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Kvaliteta života osoba sa stomom - kvalitativno istraživanje
No full textFacing a malignant disease, surgery and creation of an intestinal stoma is a complex
process in anyone’s life. Adjusting to a new way of life can be complicated, stressful and challenging
for patients. With continued education from professional caregivers, the patient and/or family can
avoid or mitigate adverse events and improve the quality of life of stoma carriers. The aim of this study
was to investigate the quality of life of stoma patients and their relationship with health education in
hospital in a qualitative way. Th e present study included 15 patients of both sexes older than 18 years
and living with a stoma for at least one year after surgery. Patients were interviewed using a semistructured
interview, which was recorded. Transcripts were made and analyzed after the interview. A
total of 6 women and 9 men aged between 40 and 86 years took part in the study. The results show
that patients were very satisfi ed with health education they received in hospital, but their subjective
experience of the quality of life was not satisfactory in all areas analyzed, such as travel and social life.
Stoma has an impact on the participants’ quality of life. High quality health education of patients by
professionals, as well as family and social support play an important role in the lives of stoma patients.
These are protective factors that improve the participants’ quality of life.Suočavanje sa zloćudnom bolešću i kirurškim zahvatima te postavljanje stome predstavlja složen proces u životu svakog
pojedinca. Prilagodba na nov način života može biti komplicirana, iscrpljujuća i izazovna za bolesnika. Uza stalnu poduku
koju pružaju medicinske sestre bolesnik sa stomom i/ili njegova obitelj mogu izbjeći ili ublažiti neželjene događaje te
poboljšati kvalitetu života. Cilj ovog istraživanja bio je kvalitativno ispitati kvalitetu života bolesnika sa stomom i povezanost
sa zdravstvenom podukom koja se provodi u bolnici. Predmetno istraživanje je uključilo bolesnike obaju spolova starije od
18 godina koji imaju stomu najmanje godinu dana nakon kirurškog zahvata. Ispitanici su intervjuirani polustrukturiranim
intervjuom koji je snimljen. Nakon provedbe intervjua izrađeni su transkripti koji su analizirani. U istraživanju je sudjelovalo
ukupno 6 žena i 9 muškaraca u dobi od 40 do 86 godina. Rezultati pokazuju da su bolesnici zadovoljni zdravstvenom
podukom koja se provodi u bolnici, no njihovo subjektivno iskustvo nije zadovoljavajuće u svim ispitivanim domenama
kvalitete života. Stoma ima utjecaj na kvalitetu života ispitanika. Kvalitetna zdravstvena poduka bolesnika uz potporu obitelji
i prijatelja ima važnu ulogu u životu osoba sa stomom. To su zaštitni čimbenici koji unaprjeđuju kvalitetu života ispitanika
Acute Abdomen in the Emergency Medicine – Practical Clinical Guidelines
No full textAkutni abdomen podrazumijeva skup različitih kliničkih stanja koja zbog svoje ozbiljnosti i nepredvidljivog ti jeka bolesti vrlo često iziskuju neodložne dijagnosti čke i terapijske postupke uključujući i hitan operacijski zahvat. Zbog svoje složenosti , usprkos brojnim dijagnosti čkim mogućnosti ma, još uvijek predstavlja jednu od najčešćih dilema u hitnoj medicinskoj službi. Glavno je obilježje akutnog abdomena bol te se procjenjuje da je
5 – 10 % svih posjeta hitnoj medicinskoj službi povezano s akutnom boli u trbuhu, što ga čini jednim od najčešćih razloga dolaska bolesnika liječniku. Budući da se pristup bolesnicima s akutnom boli u trbuhu razlikuje i uglavnom ovisi o stavovima liječnika, cilj ovih smjernica je stvoriti standardiziran pristup koji će omogućiti brže postavljanje dijagnoze, opti mizaciju terapije i poboljšanje kvalitete skrbi u hitnoj medicinskoj službi za navedene bolesnike. Smjernice su nastale kao rezultat suradnje članova Hrvatskog društva za hitnu medicinu Hrvatskog liječničkog zbora i Hrvatskog društva za digesti vnu kirurgiju Hrvatskog liječničkog zbora.Acute abdomen implies a set of different clinical conditi ons which, due to its severity and unpredictable course of the disease, very often require immediate diagnosti c and therapeuti c procedures, including emergency surgery. Due to its complexity, despite numerous diagnosti c possibiliti es, it sti ll represents one of the most common dilemmas in the emergency medicine. The main feature of acute abdomen is pain, and it is esti mated that between 5 and 10% of all visits to the emergency department are related to acute abdominal pain, which is one of the most common reasons for a pati ent to visit a doctor. Since the approach to pati ents with acute abdominal pain varies and mainly depends on the views of doctors, the goal of these guidelines is to create a standardized approach that will enable faster diagnosis, opti mizati on of therapy and improvement of the quality of care for these pati ents in emergency medicine. The guidelines were created as a result of the cooperati on of the members of the Croati an Society for Emergency Medicine – Croati an Medical Associati on and the Croati an Society for Digesti ve Surgery – Croati an Medical Associati on
Antiphospholipid syndrome, thrombosis, and vaccination in the COVID-19 pandemic
No full textThrombosis is one of the many signs of antiphospholipid syndrome (APS) and COVID- 19 infection. Although the mechanisms contributing to thrombosis in APS and COVID- 19 are relatively similar, this remains an open subject. Even now (when the COVID-19 pandemic has subsided), there is no conclusive solution to APS and COVID-19 cooccurrence. The presence of newly generated antiphospholipid antibodies (aPLs) in COVID-19 infection may or may not be connected to the diagnosis of APS. The prevalence of aPLs is substantial in severe COVID-19 but not related to thrombosis or a worse outcome. Adequate monitoring of antibody positivity over time is recommended for APL diagnosis. On the other hand, thrombosis and thrombocytopenia can rarely occur with vaccination with mRNA vaccines. Some studies have shown that COVID-19 immunization is well tolerated among APS patients who are triple-positive for aPL, which may comfort patients and referring physicians and lessen hesitation in unvaccinated APS/aPL-positive patients. In this narrative review we will give an overview of the interaction between aPL-APS-COVID-19- thrombosis and related diagnostic insights learned during the pandemic
Bortezomib-based regimen affects cognitive functions in multiple myeloma patients through the VEGF pathway – Hypothesis that connects different knowledge streams
No full textMultiple myeloma is a chronic hematological malignancy that usually affects older adults. Cancer-related cognitive impairment in multiple myeloma patients significantly impacts the everyday quality of life, however its pathophysiology remains poorly understood. Bortezomib is a commonly used drug in the treatment of multiple myeloma that does not pass the blood–brain barrier. Nevertheless, it can still affect central nervous system (CNS) through yet unknown mechanisms. This article discusses the potential effect of bortezomib-based treatment on cognitive functions in multiple myeloma patients. We hypothesize that bortezomib impairs cognition by decreasing the levels of a neuroprotective cytokine – vascular endothelial growth factor (VEGF). The generation of hypotheses about the pathophysiology of cognitive impairment paves the way for future basic and clinical studies to improve multiple myeloma management. VEGF could serve as a biomarker of cognitive dysfunction while systematic evaluation of cognition could enable early detection of cognitive impairment. Timely recognition of cognitive impairment might be crucial when selecting the most appropriate treatment. Furthermore, this could allow the implementation of preventive measures against further deterioration in cognitive function and quality of life for patients with multiple myeloma
Overview Of The Positive Effects Of Ikebana Creation As A Possible Extension Of Shinrin-Yoku Practice On The Improvement Of Mental Health, Emotional Well-Being, And Quality Of Life
No full textShinrin-yoku ili „šumska kupka” i ikebana kao tradicionalna japanska umjetnost aranžiranja cvijeća predstavljaju dvije prakse koje, iako različite u svojem pristupu, dijele zajednički metodološki pristup – usredotočenu svjesnost i zajednički cilj – promicanje mentalnog zdravlja i emocionalne dobrobiti kroz predano, potpuno i svjesno povezivanje s prirodom.
Shinrin-yoku uključuje svjesno polako hodanje kroz šumske prostore, gdje sudionici aktivno angažiraju svojih pet osjetila kako bi potpuno „uronili” u prirodno šumsko okruženje. Ova je praksa pokazala znatne učinke na smanjenje razine stresa i kortizola, poboljšanje raspoloženja, te smanjenje simptoma anksioznosti i depresije, dok istodobno jača imunosni sustav. S druge strane, umjetnost i tehnika izrade ikebane nije samo estetski izraz, već i duhovna praksa koja omogućava dublje razumijevanje prirodnog svijeta i vlastite unutarnje stvarnosti. Naglašava estetiku, ravnotežu i jednostavnost u aranžiranju cvijeća, omogućujući pojedincima da kroz kreativni proces izraze poštovanje prema prirodi i reflektiraju filozofske koncepte poput prolaznosti i ljepote nesavršenosti. Obje prakse potiču usredotočenu svjesnost i meditaciju, omogućujući sudionicima da se usmjere na sadašnji trenutak, čime se pridonosi smanjenju stresa, promicanju unutarnjeg mira i poboljšanju kvalitete života.
Cilj ovog rada bio je istražiti sinergiju između metode Shinrin-yoku i ikebane te analizirati i sintetizirate rezultate
dosadašnjih istraživanja kako kontinuirana primjena ovih praksi može pridonijeti cjelokupnom blagostanju pojedinaca kroz povezivanje s prirodom i promicanje emocionalne stabilnosti. Kroz analizu zajedničkih elemenata, u radu se objašnjava kako kombinacija ovih dviju praksi može obogatiti svakodnevni život, potičući kreativnost i jačajući emocionalnu otpornost.Shinrin-yoku, or “forest bathing,” and Ikebana, the traditional Japanese art of flower arrangement, represent
two practices that, despite their differing approaches, share a common methodological approach—focused awareness—and a shared goal—promoting mental health and emotional well-being through dedicated, complete, and mindful connection with nature.
Shinrin-yoku involves consciously slow walking through forest environments, where participants actively engage
their five senses to fully “immerse” themselves in the natural forest setting. This practice has shown significant effects in reducing stress and cortisol levels, improving mood, and alleviating symptoms of anxiety and depression, while simultaneously boosting the immune system. On the other hand, the art and technique of Ikebana is not only an aesthetic expression but also a spiritual practice that allows for a deeper understanding of the natural world and one’s inner reality. It emphasizes
aesthetics, balance, and simplicity in flower arrangement, enabling individuals to express respect for nature and reflect on philosophical concepts such as impermanence and the beauty of imperfection through the creative process. Both practices foster focused awareness and meditation, allowing participants to center themselves in the present moment, thereby reducing stress, promoting inner peace, and enhancing the overall quality of life.
The aim of this paper was to explore the synergy between Shinrin-yoku and Ikebana and to analyze and synthesize the results of existing research on how the continuous application of these practices can contribute to overall well-being through connecting with nature and promoting emotional stability. By examining their common elements, the paper explains how this combination can enrich daily life by fostering creativity and strengthening emotional resilience
Uloga adiponektina u biologiji memorijskih CD8 T stanica : Plan upravljanja istraživačkim podacima
No full textHrvatske smjernice za specifično profilaktičko liječenje migrene monoklonskim protutijelima na peptid povezan s kalcitoninskim genom (CGRP) (eptinezumab, fremanezumab i galkanezumab) i na CGRP receptor (erenumab)
No full textCalcitonin gene-related peptide (CGRP) plays a key role in the pathophysiology of
migraine, acting on CGRP receptors in the trigeminovascular system, causing neurogenic inflammation
and vasodilation, and promoting nociception. Four specific monoclonal antibodies targeting CGRP
are available for prevention of episodic and chronic migraine in adults with at least four migraine
days per month. The aim of these guidelines is to provide evidence-based recommendations for the
use of monoclonal antibodies targeting CGRP in migraine prevention in Croatia. The questions were
formulated using the Patients, Intervention, Comparison, Outcome (PICO) criteria, with evidencebased
answers. To assess the quality of scientific evidence, a review of the literature available in PubMed
was performed. Relevant studies were reviewed by the Expert Group of the Headache Section of
the Croatian Neurological Society, and served as the basis for formulating the recommendations
outlined in these guidelines. We found high quality evidence for good safety and efficacy of anti-
CGRP monoclonal antibodies in the preventive treatment of episodic and chronic migraine. These
medications may be considered as first-line prophylactic therapy depending on the patient’s history,
concomitant diseases, and disease burden. Further real-world studies are needed to elucidate other
aspects of their application.Peptid povezan s kalcitoninskim genom (CGRP) igra ključnu ulogu u patofiziologiji migrene djelujući na CGRP
receptore u trigeminovaskularnom sustavu, time uzrokujući neurogenu upalu i vazodilataciju, uz promociju nocicepcije.
Četiri specifična monoklonska protutijela koja djeluju na CGRP su dostupna u profilaksi epizodne i kronične migrene u
odraslih osoba s najmanje četiri migrenozna dana na mjesec. Cilj ovih smjernica je pružiti preporuke zasnovane na dokazima
za primjenu monoklonskih protutijela koja djeluju na CGRP u prevenciji migrene u Hrvatskoj. Pitanja su formulirana
primjenom kriterija PICO (Patients, Intervention, Comparison, Outcome), uz odgovore zasnovane na dokazima. Kako bismo
procijenili kvalitetu znanstvenih dokaza pretražili smo literaturu u bazi podataka PubMed. Pronađene relevantne studije
analizirala je Stručna skupina Sekcije za glavobolju Hrvatskoga neurološkog društva i služile su kao osnova za oblikovanje
preporuka navedenih u ovim smjernicama. Pronašli smo visokokvalitetne dokaze u smislu dobre sigurnosti i učinkovitosti
monoklonskih protutijela na CGRP u profilaksi epizodne i kronične migrene. Ovi lijekovi se mogu razmatrati u prvoj liniji
profilaktičke terapije, ovisno o bolesnikovoj povijesti bolesti, supostojećim bolestima i opterećenosti bolešću. Daljnje studije
u kliničkim uvjetima potrebne su kako bi se rasvijetlili dodatni aspekti njihove primjene
Biogenesis of cytomegalovirus assembly compartment through rearrangement of sorting mechanisms in endosomal recycling domains
No full textCilj istraživanja: Infekcija citomegalovirusima (CMV) uzrokuje opsežno remodeliranje i ekspandiranje unutarstaničnih membrana na sučelju ranih endosoma (EE), endosomalnog reciklirajućeg odjeljka (ERC) i Golgija. Cilj istraživanja je bio identificirati stanične proteine na sučelju EE i ERC-a koje mišji citomegalovirus (MCMV) regrutira tijekom infekcije. Također, istražili smo kako regrutirani proteini utječu na replikacijski ciklus virusa i stvaranje odjeljka za sklapanje virusnih čestica (pre-AC). Posebna pažnja posvećena je promjenama u interaktomu proteina Rab10, koji je biljeg pre-AC-a. Materijal i metode: Koristili smo imunofluorescentnu mikroskopiju i western blot analizu za praćenje izražaja staničnih proteina i proteina MCMV-a. Pericentriolarno nakupljanje Rab10 služilo je kao marker nastanka pre-AC-a. Za identifikaciju proteina koji imaju ulogu u nastanku pre-AC-a, proteine sučelja EE-ERC-a utišali smo transfekcijom specifičnom siRNA. Također smo koristili inhibitore i transfekciju dominantno negativnim (DN) konstruktima za istraživanje uloge ključnih proteina. Metoda BioID2 korištena je za analizu interaktoma Rab10, a za to smo proizveli staničnu liniju NIH3T3 Rab10 BioID2-HA sa stabilnim izražajem Rab10-BioID2-HA fuzijskog proteina. Rezultati: Otkrili smo da se većina proteina sučelja EE-ERC-a nakuplja u pericentriolarnom području koje odgovara pre-AC-u, bez promjena njihove količine tijekom infekcije. Utišavanje proteina SNX27, Vps35, SNX1, SNX4 i dinamina 2 je inhibiralo nastanak pre-AC-a. Daljnje istraživanje SNX27 potvrdilo je njegovu ključnu ulogu u nastanku unutarnjeg dijela pre-AC-a, posebno u sintezi proteina MCMV-a odgođene rane i kasne faze infekcije, kao i za sintezu viriona. Inhibitor dinamina, dynasore, te DN konstrukt K44A Dyn2 EGFP također su inhibirali nastanak pre-AC-a i replikacijski ciklus MCMV-a. Interaktom Rab10 u neinficiranim i MCMV-om inficiranim stanicama većinom sačinjavaju proteini EHBP1, MICAL-L1 i Rab11 FIP1. Zaključci: Proteini SNX27:Retromer:ESCPE-1 kompleksa (SNX27, Vps35, SNX1), te dinamin 2 potrebni su za najranije događaje u uspostavljanju pre-AC-a tokom rane faze infekcije MCMV-om. Funkcionalni SNX27,osobito njegova domena F3 FERM, i dinamin 2 su neophodni za odvijanje normalnog replikacijskog ciklusa MCMV-a. Interaktom biljega pre-AC-a, proteina Rab10, ne mijenja se znatnije u ranoj fazi infekcije MCMV-om, a dominiraju interakcije Rab10 s proteinima EHBP1, MICAL-L1 i Rab11 FIP1.Objectives: Cytomegalovirus (CMV) infection causes extensive remodeling and expansion of intracellular membranes at the interface of early endosomes (EE), the endosomal recycling compartment (ERC), and the Golgi. The aim of this research was to identify cellular proteins at the EE and ERC interface that murine cytomegalovirus (MCMV) recruits in the early phase of infection. Additionally, we investigated how these proteins affect the viral replication cycle and the formation of the viral assembly compartment (pre-AC). Special attention was given to changes in the interactome of the protein Rab10, which is a marker of the pre-AC. Materials and methods: We used immunofluorescence microscopy and western blot analysis to monitor the expression of cellular and MCMV proteins. Pericentriolar accumulation of Rab10 served as a marker for the formation of the pre-AC. To identify proteins involved in the formation of the pre-AC, proteins at the EE-ERC interface were silenced by transfection with specific siRNA. We also used chemical inhibitors and transfection with dominant negative (DN) constructs for further investigation of the role of key proteins. The BioID2 method was used to analyze the Rab10 interactome, and for this purpose, we generated an NIH3T3 cell line stably expressing the Rab10-BioID2-HA fusion protein. Results: We discovered that most proteins at the EE-ERC interface accumulate in the pericentriolar area corresponding to the pre-AC, without significant changes in their quantity during infection. Knockdown the proteins SNX27, Vps35, SNX1, SNX4 and dynamin 2 significantly inhibited the formation of the pre-AC. Further investigation of SNX27 confirmed its key role in the formation of the inner part of the pre-AC, particularly in the synthesis of MCMV proteins during the delayed early and late phases of infection, as well as in virion synthesis. The dynamin inhibitor dynasore and the DN construct K44A Dyn2 EGFP also inhibited the formation of the pre-AC and the MCMV replication cycle. The Rab10 interactome in uninfected and MCMV-infected cells predominantly consisted of proteins EHBP1, MICAL-L1, and Rab11 FIP1. Conclusions: The SNX27:Retromer:ESCPE-1 complex (proteins SNX27, Vps35, SNX1) and dynamin 2 are required for the earliest events during pre-AC establishment in the early phase of MCMV infection. Furthermore, functional SNX27 (particularly its F3 FERM domain) and dynamin 2 are essential for the normal progression of the MCMV replication cycle. Finally, the Rab10 interactome does not change significantly in the early phase of MCMV infection, with Rab10 primarily interacting with EHBP1, MICAL-L1, and Rab11 FIP1 proteins
Clinical and Analytical Comparison of Monoclonal and Polyclonal Immunoassays for Fecal Pancreatic Elastase
No full textBackground: Numerous immunoassays have been commercialized to determine pancreatic elastase (PE) in feces in screening for exocrine pancreatic insufficiency (EPI), but how the different assays compare to one another is controversial, especially in the context that all methods use the same cut-off values for interpreting the results obtained on the presence or absence of EPI or the degree of insufficiency if it is present. Our aim was to analytically verify a new method for determining PE, compare the results with a previous method, and verify the declared cut-off values for interpretation of the results. Methods: PE in the stool was assayed using a previous monoclonal enzyme-linked immunosorbent assay (“ScheBo ELISA”) and a new polyclonal particle-enhanced turbidimetric immunoassay (“Bühlmann PETIA”). The direct method comparison of two immunoassays was performed in 40 samples. Clinical comparisons were conducted against each other for the binary determination of “abnormal/normal” elastase levels and the three-way determination of “severe/moderate/no” EPI in 56 samples. The indirect comparison method used external quality assessment (EQA) data to compare the monoclonal and polyclonal immunoassays for PE, and additionally compare the monoclonal ScheBo ELISA to a monoclonal chemiluminescence immunoassay (“DiaSorin CLIA”). Results: Precision in the series and intra-laboratory precision for Bühlmann PETIA met the manufacturer’s specifications for the concentration range of limit/lower values and the range of normal values. The Bühlmann PETIA immunoassay on different analytical platforms yielded comparable results and nearly perfect agreement in the case of three-way classification (kappa = 0.89 with 95%CI from 0.79 to 1.00. ScheBo ELISA tends to generate higher values of pancreatic elastase than the Bühlmann PETIA; agreement between the methods was moderate in the case of binary classification (kappa = 0.43; 95% CI 0.25 to 0.62), and substantial in the case of three-way classification (kappa = 0.62; 95% CI 0.50 to 0.75). EQA data analysis showed a statistically significant difference between ScheBo ELISA and Bühlmann PETIA peer groups (p = 0.031), as well as the DiaSorin CLIA and ScheBo ELISA peer groups (p = 0.010). Conclusion: The ScheBo ELISA and Bühlmann PETIA do not appear to be commutable in the analytical and clinical context. Our data address a discordance between different mono- and polyclonal immunoassays for pancreatic elastase and the potential of misclassification using its universal cut-off values in screening suspected patients for exocrine pancreatic insufficiency
Antithrombotic Therapy after the Transcatheter Aortic Valve Implantation
No full textAortalna stenoza (AS) najčešća je primarna valvularna bolest srca. Teška simptomatska aortalna stenoza indikacija je za liječenje kirurškim ili perkutanim putem. Transkateterska implantacija aortalnog zaliska (engl. transcatheter aortic valve implantation; TAVI) perkutana je metoda koja se unatrag 20 godina koristi kod velikog broja bolesnika, sukladno odluci konzilija (engl. Heart Team). Period tijekom i nakon zahvata od izrazite je važnosti kako bi se spriječio nastanak tromboembolijskih komplikacija. 7 % bolesnika nakon TAVI zahvata u prvih 12 mjeseci doživi ishemijski moždani udar. Postproceduralno, uzrok moždanog udara najčešće je posljedica novonastale fibrilacije atrija ili tromboze bioproteze. Antitrombotska terapija je terapija izbora za prevenciju nastanka tromboembolijskog incidenta nakon TAVI zahvata. Istovremeno, potrebno je obratiti pažnju na moguće jatrogene komplikacije poput krvarenja u ranom poslijeoperacijskom periodu. Vrsta antitrombotske terapije nakon TAVI zahvata razlikuje se s obzirom na prisutnost kronične antikoagulantne terapije. U bolesnika bez indikacije za kroničnu antikoagulantnu terapiju acetilsalicilna kiselina je lijek izbora, dok u bolesnika s indikacijom za antikoagulantnu terapiju, oralni antikoagulansi pokazali su se sigurnima. Trombocitopenija je česta komplikacija nakon TAVI zahvata. U tih bolesnika ili u onih s prisutnom trombocitopenijom prije zahvata, vrsta i trajanje antitrombotske terapije ovisi o težini trombocitopenije te se prilagođava bolesniku u dogovoru multidisciplinarnog tima kardiologa i hematologa s obzirom na kombinirani ishemijski rizik i rizik od krvarenja.Aortic stenosis (AS) is the most common primary valvular heart disease. Severe symptomatic aortic stenosis should be treated surgically or percutaneously. Transcatheter aortic valve implantation (TAVI) is a percutaneous method that has become a choice of treatment in many patients in the past 20 years, according to the decision of the Heart Team. The period during and after the procedure is extremely important to prevent the onset of thromboembolic complications. 7% of patients experience an ischemic stroke in the first 12 months after the TAVI procedure. Postprocedurally, the stroke is most often caused by new atrial fibrillation onset or thrombosis of the bioprosthesis. Antithrombotic therapy is the therapy of choice for preventing thromboembolic events after the TAVI procedure. On the other hand, iatrogenic bleeding complications can occur in the early postoperative period. The type of antithrombotic therapy after the TAVI procedure differs depending on the presence of chronic anticoagulant therapy. In patients without an indication for chronic anticoagulant therapy, acetylsalicylic acid is the drug of choice, while in patients with an indication for anticoagulant therapy, oral anticoagulants should be prescribed. Thrombocytopenia is a common complication after TAVI. In these patients or in those with chronic thrombocytopenia, the type and duration of antithrombotic therapy depend on the severity of thrombocytopenia. Those patients should be discussed with the multidisciplinary team of cardiologists and hematologists, taking into consideration ischemic and bleeding risks