Current Vascular Pharmacology - Online First
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Cytokine and Oxidative Stress Imbalances in Relation to Complex Coronary Lesions in Elderly Patients
Authors: Xia Li, Yongjuan zhao, Hualan Zhou, Youdong Hu, Ying Chen and Dianxuan GuoAvailable online: 11 February 2025More LessBackgroundComplex coronary lesions have been an understudied aspect of coronary artery disease in elderly patients. Oxidative stress and inflammation may be implicated in the pathogenesis of complex coronary lesions.
ObjectiveThe aim of this study is to investigate the complex interplay between pro-oxidative stress response, pro-inflammatory response, and complex coronary lesions in elderly patients.
MethodsEnzyme-linked immunosorbent assays for the detection of serum biomarkers [reactive oxygen species (ROS), malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), interferon-gamma (IFN-γ), superoxide dismutase (SOD) activity, total antioxidant capacity (TAC), transforming growth factor beta (TGF-β) and interleukin-4 (IL-4)] were performed in elderly patients with complex coronary lesions.
ResultsThe levels of pro-oxidative stress and pro-inflammatory markers (ROS, MDA, TNF-α and IFN-γ) were increased in the complex coronary lesion group when compared with the non-complex coronary lesion group (P < 0.01) in elderly patients. Anti-oxidative stress and anti-inflammatory markers (SOD activity, TAC, TGF-β, and IL-4) were decreased in the complex coronary lesion group when compared with the non-complex coronary lesion group (P < 0.01) in elderly patients.
ConclusionOur findings suggest that the pathogenesis of complex coronary lesions may involve pro-oxidant/anti-oxidant and pro-inflammation/anti-inflammation imbalance, as well as the interplay between oxidative stress and inflammation in elderly patients.
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The Efficacy and Safety of Direct Oral Anticoagulants Compared to Warfarin in Morbidly Obese Patients on Anticoagulation: A Systematic Review and Meta-Analysis
Available online: 11 February 2025More LessIntroductionCurrent guidelines and consensus statements advise caution in using direct oral anticoagulants (DOACs) for morbidly obese patients with body mass index (BMI) >40 kg/m2, indicating warfarin as the most studied treatment.
MethodsWe systematically searched databases from their inception to January 4, 2024, to identify studies that evaluated the effectiveness and safety of DOACs compared to warfarin in patients with BMI >40 kg/m2 and atrial fibrillation (AF) or venous thromboembolism (VTE). The outcomes of all-cause mortality, major and minor bleeding, stroke/systematic embolism (SE), VTE, and their composite endpoint were analyzed using a random-effects model.
ResultsThis meta-analysis included 24 studies and 119,960 morbidly obese patients with AF or VTE on oral anticoagulation therapy: 51,363 on DOACs (43%) vs. (57%) 68,597 on warfarin. DOAC use was significantly associated with lower all-cause mortality and major bleeding risk compared to warfarin. Although the risk of composite endpoint, stroke/SE, and VTE was lower in the DOAC group, no statistically significant difference was observed, indicating no superiority of warfarin compared to DOAC use. The risk of minor bleeding events, hemorrhagic stroke, and ischemic stroke was lower in the DOAC compared to the warfarin group. The same trend favoring DOACs over warfarin in all assessed endpoints was observed in the subgroup analysis based on anticoagulation indication (AF or VTE).
ConclusionOur findings have documented a potentially more effective and safer profile of DOACs compared to warfarin in morbidly obese patients regardless of the indication for anticoagulation.
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