ABSTRACT
Objective:To investigate the risk factors of bleeding events in patients with high international normalized ratio (INR) values (INR>3.5) in warfarin therapy.Methods:Two hundred and one patients with high INR values (INR>3.5) during warfarin therapy admitted in Beijing Tongren Hospital from August 2013 to August 2019 were enrolled. The bleeding occurred in 75 patients (bleeding group) and did not occur in 126 cases (non-bleeding group) during hospitalization. The bleeding group included 12 major bleeding patients and 63 minor bleeding patients. The baseline information, laboratory results and medication of other drugs were recorded.Results:There were no significant differences in age, sex, smoking history, drinking history, previous bleeding history and the proportion of first application of warfarin between the two groups ( P>0.05).The proportion of patients with liver dysfunction [7.14%(9/126)], renal dysfunction [11.90%(15/126)], anemia [4.76%(6/126)], hypoproteinemia [4.76%(6/126)], infectious diseases [20.63%(26/126)] in non-bleeding group were significantly lower than that in bleeding group [16.00% (12/75), 32.00% (24/75), 29.33%(22/75), 16.00%(12/75), 44.00%(33/75); χ 2=3.942, 12.140, 23.675, 7.283, 12.377, respectively; all P<0.05]. A total of 54 kinds of drugs were associated with the INR elevation. The most commonly used drugs were cardiovascular system drugs ( n=162, 80.60%), blood system drugs ( n=155, 77.11%), anti-infective drugs ( n=112, 55.72%), digestive system drugs ( n=82, 40.80%), and endocrine system drugs ( n=56, 27.86%). The INR values [4.58(3.94, 5.90), 4.96(4.03, 8.27)] and the HAS-BLED scores [3.00 (2.00,3.00), 3.00(2.25,3.00)] in minor bleeding group ( n=63) and major bleeding group ( n=12) were higher than those in non-bleeding group [4.00(3.74, 4.35), 2.00 (1.00,3.00), P<0.01), but there was no significant difference in INR values and HAS-BLED scores between minor bleeding group and major bleeding group ( P>0.05). Conclusion:There are many factors leading to the increase of INR in patients taking warfarin, such as abnormal liver and kidney function, anemia, hypoproteinemia, and the use of antibacterial drugs. It is necessary to be cautious about co-administration in these patients.
ABSTRACT
Objective Using Z-score to assess the prevalence of proximal aorta dilatation in middle-aged and aged individuals during routine transthoracic echocardiogram examinations and to identify its risk factors. Methods A total of 823 middle-aged or elderly patients on routine transthoracic echocardiogram examinations were consecutively enrolled. The internal diameters of the sinus of Valsalva (SoV ) and the ascending aorta (AA ) were measured. Z-scores were calculated according to the proposed equation for SoV and AA. A dilated aortic root was defined as a Z-score ≥1.96 or the diameter of SoV or AA ≥ 40 mm. The prevalence of proximal aorta dilatation and associated factors were analyzed. Results The prevalences of proximal aorta dilatation ,SoV dilatation ,and AA dilatation were 26.1%(25/823 ) ,6.0%(49/823 ) ,and 23.7%(195/823 ) , respectively.In the aortic root dilatation group ,age and the proportion of obesity were higher (both P＜0.05) ,and there were more female subjects (30.5% or 117/384 vs.22.3% or 98/439 ,P＜0.01) . The incidences of left atrial dilation ,left ventricular dilation ,left ventricular hypertrophy ,and aortic regurgitation in the aortic root dilatation group were higher than those in the non-aortic root dilatation group(P＜0.05 ) .Logistic regression analysis demonstrated that sex (OR＝ 1.827 ,95% CI :1.248-2.673 ,P＝0.002) ,hypertension (OR＝1.441 ,95% CI :1.000-2.075 ,P＝0.050)and left ventricular hypertrophy (OR＝1.827 ,95% CI :1.248-2.673 ,P＝0.002)were independently correlated with aortic root dilatation. Conclusions The prevalence of proximal aorta dilatation is high in middle-aged and aged individuals. Proximal aorta dilatation is related to sex ,age ,and body size ,and it is often accompanied by structural abnormalities of the heart.
ABSTRACT
[Objective] To explore the activity aberration of primary insomnia (PI) patients with resting-state fMRI.[Methods]Resting-state fMRI datasets of 60 PI and 60 healthy controls were acquired.We investigated the cortical connectivity patterns of the insula in PI and independent-sample t-test were used to compare the brain activity abnormalities between two groups.[Results] In PI,we found enhanced connectivity between left insular with the left middle cingulate cortex,the Frontal_Sup_Media and right Parietal_Inf,as well as decreased connectivity with the left precentral gyrusand the right fusiformgyrus (P ＜ 0.05).The right insular show increased FC with the right middle cingulate cortex,the right fusiform gyrus and the right middle frontal gyrus,as well as decreased FC with the right precentral gyrus and the right middle temporal gyrus (P ＜ 0.05).[Conclusion] This study provides additional evidence of brain functional integration alterations in PI.Those may help us understand the possible neural mechanisms of PI.
ABSTRACT
Objective To investigate the effect of surround needling at articular six meridians plus finger (toe) tip bloodletting therapy on sciatic nerve conduction velocity and lower limb microcirculatory flow in diabetic rats. Method The model was made with streptozotocin. The rats were allocated to model, methycobal, acupuncture and normal groups. The methycobal group received a muscular injection of 50 ?g/kg in the left and right lower limbs alternately, every other day. The acupuncture group received acupuncture at points Taixi(KI3), Kunlun(BL60) and Jiexi(ST41), once daily plus toe tip bloodletting. The normal and model groups were bound 30 min once every other day. Every group was treated for eight weeks. General condition was observed, and sciatic nerve conduction velocity and lower limb microcirculatory flow were measured in the rats before and after treatment. Result Compared with the normal group, sciatic nerve conduction velocity decreased in the other groups of rats (P<0.01). Compared with the model group, sciatic nerve conduction velocity was higher in every treatment group of rats (P<0.05). Conclusion Surround needling at articular six meridians plus finger (toe) tip bloodletting therapy can increase sciatic nerve conduction velocity and improve lower limb microcirculation.
ABSTRACT
Objective To investigate impact of admission renal dysfunction on in-hospital and longterm outcome of patients with ST-elevation myocardial infarction (STEMI).Methods This was a multicentre,observational,prospective-cohort study.Totally 718 consecutive patients were admitted to 19 hospitals in Beijing within 24 hours of onset of STEMI.Estimation of glomerular filtration rate (eGFR) was calculated according to the abbreviated MDRD equation.The patients were categorized into two groups as renal preservation group(eGFR ≥60 ml · min-1 · 1.73 m-2) and renal dysfunction group(eGFR ＜ 60 ml ·min-1 · 1.73 m-2).The association between admission renal dysfunction and in-hospital and six-year outcome was evaluated.Results A total of 718 patients with STEMI were evaluated.There were 551 men and 167 women with age of (61.0 ± 13.0) years.One hundred and thirty-three patients(18.5％) had renal dysfunction.Patients with renal dysfunction were more often female and older,more patients had hypertension,diabetes and heart failure,and more patients had ≥ Killip Ⅱ classes on admission.These patients were less likely to present with chest pain.The in-hospital mortality(16.5％ vs 2.6％,P＜0.001),major adverse cardiac events(MACE) (60.9％ vs 24.4％,P ＜0.001),six-year all-cause mortality(35.3％vs 11.4％,P ＜ 0.001),six-year cardiac mortality (15.9％ vs 5.7％,P =0.001) and six-year MACE (52.4％ vs 28.0％,P ＜ 0.001)were markedly increased in renal dysfunction group than in renal preservation group.After adjusting for other confounding factors,renal dysfunction was an independent predictor of in-hospital MACE (OR 2.120,95％ CI 1.563-2.878,P =0.003),six-year all-cause mortality (RR 2.122,95％ CI 1.127-3.996,P =0.020) and six-year MACE(RR 1.586,95％ CI 1.003-2.530,P =0.047).Conclusions The mortality and MACE in STEMI patients with renal dysfunction were higher than in those with preserved renal function.Renal dysfunction evaluated by eGFR on admission is an important independent predictor of short-term and long-term outcome in patients with acute STEMI.
ABSTRACT
<p><b>BACKGROUND</b>Numerous previous studies have shown that renal insufficiency (RI) in patients with acute coronary syndrome is associated with poor cardiovascular outcomes. These studies do not well address the impact of RI on the long-term outcome of patients with acute ST-elevation myocardial infarction (STEMI) in China. The aim of this study was to investigate the association of admission RI and inhospital and long-term mortality of patients with acute STEMI.</p><p><b>METHODS</b>This was a multicenter, observational, prospective-cohort study. 718 consecutive patients were admitted to 19 hospitals in Beijing within 24 hours of onset of STEMI, between January 1,2006 and December 31,2006. Estimation of glomerular filtration rate (eGFR) was calculated using the modified abbreviated modification of diet in renal disease equation-based on the Chinese chronic kidney disease patients. The patients were categorized according to eGFR, as normal renal dysfunction (eGFR ≥ 90 ml·min -1·1.73 m -2 ), mild RI (60 ml·min -1·1.73 m -2 ≤ eGFR < 90 ml·min -1·1.73 m -2 ) and moderate or severe RI (eGFR < 60 ml·min -1·1.73 m -2 ). The association between RI and inhospital and 6-year mortality of was evaluated.</p><p><b>RESULTS</b>Seven hundred and eighteen patients with STEMI were evaluated. There were 551 men and 167 women with a mean age of 61.0 ± 13.0 years. Two hundred and eighty patients (39.0%) had RI, in which 61 patients (8.5%) reached the level of moderate or severe RI. Patients with RI were more often female, elderly, hypertensive, and more patients had heart failure and stroke with higher killip class. Patients with RI were less likely to present with chest pain. The inhospital mortality (1.4% vs. 5.9% vs. 22.9%, P < 0.001), 6-year all-cause mortality (9.5% vs. 19.8 vs. 45.2%, P < 0.001) and 6-year cardiac mortality (2.9% vs. 12.2% vs. 23.8%, P < 0.001) were markedly increased in patients with RI. After adjusting for other confounding factors, classification of admission renal function was an independent predictor of inhospital mortality (Odd ratio, 1.966; 95% confidence interval [CI], 1.002-3.070, P = 0.019), 6-year all-cause mortality (relative risk [RR] = 1.501, 95% CI: 1.018-4.373, P = 0.039) and 6-year cardiac mortality (RR = 1.663, 95% CI: 1.122-4.617, P = 0.042).</p><p><b>CONCLUSIONS</b>RI is very common in STEMI patients. RI evaluated by eGFR is an important independent predictor of short-term and long-term outcome in patients with acute STEMI.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Glomerular Filtration Rate , Physiology , Hospital Mortality , Myocardial Infarction , Mortality , Renal Insufficiency , MortalityABSTRACT
Objective This study was designed to determine the in vitro sensitivity of LMWH caused by different reagents,and to explore whether the ACT can be used to monitor LMWH.Methods This study was performed in vitro.ACT was measured with different reagents(glass beads,celite,and kaolin)on volunteer(n =30)blood samples spiked with increasing concentrations of LMWH(datleparin,0.2-1.8IU/ml).Linear regression analysis was performed to establish a regression equation from different concentration of datleparin and corresponding ACT values.Results Analysis of dose-response curves obtained in vitro,an excellent linear relationship was observed between the ACT and dalteparin concentrations for all three reagents(p less than 0.01).Differences in slope of the regression curves of ACT were observed with all the reagents tested(glass beads 249.7s/IU,celite 77.7s/IU,and kaolin 59.3s/IU,p less than 0.01).Reagents vary widely in their in-vitro sensitivity related to dalteparin.In the concentration range of 0.2-1.8 IU/ml,the gaolin reagent was insensitive to dalteparin,and glass beads was the most suitable reagent for monitoring the anticoagulant effect of dalteparin.Conclusions Glass beads,celite,and kaolin.Glass beads were the most suitable reagent for monitoring the anticoagulant effect of dalteparin.Vary widely in their in-vitro sensitivity related to datleparin.
ABSTRACT
Objective To study the in vitro effects of different doses and different kinds of LMWH on CR, and to determine whether the CR test could be used to monitor LMWH. Methods The CR value was measured with different reagents ( glass beads, celite and kaolin ) in blood samples from twenty volunteer donors, which were spiked with increasing concentration of LMWH ( dalteparin, 0-1.8 IU/ml ). Then the CR test was performed again on the same blood samples spiked with the same concentration ( 0. 8 IU/ml ) but different LMWH ( dalteparin, enoxaparin and nadroparin ). Regression analysis was performed to establish a regression equation from corresponding LMWH levels. Results With the increasing of dalteparin dose, CR values were reduced gradually for all three reagents. When the concentration of dalteparin was 0-1.8 IU/ml,the value of CR was 20. 0-4. 5 IU/min for glass beads, 26. 1-6.6 IU/min for celite and 27. 2-7. 5 IU/min for kaolin. An exponential relationship was observed between the CR value and dalteparin concentration for three reagents( R2 = -0.796, -0.884, -0.921 ,P ＜0.01 ). All three kinds of LMWH with the same concentration (0.8 IU/ml ) induced a different change in CR. The value of CR was 7.4 IU/min with dalteparin,8. 5 IU/min with enoxaparin and 8.5 IU/min with nadroparin. Compared with the control group ( CR was 17.6 IU/min ), three kinds of LMWH had statistical significance ( t = 18.45, 12. 33, 14. 93, P ＜ 0.01 ).Compared with the enoxaparin and nadroparin, dalteparin induced a higher CR value ( t = 2. 552,2. 924,P＜0. 05 ). Conclusions There is an exponential relationship between CR value and dalteparin concentration for three reagents. Three kinds of LMWH can significantly reduce the value of CR. CR test can be used to monitor the anticoagulant effect of LMWH.
ABSTRACT
Objective To determine the correlation of cardiovascular MRI with cardiac biomarkers and electrocardiography(ECG)in acute myocardial infarction(MI).Methods Nineteen patients with first acute MI were selected to undergo MRI on a 1.5 T system within 3-7 days after the onset of symptoms.A first-pass perfusion scan was performed with the administration of Gd-DTPA at a speed after cine MRI for global left ventricle(LV)funotions.Delay-enhanced MRI was performed by using an ECG-gated inversionrecovery fast-gradient echo-pulse sequence 5 to 10 minutes later with second bolus injection at a s peed.Infarct mass(IM),percentage size of infarction(PSI)and LV functions were compared with peak troponin T (peak TnT)and peak ereatine kinase-MB fraction (peak CK-MB).The 12-lead ECG was analysed for STelevation on admission.Pearson and Spearman correlation test and independent-Sample t test wel-e used for statistics.Results The IM (median 6.3 g) was correlated with peak TnT(median 0.8μg/L,r=0.487,P=0.0340)and left ventricle end-systolic volume index(LVESVI)(median 23.4 ml/m2,r=0.480,P=0.038).IM showed a negative correlation with left ventricle ejection fraction(LVEF)(54.1±15.4)/(r=-0.563.P:0.012).The PSI(median 6.0/)was correlated with peak TnT(r=0.583,P=0.009),peak CK.Mn(median 43.0 U/L,r=0.470,P=0.042)and LVSV[(57.6 ±15.0)ml,r=-0.482,P=0.036],peak TnT was also correlated with LVSV(r=-0.524,P=0.021).There were more involved segments(IS)(t=2.972,P=0.009),higher peak TnT(t=2.245,P=0.041)and peak CK-MB(t=2.508,P=0.024)in ST-elevation MI(STEMI)than in non ST-elevation MI(NSTEMI).Conclusions IM directly influences LV functions in acute MI.Peak TnT was a better biomarker reflecting PSI and LV functions.There were more involved segments in STEMI than in NSTEMI.
ABSTRACT
Background and Objective Previous study showed tenecteplase and alteplaxe were equovalent for 30-day mortality in the treatment of acute myocardial infarction. The purpose of this open-label, randomized, multi-center, angiographic trial was to assess the efficacy and safety of tenecteplase compared with alteplase in Chinese patients with acute myocardial infarction. Methods We recruited patients with acute ST-elevation myocardial infarction presenting within 6 hours of symptom onset from October, 2002 to March,2004, in 5 hospitals in Beijing. After giving informed consent, patients were randomly assigned a single-bolus injection of tenecteplase (30-50 mg according to body weight) or front loaded alteplase (100 mg), and underwent coronary angiography at 90 min after starting the study drug. All patients received aspirin and heparin (target activated partial thromboplastin time 50-70 s). The primary efficacy end point was the rate of TIMI grade 3 flow at 90 minutes. Other efficacy end points included TIMI grade 2/3 flow at 90 minutes. Safety end points included all stroke, intracranial hemorrhage (ICH), moderate/severe hemorrhage (except for ICH), all-cause mortality at 30-days, and major non-fatal cardiac events at 30 days. Results Overall 110 patients were eligible for statistical analysis, with 58 patients assigned to receive tenecteplase and 52 patients to alteplase. Tenecteplase produced a rate of TIMI grade 3 flow at 90 minutes after the start of thrombolysis(68.4%) similar to that of alteplase (66.7%, P=1.0); the rates of TIMI grade 2 or 3 were similar for patients treated with tenecteplase versus alteplase (89.5% versus 80.4%, respectively, P=0.278). At 30 days, rates for all strokes were similar for the two groups (5.17% for tenecteplase and 1.92% for alteplase, P=0.62); rates of ICH were 3.45% and 1.92% (tenecteplase and rt-PA,P=1.00) respectively. The rate of moderate/severe hemorrhage was 8.62% with tenecteplase and 5.77% with alteplase (P=0.72); total mortality was almost identical in the two groups (13.8% versus 9.6%, respectively, P=0.565) while the rates of non-fatal cardiac complications were 10.35% and 11.54% (tenecteplase and alteplase, P=1.0). Conclusions The efficacy of a single-bolus, weightadjusted tenecteplase fibrinolytic regimen is equivalent to front-loaded alteplase in terms of the rates of TIMI grade 3 flow, and TIMI 2 or 3 flow, but the 30-day mortality and ICH in both groups was so high that the use of tenecteplase is not permitted in China. These negative safety results might be due to the high rate of percutaneous coronary intervention (PCI) and high dose of bolus heparin and suboptimal concomitant medical therapy during hospitalization, so further studies are needed to confirm the safety for tenecteplase in Chinese patients.