Hospitalisations and emergency department visits due to drug-drug interactions: a literature review

PURPOSE: Our objective was to evaluate the incidence of adverse patient outcomes due to drug-drug interactions (D-DIs), the type of drugs involved and the underlying reason. As a proxy for adverse patient outcomes, emergency department (ED) visits, hospital admissions and re-hospitalisations were assessed. METHODS: A literature search in the Medline and Embase database (1990-2006) was performed and references were tracked. An overall cumulative incidence was estimated by dividing the sum of the cases by the sum of the study populations. RESULTS: Twenty-three studies were found assessing the relationship between D-DIs and ED-visits, hospitalisations or re-hospitalisations. The studies with a large study size showed low incidences and vice versa. D-DIs were held responsible for 0.054% of the ED-visits, 0.57% of the hospital admissions and 0.12% of the re-hospitalisations. In the elderly population, D-DIs were held responsible for 4.8% of the admissions. Drugs most often involved were NSAIDs and cardiovascular drugs. The reasons for admissions or ED-visits, which were most often found were GI-tract bleeding, hyper- or hypotension and cardiac rhythm disturbances. CONCLUSION: This review provides information on the overall incidence of D-DIs as a cause of adverse patient outcomes, although there is still uncertainty about the impact of D-DIs on adverse patient outcomes. Our results suggest that a limited number of drugs are involved in the majority of cases and that the number of reasons for admission as a consequence of D-DIs seems to be modest.     

质子泵抑制剂对PCI术后患者服用氯吡格雷疗效影响的Meta分析

目的系统评价质子泵抑制剂(PPI)对经皮冠状动脉介入治疗(PCI)术后患者服用氯吡格雷疗效的影响。方法按照系统评价的要求全面检索Cochrane图书馆、PubMed、Embase数据库、中文生物医学文献数据库、中国期刊全文数据库,Jadad法对纳入文献进行质量评价,应用Stata 11.0软件对1980至201 1年PPI与氯吡格雷联用对PCI术后治疗患者远期心血管事件的临床研究文献进行Meta分析。结果共检索出115篇文献,符合标准的11篇文献进入Meta分析,研究分析发现纳入文献可能存在异质性,采用随机模型进行分析,PCI术后患者联合服用PPI和氯吡格雷后心血管事件发生率显著增加[RR=1.37,95%CI(1.22,1.54),P<0.01]。纳入文献可能存在异质性,但经过各研究影响力分析合并结果可信。结论从现有的调查研究结果证据来看,联合应用PPI与氯吡格雷可使冠心病PCI术后患者再次发生心血管不良事件的风险增加,建议临床医师应谨慎选择联合用药。     

蝙蝠葛碱对心血管病患者血小板聚集性的影响

蝙蝠葛碱对二磷酸腺苷、肾上腺素和胶原诱导的体外血小板聚集有明显的浓度依赖性抑制作用。心血管病患者每日口服本品９００ｍｇ．血小板聚集抑制率达２０％～３０％。临床随机对照试验表明阿斯匹林、蝙蝠葛碱和硝苯吡啶均降低血小板聚集率，其中阿斯匹林、蝙蝠葛碱组的血小板聚集抑制率与对照组比较，其差异有显著性。     

Detection of problem-drinkers in an emergency department using a breathalyser and questionnaire

Over a 2-week period in January 1990 consecutive adult emergency attenders were breathalysed and screened for problem drinking using the WHO screening instrument. Results were compared with a similar study conducted 8 years previously. Of the patients tested, 12.5% had a positive alcohol in 1990 compared with 16% in 1982. Of those with positive alcohol results, the mean blood alcohol equivalent (BAE) concentration was significantly (p=0.0006) lower in 1990 (73.6+/-65.1; mg/100 ml; mean+/-SD) when compared to those levels found in 1982 (136.9+/-102.4 mg/100 ml). There was also significant reductions in 1990 of positive breath alcohol attenders both from road traffic accidents (p<0.03), and from head injuries (p<0.005) compared to 1982. In 1990 the questionnaire was positive in 23% of attendees. These studies suggest a trend towards less alcohol misuse in emergency department patients, but nevertheless indicate high rates of problem drinking. It is suggested that alcohol breathalysers be available in emergency departments to assist the detection of alcohol misusers and predict alcohol-associated medical problems.     

真实世界生脉注射液治疗9215例老年心血管疾病的临床特征及联合用药研究

目的 为深入研究真实世界中生脉注射液(SMI)治疗老年心血管疾病的临床特征,以医院信息管理系统(hospital information system,HIS)为基础,进行了生脉注射液的真实世界研究.方法 利用R软件对HIS数据库中2001年1月1日至2016年12月31日29家三甲医院的9215例老年心血管疾病患者数...     

复方阿司匹林抑制心血管病患者血小板聚集的24周疗效

目的:观察24周疗程中复方阿司匹林(铝镁匹林)抑制心血管病患者血小板聚集功能的效果变化。方法:选择临床需要服用阿司匹林抗血小板治疗且ADP诱导的血小板聚集率增高的心血管病患者103例,给予铝镁匹林2片(含阿司匹林162 mg)口服24周。于用药前及用药6,12,24周后分别测定血小板聚集率。结果:服用铝镁匹林后患者的血小板聚集率显著降低,6,12,24周测定血小板聚集率与基线比较有极显著差异,血小板聚集抑制率分别为-(20.49±22.35)%,-(28.10±22.88)%,-(23.23±22.68)%。12周的血小板聚集率较6周进一步下降,但24周较12周则明显升高,两个差值均有统计学差异(P<0.05)。结论:铝镁匹林可明显降低患者的血小板聚集功能,但抗血小板聚集作用在24周后较12周有明显下降。     

2型糖尿病患者微量白蛋白尿与心血管危险因素的相关性

目的探讨2型糖尿病(T2DM)患者微量白蛋白尿(MAU)与心血管危险因素的相关性。方法 T2DM患者483例,根据尿白蛋白与肌酐比值(ACR)分为正常白蛋白尿组(A组,248例,ACR<30mg/g)和MAU组(B组,235例,ACR 30-300mg/g)。检测两组血清甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、糖化血红蛋白(HbA1c)、空腹血糖(FBG)、餐后2-h血糖(PBG)、空腹胰岛素(FIns)。结果与A组比较,B组TG、TC、LDL-C、FBG、PBG、FIns均明显增加(P<0.05);高血压病、冠心病、动脉粥样硬化的发病率升高(P<0.05)。体重指数、收缩压、TC、FBG是发生MAU的独立危险因素。结论 T2DM患者MAU易合并超重、高血压、糖脂代谢紊乱,心血管疾病风险增加。     

心房颤动患者左心耳封堵术后抗栓策略

心房颤动可引起血栓栓塞,甚至脑卒中.大多数房颤患者血栓主要形成于左心耳.左心耳封堵术(LAAO)通过对左心耳进行介入封堵,以替代长期口服抗凝药预防血栓栓塞,其安全性和有效性已在众多临床研究中得到证实.LAAO后抗栓治疗对患者的康复及减少不良反应的发生至关重要.目前LAAO后抗栓治疗策略主要有抗凝+抗血小板联合治疗、双联...     

Therapeutic potential of colchicine in cardiovascular medicine: a pharmacological review

Colchicine is an ancient herbal drug derived from Colchicum autumnale. It was first used to treat familial Mediterranean fever and gout. Based on its unique efficacy as an anti-inflammatory agent, colchicine has been used in the therapy of cardiovascular diseases including coronary artery disease, atherosclerosis, recurrent pericarditis, vascular restenosis, heart failure, and myocardial infarction. More recently, colchicine has also shown therapeutic efficacy in alleviating cardiovascular complications of COVID-19. COLCOT and LoDoCo2 are two milestone clinical trials that confirm the curative effect of long-term administration of colchicine in reducing the incidence of cardiovascular events in patients with coronary artery disease. There is growing interest in studying the anti-inflammatory mechanisms of colchicine. The anti-inflammatory action of colchicine is mediated mainly through inhibiting the assembly of microtubules. At the cellular level, colchicine inhibits the following: (1) endothelial cell dysfunction and inflammation; (2) smooth muscle cell proliferation and migration; (3) macrophage chemotaxis, migration, and adhesion; (4) platelet activation. At the molecular level, colchicine reduces proinflammatory cytokine release and inhibits NF-κB signaling and NLRP3 inflammasome activation. In this review, we summarize the current clinical trials with proven curative effect of colchicine in treating cardiovascular diseases. We also systematically discuss the mechanisms of colchicine action in cardiovascular therapeutics. Altogether, colchicine, a bioactive constituent from an ancient medicinal herb, exerts unique anti-inflammatory effects and prominent cardiovascular actions, and will charter a new page in cardiovascular medicine.     

呼气末二氧化碳在急诊科机械通气患者的应用

目的探讨呼气末二氧化碳(ETCO2)监测在急诊科机械通气患者中的应用价值。方法回顾性分析2012年1月—2013年1月该院急诊抢救室应用有创机械通气患者58例,分为ETCO2监测组(A组)27例及非ETCO2监测组(B组)31例,统计发生错误插管、呼吸机工作故障及其所致的不良事件发生频次、从不良事件发生到医护人员响应时间,并对医务人员反应时间进行比较。结果医务人员对A、B两组患者错误插管反应时间为[(0.59±0.21)min vs(2.12±0.48)min,P=0],呼吸机管路脱落反应时间为[(0.27±0.15)min vs(0.87±0.16)min,P=0],呼吸机管路扭曲、打折反应时间为[(1.17±0.24)min vs(1.93±0.18)min,P=0],通气不足反应时间为[(4.27±1.44)min vs(8.08±1.81)min,P=0]。两组患者严重不良反应事件之间相比差异无统计学意义(P=0.087)。结论急诊科各种接受有创机械通气患者,通过监测ETCO2可以尽早发现不良事件并及时处理,从而避免造成不必要的医源性事故发生。     

Mean platelet volume and high-residual platelet reactivity in patients receiving dual antiplatelet therapy with clopidogrel or ticagrelor

Objective: High on-treatment platelet reactivity (HRPR) is associated with a two- to ninefold increased risk of recurrent ischemic events among patients receiving dual antiplatelet therapy (DAPT) for coronary artery disease. However, its determinants are still poorly understood. The aim of the present study was to assess the impact of mean platelet volume (MPV) on platelet reactivity in patients receiving DAPT after an acute coronary syndrome or PCI.

Methods: Patients treated with DAPT (acetylsalicylic acid [ASA] and clopidogrel or ticagrelor) were scheduled for platelet function assessment at 30 – 90 days post-discharge. By whole blood impedance aggregometry, HRPR was considered for ASPI test > 862 aggregation units (AU)*min (for ASA) and ADP test values ≥ 417 AU*min (for ADP-antagonists).

Results: Our population is represented by a total of 487 patients on DAPT, divided according to MPV tertiles (< 10.4 fl; 10.4 – 11.29 fl; ≥ 11.3 fl). Larger-sized platelets were associated with use of statins (p < 0.001) and beta-blockers (p = 0.03), higher hemoglobin levels (p = 0.002) and lower platelets count (p < 0.001). Higher platelet reactivity was observed at ASPI test in patients with higher MPV (r = 0.12, p = 0.008), but not for ADP-mediated aggregation (r = -0.007, p = 0.88). However, a low prevalence of HRPR was observed with ASA, with no impact of MPV tertiles (1.2 vs 1.1 vs 1.6%, p = 0.70, adjusted OR [95% CI] = 1.05 [0.51 – 1.77], p = 0.87). MPV did not influence the prevalence of HRPR for ADP-antagonists (25.9 vs 1 vs 26.5%, p = 0.89; adjusted OR [95% CI] = 1.1 [0.84 – 1.45], p = 0.50) with similar results among the 259 patients receiving clopidogrel (adjusted OR [95% CI] = 1.15 [0.82 – 1.62], p = 0.43) and the 228 patients on ticagrelor (adjusted OR [95% CI] = 1.46 [0.84 – 2.55], p = 0.18).

Conclusion: In patients receiving DAPT, MPV does not affect the response to major antiplatelet therapies. In fact, MPV elevation does not influence the risk of HRPR with clopidogrel, ticagrelor or ASA.     

Drinking patterns and problems and drinking in the injury event: an analysis of emergency room patients by ethnicity

While a substantial literature exists on the association of alcohol consumption and injury, less is known about the context in which drinking occurs within specific ethnic groups in the United States. This paper analyzes drinking patterns, alcohol-related problems and drinking-in-the-event variables among a probability sample of 359 black, 528 Hispanic and 458 white patients who were breathalyzed and interviewed after admission to the emergency room. Injured patients among both Hispanics and whites were more likely to be positive on the breathalyzer and to report heavy drinking and more frequent drunkenness during the preceding year than their non-injured counterparts. Blacks were less likely than either Hispanics or whites to report a larger number of drinks prior to injury, feeling drunk at the time, or a causal association of alcohol and the injury event. These data suggest a differential role of alcohol in injury occurrence within ethnic groups, with alcohol possibly playing less of a role in the injury event for blacks than for Hispanics or whites.     

硝酸异山梨酯针剂对不稳定型心绞痛病人血小板活性的抑制作用

目的 :观察体内外不同浓度硝酸异山梨酯(ISDN)对不稳定型心绞痛 (UAP)病人血浆P 选择素、凝血烷B2 (TXB2 )、6 酮 前列腺素F1α(6 keto PGF1α)水平的影响及其量效关系。方法 :体内实验 ,4 5例UAP病人分为 3组 ,分别给予ISDN 2 ,4 ,8mg·h- 1静脉滴注。体外实验 ,16例UAP病人清晨空腹采静脉血与不同浓度ISDN体外培养。测定用药前后血中P 选择素 ,TXB2 ,6 keto PGF1α的含量 ,计算TXB2 / 6 keto PGF1α。健康对照 2 0人。结果 :体内实验中 ,P 选择素和TXB2 在各剂量组 ,用药后 2h和 8h均明显抑制 (P <0 .0 5或P <0 .0 1)。6 keto PGF1α 在 2mg·h- 1组用药后变化不明显(P >0 .0 5 ) ,其余均较用药前升高 (P <0 .0 5或P <0 .0 1)。体外实验中 30min时 12 5mg·L- 1组P 选择素和TXB2 表达下降 (P <0 .0 5和P <0 .0 1) ,2h时12 .5mg·L- 1及 12 5mg·L- 1组P 选择素和TXB2均表达下降 (P <0 .0 1)。 6 keto PGF1α无明显变化。结论 :ISDN在体内外均可抑制UAP病人血小板P 选择素和TXB2 的表达且存在量效依赖关系 ,体外起效浓度远远大于体内浓度。     

Risk of acute pancreatitis with incretin-based therapy: a systematic review and updated meta-analysis of cardiovascular outcomes trials

ABSTRACT

Background

The link of acute pancreatitis (AP) with Incretin based therapies (IBTs) in type 2 diabetes has existed since United States Food and Drug Administration alert in 2010. This issue still remains unresolved due to conflicting results among studies.