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Biomedical subjects

S Coccheri

Publications and source records attributed to S Coccheri.

At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

Pulmonary vascular reactivity and hemorheology in patients with chronic cor pulmonale: responses to pentoxifylline at rest and during exercise.

This study was carried out in order to evaluate changes in pulmonary vascular reactivity and in hemorheology induced by pentoxifylline infusion (100 mg) at rest and during standardized exercise in patients with chronic cor pulmonale secondary to chronic obstructive pulmonary disease. The administration of pentoxifylline at rest was associated with reduction in mean pulmonary artery pressure (p less than 0.01), pulmonary vascular resistance (p less than 0.01) and right ventricular stroke work index (p less than 0.02). Standard exercise performed after pentoxifylline infusion was also associated with significant reduction in mean pulmonary artery pressure and pulmonary vascular resistance. Rheologic tests showed less evident changes. Our data suggest that pentoxifylline significantly improves pulmonary hemodynamics at rest and partly reverses its changes, after exercise, in patients with chronic obstructive pulmonary disease.

Blood Viscosity↗
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Thrombophilia in young women candidate to the pill: reasons for and against screening.

Screening for thrombophilia in women candidate to the pill is still a matter of debate. Oral contraceptives may trigger venous thromboembolic events in carriers of common inherited thrombophilic defects. General screening is not cost-effective from an epidemiological point of view if the objective is to prevent death due to venous thromboembolism during oral contraception (OC). However, clinicians deal with single patients and personal and/or family history for venous thromboembolism have limited value for identifying those women at risk of VTE complications during OC. A pharmacogenetics approach in prescribing OC on the basis of each woman's genetic make-up could increase drug safety. A proper evaluation of the cost-effectiveness, the medical, psychosocial and legal consequences is needed before general screening with genetic testing for inherited thrombophilia can be recommended before OC.

Adult↗
PubMedDate not supplied

Management of patients with carotid stenosis.

Carotid atherosclerosis is one of the main risk factors for ischemic stroke. The annual risk of ipsilateral stroke for asymptomatic, albeit severe stenoses is as low as 1 to 2%, but increases to 13% in patients with recent ischemic symptoms. However the risk decreases after the first 2-3 years from the symptomatic episode, dropping to 3%. Echo-color Doppler ultrasonography is the screening method of choice, being highly accurate, noninvasive and low-cost. Carotid angiography still represents the gold standard, however, less invasive techniques as RM angiography and Angio-CT are becoming increasingly common. Based on NASCET, ECST and ACAS results, carotid endarterectomy (CE) is strongly recommended for severe symptomatic stenoses, while for the moderate symptomatic and the severe asymptomatic ones the benefit in terms of stroke risk reduction is modest and surgery should be restricted to selected cases in surgical centers of high experience. For severe asymptomatic stenoses NNT is too high to recommend indiscriminate surgery; we are waiting for the results of ACSRS trial, designed to identify a subset of patients at risk of ipsilateral stroke greater than 4%/y, that may be considered for CE, while patients at low risk will be spared from unnecessary operation. Apart from surgery, in all patients with carotid atherosclerosis correction of cardiovascular risk factors is mandatory. Antiplatelet therapy (ASA alone or with dypiridamole, ticlopidine) is effective in secondary prophylaxis of athero-thrombotic stroke; its use in asymptomatic carotid stenoses can be recommended, even if more because of a plausible rationale than of clinical trial-based evidences.

Carotid Stenosis↗
PubMedDate not supplied

Antithrombotic drugs in peripheral obliterative arterial diseases.

In the natural history of patients with peripheral obliterative arterial disease (POAD) the prognosis of the complaint "intermittent claudication" is relatively good and the amputation rate is presently only about 3%. However, POAD patients carry a high risk of cardiovascular events and their cumultative mortality rate within 10 years is as high as 40-50%. Atherothrombotic events in the coronary and, less frequently, cerebral arteries are by far the first cause of death and disability in these patients. The rationale for antithrombotic drugs in the treatment of POAD lies in the pivotal role of platelet activation and thrombin formation in the evolution of the atherothrombotic lesions, but also in the effect of some of these drugs on the regulation of microcirculatory responses. In acute thrombotic arterial occlusion, Heparin is the "first application" drug, especially in support of interventional revascularisation procedures. Regional thrombolysis often coupled with angioplasty (PTA), or systemic thrombolysis, are effective in revascularisation of especially infrainguinal-supra popliteal occlusions. However, controlled clinical trials are needed. In chronic POAD, intermittent claudication can be improved with a rational walking exercise programme, but, besides pentoxyphilline, especially ticlopidine significantly adds to the benefits of exercise. Regarding districtual progression of atherothrombosis and especially cardiovascular events, both aspirin and ticlopidine have been shown effective in single studies or meta-analyses. In a recent observational study of pooled data the cumulative endpoint including myocardial infarction, stroke and vascular death was reduced by 25 +/- 10% in the generality of patients treated with antiplatelet drugs. Finally, in critical limbs ischemia (CLI), some prostanoid compounds as Iloprost and Prostaglandin E1 favourably influence rest pain and ulcer healing, but less evidence is available on their effects on hard events as amputation and death. In conclusion, following the general indication to "be conservative" in the treatment of these patients, it seems clear that antithrombotic drugs have become by far a key medication in all different phases of POAD.

Arterial Occlusive Diseases↗
PubMedDate not supplied

Prophylaxis of venous thrombosis after gynaecological surgery: a controlled pilot study of defibrotide.

BACKGROUND: Defibrotide (Def), a new antithrombotic drug, has been proposed as a prophylactic agent in postoperative DVT. Most of the studies to date, however, have either not been controlled or have used unverifiable systems for asymptomatic DVT diagnosis. This randomized pilot study compared Def versus standard low-dose calcium heparin (CH) prophylaxis after gynaecological surgery, using objective criteria for DVT diagnosis. METHODS: Forty-one pts received 400 mg Def intramuscularly twice a day starting the day before surgery; 40 pts received 5000 IU CH s.c. twice daily beginning 2h before surgery. The two groups were well matched for all relevant risk factors. DVT was diagnosed by means of the 125I fibrinogen uptake test (FUT) and venography. Blood coagulation and fibrinolysis tests were also carried out perioperatively. RESULTS: Isotopic DVT (FUT-positive for two consecutive days) was recorded in 6 (14.6%) of the Def and 5 (12.5%) of the CH groups. In cases where FUT was positive for at least three consecutive days (4 in Def and 1 in CH), venography confirmed DVT in 3 cases (all in the Def group). No side-effects were recorded in either group and the amounts of transfused blood were not different. No significant differences in blood coagulation or fibrinolysis tests were recorded, except for higher fibrinogen levels on the 8th post-operative day in the Def group. CONCLUSIONS: These results do not indicate any trend suggesting that Def, as a prophylactic agent in gynaecological surgery, offers any clinical or practical advantages over standard low-dose heparin prophylaxis.

Blood Coagulation Tests↗
PubMedDate not supplied

[The risk indices for atherothrombotic disease: the coagulation factors].

During the last decade interesting data have been collected on the epidemiological significance of some coagulation factors as risk indices for major cardiovascular events and, also, for the prognosis of atherothrombotic disease. The factors for which evidence is most convincing include: plasma fibrinogen, coagulation factor VII, and an inhibitor of fibrinolysis, namely the plasminogen activator inhibitor PAI-1. These data have been provided by studies of primary predictivity, in which the said parameters were measured in healthy subjects whose cardiovascular outcome was followed. Studies of secondary predictivity, or prevalence studies have also been extremely helpful. In these, the coagulation factors measured in patients already suffering from atherothrombotic disease were correlated with its severity, extension and outcome. From these data, the plasma fibrinogen level emerges as the coagulation parameter best correlated with cardiovascular events, that is, as both a primary and a secondary predictor. The predictive power of plasma fibrinogen level appears to be no less significant than that of blood cholesterol. Although a few methodological problems must still be overcome, hyperfibrinogenemia is gaining increasing consideration as a new, important risk factor for cardiovascular events. It is however premature to consider the said parameters not only as risk indices but also as causal factors of atherothrombotic disease. In fact, their pathogenic and causal role, although supported by high biological plausibility, has not yet been confirmed by interventional studies aimed at assessing whether or not therapeutic lowering of these values is associated with reduced cardiovascular risk.

Age Factors↗
PubMedDate not supplied

Hemorheologic changes in patients with a history of stroke or cerebral remittent ischemic attacks.

Hemorheologic parameters were measured in cerebrovascular patients with a history of stroke or recurrent ischemic attacks in a quiescent phase of the disease. All patients were submitted to aortic arch angiography and then classified according to the presence or absence of detectable arterial lesions. In comparison with a group of control subjects, cerebrovascular patients had significantly elevated levels of blood and plasma viscosity, fibrinogen, factors VIII:C and VIIIR:Ag and lowered values of erythrocyte filtration. Blood viscosity was increased and erythrocyte filtration reduced only in male patients. Elderly patients had higher blood viscosity and fibrinogen levels, and those with a history of stroke also showed the highest hematocrit and plasma viscosity values. Patients with a stroke history compared with those affected by remittent ischemic attacks, and patients with positive in comparison with those with negative angiograms were characterized only by higher fibrinogen (and sometimes factor VIII) levels, but not by other differences in hemorheologic values. It is concluded that changes in hemorheologic values consistent with hyperviscosity are a feature of cerebrovascular patients also in the quiescent phase of the disease and not only as a result of acute ischemic attacks. These changes are however most frequent in males and in elderly subjects, while they seem to be almost evenly distributed in patients with or without evidence of arterial disease.

Aging↗