Validation of the BATT score for prehospital risk stratification of traumatic haemorrhagic death: usefulness for tranexamic acid treatment criteria.

Tranexamic acid reduces surgical blood loss and reduces deaths from bleeding in trauma patients. Tranexamic acid must be given urgently, preferably by paramedics at the scene of the injury or in the ambulance. We developed a simple score (Bleeding Audit Triage Trauma score) to predict death from bleeding. We conducted an external validation of the BATT score using data from the UK Trauma Audit Research Network (TARN) from 1st January 2017 to 31st December 2018. We evaluated the impact of tranexamic acid treatment thresholds in trauma patients. We included 104,862 trauma patients with an injury severity score of 9 or above. Tranexamic acid was administered to 9915 (9%) patients. Of these 5185 (52%) received prehospital tranexamic acid. The BATT score had good accuracy (Brier score = 6%) and good discrimination (C-statistic 0.90; 95% CI 0.89-0.91). Calibration in the large showed no substantial difference between predicted and observed death due to bleeding (1.15% versus 1.16%, P = 0.81). Pre-hospital tranexamic acid treatment of trauma patients with a BATT score of 2 or more would avoid 210 bleeding deaths by treating 61,598 patients instead of avoiding 55 deaths by treating 9915 as currently. The BATT score identifies trauma patient at risk of significant haemorrhage. A score of 2 or more would be an appropriate threshold for pre-hospital tranexamic acid treatment

Comparison of serum lipoprotein(a) distribution and its correlates among black and white populations.

BACKGROUND. Epidemiological data on serum lipoprotein(a) (Lp(a)), a presumably strong risk factor for coronary artery disease in White populations, has mostly been derived, in Black populations, from small samples. This study compares the distribution and the determinants of serum Lp(a) in Blacks and in Whites using large representative samples and the same methods in both populations. METHODS. The distribution and the correlates of serum Lp(a) were investigated in population-based samples of 701 Blacks in the Seychelles and 634 Whites in Switzerland, aged 25-64 years. Serum Lp(a) was quantified using a commercial immunoradiometric assay. RESULTS. The distribution of serum Lp(a) was similarly skewed in both ethnic groups, but median Lp(a) concentration was about twofold higher in Blacks (210 mg/l) compared to Whites (100 mg/l). The proportions of individuals with elevated serum Lp(a) (> 300 mg/l) was about 50% higher in Blacks (37.5%) than in Whites (25.2%). In both ethnic groups, serum Lp(a) was found to correlate with total cholesterol, LDL-cholesterol and apoprotein B but not with HDL-cholesterol, alcohol intake, smoking, and body mass index. The variance in serum Lp(a) concentration explained by any combination of these factors was smaller than 5.3% in the two populations. CONCLUSIONS. The measured factors did not explain the higher levels of serum Lp(a) found in Blacks compared to Whites. These findings are consistent with the hypothesis that genetic factors account for much of the variation of serum Lp(a) in both populations

La lipoprotéine(A) est-elle athérogène ?

La lipoprotéine(a) (Lp(a)) est une particule dont la concentration plasmatique varie de <0,1 mg dl à >100 mg dl. Des taux plasmatiques de Lp(a) >20-30 mg dl confèrent un risque accru de développer un accident cardiovasculaire, notemment en présence de facteurs de risque associés. Le dosage de la Lp(a) plasmatique est particulièrement indiqué chez les sujets dyslipidémiques, diabétiques, hypertendus ou tabagiques et ceux dont l'anamnèse familiale est positive pour des problèmes cardiovasculaires, et ce pour compléter le profil de risque individuel. Si les fibrates et les statines n'ont pas d'effet significatif sur les taux plasmatiques de Lp(a), les dérivés de l'acide nicotinique et l'hormonothérapie substitutive chez la femme tendent à réduire les taux plasmatiques de Lp(a). Ils peuvent donc être particulièrement indiqués comme hypolipémiants en présence de taux de Lp(a) > 20-30 mg dl

Dyslipidémies et maladies cardiovasculaires: vers de nouvelles perspectives [Dyslipidemias and cardiovascular diseases: towards a new perspective]

During the last decades, new developments in the detection and therapy of dyslipidemia provided a firm conviction for the efficacy and the safety of lipid-lowering therapies in primary and secondary prevention of cardiovascular diseases. To be cost-effective in primary prevention, the statin-therapy needs to select high risk patients. According to the guidelines, the global assessment of cardiovascular risk is based on traditional risk factors (RF-CV). The emergence of new RF-CV is helpful. However, at every level of risk factor exposure, there is a substantial variation of atherosclerosis. Thus, subclinical disease measurements, representing the end result of risk exposure may be useful for improving cardiovascular risk prediction. Using the high resolution B-mode ultrasound to detect plaques both on femoral and carotid arteries in asymptomatic patients, our results show the advantages and limits of a non invasive method to improve the selection of eligible patients requiring a more aggressive lipid-lowering therapy