Despite a growing body of literature supporting the potential benefit of pharmacist‐managed warfarin therapy (PMWT), comprehensive reviews regarding this topic are still lacking. A systematic search of literature was done in Pubmed/Medline, Scopus, Google Scholar, and Cochrane Library from database inception to January 2014. Studies comparing PMWT with usual medical care (UMC) regarding the control of anticoagulation, bleeding and thromboembolic events, mortality, hospitalization, emergency department visit, cost, patients' satisfaction, and quality of life were included. Of 758 potential articles identified, 24 studies (4 randomized controlled trials [RCT] and 20 non‐RCT studies) with a population of 11 607 were included. Among non‐RCT studies, the percentage of time in the therapeutic range (72.1% vs 56.7%; P = .013), major bleeding events (0.6% vs 1.7%, P < .001), thromboembolic events (0.6% vs 2.9%; P < .001), hospitalization (3% vs 10%; P < .001), emergency department visits (7.9% vs 23.9%; P < .0001) significantly favored PMWT. The study supported PMWT regarding cost saving and patient satisfaction. The results showed that the PMWT model is superior to UMC in managing warfarin therapy based on observational studies. As well, it is comparable to UMC based on RCT studies.
Despite the known role of vitamin D deficiency in development of thrombosis, no studies have evaluated the impact of treating of vitamin D deficiency on the markers of thrombosis. A pilot randomized clinical trial was done on 40 vitamin D-deficient patients with deep vein thrombosis (DVT) or pulmonary embolism (PE). The intervention group received an oral dose of 50,000 IU vitamin D every week for 8 weeks, followed by 1 pearl every 2 weeks for 4 weeks (a total of 3 months), while the control group did not receive vitamin D. Then, P-selectin and hs-CRP were measured at baseline and 1 and 3 months after the intervention. There was no significant decrease in hs-CRP in either group after 1 month (P = .955) or after 3 months (P = .525). Likewise, there was no significant decrease in P-selectin between the 2 groups after 1 month (P = .921) or 3 months (P = .795). The results indicated that treatment of vitamin D deficiency had no significant effect on hs-CRP or P-selectin after 3 months among DVT/PE patients. However, treatment of vitamin D deficiency in these patients resulted in the control of the international normalized ratio (INR) with the lower doses of warfarin. This observation is the first clinical report of enhancement of the anticoagulant effect of warfarin by the supplementing of vitamin D. Larger trials are needed to clearly show the effect of treating of vitamin D deficiency on thrombosis.
High plasma level of P-selectin is associated with the development of venous thromboembolism (VTE). Furthermore, supplementation of vitamin D could decrease thrombotic events. Hence, this study was designed to examine whether the administration of vitamin D can influence the plasma level of P-selectin in patients with VTE. In the randomized controlled trial, 60 patients with confirmed acute deep vein thrombosis and/or pulmonary embolism (PE) were randomized into the intervention (n = 20) and control (n = 40) groups. The intervention arm was given an intramuscular single dose of 300 000 IU vitamin D3 Plasma level of 25-hydroxy vitamin D, P-selectin, and high-sensitive C-reactive protein (hs-CRP) was measured at baseline and 4 weeks after. The plasma level of P-selectin (95% confidence interval = -5.99 to -1.63, P = .022) and hs-CRP (P = .024) significantly declined in vitamin D-treated group, while only hs-CRP was significantly decreased in the control group (P = .011). However, the magnitude of these reductions was not statistically significant. This study could not support the potential benefit of the high-dose vitamin D on plasma level of P-selectin and hs-CRP in patients with VTE.
Introduction:Periprocedural myocardial injury (PMI) following elective percutaneous coronary intervention (PCI) is an important therapeutic concern with remaining some mortality and morbidity. To the best of our knowledge, there is no published study that investigates the potential benefit of CoQ10 in preventing PMI following elective PCI.
Methods:In a randomized, clinical trial, 100 patients who scheduled for elective PCI were allocated in to the intervention (n=50) and control group (n=50). The intervention received a 300 mg loading dose CoQ10 12 hours before procedure.The level of CK-MB and troponin-I was measured before procedure, and 8 and 24 hours after. Furthermore, hs-CRP was measured at baseline and 24 hours after.All patients were assessed for the incidence of major adverse cardiac effects (MACEs) after 1 month.
Results:The CK-MB elevation (above the upper limit normal) was occurred in 22% (n=11) of CoQ10 and 20% (n=10) of control (P=.806). The elevation of troponin-I was documented in 8% (n=4) of both groups. No significant change in the level of cardiac biomarkers was noted. However, the significant reduction in hs-CRP level was occurred in CoQ10 group (P=.032).
Conclusion:The results showed that pretreatment with 300 mg CoQ10 12 hours before procedure could not reduce PMI following elective PCI, however, significantly decreased hs-CRP.
K E Y W O R D SCK-MB, CoQ10, hs-CRP, Percutaneous coronary intervention, Periprocedural myocardial injury, Troponin-I
This study could not support the pretreatment with pentoxifylline in the prevention of PMI in patients undergoing elective PCI. However, the trend was toward the potential benefit of pentoxifylline.
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