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Prescription of antithrombotic therapy in older patients hospitalized for stroke and TIA. The gifa study
XVII S.I.S.A. National Congress CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND DEEP VENOUS THROMBOSIS: RELATIONSHIPS WITH ATHEROSCLEROSIS I N A LARGE SAMPLE OF HOSPITALIZED PATIENTS
339 PRESCRIPTION OF ANTITHROMBOTIC THERAPY I N OLDER PATIENTS HOSPITALIZED FOR STROKE AND TIA. THE GIFA STUDY
Vigna GB, Barban A, Gallerani M, Manfredini R, Fellin R
S Volpato, G Zuliani, C Maraldi, A BI~, M Ranzini, AR Atti & R Fellin
Department of Clinical and Experimental Medicine, Section of Internal Medicine 2, University of Ferrara, ITALY
2nd Section of Internal Medicine, Department Experimental Medicine, University of Ferrara, Italy
We evaluated the possible association between clinical atherosclerosis, chronic obstructive pulmonary disease (COPD) and venous thromboembolism (VT), since the latter two may share some pathogenic features with cardiovascular disease. All subjects older than 18 yrs., admitted to the Ferrara Hospital over a 5-year period were considered. In the same time-interval 235,637 admission were registered for 121,628 different subject~, 104,381 of whom satisfied our inclusion criteria. Of these patients, 4134 had a diagnosis of COPD and 512 of VT according to ICD9 coding. The statistical evaluation was performed by logistic regression analysis, covariating for gender, age, presence of diabetes, dyslipidemia and hypertension. Arterial disease, including coronary heart disease (CHD, adjusted odds ratio [OR]=2.161, CI 95% 2.012-2.321), cerebral ischemia (OR=1.186, CI 1.065-1.321), lowerlimb disease (OR=1.403, CI 1.189-1.656) and chronic heart failure (OR=3.645, CI 3.343-3.974) significantly more common in patients with COPD. Atherosclerosis was also more prevalent in subjects with a diagnosis of deep venous thrombosis: CHD (OR=1.341, CI 1.0711.679), cerebral ischemia (OR=1.724, CI 1.290-2.303), lower-limb disease (OR=1.662, CI 1.023-2.700) and vascular dementia (OR=1.652, CI 1.170-2.332). In conclusion, this rather large inhospital epidemiological survey, seems to confirm the link between inflammatory (COPD) and prothrombotic (TV) settings and atherosclerotic manifestation, in spite of some investigational limits and debatable interpretation.
Antithrombotic therapy has been demonstrated as an effective tool for secondary ischemic stroke prevention. Nevertheless scant data are available on actual prescription of this therapy in clinical practice. A total of 17,337 patients admitted to geriatric and internal medicine wards participating in the study in the 1993-1998 survey period were analyzed. Patients with coded diagnoses of ischemic stroke and transient ischemic attack (TIA) were selected. Data recorded included demographic and clinical characteristics and medication prescription during hospital stay and at discharge. Logistic regression analyses were used to identify conditions associated with the prescription of antiplatelet or anticoagulant drugs. Among 946 patients with diagnosis of stroke or TIA (mean age 78 years), 40% was discharged without antithrombotic prescription. Conditions that made the prescription more unlikely were diagnosis of stroke (odds ratio [OR:]: 0.61; 95% confidence interval [CI], 0.44-0.86), presence of anemia (OR: 0.70; 0.49-0.98), severe disability (OR: 0.48; 0.30-0.75), and cognitive impairment (OR: 0.58; 0.43-0.75). There was an independent and additive association of physical and cognitive status with antithrombotic therapy prescription. An high rate of patients affected by stroke or TIA are discharged from the hospital without antithrombotic therapy. The most important determinants of risk of not receiving an antithrombotic medication were cognitive and functional status. Clinicians should more carefully evaluate the possibility of prescribing antithrombotic therapy in older patients.
TEN YEARS OF SIMVASTATIN (S) / GEMFIBROZIL (G) COMBINATION TREATMENT I N PATIENTS WITH FAMILIAL COMBINED HYPERLIPIDEMIA (FCH) RESISTANT TO MONOTH ERAPY Volpe R, Rossetti A 1, Di Lecce VN ~, Guidi V 2, Antonini R~
Italian National Council of Research, Prevention and Safety Service, Rome; In our Lipid Clinic, during the period 1991-19921 we treated patients with FCH starting the treatment with a diet plus physical activity followed with a pharmacological therapy: S 20 mg/day or G 1,200 rag/day depending from baseline values. In 36 selected patients (below 65 years old, without heart, hepatic, renal or muscular diseases, endocrine disorders, impaired Na and K balance, not taking cyclosporine or erythromycin, and without strenuous muscular work), that under monotherapy showed a TC value still >240 mg/dL and a TG value still >200 mg/dL, the two drugs have been associated. In the 29 patients who reached the 10 years of combination treatment, compared to monotherapy, S+G produced a statistically higher improvement in TC (-16.8%), LDL-C (-17.9%), in HDL-C (+9.5%), in ApoB (-15.8%) and ApoAI (+12.5%). During the 10 years of follow-up, 7 patients dropped-out because adverse effects (mainly gastrointestinal distress and in 2 cases for high transaminases). However, none of the patients exhibited myopathy (muscle pain, weakness, CK levels >3 the u.n.I.) or rhabdomyolisis. In conclusion, S+G can be suggested in selected patients with FCH who are resistant to monotherapy. However, a strict monitoring of liver and kidney parameters and CK activity as well as patient counselling on the risk and warning signs of myopathy, are highly recommended in achieving a rapid diagnosis of myopathy, a possible adverse effect of this combination therapy.
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Clinical
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339 PRESCRIPTION OF ANTITHROMBOTIC THERAPY I N OLDER PATIENTS HOSPITALIZED FOR STROKE AND TIA. THE GIFA STUDY
Vigna GB, Barban A, Gallerani M, Manfredini R, Fellin R
S Volpato, G Zuliani, C Maraldi, A BI~, M Ranzini, AR Atti & R Fellin
Department of Clinical and Experimental Medicine, Section of Internal Medicine 2, University of Ferrara, ITALY
2nd Section of Internal Medicine, Department Experimental Medicine, University of Ferrara, Italy
We evaluated the possible association between clinical atherosclerosis, chronic obstructive pulmonary disease (COPD) and venous thromboembolism (VT), since the latter two may share some pathogenic features with cardiovascular disease. All subjects older than 18 yrs., admitted to the Ferrara Hospital over a 5-year period were considered. In the same time-interval 235,637 admission were registered for 121,628 different subject~, 104,381 of whom satisfied our inclusion criteria. Of these patients, 4134 had a diagnosis of COPD and 512 of VT according to ICD9 coding. The statistical evaluation was performed by logistic regression analysis, covariating for gender, age, presence of diabetes, dyslipidemia and hypertension. Arterial disease, including coronary heart disease (CHD, adjusted odds ratio [OR]=2.161, CI 95% 2.012-2.321), cerebral ischemia (OR=1.186, CI 1.065-1.321), lowerlimb disease (OR=1.403, CI 1.189-1.656) and chronic heart failure (OR=3.645, CI 3.343-3.974) significantly more common in patients with COPD. Atherosclerosis was also more prevalent in subjects with a diagnosis of deep venous thrombosis: CHD (OR=1.341, CI 1.0711.679), cerebral ischemia (OR=1.724, CI 1.290-2.303), lower-limb disease (OR=1.662, CI 1.023-2.700) and vascular dementia (OR=1.652, CI 1.170-2.332). In conclusion, this rather large inhospital epidemiological survey, seems to confirm the link between inflammatory (COPD) and prothrombotic (TV) settings and atherosclerotic manifestation, in spite of some investigational limits and debatable interpretation.
Antithrombotic therapy has been demonstrated as an effective tool for secondary ischemic stroke prevention. Nevertheless scant data are available on actual prescription of this therapy in clinical practice. A total of 17,337 patients admitted to geriatric and internal medicine wards participating in the study in the 1993-1998 survey period were analyzed. Patients with coded diagnoses of ischemic stroke and transient ischemic attack (TIA) were selected. Data recorded included demographic and clinical characteristics and medication prescription during hospital stay and at discharge. Logistic regression analyses were used to identify conditions associated with the prescription of antiplatelet or anticoagulant drugs. Among 946 patients with diagnosis of stroke or TIA (mean age 78 years), 40% was discharged without antithrombotic prescription. Conditions that made the prescription more unlikely were diagnosis of stroke (odds ratio [OR:]: 0.61; 95% confidence interval [CI], 0.44-0.86), presence of anemia (OR: 0.70; 0.49-0.98), severe disability (OR: 0.48; 0.30-0.75), and cognitive impairment (OR: 0.58; 0.43-0.75). There was an independent and additive association of physical and cognitive status with antithrombotic therapy prescription. An high rate of patients affected by stroke or TIA are discharged from the hospital without antithrombotic therapy. The most important determinants of risk of not receiving an antithrombotic medication were cognitive and functional status. Clinicians should more carefully evaluate the possibility of prescribing antithrombotic therapy in older patients.
TEN YEARS OF SIMVASTATIN (S) / GEMFIBROZIL (G) COMBINATION TREATMENT I N PATIENTS WITH FAMILIAL COMBINED HYPERLIPIDEMIA (FCH) RESISTANT TO MONOTH ERAPY Volpe R, Rossetti A 1, Di Lecce VN ~, Guidi V 2, Antonini R~
Italian National Council of Research, Prevention and Safety Service, Rome; In our Lipid Clinic, during the period 1991-19921 we treated patients with FCH starting the treatment with a diet plus physical activity followed with a pharmacological therapy: S 20 mg/day or G 1,200 rag/day depending from baseline values. In 36 selected patients (below 65 years old, without heart, hepatic, renal or muscular diseases, endocrine disorders, impaired Na and K balance, not taking cyclosporine or erythromycin, and without strenuous muscular work), that under monotherapy showed a TC value still >240 mg/dL and a TG value still >200 mg/dL, the two drugs have been associated. In the 29 patients who reached the 10 years of combination treatment, compared to monotherapy, S+G produced a statistically higher improvement in TC (-16.8%), LDL-C (-17.9%), in HDL-C (+9.5%), in ApoB (-15.8%) and ApoAI (+12.5%). During the 10 years of follow-up, 7 patients dropped-out because adverse effects (mainly gastrointestinal distress and in 2 cases for high transaminases). However, none of the patients exhibited myopathy (muscle pain, weakness, CK levels >3 the u.n.I.) or rhabdomyolisis. In conclusion, S+G can be suggested in selected patients with FCH who are resistant to monotherapy. However, a strict monitoring of liver and kidney parameters and CK activity as well as patient counselling on the risk and warning signs of myopathy, are highly recommended in achieving a rapid diagnosis of myopathy, a possible adverse effect of this combination therapy.
of
Clinical
and