[SSRI - treatment and bleeding. What risks do we take?]. / Blutungsrisiko unter SSRI-Behandlung.

Treatment with selective serotonin reuptake inhibitors (SSRI) increases the risk of gastrointestinal bleeding. The combination with non-steroidal anti-inflammatory drugs (NSAIDs) further augments this hazard. Particular precaution is also necessary in patients on platelet aggregation inhibitors, with a known bleeding disorder or preceding gastrointestinal lesions. The incidence of bleeding events apart from the gastrointestinal tract, e.g. intracerebral hemorrhages, is not cumulated under SSRI treatment. This also applies for the combination of SSRI and coumarin or aspirin. Prescribing doctors have to be aware of the bleeding risks of SSRI and should explain this to their patients. High-risk patients have to be followed up closely and an SSRI with a low potential for drug interaction should be used. The prescription of gastroprotective agents and a change of the antidepressant should be considered in particular cases. We provide a literature survey and recommendations for the clinical routine.

[Efficient and rational laboratory diagnostics in otolaryngology]. / Rationelle und rationale Laboratoriumsdiagnostik in der Hals-Nasen-Ohren-Heilkunde.

This article describes the value of laboratory diagnostic procedures in the diagnostic arsenal of otolaryngologists. The rational and therefore the rationale of the application of laboratory medical methods are critically evaluated. In the era of diagnosis-related groups a high value is placed on a rational laboratory diagnostic, in the sense of a cost-oriented medicine, so that the laboratory diagnostic procedure is always carried out in stages, just as in other diagnostic procedures. The possibilities of clinical chemistry, separated into the theme blocks "clinical chemical basic diagnostics", "haematological parameters", "coagulation investigations" and "immunological diagnostics" are demonstrated based on examples. These are aimed at the needs of otolaryngologists, in that the emphasis in each theme block is centred on the indications and evaluation of the individual laboratory investigation.

Prospective evaluation of hemostatic predictors of subacute stent thrombosis after coronary Palmaz-Schatz stenting.

OBJECTIVES: This study sought to investigate hemostatic predictors of subacute occlusive coronary stent thrombosis. BACKGROUND: Better hemostatic monitoring may improve antithrombotic therapy after stenting. METHODS: In 140 consecutive patients undergoing Palmaz-Schatz stent implantation for suboptimal angioplasty results, we obtained serial blood samples immediately before and daily for 12 days after stenting. We prospectively tested the hypothesis that subacute stent thrombosis was more frequent if the surface expression of the inducible fibrinogen receptor on platelets (flow cytometry) or the concentration of plasma fibrinogen or that of the prothrombin fragments F1 + 2 before stent implantation exceeded the 75th percentile of the entire study cohort. RESULTS: All five stent occlusions encountered during the study occurred in patients with platelet fibrinogen receptor expression above the 75th percentile. Thus, the rate of stent occlusion differed significantly between the groups defined by platelet fibrinogen receptor expression (14.3% vs. 0%, p = 0.0008). In both the group with fibrinogen concentration and that with F1 + 2 concentration above the 75th percentile, three stent occlusions occurred. Between the groups defined by these variables, the rate of stent occlusion did not differ significantly (8.6% vs. 1.9%, p = 0.10). Logistic regression analysis, including angiographic and hemostatic variables, confirmed platelet fibrinogen receptor expression as an independent predictor of stent occlusion (p = 0.020). Stent occlusion could not be predicted by the time course of any of the hemostatic variables. CONCLUSIONS: Platelet fibrinogen receptor expression is an independent predictor of subacute stent occlusion. However, fibrinogen and F1 + 2 concentrations do not show a strong relation to the risk of stent occlusion.

Highly significant negative correlations between erythrocyte aggregation value and serum concentration of high density lipoprotein cholesterol in a sample from a normal population and in patients with coronary heart disease.

In a previous clinical study it was found that patients with coronary heart disease and diabetics with peripheral artery disease often have an elevated erythrocyte aggregation value (AW) and that there is a positive correlation between AW and the number of risk factors found in a subject. In the present investigation we studied the relationship between AW and the serum concentration of high density lipoprotein cholesterol (HDL-C), which is known to be inversely associated with coronary heart disease (CHD) incidence. We found highly significant negative correlations between AW and HDL-C both in a subsample of the study population of a cross-sectional epidemiologic study on CHD risk factors (First Survey of the MONICA Project Augsburg) and in male patients with angiographically confirmed CHD. Correlation coefficients were -0.233 for normal men (P less than 0.01, n = 136), -0.261 for normal women (P less than 0.01, n = 117), and -0.745 for CHD patients (P less than 0.01, n = 14). The results support the concept that the erythrocyte aggregation value as an indicator of cardiovascular risk is consistent with established risk factor associations.