Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine最新文献

{"title":"Direct oral anticoagulants in older patients with atrial fibrillation and comorbidities: frailty, renal impairment, acute or chronic coronary syndromes, and acute stroke.","authors":"Felicita Andreotti, Adhithya N Balaji, Luigi Cappannoli, Lidia Megaro, Francesco Landi, Francesco Burzotta","doi":"10.20452/pamw.17319","DOIUrl":"10.20452/pamw.17319","url":null,"abstract":"<p><p>Direct oral anticoagulants (DOACs) have been available since 2008, boosting appropriate anticoagulation and reducing intracranial hemorrhages, as compared with warfarin therapy. However, for older individuals with atrial fibrillation (AF) and comorbidities, decisions on DOAC therapy may be challenging. In frail, stable‑on‑warfarin patients, the FRAIL‑AF (Safety of Switching from a Vitamin K Antagonist to a Non-Vitamin K Antagonist Oral Anticoagulant in Frail Older Patients with Atrial Fibrillation) trial reported increased relevant bleeding after switching to a DOAC. Subsequent individual patient‑data analyses of 4 pivotal DOAC‑vs‑warfarin AF trials confirmed the overall advantages of DOACs over warfarin even among older, frail, warfarin‑experienced individuals. Advanced age should not exclude the use of any DOAC for AF, but care is needed to adjust the doses, when indicated, particularly based on renal function. All DOACs undergo variable renal clearance and, in Europe, creatinine clearance below 30 ml/min contraindicates dabigatran, and below 15 ml/min factor‑Xa inhibitors. AF patients on DOACs presenting with acute coronary syndrome and / or requiring percutaneous coronary interventions are generally managed with additional dual antiplatelet therapy for 1-4 weeks, followed by clopidogrel plus DOAC for up to 1 year. AF patients with chronic coronary syndromes should generally receive a DOAC without additional antiplatelet therapy, as this abates major bleeding and improves cardiovascular survival without evidence of increased ischemic risk. For AF patients who develop acute ischemic stroke, recent exposure to a DOAC is a relative contraindication to intravenous thrombolysis, but the latter may be considered when clinically‑relevant anticoagulation can be excluded. Finally, for AF patients who develop nonsevere hemorrhagic stroke during DOAC therapy, resuming a DOAC to prevent ischemic strokes is counterbalanced by considerably enhanced major bleeding, including intracranial.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A hybrid strategy of left atrial appendage closure on top of anticoagulation in patients with prior anticoagulation failure: a multicenter study.","authors":"Kamil Zieliński, Krzysztof Kaczmarek, Marek Grygier, Paweł Kralisz, Aleksander Strzelecki, Joanna Grygier, Krzysztof Struniawski, Maksymilian Mielczarek, Jerzy Pręgowski, Adam Witkowski, Marcin Demkow, Radosław Pracoń","doi":"10.20452/pamw.17325","DOIUrl":"10.20452/pamw.17325","url":null,"abstract":"<p><strong>Introduction: </strong>A hybrid strategy involving left atrial appendage closure (LAAC) followed by long‑term anticoagulation may be considered in patients experiencing thromboembolic events or LAA thrombus despite anticoagulant treatment (anticoagulation failure).</p><p><strong>Objectives: </strong>We aimed to report the adoption rate and outcomes of the hybrid strategy in patients treated with LAAC for thromboembolic indications at 5 centers in Poland.</p><p><strong>Patients and methods: </strong>High‑volume Polish centers reported outcomes of LAAC after anticoagulation failure between the years 2014 and 2024. The hybrid strategy was compared with other pharmacotherapy regimens (nonhybrid strategy) with respect to thromboembolic events, device‑related thrombus (DRT), and major bleeding occurrence.</p><p><strong>Results: </strong>Out of 1625 patients undergoing LAAC procedures across 5 centers, 141 (8.7%) had a history of anticoagulation failure. The hybrid strategy was applied in 64 individuals (45%), and its rate increased from 0% in 2014 to 80% in 2024. As compared with the nonhybrid group, the patients treated with the hybrid strategy more often received newer‑generation occluders (98.4% vs 68.8%; P <0.001), had lower rates of prior bleeding (12.5% vs 35.1%; P = 0.003) and lower HAS‑BLED scores (median [interquartile range], 3 [2-3] vs 3 [2-4] points; P = 0.008), and more often had a history of LAA thrombus (23.4% vs 10.4%; P = 0.04) and left ventricular ejection fraction below 40% (18.8% vs 6.5%; P = 0.04). During a median 1.3‑year follow‑up, the hybrid strategy showed greater thromboembolic risk reduction relative to the CHA2DS2‑VASc-predicted rate (91% vs 60%; annualized event rates of 1.1% vs 5.5%), and greater major bleeding risk reduction relative to the HAS‑BLED-predicted rate (100% vs 73%; annualized rates of 0% vs 1.7%), with similar DRT rates (6.9% vs 6.8%; P >0.99).</p><p><strong>Conclusions: </strong>In patients with anticoagulant treatment failure, the hybrid strategy (LAAC + long‑term anticoagulation) is increasingly adopted and was associated with greater thromboembolic risk reduction, as compared with the standard nonhybrid strategy, without compromising the bleeding profile.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nontraumatic left-sided atrioesophageal fistula.","authors":"Jakub Jurica, Renáta Michalová, Marián Mokáň","doi":"10.20452/pamw.17366","DOIUrl":"10.20452/pamw.17366","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":"136 7-8","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of sirolimus therapy in sporadic and tuberous sclerosis complex-associated lymphangioleiomyomatosis: a retrospective cohort study.","authors":"Joanna Nowacka-Ejsmont, Karol Bączek, Iwona Bestry, Katarzyna Błasińska, Paulina Skrońska, Adriana Rozy, Renata Langfort, Małgorzata Sobiecka, Miquel A Pujana, Joanna Chorostowska-Wynimko, Joanna Miłkowska-Dymanowska, Elżbieta Radzikowska","doi":"10.20452/pamw.17320","DOIUrl":"10.20452/pamw.17320","url":null,"abstract":"<p><strong>Introduction: </strong>Sirolimus is a standard disease‑modifying therapy for lymphangioleiomyomatosis (LAM), but long‑term routine‑care data integrating pulmonary, lymphatic, extrapulmonary, and biomarker outcomes remain limited.</p><p><strong>Objectives: </strong>Our aim was to assess long‑term effectiveness and safety of sirolimus in routine clinical practice.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed consecutive adult patients with definite LAM treated with sirolimus at a national tertiary referral center in Poland between 2010 and 2020.</p><p><strong>Results: </strong>Seventy‑one patients were included (70 women; 57 [80%] with sporadic LAM and 14 [20%] with tuberous sclerosis complex-associated disease). Median (interquartile range) duration of available functional follow‑up was 5 (2-5) years, and mean (SD) trough sirolimus concentration was 7.85 (2.36) ng/ml. Baseline chylous pleural and / or peritoneal effusions were present in 15 patients (21%), renal angiomyolipomas in 33 (46%), and lymphangioleiomyomas in 28 individuals (39%). Forced expiratory volume in 1 second increased at 12 months by a median of 0.03 (-0.1 to 0.3) l from baseline (n = 66; P = 0.03). Forced vital capacity and 6‑minute walk distance also improved during early follow‑up, while transfer factor of the lung for carbon monoxide remained generally stable. Chylous effusions resolved in all affected patients by 12 months without recurrence, and renal angiomyolipoma and lymphangioleiomyoma volumes decreased significantly in patients who underwent paired magnetic resonance imaging. Higher baseline level of vascular endothelial growth factor D (VEGF‑D) was associated with lymphatic involvement, and decreased during treatment. Adverse events were mostly mild; permanent discontinuation occurred in approximately 6% of the patients.</p><p><strong>Conclusions: </strong>In routine practice, sirolimus treatment was associated with long‑term stabilization of lung function, marked improvement of lymphatic disease, reduction of angiomyolipoma burden, and acceptable tolerability. VEGF‑D level aligned with lymphatic phenotype and declined with treatment, thus supporting its role as a monitoring biomarker.</p>","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Salivary oxidative stress enzymes in patients with Graves orbitopathy: associations with clinical activity and treatment status.","authors":"Kacper Nijakowski, Martyna Ortarzewska, Nadia Sawicka-Gutaj, Dawid Gruszczyński, Alicja Stańska, Marek Ruchała","doi":"10.20452/pamw.17339","DOIUrl":"10.20452/pamw.17339","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypokalemic rhabdomyolysis due to geophagia during pregnancy.","authors":"Piero Saieva, Darlene Boakye, Nicola Wearne","doi":"10.20452/pamw.17362","DOIUrl":"10.20452/pamw.17362","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":"136 7-8","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammatory arthritis as a case study for sustainable access to high-cost therapies.","authors":"Giorgia Gribaudo, Paolo A Cortesi","doi":"10.20452/pamw.17372","DOIUrl":"10.20452/pamw.17372","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":"136 7-8","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipoprotein(a) in prevention: from an index result to family care.","authors":"Tianshu Gu, Garry McDowell, Kang-Yin Chen, Gregory Y H Lip","doi":"10.20452/pamw.17386","DOIUrl":"10.20452/pamw.17386","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":"136 7-8","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous glucose monitoring-derived glycemic metrics and platelet morphology in individuals with type 1 diabetes.","authors":"Ramzi A Ajjan, Robert F Storey","doi":"10.20452/pamw.17373","DOIUrl":"10.20452/pamw.17373","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":"136 7-8","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare case of electrical storm after accidental poisoning with Delphinium species.","authors":"Abhishek Tiwary, Binayak Gautam, Kunjang Sherpa","doi":"10.20452/pamw.17367","DOIUrl":"10.20452/pamw.17367","url":null,"abstract":"","PeriodicalId":49680,"journal":{"name":"Polskie Archiwum Medycyny Wewnetrznej-Polish Archives of Internal Medicine","volume":"136 7-8","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}