Thrombosis Journal最新文献_第6页

External validation and update of the International Medical Prevention Registry on Venous Thromboembolism bleeding risk score for predicting bleeding in acutely ill hospitalized medical patients: a retrospective single-center cohort study in Japan 用于预测急性住院病人出血情况的静脉血栓栓塞症出血风险评分的外部验证和更新：日本的一项回顾性单中心队列研究

IF 3.1 4区医学 Q2 Medicine

Thrombosis Journal

Pub Date : 2024-03-28 DOI: 10.1186/s12959-024-00603-w

Daichi Arakaki, Mitsunaga Iwata, Teruhiko Terasawa

The International Medical Prevention Registry for Venous Thromboembolism (IMPROVE) Bleeding Risk Score is the recommended risk assessment model (RAM) for predicting bleeding risk in acutely ill medical inpatients in Western countries. However, few studies have assessed its predictive performance in local Asian settings. We retrospectively identified acutely ill adolescents and adults (aged ≥ 15 years) who were admitted to our general internal medicine department between July 5, 2016 and July 5, 2021, and extracted data from their electronic medical records. The outcome of interest was the cumulative incidence of major and nonmajor but clinically relevant bleeding 14 days after admission. For the two-risk-group model, we estimated sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively). For the 11-risk-group model, we estimated C statistic, expected and observed event ratio (E/O), calibration-in-the-large (CITL), and calibration slope. In addition, we recalibrated the intercept using local data to update the RAM. Among the 3,876 included patients, 998 (26%) were aged ≥ 85 years, while 656 (17%) were hospitalized in the intensive care unit. The median length of hospital stay was 14 days. Clinically relevant bleeding occurred in 58 patients (1.5%), 49 (1.3%) of whom experienced major bleeding. Sensitivity, specificity, NPV, and PPV were 26.1% (95% confidence interval [CI]: 15.8–40.0%), 84.8% (83.6–85.9%), 98.7% (98.2–99.0%), and 2.5% (1.5–4.3%) for any bleeding and 30.9% (95% CI: 18.8–46.3%), 84.9% (83.7–86.0%), 99.0% (98.5–99.3%), and 2.5% (1.5–4.3%) for major bleeding, respectively. The C statistic, E/O, CITL, and calibration slope were 0.64 (95% CI: 0.58–0.71), 1.69 (1.45–2.05), − 0.55 (− 0.81 to − 0.29), and 0.58 (0.29–0.87) for any bleeding and 0.67 (95% CI: 0.60–0.74), 0.76 (0.61–0.87), 0.29 (0.00–0.58), and 0.42 (0.19–0.64) for major bleeding, respectively. Updating the model substantially corrected the poor calibration observed. In our Japanese cohort, the IMPROVE bleeding RAM retained the reported moderate discriminative performance. Model recalibration substantially improved the poor calibration obtained using the original RAM. Before its introduction into clinical practice, the updated RAM needs further validation studies and an optimized threshold.

静脉血栓栓塞症国际医疗预防登记（IMPROVE）出血风险评分是西方国家预测急性内科住院病人出血风险的推荐风险评估模型（RAM）。然而，很少有研究对其在亚洲本地环境中的预测性能进行评估。我们回顾性地识别了2016年7月5日至2021年7月5日期间在我院普通内科住院的急性病青少年和成人（年龄≥15岁），并从他们的电子病历中提取了数据。研究结果是入院 14 天后大出血和非大出血但临床相关出血的累积发生率。对于两组风险模型，我们估算了灵敏度、特异性以及阳性和阴性预测值（分别为 PPV 和 NPV）。对于 11 组风险模型，我们估算了 C 统计量、预期和观察到的事件比（E/O）、大样本校准（CITL）和校准斜率。此外，我们还利用本地数据重新校准了截距，以更新 RAM。在纳入的 3876 名患者中，998 人（26%）年龄≥ 85 岁，656 人（17%）在重症监护室住院。住院时间中位数为 14 天。58名患者（1.5%）发生了临床相关出血，其中49名（1.3%）发生了大出血。任何出血的敏感性、特异性、NPV 和 PPV 分别为 26.1%（95% 置信区间 [CI]：15.8-40.0%）、84.8%（83.6-85.9%）、98.7%（98.2-99.0%）和 2.5%（1.5-4.3%），大出血分别为 30.9%（95% CI：18.8-46.3%）、84.9%（83.7-86.0%）、99.0%（98.5-99.3%）和 2.5%（1.5-4.3%）。任何出血的 C 统计量、E/O、CITL 和校准斜率分别为 0.64（95% CI：0.58-0.71）、1.69（1.45-2.05）、- 0.55（- 0.81 至- 0.29）和 0.58（0.任何出血的死亡率分别为 0.67（95% CI：0.60-0.74）、0.76（0.61-0.87）、0.29（0.00-0.58）和 0.42（0.19-0.64）。更新模型大大纠正了所观察到的校准不良情况。在我们的日本队列中，IMPROVE出血RAM保持了报告中的中等鉴别性能。模型的重新校准大大改善了使用原始 RAM 所获得的较差校准。在引入临床实践之前，更新的 RAM 需要进一步的验证研究和优化阈值。

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引用次数: 0

Insight into antiphospholipid syndrome: the role and clinical utility of neutrophils extracellular traps formation 抗磷脂综合征透视：中性粒细胞胞外捕获物形成的作用和临床实用性

IF 3.1 4区医学 Q2 Medicine

Thrombosis Journal

Pub Date : 2024-03-28 DOI: 10.1186/s12959-024-00598-4

Shams ElDoha Galal ElDin Zaiema, Menna Allah Zakaria Mohammad Ali Abou Elwafa, Shaymaa Gamal Arafa Hassan, Radwa Hassan Abou El Fotoh El Adwey, Raghda Mohammed Mostafa Ghorab, Raghda El Sayed Abdel Monem Galal

Antiphospholipid syndrome (APLS) is a systemic immune dysregulation distinguished by repetitive complications and pregnancy loss in the absence of definite etiology. Most research focuses on the laboratory detection and clinical features of APLS, but its precise etiology remains to be deeply explored. NETosis is a newly developed theory in the pathophysiology of APLS which may serve as the missing bridge between coagulation and inflammation reaching the disease progression and severity. We aimed in this study to navigate the prognostic role of NETosis in thrombotic APLS. Our study included 49 newly diagnosed APLS patients (both 1ry and 2ry) who met clinical and laboratory criteria as per the international consensus statement on the update of the classification criteria for definite APLS and were sub-classified according to the occurrence of thrombotic events in thrombotic and non-thrombotic types. In addition, 20 sex and age-matched reactive subjects and 20 sex and age-matched healthy volunteer controls were enrolled. NETosis formation was assessed by measuring serum Myeloperoxidase (MPO) and Histones level using the enzyme-linked immunosorbent assay (ELISA) technique. Both MPO and Histones levels were able to discriminate among APLS cases from normal controls, showing significant cutoffs of > 2.09 ng/ml for MPO and > 1.45 ng/ml for Histones (AUC values were 0.987and 1.000, respectively). These values can be used as predictors for NETosis pathophysiology in APLS patients. Additionally, these markers demonstrated a significant association with several prognostic indicators, including thrombosis, higher PT and INR, and lower hemoglobin (Hb) levels which are supposed to be ameliorated by using NETs inhibitors. In conclusion, we suggest that measuring NETosis markers, MPO, and Histones, in the early course of APLS using proposed cutoff values will facilitate the timely initiation of anti-NETosis therapy and improve the overall prognosis, particularly for patients with thrombotic APLS.

抗磷脂综合征（APLS）是一种全身性免疫失调症，其特点是在没有明确病因的情况下反复出现并发症和妊娠失败。大多数研究都集中在抗磷脂综合征的实验室检测和临床特征上，但其确切的病因仍有待深入探讨。NETosis是APLS病理生理学中新提出的理论，它可能是凝血和炎症之间缺失的桥梁，影响着疾病的进展和严重程度。本研究旨在探讨 NETosis 在血栓性 APLS 中的预后作用。我们的研究纳入了 49 名新确诊的 APLS 患者（包括 1ry 和 2ry），他们均符合关于更新确诊 APLS 分类标准的国际共识声明中规定的临床和实验室标准，并根据血栓事件的发生情况分为血栓性和非血栓性两种类型。此外，还招募了 20 名性别和年龄匹配的反应性受试者和 20 名性别和年龄匹配的健康志愿者对照组。采用酶联免疫吸附试验（ELISA）技术测量血清髓过氧化物酶（MPO）和组蛋白水平，以评估 NETosis 的形成。MPO 和组蛋白水平都能区分 APLS 病例和正常对照组，MPO 临界值大于 2.09 ng/ml，组蛋白临界值大于 1.45 ng/ml（AUC 值分别为 0.987 和 1.000）。这些值可作为 APLS 患者 NETosis 病理生理学的预测指标。此外，这些标记物还与一些预后指标有显著关联，包括血栓形成、PT 和 INR 升高以及血红蛋白（Hb）水平降低，而使用 NETs 抑制剂可改善这些预后指标。总之，我们建议，在 APLS 早期病程中使用建议的临界值测量 NETosis 标志物、MPO 和组蛋白，将有助于及时启动抗 NETosis 治疗，并改善总体预后，尤其是血栓性 APLS 患者的预后。

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引用次数: 0

Prophylaxis with enoxaparin and antithrombin III in drug-induced coagulation alterations in childhood leukemia: a retrospective experience of 20 years. 使用依诺肝素和抗凝血酶 III 预防药物诱发的儿童白血病凝血功能改变：20 年的回顾性经验。

IF 3.1 4区医学 Q2 Medicine

Thrombosis Journal

Pub Date : 2024-03-27 DOI: 10.1186/s12959-024-00602-x

Christina Salvador, Robert Salvador, Gabriele Kropshofer, Bernhard Meister, Marie Rock, Petra Obexer, Benjamin Hetzer, Evelyn Rabensteiner, Roman Crazzolara

Background: Thromboembolic complications are well known in the treatment of childhood acute lymphoblastic leukemia. Over the years it has not been possible to reach a consensus on a possible prophylaxis of thromboembolic events during intensive therapy. Only the administration of enoxaparin was able to achieve evidence in the literature to date.

Methods: In this retrospective study, 173 childhood leukemia patients were treated over 20 years with a thromboembolic prophylaxis including enoxaparin and AT III during induction therapy with L-asparaginase and cortisone.

Results: We here report the effectiveness of administration of enoxaparin and AT III in childhood leukemia, showing a strikingly low prevalence of deep vein thrombosis (2.9%). Especially in adolescent patients, a particularly great need for AT III was demonstrated.

Conclusions: We recommend thromboembolic prophylaxis with enoxaparin and AT III substitution during induction/reinduction therapy with L-asparaginase and glucocorticosteroids, especially from adolescence onwards.

背景：血栓栓塞并发症在儿童急性淋巴细胞白血病的治疗中是众所周知的。多年来，人们一直未能就强化治疗期间预防血栓栓塞事件的可能性达成共识。迄今为止，只有服用依诺肝素能够在文献中获得证据：在这项回顾性研究中，173 名儿童白血病患者在接受 L-天冬酰胺酶和可的松诱导治疗期间接受了长达 20 年的血栓栓塞预防治疗，包括依诺肝素和 AT III：我们在此报告在儿童白血病患者中使用依诺肝素和 AT III 的效果，结果显示深静脉血栓的发生率非常低（2.9%）。结论：我们建议儿童白血病患者进行血栓栓塞预防：我们建议在使用 L-天冬酰胺酶和糖皮质激素进行诱导/还原治疗期间，使用依诺肝素和 AT III 进行血栓栓塞预防，尤其是从青春期开始。

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引用次数: 0

Renal damage and old age: risk factors for thrombosis in patients with ANCA-associated vasculitis 肾损伤和高龄：ANCA 相关性血管炎患者血栓形成的风险因素

IF 3.1 4区医学 Q2 Medicine

Thrombosis Journal

Pub Date : 2024-03-20 DOI: 10.1186/s12959-024-00593-9

Xin Chen, Shuo Zhang, Ruilian You, Yixin Ma, Peng Xia, Xiaoxiao Shi, Haiting Wu, Ke Zheng, Yan Qin, Xinping Tian, Limeng Chen

Thrombosis in ANCA-associated vasculitis (AAV) was prevalent and has been neglected in Chinese patients. This study tried to describe the clinical characteristics, identify the risk factors, and investigate the causal relationship between AAV and venous thromboembolism (VTE) by two-sample Mendelian randomization (MR) analysis. In this retrospective, observational study, we included all hospitalized AAV patients from Jan 2013 to Apr 2022 in Peking Union Medical College Hospital. We collected their clinical data for multivariate regression analysis to determine the risk factors for thrombosis. The nomogram was constructed by applying these risk factors to predict thrombosis in AAV patients. As for MR analysis, we selected single nucleotide polymorphisms (SNPs) related to AAV from published genome-wide association studies and extracted the outcome data containing deep vein thrombosis (DVT) and pulmonary embolism (PE) from the UK biobank. 1203 primary AAV patients were enrolled, and thrombosis occurred in 11.3%. Multivariate regression suggested that older than 65 years, EGPA, neurological involvement, lung involvement, significantly elevated serum creatinine (> 500µmol/L), and elevated D-dimer were associated with thrombosis in AAV patients. The model demonstrated satisfied discrimination with an AUC of 0.769 (95% CI, 0.726–0.812). MR analysis showed that EGPA could increase the risk of developing DVT and PE (OR = 1.0038, 95%CI = 1.0035–1.0041, P = 0.009). Thrombosis was not rare in Chinese patients with AAV. Renal damage and old age emerged as critical risk factors for thrombosis. EGPA might have a potential causal relationship with DVT and PE.

ANCA相关性血管炎（AAV）血栓形成在中国患者中普遍存在，但一直被忽视。本研究试图通过双样本孟德尔随机分析法（MR）描述AAV的临床特征、识别风险因素并探讨AAV与静脉血栓栓塞（VTE）之间的因果关系。在这项回顾性观察研究中，我们纳入了 2013 年 1 月至 2022 年 4 月在北京协和医院住院的所有 AAV 患者。我们收集了他们的临床数据进行多变量回归分析，以确定血栓形成的风险因素。应用这些风险因素构建了预测 AAV 患者血栓形成的提名图。至于MR分析，我们从已发表的全基因组关联研究中选择了与AAV相关的单核苷酸多态性（SNPs），并从英国生物库中提取了包含深静脉血栓（DVT）和肺栓塞（PE）的结果数据。共有1203名原发性AAV患者入选，其中11.3%的患者发生了血栓形成。多变量回归表明，年龄大于65岁、EGPA、神经系统受累、肺部受累、血清肌酐明显升高（> 500µmol/L）和D-二聚体升高与AAV患者血栓形成有关。该模型的AUC为0.769（95% CI，0.726-0.812），显示了令人满意的辨别能力。MR分析显示，EGPA可增加发生深静脉血栓和PE的风险（OR = 1.0038，95%CI = 1.0035-1.0041，P = 0.009）。血栓形成在中国 AAV 患者中并不罕见。肾损伤和高龄是血栓形成的关键风险因素。EGPA 可能与深静脉血栓和 PE 有潜在的因果关系。

{"title":"Renal damage and old age: risk factors for thrombosis in patients with ANCA-associated vasculitis","authors":"Xin Chen, Shuo Zhang, Ruilian You, Yixin Ma, Peng Xia, Xiaoxiao Shi, Haiting Wu, Ke Zheng, Yan Qin, Xinping Tian, Limeng Chen","doi":"10.1186/s12959-024-00593-9","DOIUrl":"https://doi.org/10.1186/s12959-024-00593-9","url":null,"abstract":"Thrombosis in ANCA-associated vasculitis (AAV) was prevalent and has been neglected in Chinese patients. This study tried to describe the clinical characteristics, identify the risk factors, and investigate the causal relationship between AAV and venous thromboembolism (VTE) by two-sample Mendelian randomization (MR) analysis. In this retrospective, observational study, we included all hospitalized AAV patients from Jan 2013 to Apr 2022 in Peking Union Medical College Hospital. We collected their clinical data for multivariate regression analysis to determine the risk factors for thrombosis. The nomogram was constructed by applying these risk factors to predict thrombosis in AAV patients. As for MR analysis, we selected single nucleotide polymorphisms (SNPs) related to AAV from published genome-wide association studies and extracted the outcome data containing deep vein thrombosis (DVT) and pulmonary embolism (PE) from the UK biobank. 1203 primary AAV patients were enrolled, and thrombosis occurred in 11.3%. Multivariate regression suggested that older than 65 years, EGPA, neurological involvement, lung involvement, significantly elevated serum creatinine (> 500µmol/L), and elevated D-dimer were associated with thrombosis in AAV patients. The model demonstrated satisfied discrimination with an AUC of 0.769 (95% CI, 0.726–0.812). MR analysis showed that EGPA could increase the risk of developing DVT and PE (OR = 1.0038, 95%CI = 1.0035–1.0041, P = 0.009). Thrombosis was not rare in Chinese patients with AAV. Renal damage and old age emerged as critical risk factors for thrombosis. EGPA might have a potential causal relationship with DVT and PE.","PeriodicalId":22982,"journal":{"name":"Thrombosis Journal","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140171867","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

Two cases of venous thromboembolism in siblings after splenectomy due to a novel PROC gene mutation 两例因新型 PROC 基因突变导致的脾切除术后兄弟姐妹静脉血栓栓塞症病例

IF 3.1 4区医学 Q2 Medicine

Thrombosis Journal

Pub Date : 2024-03-19 DOI: 10.1186/s12959-024-00597-5

Yunfang Zhang, Bo Wang, Yuxin Bai, Anxin Wang

Venous thromboembolism(VTE)is a common multifactorial disease. Anticoagulant protein deficiency is the most usual hereditary thrombophilia in the Chinese people, which includes protein C(PC), protein S and antithrombin deficiencies. A retrospective analysis was conducted on clinical manifestations, laboratory tests, genetic information, and other relevant data of siblings diagnosed with VTE in 2020 at the Department of Pediatrics of Shenzhen Second People’s Hospital. The proband, a 12-year-old female, was admitted to the hospital in December 2020 with a complaint of pain in the left lower limb for four days. The examination found that the PC activity was 53%, and B-ultrasound showed bilateral thrombosis of the great saphenous vein in the thigh segment. The proband’s younger brother, a 10-year-old male, was admitted to the hospital in January 2021 due to right lower limb pain for two weeks. PC activity is 40%. B-ultrasound showed superficial venous thrombosis in the left lower limb and upper limb. Both siblings suffered from thalassemia and underwent splenectomy before recurrent thrombosis occurred. The proband’s mother was asymptomatic, and her PC activity was 45%. Both cases were treated with warfarin anticoagulation, and their symptoms improved. The proband’s mother was found to have a heterozygous mutation at this locus through Sanger sequencing. Protein C deficiency should be considered for venous thromboembolism in childhood. The heterozygous mutation 1204 A > G in PROC exon 9 in this family is reported for the first time.

静脉血栓栓塞症（VTE）是一种常见的多因素疾病。抗凝血蛋白缺乏症是中国人最常见的遗传性血栓性疾病，包括蛋白C（PC）、蛋白S和抗凝血酶缺乏症。本研究对深圳市第二人民医院儿科2020年确诊的VTE同胞的临床表现、实验室检查、遗传信息及其他相关资料进行了回顾性分析。该患者为女性，12 岁，因左下肢疼痛 4 天于 2020 年 12 月入院。检查发现PC活动度为53%，B超显示双侧大隐静脉大腿段血栓形成。原告的弟弟，男性，10 岁，因右下肢疼痛两周于 2021 年 1 月入院。PC 活动度为 40%。B 超显示左下肢和上肢浅静脉血栓形成。两兄妹均患有地中海贫血症，并在血栓复发前接受了脾脏切除术。原发性血栓患者的母亲无症状，PC活性为45%。两个病例都接受了华法林抗凝治疗，症状均有所改善。通过桑格测序，发现该患者的母亲在该基因位点上存在杂合突变。儿童静脉血栓栓塞症应考虑蛋白 C 缺乏症。该家族首次报告了 PROC 第 9 外显子 1204 A > G 的杂合突变。

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引用次数: 0

C-type lectin-like receptor 2: roles and drug target C 型凝集素样受体 2：作用和药物靶点

IF 3.1 4区医学 Q2 Medicine

Thrombosis Journal

Pub Date : 2024-03-19 DOI: 10.1186/s12959-024-00594-8

Lan Sun, Zhe Wang, Zhiyan Liu, Guangyan Mu, Yimin Cui, Qian Xiang

C-type lectin-like receptor-2 (CLEC-2) is a member of the C-type lectin superfamily of cell surface receptors. The first confirmed endogenous and exogenous ligands of CLEC-2 are podoplanin and rhodocytin, respectively. CLEC-2 is expressed on the surface of platelets, which participates in platelet activation and aggregation by binding with its ligands. CLEC-2 and its ligands are involved in pathophysiological processes, such as atherosclerosis, cancer, inflammatory thrombus status, maintenance of vascular wall integrity, and cancer-related thrombosis. In the last 5 years, different anti- podoplanin antibody types have been developed for the treatment of cancers, such as glioblastoma and lung cancer. New tests and new diagnostics targeting CLEC-2 are also discussed. CLEC-2 mediates thrombosis in various pathological states, but CLEC-2-specific deletion does not affect normal hemostasis, which would provide a new therapeutic tool for many thromboembolic diseases. The CLEC-2-podoplanin interaction is a target for cancer treatment. CLEC-2 may be applied in clinical practice and play a therapeutic role.

C 型凝集素样受体-2（CLEC-2）是细胞表面受体 C 型凝集素超家族的成员。第一个被证实的 CLEC-2 内源性和外源性配体分别是 podoplanin 和 rhodocytin。CLEC-2 表达于血小板表面，通过与其配体结合参与血小板的活化和聚集。CLEC-2 及其配体参与病理生理过程，如动脉粥样硬化、癌症、炎性血栓状态、血管壁完整性的维护以及癌症相关血栓形成。在过去 5 年中，已开发出不同类型的抗 podoplanin 抗体，用于治疗胶质母细胞瘤和肺癌等癌症。此外，还讨论了针对 CLEC-2 的新测试和新诊断方法。CLEC-2在各种病理状态下介导血栓形成，但CLEC-2特异性缺失不会影响正常止血，这将为许多血栓栓塞性疾病提供新的治疗工具。CLEC-2-podoplanin相互作用是癌症治疗的一个靶点。CLEC-2可应用于临床并发挥治疗作用。

引用次数: 0

Risk factors for venous thromboembolism in a single pediatric intensive care unit in China. 中国一家儿科重症监护病房的静脉血栓栓塞风险因素。

IF 3.1 4区医学 Q2 Medicine

Thrombosis Journal

Pub Date : 2024-03-15 DOI: 10.1186/s12959-024-00596-6

Jintuo Zhou, Yanting Zhu, Ying Liu, Hairong Zhan, Peiguang Niu, Huajiao Chen, Jinhua Zhang

Background: Analyses of extensive, nationally representative databases indicate a rising prevalence of venous thromboembolism (VTE) among critically ill children. However, the majority of studies on childhood VTE have primarily concentrated on Caucasian populations in the United States and European countries. There is a lack of epidemiological studies on VTE in Chinese children.

Methods: We conducted a retrospective cohort study of data from the Pediatric Intensive Care (PIC) database. Data were obtained and extracted by using Structured Query Language (SQL) and the administrative platform pgAdmin4 for PostgreSQL. Bivariate analyses were conducted in which categorical variables were analyzed by a chi-square test and continuous variables were analyzed by a Student's t-test. Separate multivariable logistic regressions were employed to investigate the associations between VTE and sociodemographic factors as well as clinical factors.

Results: Our study included 12,881 pediatric patients from the PIC database, spanning the years 2010 to 2018. The incidence rate of pediatric VTE was 0.19% (24/12,881). The venous thrombotic locations were deep venous thrombosis extremities (n = 18), superior vena cava (n = 1), cerebral sinovenous (n = 1), and other deep venous thrombosis (n = 4). Univariate analysis showed that age, weight, shock, sepsis, cancer and vasopressor receipt were statistically significant risk factors for pediatric VTE (all p ≤ 0.05). After multivariable logistic regression analysis, only shock (aOR: 6.77, 95%CI: 1.33-34.73, p = 0.019) and admission for sepsis (aOR: 6.09, 95%CI: 1.76-21.09, p = 0.004) were statistically significant associated with pediatric VTE.

Conclusions: In conclusion, data obtained from the Pediatric Intensive Care (PIC) database revealed a prevalence of VTE in pediatric patients of 0.19%. The most common location for venous thrombi was deep venous thrombosis (DVT) in the extremities. We identified that shock and sepsis were statistically significant factors associated with pediatric VTE.

背景：对具有广泛全国代表性的数据库进行的分析表明，重症儿童中静脉血栓栓塞症（VTE）的发病率呈上升趋势。然而，大多数有关儿童 VTE 的研究主要集中在美国和欧洲国家的白种人群体。目前还缺乏针对中国儿童 VTE 的流行病学研究：我们对儿科重症监护（PIC）数据库中的数据进行了一项回顾性队列研究。数据通过结构化查询语言（SQL）和PostgreSQL管理平台pgAdmin4获取和提取。在进行二变量分析时，分类变量采用卡方检验，连续变量采用学生 t 检验。分别采用多变量逻辑回归研究 VTE 与社会人口学因素和临床因素之间的关系：我们的研究纳入了 PIC 数据库中的 12881 名儿科患者，时间跨度为 2010 年至 2018 年。儿科 VTE 的发病率为 0.19%（24/12881）。静脉血栓部位为四肢深静脉血栓（18例）、上腔静脉（1例）、脑窦静脉（1例）和其他深静脉血栓（4例）。单变量分析表明，年龄、体重、休克、脓毒症、癌症和接受血管加压素是小儿 VTE 的重要统计风险因素（所有 p 均小于 0.05）。经过多变量逻辑回归分析，只有休克（aOR：6.77，95%CI：1.33-34.73，p = 0.019）和因败血症入院（aOR：6.09，95%CI：1.76-21.09，p = 0.004）与小儿 VTE 有显著的统计学相关性：总之，从儿科重症监护（PIC）数据库获得的数据显示，儿科患者的 VTE 发生率为 0.19%。静脉血栓最常见的部位是四肢深静脉血栓（DVT）。我们发现，休克和败血症是与儿科 VTE 相关的重要统计学因素。

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引用次数: 0

Successful retrieval of tip-embedded inferior vena cava filter using a modified forceps technique: case report. 使用改良镊子技术成功取出尖端嵌入的下腔静脉过滤器：病例报告。

IF 3.1 4区医学 Q2 Medicine

Thrombosis Journal

Pub Date : 2024-03-12 DOI: 10.1186/s12959-024-00595-7

Yang Liu, Junlong Ma, Qiqi Wang, Wei Zeng, Chunshui He

Background: The retrieval of inferior vena cava (IVC) filter is essential for preventing complications associated with the device. Advanced techniques have been developed to improve the success rate of retrieving tip-embedded filters. The forceps technique is frequently used to address this issue.

Case presentation: We present a case study of two patients who underwent a successful tip-embedded IVC filter retrieval using a modified forceps technique, which has not been previously reported. This technique involves using a wire loop under the filter tip and a forceps to grasp the filter shoulder. By pulling the wire loop and pushing the forceps in counterforce, the filter tip is straightened and aligned with the vascular sheath. The vascular sheath can then dissect the filter tip out from the caval wall and get inside the sheath to complete the retrieval.

Conclusions: The modified forceps technique we present here offers a new solution for the complex retrieval of IVC filters.

背景：取回下腔静脉（IVC）滤器对于预防与该装置相关的并发症至关重要。为了提高取回尖端嵌入滤器的成功率，人们开发了先进的技术。镊子技术常用于解决这一问题：我们对两名患者进行了病例研究，他们使用改良的镊子技术成功取回了尖端嵌入式 IVC 过滤器。该技术包括在过滤器顶端下方使用钢丝圈，并用镊子夹住过滤器肩部。通过拉动钢丝圈和反作用力推动镊子，过滤器顶端被拉直并与血管鞘对齐。然后，血管鞘可将滤器尖端从腔壁剥离，并进入鞘内完成取出：我们在此介绍的改良镊子技术为复杂的 IVC 过滤器取出术提供了一种新的解决方案。

引用次数: 0

Clot time ratio (CTR) and relation to treatment outcome in patients with atrial fibrillation treated with Rivaroxaban 接受利伐沙班治疗的心房颤动患者的凝血时间比（CTR）及其与治疗结果的关系

IF 3.1 4区医学 Q2 Medicine

Thrombosis Journal

Pub Date : 2024-03-01 DOI: 10.1186/s12959-024-00591-x

Liselotte Onelöv, Elvar Theodorsson, Mojca Božič-Mijovski†, Alenka Mavri

There are situations where information about the anticoagulant effects of Rivaroxaban could be clinically useful. Methods for measuring Rivaroxaban concentrations are not available at all medical laboratories while the test MRX PT DOAC for measuring the functional effects of Rivaroxaban, in CTR (Clot Time Ratio), can be made available around the clock. The objectives of this study were to investigate CTR in trough and peak samples during Rivaroxaban treatment of atrial fibrillation and to correlate the findings to bleeding episodes. 3 trough- and 3 peak samples from 60 patients (30 on 20 mg daily and 30 on 15 mg daily) were analyzed with PT DOAC. Patients were monitored for 20 months, and bleeding and thrombotic events were documented. Descriptive statistics were used to summarize the data and non-parametric t-test for comparison between groups. ROC curves for the prediction of DOAC plasma levels > 50 ng/mL as determined with LC-MS/MS and anti-FXa methods were computed. There was a significant difference between trough and peak CTR (median CTR 1.33 vs. 3.57, p < 0.001). 28 patients suffered bleeds. Patients on 20 mg Rivaroxaban with bleeds had higher mean peak CTR than patients without bleeds (CTR 4.11 vs. CTR 3.47, p = 0.040). There was no significant difference in mean CTR between patients on 15 mg Rivaroxaban with or without bleeds (CTR 3.81 vs. 3.21, p = 0.803), or when considering all patients (CTR 3.63 vs. 3.56, p = 0.445). Five out of seven patients on Rivaroxaban 20 with mean peak CTR above the dose specific first to third quartile range (Q1-Q3) suffered bleeds, while 7/16 patients with mean peak CTR within, and 1/7 patients with mean peak CTR below the Q1-Q3 suffered bleeds. The area under the ROC curve was > 0.98 at the upper limit of the PT DOAC reference interval and the negative predictive value of PT DOAC for the prediction of DOAC plasma levels > 50 ng/mL was > 0.96. The sample size was too low to draw any firm conclusions but is seems that MRX PT DOAC might be a useful laboratory test in situations where the effect of Rivaroxaban needs evaluation.

在某些情况下，有关利伐沙班抗凝效果的信息可能对临床有用。测量利伐沙班浓度的方法并非所有医学实验室都能提供，而用于测量利伐沙班功能效应的 MRX PT DOAC（凝血时间比）测试却可以全天候提供。本研究的目的是调查利伐沙班治疗心房颤动期间谷值和峰值样本中的凝血时间比，并将调查结果与出血发作相关联。使用 PT DOAC 分析了 60 名患者（30 人每天服用 20 毫克，30 人每天服用 15 毫克）的 3 份波谷和 3 份波峰样本。对患者进行了长达 20 个月的监测，并记录了出血和血栓事件。描述性统计用于总结数据，非参数 t 检验用于组间比较。计算了用LC-MS/MS和抗FXa方法测定的DOAC血浆水平> 50纳克/毫升的预测ROC曲线。在 PT DOAC 参考区间的上限，谷值和峰值 CTR 之间存在显著差异（中位数 CTR 1.33 vs. 3.57，p 0.98），PT DOAC 预测 DOAC 血浆水平 > 50 ng/mL 的阴性预测值 > 0.96。样本量太少，无法得出任何确切结论，但在需要评估利伐沙班效果的情况下，MRX PT DOAC似乎是一种有用的实验室检测方法。

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引用次数: 0

Comparative effectiveness and safety of DOACs vs. VKAs in treatment of left ventricular thrombus- a meta-analysis update DOACs 与 VKAs 治疗左心室血栓的有效性和安全性比较--最新荟萃分析

IF 3.1 4区医学 Q2 Medicine

Thrombosis Journal

Pub Date : 2024-03-01 DOI: 10.1186/s12959-024-00585-9

Tong Hu, Changli Chen, Kellina Maduray, Wenqiang Han, Tongshuai Chen, Jingquan Zhong

Left ventricular thrombus (LVT) formation in patients with acute myocardial infarction (AMI) or cardiomyopathies is not uncommon. The optimal oral anticoagulation therapy for resolving LVT has been under intense debate. Vitamin K antagonists (VKAs) remain the anticoagulant of choice for this condition, according to practice guidelines. Evidence supporting the use of direct oral anticoagulants (DOACs) in the management of LVT continues to grow. We performed a systematic review and meta-analysis to compare the efficacy and safety of DOACs versus VKAs. A comprehensive literature search was carried out in PubMed, Cochrane Library, Web of Science, Embase, and Scopus databases in July 2023. The efficacy outcomes of this study were thrombus resolution, ischemic stroke, systemic embolism, stroke/systemic embolism, all-cause mortality, and adverse cardiovascular events. The safety outcomes were any bleeding, major bleeding, and intracranial hemorrhage. A total of twenty-seven eligible studies were included in the meta-analysis. Data were analyzed utilizing Stata software version 15.1. There was no significant difference between DOACs and VKAs with regard to LVT resolution (RR = 1.00, 95% CI 0.95–1.05, P = 0.99). In the overall analysis, DOACs significantly reduced the risk of stroke (RR = 0.74, 95% CI 0.57–0.96, P = 0.021), all-cause mortality (RR = 0.70, 95% CI 0.57–0.86, P = 0.001), any bleeding (RR = 0.75, 95% CI 0.61–0.92, P = 0.006) and major bleeding (RR = 0.67, 95% CI 0.52–0.85, P = 0.001) when compared to VKAs. Meanwhile, in the sub-analysis examining randomized controlled trials (RCTs), the aforementioned outcomes no longer differed significantly between the DOACs and VKAs groups. The incidences of systemic embolism (RR = 0.81, 95% CI 0.54–1.22, P = 0.32), stroke/systemic embolism (RR = 0.85, 95% CI 0.72–1.00, P = 0.056), intracranial hemorrhage (RR = 0.59, 95% CI 0.23–1.54, P = 0.28), and adverse cardiovascular events (RR = 0.99, 95% CI 0.63–1.56, P = 0.92) were comparable between the DOACs and VKAs groups. A subgroup analysis showed that patients treated with rivaroxaban had a significantly lower risk of stroke (RR = 0.24, 95% CI 0.08–0.72, P = 0.011) than those in the VKAs group. With non-inferior efficacy and superior safety, DOACs are promising therapeutic alternatives to VKAs in the treatment of LVT. Further robust investigations are warranted to confirm our findings.

急性心肌梗死（AMI）或心肌病患者左心室血栓（LVT）的形成并不少见。解决左心室血栓的最佳口服抗凝疗法一直备受争议。根据实践指南，维生素 K 拮抗剂 (VKAs) 仍是治疗这种情况的首选抗凝剂。支持使用直接口服抗凝剂（DOACs）治疗 LVT 的证据不断增加。我们进行了一项系统综述和荟萃分析，以比较 DOAC 与 VKAs 的疗效和安全性。我们于 2023 年 7 月在 PubMed、Cochrane Library、Web of Science、Embase 和 Scopus 数据库中进行了全面的文献检索。本研究的疗效指标为血栓溶解、缺血性中风、全身性栓塞、中风/全身性栓塞、全因死亡率和不良心血管事件。安全性结果为任何出血、大出血和颅内出血。共有 27 项符合条件的研究被纳入荟萃分析。数据采用Stata软件15.1版进行分析。DOACs 和 VKAs 在 LVT 解救方面无明显差异（RR = 1.00，95% CI 0.95-1.05，P = 0.99）。在总体分析中，与 VKAs 相比，DOACs 能显著降低卒中风险（RR = 0.74，95% CI 0.57-0.96，P = 0.021）、全因死亡率（RR = 0.70，95% CI 0.57-0.86，P = 0.001）、任何出血（RR = 0.75，95% CI 0.61-0.92，P = 0.006）和大出血（RR = 0.67，95% CI 0.52-0.85，P = 0.001）。同时，在研究随机对照试验（RCT）的子分析中，DOACs 组和 VKAs 组的上述结果不再有显著差异。全身性栓塞（RR = 0.81，95% CI 0.54-1.22，P = 0.32）、卒中/全身性栓塞（RR = 0.85，95% CI 0.72-1.00，P = 0.056）、颅内出血（RR = 0.59，95% CI 0.23-1.54，P = 0.28）和不良心血管事件（RR = 0.99，95% CI 0.63-1.56，P = 0.92）在 DOACs 组和 VKAs 组之间具有可比性。一项亚组分析显示，接受利伐沙班治疗的患者发生中风的风险（RR = 0.24，95% CI 0.08-0.72，P = 0.011）明显低于VKAs组。DOACs具有非劣效性和优越的安全性，是治疗LVT的VKAs的有前途的替代治疗药物。为了证实我们的研究结果，有必要进行进一步的深入研究。

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