Assessment of platelet activation and prothrombotic risk following acute upper gastrointestinal bleeding and bleeding in the context of acute coronary syndromes

Disney, Benjamin Robert (2017). Assessment of platelet activation and prothrombotic risk following acute upper gastrointestinal bleeding and bleeding in the context of acute coronary syndromes. University of Birmingham. M.D.

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Abstract

Patients presenting with acute upper gastrointestinal bleeding have an increased incidence of cardiovascular events, with mortality invariably related to factors other than the bleeding itself; the majority of deaths related to cardiovascular disease. Patients presenting with bleeding complicating acute coronary syndromes are at an increased risk of recurrent cardiovascular events and have higher short-term and long-term mortality when compared to patients with uncomplicated acute coronary syndromes. This study has shown the preferential use of the Blatchford score in identifying patients suitable for early discharge; using a cut-off score of 2 could avoid up to 15% of admissions. The results show significant diurnal and seasonal variation in the presentation of acute upper gastrointestinal bleeding with fewer admissions in the winter months. This study has shown an increase in levels of platelet activation and prothrombotic markers (d-dimer and vWF) in the acute upper gastrointestinal bleeding population. No such findings were seen in the acute coronary syndromes complicated by bleeding group. These novel findings may help explain the excess of cardiovascular mortality in patients with presenting upper gastrointestinal bleeding and give a biological rationale to restarting antiplatelet agents early in these patients. Further studies are required to confirm and further investigate these findings.

Type of Work:

Thesis (Higher Doctorates > M.D.)

Award Type:

Higher Doctorates > M.D.

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