Platelet function, coagulation and fibrinolysis in patients with previous coronary and cerebrovascular ischemic events.

OBJECTIVES: Ischemic stroke (IS) or transient ischemic attack (TIA) history is present in 4-17% of patients with coronary artery disease (CAD). This subgroup of patients is at high risk for both ischemic and bleeding events. The aim of this study was to determine the role of platelet aggregability, coagulation and endogenous fibrinolysis in patients with CAD and previous IS or TIA. METHODS: A prospective case-control study that included 140 stable CAD patients divided into two groups: the CASE group (those with a previous IS/TIA, n=70) and the CONTROL group (those without a previous IS/TIA, n=70). Platelet aggregability (VerifyNow Aspirin® and VerifyNow P2Y12®), coagulation (fibrinogen and thromboelastography by Reorox®) and endogenous fibrinolysis (D dimer and plasminogen activator inhibitor-1) were evaluated. RESULTS: Patients in the CASE group presented significantly higher systolic blood pressure levels (135.84±16.09 vs 123.68±16.11, p<0.01), significantly more previous CABG (25.71% vs 10%, p=0.015) and significantly higher calcium channel blocker usage (42.86% vs 24.29%, p=0.02) than those in the control group. In the adjusted models, low triglyceride values, low hemoglobin values and higher systolic blood pressure were significantly associated with previous IS/TIA (CASE group). Most importantly, platelet aggregability, coagulation and fibrinolysis tests were not independently associated with previous cerebrovascular ischemic events (CASE group). CONCLUSION: Platelet aggregability, coagulation and endogenous fibrinolysis showed similar results among CAD patients with and without previous IS/TIA. Therefore, it remains necessary to identify other targets to explain the higher bleeding risk presented by these patients.

Platelet function, coagulation and fibrinolysis in patients with previous coronary and cerebrovascular ischemic events

OBJECTIVES: Ischemic stroke (IS) or transient ischemic attack (TIA) history is present in 4-17% of patients with coronary artery disease (CAD). This subgroup of patients is at high risk for both ischemic and bleeding events. The aim of this study was to determine the role of platelet aggregability, coagulation and endogenous fibrinolysis in patients with CAD and previous IS or TIA. METHODS: A prospective case-control study that included 140 stable CAD patients divided into two groups: the CASE group (those with a previous IS/TIA, n=70) and the CONTROL group (those without a previous IS/TIA, n=70). Platelet aggregability (VerifyNow Aspirin® and VerifyNow P2Y12®), coagulation (fibrinogen and thromboelastography by Reorox®) and endogenous fibrinolysis (D dimer and plasminogen activator inhibitor-1) were evaluated. RESULTS: Patients in the CASE group presented significantly higher systolic blood pressure levels (135.84±16.09 vs 123.68±16.11, p<0.01), significantly more previous CABG (25.71% vs 10%, p=0.015) and significantly higher calcium channel blocker usage (42.86% vs 24.29%, p=0.02) than those in the control group. In the adjusted models, low triglyceride values, low hemoglobin values and higher systolic blood pressure were significantly associated with previous IS/TIA (CASE group). Most importantly, platelet aggregability, coagulation and fibrinolysis tests were not independently associated with previous cerebrovascular ischemic events (CASE group). CONCLUSION: Platelet aggregability, coagulation and endogenous fibrinolysis showed similar results among CAD patients with and without previous IS/TIA. Therefore, it remains necessary to identify other targets to explain the higher bleeding risk presented by these patients.

Do Diabetic Patients with Acute Coronary Syndromes Have a Higher Threshold for Ischemic Pain? / Pacientes Diabéticos com Síndromes Coronárias Agudas têm um Limiar Maior para a Dor Isquêmica?

Background: Data from over 4 decades have reported a higher incidence of silent infarction among patients with diabetes mellitus (DM), but recent publications have shown conflicting results regarding the correlation between DM and presence of pain in patients with acute coronary syndromes (ACS). Objective: Our primary objective was to analyze the association between DM and precordial pain at hospital arrival. Secondary analyses evaluated the association between hyperglycemia and precordial pain at presentation, and the subgroup of patients presenting within 6 hours of symptom onset. Methods: We analyzed a prospectively designed registry of 3,544 patients with ACS admitted to a Coronary Care Unit of a tertiary hospital. We developed multivariable models to adjust for potential confounders. Results: Patients with precordial pain were less likely to have DM (30.3%) than those without pain (34.0%; unadjusted p = 0.029), but this difference was not significant after multivariable adjustment, for the global population (p = 0.84), and for subset of patients that presented within 6 hours from symptom onset (p = 0.51). In contrast, precordial pain was more likely among patients with hyperglycemia (41.2% vs 37.0% without hyperglycemia, p = 0.035) in the overall population and also among those who presented within 6 hours (41.6% vs. 32.3%, p = 0.001). Adjusted models showed an independent association between hyperglycemia and pain at presentation, especially among patients who presented within 6 hours (OR = 1.41, p = 0.008). Conclusion: In this non-selected ACS population, there was no correlation between DM and hospital presentation without precordial pain. Moreover, hyperglycemia correlated significantly with pain at presentation, especially in the population that arrived within 6 hours from symptom onset. .

Fundamento: Dados de mais de 4 décadas relataram maior incidência de infarto silencioso entre os pacientes com diabetes mellitus (DM), mas publicações recentes mostraram resultados conflitantes quanto à correlação entre DM e presença de dor em pacientes com síndromes coronárias agudas (SCA). Objetivo: Nosso objetivo principal foi analisar a associação entre dor precordial e DM na chegada ao hospital. Análises secundárias avaliaram a associação entre hiperglicemia e dor precordial na apresentação, e o subgrupo de pacientes que se apresentaram em até 6 horas após o início dos sintomas. Métodos: Analisamos um registro prospectivo de 3.544 pacientes com SCA internados em unidade coronária de um hospital terciário. Desenvolvemos modelos multivariados para ajustar potenciais fatores de confusão. Resultados: Os pacientes com dor precordial eram menos propensos a ter DM (30,3%) do que aqueles sem dor (34,0 %, p não ajustado = 0,029), mas essa diferença não foi significativa após ajuste multivariado, para a população global (p = 0,84), e para o subgrupo de pacientes que se apresentaram dentro do período de 6 horas após o início dos sintomas (p = 0,51). Em contraste, a dor precordial era mais provável entre os pacientes com hiperglicemia (41,2% vs. 37,0% sem hiperglicemia, p = 0,035) na população total, e também entre aqueles que se apresentaram no período de 6 horas (41,6% vs. 32,3%, p = 0,001). Modelos ajustados mostraram uma associação independente entre hiperglicemia e dor na apresentação, especialmente entre os pacientes que se apresentaram no período de até 6 horas (OR = 1,41, p = 0,008). Conclusão: Nesta população não-selecionada com SCA, não houve correlação entre DM e a ...

Do diabetic patients with acute coronary syndromes have a higher threshold for ischemic pain?

BACKGROUND: Data from over 4 decades have reported a higher incidence of silent infarction among patients with diabetes mellitus (DM), but recent publications have shown conflicting results regarding the correlation between DM and presence of pain in patients with acute coronary syndromes (ACS). OBJECTIVE: Our primary objective was to analyze the association between DM and precordial pain at hospital arrival. Secondary analyses evaluated the association between hyperglycemia and precordial pain at presentation, and the subgroup of patients presenting within 6 hours of symptom onset. METHODS: We analyzed a prospectively designed registry of 3,544 patients with ACS admitted to a Coronary Care Unit of a tertiary hospital. We developed multivariable models to adjust for potential confounders. RESULTS: Patients with precordial pain were less likely to have DM (30.3%) than those without pain (34.0%; unadjusted p = 0.029), but this difference was not significant after multivariable adjustment, for the global population (p = 0.84), and for subset of patients that presented within 6 hours from symptom onset (p = 0.51). In contrast, precordial pain was more likely among patients with hyperglycemia (41.2% vs 37.0% without hyperglycemia, p = 0.035) in the overall population and also among those who presented within 6 hours (41.6% vs. 32.3%, p = 0.001). Adjusted models showed an independent association between hyperglycemia and pain at presentation, especially among patients who presented within 6 hours (OR = 1.41, p = 0.008). CONCLUSION: In this non-selected ACS population, there was no correlation between DM and hospital presentation without precordial pain. Moreover, hyperglycemia correlated significantly with pain at presentation, especially in the population that arrived within 6 hours from symptom onset.

Apnéia obstrutiva do sono e arritmias cardíacas: o papel da síndrome no surgimento e evolução das arritmias / Apnéia obstrutiva do sono e arritmias cardíacas: o papel da síndrome no surgimento e evolução das arritmias

A busca de fatores de risco para doenças cardiovasculares sempre foi de suma importância dentro da cardiologia. Da mesma forma, esses fatores de risco que geram e sustentam as arritmias cardíacas também aguçam a curiosidadede letrofisiologistas em todo o mundo, com o único intuito de se combater da forma mais efetiva eventos arrítmicos. Em uma realidade de poucos avanços farmacológicos no tratamento das arritmias , a pesquisa destes fatores moduladores e desencadeantes de fenômenos arrítmicos pode permitir maior eficácia terapêutica, que em última análise, melhorará a qualidade de vida destes pacientes...

Disseminated toxoplasmosis presenting as sepsis in two AIDS patients.

This report describes two patients who presented acute disseminated and severe toxoplasmosis as the first opportunistic disease related to acquired immunodeficiency syndrome. At admission, clinical and laboratory findings were similar to sepsis or septic shock and a fast evolutive course to death occurred in both cases. At necropsy, an inflammatory reaction and presence of a great number of Toxoplasma gondii cysts and tachyzoites were observed in most organs examined.

Disseminated toxoplasmosis presenting as sepsis in two AIDS patients

This report describes two patients who presented acute disseminated and severe toxoplasmosis as the first opportunistic disease related to acquired immunodeficiency syndrome. At admission, clinical and laboratory findings were similar to sepsis or septic shock and a fast evolutive course to death occurred in both cases. At necropsy, an inflammatory reaction and presence of a great number of Toxoplasma gondii cysts and tachyzoites were observed in most organs examined.

O presente relato descreve dois pacientes que apresentaram toxoplasmose aguda, disseminada e grave como primeira manifestação oportunista da síndrome da imunodeficiência adquirida. Os achados clínicos e laboratoriais foram similares aos de sepse ou choque séptico e, em ambos os casos houve evolução rápida para óbito. A necropsia, foi observada reação inflamatória e presença de taquizoítos e cistos de Toxoplasma gondii na maioria dos órgãos examinados.