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Clinical and Applied Thrombosis/Hemostasis
Journal Prestige (SJR): 0.49

Citation Impact (citeScore): 1
Number of Followers: 28

This is an Open Access Journal

Open Access journal
ISSN (Print) 1076-0296 - ISSN (Online) 1938-2723
Published by Sage Publications

[1176 journals]

Exploring the Mediating Role of Multiple Organ Dysfunction in
Sepsis-Induced Disseminated Intravascular Coagulation and Its Impact on
Worsening Prognosis
- Authors: Guangjie Wang, Chenxiao Hao, Sun Yao, Yiqin Wang, Zongtao Xu, Huiying Zhao, Youzhong An
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Disseminated intravascular coagulation (DIC) poses a high mortality risk, yet its exact impact remains contentious. This study investigates DIC's association with mortality in individuals with sepsis, emphasizing multiple organ function. Using data from the Peking University People's Hospital Investigation on Sepsis-Induced Coagulopathy database, we categorized patients into DIC and non-DIC groups based on DIC scores within 24 h of ICU admission (< 5 cutoff). ICU mortality was the main outcome. Initial data comparison preceded logistic regression analysis of mortality factors post-propensity score matching (PSM). Employing mediation analysis estimated direct and indirect associations. Of 549 participants, 131 were in the DIC group, with the remaining 418 in the non-DIC group. Following baseline characteristic presentation, PSM was conducted, revealing significantly higher nonplatelet sequential organ failure assessment (nonplt-SOFA) scores (6.3 ± 2.7 vs 5.0 ± 2.5, P
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-08-07T01:44:34Z
  DOI: 10.1177/10760296241271358
  Issue No: Vol. 30 (2024)
Direct Oral Anticoagulants for Treating Acute Venous Thromboembolism in
Children: Meta-Analysis of Randomized Controlled Trials
- Authors: Xin Yu, Wengen Zhu, Chen Liu, Renrong Lu
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  BackgroundAcute venous thromboembolism (VTE) in children presents unique challenges due to the limitations of standard anticoagulation therapies. Herein, we aimed to systematically review randomized controlled trials (RCTs) evaluating the efficacy and safety of direct oral anticoagulants (DOACs) in pediatric patients with acute VTE.MethodsPubMed and Embase databases were searched for RCTs comparing DOACs to standard anticoagulation in pediatric VTE patients. Efficacy outcomes included VTE recurrence and all-cause mortality, while safety outcomes comprised major bleeding and other adverse events.ResultsThree RCTs with 790 participants were included. When compared with standard anticoagulation, DOACs demonstrated a reduced risk of VTE recurrence (risk difference[RD] = −3%, 95% confidence interval[CI]: −6% to 0%, P = 0.04) and an increased risk of any adverse event (RD = 8%, 95% CI: 1% to 14%, P = 0.02). No significant differences were found in all-cause mortality, major bleeding, clinically relevant non-major bleeding, or total bleeding between the DOAC and control groups.ConclusionDOACs, primarily dabigatran and rivaroxaban, are non-inferior to standard anticoagulants in reducing VTE recurrence in pediatric patients, with comparable safety profiles. Further research is essential to confirm these findings.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-08-06T07:16:10Z
  DOI: 10.1177/10760296241271386
  Issue No: Vol. 30 (2024)
Validation of the RIETE, Kuijer, and HAS-BLED Models to Assess 3-Month
Bleeding Risk in Anticoagulated Patients Diagnosed with Venous
Thromboembolic Disease
- Authors: Stephanie Ortiz Gómez, Paula Ruiz-Talero, Oscar Muñoz, Luis Manuel Hoyos Pumarejo
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  ObjectiveTo evaluate the discriminative ability and calibration of the RIETE, Kuijer, and HAS-BLED models for predicting 3-month bleeding risk in patients anticoagulated for venous thromboembolism (VTE).MethodsExternal validation study of a prediction model based on a retrospective cohort of patients with VTE seen at the Hospital Universitario San Ignacio, Bogotá (Colombia) between July 2021 and June 2023. The calibration of the scales was evaluated using the Hosmer-Lemeshow test and the ratio of observed to expected events (ROE) within each risk category. Discriminatory ability was assessed using the area under the curve (AUC) of a ROC curve.ResultsWe analyzed 470 patients (median age 65 years, female sex 59.3%) with a diagnosis of deep vein thrombosis in most cases (57.4%), 5.7% bleeding events were observed. Regarding calibration, adequate calibration cannot be ruled out given the limited number of events. The discriminatory ability was limited with an area under the curve (AUC) of 0.48 (CI 0.37–0.59) for Kuijer Score, 0.58 (CI 0.47–0.70) for HAS-BLED and 0.64 (CI 0.51–0.76) for RIETE.ConclusionThe Kuijer, HAS-BLED, and RIETE models in patients with VTE generally do not adequately estimate the risk of bleeding at three months, with a low ability to discriminate high-risk patients. Cautious interpretation is recommended until further evidence is available.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-08-06T07:16:01Z
  DOI: 10.1177/10760296241271351
  Issue No: Vol. 30 (2024)
Systematic Review of Randomized Clinical Trials on Direct Oral
Anticoagulants in Pediatric Heart Diseases
- Authors: Chaokun Guan, Linjuan Guo, Shucheng Liang
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  BackgroundDirect oral anticoagulants (DOACs) have been widely applied in adults for thrombosis prophylaxis. However, the effect of DOACs in pediatric patients with congenital or acquired heart diseases who need anticoagulation therapy remains unclear.MethodsWe systematically searched the databases of PubMed, Embase, and the Cochrane Library, as well as the ClinicalTrials.gov registry and the World Health Organization's International Clinical Trials Registry Platform until June 2024 to identify relevant randomized clinical trials (RCTs). If the number of included studies was less than 5, we performed a narrative review to assess the effect of DOACs in pediatric patients.ResultsFour studies were included. In the UNIVERSE study, thrombotic events occurred in 2% of the rivaroxaban group and 9% of the aspirin group, with bleeding events in 36% and 41%, respectively. The ENNOBLE-ATE study showed no thromboembolic events in the edoxaban group and 1.7% in the SOC group (rate difference: −0.07%, 95% CI: −0.22 to 0.07%). Major bleeding rates were similar (rate difference: −0.03%, 95% CI: −0.18 to 0.12%). The SAXOPHONE trial showed no thromboembolic events in either group and similar major bleeding rates (−0.8%, 95% CI: −8.1 to 3.3%). In the DIVERSITY trial, 81% of dabigatran patients achieved the primary outcome versus 59.3% in the SOC group (Odds ratio: 0.342, 95% CI: 0.081–1.229). No major bleeding occurred in either group.ConclusionExisting studies suggest that the use of DOACs hold promise as an effective and safe alternative for preventing and treating thromboembolism in pediatric patients with heart conditions.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-08-05T08:25:51Z
  DOI: 10.1177/10760296241271974
  Issue No: Vol. 30 (2024)
Reduced Platelets Associated with All-Cause Mortality in the Pediatric
Intensive Care Unit
- Authors: Yajing Pang, Yong Hong Zhang, Chaoyan Yue, Li Wang
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Platelets are crucial for maintaining physiological equilibrium, thrombosis formation, inflammation, bacterial defense, wound repair, angiogenesis, and tumorigenesis. In the Pediatric Intensive Care Unit (PICU), children frequently exhibit platelet reductions or functional alterations due to diverse pathological conditions, which significantly influence disease progression and therapeutic approaches. We analyzed the association between platelets count and its derived parameters and all-cause mortality. Adjusted smoothing spline plots, subgroup analysis and segmented multivariate logistic regression analysis were conducted to estimate the relative risk between proportional risk between platelets and all-cause mortality. Of the 11625 children, 677 (5.82%) died. After adjusting for confounders, there was a negative association between platelets and the risk of all-cause mortality in PICU. For every 100 × 10^9/L increase in platelets, the risk of death was reduced by 17% (adjusted OR = 0.83, 95% CI: 0.78, 0.89). The results of sensitivity analysis showed that in different stratified analyses (age, ICU category,WBC Count), the effect of platelets count on all-cause mortality remained stable. After adjusting for inflammation, nutrition, and liver function factors, platelets reduction is still an independent risk factor for PICU all-cause mortality.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-08-05T07:54:11Z
  DOI: 10.1177/10760296241271390
  Issue No: Vol. 30 (2024)
Association Between Heart Rate at Diagnosis and Long-Term Recurrence Risk
of Pulmonary Embolism in a Historical Cohort Study of Elder Women
- Authors: Yuan Li, Fang Li, Meizhi Li, Qiong Yi, Shangjie Wu
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  To investigate the association between heart rate (HR) at diagnosis and long-term pulmonary embolism (PE) recurrence among elderly (≥ 50 year-old) female patients after acute PE (APE). Hospitalized patients with APE were grouped separately according to whether they experienced recurrent PE and whether the HR was
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-07-26T09:49:45Z
  DOI: 10.1177/10760296241268432
  Issue No: Vol. 30 (2024)
Global Hemostatic Methods to Tailor Treatment With Bypassing Agents in
Hemophilia A With Inhibitors— A Single-Center, Pilot Study
- Authors: Roza Chaireti, Nida Soutari, Margareta Holmström, Pia Petrini, Maria Magnusson, Susanna Ranta, Iva Pruner, Jovan P. Antovic
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  For patients with hemophilia A and high-titer inhibitors treated with bypassing agents there are no reliable methods to assess treatment effect. We investigated the utility of global hemostatic methods in assessing treatment with bypassing agents (rFVIIa or activated prothrombin complex [aPCC]). All patients with hemophilia A and inhibitors followed at the Coagulation Unit or the Pediatric Coagulation Unit at Karolinska University Hospital aged 6 years and above were eligible for this noninterventional study. Baseline plasma samples were spiked with bypassing agents in increasing concentrations (aPCC 50 U/kg, 100 U/kg, 150 U/kg, and rFVIIa 90 μg/kg and 270 μg/kg) in vitro. For patients treated with factor concentrates or bypassing agents follow-up samples were collected (in vivo tests). The samples were analyzed using overall hemostatic potential (OHP), and calibrated automated thrombogram, Calibrated Automated Thrombogram (CAT). Nine patients with hemophilia A with inhibitors were included. Spiking with rFVIIa normalized the coagulation potential in 6/8 samples, in 3 only with high dose. Only one sample did not improve adequately after spiking with aPCC. The improvement in hemostasis was reliably shown by both CAT and OHP. The baseline potential was, however, more often measurable by OHP compared to CAT. Factor concentrate had been administered to 5 patients normalizing the hemostatic potential in vivo in 2 (without spiking). The hemostatic improvement induced by spiking with rFVIIa or aPCC is shown by OHP and CAT, but the results have to be evaluated in larger cohorts.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-07-25T11:09:22Z
  DOI: 10.1177/10760296241260053
  Issue No: Vol. 30 (2024)
Thrombotic Prediction Model Based on Epigenetic Regulator Mutations in
Essential Thrombocythemia Patients Using Survival Analysis in Recurrent
Events
- Authors: Pirun Saelue, Patuma Sinthujaroen, Supaporn Suwiwat, Paramee Thongsuksai
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  IntroductionEssential thrombocythemia (ET) involves the proliferation of megakaryocytes and platelets and is associated with an increased risk of thrombosis. We aimed to evaluate thrombotic risks in patients with epigenetic regulator mutations and generate a model to predict thrombosis in ET.Materials and MethodsThis cohort study enrolled patients aged > 15 years diagnosed with ET at the Songklanakarind Hospital between January 2002 and December 2019. Twenty-five targeted gene mutations, including somatic driver mutations (JAK2, CALR, MPL), epigenetic regulator mutations (TET2, DNMT3A, IDH1, IDH2, TET2, ASXL1, EZH2, SF3B1, SRSF2) and other genes relevant to myeloid neoplasms, were identified using next-generation sequencing. Thrombotic events were confirmed based on clinical condition and imaging findings, and thrombotic risks were analyzed using five survival models with the recurrent event method.ResultsNinety-six patients were enrolled with a median follow-up of 6.91 years. Of these, 15 patients experienced 17 arterial thrombotic events in total. Patients with JAK2 mutation and IDH1 mutation had the highest frequency of thrombotic events with somatic driver mutations (17.3%) and epigenetic regulator mutations (100%). The 10-year thrombosis-free survival rate was 81.3% (95% confidence interval: 72.0-91.8%). IDH1 mutation was a significant factor for thrombotic risk in the multivariate analysis for all models. The Prentice, William, and Peterson (PWP) gap-time model was the most appropriate prediction model.ConclusionsThe PWP gap-time model was a good predictive model for thrombotic risk in patients with ET. IDH1 mutation was significant risk factors for thrombosis; however, further studies with a larger sample size should confirm this and provide more insight.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-07-25T09:54:44Z
  DOI: 10.1177/10760296241263099
  Issue No: Vol. 30 (2024)
Decreased Thrombin Generation is Associated with Increased Thrombin
Generation Biomarkers and Blood Cellular Indices in Pulmonary Embolism
- Authors: Fakiha Siddiqui, Alfonso Tafur, Amir Darki, Bulent Kantarcioglu, Debra Hoppensteadt, Emily Krupa, Omer Iqbal, Jawed Fareed, Manuel Monreal
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Pulmonary embolism (PE) is a heterogenous condition with variable clinical presentations. Thrombin generation potential (TGP) and biomarkers, and blood cellular indices can reflect the underlying pathophysiology and risk stratification of PE. This case–control study analyzed TGP in 209 PE patients from Loyola University, Pulmonary Embolism Response Team program compared to normal human plasma (NHP) controls. The present study evaluates TGP and biomarkers, and cellular indices in relation to PE severity, according to the European Society of Cardiology (ESC) guidelines. Statistical analysis including median with interquartile range (IQR), 2-tailed Wilcoxon Mann–Whitney test, Chi-square test, and Spearman Correlational analysis were performed. There were 209 patients with PE, with an almost equal distribution between sex, and a median age of 63 years. Significant downregulation in peak thrombin and endogenous thrombin potential (ETP), as well as upregulation in lag time, were observed in PE patients versus controls. Biomarker analysis revealed pronounced elevations, with D-dimer demonstrating the most significant increase. Blood cellular indices also rose in PE patients, correlating with disease severity. PE severity was associated with higher TGP and biomarker levels. Mortality rates differed significantly across risk categories and were highest in patients with elevated cellular indices. TGP and biomarkers are intricately linked to PE severity and can aid in risk stratification. Elevated cellular indices are associated with increased mortality, highlighting their potential as prognostic markers. These findings could enhance the precision of PE management strategies.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-07-23T11:10:16Z
  DOI: 10.1177/10760296241261076
  Issue No: Vol. 30 (2024)
Risk Scores in Venous Thromboembolism Guidelines of ESC, ACCP, and ASH: An
Updated Review
- Authors: Wei Xiong, Yi Cheng, Yunfeng Zhao
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Venous thromboembolism (VTE) is associated with high morbidity and mortality. Risk scores associated with VTE have been widely used in clinical practice. Among numerous scores published, those included in guidelines are usually typical risk scores which have been extensively validated and globally recognized. This review provides an updated overview of the risk scores associated with VTE endorsed by 3 guidelines which are highly recognized in the field of VTE including the European Society of Cardiology, American College of Chest Physicians, and American Society of Hematology, focusing on the development, modification, validation, and comparison of these scores, to provide a comprehensive and updated understanding of all the classic risk scores associated with VTE to medical readers including but not limited to cardiologists, pulmonologists, hematologists, intensivists, physicians, surgeons, and researchers. Although each score recommended by these guidelines was more or less validated, there may still be room for further improvement. It may still be necessary to seek simpler, more practical, and more universally applicable VTE-related risk scores in the future.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-06-18T06:30:00Z
  DOI: 10.1177/10760296241263856
  Issue No: Vol. 30 (2024)
Periprocedural Edoxaban Management and Clinical Outcomes in Patients
Undergoing Transcatheter Cardiovascular Procedures in the EMIT-AF/VTE
Program
- Authors: Martin Unverdorben, Paolo Colonna, James Jin, Sabine Köhler, Amparo Santamaria, Manish Saxena, Amanda Borrow, Cathy Chen, Christian von Heymann, Thomas Vanassche
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Annually, 10% of patients with atrial fibrillation (AF) or venous thromboembolism (VTE) treated with non-vitamin K oral anticoagulants undergo diagnostic or therapeutic procedures. This subanalysis of the multicenter, prospective, observational Edoxaban Management in Diagnostic and Therapeutic Procedures real-world registry included patients in Europe and Asia with AF or VTE who underwent transcatheter cardiovascular (CV) procedures. Edoxaban interruption and clinical outcomes were assessed for all arterial or venous access procedures and stratified by bleeding risk. Overall, 2695 procedures were reported; 755 (28.0%) were transcatheter CV procedures, of which 373 (49.4%) were arterial access and 382 (50.6%) were venous access procedures. Patients with arterial versus venous access procedures had significantly higher bleeding and stroke and thromboembolism risk scores (P
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-06-17T08:09:11Z
  DOI: 10.1177/10760296241260728
  Issue No: Vol. 30 (2024)
A Practical Nomogram for Predicting the Bleeding Risk in Patients with a
History of Myocardial Infarction Treating with Aspirin
- Authors: Jin Jing, Lei Wanling, Wang Maofeng
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  BackgroundAspirin is a widely used antiplatelet medication to prevent blood clots, reducing the risk of cardiovascular event. Healthcare providers need to be mindful of the risk of aspirin-induced bleeding and carefully balancing its benefits against potential risks. The objective of this study was to create a practical nomogram for predicting bleeding risk in patients with a history of myocardial infarction treating with aspirin.MethodsA total of 2099 myocardial infarction patients with aspirin were enrolled. The patients were randomly divided into two groups, with a 7:3 ratio, for model development and internal validation. Boruta analysis was utilized to identify clinically significant features associated with bleeding. Logistic regression model based on independent bleeding risk factors was constructed and presented as a nomogram. Model performance was assessed from three aspects: identiﬁcation, calibration, and clinical utility.ResultsBoruta analysis identified eight clinical features from 25, and further multivariate logistic regression analysis selected four independent risk factors: hemoglobin, platelet count, previous bleeding, and sex. A visual nomogram was created based on these variables. The model achieved an area under the curve of 0.888 (95% CI: 0.845-0.931) in the training dataset and 0.888 (95% CI: 0.808-0.968) in the test dataset. Calibration curve analysis showed close approximation to the ideal curve. Decision curve analysis demonstrated favorable clinical net benefit for the model.ConclusionsOur study focused on creating and validating a model to evaluate bleeding risk in patients with a history of myocardial infarction treated with aspirin, which demonstrated outstanding performance in discrimination, calibration, and net clinical benefit.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-06-13T06:31:13Z
  DOI: 10.1177/10760296241262789
  Issue No: Vol. 30 (2024)
Efficacy and Safety of Rivaroxaban Versus Enoxaparin in Prevention of
Recurrence of Venous Thrombo-Embolism Events in Cancer Patients: A
Meta-Analysis
- Authors: Abdul Rafeh Awan, Abdullah Ahmad, Muhammad Daniyal, Malik Muhammad Hamza Khan, Shaikh Jehanzaib Saeed, Muhammad Bilal Siddiqui, Sheraz Hakeem, Azka Shahab, Syed Hasham Ali, Ahmed Kamal Siddiqi
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  ObjectiveTo examine the effectiveness of rivaroxaban compared to enoxaparin in patients diagnosed with cancer and venous thromboembolism.MethodsA search of Pub Med, Scopus, and Google Scholar, from inception through April 2023 was conducted. Articles comparing rivaroxaban with enoxaparin in patients with cancer and VTE/PE/DVT were included. Review Manager Version 5.2 was utilised for the analysis of the following outcomes; VTE, PE, DVT, major bleeding, and mortality.ResultsA total of 8 articles and 2276 patients were included in the final analysis. Pooled analysis showed that rivaroxaban had a statistically insignificant reduced association with VTE occurrence (RR:0.83, 95% CI:0.58–1.18, P:0.3) as well as a statically insignificant reduction in major bleeding (RR:0.79, 95% CI:0.53–1.18, P:0.25). Analysis showcased that there was an insignificant reduction of mortality rivaroxaban as compared to enoxaparin (RR:0.74, 95% CI: 0.46–1.20, P:0.23).ConclusionRivaroxaban can serve as a viable alternative to enoxaparin, with no appreciable drawbacks, for preventing and managing VTE in patients with malignancy.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-06-13T06:30:14Z
  DOI: 10.1177/10760296241261364
  Issue No: Vol. 30 (2024)
Thromboinflammatory Biomarkers of Cardiorenal Syndrome in Patients With
End-Stage Renal Disease
- Authors: Pranathi Karumanchi, Divya Sridharan, Debra Hoppensteadt, Fakiha Siddiqui, Jawed Fareed, Vinod Bansal
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Cardiovascular disease is a prevalent complication in patients with end-stage renal disease (ESRD) on maintenance hemodialysis. In the ESRD patient population, cardiovascular mortality is 20 times higher compared to the general population. The strong relationship between both illnesses can be explained through cardiorenal syndrome (CRS). CRS encompasses a spectrum of disorders involving both the heart and kidneys in which acute or chronic dysfunction in one organ may induce a similar effect in the other organ. Current literature reveals that inflammation and thrombosis are integral to CRS development. Hence, this study aims to demonstrate whether thromboinflammatory biomarkers and laboratory parameters correlate with ESRD progression and the development of CRS. Ninety-five ESRD patients were recruited at Loyola University Medical Center hemodialysis unit. Epic chart analysis was used to determine patients with CRS. Biomarkers (C-reactive protein, tumor necrosis factor alpha, interleukin-6, Annexin V, L-fatty acid binding protein, monocyte chemoattractant protein 1, nitric oxide, von Willebrand factor, D-dimer, and plasminogen activator inhibitor-1) were profiled using the enzyme-linked immunosorbent assay method in patients with and without CRS in the ESRD cohort. All biomarkers were significantly elevated in ESRD patients compared to normal controls (P
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-06-12T05:47:09Z
  DOI: 10.1177/10760296241263101
  Issue No: Vol. 30 (2024)
Knowledge, Adherence, and Satisfaction With Warfarin Therapy and
Associated Factors Among Outpatients at University Teaching Hospital in
Ethiopia
- Authors: Tamrat Assefa Tadesse, Dejuma Yadeta, Legese Chelkeba, Amha Gebremedhin, Teferi Gedif Fenta
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Anticoagulation management using warfarin is challenging in clinical practice. This study aimed to evaluate the knowledge, adherence, and satisfaction with warfarin therapy and associated factors among outpatients at the Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia. An interview-based cross-sectional study was conducted among 350 patients receiving warfarin therapy at cardiac and hematology clinics of TASH. Anticoagulation knowledge assessment (AKA) questionnaires assessed the patients’ warfarin knowledge. Adherence to warfarin was evaluated using the Morisky Green Levine Scale (MGLS), and patient satisfaction with warfarin therapy was assessed using the 17-item anticlot treatment scale (ACTS). Binary logistic regression was used to determine factors associated with the outcome variables, and p
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-06-12T05:35:19Z
  DOI: 10.1177/10760296241260736
  Issue No: Vol. 30 (2024)
What Is the Impact of Baseline Inflammatory and Hemostatic Indicators with
the Risk of Mortality in Severe Inpatients with COVID-19: A Retrospective
Study
- Authors: Huiqi Zhu, Yeping Li, Hua Su, Chao Yan, Wanghao Xin, Kejing Ying
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  The purpose of the study was to investigate baseline inflammatory, hemostatic indicators and new-onset deep vein thrombosis (DVT) with the risk of mortality in COVID-19 inpatients. In this single-center study, a total of 401 COVID-19 patients hospitalized in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were enrolled from December 1, 2022 to January 31, 2023. The basic information, first laboratory examination results, imaging examination, and outcome-related indicators were compared between patients in the moderate and severe subgroups. We found that baseline D-dimer and baseline absolute neutrophil count (ANC) levels were associated with new-onset DVT and death in severe hospitalized patients with COVID-19. The odds ratio (OR) of baseline D-dimer and baseline ANC with mortality was 1.18 (95% confidence interval [CI], 1.08–1.28; P
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-06-04T05:31:31Z
  DOI: 10.1177/10760296241255959
  Issue No: Vol. 30 (2024)
Interpretable Machine Learning Models Using Peripheral Immune Cells to
Predict 90-Day Readmission or Mortality in Acute Heart Failure Patients
- Authors: Junming Chen, Liting Yang, Jiangchuan Han, Liang Wang, Tingting Wu, Dongsheng Zhao
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  BackgroundAcute heart failure (AHF) carries a grave prognosis, marked by high readmission and mortality rates within 90 days post-discharge. This underscores the urgent need for enhanced care transitions, early monitoring, and precise interventions for at-risk individuals during this critical period.ObjectiveOur study aims to develop and validate an interpretable machine learning (ML) model that integrates peripheral immune cell data with conventional clinical markers. Our goal is to accurately predict 90-day readmission or mortality in patients AHF.MethodsIn our study, we conducted a retrospective analysis on 1210 AHF patients, segregating them into training and external validation cohorts. Patients were categorized based on their 90-day outcomes post-discharge into groups of ‘with readmission/mortality’ and ‘without readmission/mortality’. We developed various ML models using data from peripheral immune cells, traditional clinical indicators, or both, which were then internally validated. The feature importance of the most promising model was examined through the Shapley Additive Explanations (SHAP) method, culminating in external validation.ResultsIn our cohort of 1210 patients, 28.4% (344) faced readmission or mortality within 90 days post-discharge. Our study pinpointed 10 significant indicators—spanning peripheral immune cells and traditional clinical metrics—that predict these outcomes, with the support vector machine (SVM) model showing superior performance. SHAP analysis further distilled these predictors to five key determinants, including three clinical indicators and two immune cell types, essential for assessing 90-day readmission or mortality risks.ConclusionOur analysis identified the SVM model, which merges traditional clinical indicators and peripheral immune cells, as the most effective for predicting 90-day readmission or mortality in AHF patients. This innovative approach promises to refine risk assessment and enable more targeted interventions for at-risk individuals through continuous improvement.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-06-03T02:47:10Z
  DOI: 10.1177/10760296241259784
  Issue No: Vol. 30 (2024)
Long-Term Safety Analysis of a Fibrinogen Concentrate
(RiaSTAP®/Haemocomplettan® P)
- Authors: Niels Rahe-Meyer, Gabriele Neumann, Dirk S Schmidt, Laura A Downey
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Fibrinogen concentrate treatment is recommended for acute bleeding episodes in adult and pediatric patients with congenital and acquired fibrinogen deficiency. Previous studies have reported a low risk of thromboembolic events (TEEs) with fibrinogen concentrate use; however, the post-treatment TEE risk remains a concern. A retrospective evaluation of RiaSTAP®/Haemocomplettan® P (CSL Behring, Marburg, Germany) post-marketing data was performed (January 1986–June 2022), complemented by a literature review of published studies. Approximately 7.45 million grams of fibrinogen concentrate was administered during the review period. Adverse drug reactions (ADRs) were reported in 337 patients, and 81 (24.0%) of these patients experienced possible TEEs, including 14/81 (17.3%) who experienced fatal outcomes. Risk factors and the administration of other coagulation products existed in most cases, providing alternative explanations. The literature review identified 52 high-ranking studies with fibrinogen concentrate across various clinical areas, including 26 randomized controlled trials. Overall, a higher number of comparative studies showed lower rates of ADRs and/or TEEs in the fibrinogen group versus the comparison group(s) compared with those that reported higher rates or no differences between groups. Post-marketing data and clinical studies demonstrate a low rate of ADRs, including TEEs, with fibrinogen concentrate treatment. These findings suggest a favorable safety profile of fibrinogen concentrate, placing it among the first-line treatments effective for managing intraoperative hemostatic bleeding.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-05-28T06:14:31Z
  DOI: 10.1177/10760296241254106
  Issue No: Vol. 30 (2024)
Venous Thromboembolism Risk and Adherence to Pharmacological
Thromboprophylaxis in Hospitalized Patients in Uruguay: First Nationwide
Study
- Authors: Valentina Mérola, Ana Carina Pizzarossa, Maynés López, Franco Peverelli, Gustavo Bruno, Mariana González, Federico Roca, Leticia Dentone, Gerardo Pérez, Lucía Da Silveira, Lilián Díaz, Josefina Tafuri, Rosario Cuadro, Martín Zaquiere, Guillermina Bartaburu, Franco Pacello, Carina Celio, María José López, Marcelo Viana, Laura Fraga, Valeria Blanco, Paula Chalart, Daniel Leal, Xilef Rodríguez, Laura Teti, Carolina Goñi, Eduardo Infante, Alejandra Prícoli, Victoria Altieri, Cecilia Guillermo, Rosario Martínez
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  IntroductionVenous thromboembolism (VTE) is a serious, frequent, and preventable medical complication in hospitalized patients. Although the efficacy of prophylaxis (pharmacological and/or mechanical) has been demonstrated, compliance with prophylaxis is poor at international and national levels.AimTo determine the indication and use of pharmacological thromboprophylaxis in hospitalized patients in Uruguay.MethodsAn observational, descriptive, cross-sectional, multicentre study involving 31 nationwide healthcare facilities was conducted. Baseline characteristics associated with hospital admission, the percentage of the population with an indication for thromboprophylaxis, and the percentage of patients receiving pharmacological thromboprophylaxis were assessed. The VTE risk was determined using the Padua score for medical patients; the Caprini score for surgical patients; the Royal College of Obstetricians and Gynaecologists (RCOG) guidelines for pregnant-postpartum patients.Results1925 patients were included, representing 26% of hospitalized patients in Uruguay. 71.9% of all patients were at risk of VTE. Of all patients at risk of VTE, 58.6% received pharmacological thromboprophylaxis. The reasons for not receiving thromboprophylaxis were prescribing omissions in 16.1% of cases, contraindication in 15.9% and 9.4% of patients were already anticoagulated for other reasons. Overall, just 68% of patients were “protected” against VTE. Recommendations of major thromboprophylaxis guidelines were followed in 70.1% of patients at risk.ConclusionsDespite the progress made in adherence to thromboprophylaxis indications, nonadherence remains a problem, affecting one in six patients at risk of VTE in Uruguay
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-05-27T06:57:00Z
  DOI: 10.1177/10760296241256368
  Issue No: Vol. 30 (2024)
Exploring Risk Factors for Lower Extremity Deep Vein Thrombosis Patients
with Co-existing Pulmonary Embolism Based on Multiple Logistic Regression
Model
- Authors: Jiahong Zu, Tao Yang
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Valuable data on deep vein thrombosis (DVT) patients with coexisting pulmonary embolism (PE) is scarce. This study aimed to identify risk factors associated with these patients and develop logistic regression models to select high-risk DVT patients with coexisting PE. We retrospectively collected data on 150 DVT patients between July 15, 2022, and June 15, 2023, dividing them into groups based on the presence of coexisting PE. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors and construct predictive models. Discrimination and calibration statistics evaluated the validation and accuracy of the developed models. Of the 130 patients analyzed, 40 (30.77%) had coexisting PE. Univariate analysis revealed four significant predictors of DVT patients with coexisting PE: sex (OR 3.83, 95% CI: [1.76; 8.59], P = 0.001), body mass index (BMI) (OR 1.50, 95% CI: [1.28; 1.75], P
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-05-24T08:46:06Z
  DOI: 10.1177/10760296241258230
  Issue No: Vol. 30 (2024)
Elevation of Serum Prostate-Specific Antigen Levels in Males With
Pulmonary Embolism
- Authors: You-Fan Peng, Li-Ya Ma, Miao Luo
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Hypoxemia is a clinical characteristic of pulmonary embolism (PE). Hypoxemia is associated with variations in serum prostate-specific antigen (PSA) levels. Thus, the present study aimed to determine serum PSA levels in patients with PE, which may be helpful in improving clinical evaluation in screening for prostate diseases in those with PE. Clinical data from 61 consecutive male patients with PE and 113 age-matched healthy male controls were retrospectively analyzed. The pulmonary artery obstruction index (PAOI) was used to evaluate the pulmonary embolic burden. Compared with healthy controls, serum total PSA (tPSA) levels were significantly increased (P = .003), and free PSA (fPSA)/tPSA ratio was significantly decreased in patients with PE (P
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-05-23T08:25:14Z
  DOI: 10.1177/10760296241250002
  Issue No: Vol. 30 (2024)
Direct Oral Anticoagulants in Chronic Thromboembolic Pulmonary
Hypertension: First Meta-Analysis of Prospective Studies
- Authors: Tang Zhang, Linjuan Guo, Shucheng Liang, Hao Liu
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Direct oral anticoagulants (DOACs) are becoming increasingly popular clinically, but their safety and effectiveness profile in patients with chronic thromboembolic pulmonary hypertension (CTEPH) is not well-established. Literature from the PubMed and EMBASE databases was systematically screened up to February 2024 to identify relevant studies on the use of DOACs in CTEPH patients. The bias risk of RCTs was assessed using the Cochrane Risk of Bias Tool 2.0. The quality of observational prospective cohorts was assessed using the Newcastle-Ottawa Scale tool. Data pooled from different studies were analyzed. Results from 4 studies were gathered, including 2 randomized controlled trials and 2 prospective cohorts, with a total of 2038 patients, of which 751 were on DOACs and 1287 were on vitamin K antagonists (VKAs). Similar rates of all-cause mortality (3.33% vs 3.33%, RD = −0.01%, 95% CI [−0.02%, 0.00%], P = .17), VTE recurrence (1.46% vs 2.12%, RD = −0.00%, 95% CI [−0.01%, 0.01%], P = .92) were observed. DOACs were associated with a nonsignificant reduction in bleeding events including major bleeding (2.22% vs 3.71%, RD = −0.01%, 95% CI [−0.04%, 0.01%], P = .30), any bleeding (5.33% vs 9.94%, RD = −0.03%, 95% CI [−0.07%, 0.01%], P = .10), and minor bleeding (4.17% vs 13.3%, RD = −0.06%, 95% CI [−0.23%, 0.10%], P = .45). Data pooled from existing perspective trials suggests the use of DOACs in CTEPH patients as an effective and safe alternative to VKAs.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-05-23T06:54:52Z
  DOI: 10.1177/10760296241257931
  Issue No: Vol. 30 (2024)
Diagnostic and Prognostic Value of C1q in Sepsis-Induced Coagulopathy
- Authors: Ye Zhang, Li Wang, Xiandong Kuang, Dongling Tang, Pingan Zhang
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Early identification of biomarkers that can predict the onset of sepsis-induced coagulopathy (SIC) in septic patients is clinically important. This study endeavors to examine the diagnostic and prognostic utility of serum C1q in the context of SIC. Clinical data from 279 patients diagnosed with sepsis at the Departments of Intensive Care, Respiratory Intensive Care, and Infectious Diseases at the Renmin Hospital of Wuhan University were gathered spanning from January 2022 to January 2024. These patients were categorized into two groups: the SIC group comprising 108 cases and the non-SIC group consisting of 171 cases, based on the presence of SIC. Within the SIC group, patients were further subdivided into a survival group (43 cases) and non-survival group (65 cases). The concentration of serum C1q in the SIC group was significantly lower than that in the non-SIC group. Furthermore, A significant correlation was observed between serum C1q levels and both SIC score and coagulation indices. C1q demonstrated superior diagnostic and prognostic performance for SIC patients, as indicated by a higher area under the curve (AUC). Notably, when combined with CRP, PCT, and SOFA score, C1q displayed the most robust diagnostic efficacy for SIC. Moreover, the combination of C1q with the SOFA score heightened predictive value concerning the 28-day mortality of SIC patients.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-05-23T05:40:12Z
  DOI: 10.1177/10760296241257517
  Issue No: Vol. 30 (2024)
Oral Rivaroxaban Versus Warfarin After inferior Vena cava Filter
Implantation: A Retrospective Cohort Study
- Authors: Ilya Schastlivtsev, Aleksey Pankov, Sergey Tsaplin, Evgeny Stepanov, Sergey Zhuravlev, Kirill Lobastov
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  ObjectivesTo assess the efficacy and safety of rivaroxaban compared to warfarin after inferior vena cava (IVC) filter implantation.MethodThis retrospective analysis includes data from 100 patients with deep vein thrombosis (DVT) who underwent IVC filter implantation due to a free-floating thrombus (n = 64), thrombus propagation (n = 8), or acute bleeding (n = 8) on therapeutic anticoagulation, catheter-directed thrombolysis (n = 8), or had previously implanted filter with DVT recurrence. Patients were treated with warfarin (n = 41) or rivaroxaban (n = 59) for 3-12 months. Symptomatic venous thromboembolism (VTE) recurrence and bleeding events were assessed at 12 months follow-up.ResultsThree (7.3%) cases of VTE recurrence without IVC filter occlusion occurred on warfarin and none on rivaroxaban. The only (2.4%) major bleeding occurred on warfarin. Three (5.1%) clinically relevant non-major bleedings were detected on rivaroxaban. No significant differences existed between groups when full and propensity scores matched datasets were compared.ConclusionsRivaroxaban seems not less effective and safe than warfarin after IVC filter implantation.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-05-23T05:39:03Z
  DOI: 10.1177/10760296241256938
  Issue No: Vol. 30 (2024)
New Score Models for Predicting Bleeding and Ischemic of Ticagrelor
Therapy in Patients with Diabetes Mellitus
- Authors: Xiaotong Xia, Shu Chen, Chang Cao, YanRong Ye, Yun Shen
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  PurposeTicagrelor is an antiplatelet drug, and its use increases the risk of bleeding. Coronary artery disease is significantly influenced by the widespread occurrence of diabetes mellitus. In order to decrease the incidence of clinical adverse events, a novel bleeding and thrombosis score is developed in this research.MethodsWe conducted a retrospective analysis of patient data from two medical centers who were diagnosed with diabetes mellitus and treated with ticagrelor. We gathered information on every patient from the electronic database of the hospital and follow-up. The collected data were statistically analyzed to obtain risk factors for bleeding and ischemic events.ResultsA total of 851 patients with diabetes mellitus who have been administered ticagrelor are included in our investigation. A total of 76 patients have bleeding events and 80 patients have ischemic events. The analysis of multiple variables indicates that characteristics like the age of>65, having a previous occurrence of bleeding, experiencing anemia, using aspirin, and taking atorvastatin are linked to a higher likelihood of bleeding. Additionally, the age of>65, smoking, having a history of blood clots, and having a BMI ≥ 30 are found to increase the risk of ischemia.ConclusionThe A4B score established in this study was better than the HAS-BLED score，and the same is true for the ABST score to the CHA2DS-VASc score. This new risk assessment model can potentially detect patients who are at high risk for bleeding and ischemic events. For high-risk patients, the dose of ticagrelor can be adjusted appropriately or the medication can be adjusted.(2023-09-11, ChiCTR2300075627)
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-05-23T01:12:00Z
  DOI: 10.1177/10760296241254107
  Issue No: Vol. 30 (2024)
Efficacy and Safety of Direct Oral Anticoagulants in Cerebral Venous
Thrombosis: Meta-Analysis of Randomized Clinical Trials
- Authors: Xi Chen, Linjuan Guo, Meiming Lin
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Current guidelines recommend the standard-of-care anticoagulation (vitamin K antagonists or low-molecular-weight heparin) in patients with cerebral venous thrombosis (CVT). Herein, we performed a meta-analysis of randomized clinical trials (RCTs) to assess the efficacy and safety of direct oral anticoagulants (DOACs) compared with the current standard of care in patients with CVT. We systematically searched the PubMed and Embase databases up to December 2023 to identify clinical trials on the effect of DOACs in patients with CVT. A Mantel-Haenszel fixed effects model was applied, and the effect measures were expressed as the absolute risk differences (RDs) and 95% confidence intervals (CIs). A total of 4 RCTs involving 270 participants were included. In the pooled analysis, DOACs and standard of care had low incidence rates of recurrent VTE and all-cause death, and similar rates of any recanalization (78.2% vs 83.2%; RD = −4%, 95%CI:−14% to 5%) and complete recanalization (60.9% vs 69.4%; RD = −7%, 95%CI:−24% to 10%). Compared with the standard of care, DOACs had non-significant reductions in the rates of major bleeding (1.2% vs 2.4%; RD = −1%, 95%CI: −6% to 3%), intracranial hemorrhage (1.9% vs 3.6%; RD = −2%, 95%CI:−7% to 3%), clinically relevant non-major bleeding (3.8% vs 7.4%; RD = −4%, 95%CI:−9% to 2%), and any bleeding (17.3% vs 21.4%; RD = −4%, 95%CI:−16% to 8%) in patients with CVT. DOACs and standard of care showed similar efficacy and safety profiles for the treatment of CVT. DOACs might be safe and a convenient alternative to vitamin K antagonists for thromboprophylaxis in patients with CVT.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-05-22T12:13:48Z
  DOI: 10.1177/10760296241256360
  Issue No: Vol. 30 (2024)
Nomogram for Risk of Secondary Venous Thromboembolism in Stroke Patients:
A Study Based on the MIMIC-IV Database
- Authors: Folin Lan, Tianqing Liu, Celin Guan, Yufen Lin, Zhiqin Lin, Huawei Zhang, Xiaolong Qi, Xiaomei Chen, Junlong Huang
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  This study aims to identify risk factors for secondary venous thromboembolism (VTE) in stroke patients and establish a nomogram, an accurate predictor of probability of VTE occurrence during hospitalization in stroke patients. Medical Information Mart for Intensive Care IV (MIMIC-IV) database of critical care medicine was utilized to retrieve information of stroke patients admitted to the hospital between 2008 and 2019. Patients were randomly allocated into train set and test set at 7:3. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for secondary VTE in stroke patients. A predictive nomogram model was constructed, and the predictive ability of the nomogram was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). This study included 266 stroke patients, with 26 patients suffering secondary VTE after stroke. A nomogram for predicting risk of secondary VTE in stroke patients was built according to pulmonary infection, partial thromboplastin time (PTT), log-formed D-dimer, and mean corpuscular hemoglobin (MCH). Area under the curve (AUC) of the predictive model nomogram was 0.880 and 0.878 in the train and test sets, respectively. The calibration curve was near the diagonal, and DCA curve presented positive net benefit. This indicates the model's good predictive performance and clinical utility. The nomogram effectively predicts the risk probability of secondary VTE in stroke patients, aiding clinicians in early identification and personalized treatment of stroke patients at risk of developing secondary VTE.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-05-22T12:13:19Z
  DOI: 10.1177/10760296241254104
  Issue No: Vol. 30 (2024)
Construction and Validation of a Nomogram to Predict the Postoperative
Venous Thromboembolism Risk in Patients with HGSOC
- Authors: Zhen Huang, Ling Li, Zhengxin Gong, Liangdan Tang
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Venous thromboembolism (VTE) is a common complication in patients with high-grade serous ovarian cancer (HGSOC) after surgery. This study aims to establish a comprehensive risk assessment model to better identify the potential risk of postoperative VTE in HGSOC. Clinical data from 587 HGSOC patients who underwent surgical treatment were retrospectively collected. Univariate and multivariate logistic regression analyses were performed to identify independent factors influencing the occurrence of postoperative VTE in HGSOC. A nomogram model was constructed in the training set and further validated in the verification set. Logistic regression identified age (odds ratio [OR] = 1.063, P = .002), tumor size (OR = 3.815, P
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-05-20T10:02:33Z
  DOI: 10.1177/10760296241255958
  Issue No: Vol. 30 (2024)
Charlson and Elixhauser Comorbidity Indices for Prediction of Mortality
and Hospital Readmission in Patients With Acute Pulmonary Embolism
- Authors: Alexander O’Hara, Jacob Pozin, Mohammed Abourahma, Ryan Gigstad, Danny Torres, Benji Knapp, Bulent Kantarcioglu, Jawed Fareed, Amir Darki
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Several risk stratification systems aid clinicians in classifying pulmonary embolism (PE) severity and prognosis. We compared 2 clinical PE scoring systems, the PESI and sPESI scores, with 2 comorbidity indices, the Charlson Comorbidity Index (CCI) and the val Walraven Elixhauser Comorbidity Index (ECI), to determine the utility of each in predicting mortality and hospital readmission. Information was collected from 436 patients presenting with PE via retrospective chart review. The PESI, sPESI, CCI, and ECI scores were calculated for each patient. Multivariate analysis was used to determine each system's ability to predict in-hospital mortality, 90-day mortality, overall mortality, and all-cause hospital readmission. The impact of various demographic and clinical characteristics of each patient on these outcomes was also assessed. The PESI score was found to be an independent predictor of in-hospital mortality and 90-day mortality. The PESI score and the CCI were able to independently predict overall mortality. None of the 4 risk scores independently predicted hospital readmission. Other factors including hypoalbuminemia, serum BNP, coagulopathy, anemia, and diabetes were associated with increased mortality and readmission at various endpoints. The PESI score was the best tool for predicting mortality at any endpoint. The CCI may have utility in predicting long-term outcomes. Further work is needed to better determine the roles of the CCI and ECI in predicting patient outcomes in PE. The potential prognostic implications of low serum albumin and anemia at the time of PE also warrant further investigation.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-05-17T05:03:50Z
  DOI: 10.1177/10760296241253844
  Issue No: Vol. 30 (2024)
Thanks to Reviewers
- Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-05-15T09:48:12Z
  DOI: 10.1177/10760296241234192
  Issue No: Vol. 30 (2024)
Factors Affecting the Discrepancy Between Coagulation Times on
Extracorporeal Circulation Using Unfractionated Heparin in Children and
Young Adults
- Authors: Taiki Haga, Yotaro Misaki, Takaaki Sakaguchi, Yoko Akamine
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  In unfractionated heparin (UFH) monitoring during extracorporeal circulation, the traditional measures of activated clotting time (ACT) or activated partial thromboplastin time (APTT) may diverge, confounding anticoagulant adjustments. We aimed to explore the factors explaining this discrepancy in children and young adults. This retrospective observational study, conducted at an urban regional tertiary hospital, included consecutive pediatric patients who received UFH during extracorporeal circulation (continuous kidney replacement therapy or extracorporeal membrane oxygenation) between April 2017 and March 2021. After patients whose ACT and APTT were not measured simultaneously or who were also taking other anticoagulants were excluded, we analyzed 94 samples from 23 patients. To explain the discrepancy between ACT and APTT, regression equations were created using a generalized linear model (family = gamma, link = logarithmic) with ACT as the response variable. Other explanatory variables included age, platelet count, and antithrombin. Compared to APTT alone as an explanatory variable, the Akaike information criterion and pseudo-coefficient of determination improved from 855 to 625 and from 0.01 to 0.42, respectively, when these explanatory variables were used. In conclusion, we identified several factors that may explain some of the discrepancy between ACT and APTT in the routinely measured tests. Evaluation of these factors may aid in appropriate adjustments in anticoagulation therapy.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-05-07T06:03:48Z
  DOI: 10.1177/10760296241252838
  Issue No: Vol. 30 (2024)
Comparison of Fixed Versus Weight-Based Prothrombin Complex Concentrate
Dosing Strategies for Factor Xa Inhibitor Reversal
- Authors: Snyder Brett, Miller Taylor, McCormick Pamela, Gionfriddo Michael
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Background: Our institution introduced fixed-dose prothrombin complex concentrate (PCC) to streamline order verification and medication administration. Previous studies using fixed-dose PCC for vitamin K antagonist reversal showed comparable efficacy to weight-based dosing. Objective: To compare fixed versus weight-based PCC dosing for reversal of Factor Xa Inhibitor (FXaI) effects. Methods: Retrospective cohort study conducted at a tertiary care academic medical center. Patients who received PCC to reverse the effects of apixaban or rivaroxaban were eligible. Subjects in the fixed-dose group (5000 units or 2000 units) were compared to weight-based PCC (50 units/kg). The primary outcome was time between order entry and medication administration. Secondary outcomes included: average PCC dose, postadministration procedures, achieved hemostasis, 30-day mortality, hospital length of stay, and adverse drug events. Results: 72 patients received fixed-dose PCC and 101 received weight-based PCC. Median time between order entry and administration was 4.5 min shorter in the fixed-dose group compared to weight-based (34.5 vs 39 min, P = .10). In patients who received fixed-dose, 79.2% achieved hemostasis versus 71.3% in the weight-based group (RR = 1.11, 95% CI = 0.94-1.32). There was no difference in the number of subsequent hemorrhage-related surgeries (29.2% vs 36.7%, RR = 0.80, 95% CI = 0.51-1.24) or mortality rate (26.4% vs 35.6%, RR = 0.73, 95% CI = 0.46-1.17). There were zero adverse drug events reported. Rates of thrombosis were 2.8% and
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-05-06T10:08:47Z
  DOI: 10.1177/10760296241243368
  Issue No: Vol. 30 (2024)
Anti-Xa Monitoring of Apixaban (ZyQuis) in Venous Thrombo-Embolism and
Atrial Fibrillation
- Authors: Elise Schapkaitz, Byron Ter Morshuizen, Melanie Mc Cree, Barry F. Jacobson
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Apixaban is a direct oral Xa inhibitor and is indicated for the treatment of venous thrombo-embolism (VTE) and prevention of stroke in atrial fibrillation (AF). Recently, a generic (ZyQuis, Zydus Lifesciences Limited, India) has received Food and Drug Administration approval. While bioequivalence has been demonstrated with Eliquis (Bristol-Myers Squibb/Pfizer, UK), it is necessary to monitor its effectiveness prior to acceptance in medical practice. This prospective study independently evaluated Apixaban (ZyQuis) at two accredited laboratories. Participants were converted from Warfarin or Rivaroxaban to Apixaban 5 mg bd for a duration of one month. Peak anti-Xa levels were measured 3-4 h post the morning dose. The samples were processed on the Atellica COAG 360 (Siemens Healthineers, Marburg, Germany) analyzers with a chromogenic anti-Xa assay (Innovance, reference interval 69-321 ng/mL). There were 26 participants; 5 men, 21 women; mean ± standard deviation age of 46 ± 12 years. Indications for anticoagulation included: VTE (88.5%) and AF (11.5%). 69.2% of the participants had at least one comorbidity. 96.2% of the anti-Xa levels were within the laboratory's 95% reference interval. Mean anti-Xa activity was 191 ± 69 ng/mL and 186 ± 68 ng/mL measured at respective laboratories. Mean differences in anti-Xa measurements represented by Bland–Altman statistics were small (bias of −2.6%, 95% confidence interval −1.11 to −4.09) and a strong correlation was observed on Deming regression analysis (0.995). Apixaban (ZyQuis) was effective for the management of VTE and AF as evidenced by anti-Xa activity.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-04-25T06:50:49Z
  DOI: 10.1177/10760296241249167
  Issue No: Vol. 30 (2024)
Reference Value Fibrin Monomer in Healthy Children: A Cross-Sectional
Study
- Authors: Ta Anh Tuan, Tran Dang Xoay, Tran Thi Kieu My, Nguyen Thi Duyen, Nguyen Thi Trang, Nguyen Tat Kien, Chu Thanh Son, Nguyen Van Thang, Thieu Quang Quan, Dau Viet Hung
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  The objective of this study is to determine the fibrin monomer reference intervals in healthy children. This cross-sectional study was conducted in the Hematology Department at Vietnam National Children's Hospital (April 2023 to March 2024). Children without prior history of clotting disorders or anticoagulants use hospitalized in preparation for orthopedic surgery or inguinal hernia surgery were enrolled in the study. The fibrin monomer test method was the quantitative fibrin monomer test on the STA-R system (Diagnostica Stago™, France). Eighty-six children (58 males and 28 females) were enrolled in the study. The median (interquartile range, 2.5th-97.5th) fibrin monomer value of the study subjects was 2.56 (0.11-5.93) µg/mL, with no statistically significant difference in fibrin monomer values among the age groups of 1 month to 3 years, 3 years to 13 years, and 13 years to 18 years. This is the first study conducted in Vietnam to determine reference values of fibrin monomer in children. This information can help in the diagnosis and treatment of early hypercoagulation stage and disseminated intravascular coagulation in children.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-04-24T01:02:06Z
  DOI: 10.1177/10760296241247560
  Issue No: Vol. 30 (2024)
Andexanet Alfa Neutralizes the Anticoagulant Effects of Unfractionated
Heparin of Bovine, Ovine and Porcine Origin Almost as Protamine Sulfate
- Authors: Fakiha Siddiqui, Debra Hoppensteadt, Walter Jeske, Eduardo Ramacciotti, Alfonso Tafur, Jawed Fareed
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  IntroductionAndexanet alfa (AA) - zhzo, recombinant coagulation factor Xa, is an approved antidote for oral Xa inhibitors (apixaban and rivaroxaban). Unfractionated heparin (UFH) is commonly used for therapeutic, interventional, and surgical indications. Protamine sulfate (PrSO4) is frequently used to neutralize UFH. This study aimed to investigate the comparative neutralization profiles of AA and PrSO4 for heparins of bovine, ovine, and porcine origin.Materials and MethodsThe neutralization effect of PrSO4 at 25 µg/ml and AA at 100 µg/ml was studied on an approximate surgical/interventional concentration of heparin by supplementing whole blood with each of the heparins at 25 µg/ml. For the clotting profile (activated partial thromboplastin time: aPTT), amidolytic (anti-Xa and anti-IIa), and thrombin generation assay each of the heparin were supplemented from –10–0.62 µg/ml.ResultsIn the whole blood ACT studies, all three heparins produced strong anti-coagulant effects (400–450 seconds) compared to saline (130–150 seconds). Both AA and PrSO4 almost fully neutralized the anti-coagulant effects of heparins (140–160 seconds). Both antidotes completely reversed the anticoagulant effects of all three heparins in the aPTT and thrombin generation assay. However, PrSO4 was more effective in neutralizing the anti-Xa, and anti-IIa effects than AA, which only partially neutralized these effects.ConclusionAndexanet alfa at 100 µg/ml effectively neutralizes the therapeutic and surgical/interventional concentrations of heparins in in-vitro settings. While differences in the anti-Xa, and anti-IIa effects between heparins were noted, anti-coagulant effect of these agents in the aPTT assay were comparable. A similar neutralization profile was observed in the ACT and thrombin generation assays by both agents.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-04-24T01:01:27Z
  DOI: 10.1177/10760296241247558
  Issue No: Vol. 30 (2024)
Challenges to Laboratory Monitoring of Direct Oral Anticoagulants
- Authors: Jesse Qiao, Minh-Ha Tran
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Direct oral anticoagulants (DOACs) exert anticoagulation effect by directly inhibiting Factor Xa (rivaroxaban, apixaban, and edoxaban) or thrombin (dabigatran). Though DOACs are characterized by fixed-dose prescribing and generally do not require routine laboratory drug-level monitoring (DLM), circumstances may arise where the DLM may aid in clinical decision-making, including DOAC dose adjustment, anticoagulant class change, or decisions to withhold or administer reversal agents. We review the current literature that describes high-risk patient groups in which DLM may be beneficial for improved patient anticoagulation management and stewardship. The review also summarizes the limitations of conventional coagulation testing and discuss the emerging utility of quantitative methods for routine and rapid emergent evaluation of DOAC drug levels—in particular, the Anti-Xa activity to detect Factor Xa Inhibitors (rivaroxaban, apixaban, and edoxaban). Both technical and regulatory barriers to widespread DLM implementation are limiting factors to further clinical research that must be overcome, in order to propose universal DOAC DLM strategies and provide clinical-laboratory correlation to formally classify high-risk patient groups.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-04-23T05:00:25Z
  DOI: 10.1177/10760296241241524
  Issue No: Vol. 30 (2024)
The Relationship of Coronary Thrombus Burden and Anticoagulation and Risk
Factors in Atrial Fibrillation (ATRIA) Score in Patients With ST-Segment
Elevation Myocardial Infarction
- Authors: Gökhan Coşkun, Cem Ozde, Osman Kayapinar, Gulsah Aktore, Ensar Ekşi, Hamdi Afşin, Ahmet Egemen Sayın
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  BackgroundThe anticoagulation and risk factors in atrial fibrillation (ATRIA) score is associated with adverse cardiovascular events. However, its relationship with coronary thrombus burden is unclear. Therefore, we aimed to investigate the relationship between the ATRIA score and thrombus burden in patients with ST-segment elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention (PCI).Materials and MethodsThe study was designed as a prospective cross-sectional observational study. Our study included 319 patients who were prospectively admitted with STEMI between January 2021 and April 2022. Patients were divided into 2 groups with low thrombus burden (LTB) (grade 8 sensitivity of 98% and specificity of 100% predicted HTB.ConclusionIn this study, we found that thrombus burden may be associated with ATRIA risk score in patients presenting with STEMI.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-04-22T07:33:41Z
  DOI: 10.1177/10760296241237232
  Issue No: Vol. 30 (2024)
External Validation of the Risk Assessment Model of Venous Thromboembolism
in Multicenter Internal Medicine Inpatients
- Authors: Xiaolan Chen, Hongning Shi, Jiaqi Chang, Wenjia Guo, Yuanhua Yang, Yong Wang, Lei Pan
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  To external validate the risk assessment model (RAM) of venous thromboembolism (VTE) in multicenter internal medicine inpatients. We prospectively collected 595 internal medical patients (310 with VTE patients, 285 non-VTE patients) were from Beijing Shijitan Hospital, Beijing Chaoyang Hospital, and the respiratory department of Beijing Tsinghua Changgeng Hospital from January 2022 to December 2022 for multicenter external validation. The prediction ability of Caprini RAM, Padua RAM, The International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) RAM, and Shijitan (SJT) RAM were compared. This study included a total of 595 internal medicine inpatients, including 242 (40.67%) in the respiratory department, 17 (2.86%) in the respiratory intensive care unit, 49 (8.24%) in the neurology department, 34 (5.71%) in the intensive care unit, 26 (4.37%) in the geriatric department, 22 (3.70%) in the emergency department, 71 (11.93%) in the nephrology department, 63 (10.59%) in the cardiology department, 24 (4.03%) in the hematology department, 6 (1.01%) in the traditional Chinese medicine department, 9 (1.51%) cases in the rheumatology department, 7 (1.18%) in the endocrinology department, 14 (2.35%) in the oncology department, and 11 (1.85%) in the gastroenterology department. Multivariate logistic regression analysis showed that among internal medicine inpatients, age > 60 years old, heart failure, nephrotic syndrome, tumors, history of VTE, and elevated D-dimer were significantly correlated with the occurrence of VTE (P
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-04-18T07:06:28Z
  DOI: 10.1177/10760296241247205
  Issue No: Vol. 30 (2024)
Venous Thromboembolism Risk Factors in Women With Obesity Who Undergo
Cesarean Delivery
- Authors: Tolulope B. Fatokun, Sarah E. Swartz, Ahmed Ebeid, Sophia A. Cordes, Alexis C. Gimovsky, Andrew D. Sparks, Richard L. Amdur, Homa K. Ahmadzia
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Venous thromboembolism (VTE) is a leading cause of maternal mortality. Obesity and cesarean delivery are established risk factors for pregnancy-related VTE. We identified additional risk factors among patients with obesity who underwent a cesarean delivery to identify those who need VTE prophylaxis. We conducted a secondary analysis of data from the Maternal-Fetal Medicine Units Network (MFMU) Cesarean Registry Database using a case-control design. Cases were identified as women with obesity having a pre-pregnancy body mass index of>30 kg/m2, who underwent cesarean delivery and subsequently developed deep venous thrombosis (DVT) or pulmonary embolism (PE). These women were compared to a control group of women with obesity who underwent cesarean delivery but did not develop DVT or PE. Analysis of risk factors associated with VTE was performed using Chi-Square test and Fisher's exact test. We identified 43 VTE cases and 172 controls in the MFMU database. Increased risk of VTE was noted in women with endometritis (OR of 4.58 [95% CI: 1.86-11.2, P = .0004]), receiving a blood transfusion (OR 17.07 [95% CI: 4.46-65.3, P = .0001]), having a coagulopathy (OR 27.73 [95% CI: 3.24-237.25, P = .0003]), and urinary tract infection (OR 2.39 [95% CI: 1.08-5.28, P = .03]). Important risk factors for VTE in women with obesity who undergo cesarean delivery include endometritis, intra- or post-operative transfusion, coagulopathy, and urinary tract infection. The presence of one or more of these factors may help guide provider decision-making regarding whether to administer thromboprophylaxis.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-04-15T04:13:06Z
  DOI: 10.1177/10760296241247203
  Issue No: Vol. 30 (2024)
Risk Factors Associated With Exclusion of Obese Patients Ischemic Stroke
With a History of Smoking From Thrombolysis Therapy
- Authors: Philip C. Brewer, Dami T. Ojo, Philip X. Broughton, Adebobola Imeh-Nathaniel, Samuel Imeh-Nathaniel, Thomas I. Nathaniel
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  The objective of this study is to determine risk factors that may contribute to exclusion decision from recombinant tissue plasminogen activator (rtPA) in patients with acute ischemic stroke (AIS) with a combined current or history of smoking and obesity. This study was conducted on data from 5469 patients with AIS collected from a regional stroke registry. Risk factors associated with inclusion or exclusion from rtPA were determined using multivariate logistic regression analysis. The adjusted odds ratios and 95% confidence interval for each risk factor were used to predict the increasing odds of an association of a specific risk factor with exclusion from rtPA. In the adjusted analysis, obese patients with AIS with a history of smoking (current and previous) excluded from rtPA were more likely to present with carotid artery stenosis (OR = 0.069, 95% CI 0.011-0.442), diabetes (OR = 0.604, 95% CI 0.366-0.997), higher total cholesterol (OR = 0.975, 95% CI 0.956-0.995), and history of alcohol use (OR = 0.438, 95% CI 0.232-0.828). Higher NIHSS score (OR = 1.051, 95% CI 1.017-1.086), higher triglycerides (OR = 1.004, 95% CI 1.001-1.006), and higher high-density lipoprotein (OR = 1.028, 95% CI 1.000-1.057) were associated with the inclusion for rtPA. Our findings reveal specific risk factors that contribute to the exclusion of patients with AIS with a combined effect of smoking and obesity from rtPA. These findings suggest the need to develop management strategies to improve the use of rtPA for obese patients with AIS with a history of smoking.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-04-11T07:47:38Z
  DOI: 10.1177/10760296241246264
  Issue No: Vol. 30 (2024)
Detection of a Prethrombotic State in Patients with Hepatocellular
Carcinoma, Using a Clot Waveform Analysis
- Authors: Shunsuke Fukui, Hideo Wada, Kohei Ikeda, Mayu Kobayashi, Yasuaki Shimada, Yuuichi Nakazawa, Hiroki Mizutani, Yuhuko Ichikawa, Yuuki Nishiura, Isao Moritani, Yutaka Yamanaka, Hidekazu Inoue, Motomu Shimaoka, Hideto Shimpo, Katsuya Shiraki
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Background: Although hepatocellular carcinoma (HCC) is frequently associated with thrombosis, it is also associated with liver cirrhosis (LC) which causes hemostatic abnormalities. Therefore, hemostatic abnormalities in patients with HCC were examined using a clot waveform analysis (CWA). Methods: Hemostatic abnormalities in 88 samples from HCC patients, 48 samples from LC patients and 153 samples from patients with chronic liver diseases (CH) were examined using a CWA-activated partial thromboplastin time (APTT) and small amount of tissue factor induced FIX activation (sTF/FIXa) assay. Results: There were no significant differences in the peak time on CWA-APTT among HCC, LC, and CH, and the peak heights of CWA-APTT were significantly higher in HCC and CH than in HVs and LC. The peak heights of the CWA-sTF/FIXa were significantly higher in HCC than in LC. The peak times of the CWA-APTT were significantly longer in stages B, C, and D than in stage A or cases of response. In the receiver operating characteristic (ROC) curve, the fibrin formation height (FFH) of the CWA-APTT and CWA-sTF/FIXa showed the highest diagnostic ability for HCC and LC, respectively. Thrombosis was observed in 13 HCC patients, and arterial thrombosis and portal vein thrombosis were frequently associated with HCC without LC and HCC with LC, respectively. In ROC, the peak time×peak height of the first derivative on the CWA-sTF/FIXa showed the highest diagnostic ability for thrombosis. Conclusion: The CWA-APTT and CWA-sTF/FIXa can increase the evaluability of HCC including the association with LC and thrombotic complications.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-04-09T01:33:45Z
  DOI: 10.1177/10760296241246002
  Issue No: Vol. 30 (2024)
Assessment of the Clinical Value of Platelet-to-Lymphocyte Ratio in
Patients with Hepatocellular Carcinoma
- Authors: Xu Chen, Abdul Fatawu Mohammed, Chengbin Li
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Hepatocellular carcinoma (HCC) is associated with higher mortality as a result of poor prognosis and unavailability of effective treatment options. This study retrospectively analyzed the clinical value of platelet-to-lymphocyte ratio (PLR) to aid in differentiating early hepatocellular carcinoma from liver cirrhosis patients. Three hundred and nine (309) patients including 155 patients with hepatocellular carcinoma (HCC) and 154 patients with liver cirrhosis were enrolled in this study. General clinical characteristics and blood parameters of each patient were collected, calculated, and retrospectively analyzed. Mann–Whitney U test was calculated to compare the two groups. Receiver operating characteristics (ROC) curve was performed to investigate the diagnostic potential of PLR in the prediction of HCC at a cut-off with high accuracy (area under the curve [AUC]) > 0.80. Hemoglobin (HB) concentration, red blood cell (RBC) count, neutrophil (NEU) count, platelet count, platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR) were significantly higher in the HCC patients than in the liver cirrhosis patients (p
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-04-09T01:32:26Z
  DOI: 10.1177/10760296231221535
  Issue No: Vol. 30 (2024)
Efficacy and Safety of Long-Term Dual Antiplatelet Therapy: A Systematic
Review and Meta-Analysis
- Authors: Xiaoming Zhang, Da Zhou, Siying Song, Xiangqian Huang, Yuchuan Ding, Ran Meng
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  BackgroundDual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is a standard therapy in patients with ischemic vascular diseases (IVD) including coronary artery, cerebrovascular and peripheral arterial diseases, although the optimal duration of this treatment is still debated. Previous meta-analyses reported conflicting results about the effects of long-term and short-term as well as non-DAPT use in various clinical settings. Herein, we conducted a comprehensive meta-analysis to assess the efficacy and safety of different durations of DAPT.MethodsWe reviewed relevant articles and references from database, which were published prior to April 2023. Data from prospective studies were processed using RevMan5.0 software, provided by Cochrane Collaboration and transformed using relevant formulas. The inclusion criteria involved randomization to long-term versus short-term or no DAPT; the endpoints included at least one of total or cardiovascular (CV) mortalities, IVD recurrence, and bleeding.ResultsA total of 34 randomized studies involving 141 455 patients were finally included. In comparison with no or short-term DAPT, long-term DAPT reduced MI and stroke, but did not reduce the total and CV mortalities. Meanwhile, bleeding events were increased, even though intracranial and fatal bleedings were not affected. Besides, the reduction of MI and stroke recurrence showed no statistical significance between long-term and short-term DAPT groups.ConclusionLong-term DAPT may not reduce the mortality of IVD besides increasing bleeding events, although reduced the incidences of MI and stroke early recurrence to a certain extent and did not increase the risk of fatal intracranial bleeding.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-04-04T07:37:48Z
  DOI: 10.1177/10760296241244772
  Issue No: Vol. 30 (2024)
International Normalized Ratio Predicts Recurrence and Bleeding in
Patients With Acute Venous Thromboembolism Who Undergo Direct Oral
Anticoagulants
- Authors: Yunfeng Zhao, Yi Cheng, Yong Luo, Qihuan Yao, Jianmin Qu, Jinyuan Sun, Song Liu, Mei Xu, Wei Xiong
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Prothrombin time/international normalized ratio (PT/INR) is related to both antithrombotic effect and risk of bleeding. Its role in the prediction of venous thromboembolism (VTE) recurrence and bleeding for patients with acute VTE who undergo direct oral anticoagulants (DOACs) treatment is unclear, despite previous studies revealed some association between them. The predictive efficiency of INR for VTE recurrence and bleeding were analyzed in a retrospective cohort with VTE patients who underwent DOACs treatment. Then its predictive efficiency for VTE recurrence and bleeding were validated in a prospective cohort with the acquired cutoffs range, and compared with anti-Xa level, DASH and VTE-BLEED scores. In the retrospective cohort (n = 1083), the sensitivity and specificity of INR for the prediction of VTE recurrence were 79.4% and 92.8%, respectively. The area under the curve (AUC) was 0.881 (0.803-0.960)(P = .025). The cutoff value of INR was 0.9. The sensitivity and specificity of INR for the prediction of bleeding were 85.7% and 77.9%, respectively. The AUC was 0.876 (0.786-0.967)(P
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-04-03T07:33:48Z
  DOI: 10.1177/10760296241246004
  Issue No: Vol. 30 (2024)
Biomarkers Profile in Provoked Versus Unprovoked Deep Venous Thrombosis
- Authors: Isabela Rodrigues Tavares, Roberto Augusto Caffaro, Maria Fernanda Portugal, Camilla Moreira Ribeiro, Viviane Santana da Silva, Emily Krupa, Srdjan Nikolovski, Karen Falcão de Britto, Ana Cláudia Gomes Pereira Petisco, Maria Cristina Miranda, Sandra Gomes de Souza Santos, Marcela da Silva Dourado, Paula Veloso Siqueira, Fakiha Siddiqui, Jawed Fareed, Eduardo Ramacciotti
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), represents a substantial healthcare challenge. Provoked and unprovoked DVT cases carry distinct risks and treatment considerations. Recognizing the limitations of this classification, molecular markers may enhance diagnostic precision and guide anticoagulation therapy duration relying on patient history and risk factors. This preliminary, open-label, prospective cohort study was conducted including 15 patients (10 provoked DVT and 5 unprovoked DVT) and a control group of healthy plasmatic subjects. Plasma levels of 9 biomarkers were measured at diagnosis (baseline, day 0, and D0) and after 30 days (day 30-D30). Patient demographics, clinical data, and biomarker concentrations were analyzed. Serum concentrations of D-dimer, von Willebrand factor, C-reactive protein, and Anti-Xa were elevated in DVT groups at D0 compared to controls. No significant differences were observed between the provoked and unprovoked groups on the day of diagnosis and 30 days later. Over 30 days, the provoked group exhibited significant biomarker changes related to temporal assessment. No significant differences were noted in the biomarker profile between provoked and unprovoked DVT groups. This study is indicative of the concept of individualized thrombosis assessment and subsequent treatment for VTE. Larger cohorts are warranted to validate these findings and further define the most appropriate use of the molecular markers.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-04-03T07:32:49Z
  DOI: 10.1177/10760296241238211
  Issue No: Vol. 30 (2024)
Evaluating of Existing VTE Risk Scales in Glioma Patients
- Authors: Simakova Maria, Pishchulov Konstantin, Lukinov Vitaliy, Voynov Nikita, Bulaeva Maria, Melnichnikova Olga, Zhilenkova Yulia, Savelyeva Аnna, Moiseeva Olga, Samochernykh Konstantin
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  IntroductionPostoperative venous thromboembolism (VTE) is a frequently occurring complication among glioma patients. Several risk assessment models (RAMs), including the Caprini RAM, the IMPROVE Risk Score, the IMPROVED VTE Risk Score, and the Padua Prediction Score, have not been validated within the glioma patient population. The purpose of this study was to assess the predictive accuracy of established VTE risk scales in patients with glioma.Materials and MethodsA single-center, retrospective, observational cohort study was conducted on 265 glioma patients who underwent surgery at the Almazov Medical and Research Centre between 2021 and 2022. VTE detection followed the current clinical guidelines. Threshold values for the Caprini, IMPROVE VTE, IMPROVEDD, and Padua scales were determined using ROC analysis methods, with cumulative weighting for sensitivity and specificity in predicting VTE development. The areas under the ROC curves (AUC) were calculated, and comparisons were made using the DeLong test.ResultsThe area under the curve for the Caprini risk assessment model was 80.41, while the IMPROVEDD VTE risk score was 75.38, the Padua prediction score was 76.9, and the IMPROVE risk score was 72.58. No significant differences were observed in the AUC values for any of the scales. The positive predictive values of all four scales were low, with values of 50 (28–72) for Caprini, 48 (28–69) for IMPROVEDD VTE, 50 (30–70) for Padua, and 64 (35–87) for IMPROVE RAM. No significant differences were found in terms of PPV, NPV, positive likelihood ratio, and negative likelihood ratio among the analyzed scales.ConclusionsThe Caprini Risk Assessment Model, the IMPROVE Risk Score, the IMPROVED VTE Risk Score, and the Padua Prediction Score exhibit acceptable specificity and sensitivity for glioma patients. However, their low positive predictive ability, coupled with the complexity of interpretation, limits their utility in neurosurgical practice.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-04-02T07:27:44Z
  DOI: 10.1177/10760296241238210
  Issue No: Vol. 30 (2024)
The Impact of Atherosclerotic Burden on Vascular Outcomes in Patients with
Stroke and Atrial Fibrillation: The ATHENA study
- Authors: Andrea Galeazzo Rigutini
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Introduction: Patients with ischemic stroke (IS) and atrial fibrillation (AF) face a higher risk of recurrent vascular events. This study evaluates the impact of atherosclerotic vascular disease burden across different vascular territories on the risk of vascular events in patients with recent ischemic stroke and AF within 90 days. Patients and Methods: We included patients with IS and AF from the International RAF network in a prospective 90-day follow-up. Atherosclerotic vascular disease was identified by at least one of the following: Symptomatic ischemic heart disease, symptomatic peripheral artery disease, internal carotid stenosis ≥50%, or the presence of plaques in the aorta. The primary outcome was a composite of stroke, transient ischemic attack, systemic embolism, cerebral bleeding, and major extracranial bleeding within 90 days postacute stroke. Patients were categorized into 5 groups based on the number of affected atherosclerotic vascular territories, with those with no atherosclerotic vascular disease as the reference. Kaplan–Meier curves were generated and compared using the log-rank test to determine the predictive value of the number of diseased territories for the risk of events. Data analysis was performed with SPSS/PC Win Package 25.0. Results: Of the 2148 patients (mean age 77.59; 53.86% female), 744 (34.60%) had atherosclerosis. Multivariable analysis revealed that involvement of 3 (hazard ratio [HR] 2.80, 95% confidence interval [CI]: 1.20-6.53) or 4 (HR 6.81, 95% CI: 1.02-36.24) vascular territories was significantly associated with the risk of combined events. Conclusions: In patients with recent ischemic stroke and AF, atherosclerosis across multiple territories correlates with a higher risk of future vascular events.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-04-02T07:21:15Z
  DOI: 10.1177/10760296241240746
  Issue No: Vol. 30 (2024)
A Call to Leadership: New VTE Treatment and Prevention Guidelines
- Authors: Omar L. Esponda, Alfonso J. Tafur
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-04-02T06:26:45Z
  DOI: 10.1177/10760296241243079
  Issue No: Vol. 30 (2024)
Sex Differences and Clinical Outcomes of Patients with Coronavirus Disease
2019 Infection and Cerebral Venous Sinus Thrombosis: A Systematic Review
- Authors: Saleh A. Algarni, Naif S. ALGhasab, Mohammed S. Alharbi, Anas Albarrak, Ahmad A. Alanezi, Hamdan M. Al Shehri
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Cerebral venous sinus thrombosis (CVST) is a rare neurovascular condition that has been observed in individuals with coronavirus disease 2019 (COVID-19). This systematic review aimed to explore the sex differences and characteristics of concurrent COVID-19 and CVST cases. A total of 212 CVST patients were included in the study. Women with CVST had a slightly higher mean age compared to men (47.359 years vs 46.08 years). Women were more likely to report symptoms such as fever (56.1%) and decreased sense of smell or taste (71.4%), while men more frequently experienced nausea or vomiting (55.6%), headache (62.9%), and seizures (72%). Notably, current smokers, who were predominantly men, had a higher occurrence of CVST. On the other hand, women had a higher likelihood of CVST risk factors such as oral contraceptive pill (OCP) use and autoimmune diseases. Treatment approaches also showed sex-based differences. Unfractionated heparin was administered more often to women with CVST (63.2%). The in-hospital mortality rate for CVST patients was 21.3%, with men having a significantly higher mortality rate than women (65.2% vs 34.8%, P = .027). Survival analysis revealed that factors such as smoking history, diabetes mellitus, hypertension, OCP use, COVID-19 symptoms, CVST symptoms, and the need for intubation significantly influenced survival outcomes. Understanding these sex differences in COVID-19-related CVST is crucial for accurate diagnosis and effective management, ultimately leading to improved patient outcomes. Our findings highlight the importance of considering sex as a factor in the evaluation and treatment of individuals with COVID-19 and concurrent CVST.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-03-29T08:06:56Z
  DOI: 10.1177/10760296241240748
  Issue No: Vol. 30 (2024)
Effect of Reduced INR in Early Pregnancy on the Occurrence of
Preeclampsia: A Retrospective Cohort Study
- Authors: Pei-Pei Jin, Ning Ding, Jing Dai, Xiao-Yan Liu, Pei-Min Mao
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  To investigate the effect of reduced early-pregnancy activated partial thrombin time (APTT), prothrombin time (PT), and international standardized ratio (INR) on the risk of preeclampsia. A total of 8549 pregnant women with singleton births were included. Early pregnancy APTT, PT, and INR levels, with age, birth, prepregnancy body mass index, fibrinogen (FBG), thrombin time (TT), D-dimer (DD2), antithrombin III (ATIII), fibrin degradation products (FDP) as confounders, generalized linear model of APTT, the relative risk of PT and INR when INR reduction. After adequate adjustment for confounders, the relative risk of preeclampsia was 0.703 for every 1 s increase in plasma PT results in early pregnancy, and for every 0.1 increase in plasma INR results, the relative risk of preeclampsia was 0.767. With a PT less than the P25 quantile (
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-03-26T08:48:23Z
  DOI: 10.1177/10760296241238015
  Issue No: Vol. 30 (2024)
Analysis of Risk Factors of Postoperative Lower Extremity Deep Venous
Thrombosis in Patients With Cervical Cancer
- Authors: Shiyu Cheng, Han Gao, Yanli Li, Xiuting Shi, Xin Li, Tianzhuo Yang, Dan Teng, Tingzhu Meng, Jie Shi
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Deep venous thrombosis (DVT) has a significant negative impact on surgical and tumor patient's safety and quality of life. There was no specific report on the incidence and risk factors of postoperative lower extremity DVT in cervical cancer patients. Analysis of the risk factors of postoperative DVT in patients with cervical cancer is of great clinical significance for prevention and treatment. We retrospectively analyzed 309 cervical cancer patients treated by the Hubei Cervical Cancer Prevention Center and used a logistic regression model to test the risk variables of postoperative lower extremity deep venous thrombosis in cervical cancer patients. By univariate analyses, the results of the study showed that the incidence of postoperative DVT was significantly increased in cervical cancer patients complicated with old age, obesity, high preoperative plasma D-dimer level, increased preoperative triglyceride level, chronic diseases (hypertension, diabetes, and cardiovascular disease), open surgery, long operation time, intraoperative blood transfusion, advanced tumor stage, and preoperative chemotherapy/radiotherapy. Advanced age, obesity, elevated preoperative D-dimer level, high preoperative triglyceride level, and open surgery were independent risk factors for postoperative lower extremity DVT in patients with cervical cancer by multivariate regression analyses (all P
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-03-26T06:18:49Z
  DOI: 10.1177/10760296241240747
  Issue No: Vol. 30 (2024)
Outcomes and Costs in Patients with Immune Thrombotic Thrombocytopenic
Purpura Receiving Front-Line Versus Delayed Caplacizumab: A US Hospital
Database Study
- Authors: Alix Arnaud, Samantha Schilsky, Jackie Lucia, Marta Maia, Fernando Laredo, Ana Paula Marques, Hikaru Okada, Andrew W. Roberts
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  European real-world data indicate that front-line treatment with caplacizumab is associated with improved clinical outcomes compared with delayed caplacizumab treatment. The objective of the study was to describe the characteristics, treatment patterns, and outcomes in hospitalized patients with an immune-mediated thrombotic thrombocytopenic purpura (iTTP) episode treated with front-line versus delayed caplacizumab in the US. This retrospective cohort analysis of a US hospital database included adult patients (≥18 years) with an acute iTTP episode (a diagnosis of thrombotic microangiopathy and ≥1 therapeutic plasma exchange [TPE] procedure) from January 21, 2019, to February 28, 2021. Unadjusted baseline characteristics, treatment patterns, healthcare resource utilization, and costs were compared between patients who received front-line versus delayed (
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-03-25T04:42:50Z
  DOI: 10.1177/10760296241241525
  Issue No: Vol. 30 (2024)
Use of Andexanet Alfa for Factor Xa Inhibitor Reversal in US Verified
Trauma Centers: A National Survey
- Authors: Charles Fasanya, Abenámar Arrillaga, Catherine Caronia, Lauren Rothburd, Tenzing Japhe, Younghee Hahn, Paul Joseph, Dajana Reci, Patricia Eckardt
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Direct oral factor Xa inhibitors are replacing vitamin K-dependent antagonists as anticoagulation treatment in many clinical scenarios. Trauma centers are noting an increase in patients presenting on these medications. The 2018 Food and Drug Administration approval of andexanet alfa provides an alternative anticoagulation reversal. Barriers may limit utilization of new medications including a lack of grade 1A evidence supporting the use of prothrombin complex concentrate (PCC) versus andexanet alfa and cost. To evaluate barriers of andexanet alfa utilization by trauma surgeons, a 15-question survey was conducted. There was a 9% completion rate (n = 89). The results revealed 23.5% would choose andexanet alfa as first-line treatment in children, and 25.8% as first-line treatment in adults. The majority of respondents, 64.7% and 67.4%, would use PCC preferentially in children and adults, respectively. Respondents indicated that cost burden was an overriding factor (76.3%); 42.4% cited lack of high-level efficacy data of andexanet alfa for reversal of factor Xa inhibitors. Additional double-blinded multi-institutional randomized controlled trials comparing 4F-PCC and andexanet alfa for factor Xa inhibitor reversal are needed to support efficacy especially with the increased cost associated.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-03-18T07:22:12Z
  DOI: 10.1177/10760296241238013
  Issue No: Vol. 30 (2024)
Role of Angiopoietin/Tie2 System in Sepsis: A Potential Therapeutic Target
- Authors: Yawen Chi, Sihan Yu, Jia Yin, Danyan Liu, Mengke Zhuo, Xu Li
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Sepsis is a disorder of host response caused by severe infection that can lead to life-threatening organ dysfunction. There is no specific treatment for sepsis. Although there are many different pathogens that can cause sepsis, endothelial dysfunction is a frequent mechanism resulting in vascular leakage and coagulation problem. Recent studies on the regulatory pathways of vascular endothelium have shown that the disturbance of angiopoietin (Ang) /Tie2 axis can induce endothelial cell activation, which is the core pathogenesis of sepsis. In this review, we aim to discuss the regulation of Ang/Tie2 axis and the biomarkers involved in the context of sepsis. Also, we attempt to explore the prospective and feasibility of Ang/Tie2 axis as a potential target for sepsis intervention to improve clinical outcomes.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-03-07T05:05:12Z
  DOI: 10.1177/10760296241238010
  Issue No: Vol. 30 (2024)
The Contribution of Inherited Thrombophilia to Venous Thromboembolism in
Cancer Patients
- Authors: José Costa, António Araújo
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Although the relationship between venous thromboembolism (VTE) and cancer has been a subject of study, knowledge of the contribution of thrombophilia to thrombosis in patients with cancer is still very limited. The aim of this article is to collect present knowledge on the contribution of inherited thrombophilia to VTE in cancer patients. We performed a search in Google Scholar and PubMed and selected 21 from 76 returned articles. Then we made a narrative review of the selected articles. We describe 11 studies on the contribution of inherited thrombophilia to VTE in cancer patients in general and 10 on that contribution in specific types of cancer: 1 in colorectal cancer, 4 in breast cancer, 1 in gynecologic cancer and 4 in hematopoietic malignancies. All studies investigate the relation of factor V Leiden (FVL) to VTE, 13 that of the prothrombin G20210A mutation (PTG20210A) and 7 studies also investigate other inherited thrombophilias, such methylenetetrahydrofolate reductase gene mutations, although only 2 investigate the contribution of deficiencies of the natural anticoagulants. Studies are very heterogeneous, in design and sample size and conclusions differ considerably. There is no consensus on the contribution of inherited thrombophilia to VTE in cancer patients except for acute lymphoblastic leukemia in children. Probably, that contribution is not the same for all types of cancer and more studies are needed to bring more knowledge on this subject.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-03-06T12:28:21Z
  DOI: 10.1177/10760296241232864
  Issue No: Vol. 30 (2024)
Triglyceride-glucose Index as a Valuable Marker to Predict Severity of
Coronary Artery Disease: A Retrospective Cohort Study
- Authors: Xu Geng, Xi Zhang, XiaoWei Li, ChunTing Zhong, Min Hou
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Background and AimsThe diagnostic standard of coronary artery disease (CAD) is coronary angiography (CAG). Since CAG is an invasive procedure underscores the need for identifying non-invasive, effective, and innovative biomarkers. Our study aimed to retrospectively analyze hematological markers for predicting the severity of CAD.Methods and ResultsCase data were collected from 195 CAD patients admitted to the hospital for CAG. According to Gensini score, patients were divided into mild, moderate, and severe CAD groups. Blood indexes and predictive efficacy of the triglyceride-glucose (TyG) index were retrospectively analyzed. Among 195 CAD patients, 81 had mild CAD, 60 had moderate CAD, and 54 had severe CAD. Sex, fast blood glucose (FBG), TyG index, and high-sensitivity C-reactive protein (hs-CRP) significantly differed among the three groups. The TyG index demonstrated higher values in patients with moderate (9.07[8.62-9.44]) and severe (8.98[8.46-9.45]) CAD compared to those with mild CAD (8.75[8.49-9.14]). The AUC of the TyG index was 0.615 (95% confidence interval (CI): 0.536-0.694, P =.004), with a cut-off value of 8.997, specificity of 0.704, and sensitivity of 0.535. Logistics analysis showed the risk of moderate and severe CAD with an odds ratio (OR) value of 2.595 (95% CI: 1.199-5.619, adjusted P = .016) following regrouping by the TyG index optimal cut-off value of 8.997. The TyG index combined with FBG and hs-CRP had an elevated AUC value, significantly higher than other combinations (P = .011 and 0.02, respectively).ConclusionsThe severity of CAD is positively correlated with an increased TyG index value. A combination of TyG, FBG, and hs-CRP has demonstrated improved diagnostic efficiency, suggesting its potential as a novel indicator for predicting and diagnosing CAD progression.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-03-06T07:10:54Z
  DOI: 10.1177/10760296241234320
  Issue No: Vol. 30 (2024)
Platelet Function Testing to Guide Cangrelor Dosing in Patients with
Temporary Mechanical Circulatory Support or as a Bridge to Procedure
- Authors: Margaret M. Buck, Chelsea I. Barry, Courtney A. Montepara, Nathan J. Verlinden
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Cangrelor is a rapid-acting, intravenous P2Y12 inhibitor that can be used in patients after percutaneous coronary intervention who require mechanical circulatory support or as a bridge to procedure. We retrospectively reviewed adult patients who received platelet function testing (PFT) with the VerifyNow P2Y12 assay while on cangrelor from March 2021 through November 2022. All patients were initiated on 0.75 mcg/kg/min of cangrelor with P2Y12 reaction unit (PRU) values collected 12–24 h after initiation. Cangrelor doses were adjusted per protocol to maintain PRU values of 85–208. A total of 42 patients were included. Thirty-eight patients (90.5%) required temporary mechanical circulatory support while on cangrelor, and 4 patients (9.5%) received cangrelor as a bridge to procedure. The median cangrelor maintenance dose was 0.5 (interquartile range [IQR]: 0.375–0.75) mcg/kg/min, and the median time in therapeutic range with a PRU value between 85 and 208 was 66.6% (IQR: 39.6%-100%). No patients experienced stent thrombosis. A composite major adverse cardiovascular event occurred in 4 patients (9.5%), and major bleeding occurred in 16 patients (38.1%). Compared to empiric cangrelor dosing of 0.75 mcg/kg/min, PFT-guided cangrelor dose adjustment was associated with a median drug cost savings of $1605.60 (IQR: $0-4281.56). Utilizing PFT with cangrelor may allow for lower, individualized dosing while preventing stent thrombosis.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-03-05T08:01:01Z
  DOI: 10.1177/10760296241237228
  Issue No: Vol. 30 (2024)
Super Formula for Soluble C-Type Lectin-Like Receptor 2 × D-Dimer in
Patients With Acute Cerebral Infarction
- Authors: Toshitaka Kamon, Hideo Wada, Shotaro Horie, Tomoya Inaba, Karin Okamoto, Katsuya Shiraki, Yuhuko Ichikawa, Minoru Ezaki, Motomu Shimaoka, Akisato Nishigaki, Akihiro Shindo, Hideto Shimpo, Nobuo Ito
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Acute cerebral infarction (ACI) includes atherosclerotic and cardiogenic ACI and involves a thrombotic state, requiring antithrombotic treatment. However, the thrombotic state in ACI cannot be evaluated using routine hemostatic examinations. Plasma soluble C-type lectin-like receptor 2 (sCLEC-2) and D-dimer levels were measured in patients with ACI. Plasma sCLEC-2 and D-dimer levels were significantly higher in patients with ACI than in those without it. The sCLEC-2 × D-dimer formula was significantly higher in patients with ACI than in those without it. A receiver operating characteristic curve showed a high sensitivity, area under the curve, and odds for diagnosing ACI in the sCLEC-2 × D-dimer formula. Although the sCLEC-2 and D-dimer levels were useful for the differential diagnosis between cardiogenic and atherosclerotic ACI, the sCLEC-2 × D-dimer formula was not useful. sCLEC2 and D-dimer levels are useful for the diagnosis of ACI and the sCLEC2 × D-dimer formula can enhance the diagnostic ability of ACI, and sCLEC2 and D-dimer levels may be useful for differentiating between atherosclerotic and cardioembolic ACI.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-02-26T05:26:49Z
  DOI: 10.1177/10760296241232858
  Issue No: Vol. 30 (2024)
A Novel Nomogram for Predicting Warfarin-Related Bleeding: A Retrospective
Cohort Study
- Authors: Shaohua Yang, Wensen Yao
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Warfarin is a widely used anticoagulant, and bleeding complications are the main reason why patients discontinue the drug. Currently, there is no nomogram model for warfarin-associated bleeding risk. The aim of this study was to develop a risk-prediction nomogram model for warfarin-related major and clinically relevant non-major (CRNM) bleeding. A total of 280 heart disease outpatients taking warfarin were enrolled, 42 of whom experienced major or CRNM bleeding at the one-year follow-up. The Least Absolute Shrinkage and Selection Operator regression model was employed to identify potential predictors. Backward stepwise selection with the Akaike information criterion was used to establish the optimal predictive nomogram model. The receiver operating characteristic (ROC) curve, calibration plot, Hosmer–Lemeshow goodness-of-fit test, and decision curve analysis (DCA) were used to evaluate the performance of the nomogram. The nomogram consisted of four predictors: female (OR = 1.85; 95% CI: 0.91-3.94), TIA (OR = 6.47; 95% CI: 1.85-22.7), TTR (OR = 0.99; 95% CI: 0.97-1.00), and anemia (OR = 2.30; 95% CI: 1.06-4.84). The model had acceptable discrimination (area under the ROC curve = 0.68, 95% CI: 0.59-0.78), and was significantly better than the existing nine warfarin-related bleeding prediction scoring systems. The calibration plot and Hosmer–Lemeshow test (χ² = 7.557; P = .478) indicated well-calibrated data in the model. The DCA demonstrated good clinical utility. In this study, we developed a nomogram to predict the risk of warfarin-related major or CRNM bleeding. The model has good performance, allows rapid risk stratification of warfarin users, and provides a basis for personalized treatment.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-02-23T07:59:50Z
  DOI: 10.1177/10760296241234894
  Issue No: Vol. 30 (2024)
Development and Validation of a Nomogram for Predicting the Severity of
Coronary Artery Disease Based on Cardiopulmonary Exercise Testing
- Authors: Hongmin Wang, Yi Wang, Qingmin Wei, Liyan Zhao, Qingjuan Zhang
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  As a major global health concern, coronary artery disease (CAD) demands precise, noninvasive diagnostic methods like cardiopulmonary exercise testing (CPET) for effective assessment and management, balancing the need for accurate disease severity evaluation with improved treatment decision-making. Our objective was to develop and validate a nomogram based on CPET parameters for noninvasively predicting the severity of CAD, thereby assisting clinicians in more effectively assessing patient conditions. This study analyzed 525 patients divided into training (367) and validation (183) cohorts, identifying key CAD severity indicators using least absolute shrinkage and selection operator (LASSO) regression. A predictive nomogram was developed, evaluated by average consistency index (C-index), the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA), confirming its reliability and clinical applicability. In our study, out of 25 variables, 6 were identified as significant predictors for CAD severity. These included age (OR = 1.053, P
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-02-20T11:01:15Z
  DOI: 10.1177/10760296241233562
  Issue No: Vol. 30 (2024)
Immature Platelet Fraction and Clinical Outcomes in Patients Undergoing
Transcatheter Aortic Valve Implantation
- Authors: Lee Oppenheim, Ranel Loutati, David Marmor, Nimrod Perel, Meir Tabi, Louay Taha, Danny Dvir, Mony Shuvy, Rami Jubeh, Michael Glikson, Elad Asher
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  IntroductionImmature platelets or reticulated platelets are newly released thrombocytes. They can be identified by their large size and high RNA cytoplasm concentration. Immature platelet fraction (IPF) represents the percentage of immature circulative platelets relative to the total number of platelets. The role of IPF in patients undergoing transcatheter aortic valve implantation (TAVI) is unknown. The aim of the current trial was to assess the levels of IPF in patients undergoing TAVI and correlation with clinical outcomes.Material and MethodsImmature platelet fraction levels were measured 3 times in all patients (preprocedure, 1-2 days post-procedure and 1-month post-procedure). Immature platelet fraction measurement was carried out using an autoanalyzer (Sysmex XE-2100). Patients were followed for 12 months. Primary outcomes were defined as complications during hospitalizations, rehospitalization, and mortality.ResultsFifty-one patients were included in the study. Mean age was 79.8 (±9.6), and 28 (55%) were women. Twenty-one patients (41%) had complications: Of them, 6 of 21 (29%) occurred during hospitalizations (2—vascular complications; 2—sepsis, 2—implantation of a pacemaker), 9 of 21 (43%) patients were rehospitalized after the index admission, and 6 patients died during the follow-up period. Multivariate Cox regression analysis found that IPF 7% in patients undergoing TAVI is associated with worse outcomes. Further studies are needed to better understand this phenomenon.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-02-20T11:00:16Z
  DOI: 10.1177/10760296241232852
  Issue No: Vol. 30 (2024)
Evaluation of Hemogram Parameters in the Diagnosis of Pulmonary Embolism:
Immature Granulocytes and Other New Tips
- Authors: Gokhan Karakurt, Oya Guven, Engin Aynaci, Bugra Kerget, Gizem Senkardesler, Mustafa Duger
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Pulmonary embolism (PE) is an important cause of sudden death and is difficult to diagnose. Therefore unnecessary radiological investigations are often resorted to. Although some inflammatory parameters in the hemogram have been found to play a role in the diagnosis of PE, many parameters have not been adequately investigated. We aimed to evaluate potential inflammatory parameters in hemogram in the diagnosis of PE and to determine the parameters with the highest diagnostic value. This single-center, retrospective study was performed by evaluating 114 cases with suspected PE admitted to the emergency department between January 2017 and June 2022. Among 114 cases, 62 cases with a definitive diagnosis of PE by pulmonary computed tomography angiography served as the PE group and 52 cases without PE served as the control group. Admission hemogram parameters of both groups were recorded. Potential chronic diseases and acute conditions affecting hemogram were excluded from the study. In the multivariate model; immature granulocyte (IG), neutrophil/lymphocyte ratio (NLR), monocyte % and platelet large cell ratio (P-LCR) were found to be significantly and independently effective in differentiating cases with and without PE (P˂.05). Our findings suggest that high IG, high NLR, high monocyte %, and low P-LCR values have diagnostic value in cases with suspected PE. However the usability of IGs in the diagnosis of PE is a new finding. Hemogram is cheap, easily accessible, and potential inflammatory biomarkers in hemograms may increase physicians’ awareness in the diagnosis of PE.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-02-13T09:25:08Z
  DOI: 10.1177/10760296241227212
  Issue No: Vol. 30 (2024)
Investigating the Impact on Long-Term Outcomes and the Necessity of
Hereditary Thrombophilia Screening in Presumed or Perinatal Arterial
Ischemic Stroke
- Authors: Ömer Bektaş, Özben Akıncı Göktaş, Begüm Atasay, Serap Teber
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  This study aimed to investigate the influence of prothrombotic risk factors on long-term outcomes of patients with perinatal arterial ischemic stroke. The study was conducted through an analysis of monitoring results that were regularly maintained for approximately 20 years at a tertiary stroke-monitoring center. The study assessed prothrombotic risk factors, radiological area of involvement, clinical presentation, treatments, clinical outcomes, and long-term outcomes of the 48 patients included in the study, with a mean monitoring time of 77.6 ± 45.7 months (range: 6-204). Our results showed that the presence of prothrombotic risk factors did not affect long-term outcomes. However, patients with middle cerebral artery infarction had the highest risk of developing cerebral palsy, whereas those with presumed stroke had the highest risk of developing epilepsy. This study suggests that prothrombotic risk factors should not be evaluated during the acute stage unless there is a strong suspicion of the patient's history, and prevention or early diagnosis of presumed stroke patients will positively impact their long-term prognosis.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-02-08T07:29:26Z
  DOI: 10.1177/10760296241231944
  Issue No: Vol. 30 (2024)
Coagulation Testing in Real-World Setting: Insights From a Comprehensive
Survey
- Authors: Hae In Bang, Ja Young Lee, Hyun-Young Kim, Saeam Shin, Myung Hyun Nam, In-Suk Kim, Ji Myung Kim, Jong-Hyun Yoon, Myung-Geun Shin, Sang Mee Hwang, Sun-Young Kong
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  The objective of this survey was to gain a real-world perspective on coagulation testing by evaluating the availability of various coagulation laboratory tests, assessing specific analytic and postanalytic steps in clinical laboratories in Korea.Participants were surveyed using a 65-question questionnaire specifically focused on their coagulation testing practices related to prothrombin time (PT), activated partial thromboplastin time (aPTT), plasma-mixing studies, lupus anticoagulant (LA) tests, platelet function tests, coagulation factor assays, and the composition of hemostasis and thrombosis test panels. The survey was performed between July and September 2022.The survey achieved a 77.9% (81 of 104) response rate. PT or aPTT tests were performed directly at all participating institutions, followed by D-dimer and fibrinogen tests, platelet function test, and plasma-mixing studies in order of frequency. Variations existed in the performance of mixing test and LA assessment. Patterns of coagulating testing differed depending on the size of the hospital. The survey revealed that most laboratories conducted coagulation tests following the international guidelines such as Clinical Laboratory Standards Institute guidelines and the Korean Laboratory Certification system. However, some coagulation tests, including mixing test and LA tests, are yet to be standardized in Korea.Continuous education on coagulation test methods and internal and external quality control are required to encourage laboratories to enhance the performance of coagulation testing.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-02-07T07:01:22Z
  DOI: 10.1177/10760296241228239
  Issue No: Vol. 30 (2024)
The Role of HATCH Score in the Prediction of Ischemic Cerebrovascular
Events in Patients with Heart Failure and Atrial Fibrillation
- Authors: Sidar Şiyar Aydın, Emrah Aksakal
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  The presence of both atrial fibrillation (AF) and heart failure (HF) increases the risk of an ischemic cerebrovascular event (CVE) by roughly fivefold. The HATCH score is a score used to predict new-onset AF. Although there are some differences, it contains risk factors similar to the CHA2DS2-VASc score. Our study aimed to investigate the relationship between the HATCH score and ischemic CVE. This retrospective study obtained data from 1719 HF patients between 2015 and 2022. About 673 patients with AF were included in the study. In the univariate and multivariate Cox regressions, we found that CHA2DS2-VASc and HATCH scores were independent predictors of ischemic CVE (p = 0.001 and
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-01-19T05:55:48Z
  DOI: 10.1177/10760296241227935
  Issue No: Vol. 30 (2024)
Determination of vWF, ADAMTS-13 and Thrombospondin-1 in Venous
Thromboembolism and Relating Them to the Presence of Factor V Leiden
Mutation
- Authors: Anwar Al-Awadhi, Rajaa Marouf, Mehrez M. Jadaon, Mohammad M. Al-Awadhy
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Thrombophilia in venous thromboembolism (VTE) is multifactorial. Von Willebrand factor (vWF) plays a major role in primary hemostasis. While elevated vWF levels are well documented in VTE, findings related to its cleaving protease (ADAMTS-13) are contradicting. The aim of this study was to determine vWF, ADAMTS-13, and the multifactorial Thrombospondin-1 (TSP-1) protein levels in patients after 3-6 months following an unprovoked VTE episode. We also explored a possible association with factor V Leiden (FVL) mutation. vWF, ADAMTS-13 and TSP-1 were analyzed using ELISA kits in 60 VTE patients and 60 controls. Patients had higher levels of vWF antigen (P = .021), vWF collagen-binding activity (P = .008), and TSP-1 protein (P .05). There appears to be an imbalance between vWF and ADAMTS-13 in VTE patients even after 3-6 months following the onset of VTE. We report that the odds of developing VTE in carriers of FVL mutation are 9.672 times those without the mutation, but the presence of this mutation is not associated with the studied proteins.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-01-16T01:52:49Z
  DOI: 10.1177/10760296231223195
  Issue No: Vol. 30 (2024)
Clinical Outcomes at 3 Years After Stenting for Thrombotic and
Non-thrombotic Iliac Vein Compression Syndrome Patients
- Authors: Lei Jiang, Hao Zhuang, Tao Song, Xiao-Qiang Li
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Iliac vein stenting for the treatment of iliac vein compression syndrome (IVCS) has been gradually developed. This article investigated the long-term patency and improvement of clinical symptoms after endovascular stenting for iliac vein obstruction patients. From 2020 to 2022, 83 patients at a single institution with IVCS underwent venous stent implantation and were divided into two groups: non-thrombotic IVCS (n = 55) and thrombotic IVCS (n = 28). The main stent-related outcomes include technical success, long-term patency, and thrombotic events. The technical success rate of all stent implantation was 100%. The mean length of hospital stay and cost were higher in the thrombotic IVCS group than in the non-thrombotic ICVS group, as well as the length of diseased vessel segment and the number of stents implanted were higher than in the control non-thrombotic group. The 1-, 2-, and 3-year patency rates were 85.4%, 80% and 66.7% in the thrombosis group, which were lower than 93.6%, 88.7%, and 87.5% in the control group (P = .0135, hazard ratio = 2.644). In addition, patients in both groups had a foreign body sensation after stent implantation, which resolved spontaneously within 1 year after surgery. Overall, there were statistically significant differences in long-term patency rate outcome between patients with thrombotic and non-thrombotic IVCS, the 1-, 2-, and 3-year patency rates in non-thrombotic IVCS patients were higher than those in thrombotic IVCS patients.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-01-12T07:26:46Z
  DOI: 10.1177/10760296231220053
  Issue No: Vol. 30 (2024)
Cardiac Arrest-Associated Coagulopathy Could Predict 30-day Mortality: A
Retrospective Study from Medical Information Mart for Intensive Care IV
Database
- Authors: Jingwei Duan, Hongxia Ge, Wenyang Fan, Lanfang Du, Hua Zhang, Ayijiang Jiamaliding, Baomin Duan, Qingbian Ma
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  BackgroundCardiac arrest (CA) can activate the coagulation system. Some coagulation-related indicators are associated with clinical outcomes. Early evaluation of patients with cardiac arrest-associated coagulopathy (CAAC) not only predicts clinical outcomes, but also allows for timely clinical intervention to prevent disseminated intravascular coagulation.ObjectiveTo assess whether CAAC predicts 30-day cumulative mortality.MethodsFrom the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, we conducted a retrospective cohort study from 2008 to 2019. Based on international normalized ratio (INR) value and platelet count, we diagnosed CAAC cases and made the following stratification of severity: mild CAAC was defined as 1.4 > INR≧1.2 and 100,000/µL INR≧1.4 or 80,000/µL
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-01-10T07:15:25Z
  DOI: 10.1177/10760296231221986
  Issue No: Vol. 30 (2024)
Treatment Patterns and Healthcare Resource Utilization of Patients With
- Authors: Denise Clayton, Jason Shafrin, Glorian Yen, Soyon Lee, Lincy Geevarghese, Yulin Shi, Luyang He, Ying Shen, Anem Waheed
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired hematologic disorder commonly treated with complement inhibitors such as eculizumab, ravulizumab, and pegcetacoplan. This study aims to describe treatment patterns, healthcare resource utilization, and cost for newly diagnosed PNH patients in 2 large, health insurance claims databases: MarketScan and Optum. Among the 271 patients meeting the inclusion criteria in MarketScan, 57.9% were female, and the average age was 46.6 years. Among these newly diagnosed patients, 25.1% (n = 68) of patients received a PNH-specific pharmacologic treatment, and the average time from diagnosis to treatment was 4.7 months. The medication possession ratio was 97.0%, but discontinuation was common (58.8%). The average per-patient-per-month costs were $18,978, driven by pharmacy and infusion ($11,182), outpatient ($4086), and inpatient ($3318) costs. Despite the availability of multiple treatments, 39.9% of patients had an inpatient stay, and 50.9% had an emergency department visit. Better care management and the introduction of new treatment options are needed to address delays between diagnosis and treatment, and high rates of hospitalization and emergency department use among patients with PNH.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-01-04T08:05:07Z
  DOI: 10.1177/10760296231213073
  Issue No: Vol. 30 (2024)
Thrombotic Risk and Calculated Whole Blood Viscosity in a Cohort of
Patients With New Diagnosis of Multiple Myeloma
- Authors: Melania Carlisi, Rosalia Lo Presti, Salvatrice Mancuso, Sergio Siragusa, Gregorio Caimi
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  The pathogenesis of venous thromboembolism in multiple myeloma is still poorly understood because multiple factors are involved. In particular, the increase in whole blood viscosity has a key role and, therefore, we performed an evaluation of some hemorheological determinants in multiple myeloma patients, putting them in relation to the thrombotic risk, with the aim to evaluate if an alteration of the hemorheological pattern was associated with a higher thrombotic risk. We performed an observational retrospective cohort study with data collected from January 2017 to September 2022. In a group of 190 patients with newly diagnosed multiple myeloma, we have examined the trend of calculated blood viscosity according to the Merrill formula, and we stratified the patients for the thrombotic risk in accordance with the IMWG/NCCN guidelines and with IMPEDE VTE score. Using the thrombotic risk stratification proposed by IMWG/NCCN any variation in calculated blood viscosity is evident, while, with the IMPEDE VTE score, we observed an increase in calculated blood viscosity in patients with “intermediate + high” risk. The calculated blood viscosity is higher in subjects presenting an “intermediate + high” thrombotic risk according to the IMPEDE VTE score. This association could therefore lay the groundwork for further research with the aim to confirm the role of hemorheological pattern in MM-related thrombotic risk.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-01-04T07:14:27Z
  DOI: 10.1177/10760296231222477
  Issue No: Vol. 30 (2024)
Predictive Value of Pulmonary Artery Distensibility for Short-Term Adverse
Clinical Outcomes in Patients with Acute Pulmonary Embolism
- Authors: Fei Yang, Rong Chen, Yue Yang, Yaxi Yu, Zhixiang Yang, Dianjun Zou, Zhiying Pang, Dawei Wang
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  We aimed to explore the relationship between pulmonary artery distensibility obtained from computed tomography pulmonary angiography (CTPA) and short-term adverse clinical outcomes in patients with acute pulmonary embolism (APE). We included patients who underwent retrospective electrocardiogram-gated CTPA and were subsequently diagnosed with APE. Patients were categorized into good and poor outcome groups based on short-term clinical outcomes. Pulmonary artery distensibility (AD), right ventricle/left ventricle (RV/LV) ratio, and pulmonary artery obstruction index (PAOI) were measured, and the receiver operating characteristic curves were constructed. Sixty-four patients with APE (good outcome, 46; poor outcome, 18) were enrolled. AD, RV/LV ratio, and PAOI differed significantly between groups (P
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-01-03T07:07:27Z
  DOI: 10.1177/10760296231224344
  Issue No: Vol. 30 (2024)
Emicizumab Prophylaxis in Patients with Severe Hemophilia A: Insights from
A Resource Limited Country
- Authors: Munira Borhany, Aisha Arshad, Heeba Qureshi, Rukhshanda Nadeem, Arif Jamal, Raheel Ahmed Khan
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  Emicizumab is a humanized, bispecific monoclonal antibody that connects active factor IX and X to replace the function of absent factor VIII, restoring hemostasis. It has a long half-life with a subcutaneous route of administration and high bioavailability. Here, we assessed the efficacy of Emicizumab prophylaxis in terms of efficiency, safety, and quality of life of severe hemophilia A (HA) patients with and without inhibitors before and after this treatment.MethodsIn this prospective study, severe HA patients were recruited from January 2022 to June 2023. Inhibitor positive and inhibitor negative patients with annual bleeding rate (ABR) 8 or greater and past histories of bleeding like intra-cranial, intra-abdominal, and pseudo-tumors were included. Emicizumab loading dose was 3 mg/kg in the first 4 weeks, and the maintenance dose was started at week 5 at 6 mg/kg/month. Patients’ detailed bleeding history and demographics were recorded. The five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) was used to evaluate patients’ HRQoL. Furthermore, Hemophilia Joint Health Score (HJHS) and Functional Independence score in Hemophilia (FISH) were applied for the assessment of joints at different time points. Results were analyzed by SPSS version 21.ResultsA total of 36 HA male patients with the mean age of 19.7 ± 14.42 years were recruited in the study; among them, 19 patients were inhibitor positive, while 17 were negative. Patients clinically presented with bleeding symptoms which included: hemarthrosis 95%, GI bleeding 13.8%, and bruises and gums bleeding 13.8%. Significant reduction was observed in the bleeding episodes after the therapeutic intervention, and joints assessment and Euro-Quality-of-life Visual Analog Scale showed a significant improvement in health after treatment. Similarly, there was a remarkable reduction in bleeding episodes and improved quality of life among HA patients. The ABR decreased from 53.6% episodes per year prior to treatment to 2.4% during Emicizumab therapy. Prior to initiating Emicizumab therapy, participants exhibited an average FISH score of 16 and HJHS score of 10, indicating moderate limitations due to joint-related issues. After treatment, the mean FISH score improved to 9 and HJHS score to 4 reflecting a substantial enhancement in participants’ ability to perform daily activities (P
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-01-03T05:40:06Z
  DOI: 10.1177/10760296231224357
  Issue No: Vol. 30 (2024)
Predictive Role of Pre-Thrombolytic Neutrophil-Platelet Ratio on
Hemorrhagic Transformation After Intravenous Thrombolysis in Acute
Ischemic Stroke
- Authors: Xu-Dong Cheng, Chun-Xi Zhang, Qi Zhang, Sen Zhou, Li-Jun Jia, Li-Rong Wang, Jian-Hong Wang, Neng-Wei Yu, Bing-Hu Li
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  To investigate the predictive role of the neutrophil-platelet ratio (NPR) before intravenous thrombolysis (IVT) on hemorrhagic transformation (HT) in patients with acute ischemic stroke (AIS). AIS patients treated with IVT without endovascular therapy between June 2019 and February 2023 were included. Patients were divided into high NPR (>35) and low NPR (≤35) groups according to the optimal threshold NPR value for identifying high-risk patients before IVT. The baseline data and the incidence of HT and symptomatic intracranial hemorrhage (sICH) were compared between the two groups. The predictive role of the NPR and other related factors on HT after IVT was analyzed by multivariate logistic regression. A total of 247 patients were included, with an average age of 67.5 ± 12.4 years. Post-thrombolytic HT was observed in 18.6% of the patients, and post-thrombolytic sICH was observed in 1.2% of the patients. There were 69 patients in the high NPR group and 178 patients in the low NPR group. The incidence of HT in the high NPR group was significantly higher than that in the low NPR group (30.4% vs 16.3%, P 35) before IVT may be a predictor of HT in AIS patients. This finding may help clinicians make clinical decisions before IVT in AIS patients.
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-01-03T05:25:31Z
  DOI: 10.1177/10760296231223192
  Issue No: Vol. 30 (2024)
Efficacy and Safety of a Pharmaco-Invasive Strategy Using Half-Dose
Recombinant Human Prourokinase in Patients with ST-Segment Elevation
Myocardial Infarction During Hospitalization
- Authors: Jie Dou, Jie Gao, Huihui Yang, Ruoling Guo, Chao Jiang, Jingtao Guo, Donglei Luo
  Abstract: Clinical and Applied Thrombosis/Hemostasis, Volume 30, Issue , January-December 2024.
  This study investigated the efficacy and safety of pharmaco-invasive strategy with half-dose recombinant human prourokinase (PHDP) during hospitalization for patients with ST-segment elevation myocardial infarction (STEMI) to provide references for the treatment of STEMI. Patients with STEMI who fulfilled the inclusion and exclusion criteria and attended Chengde Central Hospital, Hebei Province, China, between September 3, 2019, and December 28, 2021, were included in this study. The experimental group received PHDP and the control group underwent primary percutaneous coronary intervention (PPCI). This study enrolled 150 patients with STEMI, 75 in the experimental group and 75 in the control group. Coronary angiography revealed successful thrombolysis in 64 (85.33%) patients. Compared with the control group, the experimental group had shorter first medical contact-reperfusion time (P
  Citation: Clinical and Applied Thrombosis/Hemostasis
  PubDate: 2024-01-03T05:24:45Z
  DOI: 10.1177/10760296231221772
  Issue No: Vol. 30 (2024)

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