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Background: Mortality after coronary artery bypass grafting (CABG) is primarily thromboembolic by nature. We investigated whether impaired fibrinolysis observed in cardiovascular diseases is associated with long‐term mortality following CABG. Methods: The study population comprised 292 consecutive patients (aged 64.6 ± 8.1 years) who underwent scheduled CABG. We measured plasma clot lysis time (CLT) preoperatively as a measure of fibrinolysis capacity. Cardiovascular and all‐cause deaths were recorded during a median follow‐up of 13.8 years. Result: CLT positively correlated with age (r =.56, p <.001), fibrinogen (r =.25, p =.002) and EuroSCORE I (r =.32, p <.001). The cardiovascular and overall mortality rates were 3.0 and 4.9 per 100 patient‐years (32.4% vs 52.8%) respectively. In patients who died from cardiovascular and all causes, CLT was prolonged compared with survivors (both p <.050). Multivariable Cox regression analysis adjusted for potential confounders showed that long‐term cardiovascular and all‐cause deaths were associated with CLT (HR per 10 min 1.206; 95% CI 1.037–1.402, p =.015 and HR 1.164; 96% CI 1.032–1.309, p =.012), low‐density lipoprotein cholesterol (HR per 1 mmol/L 1.556; 95% CI 1.205–2.010, p <.001 and HR 1.388; 96% CI 1.125–1.703, p =.002), C‐reactive protein (HR per 10 mg/L 1.171; 95% CI 1.046–1.312, p =.006 and HR 1.127; 95% CI 1.005–1.237, p =.022) and EuroSCORE I (HR 1.173; 95% CI 1.016–1.355, p =.030 and HR 1.183; 95% CI 1.059–1.317, p =.003 respectively). Type 2 diabetes was solely associated with overall mortality (HR 1.594; 96% CI 1.088–2.334, p =.017). Conclusions: In this study, we showed that reduced fibrin clot susceptibility to fibrinolysis is weekly associated with long‐term mortality in advanced CAD. [ABSTRACT FROM AUTHOR]

Background. Adequate thromboprophylaxis reduces the risk of venous thromboembolism (VTE) by half in hospitalized patients. A single scoring system is recommended to improve thromboprophylaxis. Objectives. We investigated the impact of implementing a computerized system to prevent VTE in inpatients with pulmonary diseases and identified predictors of the overuse and underuse of pharmacological thromboprophylaxis. Materials and methods. We compared the use of thromboprophylaxis with enoxaparin in all patients hospitalized for pulmonary disorders in a tertiary hospital in Kraków, Poland, in 2014 and 2017, before and after introducing a computerized thromboprophylaxis system. Using the Caprini risk assessment, the overuse and underuse of thromboprophylaxis were defined as the use in patients with <5 points and ≥5 points, respectively. Results. Both cohorts (n = 2007 in 2014 and n = 1570 in 2017) were similar with regard to age and sex. The most frequent causes of hospitalization were intestinal lung disease (39.0%) and lung cancer (20.4%) in 2017, and pneumonia (38.8%) and lung cancer (27.5%) in 2014. Although the use of thromboprophylaxis was comparable in both cohorts, it was used more frequently in high VTE risk patients in 2017 compared with 2014 (96.98% compared to 29.17%, respectively, p < 0.001), with a concomitant reduction in its overuse (2.26% compared to 6.26%, respectively, p < 0.001). In 2017, no predictors of thromboprophylaxis underuse were identified. The overuse was mainly predicted by the diagnosis of airway diseases (odds ratio (OR) = 0.16, 95% confidence interval (95% CI) = 0.02-1.17, p = 0.015). Conclusions. Our findings indicate the benefits of using a computerized system to manage pharmacological thromboprophylaxis in pulmonary inpatients. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. 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.)

Background: Post–pulmonary embolism (PE) syndrome occurs in up to 50% of PE patients. The pathophysiology of this syndrome is obscure. Objective: We investigated whether enhanced oxidative stress and prothrombotic state may be involved in post‐PE syndrome. Methods: We studied 101 normotensive noncancer PE patients (aged 56.5 ± 13.9 years) on admission, after 5‐7 days and after a 3‐month anticoagulation, mostly with rivaroxaban. A marker of oxidative stress, 8‐isoprostane, endogenous thrombin potential, fibrinolysis proteins, clot lysis time (CLT) and fibrin clot permeability (Ks), along with PE biomarkers, were determined. Results: Patients who developed the post‐PE syndrome (n = 31, 30.7%) had at baseline 77.6% higher N‐terminal brain natriuretic propeptide and 46.8% higher growth differentiation factor 15, along with 14.1% longer CLT associated with 34.4% higher plasminogen activator inhibitor‐1 as compared to subjects without post‐PE syndrome (all P <.05). After 5‐7 days, only hypofibrinolysis was noted in post‐PE syndrome patients. When measured at 3 months, prolonged CLT and reduced Ks were observed in post‐PE syndrome patients, accompanied by 23.8% higher growth differentiation factor 15 and 35.8% higher plasminogen activator inhibitor‐1 (all P <.05). 8‐isoprostane levels ≥108 pg/ml (odds ratio=4.36; 95% confidence interval 1.63‐12.27) and growth differentiation factor 15 ≥ 1529 pg/ml (odds ratio=3.89; 95% confidence interval 1.29‐12.16) measured at 3 months were associated with higher risk of developing post‐PE syndrome. Conclusions: Enhanced oxidative stress and prothrombotic fibrin clot properties could be involved in the pathogenesis of the post‐PE syndrome. Elevated growth differentiation factor 15 assessed at 3 months might be a new biomarker of this syndrome. [ABSTRACT FROM AUTHOR]

Introduction: Myxomatous mitral valve disease (MMVD) in dogs inevitably causes renal dysfunction. These interactions are known as the cardiorenal syndrome (CRS). The main aims of the study were to evaluate whether renal resistive index (RRI) may be useful as a non-invasive marker in subclinical stage of kidney injury in dogs with MMVD and to compare RRI with SDMA and Cyst C.Methods: Forty-four dogs were divided into two groups: control-15 healthy dogs and the heart group-29 dogs with MMVD (ACVIM class Cc). Study protocol included: anamnesis, clinical examination, electrocardiography, echocardiography, chest radiography, abdominal ultrasonography with measurements of the renal resistive index (RRI), urine, and blood analysis.Results: The RRI in the heart group was significantly higher 0.725 ± 0.035 versus control group 0.665 ± 0.028 (p < 0.00085). The RRI cut-off point in dogs with stable chronic heart failure (CHF) under 8 years is 0.775, in older 0.64. RRI was similar in MMVD dogs treated with ACE-I + furosemide and dogs treated ACE-I + torasemide + pimobendan + spironolactone. There was no correlation between RRI and SDMA or Cyst C.Conclusion: RRI is more sensitive than creatinine, SDMA and Cyst C to reveal kidney injury in MMVD dogs class Cc younger than 8 years. [ABSTRACT FROM AUTHOR]

Introduction: Prevention of peri- and postprocedural complications is still a challenge in carotid artery stenting (CAS). Aim: To assess immediate and long-term safety and effectiveness of CAS using the Roadsaver double-nitinol-layer-micromesh stent. Material and methods: Since 2014, 298 CAS procedures in 287 non-consecutive patients (203 men, mean age 70.5 ±8.6 years, 100% symptomatic/high risk lesions) have been performed using the Roadsaver stent and proximal (40%) or distal (60%) neuroprotection system. Clinical and neurological examinations as well as duplex ultrasound were completed before CAS, before discharge, at 1, 6 and 12 months, then annually. Results: All CAS procedures were successful. Carotid stenosis was reduced from 84.9 ±9.9% to 11.0 ±9.4% (p < 000.1). In hospital, 1 ipsilateral periprocedural major (0.3%) and 3 minor (1.34%) ischemic strokes occurred, 2 (0.7%) patients died due to a cerebral hemorrhage on day 9 and 21. Three (1.0%) additional ipsilateral minor strokes within 30 consecutive days occurred. Thus, 30-day complications were observed in 9 (3.0%) patients. Two minor strokes were associated with in-stent thrombosis (0.7%). The 4-year follow-up showed 82% overall survival (95% CI: 69-91%) with no significant difference between asymptomatic (77%) and symptomatic patients (97%; p = 0.076). The stroke-free survival was 89% (95% CI: 77-95%), 84% asymptomatic vs. 98% symptomatic (p = 0.187). Seven (2.3%) patients developed > 50% in-stent restenosis. Conclusions: Carotid artery stenting using the Roadsaver stent for symptomatic patients and high risk lesions showed to be safe and effective, with a low complication rate and acceptable in-stent restenosis risk in 4-year follow-up. [ABSTRACT FROM AUTHOR]

Background: With the emerging interest in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA), there is a need to define an even broader group of patients with the syndrome of myocardial ischemia with non-obstructive coronary arteries (INOCA). There are limited data on the clinical characteristics and prognoses of such patients who present with symptoms of acute coronary syndrome (ACS) and undergo urgent coronary angiography that reveals no significant lesions. The aim of this observational study was to compare patients with ACS INOCA and those with ACS with obstructive coronary artery disease (OCAD) both within unadjusted cohorts and with propensity score matched controls. Methods and results: This observational study was based on the data from the Polish National Registry of Invasive Cardiology Procedures. Of 9744 patients included, 7624 had OCAD and 2120 had ACS INOCA. In unadjusted cohorts, the overall survival and incidence of major adverse cardiovascular events (MACE: death, cardiac arrest, myocardial infarction, stroke, and heart failure hospitalization) until 36 months were higher in patients with ACS OCAD. Following propensity matching, higher win ratios of death (p = 0.02), additional revascularizations by percutaneous coronary intervention or coronary artery bypass graft surgery (p<0.001), and cardiac hospitalization (p<0.001) were observed in these patients. In contrast, the win ratios of myocardial infarction (p = 0.74), heart failure hospitalization (p = 0.86), and MACE (p = 0.07) were not significantly different between the groups. Conclusions: The prognosis of patients with ACS INOCA was more favorable than that of patients with ACS OCAD; however, the differences diminished after adjustments for the initial clinical profiles. An ACS incident should not be judged as trivial even when cardiac markers remain stable and no significant lesions are found on angiography. [ABSTRACT FROM AUTHOR]

Introduction: Constant technological progress in the field of carotid stenting translates into improved short- and long-term results of endovascular treatment. The introduction of a new generation, self-expanding, open-cell stent has provided a new treatment option in endovascular management of carotid stenosis. Aim: To evaluate 30-day and 1-year clinical outcomes of non-consecutive patients with high risk of carotid endarterectomy, who underwent 5F cylinder-tapered MER™ open-cell carotid stent implantation. Material and methods: It was a single-arm, prospective study conducted in four experienced catheterisation centres. The use of embolic protection devices was mandatory. The primary endpoint was stroke in 30-day follow-up. The secondary endpoints were 30-day and 1-year cumulative incidence of death, stroke and myocardial infarction, 1-year target vessel revascularisation, procedural success (residual stenosis < 30%), restenosis rate (%DS > 50%), and Serious Adverse Device Effect (SADE) rate in 1-year follow-up. Results: In total 100 patients were recruited for the study, with the majority being males (n = 61). The mean age was 68.3 ±8.2 years, and most of the patients were asymptomatic (n = 56). In 55 (55%) patients direct stenting was performed, with the use of proximal protection devices in 19 (19%) patients. Mean internal carotid artery/common carotid artery stenosis before and after stent implantation was 81.98 ±9.15% and 12.52 ±8.70%, respectively (p < 0.001). Procedural success was achieved in all cases. One ischaemic stroke was observed at 30 days (1%, primary endpoint). At 1-year follow-up two myocardial infarctions and three deaths occurred with no additional stroke. Conclusions: The OCEANUS study indicated the safety and efficacy of the MER™ stent during 30-day and 1-year follow-up in both symptomatic and asymptomatic patients. The majority of patients were event-free. However, larger cohort studies are needed to evaluate MER™ stents in detail. [ABSTRACT FROM AUTHOR]

Background. Monocyte subsets are involved in atherosclerotic vascular disease and its thromboembolic complications. Moreover, the role of monocytes has been suggested in the pathogenesis of venous thromboembolism (VTE). Objectives. We hypothesized that pro-inflammatory non-classical and intermediate monocytes are increased in the first months following VTE. Material and methods. We enrolled 70 patients aged 18-65 years (mean age 41.6 ±11.6) with the firstever provoked (n = 32; 45.7%) or unprovoked (n = 38; 54.28%) VTE episode, and 46 healthy controls. The exclusion criteria were: acute infection, cancer, autoimmune disorders, previous myocardial infarction (MI), or stroke. Monocyte subsets were assessed 12 (8.5-21.5) months after VTE using flow cytometry and were defined as classical (CD14++CD16-), intermediate (CD14++CD16+) and non-classical (CD14+CD16++). Results. Patients with VTE had higher intermediate and non-classical monocyte counts compared to the control group (16.8 ±9.3 vs 10.4 ±4.0 cells/μL, and 64.1 ±25.2 vs 44.1 ±19.2 cells/μL, respectively, both p < 0.001). Increased non-classical monocyte counts were observed in patients who experienced a VTE incident within 12 months prior to enrollment (71.5 ±27.4 vs 56.03 ±20.6 cells/μL; p = 0.01) and those with unprovoked VTE (70.2 ±4.1 vs 58.8 ±4.3 cells/μL; p = 0.06). There were no differences in monocyte subsets related to the current anticoagulation. Conclusions. Our data has shown for the first time that VTE is associated with an increased number of nonclassical and intermediate monocytes, which may indicate the involvement of monocyte-related mechanisms in the pathophysiology of this disease. [ABSTRACT FROM AUTHOR]

Copyright of Review of Medicine / Przeglad Lekarski is the property of Wydawnictwo Przegld Lekarski / Publisher Medicine Review 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.)

Objectives APS is associated with arterial and venous thrombosis. The unfavourable fibrin clot phenotype, including formation of dense and poorly lysable clots, has been reported in thrombotic APS. We investigated whether abnormal plasma clot properties are predictive of recurrent thromboembolism in APS. Methods We followed 126 consecutive patients with thrombotic APS and 105 control subjects, without APS, matched for thrombotic events. Plasma fibrin clot permeability (K s), turbidity measurements and clot lysis time were evaluated ⩾5 months after a thrombotic event. The primary composite end point was symptomatic recurrent venous thromboembolism, ischaemic stroke and/or myocardial infarction. Results During follow-up (median, 62 months; range 46–74 months; 1183.2 patient-years), the primary outcome was observed in 33 (26.2%) APS patients and 16 (15.2%) controls, including 25 (19.8%) and 14 (13.3%) subjects with recurrent venous thromboembolism, respectively. Reduced K s and prolonged clot lysis time predicted recurrent thromboembolic events in APS patients [per 1 × 10−9 cm2: hazard ratio (HR) = 0.37; 95% CI: 0.24, 0.56; and per 10 min: HR = 1.20; 95% CI: 1.01, 1.40, respectively] and in controls (per 1×10−9 cm2: HR = 0.23; 95% CI: 0.11, 0.42; and per 10 min: HR = 1.51; 95% CI: 1.08, 2.16, respectively). A multivariate analysis showed that positive IgG and IgM anti-β2 glycoprotein I antibodies, withdrawal of anticoagulation, lower platelet count and reduced K s predicted thromboembolic events in APS patients. Conclusion Formation of denser fibrin networks could be a novel risk factor for recurrent thromboembolism in APS, which highlights the importance of fibrin phenotype in thrombotic disorders. [ABSTRACT FROM AUTHOR]

Background. Underuse of thromboprophylaxis in hospitalized medical patients is still common worldwide. Little is known about the use of thromboprophylaxis in patients with pulmonary diseases in everyday hospital practice. Objectives. The aim of this study was to assess the use of pharmacological prophylaxis of venous thromboembolism (VTE) in real-life patients with pulmonary diseases. Material and methods. In this retrospective study, 2 validated scoring systems, i.e., the Padua prediction score and Caprini VTE risk assessment, were used to assess the VTE risk in 2011 patients (1133 men and 878 women), aged 18 years or more, hospitalized for pulmonary diseases (median 6 days) in a single tertiary pulmonary medical center from January to December 2014. Results. Using the Padua prediction score, we identified 428 (21.28%) patients at a high risk for VTE, including 167 (39.01%) who received thromboprophylaxis with low-molecular-weight heparin, and 261 (60.98%) individuals at a high risk without thromboprophylaxis (p < 0.001). A total of 888 (44.16%) patients who scored 5 points or more using the Caprini VTE risk assessment were identified as subjects at a high risk for VTE, including 34.79% of patients receiving thromboprophylaxis. From among patients at a high risk for VTE, 579 (65.20%) did not receive appropriate thromboprophylaxis (p < 0.001). Underuse of thromboprophylaxis was observed more commonly among patients hospitalized for lung cancer or pneumonia (50.60% and 24.87% of patients at a high risk for VTE without prophylaxis, respectively). Conclusions. Thromboprophylaxis is underutilized in hospitalized patients with pulmonary diseases regardless of the scoring system used. Implementation of thromboprophylaxis should be markedly improved in this patient group. [ABSTRACT FROM AUTHOR]

According to guidelines, it is recommended to give P2Y inhibitors (preferably ticagrelor or prasugrel) at the time of first medical contact in patients with STEMI. However, in real life antiplatelet treatment strategies are different among countries. We analyzed data on antiplatelet treatment in STEMI patients included into Polish ORPKI national registry. A total of 23,139 STEMI patients from 153 invasive cardiology centers were reported in ORPKI registry between September 2015 and August 2016. Finally 19,437 patients from 122 centers (immediate PCI in 94%) were included into the analysis (lack of ticagrelor or prasugrel usage reported in 31 centers). The dominant P2Y inhibitor was clopidogrel (69%) with a high rate of precathlab administration (51.3%). Ticagrelor was administered in 10.1% of patients (2.3% during precathlab phase) and prasugrel in 1.1% (0.4% precathlab). The periprocedural switch from clopidogrel to newer generation oral P2Y inhibitors was rare (to ticagrelor: 2%; to prasugrel: 0.15%). Analysis of data from top 10 centers with the highest rate of newer generation P2Y inhibitors usage (1295 patients) revealed ticagrelor administration in 43.1% (prasugrel in 3%). During precathlab phase higher proportion of ticagrelor instead of clopidogrel (ticagrelor 17.9%, clopidogrel 29.8%) and higher rate of periprocedural switch from clopidogrel to ticagrelor (11.9%) was found comparing to all centers data (p < 0.001 for all). The strategy of precathlab administration of P2Y inhibitors applies to about half of STEMI patients in Poland. Generally, ticagrelor or prasugrel use is low, and not equally distributed among centers. In centers with high usage, ticagrelor is main newer generation P2Y inhibitor for precathlab and periprocedural administration. [ABSTRACT FROM AUTHOR]

Aim of the study: Thromboprophylaxis in cancer patients during hospitalization reduces the risk of venous thromboembolism (VTE). Material and methods: To assess the underuse and the overuse of thromboprophylaxis in cancer patients at a tertiary oncology department, we retrospectively analyzed 1983 consecutive hospitalizations of 498 cancer patients who received chemotherapy from October 2016 to May 2017. The Padua prediction score (≥ 4 points) and Caprini risk assessment (≥ 5 points) were used to identify patients at high risk of VTE. Results: The majority of individuals (n = 363, 72.9%) suffered from advanced lung cancer. We found that 419 (84.14%) patients received thromboprophylaxis with enoxaparin 40 mg qd, including 181 (43.2%) individuals using concomitant mechanical thromboprophylaxis. As few as 44 (8.8%) and 11 (2.2%) patients did not receive thromboprophylaxis despite high VTE risk based on the Caprini risk assessment and Padua prediction score, respectively (p < 0.001). The number of patients without high risk of VTE, who received pharmacological thromboprophylaxis, was higher when the Padua prediction score was used compared with the Caprini risk assessment (n = 391 [78.5%] vs. n = 210 [42.2%], respectively; p < 0.001). Three patients (0.6%) experienced vascular events during hospital stay, including one symptomatic deepvein thrombosis. No major bleeding was observed. Predictors of thromboprophylaxis overuse were as follows: previous VTE and abnormal pulmonary function for both scales. Conclusions: This study shows that thromboprophylaxis in cancer in patients undergoing chemotherapy is suboptimal in Poland in part due to the use of various VTE risk scores yielding discrepant results in everyday practice. [ABSTRACT FROM AUTHOR]

Introduction: Previously, we have demonstrated that significant proportions of patients with various cardiovascular diseases have active tissue factor and active factor XIa in their plasma. In the current study, we evaluated active tissue factor and active factors (F)XI and FIX in plasma from patients with atrial fibrillation.Material and Methods: In 110 consecutive patients with permanent atrial fibrillation receiving warfarin, we determined active tissue factor, together with plasma FIXa and FXIa, using clotting assays by measuring the response to inhibitory monoclonal antibodies.Results: Sixteen (14.5%) patients had detectable active tissue factor and active FXIa, including 11 subjects with both factors, while FIXa was observed in 28 (25.7%) patients. The three positive groups did not differ from the patients without these factors with regard to demographic and clinical characteristics. Von Willebrand factor was higher in the active tissue factor-positive group (p < 0.0001) and FXIa-positive group (p = 0.0037). Individuals positive for active tissue factor and FXIa had higher plasma interleukin-6 levels (p = 0.0014 and 0.0322, respectively). The presence of active tissue factor, FXIa and FIXa in anticoagulated patients with permanent atrial fibrillation correlated with elevated von Willebrand factor and interleukin-6. During a 3-year follow-up, ischemic stroke (n = 12, 10.9%) occurred more commonly among atrial fibrillation patients who had circulating TF (p = 0.002) or FXIa (p = 0.013).Conclusions: These data suggest that circulating active coagulation factors, in particular TF and FXIa, can be detected despite oral anticoagulation in a significant proportion of patients with atrial fibrillation, and could represent novel markers of persistent prothrombotic alterations predisposing to ischemic stroke. [ABSTRACT FROM AUTHOR]