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Objectives: The aim of this study is to analyze the effectiveness and safety of medical treatment (MT) versus endovascular treatment (EVT) in acute large vessel occlusion patients with mild nondisabling stroke symptoms. Methods: This study is a multicenter observational study in which data from patients at three stroke centers were prospectively obtained and retrospectively analyzed. Patients were included if they arrived for treatment within 6 h of stroke onset or last known well time and had a baseline National Institutes of Health Stroke Scale (NIHSS) score of ≤5. Primary outcome was modified Rankin Scale (mRS) score 0–2 at 90 days. Secondary outcomes included symptomatic intracranial hemorrhage (sICH), discharge NIHSS score, 90-day all-cause mortality and length of stay. Clinical outcomes were compared through a multivariable logistic regression after adjusting for age, treatment type admission and discharge NIHSS score, admission Alberta Stroke Program Early CT (ASPECT) score and length of stay. Results: Of the 82 patients included in the study, 42 were in the EVT group and 40 were in the MT group. The groups were similar in age (MT:66, EVT:64 age; p =.62), gender (MT:55%, EVT:54.8%; male) admission NIHSS score (MT:2, EVT:3 points; p =.26), ASPECT score (MT:10, EVT:9; p =.15). While discharge NIHSS score was found to be statistically significant between the groups (MT:1, EVT:2; p =.04). There was no difference between the two groups in terms of 90-day mRS scores (MT:1, EVT:1, p =.86) and mortality rates (MT:4, EVT:4; p =.94). In unadjusted analysis, sICH rates were similar between the MT and EVT groups (MT 5%, EVT 7.1%, p =.52). Neurological intensive care unit length of stay (MT:5 days, EVT:2 days p <.001), inpatient clinic length of stay (MT:3, EVT:2 days p =.041), and total length of stay (MT:9 days, EVT:4 days p <.001) were significantly longer in the MT group. Conclusions: Our multicenter study demonstrated that MT with blood pressure augmentation and anticoagulation at hyperacute stage is an alternative option for emergency large vessel occlusion patients with nondisabling mild stroke symptoms. [ABSTRACT FROM AUTHOR]

The awareness of nonocclusive thrombus has increased with the increasing frequency of imaging methods used for acute ischemic stroke; however, the best treatment for nonocclusive thrombi is still unknown. In this study, we examined how anticoagulants affect supra-aortic artery nonocclusive thrombus and clinical outcomes. This study included 52 patients with transient ischemic attack or stroke who were diagnosed with nonocclusive thrombi on computed tomography angiography at admission. Patients were treated with anticoagulant treatment and grouped according to treatment modality (either unfractionated heparin or low molecular weight heparin) and treatment duration. Primary safety outcome was major bleeding defined as immediate and clnically significant hemorrhage. Anticoagulant treatment was continued until the thrombus was resolved as determined by consecutive weekly computed tomography angiography controls. After thrombus resolution, treatment was directed according to the underlying etiology. Antiaggregation treatment was the preferred treatment after thrombus resolution for patients with no observed etiology. The affected internal carotid arteries were most frequently located in the cervical segment (48 %). Complete resolution was achieved within 2 weeks in 50 patients (96 %). The involved vasculature included the following: the extracranial carotid artery segments (n = 26, 50 %), intracranial ICA segments (n = 10, 19 %), basilar artery segments (n = 8, 15 %) and MCA segments (n = 7, 13 %). The most common underlying pathologies were atherosclerosis (n = 17), atrial fibrillation (n = 17), undetermined embolic stroke (n = 8), dissection (n = 7), and malignancy (n = 2). No symptomatic intra- or extracranial bleeding complications due to anticoagulant use were observed in any patient during the study period. A good functional outcome (modified Rankin scale score 0–2) was achieved in 49 patients (94 %) at 3 months. There was no significant difference between treatment type and duration in terms of reinfarction (p = 0.97 and p = 0.78, respectively). Anticoagulant treatment is safe and effective in symptomatic patients with intracranial or extracranial artery nonocclusive thrombus, regardless of the anticoagulant type, thrombus location and size. [ABSTRACT FROM AUTHOR]

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Background: Patients with acute venous thromboembolism (VTE) need anticoagulation (AC) therapy for at least 3/6 months (primary treatment); after that period, they should receive a decision on the duration of therapy. Methods: This study examined the complications occurring during two years of follow-up (FU) in patients with a first VTE who were recruited in 20 clinical centers and had discontinued or prolonged AC. They were included in the START2-POST-VTE prospective observational study. Results: A total of 720 patients (53.5% males) who, after the completion of primary treatment, had received the decision to continue (n = 281, 39%; 76.1% with a DOAC) or discontinue (n = 439, 61%) AC were followed up for 2 years (total FU = 1318 years). The decision to prolong or suspend AC was made in similar proportions in patients with unprovoked or provoked index events. Courses of sulodexide treatment or Aspirin (100 mg daily) were prescribed to 20.3% and 4.5%, respectively, of the patients who discontinued AC. The bleeding rate was significantly higher in patients who extended AC (1.6% pt/y) than in those who stopped AC (0.1% pt/y; p = 0.001) and was higher in patients using standard-dose DOACs (3.1% pt/y) than in those using reduced-dose DOACs (0.4% pt/y). The recurrent VTE rates were similar between the two groups (2.2% pt/y during AC vs. 3% pt/y off AC). Conclusion: Physicians' decisions about AC duration were independent of the unprovoked/provoked nature of the index event. The bleeding rate was higher in patients who continued AC using standard-dose DOACs. Surprisingly, the rate of thrombotic recurrence was not different between those who continued or discontinued AC. Randomized studies comparing different procedures to decide on the duration of AC after a first VTE are needed. [ABSTRACT FROM AUTHOR]

Abstract Background Nonpersistence in anticoagulation therapy is common and associated with undesirable clinical outcomes in patients with venous thromboembolism (VTE). Methods We investigated preceding clinical events of treatment nonpersistence (e.g., switching, discontinuing, or restarting) in VTE patients with and without active cancer using Korean claims database. Results Clinically significant events including thromboembolic events, hepatic function change and surgery preceded treatment nonpersistence, but heterogeneous distributions of clinical events were observed in the presence of active cancer. Patients with active cancer had a low rate of clinical events preceding treatment nonpersistence, and new active cancer diagnosis in the nonactive cancer group was most common before the switch to parenteral anticoagulants from warfarin or non‐vitamin K antagonist oral anticoagulants (NOACs). Conclusion These findings suggest that clinically significant events can precede treatment nonpersistence and largely paralleled current guidelines for patients with VTE, whereas heterogeneous distributions of clinical events were observed in the presence of active cancer.

缺铁性贫血是颅内静脉窦血栓非常少见的原因。本文介绍了1例以持续性头痛3周，伴有一过性意识丧失为主诉的青年女性患者的诊疗过程。患者有长期月经量大的个人史，但无其他特殊病史和血管危险因素，经头颅CT和MRV检查确诊为左侧横窦和乙状窦血栓形成，入院多次检查血常规显示缺铁性贫血。综合考虑为缺铁性贫血致颅内静脉窦血栓形成，给予针对贫血的琥珀酸亚铁，以及针对静脉窦血栓的抗凝治疗后，患者病情好转出院。 Abstract: Iron deficiency anemia is a rare cause of intracranial venous sinus thrombosis. This study described the diagnosis and treatment of a young female with persistent headache for 3 weeks accompanied by transient loss of consciousness. The patient had long term heavy menstrual flow, no other vascular risk factors. Head CT and MRV confirmed thrombosis of the left transverse sinus and sigmoid sinus. Blood routines revealed iron deficiency anemia. Her intracranial venous sinus thrombosis caused by iron deficiency anemia. The patient was given ferrous succinate for anemia and anticoagulant treatment for venous sinus thrombosis. She was improved rapidly discharged later.

Abstract Background In case of heparin-induced thrombocytopenia (HIT), the switch to a non-heparin anticoagulant is mandatory, at a therapeutic dose. Such a treatment has limitations though, especially for patients with renal and/or hepatic failure. Candidate laboratory tests could detect the more coagulable HIT patients, for whom therapeutic anticoagulation would be the more justified. Patients and methods This was a monocentre observational prospective study in which 111 patients with suspected HIT were included. Nineteen were diagnosed with HIT (ELISA and platelet activation assay), among whom 10 were classified as HITT + when a thrombotic event was present at diagnosis or during the first following week. Two plasma prethrombotic biomarkers of in vivo activation of the haemostasis system, procoagulant phospholipids (ProcoagPPL) associated with extracellular vesicles and fibrin monomers (FM test), as well as in vitro thrombin potential (ST Genesia; low picomolar tissue factor) after heparin neutralization (heparinase), were studied. The results were primarily compared between HITT + and HITT- patients. Results Those HIT + patients with thrombotic events in acute phase or shortly after (referred as HITT+) had a more coagulable phenotype than HIT + patients without thrombotic events since: (i) clotting times related to plasma procoagulant phospholipids tended to be shorter; (ii) fibrin monomers levels were statistically significantly higher (p = 0.0483); (iii) thrombin potential values were statistically significantly higher (p = 0.0404). Of note, among all patients suspected of suffering from HIT, we did not evidence a hypercoagulable phenotype in patients diagnosed with HIT compared to patients for whom the diagnosis of HIT was ruled out. Conclusion The three tests could help identify those HIT patients the most prone to thrombosis.

Ovarian vein thrombosis (OVT) is a rare but serious complication, most commonly occurring in the postpartum period. This article reports the case of a 40-year-old woman who presented 12 days after a normal vaginal delivery with fever and pelvic pain. An initial diagnosis of endometritis was made, and empiric antibiotic therapy was administered, but the fever persisted. An ultrasound scan was then done to rule out appendicitis, which revealed a thrombosis of the right ovarian vein extended to the inferior vena cava. Appropriate anticoagulant therapy was immediately started with spectacular clinical improvement.Ovarian vein thrombosis is difficult to diagnose as the signs are nonspecific, like fever and pelvic pain; radiological exploration, typically doppler ultrasound and computerized tomography, are therefore required. Early treatment is crucial to prevent severe complications, especially pulmonary embolism. This case emphasizes the need for heightened clinical awareness and a multidisciplinary approach to achieve optimal outcomes in managing ovarian vein thrombosis.

Background: Nonpersistence in anticoagulation therapy is common and associated with undesirable clinical outcomes in patients with venous thromboembolism (VTE). Methods: We investigated preceding clinical events of treatment nonpersistence (e.g., switching, discontinuing, or restarting) in VTE patients with and without active cancer using Korean claims database. Results: Clinically significant events including thromboembolic events, hepatic function change and surgery preceded treatment nonpersistence, but heterogeneous distributions of clinical events were observed in the presence of active cancer. Patients with active cancer had a low rate of clinical events preceding treatment nonpersistence, and new active cancer diagnosis in the nonactive cancer group was most common before the switch to parenteral anticoagulants from warfarin or non‐vitamin K antagonist oral anticoagulants (NOACs). Conclusion: These findings suggest that clinically significant events can precede treatment nonpersistence and largely paralleled current guidelines for patients with VTE, whereas heterogeneous distributions of clinical events were observed in the presence of active cancer. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office 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.)

Copyright of Polish Nephrology & Dialyzotherapy / Nefrologia i Dializoterapia Polska 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: In case of heparin-induced thrombocytopenia (HIT), the switch to a non-heparin anticoagulant is mandatory, at a therapeutic dose. Such a treatment has limitations though, especially for patients with renal and/or hepatic failure. Candidate laboratory tests could detect the more coagulable HIT patients, for whom therapeutic anticoagulation would be the more justified. Patients and methods: This was a monocentre observational prospective study in which 111 patients with suspected HIT were included. Nineteen were diagnosed with HIT (ELISA and platelet activation assay), among whom 10 were classified as HITT + when a thrombotic event was present at diagnosis or during the first following week. Two plasma prethrombotic biomarkers of in vivo activation of the haemostasis system, procoagulant phospholipids (ProcoagPPL) associated with extracellular vesicles and fibrin monomers (FM test), as well as in vitro thrombin potential (ST Genesia; low picomolar tissue factor) after heparin neutralization (heparinase), were studied. The results were primarily compared between HITT + and HITT- patients. Results: Those HIT + patients with thrombotic events in acute phase or shortly after (referred as HITT+) had a more coagulable phenotype than HIT + patients without thrombotic events since: (i) clotting times related to plasma procoagulant phospholipids tended to be shorter; (ii) fibrin monomers levels were statistically significantly higher (p = 0.0483); (iii) thrombin potential values were statistically significantly higher (p = 0.0404). Of note, among all patients suspected of suffering from HIT, we did not evidence a hypercoagulable phenotype in patients diagnosed with HIT compared to patients for whom the diagnosis of HIT was ruled out. Conclusion: The three tests could help identify those HIT patients the most prone to thrombosis. [ABSTRACT FROM AUTHOR]

• 24.1 % of older hospitalized patients were affected by AF, of them 97.3 % were at HTR. • About half of patients was not treated with OACs, 21.5 % used NOACs and 30.4 % VKA. • Lower probability of OAC treatment was found in patients with high CIR.S and cancer. • Hospital stay, cancer diagnoses and high INR value increased OAC discontinuation. • In NOAC users a not significant decreased mortality than VKA or not users was found. Atrial fibrillation (AF) prevalence increases in older patients which also show a high thromboembolic risk. Oral anticoagulants (OACs) are recommended to prevent cardioembolic events and direct oral anticoagulants (DOACs) improved anti-thrombotic treatment. However, the benefits/risks of anticoagulant in older patients still need to be completely defined. This retrospective observational study aimed to describe the treatment with OACs in older AF hospitalized patients, and to identify factors influencing OAC therapy or discontinuation using the REgistro Politerapie SIMI. Univariate and multivariate logistic regression models were applied to identify predictors of OACs treatment and discontinuation. Cox proportional hazards models were performed to evaluate one-year mortality by treatment groups. AF patients were 1,128(26.5 %) at discharge and 1,098(97.3 %) required OAC treatment; about half of them (N = 528;48.1 %) were no-OACs users; 236(21.5 %) and 334(30.4 %) used DOACs and VKA, respectively. Increasing DOACs use was observed during the study period. Predictors of OACs treatment were: BMI (OR:1.04; 95 %CI:1.01–1.07), Barthel index (OR:1.01; 95 %CI:1.01–1.02), medications number (OR:1.07; 95 %CI:1.01–1.13). Conversely, a lower probability was found in patients with a high CIR.S (OR:0.59; 95 %CI:0.36–0.97) and neoplasm (OR:0.57; 95 %CI:0.37–0.88). Hospital stay (OR:1.02; 95 %CI:1.01–1.05), neoplasm (OR:2.25; 95 %CI:1.07–4.70) and INR (OR:1.21; 95 %CI:1.05–1.40) increased OACs discontinuation. A lower discontinuation was observed in dyslipidemic patients (OR:0.18; 95 %CI:0.04–0.82) and heart failure (OR:0.38; 95 %CI:0.21–0.70). Among AF patients, 157(14.3 %) died during the follow-up year. Age (HR = 1.05; 95 %CI = 1.03–1.08) and CIR.S (HR = 2.54; 95 %CI = 1.53–4.21) were associated with a greater mortality risk. In conclusion, critical issues related to the underuse and discontinuation of OACs therapy in hospitalized older patients were highlighted. [Display omitted] [ABSTRACT FROM AUTHOR]

The therapeutic regimen option for the cancer-associated thrombosis (CAT) patients is still a major clinical challenge. The present study aimed to investigate the safety and efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) with AngioJet treatment compared with the conventional anticoagulation alone therapy in the patients with CAT. We retrospectively reviewed the patients who underwent PCDT and/or anticoagulation for the treatment of CAT between August 1, 2016 and March 1, 2022. Each patient was divided into the PCDT group or the anticoagulation alone group. The baseline demographics, comorbidities, clinical characteristics, treatment details, course data were reviewed. A total of 51 eligible patients were included, of whom 21 were in PCDT group (mean age, 60.1 ± 13.0 years; 52.4% male) and 30 in anticoagulation alone group (mean age, 66.6 ± 11.1 years; 50.0% male). No significant differences regarding age, sex, onset time, limb characteristics, cancer conditions or risk factors were detected (p >.05). After PCDT, grade III lysis was achieved in 8 and grade II lysis in 11 patients. Clinical success was achieved in 90.5% (19/21) patients. The symptoms of leg pain and swelling were significantly improved in both groups. Except for transient macroscopic hemoglobinuria occurring in PCDT group, none of all patients suffered from procedure-related and major complications. Minor complications such as bleeding events occurred in 23.8% (5/21) of patients in PCDT group compared with 10.0% (3/30) in anticoagulation alone group (p >.05). At the 6-month follow-up, iliofemoral patency was found an absolute risk reduction of 37.9% (70.0 vs. 32.1%) (95% CI: 1.183–4.008%; P = 0.010). The incidence of mild PTS was 5.0% (1/20) in PCDT group compared with 10.7% (3/28) in anticoagulation alone group (p >.05). The PCDT is a safe and effective modality in managing patients with CAT, leading to improved clinical outcomes with a low complication. The PCDT was more effective than anticoagulation alone in massive symptom relief and venous patency. Highlights: The therapeutic regimen option for cancer-associated thrombosis (CAT) patients is still a major clinical challenge, the optimal prevention and treatment strategies are still lacking. Both the PCDT and anticoagulation alone treatments are safe and effective in managing proximal DVT in patients with cancer, thus leading to improved outcomes with a low complication. The PCDT is more effective than the anticoagulation alone treatment in thrombus removal and symptom relief, as well with a higher venous patency. [ABSTRACT FROM AUTHOR]

Objective: To investigate the safety and effectiveness of catheter-based therapy (CBT) compared to conventional catheterdirected thrombosis (CDT) for non-oncological patients with inferior vena cava thrombosis (IVCT), as well to evaluate the differences between CBTs using AngioJet rheolytic thrombectomy (ART) and large lumen catheter aspiration (LLCA). Methods: This retrospective single-center study included eligible patients with IVCT treated with CBTs coupled with/without CDT or CDT alone as the first-line treatment between January 3, 2015 and January 28, 2022. The baseline demographics, comorbidities, clinical characteristics, treatment details, course data were all reviewed. Results: A total of 106 patients (128 limbs) were included, with 42 cases were treated with ART, 30 with LLCA, and 34 with CDT alone. Technical success rates were 100% (128/128), and 95.5% (84/88) limbs treated with CBT subsequently underwent CDT. The mean duration of CDT time and total infusion agent dosage in patients with CBTs were lower than those who underwent CDT alone (P < .05). Similarities were observed in ART compared to LLCA (P < .05). At the end of CDT, clinical success was achieved in 85.2% (75/88) of limbs treated with CBTs and 77.5% (31/40) of limbs with CDT alone, and 88.5% (46/52) in ART and 80.6% (29/36) in LLCA. The 12-month follow-up showed slightly lower incidences of recurrent thrombosis (7.7% vs 15.2%) and post-thrombotic syndrome (14.1% vs 21.2%), which persisted in patients who underwent ART compared to LLCA (4.3% vs 12.9% and 8.5% vs 22.6%). Patients who underwent CBTs tended to have lower minor complications (5.6% vs 17.6%) but were at higher risk of transient macroscopic hemoglobinuria (58.3% vs 0%) and recoverable acute kidney injury (11.1% vs 2.9%) compared to CDT alone. These findings were similar in ART compared to LLCA (2.4% vs 10.0%, 100% vs 0%, and 16.7% vs 3.3%, respectively). LLCA seemed to have more hemoglobin losses (10.50 + 9.20 vs 5.57+10. 42 g/L, P < .05). Conclusion: CBTs coupled with/without CDT are safe and effective in patients with IVCT, reducing the clot burden in a moderate time, restoring blood flow rapidly, minimizing thrombolytic drug requirement and lowering minor bleeding complication compared to CDT alone. ART and LLCA have comparable outcomes but with different adverse event profiles. [ABSTRACT FROM AUTHOR]

Portal vein thrombosis, in the clinical setting of liver cirrhosis, is a complication which increases mortality rate by leading to specific complications. Its presence also serves as a negative prognostic factor for these patients. Specialized literature, although rich in papers on this subject, presents loose and sometimes contradictory information regarding its prognosis and specific treatment. This paper brings into discussion the issue of recent portal vein thrombosis in cirrhotic patients, with emphasis on indications for initiation of anticoagulant therapy and the optimal drug of choice. It also highlights the utility of using correct terminology for facilitating clinical approach of guideline recommendations as well as increasing the quality of published scientific papers. The coagulation homeostasis of the cirrhotic patient presents many particularities that can make the optimal therapeutic choice extremely difficult when portal vein thrombosis is established. Absence of randomized clinical trials and lack of consensus regarding anticoagulant treatment in these patients leaves it up to the clinician to decide when and what anticoagulant to use. Analysis of the newest guidelines and recent meta-analysis made it possible to identify the right context for initiating therapy with the most used anticoagulants currently: low molecular weight heparin, vitamin K antagonists and direct oral anticoagulants. [ABSTRACT FROM AUTHOR]

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Abstract Background The anticoagulant treatment and clinical efficacy of heparin in sepsis remains controversial. We conducted a meta-analysis to estimate the clinical efficacy of unfractionated heparin (UFH) in adult septic patients. Method A systematic review of Medline, Cochrane Library, PubMed, Embase, WEIPU database, CNKI database, WANFANG database was performed from inception to January 2021. We included Randomized controlled trials (RCTs) and the main outcome was 28 d mortality. Data analysis was performed with Review Manager (RevMan) version 5.3 software. The meta-analysis included 2617 patients from 15 RCTs. Results Comparing to control group, UFH could reduce 28 d mortality (RR: 0.82; 95% CI: 0.72 to 0.94) especially for patient with Acute Physiology and Chronic Health Evaluation II (APACHE II) > 15, (RR: 0.83; 95% CI: 0.72 to 0.96). In UFH group, the platelet (PLT) (MD: 9.18; 95% CI: 0.68 to 17.68) was higher, the activated partial thromboplastin time (APTT) was shorter (MD: -8.01; 95% CI: − 13.84 to − 2.18) and the prothrombin time (PT) results (P > 0.05) failed to reach statistical significance. UFH decreased multiple organ dysfunction syndrome (MODS) incidence (RR: 0.61; 95% CI: 0.45 to 0.84), length of stay (LOS) in ICU (MD: -4.94; 95% CI: − 6.89 to − 2.99) and ventilation time (MD: -3.01; 95% CI: − 4.0 to − 2.02). And UFH had no adverse impact on bleeding (RR: 1.10; 95% CI: 0.54 to 2.23). Conclusion This meta-analysis suggests that UFH may reduce 28 d mortality and improve the clinical efficacy in sepsis patients without bleeding adverse effect.

Abstract Background To evaluate the anticoagulant treatment response in venous thrombi with different morphologies (size, shape, and echogenicity) by measuring the change in thrombus thickness. Materials and methods This was a retrospective cohort study of 97 lower extremity DVT patients diagnosed by venous ultrasound between March 2014 and February 2018. The demographics, clinical risk factors, anticoagulant treatment, and ultrasound findings at the first diagnosis and 2–6 months after treatment were evaluated. Results The anticoagulant treatment with LMWH followed by VKAs showed a significant decrease in the mean maximum difference in lower extremity DVT thrombus thickness compared with VKAs alone (P-value

Acute ischemic stroke (AIS) due to cerebral artery occlusion is often treated by thrombolytics or antithrombotic drugs. Thromboelastography (TEG) is a noninvasive test that provides a dynamic overview of the coagulation process. TEG may help guide thrombolytic and antithrombotic therapy in AIS. This article aims to highlight the potential use of TEG in AIS patients by reviewing available studies. We conducted a literature review, including PubMed and Cochrane library databases. The following keywords were used to find relevant studies: thromboelastography, TEG, acute ischemic stroke, stroke, coagulopathy, antiplatelet, and anticoagulant treatment. We identified 142 papers and after abstract review, we included 24 studies in this report. TEG identified a hypercoagulable state in AIS patients represented by short R, K, and greater α angle in all papers included. Modification of TEG parameters induced by intravenous thrombolysis was inconsistent but prolonged lysis (increased LY30) and weaker clots (lower maximum amplitude) were most frequent. TEG detected hypo-coagulopathy induced by dual antiplatelet therapy as well as antiplatelet drug resistance, with ticagrelor and aspirin having greater inhibition of platelet activity. A prolonged R-value seems to be the most reliable TEG parameter in detecting the anticoagulant effect of factor Xa inhibitor treatment. TEG might represent a useful point-of-care test for emergency decision-making in AIS patients and a tool for individualized treatment options. This hypothesis needs validation in a large cohort of prospectively studied AIS patients. [ABSTRACT FROM AUTHOR]

Vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC) are two groups of drugs used in the prevention of thromboembolic events. Although DOACs are currently the preferred option in such prophylaxis, there are still indications for the use of VKAs. Thromboembolic episodes may occur as a result of many cardiovascular diseases, inter alia cardiac dysrhythmias. Atrial fibrillation is an arrhythmia that may be asymptomatic or manifested by chest pain, syncope, dyspnea or fatigue. Moreover, it is associated with a high risk of serious complications. An ischemic stroke or myocardial infarction can result from poorly treated AF and may sometimes be the only symptom of an arrhythmia. Therefore, the assessment of a patient's eligibility for anticoagulation therapy is an important element in the prevention of thromboembolic events. Demographic aging and the associated comorbidity may pose a clinical problem in the treatment of atrial fibrillation. The selection of an appropriate anticoagulant therapy should be individualized to the patient's needs.

Valvular heart disease affects more that 100 million people worldwide. Valvular replacement remains the only definite treatment for most of the patients with severe disease. Careful medical management and periodic follow up of valve function is mandatory in order to prevent or diagnose prosthesis-related complications. We present a case of extensive mitral and aortic valve thrombosis and possible recurrent endocarditis in a 44-year-old woman non-adherent to anticoagulation therapy, presented with stroke. She also had a history of two mitral and aortic valvular heart replacement surgeries. Comprehensive and repeated imaging was used to evaluate and monitor the patient progression and outcome. Failure of adequate anticoagulation therapy to improve prosthesis function during hospitalization required third re-do surgery for mitral and aortic valve replacement with mechanical prosthesis.

Background: The prevalence of anticoagulant therapy-associated hemorrhagic complications in hospitalized patients with pulmonary embolism (PE) has been scarcely investigated. Aim: To evaluate the prevalence of hemorrhages in hospitalized PE patients. Methods: The Information System "ASKLIPIOS™ HOSPITAL" implemented in the Respiratory Medicine Department, University of Thessaly, was used to collect demographic, clinical and outcome data from January 2013 to April 2021. Results: 326 patients were included. Males outnumbered females. The population's mean age was 68.7 ± 17.0 years. The majority received low molecular weight heparin (LMWH). Only 5% received direct oral anticoagulants. 15% of the population were complicated with hemorrhage, of whom 18.4% experienced a major event. Major hemorrhages were fewer than minor (29.8% vs. 70.2%, p = 0.001). Nadroparin related to 83.3% of the major events. Hematuria was the most common hemorrhagic event. 22% of patients with major events received a transfusion, and 11% were admitted to intensive care unit (ICU). The events lasted for 3 ± 2 days. No death was recorded. Conclusions: 1/5 of the patients hospitalized for PE complicated with hemorrhage without a fatal outcome. The hemorrhages were mainly minor and lasted for 3 ± 2 days. Among LMWHs, nadroparin was related to a higher percentage of hemorrhages. [ABSTRACT FROM AUTHOR]

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Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia 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.)

Aim: To investigate the efficacy and safety profile of oral anticoagulants and determine the best treatment for patients with atrial fibrillation (AF) and chronic kidney disease (CKD ). Methods and materials: A systematic assessment of literature from Pubmed/MEDLINE was performed in search of studies evaluating the efficacy, safety, pharmacokinetics, and pharmacodynamics of direct oral anticoagulants (DOACs) and warfarin in patients with CKD . Results: According to guidelines, DOACs are the treatment of choice for patients with CKD 1–3 (Crcl ≥ 30 mL/min) due to their high efficacy, better safety profile, and fewer food/drug and drug/ drug interactions than warfarin. For patients with CKD 4 (Crcl 15-29 mL/min), there are no such strong recommendations as to which group of anticoagulants is the better choice, and for those with CKD 5 (Crcl

Purpose of the study: to assess the role of educational programs on anticoagulant therapy in patients with atrial fibrillation in increasing adherence to warfarin treatment.Material and methods: the study included patients with atrial fibrillation, divided into two groups: the main group (n=125) - patients who completed the training program, and the control group (n=216), randomized for routine care, without training sessions. Comparison of the groups were comparable in sex (55.8% of men and 44.2% of women – in main group and 62.4% of men (p

Although thrombotic events are uncommon in young individuals, patients with genetic mutations in coagulation factors may develop extensive multisite thrombosis. We present the case of a 26-year-old patient, a smoker for nine years, who was admitted to the hospital complaining of right thigh pain with swelling, right flank abdominal pain, dyspnea, and hemoptysis. A medical history provided by the patient indicated that one month prior to presentation, an accidental fall had resulted in multiple rib fractures, bilateral hemopneumothorax, and pneumomediastinum. These injuries were treated with bilateral pleurotomy and passive pleural drainage. Upon initial presentation, the electrocardiogram (ECG) exhibited a distinctive pattern indicative of pulmonary embolism (PE), specifically sinus tachycardia and the S1Q3T3 pattern. Additionally, the thoraco-abdominopelvic angio-CT revealed acute PE in the branches of the pulmonary arteries supplying the bilateral lower lobes and deep vein thrombosis in the right external iliac vein, right common iliac vein with a protruding filling defect of approximately 18 mm in the inferior vena cava and extension to the left common iliac vein. Furthermore, a Doppler ultrasound of the right lower extremity revealed the presence of thrombosis along the entire right femoro-popliteal axis. Subsequent screening for hereditary thrombophilia revealed a heterozygous factor V Leiden G1691A* mutation and elevated levels of anticardiolipin antibodies. Despite the patient's compliance with non-vitamin K antagonist oral anticoagulants (NOACs) following discharge, a new thrombotic event, left femoral-popliteal venous axis thrombosis, occurred after a three-month interval. Repeat testing for anticardiolipin antibodies revealed an elevated titer, leading to a diagnosis of antiphospholipid syndrome. Given this diagnosis, anticoagulation with an antivitamin K was initiated. Screening for hereditary thrombophilia is crucial in young patients with thromboembolic events, as genetic causes may influence the therapeutic management and duration of anticoagulant treatment., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sava et al.)

Vascular thrombosis and hypercoagulability are frequently observed in individuals with nephrotic syndrome (NS), particularly those diagnosed with membranous nephropathy (MN). It is extensively recognized that venous thrombosis occurs far more frequently than arterial thrombosis. However, we report a patient who experienced two significant arterial and venous thrombotic events within the past two years, and he was a 35-year-old man with nephrotic syndrome secondary to membranous nephropathy. In contrast to most previous similar studies that had shown only a single demonstration of venous embolism or arterial embolism, this case highlighted the occurrence of both venous and arterial embolic events. This suggests and prompts considerations for future research avenues and anticoagulant treatment strategies., Competing Interests: None., (AJTR Copyright © 2024.)

Background: The anticoagulant treatment and clinical efficacy of heparin in sepsis remains controversial. We conducted a meta-analysis to estimate the clinical efficacy of unfractionated heparin (UFH) in adult septic patients. Method: A systematic review of Medline, Cochrane Library, PubMed, Embase, WEIPU database, CNKI database, WANFANG database was performed from inception to January 2021. We included Randomized controlled trials (RCTs) and the main outcome was 28 d mortality. Data analysis was performed with Review Manager (RevMan) version 5.3 software. The meta-analysis included 2617 patients from 15 RCTs. Results: Comparing to control group, UFH could reduce 28 d mortality (RR: 0.82; 95% CI: 0.72 to 0.94) especially for patient with Acute Physiology and Chronic Health Evaluation II (APACHE II) > 15, (RR: 0.83; 95% CI: 0.72 to 0.96). In UFH group, the platelet (PLT) (MD: 9.18; 95% CI: 0.68 to 17.68) was higher, the activated partial thromboplastin time (APTT) was shorter (MD: -8.01; 95% CI: − 13.84 to − 2.18) and the prothrombin time (PT) results (P > 0.05) failed to reach statistical significance. UFH decreased multiple organ dysfunction syndrome (MODS) incidence (RR: 0.61; 95% CI: 0.45 to 0.84), length of stay (LOS) in ICU (MD: -4.94; 95% CI: − 6.89 to − 2.99) and ventilation time (MD: -3.01; 95% CI: − 4.0 to − 2.02). And UFH had no adverse impact on bleeding (RR: 1.10; 95% CI: 0.54 to 2.23). Conclusion: This meta-analysis suggests that UFH may reduce 28 d mortality and improve the clinical efficacy in sepsis patients without bleeding adverse effect. [ABSTRACT FROM AUTHOR]

Background: To evaluate the anticoagulant treatment response in venous thrombi with different morphologies (size, shape, and echogenicity) by measuring the change in thrombus thickness. Materials and methods: This was a retrospective cohort study of 97 lower extremity DVT patients diagnosed by venous ultrasound between March 2014 and February 2018. The demographics, clinical risk factors, anticoagulant treatment, and ultrasound findings at the first diagnosis and 2–6 months after treatment were evaluated. Results: The anticoagulant treatment with LMWH followed by VKAs showed a significant decrease in the mean maximum difference in lower extremity DVT thrombus thickness compared with VKAs alone (P-value < 0.001). After adjustment by treatment, the thrombi found in dilated veins showed a significant decrease in the thickness of such thrombi compared with those found in small veins: 4 mm vs. 0 mm (Coef. = 3, 95% CI: 1.9, 4.1 and P-value < 0.001). Anechoic and hypoechoic thrombi showed a significant decrease in the thickness compared with hyperechoic thrombi: 5 mm vs. 0 mm (Coef. = 4, 95% CI: 3.25, 4.74 and P-value < 0.001) and 3 mm vs. 0 mm (Coef. = 2, 95% CI: 1.34, 42.66 and P-value < 0.001), respectively. Concentric thrombi showed a significant decrease in thickness compared with eccentric thrombi: 4 mm vs. 0 mm (Coef. = 2, 95% CI: 1.45, 2.55 and P-value < 0.001). Conclusion: The anticoagulant treatment with LMWH followed by VKAs shows a significant decrease in lower extremity DVT thrombus thickness compared with VKAs alone. After adjustment by treatment, the morphologic finding of acute thrombi shows a significantly decreased thickness compared with the morphologic finding of chronic thrombi. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE) recurrence risk is determined by risk factors that were present at the time of the initial VTE episode. The most significant determinant of risk for recurrent VTE is whether the VTE occurred in the setting of provoked or unprovoked condition. As anticoagulation reduces the risk of recurrent VTE, initial anticoagulant treatment at the time of VTE diagnosis is indicated with consideration given to an associated risk of bleeding. After three months of initial anticoagulation, recurrence risk and bleeding risk should be assessed again to decide if anticoagulation should be stopped or continued indefinitely. If indefinite anticoagulation is recommended, annual assessment of both risks should guide decisions about further treatment. Knowledge about the various risk factors for VTE recurrence and the risk factors for bleeding associated with anticoagulation should guide anticoagulant duration. [ABSTRACT FROM AUTHOR]

Resumen: Introducción: La fibrilación auricular (FA) es la arritmia más frecuente. Su prevalencia aumenta con la edad. El flutter auricular es una arritmia análoga y menos frecuente. El tratamiento del enfermo anciano no siempre coincide con el tratamiento recomendado por las distintas sociedades científicas. Objetivos: Describir el tratamiento anticoagulante de los enfermos de al menos 75 años que ingresaron el servicio de medicina interna por cualquier motivo, con FA o flutter auricular conocidas con anterioridad o diagnosticadas en el momento del ingreso, durante los meses de abril, mayo y junio de 2018. Describir la mortalidad en ese ingreso y en el seguimiento posterior, y valorar la importancia de factores basales en el devenir de estos enfermos. Material y métodos: Trabajo observacional prospectivo de pacientes consecutivos ingresados entre el 1 de abril y el 30 de junio de 2018 en el servicio de medicina interna de un hospital de segundo nivel de la provincia de Valencia. Las variables categóricas se describieron con porcentajes, y las numéricas continuas con media, desviación estándar, mínimo y máximo. Las comparaciones entre variables categóricas se realizaron con el test Chi-cuadrado, y la comparación entre variable categórica y numérica con los test t de Student o ANOVA. Resultados: En ese intervalo temporal ingresaron 125 pacientes, 115 con FA y 10 con flutter auricular. De ellos 111 (80,8%) estuvieron anticoagulados al ingreso (78 con anti-vitamina K [AVK]) y 23 con anticoagulantes de acción directa (ACOD). Fallecieron 13 pacientes (10,4%) durante esa estancia hospitalaria. En los 2 años siguientes reingresaron en el hospital 72 pacientes (64,3%) y fallecieron 70 (62,5). Hubo 12 ingresos (9,6%) y 8 reingresos (11,1%) por hemorragia significativa. Treinta y tres enfermos (42,3%) anticoagulados con AVK se encontraron en rango terapéutico en el momento del ingreso. La supervivencia de los enfermos anticoagulados fue mayor que la de los no anticoagulados (medianas de supervivencia de 19,9 vs. 5,6 meses), y mayor en el grupo con AVK que con ACOD (medianas de supervivencia de 21,8 vs. 9,9 meses). No hubo diferencias significativas de ictus o hemorragias significativas entre los grupos de pacientes tomadores de AVK con INR alto, INR normal o bajo o tomadores de ACOD. Conclusiones: La mortalidad a medio plazo de este grupo de enfermos fue elevada, aunque la mortalidad durante el ingreso fue menor. La anticoagulación en estos enfermos pareció aportar beneficio en supervivencia y no se acompañó de complicaciones hemorrágicas significativas. Abstract: Introduction: Atrial fibrillation (AF) is the most frequent arrhythmia. Its prevalence increases with age. Atrial flutter is a less common and analogous arrhythmia. The treatment of the elderly patient is not always the same as the recommended one by the different scientific societies. Objectives: Describe the anticoagulant treatment of patients aged 75 years or older who was admitted in the Internal Medicine service for any reason, with previously known AF or atrial flutter or diagnosed at the time of admission, during the months of April, May and June 2018. Describe the mortality in this admission and in the subsequent follow-up and assess the importance of baseline factors in the future of these patients. Material and methods: Prospective observational study of consecutive patients admitted between April 1st and June 30th, 2018 in the Internal Medicine service of a second-level hospital in the province of Valencia. Categorical variables were described with percentages, and continuous numerical variables with mean, standard deviation, minimum and maximum. Comparisons between categorical variables were made with the Chi-squared test, and the comparison between categorical and numerical variables with Student's t tests or ANOVA. Results: In this time interval, 125 patients were admitted, 115 with AF and 10 with atrial flutter. Of these, 111 (80.8%) were anticoagulated upon admission (78 with vitamin K antagonists (VKA) and 23 with directly acting oral anticoagulants (DOAC). 13 patients (10.4%) died during this hospital admission. In the next 2 years, 72 patients (64.3%) had readmissions in the hospital and 70 died (62.5). There were 12 admissions (9.6%) and 8 readmissions (11.1%) due to significant bleeding. Thirty-three patients (42.3%) anticoagulated with VKA were found in the therapeutic range at the time of admission. Survival of anticoagulated patients was greater than that of non-anticoagulated patients (median survival of 19.9 vs. 5.6 months), and higher in the group with VKA than with DOAC (median survival of 21.8 vs. 9.9 months). There were no significant differences in stroke or significant bleeding between the groups of patients taking VKA with high INR, normal or low INR or taking DOAC. Conclusions: The medium-term mortality of this group of patients was high, although the mortality during admission was lower. Anticoagulation of these patients appeared to provide survival benefit and was not associated with significant bleeding complications.

Introduction: Pulmonary embolism (PE) is a serious condition with high mortality. Despite the knowledge of risk factors, it is still underdiagnosed and often left without preventive measurements. Major risk factors include: postoperative conditions (after major interventions in the abdominal, pelvic or orthopedic area), peripheral venous disease, pregnancy in the third trimester, malignancies, lack of mobility (especially in the elderly), heart diseases, chronic obstructive pulmonary disease (COPD), sepsis, thrombophilia, inflammatory bowel diseases, chronic dialysis, central catheters etc. Case Report: We present an 82-year-old male patient known with COPD, a chronic smoker, atrial fibrillation with an implantable cardioverter-defibrillator (ICD), coronary artery disease (CAD) with a percutaneous coronary intervention (PCI) for myocardial infarction, dilated cardiomyopathy (DCM), chronic heart failure (CHF) not undergoing anticoagulant treatment. He was admitted to the Pulmonology Clinic for rest dyspnea, with a SpO2 of 92%, productive cough, wheezing and chest discomfort. Radiological examination showed right middle lobe pulmonary consolidation and right pleural effusion. Under chest ultrasound guidance, a thoracentesis was performed (700 ml of serocitrin transudate liquid). Echocardiography revealed a global dilated heart, with right overload, severely depressed left ventricular systolic function with global hypokinesia (EF 20%) and severe valvular damage. Venous Doppler ultrasound of the lower limbs didn't reveal signs of deep vein thrombosis. The multiple comorbidities and the clinical appearance raised the suspicion of pulmonary thromboembolism, with a Wells criteria score of 4.5 (moderate risk). Angio-CT examination confirmed acute thrombosis of the right main pulmonary artery and right atrium, right middle lobe pneumonia and pleural effusion. Case management included treatment with anticoagulant, antibiotics, oxygen therapy, combined inhaled bronchodilators (for COPD) and transfer to the cardiology field for further treatment. Discussions : The case report underlines an undiagnosed pulmonary embolism through clinical-radiological suspicion and confirmed by angioCT. In a COPD patient, dyspnoea can result from disease exacerbation and complications (thrombosis, pulmonary embolism, heart failure) within the context of systemic inflammation of COPD, advanced age, and complex cardiovascular comorbidities. Conclusions: Considering the age, complex respiratory and cardiovascular comorbidities, the patient must be under anticoagulants and closely followed-up. Favorable evolution was made possible by multidisciplinary team management and complex investigations. Wells criteria for PE may always be quantified in people with risk factors and clinical suspicion. [ABSTRACT FROM AUTHOR]

Background: When superficial temporal artery-middle cerebral artery bypass is combined with indirect methods (e.g., revascularization surgery) to treat Moyamoya disease (MMD), antiplatelet treatment can impact bypass patency, infarction, or hemorrhage complications. Recently, heparin has been proposed as an anticoagulant treatment against white thrombus at the anastomosis site. The study aims to evaluate the effect of aspirin on the perioperative outcomes and investigate the results of heparin treatment for white thrombus. Methods: This retrospective study included 74 procedures of combined revascularization surgery for MMD patients who either received or did not receive aspirin. Perioperative outcomes were compared between the two groups. In addition, the effects of heparin treatment for white thrombus were evaluated. Results: The rate of white thrombus at the anastomosis site was significantly higher in the non-aspirin medication group (univariate: p = 0.032, multivariate: p = 0.044) and, accordingly, initial bypass patency was lower in the non-aspirin medication group (p = 0.049). Of the 17 patients with white thrombus development, five received heparin injections, and all white thrombi disappeared; however, there was one case of epidural hematoma and another of subdural hematoma. The risk of hemorrhagic complications was significantly higher in the surgical procedures that received heparin injections (p = 0.021). Conclusions: In MMD patients who received combined revascularization surgery, aspirin medication lowered the occurrence of white thrombus. Heparin injections help to treat white thrombus but can enhance the risk of hemorrhagic complications. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) broke out in Wuhan, China, in late December 2019 and has since spread rapidly around the world. Severe coronavirus disease 2019 (COVID-19) pneumonia patients have abnormal blood coagulation function, but their thromboembolism prevalence is still unknown. We reported a case of a 49-year-old man infected with COVID-19, presenting with fever, chest pain, limb weakness, myalgia, and dyspnea. The patient was diagnosed with severe COVID-19 pneumonia, pulmonary thromboembolism (PTE), deep vein thrombosis (DVT), and cerebral infarction. He received supportive and empirical treatment including anticoagulant treatment, anti-inflammatory treatment, oxygen supply, and inhalation therapy. The patient's symptoms, CT images, and laboratory results improved after treatment, and a throat swab was reported to be negative for SARS-CoV-2 virus by polymerase chain reaction (PCR) test. However, on day 51 of illness onset, CT reexamination demonstrated hemorrhagic infarction. Anticoagulant therapy was discontinued temporarily. After the patient tested negative for SARS-CoV-2 virus by PCR test six more times, he was discharged and remained in home quarantine. This case highlights the importance of clinician attentiveness to the appearance of multiple thromboembolism, especially in patients with severe pulmonary damage. It also emphasizes the diagnostic value of early CT imaging and the need for effective treatment once thrombotic events occur.

Introduction: Cerebral microbleeds (CMB) are associated with intracerebral haemorrhage. Therefore they may represent a concern if anticoagulant and/or antiplatelet therapy is needed. The aim of this study was to determine the prevalence of CMB in patients with acute myocardial infarction (AMI), and to follow their progression at 3 months under dual antiplatelet therapy (DAPT). Methods: This prospective study included patients aged over 60 hospitalized in intensive cardiac care unit in our city for AMI. These patients underwent a first brain Magnetic resonance imaging (MRI) within 72 h of admission, that was repeated 3 months. Results: 108 patients were included between November 2016 and December 2018. The prevalence of CMB was 21.3%, with a female predominance of 65.2% vs 32.1% (p = 0.004). Diabetes is significantly associated with the presence of CMB, 45.5% vs 21.2% (p = 0.021). Patients with at least one acute CMB had higher haemorrhagic risk as evaluated with CRUSADE score (40.5 ± 13.6 vs 31.2 ± 14.8 (p = 0.004).Multivariate analysis showed that only female sex was associated with the presence of a CMB on the initial MRI. On repeated MRI, an increase in CMB was observed in 6% of patients.Our results suggest that discharge treatment with anticoagulant in combination with antiplatelet therapy may be an independent predictor of early progression of CMB. Conclusion: Our study confirms the high prevalence of CMB in patients over 60 years with AMI. The association of anticoagulant with DAPT, 3 months after stenting, may be an independent factor of CMB progression.

The article presents a clinical analysis of the patient with a newly developed unprovoked episode of venous thromboembolic events. It discusses the challenges in the diagnosis of pulmonary embolism, the need for thrombolytic therapy in patients with pulmonary arterial thromboembolism of medium risk. The guidelines for diagnosis of antiphospholipid syndrome in accordance with modern principles are provided. It also considers the issues of anticoagulant treatment.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) broke out in Wuhan, China, in late December 2019 and has since spread rapidly around the world. Severe coronavirus disease 2019 (COVID-19) pneumonia patients have abnormal blood coagulation function, but their thromboembolism prevalence is still unknown. We reported a case of a 49-year-old man infected with COVID-19, presenting with fever, chest pain, limb weakness, myalgia, and dyspnea. The patient was diagnosed with severe COVID-19 pneumonia, pulmonary thromboembolism (PTE), deep vein thrombosis (DVT), and cerebral infarction. He received supportive and empirical treatment including anticoagulant treatment, anti-inflammatory treatment, oxygen supply, and inhalation therapy. The patient's symptoms, CT images, and laboratory results improved after treatment, and a throat swab was reported to be negative for SARS-CoV-2 virus by polymerase chain reaction (PCR) test. However, on day 51 of illness onset, CT reexamination demonstrated hemorrhagic infarction. Anticoagulant therapy was discontinued temporarily. After the patient tested negative for SARS-CoV-2 virus by PCR test six more times, he was discharged and remained in home quarantine. This case highlights the importance of clinician attentiveness to the appearance of multiple thromboembolism, especially in patients with severe pulmonary damage. It also emphasizes the diagnostic value of early CT imaging and the need for effective treatment once thrombotic events occur. [ABSTRACT FROM AUTHOR]

Background and Objective: Pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PA-HSOS) is a rare disease with no specific treatment. Anticoagulants, antithrombotics, and microcirculation therapy can alleviate the progression of PA-HSOS. The application of rivaroxaban in patients with PA-HSOS has not yet been reported. The aim of this study was to analyze the efficacy and safety of rivaroxaban in the treatment of PAHSOS caused by Gynura segetum. Methods: A retrospective analysis was conducted using the clinical data of patients with PA-HSOS in the acute/subacute phase caused by the administration of Gynura segetum. The patients were divided into warfarin and rivaroxaban groups according to the anticoagulant therapy they received. The related biochemical indicators were monitored during hospitalization. Liver ultrasound, liver elastography, and related biochemical indicators were reviewed every two weeks or one month after discharge. The patients were followed until 1 year after complete remission or death. The efficacy and safety of rivaroxaban was compared with that of warfarin according to the patients' hepatic venous recanalization rates and the occurrence of bleeding events. Results: The study included 20 patients, with 10 in the warfarin group and 10 in the rivaroxaban group. The results show that the average anticoagulant course in the rivaroxaban group was significantly shorter than that in the warfarin group (P = 0.007). With treatment, the remission rates of the rivaroxaban and warfarin groups reached 90%. There was no significant difference in the incidence of adverse reactions or bleeding events between the t wo groups (P > 0.05). Conclusions: Compared with warfarin, rivaroxaban, a new oral anticoagulant, is convenient and safe for clinical use. It has a significant effect on PA-HSOS and a low risk of bleeding. This provides a new anticoagulant treatment for PA-HSOS. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) causes a hypercoagulable state. Several autopsy studies have found microthrombi in pulmonary circulation. In this randomized, open-label, phase II study, we randomized COVID-19 patients requiring mechanical ventilation to receive either therapeutic enoxaparin or the standard anticoagulant thromboprophylaxis. We evaluated the gas exchange over time through the ratio of partial pressure of arterial oxygen (PaO2) to the fraction of inspired oxygen (FiO2) at baseline, 7, and 14 days after randomization, the time until successful liberation from mechanical ventilation, and the ventilator-free days. Ten patients were assigned to the therapeutic enoxaparin and ten patients to prophylactic anticoagulation. There was a statistically significant increase in the PaO2/FiO2 ratio over time in the therapeutic group (163 [95% confidence interval – CI 133–193] at baseline, 209 [95% CI 171–247] after 7 days, and 261 [95% CI 230–293] after 14 days), p = 0.0004. In contrast, we did not observe this improvement over time in the prophylactic group (184 [95% CI 146–222] at baseline, 168 [95% CI 142–195] after 7 days, and 195 [95% CI 128–262] after 14 days), p = 0.487. Patients of the therapeutic group had a higher ratio of successful liberation from mechanical ventilation (hazard ratio: 4.0 [95% CI 1.035–15.053]), p = 0.031 and more ventilator-free days (15 days [interquartile range IQR 6–16] versus 0 days [IQR 0–11]), p = 0.028 when compared to the prophylactic group. Therapeutic enoxaparin improves gas exchange and decreases the need for mechanical ventilation in severe COVID–19. REBEC RBR-949z6v. • COVID-19 is associated with microthrombi in pulmonary circulation. • We randomized severe COVID-19 patients to receive either therapeutic enoxaparin or the standard thromboprophylaxis. • Therapeutic enoxaparin resulted in improved gas exchange over time. • Larger clinical trial is urgently needed to evaluate the anticoagulant therapy in severe COVID-19. [ABSTRACT FROM AUTHOR]

Cancer-associated venous thromboembolism remains an important but challenging aspect in the treatment of patients with cancer. Recently, alternatives to injection of low-molecular-weight heparin (LMWH) have been introduced, the non-vitamin K antagonist oral anticoagulants (NOACs), which could potentially alleviate patients from burdensome daily injections. This review discusses the available evidence exploring the role of NOACs in the treatment and secondary prevention of cancer-associated venous thromboembolism, from randomized trials, observational data, contemporary guideline recommendations, and patient perspectives. Edoxaban, rivaroxaban, and apixaban have proven attractive alternatives to LMWH for the treatment of cancer-associated venous thromboembolism. Contemporary guidelines have promptly endorsed the use of NOACs in patients with most cancer types. Nonetheless, issues remain regarding bleeding risk, interactions with medical cancer treatment, and the effectiveness and safety for extended treatment periods. There are head-to-head comparisons of the NOACs, and therefore no data favoring the use of one NOAC over the others. Patient's preferences are highly diverse and should be part of routine considerations when weighing risks and benefits associated with various available anticoagulant drugs. [ABSTRACT FROM AUTHOR]

Keywords: coagulation parameter; D-dimer; COVID-19; anticoagulant treatment EN coagulation parameter D-dimer COVID-19 anticoagulant treatment e24 e27 4 07/01/20 20200701 NES 200701 Since December 2019, the severity of the coronavirus disease 2019 (COVID-19) pandemic has been escalating.[1] Coagulopathy is common in critically ill patients with COVID-19.[2] Systemic microvascular thrombosis may occur in most deaths, and was corroborated by a recent autopsy.[3] However, less is known about the coagulation parameter D-dimer in the progression of COVID-19. Moreover, it is well documented that abnormal D-dimer is helpful in indicating deep venous thrombosis in cardiovascular diseases.[8] Thus, we analysed the correlation between D-dimer level with clinical prognosis in patients with and without cardiovascular disease. Anticoagulant treatment may benefit severe COVID-19 patients, especially those without cardiovascular disease. [Extracted from the article]

Despite relatively short time since Covid-19 infection has appeared in the world, enormous amount of literature data (more than 20 000 articles currently (mid-June)) is available on PubMed. Those data, together with our own experience at Karolinska University Hospital point towards hemostatic abnormalities in significant number of severe patients. Majority of those patients experience persistent hypercoagulation with massively increased Ddimer and fibrinogen. As a consequence, clinical thrombotic events, including venous thromboembolism (VTE) are common in Covid-19 patients and it seems that increased anticoagulant prophylaxis may be beneficial for severe (ICU/mechanical ventilation) patients. The lungs are most severely injured by the virus and that the potential underlying mechanism is a crosstalk between inflammation/complement and hemostasis. It is important to emphasize that the importance of hemostatic abnormalities in Covid-19 patients should not be overestimated since thromboembolic phenomena are, to a similar extent, present in other influenza and severely ill patients. [ABSTRACT FROM AUTHOR]

Introduction: The treatment options for advanced heart failure patients drastically changed with the introduction of left ventricular assist devices (LVADs), either as bridge to transplant or as destination therapy for patients ineligible for transplant. Despite major benefits in terms of survival, functional status and quality of life, managing patients with LVADs comes with several challenges. The most significant challenge is balancing between the risks of thrombotic and bleeding complications.Areas Covered: The present review describes the pathophysiological mechanisms explaining the alterations in the hemostatic profile of LVAD patients, and summarizes current evidence to guide clinical decision making with regard to anticoagulant treatment and management of bleeding complications.Expert Opinion: LVAD patients require life-long anticoagulant therapy to reduce the risk of pump thrombosis. However, exposing LVAD patients to anticoagulant therapy, in combination with common acquired coagulopathies after LVAD implantation such as acquired von Willebrand syndrome, comes with high risks of bleeding. There is a need for randomized controlled trials in LVAD patients to determine the optimal antithrombotic regimen and find the most effective balance between thrombotic and bleeding complications. In addition, strategies to specifically target the acquired von Willebrand syndrome and its associated angiodysplasias need to be evaluated in the LVAD population. [ABSTRACT FROM AUTHOR]

Purpose: Incidentally discovered pulmonary embolism is a prevalent clinical problem for cancer patients and contributes significantly to the burden of cancer-associated thrombosis. The aim of this study was to explore if outpatient management of incidental pulmonary embolism (iPE) in cancer patients is effective and can be conducted safely. Methods/patients: We performed a prospective observational cohort study in a single Spanish tertiary hospital. Patients diagnosed with iPE and active cancer were enrolled. Between May 2016 and May 2017, 25 consecutive patients were included in the study. Results: All patients were assessed in the emergency room (ER) and started treatment with low-molecular weight heparins (LMWH) being discharged in the following 24 h. Congestive heart failure and right ventricular dysfunction were ruled out, and none of them presented massive PE, active bleeding or any disease-related reason that required hospitalization. The 90-day follow-up visit showed no venous thromboembolism (VTE) recurrence and the major bleeding rate was 4%. Mortality rate at 30 and 90 days was 0%. Conclusions: Outpatient management for iPE in cancer patients appears to be feasible and safe in selected cancer patients. [ABSTRACT FROM AUTHOR]