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Background and Objectives: In anticoagulated atrial fibrillation (AF) patients, the validity of models recommended for the stratification of the risk ratio between benefits and hemorrhage risk is limited. Cerebral small vessel disease (SVD) represents the pathologic substrate for primary intracerebral hemorrhage and ischemic stroke. We hypothesize that biological markers—both circulating and imaging-based—and their possible interaction, might improve the prediction of bleeding risk in AF patients under treatment with any type of oral anticoagulant. Materials and Methods: The Strat-AF study is an observational, prospective, single-center hospital-based study enrolling patients with AF, aged 65 years or older, and with no contraindications to magnetic resonance imaging (MRI), referring to Center of Thrombosis outpatient clinic of our University Hospital for the management of oral anticoagulation therapy. Recruited patients are evaluated by means of a comprehensive protocol, with clinical, cerebral MRI, and circulating biomarkers assessment at baseline and after 18 months. The main outcome is SVD progression—particularly microbleeds—as a selective surrogate marker of hemorrhagic complication. Stroke occurrence (ischemic or hemorrhagic) and the progression of functional, cognitive, and motor status will be evaluated as secondary outcomes. Circulating biomarkers may further improve predictive potentials. Results: Starting from September 2017, 194 patients (mean age 78.1 ± 6.7, range 65–97; 61% males) were enrolled. The type of AF was paroxysmal in 93 patients (48%), and persistent or permanent in the remaining patients. Concerning the type of oral anticoagulant, 57 patients (29%) were on vitamin K antagonists, and 137 (71%) were on direct oral anticoagulants. Follow-up clinical evaluation and brain MRI are ongoing. Conclusions: The Strat-AF study may be an essential step towards the exploration of the role of a combined clinical biomarker or multiple biomarker models in predicting stroke risk in AF, and might sustain the incorporation of such new markers in the existing stroke prediction schemes by the demonstration of a greater incremental value in predicting stroke risk and improvement in clinical outcomes in a cost-effective fashion.

Thrombosis is a common disorder with a relevant burden of morbidity and mortality worldwide, particularly among elderly patients. Growing evidence demonstrated a direct role of oxidative stress in thrombosis, with various cell types contributing to this process. Among them, erythrocytes produce high quantities of intracellular reactive oxygen species (ROS) by NADPH oxidase activation and haemoglobin autoxidation. Concomitantly, extracellular ROS released by other cells in the blood flow can be uptaken and accumulate within erythrocytes. This oxidative milieu can alter erythrocyte membrane structure, leading to an impaired erythrocyte function, and promoting erythrocytes lysis, binding to endothelial cells, activation of platelet and of coagulation factors, phosphatidylserine exposure and release of microvesicles. Moreover, these abnormal erythrocytes are able to adhere to the vessel wall, contributing to thrombin generation within the thrombus. This process results in accelerated haemolysis and in a hypercoagulable state, in which structurally impaired erythrocytes contribute to increase thrombus size, to reduce its permeability and susceptibility to lysis. However, the wide plethora of mechanisms by which oxidised erythrocytes contribute to thrombosis is not completely elucidated. This review discusses the main biochemical aspects linking erythrocytes, oxidative stress and thrombosis, addressing their potential implication for clinical and therapeutic management.

Objetivo: Determinar si la expresión de marcadores inmunofenotípicos específicos analizados mediante citometría de flujo, influyen en el pronóstico de pacientes con Leucemia Mieloide Aguda (LMA) del Hospital de Especialidades \"Teodoro Maldonado Carbo\". Materiales y métodos: Se llevó a cabo un estudio observacional, retrospectivo con un diseño no experimental en 52 pacientes con diagnóstico de LMA evaluados por consulta externa en el Hospital de Especialidades \"Teodoro Maldonado Carbo\", durante el periodo comprendido entre enero 2018 a diciembre de 2020. Se utilizaron los datos de las historias clínicas que se encuentran en la plataforma As400 del mencionado hospital. Resultados: De una muestra el promedio de edad fue 49,5 años, el 67% fueron de sexo Los marcadores más frecuentes fueron: CD117 (75%), y CD34 (73.8%) marcando el linaje mieloide como el afectado. La mayoría de los marcadores manifestaron una expresión débil, siendo el CD33 (marcador granulocítico) el que más frecuentemente tuvo una expresión fuerte. Entre los marcadores estudiados, la mayoría no mostro una correlación significativa con las variables mortalidad y complicaciones, excepto el marcador CD105 que mostró una fuerte correlación positiva con mortalidad. Conclusión: La expresión del marcador CD105 fue el único que tuvo una correlación significativa con un peor curso de la enfermedad, los demás marcadores del panel no demostró tener mayor relevancia.