RESUMO
Clopidogrel is still widely used in acute coronary syndrome despite the development of more potent P2Y12 inhibitors. Previously, we conducted a trial that evaluated serial clopidogrel dose adjustment based on platelet function testing in acute coronary syndrome patients with initial high on-treatment platelet reactivity (HTPR). In this substudy, we performed post hoc analysis of the effect of ABCB1 genetic variants C3435T and G2677T/A on platelet inhibition and outcomes. There were no differences in the proportion of HTPR patients among C3435T carriers and noncarriers in both interventional and control group. G2677T carriers expressed significantly higher proportion of HTPR pattern throughout 12-month follow-up in the control group with no difference in the interventional group. There was no difference in ischemic outcomes between C3435T and G2677T carriers and noncarriers in both groups of patients. The results indicate that ABCB1 genotyping is not useful to guide clopidogrel therapy tailoring to improve high-risk patient management.
Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Plaquetas/efeitos dos fármacos , Clopidogrel/administração & dosagem , Absorção Gastrointestinal/genética , Variantes Farmacogenômicos , Inibidores da Agregação Plaquetária/administração & dosagem , Agregação Plaquetária/efeitos dos fármacos , Antagonistas do Receptor Purinérgico P2Y/administração & dosagem , Receptores Purinérgicos P2Y12/efeitos dos fármacos , Subfamília B de Transportador de Cassetes de Ligação de ATP/genética , Subfamília B de Transportador de Cassetes de Ligação de ATP/metabolismo , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/diagnóstico , Idoso , Plaquetas/metabolismo , Clopidogrel/metabolismo , Monitoramento de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/metabolismo , Antagonistas do Receptor Purinérgico P2Y/metabolismo , Ensaios Clínicos Controlados Aleatórios como Assunto , Receptores Purinérgicos P2Y12/sangue , Resultado do TratamentoRESUMO
Chronic heart failure places heavy burden on patients, their families and on health care resources, accounting for high numbers of hospital admissions. Despite huge improvements in the treatment of many heart disorders, the clinical syndrome of chronic heart failure as a final pathway of heart pathology is an exception, in that its prevalence is rising, and only small prolongations in survival are occurring. It is associated with high morbidity and poor prognosis, and a survival rate worse than that for some malignant tumors. The reasons for the increasing overall prevalence of chronic heart failure in developed countries lie in prolonged survival owing to modern pharmacological or invasive treatment, better secondary prevention, and aging of the population. Chronic pulmonary disease is common in patients with chronic heart failure. Through sharing some risk factors and overlapping pathophysiological processes, they present diagnostic and therapeutic challenge. The aim of this article is to review various mechanisms responsible for the symptoms of chronic heart failure with consecutive pulmonary interaction and abnormalities in lung function.
Assuntos
Sistema Cardiovascular/fisiopatologia , Insuficiência Cardíaca , Sistema Respiratório/fisiopatologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Prognóstico , Testes de Função Respiratória , Fatores de Risco , Taxa de SobrevidaRESUMO
Authors report a case of a 29-year old patient with pulmonary Langerhans' cell histiocytosis who presented with chest pain as a consequence of rib osteolytic process. We carried out a diagnostic work-up which included laboratory and radiographic analysis, lung function tests, bronchoscopy, cytologic and pathologic analysis. After reaching the diagnosis, corticosteroid therapy was introduced with long-term follow-up. In this report, we included a brief review of pulmonary Langerhans' cell histiocytosis.