Anticoagulation Group Research Articles

How do anticoagulants impact menstrual bleeding and quality of life? - The PERIOD study

BackgroundThere is increasing recognition that menstruating women prescribed anticoagulants experience heavy menstrual bleeding. ObjectivesThe aim of this study is to report the extent of bleeding in menstruating women after commencing anticoagulants and the impact it has on their quality of life. MethodsWomen aged 18 to 50, initiated on anticoagulant therapy, were approached to take part in the study. In parallel, a control group of women was also recruited. Women were asked to complete the menstrual bleeding questionnaire and a pictorial blood assessment chart (PBAC) during their next 2 menstrual cycles. Differences between the control and anticoagulated group were compared. Significance was considered at < .05. Ethics committee approval: REC reference: 19/SW/0211. ResultsFifty-seven women in the anticoagulation and 109 women in the control group returned their questionnaires. Women in the anticoagulated group reported an increase in the median length of their menstrual cycle from 5 to 6 days after commencing anticoagulation, compared to 5 days for women in the control group (P < .05). Anticoagulated women reported significantly higher PBAC scores as compared to the control group (P < .05), with two-thirds of women in the anticoagulation group reporting heavy menstrual bleeding. Women in the anticoagulation group reported worsening quality of life scores following the initiation of anticoagulation, compared with women in the control group (P < .05). ConclusionHeavy menstrual bleeding occurred in two-thirds of women commencing anticoagulants, who completed a PBAC, which had negative impact on their quality of life. Clinicians commencing anticoagulation therapy should be mindful of this, and recognized measures should be taken to help minimize this problem for menstruating individuals.

Abstract WP124: Stroke Severity And In-hospital Death In Intracerebral Hemorrhage Patients Taking Antithrombotic Agents: Japan Stroke Data Bank

Purpose: The purpose of this study was to determine the associations between antithrombotic agents at onset and outcomes in intracerebral hemorrhage (ICH) patients. Methods: ICH patients admitted within 24 hours after onset from January 2017 to December 2020 were examined from a long-lasting nationwide hospital-based multicenter prospective registry, the Japan Stroke Data Bank. Patients were classified into 4 groups according to types of antithrombotic agents at onset: no-antithrombotic, antiplatelet, warfarin, and DOAC groups. Patients with combination of antiplatelet and anticoagulant agents were classified into respective anticoagulant groups. The outcomes were NIHSS on admission, in-hospital death and unfavorable outcome corresponding to mRS of 5-6 at discharge. Results: Of a total of 9,948 ICH patients (female: 4,329, age 70±15 years old), 77.4% of patients were classified into the no-antithrombotic group, 13.0% into the antiplatelet group, 3.9% into the warfarin group and 5.7% into the DOAC group. Median NIHSS on admission was 12 (interquartile range: 5-22), 13 (5-26), 15 (5-30) and 13 (6-24), respectively. In multivariable analysis, the warfarin group was significantly associated with higher NIHSS on admission (adjusted incidence rate ratio, 1.08 [95% CI, 1.05-1.12], setting the no-antithrombotic group as reference), but the antiplatelet group (1.01 [0.99-1.03]) or the DOAC group (0.97 [0.94-1.00]) was not. The rate of in-hospital death was 13.0% in the no-antithrombotic group, 17.8% in the antiplatelet group, 27.3% in the warfarin group and 18.9% in the DOAC group and that of unfavorable outcome was 30,8%, 41.9%, 48.6% and 41.5%, respectively. In multivariable analysis, the warfarin group was significantly associated with in-hospital death and unfavorable outcome (adjusted odds ratio: 1.62 [95% CI, 1.07-2.46] and 1.79 [1.23-2.6], respectively, setting the no-antithrombotic group as reference), but the antiplatelet group (1.14 [0.87-1.36], 1.11 [0.90-1.36]) or the DOAC group (1.07 [0.72-1.60], 1.27 [0.90-1.78]) was not. Conclusion: ICH patients taking warfarin at onset had higher NIHSS on admission, in-hospital death and unfavorable outcome compared to those without antithrombotic agents, but those taking DOAC did not.

Predictors of Complications at Common Femoral Artery Access Site among Patients on Oral Anticoagulants and Undergoing a Cardiac Catheterization

Introduction: It is not clear whether patients receiving oral anticoagulants (OC) during surgery involving access to the common femoral artery would experience more adverse effects than those not receiving OC. In this analysis, we determine whether patients receiving oral anticoagulants undergoing cardiac catheterization are at high risk of complications related to femoral site than subjects not receiving OACs. Study Settings: This study was held in the Cardiology department of Qazi Hussain Ahmed Medical Complex, Nowshera and Peoples University of Medical and Health Sciences for Women PUMHSW (SBA) Nawabshah for one-year duration from January 2021 to December 2021. Methods: A total of 300 patients were selected for the study. We regularly reviewed data from patients undergoing cardiac surgery at the same tertiary care center. A patient was classified as fully or partially anti-coagulated (Group A) if his international normalized ratio (INR) was greater than 1.6 on the surgery day or if he received new OAC or warfarin within 48 hours or less after surgery. The group without anticoagulants (Group B) had an INR of 1.6 or had stopped the new OAC and warfarin more than 48 and 24 hours prior to surgery, respectively. Results: A total of 300 patients (mean age 65.6±12.2, 60% male) were registered in the study. 20 (6.7%) were in Group A and Group B included 280(93.3%) patients. The intervention was done among 162/300 (54%) patients and received treatment with Intra-procedural anticoagulation with heparin (50.0%), bivalirudin (23.3%) or both (3.3%). GpIIb/IIIa inhibitors were used infrequently (1%). Conclusions: Compared to patients who did not receive anticoagulants during the procedure, OAC patients experienced no major serious adverse events after 30 days. Keywords: Oral anticoagulant, Common femoral artery, complications, access site.

Safety, efficacy and prognosis of anticoagulant therapy for portal vein thrombosis in cirrhosis: a retrospective cohort study

BackgroundThe role of anticoagulants in the treatment of cirrhotic PVT remains controversial. This study aimed to analyze the safety and efficacy of anticoagulant therapy in patients with cirrhotic portal vein thrombosis (PVT) and its impact on prognosis.MethodsA retrospective cohort study was conducted for PVT patients with liver cirrhosis in our hospital. The primary outcome of the study was the PVT recanalization rate. Other outcomes included bleeding rate, liver function, and mortality. Cox and Logistic regression were used to explore the risk factors of outcomes.ResultsThis study included 77 patients that 27 patients in the anticoagulant group and 50 in the non-anticoagulant group. Anticoagulant therapy was associated with higher rate of PVT recanalization (44.4% vs 20.0%, log-rank P = 0.016) and lower rate of PVT progression (7.4% vs 30.0%, log-rank P = 0.026), and without increasing the rate of total bleeding (14.8% vs 24%, P = 0.343), major bleeding (3.7% vs 6%, P = 0.665) and variceal bleeding (3.7% vs 16%, P = 0.109). The safety and efficacy of different anticoagulants were similar. The Child-Pugh grade of the anticoagulant therapy group was better than that of the non-anticoagulant therapy group (P = 0.030). There was no significant difference in the 2-year survival rate of the two groups.ConclusionAnticoagulants could increase the PVT recanalization rate and reduce the PVT progression rate without increasing the rate of bleeding. Anticoagulants may be beneficial to improving the liver function of patients with cirrhotic PVT. There was no significant difference in the safety and efficacy of different anticoagulants in the treatment of cirrhotic PVT.

Resumption of anticoagulant therapy after major bleeding and the risk of negative events in patients with atrial fibrillation (based on REGistry of Long-term AnTithrombotic TherApy-2 - REGATA)

It is necessary to strive to resume anticoagulants for patients with atrial fibrillation who have a high risk of thrombosis after the development of large bleeding. Due to the fact that death in these patients is caused not by a recurrence of fatal bleeding, but by the development of stroke in case of refusal of anticoagulant therapy. To evaluate the effect of the resumption of anticoagulant therapy on the risk of recurrence of major bleeding, thrombosis and death in patients with atrial fibrillation who have suffered major bleeding. To evaluate the frequency of bleeding, thrombosis and death in patients with atrial fibrillation after major bleeding according to prospective follow-up data for one year. The recurrence rate of major bleeding after the resumption of therapy was 21.7% per year. The frequency of fatal bleeding was 2.2%. In the anticoagulant withdrawal group, the incidence of thrombotic complications (ischemic stroke and myocardial infarction) was significantly higher compared to patients who resumed therapy. The frequency of death from all causes was significantly higher in the group of patients who did not resume anticoagulant therapy. Half of the deaths were due to cardiovascular causes. The presence of more than 5 points of the Charlson Comorbidity Index was a predictor of the development of the sum of all adverse events. The resumption of anticoagulant therapy after the development of major bleeding in patients with atrial fibrillation reduces the risk of thrombosis and death at a cost, while increasing the risk of recurrence of non-fatal bleeding.

Long-term efficacy and safety of anticoagulant for cavernous transformation of the portal vein cirrhotic patient with extrahepatic portal vein obstruction

Background/aimsCavernous transformation of the portal vein (CTPV) in cirrhotic patients with extrahepatic portal vein obstruction (EHPVO) was a relatively rare disease and had no consensus on the treatment. Our study aimed to explore the value of anticoagulation with warfarin treatment for CTPV cirrhotic patients with EHPVO.Methods: From January 2015 to December 2019, the clinical characteristics of cirrhotic patients who were diagnosed as CTPV with EHPVO were retrospectively analyzed. Eligible patients were distributed into the anticoagulation group (n = 46) and control group (n = 38). The change of portal vein thrombosis, hepatic decompensation, survival and adverse events were evaluated between the two groups.ResultsThe median follow-up of our patients was 51 months in the anticoagulation group and 44 months in the control group. The progress rate of the portal vein was higher in patients from the control groups (n = 12) than in patients from the anticoagulation group (n = 4, p = 0.008). There was no significant difference between the partial recanalization rate and stable rate between the two groups. Patients in anticoagulation group developed less hepatic decompensation than those in control group (13.0% vs 34.2%, p = 0.021). The Kaplan-Meier curve showed that patients in the anticoagulation group had a better prognosis than patients in the control group (P < 0.022). There were no serious complications due to warfarin treatment.ConclusionFor CTPV cirrhotic patients with EHPVO, anticoagulation with warfarin treatment was effective and safe. Anticoagulants could prevent portal vein thrombosis progression, hepatic decompensation and death. In addition, our results showed little benefit of anticoagulants on thrombosis recanalization.

Effect of Anticoagulant Versus Non-Anticoagulant Therapy on Mortality of Sepsis-Induced Disseminated Intravascular Coagulation: A Systematic Review and Meta-Analysis.

Sepsis is a syndrome of severe systemic inflammatory response. When combined with disseminated intravascular coagulation, mortality is increased. The need for anticoagulant therapy is still the focus of debate. PubMed, Embase, Cochrane Library, and Web of Science were searched. Adult patients with sepsis-induced disseminated intravascular coagulation were included in this study. All-cause mortality as efficacy and serious bleeding complications as adverse effect were measured as primary outcomes. Methodological quality of included studies were assessed using the Methodological Index for Non-randomized Studies (MINORS). Meta-analysis was performed using R software (version 3.5.1) and Review Manager (version 5.3.5). There were nine eligible studies with 17,968 patients included. There were no significant reductions in mortality between the anticoagulant group and the non-anticoagulant group (RR, 0.89; 95% CI, 0.72-1.10; P = 0.27). The DIC resolution rate in the anticoagulation group has a statistically significant increase compared with the control group [OR: 2.62, 95% CI (1.54-4.45), P < 0.05]. And there was no significant difference in bleeding complications between the two groups (RR, 1.27; 95% CI, 0.77-2.09; P = 0.69). SOFA score reduction did not change significantly between the two groups (P = 0.13). Our study observed no significant benefit of anticoagulant therapy on mortality of sepsis-induced DIC. Anticoagulation therapy can promote DIC resolution in sepsis-induced DIC. In addition, anticoagulant therapy does not increase the risk of bleeding in these patients.

Efficacy and Safety of Anticoagulant Therapy Versus Antiplatelet Therapy in Acute Ischemic Stroke Patients with Atrial Fibrillation.

The efficacy and safety of anticoagulant therapy in patients with acute ischemic stroke (AIS) and atrial fibrillation (AF) remain uncertain. This study enrolled 431 AIS and AF patients from Nanjing Drum Tower Hospital between January 2019 and December 2021 and followed for 365 days to determine the associations between anticoagulants and clinical outcomes by assessing modified Rankin Scale (mRS) score, recurrent ischemic stroke/systemic embolism (IS/SE), all-cause mortality, intracranial hemorrhage (ICH) and major bleeding. Final analysis included 400 eligible patients and divided them into antiplatelet group (n = 191) and anticoagulant group (n = 209). Anticoagulant therapy was associated with excellent (mRS 0-1; adjusted odds ratio (aOR), 2.63; 95% confidence interval (CI), 1.61-4.30) and favorable functional outcomes (mRS 0-2; aOR, 2.82; 95% CI, 1.69-4.70) and lower risk of all-cause mortality (adjusted hazard ratio (aHR), 0.35; 95% CI, 0.21-0.57), ICH (aHR, 0.45; 95% CI, 0.23-0.87) and major bleeding (aHR, 0.51; 95% CI, 0.28-0.94), without increasing the risk of recurrent IS/SE (aHR, 0.75; 95% CI, 0.45-1.24). In conclusion, anticoagulant therapy may be a more effective and safer option than antiplatelet therapy for AIS patients with AF.

Retrospective Analysis of Direct-Acting Oral Anticoagulants (DOACs) Initiation Timing and Outcomes After Thrombolysis in High- and Intermediate-Risk Pulmonary Embolism.

Direct-acting oral anticoagulants (DOACs) are prescribed in the treatment of venous thromboembolism, including pulmonary embolism (PE). Evidence is limited regarding the outcomes and optimal timing of DOACs in patients with intermediate- or high-risk PE treated with thrombolysis. We conducted a retrospective analysis of outcomes among patients with intermediate- and high-risk PE who received thrombolysis, by choice of long-term anticoagulant agent. Outcomes of interest included hospital length of stay (LOS), intensive care unit LOS, bleeding, stroke, readmission, and mortality. Descriptive statistics were used to examine characteristics and outcomes among patients, by anticoagulation group. Patients receiving a DOAC (n = 53) had shorter hospital LOS compared to those in warfarin (n = 39) and enoxaparin (n = 10) groups (mean LOS 3.6, 6.3 and 4.5 days, respectively; P < .0001). This single institution retrospective study suggests DOAC initiation <48 h from thrombolysis may result in shorter hospital LOS compared to DOAC initiation ≥48 h (P < .0001). Further larger studies with more robust research methodology are needed to address this important clinical question.

Endovascular Thrombus Removal for Treating Post-Partum Iliofemoral Deep Vein Thrombosis: A Single-Centre Retrospective Cohort Study.

To evaluate the safety and efficacy of percutaneous thrombectomy for treating postpartum iliofemoral vein thrombosis. A retrospective analysis was performed on patients with continuous postpartum acute symptomatic iliofemoral deep vein thrombosis who were treated in our center, including all patients who underwent pharmacomechanical thrombolysis (PMT) or only catheter-directed thrombolysis (CDT) (study group), and patients that received simple anticoagulation treatment (control group). We evaluated the incidence of lower extremity postthrombotic syndrome, recanalization rate of lower extremity veins, and complications in the study and control groups. Overall, 72 postpartum women were included in this study, including the PMT combined with CDT group (14 cases, 15 limbs), CDT alone group (26 cases, 27 limbs), and anticoagulant therapy alone group (32 cases, 34 limbs). The thrombectomy group completed the treatment with a technical success rate of 100%, and no serious bleeding complications occurred. The patency rate of lower limb veins in the thrombectomy group was 85.09 ± 16.51% after treatment and 82.60 ± 21.45% after 1 year. At the 1-year follow-up, the Villalta score in the study group was lower (1.90 ± 2.45 vs 8.50 ± 5.33, P < .001), and the incidence of postthrombotic syndrome was significantly different between the groups (17.50% in the study group vs 68.75% in the anticoagulant group, P < .001). Lower extremity venous thrombectomy is a safe and effective treatment for postpartum iliofemoral venous thrombosis. It can improve the patency rate of lower extremity veins and reduce the incidence of postthrombotic syndrome compared with anticoagulation alone.

Assessing operative delay and complications in hip fracture patients on anticoagulants and antiplatelets

Hip fractures represent a prevalent geriatric cause of morbidity and mortality. The presence of multiple comorbidities requiring the use of an anticoagulant or antiplatelet medication adds complexity to management and influences outcomes. International guidelines suggest expedited surgery within 48 h; however, anticoagulant and antiplatelet medications commonly cause delays. Research exploring health outcomes in this group is unclear. Therefore, we aimed to determine the impact of anticoagulant and antiplatelet medications on operative delay and overall complications in hip fracture patients. A retrospective cohort study of hip fractures was performed at a tertiary hospital over a 3-year period from 1st January 2018 to 31st December 2020. Data collected included demographics, time to surgery, length of stay, postoperative blood transfusion, venous thromboembolism, acute coronary syndrome, stroke, infections in hospital and 120-day mortality. Patients were categorised based on the use of direct oral anticoagulants, warfarin and antiplatelet medications. In total, 474 patients were included and 43.5% were on an anticoagulant or antiplatelet medication. Patients on these medications had more than twice the rate of operative delay (41.7% versus 17.2%, p < 0.001) with the greatest in the direct oral anticoagulant group (92.7% delay). After controlling for age and gender, this was still significant for direct oral anticoagulant (p < 0.001) and antiplatelet group patients (p = 0.02). These patients also had a 20% increased overall complication rate (p < 0.001). On subgroup logistic regression, the increased complication rate was noted in the direct oral anticoagulant group (p = 0.006) and the antiplatelet group (p < 0.001) but not in the warfarin group (p = 0.25). Time to surgery beyond 48 h was associated with a double increase in the odds of a postoperative complication (p = 0.005). There is a significantly greater delay to surgery in hip fracture patients on anticoagulant or antiplatelet medications as well as a higher incidence of complications. Guidelines to expedite early safe surgery in this high-risk patient group are required.

Regional Citrate Anticoagulation or Heparin Anticoagulation for Renal Replacement Therapy in Patients With Liver Failure: A Systematic Review and Meta-Analysis.

In patients with liver failure complicated by acute kidney injury, renal replacement therapy (RRT) is often required to improve the internal environment. The use of anticoagulants for RRT in patients with liver failure remains controversial. We searched the PubMed, Embase, Cochrane Library, and Web of Science databases for studies. The methodological quality of the included studies was assessed using the Methodological Index for Nonrandomized Studies. A meta-analysis was performed using R software (version 3.5.1) and Review Manager (version 5.3.5). During RRT, 348 patients from 9 studies received regional citrate anticoagulation (RCA), and 127 patients from 5 studies received heparin anticoagulation (including heparin and LMWH). Among patients who received RCA, the incidence of citrate accumulation, metabolic acidosis, and metabolic alkalosis were 5.3% (95% confidence interval [CI]: 0%-25.3%), 26.4% (95% CI: 0-76.9), and 1.8% (95% CI: 0-6.8), respectively. The potassium, phosphorus, total bilirubin (TBIL), and creatinine levels were lower, whereas the serum pH, bicarbonate, base excess levels, and total calcium/ionized calcium ratio were higher after treatment than before treatment. Among patients who received heparin anticoagulation, the TBIL levels were lower, whereas the activated partial thromboplastin clotting time and D-dimer levels were higher after treatment than before treatment. The mortality rates in the RCA and heparin anticoagulation groups were 58.9% (95% CI: 39.2-77.3) and 47.4% (95% CI: 31.1-63.7), respectively. No statistical difference in mortality was observed between the 2 groups. For patients with liver failure, the administration of RCA or heparin for anticoagulation during RRT under strict monitoring may be safe and effective.

Prospective randomized trial of antithrombotic strategies following great saphenous vein ablation using injectable polidocanol endovenous microfoam (Varithena)

ObjectivePostablation deep vein thrombosis (DVT) represents a potentially serious complication after Varithena polidocanol endovenous microfoam (PEM) ablation. The following primary outcomes were assessed: whether (1) adjunctive apixaban anticoagulation or (2) mechanical deep venous system (DVS) saline flushing could decrease saphenofemoral junction (SFJ) thrombus extension (postablation superficial thrombus extension [PASTE]) and/or DVT compared with compression alone, after great saphenous vein (GSV) PEM ablation. MethodsVarithena 1% PEM ablation patients were randomized to (1) SFJ compression, (2) compression and DVS saline flushing, or (3) compression, DVS saline flushing, and 5 days of postprocedural 5 mg oral apixaban anticoagulation twice daily. Duplex imaging was obtained 7 to 10 days after PEM ablation and PASTE/DVT incidence (primary end point) was compared between groups at this time point. ResultsWe treated 304 limbs in 257 patients with PEM. Overall, 103 limbs received SFJ compression (group C, 33.8%), 101 received compression and deep venous flushing (group D, 32.9%), and 100 received compression, deep flush, and anticoagulation (group A, 33.2%). Mean ultrasound follow-up time was 9.7 days (all patients) with a primary GSV closure rate of 92.4%. SFJ PASTE (II-IV) occurred in 0.9%, 1.0%, and 0% (groups C, D, and A, respectively). DVT occurred in 16.7%, 14.7%, and 1.98% (groups C, D, and A; χ2, P = .002). Patients in group A receiving apixaban anticoagulation had a significant reduction in DVT compared with patients in group C (1.98% vs 16.7%, χ2; P < .001); likewise, patients in group A had a significantly decreased DVT occurrence compared with group D (14.7% vs 1.98%; χ2, P = .00162), whereas patients in groups C and D were not statistically different (16.7% vs 14.7%; χ2, P = .60). Conclusions(1) Neither adjunctive DVS flushing nor anticoagulation decreased clinically relevant SFJ PASTE (II-IV) incidence, which remained similarly low across all groups and ranged between 0% and 1%, regardless of adjunctive DVS flushing or anticoagulation. This rate was significantly lower than prior reports (2.3%-4.1%). (2) DVS flushing had no influence on the rate of DVT. Observed PEM-induced DVT incidence using SFJ compression alone or compression with DVS flushing (16.7% and 14.7%, respectively) was significantly higher than prior reports (2.5%-9.6%). This finding may relate to the greater extent of AK/BK GSV territory treated in the present study. (3) Five days of postprocedural oral apixaban anticoagulation, 5 mg given twice daily, significantly decreased DVT occurrence to 1.98%, compared with nonanticoagulated patients (16.7%). This finding is comparable with the DVT rates reported after endovenous thermal ablation (0.7-1.7%). (4) Postprocedural apixaban anticoagulation may have a significant preventive role in decreasing DVT occurrence after PEM ablation.

Increased incidence of venous thromboembolism associated with inferior vena cava filter placement in patients diagnosed with isolated calf deep vein thrombosis after intracranial hemorrhage or intracranial operation.

In this study, we sought to investigate the effectiveness of inferior vena cava (IVC) filter placement in reducing the incidence of venous thromboembolism (VTE) in patients diagnosed with isolated calf deep vein thrombosis (DVT) after an intracranial hemorrhage or intracranial operation. A retrospective chart review (January 2000-December 2019) was performed to identify patients diagnosed with calf DVT after intracranial hemorrhage or intracranial operation. A total of 100 patients met the study criteria and were divided into groups based on treatment: IVC filter placement (n = 22), prophylactic anticoagulation (n = 42), or imaging surveillance (n = 36). Treatment-related complications were identified, and differences between groups in the primary endpoint (VTE occurrence after DVT diagnosis) were assessed using logistic regression. VTE occurred in 15 patients after calf DVT diagnosis. The rate of VTE was higher in the IVC filter group (9/22; 41%) than in the anticoagulation (2/42; 5%; p = 0.002) and surveillance (4/36; 11%; p = 0.013) groups. These treatment effects remained significant after adjustments were made for baseline characteristics (IVC filter vs anticoagulation, p = 0.009; IVC filter vs surveillance, p = 0.019). There was a single occurrence of pulmonary embolism in the surveillance group (3%). A single case of IVC filter thrombus was identified; no anticoagulation-related complications were reported. The findings of this study do not support IVC filter placement as a primary and solitary treatment for isolated calf DVT occurring after intracranial hemorrhage or intracranial operation.

Enoxaparin attenuates pyrrolizidine alkaloids-induced hepatic sinusoidal obstruction syndrome by inhibiting oncostatin M expression.

The definitive treatment for pyrrolizidine alkaloids (PAs)-induced hepatic sinusoidal obstruction syndrome (HSOS) is not available. The effectiveness of anticoagulation therapy remains controversial. The efficacy of low molecular weight heparin (LMWH) should be investigated in patients and animal models, and the underlying mechanism should be explored. The prognosis of patients with PAs-HSOS who received anticoagulation therapy was retrospectively analysed. The effect of enoxaparin on the liver injury was determined in animal models of monocrotaline (MCT)-induced HSOS was determined, and the underlying mechanism was investigated using a murine model. The cumulative survival rate of patients with PAs-induced HSOS was 60.00% and 90.90% in the non-anticoagulation group and anticoagulation group. Enoxaparin attenuated liver injury effectively in a rat model of MCT-induced HSOS. Additionally, the improvement of severe liver injury was observed in MCT-treated mice after the administration of enoxaparin (40 mg/kg). The alleviation of liver injury was observed in mice with hepatocyte-specific deletion of oncostatin M (Osm△Hep ). In MCT-treated mice administrated with enoxaparin, no significant differences in liver injury were observed between Osm△Hep mice and Osmflox/flox mice. Additionally, adenovirus-mediated overexpression of Osm resulted in severe liver injury in MCT-induced mice after the administration of enoxaparin. LMWH attenuated severe liver injury in patients with PAs-Induced HSOS and animal models of MCT-induced HSOS, which provides a rationale for the application of anticoagulation therapy.

Rivaroxaban Prophylaxis in Noncirrhotic Portal Vein Thrombosis

BackgroundIn patients with noncirrhotic chronic portal vein thrombosis (PVT), the benefit of long-term anticoagulation is unknown. We assessed the effects of rivaroxaban on the risk of venous thromboembolism and portal hypertension-related bleeding in such patients.MethodsIn this multicenter, controlled trial, we randomly assigned patients with noncirrhotic chronic PVT without major risk factors for thrombosis to receive either rivaroxaban 15 mg/day or no anticoagulation. The primary end point was 2-year thrombosis-free survival. Secondary end points included the occurrence of site-specific thromboses and major bleeding events.ResultsA total of 111 participants were enrolled in the trial, with a mean age of 50.4±13.2 years; 58% of participants were men. An unplanned interim analysis was requested by the independent data safety monitoring board (DSMB) after 10 thrombotic events occurred. The thrombosis incidence rate was 0 per 100 person-years in the rivaroxaban group and 19.71 per 100 person-years (95% confidence interval, 7.49 to 31.92) in the no anticoagulation group (log-rank P=0.0008) after a median follow-up of 11.8 months. Based on the interim analysis, the DSMB recommended switching patients from the no anticoagulation group to anticoagulation. After a median follow-up of 30.3 months (intraquartile range, 24.3 to 47.8), major bleeding occurred in two patients receiving rivaroxaban and in one patient not receiving anticoagulation. No deaths occurred.ConclusionsAfter a median follow-up of 11.8 months, among patients with noncirrhotic chronic PVT without major risk factors for thrombosis, daily rivaroxaban reduced the incidence of venous thromboembolism and did not increase major bleeding events. (Funded by grants from the French Ministry of Health and the Association de Malades des Vaisseaux du foie; ClinicalTrials.gov number, NCT02555111.)

In-Hospital Clinical Ooutcomes of COVID-19 Patients Treated with Oral Anticoagulants

Objective: We aimed to investigate the effects of warfar in and new-generation oral anticoagulants on the prognosis of patients diagnosed with Corona Virus Disease 2019 (COVID-19). Materials and Methods: Patients diagnosed with COVID-19 were divided into two groups depending on whether they were using warfarin or a new-generation oral anticoagulant. The types of chronic diseases, drugs used, haematological and biochemical parameters and prognoses in each group were statistically analysed. Results: Twenty-three patients (37.1%) using warfarin and 39 (62.9%) patients using new-generation oral anticoagulants were included in the study. There was no significant difference between the two groups in terms of demographic characteristics and laboratory data. The mortality rates for the warfarin and new-generation anticoagulant groups were similar (39.1% vs. 43.6%, respectively; p = 0.731). Conclusion: There was no difference in the effects of warfarin and new-generation oral anticoagulants on mortality among the patients with COVID-19.

Temporal trends in anticoagulation management for US active duty personnel with atrial fibrillation

ObjectivesThis study aims to investigate US active duty (AD) military members diagnosed with atrial fibrillation (AF) and the temporal trends of systemic anticoagulation (AC). Our secondary objective is to study...

Characteristics of Patients with Pulmonary Embolism at Dr. Soetomo General Hospital Surabaya, from 2019-2021

Background: A complication of venous thromboembolism is pulmonary embolism. Pulmonary embolism is a type of cardiovascular disease caused by a thrombus in the pulmonary artery. Nonspecific symptoms and a wide range of clinical to asymptomatic presentations make diagnosing this disease challenging. Objective: In this research, the patient profiles of pulmonary embolism patients admitted at Dr. Soetomo General Hospital in Surabaya from 2019 until 2021 were analyzed. Materials and Methods: This descriptive study utilizes a retrospective methodology using secondary data from the medical record of individuals who suffered pulmonary embolisms during 2019 and 2021. Result: A total of 33 pulmonary embolism patients met the inclusion criteria. Patients were dominated by men (66.7%) and age groups 36-45 and 56-65 years (30.3%). The most symptom was shortness of breath (43.3%). The Geneva score was dominated by the intermediate group (78.8%). PESI scores were overwhelmed by the class III group (36.4%). Vital signs are within normal limits, except respiratory rate results above normal with an average of 24x/min. Complete blood is within normal limits, except white blood cell results above normal with an average of 12.2 10 3/μl. %). Based on the CT scan results, most thrombi were found in the distal pulmonary artery (60%). The anticoagulant group is the most widely administered pharmacological therapy (76.5%). Conclusion: The majority of pulmonary embolism patients are men, with the most frequent symptoms being shortness of breath and the most thrombus locations found in the distal pulmonary artery

A descriptive cross-sectional study of self-management in patients with nonvalvular atrial fibrillation.

Self-management of non-valvular atrial fibrillation (NVAF) is characterized by complexity and diversity of content. Inadequate self-management exposes patients to the risk for complications such as stroke and bleeding. To assess the status and predictors of self-management in NVAF patients, a descriptive cross-sectional study was conducted. The self-management scales for atrial fibrillation were used to assess the status of self-management of patients who received Warfarin, NOAC, Aspirin, or No anticoagulant therapy. The general situation questionnaire was used to collect socio-demographic and clinical data from patients. A total of 555 participants completed the survey, with self-management score of 71.21 ± 12.33, 69.59 ± 13.37, 69.03 ± 12.20 and 66.12 ± 11.36 in Warfarin group, NOAC group, Aspirin group and No anticoagulant group, respectively. In Warfarin group lower educational status was associated with poor self-management; in Aspirin group, comorbidities and age < 65 years (P = .001) were associated with poor self-management; in No anticoagulant group, age < 65 years, single, poor sleep quality, and permanent AF were associated with poor self-management. Self-management was inadequate in patients with NVAF. Poor self-management might be related with the occurrence of cerebral embolism. For NVAF patients receiving anti-thrombotic therapy, relatively young age, comorbidities, and age can have a substantial impact on self-management performance; while age, type of AF, quality of sleep, married status are associated with self-management in patients with no anticoagulants.