Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0002962 (angina)
 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Notwithstanding the large number of clinical trials, most of them designed and performed according to the requirements of modern clinical pharmacology, only a few firm clinical recommendations on drugs affecting platelet function in the prevention of arterial or venous thrombosis can be made at present. There is no good evidence for the clinical effectiveness of aspirin or any other drug affecting platelet function in patients with peripheral arterial occlusion or after vascular grafting. In cerebrovascular disease there is reasonable evidence that the administration of sulfinpyrazone can significantly reduce cerebral ischemia or mortality, but similar trials performed with aspirin, dipyridamole or clofibrate failed to reveal a significant difference in favor of the experimental treatment. Patients with angina only were shown to benefit from treatment with clofibrate, but prospective trials with dipyridamole or aspirin in the primary or secondary prevention of myocardial infarction did not reveal a significant reduction in morbidity or mortality in the experimental group. Use of a combination of the latter two drugs did, however, reveal a reduction in morbidity and mortality. In patients with prosthetic heart valves, there is firm evidence that dipyridamole and sulfinpyrazone therapy can normalize decreased platelet survival, an effect which has been shown to correlate well with the incidence of thromboembolism. Provided further trials lead to confirmatory conclusions, drugs inhibiting platelet function associated or not with oral anticoagulants may constitute an ideal prophylaxis in patients with a substitute valve. There is still much uncertainty as to whether dipyridamole, given in addition to conventional treatment, benefits patients with membranous or mesangiocapillary glomerulonephritis. The same holds for drugs inhibiting platelet function after kidney or heart transplantation in man. Only scanty reports are available on the usefulness of drugs affecting platelet function in thrombotic thrombocytopenic purpura and the hemolytic uremic syndrome. Three different types of antiplatelet drugs are available for the prevention of postoperative deep vein thrombosis: dextran, oral drugs also affecting platelet function and heparin administered subcutaneously in small doses. In orthopedic surgery dextran 70 administered before and every second day after surgery was the drug showing the most convincing reduction in the incidence of phlebographically proved deep vein thrombosis. Major orthopedic surgery is precisely the type of surgery in which the effectiveness of small dose heparin is much in doubt and in which the effectiveness of aspirin and dipyridamole is still to be confirmed. In general surgery, use of a combination of 1 g aspirin and 0.225 g dipyridamole daily was shown to offer approximately the same level of protection as small doses of heparin, land these two forms of prevention seem to offer a greater degree of protection than dextran...
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PMID:Are agents affecting platelet functions clinically useful? 79 99

Between May 1989 and April 1990, 21 patients, candidates for coronary angioplasty but with major left ventricular dysfunction, underwent the procedure using percutaneous cardiopulmonary support (CPS). All patients had one or more previous infarcts, severe angina, and 19 out of 21 had one or more episodes of cardiac failure. Angioplasty was carried out by the usual method, after establishing a percutaneous femoro-femoral CPS. Twenty-three procedures were performed and 22 successes were recorded without any complications (success = 95% per patient). There were no deaths, infarcts or emergency surgical referrals. Two patients required transfusion. The canulae were removed by compression. The only local complication was one case of deep vein thrombosis. The results of this short series suggest that myocardial revascularisation is possible with an acceptable risk in selected coronary patients with severe left ventricular dysfunction by coronary angioplasty with percutaneous cardiopulmonary support.
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PMID:[Coronary angioplasty under extracorporeal circulation. Technique and experience of the Centre cardiologique du Nord]. 206 14

Laser recanalization was attempted in 13 patients in whom the risk of surgical therapy was increased by severe angina, infection, absent venous conduit, or recent deep venous thrombosis, and in 4 patients at high risk for limb loss due to severe infrapopliteal arterial occlusive disease. Total occlusions of the superficial femoral, tibial, or peroneal arteries were treated. Recanalization was accomplished using Argon laser power and a Spectraprobe-PLR. Two patients also required common femoral artery endarterectomy to improve inflow. Laser recanalization was successful in 9 patients (53%), and 8 (47%) had relief symptoms. None of the 4 patients with tibial and peroneal artery occlusion had successful recanalization or limb salvage. Restenosis or reocclusion developed in 4 patients during the first year after successful recanalization, but only 1 had recurrent symptoms. Limb salvage was initially achieved in 5 of 8 recanalization failures by surgical reconstruction but 3 developed graft infections requiring graft removal in 2 and amputation in 1. Thus, laser recanalization can accomplish limb salvage in selected patients whose medical or surgical risks complicate arterial bypass surgery.
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PMID:Laser recanalization in high risk patients. 213 8

There are 2 striking differences in the practice of medicine in the US and in the UK: 1) in the former, there is a great emphasis on private medicine, and 2) in the US there is a much higher incidence of litigation, whereas in the UK, family planning services are free, and litigation in this area is almost unknown. British medical opinion agrees with the US on the following oral contraceptive contraindications: 1) cancer of the breast, ovary, uterus, vagina, or cervix; 2) coronary thrombosis, pulmonary embolism, deep vein thrombosis, angina pectoris, or stroke; and 3) unusual or unexplained vaginal bleeding. Both countries agree that it is inadvisable to give the combined pill over the age of 45, and over the age of 35 in smokers. The UK agrees with 75% of the routines adopted by US doctors on a patient's 1st visit for oral contraceptives. However, a patient who becomes amenorrheic while taking the pill is not regarded as lightly in the UK as she would be in the US; she is closely monitored. If 1 of 4 risk factors (age 35 or over, hypertension, obesity, or smoking) is evident, a patient in the UK is closely supervised while taking the pill. If more than 2 risk factors are present, a UK doctor may advise against the pill. Since the 1960s the media have both praisd and condemned the pill. There is no doubt that, in the field of contraceptive advice, the US and the UK lead the way, and a closer liaison between the 2 medical professions is essential to reassure patients.
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PMID:Contraceptive advice: how the English differ from the Americans. 309 Feb 54

Sudden cardiac death (SCD) due to acute myocardial infarction (AMI) is mostly the result of ventricular fibrillation (VP) which is an electrical accident appearing on the basis of electrical instability of the myocardium. In addition to the chronic electrical instability predisposing to ventricular arrhythmias the trigger effect of a precipitating factor also seems necessary which may disrupt the normal sequence of cardiac contractions. In view of this hypothesis the following strategy of therapeutic interventions aimed at preventing SCD from AMI seems to be logical: Prophylactic measures to prevent pathological processes underlying chronic electrical instability of the heart i.e. elimination of identified risk factors of ischemic heart disease. Protection from SCD due to AMI: by using drugs which could, prevent further electrical destabilization as shifts in myocardial and plasma ionic balance, in pH, in pCO2, accumulation of potentially arrhythmogenic metabolites: Inhibit the trigger effect of sudden changes: in hemodynamics, in the autonomic nervous outflow and balance. The general supportive measures include therapeutic interventions which are not directly connected with appearance of lethal arrhythmias but may indirectly contribute to their development as pain, arterial Hb desaturation, deep vein thrombosis. Some of the measures listed above are capable of limiting the size of the developing infarct, a major determinant of the future conditions of life and prognosis of the patient. In the prehospital phase of AMI when two thirds of all coronary deaths occur general supportive measures and drug treatment of life threatening arrhythmias should be applied simultaneously. Sedatives and anxiolytics, furthermore analgetics are widely used. They are however often associated with bradycardia and sometimes with hypotension. This latter is dominant in patients with inferior infarction, showing a parasympathetic hyperactivity, when atropine treatment is needed. Sympathetic hyperactivity responds to analgesia and sedation but beta blockers may be required to reduce increased MVO2. These agents belong to the group of anti-ischemic drugs. The beneficial anti-ischemic action of beta-blockers is mostly due to their negative chronotropic and inotropic effect. A direct metabolic action was shown by use as well as the presence of a positive steal phenomenon in the experimental angina model in dogs. Anti-ischemic action of coronary vasodilators. The most reliable drug for preventing or abolishing anginal attack is still the classic nitroglycerin. On the other hand persantine a potent coronary dilator failed to protect against anginal attack in man.
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PMID:[Pharmacological possibilities for the prevention of complications following myocardial infarction]. 382 Nov 31

A simultaneous approach to revascularization for combined coronary and carotid disease today is well accepted. The discussion about combined procedures of carotid and aortoiliac occlusive disease is still going on. We operated upon 3 patients, aged 63,56 and 65 years, who suffered from carotid, aortoiliac and renal artery disease. Main symptoms were hypertensive crisis with pulmonary edema and intermittent claudication. Dizziness, transient ischemic attacks and slight renal insufficiency were present in two, one and two patients respectively. After recompensation a simultaneous operation was performed: carotid endarterectomy with inlying shunt, reconstruction and patch-plasty of the renal arteries and implantation of a aortofemoral artery bypass graft. Postoperative complications: hypertensive crisis, low output syndrome and oliguria (1 pt.) and deep vein thrombosis (1 pt.) could be treated conservatively. 10 and 12 months later the patients are symptom-free except one, who suffers from angina NYHA II. In conclusion we recommend carotid endarterectomy simultaneously with any major vascular procedure, if a critical stenosis is visualized to improve long-term survival in addition to reducing operative mortality.
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PMID:[Simultaneous intervention on the carotid artery, abdominal aorta and their branches]. 400 9

Beta-thromboglobulin (beta TG) plasma levels were measured by radioimmunoassay in 14 patients with acute myocardial infarction (MI), in 13 with myocardial ischemia and recurrent episodes of angina and in 14 subjects with a past history of MI. Increased beta TG plasma values were observed in patients with acute MI and with myocardial ischemia whereas subjects with a past history of MI showed results not significantly different from normal subjects. Daily measurements in acute MI showed in five cases a second peak of beta TG values which suggests the occurrence of a deep vein thrombosis. The increased platelet consumption in MI was not related with the extent of the necrosis. We suggest, therefore, that platelet activation is associated with myocardial ischemia rather than necrosis.
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PMID:Beta-thromboglobulin in patients with acute and chronic coronary artery disease. 618 23

18 out of 137 psoriasis-patients had cardio-vascular complications (myocardial infarction: 3, angina pectoris: 5, deep vein thrombosis: 3, superficial thrombophlebitis: 6, sudden death: 1). Predisposing factors may be found, however, the preliminary results reveal that psoriasis does not predispose to cardio-vascular complications by itself. An exception is psoriatic arthritis.
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PMID:[Correlation between psoriasis and cardiovascular diseases (author's transl)]. 710 23

Parnaparin is a low molecular weight (LMW) heparin which, like other members of its class, apparently demonstrates a greater antithrombotic effect relative to its anticoagulant activity when compared with the unfractionated heparin (heparin) from which it is derived. Moreover, subcutaneous parnaparin has a greater bioavailability and longer half-life than heparin, permitting once-daily administration for the prophylaxis of deep venous thrombosis (DVT) or the treatment of established vascular disorders. Prophylaxis with a 7-day regimen of parnaparin 3200 or 6400 IUaXa/day has consistently been associated with a lower incidence of confirmed DVT compared with usual prophylactic regimens of heparin. This intertreatment difference reached statistical significance in a large multicentre study involving a total of 610 surgical patients (3.2% for parnaparin vs 6.3% for heparin). Thus far, however, comparisons of parnaparin with other LMW heparins for this indication are unavailable. Parnaparin has demonstrated equivalent efficacy to heparin in the treatment of established vascular disorders, including phlebopathies and related syndromes, as well as peripheral arterial occlusive disease. Parnaparin also showed some benefit as an adjunctive therapy in patients with angina pectoris. The risk of general bleeding appears to be similar with parnaparin or heparin, although parnaparin results in fewer haematomas at the site of injection, partly because of the less frequent administration regimen. Parnaparin has also been associated with a lower incidence of pain and/or burning sensation at the injection site compared with heparin. As with other LMW heparins, the possibility that parnaparin will be infrequently associated with thrombocytopenia cannot be excluded. Thus, parnaparin may be preferred over traditional heparin for the prophylaxis of thromboembolic events in surgical patients (particularly those at high risk for DVT), as well as the treatment of established vascular disorders with a thrombotic aetiology. Compared with heparin, parnaparin offers the advantages of a more convenient administration regimen coupled with improved local tolerability. However, the therapeutic advantages of parnaparin relative to other LMW heparins have yet to be established in large scale comparative trials.
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PMID:Parnaparin. A review of its pharmacology, and clinical application in the prevention and treatment of thromboembolic and other vascular disorders. 751 62

Recombinant hirudin is currently being developed as a potential prophylactic and therapeutic antithrombotic drug in various clinical indications such as angina and deep venous thrombosis. In this report, we have discussed the production of specific polyclonal antibodies to recombinant hirudin (rH) and the development of two ELISA methods to measure rH concentrations in biological fluids: a sandwich and a competitive ELISA method. Intra- and inter-assay variations in the two methods are extremely low (3-7%). The competitive ELISA method is rapid, simple and highly reproducible. Saturation binding curves, selection of appropriate incubation times, recovery of different hirudin variants and reactivity in the presence of thrombin are discussed. The methods can be easily adapted to monitor hirudin concentrations in the clinical laboratory for diagnostic purposes as well as for performing pharmacokinetic studies.
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PMID:Development and validation of two enzyme-linked immunosorbent assay (ELISA) methods for recombinant hirudin. 766 Jan 41


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