Seminars in Thrombosis and Hemostasis

Publisher: Georg Thieme Verlag

Current impact factor: 3.88

Impact Factor Rankings

2016 Impact Factor Available summer 2017
2014 / 2015 Impact Factor 3.876
2013 Impact Factor 3.693
2012 Impact Factor 4.216
2011 Impact Factor 4.524
2010 Impact Factor 4.169
2009 Impact Factor 3.214
2008 Impact Factor 3.695
2007 Impact Factor 3.202
2006 Impact Factor 2.733
2005 Impact Factor 2.077
2004 Impact Factor 2.018
2003 Impact Factor 1.906
2002 Impact Factor 2.497
2001 Impact Factor 2.147
2000 Impact Factor 2.179
1999 Impact Factor 2.385
1998 Impact Factor 1.577
1997 Impact Factor 1.171
1996 Impact Factor 1.15
1995 Impact Factor 1.175
1994 Impact Factor 1.483
1993 Impact Factor 1.415
1992 Impact Factor 1.542

Impact factor over time

Impact factor

Additional details

5-year impact 3.57
Cited half-life 5.70
Immediacy index 2.32
Eigenfactor 0.01
Article influence 0.97
ISSN 1098-9064
OCLC 163849709
Material type Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Georg Thieme Verlag

  • Pre-print
    • Author cannot archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Author's post-print or Publisher's version/PDF on author's personal website immediately
    • Author's post-print in Institutional Repository and PubMed Central after 12 months embargo
    • Publisher's version/PDF can be used on author's personal website only
    • Publisher copyright and source must be acknowledged
    • Link to Publisher version ( must be included if article has been published online
    • Publisher last contacted on 31/03/2015
    • 'Georg Thieme Verlag' is an imprint of 'Thieme Publishing'
  • Classification

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Recombinant activated factor VIIa (rFVIIa) is a prohemostatic agent initially approved for use in hemophilia patients with inhibitors and recently for Glanzmann thrombasthenia. Despite its approval indications, rFVIIa has also been used for a diverse range of off-label indications to treat bleeding related to traumatic injury, major hemorrhage following surgery, intracranial hemorrhage, and for uncontrolled bleeding as a prothrombotic hemostatic agent. Despite its off-label use, the benefit of rFVIIa in most nonhemophilia settings remains uncertain as the majority of clinical trials have not consistently demonstrated beneficial effects as determined by reduced bleeding, decreased blood product utilization, or have not demonstrated a mortality benefit. As with any prohemostatic agent, the risk of thromboembolic events is increased when rFVIIa is used off-label. Pooled data from randomized nonhemophilia studies report an increased risk in the elderly for arterial thromboses, although most individual trials have been underpowered to determine adverse thrombotic events. The causes of thrombotic adverse events associated with off-label use of rFVIIa may be due to an increased risk of adverse events due to critical illness or due to higher doses of rFVIIa used in off-label trials. Without clearly supportive data, physicians should consider risk versus benefit and exercise restraint using rFVIIa in off-label settings. Further, evidence-based guidelines should be developed by professional organizations, and additional randomized controlled clinical trials are needed to further assess the efficacy and safety of off-label rFVIIa use.
    No preview · Article · Feb 2016 · Seminars in Thrombosis and Hemostasis
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cardiac surgery patients are prone to anemia from several mechanisms: intraoperative blood loss, preexisting anemia, and hemodilution. Patients are very frequently transfused with allogeneic red blood cells (RBC), which in itself is associated with harm. The use of RBC salvage technology has been advocated to salvage blood lost in the operative field and to reduce the need of homologous blood transfusion. Direct cardiotomy suction from the surgical field and unprocessed blood retransfusion is a common practice during cardiopulmonary bypass, but which is associated with a powerful activation of the coagulation and inflammatory systems: thrombin generation, excessive fibrinolysis, and release of proinflammatory cytokines. Compared with direct cardiotomy suction, the use of RBC salvage technology is able to reduce the amount of microparticles and activated proteins of autologous blood before retransfusion. However, when compared with no retransfusion of blood from the operative field, processed blood also triggers coagulopathy and inflammation. Clinical studies are discordant regarding the benefit of RBC salvage use during and after cardiac operations. Meta-analysis suggests reduced need of homologous blood transfusion, but no effects on mortality and morbidity.
    No preview · Article · Feb 2016 · Seminars in Thrombosis and Hemostasis
  • [Show abstract] [Hide abstract]
    ABSTRACT: Congenital von Willebrand disease (VWD) and acquired von Willebrand syndrome (AVWS) reflect conditions caused by von Willebrand factor (VWF) deficiency and/or defects. VWD is the most common inherited bleeding disorder and AVWS arises from a variety of causes. Since VWF stabilizes and protects factor VIII (FVIII) in the circulation, this is also reduced in many patients with VWD. The treatment of VWD and AVWS therefore primarily entails replacement of VWF, and sometimes FVIII, to protect against bleeding. This may entail the use of VWF concentrates (currently plasma-derived) and/or FVIII concentrates (currently plasma-derived or more increasingly recombinant forms), and/or desmopressin to release endogenous VWF in subgroups of patients. For AVWS additional treatment of the underlying condition is also required. Adjunct therapies include antifibrinolytics. Globally, various formulations exist for both VWF and FVIII concentrates and are differentially available based on manufacturer marketing or regulatory approvals/clearances in different geographies. Also, guidelines for treatment of VWD vary for different localities and recombinant VWF is undergoing clinical trials. The current review provides an overview of the treatment of VWD as currently practiced in developed countries, and also provides a glimpse towards the future.
    No preview · Article · Feb 2016 · Seminars in Thrombosis and Hemostasis
  • [Show abstract] [Hide abstract]
    ABSTRACT: Red blood cells play a key role in normal hemostasis and thrombosis. Their ability to affect coagulation is multifactorial and depends on their mechanical properties affecting viscosity and blood flow, ability to aggregate and adhere to each other and potentially to vascular endothelium, molecular signaling via microvesicles and surface proteins, including blood group antigens, and participation in nitric oxide metabolism. Transfused red blood cells suffer from a storage lesion that damages the cells leading to changes in shape, function, and intracellular communication. In this article, we review if and how transfused red blood cells may lead to both increased hemorrhage and increased thrombosis.
    No preview · Article · Feb 2016 · Seminars in Thrombosis and Hemostasis
  • [Show abstract] [Hide abstract]
    ABSTRACT: Ultrasonographic examination for deep vein thrombosis (DVT) appears to be a safe diagnostic method, but a theoretical concern has been raised for dislodgment of thrombi during examination. We conducted a systematic review of the literature to identify reports of possible or confirmed pulmonary embolism (PE) as a consequence of ultrasonographic assessment of extremities in patients with suspected DVT. We searched PubMed for studies published in English from January 1, 1960, to April 10, 2015. We included all cohort studies, case series, and case reports that described PE as a consequence of ultrasonographic assessment of extremities. We excluded studies that reported assessment of areas other than extremities. We screened 3,626 articles, 15 of which reported the issue of clot dislodgement and embolization following ultrasonographic examination of the extremities, including 8 original case reports (7 men and 1 woman). DVTs were in the lower extremities in all eight cases: five in right and three in left lower extremity. In six cases, the femoral veins were involved, and a free-floating thrombus was reported in two cases. Compression ultrasonography was used in all cases, with or without adjunct techniques. Overall, there were seven confirmed and one probable PE cases, two of which had fatal outcomes. Clot embolization is a rare but potential complication of ultrasonic examination for DVT that can lead into PE. Radiologists and clinicians should be aware of this potentially serious phenomenon and avoid excessive pressure when performing ultrasonographic studies of the extremities.
    No preview · Article · Jan 2016 · Seminars in Thrombosis and Hemostasis
  • [Show abstract] [Hide abstract]
    ABSTRACT: Management of hemophilia has evolved significantly in the last century-from recognition of the causative mechanism in the 1950s to commercially available clotting factor concentrates in the 1960s. Availability of lyophilized concentrates in the 1970s set the stage for home-based therapy, followed by introduction of virally attenuated plasma-derived, and then recombinant factor concentrates in the 1980s and 1990s, respectively. The subsequent years saw a paradigm shift in treatment goals from on-demand therapy to prophylactic factor replacement starting at an early age, to prevent hemarthrosis becoming the standard of care for patients with severe hemophilia. In the developed world, the increasing use of home-based prophylactic regimens has significantly improved the quality of life, and life expectancy of patients with severe hemophilia. Seminal developments in the past 5 years, including the commercial availability of extended half-life factor concentrates and the publication of successful results of gene therapy for patients with hemophilia B, promise to further revolutionize hemophilia care over the next few decades. In this review, we summarize the evolution of management for hemophilia, with a focus on extended half-life factor concentrates and gene therapy.
    No preview · Article · Jan 2016 · Seminars in Thrombosis and Hemostasis
  • [Show abstract] [Hide abstract]
    ABSTRACT: The novel direct oral anticoagulants (DOACs) have been proposed as alternatives to low-molecular-weight heparins (LMWHs) for the prevention of venous thromboembolism in orthopedic surgery. However, the clinical impact of postsurgical bleeding with the DOACs has not been extensively evaluated. MEDLINE and EMBASE databases, supplemented with conference abstract books and, were searched up to the first week of March 2015. We included phase II and phase III randomized controlled trials comparing the DOACs with LMWHs in patients undergoing major orthopedic surgery. Data regarding major, fatal, and intracranial bleeding were collected, to calculate the pooled relative risk (RR) and the case-fatality rate (CFR), with 95% confidence interval (CI). We retrieved 25 studies (5 evaluating dabigatran, 4 apixaban, 6 edoxaban, and 10 rivaroxaban), enrolling 42,170 patients. There was no significant difference between the DOACs and LMWHs in the risk of major (1.23 vs. 1.16%; RR: 1.07, 95% CI: 0.89-1.29), fatal (0.02 vs. 0.01%; RR: 1.63, 95% CI: 0.39-6.77), and intracranial bleeding (0 vs. 0.01%; RR: 0.33, 95% CI: 0.03-3.18). The weighted mean CFR of major bleeding was 3.3% (95% CI, 1.5-5.7) and 2.3% (95% CI, 0.7-4.6), respectively. Bleeding complications and the associated CFR during prophylactic anticoagulation in orthopedic surgery were very low and not significantly different between the DOACs and LMWHs.
    No preview · Article · Jan 2016 · Seminars in Thrombosis and Hemostasis
  • [Show abstract] [Hide abstract]
    ABSTRACT: Coagulopathy in critically ill patients is common and often multifactorial. Fresh frozen plasma (FFP) is commonly used to correct this either prophylactically or therapeutically. FFP usage is mainly guided by laboratory tests of coagulation, which have been shown to have poor predictive values for bleeding. Viscoelastic tests are an attractive option to guide hemostatic therapy, but require rigorous evaluation. The past few years have seen a gradual reduction in national use of FFP potentially due to an increased awareness of risks such as transfusion-related acute lung injury, patient blood management strategies to reduce transfusion in general, and increased awareness of the lack of high-quality evidence available to support FFP use. Within critical care, FFP is administered before invasive procedures/surgery, to treat major traumatic and nontraumatic hemorrhage, disseminated intravascular coagulation, and for urgent warfarin reversal if first-line agents, such as prothrombin complex concentrate (PCC) are not available. Alternative agents such as fibrinogen concentrate and PCC need further evaluation through large-scale clinical trials.
    No preview · Article · Dec 2015 · Seminars in Thrombosis and Hemostasis
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pathogen inactivation (PI), or pathogen reduction technology, reduces the infectious risk of plasma and platelet transfusions, and also affects clotting factor activities and platelet viabilities. Plasma is treated with solvent-detergent to disrupt enveloped viruses, or with photoactive agents methylene blue plus light, or amotosalen (AM) or riboflavin (RF) plus ultraviolet (UV) light, to disrupt pathogen nucleic acids. PI plasmas have average clotting factor activities of 75 to 85% of untreated plasma. PI plasmas are generally equivalent to regular plasma in randomized clinical trials (RCTs) in regard to coagulation test corrections and bleeding outcomes, except for one trial in which RF plasma was inferior for prothrombin time correction. Platelets are treated with UV plus RF or AM. In RCTs, the mean 1-hour corrected count increments from PI platelets are 66 to 94% (trials median, 75%) of those from untreated platelets. PI platelets also have lifespans of 4 to 5 days after 5 days of storage, compared with 6 to 7 days for untreated platelets. Bleeding outcomes comparing PI versus non-PI platelets in RCTs have been equivalent, except one study with more bleeding on AM platelets. Platelet treatment with UVC light alone for PI has entered clinical trials.
    No preview · Article · Dec 2015 · Seminars in Thrombosis and Hemostasis
  • [Show abstract] [Hide abstract]
    ABSTRACT: Fibrinogen has a central role in coagulation. Following trauma and perioperatively, low fibrinogen levels have been found to be risk factors for exaggerated bleeding, transfusion needs, and adverse outcome. Conversely, treatment with exogenous fibrinogen in critically bleeding patients with low fibrinogen levels has been shown to decrease transfusion needs. Because following trauma and in many perioperative situations fibrinogen is the first coagulation "element" to become critically low, it appears reasonable to target fibrinogen in clinical coagulation algorithms aiming at early specific and goal-directed treatment. A low fibrinogen can be a low plasma concentration or a low functional fibrinogen as assessed by point-of-care techniques such as thromboelastography (TEG) or thromboelastometry (ROTEM). This review summarizes the evidence base for perioperative algorithm-based fibrinogen administration, including the exact thresholds for fibrinogen administration used in the different algorithms. Algorithm-based individualized goal-directed use of fibrinogen resulted in highly significant reduction in transfusion needs, adverse outcomes, in certain studies even mortality, and where investigated reduced costs, with high safety levels at the same time. Best evidence exists in cardiac surgery, followed by trauma, postpartum hemorrhage, and liver transplantation. The introduction of these concepts is highly demanding and requires a tremendous educational effort to familiarize all health care workers with the necessary knowledge and the skills of how to run TEG/ROTEM tests. Future research is needed to compare the efficacy, safety, and costs of different algorithms. This, however, should not prevent us from introducing these expedient point-of-care-based algorithms clinically today.
    No preview · Article · Dec 2015 · Seminars in Thrombosis and Hemostasis
  • [Show abstract] [Hide abstract]
    ABSTRACT: Trauma-induced coagulopathy is caused by multiple factors, such as anemia, hemodilution, hypothermia, acidosis, shock, and serious trauma itself, which affects patient outcomes due to critical bleeding requiring massive transfusion. Disseminated intravascular coagulation (DIC) with the fibrinolytic phenotype directly caused by trauma and/or traumatic shock has been considered to be the primary pathophysiology of trauma-induced coagulopathy. The key to controlling DIC is vigorous treatment of the underlying disorder, that is, trauma itself and hemorrhagic shock. Damage control resuscitation, consisting of damage control surgery, permissive hypotension, and hemostatic resuscitation, aims to control severe trauma and critical bleeding, which is equivalent to managing the underlying disorder of DIC. At present, however, evidence-based practices for damage control resuscitation are lacking. A robust prospective outcome study for damage control resuscitation that considers DIC with the fibrinolytic phenotype as the main pathological condition of trauma-induced coagulopathy affecting patient outcome is essential for improving therapeutic strategies.
    No preview · Article · Dec 2015 · Seminars in Thrombosis and Hemostasis

  • No preview · Article · Nov 2015 · Seminars in Thrombosis and Hemostasis
  • [Show abstract] [Hide abstract]
    ABSTRACT: The results of lupus anticoagulant (LA), antithrombin (AT), protein C (PC), and protein S (PS) testing, and the values of von Willebrand factor antigen (VWF:Ag) are important in diagnosis and therapeutic monitoring of thrombosis and hemostasis diseases. Till now, no published study has focused on the biological variations in LA testing, and only a few studies have examined the biological variations of AT, PC, PS, and VWF:Ag. With the latest fully automated instruments and improved reagents, the analytical, within-subject, and between-subject biological variations were estimated for these five coagulant parameters in a cohort of 25 apparently healthy subjects. Blood specimens were collected at 8:00 am, 12:00 pm, and 4:00 pm on days 1, 3, and 5. The analytical biological variation (CVA) values of all the parameters were less than 3%. The within-subject biological variation (CVW) and between-subject biological variation (CVG) values of the LA normalized ratio were 4.64 and 6.83%, respectively. No significant differences were observed in the intraday and interday biological variations of LA tests, or in AT, PC, PS, and VWF:Ag values. Additionally, the utility of the conventional population-based reference intervals of the five coagulation parameters was evaluated by the index of individuality, and data on CVW and CVA were used to calculate the reference change value to identify the significance of changes in serial results from the same individual.
    No preview · Article · Oct 2015 · Seminars in Thrombosis and Hemostasis
  • [Show abstract] [Hide abstract]
    ABSTRACT: The international classification of functioning (ICF) has provided a basic framework for the measurement of outcomes in any health condition. This includes the assessment of the level of activity, participation, and the quality of life of an individual with hemophilia. The measure of activity is an assessment of the individual's ability to perform daily tasks while participation assesses the social role of the individual. The health-related quality of life is an assessment of the perception of the individual's physical, mental, and social well-being. These functional outcomes are important to understand the impact of the broad spectrum of interventions in the management of hemophilia. The generic instruments used to measure these may be less sensitive than the disease-specific measures but are useful for the comparison between cohorts with different health conditions. Cross-cultural validity is essential for tools where the question can vary in the context of different cultures.
    No preview · Article · Oct 2015 · Seminars in Thrombosis and Hemostasis
  • [Show abstract] [Hide abstract]
    ABSTRACT: Assessment of quality in terms of safety and efficacy of clotting factor concentrates (CFCs) is very important for all new therapeutic products. In rare diseases this is often complicated due to small number of trial participants. In hemophilia, an extra complication is the large impact previous treatments have on both the risk on inhibitors and the overall response to bleedings. For new CFCs, safety needs to be evaluated against inhibitor risk whereas efficacy is primarily judged against the most common clinical manifestations of the disease, namely, bleeding into joints and muscles. In this article the challenges are described for hemophilia that recruits patients globally. Recommendations of ISTH are discussed; these propose to substitute the single-arm prelicensure study with a two-stage approach, which considers epidemic and endemic incidence rate, and might increase the feasibility of studying multiple new products in populations with rare disease without compromising the assessment of product safety and efficacy. We also suggest that the annual bleeding rate (ABR) is an unreliable predictor of efficacy. The response to treatment highly depends on the current disease status of every patient participating in a clinical trial. The phenotype of patients with hemophilia is highly influenced by previous treatment history. Patients with severe hemophilia of the same age can demonstrate a different response to treatment.
    No preview · Article · Oct 2015 · Seminars in Thrombosis and Hemostasis
  • [Show abstract] [Hide abstract]
    ABSTRACT: Definitions of clinical events and end points of care are important for disease characterization as well as documentation of outcomes in clinical practice and trials. Until recently, the only definitions in hemophilia that were provided through an international scientific organization related to disease severity and levels of inhibitors. Recently, the Scientific and Standardization Committee (SSC) of the International Society on Thrombosis and Haemostasis, through its Factor VIII and IX subcommittee, published consensus definitions for several other aspects of hemophilia management, including classification of disease severity; inhibitors; bleeding (and rebleeding) into muscles and joints; target joints; different forms of factor replacement therapy; and response to therapy for joint bleeding and surgical hemostasis. These definitions should help to bring greater uniformity in the documentation of critical clinical events and laboratory data that are reported both from clinical trials as well as real-world practice. This article describes these definitions in greater detail than the SSC short report and also addresses some of the unresolved issues. Wide dissemination of these concepts and definitions and their acceptance by relevant leading scientific societies, drug regulators, industry, and patient organizations will go a long way in ensuring their acceptance and use globally.
    No preview · Article · Oct 2015 · Seminars in Thrombosis and Hemostasis

  • No preview · Article · Oct 2015 · Seminars in Thrombosis and Hemostasis
  • [Show abstract] [Hide abstract]
    ABSTRACT: Imaging assessment is an important tool to evaluate clinical joint outcomes of hemophilia. Arthropathic changes have traditionally been evaluated by plain radiography and more recently by ultrasound and magnetic resonance imaging (MRI). Early arthropathic changes can be identified by modern imaging techniques such as T2 mapping MRI of cartilage even before clinical symptoms become apparent. Cross-sectional imaging modalities such as CT, ultrasonography, and MRI are useful in assessing bleeding-related musculoskeletal complications such as pseudotumors that still exist in some parts of the world. This article provides an overview of imaging of hemophilic arthropathy, and discusses the role and scope of individual imaging modalities currently in use in clinical practice, as well as of promising techniques that require further investigation in the immediate future.
    No preview · Article · Oct 2015 · Seminars in Thrombosis and Hemostasis