[The use of anticoagulant treatment in patients with nonrheumatic atrial fibrillation]. / Utilización del tratamiento anticoagulante en los pacientes con fibrilación auricular no reumática.

INTRODUCTION: The efficacy of anticoagulant treatment in the prevention of thromboembolic complications among patients with nonrheumatic atrial fibrillation is established. In our country, data on the use of this therapy in clinical practice are not available. OBJECTIVE: To examine anticoagulants use among patients with nonrheumatic atrial fibrillation and to analyze the influence of several thromboembolic risk factors in anticoagulant use. PATIENTS AND METHODS: We have studied, 302 patients retrospectively, with nonrheumatic atrial fibrillation. We determined the presence of heart failure, hypertension, previous thromboembolism, diabetes and left atrium dilation. We added age, sex, pattern of non-permanent arrhythmia and hospitalization and we conducted univariate and multivariate analyses to identify their influence the establishment of the anticoagulant treatment. RESULTS: 28.8% of patients were treated with oral anticoagulants, 83.7% were treated with oral anticoagulant or antiplatelet agents. Only three patients, out of 49, aged 80 years or older were treated with anticoagulants. Multivariate analysis showed that previous thromboembolism (odds ratio 4.03 [1.9-8.1]), permanent atrial fibrillation (odds ratio 2.6 [1.3-5.3]), left atrium dilation (odds ratio 2.3 [1.2-4.1]) and heart failure (odds ratio 1.9 [1.07-3.6]) were factors that predicted higher use of anticoagulant treatment. CONCLUSIONS: a) Anticoagulant treatment is underused among patients with nonrheumatic atrial fibrillation; b) previous thromboembolism, left atrium dilation and heart failure have conditioned higher probability of undergoing anticoagulant treatment, and c) patients aged 80 years and over and non permanent atrial fibrillation predicted less use of the therapy.

[Hemorrhagic complications from anticoagulant treatment: analysis of predictive risk factors]. / Complicaciones hemorrágicas del tratamiento anticoagulante: Análisis de factores predictores de riesgo.

UNLABELLED: Anticoagulant therapy has shown its efficacy in the prevention of thromboembolic complications but it is not devoid of bleeding complications. Although the thromboembolic risk of some cardiac diseases may be extrapolated from well-organized clinical trials, the risk of bleeding complications should be determined in the context of the environment in which it is carried out. OBJECTIVE: To determine the complications of the patients in anticoagulant therapy, in our environment, and to analyse the of risk factors. PATIENTS AND METHODS: We have studied the complications suffered by 300 patients who underwent anticoagulation for cardiac diseases, between March-94 and March-96 retrospectively. We have classified the complications in two groups: a) Fatal or intracranial with sequelae. b) Those requiring hospitalization and/or transfusion. Univariate and multivariant analyses were conducted to identify predictors of complications, including the following factors: age, sex, diabetes, hypertension, length of therapy, distance from our Center to their place of residence, INR (> 3 vs 2 to 3) and number of drugs associated with Acenocoumarol (> or = 3 vs 2 or less). RESULTS: During the follow-up 24 patients died due to non haemorrhagic complications; 3 left the treatment on their cardiologist recommendation; 2 moved their place of residence and 1 was lost in the follow-up. Of 270 remaining 3 (0.55/100 patients-year) had complications of group a and 21 (3.88/100 patients-year) of grub b. INR > 3 and multiple medications were shown as predictors of complications when including some of the complications considered. CONCLUSIONS: 1) During two years of follow-up 1.1% (0.55/100 patients-year) of patients in anticaogulant therapy had bleeding complications resulting in death or neurological sequelae. 2) When including some of the complications considered the percentage rises to 4.44/100 patients-years. 3) Although there were no differences statistically significant, INR > 3 and polymedication have been found as predictors risk factor. 4) Patients with INR of 2 to 3 and non polymedicated presented a low risk of bleeding complications (1.66/100 patients-year).

[Macro creatine kinase type 1 as a cause of increase of CF-MB isoenzyme. Apropos of 7 cases]. / Macrocreatincinasa tipo 1 como causa de aumento de la isoenzima CK-MB. A propósito de 7 casos.

INTRODUCTION: The macro-creatine kinase type 1 is a complex of IgG linked to the BB fraction of the creatine kinase enzyme. Its presence in serum interferes with the immunoinhibition methods normally used in emergency room laboratories that produce false elevations of the creatine kinase MB isoenzyme, and which may cause a misunderstanding in the evaluation of patients who are suspected of having ischemic cardiopathy. PATIENTS AND METHOD: We have studied seven patients using an immunoinhibition method. They showed high levels of creatine kinase MB isoenzyme with normal values of creatine kinase enzyme. Electrophoresis was performed on all patients to determine the presence of creatine kinase enzyme. RESULTS: The electrophoresis showed in all the cases the presence of a macro-creatine kinase type 1 responsible for this interference. The clinical and analytical evaluation, as well as the radiological and electrocardiographical evaluation of this patients did not show any acute coronary disease. CONCLUSIONS: The macro-creatine kinase type 1 has been related to the existence of underlying cardiovascular pathology; a fact that was confirmed in three patients. With the immunoinhibition methods, the macro-creatine kinases usually, occurs with high values of creatine kinase MB isoenzyme (normally above 50% of the total activity of the creatine kinase) with normal creatine kinase levels. This fact, although strongly suggesting its presence, creates the necessity of using more sensitive methods to prevent these interferences. Likewise, we recommend using the electrophoresis of the creatine kinase enzyme to determine the nature of these interferences.