ABSTRACT
Background: Primary PCI (PPCI) is the main reperfusion treatment for ST-segment elevation myocardial infarction (STEMI). Anticoagulation therapy should be administered in patients undergoing PCI in order to limit the ischemic complications. In this study, we evaluated the effect of bolus unfractionated heparin (UFH) before PPCI on clinical outcome of patients with STEMI.Methods: In this randomized clinical trial, 196 patients (72.4% male with mean age of 63.02�.37 years) with STEMI undergoing PPCI were randomly assigned to receive bolus UFH 60-90 U/kg in emergency room (case group) or during PCI (control group). Clinical outcomes, 30 day mortality, hematoma, left ventricle function improvement during follow-up were compared between groups.Results: In both groups there was good flow in the involved coronary artery after PCI. Case group compared to control group had significantly more cases with improved LVEF (28.1% vs. 9.7%, p=0.005). Also, case group compared to control group had more hematoma (3.1% vs. 0%, p=0.24) and higher mortality rate (6% vs. 4.2%, p=0.56) which had no significant difference between groups.Conclusions: PPCI in patients with STEMI accompanies with acceptable coronary flow irrespective of receiving bolus heparin. Receiving bolus heparin in these patients may have improved left ventricle function by increasing the rate of reflow. However, using bolus heparin did not accompany with increased rate of bleeding and had no effect on 30 day mortality rate.
ABSTRACT
Background:Anthracycline antibiotics are potent antineoplastic agents. Unfortunately, despite its broad effectiveness, anthracycline therapy is associated with irreversible dilated cardiomyopathy. Toxic effect may occur at any stage of anthracycline treatment. When it takes place, medical therapy is mostly insufficient. Therefore, prevention of cardiomyopathy has great clinical importance. This study aimed at evaluating the protective effect of carvedilol against anthracycline-induced cardiomyopathy on patients with breast cancer and lymphoma.Methods: In a randomized clinical trial, 66 patients with breast cancer or lymphoma selected for chemotherapy in Tabriz city hospital. These patients randomized in three groups; the first group (control) received placebo; the second group (A) received carvedilol 6.25mg/d and the third group (B) received carvedilol 12.5mg/d for 4months. Conventional echocardiography and tissue Doppler study were employed for evaluating the patients on the baseline and at the end of survey.Results:At the end of 4 months of follow-up, 1 (4.5%) patient in group B, 2 (9.1%) patients in group A and 4 (18.2%) patients of the control group had died. Clinical systolic dysfunction was encountered in 5 (27.8%), 5 (25%) and 1 (4.8%) patients in the control, A and B groups, respectively. A distinctive clinical diastolic dysfunction was encountered in 5 (27.8%), 3 (15%) and 3 (14.3%) patients in the control, A and B groups, respectively. Carvedilol with a dose of 6.25mg/d prohibited the diastolic dysfunction at the end of study without a significant effect on the prevention of diastolic dysfunction. Carvedilol with a dose of 12.5mg/d effectively prevented both the systolic and diastolic dysfunctions at the end of study.Conclusions:The current study showed that prophylactic administration of carvedilol with a dose of 12.5 mg/d might significantly prevent the systolic and diastolic dysfunction of the left ventricle in patients receiving chemotherapy with anthracycline