Kardiologiya
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Phenomenon of ischemic post-conditioning of the myocardium (attenuation of myocardial damage during reperfusion resulting from interruption of early reperfusion period by repetitive short episodes of ischemia) was discovered in 2003. This paper contains presentation of protective effects of ischemic post-conditioning during ischemia-reperfusion of the myocardium, data on antiarrhythmic effects of post-conditioning in relation to persistent tachyarrhythmias during reperfusion, analysis of possible mechanisms of infarct-limiting effect of post-conditioning, and perspectives of its clinical application.
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Review Comparative Study
[Stroke and other thromboembolic complications of atrial fibrillation. Part VII. Prevention of cardioversion related thromboembolism].
In part VII of a series of papers on epidemiology and drug prevention of stroke and other thromboembolic complications of atrial fibrillation the authors analyze data on frequency and contemporary approaches to prevention of thromboembolic complications related to cardioversion. The stress is made on importance of prescription of indirect anticoagulants to all patients with duration of atrial fibrillation exceeding 48 hours. International normalized ratio should be controlled during anticoagulant therapy and be kept between 2.0 and 3.0 at least for 3-4 weeks before and after restoration of sinus rhythm. Absence of atrial thrombi at transesophageal echocardiography does not exclude possibility of thromboembolic complications of cardioversion conducted without anticoagulant therapy.
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Aim of the study was to assess significance of deviations of activated partial thromboplastin time (APTT) from optimal level (50-75 sec) after 48 hours of intravenous infusion of unfractionated heparin (UFH) in streptokinase treated patients with myocardial infarction (MI) for prognosis of nonfatal reinfarction and cumulative criterion comprising cardiac death, nonfatal MI and early postinfarction angina. Infusion of streptokinase (1,500,000 U in 30-60 min) was carried out after loading dose of aspirin (250 mg) and intravenous bolus (5,000 U) of UFH in 75 patients (age 34-76 years) admitted within 6 hours after onset of acute ST-elevation MI. UFH infusion was started prior to termination of administration of streptokinase and continued for 48 hours. ⋯ Independent predictors of cumulative criterion were level of risk of death according to TIMI scale (RR 1.47, 95% CI 1.-3 to 2.11; p=0.036) and deviation of APTT from optimal level in 12 hours after onset of UFH infusion (RR 3.24, 95%CI 1.05 to 10.5; p=0.046). It should be noted that rather than suboptimal excessive hypocoagulation by 12th hour of UFH infusion was associated with worse prognosis. APTT levels in 6, 24, and 36 hours of UFH infusion had no prognostic significance in relation to events assessed in the study.