AIM:To investigate the contribution of anti-platelet therapy and derangements of pre-operative classical coagulation and thromboelastometry parameters to major bleeding post-coronary artery bypass grafting(CABG).METHO...AIM:To investigate the contribution of anti-platelet therapy and derangements of pre-operative classical coagulation and thromboelastometry parameters to major bleeding post-coronary artery bypass grafting(CABG).METHODS:Two groups of CABG patients were studied:Group A,treated with aspirin alone(n=50),and Group B treated with aspirin and clopidogrel(n=50).Both had similar preoperative,clinical,biologic characteristics and operative management.Classic coagulation parameters and rotational thromboelastometry(ROTEM)profiles were determined preoperatively for both groups and the same heparin treatment was administered.ROTEM profiles(INTEM and EXTEM assays)were analyzed,both for traditional parameters,and thrombin generation potential,expressed by area-under-curve(AUC).RESULTS:There was no significant difference betweenrates of major bleeding between patients treated with aspirin alone,compared with those treated with aspirin and clopidogrel(12%vs 16%,P=0.77).In the 14 cases of major bleeding,pre-operative classic coagulation and traditional ROTEM parameters were comparable.Conversely we observed that the AUC in the EXTEM test was significantly lower in bleeders(5030±1115 Ohm*min)than non-bleeders(6568±548Ohm*min)(P<0.0001).CONCLUSION:We observed that patients with a low AUC value were at a significantly higher risk of bleeding compared to patients with higher AUC,regardless of antiplatelet treatment.This suggests that thrombin generation potential,irrespective of the degree of platelet inhibition,correlates with surgical bleeding.展开更多
The introduction of transcatheter aortic va-lve replacement changed our approach for those patients with a high-to-prohibitive risk profile,and,more recently,for those with an in-termediate-to-low risk profile.[1]Simi...The introduction of transcatheter aortic va-lve replacement changed our approach for those patients with a high-to-prohibitive risk profile,and,more recently,for those with an in-termediate-to-low risk profile.[1]Similarly,patients with mitral valve regurgitation(MVR)can now be-nefit from various transcatheter technologies,whose indications and recommendations are the subject of intense clinical investigation.展开更多
In the field of tissue regeneration,the lack of a stable endothelial lining may affect the hemocompatibility of both synthetic and biological replacements.These drawbacks might be prevented by specific biomaterial fun...In the field of tissue regeneration,the lack of a stable endothelial lining may affect the hemocompatibility of both synthetic and biological replacements.These drawbacks might be prevented by specific biomaterial functionalization to induce selective endothelial cell(EC)adhesion.Decellularized bovine pericardia and porcine aortas were selectively functionalized with a REDV tetrapeptide at 10^(-5)M and 10^(-6)M working concentrations.The scaffold-bound peptide was quantified and REDV potential EC adhesion enhancement was evaluated in vitro by static seeding of human umbilical vein ECs.The viable cells and MTS production were statistically higher in functionalized tissues than in control.Scaffold histoarchitecture,geometrical features,and mechanical properties were unaffected by peptide anchoring.The selective immobilization of REDV was effective in accelerating ECs adhesion while promoting proliferation in functionalized decellularized tissues intended for blood-contacting applications.展开更多
文摘AIM:To investigate the contribution of anti-platelet therapy and derangements of pre-operative classical coagulation and thromboelastometry parameters to major bleeding post-coronary artery bypass grafting(CABG).METHODS:Two groups of CABG patients were studied:Group A,treated with aspirin alone(n=50),and Group B treated with aspirin and clopidogrel(n=50).Both had similar preoperative,clinical,biologic characteristics and operative management.Classic coagulation parameters and rotational thromboelastometry(ROTEM)profiles were determined preoperatively for both groups and the same heparin treatment was administered.ROTEM profiles(INTEM and EXTEM assays)were analyzed,both for traditional parameters,and thrombin generation potential,expressed by area-under-curve(AUC).RESULTS:There was no significant difference betweenrates of major bleeding between patients treated with aspirin alone,compared with those treated with aspirin and clopidogrel(12%vs 16%,P=0.77).In the 14 cases of major bleeding,pre-operative classic coagulation and traditional ROTEM parameters were comparable.Conversely we observed that the AUC in the EXTEM test was significantly lower in bleeders(5030±1115 Ohm*min)than non-bleeders(6568±548Ohm*min)(P<0.0001).CONCLUSION:We observed that patients with a low AUC value were at a significantly higher risk of bleeding compared to patients with higher AUC,regardless of antiplatelet treatment.This suggests that thrombin generation potential,irrespective of the degree of platelet inhibition,correlates with surgical bleeding.
文摘The introduction of transcatheter aortic va-lve replacement changed our approach for those patients with a high-to-prohibitive risk profile,and,more recently,for those with an in-termediate-to-low risk profile.[1]Similarly,patients with mitral valve regurgitation(MVR)can now be-nefit from various transcatheter technologies,whose indications and recommendations are the subject of intense clinical investigation.
基金Padua Heart Program(CA.RI.PA.RO.Foundation)LIFELAB Program,Consorzio per la Ricerca Sanitaria-CORIS,Veneto Region,Via Giustiniani,2-Padova+1 种基金JLGR acknowledges financial support from the Spanish State Research Agency(AEI)through the PID2019-106099RB-C41/AEI/10.13039/501100011033 projectCIBER-BBN is an initiative funded by the VI National R&D&I Plan 2008-2011,Iniciativa Ingenio 2010,Consolider Program.CIBER Actions are financed by the Instituto de Salud CarlosⅢwith assistance from the European Regional Development Fund.
文摘In the field of tissue regeneration,the lack of a stable endothelial lining may affect the hemocompatibility of both synthetic and biological replacements.These drawbacks might be prevented by specific biomaterial functionalization to induce selective endothelial cell(EC)adhesion.Decellularized bovine pericardia and porcine aortas were selectively functionalized with a REDV tetrapeptide at 10^(-5)M and 10^(-6)M working concentrations.The scaffold-bound peptide was quantified and REDV potential EC adhesion enhancement was evaluated in vitro by static seeding of human umbilical vein ECs.The viable cells and MTS production were statistically higher in functionalized tissues than in control.Scaffold histoarchitecture,geometrical features,and mechanical properties were unaffected by peptide anchoring.The selective immobilization of REDV was effective in accelerating ECs adhesion while promoting proliferation in functionalized decellularized tissues intended for blood-contacting applications.
