ABSTRACT
The study included 52 patients at a high risk of thromboembolic complications, with permanent atrial fibrillation. All patients were treated with acenocoumarol for 6 months and the incidence of hemorrhages was evaluated in all of them. All patients were genotyped by CYP2C9 and VKORC1. The presence of CYP2C9*2 and CYP2C9*3 alleles of CYP2C9 locus and AA genotype of VCORC1 gene polymorphic G-1639(3673)A marker was not associated with the development of hemorrhages under conditions of acenocoumarol treatment (p=0.144 for CYP2C9, p=0.809 and 0.918 for VCORC1 in the total group and subgroup of patients with CYP2C9*1/*1 genotype, respectively). The search for other genetic markers of acenocoumarol efficiency and safety is needed for predicting the risk of hemorrhages during this treatment.
Subject(s)
Acenocoumarol/adverse effects , Anticoagulants/adverse effects , Aryl Hydrocarbon Hydroxylases/genetics , Atrial Fibrillation/genetics , Mixed Function Oxygenases/genetics , Polymorphism, Genetic , Thromboembolism/genetics , Alleles , Aryl Hydrocarbon Hydroxylases/metabolism , Atrial Fibrillation/complications , Atrial Fibrillation/drug therapy , Atrial Fibrillation/enzymology , Cytochrome P-450 CYP2C9 , Genetic Loci , Genotype , Genotyping Techniques , Hemorrhage/etiology , Hemorrhage/prevention & control , Humans , International Normalized Ratio , Mixed Function Oxygenases/metabolism , Retrospective Studies , Risk , Russia , Thromboembolism/complications , Thromboembolism/drug therapy , Thromboembolism/enzymology , Vitamin K Epoxide ReductasesABSTRACT
BACKGROUND: There has been controversy concerning the merits of enteral and parenteral nutrition compared with no supplementary nutrition in the management of patients with acute pancreatitis. AIM: To perform a systematic review of the data from randomized controlled trials (RCTs) in acute pancreatitis that compares enteral nutrition with no supplementary nutrition, parenteral nutrition with no supplementary nutrition and enteral nutrition with parenteral nutrition. METHODS: A search was undertaken in the MEDLINIE, EMBASE and the Cochrane Central Register of Controlled Trials. RESULTS: Fifteen RCTs were included. Enteral nutrition, when compared with no supplementary nutrition, was associated with no significant change in infectious complications: ratio of relative risks (RR) 0.56, 95% confidence interval (CI) 0.07-4.32, P = 0.58, but a significant reduction in mortality: ratio of RR 0.22, 95% CI 0.07-0.70, P = 0.01. Parenteral nutrition, when compared with no supplementary nutrition, was associated with no significant change in infectious complications: RR 1.36, 95% CI 0.18-10.40; P = 0.77, but a significant reduction in mortality: RR 0.36, 95% CI 0.13-0.97, P = 0.04. Enteral nutrition, when compared with parenteral nutrition, was associated with a significant reduction in infectious complications: RR 0.41, 95% CI 0.30-0.57, P < 0.001, but no significant change in mortality: RR 0.60, 95% CI 0.32-1.14, P = 0.12. CONCLUSIONS: The use of either enteral or parenteral nutrition, in comparison with no supplementary nutrition, is associated with a lower risk of death in acute pancreatitis. Enteral nutrition is associated with a lower risk of infectious complications compared with parenteral nutrition.
