Biomedical subjects
V López García-Aranda
Publications and source records attributed to V López García-Aranda.
Randomized comparative trial of triflusal and aspirin following acute myocardial infarction.
AIMS: To compare the efficacy and tolerability of the antiplatelet agent triflusal with aspirin in the prevention of cardiovascular events following acute myocardial infarction. METHODS AND RESULTS: In this double-blind, multicentre, sequential design study, patients were randomized within 24 h of acute myocardial infarction symptom onset to receive triflusal 600 mg or aspirin 300 mg once daily for 35 days. The primary end-point was death, non-fatal myocardial reinfarction or a non-fatal cerebrovascular event. The incidences of these individual outcomes and urgent revascularization were secondary end-points. The null hypothesis of no difference between treatments in the primary combined end-point was accepted with 80% power after recruiting 2124 validated patients (odds ratio (OR) for failure [95% confidence interval (CI)]: 0.882 [0.634-1.227]). Non-fatal cerebrovascular events were significantly less frequent with triflusal (OR [95% CI]: 0.364 [0.146-0.908]; P = 0.030). There was no significant difference between treatments for death (OR [95% CI]: 0.816 [0.564-1.179]; P = 0.278), non-fatal reinfarction (OR [95% CI]: 1.577 [0.873-2.848]; P = 0.131) or revascularization (OR [95% CI]: 0.864 [0.644-1.161]; P = 0.334). Overall, both drugs were well tolerated, although there was a trend towards fewer bleeding episodes with triflusal; significantly fewer central nervous system bleeding episodes were observed in triflusal-treated patients (0.27% vs. 0.97%; P = 0.033). CONCLUSION: Triflusal and aspirin have similar efficacy in preventing further cardiovascular events after acute myocardial infarction, but triflusal showed a more favourable safety profile. Triflusal significantly reduced the incidence of non-fatal cerebrovascular events compared with aspirin.
[Influence of coronary risk factors in secondary prevention: tobacco].
Tobacco smoking is a strong independent factor for atherosclerotic disease, equivalent to hypertension or high cholesterol levels. Middle age people are especially involved, with a mortality rate of about 20% as a consequence of smoking, and a mean loss of life expectancy of 20 years. There is a positive correlation between smoking and severity of atherosclerotic disease in the coronary and cerebral arteries, and the aorta. It has been shown that smoking cessation clearly enhances the prognosis of patients with myocardial infarction. Twice a increase in mortality rate has been found among nonstopping smokers compared with those who stopped smoking eight years after myocardial infarction. In addition, progression of atherosclerosis as shown by angiography is slowed by stopping to smoke. As the coronary risk factors act in a synergistic way, a comprehensive approach to the patient is recommended, especially in smokers with myocardial infarction. It is justified an intensive intervention because of the advantages in this population. The physician should clearly communicate to the patient the need of stopping to smoke, which carries sometimes as beneficial effects as other interventions. A wise use of replacement therapy with transdermal nicotine, together with other useful measures, allows us to manage patients with a broad margin of safety, especially in coronary patients, who win most benefit from ceasing to smoke.
[Adrenocortical insufficiency and syncope caused by sinus node disease].
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Magnesium sulphate for torsade de pointes in a patient with congenital long QT syndrome.
A young woman with congenital long QT syndrome presented with repetitive torsade de pointes. A single bolus of magnesium sulphate abolished the arrhythmia.
Adverse effect of sodium nitroprusside 48 hours after myocardial infarction.
We present a patient with acute myocardial infarction in whom the use of nitroprusside 48 hours after the first symptom, was accompanied by a rise in the ST segment representative of the ischemic area. Our experience suggests that precaution is needed in the use of nitroprusside even several days after an acute myocardial infarction.
[Fatal acute myocardial infarct in a 14-year old boy].
The case of a 14 year old male, with no personal or family antecedents of ischemic heart disease, who died owing to an acute myocardial infarct into the few hours of beginning to pain. In the necroscopic study it was observed that the coronary arteries did not show any anatomical alterations or stenosis from their origins, although a microscopic study revealed extensive zones of necrosis.