Postpartum wound morbidity according to timing of prophylactic anticoagulation administration

Background: Thrombotic complications are considered among the main extrapulmonary manifestations of COVID-19. The optimal type and duration of prophylactic antithrombotic therapy in these patients remain unknown. Methods: This manuscript reports the final (90-day) results of the Intermediate versus Standard-dose Prophylactic anticoagulation In cRitically-ill pATIents with COVID-19: An opeN label randomized controlled trial (INSPIRATION) study. Patients with COVID-19 admitted to intensive care were randomized to intermediate-dose versus standard-dose prophylactic anticoagulation for 30 days, irrespective of hospital discharge status. The primary efficacy outcome was a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation (ECMO), or all-cause death. The main safety outcome was major bleeding. Results: Of 600 randomized patients, 562 entered the modified intention-to-treat analysis (median age [Q1, Q3]; 62 (50, 71) years; 237 (42.2%) women), of whom 336 (59.8%) survived to hospital discharge. The primary outcome occurred in 132 (47.8%) of patients assigned to intermediate-dose and 130 (45.4%) patients assigned to standard-dose prophylactic anticoagulation (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 0.95-1.55, P=0.11). No significant differences were observed between the two groups for other efficacy outcomes, or in the landmark analysis from days 31-90. Overall, there were 7 (2.5%) major bleeding events in the intermediate-dose group (including 3 fatal events) and 4 (1.4%) major bleeding events in the standard-dose group (none fatal) (HR: 1.82, 95% CI: 0.53-6.24, P=0.33). Conclusion: Intermediate-dose compared with standard-dose prophylactic anticoagulation did not reduce a composite of death, treatment with ECMO, or venous or arterial thrombosis at 90-day follow-up.

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High-Dose Prophylactic Anticoagulation in Severe COVID-19 Pneumonia

CHEST Journal ◽

10.1016/j.chest.2021.02.036 ◽

2021 ◽

Vol 160 (1) ◽

pp. e94-e95

Author(s):

Rashid Nadeem ◽

Sahish Kamat

Keyword(s):

High Dose ◽

Prophylactic Anticoagulation

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Familial thrombophilia associated with fibrinogen Paris V: Dusart syndrome

Blood ◽

10.1182/blood.v96.3.1191 ◽

2000 ◽

Vol 96 (3) ◽

pp. 1191-1193 ◽

Cited By ~ 15

Author(s):

Takashi Tarumi ◽

Danko Martincic ◽

Anne Thomas ◽

Robert Janco ◽

Mary Hudson ◽

...

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Early Onset ◽

Family Members ◽

Initial Presentation ◽

Pulmonary Emboli ◽

Common Cause ◽

History Of ◽

Prophylactic Anticoagulation ◽

Fibrin Clots

Abstract We report on a family with a history of venous thromboembolism associated with fibrinogen Paris V (fibrinogen A-Arg554→Cys). Ten members experienced thrombotic events, including 4 with fatal pulmonary emboli. Pulmonary embolism was the presenting feature in 4. Those with the mutation and a history of thrombosis had somewhat higher fibrinogen concentrations than those with the mutation and no thrombosis (294 ± 70 mg/dL vs 217 ± 37 mg/dL, respectively). The Paris V mutation consistently caused a prolongation of the reptilase time, and fibrin clots containing the abnormal fibrinogen were more translucent than normal clots. Given the early onset of symptoms and the initial presentation with pulmonary embolism in some family members, it was justifiable to offer prophylactic anticoagulation with warfarin to carriers of the mutation. Fibrinogen Paris V has now been reported in 4 apparently unrelated families, indicating that it is a relatively common cause of dysfibrinogenemia-associated thrombosis.

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Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review

Journal of Clinical Medicine ◽

10.3390/jcm10081740 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1740

Author(s):

Marion Bareille ◽

Michaël Hardy ◽

Jonathan Douxfils ◽

Stéphanie Roullet ◽

Dominique Lasne ◽

...

Keyword(s):

Systematic Review ◽

Mechanical Strength ◽

Small Sample ◽

The Common ◽

Small Sample Sizes ◽

Definition Of ◽

Reported Data ◽

Prophylactic Anticoagulation ◽

The Impact ◽

Heparin Neutralization

Infection by SARS-CoV-2 is associated with a high risk of thrombosis. The laboratory documentation of hypercoagulability and impaired fibrinolysis remains a challenge. Our aim was to assess the potential usefulness of viscoelastometric testing (VET) to predict thrombotic events in COVID-19 patients according to the literature. We also (i) analyzed the impact of anticoagulation and the methods used to neutralize heparin, (ii) analyzed whether maximal clot mechanical strength brings more information than Clauss fibrinogen, and (iii) critically scrutinized the diagnosis of hypofibrinolysis. We performed a systematic search in PubMed and Scopus databases until December 31st, 2020. VET methods and parameters, and patients’ features and outcomes were extracted. VET was performed for 1063 patients (893 intensive care unit (ICU) and 170 non-ICU, 44 studies). There was extensive heterogeneity concerning study design, VET device used (ROTEM, TEG, Quantra and ClotPro) and reagents (with non-systematic use of heparin neutralization), timing of assay, and definition of hypercoagulable state. Notably, only 4 out of 25 studies using ROTEM reported data with heparinase (HEPTEM). The common findings were increased clot mechanical strength mainly due to excessive fibrinogen component and impaired to absent fibrinolysis, more conspicuous in the presence of an added plasminogen activator. Only 4 studies out of the 16 that addressed the point found an association of VETs with thrombotic events. So-called functional fibrinogen assessed by VETs showed a variable correlation with Clauss fibrinogen. Abnormal VET pattern, often evidenced despite standard prophylactic anticoagulation, tended to normalize after increased dosing. VET studies reported heterogeneity, and small sample sizes do not support an association between the poorly defined prothrombotic phenotype of COVID-19 and thrombotic events.

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Venous Thromboembolism Anticoagulation Prophylaxis Timing in Patients Undergoing Craniotomy for Tumor

Neurosurgery Open ◽

10.1093/neuopn/okaa018 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Hanna Algattas ◽

Spencer E Talentino ◽

Bradley Eichar ◽

Abraham A Williams ◽

Joseph M Murphy ◽

...

Keyword(s):

Venous Thromboembolism ◽

Clinical Judgment ◽

Tumor Resection ◽

The Elderly ◽

Extent Of Resection ◽

Subtotal Resection ◽

Hemorrhagic Complication ◽

Increased Risk ◽

Hemorrhagic Complications ◽

Prophylactic Anticoagulation

ABSTRACT BACKGROUND Prophylactic anticoagulation helps prevent postoperative venous thromboembolism (VTE) and time to initiation postcraniotomy has relied on clinical judgment and practice patterns. OBJECTIVE To compare risks of postoperative VTE and hemorrhage among patients undergoing tumor resection with initiation of prophylactic anticoagulation on postoperative day 1 (POD1) vs POD2. METHODS Adult patients undergoing craniotomy for tumor between 2008 and 2018 were retrospectively reviewed. Outcomes were recorded from the Electronic medical record (EMR) including deep vein thrombosis (DVT), pulmonary embolism (PE), and hemorrhage. RESULTS Of a total of 1168 patients undergoing craniotomy, 225 initiated anticoagulation on POD1 and 389 initiated on POD2. Of the 171 glioblastoma (GBM) cases, 64 initiated on POD1 and 107 on POD2. There were 9 DVTs (1.5%), 1 PE (0.20%), overall VTE rate of 1.6%, and 7 hemorrhagic complications (1.10%), 4 being clinically significant. The GBM cohort contained 4 DVTs (2.3%) and 3 hemorrhagic complications (1.80%). There was no increased risk of VTE or hemorrhage with anticoagulation initiated on POD2 compared to POD1 in either cohort. Multivariate analysis in both cohorts did not reveal a significant association between DVT, PE, or hemorrhagic complications with age, body mass index, GBM pathology, or extent of resection. Interestingly, glioma patients older than 70 with subtotal resection had a higher likelihood of suffering intracranial hemorrhage when anticoagulation was started on POD1 (odds ratio 12.98). CONCLUSION Risk of VTE or hemorrhagic complication did not significantly differ with prophylactic anticoagulation started on POD1 vs POD2. Early anticoagulation may certainly be considered in high risk cases; however, 1 group where risk may outweigh benefit is the elderly glioma population receiving a subtotal resection.

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Post‐hospitalization venous thromboembolism in COVID‐19 patients: Evidence against routine post‐hospitalization prophylactic anticoagulation

International Journal of Laboratory Hematology ◽

10.1111/ijlh.13633 ◽

2021 ◽

Author(s):

Jing Yuan Tan ◽

Chuen Wen Tan ◽

Wan Hui Wong ◽

May Anne Cheong ◽

Lai Heng Lee ◽

...

Keyword(s):

Venous Thromboembolism ◽

Prophylactic Anticoagulation

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Paroxysmal Nocturnal Hemoglobinuria in Pregnancy: A Dilemma in Treatment and Thromboprophylaxis

Case Reports in Hematology ◽

10.1155/2017/7289126 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

Arpan Patel ◽

Athira Unnikrishnan ◽

Martina Murphy ◽

Robert Egerman ◽

Sarah Wheeler ◽

...

Keyword(s):

Arterial Thrombosis ◽

Paroxysmal Nocturnal Hemoglobinuria ◽

Post Partum ◽

Current Treatment ◽

Safety And Efficacy ◽

Class A ◽

Hematologic Disorder ◽

Prophylactic Anticoagulation ◽

Risk For Thrombosis ◽

In Pregnancy

Paroxysmal nocturnal hemoglobinuria (PNH) is a hematologic disorder characterized by an acquired somatic mutation in the phosphatidylinositol glycan class A gene which leads to a higher risk for increased venous and arterial thrombosis. Current treatment for PNH includes eculizumab. Pregnant patients who have PNH have higher risk for thrombosis and hemorrhage with both pregnancy and their underlying PNH. Treatment frequently poses conundrum. The safety and efficacy of eculizumab during pregnancy and breast feeding have not been extensively studied and contraception has been recommended due to potential for teratogenicity. We present a case of a patient who was safely on both eculizumab and modest prophylactic anticoagulation for 6 weeks post-partum.

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