Polskie Archiwum Medycyny Wewnętrznej
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Microparticles (MPs) are phenotypically and functionally heterogeneous population of microvesicles. Although MP formation represents a physiological phenomenon. ⋯ Elevated levels of platelet‑, endothelial cell‑, and monocyte‑derived MPs have been documented in a number of clinical conditions in which vascular dysfunction and inflammation are important pathophysiological mechanisms (e.g., coronary artery disease or thrombotic microangiopathies). Knowledge of the functional properties of MPs will contribute to a better understanding of the pathological mechanisms of communication between cells and of the causes of various diseases.
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Pol. Arch. Med. Wewn. · Jan 2012
ReviewDosing of antibiotics in critically ill patients: are we left to wander in the dark?
Critically ill patients are frequently affected by acute kidney injury accompanied by dysfunction of other systems and organs. Sepsis is common in this population and remains a major cause of multiorgan dysfunction syndrome, indicating a crucial role in efficient antibiotic treatment. ⋯ Current guidelines concerning the dosing of antibiotics in this patient population are not particularly reliable because they are based on studies involving small and heterogeneous groups of patients, often treated with different RRT modalities. Our paper reviews the basic pharmacokinetic and pharmacodynamic parameters as well as other factors that should be considered while devising a proper therapeutic approach for this patient population.
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Pol. Arch. Med. Wewn. · Jan 2012
ReviewAntiplatelet therapy beyond 2012: role of personalized medicine.
Since its first approval in 1997, clopidogrel has revolutionized interventional cardiology and transformed therapy for non‑ST‑segment elevation myocardial infarction (NSTEMI), STEMI, and percutaneous coronary intervention‑treated patients. It enjoyed a remarkable 15‑year "homerun" in the world market without any major competition. With the introduction of more potent P2Y12 receptor blockers, the current antiplatelet strategy is undergoing a transition period. ⋯ The unpredictable, slow onset, and overall modest pharmacodynamic effects are the major limitations of clopidogrel. The new, more potent P2Y12 receptor blockers overcome the limitations of clopidogrel therapy and are associated with better clinical efficacy, but are more costly and associated with more bleeding. In this scenario, personalization of antiplatelet therapy based on platelet function and genetic testings to strike a balance between cost, benefit, and safety is a potential option.
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Pol. Arch. Med. Wewn. · Jan 2012
ReviewA new era for anticoagulation in atrial fibrillation. Which anticoagulant should we choose for long‑term prevention of thromboembolic complications in patients with atrial fibrillation?
For more than 60 years, vitamin K antagonists have been the only available oral anticoagulants for the prevention of stroke and systemic embolism in atrial fibrillation (AF). Several new molecules, with a favorable pharmacokinetic profile and avoiding routine monitoring, have been recently developed, opening a new era in anticoagulation. The oral direct thrombin inhibitor, dabigatran, and the oral activated factor X inhibitors, rivaroxaban and apixaban, are the novel oral anticoagulants with data from large randomized clinical trials showing that these drugs are noninferior to warfarin in the prevention of stroke and thromboembolic complications of AF, with the advantage of less hemorrhagic stroke and intracranial bleeding. While these trial data are extremely encouraging, several practical issues (e.g., lack of specific antidote, safety of long-term treatment or cost-effectiveness in "real-life" clinical practice) still need to be elucidated.
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Pol. Arch. Med. Wewn. · Jan 2012
ReviewTroponin T level and mortality risk after noncardiac surgery: practical implications of the VISION study.
This review article presents the current state of knowledge about major perioperative cardiovascular complications in noncardiac surgery patients and the role of the currently available stratification models and biomarkers in risk prediction. The authors discuss a recent paper presented by the VISION Investigators in the June edition of the Journal of the American Medical Association and its practical implications in day-to-day perioperative practice. ⋯ One in 25 patients with a peak fourth generation troponin T (TnT) measurement of 0.02 μg/l, 1 in 11 patients with a peak TnT measurement of 0.03 to 0.29 μg/l, and 1 in 6 patients with a peak TnT measurement of 0.30 μg/l or higher will die within 30 days of surgery. Postoperative monitoring of TnT measurements substantially improves risk stratification after noncardiac surgery and may help identify patients requiring further therapeutic interventions.