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Sabino Scardi

Publications and source records attributed to Sabino Scardi.

12 recordsLinked to original sources
PubMed2004

[Ximelagatran: a promising new drug for oral anticoagulation].

Ximelagatran is the first orally available direct thrombin inhibitor. Ximelagatran is a pro-drug with an antithrombotic effect comparable to that of warfarin. Clinical studies have demonstrated that ximelagatran is as effective as warfarin in the prevention of deep-vein thrombosis, of stroke in patients with nonvalvular atrial fibrillation, and of the adverse cardiovascular events in patients with recent myocardial infarction. Ximelagatran can be administered without any need of laboratory test.

Administration, Oral↗
PubMed2004

[Family screening of patients with premature coronary artery disease: opportunities and challenges of cardiovascular health in the 21st century].

A positive family history of premature coronary heart disease is a strong and independent risk factor for relatives and its effect is synergistic with other traditional and not traditional risk factors. It is well documented a familial aggregation of premature coronary heart disease particularly related to family clustering of several cardiovascular risk factors. The screening and the identification, by a comprehensive cardiovascular risk factor assessment, of high-risk relatives of patients with premature coronary artery disease by cardiologists and general practitioners is crucial. A family-centered approach to the prevention of coronary artery disease represents an opportunity and a challenge for promoting cardiovascular health in the 21st century.

Age Factors↗
PubMed2003

[Antithrombotic prophylaxis in patients with ventricular dysfunction: critical review of the literature and new perspectives].

Recent observational data suggest that mild or moderate heart failure is associated with an annual risk of stroke of approximately 1.2%. Indeed, it is possible that the major cause of sudden death in chronic heart failure is not related to arrhythmias, but to vascular occlusion. Anticoagulation may reduce the rate of embolic events, but there is controversy about the mandatory use of antithrombotic therapy for all patients with ventricular dysfunction in sinus rhythm. At present antithrombotic therapy is indicated only in "high risk" subgroups of patients: atrial fibrillation, mobile/protruding/irregular thrombi, acute post-myocardial infarction thrombi or a recent history of thromboembolism. Actually there is no evidence to recommend the use of aspirin to prevent thromboembolism in patients with ventricular dysfunction in sinus rhythm. Further trials of both antiplatelet agents and anticoagulation are sorely needed and we are waiting for the results of large trials such as the WATCH trial (Warfarin and Antiplatelet Therapy in Chronic Heart Failure) and the WARCEF trial (Warfarin Versus Aspirin in Reduced Ejection Fraction). The future appears promising due to the advent of a new oral direct thrombin inhibitor, ximelagatran, with good efficacy and safety profile for the treatment and prevention of thromboembolism.

Anticoagulants↗
PubMed2003

[Cardiac rehabilitation: a plus value for secondary prevention?].

In patients with a history of myocardial infarction, cardiovascular mortality in the absence of treatment is high (5% per year after a first myocardial infarction and 10% per year after a subsequent myocardial infarction). There is a convincing evidence that secondary prevention reduces the risk of new ischemic events and mortality. Specifically, the modification of cardiovascular risk factors and the use of prophylactic treatments have shown that the risk of a further major ischemic event abruptly decreases. There are a number of effective therapies to consider for these patients after myocardial infarction. Careful patient assessment and individualized treatments are required for the maximum benefit. Patients with coronary artery disease can benefit from both medical and life-style secondary prevention measures. Nevertheless half of these patients in general practice does not have the opportunity for an effective medical intervention. Thus, there appears to be a considerable gap between the ideal management and the actual management in practice of these patients. Several types of strategies to improve disease management may be ineffective. Rehabilitation Centers can assure a continuum in the standard care for patients with coronary artery disease and thus they represent a plus value in secondary prevention.

Aspirin↗
PubMed2003

Percutaneous revascularization of femoropopliteal artery disease: PTA and PTA plus stent. Results after six years' follow-up.

PURPOSE: To compare the long-term patency after the treatment of mild-to-moderate femoropopliteal artery disease by percutaneous transluminal angioplasty (PTA) alone (PTA group) and PTA plus stenting (STENT group) in a non-randomised retrospective study. MATERIALS AND METHODS: Eighty-six limbs in 64 patients (mean age 67+/-8 years, 47 males and 17 females) with femoropopliteal artery disease and symptomatic for mild-to-moderate intermittent claudication (Rutherford's category 1-2) were treated by percutaneous revascularization. None of the patients had critical lower limb ischaemia. Of the 86 lesions, 63 (40 stenoses and 23 occlusions) were treated by PTA alone and 23 (12 stenoses and 11 occlusions) by PTA plus stent implantation. The success was defined as a maximal = or < 30% residual stenosis of vessel lumen diameter, as defined by biplane angiography. The angiography findings were confirmed by colour-Doppler sonography of the treated segment. A peak systolic velocity = or < 150 cm/sec in the treated segment and an improvement of the ankle/brachial index by gs; 0.15 were considered indications of haemodynamic success. Restenosis at follow-up (mean 21 months, range 1-72 months) was defined by colour-Doppler sonography as a peak systolic velocity gs; 230 cm/sec or a peak systolic velocity ratio gs; 2.5 in the treated area and a gs; 0.15 decrease in ankle/brachial index compared with post-procedure measurements. RESULTS: Treatment by PTA plus stenting enabled correction of residual stenosis in 15/23 limbs, relief of PTA complications in 7/23 limbs and correction of restenosis after a PTA in 1/23. In the PTA group the treatment was successful in 59/86 limbs (68%) versus 21/23 (91%) in the STENT group (chi squared value= 0,04). As a whole, major complications occurred in 5.8% of cases (n=5), 3 in the PTA group and 2 in the STENT group. The primary patency rates at 6, 12, and 24 months were 70%, 66% and 58% in the PTA group versus 74%, 67% and 46% in the STENT group (Gehan p value=0.96). The secondary patency rates at 6, 12, 24 months were 75%, 73%, 65% in the PTA group versus 84%, 76%, 64% in the STENT group (Gehan p value=0,59). DISCUSSION AND CONCLUSIONS: In this study, stenting and PTA for the treatment of mild-to-moderate femoropopliteal peripheral artery disease improved the primary technical success of PTA by correcting residual stenosis, elastic recoil and occlusive intimal flaps. Moreover, stenting can prevent delayed constrictive remodelling. However, stenting did not improve long-term outcomes in comparison with PTA alone given that stent implantation increases the risk of restenosis due to myointimal hyperplasia. Our findings regarding the complication rates and long-term outcome agree with those published by other authors. Colour-Doppler US monitoring enabled early detection of restenosis in the treated area and its differentiation from the development of new lesions in other areas.

Aged↗
PubMed2003

Morbidity and mortality in 229 elderly patients with nonrheumatic atrial fibrillation. A five-year follow-up.

BACKGROUND: In the elderly the impact of atrial fibrillation on mortality and morbidity is substantial. Oral anticoagulant therapy reduces the risk of stroke by 70%; nevertheless, it remains largely underused. We evaluated, in a community prospective study, the factors associated with embolic events and death and the feasibility of oral anticoagulant therapy managed by general practitioners. METHODS: We enrolled at the Trieste Cardiovascular Center 229 patients aged > or = 65 years with non-rheumatic atrial fibrillation. At baseline, each patient underwent a transesophageal echocardiography and received instructions about oral anticoagulation. Patients were regularly followed by their general practitioner and finally evaluated at the Center. RESULTS: At baseline, the mean age was 73 years, 14% of patients were free of heart disease, 27% had had a previous embolic event, and 33% had an atrial thrombus. After a 5-year follow-up, 85% of the patients had been admitted to hospital, 17% had suffered an embolic event, and 35% were dead. Diabetes and the presence of a low flow in the left atrial appendage were predictive of embolic events. Heart failure, spontaneous echocontrast and aortic plaques were predictive of death. Anticoagulant therapy increased from 14 to 34% but the incidence of major bleeding did not change. The patients on anticoagulant therapy at follow-up constituted the group with the worst cardiovascular profile and embolic rate, but had a lower death rate (19%) compared with those on antiplatelet therapy (32%) and with those without antithrombotic therapy (67%). The hospitalization rates were respectively 78, 83 and 100%. CONCLUSIONS: In a group of elderly patients followed by their general practitioner with the support of a specialized cardiologic unit, oral anticoagulant therapy was well tolerated and associated with a significant decrease in mortality and hospitalization.

Age Distribution↗
PubMed2003

[Amiodarone and thyroid dysfunction: a pending problem].

Amiodarone is an antiarhytmic drug used in many clinical situations for its probed effect; it is also preferred in particular groups of patients (heart failure, post-ischemical) for its safe and its prognostic benefits. However, a substantial proportion of amiodarone treated patients develop either hypothyroidism or thyrotoxicosis. Both abnormalities may occur in apparently normal glands or in glandes with pre-existed abnormalities. It may be difficult to recognize the dysfunction because of the many changes in thyroid function test results that occur in euthyroid patients who are receiving amiodarone. Hypothyroidism is a well defined clinical situation managable thanks to common guidelines. The occurrence of hypothyroidism does not necessitate withdrawing amiodarone while instituting L-T4 replacement therapy, although many cases are transient and will spontaneously remit after amiodarone withdrawal. At the opposite, hyperthyroidism needs more attention to be diagnosed and to be treated, in fact there is a "personal" clinical-therapeutical behave towards it, caused by the lack of big trials made on this clinical situation. Effective strategies exist for the management of thyroid dysfunction, these should be tailored to the needs of the individual patient.

Amiodarone↗
PubMed2003

[Control of anticoagulant therapy with portable prothrombin time device in patients with mechanical heart valve prostheses: two-year follow-up].

BACKGROUND: Monitoring patients on oral anticoagulation is essential to prevent haemorrhage and recurrent thrombosis, but it is still difficult. We studied a group of 348 patients with mechanical heart valve prostheses to verify whether the use of a new portable prothrombin time device might improve the management of oral anticoagulant therapy. METHODS AND MATERIAL: We used a new portable prothrombin time device to check the anticoagulation therapy in a group of 348 patients with mechanical heart valve prostheses to validate its results by comparing to routine I.N.R. determinations (28 pts) and verify its user-friendliness by a face-to-face interview. Furthermore, the incidence of haemorrhagic and thromboembolic events has been studied by a two-year follow-up. RESULTS: Pearson correlation indicated an R2 = 0.9 between I.N.R. values determined by routine or by a new portable prothrombin time device. All patients agreed to replace the routine I.N.R. determinations with those by the new procedure, particularly female, young and those with usually difficult blood collections. During the two-year follow-up period, 21 haemorrhagic (2.6/100/patients/year) and 5 thromboembolic events (0.6/100/patients/year) occurred; but neither replaced valves' thrombi nor fatal events were found out. CONCLUSIONS: I.N.R.s determined using a new portable prothrombin time device are convincing as routine determinations. Such new procedure improves the quality of life, and the therapeutical range of anticoagulation is maintained safer and longer than by routine determinations. These results suggest that the control of anticoagulation in patients to a set I.N.R. therapeutic range is improved by using portable prothrombin time device in expert anticoagulation clinics, such improvement may result in reducing mortality as well as morbidity in patients treated with oral anticoagulants.

Anticoagulants↗
PubMed2002

[Atrial fibrillation and heart failure: cause or effect?].

The association between atrial fibrillation and heart failure is well documented. Heart failure is one of the established predisposing conditions for the development of atrial fibrillation; conversely, heart failure is a common condition in patients with atrial fibrillation. In patients with heart failure the atrial electrophysiologic properties might be modified by hemodynamic overloading and neurohumoral activation. Atrial fibrillation promotes heart failure with multiple mechanisms including uncontrolled heart rate, loss of atrioventricular synchrony, irregularity in the ventricular rhythm, valvular regurgitation and neurohormonal effects. Treatment includes correction of neurohumoral activation, prevention of thromboembolism, maintenance of sinus rhythm, and pharmacologic and interventional control of ventricular rate. The results of recent trials (PIAF-Pharmacological Intervention in Atrial Fibrillation, RACE-RAte Control versus Electrical cardioversion for persistent atrial fibrillation, AFFIRM-Atrial Fibrillation Follow-up Investigation of Rhythm Management) suggest that a rate control strategy can be better than rhythm control, particularly in patients at high risk of relapse, like those with left ventricular dysfunction.

Atrial Fibrillation↗