Clinical effects of antiplatelet drugs and statins on D‐dimer levels

Background

Acute pulmonary embolism may be ruled out by combining nonhigh clinical probability and a normal D‐dimer level. Both antiplatelet drugs and HMG‐CoA reductase inhibitors (statins) have been associated with effects on thrombus formation, potentially influencing D‐dimer levels in this setting, leading to a higher rate of false‐negative tests. Therefore, we determined whether D‐dimer levels in patients with suspected pulmonary embolism are affected by concomitant use of antiplatelet drugs and/or statins and evaluated whether the effect of antiplatelet drugs or statins might affect diagnostic accuracy.

Materials and methods

We performed a posthoc analysis in the YEARS diagnostic study, comparing age‐ and sex‐adjusted D‐dimer levels among users of antiplatelet drugs, statins and nonusers. We then reclassified patients within the YEARS algorithm by developing a model in which we adjusted D‐dimer cut‐offs for statin use and evaluated diagnostic accuracy.

Results

We included 156 statins users, 147 antiplatelet drugs users and 726 nonusers of either drugs, all with suspected pulmonary embolism . Use of antiplatelet drugs did not have a significant effect, whereas statin use was associated with 15% decrease in D‐dimer levels (95% CI, ?28% to ?0.6%). An algorithm with lower D‐dimer thresholds in statin users yielded lower specificity (0.42 compared to 0.33) with no difference in false‐negative tests.

Conclusions

We conclude that use of statins but not of antiplatelet agents is associated with a modest decrease in D‐dimer levels. Adjusting D‐dimer cut‐offs for statin use did, however, not result in a safer diagnostic strategy in our cohort.

     

Correlates of treatment satisfaction and well‐being among patients with type II diabetes

Aim

To examine the impact of patient characteristics, anthropometric measurement and patient clinical variables on their appraisal of treatment satisfaction and well‐being.

Background

Treatment satisfaction and well‐being are instrumental in achieving diabetes care goals. Nursing practices and healthcare policies may inform interventions in these areas.

Introduction

The prevalence of diabetes is high in the Middle East. An understanding of relationships between clinical and socio‐demographic variables and well‐being and treatment satisfaction is needed to improve care and patient outcomes.

Methods

A total of 1002 patients completed tools measuring well‐being, treatment satisfaction and socio‐demographic characteristics. A series of bivariate and multivariate analysis were conducted to identify factors associated with well‐being and treatment satisfaction.

Results

Males reported better treatment satisfaction and well‐being than females. Older participants, those who were compliant to diet, with controlled diabetes, and no neuropathy reported higher treatment satisfaction scores and well‐being scores. Insulin therapy was associated with better treatment satisfaction.

Discussion

Females, participants who were not prescribed diabetic diets and those with complications were more likely to be negatively impacted by diabetes. Individuals with diabetes who were treated with insulin had higher treatment satisfaction than those who used oral hypoglycaemic agents.

Conclusion and implication for nursing and health policy

These findings are important in assisting nurses and other healthcare professionals in identifying patients with diabetes with low treatment satisfaction who may present a greater risk for poor well‐being. Additionally, they lend support to developing policies for frequent screenings and special therapeutic interventions that are needed to maximize patients’ treatment satisfaction and well‐being in the Middle East and elsewhere.