Search

To analyze the differences in the effect of dual antiplatelet post PCI on the percentage of aggregation in myocardial infarction patients with DM and non DM. Percentage of aggregation were analyzed using light transmission aggregometry (LTA) before loading dose, after PCI, and after maintenance dose of dual antiplatelet (aspirin 100mg and clopidogrel 75mg). Total 22 patients were participated in this study divided into 10 and 12 patients in diabetic and non diabetic group. Percentage of aggregation after taking dual antiplatelet maintenace dose decrease significantly in both group (p=0.006 in diabetic group and p=0.002 in non diabetic group). Mean reduction of percentage of aggregation in diabetic group (3.30±2.91%) is less than non diabetic group (6.83±5.97%). Statistical analysis shows that the mean reduction of percentage of aggregation between two groups were not significantly different (p>0.05). Mean percentage of aggregation after dual antiplatelet maintenance dose was higher in diabetic group and mean reduction of percentage of aggregation was higher in non diabetic group, although statistically in both group it is not significantly different. [ABSTRACT FROM AUTHOR]

Warfarin is the most commonly prescribed oral anticoagulant in Indonesia. However, the time in the therapeutic range (TTR) remains low across different countries worldwide. This study aimed to analyze the challenges associated with achieving optimal warfarin control. The analysis consisted of two distinct stages. The first stage was a prospective observational study that aimed to analyze anticoagulation control, dosing consistency, INR monitoring compliance, medication adherence, and knowledge of warfarin. Meanwhile, in the second stage, focus group discussion was used to propose strategies for overcoming the challenges. The result showed that the average TTR was 49.4 ± 32.1, where only 37.5% of patients had values = 65%. The average dosing consistency obtained was 62.33 ± 32.42%. The majority of patients with supratherapeutic INR values required a 1-month monitoring interval after dose adjustment. Further analysis indicated that only 43.8% of patients were classified as adherent and 39.5% had good knowledge of warfarin, suggesting the level of medication adherence and knowledge was not optimal. Approximately 14.6% of patients received other drugs that potentially interacted with warfarin, causing fluctuations in INR. In conclusion, this study found several challenges associated with achieving optimal warfarin control including barriers to dosing consistency, INR monitoring, medication adherence, and knowledge of warfarin, as well as drug interactions. The proposed solution is a holistic approach combining multifaceted strategies to address each barrier. [ABSTRACT FROM AUTHOR]

NT-proBNP is an amino terminal fragment of prohormone BNP released when there is cardiac wall stretch due to volume overload. The increase in NT-proBNP associated with the severity of heart failure and left ventricular ejection fraction. PCI can be improved cardiac function of patients with CHD who indicated an increase in ejection fraction. The purpose of this study to analyze changes in NT-proBNP levels and ejection fraction, and analyze correlation between ejection fraction as an indicator of cardiac function and NT-proBNP as cardiac stress marker in CHD patients undergoing PCI. An observational cross sectional study was conducted to analyze NT-proBNP levels and ejection fraction in patients with coronary heart disease who underwent PCI. The inclusion criteria were all patients aged ≥ 30 years with a diagnosis of CHD and underwent PCI. Exclusion criteria were all patients who had history of aortic stenosis, aortic regurgitation, pulmonary hypertension, hypertrophic cardiomyopathy, and kidney disease. The sample was drawn with consecutive sampling method. NT-proBNP levels was measured before and 96 hours after PCI. In pre-PCI, NT-proBNP levels was (909.66 ± 1360.56) pg/mL while ejection fraction was (56.40 ± 11.68) % and in post-PCI, NT-proBNP levels was (791.22 ± 1234.67) pg/mL while ejection fraction was (61.33 ± 11.09)%. There was a correlation between NT-proBNP levels and ejection fraction (r = -0.572, p = 0.001), showed that every decrease in the levels of NT-proBNP indicates a change in heart function associated with an increase in ejection fraction, and vice versa. In conclusions, there was significant difference neither in NTproBNP levels nor in ejection fraction. The significant correlation between NT-proBNP levels and ejection fraction can be used for prediction of heart failure post PCI. [ABSTRACT FROM AUTHOR]

Introduction: Infective endocarditis (IE) is a focus infection caused by bacterial, viral, or fungal microorganisms within the heart that involves the endocardium and heart valves. Streptococcus alactolyticus, classified under DNA cluster IV of the S. bovis/S. equinus complex, is a sparse isolated bacterium that rarely cause IE in humans. Kocuria kristinae is a gram-positive bacteria. Until now, there have been only six IE cases caused by K. kristinae infections reported in the literature. Thrombocytopenia and platelet dysfunction can manifest in IE cases and are related to the clinical outcome. Different mechanisms have been hypothesized to explain thrombocytopenia in IE. Case report: We report the case of a 25-year-old female patient who complained of palpitation two weeks before admission. Initially, the patient complained of fever arising six months before admission. Blood cultures showed S. alactolyticus and K. kristinae. Echocardiography examination showed vegetation on anterior and posterior mitral valves with severe mitral regurgitation. During hospitalization, the patient also suffered from severe thrombocytopenia without bleeding signs. On day 16 after hospitalization, the patient suddenly complained of abdominal pain and dyspnea. The patient was declared deceased with cause of death due to septic emboli. Conclusion: We reported a case of IE caused by rare bacterial pathogens, S. alactolyticus and K. kristinae, which were aggravated by thrombocytopenia. Management of IE with thrombocytopenia requires caution because it is associated with poor outcomes. In this case, poor outcomes can be connected to thrombocytopenia coupled with the presence of specific bacteria, S. alactolyticus, which is known as a bacterium that often causes septic embolism. [ABSTRACT FROM AUTHOR]

Coronary heart disease (CHD) is a progressive disease and is closely related to the inflammatory response and acute thrombosis of atherosclerotic plaques. Use of loading dose Clopidogrel 300mg and aspirin 200 mg as anti-platelet aggregation reported to have responded quite well. Neointimal formation and restenosis are complications that arise in PCI action, triggered by the inflammatory process, IL-6 stimulates release of hsCRP in the liver. hsCRP as an inflammatory marker of cardiovascular events is still controversial. Of the 15 patients with prevalence of 80% male, with main risk factors are dyslipidemia, hypertension and smoking. All patients were found percent aggregation < 80% is included in hypoagregation. This suggests that loading dose Clopidogrel 300mg and Aspirin 200 mg is adequate as an anti-platelet aggregation. Seen positive ranks between hsCRP group pre (1.12 ± 1.34) and hsCRP post (2.34 ± 2.03), p = 0.001 (p < 0.05). This suggests that the inflammatory response occurs due to the PCI action. Seen negative correlation between hsCRP and percent aggregation r = -0.16, p = 0.56 (p > 0.05, r < 0.514). The use of Clopidogrel 300 mg loading dose and 200 mg aspirin as anti-platelet aggregation is adequate with hypoaggregation response. Identified inflammatory response occurs because of PCI with an increase in inflammatory factors hsCRP and no correlation with percent aggregation, so that hsCRP is only referred to as inflammatory factors and not a biomarkers of inflammation and is not is directly linked to the inflammatory process and reocclusion. [ABSTRACT FROM AUTHOR]