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International Studies Of Infarct Survival
The International Studies of Infarct Survival (ISIS) were four randomized controlled trials of several drugs for treating suspected acute myocardial infarction ("heart attack"). More than 134,000 patients from over 20 countries took part in four large simple trials between 1981 and 1993, coordinated from Oxford, England. ISIS-1 The First International Study of Infarct Survival (ISIS-1) was a placebo-controlled trial of the beta-blocker atenolol. It recruited 16,027 patients and was completed in 1985. ISIS-2 The Second International Study of Infarct Survival (ISIS-2) was a 2×2 factorial placebo-controlled trial of aspirin and the thrombolytic drug streptokinase. It recruited 17,187 patients and was completed in 1988. ISIS-3 The Third International Study of Infarct Survival (ISIS-3) was a 3×2 factorial trial that compared the three thrombolytic drugs streptokinase, tissue plasminogen activator (tPA) and anistreplase to each other, and also compared the anticoagulant heparin to n ...
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Randomized Controlled Trial
A randomized controlled trial (or randomized control trial; RCT) is a form of scientific experiment used to control factors not under direct experimental control. Examples of RCTs are clinical trials that compare the effects of drugs, surgical techniques, medical devices, diagnostic procedures, diets or other medical treatments. Participants who enroll in RCTs differ from one another in known and unknown ways that can influence study outcomes, and yet cannot be directly controlled. By randomly allocating participants among compared treatments, an RCT enables ''statistical control'' over these influences. Provided it is designed well, conducted properly, and enrolls enough participants, an RCT may achieve sufficient control over these confounding factors to deliver a useful comparison of the treatments studied. Definition and examples An RCT in clinical research typically compares a proposed new treatment against an existing standard of care; these are then termed the 'expe ...
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Anistreplase
Anistreplase is a thrombolytic drug. It is also known as anisoylated plasminogen streptokinase activator complex (APSAC). As a thrombolytic drug, it is used to treat blood clots in emergency situations. Uses Anistreplase is used to treat blood clots in emergency situations such as myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when Ischemia, blood flow decreases or stops in one of the coronary arteries of the heart, causing infarction (tissue death) to the heart muscle. The most common symptom .... Early treatment gives better outcomes. History Anistreplase has been developed by Beecham under the brand name Eminase. It is also known as anisoylated plasminogen streptokinase activator complex (APSAC) after its components. References Antithrombotic enzymes Fibrinolytic enzymes {{blood-drug-stub ...
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Myocardial Infarction Management
Management of acute coronary syndrome is targeted against the effects of reduced blood flow to the affected area of the heart muscle, usually because of a blood clot in one of the coronary arteries, the vessels that supply oxygenated blood to the myocardium. This is achieved with urgent hospitalization and medical therapy, including drugs that relieve chest pain and reduce the size of the infarct, and drugs that inhibit clot formation; for a subset of patients invasive measures are also employed (coronary angiography and percutaneous coronary intervention). Basic principles of management are the same for all types of acute coronary syndrome. However, some important aspects of treatment depend on the presence or absence of elevation of the ST segment on the electrocardiogram, which classifies cases upon presentation to either ST segment elevation myocardial infarction (STEMI) or non-ST elevation acute coronary syndrome (NST-ACS); the latter includes unstable angina and non-ST eleva ...
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Thrombolysis In Myocardial Infarction
The Thrombolysis In Myocardial Infarction (TIMI) Study Group, is an academic research organization (ARO) affiliated with Brigham and Women's Hospital and Harvard Medical School with a focus in the field of cardiovascular disease. The group has its headquarters in Boston, Massachusetts. The TIMI Study Group was founded by physician Eugene Braunwald in 1984. Braunwald held the chairmanship until 2010, when he appointed Marc Sabatine to the position. Among the group's most important works is the TIMI Risk Score, which assesses the risk of death and ischemic events in patients with unstable angina (UA) or non-ST elevation myocardial infarction (NSTEMI). TIMI Risk Score calculators In patients with UA/NSTEMI, the TIMI risk score is a prognostication scheme that categorizes a patient's risk of death and ischemic events and provides a basis for therapeutic decision making. TIMI Score Calculation (1 point for each): * Age ≥ 65 years * Known coronary artery disease (CAD) (stenosis � ...
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GISSI
Gissi ( Abruzzese: ) is a town and ''comune'' located in the Province of Chieti, Abruzzo, Italy. It is bordered by two tributaries of the Sinello River and is surrounded by vineyards and olive groves. History Gissi has been populated since prehistoric times. In the 12th century it was under the influence of the D'Avalos family. Main sights The ''Palazzo Carunchio'' and the ruins of the Castle are exemplary of the town's buildings, balconies, and alleys. Built in the 19th century, the Palazzo Carunchio now serves as the Town Hall, and houses the town's administrative offices. The town has other fine examples of ''palazzi'' from the 18th and 19th centuries, adorned with fine architectural details. Also notable is that many Gissi homes are covered with gesso, a material obtained from nearby caves and hills. The Church of ''Santa Maria Assunta'' is Gissi's oldest church, which was remodeled in 1955. Inside, it houses silver crosses from the Neapolitan School dating to the 17 ...
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Magnesium Sulphate
Magnesium sulfate or magnesium sulphate is a chemical compound, a salt with the formula , consisting of magnesium cations (20.19% by mass) and sulfate anions . It is a white crystalline solid, soluble in water but not in ethanol. Magnesium sulfate is usually encountered in the form of a hydrate , for various values of ''n'' between 1 and 11. The most common is the heptahydrate , known as Epsom salt, which is a household chemical with many traditional uses, including bath salts. The main use of magnesium sulfate is in agriculture, to correct soils deficient in magnesium (an essential plant nutrient because of the role of magnesium in chlorophyll and photosynthesis). The monohydrate is favored for this use; by the mid 1970s, its production was 2.3 million tons per year. The anhydrous form and several hydrates occur in nature as minerals, and the salt is a significant component of the water from some springs. Hydrates Magnesium sulfate can crystallize as several hydr ...
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Isosorbide Mononitrate
Isosorbide mononitrate, sold under many brand names, is a medication used for heart-related chest pain (angina), heart failure and esophageal spasms. It can be used both to treat and to prevent heart-related chest pain; however, it is generally less preferred than beta blockers or calcium channel blockers. It is taken by mouth. Common side effects include headache, Orthostatic hypotension, low blood pressure with standing, blurry vision, and skin flushing. Serious side effects may include low blood pressure especially if also exposed to PDE5 inhibitors such as sildenafil. Use is not recommended in pregnancy. It is believed to work by relaxing smooth muscle within blood vessels. It was patented in 1971 and approved for medical use in 1981. It is available as a generic medication. In 2022, isosorbide was the 119th most commonly prescribed medication in the United States, with more than 5million prescriptions. Medical uses Isosorbide mononitrate is a Nitrovasodilator, nitrate-cl ...
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Captopril
Captopril, sold under the brand name Capoten among others, is an ACE inhibitor, angiotensin-converting enzyme (ACE) inhibitor used for the treatment of hypertension and some types of congestive heart failure. Captopril was the first oral ACE inhibitor found for the treatment of hypertension. It does not cause fatigue as associated with beta-blockers. Captopril was patented in 1976 and approved for medical use in 1980. Structure–activity relationship Captopril has an L-proline group which allows it to be more bioavailable in oral formulations. The thiol moiety within the molecule has been associated with two significant adverse effects: the hapten or immune response. This immune response, also known as agranulocytosis, can explain the adverse drug events which may be seen in captopril with the allergic response which includes hives, severe stomach pain, difficulty breathing, and swelling of the face, lips, tongue or throat. In terms of interaction with the enzyme, the molec ...
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ACE Inhibitor
Angiotensin-converting-enzyme inhibitors (ACE inhibitors) are a class of medication used primarily for the treatment of high blood pressure and heart failure. This class of medicine works by causing relaxation of blood vessels as well as a decrease in blood volume, which leads to lower blood pressure and decreased oxygen demand from the heart. ACE inhibitors inhibit the activity of angiotensin-converting enzyme, an important component of the renin–angiotensin system which converts angiotensin I to angiotensin II, and hydrolyses bradykinin. Therefore, ACE inhibitors decrease the formation of angiotensin II, a vasoconstrictor, and increase the level of bradykinin, a peptide vasodilator. This combination is synergistic in lowering blood pressure. As a result of inhibiting the ACE enzyme in the bradykinin system, the ACE inhibitor drugs allow for increased levels of bradykinin which would normally be degraded. Bradykinin produces prostaglandin. This mechanism can explain t ...
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Angiotensin-converting Enzyme
Angiotensin-converting enzyme (), or ACE, is a central component of the renin–angiotensin system (RAS), which controls blood pressure by regulating the volume of fluids in the body. It converts the hormone angiotensin I to the active vasoconstriction, vasoconstrictor angiotensin II. Therefore, ACE indirectly increases blood pressure by causing blood vessels to constrict. ACE inhibitors are widely used as pharmaceutical drugs for treatment of cardiovascular diseases. Other lesser known functions of ACE are degradation of bradykinin, substance P and amyloid beta, amyloid beta-protein. Nomenclature ACE is also known by the following names: * dipeptidyl carboxypeptidase I * peptidase P * dipeptide hydrolase * peptidyl dipeptidase * angiotensin converting enzyme * kininase II * angiotensin I-converting enzyme * carboxycathepsin * dipeptidyl carboxypeptidase * "hypertensin converting enzyme" peptidyl dipeptidase I * peptidyl-dipeptide hydrolase * peptidyldipeptide hydrolase * en ...
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Heparin
Heparin, also known as unfractionated heparin (UFH), is a medication and naturally occurring glycosaminoglycan. Heparin is a blood anticoagulant that increases the activity of antithrombin. It is used in the treatment of myocardial infarction, heart attacks and unstable angina. It can be given intravenously or by subcutaneous injection, injection under the skin. Its anticoagulant properties make it useful to prevent blood clotting in blood specimen test tubes and kidney dialysis machines. Common side effects include bleeding, pain at the injection site, and thrombocytopenia, low blood platelets. Serious side effects include heparin-induced thrombocytopenia. Greater care is needed in those with poor kidney function. Heparin is contraindicated for suspected cases of Post-vaccination embolic and thrombotic events, vaccine-induced pro-thrombotic immune thrombocytopenia (VIPIT) secondary to SARS-CoV-2 vaccination, as heparin may further increase the risk of bleeding in an anti-PF4 ...
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Anticoagulant
An anticoagulant, commonly known as a blood thinner, is a chemical substance that prevents or reduces the coagulation of blood, prolonging the clotting time. Some occur naturally in blood-eating animals, such as leeches and mosquitoes, which help keep the bite area unclotted long enough for the animal to obtain blood. As a class of medications, anticoagulants are used in therapy for thrombotic disorders. Oral anticoagulants (OACs) are taken by many people in pill or tablet form, and various intravenous anticoagulant dosage forms are used in hospitals. Some anticoagulants are used in medical equipment, such as sample tubes, blood transfusion bags, heart–lung machines, and dialysis equipment. One of the first anticoagulants, warfarin, was initially approved as a rodenticide. Anticoagulants are closely related to antiplatelet drugs and thrombolytic drugs by manipulating the various pathways of blood coagulation. Specifically, antiplatelet drugs inhibit platelet agg ...
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