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Preview: pubmed: Thromb Haemost[jour]

pubmed: Thromb Haemost[jour]



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Long-term bleeding risk prediction in 'real world' patients with atrial fibrillation: Comparison of the HAS-BLED and ABC-Bleeding risk scores. The Murcia Atrial Fibrillation Project.
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Long-term bleeding risk prediction in 'real world' patients with atrial fibrillation: Comparison of the HAS-BLED and ABC-Bleeding risk scores. The Murcia Atrial Fibrillation Project.

Thromb Haemost. 2017 Aug 11;117(10):

Authors: Esteve-Pastor MA, Rivera-Caravaca JM, Roldan V, Vicente V, Valdés M, Marín F, Lip GYH

Abstract
Risk scores in patients with atrial fibrillation (AF) based on clinical factors alone generally have only modest predictive value for predicting high risk patients that sustain events. Biomarkers might be an attractive prognostic tool to improve bleeding risk prediction. The new ABC-Bleeding score performed better than HAS-BLED score in a clinical trial cohort but has not been externally validated. It was the aim of this study to compare the predictive performance of the ABC-Bleeding score compared to HAS-BLED score in an independent "real-world" anticoagulated AF patients with long-term follow-up. We enrolled 1,120 patients stable on vitamin K antagonist treatment. The HAS-BLED and ABC-Bleeding scores were quantified. Predictive values were compared by c-indexes, IDI, NRI, as well as decision curve analysis (DCA). Median HAS-BLED score was 2 (IQR 2-3) and median ABC-Bleeding was 16.5 (IQR 14.3-18.6). After 6.5 years of follow-up, 207 (2.84 %/year) patients had major bleeding events, of which 65 (0.89 %/year) had intracranial haemorrhage (ICH) and 85 (1.17 %/year) had gastrointestinal bleeding events (GIB). The c-index of HAS-BLED was significantly higher than ABC-Bleeding for major bleeding (0.583 vs 0.518; p=0.025), GIB (0.596 vs 0.519; p=0.017) and for the composite of ICH-GIB (0.593 vs 0.527; p=0.030). NRI showed a significant negative reclassification for major bleeding and for the composite of ICH-GIB with the ABC-Bleeding score compared to HAS-BLED. Using DCAs, the use of HAS-BLED score gave an approximate net benefit of 4 % over the ABC-Bleeding score. In conclusion, in the first "real-world" validation of the ABC-Bleeding score, HAS-BLED performed significantly better than the ABC-Bleeding score in predicting major bleeding, GIB and the composite of GIB and ICH.

PMID: 28799620 [PubMed - as supplied by publisher]




Paracelsus, poison, and colistin.
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Paracelsus, poison, and colistin.

Thromb Haemost. 2017 Aug 11;117(9):

Authors: Herwald H

PMID: 28799619 [PubMed - as supplied by publisher]




Colistin dampens fibrinolysis and endothelial activation during endotoxaemia. A randomised, double blind trial.
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Colistin dampens fibrinolysis and endothelial activation during endotoxaemia. A randomised, double blind trial.

Thromb Haemost. 2017 Aug 10;117(9):

Authors: Schoergenhofer C, Matzneller P, Mußbacher M, Schmid JA, Jilma-Stohlawetz P, Zeitlinger M, Jilma B

Abstract
Colistin electrostatically interacts with lipopolysaccharides (LPS). Pre-clinical studies demonstrated beneficial effects of colistin on LPS-induced coagulation and fibrinolysis. The objective of this trial was to investigate the effects of colistin during experimental endotoxaemia. In this randomised, double-blind, placebo-controlled, crossover trial 16 healthy volunteers received a 2 ng/kg LPS bolus after infusion of 2.5 million IU colistin or placebo. Plasma levels of F1+2 prothrombin fragments, thrombin-antithrombin complexes (TAT), von Willebrand factor antigen levels (vWF), E-selectin, plasmin-antiplasmin complexes (PAP), tissue-type plasminogen activator (t-PA) antigen and activity, plasminogen activator inhibitor-1 (PAI-1) were measured. Infusion of colistin significantly reduced peak concentrations of PAP complexes by 70 %, t-PA antigen levels by 63 % and t-PA activity by 48 %, while PAI-1 levels decreased numerically by 63 %. Two hours after the LPS bolus F1+2 levels and TAT complexes were slightly reduced in the colistin period, but peak concentrations were similar in both periods. Colistin blunted the LPS induced four-fold increase in soluble E-Selectin levels by ~50 % and the two-fold increase in vWF antigen levels by ~70 %. The LPS-scavenging actions of colistin significantly reduce endothelial activation and fibrinolytic response in the human endotoxaemia model, while the activation of the coagulation system remains largely unaffected.

PMID: 28796276 [PubMed - as supplied by publisher]




Immature platelets as a novel biomarker for adverse cardiovascular events in patients after non-cardiac surgery.
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Immature platelets as a novel biomarker for adverse cardiovascular events in patients after non-cardiac surgery.

Thromb Haemost. 2017 Aug 10;117(10):

Authors: Anetsberger A, Blobner M, Haller B, Schmid S, Umgelter K, Hager T, Langgartner C, Kochs EF, Laugwitz KL, Jungwirth B, Bernlochner I

Abstract
This study evaluates whether immature platelets (IPF) determined in the post anesthesia care unit (PACU) can predict major adverse cardiovascular events (MACE) or other thromboembolic events after intermediate and high-risk surgery. IPF are increased in patients with acute coronary syndrome and recently gained interest as novel biomarker for risk stratification. In this prospective observational trial 732 patients undergoing intermediate or high-risk non-cardiac surgery were enrolled (NCT02097602). IPF was measured preoperatively and postoperatively in the PACU. Primary outcome was a composite endpoint defined as MACE, deep vein thrombosis or pulmonary embolism during hospital stay (modMACE). A cut off for IPF identifying a threshold between a low and high risk for modMACE was calculated by log-rank optimization. A multivariate Cox regression was calculated in a forward stepwise manner to assess the relation between this IPF cut off and modMACE as well as other established risk factors (inclusion if p<0.05). Preoperatively, there were no differences in IPF between patients with and without modMACE (3.1 % [2.2 % - 4.7 %](median [interquartile range]) vs. 2.8 % [1.9 % - 4.3 %]. Patients with modMACE (28 of 730 patients; 3.8 %) had higher IPF values in the PACU compared to patients without modMACE (3.6 % [2.6-6 %] vs. 2.9 % [2-4.4 %]; p=0.011). The optimal cut off of IPF > 5.4 % was associated with an increased risk for modMACE after adjustment for covariates (hazard ratio: 2.528; 95 % confidence interval: 1.156 to 5.528, p=0.02). In conclusion, IPF is an independent predictor of modMACE after surgery and might improve risk stratification of surgical patients.

PMID: 28796275 [PubMed - as supplied by publisher]




Endothelial cell-specific overexpression of developmental endothelial locus-1 does not influence atherosclerosis development in ApoE(-/-) mice.
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Endothelial cell-specific overexpression of developmental endothelial locus-1 does not influence atherosclerosis development in ApoE(-/-) mice.

Thromb Haemost. 2017 Aug 10;117(10):

Authors: Subramanian P, Prucnal M, Gercken B, Economopoulou M, Hajishengallis G, Chavakis T

PMID: 28796274 [PubMed - as supplied by publisher]




Role of replacement therapy in the evaluation of thrombosis occurring in congenital bleeding conditions.
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Role of replacement therapy in the evaluation of thrombosis occurring in congenital bleeding conditions.

Thromb Haemost. 2017 Aug 10;117(10):

Authors: Girolami A, Ferrari S, Cosi E, Girolami B

PMID: 28796273 [PubMed - as supplied by publisher]