Use Of Anticoagulant Drugs Research Articles

An analysis of perioperative hidden blood loss in femoral intertrochanteric fractures: bone density is an important influencing factor

BackgroundTo explore the influencing factors of perioperative hidden blood loss in intertrochanteric fractures.MethodWe undertook a retrospective analysis from January 2016 to October 2019. Clinical data of 118 patients with intertrochanteric fractures were included. Hidden blood loss was calculated from the haematocrit changes before and after surgery using the Gross equation based on height, weight, and haematocrit (HCT) changes before and after surgery. Patients’ gender, age, presence of underlying diseases, fracture types, anaesthesia methods, time from injury to surgery, administration of antiplatelet drugs within 6 months before surgery, use of anticoagulant drugs after surgery, and bone density were statistically analysed. Factors having an effect on hidden blood loss were screened out. Then, hidden blood loss was used as the dependent variable, and each influencing factor was used in turn as the independent variable. Multivariate linear regression analysis was employed to analyse the related risk factors that affect hidden blood loss during the perioperative period of patients with intertrochanteric fractures.ResultThe apparent blood loss during the operation was 203.81 ±105. 51 ml, and the hidden blood loss was 517.55±191.47 ml. There were significant differences in the hidden blood loss of patients with different fracture types (stable vs unstable), anaesthesia methods (general anaesthesia vs intraspinal anaesthesia), antiplatelet or postoperative anticoagulant drugs, and bone densities (P< 0.05). 05). Multiple linear regression analysis showed that internal fixation, age, fracture type, anaesthesia method, anticoagulant application, and bone density were related risk factors that affected hidden blood loss during the surgical treatment of intertrochanteric fractures.ConclusionHidden blood loss is the main cause of perioperative blood loss in intertrochanteric fractures, and the risk factors for hidden blood loss include internal fixation, fracture type (e.g., unstable), anaesthesia (e.g., intraspinal), and use of anticoagulant drugs. Specifically, we found that low bone density was a risk factor for hidden blood loss. It is not reliable to use apparent blood loss as the basis for fluid replacement and transfusion. We must fully consider the existence of hidden blood loss and intervene as soon as possible to prevent complications.Level of evidenceIII

Nomogram for Predicting Deep Venous Thrombosis in Lower Extremity Fractures.

Deep venous thrombosis (DVT) is a common complication in patients with lower extremity fractures, causing delays in recovery short-term and possible impacts on quality of life long-term. Early prediction and prevention of thrombosis can effectively reduce patient pain while improving outcomes. Although research on the risk factors for thrombosis is prevalent, there is a stark lack of clinical predictive models for DVT occurrence specifically in patients with lower limb fractures. In this study, we aim to propose a new thrombus prediction model for lower extremity fracture patients. Data from 3300 patients with lower limb fractures were collected from Wuhan Union Hospital and Hebei Third Hospital, China. Patients who met our inclusion criteria were divided into a thrombosis and a nonthrombosis group. A multivariate logistic regression analysis was carried out to identify predictors with obvious effects, and the corresponding formulas were used to establish the model. Model performance was evaluated using a discrimination and correction curve. 2662 patients were included in the regression analysis, with 1666 in the thrombosis group and 996 in the nonthrombosis group. Predictive factors included age, Body Mass Index (BMI), fracture-fixation types, energy of impact at the time of injury, blood transfusion during hospitalization, and use of anticoagulant drugs. The discriminative ability of the model was verified using the C-statistic (0.676). For the convenience of clinical use, a score table and nomogram were compiled. Data from two centers were used to establish a novel thrombus prediction model specific for patients with lower limb fractures, with verified predictive ability.

Retrospective Analysis of Intracranial Hemorrhages in the COVID-19 Pandemic.

To identify the characteristics of patients admitted to the emergency department with intracranial hemorrhages in the era of the COVID-19 pandemic. Seventy-eight patients with spontaneous intracranial bleeding who were admitted to emergency departments and treated in neurosurgery clinics between March 11, 2020, and September 11, 2020, were included in the study. The most frequent symptom was the loss of consciousness (32.1%), followed by headache (15.4%), syncope (10.3%), motor loss (9%), and seizures (9%). Antiaggregant and anticoagulant drug use were detected in 37.2% of the patients. Intraparenchymal hematoma was the most common type of intracranial hemorrhage (59%). Viral pneumonia was detected in 52.6% of the patients in thorax CTs. Surgical treatment was applied to 23.1% of the patients. There was no significant difference between patients with pneumonia and patients without pneumonia in the treatment modalities or 30-day mortality. In this study, we found that low Glasgow Coma Scores affected mortality and that mechanical ventilation needs are higher in ICH patients with COVID-19. Nevertheless, the treatment differences may not have affected the outcomes.

A case-control study indicates that coagulation imbalance is associated with arteriosclerosis and markers of endothelial dysfunction in kidney failure

Endothelial dysfunction, one of many causes of arterial changes in end-stage kidney disease (kidney failure), is a likely link between early vascular aging and the risk of thrombosis or bleeding in this condition. To evaluate this, we compared links between arterial stiffness and endothelial/coagulation factors in 55 patients receiving hemodialysis therapy and 57 age-/sex-matched control individuals. Arterial stiffness was assessed from carotid-femoral pulse wave velocity, and coagulation status from the endogenous thrombin generating potential. Markers of endothelial dysfunction (von Willebrand factor, tissue factor pathway inhibitor), neutrophil extracellular traps and tissue factor-positive extracellular vesicles were higher in patients with kidney failure. Prothrombin fragments 1 and 2, and D-dimer markers of invivo coagulation activation were also higher. However, invitro in the presence of platelets, endogenous thrombin generating potential was lower and its downregulation by activated protein C impaired. Antiplatelet drugs did not affect these parameters. In multiple regression analysis, prothrombin fragments 1 and 2, D-dimer, factor VIII and monocyte-derived tissue factor-positive extracellular vesicles correlated with higher carotid-femoral pulse wave velocity. In patients with kidney failure, invivo hypercoagulability occurred with reduced thrombin generation in platelet-rich plasma, likely explaining the opposing thrombotic and bleeding tendencies in patients with kidney failure. Importantly, arteriosclerosis is more closely related to a prothrombotic state. Thus, coagulation changes plus arterial stiffness highlight a major therapeutic challenge for anticoagulant and antiplatelet drug use.

Effect of antiplatelet and/or anticoagulation medication on the risk of tympanic barotrauma in hyperbaric oxygen treatment patients, and development of a predictive model.

Middle ear barotrauma (MEBt) is a common side effect of hyperbaric oxygen treatment (HBOT) and can result in pain, hearing loss, tinnitus and otorrhagia. The use of antiplatelet/anticoagulant drugs is thought to increase the risk and severity of MEBt during HBOT. Single centre, retrospective observational cohort study of all patients treated with HBOT over a 4-year period (between 01 January 2015 to 31 December 2018) looking at the incidence of MEBt and the concurrent use of antiplatelet and/or anticoagulant drugs. MEBt was assessed by direct otoscopy of the tympanic membrane post-HBOT and scored using the modified Teed classification. Multivariate modelling assessed the relationship between antiplatelet and/or anticoagulation drug use, age, sex, and MEBt during HBOT. There was no evidence that antiplatelet and/or anticoagulation drugs increase the risk of tympanic barotrauma in HBOT patients. The prevalence of MEBt was higher in female patients than in males (χ2 P = 0.004), and increased with age (χ2 P = 0.048). No MEBt was recorded in patients undergoing recompression therapy for decompression sickness or cerebral arterial gas embolism. In this retrospective single-centre study, antiplatelet and/or anticoagulation drugs did not affect the risk of MEBt, but both age and sex did, with greater prevalence of MEBt among older patients and females compared with younger patients and males. A predictive model, requiring further validation, may be helpful in assessing the likelihood of MEBt in patients undergoing HBOT.

Antiplatelets, Anticoagulants and Its Implications in Dentistry-A Review of Literature

Oral health care providers must be aware of the impact of bleeding disorders on their patients during any dental procedure and management of such mishaps. Adequate knowledge of the mechanisms underlying hemostasis, and the optimised management of such patients, are therefore very important for these issues. Initial recognition of a bleeding disorder, in such patients with a systemic pathologic process, may occur in dental practice. The dental treatment of these patients might get complicated during the course of the treatment due to the use of anticoagulant and/or antiplatelet drugs raises a challenge in the daily practice of dental professionals. Adequate hemostasis is critical for the success of any invasive dental procedure, because bleeding problems can give rise to complications associated with important morbidity-mortality. Besides, prophylactic, restorative and surgical dental care of patients with any bleeding disorders is handled skilfully by practitioners who are well educated regarding the pathology, complications which could arise and treatment options associated with these conditions. The purpose of this paper is to review common bleeding disorders and their effects on the dental aspect. Many authors consider that patient medication indicated for the treatment of background disease should not be altered or suspended unless so indicated by the prescribing physician. Local hemostatic measures have been shown to suffice for controlling possible bleeding problems resulting from dental treatment.

Impact of high bleeding risk criteria on short- and long-term outcomes in patients with acute myocardial infarction

Abstract Background The Academic Research Consortium (ARC) proposed the new definition of high bleeding risk (HBR) criteria. It remains unknown about the prevalence and the impact of HBR on clinical outcome after acute myocardial infarction (AMI). Purpose To assess the prevalence and the impact of HBR on short- and long-term outcomes in patients with AMI. Methods Between January 2015 and January 2018, 412 patients with AMI underwent coronary angiography within 24 hours after the onset of chest pain. According to HBR criteria proposed by ARC, we divided patients into 2 groups; HBR and non-HBR group. We considered a patient HBR if the patient met at least 1 major criteria or 2 minor criteria. Major criteria included severe CKD (eGFR&amp;lt;30 ml/min), severe anemia (Hgb&amp;lt;11 g/dl), active cancer, and the use of oral anticoagulant drug. Minor criteria included high age (≥75), moderate CKD (eGFR 30–59 ml/min), moderate anemia (Hgb 11–12.9 g/dl for men and 11–11.9 g/dl for women). Kaplan-meier method was used to compare long-term outcome of HBR and non-HBR group. Major adverse cardiovascular events (MACE) were defined as all-cause death, non-fetal MI, and stroke. Results Patients with HBR were found in 37% of patients with AMI. In-hospital mortality (11.3% vs 4.2%, p=0.008) and MACE rate was significantly higher in HBR than non-HBR group (Figure). HBR group was associated with higher all-cause death (15.7% vs 2.5%, p&amp;lt;0.0001) and intracranial bleeding (4.8% vs 0.5%, p=0.02) than non-HBR group, although the incidence of non-fetal MI was comparable between two groups (7.6% vs 8.5%, p=0.76). Conclusions AMI patients with HBR were associated with worse outcomes both short- and long-term. Kaplan-Meier curves for MACE Funding Acknowledgement Type of funding source: None

Increasing age as a major determinant of major adverse outcomes in patients with atrial fibrillation: the EURObservational research programme in atrial fibrillation general long-term registry

Abstract Introduction Increasing age is a well-known determinant for incident atrial fibrillation (AF) as well as for adverse outcomes. With a progressively ageing population in Europe (and elsewhere), contemporary data are needed to investigate the impact of age in relation to major adverse events in AF patients. Purpose To evaluate the impact of increasing age on major adverse outcomes in a contemporary European AF cohort. Methods Patients enrolled in the EORP-AF Long Term General Registry were categorized by age: &amp;lt;65, 65–74, 75–84, and ≥85 years. Any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death, CV death, all-cause mortality were considered as outcomes. Results Among the 9762 patients included in this analysis, 2946 (30.2%) were &amp;lt;65 years, 3288 (33.7%) were 65–74 years, 2954 (30.3%) were 75–84 years and 574 (5.9%) were ≥85 years. With increasing age categories, there was a progressively higher prevalence of most risk factors and comorbidities. Accordingly, both mean CHA2DS2-VASc and HAS-BLED scores were progressively higher across the age categories (both p&amp;lt;0.0001). At discharge, use of any oral anticoagulant (OAC) drug was lower in patients ≥85 years compared to those aged 65–74 or 75–84 years (83.6% vs. 89.4% and 88.8%, respectively) but significantly higher than in those &amp;lt;65 years (80.2%) [p&amp;lt;0.001]. Rate of all major adverse events progressively increased across the age categories, being higher in those aged ≥85 (all p&amp;lt;0.001). Kaplan-Meier curves showed an increasing cumulative risk across the age groups for all the outcomes (p&amp;lt;0.0001) (Figure 1). A fully adjusted Cox regression analysis demonstrated a progressively increasing association between age categories and the risk of all major adverse outcomes (Table 1). Conclusions In a large contemporary cohort of European AF patients, increasing age was a major determinant of major adverse outcomes. Figure 1. Kaplan-Meier Curves for All-Cause Death Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Since the start of EORP programme, several companies supported its activities with unrestricted grants.

Angioplasty and Stenting of Intracranial Stenosis

Angioplasty and Stenting of Intracranial Stenosis - IJN- Print ISSN No: - 2581-8236 Online ISSN No:- 2581-916X Article DOI No:- 10.18231/j.ijn.2020.044, IP Indian Journal of Neurosciences-IP Indian J Neurosci

Novel Oral Anticoagulants in Renal Transplant Recipients: A Retrospective Cohort Study.

Data on the use of novel anticoagulant drugs (NOACc) in renal transplant recipients is scarce. The aim of our study was to investigate the safety and efficacy of NOACs in renal transplant recipients. In a single-centre retrospective cohort study we assessed adverse reactions, thromboembolic events, and interactions of calcineurin inhibitors in patients treated with NOACs. Twenty-three renal transplant recipients were treated with NOACs (70% male), mean age of 65.8 ± 1.8 years. Fourteen (61%) patients were treated with rivaroxaban, apixaban was given to 8 (35%) of our patients, and dabigatran to one patient (4%). The main indications for NOAC therapy was atrial fibrillation in 61% and deep venous thrombosis in 23% of patients. Bleeding occurred in 2 patients (1 treated with rivaroxaban and 1 with dabigatran). None of our patients developed thrombosis while treated with NOAC. During the median follow-up of 24 months graft function, as well as hematological parameters, remained stable in patients that were treated with rivaroxaban and apixaban, while dabigatran was ceased after a month of therapy due to a bleeding event. Our results show that both rivaroxaban and apixaban are safe and efficient oral anticoagulant drugs in renal transplant patients. Additional studies are needed to prove these results.

Minor bleeding in patients with atrial fibrillation using a non-vitamin-K antagonist oral anticoagulant

Aims We sought to investigate the magnitude of minor bleeding and identify risk factors for minor bleeds during non-vitamin-K antagonist oral anticoagulant (NOAC) therapy. Methods This was an observational cohort study of patients with atrial fibrillation (AF) referred to a regional NOAC outpatient clinic between February 2013 and October 2017. The study population consisted of 875 consecutive patients with AF who visited the NOAC outpatient unit to initiate treatment with apixaban (N = 303), dabigatran (N = 267) or rivaroxaban (N = 305) for long-term ischemic stroke prophylaxis. Minor bleed was defined as every overt bleeding that does not fulfil the criteria of major or non-major clinically relevant bleeding according to the International Society on Thrombosis and Haemostasis. Results Overall rate of minor bleeds was 19.2 per 100 patient years of follow-up. Bleeding rates for apixaban, dabigatran and rivaroxaban were 26, 8.3 and 23 per 100 patient-years of follow-up. Next to the type of NOAC, the main risk indicators for minor bleedings during NOAC therapy were a HAS-BLED score of 3 or higher and novel anticoagulant use (no history of vitamin K antagonist use). Limitation This was a retrospective observational study evaluating NOAC treatment in a non-randomized setting. Conclusion Our data showed that minor bleeds are common in novel NOAC users, especially when using apixaban and rivaroxaban. In the latter two NOACs, hematoma (bruises) and nose bleeds were more frequently observed and accounted for the difference with dabigatran. Besides type of NOAC, a higher HAS-BLED score and novel anticoagulant drug use were associated with an increased risk of minor bleeding.

Thrombosis Risk Assessment In The COVID-19 Era

The appearance of the coronavirus pandemic has prompted a renewed interest in thrombosis risk assessment, particularly since this disease is associated with a high risk of thrombotic events. It is known that the number one preventable cause of death in hospitalized patients including those having surgical procedures is fatal pulmonary emboli. There is also high-quality data that the use of anticoagulant drugs in the proper dose, and for the period of time shown to be efficacious, will prevent most fatal events. It is true that even with the use of the best anticoagulant regimes venous thromboembolic events (VTE) can still occur but are rarely fatal. We also realize that providing adequate anticoagulant prophylaxis for the entire period of risk is the key to preventing these deaths. Thrombosis risk scoring identifies who's at risk for these emboli and guides physician choices for appropriate preventive measures.

Left upper lobectomy is a risk factor for cerebral infarction after pulmonary resection: a multicentre, retrospective, case-control study in Japan.

The anatomical site of resected lobes may influence postoperative cerebral infarction. The objective of the current study was to determine if left upper pulmonary lobectomy is a risk factor for postoperative cerebral infarction. This was a retrospective case-control study in patients undergoing pulmonary lobectomy from 2004 to 2013 in Japan. We retrospectively identified 610 patients from 153 institutions who had developed postoperative cerebral infarction following pulmonary lobectomy. The control group consisted of 773 patients who underwent lobectomy without cerebral infarction during a randomly selected single month in 2009 at the same institutions. Factors associated with cerebral infarction were age [10-year intervals, odds ratio (OR): 1.46; 95% confidence interval (CI): 1.23-1.73; p < 0.001], male sex (OR 1.92; 95% CI 1.29-2.86; p = 0.001), presence of comorbidities (OR 1.82; 95% CI 1.35-2.44; p < 0.001), perioperative anti-platelet or anti-coagulant drug use (OR 1.71; 95% CI 1.20-2.45; p = 0.003), and lobectomy. Subgroup analyses revealed that cerebral infarction was strongly associated with left upper lobectomy. Our findings suggest that left upper lobectomy is associated with a higher risk of cerebral infarction than other types of lobectomy, particularly in the early postoperative period.

BMI differences among in-hospital management and outcomes in patients with atrial fibrillation: findings from the Care for Cardiovascular Disease project in China

BackgroundUnderweight or obese status influences the prognosis of atrial fibrillation (AF). However, the association between stratification of body mass index (BMI) and in-hospital outcomes in patients with AF, remains lacking in China.MethodsUsing data from the Improving Care for Cardiovascular Disease in China-AF project, which was launched in February 2015 and recruited 150 hospitals in China, we compared characteristics, in-hospital treatments and clinical outcomes among the stratifications of BMI for Asians.ResultsA total of 15,867 AF patients with AF were enrolled, including 830 (5.23%) underweight, 4965 (31.29%) with normal weight, 3716 (23.42%) overweight, 5263 (33.17%) obese class I and 1093 (6.89%) obese class II participants. Compared with normal weight patients, underweight, overweight, and obese patients showed increased percentages of CHADS2 scores (3–6) and CHA2DS2-VASc scores (5–9). During hospitalization, overweight or obese patients showed greater use of rhythm control medications, anticoagulant drugs, and intervention therapies than underweight–normal weight patients. In adjusted logistic models, BMI was a strong predictor of in-hospital mortality. Especially, underweight BMI was associated with higher incidence of in-hospital mortality, with an adjusted odds ratio of 2.08 (95% confidence interval, 1.56–4.46; p = 0.04) than overweight and obese BMI.ConclusionsAsian patients with AF and high BMI received more medical treatments and presented less adverse in-hospital outcomes compared with those with underweight–normal weight. Although low BMI may be associated with other comorbidities and advanced age, underweight BMI retained a negative correlation with all-cause mortality in the patients with AF during hospitalization.

Ortopedi Ameliyatı Geçiren Hastaların Venöz Tromboemboli Riskini Önlemeye Yönelik Bilgi Gereksinimleri ve Uygulamalarının Belirlenmesi

Aim: The study was conducted as a descriptive study in order to determine the knowledge requirements and practices to prevent the risk of venous thromboembolism in patients undergoing orthopedic surgery. Material and Methods: The study was conducted with 140 patients between 18. 07. 2018- 19.10. 2018 in an education research hospital in Ankara. The patient descriptive information form, VTE patient information form, DVT diagnostic criteria form which is prepared by the researcher and Autar Risk Diagnosis Scale were used in order to collect the data. Descriptive statistics such as number and percentage were used in the analysis of the data Results: In our study, according to the Autar DVT Risk Diagnosis Scale, most of the patients had more than one risk factor in the postoperative period, the most experienced risk factors were having advanced age, being above normal weight, having orthopedic (under waist) surgical intervention and living highly dependent (help requirement) risk factors. Among the patients participated in the study, 81.4% had not known VTE definition, 87.8% VTE risk factors, 87.8% the applications to reduce the risk of VTE. It was found that more than half of the patients did not have information about the use of compression stockings and 80.9% of the patients did not have any information about the use of anticoagulants despite the high rates of anticoagulant drug use. Conclusion: In our study, it was found that although the patients had more than one risk factor for VTE, there was a high level of information deficiency. Determining the level of knowledge of patients about VTE and increasing their knowledge on this subject with trainings will allow them to perform individual evaluations and thus reduce the incidence of VTE in hospital and post-discharge periods. As a result of this, it is considered that patients’ quality of life will increase and hospital stay and health expenses will decrease.

Oral anticoagulants in the prevention of thromboembolic complications in cardiac patients: analysis of use in the Russian Federation

In last years, special attention has been paid in the Russian Federation (RF) to improving medical care for patients with atrial fibrillation (AF) and the prevention of thromboembolic complications (TEC). The appearance on the Russian market of new oral anticoagulants (NOAC) has become a help for doctors, however, their cost imposes restrictions on the use. A humanitarian aid drugs to medical organizations of the RF, an active information program from manufacturers over the past 1.5 years have significantly increased the use of NOAC. In different regions, a different situation arises regarding the procurement and frequency of use of one or another anticoagulant. Analyzing the procurement of additional drug supplies for different regions of the Russian Federation, we see that dabigatran is preferred in a number of regions of the Central Federal District, and rivaroxaban in the Northern regions. The cost of warfarin is low. Data on the important role of the genotype in determining the individual dose and the development of bleeding, which is associated with the metabolism of warfarin, have been obtained. The pharmacogenetic approach allows you to quickly and efficiently choose its dose. The use of generics is highly relevant on the Russian market. Also, a number of regions are of great interest as a basis for conducting clinical trials of drugs. Aim. To analyze the current use of anticoagulant drugs taking into account personalized treatment approaches (the implementation of pharmacogenetic examinations and the work of anticoagulation clinics). Methods. Analysis of real clinical practice in the Russian Federation, patient registries, evaluation of adverse events in anticoagulation therapy and pharmacogenetic studies. Analysis of anticoagulant purchase under the Drug Reimbursement Program in several regions of the RF. Evaluation of the effect of anticoagulation clinics throughout the RF. Results. We analyzed the use of anticoagulants. To reduce the risk of thromboembolic complications and select the appropriate antithrombotic therapy, the entire range of antithrombotic agents is required, including NOACs and vitamin K antagonists (warfarin). Th e appearance of warfarin and NOACs on the Russian market has significantly improved the quality of medical care and treatment outcomes in these patients. Active awareness raising, the addition of anticoagulants to the national clinical guidelines and to clinical practice, and state support as part of the Drug Reimbursement Program have significantly increased the frequency of anticoagulant use. Nevertheless, the frequency of anticoagulant use varies slightly between regions. Warfarin is the most widely used anticoagulant and has high affordability (from 44 to 72.5 % out of all anticoagulants). The frequency of bleeding does not differ significantly between different anticoagulants, with an average of 2.8 %. A first INR value of ≥2.0 aft er 3-5 days is significantly associated with over coagulation during warfarin dose titration. The rapid achievement of an anticoagulation effect is often associated with a specific genotype (CYP2C9*2/*2, *3/*3 and 2/*3 variants and A/A of the VKORC1 gene, or CYP2C9 and VKORC1 polymorphism). Pharmacogenomics-guided warfarin dosing in clinical practice allows the warfarin dose to be selected in a faster and more effective way and for the risk of adverse reactions to be reduced. The creation of a network of anticoagulation clinics has proven to be highly effective. The most well-structured system of anticoagulation clinics is present in the Kursk Region. Rivaroxaban was the biggest selling anticoagulant out of the NOACs on the Russian sales market in 2018, but given the growth in apixaban sales, it is likely that this NOAC will move into first place in the near future.Conclusion. A personalized approach to anticoagulant use is crucial for the prevention of thromboembolic complications.

COVID-19 and Individual Genetic Susceptibility/Receptivity: Role of ACE1/ACE2 Genes, Immunity, Inflammation and Coagulation. Might the Double X-chromosome in Females Be Protective against SARS-CoV-2 Compared to the Single X-Chromosome in Males?

In December 2019, a novel severe acute respiratory syndrome (SARS) from a new coronavirus (SARS-CoV-2) was recognized in the city of Wuhan, China. Rapidly, it became an epidemic in China and has now spread throughout the world reaching pandemic proportions. High mortality rates characterize SARS-CoV-2 disease (COVID-19), which mainly affects the elderly, causing unrestrained cytokines-storm and subsequent pulmonary shutdown, also suspected micro thromboembolism events. At the present time, no specific and dedicated treatments, nor approved vaccines, are available, though very promising data come from the use of anti-inflammatory, anti-malaria, and anti-coagulant drugs. In addition, it seems that males are more susceptible to SARS-CoV-2 than females, with males 65% more likely to die from the infection than females. Data from the World Health Organization (WHO) and Chinese scientists show that of all cases about 1.7% of women who contract the virus will die compared with 2.8% of men, and data from Hong Kong hospitals state that 32% of male and 15% of female COVID-19 patients required intensive care or died. On the other hand, the long-term fallout of coronavirus may be worse for women than for men due to social and psychosocial reasons. Regardless of sex- or gender-biased data obtained from WHO and those gathered from sometimes controversial scientific journals, some central points should be considered. Firstly, SARS-CoV-2 has a strong interaction with the human ACE2 receptor, which plays an essential role in cell entry together with transmembrane serine protease 2 (TMPRSS2); it is interesting to note that the ACE2 gene lays on the X-chromosome, thus allowing females to be potentially heterozygous and differently assorted compared to men who are definitely hemizygous. Secondly, the higher ACE2 expression rate in females, though controversial, might ascribe them the worst prognosis, in contrast with worldwide epidemiological data. Finally, several genes involved in inflammation are located on the X-chromosome, which also contains high number of immune-related genes responsible for innate and adaptive immune responses to infection. Other genes, out from the RAS-pathway, might directly or indirectly impact on the ACE1/ACE2 balance by influencing its main actors (e.g., ABO locus, SRY, SOX3, ADAM17). Unexpectedly, the higher levels of ACE2 or ACE1/ACE2 rebalancing might improve the outcome of COVID-19 in both sexes by reducing inflammation, thrombosis, and death. Moreover, X-heterozygous females might also activate a mosaic advantage and show more pronounced sex-related differences resulting in a sex dimorphism, further favoring them in counteracting the progression of the SARS-CoV-2 infection.

Comparative Epidemiological Profile of Elderly and Non-elderly Patients Operated on Chronic Subdural Hematoma

Background: Traumatic brain injury is a severe condition in elder patients. Young patients usually have better prognosis compared to the elderly. Head trauma might represent an initial event that leads to death in this population. Objective: To evaluate was to evaluate the epidemiological profile of elderly patients operated on chronic subdural hematoma (CSDH). Methods: This is a descriptive, observational and retrospective case series. The use of anticoagulant and antiplatelet drugs, length of hospital stay, mortality and CSDH recurrence, among others, were the evaluated variables. Results: A total of 328 patients had their records assessed. Patients younger than 60 years formed group 1 (n=102) and those older than 60 years formed group 2 (n=226). Ageing is correlated to higher mortality. Acetylsalicylic acid and anticoagulant drugs usage in both groups did not correlate to worse outcomes. In group 2, there were 33 deaths during hospital stay (14.6%) and 14 deaths within one year after surgery (6.2%). Only one death was registered in group 1. Conclusion: Ageing is an important isolated prognostic factor.

Role of age and anticoagulants in recurrent idiopathic epistaxis

ObjectiveEpistaxis is one of the commonest causes of attendance of Otolaryngology emergency rooms. Given its incidence, potential severity and high recurrence rate, a systematic and careful management is mandatory. This work aims to define prognostic factors of epistaxis recurrence. Material and methodsRetrospective review of medical records of patients with epistaxis admitted to our emergency department from January 2012 to December 2016. Data of 1005 patients with idiopathic epistaxis were analysed and independent risk factors for recurrence were determined by multiple logistic regression analysis. ResultsRecurrence of epistaxis was found in 303 (30.1%) patients. Patients with recurrent epistaxis were older (p<.001) and more commonly had a history of hypertension (p=.001) and antiplatelet (p=.048) and anticoagulant (p=.001) use than those with episodic epistaxis. Age (adjusted OR 1.21, 95%CI 1.08–1.32, p=.003) and anticoagulant use (adjusted OR 2.68, 95%CI 1.94–3.70, p=.009) were predictors of increased risk of recurrent epistaxis. Gender, alcohol abuse, medical history, active bleeding at admission, unidentified bleeding point or treatment modalities were not associated with recurrence. ConclusionAge and use of anticoagulation drugs were risk factors for recurrence of epistaxis. None of the previously described risk factors for episodic epistaxis were found to increase the risk of recurrence. Knowledge of factors involved in recurrence might provide important information for assessment and management of increased risk patients.

Toward an artificial endothelium: Development of blood-compatible surfaces for extracorporeal life support.

A new generation of extracorporeal artificial organ support technologies, collectively known as extracorporeal life support (ECLS) devices, is being developed for diverse applications to include acute support for trauma-induced organ failure, transitional support for bridge to organ transplant, and terminal support for chronic diseases. Across applications, one significant complication limits the use of these life-saving devices: thrombosis, bleeding, and inflammation caused by foreign surface-induced blood interactions. To address this challenge, transdisciplinary scientists and clinicians look to the vascular endothelium as inspiration for development of new biocompatible materials for ECLS. Here, we describe clinically approved and new investigational biomaterial solutions for thrombosis, such as immobilized heparin, nitric oxide-functionalized polymers, "slippery" nonadhesive coatings, and surface endothelialization. We describe how hemocompatible materials could abrogate the use of anticoagulant drugs during ECLS and by doing so radically change treatments in critical care. Additionally, we examine several special considerations for the design of biomaterials for ECLS, including: (1) preserving function of the artificial organ, (2) longevity of use, and (3) multifaceted approaches for the diversity of device functions and applications.