Venous thromboembolism （VTE） is the commonest cause of preventable death in hospitalized patients. Elderly patients have higher risk of VTE because of the high prevalence of predisposing co-morbidities and acute ill...Venous thromboembolism （VTE） is the commonest cause of preventable death in hospitalized patients. Elderly patients have higher risk of VTE because of the high prevalence of predisposing co-morbidities and acute illnesses. Clinical diagnosis of VTE in the elderly patient is particularly difficult and, as such, adequate VTE prophylaxis is of pivotal importance in reducing the mortality and morbidities of VTE. Omission of VTE prophylaxis is, however, very common despite continuous education. A simple way to overcome this problem is to implement universal VTE prophylaxis for all hospitalized elderly patients instead of selective prophylaxis for some patients only according to individual＇ s risk of VTE. Although pharmacological VTE prophylaxis is effective for most patients, a high prevalence of renal impairment and drug interactions in the hospitalized elderly patients suggests that a multimodality approach may be more appropriate. Mechanical VTE prophylaxis, including calf and thigh compression devices and/or an inferior vena cava filter, are often underutilized in hospitalized elderly patients who are at high-risk of bleeding and VTE. Because pneumatic compression devices and thigh length stockings are virtually risk free, mechanical VTE prophylaxis may allow early or immediate implementation of VTE prophylaxis for all hospitalized elderly patients, regardless of their bleeding and VTE risk. Although the cost-effectiveness of this Multimodality Universal STat （＇MUST＇） VTE prophylaxis approach for hospitalized elderly patients remains uncertain, this strategy appears to offer some advantages over the traditional ＇selective and single-modal＇ VTE prophylaxis approach, which often becomes ＇hit or miss＇ or not implemented promptly in many hospitalized elderly patients. A large clustered randomized controlled trial is, however, needed to assess whether early, multimodality, universal VTE prophylaxis can improve important clinical outcomes of hospitalized elderly patients.展开更多
OBJECTIVE: To investigate the anti-embolic effect of Taorenchengqi Tang(TRCQT), a formulas from Traditional Chinese Medicine, plus aspirin in rats with embolic stroke induced by selective occlusion of the middle cereb...OBJECTIVE: To investigate the anti-embolic effect of Taorenchengqi Tang(TRCQT), a formulas from Traditional Chinese Medicine, plus aspirin in rats with embolic stroke induced by selective occlusion of the middle cerebral artery(MCA). Possible side effects of hemorrhagic incident and other bleeding events and anti-platelet effect were also explored.METHODS: Ninety rats were randomly separatedinto 9 groups(n = 10): group 1 a sham-operated group(n = 10); groups 2 and 3 orally treated with an isovolumetric solvent(distilled water) for 1 and3 months, followed by thromboembolic occlusion(n = 10); groups 4 and 5 orally treated with aspirin(5 mg/kg) alone for 1 and 3 months, followed by thromboembolic occlusion(n = 10); groups 6 and 7orally treated with TRCQT(0.5 g/kg) alone for 1 and3 months, followed by thromboembolic occlusion(n = 10); groups 8 and 9 orally treated with TRCQT plus aspirin for 1 and 3 months, respectively followed by thromboembolic occlusion(n = 10). The ischemic stroke in rats was induced by selective MCA occlusion. One was orally administered. After the treatments, rats' brains were removed, sectioned and stained with triphenyltetrazolium chloride(TTC) for infarct volume measurement. The incidence of subarachnoid hemorrhage(SAH) and intracerebral hemorrhage(ICH) were observed. A potential gastric bleeding side effect was assessed by measuring hemoglobin(Hb), and prothrombin time(PT). Collagen-induced platelet activation and tail vein bleeding time were measured.RESULTS: Treatment with TRCQT alone or in combination with aspirin reduced infarct volume for 1(P < 0.05), and 3(P < 0.01) months without SAH and ICH incidences, and gastric bleeding. TRCQT treatment for 1 month was also not altered PT. Moreover, a concentration dependent inhibition of collagen-induced platelet activation, followed by increasing of tail vein bleeding time was observed after TRCQT treatment.CONCLUSION: Either TRCQT alone or TRCQT plus aspirin exhibits potent neuroprotective effect by reducing infarct volume without changing the status of SAH, ICH and gastric bleeding possibly via inhib-iting the platelet activation and increasing bleeding time.展开更多
文摘Venous thromboembolism （VTE） is the commonest cause of preventable death in hospitalized patients. Elderly patients have higher risk of VTE because of the high prevalence of predisposing co-morbidities and acute illnesses. Clinical diagnosis of VTE in the elderly patient is particularly difficult and, as such, adequate VTE prophylaxis is of pivotal importance in reducing the mortality and morbidities of VTE. Omission of VTE prophylaxis is, however, very common despite continuous education. A simple way to overcome this problem is to implement universal VTE prophylaxis for all hospitalized elderly patients instead of selective prophylaxis for some patients only according to individual＇ s risk of VTE. Although pharmacological VTE prophylaxis is effective for most patients, a high prevalence of renal impairment and drug interactions in the hospitalized elderly patients suggests that a multimodality approach may be more appropriate. Mechanical VTE prophylaxis, including calf and thigh compression devices and/or an inferior vena cava filter, are often underutilized in hospitalized elderly patients who are at high-risk of bleeding and VTE. Because pneumatic compression devices and thigh length stockings are virtually risk free, mechanical VTE prophylaxis may allow early or immediate implementation of VTE prophylaxis for all hospitalized elderly patients, regardless of their bleeding and VTE risk. Although the cost-effectiveness of this Multimodality Universal STat （＇MUST＇） VTE prophylaxis approach for hospitalized elderly patients remains uncertain, this strategy appears to offer some advantages over the traditional ＇selective and single-modal＇ VTE prophylaxis approach, which often becomes ＇hit or miss＇ or not implemented promptly in many hospitalized elderly patients. A large clustered randomized controlled trial is, however, needed to assess whether early, multimodality, universal VTE prophylaxis can improve important clinical outcomes of hospitalized elderly patients.
基金Supported by Cathay General Hospital-Taipei Medical University(No.103CGH-TMU-06No.CGH-MR-A10308)+1 种基金Wan-Fang Hospital-Taipei Medical University(No.102TMUWFH-02-2)Taipei,Taiwan China
文摘OBJECTIVE: To investigate the anti-embolic effect of Taorenchengqi Tang(TRCQT), a formulas from Traditional Chinese Medicine, plus aspirin in rats with embolic stroke induced by selective occlusion of the middle cerebral artery(MCA). Possible side effects of hemorrhagic incident and other bleeding events and anti-platelet effect were also explored.METHODS: Ninety rats were randomly separatedinto 9 groups(n = 10): group 1 a sham-operated group(n = 10); groups 2 and 3 orally treated with an isovolumetric solvent(distilled water) for 1 and3 months, followed by thromboembolic occlusion(n = 10); groups 4 and 5 orally treated with aspirin(5 mg/kg) alone for 1 and 3 months, followed by thromboembolic occlusion(n = 10); groups 6 and 7orally treated with TRCQT(0.5 g/kg) alone for 1 and3 months, followed by thromboembolic occlusion(n = 10); groups 8 and 9 orally treated with TRCQT plus aspirin for 1 and 3 months, respectively followed by thromboembolic occlusion(n = 10). The ischemic stroke in rats was induced by selective MCA occlusion. One was orally administered. After the treatments, rats' brains were removed, sectioned and stained with triphenyltetrazolium chloride(TTC) for infarct volume measurement. The incidence of subarachnoid hemorrhage(SAH) and intracerebral hemorrhage(ICH) were observed. A potential gastric bleeding side effect was assessed by measuring hemoglobin(Hb), and prothrombin time(PT). Collagen-induced platelet activation and tail vein bleeding time were measured.RESULTS: Treatment with TRCQT alone or in combination with aspirin reduced infarct volume for 1(P < 0.05), and 3(P < 0.01) months without SAH and ICH incidences, and gastric bleeding. TRCQT treatment for 1 month was also not altered PT. Moreover, a concentration dependent inhibition of collagen-induced platelet activation, followed by increasing of tail vein bleeding time was observed after TRCQT treatment.CONCLUSION: Either TRCQT alone or TRCQT plus aspirin exhibits potent neuroprotective effect by reducing infarct volume without changing the status of SAH, ICH and gastric bleeding possibly via inhib-iting the platelet activation and increasing bleeding time.
