Frequency of aspirin resistance in patients with coronory artery disease in Pakistan

Aspirin resistance is an emerging clinical entity. However the data available on aspirin resistance in Asian population is scarce. This study was initiated to prospectively evaluate the frequency of aspirin resistance in patients with stable coronary artery disease [CAD] in Pakistan. A cross sectional prospective study was conducted in cardiology and hematology departments at Shifa International Hospital, Islamabad from January to December 2007. Two hundred and fifty patients were enrolled from cardiology out patient department having met the specific inclusion criteria. Details were entered on a pre-designed questionnaire and aspirin response assay was performed on IMPACT-R [Dia Med AG 1785 Cressier Morat, Switzerland]. Data was analyzed using SPSS V12. Aspirin resistance was observed in 12% of patients. 73.2% of study population were male and 26.8% were female, with a mean age of 57.2 years. There was no significant correlation of aspirin resistance with traditional risk factors like Diabetes Mellitus [DM], Hypertension or Dyslipidemia. 84% of Aspirin non responders were taking 75mg per day and 16% were on 150mg per day. A positive trend was noted between aspirin resistance and cigarette smoking. Aspirin resistance is a real phenomenon in Pakistani population with an estimated frequency of 12%. Large scale prospective randomized trials with long term follow up are needed to assess the impact of different doses and the clinical significance of this biochemical entity

Role of inferior vena cava filter implantation in preventing pulmonary embolism

A retrospective review of all patients undergoing IVC filter implantation at Shifa International Hospital, Islamabad, from June 2004 to June 2006 was conducted to study the indications of inferior vena cava [IVC] filter use and impact on short-term morbidity/mortality. A total of 17 patients received IVC filters. Five patients were excluded due to data loss. One month clinical follow-up was available for 12 patients and 6 months follow-up was also available for 4 of 12 patients. The underlying disease was deep venous thrombosis [DVT] with pulmonary embolism [PE] in 6 [50%], DVT without PE in 4 [33.3%] and PE with negative duplex scan for DVT in 2 [16.6%] patients, respectively. Indications for IVC filter implantation were DVT and/or PE with contraindication to anticoagulation in 8 [66.7%] and DVT and/or PE with complications of anticoagulation in 4 [33.3%] patients. No procedure-related complications were noted in all 17 patients. Three patients [25%] died of non-PE related causes during the 1st month. There were no PE related mortalities at 6 months. This data set indicates that IVC filter implantation is a safe procedure with no short-term morbidity/mortality and potential long-term mortality benefit

Rheumatic mitral stenosis presenting as acute abdominal aortic occlusion and foot drop

Systemic thromboembolism in not an infrequent complication of rheumatic mitral stenosis. We report a case of acute abdominal aortic occlusion due to rheumatic mitral stenosis, in the absence of atrial fibrillation, mimicking spinal cord compression. Systemic streptokinase given 48 hours after symptom's onset lead to rapid and dramatic recovery with limb salvage