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Metal ion chelation enhances tissue plasminogen activator (tPA)-induced thrombolysis: an in vitro and in vivo study
AbstractStroke is the third leading cause of death in the United States and the leading cause of adult disability. Despite enormous research efforts including many clinical trials, tissue plasminogen activator (tPA) remains the only FDA-approved treatment for acute ischemic stroke. Unfortunately, only 1 –3% of stroke patients in the US receive this therapy because of the narrow time window and severe side effects for using tPA. The most deadly and damaging side effect is the risk of intracranial bleeding or hemorrhage. For that reason, the dose of tPA and its overall administration are under tigh t control, which may com...
Source: Journal of Thrombosis and Thrombolysis - November 10, 2021 Category: Hematology Source Type: research

Antithrombotic strategy and its relationship with outcomes in patients with atrial fibrillation and chronic coronary syndrome
This study aimed to explore antithrombotic strategy and its relationship with outcomes in patients with atrial fibrillation (AF) at high risk for stroke and chronic coronary syndrome (CCS) in real-world clinical practice. Patients with AF at high risk for stroke complicated with CCS from China Atrial Fibrillation Registry (CAFR) were enrolled. The patients were divided into non-antithrombotic (Non-AT) group, oral anticoagulants (OAC) group, antiplatelet therapy (APT) group (aspirin or clopidogrel), and dual antiplatelet therapy (DAPT) group (aspirin  + clopidogrel) according to their antithrombotic strategies at baseli...
Source: Journal of Thrombosis and Thrombolysis - October 22, 2021 Category: Hematology Source Type: research

Oral anticoagulation patterns and prognosis in octogenarian patients with atrial fibrillation
In conclusion, in this cohort of post-discharge octogenarian patients with AF, the risk for all-cause death was similar in NOAC versus VKA users, after adjustment for baseline covariates. No differences in stroke and major bleeding events among these treatment groups were revealed.Graphic abstract
Source: Journal of Thrombosis and Thrombolysis - September 25, 2021 Category: Hematology Source Type: research

Examination of anticoagulation prescription among elderly patients with atrial fibrillation after in-hospital fall
AbstractMechanical fall is common among elders and has been associated with a lack of anticoagulant therapy among patients with atrial fibrillation (AF). However, anticoagulant therapy is recommended despite frequent fall due to an increased risk of a thromboembolic event. Using data from a large health system, we investigated the predictors of anticoagulation prescription on discharge in AF elderly patients after an in-hospital fall.  In this retrospective analysis, we examined patients aged 60 years and older discharged from 2013 to 2018 with a diagnosis of AF and a secondary diagnosis of in-hospital fall. The primary o...
Source: Journal of Thrombosis and Thrombolysis - September 4, 2021 Category: Hematology Source Type: research

Efficacy of prothrombin complex concentrate in the management of oral factor Xa inhibitors associated major bleed assessed by ISTH and ANNEXA-4 criteria
AbstractDirect oral anticoagulants (DOACs) are increasingly used for stroke prevention in atrial fibrillation and treatment and prevention of venous thromboembolism. They are also associated with bleeding risk. Existing literature suggests that prothrombin complex concentrate (PCC) administration may help control bleeding due to factor Xa inhibitors (FXaI). To determine the hemostatic efficacy of PCC in patients with major bleeding due to FXaI,  we performed a retrospective chart review of 50 patients who presented with FXaI associated major bleeding that required urgent hemostatic management. Hemostatic assessment was pe...
Source: Journal of Thrombosis and Thrombolysis - August 9, 2021 Category: Hematology Source Type: research

Appropriateness of inpatient dosing of direct oral anticoagulants for atrial fibrillation
The objective was to determine the rates of inappropriate inpatient DOAC dosing in AF and identifying its associated underlying factors. We conducted a retrospective cross-sectional study from December 2013 to November 2019 across six South Australian public hospitals utilising a centralised electronic health record. Multivariate analysis was used to identify factors associated with underdosing of patients prescribed apixaban. Of 1882 inpatients, 544 (28.9  %) were inappropriately dosed. Underdosing was the most common form of inappropriate dosing with rates of 22.9 % (n = 295), 7.1 % (n = 7), and 25.1 % (n...
Source: Journal of Thrombosis and Thrombolysis - July 24, 2021 Category: Hematology Source Type: research

Management of tandem occlusions in patients who receive rtPA
ConclusionThe use of GP2b3aI in the setting of tandem occlusions that required emergent stent placement post-rtPA appears safe and effective. Given the small sample size, these findings should be interpreted cautiously, and need to be confirmed in a larger patient population.
Source: Journal of Thrombosis and Thrombolysis - June 23, 2021 Category: Hematology Source Type: research

Interaction between thrombin potential and age on early clinical outcome in patients hospitalized for COVID-19
AbstractPatients with Coronavirus Disease-2019 (COVID ‐19) have haemostatic dysfunction and are at higher risk of thrombotic complications. Although age is a major risk factor for outcome impairment in COVID-19, its impact on coagulative patterns here is still unclear. We investigated the association of Endogenous Thrombin Potential (ETP) with thromb otic and haemorrhagic events according to different ages in patients admitted for COVID-19. A total of 27 patients with COVID‐19-related pneumonia, without need for intensive care unit admission or mechanical ventilation at hospital presentation, and 24 controls with non-C...
Source: Journal of Thrombosis and Thrombolysis - June 10, 2021 Category: Hematology Source Type: research

Thrombectomy for ischemic stroke with large vessel occlusion and concomitant subarachnoid hemorrhage
AbstractTo report our experience in treating one patient with nontraumatic subarachnoid hemorrhage (SAH) and concurrent acute ischemic stroke (AIS) due to large vessels occlusion (LVO). A man in his 50  s presented with acute right hemiparesis and aphasia. Brain CT showed a SAH in the left central sulcus; CT-angiography revealed a tandem occlusion of the left internal carotid artery and homolateral middle cerebral artery. He underwent an angiographic procedure with successful recanalization. Foll ow-up CT demonstrated a striatal-lenticular stroke without SAH progression. While the absolute contraindication to IVT during i...
Source: Journal of Thrombosis and Thrombolysis - June 8, 2021 Category: Hematology Source Type: research

Stroke risk factors and outcomes among hospitalized women with atrial fibrillation
In conclusion, women hospitalized with AF have a higher risk of stroke at 90 days compared with men. Anticoagulation at hospital discharge was omitted in 40% of women with AF, but when prescribed, was associated with a reduction in mortality and major adverse events at 90 days, respectivel y.Graphic abstractWe analyzed 5000 hospitalized patients with atrial fibrillation (AF) (1888 women and 3112 men) in an observational cohort study completed at our tertiary care medical center to assess sex-related differences in cardiovascular risk factors, prescription of antithrombotic therapy, and 90-day outcomes. We observed a 50% ...
Source: Journal of Thrombosis and Thrombolysis - May 26, 2021 Category: Hematology Source Type: research

Gender differences with short-term vs 12  months dual antiplatelet therapy in patients with acute coronary syndrome treated with the COMBO dual therapy stent: 2-years follow-up results of the REDUCE trial
ConclusionsThe present study shows that among ACS patients randomized in the REDUCE trial, a 3  months DAPT strategy offers comparable results as compared to a standard 12 months DAPT at 2-years follow-up in both male and female gender.
Source: Journal of Thrombosis and Thrombolysis - April 13, 2021 Category: Hematology Source Type: research

The outcomes of three-factor prothrombin complex concentrate (3F-PCC) in warfarin anticoagulation reversal: a prospective, single-arm, open-label, multicentre study
AbstractThere is a wide variation on the efficacy of three-factor Prothrombin Complex Concentrate (3F-PCC) in warfarin reversal. We aimed to determine the efficacy and safety of 3F-PCC in warfarin reversal. This multicentre prospective study analysed data from adult patients on warfarin who received 3F-PCC (Prothrombinex-VF ®) for anticoagulation reversal between June 2019 to October 2020. Purposive sampling was used in this study. Study endpoints included target INR achievement, adverse drug reactions (ADRs), and in-hospital all-cause mortality. Logistic regression analyses were used to assess independent predictors of s...
Source: Journal of Thrombosis and Thrombolysis - March 21, 2021 Category: Hematology Source Type: research

Safety of direct oral anticoagulants in patients with mild to moderate cirrhosis: a systematic review and meta-analysis
AbstractTo evaluate major bleeding in cirrhosis with use of traditional anticoagulation or direct oral anticoagulants (DOACs), using a standardized definition. Anticoagulation in patients with cirrhosis is often a clinical conundrum for providers as the necessary balance between thrombotic and bleeding risk is complicated by end organ damage. Recent meta-analyses have sought to evaluate the safety and efficacy of direct oral anticoagulants in patients with liver disease. These recent analyses are limited by various bleeding definitions, broad inclusion criteria, and few indications for anticoagulation. We sought to conduct...
Source: Journal of Thrombosis and Thrombolysis - March 16, 2021 Category: Hematology Source Type: research

Short-term non-vitamin K antagonist oral anticoagulants vs. warfarin in preventing device-related thrombosis after left atrial appendage closure
AbstractUp to now we have had few evidences on the Non-vitamin K Antagonist Oral Anticoagulants (NOACs) ’ efficacy and safety in preventing device-related thrombosis (DRT) after percutaneous left atrial appendage closure (LAAC). After LAAC implantation, short-term anticoagulation (NOACs or warfarin) was prescribed. Baseline clinical characteristics, procedural parameters and postoperative follow up data were collected and compared between the two groups. From May 2014 to June 2018, 361 consecutive patients underwent LAAC implantation in our center. 170 patients received warfarin for 45 days at least after LAAC implantat...
Source: Journal of Thrombosis and Thrombolysis - March 5, 2021 Category: Hematology Source Type: research

Comparative effectiveness of direct oral anticoagulants and warfarin for the treatment of left ventricular thrombus
AbstractLeft ventricular (LV) thrombus is a complication of acute endomyocardial injury and chronic ventricular wall hypokinesis, resulting in increased risk of thromboembolic complications. Observational studies support the general safety and efficacy of warfarin for this indication. Limited data exists regarding the use of direct oral anticoagulants (DOACs) for LV thrombus. This retrospective cohort study sought to compare the incidence of thromboembolic events, bleeding rates, and blood product administration in patients receiving a DOAC versus warfarin. A total of 949 patients met inclusion, 180 (19%) received a DOAC a...
Source: Journal of Thrombosis and Thrombolysis - January 9, 2021 Category: Hematology Source Type: research

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