Primary and secondary haemostasis changes related to aging

Sepúlveda, César; Palomo, Iván; Fuentes, Eduardo

doi:10.1016/j.mad.2015.08.006

Cited by 29 publications

(20 citation statements)

References 133 publications

(131 reference statements)

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“…The paradox of increased risk of thrombosis and bleeding is well documented in the elderly. Endothelial dysfunction, increased platelet activation and hyperrectivity, increased levels of von Willebrand factor, reduced activity of ADAMTS‐13, increase activity or secondary hemostasis (intrinsic, extrinsic, and common pathways), increase in natural anticoagulants, decreased plasminogen and plasminogen activator inhibitor‐1, and hormonal changes, especially estrogen all play a part in the increased risk of thrombosis and by extension thrombosis in the elderly . Oxidative stress, marked accelerated atherosclerosis, vascular dysfunction and reduction in antioxidant gene expression also occur with aging, increasing the prevalence of obstructive coronary artery disease .…”

Section: Discussionmentioning

confidence: 99%

Temporal trends, characteristics and outcomes of fibrinolytic therapy for ST‐elevation myocardial infarction among patients 80 years or older

Ogunbayo

Misumida

Ayoub

et al. 2018

Cathet Cardio Intervent

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Background: Pharmacologic reperfusion therapy is a recommended and effective strategy in patients with ST-elevation myocardial infarction (STEMI) when percutaneous coronary intervention (PCI) is not available. This study investigates temporal trends and outcomes of fibrinolytic therapy (FT) in elderly patients with STEMI.Methods: Using the Nationwide Inpatient Sample database, we extracted patients ≥80 years a primary diagnosis of STEMI admitted between 2010 and 2014. Using ICD codes, we identified patients who underwent FT. We performed temporal trend analysis, then compared characteristics and inpatient outcomes in the FT group versus no-FT group. Our primary outcome of interest was hemorrhagic stroke (HS). We also assessed the impact of HS on mortality and discharge to skilled nursing facility (SNF).Results: Of the 917,307 patients with STEMI, 16.1% (n = 147,874) were aged 80 or older. Primary PCI was performed in 46.2%, 2.4% underwent FT, and 51.3% had neither pharmacologic nor mechanical revascularization. The rate of FT increased (1.9%-2.4%) in a nonlinear trend over the five years of the study. The FT group was eight times more likely to suffer HS (P < 0.001).FT was an independent predictor of HS (OR 7.90, 95% CI 4.36-14.30; P < 0.001), whether they underwent PCI or not. HS was an independent predictor of mortality and SNF discharge.Conclusion: FT in patients 80 years or older presenting with STEMI was associated with an eight-fold increase in HS and no associated mortality advantage, both with or without PCI.These data underscore the increased risk of FT in the elderly. K E Y W O R D S elderly, fibrinolysis, hemorrhagic stroke, ST-elevation myocardial infarction

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Section: Discussionmentioning

confidence: 99%

Temporal trends, characteristics and outcomes of fibrinolytic therapy for ST‐elevation myocardial infarction among patients 80 years or older

Ogunbayo

Misumida

Ayoub

et al. 2018

Cathet Cardio Intervent

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“…This finding was also confirmed when restricting the study sample to outpatients. Since ageing is a well-known “risk factor” to promote inflammatory processes, to alter immune response and to change the balance of primary and secondary haemostasis, both the development and process of thrombus resolution may differ between DVT patients by age 17–20 . In a mouse model of stasis induced thrombosis, aging was demonstrated to be associated with impaired thrombus resolution 20 .…”

Section: Discussionmentioning

confidence: 99%

Age-related diagnostic value of D-dimer testing and the role of inflammation in patients with suspected deep vein thrombosis

Prochaska

Frank

Nagler

et al. 2017

Sci Rep

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Previous reports have investigated the impact of age on D-Dimer testing in elderly individuals with suspected deep vein thrombosis (DVT), but data on the age-related diagnostic value of D-dimer in a sample covering a broad age range are limited. The present study determined age-specifically the diagnostic accuracy of D-dimer and compared it to C-reactive protein (CRP), a marker of inflammation, in 500 patients with suspected DVT from the VTEval project (NCT02156401). Sensitivity of D-dimer was lower in patients < 60 years in comparison to patients ≥ 60 years (∆−16.8%), whereas specificity was 27.9% higher. Lowest levels of sensitivity were detected for female sex, unprovoked DVT, low thrombotic burden, and distal DVT. A fixed D-dimer threshold of 0.25 mg/L FEU resulted in elevated sensitivity for patients < 60 with a reduction of false negatives by 40.0% for proximal DVT and by 50.0% for distal DVT. In patients < 60 years, D-dimer and CRP demonstrated comparable diagnostic performance for both proximal and distal DVT (p > 0.05). In conclusion, these data outline a clinically-relevant limitation of D-dimer testing among younger patients with suspected DVT indicating a necessity for age-adapted cut-off values. Further research is required to decrypt the role of inflammation in the pathophysiology and diagnosis of venous thrombosis.

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“…Vascular endothelial dysfunction is recognized as a key mechanism underlying cardiovascular pathologies including hypertension; atherosclerosis and thrombosis [ 1 , 2 ]. It develops with aging, and is characterized by several phenotypic changes including alterations toward a vasoconstrictive; pro-inflammatory and pro-coagulant profile [ 1 , 3 ]. The endothelium-derived molecule nitric oxide (NO) has a protective influence on all of these processes.…”

Section: Introductionmentioning

confidence: 99%

Acute Effects of Nitrate-Rich Beetroot Juice on Blood Pressure, Hemostasis and Vascular Inflammation Markers in Healthy Older Adults: A Randomized, Placebo-Controlled Crossover Study

et al. 2017

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Aging is associated with a vasoconstrictive, pro-coagulant, and pro-inflammatory profile of arteries and a decline in the bioavailability of the endothelium-derived molecule nitric oxide. Dietary nitrate elicits vasodilatory, anti-coagulant and anti-inflammatory effects in younger individuals, but little is known about whether these benefits are evident in older adults. We investigated the effects of 140 mL of nitrate-rich (HI-NI; containing 12.9 mmol nitrate) versus nitrate-depleted beetroot juice (LO-NI; containing ≤0.04 mmol nitrate) on blood pressure, blood coagulation, vascular inflammation markers, plasma nitrate and nitrite before, and 3 h and 6 h after ingestion in healthy older adults (five males, seven females, mean age: 64 years, age range: 57–71 years) in a randomized, placebo-controlled, crossover study. Plasma nitrate and nitrite increased 3 and 6 h after HI-NI ingestion (p < 0.05). Systolic, diastolic and mean arterial blood pressure decreased 3 h relative to baseline after HI-NI ingestion only (p < 0.05). The number of blood monocyte-platelet aggregates decreased 3 h after HI-NI intake (p < 0.05), indicating reduced platelet activation. The number of blood CD11b-expressing granulocytes decreased 3 h following HI-NI beetroot juice intake (p < 0.05), suggesting a shift toward an anti-adhesive granulocyte phenotype. Numbers of blood CD14++CD16+ intermediate monocyte subtypes slightly increased 6 h after HI-NI beetroot juice ingestion (p < 0.05), but the clinical implications of this response are currently unclear. These findings provide new evidence for the acute effects of nitrate-rich beetroot juice on circulating immune cells and platelets. Further long-term research is warranted to determine if these effects reduce the risk of developing hypertension and vascular inflammation with aging.

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Primary and secondary haemostasis changes related to aging

Cited by 29 publications

References 133 publications

Temporal trends, characteristics and outcomes of fibrinolytic therapy for ST‐elevation myocardial infarction among patients 80 years or older

Temporal trends, characteristics and outcomes of fibrinolytic therapy for ST‐elevation myocardial infarction among patients 80 years or older

Age-related diagnostic value of D-dimer testing and the role of inflammation in patients with suspected deep vein thrombosis

Acute Effects of Nitrate-Rich Beetroot Juice on Blood Pressure, Hemostasis and Vascular Inflammation Markers in Healthy Older Adults: A Randomized, Placebo-Controlled Crossover Study

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