P657Anticoagulation strategies based on warfarin or direct oral anticoagulants compared to major hemorrhagic events: the relevance of patients aged 75 years or older

Objective

To evaluate rates of major bleeding (mBleed) associated with anticoagulant treatments in patients (pts) with age ≥75 years (y), referred to hospital in northwest Tuscany.

Methods

We analysed 4-y survey; 302,687 visits; catchment area 197,722 inhabitants, of whom 15,267 on Warfarin (W) and 10,397 on direct oral anticoagulants (DOACs). DOACs were available in the catchment area since 4 y (dabigatran and rivaroxaban), 3 y (apixaban), and 2 y (edoxaban). Overall, 3,373 pts received dabigatran, 4,046 rivaroxaban, 2,141 apixaban, and 839 edoxaban. Pts with hemorrhage were submitted to propensity score matching for mBleed and stratified according to age ≥75 y, and W or DOACs. Primary endpoint was one-month death in pts with age ≥75 y.

Results

Out of 1,919 mBleed enrolled, those of pts aged ≥75 y were 1,127 (59%) versus (vs) 792 (41%) aged <75 y, with 77 (4.0%) one-month death vs 20 (1.0%), respectively; p<0.0001.

Patients on W showed higher rate of mBleed (n=175; 9.1%) compared to DOACs (n=53; 2.8%); p<0.0001. One-month death accounted for 14 (0.7%) vs 1 (0.1%), respectively; p=0.0019. Pts aged ≥75 years were more likely to show female gender and comorbidities including atrial fibrillation; p<0.01. Among DOACs, edoxaban presented the lowest absolute rate of hospital admission for mBleed and dabigatran the highest, although without statistical differences within DOACs (p=0.6454). Interestingly, in the subset of pts aged ≥75 y, within DOACs, we found no statistical difference in one-month mortality, although edoxaban showed one death due to brain mBleed; conversely, we found statistical significance in rate of mBleed. Indeed, edoxaban vs dabigatran showed p=0.0008, edoxaban vs apixaban p=0.0242, edoxaban vs rivaroxaban p=0.0058, apixaban vs rivaroxaban p=0.7093, apixaban vs dabigatran p=0.2279, rivaroxaban vs dabigatran p=0.5087.

Warfarin or DOACs and outcomes Major Bleeding (pts ≥75 y) p value versus pts <75 y p value within group One-month death (pts ≥75 y) p value versus pts <75 y p value within group n=1,127 n=77 Warfarin 175 (9.1%) 0.0001 <0.0001 14 (1.2%) 0.514 0.0019 DOACS 53 (2.8%) 0.0001 1 (0.1%) 0.256 Dabigatran 21 (1.1%) 0.026 0.0088 0 (0%) 0.391 0.8012 Rivaroxaban 16 (0.8%) 0.121 0 (0%) 0.619 Apixaban 13 (0.7%) 0.033 0 (0%) 1 Edoxaban 3 (0.2%) 0.647 1 (0.1%) 0.191 Patients: pts; direct oral anticoagulants: DOACs; p value Yates' correction: p value.

Patients with age >75 years and bleeding

Conclusion

In pts with age ≥75 y, rate of mBleed and short-term mortality were significantly higher than in pts aged <75 y In those pts, DOACs showed significantly lower rate of mBleed, and short-term death. Within DOACs, edoxaban was more likely to show lower rate of mBleed.

Enzyme immunoassay of 17 beta-estradiol, estrone conjugates, and testosterone in urinary and fecal samples from male and female mice

ELISA measures of 17 beta-estradiol, estrone conjugates, and testosterone were adapted for fecal and urinary samples from laboratory mice. We will report on validations of these assays and data from interacting males and females. Unconjugated gonadal steroids were consistently measurable in urine and feces of both males and females. Females that were parturient following insemination excreted relatively low levels of urinary testosterone compared to non-parturient females. The results are consistent with evidence that elevated androgens and estrogens are incompatible with intrauterine implantation of fertilized ova, and suggest that steroids in male urine could contribute to pheromonal action. These methods permit repeated noninvasive measurement of steroid activity in this species.

[IgA deficiency in pediatrics]

To evaluate the IgA deficiency we have considered 368 children, admitted to "Day hospital" for different pathologies: 64 of them had serum IgA levels lower than the normal values for their age according to Ellis and Robbin. The age of the children with this deficiency was included from 4 months up to 8 years: 39 were boys, 25 were girls. In 54 cases the IgA deficiency was "partial" that is: the IgA value found out was lower than the normal for the age, but higher than 5 mg%. In 10 cases the IgA deficiency was "severe" (the IgA value was lower than 5 mg%). Six cases, among the 29 ones with intestinal diseases, had a severe deficiency, whereas among the 22 cases with respiratory diseases 3 had a "severe" deficiency. The 2 patients with urinary disease had a partial deficiency; only one case of the remaining 11 with different pathologies had a "severe" deficiency. Among the carriers of serum IgA deficiency an high incidence of chronic pathology has been found out (83%). Nevertheless the percentage of IgA deficiency extrapolated from the all case histories doesn't differ very much (64 cases among 368 = 17.39%) considering only those patients with chronic relapsing pathology (53 cases among 275 = 18.2%). Therefore it seems that the IgA deficiency could be considered a chronicizing factor in the examinated pathology even if in few cases. Anyway the frequency of IgA deficiency has reached major values (29/54; 45.3%) in the patients with enteric diseases. The frequency of IgA deficiency is smaller but still important in those patients with respiratory diseases (22/64: 34.3%).(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of the ability of eosinophils and neutrophils, and of eosinophils from patients with S. mansoni infection and normal individuals, to mediate in vitro damage to schistosomula of S. mansoni

A reliable and reproducible method that produces separate fractions of pure eosinophils and neutrophils from normal peripheral blood was described. The interaction of eosinophils and neutrophils with antibody coated schistosomula was examined in vitro. Neutrophils were highly active in the 51Cr release assay and most formed rosettes with antibody coated red cells, but they adhered poorly to schistosomula and did not kill the organisms. Eosinophils, although they were less active in the 51Cr release assay than neutrophils and few formed rosettes, adhered strongly to schistosomula and, in the presence of antibody, were able to kill organisms. Organisms from patients with S. mansoni infection and eosinophilia were more effecient than eosinophils from normal individuals in their capacity to release 51Cr from labelled somula in the presence of antibody.