Blood Coagulation & Fibrinolysis最新文献

Introduction: The applicability of venous thromboembolism (VTE) risk assessment models (RAMs), to breast cancer (BC) populations remains unclear. We aimed to compare the efficacy of current RAMs and examine the potential of additional hematologic parameters and thromboelastography (TEG); a point of care test, in improving VTE prediction in breast cancer (BC) patients.

Methods: In this pilot study, female BC patients were recruited before chemotherapy and followed for 6-12 months for VTE. VTE risk was assessed using Khorana score, Vienna CATS, PROTECHT, COMPASS-CAT, New Vienna CATSCORE, MDACC CAT, and hypercoagulability status. TEG and hematologic parameters were analyzed, and a modified RAM was developed.

Results: Among 47 patients, 5 (10.6%) developed VTE. PROTECHT was the strongest predictor [area under the curve (AUC) = 0.844], followed by Vienna CATS (AUC = 0.781). Adding immature granulocytes and red blood cell count to PROTECHT optimized prediction (AUC = 0.856).

Conclusion: Incorporating hematologic parameters into PROTECHT may improve VTE risk prediction in BC patients, warranting further evaluation in larger studies.

Centrifugation is a critical step in sample preparation and accounts for an important part of turnaround time. This step is further critical for hemostasis, which requires a low platelet count to produce reliable results. For automated laboratories, centrifugation can represent a bottleneck and thus a shorter centrifugation time would benefit tube flow and turnaround time. We compared a rapid centrifugation protocol (4000 g 4 min) with the recommended protocol (2200 g 15 min) at two different centers, after one or two centrifugation cycles. The effect of each protocol was assessed on the platelet count at every step to verify the capacity of the protocol to yield platelet-poor plasma (PPP). Results on 16 coagulation parameters were compared to verify the reliability of rapid centrifugation. In one center, a consecutive two-cycle centrifugation had been tested on platelet count. A single centrifugation cycle, using the rapid protocol, produced plasma with increased residual platelets compared with the Groupe Etude sur l'Hémostase et la Thrombose (GEHT) protocol. Despite this difference, the coagulation results were interchangeable between the protocols. In addition, a second centrifugation cycle produces plasma with a mean residual platelet less than or equal to 10 × 10 9 /l. A single cycle of rapid centrifugation can be used to assess prothrombin time (PT), activated partial thromboplastin time (aPTT), aPTT kaolin, thrombin time (TT), fibrinogen, antithrombin (AT), D-dimers, anti-Xa, factor II (FII), factor V (FV), factor VII (FVII), and factor X (FX). For frozen plasmas, a double-cycle followed by a third cycle should be performed to ensure that 100% of samples contain less than 10 × 10 9 /l platelets.

Inherited thrombocytopenias are variable in the count and size of platelets, which is related with the number of receptors and intracellular structure. So, the reference ranges do not allow interpretation of functional disorders, especially in macrothrombocytopenias and microthrombocytopenias. The flow cytometry diagnostic approach to use the reference values is necessary. Seventy-five pediatric patients were divided into three groups by platelet size: 25 with normothrombocytopenia ( RUNX1, ANKRD26, ETV6 , and CYCS ), 25 with microthrombocytopenia ( WAS ), 25 with macrothrombocytopenia ( MYH9, TUBB1, SLFN14 , and BSS ). Platelet size, granularity, GPIb/V/IX, GPIIb/IIIa, granules, and procoagulant platelets were analyzed at rest and after activation by a mixture of TRAP+CRP. In addition to the absolute value indicators, a calculated 'index at rest/after activation' in relative units was introduced for personalized changes assessment. The hemorrhage was assessed using a Pediatric Bleeding Questionnaire. The control consisted of 40 children. The bleeding score ranged from 0 to 20 (median of 2). Upon activation, in all groups, weakening in platelet size contraction and procoagulant platelet formation ( P  ≤ 0.02) were observed. In normothrombocytopenia and microthrombocytopenia groups, increased granularity upon activation, attenuation of CD42b shedding/internalization, correlation ( r  ≥ -0.65) between a decrease of procoagulant platelets less than 5% and increase of bleeding were found. Additionally, reduction of δ-granules ( P  ≤ 0.01) in normothrombocytopenias, attenuation of externalization and activation of GP IIb/III, and granules release ( P  ≤ 0.001) in the microthrombocytopenia were detected. The use of 'activation indexes' in relative units allowed to identify and characterize morphofunctional abnormality patterns in different platelet size thrombocytopenia groups and interpreted control values for detecting personalized patient disorders regardless of platelet size.

Isolated prothrombin antibody or isolated factor XI inhibitor have been reported separately in lupus-anticoagulant positive patients. We report the first case of a lupus-anticoagulant positive patient that both simultaneously occurred. A 30-year-old man with a history of systemic lupus erythematosus was positive for lupus-anticoagulant. He exhibited significantly high bleeding score compared to previous reports of lupus-anticoagulant positive patients with isolated prothrombin or factor XI deficiency. Examination via one-stage clotting assays revealed decreased levels of both prothrombin and factor XI. Factor parallelism was proven for prothrombin but not for factor XI. The factor XI inhibitor was quantified at 2.1 Bethesda units in the Bethesda assay, and antiprothrombin nonneutralizing antibody tested positive in ELISA. This study suggests that the concurrence of prothrombin nonneutralizing antibody and factor XI neutralizing inhibitor can aggravate bleeding tendency synergistically in lupus-anticoagulant positive patient. Bethesda assay or ELISA may be considered depending on the factor-parallelism in one-stage clotting assay.

Venous thromboembolism (VTE) remains a significant cause of perioperative morbidity and mortality despite the availability of prophylactic medications. There has been a debate about which thromboprophylaxis medication, Fondaparinux or low-molecular weight heparin (LMWH), is better after hip and knee arthroplasty. We have compared these two treatment regimens in our study. Electronic databases like PubMed, Cochrane, and ScienceDirect were searched from inception to August 2024. The weighted mean difference (WMD) for continuous outcomes and risk ratio (RR) for dichotomous outcomes were pooled using the Review Manager software version 5.4.1, and a random effects model was employed. The Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool (ROB 2.0) were used to assess the quality of the included studies. Publication bias was evaluated visually through funnel plots and statistically through Egger's regression. GRADE assessment was used to analyze the certainty of evidence. A total of 17 studies, 9 Cohorts, and 8 Randomized controlled trials (RCTs) pooling a total of 74 499 patients were included in this meta-analysis. Fondaparinux showed a statistically significant reduction in the risk of VTE [0.59; 95% confidence interval (CI): [0.48, 0.71]; P  < 0.00001; I2  = 36%] and deep venous thrombosis (DVT) (RR = 0.75, 95% CI: [0.56, 1.00]; P  = 0.05; I2  = 68%) compared to LMWH. Major bleeding (RR = 2.06, 95% CI: [1.19, 3.57]; P  = 0.01; I2  = 43%), surgical site bleeding (RR = 1.67, 95% CI: [1.04, 2.66]; P  = 0.03; I2  = 9%), and postoperative transfusions (RR = 1.07, 95% CI: [1.02, 1.12]; P  = 0.004; I2  = 0%) were significantly higher in the Fondaparinux group. Symptomatic VTE, pulmonary embolism, mortality, and operating time showed no significant difference between the two groups. In conclusion, Fondaparinux is superior to LMWH in VTE and DVT prophylaxis. However, it is associated with an increased risk of major bleeding, surgical site bleeding, and postoperative transfusions.

Catastrophic antiphospholipid syndrome (CAPS) is a rare and life-threatening manifestation of antiphospholipid syndrome (APS). Diagnosing CAPS can be particularly challenging, especially due to significant overlap in pathophysiology, signs, and symptoms with other complex hematologic conditions, including thrombotic microangiopathies (TMA) and immune-mediated thrombocytopenia (ITP). In many cases, definitive diagnosis is not clear, leading to delays in care and poor outcomes. Here, we present an elderly patient with previously diagnosed APS now presenting with suspected CAPS, admitted to our inpatient service with a complicated hospital course. The patient received daily plasma exchange, steroids, intravenous immunoglobulin, and therapeutic heparin for anticoagulation. Despite treatment, there was worsening of thrombocytopenia suggesting refractoriness to ongoing treatment. We outline our diagnostic approach, clinical evaluation, treatment strategies, and differential diagnoses pertinent to our atypical clinical presentation of CAPS.

This study compared the efficacy of therapeutic anticoagulation guided by anti-Xa levels vs. a D-dimer-based protocol in ICU patients with COVID-19. Given the heightened risk of thrombosis despite anticoagulation therapy in some cases, we hypothesised that anti-Xa measurement improves anticoagulation effectiveness and clinical outcomes in this population. We retrospectively analysed data from ICU patients at COVID Hospital Karaburma between April 2020 and December 2021. The primary outcome was the incidence of failed noninvasive ventilation necessitating intubation. Secondary endpoints included mortality rates, thromboembolic and bleeding complications, and anticoagulation effectiveness assessed by antifactor Xa activity. The analysis included 395 patients - 137 in the anti-Xa group and 258 in the D-dimer group. The D-dimer group showed a higher rate of failed noninvasive ventilation requiring intubation (65.7% vs. 50%, P  = 0.009). The overall mortality was 48.3%, significantly higher in the D-dimer group (52.7%) compared to the anti-Xa group (40.1%, P  = 0.02). Thromboembolic complications were lower in the anti-Xa group (2.9%) than in the D-dimer group (9.7%, P  = 0.014), with no significant difference in bleeding. Following the first LMWH administration, 70.8% of patients had anti-Xa levels below the therapeutic and 11.7% below the prophylactic range. Anti-Xa-guided anticoagulation improves survival and reduces thromboembolic complications compared to D-dimer-based treatment without increasing bleeding risk. This study highlights the potential of the anti-Xa assay in managing anticoagulation in critically ill COVID-19 patients. Our findings provide a foundation for future research on using anti-Xa measurements as a guiding tool to optimise anticoagulation therapy in other critically ill populations.

Malignancy-associated-hemophagocytic lymphohistiocytosis (HLH) is rare and often seen in high-grade lymphomas and acute leukemias; solid-tumor-associated HLH is extremely uncommon. The diagnosis of malignancy-associated-HLH remains challenging in clinical practices as it masquerades as and coexists with many other conditions. Here we presented a case with concurrent solid-tumor-associated HLH and thrombotic microangiopathy. The patient was an 80-year-old male with microangiopathic hemolytic anemia (MAHA), progressive bi-lineage cytopenia, and active Epstein-Barr virus (EBV) infection. Extensive lab works excluded all other alternative etiologies for MAHA but B12 deficiency, malignancy, and EBV infection. Concurrently, poorly differentiated gastric adenocarcinoma-associated HLH and thrombotic microangiopathy (TMA) were confirmed with extensive lab work. This patient passed away despite high-dose dexamethasone treatment. In the paper, we also discussed the possible pathophysiology of EBV infection in the development of MAHA and HLH and reviewed the treatment options for HLH and TMA.

Venous thromboembolism (TE) and arterial TE are rare in children, but can cause severe morbidity and mortality. The incidence of TE is 8.6-57 per 100 000 among hospitalized children and 0.14-0.9 per 100 000 in the general pediatric population. The risk of TE is increased in pediatric nephrotic syndrome (NS) patients. The incidence of thromboembolic complications in pediatric NS patients is approximately 3%. Herein we report a pediatric patient that presented with massive bilateral pulmonary embolism (PE) in whom the underlying condition was NS. At the onset of the clinical course the clinical findings were attributed to heart failure and, therefore, the diagnosis and treatment of NS was delayed. Based on the presented case, we think that clinicians should consider NS in pediatric patients with PE when hypoalbuminemia, diffuse edema, and massive proteinuria are present, and that timely initiation of NS treatment and concomitant administration of TE treatment can yield positive results. We further think that pediatric patients diagnosed with PE that have concomitant hypoalbuminemia, generalized edema, and massive proteinuria should be considered to have NS and that treatment for NS should be started without delay and concomitantly with TE treatment in order to achieve a positive result.