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Introduction
Patients on warfarin with sub-optimal time-in-therapeutic-range (TTR) are more likely to have adverse events. Target-specific oral anticoagulants (TSOACs) are approved and can be used as an alternative to warfarin for a number of indications. Further, the efficacy and safety profiles of the TSOACs compared to warfarin are more favourable when the TTR is ≤ 65% for certain indications.Objective
We aimed to determine simple, sensitive and specific diagnostic tools to identify TTR ≤ 65% during the initial three months of warfarin therapy.Methods
A cross-sectional study including patients newly initiated on warfarin without any interruption for three months was conducted. TTR was calculated using the Rosendaal method. Patients were stratified by TTR (≤ 65% or > 65%). Number of INR measurements, dose changes and INR measurements of ≤ 1.7 or ≥ 4.0 were evaluated as potential diagnostic tools to identify TTR ≤ 65%.Results
670 patients were included. The most common indication for anticoagulation was venous thromboembolism. The mean TTR in the first three months was 68 ± 21% (Range: 10 to 100%). Three or more dose changes identified TTR ≤ 65% and demonstrated a sensitivity and specificity of 90% (95%CI 86 to 93%) and 56% (95%CI 51 to 61%), respectively. Three or more INR measurements of ≤ 1.7 during the initial three months of anticoagulation showed a sensitivity and specificity of 37% (95%CI 32 to 43%) and 98% (95%CI 96 to 99%), respectively.Conclusion
Three or more dose changes and three or more INR measurements of ≤ 1.7 could identify patients with a TTR ≤ 65% in the first three months of warfarin therapy. 相似文献13.
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Romano E Cotari JW Barreira da Silva R Betts BC Chung DJ Avogadri F Fink MJ St Angelo ET Mehrara B Heller G Münz C Altan-Bonnet G Young JW 《Blood》2012,119(22):5182-5190
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Mebazaa A Vanpoucke G Thomas G Verleysen K Cohen-Solal A Vanderheyden M Bartunek J Mueller C Launay JM Van Landuyt N D'hondt F Verschuere E Vanhaute C Tuytten R Vanneste L De Cremer K Wuyts J Davies H Moerman P Logeart D Collet C Lortat-Jacob B Tavares M Laroy W Januzzi JL Samuel JL Kas K 《European heart journal》2012,33(18):2317-2324
Aims Biochemical marker testing has improved the evaluation and management of patients with cardiovascular diseases over the past decade. Natriuretic peptides (NPs), used in clinical practice to assess cardiac dysfunction, exhibit many limitations, however. We used an unbiased proteomics approach for the discovery of novel diagnostic plasma biomarkers of heart failure (HF). Methods and results A proteomics pipeline adapted for very low-abundant plasma proteins was applied to clinical samples from patients admitted with acute decompensated HF (ADHF). Quiescin Q6 (QSOX1), a protein involved in the formation of disulfide bridges, emerged as the best performing marker for ADHF (with an area under the receiver operator characteristic curve of 0.86, 95% confidence interval: 0.79-0.92), and novel isoforms of NPs were also identified. Diagnostic performance of QSOX1 for ADHF was confirmed in 267 prospectively collected subjects of whom 76 had ADHF. Combining QSOX1 to B-type NP (BNP) significantly improved diagnostic accuracy for ADHF by particularly improving specificity. Using thoracic aortic constriction in rats, QSOX1 was specifically induced within both left atria and ventricles at the time of HF onset. Conclusion The novel biomarker QSOX1 accurately identifies ADHF, particularly when combined with BNP. Through both clinical and experimental studies we provide lines of evidence for a link between ADHF and cardiovascular production of QSOX1. 相似文献
16.
Maria Varkanitsa Dimitrios Kasselimis Gregoire Boulouis Andrew J.B. Fugard Ioannis Evdokimidis Judit Druks 《Neurocase》2013,19(5):169-176
ABSTRACTThis case series explores the relationship between verbal memory capacity and sentence comprehension in four patients with aphasia. Two sentence comprehension tasks showed that two patients, P1 and P2, had impaired syntactic comprehension, whereas P3 and P4’s sentence comprehension was intact. The memory assessment tasks showed that P1 and P2 had severely impaired short-term memory, whereas P3 and P4 performed within the normal range in the short-term memory tasks. This finding suggests an association between short-term memory deficit and sentence comprehension difficulties. P1 and P3 exhibited impaired comparable working memory deficits, suggesting a dissociation between working memory and sentence comprehension. 相似文献
17.
Mickael Dinomais Eva Chinier Gregoire Lignon Isabelle Richard Aram Ter Minassian Sylvie Nguyen The Tich 《Research in developmental disabilities》2013,34(10):3487-3496
In patients with cerebral palsy (CP), neuroimaging studies have demonstrated that passive movement and action–observation tasks have in common to share neuronal activation in all or part of areas involved in motor system. Action observation with simultaneous congruent passive movements may have additional effects in the recruitment of brain motor areas. The aim of this functional magnetic resonance imaging (fMRI) study was to examine brain activation in patients with unilateral CP during passive movement with and without simultaneous observation of simple hand movement. Eighteen patients with unilateral CP (fourteen male, mean age 14 years and 2 months) participated in the study. Using fMRI block design, brain activation following passive simple opening–closing hand movement of either the paretic or nonparetic hand with and without simultaneous observation of a similar movement performed by either the left or right hand of an actor was compared. Passive movement of the paretic hand performed simultaneously to the observation of congruent movement activated more “higher motor areas” including contralesional pre-supplementary motor area, superior frontal gyrus (extending to premotor cortex), and superior and inferior parietal regions than nonvideo-guided passive movement of the paretic hand. Passive movement of the paretic hand recruited more ipsilesional sensorimotor areas compared to passive movement of the nonparetic hand. Our study showed that the combination of observation of congruent hand movement simultaneously to passive movement of the paretic hand recruits more motor areas, giving neuronal substrate to propose video-guided passive movement of paretic hand in CP rehabilitation. 相似文献
18.
Bani Sadr Alexandre Gregoire Bastien Tordo Jeremie Guyotat Jacques Boibieux Andre Janier Marc 《Annals of nuclear medicine》2019,33(6):424-433
Annals of Nuclear Medicine - Currently, the diagnosis of bone flap osteomyelitis (BFO) remains a challenge for medical imaging. The present study aimed to identify predictive scintigraphic patterns... 相似文献
19.
Kathryn Pfeiffer Jacob Clements McKayla Smith Matthew Gregoire Christopher Conti 《Physical Therapy Reviews》2019,24(5):216-222
AbstractBackground: Rhythmic auditory stimulation (RAS) uses music or a metronome to stimulate the audio-motor pathway in the brain. This type of stimulation uses external auditory cueing to try to create movement that is rhythmical. This has been shown to improve gait. This systematic review seeks to determine if the same benefits are seen in static and dynamic standing balance.Methods: Four researchers conducted an online search of Cochrane, Pubmed, Europe PMC, and J Stage on December 10th and December 11th, 2018. Each researcher assessed all abstracts and were then paired and assigned to each qualifying article. Quality of the selected articles was scored with two tools. Each article was summarized and the results were discussed. We screened 38 abstracts and 5 articles were used to conduct this systematic review.Results: Statistically significant results were shown in at least one objective measure in each of the five selected studies. Rhythmic Auditory Stimulation showed improvement with a P value less than .05 in patients post stroke within the past 2?years.Conclusions: Using RAS showed improvement in balance when compared to a control group in patients after experiencing a stroke. These findings can greatly assist clinicians when searching for the most effective interventions for patients after stroke who are experiencing difficulty with balance and gait. More research is needed to determine the long-term effects of RAS treatment using larger sample sizes and in the acute and subacute time frames of patients post-stroke. 相似文献
20.