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1دورية أكاديمية
المؤلفون: Larsen, Emil List, Nilius, Henning, Studt, Jan-Dirk, Tsakiris, Dimitrios A, Greinacher, Andreas, Mendez, Adriana, Schmidt, Adrian, Wuillemin, Walter A, Gerber, Bernhard, Vishnu, Prakash, Graf, Lukas, Kremer Hovinga, Johanna A, Goetze, Jens P, Bakchoul, Tamam, Nagler, Michael
المصدر: Larsen, Emil List; Nilius, Henning; Studt, Jan-Dirk; Tsakiris, Dimitrios A; Greinacher, Andreas; Mendez, Adriana; Schmidt, Adrian; Wuillemin, Walter A; Gerber, Bernhard; Vishnu, Prakash; Graf, Lukas; Kremer Hovinga, Johanna A; Goetze, Jens P; Bakchoul, Tamam; Nagler, Michael (2024). Accuracy of Diagnosing Heparin-Induced Thrombocytopenia. JAMA Network Open, 7(3) American Medical Association 10.1001/jamanetworkopen.2024.3786
مصطلحات موضوعية: 610 Medicine & health
الوصف: IMPORTANCE Heparin-induced thrombocytopenia (HIT) is a life-threatening condition that requires urgent diagnostic clarification. However, knowledge of the diagnostic utility of the recommended diagnostic tests is limited in clinical practice. OBJECTIVE To evaluate the current diagnostic practice for managing the suspicion of HIT. DESIGN, SETTING, AND PARTICIPANTS This prospective diagnostic study was conducted from January 2018 to May 2021 among consecutive patients with suspected HIT from 11 study centers in Switzerland, Germany, and the United States. Detailed clinical data and laboratory information were recorded. Platelet factor 4/heparin antibodies were quantified using an automated chemiluminescent immunoassay (CLIA). A washed-platelet heparin-induced platelet activation (HIPA) test was used as a reference standard to define HIT. EXPOSURES Suspicion of HIT. MAIN OUTCOMES AND MEASURES The primary outcome was the diagnostic accuracy of the 4Ts score, the CLIA, and the recommended algorithm serially combining both tests. RESULTS Of 1448 patients included between 2018 and 2021, 1318 were available for the current analysis (median [IQR] age, 67 [57-75] years; 849 [64.6%] male). HIPA was positive in 111 patients (prevalence, 8.4%). The most frequent setting was intensive care unit (487 [37.0%]) or cardiovascular surgery (434 [33.0%]). The 4Ts score was low risk in 625 patients (46.8%). By 2 × 2 table, the numbers of patients with false-negative results were 10 (9.0%; 4Ts score), 5 (4.5%; CLIA), and 15 (13.5%; recommended diagnostic algorithm). The numbers of patients with false-positive results were 592 (49.0%; 4Ts score), 73 (6.0%; CLIA), and 50 (4.1%; recommended diagnostic algorithm), respectively. CONCLUSIONS AND RELEVANCE In this diagnostic study of patients suspected of having HIT, when the recommended diagnostic algorithm was used in clinical practice, antibody testing was required in half the patients. A substantial number of patients were, however, still misclassified, which could lead to delayed ...
وصف الملف: application/pdf
العلاقة: https://boris.unibe.ch/194892Test/
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2دورية أكاديمية
المؤلفون: Castaman, Giancarlo, Peyvandi, Flora, Kremer Hovinga, Johanna A, Schutgens, Roger E G, Robson, Susan, Moreno, Katya, Jiménez-Yuste, Víctor
المصدر: Castaman, Giancarlo; Peyvandi, Flora; Kremer Hovinga, Johanna A; Schutgens, Roger E G; Robson, Susan; Moreno, Katya; Jiménez-Yuste, Víctor (2024). Surgical Experience from the STASEY Study of Emicizumab Prophylaxis in People with Hemophilia A with Factor VIII Inhibitors. TH open, 8(1), e42-e54. Thieme 10.1055/s-0043-1777766
مصطلحات موضوعية: 610 Medicine & health
الوصف: Background Guidelines surrounding emicizumab prophylaxis and perioperative treatment for people with hemophilia A (PwHA) with factor (F)VIII inhibitors undergoing surgeries are limited. The phase IIIb multicenter, single-arm STASEY study evaluated safety and tolerability of emicizumab prophylaxis in PwHA aged ≥12 years with FVIII inhibitors. This analysis assesses surgeries during study conduct, associated hemophilia medications, and postoperative bleeds (treated and untreated). Methods PwHA with FVIII inhibitors received emicizumab 3.0 mg/kg/week for 4 weeks, then 1.5 mg/kg/week until 2 years. Surgeries were managed and documented by treating physicians. Bleeds and treatments were recorded by physicians and participants. Results Forty-six participants had ≥1 on-study surgery, 37 underwent 56 minor surgeries, and 13 underwent 22 major surgeries. Four participants underwent both minor and major surgeries. Of 18 (81.8%) and 4 (18.2%) major surgeries managed with/without additional hemostatic medication, 33.3 and 25.0% were associated with a treated postoperative bleed, respectively. Of 24 (42.9%) and 32 (57.1%) minor surgeries managed with/without additional hemostatic medication, 15.6 and 25.0% were associated with a treated postoperative bleed, respectively. Recombinant activated FVII was the most common medication for prophylaxis and bleed treatment. There were no thrombotic microangiopathies (TMAs). One hypertrophic clot, considered unrelated to emicizumab, occurred following tooth extraction. Conclusion In this challenging population with a high bleeding risk, major surgeries were performed in PwHA receiving emicizumab with/without additional hemostatic medication. Postoperative bleeds occurred following 59.1% of major surgeries; 53.8% were treated. No arterial/venous thrombotic events or TMAs occurred due to concomitant emicizumab and bypassing agents. Trial registration This trial is registered at ClinicalTrials.gov (NCT03191799).
وصف الملف: application/pdf
العلاقة: https://boris.unibe.ch/191641Test/
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3
المؤلفون: Van De Munckhof, Anita, Lindgren, Erik, Kleinig, Timothy J., Field, Thalia S., Cordonnier, Charlotte, Krzywicka, Katarzyna, Poli, Sven, Sánchez Van Kammen, Mayte, Borhani-Haghighi, Afshin, Lemmens, Robin, Scutelnic, Adrian, Ciccone, Alfonso, Gattringer, Thomas, Wittstock, Matthias, Dizonno, Vanessa, Devroye, Annemie, Elkady, Ahmed, Günther, Albrecht, Cervera, Alvaro, Mengel, Annerose, Chew, Beng Lim Alvin, Buck, Brian, Zanferrari, Carla, Garcia-Esperon, Carlos, Jacobi, Christian, Soriano, Cristina, Michalski, Dominik, Zamani, Zohreh, Blacquiere, Dylan, Johansson, Elias, Cuadrado-Godia, Elisa, Vuillier, Fabrice, Bode, Felix J., Caparros, François, Maier, Frank, Tsivgoulis, Georgios, Katzberg, Hans D., Duan, Jiangang, Burrow, Jim, Pelz, Johann, Mbroh, Joshua, Oen, Joyce, Schouten, Judith, Zimmermann, Julian, Ng, Karl, Garambois, Katia, Petruzzellis, Marco, Carvalho Dias, Mariana, Ghiasian, Masoud, Romoli, Michele, Miranda, Miguel, Wronski, Miriam, Skjelland, Mona, Almasi-Dooghaee, Mostafa, Cuisenier, Pauline, Murphy, Seán, Timsit, Serge, Coutts, Shelagh B., Schönenberger, Silvia, Nagel, Simon, Hiltunen, Sini, Chatterton, Sophie, Cox, Thomas, Bartsch, Thorsten, Shaygannejad, Vahid, Mirzaasgari, Zahra, Middeldorp, Saskia, Levi, Marcel M., Kremer Hovinga, Johanna A., Jood, Katarina, Tatlisumak, Turgut, Putaala, Jukka, Heldner, Mirjam R., Arnold, Marcel, Aguiar De Sousa, Diana, Ferro, José M., Coutinho, Jonathan M.
المصدر: Stroke. 53(10):3206-3210
مصطلحات موضوعية: hospitalization, intracranial thrombosis, mortality, thrombocytopenia, vaccination, venous thrombosis, Neurology, neurologi
الوصف: Background: Cerebral venous thrombosis (CVT) due to vaccine-induced immune thrombotic thrombocytopenia (VITT) is a severe condition, with high in-hospital mortality rates. Here, we report clinical outcomes of patients with CVT-VITT after SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) vaccination who survived initial hospitalization.Methods: We used data from an international registry of patients who developed CVT within 28 days of SARS-CoV-2 vaccination, collected until February 10, 2022. VITT diagnosis was classified based on the Pavord criteria. Outcomes were mortality, functional independence (modified Rankin Scale score 0-2), VITT relapse, new thrombosis, and bleeding events (all after discharge from initial hospitalization).Results: Of 107 CVT-VITT cases, 43 (40%) died during initial hospitalization. Of the remaining 64 patients, follow-up data were available for 60 (94%) patients (37 definite VITT, 9 probable VITT, and 14 possible VITT). Median age was 40 years and 45/60 (75%) patients were women. Median follow-up time was 150 days (interquartile range, 94-194). Two patients died during follow-up (3% [95% CI, 1%-11%). Functional independence was achieved by 53/60 (88% [95% CI, 78%-94%]) patients. No new venous or arterial thrombotic events were reported. One patient developed a major bleeding during follow-up (fatal intracerebral bleed).Conclusions: In contrast to the high mortality of CVT-VITT in the acute phase, mortality among patients who survived the initial hospitalization was low, new thrombotic events did not occur, and bleeding events were rare. Approximately 9 out of 10 CVT-VITT patients who survived the acute phase were functionally independent at follow-up.
وصف الملف: print
الوصول الحر: https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-200400Test
https://doi.org/10.1161/STROKEAHA.122.039575Test -
4
المؤلفون: Scutelnic, Adrian, Krzywicka, Katarzyna, Mbroh, Joshua, van de Munckhof, Anita, van Kammen, Mayte Sánchez, de Sousa, Diana Aguiar, Lindgren, Erik, Jood, Katarina, Günther, Albrecht, Hiltunen, Sini, Putaala, Jukka, Tiede, Andreas, Maier, Frank, Kern, Rolf, Bartsch, Thorsten, Althaus, Katharina, Ciccone, Alfonso, Wiedmann, Markus, Skjelland, Mona, Medina, Antonio, Cuadrado-Godia, Elisa, Cox, Thomas, Aujayeb, Avinash, Raposo, Nicolas, Garambois, Katia, Payen, Jean-Francois, Vuillier, Fabrice, Franchineau, Guillaume, Timsit, Serge, Bougon, David, Dubois, Marie-Cécile, Tawa, Audrey, Tracol, Clement, De Maistre, Emmanuel, Bonneville, Fabrice, Vayne, Caroline, Mengel, Annerose, Michalski, Dominik, Pelz, Johann, Wittstock, Matthias, Bode, Felix, Zimmermann, Julian, Schouten, Judith, Buture, Alina, Murphy, Sean, Palma, Vincenzo, Negro, Alberto, Gutschalk, Alexander, Nagel, Simon, Schoenenberger, Silvia, Frisullo, Giovanni, Zanferrari, Carla, Grillo, Francesco, Giammello, Fabrizio, Martin, Mar Morin, Cervera, Alvaro, Burrow, Jim, Esperon, Carlos Garcia, Chew, Beng Lim Alvin, Kleinig, Timothy J., Soriano, Cristina, Zimatore, Domenico S., Petruzzellis, Marco, Elkady, Ahmed, Miranda, Miguel S., Fernandes, João, Vogel, Åslög Hellström, Johansson, Elias, Philip, Anemon Puthuppallil, Coutts, Shelagh B., Bal, Simerpreet, Buck, Brian, Legault, Catherine, Blacquiere, Dylan, Katzberg, Hans D., Field, Thalia S., Dizonno, Vanessa, Gattringer, Thomas, Jacobi, Christian, Devroye, Annemie, Lemmens, Robin, Kristoffersen, Espen Saxhaug, di Poggio, Monica Bandettini, Ghiasian, Masoud, Karapanayiotides, Theodoros, Chatterton, Sophie, Wronski, Miriam, Ng, Karl, Kahnis, Robert, Geeraerts, Thomas, Reiner, Peggy, Cordonnier, Charlotte, Middeldorp, Saskia, Levi, Marcel, van Gorp, Eric C. M., van de Beek, Diederik, Brodard, Justine, Kremer Hovinga, Johanna A., Kruip, Marieke J. H. A., Tatlisumak, Turgut, Ferro, José M., Coutinho, Jonathan M., Arnold, Marcel, Poli, Sven, Heldner, Mirjam R.
المصدر: DEAL Annals of Neurology. 92(4):562-573
الوصف: Objective: Cerebral venous thrombosis (CVT) caused by vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare adverse effect of adenovirus-based severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) vaccines. In March 2021, after autoimmune pathogenesis of VITT was discovered, treatment recommendations were developed. These comprised immunomodulation, non-heparin anticoagulants, and avoidance of platelet transfusion. The aim of this study was to evaluate adherence to these recommendations and its association with mortality.Methods: We used data from an international prospective registry of patients with CVT after the adenovirus-based SARS-CoV-2 vaccination. We analyzed possible, probable, or definite VITT-CVT cases included until January 18, 2022. Immunomodulation entailed administration of intravenous immunoglobulins and/or plasmapheresis.Results: Ninety-nine patients with VITT-CVT from 71 hospitals in 17 countries were analyzed. Five of 38 (13%), 11 of 24 (46%), and 28 of 37 (76%) of the patients diagnosed in March, April, and from May onward, respectively, were treated in-line with VITT recommendations (p < 0.001). Overall, treatment according to recommendations had no statistically significant influence on mortality (14/44 [32%] vs 29/55 [52%], adjusted odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.16–1.19). However, patients who received immunomodulation had lower mortality (19/65 [29%] vs 24/34 [70%], adjusted OR = 0.19, 95% CI = 0.06–0.58). Treatment with non-heparin anticoagulants instead of heparins was not associated with lower mortality (17/51 [33%] vs 13/35 [37%], adjusted OR = 0.70, 95% CI = 0.24–2.04). Mortality was also not significantly influenced by platelet transfusion (17/27 [63%] vs 26/72 [36%], adjusted OR = 2.19, 95% CI = 0.74–6.54).Conclusions: In patients with VITT-CVT, adherence to VITT treatment recommendations improved over time. Immunomodulation seems crucial for reducing mortality of VITT-CVT.
وصف الملف: electronic
الوصول الحر: https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-198052Test
https://doi.org/10.1002/ana.26431Test
https://umu.diva-portal.org/smash/get/diva2:1683226/FULLTEXT02.pdfTest -
5دورية أكاديمية
المؤلفون: van de Munckhof, Anita, Borhani-Haghighi, Afshin, Aaron, Sanjith, Krzywicka, Katarzyna, van Kammen, Mayte S. nchez, Cordonnier, Charlotte, Kleinig, Timothy J., Field, Thalia S., Poli, Sven, Lemmens, Robin, Scutelnic, Adrian, Lindgren, Erik, Duan, Jiangang, Arslan, Y. ldız, van Gorp, Eric C. M., Kremer Hovinga, Johanna A., Günther, Albrecht, Jood, Katarina, Tatlisumak, Turgut, Putaala, Jukka, Heldner, Mirjam R., Arnold, Marcel, de Sousa, Diana Aguiar, Wasay, Mohammad, Arauz, Antonio, Conforto, Adriana Bastos, Ferro, José M., Coutinho, Jonathan M.
المصدر: van de Munckhof , A , Borhani-Haghighi , A , Aaron , S , Krzywicka , K , van Kammen , M S N , Cordonnier , C , Kleinig , T J , Field , T S , Poli , S , Lemmens , R , Scutelnic , A , Lindgren , E , Duan , J , Arslan , Y L , van Gorp , E C M , Kremer Hovinga , J A , Günther , A , Jood , K , Tatlisumak , T , Putaala , J , Heldner , M R , Arnold ....
الوصف: Background: Adenovirus-based COVID-19 vaccines are extensively used in low- and middle-income countries (LMICs). Remarkably, cases of cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) have rarely been reported from LMICs. Aims: We studied the frequency, manifestations, treatment, and outcomes of CVST-VITT in LMICs. Methods: We report data from an international registry on CVST after COVID-19 vaccination. VITT was classified according to the Pavord criteria. We compared CVST-VITT cases from LMICs to cases from high-income countries (HICs). Results: Until August 2022, 228 CVST cases were reported, of which 63 were from LMICs (all middle-income countries [MICs]: Brazil, China, India, Iran, Mexico, Pakistan, Turkey). Of these 63, 32 (51%) met the VITT criteria, compared to 103 of 165 (62%) from HICs. Only 5 of the 32 (16%) CVST-VITT cases from MICs had definite VITT, mostly because anti-platelet factor 4 antibodies were often not tested. The median age was 26 (interquartile range [IQR] 20–37) versus 47 (IQR 32–58) years, and the proportion of women was 25 of 32 (78%) versus 77 of 103 (75%) in MICs versus HICs, respectively. Patients from MICs were diagnosed later than patients from HICs (1/32 [3%] vs. 65/103 [63%] diagnosed before May 2021). Clinical manifestations, including intracranial hemorrhage, were largely similar as was intravenous immunoglobulin use. In-hospital mortality was lower in MICs (7/31 [23%, 95% confidence interval (CI) 11–40]) than in HICs (44/102 [43%, 95% CI 34–53], p = 0.039). Conclusions: The number of CVST-VITT cases reported from LMICs was small despite the widespread use of adenoviral vaccines. Clinical manifestations and treatment of CVST-VITT cases were largely similar in MICs and HICs, while mortality was lower in patients from MICs.
الإتاحة: https://doi.org/10.1177/17474930231182901Test
https://research.vumc.nl/en/publications/19c2f847-7073-416f-ae6d-21275122a1ebTest
http://www.scopus.com/inward/record.url?scp=85165315215&partnerID=8YFLogxKTest -
6دورية أكاديمية
المؤلفون: Nilius, Henning, Cuker, Adam, Haug, Sigve, Nakas, Christos, Studt, Jan-Dirk, Tsakiris, Dimitrios A, Greinacher, Andreas, Mendez, Adriana, Schmidt, Adrian, Wuillemin, Walter A, Gerber, Bernhard, Kremer Hovinga, Johanna A, Vishnu, Prakash, Graf, Lukas, Kashev, Alexander, Sznitman, Raphael, Bakchoul, Tamam, Nagler, Michael
المصدر: Nilius, Henning; Cuker, Adam; Haug, Sigve; Nakas, Christos; Studt, Jan-Dirk; Tsakiris, Dimitrios A; Greinacher, Andreas; Mendez, Adriana; Schmidt, Adrian; Wuillemin, Walter A; Gerber, Bernhard; Kremer Hovinga, Johanna A; Vishnu, Prakash; Graf, Lukas; Kashev, Alexander; Sznitman, Raphael; Bakchoul, Tamam; Nagler, Michael (2023). A machine-learning model for reducing misdiagnosis in heparin-induced thrombocytopenia: A prospective, multicenter, observational study. eClinicalMedicine, 55:101745.
مصطلحات موضوعية: Clinic for Oncology and Hematology, 610 Medicine & health
الوصف: Background: Diagnosing heparin-induced thrombocytopenia (HIT) at the bedside remains challenging, exposing a significant number of patients at risk of delayed diagnosis or overtreatment. We hypothesized that machine-learning algorithms could be utilized to develop a more accurate and user-friendly diagnostic tool that integrates diverse clinical and laboratory information and accounts for complex interactions. Methods: We conducted a prospective cohort study including 1393 patients with suspected HIT between 2018 and 2021 from 10 study centers. Detailed clinical information and laboratory data were collected, and various immunoassays were conducted. The washed platelet heparin-induced platelet activation assay (HIPA) served as the reference standard. Findings: HIPA diagnosed HIT in 119 patients (prevalence 8.5%). The feature selection process in the training dataset (75% of patients) yielded the following predictor variables: (1) immunoassay test result, (2) platelet nadir, (3) unfractionated heparin use, (4) CRP, (5) timing of thrombocytopenia, and (6) other causes of thrombocytopenia. The best performing models were a support vector machine in case of the chemiluminescent immunoassay (CLIA) and the ELISA, as well as a gradient boosting machine in particle-gel immunoassay (PaGIA). In the validation dataset (25% of patients), the AUROC of all models was 0.99 (95% CI: 0.97, 1.00). Compared to the currently recommended diagnostic algorithm (4Ts score, immunoassay), the numbers of false-negative patients were reduced from 12 to 6 (-50.0%; ELISA), 9 to 3 (-66.7%, PaGIA) and 14 to 5 (-64.3%; CLIA). The numbers of false-positive individuals were reduced from 87 to 61 (-29.8%; ELISA), 200 to 63 (-68.5%; PaGIA) and increased from 50 to 63 (+29.0%) for the CLIA. Interpretation: Our user-friendly machine-learning algorithm for the diagnosis of HIT (https://toradi-hit.orgTest) was substantially more accurate than the currently recommended diagnostic algorithm. It has the potential to reduce delayed diagnosis and overtreatment ...
وصف الملف: application/pdf
العلاقة: https://www.zora.uzh.ch/id/eprint/224136/1/PIIS2589537022004746.pdfTest; info:pmid/36457646; urn:issn:2589-5370
الإتاحة: https://doi.org/10.5167/uzh-22413610.1016/j.eclinm.2022.101745Test
https://www.zora.uzh.ch/id/eprint/224136Test/
https://www.zora.uzh.ch/id/eprint/224136/1/PIIS2589537022004746.pdfTest -
7دورية أكاديمية
المؤلفون: Scutelnic, Adrian, van de Munckhof, Anita, Krzywicka, Katarzyna, van Kammen, Mayte Sánchez, Lindgren, Erik, Cordonnier, Charlotte, Kleinig, Timothy J., Field, Thalia S., Poli, Sven, Lemmens, Robin, Middeldorp, Saskia, Aaron, Sanjith, Borhani-Haghighi, Afshin, Arauz, Antonio, Kremer Hovinga, Johanna A., Günther, Albrecht, Putaala, Jukka, Wasay, Mohammad, Conforto, Adriana Bastos, de Sousa, Diana Aguiar, Jood, Katarina, Tatlisumak, Turgut, Ferro, José M., Coutinho, Jonathan M., Arnold, Marcel, Heldner, Mirjam R., Antonenko, Kateryna, Mbroh, Joshua, Brodard, Justine, Hooshmandi, Etrat, Dizonno, Vanessa, Devroye, Annemie, Ciccone, Alfonso, Wittstock, Matthias, Zimmermann, Julian, Bode, Felix J., Skjelland, Mona, Duan, Jiangang, Hiltunen, Sini, Zuurbier, Susanna M., Petruzzellis, Marco, Sharma, Aarti R., Ghoreishi, Abdoreza, Elkady, Ahmed, Negro, Alberto, Gutschalk, Alexander, Schoenenberger, Silvia, Nagel, Simon, Buture, Alina, Cervera, Alvaro, Paiva Nunes, Ana, Romina Montané Baños, Ana, Tiede, Andreas, Puthuppallil, Anemon, Tuladhar, Anil M., Mengel, Annerose, Medina, Antonio, Hellström Vogel, Åslög, Tawa, Audrey, Aujayeb, Avinash, Ramasamy, Balakrishnan, Casolla, Barbara, Lim Alvin Chew, Beng, Ziaadini, Bentalhoda, Varkey Maramattom, Boby, Buck, Brian, Zanferrari, Carla, Garcia-Esperon, Carlos, Vayne, Caroline, Legault, Catherine, Jacobi, Christian, Pfrepper, Christian, Pelz, Johann, Wahl, Christoph, Kern, Rolf, Tracol, Clement, Soriano, Cristina, Guisado-Alonso, Daniel, Bougon, David, Bal, Deepti, Sergio Zimatore, Domenico, Michalski, Dominik, Blacquiere, Dylan, Johansson, Elias, Cuadrado-Godia, Elisa, Sadeghi-Hokmabadi, Elyar, Carrera, Emmanuel, De Maistre, Emmanuel, Saxhaug Kristoffersen, Espen, Bonneville, Fabrice, Geeraerts, Thomas, Vuillier, Fabrice, Giammello, Fabrizio, D’Onofrio, Florindo, Grillo, Francesco, Caparros, François, Susen, Sophie, Maier, Frank, Tsivgoulis, Georgios, Gulli, Giosue, Frisullo, Giovanni, Franchineau, Guillaume, Cangür, Hakan, Katzberg, Hans, Mozhdehipanah, Hossein, Sibon, Igor, Baharoglu, M. Irem, Masjuan, Jaime, Brar, Jaskiran, Payen, Jean Francois, Burrow, Jim, Fernandes, João, Octavio López Esparza, Jorge, Oen, Joyce, Schouten, Judith, Ng, Karl, Chatterton, Sophie, Wronski, Miriam, Althaus, Katharina, Garambois, Katia, Derex, Laurent, Puy, Laurent, Poorsaadat, Leila, Valler, Lenise, Januzi de Almeida Rocha, Letícia, Humbertjean, Lisa, Lebrato Hernandez, Lucia, Murillo-Bonilla, Luis, Kellermair, Lukas, Morin Martin, Mar, Sofia Cotelli, Maria, Hernandez Perez, Maria, Zedde, Marialuisa, Carvalho Dias, Mariana, Dubois, Marie Cecile, Carvalho, Marta, Ghiasian, Masoud, Umaiorubahan, Meenakshisundaram, Kumar Karunakaran, Ravi, Roozbeh, Mehrdad, Romoli, Michele, Miranda, Miguel, Saadatnia, Mohammad, Bandettini di Poggio, Monica, Scholz, Moritz J., Kahnis, Robert, Almasi-Dooghaee, Mostafa, Hoseininejad Mir, Nahid, Ichaporia, Nasli R., Kumar Paramasivan, Naveen, Erat Sreedharan, Sapna, Sylaja, P. N., Raposo, Nicolas, Fadakar, Nima, Kruyt, Nyika, Detante, Olivier, Cuisenier, Pauline, Huet, Olivier, Sharma, Pankaj, Candelaresi, Paolo, Scoppettuolo, Pasquale, Reiner, Peggy, Nemati, Reza, Vieira, Ricardo, Goh, Rudy, Murphy, Seán, Timsit, Serge, Coutts, Shelagh, Sharma, Shyam S., Bal, Simerpreet, Kaul, Subhash, Karapanayiotides, Theodoros, Cox, Thomas, Gattringer, Thomas, Mathew, Thomas, Bartsch, Thorsten, Shaygannejad, Vahid, Garcia-Talavera, Veronica, Palma, Vincenzo, Arslan, Yıldız, Mirzaasgari, Zahra, Yavari, Zeinab, Zamani, Zohreh, Bakchoul, Tamam, Levi, Marcel, van Gorp, Eric C.M.
المصدر: Scutelnic , A , van de Munckhof , A , Krzywicka , K , van Kammen , M S , Lindgren , E , Cordonnier , C , Kleinig , T J , Field , T S , Poli , S , Lemmens , R , Middeldorp , S , Aaron , S , Borhani-Haghighi , A , Arauz , A , Kremer Hovinga , J A , Günther , A , Putaala , J , Wasay , M , Conforto , A B , de Sousa , D A , Jood , K , Tatlisumak , T , ....
مصطلحات موضوعية: /dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being, name=SDG 3 - Good Health and Well-being
الوصف: Introduction: Cerebral venous sinus thrombosis associated with vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is a severe disease with high mortality. There are few data on sex differences in CVST-VITT. The aim of our study was to investigate the differences in presentation, treatment, clinical course, complications, and outcome of CVST-VITT between women and men. Patients and methods: We used data from an ongoing international registry on CVST-VITT. VITT was diagnosed according to the Pavord criteria. We compared the characteristics of CVST-VITT in women and men. Results: Of 133 patients with possible, probable, or definite CVST-VITT, 102 (77%) were women. Women were slightly younger [median age 42 (IQR 28–54) vs 45 (28–56)], presented more often with coma (26% vs 10%) and had a lower platelet count at presentation [median (IQR) 50x10 9 /L (28–79) vs 68 (30–125)] than men. The nadir platelet count was lower in women [median (IQR) 34 (19–62) vs 53 (20–92)]. More women received endovascular treatment than men (15% vs 6%). Rates of treatment with intravenous immunoglobulins were similar (63% vs 66%), as were new venous thromboembolic events (14% vs 14%) and major bleeding complications (30% vs 20%). Rates of good functional outcome (modified Rankin Scale 0-2, 42% vs 45%) and in-hospital death (39% vs 41%) did not differ. Discussion and conclusions: Three quarters of CVST-VITT patients in this study were women. Women were more severely affected at presentation, but clinical course and outcome did not differ between women and men. VITT-specific treatments were overall similar, but more women received endovascular treatment.
وصف الملف: application/pdf
الإتاحة: https://doi.org/10.1177/23969873231185213Test
https://pure.eur.nl/en/publications/c9abfd22-b3d9-4aa3-a857-179dbbdd6014Test
https://pure.eur.nl/ws/files/123614236/Sex_differences_in_cerebral_venous_sinus.pdfTest
http://www.scopus.com/inward/record.url?scp=85178498350&partnerID=8YFLogxKTest -
8دورية أكاديمية
المؤلفون: Cerebral Venous Sinus Thrombosis with Thrombocytopenia Syndrome Study Group, van de Munckhof, Anita, Borhani-Haghighi, Afshin, Aaron, Sanjith, Krzywicka, Katarzyna, van Kammen, Mayte Sanchez, Cordonnier, Charlotte, Kleinig, Timothy J., Field, Thalia S., Poli, Sven, Lemmens, Robin, Scutelnic, Adrian, Lindgren, Erik, Duan, Jiangang, Arslan, Yildiz, van Gorp, Eric C. M., Kremer Hovinga, Johanna A., Guenther, Albrecht, Jood, Katarina, Tatlisumak, Turgut, Putaala, Jukka, Heldner, Mirjam R., Arnold, Marcel, de Sousa, Diana Aguiar, Wasay, Mohammad, Arauz, Antonio, Conforto, Adriana Bastos, Ferro, Jose M., Coutinho, Jonathan M.
المساهمون: HUS Neurocenter, Clinicum, Department of Neurosciences, Neurologian yksikkö
مصطلحات موضوعية: Covid-19, Cvst, Vitt, Global health, Thrombosis, Vaccination, 3124 Neurology and psychiatry
الوصف: Background: Adenovirus-based COVID-19 vaccines are extensively used in low- and middle-income countries (LMICs). Remarkably, cases of cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) have rarely been reported from LMICs. Aims: We studied the frequency, manifestations, treatment, and outcomes of CVST-VITT in LMICs. Methods: We report data from an international registry on CVST after COVID-19 vaccination. VITT was classified according to the Pavord criteria. We compared CVST-VITT cases from LMICs to cases from high-income countries (HICs). Results: Until August 2022, 228 CVST cases were reported, of which 63 were from LMICs (all middle-income countries [MICs]: Brazil, China, India, Iran, Mexico, Pakistan, Turkey). Of these 63, 32 (51%) met the VITT criteria, compared to 103 of 165 (62%) from HICs. Only 5 of the 32 (16%) CVST-VITT cases from MICs had definite VITT, mostly because anti-platelet factor 4 antibodies were often not tested. The median age was 26 (interquartile range [IQR] 20-37) versus 47 (IQR 32-58) years, and the proportion of women was 25 of 32 (78%) versus 77 of 103 (75%) in MICs versus HICs, respectively. Patients from MICs were diagnosed later than patients from HICs (1/32 [3%] vs. 65/103 [63%] diagnosed before May 2021). Clinical manifestations, including intracranial hemorrhage, were largely similar as was intravenous immunoglobulin use. In-hospital mortality was lower in MICs (7/31 [23%, 95% confidence interval (CI) 11-40]) than in HICs (44/102 [43%, 95% CI 34-53], p = 0.039). Conclusions: The number of CVST-VITT cases reported from LMICs was small despite the widespread use of adenoviral vaccines. Clinical manifestations and treatment of CVST-VITT cases were largely similar in MICs and HICs, while mortality was lower in patients from MICs. ; Peer reviewed
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العلاقة: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article:& nbsp;Netherlands Organization for Health Research and Development (ZonMw, grant 10430072110005), Dr CJ Vaillant Foundation, Hospital District of Helsinki and Uusimaa (grant TYH2022223); Cerebral Venous Sinus Thrombosis with Thrombocytopenia Syndrome Study Group , van de Munckhof , A , Borhani-Haghighi , A , Aaron , S , Krzywicka , K , van Kammen , M S , Cordonnier , C , Kleinig , T J , Field , T S , Poli , S , Lemmens , R , Scutelnic , A , Lindgren , E , Duan , J , Arslan , Y , van Gorp , E C M , Kremer Hovinga , J A , Guenther , A , Jood , K , Tatlisumak , T , Putaala , J , Heldner , M R , Arnold , M , de Sousa , D A , Wasay , M , Arauz , A , Conforto , A B , Ferro , J M & Coutinho , J M 2023 , ' Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia in middle-income countries ' , International Journal of Stroke , vol. 18 , no. 9 , pp. 1112-1120 . https://doi.org/10.1177/17474930231182901Test; b75f3683-8102-45a8-8e27-741d9e5df4fc; http://hdl.handle.net/10138/567787Test; 001019131700001
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9دورية أكاديمية
المؤلفون: Vrotniakaite-Bajerciene, Kristina, Tritschler, Tobias, Jalowiec, Katarzyna Aleksandra, Broughton, Helen, Schmidli, Fabienne, Schneider, Jenny Sarah, Haynes, Alan, Rovo, Alicia, Kremer Hovinga, Johanna Anna, Aujesky, Drahomir, Angelillo, Anne
المصدر: Vrotniakaite-Bajerciene, Kristina; Tritschler, Tobias; Jalowiec, Katarzyna Aleksandra; Broughton, Helen; Schmidli, Fabienne; Schneider, Jenny Sarah; Haynes, Alan; Rovo, Alicia; Kremer Hovinga, Johanna Anna; Aujesky, Drahomir; Angelillo, Anne (2023). Adherence to thrombophilia testing guidelines and its influence on anticoagulation therapy: A single-center cross-sectional study. Thrombosis research, 223, pp. 87-94. Elsevier 10.1016/j.thromres.2022.12.001
مصطلحات موضوعية: 610 Medicine & health
الوصف: INTRODUCTION The collected evidence on thrombophilia guidelines is scarce and data about their impact on clinical decisions are unknown. We aimed to investigate the adherence to thrombophilia testing guidelines, its therapeutic impact in patients with guideline-adherent and non-adherent testing and identify the patients' clinical characteristics mostly associated with treatment decisions. MATERIALS AND METHODS We conducted a single-center cross-sectional study of patients referred for thrombophilia testing at the outpatient clinic of a tertiary hospital between 01/2010-10/2020. We systematically evaluated the adherence of thrombophilia testing to internal guidelines and the influence of test results on anticoagulation therapy. Using multivariable logistic regression, we evaluated the association between clinical characteristics and influence of thrombophilia tests on anticoagulation therapy in the entire cohort and by indication for referral. RESULTS Of 3686 included patients, mostly referred for venous thromboembolism (2407, 65 %) or arterial thrombosis (591, 16 %), 3550 patients (96 %) underwent thrombophilia testing. Indication for testing was according to guidelines in 1208 patients (33 %). Test results influenced treatment decisions in 56 of 1102 work-ups (5.1 %) that were adherent to guidelines, and in 237 of 2448 (9.7 %) non-adherent work-ups (absolute difference, 4.3 %; 95 % confidence interval, 2.9-6.3 %). Age < 50 years, female sex, absence of risk factors and co-morbidities, weakly provoked venous thromboembolism and referral indication other than venous thromboembolism were associated with influence on anticoagulation therapy. CONCLUSIONS Adherence to guidelines for thrombophilia testing was poor and did not have an impact on treatment decisions. Refinement of selection criteria is needed to increase the therapeutic impact of thrombophilia testing.
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العلاقة: https://boris.unibe.ch/178298Test/
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10دورية أكاديمية
المؤلفون: Ruberti, Andrea Alberto, Kremer Hovinga, Johanna A, Federico, Nappi, Aurora, Vettese, Elena, Bianchi, Eliana, Fernandes, Elena, Galfetti, Rita, Monotti, Pamella, Paul, Stefano, Regazzoni, Daniela, Valente, Davide, Rossi, Georg, Stussi, Bernhard, Gerber
المصدر: Ruberti, Andrea Alberto; Kremer Hovinga, Johanna A; Federico, Nappi; Aurora, Vettese; Elena, Bianchi; Eliana, Fernandes; Elena, Galfetti; Rita, Monotti; Pamella, Paul; Stefano, Regazzoni; Daniela, Valente; Davide, Rossi; Georg, Stussi; Bernhard, Gerber (2023). Acquired haemophilia A in southern Switzerland from 2013 to 2019: a case series. Swiss medical weekly, 153, p. 40048. EMH Schweizerischer Ärzteverlag 10.57187/smw.2023.40048
مصطلحات موضوعية: 610 Medicine & health
الوصف: AIMS OF THE STUDY Acquired haemophilia A is a rare disease with an annual incidence of 1.48 per million. Based on clinical observations, we suspect a higher incidence in southern Switzerland, and aimed at providing local epidemiological data, and clinical information regarding diagnosis, treatment and outcome in our region. METHODS All adult patients with acquired haemophilia A treated between 2013 and 2019 in our facility were included in the present retrospective analysis. RESULTS We treated 11 patients with acquired haemophilia A between 2013 and 2019, resulting in an annual incidence of 4.5 per million (95% confidence interval [CI] 0-9.0). Median delay from first symptoms to diagnosis was 4.5 days, and the median age at diagnosis was 79 years (range 23-87). Possible causative conditions were: pregnancy (n = 1), polyarteritis nodosa (n = 1), myelodysplastic syndrome (n = 1), chronic human immunodeficiency virus (HIV) (n = 1), and HIV postexposure prophylaxis (n = 1). In five patients no underlying or associated condition was identified. Median activated partial thromboplastin time (aPTT)) at baseline was 79 seconds (65-117; ref. value <38 sec), and FVIII:C 2.15% (<1-3.75%). A FVIII:C <1% was present in 4/10 patients. Median FVIII-inhibitor titre was 10.3 BU/ml (2.4-75.0 BU/ml). All patients had bleeding symptoms, 5/10 patients had major bleedings, and 7/10 patients were treated with bypassing agents. All patients received corticosteroids; 7/10 patients received immunosuppressive combination therapy. FVIII levels of ≥50% were achieved after a median of 40 days (8-62). One patient had a severe immunosuppressive therapy-related infection. An 87-years-old woman died for reasons not related to acquired haemophilia A or immunosuppressive therapy. CONCLUSIONS Acquired haemophilia A is a rare disease, but manageable despite the advanced patient age and comorbidities. Its incidence in Southern Switzerland is higher than previously suspected.
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العلاقة: https://boris.unibe.ch/181593Test/
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