Clinical and Applied Thrombosis/Hemostasis最新文献

BackgroundMethods for measuring activated clotting time (ACT) are not yet standardized.ObjectivesTo adjust and compare values between two measurement systems and to optimize ACT during atrial fibrillation (AF) ablation.MethodsTwo systems were compared: electromagnetic detection using a rotating tube (EM system; Hemochron Response) and photo-optical detection using a cartridge immersed in blood (PO system; ACT CA-300TM).ResultsACT was measured simultaneously in 124 instances in 53 patients before and during AF ablations using both methods. A linear regression analysis showed ACT (EM system) = 1.19 × ACT (PO system) + 9.03 (p < .001, r = 0.90). Bland-Altman plots indicated an average difference of 50 s between the two systems. In 3364 ACT measurements from 1161 ablations, the EM system recorded a mean ACT of 320 ± 44 s (range 156-487 s). Estimating the target range as mean ± 1 SD range, the EM system's range was 275-365 s, in 5-s increments. The pre-ablation ACT measured on the EM system was 143 ± 28 s (115-170 s). Cardiac tamponade occurred in 4 out of 2085 ablations (0.19%) over 5 years, with ACT values ranging from 330 to 391 s on the EM system. Based on these findings, the estimated optimal ACT range for the PO system was adjusted to 225-300 s to align with the EM system's range of 275-365 s.ConclusionsACT target ranges should be system-specific, and direct extrapolation between devices is not recommended. Adjustment is clinically necessary when switching systems.

Background and objective: Direct oral anticoagulants (DOACs) have been proven to be cost-effective for treating various conditions, including venous thromboembolism (VTE). Nevertheless, there are no studies assessing the cost-effectiveness of DOACs for VTE treatment in Saudi Arabia using real-world data. Hence, this study seeks to examine the costs and medical consequences of apixaban compared to rivaroxaban in treating VTE patients in Saudi Arabia.

Methods: A retrospective cohort study was carried out in three tertiary care hospitals spanning from January 2016 to December 2020. The measure of effectiveness is defined as the likelihood of preventing the composite of VTE recurrence (rVTE), major bleeding (MB), or clinically relevant non-major bleeding (CRNMB) within 90 days of the indexed VTE event, and rehospitalization due to rVTE, MB, or CRNMB. The effectiveness was determined by calculating 1 minus the probability of experiencing the composite outcome. The incremental cost-effectiveness ratio (ICER) was computed from the perspective of the Saudi National Health System, therefore only direct costs were considered. The 95% confidence interval surrounding mean costs and effectiveness rates was calculated using the bootstrapping method. Sensitivity analyses were also carried out.

Results: In the analysis, 367 patients were included, with 176 on apixaban and 191 on rivaroxaban. The average annual medication costs for apixaban and rivaroxaban were $547.05 and $577.77, respectively. The mean annual direct medical costs for apixaban and rivaroxaban were $6496.83 (95%CI 5748.86-7457.97) and $5528.58 (95%CI 4836.21-6024.52), respectively. Apixaban's and rivaroxaban's mean effectiveness rates were 0.91 (95%CI 0.87-0.96) and 0.77 (95%CI 0.71-0.83), respectively. This resulted in an ICER of $6916.07 for the prevention of an additional composite outcome when using apixaban instead of rivaroxaban. The use of apixaban for preventing composite outcomes has been found to be more effective but costlier in 94.81% of the bootstrap cost-effectiveness distributions compared to rivaroxaban. It was also found to be more effective and less costly in 5.19% of the bootstrap cost-effectiveness distributions.

Conclusion: Apixaban demonstrated superiority over rivaroxaban in preventing composite outcomes, encompassing rVTE, MB, CRNMB, and rehospitalization. Nevertheless, this was correlated with increased direct medical expenses. These findings emphasize the necessity of a well-rounded approach when choosing anticoagulants, considering both clinical effectiveness and economic considerations. This study's results are impactful for improving patient care and resource allocation, underscoring the pivotal role of cost-effectiveness in healthcare decision-making.

IntroductionStudy aimed to determine the occurrence of 5 thrombosis-related single-nucleotide polymorphisms (SNPs) in patients with venous thromboembolism (VTE) (n = 2630) and a control group (n = 2637) in the Czech population.MethodsThe following gene SNPs were detected in both groups: F5 Leiden (rs6025), F2 (rs1799963), FGG, fibrinogen gamma' (rs2066865), F11 (rs2289252) and ABO (rs8176719). Statistical analysis was performed using SAS statistical software with population genetics tools.ResultsHeterozygotes for F5 Leiden were associated with a 5.58-fold and homozygotes F5 Leiden with a 33.46-fold increased risk of VTE. At SNP rs1799963 (F2, prothrombin), only heterozygotes had a significant 3.9-fold increased risk of VTE. The findings at SNP rs2066865 (fibrinogen gamma', FGG) showed a 1.37-fold increased risk of VTE for FGG heterozygotes and a 1.77-fold increased risk of VTE for FGG homozygotes. There is also a significant 1.42-fold increase risk of VTE in the heterozygotes and a 1.80-fold increase risk of VTE in the homozygotes of the SNP rs 2289252 (F11). Further higher increases in the risk of VTE in both variants were found in patients with VTE at rs8176719 (ABO, non-O). It corresponds to a 2.2-fold increase in the risk of VTE in heterozygotes and a 3.5-fold increase in the risk of VTE in homozygotes.ConclusionBesides F5 Leiden and prothrombin mutation, the study suggests that the gene polymorphisms of FGG (rs2066865), F11 (rs2289252) and ABO (rs8176719) play a role as an independent heritable risk factor for VTE in the Czech population.

Background: Prognostic nutritional index (PNI) has recently been identified as a novel marker of nutritional status. However, existing evidences on the association between PNI and the risk of lower extremity deep venous thrombosis (LEDVT) are limited and conflicting.

Objective: To determine the association between PNI and the risk of LEDVT, and further evaluate its diagnostic value.

Methods: Over a 10-year period (2012-2022), a total of 12790 patients who underwent compression ultrasonography examinations were consecutively included, and 1519 (11.9%) LEDVT events occurred. Multivariate logistic regression analysis was used to investigate the association, and receiver operating characteristic (ROC) curve was constructed to evaluate its diagnostic performance.

Results: After full adjustment, patients in third quartile (odds ratio [OR] = 1.486, 95% confidence interval [CI]: 1.205-1.832), second quartile (OR = 2.436, 95% CI: 1.993-2.978) and first quartile (OR = 3.422, 95% CI: 2.791-4.195) of PNI were at higher risk of LEDVT compared with those in fourth quartile, and the test for trend was significant. Consistently, each unit decrease in PNI was associated with a 6.0 % (95% CI: 1.052-1.069) increased risk of LEDVT. Moreover, adding PNI to a base model improved the area under the curve (AUC) from 0.721 (95% CI: 0.709-0.734) to 0.746 (95% CI: 0.734-0.758).

Conclusion: PNI is inversely associated with the risk of LEDVT, and provides significant incremental diagnostic value for the identification of LEDVT events. These findings suggest that PNI may be a potential biomarker to help clinicians identify patients at risk of thrombosis and make clinical decisions timely.

Background: this study aimed to investigate the efficacy of recombinant human thrombopoietin (rhTPO) in the treatment of sepsis-associated thrombocytopenia, and to evaluate its impact on coagulation function, inflammatory markers, platelet (Plt) count, and patient prognosis.

Methods: a total of 144 patients with sepsis-associated thrombocytopenia, admitted to our hospital between 2022 and 2023, were selected for the study. The patients were randomly divided into two groups using a random number table: the control group (Group C, n = 72) and the research group (Group R, n = 72). The Group C received standard treatment, while the Group R received rhTPO in addition to standard care. We compared the general demographic data, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, coagulation parameters, serum levels of Toll-like receptor 4 (TLR4), interleukin-6 (IL-6), serum creatinine (SCr), tumor necrosis factor-alpha (TNF-α), Plt count, transfusion volume, treatment duration, incidence of complications, and mortality rates between the two groups.

Results: there were no significant differences in the general demographic characteristics between the two groups (P > 0.05). After treatment, the APACHE II scores in both groups significantly decreased, with a more pronounced reduction observed in the Group R. Coagulation function indicators, including activated partial thromboplastin time (APTT), fibrinogen (FIB), plasminogen activator inhibitor-1 (PAI-1), antithrombin III (AT-III), protein C, thrombomodulin (TM), and Plt factor 4 (PF4), showed greater improvement in the Group R compared to the Group C (P < 0.05). The serum levels of TLR4, IL-6, and TNF-α in the Group R were significantly lower than those in the Group C (P < 0.05), whereas no significant difference in SCr levels was observed between the groups (P > 0.05). The Plt count in the Group R began to significantly increase on day 3 of treatment, and was consistently higher than that in the Group C on days 3, 5, and 7 (P < 0.05). The Group R required significantly fewer red blood cell transfusions compared to the Group C and did not require Plt suspension (P < 0.05). No significant differences were found between the groups in terms of mechanical ventilation time, intensive care unit (ICU) length of stay, and total hospital stay (P > 0.05). However, the ICU and overall hospital mortality rates were significantly lower in the Group R than in the Group C (P < 0.05). Multivariate logistic regression analysis indicated that rhTPO treatment was an independent protective factor for reducing mortality (OR = 0.475, P = 0.042).

Conclusion: rhTPO treatment effectively improves coagulation function and inflammatory status in patients with sepsis-associated thrombocytopenia, increases Plt count, reduces transfusion requirements, and lowers mortal

Purpose: The aim of this study is to compare the efficacy and safety of both agents in patients with acute STEMI.

Methods: This was a multicenter retrospective observational study comparing tenecteplase and reteplase in patients with acute STEMI. The primary outcome was the incidence of failed thrombolysis. Secondary outcomes included the incidence of major bleeding, cardiogenic shock, re-infarction and mortality.

Results: A total of 282 patients were included, 229 and 53 received tenecteplase and reteplase, respectively. The incidence of failed thrombolysis was 33.2% in the tenecteplase group compared to 20.8% in the reteplase group (adjusted odds ratio 0.53, 95% confidence interval 0.25-1.1; p = 0.089). The incidence of major bleeding was 0.9% in the tenecteplase group and 5.7% in the reteplase group (p = 0.017). There was no significant difference in mortality or other secondary outcomes.

Conclusion: There was no difference in the primary outcome of failed thrombolysis between tenecteplase and reteplase; however, major bleeding events were significantly higher in the reteplase group. Randomized controlled trials are needed to confirm our findings.

Objectives: Multiple myeloma (MM) is a hematologic malignancy comprising approximately 10% of all blood cancers. Patients with MM are at risk for disseminated intravascular coagulation (DIC), a serious complication characterized by systemic coagulation activation, leading to microthrombi, organ dysfunction, and severe bleeding. This study aims to investigate the incidence of DIC among MM patients and identify risk factors associated with DIC development. We also sought to develop a predictive formula for assessing DIC risk.

Methods: A retrospective analysis was conducted on MM patients. Logistic regression analysis was used to identify factors significantly associated with DIC. The predictive power of the logistic regression model was evaluated using receiver operating characteristic (ROC) curve analysis.

Results: The incidence of DIC among hospitalized MM patients was 16.8%. Significant factors identified by logistic regression analysis included prothrombin time (PT), fibrin degradation products (FDP), and D-dimer levels. ROC curve analysis indicated that the predictive model had strong discriminatory power, with an area under the curve (AUC) of 0.927. A predictive formula for the probability of DIC occurrence was developed based on the logistic regression model.

Conclusions: The predictive formula developed in this study offers a tool for early identification of MM patients at high risk of DIC. While the model demonstrates strong predictive capability, further validation and refinement are required to improve its accuracy and clinical application.

Clopidogrel is usually discontinued 5-7 days before elective surgery to reduce the risk of bleeding. However, the perioperative safety of patients receiving low-molecular-weight heparin (LMWH) bridging therapy or continuing clopidogrel therapy remains unknown. We identified patients who received clopidogrel for cardiovascular diseases and underwent elective surgery at a large central hospital in China between June 2022 and January 2024. The primary endpoints were perioperative blood transfusion events and bleeding-related reoperations. A total of 62 patients who received clopidogrel and underwent abdominal surgery were included in this study. Based on the preoperative clopidogrel therapy strategy, patients were categorised into three groups: the LMWH bridging group (clopidogrel withdrawal followed by LMWH bridging therapy for 5-7 days; n = 22), the no-bridging group (clopidogrel withdrawal for 5-7 days; n = 26), and the continued group (clopidogrel therapy maintained; n = 24). Perioperative blood transfusion rates were higher in the LMWH bridging and continued groups. However, there was not a significant distinction (P = .197). Additionally, hospital stay length, bleeding-related reoperation, and 3-month mortality were similar across the groups (P > .05). No patients experienced myocardial infarction or stroke within 3 months post-procedure. Patients who received preoperative LMWH bridging therapy or continued clopidogrel therapy had a slightly higher risk of perioperative bleeding. These findings need to be confirmed by further randomised controlled trials.

Acute ischemic stroke (AIS) is a leading cause of mortality and disability worldwide. Recombinant human prourokinase (rhPro-UK) has emerged as a promising thrombolytic agent amid the global shortage of thrombolytics. We assessed the safety and efficacy of rhPro-UK in AIS patients within 4.5 h of stroke onset through a systematic review and meta-analysis of RCTs from PubMed, Web of Science, Scopus, and Cochrane until January 2024. Data were pooled using risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI) in R version 4.3. PROSPERO ID: CRD42025638980. Three RCTs (2289 patients) were included. rhPro-UK showed comparable efficacy to recombinant tissue plasminogen activator (r-tPA) in excellent neurological recovery (mRS 0-1: RR 1.04, 95% CI [0.98, 1.10], P = 0.19) and functional independence (mRS 0-2: RR 1.00, 95% CI [0.96, 1.05], P = 0.87). However, rhPro-UK significantly reduced NIHSS scores at 24 h (MD -0.43, 95% CI [-0.85, -0.02], P = 0.04) and seven days (MD -0.85, 95% CI [-1.39, -0.30], P < 0.01), and decreased systemic bleeding (RR 0.60, 95% CI [0.49, 0.75], P < 0.01). No significant differences were observed in 90-day mortality (RR 1.13, 95% CI [0.62, 2.05], P = 0.69) or intracerebral hemorrhage (RR 0.83, 95% CI [0.61, 1.13], P = 0.23). rhPro-UK demonstrates comparable efficacy to r-tPA with reduced NIHSS scores and systemic bleeding, supporting its role as a cost-effective and safer alternative for AIS treatment within 4.5 h. Further investigation in stroke management protocols is warranted.

Surgery of gynecologic malignancies often increases the incidence of Venous thromboembolism (VTE). TAT, TM, PIC, t-PAIC are considered to be potential monitoring significance for the change of coagulation and fibrinolytic balance with gynecological malignant tumors. We aimed to explore TAT, PIC, TM, t-PAIC as diagnostic and predictive new marker of postoperative VTE for patients undergoing surgery of gynecologic malignancies and evaluate its related high-risk factors. 103 cases of gynecological surgery were selected. The malignant tumor patients were divided into VTE and non-VTE group. All patients were detected by chemiluminescence immunoassay for TAT, TM, PIC and t-PAIC before and d1, d3 after operation. One month after surgery, the incidence rate of deep vein thrombosis(DVT) in malignant tumor group was 10.20%. Before operation, PIC, t-PAIC levels in malignant tumor group were significantly higher than those in benign tumor group (P = .025, P = .030). D3 after operation, TAT, TM, PIC and t-PAIC levels in malignant tumor group were significantly higher than those in benign tumor group (P < .0001, P = .036, P = .037, P < .0001). PIC level of the VTE group was significantly higher than that of the non-VTE group in malignant patients (P < .0001). Logistics regression analysis showed that pre-PIC and post-PIC were independent factors of VTE. The AUC of pre-PIC and post-PIC were 0.95, 0.941, with a sensitivity of 100%, 100% and a specificity of 86.4%, 88.6%. As a new predictive biomarker for VTE after the gynecologic malignant surgery, pre-PIC and post-PIC levels are the independent risk factors of DVT and has accurate diagnostic value.