Pol Arch Intern Med
· 2025 Dec · PMID 41123359
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Embolic stroke of undetermined source (ESUS) represents up to one‑sixth of ischemic strokes, and is associated with an annual recurrence risk of 4%-5% despite contemporary secondary prevention. The hypothesis that oral a...Embolic stroke of undetermined source (ESUS) represents up to one‑sixth of ischemic strokes, and is associated with an annual recurrence risk of 4%-5% despite contemporary secondary prevention. The hypothesis that oral anticoagulation would reduce recurrence more effectively than aspirin has been tested in large randomized trials, yet the NAVIGATE‑ESUS and RE‑SPECT ESUS trials failed to demonstrate superiority of direct oral anticoagulants over aspirin in the unselected ESUS population. These neutral findings reflect the heterogeneity of underlying mechanisms captured within the ESUS definition, which includes occult atrial fibrillation (AF), atrial cardiopathy (AC), structural cardiac disease, patent foramen ovale (PFO), and supracardiac atherosclerosis. Subgroup analyses, however, generate a hypothesis that anticoagulation may benefit selected patient groups. For example, rivaroxaban reduced recurrence in patients with left atrial enlargement, left ventricular dysfunction, and PFO in the NAVIGATE‑ESUS trial, and dabigatran was more effective in patients aged 75 years or older in the RE‑SPECT ESUS trial. The ATTICUS trial highlighted the importance of atrial high‑rate episodes as predictors of future AF, and the ARCADIA study underscored the need for a refined definition of AC. Meta‑analyses further support anticoagulation in patients with low‑risk supracardiac atherosclerosis, AC, or medically managed PFO, although these effects remain inconsistent. Overall, ESUS should not be considered an indication for anticoagulation. A precision‑medicine approach, integrating cardiovascular imaging and biomarkers, is essential to identify subgroups most likely to benefit from it. Future research needs to refine risk stratification and target pathophysiologically homogeneous cohorts to improve secondary prevention in ESUS.
Pol Arch Intern Med
· 2025 Dec · PMID 41117588
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INTRODUCTION: This systematic review and meta‑analysis is the first to comprehensively compare oral and subcutaneous semaglutide for type 2 diabetes (T2D) management. OBJECTIVES: Our aim was to determine whether oral sem...INTRODUCTION: This systematic review and meta‑analysis is the first to comprehensively compare oral and subcutaneous semaglutide for type 2 diabetes (T2D) management. OBJECTIVES: Our aim was to determine whether oral semaglutide is noninferior to the subcutaneous preparation, assess potential superiority, and provide evidence‑based guidance for clinical decisions. PATIENTS AND METHODS: We searched clinical trial registries and bibliographic databases through April 30, 2025. Twelve randomized controlled trials involving 6253 adults with T2D were analyzed. Following the PRISMA and Cochrane guidelines (PROSPERO, CRD420251017953), the data were extracted on efficacy, safety, and clinical outcomes. Noninferiority was assessed using predefined margins, and post hoc superiority analyses examined secondary end points. Evidence certainty was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation criteria. RESULTS: Both formulations of semaglutide significantly reduced the level of glycated hemoglobin (HbA1c), that is, oral by 1.16 percentage points (95% CI, -1.22 to -1.09) and subcutaneous by 1.4 percentage points (95% CI, -1.47 to -1.33). Oral semaglutide met the noninferiority margin at 50% of the subcutaneous effect. Subcutaneous semaglutide was superior for weight loss (2.19 kg; 95% CI, -3.57 to -0.81; P <0.002), body mass index (BMI) reduction (0.88 kg/m2; 95% CI, -1.55 to -0.21; P <0.011), and triglyceride level lowering (0.09 mmol/l; 95% CI, -0.14 to -0.04; P <0.001). CONCLUSIONS: Both forms of semaglutide effectively improve glycemic control in T2D. Oral semaglutide is noninferior to subcutanous semaglutide in lowering HbA1c level, while subcutaneous semaglutide is superior in weight, BMI, and triglyceride reduction. Given similar safety profiles and modest differences in other outcomes, treatment selection should be guided by clinical goals and patient preferences.
Piróg M, Ząbczyk M, Natorska J
… +3 more, Jach R, Butenas S, Undas A
Pol Arch Intern Med
· 2025 Dec · PMID 41117585
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INTRODUCTION: Formation of denser and poorly lysable fibrin clots has been reported in thrombotic antiphospholipid syndrome (APS). However, it is not known whether unfavorably altered fibrin clot properties and suppresse...INTRODUCTION: Formation of denser and poorly lysable fibrin clots has been reported in thrombotic antiphospholipid syndrome (APS). However, it is not known whether unfavorably altered fibrin clot properties and suppressed fibrinolysis characterize women with obstetric APS (OAPS) free of thromboembolic events (TEs). OBJECTIVES: This study sought to investigate fibrin clot characteristics and if they predict TE in women with OAPS. PATIENTS AND METHODS: In 62 women with OAPS and 62 controls, we determined plasma fibrin clot properties, including permeability (Ks) and clot lysis time (CLT), along with the levels of thrombin activatable fibrinolysis inhibitor (TAFI), plasminogen activator inhibitor‑1 (PAI‑1), plasminogen, and endogenous thrombin potential (ETP). TEs were recorded during median (interquartile range) follow‑up of 54 (49-58) months. RESULTS: The patients with OAPS had lower Ks (by 16.4%) and longer CLT (by 16.9%), with slightly higher ETP (by 4.2%), higher TAFI antigen level (by 15.6%), lower plasminogen level (by 7.9%), and similar PAI‑1 antigen level, as compared with controls (all P <0.05). The patients with high‑risk OAPS (n = 47; 75.8%) and positive for lupus anticoagulant (LA) had lower Ks and longer CLT than the low‑risk and LA‑negative individuals. There were no differences in fibrin clot properties and ETP between the patients positive for a single antiphospholipid antibody and controls. During follow‑up, higher odds of developing TEs were observed in the patients with OAPS (adjusted odds ratio, 5.26; 95% CI, 1.27-21.87), and those with OAPS who experienced a TE (16.1%; 2.2/year) had lower baseline Ks (by 17.5%) and longer CLT (by 12.2; both P <0.05). Reduced Ks (≤6.1 × 10‑9 cm2) predicted TE in the patients with OAPS. CONCLUSIONS: Prothrombotic fibrin clot properties characterize the patients with OAPS, which may increase the risk of TEs.
Oskroba A, Dworakowska AM, Rdzanek M
… +1 more, Bujalska-Zadrożny M
Pol Arch Intern Med
· 2025 Dec · PMID 41099719
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INTRODUCTION: Chronic kidney disease (CKD) affects over 700 million people worldwide, with its prevalence rising steadily each year. Early diagnosis remains challenging due to a lack of awareness of CKD risk factors and...INTRODUCTION: Chronic kidney disease (CKD) affects over 700 million people worldwide, with its prevalence rising steadily each year. Early diagnosis remains challenging due to a lack of awareness of CKD risk factors and the absence of noticeable symptoms in the initial stages. Pharmacists can play a pivotal role in CKD screening and patient education. OBJECTIVES: The primary aim of this systematic review was to identify specific pharmacist‑led interventions in community pharmacy settings that support CKD detection, assess their effectiveness, and evaluate their impact on patient outcomes. PATIENTS AND METHODS: The review was conducted in accordance with the 2020 PRISMA guidelines and, given the absence of randomized trials, it included nonrandomized controlled trials and observational studies. A comprehensive search was carried out across 3 databases in 2025: PubMed, Embase, and the Cochrane Library. RESULTS: Nine original clinical research articles met the inclusion criteria. The findings indicated that pharmacist‑led interventions in the community pharmacies are diverse but consistently contribute to early detection of CKD. Moreover, the pharmacists can further help by supporting ongoing CKD management, enhancing collaboration with general practitioners within coordinated care frameworks, and increasing public awareness of the disease. CONCLUSIONS: Pharmacist involvement in CKD screening improves public understanding of CKD risk factors, facilitates earlier initiation of treatment, and contributes to better long‑term patient outcomes.
Galas A, Morawiec R, Tymińska A
… +9 more, Leszek P, Tkaczyszyn M, Stefański A, Major A, Klimczak-Tomaniak D, Hamala P, Byczkowska K, Furman-Niedziejko A, Krzesiński P
Pol Arch Intern Med
· 2025 Nov · PMID 41084891
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INTRODUCTION: Optimization of guideline‑directed medical therapy (GDMT) to improve the prognosis of patients with heart failure (HF) is one of the main goals of chronic care. OBJECTIVES: We aimed to assess implementation...INTRODUCTION: Optimization of guideline‑directed medical therapy (GDMT) to improve the prognosis of patients with heart failure (HF) is one of the main goals of chronic care. OBJECTIVES: We aimed to assess implementation of the recommendations regarding GDMT optimization in HF patients undergoing scheduled hospitalization, with particular emphasis on the patients with reduced left ventricular ejection fraction (LVEF). PATIENTS AND METHODS: Our analysis included 412 patients with known LVEF (mean [SD] age, 66.7 [13.5] y; 297 men) admitted for elective hospitalization, representing a subset of 1422 participants of the HEROES study (Heart Failure Observational Study of the Polish Cardiac Society). Recruitment across 41 Polish centers took place from April 2022 to May 2024. RESULTS: Mean (SD) LVEF in the study group was 34.9% (14.4%). The patients with HF with reduced LVEF (HFrEF) constituted 69.7% (n = 287) of the whole group. In this subgroup, the use of angiotensin receptor‑neprilysin inhibitor (ARNI) / angiotensin‑converting enzyme inhibitor (ACEI) / angiotensin receptor blocker (ARB) increased from 81.5% of the patients at admission to 88.9% at discharge, of β‑blocker from 85% to 94.4%, of mineralocorticoid receptor antagonist (MRA) from 69.7% to 86.1%, and of sodium‑glucose cotransporter 2 inhibitor (SGLT2i) from 59.2% to 83.6%. ARNI/ACEI/ARB therapy was optimized in 36.2% of the participants, while the rates of optimization were 24.7%, 27.2%, and 24.4% for β‑blockers, MRA, and SGLT2i, respectively. However, only 64 patients (22.3%) attained the 4‑pillar GDMT of SGLT2i, ARNI/ACEI/ARB, β‑blockers, and MRA at doses equal to or above 50% of the target dose. CONCLUSIONS: In the Polish multicenter HEROES registry, over 80% of the patients with HFrEF were discharged on 4‑pillar GDMT. Nevertheless, the attainment of target high‑dose GDMT remained suboptimal. These findings provide new insights into the variability of GDMT implementation at the national level and underline the need for strategies to improve dosing optimization.
Zarębska-Michaluk D, Brzdęk M, Tronina O
… +9 more, Laurans Ł, Wawrzynowicz-Syczewska M, Dybowska D, Parfieniuk-Kowerda A, Tudrujek-Zdunek M, Białkowska-Warzecha J, Janczewska E, Mikołajczyk-Korniak N, Flisiak R
Pol Arch Intern Med
· 2025 Nov · PMID 41055085
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INTRODUCTION: Data on the risk of hepatocellular carcinoma (HCC) recurrence in a transplanted liver following direct‑acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection are sparse and inconsistent. OBJEC...INTRODUCTION: Data on the risk of hepatocellular carcinoma (HCC) recurrence in a transplanted liver following direct‑acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection are sparse and inconsistent. OBJECTIVES: This study aimed to evaluate the safety and efficacy of DAA treatment in patients with a history of orthotopic liver transplant (OLTx) performed due to HCV‑related cancer, and to assess the risk of HCC recurrence. PATIENTS AND METHODS: This real‑world retrospective study included all consecutive patients with chronic hepatitis C who underwent LTx for HCV‑related HCC before DAA therapy. Treatment efficacy (measured by sustained virologic response) and patient outcomes (adverse events, mortality, HCC recurrence) were assessed during treatment, 12 weeks after treatment completion, and in long‑term follow‑up. RESULTS: The analyzed population included 58 patients at a median (interquartile range [IQR]) age of 59 (53-63) years; predominantly men (70.7%). The majority of patients had comorbidities (83%) and were infected with the genotype 1b of HCV (86.2%). Less than half of the population was treatment‑experienced. The median (IQR) time from OLTx to DAA initiation was 19.5 (9.8-36) months. Twelve patients had cirrhosis at the start of DAA therapy, including 4 with decompensated cirrhosis. Ttreatment effectiveness was 98.2%, with no differences according to the stage of fibrosis, time since OLTx, and type of DAA regimen used. During a median (IQR) long‑term follow‑up of 8 (6-9) years, 3 patients (5.4%) developed recurrent HCC in the transplanted liver; one during DAA therapy, one 12 weeks after treatment initiation, and one 2 years after the DAA therapy completion. All these patients died from liver cancer dissemination. CONCLUSIONS: DAA therapy in patients who received antiviral treatment after OLTx performed due to HCV‑related HCC was highly effective, and the long‑term HCC recurrence rate was 5.4%, which is lower than expected based on the natural history of the disease.