Risultati per: Linee Guida per le cure post-parto

Circulation, Volume 146, Issue Suppl_1, Page A13481-A13481, November 8, 2022. Introduction:Cardiac procedures and surgeries can cause injury to the pericardium and result in pericarditis, termed post-cardiotomy syndrome or post-cardiac injury syndrome (PCIS). The incidence of PCIS after transcatheter aortic valve replacement (TAVR) is unknown, and the aim of the current study is to compare the incidence of PCIS in surgical versus transcatheter aortic valve replacement (SAVR, TAVR).Methods:In a single-center retrospective cohort study of randomly selected patients who had TAVR or SAVR in 2019, the primary outcome was PCIS, defined according to ESC guidelines. Pericarditis recurrence was also defined according to ESC guidelines. Due to baseline differences in SAVR and TAVR patients, propensity score matching was performed using calipers of width equal to 0.2 of the standard deviation of the logit of the propensity score.Results:Patients undergoing TAVR (n=103) were older, had higher STS-PROM scores, and generally more co-morbidities compared to patients undergoing SAVR (n=100), with the exception of atrial fibrillation (Table). Overall, 17 patients (17%) with SAVR had PCIS compared to 1 patient (1%) with TAVR (p

Circulation, Volume 146, Issue Suppl_1, Page A15083-A15083, November 8, 2022. Introduction:Among patients hospitalized for HF, patients hospitalized with worsening chronic heart failure (WCHF) are at increased risk for morbidity and mortality compared with those who are recently diagnosed with HF. Whether there are differences in clinical course during hospitalization for HF is unclear.Methods:We pooled 735 participants hospitalized for HF in the DOSE, CARRESS, and ROSE trials. We grouped participants by whether HF was recently diagnosed (≤12 months) or WHCF ( >12 months). We compared changes in congestion, kidney function, and symptoms during hospitalization, as well as early post-discharge kidney and mortality outcomes.Results:Overall, 132 (18%) had recently diagnosed HF and 603 (82%) had WCHF. Compared with WCHF, patients with recently diagnosed HF tended to have lower serum creatinine and higher systolic blood pressure, ejection fraction, and serum NT-proBNP (all p0.15) (Figure). Recently diagnosed HF showed improved dyspnea at 72 hours (p=0.03). There was no difference in change in serum creatinine from baseline to 60 days (p=0.75). There was a trend toward significantly increased odds of mortality during study follow-up (adjusted odds ratio 1.96 [95% confidence interval 0.97-3.94], p=0.06).Conclusion:Patients hospitalized for recently diagnosed and WCHF have generally similar in-hospital clinical trajectories, and similar changes in kidney function early post-discharge. Despite these similarities and adjustment for other clinical factors, patients with WCHF remain at increased risk for post-discharge mortality as compared with patients who are more recently diagnosed.

Circulation, Volume 146, Issue Suppl_1, Page A9525-A9525, November 8, 2022. Introduction:Supporting self-management is essential to improving health outcomes after stroke. More evidence on the stroke survivors’ experiences and perceived usefulness of the self-management interventions are needed to provide better support.Purpose:This study was aimed to explore stroke survivors’ experiences of attending an 8-week programme which consisted of four home visits and five follow-up phone calls and delivered by a collaborative team of nurses and trained lay volunteers.Methods:A qualitative study was conducted with a convenience sample of the survivors who had received the programme. After completing the programme, the survivors were interviewed individually by phone using a semi-structured interview guide about their changes in perceiving and responding to post-stroke physical and psychosocial challenges. Suggestions to improve their experience of participation were collected. Interview data were transcribed verbatim and analysed thematically.Results:Thirty stroke survivors (mean age=60 years, SD=11.74) were interviewed. Most of them were male (60%), married (63.3%) and had a first-ever ischaemic stroke (50%). The mean duration of onset after stroke was 5.63 years (SD=3.12). About 63% of them walked unaided or with a stick. Four (13.3%) had mild dysphasia. Four themes were derived: developed short-term goals with lifestyle-integrated action plans; resumed social activities or work; increased satisfaction with life and sense of being cared for; more effective communication and relief of negative emotions; increased adoption of new and creative strategies to improve limb functions. Suggestions for improving the programme included longer duration, more home visits, earlier support upon discharge from the hospital, meetings with other survivors for mutual support while working towards the goals, and more structured follow-up phone calls.Conclusions:The self-management programme was found helpful in improving the survivors’ confidence and performance of self-management behaviours. Making the programme available upon discharge, and extending its duration with more home visits, group sessions and structured phone calls would build stronger self-management capabilities in survivors.

Circulation, Volume 146, Issue Suppl_1, Page A11765-A11765, November 8, 2022. Introduction:Catheter ablation therapy (CAT) is recommended for the management of symptomatic atrial fibrillation (AF). Previous real-world studies using the National Inpatient Sample (NIS) have described a disproportionately higher burden of post-CAT complications in womenHypothesis:We sought to determine whether the prior gender disparities in complications post-CAT for AF still exist. We hypothesize that with increasing CAT proficiency women would be no more likely to suffer complications compared to menMethods:We identified all percutaneous AF CAT hospitalizations in the NIS 2016-2019. We used Inverse-Probability Weighting (IPW) to create a pseudo-population where gender was independent of the following confounders: age, race/ethnicity, primary payor, median income, CHA2DS2VASc and Elixhauser scores, comorbidities including obesity, alcohol use disorder, obstructive sleep apnea, chronic pulmonary disease, and hospital characteristics-region, teaching-status, and bed-size. We compared in-hospital mortality rate, total procedural complications including pericardial (tamponade/effusion/pericarditis); cardiac (heart failure/perioperative MI/shock); respiratory (pneumothorax/respiratory failure); esophageal (perforation/injury); vascular (access-site fistulas/bleeding); and renal (acute kidney injury) between men and womenResults:Of the 5,835 AF CATs identified (representing 29,175 nationally), 43.2% were performed in women. Before IPW, women were older, and had higher proportions of comorbidities. After applying weights, baseline characters were well-balanced. In the weighted-cohort, there was no difference in mortality (0.48% vs 0.29%, p=0.52) or total complications (8.3% vs 9.6%, p=0.20). Likewise, pericardial (4.5% vs 4.1%, p=0.26); cardiac (0.3% vs 0.4%, p=0.40); vascular (3.6% vs 3.4%, p=0.37); respiratory (0.7% vs 0.8%, p=0.70); esophageal (0.5% vs 0.4%, p=0.31); and renal (1.2% vs 2.3%, p=0.38) complications, were similar across genderConclusion:In this real-world cohort, the burden of complications after CAT for AF was similar across gender. Sustained national efforts at maintaining awareness of gender disparities in complications post-AF CAT are needed to keep this new status quo

Circulation, Volume 146, Issue Suppl_1, Page A12760-A12760, November 8, 2022. Introduction:Post-acute sequelae of COVID-19 (PASC) is a novel clinical syndrome. We have previously reported that PASC patients can develop postural orthostatic tachycardia syndrome (POTS) and that COVID-19 induce microvascular endothelial dysfunction in acutely ill, hospitalized patients, that persist up to four months post discharge. Whether microvascular endothelial dysfunction contributes to POTS pathophysiology in PASC remains unclear.Hypothesis:Patients with PACS combined with POTS have impaired microvascular endothelial function.Methods:PASC patients (n=44) with mild SARS-CoV-2 infection (not hospitalized) were recruited from the post-COVID multidisciplinary clinic at Karolinska University Hospital. PASC diagnosis was based on the WHO PASC criteria. POTS was diagnosed in 21 patients (PASC + POTS) while 23 had a negative head-up tilt test (PASC – POTS). Age- and gender-matched healthy subjects (n=15) served as controls. Microvascular endothelial function was quantified as reactive hyperemia index (RHI) determined from the changes in pulse amplitude tonometry before and after a 5 min episode of arterial occlusion. Stress-perfusion cardiac magnetic resonance imaging (cMRI) with adenosine was performed in a subset of patients.Results:Mean age was 42±11 years and 95 % were women among PACS patients. Time from COVID-19 symptom onset to study inclusion was 18±3 months. RHI was significantly lower in PASC + POTS than in healthy controls and PASC – POTS (Figure 1). The prevalence of cardiac microvascular dysfunction on cMRI did not differ between the PASC groups (8% in PASC + POTS vs. 13% in PASC – POTS, p=1.00). All subjects with microvascular dysfunction on cMRI except one had a RHI below the cutoff (1.67) indicating microvascular dysfunction.Conclusions:Microvascular endothelial dysfunction is common in patients with PACS-associated POTS and may cause stress-induced myocardial ischemia up to 18 months after a mild primary infection.

Circulation, Volume 146, Issue Suppl_1, Page A12848-A12848, November 8, 2022. Introduction:Immunosuppression of heart transplant (txp) recipients increases risk of infection. This study will identify the most common pathogens and characterize the most at-risk patients.Methods:We performed a single center retrospective cohort study at the University of Rochester. Demographics, pretransplant characteristics, and infections requiring rehospitalization were obtained (table 1) from electronic records of patients who received a txp from January 1, 2011 through July 1, 2020. Chi-square, t-test, and Wilcoxon rank-sum test assessed association between mortality, infection risk and other variables.Results:We identified 132 patients who received txp but excluded 4 due to incomplete data, 10 (7.6%) patients died during index admission while 12 (9.4%) more patients died in the year following their txp. Infections occurring 1 month post txp were associated with mortality (p-adj 0.026). Prior sternotomies (n=65, 50.8%) were associated with both mortality and bacterial infection (p-adj

Circulation, Volume 146, Issue Suppl_1, Page A10900-A10900, November 8, 2022. Pulmonary Arterial Hypertension (PAH) is characterized by progressive pulmonary arteries (PAs) obstruction leading to heart failure and death. PA smooth muscle cells (PASMCs) of PAH patients display a “cancer-like” phenotype that contributes to PA remodeling. Eukaryotic translation initiation factor 5A (eIF5A) was shown to provide cancer cells with a competitive advantage by increasing translation of mRNAs with oncogenic proprieties, many of them containing proline/glycine-rich patterns. Strikingly, eIF5A is the only protein containing the unique, polyamine-derived amino acid hypusine, which is required for its function. Hypusine formation is catalyzed by the sequential actions of deoxyhypusine synthase (DHPS) and deoxyhypusine hydrolase (DOHH). We hypothesized that increased eiF5AHypin PAH-PASMCs is required to promote translational efficiency of a set of factors conferring a higher survival and fibroproliferative capacity, leading to pulmonary vascular remodeling.Data derived from a comparative proteomic analysis (LC-MSMS) between normal and PAH-PASMCs and confirmed by Western blot indicate that DHPS and DOHH are overexpressed in PAH-PASMCs compared to controls (p

Circulation, Volume 146, Issue Suppl_1, Page A13291-A13291, November 8, 2022. Introduction:Successful management of Heart Failure (HF) patients post-discharge requires a multi-faceted approach including close medication management to decrease preventable readmissions.Methods:We conducted a one-year single center, single-blinded randomized trial of HF patients post-discharge comparing standard of care vs. intensive virtual care on HF readmission rates. The intensive virtual care included comprehensive medication management by a Virtual Clinical Pharmacist (VCP).Results:Among the 591 participants, the median age was 73.2 years, 52.5% male, and 56.2% white. There were 308 patients randomized into the intervention group of which 165 (53.5%) enrolled. During VCP visits, 155 patient concerns were identified including active symptoms (45.2%), lack of clarity of medication regimen (40.6%), concurrent uncontrolled hyperglycemia or hypertension (9%) and non-adherence with provider follow up appointments (5.2%). There were 625 VCP interventions in 165 HF patients. Of these patients, VCPs increased access to medical care (33.9%), optimized guideline directed medical therapy (17.6%), addressed symptoms of HF exacerbations (7.9%), and other impactful interventions (Table). VCP recommendations had a 59% acceptance rate into the patient’s treatment plan when clinicians were contacted directly. A 6.9% decrease in 30-day readmission rates was demonstrated (p=0.03) in the intervention group, in addition to a decrease from 24.4% to 19.2% in emergency department visits (p=0.15). For patients readmitted, the intervention arm had a shorter length of stay, 5.6 days, when compared to control, 6.8 days (p=0.14).Conclusion:This single center randomized trial demonstrated that Virtual Clinical Pharmacist-led comprehensive medication management identified key interventions with high-level clinician engagement for post-discharge HF patients that resulted in a 6.9% reduction in HF readmissions.

Circulation, Volume 146, Issue Suppl_1, Page A12070-A12070, November 8, 2022. Introduction:The majority of patients resuscitated from cardiac arrest (CA) present in coma or with an altered level of consciousness. Although CA survivors are routinely sedated during targeted temperature management, the effects of sedation on CA outcomes remain to be determined.Hypothesis:Post-CA sedation would modulate cerebral physiology and improve neurological outcomes in mice.Methods:Adult C57BL/6J mice of both sexes were subjected to potassium chloride-induced CA and thereafter resuscitated with manual chest compression. Starting at return of spontaneous circulation (ROSC) or at 60 minutes after ROSC, mice received intravenous infusion of propofol at 40 mg · kg-1· h-1, dexmedetomidine at 1 μg · kg-1· h-1, or normal saline for 2 hours. Body temperature was lowered and maintained at 33°C during sedation. Cerebral blood flow was measured for 4 hours after ROSC. Telemetric electroencephalogram (EEG) was recorded in freely moving mice from 3 days before up to 7 days after CA.Results:Sedation with propofol or dexmedetomidine starting at ROSC attenuated brain injury and improved survival in hypothermia-treated post-CA mice (propofol [13/16] vs. no sedation [4/16],P= 0.008; dexmedetomidine [14/16] vs. no sedation [4/16],P= 0.002). Mice that were not sedated after ROSC exhibited cerebral hyperemia immediately after resuscitation and EEG power in all frequency bands remained less than 20% of the baseline in the first 4 hours after ROSC. Administration of propofol or dexmedetomidine starting at ROSC attenuated cerebral hyperemia and induced slow-wave (0.5-4 Hz) EEG activity that reached near baseline levels during and early after sedation. Increased EEG activity within 6 hours after ROSC was associated with improvement in neurological outcomes at 24 hours post-CA. In contrast, delayed sedation starting at 60 minutes after ROSC failed to improve outcomes, without attenuating cerebral hyperemia and inducing slow-wave EEG activity.Conclusions:Post-CA sedation with propofol or dexmedetomidine improved neurological outcomes and survival in mice resuscitated from CA and treated with hypothermia. The beneficial effects of sedation were accompanied by attenuation of the cerebral hyperemic response and induction of EEG slow-wave activity.

Circulation, Volume 146, Issue Suppl_1, Page A10282-A10282, November 8, 2022. Introduction:Despite anticoagulation (AC), up to 50% of proximal deep vein thrombosis (DVT) patients will develop the post-thrombotic syndrome (PTS). In a substudy of the ATTRACT DVT trial, catheter-directedthrombectomy/thrombolysis (CDT) in addition to AC improved PTS outcomes for patients presenting at an intermediate day (D) 4-8 symptom-onset-to-randomization (SOR) timeframe, but not at an early D0-3 or late D9+ SOR timeframe. Mechanisms underlying the role of early AC and CDT are unknown, particularly iliofemoral DVT (IFDVT) patients that preferentially benefit from CDT.Methods:First, we assessed the temporal impact of AC on Villalta and VEINES-QoL PTS scores in a post-hoc analysis of the IFDVT ATTRACT patients (N=391). Mean scores were estimated by a piecewise linear-regression growth-curve model. Next, to mechanistically explore the effects of AC on PTS measures, C57/BL6 mice (N=76) underwent inferior vena cava (IVC) ligation to produce stasis DVT. Mice then underwent true or sham de-ligation at D2 to spur restoration of blood flow (RBF). Last, enoxaparin AC was initiated at D2 and given daily until D8, at either 0, 10, or 30 mg/kg/d SQ. D4 RBF rates in the IVC, and D8 thrombus burden were assessed.Results:In IFDVT ATTRACT patients, CDT+AC improved PTS scores in the intermediate D4-8 SOR timeframe (p0.05 vs. AC alone). In the AC alone groups, early AC D0-3 significantly improved PTS scores over delayed AC (p

Circulation, Volume 146, Issue Suppl_1, Page A10209-A10209, November 8, 2022. Introduction:SGLT inhibitors demonstrate reductions in CV mortality and HHF in patients with diabetes and chronic HF. Despite therapy, patients hospitalized for worsening HF (WHF) are at high risk of death or readmission.Hypothesis:The SOLOIST-WHF trial admitted patients for their index WHF event and initiated randomized therapy during hospitalization. This study evaluated the effect of the SGLT1 and 2 inhibitor sotagliflozin on 30- and 90-day CV death and HF readmission rates after discharge.Methods:Of 1222 randomized patients with T2D, 86% were admitted for their index WHF event. Of them, 46% (n = 563) started study drug prior to or at discharge. In post hoc exploratory analyses, CV death and HF readmission (HHF or urgent visits for HF) rates were determined 30- or 90-days post discharge. Comparisons were done by Cochran-Mantel-Haenszel test stratified by region and baseline LVEF (50% for readmission for non-fatal HF-related events or the composite of CV death and readmission for HF-related events within 30 or 90 days of discharge vs placebo (Table 1). The sotagliflozin safety profile in those windows was generally consistent with the overall study duration. Incidence of adverse events (AEs) and serious AEs was similar between groups. Increased incidence of diarrhea and volume-related AEs was noted with sotagliflozin. No appreciable eGFR change from baseline occurred at 30 days, but there was lower incidence of AEs linked to acute kidney injury with sotagliflozin.Conclusions:Sotagliflozin, given to patients with T2D prior to or at hospital discharge after an episode of WHF, was well tolerated and resulted in a significant >50% reduction in CV mortality or readmission for a HF event at 30 and 90 days post-discharge.

Circulation, Volume 146, Issue Suppl_1, Page A14439-A14439, November 8, 2022. Introduction:Post-transcatheter aortic valve replacement (TAVR) outcome of patients is an important research topic. To accurately assess post-TAVR mortality, we examined a family of new echo-parameters (augmented systolic blood pressure (AugSBP) and arterial mean pressure parameters (AugMAP)) derived from blood pressure and aortic valve gradient (Figure 1).Methods:Patients in the Mayo Clinic National Cardiovascular Diseases Registry-TAVR database who underwent TAVR between January 1, 2012, and June 30, 2017, were identified to retrieve baseline clinical, echocardiographic, and mortality data. The median of AugSBP and AugMAP were used to stratify patients in Kaplan-Meier analysis.Results:The final cohort contained 974 patients with a mean age of 81.4±8.3 years old, and 56.6% were male. The mean Society of Thoracic Surgeons risk score was 8.2±5.2. The median follow-up duration was 354 days, and the one-year all-cause mortality rate was 14.2%. Detailed characteristics are summarized inTable 1.AugMAP1 < 102.5 mmHg (median) was associated with a 3-fold risk of all-cause mortality post-TAVR at 1 year (hazard ratio 3.0, 95%confidence interval 2.0-4.5, p

Circulation, Volume 146, Issue Suppl_1, Page A12970-A12970, November 8, 2022. Introduction:Ventricular assist devices (VAD) have improved outcomes in children with advanced heart failure. However, despite improvements in adverse event rates, mortality and early post-VAD stroke remain important consequences. We sought to determine pre and post-operative factors that increase the risk of these outcomes utilizing data linked from the ACTION and PC4 registries.Methods:ACTION and PC4 registries are audited, comprehensive, encounter-based registries of patient course and outcomes for pediatric heart failure and pediatric cardiac critical care respectively. Data from patients who underwent initial VAD placement in each registry from 8/2014-7/2020 were linked using indirect patient identifiers. Patient demographics, heart disease, pre and post-operative ICU courses and outcomes were compiled. Appropriate descriptive and univariate statistics assessed association of patient factors with hospital mortality and stroke. Multivariable logistic regression sought independent associations with these outcomes.Results:248 ACTION subjects were linked to a matching patient in PC4 with 98% match concordance. Median age was 7.7 years (1.5-15.5), weight 21.3kg (9.1-58) and 56% male. The cohort had 66% LVAD, 23% Single ventricle VAD and 10% BiVAD. Of the devices, 52 (21%) were Berlin EXCOR, 95 (38%) intracorporeal continuous flow, and 30 (12%) temporary continuous flow. The primary diagnosis was congenital heart disease in 35% of patients. Overall, 32 patients (13%) had a stroke and 45 patients (18%) died prior to discharge. Multivariable analysis found risk factors for mortality included only congenital heart disease (OR=3.78 [95%CI: 1.16-12.29], p=0.027), INTERMACS profile 1 (OR=6.51 [95%CI: 1.08-39.26], p=0.041), post-operative hepatic dysfunction (OR=37.35 [95%CI: 4.39-317.76], p

Circulation, Volume 146, Issue Suppl_1, Page A13431-A13431, November 8, 2022. Introduction:Mitral valve (MV) leaflet morphology plays an important role insuring efficient, unidirectional blood flow from the left atrium (LA) to ventricle (LV). When treating severe mitral regurgitation (MR), surgical repair, valve replacement, or transcatheter edge-to-edge (E-2-E) repair all provide valid options depending on anatomy and clinical circumstances. These interventions alter the MV morphology, impacting LV filling dynamics. We used fluid-structure interactions (FSI) to evaluate LV filling dynamics after MV interventions, taking into consideration full left-heart (LH) dynamics.Methods:3-D MV model of a patient suffering from severe MR was reconstructed from echocardiographic data. A LH wall motion algorithm was developed and applied to CT-derived LA and LV walls to realistically represent LH dynamics. LH wall motion, MV dynamics and blood flow in LA and LV during MV function was simulated using a strongly coupled fluid structure interaction approach. Virtual interventions using a surgical 33mm bioprosthetic valve (BPV) and transcatheter E-2-E repair were performed and evaluated.Results:Our FSI model predicted a physiological vortex ring developing in the LV for the pre-op MV during early diastole. BPV produced complex asymmetrical vortices. Due to its double orifice, the E-2-E clip produced two separate vortex rings with the largest velocity magnitude. Of all the three treatments, BPV had the greatest leaflet deformation rate.Conclusion:This model provides realistic quantitative insights into post-op filling dynamics that can be used to personalize and optimize valve intervention. These methodologies may help clinicians to realistically predict and evaluate patient-specific LV filling dynamics to tailor MV interventions.

Circulation, Volume 146, Issue Suppl_1, Page A12949-A12949, November 8, 2022. Introduction:Pulmonary hypertension due to left heart disease (Group 2) is the most common type of pulmonary hypertension and has two subtypes: isolated post-capillary pulmonary hypertension (Ipc-PH) and combined post-capillary and pre-capillary pulmonary hypertension (Cpc-PH). Little is known about the molecular characteristics that distinguish these two subphenotypes or if Cpc-PH shares molecular similarities to pulmonary arterial hypertension (PAH), as has previously been suggested. Many lipid metabolites, including a diverse group of bioactive lipid mediators known as oxylipins, have been associated with cardiovascular disease and other inflammatory conditions. Therefore, we sought to characterize oxylipin and other bioactive lipid profiles among patients with Ipc-PH and Cpc-PH, as well as those with PAH.Methods:We studied 129 patients with Ipc-PH (n=38), Cpc-PH (n=52), or PAH (n=39) between June 2006 and March 2012. Liquid chromatography-mass spectrometry was used to assess 350 lipid metabolite analytes in each patient.Results:In multivariable analyses adjusting for age, sex, BMI, and pulmonary hypertension medications, we observed 34 metabolites were significantly increased and 10 were decreased in Ipc-PH compared to Cpc-PH (Figure). Among these same metabolites, only 9 were significantly different between Cpc-PH and PAH. Compared to patients with Ipc-PH, those with Cpc-PH had elevated levels of fatty acyl esters of hydroxy fatty acids and polyunsaturated fatty acids as well as lower levels of anti-inflammatory and pulmonary vascular relaxant oxylipins.Conclusions:Overall, these findings suggest that Cpc-PH may diverge from Ipc-PH and share some molecular similarities with PAH. Identifying key molecular targets involved in Cpc-PH pathophysiology may be critical for diagnostic purposes and in the development of novel therapeutic avenues for patients with Cpc-PH.

Circulation, Volume 146, Issue Suppl_1, Page A10315-A10315, November 8, 2022. Introduction:Biomarker research related to protease-activated receptor-1 (PAR-1) inhibition with vorapaxar in humans has essentially focused on platelets. Follow-up (FU) time has been short, whereas in the current study, focus has been on endothelial function during both short- and long-term PAR-1 inhibition.Aim:To assess short- and long-term effects of vorapaxar (V) as compared to Placebo (PL) on the following biomarkers: Angiopoietin-2 (ANGPT2), Angiopoietin-like 4 (ANGPTL4), VEGF, ICAM-1, VCAM-1, E-Selectin (ESEL), von Willebrand Factor (VWF), Thrombomodulin (TM), PAI-1 and PAI-2.Methods:In an independent collective subproject performed in Norway, post-MI patients at steady state were recruited from the “Trial to Assess the Effects of Vorapaxar in Preventing Heart Attack and Stroke in Patients with Atherosclerosis” (TRA2ᵒP-TIMI 50) and NSTEMI patients were recruited from the “Thrombin Receptor Antagonist for Clinical Event Reduction in acute coronary syndrome” (TRACER) trial. Biomarkers were measured in duplicate by enzyme immunoassays (EIA) in citrated plasma at one month follow-up and at study completion (median 2.3 years) for subjects recruited from both trials.Results:Biomarkers were measured in 265 consecutive patients [age median 62.0 years (Q1-Q3: 55.0-68.0 years), males 83%] with at least one change from baseline value. Among these, biomarkers were available at both short- and long-term follow-up in 221 subjects.ANGPT2 increased significantly in V as compared to PL at 1-month follow-up in the total population (p=0.034), and in males in both post-MI (p=0.031) and NSTEMI subjects (p=0.012), respectively. ANGPTL4 increased (p=0.028) and PAI-2 decreased (p=0.025) significantly in the total population in favor of V at final FU. In the total post-MI subgroup and among males of that group, a short-term significant increase in ESEL in favor of V was observed, p=0.029 and p=0.018, respectively. Also, a transient significant increase in VWF (p=0.032) in favor of V was seen at one month in NSTEMI patients.Conclusions:Significant changes suggesting potential harmful effects in some biomarkers were observed during 1-month and long-term PAR-1 inhibition as compared to placebo in post-MI and acute coronary syndrome patients.