Browsing by Author "Knipse, Agnese"

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    Decrease in annual incidence of acute coronary syndrome and restructuring of coronary care in Latvia
    (2014-08) Erglis, Andrejs; Maca, Aija; Narbute, Inga; Jegere, Sanda; Ratobilska, Svetlana; Knipse, Agnese; Dzerve, Vilnis; Bajare, Iveta; Zakke, Ilja
    Introduction Improvement in coronary heart disease prevention and treatment, as well as availability of coronary care facilities, is important for the reduction of acute coronary syndrome (ACS) incidence. Centralized acute coronary care system is crucial to provide optimal hospitalization and management algorithm for ACS patients. Aim The aim of the current report was to assess the annual incidence of ACS and the quality of acute coronary care in Latvia. Methods The Data from The Latvian Registry of Acute Coronary Syndromes were analyzed covering the time period from 2005 to 2010. Results Since the year 2005 the annual incidence of hospitalization due to ACS decreased significantly in Latvia. The annual incidence of non-ST-elevation ACS (NSTE-ACS) decreased from 8019 to 4613 in absolute numbers based on the registry data during six years. Improvement in the use of guidelines based therapy and early invasive strategy in ACS patients was observed. Increase in primary percutaneous coronary intervention was achieved from 7.9% in 2005 to 57.0% in 2010, contributing to reduction in the proportion of STEMI patients without any reperfusion (from 45% in 2005 to 21% in 2010). Conclusions The annual incidence of hospitalized ACS, especially NSTE-ACS, decreased and guidelines based management of ACS improved from 2005 to 2010 in Latvia.
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    Role of genetic factors on the effect of additional loading doses and two maintenance doses used to overcome clopidogrel hyporesponsiveness
    (2014) Latkovskis, Gustavs; Urtane, Inga; Knipse, Agnese; Peculis, Raitis; Cakstina, Inese; Klovins, Janis; Erglis, Andrejs; Faculty of Pharmacy
    Background and objective: Additional loading doses and higher maintenance doses (MDs) have been used to overcome hyporesponsiveness of clopidogrel. We aimed to investigate whether genetic polymorphisms of two cytochromes (CYP2C19 and CYP2C9) and ABCB1 modify effect of such dose-adjustment strategy. Materials and methods: We enrolled 118 patients undergoing elective or acute percutaneous coronary intervention (PCI) with drug eluting stent (DES). Platelet reactivity index (PRI) was measured using the vasodilator-stimulated phosphoprotein (VASP) index and a cut-off value of ≥60% was defined as hyporesponsiveness. Polymorphism of two cytochromes (CYP2C19, CYP2C9) and gene ABCB1 were determined. In patients hyporesponsive to the initial LD the dose-adjustment was performed using up to 3 additional 600mg LDs in order to achieve PRI <60%, and both 150mg and 75mg MD were tested at the follow-up. Results: Patients with at least one CYP2C19*2 allele had higher baseline PRI after the initial LD (78.2 ± 13.1 vs. 65.3 ± 19.5, P = 0.005). The PRI reduction with additional LD was significantly smaller in carriers of the CYP2C19*2 (25.2 ± 15.6 vs. 35.5 ± 16.8, P = 0.025) and similar trend was observed with subsequent additional LDs. Both MDs were less effective in presence of CYP2C19*2. Target PRI was, however, more frequently achieved with higher MD even in presence of CYP2C19*2 (in 70.6% vs. 23.5% of hyporesponders, P = 0.008). No such differences were observed for other polymorphisms. Conclusions: In patients hyporesponsive to a routine clopidogrel doses the potency of additional LD and higher MD of clopidogrel is compromised by presence of CYP2C19*2 allele. The dose-adjustment strategy is not affected by ABCB1 C3435T or CYP2C9 genotypes.