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Sudden Death in Sickle Cell Disease: An Assessment of Risk Factors
ConclusionOur results suggest that ACS and priapism may be indicative of a high risk of sudden death in patients with SCD. Our data are preliminary and need to be further investigated using a larger cohort of patients, as well as exploring the prevalence of these factors in SCD patients who are not yet deceased.DisclosuresAchebe: Bluebird Bio: Consultancy; AMAG Pharmaceuticals: Other: Advisory Board; Luitpold pharmaceuticals: Consultancy.
Source: Blood - November 21, 2018 Category: Hematology Authors: Nze, C., Fortin, B. M., Freedman, R., Puligandla, M., Neuberg, D. S., Mandell, E., Achebe, M. Tags: 114. Hemoglobinopathies, Excluding Thalassemia-Clinical Source Type: research

Non-invasive imaging techniques for the differentiation of acute and chronic thrombosis
Thrombosis is the localized clotting of blood that can occur in both the arterial and venous circulation. It is a key factor in the pathogenesis of acute coronary syndrome, myocardial infarction and stroke and the primary cause of deep vein thrombosis and pulmonary embolism. Rapid and accurate diagnosis of thrombotic episodes is crucial in reducing the morbidity and potential mortality associated with arterial and venous thrombotic disorders by allowing early targeted therapeutic interventions. From a clinical perspective the ability to accurately assess the age and composition of thrombus is highly desirable given that an...
Source: Thrombosis Research - March 13, 2019 Category: Hematology Authors: Nur Nazifah Mohd Yusof, Andrew McCann, Peter J. Little, Hang T. Ta Tags: Review Article Source Type: research

How I manage anticoagulant therapy in older individuals with atrial fibrillation or venous thromboembolism
Anticoagulant therapy is the most effective strategy to prevent arterial and venous thromboembolism, but treating older individuals is challenging, because increasing age, comorbidities, and polypharmacy increase the risk of both thrombosis and bleeding. Warfarin and non–vitamin K antagonist oral anticoagulants are underused and often underdosed in the prevention of stroke in older patients with atrial fibrillation because of concerns about the risk of bleeding. Poor adherence to anticoagulant therapy is also an issue for older patients with atrial fibrillation and those at risk of recurrent pulmonary embolism. In th...
Source: Blood - May 22, 2019 Category: Hematology Authors: Chan, N. C., Eikelboom, J. W. Tags: How I Treat, Free Research Articles, Thrombosis and Hemostasis Source Type: research

Low persistence to rivaroxaban or warfarin among patients with new venous thromboembolism at a safety net academic medical center
This study evaluated 90 day persistence among patients prescribed rivaroxaban or warfarin for the treatment of acute VTE at an academic safety net hospital. We conducted a single center, retrospective cohort study of 314 consecutive patients newly prescribed rivaroxaban or warfarin for acute VTE between January 2016 and July 2017. Primary outcome was 90 day persistence, and secondary outcomes included 90 day readmission and/or ED visit, time to 90 m day readmission and/or ED visits, and attendance of direct oral anticoagulant education class. Of 314 patients, 78 were prescribed warfarin and 236 rivaroxaban. Patients had a ...
Source: Journal of Thrombosis and Thrombolysis - October 8, 2019 Category: Hematology Source Type: research

Reduced dose thrombolysis with ultrasound-facilitated catheter-directed administration for acute pulmonary embolism reduces length of stay
AbstractThe optimal dose and duration of tissue plasminogen activator (tPA) administered with ultrasound-facilitated catheter-directed thrombolysis (USCDT) to patients with acute PE remains to be determined. Our institution recently adopted a shorter duration (4  h) of USCDT and lower dosing strategy (tPA 1 mg/h) based on data from the OPTALYSE PE Trial. The purpose was to evaluate the implementation at our institution of shorter duration (4 h) of USCDT and lower dosing strategy (tPA 1 mg/h) as outlined by OPTALYSE PE Trial. This was a retrospective, si ngle-center, observational study included patients from 01/01/2017...
Source: Journal of Thrombosis and Thrombolysis - December 2, 2019 Category: Hematology Source Type: research

Increased prevalence of VTE reported by Klok and colleagues, the numbers don't add up
In this study the authors report that 31% of patients met the composite outcome of having a thrombotic complication which they define as having a pulmonary embolism, deep vein thrombosis, or an ischemic stroke. The study included 184 patients with 31 patients having a thrombotic complication. This adds up to an incidence of 16.8%, not 31%.
Source: Thrombosis Research - April 25, 2020 Category: Hematology Authors: Yonatan Y. Greenstein Tags: Letter to the Editors-in-Chief Source Type: research

Sickle cell disease as a vascular disorder.
Authors: Ofori-Acquah SF Abstract Introduction: In sickle cell disease (SCD), hemoglobin S (HbS) red blood cells (RBCs) are characteristically deformed and inflexible. Often breaking down in the circulation, they exhibit increased adhesive properties with the endothelium and activated neutrophils and platelets, increasing the risk of occlusion of the microcirculation. SCD is categorized into two sub-phenotypes: hyperhemolytic, associated with priapism, leg ulcers, pulmonary hypertension, and stroke, and high hemoglobin/viscosity, which may promote vaso-occlusion-associated pain, acute chest syndrome, and osteonecro...
Source: Expert Review of Hematology - May 6, 2020 Category: Hematology Tags: Expert Rev Hematol Source Type: research

Hyperacute multi-organ thromboembolic storm in COVID-19: a case report
We report a 66-year-old female patient with post-mortem diagnosis of COVID-19 who presented progressive livedo racemosa, acute renal failure and myocardial injury, as well as an absence of respiratory symptoms. Transthoracic echocardiography showed severe spontaneous echo contrast in the right cardiac chambers and right-sided cardiac overload presumed to result from pulmonary microvascular thrombosis or embolism.d-dimer levels were increased. The patient developed an acute ischemic stroke and died 2  days following presentation despite therapeutic anticoagulation. Her predominantly thromboembolic presentation supports the...
Source: Journal of Thrombosis and Thrombolysis - June 5, 2020 Category: Hematology Source Type: research

Incidence and consequences of systemic arterial thrombotic events in COVID-19 patients
AbstractA high incidence of thrombotic events, particularly deep vein thrombosis and pulmonary embolism, has been clearly documented in COVID-19 patients. In addition, small series of patients with coronary, cerebrovascular and peripheral arterial thrombotic events have also been reported, but their true incidence and consequences are not well described, and constitute the objective of this study. From February 1st to April 21st, 2020, 2115 COVID-19 patients were treated at Hospital Universitario Fundaci ón Alcorcón (Madrid, Spain), and 1419 were eventually admitted. Patient characteristics and outcomes were collected by...
Source: Journal of Thrombosis and Thrombolysis - June 8, 2020 Category: Hematology Source Type: research

Thrombin generation in children with sickle cell Anemia is Higher in the presence of platelets ⋆ and ⋆
Sickle cell disease (SCD) is a hemoglobin disorder leading to chronic hemolysis and multi-organ morbidity. Increasing evidence suggests that activation of coagulation contributes to its complications such as stroke, pulmonary hypertension, venous thromboembolism and avascular necrosis [1]. The effects are most profound in homozygous state Hemoglobin SS (HbSS) and Hemoglobin S-Beta zero thalassemia referred together as sickle cell anemia (SCA). With improved survival of patients with SCA in the current era, early recognition of long-term complications is a priority, but there is a paucity of biomarkers to identify SCA hypercoagulability.
Source: Transfusion and Apheresis Science - June 14, 2020 Category: Hematology Authors: Neethu Menon, Janna Journeycake, Rong Huang, Paul Riley, Ayesha Zia Source Type: research

Intravenous Fat Emulsion Does Not Significantly Alter Clotting Markers in Dabigatran-Treated Blood
AbstractDabigatran etexilate is an oral direct thrombin (Factor IIa) inhibitor approved for patients with atrial fibrillation and for management of risk of deep vein thrombosis and pulmonary embolism. Dabigatran offers advantages over treatment with warfarin, including limited laboratory monitoring. It is equivalent in prevention of stroke and deep vein thrombosis with essentially equivalent complication rates. In contrast to warfarin, reversal of the anticoagulation is less well established. Idarucizumab is available for reversal, however supporting research is mixed; the agent also happens to be quite expensive making av...
Source: Indian Journal of Hematology and Blood Transfusion - June 21, 2020 Category: Hematology Source Type: research

High molecular weight kininogen contributes to early mortality and kidney dysfunction in a mouse model of sickle cell disease.
CONCLUSIONS: We found elevated plasma levels of cleaved HK in sickle patients compared to healthy controls, suggesting ongoing HK activation in SCD. We used bone marrow transplantation to generate wild type and sickle cell mice on a HK-deficient background. We found that short-term HK deficiency attenuated thrombin generation and inflammation in sickle mice at steady state, which was independent of bradykinin signaling. Moreover, long-term HK deficiency attenuates kidney injury, reduces chronic inflammation, and ultimately improves of sickle mice. PMID: 32573897 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - June 22, 2020 Category: Hematology Authors: Sparkenbaugh EM, Kasztan M, Henderson MW, Ellsworth P, Davis PR, Wilson KJ, Reeves B, Key NS, Strickland S, McCrae K, Pollock DM, Pawlinski R Tags: J Thromb Haemost Source Type: research

Incidence and prevalence of venous thromboembolism in Norway 2010 –2017
Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a major cause of mortality and morbidity, and is associated with reduced survival, substantial healthcare costs, and high recurrence rates [1]. It is the third-leading cardiovascular disorder, after myocardial infarction and stroke with approximately 10 million global cases diagnosed annually [2].
Source: Thrombosis Research - July 6, 2020 Category: Hematology Authors: Waleed Ghanima, Ellen Brodin, Anna Schultze, Leah Shepherd, Dimitra Lambrelli, Maria Ulvestad, Sreeram Ramagopalan, Sigrun Halvorsen Tags: Letter to the Editors-in-Chief Source Type: research

Risk of thromboembolism in patients with multiple myeloma treated with daratumumab: a systemic review and meta-analysis.
CONCLUSION: Daratumumab is associated with lower risk of VTE in clinical trials. PMID: 32710431 [PubMed - as supplied by publisher]
Source: International Journal of Hematology - July 23, 2020 Category: Hematology Authors: Wang J, Kim Y Tags: Int J Hematol Source Type: research

Evaluation of Oral Factor Xa inhibitor-associated Extracranial Bleeding Reversal with Andexanet alfa.
CONCLUSION: We report poor overall outcomes, a low rate of hemostatic effectiveness, and a high rate of ischemic complications and mortality in this retrospective analysis of oral FXa inhibitor reversal with andexanet alfa for extracranial bleeds. More rigorous epidemiological, and ideally randomized studies are needed to determine the role of andexanet alfa for FXa inhibitor-associated bleeding for extracranial hemorrhages, where large variation in severity and presentation exists. PMID: 32738161 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - July 31, 2020 Category: Hematology Authors: Nederpelt CJ, Naar L, Sylvesterc KW, Barra ME, Roberts RJ, Velmahos GV, Kaafarani HMA, Rosenthal MG, King DR Tags: J Thromb Haemost Source Type: research

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