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  • 1
    In: British Journal of Clinical Pharmacology, Wiley, Vol. 86, No. 12 ( 2020-12), p. 2455-2463
    Abstract: To investigate the decline of estimated glomerular filtration rate (eGFR) in patients with atrial fibrillation (AF) treated with vitamin K antagonists (VKAs) or non‐VKA oral anticoagulants (NOACs). Methods Multicentre prospective cohort study including 1667 patients with nonvalvular AF. The eGFR was assessed by the CKD‐EPI formula at baseline and during follow‐up. The primary endpoint of the study was the median annual decline of eGFR according to VKA (n = 743) or NOAC (n = 924) use. As secondary endpoints, we analysed the transition to eGFR 〈 50 mL/min/1.73 m 2 and the eGFR class worsening. Results Median age was 73.7 ± 9.1 years and 43.3% were women. VKA‐treated patients showed an eGFR decline of −2.11 (interquartile range [IQR] –5.68/−0.62), which was −0.27 (IQR –9.00/4.54, P 〈 0.001 vs VKAs), −1.21 (IQR –9.98/4.02, P = 0.004 vs VKAs) and −1.32 (IQR –8.70/3.99, P = 0.003 vs VKAs) in patients on dabigatran, rivaroxaban and apixaban, respectively. Transition to eGFR 〈 50 mL/min/1.73 m 2 was lower in dabigatran‐ and apixaban‐treated patients: odds ratio (OR) 0.492, 95% confidence interval (CI) 0.298‐0.813, P = 0.006 and OR 0.449, 95% CI 0.276‐0.728, P = 0.001, respectively. A lower rate of eGFR class worsening was found in all groups of NOACs compared to VKAs. No difference between full and reduced dose of NOAC was found. Subgroup analysis showed that the association between NOAC and eGFR changes was markedly reduced in diabetic patients. Conclusion Patients prescribed NOACs showed a lower decline of renal function compared to those prescribed VKAs. This effect was partially lost in patients with diabetes.
    Type of Medium: Online Resource
    ISSN: 0306-5251 , 1365-2125
    URL: Issue
    RVK:
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 1498142-7
    SSG: 15,3
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  • 2
    Online Resource
    Online Resource
    Wiley ; 2017
    In:  British Journal of Clinical Pharmacology Vol. 83, No. 1 ( 2017-01), p. 88-95
    In: British Journal of Clinical Pharmacology, Wiley, Vol. 83, No. 1 ( 2017-01), p. 88-95
    Abstract: Non‐alcoholic fatty liver disease (NAFLD) represents the most common chronic liver disease. It is characterized by a wide spectrum of hepatic changes, which may progress to liver fibrosis and to cirrhosis. NAFLD is considered as the hepatic component of the metabolic syndrome but mechanisms underlying the onset and progression of NAFLD are still under investigation. The traditional ‘two hit hypothesis’ has been developed within a more complex ‘multiple parallel hit hypothesis’ which comprises a wide spectrum of parallel hits. Many therapeutic approaches have been proposed so far and several types of nutraceuticals have been suggested for the treatment of NAFLD and non‐alcoholic steatohepatitis (NASH), the most promising of which are those with antioxidant effects. In particular, vitamin E appears to be effective for the treatment of nondiabetic subjects with more advanced NASH, although the high suggested daily dosages are a matter of concern. Moreover, polyphenols reduce liver fat accumulation, mainly by inhibiting lipogenesis. At present, there are insufficient data to support the use of vitamin C supplements in patients with NAFLD. Data on polyunsaturated fatty acid (PUFA) supplementation are heterogeneous, and no well‐designed randomized controlled studies (RCTs) of adequate size, with histological assessment of steatosis, have been conducted. Based on the available data, silymarin supplementation for the treatment of NAFLD seems to have a favourable effect. The results with anti‐inflammatory agents, such as vitamin D and carnitine are uncertain. In conclusion, there are insufficient data either to support or refute the use of nutraceuticals for subjects with NAFLD. Further RTCs, with histological changes as an outcome measure, are needed.
    Type of Medium: Online Resource
    ISSN: 0306-5251 , 1365-2125
    URL: Issue
    RVK:
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 1498142-7
    SSG: 15,3
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  • 3
    In: British Journal of Clinical Pharmacology, Wiley, Vol. 85, No. 3 ( 2019-03), p. 508-515
    Abstract: The prevalence and incidence of atrial fibrillation/flutter (AF/AFL) in patients with human immunodeficiency virus type‐1 (HIV‐1) infection have been poorly investigated. We performed a systematic review using PubMed and Cochrane Database of Systematic Reviews, and screening of references, searching for clinical studies reporting on the association between HIV‐1 infection and AF/AFL. We also summarized the main interactions of antiretroviral agents with antithrombotic and antiarrhythmic drugs. We found a prevalence of AF/AFL ranging from 2.0% to 5.13% in patients with HIV‐1, with an incidence rate of 3.6/1000 person‐years. Low CD4+ count ( 〈 200–250 cells ml −1 ) and high viral load were predictors of AF/AFL. Regarding drugs interactions, nucleoside reverse transcriptase inhibitors, integrase inhibitor and maraviroc have the lowest interactions with oral anticoagulants. Among anticoagulants, dabigatran presents the most favourable profile. Most of antiarrhythmic drugs interact with protease inhibitors, with beta blockers and diltiazem having fewer interactions. The few studies available suggest a non‐negligible prevalence of AF/AFL in patients with HIV‐1 infection. Awareness of potential interactions with anticoagulation and antiarrhythmic drugs is needed to offer optimal management in this population.
    Type of Medium: Online Resource
    ISSN: 0306-5251 , 1365-2125
    URL: Issue
    RVK:
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 1498142-7
    SSG: 15,3
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  • 4
    In: British Journal of Haematology, Wiley, Vol. 190, No. 4 ( 2020-08), p. 588-593
    Abstract: Quality of warfarin therapy in patients with a mechanical prosthetic heart valve (MPHV) has been barely investigated. We analysed determinants of low time in the therapeutic range (TiTR 〈 60%) in 2111 patients with MPHVs from the nationwide PLECTRUM study by the Italian Federation of Anticoagulation Clinics. Overall, 48·5% of patients had a TiTR of 〈  60%. At logistic regression analysis, arterial hypertension (odds ratio [OR] 1·502, P   〈  0·001), diabetes (OR 1·732, P   〈  0·001), heart failure (OR 1·484, P  = 0·004), mitral site (vs. aortic) (OR 1·399, P  = 0·006), international normalised ratio (INR) ranges of 2·5–3·5 (OR 2·575, P   〈  0·001) and 3·0–4·0 (OR 8·215, P   〈  0·001) associated with TiTR 〈  60%. TiTR is substantially suboptimal in MPHV patients, particularly in higher INR ranges.
    Type of Medium: Online Resource
    ISSN: 0007-1048 , 1365-2141
    URL: Issue
    RVK:
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 1475751-5
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  • 5
    In: International Journal of Cancer, Wiley, Vol. 147, No. 12 ( 2020-12-15), p. 3424-3430
    Abstract: What's new? While patients with atrial fibrillation (AF) are at increased risk of death from cardiovascular events (CVEs), a significant proportion die of cancer. Cancer and CVEs may be related, though little is known about cancer site and cardiovascular complications in AF. In this study involving more 2090 AF patients taking vitamin K anticoagulants, cancer was found to be a common comorbidity, affecting 17.5 percent of patients. In particular, gastrointestinal cancer was associated with increased risk of CVEs, while respiratory tract cancer was associated with an increased risk of thromboembolism. The findings link specific vascular outcomes with cancer site in AF.
    Type of Medium: Online Resource
    ISSN: 0020-7136 , 1097-0215
    URL: Issue
    RVK:
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 218257-9
    detail.hit.zdb_id: 1474822-8
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  • 6
    In: British Journal of Clinical Pharmacology, Wiley, Vol. 88, No. 2 ( 2022-02), p. 441-451
    Abstract: Statin liver safety in non‐alcoholic fatty liver disease (NAFLD) patients is not well defined. We analysed differences in liver function tests, including alanine transaminase aminotransferase (ALT), aspartate transaminase (AST) and gamma‐glutamyl transpeptidase (GGT) in NAFLD patients treated or not treated with statins. Methods We performed a systematic review of MEDLINE via PubMed and EMBASE databases and metanalysis of clinical studies investigating levels of ALT, AST and GGT in NAFLD according to statin treatment. Mean difference (MD) and percentage MD were calculated between the two groups. Results We included 22 studies with 2345 NAFLD patients. Overall, 16 were before‐after interventional, five were cross‐sectional and one was combined cross‐sectional/interventional study. In all interventional studies, except one, patients had raised ALT, AST and GGT at baseline. Interventional studies showed reduced ALT values with an MD reduction of −27.2 U/L (95% CI −35.25/−19.15) and a percentage MD reduction of −35.41% (95% CI −44.78/−26.04). Also, AST values were reduced after statin treatment in interventional studies with an MD of −18.82 U/L (95% CI −25.63/−12.02) (percentage −31.78%, 95% CI −41.45/−22.11). Similarly, GGT levels were reduced after statin treatment with an MD of −19.93 U/L (95% CI −27.10/−12.77) (percentage −25.57%, 95% CI −35.18/−15.97). Cross‐sectional studies showed no difference in AST and GGT values between patients treated with and without statins. Conclusion In interventional studies, ALT, AST and GGT were reduced after statin treatment with a percentage mean difference of −35.41%, −31.78% and −25.57%, respectively, while observational studies showed a null effect, suggesting liver safety of statins in NAFLD patients.
    Type of Medium: Online Resource
    ISSN: 0306-5251 , 1365-2125
    URL: Issue
    RVK:
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 1498142-7
    SSG: 15,3
    Location Call Number Limitation Availability
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