Thrombosis research最新文献

{"title":"Limitations of a platelet count-based clinical decision support system to facilitate diagnosis of heparin-induced thrombocytopenia","authors":"Brian C. Westbrook ,&nbsp;Laura J. Taylor ,&nbsp;Eric Wallace ,&nbsp;Marisa B. Marques ,&nbsp;Jori E. May","doi":"10.1016/j.thromres.2024.109171","DOIUrl":"10.1016/j.thromres.2024.109171","url":null,"abstract":"<div><div>Heparin-induced thrombocytopenia (HIT) is a rare complication of heparin exposure with potential for significant morbidity and mortality. Early identification and treatment can prevent catastrophic thrombosis. Herein, we report the performance of a platelet count-based clinical decision support system (CDSS) where providers received a notification when a patient had a platelet count decline of ≥50 %. In the 90-day study period, the CDSS sent 302 notifications on 270 patients. Notifications were frequently inappropriate; 25 % had an expected platelet count decline (organ donation, stem cell transplant), an inaccurate count, or no heparin exposure. Patient testing for HIT prompted by the CDSS was not in accordance with best practice guidelines in most circumstances. For example, 36 % had a low probability 4Ts score, while 42 % with an intermediate or high probability 4Ts score were not tested. Due to concern for lack of efficacy, the CDSS was discontinued. Analysis of an 8-month period before and after discontinuation showed a significant decrease in the number of enzyme immunoassays ordered (547 vs. 386) without a change in the number of patients with HIT identified (13 vs. 13) or the rate of thrombosis in those with confirmed HIT (62 % vs. 62 %). In conclusion, a CDSS based on platelet count decline contributed to “alert fatigue” via inappropriate notification and did not improve evidence-based HIT testing. In addition, its removal did not decrease or delay HIT identification. Additional efforts are needed to better define how CDSS can support the rapid diagnosis and appropriate treatment of patients with HIT.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"243 ","pages":"Article 109171"},"PeriodicalIF":3.7,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142327826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prothrombin complex concentrate for direct factor Xa inhibitor-associated bleeding or before urgent surgery","authors":"Joseph R. Shaw ,&nbsp;Abdulrahman Abdulaziz Almujalli ,&nbsp;Yan Xu ,&nbsp;Jerrold H. Levy ,&nbsp;Sam Schulman ,&nbsp;Deborah Siegal ,&nbsp;Dar Dowlatshahi ,&nbsp;Melanie Tokessy ,&nbsp;Hakan Buyukdere ,&nbsp;Marc Carrier ,&nbsp;Lana A. Castellucci","doi":"10.1016/j.thromres.2024.109172","DOIUrl":"10.1016/j.thromres.2024.109172","url":null,"abstract":"<div><h3>Introduction</h3><div>Factor Xa inhibitor (FXaI)-associated bleeding events are common and associated with substantial morbidity. Systematic evaluation of widely available, effective, and affordable FXaI bleed management strategies is needed.</div></div><div><h3>Materials and methods</h3><div>We conducted a single-center retrospective cohort study of FXaI-treated patients presenting to a tertiary academic medical center from January 2018 to May 2019 who received 25–50 IU/kg 4F-PCC for either FXaI-associated major bleeding or urgent surgery. The primary outcome was hemostatic efficacy, and the safety outcome was the 30-day risk of thromboembolism.</div></div><div><h3>Results</h3><div>PCC was used to treat FXaI-associated bleeding in 83 cases (79.1 %) and was given before urgent surgery in 22 cases (20.9 %). Sixty-six patients were on apixaban, 38 were on rivaroxaban and one patient was on edoxaban. Intracranial hemorrhage (ICH) and gastrointestinal bleeding accounted for most bleeds (74.7 %). Median interval between last DOAC intake and presentation to triage was 9 h [IQR 5.3–14.8] and median PCC dosing was 40.0 IU/kg [IQR 28.5–46.6]. Forty-two patients (40.0 %) had pre-PCC FXaI levels drawn with median FXaI levels of 114.5 ng/mL [IQR 70.0–175.0]. Effective hemostasis occurred in 66.7 % [95%CI 55.4–76.3] of patients receiving PCC for bleeding and surgical hemostasis was rated as normal in 95.5 % (95%CI 76.5–100.0) for patients having urgent surgery. The 30-day risk of thromboembolism was 7.6 % [95%CI 3.7–14.5] and 22.9 % [95%CI 15.8–31.8] of patients died.</div></div><div><h3>Conclusions</h3><div>PCC for FXaI-associated bleeding was associated with hemostatic efficacy in two-thirds of patients and thromboembolic events were uncommon. PCC represents a promising treatment strategy for FXaI-associated bleeding.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"243 ","pages":"Article 109172"},"PeriodicalIF":3.7,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372945","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":"COVID-19 venous thromboembolism prophylaxis guidelines in pediatrics","authors":"Sara McElroy ,&nbsp;Emily Cramer ,&nbsp;Lauren Amos","doi":"10.1016/j.thromres.2024.109169","DOIUrl":"10.1016/j.thromres.2024.109169","url":null,"abstract":"<div><h3>Introduction</h3><div>SARS-CoV-2 (COVID-19) infection and multisystem inflammatory syndrome in children (MIS-C) are risk factors for venous thromboembolism (VTE). Guidelines for VTE prophylaxis were established at our institution at the beginning of the pandemic. Patients who had any VTE risk factors in addition to COVID-19 met criteria for anticoagulation prophylaxis. Patients who were diagnosed with MIS-C met criteria regardless of additional risk factors.</div></div><div><h3>Materials and methods</h3><div>We conducted a retrospective review of patients admitted with COVID-19 or MIS-C to determine compliance with VTE prophylaxis guidelines and to evaluate the incidence of VTE and bleeding events in our population.</div></div><div><h3>Results and conclusions</h3><div>Among a total of 678 patients admitted with COVID-19 or MIS-C, 519 (76 %) patients met criteria for VTE prophylaxis and 348 (65.6 %) started prophylaxis. Logistic regression analysis identified a personal or family history of thrombosis or thrombophilia, diagnosis of MIS-C, admission to the intensive care unit, and presence of a central venous catheter as significantly associated with starting VTE prophylaxis. There were 18 patients who developed VTE. Minor bleeding events occurred in 19 patients (5 %), patient important bleeding, no intervention occurred in 8 patients (2 %), clinically relevant nonmajor bleeding in 8 patients (2 %), and major bleeding in 10 patients (3 %). The incidence of VTE in our patients with COVID-19 and MIS-C is similar to VTE rates at other institutions. We found that universally recognized VTE risk factors were appropriate to include as risk factors for thrombosis in hospitalized children with COVID-19 and MIS-C.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"243 ","pages":"Article 109169"},"PeriodicalIF":3.7,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolving patterns of intracranial hemorrhage in advanced therapies in patients with acute pulmonary embolism","authors":"Konstantinos C. Christodoulou ,&nbsp;Katharina Mohr ,&nbsp;Timo Uphaus ,&nbsp;Max Jägersberg ,&nbsp;Luca Valerio ,&nbsp;Ioannis T. Farmakis ,&nbsp;Thomas Münzel ,&nbsp;Philipp Lurz ,&nbsp;Stavros V. Konstantinides ,&nbsp;Lukas Hobohm ,&nbsp;Karsten Keller","doi":"10.1016/j.thromres.2024.109168","DOIUrl":"10.1016/j.thromres.2024.109168","url":null,"abstract":"<div><h3>Background</h3><div>Dissecting trends and contributing risk factors for intracranial hemorrhage (ICH) in patients treated for acute pulmonary embolism (PE) may allow for a better patient selection for existing and emerging treatment options.</div></div><div><h3>Methods</h3><div>The German nationwide inpatient sample was screened for patients admitted due to PE 2005–2020. Hospitalizations were stratified for the occurrence of ICH; risk factors for ICH and temporal trends were investigated.</div></div><div><h3>Results</h3><div>Overall, 816,653 hospitalizations due to acute PE in the period 2005–2020 were analyzed in the study. ICH was reported in 2516 (0.3 %) hospitalizations, and time trend analysis revealed a fluctuating but overall, largely unchanged annual incidence. There was an increase of ICH with age. Patients with ICH had a higher comorbidity burden (Charlson-Comorbidity-Index [CCI], 5.0 [4.0–7.0] vs. 4.0 [2.0–5.0]; <em>P</em> &lt; 0.001), and higher CCI was associated with an OR of 1.26 (95%CI 1.24–1.27) for ICH. Further independent risk factors for ICH were age ≥ 70 years (OR 1.23 [1.12–1.34]), severe (versus low-risk) PE (OR 3.09 [2.84–3.35]), surgery (OR 1.59 [1.47–1.72]), acute kidney injury (OR 3.60 [3.09–4.18]), and ischemic stroke (OR 14.64 [12.61–17.00]). The identified risk factors for ICH varied among different reperfusion treatment groups. As expected, ICH had a substantial impact on case-fatality of PE (OR 6.16 [5.64–6.72]; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Incidence of ICH in patients hospitalized for acute PE in Germany was overall low and depended on the patients' comorbidity burden. Identifying patients at risk for ICH allows tailored patient selection for the different reperfusion treatments and might prevent ICH.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"243 ","pages":"Article 109168"},"PeriodicalIF":3.7,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142318638","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":"The hemostatic system in chronic brain diseases: A new challenging frontier?","authors":"Mathias Chea ,&nbsp;Sylvie Bouvier ,&nbsp;Jean-Christophe Gris","doi":"10.1016/j.thromres.2024.109154","DOIUrl":"10.1016/j.thromres.2024.109154","url":null,"abstract":"<div><p>Neurological diseases (ND), including neurodegenerative diseases (NDD) and psychiatric disorders (PD), present a significant public health challenge, ranking third in Europe for disability and premature death, following cardiovascular diseases and cancers. In 2017, approximately 540 million cases of ND were reported among Europe's 925 million people, with strokes, dementia, and headaches being most prevalent. Nowadays, more and more evidence highlight the hemostasis critical role in cerebral homeostasis and vascular events. Indeed, hemostasis, thrombosis, and brain abnormalities contributing to ND form a complex and poorly understood equilibrium. Alterations in vascular biology, particularly involving the blood-brain barrier, are implicated in ND, especially dementia, and PD. While the roles of key coagulation players such as thrombin and fibrinogen are established, the roles of other hemostasis components are less clear. Moreover, the involvement of these elements in psychiatric disease pathogenesis is virtually unstudied, except in specific pathological models such as antiphospholipid syndrome. Advanced imaging techniques, primarily functional magnetic resonance imaging and its derivatives like diffusion tensor imaging, have been developed to study brain areas affected by ND and to improve our understanding of the pathophysiology of these diseases. This literature review aims to clarify the current understanding of the connections between hemostasis, thrombosis, and neurological diseases, as well as explore potential future diagnostic and therapeutic strategies.</p></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"243 ","pages":"Article 109154"},"PeriodicalIF":3.7,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142272019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regulation of macrophage fibrinolysis during venous thrombus resolution","authors":"Tierra A. Johnson ,&nbsp;Subhradip Mukhopadhyay ,&nbsp;Marguerite S. Buzza ,&nbsp;Jacob A. Brooks ,&nbsp;Rajabrata Sarkar ,&nbsp;Toni M. Antalis","doi":"10.1016/j.thromres.2024.109149","DOIUrl":"10.1016/j.thromres.2024.109149","url":null,"abstract":"<div><h3>Background</h3><div>Venous thromboembolism (VTE), which includes pulmonary embolism (PE) and deep vein thrombosis (DVT), is a serious cardiovascular disease with significant mortality and morbidity. Clinically, patients with faster resolution of a venous thrombi have improved prognosis. Urokinase-plasminogen activator (uPA), produced by macrophages, is a key mediator of fibrinolysis required for resolving venous thrombi and restoring vascular integrity. The major macrophage protein, plasminogen activator inhibitor type-2 (PAI-2), was originally identified as an inhibitor of uPA and is implicated in the modulation of pathways affecting fibrinolytic uPA activity, however its direct role in blocking uPA-mediated clot lysis is not known.</div></div><div><h3>Objective</h3><div>To determine the contribution of macrophage PAI-2 in inhibiting uPA-mediated fibrinolysis during resolution of DVT.</div></div><div><h3>Methods</h3><div>Using a murine model of venous thrombosis and resolution, we determined histological changes and molecular features of fibrin degradation in venous thrombi from WT mice and mice genetically deficient in PAI-2 and PAI-1, and determined the fibrinolytic activities of macrophages from these genotypes <em>ex vivo</em>.</div></div><div><h3>Results</h3><div>Acceleration of venous thrombus resolution by PAI-2^−/− mice increases fibrin degradation in venous thrombi showing a pattern similar to genetic deficiency of PAI-1, the major attenuator of fibrinolysis. PAI-2 deficiency was not associated with increased macrophage infiltration into thrombi or changes in macrophage PAI-1 expression. uPA-initiated fibrinolysis by macrophages <em>in vitro</em> could be accelerated by PAI-1 deficiency, but not PAI-2 deficiency.</div></div><div><h3>Conclusion</h3><div>PAI-2 has an alternate anti-fibrinolytic activity that is macrophage uPA independent, where PAI-1 is the dominant uPA inhibitor during DVT resolution.</div></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"243 ","pages":"Article 109149"},"PeriodicalIF":3.7,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting intracranial bleeding during anticoagulation for venous thromboembolism within different time frames: Findings from the RIETE registry","authors":"Ana Maestre ,&nbsp;Mar Martín del Pozo ,&nbsp;Farès Moustafa ,&nbsp;Romain Chopard ,&nbsp;José Antonio Nieto ,&nbsp;María Ángeles Fidalgo Fernández ,&nbsp;Patricia López Miguel ,&nbsp;Peter Verhamme ,&nbsp;Maurizio M. Ciammaichella ,&nbsp;Manuel Monreal ,&nbsp;the RIETE investigators","doi":"10.1016/j.thromres.2024.109153","DOIUrl":"10.1016/j.thromres.2024.109153","url":null,"abstract":"<div><h3>Background</h3><p>The risk of intracranial bleeding during anticoagulation for venous thromboembolism (VTE) is substantial and persists beyond the initial treatment phase. We aimed to refine risk-assessment through phase-specific prognostic scores.</p></div><div><h3>Methods</h3><p>We identified data from 77,786 VTE patients in the RIETE registry from March 2009 to October 2023 to develop two prognostic scores for intracranial bleeding. Multivariable Cox regression was used to analyze distinct variables for the early (≤90 days) and late (&gt;90 days) phases, with comparative validation against existing scores (modified ACCP, RIETE, VTE-BLEED, and CHAP).</p></div><div><h3>Results</h3><p>Intracranial bleeding occurred in 411 patients (0.53 %), with 208 cases in the early phase and 203 in the late phase. The 30-day mortality was 45 % and 35 %, respectively. Shared significant predictors for both phases include baseline abnormal mental status, brain cancer, recent intracranial bleeding, and epilepsy. Unique to early-phase bleeding were body weight, non-brain cancer, hypertension, dementia, thrombocytopenia, renal insufficiency, and thrombolytic therapy. Advanced age, pulmonary embolism initially, prior stroke, depression, treatment with direct oral anticoagulants, and use of corticosteroids predicted late-phase bleeding. Both prognostic scores showed a c-statistic of 0.68, outperforming existing scores.</p></div><div><h3>Conclusions</h3><p>The study introduces two temporal prognostic scores for intracranial bleeding during anticoagulation for VTE. By discerning specific risk factors pertinent to each treatment phase, these scores outperform traditional models, offering an advanced tool for clinical decision-making. They hold significant potential for optimizing anticoagulation management and reducing bleeding-related mortality.</p></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"243 ","pages":"Article 109153"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Main features of ischemic stroke in patients with acute immune-mediated thrombotic thrombocytopenic purpura","authors":"Addolorata Truma ,&nbsp;Ilaria Mancini ,&nbsp;Pasquale Agosti ,&nbsp;Andrea Artoni ,&nbsp;Juri Alessandro Giannotta ,&nbsp;Barbara Ferrari ,&nbsp;Pasqualina De Leo ,&nbsp;Flora Peyvandi","doi":"10.1016/j.thromres.2024.109151","DOIUrl":"10.1016/j.thromres.2024.109151","url":null,"abstract":"<div><h3>Background</h3><p>Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a microangiopathy often characterized by acute neurological involvement including ischemic stroke (IS). The characteristics of IS in iTTP remain largely unknown.</p></div><div><h3>Aims</h3><p>To evaluate the epidemiology, neuroimaging patterns and risk factors of IS in iTTP patients.</p></div><div><h3>Methods</h3><p>We performed a cross-sectional study of patients enrolled in the Milan TTP Registry presenting with neurological signs/symptoms and underwent neuroimaging evaluation during their first acute iTTP episode.</p></div><div><h3>Results</h3><p>Seventy-eight patients were enrolled, the majority of patients were female (72 %), with a median age of 46 years. Computed tomography (CT) was performed in all patients, and magnetic resonance (MRI) was performed in 38 % of patients. IS was confirmed in 18 out of 78 patients (23 %), most of whom (70 %) showed a non-lacunar pattern with multifocal involvement. In the subgroup of patients who had MRI (<em>n</em> = 30), IS was identified in 12 patients (40 %) and of them 6 (50 %) had a false negative result with CT scan. Patients with IS were slightly older than those without, whereas the prevalence of cardiovascular risk factors and iTTP-related parameters were comparable between the two groups.</p></div><div><h3>Conclusion</h3><p>23 % of patients presenting with neurological manifestations at their first acute TTP episode, showed brain IS. As expected, MRI showed higher sensitivity in detecting ischemic lesions underscoring its usefulness over CT in this setting. An unexpected prevalence of non-lacunar and multifocal stroke patterns warrants further investigation. Cardiovascular risk factors and iTTP-related clinical and laboratory parameters were similarly distributed in patients with and without IS.</p></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"243 ","pages":"Article 109151"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel nomogram for the prediction of sepsis-induced coagulopathy in the PICU: A multicentre retrospective study","authors":"Yan Gao ,&nbsp;Yanan Fu ,&nbsp;Enyu Guo ,&nbsp;Teng Wang ,&nbsp;Qin Jiang ,&nbsp;Chen Zhang ,&nbsp;Jing Liu ,&nbsp;Guan Wang","doi":"10.1016/j.thromres.2024.109152","DOIUrl":"10.1016/j.thromres.2024.109152","url":null,"abstract":"<div><h3>Introduction</h3><p>Sepsis-induced coagulopathy (SIC) is a severe complication of sepsis, characterized by poor prognosis and high mortality. However, the predictors of SIC in pediatric patients have yet to be identified. Our aim was to develop a user-friendly and efficient nomogram for predicting SIC in sepsis patients admitted to the pediatric intensive care unit (PICU).</p></div><div><h3>Materials and methods</h3><p>We screened 948 sepsis patients admitted to the PICU in three hospitals located in Shandong, China. Least absolute shrinkage and selector operation (LASSO) regression was used in the training cohort for variable selection and regularization. The selected variables were utilized to construct a nomogram for predicting the risk of SIC among sepsis patients admitted to the PICU.</p></div><div><h3>Results</h3><p>Overall, SIC was observed in 324 (40.3 %) patients. The morbidity of SIC in sepsis patients is associated with age, fibrinogen, prothrombin time, C-reactive protein, lactate and the pediatric sequential organ failure assessment score. We developed a nomogram for the early identification of SIC in the training cohort (area under the curve [AUC] 0.869, 95 % confidence interval [CI] 0.830–0.907, sensitivity 75.7 %, specificity 84.8 %) and validation cohorts (validation cohort 1: AUC 0.854, 95 % CI 0.805–0.903, sensitivity 72.0 %, specificity 86.9 %; validation cohort 2: AUC 0.853, 95 % CI 0.796–0.910, sensitivity 70.1 %, specificity 87.8 %). The calibration plots of the nomogram demonstrated a high level of concordance in the SIC probabilities between the observed and predicted values.</p></div><div><h3>Conclusions</h3><p>The novel nomogram showed excellent predictive performance for the morbidity of SIC among sepsis patients admitted to the PICU, potentially assisting healthcare professionals in early identification and intervention for SIC.</p></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"243 ","pages":"Article 109152"},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142233732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative incidence and risk factors for gastrointestinal bleeding following percutaneous coronary intervention for coronary artery disease: Insights from the Keio Cardiovascular Registry in Japan","authors":"Ikuko Ueda ,&nbsp;Shun Kohsaka ,&nbsp;Yohei Numasawa ,&nbsp;Ryo Takemura ,&nbsp;Naoki Hosoe ,&nbsp;Masaki Ieda","doi":"10.1016/j.thromres.2024.109150","DOIUrl":"10.1016/j.thromres.2024.109150","url":null,"abstract":"<div><h3>Background</h3><p>In patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI), antiplatelet medication usage is crucial for preventing thrombotic events. However, it requires careful monitoring, especially because of the risk of life-threatening bleeding complications. In hemorrhagic complications, assessment of patient background and risk of gastrointestinal bleeding (GIB) remain limited for GIB that develops during long-term observation after hospital discharge. This study aimed to examine the incidence of GIB and patient characteristics in CAD post-PCI.</p></div><div><h3>Methods</h3><p>All CAD patients undergoing PCI for urgent, emergent, or elective indications were enrolled in the Keio Interhospital Cardiovascular Studies (JCD-KiCS)-PCI registry (January 2009 and December 2017) and followed up to 2 years after PCI discharge. From the JCD-KiCS PCI registry, 8864 patients (median [interquartile range [IQR]] age: non-GIB: 69.0 y [16 y], upper GIB (UGI): 72.0 y [15.5 y], lower GIB (LGI): 73.0 y [IQR: 13 y]) were categorized based on the occurrence of hospitalization-requiring GIB. Patient characteristics and detailed information regarding these GIB events, including the location (upper vs lower GI) and bleeding severity, were analyzed.</p></div><div><h3>Results</h3><p>Overall, 36 patients experienced UGI, while 85 patients experienced LGI. The rates of dual antiplatelet therapy (DAPT) and triple therapy were significantly different among the non-GIB (n = 8734), UGI (n = 36) and LGI (n = 85) groups (DAPT [aspirin + P2Y12 (clopidogrel/prasugrel/ticlopidine)]: 64 [76.2 %] in the LGI group vs 24 [68.6 %] in the UGI group vs 7330 [84.6 %] in the non-GIB group; triple therapy [aspirin + P2Y12 (clopidogrel/prasugrel/ticlopidine)] + oral anticoagulant (OAC) (warfarin/direct oral anticoagulant [DOAC]): 17 [20.2 %] in the LGI group vs 8 [22.9 %] in the UGI group vs 836 [9.6 %] in the non-GIB group; p &lt; 0.001). In the LGI and UGI groups, aspirin and warfarin were used in 2 (2.4 %) and 2 (5.7 %) patients, respectively, but not in combination with DOAC. The 2-year post-PCI hospitalization incidence for GIB was 1.4 % (LGI, 1.0 %; UGI, 0.4 %). The most common causes were colonic diverticular hemorrhage (43.5 %) for LGI and duodenal ulcer (21.9 %) for UGI. No significant differences were found in the cumulative 2-year post-PCI risks between the LGI and UGI groups (log-rank p = 0.97). Most GIB events were Bleeding Academic Research Consortium 2-equivalent (hemoglobin decrease &lt;3 g/dL). Notably, the use of OACs at PCI discharge, bleeding complications within 72 h, and preprocedural anemia were significantly correlated with an increased GIB risk.</p></div><div><h3>Conclusions</h3><p>The real-world incidence of LGI is two times higher than that of UGI in CAD patients undergoing PCI, and most events are mild. OAC use at PCI discharge is the strongest potential risk factor for GIB development.</p></div>","PeriodicalId":23064,"journal":{"name":"Thrombosis research","volume":"243 ","pages":"Article 109150"},"PeriodicalIF":3.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0049384824002822/pdfft?md5=183c1e641cf929263bc192156fd36c12&pid=1-s2.0-S0049384824002822-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239592","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}