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Direct oral anticoagulants (DOACs) are increasingly used for the treatment of thrombosis. While inhibitors of factor IIa and factor Xa have shown effectiveness, the risk of bleeding remains a significant concern. Recently, direct factor XIa inhibitors—including asundexian and milvexian—have emerged as potential anticoagulation therapies, based on clinical observations that patients with factor XIa deficiencies seldom present with spontaneous bleeding tendencies. The interferences associated with DOACs in routine and specialised coagulation assays are well-described; however, the interferences associated with emerging FXIa inhibitors are largely uncharacterised. Here, we briefly report the impact of asundexian and milvexian in routine coagulation assays using in vitro plasma-based systems. Asundexian and milvexian induce concentration-dependent prolongations in APTT-based assays with curvilinear regressions, which may be suitable for the measurement of pharmacodynamic effects at peak levels ex vivo. We also report differential sensitivities of APTT-based assays—particularly at higher FXIa inhibitor concentrations—highlighting the clinical need for an extensive evaluation of interferences associated with FXIa inhibitors in coagulation assays. [ABSTRACT FROM AUTHOR]

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to an unprecedented global healthcare crisis. While SARS-CoV-2-associated COVID-19 affects primarily the respiratory system, patients with COVID-19 frequently develop extrapulmonary manifestations. Notably, changes in the hematological system, including lymphocytopenia, neutrophilia and significant abnormalities of hemostatic markers, were observed early in the pandemic. Hematological manifestations have since been recognized as important parameters in the pathophysiology of SARS-CoV-2 and in the management of patients with COVID-19. In this narrative review, we summarize the state-of-the-art regarding the hematological and hemostatic abnormalities observed in patients with SARS-CoV-2-associated COVID-19, as well as the current understanding of the hematological system in the pathophysiology of acute and chronic SARS-CoV-2-associated COVID-19. [ABSTRACT FROM AUTHOR]

Background: External compression, thrombosis, or stenosis of the superior vena cava can lead to superior vena cava syndrome, a diagnosis that should be considered swiftly in patients presenting with classic symptoms such as facial and neck swelling, plethora, and distended neck veins. Case Presentation: We report a case of acute port-a-cath associated superior vena cava thrombosis in a longstanding, previously uncomplicated vascular access device in a patient with stable ER+/PR+/HER2+ metastatic breast cancer. After initial treatment, there was limited clinical improvement with subcutaneous low molecular weight heparin (LMWH). Following multidisciplinary team discussion, catheter-directed thrombolysis was performed, which resulted in complete symptom resolution. Conclusion: The recognition of signs and symptoms is crucial in diagnosing acute superior vena cava syndrome, particularly in patients with a malignancy history or a central venous access device in situ. The thrombotic complications of port-a-cath symptoms can occur at any time and management should be guided by multidisciplinary discussion. In appropriately selected patients, catheter-directed thrombolysis can be successful and can lead to rapid symptom resolution. [ABSTRACT FROM AUTHOR]

International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer. Von Willebrand disease (VWD) is the most frequently inherited bleeding disorder worldwide (prevalence: one in 10 000) with a bleeding phenotype ranging from minor mucosal bleeds to life-threatening haemorrhage.1 Treatment includes antifibrinolytic agents such as tranexamic acid and therapies that directly increase Von Willebrand factor (VWF) levels, such as desmopressin (DDAVP SP ® sp ) and VWF-containing concentrates.2 Acute myeloid leukaemia (AML) is a heterogenous haematological malignancy (annual incidence: five per 100 000). As this was a novel I VWF i variant, the patient's phenotype and VWF levels were used to estimate her bleeding risk and the treatment required. [Extracted from the article]

The article reports on the rising use of antithrombotics in case of children. Antiplatelets are generally used in arterial thromboses which include large number of platelets while anticoagulants are used to treat and for prevention of condition called venous thromboembolism. The authors also provides information on low molecular weight heparin.

Sickle cell anaemia (SCA) is a recognised prothrombotic condition.[1] The incidence rate for first venous thromboembolism (VTE) is reported at 5.2 events/1000 person years with a cumulative incidence of 11.3% by age 40 years.[[2]] This is fifty times higher than the quoted VTE risk for under 40 year olds.[4] Long-term exchange blood transfusion (EBT) is an important therapeutic option, however, use of an indwelling venous access device (IVAD) may be necessary to maintain venous access. We were also therefore able to review catheter tip positions; lying deeper in the right atrium predisposed to atrial thrombus formation (3 of 7) whereas, positioning at the cavo-atrial junction, or proximal right atrium did not (0 of 9), although one of these did develop a thrombus more proximally in the superior vena cava (SVC). In those with atrial thrombi, the TTE was repeated 4-6 weeks later to assess whether the thrombus had dissipated or detached from the catheter line before it was considered safe to attempt port removal. [Extracted from the article]

The etiology of the prothrombotic state in myeloma has yet to be definitively characterized. Similarly, while recent evidence suggests that patients with monoclonal gammopathy of undetermined significance (MGUS) may also be at increased risk of thrombosis, the magnitude and the etiology of this risk have also yet to be defined. The present study aims to characterize patterns of plasma thrombin generation and sensitivity to the anticoagulant activity of activated protein C (APC) at the time of initial diagnosis of myeloma and in response to therapy in comparison to that observed among patients with MGUS and matched, healthy volunteers. Patients presenting with newly diagnosed/newly relapsed myeloma (n = 8), MGUS (n = 8), and matched healthy volunteers (n = 8) were recruited. Plasma thrombin generation was determined by calibrated automated thrombography. Peak thrombin generation was significantly higher in patients with myeloma (383.4 ± 33.4 nmol/L) and MGUS (353.4 ± 16.5 nmol/L) compared to healthy volunteers (276.7 ± 20.8 nmol/L; P < .05). In the presence of APC, endogenous thrombin potential was significantly lower in control plasma (228.6 ± 44.5 nmol/L × min) than in either myeloma (866.2 ± 241.3 nmol/L × min, P = .01) or MGUS plasma (627 ± 91.5 nmol/L × min, P = .003). Within the myeloma cohort, peak thrombin generation was significantly higher at diagnosis (353.2 ± 15.9 nmol/L) than following completion of the third cycle of therapy (282.1 ± 15.2 nmol/L; P < .005). Moreover, sensitivity to APC increased progressively with each cycle of chemotherapy. Further study of the etiology and evolving patterns of hypercoagulability among patients with these conditions is warranted and may have future implications for thromboprophylaxis strategies. [ABSTRACT FROM AUTHOR]

Myeloma has a well-described association with venous thromboembolism (VTE). There are few dedicated studies investigating the incidence and risk factors. Many assessment scores have been suggested to estimate the risk of VTE in patients with cancer but these have been validated in solid organ tumors. The records of patients with myeloma attending a university hospital between January 2007 and December 2012 were reviewed to investigate the incidence of VTE and the associated risk factors. In all, 217 patients with a mean (standard deviation) age at diagnosis of 65 (12) years were included. Of 217 patients, 12% had an episode of VTE, 69% received at least 1 immunomodulatory agent, and 95% had low or intermediate risk of VTE according to the Khorana score. Venous thromboembolism was a frequent occurrence in this cohort. Patients had many risk factors for VTE but no one was predictive. As myeloma outcomes continue to improve, a dedicated prospective study is warranted to investigate the most appropriate thromboprophylaxis strategy. [ABSTRACT FROM PUBLISHER]