The Predictive Value of Thromboelastogram in the Evaluation of Patients with Suspected Acute Venous Thromboembolism

Abstract The diagnosis of venous thromboembolism (VTE) is being done by imaging studies but can be ruled out by clinical probability assessment together with a D-dimer blood test. Thromboelastogram (TEG) is usually used for the evaluation of bleeding tendency but can demonstrate also hypercoagulable states. Our hypothesis was that TEG may estimate the presence of VTE more accurately than D-dimer. This prospective study recruited patients that presented to the emergency room or to the vascular laboratory with signs/ symptoms that raise the suspicion of acute VTE. TEG parameters that were examined were: Reaction time(R), Clot time formation (K), Alpha angle (α), Maximal amplitude (MA), Clot viscoelasticity (G), Coagulation Index (CI) and Clot lysis at 30 minutes (LY30). The expected values for hypercoagulable state include: short R and K and high α, MA, G, LY30 and CI. Between April and October 2016, a total of 109 patients were enrolled in the study with a median age of 55.7 (21-89) years. Their characteristics are summarized in table 1. Forty-eight percent of the patients had at least one risk factor for development of VTE. According to the Well's criteria, 54 (49.5%) patients had low probability, 46 (42.2%) - moderate and 9 (8.3%) - high probability for developing VTE. Eighteen patients were diagnosed with VTE; 12 with DVT, 7 with PE and one with both. Analyzing the different TEG parameters, both as continuous (table 2) or categorical variables (according to their normal range), did not reveal a statistically significant difference between VTE positive and negative patients. Combining different TEG parameters or dividing the cohort according to: gender, clinical suspicion of VTE based on the Well's criteria or different levels of D-dimer did not change the results of the analysis. In conclusion, the current study could not demonstrate a significant value of any TEG parameter as a predictor of VTE in a general population of patients who came to the emergency room or vascular laboratory with signs/ symptoms that raise the suspicion of VTE. Disclosures No relevant conflicts of interest to declare.

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The Predictive Value of Thromboelastogram in the Evaluation of Patients with Suspected Acute Venous Thromboembolism

Acta Haematologica ◽

10.1159/000502348 ◽

2019 ◽

Vol 143 (3) ◽

pp. 272-278

Author(s):

Tareq Abu Assab ◽

David Raveh-Brawer ◽

Julia Abramowitz ◽

Mira Naamad ◽

Chezi Ganzel

Keyword(s):

Venous Thromboembolism ◽

Emergency Room ◽

Alpha Angle ◽

Categorical Variables ◽

Clot Lysis ◽

Fisher Exact Test ◽

Continuous Variables ◽

Exact Test ◽

Significant Difference ◽

D Dimer

Introduction: The objective of this prospective study was to examine whether thromboelastogram (TEG) can predict the presence of venous thromboembolism (VTE) in patients who arrive at the emergency room with signs/symptoms that raise the suspicion of acute VTE. Methods: Every patient was tested for D-dimer and all TEG parameters, including: reaction time, clot time formation, alpha-angle, maximal amplitude, clot viscoelasticity, coagulation index, and clot lysis at 30 min. For categorical variables, χ2 or the Fisher exact test were used, and for continuous variables the t test or other non-parametric tests were used. Results: During 2016, a total of 109 patients were enrolled with a median age of 55.7 (21–89) years. Eighteen patients were diagnosed with VTE. Analyzing the different TEG parameters, both as continuous and categorical variables, did not reveal a statistically significant difference between VTE-positive and VTE-negative patients. Combining different TEG parameters or dividing the cohort according to gender, clinical suspicion of VTE (Well’s criteria), or different levels of D-dimer did not change the results of the analysis. Conclusion: The current study could not demonstrate a significant value of any TEG parameter as a predictor of VTE among patients who came to the emergency room with signs/symptoms that raise the suspicion of VTE.

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Clinical Profile and Outcome of COVID Positive Hematology Patients during the COVID-19 Pandemic - an Analytical Cross Sectional Study from a Tertiary Care Centre in India

Blood ◽

10.1182/blood-2021-154144 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 4996-4996

Author(s):

Faisal Kassim ◽

Chirag Sunil Lalwani ◽

Hamsini Movva ◽

Sani Kodathumuriyil Sunny ◽

Merlin Moni ◽

...

Keyword(s):

Active Treatment ◽

Conflicts Of Interest ◽

Tertiary Care ◽

Outcome Variable ◽

Categorical Variables ◽

Care Hospital ◽

Cross Sectional ◽

Hematological Diseases ◽

Significant Difference ◽

D Dimer

Abstract Introduction: The COVID-19 pandemic is a global public health challenge that has affected more than 30 million people and taken more than 4 lakh lives in India. The first and second COVID waves have greatly impacted the lives of a vast majority and vaccination of the masses remains a struggle. Although SARS -CoV-2 infections in patients with hematological diseases are expected to have an adverse outcomes, only limited reports are available from India. Hence, our study aims to identify the outcome in terms of severity and mortality in this group and the risk factors involved in developing severe COVID-19 and death. Methodology: This is a cross sectional analytical study done in a tertiary care hospital in Southern India for a period of 11 months. All hematological patients irrespective of age, who were infected with SARS-CoV-2 during the first wave (June -December 2020) and second wave (March - June 2021) were consecutively enrolled for the study after IRB approval. The patients were then categorized as neoplastic (acute and chronic leukemia, lymphoma, myeloma, MPN and MDS ) and non-neoplastic (ITP, aplastic anemia, hemolytic anemia, MGUS and TTP ) diseases. The clinical data was collected retrospectively from the electronic medical records and by direct telephonic contact. Patients were categorized as having mild (spO2 > 94 % symptomatic /asymptomatic), moderate (spO2 90 - 94 %) and severe (spO2 < 90 %) disease based on their severity of infection, each category of patients received appropriate clinical management. Treatment details, mortality and other outcomes were recorded for 30 days. The continuous variables were represented as mean (± SD)/median (IQR) and categorical variables as frequency and percentage. The association of the outcome variable with selected variables were calculated using Chi-square tests and kaplan meier survival analysis. The data sets were analyzed (SPSS version 21) and a p value of < 0.05 was considered statistically significant. Results: The study was conducted with 70 patients (n=70). Demographic details of patients are summarized in Table 1.Seventeen (24.3%) out of 49 (70%) hospitalized patients required ICU care. There were 13 (18.6%)deaths. in the patients who survived, prolonged antigen positivity of COVID on testing after 21 days was seen in 9 patients (16.1%). In 35 patients (50%)hematological treatment was restarted with a mean delay of 9.2 +/- 10.72 days. Predictors of severity of the disease is summarized in Table 2. Age more than 50 years (P=0.002)(Figure 1a), severe COVID (P=<0.001) and D dimer value of >2 times normal (P=0.047) were associated with a 30-day mortality. Additionally, patients on active treatment for hematological disease were at greater risk of severe COVID (P=0.012). There was no significant difference in severity (P=0.197) or mortality (P=0.556)in patients with neoplastic vs. non-neoplastic disorders Conclusion: COVID-19 patients with malignant and non-malignant hematological diseases showed an increased mortality. Age > 50 years and high D dimer values (>2N) were identified as predictors of mortality. Active treatment for haematological disease predisposed to severe disease.The study needs to be validated further on a larger cohort of patients . Preventive strategies including vaccination is warranted in patients with hematological disorders. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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The Correlation Analysis of Venous Thromboembolism and Acute Myocardial Infarction with the Levels and Polymorphisms of Coagulation and Anticoagulation Factors.

Blood ◽

10.1182/blood.v110.11.3929.3929 ◽

2007 ◽

Vol 110 (11) ◽

pp. 3929-3929

Author(s):

Linhua Yang ◽

Xuanmao Han ◽

Zhenhua Qiao ◽

Jinfang Ren ◽

Xiue Liu ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Venous Thromboembolism ◽

Gene Polymorphisms ◽

Allele Frequencies ◽

Occurrence Rate ◽

Healthy Group ◽

Significant Difference ◽

And Control ◽

D Dimer

Abstract To evaluate levels of coagulation /anticoagulation factors and distribution of their gene polymorphisms in patients with venous thromboembolism(VTE) and acute myocardial infarction(AMI). Of 95 VTE, 95 AMI patients and 95 normal controls were be studied. The results showed that the levels of fibrinogen and D-Dimer, the activies of FII, FV and FVIII were remarkably higher in patient with VTE than those in healthy group, and the activities of FIX, PC and AT were of no significant difference between VTE group and healthy group. The mean levels of fibrinogen, D-Dimer, FV:C and FVIII:C were significantly higher in AMI group than that in controls; while, no significant difference of FII:C, FIX:C, PC:A and AT:A between AMI patients and the controls. In controls, -148CT + -148TT was associated with higher fibrinogen concentrations, the genotypes of other gene polymorphisms were not associated with levels of coagulation /anticoagulation factors. Clear difference were observed for the T allele frequencies of -148C/T and distribution frequencies of FII A19911G were found between VTE group and normal group. there was significant difference of -1476TT genotype distributions and T allele frequencies in -1476A/T between VTE and control subjects. There was significant difference of AC+CC genotype distribution in 1298 A/C polymorphisms between AMI and control, and it was so with the GA genotype in 1793 G/A polymorphisms. But neither genotype frequencies nor allele frequencies of other polymorphisms were found to be no of significant difference between VTE /AMI group and control group. This study proved the importance of combined functions of several coagulant factors in causing VTE and AMI. The carriage of the C148T mutation, FII 20210G/A and -1476A/T polymorphism might be associated with an increased risk of VTE, while the MTHFR 1298A/C and 1793G/A polymorphisms may be related to the development of AMI. Only some of joint occurrence of above polymorphisms might increase the occurrence rate of VTE or AMI.

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Increased Neutrophil Adhesive Properties In Patients with Venous Thromboembolism and Residual Vein Thrombosis and High D-Dimer Levels

Blood ◽

10.1182/blood.v118.21.2301.2301 ◽

2011 ◽

Vol 118 (21) ◽

pp. 2301-2301

Author(s):

kiara Cristina Senger Zapponi ◽

Luis Fernando Bittar ◽

Bruna m Mazetto ◽

Fernanda Dutra Santiago-Bassora ◽

Fernanda A. Orsi ◽

...

Keyword(s):

Venous Thromboembolism ◽

Venous Thrombosis ◽

Recurrence Risk ◽

Neutrophil Adhesion ◽

Baseline Characteristic ◽

Adherent Cells ◽

Adhesive Properties ◽

Vein Thrombosis ◽

Significant Difference ◽

D Dimer

Abstract Abstract 2301 Introduction: Venous Thromboembolism (VTE) is a multifactorial disease that affects 1:1000 individuals worldwide, with a recurrence rate of about 25% in 10 years. Although many risk factors for VTE are well defined, first presentation and recurrence depend, at least in part, on as yet unknown etiologic factors. Studies in animal models show a tight relation between inflammation and hemostasis, as well as the infiltration of neutrophils in the venous wall after the induction of venous thrombosis. Neutrophils also participate in different stages in the formation and resolution of venous thrombosis. Methods: In this study, we investigated the adhesive properties of neutrophils in VTE patients. We hypothesized that increased adhesive properties of these cells, either as an individual baseline characteristic or as an acquired alteration after a previous VTE episode, could be associated with the thrombotic process. The patient population consisted of 22 VTE patients (14F:8M; median age: 46.1 years) that had completed at least 6 months of oral anticoagulation. Twenty-two healthy volunteers matched to VTE patients by age, gender and ethnic background were used as controls. Neutrophil adhesion was measured by a static adhesion assay in triplicate. Peripheral blood was collected with heparin and neutrophils were separated on Histopaque® (Sigma-Aldrich, St. Louis, MO, USA). Isolated neutrophils (2.2×106 cells/ml) were allowed to adhere to fibronectin (FN)-coated 96-well plates (30 min, 37°C, 5%CO2). Non-adherent cells were then removed by washing and adherent cells calculated as the percentage of cells adhered, compared to a standard curve of known cell concentrations and using a colorimetric enzyme assay. Results are expressed as means ± standard error of mean (SEM) and were compared using the Mann-Whitney test. Results: Overall, adhesion of neutrophils from VTE patients (25.40% ±2.35) was not increased when compared to the control group (21.25%±1.20 p=0.2). However when only patients at a higher risk of recurrence (n=13) - here defined as the presence of elevated D-dimer (higher than 0.5mg/L) and residual vein thrombosis - were analyzed, a statistically significant increase in cell adhesion compared to matched controls was observed (26.70%±2.08 and 21.36%±1.26, respectively, p = 0.04). When these patients (higher recurrence risk; n=13) were compared to the remaining VTE patients (standard recurrence risk, n=9), a non significant increase in neutrophil adhesion was observed (26.70%±2.08 vs 23.51%±5.03 respectively, p=0.1). Conclusions: We demonstrate that neutrophil adhesion is increased in patients with VTE with characteristics associated with increased recurrence risk. In addition, we also observed a non-significant difference in neutrophil adhesion in these patients compared to other VTE patients. Our results suggest that the increased adhesive properties of neutrophils in VTE patients could play a role in the exacerbation of inflammation, and in the pathophysiology of VTE. Further studies are warranted to study whether neutrophil adhesiveness could be used as a biomarker of VTE recurrence. Disclosures: No relevant conflicts of interest to declare.

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The Effects of Thrombocytopenia on Clotting Profile in Whole Blood As Determined By Thromboelastography When Anticoagulant Is Present at Therapeutic or Prophylactic Concentration

Blood ◽

10.1182/blood.v124.21.1550.1550 ◽

2014 ◽

Vol 124 (21) ◽

pp. 1550-1550

Author(s):

Jason Chung ◽

Ivan Stevic ◽

Jorell Gantioque ◽

Anthony K.C. Chan ◽

Howard H.W. Chan

Keyword(s):

Anticoagulant Therapy ◽

Whole Blood ◽

Statistical Difference ◽

Conflicts Of Interest ◽

Maximum Amplitude ◽

Clot Formation ◽

Bleeding Tendency ◽

Therapeutic Concentration ◽

Significant Difference

Abstract Background: Anticoagulant therapy for the treatment of venous thromboembolism in patients with concomitant thrombocytopenia has been based on anecdotal evidence. The platelet (PLT) threshold at which anticoagulant therapy should be withheld is still controversial. A PLT count of 50 × 109/L was recommended to be the threshold in the past, but newer reviews have lowered the threshold to 30 × 109/L. We previously used thromboelastography (TEG) to study clotting in plasma reconstituted with autologous PLT. Since red cells also play a significant role in hemostasis and coagulation, we hereby developed a TEG model with whole blood (WB) in order to better mimic in vivo conditions to evaluate the clot formation in thrombocytopenic blood. Objective: Using TEG to monitor clotting in whole blood samples containing unfractionated heparin (UFH) or dalteparin, we evaluated the differences in clotting profile when PLT in the samples were reduced to thrombocytopenic range. Methods: Whole blood was collected from healthy volunteers in syringes containing citrate phosphate dextrose adenine (CDPA-1, pH=5.5) and 30 μg/L corn trypsin inhibitor. Magnetic CD 61 antibody chromatography was used to deplete PLT in the blood to a count of ≤ 15 × 109/L. Platelet-depleted whole blood (PDWB) was then mixed with untouched blood from the same donor to obtain the predefined PLT counts. Clotting was initiated in the TEG cups with 10 mM CaCl2 and tissue factor (TF) in the presence of either UFH (0.3 U/mL or 0.1 U/mL) or dalteparin (1 IU/mL or 0.3 IU/mL). Due to the mechanistic differences between UFH and dalteparin, we optimized the amount of TF to maximize the sensitivity of TEG assay for individual anticoagulants; thus, 2.25 pM and 2.05 pM were used for UFH and dalteparin experiments, respectively. However, the same amount of TF was used to evaluate the clotting with the same anticoagulant at both therapeutic and prophylactic concentrations. Clotting was monitored using a Haemoscope TEG at 37 ºC for a maximum of 3 hr or until maximum amplitude (MA) had been achieved. Three parameters of clotting profile including R, MA and area under the curve within the first 15 min of clotting (AUC15) were used for further analysis. A p-value < 0.05 was considered statistically significant. Results: All3 parameters showed significant compromise of clotting when PLT decreased from 150 × 109/L to < 15 × 109/L in the presence of UFH or dalteparin at therapeutic range. When these anticoagulants were reduced to prophylactic concentration, the clotting was also significantly moderated, but to a lesser extent, comparing samples with PLT at 150 × 109/L and those with PLT < 15 × 109/L. These are in accordance with the bleeding tendency in vivo. At 30 × 109/L, the newer recommended PLT threshold at which anticoagulant should be withheld in thrombocytopenic patients, the clotting parameters did not show any significant difference as compared to those at the traditional threshold of 50 × 109/L when UFH and dalteparin were at therapeutic concentrations. Similarly, when UFH was reduced to a prophylactic concentration, we detected no significant difference in the clotting profile between 50 × 109 PLT/L and 30 × 109 PLT/L. In contrast, in samples with dalteparin at a prophylactic concentration, MA was significantly lower at 30 × 109 PLT/L when compared with that at 50 × 109 PLT/L although R and AUC15 had no statistical difference. Additionally, samples of PDWB containing either anticoagulant at prophylactic concentration had better clot formation than those samples of 50 × 109 PLT/L containing UFH or dalteparin at therapeutic concentration. Conclusion: The TEG profile of WB clotting in this in vitro model simulates bleeding tendency observed clinically. In the presence of UFH or dalteparin at therapeutic concentration, there was no statistical difference in the TEG parameters comparing thrombocytopenic blood with 50 × 109 PLT/L and 30 × 109 PLT/L, supporting the latter as the new threshold to hold anticoagulant in thrombocytopenic patients. In addition, instead of holding all anticoagulants in severe thrombocytopenic patients with PLT < 30 × 109/L, administering UFH or dalteparin at prophylactic doses may offer a safe alternative, as both imped clotting in TEG even less than those at therapeutic concentration with thrombocytopenic blood at 50 × 109 PLT/L. Fig 1. TEG profile of clots with UFH Fig 1. TEG profile of clots with UFH Fig 2. TEG profile of clots with dalteparin Fig 2. TEG profile of clots with dalteparin Disclosures No relevant conflicts of interest to declare.

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D-Dimer Levels and Risk of Recurrence Following Provoked Venous Thromboembolism: Findings from the Riete Registry

Blood ◽

10.1182/blood-2018-99-111190 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 3810-3810

Author(s):

Martin Ellis ◽

Martin Mar ◽

Monreal Manuel ◽

Orly Hamburger-Avnery ◽

Alessandra Bura-Riviere ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Venous Thromboembolism ◽

Anticoagulant Therapy ◽

Conflicts Of Interest ◽

Hazard Ratio ◽

Increased Risk ◽

Risk Patients ◽

Recurrent Vte ◽

D Dimer

Abstract Background. Patients with venous thromboembolism (VTE) secondary to transient risk factors or cancer may develop VTE recurrences after discontinuing anticoagulant therapy. Identifying at-risk patients could help to guide the ideal duration of anticoagulant therapy in these patients. Methods. We used the RIETE database to assess the prognostic value of d-dimer testing after discontinuing anticoagulation to identify patients at increased risk for recurrences. The proportion of patients with raised d-dimer levels was determined and the hazard ratio (HR) for VTE recurrences compared to those with normal levels was calculated. Univariate and multivariate analyses of factors associated with VTE recurrence were performed. Results. 3 606 patients were identified in the database in April 2018: 2 590 had VTE after a transient risk factor and 1016 had a cancer. D-dimer levels were measured after discontinuing anticoagulation in 1 732 (67%) patients with transient risk factors and 732 (72%) patients with cancer-associated VTE and these patients formed the cohort in which recurrent VTE rate was calculated. D-dimers and were elevated in 551 (31.8%) of patients with a transient risk factor and were normal in 1181 (68.2%). In the cancer-associated group, d-dimers were elevated in 398 (54.3%) and normal in 334 (45.7%) patients. The adjusted hazard ratio for recurrent VTE was: 2.32 (95%CI: 1.55-3.49) in patients with transient risk factors and 2.23 (95%CI: 1.50-3.39) in those with cancer. Conclusions. Patients with raised d-dimer levels after discontinuing anticoagulant therapy for provoked or cancer-associated VTE are at increased risk for recurrent VTE and death. Future studies could target these patients for extended anticoagulation. Disclosures No relevant conflicts of interest to declare.

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Effect of tranexamic acid on coagulation and fibrinolysis in women with postpartum haemorrhage (WOMAN-ETAC): a single-centre, randomised, double-blind, placebo-controlled trial

Wellcome Open Research ◽

10.12688/wellcomeopenres.14722.1 ◽

2018 ◽

Vol 3 ◽

pp. 100 ◽

Cited By ~ 9

Author(s):

Haleema Shakur-Still ◽

Ian Roberts ◽

Bukola Fawole ◽

Modupe Kuti ◽

Oladapo O. Olayemi ◽

...

Keyword(s):

Tranexamic Acid ◽

Postpartum Haemorrhage ◽

Clot Lysis ◽

Adult Women ◽

Matching Placebo ◽

Link Type ◽

Significant Difference ◽

To Receive ◽

Trial Participants ◽

D Dimer

Background:Postpartum haemorrhage (PPH) is a leading cause of maternal death. The WOMAN trial showed that tranexamic acid (TXA) reduces death due to bleeding in women with PPH. We evaluated the effect of TXA on fibrinolysis and coagulation in a sample of WOMAN trial participants.Methods:Adult women with a clinical diagnosis of PPH were randomised to receive 1 g TXA or matching placebo in the WOMAN trial. Participants in the WOMAN trial at University College Hospital (Ibadan, Nigeria) also had venous blood taken just before administration of the first dose of trial treatment and again 30 (±15) min after the first dose (the ETAC study). We aimed to determine the effects of TXA on fibrinolysis (D-dimer and rotational thromboelastometry maximum clot lysis (ML)) and coagulation (international normalized ratio and clot amplitude at 5 min). We compared outcomes in women receiving TXA and placebo using linear regression, adjusting for baseline measurements.Results:Women (n=167) were randomised to receive TXA (n=83) or matching placebo (n=84). Due to missing data, seven women were excluded from analysis. The mean (SD) D-dimer concentration was 7.1 (7.0) mg/l in TXA-treated women and 9.6 (8.6) mg/l in placebo-treated women (p=0.09). After adjusting for baseline, the D-dimer concentration was 2.16 mg/l lower in TXA-treated women (-2.16, 95% CI -4.31 to 0.00, p=0.05). There was no significant difference in ML between TXA- and placebo-treated women (12.3% (18.4) and 10.7% (12.6), respectively; p=0.52) and no significant difference after adjusting for baseline ML (1.02, 95% CI -3.72 to 5.77, p=0.67). There were no significant effects of TXA on any other parameters.Conclusion:TXA treatment was associated with reduced D-dimer levels but had no apparent effects on thromboelastometry parameters or coagulation tests.Registration:ISRCTN76912190(initially registered 10/12/2008, WOMAN-ETAC included on 22/03/2012) andNCT00872469(initially registered 31/03/2009, WOMAN-ETAC included on 22/03/2012).

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Evaluation of ADAMTS13 Activity and Inflammatory Markers in Deep Venous Thrombosis Patients

Blood ◽

10.1182/blood.v118.21.5246.5246 ◽

2011 ◽

Vol 118 (21) ◽

pp. 5246-5246

Author(s):

Bruna de Moraes Mazetto ◽

Fernanda A. Orsi ◽

Aline Barnabé ◽

Erich V de Paula ◽

Joyce M Annichino-Bizzacchi

Keyword(s):

Inflammatory Markers ◽

Conflicts Of Interest ◽

Adamts13 Activity ◽

Vein Thrombosis ◽

Outpatient Unit ◽

Inflammatory Conditions ◽

Significant Difference ◽

Von Willebrand ◽

D Dimer

Abstract Abstract 5246 BACKGROUND: The role of inflammation on the pathophysiology of arterial thrombosis has been extensively studied. However, the relationship between inflammation and deep vein thrombosis (DVT) is not completely understood. Conflicting reports have been published about the levels of proteins involved in the inflammatory response in the context of DVT. Changes in ADAMTS13 levels have been reported in other inflammatory conditions such as sepsis, and this protease could be involved in the interplay between hemostasis and inflammation. OBJECTIVE: To evaluate ADAMTS13 activity in DVT patients and its association with inflammatory markers (IL-6, IL-8, CRP, TNF-α), D-dimer and von Willebrand Factor (VWF) levels. METHODOLOGY: Thirty-eight DVT patients, from 6 months to five years after the diagnosis of DVT, followed at the outpatient unit of thrombotic diseases from University of Campinas and 38 healthy volunteers selected as controls were included in the study. ADAMTS13 activity was determined by the residual binding of VWF to collagen. VWF, IL-6, IL-8 and TNF-alpha levels were determined by ELISA, and D-dimer levels was determined by a turbidimetric method. RESULTS: In this study population DVT was triggered by transient risk factors, particularly the use of oral contraceptives. No patient presented renal, hepatic or malignant disease. Median ADAMTS13 activity was not statistically different between patients (median: 98.2%; range: 70–146) and controls (median: 96.1%; range: 66–117; p=0.35). IL-6 and TNF-alfa levels were also higher in patients (median: 1.0pg/mL and 2.3pg/mL) compared to controls (median: 0.64pg/mL and 1.7pg/mL, p=0,01 and p=0,009). In addition, VWF and D-dimer levels were also significantly higher in patients (all P<0.01). No significant difference could be demonstrated between IL-8 and CRP levels from patients and controls. No significant correlation between ADAMTS13 levels and other inflammatory markers could be demonstrated. VWF levels correlated significantly with IL-8 (r=-0.4635, p< 0.0001). CONCLUSIONS: This study reinforces the role of inflammation in the pathogenesis of DVT. The correlation of VWF and IL-8 supports the notion that IL-8 stimulates the secretion of VWF. The role of ADAMTS13 in the context of DVT is yet to be determined. Disclosures: No relevant conflicts of interest to declare.

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Rivaroxaban Versus Low Molecular Weight Heparin For The Prevention Of Venous Thromboembolism After Orthopedic Surgery: A Population-Based Study

Blood ◽

10.1182/blood.v122.21.215.215 ◽

2013 ◽

Vol 122 (21) ◽

pp. 215-215 ◽

Cited By ~ 1

Author(s):

Alejandro Lazo-Langner ◽

Jamie L. Fleet ◽

Eric McArthur ◽

Amit X. Garg

Keyword(s):

Molecular Weight ◽

Venous Thromboembolism ◽

Emergency Room ◽

Population Based ◽

Low Molecular Weight ◽

Routine Practice ◽

Bleeding Events ◽

Population Based Study ◽

Major Hemorrhage ◽

Significant Difference

Abstract Introduction Venous thromboembolism (VTE) occurs in up to 25% of patients undergoing total hip (THA) or knee arthroplasty (TKA) without the use of prophylactic anticoagulation. Low molecular weight heparins (LMWH) are the standard agents for preventing VTE in this setting. In recent years, rivaroxaban, apixaban and dabigatran have been approved for this indication and, although results from randomized trials suggest that they are non-inferior and potentially superior to LMWH, information regarding outcomes in routine use is lacking. Objectives To evaluate the safety and efficacy of rivaroxaban for the prevention of VTE in patients undergoing THR or TKR in routine practice. Methods We conducted a population-based retrospective cohort study using linked healthcare databases in Ontario, Canada, including information on hospital discharge, emergency room visits, medication use, demographics and physician billing. In Ontario older patients have universal drug coverage and thus we included patients aged 66 years or older who received an outpatient prescription for a LMWH, (including dalteparin, tinzaparin and enoxaparin) or rivaroxaban after discharge from THR or TKR between 2002 and 2012 across 121 hospitals. Patients were excluded if they had other indications for anticoagulation. Primary efficacy and safety outcomes in the 30 days after surgery were the occurrence of an Emergency Room visit or hospitalization with a VTE (either deep vein thrombosis or pulmonary embolism) or a hospitalization with non traumatic major hemorrhage, respectively. Secondary outcomes included the previous 2 endpoints at 90 days as well as hospitalization for digestive system endoscopy (a proxy for gastrointestinal hemorrhage) and all cause mortality, both at 30 and 90 days after surgery. Unadjusted and adjusted odds ratios with 95% confidence intervals (CI) were obtained using logistic regression and reported as relative risks (RR) (appropriate given the incidence observed). Results The cohort included 24,321 patients and there was no significant difference on over 35 baseline characteristics between the LMWH (n=11,471) and rivaroxaban (n=12,850) groups. The median age for both groups was 73 years, 14,366 patients were women (59.1%) and 8,612 patients (35.4%) underwent THR. Anticoagulants were prescribed for a median of 14 days after discharge (interquartile range 10 to 21). The main results are shown in the table. Results were consistent in multiple additional analyses accounting for years rivaroxaban was approved in provincial formulary, adjusting for potential confounders, secular trends, individual LMWH, prescriber characteristics, and for subgroup analyses examining THR and TKR separately. Conclusions In this routine practice population-based study, the use of rivaroxaban compared to LMWH was associated with a lower risk of VTE without an increase in bleeding events. Financial Support Canadian Institutes of Health Research; ICES Western Scholars program. Disclosures: Lazo-Langner: Pfizer: Honoraria; Leo Pharma: Honoraria; Boehringer Ingelheim: Honoraria.

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Covid-19 Disease Is Not Associated with Venous Thromboembolism in a Cohort of Patients in Jeddah, Saudi Arabia

Blood ◽

10.1182/blood-2020-142970 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 24-24

Author(s):

Fatemah Kamel ◽

Rania Magadmi ◽

Sulafa Alqutub ◽

Maha A. Badawi ◽

Fatin Al-Sayes ◽

...

Keyword(s):

Risk Factors ◽

Saudi Arabia ◽

Venous Thromboembolism ◽

Conflicts Of Interest ◽

Demographic Data ◽

White Blood Cells ◽

Gastrointestinal Symptoms ◽

University Hospital ◽

Retrospective Case ◽

D Dimer

Background: Coronavirus disease 2019 (COVID-19) caused by acute respiratory syndrome coronavirus 2 (SARS2), is associated with significant morbidity and mortality. The aim of this study is to characterize risk factors and clinical features of COVID-19 disease in an adult cohort in Jeddah, Saudi Arabia. Methods: A retrospective case control study was conducted at King Abdulaziz University hospital (KAUH) in Jeddah, Saudi Arabia. Clinical and demographic data on patients presenting at KAUH with concern for COVID-19 disease between March 18 and May 18, 2020 were collected and analyzed. Results: Electronic medical records on 297 patients presenting at KAUH were reviewed. Of these, 175 (59%) tested positive for COVID-19 by polymerase chain reaction (PCR) and 122 (41%) tested negative. COVID-19 positive patients were more likely to be males (OR=1.59; 95% CI=1.22-2.07), and non-health care workers (OR=1.53; 95% CI=1.13-2.08). Hypertension (10%), diabetes (10%), and two or more concurrent co-morbid conditions (54.4%), were more prevalent among COVID-19 positive patients. Patients presenting with fever, cough, and loss of sense of taste or smell were more likely to test positive for COVID-19 (p=0.001, 0.008, 0.008, respectively. Radiological evidence of pneumonia was associated with confirmed COVID-19 disease. Dyspnea, cough and gastrointestinal symptoms were not associated with risk of COVID-19 at presentation. On admission, white blood cells, neutrophils, lymphocytes, eosinophils, basophils, and platelets were significantly lower among COVID-19 positive patients compared to controls. Surprisingly, D-dimer levels were lower among COVID-19 positive patients. Furthermore, only two patients developed thrombosis; one with pulmonary embolism and one with coronary artery thrombosis. Conclusion: Male gender, hypertension and diabetes were associated with risk of COVID-19 disease in this study population. D-dimer levels were not elevated in COVID-19 patients, and venous thromboembolism was not prevalent in cases, compared to controls. This is in contrast to previous reports on the association of COVID-19 disease with venous thromboembolism in other populations. Thus, individual and environmental risk factors may play an important role in the pathophysiology of thrombosis in COVID-19 disease. Disclosures No relevant conflicts of interest to declare.

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