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Thrombosis & Haemostasis
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ISSN (Print) 0340-6245 - ISSN (Online) 2567-689X
Published by Thieme Publishing Group Homepage  [239 journals]
  • Idelvion® as a modern treatment option for haemophilia B (Sponsor: CSL
           Behring GmbH)
    • Abstract: Idelvion® (albutrepenonacog alfa, rIX-FP) is a long-acting recombinant factor IX (FIX) albumin fusion protein indicated for the treatment and prophylaxis of bleeding in patients with haemophilia B. It allows prophylaxis intervals of up to 14 days.* Compared with previous therapy, this fusion protein allows for a significant reduction in injection frequency while maintaining a favourable efficacy and safety profile.
      Citation: Thromb Haemost 2020; 120:
      PubDate: 2020-01-22T00:00:00+0100
      DOI: 10.1055/a-1019-1794
      Issue No: Vol. 120, No. 02 (2020)
       
  • Oral Anticoagulant Treatment in Patients with Atrial Fibrillation and
           Cancer
    • Thromb Haemost 2020; 120: 194-196
      DOI: 10.1055/s-0039-3402809



      Georg Thieme Verlag KG Stuttgart · New York

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      Thromb Haemost 2020; 120: 194-1962020-02-02T00:00:00+0100
      Issue No: Vol. 120, No. 02 (2020)
       
  • Myeloid Cells to the Rescue: Improving Thrombus Resolution
    • Thromb Haemost 2020; 120: 197-198
      DOI: 10.1055/s-0039-1701044



      Georg Thieme Verlag KG Stuttgart · New York

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      Thromb Haemost 2020; 120: 197-1982020-02-02T00:00:00+0100
      Issue No: Vol. 120, No. 02 (2020)
       
  • A Toast to the Last Decade and a Very Happy 2020 from Thrombosis and
           Haemostasis!
    • Thromb Haemost 2020; 120: 001-004
      DOI: 10.1055/s-0039-3402054



      Georg Thieme Verlag KG Stuttgart · New York

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      Thromb Haemost 2020; 120: 001-0042020-01-13T00:00:00+0100
      Issue No: Vol. 120, No. 01 (2020)
       
  • Thrombosis and Haemostasis 2019 Editor's Choice Papers
    • Thromb Haemost 2020; 120: 184-190
      DOI: 10.1055/s-0039-3402055



      Georg Thieme Verlag KG Stuttgart · New York

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      Thromb Haemost 2020; 120: 184-1902020-01-13T00:00:00+0100
      Issue No: Vol. 120, No. 01 (2020)
       
  • Platelet Inhibition in Acute Coronary Syndrome and Percutaneous Coronary
           Intervention: Insights from the Past and Present
    • Authors: Gorog; Diana A., Geisler, Tobias
      Abstract: Platelet activation and aggregation have a pivotal role in arterial thrombosis and in the pathogenesis of both acute coronary syndromes (ACS) and in the thrombotic complications that occur in patients undergoing percutaneous coronary intervention (PCI). The past 30 years has seen the progress from early trials of clopidogrel and glycoprotein IIb/IIIa inhibitors to the application of more potent P2Y12 inhibitors prasugrel and ticagrelor. Early enthusiasm for newer and more potent antiplatelet agents, which could reduce ischemic events, has led to the understanding of the importance of bleeding and a desire to individualize and optimize treatment. It has increasingly become apparent that the potency and duration of dual antiplatelet therapy (DAPT) has to reflect the balance between ischemic and bleeding risk. Recently, multiple strategies have been proposed to individualize DAPT intensity and duration to reduce the bleeding and ischemic risks. Strategies of de-escalation of DAPT intensity, as well as shorter (less than a year) or more prolonged (beyond a year) treatment have been proposed, as well as platelet function test and genotype guidance of P2Y12 inhibitor therapy. Herein, we provide an overview of the progress in the field of antiplatelet therapy for ACS and PCI over the years, showing the current directions of travel. Ongoing studies focusing on personalized antiplatelet treatment will hopefully yield further insight into ways of optimizing outcomes for the individual.
      Citation: Thromb Haemost ; : -
      PubDate: 2020-02-19T00:00:00+0100
      DOI: 10.1055/s-0040-1702920
       
  • Nadroparin Plus Compression Stockings versus Nadroparin Alone for
           Prevention of Venous Thromboembolism in Cerebellopontine Angle Tumour
           Excisions: A Cohort Study
    • Authors: Koopmans; Raoul J., Cannegieter, Suzanne C., Koot, Radboud W., Vleggeert-Lankamp, Carmen L. A.
      Abstract: Background Both compression stockings and low molecular weight heparin (LMWH) are used for the prevention of post-operative venous thromboembolism (VTE) in cerebellopontine angle (CPA) tumour excisions. Objective In an attempt to optimise the prophylactic treatment in these patients, we compared LMWH (nadroparin) plus compression stockings to nadroparin as single therapy. Methods Patients undergoing CPA tumour excision in the period between January 2014 and November 2015 received nadroparin as a single therapy. Patients treated since November 2015 received, in addition to this therapy, peri-operative compression stockings as VTE prophylaxis due to a change in protocol. VTE was defined as symptomatic deep vein thrombosis or pulmonary embolism and was confirmed via radiological imaging or autopsy. Results A total of 146 consecutive patients were reviewed. Treatment groups were comparable with respect to demographics and risk factors. Six of the 60 patients (10.0%; 95% confidence interval [CI] 3.8–20.5) receiving nadroparin single therapy developed symptomatic VTE. One out of 86 patients (1.2%; 95% CI 0–6.3) treated with combination therapy developed VTE (p = 0.019) with a risk difference of 8.8% (95% CI 1.43–19.0). In comparison to combination therapy, nadroparin single therapy showed a relative risk of 8.6 (95% CI 1.1–69.6). Conclusion Adding compression stockings to peri-operative nadroparin, as a prophylactic strategy for thromboembolic complications in patients undergoing surgical intervention for CPA tumours, was associated with a significant reduction in the occurrence of VTE.
      Citation: Thromb Haemost ; : -
      PubDate: 2020-02-06T00:00:00+0100
      DOI: 10.1055/s-0039-3402732
       
  • Hypothyroidism and the Risk of Venous Thromboembolism: A Nationwide Cohort
           Study
    • Authors: Wei; Wei-Ting, Liu, Peter Pin-Sung, Lin, Shu-Man, Peng, Carol Chiung-Hui, Wang, Jen-Hung, Huang, Huei-Kai, Loh, Ching-Hui
      Abstract: Background Previous studies have shown that hypothyroidism may have an impact on blood coagulation. However, how hypothyroidism and thyroxine replacement therapy (TRT) affect the risk of venous thromboembolism (VTE) remains controversial. This study aimed to examine the associations of hypothyroidism and TRT with VTE risks. Materials and Methods This nationwide population-based cohort study was conducted using Taiwan's National Health Insurance Research Database. We enrolled 10,818 hypothyroid patients (the exposed cohort) and 21,636 non-hypothyroid subjects (the unexposed cohort) between 2001 and 2014 after 1:2 exact matching according to age, sex, and index year. Hypothyroid patients were further divided into two groups depending on whether they received TRT or not. Adjusted hazard ratios (aHRs) for VTE were calculated using Fine and Gray competing risk models. Results The mean follow-up period was 7.5 years. Hypothyroidism was significantly associated with a higher risk of VTE (aHR = 1.83 [95% confidence interval [CI]: 1.44–2.33, p 
      Citation: Thromb Haemost ; : -
      PubDate: 2020-02-06T00:00:00+0100
      DOI: 10.1055/s-0039-3402761
       
  • Routine Postoperative Antithrombotic Therapy in Pediatric Liver
           Transplantation: Impact on Bleeding and Thrombotic Complications
    • Authors: Werner; Maureen J. M., de Kleine, Ruben H. J., de Boer, Marieke T., de Meijer, Vincent E., Scheenstra, René, Verkade, Henkjan J., Bodewes, Frank A. J. A., Bontemps, Sander T. H., Reyntjens, Koen M. E. M., Dikkers, Riksta, Lisman, Ton, Porte, Robert J.
      Abstract: Background Hepatic artery thrombosis (HAT) and portal vein thrombosis (PVT) are serious causes of morbidity and mortality after pediatric liver transplantation. To reduce thrombotic complications, routine antithrombotic therapy consisting of 1 week heparin followed by 3 months acetylsalicylic acid, was implemented in our pediatric liver transplant program in 2003. This study aimed to evaluate incidences of bleeding and thrombotic complications since the implementation of routine antithrombotic therapy and to identify risk factors for these complications. Methods This retrospective cohort study includes 200 consecutive pediatric primary liver transplantations performed between 2003 and 2016. Uni- and multivariate logistic regression analysis, Kaplan–Meier method, and Cox regression analysis were used to evaluate recipient outcome. Results HAT occurred in 15 (7.5%), PVT in 4 (2.0%), and venous outflow tract thrombosis in 2 (1.0%) recipients. Intraoperative vascular interventions (odds ratio [OR] 14.45 [95% confidence interval [CI] 3.75–55.67]), low recipient age (OR 0.81 [0.69–0.95]), and donor age (OR 0.96 [0.93–0.99]) were associated with posttransplant thrombosis. Clinically relevant bleeding occurred in 37%. Risk factors were high recipient age (OR 1.08 [1.02–1.15]), high Child–Pugh scores (OR 1.14 [1.02–1.28]), and intraoperative blood loss in mL/kg (OR 1.003 [1.001–1.006]). Both posttransplant thrombotic (hazard ratio [HR] 3.38 [1.36–8.45]; p = 0.009) and bleeding complications (HR 2.50 [1.19–5.24]; p = 0.015) significantly increased mortality. Conclusion In 200 consecutive pediatric liver transplant recipients receiving routine postoperative antithrombotic therapy, we report low incidences of posttransplant vascular complications. Posttransplant antithrombotic therapy seems to be a valuable strategy in pediatric liver transplantation. Identified risk factors for bleeding and thrombotic complications might facilitate a more personalized approach in antithrombotic therapy.
      Citation: Thromb Haemost ; : -
      PubDate: 2020-01-29T00:00:00+0100
      DOI: 10.1055/s-0039-1701010
       
  • Erratum: Tie2 Activation Promotes Protection and Reconstitution of the
           Endothelial Glycocalyx in Human Sepsis
    • Thromb Haemost
      DOI: 10.1055/s-0039-3400534



      Georg Thieme Verlag KG Stuttgart · New York

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      Thromb Haemost ; : -2020-01-29T00:00:00+0100
       
  • Erratum: Effectiveness and Safety of Apixaban versus Warfarin as
           Outpatient Treatment of Venous Thromboembolism in U.S. Clinical Practice
    • Thromb Haemost
      DOI: 10.1055/s-0039-3400530



      Georg Thieme Verlag KG Stuttgart · New York

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      Thromb Haemost ; : -2020-01-27T00:00:00+0100
       
  • Effect of Tranexamic Acid on Coagulation and Fibrin Clot Properties in
           Children Undergoing Craniofacial Surgery
    • Authors: Fenger-Eriksen; Christian, Lindholm, Alexander D'Amore, Krogh, Lisbeth, Hell, Tobias, Berger, Martin, Hermann, Martin, Fries, Dietmar, Juul, Niels, Rasmussen, Mads, Hvas, Anne-Mette
      Abstract: Objective Craniosynostosis surgery in small children is very often associated with a high blood loss. Tranexamic acid (TXA) reduces blood loss during this procedure, although the potential underlying coagulopathy in these children is not known in detail. Objective was to determine the nature of any coagulopathy found during and after craniosynostosis surgery and to characterize the effect of TXA on fibrin clot formation, clot strength, and fibrinolysis. Materials and Methods Thirty children received either TXA (bolus dose of 10 mg/kg followed by 8 hours continuous infusion of 3 mg/kg/h) or placebo. Dynamic whole blood clot formation assessed by thromboelastometry, platelet count, dynamic thrombin generation/thrombin-antithrombin, clot lysis assay, and fibrinogen/factor XIII (FXIII) levels were measured. Additionally, clot structure was investigated by real-time live confocal microscopy and topical data analysis. Results Increased ability of thrombin generation was observed together with a tendency toward shortened activated partial thromboplastin time and clotting time. Postoperative maximum clot firmness was higher among children receiving TXA. FXIII decreased significantly during surgery in both groups.Resistance toward tissue plasminogen activator-induced fibrinolysis was higher in children that received TXA, as evidenced by topical data analysis and by a significant longer lysis time. Fibrinogen levels were higher in the TXA group at 24 hours. Conclusion A significant coagulopathy mainly characterized by changes in clot stability and not parameters of thrombin generation was reported. Tranexamic acid improved clot strength and reduced fibrinolysis, thereby avoiding reduction in fibrinogen levels.
      Citation: Thromb Haemost ; : -
      PubDate: 2020-01-23T00:00:00+0100
      DOI: 10.1055/s-0039-3402762
       
  • Impaired Fibrinolysis Predicts Adverse Outcome in Acute Coronary Syndrome
           Patients with Diabetes: A PLATO Sub-Study
    • Authors: Sumaya; Wael, Wallentin, Lars, James, Stefan K., Siegbahn, Agneta, Gabrysch, Katja, Himmelmann, Anders, Ajjan, Ramzi A., Storey, Robert F.
      Abstract: Hypofibrinolysis is a key abnormality in diabetes but the role of impaired clot lysis in predicting vascular events and mortality in this population is yet to be determined. We aimed to investigate the relationship between fibrin clot properties and clinical outcomes in patients with diabetes and recent acute coronary syndrome (ACS). Plasma samples were collected at hospital discharge from 974 ACS patients with diabetes randomised to clopidogrel or ticagrelor in the PLATO trial. A validated turbidimetric assay was employed to study fibrin clot lysis and maximum turbidity. One-year rates of cardiovascular (CV) death, spontaneous myocardial infarction (MI) and PLATO-defined major bleeding events were assessed after sample collection. Hazard ratios (HRs) were determined using Cox proportional analysis. After adjusting for CV risk factors, each 50% increase in lysis time was associated with increased risk of CV death/MI (HR 1.21; 95% confidence interval [CI] 1.02–1.44; p = 0.026) and CV death alone (HR 1.38; 1.08–1.76; p = 0.01). Similarly, each 50% increase in maximum turbidity was associated with increased risk of CV death/MI (HR 1.25; 1.02–1.53; p = 0.031) and CV death alone (HR 1.49; 1.08–2.04; p = 0.014). The relationship between lysis time and the combined outcome of CV death and MI remained significant after adjusting for multiple prognostic vascular biomarkers (p = 0.034). Neither lysis time nor maximum turbidity was associated with major bleeding events. Impaired fibrin clot lysis predicts 1-year CV death and MI in diabetes patients following ACS. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier NCT00391872.
      Citation: Thromb Haemost ; : -
      PubDate: 2020-01-23T00:00:00+0100
      DOI: 10.1055/s-0039-1701011
       
  • The Dangerous Liaisons between Chronic Obstructive Pulmonary Disease and
           Venous Thromboembolism
    • Thromb Haemost
      DOI: 10.1055/s-0039-1701012



      Georg Thieme Verlag KG Stuttgart · New York

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      Thromb Haemost ; : -2020-01-23T00:00:00+0100
       
  • Thromboprophylaxis with Rivaroxaban in Acutely Ill Medical Patients with
           Renal Impairment: Insights from the MAGELLAN and MARINER Trials
    • Authors: Weitz; Jeffrey I., Raskob, Gary E., Spyropoulos, Alex C., Spiro, Theodore E., De Sanctis, Yoriko, Xu, Jianfeng, Lu, Wentao, Suh, Eunyoung, Argenti, Domenick, Yang, Haitao, Albanese, John, Lipardi, Concetta, Barnathan, Elliot S.
      Abstract: Patients with renal impairment are at higher risk of thrombosis and bleeding than those with normal renal function. The optimal rivaroxaban dose for thromboprophylaxis in acutely ill medical patients with renal impairment is unknown. MARINER and MAGELLAN were multicenter, randomized clinical trials of rivaroxaban in acutely ill medical patients. Efficacy and safety outcomes in patients with renal impairment in MARINER (7.5 mg once daily) were compared with those in patients with normal renal function in MARINER (10 mg once daily) and in a subpopulation of MAGELLAN that excluded patients at high risk for bleeding at baseline (10 mg once daily). Compared with enoxaparin/placebo in the MAGELLAN subpopulation, the relative risk (RR) of symptomatic venous thromboembolism (VTE) and VTE-related death with rivaroxaban 10 mg in patients with renal impairment (RR = 0.62; 95% confidence interval [CI] 0.27–1.44) was similar to that in those with normal renal function (RR = 0.78; 95% CI 0.44–1.40), while in MARINER, the 7.5 mg dose did not reduce the risk in patients with renal impairment (hazard ratio = 1.00; 95% CI 0.52–1.92). Major bleeding with rivaroxaban 10 mg once daily was higher in patients with renal impairment than in those with normal renal function in MAGELLAN (1.54% vs. 0.98%) and in the MAGELLAN subpopulation (0.94% vs. 0.61%). At a dose of 10 mg once daily, rivaroxaban is effective for thromboprophylaxis in acutely ill medical patients with impaired or normal renal function. The safety of this regimen is enhanced without loss of efficacy by excluding patients at high risk for bleeding, but not by using a reduced-dose strategy. Trial Registration ClinicalTrials.gov identifiers: NCT00571649 for the MAGELLAN trial, NCT02111564 for the MARINER trial.
      Citation: Thromb Haemost ; : -
      PubDate: 2020-01-23T00:00:00+0100
      DOI: 10.1055/s-0039-1701009
       
  • Effect of Smoking Cessation on the Pharmacokinetics and Pharmacodynamics
           of Clopidogrel after PCI: The Smoking Cessation Paradox Study
    • Authors: Ramotowski; Bogumił, Gurbel, Paul A., Tantry, Udaya, Bracha, Jan S., Karaźniewicz-Łada, Marta, Lewandowski, Zbigniew, Budaj, Andrzej
      Abstract: Background Cigarette smoking is associated with enhanced clopidogrel effect and platelet inhibition. However, the effect of smoking cessation on clopidogrel pharmacokinetics (PK) and pharmacodynamics (PD) is unknown. We aimed to determine the effect of smoking cessation, confirmed by cotinine measurement, on clopidogrel PK and PD after percutaneous coronary intervention (PCI). Methods and Results Following successful PCI, patients treated with 75 mg/day clopidogrel who reported smoking ≥10 cigarettes/day with NicAlert urine cotinine level 6 were enrolled. Clopidogrel and its metabolite concentrations, VerifyNow P2Y12 reaction units (PRUs), and NicAlert levels were measured in the study group before and at 30 days after smoking cessation and in a control group. CYP1A2 and CYP2C19 genotypes were determined. At 30-day visit (n = 87), 45 patients continued smoking, whereas 42 patients stopped smoking. Baseline PRUs were similar between groups. At 30 days, the smoking cessation group had higher PRUs (150.5 ± 68.6 vs. 118.4 ± 65.9, p = 0.03), greater absolute PRU change (27.7 ± 39.8 vs. −12.9 ± 55.4, p = 0.0002), greater change of PRUs adjusted for baseline platelet reactivity (38.6 ± 10.0, p 
      Citation: Thromb Haemost ; : -
      PubDate: 2020-01-15T00:00:00+0100
      DOI: 10.1055/s-0039-3402758
       
  • The Fibronectin Type II Domain of Factor XII Ensures Zymogen Quiescence
    • Authors: Clark; Chantal C., Hofman, Zonne L. M., Sanrattana, Wariya, den Braven, Lyanne, de Maat, Steven, Maas, Coen
      Abstract: Factor XII (FXII) zymogen activation requires cleavage after arginine 353 located in the activation loop. This cleavage can be executed by activated FXII (autoactivation), plasma kallikrein (PKa), or plasmin. Previous studies proposed that the activation loop of FXII is shielded to regulate FXII activation and subsequent contact activation. In this study, we aimed to elucidate this mechanism by expressing and characterizing seven consecutive N-terminally truncated FXII variants as well as full-length wild-type (WT) FXII. As soon as the fibronectin type II domain is lacking (FXII Δ1–71), FXII cleavage products appear on Western blot. These fragments display spontaneous amidolytic activity, indicating that FXII without the fibronectin type II domain is susceptible to autoactivation. Additionally, truncated FXII Δ1–71 is more easily activated by PKa or plasmin than full-length WT FXII. To exclude a contribution of autoactivation, we expressed active-site incapacitated FXII truncation variants (S544A). FXII S544A Δ1–71 is highly susceptible to cleavage by PKa, indicating exposure of the activation loop. In surface binding experiments, we found that the fibronectin type II domain is non-essential for binding to kaolin or polyphosphate, whereas the following epidermal growth factor-like domain is indispensable. Binding of full-length FXII S544A to kaolin or polyphosphate increases its susceptibility to cleavage by PKa. Moreover, the activation of full-length WT FXII by PKa increases approximately threefold in the presence of kaolin. Deletion of the fibronectin type II domain eliminates this effect. Combined, these findings suggest that the fibronectin type II domain shields the activation loop of FXII, ensuring zymogen quiescence.
      Citation: Thromb Haemost ; : -
      PubDate: 2020-01-15T00:00:00+0100
      DOI: 10.1055/s-0039-3402760
       
  • Fibrinogen Concentrate to Cardiac Surgery Patients with Ongoing Bleeding
           does not Increase the Risk of Thromboembolic Complications or Death
    • Authors: Waldén; Katarina, Jeppsson, Anders, Nasic, Salmir, Karlsson, Martin
      Abstract: Background We investigated whether fibrinogen concentrate administration to bleeding patients is associated with an increased risk of thromboembolic complications and death. Methods All consecutive patients who underwent first-time cardiac surgery at Sahlgrenska University Hospital from 2009 to 2014 were included. Patients, who had received fibrinogen concentrate, were compared with those who had not received fibrinogen concentrate. The primary endpoint was a composite of thromboembolic complications and death within 1 year after surgery. Secondary endpoints included the composite and mortality within 30 days and mortality within 1 year after surgery. Multivariable logistic regression and Cox regression models were used to compare the groups. Propensity score (PS)-matched models were used for sensitivity analyses. Results A total of 5,408 patients were included in the present study, of which 564 (10.4%) received fibrinogen concentrate. The composite endpoint occurred in 3.5% of patients at 30 days and 10.5% at 1 year. There was no significant difference between the groups in the composite endpoint at 1 year (adjusted hazard ratio [HR]: 1.11, 95% confidence interval [CI]: 0.84–1.46, p = 0.45) or in the secondary endpoints, that is, mortality at 1 year (adjusted HR: 1.38, 95% CI: 0.93–2.04, p = 0.11), composite at 30 days (adjusted odds ratio [OR]: 1.07, 95% CI: 0.64–1.81, p = 0.79) and mortality at 30 days (adjusted OR: 1.00, 95% CI: 0.51–1.96, p = 0.50). The results of the sensitivity analyses were consistent with those of main analyses. Conclusion Perioperative administration of fibrinogen concentrate to bleeding cardiac surgery patients is not associated with an increased risk of thromboembolic complications or death.
      Citation: Thromb Haemost ; : -
      PubDate: 2020-01-15T00:00:00+0100
      DOI: 10.1055/s-0039-3402759
       
  • Traps N' Clots: NET-Mediated Thrombosis and Related Diseases
    • Thromb Haemost
      DOI: 10.1055/s-0039-3402731



      Georg Thieme Verlag KG Stuttgart · New York

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      Thromb Haemost ; : -2020-01-15T00:00:00+0100
       
  • Perioperative Management in Patients Using Vitamin K Antagonists:
           Observational Cohort Study
    • Authors: Burggraaf; J. Louise I., van Rein, Nienke, van der Meer, Felix J. M., Lijfering, Willem M.
      Abstract: Background The benefit of periprocedural bridging with low-molecular-weight heparin (LMWH) in patients with atrial fibrillation has been contested by the publication of the BRIDGE trial. Objective This article determines whether publication of the BRIDGE trial has led to less bridging procedures and better patient outcomes (i.e., a composite of thromboembolism, major bleeding, and death) in patients undergoing invasive procedures at the Leiden Anticoagulation Clinic, the Netherlands. Methods We identified all procedures that required vitamin K antagonist interruption. Procedures were divided in a period before (2014–2016; 22 months) and after the publication of the BRIDGE trial (2016–2017; 22 months). Cumulative incidences 30 days postprocedure and relative risks of thromboembolic events, major bleeding, and mortality were calculated. Results A total of 4,892 and 4,237 eligible procedures were performed in 2014 to 2016 and 2016 to 2017, respectively. The cumulative incidence of thromboembolism was 0.5% in 2014 to 2016 compared with 0.3% in 2016 to 2017; adjusted odds ratio (OR) 0.60 (95% confidence interval [CI] 0.30–1.21). The cumulative incidence of major bleeding was 1.0% in the 2014 to 2016 period as compared with 1.3% in the 2016 to 2017 period; adjusted OR was 1.27 (95% CI 0.85–1.90). The adjusted OR of the composite endpoint was 1.05 (95% CI 0.74–1.48). The frequency of bridging with LMWH (14.8% in 2014–2016 vs. 16.6% in 2016–2017) as well as mean CHA2DS2-VASc scores of patients receiving bridging did not change after publication of the BRIDGE trial. Conclusion We showed that despite publication of the BRIDGE trial, the frequency of bridging with LMWH and patient outcomes regarding bleeding complications did not change.
      Citation: Thromb Haemost ; : -
      PubDate: 2020-01-15T00:00:00+0100
      DOI: 10.1055/s-0039-3402763
       
  • Lower versus Standard INR Targets in Atrial Fibrillation: A Systematic
           Review and Meta-Analysis of Randomized Controlled Trials
    • Authors: Pandey; Arjun K., Xu, Ke, Zhang, Li, Gupta, Saurabh, Eikelboom, John, Cook, Olivia, McIntyre, William F., Lopes, Renato D., Crowther, Mark, Belley-Côté, Emilie P., Whitlock, Richard P.
      Abstract: Background Western guidelines recommend an international normalized ratio (INR) range of 2 to 3 when using warfarin for stroke prevention in atrial fibrillation (AF), but lower INR ranges are frequently used in East Asia. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) in AF patients comparing the effect of lower versus standard INR targets on thromboembolism, major bleeding, and mortality. Methods We searched Western databases including Cochrane CENTRAL, Medline, and Embase as well as Chinese databases including SinoMed, CNKI, and Wanfang Data. We pooled risk ratios (RRs) using random-effects model. We grouped INR targets in two ways: (1) any study-specific lower versus standard targets and (2) INR ranges of approximately 1.5 to 2 versus 2 to 3. Results Seventy-nine RCTs (n = 12,928) met eligibility criteria: 74 (n = 11,322) from East Asia and 5 (n = 1,606) from Western countries. Compared with standard targets, lower INR ranges were associated with higher rates of thromboembolism (76 RCTs, n = 12,577: 7.1% vs. 4.4%, RR 1.50, 95% confidence interval [CI] 1.29–1.74, I 2 = 0%), lower rates of major bleeding (61 RCTs, n = 10,815: 2.2% vs. 4.4%, RR 0.54, 95% CI 0.44–0.67, I 2 = 0%), and similar mortality (32 RCTs, n = 7,327: 4.8% vs. 5.2%, RR 1.00, 95% CI 0.85–1.19, I 2 = 0%). Results were similar when comparing target ranges of approximately 1.5 to 2 versus 2 to 3. Conclusion Moderate quality evidence suggests lower INR targets reduce bleeding but increase thromboembolism in AF. The data are dominated by East-Asian studies, limiting generalizability to Western populations. Until higher quality data demonstrate otherwise, an INR range of 2 to 3 should remain standard for thromboembolic prophylaxis in AF.
      Citation: Thromb Haemost ; : -
      PubDate: 2020-01-15T00:00:00+0100
      DOI: 10.1055/s-0039-3401823
       
  • Chronic Obstructive Pulmonary Disease and Risk of Mortality in Patients
           with Venous Thromboembolism—The Tromsø Study
    • Authors: Børvik; Trond, Brækkan, Sigrid K., Evensen, Line H., Brodin, Ellen E., Morelli, Vania M., Melbye, Hasse, Hansen, John-Bjarne
      Abstract: Background Previous studies have shown increased mortality in venous thromboembolism (VTE) patients with chronic obstructive pulmonary disease (COPD), but it is unknown to what extent the association is influenced by the severity of COPD and physical inactivity. Objectives This article investigates whether COPD, and stages of COPD, influenced the risk of mortality after a first episode of VTE when physical inactivity was taken into account. Methods Patients with a first lifetime VTE (n = 256) were recruited among individuals who participated and performed spirometry in the fifth (2001–2002) and sixth (2007–2008) surveys of the Tromsø Study (n = 9577). All-cause mortality was registered up to December 31, 2015. Results There were 123 deaths during a median of 2.9 years of follow-up. The overall mortality rate was 11.9 (95% confidence interval [CI] 10.0–14.2) per 100 person-years. The risk of death was twofold higher in COPD patients compared with those with normal airflow (hazard ratio [HR] 2.00, 95% CI 1.30–3.08) after multivariable adjustment. The risk of death increased with the severity of COPD. VTE patients with COPD stage III/IV had a fivefold increased risk of death (HR 5.20, 95% CI 2.65–10.2) compared with those without COPD, and 50% of these patients died within 3.5 months after the incident VTE event. Adjustment for physical inactivity had minor effect on the risk estimates. Conclusion VTE patients with COPD had increased risk of death, particularly patients with severe COPD. The detrimental effect of COPD on mortality in VTE patients was apparently explained by factors other than physical inactivity among patients with COPD.
      Citation: Thromb Haemost ; : -
      PubDate: 2019-12-30T00:00:00+0100
      DOI: 10.1055/s-0039-3400744
       
 
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