thromboembolic disease
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Medwave ◽  
2021 ◽  
Vol 21 (11) ◽  
pp. e002068-e002068
Author(s):  
María Lourdes Posadas-Martínez ◽  
Felipe Torres Gómez ◽  
Daniela Mezzarobba ◽  
Natalia Schutz ◽  
Jesica Ruberto ◽  
...  

Objective We aim to evaluate factors associated with the recurrence of thromboembolic episodes among patients with a first episode of venous thromboembolic disease during anticoagulation treatment and at least one year after treatment suspension. Methods A prospective cohort of patients with a first episode of deep vein thrombosis confirmed by Doppler ultrasound and initiated anticoagulation treatment. Participants were registered in the Institutional Registry of Thromboembolic Disease between June 2015 and March 2019. Patients with cancer, with permanent inferior vena cava filter implant, and those who refused to participate or did not provide informed consent were excluded. All patients were evaluated within treatment at 30 days and at least one year after the suspension of anticoagulation with a D-dimer study and an ultrasound. All patients were evaluated for recurrence, bleeding (major and minor), and death. Results A total of 304 patients were recruited during the study period. Seventy-three percent were female, and the median age was 80 years. The rate of recurrence rate during anticoagulation treatment was 5% (N = 16/303; 95% confidence interval: 3 to 8), and 5% during post-suspension follow-up (N = 11/202; 95%CI: 3 to 9). The overall bleeding rate was 13% (N = 39; 95%CI: 9 to 17), and 5% for major bleeding. Patients who recurred had higher basal D-dimer mean, higher neutrophils and monocytes, and a higher prevalence of age-adjusted D-dimer ratio greater than 0.5 before discontinuation. In addition, they more frequently had complete leg involvement by ultrasound and received a shorter treatment. Conclusions Although some baseline and pre-suspension parameters had a higher recurrence incidence, statistical significance was not reached, probably due to small statistical power and a short-term follow-up.


2021 ◽  
Vol 66 (1) ◽  
Author(s):  
Abimael López-Pérez ◽  
Jesús Hernández Juárez ◽  
Rodolfo Solano ◽  
Pedro Antonio Hernández Cruz ◽  
Luicita Lagunez-Rivera

Abstract. Laelia furfuracea is an endemic orchid from Mexico, with antioxidant activity. The objective of this study was to evaluate the effect of hydroethanolic extract and fractions obtained from the orchid leaves on the clotting times of patients with venous thromboembolic disease (VTD) and to identify their tentative compounds. The anticoagulant activity was evaluated by determining prothrombin (PT), thrombin (TT) and, activated partial thromboplastin (APTT) times. Identification of the compounds was carried out using a chromatographic technique with an ultra-high-performance liquid chromatographic analyzer coupled with electrospray ionization with quadrupole time of flight-mass-mass spectrometry. The extract prolonged the clotting times depending on the concentration-response (5-60 mg / mL); 25 mg/mL prolonged the PT (33.2 ± 2.3 s) and TT (33.1 ± 0.3 s); and APTT (61.8 ± 3.4 s) at a concentration of 15 mg/mL. The main groups tentatively identified were xanthine, carboxylic acid, amino acid, and phenolic compounds. These compounds or the synergy between them prolong clotting times. Laelia furfuracea is an orchid with research potential in the search for new anticoagulant agents.   Resumen. Laelia furfuracea es una orquídea endémica de México, la cual posee actividad antioxidante. El objetivo de este estudio fue evaluar el efecto del extracto hidroetanólico y fracciones obtenidas de hojas de la orquídea sobre los tiempos de coagulación de pacientes con enfermedad tromboembólica venosa (ETV) e identificar sus posibles compuestos. La actividad anticoagulante se evaluó determinando los tiempos de protrombina (TP), trombina (TT) y tromboplastina parcial activada (TTPA). La identificación de los compuestos se realizó usando una técnica cromatográfica con un analizador cromatográfico líquido de Ultra Alta Resolución con Ionización por electroespray acoplado a espectrometría de masas con Cuadrupolo y Tiempo de Vuelo. El extracto prolongó los tiempos de coagulación dependiente de la concentración-respuesta (5-60 mg/mL); 25 mg/mL prolongó el TP (33.2±2.3 s) y TT (33.1±0.3 s); y TTPA (61.8±3.4 s) a una concentración de 15 mg/mL. Los principales grupos de posibles compuestos identificados fueron xantina, ácido carboxílico, aminoácido y compuestos fenólicos. Estos compuestos o la sinergia entre ellos prolongan los tiempos de coagulación. Laelia furfuracea es una orquídea con potencial en investigación para la búsqueda de nuevos agentes anticoagulantes.


Cureus ◽  
2021 ◽  
Author(s):  
Anthony Lyonga Ngonge ◽  
Nitheesha Ganta ◽  
Abdelawab Jalal Eldin ◽  
Valery Effoe ◽  
Nso Nso ◽  
...  

2021 ◽  
Vol 99 (5-6) ◽  
pp. 369-374
Author(s):  
V. N. Ardashev ◽  
A. V. Nagovitsyn ◽  
N. V. Zakaryan ◽  
O. P. Donetskaya ◽  
G. E. Kubenskiy ◽  
...  

New facts suggest that COVID-19 coronavirus infection is partly mediated by hypercoagulability reactions characterized by micro- and macrovascular thrombotic angiopathy, which leads to acute myocardial injury, myocarditis, arrhythmias and numerous cases of pulmonary thromboembolic disease . The article presents a clinical observation of acute myocardial infarction development as a result of early thrombosis of an implanted coronary stent in a patient diagnosed with a new coronavirus infection COVID-19.


Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 179-179
Author(s):  
Jordan K Schaefer ◽  
Josh Errickson ◽  
Xiaowen Kong ◽  
Tina Alexandris-Souphis ◽  
Mona A Ali ◽  
...  

Abstract Introduction The direct oral anticoagulants (DOACs) including apixaban, dabigatran, edoxaban, and rivaroxaban are increasingly utilized for the management of venous thromboembolic disease (VTE) and/or non-valvular atrial fibrillation (NVAF). Adding aspirin (ASA) to warfarin or DOAC therapy increases bleeding risk. Patients on combination therapy with ASA and an anticoagulant were not well represented in clinical trials comparing DOACs to warfarin. We sought to compare bleeding and thrombotic outcomes with DOACs and ASA compared to warfarin and ASA in a non-trial setting. Methods We conducted a retrospective registry-based cohort study of adults on DOAC or warfarin therapy for VTE and/or NVAF. Warfarin treated patients were followed by six anticoagulation clinics. Four out of the six clinics contributed data on their patients that were on DOACs in the Michigan Anticoagulation Quality Improvement Initiative (MAQI 2) from January 2009 to June 2021. Patients were excluded if they had a history of heart valve replacement, recent myocardial infarction, or less than 3 months of follow-up. Two propensity matched cohorts (warfarin+ASA vs DOAC+ASA) of patients were analyzed based on ASA use at the time of study enrollment. The primary outcome was any new bleeding event. Secondary outcomes included new episodes of arterial or venous thrombosis, bleeding event type (major, fatal, life threatening, central nervous system, and non-major bleeding), emergency room visits, hospitalizations, transfusions, and death. Random chart audits were done to confirm the accuracy of the abstracted data. Event rates were compared using Poisson regression. Results We identified a total of 1,139 patients on DOACs plus ASA and 4,422 patients on warfarin plus ASA. After propensity matching, we compared two groups of 1,114 matched patients. DOAC treated patients were predominately on apixaban (62.3%) and rivaroxaban (30.4%), most often at therapeutic doses (Table 1). Patients were largely (90.5%) on low dose ASA (≤ 100 mg). Patient demographics, co-morbidities, indication for anticoagulation, history of bleeding or clotting, medications, and duration of follow-up were well-balanced after matching. Patients were followed for a median of 11.7 months (interquartile range 4.4 and 34 months). Patients treated with DOAC+ASA had 2.4 thrombotic events per 100 patient years compared to 2.2 thrombotic events per 100 patient years with warfarin+ASA (P=0.78). There were no significant differences observed between groups by thrombotic subtype (stroke, transient ischemic attack, pulmonary embolism, deep vein thrombosis, table 1). Bleeding was also similar with 30.1 bleeding events per 100 patient years with DOAC+ASA compared to 27.8 bleeds per 100 patient years with warfarin+ASA (P=0.24). There were no significant differences by bleeding subtype (table 1). Hospitalizations for clotting occurred less frequently with DOAC+ASA (0.9 hospitalizations per 100 patient years) compared to warfarin+ASA (1.7 hospitalizations per 100 patient years, P=0.03). Mortality, transfusions, and healthcare utilization were otherwise similar between the two groups. Conclusions For patients on a DOAC versus warfarin with ASA for atrial fibrillation and/or venous thromboembolic disease without a recent myocardial infarction or heart valve replacement, bleeding and thrombotic outcomes were similar. Figure 1 Figure 1. Disclosures Kaatz: Gilead: Consultancy; CSL Behring: Consultancy; Novartis: Consultancy; Bristol Myer Squibb: Consultancy, Research Funding; Pfizer: Consultancy; Alexion: Consultancy; Janssen: Consultancy, Research Funding; Osmosis Research: Research Funding. Kline-Rogers: Janssen: Consultancy; American College of Physicians: Consultancy. Sood: Bayer: Consultancy. Froehlich: Merck: Consultancy; Janssen: Consultancy; Novartis: Consultancy; Boehringer-Ingelheim: Consultancy; Pfizer: Consultancy; Blue Cross Blue Shield of Michigan: Research Funding; Fibromuscular Disease Society of America: Research Funding. Barnes: National Certification Board of Anticoagulation Providers: Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy; Acelis: Consultancy; AMAG Pharmaceuticals: Consultancy; Connected Health: Consultancy; Blue Cross Blue Shield of Michigan: Research Funding; AC Forum: Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy; Bristol-Myers Squibb: Consultancy.


Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3213-3213
Author(s):  
Loula Papageorgiou ◽  
Job Harenberg ◽  
Ismail Elalamy ◽  
Grigoris Gerotziafas

Abstract Background: The efficacy and safety of direct oral anticoagulants (DOACs) in patients with thromboembolic disease is closely related to patient's adherence to therapy. Objective documentation of drug intake is a useful tool for patients' education and improvement of adherence to treatment but may be improved by accurate point-of-care (POCT) testing. Results of DOAC Dipstick may be one of these methods but may depend on interpretation variability. Aim: We aim to analyze the inter-observer agreement of DOAC Dipstick near-patient device in outpatients on stable anticoagulation with rivaroxaban (R), apixaban (A) and dabigatran (D). Methods: A prospective observational cohort study was performed including patients on active treatment with R, A, and D for secondary VTE prevention. All participants were routinely assessed for DOACs' plasma concentration using STA ® Liquid anti-Xa and STA ® Liquid anti-IIa chromogenic assays , and creatinine clearance (Cockroft -Gault equation). DOAC Dipstick test was performed in patients' urine samples were performed by trained staff according the instructions for use. The assessment was based on pads'colors which are specific for indicating the presence and absence of factor -Xa (FXA) and thrombin inhibitors (THI). In order to assess inter-observer agreement, the study nurse performing the test and the medication-prescribing physician were in charge of evaluating independently each test strip. THI pad and FXA pad served as negative control for patients treated with R and A, and D, respectively. Inter-observer agreement was calculated by Cohen's kappa coefficient (kappa index). Results: A new interim analysis shortly before study termination was performed after enrolment of 79 patients (female/ male 44/35, age 56 ± 18 years, mean and standard deviation). Of those, 20% (n=17) were treated for deep vein thrombosis, 13% (n=10) for pulmonary embolism (PE), 40% (n=32) for recurrent thromboembolic disease, 18.3% (n=13), for cancer-associated thrombosis, 6 for antiphospholipid syndrome (n= 5), 2 % (n=2) for AF. 60 % (n=48 ) were treated with R, 37% (n=29) with A and 3% (n=2) with D. All patients had normal renal function. Anti-factor Xa levels were determined with a median value of 156.6±129.2 ng/ml and anti-factor IIa levels with 191.66±110.34 ng/mL. The inter- observer agreement of colors of FXA and THI pads of urine samples was 0.99 for positivity for R, A, and D. Pads that served as negative controls were assessed correctly as negative by both observers in all cases (kappa index 1.0). Conclusion: Given the encouraging results, the ongoing study should allow the device's validation as an accurate, easy-to-use assessment tool for determination of the presence or absence of DOACs in patients' urine samples also based on a very low inter-observer variability. The aforementioned data confirm the results of the first interim analysis presented in the ISTH 2021 congress. Disclosures Harenberg: DOACSENCE: Other: Founder and managing director.


2021 ◽  
Vol 8 ◽  
Author(s):  
Sebastian Daniel Trancǎ ◽  
Oana Antal ◽  
Anca Daniela Farcaş

The incidence of thromboembolic disease is reported to be high in SARS-CoV2 disease. Pregnancy, an already physiologically hypercoagulable state, associated to COVID 19, generates even more concern regarding the potentially increased risk of thrombotic events. The exact incidence of such complications is yet unknown, but there is data suggesting that coagulopathy and thromboembolism are both increased in pregnancies affected by COVID-19. Since the outbreak of the COVID 19 pandemics, the most common described thrombotic events associated with SARS-COV2 infection have been venous thromboembolism and disseminated intravascular coagulation, while arterial thrombotic events are less commonly described. Splenic infarction is a rare disorder that can be secondary to a hypercoagulable state. There are only few cases of splenic infraction described, but none with splenic artery thrombosis, in a post-partum patient, on therapeutic anticoagulation regimen. We present the case of a 31-year-old Caucasian, 26 weeks pregnant woman, with no prior medical history, admitted to the hospital with a severe form of COVID 19 pneumonia and who, during the course of the disease, developed a massive splenic infarction with splenic artery thrombosis.


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