Prof. Fahad A S Aleidan (original) (raw)

Papers by Prof. Fahad A S Aleidan

International Journal of General Medicine

Background: Little is written about recurrence and mortality rates after a first episode of venou... more Background: Little is written about recurrence and mortality rates after a first episode of venous thromboembolism (VTE) among Saudi population. Aim: Determine incidence rates and assess predictors of recurrence and mortality following the first VTE event. Patients and Methods: A total of 1124 patients aged ≥18 years with symptomatic VTE confirmed by imaging tests were evaluated. The incidence of VTE recurrence and mortality were assessed. The association between patient characteristics, and VTE recurrence and mortality was explored by estimating the hazard ratio (HR) and 95% confidence interval (CI). The difference between cancerrelated, provoked and unprovoked VTE in terms of recurrence and mortality was explored using Kaplan-Meier curves.

BackgroundSystemic infections are one of several risk factors leading to the development of infla... more BackgroundSystemic infections are one of several risk factors leading to the development of inflammation and venous thromboembolism (VTE) formation.Aim of the studyTo assess the risk factors associated with the development of VTE during the stay of critically ill patients in the intensive care unit (ICU).Materials and methodsThis is a matched case-control study of patients with VTE admitted to the ICU, at a single centre, from January 1 2018 to December 31 2019. We included all adult patients who stayed more than two days before the development of VTE. Conditional logistic regression was used to estimate the odds ratio (OR) for the risk factors for VTE.ResultsUnivariate and multivariate analyses uncovered three of six factors to have significant influence in the development of VTE in ICU patients: Carbapenem-resistant Enterobactereaceae (CRE) infections (OR 2.95, 95% confidence interval (CI) 1.21–7.33, p = .010), length of ICU stay (OR 1.02, 95% CI 1.01–1.04, p = .011) and the seque...

Immunogenic heparin-induced thrombocytopenia (HIT) is an immune response to heparin associated wi... more Immunogenic heparin-induced thrombocytopenia (HIT) is an immune response to heparin associated with significant morbidity and mortality in hospitalized patients if unidentified as soon as possible, due to thromboembolic complications involving both arterial and venous systems. Early diagnoses based on a comprehensive interpretation of clinical and laboratory information improve clinical outcomes. Management principles of strongly suspected HIT should not be delayed for laboratory result confirmation. Treatment strategies have been introduced including new, safe, and effective agents. This review summarizes the clinical therapeutic options for HIT addressing the use of parenteral direct thrombin inhibitors and indirect factor Xa inhibitors as well as the potential non-Vitamin K antagonist oral anticoagulants.

Vascular Health and Risk Management, 2020

Background: Incidence and outcomes of recurrent venous thromboembolism (VTE) in the elderly are s... more Background: Incidence and outcomes of recurrent venous thromboembolism (VTE) in the elderly are still not fully elucidated. The purpose of this study was to determine the incidence and identify the risk factors of VTE recurrence in this population. Methods: A prospective cohort study of a one-year follow-up of 277 patients aged ≥65 years with primary VTE was performed at King Abdulaziz Medical City, a tertiary care teaching hospital in Riyadh, Saudi Arabia. Demographic data, risk factors, and the consequences of VTE (recurrence, bleeding, and mortality) were recorded. Results: Of the 277 VTE patients, 39 (14%) were diagnosed with recurrent VTE over a median follow-up period of 12 months. The cumulative incidence of recurrent VTE was 12.75 per hundred patient-year (95% CI, 8.24-17.36). In multivariate Cox regression, malignancy (hazard ratio [HR], 2.87, 95% CI, 1.32-6.24, p=0.008) and surgery (HR 2.78, 95% CI, 1.36-5.67, p=0.005) were identified as independent risk factors for recurrent VTE. Metformin had a significant independent protection effect (HR, 0.16, 95% CI, 0.08-0.33, p<0.001). During follow-up, two patients in the recurrent VTE group and five patients in the group with no recurrent VTE, all of whom were minor bleeding cases, reported no major bleeding. Seven (18%) patients in the recurrent VTE group and nine (4%) patients in the group with no recurrent VTE died (p<0.001). Conclusion: The findings of this study show that elderly patients with initial VTE have a recurrent rate (14%), with a cumulative incidence rate of 12.75 per hundred patient-year. Malignancy and surgery were the most important clinical risk factors to impact significantly the development of recurrent VTE in our elderly population. Metformin may have a protective effect against recurrent VTE in the elderly population, and a larger study is needed to validate our findings.

Frontiers in Public Health, 2020

Aim: Diabetic peripheral neuropathy (DPN) is a common, severe microvascular complication of diabe... more Aim: Diabetic peripheral neuropathy (DPN) is a common, severe microvascular complication of diabetes. Our study was to assess prevalence and risk factors for DPN in subjects with type 2 diabetes from 14 different countries. Methods: A total of 2,733 subjects with type 2 diabetes aged 18-65 years (45.3% men, mean duration of diabetes = 8.8 years) were included to perform this International Prevalence and Treatment of Diabetes and Depression (INTERPRET-DD) study in 14 countries. After a structured questionnaire was used in face-to-face interviews to collect sociodemographic characteristics and medical records of the participating subjects, laboratory tests were carried out for clinical measurement. Depressive symptoms were diagnosed and measured using the Patient Health Questionnaire-9. The potential risk factors for DPN were determined by multilevel mixed-effects logistic regression, accounting for clustering of participants within the country. Robustness of the estimates was assessed by sensitivity analysis. Results: The overall prevalence of DPN across different countries was 26.71%, whereas country-specific prevalences showed considerable variation. Multivariate analysis revealed that duration of diabetes (OR: 1.08 per 1-year increase, 95% CI: 1.06-1.09), poor glycemic control (OR: 1.11 per 1% increase in HbA1c, 95% CI: 1.05-1.18), and history of hypertension (OR: 1.58, 95% CI: 1.18-2.12), cardiovascular disease (OR: 2.07, 95% CI: 1.55-2.78) and depressive symptoms (OR: 1.92, 95% CI: 1.43-2.58) were independently and positively associated with the risk of DPN. Sensitivity analyses including or excluding patients from countries with extreme low or high prevalence of DPN yielded similar estimates in terms of trend and magnitude. Conclusions: This international study illustrates that more than a quarter of individuals with type 2 diabetes developed DPN. The prevalence was positively associated with the duration of diabetes, poor glycemic control, and history of hypertension, cardiovascular disease and depressive symptoms.

International Journal of Hematology, 2020

Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in pregnant women. Eno... more Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in pregnant women. Enoxaparin is a lowmolecular-weight heparin used during pregnancy to treat or prevent VTE. In this study, we compare anti-factor Xa peak levels in pregnant and non-pregnant women, and explore the association between anti-factor Xa (AFXa) peak levels and possible predictive parameters. Pregnant and non-pregnant patients received a therapeutic dose of enoxaparin every 12 h and three steady-state AFXa peak levels at 4-week intervals were collected. Sixty-eight patients (36 pregnant and 32 non-pregnant women) were enrolled. AFXa peak levels within therapeutic range (0.6-1.0 IU/ml) were achieved in the first measurement in 14 (38.9%) pregnant women compared to 21 (65.6%) non-pregnant women (p = 0.028). In the second anti-factor Xa measurement, 20 (55.6%) compared to 25 (78.1%) were within the reference interval (p = 0.008). Similar results were seen with the third measurement 20 (55.6%) compared to 26 (81.3%) (p = 0.003). In a mixed-effect repeated-measures model, pregnancy was associated with AFXa peak level (Mean difference =-0.177; 95% CI-0.349 to-0.005, p = 0.044). These findings suggest that further evaluation of a strategy involving more frequent monitoring of achieved AFXa levels could result in more effective anticoagulation.

Journal of Hematology & Thromboembolic Diseases, 2015

Heparin-induced thrombocytopenia (HIT) is a well known life-threatening, immune-mediated reaction... more Heparin-induced thrombocytopenia (HIT) is a well known life-threatening, immune-mediated reaction to all heparin preparations [1-6]. Of the patient's who were exposed to unfractionated heparin (UFH) preparation, 3-5% developed HIT. Up to 2% of those exposed low-molecular-weight-heparin (LMWH) also developed HIT [7-9]. Patients who developed HIT had a high rate of venous thromboembolic complications leading to increased morbidity and mortality [4-6,10]. The healthcare costs are increased when patients develop HIT and even more so if heparin-induced thrombotic thrombocytopenia (HITT) occurs. Patients, at the very least, require longer hospital stay for parenteral administration of nonheparin anticoagulant as well as management of any thrombotic complications [11]. Although it is known that HIT and HITT have been associated with a negative impact on patient outcomes, the attributable healthcare costs associated with this adverse drug reaction have not been extensively studied. The objective of this study was to evaluate thehealth care costs and length of hospital stay (LOS) involved with HIT and identifies the main cost driver elements, based on a patient-oriented approach.

Mediterranean Journal of Hematology and Infectious Diseases, 2015

Background: The increasing trend of using low-molecular-weight-heparin (LMWH) versus unfractionat... more Background: The increasing trend of using low-molecular-weight-heparin (LMWH) versus unfractionated heparin (UFH) in hospitalized adult patients is raising concerns about the incidence of heparin-induced thrombocytopenia (HIT). Method: A retrospective study analyzed the requests for heparin-induced antibodies by enzyme-linked immunosorbent assay (ELISA) among adult hospitalized patients during the period from January 2011 to December 2013. These patients received either UFH or LMWH for prevention or therapeutic indications. Those with positive immune-mediated HIT were identified and considered as case patients. Result: The usage of LMWH and UFH and development of HIT was determined during the study period. The incidence of HIT in patients receiving UFH and those receiving LMWH was 4.09 per thousand patients and 0.48 per thousand patients, respectively, (p<0.0001) with an overall incidence of 2.49 per thousand patients. Conclusion: The increased trend of using LMWH over UFH among ...

Journal of vascular nursing : official publication of the Society for Peripheral Vascular Nursing, 2015

Heparin-induced thrombocytopenia (HIT) is an immune response to heparin associated with significa... more Heparin-induced thrombocytopenia (HIT) is an immune response to heparin associated with significant morbidity and mortality in hospitalized patients if unidentified as soon as possible, owing to thromboembolic complications involving both arterial and venous systems. Early diagnoses based on a comprehensive interpretation of clinical and laboratory information improves clinical outcomes. Management principles of strongly suspected HIT should not be delayed for laboratory result confirmation. Treatment strategies have been introduced including new, safe, and effective agents. This review summarizes the clinical therapeutic options for HIT addressing the use of parenteral direct thrombin inhibitors and indirect factor Xa inhibitors as well as the potential non-vitamin K antagonist oral anticoagulants.

British Journal of Clinical Pharmacology, 2002

Aims Helicobacter pylori (H. pylori) eradication rate varies according to the treatment regimen u... more Aims Helicobacter pylori (H. pylori) eradication rate varies according to the treatment regimen used and other factors, e.g. antimicrobial resistance and patient compliance. The aim of the present study was to evaluate the in¯uence of patient counselling and follow-up on H. pylori eradication rates and to document the effectiveness of a 1 week eradication regimen consisting of lansoprazole (30 mg once daily), amoxicillin (1 g twice daily) and clarithromycin (500 mg twice daily). Methods Seventy-six dyspeptic patients, who at endoscopy were found to have gastritis, duodenitis or ulceration, and a positive H. pylori urease test, were recruited. Patients were randomly assigned to an intervention group (n=38) or a control group (n=38). Intervention patients received their medicines via the hospital pharmacy and were counselled (and followed up) by a hospital pharmacist. Control patients were given a standard advice sheet and referred to their GP who prescribed the same therapy. Results Intervention patients exhibited a statistically signi®cant improvement in the H. pylori eradication rate (94.7% vs 73.7%; P=0.02) and compliance (92.1% vs 23.7; P<0.001). Of the 64 H. pylori eradicated patients, 62 were able to eliminate their antisecretory medication compared with only 12 of the H. pylori persistent patients (P<0.001). A pharmacoeconomic evaluation indicated that counselling and follow-up reduced the direct costs of eradication by approximately £30 per patient. Conclusions Structured patient counselling and follow-up can have a signi®cant effect on H. pylori eradication rates and should be a routine part of therapy.

Expert Review of Anti-infective Therapy, 2020

Background: Carbapenem-resistant Enterobacteriaceae (CRE) infection is associated with intensive ... more Background: Carbapenem-resistant Enterobacteriaceae (CRE) infection is associated with intensive care admissions, morbidity and mortality. Our study aimed to determine the incidence, risk factors and patient outcomes of CRE in the ICU units. Methods: This was a retrospective matched case-control study of patients admitted to ICUs. Patients who have positive cultures of CRE and carbapenem-susceptible Enterobacteriaceae (CSE) were included in the study. Patients were randomly selected from a pool of CSE subjects in a ratio of 1:1 of CRE to CSE as control patients. Results: The infection rate with CRE among all patients admitted to ICUs was 7.6% and the incidence of CRE infection was 5.6 per 1,000 person-day. The risk factors independently associated with CRE infection were: Higher Sequential Organ Failure Assessment (SOFA) and Nutrition Risk in Critically ill (NUTRIC) scores, prolonged ICU length of stay (LOS), previous surgery, dialysis and mechanical ventilation during ICU stay, previous use of aminoglycoside and carbapenems. Conclusion: In this retrospective study the incidence of CRE infection was relatively elevated in patients admitted to ICU. Patients with high SOFA and NUTRIC scores, prolonged ICU LOS, previous surgery, dialysis and mechanical ventilation, prior aminoglycosides and carbapenems use, may have an increased risk of CRE infection.