Thrombosis Journal最新文献

Background: Sickle cell disease is a hemoglobinopathy characterized by alterations in the components of hemostasis. Despite efforts and individual and multiple studies carried out to understand the pathophysiology of the disease, particularly regarding abnormalities of hemostasis and coagulation, questions remain. This meta-analysis aimed to evaluate the studies linking inflammatory, coagulation, and fibrinolysis abnormalities in sickle cell patients, putting them in an intrinsic state of hypercoagulability and predisposing them to thrombotic risk.

Methods: The systematic review of databases and search engines was conducted over 24 years (2000-2024) and worldwide according to the reporting guidelines of PRISMA and the Cochrane Handbook. The research articles listed were searched in the PubMed and Web of Science databases. Only case-control articles were retained. Data were extracted from the articles and analyzed using the statistical software R version 4.3.2. The standardized mean difference (SMD) was used to assess the extent of the disease on the different parameters studied. Heterogeneity across individual studies was assessed using Higgins's inconsistency Q statistics and reported as I² and p-value. ROBINS-E was used to assess the risk of bias in the included studies.

Results: 303 studies were initially identified; after the elimination of duplicates and of works not meeting the objective of the study, 17 studies were finally included for meta-analyses. The standardized mean difference (SMD) using the common effect model is 0.79 [0.58, 1.00] for prothrombin time for 5 studies analyzed (p < 0.01), 0.26 [0.06, 0.46] for fibrinogen for 6 studies analyzed (p < 0.01), and 0.87 [0.62, 1.11] for D-dimer for 6 studies analyzed (p < 0.01); thus reflecting the strong influence of sickle cell disease on the production of Prothrombin, fibrinogen and D-dimer when compared to normal controls. For protein C, the SMD with the common effect model is -1.32 [-1.54, -1.09] for 5 studies analyzed (p < 0.01), and for protein S, it is -1.45 [-1.69, -1.22] for 5 studies analyzed (p < 0.01); thus reflecting a significant negative influence of sickle cell disease on protein C and protein S production when compared to normal controls. Finally, the SMD for antithrombin using the common effect model is 0.66 [0.35, 0.98] for 5 studies analyzed (p < 0.01), thus reflecting the strong influence of sickle cell disease on the production of antithrombin when compared to normal controls.

Conclusion: Analyses performed from these studies reported a large influence of sickle cell disease on the inflammatory, coagulation, fibrinolysis, and natural anticoagulant system when compared to normal controls, assessed by a SMD that ranged from moderate to large. These results provide more information on research related to coagulation abnormalities in sickle cell disease and will help impro

Background: Plasma coagulation factor XIII (OMIM#134570 (F13A1) and 134580(F13B), synthesized in haematopoietic cells (FXIII-A) and hepatocytes (FXIII-B); stabilizes and protects fibrin clots against fibrinolytic breakdown, ensuring haemostasis. Inherited FXIII deficiency is a rare inherited autosomal recessive bleeding disorder affecting 1-3 million people globally and demonstrating strong consanguinity contributing to high incidence of cases in Pakistan. Patients manifesting severe illness are homozygotes or compound heterozygotes.

Aims: This study aims to estimate phenotypic traits, genetic alterations, and carrier rates in families with known genetic abnormalities in individuals with Factor XIII deficiency.

Methods: This cross-sectional study was approved by Advanced Studies Research Board and Ethical Review Committee of LUMHS, Jamshoro and conducted in concordance with Declaration of Helsinki 2000 in collaboration at the Biochemistry Department of LUMHS and Haematology Department, Baqai medical university, Karachi. Written informed consent obtained from all participants included in the study. Pedigree was constructed. Direct DNA sequencing performed via big dye terminator by using selective exon as per previously identified mutations in the patients of their families. FXIII confirmed with clot solubility testing and Elisa performed for Assay antigen detection for FXIII. Pathogenicity scoring done by using different software.

Results: All the families had a history of consanguineous marriages and history of bleeding. From the six families, four families show same mutation in patient i.e. IVS11 (+ 1) G > A while two families showed c.2045G > A mutation in their homozygous patient.

Conclusion: The results of this study highlight how crucial it is to combine biochemical, clinical, and statistical approaches to increase the precision of diagnoses, improve patient treatment, and make genetic counselling easier for families who are at risk.

Background: Over the past few years, a growing number of knee arthroscopy (KA) procedures have been associated with an escalating incidence of postoperative venous thromboembolism (VTE), posing a significant threat to patient well-being. Nevertheless, the purpose of this study is to evaluate and synthesize the risk factors associated with VTE following KA, thereby establishing a scientific foundation for developing evidence-based clinical preventive measures.

Methods: We conducted a comprehensive search across the PubMed, Embase, Web of Science, and Cochrane Library databases for relevant literature spanning from January 1, 2019, to January 1, 2025. We meticulously reviewed all English-language observational studies about the risk factors associated with VTE after KA. The quality of the selected studies was critically appraised utilizing the Newcastle-Ottawa Scale (NOS). Subsequently, odds ratios (OR) and 95% confidence intervals (CI) were determined to assess the relationship between various risk factors and the incidence of VTE after KA.

Results: A total of 11 observational studies were included, all of which demonstrated moderate to high methodological quality. The studies involved 875,099 patients who underwent arthroscopic KA. The meta-analysis results indicated that the risk factors for venous thrombosis after KA include age over 30 years (OR = 1.59, 95% CI: [1.20, 2.12], P < 0.001), body mass index (BMI) over 25 (OR = 1.23, 95% CI: [1.07, 1.41], P = 0.004), and D-dimer over 0.62 mg/L (OR = 5.69, 95% CI: [1.41, 22.89], P = 0.014).

Conclusion: Age over 30 years, BMI over 25, and D-dimer over 0.62 mg/L are significant risk factors for VTE following KA. Limited evidence also suggests an association between oral contraceptive use and a higher risk of VTE following KA.

Background: Critically ill patients are at high risk for venous thromboembolism (VTE). In non-Caucasian patients, routine thromboprophylaxis is controversial. No standard guidelines exist for critically ill Thai patients.

Objectives: To evaluate the efficacy and safety of a risk-adapted VTE prophylaxis protocol in medically ill patients.

Methods: A single-center, prospective pre- and post-implementation trial conducted from March to December 2024. Patients admitted to three medical ICUs were enrolled. Patients were stratified by risk of VTE and bleeding. In the pre-implementation phase, patients did not receive thromboprophylaxis, whereas in the post-implementation phase, patients received thromboprophylaxis with either pharmacological or mechanical prophylaxis. The primary outcome was the 45-day incidence of VTE, VTE-related death, and bleeding events. Secondary outcomes included all-cause mortality, ICU stay, and days on mechanical ventilation.

Results: There were 462 patients enrolled with a mean age of 65.82 ± 16.65 years and 53.90% were male. In the post-implementation phase, 151 out of 211 patients (65.37%) received thromboprophylaxis, primarily with pneumatic compression (41.56%), low molecular weight heparin/unfractionated heparin (15.58%) and aspirin (7.36%). VTE events occurred in 14 patients (6.06%) in the pre-implementation group and 5 (2.16%) in the post-implementation group. The composite primary outcome occurred in 14 patients (6.06%, 95% CI 3.35-9.96%) in the pre-implementation group and 5 (2.16%, 95% CI 0.71-4.98%) in the post-implementation group (RR 0.35, 95% CI 0.13-0.97, P = 0.04). A competing-risks analysis showed that post-implementation group was associated with significantly lower risk of VTE (adjusted subdistribution hazard ratio 0.35, 95% CI 0.13-0.97; p = 0.043). No VTE-related deaths occurred. Overall bleeding occurred in 28.14% of pre-implementation and 32.03% of post-implementation patients (RR 1.13, 95% CI 0.86-1.50, P = 0.361). Major bleeding rates were 11.26% vs. 8.22%, respectively (RR 0.65, 95% CI 0.40-1.07, P = 0.075).

Conclusion: A risk-adapted VTE prophylaxis protocol significantly reduced VTE incidence in critically ill Asian patients without increasing bleeding complication.

Clinical trial registration: TCTR20230927002, First Posted Date: 27 September 2023.

Background: Central venous catheter (CVC)-related thrombosis (CRT) has become a common iatrogenic complication in burn patients. Early and precise prediction is the foundations of effective prevention of CRT. However, there is not specific tool to predict CRT in burn populations. This study aimed to investigate the risk factors of CRT and develop a prediction model for CRT in burn populations.

Methods: This retrospective observational study was conducted at a large burn center in Southwest China from January 2018 to December 2022. All adult patients with burn injuries undergoing central venous catheterization were included in the cohort. The clinical data, thrombosis profile, and catheter management were collected and analyzed.

Results: A total of 271 burn patients (mean burn area: 53.29 ± 23.65%) with 797 CVCs were finally included. The incidence of CRT was 13.28%, with a mean time from burn injuries to CRT onset of 25.96 ± 19.00 days. Half of the thrombotic events occurred between 15 and 30 days following burn trauma. Notably, 91.07% and 87.5% of CRT cases had diameters less than 5 mm and lengths shorter than 7 mm, respectively. Compared with the non-CRT cohort, the CRT cohort exhibited significantly larger burn area, more insertion times, higher proportion of blood purification procedures, and longer in-bed durations. Logistic regression and LASSO regression analyses identified burn index and continuous blood purification as independent risk factors for CRT. Consequently, a predictive nomogram model for CRT was successfully developed, achieving an AUROC of 0.75 (95% CI: 0.675-0.834) and a mean absolute error of the calibration curve of 0.029.

Conclusion: The incidence of CRT was relatively high in burn populations. The established nomogram could provide a straightforward, quantitative and effective strategy for identifying patients at high-risk for CRT. Clinicians can utilize this assessment tool periodically to facilitate the early identification of individuals at high risk for CRT.

Objective: Deep vein thrombosis (DVT) is a serious complication in patients with tibial plateau fractures, yet the association between surgical delay and preoperative DVT risk remains insufficiently explored. This study aimed to investigate the impact of fracture-to-operation time on preoperative DVT risk in this patient population.

Methods: A retrospective association analysis was conducted on 267 patients with tibial plateau fractures treated at Quanzhou Orthopedic Hospital between January 2020 and January 2022. The primary exposure was fracture-to-operation time, and the outcome was preoperative DVT confirmed by ultrasound. Multiple regression analyses and generalized additive models were employed, adjusting for demographic, clinical, and coagulation parameters.

Results: The incidence of thrombosis before the operation for tibial plateau fractures is as high as 27.34%. Each day of surgical delay was associated with a 48% increased risk of DVT (adjusted OR = 1.48, 95% CI: 1.32-1.67). A non-linear trend was observed, with risk increasing more rapidly within the first 14 days post-fracture. Patients in the highest tertile of surgical delay had a significantly elevated DVT risk compared to the lowest tertile (adjusted OR = 35.27, 95% CI: 9.53-130.56). Subgroup analyses confirmed the robustness of this association across age groups, calcaneus traction status, and D-dimer levels.

Conclusion: Delayed surgery is associated with increased preoperative DVT risk in tibial plateau fracture patients, and this association appears stronger within the first 14 days post-injury. Early surgical intervention may mitigate this risk, supporting the need for timely management in clinical practice. However, these findings require validation in prospective studies.