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Impact of Thrombophilia Testing on Clinical Management: A Retrospective Cohort Study.
IF 2.7 4区 医学
Hamostaseologie Pub Date : 2024-12-10 DOI: 10.1055/a-2447-5522
Hannah L McRae, Jens Müller, Heiko Rühl, Bernd Pötzsch
{"title":"Impact of Thrombophilia Testing on Clinical Management: A Retrospective Cohort Study.","authors":"Hannah L McRae, Jens Müller, Heiko Rühl, Bernd Pötzsch","doi":"10.1055/a-2447-5522","DOIUrl":"https://doi.org/10.1055/a-2447-5522","url":null,"abstract":"<p><p>Thrombophilia management is based on the personal and family history of thrombosis. Current guidelines recommend performing thrombophilia testing only when the results will change clinical management. To investigate to what extent treatment recommendations changed following thrombophilia testing, clinical and laboratory data of 255 patients with and without venous thromboembolism who underwent thrombophilia screening were assessed retrospectively. A local score based on clinical indicators for thrombophilia was used to assess the pretest probability of thrombophilia. A total of 144 patients (57.6%) were found to have a clear thrombophilic phenotype, of which 78 were predicted to have definite thrombophilia and considered for indefinite anticoagulation; 66 were likely to have thrombophilia and were considered for indefinite or prolonged anticoagulation. Eighty-three (32.5%) could not be clearly classified and 28 (11%) were asymptomatic. A thrombophilic risk factor was diagnosed in 98 (38.4%) patients; this included 64 of 144 (44.5%) patients with a clear thrombophilic phenotype and 26 of 83 (31.3%) patients who could not be easily classified. Treatment recommendations changed in 57 of 255 (22%) patients following thrombophilia testing. Eight patients were switched from direct oral anticoagulants to vitamin K antagonists due to confirmed triple-positive antiphospholipid syndrome. In 49 patients, the anticoagulant dose was either increased (<i>n</i> = 3) or treatment was prolonged (<i>n</i> = 46) following diagnosis of high-risk thrombophilia. Clinically, assessing thrombophilia probability score before thrombophilia testing improves thrombophilia management recommendations.</p>","PeriodicalId":55074,"journal":{"name":"Hamostaseologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Update on Cancer-Associated Venous Thromboembolism in Children.
IF 2.7 4区 医学
Hamostaseologie Pub Date : 2024-12-10 DOI: 10.1055/a-2407-7914
Rahel Kasteler, Manuela Albisetti, Alessandra Bosch
{"title":"Update on Cancer-Associated Venous Thromboembolism in Children.","authors":"Rahel Kasteler, Manuela Albisetti, Alessandra Bosch","doi":"10.1055/a-2407-7914","DOIUrl":"https://doi.org/10.1055/a-2407-7914","url":null,"abstract":"<p><p>Children with cancer have an increased risk for venous thromboembolic events (VTEs) compared to the healthy pediatric population. VTE rates in children with cancer vary among cancer types. Other VTE risk factors include central venous catheters and cancer therapies. VTE diagnosis relies on objective radiological imaging, and management to this date typically involves anticoagulant therapy. Low-molecular-weight heparins (LMWHs) are the most common choice. Evidence for primary VTE prevention is conflicting, and antithrombin replacement, LMWH, or apixaban have been studied. Recently, direct oral anticoagulants such as rivaroxaban or dabigatran were investigated for VTE treatment, showing promise in efficacy and safety. However, bleeding risks in this population need careful consideration, especially periprocedurally or with treatment-related thrombocytopenia. Prediction tools for VTE require adaptation for pediatric cancer patients. Progress in understanding and managing VTE in children with cancer is significant, with ongoing trials and real-world data contributing to improved strategies.</p>","PeriodicalId":55074,"journal":{"name":"Hamostaseologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Leitlinie der Gesellschaft für Thrombose- und Hämostaseforschung (GTH) zur Struktur- und Prozessqualität von Hämophilie-Zentren.
IF 2.7 4区 医学
Hamostaseologie Pub Date : 2024-12-04 DOI: 10.1055/a-2410-8557
H Eichler, M Albisetti, S Halimeh, R Knöfler, C Königs, F Langer, W Miesbach, J Oldenburg, U Scholz, W Streif, R Klamroth
{"title":"Leitlinie der Gesellschaft für Thrombose- und Hämostaseforschung (GTH) zur Struktur- und Prozessqualität von Hämophilie-Zentren.","authors":"H Eichler, M Albisetti, S Halimeh, R Knöfler, C Königs, F Langer, W Miesbach, J Oldenburg, U Scholz, W Streif, R Klamroth","doi":"10.1055/a-2410-8557","DOIUrl":"https://doi.org/10.1055/a-2410-8557","url":null,"abstract":"<p><p>Since the 1970s, specialized hemophilia centers have been established to optimize the complex and costly treatment of patients with severe bleeding disorders. In 2019, the first GTH guidelines on the structural and process quality of hemophilia centers were published. On this basis, a procedure for the certification of hemophilia centers has been established under the technical leadership of the GTH. These GTH guidelines are essentially based on the European Guidelines for the Certification of Haemophilia Centers published in 2013, created by the European Haemophilia Network (EUHANET). In 2023, this European guideline was revised by the EAHAD Accreditation and Audit of Haemophilia Centers Working Group. On this background, the GTH guidelines have now been revised to take relevant updates to the European guidelines into account.</p>","PeriodicalId":55074,"journal":{"name":"Hamostaseologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Challenging Situations in the Treatment of Cancer-Associated Thrombosis.
IF 2.7 4区 医学
Hamostaseologie Pub Date : 2024-12-04 DOI: 10.1055/a-2431-6818
Ekaterina Balaian, Sandra Marten, Jan Beyer-Westendorf, Karolin Trautmann-Grill
{"title":"Challenging Situations in the Treatment of Cancer-Associated Thrombosis.","authors":"Ekaterina Balaian, Sandra Marten, Jan Beyer-Westendorf, Karolin Trautmann-Grill","doi":"10.1055/a-2431-6818","DOIUrl":"https://doi.org/10.1055/a-2431-6818","url":null,"abstract":"<p><p>Cancer-associated thrombosis (CAT) is a common clinical problem in the treatment of cancer patients posing some unique challenges. These include the need to balance between the risk of recurrent thromboembolic events and bleeding complications in the individual cancer patient. A frequently encountered dilemma is the need for long-term anticoagulation in the setting of active malignancy. Until now, optimal duration, intensity, and type of anticoagulation in cancer patients remain an area of ongoing debate. In this case-based review, we present several challenging clinical scenarios and provide guidance on management. For optimal treatment results, CAT generally requires a multidisciplinary approach including specialists for thrombosis and hemostasis as well as hematology and oncology. Individual patient preferences should always be taken into account, especially in clinical situations with weak treatment evidence.</p>","PeriodicalId":55074,"journal":{"name":"Hamostaseologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Emicizumab for the Treatment of Acquired Hemophilia A: Consensus Recommendations from the GTH-AHA Working Group. Emicizumab治疗获得性血友病A: GTH-AHA工作组的共识建议
IF 2.7 4区 医学
Hamostaseologie Pub Date : 2024-12-01 Epub Date: 2023-12-04 DOI: 10.1055/a-2197-9738
Christian Pfrepper, Robert Klamroth, Johannes Oldenburg, Katharina Holstein, Hermann Eichler, Christina Hart, Patrick Moehnle, Kristina Schilling, Karolin Trautmann-Grill, Mohammed Alrifai, Cihan Ay, Wolfgang Miesbach, Paul Knoebl, Andreas Tiede
{"title":"Emicizumab for the Treatment of Acquired Hemophilia A: Consensus Recommendations from the GTH-AHA Working Group.","authors":"Christian Pfrepper, Robert Klamroth, Johannes Oldenburg, Katharina Holstein, Hermann Eichler, Christina Hart, Patrick Moehnle, Kristina Schilling, Karolin Trautmann-Grill, Mohammed Alrifai, Cihan Ay, Wolfgang Miesbach, Paul Knoebl, Andreas Tiede","doi":"10.1055/a-2197-9738","DOIUrl":"10.1055/a-2197-9738","url":null,"abstract":"<p><strong>Background: </strong> Acquired hemophilia A (AHA) is a severe bleeding disorder caused by autoantibodies against coagulation factor VIII (FVIII). Standard treatment consists of bleeding control with bypassing agents and immunosuppressive therapy. Emicizumab is a bispecific antibody that mimics the function of activated FVIII irrespective of the presence of neutralizing antibodies. Recently, the GTH-AHA-EMI study demonstrated that emicizumab prevents bleeds and allows to postpone immunosuppression, which may influence future treatment strategies.</p><p><strong>Aim: </strong> To provide clinical practice recommendations on the use of emicizumab in AHA.</p><p><strong>Methods: </strong> A Delphi procedure was conducted among 33 experts from 16 German and Austrian hemophilia care centers. Statements were scored on a scale of 1 to 9, and agreement was defined as a score of ≥7. Consensus was defined as ≥75% agreement among participants, and strong consensus as ≥95% agreement.</p><p><strong>Results: </strong> Strong consensus was reached that emicizumab is effective for bleed prophylaxis and should be considered from the time of diagnosis (100% consensus). A fast-loading regimen of 6 mg/kg on day 1 and 3 mg/kg on day 2 should be used if rapid bleeding prophylaxis is required (94%). Maintenance doses of 1.5 mg/kg once weekly should be given (91%). Immunosuppression should be offered to patients on emicizumab if they are eligible based on physical status (97%). Emicizumab should be discontinued when remission of AHA is achieved (97%).</p><p><strong>Conclusion: </strong> These GTH consensus recommendations provide guidance to physicians on the use of emicizumab in AHA and follow the results of clinical trials that have shown emicizumab is effective in preventing bleeding in AHA.</p>","PeriodicalId":55074,"journal":{"name":"Hamostaseologie","volume":" ","pages":"466-471"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138483537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Artificial Intelligence in Medicine: Are We Ready?
IF 2.7 4区 医学
Hamostaseologie Pub Date : 2024-12-01 Epub Date: 2024-12-10 DOI: 10.1055/a-2443-4130
Michael Nagler
{"title":"Artificial Intelligence in Medicine: Are We Ready?","authors":"Michael Nagler","doi":"10.1055/a-2443-4130","DOIUrl":"https://doi.org/10.1055/a-2443-4130","url":null,"abstract":"<p><p>In spite of my personal belief in the benefits of artificial intelligence (AI), reading Cathy O'Neil's book \"Weapons of Math Destruction\" left me feeling unsettled.1 She describes how flawed and unchecked algorithms are widely applied in areas that affect us all: hiring, credit scoring, access to education, and insurance pricing. In one example, a fixed percentage of teachers in a U.S. region was dismissed every year based on biased and opaque algorithms. The authors concluded that such algorithms act as \"weapons of math destruction,\" perpetuate and amplify societal biases, act unethically, and harm vulnerable populations. The question arises as to what happens when we apply these algorithms to medicine? How do we know whether we are giving our patients the correct diagnosis or prognosis? Are we still sure that patients are receiving the appropriate treatment? Would we notice if the algorithms were geared more toward the needs of companies (make a lot of money) or health insurance companies (spend as little as possible)? In fact, evidence of bias and inequality of algorithms in medicine is already available.2 Due to these risks, some of my colleagues suggest that AI should be completely banned from medicine.</p>","PeriodicalId":55074,"journal":{"name":"Hamostaseologie","volume":"44 6","pages":"422-424"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Aktueller Stand zur Reform der Gebührenordnung für Ärzte (GOÄ).
IF 2.7 4区 医学
Hamostaseologie Pub Date : 2024-12-01 Epub Date: 2024-12-10 DOI: 10.1055/a-2352-2807
Günther Kappert, Jürgen Koscielny, Christoph Sucker
{"title":"Aktueller Stand zur Reform der Gebührenordnung für Ärzte (GOÄ).","authors":"Günther Kappert, Jürgen Koscielny, Christoph Sucker","doi":"10.1055/a-2352-2807","DOIUrl":"https://doi.org/10.1055/a-2352-2807","url":null,"abstract":"","PeriodicalId":55074,"journal":{"name":"Hamostaseologie","volume":"44 6","pages":"481-482"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Machine-Learning Applications in Thrombosis and Hemostasis. 血栓与止血中的机器学习应用。
IF 2.7 4区 医学
Hamostaseologie Pub Date : 2024-12-01 Epub Date: 2024-11-05 DOI: 10.1055/a-2407-7994
Henning Nilius, Michael Nagler
{"title":"Machine-Learning Applications in Thrombosis and Hemostasis.","authors":"Henning Nilius, Michael Nagler","doi":"10.1055/a-2407-7994","DOIUrl":"10.1055/a-2407-7994","url":null,"abstract":"<p><p>The use of machine-learning (ML) algorithms in medicine has sparked a heated discussion. It is considered one of the most disruptive general-purpose technologies in decades. It has already permeated many areas of our daily lives and produced applications that we can no longer do without, such as navigation apps or translation software. However, many people are still unsure if ML algorithms should be used in medicine in their current form. Doctors are doubtful to what extent they can trust the predictions of algorithms. Shortcomings in development and unclear regulatory oversight can lead to bias, inequality, applicability concerns, and nontransparent assessments. Past mistakes, however, have led to a better understanding of what is needed to develop effective models for clinical use. Physicians and clinical researchers must participate in all development phases and understand their pitfalls. In this review, we explain the basic concepts of ML, present examples in the field of thrombosis and hemostasis, discuss common pitfalls, and present a methodological framework that can be used to develop effective algorithms.</p>","PeriodicalId":55074,"journal":{"name":"Hamostaseologie","volume":" ","pages":"459-465"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Die Gesellschaft für Thrombose- und Hämostaseforschung e.V. informiert.
IF 2.7 4区 医学
Hamostaseologie Pub Date : 2024-12-01 Epub Date: 2024-12-10 DOI: 10.1055/s-0044-1800983
{"title":"Die Gesellschaft für Thrombose- und Hämostaseforschung e.V. informiert.","authors":"","doi":"10.1055/s-0044-1800983","DOIUrl":"https://doi.org/10.1055/s-0044-1800983","url":null,"abstract":"","PeriodicalId":55074,"journal":{"name":"Hamostaseologie","volume":"44 6","pages":"478-479"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Erhöhte Thrombozytenaktivierung bei zirrhotischen Patienten mit Pfortaderthrombose.
IF 2.7 4区 医学
Hamostaseologie Pub Date : 2024-12-01 Epub Date: 2024-12-10 DOI: 10.1055/s-0044-1800986
{"title":"Erhöhte Thrombozytenaktivierung bei zirrhotischen Patienten mit Pfortaderthrombose.","authors":"","doi":"10.1055/s-0044-1800986","DOIUrl":"https://doi.org/10.1055/s-0044-1800986","url":null,"abstract":"","PeriodicalId":55074,"journal":{"name":"Hamostaseologie","volume":"44 6","pages":"427"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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