vitamin-k-semiquinone-radical and Coronary-Disease

Atrial fibrillation (AF) is the most frequently encountered sustained arrhythmia with a prevalence of 0.5-10%, depending predominantly on age. The arrhythmia is associated with significant morbidity and mortality, mainly due to thromboembolic events including stroke and systemic embolisms. These complications can be effectively prevented with anticoagulation therapy either with vitamin K antagonists (VKA) or with non-vitamin K antagonists (NOAC). VKA therapy is effective in preventing strokes but these medications are difficult to use, are associated with significant bleeding risk, and have pharmacokinetic/dynamic properties that make their use cumbersome. NOACs-either factor II or factor Xa inhibitors-have been developed over the past two decades and have been tested against VKA in large randomized controlled trials. This trial evidence was complemented more recently by increasing real-world data comprising several 100,000 patients. Finally, NOACs have been examined for their use in specific clinical situations, for example, in patients undergoing cardioversion, catheter ablation, or coronary interventions. In all of these clinical scenarios, NOACs have been similarly effective or-in many instances-even superior to treatment with VKA. Recent guidelines, therefore, recommend NOAC therapy for stroke prevention in AF as first-line therapy.

Topics: Anticoagulants; Atrial Fibrillation; Coronary Disease; Drug Therapy, Combination; Factor Xa Inhibitors; Humans; Platelet Aggregation Inhibitors; Prothrombin; Pulmonary Embolism; Randomized Controlled Trials as Topic; Risk Factors; Stents; Thromboembolism; Venous Thrombosis; Vitamin K

The Multimorbid Patient: Use of New Oral Anticoagulants in Patients with Chronic Kidney Disease Abstract. Increasing life expectancy in Western countries is associated with a high prevalence of multiple chronic diseases which is defined by the term "multimorbidity". Many of these patients suffer from chronic kidney disease (CKD) and thrombogenic comorbidities such as atrial fibrillation with the need for oral anticoagulation. For decades vitamin K antagonists have been exclusively prescribed for oral anticoagulation. However, due to altered pharmacokinetics and bioavailability of these drugs in CKD, a significant risk of bleeding exists. The introduction of direct oral anticoagulants as a new and promising alternative to vitamin K antagonists was -especially for CKD patients - highly anticipated. However, data from randomized studies are missing for older patients with advanced CKD. Consequently, a careful evaluation of the risk-benefit ratio is recommended for this sensitive patient population.. Zusammenfassung. Die zunehmende Lebenserwartung in den westlichen Ländern führt zu einer gleichzeitigen Zunahme chronischer Krankheiten, was mit «Multimorbidität» bezeichnet wird. Viele dieser Patienten leiden an chronischer Niereninsuffizienz (CKD) sowie thrombogenen Komorbiditäten wie z.B. Vorhofflimmern, weshalb eine orale Antikoagulation indiziert ist. Für lange Zeit standen lediglich die Vitamin-K-Antagonisten zur Verfügung. Aufgrund der unter anderem veränderten Pharmakokinetik sowie Bioverfügbarkeit dieser Medikamente bei CKD besteht jedoch gleichzeitig ein deutlich erhöhtes Blutungsrisiko. Die Einführung der direkten oralen Antikoagulanzien als neue und vielversprechende Alternative zu Vitamin-K-Antagonisten wurde daher insbesondere für die Population der CKD-Patienten mit grosser Spannung erwartet. Aufgrund der noch nicht ausreichenden Datenlage insbesondere bei älteren Patienten mit fortgeschrittener Niereninsuffizienz sollte das Risiko-Nutzen-Verhältnis vor Therapiebeginn sorgfältig evaluiert werden.

Topics: Anticoagulants; Arterial Occlusive Diseases; Atrial Fibrillation; Comorbidity; Contraindications; Coronary Disease; Dabigatran; Glomerular Filtration Rate; Kidney Failure, Chronic; Pyrazoles; Pyridines; Pyridones; Rivaroxaban; Thiazoles; Thromboembolism; Vitamin K

Atrial fibrillation (AF) is the most frequent sustained arrhythmia. Overall prevalence is estimated to 5.5% and the incidence increases with age. As the population ages, the prevalence and costs of AF are expected to increase. AF is the most important cause of stroke in patients >75years. Until recently, Vitamin K antagonists (VKAs) were the only available oral anticoagulants (OACs) evaluated for long-term treatment of patients with AF with or without coronary heart disease (CHD). This situation was challenged by introduction of non-VKA oral anticoagulants (NOACs). In AF, use of NOACs seems to be as effective and safe as VKAs, especially in elderly patients. AF and CHD are frequently associated and the question of antithrombotic management in aging patients is delicate. In elderly patients experiencing a new AF episode after an acute coronary syndrome, triple antithrombotic therapy should be as short as possible in order to decrease the risk of major bleedings. To date, there is no specific study or available guidelines regarding the NOACs use specifically in elderly patients experiencing both AF and CHD. In this review, we try to provide a perspective on NOACs future incorporation into clinical practice in elderly patients with both AF and CHD.

Topics: Administration, Oral; Aged; Anticoagulants; Atrial Fibrillation; Coronary Disease; Humans; Stroke; Vitamin K

Data regarding the clinical outcomes in patients with atrial fibrillation (AF) receiving dual antiplatelet therapy (DAPT) and an anticoagulant in addition to DAPT (DAPT + vitamin K antagonist [VKA]) after coronary stent implantation are still controversial. Therefore, in order to solve this issue, we aim to compare the adverse clinical outcomes in AF patients receiving DAPT and DAPT + VKA after percutaneous coronary intervention and stenting (PCI-S).. Observational studies comparing the adverse clinical outcomes such as major bleeding, major adverse cardiovascular events, stroke, myocardial infarction, all-cause mortality, and stent thrombosis (ST) in AF patients receiving DAPT + VKA therapy, and DAPT after PCI-S have been searched from Medline, EMBASE, and PubMed databases. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to express the pooled effect on discontinuous variables, and the pooled analyses were performed with RevMan 5.3.. Eighteen studies consisting of a total of 20,456 patients with AF (7203 patients received DAPT + VKA and 13,253 patients received DAPT after PCI-S) were included in this meta-analysis. At a mean follow-up period of 15 months, the risk of major bleeding was significantly higher in DAPT + VKA group, with OR 0.62 (95% CI 0.50-0.77, P < 0.0001). There was no significant differences in myocardial infarction and major adverse cardiovascular event between DAPT + VKA and DAPT, with OR 1.27 (95% CI 0.92-1.77, P = 0.15) and OR 1.17 (95% CI 0.99-1.39, P = 0.07), respectively. However, the ST, stroke, and all-cause mortality were significantly lower in the DAPT + VKA group, with OR 1.98 (95% CI 1.03-3.81, P = 0.04), 1.59 (95% CI 1.08-2.34, P = 0.02), and 1.41 (95% CI 1.03-1.94, P = 0.03), respectively.. At a mean follow-up period of 15 months, DAPT + VKA was associated with significantly lower risk of stroke, ST, and all-cause mortality in AF patients after PCI-S compared with DAPT group. However, the risk of major bleeding was significantly higher in the DAPT + VKA group.

Topics: Anticoagulants; Atrial Fibrillation; Blood Vessel Prosthesis Implantation; Coronary Disease; Drug Therapy, Combination; Humans; Observational Studies as Topic; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Stents; Vitamin K

The separate nature of venous and arterial thrombotic disorders has recently been challenged. Patients with venous thromboembolism (VTE) have an increased risk of subsequent symptomatic arterial cardiovascular events, the risk being higher in those with unexplained episodes. Among the implications of this association, there is the potential for old and new antithrombotic drugs to impact on the development of both venous and arterial cardiovascular events. According to the results of recent studies, aspirin in low doses, when administered for the long-term management of patients with unprovoked VTE, reduces by approximately 35% the risk of recurrent VTE while offering a considerable protection against the development of arterial cardiovascular events. By contrast, there is no room to expect a reduction in the risk of subsequent arterial cardiovascular events in patients treated with vitamin K antagonists (VKA) in comparison to patients in whom VKAs are discontinued. According to the results from recent randomized clinical trials, the likelihood of arterial cardiovascular events in patients on the novel direct factor Xa inhibitors is unlikely to differ from that of patients receiving conventional anticoagulation. As dabigatran has been associated with a slight increase in the risk of myocardial infarction over warfarin, its use should be discouraged in patients with coronary heart disease. The long-term use of low-dose apixaban beyond the first months in patients with unprovoked VTE may decrease the long-term risk of arterial, as well as venous, thrombotic events.

Topics: Anticoagulants; Coronary Disease; Embolism; Humans; Incidence; Myocardial Infarction; Risk Factors; Time Factors; Venous Thromboembolism; Vitamin K

The review analyses various approaches to management of patients presenting with atrial fibrillation and having to take vitamin K agonists in order to prevent arterial thromboembolic complications in cases they develop exacerbations of their coronary hear disease and/or require transcutaneous coronary interventions. With the problem being insufficiently studied as yet, the majority of therapeutic decisions as to the most efficient and safe methods of administering antithrombotic agents in the clinical situations involved are made based on the results of follow up of the patients, the data regarding peculiarities of the action of therapeutic agents, and common sense. Presented herein are contemporary recommendations on long-term antithrombotic therapy in patients suffering from atrial fibrillation and taking vitamin K antagonists and subjected to coronary stenting.

Topics: Aged; Angioplasty, Balloon, Coronary; Anticoagulants; Atrial Fibrillation; Coronary Disease; Fibrinolytic Agents; Follow-Up Studies; Heparin; Humans; Multicenter Studies as Topic; Randomized Controlled Trials as Topic; Retrospective Studies; Thromboembolism; Time Factors; Vitamin K; Warfarin

Topics: Angioplasty, Balloon, Coronary; Angiotensin II Type 2 Receptor Blockers; Anticoagulants; Atrial Fibrillation; Cardiology; Coronary Disease; Drug-Eluting Stents; Heart Diseases; Humans; Morpholines; Myocardial Infarction; Rivaroxaban; Thiophenes; Thrombosis; Vitamin K

Topics: Animals; Arteries; Atherosclerosis; Biomechanical Phenomena; Calcinosis; Calcium-Binding Proteins; Coronary Disease; Extracellular Matrix Proteins; Humans; Matrix Gla Protein; Mice; Mixed Function Oxygenases; Rupture; Vitamin K; Vitamin K Epoxide Reductases

Although vitamin deficiency is encountered infrequently in developed countries, inadequate intake of several vitamins is associated with chronic disease.. To review the clinically important vitamins with regard to their biological effects, food sources, deficiency syndromes, potential for toxicity, and relationship to chronic disease.. We searched MEDLINE for English-language articles about vitamins in relation to chronic diseases and their references published from 1966 through January 11, 2002.. We reviewed articles jointly for the most clinically important information, emphasizing randomized trials where available.. Our review of 9 vitamins showed that elderly people, vegans, alcohol-dependent individuals, and patients with malabsorption are at higher risk of inadequate intake or absorption of several vitamins. Excessive doses of vitamin A during early pregnancy and fat-soluble vitamins taken anytime may result in adverse outcomes. Inadequate folate status is associated with neural tube defect and some cancers. Folate and vitamins B(6) and B(12) are required for homocysteine metabolism and are associated with coronary heart disease risk. Vitamin E and lycopene may decrease the risk of prostate cancer. Vitamin D is associated with decreased occurrence of fractures when taken with calcium.. Some groups of patients are at higher risk for vitamin deficiency and suboptimal vitamin status. Many physicians may be unaware of common food sources of vitamins or unsure which vitamins they should recommend for their patients. Vitamin excess is possible with supplementation, particularly for fat-soluble vitamins. Inadequate intake of several vitamins has been linked to chronic diseases, including coronary heart disease, cancer, and osteoporosis

Topics: Ascorbic Acid; Avitaminosis; Blood Coagulation; Breast Neoplasms; Carotenoids; Chronic Disease; Colorectal Neoplasms; Coronary Disease; Dietary Supplements; Female; Folic Acid; Fractures, Bone; Humans; Lung Neoplasms; Male; Neoplasms; Neural Tube Defects; Prostatic Neoplasms; Risk Factors; Vitamin A; Vitamin B 12; Vitamin B 6; Vitamin D; Vitamin E; Vitamin K; Vitamins

Topics: Antidepressive Agents; Antihypertensive Agents; Appetite Depressants; Blood Coagulation Disorders; Cardiovascular Diseases; Contraceptives, Oral; Coronary Disease; Daunorubicin; Dihydroxyphenylalanine; Heart Diseases; Humans; Iatrogenic Disease; Imipramine; Monoamine Oxidase Inhibitors; Phenothiazines; Shock, Cardiogenic; Transfusion Reaction; Vitamin K

The authors assessed the use of dual antiplatelet therapy (DAPT) and outcomes in patients undergoing percutaneous coronary intervention (PCI) during the ROCKET AF (Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation).. The frequency, patterns, and outcomes when adding DAPT to non-vitamin K antagonist oral anticoagulants in the setting of PCI in patients with AF are largely unknown.. The study population included all patients in the treatment group of the ROCKET AF trial divided by the receipt of PCI during follow-up. Clinical characteristics, PCI frequency, and rates of DAPT were reported. Clinical outcomes were adjudicated independently as part of the trial.. Among 14,171 patients, 153 (1.1%) underwent PCI during a median 806 days of follow-up. Patients treated with rivaroxaban were significantly less likely to undergo PCI compared with warfarin-treated patients (61 vs. 92; p = 0.01). Study drug was continued during PCI in 81% of patients. Long-term DAPT (≥30 days) was used in 37% and single antiplatelet therapy in 34%. A small number switched from DAPT to monotherapy within 30 days of PCI (n = 19 [12.3%]) and 15% of patients received no antiplatelet therapy after PCI. Rates of stroke/systemic embolism and major bleeding events were high in post-PCI patients (4.5/100 patient-years and 10.2/100 patient-years) in both treatment groups.. In patients with AF at moderate to high risk for stroke, PCI occurred in <1% per year. DAPT was used in a variable manner, with the majority of patients remaining on study drug after PCI. Rates of both thrombotic and bleeding events were high after PCI, highlighting the need for studies to determine the optimal antithrombotic therapy.

Topics: Administration, Oral; Aged; Anticoagulants; Atrial Fibrillation; Coronary Disease; Coronary Thrombosis; Double-Blind Method; Drug Substitution; Drug Therapy, Combination; Factor Xa Inhibitors; Female; Hemorrhage; Humans; Intracranial Embolism; Male; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Risk Factors; Rivaroxaban; Stroke; Time Factors; Treatment Outcome; Vitamin K

The respective roles of thrombosis and spasm in the pathogenesis of coronary disease is a subject of current discussion. Critical study of trials of long-term secondary prevention of myocardial infarction carried out between 1967 and 1982 have failed to yield any definitive conclusion as to the value of oral anticoagulants, aspirin, sulfinpyrazone or dipyridamole. However oral anticoagulants should be prescribed in the long-term, in the absence of any contra-indication, in cases of myocardial infarction complicated by ventricular ectasia, arrhythmias or cardiac failure with cardiomegaly. The use of better methods in secondary prevention trials would be desirable. Primary prevention of myocardial infarction using drugs raises difficult problems, in particular economic.

Topics: 4-Hydroxycoumarins; Anticoagulants; Aspirin; Clinical Trials as Topic; Coronary Disease; Fibrinolytic Agents; Humans; Indenes; Long-Term Care; Middle Aged; Myocardial Infarction; Platelet Aggregation; Vitamin K

Topics: Adult; Aged; Clinical Trials as Topic; Coronary Disease; Diet; Humans; Injections, Subcutaneous; Prothrombin Time; Vitamin K; Vitamin K 1; Warfarin

To explore the predictive value of ABC bleeding score and SAMe-TT2R2 score on the risk of bleeding in patients with nonvalvular atrial fibrillation (NVAF) complicated with coronary heart disease (CHD) after anticoagulation.. 149 patients with NVAF complicated with CHD were followed up in our hospital for one year. The bleeding events during the follow-up period were observed, the ABC bleeding score and SAMe-TT2R2 score were calculated, the predictive value of the two scoring methods for the main bleeding risk was analyzed by the ROC curve, and the AUC area under the ROC curve of the two scoring methods was compared by the Delong test.. There were 32 bleeding events during the follow-up period. The AUC of ABC bleeding score and SAMe-TT2R2 score were 0.775 (. Both the ABC bleeding score and SAMe-TT2R2 score can predict the risk of bleeding after anticoagulation in patients with NVAF and CHD. The critical value of the SAMe-TT2R2 score for predicting bleeding events in patients with NVAF and CHD may need to be increased to 4 or 5, and the prediction ability of ABC bleeding score is significantly better than that of the SAMe-TT2R2 score.

Topics: Anticoagulants; Atrial Fibrillation; Coronary Disease; Hemorrhage; Humans; Predictive Value of Tests; Stroke; Vitamin K

The role of vitamin K in the regulation of vascular calcification is established. However, the association of dietary vitamins K1 and K2 with risk of coronary heart disease (CHD) is inconclusive.. Prospective cohort study.. We followed participants in the community-based Hordaland Health Study from 1997 - 1999 through 2009 to evaluate associations between intake of vitamin K and incident (new onset) CHD. Baseline diet was assessed by a past-year food frequency questionnaire. Energy-adjusted residuals of vitamin K1 and vitamin K2 intakes were categorised into quartiles.. 2987 Norwegian men and women, age 46-49 years.. Information on incident CHD events was obtained from the nationwide Cardiovascular Disease in Norway (CVDNOR) Project. Multivariable Cox regression estimated HRs and 95% CIs with test for linear trends across quartiles. Analyses were adjusted for age, sex, total energy intake, physical activity, smoking and education. A third model further adjusted K1 intake for energy-adjusted fibre and folate, while K2 intake was adjusted for energy-adjusted saturated fatty acids and calcium.. During a median follow-up time of 11 years, we documented 112 incident CHD cases. In the adjusted analyses, there was no association between intake of vitamin K1 and CHD (HR. A higher intake of vitamin K2 was associated with lower risk of CHD, while there was no association between intake of vitamin K1 and CHD.. NCT03013725.

Topics: Adult; Cohort Studies; Coronary Disease; Diet; Female; Humans; Male; Middle Aged; Norway; Prospective Studies; Risk Factors; Vitamin K

The aim of this investigation was to analyse "total blood loss" (TBL), "blood transfusion rate" (BT) and the "amount of transfused blood units" (BU) between the different primary shoulder arthroplasty (SA) types: reverse, anatomical and stemless. Only primary SA was included. Further goal was to identify risk factors for TBL, amount of BU and BT rate.. A retrospective charts analysis of patients who received primary SA for degenerative shoulder pathology in our institution between 2004 and 2016 was performed. The demographic data, co-morbidities, haemoglobin and hematocrit level, BT rate, amount of transfused BU etc. were collected. TBL was estimated. Linear regression, log-linear poisson regression and logistic regression were used to compare the outcomes TBL, amount of transfused BU and BT rate, respectively, between different prosthesis types.. Of 278 patients included in this study 209 received reverse, 57 anatomical and 12 stemless SA. Mean TBL was 392.7 ml in reverse, 394.6 ml in anatomical and 298.3 ml in stemless SA. The BT rate and mean amount of BU were, respectively, 14.4% and 0.32 in reverse and 8.77% and 0.23 in anatomical SA. None of the patients with stemless arthroplasty received BT. Significant risk factors for elevated TBL are operation time, higher BMI, male sex. Significant risk parameters for BT and higher amount of transfused BU are low BMI, cemented arthroplasty, coronary heart disease, ASA score > 2 and previous therapy with vitamin K antagonists.. Although there were little differences between the blood transfusion rates in reverse vs. anatomical arthroplasty, there was no difference in total blood loss between these different prosthesis types. None of the patients with stemless arthroplasty received blood transfusion. There are various risk factors affecting total blood loss and blood transfusion rate. However, risk parameters influencing blood transfusion may be different to them affecting total blood loss.

Topics: Aged; Arthroplasty, Replacement, Shoulder; Blood Loss, Surgical; Blood Transfusion; Body Mass Index; Coronary Disease; Female; Humans; Male; Middle Aged; Operative Time; Retrospective Studies; Risk Factors; Sex Factors; Vitamin K

High vitamin K intake is associated with a reduced risk of coronary heart disease (CHD). This is thought to be mediated by increased activation of the vitamin K-dependent matrix γ-carboxyglutamate protein (MGP). Desphospho-uncarboxylated MGP (dp-ucMGP) is associated with both vitamin K status and vascular calcification. However, the association of dp-ucMGP with CHD and stroke in the general population has not been investigated to date.. To investigate the association of dp-ucMGP with incident CHD or stroke.. A prospective case-cohort study with a representative baseline sample of 1406 participants and 1154 and 380 incident cases of CHD and stroke, respectively, was nested within the EPIC-NL study. Circulating dp-ucMGP levels were measured with ELISA in baseline plasma samples. The incidence rates of fatal and non-fatal CHD and stroke were obtained by linkage to national registers. Cox proportional hazard models were used to calculate hazard ratios (HRs) per standard deviation (SD) and per quartile of circulating dp-ucMGP levels.. The average follow-up was 11.5 years. Levels of dp-ucMGP were not associated with CHD risk, with an HR per SD of 1.00 (95% confidence interval [CI] 0.93-1.07) and an HRQ4 vs. Q1 of 0.94 (95% CI 0.79-1.13) after adjustment for cardiovascular risk factors. There was no association of dp-ucMGP stroke risk (HRSD  0.98, 95% CI 0.90-1.08; and HRQ4 vs. Q1  1.09, 95% CI 0.78-1.51). This study could not confirm that high dp-ucMGP levels, reflecting poor vitamin K status, are associated with increased CHD or stroke risk in the general population.

Topics: Adult; Aged; Calcinosis; Calcium-Binding Proteins; Case-Control Studies; Coronary Disease; Enzyme-Linked Immunosorbent Assay; Extracellular Matrix Proteins; Female; Follow-Up Studies; Humans; Incidence; Male; Matrix Gla Protein; Middle Aged; Proportional Hazards Models; Risk Factors; Stroke; Treatment Outcome; Vitamin K

To investigate the relationship of circulating matrix Gla protein (MGP) species with incident cardiovascular disease (CVD) or coronary heart disease (CHD) in type 2 diabetic patients.. EPIC-NL is a prospective cohort study among 40,011 Dutch men and women. At baseline (1993-1997), 518 participants were known to have type 2 diabetes. MGP levels were measured by ELISA techniques in baseline plasma samples. The incidence of fatal and nonfatal CVD and CVD subtypes-CHD, peripheral arterial disease (PAD), heart failure, and stroke-were obtained by linkage to national registers. Cox proportional hazard models were used to calculate hazard ratios (HRs), adjusted for sex, waist-to-hip ratio, physical activity, and history of CVD.. During a median 11.2 years of follow-up, 160 cases of CVD were documented. Higher circulating desphospho-uncarboxylated MGP (dp-ucMGP) levels were significantly associated with higher risk of CVD, with an HR per SD (HRSD) of 1.21 (95% CI 1.06-1.38), PAD (HRSD 1.32 [95% CI 1.07-1.65]), and heart failure (HRSD 1.75 [95% CI 1.42-2.17]) after adjustment. Higher circulating dp-ucMGP levels were not related to risk of CHD (HRSD 1.12 [95% CI 0.94-1.34]) or stroke (HRSD 1.05 [95% CI 0.73-1.49]). Circulating desphospho-carboxylated MGP and circulating total-uncarboxylated MGP levels were not associated with CVD or CVD subtypes.. High dp-ucMGP levels were associated with increased CVD risk among type 2 diabetic patients, especially with the subtypes PAD and heart failure, while other MGP species were not related to CVD risk. These results suggest that a poor vitamin K status is associated with increased CVD risk.

Topics: Calcium-Binding Proteins; Cardiovascular Diseases; Coronary Disease; Diabetes Mellitus, Type 2; Extracellular Matrix Proteins; Female; Humans; Incidence; Male; Matrix Gla Protein; Middle Aged; Netherlands; Proportional Hazards Models; Prospective Studies; Risk; Vitamin K; Waist-Hip Ratio

To evaluate outcomes of the endothelial progenitor cell (EPC) capture stent in patients on chronic anti-vitamin K (AVK) regimen, requiring percutaneous coronary intervention (PCI).. Between February 2007 and February 2008, 78 consecutive patients under chronic AVK treatment undergoing PCI were enrolled in the registry and received an EPC capture stent. The incidence of comorbid conditions was analysed by the Charlson index. Dual antiplatelet therapy (DAT, aspirin and clopidogrel) was prescribed for one month only together with the AVK treatment, after PCI. Major adverse clinical events (MACE) rate, included death, acute myocardial infarction (MI) or target lesion revascularisation (TLR), incidence of stent thrombosis and rate of haemorrhagic events were collected. A?Charlson index >3 was present in 89% of patients. At 14±8 months the cumulative rate of MACE was 22%: 10 deaths (six cardiac deaths), and six TLR. No MI or definitive/probable stent thromboses occurred during follow-up. Four major haemorrhagic episodes occurred during follow-up, all of them after the first month.. Patients on AVK treatment represent a highly comorbid population with a high event rate after PCI. The strategy of PCI with an EPC capture stent and short duration of DAT may be used in patients who need a short-term DAT.

Topics: Aged; Angioplasty, Balloon, Coronary; Anticoagulants; Aspirin; Clopidogrel; Coated Materials, Biocompatible; Coronary Disease; Disease-Free Survival; Endothelial Cells; Female; Humans; Male; Platelet Aggregation Inhibitors; Stem Cells; Stents; Ticlopidine; Vitamin K

In vitro data suggest protective roles for vitamins K and D in inflammation. To examine associations between vitamins K and D and inflammation in vivo, the authors used multiple linear regression analyses, adjusted for age, sex, body mass index, triglyceride concentrations, use of aspirin, use of lipid-lowering medication, season, menopausal status, and hormone replacement therapy. Participants were from the Framingham Offspring Study (1997-2001; n = 1,381; mean age = 59 years; 52% women). Vitamin K status, measured by plasma phylloquinone concentration and phylloquinone intake, was inversely associated with circulating inflammatory markers as a group and with several individual inflammatory biomarkers (p < 0.01). Percentage of undercarboxylated osteocalcin, a functional measure of vitamin K status, was not associated with overall inflammation but was associated with C-reactive protein (p < 0.01). Although plasma 25-hydroxyvitamin D was inversely associated with urinary isoprostane concentration, an indicator of oxidative stress (p < 0.01), overall associations between vitamin D status and inflammation were inconsistent. The observation that high vitamin K status was associated with lower concentrations of inflammatory markers suggests that a possible protective role for vitamin K in inflammation merits further investigation.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Coronary Disease; Cross-Sectional Studies; Cytokines; Female; Humans; Inflammation; Inflammation Mediators; Longitudinal Studies; Male; Middle Aged; Risk Factors; Survival Analysis; Vitamin D; Vitamin K; Vitamins

Topics: Adrenergic beta-Antagonists; Anemia; Angioplasty, Balloon, Coronary; Anticoagulants; Biomarkers; Blood Coagulation Factors; Cardiotonic Agents; Coronary Angiography; Coronary Disease; Diabetic Angiopathies; Diabetic Nephropathies; Diagnosis, Differential; Drug Interactions; Drug Resistance; Electrocardiography; Exercise Therapy; Hemorrhage; Humans; Long-Term Care; Nitrates; Physical Examination; Platelet Aggregation Inhibitors; Risk Assessment; Thrombin; Vitamin K

Topics: 4-Hydroxycoumarins; Abdomen; Acenocoumarol; Aged; Anti-Bacterial Agents; Anticoagulants; Coronary Disease; Cytochrome P-450 Enzyme System; Drug Interactions; Hematoma; Humans; Indenes; Liver; Male; Roxithromycin; Vitamin K

Complex I (nicotinamide adenine dinucleotide-ubiquinone reductase) is a complex enzyme system located in the inner mitochondrial membrane. It has the ability to catalyze several different enzymatic reactions in electron transport, and is known to be one of the respiratory chain components most sensitive to ischaemia. Mitochondria and two complexes I (complex IA and complex IB) were isolated from normal and ischaemic myocardial tissue. Enzymatic activities, polypeptide composition, as well as other components such as non-haem iron, acid-labile sulphur and ubiquinone, were determined. The results indicated that complex IB reflected the enzymatic changes in the mitochondria during myocardial ischaemia, but complex IA did not. The lesion that resulted from ischaemia was localised as altered enzymatic activities due to a different polypeptide composition, as well as loss of ubiquinone and non-haem iron from complex IB.

Topics: Animals; Coronary Disease; Electron Transport; Female; Ferricyanides; Glutamates; Glutamic Acid; Kinetics; Male; Mitochondria, Heart; NAD; NAD(P)H Dehydrogenase (Quinone); NADP; Oxidative Phosphorylation; Oxygen Consumption; Peptides; Perissodactyla; Quinone Reductases; Ubiquinone; Vitamin K

Complex I (NADH-ubiquinone reductase) is a complex system located in the inner mitochondrial membrane and has the ability to catalyse several different enzymatic reactions concerned in electron transport. It is known to be one of the first components of the respiratory chain to be damaged by ischemia. Our results, using autolysis in the rat heart as experimental model, indicate that the NADH dehydrogenase system was impaired relatively early during ischemia while transhydrogenation and NADPH dehydrogenation appeared to be relatively resistant.

Topics: 2,6-Dichloroindophenol; Animals; Autolysis; Coronary Disease; Female; Ferrocyanides; Mitochondria, Heart; NAD(P)H Dehydrogenase (Quinone); NADH, NADPH Oxidoreductases; Oxygen; Oxygen Consumption; Phosphorylation; Quinone Reductases; Rats; Rats, Inbred Strains; Ubiquinone; Vitamin K

Topics: Adult; alpha-Tocopherol; Animals; Blood Coagulation Factors; Coronary Disease; Drug Interactions; Hemorrhage; Humans; Male; Middle Aged; Tocopherols; Vitamin E; Vitamin K; Warfarin

Report of an anatomical-clinical study concerning 173 patients with an average follow-up period of 5 and 1/2 years after the onset of myocardial infarction. They were subdivided into four comparable groups differing only in the quality of the long-term antivitamin K treatment which was administered. A survey of the coronary artery and myocardial lesions was performed for every heart. Acute occlusive coronary artery thromboses were four times less frequent in the correctly treated group then in the other three groups (p less than 0.001). There was no significant difference between the insufficiently treated groups and the untreated group. Recurrent myocardial infarctions were accompanied in 90 per cent of cases by acute occlusive coronary artery thromboses and were four times less frequent when treatment was efficient (p less than 0.001). These results confirm the part played by coronary artery thrombosis in the aggravation of coronary atherosclerosis and justify the attempts at long-term prophylaxis. The provide the proof that antivitamin K administration, at efficient dosage, maintained for a long time, has a significant influence on the cause of death in these patients, by decreasing the number of coronary artery thrombosis. Long-term anticoagulant treatment, in spite of its haemorrhagic complications and limits, should not be given up until a new efficient treatment is available.

Topics: Aged; Anticoagulants; Autopsy; Coronary Disease; Follow-Up Studies; Humans; Long-Term Care; Middle Aged; Myocardial Infarction; Vitamin K

Topics: Adult; Aged; Aneurysm; Coronary Angiography; Coronary Disease; Electrocardiography; Female; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Vitamin K

Topics: Aged; Arrhythmias, Cardiac; Blood Transfusion; Coronary Disease; Diverticulum, Colon; Gastrointestinal Hemorrhage; Hematocrit; Humans; Hypertension; Intracranial Embolism and Thrombosis; Middle Aged; Prothrombin Time; Pulmonary Embolism; Thrombophlebitis; Vitamin K; Warfarin

Topics: Arteriosclerosis; Blood Platelets; Coronary Disease; Fibrinolytic Agents; Humans; Myocardial Infarction; Terminology as Topic; Thrombosis; Vitamin K

Topics: Aged; Anticoagulants; Coronary Care Units; Coronary Disease; Female; Heparin; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Statistics as Topic; Streptokinase; Thrombosis; Vitamin K

Topics: Anti-Bacterial Agents; Anticoagulants; Coronary Disease; Diabetes Complications; Facial Paralysis; Hematoma; Humans; Infections; Male; Middle Aged; Mouth Diseases; Palate; Parotid Gland; Phenindione; Salivary Gland Diseases; Vitamin K

Topics: Aged; Aging; Angina Pectoris; Anticoagulants; Coronary Disease; Ethanolamines; Humans; Middle Aged; Nitroglycerin; Propranolol; Vitamin K

Topics: Arteriosclerosis; Atrial Fibrillation; Cerebrovascular Disorders; Coronary Disease; Dicumarol; Diet; Diet Therapy; Family Practice; General Practice; Humans; Intracranial Embolism; Intracranial Embolism and Thrombosis; Myocardial Infarction; Prothrombin Time; Thrombosis; Vitamin K; Warfarin

Topics: Coronary Artery Disease; Coronary Disease; Humans; Vitamin A; Vitamin E; Vitamin K; Vitamins

Topics: Coronary Disease; Diet; Humans; Lipid Metabolism; Lipids; Nutrition Assessment; Nutrition Disorders; Vitamin K; Vitamins