Increase In D-dimer Research Articles

Catheter-directed thrombolysis of massive pulmonary embolism in high risk bleeding patients (local experience in kenya, single centre study)

Abstract Background Pulmonary Embolism (PE) is the third most common cause of death after myocardial infarction (MI), and cerebrovascular accidents (CVA) (1). For patients who are at risk of major bleeding such as advanced age, recent operation or delivery or major trauma, strategies to minimise bleeding risk should be considered, including catheter directed thrombolysis therapy (2) in reduced dose. Death from massive PE often occurs within the first two hours, and the risk remains elevated for up to 72 hours after presentation (3,4). Thirty-day survival following the diagnosis of a PE is only estimated to be 59.1%, and despite advances in medical care, in-hospital mortality from acute PE has remained stable over the past decade (5). Catheter directed thrombolysis (CDT) is a novel treatment option for massive/sub massive pulmonary embolism as systemic thrombolysis for acute PE carries up to 20% risk of major bleeding, including 2-5% risk of hemorrhagic stroke (6). Purpose To determine the clinical outcomes of catheter directed thrombolysis in patients with massive/ sub massive pulmonary embolism. Methods We conducted a retrospective quantitative study of 15 patients who presented with massive pulmonary embolism. A systematic random sampling was done to select the patients at advanced age, recent operation or first 2 weeks post labour with high bleeding risk, clinical data was recorded. All patients were taken to Cath lab with right heart catheterization, RA, RV and PA pressure were measured. Swan-Ganz catheter were placed in the main pulmonary trunk in case of bilateral PE, or sub-selective in the culprit branch. Alteplase infusion was given for 24-72 hours until proof for significant lysis of the clot. Clinical success defined as: 1. Stabilization of hemodynamics 2. Improvement in pulmonary systolic pressures, D-Dimer, TAPSE, RV/LV ratio and repeat CT findings 3. Survival to hospital discharge 4. Improvement in 30-day morbidity and mortality. Results There were no death on the trial group at discharge or at 30 days follow up. There were significant improvement of RV size and function elucidated by improvement of RV/LV ratio which were reduced from 1.06±0.18 to 0.89±0.2, TAPSE increased from 14.07±1.6 to 17.6±2.2, p < 0.01. There was significant drop in systolic pulmonary pressure(sPA) 67±14.5 mmHg to 38±14.5mmHg, p<0.001. The improvement of RV function and reduced sPA pressure were associated with increase in D-Dimer by at least 35% post thrombolysis, p<0.001. Conclusion Catheter directed thrombolysis (CDT) improves clinical outcomes in patients with acute pulmonary embolism with minimal risk of minor bleeding, and rapid recovery of right ventricular dysfunction. There were no major bleeding or death noticed in the treatment group and at one month follow up. In experienced centres, CDT is a safe and an effective treatment for both massive and/ or submassive PE. Echocardiography findings before CDT Echocardiography findings after CDT

Post-procedural Plasma D-dimer Level May Predict Futile Recanalization in Stroke Patients with Endovascular Treatment.

High D-dimer levels may increase the likelihood of unfavorable clinical outcomes in patients with acute ischemic stroke. However, the impacts of serum D-dimer levels on outcomes of reperfusion treatment in patients with acute ischemic stroke have not been evaluated. This study aims to assess a possible relationship between serum D-dimer and functional outcomes in stroke patients with endovascular treatment (EVT). Patients with acute ischemic stroke who underwent successful EVT were enrolled. Plasma D-dimer was measured before and within 6 hours after endovascular procedures. Futile recanalization was defined as a modified Rankin Scale score of 3-6 at 90 days of stroke onset. Multivariable logistic regression analyses were performed to determine the relationships between D-dimer and futile recanalization. Of the 161 enrolled patients, 78 (48.4%) were classified as futile recanalization. After adjusting for potential confounders, high post-procedural D-dimer level was associated with futile recanalization (odds ratio, 1.25; 95% CI, 1.05-1.51; P =0.016). In patients with futile recanalization, change in serum D-dimer levels increased significantly after EVT (P <0.001). Furthermore, change in D-dimer level after EVT was associated with futile recanalization (odds ratio, 1.33; 95% CI, 1.11-1.65; P =0.005) independently. High post-procedural plasma D-dimer levels and a significant increase in D-dimer after EVT may predict futile recanalization in patients with acute ischemic stroke.

Disseminated Intravascular Coagulation in Pediatric Acute Leukemia: Prevalence, Laboratory Features, and Prognostic Significance of ISTH Score.

Disseminated intravascular coagulation (DIC) is associated with acute leukemia. DIC prevalence and clinical consequences are complex and varies across acute leukemia subtypes. The International Society of Thrombosis and Hemostasis (ISTH) scoring system is used for the detection of overt DIC. Children of both sexes (1 day-18 years) with acute leukemia, suspected to have DIC and referred to hematology laboratory were included in the study. DIC score was calculated according to ISTH guidelines from laboratory values obtained within 24 h of admission and repeated after 2 weeks. The DIC cases were classified into overt DIC if ISTH score ≤ 5 and non-overt if ISTH score > 5. Sixty-two children diagnosed with acute leukemia and having the clinical and laboratory diagnostic features of DIC along with 48 age-matched healthy controls participated in the study. DIC was more frequently diagnosed in cases of AML (66.13%) compared to ALL (33.87%). Cases with T-ALL had DIC (19.4%) more frequently than B-ALL type (14.5%). Similarly, children with M5, M2, and M3 had DIC more frequently (16.1%, 15.58% and 14.28%, respectively) compared to other AML types. Overt DIC was observed in 71% of DIC cases with acute leukemia while non-overt DIC was diagnosed in 29% of them. Follow-up for 14 days of non-overt cases showed that 12 out of 18 patients progressed from non-overt to overt DIC with a significant increase in D-dimer and a decline in platelets count. The incidence of bleeding (35.4%) was higher than thrombosis (19.4%) among acute leukemia patients with DIC. An ISTH score ≤ 5 predicted increased intensive care unit (ICU) admission, death and end organ dysfunction with odds ratio of 4.28, 6.77, and 6.67, respectively. Based on receiver-operator analysis of DIC cases classified as overt and non-overt DIC based on ISTH score, D-Dimer was excellent predictor of overt DIC with the high sensitivity and specificity. ISTH score predicts death, ICU admission and organ dysfunction in children with acute leukemia. D-Dimer is an excellent predictor of overt DIC in acute leukemia.

Clinical Characteristics and Risk Factors of Patients with Lung Cancer Complicated with Pulmonary Embolism: A Case Control Study.

The purpose of this study was to investigate the clinical characteristics and risk factors for patients with lung cancer complicated by pulmonary embolism and to provide a reference for the early clinical identification of these patients. Eighty patients with lung cancer complicated with pulmonary embolism who were treated at Bethune Hospital of Shanxi from October 2018 to October 2025 were compared with 80 patients with lung cancer without pulmonary embolism. The clinical data of the two groups of patients were collected and analysed. Compared with that in patients in the LC group, the proportion of patients with pulmonary interstitial fibrosis in the LP group was significantly greater (p < 0.05). The incidence of dyspnoea in the LP group was significantly greater than that in the LC group (p < 0.05). Compared with that in the LC group, the proportion of pulmonary artery compression in the LP group was significantly greater, and the difference was statistically significant (p < 0.05). In terms of pathological type, the proportion of adenocarcinoma patients in the LP group was significantly greater than that in the LC group (p < 0.05). In terms of tumor stage, the proportion of patients with stage III/IV disease in the LP group was significantly greater than that in the LC group, while the proportion of patients with stage I/II disease was significantly lower than that in the LC group, and the difference was statistically significant (p < 0.05). The neutrophil [NEUT (%)], prothrombin time (PT), white blood cell (WBC), carcinoma embryonic antigen (CEA) and D-dimer (DD) levels were significantly greater in the LP group than in the LC group (p < 0.05). In terms of treatment, the proportion of patients receiving systemic chemotherapy in the LP group was significantly greater than that in the LC group (p < 0.05). Logistic regression analysis revealed that adenocarcinoma, systemic chemotherapy and tumor stage III-IV were independent risk factors for lung cancer complicated with pulmonary embolism. (1) Tumor stage (III/IV), systemic chemotherapy, and adenocarcinoma were independent risk factors for pulmonary thromboembolism in patients with lung cancer. (2) In addition, patients with LP were more likely to have pulmonary interstitial fibrosis, dyspnoea, compression of the pulmonary artery by the tumor location, biological targeted therapy, and abnormal increases in D-dimer, WBC, NEUT (%), CEA and PT levels as laboratory indicators. (3) Pulmonary thromboembolism should be considered in lung cancer patients with a combination of the factors described above.

Prognostic significance of D-dimer, neuron-specific enolase, and lactate dehydrogenase changes in patients with severe traumatic brain injury: a logistic regression analysis.

The retrospective study was conducted at Baoding No.1 Central Hospital, China, and comprised data from July 2021 to January 2023, and aimed at exploring the relationship of neuron-specific enolase, D-dimer and lactate dehydrogenase with prognosis in patients with serous traumatic brain injury. Data of 100 patients was categorised into favourable prognosis group A having 50(50%) patients and unfavourable prognosis group B having 50(50%) patients, and was compared with as many healthy controls in group C. Increase in neuron-specific enolase, D-dimer and lactate dehydrogenase concentrations was significantly elevated in groups A and B compared to group C (p<0.05), and in group B compared to group A (p<0.05).

A retrospective analysis on the effectiveness of cytokine hemadsorption in patients with severe coronavirus disease 2019

Background: An increase in systemic inflammation due to hyperimmune activation leads to severe coronavirus disease 2019 (COVID-19) disease, acute respiratory distress syndrome, multiple organ failure, and ultimately death. Extracorporeal blood purification using hemadsorption to reduce excessive inflammatory cytokine was suggested as an effective treatment for patients with severe COVID-19. We investigated the effectiveness of intermittent cytokine hemadsorption with a HA330 cartridge in patients with severe COVID-19. Methods: We gathered data from severe COVID-19 patients who underwent hemadsorption using Jafron® (HA330) between October and December 2021. We assessed pre- and post-hemadsorption inflammatory cytokine levels, treatment complications, and mortality. Statistical significance was set at P &lt; 0.05. Results: Of the total 40 patients, 13 (32.5%) were males with a mean age of 63.6 years. In patients who survived (n = 23), a 2-fold decrease in interleukin-6 (IL-6, P = 0.0433), a 3-fold decrease in procalcitonin (P = 0.0163), a 2.5-fold decrease in C-reactive protein (CRP, P = 0.0080), a 2.5-fold increase in D-dimer (P = 0.0337), and a 1.3-fold increase in white blood cell (WBC) (P = 0.0102) were observed before and after cytokine hemadsorption. In patients who died (n = 17), a 2-fold increase in WBC (P = 0.0022) was observed with no significant changes in other parameters. Except for a few cases of platelet transfusion, catheter occlusion, hypotension, and hematoma, no other complications were observed. A low rate of mortality (33.3%) was observed in patients who received 3 sessions of hemadsorption. Conclusion: Intermittent hemadsorption reduced inflammatory factors and improved outcomes of patients with severe COVID-19. Cytokine hemadsorption can be an effective therapeutic option for establishing inflammatory equilibrium. Our study was a non-comparator and single-center observational study. Larger studies like RCTs are warranted.

Concizumab prophylaxis in people with haemophilia A or haemophilia B without inhibitors (explorer8): a prospective, multicentre, open-label, randomised, phase 3a trial

Concizumab is an anti-tissue factor pathway inhibitor monoclonal antibody in development as a once-daily, subcutaneous prophylaxis for patients with haemophilia A or haemophilia B with or without inhibitors. We aimed to assess the efficacy and safety of concizumab in patients with haemophilia A or B without inhibitors. Here we report the results from the confirmatory analysis cutoff. This prospective, multicentre, open-label, randomised, phase 3a trial (explorer8) was conducted at 69 investigational sites in 31 countries. Eligible patients were male, aged 12 years or older, and had congenital severe haemophilia A or moderate or severe haemophilia B without inhibitors and with documented treatment with clotting factor concentrate in the 24 weeks before screening. The trial was paused because of non-fatal thromboembolic events in three patients (two from this trial [explorer8] and one from a related trial in haemophilia with inhibitors [explorer7; NCT04083781]) and restarted with mitigation measures, including a revised dosing regimen of subcutaneous concizumab at 1·0 mg/kg loading dose on day 1 and subsequent daily doses of 0·20 mg/kg from day 2, with options to decrease to 0·15 mg/kg, stay on 0·20 mg/kg, or increase to 0·25 mg/kg on the basis of concizumab plasma concentration measured after 4 weeks on concizumab. Patients recruited after treatment restart were randomly assigned 1:2 using an interactive web response system to receive no prophylaxis and continue on-demand clotting factor (group 1) or concizumab prophylaxis (group 2). The primary endpoints were the number of treated spontaneous and traumatic bleeding episodes for patients with haemophilia A and haemophilia B separately, assessed at the confirmatory analysis cutoff in randomly assigned patients. Analyses were by intention-to-treat. There were two additional groups containing non-randomly-assigned patients: group 3 contained patients who entered the trial before the trial pause and were receiving concizumab in the phase 2 trial (explorer5; NCT03196297), and group 4 contained patients who received previous clotting factor concentrate prophylaxis or on-demand treatment in the non-interventional trial (explorer6; NCT03741881), patients randomly assigned to groups 1 or 2 before the treatment pause, and patients from explorer5 enrolled after the treatment pause. The safety analysis set contained all patients who received concizumab. Superiority of concizumab over no prophylaxis was established if the two-sided 95% CI of the treatment ratio was less than 1 for haemophilia A and for haemophilia B. This trial is registered with ClinicalTrials.gov, NCT04082429, and its extension part is ongoing. Patients were recruited between Nov 13, 2019 and Nov 30, 2021; the cutoff date for the analyses presented was July 12, 2022. 173 patients were screened, of whom 148 (86%) were randomly assigned or allocated to the four groups in the study after trial restart on Sept 30, 2020 (nine with haemophilia A and 12 with haemophilia B in group 1; 18 with haemophilia A and 24 with haemophilia B in group 2; nine with haemophilia A in group 3; and 46 with haemophilia A and 30 with haemophilia B in group 4). The estimated mean annualised bleeding rate ratio for treated spontaneous and traumatic bleeding episodes during concizumab prophylaxis versus no prophylaxis was 0·14 (95% CI 0·07-0·29; p<0·0001) for patients with haemophilia A and 0·21 (0·10-0·45; p<0·0001) for patients with haemophilia B. The most frequent adverse events in patients who received concizumab were SARS-CoV-2 infection (19 [13%] of 151 patients), an increase in fibrin D-dimers (12 [8%] patients), and upper respiratory tract infection (ten [7%] patients). There was one fatal adverse event possibly related to treatment (intra-abdominal haemorrhage in a patient from group 4 with haemophilia A with a long-standing history of hypertension). No thromboembolic events were reported between the trial restart and confirmatory analysis cutoff. Concizumab was effective in reducing the bleeding rate compared with no prophylaxis and was considered safe in patients with haemophilia A or B without inhibitors. The results of this trial suggest that concizumab has the potential to be one of the first subcutaneous treatment options for patients with haemophilia B without inhibitors. Novo Nordisk.

The value of D-dimer in the prognosis of dilated cardiomyopathy: a retrospective cohort study.

D-dimer is a biomarker of coagulation and fibrinolytic system activation in response to the hypercoagulable state of the body. The research aimed to analyze the value of D-dimer in the prognosis of patients with dilated cardiomyopathy (DCM). Patients admitted to our center for the first time with DCM were enrolled consecutively. The clinical characteristics variables were obtained from the electronic medical record system, and the prognostic information was obtained using telephone return visits and a review of repeated hospitalization records. Univariate and multivariate Cox regression was used to explore the association of D-dimer with all-cause mortality. Smooth curve fitting, threshold saturation effect analysis, and subgroup analysis were performed. Ultimately, 534 patients were included. After a follow-up of the enrolled patients, 485 patients obtained prognostic information, of which 159 died from all causes, and the main cause of death was heart failure (89/159), the sudden death accounted for about 17%. The independent positive association between D-dimer and all-cause mortality remained unchanged in both unadjusted and adjusted Cox regression models. In the fully adjusted model, each standard deviation increase in D-dimer was associated with a 14% increase in all-cause mortality (HR = 1.14; 95% CI: 1.02 ~ 1.27; P < 0.05). Curve fitting and threshold effect analysis showed an inflection point in the relationship between D-dimer and all-cause mortality (non-linear test: P = 0.03). When D-dimer was equal to 362ng/ml, HR = 1; and as the value increased, the risk of all-cause mortality increased by 34.7% for every 2-fold increase in D-dimer gradually (HR = 1.347; 95% CI: 1.069 ~ 1.697; P = 0.012). In subgroup analysis, D-dimer and BMI had a significant interaction on all-cause mortality, with a significantly increased risk of all-cause mortality in subjects with BMI ≥ 25kg/m2 (HR = 1.99; 95% CI: 1.34 ~ 2.97; P < 0.01). The ROC curve showed that D-dimer was a good predictor of all-cause mortality, and the areas under the curve at 1-, 3-, and 5-year were 0.71, 0.64, and 0.59, respectively. In addition, D-dimer improved the predictive performance of the MAGGIC heart failure score in patients with DCM. D-dimer is not only independently associated with all-cause mortality in DCM patients, but also has good predictive value, suggesting that D-dimer may be an early and useful marker for improving the management of DCM patients.

Hyper fibrinolysis state in COVID 19 and its correlation to lipid parameters

Hyper fibrinolysis state in COVID 19 and its correlation to lipid parameters

Thrombosis with thrombocytopenia syndrome following adenovirus vector-based vaccines to prevent COVID-19: Epidemiology and clinical presentation in Spain

We describe the epidemiological and clinical characteristics of thrombosis with thrombocytopenia syndrome (TTS) cases reported in Spain. We included all cases of venous or arterial thrombosis with thrombocytopenia following administration of adenoviral vector vaccines (AstraZeneca or Janssen) against COVID-19 disease between 1 February and 26 September 2021. We describe the crude rate and the standardised morbidity ratio. We assessed the predictors of mortality. Sixty-one cases were reported and 45 fulfilled eligibility criteria; 82% of patients were women. The crude TTS rate was 4 cases/1 000 000 doses, and 14-15 cases/1 000 000 doses among patients aged 30-49 years. The number of observed cases of cerebral venous thrombosis was 6-18 times higher than that expected in patients younger than 49 years. Symptoms started a median (quartiles 1 and 3 [Q1-Q3]) of 10 (7-14) days after vaccination. Eighty percent (95% confidence interval [CI]: 65%-90%) had thrombocytopenia at the time of the emergency department visit, and 65% (49%-78%) had D-dimer levels > 2000ng/mL. Patients had thromboses affecting multiple locations in 36% of cases and fatal outcomea in 24%. Platelet nadir<50 000/μL (odds ratio [OR]: 7.4; 95% CI: 1.2-47.5) and intracranial hemorrhage (OR: 7.9; 95% CI: 1.3-47.0) were associated with fatal outcomes. TTS must be suspected in patients with symptoms 10 days after vaccination and thrombocytopenia and/or elevated D-dimer levels.

Serum Ferritin versus C-Reactive Protein in Predicting Outcome and Mortality in Corona Virus Disease 2019 (Covid-19) A Retrospective Observational Study

Abstract Background In coronavirus disease 2019 (COVID-19), finding sensitive biomarkers is critical for detecting severe cases early and intervening effectively. Very few studies evaluated how ferritin and CRP are altered in COVID-19. Therefore, it is of clinical significance to evaluate the disease severity and investigate ferritin and CRP in patients with COVID-19. Objective To explore the infection biomarkers, including ferritin and CRP in ICU patients with COVID-19. We will aim to describe the clinical characteristics of infection markers in patients with COVID-19. Patients and Methods After approval of anesthesiology department and scientific and ethical committees, this retrospective observational study was carried out on 105 consecutive patients with confirmed COVID-19 status attending Ain Shams University Hospital, intensive care units during a 6-month period from January 2020 to July 2020; divided into 2 groups; severe and critically ill cases. Results As regards the follow-up laboratory data, there was a significant increase in follow-up CRP, ferritin, D-dimer and PTT in critical group; compared to severe group. Our study showed that there was a highly significant difference between the 2 groups as regards the need of mechanical ventilation and mortality rate, as 68.3% of critical cases need mechanical ventilation and 58.5% died. As regard the length of stay in the ICU, the critical group had longer stay in the ICU in comparison to the severe group, although this difference was not statistically significant. Conclusion High baseline and follow up laboratory tests of CRP and serum ferritin both can be used as a predictor of outcome and mortality in COVID 19 infection. There is significant positive correlation between age, CRP and duration of stay in the ICU. Also there was a significant positive correlation between CRP, ferritin and duration of stay in the ICU. The increase in age and CRP; had an independent effect on increasing ICU stay. Increase in CRP levels; had an independent effect on increasing the probability of severity of COVID-19 infection. While ferritin shows a significant effect on increasing the probability of severity of COVID-19 infection in univariate analysis. Ferritin level at a cut-off point (&amp;gt;598) predict mortality outcome, with good (89%) accuracy, sensitivity (93.8%) and specificity (42.9%). Also, CRP level at cut-off point (&amp;gt;25) predict mortality outcome, with lower (80%) accuracy, sensitivity (87%) and specificity (33.3%).

Evaluation of the Relationship between Early Clinical Manifestations and Changes in Biochemical, Inflammatory, and Coagulation Parameters and the Prognosis of Pregnant Women with COVID-19 Admitted to the ICU.

In the SARSCov2 virus epidemic, pregnant women are more susceptible to infectious diseases due to changes in biochemical parameters and are at higher risk of severe respiratory disease and pneumonia. This study aimed to evaluate the biochemical, inflammatory and coagulation parameters in pregnant women with severe disease conditions (as one of the high-risk groups) as well as prognosis and outcome. This cross-sectional study was performed on 135 pregnant women with COVID-19 admitted to ICU. Demographic and clinical information and laboratory parameters of the patients were evaluated and recorded at the time of admission and in the next follow-up until discharge or death in addition to the outcome and also the pregnancy outcome. The mortality rate of pregnant women with COVID-19 was 9.6%. The mortality rate decreases with increasing Hb (OR (95% CI): 0.68 (0.47-0.99); P value = 0.043) and lymphocytes (OR (95% CI): 0.92 (0.85-0.96); P value = 0.028) and will increase significantly with increasing PT (OR (95% CI): 1.24 (1.01-1.51); P value = 0.037), INR (OR (95% CI): 1.89 (1.26-2.25); P value = 0.004), D-dimer (OR (95% CI): 1.68 (1.10-2.08); P value = 0.027), and LDH (OR (95% CI): 1.20 (1.01-1.61); P value = 0.010). According to the results of the present study, inflammatory factors such as leukocytes, neutrophils, NLR, CRP have an increasing and lymphocytes have a decreasing trend, so that lymphocytopenia is more common in non-survivors. In addition, increase of PT, INR, D-dimer and LDH and decrease of Hb were significantly associated with increased chance of mortality. But fibrinogen, ferritin, ALT and AST were not significantly associated with mortality in these women.

Outcomes after open and endovascular treatment for mesenteric artery embolism patients: a retrospective inverse probability of treatment-weighted analysis.

This study aims to evaluate outcomes in patients with mesenteric artery embolism (MAE) who received primary endovascular therapy (EVT) or laparotomy, and investigate risk factors for 30-day mortality. A retrospective analysis of 94 MAE patients who underwent two different treatment strategies was undertaken. An inverse probability of treatment weighting (IPTW) method was used to balance the confounding effects of baseline clinical data. Logistic regression analysis was performed to compare the outcomes according to type of treatment regimens before and after IPTW. Univariate and multivariable analysis were conducted to determine the risk factors for 30-day mortality. Twenty-eight MAE patients received primary EVT, and 66 Open Surgery (OS). Logistic regression analysis showed that there was no significant difference between the EVT and OS group in 30-day mortality rate before (odds ratio [OR] 0.477, 95% confidence interval [CI] 0.170 to 1.340, P = 0.160), and after IPTW (OR 0.647, 95% CI 0.210 to 1.993, P = 0.449). After IPTW, it revealed that the rates of second-look surgery (OR 36.727, 95% CI 5.407 to 249.458, P < 0.001) and hospital stay [> 30 days] (OR 0.006, 95% CI 0.000 to 0.363, P = 0.014) were different in the two groups. D-dimer (> 4mg/L) and procalcitonin (> 0.5 ng/mL) were the independent risk factors for 30-day mortality in MAE patients postoperatively (P < 0.05). In this retrospective study, MAE patients who performed primary EVT had no obvious difference in 30-day mortality rate compared to those who received OS; but it was conducive to reducing prolonged hospital stays. An increase in procalcitonin level and higher D-dimer were associated with short-term poor prognosis in patients with MAE.

Temporal changes in markers of coagulation and fibrinolysis in adults during extracorporeal membrane oxygenation.

Bleeding and thrombotic events (BTE) are frequent during extracorporeal membrane oxygenation (ECMO). They occur at varying timepoints and may be affected by temporal changes in coagulation and fibrinolysis. We aimed to assess various coagulation and fibrinolytic markers over time and their relationship with BTE. A single-centre prospective study was performed in 17 patients with severe respiratory failure receiving veno-venous ECMO. Blood samples were collected before and during ECMO, and around circuit decannulation. Prior to ECMO, D-Dimer, Plasmin-Antiplasmin complexes (PAP), Plasminogen-Activator Inhibitor-1 (PAI-1) and fibrinogen were elevated. There was an increase in D-Dimer and Prothrombin Fragments 1+2 (PF1+2) (729 to 1305pmol/L, p = .034) by day 1 and PAP increased by day 2 from baseline levels (median 1022 to 1797µg/L, p = .023). There was a strong positive correlation in PAP, PF1+2 and thrombin-antithrombin complexes (TAT) to D-Dimer. BTE were frequent - 18% had major extracranial haemorrhage and 24% had intracranial haemorrhage. Over time, there was a progressive elevation PAP in patients developing subsequent extracranial haemorrhage, whereas D-Dimer, PAP and PF1+2 increased after intracranial haemorrhage. There were early changes in coagulation activity during ECMO by PF1+2 followed by subsequent fibrinolysis by PAP. Changes in PAP, PF1+2 and TAT were associated with major haemorrhage.

Levels of markers of coagulation and fibrinolysis systems in patients with pulmonary tuberculosis with concomitant diabetes mellitus after COVID-19

Background. It is known that COVID-19 can be followed by a shift in the hemostatic system towards hypercoagulation, which is more pronounced in the presence of diabetes mellitus (DM). Tuberculosis process is often accompanied with hypercoagulation syndrome. Of great interest is the study of the state of hemostatic systems in patients with pulmonary tuberculosis (TB) with concomitant DM who have had COVID-19.The aim. To study the relationship between the state of the hemostatic and fibrinolysis systems and moderate and severe COVID-19 in patients with pulmonary tuberculosis and diabetes mellitus.Methods. 32 patients with TB and DM were divided into two groups. Group 1 included 16 patients with TB and DM who have previously had COVID-19 (TB-DM-COVID). Group 2 included 16 patients with TB and DM who did not have COVID-19 (TB-DM).Results. It was found that TB-DM-COVID patients were more likely to develop a hypercoagulable shift compared to TB-DM patients. This was evidenced by a more frequent shortening of such indicator as activated partial thromboplastin time (43.7 % and 25.0 % of cases, respectively; χ2 = 7.22; p = 0.01), an increase in fibrinogen levels (43.7 % and 25.0%, respectively; χ2 = 7.22; p = 0.01) and D-dimer (43.7 % and 18.7 %, respectively; χ2 = 14.74; p = 0.0001). These changes were closely associated with the systemic inflammatory response, as strong and positive correlations were found between fibrinogen and C-reactive protein levels (r = 0.420; p = 0.01), and erythrocyte sedimentation rate (r = 0.433; p = 0.01) in TB-DM-COVID patients.Conclusion. In patients with pulmonary tuberculosis and diabetes mellitus after moderate and severe COVID-19, compared to patients who have not had COV ID-19, a hypercoagulable shift associated with the development of more pronounced systemic inflammation develops more often.

D-dimer as a Useful Biomarker in Early Diagnosis of Neonatal Sepsis: A Single-Center Study From Romania.

This study evaluates the role of D-dimer in identifying neonatal sepsis and their potential value in clinical decision-making due to challenges in early detection. A case-control study was conducted on 102 neonates at the Children's Clinical Hospital "Louis Turcanu" in Timisoara, Romania, from October 2018 to July 2023. The participants were divided into two groups: those with neonatal sepsis and those without sepsis. The study found that neonates with sepsis were more likely to be delivered by cesarean section and had higher rates of premature ruptured membranes compared to those without sepsis. The D-dimer biomarker's predictive value for sepsis was assessed using a receiver operating characteristic (ROC) curve, with an area under the curve (AUC) exceeding 0.982 and an optimum cutoff value of 342 ng/mL. An increase in neonatal D-dimer significantly increases the likelihood of sepsis by 2.7% per unit increase. A value above 250 ng/mL indicates a 127-fold increased likelihood of sepsis. The D-dimer's ability to predict mortality innewborns with sepsis is unsatisfactory, with an AUC of 0.528. D-dimer, a potential biomarker of neonatal sepsis, warrants further clinical investigation to enhance diagnostic sensitivity and specificity, demonstrating its potential in conjunction with other sepsis markers.

Interrelation of plasma haemostasis and heart rate variability in patients with chronic coronary syndrome in combination with COVID-19

The aim of the study was to identify the relationship between activated partial thromboplastin time, prothrombin time, fibrinogen, D-dimer and indicators of N-N interval deviations, heart rate, on the one hand, and to identify the relationship between parasympathetic and sympathetic heart rate activity and dynamic blood viscosity, on the other hand. The COVID-19 pathogen affects the functioning of the parasympathetic and sympathetic nervous systems, which also changes the heart rate. To study this process, a group of 10 patients with chronic coronary syndrome in combination with COVID-19 without comorbidities aged 35-48 years was observed in a hospital. To study this relationship, plasma haemostasis parameters (activated partial thromboplastin time, prothrombin time, fibrinogen, D-dimer) and heart rate variability were taken at the time of admission to the hospital and after discharge from the hospital. A direct correlation between the indicators was found: in patients 1 and 4, at the time of admission to the hospital, there was an increase in activated partial thromboplastin time, prothrombin time, D-dimer and a decrease in fibrinogen, which coincides with an increase in heart rate, 5-10 minute and long-term deviation of the N-N segments. That is, changes in blood plasma affect the rhythm of the heart already at the onset of COVID-19 in combination with chronic coronary syndrome. Patients 1 and 4 had an increase in D-dimer at the time of discharge from the hospital, which coincided with an increase in heart rate. Patients require further follow-up, as these are signs of a cautious prognosis. All other plasma haemostasis parameters are normal in all patients, with minor changes. It is necessary to monitor plasma haemostasis and heart rate variability to adjust treatment during hospitalization of patients with chronic coronary syndrome in combination with COVID-19 and after discharge from hospital

Cerebral Small Vessel Disease in Children and Adolescents with Type 1 Diabetes Presenting with Diabetic Ketoacidosis during COVID-19 Era

Abstract Aim Cerebrovascular insult (CVI) is a known and significant morbidity of diabetic ketoacidosis (DKA); yet, its prevalence is underestimated. Untreated cerebral hypoperfusion in DKA may lead to cerebral injury, arterial ischemic stroke, cerebral venous thrombosis, and hemorrhagic stroke. This study assesses the cerebral perfusion status among children and adolescents with DKA during and after the resolution of DKA. Methodology Forty children and adolescents with type 1 diabetes mellitus (T1DM) presenting with DKA were assessed for severity of DKA, diabetes-duration, insulin therapy, Rappaport coma/ Near coma scale, Rancho los amigos levels of cognitive functioning scale, glycated-hemoglobin (HbA1c), D-dimer, INR and brain magnetic resonance imaging (MRI) during DKA and repeated neuro cognitive scoring, laboratory and MRI after resolution of the DKA. Results The mean age of the children and adolescents with T1DM presenting with DKA was 11.40 ± 2.82 years; their median diabetes-duration was 3 year; their mean HbA1c was 13.54 ± 2%. There was significant increase in platelet (P = 0.005), D-dimer (P &amp;lt; 0.001), Creatinine (P &amp;lt; 0.001) and Pulse wave velocity (P = 0.004) during attack of DKA while there was significance decrease in Apparent diffusion coefficient (P &amp;lt; 0.001). There was 30% of children and adolescents with T1DM had ischemic MRI changes during DKA. In children and adolescent with ischemic changes there was significant increase in severity of DKA (P = 0.003), HbA1c (P = 0.016), INR (P = 0.002), D-dimer (P &amp;lt; 0.001), Creatinine (P = 0.003). Conclusion Significant cerebral hypoperfusion occur during the DKA which is correlated with the DKA severity and D-dimer levels.

Influence of Covid-19 disease on hemostasis dynamics during extracorporeal membrane oxygenation (ECMO)1.

COVID-19 causes a considerable degradation of pulmonary function to the point of an acute respiratory distress syndrome (ARDS). Over the course of the disease the gas exchange capability of the lung can get impaired to such an extent that extracorporeal membrane oxygenation (ECMO) is needed as a life-saving intervention. In patients COVID-19 as well as ECMO may cause severe coagulopathies which manifest themselves in micro and macro thrombosis. Previous studies established D-dimers as a marker for critical thrombosis of the ECMO system while on admission increased D-dimers are associated with a higher mortality in COIVD-19 patients. It is therefore crucial to determine if COVID-19 poses an increased risk of early thrombosis of the vital ECMO system. 40 patients who required ECMO support were enrolled in a retrospective analysis and assigned into 2 groups. The COVID group consist of 20 COVID-19 patients who required ECMO support (n = 20), whereas 20 ECMO patients without COVID-19 were assigned to the control group. D-dimers, fibrinogen, antithrombin III (AT III), lactate dehydrogenase (LDH) and platelet count were analysed using locally weighted scatterplot smoothing and MANOVAs. The analysis of both groups shows highly significant differences in the dynamics of hemostasis. The increase in D-dimers that is associated with thrombosis of the ECMO systems occurs in COVID-19 patients around 2 days earlier (p = 2,8115 10-11) while fibrinogen is consumed steadily. In the control group fibrinogen levels increase rapidly after ten days with a plateau phase of around five days (p = 1,407 10-3). Both groups experience a rapid increase in AT III after start of support by ECMO (p = 5,96 10-15). In the COVID group platelet count decreased from 210 giga/l to 130 giga/l within eight days, while in the same time span in the control group platelets decreased from 180 giga/l to 105 giga/l (p = 1,1 10-15). In both groups a marked increase in LDH beyond 5000 U/l occurs (p = 3,0865 10-15). The early increase in D-dimers and decrease in fibrinogen suggests that COVID-19 patients bear an increased risk of early thrombosis of the ECMO system compared to other diseases treated with ECMO. Additionally, the control group shows signs of severe inflammation 10 days after the start of ECMO which were absent in COVID-19 patients.

#653 Changes in iron markers and D-dimer levels during enarodustat treatment depends on different iron prescription patterns in hemodialysis patients

Abstract Background and Aims Iron preparations are commonly administered with erythropoiesis-stimulating agents or hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PH inhibitors) in hemodialysis patients to promote hematopoiesis and prevent iron deficiency. A recent study highlighted the causal relationship between thrombosis and upregulated serum transferrin levels due to iron deficiency. Additionally, rapid increase of hemoglobin (Hb) during HIF-PH inhibitor use is also considered a risk factor for the development of thromboembolism. Therefore, monitoring iron parameters and Hb is essential for managing anemia and thrombosis risk. We investigated the impact of practice patterns of iron supplementation on iron metabolism in patients receiving a HIF-PH inhibitor enarodustat. Changes in D-dimer levels, a thrombosis-related factor, were also assessed. Method We performed a post-hoc analysis using pooled data from two phase 3 clinical studies of enarodustat in Japanese maintenance hemodialysis patients, SYMPHONY HD and SYMPHONY HD-Long studies. We divided the subjects into three groups according to practice patterns of iron administration: subjects who did not receive iron at all during the enarodustat administration period (Non-Iron Group), subjects who received intravenous iron at least once (IV Iron Group), and subjects who continuously received oral iron-containing preparations including ferric citrate (Oral Iron Group). The time courses of transferrin saturation (TSAT), serum ferritin, and D-dimer levels were compared across these three groups using mixed effects models for repeated measures (MMRM) (with an unstructured covariance structure for the dependent variables). Results The Non-Iron Group, IV Iron Group, and Oral Iron Group consisted of 60, 69, and 73 cases, respectively. Figures show the time courses of TSAT, serum ferritin levels, and changes in D-dimer levels for each practice pattern. MMRM analysis revealed that TSAT levels in the Non-Iron Group and IV Iron Group during the enarodustat administration period were significantly lower than those in the Oral Iron Group (p &amp;lt; 0.01 and p &amp;lt; 0.01, respectively). Similar results were observed for serum ferritin levels (p &amp;lt; 0.01 and p &amp;lt; 0.01, respectively). Moreover, the rate of D-dimer increase in the Non-Iron Group was significantly higher than in the Oral Iron Group (p = 0.029). There was a trend toward a higher rate of D-dimer increase in IV Iron Groups compared to the Oral Iron Group (p = 0.11). Conclusion These findings suggest the superiority of continuous oral iron supplementation over intermittent IV iron supplementation or no iron supplementation during HIF-PH inhibitor administration in terms of preventing thrombosis through maintaining TSAT levels. The association between iron-related parameters and the occurrence of thrombosis needs to be analyzed.