Treatment with ximelagatran has been associated with mainly asymptomatic elevation of ALT levels in a mean of 7.9% of patients in the long-term clinical trial programme and nearly all of the cases occurred within the first 6 months of therapy. Rare symptomatic cases have been observed. An algorithm has been developed for testing ALT to ensure appropriate management of patients with elevated ALT levels. Regular ALT testing should allow the clinical benefits of ximelagatran to reach the widest population of patients while minimising the risk of hepatic adverse effects.
We studied the prevalence of thalassemia trait in a group of Italian male myocardial infarction (MI) patients and an ethnically similar group of men admitted for other conditions. Italian men constituted approximately 13% of each group. Of 359 Italian men with a MI, only 2 had thalassemia trait. In contrast, of 330 adult Italian males in the non-MI group (mean age 59.6 years), 11 had thalassemia trait. Because the frequency of thalassemia trait was significantly (p < 0.01) lower in the myocardial infarct group, we conclude that thalassemia trait may be a protective attribute as regards MI. A prospective study of individuals with thalassemia minor is indicated to elucidate the mechanism for the observed protective effect and to determine what risk factors may offset the protective effect in those that do experience MI
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