coagulation disorders
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Author(s):  
Nguyen Van Thuc ◽  
Tran Thanh Hoa ◽  
Dinh Hai Nam ◽  
Nguyen Van Quy ◽  
Vu Dinh Hung ◽  
...  

Background: The most commonly used oral anticoagulant is acenocoumarol with the brand name is Sintrom and recently, warfarin with the brand name is Coumadin has begun to be used. Anticoagulation with vitamin K antagonists faces two main obstacles: the narrow therapeutic range and the effectiveness of the drug varies by many factors. Objective: " Current status of coagulation disorders in the treatment of anticoagulants with vitamin K antagonists. Understanding some factors affecting the goal of anticoagulant treatment". Method: Cross-sectional, retrospective, descriptive analysis of drug use and influencing factors of patients diagnosed with coagulopathy admitted to the emergency department at Hanoi Heart Hospital from April 2020 to August 2021. Results: There were 675 patients admitted to the hospital with blood clotting disorders. The average age is 60,17±10,13, the youngest is 30, the oldest is 90; 63 patients, accounting for 9.42%, need to be hospitalized for inpatient treatment; There are 108 patients, accounting for 16%, with bleeding and 18 patients, accounting for 2.7%, with thromboembolism or valve obstruction. Conclusion: Coagulation disorders during treatment with vitamin K antagonist anticoagulants is a common condition in the emergency department. However, the complication rate is not high. There are many factors that affect the patient's treatment goals and the drug use is a fairly common factor.


2021 ◽  
Vol 20 (4) ◽  
pp. 191-198
Author(s):  
E. M. Koltsova ◽  
G. S. Svidelskaya ◽  
Yu. A. Shifrin ◽  
F. I. Ataullakhanov

Malignant neoplasms are characterized by the presence of the hemostasis system pathology, predisposing cancer patients to thrombohemorrhagic complications. The pathogenesis of cancer-associated coagulopathy is complex and involves a variety of mechanisms. Tumor cells have the ability to activate the host’s hemostasis system, and this phenomenon is controlled by the same oncogenes that are responsible for neoplastic transformation. In addition to predisposing factors to impaired hemostasis from the side of the disease, the anticancer drugs themselves carry risks of developing coagulation disorders. The pathophysiological basis of this kind of disorders caused by chemotherapy is associated with damage to the endothelium, imbalance of coagulation and anticoagulant proteins, platelet dysfunction and their deficiency. In this article, the authors set themselves the goal of generalizing and updating the current knowledge of the molecular mechanisms that cause thrombohemorrhagic risk in cancer. 


2021 ◽  
Vol 24 (9) ◽  
pp. 273-276
Author(s):  
Anna Attico ◽  
Alessandra Iacono ◽  
Loretta Biserna ◽  
Sara Brandolini ◽  
Federico Marchetti

The paper presents the case of a 16-year-old girl with a 6-month history of eating disorder, restrictive subtype and diffuse ecchymosis. Anamnestic history and laboratory investigations allowed excluding coagulation disorders and making the diagnosis of vitamin C deficiency. Vitamin C deficiency is a rare disease but still sporadically described in children with unusual eating habits.


2021 ◽  
Author(s):  
Tatyanny Paula Pinto da Costa Santos Fucci ◽  
Rubens Pitliuk ◽  
Ane Claudia Fernandes Nunes

Coronavirus disease 2019 (COVID-19) is a major issue of our times. Many aspects and features of this new and complex disease are being described on a daily basis. Major endpoints are systemic inflammation, markedly characterized by the cytokine storm, respiratory failure, and coagulation disorders, such as thrombophilia. In its terms, thrombophilia has a major impact on the COVID-19 prognosis. With regard to this, paying attention on molecular variants, such as DNA polymorphisms, epigenetic factors, and other biomarkers, could be an important approach to optimizing and personalizing the treatment of patients according to their inherited thrombotic features. This chapter brings an overview on the three major DNA polymorphisms associated with thrombophilia and proposes that these same biomarkers could be used in pretreatment screenings of patients with COVID-19 to seek the most appropriate therapy for each individual molecular profile.


2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Javier Batlle ◽  
Almudena Pérez-Rodríguez ◽  
Irene Corrales ◽  
Nina Borràs ◽  
Joana Costa Pinto ◽  
...  

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4839-4839
Author(s):  
Safia Belbachir ◽  
Jean Jacques Tudesq ◽  
Sylvain Lamure ◽  
Pierre Rocanieres ◽  
Elena Properzi ◽  
...  

Abstract Background. Immunotherapy with chimeric antigen receptor T (CAR-T cells) is a new therapeutic approach approved for patients with relapsed/refractory (R/R) B-lymphoproliferative malignancies. Specific toxicities have been described following CAR-T cells therapy, mainly cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Coagulation disorders have been described in patients experiencing CRS. However, data is scarce regarding such consequences. Methods. We retrospectively evaluated patients treated with CAR T-cells for R/R B-cell lymphoma in our tertiary hospital between 2019, January 1 st and 2021, March 1 st. Post-infusion coagulation disorders were assessed, as well as factors associated with such anomalies using a multivariate logistic regression model. Results. During the study period, 64 patients received CAR T-cell therapy for R/R diffuse large B-cell lymphoma (n=52, 81%), transformed follicular lymphoma (n=9, 14%) and mantel cell lymphoma (n=3, 5%).The median follow-up was 7.98 months (IQR 4.24; 12.39). All patients had a normal coagulation panel at CAR-T cells infusion. The incidence of CRS was 92% (n=59; grade 3-4 n=2, 3%) and ICANS 38% (n=24; grade 3-4 n=7; 11%). We observed a decrease in fibrinogen level in all patients (grade 3-4 n=44, 69%), occurring at day 11 (median) post-infusion, prolonged prothrombin time (PT) in 27 patients (42%, grade 3-4 n=0), at day 4 (median), and thrombocytopenia in 62 patients (97%, grade 3-4 n=46, 72%) at day 1 (median). By multivariate analysis, fibrinogen below 2 g/L after CAR-T cells infusion was independently associated with CRS grade 2 or greater (OR 58.4; 95%CI [5.8-4212.8] p = 0.009), ICANS grade 2 or greater (OR 2.36; 95%CI [2.2-80.6] p = 0.007) and day-0 lymphocyte count (OR 0.32 per 0.1 G/L; 95%CI [0.10-0.89] p = 0.037). However, it was not associated with comorbidities, disease history, tumor burden, CAR product, or outcomes. Furthermore, by the end of the study, 5 patients (8%) did not recover a normal fibrinogen level and 41 (64%) did not recover a normal platelet count. Others recovered a normal fibrinogen level within a median of 69 days, a normal platelet count within a median of 15 days, and a normal PT within in a median of 7 days. Interestingly, no significant thrombotic or hemorrhagic events were recorded for those patients. Conclusion. A high incidence of asymptomatic coagulation disorders was observed after CAR-T cell therapy, notably prolonged hypofibrinogenemia. Further studies should focus on the mechanisms involved in such abnormalities. Disclosures Lamure: Janssen: Other: miscellaneous support , Research Funding; Gilead: Other: miscellaneous support ; Roche: Other: miscellaneous support ; Abbvie: Other: miscellaneous support ; Sanofi: Other: miscellaneous support ; Novartis: Other: miscellaneous support ; Pfizer: Other: miscellaneous support ; Actelion: Other: miscellaneous support . Paul: NOVARTIS: Other: BOARD; SERVIER: Other: BOARD. Tchernonog: JANSSEN: Consultancy; ABBVIE: Consultancy; ASTRAZENECA: Consultancy. Herbaux: Takeda: Honoraria, Research Funding; Abbvie: Honoraria, Research Funding; Roche: Honoraria; Janssen: Honoraria. Cartron: Roche, Celgene-BMS: Consultancy; Danofi, Gilead, Novartis, Jansen, Roche, Celgene-BMS, Abbvie, Takeda: Honoraria.


2021 ◽  
pp. 253-290
Author(s):  
Peter Valentine ◽  
Pete Ford

This chapter describes the anaesthetic management of the patient with a haematological disorder. Topics covered include anaemia; sickle-cell disease; porphyria; coagulation disorders; haemophilia and related disorders; platelet disorders and hypercoagulability syndromes. For each topic, pre-operative investigation and optimisation, treatment, and anaesthetic management are described. There is detailed discussion about the perioperative management of the patient taking a drug which affects the coagulation system, including anticoagulants, antiplatelet drugs, fibrinolytic and antifibrinolytic drugs. Coagulation tests are discussed in detail, and the haematological management of the bleeding patient is described.


2021 ◽  
pp. 1099-1150
Author(s):  
Mark Fairley

This chapter discusses the techniques of regional anaesthesia and analgesia. It begins with an overview of regional anaesthesia and goes on to describe safe practice, and local anaesthetic agents. Techniques of locating nerves are then discussed, including ultrasound, and needle design is explored. Nerve blocks of the neck; upper limb; trunk; lower limb, and the neuraxis (spine) are described. Coagulation disorders, nerve injury and the management of local anaesthetic toxicity are discussed. The chapter concludes with a dermatome map and tables of recommended nerve blocks for particular operations.


2021 ◽  
Vol 161 (5) ◽  
pp. 1629
Author(s):  
Perica Davitkov ◽  
Cynthia W. Ko ◽  
Shahnaz Sultan

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