2,697 publications from this institution
This is the first validation of CHA2DS2-VASc and HAS-BLED scores in AF patients with VHD (so-called 'valvular AF') using the new EHRA classification. Both scores are modestly predictive of thromboembolism and bleeding events in VHD, respectively. Event rates increased with increasing risk factors as evident by increasing CHA2DS2-VASc and HAS-BLED score points, consistent with performance of these clinical scores in 'non-valvular AF' patients.
This editorial refers to 'Estimating individual lifetime benefit and bleeding risk of adding rivaroxaban to aspirin for patients with stable cardiovascular disease: results from the COMPASS trial', by T. I. deVries et al., on page 3771. Published on behalf of the European Society of Cardiology. All rights reserved.
This year's Editor's Choice highlights the 2021 manuscripts published in Thrombosis and Haemostasis and its open access companion journal TH Open that found most resonance within our academic community. As in the precedent year, the 2021 COVID-19 pandemic situation has dictated the pace and direction of our research and clinical management efforts which, although not exclusively, is well reflected by this years' Editor's Choice contents.[1] [2] [3] [4]
Patients prescribed NOACs showed a lower decline of renal function compared to those prescribed VKAs. This effect was partially lost in patients with diabetes.
Atrial fibrillation • Thoracic aortic aneurism • Pathways commonality A thoracic aortic aneurysm (TAA) is a localized dilatation of the ascending and thoracic aorta that can lead to dissection and rupture of the vessel wall. 1 The most worrisome aspect of this clinical condition is related to its silent clinical progression with one in two cases completely asymptomatic and indeed diagnosed incidentally during imaging studies performed for other clinical condition. 1In addition, its first clinical manifestation may occur as an acute dissection which carries a very high risk for extra-and intra-hospital mortality.
Atrial fibrillation (AF) underlies almost one third of all ischaemic strokes, with the left atrial appendage (LAA) identified as the primary thromboembolic source. Current stroke risk stratification approaches, such as the CHA<sub>2</sub>DS<sub>2</sub>-VASc score, rely mostly on clinical comorbidities, rather than thrombogenic mechanisms such as blood stasis, hypercoagulability and endothelial dysfunction-known as Virchow's triad. While detection of AF-related thrombi is possible using established cardiac imaging techniques, such as transoesophageal echocardiography, there is a growing need to reliably assess AF-patient thrombogenicity prior to thrombus formation. Over the past decade, cardiac imaging and image-based biophysical modelling have emerged as powerful tools for reproducing the mechanisms of thrombogenesis. Clinical imaging modalities such as cardiac computed tomography, magnetic resonance and echocardiographic techniques can measure blood flow velocities and identify LA fibrosis (an indicator of endothelial dysfunction), but imaging remains limited in its ability to assess blood coagulation dynamics. In-silico cardiac modelling tools-such as computational fluid dynamics for blood flow, reaction-diffusion-convection equations to mimic the coagulation cascade, and surrogate flow metrics associated with endothelial damage-have grown in prevalence and advanced mechanistic understanding of thrombogenesis. However, neither technique alone can fully elucidate thrombogenicity in AF. In future, combining cardiac imaging with in-silico modelling and integrating machine learning approaches for rapid results directly from imaging data will require development under a rigorous framework of verification and clinical validation, but may pave the way towards enhanced personalised stroke risk stratification in the growing population of AF patients. This Review will focus on the significant progress in these fields.
At the same time last year we were very much hoping that the extraordinary research and clinical efforts deployed in response to the pandemic outbreak would mean that we would have stepped out of the rollercoaster wagon this year.[1] But here we are in early 2022: the roller coaster elevating again ready for the next vertical plunge. On this ride, however, we came over unprecedented challenges and worldwide scientific collaboration towards vaccine development was accomplished at a speed and efficiency never imaginable so far. As it became evident thrombosis is playing an intrinsic part of COVID-19, our scientific community naturally fully engaged in this race against the disease. In this New Year Editorial, we reflect back on this rollercoaster year, which 2021 has presented to us all, and project ourselves into the New Year 2022.
WYD: None declared. TSP: Consultant for Bayer and Pfizer (no fees). GYHL: Consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon and Daiichi-Sankyo. Speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. No fees are directly received personally. The funders had no role in the submitted paper. All authors declare no conflict of interest.
