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  1. AU="Gil-Pérez, Pablo"
  2. AU="Donno, Federica"
  3. AU="Vom Saal, Frederick S."
  4. AU="Gazzana, S"
  5. AU="Viswanadha, Vijaya P"
  6. AU="Anastasi, G A"
  7. AU="Romerosa, Antonio"
  8. AU=Gupta Gaorav P
  9. AU="Fernández-Susavila, Héctor"

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  1. Artikel: Impact of renal function on Ticagrelor-induced antiplatelet effects in coronary artery disease patients.

    Porlán, Manuel Veas / Tello-Montoliu, Antonio / López-García, Cecilia / Gil-Pérez, Pablo / Quintana-Giner, Miriam / López-Gálvez, Raquel / Rivera-Caravaca, José Miguel / Marín, Francisco / Figal, Domingo Pascual

    International journal of cardiology. Heart & vasculature

    2023  Band 46, Seite(n) 101195

    Abstract: Background: Chronic renal failure (CKD) is associated with the presence of increased platelet reactivity and lower clinical benefit of clopidogrel. Ticagrelor has a more favorable pharmacodynamic and pharmacokinetic profile compared to clopidogrel, ... ...

    Abstract Background: Chronic renal failure (CKD) is associated with the presence of increased platelet reactivity and lower clinical benefit of clopidogrel. Ticagrelor has a more favorable pharmacodynamic and pharmacokinetic profile compared to clopidogrel, which has translated into better clinical outcomes in patients with acute coronary syndrome (ACS). We conducted a prospective mechanistic cohort study in order to investigate the impact of renal failure on the pharmacokinetics and pharmacodynamics of ticagrelor in patients with acute ACS.
    Methods: Patients were divided into two groups based on their estimated renal clearances (eGFR ≥ 60 mL/min and eGFR < 60 mL/min). Platelet function was determined using the VerifyNow system at baseline, after the ticagrelor loading dose and at discharge. In addition, levels of ticagrelor and its active metabolite (AR-C124910XX) were determined in the first hour after loading dose.
    Results: 48 patients were recruited (eGFR ≥ 60 mL/min: 35 and eGFR < 60 mL/min: 13). There were no significant differences between the groups in terms of platelet inhibition after the loading or after 7 days of treatment (p = 0.219). However, the levels of ticagrelor and its active metabolite were lower in subjects with normal renal function than in CKD, especially at 4 (p = 0.02 and 0.04 respectively) and 6 h of loading (p = 0.042 and 0.08 respectively).
    Conclusion: No differences in platelet inhibition were observed after treatment with ticagrelor in patients with different renal function, although patients with renal impairment showed higher levels of ticagrelor and AR-C124910XX after 4 h of the loading dose.
    Sprache Englisch
    Erscheinungsdatum 2023-03-27
    Erscheinungsland Ireland
    Dokumenttyp Journal Article
    ZDB-ID 2818464-6
    ISSN 2352-9067
    ISSN 2352-9067
    DOI 10.1016/j.ijcha.2023.101195
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  2. Artikel ; Online: Simplified Geleijnse score for identifying chest pain features associated with coronary ischemia.

    Ding, Wern Yew / Romero-Aniorte, Ana Isabel / Tello-Montoliu, Antonio / Gil-Pérez, Pablo / López-García, Cecilia / Veliz-Martínez, Andrea / Quintana-Giner, Miriam / Lip, Gregory Y H / Rivera-Caravaca, José Miguel / Marín, Francisco

    Heart & lung : the journal of critical care

    2023  Band 59, Seite(n) 61–66

    Abstract: Background: The Geleijnse score, which was proposed to assess for coronary ischemia, has practical limitations.: Objectives: Our aim was to design and evaluate a simplified version of the Geleijnse score.: Methods: We enrolled patients with ... ...

    Abstract Background: The Geleijnse score, which was proposed to assess for coronary ischemia, has practical limitations.
    Objectives: Our aim was to design and evaluate a simplified version of the Geleijnse score.
    Methods: We enrolled patients with suspected coronary heart disease but negative troponin T or absence of enzymatic curve, and a non-diagnostic 12-lead ECG. The initial study was performed in a retrospective derivation cohort and the results were subsequently validated in a prospective cohort.
    Results: From 109 patients included in the derivation cohort, 33 (30.3%) received a diagnosis of coronary heart disease. Chest pain with both arms radiation (OR 3.54), severe intensity (OR 2.41), improvement by nitroglycerin (OR 1.61), associated dyspnea (OR 1.97) and prior exertional angina history (OR 2.91) were independently associated with an ischemic origin on multivariate logistic regression analysis. ROC curves comparison demonstrated both the original and simplified scores presented modest predictive ability with significant difference when analyzed using dichotomous cut-offs (0.647 [simplified] vs. 0.544 [original], p = 0.042) but not as a continuous variable (0.670 [simplified] vs. 0.621 [original], p = 0.396). In 305 patients from the validation cohort, the simplified score presented extensively increased predictive accuracy than the Geleijnse, in the continuous (c-indexes = 0.735 vs. 0.685, p = 0.040) and the dichotomic (c-indexes = 0.682 vs. 0.514, p<0.001) forms.
    Conclusions: A simplified version of the Geleijnse score, including some routine clinical manifestations associated with coronary heart disease, presented significantly better predictive ability compared to the original score.
    Mesh-Begriff(e) Humans ; Prospective Studies ; Retrospective Studies ; Chest Pain/diagnosis ; Chest Pain/etiology ; Coronary Disease ; Electrocardiography/methods ; Emergency Service, Hospital
    Sprache Englisch
    Erscheinungsdatum 2023-02-03
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 193129-5
    ISSN 1527-3288 ; 0147-9563
    ISSN (online) 1527-3288
    ISSN 0147-9563
    DOI 10.1016/j.hrtlng.2023.01.010
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  3. Artikel ; Online: Antithrombotic Therapy in Patients with Peripheral Artery Disease: A Focused Review on Oral Anticoagulation.

    Rivera-Caravaca, José Miguel / Camelo-Castillo, Anny / Ramírez-Macías, Inmaculada / Gil-Pérez, Pablo / López-García, Cecilia / Esteve-Pastor, María Asunción / Orenes-Piñero, Esteban / Tello-Montoliu, Antonio / Marín, Francisco

    International journal of molecular sciences

    2021  Band 22, Heft 13

    Abstract: Peripheral artery disease (PAD) is a major cause of morbidity and mortality but it is usually underdiagnosed and undertreated. Patients with PAD present dysregulated procoagulant, anticoagulant, and fibrinolytic pathways leading to arterial and venous ... ...

    Abstract Peripheral artery disease (PAD) is a major cause of morbidity and mortality but it is usually underdiagnosed and undertreated. Patients with PAD present dysregulated procoagulant, anticoagulant, and fibrinolytic pathways leading to arterial and venous thrombosis. The risk of several ischemic-related complications could be mitigated with appropriate antithrombotic therapy, which plays a central role in all types of PAD. For years, antiplatelets have been indicated in patients with symptomatic PAD or those who have undergone revascularization. Unfortunately, a non-negligible proportion of patients with PAD will suffer from adverse events during the follow-up, even despite proper medical therapies for the prevention of PAD complications. Thus, there is room for improving clinical outcomes in these patients. Given the implication of both, primary and secondary hemostasis in arterial thrombosis and the pathophysiology of PAD, the combination of antiplatelets and anticoagulants has emerged as a potential antithrombotic alternative to antiplatelets alone. In this narrative review article, we have highlighted the most recent evidence about antithrombotic therapy in PAD patients, with a special focus on oral anticoagulation. Certainly, COMPASS and VOYAGER PAD trials have shown promising results. Thus, rivaroxaban in combination with aspirin seem to reduce cardiovascular outcomes with a similar bleeding risk compared to aspirin alone. Nevertheless, results from real-world studies are needed to confirm these observations, and other trials will provide novel evidence about the safety and efficacy of emerging anticoagulant agents.
    Mesh-Begriff(e) Anticoagulants/therapeutic use ; Aspirin/therapeutic use ; Blood Coagulation/drug effects ; Drug Therapy, Combination ; Factor Xa Inhibitors/therapeutic use ; Fibrinolytic Agents/therapeutic use ; Humans ; Peripheral Arterial Disease/drug therapy ; Platelet Aggregation Inhibitors/therapeutic use ; Rivaroxaban/therapeutic use ; Thrombolytic Therapy ; Thrombosis/drug therapy
    Chemische Substanzen Anticoagulants ; Factor Xa Inhibitors ; Fibrinolytic Agents ; Platelet Aggregation Inhibitors ; Rivaroxaban (9NDF7JZ4M3) ; Aspirin (R16CO5Y76E)
    Sprache Englisch
    Erscheinungsdatum 2021-07-01
    Erscheinungsland Switzerland
    Dokumenttyp Journal Article ; Review
    ZDB-ID 2019364-6
    ISSN 1422-0067 ; 1422-0067 ; 1661-6596
    ISSN (online) 1422-0067
    ISSN 1422-0067 ; 1661-6596
    DOI 10.3390/ijms22137113
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  4. Artikel ; Online: Influence of the matrix type over the concentration of GDF-15.

    Rivera-Caravaca, José Miguel / Vílchez, Juan Antonio / Rodríguez-Rojas, Carlos / Albadalejo-Otón, María Dolores / Gil-Pérez, Pablo / Lopez-García, Cecilia / Veliz-Martínez, Andrea / Roldán, Vanessa / Marín, Francisco

    Journal of investigative medicine : the official publication of the American Federation for Clinical Research

    2020  Band 68, Heft 8, Seite(n) 1402–1404

    Abstract: Growth differentiation factor 15 (GDF-15) has been suggested as a prognostic biomarker for bleeding and mortality in atrial fibrillation (AF). To date, serum and EDTA matrices are standardized for the GDF-15 assay but it is unclear if it can be measured ... ...

    Abstract Growth differentiation factor 15 (GDF-15) has been suggested as a prognostic biomarker for bleeding and mortality in atrial fibrillation (AF). To date, serum and EDTA matrices are standardized for the GDF-15 assay but it is unclear if it can be measured also in citrate. In this study, we aim to investigate if the Elecsys GDF-15 assay (Roche Diagnostics, Mannheim, Germany) can be determined accurately in citrate samples in a cohort of 10 patients with AF and 10 healthy controls. From January 2018 to March 2018, we included healthy controls and patients with AF under vitamin K antagonists in a tertiary hospital. Blood samples were drawn in both groups. We included 10 controls (50% males, mean age 36.4±8.9 years) and 10 patients with AF (80% males, mean age 76.5±16.6 years). The mean GDF-15 levels were increased in patients with AF in comparison to healthy controls, as expected by the presence of a heart-related condition and the higher age of this population. In healthy controls, GDF-15 levels showed an optimal correlation between EDTA-serum (r=0.975; p<0.001), EDTA-citrate (r=0.972; p<0.001), and serum-citrate (r=0.997; p<0.001) samples. This was also observed in patients with AF: EDTA-serum (r=0.975; p<0.001), serum-citrate (r=0.835; p=0.003), and EDTA-citrate (r=0.768; p=0.009). Our results demonstrate that citrate samples may be used for the determination of GDF-15 in AF given the positive and good correlation with EDTA and serum matrices. Further studies should validate these observations.
    Mesh-Begriff(e) Adult ; Aged ; Atrial Fibrillation/blood ; Case-Control Studies ; Citric Acid/chemistry ; Edetic Acid/chemistry ; Female ; Growth Differentiation Factor 15/blood ; Humans ; Male
    Chemische Substanzen Growth Differentiation Factor 15 ; Citric Acid (2968PHW8QP) ; Edetic Acid (9G34HU7RV0)
    Sprache Englisch
    Erscheinungsdatum 2020-09-08
    Erscheinungsland England
    Dokumenttyp Journal Article
    ZDB-ID 1217870-6
    ISSN 1708-8267 ; 0009-9279 ; 1081-5589
    ISSN (online) 1708-8267
    ISSN 0009-9279 ; 1081-5589
    DOI 10.1136/jim-2020-001351
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  5. Artikel: MiR-146a Contributes to Thromboinflammation and Recurrence in Young Patients with Acute Myocardial Infarction.

    de Los Reyes-García, Ascensión M / Rivera-Caravaca, José Miguel / Zapata-Martínez, Laura / Águila, Sonia / Véliz-Martínez, Andrea / García-Barberá, Nuria / Gil-Perez, Pablo / Guijarro-Carrillo, Pedro J / Orenes-Piñero, Esteban / López-García, Cecilia / Lozano, María L / Marín, Francisco / Martínez, Constantino / González-Conejero, Rocío

    Journal of personalized medicine

    2022  Band 12, Heft 7

    Abstract: Studies on older patients have established notable conceptual changes in the etiopathogenesis of acute coronary syndrome (ACS), but little is known about this disease in young patients (<45 years). Of special interest is thromboinflammation, key at onset, ...

    Abstract Studies on older patients have established notable conceptual changes in the etiopathogenesis of acute coronary syndrome (ACS), but little is known about this disease in young patients (<45 years). Of special interest is thromboinflammation, key at onset, evolution and therapy of cardiovascular pathology. Therefore, we explored whether ACS at an early age is a thromboinflammatory disease by analyzing NETs and rs2431697 of miR-146a (a miRNA considered as a brake of TLR/NF-kB pathway), elements previously related to higher rates of recurrence in atrial fibrillation and sepsis. We included 359 ACS patients (<45 years) and classified them for specific analysis into G1 (collected during the hospitalization of the first event), G2 and G3 (retrospectively collected from patients with or without ACS recurrence, respectively). cfDNA and citH3−DNA were quantified, and rs2431697 was genotyped. Analysis in the overall cohort showed a moderate but significant correlation between cfDNA and citH3−DNA and Killip−Kimball score. In addition, patients with citH3−DNA > Q4 more frequently had a history of previous stroke (6.1% vs. 1.6%). In turn, rs2431697 did not confer increased risk for the onset of ACS, but T carriers had significantly higher levels of NET markers. By groups, we found that cfDNA levels were similarly higher in all patients, but citH3−DNA was especially higher in G1, suggesting that in plasma, this marker may be attenuated over time. Finally, patients from G2 with the worst markers (cfDNA and citH3−DNA > Q2 and T allele) had a two-fold increased risk of a new ischemic event at 2-year follow-up. In conclusion, our data confirm that ACS is younger onset with thromboinflammatory disease. In addition, these data consolidate rs2431697 as a silent proinflammatory factor predisposing to NETosis, and to a higher rate of adverse events in different cardiovascular diseases.
    Sprache Englisch
    Erscheinungsdatum 2022-07-20
    Erscheinungsland Switzerland
    Dokumenttyp Journal Article
    ZDB-ID 2662248-8
    ISSN 2075-4426
    ISSN 2075-4426
    DOI 10.3390/jpm12071185
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  6. Artikel ; Online: Clinical implications of diabetes mellitus in patients with acute coronary syndrome: Prognostic role and use of new P2Y

    Gil-Perez, Pablo / Ruiz-Nodar, Juan Miguel / Esteve-Pastor, María Asunción / Hortelano, Ignacio / Villamía, Beatriz / Vicente-Ibarra, Nuria / Orenes-Piñero, Esteban / Macías, Manuel Jesús / Núñez-Martínez, Laura / Carrillo, Luna / Candela, Elena / Véliz-Martínez, Andrea / López-García, Cecilia / Martínez-Martínez, Juan Gabriel / Rivera-Caravaca, José Miguel / Marín, Francisco

    Diabetes research and clinical practice

    2022  Band 184, Seite(n) 109215

    Abstract: Aims: We investigated the impact of diabetes mellitus (DM) in acute coronary syndrome (ACS) patients, and the 2-year prognosis based on antiplatelet therapy.: Methods: This is a prospective and multicenter registry including hospitalized ACS patients. ...

    Abstract Aims: We investigated the impact of diabetes mellitus (DM) in acute coronary syndrome (ACS) patients, and the 2-year prognosis based on antiplatelet therapy.
    Methods: This is a prospective and multicenter registry including hospitalized ACS patients. Clinical management and antiplatelet therapy at discharge were recorded. Bleeding events, all-cause mortality and major adverse cardiovascular events (MACEs) were recorded during 2-years and compared according to DM and the P2Y
    Results: From 1717 ACS patients, 653 (38%) had DM. Diabetic patients were older, more commonly females, with higher prevalence of comorbidities and more conservative management. After excluding antiplatelet monotherapy or oral anticoagulation, clopidogrel was prescribed in 59.6% of DM patients. Cox regression analysis showed that DM was an independent risk factor for MACE (aHR 1.39, 95% CI 1.05-1.83). The use of clopidogrel instead of ticagrelor/prasugrel was also independently associated with MACE (aHR 1.71, 95% CI 1.11-2.63), and all-cause mortality (aHR 2.47, 95% CI 1.23-4.96) in diabetic patients (log-rank p-values < 0.001).
    Conclusions: In ACS patients, DM was associated with higher risk of MACE. In such patients, the use of ticagrelor/prasugrel reduced MACE and mortality compared to clopidogrel. Novel P2Y
    Mesh-Begriff(e) Acute Coronary Syndrome/drug therapy ; Diabetes Mellitus/chemically induced ; Diabetes Mellitus/drug therapy ; Female ; Humans ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors/therapeutic use ; Prognosis ; Prospective Studies ; Purinergic P2Y Receptor Antagonists/therapeutic use ; Treatment Outcome
    Chemische Substanzen Platelet Aggregation Inhibitors ; Purinergic P2Y Receptor Antagonists
    Sprache Englisch
    Erscheinungsdatum 2022-01-24
    Erscheinungsland Ireland
    Dokumenttyp Journal Article ; Multicenter Study
    ZDB-ID 632523-3
    ISSN 1872-8227 ; 0168-8227
    ISSN (online) 1872-8227
    ISSN 0168-8227
    DOI 10.1016/j.diabres.2022.109215
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  7. Artikel ; Online: A nurse-led atrial fibrillation clinic: Impact on anticoagulation therapy and clinical outcomes.

    Rivera-Caravaca, José Miguel / Gil-Perez, Pablo / Lopez-García, Cecilia / Veliz-Martínez, Andrea / Quintana-Giner, Miriam / Romero-Aniorte, Ana Isabel / Fernandez-Redondo, Concepción / Muñoz, Luis / Quero, Eva / Esteve-Pastor, María Asunción / Lip, Gregory Y H / Roldán, Vanessa / Marín, Francisco

    International journal of clinical practice

    2020  Band 74, Heft 12, Seite(n) e13634

    Abstract: Background: Nurses play a central role in the management of atrial fibrillation (AF) patients. An unresolved question is whether a nurse-led clinic would improve clinical outcomes. Herein, we investigated the impact of a nurse-led clinic on ... ...

    Abstract Background: Nurses play a central role in the management of atrial fibrillation (AF) patients. An unresolved question is whether a nurse-led clinic would improve clinical outcomes. Herein, we investigated the impact of a nurse-led clinic on anticoagulation therapy and clinical outcomes in a cohort of naïve AF patients.
    Methods: Prospective study including AF patients starting vitamin K antagonists (VKAs) into a nurse-led AF clinic. These patients were followed in this specific AF clinic. Additionally, AF patients already taking VKAs for 6 months followed according to the routine clinical practice were included as comparison group. The quality of anticoagulation was assessed at 6 months. Efficacy and safety endpoints were recorded during follow-up.
    Results: We included 223 patients (Nurse-led clinic: 107; Usual care: 116). The mean time in therapeutic range and the proportion of INRs within the therapeutic range were similar in both groups. During 2.06 (IQR 1.01-2.94) years of follow-up, 64 (28.7%) patients changed to direct-acting oral anticoagulants. The proportion of switchers was higher in the nurse-led clinic (37.4%) than in the usual care group (20.7%) (P = .006) and these patients spent less time to switch (2.0 [IQR 0.7-2.9] vs 6.0 [IQR 3.7-11.2] years; P < .001). Importantly, the annual rate of ischaemic stroke/TIA was significantly lower in the nurse-led clinic (0.47%/year vs 3.88%/year, P = .016), without differences in safety endpoints.
    Conclusion: A nurse-led AF clinic may offer a "patient-centered" review and holistic follow-up, and it would be associated with a reduction of ischaemic stroke/TIA, without increasing bleeding complications. Further studies should confirm these results.
    Mesh-Begriff(e) Administration, Oral ; Anticoagulants/therapeutic use ; Atrial Fibrillation/complications ; Atrial Fibrillation/drug therapy ; Brain Ischemia/drug therapy ; Humans ; Prospective Studies ; Stroke/drug therapy ; Stroke/prevention & control ; Vitamin K
    Chemische Substanzen Anticoagulants ; Vitamin K (12001-79-5)
    Sprache Englisch
    Erscheinungsdatum 2020-08-25
    Erscheinungsland England
    Dokumenttyp Journal Article
    ZDB-ID 1386246-7
    ISSN 1742-1241 ; 1368-5031
    ISSN (online) 1742-1241
    ISSN 1368-5031
    DOI 10.1111/ijcp.13634
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