Randomized Comparison of Two Approaches to Initial Warfarin Dosing: Time in Therapeutic Range of International Normalized Ratio During Hospitalization.

AIM: To perform a randomized, open-label comparison of average time in therapeutic range (TTR) of international normalized ratio (INR) using two approaches to initial warfarin dosing during hospitalization: the standard method and the one using individual patient characteristics (clinical algorithm - the studied approach). MATERIALS AND METHODS: We randomly assigned 60 patients with different indications for vitamin K antagonist therapy to the studied approach (n=31, intervention group) or to the standard method (n=29, control group). А target INR range for all patients was 2.0 to 3.0. RESULTS: The average TTR and portions of INR values within target range during the whole time of drug dosing turned out to be small. TTR was 22.4% with standard method and 21.4% with clinical algorithm, which was well below desired 60%. CONCLUSION: The opportunities for achieving target INR in inpatient settings, regardless of warfarin dosing regimen, are limited.

[Randomized Comparison of Two Approaches to Initial Warfarin Dosing: Time in Therapeutic Range of International Normalized Ratio During Hospitalization].

AIM: To perform a randomized, open-label comparison of average time in therapeutic range (TTR) of international normalized ratio (INR) using two approaches to initial warfarin dosing during hospitalization: the standard method and the one using individual patient characteristics (clinical algorithm - the studied approach). MATERIALS AND METHODS: We randomly assigned 60 patients with different indications for vitamin K antagonist therapy to the studied approach (n=31, intervention group) or to the standard method (n=29, control group). А target INR range for all patients was 2.0 to 3.0. RESULTS: The average TTR and portions of INR values within target range during the whole time of drug dosing turned out to be small. TTR was 22.4% with standard method and 21.4% with clinical algorithm, which was well below desired 60%. CONCLUSION: The opportunities for achieving target INR in inpatient settings, regardless of warfarin dosing regimen, are limited.

[Change in the Nature of the Course of Arterial Hypertension in Patients With Chronic Arterial Insufficiency of the Extremities in Acute Thrombotic Occlusion].

The article is devoted to the investigation of the mechanisms of the development of arterial hypertension (AH) in patients with atherosclerosis of the abdominal aorta and the formation of chronic lower limb ischemia (Lerish syndrome). With the development of thrombotic occlusion of arteries of the lower extremities, the nature of the course of hypertension worsens. The operational recovery of the main blood flow in the limbs positively influences the course of hypertension in the majority of patients.

[Clinico-statistical analysis of chronic cardiac failure]. / Kliniko-statisticheskii analiz khronicheskoi serdechnoi nedostatochnosti.

AIM: To analyse epidemiologically chronic heart failure (CHF) according to 1996 records for patients admitted to therapeutic and cardiological departments of Moscow city hospital N 64. MATERIALS AND METHODS: An individual sheet has been developed for computer. The statistical processing has been conducted according to Access 97 program. It has covered 4019 case histories for 1996. 1232 patients were hospitalized for chronic cardiac failure this making 30.6% of all the hospitalizations. RESULTS: CHF was encounted in 60.9% of females and 39.1% of males. It was due to: ischemic heart disease (63.7%, with myocardial infarction in 73%), hypertension (17.5%), valvular disease (13.7%), dilated cardiomyopathy (3.7%), myocarditides and perocarditis (1.4%). Age groups 30-39 years, 40-49, 50-59, 60-69, 70-79, 80-89, 90-99 consisted of 0.6, 4, 11, 35.2, 31.4, 16.9, 0.6% of patients respectively. Females prevailed in the oldest age groups. The time from CHF diagnosis was 2, 3, 4, 5, 6, 7, 8, 9 and > 10 years in 26, 10.9, 4, 5.7, 0.9, 1.4, 1.7, 0.6 and 4% of patients, respectively. 72.9% of patients were admitted to hospital once a year. 19.7%, 5.2%, 0.9%, 0.6%, 0.9% of patients were hospitalized 2, 3, 4, 5 and more than 6 times, respectively. CHF was responsible for 50(27.8%) lethal outcomes of 180. Lethality resulted from cardiovascular insufficiency (50%), thromboembolism (30%), pneumonia (10%). CONCLUSION: CHF is a frequent cause of hospitalizations. Development of CHF, lethality, age groups distribution are closely associated with the patients' gender.

[The angiotensin-converting enzyme inhibitor perindopril in the treatment of congestive heart failure]. / Ingibitor angiotenzinprevrashchaiushchego fermenta perindopril pri lechenii zastoinoi serdechnoi nedostatochnosti.

The efficacy of perindopril in congestive heart failure (CHF) class II-III (NYHA) was studied in a trial including 37 patients (35 males and 2 females) aged 39-71 years (mean age 57.9 +/- 1.4) with postinfarction cardiosclerosis. They had CHF class II-III and ejection fraction (EF) < 45%. Perindopril was given in a single daily dose 2-4 mg for 6 months. The treatment resulted in a significant lowering of CHF class (from 2.5 +/- 0.1 to 1.7 +/- 0.1 (p < 0.01). Exercise tolerance increased from 256.2 +/- 18.6 s to 349.8 +/- 27.0 s (p < 0.05). Pump and contractile functions of the myocardium improved: stroke volume increased by 12.7%, ejection fraction by 20.5%, total peripheral vascular resistance fell by 9.7%, circulating blood volume by 9.2%. Parameters of oxygen transport to tissues and tissue respiration also changed for the better. The authors state high efficacy of perindopril in CHF patients.

[Plasma hemostasis and biochemical indices in trimetazidine treatment of patients with chronic heart failure]. / Plazmennoe zveno gemostaza i nekotorye biokhimicheskie pokazateli na fone lecheniia trimetazidinom u bol'nykh s khronicheskoi serdechnoi nedostatochnost'iu.

AIM: This study of trimetasidine effects on plasmic hemostasis and blood biochemistry in patients with chronic heart failure (CCF) of NYHA functional class II-III. MATERIALS AND METHODS: This study enrolled 30 patients (24 males and 6 females) aged 40-72 years with class II-III CCF, postinfarction cardiosclerosis and ejection fraction under 40%. Previously the patients received perindopril (the inhibitor of angiotensin converting enzyme) in daily dose 2-4 mg, on-demand digoxin and diuretics. Trimetasidine was given in a daily dose 60 mg for 6 months. Before and after the treatment the patients' blood was examined for: levels of factors VII and X of antithrombin III coagulation, soluble fibrinomonomeric complexes (SFMC), fibrinogen, glucose, uric acid, creatinines, total cholesterol, high density lipoprotein, triglycerides, AST, ALT, LDH, acid phosphotase, gamma-GT, sodium, potassium, activated partial thrombin time. RESULTS: Initially, the patients had a 23.9% increase in the levels of factors VII and X, a 14.3% decrease of antithrombin III, 29.8 and 227.6% rise in concentrations of fibrinogen and SFMC, respectively, compared to controls. Aftertreatment values of fibrinogen, factors VII and X, SFMC fell by 21.1, 17 and 35.5%, respectively. The thrombin time arose by 17.9% (p > 0.05). Insignificant inhibition was registered in the activity of acid phosphotase and gamma-GT. Glucose, AST, ALT, LDH levels remained unchanged. Plasma creatinine tended to lowering. Total cholesterol insignificantly increased at high levels of HDL cholesterol (p > 0.05) and reduced levels of triglycerides (p > 0.05). CONCLUSIONS: Trimetasidine therapy, given after conventional treatment with diuretics, digoxin, inhibitor of angiotensin-converting enzyme, aspirin has a beneficial effect in patients with circulatory deficiency through improving hemostatic and biochemical parameters.

[Level of blood uric acid in patients with postinfarction heart failure]. / Uroven' mochevoi kisloty v krovi bol'nykh s postinfarktnoi serdechnoi nedostatochnost'iu.

AIM: To evaluate uric acid (UA) levels in patients with postinfarction chronic cardiac failure (CCF) and to investigate correlation between accumulation of uric acid, CCF severity and some other parameters. MATERIAL AND METHODS: UA levels were determined with enzyme immunoassay and acid-base status of capillary and venous blood was studied in 120 men 35-78 years of age (mean age 46.3 +/- 1.8 years) with CCF of NYHA functional class (FC) I-IV. CCF was caused by Q-wave myocardial infarction in all the patients. RESULTS: It was found that a close direct relationship exists between FC of CCF and UA content (r = 0.735, p < 0.001), FC of CCF and creatinine levels (r = 0.648, p < 0.001). Analysis of acid-base condition shows the existence of compensated gas acidosis in CCF patients. Acid-base changes were more prominent in FC III and IV. FC and gas acidosis directly correlated. CONCLUSION: In CCF there is a pathogenetic relation between high uric acid and hypoxia. However, further studies are necessary of the causes of UC rise in CCF and its influence on the severity of circulatory insufficiency.

[Polymorphism of GPIIIA platelet glycoprotein gene PIA1/A2 compared to plasma hemostasis in myocardial infarction patients]. / Polimorfism gena PIA1/A2 trombotsitarnogo glikoprotein GPIIIA v sopostavlenii s plazmennym zvenom gemostaza u bol'nykh infarktom miokarda.

AIM: To investigate gene PIA1/A2 polymorphism and some parameters of plasma hemostasis in postmyocardial infarction (PMI) patients with chronic cardiac failure (CCF). MATERIALS AND METHODS: A total of 58 PMI patients with CCF, pulmonary artery thromboembolism (PATE), phlebothrombosis (PT) were examined. The age of the patients ranged from 24 to 84 years. Polymorphism of platelet glycoprotein GPIIIa gene was assessed according to the standard PCR-RFLP. RESULTS: Occurrence of genotypes PIA1/A2, PIA1/A2 was 70.8 and 29.2%, respectively; of allele PIA1 and PIA2 84.5 and 15.5%, respectively. In PMI patients genotype PIA1/A1 occurred in 71.7% of cases, genotype PIA1/A2--in 28.3%. Incidence of alleles was: 84.0% (PIA1), 16.0% (PIA2). PATE patients had genotype PIA1/A1, PT patients had distribution of the genotypes 50.0% and 50.0%, respectively. In patients who had suffered MI at the age under 45 years prevalence of the genotypes was 63.2% PIA1A1, 36.8% PIA1A2, of alleles 83.6% PIA1, 16.4% PIA2. In patients with a history of MI at the age over 50 the incidence of the genotypes and alleles was, respectively, 75.0% PIA1A1, 25.0% PIA1A2, 87.7% PIA1, 12.3% PIA2. Patients with genotype PIA1/A2 had a significantly higher fibrinogen than PIA1A1. Concentration of soluble fibrin monomeric complex was higher in patients with genotype PIA1/A2 reflecting activation of intravascular clotting. AT-III decrease by 5.4% indicated lower anticoagulant activity in patients with genotype PIA1A2. CONCLUSION: In patients with MI at the age under 45 years gene PIA1A2 and allel PIA2 occurred more frequently than in patients who had MI at older age. Allele PIA2 was associated with the risk of MI onset at young age. It is suggested that patients with genotype PIA1/A2 are at higher risk of thrombotic conditions, of coronary artery thrombosis in particular, than patients with genotype PIA1/A1.