ABSTRACT
Aim To study efficacy and safety of a triple antithrombotic therapy with direct oral anticoagulants (DOAC) versus warfarin in patients with atrial fibrillation after acute coronary syndrome, for 12 months following discharge from the hospital.Materials and methods This single-site cohort, prospective, observational study performed at the Regional Vascular Center 2 of the N.A. Semashko Nizhniy Novgorod Regional Clinical Hospital included 402 patients. It was possible to maintain contacts with 206 patients for 12 months. These patients were divided into two groups, the DOAC treatment (n=105) and the warfarin treatment (n=101) as a part of triple antithrombotic therapy upon discharge. Clinical observation was performed at 1, 3, 6, and 12 months after the discharge by structured telephone interview. Predetermined efficacy endpoints included cardiovascular death, myocardial infarction, stent thrombosis, and ischemic stroke. Safety endpoints included bleeding defined as small, medium (clinically significant), and major in accordance with the TIMI classification.Results At 12 months of follow-up, 80 patients (76.19%) continued taking DOAC and 39 patients (38.61%, p<0.001) continued taking warfarin; in this process, only 25 patients (24.75%) monitored their INR on a regular basis. With a regular INR monitoring and TTR >70%, death rate did not differ in the warfarin and the DOAC treatment groups. However, there was a difference in reaching the composite efficacy endpoint (p=0.048): ischemic events occurred statistically significantly more frequently in the warfarin treatment group than in the DOAC treatment group.Conclusions In 12 months after discharge from the hospital, compliance with the DOAC treatment as a part of the antithrombotic therapy was significantly higher than compliance with the warfarin treatment. The triple antithrombotic therapy with DOAC was safer than the warfarin treatment by the number of hemorrhagic complications and more effective in prevention of ischemic events, primarily due to no need for monitoring of lab test values.
Subject(s)
Acute Coronary Syndrome , Atrial Fibrillation , Stroke , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/drug therapy , Administration, Oral , Anticoagulants/adverse effects , Atrial Fibrillation/complications , Atrial Fibrillation/drug therapy , Fibrinolytic Agents/adverse effects , Humans , Prospective Studies , Stroke/drug therapy , Stroke/etiology , Stroke/prevention & controlABSTRACT
The paper presents the results of a retrospective analysis of the chemoradiotherapy of 393 infant patients with Hodgkin's disease.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Hodgkin Disease/drug therapy , Hodgkin Disease/radiotherapy , Adolescent , Adult , Chemotherapy, Adjuvant/adverse effects , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Male , Neoplasms, Second Primary/etiology , Radiotherapy Dosage , Radiotherapy, Adjuvant/adverse effects , Retrospective Studies , Survival Analysis , Treatment Outcome , Young AdultSubject(s)
Hodgkin Disease/radiotherapy , Neoplasms, Radiation-Induced/epidemiology , Thyroid Neoplasms/epidemiology , Adult , Child , Dose-Response Relationship, Radiation , Female , Humans , Male , Neoplasms, Radiation-Induced/etiology , Risk Factors , Sex Factors , Thyroid Neoplasms/etiology , Thyroid Nodule/epidemiology , Thyroid Nodule/etiologyABSTRACT
Function of the hypothalamo-hypophyseal-thyroid system was investigated in 51 patients with euthyroid hyperplasia. Basal and TRH-stimulated levels of TSH and STH were investigated. Hyperergic ejection of STH and two pathological types of STH reaction (suggesting dysfunction of the hypothalamohypophyseal-thyroid system in euthyroid hyperplasia) were revealed. A group of patients with a low level of STH in response to TRH-stimulation demonstrated more pronounced changes of the hypothalamo-hypophyseal-thyroid system, characterized by a rise of a TSH level in response to stimulation up to 27.59 +/- 3.7 microU and a slightly reduced level of thyroid hormones. Changes in the level of STH indicated certain interest of growth hormone in the genesis of thyroid hyperplasia and could also serve an additional sign in the evaluation of a severity of disorders of the hypothalamo-hypophyseal-thyroid system.
