Urethritis in the Female

A major feature of some inherited diseases affecting multiple body systems is defective dentition. Teeth may fail to develop, may erupt late, may be lost prematurely, or may be deformed. Shedding of teeth may be the first sign of hypophosphatasia. Anodontia is almost complete in some cases of Rieger's syndrome.     

Non-vitamin K oral anticoagulants versus vitamin K antagonists in the treatment of venous thromboembolic disease

Introduction: Venous thromboembolism (VTE) is a major cause of morbidity and mortality in the western world. The approval of non-vitamin K oral anticoagulants (NOACs) as antithrombotic alternatives to vitamin K antagonists (VKAs) has offered more treatment options to physicians for the prevention of VTE recurrence, fatal pulmonary embolism (PE) and long-term complications. Four NOACs (dabigatran, rivaroxaban, apixaban and edoxaban) that have been approved for the treatment of acute VTE following large phase III trials, where NOACs demonstrated similar efficacy and superior safety profile compared to VKAs.

Areas covered: The purpose of this review article is to summarise current knowledge of oral anticoagulation for the treatment of acute VTE and to compare NOACs with VKAs, highlighting the factors that might influence the decisions of physicians. Data for this article were obtained through a search of PubMed for trials comparing NOACs with VKAs in acute VTE setting and articles or analyses that interpreted results from these trials.

Expert opinion: The NOACs have changed clinical practice regarding oral anticoagulation for acute VTE. Despite their advantages, ‘grey zones’ still remain and more studies are needed to provide evidence and confirm the superiority (or at least non-inferiority) of NOACs over VKAs. Real world data might give additional insights.     

Dabigatran Dual Therapy Versus Warfarin Triple Therapy Post–PCI in Patients With Atrial Fibrillation and Diabetes

ObjectivesThe aim of this study was to evaluate dabigatran dual therapy versus warfarin triple therapy in patients with or without diabetes mellitus in the RE-DUAL PCI (Randomized Evaluation of Dual Antithrombotic Therapy With Dabigatran Versus Triple Therapy With Warfarin in Patients With Nonvalvular Atrial Fibrillation Undergoing Percutaneous Coronary Intervention) trial.BackgroundIt is unclear whether dual therapy is as safe and efficacious as triple therapy in patients with atrial fibrillation with diabetes following percutaneous coronary intervention.MethodsIn RE-DUAL PCI, 2,725 patients with atrial fibrillation (993 with diabetes) who had undergone PCI were assigned to warfarin triple therapy (warfarin, clopidogrel or ticagrelor, and aspirin) or dabigatran dual therapy (dabigatran 110 mg or 150 mg twice daily and clopidogrel or ticagrelor). Median follow-up was 13 months. The primary outcome was the composite of major bleeding or clinically relevant nonmajor bleeding, and the main efficacy outcome was the composite of death, thromboembolic events, or unplanned revascularization.ResultsAmong patients with diabetes, the incidence of major bleeding or clinically relevant nonmajor bleeding was 15.2% in the dabigatran 110 mg dual therapy group versus 27.5% in the warfarin triple therapy group (hazard ratio [HR]: 0.48; 95% confidence interval [CI] 0.35 to 0.67) and 23.8% in the dabigatran 150 mg dual therapy group versus 25.1% in the warfarin triple therapy group (HR: 0.87; 95% CI: 0.62 to 1.22). Risk for major bleeding or clinically relevant nonmajor bleeding was also reduced with both dabigatran doses among patients without diabetes (dabigatran 110 mg dual therapy: HR: 0.54; 95% CI: 0.42 to 0.70; dabigatran 150 mg dual therapy: HR: 0.63; 95% CI: 0.48 to 0.83). Risk for the efficacy endpoint was comparable between treatment groups for both patients with and those without diabetes. No interaction between treatment and diabetes subgroup could be observed, either for bleeding or for composite efficacy endpoints.ConclusionsIn this subgroup analysis, dabigatran dual therapy had a lower risk for bleeding and a comparable rate of the efficacy endpoint compared with warfarin triple therapy in patients with atrial fibrillation with or without diabetes following percutaneous coronary intervention.     

Renal Function and Outcomes With Dabigatran Dual Antithrombotic Therapy in Atrial Fibrillation Patients After PCI

ObjectivesThe study sought to evaluate the effect of dabigatran dual therapy versus warfarin triple therapy across categories of renal function in the RE-DUAL PCI (Randomized Evaluation of Dual Antithrombotic Therapy with Dabigatran versus Triple Therapy with Warfarin in Patients with Nonvalvular Atrial Fibrillation Undergoing Percutaneous Coronary Intervention) trial.BackgroundThe RE-DUAL PCI (NCT02164864) trial of patients with atrial fibrillation undergoing percutaneous coronary intervention reported that dabigatran dual therapy (110 or 150 mg twice daily, plus clopidogrel or ticagrelor) reduced the primary endpoint of major bleeding events (MBE) or clinically relevant nonmajor bleeding events (CRNMBE) compared with warfarin triple therapy, with noninferiority in overall thromboembolic events.MethodsRisk of a first MBE or CRNMBE and the composite of death or thromboembolic event (DTE) or unplanned revascularization were evaluated in 2,725 patients according to baseline creatinine clearance (CrCl) categories: 30 to <50, 50 to <80, and ≥80 ml/min.ResultsCompared with warfarin, dabigatran 110 mg dual therapy reduced risk of MBE or CRNMBE across all categories of CrCl (p for interaction = 0.19). Dabigatran 150 mg dual therapy reduced risk of MBE or CRNMBE regardless of the CrCl category (p for interaction = 0.31). Risk of DTE or unplanned revascularization was similar to warfarin triple therapy for dabigatran 110 mg dual therapy across all CrCl categories. Dabigatran 150 mg dual therapy versus warfarin triple therapy had similar risk for DTE or unplanned revascularization in patients with CrCl 30 to <80 ml/min and lower risk at CrCl ≥80 ml/min (p for interaction = 0.02).ConclusionsIn the RE-DUAL PCI trial, dabigatran dual therapy reduced bleeding events versus warfarin triple therapy irrespective of renal function, with overall similar risks of thromboembolic events but lower risks with dabigatran 150 mg in patients with normal CrCl.     

口服新型抗凝药患者牙拔除术后出血情况分析

 目的　分析口服新型抗凝药患者牙拔除术后出血情况。方法　选取2018年1月至2019年8月于大连市口腔医院心电监护门诊行牙拔除术的口服抗凝药患者212例作为研究组,其中口服新型抗凝药直接凝血酶抑制剂达比加群酯患者67例（凝血酶抑制剂组）,口服新型抗凝药直接Ⅹa因子抑制剂利伐他班或阿哌沙班患者59例（Ⅹa因子抑制剂组）,口服华法林患者86例（华法林组）。选取同期行牙拔除术的未服用抗凝药患者99例作为对照组。观察并记录各组患者牙拔除术后0.5、1、24、72 h的出血情况。结果　术后0.5、24 h各组出血发生率总的比较,差异有统计学意义（χ2值分别为9.79、8.13,P值分别为0.021、0.044）。进一步组间两两比较发现,各研究组出血发生率高于对照组,且华法林组出血发生率高于凝血酶抑制剂组和Ⅹa因子抑制剂组,差异均有统计学意义（均P < 0.05）,而两新型抗凝药组（凝血酶抑制剂组与Ⅹa因子抑制剂组）比较,差异无统计学意义（P > 0.05）。术后1、72 h各组出血发生率比较,差异均无统计学意义（χ2值分别为4.06、5.56,P值分别为0.251、0.165）。结论　相较于口服华法林患者,口服新型抗凝药患者牙拔除术后出血发生率更低,故口服新型抗凝药患者无需因简单的牙拔除术而调整或中断服用抗凝药。     

达比加群临床疗效与安全性评价

达比加群作为新型口服抗凝药,近年已被众多指南推荐为防治血栓栓塞性疾病或心房颤动且具有脑卒中风险的一线药物。相对于华法林,达比加群在临床疗效、患者依从性及安全性等方面具有更多优势。现就达比加群的临床疗效及安全性等方面的新近报道进行综述。