Thrombosis Update最新文献

英文中文

Reduced versus full apixaban lead-in dosing following parenteral treatment of acute venous thromboembolism

Q4 Medicine

Thrombosis Update

Pub Date : 2025-01-03 DOI: 10.1016/j.tru.2025.100199

Daniella Veloria , Benjamin Wang , Ran Ran , David Ha , Robert Diep , Calvin Diep

引用次数: 0

Multimorbidity is associated with risk of incident venous thromboembolism – A nationwide proof-of-concept study

Q4 Medicine

Thrombosis Update

Pub Date : 2025-01-03 DOI: 10.1016/j.tru.2025.100198

Jonatan Ahrén , MirNabi Pirouzifard , Björn Holmquist , Jan Sundquist , Kristina Sundquist , Bengt Zöller

Background

Multimorbidity, i.e. two or more non-communicable diseases (NCDs), has been associated with venous thromboembolism (VTE), but whether multimorbidity is a predictor for incident VTE is unknown.

Aims

To examine the associations between multimorbidity and its severity with risk of incident VTE, and examine the association between nine different disease clusters and incident VTE.

Methods

A cohort study using landmark analysis of 2,694,442 individuals. Swedish national registers were linked and three landmarks (L1, L2, L3), i.e. baselines, were created with 14-, nine- and four-year follow-up times, respectively. Two or more NCDs defined multimorbidity and ≥5 marked multimorbidity severity. A hazard ratio (HR) with 95 % confidence interval (CI) for VTE was calculated and adjusted for sex, education and year of birth. Death and emigration were treated as competing events.

Results

A total of 2,694,442 individuals were included. Multimorbidity was associated with incident VTE in all three analyzed landmarks: adjusted HR for VTE was 2.47 (95%CI 2.24–2.72) for L1, HR was 2.23 (95%CI 2.11–2.36) for L2, and HR was 2.16 (95%CI 2.03–2.29) for L3. HR increased with multimorbidity severity. For instance, HRs for multimorbidity with five or more NCDs was 4.29 (95%CI 2.53–7.28) in L1 analysis, 4.45 (95%CI 3.64–5.45) in L2 analysis and 4.83 (95%CI 4.20–5.55) in L3 analysis. Moreover, seven of nine different multimorbidity disease clusters were predictors for VTE.

Conclusion

This study demonstrated proof-of-concept that multimorbidity is a novel dose-graded predictor for VTE. Further studies will determine the usefulness of multimorbidity for VTE prediction in different clinical settings.

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引用次数: 0

Involving patients and the public in cancer associated thrombosis research: A strategy for success

Q4 Medicine

Thrombosis Update

Pub Date : 2024-12-13 DOI: 10.1016/j.tru.2024.100196

Michelle Edwards , Kathy Seddon , Elin Baddeley , Anne Gulbech Ording , Mark Pearson , Isabelle Mahe , Simon Mooijaart , Frederikus A. Klok , Simon I.R. Noble , SERENITY consortium

The role of public involvement (PI) in biomedical research has never been greater, with accumulating evidence demonstrating its ability to improve the quality of research and the likelihood of translating findings into clinical practice. As the demand for meaningful PI in research continues to grow, research teams are required to provide more than a tokenistic acknowledgement of the role of public contributors to the success of a project.

This paper presents an overview of PI as a whole and specifically reflects on how it has added value, to an international cancer associated thrombosis research program. It introduces tools designed to guide teams unfamiliar with PI, introducing the Public Involvement in Research Impact Toolkit (PIRIT) which provides a structure for planning and reporting on PI activities from the study inception through conduct, to its impact.

引用次数: 0

Revisiting hemodynamic definition: Incidence of chronic thromboembolic pulmonary hypertension following acute intermediate-high and high-risk pulmonary embolism

Q4 Medicine

Thrombosis Update

Pub Date : 2024-12-01 DOI: 10.1016/j.tru.2024.100194

Bárbara Lacerda Teixeira, André Grazina, Ricardo Carvalheiro, Tiago Mendonça, Tiago Pereira da Silva, António Fiarresga, Ruben Ramos, Duarte Cacela, João Reis, Ana Galrinho, Luís Almeida Morais, Rui Cruz Ferreira

Background

The hemodynamic definition of pulmonary hypertension (PH) was updated, lowering the mean pulmonary arterial pressure (PAP) threshold to 20 mmHg and the pulmonary vascular resistance (PVR) to 2 Wood units. The impact of these revised criteria on the number of patients reclassified as PH has not been extensively studied, namely in chronic thromboembolic pulmonary hypertension (CTEPH) population. Since the true incidence of CTEPH after acute pulmonary embolism (PE) is debatable, we aimed to analyze the incidence of CTEPH after high-risk forms of acute PE according to the new 2022 ESC/ERS hemodynamic criteria.

Methods

A prospective registry of consecutive intermediate-high- and high-risk PE patients submitted to catheter directed therapies (CDT) in a tertiary center was used. Clinical, echocardiographic, computed tomography angiography (CTA), right heart catheterization (RHC) and digital subtraction pulmonary angiogram (DSPA) data were collected at admission and at 3 months.

Results

Among 25 patients, RHC revealed that 36 % of patients met the criteria for PH per the new guidelines, compared to 16 % under the previous definition (p = 0.010), resulting in 20 % being reclassified. Mean PAP and PVR differed significantly according to both definitions. Under the new definition, additional parameters of RHC also showed significant differences (p < 0.05). Perfusion defects were noted in 33 % of PH patients on DSPA but not on CTA, while the remained displayed them on both modalities. Among patients without PH, 31.3 % exhibited perfusion defects.

Conclusion

According to the new updated criteria for PH, 36 % of intermediate-high- and high-risk PE patients met the criteria of CTEPH at 3 months of follow-up. With a possible rising incidence of CTEPH, special monitoring and management is crucial.

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引用次数: 0

Long-term survival and cerebrovascular events after carotid artery stenting in patients with chronic kidney disease

Q4 Medicine

Thrombosis Update

Pub Date : 2024-12-01 DOI: 10.1016/j.tru.2024.100193

Qiaoming Jiang , Jiangkai Yu , Yutao Zhao , Bichao Wang , Xixiang Gao , Yingchun Xiao

Objective

Chronic kidney disease (CKD) is associated with cerebrovascular diseases (CVDs) due to chronic systemic inflammation. This study aimed to estimate perioperative and long-term outcomes in Chinese patients undergoing carotid artery stenting (CAS) who had different stages of CKD.

Method

This retrospective study enrolled 888 patients undergoing CAS for carotid artery stenosis. Patients were classified into normal, mild, moderate, and severe CKD and dialysis groups based on their renal function. The primary endpoint was long-term survival from a major adverse event (MAE), which was predefined as the development of a stroke, myocardial infarction (MI), or death during a 10-year long-term follow-up.

Results

Perioperative rates for MAE were 1.5 %, 1.8 %, 3.0 %, 10.3 %, and 9.1 % for the five categories (p < 0.001). There was no death within the perioperative 30 days. The estimated 5-year death-free survival rates decreased with worsening renal function (92.2 % vs. 82.7 % vs. 76.9 % vs. 61.4 % vs. 58.6 %, p < 0.001). The long-term MAE-free survival was 94.7 % vs. 91.0 % vs. 80.2 % vs. 63.7 % vs. 52.2 % for the groups, with the differences being significant between normal to moderate CKD and severe CKD and hemodialysis-dependent cases. Cox regression analysis revealed that dialysis (HR = 3.216 (95%CI: 1.662, 6.223), p = 0.001), severe CKD (HR = 4.592 (95%CI: 2.348, 8.982), p < 0.001), hypertension (HR = 1.977 (95%CI: 1.292, 3.024), p = 0.002), coronary artery disease (HR = 1.509 (95%CI: 1.037, 2.196), p = 0.032) and diabetes mellitus (HR = 2.459 (95%CI: 1.482, 4.079), p < 0.001) were predictors of long-term MAE after CAS.

Conclusion

Risk of perioperative and long-term MAE increased with CKD severity. Patients with normal to moderate CKD benefited from MAE-free survival after CAS. However, preventive CAS appeared to be inappropriate in severe CKD or hemodialysis cases with asymptomatic carotid stenosis, particularly in those with a number of comorbidities.

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引用次数: 0

Improving management of catheter related thrombosis (CRT) in cancer patients by incorporating real world data. The value of cancer VTE registries

Q4 Medicine

Thrombosis Update

Pub Date : 2024-12-01 DOI: 10.1016/j.tru.2024.100195

Dr Emmanouil S. Papadakis MD, MSc, Dr Lucy A. Norris PhD

引用次数: 0

Tissue factor (F3) gene variants and thrombotic risk among middle-aged and older adults: A population-based cohort study 组织因子 (F3) 基因变异与中老年人血栓风险：基于人群的队列研究

Q4 Medicine

Thrombosis Update

Pub Date : 2024-09-28 DOI: 10.1016/j.tru.2024.100190

Eric Manderstedt , Christina Lind-Halldén , Christer Halldén , Johan Elf , Peter J. Svensson , Gunnar Engström , Olle Melander , Aris Baras , Luca A. Lotta , Bengt Zöller , for the Regeneron Genetics Center

Background

Tissue factor (TF), encoded by the F3 gene, is the main initiator of blood coagulation. The molecular epidemiology of the F3 gene and the relation to venous thromboembolism (VTE) remains to be determined.

Objectives

The aim was to determine the molecular epidemiology and the importance of F3 variants for incident VTE by analysis of the population-based MDC study (Malmö Diet and Cancer), consisting of unselected middle-aged and older individuals.

Methods

The exons of F3 were analyzed in a total of 28,794 individuals from the MDC cohort, and of these, 2584 (9 %) were affected by VTE during follow‐up (1991–2018). Qualifying variants used in gene-collapsing analysis were defined as loss-of-function or non-benign (PolyPhen-2) missense variants with minor allele frequency less than 0.1 %.

Results

Exon sequencing of the F3 gene identified 61 different variants, 3′ UTR variants (n = 5), 5′ UTR variants (n = 9) synonymous (n = 10), in frame insertion (n = 1), splice region variants (n = 2), missense (n = 33) or loss-of-function variants (n = 1). No associations between common F3 gene variants and incident VTE were found. Seventeen rare variants were classified as qualifying and included in collapsing analysis (16 non-benign missense and 1 loss-of-function variants). The prevalence of F3 qualifying variants was 0.14 %. Seven individuals with F3 qualifying variants had VTE, while 34 individuals had no VTE. The adjusted VTE model was significant (hazard ratio = 2.1 [95 % confidence interval, 1.02–4.48], P-value = 0.045).

Conclusions

Qualifying F3 gene variants are very rare, indicating a constrained gene. Rare but not common variation in the F3 gene may be involved in VTE.

背景F3基因编码的组织因子（TF）是血液凝固的主要启动因子。目的通过分析以人口为基础的 MDC 研究（马尔默饮食与癌症研究），确定分子流行病学以及 F3 变体对 VTE 事件的重要性，该研究由未经筛选的中老年人组成。方法分析了MDC队列中28794人的F3外显子，其中2584人（9%）在随访期间（1991-2018年）受到VTE影响。用于基因重组分析的合格变异被定义为功能缺失或非良性（PolyPhen-2）错义变异，其小等位基因频率低于 0.1%。结果 F3 基因的外显子测序发现了 61 个不同的变异，包括 3′ UTR 变异（n = 5）、5′ UTR 变异（n = 9）、同义变异（n = 10）、框内插入变异（n = 1）、剪接区变异（n = 2）、错义变异（n = 33）或功能缺失变异（n = 1）。未发现常见的F3基因变异与VTE事件之间存在关联。17个罕见变异被归类为合格变异并纳入折叠分析（16个非良性错义变异和1个功能缺失变异）。F3合格变异的发生率为0.14%。7名F3合格变异体患者出现了VTE，34名患者未出现VTE。调整后的 VTE 模型具有显著性（危险比 = 2.1 [95 % 置信区间，1.02-4.48]，P 值 = 0.045）。F3 基因中罕见但不常见的变异可能与 VTE 有关。

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引用次数: 0

Q4 Medicine

Thrombosis Update

Pub Date : 2024-09-25 DOI: 10.1016/j.tru.2024.100191

Francisco José Pelegrín Mateo , Teresa Quintanar Verdúguez , Dialina Brilhante , Asia Ferrández Arias , Alejandra Romano Cardozo , Eva Martínez de Castro , José Muñoz Langa , Elena Brozos Vázquez , María Vallamayor Delgado , Berta Obispo Portero , Enrique Gallardo , José Rubio Pérez , Isaura Fernández Pérez , Ignacio García Escobar , Silvia García Adrián , José Antonio Santiago Crespo , Lola Rodríguez-Nogueira , Gretel Benítez López , Paula Jimenez-Fonseca , Andrés Muñoz Martín

Background

Catheter related thrombosis (CRT) is the most frequent non-infectious complication associated with central venous access devices (CVAD), with a reported incidence between 13 % and 66 % in symptomatic and asymptomatic patients, respectively, with several factors influencing its development.

Methods

CRT events recorded in TESEO, an international, multicentric, and prospective cancer-associated thrombosis registry were assessed. Descriptive analyses were conducted.

Results

Between July 2018 and December 2023, 2,567 patients were included in TESEO. Of these, 245 patients developed CRT and were included in this analysis. Mean age was 60.5 years (SD 12.3). Peripherally inserted central catheters (PICC) were present in 42.1%, totally implanted ports (PORT) in 40.9% while 17% had missing data. The most common reported comorbidities were arterial hypertension (28.6%) and dyslipidemia (28.2%). Other thromboembolism associated risk factors were present in ≤10% of patients.

Venous thromboembolism (VTE) related symptoms occurred in 70.2% of cases at presentation. Pulmonary embolism (PE) was present in 6.5%, being clinically suspected in 56.2% of cases. The diagnosis was mainly unilateral (81.3%) and 50% were central. Arterial and venous rethrombosis was present in 0.8% and 4.9% of cases respectively. Minor bleeding episodes occurred in 2.5% of cases, while major/clinically relevant episodes were present in 3.6%.

Conclusions

Usual VTE associated risk factors were infrequent in the TESEO registry population. CRT was symptomatic in most cases, with reduced complication rates after treatment.

背景导管相关血栓形成（CRT）是与中心静脉通路装置（CVAD）相关的最常见的非感染性并发症，有报道称无症状和无症状患者的发生率分别在13%和66%之间，其发生有多种影响因素。方法对TESEO记录的CRT事件进行了评估，TESEO是一个国际性、多中心和前瞻性的癌症相关血栓形成登记处。结果2018年7月至2023年12月期间，TESEO共纳入2567名患者。其中，245 名患者进行了 CRT 并纳入本分析。平均年龄为 60.5 岁（标清 12.3）。42.1%的患者存在外周插入中心导管（PICC），40.9%的患者存在完全植入端口（PORT），17%的患者数据缺失。最常见的合并症是动脉高血压（28.6%）和血脂异常（28.2%）。70.2%的患者在就诊时出现与静脉血栓栓塞症（VTE）相关的症状。6.5%的病例出现肺栓塞（PE），56.2%的病例在临床上被怀疑为肺栓塞。诊断结果主要是单侧性的（81.3%），50%是中心性的。分别有 0.8% 和 4.9% 的病例出现动脉和静脉血栓再形成。2.5%的病例出现轻微出血，3.6%的病例出现严重/临床相关出血。CRT在大多数病例中无症状，治疗后并发症发生率降低。

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引用次数: 0

Usability study of the qLabs® FIB: A new point-of-care system for functional fibrinogen testing qLabs® FIB 的可用性研究：功能性纤维蛋白原检测的新型床旁系统

Q4 Medicine

Thrombosis Update

Pub Date : 2024-09-25 DOI: 10.1016/j.tru.2024.100192

Maxence Hureau , Anne-Sophie Bouthors , Lucie Deroo , Anne-Sophie Baptiste , Agnès Le Gouez , Mathias Rossignol , Frederic J. Mercier , Agnès Rigouzzo

Background

Identification of hypofibrinogenemia is particularly important in obstetrics since this predicts progression to severe Post-Partum Haemorrhage (PPH).

Objectives

To evaluate the usability of qLabs® FIB at the bedside of patients with PPH.

Methods

The qLabs® FIB test was performed using a drop of whole blood from a citrated laboratory tube sampled from each parturient with PPH >1 L by a trained user. A usability survey was completed by each clinician performing the test.

Results

During the evaluation, 101 qLabs® FIB tests were performed. One hundred completed surveys and 58 free comments were collected. Satisfaction was achieved in 84 % of tests. Usability in emergency setting, timeliness of results, and the results display were considered positive. The qLabs® FIB results were obtained in <3 min for concentrations below 3 g/L whilst the median time to paired laboratory results was 60 (20–120) minutes. The lower a patient's fibrinogen level, the faster the qLabs® FIB result.

Conclusion

The usability study was the first step in the validation process of the qLabs® FIB point of care device in obstetric settings.

背景识别低纤维蛋白原血症在产科尤为重要，因为它可预测严重产后出血（PPH）的进展。方法qLabs® FIB 检验由一名经过培训的使用者从每名 PPH >1 L 的产妇身上取样，从枸橼酸化验管中滴入一滴全血。在评估期间，共进行了 101 次 qLabs® FIB 测试。共收集到 100 份填写完整的调查问卷和 58 条自由评论。84%的测试结果令人满意。在紧急情况下的可用性、结果的及时性和结果显示等方面都得到了肯定。浓度低于 3 克/升时，qLabs® FIB 可在 3 分钟内得出结果，而得出配对实验室结果的中位时间为 60 (20-120) 分钟。病人的纤维蛋白原水平越低，qLabs® FIB 的结果就越快。

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引用次数: 0

Nitrous oxide and VTE – no laughing matter 一氧化二氮和 VTE--不是笑料

Q4 Medicine

Thrombosis Update

Pub Date : 2024-09-01 DOI: 10.1016/j.tru.2024.100188

Lucy A. Norris, Emmanouil S. Papadakis

引用次数: 0

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