Background: No studies have compared aspirin to P2Y12 inhibitor monotherapy following short dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients with diabetes. Methods and Results: We conducted a prespecified diabetes subgroup analysis of the 1-year STOPDAPT-3 trial; patients were randomized at the time of index PCI, and outcomes from 30 days to 1 year were assessed using a 30-day landmark analysis comparing 1-month DAPT followed by aspirin monotherapy (aspirin group) to 1-month prasugrel monotherapy followed by clopidogrel monotherapy (clopidogrel group). The effect of aspirin relative to clopidogrel was not significant for the coprimary cardiovascular endpoint (composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke) regardless of diabetes (aspirin/clopidogrel 5.3/5.6 vs. 3.9/3.7 per 100 person-years for diabetes vs. non-diabetes, respectively; hazard ratios [HRs] 0.96 [95% confidence interval {CI} 0.67-1.37] and 1.06 [95% CI 0.72-1.55], respectively; Pinteraction=0.71), but there was a significant interaction between diabetes and the effect of aspirin relative to clopidogrel for the coprimary bleeding endpoint (Bleeding Academic Research Consortium 3 or 5; aspirin/clopidogrel 2.8/1.8 vs. 1.3/2.0 per 100 person-years diabetes vs. non-diabetes, respectively; HR 1.54 [95% CI 0.88-2.71] vs. 0.65 [95% CI 0.36-1.17], respectively; Pinteraction=0.04). Conclusions: From 30 days to 1 year after PCI, cardiovascular outcomes were similar between aspirin and clopidogrel regardless of diabetes. A nominal bleeding interaction was observed; given the exploratory and underpowered subgroup analyses, this finding should be interpreted cautiously.
Drug-induced acute interstitial nephritis (DI-AIN) is a common cause of acute kidney injury (AKI), particularly in patients receiving multiple medications. We report a case of AKI in a 47-year-old man with lung squamous cell carcinoma who was treated with carboplatin, paclitaxel, and tazobactam/piperacillin (TAZ/PIPC). A renal biopsy revealed acute tubulointerstitial nephritis with eosinophilic infiltration and non-caseating epithelioid granulomas. The drug lymphocyte stimulation test was positive for TAZ/PIPC, thus supporting a diagnosis of drug-associated DI-AIN. The discontinuation of TAZ/PIPC and corticosteroid therapy led to a recovery of the renal function, thereby allowing for the safe resumption of chemotherapy.
A 64-year-old man with a mild cough presented with abnormal chest imaging with centrilobular ground-glass opacities in the upper lobes, peribronchovascular and subpleural consolidation and small nodules. Bronchoalveolar lavage fluid (BALF) lacked foamy macrophages, transbronchial lung cryobiopsy revealed features consistent with amiodarone-induced interstitial pneumonia, including vacuolization of type II alveolar epithelial cells, lymphoid follicle formation and granulation tissue. After discontinuation of amiodarone, the patient's symptoms and radiographic abnormalities improved. This case highlights that the absence of foamy macrophages in BALF should not preclude amiodarone-induced pneumonia, and that histological evaluation plays a pivotal role in establishing an accurate diagnosis.
This study aimed to examine the impact of planned versus unplanned initiation of hemodialysis on physical function and activities of daily living (ADL) during the induction phase. This single-center retrospective cohort study was conducted at Shizuoka Saiseikai General Hospital. Thirty-two patients with chronic kidney disease who started hemodialysis between June 2022 and August 2023 were included and classified into either the planned or unplanned initiation group. Physical function was assessed at admission and discharge using the Barthel Index (BI), Functional Independence Measure (FIM) mobility score, 10-m walking speed (10MWS), grip strength, isometric knee extensor strength (IKES), Short Physical Performance Battery (SPPB), and Clinical Frailty Scale (CFS). Comparisons between groups in the planned initiation and unplanned initiation groups were made using the unpaired t-test or χ2 test, and linear mixed models were used for pre- and post-admission and discharge comparisons. Compared with the planned group, the unplanned initiation group showed significantly lower BI scores (83.0 versus 92.6, p = 0.029), lower SPPB gait scores (2.1 versus 3.7, p = 0.026), and higher CFS scores (4.8 versus 3.9, p = 0.038) at admission. The length of hospital stay was also significantly longer in the unplanned group (38.8 days versus 14.5 days, p = 0.001). Although the unplanned group demonstrated improvements in BI and grip strength during hospitalization, the gain in grip strength was significantly smaller than in the planned group. Unplanned hemodialysis initiation was associated with impaired physical function, higher frailty, limited functional recovery through rehabilitation, and prolonged hospitalization. These findings highlight the need for early and structured rehabilitation interventions in patients undergoing unplanned dialysis initiation to mitigate physical decline during the induction phase.
