Subject(s)
Hospital Departments/statistics & numerical data , Internal Medicine , Patient Readmission/statistics & numerical data , Adult , Aged , Aged, 80 and over , Case-Control Studies , Chronic Disease , Female , Hospital Departments/economics , Humans , Male , Middle Aged , Patient Readmission/economics , Retrospective Studies , Socioeconomic FactorsSubject(s)
Crohn Disease/diagnosis , Cutaneous Fistula/diagnosis , Rectal Fistula/diagnosis , Colonoscopy , Crohn Disease/drug therapy , Cutaneous Fistula/therapy , Humans , Immunosuppressive Agents/therapeutic use , Rectal Fistula/therapy , Recurrence , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
INTRODUCTION: Anticoagulation is rarely indicated in patients with left ventricular dysfunction who show an increased risk for thromboembolism. In theory, the three arms of the Virchow' triad may be present: abnormal blood flow, endothelial damage and prothrombotic markers. The aim of this study was to identify the last two arms. PATIENTS AND METHOD: We studied 82 consecutive patients with demonstrated ischaemic heart disease and sinus rhythm, and compared them with a control group comprised of 32 healthy subjects matched for age and sex. None or the patients had had an acute coronary event or hemodynamic decompensation within the 3 months prior to inclusion in the study. The plasma concentration or von Willebrand factor and fibrin d-dimer and fibrinogen were determined as endothelial damage and prothrombotic markers, respectively. A fractional shortening less than 29% by echography was defined as ventricular systolic dysfunction. RESULTS: The patients showed significantly higher levels of von Willebrand factor with respect to the control group (109.2 31.9 vs 85.5 32.6%, p < 0.01), with no differences in fibrinogen and fibrin d-dimer values. Twenty-six patients fulfilled criteria of left ventricular systolic dysfunction. Patients with left ventricular dysfunction showed higher fibrinogen (386 118 vs 322 102 mg/dl, p = 0.03) and fibrin d-dimer (0.36 0.22 vs 0.26 0.10 g/ml; p = 0.04) levels, with no differences in von Willebrand factor levels. CONCLUSIONS: After acute coronary events, patients with ischaemic heart disease show markers of endothelial damage. However, patients with left ventricular dysfunction show a hypercoagulable state.