ABSTRACT
Multiple factors play a pathophysiologic role for the venous thromboembolism (VTE) as a multi-factorial disease. Inflammation might play a peculiar role in shifting towards a pro-thrombotic state. Anticoagulant drugs are the first cure line for VTE. The low-molecular-weight heparins (LMWH) show anti-coagulant capability as well as reducing levels of inflammatory factors, including interleukin (IL)-6. The direct oral anticoagulants (DOACs) have shown efficacy in threating VTE, additionally to the anti-activated factor X these drugs seem able to reduce the abnormal release of pro-inflammatory agents. The present study evaluated the capability of DOACs in reducing plasma level of IL-6 in patients suffered from deep vein thrombosis (DVT) of the lower limbs. Our results showed reduced IL-6 expression levels in the peripheral lymphocytes of DVT compared to controls (fold-change, 2.8; P<0.05). We postulate that lowered IL-6 expression in the lymphocytes of DVT patients may mediate the anti-inflammatory action of DOACs. The present study is the first evidence concerning the anti-inflammatory properties of DOACs in specific setting of VTE patients such as DVT.
ABSTRACT
Reduction of hazard risk of cerebral ischemic event (stroke, transient ischemic attack (TIA)) represents the hard point to be achieved from primary or secondary preventive strategy in the best clinical practice. However, results from clinical trials, recommendations, guidelines, systematic review, expert opinions, and meta-analysis debated on the optimal pharmacotherapy to achieve the objective. Aspirin and a number of antiplatelet agents, alone or in combination, have been considered from large trials focused on stroke prevention. The present review summarizes, discusses results from trials, and focuses on the benefits or disadvantages originating from antiplatelet drugs. Sections of the review were organized to show both benefits or consequences from antiplatelet pharmacotherapy. Conclusively, this review provides a potential synopsis on the most appropriate therapeutic approach for stroke prevention in clinical practice.
Subject(s)
Diabetes Mellitus, Type 2 , Ischemic Attack, Transient , Platelet Aggregation Inhibitors , Stroke , Aged , Diabetes Mellitus, Type 2/drug therapy , Double-Blind Method , Drug Therapy, Combination , Female , Humans , Ischemic Attack, Transient/drug therapy , Male , Middle Aged , Platelet Aggregation Inhibitors/therapeutic use , Secondary Prevention , Stroke/prevention & controlABSTRACT
Low frequency of rare diseases origins from missed diagnosis addressing to poor prognosis. Acquired factor V inhibitor is a very low frequent bleeding condition (prevalence: 0.09/100,000,000-0.29/1,000,000 per year). Antibiotics, surgery, bacterial infections, malignancies, and autoimmune diseases are predisposing factors; however, no predisposing factor was found often. Authors reported a case of bleeding originating from an acquired factor V deficiency because they wish to draw attention to unfrequented or rare clinical situations rarely diagnosed in internal medicine unit.
