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Advances in Gerontology = Uspekhi... 2024In the treatment of coronavirus infections, it is important not only to understand the course of the disease, but also to understand what is happening in the human body,... (Review)
Review
In the treatment of coronavirus infections, it is important not only to understand the course of the disease, but also to understand what is happening in the human body, especially in the circulatory system, that is, which disorders lead to deterioration and further complications. Hemostasis disorder in COVID-19 plays an important role in the etiology and clinical manifestations of the disease. The ability to identify factors and risk groups for the development of thrombotic complications, the ability to dynamically interpret peripheral blood parameters and coagulograms, knowledge of diagnostic criteria for possible hemostasis disorders (for example, DIC syndrome, sepsis-associated coagulopathy, antiphospholipids, hemophagocytosis and hypercoagulation syndrome) are necessary to determine the indications for the test. Differentiated prescribing of clinically justified therapy (including anticoagulants and blood components) is important, which determines the complexity of treatment and prognosis for patients with COVID-19. This article is a review of the literature on the topic of hemostasis disorders in elderly and senile patients with mesenteric thrombosis in COVID 19 over the past few years.
Topics: Humans; COVID-19; Aged; Thrombosis; SARS-CoV-2; Blood Coagulation Disorders; Hemostasis; Anticoagulants
PubMed: 38944786
DOI: No ID Found -
The American Journal of Case Reports Jun 2024BACKGROUND Heparin-induced thrombocytopenia (HIT) is a disease in which the immune response elicited by heparin results in a state of hypercoagulability and platelet...
BACKGROUND Heparin-induced thrombocytopenia (HIT) is a disease in which the immune response elicited by heparin results in a state of hypercoagulability and platelet activation, leading to thrombocytopenia and thromboembolism. Gustilo-Anderson type IIIC open fractures of the extremities are defined as open fractures presenting with arterial injuries that require repair and result in treatment challenges and complications. The diagnosis of HIT can be difficult in patients with severe trauma with consumptive thrombocytopenia associated with heavy bleeding and the use of heparin after vascular anastomosis. CASE REPORT A 48-year-old man was injured in a car accident, pinching his right lower leg and sustaining a Gustilo-Anderson type IIIc open fracture, for which he underwent emergency revascularization surgery. Heparin was administered continuously immediately after the surgery. On postoperative day 9, ischemic changes were observed in the right foot, and we performed suture re-anastomosis; however, the blood circulation in the right lower leg did not resume, and right lower leg amputation was performed due to ischemic necrosis with the onset of HIT. Postoperatively, the patient was switched to edoxaban after the recovery of his platelet count. Thereafter, the patient experienced no new thrombus occlusion or wound trouble, and was able to walk on a prosthetic leg and return to daily life. CONCLUSIONS It is important to consider the possibility of HIT as soon as thrombocytopenia appears in patients with Gustilo-Anderson type IIIC open fracture who are receiving heparin after vascular anastomosis, as a delayed diagnosis of HIT can make it difficult to save the limb.
Topics: Humans; Male; Middle Aged; Heparin; Thrombocytopenia; Fractures, Open; Limb Salvage; Anticoagulants; Ischemia
PubMed: 38944681
DOI: 10.12659/AJCR.944121 -
Surgery Jun 2024The focus of this research is to examine the growing use of robotic-assisted minimally invasive esophagectomy. Specifically, it evaluates the immediate clinical and...
BACKGROUND
The focus of this research is to examine the growing use of robotic-assisted minimally invasive esophagectomy. Specifically, it evaluates the immediate clinical and cancer-related results of combining robotic-assisted minimally invasive esophagectomy with a systematic approach to total mesoesophageal excision, as opposed to traditional open transthoracic esophagectomy methods that do not employ a structured total mesoesophageal excision protocol.
METHODS
A propensity score-matched analysis of 185 robotic-assisted minimally invasive esophagectomies and 223 open transthoracic esophagectomies after standardized Ivor Lewis esophagectomy was performed. After 1:1 nearest neighbor matching to account for confounding by covariates, outcomes of 181 robotic-assisted minimally invasive esophagectomy and 181 open transthoracic esophagectomy were compared.
RESULTS
The patient characteristics showed significant differences in the age distribution and in comorbidities such as coronary heart disease, arterial hypertension, and anticoagulant intake. The R0-resection rate of robotic-assisted minimally invasive esophagectomy (96.7%) was significantly higher than open transthoracic esophagectomy (89.0%, P = .004). Thirty-day mortality and hospital mortality showed no significant differences. Postoperative pneumonia rate after robotic-assisted minimally invasive esophagectomy (12.7%) was significantly reduced (open transthoracic esophagectomy 28.7%, P < .001). Robotic-assisted minimally invasive esophagectomy had a significantly shorter intensive care unit stay (P < .001) and shorter hospital stay (P < .001).
CONCLUSION
This single-center, retrospective study employing propensity score matching found that combining robotic-assisted minimally invasive esophagectomy with structured total mesoesophageal excision results in better short-term clinical and oncologic outcomes than open transthoracic esophagectomy. This finding is significant because the increased rate of R0 resection could indicate a higher likelihood of improved long-term survival. Additionally, enhanced overall postoperative recovery may contribute to better risk management in esophagectomy procedures.
PubMed: 38944589
DOI: 10.1016/j.surg.2024.05.023 -
Foot and Ankle Surgery : Official... Jun 2024Venous thrombo-embolism (VTE) is a recognised complication of foot and ankle surgery. There are multiple possible anticoagulation treatments available in the UK to...
INTRODUCTION
Venous thrombo-embolism (VTE) is a recognised complication of foot and ankle surgery. There are multiple possible anticoagulation treatments available in the UK to mitigate the risk of developing VTE. Our primary objective was to assess the variability of chemical anticoagulation prescribed in patients undergoing foot and ankle procedures.
METHODS
This was a UK-based national, multicenter, prospective audit spanning a collection duration of 9 months on all foot and ankle procedures, carried out in 68 UK centers between 1st June 2022 and 30th November 2022, with a further 3-month follow up period. All patients who underwent a foot and ankle surgical procedure (including Achilles tendon rupture treatment) were included in this study.
RESULTS
Data on a total of 13,569 patients was submitted. Following data cleansing, 11,363 patients were available for further analysis, with anticoagulation data available for 11,099 patients. There were eleven different chemical anticoagulation treatments recorded across the cohort. A total of 3630 (31.95 %) patients received no chemical anticoagulation. The patients receiving chemical anticoagulation medication could be split into 4 main groups. The most common chemical anticoagulation received was low molecular weight heparin (LMWH) (6303, 84.4 % of patients receiving chemical anticoagulation). Aspirin was given in 4.1 % (308 patients), a Factor Xa inhibitor in 10 % (744 patients) and other anticoagulants (e.g. Warfarin) in 1.5 % (114 patients). The overall VTE rate in this sub analysis of patients receiving chemical anticoagulation, was 1.1 % (83 cases out of 7469). There was no significant difference seen in incidence of VTE between types of anticoagulants, when confounding factors were considered. The duration of post-operative chemical prophylaxis used by participants for most chemical anticoagulants was 6 weeks (64.50 %).
CONCLUSION
There was significant variability of chemical anticoagulants reported in the study, with five different categories of anticoagulants used (including no chemical anticoagulation), and none clearly superior/inferior. The duration of anticoagulation was consistent across types of thromboprophylaxis.
PubMed: 38944567
DOI: 10.1016/j.fas.2024.06.005 -
Journal of Stroke and Cerebrovascular... Jun 2024-Patients with atrial fibrillation (AF) undergoing elective procedures are at risk for Major Adverse Cardiovascular Events (MACE) and symptomatic bleeding. We aimed to...
INTRODUCTION
-Patients with atrial fibrillation (AF) undergoing elective procedures are at risk for Major Adverse Cardiovascular Events (MACE) and symptomatic bleeding. We aimed to identify risk factors to guide perioperative risk stratification.
METHODS
-We conducted a post-hoc analysis of the "Bridging Anticoagulation in Patients who Require Temporary Interruption of Warfarin Therapy for an Elective Invasive Procedure or Surgery" randomized trial. The primary outcomes were MACE and symptomatic bleeding. Our statistical approach encompassed standard univariate analysis, logistic stepwise regression, and Cox regression models. Additional interaction analyses evaluated the interplay between low-molecular-weight heparin bridge therapy and other identified risk factors.
RESULTS
-Among A total of 1,813 participants (mean age 71.6±8.8, 73.3% male), MACE occurred in 25 (1.4%) individuals, with pre-procedure clopidogrel use (adjusted hazard ratio [aHR] 7.73, 95% CI 2.63-22.72, p<0.001) and CHADS-VASc score ≥ 5 (aHR 2.89, 95% CI 1.26-6.63, p=0.012) identified as risk factors. Symptomatic bleeding occurred in 57 (3.1%) individuals, with bridge therapy (aHR 1.84, 95% CI 1.07-3.19, p=0.029), renal disease (aHR 2.50, 95% CI 1.34-4.67, p=0.004), post-procedure aspirin use (aHR 2.86, 95% CI 1.66-4.91, p<0.001), post-procedure nonsteroidal anti-inflammatory drug use excluding aspirin (aHR 3.40, 95% CI 1.22-9.43, p=0.019), and major surgery (aHR 3.94, 95% CI 2.26-6.85, p<0.001) identified as risk factors. The interactions between risk factors and bridging therapy on MACE and symptomatic bleeding outcomes were not significant (p>0.05).
CONCLUSION
-We identified predictors for MACE and symptomatic bleeding in AF patients undergoing elective procedures. These insights may help guide perioperative decisions to reduce the risk of adverse outcomes.
PubMed: 38944363
DOI: 10.1016/j.jstrokecerebrovasdis.2024.107839 -
Journal of Thrombosis and Haemostasis :... Jun 2024Antiphospholipid antibodies (aPL), including lupus anticoagulant (LA), antibodies against β2 glycoprotein I (anti-β2GPI) and anticardiolipin antibodies (aCL) are...
BACKGROUND
Antiphospholipid antibodies (aPL), including lupus anticoagulant (LA), antibodies against β2 glycoprotein I (anti-β2GPI) and anticardiolipin antibodies (aCL) are associated with ischemic stroke (IS). Their prevalence and clinical relevance in atrial fibrillation (AF) remain unclear.
AIM
To assess whether aPL are associated with increased risk of ischemic stroke (IS) in AF patients despite anticoagulation.
MATERIAL AND METHODS
We conducted a post hoc analysis of aPL using blood samples from 243 consecutive AF patients enrolled in the cohort study. Markers of a prothrombotic state, including endogenous thrombin potential (ETP), fibrin clot permeability and lysis time were measured at baseline. During a median follow-up of 52 months, IS/transient ischemic attack (TIA) and major bleeding were recorded.
RESULTS
We observed aPL at a moderate or high titer in 51 (21%) patients, including 17 (7%) with anti-β2GPI, 19 (7.8%) with aCL antibodies, and 37 (15.2%) with LA. aPL-positive patients were more likely to have prior stroke (p=0.01) and be active smokers (p=0.03), along with increased ETP (p=0.02), without any changes in fibrin clot properties. Anti-β2GPI (HR=4.38, 95% CI 1.58-12.19) and aCL (HR=4.70, 95% CI 1.80-12.30) at a moderate or high titer were associated with IS during follow-up (n=20; 1.9%/year). There were 23 major bleedings (2.1% per year) and 20 deaths (1.9% per year), which were not associated with aPL.
CONCLUSION
Our study showed a relatively high prevalence of aPL-positivity in AF patients, which was linked to increased risk of IS/TIA. This suggests that screening for aPL might help optimizing anticoagulant therapy in such patients.
PubMed: 38944242
DOI: 10.1016/j.jtha.2024.05.038 -
Journal of Thrombosis and Haemostasis :... Jun 2024There is no established risk score for anticoagulant-related bleeding during the acute phase in patients with pulmonary embolism (PE). The Syncope, Anemia, Renal...
BACKGROUND
There is no established risk score for anticoagulant-related bleeding during the acute phase in patients with pulmonary embolism (PE). The Syncope, Anemia, Renal Dysfunction (PE-SARD) bleeding score was developed to predict early major bleeding, but has not yet been fully externally validated.
OBJECTIVES
To externally validate the PE-SARD bleeding score.
PATIENTS/METHODS
Using the COMMAND VTE Registry-2 database, which enrolled 5197 consecutive acute symptomatic venous thromboembolism patients among 31 centers in Japan between January 2015 and August 2020, we identified acute PE patients. We divided those into 3 groups by the score: high-risk (>2.5 points), intermediate-risk (1-2.5 points), and low-risk (0 points). The discriminating and calibration performances of the score for 30-day major bleeding were assessed. Subgroup analyses based on active cancer were also performed.
RESULTS
Of 2781 eligible patients, the high-risk group accounted for 557 patients (20%), intermediate-risk group for 1412 (51%), and low-risk group for 812 (29%). Major bleeding occurred in 121 patients within 30 days. The cumulative 30-day incidence of major bleeding substantially increased in the higher risk categories by the score (high-risk group: 8.2% [95%CI, 5.9%-10.5%], intermediate-risk group: 4.6% [95%CI, 3.5%-5.7%], and low-risk group: 1.8% [95%CI, 0.8%-2.7%]). The discriminating power of the score was modest with a C-statistic of 0.65 (95%CI, 0.61-0.70) with a good calibration performance with a score of <4 points except for in active cancer patients.
CONCLUSIONS
The PE-SARD bleeding score had a modest discriminating performance with a limited calibration performance in acute PE patients without active cancer.
PubMed: 38944241
DOI: 10.1016/j.jtha.2024.06.011 -
Drug Metabolism and Personalized Therapy Jul 2024Apixaban, a direct oral anticoagulant, is increasingly used worldwide for the treatment and prevention of venous thromboembolism and ischemic stroke in patients with...
OBJECTIVES
Apixaban, a direct oral anticoagulant, is increasingly used worldwide for the treatment and prevention of venous thromboembolism and ischemic stroke in patients with nonvalvular atrial fibrillation (AF). Obviously, one of the ways to enhance effectiveness and safety of drug therapy is a personalized approach to therapy, which involves pharmacogenetic and pharmacokinetic tests. The study aims to investigate the effect of , and polymorphisms on the pharmacokinetics of apixaban and the risk of bleeding.
METHODS
A total of 84 patients were enrolled in this prospective observational study. All patients received apixaban 5 or 2.5 mg twice daily. Real-time polymerase chain reaction was used to evaluate single-nucleotide polymorphisms of the gene (rs1045642 and rs4148738), (rs35599367) C>T, (rs776746) A>G. A plasma trough concentration/dose (C/D) ratio was used as a pharmacokinetic index.
RESULTS
The C/D ratio was higher in patients aged >80 years (F(1)=11.209, p=0.00124) and was affected by serum creatinine (>133 μmol/L, F(1)=6.7, p=0.01124). (rs1045642 and rs4148738), () and (rs35599367) polymorphisms did not show a correlation with C/D ratio of apixaban. Multivariate logistic regression analyses showed that none of the clinical or genetic factors predicted the fact of bleeding.
CONCLUSIONS
We report no significant association between gene polymorphisms (rs1045642 and rs4148738), (rs35599367) C>T, (rs776746) A>G and bleeding events on apixaban treatment. Complementing the existing criteria with pharmacogenetic and pharmacokinetics information for the patients with AF will enable further individualization of apixaban.
PubMed: 38943286
DOI: 10.1515/dmpt-2024-0013 -
Thrombosis Journal Jun 2024Hypercoagulability emerges as a central pathological feature and clinical complication in nephrotic syndrome. Increased platelet activation and aggregability are closely...
BACKGROUND
Hypercoagulability emerges as a central pathological feature and clinical complication in nephrotic syndrome. Increased platelet activation and aggregability are closely related to hypercoagulability in nephrotic syndrome. Monocyte-platelet aggregates (MPAs) have been proposed to represent a robust biomarker of platelet activation. The aim of this study was to investigate levels of the circulating MPAs and MPAs with the different monocyte subsets to evaluate the association of MPAs with hypercoagulability in nephrotic syndrome.
METHODS
Thirty-two patients with nephrotic syndrome were enrolled. In addition, thirty-two healthy age and sex matched adult volunteers served as healthy controls. MPAs were identified by CD14 monocytes positive for CD41a platelets. The classical (CD14 + + CD16-, CM), the intermediate (CD14 + + CD16+, IM) and the non-classical (CD14 + CD16++, NCM) monocytes, as well as subset specific MPAs, were measured by flow cytometry.
RESULTS
Patients with nephrotic syndrome showed a higher percentage of circulating MPAs as compared with healthy controls (p < 0.001). The percentages of MPAs with CM, IM, and NCM were higher than those of healthy controls (p = 0.012, p < 0.001 and p < 0.001, respectively). Circulating MPAs showed correlations with hypoalbuminemia (r=-0.85; p < 0.001), hypercholesterolemia (r = 0.54; p < 0.001), fibrinogen (r = 0.70; p < 0.001) and D-dimer (r = 0.37; p = 0.003), but not with hypertriglyceridemia in nephrotic syndrome. The AUC for the prediction of hypercoagulability in nephrotic syndrome using MPAs was 0.79 (95% CI 0.68-0.90, p < 0.001). The sensitivity of MPAs in predicting hypercoagulability was 0.71, and the specificity was 0.78.
CONCLUSION
Increased MPAs were correlated with hypercoagulability in nephrotic syndrome. MPAs may serve as a potential biomarker for thrombophilic or hypercoagulable state and provide novel insight into the mechanisms of anticoagulation in nephrotic syndrome.
PubMed: 38943162
DOI: 10.1186/s12959-024-00626-3 -
Internal and Emergency Medicine Jun 2024It is still uncertain whether direct oral anticoagulants (DOACs) perform better than vitamin K antagonists (VKAs) in subjects with non-valvular atrial fibrillation...
It is still uncertain whether direct oral anticoagulants (DOACs) perform better than vitamin K antagonists (VKAs) in subjects with non-valvular atrial fibrillation (NVAF) and advanced chronic kidney disease (CKD). The aim of the study was to compare safety and effectiveness of DOACs and VKAs in patients with NVAF and stage 4 CKD (creatinine clearance 15-29 mL/min). We searched the hospital databases of two academic centers to retrospectively identify patients with stage 4 CKD who were on treatment with DOACs or VKAs for NVAF. Safety was the primary outcome of the study and was assessed in terms of incidence of major bleeding (MB). Secondary outcomes were clinically relevant non-major bleeding (CRNMB) and death for any cause. A total of 176 patients (102 on DOACs and 74 on VKAs) were found and included in the analysis. The incidence rate of MB was not statistically different between groups (8.6 per 100 patients-year in the DOAC group and 5.6 per 100 patients-year in the VKA group). Rates of IS/SSE and CRNMB were statistically similar in the two treatment groups, as well. There were less deaths for any cause in the DOAC group than in the VKA group (8.6 and 15.8 per 100 patients-year, respectively), but the difference was not statistically significant. This study found no difference in terms of safety and effectiveness between patients with NVAF and stage 4 CKD treated with DOACs and VKAs. Larger prospective or randomized studies are needed to confirm these findings.
PubMed: 38943034
DOI: 10.1007/s11739-024-03658-9