ObjectiveTo assess rates of cardiovascular and haemostatic events in the first 28 days after vaccination with the Oxford-AstraZeneca vaccine ChAdOx1-S in Denmark and Norway and to compare them with rates observed in the general populations.DesignPopulation based cohort study.SettingNationwide healthcare registers in Denmark and Norway.ParticipantsAll people aged 18-65 years who received a first vaccination with ChAdOx1-S from 9 February 2021 to 11 March 2021. The general populations of Denmark (2016-18) and Norway (2018-19) served as comparator cohorts.Main outcome measuresObserved 28 day rates of hospital contacts for incident arterial events, venous thromboembolism, thrombocytopenia/coagulation disorders, and bleeding among vaccinated people compared with expected rates, based on national age and sex specific background rates from the general populations of the two countries.ResultsThe vaccinated cohorts comprised 148 792 people in Denmark (median age 45 years, 80% women) and 132 472 in Norway (median age 44 years, 78% women), who received their first dose of ChAdOx1-S. Among 281 264 people who received ChAdOx1-S, the standardised morbidity ratio for arterial events was 0.97 (95% confidence interval 0.77 to 1.20). 59 venous thromboembolic events were observed in the vaccinated cohort compared with 30 expected based on the incidence rates in the general population, corresponding to a standardised morbidity ratio of 1.97 (1.50 to 2.54) and 11 (5.6 to 17.0) excess events per 100 000 vaccinations. A higher than expected rate of cerebral venous thrombosis was observed: standardised morbidity ratio 20.25 (8.14 to 41.73); an excess of 2.5 (0.9 to 5.2) events per 100 000 vaccinations. The standardised morbidity ratio for any thrombocytopenia/coagulation disorders was 1.52 (0.97 to 2.25) and for any bleeding was 1.23 (0.97 to 1.55). 15 deaths were observed in the vaccine cohort compared with 44 expected.ConclusionsAmong recipients of ChAdOx1-S, increased rates of venous thromboembolic events, including cerebral venous thrombosis, were observed. For the remaining safety outcomes, results were largely reassuring, with slightly higher rates of thrombocytopenia/coagulation disorders and bleeding, which could be influenced by increased surveillance of vaccine recipients. The absolute risks of venous thromboembolic events were, however, small, and the findings should be interpreted in the light of the proven beneficial effects of the vaccine, the context of the given country, and the limitations to the generalisability of the study findings.

In real-life AF patients with indication for multiple antithrombotic drugs after MI/PCI, OAC and clopidogrel was equal or better on both benefit and safety outcomes compared to triple therapy.

Abstract. Supraglacial lakes represent an ephemeral storage buffer for meltwater runoff and lead to significant, yet shortlived, episodes of ice-flow acceleration by decanting large meltwater and energy fluxes into the ice sheet's hydrological system. Here, a methodology for calculating lake volume is used to quantify storage and drainage across Russell Glacier, West Greenland, between 2002 and 2012. Using 502 MODIS scenes, water volume at ∼ 200 seasonally occurring lakes was derived using a depth-reflectance relationship, which was independently calibrated and field validated against lake bathymetry. The inland expansion of lakes is strongly correlated with air temperature: during the record melt years of 2010 and 2012, lakes formed and drained earlier, attaining their maximum volume 38 and 20 days earlier than the 11 yr mean, as well as occupying a greater area and forming at higher elevations (> 1800 m) than previously. Despite occupying under 2 % of the study area, lakes delay the transmission of up to 7-13 % of the bulk meltwater discharged. Although the results are subject to an observational bias caused by periods of cloud cover, we estimate that across Russell Glacier, 28 % of supraglacial lakes drain rapidly (< 4 days). Clustering of such events in space and time suggests a synoptic trigger mechanism. Further, we find no evidence to support a unifying critical size or depth-dependent drainage threshold.

declined, and VKA alone is now recommended in AF patients who are >1 year from an acute coronary event or revascularization procedure.8 New data also suggest that MI risk could actually increase with the addition of multiple antiplatelets to oral anticoagulation treatment.

Among oral anticoagulation-naïve AF patients initiated on oral anticoagulation in Denmark, warfarin initiation has declined since the introduction of dabigatran in August 2011. Dabigatran is the most frequently used alternative option to warfarin; however, use of rivaroxaban and apixaban is increasing. Patients initiated with rivaroxaban or apixaban in general have a higher predicted stroke and bleeding risks compared with warfarin or dabigatran initiators.

We present surface velocity measurements from a high-elevation site located 140 km from the western margin of the Greenland ice sheet, and~50 km into its accumulation area. Annual velocity increased each year from 51.78 ± 0.01 m yr À1 in 2009 to 52.92 ± 0.01 m yr À1 in 2012-a net increase of 2.2%. These data also reveal a strong seasonal velocity cycle of up to 8.1% above the winter mean, driven by seasonal melt and supraglacial lake drainage. recently argued that ice motion in the ablation area is mediated by reduced winter flow following the development of efficient subglacial drainage during warmer, faster, summers. Our data extend this analysis and reveal a year-on-year increase in annual velocity above the equilibrium line altitude, where despite surface melt increasing, it is still sufficiently low to hinder the development of efficient drainage under thick ice.

Meltwater drainage across the surface of the Greenland ice sheet (GrIS) is well constrained by measurements and modeling, yet despite its critical role, knowledge of its transit through the subglacial environment remains limited. Here we present a subglacial hydrological analysis of a land-terminating sector of the GrIS at unprecedented resolution that predicts the routing of surface-derived meltwater once it has entered the basal drainage system. Our analysis indicates the probable existence of small subglacial lakes that remain undetectable by methods using surface elevation change or radar techniques. Furthermore, the analysis suggests transient behavior with rapid switching of subglacial drainage between competing catchments driven by seasonal changes in the basal water pressure. Our findings provide a cautionary note that should be considered in studies that attempt to relate and infer future response from surface temperature, melt, and runoff from point measurements and/or modeling with measurements of proglacial discharge and ice dynamics. Hydraulic potential analysis enables subglacial drainage to be estimated from ice thickness and basal topography on spatial scales where the main control of the drainage is the geometry of the ice sheet [Shreve, 1972]. This method has been applied in Greenland [e.g.

Intense rainfall events significantly affect Alpine and Alaskan glaciers through enhanced melting, ice-flow acceleration and subglacial sediment erosion, yet their impact on the Greenland ice sheet has not been assessed. Here we present measurements of ice velocity, subglacial water pressure and meteorological variables from the western margin of the Greenland ice sheet during a week of warm, wet cyclonic weather in late August and early September 2011. We find that extreme surface runoff from melt and rainfall led to a widespread acceleration in ice flow that extended 140 km into the ice-sheet interior. We suggest that the late-season timing was critical in promoting rapid runoff across an extensive bare ice surface that overwhelmed a subglacial hydrological system in transition to a less-efficient winter mode. Reanalysis data reveal that similar cyclonic weather conditions prevailed across southern and western Greenland during this time, and we observe a corresponding ice-flow response at all land- and marine-terminating glaciers in these regions for which data are available. Given that the advection of warm, moist air masses and rainfall over Greenland is expected to become more frequent in the coming decades, our findings portend a previously unforeseen vulnerability of the Greenland ice sheet to climate change.authorsversionPeer reviewe