Zbigniew Kadziola

Thromboprophylaxis in Hip Fracture Surgery: A Pilot Study Comparing Danaparoid, Enoxaparin and Dalteparin

A pilot study was performed to compare the thromboprophylactic effect of danaparoid, enoxaparin and dalteparin in patients with hip fracture. The study was a prospective, randomised assessor-blind, four-centre trial. Prophylaxis was given for 9–11 days, whereafter bilateral phlebography was performed. A total of 197 patients were randomised. There were no statistically significant differences in the frequency of deep vein thrombosis, in blood loss or bleeding complications between the three prophylaxis groups. In conclusion, this moderately sized study revealed no statistically significant difference in efficacy or safety between danaparoid, enoxaparin and dalteparin in patients undergoing hip fracture surgery.

Induced ischemia detected by dobutamine stress echocardiography in coronary heart disease patients after myocardial re-vascularization.: Experience in a District General Hospital

Most episodes of myocardial ischemia in patients with known coronary artery disease (CHD) are asymptomatic. Silent myocardial ischemia (SMI) is an important predictor of adverse outcome in patients with proven coronary artery disease. beta-blockers are effective in suppressing ischemia, and improve clinical outcome in patients with coronary artery disease. At present, it is common practice to stop treatment with beta-blockers in clinically asymptomatic patients after coronary artery bypass graft (CABG) and/or myocardial re-vascularization (PTCA/Stent), although the possible presence of SMI/inducible ischemia after myocardial re-vascularization is not known. We examined 56 asymptomatic CHD patients after coronary artery bypass graft (n=36), percutaneous coronary angioplasty PTCA/stent (n=15), or both (n=5); therapy with beta-blockers was stopped in all of them after myocardial revascularization. All these patients underwent a dobutamine stress echocardiography test (DSE test). The DSE test was proposed to these asymptomatic CHD patients to investigate the possible presence of SMI/inducible ischemia after myocardial re-vascularization. All patients had history of myocardial infarction or evidence of mildly impaired left ventricular function at rest as assessed by cardiac catheterization. Abnormal DSE studies occurred in eight of the 56 patients (14%; 95% C.I.: 6-26%). Therapeutic approaches specifically targeted at reducing total ischaemic burden include pharmacologic therapy and myocardial revascularization. On the basis of these data, it can be concluded that asymptomatic CHD patients after myocardial re-vascularization must be re-evaluated to rule out SMI/inducible ischemia that can be treated (e.g. with beta-blockers) reducing cardiovascular morbidity and mortality.

Correlation of circulating 17β-oestradiol with haemostatic factors in healthy postmenopausal women

The aim of the study was to evaluate any correlation between the circulating oestrogenic hormone 17β-oestradiol and haemostatic factors in healthy postmenopausal women. In keeping with this objective, the correlations were evaluated irrespective of whether the source of the hormone was purely endogenous or exogenous as well. Accordingly, a univariate correlation adjusted for age, body mass index, and duration of menopause was determined in 42 healthy postmenopausal women aged 47–78 years, 19 of whom were self-reported users of hormone replacement therapy. The rest were self- reported never users. Serum 17β-oestradiol exhibited a direct correlation with endogenous thrombin potential extrinsic pathway (R = 0.42, p = 0.01) and prothrombin fragments 1 and 2 (R = 0.37, p = 0.03) and an inverse correlation with antithrombin III (R = –0.36, p = 0.03) and α2-antiplasmin (R = –0.45, p = 0.005). The observations suggest an association of this hormone with net thrombin generation on the one hand and improved fibrinolysis on the other.

Risk of recurrent thrombotic events in patients with coronary heart disease and left ventricular dysfunction.

Left ventricular resting wall motion score index is years) underwent the DSE test to investigate the associated with impaired fibrinolysis and enhanced possible presence of inducible ischaemia. Written thrombin generation. Future studies are needed to informed consent was obtained from each patient. assess the clinical utility of this marker to select IHD The study was in accordance with the guidelines patients that might respond to more aggressive antiapproved by the local ethics committee. Dobutamine coagulant therapy. was infused intravenously with an infusion pump at It is now generally accepted that in about 80% of an incremental regimen of 5, 10, 20, 30, and 40 patients with an acute myocardial infarction, the mg/kg per min every 3 min. Atropine 300–600 mg ischaemic attack is precipitated by an occlusive intravenously was given at the end of the 40 mg/kg thrombus. One possible mechanism could be a tenper min dose if target heart rate (i.e. 85% predicted dency to thrombosis in the patients’ blood. The maximum) was not achieved. The used endpoints for hypercoagulable state persists for a prolonged period termination were according to the recommendations in patients with unstable angina and myocardial of the American Society of Echocardiography [4]. infarction [1]. An impaired fibrinolytic activity has The left ventricle was divided into 16 segments also been associated prospectively with an increased according to the recommendations of the American coronary risk in patients with angiographically docuSociety of Echocardiography [4]. Each segment was mented IHD and in healthy subjects [2]. then scored in the following way: normal51, At present, the severity and extent of echocardiohypokinetic52, akinetic53, dyskinetic54. All echgraphically detected wall motion abnormalities are ocardiographic recordings were reviewed by one considered among the most important predictors of independent observer who was blinded to the pasubsequent cardiac events in patients after an acute tients’ clinical data. The total number of myocardial myocardial infarction [3], and can assist physicians to segments per patient was graded, and the wall motion identify a subgroup of patients at high risk of score index (WMSI), representing the ratio between subsequent cardiac events. the sum of scores and the number of visualized Three hundred and nineteen patients with previous segments, was calculated at baseline. myocardial infarction and/or documented IHD (,85 After the patient had rested supine on bed for at least 10 min, blood was drawn via an indwelling catheter placed in the right antecubital vein. All *Corresponding author. Tel.: 144-207-351-8347; fax: 144-207-351samples were taken between 09.00 and 14:00 h after 8345. E-mail address: dlorenzo@tri-london.ac.uk (F. De Lorenzo). the subjects had fasted for at least 4 h prior to the