digitoxin and Thromboembolism

Topics: Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Atrial Fibrillation; Catheter Ablation; Clinical Trials as Topic; Diagnosis, Differential; Digitalis; Humans; Pacemaker, Artificial; Thromboembolism; Warfarin

Topics: Acute Disease; Adrenal Cortex Hormones; Anti-Bacterial Agents; Asthma; Bronchodilator Agents; Chronic Disease; Diagnosis, Differential; Digitalis; Electrocardiography; Heart Auscultation; Humans; Hypertension, Pulmonary; Phytotherapy; Plants, Medicinal; Plants, Toxic; Pulmonary Circulation; Pulmonary Emphysema; Pulmonary Heart Disease; Radiography; Streptokinase; Thromboembolism

In heart failure, digitalis increases exercise capacity and reduces morbidity, but has no effect on survival. This raises the suspicion that the inotropic benefits of digitalis may be counteracted by serious adverse effects. Patients with atrial fibrillation (AF) were studied to clarify this.. In the Stroke Prevention using an ORal Thrombin Inhibitor in atrial Fibrillation (SPORTIF) III and V studies, 7329 patients with AF at moderate-to-high risk were randomised to preventive treatment of thromboembolism, either with warfarin or the oral direct thrombin inhibitor ximelagatran. The survival of users and non-users of digitalis was investigated.. At baseline, 53.4% of the study population used digitalis, and these patients had a higher mortality than non-users (255/3911 (6.5%) vs 141/3418 (4.1%), p<0.001; hazard ratio (HR) = 1.58 (95% CI 1.29 to 1.94)). Digitalis users also had more baseline risk factors. After multivariate risk factor adjustment, the increased mortality persisted (p<0.001; HR = 1.53 (95% CI 1.22 to 1.92 vs 1.23 to 1.92)).. The results suggest that digitalis, like other inotropic drugs, may increase mortality. This may be concealed in heart failure, but be revealed in patients with AF, who need the rate-reducing effect of digitalis, but do not benefit much from an increased inotropy. Cautious interpretation of the data is mandatory since the patients were not randomised with respect to digitalis use.

Topics: Aged; Anticoagulants; Atrial Fibrillation; Azetidines; Benzylamines; Cardiotonic Agents; Digitalis; Digitalis Glycosides; Double-Blind Method; Female; Humans; Kaplan-Meier Estimate; Male; Phytotherapy; Plant Preparations; Stroke; Thromboembolism; Warfarin

This survey deals with the 5 most important internal problems of old aged people undergoing surgery: chronic emphysematous bronchitis, geriatric heart, Diabetes mellitus, bleeding tendency during operation and venous thromboembolism.

Topics: Aged; Bandages; Blood Coagulation Disorders; Bronchitis; Diabetes Mellitus; Digitoxin; Digoxin; Emphysema; Exercise Therapy; Heart Failure; Humans; Hypoglycemic Agents; Preoperative Care; Respiratory Therapy; Strophanthins; Thromboembolism