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Alfredsson, Joakim
Publications (10 of 79) Show all publications
Yndigegn, T., Lindahl, B., Alfredsson, J., Benatar, J., Brandin, L., Erlinge, D., . . . Jernberg, T. (2023). Design and rationale of randomized evaluation of decreased usage of beta-blockers after acute myocardial infarction (REDUCE-AMI). European Heart Journal - Cardiovascular Pharmacotherapy, 9(2), 192-197
Open this publication in new window or tab >>Design and rationale of randomized evaluation of decreased usage of beta-blockers after acute myocardial infarction (REDUCE-AMI)
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2023 (English)In: European Heart Journal - Cardiovascular Pharmacotherapy, ISSN 2055-6837, E-ISSN 2055-6845, Vol. 9, no 2, p. 192-197Article in journal (Refereed) Published
Abstract [en]

Aims Most trials showing benefit of beta-blocker treatment after myocardial infarction (MI) included patients with large MIs and are from an era before modern biomarker-based MI diagnosis and reperfusion treatment. The aim of the randomized evaluation of decreased usage of beta-blockers after acute myocardial infarction (REDUCE-AMI) trial is to determine whether long-term oral beta-blockade in patients with an acute MI and preserved left ventricular ejection fraction (EF) reduces the composite endpoint of death of any cause or recurrent MI. Methods and results It is a registry-based, randomized, parallel, open-label, multicentre trial performed at 38 centres in Sweden, 1 centre in Estonia, and 6 centres in New Zealand. About 5000 patients with an acute MI who have undergone coronary angiography and with EF >= 50% will be randomized to long-term treatment with beta-blockade or not. The primary endpoint is the composite endpoint of death of any cause or new non-fatal MI. There are several secondary endpoints, including all-cause death, cardiovascular death, new MI, readmission because of heart failure and atrial fibrillation, symptoms, functional status, and health-related quality of life after 6-10 weeks and after 1 year of treatment. Safety endpoints are bradycardia, AV-block II-III, hypotension, syncope or need for pacemaker, asthma or chronic obstructive pulmonary disease, and stroke. Conclusion The results from REDUCE-AMI will add important evidence regarding the effect of beta-blockers in patients with MI and preserved EF and may change guidelines and clinical practice.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2023
Keywords
Myocardial infarction; Beta-blocker; Outcome; Clinical trial; Registry; RRCT
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-191216 (URN)10.1093/ehjcvp/pvac070 (DOI)000905503100001 ()36513329 (PubMedID)
Note

Funding Agencies|Swedish Research Council [2016-00493]; Swedish heart-and lung foundation [20210423]; Stockholm County Council; Estonian Research Council [PRG435]

Available from: 2023-01-25 Created: 2023-01-25 Last updated: 2024-02-20
Hammaréus, F., Nilsson, L., Ong, K.-L., Kristenson, M., Festin, K., Lundberg, A. K., . . . Jonasson, L. (2023). Plasma type I collagen α1 chain in relation to coronary artery disease: findings from a prospective population-based cohort and an acute myocardial infarction prospective cohort in Sweden.. BMJ Open, 13(9), Article ID e073561.
Open this publication in new window or tab >>Plasma type I collagen α1 chain in relation to coronary artery disease: findings from a prospective population-based cohort and an acute myocardial infarction prospective cohort in Sweden.
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2023 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 9, article id e073561Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To investigate the association between type I collagen α1 chain (COL1α1) levels and coronary artery disease (CAD) by using absolute quantification in plasma. Also, to investigate the correlates of COL1α1 to clinical characteristics and circulating markers of collagen metabolism.

DESIGN: Life conditions, Stress and Health (LSH) study: prospective cohort study, here with a nested case-control design.Assessing Platelet Activity in Coronary Heart Disease (APACHE) study: prospective cohort study.

SETTING: LSH: primary care setting, southeast Sweden.APACHE: cardiology department, university hospital, southeast Sweden.

PARTICIPANTS: LSH: 1007 randomly recruited individuals aged 45-69 (50% women). Exclusion criteria was serious disease. After 13 years of follow-up, 86 cases with primary endpoint were identified and sex-matched/age-matched to 184 controls.

APACHE: 125 patients with myocardial infarction (MI), 73 with ST-elevation MI and 52 with non-ST-elevation MI.

EXCLUSION CRITERIA: Intervention study participation, warfarin treatment and short life expectancy.

PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was the association between baseline COL1α1 and first-time major event of CAD, defined as fatal/non-fatal MI or coronary revascularisation after 13 years. Secondary outcomes were the association between the collagen biomarkers PRO-C1 (N-terminal pro-peptide of type I collagen)/C1M (matrix metalloproteinase-mediated degradation of type I collagen) and CAD; temporal change of COL1α1 after acute MI up to 6 months and lastly, correlates between COL1α1 and patient characteristics along with circulating markers of collagen metabolism.

RESULTS: COL1α1 levels were associated with CAD, both unadjusted (HR=0.69, 95% CI=0.56 to 0.87) and adjusted (HR=0.55, 95% CI=0.41 to 0.75). PRO-C1 was associated with CAD, unadjusted (HR=0.62, 95% CI=0.47 to 0.82) and adjusted (HR=0.61, 95% CI=0.43 to 0.86), while C1M was not. In patients with MI, COL1α1 remained unchanged up to 6 months. COL1α1 was correlated to PRO-C1, but not to C1M.

CONCLUSIONS: Plasma COL1α1 was independently and inversely associated with CAD. Furthermore, COL1α1 appeared to reflect collagen synthesis but not degradation. Future studies are needed to confirm whether COL1α1 is a clinically useful biomarker of CAD.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023
Keywords
coronary heart disease, ischaemic heart disease, vascular medicine
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-198543 (URN)10.1136/bmjopen-2023-073561 (DOI)001127161700042 ()37714678 (PubMedID)
Funder
Futurum - Academy for Health and Care, Jönköping County Council, SwedenSwedish Heart Lung Foundation
Note

Funding: Swedish Research Council [2004-1881]; Swedish Heart and Lung Foundation [2004053]; ALF Region Ostergotland [LIO 131 471]; County Council of Ostergotland [ROE-910951]; Academy of Health Care, County Council of Jonkoping; Danish Research Foundation; Linkoping University; Innovation Fund Denmark

Available from: 2023-10-16 Created: 2023-10-16 Last updated: 2024-03-18Bibliographically approved
Ekerstad, N., Cederholm, T., Boström, A.-M., de Geer, L., Ekdahl, A., Guidetti, S., . . . Alfredsson, J. (2022). Clinical frailty scale – skörhet ärett sätt att skatta biologisk ålder: [Clinical Frailty Scale - a proxy estimate of biological age]. Läkartidningen, 119, Article ID 22040.
Open this publication in new window or tab >>Clinical frailty scale – skörhet ärett sätt att skatta biologisk ålder: [Clinical Frailty Scale - a proxy estimate of biological age]
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2022 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 119, article id 22040Article, review/survey (Refereed) Published
Abstract [en]

The term frailty denotes a multi-dimensional syndrome characterised by reduced physiological reserves and increased vulnerability. Frailty may be used as a marker of biological age, distinct from chronological age. There are several instruments for frailty assessment. The Clinical Frailty Scale (CFS) is probably the most commonly used in the acute care context. It is a 9-level scale, derived from the accumulated deficit model of frailty, which combines comorbidity, disability, and cognitive impairment. The CFS assessment is fast and easy to implement in daily clinical practice. The CFS is relevant for risk stratification, and may also be used as a screening instrument to identify frail patients suitable for further geriatric evaluation, i.e. a comprehensive geriatric assessment (CGA). By providing information on long-term prognosis, it may improve informed decision-making on an individual basis.

Abstract [sv]

Skörhet (frailty) är ett kliniskt syndrom med sviktandefysiologiska reserver och ökad sårbarhet för påfrestningar.b Clinical frailty scale (CFS) är ett av de vanligaste skattningsinstrumentenför skörhet.b CFS är en markör för biologisk ålder, och skalanbygger på klinisk bedömning av samsjuklighet, ADL ochkognitiv förmåga.b CFS kan användas som stöd för riskstratifiering ochför att göra ett första urval av vilka personer som kangagnas av övergripande geriatrisk handläggning (comprehensivegeriatric assessment, CGA).b CFS kan användas på klinisk nivå som ett av flera stödför individualiserad behandling.b CFS kan bidra till att individer med hög kronologiskålder inte slentrianmässigt ges låg prioritet beträffandeolika interventioner.

Place, publisher, year, edition, pages
Sveriges Läkarforbund, 2022
National Category
Geriatrics
Identifiers
urn:nbn:se:liu:diva-192855 (URN)36345801 (PubMedID)
Available from: 2023-04-03 Created: 2023-04-03 Last updated: 2023-05-02Bibliographically approved
Rylance, R. T., Wagner, P., Olesen, K. K. W., Carlson, J., Alfredsson, J., Jernberg, T., . . . Erlinge, D. (2022). Patient-oriented risk score for predicting death 1 year after myocardial infarction: the SweDen risk score. Open heart, 9(2), Article ID e002143.
Open this publication in new window or tab >>Patient-oriented risk score for predicting death 1 year after myocardial infarction: the SweDen risk score
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2022 (English)In: Open heart, E-ISSN 2053-3624, Vol. 9, no 2, article id e002143Article in journal (Refereed) Published
Abstract [en]

ObjectivesOur aim was to derive, based on the SWEDEHEART registry, and validate, using the Western Denmark Heart registry, a patient-oriented risk score, the SweDen score, which could calculate the risk of 1-year mortality following a myocardial infarction (MI).MethodsThe factors included in the SweDen score were age, sex, smoking, diabetes, heart failure and statin use. These were chosen a priori by the SWEDEHEART steering group based on the premise that the factors were information known by the patients themselves. The score was evaluated using various statistical methods such as time-dependent receiver operating characteristics curves of the linear predictor, area under the curve metrics, Kaplan-Meier survivor curves and the calibration slope.ResultsThe area under the curve values were 0.81 in the derivation data and 0.76 in the validation data. The Kaplan-Meier curves showed similar patient profiles across datasets. The calibration slope was 1.03 (95% CI 0.99 to 1.08) in the validation data using the linear predictor from the derivation data.ConclusionsThe SweDen risk score is a novel tool created for patient use. The risk score calculator will be available online and presents mortality risk on a colour scale to simplify interpretation and to avoid exact life span expectancies. It provides a validated patient-oriented risk score predicting the risk of death within 1 year after suffering an MI, which visualises the benefit of statin use and smoking cessation in a simple way.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2022
Keywords
acute coronary syndrome; biostatistics; myocardial infarction
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-190807 (URN)10.1136/openhrt-2022-002143 (DOI)000894247300001 ()36460308 (PubMedID)
Note

Funding Agencies|Swedish Research Council; Swedish Heart and Lung Foundation

Available from: 2023-01-12 Created: 2023-01-12 Last updated: 2023-02-03
Törnudd, M., Al Ghraoui, M. R., Wahlgren, S., Björkman, E., Berg, S., Kvitting, J.-P. E., . . . Ramström, S. (2022). Quantification of platelet function: a comparative study of venous and arterial blood using a novel flow cytometry protocol. Platelets, 33(6), 926-934
Open this publication in new window or tab >>Quantification of platelet function: a comparative study of venous and arterial blood using a novel flow cytometry protocol
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2022 (English)In: Platelets, ISSN 0953-7104, E-ISSN 1369-1635, Vol. 33, no 6, p. 926-934Article in journal (Refereed) Published
Abstract [en]

Studies of platelet function in surgical patients often involve both arterial and venous sampling. Possible effects of different sampling sites could be important, but have not been thoroughly investigated. We aimed to compare platelet function in arterial and venous blood samples using a novel flow cytometry protocol and impedance aggregometry. Arterial and venous blood was collected before anesthesia in 10 patients undergoing cardiac surgery of which nine was treated with acetylsalicylic acid until the day before surgery. Flow cytometry included simultaneous analysis of phosphatidylserine exposure, active conformation of the fibrinogen receptor (PAC-1 binding), alpha-granule and lysosomal release (P-selectin and LAMP-1 exposure) and mitochondrial membrane integrity. Platelets were activated with ADP or peptides activating thrombin receptors (PAR1-AP/PAR4-AP) or collagen receptor GPVI (CRP-XL). Leukocyte-platelet conjugates and P-selectin exposure were evaluated immediately in fixated samples. For impedance aggregometry (Multiplate®), ADP, arachidonic acid, collagen and PAR1-AP (TRAP) were used as activators. Using impedance aggregometry and in 27 out of 37 parameters studied with flow cytometry there was no significant difference between venous and arterial blood sampling. Arterial blood showed more PAC-1 positive platelets when activated with PAR1-AP or PAR4-AP and venous blood showed more monocyte-platelet and neutrophil-platelet conjugates and higher phosphatidylserine exposure with CRP-XL alone and combined with PAR1-AP or PAR4-AP. We found no differences using impedance aggregometry. In conclusion, testing of platelet function by flow cytometry and impedance aggregometry gave comparable results for most of the studied parameters in venous and arterial samples. Flow cytometry identified differences in PAC-1 binding when activated with PAR1-AP, exposure of phosphatidyl serine and monocyte/neutrophil-platelet conjugates, which might reflect differences in blood sampling technique or in flow conditions in this patient cohort with coronary artery disease. These differences might be considered when comparing data from different sample sites, but caution should be exercised if a different protocol is used or another patient group is studied.

Place, publisher, year, edition, pages
Abingdon, United Kingdom: Taylor & Francis, 2022
Keywords
Flow cytometry, impedance aggregometry, platelet function
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-182637 (URN)10.1080/09537104.2021.2019209 (DOI)000746724500001 ()35073813 (PubMedID)2-s2.0-85123823315 (Scopus ID)
Note

Funding Agencies: County Council of Östergotland [LIO661221, LIO-603321]

Available from: 2022-02-02 Created: 2022-02-02 Last updated: 2024-01-10Bibliographically approved
Bollano, E., Redfors, B., Rawshani, A., Venetsanos, D., Völz, S., Angerås, O., . . . Omerovic, E. (2022). Temporal trends in characteristics and outcome of heart failure patient with and without signification coronary artery disease. ESC Heart Failure, 9(3), 1812-1822
Open this publication in new window or tab >>Temporal trends in characteristics and outcome of heart failure patient with and without signification coronary artery disease
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2022 (English)In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 9, no 3, p. 1812-1822Article in journal (Refereed) Published
Abstract [en]

Aims

Ischaemic coronary artery disease (CAD) remains the leading cause of mortality globally due to sudden death and heart failure (HF). Invasive coronary angiography (CAG) is the gold standard for evaluating the presence and severity of CAD. Our objective was to assess temporal trends in CAG utilization, patient characteristics, and prognosis in HF patients undergoing CAG at a national level.

Methods and results

We used data from the Swedish Coronary Angiography and Angioplasty Registry. Data on all patients undergoing CAG for HF indication in Sweden between 2000 and 2018 were collected and analysed. Long-term survival was estimated with multivariable Cox proportional hazards regression adjusted for differences in patient characteristics. In total, 22 457 patients (73% men) with mean age 64.2 ± 11.3 years were included in the study. The patients were increasingly older with more comorbidities over time. The number of CAG specifically for HF indication increased by 5.5% per calendar year (P<0.001). No such increase was seen for indications angina pectoris and ST-elevation myocardial infarction. A normal CAG or non-obstructive CAD was reported in 63.2% (HF-NCAD), and 36.8% had &gt;50% diameter stenosis in one or more coronary arteries (HF-CAD). The median follow-up time was 3.6 years in HF-CAD and 5 years in HF-NCAD. Age and sex-adjusted survival improved linearly by 1.3% per calendar year in all patients. Compared with HF-NCAD, long-term mortality was higher in HF-CAD patients. The risk of death increased with the increasing severity of CAD. Compared with HF-NCAD, the risk estimate in patients with a single-vessel disease was higher [hazard ratio (HR) 1.3; 95% confidence interval (CI) 1.20-1.41; P<0.0011, a multivessel disease without the involvement of left main coronary artery (HR 1.72; 95% C11.58-1.88; P &lt; 0.001), and with left main disease (HR 2.02; 95% CI 1.88-2.18; P &lt; 0.001). The number of HF patients undergoing revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) increased by 7.5% (P &lt; 0.001) per calendar year. The majority (53.4%) of HF-CAD patients were treated medically, while a minority (46.6%) were referred for revascularization with PCI or CABG. Compared with patients treated with PCI, the proportion of patients treated medically or with CABG decreased substantially (P<0.001).

Conclusions

Over 18 years, the number of patients with HF undergoing CAG has increased substantially. Expanded utilization of CAG increased the number of HF patients treated with percutaneous coronary intervention and coronary artery bypass surgery. Long-term survival improved in all HF patients despite a steady increase of elderly patients with comorbidities.

Place, publisher, year, edition, pages
Oxford, United Kingdom: John Wiley & Sons, 2022
Keywords
Coronary angiography; Coronary artery disease; Heart failure; Long-term survival
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-183875 (URN)10.1002/ehf2.13875 (DOI)000766009800001 ()35261201 (PubMedID)2-s2.0-85125937796 (Scopus ID)
Note

Funding Agencies: Swedish Heart Lung Foundation; Swedish Research Council; Swedish federal government under the ALF agreement; Sahlgrenska Akademin; Västra Götalandsregionen

Available from: 2022-03-30 Created: 2022-03-30 Last updated: 2023-02-03Bibliographically approved
Sederholm Lawesson, S., Swahn, E. & Alfredsson, J. (2021). Adherence to Study Drugs A Matter of Sex?. Circulation, 143(7), 696-698
Open this publication in new window or tab >>Adherence to Study Drugs A Matter of Sex?
2021 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 143, no 7, p. 696-698Article in journal, Editorial material (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2021
Keywords
Editorials; cardiovascular agents; cardiovascular diseases; medication adherence; randomized controlled trial; sex factors
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-175425 (URN)10.1161/CIRCULATIONAHA.121.053493 (DOI)000639305800013 ()33587664 (PubMedID)
Available from: 2021-05-03 Created: 2021-05-03 Last updated: 2021-05-11Bibliographically approved
Nasr, P., Iredahl, F., Dahlström, N., Rådholm, K., Henriksson, P., Cedersund, G., . . . Ekstedt, M. (2021). Evaluating the prevalence and severity of NAFLD in primary care: the EPSONIP study protocol. BMC Gastroenterology, 21(1), Article ID 180.
Open this publication in new window or tab >>Evaluating the prevalence and severity of NAFLD in primary care: the EPSONIP study protocol
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2021 (English)In: BMC Gastroenterology, ISSN 1471-230X, E-ISSN 1471-230X, Vol. 21, no 1, article id 180Article in journal (Refereed) Published
Abstract [en]

BackgroundNon-alcoholic fatty liver disease (NAFLD) affects 20-30% of the general adult population. NAFLD patients with type 2 diabetes mellitus (T2DM) are at an increased risk of advanced fibrosis, which puts them at risk of cardiovascular complications, hepatocellular carcinoma, or liver failure. Liver biopsy is the gold standard for assessing hepatic fibrosis. However, its utility is inherently limited. Consequently, the prevalence and characteristics of T2DM patients with advanced fibrosis are unknown. Therefore, the purpose of the current study is to evaluate the prevalence and severity of NAFLD in patients with T2DM by recruiting participants from primary care, using the latest imaging modalities, to collect a cohort of well phenotyped patients.MethodsWe will prospectively recruit 400 patients with T2DM using biomarkers to assess their status. Specifically, we will evaluate liver fat content using magnetic resonance imaging (MRI); hepatic fibrosis using MR elastography and vibration-controlled transient elastography; muscle composition and body fat distribution using water-fat separated whole body MRI; and cardiac function, structure, and tissue characteristics, using cardiovascular MRI.DiscussionWe expect that the study will uncover potential mechanisms of advanced hepatic fibrosis in NAFLD and T2DM and equip the clinician with better diagnostic tools for the care of T2DM patients with NAFLD.Trial registration: Clinicaltrials.gov, identifier NCT03864510. Registered 6 March 2019, https://clinicaltrials.gov/ct2/show/NCT03864510.

Place, publisher, year, edition, pages
BMC, 2021
Keywords
Non-alcoholic fatty liver disease; Type 2 diabetes mellitus; T2DM; Cirrhosis; Biomarkers
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-175702 (URN)10.1186/s12876-021-01763-z (DOI)000642544000002 ()33879084 (PubMedID)
Note

Funding Agencies|Linkoping University; ALF Grants, Region Ostergotland; GILEADGilead Sciences; Diapharma; Lion Research Grant, Faculty of Medicine, Linkoping University; Swedish Research CouncilSwedish Research CouncilEuropean Commission [VR 2020-04826]

Available from: 2021-05-18 Created: 2021-05-18 Last updated: 2023-09-29
Venetsanos, D., Omerovic, E., Sarno, G., Pagonis, C., Witt, N., Calais, F., . . . Alfredsson, J. (2021). Long term outcome after treatment of de novo coronary artery lesions using three different drug coated balloons. International Journal of Cardiology, 325, 30-36
Open this publication in new window or tab >>Long term outcome after treatment of de novo coronary artery lesions using three different drug coated balloons
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2021 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 325, p. 30-36Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the long-term efficacy of three currently available drug coated balloons (DCB) for the treat-ment of de-novo coronary lesions.

Methods: This was a retrospective analysis of prospectively collected data from the Swedish Coronary Angiogra-phy and Angioplasty Registry. Between 2009 and 2017, three currently available DCB brands used in the treat-ment of de novo lesions were included. Outcomes were clinically driven restenosis and target lesionthrombosis (TLT) (per device) and major adverse cardiac events (MACE) including death, myocardial infarctionor target vessel revascularization (per patient) at 4 years. Multivariable Cox regression models were used to ad-just for differences.

Results: We included 6715 lesions treated with DCBs, 4483 SeQuent® Please (S-DCB), 1071 IN.PACT Falcon (I-DCB) and 1161 Pantera® Lux (P-DCB), in 5670 patients. The mean DCB diameter was 2.4 mm. Bailout stentingoccurred in 6.7% of lesions. Angiographic success was 98.5%. The overall cumulative rate of restenosis was 5.5% (299 events). The risk for reported restenosis did not signifi-cantly differ between I-DCB vs S-DCB, adjusted hazard ratio (aHR) 0.96; 95% confidence interval (CI) 0.69–1.34,P-DCB vs S-DCB aHR 0.88; 95% CI 0.63–1.23 and I-DCB vs P-DCB aHR 1.10; 95% CI 0.72–1.68. The cumulative riskfor TLT was 0.8% in all three DCBs. The risk for MACE or individual components of MACE did not differ betweenthe three patient-groups.

Conclusion:In de novo coronary lesions, we found comparable long-term efficacy with three currently availableDCB brands. DCB angioplasty was feasible with low risk for long-term restenosis and TLT.

Place, publisher, year, edition, pages
Elsevier, 2021
Keywords
Drug-coated balloons; Drug-eluting balloons; Restenosis; de novo lesions
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-174350 (URN)10.1016/j.ijcard.2020.09.054 (DOI)000623745900005 ()32980433 (PubMedID)2-s2.0-85092016972 (Scopus ID)
Available from: 2021-03-20 Created: 2021-03-20 Last updated: 2022-05-25Bibliographically approved
Holm, A., Henriksson, M., Alfredsson, J., Janzon, M., Johansson, T., Swahn, E., . . . Sederholm Lawesson, S. (2021). Long term risk and costs of bleeding in men and women treated with triple antithrombotic therapy: An observational study. PLOS ONE, 16(3), Article ID e0248359.
Open this publication in new window or tab >>Long term risk and costs of bleeding in men and women treated with triple antithrombotic therapy: An observational study
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2021 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 16, no 3, article id e0248359Article in journal (Refereed) Published
Abstract [en]

Objectives Bleeding is the most common non-ischemic complication in patients with coronary revascularisation procedures, associated with prolonged hospitalisation and increased mortality. Many factors predispose for bleeds in these patients, among those sex. Anyhow, few studies have characterised the population receiving triple antithrombotic therapy (TAT) as well as long term bleeds from a sex perspective. We investigated the one year rate of bleeds in patients receiving TAT, potential sex disparities and premature discontinuation of TAT. We also assessed health care costs in bleeders vs non-bleeders. Setting Three hospitals in the County of ostergotland, Sweden during 2009-2015. Participants All patients discharged with TAT registered in the SWEDEHEART registry. Primary and secondary outcome measures All bleeds receiving medical attention during one-year follow-up were collected by retrieving relevant information about each patient from medical records. Resource use associated with bleeds was assigned unit cost to estimate the health care costs associated with bleeding episodes. Results Among 272 patients, 156 bleeds occurred post-discharge, of which 28.8% were gastrointestinal. In total 54.4% had at least one bleed during or after the index event and 40.1% bled post discharge of whom 28.7% experienced a TIMI major or minor bleeding. Women discontinued TAT prematurely more often than men (52.9 vs 36.1%, p = 0.01) and bled more (48.6 vs. 37.1%, p = 0.09). One-year mean health care costs were EUR 575 and EUR 5787 in non-bleeding and bleeding patients, respectively. Conclusion The high bleeding incidence in patients with TAT, especially in women, is a cause of concern. There is a need for an adequately sized randomised, controlled trial to determine a safe but still effective treatment for these patients.

Place, publisher, year, edition, pages
Public Library of Science, 2021
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-175450 (URN)10.1371/journal.pone.0248359 (DOI)000634832800066 ()33764988 (PubMedID)
Note

Funding Agencies|County Council of Ostergotland

Available from: 2021-05-05 Created: 2021-05-05 Last updated: 2022-05-23Bibliographically approved
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