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Aim: The aim of the work is to analyze the results of carotid stenting in our group of patients routinely tested for the effectiveness of dual antiplatelet therapy. We compare the results with data from randomized controlled trials. Methods: Retrospective analysis of results of carotid stenting performed at the Radiology in the Masaryk Hospital in Ústí nad Labem from 2014 to 2022. 241 patients who were not suitable for surgical treatment underwent carotid stenting. The set of consecutive patients is specific for the setting of effective antiplatelet therapy in the preprocedural period. The monitored period is within 30 days after the intervention. Results: We treated 179 men (74.2%) and 62 women (25.8%). Five patients (2%) suffered a periprocedural stroke (CMP) during the monitored period, two (0.8%) died from a complication directly related to the procedure. Three patients died of a cause unrelated to the intervention (1.2%). We did not encounter a myocardial infarction. The risk of periprocedural death or stroke in the entire cohort was significantly lower compared to the results of the CREST study (2.0% vs. 4.8%, p = 0.0243). In the group of symptomatic patients, periprocedural death or stroke was significantly lower compared to the ICSS study (2.9% vs. 7.4%, p = 0.0243). Conclusion: In our group of patients, who were unsuitable for surgical treatment of carotid stenosis, we evaluated the effectiveness of antiplatelet therapy in carotid stenting. The risk of periprocedural death or CMP was statistically significantly lower than in the CREST or the ICSS study. The results demonstrate that routine testing of antiplatelet therapy is safe and may reduce the risk of stroke and periprocedural death. [ABSTRACT FROM AUTHOR]

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Objective: To assess the limitations of intended change from one type of high sensitivity (hs) cardiac troponin (cTn) to another (hs-cTnT and hs-cTnI) in a real clinical setting. Design: An observation study. Settings: Acute emergency unit, Cardiology department, Institute for clinical and experimental medicine (IKEM), Praha. Material and Methods: Parallel testing of hs-cTnT (Cobas, Roche) and hs-cTnI (Architect, Abbott) in 567 consecutive patients of cardiology emergency. Method comparison (Passing-Bablok), calculation of time interval between sampling, assessment of delta concentration between two consecutive concentrations of hs-cTn, and comparison of classification. The time intervals between two consecutive samples were sorted into tertiles, and delta concentration was evaluated for the time interval up to 6 hours. A classification of the agreement for rule-in and rule-out diagnostics was evaluated according to the ESC Guidelines 2020 (kappa statistics). Results: There were 821 pairs of hs-cTnT and hs-cTnI results. Passing-Bablok test revealed a slope of 3.07 (95% CI 2.77-3.40), an intercept of -30.1 (95% CI -3.9 to -25.0), the equation was hs-cTnI = -30.4 + 3.07 * hs-cTnT, r= 0.934, p<0.001. The delta concentrations in the 1st tertile (42-65 min), 2nd tertile (66-112 min), and 3rd tertile (115-359 min) were (median and IQR) 3.3 (1.5-5.7); 2.6 (1.3-4.5); 48.5 (3.7-172.7) ng/L for hs-cTnT and 1.4 (0.4-2.9); 1.6 (0.6-9.5); 57.8 (5.5-755.9) ng/L for hs-cTnI. The classification agreement between hs-cTnT and hs-cTnI (ESC 1hour algorithm) was 63 % (kappa 0.425) and 77 % (kappa 0.716) for ESC 2-hour algorithm). The comparison of rule-in and rule-out classification revealed up- and down classification both for hs-cTnT and hs-cTnI. Conclusion: A relationship between hs-cTnT and hs-cTnI exists, however, recalculation is impossible. A study revealed a low adherence to the recommended diagnostic algorithms with very high variability in the time intervals between sampling. The delta concentration of hs-cTnT is lower than the delta concentration of hs-cTnI for a shorter interval between samples, and vice versa, the delta concentration of hs-cTnI is higher with the longer time interval between samples. The classification agreement between hs-cTnT and hs-cTnI was moderate for the ESC 1-hour algorithm and suitable for the ESC 2hour algorithm. Switching from one type of high-sensitivity cardiac troponin to another is not trivial, and real data analysis, clinical assessment, and communication with clinicians is required. [ABSTRACT FROM AUTHOR]

Galectin-3 is mainly used in cardiology as a prognostic marker. Its pathophysiological effects correlate with the risk of cardiac fibrosis and remodelation. Elevated concentrations of galectin-3 in plasma (above the decision limit of 18 µg/L) increase the risk of cardiovascular morbidity and overall mortality, especially in patients with heart failure, myocardial infarction, heart transplantation and other cardiac diseases. The predictive value of galectin-3 increases when combined with natriuretic peptides. In cardiology, galectin-3 is recognized as a candidate molecule for prognostication. [ABSTRACT FROM AUTHOR]

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Copyright of Medicina Pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Increased neurohumoral activation of the renin-angiotensin-aldosterone system and sympathoadrenal activation at both systemic and tissue levels are the main pathophysiological mechanisms of the development and progression of a number of cardiovascular diseases: arterial hypertension, coronary artery disease, and chronic heart failure. Pharmacological intervention at the level of key enzyme inhibition and selective blockade of relevant receptors is associated with a reduced risk of cardiovascular and cerebrovascular events. Inhibition of both systems is a logical step. The combination of an angiotensin-converting enzyme (ACE) inhibitor and a beta blocker is effective in patients with coronary artery disease. To increase patient adherence to treatment, the use of fixed-dose drug combinations is an appropriate choice. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (covid-19) is an infectious disease caused by a novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The mortality increases in patients older than 60 years. Younger patients with underlying serious chronic diseases are endangered by a fatal course of this infection as well. Cardiovascular manifestations of SARS-CoV-2 infection are diverse and include acute coronary syndromes, myocarditis, heart failure, arrhythmias, pericardial effusion, and thromboembolic complications. Direct and indirect myocardial injury is common in moderate and severe disease course. Troponin elevation is a marker of worse prognosis. [ABSTRACT FROM AUTHOR]

Stroke and ischemic heart diseases are some of the most common causes of death in the world. The HOBIT project was created to increase awareness of these diseases and increase the number of people who are able to recognize them and respond correctly. The project is aimed mainly at pupils in primary schools and multi-year grammar schools, but the general public can also join in. The project is targeted at easily recognizing the symptoms, providing first aid, and quickly calling an ambulance. Everyone can save a life. [ABSTRACT FROM AUTHOR]

The administration of proton pump inhibitors (PPIs) along with antithrombotic therapy indicated to reduce gastrointestinal bleeding is common practice. Evidence of reduced bleeding risk with this strategy is only available at the level of observational studies, with a reduction by approximately one-third being significant. However, with a relatively low rate of gastrointestinal bleeding, the absolute risk reduction is small, somewhere near 0.3 %. The observed value of NNT (number needed to treat) is around 250, i.e. for every 250 patients treated with PPIs, one bleeding episode (typically not a critical one) is prevented. On the other hand, there has been an increasing number of papers reporting a higher rate of cardiovascular events, renal failure, and neural involvement in the case of treatment with PPIs. In the population with a high cardiovascular risk, i.e. a typical population in which PPIs are added to antithrombotic therapy, the risk is significant. The value of NNH (number needed to harm) is around 50. There may be multiple reasons for increased cardiovascular morbidity and mortality, ranging from gastroesophageal involvement itself to comprehensive action of PPIs on numerous transporters or enzymes to negative action of PPIs related to drug-drug interactions. [ABSTRACT FROM AUTHOR]

The article summarizes new advances in cardiology published in 2022, which have an impact to everyday practice of not only internists and cardiologists. The administration of polypill to patients after myocardial infarction (SECURE study), early pharmacotherapy of hypertension in pregnant women with blood pressure exceeding 140/90 mmHg (CHAP study), or the administration of dapagliflozin to patients with heart failure with preserved or mildly reduced ejection fraction (DELIVER study) have been shown to be effective. Patients with heart failure do not have to limit their sodium intake (SODIUM-HF study), on the contrary, they benefit from up-titration of guideline-recommended drugs to the maximum tolerated doses as quickly as possible (STRONG-HF study). For antihypertensives, it does not matter whether they are taken in the morning or in the evening (TIME study), nor has there been found any difference in the incidence of cardiovascular events with hydrochlorothiazide and chlortalidone (DCP study). In patients with increased cardiovascular risk, highly sensitive troponin should be measured before non-cardiac surgery as well as 24 and 48 hours after surgery to detect perioperative myocardial infarction. Different blood pressure and oxygenation targets in patients after resuscitation for out-of-hospital cardiac arrest do not affect the outcomes of their treatment.

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Uptitration of ACE-inhibitors (ACEI) and beta-blockers (BB) in secondary prevention (patents after myocardial infarction, MI) is sometimes quite difficult to manage especially for prolonged therapy. This article presents the strategy for the optimisaton of pharmacotherapy with use of fixed combination of betablocker (bisoprolol fumarat) and ACE inhibitor (perindopril arginin). In this case, hypotension limited uptitration of ACEI and BB, with participation of poor treatment tolerance and also subsequent non-adherence. ACEI and BB are routinely initiated after MI, however, uptitration to target /maximally tolerated doses is another matter, and usually in clinical practice not so easily achieved. [ABSTRACT FROM AUTHOR]

The 2018 ESC/EACTS Guidelines on myocardial revascularization are the guidelines' third version, having 70 pages of text and a total of 786 citations. Along with the main document, Supplementary data are available with another 19 pages of text and 122 citations. The article deals with the guidelines published, briefly summarizing the main principles in the indications of myocardial revascularization in patients with both acute and chronic forms of CAD and in specific patient subgroups. [ABSTRACT FROM AUTHOR]

Arrhythmias are the most frequent complication of myocardial infarction. This review summarizes the up-to-date management of the most common arrhythmias in acute and post-myocardial infarction patients. [ABSTRACT FROM AUTHOR]

A case of post-traumatic coronary injury presenting with coronary occlusion and myocardial infarction is described. A 50-years-old man sustained a blunt chest trauma a three years ago. Myocardial infarction was not recognised, because chest pain was attributed to (and masked by) rib injury. Coronary angiography was indicated based on an incidental abnormal ECG finding during a preventive examination [ABSTRACT FROM AUTHOR]

Elevated LDL cholesterol (LDL-C) concentration is an independent risk factor for cardiovascular morbidity and mortality aimed at by numerous therapeutic interventions. However, despite maximum possible treatment with statins, a wide range of patients fail to reach satisfactory control. It is these patients who can now be offered modern treatment with proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors. The FOURIER trial involved 27,564 patients with established cardiovascular disease treated with a maximum tolerated statin dose who were randomized to receive evalocumab or placebo. The reduction in LDL cholesterol levels with evalocumab was 59 %, from a median of 90 mg/dL to 30 mg/dL, i.e. approximately 0.8 mmol/L. The primary end point (myocardial infarction, stroke, hospitalization for angina pectoris, revascularization and/or death) was reduced from 14.6 % to 12.6 % (p < 0.0001), and the key secondary end point (death, myocardial infarction, and stroke) from 9.9 % to 7.9 % (p < 0.0001). There was no effect on all-cause mortality (2.5 % vs. 2.4 %); there was a significant reduction in myocardial infarction rate (4.4 % vs 6.3 %) and stroke rate (2.2 % vs. 2.6 %). It made no difference whether patients received one dose in 2 weeks or one in 4 weeks. No significant differences between adverse effects were reported. The Ebbinghaus substudy showed no negative effect on neurocognitive function. [ABSTRACT FROM AUTHOR]

Primary percutaneous coronary intervention (PCI) is currently a widely preferred reperfusion strategy for myocardial infarction therapy due to superior results compared to thrombolytic therapy. However, the presence of massive intracoronary thrombus in patients with myocardial infarction is often associated with adverse procedural results, including failure of aspiration and failure of reperfusion. Administration of a low dose of intracoronary thrombolysis in patients with myocardial infarction with ST elevations and massive thrombus after insufficient PCI and thrombectomy resulted in decreased thrombotic burden, improvement of epicardial flow and perfusion. [ABSTRACT FROM AUTHOR]

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Introduction: A patient with suspected non-ST elevation myocardial infarction is indicated for early coronary angiography. In the case of an unclear finding or “hazy” lesion it is advisable to supplement the examination with optical coherence tomography (OCT) or intravascular ultrasound (IVUS) to confirm the diagnosis and to consider the indication of revascularization. After myocardial infarction, long-term pharmacotherapy includes angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, dual antiplatelet therapy and statins. Case presentation: A 58-year-old male smoker with typical stenocardial pain with suspected acute myocardial infarction without ST elevation (NSTEMI) and slightly positive troponin presented, after treatment in a peripheral hospital, to the CathLab of the First. Department of Internal Medicine - Cardioangiology where coronary angiography was performed. Coronary arteries were without stenoses, but with an unclear "hazy" lesion on the proximal left anterior descending artery (LAD). Using optical coherence tomography, an unstable plaque was detected and subsequently treated with percutaneous coronary intervention (PCI) with a drug-eluting stent implantation. The definitive diagnosis was anterior NSTEMI. Standard pharmacotherapy was used, i.e. angiotensin- converting enzyme inhibitor, beta-blocker, dual antiplatelet therapy with acetylsalicylic acid and ticagrelor, and statin. Conclusion: In case of unclear "hazy" coronary artery lesions, optical coherence tomography or intravascular ultrasound can determine their significance and, if necessary, may also guide the treatment of an unstable plaque. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases are the most common cause of the mortality in developed countries. The coronary artery disease is on the first place as a cause of a death what represent seven million people every year and 12.8 % from all deaths in the world. Every sixth man and every seventh woman die of myocardial infarction (MI). Diabetes mellitus (DM) belongs to the most common chronic diseases and cardiovascular diseases occur with this diagnose 4-8 times more often. The acute complications of DM are caused by sudden metabolic decompensation, which can directly threaten the life of the patient. We present a case report of 20 years old woman with juvenile DM and a progression to severe ketoacidosis during the application of insulin with insulin pump. This acute metabolic complication led to an acute myocardial infarction (AMI) with the elevation of ST segment (STEMI). Urgent coronary angiografy was performed and single vessel involvement wth LAD TIMI flow 0 was found. LAD was filled by thrombotic material. Primary coronary intervention was performed with thrombi removal by thrombectomy catheter, nevertheless the flow in LAD was not restored in midportion and distal vessel with TIMI flow 1 only. [ABSTRACT FROM AUTHOR]

Betablockers have been extensively used for more than 30 years as “routine” therapy in secondary prevention of myocardial infarction. On the hand, the relative oldness of evidence leads to weakening of heretofore “strong position” of betablockers in the last years and its role in secondary prevention (at least as general procedure) are currently downgraded. We summarize on which subgroups of patients after myocardial infarction betablockers promised the most presumable benefit. [ABSTRACT FROM AUTHOR]

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Copyright of Remedia is the property of Medical Tribune CZ, s.r.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Treatment with beta blockers has for several decades been the mainstay of secondary prevention after a recent myocardial infarction. Studies that showed a favourable prognostic effect of beta blockers were carried out in a period prior to the routine use of reperfusion treatment. In patients treated with fibrinolytic therapy, the benefit is less pronounced. Even less clear is the situation in patients who are treated with primary percutaneous coronary intervention, since previous prospective studies as well as observational data from registries have so far failed to provide an unequivocal opinion as to the indications and clinical benefit of beta blockers. [ABSTRACT FROM AUTHOR]

Aim: To assess an association between sonographic characteristic of carotid plaque instability and increased serum level of lipoprotein- associated phospholipase A2 (Lp- PLA2, marker of atherosclerotic plaque inflammation), in consideration of the fact that carotid plaque and Lp-PLA2 are reckoned to be the cardiovascular risk markers. Methods: We performed the examination of 90 persons totally, 44 men (48.9%) and 46 women (51.4%). The participants were randomly selected from 4 groups: 1. control group of healthy persons (n = 6),men account for 67%, 2. patients with arterial hypertension (n = 17), men account for 47%, 3. patients with ischemic heart disease (n = 34), men account for 29% and 4. patients with ischemic stroke (n = 36), men account for 56%.We examined carotid bifurcation and internal carotid artery bulb sonographically by device Mylab 60 (Esaote, Bologna, Italy) and assessed 3 categorical variables: plaque surface and echogenicity and degree of stenosis. We examined the plasma level of Lp-PLA2 by ELISA method (Diadexus, Inc., San Francisco, USA). All examined participants were divided into 2 groups subsequently: 1. individuals with normal plasma level of Lp-PLA2 (< 235 ng/ml) and 2. individuals with elevated plasma level of Lp-PLA2 (> 235 ng/ml). We used x2-test for independence to compare plaque echogenicity and surfice and degree of stenosis between group with normal and eleveted level of Lp-PLA2. L. Cervova, M.Sc. from ACREA CR Ltd. performed statistical analysis using IBM SPSS Statistics 23. Results: There were no significant differences between group with normal and elevated Lp-PLA2 for plaque surface (p = 0.058) and echogenicity (p = 0.285) and degree of stenosis (p = 0.783) at confidence level of 0.05 in our cohort. Conclusion: Our study did not ascertain the association of elevated level of Lp-PLA2 with sonographic characteristic of carotid plaque instability. [ABSTRACT FROM AUTHOR]

Echocardiography is a non-invasive diagnostic technique that provides information regarding heart function and haemodynamics. It is essential both for diagnosing the acute coronary syndrome, evaluation of the ventricular function and the presence of regional wall motion abnormalities, and for ruling out other etiologies of acute chest pain or dyspnoea. It also provides timely and accurate diagnosis in the haemodynamically unstable patients presenting with myocardial infarction complications including cardiac tamponade, severe mitral regurgitation or ventricular septal defect. This review focuses on the current role of echocardiography in patients with the acute coronary syndrome and its complications. [ABSTRACT FROM AUTHOR]

The objective of the research was to determine the relation of vertigo to selected grave disease in senior subjects such as cerebral vascular events (CVE), myocardial infarction (MI) and diabetes mellitus (DM). The data were collected from 2011 to 2014 in otolaryngology outpatients of the Karviná district. The examination of each patient consisted of anamnesis and basic data necessary for their further processing. The anamnesis data were obtained from questionnaires. The observed cohort included 10,992 persons. The data were processed by the methodology of American Geriatric Society (AGS) and World Health Organization (WHO). For the sake of comparison, the respondents were divided according to WHO and AGS. The results were fed into the program EpiData 3.1 and subsequently transferred into the Microsoft Excel program. The method of descriptive and induction statistics were employed. The level of significance was set at 5%. The dependence of two category quantities was calculated by the Pearson correlation. The data are presented in tables and figures. In the senior persons evaluated according to WHO and AGS, the statistical dependence of vertigo was demonstrated with cerebral vascular events, myocardial infarction and diabetes mellitus. The highest dependence was in cerebral vascular events, lower in myocardial infarction and lowest in diabetes mellitus. The statistical significance increased when the diseases were combined. The highest significance was observed in the combination of CMP and MI, lower in combination of CVE and DM. When all the three diseases occurred at simultaneously, the probably of vertigo was at the highest. [ABSTRACT FROM AUTHOR]

Perioperative myocardial ischaemia and myocardial infarction have become a growing problem bringing an increase in mortality, hospital length of stay and financial costs. The incidence is higher postoperatively than in the immediate preoperative and perioperative period. There are two distinct patho-physiological mechanisms which may lead to perioperative myocardial infarction: myocardial injury related to the rupture, fissuring, erosion or dissection of an atherosclerotic plaque (myocardial infarction type 1) and prolonged imbalance in myocardial oxygen supply and demand (myocardial infarction type 2). The review article discusses the diagnostics (ECG, cardiac biomarkers, intraoperative ECHO), prevention (the question of preoperative myocardial revascularization) and management according to guidelines reflecting Evidence Based Medicine. [ABSTRACT FROM AUTHOR]

The case study describes a young man diagnosed with acute myocardial infarction, without a history of significant cardiovascular risk factors -- apart from smoking. Based on the changes in the blood picture, thrombocytosis was determined as the cause of the myocardial infarction, which was subsequently diagnosed as essential thrombocythemia. Essential thrombocythemia is a rare disease more frequently occurring in the elderly population. An incidence at younger age is rare, but it is vital not to forget about this diagnosis. The aim of this case report is to draw attention to the risk of thrombotic complications in essential thrombocythemia. In order to prevent these often fatal complications, it is important to make an early diagnosis, determine the risk of complications and carry out a follow-up treatment or monitoring of the development of this disease. Generally, the main cause of myocardial infarction is atherosclerosis; however, in younger patients it is also necessary to think of less common risk factors such as essential thrombocythemia. [ABSTRACT FROM AUTHOR]

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Myocardial free wall rupture is a rare, but serious complication of acute myocardial infarction with high mortality. We present a case of a 64-year-old patient with this devastating complication of an anterior ST segment elevation myocardial infarction (STEMI) with a prolonged time delay. Cardiac surgery was not performed due to prohibitive surgical risk and predicted poor prognosis. We describe our successful therapeutic intervention consisting of immediate pericardial drainage, vasoactive and inotropic support, intraaortic balloon pump placement and continuous veno-venous hemodialysis. This combined therapy led to patient stabilization and after incremental clinical improvement the patient was able to return to a normal life. After several months a long-term mechanical circulatory support was implanted as a bridge to heart transplant.

Treatment with beta-blockers has been an essential part of secondary prevention after myocardial infarction or chronic CHD for several decades. Studies that have shown a beneficial prognostically beneficial effect of beta-blockers were conducted in the period prior to the routine use of reperfusion therapy. In patients who have been treated with fibrinolytic therapy, their contribution is less pronounced. The situation is even less clear in patients who are treated with primary percutaneous coronary intervention, as prospective studies and observational data from registries do not yet give a clear view of the indications and clinical contribution of beta-blockers, especially in the group with normal ejection fraction, without signs of heart failure. Here are the latest different studies from the South Korean and Danish national registries in patients with CHD without heart failure and the effect of beta-blockers on the long-term prognosis.

The COLCOT trial evaluated the administration of colchicine versus placebo in patients after myocardial infarction. The trial was conducted based on a clinical hypothesis that inflammatory processes may play a role in the process of atherogenesis and its complications. The primary composite endpoint was: time to cardiovascular death, cardiac arrest, myocardial infarction, stroke, urgent hospitalization for angina pectoris leading to revascularization. A primary endpoint event occurred in 5.5 % of the patients in the colchicine group as compared with 7.1 % of those in the placebo group (p < 0.02). The overall mortality did not differ between the groups. Colchicine tolerance was comparable to that of the placebo, including the incidence of diarrhoea. [ABSTRACT FROM AUTHOR]

Acute papillary muscle rupture is one of the mechanical complications of acute myocardial infarction. If treated conservatively, mortality exceeds 90%. Rapid diagnosis and indication of a surgical procedure can dramatically improve the patients' prognosis. During the diagnostic process, transoesophageal echocardiography plays a major role as it reveals the mechanism of mitral valve regurgitation. We present a case report of a 66 year old man with papillary muscle rupture, where fast diagnosis and surgical treatment resulted in successful management of the disease. [ABSTRACT FROM AUTHOR]

We admitted a 42 year old woman with clinical signs of shock, coma, and ecg changes consistent with a ST elevation myocardial infarction to percutaneous coronary intervention. Normal coronary arteries were found. Due to the comatose state a cranial computed tomography scan was performed, where a subarachnoid hemorrhage was detected. We discuss the difficulty of diagnosing a subarachnoid hemorrhage, the pathophysiological cause of cardiac damage and ecg changes in acute neurological disease, and the differential diagnosis of ST elevation in the ecg. [ABSTRACT FROM AUTHOR]

A rise of troponins reflects irreversible myocardial cell necrosis. Accordingly, abnormal values have been described in various conditions not related to acute coronary disease, such as myocarditis, pulmonary embolism, acute heart failure, septic shock, as a result of cardiotoxic drugs and following therapeutic procedures such as electrophysiological ablations, or electrical cardioversion. This review focuses on the incidence and clinical significance of increased troponin in conditions with symptoms that resemble acute myocardial infarction. [ABSTRACT FROM AUTHOR]

Background: Tranexamic acid can reduce bleeding in patients undergoing elective surgery. We assessed the effects of early administration of a short course of tranexamic acid on death, vascular occlusive events, and the receipt of blood transfusion in trauma patients. Methods: This randomised controlled trial was undertaken in 274 hospitals in 40 countries. 20,211 adult trauma patients with, or at risk of, significant bleeding were randomly assigned within 8 h of injury to either tranexamic acid (loading dose 1 g over 10 min then infusion of 1 g over 8 h) or matching placebo. Randomisation was balanced by centre, with an allocation sequence based on a block size of eight, generated with a computer random number generator. Both participants and study staff (site investigators and trial coordinating centre staff) were blinded to treatment allocation. The primary outcome was death in hospital within 4 weeks of injury, and was described with the following categories: bleeding, vascular occlusion (myocardial infarction, stroke and pulmonary embolism), multiorgan failure, head injury, and other. All analyses were by intention to treat. This study is registered as ISRCTN86750102, Clinicaltrials.gov NCT00375258, and South African Clinical Trial Register DOH-27-0607-1919. Findings: Total 10,096 patients were allocated to tranexamic acid and 10,115 to placebo, of whom 10,060 and 10,067, respectively, were analysed. All-cause mortality was significantly reduced with tranexamic acid (1,463 [14.5%] in the tranexamic acid group vs 1,613 [16.0%] in the placebo group; relative risk 0.91, 95% CI 0.85-0.97; p = 0.0035). The risk of death due to bleeding was significantly reduced (489 [4.9%] vs 5.74 [5.7%]; relative risk 0.85, 95% CI 0.76-0.96; p = 0.0077). Interpretation: Tranexamic acid safely reduced the risk of death in bleeding trauma patients in this study. On the basis of these results, tranexamic acid should be considered for use in bleeding trauma patients. Funding: UK NIHR Health Technology Assessment programme, Pfizer, BUPA Foundation, and J P Moulton Charitable Foundation. [ABSTRACT FROM AUTHOR]