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Absence of sex differences in pharmacotherapy for acute myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature179138
Source
Can J Cardiol. 2004 Jul;20(9):899-905
Publication Type
Article
Date
Jul-2004
Author
Susan E Jelinski
William A Ghali
Gerry A Parsons
Colleen J Maxwell
Author Affiliation
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Source
Can J Cardiol. 2004 Jul;20(9):899-905
Date
Jul-2004
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Aged
Aged, 80 and over
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Anticoagulants - therapeutic use
Aspirin - therapeutic use
Calcium Channel Blockers - therapeutic use
Canada - epidemiology
Cohort Studies
Drug Evaluation
Drug Therapy
Female
Fibrinolytic Agents - therapeutic use
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction - drug therapy
Patient Admission
Platelet Aggregation Inhibitors - therapeutic use
Sex Factors
Urban health
Abstract
Previous studies have indicated that sex differences may exist in the pharmacological management of acute myocardial infarction (AMI), with female patients being treated less aggressively.
To determine if previously reported sex differences in AMI medication use were also evident among all AMI patients treated at hospitals in an urban Canadian city.
All patients who had a primary discharge diagnosis of AMI from all three adult care hospitals in Calgary, Alberta, in the 1998/1999 fiscal year were identified from hospital administrative records (n=914). A standardized, detailed chart review was conducted. Information collected from the medical charts included sociodemographic and clinical characteristics, comorbid conditions, and cardiovascular medication use during hospitalization and at discharge.
Similar proportions of female and male patients were treated with thrombolytics, beta-blockers, angiotensin-converting enzyme inhibitors, nitrate, heparin, diuretics and digoxin. Among patients aged 75 years and over, a smaller proportion of female patients received acetylsalicylic acid in hospital than did male patients (87% versus 95%; P=0.026). Multivariable logistic regression analysis revealed that, after correction for age, use of other anticoagulants/antiplatelets and death within 24 h of admission, sex was no longer an independent predictor for receipt of acetylsalicylic acid in hospital. Medications prescribed at discharge were similar between male and female patients.
The results from this Canadian chart review study, derived from detailed clinical data, indicate that the pattern of pharmacological treatment of female and male AMI patients during hospitalization and at discharge was very similar. No sex differences were evident in the treatment of AMI among patients treated in an urban Canadian centre.
PubMed ID
15266360 View in PubMed
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Acute coronary syndromes: a Canadian perspective.

https://arctichealth.org/en/permalink/ahliterature129039
Source
Can J Cardiol. 2011 Nov-Dec;27 Suppl A:S385-6
Publication Type
Article
Author
David H Fitchett
Author Affiliation
St Michael's Hospital, University of Toronto and Canadian Heart Research Centre, Toronto, Ontario, Canada. fitchettd@smh.ca
Source
Can J Cardiol. 2011 Nov-Dec;27 Suppl A:S385-6
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - mortality - therapy
Canada - epidemiology
Fibrinolytic Agents - therapeutic use
Humans
Platelet Aggregation Inhibitors - therapeutic use
Practice Guidelines as Topic
PubMed ID
22118041 View in PubMed
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Age- and gender-related differences in the use of secondary medical prevention after primary vascular surgery: a nationwide follow-up study.

https://arctichealth.org/en/permalink/ahliterature127996
Source
Eur J Vasc Endovasc Surg. 2012 Mar;43(3):300-7
Publication Type
Article
Date
Mar-2012
Author
A. Høgh
J S Lindholt
H. Nielsen
L P Jensen
S P Johnsen
Author Affiliation
Department of Vascular Surgery, Regionshospitalet Viborg, Denmark. a_l_hogh@yahoo.dk
Source
Eur J Vasc Endovasc Surg. 2012 Mar;43(3):300-7
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Age Factors
Aged
Aged, 80 and over
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Antihypertensive Agents - therapeutic use
Atherosclerosis - epidemiology - surgery
Calcium Channel Blockers - therapeutic use
Comorbidity
Denmark - epidemiology
Diuretics - therapeutic use
Female
Follow-Up Studies
Humans
Hypolipidemic Agents - therapeutic use
Male
Middle Aged
Peripheral Arterial Disease - epidemiology - prevention & control
Platelet Aggregation Inhibitors - therapeutic use
Practice Guidelines as Topic
Registries
Retrospective Studies
Secondary Prevention - statistics & numerical data
Sex Distribution
Sex Factors
Vascular Surgical Procedures - utilization
Abstract
This study examined the possible age- and gender-related differences in the use of secondary medical prevention following primary vascular reconstruction in a population-based long-term follow-up study.
Using information from nationwide Danish registers, we identified all patients undergoing primary vascular reconstruction in-between 1996 and 2006 (n = 20,761). Data were obtained on all filled prescriptions 6 months and 3, 5 and 10 years after primary vascular reconstruction. Comparisons were made across age and gender groups, using men 40-60 years old as a reference.
Compared to current guidelines the overall use of secondary medical prevention was moderate to low (e.g., lipid-lowering drugs 49.5%, angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists (ACE/ATII) 43.4%, combination of lipid-lowering drugs and anti-platelet therapy and any anti-hypertensive therapy 44.7%). A decline was observed between 6 months and 3 years after surgery. Patients >80 years old were less likely to be prescribed lipid-lowering drugs and combination therapy (e.g.: adjusted risk ratio (RR) 5 years after surgery for men and women 0.63 (95% confidence interval (CI): 0.39-1.02) and 0.48 (95%CI: 0.31-0.75), respectively, whereas smaller and statistical non-significant gender-related differences were observed. The age- and gender-related differences appeared eliminated or substantially reduced in the latest part of the study period (2001-2007).
We found moderate to low use of secondary medical prevention in Denmark compared with recommendations from clinical guidelines. However, the use has increased in recent years and age- and gender-related differences have been reduced or even eliminated.
PubMed ID
22244910 View in PubMed
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Angiographic and clinical outcomes of drug-eluting versus bare metal stent deployment in the Occluded Artery Trial.

https://arctichealth.org/en/permalink/ahliterature151893
Source
Catheter Cardiovasc Interv. 2009 May 1;73(6):771-9
Publication Type
Article
Date
May-1-2009
Author
Vladimír Dzavík
Christopher E Buller
Gerard Devlin
Ronald G Carere
G B John Mancini
Warren J Cantor
Pawel E Buszman
James M Rankin
Carlos Vozzi
John R Ross
Sandra Forman
Bruce A Barton
A Gervasio A Lamas
Judith S Hochman
Author Affiliation
Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
Source
Catheter Cardiovasc Interv. 2009 May 1;73(6):771-9
Date
May-1-2009
Language
English
Publication Type
Article
Keywords
Adult
Aged
Angina Pectoris - etiology
Angioplasty, Balloon, Coronary - adverse effects - instrumentation - mortality
Canada
Coronary Angiography
Coronary Occlusion - mortality - physiopathology - radiography - therapy
Coronary Restenosis - etiology - mortality - physiopathology - radiography
Drug-Eluting Stents
Female
Heart Failure - etiology
Humans
Kaplan-Meier Estimate
Logistic Models
Male
Metals
Middle Aged
Myocardial Infarction - etiology
Platelet Aggregation Inhibitors - therapeutic use
Prospective Studies
Prosthesis Design
Risk assessment
Stents
Stroke Volume
Time Factors
Treatment Outcome
Ventricular Function, Left
Abstract
The majority of patients randomized to percutaneous coronary intervention (PCI) in the Occluded Artery Trial (OAT) and its angiographic substudy, the Total Occlusion Study of Canada 2 (TOSCA-2) were treated with bare metal stents (BMS). We aimed to determine if stenting of the target occlusion in OAT with drug-eluting stents (DES) was associated with more favorable angiographic results and clinical outcome when compared with treatment with BMS.
TOSCA-2 DES was a prospective nonrandomized substudy that provided 1-year angiographic comparison of late loss and reocclusion in 25 patients treated with DES and in 128 treated with BMS. In addition, all PCI-assigned patients enrolled from the time when DES were first utilized were similarly categorized (DES n = 77, and BMS n = 386) and compared using the 3-year cumulative OAT primary combined endpoint of death, myocardial infarction, or Class-IV heart failure, as well as angina.
In-segment late loss was 0.14 +/- 0.45 mm for DES and 0.75 +/- 0.86 mm for BMS (P
Notes
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Comment In: Catheter Cardiovasc Interv. 2009 May 1;73(6):78019370758
PubMed ID
19309733 View in PubMed
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Antiplatelet therapy following drug-eluting stent implantation: new clinical data and recommendations.

https://arctichealth.org/en/permalink/ahliterature157572
Source
Minerva Cardioangiol. 2008 Feb;56(1):139-54
Publication Type
Article
Date
Feb-2008
Author
J M Paradis
G. Ducrocq
J F Tanguay
Author Affiliation
University of Montreal, Montreal, Montreal Heart Institute, Faculty of Medicine, Montreal, Québec, Canada.
Source
Minerva Cardioangiol. 2008 Feb;56(1):139-54
Date
Feb-2008
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Coronary Artery Disease - therapy
Coronary Restenosis - prevention & control
Coronary Thrombosis - diagnosis - epidemiology - physiopathology - prevention & control
Drug-Eluting Stents - adverse effects
Europe - epidemiology
Humans
Italy - epidemiology
Platelet Aggregation Inhibitors - therapeutic use
Practice Guidelines as Topic
Prevalence
Randomized Controlled Trials as Topic
Risk assessment
Risk factors
Treatment Outcome
United States - epidemiology
Abstract
Technological developments in percutaneous coronary interventions (PCI) allow the possibility for less invasive revascularization in an increasing number of patients with atherosclerotic coronary artery disease. Bare-metal stents (BMS) have considerably improved the efficacy of PCI in addition to greatly reducing restenosis. However, even with standard stents, restenosis has remained a significant limitation of this revascularization technique. The advent of drug-eluting stents (DES) has dramatically reduced in-stent restenosis and, as a result, the need for repeat revascularization. However, their potential thrombogenicity has raised concerns about their clinical utility and long-term safety. Indeed, there is a possible higher rate of late stent thrombosis (LST) with DES compared with BMS. Antiplatelet therapy has been shown to be efficient in preventing DES thrombosis. Nevertheless, in the future, significant improvement will occur to improve the safety and efficacy of this therapy. This article will summarize the pathophysiology and the epidemiology of stent thrombosis (ST). Definitions of definite, probable and possible ST will be described. Furthermore, clinical risk factors for ST will be clearly enumerated. Then, the various antiplatelet therapeutic strategies used to prevent ST will be taken in consideration. Finally, a summary of the major recommendations about antiplatelet therapy made by some of the most prestigious learned societies will be presented.
PubMed ID
18432176 View in PubMed
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Antithrombotic- and anticoagulation regimens in OPCAB surgery. A Nordic survey.

https://arctichealth.org/en/permalink/ahliterature171529
Source
Scand Cardiovasc J. 2005 Dec;39(6):369-74
Publication Type
Article
Date
Dec-2005
Author
Katrine H Hansen
Pia Hughes
Daniel A Steinbrüchel
Author Affiliation
Department of Cardiothoracic Surgery, H:S Rigshospitalet, Copenhagen University Hospital, Denmark. katrineha3@m1.stud.ku.dk
Source
Scand Cardiovasc J. 2005 Dec;39(6):369-74
Date
Dec-2005
Language
English
Publication Type
Article
Keywords
Anticoagulants - therapeutic use
Chemoprevention
Coronary Artery Bypass, Off-Pump - adverse effects - methods - utilization
Drug Utilization Review
Fibrinolytic Agents - therapeutic use
Finland
Health Care Surveys
Heparin, Low-Molecular-Weight - therapeutic use
Humans
Iceland
Physician's Practice Patterns
Platelet Aggregation Inhibitors - therapeutic use
Postoperative Care - methods
Preoperative Care - methods
Questionnaires
Scandinavia
Abstract
The aim of the survey was to determine current practices for antiplatelet- and heparin therapy in OPCAB surgery in the Nordic countries.
A postal survey questionnaire was sent to all 26 departments of Cardiothoracic Surgery in Norway, Sweden, Iceland, Finland, and Denmark.
The overall response rate was 100%. The respondents performed between 130 and 1000 CABG procedures per year. Between 0.3% and 42.0% of these procedures were performed as OPCAB. Preoperative antiplatelet therapy was administered by 48%, while 96% routinely administer postoperative antiplatelet therapy. In the postoperative antiplatelet therapy there was a trend toward a combination of aspirin and low molecular weight heparin. Perioperative anticoagulation practices with heparin varied among departments as well as reversal with protamine. Eighty percent of the respondents register postoperative complications.
In the Nordic countries there is no uniform practice regarding antiplatelet therapy pre- and postoperatively as well as heparin therapy perioperatively. Dose regimens are highly variable and standard protocols have not yet been developed.
PubMed ID
16352490 View in PubMed
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Aspirin in the prevention of pre-eclampsia in high-risk women: a randomised placebo-controlled PREDO Trial and a meta-analysis of randomised trials.

https://arctichealth.org/en/permalink/ahliterature119203
Source
BJOG. 2013 Jan;120(1):64-74
Publication Type
Article
Date
Jan-2013
Author
P M Villa
E. Kajantie
K. Räikkönen
A-K Pesonen
E. Hämäläinen
M. Vainio
P. Taipale
H. Laivuori
Author Affiliation
Research Programmes Unit, Women's Health, University of Helsinki, Helsinki, Finland. pia.villa@helsinki.fi
Source
BJOG. 2013 Jan;120(1):64-74
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aspirin - therapeutic use
Double-Blind Method
Female
Finland
Humans
Platelet Aggregation Inhibitors - therapeutic use
Pre-Eclampsia - prevention & control - ultrasonography
Pregnancy
Pregnancy, High-Risk
Randomized Controlled Trials as Topic
Treatment Outcome
Ultrasonography, Doppler, Color
Young Adult
Abstract
To study the effect of aspirin in the prevention of pre-eclampsia in high-risk women.
Randomised, double-blinded, placebo-controlled trial.
Maternity clinics in ten Finnish hospitals participating in the PREDO Project.
A total of 152 women with risk factors for pre-eclampsia and abnormal uterine artery Doppler velocimetry.
Participants were randomised to start either aspirin 100 mg/day or placebo at 12 + 0 to 13 + 6 weeks + days of gestation. Because of the limited power of this trial, we also conducted a meta-analysis of randomised controlled trials that included data on 346 women with abnormal uterine artery Doppler flow velocimetry, and aspirin 50-150 mg/day started at or before 16( ) weeks of gestation.
Pre-eclampsia, gestational hypertension and birthweight standard deviation (SD) score. Outcome measures for the meta-analysis were pre-eclampsia, severe pre-eclampsia, preterm (diagnosed
Notes
Comment In: BJOG. 2013 May;120(6):774-523565954
Comment In: BJOG. 2013 May;120(6):773-423565953
Comment In: BJOG. 2013 May;120(6):77323565952
PubMed ID
23126307 View in PubMed
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Assessment of the Siksika chronic disease nephropathy-prevention clinic.

https://arctichealth.org/en/permalink/ahliterature117000
Source
Can Fam Physician. 2013 Jan;59(1):e19-25
Publication Type
Article
Date
Jan-2013
Author
David R R Ward
Ellen Novak
Nairne Scott-Douglas
Sony Brar
Melvin White
Brenda R Hemmelgarn
Author Affiliation
Department of Medicine, University of Calgary, Alberta.
Source
Can Fam Physician. 2013 Jan;59(1):e19-25
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Angiotensin Receptor Antagonists - therapeutic use
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Aspirin - therapeutic use
Blood pressure
Canada
Diabetes Mellitus - drug therapy
Diabetic Nephropathies - prevention & control
Dyslipidemias - complications - drug therapy
Female
Hemoglobin A, Glycosylated
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Hypertension - complications - drug therapy
Hypertension, Renal - prevention & control
Indians, North American
Lipoproteins, LDL
Male
Middle Aged
Nephritis - prevention & control
Nurse's Practice Patterns
Nursing Evaluation Research
Platelet Aggregation Inhibitors - therapeutic use
Qualitative Research
Renal Insufficiency, Chronic - etiology - prevention & control
Treatment Outcome
Abstract
To determine if a community-based multifactorial intervention clinic led by a nurse practitioner would improve management of First Nations people at risk of developing chronic kidney disease.
Qualitative descriptive study.
A nephropathy-prevention clinic in Siksika Nation, Alta.
First Nations people with diabetes, hypertension, or dyslipidemia who were referred to the clinic.
Changes in blood pressure (BP), hemoglobin A(1c), and low-density lipoprotein levels, as well as in use of antiplatelet therapy, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker medications, and statin therapy.
Members of the Siksika Nation were treated according to clinical practice guidelines. A total of 78 patients had at least 2 visits to the clinic and were included in this analysis (61.5% were women; mean age 56 years). Among those initially above target, a significant reduction was achieved in mean hemoglobin A(1c) (0.96%; P
Notes
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PubMed ID
23341675 View in PubMed
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Association between antithrombotic treatment and hemorrhagic stroke in patients with atrial fibrillation-a cohort study in primary care.

https://arctichealth.org/en/permalink/ahliterature280552
Source
Eur J Clin Pharmacol. 2017 Feb;73(2):215-221
Publication Type
Article
Date
Feb-2017
Author
Per Wändell
Axel C Carlsson
Martin Holzmann
Johan Ärnlöv
Sven-Erik Johansson
Jan Sundquist
Kristina Sundquist
Source
Eur J Clin Pharmacol. 2017 Feb;73(2):215-221
Date
Feb-2017
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anticoagulants - therapeutic use
Aspirin - therapeutic use
Atrial Fibrillation - drug therapy
Cohort Studies
Female
Fibrinolytic Agents - therapeutic use
Humans
Intracranial Hemorrhages - epidemiology
Male
Middle Aged
Platelet Aggregation Inhibitors - therapeutic use
Primary Health Care
Stroke - epidemiology
Sweden - epidemiology
Ticlopidine - analogs & derivatives - therapeutic use
Warfarin - therapeutic use
Abstract
The objective of this study was to study the association between antithrombotic treatment and risk of hemorrhagic stroke (HS) in patients with atrial fibrillation (AF) treated in primary health care.
Study population included all adults (n = 12,215) 45 years and older diagnosed with AF at 75 primary care centers in Sweden 2001-2007. Outcome was defined as a first hospital episode with a discharge episode of HS after the AF diagnosis. Association between HS and persistent treatment with antithrombotic agents (warfarin, acetylsalicylic acid (ASA), clopidogrel) was explored using Cox regression analysis, with hazard ratios (HRs) and 95 % CIs. Adjustment was made for age, socioeconomic status, and co-morbid cardiovascular conditions.
During a mean of 5.8 years (SD 2.4) of follow-up, 162 patients (1.3 %; 67 women and 95 men) with HS were recorded. The adjusted risk associated with persistent warfarin treatment compared to no antithrombotic treatment consistently showed no increased HS risk, HR for women 0.53 (95 % CI 0.23-1.27) and for men 0.55 (95 % CI 0.29-1.04); corresponding HRs for ASA were, for women, 0.45 (95 % CI 0.14-1.44) and, for men, 0.56 (95 % CI 0.24-1.29).
In this clinical setting, we found no evidence pointing to an increased risk of HS with antithrombotic treatment.
Notes
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PubMed ID
27826643 View in PubMed
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149 records – page 1 of 15.