Systemic biomarker associated with poor outcome after futile reperfusion.

BACKGROUND: Successful recanalization does not lead to complete tissue reperfusion in a considerable percentage of ischemic stroke patients. This study aimed to identify biomarkers associated with futile recanalization. Leukoaraiosis predicts poor outcomes of this phenomenon. Soluble tumour necrosis factor-like weak inducer of apoptosis (sTWEAK), which is associated with leukoaraiosis degrees, could be a potential biomarker. METHODS: This study includes two cohorts of ischemic stroke patients in a multicentre retrospective observational study. Effective reperfusion, defined as a reduction of ≥8 points in the National Institutes of Health Stroke Scale (NIHSS) within the first 24 h, was used as a clinical marker of effective reperfusion. RESULTS: In the first cohort study, female sex, age, and high NIHSS at admission (44.7% vs. 81.1%, 71.3 ± 13.7 vs. 81.1 ± 6.7; 16 [13, 21] vs. 23 [17, 28] respectively; p < .0001) were confirmed as predictors of futile recanalization. ROC curve analysis showed that leukocyte levels (sensitivity of 99%, specificity of 55%) and sTWEAK level (sensitivity of 92%, specificity of 88%) can discriminate between poor and good outcomes. Both biomarkers simultaneously are higher associated with outcome after effective reperfusion (OR: 2.17; CI 95% 1.63-4.19; p < .0001) than individually (leukocytes OR: 1.38; CI 95% 1.00-1.64, p = .042; sTWEAK OR: 1.00; C I95% 1.00-1.01, p = .019). These results were validated using a second cohort, where leukocytes and sTWEAK showed a sensitivity of 100% and specificity of 66.7% and 75% respectively. CONCLUSIONS: Leukocyte and sTWEAK could be biomarkers of reperfusion failure and subsequent poor outcomes. Further studies will be necessary to explore its role in reperfusion processes.

Consenso de expertos sobre la insuficiencia cardiaca con fracción de eyección reducida: más allá de las guías / Expert consensus statement on heart failure with reduced ejection fraction: beyond the guidelines

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Perfil clínico de pacientes con fibrilación auricular tratados con anticoagulantes orales de acción directa atendidos en atención primaria. Estudio SILVER-AP / Clinical characteristics of patients with atrial fibrillation treated with direct oral anticoagulants attended in primary care setting. The SILVER-AP study

OBJETIVO: Describir las características clínicas y el manejo de pacientes con fibrilación auricular no valvular (FANV) tratados con anticoagulantes orales de acción directa (ACOD). DISEÑO: Estudio observacional, transversal y multicéntrico. Emplazamiento: Comunidades autónomas en las que el médico de atención primaria puede prescribir ACOD (n = 9). PARTICIPANTES: Un total de 790 pacientes con riesgo de ictus o embolia sistémica que estuviesen en tratamiento crónico con anticoagulantes, que hubiesen modificado su pauta terapéutica, y que actualmente estuviesen en tratamiento con un ACOD durante al menos 3 meses. Mediciones principales: Recogida de datos sociodemográficos y de manejo clínico. RESULTADOS: La edad media de los sujetos fue de 78,6 ± 8,4 años; un 50,5% eran varones; CHADS2: 2,6 ± 1,2; CHA2DS2-VASc: 4,3 ± 1,6; HAS-BLED: 2,3 ± 1,0. La duración media del tratamiento con ACOD fue de 15,8 ± 12,5 meses. El ACOD más frecuentemente prescrito fue rivaroxabán (57,8%), seguido de dabigatrán (23,7%) y apixabán (18,5%). De los pacientes que tomaban rivaroxabán, el 70,2% recibieron la dosis de 20mg/día. En el caso de dabigatrán, el 41,7% tomaban la dosis de 150 mg/12h, y con respecto a apixabán, el 56,2% tomaban la dosis de 5 mg/12h. La satisfacción con el tratamiento con ACOD (cuestionario ACTS: 52,0 ± 7,2 puntos en la escala Carga y 12,1 ± 2,2 puntos en la escala Beneficio) y el cumplimiento (97,8% de los pacientes fueron cumplidores) fueron elevados. CONCLUSIONES: Los pacientes en tratamiento con ACOD en España tienen un elevado riesgo tromboembólico. Una proporción significativa de sujetos reciben una dosis menor de ACOD de la que les correspondería por sus características clínicas. La satisfacción y la adherencia son elevadas

OBJECTIVE: To analyse the clinical characteristics and management of patients with non-valvular atrial fibrillation (NVAF) treated with direct oral anticoagulants (DOAC). DESIGN: Observational, cross-sectional and multicentre study. LOCATION: Autonomous Communities in which the general practitioner can prescribe DOAC (n = 9). PARTICIPANTS: The study included a total of 790 patients on chronic treatment with anticoagulants, and on whom therapy was changed, as well as being currently on treatment with DOAC for at least for 3 months. Main measures: A record was made of the sociodemographic and clinical management date. RESULTS: Mean age was 78.6±8.4 years, and 50.5% of patients were men. Mean CHADS2 score was 2.6 ± 1.2, mean CHA2DS2-VASc score was 4.3 ± 1.6, and the mean HAS-BLED score was 2.3 ± 1.0. Mean duration of treatment with DOAC was 15.8 ± 12.5 months. Rivaroxaban was the DOAC most frequently prescribed (57.8%), followed by dabigatran (23.7%), and apixaban (18.5%). Of the patients receiving rivaroxaban, 70.2% were taking the dose of 20mg/daily. Of the patients receiving dabigatran, 41.7% were taking the dose of 150 mg twice daily, and in the case of apixaban, 56.2% were taking the dose of 5 mg twice daily. Satisfaction (ACTS Burdens scale 52.0 ± 7.2 and ACTS Benefits scale 12.1 ± 2.2), and therapeutic adherence (97.8% of patients took their medication regularly) with DOAC were high. CONCLUSIONS: Patients treated with DOAC in Spain have a high thromboembolic risk. A significant proportion of patients receive a lower dose of DOAC than that recommended according to their clinical profile. Satisfaction and medication adherence are high

[Clinical characteristics of patients with atrial fibrillation treated with direct oral anticoagulants attended in primary care setting. The SILVER-AP study]. / Perfil clínico de pacientes con fibrilación auricular tratados con anticoagulantes orales de acción directa atendidos en atención primaria. Estudio SILVER-AP.

OBJECTIVE: To analyse the clinical characteristics and management of patients with non-valvular atrial fibrillation (NVAF) treated with direct oral anticoagulants (DOAC). DESIGN: Observational, cross-sectional and multicentre study. LOCATION: Autonomous Communities in which the general practitioner can prescribe DOAC (n=9). PARTICIPANTS: The study included a total of 790 patients on chronic treatment with anticoagulants, and on whom therapy was changed, as well as being currently on treatment with DOAC for at least for 3 months. MAIN MEASURES: A record was made of the sociodemographic and clinical management date. RESULTS: Mean age was 78.6±8.4 years, and 50.5% of patients were men. Mean CHADS2 score was 2.6±1.2, mean CHA2DS2-VASc score was 4.3±1.6, and the mean HAS-BLED score was 2.3±1.0. Mean duration of treatment with DOAC was 15.8±12.5 months. Rivaroxaban was the DOAC most frequently prescribed (57.8%), followed by dabigatran (23.7%), and apixaban (18.5%). Of the patients receiving rivaroxaban, 70.2% were taking the dose of 20mg/daily. Of the patients receiving dabigatran, 41.7% were taking the dose of 150mg twice daily, and in the case of apixaban, 56.2% were taking the dose of 5mg twice daily. Satisfaction (ACTS Burdens scale 52.0±7.2 and ACTS Benefits scale 12.1±2.2), and therapeutic adherence (97.8% of patients took their medication regularly) with DOAC were high. CONCLUSIONS: Patients treated with DOAC in Spain have a high thromboembolic risk. A significant proportion of patients receive a lower dose of DOAC than that recommended according to their clinical profile. Satisfaction and medication adherence are high.