Purpose The main objective of this study was to evaluate the effectiveness and safety of apixaban versus warfarin in patients with venous thromboembolism (VTE) in a “real-world” setting. Patients and Methods A retrospective cohort study was conducted using data from a large tertiary hospital in Saudi Arabia. Patients were included if they were adults (≥18 years), diagnosed with VTE, and treated with either apixaban or warfarin between January 2016 and September 2018. Patients who had received anticoagulation therapy within three months of the date of the index event were excluded. The effectiveness outcomes were incidence of VTE recurrence (ie, deep vein thrombosis DVT or pulmonary embolism [PE]), while the safety outcome was incidence of any major bleeding (MB) event within 90 days of follow-up. Results Among the 492 patients included for study, 212 (43.1%) received apixaban and 280 (56.1%) received warfarin. The mean age of patients was 53.6±19.1 years and 62% of the cohort was female. Comparable rates of VTE recurrence were observed for apixaban and warfarin treatment groups during follow-up (adjusted odds ratio (AOR) =0.95; 95% CI 0.53–1.68), including DVT (AOR=1.06; 95% CI 0.52–2.17) and PE (AOR=0.78; 95% CI 0.31–1.96). However, apixaban was associated with significantly fewer MB events than warfarin (AOR=0.18; 95% CI 0.04–0.83). Conclusion The use of apixaban for the treatment of Saudi patients with acute VTE is associated with a VTE recurrence rate comparable to that of warfarin, with significantly fewer MB events.
Background Potassium balance in heart failure is affected by many factors including neurohormonal mechanisms and drugs used in its management. Renin–angiotensin–aldosterone system inhibitor therapies are part of heart failure therapy and have been associated with increase the risk of hyperkalemia. Currently, there are limited data on the prevalence and risk factors of hyperkalemia in heart failure patients who received spironolactone as an add-on to standard therapy which include Angiotensin-Converting Enzyme Inhibitors (ACEIs) or Angiotensin II receptor blockers (ARBs). The objective of this study is to identify Incidence and determine of hyperkalemia risk factors among heart failure patients who have been using spironolactone. Methods This is a retrospective chart review, from March 1, 2016 to March 31, 2019 conducted at King Abdulaziz Medical City-Riyadh. All heart failure patients with age more than 18 year who are using spironolactone were included and we excluded if they had any of the following criteria: (1) end stage renal disease on dialysis; (2) cancer; (3) history of hyperkalemia. A data collection sheet was used to collect demographics (e.g., age, gender, weight, ejection fraction, and baseline potassium), comorbidities (e.g., chronic kidney disease, and diabetes), visit history (dose of spironolactone, hyperkalemia incidence, time to the event, medication that was patient on include (ACEI, ARB, digoxin, furosemide, beta-blockers, and potassium supplements), average potassium level, average creatinine, and average BNP). An Excel-based tool (Microsoft® Excel; Version 2018) was used for systematic data sampling and analysis. The study was approved by Institutional Review Board. Results A total of 349 patients met the inclusion criteria. 43% of patients were men while 57% were women. The mean age of patients was 64.87 ± 14.02 years. The mean baseline of potassium before start spironolactone were 4.34 ± 3.45 mmol/L. Hyperkalemia were assessed with different dose of spironolactone (12.5 mg, 25 mg, 50 mg). 161 patients were received 12.5 mg spironolactone, 40% of those patients who had incidence of hyperkalemia. 62% of those who developed hyperkalemia were on ACEI, 28% on ARB, 14% on potassium supplements. 263 patients were received 25 mg spironolactone, 47% of patients had incidence of hyperkalemia. 49% of those who developed hyperkalemia were on ACEI, 31% on ARB, and 22% on potassium supplements. 17 patients were received 50 mg spironolactone, 53% of patients had incidence of hyperkalemia. 44% of those who developed hyperkalemia were on ACEI, 22% on ARB, and 22% on potassium supplements. Conclusion Our study showed that half of heart failure patients who used spironolactone developed hyperkalemia. The majority of patients who developed hyperkalemia were either on ACEIs or ARBs. Spironolactone dosing of 50 mg was associated with highest incidence of hyperkalemia. Further study with a larger sample size is required to clarify and confirm our study findings.
Objectives A systematic review was conducted to explore the clinical evidence of pharmacogenetic testing with statins in a personalised approach to minimise the incidence of adverse drug reaction (ADR), ensure better response and optimise medication adherence. Methods Systematic literature review using PubMed and EMBASE/Medline database that includes all clinically relevant pharmacogenomic studies involving statins. Key findings Twenty-four articles were evaluated for a total of 120 articles screened. The included studies were classified according to study design (two randomised controlled trial studies (RCTs), three meta-analysis studies, two interventional studies, four prospective studies, 10 case-control studies, two cross-sectional studies and one data analysis study). There were 23 different genetic polymorphisms related to statins were studied clinically with the specified outcome either LDL-lowering response or adverse drug reaction. Those genes were diverse and involve metabolic enzymes, transporters and other receptors. Conclusions Many studies suggest a strong association between clinical outcomes and certain genes relevant to statins. However, these studies were observational and only a few were randomised controlled trials (RCTs). The strength of evidence to support pharmacogenetic testing for statin is not adequate.
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