Aim To compare hemorrhagic safety of ticagrelor and clopidogrel in patients with ST-segment elevation acute coronary syndrome (STEACS) after thrombolytic therapy (TLT).Material and methods This nonrandomized study included 183 patients followed up for 30 days. Hemorrhagic safety was compared in a group of patients with STEACS (n=71) after a thrombolytic treatment with alteplase and early ticagrelor treatment (180 mg followed by switching to 90 mg twice daily) and in a group of patients (n=112) with STEACS receiving TLT with alteplase and clopidogrel (loading dose, 600 mg followed by switching to 75 mg daily). Primary endpoint was hemorrhage associated with TLT; patients were followed up for 30 days.Results During the follow-up period, TLT-associated hemorrhages were observed in 11.3% of patients in the ticagrelor treatment group and in 10.7% of patients in the clopidogrel treatment group (p=0.9; odds ratio, 1.06 at 95 % confidence interval, from 0.41 to 2.73). Intracranial hemorrhages and fatal hemorrhages were absent in both groups.Conclusion There were no significant differences in hemorrhagic safety between patients with STEACS after the TLT treatment with alteplase and early treatment with ticagrelor or clopidogrel.
This article considers the legal status of tokens, their specifics and distinctive features, as well as the possibility of inheriting this digital asset. The study aims at analyzing the legal nature and classification of tokens, as well as the specifics of their inheritance. While conducting this research, it has been used the methods of collecting and studying singularities, generalization, scientific abstraction, cognition of objective laws, objectivity, specificity and pluralism. It has been concluded that a token is an entry in the transaction block registry (blockchain) or other distributed information systems, which certifies that the token owner is entitled to civil law protections and/or is a cryptocurrency. It has been proved that tokens by their legal nature are digital units of accounting in the participating interest shares of entrepreneurial projects and authorized capitals of any company, digital price analogues of uncertificated securities and other objects of civil law. It has been developed a classification of tokens and emphasized the need to create an electronic data warehouse that contains access codes for these digital assets. After the testator’s death, these codes can be given to the heir by testament or by law in case the testator did not draw up the corresponding testament during their life. These conclusions and suggestions will allow to legally qualify tokens and resolve inheritance issues in this area.
Background: The presented clinical case shows a version of successful step-by-step medical care for a patient with a dissecting aneurysm of the ascending aorta involving the trunk of the left coronary artery in a vascular center without a cardiac surgical support. Clinical case description: The patient was admitted to the Kostroma Regional Vascular Center with the symptoms of Acute Coronary Syndrome. During the examination in the clinic, the diagnosis of acute coronary syndrome with ST segment elevation was confirmed, and a dissecting aneurysm of the ascending aorta was also revealed. According to emergency coronary angiography, the dissection of the left coronary artery trunk was visualized, and the left coronary artery trunk was successfully stented with a bare metal stent. Later, the patient was transferred to a federal center, where aortic prosthetic reconstruction was performed. Conclusion: In patients with a dissecting thoracic aortic aneurysm involving the trunk of the left coronary artery and acute myocardial damage, who are admitted to a vascular center without a cardiac surgery support, the following step-by-step treatment strategy is likely to be effective: stenting the trunk of the left coronary artery with a bare metal stent and a further transfer to a center of cardiac surgery for a surgical treatment.