ABSTRACT
ABSTRACT: The aim of our study is to assess the impact of anemia, chronic kidney disease, and diabetes mellitus on platelet reactivity (PR) in patients with severe aortic stenosis, both at baseline and after transcatheter aortic valve implantation (TAVI). This study is a prespecified subanalysis of the REAC-TAVI prospective, multicenter trial that included patients pretreated with aspirin + clopidogrel before TAVI. PR was measured at baseline and at 5 different time points after TAVI with the VerifyNow assay (Accriva Diagnostics, San Diego, CA), over a 3-month follow-up period. Patients with high PR (HPR) at baseline, before TAVI (n = 48) were randomized to aspirin + clopidogrel or aspirin + ticagrelor for 3 months, whereas those with normal PR (NPR) (n = 20) were continued on aspirin + clopidogrel. A "raiser response" in PR was defined as an increase in PR units >20% of baseline after TAVI. Patients with HPR before TAVI presented concomitant anemia and chronic kidney disease more frequently than their counterparts with NPR. Anemia and higher body mass index were independently associated with HPR to clopidogrel at baseline. Moreover, anemic patients with baseline HPR who were continued on clopidogrel presented higher PR after TAVI than patients with HPR switched to ticagrelor. All patients with baseline NPR presented a "raiser response" after TAVI, which was nonexistent among patients with HPR managed with ticagrelor. In summary, anemia seems as a relevant factor associated with baseline HPR and higher PR after TAVI in patients with baseline HPR randomized to clopidogrel, whereas ticagrelor proved more effective than clopidogrel at attaining sustained reductions in PR during follow-up, regardless of baseline comorbidities.
Subject(s)
Aortic Valve Stenosis/surgery , Aspirin/therapeutic use , Blood Platelets/drug effects , Clopidogrel/therapeutic use , Dual Anti-Platelet Therapy , Platelet Aggregation Inhibitors/therapeutic use , Ticagrelor/therapeutic use , Transcatheter Aortic Valve Replacement/adverse effects , Aged , Aged, 80 and over , Anemia/blood , Anemia/epidemiology , Aortic Valve Stenosis/blood , Aortic Valve Stenosis/diagnosis , Aortic Valve Stenosis/epidemiology , Aspirin/adverse effects , Blood Platelets/metabolism , Clopidogrel/adverse effects , Comorbidity , Diabetes Mellitus/blood , Diabetes Mellitus/epidemiology , Dual Anti-Platelet Therapy/adverse effects , Female , Humans , Male , Middle Aged , Platelet Aggregation Inhibitors/adverse effects , Platelet Function Tests , Prevalence , Prospective Studies , Renal Insufficiency, Chronic/blood , Renal Insufficiency, Chronic/epidemiology , Severity of Illness Index , Spain/epidemiology , Ticagrelor/adverse effects , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Brazil is an important example to study the situation of poverty and its determinants. Brazil owns a great part of the poor population of Latin America and presents great potential to eradicate this situation. The present study tries to show the association between the mortality risk and poverty in the city of Fortaleza. METHODS: Cross-sectional ecological study, the unit of analysis was the districts of the city of Fortaleza. We included any death happened during year 2007. Mortality data were obtained through Unique System of Health, socioeconomic indicators and number of inhabitants was extracted from the Census of Inhabitants and Houses of the Brazilian Institute of Statistics of the year 2000. An index composed from the main simple indicators of deprivation was calculated using a Cluster technique. The deprivation index was divided in five groups, group 1 presented the best socio-economic conditions and group 5 the worst ones. Correlation analysis was done to evaluate the association between socioeconomic level and mortality. RESULTS: We observed a significant association of the socioeconomic level with total mortality (p < 0.001), circulatory disease (p < 0.001) and external causes (p < 0.001). In addition, 86% of the cases of aggression happened in groups 4 and 5. CONCLUSIONS: The results show a relation between socioeconomic conditions and mortality by any cause, by circulatory causes and by external causes.
Subject(s)
Mortality/history , Mortality/trends , Socioeconomic Factors , Brazil , History, 21st Century , HumansABSTRACT
Fundamentos: Brasil es un ejemplo para estudiar la situación de la pobreza y sus determinantes, ya que posee una gran parte de la población pobre de América Latina y presenta gran potencial para erradicar esta pobreza. El presente trabajo pretende mostrar la asociación entre la mortalidad y el índice de pobreza en la ciudad de Fortaleza, capital del estado Ceará. Métodos: Estudio ecológico transversal, la unidad de análisis fueron los barrios de la ciudad de Fortaleza. Los datos de mortalidad se obtuvieron a través del Sistema Único de Salud, incluyendo todas las defunciones del año 2007 y sus causas. Los indicadores socioeconómicos y número de habitantes se extrajeron del Censo de Habitantes y Viviendas del Instituto Brasileño de Estadísticas del año 2000. Se calculó un índice compuesto de privación a partir de los principales indicadores simples de privación utilizando una técnica de agrupamiento tipo Cluster y se realizó un análisis de correlación para valorar la asociación entre nivel socioeconómico y mortalidad. El índice compuesto de privación se dividió en cinco grupos, el grupo 1 presentaba las mejores condiciones socioeconómicas y el 5 las peores. Resultados: Se observó asociación significativa del nivel socioeconómico con la mortalidad total (p<0,001), por enfermedades circulatorias (p<0,001) y por causas externas (p<0,001). Además, el 86% de los casos de agresión sucedieron en los grupos 4 y 5. Conclusiones: Existe relación directa entre la condición socioeconómica y la mortalidad total por causas circulatorias y por causas externas(AU)
Background: Brazil is an important example to study the situation of poverty and its determinants. Brazil owns a great part of the poor population of Latin America and presents great potential to eradicate this situation. The present study tries to show the association between the mortality risk and poverty in the city of Fortaleza. Methods: Cross-sectional ecological study, the unit of analysis was the districts of the city of Fortaleza. We included any death happened during year 2007. Mortality data were obtained through Unique System of Health, socioeconomic indicators and number of inhabitants was extracted from the Census of Inhabitants and Houses of the Brazilian Institute of Statistics of the year 2000. An index composed from the main simple indicators of deprivation was calculated using a Cluster technique. The deprivation index was divided in five groups, group 1 presented the best socio-economic conditions and group 5 the worst ones. Correlation analysis was done to evaluate the association between socioeconomic level and mortality. Results: We observed a significant association of the socioeconomic level with total mortality (p<0,001), circulatory disease (p<0,001) and external causes (p<0,001). In addition, 86% of the cases of aggression happened in groups 4 and 5. Conclusions: The results show a relation between socioeconomic conditions and mortality by any cause, by circulatory causes and by external causes(AU)
