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  • NLM标题： Clin Appl Thromb Hemost
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  • 1.

    【2hr】Polymorphisms C677T and A1298C of MTHFR Gene: HomocysteineLevels and Prothrombotic Biomarkers in Coronary and Pulmonary ThromboembolicDisease

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    机译 MTHFR基因同型半胱氨酸的多态性C677T和A1298C冠状动脉和肺血栓栓塞中的水平和血栓前生物标志物疾病
    摘要：The activity of the enzyme methylenetetrahydrofolate reductase (MTHFR) determines homocysteine (Hcy) levels, and polymorphisms in its gene affect the activity of the enzyme. Changes in the enzyme’s activity may lead to a higher susceptibility to develop arterial and venous thromboembolic disease. The aim was to analyze the relationship between the C677T and A1298C polymorphisms of MTHFR, Hcy levels, and prothrombotic biomarkers in pulmonary embolism (PE) and acute myocardial ischemia (AMI). Clinical files of patients with thromboembolic diseases having complete data and whose doctor had requested an assay to determine the polymorphisms of the MTHFR gene, Hcy levels, and prothrombotic biomarkers were studied to search for the correlation between mutations of the MTHFR gene and Hcy levels in the different diseases. We included 334 files: 158 were from women and 176 from men (51 [19 SD] years). Sixty-three percent have had thrombosis, 8% AMI, and 31% PE. Patients with thrombosis had elevated frequency of the C677T polymorphism. The CC genotype was higher than the TT genotype (P = .003) and CT versus the TT (P = .009). In patients with PE, the CC genotype was higher than the TT genotype(P = .038). Pulmonary embolism with massive and submassive events hadpredominant genotypes 677 TT (P = .003) and theAA 1298 (P = .017). Elevated Hcy levels in thepresence of the T allele in the C677T gene and of theA allele in the A1298C gene are associated with AMIand massive and submassive PE.
  • 2.

    【2hr】Platelet Aggregation in Healthy Participants is Not Affected by Smoking,Drinking Coffee, Consuming a High-Fat Meal, or Performing PhysicalExercise

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    机译 健康参与者的血小板聚集不受吸烟的影响，喝咖啡，食用高脂餐或进行体育锻炼行使
    摘要：Platelet aggregation can be measured using optical aggregation (light transmission aggregometry, LTA) as well as by impedance (Multiplate analyzer). The LTA (the gold standard method) can be influenced by many preanalytical variables. Several guidelines differ in recommendations for the duration patients should refrain from smoking, coffee, fatty meals, and physical exercise prior to blood collection for performing platelet function tests. In this pilot study, the influence of smoking, coffee, high-fat meal, or physical exercise on platelet aggregation was investigated to improve patient friendliness and laboratory logistics in platelet function diagnostics. Standardized blood collection was performed when participants were fasting and after each parameter (n=5 per group). As a control for diurnal fluctuations, participants (n=6) were fasting during both blood collections. Platelet aggregation was executed using standardized methods for LTA and Multiplate analyzer. Statistical analysis of the results using Wilcoxon signed-rank test did not show any significant differences in platelet aggregation in healthy participants under different preanalytical variables. Therefore, these variables are not expected to adversely affect testing, which can avoid canceling tests for those patients who inevitably did.
  • 3.

    【2hr】Management of Extremity Venous Thrombosis in Neonates and Infants: AnExperience From a Resource Challenged Setting

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    机译 新生儿和婴儿肢体静脉血栓形成的管理：资源匮乏的环境中的经验
    摘要：We aimed to evaluate the outcome of different treatment modalities for extremity venous thrombosis (VT) in neonates and infants, highlighting the current debate on their best tool of management. This retrospective study took place over a 9-year period from January 2009 to December 2017. All treated patients were referred to the vascular and pediatric surgery departments from the neonatal intensive care unit. All patients underwent a thorough history-taking as well as general clinical and local examination of the affected limb. Patients were divided into 2 groups: group I included those who underwent a conservative treated with the sole administration of unfractionated heparin (UFH), whereas group II included those who were treated with UFH plus warfarin. Sixty-three patients were included in this study. They were 36 males and 27 females. Their age ranged from 3 to 302 days. Forty-one (65%) patients had VT in the upper limb, whereas the remaining 22 (35%) had lower extremity VT. The success rate of the nonsurgical treatment was accomplished in 81% of patients. The remaining 19% underwent limb severing, due to established gangrene. The Kaplan-Meier survival method revealed a highly significant increase in both mean and median survival times in those groups treated with heparin and warfarin compared to heparin-only group (P < .001). Nonoperative treatment with anticoagulation or observation (ie, wait-and-see policy) alone may be an easilyapplicable, effective, and a safe modality for management of VT in neonates and infants,especially in developing countries with poor or highly challenged resource settings.
  • 4.

    【2hr】Correlation Between ROTEM FIBTEM Maximum Clot Firmness and Fibrinogen Levelsin Pediatric Cardiac Surgery Patients

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    机译 ROTEM FIBTEM最大凝块硬度与纤维蛋白原水平之间的相关性小儿心脏外科手术患者
    摘要：This study evaluated whether rotational thromboelastometry (ROTEM; Tem International GmbH, Munich, Germany) FIBTEM maximum clot firmness (MCF) can be used to predict plasma fibrinogen level in pediatric patients undergoing cardiac surgery. Linear regression was conducted to predict plasma fibrinogen level using FIBTEM MCF (0.05 level of significance). Scatter plot with the regression line for the model fit was created. Fifty charts were retrospectively reviewed, and 87 independent measurements of FIBTEM MCF paired with plasma fibrinogen levels were identified for analysis. Linear regression analysis suggested a significant positive linear relationship (P < .0001) between plasma fibrinogen levels and MCF. Both MCF intercept and slope were significantly correlated with fibrinogen level (P < .0001). The estimated regression equation (predicted fibrinogen = 78.6 + 12.4 × MCF) indicates that a 1-mm increase in MCF raises plasma fibrinogen level by an average of 12.4 mg/dL. The statistically significant positive linear relationship observed between MCF and fibrinogen levels (P < .001) suggests that MCF can be used as a surrogate for fibrinogen level. This relationship is of clinical relevance in the calculation of patient-specific dosing of fibrinogen supplementation in this setting.
  • 5.

    【2hr】Early Postpartum Venous Thromboembolism: Risk Factors and PredictiveIndex

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    机译 产后早期静脉血栓栓塞症：危险因素和预测。指数
    摘要：The aim of our study was to quantify risk factors for venous thromboembolism (VTE) during the puerperal period. The case–control study was conducted in Women’s Hospital, Zhejiang University, China, from January 2006 to December 2016; cases of hospitalized VTE within 1 week after delivery were identified according to International Classification of Diseases, Ninth Revision, Clinical Modification codes. Control postpartum women without VTE were randomly selected, matched on birth day, age, delivery mode, and number of fetus with 4:1 ratio. Clinical risk factors for postpartum VTE and coagulation parameters were analyzed. We found independent variables that were significantly related to postpartum VTE (all P < .05) in a binary logistic regression analysis included preeclampsia/eclampsia (odds ratio [OR], 2.89; 95% confidence interval [CI], 1.56-5.37) and postpartum hemorrhage (OR, 4.6; 95% CI, 1.71-12.40). D-dimer was the only biomarker that statistically significant associated with postpartum VTE in 3 days after delivery (all P < .05). These findings showed preeclampsia/eclampsia and postpartum hemorrhage were important risk factors for early VTE during puerperal period. A higher level of D-dimer was more meaningful than other coagulation parameters to suspect early thrombotic disease after delivery.
  • 6.

    【2hr】Thromboprophylaxis for Hip Revision Arthroplasty: Can We Use theRecommendations for Primary Hip Surgery? A Cohort Study

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    机译 髋关节置换术的血栓预防：我们可以使用对初次髋关节手术的建议？队列研究
    摘要：The risk of thromboembolic events after hip revision arthroplasty might be higher than in primary hip arthroplasty. However, evidence regarding the use of thromboprophylaxis in revisions is scarce. The purpose of this study is to determine whether thromboprophylaxis recommendations for primary arthroplasty produce similar results in hip revision arthroplasty. This comparative cohort study retrospectively analyzed consecutive patients undergoing primary hip arthroplasty and hip revision surgery between March 2004 and December 2015, who received thromboprophylaxis according to local clinical practice guidelines for primary hip arthroplasty. The prevalence of deep vein thrombosis and pulmonary embolism and the presence of major bleeding events were assessed during hospitalization and at 3 months after discharge and compared between groups. The overall prevalence of thromboembolic events in the hip revision surgery cohort and in the primary hip cohort was 1.62% and 1.35%, respectively (P = .801). The 38.4% of hip revision patients and 20.3% of primary hip patients presented major bleeding events. Thromboembolic disease outcomes with the use of a standardized thromboprophylaxis regimen were similar in both cohorts, regardless of the high variability of hip revision surgery and the increased risk of complications. Implementation of this regimen is recommended in patients requiring joint replacement revision surgery.
  • 7.

    【2hr】Zika and Chikungunya Virus and Risk for VenousThromboembolism

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    机译 寨卡病毒和基孔肯雅病毒与静脉感染的风险血栓栓塞
    摘要：A variety of viral infections are associated with hypercoagulable states and may be linked to the development of deep venous thrombosis and pulmonary embolism. The Zika and Chikungunya viral infections spread through the South and Central American continents, moving to North America in 2016, with severe cases of polyarthralgia, fever, and Guillain-Barré syndrome leading eventually to death. A decreased trend for both infections was reported in the first quarter of 2017. In this article, we report the possible association of venous thromboembolic events associated with Zika infection. After 2 cases of deep venous thrombosis in patients with acute Zika infections, D-dimer levels were measured in 172 consecutive patients who presented to the emergency department of a university hospital in an endemic region of Brazil with either Zika or Chikungunya infections confirmed by polymerase chain reaction tests. D-dimer levels were increased in 19.4% of 31 patients with Zika and in 63.8% of 141 patients with Chikungunya infections. The mechanisms behind this association are yet to be elucidated as well as the potential for venous thromboembolism prevention strategies for in-hospital patients affected by Zika and Chikungunya infections.
  • 8.

    【2hr】Changes in Mannose-Binding Lectin and Collectin Kidney 1 Levels in SepsisPatients With and Without Disseminated Intravascular Coagulation

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    机译 脓毒症中与甘露糖结合的凝集素和肾脏集合素1水平的变化有无弥散性血管内凝血的患者
    摘要：In sepsis, systemic coagulation activation frequently causes disseminated intravascular coagulation (DIC), and the uncontrolled activation of the complement system can induce multiple organ dysfunction and poor prognosis. This study aimed to examine the association of DIC with levels of collectin kidney 1 (CL-K1), a novel collectin of the complement system, and mannose-binding lectin (MBL), a classical-type collectin in patients with sepsis. We collected blood samples prospectively from adult patients with sepsis admitted to the intensive care unit (ICU) from day 1 (admission) to day 5. The CL-K1 and MBL levels were measured by enzyme-linked immunosorbent assay, and DIC was diagnosed by using a scoring algorithm. The correlation of CL-K1 and MBL levels with other coagulation markers was analyzed. There were 37 patients with DIC (DIC group) and 15 without DIC (non-DIC group). Compared to the non-DIC group, the DIC group had more severe conditions and higher mortality. During the 5 days after ICU admission, plasma CL-K1 levels were similar between the groups, but plasma MBL levels were significantly lower in the DIC group. Plasma CL-K1 levels were weakly correlated with prothrombin time, activated partial thromboplastin time, and antithrombin levels; plasma MBL levels were weakly correlated with fibrin/fibrinogen degradation product levels and DIC score. In conclusion, during the first 5 days of ICU admission, plasma CL-K1 levels were similar between the DIC andnon-DIC groups. However, plasma MBL levels were lower in the DIC group compared to thenon-DIC group, and the significance of this difference grew gradually over time.
  • 9.

    【2hr】Pharmacomechanical Thrombectomy Versus Catheter-Directed Thrombolysis forIliofemoral Deep Vein Thrombosis: A Meta-Analysis of Clinical Trials

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    机译 药物力学血栓切除术与导管定向溶栓治疗li股深静脉血栓形成：临床试验的荟萃分析
    摘要：Early catheter-directed thrombolysis (CDT) for deep vein thrombosis (DVT) can reduce postthrombotic morbidity. Pharmacomechanical thrombolysis (PMT) is a new therapy that can be selected for the treatment of iliofemoral deep vein thrombosis (IFDVT). We performed a meta-analysis of clinical trials comparing PMT versus CDT for treatment of acute IFDVT. Literature on this topic published between January 1, 1990, and June 1, 2018, was identified using PubMed, Embase, Cochrane Library, and Web of Science. Six trials were included in the meta-analysis. Compared to CDT, PMT significantly reduced the Villalta score (P = .007; I 2 = 0%), thrombus score (P = .01; I 2 = 0%), the duration in the hospital (P = .03; I 2 = 64%), and thrombolysis time (P < .00001, I 2 = 0%). There was no significant difference in valvular incompetence events (P = .21; I 2 = 0%), minor bleeding events (P = .59; I 2 = 0%), stent events (P = .09; I2 = 24%), and clot reduction grade I events (P = .16;I2 = 43%) between PMT and CDT. Subgroup analysis was performed by dividing theclot reduction grade I events group into PMT plus CDT versus CDT group and significantdifferences were found (P = .03, I2 = 0%) as well as for PMT alone versus CDT group (P = .88,I2 = 37%). This meta-analysis shows that PMT reduces the severity ofpostthrombotic syndrome (PTS), thrombus score, duration in hospital, and thrombolysis timecompared to CDT. More specifically, PMT plus CDT reduces clot reduction grade I events. Nosignificant difference in valvular incompetence events, stent events, and minor bleedingevents were found when PMT was compared to CDT.
  • 10.

    【2hr】Dynamic Analysis of Perioperative Hidden Blood Loss in IntertrochantericFractures

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    机译 股骨转子间围手术期隐性失血的动态分析骨折
    摘要：To analyze the dynamic variation in perioperative hidden blood loss in patients with intertrochanteric fracture. From January to December 2017, 79 patients with intertrochanteric fracture were treated with proximal femoral nail antirotation. Serial complete blood count assays were performed consecutively in the 3 days after admission, on the day of surgery, and 7 days postoperatively. Blood loss during surgery, postoperative drainage, and perioperative blood transfusion volumes were recorded. Dynamic changes in hemoglobin (Hb) prior to surgery were recorded and compared between males and females. Patients were divided into the no blood transfusion group, the 400-mL blood transfusion group, and the 800-mL blood transfusion group depending on the volume of perioperative blood transfusion. Total and hidden blood loss were separately calculated according to the Gross equation. Lowest mean Hb values occurred on day 2 after admission among men (104.8 g/L) and on day 3 after admission among women (98.6 g/L). The average Hb decrease was 11.4 g/L, 11.8 g/L, and 8.9 g/L in the no, 400-mL, and 800-mL blood transfusion groups, respectively. The lowest Hb value occurred on postoperative day 2. Hemoglobin increased on postoperative day 3 and stabilized by day 6. In the no blood transfusion group, the average total blood loss was 406.0 ± 255.6 mL, 628.3 ± 267.2 mL, and 759.7 ± 322.1 mL in the no blood transfusion, 400-mL blood transfusion, and 800-mL blood transfusion groups,respectively, and hidden blood loss was 326.0 ± 246.6 mL, 512.1 ± 247.3 mL, and 596.1 ±306.9 mL, respectively. Perioperative hidden blood loss occurred prior to surgery forintertrochanteric fracture and ended on postoperative day 2.
  • 11.

    【2hr】Plasma Levels of Vascular Endothelial Growth Factor and Selected HemostaticParameters in Association With Treatment Response in Multiple Myeloma

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    机译 血浆血管内皮生长因子水平和部分止血与多发性骨髓瘤的治疗反应相关的参数
    摘要：Multiple myeloma (MM) is a neoplastic plasma cell disorder characterized by the clonal proliferation of plasma cells in the bone marrow and presence of monoclonal protein in the blood or urine. Diverse hemostatic abnormalities have been reported in patients with myeloma which predispose the patient to bleeding and also thrombosis. The aim of this study was to measure the concentrations of serum levels of vascular endothelial growth factor, D-dimer, and von Willebrand factor in patients with newly diagnosed or relapsed multiple myeloma before treatment, during therapy, and after successful therapy. The working hypothesis was that all of these factors reflect the total body burden of tumor. Angiogenic and coagulation activity should therefore decrease after successful therapy. Our study indicates that selected prothrombotic abnormalities occur in patients with MM, which may contribute to the increased risk of venous thromboembolism observed in these patients. The levels of our 3 parameters were strongly elevated in patient with newly diagnosed MM and also in patients with clinical stage III based on International Staging System criteria. Furthermore, there was a correlation between prognostic disease stages in all study population. It would be appropriate to include angiogenic and coagulation parameters into prognostic parameters.
  • 12.

    【2hr】Venous Thromboembolism Prophylaxis and Risk for Acutely Medically IllPatients Stratified by Different Ages and Renal Disease Status

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    机译 静脉血栓栓塞的预防和急性医学疾病风险按年龄和肾脏疾病状况分层的患者
    摘要：The objectives of this study were to examine venous thromboembolism (VTE) prophylaxis patterns and risk for VTE events during hospitalization and in the outpatient continuum of care among patients hospitalized for acute illnesses in the United States with stratification by different age groups and renal disease status. Acutely ill hospitalized patients were identified from the MarketScan databases (January 1, 2012-June 30, 2015) and grouped by age (<65, 65-74, ≥75 years old) and whether or not they had a baseline diagnosis of renal disease, separately. Of acutely ill hospitalized patients, 60.1% (n = 10 748) were <65 years old, 15.7% (n = 2803) were 65 to 74 years old, and 24.3% (n = 4344) were ≥75 years old; 32.9% (n = 5892) had baseline renal disease. Among the study cohorts, the majority of patients received no VTE prophylaxis regardless of age or baseline renal status (52.1%-63.6%). Rates of VTE during hospitalization and in the 6 months postdischarge were 4.7%, 4.6%, and 4.5% for patients <65, 65 to 74, and ≥75 years old, respectively, and 6.3% and 3.8% for patients with and without baseline renal disease. The risk for VTE was elevated for 30 to 40 days after index admission regardless of age and renal disease status.
  • 13.

    【2hr】Influence of Tumor Thrombus on Occurrence of Distant Venous Thromboembolismand Survival in Patients With Renal Cell Carcinoma After Surgery

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    机译 肿瘤血栓对远处静脉血栓栓塞发生的影响肾细胞癌患者术后的生存与生存
    摘要：Tumor thrombus is a unique characteristic of renal cell carcinoma (RCC). However, only a few studies have reported its clinical influence on the occurrence of venous thromboembolism (VTE). This study aimed to clarify the influence of tumor thrombus and other risk factors for VTE and to elucidate the impact of tumor thrombus on survival outcomes. We retrospectively reviewed data from patients with RCC who underwent radical or partial nephrectomy from September 1999 to August 2015 at Seoul National University Hospital. A total of 2762 patients were enrolled. The 1- and 5-year cumulative incidences of VTE were 0.5% ± 0.1% and 1.5% ± 0.3%, respectively. During a median follow-up of 39.0 months (95% confidence interval [CI], 37.1-41.0 months), deep vein thrombosis occurred in 13 patients and pulmonary embolism in 15 patients. Patients with tumor thrombus (diagnosed by surgical pathology findings) had a significantly higher incidence of VTE than those without thrombus (odds radio 8.160, 95% CI, 1.480-45.004). Older age (≥60 years) and higher preoperative C-reactive protein (>0.5 mg/dL) were also significant risk factors for VTE. Additionally, tumor thrombus was independently associated with worse progression-free survival (PFS) but not with overall survival (OS) in multivariable analysis (hazard ratio [HR] 1.916, 95% CI, 1.295-2.834 for PFS; HR 1.164, 95% CI, 0.755-1.793 for OS). In conclusion, the incidence of VTE was relatively low in patientswho underwent surgery for RCC. Nevertheless, patients with tumor thrombus had an increasedrisk of VTE and should be closely monitored for VTE.
  • 14.

    【2hr】Effects of Obesity on Warfarin Reversal With Vitamin K

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    机译 肥胖对维生素K逆转华法林的影响
    摘要：Phytonadione (vitamin K1, VK) is fat soluble and may be sequestered by adipose tissue, thus potentially altering drug distribution in obese patients requiring warfarin reversal. This single-center retrospective cohort study aimed to determine the effects of obesity (defined as body mass index [BMI] ≥ 30 kg/m2) on warfarin reversal following administration of VK in adult patients. The primary outcome was complete or partial warfarin reversal (defined as an international normalized ratio [INR] ≤ 2.0) within 72 hours post-VK administration. Of 688 identified patients, 215 were included in primary INR analysis. Mean BMIs for obese (n = 84) and nonobese (n = 131) patients were 37.3 and 24.3 kg/m2 (P < .001), and mean baseline INRs were 4.73 and 4.42 (P = .534), respectively. Within 72 hours post-VK administration, 70% and 69% of the obese and nonobese groups, respectively, achieved complete or partial warfarin reversal (P = .904). Multiple logistic regression determined baseline INR and concomitant fresh frozen plasma administration to be factors influencing warfarin reversal. These findings do not suggest obesity is significantly associated with a decreased likelihood of warfarin reversal within 72 hours post-VK administration.
  • 15.

    【2hr】Usefulness of Measuring Changes in SOFA Score for the Prediction of 28-DayMortality in Patients With Sepsis-Associated Disseminated IntravascularCoagulation

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    机译 测量SOFA分数变化对预测28天的有用性脓毒症相关性弥散性血管内患者的死亡率凝结
    摘要：The primary end point for sepsis trial is 28-day mortality. However, additional methods for determining the efficacy may have benefits. The purpose of this study was to search a useful indicator of anticoagulant therapy in patients with sepsis with disseminated intravascular coagulation (DIC). Data from 323 patients with sepsis with coagulopathy treated with antithrombin supplementation were analyzed. The changes in the Sequential Organ Failure Assessment (Δ SOFA) score, the overt-DIC (Δ overt-DIC) score, and the Japanese Society for Acute Medicine DIC (Δ JAAM DIC) score from baseline to day 7 were retrospectively analyzed in relation to the 28-day mortality. Significant correlations were found between the 28-day mortality and Δ SOFA, Δ overt-DIC score, and Δ JAAM DIC score. The accuracy of the prediction was higher for Δ SOFA (80.5%) than for Δ overt-DIC (66.7%, P < .001). The areas under the curve for mortality calculated using a receiver operating characteristic curve analysis were 0.812 for Δ SOFA, 0.655 for Δ overt-DIC, and 0.693 for Δ JAAM DIC. The mortality rate was significantly lower among cases with an improved SOFA score compared to those without an improvement. The Δ SOFA had the strongest association with the 28-day mortality in patients with sepsis and DIC.
  • 16.

    【2hr】Relationship Between C-Reactive Protein to Albumin Ratio and Thrombus Burdenin Patients With Acute Coronary Syndrome

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    机译 C反应蛋白与白蛋白比率与血栓负担的关系急性冠状动脉综合征的患者
    摘要：Increased coronary thrombus burden is known to be a strong predictor of adverse cardiovascular (CV) outcomes. C-reactive protein to albumin ratio (CAR) can be used as a surrogate marker of pro-inflammation which is closely related to prothrombotic state. We aimed to evaluate the association between CAR and coronary thrombus burden in patients who presented with acute coronary syndrome (ACS). Patients who presented with ACS and treated with primary percutaneous coronary intervention were included in the study. Patients were divided into 2 groups as high thrombus burden and low thrombus burden. The study population included 347 patients with non-ST-segment elevation myocardial infarction (169 [48.7%]) and ST-segment elevation myocardial infarction (178 [51.3%]). The CAR was significantly higher in patients with higher thrombus burden (24.4 [1.2-30.2] vs 31.9 [2.2-31.3], P < .001). Independent predictors for increased thrombus burden were higher CRP level (odds ratio [OR]: 0.047; 95% confidence interval [CI]: 0.004-0.486; P = .010), lower serum albumin level (OR: 0.057; 95% CI: 0.033-0.990; P = .049), higher CAR (OR: 1.13; 95% CI: 1.03-1.23; P = .008), higher neutrophil–lymphocyte ratio (OR: 1.18; 95% CI: 1.05-1.31; P = .004), and baseline troponin I level (OR: 1.06; 95% CI: 1.01-1.13; P = .017). Novel CAR can be used as a reliable marker forincreased coronary thrombus burden that is associated with adverse CV outcomes.
  • 17.

    【2hr】Comparison of the Long-Term Remission of Rituximab and Conventional Treatmentfor Acquired Thrombotic Thrombocytopenic Purpura: A Systematic Review andMeta-Analysis

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    机译 利妥昔单抗与常规治疗的长期缓解比较获得性血栓性血小板减少性紫癜：系统评价和荟萃分析
    摘要：The current systematic review and meta-analysis aimed to summarize the results of all available studies to compare the efficacies of rituximab and conventional treatment for acquired thrombotic thrombocytopenic purpura (TTP). Three investigators independently searched studies in the MEDLINE and EMBASE databases published before December 11, 2018. To be included in the meta-analysis, studies needed to be randomized-controlled or cohort studies comparing the efficacies of rituximab and conventional therapy for TTP treatment. The effect estimates and 95% confidence intervals (CIs) from each study were collected, and Mantel-Haenszel methods were used to pool the data. A total of 570 patients from 9 eligible studies were included in the meta-analysis (280 patients in the rituximab arm and 290 in the conventional treatment arm). Patients receiving rituximab in an acute phase to induce disease remission had a significantly lower relapse rate than those given conventional treatment (odds ratio [OR]: 0.40, 95% CI: 0.19-0.85, P = .02, I2 = 43%). Similarly, the relapse rate in the rituximab group for preemptive therapy to prevent clinical relapse was also significantly lower than in the control group (OR: 0.09, 95% CI: 0.04-0.24, P < .00001, I2 = 11%). Furthermore, the conventional treatment group had a significantly higher mortality rate than the rituximab group during the follow-up (OR: 0.41, 95% CI: 0.18-0.91,P = .03, I2 = 0%). Rituximab offered high efficacy for theprevention of relapses and lower mortality rate in cases of acquired TTP.
  • 18.

    【2hr】Contact System Activation and Neutrophil Extracellular Trap Markers: RiskFactors for Portal Vein Thrombosis in Patients With HepatocellularCarcinoma

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    机译 接触系统激活和嗜中性粒细胞胞外标记物：风险肝细胞癌患者门静脉血栓形成的因素癌
    摘要：Although portal vein thrombosis (PVT) commonly occurs in patients with hepatocellular carcinoma (HCC), the hypercoagulability mechanism in patients with HCC is not entirely clear. Recently, tumor-induced formation of neutrophil extracellular traps (NET) has been shown to trigger contact system activation, and contact system activation has been shown to be a new mechanism of thrombosis. Therefore, we investigated whether contact system activation and NET formation occurred in relation to PVT in HCC patients. The circulating levels of NET formation markers (DNA–histone complex, double-stranded DNA, neutrophil elastase) and contact system activation markers (factor XIIa and high-molecular-weight kininogen) were measured in 177 patients who had been diagnosed with HCC and 48 healthy controls. Presence of PVT was confirmed in 77 HCC patients. The levels of NET formation and contact system activation markers were significantly higher in patients than in healthy controls and they increased significantly with the increase in the model for end-stage liver disease (MELD) scores. Of note, these markers were significantly higher in HCC patients with PVT than in those without PVT. These NET formation markers and the contact system activation markers were significant thrombotic risk factors in HCC patients. The well-known liver injury markers (alanine transaminase, prothrombin time) significantly contributed to factor XIIa level. Contact system activation and NETformation are well correlated with liver disease severity and the markers of these can beused as thrombotic risk factors in HCC patients. In addition, therapeutics inhibiting thecontact system can be potentially used to manage PVT in HCC patients.
  • 19.

    【2hr】Circulating Endothelial Cells, Circulating Endothelial Progenitor Cells, andCirculating Microparticles in Type 1 Diabetes Mellitus

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    机译 循环内皮细胞，循环内皮祖细胞和1型糖尿病中的循环微粒
    摘要：Background and Aim:Hyperglycemia in type 1 diabetes (T1D) is accompanied by endothelial cell dysfunction which is known to contribute to the pathogenesis of cardiovascular disorders. The aim of the current study was to explore the profile of circulating endothelial progenitor cells (EPCs), circulating endothelial cells (CECs), endothelial and platelet derived micropaticles (EMPs, PMPs) and total microparticles (TMPs), in T1D children in relation to each other and to the metabolic disorders accompanying T1D.
  • 20.

    【2hr】Utilization of Anticoagulants in Nonvalvular Atrial Fibrillation Before andAfter Catheter Ablation at Shanghai, China

    包量

    机译 抗凝剂在非瓣膜性心房颤动中的应用中国上海导管消融术后
    摘要：Both vitamin K antagonists (VKAs) and novel oral anticoagulants (NOACs) are effective for stroke prevention in nonvalvular atrial fibrillation (NVAF) patients. This study evaluated the utilization of VKA and NOACs in NVAF patients before and after catheter ablation in China. Prescription data were retrospectively collected between January 1, 2016, and December 31, 2016, including indication of use, dose, renal function, and risk assessment (CHA2DS2-VASc score and HAS-BLED score) in Zhongshan Hospital of Fudan University. Trends and factors associated with anticoagulants use before and after ablation were evaluated. A total of 475 patients with NVAF who received ablation were included in the analysis. Of all, 53.26% of them received antithrombotic therapy preablation. Warfarin was prescribed in 35.26%, with NOACs in 11.37%. Four hundred seventy-three patients received antithrombotic therapy (99.58%) postablation, 236 patients with NOACs (49.68%). CHA2DS2-VASc score, HAS-BLED score, hypertension, diabetes mellitus, and alcohol were independently associated with anticoagulant utilization before catheter ablation. The higher CHA2DS2-VASc score was associated with less frequent prescription of NOACs postablation. The preablation anticoagulation use was still inadequate in China, and CHA2DS2-VASc score was a significant factor influencing thepreablation anticoagulant utilization. The utilization rate of NOACs increasedsignificantly postablation, especially for dabigatran, which implied that more physiciansprefer to prescribe NOACs for NVAF patients after ablation in our country and may beattributed to the aspects such as ease of NOAC use but also possibly the greater safetyand efficacy. Furthermore, the physicians may reluctant to use NOACs for high stroke riskatrial fibrillation patients after catheter ablation.
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