Publisher: Sage Publications   (Total: 1166 journals)

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Showing 1 - 200 of 1166 Journals sorted alphabetically
AADE in Practice     Hybrid Journal   (Followers: 6)
Abstracts in Anthropology     Full-text available via subscription   (Followers: 29)
Academic Pathology     Open Access   (Followers: 6)
Accounting History     Hybrid Journal   (Followers: 18, SJR: 0.527, CiteScore: 1)
Acta Radiologica     Hybrid Journal   (Followers: 1, SJR: 0.754, CiteScore: 2)
Acta Radiologica Open     Open Access   (Followers: 2)
Acta Sociologica     Hybrid Journal   (Followers: 39, SJR: 0.939, CiteScore: 2)
Action Research     Hybrid Journal   (Followers: 53, SJR: 0.308, CiteScore: 1)
Active Learning in Higher Education     Hybrid Journal   (Followers: 395, SJR: 1.397, CiteScore: 2)
Adaptive Behavior     Hybrid Journal   (Followers: 9, SJR: 0.288, CiteScore: 1)
Administration & Society     Hybrid Journal   (Followers: 18, SJR: 0.675, CiteScore: 1)
Adoption & Fostering     Hybrid Journal   (Followers: 25, SJR: 0.313, CiteScore: 0)
Adsorption Science & Technology     Open Access   (Followers: 9, SJR: 0.258, CiteScore: 1)
Adult Education Quarterly     Hybrid Journal   (Followers: 259, SJR: 0.566, CiteScore: 2)
Adult Learning     Hybrid Journal   (Followers: 51)
Advances in Dental Research     Hybrid Journal   (Followers: 11, SJR: 1.791, CiteScore: 4)
Advances in Developing Human Resources     Hybrid Journal   (Followers: 35, SJR: 0.614, CiteScore: 2)
Advances in Mechanical Engineering     Open Access   (Followers: 156, SJR: 0.272, CiteScore: 1)
Advances in Methods and Practices in Psychological Science     Full-text available via subscription   (Followers: 20)
Advances in Structural Engineering     Full-text available via subscription   (Followers: 51, SJR: 0.599, CiteScore: 1)
AERA Open     Open Access   (Followers: 14)
Affilia     Hybrid Journal   (Followers: 6, SJR: 0.496, CiteScore: 1)
Africa Spectrum     Open Access   (Followers: 17)
Agrarian South : J. of Political Economy     Hybrid Journal   (Followers: 3)
Air, Soil & Water Research     Open Access   (Followers: 13, SJR: 0.214, CiteScore: 1)
Alexandria : The J. of National and Intl. Library and Information Issues     Full-text available via subscription   (Followers: 68)
Allergy & Rhinology     Open Access   (Followers: 5)
AlterNative : An Intl. J. of Indigenous Peoples     Full-text available via subscription   (Followers: 39, SJR: 0.194, CiteScore: 0)
Alternative Law J.     Hybrid Journal   (Followers: 12, SJR: 0.176, CiteScore: 0)
Alternatives : Global, Local, Political     Hybrid Journal   (Followers: 12, SJR: 0.351, CiteScore: 1)
Alternatives to Laboratory Animals     Full-text available via subscription   (Followers: 11, SJR: 0.297, CiteScore: 1)
American Behavioral Scientist     Hybrid Journal   (Followers: 26, SJR: 0.982, CiteScore: 2)
American Economist     Hybrid Journal   (Followers: 7)
American Educational Research J.     Hybrid Journal   (Followers: 259, SJR: 2.913, CiteScore: 3)
American J. of Alzheimer's Disease and Other Dementias     Hybrid Journal   (Followers: 23, SJR: 0.67, CiteScore: 2)
American J. of Cosmetic Surgery     Hybrid Journal   (Followers: 9)
American J. of Evaluation     Hybrid Journal   (Followers: 18, SJR: 0.646, CiteScore: 2)
American J. of Health Promotion     Hybrid Journal   (Followers: 35, SJR: 0.807, CiteScore: 1)
American J. of Hospice and Palliative Medicine     Hybrid Journal   (Followers: 47, SJR: 0.65, CiteScore: 1)
American J. of Law & Medicine     Full-text available via subscription   (Followers: 12, SJR: 0.204, CiteScore: 1)
American J. of Lifestyle Medicine     Hybrid Journal   (Followers: 7, SJR: 0.431, CiteScore: 1)
American J. of Medical Quality     Hybrid Journal   (Followers: 13, SJR: 0.777, CiteScore: 1)
American J. of Men's Health     Open Access   (Followers: 9, SJR: 0.595, CiteScore: 2)
American J. of Rhinology and Allergy     Hybrid Journal   (Followers: 11, SJR: 0.972, CiteScore: 2)
American J. of Sports Medicine     Hybrid Journal   (Followers: 247, SJR: 3.949, CiteScore: 6)
American Politics Research     Hybrid Journal   (Followers: 36, SJR: 1.313, CiteScore: 1)
American Review of Public Administration     Hybrid Journal   (Followers: 28, SJR: 2.062, CiteScore: 2)
American Sociological Review     Hybrid Journal   (Followers: 356, SJR: 6.333, CiteScore: 6)
American String Teacher     Full-text available via subscription   (Followers: 3)
Analytical Chemistry Insights     Open Access   (Followers: 26, SJR: 0.224, CiteScore: 1)
Angiology     Hybrid Journal   (Followers: 5, SJR: 0.849, CiteScore: 2)
Animation     Hybrid Journal   (Followers: 15, SJR: 0.197, CiteScore: 0)
Annals of Clinical Biochemistry     Hybrid Journal   (Followers: 10, SJR: 0.634, CiteScore: 1)
Annals of Otology, Rhinology & Laryngology     Hybrid Journal   (Followers: 20, SJR: 0.807, CiteScore: 1)
Annals of Pharmacotherapy     Hybrid Journal   (Followers: 58, SJR: 1.096, CiteScore: 2)
Annals of the American Academy of Political and Social Science     Hybrid Journal   (Followers: 51, SJR: 1.225, CiteScore: 3)
Annals of the ICRP     Hybrid Journal   (Followers: 4, SJR: 0.548, CiteScore: 1)
Anthropocene Review     Hybrid Journal   (Followers: 8, SJR: 3.341, CiteScore: 7)
Anthropological Theory     Hybrid Journal   (Followers: 48, SJR: 0.739, CiteScore: 1)
Antitrust Bulletin     Hybrid Journal   (Followers: 14)
Antiviral Chemistry and Chemotherapy     Open Access   (Followers: 2, SJR: 0.635, CiteScore: 2)
Antyajaa : Indian J. of Women and Social Change     Hybrid Journal   (Followers: 1)
Applied Biosafety     Hybrid Journal   (Followers: 1, SJR: 0.131, CiteScore: 0)
Applied Psychological Measurement     Hybrid Journal   (Followers: 21, SJR: 1.17, CiteScore: 1)
Applied Spectroscopy     Full-text available via subscription   (Followers: 27, SJR: 0.489, CiteScore: 2)
Armed Forces & Society     Hybrid Journal   (Followers: 25, SJR: 0.29, CiteScore: 1)
Arthaniti : J. of Economic Theory and Practice     Full-text available via subscription  
Arts and Humanities in Higher Education     Hybrid Journal   (Followers: 49, SJR: 0.305, CiteScore: 1)
Asia Pacific Media Educator     Hybrid Journal   (Followers: 1, SJR: 0.23, CiteScore: 0)
Asia-Pacific J. of Management Research and Innovation     Full-text available via subscription   (Followers: 3)
Asia-Pacific J. of Public Health     Hybrid Journal   (Followers: 15, SJR: 0.558, CiteScore: 1)
Asia-Pacific J. of Rural Development     Hybrid Journal   (Followers: 2)
Asian and Pacific Migration J.     Full-text available via subscription   (Followers: 8, SJR: 0.324, CiteScore: 1)
Asian Cardiovascular and Thoracic Annals     Hybrid Journal   (Followers: 2, SJR: 0.305, CiteScore: 0)
Asian J. of Comparative Politics     Hybrid Journal   (Followers: 5)
Asian J. of Legal Education     Full-text available via subscription   (Followers: 4)
Asian J. of Management Cases     Hybrid Journal   (Followers: 6, SJR: 0.101, CiteScore: 0)
ASN Neuro     Open Access   (Followers: 2, SJR: 1.534, CiteScore: 3)
Assessment     Hybrid Journal   (Followers: 19, SJR: 1.519, CiteScore: 3)
Assessment for Effective Intervention     Hybrid Journal   (Followers: 15, SJR: 0.578, CiteScore: 1)
Australasian J. of Early Childhood     Hybrid Journal   (Followers: 7, SJR: 0.535, CiteScore: 1)
Australasian Psychiatry     Hybrid Journal   (Followers: 18, SJR: 0.433, CiteScore: 1)
Australian & New Zealand J. of Psychiatry     Hybrid Journal   (Followers: 30, SJR: 1.801, CiteScore: 2)
Australian and New Zealand J. of Criminology     Hybrid Journal   (Followers: 546, SJR: 0.612, CiteScore: 1)
Australian J. of Career Development     Hybrid Journal   (Followers: 5)
Australian J. of Education     Hybrid Journal   (Followers: 51, SJR: 0.403, CiteScore: 1)
Australian J. of Management     Hybrid Journal   (Followers: 13, SJR: 0.497, CiteScore: 1)
Autism     Hybrid Journal   (Followers: 356, SJR: 1.739, CiteScore: 4)
Autism & Developmental Language Impairments     Open Access   (Followers: 16)
Avian Biology Research     Hybrid Journal   (Followers: 6, SJR: 0.401, CiteScore: 1)
Behavior Modification     Hybrid Journal   (Followers: 14, SJR: 0.877, CiteScore: 2)
Behavioral and Cognitive Neuroscience Reviews     Hybrid Journal   (Followers: 27)
Behavioral Disorders     Hybrid Journal   (Followers: 1)
Beyond Behavior     Hybrid Journal   (Followers: 1)
Bible Translator     Hybrid Journal   (Followers: 13)
Biblical Theology Bulletin     Hybrid Journal   (Followers: 24, SJR: 0.184, CiteScore: 0)
Big Data & Society     Open Access   (Followers: 55)
Biochemistry Insights     Open Access   (Followers: 7)
Bioinformatics and Biology Insights     Open Access   (Followers: 12, SJR: 1.141, CiteScore: 2)
Biological Research for Nursing     Hybrid Journal   (Followers: 7, SJR: 0.685, CiteScore: 2)
Biomarker Insights     Open Access   (Followers: 1, SJR: 0.81, CiteScore: 2)
Biomarkers in Cancer     Open Access   (Followers: 11)
Biomedical Engineering and Computational Biology     Open Access   (Followers: 13)
Biomedical Informatics Insights     Open Access   (Followers: 8)
Bioscope: South Asian Screen Studies     Hybrid Journal   (Followers: 4, SJR: 0.235, CiteScore: 0)
BMS: Bulletin of Sociological Methodology/Bulletin de Méthodologie Sociologique     Hybrid Journal   (Followers: 4, SJR: 0.226, CiteScore: 0)
Body & Society     Hybrid Journal   (Followers: 29, SJR: 1.531, CiteScore: 3)
Bone and Tissue Regeneration Insights     Open Access   (Followers: 2)
Brain and Neuroscience Advances     Open Access  
Brain Science Advances     Open Access  
Breast Cancer : Basic and Clinical Research     Open Access   (Followers: 12, SJR: 0.823, CiteScore: 2)
British J. of Music Therapy     Hybrid Journal   (Followers: 9)
British J. of Occupational Therapy     Hybrid Journal   (Followers: 251, SJR: 0.323, CiteScore: 1)
British J. of Pain     Hybrid Journal   (Followers: 31, SJR: 0.579, CiteScore: 2)
British J. of Politics and Intl. Relations     Hybrid Journal   (Followers: 39, SJR: 0.91, CiteScore: 2)
British J. of Visual Impairment     Hybrid Journal   (Followers: 14, SJR: 0.337, CiteScore: 1)
British J.ism Review     Hybrid Journal   (Followers: 18)
BRQ Business Review Quarterly     Open Access   (Followers: 1)
Building Acoustics     Hybrid Journal   (Followers: 4, SJR: 0.215, CiteScore: 1)
Building Services Engineering Research & Technology     Hybrid Journal   (Followers: 3, SJR: 0.583, CiteScore: 1)
Bulletin of Science, Technology & Society     Hybrid Journal   (Followers: 9)
Business & Society     Hybrid Journal   (Followers: 15)
Business and Professional Communication Quarterly     Hybrid Journal   (Followers: 9, SJR: 0.348, CiteScore: 1)
Business Information Review     Hybrid Journal   (Followers: 17, SJR: 0.279, CiteScore: 0)
Business Perspectives and Research     Hybrid Journal   (Followers: 3)
Cahiers Élisabéthains     Hybrid Journal   (Followers: 1, SJR: 0.111, CiteScore: 0)
Calcutta Statistical Association Bulletin     Hybrid Journal   (Followers: 1)
California Management Review     Hybrid Journal   (Followers: 37, SJR: 2.209, CiteScore: 4)
Canadian Association of Radiologists J.     Full-text available via subscription   (Followers: 2, SJR: 0.463, CiteScore: 1)
Canadian J. of Kidney Health and Disease     Open Access   (Followers: 8, SJR: 1.007, CiteScore: 2)
Canadian J. of Nursing Research (CJNR)     Hybrid Journal   (Followers: 15)
Canadian J. of Occupational Therapy     Hybrid Journal   (Followers: 166, SJR: 0.626, CiteScore: 1)
Canadian J. of Psychiatry     Hybrid Journal   (Followers: 28, SJR: 1.769, CiteScore: 3)
Canadian J. of School Psychology     Hybrid Journal   (Followers: 12, SJR: 0.266, CiteScore: 1)
Canadian Pharmacists J. / Revue des Pharmaciens du Canada     Hybrid Journal   (Followers: 3, SJR: 0.536, CiteScore: 1)
Cancer Control     Open Access   (Followers: 2)
Cancer Growth and Metastasis     Open Access   (Followers: 1)
Cancer Informatics     Open Access   (Followers: 4, SJR: 0.64, CiteScore: 1)
Capital and Class     Hybrid Journal   (Followers: 10, SJR: 0.282, CiteScore: 1)
Cardiac Cath Lab Director     Full-text available via subscription   (Followers: 1)
Cardiovascular and Thoracic Open     Open Access   (Followers: 1)
Career Development and Transition for Exceptional Individuals     Hybrid Journal   (Followers: 10, SJR: 0.44, CiteScore: 1)
Cartilage     Hybrid Journal   (Followers: 6, SJR: 0.889, CiteScore: 3)
Cell Transplantation     Open Access   (Followers: 5, SJR: 1.023, CiteScore: 3)
Cephalalgia     Hybrid Journal   (Followers: 8, SJR: 1.581, CiteScore: 3)
Cephalalgia Reports     Open Access   (Followers: 4)
Child Language Teaching and Therapy     Hybrid Journal   (Followers: 34, SJR: 0.501, CiteScore: 1)
Child Maltreatment     Hybrid Journal   (Followers: 11, SJR: 1.22, CiteScore: 3)
Child Neurology Open     Open Access   (Followers: 6)
Childhood     Hybrid Journal   (Followers: 19, SJR: 0.894, CiteScore: 2)
Childhood Obesity and Nutrition     Open Access   (Followers: 12)
China Information     Hybrid Journal   (Followers: 9, SJR: 0.767, CiteScore: 2)
China Report     Hybrid Journal   (Followers: 11, SJR: 0.221, CiteScore: 0)
Chinese J. of Sociology     Full-text available via subscription   (Followers: 5)
Christian Education J. : Research on Educational Ministry     Hybrid Journal   (Followers: 1)
Chronic Illness     Hybrid Journal   (Followers: 6, SJR: 0.672, CiteScore: 2)
Chronic Respiratory Disease     Hybrid Journal   (Followers: 12, SJR: 0.808, CiteScore: 2)
Chronic Stress     Open Access  
Citizenship, Social and Economics Education     Full-text available via subscription   (Followers: 6, SJR: 0.145, CiteScore: 0)
Cleft Palate-Craniofacial J.     Hybrid Journal   (Followers: 8, SJR: 0.757, CiteScore: 1)
Clin-Alert     Hybrid Journal   (Followers: 1)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 32, SJR: 0.49, CiteScore: 1)
Clinical and Translational Neuroscience     Open Access   (Followers: 1)
Clinical Case Studies     Hybrid Journal   (Followers: 3, SJR: 0.364, CiteScore: 1)
Clinical Child Psychology and Psychiatry     Hybrid Journal   (Followers: 45, SJR: 0.73, CiteScore: 2)
Clinical EEG and Neuroscience     Hybrid Journal   (Followers: 8, SJR: 0.552, CiteScore: 2)
Clinical Ethics     Hybrid Journal   (Followers: 13, SJR: 0.296, CiteScore: 1)
Clinical Medicine Insights : Arthritis and Musculoskeletal Disorders     Open Access   (Followers: 3, SJR: 0.537, CiteScore: 2)
Clinical Medicine Insights : Blood Disorders     Open Access   (Followers: 1, SJR: 0.314, CiteScore: 2)
Clinical Medicine Insights : Cardiology     Open Access   (Followers: 8, SJR: 0.686, CiteScore: 2)
Clinical Medicine Insights : Case Reports     Open Access   (Followers: 1, SJR: 0.283, CiteScore: 1)
Clinical Medicine Insights : Circulatory, Respiratory and Pulmonary Medicine     Open Access   (Followers: 4, SJR: 0.425, CiteScore: 2)
Clinical Medicine Insights : Ear, Nose and Throat     Open Access   (Followers: 2)
Clinical Medicine Insights : Endocrinology and Diabetes     Open Access   (Followers: 33, SJR: 0.63, CiteScore: 2)
Clinical Medicine Insights : Oncology     Open Access   (Followers: 3, SJR: 1.129, CiteScore: 3)
Clinical Medicine Insights : Pediatrics     Open Access   (Followers: 3)
Clinical Medicine Insights : Psychiatry     Open Access   (Followers: 10)
Clinical Medicine Insights : Reproductive Health     Open Access   (Followers: 1, SJR: 0.776, CiteScore: 0)
Clinical Medicine Insights : Therapeutics     Open Access   (Followers: 1, SJR: 0.172, CiteScore: 0)
Clinical Medicine Insights : Trauma and Intensive Medicine     Open Access   (Followers: 4)
Clinical Medicine Insights : Urology     Open Access   (Followers: 3)
Clinical Medicine Insights : Women's Health     Open Access   (Followers: 4)
Clinical Nursing Research     Hybrid Journal   (Followers: 34, SJR: 0.471, CiteScore: 1)
Clinical Pathology     Open Access   (Followers: 5)
Clinical Pediatrics     Hybrid Journal   (Followers: 25, SJR: 0.487, CiteScore: 1)
Clinical Psychological Science     Hybrid Journal   (Followers: 16, SJR: 3.281, CiteScore: 5)
Clinical Rehabilitation     Hybrid Journal   (Followers: 78, SJR: 1.322, CiteScore: 3)
Clinical Risk     Hybrid Journal   (Followers: 5, SJR: 0.133, CiteScore: 0)
Clinical Trials     Hybrid Journal   (Followers: 22, SJR: 2.399, CiteScore: 2)
Clothing and Textiles Research J.     Hybrid Journal   (Followers: 28, SJR: 0.36, CiteScore: 1)
Collections : A J. for Museum and Archives Professionals     Full-text available via subscription   (Followers: 3)
Common Law World Review     Full-text available via subscription   (Followers: 17)
Communication & Sport     Hybrid Journal   (Followers: 8, SJR: 0.385, CiteScore: 1)
Communication and the Public     Hybrid Journal   (Followers: 2)
Communication Disorders Quarterly     Hybrid Journal   (Followers: 15, SJR: 0.458, CiteScore: 1)
Communication Research     Hybrid Journal   (Followers: 24, SJR: 2.171, CiteScore: 3)
Community College Review     Hybrid Journal   (Followers: 8, SJR: 1.451, CiteScore: 1)
Comparative Political Studies     Hybrid Journal   (Followers: 291, SJR: 3.772, CiteScore: 3)
Compensation & Benefits Review     Hybrid Journal   (Followers: 8)
Competition & Change     Hybrid Journal   (Followers: 12, SJR: 0.843, CiteScore: 2)

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Similar Journals
Journal Cover
Clinical and Applied Thrombosis/Hemostasis
Journal Prestige (SJR): 0.49
Citation Impact (citeScore): 1
Number of Followers: 32  

  This is an Open Access Journal Open Access journal
ISSN (Print) 1076-0296 - ISSN (Online) 1938-2723
Published by Sage Publications Homepage  [1166 journals]
  • Iron Chelation Reduces DNA Damage in Sickle Cell Anemia

    • Authors: Rawan S. Al-Khateeb, Hanan S. Althagafy, Mohammad Zaki ElAssouli, Dunya A. Nori, Mohammed AlFattani, Salwa A. Al-Najjar, Turki Al Amri, Anwar M. Hashem, Steve Harakeh, Nawal Helmi
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Sickle cell anemia (SCA) is a blood condition that causes severe pain. One of the therapeutic agents used for the treatment of SCA is hydroxyurea, which reduces the episodes of pain but causes DNA damage to white blood cells. The aim of this study was to evaluate the efficacy of the combination of hydroxyurea and iron chelation therapy in relation to the extent of DNA-associated damage. Blood samples were collected from 120 subjects from five groups. Various hematological parameters of the obtained serum were analyzed. The amount of damage caused to their DNA was detected using the comet assay and fluorescent microscopy techniques. The percentage of DNA damage in the group that was subjected to the combination therapy (target group) was 1.32% ± 1.51%, which was significantly lower (P 
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-10-11T06:16:11Z
      DOI: 10.1177/10760296211047230
      Issue No: Vol. 27 (2021)
       
  • Primary Thrombophilia XVI: A Look at the Genotype of the Sticky Platelet
           Syndrome Phenotype

    • Authors: Elizabeth García-Villaseñor, Lorena Bojalil-Álvarez, Iván Murrieta-Álvarez, Yahveth Cantero-Fortiz, Guillermo J. Ruiz-Delgado, Guillermo J. Ruiz-Argüelles
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      The sticky platelet syndrome (SPS) was described by Mammen in 1983. Since then, scientists in several countries have identified the condition and published cases or series of patients, thus enabling the description of the prevalence of the inherited condition, its salient clinical features, and the treatment of the disease. The diagnosis of the SPS phenotype requires fresh blood samples and special equipment which is not available in all coagulation laboratories. In the era of molecular biology, up to now it has not been possible to define a clear association of the SPS phenotype with a specific molecular marker. Some molecular changes which have been described in platelet proteins in some persons with the phenotype of the SPS are here discussed. Nowadays, the SPS phenotype may be considered as a risk factor for thrombosis and most cases of the SPS developing vaso-occlussive episodes are the result of its coexistence with other thrombosis-prone conditions, some of the inherited and some of them acquired, thus leading to the concept of multifactorial thrombophilia. Ignoring all these evidence-based concepts is inappropriate, same as stating that the SPS is a nonentity simply because not all laboratories are endowed with adequate equipment to support the diagnosis.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-10-07T11:58:21Z
      DOI: 10.1177/10760296211044212
      Issue No: Vol. 27 (2021)
       
  • Effect of Statin Therapy on Diabetes Retinopathy in People With Type 2
           Diabetes Mellitus: A Meta-Analysis

    • Authors: Jun Liu, Yi-Ping Wu, Jun-Juan Qi, Zeng-Ping Yue, Cheng-Dong Hu
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Objective: We tried to find the relationship between statin and diabetes retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM). Methods: We searched the databases of PubMed, EMBASE, and the Cochrane Library for eligible studies reporting on the relationships between statin use and DR, from inception to September 25, 2020. The terms searched including Diabetes Mellitus, Type 2, Hydroxymethylglutaryl-CoA Reductase Inhibitors, and Diabetic Retinopathy. We expressed the results as the odds ratios (ORs) with 95% confidence intervals (CIs) which were calculated using a random-effects model. Results: A total of 6 eligible studies, including 43 826 patients, were included in the meta-analysis. The meta-analysis showed that statin was not associated with elevated risk of DR [OR = 0.96 (95% CI: 0.80-1.16), P = .68]. Similarly, no differences were found between statin and placebo in participants ≥500 [OR = 0.98 (95% CI: 0.80-1.21)] or participants
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-10-07T11:58:13Z
      DOI: 10.1177/10760296211040109
      Issue No: Vol. 27 (2021)
       
  • The Pre- and Postoperative Prevalence and Risk Factors of ASA Nonresponse
           in Vascular Surgery

    • Authors: Alia Uzra Kazimi, Christian Friedrich Weber, Michael Keese, Wolfgang Miesbach
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      BackgroundAn antiplatelet therapy with acetylsalicylic acid (ASA) is prescribed in the prevention of cardiovascular events, but around 24% of ASA takers are resistant to the treatment.AimIn this prospective, observational cohort study, we aimed to identify the prevalence and risk factors of ASA nonresponse in patients who underwent vascular surgery.MethodsThe study was conducted in the University hospital in Frankfurt am Main. In total, 70 patients were pre-treated with 100 mg of ASA per day and underwent either elective carotid thromboendarterectomy, femoral thromboendarterectomy or endovascular aneurysm repair of the abdominal aorta. The platelet function was measured on the first preoperative and the second or fourth postoperative day with the multiple electrode aggregometry by in-vitro stimulation with arachidonic acid (ASPItest) and thrombin receptor activating peptide 6 (TRAPtest). The primary end point was the in-vitro induced platelet aggregation in the ASPItest. If the ASPItest amounted ≥400 AU × min, the patients were categorized as ASA nonresponders.ResultsThe total prevalence of ASA nonresponse in our study was 20% preoperatively and 35.7% postoperatively (p = 0.005). As significant predictors for ASA nonresponse, we demonstrated the area under the aggregation curve in the TRAPtest preoperatively (p = 0.04) and postoperatively (p = 0.02), and the two comorbidities arterial hypertension (P 
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-10-05T04:19:26Z
      DOI: 10.1177/10760296211044723
      Issue No: Vol. 27 (2021)
       
  • Impact of the Result of Continued Thrombolysis After Stenting Following
           Pharmacomechanical Thrombectomy for Iliofemoral Deep Vein Thrombosis—A
           Retrospective Study

    • Authors: Ya-dong Zhou, Ying-ying Chen, Ming Xue, Xue-xun Zheng, Xing-sheng Chen, Yun-biao Guan
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      ObjectiveThe aim of this study is to compare the procedure and treatment outcomes of using either direct stenting alone following pharmacomechanical thrombectomy or continued catheter-directed thrombolysis after stenting for treatment of acute left iliofemoral deep vein thrombosis while clot removal degree achieved grade III.MethodsFrom March 2018 to May 2019, 82 patients who underwent iliac venous stenting for treatment of acute left iliofemoral deep vein thrombosis with iliac vein stenosis after pharmacomechanical thrombectomy therapy using the AngioJet system while Clot removal degree achieved grade III were divided into two groups: Direct stenting alone group (n = 39) and continued catheter-directed thrombolysis after stenting group (n = 43). Comparisons were made regarding the treatment outcomes, stent patency rate, and Villalta scale between these two groups.ResultsNo serious perioperative complications occurred. The mean urokinase dose and hospitalization time in the stenting alone group and continued catheter-directed thrombolysis after the stenting group were 0.30 million U versus 1.76 ± 0.54 million U and 4.85 ± 0.93 days versus 6.33 ± 1.02 days, (P 
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-10-04T03:37:49Z
      DOI: 10.1177/10760296211041169
      Issue No: Vol. 27 (2021)
       
  • Anticoagulation for COVID-19 Patients: A Bird's-Eye View

    • Authors: Firas Kreidieh, Sally Temraz
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Coronavirus disease 2019 (COVID-19) is a systemic disease that can be life-threatening involving immune and inflammatory responses, and that can result in potentially lethal complications, including venous thrombo-embolism (VTE). Forming an integrative approach to thrombo-prophylaxis and coagulation treatment for COVID-19 patients ensues. We aim at reviewing the literature for anticoagulation in the setting of COVID-19 infection to provide a summary on anticoagulation for this patient population. COVID-19 infection is associated with a state of continuous inflammation, which results in macrophage activation syndrome and an increased rate of thrombosis. Risk assessment models to predict the risk of thrombosis in critically ill patients have not yet been validated. Currently published guidelines suggest the use of prophylactic intensity over intermediate intensity or therapeutic intensity anticoagulant for patients with critical illness or acute illness related to COVID-19 infection. Critically ill COVID-19 patients who are diagnosed with acute VTE are considered to have a provoking factor, and, therefore, treatment duration should be at least 3 months. Patients with proximal deep venous thrombosis or pulmonary embolism should receive parenteral over oral anticoagulants with low-molecular-weight heparin or fondaparinux preferred over unfractionated heparin. In patients with impending hemodynamic compromise due to PE, and who are not at increased risk for bleeding, reperfusion may be necessary. Internists should remain updated on new emerging evidence regarding anticoagulation for COVID-19 patients. Awaiting these findings, we invite internists to perform individualized decisions that are unique for every patient and to base them on clinical judgment for risk assessment.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-10-01T10:24:19Z
      DOI: 10.1177/10760296211039288
      Issue No: Vol. 27 (2021)
       
  • Dengue After COVID-19 Vaccination: Possible and Might be Missed

    • Authors: Amnuay Kebayoon, Viroj Wiwanitkit
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.

      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-09-30T10:50:36Z
      DOI: 10.1177/10760296211047229
      Issue No: Vol. 27 (2021)
       
  • The Application of the ThroLy Risk Assessment Model to Predict Venous
           Thromboembolism in Patients with Diffuse Large B-Cell Lymphoma

    • Authors: Hikmat Abdel-Razeq, Mohammad Ma’koseh, Asem Mansour, Rayan Bater, Rula Amarin, Alaa Abufara, Khalid Halahleh, Mohammad Manassra, Mohammad Alrwashdeh, Mohammad Almomani, Mais Zmaily
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      BackgroundPatients with aggressive lymphomas are at higher risk for venous thromboembolism (VTE). ThroLy is a risk assessment model (RAM) derived to predict the occurrence of VTE in various types of lymphomas. In this study, we assess the clinical application of ThroLy RAM in a unified group of patients with diffuse large B-cell lymphoma (DLBCL).MethodsHospital databases were searched for patients with DLBCL and radiologically-confirmed VTE. Items in the ThroLy RAM, including prior VTE, reduced mobility, obesity, extranodal disease, mediastinal involvement, neutropenia and hemoglobin  3) ThroLy score, 22.3% developed VTE compared to 8.4% and 12.4% in those with low and intermediate risk scores, respectively (P = .014). Simplifying the ThroLy model into two risk groups; high-risk (score ≥ 3) and low risk (score
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-09-30T10:49:27Z
      DOI: 10.1177/10760296211045908
      Issue No: Vol. 27 (2021)
       
  • D-dimer Level and Diabetes in the COVID-19 Infection

    • Authors: Chaymae Miri, Hajar Charii, Mohammed-Amine Bouazzaoui, Falmata Laouan Brem, Soumia boulouiz, Naima Abda, Hatim Kouismi, Zakaria Bazid, Nabila Ismaili, Noha El Ouafi
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      IntroductionDiabetes is the most common of comorbidity in patients with SARS-COV-2 pneumonia. Coagulation abnormalities with D-dimer levels are increased in this disease.ObjectifsWe aimed to compare the levels of D-dimer in diabetic and non-diabetic patients with COVID 19. A link between D-dimer and mortality has also been established.MaterialsA retrospective study was carried out at the University Hospital Center of Oujda (Morocco) from November 01st to December 01st, 2020. Our study population was divided into two groups: a diabetic group and a second group without diabetes to compare clinical and biological characteristics between the two groups. In addition, the receiver operator characteristic curve was used to assess the optimal D-dimer cut-off point for predicting mortality in diabetics.Results201 confirmed-COVID-19-patients were included in the final analysis. The median age was 64 (IQR 56-73), and 56% were male. Our study found that D-dimer levels were statistically higher in diabetic patients compared to non-diabetic patients. (1745 vs 845 respectively, P = 0001). D-dimer level> 2885 ng/mL was a significant predictor of mortality in diabetic patients with a sensitivity of 71,4% and a specificity of 70,7%.ConclusionOur study found that diabetics with COVID-19 are likely to develop hypercoagulation with a poor prognosis.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-09-30T10:47:27Z
      DOI: 10.1177/10760296211045902
      Issue No: Vol. 27 (2021)
       
  • The Correlation Between FGB Promoter Polymorphism and Clotting Function in
           Patients With Idiopathic Lower Extremity Deep Venous Thrombosis

    • Authors: Shengbin Han, Bin Yang, Yaoyu Feng, Lingfeng Zhao, Qun Feng, Hongxi Guan, Donghui Song, Fang Yin, Li Zhuang
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      To explore the possible single nucleotide polymorphisms (SNPs) sites in the promoter region of fibrinogen B β (FGB), and construct logistic regression model and haplotype model, so as to reveal the influence of FGB promoter SNPs on susceptibility, hemodynamics and coagulation function of lower extremity deep venous thrombosis (LEDVT) in the genetic background. LEDVT patients (120) and healthy people (120) were taken as case and control objects, respectively. SNPs and their genotypes of FGB promoter were detected by promoter sequencing and PCR-RFLP. The parameters of coagulation system were evaluated. There were 6 SNPs in FGB promoter, which were β-148C/T, β-249C/T, β-455G/A, β-854G/A, β-993C/T and β-1420G/A. The genotype and allele frequency of β-1420 G/A, β-455G/A, β-249c/T and β-148C/T were significantly different between the LEDVT group and the control group, but not β-993C/T and β-854G/A. In addition, we found that the higher the content of Fibrinogen (FG), the higher the risk of LEDVT. The risk of LEDVT increased by 4.579 times for every unit increase of fibrinogen. We also found that FG, PT and APTT in LEDVT group were higher than those in control group, while TT was lower than those in control group; Furthermore, there was no significant difference in all coagulation indexes among 6 SNP genotypes in LEDVT group, while a significant difference was found between the 2 genotypes of β-993C/T in the control group. β-993C/T may indirectly affect the susceptibility of LEDVT by improving the basic level of plasma FG.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-09-29T03:22:31Z
      DOI: 10.1177/1076029620967108
      Issue No: Vol. 27 (2021)
       
  • Incidence, Outcomes and Risk Factors of Heparin-Induced Thrombocytopenia
           After Total Joint Arthroplasty: A National Inpatient Sample Database Study
           

    • Authors: Yuhang Chen, Jian Wang, Zhan-jun Shi, Yang Zhang, Qinfeng Yang, Yichuan Xu
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Backgrounds: Heparin-induced thrombocytopenia (HIT) is a severe immune-mediated complication of heparin exposure, leading to negative consequences after total hip (THA) and knee arthroplasty (TKA). Materials and Methods: A retrospective study was conducted using the National Inpatient Sample (NIS) database from 2005 to 2014. The incidence and outcomes of HIT after THA or TKA were documented. Logistic regression analysis was performed to identify the postoperative HIT risk factors. Results: A total of 59 3045 patients who underwent THA and 1228 707 patients who underwent TKA were identified. The cumulative incidences were 0.02% and 0.01%, respectively. The HIT group presented significantly higher Charlson Comorbidity Index and Elixhauser Comorbidity Index scores, longer hospital stays (LOS), and higher medical costs. HIT led to a significantly higher mortality rate after THA (2.17% vs 0.16%, P = .0091). In THA, the HIT risk factors were racial minority, AIDS, pulmonary circulation disorders (PCD), psychoses, and hypertension. In TKA, the HIT risk factors were racial minority, PCD, and weight loss. Conclusion: The incidence of HIT after THA and TKA is relatively low; however, HIT significantly increases inpatient mortality, LOS, and medical cost.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-09-24T10:56:59Z
      DOI: 10.1177/10760296211042938
      Issue No: Vol. 27 (2021)
       
  • Construction of a Risk Prediction Model for Hospital-Acquired Pulmonary
           Embolism in Hospitalized Patients

    • Authors: Lengchen Hou, Longjun Hu, Wenxue Gao, Wenbo Sheng, Zedong Hao, Yiwei Chen, Jiyu Li
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      The purpose of this study is to establish a novel pulmonary embolism (PE) risk prediction model based on machine learning (ML) methods and to evaluate the predictive performance of the model and the contribution of variables to the predictive performance. We conducted a retrospective study at the Shanghai Tenth People's Hospital and collected the clinical data of in-patients that received pulmonary computed tomography imaging between January 1, 2014 and December 31, 2018. We trained several ML models, including logistic regression (LR), support vector machine (SVM), random forest (RF), and gradient boosting decision tree (GBDT), compared the models with representative baseline algorithms, and investigated their predictability and feature interpretation. A total of 3619 patients were included in the study. We discovered that the GBDT model demonstrated the best prediction with an area under the curve value of 0.799, whereas those of the RF, LR, and SVM models were 0.791, 0.716, and 0.743, respectively. The sensibilities of the GBDT, LR, RF, and SVM models were 63.9%, 68.1%, 71.5%, and 75%, respectively; the specificities were 81.1%, 66.1, 72.7%, and 65.1%, respectively; and the accuracies were 77.8%, 66.5%, 72.5%, and 67%, respectively. We discovered that the maximum D-dimer level contributed the most to the outcome prediction, followed by the extreme growth rate of the plasma fibrinogen level, in-hospital duration, and extreme growth rate of the D-dimer level. The study demonstrates the superiority of the GBDT model in predicting the risk of PE in hospitalized patients. However, in order to be applied in clinical practice and provide support for clinical decision-making, the predictive performance of the model needs to be prospectively verified.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-09-24T10:54:43Z
      DOI: 10.1177/10760296211040868
      Issue No: Vol. 27 (2021)
       
  • Dysregulation Serum miR-19a-3p is a Diagnostic Biomarker for Asymptomatic
           Carotid Artery Stenosis and a Promising Predictor of Cerebral Ischemia
           Events

    • Authors: Xiaoliang Liu, Xiaojun Zheng, Ying Wang, Juan Liu
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      This study aims to identify the diagnostic potential of microRNA-19a-3p (miR-19a-3p) for asymptomatic carotid artery stenosis (CAS) and clinical predictive potential for cerebral ischemia events (CIEs). Serum samples from 101 asymptomatic CAS patients and 98 healthy controls were collected. And it was found that serum miR-19a-3p in asymptomatic CAS patients was generally elevated (P 
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-09-24T10:54:25Z
      DOI: 10.1177/10760296211039287
      Issue No: Vol. 27 (2021)
       
  • The Comparison of Therapeutic Efficacy Between Dabigatran Versus Warfarin
           in Patients With Nonvalvular Atrial Fibrillation

    • Authors: Hongxia Li, Lei Zhang, Ming Xia, Chi Zhang, Tingbo Jiang
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      BackgroundNovel oral anticoagulants and warfarin are widely used for stroke prevention in patients with atrial fibrillation. The anticoagulation status of patients receiving warfarin or rivaroxaban has been studied. In this study, we aimed to evaluate the effect of dabigatran and warfarin on preventing thrombin generation (TG).MethodsThis retrospective study enrolled 237 nonvalvular atrial fibrillation (NVAF) subjects treated with 110 mg dabigatran etexilate twice daily and 224 NVAF patients received adjusted-dose warfarin (international normalized ratio [INR] of 2 to 3)). Coagulation assays, prothrombin fragment 1  +  2 (F1+2), calibrated automated thrombogram, and thrombin–antithrombin complex (TAT) were detected at the steady state.ResultsActivated partial thromboplastin time (APTT), antithrombin III activity, fibrinogen, and lag time showed no difference between the two groups. Compared to the dabigatran group, prothrombin time and INR values were higher in the warfarin group (all P 
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-09-24T03:57:25Z
      DOI: 10.1177/10760296211044722
      Issue No: Vol. 27 (2021)
       
  • Novel Drug Interaction index and Risk of Mortality in Older Patients With
           Atrial Fibrillation Receiving Non Vitamin K Oral Anticoagulants (NOEL
           Drug)

    • Authors: İbrahim Ersoy
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Drug interactions with novel oral anticoagulants (NOACs) may decrease their advantages. We aimed to explore the drug interaction rates with NOACs and impacts of drug interaction index (DII) on mortality among older patients with atrial fibrillation (AF). In this retrospective cohort study, we enrolled 704 eligible patients aged 65≤ with AF between January 1, 2018 and December 30, 2019 in a tertiary outpatient cardiology clinic. We recorded demographic, clinical characteristics, and medications for the last 3 months. At the end of the evaluation visit (March 1, 2020), death events and dates were recorded. All medications were checked for drug interactions using Lexicomp® software. Each drug interaction was annotated according to risk grade. Moreover, we determined a new index ratio of C/D/X classes to total interactions called DII. The mean age was 75.19  ±  7.13 and 398 (56%) were male. Death events were observed in 106 (15%) patients. A total of 9883 drugs were analyzed for drug interactions. The majority of drug interactions were in class A (80.7%). Clinically relevant interactions were 14.6% (Class C/D/X). The area under receiver operating characteristic curve was 0.704 (95% confidence interval: 0.653-0.754) and 0.167 cutoff value (68.9% sensitivity and 80.2% specificity [3.11 positive likelihood ratio]) for DII to predict mortality. This study showed an overview of the NOACs interactions in older patients with AF. Additionally, the inappropriate NOAC dose and DII showed an association with mortality. NOAC treatment should be guided by drug interaction applications to reduce mortality.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-09-20T12:14:09Z
      DOI: 10.1177/10760296211038685
      Issue No: Vol. 27 (2021)
       
  • Concern About the Adverse Effects of Thrombocytopenia and Thrombosis After
           Adenovirus-Vectored COVID-19 Vaccination

    • Authors: MA Haimei
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Since the outbreak of Covid-19 in December, 2019, scientists worldwide have been committed to developing COVID-19 vaccines. Only when most people have immunity to SARS-CoV-2, COVID-19 can reduce even wholly overcome. So far, nine kinds of COVID-19 vaccines have passed the phase III clinical trials and have approved for use. At the same time, adverse reactions after COVID-19 vaccination have also reported. This paper focuses on the adverse effects of thrombosis and thrombocytopenia caused by the COVID-19 vaccine, especially the adenovirus-vector vaccine from AstraZeneca and Pfizer, and discusses its mechanism and possible countermeasures.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-09-20T11:29:18Z
      DOI: 10.1177/10760296211040110
      Issue No: Vol. 27 (2021)
       
  • Association Between the Change of Coagulation Parameters and Clinical
           Prognosis in Acute Ischemic Stroke Patients After Intravenous Thrombolysis
           With rt-PA

    • Authors: Yu Wang, Jia Zhang, Zhentang Cao, Qian Zhang, Xingquan Zhao
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Acute ischemic stroke patients with intravenous (IV) recombinant tissue plasminogen activator (rt-PA) thrombolysis have different outcomes. The degree of thrombolysis depends largely on the delicate balance of coagulation and fibrinolysis. Thus, our study aimed to investigate the prognostic value of routine coagulation parameters in acute stroke patients treated with rt-PA. From December 2016 to October 2018, consecutive patients treated with standard-dose IV rt-PA within 4.5 h of stroke onset were collected in Beijing Tiantan Hospital. Routine coagulation parameters, including platelet count, mean platelet volume, platelet distribution width, prothrombin time (PT), activated partial thromboplastin time, thrombin time, and fibrinogen, were measured at baseline (h0) and 24 h (h24) after thrombolysis. The change of coagulation parameters was defined as the (h24-h0)/h0 ratio. The prognosis included short-term outcome at 24 h and functional outcome at 3 months. A total of 267 patients were investigated (188 men and 79 women) with a mean age of 60.88  ± 12.31 years. In total, 9 patients had early neurological deterioration within 24 h, and 99 patients had an unfavorable outcome at the 3-month visit. In multivariate logistic regression, the (h24-h0)/h0 of PT was associated with unfavorable functional outcomes at 3 months (odds ratio: 1.42, 95% confidence interval: 1.02-2.28). While the change of other coagulation parameters failed to show any correlation with short-term or long-term prognosis. In conclusion, the prolongation of PT from baseline to 24 h after IV rt-PA increases the risk of 3-month unfavorable outcomes in acute stroke patients.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-09-20T11:27:58Z
      DOI: 10.1177/10760296211039285
      Issue No: Vol. 27 (2021)
       
  • Retrospective Comparison of Andexanet Alfa and 4-Factor Prothrombin
           Complex for Reversal of Factor Xa-Inhibitor Related Bleeding

    • Authors: Victoria M. Stevens, Toby C. Trujillo, Tyree H. Kiser, Robert MacLaren, Paul M. Reynolds, Scott W. Mueller
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      The aim of this retrospective study was to compare andexanet alfa and 4-factor prothrombin complex (4F-PCC) for reversal of factor Xa (FXa)-inhibitor bleeding. Patients that received andexanet alfa for reversal were included. An equivalent number of patients administered 4F-PCC for FXa-inhibitor bleeding were randomly selected as historical controls. The primary outcome was effective hemostasis achievement within 12 h, defined using ANNEXA-4 criteria. Thromboembolic events and mortality within 30 days were also evaluated. A total of 32 patients were included. Baseline characteristics were not statistically different between andexanet alfa (n = 16) and 4F-PCC (n = 16). Intracranial bleeding was the primary reversal indication in 43.8% versus 62.5% of patients, respectively. Effective hemostasis was reached in 75.0% of andexanet alfa patients compared to 62.5% of 4F-PCC patients (P = .70). Thromboembolic events occurred in 4 (25.0%) patients and 3 (18.8%) patients, respectively (P = .99). Mortality incidence was 12.5% and 31.3%, respectively (P = .39). Andexanet alfa and 4F-PCC attained hemostasis in a majority of patients. A high, but a similar rate of thromboembolic events was seen with both treatments. Prospective studies are needed to elucidate comparative risks and benefits of the 2 agents.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-09-20T11:26:58Z
      DOI: 10.1177/10760296211039020
      Issue No: Vol. 27 (2021)
       
  • Meta-analysis of Different Pressing Time on the Incidence of Subcutaneous
           Hemorrhage of Low Molecular Weight Heparin Administration

    • Authors: Juan Fang, Gefeng Pan, Xufei Bao, Yanhong Wang
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      To investigate the effect of different pressing time on the incidence of subcutaneous hemorrhage of low molecular weight heparin (LMWH) administration by meta-analysis. Cochrane Library, PubMed, MEDLINE, CINAHL, EMbase, Springer, EBSCO, China Biomedical Literature Database, CNKI, Wanfang Database, and VIP Database were searched. To screen the literature of randomized controlled trials with different pressing time in patients with subcutaneous LMWH injection from the establishment of the database to December 2020. The quality of the literature was evaluated and the data were extracted. Meta-analysis was performed by RevMan 5.3. A total of 17 randomized controlled trials were included. Meta-analysis showed that the bleeding rate of pressing for 5 min odds ratio (OR  =  3.89, 95% confidence interval [CI]: 2.68-5.64, P 
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-09-20T11:25:55Z
      DOI: 10.1177/10760296211038682
      Issue No: Vol. 27 (2021)
       
  • Safety, Efficacy of an Accelerated Regimen of Low-Dose Recombinant
           Tissue-Type Plasminogen Activator for Reperfusion Therapy of Acute
           Pulmonary Embolism

    • Authors: Bui Hai Hoang, Phuc Giang Do, Lac Duy Le, Thao Thi Huong Bui, Thinh Nghia Bui, Quan Minh Nguyen, Duong Hoang To, Anh Dat Nguyen, Michael M. Dinh, Samuel Z. Goldhaber, Richard Day, Hieu Lan Nguyen
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Controversy persists regarding the safety and efficacy of an accelerated low-dose recombinant tissue-type plasminogen activator (rt-PA) regimen for reperfusion therapy in acute pulmonary embolism. This study describes the outcomes of an accelerated low-dose rt-PA regimen for the treatment of acute pulmonary embolism in Vietnamese patients. This was a case series from October 2014 to October 2020 from 9 hospitals across Vietnam. Patients presenting with acute pulmonary embolism with high to intermediate mortality risk were administered alteplase 0.6 mg per kilogram (maximum of 50 mg) over 15 min. The main outcomes were the proportion who survived to hospital discharge and at 3 months as well as in-hospital hemorrhage (major and minor according to International Society of Thrombosis and Hemhorrage definitions). A total of 80 patients were enrolled: 48 (60%) with high risk for mortality and 32 patients (40%) with intermediate risk for mortality. A total of 7 (8.8%) died in hospital. All deaths occurred in the high-risk mortality group. The 73 patients who were discharged alive remained alive at 3 months follow up. During hospitalization, 1 patient (1.3%) suffered major bleeding, and 7 (8.8%) had minor bleeding. An accelerated thrombolytic regimen with alteplase 0.6 mg/kg (maximum of 50 mg) over 15 min for acute pulmonary embolism appeared be effective and safe in a case series of Vietnamese patients.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-09-13T12:03:03Z
      DOI: 10.1177/10760296211037920
      Issue No: Vol. 27 (2021)
       
  • Safety Interval From Increased Viscosity After COVID-19 Vaccination Among
           Persons With Cerebrovascular Problems

    • Authors: Rujittika Mungmunpuntipantip, Viroj Wiwanitkit
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.

      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-09-09T11:56:09Z
      DOI: 10.1177/10760296211039015
      Issue No: Vol. 27 (2021)
       
  • Risk Factors of Thromboembolism in Lymphoma Patients Undergoing
           Chemotherapy and its Clinical Significance

    • Authors: Xiao Li, Shu-Ling Hou, Xi Li, Li Li, Ke Lian, Ju-Ya Cui, Gang-Gang Wang, Tao Yang
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      This study investigated the risk factors of thromboembolism (TE) in lymphoma patients undergoing chemotherapy and its clinical significance. A total of 304 lymphoma patients who received chemotherapy from January 2012 to July 2019 were retrospectively analyzed, including 111 patients with and 193 patients without TE. The clinical characteristics and related laboratory test results were compared between the 2 groups using univariate analysis, while the risk factors for TE in lymphoma patients undergoing chemotherapy were analyzed using multivariate logistic regression analysis. Univariate analysis revealed an increase in the risk of TE among lymphoma patients with chemotherapy in the following categories: female patients, patients with body mass index 24, patients aged ≥60 years, those with platelet abnormality before chemotherapy, single hospital-stay patients, and Ann Arbor stage III/IV patients. Multivariate logistic regression analysis revealed that for platelet count abnormality before chemotherapy, Ann Arbor stage III/IV and female patients represented independent risk factors for TE among lymphoma patients after chemotherapy (P 
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-09-09T11:55:19Z
      DOI: 10.1177/10760296211037923
      Issue No: Vol. 27 (2021)
       
  • Combined Effect of MTHFR C677T and PAI-1 4G/5G Polymorphisms on the Risk
           of Venous Thromboembolism in Chinese Lung Cancer Patients

    • Authors: Baoyan Wang, Peijuan Xu, Qing Shu, Simin Yan, Hang Xu
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Venous thromboembolism (VTE) is a common and potentially fatal complication in cancer patients. Although several genetic risk factors related to thrombophilia have been identified, their contributions for the occurrence of VTE in cancer patients have conflicting results. The aim of this study was to evaluated the gene polymorphisms of methylenetetrahydrofolate reductase (MTHFR) C677T and plasminogen activator inhibitor-1 (PAI-1) 4G/5G in lung cancer patients, with and without VTE, and the combined effect on the risk of VTE. 92 lung cancer patients diagnosed with VTE (VTE group) and 122 lung cancer patients without VTE (non-VTE group) were enrolled in the study. The gene polymorphisms were analyzed by the method of polymerase chain reaction-restriction fragment length polymorphism. Gene mutation of factor V Leiden was not detected both in non-VTE group and VTE group. The frequency of MTHFR C677T homozygous mutation in VTE group was 25.00%, higher than that in the non-VTE group without statistical difference. It was found that the PAI-1 4G4G genotype is associated with a higher risk of VTE (OR: 2.62, 95%CI: 1.19-5.75). Interestingly, the interaction between MTHFR C677T and PAI-1 4G/5G polymorphisms showed that the coexistence of the 2 homozygous mutation could further increase the risk of VTE. In conclusion, PAI-1 4G/5G polymorphism may be an increased risk factor for VTE among lung cancer patients in Chinese population. The homozygous MTHFR C677T mutation may be not a risk factor for VTE but increases the risk, accompanied with PAI-1 4G5G genotype.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-07-30T08:54:16Z
      DOI: 10.1177/10760296211031291
      Issue No: Vol. 27 (2021)
       
  • Diagnostic and Prognostic Significance of miR-675-3p in Patients With
           Atherosclerosis

    • Authors: Shuangquan Wang, Wei Shao, Yang Gao, Hongwei Zhao, Deyong Du
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      In recent years, a rising number of studies have confirmed that microRNA (miRNA) plays a prominent role in the early diagnosis and prognostic value assessment of cardiovascular diseases. The current study was conducted to examine the expression of miR-675-3p in atherosclerosis (AS) patients and to evaluate its clinical diagnosis and prognostic value. 110 AS patients and 70 healthy controls were included in the study. Serum miR-675-3p levels were detected by quantitative real-time PCR (qRT-PCR). The clinical diagnostic significance of serum miR-675-3p in AS patients were investigated by the receiver operating characteristic (ROC) curve. The correlation between miRNA and carotid intima-media thickness (CIMT) was analyzed by the Spearman correlation coefficient. The prognostic significance of serum miR-675-3p was evaluated by the Kaplan-Meier method and Cox regression analysis. The patient’s serum miR-675-3p was significantly increased than the healthy individuals (P < 0.05). An increase of carotid intima-media thickness (CIMT) was positively correlated with the promotion of serum miR-675-3p levels. The area under the ROC curve (AUC) was 0.918, with high sensitivity and specificity. miR-675-3p is a key independent predictor of cardiovascular adverse events in AS patients (HR = 5.375, 95%CI = 1.590-18.170, P = 0.007), and patients with elevated miR-675-3p were more likely to have cardiovascular adverse events (log-rank P = 0.030). Increased miR-675-3p can be used as a potential marker for the diagnosis of AS, and was associated with the poor prognosis of AS.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-07-29T09:01:13Z
      DOI: 10.1177/10760296211024754
      Issue No: Vol. 27 (2021)
       
  • The Perioperative Deep Vein Thrombosis in Lower Extremities in Patients
           With Pelvic Fracture: A Case-Control Study

    • Authors: Yun Yan, Baobao Zhang, Jie Yang, Yan Zhang, Lei Zhang, Dan Wang, Jing Gao, Lianzhi He, Pengfei Wang, Yan Zhuang, Kun Zhang, Ping Liu
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      This study was to investigate the incidences of DVT in lower extremities after pelvic fracture before and after operation, and explore the risk factors. The records of patients with pelvic fractures receiving operation were collected. The patients were examined by preoperative and postoperative ultrasonography, and divided into thrombosis group and non-thrombosis group according to the preoperative and postoperative ultrasonographic results. Totally, 128 patients with pelvic fractures were included in this study. The incidence of DVT was 21.09% preoperatively, and increased to 35.16% postoperatively. Peripheral DVT constituted 92.60% and 86.67% of preoperative and postoperative DVTs, respectively. The results showed that age (odds ratio [OR] = 1.07; 95% CI: 1.01-1.12; P = 0.013), fracture classification (OR = 3.80; 95% CI: 1.31-11.00; P = 0.014) and D-dimer at admission (OR = 1.04; 95% CI: 1.00-1.08; P = 0.029) were independent risk factors of preoperative DVT, and female (OR = 0.21; 95% CI: 0.06-0.81; P = 0.023) was independent protective factor. In addition, age (OR, 1.06; 95% CI, 1.00-1.11; P = 0.026), operative blood transfusion (OR, 1.34; 95% CI, 1.05-1.72; P = 0.020) were independent risk factors of postoperative DVT. In conclusion, the DVT prevention strategy has not changed the high incidence of DVT in pelvic fractures, and orthopedic surgeons should pay more attention to perioperative DVT. When a male or patient with Tile-C type pelvic fracture is at admission, it is should be reminded that the screening the DVT in lower extremities. In addition, the surgeon should stanch bleeding completely, to reduce the blood transfusion and formation of DVT.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-07-26T09:39:43Z
      DOI: 10.1177/10760296211033024
      Issue No: Vol. 27 (2021)
       
  • The Association of Coagulation Indicators and Coagulant Agents With 30-Day
           Mortality of Critical Diabetics

    • Authors: Yingxin Huang, Zhihua Zhong, Fanna Liu
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Diabetes, regarded as a global health concerned disease, was focused by the World Health Organization (WHO). Patients with diabetes may have a hypercoagulable and hypo-fibrinolysis state. There is lots of research about cardiovascular effects on diabetes patients, but less about the coagulation system. This study is designed to investigate the relationship between coagulation indicators and 30-day mortality of critical diabetes patients. In this retrospective, single-center study, we included adult patients diagnosed with diabetes. Data, including demographic, complication, laboratory tests, scoring system, and anticoagulant treatment, were extracted from Medical Information Mart for Intensive Care (MIMIC-III). The receiver operating characteristic (ROC) curve and Kaplan-Meier curve were applied to predict the association of mortality and coagulation indicators. Cox hazard regression model and subgroup analysis were used to analyze the risk factors associated with 30-day mortality. A total of 4026 patients with diabetes mellitus were included in our study, of whom 3312 survived after admitted to the hospital and 714 died. Cox hazard regression showed anticoagulant therapy might decrease the risk of 30-day mortality after adjusted. In age 16.3 s, a high level of hypo-coagulation state, increase risk of mortality (HR, 95%CI, 0.756 (0.574, 0.996), 1.756 (1.129, 2.729)). Critical diabetes patients may benefit from anticoagulant agents. The abnormal coagulant function is related to the risk of 30-day mortality.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-07-22T09:26:32Z
      DOI: 10.1177/10760296211026385
      Issue No: Vol. 27 (2021)
       
  • Reduced Activity of Protein S in Plasma: A Risk Factor for Venous
           Thromboembolism in the Japanese Population

    • Authors: Xiuri Jin, Sachiko Kinoshita, Hiroyuki Kuma, Tomohide Tsuda, Tatsusada Yoshida, Dongchon Kang, Naotaka Hamasaki
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      The quantitative assay of protein S can help in rapidly identifying carriers of abnormal protein S molecules through a simple procedure (by determining the total protein S mass, total protein S activity, and protein S-specific activity in blood), without genetic testing. To clarify the relationship between venous thromboembolism (VTE) and protein S-specific activity, and its role in the diagnosis of thrombosis in Japanese persons, the protein S-specific activity was measured and compared between patients with thrombosis and healthy individuals. The protein S-specific activity of each participant was calculated from the ratio of total protein S activity to total protein S antigen level. Plasma samples were collected from 133 healthy individuals, 57 patients with venous thrombosis, 118 patients with arterial thrombosis, and 185 non-thrombotic patients. The protein S-specific activity of one-third of the patients with VTE was below the line of Y = 0.85X (−2 S.D.). Most protein S activities in the plasma of non-thrombotic patients were near the Y = X line, as observed in healthy individuals. In conclusion, it was clearly shown that monitoring protein S activity and protein S-specific activity in blood is useful for predicting the onset and preventing venous thrombosis in at least the Japanese population.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-07-21T09:32:42Z
      DOI: 10.1177/10760296211033908
      Issue No: Vol. 27 (2021)
       
  • Mild Acquired Factor XIII Deficiency and Clinical Relevance at the ICU—A
           Retrospective Analysis

    • Authors: Felix Carl Fabian Schmitt, Maik von der Forst, Wolfgang Miesbach, Sebastian Casu, Markus Alexander Weigand, Sonja Alesci
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Acquired FXIII deficiency is a relevant complication in the perioperative setting; however, we still have little evidence about the incidence and management of this rarely isolated coagulopathy. This study aims to help find the right value for the substitution of patients with an acquired mild FXIII deficiency. In this retrospective single-center cohort study, we enrolled critically ill patients with mild acquired FXIII deficiency (>5% and ≤70%) and compared clinical and laboratory parameters, as well as pro-coagulatory treatments. The results of the present analysis of 104 patients support the clinical relevance of FXIII activity out of the normal range. Patients with lower FXIII levels, beginning at
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-07-21T09:31:42Z
      DOI: 10.1177/10760296211024741
      Issue No: Vol. 27 (2021)
       
  • The Prognostic Value of a Derived Neutrophil-Lymphocyte Ratio in Patients
           With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
           

    • Authors: Wenjun Fan, Ying Zhang, Xiuxin Gao, Yixiang Liu, Fei Shi, Jingyi Liu, Lixian Sun
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      The systemic immune-inflammatory index (SII) and derived neutrophil-lymphocyte ratio (dNLR) are novel indexes that simultaneously reflect the host inflammatory and immune status and have prognostic value in some cancers. SII was associated with major cardiovascular events in coronary artery disease patients who received percutaneous coronary intervention (PCI). However, dNLR correlations with clinical outcomes in acute coronary syndrome (ACS) patients undergoing PCI remain unclear. This study aimed to elucidate the predictive values of SII and dNLR on the long-term prognosis of patients with ACS undergoing PCI. In total, 1,553 ACS patients undergoing PCI were consecutively enrolled from January 2016 to December 2018. The subjects were divided into high and low SII and dNLR groups for comparison (high vs. low). The SII and dNLR cutoff values for predicting major adverse cardiovascular events (MACE) were calculated using receiver operating characteristic curves, and Kaplan-Meier curves and Cox regression models were used for survival analyses. The endpoint was a MACE, which included all-cause mortality and rehospitalization for severe heart failure during follow-up. The Kaplan-Meier curves showed that a higher SII or dNLR value was associated with a higher risk of MACE (all P < 0.001). Multivariate Cox regression models showed that SII (hazard ratio [HR]: 2.545; 95% confidence interval [CI]: 1.416-4.574; P = 0.002) and dNLR (HR: 2.610, 95% CI: 1.454-4.685, P = 0.001) were independent predictors for MACE. dNLR may be a suitable laboratory marker to identify high-risk ACS patients after PCI.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-07-21T09:13:05Z
      DOI: 10.1177/10760296211034579
      Issue No: Vol. 27 (2021)
       
  • Age Is Associated With the Efficacy of Anticoagulant Therapies Against
           Sepsis-Induced Disseminated Intravascular Coagulation

    • Authors: Kyosuke Takahashi, Yutaka Umemura, Kazuma Yamakawa, Hiroshi Ogura, Takeshi Shimazu
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Disseminated Intravascular Coagulation (DIC) commonly complicates sepsis and considerably worsens mortality. Recent studies suggested that anticoagulant therapies improved mortality only in specific sepsis populations, and key pathologies for selecting optimal targets needed to be identified. Anticoagulant activities were naturally altered with aging. This study aimed to evaluate age-related differences in efficacy of anticoagulant therapies in sepsis. This post hoc analysis of a nationwide multicenter cohort study was conducted in 42 intensive care units in Japan. Adult patients with septic DIC were divided into anticoagulant and control groups. Age-related changes in predicted mortality in both groups were compared using a logistic regression model including 2-way interaction terms. Patients were also stratified into 3 subsets based on age, and propensity score-adjusted Cox regression analyses were conducted to examine survival effect of anticoagulants in each subset. We included 1432 patients with septic DIC; 867 patients received anticoagulants and 565 received none. Age-related change in predicted mortality was significantly different between groups (P for interaction = 0.013), and the gap between groups was broad in the younger population. Similarly, in Cox regression analyses, anticoagulant therapies were associated with significantly lower mortality in the subsets of age ≤ 60 and 60-79 (hazard ratios = 0.461, 0.617, P = 0.007, 0.005, respectively), whereas there was no difference in survival between the groups in the subsets of age ≥ 80. The efficacy of anticoagulant therapies for septic DIC might be associated with patient age.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-07-19T09:52:52Z
      DOI: 10.1177/10760296211033030
      Issue No: Vol. 27 (2021)
       
  • Scavenger Receptor BI Induced by HDL From Coronary Heart Disease May Be
           Related to Atherosclerosis

    • Authors: Fen Gao, Gao-jie Feng, Hong Li, Wei-wei Qin, Chuan-shi Xiao
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      This study aims to determine whether dysfunctional High Density Lipoprotein (HDL) influenced the expression of scavenger receptor class B type Ⅰ (SR-B1) to determine reverse cholesterol transport. Blood samples obtained from coronary heart disease patients confirmed by angiography were collected. HDL was extracted from the blood via ultracentrifugation. Then, the HDL was injected into apoE−/− mice, and the HepG2 cells cultured with Dulbecco’s modified eagle medium (DMEM) were added the HDL extracted from coronary heart disease patients. As controls, normal cases without coronary heart disease (CHD) and patients with angina pectoris and acute myocardial infarction were used. The protein expression levels of SR-B1 were detected by western blot, and the lipid accumulation levels were detected by Oil Red O staining in both tissues and cell levels. These results revealed that the HDL obtained from CHD patients downregulate the SR-B1 expression in ex vitro and in vitro studies. In addition, dysfunctional HDL may result in lower SR-B1 expression levels. The degree of SR-B1 expression levels could be relative to the degree of coronary congestion. Along with the increase in severe coronary congestion, such as myocardial infarction, the SR-B1 expression levels were lower. The dysfunctional HDL derived from coronary heart disease patients decreased the expression of SR-B1, and promoted lipid accumulation.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-07-13T09:09:05Z
      DOI: 10.1177/10760296211029710
      Issue No: Vol. 27 (2021)
       
  • Assessment of Coagulation and Hemostasis Biomarkers in a Subset of
           Patients With Chronic Cardiovascular Disease

    • Authors: Maureen J. Miller, Cheryl L. Maier, Alexander Duncan, Jeannette Guarner
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Measurement of a single marker of coagulation may not provide a complete picture of hemostasis activation and fibrinolysis in patients with chronic cardiovascular diseases. We assessed retrospective orders of a panel which included prothrombin fragment 1.2 (PF1.2), thrombin: antithrombin complexes, fibrin monomers, and D-dimers in patients with heart assist devices, cardiomyopathies, atrial fibrillation and intracardiac thrombosis (based on ordering ICD-10 codes). During 1 year there were 117 panels from 81 patients. Fifty-six (69%) patients had heart assist devices, cardiomyopathy was present in 17 patients (21%) and 29 patients (36%) had more than 1 condition. PF1.2 was most frequently elevated in patients with cardiomyopathy (61.1%) compared to those with cardiac assist devices (15.7%; P = 0.0002). D-dimer elevation was more frequent in patients with cardiac assist devices (98.8%) compared to those patients with cardiomyopathy (83.3%; P = 0.014). Patients with cardiomyopathy show increases of PF1.2 suggesting thrombin generation. In contrast, elevations of D-dimers without increase in other coagulation markers in patients with cardiac assist devices likely reflect the presence of the intravascular device and not necessarily evidence of hemostatic activation.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-07-08T09:17:39Z
      DOI: 10.1177/10760296211032292
      Issue No: Vol. 27 (2021)
       
  • Neutrophil Gelatinase-Associated Lipocalin as an Early Predictor of
           Contrast-Induced Nephropathy Following Endovascular Aortic Repair for
           Abdominal Aortic Aneurysm

    • Authors: Lubin Li, Juan Shao, Wenqiang Niu, Haijie Che, Fubo Song, Guolong Liu, Shaoying Lu
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      To investigate serum neutrophil gelatinase-associated lipocalin (sNGAL) and urine neutrophil gelatinase-associated lipocalin (uNGAL) as early predictors of contrast-associated acute kidney injury(contrast-induced nephropathy)following endovascular aortic repair for abdominal aortic aneurysm. Prospective cohort study. Subjects included 202 consecutive patients with abdominal aortic aneurysm diagnosed between February 2016 and October 2018. We divided the patients into 2 groups: contrast-induced nephropathy (CIN) (n = 26) and non-CIN (n = 176). We assessed correlations between sNGAL and uNGAL concentrations and standard renal markers at baseline, 6, 24, and 48 hours post-procedure. We constructed conventional receiver operating characteristic (ROC) curves and calculated the area under the curve to assess SCr, eGFR, sNGAL, and uNGAL performance. We derived biomarker cutoff levels from ROC analysis results to maximize sensitivity and specificity values. The CIN incidence within our cohort was 12.9%. sNGAL levels correlated significantly with SCr and eGFR at baseline, 6, and 24 hours post-contrast medium exposure. Similarly, uNGAL levels correlated with SCr and estimated glomerular filtration rate (eGFR) at baseline, 6, and 24 hours post-exposure. sNGAL and uNGAL were significantly elevated as early as 6 hours post-endotherapy in the CIN group; there were only minor changes in the non-CIN group. SCr was also significantly elevated in the CIN group, but not until 48 hours post-catheterization. Both sNGAL and uNGAL may be more accurate than SCr and eGFR as early biomarkers of CIN in patients with abdominal aortic aneurysm undergoing endovascular therapy.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-07-08T09:12:26Z
      DOI: 10.1177/10760296211025618
      Issue No: Vol. 27 (2021)
       
  • Evaluation of Deep Vein Thrombosis Risk Factors After Arthroscopic
           Posterior Cruciate Ligament Reconstruction: A Retrospective Observational
           Study

    • Authors: Pu Ying, Wenge Ding, Xiaowei Jiang, Yue Xu, Yi Xue, Qiang Wang, Lei Zhu, Xiaoyu Dai
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      We evaluated the risk factors of deep venous thrombosis (DVT) after knee arthroscopic posterior cruciate ligament (PCL) reconstruction in patients with only PCL injury. From August 2014 to December 2020, a total of 172 patients who had accepted knee arthroscopic PCL reconstruction underwent the color Doppler ultrasound of bilateral lower-extremities deep veins on 3 days postoperatively. Based on the inspection results, patients were divided into DVT group (18 males and 8 females, mean age 43.62 years) and non-DVT group (108 males and 38 females, mean age 33.96 years). The potential associations of DVT risk and age, gender, body mass index (BMI), diabetes, hypertension, smoking and other factors were analyzed. An old age (OR = 1.090; 95% CI = 1.025-1.158; P = 0.006), a high BMI (OR = 1.509; 95% CI = 1.181-1.929; P = 0.001) and an increased post-surgery D-dimer (OR = 5.034; 95% CI = 2.091-12,117; P ≤ 0.001) value were significantly associated with an elevated DVT risk after knee arthroscopic PCL reconstruction. Increased age, BMI, and postoperative D-dimer were risk factors of DVT following knee arthroscopic PCL reconstruction in patients with only PCL injury.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-06-30T10:12:51Z
      DOI: 10.1177/10760296211030556
      Issue No: Vol. 27 (2021)
       
  • Relationship Between Polymorphism of Thrombin-Activatable Fibrinolysis
           Inhibitor Gene +1040C/T and a Cohort of Chinese Women With Recurrent
           Spontaneous Abortion

    • Authors: Ping Fang, Decheng Cai, Lijun Du, Fei Shen, Chengfang Zhang, Meijuan Li
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      The balance between coagulation and fibrinolysis is essential for a successful pregnancy. This study aimed to explore the genetic variant of +1040C/T in the coding region of thrombin-activatable fibrinolysis inhibitor (TAFI) gene in women with recurrent spontaneous abortion (RSA) and in unrelated healthy controls and to investigate the possible association between TAFI +1040C/T polymorphism and RSA. Peripheral blood samples were collected from 137 Chinese patients with RSA and 103 unrelated healthy Chinese controls. The TAFI +1040C/T polymorphism was analyzed using SNaPshot SNP typing after DNA extraction. The frequency of the C allele was lower in RSA patients compared with the controls (0.78 vs 0.84). A subanalysis of the TAFI +1040C/T polymorphism in the 2 populations of RSA women (groups 2RSA and>2RSA) showed that the +1040CT genotype was significantly higher and the +1040CC genotype was significantly lower than from that found in controls. The allele +1040C was associated with a reduced risk of RSA in both group 2RSA (OR = 0.418, 95%CI, 0.255-0.685) and group>2RSA (OR = 0.473, 95%CI, 0.274-0.819) compared with controls. Our data indicate a protective role for TAFI +1040C allele against RSA, and may be associated with the genetic susceptibility of RSA.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-06-30T10:12:12Z
      DOI: 10.1177/10760296211029720
      Issue No: Vol. 27 (2021)
       
  • Acetylsalicylic Acid and COVID-19 Prevention: A Comment

    • Authors: Pathum Sookaromdee, Viroj Wiwanitkit
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.

      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-06-30T09:19:00Z
      DOI: 10.1177/10760296211027660
      Issue No: Vol. 27 (2021)
       
  • Prediction and Diagnosis of Venous Thromboembolism Using Artificial
           Intelligence Approaches: A Systematic Review and Meta-Analysis

    • Authors: Qi Wang, Lili Yuan, Xianhui Ding, Zhiming Zhou
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Venous thromboembolism (VTE) is a fatal disease and has become a burden on the global health system. Recent studies have suggested that artificial intelligence (AI) could be used to make a diagnosis and predict venous thrombosis more accurately. Thus, we performed a meta-analysis to better evaluate the performance of AI in the prediction and diagnosis of venous thrombosis. PubMed, Web of Science, and EMBASE were used to identify relevant studies. Of the 741 studies, 12 met the inclusion criteria and were included in the meta-analysis. Among them, 5 studies included a training set and test set, and 7 studies included only a training set. In the training set, the pooled sensitivity was 0.87 (95% CI 0.79-0.92), the pooled specificity was 0.95 (95% CI 0.89-0.97), and the area under the summary receiver operating characteristic (SROC) curve was 0.97 (95% CI 0.95-0.98). In the test set, the pooled sensitivity was 0.87 (95% CI 0.74-0.93), the pooled specificity was 0.96 (95% CI 0.79-0.99), and the area under the SROC curve was 0.98 (95% CI 0.97-0.99). The combined results remained significant in the subgroup analyzes, which included venous thrombosis type, AI type, model type (diagnosis/prediction), and whether the period was perioperative. In conclusion, AI may aid in the diagnosis and prediction of venous thrombosis, demonstrating high sensitivity, specificity and area under the SROC curve values. Thus, AI has important clinical value.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-06-29T09:45:53Z
      DOI: 10.1177/10760296211021162
      Issue No: Vol. 27 (2021)
       
  • Genetic and Clinical Predictors of Left Atrial Thrombus: A Single Center
           Case-Control Study

    • Authors: Adrian Springer, Ruben Schleberger, Florian Oyen, Boris A. Hoffmann, Stephan Willems, Christian Meyer, Florian Langer, Renate B. Schnabel, Paulus Kirchhof, Reinhard Schneppenheim, Marc D. Lemoine
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Left atrial (LA) thrombus formation is the presumed origin of thromboembolic complications in patients with atrial fibrillation (AF). Beyond clinical risk factors, the factors causing formation of LA thrombi are not well known. In this case-control study, we analyzed clinical characteristics and genetic thrombophilia markers (factor V Leiden (FVL), prothrombin G20210A (FIIV), Tyr2561 variant of von Willebrand factor (VWF-V)) in 42 patients with AF and LA thrombus (LAT) and in 68 control patients with AF without LAT (CTR). Patients with LAT had more clinical conditions predisposing to stroke (mean CHA2DS2-VASc-score 3.4 ± 1.5 vs. 1.9 ± 1.4; P < 0.001), a higher LA volume (96 ± 32 vs. 76 ± 21 ml, P = 0.002) and lower LA appendage emptying velocity (0.21 ± 0.11vs. 0.43 ± 0.19 m/s, P < 0.001). Prevalence of FVL, FIIV and VWF-V mutations was not different, but in the subgroup of patients
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-06-29T09:31:30Z
      DOI: 10.1177/10760296211021171
      Issue No: Vol. 27 (2021)
       
  • Rotational Thromboelastometry Reveals Distinct Coagulation Profiles for
           Patients With COVID-19 Depending on Disease Severity

    • Authors: Mehmet Gökhan Gönenli, Zeynep Komesli, Said İncir, Özlem Yalçın, Olga Meltem Akay
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Identifying a hypercoagulable state in patients with COVID-19 may help identify those at risk for virus–induced thromboembolic events and improve clinical outcomes using personalized therapeutic approaches. Herein, we aimed to perform a global assessment of the patients’ hemostatic system with COVID-19 using rotational thromboelastometry (ROTEM) and to describe whether patients with different disease severities present different coagulation profiles. Together with 37 healthy volunteers, a total of 65 patients were included and then classified as having mild, moderate, and severe disease depending on clinical severity. Peripheral blood samples were collected and analyzed using a ROTEM Coagulation Analyzer. Also, complete blood count and coagulation parameters including prothrombin time, activated partial thromboplastin time, fibrinogen levels, and D-dimer levels were measured at admission. EXTEM and INTEM MCF (P < 0.001) values were significantly higher and the EXTEM CFT (P = 0.002) value was significantly lower in patients with COVID-19 when compared with controls. In particular, patients with the severe disease showed a significant decrease in CFT (P < 0.001) and an increase in MCF (P < 0.001) in both INTEM and EXTEM assays compared with patients with the non-severe disease. Correlation analysis revealed significant correlations between ROTEM parameters and other coagulation parameters. There were significant positive correlations between fibrinogen, D-dimer, platelet count, and MCF in both EXTEM and INTEM assays. Our data demonstrate thromboelastographic signs of hypercoagulability in patients with COVID-19, which is more pronounced in patients with increased disease severity. Therefore, ROTEM analysis can classify subsets of patients with COVID-19 at significant thrombotic risk and assist in clinical decisions.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-06-29T09:30:37Z
      DOI: 10.1177/10760296211027653
      Issue No: Vol. 27 (2021)
       
  • Clinical Features of COVID-19 Patients With Venous Thromboembolism

    • Authors: Kai Liang, Ying Fu, Yi Kang, Huanzhang Shao, Jianxu Yang, Mingzhe Cui, Shuiting Zhai
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      This study aimed to assess the clinical features of coronavirus disease 2019 (COVID-19) patients with VTE, to help develop preventive measures for venous thromboembolism (VTE in COVID-19) cases. COVID-19 patients admitted to Henan Provincial People’s Hospital were retrospectively analyzed, including 23, 4 and 8 cases with mild to moderate, severe and critical symptoms, respectively. VTE incidence, age at onset, relevant laboratory parameters and prognosis were analyzed. Overall, VTE incidence in the 35 patients was 20.0%, occurring in severe (n = 1) and critical (n = 6) cases. D-dimer showed statistical significance in laboratory examination, representing except a diagnostic index and especial can be a prognostic factor in VTE among COVID-19 patients. Severe and critical COVID-19 cases had significantly reduced platelet counts, with a risk of hemorrhage. During treatment, the risk of both hemorrhage and thrombosis should be considered. VTE occurs in COVID-19 cases, affecting individuals with severe and critical symptoms. Significant D-dimer increase is of great significance in the risk assessment of death in critical cases of COVID-19. Appropriate measures should be taken to prevent VTE during treatment.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-06-25T09:20:13Z
      DOI: 10.1177/10760296211013104
      Issue No: Vol. 27 (2021)
       
  • Increased Risk of e-Thrombosis in e-Life Era

    • Authors: Ufuk Demirci, Elif Gülsüm Ümit, Ahmet Muzaffer Demir
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.

      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-06-22T09:10:20Z
      DOI: 10.1177/10760296211028282
      Issue No: Vol. 27 (2021)
       
  • National Trends for Peripheral Artery Disease and End Stage Renal Disease
           From the National Inpatient Sample Database

    • Authors: Frank De Stefano, Luis H. Paz Rios, Brian Fiani, Jawed Fareed, Alfonso Tafur
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Peripheral artery disease (PAD), and subsequent chronic limb-threatening ischemia (CLTI), are frequently encountered among patients with end-stage renal disease (ESRD). Their coexistence is less favorable in comparison to patients with ESRD alone. We sought to investigate trends, comorbidities, determinants for cost, and prognostic outcomes in patients with concomitant ESRD and PAD. A retrospective analysis was performed using data from the National Inpatient Sample database from the years 2005-2014. ICD-9 codes were used to identify patients with diagnoses of PAD, CLTI, and ESRD. Pearson’s Chi-square, T-test, ANOVA, and multivariate binary logistic regression were used in this analysis. 7,214,843 patients with ESRD were identified. Of these, 123,499 patients were diagnosed with PAD and 102,447 with CLTI. Compared to ESRD alone, mortality rates increased with PAD and CLTI (5.7% vs. 13.9% vs. 15.9%, P < 0.001). Length of stay in days (7.3 vs. 10.2 vs. 11.1, P < 0.001) and in-hospital costs (59,872 vs. 85,866 vs. 89,016, P < 0.001) were higher with PAD and CLTI, respectively. CLTI demonstrated the highest independent predictor of mortality [OR = 6.93 (6.43-7.46), P < 0.001]. A decreasing trend in the rate of PAD (2005: 1.9% vs. 2014: 1.4%, P < 0.001) and CLTI (2005: 1.6% vs. 2014: 1.1%, P < 0.001) was noted. The presence of coexisting PAD, and furthermore CLTI, in patients with ESRD significantly raised in-hospital mortality, cost, and length of stay. A negative trend in rates of PAD and CLTI were observed. Proactive identification of this high-risk population may lead to accurate diagnosis and tailored therapeutic strategies.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-06-21T09:44:50Z
      DOI: 10.1177/10760296211025625
      Issue No: Vol. 27 (2021)
       
  • Timing of Endovascular Interventions for Iliac Vein Compression Syndrome
           With Thrombus

    • Authors: Wenxu Jin, Guanfeng Yu, Jingyong Huang, Kangkang Lu, Chongqing Huang
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      The aim of this study is to explore the timing and method of endovascular intervention for iliac vein compression syndrome (IVCS) with thrombus. Data from 111 patients with IVCS, complicated acute deep vein thrombosis (DVT), or post-thrombotic syndrome (PTS) who underwent endovascular interventions were analyzed retrospectively. Patients were divided into Group A (DVT group), including 56 patients with IVCS and iliofemoral DVT, with or without femoropopliteal DVT, with sudden lower limb swelling, and Group B (PTS group) included 55 patients with IVCS and PTS, including 18 with lower extremity wet ulcers and 32 with lower limb infections. Interventional therapies were used to treat the thrombus and eliminate stenosis and occlusion of the iliac vein. In both groups, clinical symptoms in the lower limbs after surgery were reduced significantly, and PTS incidence was low during long-term follow-up. The cumulative patency rate was 75.2% in the DVT group and 88.6% in the PTS group. Comprehensive interventional therapies are safe and effective in patients with IVCS and thrombi. Long-term efficacy in the PTS group tended to be better than that in the DVT group.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-06-21T09:44:17Z
      DOI: 10.1177/10760296211026974
      Issue No: Vol. 27 (2021)
       
  • Evaluation of Bleeding Rate and Time in Therapeutic Range in Patients
           Using Warfarin Before and During the COVID-19 Pandemic—Warfarin
           Treatment in COVID-19

    • Authors: Zeynep Yapan Emren, Oktay Şenöz, Ahmet Erseçgin, Sadık Volkan Emren
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      The treatment process of patients using warfarin is expected to be hindered during the COVID-19 pandemic. Therefore we investigated whether the time in therapeutic range (TTR) and bleeding complications were affected during the COVID-19 pandemic. 355 patients using warfarin were included between March 2019 to March 2021. Demographic parameters, INR (international normalized ratio), and bleeding rates were recorded retrospectively. The TTR value was calculated using Rosendaal’s method. The mean age of the patients was 61 ± 12 years and 55% of them were female. The mean TTR value during the COVID-19 pandemic was lower than the pre-COVID-19 period (56 ± 21 vs 68 ± 21, P < 0.001). Among the patients, 41% had a lack of outpatient INR control. During the COVID-19 pandemic, 71 (20%) patients using VKA suffered bleeding. Among patients with bleeding, approximately 60% did not seek medical help and 6% of patients performed self-reduction of the VKA dose. During the COVID-19 pandemic, TTR values have decreased with the lack of monitoring. Furthermore, the majority of patients did not seek medical help even in case of bleeding.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-06-18T09:51:57Z
      DOI: 10.1177/10760296211021495
      Issue No: Vol. 27 (2021)
       
  • Expected Viscosity After COVID-19 Vaccination, Hyperviscosity and Previous
           COVID-19

    • Authors: Beuy Joob, Viroj Wiwanitkit
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.

      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-06-18T09:49:25Z
      DOI: 10.1177/10760296211020833
      Issue No: Vol. 27 (2021)
       
  • Case Study of Pediatric Cerebral Sinus Venous Thrombosis Center of a Low
           Middle-Income Country

    • Authors: Bushra Moiz, Ronika Devi Ukrani, Aiman Arif, Inaara Akbar, Muhammed Wahhaab Sadiq, Sadaf Altaf
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Pediatric cerebral venous sinus thrombosis (CVST) is rare but a potentially fatal disease requiring its understanding in local setting. In this study, we observed the clinical course, management, and outcome of pediatric patients with sinus thrombosis in a tertiary care center at Pakistan. Patients between age 0 to 18 years of both genders diagnosed with sinus thrombosis during 2011 to 2020 were included. Data was collected through in-house computerized system and SPSS version 19 was used for analysis. Of 143492 pediatric admissions, 32 (21 males and 11 females) patients with a median (IQR) age of 4.5 years (0-16) had CVST. This is equivalent to 18.5 CVST events per million pediatric admissions. Adolescents were mostly affected, and the overall mortality was 7%. Primary underlying disorders were infections (59%), hematological neoplasms (12.5%), thrombotic thrombocytopenic purpura (3%) and antiphospholipid syndrome (3%). Activated protein C resistance (44%) was the most common inherited thrombophilia. Twenty-one (66%) patients were anemic with a mean (±SD) hemoglobin of 9.0 g/dL (±2.3). Regression analysis showed a positive association of anemia with multiple sinus involvement (P-value 0.009) but not with duration of symptoms (P-value 0.344), hospital stay (P-value 0.466), age (P-value 0.863) or gender (P-value 0.542) of the patients. SARS-COV2 was negative in patients during 2020. Adolescents were primarily affected by sinus thrombosis and infections was the predominant risk factor for all age groups, with a low all-cause mortality. A high index of clinical suspicion is required for prompt diagnosis and intervention.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-06-17T09:14:23Z
      DOI: 10.1177/10760296211022847
      Issue No: Vol. 27 (2021)
       
  • Predictors of Venous Thromboembolism in Patients With Testicular Germ Cell
           Tumors: A Retrospective Study

    • Authors: Hikmat Abdel-Razeq, Faris Tamimi, Rashid Abdel-Razeq, Samer Salah, Zaid Omari, Osama Salama, Alaa Abufara, Abdalla Al-Tell, Hanna Qahoush, Ahmad Nasman, Ayat Taqash, Yazan Alhalaseh, Rayan Bater
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Malignancy, including testicular tumors, significantly increases the risk of venous thromboembolism (VTE). In this study, we search for predictors that may help identify subgroups of patients at higher risk of VTE. Patients with confirmed diagnosis of testicular germ cell tumor and proven VTE were identified. Clinical and pathological features possibly associated with VTE were reviewed. A total of 322 patients, median age (range) 31 (18-76) years were identified. Tumors were mostly non-seminoma (n = 194, 60.2%), node-positive (n = 130, 40.4%) and 58 (18.0%) had metastatic disease at diagnosis. Venous thromboembolism were confirmed in 27 (8.4%) patients; however, rates were significantly higher (P < 0.001) in patients with node-positive (18.5%), metastatic disease (22.4%), and those with high lactate dehydrogenase (LDH) (21.3%). Rates were also significantly higher among those who received multiple lines of chemotherapy (27.5%) compared to those who received one line (13.8%) or none (
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-06-14T09:12:58Z
      DOI: 10.1177/10760296211024756
      Issue No: Vol. 27 (2021)
       
  • Efficacy and Safety of Bioabsorbable Bone Hemostatic Agent in Total Knee
           Arthroplasty: A Prospective Randomized Controlled Trial

    • Authors: Jong-Keun Kim, Du Hyun Ro, Sang-Min Han, Myung Chul Lee, Hyuk-Soo Han
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Although a bioabsorbable bone hemostatic agent (BBHA) was developed approximately 20 years ago to overcome the shortcomings of conventional bone wax, its bleeding control capacity has not yet been studied. This study was aimed at investigating the efficacy and safety of BBHA in total knee arthroplasty (TKA). Sixty-two patients who underwent unilateral primary TKA for knee osteoarthritis were included and randomized to the control or BBHA group. Before releasing the tourniquet, BBHA was applied on the bone-cut surface that was not covered by implants. The primary variable was the drainage volume during the postoperative period. The secondary outcomes were total estimated blood loss (EBL), hemoglobin level, hematocrit level, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, range of motion (ROM), pain visual analog scale (VAS) score, and rate of complications. There were no significant differences in drainage volume or EBL between the 2 groups. Hemoglobin and hematocrit levels were higher in the BBHA group during the 4-week postoperative period; however, the intergroup differences were not significant. The ESR, CRP, ROM, and pain VAS scores in the BBHA group were not significantly different from the corresponding values in the control group. No specific complications were observed. Although BBHA was found to be safe without complications, it did not decrease bleeding after TKA in general cases. Further studies are necessary to evaluate the efficacy of BBHA in patients with coagulation problems.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-06-11T09:49:40Z
      DOI: 10.1177/10760296211023589
      Issue No: Vol. 27 (2021)
       
  • Venous Thromboembolism Prophylaxis in Underweight Hospitalized Patients

    • Authors: Douglas Buckheit, Amanda Lefemine, Diana M. Sobieraj, Laura Hobbs
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      There is limited evidence about optimal anticoagulant dosing for venous thromboembolism (VTE) prophylaxis in underweight patients. The purpose of this study was to characterize dosing strategies used in underweight patients and compare the incidence of bleeding and VTE to patients receiving a standard dose. This multi-center retrospective study evaluated medicine patients who weighed 45 kilograms or less and received VTE prophylaxis with unfractionated heparin or enoxaparin. We categorized subjects into groups as either standard or reduced dose and compared the incidence of bleeding and VTE between groups. Of the 300 patients included in the outcome analysis, 40.7% received a reduced dose regimen, most often enoxaparin 30 mg daily. Standard dose was associated with major bleeding compared with reduced dose, when adjusted for age, gender and admission hemoglobin (odds ratio 4.73, 95% confidence interval 1.05 to 21.34). Incidence of clinically relevant non-major bleeding (2.4% vs. 1.1%) and VTE (0.6% vs. 0%) were similar between groups. Anticoagulant dose reduction for VTE prophylaxis in underweight hospitalized medicine patients is common practice and associated with less major bleeding.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-06-03T09:12:52Z
      DOI: 10.1177/10760296211018752
      Issue No: Vol. 27 (2021)
       
  • Critical Analysis of Apixaban Dose Adjustment Criteria

    • Authors: Anh Vu, Tao T. Qu, Rachel Ryu, Shuktika Nandkeolyar, Alan Jacobson, Lisa T. Hong
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Apixaban is indicated for the prevention of ischemic stroke in non-valvular atrial fibrillation (NVAF), as well as for the prevention and treatment of venous thromboembolism (VTE). Dose adjustment is based on age, weight, and serum creatinine in NVAF, while there are no recommended adjustment criteria for VTE. Such adjustment is unconventional compared to other commonly used medications. The objective of this manuscript is to critically analyze each apixaban dosing adjustment criterion and its associated outcomes. PubMed articles from March 2013 to March 2020 were selected with search terms “apixaban,” and “dose adjustment,” “adjustment,” or “adjustment criteria.” Pharmacokinetic studies demonstrated increased apixaban exposure in patients>65 years of age, those with extreme body weights, and those with advanced renal impairment, though post-hemodialysis dosing may off-set the elevated apixaban exposure. However, clinical data show that among patients>75 years,
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-06-02T09:18:16Z
      DOI: 10.1177/10760296211021158
      Issue No: Vol. 27 (2021)
       
  • An Update on the Pathogenesis of COVID-19 and the Reportedly Rare
           Thrombotic Events Following Vaccination

    • Authors: Bulent Kantarcioglu, Omer Iqbal, Jeanine M. Walenga, Bruce Lewis, Joseph Lewis, Charles A. Carter, Meharvan Singh, Fabio Lievano, Alfonso Tafur, Eduardo Ramacciotti, Grigoris T. Gerotziafas, Walter Jeske, Jawed Fareed
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Today the coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has become a global health problem. After more than a year with the pandemic, although our knowledge has progressed on COVID-19, there are still many unknowns in virological, pathophysiological and immunological aspects. It is obvious that the most efficient solution to end this pandemic are safe and efficient vaccines. This manuscript summarizes the pathophysiological and thrombotic features of COVID-19 and the safety and efficacy of currently approved COVID-19 vaccines with an aim to clarify the recent concerns of thromboembolic events after COVID-19 vaccination. The influx of newer information is rapid, requiring periodic updates and objective assessment of the data on the pathogenesis of COVID-19 variants and the safety and efficacy of currently available vaccines.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-06-01T09:24:29Z
      DOI: 10.1177/10760296211021498
      Issue No: Vol. 27 (2021)
       
  • Investigation of the Optimal Dose aPCC in Reversing the Effect of Factor
           Xa Inhibitors—An In Vitro Study

    • Authors: Nina Haagenrud Schultz, Jawed Fareed, Pål Andre Holme
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Factor (F) Xa inhibitors are safe and effective alternatives to warfarin. There are concerns about the lack of a reversal strategy in case of serious bleeds or need for emergency surgery in situations when the antidote andexanet alfa is not available. Factor concentrates are widely used, but there are few clinical studies regarding the reversal effect of activated prothrombin complex concentrate (aPCC). Because of the feared thrombogenicity, administration of the lowest effective dose would be desirable. To determine the lowest concentration of aPCC sufficient to reverse the effect of rivaroxaban and apixaban. Blood from 18 healthy volunteers were supplemented with apixaban or rivaroxaban. aPCC was added to obtain 10 different concentrations ranging from 0.08-1.60 U/mL. Thromboelastometry and thrombin generation assay were used to assess the reversal effect. aPCC concentrations of 0.08 and 0.16 U/mL restored thromboelastometry clotting time to baseline in apixaban (P = 1.0) and rivaroxaban (P = 1.0)-containing samples, respectively. The concentrations 0.08 U/mL (P = 0.5) and 0.24 U/mL (P = 0.2) were sufficient to restore thrombin generation. Concentrations of 0.56 U/mL and higher, caused significantly higher ETP than baseline in apixaban-containing samples (P < 0.05). aPCC concentrations lower than previously reported were effective in reversing the effect of FXa inhibitors in vitro.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-06-01T09:17:24Z
      DOI: 10.1177/10760296211021156
      Issue No: Vol. 27 (2021)
       
  • Slounase, a Batroxobin Containing Activated Factor X Effectively Enhances
           Hemostatic Clot Formation and Reducing Bleeding in Hypocoagulant
           Conditions in Mice

    • Authors: Reheman Adili, Madeline Jackson, Livia Stanger, Xiangrong Dai, Mandy Li, Benjamin Xiaoyi Li, Michael Holinstat
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Uncontrolled bleeding associated with trauma and surgery is the leading cause of preventable death. Batroxobin, a snake venom-derived thrombin-like serine protease, has been shown to clot fibrinogen by cleaving fibrinopeptide A in a manner distinctly different from thrombin, even in the presence of heparin. The biochemical properties of batroxobin and its effect on coagulation have been well characterized in vitro. However, the efficacy of batroxobin on hemostatic clot formation in vivo is not well studied due to the lack of reliable in vivo hemostasis models. Here, we studied the efficacy of batroxobin and slounase, a batroxobin containing activated factor X, on hemostatic clot composition and bleeding using intravital microcopy laser ablation hemostasis models in micro and macro vessels and liver puncture hemostasis models in normal and heparin-induced hypocoagulant mice. We found that prophylactic treatment in wild-type mice with batroxobin, slounase and activated factor X significantly enhanced platelet-rich fibrin clot formation following vascular injury. In heparin-treated mice, batroxobin treatment resulted in detectable fibrin formation and a modest increase in hemostatic clot size, while activated factor X had no effect. In contrast, slounase treatment significantly enhanced both platelet recruitment and fibrin formation, forming a stable clot and shortening bleeding time and blood loss in wild-type and heparin-treated hypocoagulant mice. Our data demonstrate that, while batroxobin enhances fibrin formation, slounase was able to enhance hemostasis in normal mice and restore hemostasis in hypocoagulant conditions via the enhancement of fibrin formation and platelet activation, indicating that slounase is more effective in controlling hemorrhage.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-05-28T09:12:25Z
      DOI: 10.1177/10760296211018510
      Issue No: Vol. 27 (2021)
       
  • Spotlight on Adenovirus-Based Vaccines and Rare Thrombotic Events

    • Authors: Salvatore Chirumbolo
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.

      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-05-26T09:54:51Z
      DOI: 10.1177/10760296211020829
      Issue No: Vol. 27 (2021)
       
  • Increased Levels of Platelets and Endothelial-Derived Microparticles in
           

    • Authors: Aleksandra Lenart-Migdalska, Leszek Drabik, Magdalena Kaźnica-Wiatr, Lidia Tomkiewicz-Pająk, Piotr Podolec, Maria Olszowska
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      It is known that atrial fibrillation (AF) is associated with the procoagulant state. Several studies have reported an increase of circulating microparticles in AF, which may be linked to a hypercoagulable state, atrial thrombosis and thromboembolism. We evaluated in our study alterations in both platelet (PMP, CD42b) and endothelial-derived (EMP, CD144) microparticle levels on anticoagulant therapy with rivaroxaban in nonvalvular AF. After administration of rivaroxaban, PMP levels were increased (median, [IQR] 35.7 [28.8-47.3] vs. 48.4 [30.9-82.8] cells/µL; P = 0.012), along with an increase in EMP levels (14.6 [10.0-18.6] vs. 18.3 [12.9-37.1] cells/µL, P < 0.001). In the multivariable regression analysis, the independent predictor of post-dose change in PMPs was statin therapy (HR −0.43; 95% CI −0.75,−0.10, P = 0.011). The post-dose change in EMPs was also predicted by statin therapy (HR −0.34; 95% CI −0.69, −0.01, P = 0.046). This study showed an increase in both EMPs and PMPs at the peak plasma concentration of rivaroxaban. Statins have promising potential in the prevention of rivaroxaban-related PMP and EMP release. The pro-thrombotic role of PMPs and EMPs during rivaroxaban therapy requires further study.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-05-25T09:13:15Z
      DOI: 10.1177/10760296211019465
      Issue No: Vol. 27 (2021)
       
  • The Evaluation of Hemostatic Abnormalities Using a CWA-Small Amount Tissue
           Factor Induced FIX Activation Assay in Major Orthopedic Surgery Patients

    • Authors: Masahiro Hasegawa, Shine Tone, Hideo Wada, Yohei Naito, Takeshi Matsumoto, Yoshiki Yamashita, Motomu Shimaoka, Akihiro Sudo
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      We analyzed the utility for a clot waveform analysis (CWA) of small tissue factor induced FIX activation (sTF/FIXa) assay in patients with major orthopedic surgery (including total hip arthroplasty [THA] and total knee arthroplasty [TKA]) receiving edoxaban for the prevention of venous thromboembolism (VTE). The sTF/FIXa assay using recombinant human TF in platelet-rich plasma (PRP) and platelet-poor plasma (PPP) was performed using a CWA in the above patients to monitor the efficacy of edoxaban administration. Of 147 patients (109 THA and 38 TKA), 21 exhibited deep vein thrombosis (DVT), and 15 had massive bleeding. Increased peak heights of the CWA-sTF/FIX were observed in almost patients after surgery and prolonged peak heights of the CWA-sTF/FIX were observed in almost patients treated with edoxaban. The peak heights and times of the CWA-sTF/FIX were significantly higher and shorter, respectively, in PRP than in PPP. There were no significant differences in parameters of the CWA-sTF/FIXa between the patients with and without DVT or between those with and without massive bleeding. The peak time of CWA-sTF/FIXa were significantly longer in TKA patients than in THA patients on day 1 after surgery. The second derivative peak height of the CWA-sTF/FIXa was significantly lower in TKA patients than in THA patients on day 4. The CWA-sTF/FIX reflected hemostatic abnormalities after surgery and the administration of edoxaban, and the results were better in PRP than PPP. Further studies separately analyzing the THA and TKA subgroups should be conducted.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-05-24T09:32:10Z
      DOI: 10.1177/10760296211012094
      Issue No: Vol. 27 (2021)
       
  • Prophylactic Anticoagulation With Intermediate-Dose Certoparin in
           Vascular-Risk Pregnancies—The PACER-VARP Registry

    • Authors: Martin Grünewald, Esther Häge, Stephanie Lehnert, Christiane Maier, Alexandra Schimke, Peter Bramlage, Martina Güth
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      The management of pregnant women at increased risk of thromboembolic/other vascular events is still a matter of debate. In a single-center, retrospective, observational trial, we analyzed the safety and efficacy of prophylactic anticoagulation with certoparin in pregnant women at intermediate- or high-risk by EThIG criteria of thromboembolic/other vascular events. Subcutaneous certoparin 8,000 IU once daily was administered immediately after pregnancy confirmation and continued for 6 weeks postpartum. We investigated 74 pregnancies (49 women; mean age 31.8 years; weight 77.3 kg). Most prevalent risk factors were factor V Leiden mutation (40.5%), thrombogenic factor II mutation (12.2%) and protein S deficiency (8.1%). In 76 control pregnancies prior to registry inclusion/without anticoagulation there were 14 cases [18.4%] of venous thromboembolism (between week 7 gestation and week 8 postpartum); 63.2% pregnancies resulted in abortion (median week 8.6 gestation). With certoparin anticoagulation, thromboembolism was 1.4%, exclusively non-major bleeding was 4.1% and abortion was 10.8%. One case of pre-eclampsia necessitating obstetric intervention occurred. Prophylactic anticoagulation with intermediate-dose certoparin throughout pregnancies at increased venous vascular risk was safe and effective.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-05-24T09:30:49Z
      DOI: 10.1177/10760296211016550
      Issue No: Vol. 27 (2021)
       
  • Evaluation of the Safety and Efficacy of a Novel Thrombin Containing
           Combination Hemostatic Powder Using a Historical Control

    • Authors: Brian A. Bruckner, William D. Spotnitz, Erik Suarez, Matthias Loebe, Uy Ngo, Daniel L. Gillen, Roberto J. Manson
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      This clinical study compares 2 hemostatic agents, a novel combination powder (CP) (HEMOBLAST™ Bellows) and an established polysaccharide starch powder (PP) (Arista™ AH) to assess the usefulness of CP. Retrospective comparative analysis of CP (July 2018 to July 2019, 68 patients) to PP (January 2011 to January 2013, 94 patients) in cardiothoracic patients was performed using linear regression models adjusting for age, sex, and procedure type for the endpoints: blood loss; protamine to skin closure time (hemostasis time); chest tube output and blood products required 48 hours postoperatively; ICU stay; postoperative comorbidities; and 30 day mortality. 162 patients (108 M: 54 F) underwent 162 cardiothoracic surgical procedures including: transplantation (n = 44), placement of ventricular assist device (n = 87), and others (n = 31). Use of CP compared to PP (Estimated Mean Difference [95% CI], P-value) produced significant reductions: blood loss (mL) (−886.51 [−1457.76, −312.26], P = 0.003); protamine to skin closure time (min) (−16.81 [−28.03, −5.59], P = 0.004); chest tube output (48 hrs, mL) (−445.76 [−669.38, −222.14], P < 0.001); packed red blood cell transfusions (units) (−0.98 [−1.56, −0.4], P = 0.001); and postoperative comorbidities (−0.31 [−0.55, −0.07], P = 0.012). There were no differences in the ICU stay (4.07 [−2.01, 10.15], P = 0.188) or 30-day mortality (0.57 [0.20, 1.63], P = 0.291). The use of CP in complex cardiothoracic operations resulted in improved hemostasis and significant clinical benefits in blood loss, transfusion requirements, morbidity, and time in operating room.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-05-24T07:23:02Z
      DOI: 10.1177/10760296211017238
      Issue No: Vol. 27 (2021)
       
  • Thrombotic Events in COVID-19: Inquires About the Deleterious Procoagulant
           Effect of Corticosteroid Therapy

    • Authors: Radu Crisan-Dabija, Alexandru Burlacu
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.

      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-05-21T09:39:45Z
      DOI: 10.1177/10760296211020139
      Issue No: Vol. 27 (2021)
       
  • Biomarkers of Thrombo-Inflammatory Responses in Pulmonary Embolism
           Patients With Pre-Existing Versus New-Onset Atrial Fibrillation

    • Authors: Dimpi Patel, Amir Darki, Debra Hoppensteadt, Iman Darwish, Mushabbar Syed, Yevgeniy Brailovsky, Jawed Fareed
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Pulmonary embolism (PE) patients have an increased prevalence and incidence of atrial fibrillation (AF). Because comorbid AF increases risk of morbidity and mortality, we sought to investigate the role of thrombo-inflammatory biomarkers in risk stratifying patients who experience an acute PE episode. Study participants were enrolled from a Pulmonary Embolism Response Team (PERT) registry between March 2016 and March 2019 at Loyola University Medical Center and Gottlieb Memorial Hospital. This cohort was divided into 3 groups: PE patients with a prior diagnosis of AF (n = 8), PE patients with a subsequent diagnosis of AF (n = 11), and PE patients who do not develop AF (n = 71). D-dimer, CRP, PAI-1, TAFIa, FXIIIa, A2A, MP, and TFPI were profiled using the ELISA method. All biomarkers were significantly different between controls and PE patients (P < 0.05). Furthermore, TFPI was significantly elevated in PE patients who subsequently developed AF compared to PE patients who did not develop AF (157.7 ± 19.0 ng/mL vs. 129.0 ± 9.3 ng/mL, P = 0.0386). This study suggests that thrombo-inflammatory biomarkers may be helpful in indicating an acute PE episode. Also, elevated TFPI levels may be associated with an increased risk of developing AF after a PE.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-05-20T09:21:06Z
      DOI: 10.1177/10760296211014964
      Issue No: Vol. 27 (2021)
       
  • Association of Plasma Fibrinogen and Thromboelastography With Blood Loss
           in Complex Cardiac Surgery

    • Authors: Eline A. Vlot, Eric P.A. van Dongen, Laura M. Willemsen, Jur M. ten Berg, Christian M. Hackeng, Stephan A. Loer, Peter G. Noordzij
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Postoperative coagulopathic bleeding is common in cardiac surgery and is associated with increased morbidity and mortality. Ideally, real-time information on in-vivo coagulation should be available. However, up to now it is unclear which perioperative coagulation parameters can be used best to accurately identify patients at increased risk of bleeding. The present study analyzed the associations of perioperative fibrinogen concentrations and whole blood viscoelastic tests with postoperative bleeding in 89 patients undergoing combined cardiac surgery procedures. Postoperative bleeding was recorded until 24 hours after surgery. Regression analyses were performed to establish associations between blood loss and coagulation parameters after cardiopulmonary bypass including a prediction model with known confounding factors for bleeding. Coagulation tests show large changes over the perioperative course with the strongest coagulopathic deviations from baseline after cardiopulmonary bypass. After adjustment for multiple confounders, viscoelastic clot strength instead of fibrinogen concentration showed a similar performance for 24 hour blood loss and a better performance for 6 hour blood loss. This makes intraoperative viscoelastic testing a useful tool to strengthen early clinical decision-making with the potential to reduce perioperative blood transfusions.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-05-20T09:20:07Z
      DOI: 10.1177/10760296211016541
      Issue No: Vol. 27 (2021)
       
  • The Meaning of D-Dimer value in Covid-19

    • Authors: Giulia Conte, Marco Cei, Isabella Evangelista, Alessandra Colombo, Josè Vitale, Antonino Mazzone, Nicola Mumoli
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.

      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-05-20T08:48:31Z
      DOI: 10.1177/10760296211017668
      Issue No: Vol. 27 (2021)
       
  • Regulation of Cortisol in Patients Undergoing Total Joint Arthoplasty

    • Authors: Rajan Khanna, Hannah Slovacek, Jeffrey Liles, Sandra Haddad, Pavel Poredos, Emily Bontekoe, Mateja Jezovnik, Debra Hoppensteadt, Jawed Fareed, William Hopkinson
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Osteoarthritis is a condition in which joint cartilage and bone degenerate progressively over time. Total joint arthroplasty is a definitive treatment. Cortisol is a hormone that is associated with pain and inflammation. This study aims to investigate the cortisol levels in patients undergoing total joint arthroplasty. Plasma samples were collected from 71 total joint arthroplasty (TJA) patients at baseline (pre-surgery), 24 hours post-operation, and 5 days post-operation. Cortisol levels were measured in each sample using a commercially available ELISA kit. All results were compiled as group means ± SD. The plasma cortisol level at baseline were 218.5 ± 12 ng/mL. The 24-hour post-surgical samples showed a marked increase in cortisol levels 240.7 ± 15 ng/mL. The blood samples drawn at the 5th day after surgery showed a downward trend (74 ± 12 ng/mL). At 5 days post-operation, cortisol levels were significantly lower than at baseline or 24 hours post-operation. These results point to the fact that prior to surgery, the patient’s emotional stress contributes to increased serum cortisol levels. The higher level of cortisol persists at 24 hours post-operation due to inflammation from the procedure. This data also suggests that at 5 days post-operation, the inflammatory response from the surgery and emotional stress subside, resulting in a near normalization of the cortisol levels. Cortisol is a hormone that plays a major role in the body’s response to surgery. The relevance between cortisol and different points in the surgical timeline has the potential to prognosticate and improve recovery measures.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-05-18T06:56:06Z
      DOI: 10.1177/1076029621987614
      Issue No: Vol. 27 (2021)
       
  • Upregulation of Inflammatory Cytokines in Pulmonary Embolism Using
           Biochip-Array Profiling

    • Authors: Emily Bontekoe, Yevgeniy Brailovsky, Debra Hoppensteadt, Jack Bontekoe, Fakiha Siddiqui, Joshua Newman, Omer Iqbal, Trent Reed, Jawed Fareed, Amir Darki
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      The complex pathophysiology of pulmonary embolism (PE) involves hemostatic activation, inflammatory processes, cellular dysfunction, and hemodynamic derangements. Due to the heterogeneity of this disease, risk stratification and diagnosis remains challenging. Biochip-array technology provides an integrated high throughput method for analyzing blood plasma samples for the simultaneous measurement of multiple biomarkers for potential risk stratification. Using biochip-array method, this study aimed to quantify the inflammatory biomarkers such as interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, vascular endothelial growth factor (VEGF), interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), monocyte chemoattractant protein-1 (MCP-1), and epidermal growth factor (EGF) in 109 clinically confirmed PE patients in comparison to the control group comprised of plasma samples collected from 48 healthy subjects. Cytokines IL-4, IL-6, IL-8, IL-10, IL-1β, and MCP-1 demonstrated varying level of significant increase (P < 0.05) in massive-risk PE patients compared to submassive- and low-risk PE patients. The upregulation of inflammatory cytokines in PE patients observed in this study suggest that inflammation plays an important role in the overall pathophysiology of this disease. The application of biochip-array technology may provide a useful approach to evaluate these biomarkers to understand the pathogenesis and risk stratification of PE patients.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-05-10T09:15:54Z
      DOI: 10.1177/10760296211013107
      Issue No: Vol. 27 (2021)
       
  • Fondaparinux Pre-, Peri-, and/or Postpartum for the Prophylaxis/Treatment
           of Venous Thromboembolism (FondaPPP)

    • Authors: Carl-Erik Dempfle, Jürgen Koscielny, Edelgard Lindhoff-Last, Birgit Linnemann, Irene Bux-Gewehr, Günther Kappert, Ute Scholz, Stefan Kropff, Sonja Eberle, Peter Bramlage, Andreas Heinken
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      We analyzed data for women who received fondaparinux for ≥7 days during pregnancy. The study retrospectively included women who received fondaparinux pre-, peri- and/or postpartum for ≥7 days for prophylaxis/venous thromboembolism (VTE) treatment at German specialist centers (2004-2010). Data on pregnancy, VTE risk factors, anticoagulant treatment, pregnancy outcome and adverse events were extracted from medical records. 120 women (mean age 31.5 years) were included. Among 84 women with prior pregnancies, 41.0% had ≥1 abortion. Anticoagulation was indicated for prophylaxis in 92.5% cases, including 82.5% women with an elevated VTE risk (82.8% thrombophilia, 34.2% VTE history). All women received low-molecular-weight heparin (LMWH) as first-line therapy; 3 also unfractionated heparin. Treatment changed to fondaparinux, due to heparin allergy (41.7%) or heparin-induced thrombocytopenia (10.0%). Fondaparinux was generally well tolerated. Adverse events included bleeding events (n = 5), abortion (n = 2), premature births (n = 2), stillbirth (n = 1), arrested labors (n = 2), injection site erythema (n = 4) and unspecified drug hypersensitivity (n = 6). No VTE events or increased liver enzymes occurred during treatment. In this retrospective study, fondaparinux was effective and well tolerated. Trial registration: ClinicalTrials.gov NCT01004939.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-05-04T10:02:26Z
      DOI: 10.1177/10760296211014575
      Issue No: Vol. 27 (2021)
       
  • The Association of Syndecan-1, Hypercoagulable State and Thrombosis and in
           Patients With Nephrotic Syndrome

    • Authors: Xin Chen, Xuemei Geng, Shi Jin, Jiarui Xu, Man Guo, Daoqi Shen, Xiaoqiang Ding, Hong Liu, Xialian Xu
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      The aim of this study is to investigate whether Syndecan-1 (SDC-1), an indicator of endothelial glycocalyx injury, would increase the risk of hypercoagulable state and thrombosis in patients with nephrotic syndrome (NS). The prospective study was conducted among patients undergoing renal biopsy in the Department of Nephrology in our hospital from May to September 2018. We enrolled in patients with NS as the experimental group and patients with normal serum creatinine and proteinuria less than 1 g as the control group. Patients’ characteristics including age, sex, laboratory test results and blood samples were collected for each patient. The blood samples were taken before the renal biopsy. The samples were immediately processed and frozen at −80°C for later measurement of Syndecan-1. One hundred and thirty-six patients were enrolled in the study. Patients with NS and hypercoagulability had a higher level of SDC-1 compared with control group. Patients with membranous nephropathy occupied the highest SDC-1 level (P = 0.012). Logistic regression showed that highly increased level of SDC-1 (>53.18 ng/ml) was an independent predicator for predicting hypercoagulable state. The elevated level of SDC-1 indicated that endothelial injury, combined with its role of accelerating hypercoagulable state, might be considered of vital importance in the pathophysiological progress of thrombosis formation in patients with NS.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-05-04T10:01:27Z
      DOI: 10.1177/10760296211010256
      Issue No: Vol. 27 (2021)
       
  • Could Low Doses Acetylsalicylic Acid Prevent Thrombotic Complications in
           COVID-19 Patients'

    • Authors: Federico Cacciapuoti, Fulvio Cacciapuoti
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) can induce inflammatory and thrombotic complications of pulmonary district (interstitial pneumonia), sometimes evolving toward acute respiratory failure. In adults, Acetylsalicylic Acid (ASA) is widely employed at low doses for primary and secondary prevention of cardiovascular diseases (CVD). Apart their anti-thrombotic effect, low ASA doses also exert an anti-inflammatory action. So, when these are assumed for CVD prevention, could prevent both inflammatory reaction and pro-coagulant tendency of Coronavirus-2019 (COVID-19) infection. In addition, some patients receiving ASA are simultaneously treated with Statins, to correct dyslipidemia. But, for their pleiotropic effects, Statins can also be useful to antagonize pulmonary thrombo-inflammation induced by COVID-19. Thus ASA, with or without Statins, employed for CVD prevention, could be useful to avoid or minimize inflammatory reaction and thrombotic complications of COVID-19. But, further studies performed in a wide range are requested to validate this hypothesis.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-30T10:18:50Z
      DOI: 10.1177/10760296211014592
      Issue No: Vol. 27 (2021)
       
  • Cost-Effective Machine Learning Based Clinical Pre-Test Probability
           Strategy for DVT Diagnosis in Neurological Intensive Care Unit

    • Authors: Li Luo, Ran Kou, Yuquan Feng, Jie Xiang, Wei Zhu
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      In order to overcome the shortage of the current costly DVT diagnosis and reduce the waste of valuable healthcare resources, we proposed a new diagnostic approach based on machine learning pre-test prediction models using EHRs. We examined the sociodemographic and clinical factors in the prediction of DVT with 518 NICU admitted patients, including 189 patients who eventually developed DVT. We used cross-validation on the training data to determine the optimal parameters, and finally, the applied ROC analysis is adopted to evaluate the predictive strength of each model. Two models (GLM and SVM) with the strongest ROC were selected for DVT prediction, based on which, we optimized the current intervention and diagnostic process of DVT and examined the performance of the proposed approach through simulations. The use of machine learning based pre-test prediction models can simplify and improve the intervention and diagnostic process of patients in NICU with suspected DVT, and reduce the valuable healthcare resource occupation/usage and medical costs.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-30T10:17:53Z
      DOI: 10.1177/10760296211008650
      Issue No: Vol. 27 (2021)
       
  • Blood Urea Nitrogen to Serum Albumin Ratio Independently Predicts
           Mortality in Critically Ill Patients With Acute Pulmonary Embolism

    • Authors: Jihong Fang, Bin Xu
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Acute pulmonary embolism (APE) is one of the prominent causes of death in patients with cardiovascular disease. Currently, reliable biomarkers to predict the prognosis of patients with APE are limited. The present study aimed to investigate the association of blood urea nitrogen to serum albumin (B/A) ratio and intensive care unit (ICU) mortality in critically ill patients with APE. A retrospective cohort study was performed using data extracted from a freely accessible critical care database (MIMIC-III). Adult (≥18 years) patients of first ICU admission with a primary diagnosis of APE in the database were enrolled in the study. The primary endpoint was the ICU mortality rate while the 28-day mortality after ICU admission was the secondary endpoint. The data of survivors and non-survivors were compared. A total of 1048 patients with APE were enrolled in this study, of which 131 patients died in ICU and 169 patients died within 28 days after ICU admission. The B/A ratio in the non-survivors group was significantly higher compared to the survivors group (P < 0.001). The multivariate analysis revealed that the B/A ratio was an independent predictor of ICU mortality (odds ratio [OR] 1.10, 95% CI 1.07-1.14, P < 0.001) and all-cause mortality within 28 days after ICU admission (hazard ratio [HR] 1.07, 95% CI 1.05-1.09, P < 0.001) in APE patients. The B/A ratio showed a greater area under the curve (AUC) of ICU mortality prediction (0.80; P < 0.001) than simplified acute physiology score II (SAPSII) (0.79), systemic inflammatory response syndrome score (SIRS) (0.62), acute physiology score III (APSIII) (0.76) and sequential organ failure assessment (SOFA) score (0.71). The B/A ratio could be a simple and useful prognostic tool to predict mortality in critically ill patients with APE.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-30T06:57:03Z
      DOI: 10.1177/10760296211010241
      Issue No: Vol. 27 (2021)
       
  • Protamine Sulfate Neutralization Profile of Various Dosages of Bovine,
           Ovine and Porcine UFHs and Their Depolymerized Derivatives in Non-Human
           Primates

    • Authors: Ahmed Kouta, Walter Jeske, Lee Cera, Azarfrooz Farshid, Richard Duff, Debra Hoppensteadt, Jawed Fareed
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Introduction:Currently used unfractionated heparins (UFHs) and low molecular weight heparins (LMWHs) are derived from porcine intestinal mucosa. However, heparins have also been manufactured from tissues of other mammalian species such as cow (Bovine) and sheep (Ovine). Protamine sulphate (PS) is an effective inhibitor of heparin and is used clinically to neutralize both LMWH and UFH. In this study, we determined the PS neutralization profile of these agents in non-human primate model using anti-Xa and anti-IIa methods.Material and Methods:UFHs obtained from bovine, ovine and porcine mucosal tissues and their respective depolymerized LMWHs were administered at both, gravimetric (0.5 mg/kg) and potency adjusted (100 U/kg) dosages regimen intravenously to individual groups of primates in cross over studies. PS was administered at a fixed dosage and the relative neutralization of these anticoagulants was measured utilizing amidolytic anti-Xa and anti-IIa methods.Results:These studies have demonstrated that, the equi-gravimetric dosages of BMH, PMH and OMH have comparable PS neutralization profiles. At potency adjusted dosages, all UFHs were completely neutralized by PS. Although comparable, the LMWHs were not fully neutralized by PS in both the anti-Xa and anti-IIa assays. PS was more efficient in neutralizing the anti-IIa effects of LMWHs.Conclusion:Heparins of diverse origins showed comparable neutralization profiles by PS in the amidolytic anti-Xa and anti-IIa assays.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-30T05:38:39Z
      DOI: 10.1177/10760296211005544
      Issue No: Vol. 27 (2021)
       
  • Diagnostic Value of D-Dimer in COVID-19: A Meta-Analysis and
           Meta-Regression

    • Authors: Haoting Zhan, Haizhen Chen, Chenxi Liu, Linlin Cheng, Songxin Yan, Haolong Li, Yongzhe Li
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      The prognostic role of hypercoagulability in COVID-19 patients is ambiguous. D-dimer, may be regarded as a global marker of hemostasis activation in COVID-19. Our study was to assess the predictive value of D-dimer for the severity, mortality and incidence of venous thromboembolism (VTE) events in COVID-19 patients. PubMed, EMBASE, Cochrane Library and Web of Science databases were searched. The pooled diagnostic value (95% confidence interval [CI]) of D-dimer was evaluated with a bivariate mixed-effects binary regression modeling framework. Sensitivity analysis and meta regression were used to determine heterogeneity and test robustness. A Spearman rank correlation tested threshold effect caused by different cut offs and units in D-dimer reports. The pooled sensitivity of the prognostic performance of D-dimer for the severity, mortality and VTE in COVID-19 were 77% (95% CI: 73%-80%), 75% (95% CI: 65%-82%) and 90% (95% CI: 90%-90%) respectively, and the specificity were 71% (95% CI: 64%-77%), 83% (95% CI: 77%-87%) and 60% (95% CI: 60%-60%). D-dimer can predict severe and fatal cases of COVID-19 with moderate accuracy. It also shows high sensitivity but relatively low specificity for detecting COVID-19-related VTE events, indicating that it can be used to screen for patients with VTE.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-30T05:37:04Z
      DOI: 10.1177/10760296211010976
      Issue No: Vol. 27 (2021)
       
  • Natural Language Processing Performance for the Identification of Venous
           Thromboembolism in an Integrated Healthcare System

    • Authors: Bela Woller, Austin Daw, Valerie Aston, Jim Lloyd, Greg Snow, Scott M. Stevens, Scott C. Woller, Peter Jones, Joseph Bledsoe
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Real-time identification of venous thromboembolism (VTE), defined as deep vein thrombosis (DVT) and pulmonary embolism (PE), can inform a healthcare organization’s understanding of these events and be used to improve care. In a former publication, we reported the performance of an electronic medical record (EMR) interrogation tool that employs natural language processing (NLP) of imaging studies for the diagnosis of venous thromboembolism. Because we transitioned from the legacy electronic medical record to the Cerner product, iCentra, we now report the operating characteristics of the NLP EMR interrogation tool in the new EMR environment. Two hundred randomly selected patient encounters for which the imaging report assessed by NLP that revealed VTE was present were reviewed. These included one hundred imaging studies for which PE was identified. These included computed tomography pulmonary angiography—CTPA, ventilation perfusion—V/Q scan, and CT angiography of the chest/ abdomen/pelvis. One hundred randomly selected comprehensive ultrasound (CUS) that identified DVT were also obtained. For comparison, one hundred patient encounters in which PE was suspected and imaging was negative for PE (CTPA or V/Q) and 100 cases of suspected DVT with negative CUS as reported by NLP were also selected. Manual chart review of the 400 charts was performed and we report the sensitivity, specificity, positive and negative predictive values of NLP compared with manual chart review. NLP and manual review agreed on the presence of PE in 99 of 100 cases, the presence of DVT in 96 of 100 cases, the absence of PE in 99 of 100 cases and the absence of DVT in all 100 cases. When compared with manual chart review, NLP interrogation of CUS, CTPA, CT angiography of the chest, and V/Q scan yielded a sensitivity = 93.3%, specificity = 99.6%, positive predictive value = 97.1%, and negative predictive value = 99%.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-28T07:44:25Z
      DOI: 10.1177/10760296211013108
      Issue No: Vol. 27 (2021)
       
  • Device-Related Thrombosis in Patients Receiving One-Stop Intervention for
           Nonvalvular Atrial Fibrillation: A Systemic Review and Meta-Analysis

    • Authors: Li-xing Hu, Min Tang, Jing-tao Zhang
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      This study aimed to assess the incidence, clinical implications, and treatment strategies of device-related thrombus (DRT) following catheter ablation and percutaneous left atrial appendage occlusion combined in one intervention. A meta-analysis of observational studies was conducted to evaluate the incidence rates, treatment strategies, and clinical implications of DRT. A total of 21 studies describing DRT events and 1 case were included in the current study. The 21 included studies comprised 3 multi-center registries and 18 single-center registries, and we also included 1 case report analyzing the characteristics of DRT. The pooled incidence of DRT in one-stop intervention was 18/1,708 (1.2%; range = 0%-7.3%; 95% CI = 0.7%-1.8%; I 2 = 0). Of these DRT events, 56.25% were diagnosed in the first 3 months after the procedure. All cases were diagnosed via trans-esophagus echocardiogram. All of the patients diagnosed with DRT were prescribed anticoagulation treatment, and 63% (12/19) of the events were reported with an outcome of complete thrombus resolution. The duration of anticoagulation treatment varied greatly, from 30 days to 6 months. Unknown clinical events were reported relating to DRT. Device-related thrombus is an uncommon complication of one-stop intervention. It occurs mainly in the early period following the procedure. Anticoagulation appears to be an appropriate treatment method for dissolving occurrences of DRT.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-28T07:43:23Z
      DOI: 10.1177/10760296211005033
      Issue No: Vol. 27 (2021)
       
  • Blood Viscosity at the First Clinical Presentation in Fatal and Non-Fatal
           COVID-19: An Observation

    • Authors: Rujittika Mungmunpuntipantip, Viroj Wiwanitkit
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.

      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-28T07:42:48Z
      DOI: 10.1177/10760296211006779
      Issue No: Vol. 27 (2021)
       
  • Splanchnic Vein Thrombosis in Acute Pancreatitis and Its Consequences

    • Authors: Łukasz Nawacki, Jarosław Matykiewicz, Ewa Stochmal, Stanisław Głuszek
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Splanchnic vein thrombosis (SVT) is a serious vascular complication that can occur in patients with acute pancreatitis. We assessed the incidence of SVT and its relationship with acute pancreatitis (AP) and associated complications. We carried out a retrospective analysis of medical histories from patients hospitalized with AP in a single surgical center. Histories were acquired from patients with abdominal and pelvic computed tomography scans performed between the 2nd and 3rd day of hospitalization. We assessed the impact and extent of thrombosis over the disease course. We found a strong positive correlation (Cramer’s V coefficient = 0.34) between SVT and disease severity. Mortality in the study group was 7.2% (8 patients) of which 5 patients (62.5%) were diagnosed with SVT. We observed an increased incidence of death among patients with thrombosis, with results approaching significance (P = 0.056). In our study, we found that SVT has a negative effect on the course of AP and is associated with more severe disease and increased mortality.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-23T07:18:32Z
      DOI: 10.1177/10760296211010260
      Issue No: Vol. 27 (2021)
       
  • No Association of Homocysteine, Anticardiolipin Antibody, and Anti-β2
           Glycoprotein I Antibody With Portal Venous System Thrombosis in Liver
           Cirrhosis

    • Authors: Le Wang, Xiaozhong Guo, Xiangbo Xu, Shixue Xu, Juqiang Han, Ran Wang, Zeqi Guo, Fangfang Yi, Xingshun Qi
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Portal venous system thrombosis (PVST), a common complication of liver cirrhosis, is closely associated with thrombophilia. To explore the association of homocysteine (Hcy), anticardiolipin antibody (aCL), and anti-β2 glycoprotein I antibody (aβ2GPI), which are possible thrombophilic factors, with PVST in liver cirrhosis. Overall, 654 non-malignant patients (219 with and 435 without liver cirrhosis) admitted between January 2016 and June 2020 were retrospectively evaluated. Presence of PVST, degree of main portal vein (MPV) thrombosis, and clinically significant PVST were identified. Hcy level, hyperhomocysteinemia (HHcy), aCL positivity, and aβ2GPI positivity were compared according to the presence of liver cirrhosis and PVST. Positive aβ2GPI was significantly more frequent in patients with liver cirrhosis than those without, but Hcy level and proportions of HHcy and positive aCL were not significantly different between them. PVST could be evaluated in 136 cirrhotic patients. Hcy level [10.57 μmol/L (2.71-56.82) versus 9.97 μmol/L (2.05-53.44); P = 0.796] and proportions of HHcy [4/44 (9.1%) versus 13/81 (16.0%); P = 0.413] and positive aCL [1/23 (4.3%) versus 10/52 (19.2%); P = 0.185] and aβ2GPI [9/23 (39.1%) versus 21/52 (40.4%); P = 0.919] were not significantly different between cirrhotic patients with and without PVST. There was still no significant association of Hcy level, HHcy, aCL, or aβ2GPI with PVST based on Child-Pugh classification, MPV thrombosis>50%, and clinically significant PVST. Hcy, aCL, and aβ2GPI may not be associated with PVST in liver cirrhosis, suggesting that routine screening for Hcy, aCL, and aβ2GPI should be unnecessary in such patients.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-22T07:45:11Z
      DOI: 10.1177/10760296211010969
      Issue No: Vol. 27 (2021)
       
  • Anticoagulation and In-Hospital Mortality From Coronavirus Disease 2019: A
           Systematic Review and Meta-Analysis

    • Authors: Chatphatai Moonla, Darintr Sosothikul, Thita Chiasakul, Ponlapat Rojnuckarin, Noppacharn Uaprasert
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Hypercoagulability in coronavirus disease 2019 (COVID-19) may aggravate disease severity during hospitalization but the reported survival benefits from anticoagulation (AC) vary among studies. We performed a literature research to estimate pooled odds ratios (ORs) of in-hospital mortality and major bleeding comparing among intermediate-to-therapeutic dose AC, prophylactic dose AC, and no AC. Until October 22, 2020, PubMed, EMBASE, and Cochrane Library Database were searched for studies reporting AC utilization and mortality in COVID-19. Studies with suspected risk of bias were excluded before the synthesis of pooled ORs with 95% confidence intervals (CIs) using random-effects models. Of 37 identified studies (N = 19,510), 17 (N = 17,833) were aggregated in the meta-analysis. The overall mortality rate was 23.1% (95% CI 18.7-28.2). The pooled odds of mortality comparing anticoagulated to non-anticoagulated patients were similar, but lower in prophylactic dose AC group (OR 0.83; 95% CI 0.73-0.95). Notably, intermediate-to-therapeutic dose AC increased mortality (OR 1.60; 95% CI 1.11-2.31) and major bleeding compared to prophylactic dose AC (OR 3.33; 95% CI 2.34-4.72). Our findings support the optimal efficacy and safety profiles of prophylactic dose AC in hospitalized COVID-19 patients.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-20T07:37:32Z
      DOI: 10.1177/10760296211008999
      Issue No: Vol. 27 (2021)
       
  • Eltrombopag Effectiveness and Tolerability in Chronic Immune
           Thrombocytopenia: A Meta-Analysis

    • Authors: Hafiz Abdul Waqas Ahmed, Ahmed Taher Masoud, Jia Han, Ahmed Adel Sofy, Ahmed Saeed Ahmed, Ahmed Taha Abdesattart, Emmanuel Kwateng Drokow, Kai Sun
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Eltrombopag is an orally administered, non-peptide, thrombopoietin receptor agonist which initiates thrombopoietin signaling and stimulates the production of normally functioning platelet. We aimed to do a systematic review and meta-analysis of currently available published data to verify whether eltrombopag treatment in patients with chronic immune-mediated thrombocytopenia can prolong survival. We searched for published, randomized, controlled trials in PubMed, Cochrane and Scopus databases using the following search strategy (“Eltrombopag” OR “Benzoates” OR “Hydrazines”) AND (“Idiopathic Thrombocytopenic Purpura” OR “immune thrombocytopenia” OR “Idiopathic Thrombocytopenic Purpuras” OR “Immune Thrombocytopenia” OR “Autoimmune Thrombocytopenia” OR “Werlhof”). The pooled relative risk (RR) showed that eltrombopag group has significantly higher overall platelet response than placebo group (MD = 3.42, 95% CI [2.51, 4.65], P> .0001); pooled results were homogenous (P = .27, I2 = 22%). The pooled relative risk showed that eltrombopag group has lower incidence of any bleeding than placebo group (MD = 0.65, 95% CI [0.48, 0.87], P = .003); pooled results were heterogenous (P = .001, I2 = 75%) and the detected heterogeneity was best resolved after excluding Bussel et al (P = .10). Homogeneous results were still favored eltrombopag group (MD = 0.75, 95% CI [0.60, 0.93], P = .008).
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-20T07:36:53Z
      DOI: 10.1177/10760296211005555
      Issue No: Vol. 27 (2021)
       
  • Ischemic Stroke in the Young

    • Authors: Samuel A. Berkman, Shlee S. Song
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      The purpose of this article is to address several challenging questions in the management of young patients (those age 60 and under) who present with ischemic stroke. Do genetic thrombophilic states, strongly associated with venous thrombosis, independently cause arterial events in adults' Should cases of patent foramen ovale be closed with mechanical devices in patients with cryptogenic stroke' What are the optimal treatments for cerebral vein thrombosis, carotid artery dissection, and antiphospholipid syndrome and are DOACs acceptable treatment for these indications' What is the mechanism underlying large vessel stroke in patients with COVID-19' This is a narrative review. We searched PubMed and Embase and American College of physicians Journal club database for English language articles since 2000 looking mainly at randomized clinical trials, Meta analyses, Cochran reviews as well as some research articles viewed to be cutting edge regarding anticoagulation and cerebrovascular disease. Searches were done entering cerebral vein thrombosis, carotid dissection, anticoagulation therapy and stroke, antiphospholipid antibody and stroke, stroke in young adults, cryptogenic stroke and anticoagulation, patent foramen ovale and cryptogenic stroke, COVID-19 and stroke.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-19T11:22:00Z
      DOI: 10.1177/10760296211002274
      Issue No: Vol. 27 (2021)
       
  • Portuguese Consensus and Recommendations for Acquired Coagulopathic
           Bleeding Management (CCBM)

    • Authors: Manuela Gomes, Anabela Rodrigues, Alexandre Carrilho, José Aguiar, Luciana Gonçalves, Fernando Fernandez-Llimos, Filipa Duarte-Ramos, Joana Rodrigues
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      We aimed to determine how Portuguese physicians handle major bleeding. We also aim to establish global diagnostic and therapeutic recommendations to be followed in clinical practice by using a step-wise approach of evidence generation. This study followed a three-step process: a steering committee desk review, a Delphi technique, an expert panel meeting. A modified 3-round Delphi including 31 statements was performed. Questions were answered in a five-point Likert-type scale. Consensus threshold was established as a percentage of agreement among participants ≥90% in the first round, and ≥85% in the second and third rounds. The level of consensus achieved by panelists was discussed with the scientific committee (January-2020). Fifty-one physicians participated in the study (compliance rate>90%). Analyzing the three rounds, consensus was reached on 20 items (64.5%) in the first, 4/11 items (36.4%) in the second and 6/7 items (85.7%) in the third. One statement about administration of clotting factor concentrates for bleeding control did not reach consensus. A high level of consensus was reached toward the need for implementing Patient Blood Management strategies in Portuguese hospitals, reduce exposure to allogeneic blood components, to use goal directed therapies for acquired bleeding management, and the need for evaluating blood transfusion indirect costs. A final version with 12 recommendations was built, according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Our results provide critically appraised and updated evidence on bleeding coagulopathies management in Portugal. Additional studies, mainly about indirect costs of blood transfusion, are needed.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-19T08:13:32Z
      DOI: 10.1177/10760296211003984
      Issue No: Vol. 27 (2021)
       
  • Clinical Characteristics and Management of Cerebral Venous Sinus
           Thrombosis in Patients With Antiphospholipid Syndrome: A Single-Center
           Retrospective Study

    • Authors: Huixin Shen, Xiaoqin Huang, Chunqiu Fan
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Antiphospholipid syndrome (APS) with cerebral venous sinus thrombosis (CVST) is a relatively rare phenomenon, and this observational study aimed to investigate the clinical characteristics of APS patients complicated with CVST. We retrospectively investigated the clinical characteristics of CVST events in APS and compared differential characteristics and associated factors between APS patients with and without CVST. Twenty-one CVST patients with APS were enrolled including 14 females (9.4%) and 7 males (5.8%). The median age and disease duration at onset of CVST was 33 years (IQR 28-48) old and 1.3 months (IQR 0.7-4), respectively. Among APS patients with CVST, 12 (57.1%) cases presented with neurologic symptoms of CVST as the initial manifestation. Onset of CVST was mainly chronic (52.4%). Headache (90.5%) was the most common neurological symptom. The common locations of CVST were transverse sinus (76.2%) and superior sagittal sinus (57.1%), with more frequently (76.2%) dual or multiple sinuses involved. All patients with CVST were treated with anticoagulant, and 5 (23.8%) patients received endovascular therapy. Sixteen (84.2%) patients had good outcomes and 3 (15.8%) patients died at last follow-up. There were no significant differences (P> 0.05) between two groups in the analysis of related APS indicators. There were no significant differences (P> 0.05) between two groups in the analysis of related APS indicators. Although APS complicated with CVST is rare and predominately chronic developed. The evaluation of CVST should be performed for APS patients with intracranial hypertension syndrome. The routine screening of antiphospholipid antibodies (aPLs) is highly recommended in unexplained CVST patients. Most CVST patients with APS will have a good prognosis after treatment, and endovascular therapy is an alternative treatment.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-19T05:47:47Z
      DOI: 10.1177/1076029621999104
      Issue No: Vol. 27 (2021)
       
  • Do Inpatients Receive Risk-Based Prophylactic Treatment for Thrombotic
           Events'

    • Authors: Armin Nemani, Constantin von zur Mühlen, Friederike Steffen, Johannes Schulte, Christoph Bode, Marvin Krohn-Grimberghe
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Background:Current guidelines recommend risk-based use of prophylaxis for preventing medical inpatients from venous thromboembolism (VTE). Little is known about the current prescription practice, and even less whether differences between subspecialists like cardiologists, usually treating patients with thrombotic or thromboembolic diseases, and gastroenterologists, treating more patients with gastrointestinal bleeding complications, exist.Methods:We performed a retrospective chart review of patients on cardiology and gastroenterology wards of our university hospital. Patients with a clear indication for anticoagulation and contraindication against antithrombotic treatment were excluded. A total of 450 patients per specialty were included. Quantitative risk assessment models were used to determine the risk of a VTE (Padua Prediction Score (PPS), IMPROVE Score) and bleeding (IMPROVE-Bleeding and HAS-BLED Score).Results:The overall rate of VTE prophylaxis was high in both patient populations. Significant more low-risk cardiology compared to gastroenterology patients received drug-based prophylaxis. Furthermore, crucial discrepancies were found in the way individual patients would be classified based on PPS and IMPROVE Score. Finally, not the risk category but the length of hospital stay was best at predicting which patient received prophylaxis.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-19T05:45:55Z
      DOI: 10.1177/1076029621995563
      Issue No: Vol. 27 (2021)
       
  • The Relationship of the Type of Intracerebral Hemorrhage to Early Disease
           Evolution and Long-Term Prognosis After r-tPA Thrombolysis

    • Authors: Ting Yang, Hongfei Jing, Yungang Cao, Xianda Lin, Jueyue Yan, Meijuan Xiao, Xiaoyan Huang, Zicheng Cheng, Zhao Han
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      To investigate the relationship of different subtypes of intracerebral hemorrhage (ICH) to early disease evolution and long-term prognosis in patients with acute cerebral infarction after intravenous recombinant tissue plasminogen activator(r-tPA). Seventy ischemic stroke patients treated with intravenous r-tPA who underwent computed tomography (CT) within 24 hours after thrombolysis were divided into 4 types (hemorrhagic infarction type 1 [HI-1], HI-2, parenchymal hemorrhage type 1 [PH-1], or PH-2 which according to the size of the hematoma and the presence or absence of space-occupying effect). Early evolution of the disease was observed by the change in the National Institutes of Health Stroke Scale (NIHSS) score within 24 hours after thrombolysis. The long-term prognosis was assessed by the modified Rankin Scale (mRS) score at the third month. There were 17 (24.3%) patients with ICH. Compared with patients in the non-ICH group, HI did not affect early neurological function or clinical outcome at the third month. PH-1 did not increase the risk of early neurological deterioration; however, PH-1 has a tendency to increase the risk of death at the third month (50% vs 11.3%, P = 0.090). PH-2 was significantly related to early neurological deterioration (66.7% vs 3.8%, P < 0.001) and mortality at the third month (50.0% vs 11.3%, P = 0.040). Patients with different subtypes of ICH after thrombolysis have different clinical outcomes. PH-2 is significantly associated with early neurological deterioration and increases mortality at the third month.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-19T05:45:03Z
      DOI: 10.1177/1076029621992125
      Issue No: Vol. 27 (2021)
       
  • Bleeding and Thrombotic Adverse Events in Hospitalized Patients Under
           Empiric Treatment for Suspected Heparin-Induced Thrombocytopenia While
           Awaiting Confirmatory Testing

    • Authors: Kaitlyn C. Dykes, Cassandra A. Johnson, Jerald Z. Gong, Steven E. McKenzie, Holleh D. Husseinzadeh
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Empiric management in suspected heparin-induced thrombocytopenia (HIT) is challenging due to imperfect prediction models, latency while awaiting test results and risks of empiric therapies. When there is high clinical suspicion for HIT, cessation of heparin and empiric non-heparin anticoagulation with FDA-approved argatroban is recommended. Alternatively off-label fondaparinux or watchful waiting have been utilized in clinical practice. Outcomes of patients empirically managed for HIT have not been compared directly in clinical trials and patients that ultimately do not have HIT are often overlooked. Clinicians need studies investigating empiric management to guide decision making in suspected HIT. In this study, adverse events (AE) were categorized and compared in patients being evaluated for HIT while undergoing empiric management by non-heparin anticoagulation with argatroban or fondaparinux, both at therapeutic or reduced doses, or watchful waiting with or without heparin. AE were defined as new thrombosis confirmed on imaging or new bleeding event after HIT was first suspected. A retrospective chart review of 312 patients tested for HIT at an academic hospital was conducted. 170 patients met inclusion criteria. Patients were excluded if the 4Ts score was < 4. The 4Ts score is a pretest probability for HIT based on thrombocytopenia degree, timing, alternative causes and presence of thrombosis. Included patients were divided according to management groups and compared with logistic regression analysis. Bleeding risk significantly differed between management groups (p = 0.002). Despite adjustment for bleeding risk, fondaparinux was associated with increased AE, (p = 0.03, OR = 5.81), while argatroban was not. There was no difference in AE based on time to initiation of empiric treatment and no advantage to reduced dosing with either anticoagulant. These findings challenge assumptions surrounding empiric HIT management.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-13T07:46:14Z
      DOI: 10.1177/1076029621996473
      Issue No: Vol. 27 (2021)
       
  • Efficacy and Safety of Long-Term Intravenous Tranexamic Acid
           Administration for Blood Management in Revision Surgery for Femoral Shaft
           Nonunion: A Retrospective Case-Control Study

    • Authors: Zhimeng Wang, Yao Lu, Qiang Huang, Hanzhong Xue, Cheng Ran, Qian Wang, Teng Ma, Kun Zhang, Zhong Li, Liang Sun
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Femoral shaft nonunion is a complication that seriously affects physiological functions. We aimed to assess the effectiveness and safety of short- and long-term intravenous tranexamic acid (TXA) administration in the perioperative period of revision surgery for femoral shaft nonunion. In this retrospective study, 53 patients undergoing double-locking plates with channel bone grafting technology for the treatment of femoral shaft nonunion were divided into 3 groups: the patients in group A without use TXA during hospitalization, the patients in group B received intravenous (IV) 1-g TXA at 30 min before the surgery and deep soaked 1-g TXA for 5 min before closing the incision, and then 1-g TXA IV again 6 h after surgery, and the patients in group C received 1-g TXA IV before the operation, 1-g TXA topically during the operation, and subsequent long-term 1-g TXA IV until discharged. The primary outcomes were total blood loss (TBL) and hidden blood loss (HBL). The secondary outcomes included actual hemoglobin (Hb) loss values, transfusion requirement, number of units transfused, postoperative laboratory values (Hb, hematocrit, fibrinogen, and D-dimer), visual analogue scale (VAS) scores, and hospitalization time. The mean TBL was lower in group C than in group A (1168 mL vs. 2714 mL, P < 0.001) and group B (1168 mL vs. 1557 mL, P = 0.008). The differences in HBL volumes were also significant between groups A and C (P < 0.001) and between groups A and B (P < 0.01). The actual Hb loss in the 3 groups showed a consistent trend with TBL, but no significant differences between groups B and C (P = 0.23). On postoperative day (POD) 3, the Hb level was higher in group C than in group A (111.1 g/L vs. 94.6 g/L, P = 0.02). No significant differences were found in VAS, hospital stay, thromboembolic complications, incision-related complications, and TXA adverse reactions among groups. Long-term intravenous TXA during hospitalization can effectively reduce perioperative blood loss, Hb drop, and postoperative hyperfibrinolysis, but is associated with an increased incidence of adverse reactions.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-13T07:06:12Z
      DOI: 10.1177/10760296211002277
      Issue No: Vol. 27 (2021)
       
  • Inflammatory and Prothrombotic Biomarkers Associated With the Severity of
           COVID-19 Infection

    • Authors: Sandra Lopez-Castaneda, Nallely García-Larragoiti, Alan Cano-Mendez, Kenia Blancas-Ayala, Guadalupe Damian-Vázquez, Ana Itzel Perez-Medina, Luis David Chora-Hernández, Carlos Arean-Martínez, Martha Eva Viveros-Sandoval
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Among COVID-19 hospitalized patients, high incidence of alterations in inflammatory and coagulation biomarkers correlates with a poor prognosis. Comorbidities such as chronic degenerative diseases are frequently associated with complications in COVID-19 patients. The aim of this study was to evaluate inflammatory and procoagulant biomarkers in COVID-19 patients from a public hospital in Mexico. Blood was sampled within the first 48 h after admission in 119 confirmed COVID-19 patients that were classified in 3 groups according to oxygen demand, evolution and the severity of the disease as follows: 1) Non severe: nasal cannula or oxygen mask; 2) Severe: high flow nasal cannula and 3) Death: mechanical ventilation eventually leading to fatal outcome. Blood samples from 20 healthy donors were included as a Control Group. Analysis of inflammatory and coagulation biomarkers including D-dimer, interleukin 6, interleukin 8, PAI-1, P-selectin and VWF was performed in plasma. Routine laboratory and clinical biomarkers were also included and compared among groups. Concentrations of D-dimer (14.5 ± 13.8 µg/ml) and PAI-1 (1223 ± 889.6 ng/ml) were significantly elevated in severe COVID-19 patients (P < 0.0001). A significant difference was found in interleukin-6, PAI-1 and P-selectin in non-severe and healthy donors when compared to Severe COVID-19 and deceased patients (P < 0.001). VWF levels were also significantly different between severe patients (153.5 ± 24.3 UI/dl) and non-severe ones (133.9 ± 20.2 UI/dl) (P < 0.0001). WBC and glucose levels were also significantly elevated in patients with Severe COVID-19. Plasma concentrations of all prothrombotic biomarkers were significantly higher in patients with a fatal outcome.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-09T08:16:37Z
      DOI: 10.1177/1076029621999099
      Issue No: Vol. 27 (2021)
       
  • ABO Blood Group, SARS-CoV-2 Infection, and Risk of Venous Thromboembolism:
           Population-Based Cohort Study

    • Authors: Joel G. Ray, Marian J. Vermeulen, Michael J. Schull, Alison L. Park
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.

      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-08T07:39:31Z
      DOI: 10.1177/10760296211008986
      Issue No: Vol. 27 (2021)
       
  • AngioJet Thrombectomy Versus Catheter-Directed Thrombolysis for Lower
           Extremity Deep Vein Thrombosis: A Meta-Analysis of Clinical Trials

    • Authors: Guan Qiang Li, Lei Wang, Xi Cheng Zhang
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Early catheter-directed thrombolysis (CDT) for lower extremity deep vein thrombosis (LEDVT) can reduce post-thrombotic morbidity and the AngioJet thrombectomy is a new therapy that can be selected for the treatment of LEDVT. We performed a systematic review and meta-analysis of clinical trials comparing AngioJet versus CDT to assess the efficacy and safety of AngioJet thrombectomy. We systematically searched PubMed and Embase for clinical trials that published before November 1, 2020 and compared AngioJet thrombectomy and CDT in the treatment of LEDVT. We meta-analyzed effective rate of treatment, serious complications, PTS, Villalta score, duration of treatment and drug dose. AngioJet does not result in a significant difference in the effective rate (OR 1.00, CI 0.73-1.36, P = 0.98; I2 = 0%) and complications (OR 1.16 CI 0.84-1.61, P = 0.36; I2 = 39%) compare to CDT. And there was a statistically significant decrease in incidence of PTS (OR 0.58 CI 0.37-0.91, P = 0.02; I2 = 0%) and Villalta score (OR −1.86 CI −3.49 to −0.24, P = 0.02; I2 = 34%) for AngioJet compared to CDT. In addition, there was a statistically significant decrease in duration of the treatment (OR −2.45 CI −2.75 to −2.15, P < 0.0001; I2 = 95%) and drug dose (OR −3.15 CI −3.38 to −2.93, P < 0.0001; I2 = 98%) between AngioJet and CDT. AngioJet results in a low severity of PTS compared to CDT therapy. Moreover, the average duration of treatment and thrombolysis time was shorter in the AngioJet group compared to the CDT group. However, the AngioJet group was not significantly different in effective rate of treatment and serious complications compared to the CDT group.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-05T07:55:58Z
      DOI: 10.1177/10760296211005548
      Issue No: Vol. 27 (2021)
       
  • Clinical Outcomes of Pulmonary Embolism in Mexican Patients With COVID-19

    • Authors: Luis O. Bobadilla-Rosado, Santiago Mier y Teran-Ellis, Gabriel Lopez-Pena, Javier E. Anaya-Ayala, Carlos A. Hinojosa
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Coagulation abnormalities have been reported in COVID-19 patients, which may lead to an increased risk of Pulmonary Embolism (PE). We aimed to describe the clinical characteristics and outcomes of COVID-19 patients diagnosed with PE during their hospital stay. We analyzed patients with PE and COVID-19 in a tertiary center in Mexico City from April to October of 2020. A total of 26 (100%) patients were diagnosed with Pulmonary Embolism and COVID-19. We observed that 14 (54%) patients were receiving either prophylactic or full anticoagulation therapy, before PE diagnosis. We found a significant difference in mortality between the group with less than 7 days (83%) and the group with more than 7 days (15%) in Intensive Care Unit (P = .004); as well as a mean of 8 days for the mortality group compared with 20 days of hospitalization in the survivor group (P = .003). In conclusion, there is an urgent need to review antithrombotic therapy in these patients in order to improve clinical outcomes and decrease hospital overload.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-04-05T07:47:13Z
      DOI: 10.1177/10760296211008988
      Issue No: Vol. 27 (2021)
       
  • Antiphospholipid Antibodies in Sickle Cell Disease: A Systematic Review
           and Exploratory Meta-Analysis

    • Authors: Mira Merashli, Alessia Arcaro, Maria Graf, Matilde Caruso, Paul R. J. Ames, Fabrizio Gentile
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      The relationship between antiphospholipid antibodies (aPL) and sickle cell disease (SCD) has never been systematically addressed. Our aim was to evaluate potential links between SCD and aPL in all age groups. EMBASE/PubMed was screened from inception to May 2020 and Peto odds ratios for rare events were calculated. The pooled prevalence (PP) of IgG anticardiolipin antibodies (aCL) was higher in individuals with SCD than in controls (27.9% vs 8.7%, P < 0.0001), that of IgM aCL was similar in the two groups (2.9% vs 2.7%); only individuals with SCD were positive for lupus anticoagulant (LA) (7.7% vs 0%, P < 0.0001). The PP of leg ulcers was similar between aPL positive and negative individuals (44% vs 53%) and between patients in acute crisis and stable patients (5.6% vs 7.3%). Reporting of aPL as a binary outcome and not as a titer precluded further interpretation. The results indicate that a prospective case-control study with serial measurements of a panel of aPL in SCD patients might be warranted, in order to understand further the possible pathogenic role of aPL in SCD.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-03-31T08:50:24Z
      DOI: 10.1177/10760296211002914
      Issue No: Vol. 27 (2021)
       
  • Role of Tissue Factor in the Pathogenesis of COVID-19 and the Possible
           Ways to Inhibit It

    • Authors: Carlos A. Cañas, Felipe Cañas, Mario Bautista-Vargas, Fabio Bonilla-Abadía
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      COVID-19 (Coronavirus Disease 2019) is a highly contagious infection and associated with high mortality rates, primarily in elderly; patients with heart failure; high blood pressure; diabetes mellitus; and those who are smokers. These conditions are associated to increase in the level of the pulmonary epithelium expression of angiotensin-converting enzyme 2 (ACE-2), which is a recognized receptor of the S protein of the causative agent SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2). Severe cases are manifested by parenchymal lung involvement with a significant inflammatory response and the development of microvascular thrombosis. Several factors have been involved in developing this prothrombotic state, including the inflammatory reaction itself with the participation of proinflammatory cytokines, endothelial dysfunction/endotheliitis, the presence of antiphospholipid antibodies, and possibly the tissue factor (TF) overexpression. ARS-Cov-19 ACE-2 down-regulation has been associated with an increase in angiotensin 2 (AT2). The action of proinflammatory cytokines, the increase in AT2 and the presence of antiphospholipid antibodies are known factors for TF activation and overexpression. It is very likely that the overexpression of TF in COVID-19 may be related to the pathogenesis of the disease, hence the importance of knowing the aspects related to this protein and the therapeutic strategies that can be derived. Different therapeutic strategies are being built to curb the expression of TF as a therapeutic target for various prothrombotic events; therefore, analyzing this treatment strategy for COVID-19-associated coagulopathy is rational. Medications such as celecoxib, cyclosporine or colchicine can impact on COVID-19, in addition to its anti-inflammatory effect, through inhibition of TF.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-03-31T08:49:26Z
      DOI: 10.1177/10760296211003983
      Issue No: Vol. 27 (2021)
       
  • Considerations for Patients With Peripheral Artery Disease During the
           COVID-19 Pandemic

    • Authors: Serdar Farhan, Haroon Kamran, Birgit Vogel, Karan Garg, Ajit Rao, Navneet Narula, Glenn Jacobowitz, Arthur Tarricone, Vishal Kapur, Peter Faries, Michael Marin, Jagat Narula, Robert Lookstein, Jeffrey W. Olin, Prakash Krishnan
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      New York City was one of the epicenters of the COVID-19 pandemic. The management of peripheral artery disease (PAD) during this time has been a major challenge for health care systems and medical personnel. This document is based on the experiences of experts from various medical fields involved in the treatment of patients with PAD practicing in hospitals across New York City during the outbreak. The recommendations are based on certain aspects including the COVID-19 infection status as well as the clinical PAD presentation of the patient. Our case-based algorithm aims at guiding the treatment of patients with PAD during the pandemic in a safe and efficient way.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-03-30T09:27:57Z
      DOI: 10.1177/1076029620986877
      Issue No: Vol. 27 (2021)
       
  • Oral Anticoagulant and Antiplatelet Therapy for Peripheral Arterial
           Disease: A Meta-analysis of Randomized Controlled Trials

    • Authors: Tao Tang, Ming Zhang, Wendong Li, Nan Hu, Xiaolong Du, Feng Ran, Xiaoqiang Li
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Peripheral artery disease (PAD) is a common disease affecting over 200 million people worldwide. PAD is associated with significant limb and cardiovascular morbidity and mortality which is reduced by antiplatelet and antithrombotic therapy. However, the optimal type, dose, and time of antithrombotic therapy is still uncertain.We searched 4 electronic databases from January 1, 1990, to June 1, 2020, for randomized controlled trials of patients who received oral anticoagulant and antiplatelet therapy for PAD. The primary outcome was a composite of acute limb ischemia, major amputation, myocardial infarction, ischemic stroke, death from cardiovascular events, or death from any cause. Secondary outcomes included major bleeding, fatal bleeding, and intracranial hemorrhage events.We identified 3 studies that satisfied inclusion and exclusion criteria. Compared with antiplatelet alone, oral anticoagulant plus antiplatelet therapy improved acute limb ischemia (p < 0.00001), stroke (p = 0.005), and major amputation events (p = 0.11). However, oral anticoagulant plus antiplatelet therapy was not effective for prevention of myocardial infarction (p = 0.23), death from cardiovascular events (p = 0.65), or death from any cause (p = 0.66). Additionally, a significant increase in major bleeding events was demonstrated (p < 0.00001). There was no significant difference in fatal bleeding (p = 0.16) or intracranial hemorrhage events (p = 0.43). This meta-analysis showed that oral anticoagulant plus antiplatelet therapy for PAD may improve acute limb ischemia and major amputation or stroke risk compared with antiplatelet therapy alone, but could increase the risk of major bleeding events. On the other hand, measuring myocardial infarction, death, fatal bleeding, or intracranial hemorrhage risk remains controversial.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-03-30T09:26:27Z
      DOI: 10.1177/1076029621996810
      Issue No: Vol. 27 (2021)
       
  • Comparison of Percutaneous Transluminal Angiography With or Without
           Catheter-Directed Thrombolysis for Chronic Femoropopliteal Occlusive
           Disease

    • Authors: Mengfei Yi, Jianjun Guo, Yanxia Gao, Jianzhuang Ren, Yonghua Bi, Xinwei Han
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Background:Catheter-directed thrombolysis (CDT) is seldom used for chronic femoropopliteal occlusive disease.Methods:Patients with chronic femoropopliteal occlusive disease enrolled between January, 2011 and April, 2017. Hospitalization expense, limb salvage rate and survival rate were calculated.Results:Twenty-nine patients were treated with CDT (CDT group) and 31 patients without CDT (Non-CDT group).The mean hospitalization expense (5.2 ± 0.5), balloon catheter (1.0 ± 0.2) and stents number (0.8 ± 0.2) in CDT group were significantly less compared to Non-CDT group (P < 0.05). The short-term and long-term effect scales showed similar in both groups. The incidences of perioperative complications (10.3% vs. 19.4%), primary patency and second patency rate, limb salvage rate (14.8% vs. 16.1%) and survival rate were also similar (P> 0.05). Six patients died in each group and only 2 disease related deaths were found in Non-CDT group.Conclusion:CDT is a safe and economic strategy for patients with chronic femoropopliteal occlusive disease, and should be served as blanket treatment for every patient without thrombolytic contradictions or a remedy for failure PTA to achieve a comparable clinical effect.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-03-30T09:25:38Z
      DOI: 10.1177/10760296211005025
      Issue No: Vol. 27 (2021)
       
  • Congenital Combined Bleeding Disorders, a Comprehensive Study of a Large
           Number of Iranian Patients

    • Authors: Seyed Esmaeil Ahmadi, Mohammad Jazebi, Gholamreza Bahoush, Mohammad Reza Baghaipour, Fereydoun Ala, Shadi Tabibian
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Congenital combined bleeding disorders (CBDs) are extremely rare disorders which mainly occur in regions with a high rate of consanguineous marriage. These disorders can present with a variety of symptoms ranging from mucocutaneous bleeding to life-threatening episodes. This study aims to evaluate the prevalence and clinical course of Iranian patients with congenital CBDs. This study is conducted on 450 patients with CBDs who were referred to the Iranian Comprehensive Hemophilia Care Center (ICHCC) between 2010 and 2020. All these patients were diagnosed through evaluation of past medical history and coagulation laboratory investigation. Out of 450 patients, 33 were entered in this study. Having excluded cases with factor (F) V and FVIII deficiency, as well as those with hereditary combined Vitamin K dependent clotting factor deficiency (VKCFD), We found the most common CBDs to be FV-FVII deficiency (n: 6, 18.1%), together with FVII and FX deficiency (n: 6, 18.1%). The most common reason for referral of these patients to ICHCC was postoperative bleeding (14.3%). The mean of The International Society on Thrombosis and Hemostasis-Bleeding Assessment Tool (ISTH-BAT) and condensed MCMDM-1VWD bleeding assessment tool were 9.6 ± 4.79 and 9.1 ± 4.87, respectively (P < 0.005). In 10 females of reproductive age, the mean of Pictorial Bleeding Assessment Chart (PBAC) score was 649.3 ± 554. Among all patients, 23 (69.7%) received on-demand replacement therapy, whereas 5 patients (15.1%) received prophylaxis. In Iran, the coinheritance of bleeding disorders is surprisingly higher than expected. Moreover, patients with congenital CBDs may experience serious bleeding manifestations.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-03-25T04:33:41Z
      DOI: 10.1177/1076029621996813
      Issue No: Vol. 27 (2021)
       
  • Determinants of Increased Fibrinogen in COVID-19 Patients With and Without
           Diabetes and Impaired Fasting Glucose

    • Authors: Zhenzhou Wang, Zhe Du, Xiujuan Zhao, Fuzheng Guo, Tianbing Wang, Fengxue Zhu
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Background:To investigate the factors associated with elevated fibrinogen (Fbg) levels in COVID-19 patients with and without diabetes (DM) and impaired fasting glucose (IFG).Methods:According to whether or not their glucose metabolism was impaired, COVID-19 patients were subdivided into 2 groups: 1) with DM and IFG, 2) control group. Their demographic data, medical history, signs and symptoms, laboratory results, and final clinical results were analyzed retrospectively.Results:28 patients (16.3%) died during hospitalization, including 21 (29.2%) in group 1 and 7 (7.0%) in group 2 (P < 0.001). Fbg levels in groups 1 and 2 were higher than the normal range, at 5.6 g/L (IQR 4.5–7.2 g/L) and 5.0 g/L (IQR 4.0–6.1 g/L), respectively (P = 0.009). Serum ferritin levels, C-reactive protein (CRP), interleukin-6 (IL-6), IL-8, tumor necrosis factor-α (TNF-α), triglycerides (TG) were significantly increased in group 1 compared to those in the control. TG levels were 1.3 mmol/L in the control, while that in group 1 was 1.8 mmol/L. Multiple linear regression showed that the predicting factors of Fbg in the control group were serum ferritin and CRP, R2 = 0.295; in group 1, serum ferritin, CRP, and TG, R2 = 0.473.Conclusions:Fbg in all COVID-19 patients is related to serum ferritin and CRP involved in inflammation. Furthermore, in COVID-19 patients with insulin resistance, Fbg is linearly positively correlated with TG. This suggests that regulation of TG, insulin resistance, and inflammation may reduce hypercoagulability in COVID-19 patients, especially those with insulin resistance.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-03-24T06:02:45Z
      DOI: 10.1177/1076029621996445
      Issue No: Vol. 27 (2021)
       
  • Interrelationship of MMP-9, Proteoglycan-4, and Inflammation in
           Osteoarthritis Patients Undergoing Total Hip Arthroplasty

    • Authors: Hannah Slovacek, Rajan Khanna, Pavel Poredos, Peter Poredos, Mateja Jezovnik, Debra Hoppensteadt, Jawed Fareed, William Hopkinson
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Osteoarthritis (OA) is a chronic condition marked by joint pain, inflammation and loss of articular cartilage, that can be treated with total joint arthroplasty (TJA) at end stages. TJA is marked by post-operative inflammation, which directly effects levels of cartilage degradation biomarkers, proteoglycan-4 (PRG4) and matrix metalloproteinase-9 (MMP-9). PRG4 is a protective glycoprotein that is decreased in individuals with OA. MMP-9 is a matrix metalloproteinase that contributes to articular cartilage loss and is elevated in OA patients. It is upregulated by pro-inflammatory markers, such as IL-1, IL-6 and CRP. This study aims to elucidate the immediate post-operative changes in levels of PRG4, MMP-9, IL-6, CRP, and WBC in patients undergoing TJA to clarify the role of inflammation in recovery after surgery and in the overall pathogenesis of OA. Blood was collected at 3 time points (day 0, day 1 post-operatively, and days 5-7 post-operatively), from 63 patients undergoing TJA due to OA, and levels of these biomarkers were quantified. IL-6, CRP, WBC and MMP-9 were lowest at day 0, highest at day 1, and stabilized at an intermediate level at days 5-7. Meanwhile, PRG4 followed the opposite trend. These studies suggest that IL-6, CRP and WBC showed predictable fluctuations, with pro-inflammatory biomarkers upregulating MMP-9 and downregulating PRG4. Measuring these biomarkers may help expose the role of inflammation in the post-surgical recovery of TJA patients and in long-term pathogenesis of OA. These levels may help risk stratify patients pre-operatively and help develop individualized post-surgical plans.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-03-23T09:22:49Z
      DOI: 10.1177/1076029621995569
      Issue No: Vol. 27 (2021)
       
  • Study on the Risk Factors of Preoperative Deep Vein Thrombosis (DVT) in
           Patients With Lower Extremity Fracture

    • Authors: Wenjie Chang, Bin Wang, Qiwei Li, Yongkui Zhang, Wenpeng Xie
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Objective:The objective of this work is to discuss and analyze the related factors of lower extremity fracture complicated by preoperative deep vein thrombosis (DVT).Methods:A total of 11,891 patients with closed fractures of lower extremities were selected. By analyzing each patient’s gender, age, presence or absence of diabetes and hypertension, preoperative plasma D-dimer level, and color Doppler ultrasound of the lower extremity vein, the pertinent factors of the patients with lower extremity fractures complicated by preoperative DVT were analyzed.Results:A total of 578 with preoperative DVT were detected, displaying a total incidence of 4.86%. All patients were categorized into either the DVT group or non-DVT group. The results demonstrate that there were statistically significant differences between the 2 groups in age, the presence of diabetes and hypertension, the fracture site, and the preoperative plasma D-dimer level (P < 0.05). Logistic multivariate analysis revealed that age, the presence of diabetes, and the preoperative plasma D-dimer level of patients were independent risk factors for lower extremity fracture complicated by DVT.Conclusion:Age, the presence of diabetes, the fracture site, and increased D-dimer levels were found to be potential risk factors and indicators for preoperative DVT in patients with lower extremity fractures. In addition, the preoperative plasma D-dimer level has certain guiding significance for the prediction of venous thrombosis after lower extremity fracture, which is conducive to the early prediction and diagnosis of DVT, but it often must be followed with good clinic acumen and examinations.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-03-23T09:21:02Z
      DOI: 10.1177/10760296211002900
      Issue No: Vol. 27 (2021)
       
  • The Incidence and Location of Deep Vein Thrombosis in Lower Extremity
           Fracture Patients Receiving Sequential Chemical Prophylaxis

    • Authors: Peng-Fei Wang, Bin-Fei Zhang, Hanzhong Xue, Yan Zhuang, Zhong Li, Yanjun Zhu, Kun Zhang, Ping Liu
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      To investigate the incidence and location of deep vein thrombosis (DVT) in patients with lower extremity fractures receiving pharmacological thromboprophylaxis with LMWH followed by rivaroxaban. All patients aged ≥18 years with lower extremity fractures were included in the study. Duplex ultrasonography (DUS) was performed in the lower extremities before and after surgery for DVT evaluation. According to the location, the DVT was divided into proximal, distal, and mixed thromboses. According to fracture location, patients were classified as having fractures proximal, around, and distal to the knee. All patients received sequential chemical prophylaxis. A total of 404 patients with a mean age of 44.2 ± 13.8 years were included. The incidence of DVT postoperatively was higher than that preoperatively and at 1 month postoperatively. Patients with fractures proximal and around the knee had higher DVT incidences detected on DUS postoperatively and at 1 month postoperatively. Most DVTs were located in the distal vein. DVT incidence and severity were the highest immediately after surgery. DVT incidence in fractures around and proximal to the knee increased after surgery and at 1 month postoperatively. Although with chemical thromboprophylaxis, distal DVT was the most variable during the early stage.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-03-23T06:16:48Z
      DOI: 10.1177/1076029620987630
      Issue No: Vol. 27 (2021)
       
  • A Correlation Between Monocyte to Lymphocyte Ratio and Long-Term Prognosis
           in Patients With Coronary Artery Disease After PCI

    • Authors: Feng-Hua Song, Ying-Ying Zheng, Jun-Nan Tang, Wei Wang, Qian-Qian Guo, Jian-Chao Zhang, Yan Bai, Kai Wang, Meng-Die Cheng, Li-Zhu Jiang, Ru-Jie Zheng, Lei Fan, Zhi-Yu Liu, Xin-Ya Dai, Zeng-lei Zhang, Xiao-ting Yue, Jin-Ying Zhang
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Monocyte to lymphocyte ratio (MLR) has been confirmed as a novel marker of poor prognosis in patients with coronary heart disease (CAD). However, the prognosis value of MLR for patients with CAD after percutaneous coronary intervention (PCI) needs further studies. In present study, we aimed to investigate the correlation between MLR and long-term prognosis in patients with CAD after PCI. A total of 3,461 patients with CAD after PCI at the First Affiliated Hospital of Zhengzhou University were included in the analysis. According to the cutoff value of MLR, all of the patients were divided into 2 groups: the low-MLR group (
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-03-22T02:11:08Z
      DOI: 10.1177/1076029621999717
      Issue No: Vol. 27 (2021)
       
  • Efficacy of Monitoring Platelet Function by an Automated PL-12 Analyzer
           During the Treatment of Acute Cerebral Infarction With Antiplatelet
           Medicine

    • Authors: Cen Yue, Zhiwei Lin, Congxia Lu, Hanshui Chen
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Numerous methods can be used to investigate the function of platelets; however, technical issues limit tends to limit the applicability of such methods in the clinic.Methods:All participants were administered with oral aspirin (100 mg/d) for 7 days. Blood samples were then collected and platelet function evaluated by an automated PL-12 analyzer, TEG, and the platelet count drop method. We found that platelet counts determined by the traditional platelet drop method were significantly lower in the PL-12 sensitive group and significantly higher in the PL-12 insensitive group (P < 0.05). Furthermore, MAR measured by PL-12 was positively correlated with the MA values determined by TEG and the platelet drop method (r = 0.322, r = 0.036, respectively, P < 0.05), More importantly, the PL-12 analyzer showed the largest AUC (0.748) with a sensitivity of 87.4% and a specificity of 57.4%, indicating PL-12 analyzer using in platelet aggregation evaluation of ACI patients more credibly and accuracy. Additionally, genetic analysis showed that the polymorphic of A-allele in the PEAR1 (rs12041331) gene was significantly increased in the PL-12 sensitive group rather than in the PL-12 insensitive group (P < 0.05), suggesting the predictive value of PL-12 analyzer for the prognosis of ACI patients was superior to the other methods tested herein. Our analyses demonstrate that PL-12 analysis offer a new superior technology for monitoring antiplatelet drug efficacy and for clinical prognosis of ACI patients, which has the advantages of simplicity, speed, and automation in platelet aggregation measurement.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-03-22T02:07:28Z
      DOI: 10.1177/10760296211001119
      Issue No: Vol. 27 (2021)
       
  • Performance Characteristics of DOAC Dipstick in Determining Direct Oral
           Anticoagulants in Urine

    • Authors: Job Harenberg, Andrea Martini, Shanshan Du, Sandra Krämer, Christel Weiss, Svetlana Hetjens
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Testing for direct oral anticoagulants (DOACs) in patient urine may facilitate medical treatment decisions. The aim of this study was to investigate interobserver variability by 2 independent observers compared to laboratory staff in the visual interpretation of factor Xa (DXI) and thrombin inhibitors (DTI) using the DOAC Dipstick test. We also examined whether test pads reacted to other anticoagulants and abnormal urine colors. The colors of the DOAC Dipstick direct factor Xa inhibitor and thrombin inhibitor pads were interpreted with 100% accuracy (95% confidence interval 0.862 to 1.000) for urine samples from persons treated with apixaban (n = 26), rivaroxaban (n = 24), and dabigatran (n = 29) and without anticoagulant therapy (n = 29). The factor Xa and thrombin inhibitor pads did not interact with heparin, nadroparin, fondaparinux, or coumadin. One µg/mL r-Hirudin and 6 µg/mL argatroban interacted with the DTI pad; however, this is unlikely to cause clinical problems because dabigatran is unlikely to be administered together with r-Hirudin and argatroban in clinical circumstances. Abnormal urine color was reliably detected by the urine color pad, so can prevent false interpretation of the DOAC Dipstick pad colors. In conclusion, we have demonstrated that interobserver variability when interpreting the DOAC Dipstick test strip is low and that factor Xa and thrombin inhibitor pads do not react to other anticoagulants such as heparins and coumadin. R-Hirudin and argatroban can be detected by the thrombin inhibitor pad and abnormal urine colors can be detected by the urine color pad to prevent false interpretation of the results in patient urine samples.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-03-18T02:58:51Z
      DOI: 10.1177/1076029621993550
      Issue No: Vol. 27 (2021)
       
  • Persons With Hemophilia of Generation Y and Their Relatives Attitudes and
           Expectations From Treatment

    • Authors: Bulent Zulfikar, Basak Koc, Irmak Gumustas, Haluk Zulfikar
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      This multicenter cohort study aimed to determine the attitudes and expectations of persons with hemophilia of Generation Y (PwH-Y) toward hemophilia and its treatment comparatively with the opinions of their non-hemophiliac relatives. The study was representative regarding quota-control variables of hemophiliacs registered to the provincial representatives of the Hemophilia Society of Turkey in 4 geographic regions and Istanbul. Sixty-four PwH-Y (62 males) and their 56 first-degree relatives (17 males; Generation X/baby boomers) were interviewed face-to-face using mixed data collection method. “Focus Group Study” method was used for qualitative data. Treatment adherence, requirements, and social activities were questioned with a semi-structured form. Treatment adherence rate of the PwH-Y (46.2%) was lower than that perceived by their relatives (71.4%) (p ≤ 0.05). Vascular access problems were the most common reasons for non-adherence (60% in PwH-Y and 25% in relatives). Among the components the hemophiliacs and their relatives needed most, support for accessibility of drugs/treatment ranked first (41.1% and 45%, respectively), followed by emotional support (26.1% and 32.5%, respectively). For increasing treatment success in PwH-Y, treatment should be personalized and shaped based on personal requirements.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-03-18T02:56:52Z
      DOI: 10.1177/10760296211000131
      Issue No: Vol. 27 (2021)
       
  • FM Combined With NIHSS Score Contributes to Early AIS Diagnosis and
           Differential Diagnosis of Cardiogenic and Non-Cardiogenic AIS

    • Authors: Dan Wu, Yong’e Liu
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      A growing researchers have suggested that fibrin monomer (FM) plays an important role in early diagnosis of thrombotic diseases. We explored the application of FM in the diagnosis and classification of acute ischemic stroke (AIS). The differences in FM, D-dimer, and NIHSS scores between different TOAST (Trial of ORG 10172 in Acute Stroke Treatment) types were analyzed with one-way ANOVA; the correlation between FM, D-dimer and NIHSS score in patients with different TOAST classification was analyzed by Pearson linear correlation. The ROC curve was utilized to analyze the diagnostic performance. 1. FM was more effective in diagnosing patients with AIS than D-dimer. 2. The FM level in cardiogenic AIS was significantly different from that in non-cardiogenic patients (P < 0.05); the NIHSS score in cardiogenic stroke was significantly higher than in atherosclerotic and unexplained stroke group. Whereas, no statistical difference was observed in the D-dimer level between these groups (P> 0.05). 3. The correlation between FM and NIHSS scores in the cardiogenic (r = 0.3832) and atherosclerotic (r = 0.3144) groups was statistically significant. 4. FM exhibited the highest diagnostic efficacy for cardiogenic AIS; furthermore, FM combined with the NIHSS score was more conducive to the differential diagnosis of cardiogenic and non-cardiogenic AIS. FM detection contributes to the early diagnosis of AIS, and is important for the differential diagnosis of different TOAST types of AIS. Moreover, FM combined with the NIHSS score is valuable in the differential diagnosis of cardiogenic and non-cardiogenic AIS.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-03-16T04:40:01Z
      DOI: 10.1177/10760296211000129
      Issue No: Vol. 27 (2021)
       
  • Pulmonary Embolism Does Not Have an Unusually High Incidence Among
           Hospitalized COVID19 Patients

    • Authors: Nicolas Gallastegui, Jenny Y. Zhou, Annette von Drygalski, Richard F. W. Barnes, Timothy M. Fernandes, Timothy A. Morris
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Introduction:Acute respiratory illnesses from COVID19 infection are increasing globally. Reports from earlier in the pandemic suggested that patients hospitalized for COVID19 are at particularly high risk for pulmonary embolism (PE). To estimate the incidences of PE during hospitalization for COVID19, we performed a rigorous systematic review of published literature.Methods:We searched for case series, cohort studies and clinical trials from December 1, 2019 to July 13, 2020 that reported the incidence of PE among consecutive patients who were hospitalized for COVID19 in ICUs and in non-ICU hospital wards. To reflect the general population of hospitalized COVID19 patients, we excluded studies in which subject enrollment was linked to the clinical suspicion for venous thromboembolism (VTE).Results:Fifty-seven studies were included in the analysis. The combined random effects estimate of PE incidence among all hospitalized COVID19 patients was 7.1% (95% CI: 5.2%, 9.1%). Studies with larger sample sizes reported significantly lower PE incidences than smaller studies (r2 = 0.161, p = 0.036). The PE incidence among studies that included 400 or more patients was 3.0% (95% CI: 1.7%, 4.6%). Among COVID19 patients admitted to ICUs, the combined estimated PE incidence was 13.7% (95% CI: 8.0%, 20.6%). The incidence of ICU-related PE also decreased as the study sample sizes increased. The single largest COVID19 ICU study (n = 2215) disclosed a PE incidence of 2.3% (95% CI: 1.7%, 3.0%).Conclusion:PE incidences among hospitalized COVID19 patients are much lower than has been previously postulated based on smaller, often biased study reports. The incidence of “microthrombosis,” leading to occlusion of microscopic blood vessels, remains unknown.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-03-10T05:45:47Z
      DOI: 10.1177/1076029621996471
      Issue No: Vol. 27 (2021)
       
  • Homozygous Prekallikrein Deficiency in the USA: Several Patients but Still
           Few Mutation Studies

    • Authors: Antonio Girolami, Silvia Ferrari
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.

      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-03-03T08:07:56Z
      DOI: 10.1177/1076029621998773
      Issue No: Vol. 27 (2021)
       
  • Serum Adenosine Deaminase as a Useful Marker to Estimate Coronary Artery
           Calcification in Type 2 Diabetes Mellitus Patients

    • Authors: Ming Yu, Hanyun Zhou, Qingan Li, Juan Ding, Hongxia Shuai, Ji Zhang
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      We investigated the association between serum adenosine deaminase and coronary artery calcification (CAC) in type 2 diabetes mellitus (T2DM) patients. The cross-sectional study included 459 patients with T2DM, the clinical and laboratory tests were performed, and all T2DM patients were separated into the 3 groups based on the tertile of serum adenosine deaminase levels. In the baseline data, the CAC score had statistically significant differences between the 3 groups (p < 0.001). Serum adenosine deaminase levels were positively correlated with CAC score in T2DM patients (r = 0.355, p < 0.001). The results of multiple linear regression analysis showed that serum adenosine deaminase was independent positively correlated with CAC score in T2DM patients (r = 0.255, p < 0.001). Receiver-operating characteristic curve analysis showed that area under curve was 0.750 to identify T2DM patients with CAC. Serum adenosine deaminase levels are correlated with CAC scores in T2DM patients, clinically, serum adenosine deaminase should be considered as an underlying marker to determine the severity of atherosclerosis in T2DM patients.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-03-02T06:00:57Z
      DOI: 10.1177/1076029621999722
      Issue No: Vol. 27 (2021)
       
  • The Net Clinical Benefit of Rivaroxaban Compared to Low-Molecular-Weight
           Heparin in the Treatment of Cancer-Associated Thrombosis: Systematic
           Review and Meta-Analysis

    • Authors: Mouhand F. H. Mohamed, Mohamad Nabil ElShafei, Mohamed Badie Ahmed, Lina O. Abdalla, Israa Ahmed, Abdel-Naser Elzouki, Mohammed ibn-mas’ud Danjuma
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Cancer-associated thrombosis (CAT) carries significant morbidity and mortality. Low-molecular-weight heparin (LMWH) remains the standard of care, with recent systematic studies suggesting the efficacy and safety of rivaroxaban in the treatment of CAT. Uncertainty, however, remains regarding rivaroxaban efficacy and safety in real-world settings. We performed a systematic review and meta-analysis of studies comparing rivaroxaban to LMWH. We searched PubMed, MEDLINE, and EMBASE. The primary outcome was the net clinical benefit (NCB), while rates of major bleeding (MB), venous thromboembolism (VTE), clinically relevant nonmajor bleeding (CRNMB), and all-cause mortality events were secondary outcomes. Seventeen studies were included in the final analysis. Rivaroxaban had a better NCB (relative risk [RR] = 0.82; 95% CI = 0.75-0.89, Q = 10.51, I 2 = 0%), less VTE events (RR = 0.73, 95% CI = 0.65-0.82, Q = 6.76, I 2 = 0%), and lower all-cause mortality (RR = 0.72, 95% CI = 0.57-0.91, Q = 32.8, I 2 = 79%) compared to LMWH. Additionally, comparable MB events (RR = 1.07, 95% CI = 0.85-1.33, Q = 16.9, I 2 = 11%). However, CRNMB events were higher in the rivaroxaban group (RR = 2.02, 95% CI = 1.46-2.80, Q = 9.9, I 2 = 19%). Additional analyses demonstrated consistency of results. Our review encompassing data from randomized and real-world data suggested rivaroxaban superiority compared to LMWH in terms of a better NCB, fewer VTE events, lower all-cause mortality, and comparable MB risk while carrying a higher risk of CRNMB. These findings support the use of rivaroxaban in the treatment of CAT. Additionally, it warrants a sizable randomized controlled study testing the superiority of rivaroxaban versus LMWH formulation and ascertaining bleeding outcomes according to cancer type and site.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-03-02T05:36:32Z
      DOI: 10.1177/1076029620940046
      Issue No: Vol. 27 (2021)
       
  • A Machine Learning Approach to Predict Deep Venous Thrombosis Among
           Hospitalized Patients

    • Authors: Logan Ryan, Samson Mataraso, Anna Siefkas, Emily Pellegrini, Gina Barnes, Abigail Green-Saxena, Jana Hoffman, Jacob Calvert, Ritankar Das
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Deep venous thrombosis (DVT) is associated with significant morbidity, mortality, and increased healthcare costs. Standard scoring systems for DVT risk stratification often provide insufficient stratification of hospitalized patients and are unable to accurately predict which inpatients are most likely to present with DVT. There is a continued need for tools which can predict DVT in hospitalized patients. We performed a retrospective study on a database collected from a large academic hospital, comprised of 99,237 total general ward or ICU patients, 2,378 of whom experienced a DVT during their hospital stay. Gradient boosted machine learning algorithms were developed to predict a patient’s risk of developing DVT at 12- and 24-hour windows prior to onset. The primary outcome of interest was diagnosis of in-hospital DVT. The machine learning predictors obtained AUROCs of 0.83 and 0.85 for DVT risk prediction on hospitalized patients at 12- and 24-hour windows, respectively. At both 12 and 24 hours before DVT onset, the most important features for prediction of DVT were cancer history, VTE history, and internal normalized ratio (INR). Improved risk stratification may prevent unnecessary invasive testing in patients for whom DVT cannot be ruled out using existing methods. Improved risk stratification may also allow for more targeted use of prophylactic anticoagulants, as well as earlier diagnosis and treatment, preventing the development of pulmonary emboli and other sequelae of DVT.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-02-24T05:31:49Z
      DOI: 10.1177/1076029621991185
      Issue No: Vol. 27 (2021)
       
  • The Evaluation of APTT Reagents in Reference Plasma, Recombinant FVIII
           Products; Kovaltry® and Jivi® Using CWA, Including sTF/7FIX Assay

    • Authors: Hideo Wada, Katsuya Shiraki, Takeshi Matsumoto, Kohshi Ohishi, Hideto Shimpo, Yumi Sakano, Hiroko Nishii, Motomu Shimaoka
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      The FVIII activity in patients treated with several extended half-life FVIII (EHL-FVIII) agents different when various activated partial thromboplastin time (APTT) reagents were used. The present study examined the difference in clot waveform analysis (CWA) findings and FVIII activity when various APTT reagents and CWA were used. The CWA including FVIII activity was measured using 12 APTT reagents, and the FIX activation based on a small amount of tissue factor assay (sTF/FIX) were examined in reference plasma (RP), EHL-FVIII (Jivi®) and Kovaltry®. The 3 APTT reagents were associated with high variation in the peak time and height in the CWA when analyzing low concentrations of FVIII. The peak time and height could not be measured with one APTT reagent, and there were marked differences in the CWA findings between Jivi® and Kovaltry® among APTT reagents. Several APTT reagents showed a markedly lower FVIII activity with Jivi® than with Kovaltry®. In the FVIII assay, the peak time measured with sTF/FIX did not differ markedly between Jivi® and Kovaltry®; however, the FVIII activity in Jivi® (as measured by the peak height) tended to be higher than in Kovaltry®. The CWA findings for monitoring Jivi® varied for monitoring Jivi® depending on the APTT reagents used, and sTF/FIX assay may be able to measure the EHL-FVIII.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-02-20T12:36:50Z
      DOI: 10.1177/1076029620976913
      Issue No: Vol. 27 (2021)
       
  • Risk Assessment and Outcome of Venous Thromboembolism in Pediatric
           Population in an Academic Care Center of a Low-Middle Income Country

    • Authors: Muhammed Wahhaab Sadiq, Ronika Devi Ukrani, Aiman Arif, Inaara Akbar, Sadaf Altaf, Bushra Moiz
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Venous thromboembolism (VTE) is a recognized complication of hospital stay in young patients in many developed countries, but such an information is largely unavailable from a low middle-income country (LMIC). This study aimed at identifying the frequency, risk factors, treatment options and outcome of deep venous thrombosis/pulmonary embolism (DVT/PE) in pediatric population in a tertiary care center from a LMIC. International classification of disease, ninth revision (ICD-9) was used to identify VTE in patients aged 0-18 years during January 2011 to September 2019. In-house computerized system was used to collect data for demographics, clinical and laboratory details. SPSS version 19 was used to analyzed data. The study was approved by Institutional ethical review committee (3872-Pat-ERC-15). During the study period, 134617 pediatric patients were hospitalized, DVT/PE was observed in 77 unique patients (47 males and 30 females) with a median (IQR) age of 14 (5-16) years equivalent to 5.9 VTE events /10,000 hospital admissions. Malignancy, community acquired infections and autoimmune diseases were the predominant risk factors (75%) in adolescent age-group while surgery for congenital heart anomalies was the primary reason (71%) in infants. Overall, lower extremity thrombosis was the most frequent (51%) followed by pulmonary embolism (25%). and upper extremity thrombosis (24%). Enoxaparin and unfractionated heparin were mainly used to treat VTE and all-cause mortality was 13% in the cohort studied. We observed substantial VTE events in pediatric patients during their hospital stay in a tertiary care center of a low-middle income country.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-02-19T10:18:22Z
      DOI: 10.1177/1076029621995895
      Issue No: Vol. 27 (2021)
       
  • Solid Tumor Complicated With Venous Thromboembolism: A 10-Year
           Retrospective Cross-Sectional Study

    • Authors: Miao Peng, Shengli Yang, Guiling Li, Tao Zhang, Xiaojuan Qin, Chen Shi, Jian Chang, Mengni Chen, Chen Chen, Bingjie Li, Sihang Cao, Ting Li, Renwang Chen, Prapti Bakhshi, Min Jin, Gang Wu, Jianli Hu
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT) occurs more frequently in cancer patients than in the general population. A retrospective cross-sectional study was carried out in patients with solid tumor complicated with VTE admitted to the Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 1st, 2008 and December 31th, 2017. The incidence of VTE in hospitalized cancer patients was 1.8%, twice the incidence of VTE in hospitalized non-cancer patients. The annual incidence of cancer-associated VTE in our center varied between 1.6% in 2015 and 0.4% in 2009 with an overall average incidence of 1.3% over the research decade. BMI values of 549(67.7%) cancer patients were within the normal range, but none of patients had BMI greater than 35 kg/m2. 747(92.1%) cancer patients had ECOG PS score ≤ 2 and 481(59.3%) had distant metastasis. Patients with pancreatic, bladder, ovarian and endometrial cancer had the highest incidence of VTE. Upper extremity DVT (47.2%) was more common in cancer patients and might be closely associated with CVC (74.9%), while lower extremities DVT (36.1%) intended to PE development (15.0%). The annual incidence rates showed a fluctuating and upward trend over the research decade. VTE occurrence was closely related to tumor stage, tumor site, catheterization and anti-neoplasm therapy in cancer patients.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-02-16T07:22:22Z
      DOI: 10.1177/1076029620975484
      Issue No: Vol. 27 (2021)
       
  • Phase 4 Safety and Efficacy Study of Antihemophilic Factor (Recombinant)
           in Previously Treated Chinese Patients With Severe/Moderately Severe
           Hemophilia A

    • Authors: Yongqiang Zhao, Yu Hu, Jie Jin, Xielan Zhao, Xuefeng Wang, Runhui Wu, Depei Wu, Renchi Yang, Feng’e Yang, Qun Hu, Juan Wang, Hai Fang, Werner Engl
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Antihemophilic factor (recombinant) (rAHF; ADVATE®; Baxalta US Inc., a Takeda company, Lexington, MA, USA) is indicated for the treatment and prevention of bleeding in patients with hemophilia A. We aimed to assess the safety and efficacy of standard prophylaxis versus on-demand treatment with rAHF in previously treated Chinese patients with severe/moderately severe hemophilia A. This open-label, sequential, interventional, postapproval study (NCT02170402) conducted in China included patients of any age with hemophilia A with factor VIII (FVIII) level ≤2%. Patients received 6 months’ on-demand rAHF then 6 months’ rAHF prophylaxis (20-40 IU/kg every 48 ± 6 hours). The primary objective was percentage reduction in annualized bleeding rate (ABR) in the per-protocol analysis set (PPAS); secondary objectives included ABR by bleeding subtype, hemostatic efficacy, immunogenicity, and safety. Of 72 patients who received ≥1 rAHF dose, 61 were included in the PPAS. Total ABR was lower during prophylaxis (mean 2.5, 95% CI 1.5-3.7; median 0) versus on-demand treatment (mean 58.3, 95% CI 52.5-64.7; median 53.9), representing a 95.9% risk reduction. Similar findings in favor of prophylaxis were observed for all types of bleeding event by cause and location. rAHF hemostatic efficacy was rated as “excellent”/“good” in 96.1% of treated bleeding events. Transient FVIII inhibitors (0.6-1.7 BU) in 4 patients resolved before study end; no unexpected safety issues were observed. rAHF prophylaxis in this study of previously treated Chinese patients with severe/moderately severe hemophilia A resulted in a clear reduction in bleeding events versus rAHF on-demand treatment, with no change in safety profile.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-02-15T08:10:30Z
      DOI: 10.1177/1076029621989811
      Issue No: Vol. 27 (2021)
       
  • Biomarkers of Platelet Activation and Their Prognostic Value in Patients
           With Sepsis-Associated Disseminated Intravascular Coagulopathy

    • Authors: Gracelene Wegrzyn, Amanda Walborn, Matthew Rondina, Jawed Fareed, Debra Hoppensteadt
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Sepsis-associated disseminated intravascular coagulation (DIC) is related to marked hemostatic changes such as transient thrombocytopenia secondary to the endogenous activation and consumption of platelets. This study measured markers of platelet function in 103 adult ICU patients with clinically established sepsis-associated DIC to determine the biomarker association with disease severity. Patients were categorized as having no DIC, nonovert DIC, or overt DIC using the International Society of Thrombosis and Hemostasis scoring system. Plasma levels of CD40L, platelet factor 4 (PF4), platelet-derived microparticles, and microparticle-associated tissue factor were quantified. Markers of platelet activation were significantly elevated in patients with DIC compared to healthy individuals. This increase was independent of platelet count. Levels of PF4 differed based on the severity of DIC and differentiated nonsurvivors and survivors. These findings suggest that the markers of platelet activation in DIC may not be regulated by the number of circulating platelets and may be independent of the factors leading to their consumption.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-02-15T06:59:15Z
      DOI: 10.1177/1076029620943300
      Issue No: Vol. 27 (2021)
       
  • Venous Thromboembolism, Corticosteroids and COVID-19: A Systematic Review
           and Meta-Analysis

    • Authors: Azza Sarfraz, Zouina Sarfraz, Aminah Abdul Razzack, Gaurav Patel, Muzna Sarfraz
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      The novel coronavirus disease 2019 (COVID-19) predisposes patients to venous thromboembolism (VTE) due to risk factors, severe infection, and severe inflammatory responses. The objective is to determine the risk of developing VTE after corticosteroid administration during COVID-19 treatment. Using PRISMA reporting guidelines, a review was conducted from inception until 20 September 2020 with MESH terms including “venous thromboembolism” and “covid-19,” using MEDLINE, Scopus, CINAHL Plus, and WHO Global Database. The inclusion criteria included studies with COVID-19 patients aged 18 years and older with VTE diagnosed by duplex ultrasonography or computed tomography pulmonary angiography (CTPA). Exclusion criteria were studies with non COVID-19 patients and non-VTE patients aged less than 18 years. Quality appraisal was conducted of included studies using the Newcastle-Ottawa Scale (NOS). A random-effect model using 95% confidence intervals, and significance of findings was assessed using Review Manager V5.4.We included 12 observational studies with 2801 patients (VTE n = 434; non-VTE; n = 2367). Patients had a higher risk of presenting with VTE when being administered corticosteroids during treatment of COVID-19 (RR = 1.39, 95% CI = 1.10 to 1.77, I2 = 0%). A positive effect size was found (SMD = 1.00, 95% CI = 0.67 to 1.32, I2 = 85%) for D-dimer laboratory values (µg/mL) in the VTE group. While critically ill COVID-19 patients are more likely to require corticosteroid treatment, it may be associated with increased risk of VTE, and poor clinical prognosis. Risk assessment is warranted to further evaluate patients as case-by-case in reducing VTE and worsening clinical outcomes.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-02-11T06:08:57Z
      DOI: 10.1177/1076029621993573
      Issue No: Vol. 27 (2021)
       
  • Device-Induced Hemostatic Disorders in Mechanically Assisted Circulation

    • Authors: Shigang Wang, Bartley P. Griffith, Zhongjun J. Wu
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Mechanically assisted circulation (MAC) sustains the blood circulation in the body of a patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) or on ventricular assistance with a ventricular assist device (VAD) or on extracorporeal membrane oxygenation (ECMO) with a pump-oxygenator system. While MAC provides short-term (days to weeks) support and long-term (months to years) for the heart and/or lungs, the blood is inevitably exposed to non-physiological shear stress (NPSS) due to mechanical pumping action and in contact with artificial surfaces. NPSS is well known to cause blood damage and functional alterations of blood cells. In this review, we discussed shear-induced platelet adhesion, platelet aggregation, platelet receptor shedding, and platelet apoptosis, shear-induced acquired von Willebrand syndrome (AVWS), shear-induced hemolysis and microparticle formation during MAC. These alterations are associated with perioperative bleeding and thrombotic events, morbidity and mortality, and quality of life in MCS patients. Understanding the mechanism of shear-induce hemostatic disorders will help us develop low-shear-stress devices and select more effective treatments for better clinical outcomes.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-02-11T06:06:18Z
      DOI: 10.1177/1076029620982374
      Issue No: Vol. 27 (2021)
       
  • The Role of IL-13, IL-15 and Granulysin in the Pathogenesis of
           Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

    • Authors: Michael Sadek, Omer Iqbal, Fakiha Siddiqui, Sean Till, Melissa Mazariegos, Edward Campbell, Kumaran Mudaliar, Jodi Speiser, Emily Bontekoe, Ahmed Kouta, Ambar Farooqui, Bharathi Daravath, Dalia Qneibi, Ramy Sadek, Debra Hoppensteadt, Jawed Fareed, Charles Bouchard
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are Severe Cutaneous Adverse Reactions (SCARS) characterized by fever and mucocutaneous lesions leading to necrosis and sloughing of the epidermis. Conjunctival lesions are reported in 85% of patients. The pathogenesis of SJS/TEN/SCARS is not completely understood. It is hypothesized that IL-13, IL-15 and Granulysin expressed in plasma and skin may play a role. We measured the circulating levels of these cytokines in the plasma using ELISA and their expression in the skin using immunofluorescence microscopy. A total of 12 SJS/TEN skin biopsy samples (8 SJS, 2 SJS/TEN overlap and 2 TEN) were analyzed. Biopsy samples from patients with Lichen Planus (an inflammatory condition of the skin and mucous membranes) served as controls. Studies were also performed in human corneal epithelial cells where expression of these cytokines were measured following a challenge with TNF-α (0, 1, 10 and 100 ng/ml). The intensity of immunofluorescence was measured Using Imaris® software. The results showed significantly increased expression of these cytokines in the skin biopsy samples as measured by the average intensities of IL-13 (6.1 x 133.0 ± 4.231 x 10^8), and Granulysin (4.2 x 123.0 ± 4.231 x 10^8) compared to Lichen planus control (3.0 x 123.0 ±1.62 x 10^5). Increased expression of IL-13 and IL-15 were noted in cell culture studies and in the plasma samples when compared to Normal Human Plasma as controls. It is concluded that IL-13, IL-15 and Granulysin play a role in the pathogenesis of SJS/TEN.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-02-09T05:41:58Z
      DOI: 10.1177/1076029620950831
      Issue No: Vol. 27 (2021)
       
  • Secretion of von Willebrand Factor and Suppression of ADAMTS-13 Activity
           by Markedly High Concentration of Ferritin

    • Authors: Dalia A. Bashir, Qi Da, Subhashree Pradhan, Nitin Sekhar, Christian Valladolid, Fong Lam, Danielle Guffey, Jordana Goldman, Moreshwar S. Desai, Miguel A. Cruz, Carl Allen, Trung C. Nguyen, K. Vinod Vijayan
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Hyperferritinemia is associated with poor outcomes in critically ill patients with sepsis, hemophagocytic lymphohistiocytosis (HLH), macrophage activation syndromes (MAS) and coronavirus disease 19 (COVID-19). Autopsies of hyperferritinemic patients that succumbed to either sepsis, HLH, MAS or COVID-19 have revealed disseminated microvascular thromboses with von Willebrand factor (VWF)-, platelets-, and/or fibrin-rich microthrombi. It is unknown whether high plasma ferritin concentration actively promotes microvascular thrombosis, or merely serves as a prognostic biomarker in these patients. Here, we show that secretion of VWF from human umbilical vein endothelial cells (HUVEC) is significantly enhanced by 100,000 ng/ml of recombinant ferritin heavy chain protein (FHC). Ferritin fraction that was isolated by size exclusion chromatography from the plasma of critically ill HLH patients promoted VWF secretion from HUVEC, compared to similar fraction from non-critically ill control plasma. Furthermore, recombinant FHC moderately suppressed the activity of VWF cleaving metalloprotease ADAMTS-13. These observations suggest that a state of marked hyperferritinemia could promote thrombosis and organ injury by inducing endothelial VWF secretion and reducing the ADAMTS-13 activity.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-02-04T08:26:54Z
      DOI: 10.1177/1076029621992128
      Issue No: Vol. 27 (2021)
       
  • Rationale for the Role of Heparin and Related GAG Antithrombotics in
           COVID-19 Infection

    • Authors: Harry N. Magnani
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      The SARS-CoV-2 pandemic has focused attention on prevention, restriction and treatment methods that are acceptable worldwide. This means that they should be simple and inexpensive. This review examines the possible role of glycosaminoglycan (GAG) antithrombotics in the treatment of COVID-19. The pathophysiology of this disease reveals a complex interplay between the hemostatic and immune systems that can be readily disrupted by SARS-CoV-2. Some of the GAG antithrombotics also possess immune-modulatory actions and since they are relatively inexpensive they could play an important role in the management of COVID-19 and its complications.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-02-04T08:23:55Z
      DOI: 10.1177/1076029620977702
      Issue No: Vol. 27 (2021)
       
  • Time Course of Inflammatory and Procoagulant Markers in the Early Period
           After Total Hip Replacement

    • Authors: Peter Poredos, Pavel Poredos, Mateja K. Jezovnik, Ana Mavric, Lara Leben, Mojca Bozic Mijovski, Paula Maia, Sandra Haddad, Jawed Fareed
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Our study aimed to investigate the levels and time-course of systemic inflammatory and hemostasis markers in the early postoperative period in patients undergoing total hip replacement (THR). The study included 70 patients of both sexes, average age 68.4 ± 10.9 years. Levels of inflammatory and hemostasis markers were measured before surgery (POD 0), a day after the surgery (POD 1) and 5 days after surgery (POD 5). In the postoperative period inflammatory markers increased. The operation provoked a significant increase of CRP on POD 1 in comparison to POD 0 (68.5 ± 5.4 vs 6.8 ± 2.2 μg/mL, p < 0.001) and the additional increase was registered on POD 5 (87.5 ± 8.1 vs 68.5 ± 5.4 μg/mL, p < 0.001). Interleukin-6 significantly increased on POD 1 (251.5 ± 21.6 vs 14.6 ± 7.1 μg/mL, p < 0.001) and after that (POD 5) decreased. After surgery leukocyte count, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were significantly higher compared to POD 0. Activation of coagulation in the postoperative period was shown by increased peak thrombin on POD 5 in comparison to POD 0 (185 ± 27 vs. 124 ± 31 nM, p < 0.001). D-dimer was increased on POD 1 and an additional rise was observed on POD 5. vWF also progressively increased in the observed period. Results of our study showed that after THR systemic inflammatory markers increased and coagulation function was enhanced. Determination of inflammatory and procoagulant markers could help identify patients at risk for cardiovascular thromboembolic events.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-02-02T08:58:37Z
      DOI: 10.1177/1076029620985941
      Issue No: Vol. 27 (2021)
       
  • Impact of Dabigatran Treatment on Rotation Thromboelastometry

    • Authors: Juraj Sokol, Frantisek Nehaj, Jela Ivankova, Michal Mokan, Jana Zolkova, Lenka Lisa, Ludmila Linekova, Marian Mokan, Jan Stasko
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      A rapid and reliable assessment of the dabigatran effect is desirable in dabigatran treated patients with uncontrolled bleeding or before acute surgery. The aim of this study was to study the anticoagulant effects of dabigatran in patients with atrial fibrillation (AF) as assessed by the whole blood assays ROTEM, and how data from these methods correlate to plasma dabigatran concentrations measured by Hemoclot. ROTEM was performed with ROTEM Gamma (Pentapharm GmbH, Munich, Germany). The assays used in our study were Ex-tem and In-tem assay. Plasma dabigatran concentrations were determined by hemoclot thrombin inhibitor assay (Hyphen BioMed, France) at trough and post-dose in 27 patients on dabigatran 150 mg BID. Median plasma dabigatran concentrations at trough were 74 ng/mL (11.2–250) and post-dose (2 h after ingestion) 120 ng/mL (31–282). The ROTEM clotting time (CT) and maximum clot firmnes (MCF) correlated strongly with dabigatran concentrations when activated with the reagents Ex-tem (p < 0.0001) and In-tem (p < 0.0001). In summary, in our study, we have found that the ROTEM variable CT and MCF, when activated with triggers Ex-tem and In-tem, has a strong and highly significant correlation with the plasma dabigatran concentration in a real-life population of AF-patients and could thereby be an alternative to estimate dabigatran concentration in emergency situations. However, additional studies are needed to further validate these findings.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-02-01T05:58:27Z
      DOI: 10.1177/1076029620983902
      Issue No: Vol. 27 (2021)
       
  • Evaluation of Direct Oral Anticoagulant Prescribing in Patients With
           Moderate to Severe Renal Impairment

    • Authors: Clara Ting, Megan Rhoten, Jillian Dempsey, Hunter Nichols, John Fanikos, Christian T. Ruff
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Patients with renal impairment require dose adjustments for direct oral anticoagulants (DOACs), though there is uncertainty regarding their use in severe chronic kidney disease. Inappropriately dosed DOACs may increase risk of ischemic events when under-dosed, or risk of bleeding when over-dosed. The purpose of this study was to describe DOAC selection, dosing strategies, and associated clinical outcomes in patients with moderate to severe renal impairment at our institution. This was a single-center retrospective analysis of adult outpatients with moderate to severe renal impairment (estimated creatinine clearance
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-02-01T05:56:02Z
      DOI: 10.1177/1076029620987900
      Issue No: Vol. 27 (2021)
       
  • Brain-Derived Neurotrophic Factor, a New Predictor of Coronary Artery
           Calcification

    • Authors: Hong Jin, Jing-jing Ji, Yi Zhu, Xiao-dong Wang, Yi-ping Li, Qiu-yin Shi, Yi-fei Chen
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Brain-derived neurotrophic factor (BDNF) plays a functional role in vascular endothelium homeostasis and the alleviation of atherosclerosis. Matrix gla protein (MGP) and Nε-(1-carboxymethyl)-l-lysine (CML) are both confirmed to be VC predictors. This study investigated the association between BDNF, MGP, CML and coronary artery calcification (CAC). Plasma BDNF, MGP, and CML levels were measured in 274 patients who underwent computed tomography to determine the CAC score (Agatston score). It was found that patients with CAC exhibited lower BDNF and MGP and higher CML levels than those without CAC. Plasma BDNF levels in patients with diabetes or hypertension were lower compared with the control groups. In logistic regression analysis, age, hypertension, BDNF, and MGP were independent predictors of CAC. Plasma BDNF and MGP levels were both correlated with the Agatston score even after adjustment for age, total cholesterol level, triglycerides, low-density lipoprotein level, creatinine clearance rate, and the presence of hypertension and diabetes mellitus. In 167 patients with CAC, circulating BDNF level was inversely associated with CML level and positively related to MGP level. In the receiver operating characteristic analysis for CAC, the areas under the curves for BDNF, MGP, and CML were 0.757, 0.777 and 0.653, respectively. In summary, plasma BDNF levels are associated with the Agatston score, and BDNF further predicts the occurrence of CAC.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-02-01T05:40:47Z
      DOI: 10.1177/1076029621989813
      Issue No: Vol. 27 (2021)
       
  • Treatment Patterns and Clinical Outcomes in Korean Cancer Patients With
           Venous Thromboembolism: A Retrospective Cohort Study

    • Authors: Soo-Mee Bang, Jin-Hyoung Kang, Min Hee Hong, Jin-Seok Ahn, So Yeon Oh, Jin Ho Baek, Yoon Ji Choi, Seong Hoon Shin, Young-Joo Kim, Ha-Yeong Gil, Hyung-Eun Park, Juneyoung Lee, Eun-Lyeong Park
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      This study assessed epidemiologic data and clinical outcomes, including venous thromboembolism (VTE) recurrence and bleeding events, in patients with cancer-associated VTE, and assessed factors associated with clinical outcomes. Data were extracted from retrospective medical-chart review of adult patients diagnosed with cancer-associated deep vein thrombosis or pulmonary embolism who received anticoagulation treatment for ≥3 months. Patients were classified by: low-molecular-weight heparin (LMWH), direct oral anticoagulants (DOACs), and other anticoagulants. First VTE recurrence and bleeding events, and factors associated with their occurrence, were assessed during the initial 6 months of treatment. Overall, 623 patients (age: 63.7 ± 11.3 years, 49.3% male) were included (119, 132, and 372 patients in LMWH, DOACs and other anticoagulants groups, respectively). The cumulative 6-month incidence of VTE recurrence was 16.6% (total), 8.3% (LMWH), 16.7% (DOACs), and 20.7% (other); respective bleeding events were 22.5%, 11.0%, 12.3%, and 30.7%). VTE recurrence and bleeding rates differed only between LMWH and other anticoagulants (HR 2.4, 95% CI: 1.2-5.0 and 3.6, 1.9-6.8, respectively). These results highlight the importance of initial VTE treatment choice for preventing VTE recurrence and bleeding events. LMWH or DOACs for ≥3 months can be considered for effective VTE management in cancer patients.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-01-20T09:08:17Z
      DOI: 10.1177/1076029620979575
      Issue No: Vol. 27 (2021)
       
  • Tinzaparin Safety in Patients With Cancer and Renal Impairment: A
           Systematic Review

    • Authors: I. A. Vathiotis, N. K. Syrigos, E. P. Dimakakos
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Low-molecular-weight heparins are approved for primary and secondary venous thromboembolism prevention. Tinzaparin is the low-molecular-weight heparin with the highest average molecular weight. The purpose of this systematic review is to provide an update regarding the safety profile of tinzaparin, prescribed either as a prophylactic or as a therapeutic regimen for venous thromboembolism in special populations, including cancer patients and patients with renal impairment. We identified prospective studies up to August 2020 reporting safety outcomes for cancer patients and patients with renal impairment on tinzaparin regimens. In patients with cancer major bleeding rates fluctuated between 0.8% and 7%. Patients on tinzaparin exhibited significantly lower rates of clinically relevant nonmajor bleeding events in comparison with those on vitamin K antagonists. Bioaccumulation of tinzaparin was not correlated with age, body weight or creatinine clearance. Periodic administration of either prophylactic or therapeutic doses of tinzaparin did not result in bioaccumulation, even in patients with severe renal impairment and creatinine clearance < 20 ml/min. Major bleeding rates for non-cancer patients with renal impairment on prophylactic tinzaparin regimens were 0%. Non-cancer patients with renal impairment on therapeutic tinzaparin regimens exhibited major bleeding in 0 to 3.4% of cases; major bleeding rates were higher for cancer patients with renal impairment on therapeutic tinzaparin regimens (4.3 to 10%). Tinzaparin can be used without dose adjustment in patients with severe renal impairment and creatinine clearance> 20 ml/min. Tinzaparin represents a safe choice for special populations at increased risk for thrombosis and bleeding.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-01-19T06:34:55Z
      DOI: 10.1177/1076029620979592
      Issue No: Vol. 27 (2021)
       
  • Prevalence of the Factor V Leiden Mutation Arg534Gln in Western Region of
           Saudi Arabia: Functional Alteration and Association Study With Different
           Populations

    • Authors: Mohammad Athar, Zainularifeen Abduljaleel, Ibrahim S. Ghita, Amani A. Albagenny, Saeed H. Halawani, Mohammad M. Alkazmi, Wafa M. Elbjeirami, Khalid Alquthami, Mohammad M. Alkhuzae, Fadel M. Ragab, Faisal A. Al-Allaf
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      The rare Gln534 (Factor V Leiden; FVL) allele (1:169,519,049 T>C) is associated with an increased risk of venous thrombosis. The purpose of this study was to measure the prevalence of Factor V Leiden mutation in thrombophilia patients with deep vein thrombosis. Also, we investigated the functional and structural characteristics of this mutation p.(Arg534Gln) to be examined the cumulative impact on venous thrombosis risk as well correlated with different populations by Genome Wide Association Studies (GWAS). A total of 108 patients with idiopathic deep vein thrombosis were examined for Factor V Leiden gene mutation. Our preliminary data show that about 10% of patients were detected with the heterozygous and homozygous form of the Factor V Leiden mutation. An association analysis confirmed that the Factor V SNP variant (rs6025) was highly associated (P-value 4.91 x10-^ -39) with an increased risk of venous thrombosis. Also, we found that the recognized SNP was important among HapMap populations. Our results indicated that among the 3 populations (Asian, African, and American) studied, this association was highest in the African population based on the r(2) significant threshold (P-value 5e-190). In addition, this mutation was located at the domain F5/8 type A 2, which can disturb this domain and abolish its function. Because of aspartic acid nearby wild type position as form in the salt bridge due to this discharge will disturb the ionic interaction made by the wild type residue Arg534. This residue was not found to be in contact with other domains of which the function was known. However, contact with other molecules or domains (THPH2: MIM: 188055) were still possible and might be affected by this mutation that may cause thrombophilia due to activated protein C resistance.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-01-15T02:06:39Z
      DOI: 10.1177/1076029620978532
      Issue No: Vol. 27 (2021)
       
  • Endothelial Function in Patients With Von Willebrand Disease

    • Authors: Stephanie Noone, Ralf Schubert, Stephan Fichtlscherer, Thomas Hilberg, Sonja Alesci, Wolfgang Miesbach
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      In patients with von Willebrand disease (vWD) the interest in age-related comorbidities has grown, because the life expectancy of these patients has increased. The research question of this study was whether patients with vWD show a different endothelial function compared to the general population. A total of 37 patients with type 1 (n = 23), type 2 (n = 10) and type 3 (n = 4) vWD, 14 controls and 38 patients with coronary artery disease (CAD) were included in this study. Five markers of endothelial dysfunction (MOED) were determined. Moreover, the endothelial function was examined using the Itamar Endo-PAT. The reactive hyperemia index (RHI) was calculated from the results. The markers soluble intercellular adhesion molecule-1 (p = 0.171), P-Selectin (p = 0.512), interleukin-6 (p = 0.734) and monocyte chemoattractant protein-1 (p = 0.761) showed higher levels in patients with vWD, but were not significantly different compared to the control group. RHI was impaired in CAD-patients (1.855), whereas vWD patients had mean results of 1.870 and controls 2.112 (p = 0.367). In this study, the endothelial function measurements of patients with von Willebrand disease were not significantly different compared to healthy controls.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-01-15T02:00:59Z
      DOI: 10.1177/1076029620984546
      Issue No: Vol. 27 (2021)
       
  • Systemic Coagulopathy in Hospitalized Patients With Coronavirus Disease
           2019: A Systematic Review and Meta-Analysis

    • Authors: Noppacharn Uaprasert, Chatphatai Moonla, Darintr Sosothikul, Ponlapat Rojnuckarin, Thita Chiasakul
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Coagulation activation has been reported in several cohorts of patients Coronavirus Disease 2019 (COVID-19). However, the true burden of systemic coagulopathy in COVID-19 remains unknown. In this systematic review and meta-analysis, we performed a literature search using PubMed, EMBASE, and Cochrane Database to identify studies that reported the prevalence of systemic coagulopathy using established criteria in patients with COVID-19. The primary outcome was the prevalence of systemic coagulopathy (disseminated intravascular coagulation [DIC] and/or sepsis-induced coagulopathy [SIC]). Pooled prevalences and 95% confidence intervals [CIs] were calculated using random-effects model. A total of 5 studies including 1210 patients with confirmed COVID-19 were included. The pooled prevalence of systemic coagulopathy was 7.1% (95%CI: 3.2%,15.3%, I2 = 93%). The pooled prevalence of DIC (N = 721) and SIC (N = 639) were 4.3% (95%CI 1.7%, 10.4%, I2 = 84%) and 16.2% (95%CI: 9.3%, 26.8%, I2 = 74%), respectively. Only 2 studies reported the prevalence of elevated D-dimer levels with the pooled prevalence of 84.6% (95%CI: 52.0%,96.5%, I2 = 94%). Average D-dimer and fibrinogen levels were remarkably increased, while platelet counts, PT, and aPTT ratios were minimally affected in COVID-19. The estimated prevalence of systemic coagulopathy in patients with COVID-19 was low despite D-dimer elevation in most patients. Relatively low systemic coagulopathy in COVID-19 may contribute to the high incidence of thrombosis rather than bleeding in patients with COVID-19.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-01-14T04:05:20Z
      DOI: 10.1177/1076029620987629
      Issue No: Vol. 27 (2021)
       
  • Retrospective Review of Prescribing Patterns in Cancer-Associated
           Thrombosis: A Single Center Experience in Edmonton, Alberta, Canada

    • Authors: Hannah Kaliel, Meghan Mior, Steven Quan, Sunita Ghosh, Cynthia Wu, Tammy J. Bungard
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      Low molecular weight heparin (LMWH) is the standard of care for treating cancer-associated thrombosis (CAT), although new evidence for direct oral anticoagulants (DOACs) supports use in specific cancer populations. In this retrospective review at a specialty CAT clinic from 2016 to 2019, we report the use of anticoagulants (LMWH, DOACs, warfarin, anticoagulant class change) in the acute and chronic phases of CAT and compare use before/after publication of the Hokusai-VTE Cancer trial. Death, venous thromboembolism (VTE) recurrence and bleeding was also reported. Of the 221 included, median age was 69 years, with 57.5% having metastatic disease. In the acute phase, 80.1% were prescribed LMWH, 4.1% DOAC, and 14.5% had an anticoagulant class change (LMWH to DOAC; 78.1%). In the chronic phase, 35.8% were prescribed LMWH, 11.3% DOAC, and 42.9% had an anticoagulant class change (LMWH to DOAC; 90.1%). Use of DOACs in the acute and chronic phase prior to the Hokusai-VTE trial was 1.0% and 2.0%, respectively, and following publication was 6.8% and 19.6%. Death occurred for 22.6% patients, recurrent VTE in 7.2%, and bleeding in 5.0%. DOAC use is increasing with time; real-world data may help to guide optimization of the care of complex patients.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-01-14T04:03:40Z
      DOI: 10.1177/1076029620975489
      Issue No: Vol. 27 (2021)
       
  • Long-Term Safety and Efficacy of Antiplatelet Therapy in Patients With
           Cerebral Infarction With Thrombocytopenia

    • Authors: Shijie Guo, Yingying Lin, Xiaoye Ma, Yanxin Zhao, Aiping Jin, Xueyuan Liu, Letao Sun, Guilin Meng
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      This study aimed to investigate the long-term safety and benefits of antiplatelet therapy in patients with cerebral infarction with thrombocytopenia, as evidence regarding this was limited. This cohort trial assessed patients with acute cerebral infarction with thrombocytopenia treated in the Neurology Department of Shanghai Tenth People’s Hospital from January 2016 to December 2018, and enrolled patients were followed up for 9 months. The patients were divided into non-antiplatelet and antiplatelet groups based on the actual intake of antiplatelet drugs. Primary endpoints included hemorrhagic events, recurrence of cerebral infarction, and activity of daily living (ADL) score changes. To balance baseline clinical data, propensity score matching was applied, and there were finally 65 matched patients, including 30 and 35 in the antiplatelet and non-antiplatelet groups, respectively. There were no differences in hemorrhagic and cerebral infarction recurrence rates between the 2 groups. ADL score change was higher in the antiplatelet group than in the non-antiplatelet group (10 vs 5, p = 0.039). In multivariate regression analysis, antiplatelet therapy significantly predicted a positive change in ADL scores [B = 8.381, 95% confidence interval (0.56-16.19)]. In patients with acute cerebral infarction with thrombocytopenia, antiplatelet therapy could the improve the quality of life in the chronic stage.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-01-14T04:02:00Z
      DOI: 10.1177/1076029620980067
      Issue No: Vol. 27 (2021)
       
  • Deep Vein Thrombosis in the Uninjured Lower Extremity: A Retrospective
           Study of 1454 Patients With Lower Extremity Fractures

    • Authors: Shuang-Wei Qu, Yu-Xuan Cong, Peng-Fei Wang, Chen Fei, Zhi Li, Kun Yang, Kun Shang, Chao Ke, Hai Huang, Yan Zhuang, Bin-Fei Zhang, Kun Zhang
      Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 27, Issue , January-December 2021.
      The purpose of this study was to identify patients at higher risk of deep venous thrombosis (DVT) in the uninjured lower extremity both preoperatively and postoperatively in patients with lower extremity fractures. We collected the clinical data of patients with lower extremities fractures who presented at Xi’an Honghui Hospital between 1 July, 2015 and 31 October, 2017. Doppler ultrasonography was used to diagnose the DVT. Patients were examined pre- and postoperatively. The patients were divided into thrombosis group and no thrombosis group according to the preoperative and postoperative ultrasonography results. The thrombosis group was defined as patients with DVT in the uninjured lower extremity and the no thrombosis group was defined as patients without DVT in the uninjured lower extremity. This study enrolled 1454 patients who met the inclusion criteria. The incidence of preoperative DVT in the uninjured lower extremity was 9.63% whereas the postoperative incidence was 20.29%. Age (OR = 0.965, 95 CI%: 0.954-0.977; P ≤ 0.001) and female (OR = 0.667, 95% CI: 0.451-0.986, P = 0.042) were independent risk factors for preoperative DVT in the uninjured lower extremity. Blood loss (OR = 0.997, 95 CI%: 0.995-1.000; P = 0.020), D-dimer level at admission (OR = 0.941, 95 CI%: 0.887-0.999; P = 0.045), and postoperative day 5 D-dimer level (OR = 0.889, 95 CI%: 0.819-0.965; P = 0.005), were independent risk factors for postoperative DVT in the uninjured lower extremity. For the patients with lower extremity fractures, age and female were associated with the preoperative DVT in the uninjured lower extremity. Blood loss, D-dimer at admission and postoperative day 5 D-dimer were associated with the postoperative DVT in the uninjured lower extremity.
      Citation: Clinical and Applied Thrombosis/Hemostasis
      PubDate: 2021-01-10T06:18:09Z
      DOI: 10.1177/1076029620986862
      Issue No: Vol. 27 (2021)
       
 
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