Clot structure and plasma microparticles in atrial fibrillation

Chronic oral anticoagulation (OAC) is an important decision related with stroke thromboprophylaxis in non-valvular atrial fibrillation (NVAF). Almost a decade after the approval of Non vitamin K oral anticoagulants (NOACs) for prevention of thromboembolic events in NVAF, there is now confidence regarding their efficacy and safety as real word evidence complements the findings from the phase III pivotal trials. NOACs favourable safety profile against warfarin have changed the threshold of starting OAC, even with lower risk for systemic thromboembolism. Apixaban, one of the four licenced NOACs for stoke prevention in NVAF, even at the higher recommended dose (5mg BID), has significantly reduced the haemorrhagic complications but there is still a considerable risk of intracranial bleeding. This MD research thesis studies the influence of antithrombotics (aspirin, warfarin and apixaban) on the fibrin polymerisation and fibrinolysis pathway. To highlight antithrombotic activity variances, this analysis is based on dynamic assays and biomarker quantification related with clot structure features. Additionally, explores possible relationship between microparticle levels and physical status in NVAF patients. My findings suggest that NVAF is associated with impaired haemostasis and each antithrombotic class is related to different clot structure characteristics. Apixaban has distinctive anticoagulation dynamics and induces a reduction of coagulation biomarkers. My results also support that microparticles levels may be a useful marker of physical status as suggested by the relation between objective (cardiopulmonary exercise test) and subjective (quality of life questionnaire – EQ5D5L) evidence of fitness level

Report from the Annual Conference of the British Society of Echocardiography, November 2017, Edinburgh International Conference Centre, Edinburgh

No abstract available

Emerging Tools for Stroke Prevention in Atrial Fibrillation

Ischaemic strokes resulting from atrial fibrillation (AF) constitute a devastating condition for patients and their carers with huge burden on health care systems. Prophylactic treatment against systemic embolization and ischaemic strokes is the cornerstone for the management of AF. Effective stroke prevention requires the use of the vitamin K antagonists or non-vitamin K oral anticoagulants (NOACs). This article summarises the latest developments in the field of stroke prevention in AF and aims to assist physicians with the choice of oral anticoagulant for patients with non-valvular AF with different risk factor profile

Determinants of mortality in patients with chronic kidney disease undergoing percutaneous coronary intervention

BACKGROUND: Renal impairment is a known predictor of mortality in both the general population and in patients with cardiac disease. The aim of this study was to evaluate factors that determine mortality in patients with chronic kidney disease (CKD) who have undergone percutaneous coronary intervention (PCI). METHODS: In this study we included 293 consecutive patients with CKD who underwent PCI between 1st January 2007 and 30th September 2012. The primary outcome that we studied was all-cause mortality in a follow-up period of 12-69 months (mean 38.8 ± 21.7). RESULTS: Age (p < 0.001), PCI indication (p = 0.035), CKD stage (p < 0.001) and left ventricular ejection fraction (p < 0.001) were significantly related to mortality. CKD stage 5 [hazard ratio (HR) = 6.39, 95% CI: 1.51-27.12) and severely impaired left ventricular function (HR = 4.04, 95% CI: 2.15-7.59) were the strongest predictors of mortality. Other factors tested (gender, hypertension, diabetes, hyperlipidaemia, established peripheral vascular disease/stroke, coronary arteries intervened, number of vessels treated, number of stents implanted and length of lesion treated) did not show any correlation with mortality. CONCLUSIONS: The mortality of patients with CKD undergoing PCI increases with age, worsening CKD stage and deteriorating left ventricular systolic function, and it is also higher in patients with acute coronary syndromes compared to those with stable coronary artery disease