Kardiologia polska最新文献

Background: Renal dysfunction increases thromboembolic risk but is not consistently included in standard risk scores.

Aims: To compare the prevalence of left atrial thrombus (LAT) in atrial fibrillation (AF)/atrial flutter (AFl) patients based on renal function and oral anticoagulant (OAC) regimens.

Material and methods: Consecutive AF/AFl patients undergoing transesophageal echocardiography before cardioversion or ablation were included.

Results: Among 2790 patients with creatinine clearance (CrCl) data, 89% had CrCl ≥50 ml/min, 9.6% had CrCl 30-49 ml/min, and 1.5% had CrCl <30 ml/min. LAT prevalence was 6.7%, 16%, and 19%, respectively (P = 0.008). CrCl <50 ml/min was an independent predictor of LAT (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.25-2.64). Of 2028 patients treated with non-vitamin K antagonist OACs (NOACs), 17% received reduced doses, with 56% of these reductions deemed inappropriate. LAT prevalence was higher with reduced NOAC doses (12%) compared to standard doses (4.6%, P <0.001). Patients with no indication for dose reduction but receiving reduced doses had a higher LAT risk (12% vs. 4.2%; P <0.001). Among those with an indication for reduced doses, LAT prevalence was similar (11%) regardless of dose appropriateness. There were no significant differences in LAT prevalence among different NOACs. Inappropriate NOAC dosing increased LAT risk (OR, 1.74; 95% CI, 1.11-2.73). Inappropriate dose reductions, especially with apixaban and rivaroxaban, was the main issue in inappropriate NOAC prescribing, likely influenced by age, bleeding risk, anemia, low CrCl, and antiplatelet use.

Conclusions: AF patients with CrCl <50 ml/min face a doubled LAT risk despite OAC therapy. Inappropriate NOAC dosing, particularly with apixaban and rivaroxaban, leads to double LAT risk.

Influenza increases the risk of cardiovascular incidents, hospitalization for heart failure, heart attack, stroke and cardiovascular death. Annual influenza vaccination is a well-known, safe and effective method of reducing the risk of infection in general and, above all, reducing the risk of severe disease. The preventive effect of annual vaccination is particularly important in groups at risk of a severe course of infection and the development of complications - these include cardiac patients. In this group, the additional benefits of vaccination are also particularly important - reducing the risk of cardiovascular incidents and death. However, vaccination coverage in Poland is still at a staggeringly low level. This document aims to popularise influenza vaccination as one of the key elements of general health and cardiovascular prevention.

Platelet-fibrin clot generation at the site of vascular injury in coronary arteries is a primary pathophysiologic event that leads to vascular occlusion and the subsequent clinical manifestations of acute coronary syndrome (ACS). Therefore, a strategy to optimally inhibit both platelet and coagulation pathways simultaneously - known as dual pathway inhibition (DPI) - has been proposed. In this strategy, when bleeding risk is acceptable, patients suffering from ACS are often treated with potent parenteral antiplatelet and anticoagulant therapies to facilitate efficient reperfusion and prevent reocclusion of coronary arteries. With the development of safer direct oral anticoagulants in recent years, a DPI strategy has been explored for the long-term management of patients with a history of ACS. It has been hypothesized that FXIa and FXIIa are essential for the amplification of thrombin generation beyond the initial burst of thrombin generated by tissue factor, and for the growth and stabilization of pathological clot, but not for normal hemostasis. In this scenario, potential oral agents include FXa (rivaroxaban, apixaban, edoxaban), FXIa (asundexian and milvexian), and FXIIa inhibitors. However, trials of full-dose FXa inhibitors added to an antiplatelet agent were associated with an unacceptable risk of bleeding. In patients with recent ACS, very low dose (2.5 mg bid) was associated with a significant reduction in efficacy endpoints compared to dual antiplatelet therapy and lower bleeding compared to 5 mg bid rivaroxaban dose. In patients with chronic atherosclerotic vascular disease, very low dose rivaroxaban plus aspirin compared to aspirin alone was associated with favorable net clinical benefits. Understanding the relative contributions of platelet and coagulation pathways to clot formation in an individual patient is likely critical to achieve a balance between anti-ischemic effects and bleeding risk. In this line, we discuss the importance of objectively measuring thrombogenicity and its potential role in personalizing DPI strategies in patients with ACS.