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Background: Apixaban has been increasingly utilized for various FDA-approved indications, including stroke prevention and venous thromboembolism (VTE) treatment in patients with end stage kidney disease (ESKD) on hemodialysis. However, the safety and efficacy of its use in this population is not well established. Hence, the purpose of this study is to evaluate the safety and effectiveness of apixaban by examining outcomes in this population. Methods: This was a retrospective observational study that involved adults with ESKD who were on hemodialysis and prescribed apixaban from our hospital's outpatient pharmacy between 1 May 2015, and 31 March 2022. Demographics, apixaban indications, dose appropriateness, concomitant antiplatelet use, and comorbidities data were collected. Bleeding and thromboembolic events were also collected. Results: Sixty-six patients fulfilled the inclusion criteria, 50% of them males. Median age was 71 (63.5-82) years, and the median BMI 28.2 (59.5-86.25) kg/m2. The median follow-up time was 5 (1.9-12.3) months. Concomitant antiplatelet use (39.4%) and high medication adherence (84.8%) were observed. During follow-up, major bleeding events occurred in 15.2% of cases, with minor bleeding being more common (36.4%), and VTE and stroke events occurred in 4.5% of cases; appropriate dosing was prevalent (62.1%), and there was an overall all-cause mortality rate of 34.8%. Most patients received a 2.5 mg BID apixaban dose (56.1%), including both NVAF and VTE groups. Notably, the multivariate logistic regression analysis indicated that weight, and daily dose were insignificant predictors of bleeding events (p = 0.104, 0.591), however, the BMI was the main independent risk factor for bleeding in this population [OR = 0.9, 95% CI: 0.8-0.99; p = 0.023]. Conclusions: Our analysis of apixaban-treated ESKD patients highlights that the risk of bleeding is significant, and BMI was the main independent risk factor. A larger prospective study is needed to confirm our findings.
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BACKGROUND AND PURPOSE: ß-catenin has crucial roles in cell-cell adhesion as well as Wingless (Wnt) signaling pathway, which is closely associated with carcinogenesis. The aim of this study was to evaluate the expression of ß-catenin in invasive ductal breast carcinomas and investigate its associations with known clinicopathological parameters, estrogen receptor (ER), progesterone receptor (PR) and tumor proliferative activity then, to explore ßcatenin expressional differences in primary tumors and corresponding axillary lymph node metastasis (ALNM). MATERIAL AND METHODS: Immunohistochemistry using streptavidin biotin immunoperoxidase method was applied on 65 formalin-fixed paraffin-embedded primary invasive ductal breast carcinomas. Among them, 39 primary tumors (showing LN metastasis) and their corresponding ALNM were further evaluated for differential expression of Βcatenin. Cases were diagnosed during the time period between 2005 to 2007 and retrieved from the archival material of the Pathology Department, Minia University Hospital. RESULTS: Of the 65 primary tumors, positive staining for ß-catenin was observed in 60 (92.3%) cases with membrane and /or cytoplasmic localization in the examined tumor cells. Reduced membrane expression was significantly associated with advanced stage, lymph node metastasis and negative ER. On the contrary, cytoplasmic localization seemed to be related to an aggressive tumor phenotype where significant associations were identified between high cytoplasmic expression and a large tumor size, a high grade, advanced stage, lymph node positivity, high Ki-67 proliferation index and poor Nottingham Prognostic Index. Membrane ßcatenin expression was significantly higher in ALNM compared to their primary where it was significantly reduced with re-expression in ALNM. CONCLUSION: ß-catenin seemed to have different roles in invasive ductal breast carcinomas, based on its expression levels and subcellular distribution. Altered ß-catenin expression in primary tumors with re-expression in nodal metastases is a common event in breast ductal carcinomas and may play a central role in establishing metastasis. These results may offer new insights regarding the role of ß-catenin in breast cancer.