ABSTRACT
Background: Oral anticoagulation (OAC) is used in neurology practice for primary and secondary stroke prevention in atrial fibrillation (AF). Since, there are lacunae of literature on the quality of anticoagulation in neurological patients this study was planned. Objective: To Evaluate the quality of oral anticoagulation therapy in neurology patients. Materials and methods: A prospective study was conducted on patients attending tertiary care neurology OPD who were prescribed oral anticoagulant (OAC). Consecutive sampling technique was used. Their international normalized ratio (INR) values were prospectively observed and the earlier INR values of the patients who were already on OAC were retrospectively scrutinized. The level of anticoagulation, factors intrusive with OAC and complications were noted. Results: The results were based on 70 patients with median age 45 year. Fifty patients received OAC for secondary stroke prevention, 16 for cerebral venous sinus thrombosis (CVST) and four for deep vein thrombosis (DVT). Of the 1280 INR reports, 500 (39.5%) reports were in the therapeutic range, 496 (38.5%) were below and 280 (21.9%) were above the therapeutic level. Stable INR was obtained in 30 (42.86%) patients only. The overall complication rate was 16.4 per 100 person-years. Conclusions: In the present study, it was concluded that stable therapeutic INR is tough to maintain in neurological patients. Optimal modification of diet, drug and dose of oral anticoagulant may support in stabilization of INR.
ABSTRACT
Background: Patients with systolic heart failure have generally been excluded from statin trials. Acute coronary events are uncommon in this population, and statins have theoretical risks in these patients. Objective: To evaluate the impact of Rosuvastatin in patient of Systolic Heart Failure. Materials and methods: A randomized controlled clinical trial was conducted among 500 patients of at least 60 years of age with New York Heart Association class II, III, or IV ischemic, systolic heart failure. The patients were randomly allocated to accept 10 mg of rosuvastatin or placebo per day. The primary composite outcome was death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. Epi-info was used for analysis. Results: As compared with the placebo group, patients in the rosuvastatin group had decreased levels of low-density lipoprotein cholesterol (P<0.001) and of high-sensitivity C-reactive (P<0.001). During a median follow-up of 30 months, the primary outcome occurred in 500 patients in the rosuvastatin group and 700 in the placebo group (hazard ratio, 0.92; 95% confidence interval (CI), 0.83 to 1.02; P = 0.12. There were no significant differences between the two groups in the coronary outcome or death from cardiovascular causes. No excessive episodes of muscle-related or other adverse events occurred in the rosuvastatin group. Conclusions: Rosuvastatin did not reduce the primary outcome or the number of deaths from any cause in older patients with systolic heart failure, although the drug did reduce the number of cardiovascular hospitalizations.