Once versus twice daily enoxaparin for the initial treatment of acute venous thromboembolism.

Essentials In venous thromboembolism (VTE), it is uncertain if enoxaparin should be given twice or once daily. We compared the 15- and 30-day outcomes in VTE patients on enoxaparin twice vs. once daily. Patients on enoxaparin once daily had fewer major bleeds and deaths than those on twice daily. The rate of VTE recurrences was similar in both subgroups. SUMMARY: Background In patients with acute venous thromboembolism (VTE), it is uncertain whether enoxaparin should be administered twice or once daily. Methods We used the RIETE Registry data to compare the 15- and 30-day rates of VTE recurrence, major bleeding and death between patients receiving enoxaparin twice daily and those receiving it once daily. We used propensity score matching to adjust for confounding variables. Results The study included 4730 patients: 3786 (80%) received enoxaparin twice daily and 944 once daily. During the first 15 days, patients on enoxaparin once daily had a trend towards more VTE recurrences (odds ratio [OR], 1.79; 95% confidence interval [CI], 0.55-5.88), fewer major bleeds (OR, 0.42; 95% CI, 0.17-1.08) and fewer deaths (OR, 0.32; 95% CI, 0.13-0.78) than those on enoxaparin twice daily. At day 30, patients on enoxaparin once daily had more VTE recurrences (OR, 2.5; 95% CI, 1.03-5.88), fewer major bleeds (OR, 0.40; 95% CI, 0.17-0.94) and fewer deaths (OR, 0.58; 95% CI, 0.33-1.00). On propensity analysis, patients on enoxaparin once daily had fewer major bleeds at 15 (hazard ratio [HR], 0.30; 95% CI, 0.10-0.88) and at 30 days (HR, 0.16; 95% CI, 0.04-0.68) and also fewer deaths at 15 (HR, 0.37; 95% CI, 0.14-0.99) and at 30 days (HR, 0.19; 95% CI, 0.07-0.54) than those on enoxaparin twice daily. Conclusions Our findings confirm that enoxaparin prescribed once daily results in fewer major bleeds than enoxaparin twice daily, as suggested in a meta-analysis of controlled clinical trials.

Beta-blocker therapy and prognosis of heart failure patients with new-onset diabetes mellitus.

BACKGROUND: The influence of beta-blocker therapy (bisoprolol or carvedilol) (bB) on the prognosis of heart failure (HF) patients with diabetes mellitus (DM) is uncertain. AIMS: To assess the effect of bB on the prognosis of HF patients with new-onset DM treated with a contemporary medical regime. METHODS: Prospective study of 5314 HF patients with previously unknown DM. Mean age was 71.8±7.9 years, 53.0% were women, and 50.2% had HF with preserved ejection fraction (HFpEF). During a median follow-up of 56.9±18.2 months, 68.9% of the patients died, 88.6% were hospitalised for HF, and 1519 (27.3%) developed DM (62.3% of them received bB, 947 patients). We propensity-matched 572 HF patients with DM on bB, with 572 HF patients with DM non-treated with bB. RESULTS: Beta-blocker therapy was associated with a decreased hazard risk (HR) of all-cause death [HR: 0.68, CI 95% (0.61-0.75)], mainly because of a reduced risk of death from cardiovascular causes [HR: 0.70 (0.64-0.77)] (p<0.001). Similarly, bB was associated with a decreased HR of hospitalisation [HR: 0.82 (0.72-0.92)] (p<0.001). Nevertheless, the 30-day re-admission rate and the number of visits were not significantly associated with bB. These relationships of bB with prognosis were maintained, independently of the gender, the type of HF (HFpEF ot HFdEF), the comorbidities and the medication used (p<0.01). CONCLUSION: Therapy with bB, bisoprolol or carvedilol, is associated with a reduced mortality and morbidity of HF patients with new-onset DM, not only in men but also in women, as well as in patients with HFpEF or HFdEF.

[Possible prognostic value of arterial hypertension in postmenopausal women with breast cancer in complete clinical remission. Pilot study]. / Posible valor pronóstico de la hipertensión arterial en mujeres postmenopáusicas con cáncer de mama. Estudio piloto.

BACKGROUND: The objective of this work was to determine the blood pressure of postmenopausal women with breast cancer in complete clinical remission of long duration. MATERIAL AND METHODS: It in a pilot study of case and controls, in which we measure the Blood Pressure (BP) of 83 postmenopausal women, with breast cancer histologically confirmed, in complete clinical remission of long duration, recruited by consecutive sampling, to compare it with that of 70 normal postmenopausal women of the same age used as controls. They ara calculated the body mass index (BMI), the corporal surface, the confidence intervals (CI) of the means, the correlation between the BMI and the BP in both groups (breast cancer patients and normal control) and between the free disease interval and the systolic and diastolic blood pressures. RESULTS: The mean of the systolic BP in 93 breast cancer patients in complete clinical remission was 163 mm Hg (95% CI 155-171) and in 70 normal controls was 134 mm Hg (95% CI 129-139). The difference between both groups in statistically significant (p < 0.001). The mean of the diastolic BP in the breast cancer patient in complete remission it was 98 mm Hg (94-104) and in the normal controls was 78 mm Hg (74-82). The difference between both groups was statistically significant (p < 0.001). CONCLUSIONS: This arterial hypertension, independent of the BMI and from the duration of the free disease interval, is associated with a long duration of the complete remission in postmenopausal breast cancer patients and consequently with a good prognostic of this disease.

Posible valor pronóstico de la hipertensión arterial en mujeres postmenopáusicas con cáncer de mama. Estudio piloto / Possible prognostic value of arterial hypertension in postmenopausal women with breast cancer in complete clinical remission. Pilot study

Fundamento: El objetivo de este trabajo fue determinar la presión arterial (PA) en mujeres postmenopáusicas con cáncer de mama en remisión clínica completa de larga duración. Material y métodos: Se trata de un estudio piloto, de casos y controles, en los cuales se midieron la presión arterial de 83 mujeres postmenopáusicas, con cáncer de mama histológicamente confirmado en situación de remisión clínica completa de larga duración comparándolo con un grupo control de 70 mujeres sanas postmenopáusicas, de la misma edad. Se calculó el índice de masa corporal (BMI), la superficie corporal, el intervalo de confianza de la media, la correlación entre el BMI y la PA, en ambos grupos (cáncer de mama/mujeres sanas) y las presiones sistólicas y diastólicas. Resultados: La media de la presión sistólica en las 83 mujeres con cáncer de mama fue de 163 mm de Hg (95 por ciento CI 155-171) y en los 70 controles normales fue de 134 mm de Hg (95 por ciento CI 129-139). La diferencia entre ambos grupos fue estadísticamente significativa (p<0,001). La media de la presión diastólica en las mujeres con cáncer fue de 98 mm de Hg (94-104) y en los controles normales fue de 78 mm de Hg (74-82). La diferencia entre ambos grupos fue estadísticamente significativa (p<0,001). Conclusiones: La hipertensión arterial, independientemente del BMI y de la duración del intervalo libre de enfermedad, está asociado con una mayor duración de la remisión clínica completa en las mujeres postmenopáusicas con cáncer de mama y consecuentemente con un mejor pronóstico de su enfermedad cancerosa (AU)

Prevalence of Helicobacter pylori infection in two Spanish regions with different incidence of gastric cancer.

It is a cross-sectional study, comparing the prevalence of Helicobacter pylori infection (prevalence of IgG antibodies to H. pylori) in the healthy population of Ubrique and Grazalema (mountain location, mortality from stomach cancer 20/100,000) and in Barbate, (coastal location, mortality from stomach cancer 10/100,000) in the province of Cadiz, southern Spain. The subjects were randomly selected, 163 men and 169 women, 18 years or older; 179 persons were studied in the inland, and 154 in the littoral in January 1997. Of the 332 subjects investigated, 43% were positive, a mean antibody titer of 337 IU/1 (95 % CI: 254-420), and 56% were negative, with a mean titer of 18 IU/1 (95% CI: 15-19). In the coastal population, 30% has positive titers and 54% in the mountain location. By age: 18-40 years, 30% of littoral and 41% of inland population had positive titers; 41-60 years, 35% of those living in the littoral and 58% of inland population had positive titers; > 60 years, 24% of coastal inhabitants and 62% of those living in the inland had positive titers. Living in mountain locations in the province of Cadiz involves a greater ecological risk for H. pylori infection (p < 0.05).

Effects of tubulin-inhibiting agents in human lung and breast cancer cell lines with different multidrug resistance phenotypes.

Drug sensitivity was studied for the tubulin inhibitors taxol, taxotere, rhizoxin and for doxorubucin and cisplatin, in human lung and breast cancer cell lines, including drug-selected cell lines, overexpressing the membrane transporter P-glycoprotein (Pgp) or the multidrug resistance protein (MRP). All tubulin-inhibiting agents were more potent than doxorubicin and cisplatin in all cell lines. In the drug resistance-selected cell lines (doxorubicin or mitoxantrone resistant) there was cross-resistance between the tubulin inhibitors and the selecting agent; however, MRP overexpressing cells were relatively less resistant to taxanes than the Pgp overexpressing cells. Polymerization of microtubules after exposure to taxol was observed in drug sensitive cell lines, but not in resistant cell lines, even at high taxol concentrations and after long exposure times. In the Pgp overexpressing cell lines, steady accumulation of 14C-taxol was defective and could be reverted by verapamil. MRP overexpressing cells did not have a significant accumulation defect of taxol, compared to the parental cell lines, and verapamil did not have any effect. These data confirm that the Pgp overexpression is an important mechanism of resistance to taxanes and rhizoxin in human lung and breast tumor cells. However, the presence of mechanisms other than transport defects may play an important role in non-Pgp expressing cells, and these may include an altered function of tubulins.