BACKGROUND: Antithrombotic strategies after percutaneous coronary interventions (PCI) in elderly patients on oral anticoagulant therapy (OAT) are debated due to the balance between ischemic and bleeding risks. Recent guidelines recommend early transitioning from triple antithrombotic therapy to dual antithrombotic therapy, but there are limited data on elderly patients. METHODS: We performed a post-hoc age-specific analysis of the PERSEO Registry population aimed to compare clinical features, therapeutic strategies, and outcomes of individuals aged ≥ 80 years and < 80 years who were on OAT and underwent PCI with stent. The primary endpoint was net adverse clinical events at 1-year follow-up. Secondary endpoints included major adverse cardiac and cerebral events (MACCE), major bleeding [Bleeding Academic Research Consortium (BARC) type 3-5], and clinically relevant bleeding (BARC type 2-5). RESULTS: Among the 1234 patients enrolled, 31% of patients were aged ≥ 80 years (84 ± 3 years, 76% males). Compared to younger patients, elderly patients had higher rates of comorbidities such as hypertension, anaemia or chronic kidney disease, and atrial fibrillation was the leading indication for OAT. Elderly patients were more often discharged on dual antithrombotic therapy (23%) compared to younger patients (13%) (P < 0.0001). They experienced higher net adverse clinical events (38% vs. 21%, P < 0.001), MACCE (24% vs. 12%, P < 0.001), as well as higher bleeding rates. Specifically, rates of major bleeding (9% vs. 6%, P = 0.026), and clinically relevant bleeding (21% vs. 12%, P < 0.001) were significantly higher in elderly patients. CONCLUSIONS Elderly patients on OAT undergoing PCI are a particular frail population with higher risk of MACCE and bleeding compared to younger patients despite a less aggressive antithrombotic therapy.

PURPOSE: To determine the relationship between the neurogenic bladder symptoms score (NBSS) and urodynamic examination in patients affected by multiple sclerosis (MS) and related lower urinary tract dysfunction (LUTD). METHODS: We recruited 122 consecutive patients with MS in remission and LUTD from January 2011 to September 2013 who underwent their first urodynamic examination. Neurological impairment was assessed using the Expanded Disability Status Scale (EDSS) and bladder symptoms were studied with the NBSS. RESULTS: Median NBSS was 20.0 (interquartile range, 12.75-31.0). Neurogenic detrusor overactivity (NDO) was discovered in 69 patients (56.6%). The concordance between patients with NDO and maximum detrusor pressure during involuntary detrusor contraction (PdetmaxIDC)> or =20.0 cm H2O was 0.89 (kappa-Cohen; P<0.05). Patients with EDSS scores of > or =4.5 had a greater NBSS (25.41 vs. 20.19, P<0.05), NBSS-incontinence (8.73 vs. 4.71, P<0.05), NBSS-consequence (4.51 vs. 3.13, P<0.05) and NBSS-quality of life (2.14 vs. 1.65, P<0.05). The NBSS was not associated with PdetmaxIDC> or =20 cm H2O (P=0.77) but with maximum cystometric capacity<212 mL (odds ratio, 0.95; P<0.05). CONCLUSIONS: The NBSS cannot give adequate information the way urodynamic studies can, in patients with MS and LUTD.
Humans ; Multiple Sclerosis* ; Urinary Bladder ; Urinary Bladder, Neurogenic* ; Urinary Bladder, Overactive ; Urinary Tract* ; Urodynamics*