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dc.contributor.authorChristopoulos, Christos
dc.contributor.authorFarag, Mohamed
dc.contributor.authorSullivan, Keith
dc.contributor.authorWellsted, David
dc.contributor.authorGorog, Diana A
dc.date.accessioned2017-08-22T13:06:11Z
dc.date.available2017-08-22T13:06:11Z
dc.date.issued2017-03-01
dc.identifier.citationChristopoulos , C , Farag , M , Sullivan , K , Wellsted , D & Gorog , D A 2017 , ' Impaired thrombolytic status predicts adverse cardiac events in patients undergoing primary percutaneous coronary intervention ' , Thrombosis and haemostasis , vol. 2017 , no. 3 , pp. 457-470 . https://doi.org/10.1160/TH16-09-0712
dc.identifier.issn0340-6245
dc.identifier.otherPURE: 10868232
dc.identifier.otherPURE UUID: fddda4e1-d1d1-4415-b45c-dc7c05c16928
dc.identifier.otherPubMed: 28004059
dc.identifier.otherScopus: 85014306752
dc.identifier.urihttp://hdl.handle.net/2299/19252
dc.descriptionThis document is the Accepted Manuscript version of the following article: C. Christopoulos, M. Faraf, K. Sullican, D. Wellsted, and D. A. Gorog, 'Impaired thrombolytic status predicts adverse cardiac events in patients undergoing primary percutaneous coronary intervention', Thrombosis and Haemostasis, Issue 3: 457-470, 2017. Under embargo. Embargo end date: 1 March 2018. The Version of Record is available online at doi: https://doi.org/10.1160/TH16-09-0712.
dc.description.abstractAntithrombotic medications reduce thrombosis but increase bleeding. Identification of ST-elevation myocardial infarction (STEMI) patients at risk of recurrent thrombosis could allow targeted treatment with potent antithrombotic medications, with less potent agents in others, to reduce bleeding. Conventional platelet function tests assess platelet reactivity only, yet there is increasing evidence that endogenous thrombolytic potential determines outcome following thrombus initiation. We investigated whether assessing both platelet reactivity and endogenous thrombolysis, could identify STEMI patients at high-risk of recurrent thrombotic events. Thrombotic status was assessed in STEMI patients, before and after primary percutaneous coronary intervention (PPCI), at discharge and at 30 days; with 12 months' follow-up. The time to form an occlusive thrombus under high shear (occlusion time, OT), and time to restore flow by endogenous thrombolysis (lysis time, LT) was measured using the point-of-care Global Thrombosis Test (GTT) in the cardiac catheterisation laboratory. Impaired endogenous thrombolysis (prolonged LT ≥ 3000 s), seen in 13 % patients pre-PPCI, was related to major adverse cardiac events, MACE (HR: 3.31, 95 %CI: 1.02-10.78, p = 0.045), driven by cardiovascular death (HR: 4.17, 95 %CI: 0.99-17.51, p = 0.05). Enhanced (rapid) endogenous thrombolysis (LT < 1000 s) was associated with spontaneous reperfusion, ST-segment resolution and Thrombolysis In Myocardial Infarction 3 flow pre-PPCI. Baseline OT was shorter in those with MACE (especially recurrent myocardial infarction and stroke) than those without (253 ± 150 s vs 354 ± 134 s, p=0.017). Endogenous thrombolysis, when impaired, is associated with increased cardiovascular risk, and when enhanced, with spontaneous reperfusion. Endogenous thrombolysis may be a novel target for pharmacological intervention, and allow targeting of potent antithrombotic medications to high-risk patients.en
dc.format.extent14
dc.language.isoeng
dc.relation.ispartofThrombosis and haemostasis
dc.rightsEmbargoed
dc.subjectthrombosis
dc.subjectmyocardial infarction
dc.subjectpercutaneous coronary intervention
dc.subjectcoronary reperfusion
dc.subjectendogenous thrombolysis
dc.titleImpaired thrombolytic status predicts adverse cardiac events in patients undergoing primary percutaneous coronary interventionen
dc.contributor.institutionCentre for Lifespan and Chronic Illness Research
dc.contributor.institutionSchool of Life and Medical Sciences
dc.contributor.institutionDepartment of Psychology and Sports Sciences
dc.contributor.institutionPsychology
dc.contributor.institutionHealth and Clinical Psychology group
dc.contributor.institutionHealth Services and Medicine
dc.contributor.institutionBehaviour Change in Health and Business
dc.contributor.institutionPostgraduate Medicine
dc.contributor.institutionPharmacology and Clinical Science Research
dc.contributor.institutionDepartment of Pharmacy, Pharmacology and Postgraduate Medicine
dc.description.statusPeer reviewed
dc.date.embargoedUntil2018-03-01
dc.relation.schoolSchool of Life and Medical Sciences
dc.description.versiontypeFinal Accepted Version
dcterms.dateAccepted2017-03-01
rioxxterms.versionAM
rioxxterms.versionofrecordhttps://doi.org/10.1160/TH16-09-0712
rioxxterms.typeJournal Article/Review
herts.preservation.rarelyaccessedtrue
herts.rights.accesstypeEmbargoed


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