RESUMO
Objectives: Many patients undergoing antiplatelet therapy continue to experience thrombotic events and failure of therapy leading to so-called 'resistance' to antiplatelet therapy. Recently, there has been an increasing focus on in vitro laboratory monitoring of platelet functions, which has the promise of identifying these patients. This study aimed to document the prevalence of laboratory evidence of resistance to aspirin and clopidogrel therapy in Saudi patients with stable coronary heart disease [CHD]
Methods: Light transmission aggregometry in plateletrich plasma was performed in response to adenosine diphosphate [ADP], arachidonic acid [AA], collagen and adrenaline. In addition, a platelet function analyser [PFA100] was employed using both collagen/ADP and collagen/epinephrine cartridges
Results: Light transmission aggregometry [LTA] identi- fied the resistance to aspirin and clopidogrel therapy, according to the persistence of the aggregation response to AA aggregation, to be 13% and 26%, respectively. By PFA100 testing, closure times within the limits of laboratory reference values indicated residual platelet reactivity, and the prevalence of resistance to anti-platelet therapy was reported to be 33% for collagen/ADP cartridges and 30.7% for collagen/epinephrine. A concordance between LTA and PFA100 CT was noted in only 22.6% of patients
Conclusion: This study showed a wide prevalence of ontreatment platelet reactivity in patients with CHD on dual platelet therapy [aspirin and clopidogrel]. In addition, the global whole blood test of platelet function by PFA100 estimated a much higher prevalence of resistance than LTA when compared to the gold standard and more specific LTA analysis
RESUMO
Congestive heart failure is an uncommon complication of pregnancy with potentially life-threatening consequences. Peripartum cardiomyopathy [PPCM] is a disease of unknown cause in which severe left ventricular dysfunction occurs during late pregnancy or the early puerperium. In the past, the diagnosis of this entity was made on clinical grounds; however, modern echocardiographic techniques have allowed more accurate diagnoses by excluding cases of diseases that mimic the clinical symptoms and signs of heart failure. Risk factors for peripartum cardiomyopathy include advanced maternal age, multiparity, African descent, twinning, and long-term tocolysis. An extensive search for the causes of peripartum cardiomyopathy has been unrevealing. Treatment does not differ from treatment of idiopathic cardiomyopathy. The prognosis of peripartum cardiomyopathy is related to the recovery of ventricular function. Caution is advised in recommending subsequent pregnancy especially if left ventricular dysfunction is persistent. In this review, we will discuss different aspects of PPCM as the initial patient contact, obstetricians and family practitioners must recognize this malady early and rapidly institute the proper medical therapy directed towards the congestive state