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Clinical and Applied Thrombosis/Hemostasis
Journal Prestige (SJR): 0.49
Citation Impact (citeScore): 1
Number of Followers: 16  

  This is an Open Access Journal Open Access journal
ISSN (Print) 1076-0296 - ISSN (Online) 1938-2723
Published by Sage Publications Homepage  [1086 journals]
  • The Predictive Value of d-Dimer Test for Venous Thromboembolism During
           Puerperium: A Prospective Cohort Study

    • Authors: Wen Hu, Yali Wang, Juan Li, Jian Huang, Yuqun Pu, Ying Jiang, Dong Xu, Zhiming Ding, Baihui Zhao, Qiong Luo
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 26, Issue , January-December 2020.
      The aim of this study was to investigate the d-dimer for prediction of venous thromboembolism (VTE) events in puerperium and to identify other risk factors associated with the occurrence of VTE. This was a prospective observational cohort study, which included 16 127 women who gave birth after 28 weeks of gestation at Women’s Hospital of Zhejiang University, School of Medicine, from January 2016 to December 2016. Data including basic maternal and fetal characteristics, pregnancy complications, and predictive biomarkers within postpartum 24 hours including d-dimer, platelet, and fibrinogen were collected for analyses. In the cohort study, 19 (0.12%) women were identified as VTE, including 1 pulmonary embolism event and 18 deep venous thrombosis events. The receiver operating characteristic curve analysis suggested the best cutoff point for d-dimer level within postpartum 24 hours was 3.695 mg/L, with a specificity of 75.5% and a sensitivity of 73.7%, and there was no statistical correlation between fibrinogen and VTE, as well as between platelets and VTE. On multivariate analysis, age ≥35 years (odds ratio [OR] = 2.895, 95% confidence interval [CI]: 1.079-7.773), scarred uterus (OR = 3.894, 95% CI: 1.234-12.282), intrauterine infection (OR = 7.214, 95% CI: 1.519-34.262), antiphospholipid syndrome (OR = 199.530, 95% CI: 15.152-2627.529), d-dimer ≥3.70 mg/L (OR = 7.573, 95% CI: 2.699-21.247), and emergency cesarean delivery (OR = 23.357, 95% CI: 2.819-193.508) were independently associated with VTE in puerperium. We concluded that d-dimer ≥3.70 mg/L was an independent predictor of VTE during puerperium and d-dimer testing was necessary for perinatal women.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2020-02-24T12:09:09Z
      DOI: 10.1177/1076029620901786
      Issue No: Vol. 26 (2020)
       
  • The Incidence and Characteristics of Venous Thromboembolism in
           Neurocritical Care Patients: A Prospective Observational Study

    • Authors: Ping Zhang, Yi Bian, Feng Xu, Lifei Lian, Suiqiang Zhu, Zhouping Tang, Furong Wang
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 26, Issue , January-December 2020.
      Risk of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is presumed to be high for neurologic intensive care unit (NICU) patients. However, exact incidences of VTE have yet to be reported. In this prospective observational study, we consecutively enrolled 126 neurocritical care patients who had an NICU stay ≥1 week with paralysis and/or unconsciousness. All patients received DVT prevention strategies. Patients were screened for VTE after 1 week of hospitalization, using venous ultrasonography and computed tomography pulmonary angiography. Following 1 week of NICU hospitalization, DVT incidence was 35.7% and PE incidence was 17.5%. Of the DVTs, 75.6% were in the muscular calf vein. Of the PEs, 22.7% were in main pulmonary arteries, while 77.3% were in branches. Approximately 96% of the DVTs and 86% of the PEs were asymptomatic. Approximately 24% of patients with DVT had a concurrent PE, while 50% of PE patients had a DVT. Paralysis, raised d-dimer on admission, and pulmonary infection were found to be independent risk factors for DVT. Paraplegia, femoral vein thrombosis, and pulmonary infection were found to be independent risk factors for PE. Despite active preventive measures, incidences of VTE in NICU patients were high. Most VTEs were asymptomatic, meaning they could have led to a missed diagnosis. Attention should be paid to the VTE events of critically ill neurological patients.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2020-02-24T12:05:49Z
      DOI: 10.1177/1076029620907954
      Issue No: Vol. 26 (2020)
       
  • von Willebrand Factor as a Predictor for Transplant-Associated Thrombotic
           Microangiopathy

    • Authors: Zhenzhen Xu, Chengwei Luo, Peilong Lai, Wei Ling, Suijing Wu, Xin Huang, Lisi Huang, Guanrong Zhang, Xin Du, Jianyu Weng
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 26, Issue , January-December 2020.
      Transplant-associated thrombotic microangiopathy (TA-TMA) after hematopoietic stem cell transplantation (HSCT) is a severe complication associated with underlying endothelial damage. Secreted and released von Willebrand factor (vWF) correlates with endothelial cell injury, but its role in predicting prognosis for TA-TMA is unclear. In this prospective study, we evaluated the relationship between vWF and the incidence of TA-TMA after HSCT. A total of 79 consecutive patients undergoing HSCT from August 2016 to June 2018 were enrolled. Twenty-three (29%) patients met the established diagnostic criteria. Patients with TA-TMA had significantly higher nonrelapse mortality compared with those without TA-TMA (78.3% vs 8.9%; P < .001). Multivariable analysis demonstrated that vWF was a predictive biomarker for TA-TMA. The vWF value was higher for the TA-TMA group (mean ± standard deviation, 380.7% ± 78.8% vs 284.9% ± 104.5%; P < .001), and the area under the curve for vWF in the diagnosis of TA-TMA was 0.756. Furthermore, patients with ≥325% vWF had a higher 2-year cumulative hazard of TA-TMA (53.1% ± 8.2% vs 7.5% ± 4.2%; P < .001) and a lower 2-year survival (32.1% ± 9.1% vs 83.7% ± 6.2%; P < .001) compared with those with
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2020-02-24T05:05:30Z
      DOI: 10.1177/1076029619892684
      Issue No: Vol. 26 (2020)
       
  • Relationship Between 25-Hydroxyvitamin D, Renin, and Collagen Remodeling
           Biomarkers in Atrial Fibrillation

    • Authors: Dimpi Patel, Aleksander Druck, Debra Hoppensteadt, Vinod Bansal, Yevgeniy Brailovsky, Mushabbar Syed, Jawed Fareed
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 26, Issue , January-December 2020.
      The interplay between vitamin D, the renin–angiotensin system (RAS), and collagen remodeling has been implicated in the pathogenesis of various cardiovascular diseases. This study sought to explore this relationship in atrial fibrillation (AF) by profiling plasma levels of 25-hydroxyvitamin D, RAS biomarkers, and collagen remodeling biomarkers using the enzyme-linked immunosorbent assay method. We hypothesized that 25-hydroxyvitamin D levels would inversely correlate with RAS biomarkers and that levels of RAS and collagen remodeling biomarkers would positively correlate with each other. Although our AF cohort (n = 37) did not exhibit decreased 25-hydroxyvitamin D levels compared to normal controls (n = 26), these levels inversely correlated with renin (Spearman r = −0.57, P = 0.005). Renin levels were elevated in patients with AF compared to normal controls (1233 ± 238 ng/mL vs 401 ± 27 ng/mL, P = 0.0002) and positively correlated with levels of matrix metalloproteinase 1 (MMP-1; Spearman r = 0.89, P = 0.01) and MMP-2 (Spearman r = 0.82, P = 0.03). These data suggest that 25-hydroxyvitamin D may influence RAS activation, and renin may help mediate the collagen remodeling process in AF. Understanding mediators of RAS dysregulation in AF may elucidate targets for therapeutic intervention to prevent collagen remodeling.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2020-02-19T12:09:18Z
      DOI: 10.1177/1076029619899702
      Issue No: Vol. 26 (2020)
       
  • XKR6 rs7014968 SNP Increases Serum Total Cholesterol Levels and the Risk
           of Coronary Heart Disease and Ischemic Stroke

    • Authors: Kai-Guang Li, Rui-Xing Yin, Feng Huang, Wu-Xian Chen, Jin-Zhen Wu, Xiao-Li Cao
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 26, Issue , January-December 2020.
      The X Kell blood group complex subunit-related family member 6 (XKR6) gene single-nucleotide polymorphisms (SNPs) have been associated with serum lipid profiles and the risk of coronary heart disease (CHD) and ischemic stroke (IS) in several previous studies, but the association between the XKR6 rs7014968 SNP and serum lipid levels and the risk of CHD and IS has not been detected previously. This study aims to explore the association between the XKR6 rs7014968 SNP and serum lipid traits and the susceptibility to CHD and IS in the Guangxi Han Chinese population. Snapshot technology was used to determine the genotypes of the XKR6 rs7014968 SNP in 624 controls, 588 patients with CHD, and 544 patients with IS. The XKR6 rs7014968C allele carriers in the control group had higher serum total cholesterol (TC) levels than the C allele noncarriers (P = .025). The XKR6 rs7014968C allele carriers also had an increased risk of CHD and IS (P < .05-.01). Stratified analysis showed that the patients with the rs7014968C allele in the female, age>60 years, body mass index (BMI)>24 kg/m2, and hypertension subgroups had a higher risk of CHD than those in the subgroup counterparts. The patients with the rs7014968C allele in the male, BMI> 24 kg/m2, smoker, and hypertension subgroups also had a higher risk of IS than those in the subgroup counterparts. These results suggest that the XKR6 rs7014968 SNP is likely to increase the risk of CHD and IS by increasing serum TC levels in our study populations.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2020-02-06T09:15:49Z
      DOI: 10.1177/1076029620902844
      Issue No: Vol. 26 (2020)
       
  • Prenatal Plasma Fibrinogen Level Predicts Postpartum Hemorrhage of
           Patients With HELLP Syndrome

    • Authors: Chanjuan Cui, Sisi Ma, Rui Qiao
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 26, Issue , January-December 2020.
      Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is a serious complication of pregnancy. Postpartum hemorrhage indicates poor prognosis of pregnant women with HELLP syndrome. The aim of our study is to investigate the predictive value of coagulation markers for postpartum hemorrhage of pregnant women with HELLP syndrome. In a retrospective cohort study, 106 patients who were diagnosed as pregnant women with HELLP syndrome in Peking University Third Hospital from August 2010 to January 2017 were analyzed. The demographic characters of maternal and fetus, days of hospital stay, postpartum complications, and the laboratory tests of coagulation markers within 3 days before delivery were collected. In addition, 100 healthy pregnant women were collected as a control group. The result showed that the incidence of preeclampsia in pregnant women with postpartum hemorrhage was higher than that in pregnant women without hemorrhage (P = .011). The level of fibrinogen (FIB) in postpartum hemorrhage pregnant women with HELLP syndrome was lower than that in nonpostpartum hemorrhage pregnant women with HELLP syndrome and healthy pregnant women (2.3 [1.68-2.81] vs 3.64 ± 0.95, P = .000; 2.3 [1.68-2.81] vs 4.48 ± 0.62, P = .000). Multivariate analysis showed that decreased FIB levels independently predicted the postpartum hemorrhage of pregnant women with HELLP syndrome (odds ratio = 7.374, 95% confidence interval [CI], 1.551-35.05, P = .012). The receiver operating characteristic curve showed that the area under the curve of FIB level when predicting postpartum hemorrhage is 0.841 (95% CI, 0.708-0.976). When the cutoff value of FIB was 3.04 g/L, the sensitivity was 90.90% and the specificity was75.80%. Therefore, the low level of prenatal FIB is a reliable biomarker to predict postpartum hemorrhage of pregnant women with HELLP syndrome, which make it useful for pregnant women with HELLP syndrome in guiding surveillance therapy and prognosis assessment.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2020-02-04T04:37:43Z
      DOI: 10.1177/1076029619894057
      Issue No: Vol. 26 (2020)
       
  • Effect of Argatroban Combined With Dual Antiplatelet Therapy on Early
           Neurological Deterioration in Acute Minor Posterior Circulation Ischemic
           Stroke

    • Authors: Ling-Shan Zhou, Xiao-Qiu Li, Zhong-He Zhou, Hui-Sheng Chen
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 26, Issue , January-December 2020.
      There is a lack of studies on anticoagulant plus antiplatelet therapy for acute ischemic stroke. The present study made a pilot effort to investigate the efficacy and safety of argatroban plus dual antiplatelet therapy (DAPT) in patients with acute posterior circulation ischemic stroke (PCIS). We retrospectively collected patients diagnosed with acute PCIS according to inclusion/exclusion criteria. According to treatment drugs, patients were divided into an argatroban plus DAPT group and a DAPT group. The primary efficacy end point was the proportion of early neurological deterioration (END). The primary safety outcome was symptomatic intracranial hemorrhage. All outcomes were compared between the 2 groups before and after propensity score matching (PSM). A total of 502 patients were enrolled in the study, including 35 patients with argatroban plus DAPT and 467 patients with DAPT. There was a higher National Institutes of Health Stroke Scale (NIHSS) score in the argatroban plus DAPT group than the DAPT group before PSM (3 vs 2, P = .017). Compared with the DAPT group, the argatroban plus DAPT group had no END (before PSM: 0% vs 6.2%, P = .250; after PSM: 0% vs 5.9%, P = .298). Argatroban plus DAPT yielded a significant decrease in the NIHSS score from baseline to 7 days after hospitalization, compared with that of the DAPT group before PSM (P = .032), but not after PSM (P = .369). No symptomatic intracranial hemorrhage was found in any patient. A short-term combination of argatroban with DAPT appears safe in acute minor PCIS.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2020-02-04T04:36:03Z
      DOI: 10.1177/1076029620904131
      Issue No: Vol. 26 (2020)
       
  • Diagnostic Values of Inflammatory and Angiogenic Factors for Acute Joint
           Bleeding in Patients With Severe Hemophilia A

    • Authors: Huijuan Xu, Ren Zhong, Kai Wang, Xuerong Li, Yanxia Zhao, Jian Jiang, Shaoyong Si, Lirong Sun
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 26, Issue , January-December 2020.
      This study was conducted to assess the levels of inflammatory factors and angiogenic factors in patients with severe hemophilia A and evaluate their diagnostic values for acute joint bleeding. This study included a total of 144 patients with severe hemophilia A. Of them, 66 had acute joint bleeding. Ninety healthy volunteers were recruited as control. The levels of leukocytes, monocytes, platelets, hemoglobin, phagocyte migration inhibitory factor (MIF), plasminogen, fibrin/fibrinogen degradation products, d-dimer, and α2 antifibrinolytic enzyme were measured using hematology analyzer. Thrombomodulin, endostatin, intercellular adhesion molecule 1, and vascular endothelial growth factor (VEGF) were assessed using enzyme-linked immunosorbent assay. Logistic regression analysis was performed to analyze the factors affecting acute joint bleeding. Compared with healthy volunteers, the levels of leukocytes, C-reactive protein (CRP), MIF, and VEGF were significantly (P < .05) elevated in the patients with severe hemophilia A and were significantly higher in patients with joint bleeding than in patients with nonbleeding (P < .05). Multivariate analysis showed that CRP and VEGF were independent risk factors for acute joint bleeding (P < .05). The area under the curve, sensitivity, and specificity of CRP for the diagnosis of acute joint bleeding were 0.829, 88.43%, and 67.87%, respectively, and those of VEGF were 0.758, 82.8%, and 68.3%, respectively. The levels of inflammatory factors and angiogenesis factors are elevated in patients with severe hemophilia A and both CRP and VEGF are closely related to acute joint bleeding and may be used as potential biomarkers for predicting acute joint bleeding in patients with severe hemophilia A.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2020-01-30T09:06:28Z
      DOI: 10.1177/1076029619892683
      Issue No: Vol. 26 (2020)
       
  • Identification of the Intron 22 and Intron 1 Inversions of the Factor VIII
           Gene in Iraqi Kurdish Patients With Hemophilia A

    • Authors: Aveen M. Raouf Abdulqader, Ali Ibrahim Mohammed, Shwan Rachid, Peyman Ghoraishizadeh, Sarwar Noori Mahmood
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 26, Issue , January-December 2020.
      Hemophilia A (HA) is a severe coagulation disorder affecting 1 in 5000 to 10 000 male births. In severe cases, the most deleterious large DNA rearrangements are inversions of intron 22 (Inv22) and intron 1 (Inv1) of the factor VIII (FVIII) gene. These account for 40% to 50% and 1% to 5% of all causative mutations, respectively. Nevertheless, no genetic analysis to identify the actual causative mutation of FVIII, particularly Inv22 and Inv1, among Iraqi Kurdish hemophiliacs has been performed. In this study, we aimed to genotype Inv22 and Inv1 of the FVIII gene in our patients with HA and reveal the genotype/phenotype correlation with the inversion mutations and their role as a risk factor for the development of inhibitors. Analyses of the Inv22 and Inv1 mutations in 80 Iraqi Kurdish patients with HA (60 severe, 18 moderate, and 2 mild) were performed using the inverse shifting–polymerase chain reaction (IS-PCR) method. In severe cases, 46.7% (28/60) had Inv22 and 3.3% (2/60) had Inv1. The genotype/phenotype relation of Inv22 and Inv1 illustrated a statistically significant association (P = .012) between disease severity and inversion mutations. Slightly more patients with Inv22 (39%) developed inhibitors than those without Inv22 (28%; odds ratio = 1.65, 95% confidence interval = 0.56-4.87, P = .361). Inv22 is a major cause of severe HA in Iraqi Kurdish patients, and IS-PCR is a rapid, robust, and effective method that can be applied for carrier detection and prenatal diagnosis of HA in developing countries.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2020-01-29T10:53:45Z
      DOI: 10.1177/1076029619888293
      Issue No: Vol. 26 (2020)
       
  • Proenkephalin A Adds No Incremental Prognostic Value After Acute Ischemic
           Stroke

    • Authors: Philipp Gruber, Felix Fluri, Juliane Schweizer, Andreas Luft, Beat Müller, Mirjam Christ-Crain, Mira Katan
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 26, Issue , January-December 2020.
      Objective:The aim of this study was to confirm previous observations that proenkephalin A (PENK-A) may serve as prognostic marker in the setting of acute ischemic stroke in a large stroke cohort.Methods:The plasma concentration of PENK-A was measured within 72 hours of symptom onset in 320 consecutively enrolled patients with stroke. The primary outcome measures were unfavorable functional outcome (modified Rankin Scale score 0-2 vs 3-6) and mortality within 90 days. Logistic and cox proportional regression analyses were fitted to estimate odds ratios (ORs), hazard ratios (HRs) and 95% confidence intervals (CIs), respectively, for the association between PENK-A and the primary outcome measures.Results:After adjusting for demographic and vascular risk factors, PENK-A was neither independently associated with functional outcome (OR: 1.29, 95% CI: 0.16-10.35) nor mortality (HR: 1.02, 95% CI: 0.14-7.33).Conclusion:Among patients with acute stroke, PENK-A does not serve as an independent prognostic marker in this external validation cohort.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/1076029619895318
      Issue No: Vol. 26 (2020)
       
  • Elevated Plasma von Willebrand Factor Antigen and Activity Levels Are
           Associated With the Severity of Coronary Stenosis

    • Authors: Bin Yan, Qi Wang, Weipeng Du, Suping Zhai, Chaoyang Gou, Tianxi Hu, Lijun Xia, Changgeng Ruan, Yiming Zhao
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 26, Issue , January-December 2020.
      von Willebrand factor (VWF) acts as a bridge between platelets and the subendothelial matrix following vessel damage and plays a vital role in coronary artery disease (CAD). The aim of this study was to investigate the association between VWF and the severity of coronary stenosis quantified by the Gensini score in acute myocardial infarction (AMI), the most dangerous complication of CAD. Plasma VWF antigen (VWF: Ag) and VWF-collagen binding (VWF: CB) in normal controls (n = 123) and in patients with AMI (n = 205) were tested, and then the patients were divided based on Gensini scores. The levels of VWF: Ag and VWF: CB in patients with AMI were significantly higher than those in the control group (P < .001). Plasma levels of VWF: Ag and VWF: CB were positively correlated with both Gensini score and the number of affected vessels. Both VWF: Ag and VWF: CB were independent factors for coronary stenosis, adjusting confounding factors. Thus, the levels of VWF: Ag and VWF: CB were positively correlated with the severity of coronary stenosis. Screening of VWF at time of AMI may have prognostic value in terms of the severity of coronary stenosis.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/1076029619900552
      Issue No: Vol. 26 (2020)
       
  • Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict
           All-Cause Mortality in Acute Pulmonary Embolism

    • Authors: Trung Phan, Yevgeniy Brailovsky, Jawed Fareed, Debra Hoppensteadt, Omer Iqbal, Amir Darki
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 26, Issue , January-December 2020.
      The aim of this study was to investigate the utility of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) to predict all-cause mortality in patients presenting with acute pulmonary embolism (PE). Three hundred consecutive patients with acute PE between March 2016 and December 2018 were retrospectively analyzed. We identified 191 patients who met the study inclusion criteria. Twenty-eight patients died during the study period. There was a significant difference in PLR, but not NLR, between patients with low risk, submassive, and massive risk PE (P = .02 and P = .58, respectively, by the Kruskal-Wallis test). Elevated NLR and PLR were associated with all-cause mortality (P < .01 and P < .01, respectively). Neutrophil-to-lymphocyte ratio of 5.46 was associated with all-cause mortality with sensitivity of 75.0% and specificity of 66.9% (area under the curve [AUC]: 0.692 [95% confidence interval, CI]: 0.568-0.816); P < .01). Platelet-to-lymphocyte ratio of 256.6 was associated with all-cause mortality with sensitivity of 53.6% and specificity of 82.2% (AUC: 0.693 [95% CI: 0.580-0.805]; P < .01). Neutrophil-to-lymphocyte ratio and PLR are simple biomarkers that are readily available from routine laboratory values and may be useful components of PE risk prediction models.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/1076029619900549
      Issue No: Vol. 26 (2020)
       
  • Effect of Hydroxyurea Treatment on the Inflammatory Markers Among Children
           With Sickle Cell Disease

    • Authors: Asmaa M. Zahran, Asmaa Nafady, Khaled Saad, Helal F. Hetta, Alam-Eldin M. Abdallah, Safwat M. Abdel-Aziz, Mostafa M. Embaby, Amir M. Abo Elgheet, Sanaa F. Darwish, Mohamed Gamil M. Abo-Elela, Amira Elhoufey, Khalid I. Elsayh
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 26, Issue , January-December 2020.
      Background:Neutrophil-to-lymphocyte ratio (NLR) was introduced as a potential inflammatory marker in sickle cell disease (SCD). This study aimed to evaluate the impact of hydroxyurea (HU) treatment on the value of NLR and some inflammatory mediators in SCD.Methods:The hematological parameters and clinical events were analyzed in 35 children with SCD under HU treatment and followed up for 1 year and in 20 healthy controls. Enzyme-linked immunosorbent assay was performed for the evaluation of proinflammatory cytokines, including interleukin (IL) 6, IL-8, high-sensitivity C-reactive protein (hs-CRP), and tumor necrosis factor α (TNF-α).Results:Hydroxyurea significantly improves most of the hematological parameters in children with SCD. The percentages of hemoglobin fraction S, serum levels of TNF-α and IL-6 were significantly decreased when compared to baseline value but did not reach the value of the healthy control. The HU treatment led to a significant decrease in NLR compared to the baseline values and reached healthy control values. Neutrophil-to-lymphocyte ratio was positively correlated with hs-CRP, TNF-α, and IL-8 serum levels and negatively correlated with percentage of fetal hemoglobin and hematocrit values. The cutoff value of NLR to expect a response to HU among SCD was 3.0, with 76% specificity and 85% sensitivity (area under the curve: 0.85, P < .0001). In conclusion, hydroxyurea induced a decrease in NLR and inflammatory cytokines, which represent a biomarker of inflammation in SCD. The calculation of NLR is a straightforward and cheap method for SCD outcome prediction in young children.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/1076029619895111
      Issue No: Vol. 26 (2020)
       
  • Blood Group Types O and Non-O Are Associated With Coronary Collateral
           Circulation Development

    • Authors: Savas Celebi, Ozlem Ozcan Celebi, Berkten Berkalp, Sinan Aydogdu, Basri Amasyali
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 26, Issue , January-December 2020.
      Blood group types are associated with coronary artery disease. However, data are scarce about the impact of blood group types on coronary collateral circulation. In this study, we aimed to investigate the relationship between the blood group types and coronary collateral circulation. Two hundred and twelve patients who underwent coronary angiography in our department and had a stenosis of ≥ 90% in at least one major epicardial vessel were included in our study. Collateral degree was graded according to Rentrop-Cohen classification. After grading, patients were divided into poor coronary collateral circulation (Rentrop grade 0 and 1) and good coronary collateral circulation (Rentrop 2 and 3) groups. The ABO blood type of all participants was determined. The incidence rates of O blood group type were significantly higher in the good coronary collateral group compared to the poor collateral group (37.9% vs 17.1%, P < .001). The O type blood group was an independent predictor of good coronary collateral circulation (odds ratio = 1.83, 95% confidence interval = 1.56-6.18, P = .015). Coronary collateral circulation is associated with blood group types. The O blood group predicts good coronary collateral development among patients with coronary artery disease.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/1076029619900544
      Issue No: Vol. 26 (2020)
       
  • A Systematic Review of Network Meta-Analyses and Real-World Evidence
           Comparing Apixaban and Rivaroxaban in Nonvalvular Atrial Fibrillation

    • Authors: Nathan R. Hill, Belinda Sandler, Evelien Bergrath, Dušan Milenković, Ajibade O. Ashaye, Usman Farooqui, Alexander T. Cohen
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 26, Issue , January-December 2020.
      There is no direct evidence comparing the 2 most commonly prescribed direct oral anticoagulants, apixaban and rivaroxaban, used for stroke prevention in nonvalvular atrial fibrillation (NVAF). A number of network meta-analyses (NMAs) of randomized control trials and real-world evidence (RWE) studies comparing the efficacy, effectiveness, and safety of apixaban and rivaroxaban have been published; however, a comprehensive evidence review across the available body of evidence is lacking. In this study, we aimed to systematically review and evaluate the clinical outcomes of apixaban and rivaroxaban using a combination of data gleaned from both NMAs and RWE studies. The review identified 21 NMAs and 5 RWE studies. The data demonstrated that apixaban was associated with fewer major bleeding events compared to rivaroxaban. There was no difference in the efficacy/effectiveness profiles between these treatments. Bleeding is a serious complication of anticoagulation therapy for the management of NVAF, and is associated with increased rates of hospitalization, morbidity, mortality, and health-care expenditure. The majority of studies in this comprehensive evidence review suggests that apixaban has a lower risk of major bleeding events compared to rivaroxaban in patients with NVAF.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/1076029619898764
      Issue No: Vol. 26 (2020)
       
  • Assay-Based Differentiation in the Neutralization Profile of
           Unfractionated Heparin, Enoxaparin, and Fondaparinux by Andexanet Alfa

    • Authors: Fakiha Siddiqui, Alfonso Tafur, Emily Bontekoe, Omer Iqbal, Walter Jeske, Siddharth Mehrotra, Debra Hoppensteadt, Eduardo Ramacciotti, Jawed Fareed
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 26, Issue , January-December 2020.
      Andexanet alfa is a recombinant factor Xa decoy protein, designed to reverse bleeding associated with oral anti-Xa agents. Andexanet alfa is also reported to neutralize the effects of heparin-related drugs. This study focused on the neutralization profiles of unfractionated heparin (UFH), enoxaparin, and, a chemically synthetic pentasaccharide, fondaparinux by andexanet alfa. Whole blood clotting studies were carried out using thromboelastography (TEG) and activated clotting time (ACT). The anticoagulant profile of UFH, enoxaparin, and fondaparinux was studied using the activated partial thromboplastin time (aPTT), thrombin time (TT), and amidolytic anti-Xa, and anti-IIa methods. Thrombin generation inhibition was studied using the calibrated automated thrombogram system. Reversal of each of these agents was studied by supplementing andexanet alfa at 100 µg/mL. In the TEG, andexanet alfa produced almost a complete reversal of the anticoagulant effects of UFH and enoxaparin; however, it augmented the effects of fondaparinux. In the ACT, aPTT, and TT, UFH produced strong anticoagulant effects that were almost completely neutralized by andexanet alfa. Enoxaparin produced milder anticoagulant responses that were partially neutralized, whereas fondaparinux did not produce any sizeable effects. In the anti-Xa and anti-IIa assays, UFH exhibited partial neutralization whereas enoxaparin and fondaparinux did not show any neutralization. All agents produced varying degrees of the inhibition of thrombin generation, which were differentially neutralized by andexanet alfa. These results indicate that andexanet alfa is capable of differentially neutralizing anticoagulant and antiprotease effects of UFH and enoxaparin in an assay-dependent manner. However, andexanet alfa is incapable of neutralizing the anti-Xa effects of fondaparinux.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/1076029619895120
      Issue No: Vol. 26 (2020)
       
  • A Machine Learning–Based Model to Predict Acute Traumatic Coagulopathy
           in Trauma Patients Upon Emergency Hospitalization

    • Authors: Kaiyuan Li, Huitao Wu, Fei Pan, Li Chen, Cong Feng, Yihao Liu, Hui Hui, Xiaoyu Cai, Hebin Che, Yulong Ma, Tanshi Li
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 26, Issue , January-December 2020.
      Acute traumatic coagulopathy (ATC) is an extremely common but silent murderer; this condition presents early after trauma and impacts approximately 30% of severely injured patients who are admitted to emergency departments (EDs). Given that conventional coagulation indicators usually require more than 1 hour after admission to yield results—a limitation that frequently prevents the ability for clinicians to make appropriate interventions during the optimal therapeutic window—it is clearly of vital importance to develop prediction models that can rapidly identify ATC; such models would also facilitate ancillary resource management and clinical decision support. Using the critical care Emergency Rescue Database and further collected data in ED, a total of 1385 patients were analyzed and cases with initial international normalized ratio (INR) values>1.5 upon admission to the ED met the defined diagnostic criteria for ATC; nontraumatic conditions with potentially disordered coagulation systems were excluded. A total of 818 individuals were collected from Emergency Rescue Database as derivation cohorts, then were split 7:3 into training and test data sets. A Pearson correlation matrix was used to initially identify likely key clinical features associated with ATC, and analysis of data distributions was undertaken prior to the selection of suitable modeling tools. Both machine learning (random forest) and traditional logistic regression were deployed for prediction modeling of ATC. After the model was built, another 587 patients were further collected in ED as validation cohorts. The ATC prediction models incorporated red blood cell count, Shock Index, base excess, lactate, diastolic blood pressure, and potential of hydrogen. Of 818 trauma patients filtered from the database, 747 (91.3%) patients did not present ATC (INR ≤ 1.5) and 71 (8.7%) patients had ATC (INR> 1.5) upon admission to the ED. Compared to the logistic regression model, the model based on the random forest algorithm showed better accuracy (94.0%, 95% confidence interval [CI]: 0.922-0.954 to 93.5%, 95% CI: 0.916-0.95), precision (93.3%, 95% CI: 0.914-0.948 to 93.1%, 95% CI: 0.912-0.946), F1 score (93.4%, 95% CI: 0.915-0.949 to 92%, 95% CI: 0.9-0.937), and recall score (94.0%, 95% CI: 0.922-0.954 to 93.5%, 95% CI: 0.916-0.95) but yielded lower area under the receiver operating characteristic curve (AU-ROC) (0.810, 95% CI: 0.673-0.918 to 0.849, 95% CI: 0.732-0.944) for predicting ATC in the trauma patients. The result is similar in the validation cohort. The values for classification accuracy, precision, F1 score, and recall score of random forest model were 0.916, 0.907, 0.901, and 0.917, while the AU-ROC was 0.830. The values for classification accuracy, precision, F1 score, and recall score of logistic regression model were 0.905, 0.887, 0.883, and 0.905, while the AU-ROC was 0.858. We developed and validated a prediction model based on objective and rapidly accessible clinical data that very confidently identify trauma patients at risk for ATC upon their arrival to the ED. Beyond highlighting the value of ED initial laboratory tests and vital signs when used in combination with data analysis and modeling, our study illustrates a practical method that should greatly facilitates both warning and guided target intervention for ATC.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/1076029619897827
      Issue No: Vol. 26 (2020)
       
 
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