Research and Practice in Thrombosis and Haemostasis最新文献

{"title":"Balancing safety and efficacy of low-molecular-weight heparins in neonates: a systematic review","authors":"Marieke Verweij ,&nbsp;Mirjam M. van Weissenbruch ,&nbsp;Irene L.M. Klaassen","doi":"10.1016/j.rpth.2024.102601","DOIUrl":"10.1016/j.rpth.2024.102601","url":null,"abstract":"<div><div>The rising incidence of venous thromboembolism (VTE) in neonates has led to increased use of low-molecular-weight heparins (LMWHs), but optimal dosages remain uncertain. A serious adverse effect of LMWHs is major bleeding. Given the vulnerability of neonates to major bleeding, we aimed to review therapeutic and prophylactic LMWH dosages to achieve target anti-factor Xa ranges of 0.5 and 1.0 U/mL and 0.1 and 0.4 U/mL, respectively. Our secondary aim was to assess the safety and efficacy of LMWHs in neonates. A systematic review of all published studies between 1996 and 2023 that pertained to the dosing, safety, or efficacy of LMWH in preterm and term neonates. Studies were identified through the Medline database. Data on LMWH dosages, bleeding events, resolution and recurrence, and anti-factor Xa levels were analyzed. A total of 38 studies involving 1145 neonates were included. To achieve a therapeutic or prophylactic target range, weight-adjusted initial dosages of LMWH had to be increased by 21% particularly in premature neonates. During therapeutic therapy, major bleeding occurred in 4.1% and minor bleeding in 7.1%. During prophylactic therapy, 11.4% experienced major bleeding and 17.1% minor bleeding. With therapeutic dosages, 55.8% achieved complete VTE resolution. Additionally, 68.5% of neonates initially failed to achieve therapeutic anti-factor Xa levels, persisting in 29.4% despite dose adjustments. A higher initial therapeutic dosage of LMWHs may be needed in neonates. In addition, the patient’s gestational age must be considered in the dosing strategy to optimize outcomes. Although this must be weighed against bleeding risk at an individual level.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"8 7","pages":"Article 102601"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to ‘Hand grip strength and risk of incident venous thromboembolism: The Tromsø study’","authors":"Oda G.R. Leknessund BSc ,&nbsp;Vania M. Morelli MD PhD ,&nbsp;Bjørn Heine Strand ,&nbsp;John-Bjarne Hansen MD PhD ,&nbsp;Sigrid K. Brækkan PhD","doi":"10.1016/j.rpth.2024.102621","DOIUrl":"10.1016/j.rpth.2024.102621","url":null,"abstract":"","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"8 7","pages":"Article 102621"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142702671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple myeloma: retrospective assessment of routine thromboprophylaxis and utility of thrombotic risk scores","authors":"Omar Eduardo Fernandez-Vargas,&nbsp;Isabel Amezcua,&nbsp;Beatriz Cabello,&nbsp;Andrea Quintana Martinez,&nbsp;Ramiro Espinoza,&nbsp;Gabriela Cesarman-Maus","doi":"10.1016/j.rpth.2024.102571","DOIUrl":"10.1016/j.rpth.2024.102571","url":null,"abstract":"<div><h3>Background</h3><div>The high risk of venous thromboembolism (VTE) in multiple myeloma (MM) warrants primary thromboprophylaxis for most patients. Myeloma-specific thrombotic risk scores (TRSs), such as IMPEDE-VTE, SAVED, and PRISM, were developed to improve risk assessment and guide antithrombotic strategies. Their performance is variable and has not yet been tested in Latin America.</div></div><div><h3>Objectives</h3><div>We aimed to assess the use of primary thromboprophylaxis, the incidence of VTE and bleeding events, and the effectiveness of TRSs in patients with newly diagnosed MM.</div></div><div><h3>Methods</h3><div>This was a retrospective, single-center study. Cumulative VTE rates and TRS performance were analyzed using survival and receiver operating characteristic curves.</div></div><div><h3>Results</h3><div>The study included 250 newly diagnosed MM patients; the vast majority (98.6%) received aspirin as thromboprophylaxis. VTE occurred in 8% within the initial 6 months, increasing to 14.8% over a median follow-up of 19 months. High rates of major bleeding (4.8%) and clinically relevant nonmajor bleeding (4.4%) events were documented. A minimal proportion (0.8%, 0.5%, and 1.2%) of patients were classified as low risk by IMPEDE-VTE, PRISM, and SAVED scores, respectively. Only IMPEDE-VTE exhibited a trend for distinguishing between intermediate-risk (7.14%) and high-risk (13.2%) groups (<em>P</em> = .09). PRISM and SAVED scores showed limited utility. VTE did not impact survival.</div></div><div><h3>Conclusion</h3><div>Aspirin as primary thromboprophylaxis carries an unacceptable risk of VTE and bleeding in patients at intermediate or high thrombotic risk. The IMPEDE-VTE score performed best, although without reaching statistical significance. We confirm that VTE does not portend poor overall survival in MM.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"8 7","pages":"Article 102571"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142552329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperfibrinolysis: a crucial phenotypic abnormality of posttraumatic fibrinolytic dysfunction","authors":"Kyosuke Takahashi ,&nbsp;Kazuma Yamakawa ,&nbsp;Anaar E. Siletz ,&nbsp;Morihiro Katsura ,&nbsp;John B. Holcomb ,&nbsp;Charles E. Wade ,&nbsp;Jessica C. Cardenas ,&nbsp;Erin E. Fox ,&nbsp;Morgan Schellenberg ,&nbsp;Matthew Martin ,&nbsp;Kenji Inaba ,&nbsp;Kazuhide Matsushima","doi":"10.1016/j.rpth.2024.102568","DOIUrl":"10.1016/j.rpth.2024.102568","url":null,"abstract":"<div><h3>Background</h3><div>Traumatic fibrinolytic dysfunction is often categorized into 3 phenotypes based on the result of thromboelastography (TEG) lysis at 30 minutes (LY30): fibrinolysis shutdown, physiologic fibrinolysis, and hyperfibrinolysis. However, the molecular pathophysiology of fibrinolytic dysfunction and the association with clinical outcomes have not been fully evaluated.</div></div><div><h3>Objectives</h3><div>To assess whether posttraumatic fibrinolysis phenotypes identified by TEG correlate with levels of key fibrinolysis-related serum markers and with risk of mortality and hospital complications.</div></div><div><h3>Methods</h3><div>This is a secondary analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios trial. Patients were stratified according to the degree of fibrinolysis upon arrival using TEG LY30 values: low LY30, &lt;0.8%; normal LY30, 0.81% to 0.9%; and high LY30, ≥3%. Serial values of molecular markers (0-72 hours after admission) and clinical outcomes were compared between fibrinolysis groups.</div></div><div><h3>Results</h3><div>A total of 547 patients were included (low LY30, 320; normal LY30, 108; high LY30, 119). The high LY30 group had higher tissue plasminogen activator and plasmin-antiplasmin values upon hospital arrival than the low LY30 or normal LY30 groups (<em>P</em> &lt; .001, respectively). There was no significant difference in levels of tissue plasminogen activator, plasmin-antiplasmin, and plasminogen activator inhibitor 1 between the low LY30 and normal LY30 groups. The high LY30 group was associated with an increased risk of 24-hour and 30-day mortality, while there was no significant difference in mortality between the low LY30 and normal LY30 groups.</div></div><div><h3>Conclusion</h3><div>Our results suggest that hyperfibrinolysis is the most common form of traumatic fibrinolytic dysfunction and is associated with worse outcome.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"8 7","pages":"Article 102568"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142419946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparable hemostatic capacity of blood taken from the portal vein compared with systemic blood in patients with cirrhosis","authors":"Annabel Blasi ,&nbsp;Andrea Calvo ,&nbsp;Ricard Mellado ,&nbsp;Miguel Angel Torrente ,&nbsp;Fanny Turon ,&nbsp;Juan Carlos Garcia-Pagan ,&nbsp;Virginia Hernandez-Gea ,&nbsp;Dolors Tassies ,&nbsp;Joan Carles Reverter ,&nbsp;Ton Lisman","doi":"10.1016/j.rpth.2024.102583","DOIUrl":"10.1016/j.rpth.2024.102583","url":null,"abstract":"","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"8 7","pages":"Article 102583"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of direct oral anticoagulants in chronic kidney disease: a meta-analysis","authors":"Daniel Tham ,&nbsp;Lucy Zhao ,&nbsp;Wenhui Yu ,&nbsp;Jayhan Kherani ,&nbsp;Roger Kou ,&nbsp;Allen Li ,&nbsp;Pei Ye Li ,&nbsp;Ali Eshaghpour ,&nbsp;Mark Andrew Crowther","doi":"10.1016/j.rpth.2024.102584","DOIUrl":"10.1016/j.rpth.2024.102584","url":null,"abstract":"<div><h3>Background</h3><div>Direct oral anticoagulants (DOACs) have emerged as the first-line therapy for venous thromboembolism and stroke prophylaxis in atrial fibrillation. As DOACs are partially excreted renally, their safety in patients with chronic kidney disease (CKD) is unclear.</div></div><div><h3>Objectives</h3><div>To synthesize primary evidence on the safety profile of DOACs in patients with CKD.</div></div><div><h3>Methods</h3><div>We searched MEDLINE and Embase from inception to June 2023 for randomized and nonrandomized cohort studies comparing DOACs with vitamin K antagonists (VKAs) in CKD patients. Screening and data collection were conducted in duplicate. The primary safety outcome was major bleeding, defined by International Society on Thrombosis and Haemostasis criteria, stratified by CKD severity. Meta-analysis was done using the Mantel–Haenszel random-effects model, presented as odds ratios (ORs) with corresponding 95% CIs.</div></div><div><h3>Results</h3><div>Of the 2355 articles captured in the literature search, 25 nonrandomized studies (<em>n</em> = 6832) and 6 randomized studies (<em>n</em> = 66,898) were included. DOACs reduced major bleeding compared with VKAs in all subgroups (stage 4: OR, 0.73; 95% CI, 0.58, 0.93; stage 5/renal replacement therapy: OR, 0.70; 95% CI, 0.50, 0.98; stage unspecified: OR, 0.72; 95% CI, 0.63, 0.83). Apixaban and rivaroxaban both reduced major bleeding in stage 5/renal replacement therapy patients (apixaban: OR, 0.66; 95% CI, 0.52, 0.85; rivaroxaban: OR, 0.58; 95% CI, 0.35, 0.94).</div></div><div><h3>Conclusion</h3><div>In this meta-analysis, DOACs reduced major bleeding compared with VKAs in stage 4, stage 5/renal replacement therapy, and CKD stage unspecified patients. Future analysis should evaluate the impact of specific DOACs and dosage on safety and efficacy in this population.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"8 7","pages":"Article 102584"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cluster of pediatric vaccine-induced immune thrombotic thrombocytopenia–like cases with thrombosis and thrombocytopenia following respiratory infections—case series","authors":"Dimitra Dimopoulou ,&nbsp;Lida Mentesidou ,&nbsp;Athina Dettoraki ,&nbsp;Christina Karastathi ,&nbsp;Maria Berikopoulou ,&nbsp;Panagiota Katsouli ,&nbsp;Ioanna Anastasopoulou ,&nbsp;Iason G. Stamatakis ,&nbsp;Theodora Bachou ,&nbsp;Flora Tzifi ,&nbsp;Aikaterini Michalopoulou ,&nbsp;Anna Messaritaki ,&nbsp;Vana Spoulou ,&nbsp;Helen Pergantou","doi":"10.1016/j.rpth.2024.102589","DOIUrl":"10.1016/j.rpth.2024.102589","url":null,"abstract":"<div><h3>Background</h3><div>Adenoviral vector COVID-19 vaccine-induced immune thrombotic thrombocytopenia (VITT) is a heparin-independent platelet-activating disorder. An increasing number of VITT-like disorders without previous vaccination are being identified.</div></div><div><h3>Key Clinical Question</h3><div>To explore the association of the pediatric cluster of postinfectious thrombosis and thrombocytopenia with VITT-like disorders.</div></div><div><h3>Clinical Approach</h3><div>Three children with severe thrombocytopenia, coagulopathy, elevated D-dimer, and thrombotic events (cerebral venous sinus thrombosis) were reported. Two had positive nasopharyngeal samples for adenovirus, and 1 had group A streptococcus infection. They all had a COVID-19 history and low-risk antiphospholipid syndrome. Heterozygosity for factor V Leiden was found in 2 children. In 2 patients for whom anti–platelet factor 4 (PF4) serology was performed, positive results were found by PF4/polyanion lateral-flow immunoassay but negative results by PF4/polyanion chemiluminescence immunoassay. All patients were treated with enoxaparin or fondaparinux and intravenous immunoglobulin, while 3 received platelets transfusion and steroids.</div></div><div><h3>Conclusion</h3><div>This cluster of pediatric cases with thrombosis and thrombocytopenia may indicate a postinfectious (most notably, postadenovirus) VITT-like disorder.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"8 7","pages":"Article 102589"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics, treatment, and outcomes of provoked acute cerebral sinovenous thrombosis in patients <21 years old: findings from the Kids-DOTT Multinational Trial","authors":"Gary M. Woods ,&nbsp;Alexandra Miller ,&nbsp;Maua Mosha ,&nbsp;Christoph Male ,&nbsp;Anupam Verma ,&nbsp;Nicole Kucine ,&nbsp;Christine Sabapathy ,&nbsp;Kisha Beg ,&nbsp;Sanjay Ahuja ,&nbsp;Deepti Raybagkar ,&nbsp;Kerry Hege ,&nbsp;Clara Lo ,&nbsp;Rukhmi Bhat ,&nbsp;Thomas Abshire ,&nbsp;Neil A. Goldenberg","doi":"10.1016/j.rpth.2024.102605","DOIUrl":"10.1016/j.rpth.2024.102605","url":null,"abstract":"<div><h3>Background</h3><div>Prospective multicenter data on the treatment and outcomes of children with cerebral sinovenous thrombosis (CSVT) are limited. We aimed to describe the clinical characteristics, treatment strategies, and outcomes of patients with a first-episode of provoked acute CSVT enrolled in the Kids-DOTT trial and compare these features with those of participants with non-CSVT venous thromboembolism (VTE).</div></div><div><h3>Methods</h3><div>This was a subgroup analysis from the Kids-DOTT trial, a multinational randomized clinical trial on duration of anticoagulation for provoked acute VTE in patients younger than 21 years. Patient and thrombus characteristics, treatments, and outcomes of patients diagnosed with CSVT were compared with those of patients with non-CSVT VTE.</div></div><div><h3>Results</h3><div>CSVT was diagnosed in 75 of the 532 (14%), 25 of whom received 6 weeks of anticoagulant treatment and 50 received 3 or more months. When compared with non-CSVT VTE, CSVT was more likely to occur in neonates and young children, associated with infection in general and acute head/neck infection in particular, and less likely to be related to central venous catheter. No patient in either group developed symptomatic recurrent VTE or clinically relevant bleeding, and there was no significant difference in rates of complete thrombus resolution between the 2 treatment durations.</div></div><div><h3>Conclusion</h3><div>CSVT is most common in neonates and young children and those with acute head and neck infections. A 6-week anticoagulation treatment course appears to be safe (no clinically relevant bleeding) and effective (no difference in symptomatic recurrent VTE) for provoked acute pediatric CSVT. Nevertheless, given the nature of a subpopulation analysis, these findings should be interpreted with caution.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"8 7","pages":"Article 102605"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142654130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective analysis of hemophilia B in Turkey: identifying main characteristics and treatment options","authors":"Bülent Zülfikar ,&nbsp;Başak Koç ,&nbsp;Fahri Şahin ,&nbsp;Hatice İlgen Şaşmaz ,&nbsp;Kaan Kavaklı ,&nbsp;Can Balkan ,&nbsp;Ali Bülent Antmen ,&nbsp;Sinan Akbayram ,&nbsp;Birol Güvenç ,&nbsp;Vahap Okan ,&nbsp;Emine Türkkan ,&nbsp;Canan Albayrak ,&nbsp;Davut Albayrak ,&nbsp;Nazan Sarper ,&nbsp;Tülin Tiraje Celkan ,&nbsp;Orhan Ayyıldız ,&nbsp;Salih Aksu ,&nbsp;Türkan Patıroğlu ,&nbsp;Zafer Şalcıoğlu ,&nbsp;Adalet Meral Güneş ,&nbsp;Muhlis Cem Ar","doi":"10.1016/j.rpth.2024.102588","DOIUrl":"10.1016/j.rpth.2024.102588","url":null,"abstract":"<div><h3>Background</h3><div>Hemophilia B (HB), an X-linked recessive inherited bleeding disorder, exhibits a high prevalence among males.</div></div><div><h3>Objectives</h3><div>To present the first national cohort of persons with HB to define the demographics, clinical characteristics, and treatment patterns in Turkey.</div></div><div><h3>Methods</h3><div>This multicenter, retrospective study included 433 alive persons with HB registered in 35 centers between 1961 and 2018. Analyses were performed by age subgroups (0-17 years, 18-64 years, and ≥65 years), disease severity by factor levels (severe, &lt;1 IU/dL; moderate, 1-5 IU/dL; mild, &gt;5 IU/dL). Additionally, patients were stratified based on the initiation year of follow-up at the relevant study center, creating 2 periods: 1993-2006 (referred to as period A) and 2007-2018 (referred to as period B).</div></div><div><h3>Results</h3><div>Predominantly male (98.6%), the median age at data entry was 22.1 years (<em>n</em> = 429). The majority (49.0%) had moderate HB, followed by severe (30.0%) and mild (15.7%) disease. Of the 377 patients with complete treatment details, 209 (55.4%) were under prophylaxis from their diagnosis onwards, while 79 patients (21.0%) only received on-demand treatment. Additionally, 89 patients (23.6%) initially underwent on-demand treatment and later were switched to prophylaxis. Knees were the primary site of bleeding and the most frequently intervened joints. Most of the major (47.5%) and minor (53.3%) orthopedic procedures were carried out in persons with severe HB, while half of radioactive synovectomy procedures were performed on persons with moderate HB.</div></div><div><h3>Conclusion</h3><div>This paper describes the demographics, clinical characteristics, and treatments patterns of a large cohort of alive persons with HB on a national scale.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"8 7","pages":"Article 102588"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142654132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incident thrombocytopenia and bleeding risk in elderly patients with atrial fibrillation on direct oral anticoagulants: insights from the ATHEROsclerosis in Atrial Fibrillation study","authors":"Danilo Menichelli ,&nbsp;Luca Crisanti ,&nbsp;Tommaso Brogi ,&nbsp;Gregory Y.H. Lip ,&nbsp;Alessio Farcomeni ,&nbsp;Pasquale Pignatelli ,&nbsp;Daniele Pastori","doi":"10.1016/j.rpth.2024.102575","DOIUrl":"10.1016/j.rpth.2024.102575","url":null,"abstract":"<div><h3>Background</h3><div>The bleeding risk of patients with atrial fibrillation (AF) changes over time. Most studies thus far evaluated only the baseline bleeding risk with discordant results. The impact of incident thrombocytopenia during direct oral anticoagulant (DOAC) therapy and its relation to bleeding has not been previously investigated.</div></div><div><h3>Objectives</h3><div>To investigate the incidence rate of thrombocytopenia and major bleeding (MB) risk in AF patients on DOACs.</div></div><div><h3>Methods</h3><div>Prospective ongoing ATHEROsclerosis in Atrial Fibrillation study including patients with nonvalvular AF on DOACs. Incident thrombocytopenia was defined as a platelet count &lt;150 × 10⁹/L. MB events were recorded at each follow-up visit. Gray estimator for competing risk data was used. Estimates are expressed in terms of subdistributional hazard ratios (sHR) and relative 95% CI for MB.</div></div><div><h3>Results</h3><div>We enrolled 957 AF patients treated with DOACs (mean age, 77.3 ± 9.0 years; 49.1% women). During a follow-up (median time to censoring 1330 days; 95% CI, 1246-1443), 139 patients developed thrombocytopenia (3.08 per 100 person-years; 95% CI, 2.27-3.89) with no difference between direct thrombin and factor Xa inhibitors. Overall, 179 bleedings occurred, of which 80 were major (3.17 per 100 person-years; 95% CI, 2.34-3.99). Patients sustaining bleedings were more frequently affected by arterial hypertension, heart failure, anemia and had higher CHA₂DS₂-VASc and HAS-BLED scores. On multivariable Cox analysis, independent risk factors for MB were incident thrombocytopenia (sHR, 12.77; 95% CI, 8.880-18.360; <em>P</em> &lt; .001), and age (sHR, 1.030 per year; 95% CI, 1.010-1.040; <em>P</em> = .002).</div></div><div><h3>Conclusion</h3><div>Patients developing thrombocytopenia have an increased risk of MB. Dynamic evaluation of platelet count during follow-up may provide better prognostic value than baseline assessment only.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"8 7","pages":"Article 102575"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142419950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}