Platelet Reactivity Unit in Predicting Risk of Bleeding in Patients Undergoing Coronary Artery Bypass Graft Surgery.

Bleeding is a common complication of cardiac surgery, accounting for a significant proportion of the total transfusions performed in the United States and Europe. The relationship between platelet reactivity, bleeding, and other adverse events after coronary artery bypass graft surgery (CABGS) has been incompletely characterized. This study investigated the relationship between platelet reactivity and bleeding as a clinical outcome after successful CABGS. A total of 238 patients who underwent CABGS were retrospectively followed for postoperative bleeding. Platelet reactivity unit (PRU) values for all patients were obtained preoperatively to assess the platelet reactivity. The data showed that a range of 180-200 PRU suggests the likelihood of bleeding after CABGS (P = 0.004), with a statistically significant association only for dual antiplatelet therapy with aspirin and clopidogrel. In conclusion, by using PRU values as a method to assess platelet reactivity and antiplatelet responsiveness, our findings suggest that it may be possible to stratify patients undergoing CABGS for the risk of postoperative bleeding particularly patients on dual antiplatelet therapy.

An unusual cause of postpartum heart failure.

Peripartum cardiomyopathy is a weakness of the heart muscle. It is an idiopathic cardiomyopathy that presents with heart failure secondary to left ventricular systolic dysfunction toward the end of pregnancy or in the months after delivery, in the absence of any other cause of heart failure. It is a rare condition that can carry mild or severe symptoms.

Utility of brain natriuretic peptide assay as a predictor of short term outcomes in patients presenting with syncope to the emergency department.

BACKGROUND: Syncope is a common condition that accounts for 3% of emergency department (ED) visits and 1-6% of hospital admissions. Current admissions practices result in marginal diagnostic and therapeutic benefit and consume healthcare resources. METHODS: This prospective cohort study examined the use of brain natriuretic peptide (BNP) test as a predictor of short term serious outcome in 159 patients who presented to ED with syncope between August 2012 and August 2013 in two tertiary teaching medical centers. RESULTS: A total of 41 patients (36%) had serious outcomes within 1 month, 21 of them were in the low BNP group and 20 were in the high BNP group. There was a significantly higher incidence of serious outcomes, myocardial infarction (MI), and life-threatening arrhythmias in the high BNP group. Patients with BNP >250 has an 8.844 fold increase risk of serious outcomes [odds ratio (OR) 8.844, 95% CI: (3.281 to 23.8), P<0.001], a 14.8-fold increase risk of MI [OR =14.8, 95% CI: (1.57 to 139), P=0.011], and a 4.46-fold increase risk life threatening arrhythmia [OR =4.46, 95% CI: (1.15-18.8), P=0.034]. However, there was no statistically significant difference between the two groups in one month mortality, major bleeding, major cardiac procedures or stroke. CONCLUSIONS: Our study results further validates the ROSE rule and the utility of BNP in risk stratification of syncope patients. This study showed that measuring BNP and adding ROSE rule to the standard evaluation of syncope can sufficiently predict short-term serious outcomes for patients presenting to ED with syncope.