Faculty of Medicine

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    Clinical outcomes during anticoagulant therapy in fragile patients with venous thromboembolism.
    (2017)
    Moustafa F
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    Giorgi Pierfranceschi M
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    Di Micco P
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    Bucherini E
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    Lorenzo A
    Background Subgroup analyses from randomized trials suggested favorable results for the direct oral anticoagulants in fragile patients with venous thromboembolism (VTE). The frequency and natural history of fragile patients with VTE have not been studied yet. Objectives To compare the clinical characteristics, treatment and outcomes during the first 3 months of anticoagulation in fragile vs non‐fragile patients with VTE. Methods Retrospective study using consecutive patients enrolled in the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry. Fragile patients were defined as those having age ≥75 years, creatinine clearance (CrCl) levels ≤50 mL/min, and/or body weight ≤50 kg. Results From January 2013 to October 2016, 15 079 patients were recruited. Of these, 6260 (42%) were fragile: 37% were aged ≥75 years, 20% had CrCl levels ≤50 mL/min, and 3.6% weighed ≤50 kg. During the first 3 months of anticoagulant therapy, fragile patients had a lower risk of VTE recurrences (0.78% vs 1.4%; adjusted odds ratio [OR]: 0.52; 95% confidence intervals [CI]: 0.37‐0.74) and a higher risk of major bleeding (2.6% vs 1.4%; adjusted OR: 1.41; 95% CI: 1.10‐1.80), gastrointestinal bleeding (0.86% vs 0.35%; adjusted OR: 1.84; 95% CI: 1.16‐2.92), haematoma (0.51% vs 0.07%; adjusted OR: 5.05; 95% CI: 2.05‐12.4), all‐cause death (9.2% vs 3.5%; adjusted OR: 2.02; 95% CI: 1.75‐2.33), or fatal PE (0.85% vs 0.35%; adjusted OR: 1.77; 95% CI: 1.10‐2.85) than the non‐fragile. Conclusions In real life, 42% of VTE patients were fragile. During anticoagulation, they had fewer VTE recurrences and more major bleeding events than the non‐fragile.
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    MATERNAL PLASMA BIOMARKERS (ANTITHROMBIN 3, PLASMOINOGEN ACTIVATOR INHIBITOR 1, SOLUBLE TIE 2, VASCULАR ENDOTHELIAL GROWTH FACTOR RECEPTOR2) AS INDICATORS FOR PLACENTA ACCRETA SPECTRUM (PAS) IN THE THIRD TRIMESTER OF PREGNANCY
    (SHMSHM - AAMD, 2022-04)
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    Gjoreski, Josif
    Introduction: Placenta accreta spectrum (PAS)- an abnormally adherent placenta into the uterine wall with the inability to properly detach after the birth of the fetus. Factors that increase the risk of PAS are: regions of poorly developed decidua, previous caesarean section/s, etc. Materials and Methods: This study is a prospective cohort study conducted at The University Clinic of Gynecology and Obstetrics Skopje, Republic of North Macedonia in February and March 2021. The study involved 8 patients, diagnosed with PAS, from whom maternal plasma samples were taken. Measurements of concentration of antithrombin III, plasminogen activator inhibitor 1(PAI1), soluble Tie 2 (sol Tie2), vascular endothelial growth factor receptor 2(VEGFR2), in the third trimester of pregnancy were done. Results: In all 8 patients, a PAS diagnosis was detected. In previous ultrasound findings, placenta praevia was diagnosed in 4 of 8 patients, and the remaining 4 had ultrasound signs for placenta accreta. In terms of biomarker values, we received significant values in all 4 biomarkers we examined. Conclusion: The examination of these biomarkers is useful for predicting and early diagnosis of PAS. We confirmed antithrombin III, PAI-1, soluble Tie2 and soluble VEGF 2 receptor as new biomarkers for this condition.