Thrombosis Journal via MedWorm.com

Bleeding tendency in dual antiplatelet therapy with aspirin/clopidogrel: rescue of the template bleeding time in a single-center prospective study

Thrombosis Journal — Wed, 11 Jan 2012 05:00:00 +0100

Conclusion: In patients treated with dual aspirin/clopidogrel therapy, nuisance and internal bleeding were significantly associated with template BT and with IPAmax in response to ADP 2 mumol/L but not in response to ADP 4 umol/L or 8 umol/L. (Source: Thrombosis Journal)

Effects of inhaled nitric oxide on haemostasis in healthy adults treated with heparin: a randomized, controlled, blinded crossover study

Thrombosis Journal — Mon, 09 Jan 2012 05:00:00 +0100

Conclusions: Inhaled NO, when administered with heparin, exhibited no significant additive effects on ACT, PT, aPTT, bleeding time or platelet aggregation. (Source: Thrombosis Journal)

SMTP (Stachybotrys microspora triprenyl phenol) enhances clot clearance in a pulmonary embolism model in rats

Thrombosis Journal — Mon, 09 Jan 2012 05:00:00 +0100

Conclusions: Our results show that SMTP-7 is a superior plasminogen modulator among the SMTP family compounds and suggest that the agent enhances plasmin generation in vivo, leading to clearance of thrombi in a model of pulmonary embolism. (Source: Thrombosis Journal)

Adherence to local guidelines for venous thromboprophylaxis: a cross-sectional study of medical inpatients in Argentina.

Thrombosis Journal — Thu, 15 Dec 2011 05:00:00 +0100

Conclusions: Most medical inpatients received some thromboprophylaxis measure, but thecompliance with recommendations was less frequent. Efforts should be made toimprove the appropriate prescription. (Source: Thrombosis Journal)

Preoperative versus postoperative initiation of thromboprophylaxis following major orthopedic surgery: safety and efficacy of postoperative administration supported by recent trials of new oral anticoagulants

Thrombosis Journal — Wed, 16 Nov 2011 05:00:00 +0100

The objective of this review is to compare pre- and postoperative thromboprophylaxis strategies using available evidence, and discuss the challenges and issues that arise. Surgery is the first step in the process of thrombus formation, but thrombosis is not an instant process and the formation and growth of the thrombus can take several days or weeks. Hence, it may be possible to stop this process if thromboprophylaxis is initiated after surgery. Meta-analyses or systematic reviews comparing pre- and postoperative initiation of therapy have found no consistent differences in efficacy and similar safety (bleeding rates) between the two strategies. The recently available oral anticoagulant dabigatran etexilate provides thromboprophylaxis when administered postoperatively and is as safe as pr...

Sequential thrombosis and bleeding in a woman with a prolonged activated partial thromboplastin time

Thrombosis Journal — Thu, 27 Oct 2011 04:00:00 +0100

Simultaneous or sequential haemorrhage and thrombosis in the presence of a prolonged activated partial thromboplastin time (aPTT) is a rare occurrence: we describe the case a 37 year old lady who developed post-delivery deep vein thrombosis treated with low molecular heparin and warfarin followed a week later by extensive bruising over legs and forearms, a significant drop in haemoglobin and a very prolonged aPTT. Further tests revealed an acquired factor VIII inhibitor at 35 Bethesda Units. We discuss the clinical and laboratory implications and provide a literature review of simultaneous thrombophilia and haemophilia in the presence of a prolonged aPTT. (Source: Thrombosis Journal)

Risk of venous thromboembolism and benefits of prophylaxis use in hospitalized medically ill US patients up to 180 days post-hospital discharge

Thrombosis Journal — Thu, 13 Oct 2011 04:00:00 +0100

Conclusions: In this analysis, VTE and major bleeding event rates were lower for patients who received prophylaxis compared with those who did not. Prophylaxis use was associated with lower healthcare costs. (Source: Thrombosis Journal)

Using highly variable warfarin dosing to identify patients at risk for adverse events

Thrombosis Journal — Mon, 10 Oct 2011 04:00:00 +0100

Conclusion: CoV can be used to identify patients at risk for poor anticoagulation control and adverse events. This new measure has the potential to identify patients at high risk before they suffer adverse events. (Source: Thrombosis Journal)

Upper limb artery segmental occlusions due to chonic use of ergotamine combined with itraconazole, treated by thrombolysis

Thrombosis Journal — Mon, 29 Aug 2011 23:00:00 +0100

Conclusion: angiography showed regression of vasospasm and the resumption of flow in distal vessels. The patient had regained sensitivity and motility in the upper limbs and bilaterally radial and ulnar were present. (Source: Thrombosis Journal)

Battle of oral anticoagulants in the field of atrial fibrillation scrutinized from a clinical practice (the real world) perspective

Thrombosis Journal — Tue, 26 Jul 2011 23:00:00 +0100

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Development of a microplate coagulation assay for Factor V in human plasma.

Thrombosis Journal — Mon, 27 Jun 2011 23:00:00 +0100

Conclusions: The FV microplate assay may be easily adapted to measure the activity of any coagulation factor using the appropriate factor-deficient plasma and clot initiating reagent. The microplate assay will find use in both research and clinical laboratories to provide measurement of the functional coagulation activity of FV in human plasma. (Source: Thrombosis Journal)

Prothrombotic profile in patients with vasospastic or non vasospastic angina and non significant coronary stenosis

Thrombosis Journal — Thu, 26 May 2011 23:00:00 +0100

Background: Patients with vasospastic (VA) or non vasospastic angina (NVA) without significant coronary stenosis have a reduced risk of infarction but is unclear whether or not this may be attributable to a lack of prothrombotic profile - similar to that present in patients with stable coronary artery disease (CAD). Methods: Plasma levels of von Willebrand factor, total and free tissue factor pathway inhibitor, plasminogen activator inhibitor-1, and fibrinogen were analyzed in 15 patients with stable VA and 23 with NVA, all with vasoconstrictive response to acetylcholine although with different severity. Results were compared with those of 20 age-matched controls and 10 patients with CAD. Results: Plasma levels of von Willebrand factor in patients with VA or NVA were higher than in control...

EMILIN2 (Elastin Microfibril Interface Located Protein), Potential Modifier of Thrombosis

Thrombosis Journal — Tue, 10 May 2011 23:00:00 +0100

Conclusions: These results suggest EMILIN2 could play a role in thrombosis as a constituent of the vessel wall and/or a component of the thrombus. (Source: Thrombosis Journal)

Life-threatening aortic thrombosis in a trauma patient homozygous for factor V Leiden mutation: a case report

Thrombosis Journal — Sun, 08 May 2011 23:00:00 +0100

We report a case of near fatal aortic thrombosis in a trauma patient homozygous for mutation of Factor V Leiden. He responded well to vascular surgery and intensive care unit management and was discharged successfully from the hospital one month later. (Source: Thrombosis Journal)

Venous thromboembolism prophylaxis guideline implementation is improved by nurse directed feedback and audit

Thrombosis Journal — Mon, 04 Apr 2011 23:00:00 +0100

Conclusions: Utilization of VTE prophylaxis amongst hospitalized medical patients can be significantly improved by implementation of a multifaceted educational program coordinated by a dedicated nurse practitioner. (Source: Thrombosis Journal)

Assessment of MMP-9,TIMP-1, and COX-2 in normal tissue and advanced symptomatic and asymptomatic carotid plaques

Thrombosis Journal — Sat, 02 Apr 2011 23:00:00 +0100

Conclusions: MMP-9 and TIMP-1 are present in all stages of atherosclerotic plaque progression, from normal tissue to advanced lesions. When sections of a plaque are analyzed without preselection, MMP-9 concentration is higher in normal tissues and asymptomatic surgical specimens than in symptomatic specimens, and TIMP-1 concentration is higher in normal tissue than in symptomatic specimens. (Source: Thrombosis Journal)

Differentiation of parenteral anticoagulants in the prevention and treatment of venous thromboembolism

Thrombosis Journal — Sun, 27 Mar 2011 23:00:00 +0100

Conclusions: Parenteral anticoagulants should be prescribed in accordance with recommended dose regimens for each clinical indication, based on the available clinical evidence for each agent to assure optimal safety and efficacy. (Source: Thrombosis Journal)

The influence of CYP 2C19*2 polymorphism on platelet function testing during single antiplatelet treatment with clopidogrel

Thrombosis Journal — Tue, 22 Mar 2011 00:00:00 +0100

Background: Different platelet function tests can be used to evaluate the degree of achieved platelet inhibition in patients treated with clopidogrel. The presence of CYP 2C19*2 polymorphism can reduce the formation of the active metabolite of clopidogrel, resulting in less platelet inhibition.Patients and Methods: Patients with symptomatic coronary artery disease, all on chronic single aspirin treatment were randomized to continue on aspirin or change to clopidogrel. In 219 randomly selected clopidogrel treated patients, platelet reactivity was evaluated by VASP-PRI determination and by use of VerifyNow P2Y12-PRU. The CYP 2C19*2 G/A polymorphism was further determined. Results: The total frequency of clopidogrel resistance was 29.0% by VASP-PRI and 31.6% by VerifyNow-PRU. The number of pa...

Meta Regression Analysis to Indirectly Compare Dalteparin to Enoxaparin for the Prevention of Venous Thromboembolic Events following Total Hip Replacement

Thrombosis Journal — Thu, 27 Jan 2011 00:00:00 +0100

Conclusions: The findings suggested comparable safety and efficacy between dalteparin and enoxaparin in TKR patients. Therefore, treatment decisions should be based on other considerations, such as patient or physician preference, ease of administration and cost. (Source: Thrombosis Journal)

An unexpected case of venous and pulmonary thrombo-embolism in a patient treated with thalidomide for refractory erythema nodosum leprosum: a case report

Thrombosis Journal — Tue, 18 Jan 2011 00:00:00 +0100

We report a case of deep vein thrombosis (DVT) and pulmonary embolism (PE) following thalidomide use in a patient with erythema nodosum leprosum (ENL) reaction who was concurrently treated with prednisolone, as well as a review of relevant literature. (Source: Thrombosis Journal)

Risk factors for perioperative venous thromboembolism: A retrospective study in Japanese women with gynecologic diseases

Thrombosis Journal — Sun, 07 Nov 2010 00:00:00 +0100

Conclusions: Perioperative VTE is often fatal and preventive measures should be taken in the gynecologic field, especially when patients have the risk factors identified in this study. Since VTE is often present before surgery, preoperative screening is important and use of an IVC filter should be considered. (Source: Thrombosis Journal)

Association of serum Immunoglobulins G (IgG) levels against two periodontal pathogens and a prothrombotic state: a clinical pilot study

Thrombosis Journal — Thu, 04 Nov 2010 00:00:00 +0100

Conclusions: In periodontitis, infection with Aa together with other well accepted risk factors for CVD, may play a role in increasing the risk for prothrombotic state. (Source: Thrombosis Journal)

Risk factors for development of left ventricular thrombus after first acute anterior myocardial infarction-association with anticardiolipin antibodies

Thrombosis Journal — Sat, 18 Sep 2010 23:00:00 +0100

Conclusions: Our data demonstrate that beside the low ejection fraction, lower MDT and higher wall motion score index, modestly elevated ACA IgM and ACA IgG levels are associated with LV thrombus formation in patients with anterior MI. (Source: Thrombosis Journal)

Dual targeting of CCR2 and CX3CR1 in an arterial injury model of vascular inflammation

Thrombosis Journal — Sun, 12 Sep 2010 23:00:00 +0100

Objectives. The chemokine receptors CCR2 and CX3CR1 are important in the development of coronary artery disease. The purpose of this study is to analyze the effect of a novel CCR2 inhibitor in conjunction with CX3CR1 deletion on vascular inflammation. Methods: The novel CCR2 antagonist MRL-677 was characterized using an in vivo model of monocyte migration. To determine the relative roles of CCR2 and CX3CR1 in vascular remodeling, normal or CX3CR1 deficient mice were treated with MRL-677. After 14 days, the level of intimal hyperplasia in the artery was visualized by paraffin sectioning and histology of the hind limbs. Results: MRL-677 is a CCR2 antagonist that is effective in blocking macrophage trafficking in a peritoneal thioglycollate model. Intimal hyperplasia resulting from vascular i...

Platelet dysfunction and inhibition of multiple electrode platelet aggregometry caused by penicillin

Thrombosis Journal — Tue, 20 Jul 2010 23:00:00 +0100

We report a case of a patient with local streptococcus infection. Treatment with penicillin resulted in mild bleeding tendency after 3 days. While coagulation parameters were normal, assessment of platelet function by MEA revealed strong platelet inhibition of both ADP and arachidonic acid induced platelet aggregation comparable to normal responders to antiplatelet therapy. Change of antibiotic regime resulted in recovery of platelet function. Thus, penicillin therapy may impact on platelet function and consecutively commonly used platelet function assays, e.g. MEA. (Source: Thrombosis Journal)

Postpartal recurrent non-ST elevation myocardial infarction in essential thrombocythaemia: case report and review of the literature

Thrombosis Journal — Wed, 16 Jun 2010 23:00:00 +0100

In conclusion, with the continuing trend of childbearing at older ages, rare or unlikely conditions leading to severe events such as myocardial infarction must be considered in pregnant women. (Source: Thrombosis Journal)

Platelet function in brown bear (Ursus arctos) compared to man

Thrombosis Journal — Tue, 01 Jun 2010 23:00:00 +0100

Conclusion: Using three different tests, we conclude that platelet function is lower in brown bears compared to humans. Our findings represent the first descriptive study on platelet function in brown bears and may contribute to explain how bears can endure denning without obvious thrombus building. However, the possibility that our findings reflect test-dependent and not true biological variations in platelet reactivity needs further studies. (Source: Thrombosis Journal)

Normal levels of protein C and protein S tested in the acute phase of a venous thromboembolic event are not falsely elevated

Thrombosis Journal — Mon, 17 May 2010 23:00:00 +0100

Background: Protein C (PC) and protein S (PS) determination is part of the thrombophilia investigation in patients with idiopathic venous thromboembolism (VTE). Based on scarce evidence it is a common notion that PC and PS levels decrease during the acute phase of VTE, necessitating delay of testing and temporary transition from warfarin to low molecular weight heparin. We have previously demonstrated that an abnormal PC or PS result determined within 24 hours of VTE diagnosis and before the initiation of warfarin needs to be repeated for confirmation [greater than or equal to]3 months after starting treatment and [greater than or equal to] 14 days after stopping anticoagulation therapy. In the current study, we sought to show that normal PC and PS values determined during the acute phase ...

Selective and rapid monitoring of dual platelet inhibition by aspirin and P2Y12 antagonists by using multiple electrode aggregometry

Thrombosis Journal — Wed, 12 May 2010 23:00:00 +0100

Background: Poor platelet inhibition by aspirin or clopidogrel has been associated with adverse outcomes in patients with cardiovascular diseases. A reliable and facile assay to measure platelet inhibition after treatment with aspirin and a P2Y12 antagonist is lacking. Multiple electrode aggregometry (MEA), which is being increasingly used in clinical studies, is sensitive to platelet inhibition by aspirin and clopidogrel, but a critical evaluation of MEA monitoring of dual anti-platelet therapy with aspirin and P2Y12 antagonists is missing.Design and Methods: By performing in vitro and ex vivo experiments, we evaluated in healthy subjects the feasibility of using MEA to monitor platelet inhibition of P2Y12 antagonists (clopidogrel in vivo, cangrelor in vitro) and aspirin (100 mg per day i...

The hemostatic profile of recombinant activated factor VII. Can low concentrations stop bleeding in off-label indications?

Thrombosis Journal — Tue, 04 May 2010 23:00:00 +0100

Conclusion: Low concentrations of rFVIIa were sufficient to form enough thrombin to induce adequate hemostasis in normal PRP or in PPP when combined with TF, and suggest low concentrations for normalizing hemostasis in off-label indications. (Source: Thrombosis Journal)

Gender differences of polymorphisms in the TF and TFPI genes, as related to phenotypes in patients with coronary heart disease and type-2 diabetes

Thrombosis Journal — Tue, 04 May 2010 23:00:00 +0100

In this study we have investigated the frequency of six known TF and TFPI single nucleotide polymorphisms (SNPs) in CHD patients as compared to healthy individuals. These genotypes and the phenotypes (sTF, TFPI free and total antigen) were evaluated with special reference to gender and diabetes in the CHD population. Methods: Patients with angiographically verified CHD (n=1001; 22% women, 20% diabetics), and 204 healthy controls (28% women), were included. The investigated SNPs were: TF -1812C/T and TF -603A/G in the 5'upstream region, TF 5466A/G in intron 2, TFPI -399C/T and TFPI -287T/C in the 5'upstream region and the TFPI -33T/C in intron 7. Results: No significant differences in frequencies between the CHD population and the controls of any polymorphisms were observed. In the CHD popu...

Characteristics of ambulatory anticoagulant adverse drug events: a descriptive study

Thrombosis Journal — Thu, 18 Feb 2010 00:00:00 +0100

Conclusions: Ambulatory warfarin-related ADEs have significant patient and healthcare utilization consequences in the form of bleeding events and associated hospital admissions. Recommendations for improvement in anticoagulation management include use of information technology to assist monitoring and follow-up documentation, avoid drug interactions, and engage patients in their care. (Source: Thrombosis Journal)

A follow-up study of the fate of small asymptomatic deep venous thromboses

Thrombosis Journal — Fri, 12 Feb 2010 00:00:00 +0100

Conclusions: Asymptomatic postoperative distal DVT:s following surgery for Achilles tendon rupture have a good prognosis and a favourable clinical outcome. In our material of 46 patients the general appearance of the clinical entity of PTS at 5 years follow-up was low ( (Source: Thrombosis Journal)

Development and comparison of a minimally-invasive model of autologous clot pulmonary embolism in Sprague-Dawley and Copenhagen rats

Thrombosis Journal — Thu, 11 Feb 2010 00:00:00 +0100

Conclusions: Both SD and COP rats exhibited near complete fibrinolysis of autologous clot PE within 5 days. Neither strain developed persistent PH. Experimental models of PE designed to induce sustained PH and a robust inflammatory response appear to require significant, persistent pulmonary vascular occlusion. (Source: Thrombosis Journal)

Enhancement of fibrinogen-triggered pro-coagulant activation of monocytes in vitro by matrix metalloproteinase-9

Thrombosis Journal — Fri, 29 Jan 2010 00:00:00 +0100

Conclusions: Fibrinogen induces monocyte pro-coagulant activation in an integrin-, NFkappaB-, p38MAPK-, and MEK1.2-dependent manner. Activation of monocytes by fibrinogen increases metalloproteinase-9 secretion, metalloproteinase-9 itself enhances monocyte coagulation by an autocrine mechanism. Results provide further evidence that mediators of hemostasis have a profound impact on cells of the immune system and are closely related to inflammatory pathways. (Source: Thrombosis Journal)

The activity of pregnancy-associated plasma protein A (PAPP-A) as expressed by immunohistochemistry in atherothrombotic plaques obtained by aspiration thrombectomy in patients presenting with a ST-segment elevation myocardial infarction: a brief communication

Thrombosis Journal — Wed, 27 Jan 2010 00:00:00 +0100

Conclusion: Our results indicate that in vivo PAPP-A is strongly expressed in atherothrombotic plaques harvested from patients admitted with STEMI, as documented by IHC.Trial registration: biobankregisteret@fhi.no1846 (Source: Thrombosis Journal)

Hemostasis and inflammation: two of a kind?

Thrombosis Journal — Wed, 18 Nov 2009 00:00:00 +0100

Hemostasis is a defense mechanism to stop bleeding. Activated by vessel wall injury, it consists of intertwined activation of platelets and the coagulation cascade, tightly controlled by natural anticoagulants and the fibrinolytic system. Inflammation aims at restoring the integrity of damaged or threatened tissues, most frequently because of injury or infectious pathogens. Both are intimately coupled. (Source: Thrombosis Journal)

Application of basic and composite Thrombelastography parameters in monitoring of the antithrombotic effect of the low molecular weight heparin dalteparin: An in vivo study.

Thrombosis Journal — Tue, 10 Nov 2009 00:00:00 +0100

Conclusion: The TEG reaction time R and TDR are the most suitable TEG parameters for evaluation of the antithrombotic effect of dalteparin with a highly significant correlation with antiXa levels in healthy male volunteers. Measures for uniform clinical use of these parameters are proposed. Larger clinical trials are needed to correlate R and TDR with clinical outcomes. (Source: Thrombosis Journal)

Annexin V and anti-Annexin V Antibodies: two interesting aspects in acute myocardial infarction

Thrombosis Journal — Mon, 20 Jul 2009 23:00:00 +0100

Conclusion: Our findings suggest that low plasma ANV levels along with positive aANVAs tests in patients with AMI are indicative of hypercoagulable state that is not related to the traditional cardiovascular risk factors. (Source: Thrombosis Journal)

The impact of platelet function or C-reactive protein, on cardiovascular events after an acute myocardial infarction

Thrombosis Journal — Mon, 06 Jul 2009 23:00:00 +0100

Conclusions: In patients with myocardial infarction, measured peak CRP is associated with new cardiovascular events. Despite an association with peak CRP neither more pronounced platelet aggregation nor PFA-100 closure times independently predict new cardiovascular events. (Source: Thrombosis Journal)

Plasma TF activity predicts cardiovascular mortality in patients with acute myocardial infarction

Thrombosis Journal — Wed, 01 Jul 2009 23:00:00 +0100

Objectives and Background: Tissue factor (TF) contributes to thrombosis following plaque disruption in acute coronary syndromes (ACS). Aim of the study was to investigate the impact of plasma TF activity on prognosis in patients with ACS.Methods and Results: 174 patients with unstable Angina pectoris (uAP) and 112 patients with acute myocardial infarction (AMI) were included with a mean follow up time of 3.26 years. On admission, plasma TF activity was assessed. Patients were categorized into 2 groups: a high-TF activity group with TF >24 pmol/L and low TF activity group with TF (Source: Thrombosis Journal)

Plasma fibrinolysis is related to the degree of organ dysfunction but not to the concentration of von Willebrand Factor in critically ill patients

Thrombosis Journal — Thu, 18 Jun 2009 23:00:00 +0100

Background: Endothelial cell dysfunction, by promoting fibrin deposition, has been implicated in the development of multiple organ failure. Altered fibrinolysis during inflammation may participate in microvascular alterations. We sought to determine whether plasma fibrinolysis was related to the severity of organ dysfunction and/or to the levels of von Willebrand factor (vWF antigen), as a marker of endothelium dysfunction, in critically ill patients. Methods: Forty-nine consecutive patients admitted to an adult medico-surgical intensive care unit (ICU) with (18) or without sepsis (31) were included. C-reactive protein and vWF levels were measured on ICU admission and plasma fibrinolysis was assessed by the Euglobulin Clot Lysis Time (ECLT). The sequential organ failure assessment (SOFA) s...

Thrombotic genetic risk factors and warfarin pharmacogenetic variants in Sao Miguel's healthy population (Azores)

Thrombosis Journal — Wed, 17 Jun 2009 23:00:00 +0100

Background: The Azorean population presents the highest standardized mortality rate for cardiovascular diseases (CVD) when compared to mainland Portugal and other populations. Since thrombosis is a common cause of CVD, we assessed four polymorphisms in three thrombotic risk genes - F5 (G1691A), F2 (G20210A) and MTHFR (C677T, A1298C), in 469 healthy blood donors from Sao Miguel Island (Azores). We also analysed the CYP2C9 (C430T, A1075C) and VKORC1 (G1639A) variants in fifty-eight individuals with predisposition to thrombosis (possessing at least one variation in F5 or F2 genes and one in MTHFR) to evaluate their warfarin drug response genetic profiles. Results: Among the 469 individuals, the data showed that thrombotic risk allele frequencies - 1691A (4.9%), 20210A (1.8%), 677T (41.7%) and...

Aminaphtone in the control of Schamberg's Disease

Thrombosis Journal — Thu, 11 Jun 2009 04:00:00 +0100

We report on a case of a 28-year-old patient who presented with multiple purpuric lesions on the lower extremities which appeared spontaneously. A biopsy of the skin was then performed that showed a perivascular T-cell lymphocytic infiltrate is centered on the superficial small blood vessels of the skin and so the hypothesis of Schamberg's disease was reached. The patient started to use corticoids which controlled the appearance of lesions however on suspension of the medication the lesions reappeared in three days to one week. The attempt to control with corticoids was made during more than one year without success. Another therapeutic option was used: 75 mg of aminaphtone was prescribed twice daily for one month and the purpuric lesions disappeared within about one week. For one year the...

Delayed formation of pulmonary artery stump thrombus: a case report and review of the literature

Thrombosis Journal — Wed, 10 Jun 2009 04:00:00 +0100

We report the case of a 68 year-old man who presented with chest pain nearly ten years after undergoing a right pneumonectomy for lung cancer. Workup identified a pulmonary artery stump thrombosis. Due to the acute onset of his symptoms, the patient was anticoagulated, and his chest pain resolved. While the literature suggests that anticoagulation is not generally required for stump thromboses, we highlight features of this case that may indicate an increased risk of clinically important sequelae. Taking previous reports into account, we argue that a specific subset of patients with stump thrombosis may benefit from systemic anticoagulation. (Source: Thrombosis Journal)

Clopidogrel resistance "Live" - the risk of stent thrombosis should be evaluated before procedures

Thrombosis Journal — Tue, 19 May 2009 04:00:00 +0100

Every year, millions of people undergo percutaneous coronary intervention (PCI) with intracoronary stent implantation. A patient from the PRAGUE-8 trial (Optimal pre-PCI clopidogrel loading: 600mg before every coronary angiography vs. 600mg in the cath-lab only for PCI patients) is described who suffered from acute stent thrombosis. This patient did not have any relevant inhibition of platelet activation even after the 600mg dose of clopidogrel. Dose uptitration would have been ineffective. New P2Y12 receptor inhibitors are desperately needed. In the light of recently published data, the use of prasugrel may be considered as an alternative. (Source: Thrombosis Journal)

Acute myocardial infarction and pulmonary embolism in a young man with pernicious anemia-induced severe hyperhomocysteinemia

Thrombosis Journal — Wed, 13 May 2009 04:00:00 +0100

A 27 year-old man who presented to the hospital with progressive lower extremity weakness, developed an acute ST elevation myocardial infarction on his second hospital day. Primary angioplasty to the left anterior descending coronary artery was performed. Due to persistent dyspnea, the patient underwent a diagnostic chest computed tomography which confirmed multiple small pulmonary emboli. Laboratory analysis revealed a megaloblastic anemia with a reduced vitamin B12 level and positive titers for antibodies against intrinsic factor, establishing a diagnosis of pernicious anemia. Screening for hypercoaguable markers documented an isolated severely elevated homocysteine levels (105umol/l). No other significant risk factors for coronary artery disease including a family history of premature a...

Comparison of VerifyNow-P2Y12 test and Flow Cytometry for monitoring individual platelet response to clopidogrel. What is the cut-off value for identifying patients who are low responders to clopidogrel therapy?

Thrombosis Journal — Wed, 06 May 2009 04:00:00 +0100

Conclusions: In conclusion our findings show that a cut-off value of [less than or equal to] 15% inhibition in the VerifyNow-P2Y12test may provide the best accuracy for the identification of patients with LR. (Source: Thrombosis Journal)

Editorial on hypothesis and objectives in clinical trials: superiority, equivalence and non-inferiority

Thrombosis Journal — Sat, 21 Mar 2009 04:00:00 +0100

Randomized clinical trial is often considered as the Gold Standard method for comparing treatment effects. In practice, taking into consideration their main objectives, the majority of clinical trials are aimed to establish the superiority of an intervention regarding to an active control or placebo. But neither equivalence nor non-inferiority should be from definitively concluded from superiority trials exhibiting non-significant results.To evaluate equivalence or non-inferiority between treatments, specific trials should be designed. These designs have strengths and weaknesses dicussed in this Editorial. In spite of the limitations in the doctrine that supports the classification of the clinical experiments as "superiority", "equivalence" and "non-inferiority" trials, this methodological...

Mild hypothermia does not attenuate platelet aggregation and may even increase ADP-stimulated platelet aggregation after clopidogrel treatment

Thrombosis Journal — Mon, 23 Feb 2009 05:00:00 +0100

Conclusions: Mild hypothermia did not attenuate platelet aggregation, instead it even increased ADP-stimulated platelet aggregation after clopidogrel treatment. Dual platelet inhibition with aspirin and a P2Y12 receptor antagonist is probably needed for patients with acute coronary syndromes treated with mild hypothermia, and it is possible that future ADP blockers could be of benefit. (Source: Thrombosis Journal)

Non ST-segment Elevation Myocardial Infarction in Patient with Essential Thrombocythemia

Thrombosis Journal — Fri, 20 Feb 2009 05:00:00 +0100

A 68-year-old woman presented with acute chest pain and a greatly increased platelet count. Cardiac catheterization revealed subtotal occlusion and a thrombus-like filling defect in the right coronary artery. The patient was successfully treated with intravenous tirofiban. Essential thrombocythemia was diagnosed based on bone marrow findings, clinical presentation and laboratory analysis. The relationship between intracoronary thrombus and essential thrombocythemia is discussed. (Source: Thrombosis Journal)

Expression of sterol regulatory element-binding transcription factor (SREBF) 2 and SREBF cleavage-activating protein (SCAP) in human atheroma and the association of their allelic variants with sudden cardiac death

Thrombosis Journal — Tue, 30 Dec 2008 05:00:00 +0100

Conclusion: The results suggest that the allelic variants (SREBF-2 1784G>C and SCAP 2386A>G) in the cholesterol homeostasis regulating SREBF-SCAP pathway may contribute to SCD in early middle-aged men. (Source: Thrombosis Journal)

Expression of sterol regulatory element binding transcription factor (SREBF) 2 and SREBF cleavage-activating protein (SCAP) in human atheroma and the association of their allelic variants with sudden cardiac death

Thrombosis Journal — Tue, 30 Dec 2008 05:00:00 +0100

Conclusions: The results suggest that the allelic variants (SREBF-2 1784G>C and SCAP 2386A>G) in the cholesterol homeostasis regulating SREBF-SCAP pathway may contribute to SCD in early middle-aged men. (Source: Thrombosis Journal)

Human Activated Protein C Variants in a Rat model of Arterial Thrombosis

Thrombosis Journal — Wed, 29 Oct 2008 04:00:00 +0100

Conclusions: In conclusion, administration of human APC variants having enhanced anticoagulant efficacy together with human PS in a rat model of arterial thrombosis did not give an efficient antithrombotic effect. The lack of effect may be due to species-specific differences between the human protein C system and the rat hemostatic system. (Source: Thrombosis Journal)

Clinical factors influencing normalization of prothrombin time after stopping warfarin: a retrospective cohort study

Thrombosis Journal — Thu, 16 Oct 2008 04:00:00 +0100

Conclusions: Baseline INR, but not the size of the maintenance dose, is associated with the rate of normalization of prothrombin time after stopping warfarin, but it has limited utility as predictor in clinical practice. Whenever normal hemostasis is considered crucial for the safety, the INR should be checked again before the invasive procedure. (Source: Thrombosis Journal)

A new method to determine tissue specific tissue factor thrombomodulin activities: endotoxin and particulate air pollution induced disbalance.

Thrombosis Journal — Wed, 01 Oct 2008 04:00:00 +0100

This study was designed to assess the consequences of inflammation-driven organ specific functional properties of the procoagulant response. Methods: Addition of lung from untreated animals to human plasma suppressed the endogenous thrombin potential (ETP) (175+/-61 vs. 1437+/-112 nM.min for control). This inhibitory effect was due to TM, because a) it was absent in protein C deficient plasma and b) lungs from TMpro/pro mice allowed full thrombin generation (ETP: 1686+/-209 nM.min). The inhibitory effect of TM was lost after lipopolysaccharide (LPS) administration to mice, which induced TF activity in lungs of C57Bl/6 mice as well as increased the ETP (941+/-523 vs. 194+/-159 nM.min for control). Another pro-inflammatory stimulus, environmental air pollution (particulate matter (PM)) dose-...

Prevention and treatment of venous thromboembolism with low-molecular-weight heparins: clinical implications of the recent European guidelines

Thrombosis Journal — Tue, 09 Sep 2008 04:00:00 +0100

Venous thromboembolism (VTE) is an important cause of avoidable morbidity and mortality. However, routine prophylaxis for at-risk patients is underused. Recent guidelines issued by an international consensus group, including the International Union of Angiology (IUA), recommend use of low-molecular-weight heparins (LMWHs) for the treatment of acute VTE and prevention of recurrence, and for prophylaxis in surgical and medical patients. This review highlights current inadequacies in the provision of thromboprophylaxis, and considers the clinical implications of the European guidelines on the prevention and treatment of VTE. (Source: Thrombosis Journal)

Use of rosiglitazone before and after vascular injury in hypercholesterolemic rabbits: assessment of neointimal formation.

Thrombosis Journal — Wed, 27 Aug 2008 04:00:00 +0100

Conclusions: Pretreatment with rosiglitazone in hypercholesterolemic rabbits submitted to vascular injury significantly reduces neointimal formation. (Source: Thrombosis Journal)

Ischemic stroke risk, smoking, and the genetics of inflammation in a biracial population: the stroke prevention in young women study

Thrombosis Journal — Tue, 26 Aug 2008 04:00:00 +0100

Conclusions: This study demonstrates that inflammatory gene SNPs are associated with early-onset ischemic stroke among African-American women (IL6) and that cigarette smoking may modulate stroke risk through a gene-environment interaction (IL6 and CD14). Our finding replicates a prior study showing an interaction with smoking and the C allele of CD14 SNP rs2569190. (Source: Thrombosis Journal)

Risk of myocardial infarction and overall mortality in survivors of venous thromboembolism

Thrombosis Journal — Mon, 18 Aug 2008 04:00:00 +0100

Venous thromboembolism (VTE) and thromboembolic arterial diseases are usually considered to be distinct entities, but there is evidence to suggest that these disorders may be linked. The aim of this study was to determine whether a diagnosis of VTE increases the long-term risk of myocardial infarction (MI). The incidence rate (IR) and relative risk (RR) of MI in a cohort of patients with a diagnosis of VTE (n = 4890) compared with that of a control cohort without prior VTE (n = 43 382) were evaluated in the UK General Practice Research Database (GPRD). Death during follow-up was also determined. Patients were followed for up to 8 years (mean of 3 years). The IR of MI per 1000 person-years was 4.1 (95% CI: 3.1-5.3) for the VTE cohort and 3.5 (95% CI: 3.2-3.8) for the control cohort. The IR ...

Successful management of acute thromboembolic disease complicated with Heparin induced Thrombocytopenia type II (HIT II): a case series

Thrombosis Journal — Wed, 02 Jul 2008 04:00:00 +0100

We present two cases with massive pulmonary embolism and HIT, successfully treated with the administration of fondaparinux, an alternative anticoagulant, combined with the insertion of an inferior vena cava filter for the prevention of new thromboembolic events. The two cases supplement the available data of the use of fondaparinux in patients with HIT and pulmonary embolism, before further large studies establish its efficacy and safety in this group of patients. Moreover, the management of these patients reveals the need for future evaluation of the combined therapy of alternative anticoagulant agents with the placement of vena cava filters. (Source: Thrombosis Journal)

Venous thromboembolism prevention post neck of femur fractures - does it make a difference?

Thrombosis Journal — Thu, 26 Jun 2008 04:00:00 +0100

Neck of femur fractures predispose patients to venous thromboembolism (VTE). NICE has issued guideline 46 to reduce this risk through the use of antithrombic agents. We audited our department's VTE practise by reviewing the clinical notes of 123 consecutive patients with no exclusions. We found our compliance to be a low 6%. We also found that patients were likely to be given low molecular heparin (LMWH) only during their hospital stay. Reasons for the low adherence were probably secondary to confusion caused by the multiple thromboprophylaxis protocols used in our department. The correlation between duration of heparin administration and length of hospital stay was due to logistical difficulty in administering VTE prophylaxis out of hospital setting. (Source: Thrombosis Journal)

Warfarin dose and INR related to genotypes of CYP2C9 and VKORC1 in patients with myocardial infarction.

Thrombosis Journal — Tue, 17 Jun 2008 04:00:00 +0100

Conclusion: CYP2C9 and VKORC1 genotype frequencies in myocardial infarction patients appear similar to other patient groups and have similar impact on warfarin maintenance dose. (Source: Thrombosis Journal)

Examining warfarin underutilization rates in patients with atrial fibrillation: Detailed chart review essential to capture contraindications to warfarin therapy

Thrombosis Journal — Tue, 03 Jun 2008 04:00:00 +0100

Conclusion: Consistent with previous reports, 45.4% of patients in this atrial fibrillation cohort were not prescribed warfarin. However, after reviewing medical charts for documented reasons why warfarin was not used, the inappropriate underutilization rate was only 7.1%. These findings suggest that studies utilizing administrative database and ICD-9 CM coding might overestimate warfarin underutilization. (Source: Thrombosis Journal)

The value of D-dimer in the detection of early deep-vein thrombosis after total knee arthroplasty in Asian patients: a cohort study

Thrombosis Journal — Wed, 28 May 2008 04:00:00 +0100

Conclusion: High plasma D-dimer level is a moderately sensitive, but less specific marker in the detection of early of DVT after TKA. Measurement of serum D-dimer alone is not accurate enough to detect DVT after TKA. Venography is recommended in patients with elevated D-dimer and clinically suspected but asymptomatic DVT after TKA. (Source: Thrombosis Journal)

Effects of rosiglitazone on contralateral iliac artery after vascular injury in hypercholesterolemic rabbits.

Thrombosis Journal — Fri, 16 May 2008 04:00:00 +0100

Conclusions: These findings demonstrate that rosiglitazone given for 6 weeks did not prevent atherogenesis at a vessel distant from the injury site. (Source: Thrombosis Journal)

Pleural mesothelioma and venous thrombosis: the eosinophilia link

Thrombosis Journal — Mon, 28 Apr 2008 04:00:00 +0100

We describe a patient with mesothelioma who developed peripheral blood eosinophilia followed by deep vein thrombosis despite being on low molecular weight heparin prophylaxis. We discuss the genesis of peripheral blood eosinophilia and thrombosis in pleural mesothelioma. (Source: Thrombosis Journal)

Stroke in inflammatory bowel disease: a report of two cases and review of the literature

Thrombosis Journal — Fri, 21 Mar 2008 04:00:00 +0100

Thrombosis is a recognised complication of inflammatory bowel disease (IBD), in particular venous thrombosis. Arterial thrombosis, especially stroke is rare. There is a paucity of information regarding stroke in IBD and its management. The authors describe two cases of stroke in patients with IBD during periods of increased disease activity. The literature regarding this devastating complication and the procoagulant state that exists in IBD is reviewed. (Source: Thrombosis Journal)

Point-of-care platelet function assays demonstrate reduced responsiveness to clopidogrel, but not aspirin, in patients with Drug-Eluting Stent Thrombosis whilst on dual antiplatelet therapy

Thrombosis Journal — Fri, 29 Feb 2008 05:00:00 +0100

Conclusions: This study demonstrates reduced platelet response to clopidogrel in some patients with DES ST compared to matched controls. The availability of point-of-care assays that can detect these responses raises the possibility of prospectively identifying DES patients at risk of ST and manipulating their subsequent risk. (Source: Thrombosis Journal)

Percutaneous mechanical thrombectomy for the treatment of acute massive pulmonary embolism: case report

Thrombosis Journal — Tue, 18 Dec 2007 05:00:00 +0100

Conclusions: We illustrate here that percutaneous mechanical thrombectomy can be a safe and effective method of treating massive pulmonary embolism when thrombolysis is relatively contraindicated. It may also be of use as an adjuvant therapy in those patients able to receive thrombolysis. In the future further evaluation involving a larger cohort of subjects is necessary to determine whether this treatment is superior to surgical embolectomy when thrombolysis cannot be performed. (Source: Thrombosis Journal)

Effect of PlA1/A2 glycoprotein IIIa gene polymorphism on the long-term outcome after successful coronary stenting

Thrombosis Journal — Fri, 16 Nov 2007 05:00:00 +0100

Conclusion: The GP IIIa PlA1/A2 polymorphism does not influence the clinical long-term outcome in patients with symptomatic coronary disease undergoing percutaneous coronary intervention with stent implantation. (Source: Thrombosis Journal)

An unusual case of peripartum cardiomyopathy manifesting with multiple thrombo-embolic phenomena.

Thrombosis Journal — Mon, 29 Oct 2007 04:00:00 +0100

We report an unusual case of PPCM in a previously healthy postpartum woman who presented with an acute abdomen due to unrecognized thromboemboli of the abdominal organs. This case illustrates that abdominal pain in PPCM may not always result from hepatic congestion as previously reported, but may occur as a result of thromboemboli to abdominal organs. Further research is needed to determine the true incidence of thromboemboli in PPCM. (Source: Thrombosis Journal)

The 5, 10 methylenetetrahydrofolate reductase C677T mutation and risk of fetal loss: a case series and review of the literature

Thrombosis Journal — Wed, 17 Oct 2007 04:00:00 +0100

Conclusions: We provide evidence to support the relationship between MTHFR C677T mutations and recurrent fetal loss, and to suggest that anticoagulation of these patients during pregnancy can lead to a successful pregnancy outcome. (Source: Thrombosis Journal)

Influenza infection and risk of acute pulmonary embolism

Thrombosis Journal — Tue, 16 Oct 2007 04:00:00 +0100

Conclusion: In this clinical study, influenza infection was not associated with an increased risk of acute pulmonary embolism. The ILI score is non-specific in this clinical setting. (Source: Thrombosis Journal)

Dual antiplatelet therapy and drug eluting stents: a marriage of convenience

Thrombosis Journal — Mon, 01 Oct 2007 04:00:00 +0100

This is an editorial. No abstract or subheadings are provided (Source: Thrombosis Journal)

Relationship between ABO blood groups and von Willebrand factor levels: from biology to clinical implications

Thrombosis Journal — Tue, 25 Sep 2007 04:00:00 +0100

Although a number of studies have demonstrated the influence of ABO blood group on plasma levels of von Willebrand factor (VWF), the nature of this association and its clinical importance is still largely unknown. In this review, the most recent advances in our understanding of the mechanisms by which ABO blood group determines plasma VWF levels and their clinical impact will be discussed. (Source: Thrombosis Journal)

Heat shock inhibits lipopolysaccharide-induced tissue factor activity in human whole blood

Thrombosis Journal — Mon, 24 Sep 2007 04:00:00 +0100

Background: During gram-negative sepsis, lipopolysaccharide (LPS) induces tissue factor expression on monocytes. The resulting disseminated intravascular coagulation leads to tissue ischemia and worsens the prognosis of septic patients. There are indications, that fever reduces the mortality of sepsis, the effect on tissue factor activity on monocytes is unknown. Therefore, we investigated whether heat shock modulates LPS-induced tissue factor activity in human blood. Methods: Whole blood samples and leukocyte suspensions, respectively, from healthy probands (n=12) were incubated with LPS for 2 hours under heat shock conditions (43C) or control conditions (37C), respectively. Subsequent to further 3 hours of incubation at 37C the clotting time, a measure of tissue factor expression, was de...

Combining Taipan snake venom time/Ecarin time screening with the mixing studies of conventional assays increases detection rates of lupus anticoagulants in orally anticoagulated patients

Thrombosis Journal — Thu, 06 Sep 2007 04:00:00 +0100

Conclusions: Addition of TSVT/ET screening for LA in orally anticoagulated patients could increase diagnostic efficacy either by detecting antibodies diluted in the mixing tests of conventional assays or those that do not react in DRVVT or DAPTT. Additionally, TSVT/ET can affirm the presence of a LA where conventional assay mixing tests may not have fully counteracted the oral anticoagulant effect but confirmatory test correction suggests the presence of a LA. (Source: Thrombosis Journal)

Antithrombotic prevention in vascular disease. Bases for a new strategy in antithrombotic therapy

Thrombosis Journal — Wed, 29 Aug 2007 04:00:00 +0100

A tendency toward bleeding often undercuts the beneficial preventive effect of higher doses of a single antithrombotic drug or combined antithrombotic therapy. Although high doses of antithrombotic drugs may be necessary for optimal prevention, such therapy can also elicit more frequent bleeding. Although major bleeding could be a reversible event is likely to lead clinicians to discontinue antithrombotic therapy which in turn could increase the risk of myocardial infarction, stroke, and cardiovascular death. Thus, to prevent thrombotic events without frequent bleeding complications, the preferred approach might be to use anti-inflammatory drugs in addition to the first-line antithrombotic drugs to reduce inflammation and thrombin formation in atheroma. Although some preliminary data have ...

Hyperhomocysteinemia in women affected by unexplained sterility or recurrent early pregnancy loss from Southern Italy: a preliminary report

Thrombosis Journal — Wed, 11 Jul 2007 04:00:00 +0100

This study sought to find out a possible relationship between sterility (primary sterility or secondary sterility due to recurrent pregnancy loss) and homocysteine metabolism. Patients and Methods. We selected 20 patients with recurrent pregnancy loss, 20 patients with unexplained female sterility and 20 healthy women as control group. Several whole blood samples were collected by venipuncture. Firstly homocysteinemia and other related variables were tested (i.e. folate and vitamin B12 levels); thereafter DNA was extracted by a further whole blood sample collected in EDTA in order to screen MTHFR C677T gene polymorphism. Statistical analysis was performed by chi square test; differences were considered to be significant if p < 0.05. Results: The median fasting total plasma homocysteine con...

Deep venous thrombosis in the antenatal period in a large cohort of pregnancies from western India

Thrombosis Journal — Wed, 04 Jul 2007 04:00:00 +0100

Background: Deep venous thrombosis (DVT) is an important complication in the peripartal and postpartal period. Methods: We followed up prospectively the prevalence of DVT in 34720 prenatal mothers between June 2002 and July 2006 attending the antenatal clinics of two major hospitals in Mumbai, India. Thirty two women (0.1%) presented for the first time with symptomatic DVT i.e. 17 in the first trimester, 6 in the second and 9 in the third trimester of pregnancy. Nine had history of fetal loss while in the remaining twenty three there was no history of fetal loss. Results: The evaluation of both acquired and heritable thrombophilia showed a conglomeration of thrombophilia in this group when compared to 100 normal pregnant women who have given birth to at least one healthy baby with no histo...

Why differentiate low molecular weight heparins for venous thromboembolism?

Thrombosis Journal — Tue, 19 Jun 2007 04:00:00 +0100

Editorial (Source: Thrombosis Journal)

Increased platelet expression of FcGammaRIIa and its potential impact on platelet reactivity in patients with end stage renal disease

Thrombosis Journal — Mon, 04 Jun 2007 04:00:00 +0100

Background: Increased platelet reactivity has been implicated in cardiovascular disease -- the major cause of death in patients with end stage renal disease (ESRD). FcGammaRIIA is a component of glycoprotein VI and Ib-IX-V that mediate activation of platelets by collagen and von Willebrand factor. To determine whether expression of FcGammaRIIA impacts platelet reactivity we quantified its expression and platelet reactivity in 33 patients with ESRD who were undergoing hemodialysis. Methods: Blood samples were obtained from patients immediately before hemodialysis and before administration of heparin. Platelet expression of FcGammaRIIA and the activation of platelets in response to low concentrations of convulxin (1 ng/ml, selected to mimic effects of collagen), thrombin (1 nM), adenosine ...

Clopidogrel in Orthopaedic patients: a review of current practice in Scotland

Thrombosis Journal — Fri, 25 May 2007 04:00:00 +0100

DiscussionRecommendations on stopping clopidogrel have evolved from studies conducted on patients undergoing cardio-thoracic surgery. There is no data available on the effect of clopidogrel in orthopaedic practise. Our survey indicates that increased bleeding has not been found in patients who continue clopidogrel peri-operatively. Almost half of respondents complied with current recommendations, stopping clopidogrel 7 days pre-operatively. However there remains a lack of consensus amongst orthopaedic surgeons. Currently elective patients should stop clopidogrel 7 days pre-operatively, and emergency patients should stop clopidogrel on admission, however their operation should not be delayed due to clopidogrel usage. (Source: Thrombosis Journal)

Platelet adhesion onto immobilized fibrinogen under arterial and venous in-vitro flow conditions does not significantly differ between men and women

Thrombosis Journal — Thu, 26 Apr 2007 04:00:00 +0100

Conclusions: In our in vitro experimental system, hormonal differences between men and women did not influence platelet adhesion onto immobilized fibrinogen, neither under venous nor under arterial rheological conditions. (Source: Thrombosis Journal)

Histological composition and progression of carotid plaque

Thrombosis Journal — Mon, 26 Feb 2007 05:00:00 +0100

Conclusion: Asymptomatic and symptomatic patients could have the same histological components on their carotid plaques. Fibrotic and calcific plaques could become vulnerable as complex plaques with surface defect, hemorrhage and thrombus could remain silent. Asymptomatic carotid stenosis should be followed close with no invasive diagnostic methods and clinical evaluation. (Source: Thrombosis Journal)

Evaluation of the TEG(R)platelet mappingTM assay in blood donors

Thrombosis Journal — Tue, 20 Feb 2007 07:00:00 +0100

Background: Monitoring of antiplatelet therapy in patients at cardiovascular risk is difficult because existing platelet function tests are too sophisticated for clinical routine. The whole blood Thrombelastograph (TEG) Platelet Mapping assay measures clot strength as maximal amplitude (MA) and enables for quantification of platelet function, including the contribution of the adenosine diphosphate (ADP) and thromboxane A2 (TxA2) receptors to clot formation. Methods: In 43 healthy blood donors, the analytical (CVa) and inter-individual variability (CVg) of the TEG Platelet Mapping assay were determined together with platelet receptor inhibition in response to arachidonic acid (AA) and ADP. Results: The CVa of the assay for maximal platelet contribution to clot strength (MAThrombin) was 3....

Evaluation of the TEG® platelet mapping™ assay in blood donors

Thrombosis Journal — Tue, 20 Feb 2007 05:00:00 +0100

Conclusion: The high variability in ADP receptor inhibition may explain both the differences in response to ADP receptor inhibitor therapy and why major bleeding sometimes develops during surgery in patients not treated with ADP receptor inhibitors. An analytical variation of ~5 % for the TEG® enables, however, for routine monitoring of the variability in ADP receptor inhibition and of antiplatelet therapy. (Source: Thrombosis Journal)

HPA-1 polymorphism of αIIbβ3 modulates platelet adhesion onto immobilized fibrinogen in an in-vitro flow system

Thrombosis Journal — Mon, 19 Feb 2007 07:00:00 +0100

Conclusion: Our data support the contention that genetically determined variants of platelet integrins αIIbβ3 could play a role in arterial thrombogenesis and thus confirm the hypothesis derived from epidemiological studies. (Source: Thrombosis Journal)

Emergency correction of coagulation before major surgery in two elderly patients on oral anticoagulation

Thrombosis Journal — Wed, 10 Jan 2007 07:00:00 +0100

Recommendations for urgent reversal of oral anticoagulation with vitamin K1 antagonists are largely derived from case series employing empirical dosing regimens with vitamin K1 and prothrombin complex concentrates. Data on the use of prothrombin complex concentrates in this indication are scarce in the elderly who are at high risk of both hemorrhagic and thrombotic complications. The two cases presented here describe patients older than 75 years who underwent rapid International Normalized Ratio (INR) reversal with prothrombin complex concentrates for surgical treatment of a bleeding ruptured spleen and for emergency surgery of a dissecting aorta. Both patients had their INRs rapidly corrected to at or below 1.6 and underwent operation without complications. Evidence on treatment of patien...

Benign intracranial hypertension associated to blood coagulation derangements.

Thrombosis Journal — Sun, 24 Dec 2006 07:00:00 +0100

Background: Benign Intracranial Hypertension (BIH) may be caused, at least in part, by intracranial sinus thrombosis. Thrombosis is normally due to derangements in blood coagulation cascade which may predispose to abnormal clotting activation or deficiency in natural inhibitors' control. The aim of the study is to examine the strength of the association between risk factors for thrombosis and BIH. Patients and Methods. The incidence of prothrombotic abnormalities among a randomly investigated cohort of 17 patients with BIH, was compared with 51 healthy subjects matched for sex, age, body mass index, height and social background. Results: The number of subjects with protein C deficiency was significantly higher in patients than in controls (3 vs 1, p (Source: Thrombosis Journal)

Benign intracranial hypertension associated to blood coagulation derangements

Thrombosis Journal — Sun, 24 Dec 2006 05:00:00 +0100

DiscussionIn agreement with other authors our data suggest a state of hypercoagulability in BIH associated with gene polymorphisms. Our findings also showed that mutations in cardiovascular genes significantly discriminate subjects with a BIH history. The association between coagulation and gene derangements, usually regarded to as cryptogenic, may suggest a possible pathogenetic mechanism in BIH. So, a prothrombotic tendency may exist that would, at least in part, explain some cases of BIH.Although based on a small population, these findings raise the exciting possibility of using these haemostatic factors as markers for selecting high-risk subjects in BIH disease. (Source: Thrombosis Journal)

An unusual case of Behcets disease presenting with postpartum ovarian iliac vein thrombosis and pulmonary embolism

Thrombosis Journal — Sat, 09 Dec 2006 07:00:00 +0100

We report a case of 24-year-old woman with a history of Behcets disease, who presented with pelvic and thoracic pain, tachycardia, dyspnea and fever occurring 2 weeks after delivery. Computed tomography revealed an ascending thrombosis of the iliac and right ovarian veins complicated by bilateral pulmonary embolism.The patient responded well to the combination of anticoagulants and immunosuppressive agents. Behcets disease should also be considered as an etiologic factor for ovarian vein thrombosis. (Source: Thrombosis Journal)

An unusual case of Behçet's disease presenting with postpartum ovarian iliac vein thrombosis and pulmonary embolism

Thrombosis Journal — Sat, 09 Dec 2006 05:00:00 +0100

We report a case of 24-year-old woman with a history of Behçet's disease, who presented with pelvic and thoracic pain, tachycardia, dyspnea and fever occurring 2 weeks after delivery. Computed tomography revealed an ascending thrombosis of the iliac and right ovarian veins complicated by bilateral pulmonary embolism. The patient responded well to the combination of anticoagulants and immunosuppressive agents. Behçet's disease should also be considered as an etiologic factor for ovarian vein thrombosis. (Source: Thrombosis Journal)

Antithrombin significantly influences platelet adhesion onto immobilized fibrinogen in an in-vitro system simulating low flow

Thrombosis Journal — Fri, 13 Oct 2006 06:00:00 +0100

Background: Adhesion of platelets onto immobilized fibrinogen is of importance in initiation and development of thrombosis. According to a recent increase in evidence of a multiple biological property of antithrombin, we evaluated the influence of antithrombin on platelet adhesion onto immobilized fibrinogen using an in-vitro flow system. Methods: Platelets in anticoagulated whole blood (29 healthy blood donors) were labelled with fluorescence dye and perfused through a rectangular flow chamber (shear rates of 13s-1 to 1500 s-1). Platelet adhesion onto fibrinogen-coated slips was assessed using a fluorescence laser-scan microscope and compared to the plasma antithrombin activity. Additionally the effect of supraphysiological AT supplementation on platelets adhesion rate was evaluated. Resu...

Antithrombin significantly influences platelet adhesion onto immobilized fibrinogen in an in-vitro system simulating low flow

Thrombosis Journal — Fri, 13 Oct 2006 04:00:00 +0100

Conclusion: It appears that antithrombin in a low flow system suppresses platelet adhesion onto immobilized fibrinogen independently from its antithrombin activity. A supraphysiological substitution of blood with antithrombin significantly reduces platelet adhesion rate. This inhibitory effect might be of clinical relevance. (Source: Thrombosis Journal)

Preparation of platelet-rich plasma as a tissue adhesive for experimental transplantation in rabbits

Thrombosis Journal — Thu, 28 Sep 2006 06:00:00 +0100

Conclusions: Our method was able to produce rabbit-derived PRP with suitable properties for soft tissue adhesion. These results could be useful for researchers of the growing fields of tissue repair and experimental transplantation. (Source: Thrombosis Journal)

Outcomes of thromboprophylaxis with enoxaparin vs. unfractionated heparin in medical inpatients: a retrospective database analysis

Thrombosis Journal — Wed, 27 Sep 2006 06:00:00 +0100

Background: Clinical trials have shown low-molecular weight heparin (LMWH) to be at least as safe and efficacious as unfractionated heparin (UFH) for preventing venous thromboembolism (VTE) in acutely-ill medical inpatients. The purpose of this study was to compare clinical and economic outcomes among medical inpatients receiving the LMWH enoxaparin versus UFH prophylaxis in real-world clinical practice. Methods: Using a large, multi-hospital, US database, we identified persons aged [greater than or equal to]40 years hospitalized for [greater than or equal to]6 days for an acute medical condition (including circulatory disorders, respiratory disorders, infectious diseases, or neoplasms) from Q4 1999 to Q1 2002. From these patients, those who received thromboprophylaxis with either enoxapa...

Outcomes of thromboprophylaxis with enoxaparin vs. unfractionated heparin in medical inpatients

Thrombosis Journal — Wed, 27 Sep 2006 04:00:00 +0100

Conclusion: We observed a 74% lower risk of VTE among patients receiving enoxaparin prophylaxis versus UFH prophylaxis. There was no significant difference in side effects or economic outcomes. These results provide evidence that the LMWH enoxaparin is more effective than UFH in reducing the risk of VTE in current clinical practice. (Source: Thrombosis Journal)

The screening power of methylenetetrahydrofolate reductase C677T polymorphism versus plasma homocysteine concentration in patients with stenosis of the internal carotid artery

Thrombosis Journal — Mon, 25 Sep 2006 06:00:00 +0100

Background: Hyperhomocysteinemia is an important and independent risk factor for vascular disease. About 35% of patients with stroke and 47% of patients with peripheral arterial disease have elevated plasma homocysteine (HCY) concentration. The relationship between plasma HCY and the methylentetrahydrofolate reductase (MTHFR) C677T polymorphism is still unclear, especially in regard to screening/diagnostic power. Methods: This case-control study was performed on 96 patients, who underwent surgery due to asymptomatic or symptomatic high grade stenosis of the internal carotid artery (ICA), and 96 healthy age and sex-matched, controls. Plasma HCY concentration was determined using a commercial kit for fully automated analysis (AxSYM, Abbott). The C677T polymorphism of the MTHFR-gene was asse...

Development of an in vitro model to study clot lysis activity of thrombolytic drugs.

Thrombosis Journal — Tue, 12 Sep 2006 06:00:00 +0100

Conclusion: Our study could be a rapid and effective methodology to study clot-lytic effect of newly developed drugs as well as known drugs. (Source: Thrombosis Journal)

Hereditary thrombophilia

Thrombosis Journal — Tue, 12 Sep 2006 06:00:00 +0100

Thrombophilia can be defined as a predisposition to form clots inappropriately. Thrombotic events during infancy and childhood are increasingly recognized as a significant source of mortality and morbidity. The predisposition to form clots can arise from genetic factors, acquired changes in the clotting mechanism, or, more commonly, an interaction between genetic and acquired factors. Since the turn of the last century, there has been extensive research focusing on both the genetic and acquired causes of thrombophilia, with particular focus on clotting events in the venous circulation. This review describes clinically relevant aspects of genetic venous thrombophilia, which include well-established, lesser known, and suggested causes of inherited thrombophilias. (Source: Thrombosis Journal)

Low dose endotoxin priming is accountable for coagulation abnormalities and organ damage observed in the Shwartzman reaction. A comparison between a single-dose endotoxemia model and a double-hit endotoxin-induced Shwartzman reaction

Thrombosis Journal — Thu, 24 Aug 2006 06:00:00 +0100

In this study we demonstrate that low-dose endotoxin priming prior to an LPS challenge in the Shwartzman reaction is accountable for micro-vascular thrombosis in lung and liver and subsequent (multi-) organ failure, not observed after a single-dose endotoxin challenge, which indicates that the Shwartzman reaction is well suited-model to study sepsis-induced DIC adversities. Remarkably, only minor differences in the innate immune response were established between the single-dose endotoxin challenge and the Shwartzman reaction. (Source: Thrombosis Journal)

Soluble fibrin inhibits monocyte adherence and cytotoxicity against tumor cells: Implications for cancer metastasis

Thrombosis Journal — Tue, 22 Aug 2006 06:00:00 +0100

Conclusions: sFn inhibits monocyte adherence and cytotoxicity of tumor cells by blocking aLB2 and aMB2 binding to tumor cell CD54. These results demonstrate that sFn is immunosuppressive and may be directly involved in the etiology of metastasis. Use of specific peptides also inhibited this effect without affecting coagulation, suggesting their possible use as novel therapeutic agents in cancer metastasis. (Source: Thrombosis Journal)

Acquired activated protein C resistance and thrombosis in multiple myeloma patients

Thrombosis Journal — Mon, 21 Aug 2006 06:00:00 +0100

Conclusions APC-R appears to be a transitional condition may be related to myeloma status. Thrombotic complications can affect morbidity and even mortality in these patients. To fully evaluate the potential synergistic anticancer activity of combinations of chemotherapy and thalidomide, effective prophylactic anticoagulation should be implemented in all controlled trials, at least during the first few cycles of treatment. (Source: Thrombosis Journal)

Comparison of platelet function between sedentary individuals and competitive athletes at rest

Thrombosis Journal — Thu, 17 Aug 2006 06:00:00 +0100

Background: There are controversial evidences on the effect of different types and workloads of physical exercise on primary hemostasis. In particular, little is known on the chronic influence of a strenuous and regular aerobic training regimen on platelet function. Methods: The aim of this investigation was to compare platelet function between sedentary controls and trained athletes at rest and to evaluate whether a greater amount of exercise performed in professional cyclists may contribute to increased platelet chronic responsiveness compared to both elite cyclists and sedentary individuals. Platelets ability to adhere and aggregate was assayed following a 12-24 h resting period in 49 active professional male road cyclists, 40 elite male cyclists and 43 matched sedentary healthy male vo...

An update on prevention of venous thromboembolism in hospitalized acutely ill medical patients

Thrombosis Journal — Mon, 03 Jul 2006 06:00:00 +0100

Both the recently updated consensus guidelines published by the American College of Chest Physicians, and the International Union of Angiology recommend thromboprophylaxis with either low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) in medical patients at risk of VTE. However, no guidance is given regarding the appropriate dosing regimens that should be used for thromboprophylaxis in this patient group. LMWH (enoxaparin and dalteparin) and UFH have been shown to be effective for thromboprophylaxis in at-risk hospitalized medical patients. Although LMWH once daily (o.d.) has been shown to be as effective as UFH three times daily (t.i.d.) for thromboprophylaxis in at-risk medical patients, there are no data to show that UFH twice daily (b.i.d) is as effective as either LMW...

Antithrombin III (AT) and recombinant tissue plasminogen activator (R-TPA) used singly and in combination versus supportive care for treatment of endotoxin-induced disseminated intravascular coagulation (DIC) in the neonatal pig

Thrombosis Journal — Thu, 18 May 2006 06:00:00 +0100

Background: Disseminated intravascular coagulation (DIC) is a pathological disturbance of the complex balance between coagulation and anticoagulation that is precipitated by vascular injury, acidosis, endotoxin release and/or sepsis and characterized by severe bleeding and excessive clotting. The innately low levels of coagulation factors found in newborn infants place them at extremely high risk for DIC. Anecdotal reports suggest that either anticoagulant or fibrinolytic therapy may alleviate some of the manifestations of DIC. To test the hypothesis that replacement of both anticoagulants and fibrinolytics may improve survival and outcome better than either single agent or supportive care alone, we utilized a neonatal piglet model of endotoxin-induced DIC. Methods: DIC was induced in twen...

Oral heparin: status review

Thrombosis Journal — Wed, 10 May 2006 06:00:00 +0100

Unfractionated heparin and low molecular weight heparin are the most commonly used antithrombotic and thromboprophylactic agents in hospital practice. Extended out-of-hospital treatment is inconvenient in that these agents must be administered parenterally. Current research is directed at development of a safe and effective oral antithrombotic agent as an alternative for the effective, yet difficult to use vitamin K antagonists. A novel drug delivery technology that facilitates transport of drugs across the gastrointestinal epithelium has been harnessed to develop an oral dosage form of unfractionated heparin. Combining unfractionated heparin with the carrier sodium N-(8[2-hydroxybenzoyl]amino) caprylate, or SNAC has markedly increased the gastrointestinal absorption of this drug. Preclini...

Thrombin generation by activated factor VII on platelet activated by different agonists. Extending the cell-based model of hemostasis

Thrombosis Journal — Fri, 21 Apr 2006 06:00:00 +0100

Conclusion: Platelets activated by AA, ADP, Col or rFVIIa triggered TG. This effect was increased by combining rFVIIa with other agonists. Our intrinsic coagulation system produced a burst in TG independent of external tissue factor activity an apparent hemostatic effect with little thrombotic capacity. Thus we suggest a modification in the cell-based model of hemostasis. (Source: Thrombosis Journal)

Recent acquisitions in the pathophysiology, diagnosis and treatment of disseminated intravascular coagulation

Thrombosis Journal — Tue, 21 Feb 2006 07:00:00 +0100

Disseminated intravascular coagulation (DIC) is a disorder characterized by both acute generalized, widespread activation of coagulation, which results in thrombotic complications due to the intravascular formation of fibrin, and diffuse hemorrhages, due to the consumption of platelets and coagulation factors. Systemic activation of coagulation may occur in a variety of disorders, including sepsis, severe infections, malignancies, obstetric or vascular disorders, and severe toxic or immunological reactions.In this review, we briefly report the present knowledge about the pathophysiology and diagnosis of DIC. Particular attention is also given to the current standard and experimental therapies of overt DIC. (Source: Thrombosis Journal)

Detection and quantification of lupus anticoagulants in plasma from heparin treated patients, using addition of polybrene

Thrombosis Journal — Wed, 25 Jan 2006 07:00:00 +0100

Conclusion: By addition of polybrene to a final concentration of 7.9 μg/ml in test plasma, Lupus Ratio may be determined in lupus anticoagulant-negative as well as positive plasmas irrespective of the presence of heparin 0.0 – 1.3 U/ml. (Source: Thrombosis Journal)

Ineffective off-label use of recombinant activated factor VII in a case of bone-marrow transplantation-related gastrointestinal bleeding

Thrombosis Journal — Wed, 18 Jan 2006 07:00:00 +0100

Conclusions: Little can be concluded from single case reports of clinical improvement, because publication bias in favour of positive effects is likely. Our case suggests that rFVIIa is not a panacea, in particular for severe bleeding after bone-marrow transplantation. As long as rigorous, controlled studies or comprehensive registries are lacking, conventional interventions remain the standard of care in non-haemophilic patients with severe bleeding. (Source: Thrombosis Journal)

Plasma D-dimer concentration in patients with systemic sclerosis

Thrombosis Journal — Wed, 18 Jan 2006 07:00:00 +0100

Conclusion: We demonstrated that SSc patients with diffuse subset are characterized by increased plasma D-dimer values, reflecting a potential activation of both the hemostatic and fibrinolytic cascades, which might finally predispose these patients to thrombotic complications. (Source: Thrombosis Journal)

Socio economic crisis and mortality. Epidemiological testimony of the financial collapse of Argentina

Thrombosis Journal — Tue, 13 Dec 2005 07:00:00 +0100

Conclusion: Our findings suggest that the financial crisis may have had a negative impact on cardiovascular mortality during hospitalization, and higher incidence of medical complications. (Source: Thrombosis Journal)

Systemic coagulation parameters in mice after treatment with vascular targeting agents

Thrombosis Journal — Sat, 10 Dec 2005 07:00:00 +0100

Conclusion: We have established a standardized panel of assays that can be used to test murine blood samples for coagulation activation in preclinical studies. All tests are feasible to perform in any research laboratory without specialized equipment. In addition, this is the first report to measure soluble fibrin, an early marker of systemic coagulation activation, in mice. The panel was applied on tumor bearing mice and mice treated with a VTA. We suggest its general application for coagulation activation analyses in mice. (Source: Thrombosis Journal)

Anticoagulant treatment at a specialized outpatient anticoagulant therapy unit, a descriptive study

Thrombosis Journal — Thu, 08 Dec 2005 07:00:00 +0100

Conclusion: In patients on oral anticoagulant therapy, re-evaluation of indications and risks resulted in a substantial number of treatment withdrawals. There have been major changes in treatment indications during the last decade, possibly due to rapid development of knowledge in the field of thrombosis risk factors. Treatment should be re-considered once a year. (Source: Thrombosis Journal)