Thrombosis UpdatePub Date : 2024-07-08DOI: 10.1016/j.tru.2024.100183
Javier Soto Alsar , Roberto Jiménez Rodríguez , Ana Gutiérrez , Laura Ortega Morán , Andrés J. Muñoz Martín
{"title":"Update in venous thromboembolism in cancer: Lessons from multi-centre registries","authors":"Javier Soto Alsar , Roberto Jiménez Rodríguez , Ana Gutiérrez , Laura Ortega Morán , Andrés J. Muñoz Martín","doi":"10.1016/j.tru.2024.100183","DOIUrl":"https://doi.org/10.1016/j.tru.2024.100183","url":null,"abstract":"<div><p>Cancer-associated thrombosis is a common problem in cancer patients and one of the leading causes of death in this population. Randomised clinical trials have shown that both low-molecular-weight heparins and direct oral anticoagulants are the treatments of choice for cancer-associated thrombosis. Despite this, small sample sizes, poor representation of some patient subgroups and lack of information about real-world clinical situations are some of the limitations of randomised trials. To overcome these problems, registries have been established to collect real-world data from patients with cancer-associated thrombosis, offering new evidence and information to supplement the findings of randomised clinical trials. However, few registries have focused exclusively on cancer patients, and some have excluded various subgroups of patients. Additionally, data collection and processing are another major challenge in analysing registry results, where the emergence of artificial intelligence will play a fundamental role.</p></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"16 ","pages":"Article 100183"},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666572724000257/pdfft?md5=4ba7087b1901b77ce711ff2009d4609c&pid=1-s2.0-S2666572724000257-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141607372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thrombosis UpdatePub Date : 2024-07-01DOI: 10.1016/j.tru.2024.100182
Sara Ng, Cameron Brown, Farah Zarka, Aurélien Delluc, Marc Carrier
{"title":"The efficacy and safety of anticoagulation for the management of gonadal vein thrombosis: A systematic review and pooled analysis","authors":"Sara Ng, Cameron Brown, Farah Zarka, Aurélien Delluc, Marc Carrier","doi":"10.1016/j.tru.2024.100182","DOIUrl":"https://doi.org/10.1016/j.tru.2024.100182","url":null,"abstract":"<div><h3>Background</h3><p>Gonadal vein thrombosis (GVT) is an uncommon condition that has been associated with different risk factors (e.g., post-partum period, cancer, recent pelvic surgery, etc.). The optimal management of GVT remains unclear. We sought to assess the efficacy and safety of anticoagulation therapy in adult patients with GVT.</p></div><div><h3>Methods</h3><p>A systematic search of MEDLINE, EMBASE and PubMed, from inception to February 2023 was performed. The primary efficacy outcome was recurrent venous thromboembolism (VTE). Bleeding outcomes were assessed in the form of major and clinically relevant non-major bleeding (CRNMB) events. Incidence rates of the outcomes were pooled using the random effects model and expressed as event per 100 patient-years with its associated 95 % confidence intervals (CI) using R software.</p></div><div><h3>Results</h3><p>A total of 14 observational studies and one randomized controlled trial (1134 patients) with GVT met the inclusion criteria and were included in the review. Overall, 429 (37.8 %) patients were treated with anticoagulation. The rate of recurrent VTE was 3.1 per 100 patient-years (95 % CI, 1.6–6.3). The rate of major bleeding and CRNMB events were 1.0 (95 % CI; 0.2–4.5) and 9.9 (95 % CI; 2.6–37.8) per 100 patient-years, respectively.</p></div><div><h3>Conclusion</h3><p>Gonadal vein thrombosis seems to be associated with a relatively low risk of recurrent VTE and bleeding complications. The risk benefit ratio of anticoagulant therapy remains unclear in this patient population.</p></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"16 ","pages":"Article 100182"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666572724000245/pdfft?md5=227ccae830e5007a63ab9e4964f2f095&pid=1-s2.0-S2666572724000245-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141593593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thrombosis UpdatePub Date : 2024-06-28DOI: 10.1016/j.tru.2024.100181
Leah Flanagan , Bibi Ayesha Bassa , John M. Moriarty , Frank Lyons , Fiona Sands , Christine Comer , Lidhy Solomon , Fionnuala Ni Aínle
{"title":"Hospital PERT: Bridging VTE care across all disciplines","authors":"Leah Flanagan , Bibi Ayesha Bassa , John M. Moriarty , Frank Lyons , Fiona Sands , Christine Comer , Lidhy Solomon , Fionnuala Ni Aínle","doi":"10.1016/j.tru.2024.100181","DOIUrl":"10.1016/j.tru.2024.100181","url":null,"abstract":"<div><p>Venous thromboembolism (VTE) comprises deep vein thrombosis (DVT) and pulmonary embolism (PE). Acute PE is associated with significant morbidity and mortality. Hospital admission is a common cause of VTE.</p><p>We present a complex case of a young female patient who sustained a right tibial plateau fracture following a traumatic, hyperextension knee injury. The patient was admitted by the orthopaedic team for an open reduction and internal fixation and commenced on prophylactic low molecular weight heparin. Post-operatively, the patient became hypoxic, and computed tomography pulmonary angiogram confirmed bilateral large volume pulmonary emboli with evidence of right heart strain. Following review by the pulmonary embolism response team (PERT), the patient was stratified into an intermediate-high risk group, and received unfractionated heparin, however, remained tachycardic and hypoxic with rising lactate levels. Owing to relative contraindications to systemic thrombolysis, the patient underwent catheter-based thrombectomy and inferior vena cava filter placement. The patient improved dramatically over the course of her admission and was later discharged, asymptomatic from a cardiopulmonary standpoint. In hospitalised patients, early VTE risk assessment and prompt initiation of appropriate thromboprophylaxis are crucial in preventing hospital-acquired VTE (HAVTE). However, in instances of HAVTE in complex patients, a well-coordinated multidisciplinary PERT is necessary to consider alternative strategies for managing intermediate to high-risk PE.</p></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"16 ","pages":"Article 100181"},"PeriodicalIF":0.0,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666572724000233/pdfft?md5=4f1d5208864fd9ae5157106354d225d3&pid=1-s2.0-S2666572724000233-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141630057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Probability assessment of pulmonary embolism using clinical and laboratory variables in hospitalized patients: A single-center, retrospective observational study","authors":"Yongsub Choi , Neeti Prasai , Tanushree Bhatt , Priscilla Lajara Hallal , Elina Shrestha , Sujeirys Paulino , Abeer Qasim , Maria Jaquez Duran , Kazi Samsuddoha , Sushant Niroula , Yordanka Diaz Saez , Siddharth Chinta , Haider Ghazanfar , Guanghui Luo , Aditya Paudel , Iqra Bhatti , Amber Latif , Misbahuddin Khaja","doi":"10.1016/j.tru.2024.100180","DOIUrl":"10.1016/j.tru.2024.100180","url":null,"abstract":"<div><h3>Introduction</h3><p>Pulmonary embolism (PE) probability assessment relies on clinical scoring systems, which have limitations for certain patient populations. We aimed to investigate the use of laboratory values for PE probability assessment.</p></div><div><h3>Materials and methods</h3><p>This retrospective single-center observational study included patients with suspected PE. Nineteen variables were examined. Logistic regression analysis adjusted for confounding factors was performed, and significant variables were used to develop a scoring method. Receiver operating characteristic (ROC) curves were used to detect PE and determine the optimal cutoff value. Well's scores were also estimated.</p></div><div><h3>Results</h3><p>The model achieved an accuracy of 84.6 %. Hypocapnia, fever, alkaline phosphatase (ALP), D-dimer, and lactate levels had predictive values. The slope was negative for hypocapnia, ALP, and lactate, and positive for fever and D-dimer levels. Fever, with an adjusted odds ratio (OR) of 1.995, received a score of 2 for values above the cutoff, whereas the remaining variables were assigned a score of 1. Patients with PE had significantly higher scores (mean ± SD: 2.07 ± 0.91) than those without PE (1.80 ± 1.13; P = 0.001). The area under the ROC curve was 0.585 (95 % confidence interval: 0.563–0.606; P = 0.001). Using a cutoff score of 1.5 based on the maximum Youden's index, the scoring system achieved a sensitivity of 73.1 % and specificity of 43.4 %. The Well's score demonstrated a sensitivity of 51.1 % and specificity of 75.1 %.</p></div><div><h3>Conclusion</h3><p>This study showed statistically significant laboratory values for the probability assessment of PE and the tentative scoring system (PAPEL score). Larger prospective multicenter studies are required to validate this scoring method in a wider population.</p></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"16 ","pages":"Article 100180"},"PeriodicalIF":0.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666572724000221/pdfft?md5=5574ed18cc4cf88417dacaecb5c9171b&pid=1-s2.0-S2666572724000221-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141623978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thrombosis UpdatePub Date : 2024-06-01DOI: 10.1016/j.tru.2024.100175
Anja Sol-Maag , Hessel Peters Sengers , Mettine H.A. Bos , Tom van der Poll , Nienke van Rein , Cornelis van ’t Veer
{"title":"Plasma thrombin generation in the presence of TIX-5 may contribute significantly to a prediction model for major bleeding in patients on VKA anticoagulant therapy","authors":"Anja Sol-Maag , Hessel Peters Sengers , Mettine H.A. Bos , Tom van der Poll , Nienke van Rein , Cornelis van ’t Veer","doi":"10.1016/j.tru.2024.100175","DOIUrl":"10.1016/j.tru.2024.100175","url":null,"abstract":"<div><h3>Introduction</h3><p>Oral anticoagulant therapy comes at the cost of a significant bleeding risk. However, it is hard to predict which patients are at risk of major bleeding. Previously we found associations of Calibrated Automated Thrombinography (CAT) parameters obtained in the presence of TIX-5 (an inhibitor of the FV activation by FXa), and plasma levels of TFPIα, γ’-fibrinogen and soluble thrombomodulin with major bleeding in the BLEEDS cohort, a cohort especially powered to find new biomarkers of major bleeding during VKA therapy.</p></div><div><h3>Methods</h3><p>To determine and compare the predictive capability for major bleeding in the BLEEDS cohort of the above biomarkers, also in a combined model with clinical risk factors, we performed Univariable Prentice-weighted Cox regression analyses and Bayesian variable selection.</p></div><div><h3>Results</h3><p>The highest predictive value among the laboratory measures were found for thrombin generation lagtime in the presence of TIX-5 (TIX-5 lagtime per 25% increase, hazard ratio (HR) 1.11, 95%CI 1.04–1.18, p=0.001) and full-length tissue factor pathway inhibitor (TFPIα) (per 25% increase HR 1.12, 95%CI 1.03–1.21, p=0.008), which remained significant after correction for multiple testing, and independently associated with major bleeding after Bayesian variable selection. Only the addition of TIX-5 lagtime to the clinical risk factors improved prediction of major bleeding significantly (p<0.001).</p></div><div><h3>Conclusion</h3><p>We established predictive value of the lagtime of thrombin generation measured in the presence of TIX-5 for the risk of a major bleeding of patients on VKA therapy.</p></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"15 ","pages":"Article 100175"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666572724000178/pdfft?md5=a34507c8bcf35215533a9f35adbb8ea3&pid=1-s2.0-S2666572724000178-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141043638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thrombosis UpdatePub Date : 2024-06-01DOI: 10.1016/j.tru.2024.100177
Emmanouil S. Papadakis, Lucy A. Norris
{"title":"Breaking the barriers to VTE prevention in ambulatory cancer patients: When implementation strategy comes into play","authors":"Emmanouil S. Papadakis, Lucy A. Norris","doi":"10.1016/j.tru.2024.100177","DOIUrl":"https://doi.org/10.1016/j.tru.2024.100177","url":null,"abstract":"","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"15 ","pages":"Article 100177"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666572724000191/pdfft?md5=e47a8f1e131ed8d866c9e51569ecef58&pid=1-s2.0-S2666572724000191-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141328958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Impact of anticoagulants, antiplatelet agents, and oral antidiabetic drugs on the risk of stroke in patients with diabetes and nonvalvular atrial fibrillation: A case-referent study","authors":"Lamiae Grimaldi , Fabrice Bonnet , Yann Hamon , Emmanuel Touzé , Lucien Abenhaim","doi":"10.1016/j.tru.2024.100173","DOIUrl":"10.1016/j.tru.2024.100173","url":null,"abstract":"<div><h3>Background</h3><p>Type 2 diabetes mellitus (T2DM) and atrial fibrillation are risk factors for stroke. The potential preventive effects of cardiovascular and antidiabetic treatments on stroke risk in patients with these diseases remain insufficiently documented. Sulfonylureas have also been reported to be associated with stroke. This study aimed to assess the risk of stroke according to the use of drugs (anticoagulants, antiplatelet agents, and oral antidiabetic drugs [OADs]) in patients with T2DM and nonvalvular atrial fibrillation (NVAF).</p></div><div><h3>Methods</h3><p>Patients with a history of T2DM and NVAF were identified from two systematic registries: a registry of patients with stroke and a registry of patients with atrial fibrillation. Patients with stroke were randomly matched to patients without prior stroke events based on age, sex, body mass index, and index date. All treatments administered 12 months before the index date were documented. The associations between anticoagulants, antiplatelet agents, and OADs and stroke were assessed using multivariate conditional logistic models that yielded adjusted odds ratios (aORs) and 95 % confidence intervals, controlling for risk factors identified in the univariate comparison of cases and matched referents.</p></div><div><h3>Results</h3><p>Three-hundred and fifteen patients with stroke with both diabetes and NVAF were matched to 523 referents with both diabetes and NVAF but no history of stroke. The aORs for the use of drugs and stroke were 0.24 [0.15–0.40] for direct oral anticoagulants (DOACs), 0.42 [0.27–0.67] for vitamin K agonists (VKA), 0.80 [0.52–1.24] for antiplatelet agents, and 0.68 [0.45–1.02] for OADs. No significant associations were found between individual OAD use and stroke risk. Similar results were obtained for ischemic stroke. Only VKAs were significantly associated with hemorrhagic stroke (odds ratio = 4.25 [1.16–15.64]).</p></div><div><h3>Conclusions</h3><p>Anticoagulant use was associated with a protective effect against the risk of stroke in patients with diabetes and NVAF, with no increase in the risk of hemorrhagic stroke for DOAC. No increased risk of stroke was observed because of any OAD, including sulfonylureas.</p></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"15 ","pages":"Article 100173"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666572724000154/pdfft?md5=8a6ae7825ca7437eb90fc1fee1a15163&pid=1-s2.0-S2666572724000154-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141034334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thrombosis UpdatePub Date : 2024-04-18DOI: 10.1016/j.tru.2024.100172
Eleni Gavriilaki , Ioannis Tsakiridis , Panagiotis Kalmoukos, Anna Papakonstantinou, Maria Mauridou, Nikolaos Kotsiou, Aikaterini Mpalaska, Sofia Chissan, Apostolos Mamopoulos, Themistoklis Dagklis, Apostolos Athanasiadis, Sofia Vakalopoulou
{"title":"A rare case of thrombotic thrombocytopenic purpura during pregnancy with a successful outcome despite ovarian hyperstimulation syndrome during treatment","authors":"Eleni Gavriilaki , Ioannis Tsakiridis , Panagiotis Kalmoukos, Anna Papakonstantinou, Maria Mauridou, Nikolaos Kotsiou, Aikaterini Mpalaska, Sofia Chissan, Apostolos Mamopoulos, Themistoklis Dagklis, Apostolos Athanasiadis, Sofia Vakalopoulou","doi":"10.1016/j.tru.2024.100172","DOIUrl":"10.1016/j.tru.2024.100172","url":null,"abstract":"<div><p>Thrombotic microangiopathies during pregnancy are rare but may be life-threatening diseases for both the mother and the fetus. Thrombotic thrombocytopenic purpura (TTP) patients present with hemolytic anemia and thrombocytopenia associated with low ADAMTS-13 activity, a cleaving von Willebrand factor protein. Pregnancy has been described not only as a trigger of TTP but also as a phenotype modifier. In addition, hormonal changes induced by assisted reproduction technology (ART) swift the thrombotic – thrombolytic state towards coagulation, while increasing the pregnancy complications’ rate. We present a case of a 34-year-old pregnant woman, who conceived via ART and diagnosed with TTP at 13 weeks of gestation. She was initially treated with corticosteroids and daily plasmapheresis. Due to gradual unresponsiveness to treatment, rituximab was also added. After 3 doses, she was diagnosed with mild ovarian hyperstimulation syndrome, which resolved spontaneously after several weeks. She delivered a healthy neonate at 39<sup>+1</sup> weeks via emergency cesarean section due to fetal distress, while the postpartum follow-up was uneventful. In conclusion, TTP should be suspected to a pregnant woman with raised hemorrhagic risk presenting with hematuria, anemia and thrombocytopenia.</p></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"15 ","pages":"Article 100172"},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666572724000142/pdfft?md5=519c90b84cc55670422797893c8154a7&pid=1-s2.0-S2666572724000142-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140783376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}