New approaches to preventing venous thromboembolism, prognostication in stroke and myocardial infarction, and antiplatelet therapy after spontaneous coronary artery dissection.

IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Diana A Gorog
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引用次数: 0

Abstract

Immobility following orthopedic surgery is a risk factor for venous thromboembolism (VTE), but the optimal duration of anticoagulant thromboprophylaxis remains controversial. The protocol of the "Enhanced Recovery and Abbreviated Length of Anticoagulation for Thromboprophylaxis After Primary Hip Arthroplasty" (ENABLE-Hip) is presented, an investigator-initiated randomized double-blind trial, comparing shorter anticoagulant duration with standard-of-care. To improve outcomes after complex thrombotic events, a novel multidisciplinary approach is presented, based loosely on the tumor board model from oncology, with establishment of a "Clot Cases Conference". East Asians are more susceptible to bleeding than other ethnicities, with sub-standard dose direct oral anticoagulant (DOAC) frequently prescribed. A meta-analysis evaluating Japanese patients with AF shows that patients receiving underdosed DOACs have fewer bleeding events, similar thromboembolic events, but an increase in all-cause mortality, possibly due to increased frailty. In terms of biomarkers, transforming growth factor-β1, a cytokine that can promote VTE, was shown in patients with pulmonary embolism to be associated with residual pulmonary vascular obstruction. Although monocytes have traditionally been classified into three subsets, expression of recently described Mon4 is reported to be a marker of cardiovascular risk following acute myocardial infarction (AMI). The benefit of carotid endarterectomy for moderate carotid artery stenosis (CAS) is unclear. In patients with minor stroke and moderate ipsilateral CAS (50-69%), the severity of CAS was inversely associated with microRNA-22 levels, while decreased expression was associated with recurrent ipsilateral stroke. Although dual antiplatelet therapy for 1 year is the default recommendation for most AMI patients, the benefit of this for spontaneous coronary artery dissection (SCAD) is unclear, and a review of antiplatelet strategies for conservatively managed SCAD patients is presented herein.

预防静脉血栓栓塞、脑卒中和心肌梗死预后以及自发性冠状动脉夹层后抗血小板治疗的新途径。
骨科手术后不活动是静脉血栓栓塞(VTE)的危险因素,但抗凝血栓预防的最佳持续时间仍然存在争议。“原发性髋关节置换术后抗凝治疗的增强恢复和缩短抗凝时间”(ENABLE-Hip)方案提出,这是一项由研究者发起的随机双盲试验,比较了较短的抗凝时间和标准护理。为了改善复杂血栓事件后的预后,提出了一种新的多学科方法,该方法松散地基于肿瘤学的肿瘤委员会模型,并建立了“血栓病例会议”。东亚人比其他种族更容易出血,经常使用低于标准剂量的口服抗凝剂(DOAC)。一项评估日本房颤患者的荟萃分析显示,接受剂量不足DOACs的患者出血事件较少,血栓栓塞事件相似,但全因死亡率增加,可能是由于虚弱增加。在生物标志物方面,转化生长因子-β1是一种可以促进VTE的细胞因子,在肺栓塞患者中被证明与残留的肺血管阻塞有关。虽然单核细胞传统上被分为三个亚群,但最近报道的Mon4的表达是急性心肌梗死(AMI)后心血管风险的标志。颈动脉内膜切除术治疗中度颈动脉狭窄(CAS)的益处尚不清楚。在轻度卒中和中度同侧CAS患者(50-69%)中,CAS的严重程度与microRNA-22水平呈负相关,而表达降低与同侧卒中复发相关。虽然1年的双重抗血小板治疗是大多数AMI患者的默认建议,但这种治疗自发性冠状动脉夹层(SCAD)的益处尚不清楚,本文综述了保守治疗SCAD患者的抗血小板策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
9.20
自引率
0.00%
发文量
112
审稿时长
4-8 weeks
期刊介绍: The Journal of Thrombosis and Thrombolysis is a long-awaited resource for contemporary cardiologists, hematologists, vascular medicine specialists and clinician-scientists actively involved in treatment decisions and clinical investigation of thrombotic disorders involving the cardiovascular and cerebrovascular systems. The principal focus of the Journal centers on the pathobiology of thrombosis and vascular disorders and the use of anticoagulants, platelet antagonists, cell-based therapies and interventions in scientific investigation, clinical-translational research and patient care. The Journal will publish original work which emphasizes the interface between fundamental scientific principles and clinical investigation, stimulating an interdisciplinary and scholarly dialogue in thrombosis and vascular science. Published works will also define platforms for translational research, drug development, clinical trials and patient-directed applications. The Journal of Thrombosis and Thrombolysis'' integrated format will expand the reader''s knowledge base and provide important insights for both the investigation and direct clinical application of the most rapidly growing fields in medicine-thrombosis and vascular science.
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