Aarhus Sygehus

Århus, Denmark

Aarhus Sygehus

Århus, Denmark
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De Caterina R.,University of Chieti Pescara | Husted S.,Aarhus Sygehus | Wallentin L.,Uppsala University | Andreotti F.,Catholic University | And 12 more authors.
Thrombosis and Haemostasis | Year: 2013

Oral anticoagulants are a mainstay of cardiovascular therapy, and for over 60 years vitamin K antagonists (VKAs) were the only available agents for long-term use. VKAs interfere with the cyclic inter-conversion of vitamin K and its 2,3 epoxide, thus inhibiting γ-carboxylation of glutamate residues at the amino-termini of vitamin K-dependent proteins, including the coagulation factors (F) II (prothrombin), VII, IX and X, as well as of the anticoagulant proteins C, S and Z. The overall effect of such interference is a dose-dependent anticoagulant effect, which has been therapeutically exploited in heart disease since the early 1950s. In this position paper, we review the mechanisms of action, pharmacological properties and side effects of VKAs, which are used in the management of cardiovascular diseases, including coronary heart disease (where their use is limited), stroke prevention in atrial fibrillation, heart valves and/or chronic heart failure. Using an evidence-based approach, we describe the results of completed clinical trials, highlight areas of uncertainty, and recommend therapeutic options for specific disorders. Although VKAs are being increasingly replaced in most patients with non-valvular atrial fibrillation by the new oral anticoagulants, which target either thrombin or FXa, the VKAs remain the agents of choice for patients with atrial fibrillation in the setting of rheumatic valvular disease and for those with mechanical heart valves. © Schattauer 2013.


De Caterina R.,University of Chieti Pescara | Husted S.,Aarhus Sygehus | Wallentin L.,Uppsala University | Andreotti F.,Catholic University | And 12 more authors.
Thrombosis and Haemostasis | Year: 2013

Anticoagulants are a mainstay of cardiovascular therapy, and parenteral anticoagulants have widespread use in cardiology, especially in acute situations. Parenteral anticoagulants include unfractionated heparin, low-molecular-weight heparins, the synthetic pentasaccharides fondaparinux, idraparinux and idrabiotaparinux, and parenteral direct thrombin inhibitors. The several shortcomings of unfractionated heparin and of low-molecular-weight heparins have prompted the development of the other newer agents. Here we review the mechanisms of action, pharmacological properties and side effects of parenteral anticoagulants used in the management of coronary heart disease treated with or without percutaneous coronary interventions, cardioversion for atrial fibrillation, and prosthetic heart valves and valve repair. Using an evidence-based approach, we describe the results of completed clinical trials, highlight ongoing research with currently available agents, and recommend therapeutic options for specific heart diseases. © Schattauer 2013.


De Caterina R.,University of Chieti Pescara | Husted S.,Aarhus Sygehus | Wallentin L.,Uppsala University | Andreotti F.,Catholic University | And 12 more authors.
Thrombosis and Haemostasis | Year: 2013

Contrary to previous models based on plasma, coagulation processes are currently believed to be mostly cell surface-based, including three overlapping phases: initiation, when tissue factor-expressing cells and microparticles are exposed to plasma; amplification, whereby small amounts of thrombin induce platelet activation and aggregation, and promote activation of factors (F)V, FVIII and FXI on platelet surfaces; and propagation, in which the Xase (tenase) and prothrombinase complexes are formed, producing a burst of thrombin and the cleavage of fibrinogen to fibrin. Thrombin exerts a number of additional biological actions, including platelet activation, amplification and selfinhibition of coagulation, clot stabilisation and anti-fibrinolysis, in processes occurring in the proximity of vessel injury, tightly regulated by a series of inhibitory mechanisms. "Classical" anticoagulants, including heparin and vitamin K antagonists, typically target multiple coagulation steps. A number of new anticoagulants, already developed or under development, target specific steps in the process, inhibiting a single coagulation factor or mimicking natural coagulation inhibitors. © Schattauer 2013.


Oliveira C.L.P.,University of Aarhus | Juul S.,University of Aarhus | Jorgensen H.L.,University of Aarhus | Knudsen B.,CLC Bio | And 8 more authors.
ACS Nano | Year: 2010

The assembly, structure, and stability of DNA nanocages with the shape of truncated octahedra have been studied. The cages are composed of 12 double-stranded B-DNA helices interrupted by single-stranded linkers of thymidines of varying length that constitute the truncated corners of the structure. The structures assemble with a high efficiency in a one-step procedure, compared to previously published structures of similar complexity. The structures of the cages were determined by small-angle X-ray scattering. With increasing linker length, there is a systematic increase of the cage size and decrease of the twist angle of the double helices with respect to the symmetry planes of the cage structure. In the present study, we demonstrate the length of the single-stranded linker regions, which impose a certain degree of flexibility to the structure, to be the important determinant for efficient assembly. The linker length can be decreased to three thymidines without affecting assembly yield or the overall structural characteristics of the DNA cages. A linker length of two thymidines represents a sharp cutoff abolishing cage assembly. This is supported by energy minimization calculations suggesting substantial hydrogen bond deformation in a cage with linkers of two thymidines. © 2010 American Chemical Society.


Zoungas S.,George Institute for Global Health | Zoungas S.,University of Sydney | Chalmers J.,George Institute for Global Health | Neal B.,George Institute for Global Health | And 26 more authors.
New England Journal of Medicine | Year: 2014

Background In the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) factorial trial, the combination of perindopril and indapamide reduced mortality among patients with type 2 diabetes, but intensive glucose control, targeting a glycated hemoglobin level of less than 6.5%, did not. We now report results of the 6-year post-trial follow-up.Methods We invited surviving participants, who had previously been assigned to perindopril- indapamide or placebo and to intensive or standard glucose control (with the glucose-control comparison extending for an additional 6 months), to participate in a post-trial follow-up evaluation. The primary end points were death from any cause and major macrovascular events.Results The baseline characteristics were similar among the 11,140 patients who originally underwent randomization and the 8494 patients who participated in the post-trial follow-up for a median of 5.9 years (blood-pressure-lowering comparison) or 5.4 years (glucose-control comparison). Between-group differences in blood pressure and glycated hemoglobin levels during the trial were no longer evident by the first post-trial visit. The reductions in the risk of death from any cause and of death from cardiovascular causes that had been observed in the group receiving active blood-pressure-lowering treatment during the trial were attenuated but significant at the end of the post-trial follow-up; the hazard ratios were 0.91 (95% confidence interval [CI], 0.84 to 0.99; P = 0.03) and 0.88 (95% CI, 0.77 to 0.99; P = 0.04), respectively. No differences were observed during follow-up in the risk of death from any cause or major macrovascular events between the intensive-glucosecontrol group and the standard-glucose-control group; the hazard ratios were 1.00 (95% CI, 0.92 to 1.08) and 1.00 (95% CI, 0.92 to 1.08), respectively.Conclusions The benefits with respect to mortality that had been observed among patients originally assigned to blood-pressure-lowering therapy were attenuated but still evident at the end of follow-up. There was no evidence that intensive glucose control during the trial led to long-term benefits with respect to mortality or macrovascular events. Copyright © 2014 Massachusetts Medical Society. All rights reserved.


Bennetzen M.F.,Aarhus Sygehus | Nielsen T.S.,Aarhus Sygehus | Paulsen S.K.,Aarhus Sygehus | Bendix J.,Aarhus Sygehus | And 5 more authors.
European Journal of Clinical Investigation | Year: 2010

Background Cannabinoid 1 receptors are identified in various tissues involved in the internal metabolism including adipose tissue and the endocannabinoid system is claimed to be overactive in the obese state. To study the potential involvement of cannabinoid receptor 1 in the endocannabinoid system over-activity in adipose tissue in the obese state, we investigated the cannabinoid receptor 1 levels in adipose tissue from different fat depots in lean and obese humans. Materials and methods The adipose tissue samples were analysed by Western blot and by RT-PCR. Results Both the gene expression and the protein of cannabinoid receptor 1 were lower in subcutaneous abdominal adipose tissue from obese subjects as compared with lean subjects (P < 0·01 and P = 0·058). Moreover, in lean subjects, the level of cannabinoid receptor 1 was significantly higher in subcutaneous adipose tissue compared with visceral adipose tissue (P < 0·05) for both gene expression and protein. The level of cannabinoid receptor 1 was similar between the two depots in obese subjects. The expression of cannabinoid receptor 1 was higher in subcutaneous gluteal adipose tissue as compared with subcutaneous abdominal adipose tissue (P < 0·05). Conclusion We found in lean subjects, a robust lower level of cannabinoid receptor 1 in visceral adipose tissue compared with subcutaneous adipose tissue (both RNA and protein levels), but similar levels of cannabinoid receptor 1 between the two depots in obese subjects. Our present findings do not indicate that cannabinoid receptor 1 is directly involved in the endocannabinoid system over-activity in adipose tissue in obesity. © 2009 Stichting European Society for Clinical Investigation Journal Foundation.


Fauno P.,Aarhus Sygehus | Christiansen S.E.,Aarhus Sygehus | Lund B.,Aarhus Sygehus | Lind M.,Aarhus Sygehus
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2010

We present a case with an unusual and late cyst development after use of a biogradable femoral transfixation for ACL reconstruction. © 2010 Springer-Verlag.

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