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Edoxaban is an oral anticoagulant drug and a direct factor Xa inhibitor. However, it is still not fully understood if and how edoxaban impacts platelet function. This prospective study aimed to assess in vitro platelet function in patients with atrial fibrillation (AF) receiving edoxaban. It was a single centre study quantifying platelet aggregation in 20 patients treated with edoxaban by light transmission aggregometry. The thrombin receptor activating peptide (TRAP)-induced platelet aggregation was significantly lower 2 h after taking edoxaban compared to baseline value (44.7 ± 32.03% vs. 73.3 ± 25.55%; p

Background Many patients receiving dabigatran treatment might also require bisoprolol therapy. However, there is a possibility that bisoprolol as significant P-glycoprotein inhibitor might interact with dabigatran. Study question To investigate the impact of concomitant bisoprolol therapy on dabigatran plasma level in patients with nonvalvular atrial fibrillation. Study design A pilot drug interaction study in 29 patients with nonvalvular atrial fibrillation on dabigatran therapy. Bisoprolol was administrated in 18 patients. Blood samples were collected at baseline (in the morning, before any medication was administered) and at hour 2 (2 hours after administration of dabigatran and bisoprolol). Results The dabigatran plasma level was significantly higher at baseline and at hour 2 in patients treated with bisoprolol compared with patients without bisoprolol therapy. In addition, we have shown that this increase is affected by dabigatran dosage and concomitant treatment with proton-pump inhibitor and digoxin. The impact of bisoprolol on dabigatran concentration was still significant despite these confounders. Conclusions This study demonstrated the interaction between dabigatran and bisoprolol, which is modulated with dabigatran dosage and concomitant treatment with proton-pump inhibitor and digoxin.

Background/Introduction Cardiovascular (CV) diseases including atrial fibrillation and arteriosclerosis are associated with impaired cognitive function. Cognitive dysfunction can impact the process of shared clinical decision making, reduce adherence to polypharmacy, and decrease quality of life. The prevalence of cognitive dysfunction in contemporary patients with CV diseases and its implication on future CV events is not well known. Purpose We 1) quantified cognitive function in patients presenting to hospital with CV diseases, 2) identified clinical variables and blood biomarkers associated with cognitive dysfunction, and 3) quantified the hazard of abnormal cognitive function for predicting MACCE (major adverse CV and cerebrovascular events). Methods and results Of 1625 consecutive patients presenting acutely to a large teaching hospital with CV diseases, 614 patients (median age [Q1, Q3] 68 [58, 76] years; 66% male) who completed the Montreal Cognitive Assessment (MoCA) were analysed. The median [Q1, Q3] MoCA score was 25 points [21, 27]. 360 patients (59%) had an abnormal score ( Cox proportional hazards model adjusted for competing risk of non-CV death assessed the relationship between abnormal cognitive function and MACCE (stroke, TIA, myocardial infarction, hospitalisation for heart failure, CV death). Follow-up time ranged from 2.7 to 6.1 years. Patients were censored at 2.5 years for this analysis. 130 out of 614 patients experienced a MACCE (21%) and 71 had a non-CV death (12%). Patients with abnormal MoCA scores were at higher risk for MACCE (subhazard ratio, sHR [95% CI] 1.827 [1.253, 2.664]). The hazard remained significant after adjustment for age, sex, obesity, atrial fibrillation, stroke, heart failure, hypertension, coronary artery disease, diabetes, peripheral artery disease and renal dysfunction (sHR 1.367 [1.056, 2.326]; Figure). All-cause mortality was 1.785 times higher for those with abnormal MoCA scores [1.061, 3.002]. Conclusion In this study, 3 out of 5 patients with CV diseases had abnormal MoCA scores at baseline. Abnormal cognitive scores significantly predicted patients who went on to experience a MACCE within 2.5 years of follow-up. These observations call for further research and action to provide additional diagnostics, support and early intervention to address cognitive dysfunction in CV patients. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EU H2020 CATCH ME Cumulative incidence function

V posledných rokoch sa pozoruje trend narastu poctu pacientov s fibrilaciou predsieni (AF). V roku 2010 bol pocet mužov a žien s AF vo svete 33,5 miliona. Najvyssia incidencia bola vo vyspelých krajinach (1, 2). Odhaduje sa, že do roku 2030 bude v Europskej unii 14–17 milionov pacientov s AF a rocne bude novodiagnostikovaných 12 000–215 000 pacientov (3). Prevalencia AF je približne 3 % v dospelej populacii s prevažnou vacsinou u starsich pacientov a u pacientov s hypertenziou, srdcovým zlyhanim, koronarnou chorobou srdca, valvulopatiou, obezitou, diabetes mellitus a chronickou oblickovou chorobou (4, 5). Efektivna prevencia cievnej mozgovej prihody (CMP) sa može dosiahnuť preparatmi peroralnej antikoagulacnej terapie. Priame peroralne antikoagulancia (DOAK) ako dabigatran, rivaroxaban, apixaban a edoxaban sa využivaju v liecbe hlbokej žilovej trombozy (DVT), pľucnej embolie (PE) a prevencii rekurentnej DVT a PE u dospelých. V klinickej praxi može nastať situacia, keď nie je jasna indikacia antikoagulacnej terapie u pacienta s AF ci už vzhľadom na riziko krvacania, alebo zvaženie benefitu v porovnani s rizikom terapie.

Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): CATCH ME European Commission H2020 grant (no. 633196) Background Several novel blood biomarkers were recently found to reflect underlying pathophysiology implicated in atrial fibrillation (AF). These biomarkers could be used for stratifying patients at risk of developing AF or AF-related adverse events. Purpose We combined 9 clinical risk factors and 12 biomarkers to model composite outcomes of 1) incident AF, hospitalisation for arrhythmias, and cardiovascular death in sinus rhythm patients at risk of AF, and 2) recurrent AF, hospitalisation for arrhythmias, and cardiovascular death in patients with AF. Methods 1455 patients presenting acutely to hospital with either diagnosed AF (n = 648) or sinus rhythm and ≥2 CHA2DS2-VASc risk factors (n = 807, silent AF ruled out by 7-day ECG monitoring) were followed up for two years. Outcomes were collected from linked hospital episode statistics (HES) and Office of National Statistics (ONS) data from NHS Digital. We univariately evaluated 12 cardiovascular biomarkers quantified from EDTA plasma collected at baseline (ANG2, BMP10, CA125, CRP, ESM1, FABP3, FGF23, GDF15, IGFBP7, IL6, NTproBNP, Troponin T). Two predictive models combining clinical characteristics and biomarkers were developed for each patient group, using Cox regression with backward elimination and considering non-cardiovascular death as a competing risk. Results In sinus rhythm patients (n = 117/807 with outcome), elevated BMP10, ANG2, CA125, IGFBP7, NTproBNP univariately predicted the composite outcome (adjusted for age, sex, body mass index (BMI), eGFR, heart failure, stroke/TIA, hypertension, diabetes, coronary artery disease – see Figure part A). In the combined model, age, prior stroke/TIA, coronary artery disease, ANG2, IGFBP7 and NTproBNP predicted the outcome (C-statistic [95% confidence interval (CI)] 0.733 [0.683, 0.784]). In patients with AF (n = 193/648 with outcome), elevated BMP10, ANG2, CA125, troponin T, GDF15, IGFBP7, NTproBNP univariately predicted the composite outcome (adjusted for same variables as above – see Figure part B). In the combined model, high BMI, low eGFR, hypertension, IGFBP7, NTproBNP and troponin T were predictive of the composite outcome (C-statistic [95% CI]: 0.643 [0.596, 0.689]). Conclusion Combinations of clinical risk factors and biomarkers were predictive of two-year AF-related adverse events in sinus rhythm patients at risk of AF and in patients with AF. These markers could be used to identify patients for more intensive follow-up or therapy. IGFBP7 and NTproBNP were present in both models, implicating pathways involved with cardiac overload, inflammation, and oxidative stress. These findings call for external validation of these markers and prospective evaluation in at-risk populations. Abstract Figure. Biomarkers predicting 2-year AF outcomes

Heparin-induced thrombocytopenia (HIT) is a profoundly dangerous, potentially lethal, immunologically mediated adverse drug reaction to unfractionated heparin or, less commonly, to low-molecular weight heparin. Some patients with HIT develop serious thrombotic complications like limb ischemia and gangrene, while others may not develop such complications. Current laboratory diagnostic tools incur significant time delays before confirming HIT, therefore upon clinical suspicion, treatment of HIT should start immediately. In this review, the authors highlight heparin-induced thrombocytopenias risk factors, clinical presentation, pathophysiology, diagnostic principles, and treatment.

Background Large-scale screening for atrial fibrillation (AF) requires reliable methods to identify at-risk populations. Using an experimental semi-quantitative biomarker assay, B-type natriuretic peptide (BNP) and fibroblast growth factor 23 (FGF23) were recently identified as the most suitable biomarkers for detecting AF in combination with simple morphometric parameters (age, sex, and body mass index [BMI]). In this study, we validated the AF model using standardised, high-throughput, high-sensitivity biomarker assays. Methods and findings For this study, 1,625 consecutive patients with either (1) diagnosed AF or (2) sinus rhythm with CHA2DS2-VASc score of 2 or more were recruited from a large teaching hospital in Birmingham, West Midlands, UK, between September 2014 and February 2018. Seven-day ambulatory ECG monitoring excluded silent AF. Patients with tachyarrhythmias apart from AF and incomplete cases were excluded. AF was diagnosed according to current clinical guidelines and confirmed by ECG. We developed a high-throughput, high-sensitivity assay for FGF23, quantified plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) and FGF23, and compared results to the previously used multibiomarker research assay. Data were fitted to the previously derived model, adjusting for differences in measurement platforms and known confounders (heart failure and chronic kidney disease). In 1,084 patients (46% with AF; median [Q1, Q3] age 70 [60, 78] years, median [Q1, Q3] BMI 28.8 [25.1, 32.8] kg/m2, 59% males), patients with AF had higher concentrations of NT-proBNP (median [Q1, Q3] per 100 pg/ml: with AF 12.00 [4.19, 30.15], without AF 4.25 [1.17, 15.70]; p < 0.001) and FGF23 (median [Q1, Q3] per 100 pg/ml: with AF 1.93 [1.30, 4.16], without AF 1.55 [1.04, 2.62]; p < 0.001). Univariate associations remained after adjusting for heart failure and estimated glomerular filtration rate, known confounders of NT-proBNP and FGF23. The fitted model yielded a C-statistic of 0.688 (95% CI 0.656, 0.719), almost identical to that of the derived model (C-statistic 0.691; 95% CI 0.638, 0.744). The key limitation is that this validation was performed in a cohort that is very similar demographically to the one used in model development, calling for further external validation. Conclusions Age, sex, and BMI combined with elevated NT-proBNP and elevated FGF23, quantified on a high-throughput platform, reliably identify patients with AF. Trial registration Registry IRAS ID 97753 Health Research Authority (HRA), United Kingdom, Winnie Chua and colleagues identify and validate biomarkers for atrial fibrillation, Author summary Why was this study done? Atrial fibrillation (AF) is the most commonly sustained arrhythmia in the world, markedly increasing the risk of stroke, heart failure, and cardiovascular death. AF episodes can be transient and go undetected by ECG for a long time, leading to untreated AF and avoidable complications such as stroke. Blood biomarkers are an easy and affordable way to enable screening for undiagnosed, silent AF. An earlier study using a dual-antibody-based research assay identified a simple model, consisting of age, sex, body mass index, and 2 biomarkers, FGF23 and NT-proBNP, that identified patients with AF. What did the researchers do and find? We measured 2 biomarkers, NT-proBNP and FGF23, using high-throughput, high-sensitivity assays that are ready for clinical use. The FGF23 assay was developed for this study. We incorporated these biomarkers into a model including age, sex, and body mass index, which was derived from previous work where research assays were used to identify biomarkers to detect patients with AF. We demonstrated that the model using the standardised assays performed consistently to identify patients with AF. What do these findings mean? Elevated concentrations of FGF23 and NT-proBNP, in addition to older age, female sex, and high body mass index, identify patients who are likely to have AF. In the future, point-of-care testing can be easily performed using these biomarkers in combination with 3 simple pieces of information (age, sex, and body mass index) to target intensive screening, for example, using ECG monitoring.

Background: Early detection of atrial fibrillation (AF) and subsequent initiation of anticoagulation and rhythm control therapy markedly reduce stroke, cardiovascular death, and heart failure, but unselected ECG screening for AF is time- and resource-intensive. Combining biomarkers reflecting different biological processes may identify patients at high risk of AF, enabling targeted ECG screening. Methods: We systematically reviewed literature and patent information to define candidate biomarkers for AF detection. The top 12 biomarkers identified through this process were quantified on a high-precision, high-throughput platform in 1485 consecutive patients at risk for AF presenting acutely to hospital (median age 69 years [Q1, Q3 60,78]; 60% male). Patients had either known AF (45%) or AF ruled out by 7-day ECG-monitoring. A model simultaneously considering 7 key clinical characteristics and all biomarkers was developed in a randomly sampled discovery cohort (n=933) and validated in the remaining patients (n=552). Neural networks were also applied. Findings: Using backward elimination, a model using age, sex, body mass index (BMI), BMP10, ANG2, and FGF23 discriminated between patients with and without AF with an AUC of 0·743 [95% confidence interval (CI) 0·712-0·775]. The biomarkers represent distinct pathways relevant for atrial cardiomyopathy and AF, namely hypertrophy and fibrosis (FGF23), endothelial dysfunction (ANG2), and atrial oxidative stress and the genomic predisposition to AF (BMP10). The SHAP procedure for neural networks identified the same variables as the regression. The validation yielded an AUC of 0·719 (95%CI 0·677, 0·762), corroborated using deep neural networks (AUC 0·784 [95%CI 0·745, 0·822]). Interpretation: The combination of three simple characteristics (age, sex, BMI) and three biomarkers (BMP10, ANG2, and FGF23) robustly identifies patients with AF. Such an approach enables targeted screening for AF and provides a platform to develop personalised prevention and treatment in patients with AF. Funding Statement: This work was partially supported by the European Commission (grant agreements no. 633196 [CATCH ME]) to PKi, LF, BC, SH, SK, LM, MFS, US, and no. 116074 [BigData@Heart EU IMI] to PKi, British Heart Foundation (FS/13/43/30324 and (AA/18/2/34218) to PKi and LF), German Centre for Cardiovascular Research supported by the German Ministry of Education and Research (DZHK, via a grant to AFNET to PKi), and Leducq Foundation (14CVD01) to PKi. Declaration of Interests: LF has received institutional research grants and non-financial support from European Union, British Heart Foundation, Medical Research Council (UK), and DFG and Gilead. PKi has received additional support for research from the European Union, British Heart Foundation, Leducq Foundation, Medical Research Council (UK), and German Centre for Heart Research, from several drug and device companies active in atrial fibrillation, honoraria from several such companies. PKi and LF are listed as inventors on two patents held by University of Birmingham (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783). PKa is an employee of Roche Diagnostics GmbH. AZ is an employee of Roche Diagnostics Intl. All other authors have reported no relationships relevant to the contents of this paper to disclose. Ethics Approval Statement: This study complied with the Declaration of Helsinki, was approved by the National Research Ethics Service Committee (IRAS ID 97753), and was sponsored by the University of Birmingham.

A rapid and reliable assessment of the dabigatran effect is desirable in dabigatran treated patients with uncontrolled bleeding or before acute surgery. The aim of this study was to study the anticoagulant effects of dabigatran in patients with atrial fibrillation (AF) as assessed by the whole blood assays ROTEM, and how data from these methods correlate to plasma dabigatran concentrations measured by Hemoclot. ROTEM was performed with ROTEM Gamma (Pentapharm GmbH, Munich, Germany). The assays used in our study were Ex-tem and In-tem assay. Plasma dabigatran concentrations were determined by hemoclot thrombin inhibitor assay (Hyphen BioMed, France) at trough and post-dose in 27 patients on dabigatran 150 mg BID. Median plasma dabigatran concentrations at trough were 74 ng/mL (11.2–250) and post-dose (2 h after ingestion) 120 ng/mL (31–282). The ROTEM clotting time (CT) and maximum clot firmnes (MCF) correlated strongly with dabigatran concentrations when activated with the reagents Ex-tem (p < 0.0001) and In-tem (p < 0.0001). In summary, in our study, we have found that the ROTEM variable CT and MCF, when activated with triggers Ex-tem and In-tem, has a strong and highly significant correlation with the plasma dabigatran concentration in a real-life population of AF-patients and could thereby be an alternative to estimate dabigatran concentration in emergency situations. However, additional studies are needed to further validate these findings.

Introduction: Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired, life-threatening hemopoietic stem cell disorder characterized by the triad of hemolytic anemia, thrombosis, and impaired bone marrow function. Evidence suggests that severe outcomes in COVID19 infection are attributed to the excessive activation of the complement cascade leading to acute lung injury and associated is with an increased prothrombotic state. Patient concerns: A 27-year-old Caucasian man with PNH presented to the Emergency Department of our hospital with acute onset shortness of breath, cough and blood in urine. Diagnosis: The patient was diagnosed with acute hemolytic exacerbation of PNH complicated with moderate COVID19 pneumonia. Outcomes: The patient was initiated with an anticoagulant unfractionated heparin, dexamethasone, and cefuroxime injection. His symptoms quickly resolved, and he was discharged after 5 days. Conclusion: The complement system activation is a critical component in the sequalae of COVID19 infection. Evidence suggests that severe outcomes in COVID19 infection are attributed to the excessive activation of the complement cascade leading to acute lung injury and associated is with an increased prothrombotic state. Notably, C5a concentration was noted to be higher in patients with COVID19 infection. The use of complement inhibitors to attenuate immune mediated damage in COVID19 nevertheless represents a very interesting theoretical approach. However, careful consideration as to which patients may benefit will be required and the outcome of clinical trials needed.

Edoxaban, a direct factor Xa inhibitor (FXa), is the fourth direct oral anticoagulant (DOAC) approved for clinical use. As the main adverse event is bleeding, it is relevant whether edoxaban has additional effects on platelet function. We aimed to assess in vitro aggregation in patients with atrial fibrillation (AF) receiving edoxaban. We evaluated 20 AF patients treated with edoxaban. We assessed light transmittance platelet aggregation (LTA) with 100 nmol/L γ-thrombin. The LTA was performed at 2 time-points. The thrombin-induced platelet aggregation was significantly lower 2 hours after edoxaban was taken compared to baseline measurement (27.25% ± 30.8% vs. 60.35% ± 33.3%). In addition, we also performed 16 subanalyses in order to identify the differences in the outcome of different comorbidities, age, dosage, liver and kidney function tests, and concomitant treatment. Results of the subgroup analyses were consistent with the findings of the main analysis; there was no apparent heterogeneity across the prespecified subgroups. The thrombin-induced platelet aggregation is reduced in non-valvular AF patients receiving edoxaban.

Rivaroxaban and apixaban are direct oral anticoagulants whose target specificity is to activate factor X (FXa). It is still not fully understood how xabans impact platelet function. This single-center observational study aimed to assess in vitro platelet function in patients with atrial fibrillation receiving rivaroxaban or apixaban. It examined quantification of platelet aggregation assessed by light transmission aggregometry in thirty-four patients treated with apixaban or rivaroxaban. The thrombin-induced platelet aggregation was significantly lower 2 h after taking selected xabans compared to baseline value (69.55 ± 32.15% vs. 44.79 ± 34.97.9%; p

Toxicology is a specialized scientific discipline, focusing on microbiological, botanical and animal venoms, poisons and toxins. This discipline includes more than just the chemistry and mode of action of a toxin, but also with the biology of venom or poison producing organism, the structure and function of the venom apparatus, as well as the use of the venom or poison. The discipline of toxicology involves the study of the poison on living organisms and the therapy of the intoxication. A genus Trimeresurus, to which belongs Green Pit Viper, is large and includes around 36 types. Snake venoms have various composition and they can effect cardiovascular and nervous system, kidneys, hemocoagulation, vessel wall and muscle cells. In this article, we are presenting a rare case report about Trimeresurus albolabris, review of literature and general treatment after intoxication with snake venom. Prompt assessment, observation and early specific management are the keys to treat intoxication with snake venom. Key words: hemotoxin - intoxication - snake venom - treatment - Trimeresurus albolabris.

Dabigatran is a direct thrombin inhibitor. As the main adverse event is bleeding, it is relevant whether dabigatran has additional effects on platelet function. If so, it could affect the bleeding risk. We aimed to assess in vitro aggregation in patients with atrial fibrillation (AF) receiving dabigatran.We evaluated 32 AF patients treated with dabigatran (study group) and 18 non-anticoagulated non-AF blood donors (control group). We assessed light transmittance platelet aggregation (LTA) with 100 nmol/L γ-thrombin in both groups. The LTA was performed at two time-points in our dabigatran group of patients.The thrombin-induced platelet aggregation was significantly lower two hours after dabigatran was taken compared to baseline measurement (9% ± 6% vs. 29% ± 21%) in our study group. Moreover, we observed that the baseline value of platelet aggregation in patients on dabigatran treatment was significantly lower compared to healthy volunteers (29% ± 21% vs. 89 ± 8). However, one subanalysis showed that this significant reduction in platelet aggregation at baseline was only observed in patients who received dabigatran for over a week.The thrombin-induced platelet aggregation is reduced in non-valvular AF patients receiving dabigatran after a week-long therapy.

Kardiovaskularne ochorenia su najcastejsou pricinou umrtnosti vo vyspelých krajinach. Koronarna choroba srdca je na prvom mieste ako pricina umrtia, co predstavuje sedem milionov ľudi každý rok, ciže 12,8 % zo vsetkých umrti na svete. Každý siesty muž a každa siesta žena zomrie na infarkt myokardu (IM). Diabetes mellitus (DM) patri medzi najviac vyskytujuce sa chronicke ochorenie a kardiovaskularne ochorenia sa vyskytuju pri tejto diagnoze 4 – 8-krat castejsie. Akutne komplikacie DM su zapricinene nahlou metabolickou dekompenzaciou, ktore možu priamo ohroziť život pacienta. Prezentujeme kazuistiku 20-rocnej ženy s juvenilným DM, u ktorej pri aplikacii inzulinu pomocou inzulinovej pumpy doslo k rozvoju zavažnej diabetickej ketoacidozy. Uvedena akutna metabolicka komplikacia sposobila akutny infarkt myokardu (AIM) s elevaciami useku ST (STEMI).

Wilsonova choroba (WCH) patri medzi autozomalne recesivne dedicne metabolicke ochorenia s mutaciou genu ATP7B na 13. chromozome. Doležitu ulohu pri WCH zohrava enzým ATPaza, ktorej hlavnou funkciou je vylucovanie medi do žlce. Tento gen sprostredkovava ATPazu modifikujucu apoceruloplazmin. Pri tomto ochoreni dochadza k nedostatocnemu vylucovaniu medi z organizmu, a teda k jej hromadeniu v ľudskom organizme. Meď sa akumuluje predominantne v organoch ako je peceň a mozog, co može zapriciniť poruchu funkcie daneho organu. Podľa toho, ktore priznaky prevladaju, rozdeľujeme WCH chorobu na formu neurologicku, casto spatu s formou psychiatrickou, hepatalnu a inu. Najcastejsie sa symptomy WCH prejavia v obdobi 15.-25. roku života, v zavislosti na klinickej forme. Hepatalna sa casto objavi skor, naopak neurologicka forma sa može prejaviť neskor. V nasom clanku prezentujeme kazuistiku 45-rocnej pacientky s atypickým priebehom WCH, ktorej diagnostika bola zdĺhava a mala interdisciplinarny charakter.

The availability of direct oral anticoagulants has caused a paradigm shift in the management of thrombosis. Rivaroxaban and apixaban are 2 direct oral anticoagulants whose target specificity is activated factor X (FXa). However, it is still not fully understood if and how xabans impact platelet function. This observational study aimed to assess the in vitro platelet function in patients with atrial fibrillation receiving xabans. This was a single-center study quantifying platelet aggregation in 41 patients treated with apixaban or rivaroxaban by light transmission aggregometry. The thrombin receptor activating peptide (TRAP)-induced platelet aggregation was significantly lower 2 hours after taking rivaroxaban or apixaban compared to baseline value (56.15% [8.53%] vs 29.51% [12.9%]; P = .000). Moreover, concomitant use of angiotensin-converting enzyme blockers, proton pump inhibitors, and statins reduces the efficiency of xabans. The TRAP-induced platelet aggregation was reduced in patients with cardiovascular disease 2 hours after receiving xabans.

Myxom je najcastejsi vyskytujuci sa benigny nador srdca v dospelej populacii. Može sposobovať radu specifických a nespecifických priznakov, najma v zavislosti od lokalizacie a veľkosti nadoru. Ochorenie može prebiehať niekoľko rokov bez priznakov a nemusi byť rozpoznane. Zlatým standardom diagnostiky nadorov srdca je echokardiografia, avsak vo vacsine pripadov je diagnoza nahodna a narocna. Prezentujeme kazuistiku myxomu ľavej predsiene manifestujucu sa akutnymi koncatinovými ischemiami. Po urgentnej trombektomii a embolektomii bola vzorka trombu odoslana k histologizacii so zaverom benigneho nadoru srdca. Bolo doplnene koronarograficke vysetrenie s nalezom dvoch kritických stenoz na ľavej koronarnej arterii a uzaveru na pravej koronarnej arterii. Pacient bol odindikovaný k urgentnej inkompletnej revaskularizacii a extirpacii tumoru. Pacient je tri mesiace po operacii a echokardiograficky bez znamok recidivy nadoru.

The availability of direct oral anticoagulants has caused a paradigm shift in thrombosis management. The direct thrombin inhibitor dabigatran seems to obstruct tenase complex by inhibiting thrombin generated in the initial phase and feed back to the amplification phase of cell-based coagulation reactions. However, it is still not fully understood if and how dabigatran impact platelet function. This observational study aimed to assess in vitro platelet function in patients with atrial fibrillation receiving dabigatran. Platelet aggregability was tested with platelet-rich plasma using platelet aggregometry (PACKS-4 aggregometer). Blood samples were stimulated with thrombin receptor agonist peptide (TRAP; 32 μmol/L). RESULTS: A total of 28 patients with nonvalvular atrial fibrillation were enrolled. The mean age was 71.57 (9.75) years (range: 50-87 years), 16 patients were women, and the mean CHA(2)DS(2)VASc score was 3.93 (1.41). All patients began treatment with dabigatran as initial anticoagulant treatment. The minimum term use of dabigatran was 18 days. Dabigatran doses were 110 mg (57.14%) or 150 mg (42.86%) twice daily. The TRAP-induced platelet aggregation was significantly lower 2 hours after taking dabigatran compared to baseline value (79.39 [13.38] vs 90.14 [10.5]). CONCLUSION: The TRAP-induced platelet aggregation was reduced in cardiovascular patients 2 hours after receiving dabigatran. Our findings could have some important clinical implications because platelet aggregation and coagulation cascade are affected at the same time.

Background/Introduction Identifying patients with left ventricular dysfunction (LVDys) remains challenging outside of specialist settings. Abnormalities on the electrocardiogram (ECG) and elevated natriuretic peptides (BNP, NT-proBNP) have been associated with a diagnosis of LVDys or heart failure. As these characteristics will be affected by atrial fibrillation (AF), understanding the behaviour of these predictors in LVDys patients with and without concomitant AF could improve the detection of LVDys. Purpose To compare the predictive value of clinical characteristics, ECG parameters, and NT-proBNP for prediction of LVDys in patients with and without concomitant AF. We also compared the performance of 6 other common cardiac biomarkers which have been associated with AF. Methods ECGs from 1487 patients (36% with LVDys, 39% female, 44% with AF, mean [SD] age 68[12] years) presenting to a large teaching hospital were analysed for abnormalities. All patients underwent a standardised transthoracic echocardiogram to determine left ventricular function at baseline. All biomarkers were centrally quantified from plasma using Elisa assays. Using forward selection and logistic regression, 6 ECG parameters (resting heart rate, QRS, QT, QTc durations, presence of AF, and blocks) were modelled and adjusted for clinical characteristics (age, sex, age:sex interaction, history of myocardial infarction, and hypertension). The inclusion of biomarkers was evaluated by examining the C-statistic and 95% confidence interval. Results In the overall cohort, after adjustment for clinical characteristics, LVDys was associated with increased heart rate (OR per 10 beats increase = 1.20 [95%CI = 1.12–1.28], p Conclusion (s): Two ECG parameters obtained from automated analysis (QRS duration and QTc interval), adjusted for a combination of simple clinical characteristics, robustly identify reduced left ventricular function in unselected patients seen in hospital. NT-proBNP contributes a little to improve the identification of LVDys patients on top of these ECG parameters, with a clear need to adjust normal range in the patients presenting with AF. Conflict of Interest None

Relation between oncological diseases and venous thrombo-embolism (VTE) is well known for almost 2 centuries. In 1823 Bouillaud assumed by three patients with tumor and recent deep vein thrombosis (DVT), that peripheral edema of lower limbs emerges as a result of#8222;obturation#8220; of veins by#8222;fibrinous coagulum#8220; (caillot fibrineux), which was induced by oncological disease. French physician Armand Trousseau wrote about this relation in his book#8222;Phlegmasia alba dolens#8221; again in the year 1865. Many studies were developed in times of Bouillaud a Trousseau, which just confirmed existence of relation between tumor and VTE. Oncological disease presents a significant risk factor of formation of VTE. Recent references favorising the use of light molecular weight heparin (LMWH) in long-term anticoagulation therapy of patients with cancer. Recently we have just few clinical data about efficiency and safety of direct oral anticoagulants (DOACs) in oncological patients, however many meta-analysis of clinical studies has shown benefit of therapy with DOACs towards conventional therapy. Key words: direct oral anticoagulants (DOACs) - oncology - venous thromboembolism.

Hypertestosteronism as part of hyperandrogenic states in women is generally defined as abundance of male hormones (in this case abundance of testosterone). Spectrum of clinical symptoms include menstrual disorders, amenorrhoea, different range of hirsutism and virilization. Statistically, most androgen secreting tumors are ovarian aetiology (testosterone secreting tumors located in suprarenal gland are very rare). This rare tumor may produce excess amounts of testosterone, as well as its precursor androstenedione. The highest incidence is between 20-40 years and in postmenopausal period. The treatment is essentially surgical; with gradual adjustment of the hormones.Key words: androgen secreting ovarian tumors - hyperandrogenic states - testosterone - virilisation.

Introduction: Hormone changes during pregnancy lead to increased plasma lipid levels. When there is added disorder of lipid metabolism, this otherwise physiological change can cause extremely high triglyceride levels with potentionally life-threatening complications, such as non-biliary acute pancreatitis. Materials and Methods: We present a case report of a 27-year-old pregnant woman with familial hyperchylomicronemia and a history of 7 hypertriglyceridemia-induced acute pancreatitis attacks. Three attacks occured during her first pregnancy with the last one leading to its termination at 33 weeks owing to the death of the fetus. During her second pregnancy, standard treatment was not able to lower the triglyceride levels sufficiently and she suffered another acute pancreatitis attack. Therapeutic plasma exchange was therefore chosen as the treatment method. Results and Conclusion: Plasma exchange was succesful in the secondary prevention of acute pancreatitis attack and she delivered a healthy baby at 36 weeks of gestation. Treatment was very well tolerated by the mother and the fetus and this supports the use of apheresis as a safe and efficient method in tackling gestational hypertriglyceridemia.

The patient database at the First Department of Internal Medicine in Martin, the Central Slovak Institute for Cardiac and Vascular Diseases in Banska Bystrica, and the National Slovak Institute of Cardiovascular Diseases in Bratislava was searched to identify patients with benign tumors of the heart seen during the 5-year period between 2011 and 2016. Forty-one patients with primary cardiac myxomas were identified and their medical records were reviewed for details pertaining to presenting symptoms, staging modalities, treatment approaches, and outcomes. Most of the studied patients were diagnosed with echocardiography (n=35, 85%). The occurrence of the tumor was higher in the female population (n=25, 61%). The most common presenting symptoms were dyspnoea (n=17, 42%), chest pain (n=3, 7%), or pain and paraesthesia of the limbs (n=2, 5%). Acute embolic event due to embolization of tumor fragments resulted in cerebral stroke (n=5, 12%). All patients were treated by resection. Only one comorbid patient died due to multiple-organ dysfunction syndrome two weeks after the resection. The most common postoperative complication was bleeding (n=2, 5%) and infection (n=2, 5%). The early diagnosis and appropriate treatment are often curative, with very low risk of recurrence. Postoperative survival is high.