Therapeutics and Clinical Risk Management最新文献

{"title":"Comparative Prognostic Value of Baseline CRP, NLR, and MLR for 12-Month Outcomes After Ischaemic Stroke: A Prospective Cohort Study.","authors":"Yu Zhao, Yutong Wang, Shengyuan Wang","doi":"10.2147/TCRM.S624708","DOIUrl":"10.2147/TCRM.S624708","url":null,"abstract":"<p><strong>Background and objective: </strong>C-reactive protein (CRP), the neutrophil-to-lymphocyte ratio (NLR) and the monocyte-to-lymphocyte ratio (MLR) are routinely available inflammatory markers of uncertain relative prognostic value after stroke. This study aimed to investigate the associations of baseline CRP, NLR, and MLR with 12-month mortality and recurrence in patients with stroke.</p><p><strong>Methods: </strong>This single-center prospective cohort study enrolled hospitalized patients with stroke. Univariable analyses were performed to compare baseline characteristics according to 12-month mortality and recurrence status. Multivariable logistic regression models were constructed to evaluate the independent associations of CRP, NLR, and MLR with 12-month mortality and recurrence after adjustment for clinically relevant covariates.</p><p><strong>Results: </strong>A total of 2937 patients were included in the baseline analysis. Among them, 2166 were included in the 12-month mortality analysis, and 237 died during follow-up. In the multivariable logistic regression model, higher CRP was independently associated with an increased risk of 12-month mortality (OR = 1.01, 95% CI: 1.01-1.02, <i>P</i> < 0.001). NLR showed a borderline association with mortality (OR = 1.06, 95% CI: 1.00-1.13, <i>P</i> = 0.064), whereas MLR was not independently associated with mortality. A total of 2018 patients were included in the 12-month recurrence analysis, among whom 614 experienced recurrent events. In the multivariable model, higher CRP was independently associated with an increased risk of recurrence (OR = 1.01, 95% CI: 1.00-1.02, <i>P</i> = 0.025), whereas NLR and MLR was not independently associated with recurrence.</p><p><strong>Conclusion: </strong>Baseline CRP was independently associated with 12-month mortality and, more weakly, with recurrence. The mortality association was substantially stronger, and CRP should be regarded primarily as a marker of long-term mortality risk. NLR and MLR showed no independent association with either endpoint. CRP, combined with key clinical indicators, may assist long-term risk stratification after ischaemic stroke.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"624708"},"PeriodicalIF":2.6,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13532647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Management in First-in-Human Trials of Intravenous Drugs: Current Practices and Future Perspectives.","authors":"Wei Zhang, Dandan Yang, Rong Shao, Tiantian Lai, Xiuqin Feng","doi":"10.2147/TCRM.S623874","DOIUrl":"10.2147/TCRM.S623874","url":null,"abstract":"<p><p>In the first-in-human (FIH) study, the intravenous (IV) administration represents a critical juncture where preclinical data meet human physiology, characterized by immediate systemic exposure and an extremely narrow margin for safety. The current management measures for these trials are fragmented and lack a systematic framework. This narrative review, informed by a structured synthesis of peer-reviewed literature, regulatory guidance documents, and systematic institutional experience from multiple IV FIH trials conducted between 2020 and 2025, summarizes the key risk factors for FIH-IV trials, including pharmacological uncertainties, formulation-related toxicity, infusion rate sensitivity, and participant heterogeneity. It further evaluates preventive strategies such as determination of starting dose, personnel management and ensuring operational readiness, standardization of medication preparation and administration, comprehensive safety monitoring, and emergency response coordination and infrastructure. The primary aim is to propose a conceptual, stratified risk management framework that categorizes trials into low-, moderate-, and high-risk levels based on drug-related, procedural, and participant-specific variables. Corresponding management strategies are then applied to each level: standardized for low risk, enhanced for moderate risk, and advanced for high risk. This structured approach optimizes safety assurance in high-risk trials while avoiding the overutilization of resources in low-risk settings. The proposed framework is intended as a conceptual supplement to existing regulatory guidelines (eg, ICH E6(R3), EMA FIH guideline) and requires prospective multicenter validation before broad implementation.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"623874"},"PeriodicalIF":2.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication Safety and Perioperative Risk Management of GLP-1 Receptor Agonists: A Pharmacist-Led Framework for Individualized Care.","authors":"Naitao Shen, Chenyang Zhu, Fengqing Wang, Miaolian Wu","doi":"10.2147/TCRM.S623743","DOIUrl":"10.2147/TCRM.S623743","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used for type 2 diabetes, obesity, and broader cardiometabolic, cardiorenal, and metabolic liver disease indications, creating new challenges for perioperative medication safety. This review summarizes current evidence on GLP-1RA-associated delayed gastric emptying and proposes a structured pharmacist-led framework for individualized perioperative risk management. GLP-1RAs may increase the likelihood of residual gastric contents during anesthesia or procedural sedation despite adherence to standard fasting recommendations. Perioperative outcome studies have not consistently shown an increased risk of aspiration pneumonia; however, these findings should be interpreted in light of the low incidence of aspiration-related events, the predominance of retrospective study designs, residual confounding, and heterogeneous definitions of residual gastric contents. We review mechanisms of delayed gastric emptying, treatment- and patient-related risk modifiers, perioperative clinical evidence, areas of agreement and divergence among major guidance statements, gastric ultrasonography as a selective risk-mitigation tool, and medication-safety issues beyond aspiration, including oral drug absorption and postoperative resumption. Because perioperative GLP-1RA decisions require accurate medication history, last-dose verification, symptom assessment, evaluation of glycemic consequences of drug interruption, coordination with anesthesia and surgical teams, and safe postoperative restart planning, pharmacists are well positioned to support this process. The proposed pharmacist-led pathway provides a structured approach to GLP-1RA medication verification, gastrointestinal symptom screening, risk phenotyping, multidisciplinary escalation, day-of-surgery reassessment, postoperative restart planning, patient education, and documentation. Perioperative GLP-1RA management should not rely on routine discontinuation alone, but should integrate treatment phase, dose escalation, gastrointestinal symptoms, comorbid motility disorders, procedural urgency, anesthetic risk, oral medication considerations, and the metabolic consequences of withholding therapy. This pathway represents a structured implementation framework informed by current evidence and guidance; prospective evaluation in real-world perioperative settings is needed.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"623743"},"PeriodicalIF":2.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Preoperative Mechanical Bowel Preparation and Postoperative Cognitive Dysfunction in Patients Undergoing Colorectal Surgery: A Pilot Randomized Controlled Trial.","authors":"Ayşe Ülgey, Gamze Talih, Tutkun Talih, Elif Funda Sener, Saliha Ozsoy, Oğuz Kaan Şimşek, Ersin Sönmez, Halime Dana","doi":"10.2147/TCRM.S613539","DOIUrl":"10.2147/TCRM.S613539","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative cognitive dysfunction (POCD) is a common condition that greatly threatens patients' quality of life. While mechanical bowel preparation (MBP) enhances surgical visibility, its effect on postoperative complication rates remains debated. This study aims to evaluate the effect of MBP on POCD in patients undergoing colorectal surgery and to investigate its association with tau protein, brain-derived neurotrophic factor (BDNF) and lipopolysaccharide-binding protein (LBP) levels.</p><p><strong>Methods: </strong>This is a single-center randomized controlled trial. 80 eligible ASA-PS II-III colorectal surgery patients were randomized into his pilot study, which was designed as a randomized controlled trial. Cognitive function was assessed preoperatively (T1), postoperatively on day 15 (T2), and on day 90 (T3) using the Montreal Cognitive Assessment (MoCA). Blood samples were collected simultaneously from the patients for biomarker analysis. A decline of > 1 standard deviation from baseline on the MoCA was defined as POCD.</p><p><strong>Results: </strong>The incidence of POCD was significantly lower in patients without MBP compared to those with MBP (7.5% vs. 55%). At T3, BDNF levels were significantly higher in Group I than in Group II (p < 0.001). LBP levels were significantly higher in Group II than in Group I at T3 (p = 0.001). In patients with POCD, tau protein levels were significantly higher at T2 and T3 (p = 0.007; p = 0.012), while BDNF levels were significantly lower at T3 (p < 0.001).</p><p><strong>Conclusion: </strong>MBP was associated with a higher incidence of POCD in patients undergoing colorectal surgery; however, these preliminary findings require confirmation in larger trials.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"613539"},"PeriodicalIF":2.6,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Medicinal Encircling Therapy for Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis.","authors":"Panpan Li, Zilai Li, Shang Ju","doi":"10.2147/TCRM.S602768","DOIUrl":"10.2147/TCRM.S602768","url":null,"abstract":"<p><strong>Purpose: </strong>Diabetic foot ulcers represent a major clinical challenge due to delayed healing and high risk of complications. Medicinal encircling therapy, a traditional external treatment, has been widely used as an adjunctive intervention in clinical practice. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of medicinal encircling therapy combined with conventional treatment for diabetic foot ulcers.</p><p><strong>Material and methods: </strong>A comprehensive literature search was conducted across major English and Chinese databases from inception to November 1, 2025. Randomized controlled trials comparing medicinal encircling therapy plus conventional care versus conventional care alone were included. Primary and secondary outcomes related to ulcer healing, symptom improvement, inflammatory markers, pain, and adverse events were synthesized using risk ratios or mean differences with corresponding 95% confidence intervals. This systematic review was prospectively registered with PROSPERO (CRD420261299230).</p><p><strong>Results: </strong>Fifteen randomized controlled trials were included, all of which were published in Chinese. The pooled results showed that adjunctive medicinal encircling therapy significantly improved complete ulcer healing rate compared with conventional treatment alone (RR = 1.78, 95% CI 1.39-2.28). Overall clinical response and several secondary outcomes generally favored the intervention, although heterogeneity was observed for some outcomes. No serious treatment-related adverse events were reported.</p><p><strong>Conclusion: </strong>These findings suggest that medicinal encircling therapy may be a promising adjunctive treatment for diabetic foot ulcers; however, the certainty and generalizability of the evidence are limited by methodological shortcomings, incomplete safety reporting, and the inclusion of Chinese-language studies only. Further high-quality, multicenter randomized controlled trials are warranted.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"602768"},"PeriodicalIF":2.6,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally Invasive Evacuation for Spontaneous Supratentorial Intracerebral Hemorrhage After Contemporary Randomized Trials: Patient Selection, Timing, and Platform Choice.","authors":"Xin Shao, Chen Tan, Meiqi Yu, Fan Yang","doi":"10.2147/TCRM.S619414","DOIUrl":"10.2147/TCRM.S619414","url":null,"abstract":"<p><p>Spontaneous intracerebral hemorrhage (ICH) accounts for only 10-15% of all strokes but contributes disproportionately to stroke-related death and long-term disability. For decades, surgical evacuation of supratentorial ICH failed to show consistent functional benefit in randomized trials. The Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH) trial altered this trajectory by providing the first positive randomized evidence that an early, protocolized minimally invasive parafascicular approach can improve utility-weighted 180-day outcome in a predominantly lobar population. Interpretation was complicated by the 2025 MIND trial, which tested Artemis-based minimally invasive evacuation in a cohort dominated by deep hemorrhage and, after early termination, did not show benefit on its primary endpoint. In parallel, the SWITCH trial suggested at most a limited role for decompressive craniectomy without clot evacuation in severe deep ICH, with any possible reduction in death or extreme disability tempered by substantial residual disability among survivors. These trials indicate that the current issue is no longer the general rationale for surgery, but the specific patients, treatment window, and technical conditions under which evacuation is most likely to confer net benefit. This review traces the evidence from the International Surgical Trial in Intracerebral Haemorrhage (STICH) program and the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation (MISTIE) program to ENRICH and MIND, compares the major minimally invasive strategies, and examines hemorrhage location, hematoma volume, and treatment timing as the principal determinants of patient selection. On the basis of current randomized evidence, the clearest evidence-supported indication is early (<24 h) minimally invasive evacuation for patients resembling the ENRICH population: lobar supratentorial ICH, hematoma volume 30-80 mL, and treatment performed by a trained team using a standardized parafascicular workflow. Conversely, routine minimally invasive evacuation for most deep supratentorial hemorrhages, ultra-early (<8 h) intervention outside clinical trials, intervention beyond the ENRICH-supported early window, and the use of alternative platforms without comparable randomized support should be regarded as investigational or extrapolative rather than established standard care.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"619414"},"PeriodicalIF":2.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13401885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Multi-Disciplinary Approach to the Management of Chemotherapy-Induced Nausea and Vomiting in Breast Cancer.","authors":"Fang Chen, Kai Cao, Xiaoyan Zhao, Liping Xia, Meng Liu, Yifan Jiang","doi":"10.2147/TCRM.S620981","DOIUrl":"10.2147/TCRM.S620981","url":null,"abstract":"<p><p>Chemotherapy is a cornerstone of comprehensive breast cancer treatment. However, its non-specific cytotoxic effects frequently involve the gastrointestinal tract, leading to a spectrum of digestive adverse reactions, including chemotherapy-induced nausea and vomiting (CINV), anorexia, diarrhea, and constipation. These symptoms not only compromise patients' quality of life but may also impair treatment adherence. In severe cases, they can necessitate dose reduction or treatment discontinuation. This review systematically examines the epidemiology, pathophysiology, and classification of gastrointestinal adverse reactions associated with breast cancer chemotherapy, with a focus on CINV management strategies. These strategies include pharmacological prophylaxis, individualized risk assessment, non-pharmacological interventions, and the use of standardized assessment tools. Based on the available evidence, we discuss the transition from an experience-based nursing model to a predictive one. We also emphasize the importance of patient education, psychological support, and family involvement, and highlight specific considerations for breast cancer patients. This review provides a systematic, evidence‑based reference for the clinical care of CINV in breast cancer to optimize gastrointestinal symptom management and improve treatment outcomes and quality of life for these patients.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"620981"},"PeriodicalIF":2.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13361188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune Checkpoint Inhibitors in Breast Cancer: Mechanisms, Biomarkers, and Future Therapeutic Strategies.","authors":"Qiu-Chan Deng, Wen-Bin Kuang, Yu-Jing Yang, Cai-Ping Gong, Yi-Peng Zhang, Qiong Luo, Liu-Ping Luo, Guang-Ming Wang","doi":"10.2147/TCRM.S547154","DOIUrl":"10.2147/TCRM.S547154","url":null,"abstract":"<p><p>The landscape of breast cancer treatment has been fundamentally transformed by the emergence of immune checkpoint inhibitors (ICIs), representing a paradigm shift from traditional cytotoxic approaches to precision immunotherapy. This comprehensive review examines the current state and future directions of ICIs in breast cancer, with particular emphasis on triple-negative breast cancer (TNBC) where these therapies have shown the most promise. We explore the mechanistic foundations of checkpoint inhibition targeting CTLA-4, PD-1, and PD-L1 pathways, examine resistance mechanisms and predictive biomarkers, and discuss emerging targets including LAG-3, TIM-3, and TIGIT. The integration of ICIs with conventional therapies has yielded encouraging clinical outcomes, leading to the first FDA approvals for immunotherapy in breast cancer. However, significant challenges remain in identifying optimal patient populations, overcoming resistance mechanisms, and developing robust predictive biomarkers. This review synthesizes current evidence from recent clinical trials and provides insights into future therapeutic strategies that promise to enhance the efficacy of immune checkpoint blockade in breast cancer treatment.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"547154"},"PeriodicalIF":2.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13360958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Median Effective Dose of Esketamine Combined with Remifentanil for Anesthesia Induction in Painless Colonoscopy.","authors":"Zhengqing Cao, Haixia Xue, Huilian Wang, Xin Liu","doi":"10.2147/TCRM.S584512","DOIUrl":"10.2147/TCRM.S584512","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to determine the median effective dose (ED&lt;sub&gt;50&lt;/sub&gt;) of esketamine in combination with remifentanil for anesthesia induction during painless colonoscopy, utilizing the sequential dosing method.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study adopted a sequential design.Patients scheduled for painless colonoscopy at the Endoscopy Center of Northern Jiangsu People's Hospital in April 2023 were screened for inclusion in this study. The inclusion criteria encompassed male and female participants aged 18 to 60 years, with a body mass index (BMI) between 18 and 30 kg/m&lt;sup&gt;2&lt;/sup&gt; and classified as American Society of Anesthesiologists (ASA) physical status I or II. Participants undergoing colonoscopy as the sole procedure, without severe communication barriers, were included. Exclusion criteria included patients undergoing additional diagnostic or therapeutic procedures besides colonoscopy and those with a history of oral sedative or analgesic use exceeding one month. Data were analyzed using SPSS 20.0. Normally and non-normally distributed data were expressed as mean ± standard deviation and median (interquartile range), respectively. ED50, ED95 and 95% CI were determined by Probit regression. Correlation and logistic regression analyses were performed, and the sample size was verified by power analysis (α=0.05).For anesthesia induction, the remifentanil dose was fixed at 0.3 μg/kg, while the esketamine dose was adjusted sequentially. The initial dose of esketamine was 0.1 mg/kg and was incrementally increased by a ratio of 1:1.2 for each subsequent dose administered. Successful induction of anesthesia was defined as a positive response, while unsuccessful induction was classified as a negative response. An \"inflection point\" was defined as the dose transition from a negative response (unsuccessful anesthesia induction) to a positive response (successful anesthesia induction) within the sequential dosing framework. The sample size was determined by identifying at least seven such inflection points, where each inflection point involved two consecutive participants: one demonstrating a negative response at a given dose, immediately followed by another demonstrating a positive response at the next dose. Data from these inflection points were aggregated for the final analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 23 study participants were included in this study, with the following distribution: 13 males and 10 females. 13 participants were classified as Grade I, and 10 were classified as Grade II. The ED&lt;sub&gt;50&lt;/sub&gt; of esketamine combined with remifentanil for anesthesia induction in painless colonoscopy was 0.209 mg/kg, with a 95% confidence interval (CI) of 0.178 to 0.248 mg/kg. The dose required for 95% efficacy (ED&lt;sub&gt;95&lt;/sub&gt;) was 0.259 mg/kg, with a 95% CI of 0.231 to 0.478 mg/kg.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The ED&lt;sub&gt;50&lt;/sub&gt; and ED&lt;sub&gt;95&lt;/sub&gt; of esketamine combined with remifentani","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"584512"},"PeriodicalIF":2.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13360962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of CYP2C19 Genotype-Guided Antiplatelet Therapy Following Neurovascular Endovascular Procedures: A Prospective Non-Randomized Controlled Study.","authors":"Shaowen Xu, Xinxin Wang, Guangjun Cui, Miaomiao Li, Guoning Chen, Jinhua Hu, Qizhi Zhang","doi":"10.2147/TCRM.S615918","DOIUrl":"10.2147/TCRM.S615918","url":null,"abstract":"<p><strong>Background: </strong>CYP2C19 loss-of-function alleles are highly prevalent in Asian populations and may reduce the effectiveness of clopidogrel. This study aimed to evaluate the efficacy and safety of CYP2C19 genotype-guided antiplatelet therapy in patients with symptomatic severe intracranial atherosclerotic stenosis undergoing neurovascular endovascular treatment (EVT).</p><p><strong>Methods: </strong>This prospective non-randomized controlled study enrolled 175 patients who underwent neurovascular intervention. Patients in the genotype-guided group (n=100) received individualized antiplatelet therapy according to CYP2C19 genotyping results, whereas patients in the conventional therapy group (n=75) received routine dual antiplatelet therapy with aspirin and clopidogrel. Safety events, 90-day neurological outcomes, and the cumulative incidence of ischemic events within one year were compared between groups.</p><p><strong>Results: </strong>The incidence of bleeding events did not differ significantly between the genotype-guided group and the conventional therapy group (1.0% vs 4.0%, P>0.05). At 90 days, a significantly higher proportion of patients achieved a favorable functional outcome (modified Rankin Scale score 0-1) in the genotype-guided group than in the conventional therapy group (84.0% vs 65.3%, P=0.004). At one year, the proportion of patients experiencing at least one ischemic event was significantly lower in the genotype-guided group than in the conventional therapy group (12.0% vs 26.7%, P=0.013). Multivariable Cox regression analysis demonstrated that patients in the conventional therapy group had a significantly higher risk of ischemic events during follow-up than those in the genotype-guided therapy group (HR: 2.723, 95% CI: 1.259-5.888, P = 0.011). Interaction analysis suggested that treatment effects differed according to device type, with a numerically greater benefit observed in the stent subgroup, although this finding should be considered exploratory.</p><p><strong>Conclusion: </strong>CYP2C19 genotype-guided antiplatelet therapy following neurovascular EVT was associated with improved neurological outcomes and a lower incidence of ischemic events without increasing bleeding risk. However, because ticagrelor exposure differed between treatment groups, the independent contribution of pharmacogenetic testing requires further confirmation in larger randomized studies.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"615918"},"PeriodicalIF":2.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13361352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}