Clinical and Applied Thrombosis/Hemostasis (CLIN APPL THROMB-HEM)

Publications in this journal

• Article: Relationship Between Neutrophil-to-Lymphocyte Ratio and Saphenous Vein Graft Disease in Patients With Coronary Bypass.

  Mehmet Dogan, Ahmet Akyel, Tolga Cimen, Fatih Oksüz, Ibrahim Etem Celik, Mehmet Aytürk, Sani Namik Murat, Ekrem Yeter
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  ABSTRACT: Purpose: In this study, we aimed to investigate the relationship between saphenous vein graft disease (SVGD) and neutrophil-to-lympocyte ratio (NLR) with other possible confounding factors. Methods: A total of 120 patients were enrolled into the present study. Of all participants, 40 patients were with SVGD and 80 of them were with patent SVG. Results: The NLR, white blood cell (WBC) count, age of SVG, red cell distribution width (RDW), and mean platelet volume were significantly higher in the SVGD group. In regression analysis, NLR, WBC, RDW, and age of SVG remained as independent predictors of SVGD.Conclusion: To our knowledge, we showed for the first time that NLR is independently associated with SVGD. It can be easily used in this era, because it is easily available, widely used, and relatively cheap. Besides NLR, WBC count, SVG age, and RDW can also be used to predict SVGD.
  Clinical and Applied Thrombosis/Hemostasis 05/2013;
• Article: Confirmation of Reported Aspirin Use in Community Studies: Utility of Serum Thromboxane B2 Measurement.

  Nicole Dodge Zantek, Russell V Luepker, Sue Duval, Karen Miller, Niki Oldenburg, Alan T Hirsch
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  ABSTRACT: Aspirin (ASA) is recommended for the prevention of cardiovascular disease; however, the compliance is low. Reported use may not reflect actual use. Serum thromboxane B2 (STxB2) measurement was evaluated to validate reported ASA use. Males aged 45 to 79 years and females aged 55 to 79 years completed a survey and STxB2 measurement (Thromboxane B2 EIA Kit; Cayman Chemical, Ann Arbor, Michigan). The 107 patients were grouped by use of ASA (56 ASA+ and 51 ASA-) and possible interfering medications (INT) such as nonsteroidal anti-inflammatory drugs. The STxB2 levels (ng/mL) were significantly lower in ASA users: ASA+ INT- 3.0 (0.7, 8.4), ASA+ INT+ 2.0 (0.8, 4.9), ASA- INT+ 176 (75, 390), and ASA- INT- 271 (199, 366). The INT use did not cause a significant difference in STxB2 levels. A STxB2 cut point of 25 ng/mL had high sensitivity (94.1%) and specificity (91.1%) for ASA use. The STxB2 was a reliable marker of ASA use and could be used to confirm ASA exposure in population-based health studies.
  Clinical and Applied Thrombosis/Hemostasis 05/2013;
• Article: Prothrombotic States in Migraine.

  Roopa Rajan, Jasmina Ahluwalia, Vivek Lal
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  ABSTRACT: The increased risk of cardiovascular and cerebrovascular events in patients with migraine remains unexplained. Prothrombotic states are thought to contribute to this increased risk. The present study aimed to compare the prevalence of prothrombotic states in patients with migraine and headache-free controls. We conducted a case-control study to screen for prothrombotic states protein C, protein S (PS), antithrombin III, factor V Leiden, lupus anticoagulant, anticardiolipin, and anti-β2-glycoprotein 1 antibodies in 101 consecutive patients with migraine and 148 controls. An underlying prothrombotic state was encountered in 11.8% of the patients with migraine, PS deficiency being the most common (4.0%). There was no significant difference in the prevalence of prothrombotic states in patients with migraine compared to controls. Traditional prothrombotic states do not seem to have a higher prevalence in patients with migraine compared to controls.
  Clinical and Applied Thrombosis/Hemostasis 05/2013;
• Article: Venous Thromboembolism in Patients With Prior Stroke.

  Gregory Piazza, Samuel Z Goldhaber, Aimee Kroll, Robert J Goldberg, Catherine Emery, Frederick A Spencer
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  ABSTRACT: Patients with prior stroke are susceptible to venous thromboembolism (VTE). We studied patients with stroke in the Worcester VTE study of 2488 consecutive patients hospitalized with VTE. In all, 288 (11.6%) had a clinical history of stroke and 2200 (88.4%) did not. Patients with stroke were more likely to die inhospital (9.2% vs 4%) and within 30 days of VTE diagnosis (16.7% vs 6.9%) compared with patients without stroke (all P < .001). Recent immobilization (adjusted odds ratio [OR] 2.15; 95% confidence interval [CI] 1.15-4.09) and inferior vena cava (IVC) filter insertion (adjusted OR 2.1; 95% CI 1.15-3.83) were associated with a doubling of inhospital death. Recent immobilization (adjusted OR 1.84; 95% CI 1.19-2.83) and IVC filter insertion (adjusted OR 1.94; 95% CI 1.2-3.14) were associated with an increased risk of death within 30 days of VTE. In conclusion, patients with VTE and prior stroke were more than twice as likely to die while hospitalized and within 30 days of VTE diagnosis.
  Clinical and Applied Thrombosis/Hemostasis 05/2013;
• Article: Recombinant Human Thrombopoietin Alleviates Infection-Associated Thrombocytopenia: A Retrospective Study in Senile Patients.

  Jie Lin, Hongli Zhu, Suxia Li, Hui Fan, Xuechun Lu
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  ABSTRACT: Objective: To examine the efficacy and adverse events of recombinant human thrombopoietin (rhTPO) in the treatment of infection-associated thrombocytopenia in senile patients. Methods: The current study is a retrospective analysis of the patients receiving rhTPO for infection-associated thrombocytopenia in our hospital. Results: Forty-nine cases were included in the analysis as rhTPO group. The absolute platelet count after treatment, increase in platelet count, and the overall response rate were considerably higher in the rhTPO group than that in the control group. Improvement in bleeding score was higher in the rhTPO treatment group than that in the control group (2.1 ± 5.4 vs 0.4 ± 1.7). Bleeding event was stopped in 68.2% of the patients after rhTPO treatment and in 35% of the patients in the control group (P = .032). A stratified analysis indicated that the therapeutic efficacy is much better in patients without organ failure. Conclusion: Recombinant human TPO is effective in alleviating infection-associated thrombocytopenia and hemorrhage in senile patients, particularly if given prior to the emergence of organ failure.
  Clinical and Applied Thrombosis/Hemostasis 05/2013;
• Article: Hypercoagulation Assessed by Thromboelastography is Neither Related to Infarct Size nor to Clinical Outcome After Primary Percutaneous Coronary Intervention.

  Nadia Paarup Dridi, Jacob T Lønborg, Maria D Radu, Peter Clemmensen, Thomas Engstrøm, Henning Kelbæk, Erik Jørgensen, Steffen Helqvist, Kari Saunamäki, Troels H Christensen, Florian M M Baeres, Pär I Johansson, Lene Holmvang
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  ABSTRACT: Objectives: We investigated the relationship between coagulation assessed by thromboelastography (TEG) and myocardial damage in ST-segment elevation myocardial infarction (STEMI). Methods: We measured platelet activity with TEG-maximum amplitude (TEG-MA) in 233 patients undergoing urgent percutaneous coronary intervention (PCI). Infarct size and myocardial salvage index were evaluated using cardiac magnetic resonance, and the relation of these parameters to posttreatment coagulation was examined retrospectively. Adverse events were adjudicated and related to the coagulation status during the index event. Results: Hypercoagulation was found in 82 (35.2%) patients and was neither correlated to infarct size nor correlated to myocardial salvage index (P = .28 and .65, respectively) or clinical adverse events. Patients who experienced an adverse event during follow-up had a slightly higher TEG-MA value than patients with an event-free follow-up, but this was not statistically significant (68.1 vs 67.3, P = .44). Conclusions: The TEG-MA does not appear to be a sensitive predictor of reperfusion success and prognosis in urgent PCI for STEMI.
  Clinical and Applied Thrombosis/Hemostasis 04/2013;
• Article: Anticoagulation in Patients With Left Ventricular Systolic Dysfunction and Sinus Rhythm: When?

  Nasir Sivri, Ertan Yetkin, Gulacan Ozgun Tekin, Kenan Yalta, Johannes Waltenberger
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  ABSTRACT: Left ventricular (LV) systolic dysfunction and chronic systolic heart failure (HF) predispose to intraventricular thrombus formation and embolization resulting in stroke. Current guideline recommends the use of oral anticoagulants in patients with atrial fibrillation and history of previous thromboembolism. However, anticoagulant treatment in patients with LV systolic dysfunction with sinus rhythm and without history of previous thromboembolism is still on debate. Recent epidemiologic date has reported increased stroke rate in patients with systolic HF shortly after diagnosis. This review focuses on the possible causes of increased stroke rate shortly after the diagnosis of HF and subsequently suggests a rationale for the use of oral anticoagulant in these patient groups.
  Clinical and Applied Thrombosis/Hemostasis 04/2013;
• Article: Ischemic Stroke Predicts Myocardial Injury After Carotid Endarterectomy for Symptomatic Severe Carotid Artery Stenosis.

  Hua Feng, Tian-Long Wang, Bing Cai
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  ABSTRACT: Myocardial injury following carotid endarterectomy (CEA) is a common cause of morbidity and mortality, and its risk varies depending on the severity and extent of disease. However, when patients with sympotomatic severe carotid stenosis undergo CEA, the frequency and potential predictors of myocardial injury remain unknown. A total of 40 patients (32 men and 8 women) who underwent successful standard CEA were observed. Cardiac troponin I (cTnI) concentrations were assessed before surgery and on postoperative days 1, 2, and 3 in all patients. Myocardial injury was defined as the peak cTnI concentration > 0.04 ng/mL. In all, 42.5% patients had postoperative myocardial injury. Previous ischemic stroke and abnormal ST-segment changes were the preoperative predictors of myocardial injury after CEA, with odds ratios of 4.1 (95% confidence interval, 1.1-16.1; P = .04) and 5.9 (95% confidence interval, 1.3-27.7; P = .04), respectively. Sympotomatic patients with those conditions should receive more attention to myocardial injury, when presented for CEA.
  Clinical and Applied Thrombosis/Hemostasis 04/2013;
• Article: Weight Reduction Is Associated With Increased Plasma Fibrin Clot Lysis.

  Beata Brzezinska-Kolarz, Marek Kolarz, Angelika Walach, Anetta Undas
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  ABSTRACT: Obesity is associated with an increased risk of vascular thrombotic events. We sought to investigate how obesity and weight loss affect plasma fibrin clot properties. A total of 29 obese patients were studied before and after 3-month low-fat diet. Plasma fibrin clot parameters, including fibrin clot permeation coefficient (Ks), the lag phase of the turbidity curve, clot lysis time (t50%), maximum rate of increase in D-dimer levels, and maximum D-dimer concentrations, were determined. Low-fat diet resulted in the reduction of body weight (P < .0001), body mass index (P < .0001), fat mass (P < .0001), total cholesterol (P < .0001), low-density lipoprotein cholesterol (P = .0005), triglycerides (P = .008), and plasminogen activator inhibitor 1 (P = .02), but not in fibrinogen or C-reactive protein. The only change in fibrin clot variables was shorter t50% (P = .02). Baseline t50%, but not posttreatment, correlated with waist circumference (r = .44, p = .02). This study demonstrates that weight loss in obese people can increase the efficiency of fibrin clot lysis.
  Clinical and Applied Thrombosis/Hemostasis 04/2013;
• Article: Carbonic Anhydrase IX in the Prediction of Right Ventricular Dysfunction in Patients With Hemodynamically Stable Acute Pulmonary Embolism.

  Yasin Abul, Savas Ozsu, Ahmet Mentese, Ismet Durmus, Hayriye Bektas, Mehtap Pehlivanlar, Oguzhan Ekrem Turan, Aysegul Sumer, Asim Orem, Tevfik Ozlu
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  ABSTRACT: Right ventricular dysfunction (RVD) defined by echocardiography and/or by natriuretic peptides is a well-known predictor of prognosis in patients with pulmonary embolism (PE). This study investigated carbonic anhydrase IX (CA IX) levels for predicting echocardiographic RVD in patients with PE. A total of 150 normotensive patients with PE were included. The levels of CA IX, N-terminal pro-brain-type natriuretic peptide (NT-proBNP), and high-sensitive cardiac troponin T were significantly elevated in patients with PE with RVD on echocardiography. A receiver-operating characteristic curve analysis showed a value of 0.751 for CA IX, 0.714 for NT-proBNP, and 0.650 for high-sensitive troponin-T to predict RVD on echocardiography. The cutoff value to predict RVD was 32.45 pg/mL for CA IX (sensitivity: 89.3% and specificity: 51.1%). There was a significant positive correlation between the CA IX level and the systolic pulmonary arterial pressure on echocardiography (ρ = .21; P = .035). The CA IX is a significant serologic predictor of RVD in acute PE and correlates with systolic pulmonary arterial pressure.
  Clinical and Applied Thrombosis/Hemostasis 04/2013;
• Article: Testosterone, Thrombophilia, and Thrombosis.

  Charles J Glueck, Caitlin Richardson-Royer, Reiker Schultz, Tim Burger, Fanta Labitue, Muhammad K Riaz, Jagjit Padda, Dedrick Bowe, Naila Goldenberg, Ping Wang
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  ABSTRACT: We describe thrombosis, deep venous thrombosis (DVT) pulmonary embolism (PE; n = 9) and hip-knee osteonecrosis (n = 5) that developed after testosterone therapy (median 11 months) in 14 previously healthy patients (13 men and 1 woman; 13 Caucasian and 1 African American), with no antecedent thrombosis and previously undiagnosed thrombophilia-hypofibrinolysis. Of the 14 patients, 3 were found to be factor V Leiden heterozygotes, 3 had high factor VIII, 3 had plasminogen activator inhibitor 1 4G4G homozygosity, 2 had high factor XI, 2 had high homocysteine, 1 had low antithrombin III, 1 had the lupus anticoagulant, 1 had high anticardiolipin antibody Immunoglobulin G, and 1 had no clotting abnormalities. In 4 men with thrombophilia, DVT-PE recurred when testosterone was continued despite therapeutic international normalized ratio on warfarin. In 60 men on testosterone, 20 (33%) had high estradiol (E2 >42.6 pg/mL). When exogenous testosterone is aromatized to E2, and E2-induced thrombophilia is superimposed on thrombophilia-hypofibrinolysis, thrombosis occurs. The DVT-PE and osteonecrosis after starting testosterone are associated with previously undiagnosed thrombophilia-hypofibrinolysis. Thrombophilia should be ruled out before administration of exogenous testosterone.
  Clinical and Applied Thrombosis/Hemostasis 04/2013;
• Article: Other Inflammatory Markers Should Not be Forgetten When Assessing the Neutrophil-to-Lymphocyte Ratio.

  Sevket Balta, Sait Demirkol, Mustafa Cakar, Zekeriya Arslan, Murat Unlu, Turgay Celik
  Clinical and Applied Thrombosis/Hemostasis 04/2013;
• Article: Carotid Intima-Media Thickness in Patients With Slow Coronary Flow and Its Association With Neutrophil-to-Lymphocyte Ratio: A Preliminary Report.

  Faruk Cingoz, Atila Iyisoy, Sait Demirkol, Mehmet Ali Sahin, Sevket Balta, Turgay Celik, Murat Unlu, Zekeriya Arslan, Mustafa Cakar, Ugur Kucuk, Seref Demirbas, Necmettin Kocak
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  ABSTRACT: Background: The slow coronary flow (SCF) is characterized by angiographically normal or near-normal coronary arteries with delayed progression of the contrast agent into distal vasculature. We aimed to investigate neutrophil-to-lymphocyte (N/L) ratio and the carotid intima-media thickness (CIMT) value in patients with SCF compared to patients with newly diagnosed coronary artery disease (CAD) and normal patients. Materials and Methods: We enrolled 60 consecutive patients with SCF, 68 patients with CAD, and 72 normal patients. The association between thrombolysis in myocardial infarction frame count, CIMT, and N/L ratio and other clinical and laboratory parameters were evaluated. Results: The N/L ratio was significantly higher not only in patients with SCF but also in patients with CAD, compared to those of controls. The N/L ratio was positively and moderately correlated with CIMT in the whole study population. Conclusions: The NL ratio is significantly associated with reduced coronary blood flow, and elevated N/L ratio might be an independent predictor for the presence of SCF.
  Clinical and Applied Thrombosis/Hemostasis 04/2013;
• Article: Monitoring of Unfractionated Heparin Using Activated Partial Thromboplastin Time: An Assessment of the Current Nomogram and Analysis According to Age.

  Je Sang Kim, Hyun Jong Lee, Ji Dong Sung, Hee-Jin Kim, Soo-Youn Lee, June Soo Kim
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  ABSTRACT: Background: We frequently encounter high levels of activated partial thromboplastin time (aPTT) during heparin anticoagulation. The purpose of this study is, first, to investigate the rate of achieving and maintaining therapeutic aPTT in patients treated with heparin anticoagulation and second, to assess the adequacy the current nomogram. Methods: We included 197 patients who underwent anticoagulation with unfractionated heparin (UFH) according to the standard nomogram between September 2008 and May 2010. The primary endpoints were the rate of achieving a therapeutic range (TR) at the first sample, 24 hours, or 48 hours. We also compared heparin nomograms according to age (<70 years vs ≥70years).Results: Of the 197 patients, 131 had heparin loading. In the heparin loading group, there were 19.1% (n=25), 69.5% (n=91), and 90.1% (n=18) achieving TR at the first aPTT, 24 hours, and 48 hours, respectively. The therapeutic aPTT proportion was 39.2%, and the rate of peak level above 90 seconds was 93.1%. Peak levels of aPTT were higher in the older age group than in the younger age group (202.3 ± 124.2 versus 152.0 ± 78.9, p=0.007).Conclusion: Our results indicate a high rate of achieving therapeutic aPTT at 24hous and 48hours, but a low success rate for maintenance within the TR. Most patients had supratherapeutic aPTT of more than 90 seconds. Therefore, the TR of aPTT that matches heparin levels of 0.3 to 0.7 IU/mL measured by antifactor Xa assay should be determined. If not, we should consider adopting a new heparin dosing nomogram.
  Clinical and Applied Thrombosis/Hemostasis 04/2013;
• Article: Venous Thromboembolism in Elderly High-Risk Medical Patients: Time Course of Events and Influence of Risk Factors.

  Russell D Hull, Tazmin Merali, Allan Mills, Abigail L Stevenson, Jane Liang
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  ABSTRACT: Venous thromboembolism (VTE) causes significant morbidity and mortality in hospitalized medical populations; however, medical patients do not currently receive thromboprophylaxis beyond their hospital stay. We reviewed the real-life occurrence of VTE-related care for 100 days post-hospitalization in Calgary, Canada. Using medical visit records with a unique patient identifier number applied throughout the city's hospitals, 989 high-risk patients were selected for review. Almost three-quarters of the elderly patients received appropriate prophylaxis while in hospital, and only 2% received prophylaxis on discharge. Over the 100-day follow-up, 21% of the patients presented with clinically suspected VTE, of which 3.8% had confirmed VTE. Patients with multiple risk factors (≥3) had the highest frequency of confirmed VTE (≥6.1%). This study suggests that the actual rate of VTE-related follow-up care in patients post-hospitalization is high in the first 100 days, particularly among those who have multiple risk factors, warranting consideration of extended thromboprophylaxis in this population.
  Clinical and Applied Thrombosis/Hemostasis 04/2013;
• Article: Prediction of Antiplatelet Effects of Aspirin In Vivo Based on In Vitro Results.

  Haruko Yokoyama, Naoko Ito, Shinji Soeda, Masahiro Ozaki, Yuji Suzuki, Masayuki Watanabe, Emiko Kashiwakura, Tsutomu Kawada, Noriyuki Ikeda, Kentaro Tokuoka, Yasuhisa Kitagawa, Yasuhiko Yamada
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  ABSTRACT: The aim of this study was to establish a method to predict the antiplatelet effects of aspirin in vivo based on in vitro results. Aspirin in 5 different concentrations was added to the platelet-rich plasma samples, and the rates of platelet aggregation induced by collagen were determined in vitro. In addition, platelet aggregation and plasma drug concentration values were determined in vivo before and after the administration of aspirin (162 mg). The 50% effective concentration (EC50) values obtained from the in vivo and in vitro experiments were shown to have relevance, because the EC50 ratio for each subject was the same (0.23 ± 0.03). The actual and predicted values for the rate of inhibition of platelet aggregation were well correlated (P < .0001, r = .95) when the predicted rate was determined using the present method. Our results suggest that the antiplatelet effects of aspirin can be predicted using blood samples obtained before its administration.
  Clinical and Applied Thrombosis/Hemostasis 04/2013;
• Article: Preoperative Neutrophil-Lymphocyte Ratio and Saphenous Vein Graft Patency After Coronary Artery Bypass Grafting.

  Irfan Tasoglu, Osman Turak, Yunus Nazli, Firat Ozcan, Necmettin Colak, Serpil Sahin, Kemal Kavasoglu, Bahadir Genc, Dogan Sert, Mehmet Karahan, Omer Cicek, Ata Ecevit
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  ABSTRACT: Aim: The aim of the present study was to investigate the predictive value of preoperative neutrophil-lymphocyte ratio (NLR) in postoperative saphenous vein graft patency in patients undergoing coronary artery bypass grafting (CABG) surgery. Method: We retrospectively analyzed 444 patients who had undergone CABG and a further control coronary angiography due to recurrence of symptoms. The patients were divided into tertile groups according to the NLR. The primary end point was 50% saphenous vein graft stenosis or more or complete occlusion. Result: The saphenous vein graft failure in the 3 groups based on NLR was 33%, 66.2%, and 79.1%, in the low-, middle- and high-risk groups, respectively. In multivariate regression modeling, current smoker, diabetes mellitus, target artery diameter <1.5 mm, and NLR independently predicted saphenous vein graft patency in patients after CABG. Conclusion: Preoperative NLR is clearly an independent predictor of saphenous vein graft patency in patients after CABG.
  Clinical and Applied Thrombosis/Hemostasis 04/2013;
• Article: Protamine Overdose and Its Impact on Coagulation, Bleeding, and Transfusions After Cardiopulmonary Bypass: Results of a Randomized Double-Blind Controlled Pilot Study.

  Andreas Koster, Jochen Börgermann, Jan Gummert, Markus Rudloff, Armin Zittermann, Uwe Schirmer
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  ABSTRACT: Background: We assessed the effects of protamine overdosing on thrombelastometry, bleeding, and transfusions in patients after cardiopulmonary bypass (CPB). Methods: In group 1 (n = 15), representing the clinical standard, the protamine dose was based on the initial heparin dose, and group 2 (n = 15) received protamine based on the heparin concentration measured after CPB. Primary end points were thromboelastometric parameters. Secondary end points were perioperative blood loss and utilization of blood products. Results: During CPB, heparin concentrations decreased by 40%, resulting in overdosing of protamine in group 1. Thromboelastometry revealed longer clotting time (CT) in group 1 (P values < .05). Four patients in group 1 but none in group 2 had excessive prolonged CT values (>360 seconds) and concomitant microvascular bleeding, requiring substantial replacement of coagulation factors. Conclusions: Heparin dose-based protamine management leads to protamine overdosing with inhibition of the coagulation process. Protamine management guided by heparin concentration avoids these complications.
  Clinical and Applied Thrombosis/Hemostasis 04/2013;
• Article: Superficial vein thrombosis.

  Andrew Nicolaides, Russell D Hull, Jawed Fareed
  Clinical and Applied Thrombosis/Hemostasis 04/2013; 19(2):208-13.