TH Open最新文献

{"title":"Use of magnetic resonance direct thrombus imaging for diagnostic management of suspected thrombosis in routine clinical practice","authors":"C.M.M. de Jong, L. F. van Dam, C. Dronkers, Jeroen Eikenboom, P. D. den Exter, Sophie N.M. ter Haar, Guido R. van Haren, M. Huisman, T. V. van Mens, Lauran Stöger, L. Kroft, F.A. Klok","doi":"10.1055/a-2341-6349","DOIUrl":"https://doi.org/10.1055/a-2341-6349","url":null,"abstract":"Background: The non-invasive magnetic resonance direct thrombus imaging (MRDTI) technique can be used to diagnose acute deep-vein thrombosis (DVT), without the use of intravenous contrast. MRDTI holds the potential to differentiate between acute and chronic DVT and could be helpful when diagnosing thrombosis is challenging.\u0000Objectives: To evaluate the application of MRDTI in clinical practice, including the frequency and indications of MRDTI scans performed in practice based conditions, results, impact on treatment decisions, and associated patient outcomes.\u0000Methods: A retrospective study was performed at the Leiden University Medical Center, the Netherlands. MRDTI scans performed since its implementation in patients aged ≥18 years as part of clinical practice for diagnostic management of suspected thrombosis were evaluated.\u0000Results: Between October 2015 and September 2023, 36 patients had undergone MRDTI for the diagnostic evaluation of thrombosis. MRDTI application increased since 2019 (5 to 8 scans per year). The most common indication was to differentiate between acute and chronic thrombosis, mainly for suspected recurrent ipsilateral DVT after inconclusive compression ultrasonography. In over a third of patients, acute thrombosis was confirmed by MRDTI. MRDTI results determined treatment decisions in all except two patients. One patient had symptomatic thrombosis of the lower extremity within 3 months after an MRDTI of the upper extremity without signs of acute thrombosis (1/23; 4.3%, 95% confidence interval 0.77-21).\u0000Conclusion: Over the past 4 years, MRDTI has been used increasingly in our hospital. MRDTI results guided treatment decisions, which confirms the clinical impact and feasibility of its application in daily practice.","PeriodicalId":512452,"journal":{"name":"TH Open","volume":" 584","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141364163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical pathways and outcomes of andexanet alfa administration for reversal of critical bleeding in patients on oral direct factor Xa inhibitors","authors":"Mark Goldin, Kolton Smith, Ioannis Koulas, Tungming Leung, Mayuri Ravi, Sanjit Parhar, Sejal Shah, Kayla Floyd, Lori Ohanesian, Rachel Bain, Daniela Defonte, Kanta Ochani, Amanda Lin, Bhumi Patel, Nikolaos Tsaftaridis, Jack Jnani, Alex C. Spyropoulos","doi":"10.1055/a-2306-0804","DOIUrl":"https://doi.org/10.1055/a-2306-0804","url":null,"abstract":"Background: Andexanet is FDA-approved for reversal of critical bleeding from factor Xa inhibitors and off-label for surgical reversal. Data are lacking on andexanet administration processes. \u0000Methods: We retrospectively studied patients at a 23-hospital system who received andexanet from November 2019 to March 2023. Abstractors coded demographics, comorbidities, anticoagulant use, andexanet indication, and process times. The primary outcome was presentation-to-andexanet time; diagnosis, ordering, and administration times were calculated. Secondary outcomes included in-hospital post-andexanet major thromboembolism/bleeding and mortality.\u0000Results: 141 patients were analyzed. Andexanet indications were predominantly neurologic bleeding (85.8%). 24 patients (17.0%) transferred from non-tertiary/academic centers to tertiary/academic centers. Median presentation-to-administration time was 192.5 minutes (interquartile range [IQR] 108.0 - 337.0 minutes). Components were: 72.5 minutes (IQR 39.0 - 137.5 minutes) for bleeding diagnosis; 35.5 minutes (IQR 0 - 96.5 minutes) for andexanet ordering; and 53.0 minutes (IQR 38.5 - 78.5 minutes) for administration, which was longer at tertiary/academic hospitals (Ratio 1.5, 95% Confidence Interval [CI] 1.2 – 2.0, p = 0.002). Gastrointestinal or other critical bleeding (Ratio 2.59, 95% CI 1.67 – 4.02, p < 0.001), and tertiary/academic center treatment (Ratio 1.58, 95% CI 1.15 – 2.18, p = 0.005), were associated with increased time. Major thromboembolism, bleeding, and mortality occurred in 10.6%, 12.0%, and 22.9% of patients, respectively.\u0000\u0000Conclusions: In our cohort, median presentation-to-administration time was over 3 hours. Cumulative times were longer at tertiary/academic hospitals and for gastrointestinal/other bleeding. Post-andexanet major thromboembolism/bleeding occurred more at tertiary/academic hospitals, possibly related to transfers. Prospective studies may elucidate clinical decision-making bottlenecks.","PeriodicalId":512452,"journal":{"name":"TH Open","volume":"27 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140702126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombophilia Testing: from Genetic Predisposition to Discrimination","authors":"Andreas Verstraete, K. Freson, P. Verhamme, T. Vanassche","doi":"10.1055/a-2284-4285","DOIUrl":"https://doi.org/10.1055/a-2284-4285","url":null,"abstract":"N/A for letters to the editor","PeriodicalId":512452,"journal":{"name":"TH Open","volume":"232 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140256099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticoagulation Stewardship to Bridge the Implementation Gap in Perioperative Anticoagulation Management","authors":"Alfonso Tafur, Geoffrey D. Barnes, V. Bhagirath, James Douketis","doi":"10.1055/a-2259-0911","DOIUrl":"https://doi.org/10.1055/a-2259-0911","url":null,"abstract":"Lack of alignment of care protocols among providers in healthcare is a driver of increased costs and suboptimal patient outcomes. Perioperative anticoagulation management is a good example of a complex area where protocol creation is a clinical challenge that demands input of multiple experts. Questions regarding the need for anticoagulation interruptions are frequent. Yet, due to layers of complexity involving analysis of anticoagulation indication, surgical risk, and anesthesia-associated bleeding risk as well as institutional practices, there is heterogeneity in how these interruptions are approached. The recent perioperative anticoagulation guidelines from the American College of Chest Physicians summarize extensive evidence for the management of anticoagulant and antiplatelet medications in patients who undergo elective interventions. However, implementation of these guidelines by individual clinicians is highly varied and often does not follow the best available clinical evidence. Against this background, anticoagulation stewardship units, which exist to improve safety and quality monitoring for the anticoagulated patient, are of growing interest. These units provide a bridge for implementation of value-based, high quality guidelines for patients who need perioperative anticoagulation interruption. We use a case to pragmatically illustrate the problem and tactics for change management and implementation science that may facilitate adoption of perioperative anticoagulation guidelines.","PeriodicalId":512452,"journal":{"name":"TH Open","volume":"66 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139829200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bleeding risk prediction in patients treated with antithrombotics according to site of bleeding, indication for treatment and time since initiation","authors":"V. Bhagirath, Tanya Kovalova, Jia Steven Wang, Lizhen Xu, Shrikant Bangdiwala, Martin O'Donnell, A. Shoamanesh, J. Bosch, Rosa Coppolecchia, T. Vaitsiakhovich, Frank Kleinjung, H. Mundl, J. W. Eikelboom","doi":"10.1055/a-2259-1134","DOIUrl":"https://doi.org/10.1055/a-2259-1134","url":null,"abstract":"Reasons for the relatively poor performance of bleeding prediction models are not well understood, but may relate to differences in predictors for various anatomical sites of bleeding. We pooled individual participant data from 4 randomized controlled trials of antithrombotic therapy in patients with coronary and peripheral artery disease, embolic stroke of undetermined source (ESUS), or atrial fibrillation. We examined discrimination and calibration of models for any major bleeding, major gastrointestinal bleeding, and intracranial hemorrhage (ICH), according to time since initiation of antithrombotic therapy, and indication for antithrombotic therapy. Of 57,813 patients included, 1,948 (3.37%) experienced major bleeding, including 717 (1.24%) major gastrointestinal bleeding and 274 (0.47%) ICH. The model derived to predict major bleeding at 1 year from any site (c-index, 0.69, 95% confidence interval [CI], 0.68-0.71) performed similarly when applied to predict major gastrointestinal bleeding (0.71, 0.69-0.74), but less well to predict ICH (0.64, 0.61-0.69). Models derived to predict GI bleeding (0.75, 0.74-0.78) and ICH (0.72, 0.70-0.79) performed better than the general major bleeding model. Discrimination declined over time since starting antithrombotic treatment, stabilizing at approximately 2 years for any major bleeding and major gastrointestinal bleeding, and 1 year for ICH. Discrimination was best for the model predicting ICH in the ESUS population (0.82, 0.78-0.92) and worst for the model predicting any major bleeding in the coronary and peripheral artery disease population (0.66, 0.65-0.69). Performance of risk prediction models for major bleeding is affected by site of bleeding, time since initiation of antithrombotic therapy, and indication for antithrombotic therapy.","PeriodicalId":512452,"journal":{"name":"TH Open","volume":"130 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139825824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bleeding risk prediction in patients treated with antithrombotics according to site of bleeding, indication for treatment and time since initiation","authors":"V. Bhagirath, Tanya Kovalova, Jia Steven Wang, Lizhen Xu, Shrikant Bangdiwala, Martin O'Donnell, A. Shoamanesh, J. Bosch, Rosa Coppolecchia, T. Vaitsiakhovich, Frank Kleinjung, H. Mundl, J. W. Eikelboom","doi":"10.1055/a-2259-1134","DOIUrl":"https://doi.org/10.1055/a-2259-1134","url":null,"abstract":"Reasons for the relatively poor performance of bleeding prediction models are not well understood, but may relate to differences in predictors for various anatomical sites of bleeding. We pooled individual participant data from 4 randomized controlled trials of antithrombotic therapy in patients with coronary and peripheral artery disease, embolic stroke of undetermined source (ESUS), or atrial fibrillation. We examined discrimination and calibration of models for any major bleeding, major gastrointestinal bleeding, and intracranial hemorrhage (ICH), according to time since initiation of antithrombotic therapy, and indication for antithrombotic therapy. Of 57,813 patients included, 1,948 (3.37%) experienced major bleeding, including 717 (1.24%) major gastrointestinal bleeding and 274 (0.47%) ICH. The model derived to predict major bleeding at 1 year from any site (c-index, 0.69, 95% confidence interval [CI], 0.68-0.71) performed similarly when applied to predict major gastrointestinal bleeding (0.71, 0.69-0.74), but less well to predict ICH (0.64, 0.61-0.69). Models derived to predict GI bleeding (0.75, 0.74-0.78) and ICH (0.72, 0.70-0.79) performed better than the general major bleeding model. Discrimination declined over time since starting antithrombotic treatment, stabilizing at approximately 2 years for any major bleeding and major gastrointestinal bleeding, and 1 year for ICH. Discrimination was best for the model predicting ICH in the ESUS population (0.82, 0.78-0.92) and worst for the model predicting any major bleeding in the coronary and peripheral artery disease population (0.66, 0.65-0.69). Performance of risk prediction models for major bleeding is affected by site of bleeding, time since initiation of antithrombotic therapy, and indication for antithrombotic therapy.","PeriodicalId":512452,"journal":{"name":"TH Open","volume":"33 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139885507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticoagulation Stewardship to Bridge the Implementation Gap in Perioperative Anticoagulation Management","authors":"Alfonso Tafur, Geoffrey D. Barnes, V. Bhagirath, James Douketis","doi":"10.1055/a-2259-0911","DOIUrl":"https://doi.org/10.1055/a-2259-0911","url":null,"abstract":"Lack of alignment of care protocols among providers in healthcare is a driver of increased costs and suboptimal patient outcomes. Perioperative anticoagulation management is a good example of a complex area where protocol creation is a clinical challenge that demands input of multiple experts. Questions regarding the need for anticoagulation interruptions are frequent. Yet, due to layers of complexity involving analysis of anticoagulation indication, surgical risk, and anesthesia-associated bleeding risk as well as institutional practices, there is heterogeneity in how these interruptions are approached. The recent perioperative anticoagulation guidelines from the American College of Chest Physicians summarize extensive evidence for the management of anticoagulant and antiplatelet medications in patients who undergo elective interventions. However, implementation of these guidelines by individual clinicians is highly varied and often does not follow the best available clinical evidence. Against this background, anticoagulation stewardship units, which exist to improve safety and quality monitoring for the anticoagulated patient, are of growing interest. These units provide a bridge for implementation of value-based, high quality guidelines for patients who need perioperative anticoagulation interruption. We use a case to pragmatically illustrate the problem and tactics for change management and implementation science that may facilitate adoption of perioperative anticoagulation guidelines.","PeriodicalId":512452,"journal":{"name":"TH Open","volume":"106 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139889082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of the Integrated Simulation Model of the Intracellular, Transmembrane, and Extracellular Domain of Integrin αIIbβ3","authors":"Masamitsu Nakayama, Shinichi Goto, Shinya Goto","doi":"10.1055/a-2247-9438","DOIUrl":"https://doi.org/10.1055/a-2247-9438","url":null,"abstract":"The structure and functions of the extracellular domain of platelet Integrin αIIbβ3 (platelet membrane glycoprotein: GPIIb-IIIa) change substantially upon platelet activation. However, the stability of the integrated model of extracellular/transmembrane/intracellular domains of integrin αIIbβ3 with inactive state of extracellular domain has not been clarified. \u0000 The integrated model of Integrin αIIbβ3 was developed by combining the extracellular domain adopted from crystal structure and the transmembrane and intracellular domain obtained by NMR. The trans-membrane domain was settled into the phosphatidylcholine (POPC) lipid bilayer model. The position coordinates and velocity vectors of all atoms and water molecules around them were calculated by molecular dynamic simulation with the use of CHARMM (Chemistry at HARvard Macromolecular Mechanics) force field in every 2 x 10-15 sec. \u0000The root-mean-square deviations (RMSDs) of atoms constructing the integrated αIIbβ3 model apparently stabilized at approximately after 200 ns of calculation. However, minor fluctuation persisted during the entire calculation period of 650 ns. The RMSD of both αIIbβ3 showed similar trends before 200 ns. The RMSD of β3 3 apparently stabilized approximately at 400 ns with persisting minor fluctuation afterward while the structural fluctuation in αIIb persisted throughout the 650 ns calculation period.\u0000In conclusion, the integrated model of the intra-cellular, trans-membrane, and extra-cellular domain of integrin αIIb suggested persisting fluctuation even after convergence of molecular dynamic calculation.","PeriodicalId":512452,"journal":{"name":"TH Open","volume":"11 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139527103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}