Research and Practice in Thrombosis and Haemostasis最新文献

英文中文

Reported particles are not blood clots, so anticoagulant drugs are not a plausible treatment 报告的微粒不是血凝块，因此抗凝药物不是一种合理的治疗方法

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis

Pub Date : 2024-10-01 DOI: 10.1016/j.rpth.2024.102598

Tilly Fox , Beverley Hunt , Alan Carson , Katie Scandrett , George Davey Smith , Paul Garner , Rebecca Kuehn

引用次数: 0

Mathematical modeling identifies clotting factor combinations that modify thrombin generation in normal and factor VIII-, IX-, or XI-deficient blood 数学建模确定可改变正常血液和因子 VIII、IX 或 XI 缺乏血液中凝血酶生成的凝血因子组合

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis

Pub Date : 2024-10-01 DOI: 10.1016/j.rpth.2024.102570

Michael T. Stobb , Keith B. Neeves , Dougald M. Monroe , Suzanne S. Sindi , Karin Leiderman , Aaron L. Fogelson

Background

In healthy individuals, plasma levels of clotting proteins naturally vary within a range of 50% to 150% of their mean values. We do not know how these variations modify thrombin generation.

Objectives

To assess the impact of protein level variations on simulated thrombin generation in normal and factor (F)VIII-, FIX-, or FXI-deficient blood.

Methods

We used a mathematical model of flow-mediated coagulation to simulate thrombin generation with all possible combinations of clotting protein variations within the normal range and for various tissue factor levels. We selected, analyzed, and ranked combinations that enhanced thrombin generation compared with baseline.

Results

Protein variations most strongly affected thrombin generation at intermediate tissue factor levels. Low tissue factor levels prevented coagulation initiation, while high tissue factor levels always triggered thrombin generation. At intermediate levels, we identified protein variations that substantially modified thrombin generation. Low-normal FV shortened lag times and increased thrombin generation, whereas high-normal FV lengthened lag times and reduced thrombin generation. With severe FVIII and FIX deficiencies, low-normal tissue factor pathway inhibitor α and antithrombin amplified the effect of low-normal FV. For moderate FVIII and FIX deficiencies, high-normal tissue factor pathway inhibitor α and antithrombin enhanced the impact of high-normal FV in reducing thrombin production. In normal and FXI-deficient blood, high-normal FVIII and FIX significantly boosted thrombin generation.

Conclusion

Our mathematical model predicted how variations in clotting protein levels, within the normal range, could contribute to the variability of bleeding phenotypes observed with clotting factor deficiencies. Our study generated experimentally testable hypotheses that could aid in developing new therapies toward normal hemostasis.

背景在健康人体内，凝血蛋白的血浆水平自然会在其平均值的50%至150%范围内变化。我们使用流动介导凝血的数学模型来模拟凝血酶的生成，其中包括正常范围内凝血蛋白变化的所有可能组合以及各种组织因子水平的变化。我们选择、分析了与基线相比能增强凝血酶生成的组合，并对其进行了排序。结果在中等组织因子水平时，蛋白变化对凝血酶生成的影响最大。低组织因子水平阻止了凝血的开始，而高组织因子水平则总是触发凝血酶的生成。在中等水平时，我们发现蛋白质变异会显著改变凝血酶的生成。低正常 FV 缩短了滞后时间并增加了凝血酶的生成，而高正常 FV 则延长了滞后时间并减少了凝血酶的生成。在 FVIII 和 FIX 严重缺乏的情况下，低正常值的组织因子通路抑制剂 α 和抗凝血酶会放大低正常值 FV 的效应。对于中度 FVIII 和 FIX 缺乏症，高正常组织因子途径抑制剂 α 和抗凝血酶增强了高正常 FV 在减少凝血酶生成方面的作用。结论我们的数学模型预测了凝血蛋白水平在正常范围内的变化如何导致凝血因子缺乏症出血表型的变化。我们的研究提出了可通过实验验证的假设，这些假设有助于开发新的疗法，以实现正常止血。

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引用次数: 0

Fibrinaloid microclots in long COVID: assessing the actual evidence properly 长 COVID 中的纤维蛋白微凝块：正确评估实际证据

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis

Pub Date : 2024-10-01 DOI: 10.1016/j.rpth.2024.102566

Douglas B. Kell , M. Asad Khan , Etheresia Pretorius

引用次数: 0

Loss of endogenous Nox2-NADPH oxidase does not prevent age-induced platelet activation and arterial thrombosis in mice 内源性 Nox2-NADPH 氧化酶的缺失并不能防止小鼠因年龄增长而引起的血小板活化和动脉血栓形成

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis

Pub Date : 2024-10-01 DOI: 10.1016/j.rpth.2024.102597

Azaj Ahmed , Gokul Patil , Vijay K. Sonkar , Melissa Jensen , Jennifer Streeter , Sanjana Dayal

Background

Reactive oxygen species are known to contribute to platelet hyperactivation and thrombosis during aging; however, the mechanistic contribution of the specific oxidative pathway remains elusive.

Objectives

We hypothesized that during aging, endogenous Nox2-NADPH oxidase contributes to platelet reactive oxygen species accumulation and that loss of Nox2 will protect from platelet activation and thrombosis.

Methods

We studied littermates of Nox2 knockout (Nox2-KO) and -wild-type (Nox2-WT) mice at young (3-4 months) and old (18-20 months) age. Within platelets, we examined the expression of subunits of NADPH oxidase and enzyme activity, oxidant levels, activation markers, aggregation, and secretion. We also assessed susceptibility to in vivo thrombosis in 2 experimental models.

Results

While aged Nox2-WT mice displayed increased mRNA levels for Nox2, aged Nox2-KO mice showed an increase in Nox4 mRNA. However, neither the protein levels of several subunits nor the activity of NADPH oxidase were found to be altered by age or genotype. Both aged Nox2-WT and aged Nox2-KO mice exhibited similar enhancement in levels of platelet oxidants, granule release, α_IIbβ₃ activation, annexin V binding, aggregation and secretion, and a greater susceptibility to platelet-induced pulmonary thrombosis compared with young mice. In a photochemical injury model, adoptive transfer of platelets from aged Nox2-WT or Nox2-KO mice to the aged host mice resulted in a similar time to develop occlusive thrombus in the carotid artery. These findings suggest that loss of endogenous Nox2 does not protect against age-related platelet activation and arterial thrombosis in mice.

Conclusion

We conclude that Nox2 is not an essential mediator of prothrombotic effects associated with aging.

背景众所周知，活性氧是衰老过程中血小板过度激活和血栓形成的原因之一；然而，特定氧化途径的机理作用仍然难以确定。方法我们研究了幼年（3-4 个月）和老年（18-20 个月）Nox2 基因敲除（Nox2-KO）小鼠和野生型（Nox2-WT）小鼠的同窝小鼠。在血小板内，我们检测了 NADPH 氧化酶亚基的表达和酶活性、氧化剂水平、活化标记物、聚集和分泌。我们还在两个实验模型中评估了体内血栓形成的易感性。结果虽然老龄 Nox2-WT 小鼠的 Nox2 mRNA 水平升高，但老龄 Nox2-KO 小鼠的 Nox4 mRNA 水平升高。然而，几个亚基的蛋白质水平和 NADPH 氧化酶的活性都没有因年龄或基因型而发生变化。与年轻小鼠相比，年老的 Nox2-WT 小鼠和年老的 Nox2-KO 小鼠在血小板氧化剂水平、颗粒释放、αⅡbβ3 激活、附件素 V 结合、聚集和分泌方面都表现出相似的增强，而且更容易发生血小板诱导的肺血栓形成。在光化学损伤模型中，将老龄 Nox2-WT 或 Nox2-KO 小鼠的血小板收养转移到老龄宿主小鼠体内，颈动脉形成闭塞性血栓的时间相似。这些研究结果表明，内源性 Nox2 的缺失并不能保护小鼠免受与年龄相关的血小板活化和动脉血栓形成的影响。

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引用次数: 0

Comorbidity and adverse events in acquired hemophilia A: data from the GTH-AHA-EMI study 获得性血友病 A 的合并症和不良事件：来自 GTH-AHA-EMI 研究的数据

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis

Pub Date : 2024-10-01 DOI: 10.1016/j.rpth.2024.102565

Christian Herbert Burgmann , Ulrich J. Sachs , Karolin Trautmann-Grill , Christian Pfrepper , Paul Knöbl , Richard Greil , Johannes Oldenburg , Wolfgang Miesbach , Katharina Holstein , Hermann Eichler , Patrick Möhnle , Matthias Höpting , Christiane Dobbelstein , Robert Klamroth , Andreas Tiede

Background

Persons with acquired hemophilia A are often older and suffer from comorbidity or frailty. Little is known about the impact on clinically relevant outcomes of acquired hemophilia A.

Objectives

To assess the relevance of age, physical performance status, comorbidity, and concomitant medication on the risk of bleeding and other outcomes.

Methods

Post hoc analysis of data from the GTH-AHA-EMI study that used emicizumab for bleed protection and withheld immunosuppressive treatment during the early phase of management. Primary endpoint was the rate of clinically relevant new bleeding (CRNB) during the first 12 weeks of emicizumab prophylaxis.

Results

Forty-seven patients were enrolled. Median age was 76 years; performance status (World Health Organization performance status [WHO-PS]) was 3 or worse in 41%; Charlson comorbidity index (CCI) was 5 or higher in 63%; antithrombotic drugs were reported in 34%. Rate of CRNB during 12 weeks of emicizumab prophylaxis was similar across subgroups of age, sex, WHO-PS, CCI, baseline factor VIII activity, and inhibitor titer. Patients with CRNB during the study had more severe anemia already at baseline. However, persistent severe anemia in week 4 was not related to risk of bleeding beyond this time. CRNB was associated with injury from falling in 7 of 14 patients. Adverse events grade 3 or higher were not related to baseline CCI or age but were more frequent in patients with poor WHO-PS.

Conclusion

Emicizumab provided bleed protection regardless of age and comorbidity. Clinical baseline characteristics did not predict breakthrough bleeding under emicizumab. Poor WHO-PS at baseline was associated with severe adverse events during the study.

背景后天性甲型血友病患者通常年龄较大，患有合并症或身体虚弱。方法对 GTH-AHA-EMI 研究的数据进行事后分析，该研究使用埃米珠单抗保护出血，并在早期管理阶段暂停免疫抑制治疗。主要终点是埃米珠单抗预防性治疗头12周内临床相关新出血率（CRNB）。中位年龄为76岁；41%的患者表现状态（世界卫生组织表现状态[WHO-PS]）为3级或更差；63%的患者夏尔森合并症指数（CCI）为5级或更高；34%的患者报告服用了抗血栓药物。不同年龄、性别、WHO-PS、CCI、基线因子 VIII 活性和抑制剂滴度的亚组在埃米珠单抗预防治疗 12 周期间的 CRNB 发生率相似。在研究期间出现 CRNB 的患者在基线时已经出现了较严重的贫血。然而，第 4 周的持续严重贫血与此后的出血风险无关。14 名患者中有 7 名患者的 CRNB 与摔伤有关。3级或更高的不良事件与基线CCI或年龄无关，但在WHO-PS较差的患者中更为常见。临床基线特征并不能预测埃米珠单抗的突破性出血。基线WHO-PS较差与研究期间的严重不良事件有关。

{"title":"Comorbidity and adverse events in acquired hemophilia A: data from the GTH-AHA-EMI study","authors":"Christian Herbert Burgmann , Ulrich J. Sachs , Karolin Trautmann-Grill , Christian Pfrepper , Paul Knöbl , Richard Greil , Johannes Oldenburg , Wolfgang Miesbach , Katharina Holstein , Hermann Eichler , Patrick Möhnle , Matthias Höpting , Christiane Dobbelstein , Robert Klamroth , Andreas Tiede","doi":"10.1016/j.rpth.2024.102565","DOIUrl":"10.1016/j.rpth.2024.102565","url":null,"abstract":"<div><h3>Background</h3><div>Persons with acquired hemophilia A are often older and suffer from comorbidity or frailty. Little is known about the impact on clinically relevant outcomes of acquired hemophilia A.</div></div><div><h3>Objectives</h3><div>To assess the relevance of age, physical performance status, comorbidity, and concomitant medication on the risk of bleeding and other outcomes.</div></div><div><h3>Methods</h3><div>Post hoc analysis of data from the GTH-AHA-EMI study that used emicizumab for bleed protection and withheld immunosuppressive treatment during the early phase of management. Primary endpoint was the rate of clinically relevant new bleeding (CRNB) during the first 12 weeks of emicizumab prophylaxis.</div></div><div><h3>Results</h3><div>Forty-seven patients were enrolled. Median age was 76 years; performance status (World Health Organization performance status [WHO-PS]) was 3 or worse in 41%; Charlson comorbidity index (CCI) was 5 or higher in 63%; antithrombotic drugs were reported in 34%. Rate of CRNB during 12 weeks of emicizumab prophylaxis was similar across subgroups of age, sex, WHO-PS, CCI, baseline factor VIII activity, and inhibitor titer. Patients with CRNB during the study had more severe anemia already at baseline. However, persistent severe anemia in week 4 was not related to risk of bleeding beyond this time. CRNB was associated with injury from falling in 7 of 14 patients. Adverse events grade 3 or higher were not related to baseline CCI or age but were more frequent in patients with poor WHO-PS.</div></div><div><h3>Conclusion</h3><div>Emicizumab provided bleed protection regardless of age and comorbidity. Clinical baseline characteristics did not predict breakthrough bleeding under emicizumab. Poor WHO-PS at baseline was associated with severe adverse events during the study.</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"8 7","pages":"Article 102565"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142419945","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}

引用次数: 0

Thrombin generation to evaluate the complex hemostatic balance of hemophilia A plasma containing direct oral anticoagulant and supplemented by factor VIII 生成凝血酶以评估含有直接口服抗凝剂和补充因子 VIII 的 A 型血友病血浆的复杂止血平衡情况

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis

Pub Date : 2024-10-01 DOI: 10.1016/j.rpth.2024.102576

Sylvain Lamoine , Vincent Jury , Virginie Fourneyron , Jonathan Douxfils , Dorian Teissandier , Laurie Talon , Thomas Sinegre , Aurélien Lebreton

Background

The incidence of cardiovascular diseases is increasing in persons with hemophilia A (HA). Therefore, anticoagulant therapy based on direct oral anticoagulants (DOACs) may be needed, despite the bleeding risk. In case of surgery or bleeding, such patients may be concomitantly treated with emicizumab (routine prophylaxis), factor (F)VIII products, and DOAC. Their concomitant presence constitutes a hemostatic challenge. Recent international guidelines stated that data are scarce on the hemostatic balance of plasma samples from patients with HA receiving emicizumab and DOAC.

Objectives

The aim of this observational study was to assess the coagulation of FVIII-deficient plasma spiked with DOAC and emicizumab and to evaluate the effects of FVIII addition.

Methods

Prothrombin time, activated partial thromboplastin time, and thrombin generation (TG) using the calibrated automated thrombogram method were evaluated in aliquots of a commercial severe HA plasma supplemented with emicizumab (0, 12.5, 25, 50, and 100 ng/mL), DOAC (0, 50, 100, 200, and 400 ng/mL of apixaban, rivaroxaban, edoxaban, or dabigatran) and FVIII (0%, 5%, 15%, 50%, and 100%).

Results

DOAC rapidly induced a TG decrease. Emicizumab could counter this effect only for the lowest DOAC dose. FVIII addition to the FVIII-deficient plasma containing a DOAC and emicizumab improved TG and countered the anticoagulant effect of DOAC at ≤100 ng/mL.

Conclusion

Our findings indicate that FVIII can be safely used with emicizumab to counter the anticoagulant effect of DOAC at ≤100 ng/mL. The TG assay is an efficient tool to monitor plasma containing anti-FXa DOAC, but not dabigatran (anti-FIIa).

背景A型血友病（HA）患者的心血管疾病发病率正在上升。因此，尽管存在出血风险，但仍可能需要使用直接口服抗凝剂（DOACs）进行抗凝治疗。在手术或出血的情况下，这类患者可同时使用埃米珠单抗（常规预防）、因子（F）VIII 产品和 DOAC。它们的同时存在构成了止血挑战。本观察性研究旨在评估添加了 DOAC 和埃米珠单抗的 FVIII 缺乏血浆的凝血情况，并评估添加 FVIII 的效果。方法使用校准自动血栓图法评估了添加了埃米珠单抗（0、12、25、50 和 100）的商用重症 HA 血浆的凝血酶原时间、活化部分凝血活酶时间和凝血酶生成量（TG）。5、25、50 和 100 纳克/毫升）、DOAC（0、50、100、200 和 400 纳克/毫升的阿哌沙班、利伐沙班、依多沙班或达比加群）和 FVIII（0%、5%、15%、50% 和 100%）。只有在 DOAC 剂量最低时，Emicizumab 才能抵消这种效应。结论我们的研究结果表明，在≤100 ng/mL时，FVIII可安全地与埃米珠单抗一起用于对抗DOAC的抗凝作用。TG测定是监测血浆中含有抗FXa DOAC而非达比加群（抗FIIa）的有效工具。

{"title":"Thrombin generation to evaluate the complex hemostatic balance of hemophilia A plasma containing direct oral anticoagulant and supplemented by factor VIII","authors":"Sylvain Lamoine , Vincent Jury , Virginie Fourneyron , Jonathan Douxfils , Dorian Teissandier , Laurie Talon , Thomas Sinegre , Aurélien Lebreton","doi":"10.1016/j.rpth.2024.102576","DOIUrl":"10.1016/j.rpth.2024.102576","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of cardiovascular diseases is increasing in persons with hemophilia A (HA). Therefore, anticoagulant therapy based on direct oral anticoagulants (DOACs) may be needed, despite the bleeding risk. In case of surgery or bleeding, such patients may be concomitantly treated with emicizumab (routine prophylaxis), factor (F)VIII products, and DOAC. Their concomitant presence constitutes a hemostatic challenge. Recent international guidelines stated that data are scarce on the hemostatic balance of plasma samples from patients with HA receiving emicizumab and DOAC.</div></div><div><h3>Objectives</h3><div>The aim of this observational study was to assess the coagulation of FVIII-deficient plasma spiked with DOAC and emicizumab and to evaluate the effects of FVIII addition.</div></div><div><h3>Methods</h3><div>Prothrombin time, activated partial thromboplastin time, and thrombin generation (TG) using the calibrated automated thrombogram method were evaluated in aliquots of a commercial severe HA plasma supplemented with emicizumab (0, 12.5, 25, 50, and 100 ng/mL), DOAC (0, 50, 100, 200, and 400 ng/mL of apixaban, rivaroxaban, edoxaban, or dabigatran) and FVIII (0%, 5%, 15%, 50%, and 100%).</div></div><div><h3>Results</h3><div>DOAC rapidly induced a TG decrease. Emicizumab could counter this effect only for the lowest DOAC dose. FVIII addition to the FVIII-deficient plasma containing a DOAC and emicizumab improved TG and countered the anticoagulant effect of DOAC at ≤100 ng/mL.</div></div><div><h3>Conclusion</h3><div>Our findings indicate that FVIII can be safely used with emicizumab to counter the anticoagulant effect of DOAC at ≤100 ng/mL. The TG assay is an efficient tool to monitor plasma containing anti-FXa DOAC, but not dabigatran (anti-FIIa).</div></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":"8 7","pages":"Article 102576"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445224","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}

引用次数: 0

Distinguishing hyperfibrinolysis from enhanced–fibrinolytic-type disseminated intravascular coagulation 区分纤溶亢进与纤溶增强型弥散性血管内凝血

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis

Pub Date : 2024-10-01 DOI: 10.1016/j.rpth.2024.102574

Shinya Yamada, Toshihiro Miyamoto, Hidesaku Asakura

引用次数: 0

Hospital-acquired venous thromboembolism among critically ill children with diabetic ketoacidosis: a multicenter, retrospective cohort study 糖尿病酮症酸中毒危重患儿在医院获得性静脉血栓栓塞症：一项多中心回顾性队列研究

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis

Pub Date : 2024-10-01 DOI: 10.1016/j.rpth.2024.102581

Kristin M. DeMayo , Elizabeth E. Havlicek , Marisol Betensky , Neil A. Goldenberg , Anthony A. Sochet

Background

Critically ill children and young adults with diabetic ketoacidosis are thought to be in a prothrombotic state. However, the rate of hospital-acquired venous thromboembolism and associated risk factors in this population have not been identified.

Objectives

Children hospitalized for diabetic ketoacidosis (DKA) may be at increased risk of hospital-acquired venous thromboembolism (HA-VTE). We sought to estimate the incidence of HA-VTE and identify unique prothrombotic risk factors in this population.

Methods

We performed a multicenter, retrospective cohort study using the Pediatric Health Information Systems registry including patients aged 0 to 21 years hospitalized for DKA from January 2017 to December 2023 within 48 participating centers. The primary outcome was the frequency of HA-VTE. Secondary outcomes were rates of cerebral edema, central venous catheterization (CVC), invasive mechanical ventilation (IMV), infection, and length of stay (LOS). An adjusted logistic regression was employed to identify potential HA-VTE risk factors.

Results

Of the 27,613 patients studied, 93 (0.3%) developed a HA-VTE. Compared with those without HA-VTE, those with HA-VTE had a greater median LOS (10 [IQR, 5-21] vs 2 [IQR, 2-3] days) and rates of cerebral edema (25.8% vs 6.6%), CVC (23.7% vs 1.1%), infection (72% vs 23.5%), and IMV (39.8% vs 1.4%; all P < .001). In an adjusted logistic model, factors independently associated with increased HA-VTE were CVC (adjusted odds ratio [aOR], 3.04; 95% CI, 1.49-6.19), infection (aOR, 4.61; 95% CI, 2.81-7.56), IMV (aOR, 9.24; 95% CI, 4.83-17.56), and increasing LOS (aOR, 1.05; 95% CI, 1.02-1.06; all P < .01).

Conclusion

The frequency of HA-VTE among critically ill children and young adults hospitalized for DKA was 0.3%. After prospective validation, putative risk factors (ie, CVC, IMV, infection, and extended LOS) may be incorporated into the design of forthcoming pediatric thromboprophylaxis trials.

背景患有糖尿病酮症酸中毒的重症儿童和年轻成人被认为处于血栓形成前状态。目标因糖尿病酮症酸中毒（DKA）住院的儿童发生医院获得性静脉血栓栓塞症（HA-VTE）的风险可能增加。我们试图估算 HA-VTE 的发生率，并确定这一人群中独特的血栓形成前风险因素。方法我们利用儿科健康信息系统登记册开展了一项多中心、回顾性队列研究，研究对象包括 2017 年 1 月至 2023 年 12 月期间在 48 个参与中心因 DKA 住院的 0 至 21 岁患者。主要结果是 HA-VTE 的发生频率。次要结果是脑水肿、中心静脉导管插入术（CVC）、有创机械通气（IMV）、感染和住院时间（LOS）的发生率。结果在接受研究的27613名患者中，93人（0.3%）发生了HA-VTE。与未发生 HA-VTE 的患者相比，发生 HA-VTE 的患者的中位住院日（10 [IQR, 5-21] 天 vs 2 [IQR, 2-3] 天）和脑水肿率（25.8% vs 6.6%）、CVC（23.7% vs 1.1%）、感染（72% vs 23.5%）和 IMV（39.8% vs 1.4%；所有 P 均为 0.001）更高。在调整后的逻辑模型中，与 HA-VTE 增加独立相关的因素有 CVC（调整后的几率比 [aOR]，3.04；95% CI，1.49-6.19）、感染（aOR，4.61；95% CI，2.81-7.56）、IMV（aOR，9.24; 95% CI, 4.83-17.56), and increasing LOS (aOR, 1.05; 95% CI, 1.02-1.06; all P < .01).经过前瞻性验证后，推测的风险因素（即CVC、IMV、感染和延长的LOS）可纳入即将开展的儿科血栓预防试验的设计中。

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引用次数: 0

Evaluation of hemostasis understanding in medical and pharmacy students from a Parisian university 评估巴黎一所大学医学和药学专业学生对止血知识的了解程度

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis

Pub Date : 2024-08-01 DOI: 10.1016/j.rpth.2024.102547

Nicolas Gendron , Dominique Helley , Philippe Rousselot , Virginie Siguret , Pascale Gaussem , Chloé James , Lina Khider , Nadine Ajzenberg , Elodie Boissier , Nicolas Boissel , David M. Smadja , Benjamin Planquette

引用次数: 0

Poster Abstracts 海报摘要

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis

Pub Date : 2024-08-01 DOI: 10.1016/j.rpth.2024.102504

引用次数: 0

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