Hemostasis Issues Research Articles

Welcome to the 12<sup>th</sup> ICTHIC!

Dear Colleagues, We are pleased to present this volume of the Proceedings and the Abstracts of the 12th International Conference on Thrombosis and Hemostasis Issues in Cancer (ICTHIC) being held in Bergamo, Italy, May 17-19, 2024. Cancer-associated thrombosis – which includes both venous and arterial events in its clinical manifestations and involves cancer biology, hemostatic proteins, platelets and many other players in its subclinical terrain – is an old problem. Yet it makes its way into the newest of new themes in cancer medicine, including new paradigms of treatment which continue to be complicated by this very old effect [...]

Unresolved hemostasis issues in haemophilia.

Despite rapid technological advancement in factor and nonfactor products in the prevention and treatment of bleeding in haemophilia patients, it is imperative that we acknowledge gaps in our understanding of how hemostasis is achieved. The authors will briefly review three unresolved issues in persons with haemophilia (PwH) focusing on the forgotten function that red blood cells play in hemostasis, the critical role of extravascular (outside circulation) FIX in hemostasis in the context of unmodified and extended half-life FIX products and finally on the role that skeletal muscle myosin plays in prothrombinase assembly and subsequent thrombin generation that could mitigate breakthrough muscle hematomas.

The role of rotational thromboelastometry during the COVID-19 pandemic: a narrative review.

The coronavirus disease 2019 (COVID-19) pandemic is currently recognized as a global health crisis. This viral infection is frequently associated with hypercoagulability, with a high incidence of thromboembolic complications that can be fatal. In many situations, the standard coagulation tests (SCT) fail to detect this state of hypercoagulability in patients with COVID-19 since clotting times are either not or only mildly affected. The role of viscoelastic tests such as rotational thromboelastometry (ROTEM®) during this pandemic is explored in this review. COVID-19-associated coagulopathy, as measured using the rotational thromboelastometry parameters, can vary from hypercoagulability due to increased fibrin polymerization and decreased fibrinolysis to bleeding from hypocoagulability. The use of a multimodal diagnostic and monitoring approach, including both rotational thromboelastometry and SCT, such as plasma fibrinogen and D-dimer concentrations, is recommended. Rotational thromboelastometry provides comprehensive information about the full coagulation status of each patient and detects individual variations. Since COVID-19-associated coagulopathy is a very dynamic process, the phenotype can change during the course of infection and in response to anticoagulation therapy. Data from published literature provide evidence that the combination of rotational thromboelastometry and SCT analysis is helpful in detecting hemostasis issues, guiding anticoagulant therapy, and improving outcomes in COVID-19 patients. However, more research is needed to develop evidence-based guidelines and protocols.

Снижена ли гемостатическая активность тромбоцитов группы О?

Введение: В 2019 г. опубликованы полученные в модели артериального сдвига доказательства более слабой связи с фактором Виллебранда тромбоцитов группы О: у не-О тромбоцитов кинетика этой связи на 40% выше. Высказано предположение о меньшей гемостатической эффективности переливания этих тромбоцитов. Цель исследования: сопоставить клиническую эффективность переливания тромбоцитов группы О и других фенотипов системы группы крови АВО (не-О). Материалы и методы: У 310 пациентов проведено 674 переливания тромбоцитов. Анализировали и оценивали клиническую эффективность переливания двух групп тромбоцитов различных фенотипов системы группы крови АВО: О (n = 290) и не-О (n = 384). Результаты: При переливании О-тромбоцитов реципиентам реже требовались последующие трансфузии, а интервал до следующей трансфузии в среднем был на 21,7% больше, чем при переливании не-О тромбоцитов. После переливания О-тромбоцитов и не-О тромбоцитов не выявлено различий в концентрации тромбоцитов в крови реципиентов до переливания и спустя 20 ч. При переливании О-тромбоцитов наблюдали более высокий абсолютный прирост тромбоцитов в крови реципиентов, однако скорректированный прирост тромбоцитов после переливания О и не-О тромбоцитов не различался. Заключение: Таким образом, гипотеза о сниженной гемостатической активности тромбоцитов группы О не подтверждена. Background: In 2019 on arterial shift model the evidence was obtained of a weaker connection of von Willebrand factor and group O-platelets: in non-O platelets the kinetics of this connection was higher by 40%. A hypothesis was suggested that the O-platelet transfusion is hemostatically less effective. Objectives: to compare the clinical effectiveness of O-platelets transfusion and other phenotypes of ABO blood group (non-O). Patients/Methods: In 310 patients, 674 platelet transfusions were performed. Clinical effectiveness of transfusion of two platelet groups with different phenotypes of ABO blood group was analyzed and assessed: O (n = 290) and non-O (n = 384). Results: After O-platelets transfusion, recipients rarely required next transfusions, and the interval until next transfusion was on average 21.7% longer than after non-O platelets transfusion. After transfusion of O-platelets and non-O platelets, there were no differences between platelets concentration in recipient’s blood before transfusion and after 20 hours. After O-platelets transfusion, a higher absolute increment of platelets in recipient’s blood was observed, but the corrected increment of platelets after transfusion of O and non-O platelets did not differ. Conclusions: So, the hypothesis of reduced hemostatic activity of O-platelets is not confirmed.

Thrombosis and Hemostasis Issues in Cancer Patients with COVID-19.

Coronavirus disease 2019 (COVID-19) is an infectious pandemic disorder caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), a single-stranded RNA β-coronavirus. Virus particles that can be inhaled through the respiratory system and invade lung alveolar cells may cause a limited viral disease. However, in some patients, severe complications, including systemic inflammatory response syndrome, acute respiratory disease syndrome, multiple organ failure, and shock may develop. These presentations are particularly frequent among several risk groups, including older patients, those with hypertension, obesity, cardiovascular, pulmonary and renal diseases, autoimmunity disturbances, and cancer. COVID-19 is associated with severe thrombotic complications, both micro- and macrovascular, substantially including deep vein thrombosis (DVT), pulmonary embolism (PE), primary pulmonary arterial thrombosis, up to disseminate intravascular coagulation (DIC)-like syndrome.[1] [2] [3] [4]

Preanalytical Issues in Hemostasis and Thrombosis Testing.

Hemostasis testing is critical to many hemorrhagic and thrombotic disorders, wherein laboratory diagnostics can provide critical information for diagnosis, prognostication, and therapeutic monitoring. Due to this crucial role in modern medicine, hemostasis tests should be carried out at their highest degree of quality, thus encompassing standardization and monitoring of all phases of the testing process. It is now clearly established that the preanalytical phase is the most critical and vulnerable part of the total testing process, since up to 70% of diagnostic errors are due to highly manual activities encompassing patient preparation and collection of biological samples, as well as handling, transportation, preparation and storage of blood specimens. Due to the peculiar sample matrix required for hemostasis testing (i.e., plasma anticoagulated with buffered sodium citrate), additional critical issues may impair the reliability of these tests. Therefore, this article aims to provide an updated overview of the most important preanalytical variables that may ultimately impair the quality of hemostasis and thrombosis testing.

Post-analytical Issues in Hemostasis and Thrombosis Testing.

Analytical concerns within hemostasis and thrombosis testing are continuously decreasing. This is essentially attributable to modern instrumentation, improvements in test performance and reliability, as well as the application of appropriate internal quality control and external quality assurance measures. Pre-analytical issues are also being dealt with in some newer instrumentation, which are able to detect hemolysis, icteria and lipemia, and, in some cases, other issues related to sample collection such as tube under-filling. Post-analytical issues are generally related to appropriate reporting and interpretation of test results, and these are the focus of the current overview, which provides a brief description of these events, as well as guidance for their prevention or minimization. In particular, we propose several strategies for improved post-analytical reporting of hemostasis assays and advise that this may provide the final opportunity to prevent serious clinical errors in diagnosis.

The International Conference on Thrombosis and Hemostasis Issues in Cancer (ICTHIC) at the Peak of Adolescence – 15 Years and Counting

The International Conference on Thrombosis and Hemostasis Issues in Cancer (ICTHIC) at the Peak of Adolescence – 15 Years and Counting

Thrombosis and hemostasis issues in critically ill patients.

Thrombosis and hemostasis issues in critically ill patients.

Author index, 4 th International Conference on Thrombosis and Hemostasis Issues in Cancer, October 26–28, 2007, Bergamo, Italy

Author index, 4 th International Conference on Thrombosis and Hemostasis Issues in Cancer, October 26–28, 2007, Bergamo, Italy

Management of Coagulopathy in the Setting of Acute Neurosurgical Disease and Injury

Blood coagulation and hemostasis issues are important aspects of patient care in acute neurosurgical patients. Coagulopathy often complicates the already difficult management of cerebrovascular and intracranial hemorrhagic disease and injuries, adding to the already high associated morbidity and mortality. Common causes of coagulopathy, as well as its management in acute neurosurgical settings, are outlined in this review. Awareness of how to promptly evaluate and effectively treat coagulopathic processes is instrumental to the success of the neurosurgeon in managing acute intracranial pathologies.