Cardiovascular & hematological disorders drug targets最新文献

{"title":"The Impact of Single Nucleotide Polymorphisms and Other Mechanisms on Aspirin Resistance.","authors":"Natalia Sergeevna Nuzhdina, Aleksei Vitalievich Kurguzov, David Sergeevich Sergeevichev","doi":"10.2174/011871529X361464250319084053","DOIUrl":"https://doi.org/10.2174/011871529X361464250319084053","url":null,"abstract":"<p><p>Atherosclerosis and ischemic events play a pivotal role in the pathogenesis of several cardiovascular diseases (CVD). The primary aim of preventing recurrent thrombosis in patients who underwent cardiovascular surgery is the antiplatelet agent administration. Nevertheless, despite the aspirin therapy or double (aspirin plus clopidogrel) therapy, the effectiveness of antithrombotic treatment remains controversial. In recent years, we have learned that some percentage of patients still demonstrate no clinical response to aspirin treatment and may experience a vascular complication. This article provides an overview of recent scientific studies that have focused on experimental detection and genotyping of single nucleotide polymorphisms (SNPs) in patients, involving the main therapeutic target genes: cyclooxygenase COX-1 and COX-2, guanylate cyclase GUCY1A3, the glycoprotein complex GPIIb-IIIa, and the platelet receptor protein PEAR1.\" The aspirin resistance (AR) ranges considerably from 0 % to 66% in patients with ischemic heart disease (IHD) and relatively healthy people (control group). SNP distribution analysis has been proposed to explain the inadequate high platelet reactivity (HPR) among patients with IHD under aspirin treatment. Various SNPs have been proposed to explain the development of CVD and the persistent HPR under aspirin treatment widely used in the prevention of recurrent cardiovascular thrombotic events. Meanwhile, the efficacy of aspirin therapy in secondary thrombosis prevention in patients with IHD is not strongly associated with known SNP. The inconsistent results of different AR clinical trials are likely due to the design of the experiments and methodological and quantitative issues; therefore, careful interpretation of the SNP genotyping results is necessary.</p>","PeriodicalId":93925,"journal":{"name":"Cardiovascular & hematological disorders drug targets","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Tale of Triumph: Overcoming Challenges in Surgical ASD Closure for a Patient with Warm AIHA.","authors":"Nicodemus N Triatmojo, Valerinna Yogibuana Swastika Putri, Anna Fuji Rahimah, Gracelia Ruth Elizabeth Damanik, Koernia Kusuma Wardhana","doi":"10.2174/011871529X366103250311061025","DOIUrl":"https://doi.org/10.2174/011871529X366103250311061025","url":null,"abstract":"<p><strong>Background: </strong>Autoimmune hemolytic anemia (AIHA) is a rare disorder in hematology, with an incidence of 1-3 per 100,000 per year. The current data available on open-heart procedures in patients with AIHA is limited. Despite presenting periprocedural challenges, multidisciplinary efforts enabled the successful performance of surgical atrial septal defect (ASD) closure in a patient with warm-reactive AIHA.</p><p><strong>Case presentation: </strong>A 56-year-old woman with a large elliptical ASD was planned for surgical closure. The patient has never received a blood transfusion or experienced any previous hematological issues. During the surgical preparation, the patient's immunoglobulin G Coombs test result was positive for the presence of immunoglobulin G. The patient was diagnosed with a remission state of warm AIHA. A challenge arose when surgical ASD closure needed a cardiopulmonary bypass (CPB), which increased the risk of hemolysis. The patient also needed to be hypothermic to reduce metabolism, which may interact with the pathophysiology of AIHA. Several approaches were taken, and the procedure was conducted successfully without noteworthy obstacles.</p><p><strong>Conclusion: </strong>A successful surgical ASD closure was performed in a patient with complete remission of warm-reactive AIHA. Considering the different hemolytic mechanisms between CPB and AIHA, determining whether AIHA is cold or warm reactive is crucial for managing temperature in the heart-lung machine. Several approaches, such as utilizing a roller pump, a heparin-coated circuit, and administering steroids, can be implemented to prevent hemolysis.</p>","PeriodicalId":93925,"journal":{"name":"Cardiovascular & hematological disorders drug targets","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Green Path to Liver Health: Herbal Solutions for Non-alcoholic Steatohepatitis.","authors":"Shubham Sharma, Anjali Sharma, Parul Gupta, Deepshi Arora, Geeta Deswal, Ajmer Grewal, Devkant Sharma","doi":"10.2174/011871529X360903250211101856","DOIUrl":"https://doi.org/10.2174/011871529X360903250211101856","url":null,"abstract":"<p><p>Non-alcoholic steatohepatitis (NASH) is a progressive liver disease marked by inflammation and fibrosis, stemming from non-alcoholic fatty liver disease (NAFLD). Despite its rising predominance, current therapeutic medications are limited in efficacy and safety. Recent attention has shifted towards herbal therapies as potential adjuncts or alternatives in NASH management, given their anti-inflammatory, antioxidant, and phospholipid-controlling characteristics. This research study attempted to assess critically existing literature on the efficacy of herbal interventions while managing NASH. The main goal was to assess the possible medicinal advantages of different herbs, highlight their mechanisms of action, and identify gaps in current research to guide future studies. A systematic review of peer-reviewed articles using databases, like PubMed, Scopus, and Google Scholar, was conducted. It included studies that investigated the effects of herbal extracts (e.g., silymarin, curcumin, berberine) on NASH-related outcomes, such as liver function, fibrosis, lipid metabolism, and inflammatory markers. The review identified several herbs with promising therapeutic effects on NASH. Silymarin showed consistent improvements in liver enzymes and fibrosis markers. Curcumin and berberine were effective in reducing inflammation of the liver and oxidative damage. However, the heterogeneity in research designs, dosages, and outcome measures has limited the generalizability of findings. Herbal therapies hold potential as complementary treatments for NASH, with evidence supporting their role in improving liver function and reducing inflammation. To prove their safety and effectiveness, however, greater sample numbers and longer follow-up times are required in standardised clinical studies.</p>","PeriodicalId":93925,"journal":{"name":"Cardiovascular & hematological disorders drug targets","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Challenges of Polyneuropathy, Organomegaly, Endocrinopathy, M-protein, and Skin Changes (POEMS) Syndrome: A Rare Case Report and Review of the Literature.","authors":"Kailash Kumar, Rohit Daga, Jitendra Singh, Nilesh Kumar, Anju Dinkar","doi":"10.2174/011871529X352283250305042317","DOIUrl":"https://doi.org/10.2174/011871529X352283250305042317","url":null,"abstract":"<p><strong>Introduction: </strong>POEMS syndrome is a rare multisystem disorder associated with plasma cell dyscrasia and abnormal cytokine production, including vascular endothelial growth factor (VEGF). The mandatory criterion for its diagnosis includes polyneuropathy and monoclonal plasma cell disorder, along with other major and minor criteria. This case highlights the diagnostic and therapeutic challenges of POEMS syndrome by depicting the case of a 61-year-old male with progressive sensory-motor polyneuropathy, lymphadenopathy, and splenomegaly.</p><p><strong>Case presentation: </strong>The patient presented with a year-long history of bilateral limb weakness and sensory disturbances, accompanied by abdominal distention, weight loss, and other systemic symptoms. Clinical examination revealed skin hyperpigmentation, splenomegaly, and a right axillary lymph node enlargement. Neurological evaluation showed distal limb hypotonia, absent reflexes, and sensory deficits. Diagnostic investigations, including nerve conduction studies, imaging, and bone marrow biopsy, confirmed POEMS syndrome based on polyneuropathy, monoclonal IgG lambda plasma cells, Castleman disease, sclerotic bone lesions, elevated VEGF, and minor criteria, such as endocrinopathy and skin changes. The treatment comprised lenalidomide and dexamethasone, resulting in significant improvement at the three-month follow-up, including normalized VEGF levels and resolution of ascites.</p><p><strong>Conclusion: </strong>This case highlights the necessity of identifying the many presentations of POEMS syndrome for prompt diagnosis and treatment. Despite its rarity and diagnostic complexity, prompt treatment can significantly improve clinical outcomes. POEMS syndrome should be considered in patients with unexplained neuropathy and systemic features, enabling better outcomes through targeted therapies.</p>","PeriodicalId":93925,"journal":{"name":"Cardiovascular & hematological disorders drug targets","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treating Cardiovascular Disorders with Personalized Medicine.","authors":"Ishu Garg, Harish Kumar, Madhu Verma, Iti Chauhan, Vishal Panwar","doi":"10.2174/011871529X361429250215190129","DOIUrl":"https://doi.org/10.2174/011871529X361429250215190129","url":null,"abstract":"<p><p>The past decade has appreciated personalized medicine as a novel medical approach that deals with all practices that are tailored to individual patients. Personalized treatment or personalized cardiology for cardiovascular disorders is an emerging medicine system for related patients. Personalized cardiology is solely based on genomics and proteomics; molecular diagnostics and biomarkers of the cardiovascular system link diagnosis with therapy. Bioinformatics is useful in CVD risk stratification and might improve risk-estimating algorithms. Personalized cardiology involves 3D printing, pharmacotherapy, surgery, lifestyle modifications, and combinations thereof. Understanding the pathology of CVD and identifying causative factors at the individual level can provide opportunities for developing personalized medicine. Since it offers novel avenues for diagnosing, preventing, and treating CVD, molecular genetics has made a substantial contribution to the field of molecular cardiology. Nonetheless, there are still a lot of obstacles to overcome from the standpoints of science and policy. These obstacles can be avoided using evidence-based procedures, clinical applications, biomarker-based detection techniques, comprehensive concepts, and understanding. Targeted therapies may be developed as a result of improved disease classification and a better knowledge of the individual differences in pathology. Cardiovascular disorders, like hypertension, angina, or ischemic heart, a condition of reduced blood flow to the heart, coronary artery disease or damaged blood vessels, myocardial infarction or resisted blood flow to the myocardium, and cardiac arrhythmia or irregular cardiac cycles are the primary targets for personalized cardiology. The current review discusses various parameters for personalizing the treatment of cardiovascular disorders.</p>","PeriodicalId":93925,"journal":{"name":"Cardiovascular & hematological disorders drug targets","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning for Chromatin Regulators in Coronary Artery Disease Diagnosis.","authors":"Mei Zhao, Wanying Li, Simin Peng, Xiaocong Ma, Ding Wang, Jinghui Zheng","doi":"10.2174/011871529X352182250207062210","DOIUrl":"https://doi.org/10.2174/011871529X352182250207062210","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to investigate the mechanisms underlying the role of chromatin regulator-related genes (CRRGs) in coronary artery disease (CAD) and develop a diagnostic model for CAD.</p><p><strong>Methods: </strong>We downloaded CAD datasets from the GEO database and utilized R software for machine learning, modeling, and classification of CAD based on CRRGs.</p><p><strong>Results: </strong>The random forest model was found to be the best approach, identifying USP44, MOCS1, SSRP1, ZNF516, and SCML1 as the top contributing genes for CAD diagnosis and prevention. Differentially expressed CRRGs were associated with aberrant immune cell infiltration in CAD patients. CAD patients were classified into two subtypes based on the expression of differentially expressed CRRGs. The differential expression analysis identified MMP9, LCE1D, LOC92659, SYNGR4, EN2, CACNA1E, GPR78, and LOC92249 as differentially expressed genes distinguishing the two subtypes of CAD. Functional analyses revealed that the differentially expressed genes are enriched in biological processes related to cellular functions, such as responses to metal ions and inorganic substances. The enriched pathways included inflammation and hormone-related pathways, such as IL-17 signaling, endocrine resistance, TNF signaling, and estrogen signaling pathways.</p><p><strong>Conclusion: </strong>CAD is associated with CRRGs, which may represent a new direction for CAD treatment.</p>","PeriodicalId":93925,"journal":{"name":"Cardiovascular & hematological disorders drug targets","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143461099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vasorelaxant and Antihypertensive Effects of Extracts from the Leaves of Casimiroa edulis La Llave (Rutaceae) by NO Release and Calcium Channel Blockade.","authors":"Gabriela Pérez-Barrón, Samuel Estrada-Soto, Rafael Villalobos-Molina, Luis Arias-Durán, Jaime Escalante-García, Irene Perea-Arango, Rogelio Hernández-Pando","doi":"10.2174/011871529X346240250211090920","DOIUrl":"https://doi.org/10.2174/011871529X346240250211090920","url":null,"abstract":"<p><strong>Background: </strong>Casimiroa edulis La Llave (Rutaceae), commonly known as \"zapote blanco\", is a tree widely distributed in the tropical and subtropical areas of Mexico. The decoction of its leaves is traditionally used as a natural remedy to treat hypertension and anxiety.</p><p><strong>Objective: </strong>The present study aimed to determine the vasorelaxant and antihypertensive effects of C. edulis extracts and evaluate the acute and sub-acute toxicity of one of the most active extracts.</p><p><strong>Methods: </strong>The hydro-alcohol and organic (hexane, dichloromethane, and methanol) extracts, obtained from the leaves of C. edulis, were evaluated on isolated aorta rat rings in the presence and absence of endothelium to determine their vasorelaxant effect. Then, most active extracts were studied to evaluate the functional mechanism of their vasorelaxant action and antihypertensive effect on spontaneously hypertensive rats (SHR). The acute and sub-acute toxicity of dichloromethane extract was evaluated following the OECD 423 and 407 protocols.</p><p><strong>Results: </strong>The hexane (HE) and dichloromethane (DE) extracts from Casimiroa edulis induced significant vasorelaxant action on isolated rat aortic rings with (Emax 104.7 ± 1.4% and Emax 97.3 ± 6.7%, respectively) and without (Emax 94.9 ± 3.5% and Emax 67.4 ± 1.0%, respectively) endothelium, and this effect was partially endothelium-dependent. Their vasorelaxant action was modified by L-NAME (nitric oxide synthase inhibitor) and ODQ (soluble guanylyl cyclase inhibitor); however, indomethacin did not modify the effect. Also, both HE and DE significantly decreased the contraction induced by KCl in a concentration-dependent manner and the maximal effect induced by CaCl2. Moreover, DE showed a significant decrease in systolic and diastolic blood pressure in SHR at 7 hours and 15 days after treatment, respectively. Finally, the toxicity test of DE allowed classifying it in category 5, indicating it to be a non-toxic extract based on OECD guideline 423; the LD50 value was estimated to be greater than 2,000 mg/Kg and smaller than 5,000 mg/Kg in Wistar rats.</p><p><strong>Conclusion: </strong>The results demonstrated hexane and dichloromethane extracts to exert a vasorelaxant effect through endothelium-dependent NO release and cGMP increase, as well as by calcium channel blockade. Also, dichloromethane extract showed efficacy and security as a potential antihypertensive agent.</p>","PeriodicalId":93925,"journal":{"name":"Cardiovascular & hematological disorders drug targets","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelvic Hematoma Revealing Chronic Myeloid Leukemia: Case Report of Two Patients.","authors":"Arjun Kachhwaha, Avriti Baveja, Rahul Dev, Farhanul Huda, Uttam Kumar Nath","doi":"10.2174/011871529X365410250131120926","DOIUrl":"https://doi.org/10.2174/011871529X365410250131120926","url":null,"abstract":"<p><strong>Background: </strong>Chronic myeloid leukemia [CML] is a common hematological malignancy where patients present with varied clinical symptoms and are usually diagnosed with incidentally detected elevated total leucocyte counts in hemogram. The presence of pelvic hematoma at the presentation of CML is an uncommon finding.</p><p><strong>Case presentation: </strong>Two male young adults presented with massive splenomegaly and pelvic hematoma. On evaluation for anemia and leukocytosis with massive splenomegaly, diagnosis of CML chronic phase [CML-CP] was made on peripheral smear, bone marrow examination including cytogenetic study and molecular methods [peripheral blood quantitative BCR: ABL1 by real-- time PCR]. The first patient underwent aspiration of hematoma, and the second patient presented late where the hematoma organized into a solid mass and no intervention could be possible. A basic available coagulation study revealed no abnormalities and was managed with tyrosine kinase inhibitors.</p><p><strong>Conclusion: </strong>Initial manifestation of CML with pelvic hematoma is uncommon and should undergo aspiration or drainage to avoid organization of hematoma and compressive symptoms locally.</p>","PeriodicalId":93925,"journal":{"name":"Cardiovascular & hematological disorders drug targets","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Levothyroxine Therapy on Gestational Hypertension and Pre-Eclampsia in Pregnant Women with Subclinical Hypothyroidism, Hypothyroidism, and Thyroid Autoimmunity: A Systematic Review and Meta-analysis.","authors":"Masoomeh Goodarzi-Khoigani, Ashraf Aminorroaya, Raziyeh Mohammadi","doi":"10.2174/011871529X324722250207072454","DOIUrl":"https://doi.org/10.2174/011871529X324722250207072454","url":null,"abstract":"<p><strong>Background: </strong>Gestational hypertension (GH) and preeclampsia (PE) are two important complications of pregnancy. Considering the U-shaped association between thyroidstimulating hormone (TSH) and hypertensive disorders of pregnancy in some reports, we decided to investigate the effect of levothyroxine treatment on GH and PE in pregnant women with subclinical hypothyroidism (SGH), overt hypothyroidism (OH), and autoimmune thyroid diseases.</p><p><strong>Methods: </strong>Google Scholar and databases, such as ProQuest, Medline, Cochrane Library, ScienceDirect, and Scopus were searched electronically for clinical trials and observational studies using the following search terms: ((\"levothyroxine\" OR \"LT4\" OR \"thyroxine supplementation\") AND (\"subclinical hypothyroidism\" OR \"SCH\" OR \"thyroid peroxidase antibodies\" OR \"autoimmune thyroid disease\") AND (\"pregnancy outcomes\" OR \"preeclampsia\" OR \"gestational hypertension\" OR \"PIH\")). Further, we investigated the impact of levothyroxine on the incidence of GH and/or PE compared with control or placebo groups from April 4 to November 1, 2022.</p><p><strong>Results: </strong>After treatment with levothyroxine, the odd ratios (ORs) of GH and PE in subclinical [OR = 1.03, 95% CI: (0.85, 1.25), I² = 35.25%, P =0.78, OR = 1.02, 95% CI: (0.66,1.58), I² = 46.86%, P =0.94, respectively] and overt hypothyroidism [OR=1.10, 95% CI: (0.70,1.71), I² =38.44%, P =0.69, OR=1.32, 95% CI: (0.83, 2.09), I² =0.00%, P =0.24, respectively] were not different from controls. Furthermore, this result was observed in studies that recruited women with SCH and OH [OR=1.12, 95% CI: (0.58, 2.14), I²=92.74%, P =0.74, OR=0.51, 95% CI: (0.15, 1.72), I² =97.30%, P =0.28, respectively]. Also, these studies compared thyroperoxidase antibodies between TPOAb-positive participants with TPOAb-negative controls (OR=1.01, 95% CI: (0.80, 1.28), I² =0.00%, P =0.90). However, LT4 reduced the risk of GH in TPOAb+ women compared with untreated TPOAb+ (OR=0.43, 95% CI: (0.30, 0.62), I² =0.00%, P =0.00).</p><p><strong>Conclusion: </strong>After LT4 therapy, the incidence rates of GH and PE in any form of hypothyroidism were not significantly different from controls. However, the reduction of GH in women with TPOAb+ who used levothyroxine needs further consideration.</p>","PeriodicalId":93925,"journal":{"name":"Cardiovascular & hematological disorders drug targets","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143461095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-dose Systemic Tissue-type-plasminogen-activator Compared to Conventional Anti-coagulation for the Treatment of Intermediate-high Risk Pulmonary Embolism.","authors":"Alan De la Rosa, Adrian Rojas Murguia, Michael J Brockman, Debabrata Mukherjee, Manu Rajachandran, Nils P Nickel","doi":"10.2174/011871529X349173250119114056","DOIUrl":"https://doi.org/10.2174/011871529X349173250119114056","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary embolism (PE) is a frequent cause of death. Acute PE may be treated either with full anticoagulation (AC) alone or thrombolytic therapy with systemic tissue-- type-plasminogen-activator (tPA) based on risk assessment. Currently, AC is the standard of care for most patients with intermediate-high-risk PE, with low-dose tPA emerging as an effective alternative. However, studies directly comparing the efficacy and safety of low-dose tPA to AC are lacking in this patient population.</p><p><strong>Objective: </strong>The aim of this study was to retrospectively compare the efficacy and safety of low-- dose tPA, compared to AC alone in right ventricular function and in-hospital mortality and bleeding complications in patients presenting with intermediate-high risk PE.</p><p><strong>Methods: </strong>This is a single-center, retrospective cohort trial conducted at a university hospital. A total of 148 patients were screened, and 88 patients qualified for this study. The primary endpoints were changes in right ventricular function on echocardiogram in 24 hours, in-hospital mortality, and major bleeding complications.</p><p><strong>Results: </strong>Eighty-eight consecutive patients with intermediate high-risk PE were included. Twenty- six patients (29.5%) received low-dose systemic tPA administered via intravenous infusion, and 62 patients (70.4%) received standard full-dose anticoagulation. There were no significant differences in baseline vital signs or PESI scores between the low-dose tPA and the AC group. Patients in the low-dose tPA group had worse RV function and higher troponin levels at baseline but showed significant improvement in all RV parameters assessed during the 24-hour follow-up. In comparison, there was no significant improvement in RV function in the AC group. There were more bleeding events in the AC group. LOS was shorter in the low-dose tPA group.</p><p><strong>Conclusion: </strong>Treatment with low-dose prolonged infusion of tPA may be an effective and safe therapy in patients with intermediate-risk PE. Compared to AC, low-dose tPA was effective in decreasing PASP and restoration of RV function.</p>","PeriodicalId":93925,"journal":{"name":"Cardiovascular & hematological disorders drug targets","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}