Abstract
Background
Opioid treatment delays the onset of oral P2Y12 inhibitors in patients with acute ST-segment elevation myocardial infarction (STEMI), leading to suboptimal antithrombotic therapy ...during primary percutaneous coronary intervention (PPCI).
Material and methods
We retrospectively compared using a prolonged enoxaparin regimen (0.75 mg/kg bolus followed by 6-hour intravenous infusion) to using unfractionated heparin (UFH) with or without tirofiban in opioid-treated patients with STEMI who underwent PPCI. We compared the proportions of acute stent thrombosis (AST) and bleeding events according to the bleeding academic research consortium (BARC) within 24 hours post-PPCI.
Results
270 opioid-treated patients with a mean age of 63 SD ± 12 years were enrolled, of which 49 (18%) were with diabetes mellitus (DM). 90 (34%) patients (mean age 61 SD ± 11 years) received enoxaparin, 110 (41%) (mean age 65 SD ± 14 years) UFH with tirofiban, and 69 (25%) (mean age 63 SD ± 12 years) UFH only. Compared to the other strategies, a higher proportion of DM was observed in the enoxaparin-treated group (21%). No AST was associated with enoxaparin compared to 2 (1.8%) events in UFH with tirofiban and 1 (1.4%) in UFH only. The rate of severe bleeding events (BARC 2 and 3) was significantly lower in the enoxaparin-treated patients than in UFH with tirofiban (0 (0%) vs. 8 (7%), P = 0.01). 3 enoxaparin-treated patients needed switching to tirofiban as a bailout strategy due to distal vessel embolisation.
Conclusions
The novel 6-hour enoxaparin regimen is safe during PPCI and was associated with fewer bleeding events than UFH with tirofiban.
This dissertation will reflect an analysis of a close reading of Kurt Vonnegut's first six novels: Player Piano (1952), The Sirens of Titan (1959), Mother Night (1961), Cat's Cradle (1963), God Bless ...You, Mr. Rosewater (1964), and Slaughterhouse-Five (1969) as a means of tracing specific and repeated themes, images, sounds, smells, patterns, colors, and events that relate to Vonnegut's experience as an American POW during World War II in Dresden, Germany. Vonnegut returned from war, planning to write a novel about what he had seen; it took him twenty-three years of struggle as a writer to accomplish the task. Chapter one will establish the historical background of what happened in Dresden during Vonnegut's imprisonment. This is necessary, so that the Dresden images, when they appear in a novel, will be recognizable. Chapters two through seven will then trace these Dresden "markers" as they filter through Vonnegut's writing. This dissertation will show that the specific writing techniques, themes, and characterizations needed for Vonnegut to voice his Dresden message were being honed in these first books, and that when they came to full bloom in 1969 with the publication of Slaughterhouse-Five, they resulted in a cathartic experience for Vonnegut, who felt a sense of accomplishment and release when he was finally able to deliver his Dresden message.
Exposure of rats to a 50% N2O/oxygen mixture led to a rapid loss of methionine synthase activity in both liver and brain. This enzyme has vitamin B12 as a cofactor. There was impaired conversion of ...deoxyuridine to deoxythymidine by bone marrow cells and this defect followed loss of methionine synthase activity. There was no homocystinuria. Withdrawal of N2O was followed by a relatively slow recovery of methionine synthase activity over four days. The inactivation of vitamin B12 by N2O promises to be a valuable tool in the study of vitamin B12 metabolism.
