المؤلفون: Gian Francesco Mureddu, Paola D'Errigo, Stefano Rosato, Pompilio Faggiano, Gabriella Badoni, Roberto Ceravolo, Vito Altamura, Mirko Di Martino, Marco Ambrosetti, Fabrizio Oliva, Paola Ciccarelli, Giovanni Baglio

المصدر: International Journal of Cardiology. Cardiovascular Risk and Prevention, Vol 22, Iss , Pp 200310- (2024)

مصطلحات موضوعية: AMI, High residual risk, Thrombotic risk, Heart failure, MACCE, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Background: The reduction in long-term mortality after acute myocardial infarction (AMI) is less pronounced than that of in-hospital mortality among patients with AMI complicated by heart failure (HF) and/or in those with a high residual thrombotic risk (HTR). Aim: To investigate the relative prognostic significance of HTR and HF in AMI survivors. Methods: This retrospective cohort study enrolled patients admitted for AMI in 2014–2015 in all Italian hospitals. HTR was defined as at least one of the following conditions: previous AMI, ischemic stroke or other vascular disease, type 2 diabetes, renal failure. Patients were classified into four categories: uncomplicated AMI; AMI with HTR; AMI with HF and AMI with both HTR and HF (HTR + HF). Cox proportional hazard model was used to evaluate the impact of HTR, HF and HTR + HF on the 5-year prognosis. A time-varying coefficient analysis was performed to estimate the 5-year trend of HR for major averse cardiac and cerebrovascular events (MACCE). Results: a total of 174.869 AMI events were identified. The adjusted 5-year HR for MACCE was 1.74 (p

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2772487524000758Test; https://doaj.org/toc/2772-4875Test

الوصول الحر: https://doaj.org/article/c1939ce6afa348ffb72f5f19f8da5e94Test

المؤلفون: Agata Hanna Bryk-Wiązania, Mari Minasyan, Renata Świątkowska-Stodulska, Anetta Undas, Alicja Hubalewska-Dydejczyk, Susan M. Webb, Elena Valassi, Aleksandra Gilis-Januszewska

المصدر: Frontiers in Endocrinology, Vol 15 (2024)

مصطلحات موضوعية: Cushing's syndrome, ectopic adrenocorticotropic hormone syndrome, venous thromboembolism, thrombotic risk, thromboprophylaxis, Diseases of the endocrine glands. Clinical endocrinology, RC648-665

الوصف: IntroductionRecently, it has been reported that there is a great diversity in strategies used for thromboprophylaxis in patients with Cushing’s syndrome (CS). An aim of this review was to discuss these practices in light of the existing data on the thrombotic risk in patients with CS and guidelines for medically ill patients.MethodsThe four relevant topics and questions on thrombotic risk in CS were identified. The current guidelines on prevention and diagnosis of venous thromboembolism (VTE) were reviewed for the answers. An algorithm to consider in the assessment of the thrombotic risk in patients with CS was proposed.ResultsTo address both generic and CS-specific risk factors for VTE, the algorithm includes the stepwise approach consisting of Padua Score, urine free cortisol, and CS-VTE score, with no indication for routine thrombophilia testing in the prediction of an index VTE episode. Having confirmed VTE, selected patients require thrombophilia testing to aid the duration of anticoagulant treatment. The separate part of the algorithm is devoted to patients with ectopic adrenocorticotropic hormone syndrome in whom exclusion of VTE precedes introducing routine thromboprophylaxis to prevent VTE. The cancer-related VTE also prompts thromboprophylaxis, with the possible vessel invasion. The algorithm presents a unifactorial and multifactorial approach to exclude high-bleeding risks and safely introduce thromboprophylaxis with low-molecular-weight heparin.SummaryOur article is the first to present an algorithm to consider in the thrombotic risk assessment among patients with Cushing’s syndrome as a starting point for a broader discussion in the environment. A plethora of factors affect the VTE risk in patients with CS, but no studies have conclusively evaluated the best thromboprophylaxis strategy so far. Future studies are needed to set standards of care.

وصف الملف: electronic resource

العلاقة: https://www.frontiersin.org/articles/10.3389/fendo.2024.1350010/fullTest; https://doaj.org/toc/1664-2392Test

الوصول الحر: https://doaj.org/article/09c6de8a2169473aae27ee54c5f45acbTest

المؤلفون: Rachieru C, Luca CT, Văcărescu C, Petrescu L, Cirin L, Cozma D

المصدر: Clinical Interventions in Aging, Vol Volume 18, Pp 1737-1748 (2023)

مصطلحات موضوعية: atrial fibrillation, thrombotic risk, hemorrhagic risk, new risk scores, left atrium remodelling, genetics and inflammation in atrial fibrillation., Geriatrics, RC952-954.6

الوصف: Ciprian Rachieru,1– 3 Constantin-Tudor Luca,4– 6 Cristina Văcărescu,4– 6 Lucian Petrescu,4 Liviu Cirin,4 Dragos Cozma4– 6 1Faculty of Medicine, Department of Internal Medicine I, Discipline of Medical Semiology I “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania; 2Internal Medicine Department, County Emergency Hospital, Timisoara, 300079, Romania; 3Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania; 4Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania; 5Institute of Cardiovascular Diseases Timisoara, Timisoara, 300310, Romania; 6Research Center of the Institute of Cardiovascular Diseases Timisoara, Timisoara, 300310, RomaniaCorrespondence: Cristina Văcărescu, Cardiology Department, Institute of Cardiovascular Diseases, 13A Gheorghe Adam Street, Timișoara, 300310, Romania, Tel +40 722 956 370, Fax +40 256 207 362, Email cristina.vacarescu@umft.roAbstract: In 10% of ischemic strokes, non-valvular atrial fibrillation (NVAF) is detected retroactively. Milder, or even asymptomatic forms of NVAF have shown high mortality, thrombotic risk, and deterioration of cognitive function. The current guidelines for the diagnosis and treatment of AF contain “grey areas”, such as the one related to anticoagulant treatment in men with CHA2DS2-VASc score 1 and women with score 2. Moreover, parameters such as renal function, patient weight or left atrium remodelling are missing from the recommended guidelines scores. Vulnerable categories of patients including the elderly population, high hemorrhagic risk patients or patients with newly diagnosed paroxysmal episodes of atrial high rate at device interrogation are at risk of underestimation of the thrombotic risk. This review presents a systematic exposure of the most important gaps in evaluation of thrombotic and hemorrhagic risk in patients with NVAF. The authors propose new algorithms and risk factors that should be taken into consideration for an accurate thrombotic and hemorrhagic risk estimation, especially in vulnerable categories of patients.Keywords: atrial fibrillation, thrombotic risk, hemorrhagic risk, new risk scores, left atrium remodelling, genetics and inflammation in atrial fibrillation

وصف الملف: electronic resource

العلاقة: https://www.dovepress.com/future-perspectives-to-improve-cha2ds2vasc-score-the-role-of-left-atri-peer-reviewed-fulltext-article-CIATest; https://doaj.org/toc/1178-1998Test

الوصول الحر: https://doaj.org/article/b8a21de22a8143c08296a9a69b5e5334Test

المؤلفون: Francesco Pallante, Francesco Costa, Victoria Garcia Ruiz, Giampiero Vizzari, Pietro Iannello, Lucio Teresi, Gabriele Carciotto, Stefania Lo Giudice, Giustina Iuvara, Giulia Laterra, Ander Regueiro, Gennaro Giustino, Juan Horacio Alonso Briales, Jose Maria Hernandez, Marco Barbanti, Antonio Micari, Francesco Patanè

المصدر: Journal of Clinical Medicine, Vol 13, Iss 13, p 3636 (2024)

مصطلحات موضوعية: antithrombotic therapy, aortic valve stenosis, transcatheter aortic valve implantation (TAVI), transcatheter aortic valve replacement (TAVR), bleeding risk, thrombotic risk, Medicine

الوصف: Transcatheter aortic valve implantation (TAVI) now represents the mainstay of treatment for severe aortic stenosis. Owing to its exceptional procedural efficacy and safety, TAVI has been extended to include patients at lower surgical risk, thus now encompassing a diverse patient population receiving this treatment. Yet, long-term outcomes also depend on optimal medical therapy for secondary vascular prevention, with antithrombotic therapy serving as the cornerstone. Leveraging data from multiple randomized controlled trials, the current guidelines generally recommend single antithrombotic therapy, with either single antiplatelet therapy (SAPT) or oral anticoagulation (OAC) alone in those patients without or with atrial fibrillation, respectively. Yet, individualization of this pattern, as well as specific case uses, may be needed based on individual patient characteristics and concurrent procedures. This review aims to discuss the evidence supporting antithrombotic treatments in patients treated with TAVI, indications for a standardized treatment, as well as specific considerations for an individualized approach to treatment.

وصف الملف: electronic resource

العلاقة: https://www.mdpi.com/2077-0383/13/13/3636Test; https://doaj.org/toc/2077-0383Test

الوصول الحر: https://doaj.org/article/25f391665e6945a0b4321cbaa28a612aTest

المؤلفون: Moschetti, L., Dal Pozzolo, L., Le Guern, V., Morel, N., Yelnik, Cécile Marie, Lambert, Marc, Hachulla, Eric, Benhamou, Y., Nalli, C., Fredi, M., Franceschini, F., Andreoli, L., Costeadot-Chalumeau, N., Tincani, A.

المساهمون: Université de Lille, Inserm, CHU Lille, Service de médecine interne et centre de référence des maladies rares CHU Cochin, Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 RID-AGE, Centre Hospitalier Régional Universitaire CHU Lille CHRU Lille, Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement (RID-AGE) - U1167, Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286, Université de Rouen Normandie UNIROUEN, Endothélium, valvulopathies et insuffisance cardiaque EnVI, Service de Médecine Interne CHU Rouen

مصطلحات موضوعية: antiphospholipid syndrome, vascular involvement, gender differences, thrombotic risk factors, antiphospholipid antibodies

الوصف: OBJECTIVES: Gender can influence incidence and clinical course of autoimmune diseases (ADs). Antiphospholipid syndrome (APS) is a rare AD characterised by thromboses and/or pregnancy morbidities and antiphospholipid antibodies (aPL) positivity. Our aim is to conduct a gender-oriented analysis of primary thrombotic APS (t-APS). METHODS: Consecutive patients diagnosed with primary t-APS, followed from 1967 to 2019 in four European Centres, were enrolled. RESULTS: The cohort included 296 women and 137 men. Median age at onset [31 (24-46) vs. 41 (29-53) years, p<0.001] was lower in females. In women, venous thromboses were more frequent while, among males, arterial events prevailed. During follow-up, 14% of patients suffered at least two relapses and this occurred especially among males (22% vs. 10%, p=0.001). No gender differences were found in the aPL profile (33% single, 24% double and 43% triple aPL positivity). Most patients had concomitant risk factors (RFs) for thrombosis: established cardiovascular RFs were represented especially among men while estrogenic exposure was the main RF in women. CONCLUSIONS: Women presented mostly with venous thromboses at a younger age, while men with arterial events, later in life and suffered more recurrent events. This different frequency of arterial and venous thromboses could be attributed mainly to the presence of additional RFs rather than to biological gender-specific issues. However, some RFs are exclusive or more represented in one gender rather than the other, so assessing the link of causality between gender and manifestations of t-APS remains difficult.

وصف الملف: application/pdf

العلاقة: Clinical and experimental rheumatology; Clin Exp Rheumatol; http://hdl.handle.net/20.500.12210/100860Test

الإتاحة: https://doi.org/20.500.12210/100860Test
https://hdl.handle.net/20.500.12210/100860Test

المؤلفون: Bryk-Wiązania, Agata Hanna, Minasyan, Mari, Świątkowska-Stodulska, Renata, Undas, Anetta, Hubalewska-Dydejczyk, Alicja, Webb, Susan M., Valassi, Elena, Gilis-Januszewska, Aleksandra

مصطلحات موضوعية: Síndrome de Cushing, Síndrome de l'hormona adrenocorticotròpica ectòpica, Tromboembolisme venós, Risc trombòtic, Tromboprofilaxi, Síndrome de hormona adrenocorticotrópica ectópica, Tromboembolismo venoso, Riesgo trombótico, Tromboprofilaxis, Cushing's syndrome, Ectopic adrenocorticotropic hormone syndrome, Venous thromboembolism, Thrombotic risk, Thromboprophylaxis

الوقت: 61

الوصف: Introduction: Recently, it has been reported that there is a great diversity in strategies used for thromboprophylaxis in patients with Cushing’s syndrome (CS). An aim of this review was to discuss these practices in light of the existing data on the thrombotic risk in patients with CS and guidelines for medically ill patients. Methods: The four relevant topics and questions on thrombotic risk in CS were identified. The current guidelines on prevention and diagnosis of venous thromboembolism (VTE) were reviewed for the answers. An algorithm to consider in the assessment of the thrombotic risk in patients with CS was proposed. Results: To address both generic and CS-specific risk factors for VTE, the algorithm includes the stepwise approach consisting of Padua Score, urine free cortisol, and CS-VTE score, with no indication for routine thrombophilia testing in the prediction of an index VTE episode. Having confirmed VTE, selected patients require thrombophilia testing to aid the duration of anticoagulant treatment. The separate part of the algorithm is devoted to patients with ectopic adrenocorticotropic hormone syndrome in whom exclusion of VTE precedes introducing routine thromboprophylaxis to prevent VTE. The cancer-related VTE also prompts thromboprophylaxis, with the possible vessel invasion. The algorithm presents a unifactorial and multifactorial approach to exclude high-bleeding risks and safely introduce thromboprophylaxis with low-molecular-weight heparin. Summary: Our article is the first to present an algorithm to consider in the thrombotic risk assessment among patients with Cushing’s syndrome as a starting point for a broader discussion in the environment. A plethora of factors affect the VTE risk in patients with CS, but no studies have conclusively evaluated the best thromboprophylaxis strategy so far. Future studies are needed to set standards of care. ; info:eu-repo/semantics/publishedVersion

وصف الملف: application/pdf

العلاقة: Frontiers in Endocrinology; 15; Bryk-Wiązania, Agata Hanna; Minasyan, Mari; Świątkowska-Stodulska, Renata [et al.]. The thrombotic risk in Cushing’s syndrome—questions, answers, and the algorithm to consider in its assessment: part I—thrombotic risk not related to surgery. Frontiers in Endocrinology, 2024, 15, 1350010. Disponible en: . Fecha de acceso: 5 abr. 2024. DOI:10.3389/fendo.2024.1350010; http://hdl.handle.net/20.500.12328/4187Test; https://dx.doi.org/10.3389/fendo.2024.1350010Test

الإتاحة: https://doi.org/20.500.12328/4187Test
https://doi.org/10.3389/fendo.2024.1350010Test
https://hdl.handle.net/20.500.12328/4187Test

المؤلفون: Anna Waśkiel-Burnat, Adriana Rakowska, Michał Zaremba, Magdalena Maciejewska, Leszek Blicharz, Michela Starace, Matilde Iorizzo, Bianca Maria Piraccini, Małgorzata Olszewska, Lidia Rudnicka

المصدر: Dermatology and Therapy, Vol 13, Iss 8, Pp 1847-1855 (2023)

مصطلحات موضوعية: Autoimmune disease, Blood clot, Embolism, Hair loss, Thrombotic risk, Thrombosis, Dermatology, RL1-803

الوصف: Abstract Background Numerous studies have indicated that alopecia areata is associated with a chronic systemic inflammation, which is considered as a risk factor for venous thromboembolism. The aim of the study was to evaluate the following markers of venous thromboembolism risk: soluble fibrin monomer complex (SFMC), thrombin–antithrombin complex (TATC), and prothrombin fragment 1 + 2 (F1 + 2) in patients with alopecia areata and compare them with healthy controls. Methods In total, 51 patients with alopecia areata [35 women and 16 men; mean age: 38 (19–54) years] and 26 controls [18 women and 8 men; mean age: 37 (29–51) years] were enrolled in the study. The serum concentrations of thromboembolism markers were measured using an enzyme-linked immunosorbent assay (ELISA) kit. Results An increased level of SFMC was detected in patients with alopecia areata compared with the controls [25.66 (20–34.86) versus 21.46 (15.38–29.48) µg/ml; p

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2193-8210Test; https://doaj.org/toc/2190-9172Test

الوصول الحر: https://doaj.org/article/ebbd643859a54d1d9f7de7b35570f8e4Test

المؤلفون: Iaccarino, Corrado, Carretta, Alessandro, Demetriades, Andreas K. K., Di Minno, Giovanni, Giussani, Carlo, Marcucci, Rossella, Marklund, Niklas, Mastrojanni, Gianmattia, Pompucci, Angelo, Stefini, Roberto, Zona, Gianluigi, Cividini, Andrea, Petrella, Gianpaolo, Coluccio, Valeria, Marietta, Marco

المصدر: Neurocritical Care. 40(1):314-327

مصطلحات موضوعية: Anticoagulant, Antiplatelet, Consensus, DOAC, Hemorrhage progression, Reversal strategy, Traumatic brain injury, Thrombotic risk

الوصف: BackgroundAll available recommendations about the management of antithrombotic therapies (ATs) in patients who experienced traumatic brain injury (TBI) are mainly based on expert opinion because of the lack of strength in the available evidence-based medicine. Currently, the withdrawal and the resumption of AT in these patients is empirical, widely variable, and based on the individual assessment of the attending physician. The main difficulty is to balance the thrombotic and hemorrhagic risks to improve patient outcome.MethodsUnder the endorsement of the Neurotraumatology Section of Italian Society of Neurosurgery, the Italian Society for the Study about Haemostasis and Thrombosis, the Italian Society of Anaesthesia, Analgesia, Resuscitation, and Intensive Care, and the European Association of Neurosurgical Societies, a working group (WG) of clinicians completed two rounds of questionnaires, using the Delphi method, in a multidisciplinary setting. A table for thrombotic and bleeding risk, with a dichotomization in high risk and low risk, was established before questionnaire administration. In this table, the risk is calculated by matching different isolated TBI (iTBI) scenarios such as acute and chronic subdural hematomas, extradural hematoma, brain contusion (intracerebral hemorrhage), and traumatic subarachnoid hemorrhage with patients under active AT treatment. The registered indication could include AT primary prevention, cardiac valve prosthesis, vascular stents, venous thromboembolism, and atrial fibrillation.ResultsThe WG proposed a total of 28 statements encompassing the most common clinical scenarios about the withdrawal of antiplatelets, vitamin K antagonists, and direct oral anticoagulants in patients who experienced blunt iTBI. The WG voted on the grade of appropriateness of seven recommended interventions. Overall, the panel reached an agreement for 20 of 28 (71%) questions, deeming 11 of 28 (39%) as appropriate and 9 of 28 (32%) as inappropriate interventions. The appropriateness of intervention was rated as uncertain for 8 of 28 (28%) questions.ConclusionsThe initial establishment of a thrombotic and/or bleeding risk scoring system can provide a vital theoretical basis for the evaluation of effective management in individuals under AT who sustained an iTBI. The listed recommendations can be implemented into local protocols for a more homogeneous strategy. Validation using large cohorts of patients needs to be developed. This is the first part of a project to update the management of AT in patients with iTBI.

وصف الملف: print

الوصول الحر: https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-533291Test

المؤلفون: Anna Maria Roszkowska, Rossana Leanza, Emanuela Aragona, Ludovica Gargiulo, Angela Alibrandi, Alessandro Arrigo, Adele Bottaro, Paola Barone, Fabio Stagno, Alessandro Allegra

المصدر: Journal of Clinical Medicine, Vol 13, Iss 8, p 2232 (2024)

مصطلحات موضوعية: Philadelphia-negative chronic myeloproliferative neoplasms, thrombosis, polycythemia vera, essential thrombocythemia, primary myelofibrosis, thrombotic risk, Medicine

الوصف: Background: Philadelphia-negative chronic myeloproliferative neoplasms are a group of clonal hematopoietic disorders including polycythemia vera, essential thrombocythemia, and primary myelofi-brosis. These neoplasms are characterized by an increased risk of thrombotic complications. Several studies have highlighted that the study of vessels of the retina offers the opportunity to visualize, in vivo, the damage to microcirculation that is common in various systemic pathologies. Methods: in our study, forty patients underwent an ophthalmological examination, using non-invasive imaging tech-niques, for analyses of their retinal vascularization. The objective was to correlate the findings ob-tained from this study of the retina with different markers of thrombotic risk, to demonstrate the usefulness of studying retinal vessels as a possible new prognostic biomarker of thrombotic risk in patients affected by Philadelphia-negative chronic myeloproliferative neoplasms. Results: retinal imaging demonstrated changes in the microcirculation, with a reduced vascular density of the deep and superficial capillary plexuses with respect to a normal group, and a correlation between retinal changes and blood parameters. Conclusions: additional research will allow us to determine whether retinal changes in individuals with chronic myeloproliferative neoplasms could be predictive of the development of thrombotic events in these subjects.

وصف الملف: electronic resource

العلاقة: https://www.mdpi.com/2077-0383/13/8/2232Test; https://doaj.org/toc/2077-0383Test

الوصول الحر: https://doaj.org/article/ad20efd20e5345c889588c8186be128fTest

المؤلفون: Federica Mancazzo, Antonia Vitulli, Lavinia Dirienzo, Concetta T. Ammollo, Fabrizio Semeraro, Mario Colucci

المصدر: Bleeding, Thrombosis and Vascular Biology, Vol 2, Iss 4 (2023)

مصطلحات موضوعية: Emicizumab, protein C resistance, intrinsic pathway, thrombotic risk, Diseases of the circulatory (Cardiovascular) system, RC666-701

الوصف: Emicizumab, a FVIII-mimetic bispecific antibody, is insensitive to degradation by activated protein C (APC) and may thus induce a procoagulant state. We investigated the effect of emicizumab on protein C-mediated inhibition of coagulation under in vitro conditions mimicking physiological and pathological clotting activation. Thrombin generation (TG) in tissue factor-triggered hemophilic plasma containing emicizumab (50 μg/mL) was inhibited by APC or thrombomodulin in a concentration-dependent manner, and to a similar extent as in plasma added with FVIII (Kovaltry, 1 IU/mL). However, when clotting was activated via the intrinsic pathway, emicizumab-plasma displayed resistance to APC, manifested by a barely detectable prolongation of the lag time of TG, and by the lack of inhibition of FXa generation. Moreover, in contact-activated plasma added with APC, the generation of a second wave of thrombin, following prothrombin replenishment, was much greater in emicizumab-plasma than in Kovaltry-plasma, suggesting that the insensitivity of emicizumab to APC may translate in greater thrombin formation. Considering the major role played by the contact system in the thrombotic process, hemophilia A patients under emicizumab treatment might be at increased thrombotic risk.

وصف الملف: electronic resource

العلاقة: https://btvb.org/btvb/article/view/89Test; https://doaj.org/toc/2785-5309Test

الوصول الحر: https://doaj.org/article/d3bd705923b7416c9ee5308c7d010e4dTest