[COMPARATIVE EFFECTIVENESS AND SAFETY OF NEW ORAL ANTICOAGULANTS AND WARFARIN IN PATIENTS WITH AGE-SPECIFIC NON-VALVULAR ATRIAL FIBRILLATION].

This study was designed to compare effectiveness and safety of warfarin, direct thrombin inhibitor dabigatran, Xa factor inhibitors rivaroxaban and apixaban used to prevent stroke in 280 elderly patients in patients with age-specific non-valvular atrial fibrillation. The treatment of patients aged 65-74 and 75-80 yearsfor 2 years with dab itragan (110 mg b.i.d), apixaban (5 mg b. i. d), and rivaroxaban (20 mg once daily) prevented stroke as effectively as warfarin therapy but less frequently caused severe intracranial hemorrhage. It is concluded that these new anticoagulants can be used as alternative medication for antithrombotic therapy of elderly patients with age-specific non-valvular atrialfibrillation.

[Comparison of Novel Oral Anticoagulants and Warfarin in Elderly Patients With Nonvalvular Atrial Fibrillation].

We compared efficacy and safety of warfarin with those of direct thrombin inhibitor dabigatran, factor Xa inhibitors rivaroxaban and apixaban used for stroke prevention in 280 patients aged 65-80 years with non-valvular atrial fibrillation. Treatment for two years with dabigatran (110 mg twice daily), apixaban (5 mg twice daily) or rivaroxaban (20 mg/day) prevented strokes no less successfully than warfarin, but more rarely caused severe intracranial hemorrhages. When selecting antithrombotic therapy in geriatric patients with non-valvular AF new oral anticoagulants may be regarded as an acceptable alternative to warfarin.

[Antihypertensive therapy and dynamics of vascular wall rigidity in elderly patients with non-valvular atrial fibrillation].

This comparative ultrasound study included 210 patients aged 65-80 years with non-valvular atrial fibrillation treated with the use of 4 different therapeutic modalities. Intake of perindopril, valsartan, valsartan + rozuvastatin, and lercanidipine resulted in a rise in distension index of common carotid artery, decrease of rigidity coefficient of the aortic wall and increase of the pulsed wave propagation speed. Combination of valsartan (80-160 mg/d) and rozuvastatin (10 mg/d) had the most pronounced effect on the vascular wall compliance compared with other modalities and reduced the frequency of ischemic stroke, myocardial infarction, and mortality. It is concluded that therapy of non-valvular atrial fibrillation in elderly patients with valsartan + rozuvaststin is the optimal strategy for the improvement of elastic properties of the vascular wall and reduction of the frequency of cardiovascular complications.

[Effect of various types of antihypertensive therapy on elasticity of arterial wall in elderly patients with hypertensive disease and nonvalvular atrial fibrillation].

Basing on the data of ultrasound study we compared effects of various antihypertensive therapies on elastic properties of common carotid arteries and the thoracic aorta in 133 patients aged 65-80 years with nonvalvular atrial fibrillation (AF). The use of perindopril, lercanidipin, valsartan and its combination with rosuvastatin was associated with elevation of the distensibility index of common carotid artery and lowering of coefficient of stiffness of aortic wall compared with the initial state. Combination of valsartan (80-160 mg/day) with rosuvastatin 10 (mg/day) produced most pronounced effect on compliance of vascular wall compared with other variants of treatment. Combination of valsartan and rosuvastatin can be considered an optimal strategy of antihypertensive therapy allowing to improve elastic properties of arterial wall in elderly patients with nonvalvular AF.

[Comparison of three methods of antithrombotic therapy in elderly patients with nonvalvular atrial fibrillation].

We compared efficacy and safety of warfarin, direct thrombin inhibitor dabigatran and clopidogrel in prevention of stroke in 210 patients with nonvalvular atrial fibrillation (AF) aged 65-80 years. The use of dabigatran (110 mg twice daily) for 12 months or warfarin was associated with similar rate of ischemic stroke but caused less bleeding (2.8 vs. 16.9%, p<0.05). Treatment with clopidogrel prevented stroke no less successfully, than those with warfarin and dabigatran and turned out to be sufficiently safe. When chosing antithrombotic therapy in gerontological patients with nonvalvular AF dabigatran and clopidogrel can be considered acceptable alternative to warfarin.

[Safety and efficacy of various modalities of antiplatelet prophylaxis of ischemic stroke in elderly patients with non-valvular atrial fibrillation].

We compared the efficacy and safety of warfarin, dabigartan, and clopidogrel used to prevent tromboembolism in 210 elderly patients with non-valvular atrial fibrillation depending on the age. In patients aged 65--74 yr treatment with dabigartan (110 mg twice daily) for 6 months was associated with ischemic stroke as frequently as warfarin therapy but less frequently than with severe hemorrhages (4.4 vs. 27.7%, p < 0.05). Clopidogrel prevented stroke as effectively as warfarin and dabigartan and was equally safe. There were no differences in the frequency of thromboembolic and hemorrhagic complications in 75-80 year-old patients given the three medications. It is concluded that dabigartan and clopidorgel may be regarded as a good alternative to warfarin for anti-platelet treatment of 65-74 year-old patients with non-valvular atrial fibrillation.

[Immunity in chronic bronchitis patients with significant residual changes after prior pulmonary tuberculosis].

To study the immunological features in chronic bronchitis (CB) patients with great residual changes (GRC) after prior pulmonary tuberculosis, the authors examined two groups: 1) 40 CB patients with GRC after prior pulmonary tuberculosis (a study group) and 2) 30 CB patients without a history of pulmonary tuberculosis. The examination revealed that CB patients with GRC after prior pulmonary tuberculosis were found to have higher T lymphocytes, lower B lymphocytes on an exacerbation of the disease. The phagocytic properties of neutrophils were altered as their high phagocytic activity, decreased oxygen-dependent microbicidal activity of phagocytes with their stimulation. The humoral response remained to be slightly pronounced in CB bronchitis with GRC. The low serum levels of TBC active products may suggest the low activity of lipid peroxidation processes in the study group patients. After prior pulmonary tuberculosis, antioxidative activity preserves to be high in CB patients with GRC.

[Prevention of ischemic stroke in middle aged patients with atrial fibrillation. Effect of sinus rhythm maintenance, aspirin, warfarin, and simvastatin].

Patients (n=263, age 49-64 years) with persistent nonvalvular atrial fibrillation were subjected to controlled treatment aimed at restoration and maintenance of sinus rhythm (n=134) or slowing of rate of ventricular contractions. Efficacy of complementary use of combination of simvastatin with aspirin, warfarin and aspirin for prevention of ischemic stroke was assessed in both of these strategies. First strategy, supplemented with combination of simvastatin and aspirin prevented ischemic stroke and lethal outcome most successfully, while the use of warfarin was unexpectedly associated with comparative elevation of risk of ischemic stroke. It is impossible to exclude that long term administration of warfarin in strategy of sinus rhythm maintenance attenuated advantages of normal rhythm in relation of lowering of stroke risk in AFFIRM study and other similar works. Contrary to known cardio-embolic mechanism of cerebral embolism in permanent atrial fibrillation main aim of the treatment in successful sinus rhythm maintenance may become prevention of arterio-arterial emboli.

[Search for an optimal therapy of patients with atrial fibrillation (results of many years of comparison of three treatment strategies).]. / Poisk optimal'noi terapii bol'nykh s fibrilliatsiei predserdii (rezul'taty mnogoletnego sravneniia trekh strategii lecheniia).

Patients with nonrheumatic atrial fibrillation (n=465, mean age 59.4+/-3.8 years) received controlled therapy for 7.4+/-1.6 years. Group 1 comprised 306 patients with paroxysmal and persistent atrial fibrillation who after restoration of sinus rhythm received antiarrhythmic therapy aimed at prevention of recurrences and repetitive cardioversions. Group 2 consisted of 67 similar patients who did not receive continuous antiarrhythmic therapy. Therapy of patients with persistent atrial fibrillation (group 3, n=92) included heart rate slowing drugs and anticoagulants. Group 1 was characterized by lowest rate of complications and all cause mortality, and best quality of life. There were more nonfatal strokes in group 2. All cause mortality in group 2 was 15% (p<0.05). Highest rate of nonfatal strokes, and deaths due to chronic heart failure was observed in group 3. All cause mortality in this group was 22.8% (p<0.001 vs group 1).

[Comparative morphological characteristics of bronchial mucosa in patients with chronic obstructive bronchitis and bronchial asthma]. / Sravnitel'naia morfologicheskaia kharakteristika slizistoi obolochki bronkhov u bol'nykh khronicheskim obstruktivnym beonkhitom i bronkhial'noi astmoi.

The material for histoultrastructural study was biopsies obtained by fibrobronchoscopy from 12 patients with endogenic bronchial asthma (BA) and 4 patients with chronic obstructive bronchitis (COB). The principal periods of affection in these diseases, the role of bronchial epithelium, effector cells of inflammation, nervous elements, smooth muscle cells, microcirculatory disturbances in patho- and morphogenesis of chronic obstructive pulmonary lesions are determined. The results indicate that BA develops due to disturbances of adaptive mechanisms being in some cases the issue of COB progression.

[The reactogenicity and efficacy of a dried cell-free staphylococcal vaccine in treating chronic bronchitis]. / Reaktogennost' i éffektivnost' sukhoi beskletochnoi stafilokokkovoi vaktsiny pri lechenii khronicheskikhh bronkhitov.

The data obtained in the controlled trial of the immunotherapy of chronic bronchitis (CB) patients with lyophilized acellular staphylococcal vaccine developed at the Mechnikov Research Institute for Vaccines and Sera (USSR Acad. Med. Sci.), Moscow, are presented. The patients were divided at random into two groups; of these, one group received the vaccine and the other, placebo (0.9% sodium chloride solution). The preparations were injected subcutaneously simultaneously with traditional treatment. The vaccine was well tolerated by the patients. In the blood of the patients receiving the vaccine, in contrast to those receiving placebo, a significant increase in the level of specific antibodies determined in the passive hemagglutination test and IgG was noted. When following the remote consequences of the disease for a year after the course of immunotherapy, a significant decrease in the occurrence of aggravations, an increase in the duration of remission and a decrease in the duration of sick leaves were registered. These data indicate that the immunotherapy of CB with lyophilized acellular staphylococcal vaccine is a promising method of preventing relapses.