Current vascular pharmacology
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Curr Vasc Pharmacol · Jan 2015
ReviewGlycaemic Control in Cardiac Surgery Patients: a Double-Edged Sword.
Glycaemic management is of paramount importance in the cardiac surgery setting. A growing body of evidence confirms a J-shaped relationship between blood glucose (BG) level and perioperative morbidity and mortality. On one hand, acute hypoglycaemia causes irreversible cerebral damage. ⋯ Therefore, moderate perioperative insulin management is usually recommended, with target BG adjusted to individual needs and possibilities. Continuous BG monitoring is a promising tool that should help practitioners in everyday decision-making process of glycaemic control. This review summarises the current evidence-based knowledge on the perioperative management of hyperglycaemia.
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Curr Vasc Pharmacol · Jan 2015
Meta AnalysisA systematic review on levosimendan in paediatric patients.
Levosimendan is a calcium-sensitizing agent that improves cardiac function, hemodynamic performance, and survival in critically ill adult patient. Few data exist on its off-label use in paediatric patients. We therefore performed a systematic review updated in September 2013 of all the published articles describing the use of levosimendan in paediatric patients. ⋯ The 5 randomized studies published so far have all been performed in cardiac surgery and suggest a beneficial effect on hemodynamic data with no effect on intensive care unit stay, hospital stay or survival. Side effects (e.g. hypotension) were reported. This inodilator merits to be investigated with further randomized trials focusing on clinically relevant outcomes.
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Rhabdomyolysis is a syndrome due to a damage of skeletal muscle and the leakage of intracellular contents into the extracellular fluid and the circulation. Several causes may induce rhabdomyolysis and the major one is the crush syndrome. Most cases of non-traumatic rhabdomyolysis are related to drugs. ⋯ Subclinical rise of creatine kinase may be the expression of rhabdomyolysis that can present as a medical emergency such as acute kidney injury (AKI), compartment syndrome, cardiac dysrhythmias and disseminated intravascular coagulopathy. The main pathophysiological mechanisms of myoglobinuric-related AKI are renal vasoconstriction, formation of intraluminal casts and direct cytotoxicity promoted by heme-protein. The aim of this review is to analyze the pathophysiology of myolysis, the causes of rhabdomyolysis and especially the link between the liver and the kidney, which can represent the connecting element for the development of the syndrome.
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Curr Vasc Pharmacol · Jan 2015
ReviewTreatment of Periodontitis for the Prevention of Endothelial Dysfunction: A Narrative Review.
Endothelial dysfunction (ED) is the initial step in the development of atherosclerosis, leading to cardiovascular disease (CVD). It has been suggested that periodontal disease (PD) could be associated to pathogenesis of atherosclerosis, since it is able to trigger a host response with systemic inflammation. Although a number of epidemiological studies have shown that periodontitis could be associated with ED, it is still unclear whether periodontal treatment could improve ED and therefore cardiovascular outcomes. ⋯ ED could be related to periodontitis as well as to CVD. Periodontal treatment reduces the risk of teeth loss and may improve ED and the risk of CVD. Since controversial results exist, there is an urgent need for well-designed clinical trials to find and validate novel biomarkers of endothelial function, such as circulating endothelial progenitors, which may be crucial for further investigation of the association of PD with endothelial function and CVD.
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Curr Vasc Pharmacol · May 2014
ReviewPrimary prevention of ischaemic stroke in atrial fibrillation: new oral anticoagulant drugs for all?
Atrial fibrillation (AF) confers a 4.5% risk of stroke per year. The risk of stroke increases with various risk factors and until recently, warfarin has been the gold standard of thromboembolism prophylaxis in AF for many years. The dosage of warfarin requires regular adjustment dependent on the INR, to keep within a narrow therapeutic range of 2.0- 3.0. ⋯ Consequently approximately half who would benefit from oral anticoagulation do not have it prescribed. Novel oral anticoagulants with predictable pharmacokinetics and improved efficacy and safety profiles are currently being developed for stroke prevention in AF. Three novel oral anticoagulants have just completed Phase III trials for stroke prevention, all with impressive results; the direct thrombin inhibitor, dabigatran and the oral factor Xa inhibitors, rivaroxaban and apixaban.