European Journal of Internal Medicine最新文献

Aims: Data on the early use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) in patients with acute heart failure (HF) are conflicting, and mostly evaluating soft endpoints (i.e., indices of congestion, renal function, ejection fraction, and diuresis). The aim was to perform a meta-analysis of randomized controlled trials (RCTs) to assess their impact after an HF decompensation event.

Methods and results: Two electronic databases were screened for eligible studies. Efficacy endpoints were all-cause death, cardiovascular death, HF hospitalization, length of hospital stay, and N-terminal pro-B-type natriuretic peptide (nt-proBNP). Safety endpoints included acute kidney injury (AKI), volume depletion, ketoacidosis, hypotension, hypoglycemia, non-cardiovascular death, urinary tract infection, genital infections, serious adverse events (AE), and AE leading to treatment discontinuation. Two pre-specified subgroup analyses were planned according to the specific SGLT2i and clinical setting [i.e., acute myocardial infarction (MI) versus non-acute MI]. 16 RCTs enrolling 15,073 patients were considered. Early initiation of SGLT2i significantly reduced the risk of HF hospitalizations [Risk ratio (RR) 0.79, 95 % Confidence interval (CI) 0.72-0.87], AKI (RR 0.76, 95 % CI 0.59-0.99), and nt-proBNP levels (MD -354 pg/mL). No significant difference was detected for any of the other endpoints. In the pre-specified subgroup analysis, a significant interaction was found between the SGLT2i type and the risk of AKI, in favor of empagliflozin.

Conclusions: In patients recently hospitalized for acute HF, early administration of SGLT2i was associated with fewer readmissions for HF and AKI, as well as decongestant effects, without raising any safety concern.

For almost two decades, dual antiplatelet therapy (DAPT) has been considered the cornerstone of pharmacological treatment in patients undergoing percutaneous coronary intervention (PCI). DAPT composition and duration have considerably evolved in the last decade moving from fixed treatment durations to tailored strategies based on the individual ischemic and bleeding risks. The increasing awareness of the prognostic relevance of bleeding events after PCI and the need for tailoring DAPT according to the individual bleeding and ischemic risks paved the way to newer DAPT modulation strategies by early aspirin withdrawal which have been shown to decrease bleeding without affecting therapeutic efficacy. There is mounting evidence suggesting that P2Y₁₂ inhibitor monotherapy is associated with lower risks of adverse ischemic events without bleeding risk trade-off in patients with a history of myocardial infarction or PCI compared with aspirin. These findings suggest that aspirin-free strategies at short and long-term after PCI might be associated with net benefit in presence of potent P2Y₁₂ receptor inhibition. In this Viewpoint, we provide a contemporary overview of available evidence on aspirin-free strategies, moving from the latest guidelines recommendations to future perspectives on modulation of antiplatelet therapy after PCI.

Cognitive impairments are frequently observed in patients with Alcohol Use Disorder (AUD). Thiamine deficiency is often found in AUD patients and has been suggested as a possible cause of cognitive impairments. While thiamine deficiency is not consistently present in all AUD patients with cognitive deficits, thiamine is traditionally prescribed to patients with AUD to treat or prevent cognitive impairment. To better understand the relationship between thiamine levels and cognitive impairments in AUD patients, we conducted a systematic literature review following the Cochrane guidelines and adhering to the PRISMA-P framework. Additionally, this review is registered in PROSPERO under the reference CRD42024522058. Our research question was: "what is the impact of thiamine deficiency on cognitive function in patients with AUD?". The studies included in this review assessed thiamine levels in AUD patients and found values at or above the threshold for many measures of thiamine deficiency. Despite baseline thiamine levels being above the cutoff for deficiency in these studies, many still identified a correlation between thiamine levels and cognitive function with lower thiamine levels associated with cognitive impairments in AUD patients. This review indicates that there is a relationship between thiamine levels and cognitive function in AUD patients, even in the absence of thiamine deficit. The cognitive domains particularly affected are visuospatial/executive ability, abstraction, attention, verbal fluency, and memory scores, notably delayed memory. Additionally, studies have demonstrated that thiamine supplementation in AUD patients, even in the absence of thiamine deficit, leads to improvements in cognitive function.