Comparison of 4 different strategies of DAPT after PCI in ACS real world population from a Northern Italy registry.

Aim of the study was to compare four different strategies of dual antiplatelet therapy (DAPT) in patients with acute coronary syndromes (ACS) treated with PCI. DAPT with Clopidogrel, Ticagrelor and Prasugrel has proved to be effective in patients with ACS treated with percutaneous coronary intervention (PCI) by reducing major adverse cardiovascular outcomes (MACE). However, the effect of the different strategies in a real-world population deserves further verification. A retrospective analysis of 2404 discharged ACS patients treated with PCI was performed, with a median follow-up of 1 year. The study population was stratified in four drug treatment cohorts: ASA + Clopidogrel (A-C), ASA + Plavix (A-PLx), ASA + Ticagrelor (A-T), ASA + Prasugrel (A-P). We assessed the incidence of net adverse cardiovascular events (NACE): all-cause death, myocardial infarction (MI), target vessel revascularization (TVR), stroke and bleeding during follow-up. At 1-year, the use of A-C and A-PLx was associated with the highest cumulative incidence of NACE in comparison with A-T and A-P therapies (respectively 14.8 and 29.6% vs. 9.2 and 6%). This difference was mainly driven by the mortality and TVR outcomes. Considering selection bias and differences in the patients baseline characteristics, the association of A-T and A-P seems to be superior in comparison with a DAPT strategy of A-C and A-PLx in low risk ACS-PCI patients from real world. In our Region the prescription is consistent with guidelines recommendations and Clopidogrel and Plavix are still predominantly used in older patients with more comorbidities, and this could partially explain the inferiority of this association.

In vivo effect of aluminium upon the physical properties of the erythrocyte membrane.

Aluminium (Al (III)) is a metal with no biological function. Its organic accumulation can lead to toxic effects. To elucidate the in vivo effect of Al (III) upon the rheological properties of the erythrocyte membrane, male adult Wistar rats have been submitted to periodical injections of Al(OH)3 during three months. Significant decreases in haematocrit (34+/-0.37% versus 36+/-0.20%, p<0.0001) and blood haemoglobin concentration (10.7+/-0.15 g/dl versus 12.3+/-0.49 g/dl, p<0.005) have been found. Haemolysis curves shifted towards the left, indicating that erythrocytes became more resistant to hypotonic haemolysis. Significant increments in rigidity index (29.6+/-1.59 versus 9.2+/-0.40, p<0.0001), relative viscosity at native haematocrit (3.6+/-0.03 versus 3.5+/-0.03, p<0.04), and relative viscosity at standard haematocrit (4.5+/-0.06 versus 3.9+/-0.05, p<0.0001) have been observed. The decrease in the erythrocyte aggregate size (1.6+/-0.01 versus 1.7+/-0.01, p<0.002) and the aggregation rate (0.5+/-0.02 versus 0.6+/-0.03, p<0.002) indicated a significantly dropped aggregability process. In conclusion, Al (III) disorganised the erythrocyte membrane by altering its mechanical properties, suggesting a reduction of the middle life of circulating erythrocytes, which could play a major role in the anaemia of these animals.

Effect of food restriction on hemorheological variables in a rat model of spontaneous hypertriglyceridemic obesity and diabetes.

Few studies have been performed in humans to investigate the effect of caloric restriction and consequent biomass reduction on hemorheologic parameters and their results are not concurrent. In a previous paper we analyzed the rheological behavior of the blood in the IIMb/Fmbeta inbred obese and hypertriglyceridemic strain in relation to its eumetabolic control [G.N. Hernández, C. Dabin, M.C. Gayol and M.L. Rasia, Hemorheological variables in a rat model of hypertriglyceridemic obesity and diabetes, Veterinary Res. Commun. 26 (2002), 625-635]. In this obese line it was shown a higher blood and plasma viscosity and an impaired red cell deformability compared to the eumetabolic one. The increased plasma viscosity was significantly and positively associated with fibrinogenaemia and lipidaemia and the impaired erythrocyte deformability with cholesterolemia and hypertriglyceridaemia. The present study has been designed to find out the effect of a 30% food restriction on several biochemical and hemorheological parameters of these obese rats. Restriction resulted in a mean body weight 45% lower than ad libitum controls, preventing obesity and hypertriglyceridemia with minimal effect on glucose metabolism. Regarding hemorheological parameters, caloric restriction led to a decrease in blood viscosity, due to the reduction in erythrocyte concentration, but not because of any improvement in erythrocyte deformability.