Platelet Therapy Research Articles

Flow Diverter

The flow diverter is a relatively new but revolutionary technology in the realm of Endo vascular management of complex cerebral aneurysms. The traditional approach in the past has been stent deployment assisted coil embolisation. However, this maybe associated with partial occlusion or late recanalisation of the aneurysm. While planning the procedure for any cerebral aneurysm, the neurosurgeon needs to consider the morphology of the intracranial aneurysm as well as its proximity to the vascular branches and perforators. Giant (>25mm diameter), large (>10mm diameter), wide necked and fusiform aneurysms are the most challenging ones to treat.(1) The flow diverter works on the following principles (a)the stent deployed disrupts the blood flow from the parent vessel into the aneurysm (b) the stent works like a scaffolding for the growth of endothelial cells and separates the aneurysm from the parent vessel and gradually blocks it.(2) It is inducing endoluminal reconstruction in contrast to endosaccular filling in the older procedures. Moreover, it spares the origin of perforators from getting occluded. The sac gradually shrinks and finally collapses. This has excellent outcomes in comparison to conventional procedures for large or wide-necked aneurysms. This fascinating, innovative technology is associated with lesser complications and higher success rates. It is backed by landmark trials including the ‘Pipeline Embolisation Device for the Intracranial treatment of Aneurysms (PITA)’ trial and the ‘Pipeline for Uncoilable or Failed Aneurysms (PUFs) trial.(1) The device has thrombogenic potential and the patient needs to be on anti platelet therapy to prevent thromboembolism and late in-stent stenosis. A diversified complex case of multiple giant internal carotid artery aneurysms managed by latest phenomenal advanced technique of flow diversion in Neurointervention spectrum, that is, FLOW DIVERTER (FD). This young lady presented with sudden onset right sided complete opthalmoplegia and headache. Her investigations revealed bilateral ICA large to giant aneurysms. Considering all aspects of her case, she was counselled and planned for FD placement with some coils.

Thrombectomy and clot analysis‐guided anti‐coagulant/platelet therapy for acute ischemic stroke in a pregnancy complicated with primary antiphospholipid syndrome: A case report

AbstractA 35‐year‐old woman with antiphospholipid syndrome, with 29‐week pregnancy, developed left hemiparesis. Diffusion‐weighted imaging showed a low Alberta Stroke Program Early Computed Tomography (ASPECT) score. The right internal carotid artery occlusion was recanalized by mechanical thrombectomy (MT) and a pathologically white thrombus was confirmed. Clot analysis‐guided anti‐coagulant/platelet therapy was continued, and the patient delivered at 38 weeks and was discharged with a modified Rankin Scale score of 1. We conclude that MT should be considered, even in pregnancy with antiphospholipid syndrome and low ASPECT scores.

Anti-aging technologies and physiotherapy innovations

Abstract. At present, aesthetic anti-aging programs have acquired a new semantic content, since, on the one hand, they demonstrate the modern level of development of medicine and, on the other hand, the unity of external aestheticism with the somatogenic status of patients, both men and women. The purpose of the study was to improve the quality of anti-aging medical and aesthetic care for patients with varying degrees of age-related structural changes in the skin of the face and body, by including a combined anti-aging program with the use of injectable carboxytherapy, platelet-rich plasma (PRP), exercise therapy, a dietary program, and nutritional support (trace elements of zinc, copper, selenium, vitamins B and D) in the treatment protocol. Patients and methods: 114 patients (56 men and 58 women) with involutive face / body skin changes were studied. Prior to the combined anti-aging program, all patients underwent an anthropometric assessment (body mass index — BMI), dermatological control (dermatoscopy, ballistometry, corneometry, cutometry), and an assessment of antioxidant functions according to liquid chromatography and mass spectroscopy (superoxide dismutase — SOD, total antioxidant function index). Simple open-label randomization made it possible to divide men and women into homogeneous comparable groups: group I (n = 30) received injectable carboxytherapy along the cosmetic lines of the face and in the décolleté; group II (n = 30) received platelet-rich plasma in the form of platelet therapy in the specified areas; group III (the study group, n = 32) were treated with a combined technique including simultaneous PRP and injectable carboxytherapy; group IV (the control group, n = 22) had basic facial and body care, without physiotherapy methods. The statistical data analysis was carried out in Microsoft Office Excel (2017) and SPSS statistical processing (PASW Statistics version, 2018). Parametric (the linear correlation method, the Students test) and non-parametric methods (the Spearman»s rank correlation coefficient, the Wilcoxon and Mann-Whitney Test) were used. The differences were considered significant at p < 0.05. Results: after the combined therapy, there was a significant increase in the hydration index of the facial skin by 13.2 ± 1.2 standard units, an increase in the level of elastin by 9.4 ± 2.9 standard units, a decrease in the depth of wrinkles by 1.4 points, correction of superoxide dismutase values from 135 [133; 137] ng / mL to the physiological norm of 112.4 [111.9; 112.9] ng /mL (p < 0.01), and an improvement in the overall antioxidant function of the blood.

Recent advances in the adjunctive management of diabetic foot ulcer: Focus on noninvasive technologies.

Diabetic foot ulcer (DFU)is one of the most costly and serious complications of diabetes. Treatment of DFU is usually challenging and new approaches are required to improve the therapeutic efficiencies. This review aims to update new and upcoming adjunctive therapies with noninvasive characterization for DFU, focusing on bioactive dressings, bioengineered tissues, mesenchymal stem cell (MSC)based therapy, platelet and cytokine-based therapy, topical oxygen therapy, and some repurposed drugs such as hypoglycemic agents, blood pressure medications, phenytoin, vitamins, and magnesium. Although the mentioned therapies may contribute to the improvement of DFU to a certain extent, most of the evidence come from clinical trials with small sample size and inconsistent selections of DFU patients. Further studies with high design quality and adequate sample sizes are necessitated. In addition, no single approach would completely correct the complex pathogenesis of DFU. Reasonable selection and combination of these techniques should be considered.

HPA1-29w Genotyping and the Foundation for the Platelet Apheresis Registry in Jiangsu Province of China by MassARRAY Spectrometry

Introduction: This study aimed to investigate the allele frequencies of the human platelet antigens (HPA) HPA-1-29w system in Jiangsu (China) and establish the platelet apheresis registry in blood donors. Methods: HPA genotyping was performed using the MassARRAY iPLEX® platform. Allele and genotype frequencies were estimated by direct counting and tested for Hardy-Weinberg equilibrium. The transfusion mismatch probability was calculated for every HPA specificity. Results: The HPA allele frequencies in the Jiangsu Han population of HPA-1b, -2b, -3b, -4b, -5b, -6b, -11b, -15b, and -21b were 0.0055, 0.0530, 0.4116, 0.0015, 0.0155, 0.0162, 0.0003, 0.4683, and 0.0070, respectively, in which a heterozygote of HPA-11a/b was first detected in China. Only allele a was detected for HPA-7-10w,-12-14w,-16-20w, and -22-29w quasi-systems. The highest mismatch rate of HPA genes in 1,640 platelet donors was the HPA-15 system, followed by the HPA-3 system with a rate of 37.4% and 36.71%, respectively. Conclusion: China’s largest-scale platelet registry of HPA-1-29w has been explored. The MassARRAY platform may help found the platelet apheresis registry which would be useful to provide matching platelets and lead to a more accurate, effective, and safe transfusion for patients with platelet therapy.

Timing of SGLT2i initiation after acute myocardial infarction

BackgroundPharmacological post-MI treatment is routinely initiated at intensive/cardiac care units. However, solid evidence for an early start of these therapies is only available for dual platelet therapy and statins, whereas data on beta blockers and RAAS inhibitors are heterogenous and mainly limited to STEMI and heart failure patients. Recently, the EMMY trial provided the first evidence on the beneficial effects of SGLT2 inhibitors (SGLT2i) when initiated early after PCI. In patients with type 2 diabetes mellitus, SGLT2i are considered “sick days drugs” and it, therefore, remains unclear if very early SGLT2i initiation following MI is as safe and effective as delayed initiation.Methods and resultsThe EMMY trial evaluated the effect of empagliflozin on NT-proBNP and functional and structural measurements. Within the Empagliflozin group, 22 (9.5%) received early treatment (< 24 h after PCI), 98 (42.2%) within a 24 to < 48 h window (intermediate), and 111 (48.1%) between 48 and 72 h (late). NT-proBNP levels declined by 63.5% (95%CI: − 69.1; − 48.1) in the early group compared to 61.0% (− 76.0; − 41.4) in the intermediate and 61.9% (− 70.8; − 45.7) in the late group (n.s.) within the Empagliflozin group with no significant treatment groups—initiation time interaction (pint = 0.96). Secondary endpoints of left ventricular function (LV-EF, e/e`) as well as structure (LVESD and LVEDD) were also comparable between the groups. No significant difference in severe adverse event rate between the initiation time groups was detected.ConclusionVery early administration of SGLT2i after acute myocardial infarction does not show disadvantageous signals with respect to safety and appears to be as effective in reducing NT-proBNP as well as improving structural and functional LV markers as initiation after 2–3 days.

Platelet Therapy and Ovarian Rejuvenation in Women with Premature Ovarian Failure

Introduction: Premature Ovarian Failure (POF) is a disease that occurs before the age of 40 due to dysfunction of the ovaries. In these women، the production and secretion of estrogen hormone is not done properly. Such a situation causes irregular or interrupted periods، disturbances in the ovulation process and occurrence of menopausal symptoms. Premature ovarian failure makes it difficult for women to get pregnant، so more research in this field is necessary.&#x0D; Conclusion: The results showed that one of the recommended ways to repair and regenerate the failing ovarian tissue was the use of platelet-rich plasma (PRP). The positive effects of PRP were dependent on the high concentration of growth factors in the alpha granules of platelets. The results of this review article showed that the use of platelet-rich plasma in restoring ovarian function could be considered as a treatment method in these patients.&#x0D;

Evaluation of Post Extraction Bleeding Risk for Oral Surgery under Continued Clopidogrel Anti-platelet Therapy

Introduction: Continuous oral anti-coagulant treatment has been used to reduce the threat of thromboembolism for further than half a century, dragging the lives of thousands of cases. There is increased risk of haemorrhage doing dental procedures in patients on anticoagulant and antiplatelet therapy. Objective: To evaluate the post extraction bleeding rate for oral surgery carried out under continued anti- platelet therapy with clopidogrel. Methods: This prospective observational study was carried out in the department of 'Oral and Maxillofacial (OMF) Surgery', Military Dental Centre (MDC), Dhaka. A total of 35 patient’s maintenance once daily low dose clopidogrel were purposely selected for this study. The extraction procedure under local anesthesia using 2% lidocaine with 1:1,00,000 epinephrine were done traumatically. A gelatin sponger piece was put down in socket and shut by atraumatic silk. The patients were instructed to apply pressure pack with sterile gauze for within 30 mins. Timing of haemostasis was done in every 9.5 minutes for within 30 minutes. Results: Among 35 patients, mean age was 52.3±10.1 with age range 35 to 69 years. Male patients were predominant (60.0%) with male:female ratio was 1.5:1. Simple extraction was done in 29 patients while rest extractions were done surgically. Majority 22(62.9%) of the patients were managed by pressure pack with gelatin sponge while 15(42.9%) patients were managed by pressure pack only. Regarding post extraction bleeding, majority of the cases haemostasis (91.4%) was achieved within 9.5 minutes after teeth extraction while only 3(8.6%) patients haemostasis 19 to 28.5 minutes after teeth extraction. Conclusion: The study concluded that majority of the patients were managed pressure pack with gelatin sponge and most of the patients had post extraction bleeding time 9.5 minutes. Minor oral surgery can be carried out safely under continued mono antiplatelet therapy with clopidogrel. JAFMC Bangladesh. Vol 18, No 2 (December) 2022: 28-30

The Year in Coagulation and Transfusion: Selected Highlights from 2022

This is an annual review to cover highlights in transfusion and coagulation in patients undergoing cardiovascular surgery. The goal of this article is to provide readers with a focused summary of the most important transfusion and coagulation topics published in 2022. This includes a discussion covering the management of anemia and red blood cell transfusion, the management of factor Xa inhibitors, updates in coagulation testing, updates in the use of factor concentrates, advances in platelet therapy, advances in anticoagulation management of patients on extracorporeal membrane oxygenation and other forms of mechanical circulatory support, and advances in the diagnosis and management of heparin-induced thrombocytopenia.

Case Report: Case report: Effect of intraovarian platelet-rich plasma therapy on latent female genital tuberculosis patient

Latent female genital tuberculosis (FGTB) has been gaining attention in the world of assisted reproductive technology due to its adverse effect on the female reproductive system, which is becoming a cause of concern in the pathway of fulfilling the dream of children in infertile couples. It has been known to severely affect the ovarian reserve, which is one of the prime causes of infertility in females nowadays. Intraovarian plasma-rich platelet therapy (IOPRP) has been known to improve diminished ovarian reserve (DOR); however, its effect on DOR caused due to latent FGTB is not known. A 34-year-old middle-aged South Asian woman was unable to get pregnant due to being a victim of latent female genital tuberculosis. The patient also had a history of four failed IUI (intra-uterine insemination) cycles prior to their visit to Wardha Test Tube Baby Centre, Sawangi, Maharashtra, in January 2021. The patient had reported having improved ovarian reserve, thereby having positive clinical pregnancy upon the administration of IOPRP at our centre. This case report throws light on the aspect that the use of IOPRP on patient suffering from DOR caused due to latent FGTB may lead to significant positive pregnancy outcomes.

CARC13: Evaluation of Response to Aspirin Platelet Therapy and Hemocompatibility-Related Adverse Events with the HeartMate 3 Left Ventricular Assist Device

Background: Left ventricular assist device (LVAD) patients usually are prescribed a combination of anticoagulation and aspirin (ASA) therapy. HeartMate 3 (HM3) demonstrates reduced hemocompatibility-related adverse events (HRAEs) including stroke, thrombosis and bleeding. However, it’s not known whether ASA responders vs. non-responders are non-inferior in the incidence of HRAEs, and whether there are temporal changes in ASA sensitivity during HM3 support. Methods: This prospective, observational, single-center cohort study included 21 HM3 LVAD patients (Age: 59.0±11.1 years, female: 4.8%, BMI: 29.6±6.1kg/m2) implanted between 2019 and 2021, with serial ASA platelet sensitivity assays (VerifyNow Assay). ASA platelet therapy resistance was defined by ASA reactivity units (ARU) > 550. Primary endpoint was the incidence of HRAEs (ASA responders vs. non-responders) 6 months before initial assessment and until the next outpatient follow-up visit (3 months ± 30 days). Secondary endpoint was the temporal change in ASA resistance. Results: Eight (38.1%) patients were ASA resistant at the first ARU assessment (426 days after HM3 implantation) and 21.1% (p=0.38) during follow-up, without ARU changes over time (512±64 vs. 491±53, p=0.22). ASA responders and non-responders received a comparable ASA daily dose per-protocol (108±28mg vs. 100±28mg, p=0.43), without significant differences in baseline demographics (age: 62±9 vs. 55±14 years, p=0.17; female: 0% vs. 12.5%, p=0.38; BMI: 29±7 vs. 32±3, p=0.55; ischemic heart failure: 46.2% vs. 25.0%, p=0.45) or risk factors (Atrial fibrillation: 30.8% vs. 25.0%, diabetes: 30.8% vs. 37.5% and stroke history: 15.4% vs. 12.5%, p>0.99). The incidence of HRAEs was comparable between ASA responders and non-responders 6 months before the first measurement (15.4% vs. 0.0%, p=0.26) and between the two ARU measurements (0.0% vs. 12.5%, p=0.22). Conclusion: Although the ASA resistance varies considerably between LVAD outpatients, without significant changes over time, the HM3 demonstrated excellent hemocompatibility. Further large-scale multicenter studies are needed to confirm the findings of this study that ASA plays only a minor role in antithrombotic treatment with HM3 and can be safely removed.

P320 AN UNUSUAL CASE SYNCOPE DUE TO SILENT CORONARY VASOSPASM

Abstract Background Variant angina is a condition due to a transient vasospasm of the epicardial coronary arteries, which usually causes chest pain episodes and may be associated with dangerous arrhythmias. A non–negligible subset of patients can also experience silent myocardial ischemia, defined as objective documentation of myocardial ischemia in the absence of angina or equivalents. This condition is associated with increased cardiac mortality and incidence of acute cardiac events. Description of the case. A 65–years–old man was admitted to our Emergency Department for syncope. He reported palpitations before the event without chest pain. ECG showed biphasic T waves in V2–V6 (Fig 1A), troponin values were normal. Immediately after admission in our coronary care unit for monitoring, he developed dynamic ST segment elevation with signs of inferior and posterior transmural ischemia (Fig 1B) and non–sustained polymorphic ventricular tachycardias (Fig 2), being symptomatic only for palpitations. ECG abnormalities and symptoms quickly resolved after intra–venous nitrates administration. Coronary angiography was performed showing a critical non–occlusive (85%) fixed stenosis at the proximal right coronary artery (Fig 3 A). The lesion was treated by angioplasty and stenting (Fig 3 B) and the patients was discharged on dual anti–platelet therapy, statins and oral high–dose calcium–channel antagonist. Discussion This case underlines first the importance of searching for high–risk features in patients with syncope of non–obvious origin: our patient reported palpitations and ECG changes consistent with myocardial ischemia (even with normal troponin values and echocardiographic findings). A peculiarity of our case is that the patient did not complaint any chest pain despite the presence of ST elevation, a condition known as silent ischemia. The transient nature of ECG modification and ventricular arrhythmias, their dramatic response to nitrates and coronary angiography findings were suggestive of silent vasospasm. Coronary vasospasm induces transient myocardial ischemia and may cause ventricular arrhythmias which in turn can cause syncope due to transient cerebral hypoperfusion or, when sustained, even cardiac arrest and sudden death. We did not perform provocative test with acetylcholine or ergonovine due to the likely vasospastic origin of myocardial ischemia and to their potential risks, especially in the presence of non–sustained plymorphic ventricular tachycardias.

The Role of Platelets in Infective Endocarditis.

Over the last decade, the incidence of infective endocarditis (IE) has increased, with a change in the frequency of causative bacteria. Early evidence has substantially demonstrated the crucial role of bacterial interaction with human platelets, with no clear mechanistic characterization in the pathogenesis of IE. The pathogenesis of endocarditis is so complex and atypical that it is still unclear how and why certain bacterial species will induce the formation of vegetation. In this review, we will analyze the key role of platelets in the physiopathology of endocarditis and in the formation of vegetation, depending on the bacterial species. We provide a comprehensive outline of the involvement of platelets in the host immune response, investigate the latest developments in platelet therapy, and discuss prospective research avenues for solving the mechanistic enigma of bacteria-platelet interaction for preventive and curative medicine.

The Glanzmann Thrombasthenia Registry: safety of platelet therapy in patients with Glanzmann thrombasthenia and changes in alloimmunization status.

Not available.

The Relationship Between PRECISE-DAPT Score and Spontaneous Reperfusion of Infarct-Related Artery in Patients with ST-Segment Elevation Myocardial Infarction.

Spontaneous reperfusion (SR) presence and a low PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Anti Platelet Therapy (PRECISE-DAPT) score in patients with acute coronary syndrome have been associated with favorable clinical outcomes. This study aimed to investigate the relationship between SR and this score. The study included 436 patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). Thrombolysis in myocardial infarction (TIMI) III blood flow presence in the infarct-related artery (IRA) before primary percutaneous coronary intervention (PCI) was defined as SR. Patients were categorized into two groups based on the presence (n = 49) or absence (n = 387) of SR. The PRECISE-DAPT score was computed for each patient using the web-based calculator. The group with SR had a lower frequency of hyperlipidemia and a higher ejection fraction (EF) at admission. Conversely, the group without SR presented with higher values of glucose, troponin, creatine kinase-myocardial band (CK-MB), and PRECISE-DAPT score. The no-reflow phenomenon and elevated SYNergy between PCI with TAXUS and Cardiac Surgery (SYNTAX-I) scores were higher in the group without SR than in the one with SR. Multivariate regression analysis indicated that a high PRECISE-DAPT score was an independent predictor of the absence of SR (odds ratio: 0.96, P = 0.04). The PRECISE-DAPT score is an independent predictor of the presence of spontaneous reperfusion in patients who experienced STEMI.

Risk Factors of Haematoma Formation Following Cardiac Implantable Electronic Device Procedures.

A single-centre cohort of 2,100 adults who consecutively underwent cardiac implantable electronic device procedures were retrospectively analysed to identify and quantify risk factors of perioperative pocket haematoma formation. Dual antiplatelet therapy was significantly associated with increased odds of haematoma formation (OR 11.7 for aspirin and clopidogrel, OR 11.8 for aspirin and ticagrelor and OR 104 for aspirin and prasugrel, p<0.05) on multivariate binomial logistic regression analysis. Aspirin monotherapy was also associated with increased bleeding risk (OR 3.02, p<0.01). Direct oral anticoagulants and warfarin were also each associated with increased odds of haematoma formation although to a lesser extent than dual anti platelet therapy (DAPT). Amongst oral anticoagulants, apixaban was associated with the lowest bleeding risk (OR 2.59, p=0.03) whilst dabigatran was associated with the highest (OR 3.81, p=0.04). There was a significant incremental reduction in bleeding risk by 8% per 10x103/μL increase in platelet count. DAPT was associated with increased odds of pocket haematoma formation following cardiovascular implantable electronic device (CIED) procedure. This likelihood was higher than with oral anticoagulation therapy. Timely medication reconciliation of P2Y12 inhibitors according to guidelines is important to avoid post-procedural bleeding complications. Perioperative policies which account for the half-life of withheld anticoagulant agents may help reduce the haematoma risk.

Coupled benefits of nanotopography and titania surface chemistry in fostering endothelialization and reducing in-stent restenosis in coronary stents

Recent advances in coronary stents have all been distinctively focused towards directing re-endothelialization with minimal in-stent restenosis, potentially via alterations in surface topographical cues, for augmenting the efficacy of vascular implants. This perspective was proven by our group utilizing a simple and easily scalable nanosurface modification strategy on metallic stents devoid of any drugs or polymers. In the present work, we explore the impact of surface characteristics in modulating this cell response in-vitro and in-vivo, using titania coated cobalt-chromium (CC) stents, with and without nanotopography, in comparison to commercial controls. Interestingly, titania nanotopography facilitated a preferential cell response in-vitro as against the titania coated and bare CC surfaces, which can be attributed to surface topography, hydrophilicity, and roughness. This in turn altered the cellular adhesion, proliferation and focal contact formations of endothelial and smooth muscle cells. We also demonstrate that titania nanotexturing plays a pivotal role in fostering rapid re-endothelialization with minimal neointimal hyperplasia, leading to excellent in-vivo patency of CC stents post 8 weeks implantation in rabbit iliac arteries, in comparison to bare CC, nano-less titania coated CC, and commercial drug-eluting stents (CC DES), without administering antiplatelet agents. This exciting result for the drug and polymer-free titania nanotextured stents, in the absence of platelet therapy, reveals the possibility of proposing an alternative to clinical DES for coronary stenting.

Anticoagulants and fracture morphology have a significant influence on total blood loss after proximal femur fractures

IntroductionBlood loss after proximal femoral fractures is an important risk factor for postoperative outcome and recovery. The purpose of our study was to investigate the total blood loss depending on fracture type and additional risks, such as anticoagulant use, to be able to recognize vulnerable patients depending on planned surgery and underlying comorbidities.Materials and methodsA retrospective single center study including 1478 patients treated operatively for a proximal femoral fracture between January 2016 and June 2020 at a level I trauma center. Patient data, surgical procedure, time to surgery, complications and mortality were assessed. Lab data including hemoglobin and transfusion rates were collected. The Mercuriali formula was implemented to calculate total blood loss. Linear regression was performed to identify influencing factors.ResultsOne thousand four hundred seventy-eight mainly female patients were included in the study (mean age: 79.8 years) comprising 667 femoral neck fractures, 704 pertrochanteric- and 107 subtrochanteric fractures. Nearly 50% of the cohort were on anticoagulants or anti- platelet therapy. At time of admission average hemoglobin was 12.1 g/l. Linear regression proved fracture morphology, age, BMI, in-house mortality and anticoagulant use to have crucial influence on postoperative blood loss. Femoral neck fractures had a blood loss of 1227.5 ml (SD 740.4 ml), pertrochanteric fractures lost 1,474.2 ml (SD 830 ml) and subtrochanteric femoral fractures lost 1902.2 ml (SD 1,058 ml).ConclusionsHidden blood loss is underestimated. Anticoagulant use, fracture type, gender and BMI influence the total blood loss. Hemoglobin levels should be monitored closely. Within 48 h there was no increased mortality, so adequate time should be given to reduce anticoagulant levels and safely perform surgery.

Risk of Postdischarge Bleeding From Dual Antiplatelet Therapy After Percutaneous Coronary Intervention Among US Black and White Adults.

Background Dual antiplatelet therapy after percutaneous coronary intervention reduces myocardial infarctions but increases bleeding. The risk of bleeding may be higher among Black patients for unknown reasons. Bleeding risk scores have not been validated among Black patients. We assessed the difference in bleeding risk between Black and White patients along with the performance of the Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Anti Platelet Therapy, Patterns of Nonadherence to Antiplatelet Regimens in Stented Patients, and Academic Research Consortium for High Bleeding Risk scores among both groups. Methods and Results This was a single-center prospective study of patients who underwent percutaneous coronary intervention (2014-2019) and were followed for 1 year. The outcome was postdischarge Bleeding Academic Research Consortium 2 to 5 bleeding. Incidence rates were reported. Cox proportional hazards models measured the effect of self-reported Black race on bleeding and determined the predictors of bleeding among 19 a priori variables. The 3 risk scores were assessed among Black and White patients separately using the Harrell concordance index. Of 1529 included patients, 342 (22.4%) self-reported as being Black race. Unadjusted bleeding rates were 22.7 per 100 person-years among Black patients versus 16.3 among White patients (hazard ratio, 1.41 [95% CI, 1.00-2.00], P=0.052). Predictors of bleeding were age, glomerular filtration rate <30 mL/min per 1.73 m2, prior bleeding, ticagrelor or prasugrel use, and anticoagulant use. Among Black and White patients, respectively, the C-indexes were the following: 0.644 versus 0.600 for Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Anti Platelet Therapy (P<0.001 for both), 0.620 versus 0.612 for Patterns of Nonadherence to Antiplatelet Regimens in Stented Patients (P=0.003 and P<0.001, respectively), and 0.600 versus 0.598 for Academic Research Consortium for High Bleeding Risk (P=0.006 and P<0.001, respectively). Conclusions The risk of dual antiplatelet therapy-associated postdischarge Bleeding Academic Research Consortium 2 to 5 bleeding was not significantly different between self-reported Black and White patients. Bleeding risk scores performed similarly among both groups.

TCT-165 A Novel Ticagrelor Coated Stent to Eliminate the Need for Anti Platelet Therapy Post PCI

TCT-165 A Novel Ticagrelor Coated Stent to Eliminate the Need for Anti Platelet Therapy Post PCI