Search

Background: Antiphosphatidylserine/prothrombin complex (aPS/PT) antibodies are recognized as a marker for antiphospholipid syndrome (APS). Dense and poorly lysable fibrin clots occur in thrombotic APS. Compact clots predict thromboembolism, but determinants of the unfavorable clot phenotype remain unknown in APS. We hypothesized that elevated aPS/PT antibodies determine unfavorable clot features., Methods: In a cohort study involving 124 consecutive patients with thrombotic APS, we measured at baseline plasma fibrin clot permeability (K s ), efficiency of fibrinolysis (clot lysis time, CLT), and turbidity (off anticoagulation) along with immunoglobulin (Ig)G/IgM aPS/PT. During follow-up, symptomatic thromboembolic events were recorded., Results: Elevated IgG and IgM aPS/PT antibodies >30 international enzyme units (UI) were detected in 54.8% and 42.7% of APS patients, including 76.2% and 54% of lupus anticoagulant- (LA, n = 63) positive patients, respectively. Elevated IgG and IgM aPS/PT antibodies predicted low K s (lower quartile, <6 × 10 -9  cm 2 ; odds ratio [OR] = 5.93, 95% confidence interval [CI] 2.09-16.82 and OR = 11.79, 95% CI 4.10-33.92) and prolonged CLT (top quartile, ≥116 min; OR = 4.85, 95% CI 2.42-25.07 and OR = 6.04, 95% CI 2.42-15.07). No such associations were observed for anticardiolipin or β2-glycoprotein I antibodies or LA presence. During follow-up (median 72.5, range 66-83 months), thromboembolic events observed in 32 (26.7%, 4.6%/year) patients were independently predicted by IgG aPS/PT antibodies >30 UI (hazard ratio [HR] = 3.04, 95% CI 1.20-8.88) and low K s (HR = 3.00, 95% CI 1.41-6.50)., Conclusions: We identified aPS/PT antibodies as a determinant of denser and poorly lysable plasma fibrin clot formation in APS patients. The association of elevated aPS/PT antibodies with thromboembolism in APS could be at least in part mediated by prothrombotic clot properties., (© 2019 International Society on Thrombosis and Haemostasis.)

Objectives: APS is associated with arterial and venous thrombosis. The unfavourable fibrin clot phenotype, including formation of dense and poorly lysable clots, has been reported in thrombotic APS. We investigated whether abnormal plasma clot properties are predictive of recurrent thromboembolism in APS., Methods: We followed 126 consecutive patients with thrombotic APS and 105 control subjects, without APS, matched for thrombotic events. Plasma fibrin clot permeability (Ks), turbidity measurements and clot lysis time were evaluated ⩾5 months after a thrombotic event. The primary composite end point was symptomatic recurrent venous thromboembolism, ischaemic stroke and/or myocardial infarction., Results: During follow-up (median, 62 months; range 46-74 months; 1183.2 patient-years), the primary outcome was observed in 33 (26.2%) APS patients and 16 (15.2%) controls, including 25 (19.8%) and 14 (13.3%) subjects with recurrent venous thromboembolism, respectively. Reduced Ks and prolonged clot lysis time predicted recurrent thromboembolic events in APS patients [per 1 × 10-9 cm2: hazard ratio (HR) = 0.37; 95% CI: 0.24, 0.56; and per 10 min: HR = 1.20; 95% CI: 1.01, 1.40, respectively] and in controls (per 1×10-9 cm2: HR = 0.23; 95% CI: 0.11, 0.42; and per 10 min: HR = 1.51; 95% CI: 1.08, 2.16, respectively). A multivariate analysis showed that positive IgG and IgM anti-β2 glycoprotein I antibodies, withdrawal of anticoagulation, lower platelet count and reduced Ks predicted thromboembolic events in APS patients., Conclusion: Formation of denser fibrin networks could be a novel risk factor for recurrent thromboembolism in APS, which highlights the importance of fibrin phenotype in thrombotic disorders.

Background. Adequate thromboprophylaxis reduces the risk of venous thromboembolism (VTE) by half in hospitalized patients. A single scoring system is recommended to improve thromboprophylaxis. Objectives. We investigated the impact of implementing a computerized system to prevent VTE in inpatients with pulmonary diseases and identified predictors of the overuse and underuse of pharmacological thromboprophylaxis. Materials and methods. We compared the use of thromboprophylaxis with enoxaparin in all patients hospitalized for pulmonary disorders in a tertiary hospital in Kraków, Poland, in 2014 and 2017, before and after introducing a computerized thromboprophylaxis system. Using the Caprini risk assessment, the overuse and underuse of thromboprophylaxis were defined as the use in patients with <5 points and ≥5 points, respectively. Results. Both cohorts (n = 2007 in 2014 and n = 1570 in 2017) were similar with regard to age and sex. The most frequent causes of hospitalization were intestinal lung disease (39.0%) and lung cancer (20.4%) in 2017, and pneumonia (38.8%) and lung cancer (27.5%) in 2014. Although the use of thromboprophylaxis was comparable in both cohorts, it was used more frequently in high VTE risk patients in 2017 compared with 2014 (96.98% compared to 29.17%, respectively, p < 0.001), with a concomitant reduction in its overuse (2.26% compared to 6.26%, respectively, p < 0.001). In 2017, no predictors of thromboprophylaxis underuse were identified. The overuse was mainly predicted by the diagnosis of airway diseases (odds ratio (OR) = 0.16, 95% confidence interval (95% CI) = 0.02-1.17, p = 0.015). Conclusions. Our findings indicate the benefits of using a computerized system to manage pharmacological thromboprophylaxis in pulmonary inpatients. [ABSTRACT FROM AUTHOR]

Venous thromboembolism is associated with formation of denser fibrin clots resistant to lysis. We investigated whether prothrombotic plasma clot properties are associated with the severity of acute pulmonary embolism (PE). We enrolled 126 normotensive acute PE patients (aged 58 ± 14 years) and 25 age- and sex-matched healthy controls. Plasma fibrin clot permeability (Ks), clot lysis time (CLT), endogenous thrombin potential (ETP), plasminogen activator inhibitor-1 (PAI-1), and citrullinated histone H3 (citH3) were evaluated on admission. PE patients compared to controls had 370% higher citH3 levels, 41% higher ETP, 16.5% reduced Ks, and 25.6% prolonged CLT. Patients with intermediate-high (n = 29) and intermediate-low (n = 77) PE mortality risk had reduced Ks and prolonged CLT, increased PAI-1 and ETP as compared to low-risk PE (n = 20) patients. Prolonged CLT was predicted by PAI-1 and citH3, while low Ks by C-reactive protein. During a 12-month follow-up 9 (7.1%) patients who had 24% higher ETP, 45% higher citH3 levels, and 18% prolonged CLT at baseline died. High ETP combined with elevated citH3 levels and prolonged CLT was associated with eightfold increased risk of PE-related death. Prothrombotic fibrin clot properties and enhanced neutrophil extracellular traps formation are associated with higher early mortality risk in acute PE patients, which suggests a prognostic role of these biomarkers. [ABSTRACT FROM AUTHOR]

Background. Monocyte subsets are involved in atherosclerotic vascular disease and its thromboembolic complications. Moreover, the role of monocytes has been suggested in the pathogenesis of venous thromboembolism (VTE). Objectives. We hypothesized that pro-inflammatory non-classical and intermediate monocytes are increased in the first months following VTE. Material and methods. We enrolled 70 patients aged 18-65 years (mean age 41.6 ±11.6) with the firstever provoked (n = 32; 45.7%) or unprovoked (n = 38; 54.28%) VTE episode, and 46 healthy controls. The exclusion criteria were: acute infection, cancer, autoimmune disorders, previous myocardial infarction (MI), or stroke. Monocyte subsets were assessed 12 (8.5-21.5) months after VTE using flow cytometry and were defined as classical (CD14++CD16-), intermediate (CD14++CD16+) and non-classical (CD14+CD16++). Results. Patients with VTE had higher intermediate and non-classical monocyte counts compared to the control group (16.8 ±9.3 vs 10.4 ±4.0 cells/μL, and 64.1 ±25.2 vs 44.1 ±19.2 cells/μL, respectively, both p < 0.001). Increased non-classical monocyte counts were observed in patients who experienced a VTE incident within 12 months prior to enrollment (71.5 ±27.4 vs 56.03 ±20.6 cells/μL; p = 0.01) and those with unprovoked VTE (70.2 ±4.1 vs 58.8 ±4.3 cells/μL; p = 0.06). There were no differences in monocyte subsets related to the current anticoagulation. Conclusions. Our data has shown for the first time that VTE is associated with an increased number of nonclassical and intermediate monocytes, which may indicate the involvement of monocyte-related mechanisms in the pathophysiology of this disease. [ABSTRACT FROM AUTHOR]

Copyright of Review of Medicine / Przeglad Lekarski is the property of Wydawnictwo Przegld Lekarski / Publisher Medicine Review and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background. Underuse of thromboprophylaxis in hospitalized medical patients is still common worldwide. Little is known about the use of thromboprophylaxis in patients with pulmonary diseases in everyday hospital practice. Objectives. The aim of this study was to assess the use of pharmacological prophylaxis of venous thromboembolism (VTE) in real-life patients with pulmonary diseases. Material and methods. In this retrospective study, 2 validated scoring systems, i.e., the Padua prediction score and Caprini VTE risk assessment, were used to assess the VTE risk in 2011 patients (1133 men and 878 women), aged 18 years or more, hospitalized for pulmonary diseases (median 6 days) in a single tertiary pulmonary medical center from January to December 2014. Results. Using the Padua prediction score, we identified 428 (21.28%) patients at a high risk for VTE, including 167 (39.01%) who received thromboprophylaxis with low-molecular-weight heparin, and 261 (60.98%) individuals at a high risk without thromboprophylaxis (p < 0.001). A total of 888 (44.16%) patients who scored 5 points or more using the Caprini VTE risk assessment were identified as subjects at a high risk for VTE, including 34.79% of patients receiving thromboprophylaxis. From among patients at a high risk for VTE, 579 (65.20%) did not receive appropriate thromboprophylaxis (p < 0.001). Underuse of thromboprophylaxis was observed more commonly among patients hospitalized for lung cancer or pneumonia (50.60% and 24.87% of patients at a high risk for VTE without prophylaxis, respectively). Conclusions. Thromboprophylaxis is underutilized in hospitalized patients with pulmonary diseases regardless of the scoring system used. Implementation of thromboprophylaxis should be markedly improved in this patient group. [ABSTRACT FROM AUTHOR]

Anticoagulants increase the risk of heavy menstrual bleeding (HMB). We sought to investigate the incidence, predictors and management of HMB in women on rivaroxaban compared to those on vitamin K antagonists (VKA). We addressed the issue as to whether HMB is associated with VTE recurrences. We performed a single-center prospective study in menstruating women aged 18–55 years treated with rivaroxaban or VKA ≥ 3 months since the index VTE episode. Seventy six women on rivaroxaban and 45 patients on VKA were included. Patients on rivaroxaban more commonly reported HMB compared with those on VKA (31 [41%] vs. 8 [18%], p = 0.009). Women treated with rivaroxaban more frequently needed interventions to reduce menstruation compared with those on VKA (29 [38%] vs. 6 [13%], p = 0.004). During the median follow-up time of 13 months, there were 8 (11%) recurrent VTE on rivaroxaban and 3 (7%) on VKA (p = 0.5). Rivaroxaban treatment predisposed to HMB (odds ratio [OR] 3.2, 95% [confidence interval] CI 1.4–8.2, p = 0.007) and the interruption of anticoagulant treatment for 2–3 days (OR 3.2, 95% CI 1.1–11.6, p = 0.033). HMB during the rivaroxaban treatment predisposed to recurrent VTE (OR 5.3, 95% CI 1.1–33.3, p = 0.038). In menstruating women following VTE, rivaroxaban is associated with a two-fold higher risk of HMB compared with VKA. HMB predisposes to recurrent VTE episode, most likely due to the short interruptions of anticoagulation. [ABSTRACT FROM AUTHOR]