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  • 1
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    Penetrating aortic ulcer: Clinical and angiographic characteristics
    Georg Thieme Verlag KG ; 2011
    In:  International Journal of Angiology Vol. 4, No. 03 ( 2011-04-22), p. 143-146
    Details
    In: International Journal of Angiology, Georg Thieme Verlag KG, Vol. 4, No. 03 ( 2011-04-22), p. 143-146
    Type of Medium: Online Resource
    ISSN: 1061-1711 , 1615-5939
    URL: Article
    DOI: 10.1007/BF02043008
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2011
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  • 2
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    Clopidogrel pretreatment in primary percutaneous coronary intervention: Prevalence of high on-treatment platelet reactivity and impact on preprocedural patency of the infarct-related artery
    Georg Thieme Verlag KG ; 2013
    In:  Thrombosis and Haemostasis Vol. 110, No. 07 ( 2013), p. 110-117
    Details
    In: Thrombosis and Haemostasis, Georg Thieme Verlag KG, Vol. 110, No. 07 ( 2013), p. 110-117
    Abstract: To date, there is limited data on levels of platelet inhibition achieved in patients with ST-elevation myocardial infarction (STEMI) who are loaded with clopidogrel and aspirin (ASA) prior to undergoing primary percutaneous coronary intervention (P-PCI). The aim of this investigation was to evaluate the percentage of STEMI patients with high on-treatment platelet reactivity (HPR) to clopidogrel at the time of initiating P-PCI and its association with the initial patency of the infarct-related artery (IRA). This prospective pharmacodynamic study included 50 STEMI patients, previously naïve to oral antiplatelet agents, who received 500-mg ASA and 600-mg clopidogrel loading doses prior to P-PCI. Platelet function assessment was performed at the beginning of the procedure using various assays, including VerifyNow™ system (primary endpoint), light transmission aggregometry and multiple electrode aggregometry. The percentage of patients with suboptimal response to clopidogrel and ASA assessed with the VerifyNow™ system was 88.0% and 28.6%, respectively. Similar results were obtained with the other assays used. A higher percentage of patients with initial patency of the IRA was observed among those patients without HPR compared with those with HPR to clopidogrel (66.7% vs 15.9%; p=0.013), while no differences were observed regarding postprocedural angiographic or electrocardiographic outcomes. In conclusion, this study shows that a high percentage of STEMI patients have inadequate levels of clopidogrel-induced and, to a lesser extent, aspirin-mediated platelet inhibition when starting a P-PCI procedure, and suggests that a poor response to clopidogrel might be associated with impaired initial TIMI flow in the IRA.
    Type of Medium: Online Resource
    ISSN: 0340-6245 , 2567-689X
    URL: Article
    DOI: 10.1160/TH13-01-0057
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2013
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  • 3
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    Prediction of Post-Discharge Bleeding in Elderly Patients with Acute Coronary Syndromes: Insights from the BleeMACS Registry
    Georg Thieme Verlag KG ; 2018
    In:  Thrombosis and Haemostasis Vol. 118, No. 05 ( 2018-05), p. 929-938
    Details
    In: Thrombosis and Haemostasis, Georg Thieme Verlag KG, Vol. 118, No. 05 ( 2018-05), p. 929-938
    Abstract: Background A poor ability of recommended risk scores for predicting in-hospital bleeding has been reported in elderly patients with acute coronary syndromes (ACS). No study assessed the prediction of post-discharge bleeding in the elderly. The new BleeMACS score (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome), was designed to predict post-discharge bleeding in ACS patients. We aimed to assess the predictive ability of the BleeMACS score in elderly patients. Methods We assessed the incidence and characteristics of severe bleeding after discharge in ACS patients aged ≥ 75 years. Bleeding was defined as any intracranial bleeding or bleeding leading to hospitalization and/or red blood transfusion, occurring within the first year after discharge. We assessed the predictive ability of the BleeMACS score according to age by Fine–Gray proportional hazards regression analysis, calculating receiver-operating characteristic (ROC) curves and the area under the ROC curves (AUC). Results The BleeMACS registry included 15,401 patients of whom 3,376/15,401 (21.9%) were aged ≥ 75 years. Elderly patients were more commonly treated with clopidogrel and less often treated with ticagrelor or prasugrel. Of 3,376 elderly patients, 190 (5.6%) experienced post-discharge bleeding. The incidence of bleeding was moderately higher in elderly patients (hazard ratio [HR], 2.31, 95% confidence interval [CI] , 1.92–2.77). The predictive ability of the BleeMACS score was moderately lower in elderly patients (AUC, 0.652 vs. 0.691, p = 0.001). Conclusion Elderly patients with ACS had a significantly higher incidence of post-discharge bleeding. Despite a lower predictive ability in older patients, the BleeMACS score exhibited an acceptable performance in these patients.
    Type of Medium: Online Resource
    ISSN: 0340-6245 , 2567-689X
    URL: Article
    DOI: 10.1055/s-0038-1635259
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2018
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  • 4
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    Efficacy and Safety of Glycoprotein IIb/IIIa Inhibitors on Top of Ticagrelor in STEMI: A Subanalysis of the ATLANTIC Trial
    Georg Thieme Verlag KG ; 2020
    In:  Thrombosis and Haemostasis Vol. 120, No. 01 ( 2020-01), p. 065-074
    Details
    In: Thrombosis and Haemostasis, Georg Thieme Verlag KG, Vol. 120, No. 01 ( 2020-01), p. 065-074
    Abstract: Background Glycoprotein IIb/IIIa inhibitors (GPIs) in combination with clopidogrel improve clinical outcome in ST-elevation myocardial infarction (STEMI); however, finding a balance that minimizes both thrombotic and bleeding risk remains fundamental. The efficacy and safety of GPI in addition to ticagrelor, a more potent P2Y12-inhibitor, have not been fully investigated. Methods 1,630 STEMI patients who underwent primary percutaneous coronary intervention (PCI) were analyzed in this subanalysis of the ATLANTIC trial. Patients were divided in three groups: no GPI, GPI administration routinely before primary PCI, and GPI administration in bailout situations. The primary efficacy outcome was a composite of death, myocardial infarction, urgent target revascularization, and definite stent thrombosis at 30 days. The safety outcome was non-coronary artery bypass graft (CABG)-related PLATO major bleeding at 30 days. Results Compared with no GPI (n = 930), routine GPI (n = 525) or bailout GPI (n = 175) was not associated with an improved primary efficacy outcome (4.2% no GPI vs. 4.0% routine GPI vs. 6.9% bailout GPI; p = 0.58). After multivariate analysis, the use of GPI in bailout situations was associated with a higher incidence of non-CABG-related bleeding compared with no GPI (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.32–6.64; p = 0.03). However, routine GPI use compared with no GPI was not associated with a significant increase in bleeding (OR 1.78, 95% CI 0.88–3.61; p = 0.92). Conclusion Use of GPIs in addition to ticagrelor in STEMI patients was not associated with an improvement in 30-day ischemic outcome. A significant increase in 30-day non-CABG-related PLATO major bleeding was seen in patients who received GPIs in a bailout situation.
    Type of Medium: Online Resource
    ISSN: 0340-6245 , 2567-689X
    URL: Article
    DOI: 10.1055/s-0039-1700546
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2020
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  • 5
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    Global Geriatric Assessment and In-Hospital Bleeding Risk in Elderly Patients with Acute Coronary Syndromes: Insights from the LONGEVO-SCA Registry
    Georg Thieme Verlag KG ; 2018
    In:  Thrombosis and Haemostasis Vol. 118, No. 03 ( 2018-03), p. 581-590
    Details
    In: Thrombosis and Haemostasis, Georg Thieme Verlag KG, Vol. 118, No. 03 ( 2018-03), p. 581-590
    Abstract: Background Bleeding risk scores have shown a limited predictive ability in elderly patients with acute coronary syndromes (ACS). No study explored the role of a comprehensive geriatric assessment to predict in-hospital bleeding in this clinical setting. Methods The prospective multicentre LONGEVO-SCA registry included 532 unselected patients with non-ST segment elevation ACS (NSTEACS) aged 80 years or older. Comorbidity (Charlson index), frailty (FRAIL scale), disability (Barthel index and Lawton–Brody index), cognitive status (Pfeiffer test) and nutritional risk (mini nutritional assessment-short form test) were assessed during hospitalization. CRUSADE score was prospectively calculated for each patient. In-hospital major bleeding was defined by the CRUSADE classification. The association between geriatric syndromes and in-hospital major bleeding was assessed by logistic regression method and the area under the receiver operating characteristic curves (AUC). Results Mean age was 84.3 years (SD 4.1), 61.7% male. Most patients had increased troponin levels (84%). Mean CRUSADE bleeding score was 41 (SD 13). A total of 416 patients (78%) underwent an invasive strategy, and major bleeding was observed in 37 cases (7%). The ability of the CRUSADE score for predicting major bleeding was modest (AUC 0.64). From all aging-related variables, only comorbidity (Charlson index) was independently associated with major bleeding (per point, odds ratio: 1.23, p = 0.021). The addition of comorbidity to CRUSADE score slightly improved the ability for predicting major bleeding (AUC: 0.68). Conclusion Comorbidity was associated with major bleeding in very elderly patients with NSTEACS. The contribution of frailty, disability or nutritional risk for predicting in-hospital major bleeding was marginal.
    Type of Medium: Online Resource
    ISSN: 0340-6245 , 2567-689X
    URL: Article
    DOI: 10.1055/s-0038-1623532
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2018
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  • 6
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    Validation of the SAMe-TT2R2 score in a nationwide population of nonvalvular atrial fibrillation patients on vitamin K antagonists
    Georg Thieme Verlag KG ; 2015
    In:  Thrombosis and Haemostasis Vol. 114, No. 10 ( 2015), p. 695-701
    Details
    In: Thrombosis and Haemostasis, Georg Thieme Verlag KG, Vol. 114, No. 10 ( 2015), p. 695-701
    Abstract: The SAMe-TT2R2 score has been proposed to identify patients with non valvular atrial fibrillation (AF) who maintain a high average time in therapeutic range (TTR) on vitamin K antagonists treatment (VKA). This score has been validated in several studies, either monocentric or including very selected populations in a specialised setting. Our objective was to validate this score in a nationwide cohort of AF patients. From November 2013 to March 2014 we included in this study the first 10 patients with AF on VKA consecutively seen in 120 outpatient cardiology clinics in Spain. The SAMe-TT2R2 score was calculated for each patient and TTR in the preceding six months was estimated by Rosendaal method. A total of 1,056 patients were recruited (mean age 73.6 ± 9.8 years, 42 % female). Mean value of TTR was 63.8 ± 25.9 % (median 66.8 %, interquartile range 45.6 %-85.4 %). We found a progressive decline in mean TTR from a score of 0 (67.5 % ± 24.6 %) to4 (52.7 ± 28.7 %, p 〈 0.01). The score was able to discriminate which patients had a good anticoagulation control (TTR65 %) with a C-statistic of 0.57 (95 %CI 0.53–0.60, p 〈 0.0005). A SAMe-TT2R2 score of 0–1 was associated with a good anticoagulation control with a sensitivity, specificity, positive and negative predictive values of 64 %, 48 %, 58 % and 54 %, respectively; and the odds ratio of having a TTR 〈 65 % if the score was2 was 1.64 (95 % confidence interval 1.33–1.95, p 〈 0.001). In conclusion, in this nationwide population with AF on VKA, the SAMe-TT2R2 score had a significant, although moderate, ability to identify patients with a good anticoagulation control.
    Type of Medium: Online Resource
    ISSN: 0340-6245 , 2567-689X
    URL: Article
    DOI: 10.1160/TH15-02-0169
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2015
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  • 7
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    Relation of Renal Dysfunction to Quality of Anticoagulation Control in Patients with Atrial Fibrillation: The FANTASIIA Registry
    Georg Thieme Verlag KG ; 2018
    In:  Thrombosis and Haemostasis Vol. 118, No. 02 ( 2018), p. 279-287
    Details
    In: Thrombosis and Haemostasis, Georg Thieme Verlag KG, Vol. 118, No. 02 ( 2018), p. 279-287
    Abstract: Background One-third of atrial fibrillation (AF) patients have chronic kidney disease (CKD), a condition that itself increases thromboembolic and major bleeding risks, especially in patients with severe CKD. Bleeding would be accentuated by suboptimal anticoagulation control with vitamin K antagonists (VKA). Purpose This article aimed to investigate the incidence of cardiovascular events, mortality and quality of anticoagulation in relation to CKD in a ‘real-world’ prospective cohort of AF patients included in the FANTASIIA registry. Methods We analysed consecutive AF patients who were prospectively recruited with a year of follow-up. The quality of anticoagulation was estimated by time in therapeutic range (TTR). The annual incidence of events was analysed. Results We studied 1,936 patients (male: 55.7%, mean: 73.8 ± 9.4 years): 445 (22.9%) had normal function, 698 (36.1%) had mild CKD, 713 (36.8%) had moderate CKD and 80 (4.2%) had severe CKD. Patients with estimated glomerular filtration rate (eGFR)  〈  30 mL/min/1.73 m2 (severe CKD) had lower TTR (53.3 ± 25.6% vs. 61.8 ± 25.1%, p = 0.007) and higher proportion of poor TTR (67.2 vs. 51.8%; p = 0.014) than patients with eGFR ≥30 mL/min/1.73 m2. Severe CKD was significantly associated with cardiovascular mortality (hazard ratio [HR]: 9.33; p = 0.002), major bleeding (HR: 2.94; p = 0.036) and major adverse cardiovascular events (MACE) (HR: 4.93; p = 0.004). Importantly, 375 patients (21.1%) showed a deteriorating eGFR of ≥10 mL/min during the follow-up, with significantly higher mortality and cardiovascular events. Conclusion In a prospective and real-world AF registry, approximately 67% of patients with severe CKD had poor anticoagulation control while taking VKA. The presence of severe CKD was an independent factor for cardiovascular mortality, MACE and major bleeding. Worsening eGFR of only ≥10 mL/min during follow-up was significantly associated with mortality and major bleeding.
    Type of Medium: Online Resource
    ISSN: 0340-6245 , 2567-689X
    URL: Article
    DOI: 10.1160/TH17-06-0416
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2018
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