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18F FDG-PET/CT evaluation of histological response after neoadjuvant treatment in patients with cancer of the esophagus or gastroesophageal junction.

https://arctichealth.org/en/permalink/ahliterature299743
Source
Acta Radiol. 2019 May; 60(5):578-585
Publication Type
Journal Article
Multicenter Study
Randomized Controlled Trial
Date
May-2019
Author
Stefan Gabrielson
Alejandro Sanchez-Crespo
Fredrik Klevebro
Rimma Axelsson
Jon Albert Tsai
Ove Johansson
Magnus Nilsson
Author Affiliation
1 Department of Nuclear Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
Source
Acta Radiol. 2019 May; 60(5):578-585
Date
May-2019
Language
English
Publication Type
Journal Article
Multicenter Study
Randomized Controlled Trial
Keywords
Adult
Aged
Esophageal Neoplasms - therapy
Esophagogastric Junction - diagnostic imaging
Esophagus - diagnostic imaging
Female
Fluorodeoxyglucose F18
Humans
Male
Middle Aged
Neoadjuvant Therapy - methods
Norway
Positron Emission Tomography Computed Tomography - methods
Radiopharmaceuticals
Sweden
Abstract
In most parts of the world, curatively intended treatment for esophageal cancer includes neoadjuvant therapy, either with chemoradiotherapy or chemotherapy alone, followed by esophagectomy. Currently 18F-FDG positron emission tomography/computed tomography (PET/CT) is used for preoperative disease staging, but is not well established in the evaluation of neoadjuvant treatment.
To evaluate changes in PET parameters in relation to the histological primary tumor response in the surgical specimen in patients randomized to neoadjuvant chemoradiotherapy or chemotherapy.
Patients were randomized between either neoadjuvant chemotherapy or chemoradiotherapy followed by esophagectomy.18F-FDG PET/CT exams were conducted at baseline and following neoadjuvant treatment. Standardized uptake ratio (SUR) values were measured in the primary tumor and compared as regards histological responders and non-responders as well as different treatment arms.
Seventy-nine patients were enrolled and 51 were available for analysis. A significant rate of SUR reduction was observed ( P?=?0.02) in the primary tumor in histological responders compared to non-responders. Changes in SUR were significantly greater in responders following chemoradiotherapy ( P?=?0.02), but not following chemotherapy alone ( P?=?0.49). There was no statistically significant difference in SUR in patients with a complete histological response compared to those with a subtotal response.
Our results are similar to those of previous studies and show that changes in the rate of SUR can be used reliably to differentiate histological responders from non-responders after neoadjuvant treatment with either chemoradiotherapy or chemotherapy. Limitations of current PET technology are likely to restrict the possibility of accurately ruling out limited residual disease.
PubMed ID
30111193 View in PubMed
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Abdominal Aortic Calcifications Predict Survival in Peritoneal Dialysis Patients.

https://arctichealth.org/en/permalink/ahliterature298110
Source
Perit Dial Int. 2018 Sep-Oct; 38(5):366-373
Publication Type
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Author
Satu Mäkelä
Markku Asola
Henrik Hadimeri
James Heaf
Maija Heiro
Leena Kauppila
Susanne Ljungman
Mai Ots-Rosenberg
Johan V Povlsen
Björn Rogland
Petra Roessel
Jana Uhlinova
Maarit Vainiotalo
Maria K Svensson
Heini Huhtala
Heikki Saha
Author Affiliation
Tampere University Hospital, Tampere, Finland satu.m.makela@pshp.fi.
Source
Perit Dial Int. 2018 Sep-Oct; 38(5):366-373
Language
English
Publication Type
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Keywords
Ankle Brachial Index
Aorta, Abdominal - diagnostic imaging
Aortic Diseases - diagnosis - epidemiology - etiology
Cause of Death - trends
Critical Illness - mortality - therapy
Denmark - epidemiology
Estonia - epidemiology
Female
Finland - epidemiology
Humans
Incidence
Male
Middle Aged
Peritoneal Dialysis - adverse effects - mortality
Prognosis
Prospective Studies
Renal Dialysis
Risk factors
Survival Rate - trends
Sweden - epidemiology
Ultrasonography, Doppler
Vascular Calcification - diagnosis - epidemiology - etiology
Abstract
Peripheral arterial disease and vascular calcifications contribute significantly to the outcome of dialysis patients. The aim of this study was to evaluate the prognostic role of severity of abdominal aortic calcifications and peripheral arterial disease on outcome of peritoneal dialysis (PD) patients using methods easily available in everyday clinical practice.
We enrolled 249 PD patients (mean age 61 years, 67% male) in this prospective, observational, multicenter study from 2009 to 2013. The abdominal aortic calcification score (AACS) was assessed using lateral lumbar X ray, and the ankle-brachial index (ABI) using a Doppler device.
The median AACS was 11 (range 0 - 24). In 58% of the patients, all 4 segments of the abdominal aorta showed deposits, while 19% of patients had no visible deposits (AACS 0). Ankle-brachial index was normal in 49%, low ( 1.3) in 34% of patients. Altogether 91 patients (37%) died during the median follow-up of 46 months. Only 2 patients (5%) with AACS 0 died compared with 50% of the patients with AACS = 7 (p
PubMed ID
29386304 View in PubMed
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The Accuracy of the Computed Tomography Diagnosis of Acute Appendicitis: Does the Experience of the Radiologist Matter?

https://arctichealth.org/en/permalink/ahliterature294920
Source
Scand J Surg. 2018 Mar; 107(1):43-47
Publication Type
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Date
Mar-2018
Author
E Lietzén
P Salminen
I Rinta-Kiikka
H Paajanen
T Rautio
P Nordström
M Aarnio
T Rantanen
J Sand
J-P Mecklin
A Jartti
J Virtanen
P Ohtonen
N Ånäs
J M Grönroos
Author Affiliation
1 Division of Digestive Surgery and Urology, Department of Acute and Digestive Surgery, Turku University Hospital, Turku, Finland.
Source
Scand J Surg. 2018 Mar; 107(1):43-47
Date
Mar-2018
Language
English
Publication Type
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Keywords
Adolescent
Adult
Aged
Anti-Bacterial Agents - therapeutic use
Appendectomy - methods
Appendicitis - diagnostic imaging - drug therapy - surgery
Clinical Competence
Female
Finland
Humans
Male
Middle Aged
Prognosis
Prospective Studies
Radiologists
Risk assessment
Tomography, X-Ray Computed - methods
Treatment Outcome
Young Adult
Abstract
To assess the accuracy of computed tomography in diagnosing acute appendicitis with a special reference to radiologist experience.
Data were collected prospectively in our randomized controlled trial comparing surgery and antibiotic treatment for uncomplicated acute appendicitis (APPAC trial, NCT01022567). We evaluated 1065 patients who underwent computed tomography for suspected appendicitis. The on-call radiologist preoperatively analyzed these computed tomography images. In this study, the radiologists were divided into experienced (consultants) and inexperienced (residents) ones, and the comparison of interpretations was made between these two radiologist groups.
Out of the 1065 patients, 714 had acute appendicitis and 351 had other or no diagnosis on computed tomography. There were 700 true-positive, 327 true-negative, 14 false-positive, and 24 false-negative cases. The sensitivity and the specificity of computed tomography were 96.7% (95% confidence interval, 95.1-97.8) and 95.9% (95% confidence interval, 93.2-97.5), respectively. The rate of false computed tomography diagnosis was 4.2% for experienced consultant radiologists and 2.2% for inexperienced resident radiologists (p?=?0.071). Thus, the experience of the radiologist had no effect on the accuracy of computed tomography diagnosis.
The accuracy of computed tomography in diagnosing acute appendicitis was high. The experience of the radiologist did not improve the diagnostic accuracy. The results emphasize the role of computed tomography as an accurate modality in daily routine diagnostics for acute appendicitis in all clinical emergency settings.
PubMed ID
28929862 View in PubMed
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Acting on audit & feedback: a qualitative instrumental case study in mental health services in Norway.

https://arctichealth.org/en/permalink/ahliterature295007
Source
BMC Health Serv Res. 2018 01 31; 18(1):71
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
01-31-2018
Author
Monica Stolt Pedersen
Anne Landheim
Merete Møller
Lars Lien
Author Affiliation
Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P.B. 104, 2340, Brumunddal, Norway. monica.stolt.pedersen@sykehuset-innlandet.no.
Source
BMC Health Serv Res. 2018 01 31; 18(1):71
Date
01-31-2018
Language
English
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Benchmarking
Evidence-Based Practice
Feedback
Health Personnel
Humans
Medical Audit
Mental Disorders - rehabilitation - therapy
Mental Health Services - organization & administration - standards
Norway
Organizational Case Studies
Qualitative Research
Quality Improvement
Abstract
The National Guideline for Assessment, Treatment and Social Rehabilitation of Persons with Concurrent Substance Use and Mental Health Disorders, launched in 2012, is to be implemented in mental health services in Norway. Audit and feedback (A&F) is commonly used as the starting point of an implementation process. It aims to measure the research-practice gap, but its effect varies greatly. Less is known of how audit and feedback is used in natural settings. The aim of this study was to describe and investigate what is discussed and thematised when Quality Improvement (QI) teams in a District Psychiatric Centre (DPC) work to complete an action form as part of an A&F cycle in 2014.
This was an instrumental multiple case study involving four units in a DPC in Norway. We used open non-participant observation of QI team meetings in their natural setting, a total of seven teams and eleven meetings.
The discussions provided health professionals with insight into their own and their colleagues' practices. They revealed insufficient knowledge of substance-related disorders and experienced unclear role expectations. We found differences in how professional groups sought answers to questions of clinical practice and that they were concerned about whether new tasks fitted in with their routine ways of working.
Acting on A&F provided an opportunity to discuss practice in general, enhancing awareness of good practice. There was a general need for arenas to relate to practice and QI team meetings after A&F may well be a suitable arena for this. Self-assessment audits seem valuable, particular in areas where no benchmarked data exists, and there is a demand for implementation of new guidelines that might change routines and develop new roles. QI teams could benefit from having a unit leader present at meetings. Nurses and social educators and others turn to psychiatrists or psychologists for answers to clinical and organisational questions beyond guidelines, and show less confidence or routine in seeking research-based information. There is a general need to emphasise training in evidence-based practice and information seeking behaviour for all professional groups.
Notes
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PubMed ID
29386020 View in PubMed
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Adherence and medication belief in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension: A nationwide population-based cohort survey.

https://arctichealth.org/en/permalink/ahliterature296214
Source
Clin Respir J. 2018 Jun; 12(6):2029-2035
Publication Type
Journal Article
Multicenter Study
Date
Jun-2018
Author
Bodil Ivarsson
Roger Hesselstrand
Göran Rådegran
Barbro Kjellström
Author Affiliation
Department of Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden.
Source
Clin Respir J. 2018 Jun; 12(6):2029-2035
Date
Jun-2018
Language
English
Publication Type
Journal Article
Multicenter Study
Keywords
Aged
Antihypertensive Agents - therapeutic use
Attitude to Health
Chronic Disease
Cross-Sectional Studies
Female
Fibrinolytic Agents - therapeutic use
Humans
Hypertension, Pulmonary - drug therapy - epidemiology - etiology
Male
Medication Adherence
Morbidity - trends
Population Surveillance
Prognosis
Pulmonary Embolism - complications - drug therapy - epidemiology
Self Report
Surveys and Questionnaires
Sweden - epidemiology
Abstract
Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are rare diseases with a gradual decline in physical health. Adherence to treatment is crucial in these very symptomatic and life threatening diseases.
To describe PAH and CTEPH patients experience of their self-reported medication adherence, beliefs about medicines and information about treatment.
A quantitative, descriptive, national cohort survey that included adult patients from all PAH-centres in Sweden. All patients received questionnaires by mail: The Morisky Medication Adherence Scale (MMAS-8) assesses treatment-related attitudes and behaviour problems, the Beliefs about Medicines Questionnaire-Specific scale (BMQ-S) assesses the patient's perception of drug intake and the QLQ-INFO25 multi-item scale about medical treatment information.
The response rate was 74% (n?=?325), mean age 66?±?14 years, 58% were female and 69% were diagnosed with PAH and 31% with CTEPH. Time from diagnosis was 4.7?±?4.2 years. More than half of the patients (57%) reported a high level of adherence. There was no difference in the patients' beliefs of the necessity of the medications to control their illness when comparing those with high, medium or low adherence. Despite high satisfaction with the information, concerns about potential adverse effects of taking the medication were significantly related to adherence.
Treatment adherence is relatively high but still needs improvement. The multi-disciplinary PAH team should, together with the patient, seek strategies to improve adherence and prevent concern.
PubMed ID
29356440 View in PubMed
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Allocation of home care services by municipalities in Norway: a document analysis.

https://arctichealth.org/en/permalink/ahliterature291433
Source
BMC Health Serv Res. 2017 Sep 22; 17(1):673
Publication Type
Journal Article
Multicenter Study
Date
Sep-22-2017
Author
Solrun G Holm
Terje A Mathisen
Torill M Sæterstrand
Berit S Brinchmann
Author Affiliation
Faculty of Nursing and Health Sciences, Nord University, Storgt 105, 8370, Leknes, Norway. solrun.holm@nord.no.
Source
BMC Health Serv Res. 2017 Sep 22; 17(1):673
Date
Sep-22-2017
Language
English
Publication Type
Journal Article
Multicenter Study
Keywords
Aged, 80 and over
Cities - statistics & numerical data
Delivery of Health Care - standards
Female
Health Care Rationing - organization & administration
Health Services for the Aged - supply & distribution
Home Care Services - supply & distribution
House Calls - statistics & numerical data
Humans
Length of Stay - statistics & numerical data
Male
Norway
Residence Characteristics - statistics & numerical data
Retrospective Studies
Social Support
Abstract
In Norway, elder care is primarily a municipal responsibility. Municipal health services strive to offer the 'lowest level of effective care,' and home healthcare services are defined as the lowest level of care in Norway. Municipalities determine the type(s) of service and the amount of care applicants require. The services granted are outlined in an individual decision letter, which serves as a contract between the municipality and the home healthcare recipient. The purpose of this study was to gain insight into the scope and duration of home healthcare services allocated by municipalities and to determine where home care recipients live in relation to home healthcare service offices.
A document analysis was performed on data derived from 833 letters to individuals allocated home care services in two municipalities in Northern Norway (Municipality A = 500 recipients, Municipality B = 333 recipients).
In Municipality A, 74% of service hours were allotted to home health nursing, 12% to practical assistance, and 14% to support contact; in Municipality B, the distribution was 73%, 19%, and 8%, respectively. Both municipalities allocated home health services with no service end date (41% and 85% of the total services, respectively). Among recipients of "expired" services, 25% in Municipality A and 7% in Municipality B continued to receive assistance.
Our findings reveal that the municipalities adhered to the goal for home care recipients to remain at home as long as possible before moving into a nursing home. The findings also indicate that the system for allocating home healthcare services may not be fair, as the municipalities lacked procedures for revising individual decisions. Our findings indicate that local authorities should closely examine how they design individual decisions and increase their awareness of how long a service should be provided.
Notes
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Cites: Comput Inform Nurs. 2012 Jun;30(6):300-11 PMID 22411417
PubMed ID
28938892 View in PubMed
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An analysis of electronic health record-related patient safety incidents.

https://arctichealth.org/en/permalink/ahliterature291518
Source
Health Informatics J. 2017 06; 23(2):134-145
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
06-2017
Author
Sari Palojoki
Matti Mäkelä
Lasse Lehtonen
Kaija Saranto
Author Affiliation
University of Eastern Finland, Kuopio, Finland.
Source
Health Informatics J. 2017 06; 23(2):134-145
Date
06-2017
Language
English
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Electronic Health Records - instrumentation - standards - statistics & numerical data
Finland
Humans
Medical Errors - statistics & numerical data - trends
Patient Safety - standards - statistics & numerical data
Reproducibility of Results
Retrospective Studies
Safety Management - methods - standards
Abstract
The aim of this study was to analyse electronic health record-related patient safety incidents in the patient safety incident reporting database in fully digital hospitals in Finland. We compare Finnish data to similar international data and discuss their content with regard to the literature. We analysed the types of electronic health record-related patient safety incidents that occurred at 23 hospitals during a 2-year period. A procedure of taxonomy mapping served to allow comparisons. This study represents a rare examination of patient safety risks in a fully digital environment. The proportion of electronic health record-related incidents was markedly higher in our study than in previous studies with similar data. Human-computer interaction problems were the most frequently reported. The results show the possibility of error arising from the complex interaction between clinicians and computers.
PubMed ID
26951568 View in PubMed
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Angiogenic profile and smoking in the Finnish Genetics of Pre-Eclampsia Consortium (FINNPEC) cohort.

https://arctichealth.org/en/permalink/ahliterature292005
Source
Ann Med. 2017 11; 49(7):593-602
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
11-2017
Author
Tiina Jääskeläinen
Sanna Suomalainen-König
Esa Hämäläinen
Kari Pulkki
Jarkko Romppanen
Seppo Heinonen
Hannele Laivuori
Author Affiliation
a Medical and Clinical Genetics , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.
Source
Ann Med. 2017 11; 49(7):593-602
Date
11-2017
Language
English
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Adult
Biomarkers - blood
Case-Control Studies
Cross-Sectional Studies
Endoglin - blood
Female
Finland - epidemiology
Humans
Placenta Growth Factor - blood
Pre-Eclampsia - blood - epidemiology
Pregnancy
Pregnancy Trimester, First - blood
Pregnancy Trimester, Second - blood
Retrospective Studies
Risk factors
Risk Reduction Behavior
Smoking - adverse effects - blood - epidemiology
Vascular Endothelial Growth Factor Receptor-1 - blood
Young Adult
Abstract
The biological mechanism by which smoking reduces the risk of pre-eclampsia (PE) is unresolved. We studied serum levels of soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF) and their ratio, in addition to soluble endoglin (sEng) in early and late pregnancy to ascertain whether these factors are altered in women who smoke.
First trimester serum samples were available from 217 women who later developed PE and 238 women who did not develop PE. Second/third trimester serum samples were available from 174 PE and 54 non-PE women.
PE women who smoked during pregnancy had elevated first trimester concentrations of serum PlGF [geometric mean (95% CI): 39.8 (32.6-48.5) pg/ml, p?=?.001] and reduced sEng concentration [5.0 (4.6-5.6) ng/ml, p?=?.047] compared to PE non-smokers [30.0 (28.1-32.1) pg/ml and 6.1 (5.9-6.4) ng/ml, respectively]. Non-smoking women in the PE group had the highest sFlt-1/PlGF ratio in early and late pregnancy.
The protective effect of smoking in reducing the risk of PE may be due to the early pregnancy change towards pro-angiogenic marker profile. Also, in late pregnancy, smoking exerted effect in sFlt-1/PlGF ratio in PE pregnancies, and may complicate its use as a prognostic and diagnostic marker. Key messages Smoking appears to have angiogenic effects in early pregnancy with reduced sEng concentrations and elevated PlGF concentrations in both normal and PE pregnancies. Throughout pregnancy, smoking exerted effect in PlGF concentration and sFlt-1/PlGF ratio in PE pregnancies, and thus may complicate its use as a prognostic and diagnostic marker.
PubMed ID
28537456 View in PubMed
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Antihypertensive control and new-onset atrial fibrillation: Results from the Swedish Primary Care Cardiovascular Database (SPCCD).

https://arctichealth.org/en/permalink/ahliterature291189
Source
Eur J Prev Cardiol. 2017 07; 24(11):1206-1211
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
07-2017
Author
Georgios Mourtzinis
Linus Schiöler
Thomas Kahan
Kristina Bengtsson Boström
Per Hjerpe
Jan Hasselström
Karin Manhem
Author Affiliation
1 Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden.
Source
Eur J Prev Cardiol. 2017 07; 24(11):1206-1211
Date
07-2017
Language
English
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Aged
Antihypertensive Agents - therapeutic use
Atrial Fibrillation - epidemiology - etiology - prevention & control
Blood Pressure - drug effects
Databases, Factual
Female
Follow-Up Studies
Heart Rate - physiology
Humans
Hypertension - complications - drug therapy - physiopathology
Incidence
Male
Middle Aged
Primary Health Care - statistics & numerical data
Retrospective Studies
Risk Assessment - methods
Risk factors
Survival Rate - trends
Sweden - epidemiology
Time Factors
Abstract
Background Atrial fibrillation is associated with increased cardiovascular morbidity and mortality. Hypertension is an important risk factor for the development of atrial fibrillation. Aim This study assessed the relationship between blood pressure control and new-onset atrial fibrillation in hypertensive patients. Methods and results We followed 45,530 hypertensive patients with no previously documented atrial fibrillation, attending primary healthcare in Sweden during 2001-2008. After a mean follow-up of 3.5 years 2057 patients (4.5%) developed atrial fibrillation. Compared to patients with no atrial fibrillation, the new-onset atrial fibrillation group (after adjustment for age, sex, diabetes mellitus, heart failure, ischaemic heart disease, cerebrovascular disease and number of visits) had higher mean in-treatment systolic blood pressure (SBP) and diastolic blood pressure of 3.8?mmHg (95% confidence interval (CI) 3.0-4.6; P?
PubMed ID
28470087 View in PubMed
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Antithrombotic therapy after myocardial infarction in patients with atrial fibrillation undergoing percutaneous coronary intervention.

https://arctichealth.org/en/permalink/ahliterature298134
Source
Eur Heart J Cardiovasc Pharmacother. 2018 01 01; 4(1):36-45
Publication Type
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Date
01-01-2018
Author
Gorav Batra
Leif Friberg
David Erlinge
Stefan James
Tomas Jernberg
Bodil Svennblad
Lars Wallentin
Jonas Oldgren
Author Affiliation
Uppsala Clinical Research Center and Department of Medical Sciences, Cardiology, Uppsala University, Uppsala Science Park, MTC, Dag Hammarskjölds väg 14B, 752 37 Uppsala, Sweden.
Source
Eur Heart J Cardiovasc Pharmacother. 2018 01 01; 4(1):36-45
Date
01-01-2018
Language
English
Publication Type
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Keywords
Aged
Aged, 80 and over
Atrial Fibrillation - complications - drug therapy
Cause of Death - trends
Female
Fibrinolytic Agents - therapeutic use
Humans
Incidence
Male
Myocardial Infarction - complications - therapy
Percutaneous Coronary Intervention
Retrospective Studies
Stroke - epidemiology - etiology - prevention & control
Sweden - epidemiology
Thrombolytic Therapy - methods
Abstract
Optimal antithrombotic therapy after percutaneous coronary intervention (PCI) in patients with myocardial infarction (MI) and atrial fibrillation is uncertain. In this study, we compared antithrombotic regimes with regard to a composite cardiovascular outcome of all-cause mortality, MI or ischaemic stroke, and major bleeds.
Patients between October 2005 and December 2012 were identified in Swedish registries, n?=?7116. Landmark 0-90 and 91-365 days of outcome were evaluated with Cox-regressions, with dual antiplatelet therapy as reference. At discharge, 16.2% received triple therapy (aspirin, clopidogrel, and warfarin), 1.9% aspirin plus warfarin, 7.3% clopidogrel plus warfarin, and 60.8% dual antiplatelets. For cardiovascular outcome, adjusted hazard ratio with 95% confidence interval (HR) for triple therapy was 0.86 (0.70-1.07) for 0-90?days and 0.78 (0.58-1.05) for 91-365?days. A HR of 2.16 (1.48-3.13) and 1.61 (0.98-2.66) during 0-90 and 91-365?days, respectively, was observed for major bleeds. For aspirin plus warfarin, HR 0.82 (0.54-1.26) and 0.62 (0.48-0.79) was observed for cardiovascular outcome and 1.30 (0.60-2.85) and 1.01 (0.63-1.62) for major bleeds during 0-90 and 91-365?days, respectively. For clopidogrel plus warfarin, HR of 0.90 (0.68-1.19) and 0.68 (0.49-0.95) was observed for cardiovascular outcome and 1.28 (0.71-2.32) and 1.08 (0.57-2.04) for major bleeds during 0-90 and 91-365?days, respectively.
Compared to dual antiplatelets, aspirin or clopidogrel plus warfarin therapy was associated with similar 0-90 days and lower 91-365 days of risk of the cardiovascular outcome, without higher risk of major bleeds. Triple therapy was associated with non-significant lower risk of cardiovascular outcome and higher risk of major bleeds.
PubMed ID
29126156 View in PubMed
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