Platelet Therapy Research Articles

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

122. Anticoagulation therapy in cervical spine fractures: insights from a large health care database analysis

<h3>BACKGROUND CONTEXT</h3> The type of chemical thromboembolic event (TEE) prophylaxis to administer following cervical spine fracture is a matter of contention. The risk of TEE must be weighed against the risk of bleeding complications from the therapy itself. Patients with cervical fractures may be at greater risk of devastating bleeding complications such as epidural hematoma, particularly after surgical decompression. The goal of this database study was to provide an accurate estimate to serve as a reference in the literature for the incidence of TEE in these patients. <h3>PURPOSE</h3> The purpose of this study was to (1) evaluate comorbidity burden, (2) rate of thromboembolic events, (3) rate of anemia and transfusion events, and (4) evaluate utilization rates of various forms of pharmacologic prophylaxis following cervical spine fracture. <h3>STUDY DESIGN/SETTING</h3> Retrospective database study. <h3>PATIENT SAMPLE</h3> The study included 5,871 patients who were treated with anticoagulation therapy within 6 months of cervical spine fracture identified from the Humana Insurance Database. <h3>OUTCOME MEASURES</h3> (1) Thromboembolic events, (2) transfusion proportion, and (3) anemia proportion, based on various types of AC therapy. <h3>METHODS</h3> A retrospective review of the Humana insurance database from 2007 to 2016 was performed to identify patients who sustained a fracture of the cervical spine and prescribed anticoagulation therapy. Patients were subdivided by the type of agent prescribed: aspirin/anti platelet therapy, warfarin, heparin/low molecular weight heparin (LMWH), or factor Xa inhibitors. Each cohort was longitudinally tracked for 6 months following surgery for occurrence of deep venous thrombosis (DVT), pulmonary embolism (PE), stroke, anemia or blood transfusion. Chi-square test was used to determine significance. <h3>RESULTS</h3> A total of 5,871 patients were included. Demographics of each cohort were statistically similar. Patients receiving warfarin had a greater CCI compared to the other cohorts (4.1; p < 0.05). Patients on aspirin/anti-platelet therapy were the least likely to develop any TEE (2.1%; p < 0.05). There was no statistically significant difference found between cohorts in regard to the incidence of stroke, transfusion rate or anemia. <h3>CONCLUSIONS</h3> Aspirin and anti-platelet anticoagulation therapy after cervical fracture had the least number of thromboembolic events when used within 6 months compared to other common forms of anticoagulation, without any statistically significant difference in bleeding risk. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Alveolar osteitis: the current state of knowledge

Introduction and purpose:&#x0D; Alveolar osteitis, also known as dry socket is a common complication after tooth extraction, especially third molar extraction. Taking into consideration only third molar extractions, the prevalence of dry socket reaches even 45%. The aim of this literature review was to describe current knowledge about etiology, risk factors, treatment, and prevention of dry socket.&#x0D; State of knowledge:&#x0D; The symptoms of alveolar osteitis most frequently are reported between the first and third post-extraction days and they include discomfort, lancing, and intense pain which radiates to the neck and ear. The etiopathogenesis of dry socket remains unclear. However, the currently accepted hypothesis describes a loss of formed after an extraction blood clot from the alveolar socket as the main cause of this pathology. Several factors may increase the risk of dry socket and include smoking, oral hygiene, female gender, oral contraceptive drugs, and anesthesia. In the treatment of alveolar osteitis, irrigation of the socket with chlorhexidine gluconate, iodopovidone, or physiological saline followed by filling the socket with intra-alveolar dressing constitute a current fundamental procedure. Plenty of substances are currently used as an intra-alveolar dressing. Part of them exhibits only pain-decreasing features, whereas some drugs can also stimulate the regeneration of treated tissue. In the prevention, the use of alveolar osteitis warm saline, antibiotics, chlorhexidine, ozone gas, or autologous platelet therapy may be useful maneuvers.&#x0D; Conclusion:&#x0D; This literature review summarizes the current state of knowledge about causes, risk factors, and therapeutic and preventive methods with regard to alveolar osteitis.

Assessment of effect of anti-platelet therapy on minor surgical procedures

Background: Antiplatelet therapy is to treat thromboembolic disorders, but it causes hemorrhages. Aspirin is the drug in regular practice. The present study was conducted to assess the effect of anti- platelet therapy on minor surgical procedures. Materials &amp; Methods: 80 patients selected for mandibular third molar extraction of both genders were randomly divided into 2 groups of 40 each. In Group I, patients on antiplatelets drugs (75 mg of aspirin/ 75 mg clopidogrel) were enrolled and in group II, patients who discontinued the drug before 5 days of extraction of mandibular third molar were enrolled. Bleeding was observed after 1 and 24 hours. Results: Group I had 24 males and 16 females and group II had 14 males and 26 females. The mean bleeding time in group I was 75.21 seconds and in group II was 75.14 seconds. The mean duration of surgery in group I was 54.2 months and in group II was 52.1 months. After 1 hour, no bleeding was seen in 38 in group I and 39 in group II and ooze in 2 in group I and 1 in group II.

The Comparison of Efficacy of Platelet Rich Plasma (PRP) with Methylprednisolone in Patients with Tennis Elbow

Objective: To study the efficacy of platelet-rich plasma with Methylprednisolone in patients with tennis elbow.&#x0D; Study Design: Prospective longitudinal study.&#x0D; Place and Duration of Study: Department of Orthopedics, Jinnah Postgraduate Medical Centre, Karachi, Feb 2019 to Sep 2020.&#x0D; Methodology: All the patients with chronic lateral epicondylitis with the onset of symptoms of greater than three months were grouped into two groups. Seventy-six patients in each group were treated. Group-A received an injection of 5ml Platelet-rich plasma. Group-B was administered 1 ml of Methylprednisolone (dosage; 4-30 mg). The severity of pain using the visual analogue scale was evaluated at baseline.&#x0D; Results: In the PRP group, significant changes in pain perception were observed. The mean baseline VAS score in the PRP group was 6.9 ± 1.7, which decreased to 3.4 ± 2.9, 1.7 ± 0.3, and 1.2 ± 1.4 at four weeks, 12 weeks, and 52 weeks follow-up visit, respectively. Similarly, in group-B (Methylprednisolone), there was a significant change from baseline to 52 weeks postprocedure (p&lt;0.001). It was found that the efficacy of Platelet free plasma was significantly higher than methylprednisolone (77.6% versus 48.7%, &lt;0.005).&#x0D; Conclusions: The study concluded that Plasma rich platelet therapy was significantly more effective in relieving the pain and improving the functional outcomes in patients with elbow epicondylitis than Methylprednisolone.

Challenges and Opportunities Associated With Platelets in Pancreatic Cancer.

Pancreatic cancer is one of the most common malignant tumors in the digestive system with a poor prognosis. Accordingly, better understanding of the molecular mechanisms and innovative therapies are warranted to improve the prognosis of this patient population. In addition to playing a crucial role in coagulation, platelets reportedly contribute to the growth, invasion and metastasis of various tumors, including pancreatic cancer. This narrative review brings together currently available evidence on the impact of platelets on pancreatic cancer, including the platelet-related molecular mechanisms of cancer promotion, pancreatic cancer fibrosis, immune evasion, drug resistance mechanisms, thrombosis, targeted platelet therapy, combined radiotherapy and chemotherapy treatment, platelet combined with nanotechnology treatment and potential applications of pancreatic cancer organoids. A refined understanding of the role of platelets in pancreatic cancer provides the foothold for identifying new therapeutic targets.

Substantially High Hidden Blood Loss in Oblique Lateral Interbody Fusion: Retrospective Case Series.

Background and Objectives: Measured blood loss frequently underestimates true blood loss; this discrepancy is called hidden blood loss (HBL). The purpose of the present study was to measure HBL in oblique lateral interbody fusion (OLIF). Materials and Methods: Patients who underwent two-stage OLIF at our institute from September 2017 to September 2021 were retrospectively reviewed. Total blood loss (TBL) and HBL were calculated using the gross formula. The age, sex, body mass index (BMI), operation time, measured blood loss, the number of fused segments, hematocrit (HCT), anticoagulant or platelet medication, blood transfusion, days of hospitalization, pre-/postoperative Japanese Orthopedic Association (JOA) score, and JOA recovery rate were compared. Results: A total of thirteen patients were included in the study. The average age, BMI, number of fused segments, operation time, estimated blood loss, and blood transfusion were 69.5 years, 23.3, 2.5, 250 min, 122 mL, and 230 mL, respectively. Five patients received anticoagulant or platelet therapy. Days of hospitalization, pre-/postoperative JOA score, and JOA recovery rate were 14.9 ± 5.1, 19.9 ± 2.7, and 18.0 ± 43.4%, respectively. The TBL and HBL were 688 and 797 mL, respectively. Stepwise multiple regression analysis revealed that younger age (p = 0.01), female sex (p = 0.01), and number of fused segments (p = 0.02) were significantly associated with higher HBL. Conclusions: The HBL in OLIF was 797 mL, which was more than other previously reported procedures. Therefore, OLIF may not be less invasive in terms of HBL. Blood loss after surgery should be considered, especially when patients are younger, are female, and have a greater number of fused segments.

A Novel Technique Combining Human Acellular Dermal Matrix (HADM) and Enriched Platelet Therapy (EPT) for the Treatment of Vaginal Laxity: A Single-Arm, Observational Study.

BackgroundThere is a paucity of knowledge about cosmetic vaginal tightening procedures; therefore, the present study aimed to describe the clinical effects of a novel combination technique of human acellular dermal matrix (HADM) and enriched platelet therapy (EPT) for the treatment of vaginal laxity.MethodsThis single-arm, observational study was conducted on 52 patients with grade II to III vaginal relaxation. HADM biological band (U-shaped) was implanted in these patients by submucosal puncture in vagina under anesthesia. This was followed by thrice administration of EPT injection, once at the time surgery followed by each dose at a time interval of one month. Patients were followed up for a period of 6 months based on Female Sexual Function Index (FSFI) and Vaginal Health Index (VHI) scores. Patient satisfaction was measured using Visual Analogue Score (VAS).ResultsAbout 52 women with median age of 39 years were included in the study. The average time reported to complete HADM surgery was reported as 27 minutes. Following implantation, it was found that labia minora was significantly closed and perineal length was increased from 1.5 to 2.2 cm. Moreover, there was improvement in elasticity, contractility and lubricity of vaginal mucosa. The sexual function scores from pre- to post-surgery were significantly increased (7.95 vs. 30.09; p value: <0.001). The mean VHI score also increased significantly after 6 months of treatment (mean ± S.D. before vs after treatment: 11.2 ± 3.3 vs. 19.6 ± 4.1, P < 0.0001). The mean VAS after surgery was 1.61 ± 0.31. About 96% of the patients did not feel any pain after treatment at 6-month follow-up. No adverse effects were reported in this study.ConclusionsThese findings supported that combination treatment with HADM and EPT was safe and associated with both improved vaginal laxity and sexual function. These results may provide a novel surgical technique for this prevalent and undertreated condition.Level of Evidence IV: Therapeutic Study This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Assessment of Risk Factors for Drug Resistance of Dual Anti Platelet Therapy After PCI.

Since aspirin and clopidogrel are the widely and conventionally used drugs to treat acute myocardial infarction after percutaneous coronary intervention (PCI), it is important to explore potential risk factors of their resistance. The platelet aggregation rate with arachidonic acid (AA, PAg-AA%) and adenosine diphosphate (ADP, PAg-ADP%) of 219 PCI patients were measured after standard treatment for 24 h. The disease history and laboratory data (before PCI) were obtained. We found 101 (46.12%) patients to be aspirin-resistant, and PAg-ADP% was the most prominent risk factor of aspirin resistance. Clopidogrel resistance was present in 157 of 219 patients. Patients in the clopidogrel-resistant group carried more CYP2C19*3 or *2, which was associated with higher clopidogrel resistance in this group (69.11%, 47/68) than in the control group (64.29%, 36/56). Platelet count (109/L) and hemoglobin (g/L) were the prominent risk factors of clopidogrel resistance. Among the 219 patients, 98 showed dual antiplatelet drug resistance, for which platelet count (109/L) and monocyte count (g/L) were the risk factors. Aspirin resistance was found to usually accompany clopidogrel resistance.

Acute Renal Infarcts from Spontaneous Intra-Renal Dissection: Case Series with a Review of Literature

Introduction: To explore the causes and management of renal infarction from pathologies such as renal artery fibromuscular dysplasia and spontaneous dissection. It is a rare occurrence and often misdiagnosed in clinical practice. Methods: We present four patients, between 30-50 years of age, who have no underlying cardiac conditions, hypertension or diabetes mellitus. They presented with abdominal/loin/flank pain due to spontaneous renal artery dissection and were treated with endovascular stents. Two patients had renal artery fibromuscular dysplasia, confirmed by CT angiogram. Results: All four patients recovered fully from the operation, with no post-operative complications noted. These patients were post-operatively managed medically with anti- platelet therapy for two years and have not experience any post-procedural complications at their 24-month follow up

Coronavirus disease 2019 in patients with chronic immune thrombocytopenia on thrombopoietin receptor agonists: new perspectives and old challenges.

There are limited data on the impact of severe acute respiratory syndrome corona virus 2 infection in patients previously diagnosed with primary immune thrombocytopenia (ITP) on thrombopoietin receptor agonist therapy (TPO-RA). Seven chronic ITP patients who had contracted COVID-19 and had been treated with TPO-RA are included in the study. Demographic, ITP treatment and comorbidities data were collected retrospectively from patients' medical records. Data regarding clinical course of COVID-19 were collected prospectively. During the infection, all patients had platelet count higher than average, and platelet count peak was mainly observed on day 7. For that reason, therapy modification was required. However, platelet count increment was transient in most ITP patients. One patient developed pulmonary embolism despite the use of therapeutic dose of anticoagulants. One patient died of respiratory failure whereas another developed rebound thrombocytopenia after the infection and consequential intracerebral hemorrhage. Careful platelet count monitoring and therapy management are needed in chronic ITP patients on TPO-RAs with COVID-19.

Abstract 12563: The Trajectory of Platelet Factor 4 in Acute Myocardial Infarction and the Impact of PCSK9-Inhibition

Introduction: Increased platelet activity during the peri- and early post-infarction period may contribute to adverse outcomes during that time. Platelet factor 4 (PF4) promotes coagulation and inflammation. The trajectory of PF4 and the impact of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition on that trajectory are unknown. Hypothesis: Early administration of the PCSK9 inhibitor evulocumab, added to dual anti-platelet therapy, inhibits a rise in PF4 during the early post-infarction period. Methods: Participants from the Evolocumab in Acute Coronary Syndrome trials (EVACS; NCT03515304, NCT04082442), with a NSTEMI and a troponin-I of &gt; 5 ng/ml or a STEMI were randomized to placebo or to 420 mg SQ of evolocumab within 24 hours of hospitalization. We performed serial ex vivo serum PF4 levels obtained at baseline (prior to study drug administration), and at days 1 and 30 and PF4 values were normalized to total platelet count. Normally distributed data were summarized using means and standard deviations and non-normally distributed data using medians and interquartile ranges. Results: Twenty-three participants were randomized to placebo and 23 to evolocumab. Mean age was 60±13 years, 48% were women, 22% were African American and 96% were on dual anti platelet therapy. Baseline PF4 concentrations (expressed as ng/1k platelets) did not differ between the two groups (placebo: 9.3 [4-12] vs evolocumab 8.0 [4-12], p=0.8). There was no significant change in PF4 in the placebo group from baseline to day 1 but a significant increase to 13.0 [11-14], p&lt;0.01 (baseline vs 30 days) at 30 days (+32%). In contrast, there were no significant changes from baseline in the evolocumab group at either of the timepoints. At 30 days PF4 was higher in the placebo group 13.06 [11-14] than the evolocumab group 10.7 [6-13], p=0.04. Further analysis of results in the evolocumab group did not show any significant changes in PF4 based on the type of P2Y12 inhibitor used and no association with the change in LDL-cholesterol. Conclusion: A rise in PF4 levels was observed during the early post-infarction period in acute myocardial infarction patients. This rise was reversed by a single 420 mg SQ dose of evolocumab administered within 24 hours of hospital admission.

Outcomes of Patients with Chronic Myelomonocytic Leukemia (CMML) Treated with Hypomethylating Agents

Outcomes of Patients with Chronic Myelomonocytic Leukemia (CMML) Treated with Hypomethylating Agents

S1711 Ischemic Colitis Combined With Adenomatous Polyp Presenting as Malignant-Like Lesion

Introduction: Ischemic colitis is a common colonic vascular diordedr in the elderly population, so is adenomatous polyps in the colon. We present an unusal case where a patient had an ischemic colitis in the area of an adenomatous polyp, giving an appearance that resembles malignant neoplasm of the colon. Case Description/Methods: An 83-year-old female presented to the emergency department with flash pulmonary edema secondary to hypertensive emergency requiring urgent hemodialysis. She had no history of atrial fibrillation that would suggest thromboembolic phenomenon. She reported no GI bleeding history and never underwent an endoscopy or colonoscopy. Laboratory studies showed up trending troponin (from 0.1 to 2.5) with EKG changes concerning for non-ST elevation myocardial infarction (NSTEMI). Pt was started on treatment with dual anti platelet therapy and heparin infusion. Next morning, the patient reported a sudden urge to defecate and crampy abdominal pain which resolved after large maroon-colored bowel movement. Significant drop in Hb from 9.2 to 7.1 ( >2 grams/dl) was found but the patient remained hemodynamically stable. Colonoscopy was performed which showed a 4-5 cm ulcerated raised lesion with round semi-pedunculated polyp at the edge of the lesion (Kudo Pit pattern 3 L) in the descending colon [Figure]. Biopsies were obtained from the ulcerated lesion as well as the polyp located at the edge of the lesion. Pathologic examination of ulcer lesion biopsy showed necrotic debris and inflammatory exudates with reactive/reparative epithelial changes along with minute fragments showing crypt drop out and hyalinized lamina propria, suggestive of ischemic change. Deeper levels were examined and showed no malignancy. Biopsy of polyp showed fragments of tubular adenoma. Patient recovered from her ischemic colitis and NSTEMI and recovered well and was discharged from the hospital. Discussion: The incidental proximity of the ischemic area to the polyp gave a malignant appearance to the area. However, biopsies confirmed there was only ischemic changes in the ulcerated area and biopsies from the polyp showed tubular adenoma with no malignant cells nor high grade dysplasia. The ischemic colitis is likely the cause of bleeding in this case. She was scheduled for follow-up for discussion of repeat colonoscopy for polyp resection on elective basis.Figure 1.: Ulcerated raised lesion with round semi-pedunculated polyp at the edge of the lesion in the descending colon.

Comparison of Outcome of Bleeding with Single and Dual Antiplatelet Therapy in Beating Heart Surgery

Objective: To compare the outcome of Bleeding with Single and Dual Antiplatelet Therapy in Beating Heart Surgery Methodology: A total of 102 cases between 25 to 60 years, of either gender, advised CABG procedure and suitable for beating heart surgery were included in the study. Whereas those with known bleeding diathesis, not suitable candidate for beating heart surgery and with concomitant valvular heart disease were excluded from the study. These cases were enrolled through wards of Cardiothoracic Surgery Department, Shaikh Zayed Hospital, Lahore. Three groups were formed A,B and C. Group-A was assigned to DAPT, Group-B was SAPT (single anti platelet therapy) and Group ”C” was on DAPT that is ASPRIN 75 mg and CLOPIDOGREL 75mg till the time of surgery. Control group A was compared with group B (SAPT) and group C (DAPT) for bleeding risk. The indications of blood products transfusion was assessed by baseline HCT platelet counts, PT and APTT. The CABG was carried out through a full sternotomy incision, under general anesthesia by using routine cardio protective measures and surgical techniques. Operating surgeon decided for on pump or off pump CABG. All patients were assessed and managed in ICU after Coronary artery bypass grafting. Duty doctor and anesthetist decided about transfusion of any allogenic blood product. Transfusion decision was made on the basis of routine laboratory values of APTT, ACT, and INR of PT, as well as on Hb. and HCT levels. Moreover, the need of non-self blood products was predicted. Results: In our study, mean age was calculated as 52.65+7.48 years, 50.32+5.68 years and 48.47+5.96 years respectively, 61.76%(n=21) in Group-A, 52.94%(n=18) in Group-B and 44.12%(n=15) in Group-C were male whereas 38.24%(n=13) in Group-A, 38.24%(n=16) in Group-B and 55.88%(n=19) in Group-C were females, comparison of Perioperative blood loss as 597.29+129.26 in Group-A, 643.18+65.42 in Group-B and 654.70+59.16 in Group-C, p value was 0.02. Conclusion: We concluded that Dual Antiplatelet Therapy have more chances of Peri-Operative bleeding as compare to heparin only or Single Antiplatelet Therapy in Coronary artery bypasses grafting on Beating heart. However, it has advantage of short pre procedure stay, reduced chances of ischemic events, less chance of canula related cellulitis and less chances of HIT. Whereas the cases administered with Heparin alone are having a greater chance of canula related cellulitis, expensive, prolonged pre procedure hospital stay with increased chances of HIT (Heparin induced thrombocytopenia. Keywords: CABG , Perioperative bleeding, Dual Antiplatelet Therapy, Single Antiplatelet Therapy

Platelet dysfunction in patients with traumatic intracranial hemorrhage: Do desmopressin and platelet therapy help or harm?

BackgroundPre-injury anti-platelet use has been associated with increased risk of progression of traumatic intracranial hemorrhage (TICH) and worse outcomes. VerifyNow® assays assess platelet inhibition due to aspirin/clopidogrel. This study assesses the outcomes of patients with TICH and platelet dysfunction treated with desmopressin and/or platelets. MethodsWe performed a retrospective chart review of patients with mild TICH at a level 1 trauma center 1/1/2013–6/1/2016. Patients with documented platelet dysfunction who received desmopressin and/or platelets were compared to those who were untreated. Primary outcomes were progression of TICH and neurologic outcomes at discharge. ResultsOf 565 patients with a mild TICH, 200 patients had evidence of platelet dysfunction (a positive VerifyNow® assay). Patients had similar baseline demographics, injury characteristics, and rate of TICH progression; but patients who received desmopressin and/or platelets had worse Glasgow Outcomes Score at discharge. ConclusionTreatment of patients with mild TICH and platelet dysfunction with desmopressin and/or platelets did not affect TICH progression but correlated with worse neurologic status at discharge.

P2Y12 blocker monotherapy after percutaneous coronary intervention.

For secondary prevention of coronary artery disease (CAD) antiplatelet therapy is essential. For patients undergoing a percutaneous coronary intervention (PCI) temporary dual antiplatelet platelet therapy (DAPT: aspirin combined with a P2Y12 blocker) is mandatory, but leads to more bleeding than single antiplatelet therapy with aspirin. Therefore, to reduce bleeding after a PCI the duration of DAPT is usually kept as short as clinically acceptable; thereafter aspirin monotherapy is administered. Another option to reduce bleeding is to discontinue aspirin at the time of DAPT cessation and thereafter to administer P2Y12 blocker monotherapy. To date, five randomised trials have been published comparing DAPT with P2Y12 blocker monotherapy in 32,181 stented patients. Also two meta-analyses addressing this novel therapy have been presented. P2Y12 blocker monotherapy showed a 50–60% reduction in major bleeding when compared to DAPT without a significant increase in ischaemic outcomes, including stent thrombosis. This survey reviews the findings in the current literature concerning P2Y12 blocker monotherapy after PCI.

The Association of a PRECISE-DAPT Score With No-Reflow in Patients With ST-Segment Elevation Myocardial Infarction.

This study aimed to evaluate the association of admission PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Anti Platelet Therapy (PRECISE-DAPT) score with the development of no-reflow (NR) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). In this observational, retrospective study, 335 consecutive STEMI patients who were treated with primary PCI were included. We classified the study population into 2 groups: patients with a PRECISE-DAPT score <25 and those with a PRECISE-DAPT score ≥25. Overall, 30 (8.9%) patients developed NR. The mean PRECISE-DAPT score (20.03 ± 15.32 vs 11.33 ± 12.18; P = .005) was significantly higher in cases who developed NR. Moreover, arrhythmic complications, in-hospital shock, and in-hospital mortality rates were significantly higher in patients with a PRECISE-DAPT score ≥25 compared to those with a PRECISE-DAPT score <25. According to a multivariable analysis, the PRECISE-DAPT score was found to be independently linked with NR (odds ratio: 2.87, with P = .015). To our knowledge, these data are the first in major medical science databases to determine the relationship between the PRECISE-DAPT score and the NR phenomenon in patients with STEMI undergoing primary PCI.

Impact of extended dual antiplatelet therapy on long-term prognosis in patients with acute coronary syndrome complicated with anemia: A sub-analysis of the real-world OPT-CAD study.

To evaluate the impact of extended dual antiplatelet therapy (DAPT) beyond 12 months on long-term prognosis in acute coronary syndrome (ACS) patients complicated with anemia undergoing percutaneous coronary intervention (PCI). Anemia is frequent among ACS patients and is associated with increased risk of adverse clinical outcomes. A total of 6,953 patients were enrolled from the Optimal anti Platelet Therapy for Chinese patients with Coronary Artery Disease (OPT-CAD) study. A landmark analysis comparing extended DAPT versus single antiplatelet therapy (SAPT) at 12-24 months were performed in anemia patients without premature discontinuation of DAPT before 9months and major clinical adverse events within 12 months. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of all-cause death, myocardial infarction, and stroke. Patients with anemia (n=1,728) had higher rates of MACCE, all-cause mortality, and BARC type 2, 3, 5 bleeding (p < .05) compared to those without anemia (n=5,225). Anemia patients received extended DAPT (n=1,010) were associated with a lower risk of stroke (0.3% vs. 1.8%; HR, 0.14; 95% CI, 0.03-0.71; p=.018) compared to those received SAPT (n=342). The rates of MACCE and all revascularization were lower in patients with extended DAPT, but the differences were not statistically significant. Risk of all-cause mortality and bleeding were comparable between the two groups. Extended DAPT beyond 12 months may reduce the incidence of stroke without increasing the risk of bleeding in anemic ACS patients who tolerate 12-month DAPT.

Theory and Evidence for Platelet Therapy of the Aging Face.

Platelet preparations are autologous blood concentrates with supraphysiologic concentrations of platelets with or without leukocytes used in various clinical applications including regenerative medicine, wound healing, and facial rejuvenation. Their use harnesses the important role of platelets and their secretory products in immunoregulation, wound healing, angiogenesis, and tissue remodeling. The use of platelet preparations has been long documented in orthopaedic surgery, maxillofacial surgery, and other fields, but over the years research has increased in their application to facial plastic surgical techniques. Here we review the various formulations of platelet rich concentrates, their applications to facial skin rejuvenation, wound healing, scar reduction, and tissue fill as documented in the literature since 2018.