[Unscientific use of scientific data?].
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Clinical Trials as Topic↗
Biomedical subjects
H Arnesen
Publications and source records attributed to H Arnesen.
Stability of plasma PAI-I at room temperature.
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Adult↗
Comparison of bleeding complications of warfarin and warfarin plus acetylsalicylic acid: a study in 3166 outpatients.
OBJECTIVE: The aim of the study was to compare the incidence of bleeding complications in patients receiving warfarin alone and those receiving warfarin in combination with acetylsalicylic acid. SUBJECTS AND METHODS: This retrospective study comprises all outpatients in our hospital receiving warfarin (n = 3166) in the period 1 January 1986 to 31 December 1990. Of these, 2026 patients received warfarin alone, aiming at an international normalized ratio level of 4.2-2.5, whereas the combination of warfarin and acetylsalicylic acid (150 mg daily) was given to 1140 patients, aiming at an international normalized ratio level of 2.8-2.2. Total observation time represents 4420 treatment years. RESULTS: A total of 175 bleeding episodes was observed, 18 of which were fatal, and 96 were serious (requiring hospitalization). The incidence of minor bleedings was significantly higher in the combined therapy group than in the group receiving warfarin alone, 2.9% and 1.4% respectively (P < 0.003). However, there was no difference in the therapy groups regarding the incidence of serious and fatal bleedings. The overall incidence of gastrointestinal bleedings and was equal to the two groups. CONCLUSIONS: The combination of warfarin and aspirin 150 mg daily aiming at a less intense level of anticoagulation than in warfarin therapy alone does not increase the risk of major or fatal haemorrhage.
Adolescent↗
Long-term effects of n-3 fatty acids on serum lipids and glycaemic control.
The long-term influence of n-3 polyunsaturated fatty acids (n-3 PUFAs) on serum lipids and glucose homeostasis was studied in a group of non-diabetic, moderately hypertriglyceridaemic patients undergoing coronary artery bypass grafting. They were investigated according to the same procedure before and 6 months after the operation. Following randomization postoperatively, 28 patients received 3.4 g eicosapentaenoic and docosahexaenoic acid per day, whereas 29 patients comprised the control group. The decline in serum triglycerides after 6 months was significantly greater in the n-3 PUFA group than in the control group (median decline, -33.2% vs. -11.1%, p = 0.002), while no group difference was noted in serum total, HDL, or LDL cholesterol levels. Fasting plasma glucose levels decreased less in the n-3 PUFA group compared with the control group (median change, -0.2 mmol l-1 vs. -0.5 mmol l-1, p = 0.054). The corresponding changes in fasting insulin levels were -2 mIU ml-1 in the n-3 PUFA group and no change in the control group (p = 0.039). In both groups combined, the recorded changes in serum triglyceride and serum insulin levels were negatively correlated with the change in serum phospholipid n-3 fatty acids (r = -0.35, p = 0.008 and r = -0.32, p = 0.016, respectively). An oral glucose tolerance test revealed no significant group differences after 6 months, neither in the peak levels, nor in the areas under the curves between 0 and 3h after the glucose load for glucose, insulin, and C-peptide.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Serum cardio-specific troponin T after open heart surgery in patients with and without perioperative myocardial infarction.
One hundred and sixteen consecutive patients undergoing open heart surgery were studied to evaluate the diagnostic use of cardiac specific troponin T in serum (S-TnT) measured preoperatively, at day 1 and day 4 postoperatively. The results were related to perioperative myocardial infarction (POMI), diagnostically based on ECG-changes, as well as to other perioperative variables. Cardiac surgery resulted in increased levels of S-TnT day 1 in all patients, and the level of this increase was dependent on the type of surgical procedure performed and the duration of cardiac perioperative ischaemia. Similar results were observed for serum creatine kinase isoenzyme (mass determination) (S-CKMB), but differences were generally less well correlated with other perioperative variables. At day 1, patients with POMI had higher levels of S-TnT as well as S-CKMB when compared to patients without POMI. At day 4, most patients still had elevated levels of S-TnT, but the difference in S-TnT levels between patients with POMI and patients without POMI was more pronounced. In contrast, the levels of S-CKMB were essentially normalized in both groups. Measurements of S-TnT at day 4 appears to be of significant value in diagnosing POMI. However, most of the patients without POMI had increased levels of S-TnT at day 4, suggesting that some irreversible operatively induced myocardial damage had occurred. Thus, even at a late postoperative stage the perioperative duration of ischaemia and type and extent of the surgical procedure should be taken into consideration.
Biomarkers↗
Insulin and PAI-1 levels during oral glucose tolerance test in patients with coronary heart disease.
The present study was performed to investigate the acute effects of physiologically induced hyperinsulinemia on plasminogen activator inhibitor 1 (PAI-1), tissue plasminogen activator (t-PA) and triglycerides (TG). Forty-one male patients with chronic coronary heart disease (CHD) and moderate hypertriglyceridemia were studied for 3 h; 33 of them during an oral glucose tolerance test (OGTT), whereas eight patients served as controls, receiving water only. All subjects in the OGTT group were adequate responders to glucose administration, giving peak values of glucose (median 6.90 mmol l-1) and insulin (median 123 mU l-1) after 1 h. TG were unchanged throughout the test period in both groups. After 1 h PAI-1 activity and antigen decreased significantly more in the OGTT group than in the controls (median values: PAI-1 act 23-12 vs. 12-12 U ml-1; (p < 0.001). PAI-ag 45-35 vs. 18-16 ng ml-1 (p < 0.05)). t-PA increased more in the OGTT group (0.70-1.20 vs. 0.50-0.63 IU ml-1 (p = 0.08)). These differences tailored off after 3 h. We conclude that acute hyperinsulinemia, when generated during an OGTT, stimulates fibrinolysis with a consequent decrease in PAI-1 activity, but give no change in TG. The postulated regulating role of insulin for the steady state levels of PAI-1 could probably not be elucidated in the present dynamic model.
Adult↗
Sequential intrapulmonary and systemic activation of coagulation and fibrinolysis during and after total hip replacement surgery.
Hip joint replacement surgery, using acrylic cement for prosthesis fixation, is associated with intraoperative cardiorespiratory dysfunction, and a high frequency of postoperative proximal deep vein thrombosis (DVT). Levels of prothrombin fragments 1+2 (F1+2), tissue plasminogen activator antigen (t-PA), plasminogen activator inhibitor 1 activity (PAI-1), D-dimer and interleukin 6 (IL-6) were measured in arterial (AB) and mixed venous blood (MVB) in five patients during and after total hip replacement operation with acrylic cement prosthesis fixation. Sequential peaks of F1+2, t-PA, PAI-1 and IL-6 appeared, starting with activation of coagulation during preparation of bone, closely followed by activation of fibrinolysis. Later, this was counteracted by an antifibrinolytic response and increase of IL-6. After a fibrinolytic shutdown on the third postoperative day as evidenced by a drop in t-PA and D-dimer concentrations, a second wave of coagulation was seen at the end of the first week. The present model, with frequent sampling of blood entering and leaving the lungs, confirms our earlier findings of the lung as a key organ in promoting coagulation following traumatic activation.
Aged↗
Effects of long-term treatment with warfarin on fibrinogen, FPA, TAT, and D-dimer in patients with coronary artery disease.
Sixty-four patients undergoing aorto-coronary bypass surgery were randomized to receive antithrombotic treatment with acetylsalicylic acid (ASA), 300 mg/d (n = 30) or warfarin, INR = 2.5 - 4.2 (n = 34). The levels of fibrinogen, thrombin-antithrombin III complexes (TAT), fibrinopeptide A (FPA) and D-dimer were assessed before surgery and 9 months postoperatively. In the warfarin treated group the fibrinogen levels were increased after 9 months, while the levels of TAT, FPA and D-dimer were decreased. In the ASA group TAT levels were increased at 9 months, whereas no significant changes in fibrinogen, FPA or D-dimer from baseline were noted. Thus, a reduced activation of the coagulation system has been demonstrated during long-term treatment with warfarin in patients with coronary artery disease.
Adult↗
Antiphospholipid antibodies after myocardial infarction and their relation to mortality, reinfarction, and non-haemorrhagic stroke.
Antiphospholipid antibodies have been suggested as markers for a high risk of recurrent cardiovascular events in young survivors of an acute myocardial infarction. However, there are few data to confirm or refute this hypothesis. In a cohort study, we have measured anticephalin (aCEPHA) and anticardiolipin (aCL) antibodies in a group of patients surviving an acute infarct. Of 597 patients studied, 13.2% were IgG or IgM aCEPHA positive compared with 4.4% of a reference population (n = 158; p = 0.002). In a multivariate analysis, adjusted for major cardiovascular risk factors, neither aCEPHA (IgG or IgM) nor a CL (IgG or IgM) was an independent risk factor for mortality, reinfarction, or non-haemorrhagic stroke. Although an increased proportion of survivors of a myocardial infarction have antiphospholipid antibodies, the presence of such antibodies is not a risk factor for subsequent coronary or cerebrovascular thrombosis.
Adult↗
Introduction: the metabolic cardiovascular syndrome.
During the last few years new knowledge concerning risk factors for cardiovascular diseases (CVD) has emerged. Many of these are metabolically interrelated. The clustering of a variety of metabolic disorders in individuals prone to develop CVD has led to the launching of the so-called metabolic cardiovascular syndrome (MCVS). At the XIIIth Scandinavian Congress of Cardiology in Oslo, Norway, on June 1991, a satellite symposium was arranged on the MCVS. The present supplement comprises articles written by the symposium speakers, who are all experts in various fields of relevance to the MCVS. In addition, Per Björntorp, Stevo Julius, and Arne Westheim were invited to contribute articles to make the coverage of the topic more complete. The present introduction summarizes some of the clinical and biochemical features characteristic of the MCVS, with a special reference to the multiplicity of biochemical changes. The possibilities for at least three basic disorders being of primary or causal importance in different individuals are stressed. These are chronic sympathetic overactivity, insulin resistance, and central or visceral obesity. By including the related changes in the hemostatic systems with "hypercoagulability" and "hypofibrinolysis," whereby the importance of thrombosis for the clinically often dramatic complications of the MCVS is stressed, the more specific name atherothrombogenic syndrome (ATS) has been proposed. The non-pharmacological treatment of the syndrome with low-caloric diet and physical exercise is emphasized.(ABSTRACT TRUNCATED AT 250 WORDS)
Cardiovascular Diseases↗
Effects of long-term anticoagulant therapy in subgroups after acute myocardial infarction.
This post hoc analysis of the Warfarin Re-Infarction Study evaluates the effect of long-term anticoagulant therapy in different subgroups after acute myocardial infarction (MI). The study population comprised 1214 patients. The mean duration of treatment was 37 months. The overall significance of prespecified prognostic factors was assessed by univariate survival analyses. Those risk factors that yielded a statistically significant result were evaluated with regard to response to treatment in a stratified manner. After stratification, heterogeneity across the strata was found to pertain to the effect of treatment with warfarin in subjects with prior MI and diabetes mellitus. Hence, mortality was not found to be influenced favorably by warfarin therapy in patients with previous MI. Likewise, recurrent MI was not significantly reduced by warfarin therapy in patients with prior MI or diabetes mellitus. Although not statistically significant, increasing age was associated with less benefit from therapy. The findings persisted also after controlling for possible confounders in a Cox regression model. Thus, our data suggest a lack of a beneficial effect by warfarin therapy in subjects with prior MI or diabetes mellitus, when the therapy is given for the sole purpose of secondary prophylaxis of MI. Furthermore, a trend toward an attenuated effect of therapy was found among the oldest patients.
Confounding Factors, Epidemiologic↗
[Resource-saving treatment of deep venous thrombosis with low molecular weight heparin--but is it good enough?].
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Drug Evaluation↗
The predictability of bleeding by prothrombin times sensitive or insensitive to PIVKA during intensive oral anticoagulation.
To evaluate the effect of PIVKA (Proteins Induced by Vitamin K Absence or Antagonism) on the bleeding tendency during oral anticoagulation, we studied consecutive patients intensively treated with warfarin (INR greater than 4.8). The level of anticoagulation was measured with the PIVKA-insensitive Normotest (NT) as well as with the PIVKA-sensitive Thrombotest (TT), and the results are expressed as per cent coagulant activity. The NT/TT ratio was determined. Twenty patients with bleeding episodes had a mean NT/TT ratio of 2.06 as compared to 2.20 in 143 patients without bleeding episodes (p = 0.08). As the NT/TT ratio was not higher in patients with bleedings, we conclude that PIVKA are of no importance for bleeding during anticoagulation with vitamin K antagonists.
Adult↗
Positive psychological and life-style changes after myocardial infarction: a follow-up study after 2-4 years.
An interview study of 84 males recruited from a post-infarction anticoagulant trial revealed a number of positive changes regarding life-style and factors related to quality of life 3-5 months after the index infarction. In the present study we investigated the extent to which such changes persist after 2-4 (additional) years. Seventy-four of 75 survivors responded to a postal questionnaire. The answers concerning the total life situation, as compared with the last month before the myocardial infarction, were as follows (response after 3-5 months in brackets): improved 29% (33%), unchanged/uncertain 47% (47%) and deteriorated 24% (20%). There were still appreciable positive changes at follow-up regarding smoking, physical activity, alcohol consumption and stress at work. Similar changes or a slight reduction were observed in previously reported positive scoring of factors related to quality of life. The same applied to the two General Health Questionnaire scorings. We conclude that positive changes in psychosocial and life-style factors as seen shortly after myocardial infarction generally seem to persist after 2-4 years.
Adult↗
The effect of warfarin on mortality and reinfarction after myocardial infarction.
BACKGROUND AND METHODS: The use of oral anticoagulation in the long-term treatment of survivors of acute myocardial infarction has been highly controversial. We therefore randomly assigned 1214 patients who had recovered from acute myocardial infarction (mean interval from the onset of symptoms to randomization, 27 days) to treatment with warfarin (607 patients) or placebo (607 patients) for an average of 37 months (range, 24 to 63). RESULTS: At the end of the treatment period, there had been 123 deaths in the placebo group and 94 in the warfarin group--a reduction in risk of 24 percent (95 percent confidence interval, 4 to 44 percent; P = 0.027). A total of 124 patients in the placebo group had reinfarctions, as compared with 82 in the warfarin group--a reduction of 34 percent (95 percent confidence interval, 19 to 54 percent; P = 0.0007). Furthermore, we observed a reduction of 55 percent (95 percent confidence interval, 30 to 77 percent) in the number of total cerebrovascular accidents in the warfarin group as compared with the placebo group (44 vs. 20; P = 0.0015). Serious bleeding was noted in 0.6 percent of the warfarin-treated patients per year. CONCLUSIONS: Long-term therapy with warfarin has an important beneficial effect after myocardial infarction and can be recommended in the treatment of patients who survive the acute phase.
Cerebrovascular Disorders↗
Warfarin has no negative impact on fibrinolysis.
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Aged↗
Effects of gemfibrozil on lipids and haemostasis after myocardial infarction.
The effects of gemfibrozil on haemostatic variables were studied in 43 survivors of myocardial infarction with serum triglycerides (TG) greater than or equal to 2 mmol/l 2 weeks prior to randomization. The study was double-blind, placebo-controlled and stratified for chronic betablockade. Twenty-two individuals were given gemfibrozil 600 mg twice daily and 21 individuals received matching placebo. After 8 weeks the TG level was unchanged in the placebo group, whereas a 44% reduction was noted in the gemfibrozil group (p less than 0.001). Fibrinogen increased in both groups, while bleeding time and platelet count were unchanged. Clotting factor VII-phospholipid complex decreased in both groups, but the change was more marked and attained statistical significance only in the gemfibrozil group (60% reduction, p less than 0.01). By DDAVP-stimulated D-Dimer agglutination test 8 in 21 patients in the placebo group (38%) still had reduced fibronolytic capacity versus none in the gemfibrozil group (p = 0.001). Thus, in this study, gemfibrozil improved reduced fibrinolytic capacity and may have reduced hypercoagulability by lowering the clotting factor VII-phospholipid complex.
Aged↗
Mortality in non-consenters in a post-myocardial infarction trial.
Follow-up of 270 subjects who declined to participate in a trial of oral anticoagulant therapy after acute myocardial infarction revealed a higher mortality (25.6%) than that for participants in the placebo group (20.2%). The excess mortality in terms of odds ratios was 1.35 (90% confidence interval 1.02-1.79). Age was the only predictor of death. The event rate from ischaemic cardiovascular disease was lower among non-consenters than among participants (49.3% vs. 74.8%), as was the rate of death during the first year of follow-up. In conclusion, the differing mortality and dissimilar patterns of specific causes of death in non-consenters and placebo-treated participants emphasize the need for caution in extrapolation of treatment effects to the non-consenting group. Thus the size of the non-consenting group has implications for generalization of the overall results.
Age Factors↗