Factors associated with bleeding events from enoxaparin used for patients with acute coronary syndrome.

BACKGROUND: Low molecular weight heparins (LMWHs) are the mainstay of treatment for acute coronary syndrome (ACS). However, bleeding, the main side effect, is associated with prolonged hospitalization and mortality. Therefore, assessment of the incidence of bleeding and associated risk factors is crucial in developing an appropriate treatment plan to prevent bleeding. METHODS: A retrospective cohort study was conducted in patients with ACS admitted to a university hospital in Bangkok, Thailand between 2011 and 2015 and received enoxaparin. To estimate the incidence of bleeding events, patients were followed up for 30 days from the first enoxaparin dose. Multiple logistic regression was used to determine factors associated with bleeding events. RESULTS: From a total of 602 patients, the incidence of bleeding was 15.8%, of which 5.7% involved major bleeding. The risk factors for any form of bleeding were aged at least 65 years (odds ratio [OR], 1.99; 95% confidence interval [CI], 1.18 to 3.36), history of bleeding (OR, 3.79; 95% CI, 1.24 to 11.55), and history of oral anticoagulant exposure (OR, 4.73; 95% CI, 1.74 to 12.86). CONCLUSION: ACS patients treated with enoxaparin had an increased risk of bleeding if they were aged 65 years or older, had a history of bleeding events, and had a history of taking oral anticoagulants.

The Process of Listing Prostheses and Medical Devices in Thailand's Universal Health Coverage.

OBJECTIVES: This study aimed to characterize the processes of listing prostheses and medical devices in all insurance schemes. METHODS: A literature review was performed, and in-depth interviews were conducted with the representatives of 6 insurance agencies. Civil Servant Medical Benefits Scheme (CSMBS), Social Security Scheme, Local Government Officer Scheme (LGOS), State Enterprise Scheme (SES), Universal Coverage Scheme (UCS), and Non-Thai Resident Scheme (NTRS). RESULTS: The outcomes of interest were structure details and the body of the working groups, listing processes, and key assessment criteria. Each insurance scheme's process can be summarized in 5 steps: (1) receiving the proposed topics of health technologies, (2) screening, (3) selection, (4) consideration, and (5) approval and publicization. Notably, the organizational structures and working group compositions vary across schemes, leading to differences in process activities and assessment criteria. LGOS and SES are exceptions because they follow the application process of CSMBS. UCS demonstrates the most transparent process, providing specific working groups that are competent in undertaking each activity. The processes of listing prostheses and medical devices vary across health insurance in Thailand, leading to varying numbers of health technologies covered by insurance schemes. CONCLUSIONS: This study characterizes prostheses and medical device listing processes in 6 Thai Universal Health Coverage insurance schemes (CSMBS, Social Security Scheme, UCS, LGOS, SES, and Non-Thai Resident Scheme). Variations in processes result in differing technology listings. It offers essential insights for healthcare professionals and policy makers.

The effect of the very low dosage diltiazem on tacrolimus exposure very early after kidney transplantation: a randomized controlled trial.

The objective of this study was to assess the effect of the very low dosage of diltiazem on tacrolimus exposure during the first week post-kidney transplantation, among cytochrome P450 (CYP) 3A5 expressers who did not receive diltiazem (EXplb), CYP3A5 expressers who received the very low dose diltiazem (EXdtz), CYP3A5 nonexpressers who did not receive diltiazem (NEplb), and CYP3A5 nonexpressers who received the very low dose diltiazem (NEdtz). Forty kidney recipients who receive tacrolimus-based immunosuppressive regimen were randomly assigned, with stratification on the CYP3A5 genotypes, to receive either diltiazem 30 mg every 12 h or a matched placebo. The observed median dose-adjusted area under the 12-h curve of tacrolimus concentration (AUC/D) at day 7 post-transplantation was lowest in the EXplb group followed by EXdtz, NEplb, and NEdtz at 34.9, 43.6, 49.4, and 71.1 ng*h/mL per mg, respectively. A Kruskal-Wallis test showed a significant difference in the mean ranks of AUC/D among groups. Significant differences between EXplb and NEplb, and between EXplb and NEdtz were demonstrated, whereas no sufficient evidence of significant differences was detected between the other pairs. In conclusion, coadministration of diltiazem 30 mg twice daily may be advantageous for increasing tacrolimus exposure early after kidney transplantation among CYP3A5 expressers.

Real-World Effectiveness of High- Versus Moderate-Intensity Statin Therapy in Thai Patients With Acute Coronary Syndrome and Who Had Undergone Primary Percutaneous Coronary Intervention.

Although high-intensity statins are recommended for atherosclerotic cardiovascular disease, evidence has shown that Asians may need lower dose statins to achieve similar effect when compared to Caucasians. Moreover, awareness of adverse effects leads physicians to initiate moderate-intensity statins. Comparative of high versus moderate-intensive statins on LDL-C among patients who had undergone primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) are less established in Thailand. We conducted a retrospective cohort study to identify pattern of statins prescribing and explored the effectiveness on lipid profiles, including LDL-C goal achievement (<70 mg/dL) in STEMI patients underwent PPCI. A total of 983 patients with STEMI who had undergone PPCI were identified during 2005-2015. At 3-month follow-up, 31.9% patients were investigated for their lipid profile. There was 26.11% of patients who received high-intensity statins. When compared to baseline, we found more LDL-C reduction (38.22% ± 26.75% vs 22.36% ± 35.05%, P < .01) in the high-intensity group. Eighty-one patients achieved the target LDL-C, the high-intensity group were able to achieve the LDL-C goal than moderate-intensity group, but did not reach statistical significance (24.1% vs 30.5%, P = .26). This study confirmed that high-intensity statins have superior for LDL-C reduction and tend to achieve LDL-C goal more than moderate-intensity statins.