Journal of Thrombosis and Thrombolysis (J THROMB THROMBOLYS )

Publisher: Springer Verlag

Description

The Journal of Thrombosis and Thrombolysis is a long-awaited resource for contemporary cardiologists hematologists and clinician-scientists actively involved in treatment decisions and clinical investigation of thrombotic disorders involving the cardiovascular and cerebrovascular systems. Its principal focus centers on the pathobiology of thrombosis and the use of anticoagulants platelet antagonists and thrombolytic agents in scientific investigation and patient care. The journal publishes original work that interlinks basic scienctific principles with clinical investigation thus creating a unique forum for interdisciplinary dialogue. Published works will advocate the development of solid platforms for planned clinical research and precise clinically-applicable benchwork. The Journal of Thrombosis and Thrombolysis 's comprehensive and interdisciplinary design will expand the reader's knowledge base and provide important insights for the most rapidly growing field in medicine. The journal seeks original manuscripts devoted to laboratory investigation and clinical studies. State-of-the-art reviews and editorials will be summoned by invitation. The journal will closely follow new trends on the cutting edge of the field and highlight drugs in the early stages of development which may warrant testing in the clinical arena. Updates of major national and international clinical trials will also be provided as will a forum of guidelines for interpreting the results of these trials from a patient care perspective. The Journal will publish an ongoing educational series of topics applicable to clinician scientists that will include such topics as: 'Seminars in Thrombosis Thromboysis and Vascular Biology' and a 6-part series on 'Hematology for the Cardiologist'. Manuscripts submitted must not be under consideration by an other journal and should not have been published elsewhere in similar form. All articles will be refereed by two qualified referees. All clinical trials being considered for publication will also be reviewed by a statistician. A response will be provided within four weeks of receipt.

  • Impact factor
    1.99
    Show impact factor history
     
    Impact factor
  • 5-year impact
    1.70
  • Cited half-life
    4.00
  • Immediacy index
    0.30
  • Eigenfactor
    0.01
  • Article influence
    0.49
  • Website
    Journal of Thrombosis and Thrombolysis website
  • Other titles
    Journal of thrombosis and thrombolysis (Online)
  • ISSN
    0929-5305
  • OCLC
    41973481
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Springer Verlag

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Author's pre-print on pre-print servers such as arXiv.org
    • Author's post-print on author's personal website immediately
    • Author's post-print on any open access repository after 12 months after publication
    • Publisher's version/PDF cannot be used
    • Published source must be acknowledged
    • Must link to publisher version
    • Set phrase to accompany link to published version (see policy)
    • Articles in some journals can be made Open Access on payment of additional charge
  • Classification
    ​ green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study was to review all cases in literature in which the clinical manifestations of ischemic stroke and immune thrombocytopenia (ITP) were presented in the same patient including a new case of our own and discuss the possible mechanism and management of this syndrome. We reviewed 12 reports in which 18 cases were diagnosed as ischemic stroke and ITP. The clinical manifestations and ischemic lesion patterns of the 18 cases and our new case were analyzed in detail to elucidate the characteristics and management of this kind of syndrome. Of all the cases, 8 females and 10 males, 10 of them were Koreans; 3 were Americans; 3 were Japanese; 1 was British and 1 was Australian. The age of eight patients was no more than 50 years old. Most of them had a low platelet count. CT and/or MRI of brain were seen in all tested cases. Prognosis of ischemic stroke was good in 18 of the 19 patients. Although extremely rare, ischemic stroke and ITP may present in the same patient with variant characteristics. This paradoxical mechanism and management of ischemic stroke associated with ITP requires further investigation.
    Journal of Thrombosis and Thrombolysis 11/2014;
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    ABSTRACT: This retrospective analysis investigated the impact of baseline clinical characteristics, including atrial fibrillation (AF), on hospital discharge status (to home or continuing care), mortality, length of hospital stay, and treatment costs in patients hospitalized for stroke. The analysis included adult patients hospitalized with a primary diagnosis of ischemic or hemorrhagic stroke between January 2006 and June 2011 from the premier alliance database, a large nationally representative database of inpatient health records. Patients included in the analysis were categorized as with or without AF, based on the presence or absence of a secondary listed diagnosis of AF. Irrespective of stroke type (ischemic or hemorrhagic), AF was associated with an increased risk of mortality during the index hospitalization event, as well as a higher probability of discharge to a continuing care facility, longer duration of stay, and higher treatment costs. In patients hospitalized for a stroke event, AF appears to be an independent risk factor of in-hospital mortality, discharge to continuing care, length of hospital stay, and increased treatment costs.
    Journal of Thrombosis and Thrombolysis 11/2014;
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    ABSTRACT: Non vitamin K antagonist oral anticoagulants (NOACs) have advantages relative to traditional vitamin K antagonist oral anticoagulants and represents an important advance in the management of patients with atrial fibrillation and venous thromboembolism. Yet it is unclear whether the clinical trials evaluating these agents were inclusive of diverse populations. To assess the inclusion and reporting of race and ethnicity in clinical trials of NOACs across disease states including, atrial fibrillation, venous thromboembolism, and acute coronary syndromes, we queried PubMed and ClinicalTrials.gov for trials of NOACs between 2007 and 2013. We determined the reporting rate and inclusion of the following ethnic groups: whites, blacks, Asians, and Hispanics. We reviewed data from 30 randomized clinical trials of NOACs that enrolled 184,414 patients. Among these trials, 21 (70 %) reported race/ethnicity data in the primary manuscript or on ClinicalTrials.gov. Principal investigators provided race/ethnicity data for two additional trials. Enrollment by race included: 109,729 (75.2 %) white, 20,901 (14.3 %) Asian, 5,718 (3.9 %) Hispanic, and 2,941 (2.0 %) black. Hispanic ethnicity was only reported in 10 trials. The major clinical trials of NOACs inconsistently reported race/ethnicity and overall black and Hispanic patient enrollment was poor. As such, the relative safety and efficacy of NOACs in minority populations remains uncertain.
    Journal of Thrombosis and Thrombolysis 11/2014;
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    ABSTRACT: Pulmonary embolism due to hydatid disease has been rare clinically. Here we present a patient case who suffered from multiple cystic hydatidosis within bilateral lung parenchyma and complicated bilateral pulmonary embolisms. The case was a 70-year-old man who complained of an increasingly severe cough and hemoptysis post-operation of hepatic hydatid cyst. Chest radiographs showed that the patient had multiple nodules in the bilateral chest. Computed tomography (CT) depicted that some lesions were multivesicular cysts and some consisting of sophisticated complications. CT pulmonary angiography revealed bilateral pulmonary arterial embolisms. T2-weighted magnetic resonance images (MRI) clearly demonstrated the daughter cysts inside the lesions with high intensive signal. Echinococcosis serologic testing was positive. Thus, the pulmonary embolism was caused by hydatid cyst based on the imaging findings and serologic test.
    Journal of Thrombosis and Thrombolysis 10/2014;
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    ABSTRACT: The clinical significance of isolated subsegmental pulmonary embolism (SSPE) remains an area of controversy. In cancer patients, venous thromboembolism (VTE) is common and is a major cause of morbidity and mortality. The management of overt VTE in cancer patients is well established, nevertheless the management of incidentally diagnosed PE and especially SSPE, an increasingly frequent finding with the ubiquity of thin-slice computed tomography is less well defined. We have surveyed current attitudes towards treating SSPE in cancer patients among oncologists, respiratory and palliative care physicians. The survey was conducted between September 2012 and May 2013. Physicians surveyed were asked to select their management plan from options available depending on the site, number, symptoms, and in the presence of previous VTE. 154 physicians responded. We observed differences in the attitudes towards treatment between different specialties. In the adjuvant setting, oncologists were more likely to immediately anticoagulate for a single SSPE than palliative care physicians or chest physicians (84 vs 46 vs 56 %, respectively, p = 0.001). In the metastatic setting the differences were smaller (89 vs 69 vs 76 %, respectively, p = 0.057) but palliative care physicians remained less likely to immediately anticoagulate even in the case of multiple-site SSPE (85 vs 96 %, p = 0.014). Despite the unknown clinical significance of SSPE, and the likelihood that even in cancer patients some of these SSPEs may have trivial effects on prognosis if left untreated, the majority of the physicians surveyed would opt for anticoagulation in patients with unsuspected SSPE regardless of its extent.
    Journal of Thrombosis and Thrombolysis 10/2014;
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    ABSTRACT: In patients with acute coronary syndromes (ACS), early therapy with high-dose statins may reduce short-term adverse clinical outcomes. The mechanisms responsible are not known but could involve anti-inflammatory or anti-thrombotic effects. Compelling evidence from experimental models and clinical studies suggests that the interplay between inflammatory and thrombotic systems, typified by platelet-monocyte and platelet-neutrophil interactions, might be a key regulator of ischemic vascular events. The study sought to determine if early, high-dose administration of the HMG-CoA reductase inhibitor rosuvastatin in the setting of ACS exerts beneficial vascular effects by reducing, and inhibiting biomarkers of thromboinflammation, such as platelet-monocyte and platelet-neutrophil interactions, and biomarkers of myocardial necrosis. A total of 54 patients presenting with ACS within 8 h of symptom onset were randomized to rosuvastatin 40 mg or placebo. Rosuvastatin significantly reduced interactions between platelets and circulating neutrophils (P = 0.015) and monocytes (P = 0.009) within 24 h. No significant effects were observed on platelet aggregation or plasma levels of PF4, sP-selectin, or sCD40L, whereas significant reductions of RANTES occurred over time in both treatment groups. Plasma levels of myeloperoxidase (MPO) declined more rapidly with rosuvastatin therapy than placebo. In a subset of patients with normal cardiac necrosis biomarkers at randomization, rosuvastatin therapy was associated with less myocardial damage as measured by troponin-I or CK-MB. Early administration of high-dose statin therapy in patients with ACS appears to improve biomarkers of inflammation within 8 h, which may translate into fewer ischemic events.
    Journal of Thrombosis and Thrombolysis 10/2014;
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    ABSTRACT: The objective was to compare the pharmacodynamic (PD) and pharmacokinetic (PK) effects of ticagrelor with clopidogrel among subjects of Hispanic ethnicity, as the PD and PK effects of antiplatelet agents among Hispanics are not specifically known. This was a randomised, open-label, crossover PD/PK study of 40 Hispanic subjects with stable coronary artery disease (CAD). Subjects were allocated to either ticagrelor 180 mg loading dose (LD)/90 mg twice-daily maintenance dose (MD) followed by clopidogrel 600 mg LD/75 mg once-daily MD with an intervening washout period, or vice versa. The primary endpoint was on-treatment reactivity (OTR) at 2 h post-LD according to the VerifyNow P2Y12 test. OTR was significantly lower at 2 h post-LD with ticagrelor compared with clopidogrel (34 PRU vs. 201 PRU, least square means difference = -167 PRU [95 % CI, -197, -137], P < 0.001). OTR was also lower with ticagrelor at 30 min and 8 h post-LD (P < 0.001). The greater magnitude of antiplatelet effect with ticagrelor persisted after 7 days of MD (52 PRU [95 % CI, 30, 73] vs. 182 PRU [95 % CI, 160, 205], P < 0.001). Mean plasma concentration of ticagrelor and its active metabolite were greatest at 2 h post-LD, with similar levels at 2 h post-MD after 7 days of MD. Among Hispanic subjects with stable CAD, ticagrelor provides a more rapid onset of platelet inhibition and a significantly greater antiplatelet effect compared with clopidogrel during both the loading and maintenance phases of treatment.
    Journal of Thrombosis and Thrombolysis 10/2014;
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    ABSTRACT: Current guidelines consider outpatient treatment as an option for low-risk pulmonary embolism (PE), and risk assessment tools such as the HESTIA criteria can be used to identify PE patients who could feasibly be treated in an outpatient setting. Little is known about what proportion of patients in daily care this would comprise, and, in these patients, outcome data outside of clinical trials are scarce. To assess the proportion of PE patients receiving outpatient early discharge or in-hospital therapy, evaluate differences in patient characteristics between these subgroups and to assess clinical outcomes at 6 months. Monocentric, retrospective cohort study in 439 consecutive patients undergoing outpatient, early-discharge or in-hospital treatment for PE. Outcome data on recurrent VTE, pulmonary hypertension or death were collected from routine follow-up visits 6 months after VTE diagnosis. PE patients were treated as outpatient (OP; n = 49; 11.2 %); early-discharge (ED; n = 62; 14.1 %) or in-hospital (IH; n = 328; 74.7 %). Median duration of hospital stay in the ED and IH groups were 1 (IQR: 1) day and 9 (IQR: 7) days, respectively. Outcome event rates at 6 months were 3.9 % for recurrent VTE (95 % CI 2.3-6.1, similar between groups), 5.2 % for pulmonary hypertension (95 % CI 3.3-7.8, similar between groups) and 10.7 % for mortality (95 % CI 8.0-14.0). Mortality was significantly higher in IH patients (14.0 %; 95 % CI 10.5-18.3) compared to OP (0 %; 95 % CI 0.0-7.3) or ED (1.6 %; 95 % CI 0.0-8.7) patients. Mortality risk factors were high-risk ESC category (OR: 5.7), paraneoplastic VTE (OR: 3.0), need for oxygen supplementation (OR: 5.2), diabetes (OR: 2.5), age (OR per additional year: 1.1) and elevated INR (OR per 0.1 point increase: 1.5). No difference in the treatment groups for pulmonary hypertension during follow-up was found. Independent risk factors were thrombophilia (OR: 8.43), signs of right ventricular strain in baseline ECG (OR: 6.64) or echocardiography (RVESP > 40 mmHg OR: 2.99). 32 % of the OP or ED patients had at least one criterion of the HESTIA score that would have excluded them from outpatient treatment. In daily care, treating PE in an almost exclusively outpatient setting seems feasible and safe for up to 25 % of all PE patients. The HESTIA criteria seem to exclude up to 30 % of patients for whom outpatient or early-discharge treatment seems feasible and safe.
    Journal of Thrombosis and Thrombolysis 10/2014;
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    ABSTRACT: Antiplatelet switching in the management of acute coronary syndrome (ACS) seems to be safe, but prospective data are limited. This retrospective study assessed the safety and efficacy of in-hospital clopidogrel-to-prasugrel switching in patients with ACS. We analysed 525 consecutive patients with ACS admitted to our coronary care unit. We assessed the prevalence and the short-term outcomes of in-hospital clopidogrel-to-prasugrel switching. Bleeding and thrombotic events were assessed using propensity score matching analysis. A total of 468 patients received acetylsalicylic acid and a P2Y12 ADP receptor inhibitor. Medication switching occurred in 117 patients (25 %). Compared with the clopidogrel group, the switching group consisted preferentially of younger males with STEMI, exhibited fewer comorbidities, and had lower ischaemic risk. We found no differences between the switching group and the clopidogrel group in the bleeding rate [3.6 vs. 2.3 %, odds ratio (OR):1.59 95 % confidence interval (CI): 0.26-9.7, p NS], and in adverse cardiac or cerebrovascular events (MACCE) (5 vs. 8.4 %, OR: 0.57 95 % CI 0.16-2, p NS). In-hospital switching from clopidogrel to prasugrel in a selected high-risk ACS population resulted in a similar incidence of in-hospital haemorrhagic and thrombotic events. This strategy should be clarified in further randomised studies.
    Journal of Thrombosis and Thrombolysis 10/2014;
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    ABSTRACT: The link between myeloma and thrombosis is well established. Monoclonal gammopathy of undetermined significance (MGUS) has also been associated with an increased risk of thrombosis. It was recently demonstrated that patients with myeloma display changes in thromboelastometry that may indicate a prothrombotic state. There is little data with regard to changes in thromboelastography in patients with myeloma or MGUS. The aim of this study was to investigate the differing coagulation profiles of patients of patients with myeloma and MGUS by means of conventional coagulation tests and thromboelastography. Blood was taken by direct venepuncture from patients with myeloma, MGUS and normal controls. Routine coagulation tests were performed in an accredited hospital laboratory. Thromboelastography (TEG(®)) was performed as per the manufacturer's protocol. Eight patients were recruited in each group. Patients with myeloma had a significantly lower mean haemoglobin level than patients with MGUS or normal controls (p < 0.001). Pateints with myeloma had a significantly more prolonged mean prothrombin time than normal controls (p = 0.018) but not patients with MGUS. Patients with myeloma had significantly higher median D-dimer levels than normal controls (p = 0.025), as did patients with MGUS (p = 0.017). Patients with myeloma had a significantly higher mean factor VIII level than normal controls (p = 0.009) and there was a non-significant trend towards patients with MGUS having higher factor VIII levels than normal controls (p = 0.059). There was no significant difference in thromboelastographic parameters between the three groups. Patients with MGUS appear to have a distinct coagulation profile which is intermediate between patients with myeloma and normal controls.
    Journal of Thrombosis and Thrombolysis 10/2014;
  • Journal of Thrombosis and Thrombolysis 09/2014;
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    ABSTRACT: Deep vein thrombosis is one of the common complications of orthopedic surgery, and pulmonary embolism which is one of its lethal complications can lead to mortality. Numerous efforts have been made to identify reliable and predictive biomarkers to detect the early signs of deep vein thrombosis. These studies have, however, not delivered any more informative candidates than the D-dimer that have been available. Cell-free microRNAs are present in a range of body fluids and have recently been shown to be useful biomarkers in many diseases. Therefore, the purpose of present study was to identify potential microRNA biomarkers of deep vein thrombosis that are present in serum. Serum samples were taken from 18 deep vein thrombosis patients and 20 age- and sex-matched controls. TaqMan microRNA array was used for an initial screening. Real-time PCR assay was implemented to confirm the concentrations of candidate microRNAs. We found that the serum levels of miR-582, miR-195 and miR-532 of deep vein thrombosis patients were higher than those of controls. miR-582 yielded an AUC (the areas under the ROC curve) of 0.959, and the other two microRNAs yielded an AUC of 1.000 in discriminating deep vein thrombosis from controls. These data hint that serum miR-582, miR-195 and miR-532 might have potential to be a novel noninvasive biomarkers for detection of DVT. And this is the first study suggesting that serum microNRAs might be used as biomarkers for deep vein thrombosis.
    Journal of Thrombosis and Thrombolysis 09/2014;
  • Journal of Thrombosis and Thrombolysis 09/2014;
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    ABSTRACT: Oral anticoagulation (OAC) with either new oral anticoagulants (NOACs) or Vitamin-K antagonists (VKAs) is recommended by guidelines for patients with atrial fibrillation (AF) and a moderate to high risk of stroke. Based on a claims-based data set the aim of this study was to quantify the stroke-risk dependent OAC utilization profile of German AF patients and possible causes of OAC under-use. Our claims-based data set was derived from two German statutory health insurance funds for the years 2007-2010. All prevalent AF-patients in the period 2007-2009 were included. The OAC-need in 2010 was assumed whenever a CHADS2- or CHA2DS2-VASC-score was >1 and no factor that disfavored OAC use existed. Causes of OAC under-use were analyzed using multivariate logistic regression. 108,632 AF-prevalent patients met the inclusion criteria. Average age was 75.43 years, average CHA2DS2-VASc-score was 4.38. OAC should have been recommended for 56.1/62.9 % of the patients (regarding factors disfavouring VKA/NOAC use). For 38.88/39.20 % of the patient-days in 2010 we could not observe any coverage by anticoagulants. Dementia of patients (OR 2.656) and general prescription patterns of the treating physician (OR 1.633) were the most important factors increasing the risk of OAC under-use. Patients who had consulted a cardiologist had a lower risk of being under-treated with OAC (OR 0.459). OAC under-use still seems to be one of the major challenges in the real-life treatment of AF patients. Our study confirms that both patient/disease characteristics and treatment environment/general prescribing behaviour of physicians may explain the OAC under-use in AF patients.
    Journal of Thrombosis and Thrombolysis 09/2014;
  • Journal of Thrombosis and Thrombolysis 09/2014;
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    ABSTRACT: Anticoagulation (AC) is effective in reducing thromboembolic events for individuals with atrial fibrillation (AF) or mechanical heart valve (MHV), but maintaining patients in target range for international normalized ratio (INR) can be difficult. Evidence suggests increasing INR testing frequency can improve time in target range (TTR), but this can be impractical with in-clinic testing. The objective of this study was to test the hypothesis that more frequent patient-self testing (PST) via home monitoring increases TTR. This planned substudy was conducted as part of The Home INR Study, a randomized controlled trial of in-clinic INR testing every 4 weeks versus PST at three different intervals. The setting for this study was 6 VA centers across the United States. 1,029 candidates with AF or MHV were trained and tested for competency using ProTime INR meters; 787 patients were deemed competent and, after second consent, randomized across four arms: high quality AC management (HQACM) in a dedicated clinic, with venous INR testing once every 4 weeks; and telephone monitored PST once every 4 weeks; weekly; and twice weekly. The primary endpoint was TTR at 1-year follow-up. The secondary endpoints were: major bleed, stroke and death, and quality of life. Results showed that TTR increased as testing frequency increased (59.9 ± 16.7 %, 63.3 ± 14.3 %, and 66.8 ± 13.2 % [mean ± SD] for the groups that underwent PST every 4 weeks, weekly and twice weekly, respectively). The proportion of poorly managed patients (i.e., TTR <50 %) was significantly lower for groups that underwent PST versus HQACM, and the proportion decreased as testing frequency increased. Patients and their care providers were unblinded given the nature of PST and HQACM. In conclusion, more frequent PST improved TTR and reduced the proportion of poorly managed patients.
    Journal of Thrombosis and Thrombolysis 09/2014;
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    ABSTRACT: In randomized control trials and meta-analyses in patients with acute MI undergoing PCI, the radial artery (RA) approach compared to the femoral artery (FA) approach has shown to safely reduce access site related bleeding, length of hospitalization, and major adverse cardiac event (MACE) rates. However, these studies have excluded patients with cardiogenic shock. A systematic search was conducted to retrieve studies that investigated the safety of RA to FA PCI in patients with AMI and cardiogenic shock. Primary outcomes of interest was the pooled relative risk ratio (RR) of access site related bleeding. Secondary outcomes included (i) 30-day all cause mortality, (ii) major bleeding, (iii) final TIMI 3 flow, (iv) fluoroscopy time, and (v) amount of contrast volume administered. 6 observational studies with 7,753 patients met inclusion; 5,347 (69 %) with STEMI, 2,406 (31 %) with non-STEMI. In comparison of RA to FA PCI, there was less access site related bleeding (relative risk (RR) 0.11, p = 0.001), less 30-day mortality (RR 0.65, p = 0.0 < 0.001), and less major bleeding (RR of 0.46 p < 0.0001). There was no significant difference in final TIMI 3 flow (p = 0.27), fluoroscopy time (p = 0.95), and contrast volume administered (p = 0.59). In conclution, despite its limitations, our analysis demonstrates an association towards lower adverse events in the RA PCI group. Although we believe that the choice of access site in a high-risk setting should be at the operator discretion, if technically feasible, the RA appears to be a reasonable vascular access approach in high-risk patients in cardiogenic shock.
    Journal of Thrombosis and Thrombolysis 09/2014;
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    ABSTRACT: We present a case of a patient with calcific mitral valve stenosis and plasmatic hypercoagulability. Using thrombelastography, the patient was determined to have an abnormally large velocity of plasma thrombus growth and strength with reduced vulnerability to lysis. Critically, increased carboxyhemoglobin concentration (2.4 %) was present, likely secondary to hemolysis from mitral stenosis and engagement of systemic heme oxygenase. It was determined that the patient's plasmatic hypercoagulability was in part due to carboxyhemefibrinogen formation and iron-enhancement of coagulation via two thrombelastographic methods. In conclusion, future investigation of the involvement of both carbon monoxide and iron mediated hypercoagulability in the setting of stenotic valve disease is warranted.
    Journal of Thrombosis and Thrombolysis 08/2014;
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    ABSTRACT: Atrial fibrillation (AF) represents the most common cardiac arrhythmia and chronic oral anticoagulation (OAC) is the cornerstone therapy to prevent cerebrovascular events among those having high thromboembolic risk. However, 20-30% of patients with AF have co-existing coronary artery disease (CAD). Importantly, since the prevalence of both AF and CAD increase with age, management of these patients has become an emerging clinical problem with the ever growing elderly population. In particular, many of these patients may develop an acute coronary syndrome (ACS) or require percutaneous coronary intervention (PCI), leading to the concomitant use of dual antiplatelet therapy (DAPT) including aspirin and a P2Y12 receptor inhibitor in addition to OAC, also known as triple antithrombotic therapy (TAT). However, TAT comes at the expense of an increased risk of bleeding complications. This viewpoint focuses on the current evidence of treatment, areas of unmet needs and future perspectives in the management of these high-risk patients.
    Journal of Thrombosis and Thrombolysis 08/2014;
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    ABSTRACT: Thromboelastography (TEG) measures the effects of antithrombotic agents by assessing global functional clotting status by evaluating the viscoelastic properties of in vitro clot formation. Recently, rapid TEG (r-TEG), which uses tissue factor in addition to standard kaolin to accelerate activation of the clotting cascade, has been proposed to obtain more immediate results. The correlation between results of TEG or r-TEG with international normalized ratio (INR) in patients on vitamin K antagonist (VKA) therapy has not been explored and represents the aim of this study. Patients on chronic therapy with VKAs (n = 100) were included in an observational prospective pharmacodynamic study. The correlation between TEG parameters, in particular markers of thrombus generation [Reaction time (R), maximum rate of thrombus generation (MRTG), and time to maximum rate of thrombus generation (TMRTG)], and INR values as well as the concordance between these parameters and therapeutic INR ranges were evaluated. In addition, in a subgroup of subjects (n = 17), the correlation of r-TEG parameters with TEG parameters and INR values was also assessed. No correlation was found between INR and TEG parameters of thrombus generation, in particular between INR and R (r = 0.189, p = 0.06), MRTG (r = -0.027, p = 0.79), and TMRTG (r = 0.188, p = 0.06). Further, no concordance was found between these parameters and recommended INR ranges. Significant Spearman correlations were found between INR and activated clotting time (rS = 0.546, p < 0.001), r-R (rS = 0.572, p = 0.017), and r-TMRTG (rS = 0.510, p = 0.037), but not r-MRTG (rS = 0.131, p = 0.617). Results were obtained in 24 ± 6 versus 12 ± 4 min with TEG and r-TEG, respectively (p < 0.001). In patients on chronic VKA therapy, TEG is not a useful tool to evaluate VKA anticoagulant effect, compared with standard INR measurements. However, r-TEG parameters of thrombus generation correlate with INR levels, suggesting a possible role of this assay for measuring more expeditiously anticoagulant treatment effects.
    Journal of Thrombosis and Thrombolysis 08/2014;