Abstract:
BACKGROUND:Sulfonylurea compounds may impair ischemic preconditioning and endogenous fibrinolysis. Increased mortality has been reported in diabetics receiving these drugs prior to admission for acute myocardial infarction when treated by direct angioplasty. Although thrombolytics are currently employed far more frequently than direct angioplasty the effect of sulfonylureas on mortality in the setting of thrombolysis has not been previously addressed. METHODS:Two hundred forty five diabetics treated with either accelerated t-PA or streptokinase in a national, multi-center, randomized comparison of argatroban vs. heparin (n=1200) were grouped by anti-diabetic treatment prior to hospitalization, and their outcomes were compared by retrospective analysis. RESULTS:Baseline characteristics were similar in all groups (sulfonylureas: n=121, oral medications other than sulfonylureas: n=17, insulin: n=28, diet alone: n=79). Sulfonylurea use was not associated with increased mortality or adverse event rates. By logistic regression analysis with diet treatment as reference, only prior insulin use was associated with higher risk for mortality at 30 days and 1 year (odds ratios 4.5 and 5.22, respectively, p<0.05). CONCLUSIONS:Sulfonylureas use prior to admission is not associated with adverse outcomes in diabetics treated with thrombolytics for myocardial infarction. Since direct angioplasty may increase mortality in patients taking these drugs, a randomized trial is needed to specifically compare different strategies of acute reperfusion in diabetics.Abbreviated abstract. Increased mortality has been reported in diabetics using sulfonylureas when treated for myocardial infarction by direct angioplasty. No study has specifically addressed the effect of these drugs on outcomes in the setting of thrombolysis. In a retrospective analysis of 245 diabetics treated with thrombolysis in a randomized comparison of argatroban vs. heparin, outcomes were compared in relation to anti-diabetic therapy prior to admission. Sulfonylurea use did not adversely affect prognosis, which was worst among diabetics previously treated with insulin. In conclusion, sulfonylureas do not worsen outcomes of diabetics treated with current thrombolytic regimens in comparison with other anti-diabetic treatments.
journal_name
J Thromb Thrombolysisjournal_title
Journal of thrombosis and thrombolysisauthors
Halkin A,Roth A,Jonas M,Behar Sdoi
10.1023/a:1012979622945subject
Has Abstractpub_date
2001-10-01 00:00:00pages
177-84issue
2eissn
0929-5305issn
1573-742Xjournal_volume
12pub_type
临床试验,杂志文章,随机对照试验abstract:UNLABELLED:Platelet P-selectin and activated glycoprotein IIb-IIIa (GPIIb-IIIa) are markers of platelet activation and mediates platelet aggregation. Prasugrel (Pras) 5 mg may be used in very elderly (VE) acute coronary syndrome (ACS) patients undergoing PCI, but its effect on platelet P-selectin and activated GPIIb-II...
journal_title:Journal of thrombosis and thrombolysis
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 临床试验,杂志文章
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 临床试验,杂志文章
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pub_type: 杂志文章,评审
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pub_type: 杂志文章
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 临床试验,杂志文章,多中心研究
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 临床试验,杂志文章
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更新日期:2012-07-01 00:00:00
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pub_type: 杂志文章
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
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pub_type: 杂志文章,随机对照试验
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更新日期:2019-08-01 00:00:00
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章,评审
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pub_type: 杂志文章
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章,评审
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更新日期:2011-10-01 00:00:00
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
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更新日期:2005-04-01 00:00:00
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章,评审
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更新日期:2015-11-01 00:00:00
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章,评审
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更新日期:2016-01-01 00:00:00
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/BF01062706
更新日期:1995-01-01 00:00:00
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
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更新日期:2003-12-01 00:00:00
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
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更新日期:2006-12-01 00:00:00
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-015-1213-7
更新日期:2015-10-01 00:00:00
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pub_type: 杂志文章
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更新日期:2020-10-01 00:00:00