial diameter less than 50 mm.
Group1 has been treated by biseprolol (Coronal), losartan(Sentor), hypochlorthiazide, warfarin with the following mean doses7,5 mg, 100 mg, 12.5 mg, 3.75 mg respectively.
Group2 has been treated by metoprolol tartrate(Egiloc),lisinopril(Diraton), hypochlorthiazide, warfarin with the followingmean doses 100 mg, 15 mg, 12.5 mg, 3.75 mg respectively.
Dose of warfarin has been chosen to keep INR between 2.0–2.5before and between 1.5-2 after rhythm conversion, there were nothrombs according to data of transesophageal echocardiography. BPwas controlled between normal rages.Results: It has been noticed conversion to SR in 8 patients from 10 inGroup1 during 3rd- 4th week of treatment, after amiodaron has beenadded to treatment. Despite to it in Group2 conversion to SR has beennoticed only in 2 patients although there was well rate control inother patients. Any thromboembolic comlication has been noticedneither in Group1 nor in Group2.Comment: In abmulatory practice selective β1 blocker biseprololwhich has much less proarrhythmic side effects than other antiar-rhythmic drugs can be used for conversion to SR in patient with AFcombined with losartan and warfarin, after rhythm conversiontreatment can be continued added amiodaron to control the rhythm.
INR between 2–2.5 range before and 1.5-2 after rhythm conver-sion is saved by mean of thromboembolic complications.
Although another selective β1 blocker metoprolol can be used forsuccessful rate control.
doi:10.1016/j.thromres.2012.08.188
C0409Prevalence of atrial fibrillation in patients presenting with stroke
Uchenna Ozo1, Khalil Peroo2, Gemma Fitzpatrick2, Khalil Kawafi2
1Fairfield General Hospital, Stroke - FGH, Rochdale Road, Bury, UK;2FGH, UK
Background: Atrial fibrillation (AF) is a major risk factor in thedevelopment of thromboembolic stroke. A significant proportion ofthese patients are not receiving optimum thromboprophylaxis. Risk
stratification in AF and subsequent anticoaguation was auditedagainst NICE, SIGN and ESC guidance.
Aims/ObjectivesIdentify the incidence of new AF in stroke patientsQuantify the prevalence of AF in stroke patientsAudit documentation of risk stratificationAssess whether anti-coagulation was prescribed according to best
practiceMethods: All patients with a diagnosis of stroke to the Stroke Unit atFairfield General Hospital during the period ranging from January toJune 2011 (both inclusive) were surveyed.Case notes were reviewedretrospectively anddata collected using a specifically designed proformaResults: 272 patients were admitted to the Stroke Unit during a sixmonth. 44 patient (16.2%) met the inclusion criteria, 9 (3.3%) ofwhich were of new onset AF. 42 patients (15.4%) had indications foranticoagulation, four of whom were already on warfarin.
The rationale for the failure to anticoagulate was documented in 50%of cases, the commonest reasons being risk of falls and intracranialhaemorrhage. A small proportion of patients (12.2%) however failed toreceive the correct thrombo-prophylaxis, i.e. warfarin. Around one-fifth(18.2%) died following their stroke.Comment: Risk stratification was not consistently and systematicallycompleted for every patient admitted with AF. CHADS scores were notalways calculated, and certainly rarely documented.
The development of a clinical pathway for Stroke patients inAF, detailing risk assessment, management and onward referral.Educate medical and nursing teams about risk assessments in AFpatient. Re-audit in 6 months to ensure clinical pathway is beingadhered to.
doi:10.1016/j.thromres.2012.08.189
C0150The features of antiplatelet therapy in inflammation
Liudmila Buryachkovskaya1, Alexander Sumarokov2, Irina Uchitel11Russian Cardiology Research Complex, Department of Thrombosis -3rd Cherepkovskaya, 15A, Moscow, Russia; 2Russian Cardiology ResearchComplex, Department of Atherosclerosis - 3rd Cherepkovskaya, 15A,Moscow, Russia
Background: Platelets are important link between inflammation,thrombosis and atherogenesis. The antiplatelet drugs wide used inorder to reduce the risk of thrombotic complications have their ownfeatures in the case of accompanying inflammation. The participationof platelets from different platelets subpopulations is not well knownyet. The aim of this study was to evaluate the effect of antiplatelettherapy on platelets in inflammation.Methods: In our study there were included 36 CHD patients (pts)1 day after percutaneous coronary intervention (PCI), 12 fromwhom received GPIIb/IIIa inhibitors, 24 were on the loading dose ofclopidogrel, also 11 CHD and pneumonia pts who were taking 75 mgaspirin a day, 14 pts with yersinious taking NAIDs and 18 healthysubjects (HS) free from medications. In all study groups plateletsspontaneous and ADP 0.1, 1.0, 5.0 μM aggregation (PA) was measuredby using an aggregation analyzer BIOLA (Russia). Platelet morphologyand leukocyte-platelet aggregates (LPA) were assessed by scanningelectron microscopy. Platelet mean volume (MPV) was estimated bythrombocytocrit method, serum high sensitive CRP (hs-CRP) levelwas analysed by using nephelometric method.Results: In all ptswith inflammation therewas62.7±12.4% of LPA and4.7±1.3% of large reticulated platelets (LRP),which are normally absentin HS. The presence of LPA and LRP is usual in pts with inflammation. At64% pts the number of LRP was higher than 2% and that correlated with
Abstracts / Thrombosis Research 130 (2012) S100–S202 S173
the level of hs-CRP (1.3±0.2 μg/l in pts withb2% of LRP and 3,1±1.3 μg/lwith LRPN2%, MPV was 12.6±2.7 fl vs 8.4±0.7 fl in HS). Spontaneousand 0.1 μMADP PAwas increased. Aspirin decreased hs-CRP level but hadno influence on LRP and LPA. The reduction of LRP number was revealedin a NAIDs taking study group. Clopidogrel decreased hs-CRP, LRP andLPA, and GPIIb/IIIa inhibitors slightly diminished hs-CRP level but had noinfluence on LPA and LRP number.Comment: Using antiplatelet therapy in pts with accompanyinginflammation not only its antithrombotic efficacy must be taking intoaccount but its anti-inflammatory potential.
doi:10.1016/j.thromres.2012.08.190
C0152Incidence of haemorrhagic and thromboembolic complications inpatients with mechanical heart valve prostheses taking longtermvitamin K antagonists
Sanja Gnip, Sladjana Novakovic-Anucin, Visnja Canak, Pavica Radovic,Jelena Kovacev, Milena Scekic, Gorana MiticClinical Centre of Vojvodina, Centre of Laboratory Medicine, Departmentof Thrombosis, Haemostasis and Haematology Diagnostics -Hajduk Veljkova 1, 21000 Novi Sad, Serbia
Background: Since patients (pts) with mechanical heart valveprostheses are at high risk for thrombosis and systemic embolism,life long oral anticoagulation therapy is recommended in order toprevent these complications. However, this treatment caries the riskof bleeding which can be severe or even fatal. The purpose of thestudy was to compare the incidence of haemorrhagic and thrombo-embolic (TE) complications in pts with mechanical heart valveprostheses treated with vitamin K antagonists (VKA) only andcombination of VKA and aspirin (ASA).Methods: Total of 251 pts with mechanical heart valve prostheseshave been included (155 at aortic, 77 at mitral position and 19 ptswith both valve prostheses), age range 18–86 years, mean age 64.They have been followed up for the period of 1936 patients’ years(pts/yr) - between 4 months to 32 years 9 months. VKA only groupconsisted of 196 pts and 55 pts received combined treatment -VKA+ASA 100 mg daily. Target INR for aortic valve was 2.0-3.0, formitral and both valve prostheses was 2.5-3.5. Prothrombin time -INR was determined from capillary blood, using Thrombotestreagent and coagulometer Thrombotrack, manufactured by AxisShield, Norway. INR controls have been performed at outpatientanticoagulant clinic, Clinical Center of Vojvodina, Novi Sad onregular basis and presence of treatment complications was docu-mented.Results: During the follow up 111 (0.06%/yr) haemorrhagic compli-cations occurred, 68 (0.06%/yr), 32 (0.05%/yr) and 11 (0.06%/yr) inaortic, mitral and both valve groups respectively. Haemorrhagiccomplications occurred more frequently in VKA group as compared toVKA+ASA group. VKA+ASA (37/55) than in VKA only (74/196)pb0.05. Thromboembolic complications occurred in 25 (0.01%/yr)cases, 9 (0.008%/yr) in aortic group, 14 (0.02%/yr) in mitral and 2(0.01%/yr) in both valve group. In VKA only group (17/196) thrombo-embolic complications occurred and in VKA+ASA group (8/55) n.s.Thromboembolic complications occurred more frequently in VKA onlygroup as compared to VKA+ASA group.Comment: The incidence rates of haemorrhagic complications werefound to be more frequent with VKA+ASA regimen. The combinedantithrombotic treatment was slightly but not significantly moreefficient in terms of preventing thromboembolic events.
doi:10.1016/j.thromres.2012.08.191
C0237Exact - extended anticoagulation treatment for VTE:A randomised trial
Gail Heritage, Ellen Murray, Jayne Tullett, David FitzmauriceUniversity of BirminghamPrimary Care Clinical Sciences - Room 234,Edgbaston, Birmingham, UK, B15 2TT
Background: Venous thromboembolism (VTE), comprising pulmo-nary embolism (PE) and deep vein thrombosis (DVT), is a commoncondition causing both mortality and morbidity. The aims oftreatment with warfarin are to prevent extension or recurrence ofclot. Patients with raised D-dimer levels after discontinuing oralanticoagulation have also shown to be at high risk of recurrence andthat extended oral anticoagulation could be a possible preventativemeasure.Methods: Patients will be recruited through anticoagulation clinicsand randomly allocated to either discontinuing or continuingwarfarin treatment for a further 2 years, followed up on a sixmonthly basis. At each visit D-dimer levels will be measured using aRoche Cobas h232 POC device. In addition a venous sample will betaken for laboratory D-dimer analysis. Patients will also be examinedfor signs and symptoms of PTS and complete VEINES and EQ 5Dquality of life questionnaires.Results: Interim results will be presented.Comment: We hope to derive an algorithm to identify patients athigh risk of recurrence of VTE using both clinical and biomarker data.
doi:10.1016/j.thromres.2012.08.192
C0312Electronic alerts improve adherence and adequacy of VTEprophylaxis in a tertiary care hospital from Cordoba, Argentina
Aldo Hugo Tabares1, Guadalupe Caballero Escuti2,María Teresita Cornavaca2, Francisco Bernabeu2,María Eugenia Garzón Oliva2, Ana Soledad Vergottini2,Romina Ivana Benkovic2, Ricardo Arturo Albertini21Hospital Privado, Vascular Medicine - 346 Naciones Unidas, Argentina;2Hospital Privado, Internal Medicine - 346 Naciones Unidas, Argentina
Background: Venous thromboembolism (VTE) is the most com-mon preventable cause of death in the hospital setting. Preventivemethods are both safe and efficacious to decrease the rate of VTE,however many clinical audits have shown that approximately halfof patients at risk receive prophylactic treatment. Several strategieshave been proposed to improve adherence to clinical guidelinesincluding education, the development of local guidelines, the use ofelectronic alerts etc. The purpose of this study was to evaluate theimpact of a pop up electronic alert on the adherence and adequacyof VTE prophylaxis in a tertiary care hospital from Cordoba,Argentina.Methods: Consecutive patients admitted to the Hospital PrivadoCentro Medico de Cordoba from September 1 to December 30,2010 (Group A pre-intervention). Patients were excluded if lessthan 18 years of age, had a hospital stay less than 24 hours, werepregnant or 1 month postpartum, admitted to an Intensive CareUnit, or deemed to be at terminal stage. Demographic data and VTErisk was assessed by a standardized risk score (Caprini score). VTEprophylaxis was left to the attending physician. On March 2011 apop up electronic alert which included the Caprini score and asuggestion on appropriate thromboprophylaxis according to
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