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7 records – page 1 of 1.

Bleeding complications during warfarin treatment in primary healthcare centres compared with anticoagulation clinics.

https://arctichealth.org/en/permalink/ahliterature77121
Source
Scand J Prim Health Care. 2007 Jun;25(2):123-8
Publication Type
Article
Date
Jun-2007
Author
Wallvik Jonas
Själander Anders
Johansson Lars
Bjuhr Orjan
Jansson Jan-Håkan
Author Affiliation
Division of Hematology, Department of Medicine at Sundsvall Hospital, Sundsvall, Sweden. jonas.wallvik@lvn.se
Source
Scand J Prim Health Care. 2007 Jun;25(2):123-8
Date
Jun-2007
Language
English
Publication Type
Article
Keywords
Aged
Anticoagulants - adverse effects
Cohort Studies
Family Practice
Follow-Up Studies
Hemorrhage - chemically induced
Humans
Middle Aged
Outcome Assessment (Health Care)
Primary Health Care
Prospective Studies
Risk factors
Safety
Warfarin - adverse effects
Abstract
OBJECTIVES: To examine determinants of bleeding complications during warfarin treatment in an unselected patient population and evaluate possible differences in safety between specialized anticoagulation clinics and primary healthcare centres. DESIGN: Prospective cohort study. Data were collected with an admission form and medical records were scrutinized in order to pursue all adverse events. Differences between groups were estimated with a t-test and chi-squared test, and univariate and multivariate Cox regression analysis. SETTING: All patients treated and monitored with oral anticoagulation in primary healthcare centres and specialized anticoagulation clinics in the Sundsvall and Skellefteå region (northern Sweden) during a five-year period. SUBJECTS: A total of 2731 patients corresponding to 5044 treatment years. MAIN OUTCOME MEASURES: Bleedings were classified as fatal or major. Major bleedings were defined as an event causing admission, prolonged in-hospital care or death. RESULTS: In total 195 major bleedings occurred corresponding to 3.9% per treatment year, including 34 fatal events (0.67% per treatment year). Patients monitored at the two specialized anticoagulation clinics combined had a major bleeding frequency of 4.1% as compared with 3.9% at primary healthcare units. The frequency of fatal haemorrhage was 0.57% and 0.76%, respectively. The rate of major and fatal bleeding was age related with an increase of 4% and 5%, respectively, per year. CONCLUSIONS: There was no difference in bleeding complications between patients monitored at primary healthcare centres and specialized anticoagulation clinics. Age was continuously and independently associated with bleeding risk. These study data indicate the need to exercise caution in treatment of the elderly.
PubMed ID
17497491 View in PubMed
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Changes in plasma C-reactive protein and hemostatic factors prior to and after a first myocardial infarction with a median follow-up time of 8 years.

https://arctichealth.org/en/permalink/ahliterature89367
Source
Blood Coagul Fibrinolysis. 2009 Jul;20(5):340-6
Publication Type
Article
Date
Jul-2009
Author
Thøgersen Anna M
Nilsson Torbjörn K
Weinehall Lars
Boman Kurt
Eliasson Mats
Hallmans Göran
Jansson Jan-Håkan
Author Affiliation
Department of Public Health and Clinical Medicine, Umeå University Hospital, Umeå, Sweden. anmat@rn.dk
Source
Blood Coagul Fibrinolysis. 2009 Jul;20(5):340-6
Date
Jul-2009
Language
English
Publication Type
Article
Abstract
The objective of this study was to determine whether a first myocardial infarction leads to increased plasma levels of hemostatic factors and high sensitive C-reactive protein (hs-CRP) and whether the association between theses biomarkers and myocardial infarction was greater at follow-up compared with baseline. Of more than 36,000 persons screened in northern Sweden, 78 developed a first myocardial infarction (on average 18 months after sampling) in a population-based, prospective, nested patient-referent study. Fifty of these had participated in a follow-up health survey (on average 8 and a half years between surveys) and were sex-matched and age-matched with 56 referents. The mean increases in hs-CRP, tissue plasminogen activator (tPA) mass, plasminogen activator inhibitor-1 mass, and tPA/plasminogen activator inhibitor-1 complex concentration and von Willebrand factor among patients and referents were comparable during follow-up. Conditional logistic regression indicated that hs-CRP was not significantly associated with first myocardial infarction in a univariate analysis, whereas high plasma levels of tPA and creatinine were significantly associated with outcome at baseline and follow-up. tPA/plasminogen activator inhibitor-1 complex was not superior to tPA as a risk marker in this study. A first myocardial infarction did not in this study induce significantly different changes in plasma levels of hs-CRP and hemostatic factors among patients compared with referents during follow-up.
PubMed ID
19357504 View in PubMed
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The effects of commuting activity and occupational and leisure time physical activity on risk of myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature79552
Source
Eur J Cardiovasc Prev Rehabil. 2006 Dec;13(6):924-30
Publication Type
Article
Date
Dec-2006
Author
Wennberg Patrik
Lindahl Bernt
Hallmans Göran
Messner Torbjörn
Weinehall Lars
Johansson Lars
Boman Kurt
Jansson Jan-Håkan
Author Affiliation
Bureå Health Centre, Bureå, Sweden. patrik.wennberg@medforskskelet.se
Source
Eur J Cardiovasc Prev Rehabil. 2006 Dec;13(6):924-30
Date
Dec-2006
Language
English
Publication Type
Article
Keywords
Chi-Square Distribution
Female
Humans
Leisure Activities
Logistic Models
Male
Middle Aged
Motor Activity
Myocardial Infarction - epidemiology
Occupations
Prospective Studies
Risk factors
Statistics, nonparametric
Sweden - epidemiology
Transportation
Abstract
BACKGROUND: Risk reduction of myocardial infarction has been shown for leisure time physical activity. The results of studies on occupational physical activity and risk of myocardial infarction are incongruous and studies on commuting activity are scarce. The aim of this study was to investigate how commuting activity, occupational physical activity and leisure time physical activity were associated with risk of future first myocardial infarction. DESIGN: We used a prospective incident case-referent study design nested in Västerbotten Intervention Program and the Northern Sweden MONICA study. METHODS: Commuting habits, occupational physical activity, leisure time physical activity and cardiovascular risk factors were assessed at baseline screening and compared in 583 cases (20% women) with a first myocardial infarction and 2098 matched referents. RESULTS: Regular car commuting was associated with increased risk of myocardial infarction versus commuting by bus, cycling or walking [odds ratio (OR) 1.74; 95% confidence interval (CI), 1.20-2.52] after multivariate adjustment. High versus low leisure time physical activity was associated with reduced risk of myocardial infarction (OR 0.69; 95% CI, 0.50-0.95) after adjustment for occupational physical activity and commuting activity, but the association was not statistically significant after further multivariate adjustment. After multivariate adjustment we observed a reduced risk for myocardial infarction in men with moderate (OR 0.70; 95% CI, 0.50-0.98) or high (OR 0.67; 95% CI, 0.42-1.08) versus low occupational physical activity. CONCLUSIONS: We found a clear association between car commuting and a first myocardial infarction and a corresponding inverse association with leisure time physical activity, while the impact of occupational physical activity on the risk of myocardial infarction was weaker.
PubMed ID
17143124 View in PubMed
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Gender differences in trends of acute myocardial infarction events: the Northern Sweden MONICA study 1985 - 2004.

https://arctichealth.org/en/permalink/ahliterature92720
Source
BMC Cardiovasc Disord. 2008;8:17
Publication Type
Article
Date
2008
Author
Lundblad Dan
Holmgren Lars
Jansson Jan-Håkan
Näslund Ulf
Eliasson Mats
Author Affiliation
Department of Medicine, Sunderby Hospital, Luleå, Sweden. dan.lundblad@nll.se
Source
BMC Cardiovasc Disord. 2008;8:17
Date
2008
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Female
Humans
Incidence
Male
Middle Aged
Myocardial Infarction - epidemiology - mortality
Recurrence
Registries
Sex Factors
Sweden - epidemiology
Abstract
BACKGROUND: The registration of non-fatal and fatal MI events initiated 1985 in the WHO MONICA project has been ongoing in northern Sweden since the end of the WHO project in 1995. The purpose of the present study was to analyze gender differences in first and recurrent events, case fatality and mortality in myocardial infarction (MI) in Northern Sweden during the 20-year period 1985 - 2004. METHODS: Diagnosed MI events in subjects aged 25-64 years in the Counties of Norrbotten and Västerbotten were validated according to the MONICA protocol. The total number of events registered up to January 1, 2005 was 11,763: 9,387 in men and 2,376 in women. RESULTS: The proportion of male/female events has decreased from 5.5:1 to 3:1. For males the reductions were 30% and 70% for first and recurrent MI, respectively, and for women 0% and 40% in the 55-64 year group. For both sexes a 50% reduction in 28-day case fatality was seen in the 25-64 year-group. Mortality was reduced by 69% and 45% in men and women, respectively. CONCLUSION: First and recurrent events of myocardial infarction was markedly reduced in men over the 20-year observation period, but for women the reduction was seen only for recurrent infarctions. Case fatality, on the other hand, was markedly reduced for both sexes. As a result of the positive effects on incidence and case fatality a substantial reduction was seen in total mortality, most pronounced for men.
PubMed ID
18655697 View in PubMed
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Low levels of IgM antibodies against phosphorylcholine predict development of acute myocardial infarction in a population-based cohort from northern Sweden.

https://arctichealth.org/en/permalink/ahliterature89317
Source
Eur J Cardiovasc Prev Rehabil. 2009 Jun;16(3):382-6
Publication Type
Article
Date
Jun-2009
Author
Grönlund Hans
Hallmans Göran
Jansson Jan Håkan
Boman Kurt
Wikström Max
de Faire Ulf
Frostegård Johan
Author Affiliation
Clinical Immunology and Allergy Unit, Karolinska Institutet and University Hospital, Stockholm, Sweden.
Source
Eur J Cardiovasc Prev Rehabil. 2009 Jun;16(3):382-6
Date
Jun-2009
Language
English
Publication Type
Article
Abstract
OBJECTIVE: Phosphorylcholine (PC) is one important epitope on oxidized low-density lipoprotein that may play an important role by contributing to the atherogenicity of oxidized low-density lipoprotein. IgM antibodies against PC (anti-PC) are present ubiquitously in the population as natural antibodies. We here determine the association between anti-PC and incidence of myocardial infarction (MI). METHODS: We studied 462 incident cases of first events of MI and 888 age-matched and sex-matched controls identified through 13 years of follow-up (1987-1999) of participants in a population-based study from northern Sweden. Relative risks (RRs) with 95% confidence intervals (CIs) of incident MI with adjustments for age, sex, geographical region, hypertension, diabetes, BMI, smoking habits, s-cholesterol and high-sensitivity C-reactive protein were determined. Anti-PC levels were measured by enzyme-linked immunoassay. RESULTS: Low anti-PC values were associated with increased risk of MI. Significant associations were found for values below 26.8 U/ml, corresponding to the lowest 25th percentile, and the highest association was seen below 16.9 U/ml. These results remained almost the same after adjustment for confounding factors (RR crude: 1.56, CI: 1.07-2.28 and RR adjusted: 1.69, CI: 1.09-2.54). CONCLUSION: Low levels of natural IgM anti-PC could play an important role as risk markers for development of MI. Adjustment for common confounders only marginally affected the RR, suggesting that the addition of IgM anti-PC add independent information to the more traditional risk factors.
PubMed ID
19369878 View in PubMed
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A randomized lifestyle intervention with 5-year follow-up in subjects with impaired glucose tolerance: Pronounced short-term impact but long-term adherence problems.

https://arctichealth.org/en/permalink/ahliterature90227
Source
Scand J Public Health. 2009 Jun;37(4):434-42
Publication Type
Article
Date
Jun-2009
Author
Lindahl Bernt
Nilssön Torbjörn K
Borch-Johnsen Knut
Røder Michael E
Söderberg Stefan
Widman Lars
Johnson Owe
Hallmans Göran
Jansson Jan-Håkan
Author Affiliation
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. bernt.lindahl@medicin.umu.se.
Source
Scand J Public Health. 2009 Jun;37(4):434-42
Date
Jun-2009
Language
English
Publication Type
Article
Abstract
AIMS: To compare data on cardiovascular risk factor changes in lipids, insulin, proinsulin, fibrinolysis, leptin and C-reactive protein, and on diabetes incidence, in relation to changes in lifestyle. METHODS: The study was a randomized lifestyle intervention trial conducted in northern Sweden between 1995 and 2000, in 168 individuals with impaired glucose tolerance (IGT) and body mass index above 27 at start. The intensive intervention group (n = 83) was subjected to a 1-month residential lifestyle programme. The usual care group (n = 85) participated in a health examination ending with a single counselling session. Follow-up was conducted at 1, 3 and 5 years. RESULTS: At 1-year follow-up, an extensive cardio-metabolic risk factor reduction was demonstrated in the intensive intervention group, along with a 70% decrease of progress to type 2 diabetes. At 5-year follow-up, most of these beneficial effects had disappeared. Reported physical activity and fibre intake as well as high-density lipoprotein cholesterol were still increased, and fasting insulin and proinsulin were lower. CONCLUSIONS: The intervention affected several important cardio-metabolic risk variables beneficially, and reduced the risk for type 2 diabetes, but the effects persisted only as long as the new lifestyle was maintained. Increased physical activity seemed to be the behaviour that was most easy to preserve.
PubMed ID
19181821 View in PubMed
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Thrombomodulin as a marker for bleeding complications during warfarin treatment.

https://arctichealth.org/en/permalink/ahliterature88422
Source
Arch Intern Med. 2009 Jul 13;169(13):1210-5
Publication Type
Article
Date
Jul-13-2009
Author
Lind Marcus
Boman Kurt
Johansson Lars
Nilsson Torbjörn K
Ohlin Ann-Kristin
Birgander Lisbeth Slunga
Jansson Jan-Håkan
Author Affiliation
Department of Medicine, Skellefteå County Hospital, Skellefteå, Sweden. Marcus.lind@vll.se
Source
Arch Intern Med. 2009 Jul 13;169(13):1210-5
Date
Jul-13-2009
Language
English
Publication Type
Article
Keywords
Aged
Anticoagulants - administration & dosage - adverse effects
Biological Markers - blood
Enzyme-Linked Immunosorbent Assay
Female
Follow-Up Studies
Hemorrhage - blood - chemically induced - epidemiology
Humans
Incidence
Male
Retrospective Studies
Risk factors
Survival Rate
Sweden - epidemiology
Thromboembolism - prevention & control
Thrombomodulin - blood
Warfarin - administration & dosage - adverse effects
Abstract
BACKGROUND: The major adverse effect of warfarin treatment is hemorrhage. Several risk factors for bleeding complications are also risk factors for thromboembolic events, making the clinical decision to initiate or withhold anticoagulant treatment difficult. Specific markers that solely identify patients at high risk of bleeding would have great clinical impact. This study aimed to test if thrombomodulin (TM) concentrations were associated with bleeding complications, cardiovascular events, or mortality in long-term anticoagulant-treated patients. METHODS: In a longitudinal cohort study we followed up 719 patients receiving warfarin treatment for a mean duration of 4.2 years. All bleeding complications causing hospitalization were registered and classified. Soluble TM antigen (sTM) concentration in plasma was measured with an enzyme-linked immunosorbent assay method. RESULTS: During the follow-up time, 113 clinically relevant bleeding events and 73 major bleeding events occurred. Increased concentration of sTM was associated with both clinically relevant bleeding and major bleeding events after adjustment for age. In the multivariable models, hazard ratios for the highest tertiles compared with the lowest were 2.29 (95% confidence interval, 1.35-3.89) and 2.33 (95% confidence interval, 1.21-4.48), respectively. No association between sTM concentration and nonfatal ischemic cardiovascular events or all-cause mortality was found. CONCLUSIONS: Increased levels of sTM are associated with bleeding complications during warfarin treatment but not with cardiovascular events or all-cause mortality. Soluble TM antigen concentration has potential as a new specific marker to identify patients at high risk of bleeding during warfarin treatment.
PubMed ID
19597070 View in PubMed
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7 records – page 1 of 1.