Risk Of Thrombosis Research Articles

Optimum anastomosis angle of end-to-side microsurgical anastomosis for preventing future shear-related risk of thrombosis by computationalmodeling

End-to-side (ETS) microsurgical anastomosis is a powerful technique in microsurgery. It can overcome vessel’s diameter discrepancy and preserve the distal blood flow. Optimal angle of the ETS anastomosis has been debated and studied, and is currently limited to animal models. Computational model using Finite Element Analysis (FEA) was used to simulate the models with 45 (model45), 90 (model90), and 135 (model135) ETS anastomosis angles. Flow dynamics including flow velocity and wall shear rate were studied and compared. Maximum flow velocity ranged from the highest to the lowest in model135, model90, and model45, respectively. The velocity in model135 showed fluctuation flow. The maximum wall shear rate and distribution were highest in model45 and lowest in model90. ETS anastomosis angle of 90 degrees provided the most favourable flow dynamics to prevent shear related thrombosis in comparison to ETS anastomosis at 45 and 135 degrees.

Bleeding and Thrombotic Events in Hemodialysis Patients with Atrial Fibrillation on Anticoagulation and Antiplatelet Therapy: A 24-Month Cohort Study

Background and Objectives: Patients undergoing chronic hemodialysis (HD) are predisposed to both thrombotic and bleeding complications due to the complex interplay of end-stage renal disease (ESRD), cardiovascular comorbidities, and the routine use of anticoagulant and antiplatelet therapies. This study aimed to investigate the incidence of bleeding and thrombotic events in chronic HD patients receiving anticoagulant and antiplatelet therapy, with a specific focus on those with atrial fibrillation (AF). Materials and Methods: A total of 224 patients, with 43 (19%) of them diagnosed with AF, were included in this single-center, observational cohort study conducted over 24 months. The cohort was divided into three groups: patients without anticoagulation, those on warfarin monotherapy, and those on combined warfarin and aspirin therapy. Bleeding events were classified as major, clinically relevant non-major bleeding (CRNMB), or minor bleeding, while thrombotic events included ischemic stroke, myocardial infarction, pulmonary embolism, and arteriovenous fistula thrombosis. Results: Overall, 35.7% of patients experienced a bleeding event, with major bleeding occurring in 9.4%. Patients with AF had significantly higher rates of major bleeding (18.6%) compared to those without AF (7.18%; p = 0.043), especially in the combined therapy group. Mortality due to bleeding was also higher in AF patients (14%). In contrast, thrombotic events occurred in 26.8% of patients, with AF patients experiencing significantly more events (48.8%) compared to non-AF patients (21.5%; p = 0.0006). The hazard ratio (HR) for major bleeding in patients on combined warfarin and aspirin therapy was 2.56 (p = 0.016), while the HR for thrombotic events was 2.34 (p = 0.0202). Conclusions: These findings highlight the increased risks of both bleeding and thrombosis in chronic HD patients with AF, particularly those on combined anticoagulation and antiplatelet therapy.

Lecturer

COVID-19 is a highly contagious viral illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It primarily affects the respiratory system but can also impact other significant organs. Its rapid spread has heightened interest in biomarkers for screening and early diagnosis. This study evaluated D-dimer, C-reactive protein (CRP), and complete blood count (CBC) levels in patients with COVID-19 compared to healthy individuals. A total of 50 healthy individuals and 50 COVID-19 patients, aged 20 to 65, were included in the study, excluding individuals with conditions such as leukemia, thalassemia, or pregnancy. Whole blood and plasma samples were collected for CBC and D-dimer assays and stored at 2-4°C. The COVID-19 patients had significantly higher levels of D-dimer, CRP, white blood cells (WBC), granulocytes, and granulocyte percentage as compared with the healthy individuals (p<0.01), lower levels of lymphocyte percentage, mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) (p<0.01), as shown. The severe COVID-19 cases often show elevated D-dimer levels, indicating a higher risk of thrombosis. Increased CRP levels correlate with more severe conditions and help assess inflammation severity. A CBC provides insights into blood components, like RBC and WBC, and platelets. During COVID-19, CBC results may reveal lymphopenia, a low lymphocyte count linked to increased severity. For the most accurate and current information, consult healthcare professionals, reliable health organizations, or recent scientific studies on COVID-19.

Impact of a new coronavirus infection on the level of inflammatory, haemostasis markers and microcirculatory parameters of patients with arterial hypertension

Relevance. The COVID-19 pandemic and its consequences have significantly affected the health of the population as a whole. Persons who have undergone coronavirus infection against the background of chronic cardiovascular diseases and obesity deserve special attention. Aim. To study and compare the main indicators of carbohydrate and lipid metabolism the level of inflammatory and haemostasis markers, microvascular changes in obesity AH patients and in AH patients with normal body weight 1 month after a new coronavirus infection in moderate to severe form. Materials and methods. The study included 87 patients of both sexes, aged from 18 to 55 years, from which three groups were formed: the first group included people with AH and normal body weight (BMI<25 kg/m²) who had undergone COVID-19 within a month, the second group included people with AH and obesity (BMI≥30 kg/m²) who had undergone COVID-19 within a month, the control group consisted of 20 people with AH and obesity without COVID-19. The parameters of height, weight, waist circumference, and BMI were assessed in all subjects. The parameters of lipid profile, glucose level were determined, inflammatory markers and haemostasis parameters. All participants underwent laser Doppler flowmetry (LDF) on the forearm with constrictor and dilator functional tests, and single-photon emission computed tomography (SPECT) in combination with x-ray computed tomography (SPECT/CT). Results. Patients of groups 1 and 2 naturally differed from each other in anthropometric indicators. Lipid and carbohydrate metabolism rates were also significantly higher in group 2 patients compared to group 1 patients (p < 0.05). The CRP level in the group of people with hypertension and obesity who underwent COVID-19 was significantly higher than in people with hypertension without obesity (p < 0.001) and than in people with hypertension and obesity without a history of COVID-19. When comparing microcirculation parameters by LDF, there was a decrease in tissue hemoperfusion (M), blood flow reserve (RK) in all three groups (p < 0.001), the most pronounced dysfunction of neurogenic and myogenic blood flow regulation was detected in the group of people with hypertension andobesity who underwent COVID-19. Conclusion. The study of microcirculation indicators by LDF method in persons with hypertension and obesity after suffering a coronavirus infection indicates the predominance of the spastic type of microcirculation, which, together with an increase in the levels of inflammatory markers, indicates a higher risk of thrombosis and cardiovascular complications, requiring more careful monitoring and treatment of this group of patients.

Responsive Hydrogel-Based Drug Delivery Platform for Osteoarthritis Treatment

Osteoarthritis (OA) is the most prevalent chronic joint disorder and is a major cause of disability among the elderly population. The degeneration and damage of articular cartilage associated with OA can result in a diminished range of motion in joints, subsequently impacting fundamental activities such as ambulation, standing, and grasping objects. In severe cases, it may culminate in disability. Traditional pharmacological treatments are often accompanied by various side effects, while invasive surgical procedures increase the risk of infection and thrombosis. Consequently, identifying alternative new methods for OA treatment remains a formidable challenge. With advancements in responsive hydrogel drug delivery platforms, an increasing number of strategies have emerged to enhance OA treatment protocols. Injectable response hydrogel drug delivery platforms show many advantages in treating OA, including improved biocompatibility, prolonged drug release duration, elevated drug loading capacity and enhanced sensitivity. This article reviews the recent progress of injectable responsive hydrogel drug delivery platform for OA treatment over the past few years. These innovative methodologies present new strategies and directions for future OA treatment while summarizing a series of challenges faced during the clinical transformation of injectable response hydrogel drug delivery platforms. Overall, injectable responsive hydrogel drug delivery platforms show great potential in treating OA, especially regarding improving drug retention time and stimulus-responsive release at the lesion sites. These innovative methods provide new hope for future OA treatment and point the way for clinical applications.

Influence of Diabetes Mellitus on Postoperative Complications After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

Background and Objectives: Total knee arthroplasty (TKA) is an effective treatment option for severe knee osteoarthritis. Understanding the impact of diabetes mellitus (DM) on postoperative outcomes is crucial for improving patient satisfaction after TKA. This study aimed to investigate the influence of DM on postoperative complications and mortality after TKA. Materials and Methods: We conducted a systematic review and meta-analysis by searching relevant studies published before December 2023 in the PubMed, EMBASE, Cochrane Library, Medline, and Web of Science databases. The assessment included demographic data, comorbidities, and postoperative complications after primary TKA for both DM and non-DM patients. The odds ratio (OR) was used to represent the estimate of risk of a specific outcome. Results: Thirty-nine studies were finally included in this meta-analysis. Patients with DM had higher rates of periprosthetic joint infection (OR: 1.71, 95% confidence interval [CI]: 1.46–2.00, p < 0.01) and prosthesis revision (OR: 1.37, 95% CI: 1.23–1.52, p < 0.01). Moreover, patients with DM showed an elevated incidence of pneumonia (OR: 1.54, 95% CI: 1.15–2.07, p < 0.01), urinary tract infection (OR: 1.86, 95% CI: 1.07–3.26, p = 0.02), and sepsis (OR: 1.61, 95% CI: 1.46–1.78, p < 0.01). Additionally, the postoperative risk of cardiovascular (OR: 2.49, 95% CI: 1.50–4.17, p < 0.01) and cerebrovascular (OR: 2.38, 95% CI: 1.48–3.81, p < 0.01) events was notably higher in patients with DM. The presence of DM increased the risk of deep vein thrombosis (OR: 1.58, 95% CI: 1.22–2.04, p < 0.01), but did not lead to an increased risk of pulmonary embolism. Most importantly, DM was associated with a higher mortality rate within 30 days after TKA (OR: 1.27, 95% CI: 1.02–1.60, p = 0.03). Conclusions: Patients with DM exhibited a higher rate of postoperative complications after TKA, and DM was associated with a higher mortality rate within 30 days after TKA. It is crucial to educate patients about the perioperative risk and develop evidence-based guidelines to prevent complications after TKA.

The evaluation of complete blood count parameters in the patients with idiopathic versus secondary cerebral venous thrombosis

Background: Several laboratory markers derived from a complete blood count (CBC) have been proposed as potential indicators for assessing the risk of cerebral venous thrombosis (CVT). However, limited and conflicting evidence exists regarding this association. This study aimed to evaluate the role of CBC parameters in CVT development and their link to disease characteristics. Methods: This case-control study included patients diagnosed with CVT between March 2018 and and March 2021. All participants with CVT were registered in the organized registry system at the Neurology Research Center of Shiraz University of Medical Sciences, Shiraz, Iran (CVT registry code: 9001013381). The control group consisted of age- and sex-matched individuals without systemic diseases. CBC results from the control group and the first recorded hospital CBC of the patient group were collected. Results: The study included 295 patients with CVT [49 with idiopathic CVT (iCVT) and 246 with secondary CVT (sCVT)] and 341 healthy individuals. Among the CVT group, 72.54% were women. Patients with CVT had higher red cell distribution width (RDW) and lower red blood cell (RBC) count, hemoglobin (Hb) levels, and hematocrit compared to the non-CVT group. In iCVT cases, male gender, RBC count, Hb levels, and hematocrit were notably higher compared to sCVT cases. Logistic regression analysis showed that female gender, smoking, and higher hematocrit values were associated with increased probability of iCVT. Conclusion: The study suggests that certain CBC parameters may serve as potential markers for assessing CVT risk and differentiating between iCVT and sCVT cases. Validation and further research are needed to explore the underlying mechanisms.March 2021.

Tranexamic acid for postpartum bleeding: a systematic review and individual patient data meta-analysis of randomised controlled trials

Tranexamic acid is a recommended treatment for women with a clinical diagnosis of postpartum haemorrhage, but whether it can prevent bleeding is unclear. We conducted a systematic review and individual patient data (IPD) meta-analysis of randomised controlled trials to assess the effects of tranexamic acid in women giving birth. In this systematic review and IPD meta-analysis, we searched the WHO International Clinical Trials Registry Platform from database inception to Aug 4, 2024 for randomised trials that assessed the effects of tranexamic acid in women giving birth. Trials were eligible if they were prospectively registered, placebo-controlled, included more than 500 women, and had a low risk of bias for random sequence generation and allocation concealment. IPD were requested from the trial investigators. The primary outcomes were the numbers of women with life-threatening bleeding and thromboembolic events. We used a one-stage model to analyse the data and explored whether the effect of tranexamic acid varied by the underlying risk of life-threatening bleeding, type of birth, presence of moderate or severe anaemia, or timing of administration (before or after a diagnosis of postpartum haemorrhage). This study is registered with PROSPERO, CRD42022345775. We analysed data on 54 404 women from five trials. We obtained IPD for 43 409 women from four trials and aggregate data on 10 995 women from one trial. All trials had a low risk of bias. Life-threatening bleeding occurred in 178 (0·65%) of 27 300 women in the tranexamic acid group versus 230 (0·85%) of 27 093 women in the placebo group (pooled odds ratio [OR] 0·77 [95% CI 0·63-0·93]; p=0·008). There was no evidence that the effect of tranexamic acid varied by the underlying risk of life-threatening bleeding, type of birth, presence of moderate or severe anaemia or timing of administration. No significant difference was identified between tranexamic acid and placebo groups with regard to thromboembolic events: 50 (0·2%) of 26 571 women in the tranexamic acid group had fatal or non-fatal thromboembolic events versus 52 (0·2%) of 26 373 women in the placebo group (pooled OR 0·96 [0·65-1·41]; p=0·82) with no significant heterogeneity identified in the subgroup analyses. Tranexamic acid reduces the risk of life-threatening postpartum bleeding. We found no evidence that tranexamic acid increases the risk of thrombosis. Although we do not recommend the use of tranexamic acid in all women giving birth, consideration should be given to its use before a diagnosis of postpartum haemorrhage in women at high risk of death. The Bill & Melinda Gates Foundation.

Клиническое наблюдение ретроспективной диагностики болезни Кавасаки

This research was aimed to demonstrating to the pediatric practitioners of a wide range the clinical case of retrospective diagnosis of Kawasaki disease (KD) based on detection of coronary artery (CA) aneurysms and anamnestic data analysis. Mucocutaneous lymphonodular syndrome (KD) is a systemic vasculitis of childhood that was characterized in the observed clinical case by fever, inflammatory changes in the mucous membranes, skin, lymph nodes and CA damage. Features of this clinical case were as follows: 1. the diagnosis was established retrospectively 5 years later than the KD was suffered based on accidental detection of CA aneurysms, 2. the lack of adequate KD treatment had led to the formation of CA aneurysms, including a single one of a giant size, 3. despite the long-term absence of generally accepted thrombosis prophylaxis in a patient with a giant CA aneurysm, only 11 years later did a thrombus in the aneurysm formed for the first time, which had then regressed rapidly despite it is known from the bibliographical data and those of the Authors’ own that the risk for thrombosis is very high in patients with giant aneurysms. Conclusion: late KD diagnosis entails the development of the cardiovascular system complications, in particular, coronary aneurysms, which in its turn in the reported clinical case were an accidental finding during the patient’s checkup.

Inherited thrombophilia and risk of venous thromboembolism in females in association with contraceptive use.

Venous thromboembolism is a multifactorial dis ease and major cause of morbidity and mortality. Absolute risk of venous thromboembolism is less than 1 per 10,000 per year in women of reproductive age. Hormonal contraception is a common risk situation for venous thromboembolism in this part of the population. The risk of venous thrombosis depends on many factors, mainly female characteristics and also the type of contraception. Hematologists can help with the choice of contraception in females with inherited thrombophilia and females experiencing thrombosis. Intrauterine devices with levonorgestrel seem to be the best option in these settings.

Blood osteoprotegerin is associated with arteriovenous access thrombosis in hemodialysis patients.

A functioning arteriovenous (AV) access is essential for hemodialysis efficiency and the quality of life in hemodialysis patients. Blood osteoprotegerin (OPG) and soluble receptor activator of nuclear factor kappa B ligand (RANKL) have been linked to cardiovascular diseases and vascular calcification. This study investigated the relationship between blood OPG, RANKL, and the occurrence of AV access thrombosis. This prospective cohort study was conducted from August 2016 to August 2021 and included patients undergoing prevalent hemodialysis in two hospital-based hemodialysis units. Cox proportional hazards models and Kaplan-Meier analysis were used to evaluate the association between blood OPG, RANKL, and AV access (AV fistula [AVF] and AV graft [AVG]) outcomes. A total of 333 hemodialysis patients were enrolled, with an AV access thrombosis rate of 22.2%. Cox regression identified several factors associated with AV access thrombosis: AV access type (AVF vs. AVG; hazard ratio [HR], 0.24; p < 0.001), C-reactive protein (HR, 1.07; p = 0.002), and log-transformed OPG (HR, 5.52; p = 0.005). Subgroup analysis revealed high log-transformed OPG and RANKL were associated with AVF thrombosis (HR, 10.77; p = 0.002 and HR, 3.26; p = 0.009, respectively), while high C-reactive protein increased the risk of AVG thrombosis (HR, 1.31; p < 0.001). Kaplan-Meier analysis showed that patients with AVF in the highest tertile of log OPG (>402 pg/mL) had the highest AVF thrombosis incidence (p = 0.03). High blood OPG was associated with AV access thrombosis, particularly in the AVF.

Native Sinus Hemodynamics and Thrombosis in Transcatheter Heart Valve: Effect of Implant Depth and Coronary Flow.

This study aimed to investigate the hemodynamic and anatomic factors associated with sinus thrombosis following transcatheter aortic valve replacement (TAVR), integrating invivo patient data analysis and invitro experiments. Postprocedural, 4-dimensional, multiphase computed tomography data from 211 patients enrolled in the ADAPT-TAVR (Anticoagulation Versus Dual Antiplatelet Therapy for Prevention of Leaflet Thrombosis and Cerebral Embolization After Transcatheter Aortic Valve Replacement) study were analyzed. The prevalence of native sinus thrombosis was examined in relation to valve type, implant depth, and anatomic features. Invitro experiments used particle image velocimetry to observe changes in sinus flow based on the transcatheter heart valves (23-mm SAPIEN3, Edwards Lifesciences; and 29-mm CoreValve, Medtronic) height and coronary artery flow. Native sinus thrombosis was more common in self-expanding valves (39.1% versus 14.9%, P=0.004). In per-cusp analysis of invivo patient data, adjusted transcatheter heart valve implant depth (odds ratio, 1.2 [95% CI, 1.1-1.3]; P<0.001), noncoronary sinus of Valsalva (odds ratio, 4.0 [95% CI, 2.0-7.8]; P<0.001), sinus inflow diameter (odds ratio, 0.8 [95% CI, 0.6-0.9]; P=0.008), and implanted valve size (odds ratio, 0.8 [95% CI, 0.7-1.0]; P=0.025) were significant factors associated with native sinus thrombosis. In the invitro experiments, CoreValve showed noticeable flow stasis compared with SAPIEN3. High-positioned SAPIEN3 was linked to reduced velocity within the native sinus of Valsalva. Coronary artery flow led to higher sinus velocity and improved particle washout, reducing sinus thrombosis risk. This study provides insights into the relationship between transcatheter heart valve deployment and native sinus thrombosis, emphasizing the role of anatomic factors in relation to the risk of sinus thrombosis.

Predicting Deep Venous Thrombosis Using Artificial Intelligence: A Clinical Data Approach

Deep venous thrombosis is a critical medical condition that occurs when a blood clot forms in a deep vein, usually in the legs, and can lead to life-threatening complications such as pulmonary embolism if not detected early. Hospitalized patients, especially those with immobility or post-surgical recovery, are at higher risk of developing deep venous thrombosis, making early prediction and intervention vital for preventing severe outcomes. In this study, we evaluated the following eight machine learning models to predict deep venous thrombosis risk: logistic regression, random forest, XGBoost, artificial neural networks, k-nearest neighbors, gradient boosting, CatBoost, and LightGBM. These models were rigorously tested using key metrics, including accuracy, precision, recall, F1-score, specificity, and receiver operating characteristic curve, to determine their effectiveness in clinical prediction. Logistic regression emerged as the top-performing model, delivering high accuracy and an outstanding receiver operating characteristic curve score, which reflects its strong ability to distinguish between patients with and without deep venous thrombosis. Most importantly, the model’s high recall underscores its ability to identify nearly all true deep venous thrombosis cases, significantly reducing the risk of false negatives—a critical concern in clinical settings, where delayed or missed diagnoses can result in life-threatening complications. Although models such as random forest and eXtreme Gradient Boosting also demonstrated competitive performances, logistic regression proved the most reliable across all metrics. These results suggest that machine learning models, particularly logistic regression, have great potential for early deep venous thrombosis detection, enabling timely clinical interventions and improved patient outcomes.

A novel γ-chain mutation p.Asp318His in a Chinese family with dysfibrinogenemia.

Congenital dysfibrinogenemia is characterized by reduced fibrinogen activity, but normal immunoreactive fibrinogen levels. Here, we present a novel case with an elevated risk of thrombosis. Coagulation assays, gene analysis, in silico tools, sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), fibrin polymerization, thrombin generation assay, and electron microscopy scanning were utilized to elucidate the pathogenic mechanism. The proband manifested with a normal immunologic fibrinogen (2.13 g/l) but reduced functional fibrinogen (0.39 g/l). Subsequent genetic analysis unveiled a novel heterozygous mutation, c.1030G>C (p.Asp318His), in the γ-chain D domain of fibrinogen, which was highly conserved in homologous species and led to enhanced thrombin generation capability. The ability of the proband's fibrinogen to polymerize was significantly impaired, with decreased final turbidity. Scanning electron microscopy indicated that the fibers of the proband were thinner than normal, with smaller pores. Thromboelastography (TEG) results demonstrated prolonged K time, decreased angle value, and a normal confidence interval value in the proband. We present a novel case displaying the γAsp318His mutation, which resulted in dysfibrinogenemia.

Clopidogrel ameliorates high-fat diet-induced hepatic steatosis in mice through activation of the AMPK signaling pathway and beyond.

Metabolic dysfunction-associated steatotic liver disease (MASLD) frequently confers an increased risk of vascular thrombosis; however, the marketed antiplatelet drugs are investigated for the prevention and treatment of MASLD in patients with these coexisting diseases. To determine whether clopidogrel could ameliorate high-fat diet (HFD)-induced hepatic steatosis in mice and how it works, mice were fed on normal diet or HFD alone or in combination with or without clopidogrel for 14weeks, and primary mouse hepatocytes were treated with palmitate/oleate alone or in combination with the compounds examined for 24h. Body weight, liver weight, insulin resistance, triglyceride and total cholesterol content in serum and liver, histological morphology, transcriptomic analysis of mouse liver, and multiple key MASLD-associated genes and proteins were measured, respectively. Clopidogrel mitigated HFD-induced hepatic steatosis (as measured with oil red O staining and triglyceride kit assay) and reduced elevations in serum aminotransferases, liver weight, and the ratio of liver to body weight. Clopidogrel downregulated the expression of multiple critical lipogenic (Acaca/Acacb, Fasn, Scd1, Elovl6, Mogat1, Pparg, Cd36, and Fabp4), profibrotic (Col1a1, Col1a2, Col3a1, Col4a1, Acta2, and Mmp2), and proinflammatory (Ccl2, Cxcl2, Cxcl10, Il1a, Tlr4, and Nlrp3) genes, and enhanced phosphorylation of AMPK and ACC. However, compound C (an AMPK inhibitor) reversed enhanced phosphorylation of AMPK and ACC in clopidogrel-treated primary mouse hepatocytes and alleviated accumulation of intracellular lipids. We concluded that clopidogrel may prevent and/or reverse HFD-induced hepatic steatosis in mice, suggesting that clopidogrel could be repurposed to fight fatty liver in patients.

Revisiting Virchow’s triad: exploring the cellular and molecular alterations in cerebral venous congestion

BackgroundCerebral venous thrombosis (CVT) is a rare but serious condition that can lead to significant morbidity and mortality. Virchow’s triad elucidates the role of blood hypercoagulability, blood flow dynamics, and endothelial damage in the pathogenesis of CVT. Cerebral venous congestion (CVC) increases the risk of cerebral venous sinus thrombosis and can lead to recurrent episodes and residual symptoms. However, the precise mechanism by which blood congestion leads to thrombosis remains unclear. Our objective was to investigate the cellular and molecular alterations linked to CVC through analysis of the pathological morphology of venous sinus endothelial cells and transcriptomic profiling.ResultsThis study demonstrated a remarkable correlation between CVC and the phenotypic transformation of endothelial cells from an anticoagulant to a procoagulant state. The findings revealed that cerebral venous stasis results in tortuous dilatation of the venous sinuses, with slow blood flow and elevated pressure in the sinuses and damaged endothelial cells of the retroglenoid and internal jugular vein ligation (JVL) rat model. Mechanistically, analysis of transcriptomic results of cerebral venous sinus endothelial cells showed significant activation of platelet activation, complement and coagulation cascades pathway in the JVL rats. Furthermore, the expression of von Willebrand factor (vWF) and coagulation factor VIII (F8) in the complement and coagulation cascades and Fgg and F2 in the platelet activation was increased in the cerebral venous sinuses of JVL rats than in sham rats, suggesting that endothelial cell injury in the venous sinus induced by CVC has a prothrombotic effect. In addition, endothelial cell damage accelerates coagulation and promotes platelet activation. Significantly, the concentrations of vWF, F2 and F8 in venous sinus blood of patients with internal jugular vein stenosis were higher than in their peripheral blood.ConclusionCollectively, our data suggest that CVC can induce endothelial cell damage, which then exhibits a procoagulant phenotype and ultimately increases the risk of CVT. This research contributes to our understanding of the pathophysiology of CVC associated with procoagulant factors and reexamines the components of Virchow’s triad in the context of CVC.

Can calf massage prevent deep vein thrombosis? A systematic review

Background: Deep vein thrombosis (DVT) is a condition in which blood clots form in deep veins, usually in the legs. The causes of thrombosis are divided into two, namely those related to immobilization and those related to hypercoagulation, both of which are related to genetic factors and acquired risk factors. DVT can be prevented by preventing recurrent DVT, patients must continue to exercise, and provide compression therapy and anticoagulation therapy with the right duration. Purpose: To evaluate the efficacy of calf massage techniques in lowering the risk of deep vein thrombosis (DVT). Method: The research design used is a systematic review method with article selection referring to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The article search stage is carried out systematically using keywords written manually or using the search facility available in each database. The keywords used in the article search are (massage OR therapy OR pressure) AND (calf OR foot) AND (Deep Vein Thrombosis (DVT)). Article searches are carried out electronically to filter relevant articles. Articles are sourced from the Google Scholar, PubMed, Science Direct, and ProQuest database search engines. The inclusion criteria for this literature review were articles published in the last ten years, namely 2013-2023, articles in Indonesian and English, interventions given to patients at risk of deep vein thrombosis (DVT), interventions using calf massage either with or without tools, randomized controlled trials, experimental/quasi-experimental, and full manuscripts available. Results: Calf massage has been shown to be effective in reducing the risk of deep vein thrombosis (DVT). This is shown based on five journals that have been analyzed that there is a significant decrease in the risk of DVT in the results of the experimental group with the control group and there is only one journal that states that the use of foot pumps does not significantly reduce the incidence of DVT in patients undergoing total knee arthroplasty (TKA) with edoxaban thromboprophylaxis. Conclusion: Massage interventions carried out using tools or without tools with various versions and methods have a positive impact on reducing the risk of DVT.

Viscoelastic Hemostatic Testing as a Diagnostic Tool for Hypercoagulability in Liver Transplantation: A Narrative Review.

Liver transplantation is a complex surgical procedure in which various forms of coagulation dysfunction can occur, including perioperative hypercoagulability. The hemostasis balance in liver graft recipients with end-stage liver disease can shift to thrombosis or haemorrhage, depending on the associated risk factors and clinical conditions. Hypercoagulability can result in serious complications such as thromboembolism, which can affect the vessels of the newly transplanted liver graft. Standard coagulation tests (SCTs), such as prothrombin time and activated partial thromboplastin time (aPTT), have a poor ability to diagnose and monitor an early stage of hypercoagulability. Recent studies demonstrated that viscoelastic hemostatic elastic tests (VETs), such as rotational thromboelastometry (ROTEM) and thromboelastography (TEG), are promising alternative tools for diagnosing hypercoagulability disorders. VETs measure clotting and clot formation time, clot strength (maximum clot firmness), fibrin and platelet contribution to clot firmness, and fibrinolysis, which makes them more sensitive in identifying liver graft recipients at risk for thrombosis as compared with SCTs. However, developing evidence-based guidelines for the prophylaxis and treatment of hypercoagulability based on VET results is still needed.

Factor V Leiden (R506Q), Prothrombin G20210A, and MTHFR C677T Variants and Thrombophilia in Qatar Biobank Participants: A Case Control Study.

Background: Thrombophilia, a predisposition to develop blood clots, is very common and can have serious sequelae. Aim: This study aimed to determine the prevalence of three thrombophilia-related genetic variants-factor V Leiden (FVL), prothrombin (F2) G20210A, and MTHFR C677T-in the Qatari population and their associations with self-reported thrombosis. Methods: We analysed samples from 408 Qatari participants [304 controls and 104 with self-reported thrombosis (deep vein thrombosis, pulmonary embolus, or ischaemic stroke)] from the Qatar Biobank. FVL (rs6025), F2 (rs1799963), and MTHFR (rs1801133) variants were genotyped using TaqMan assays. Results: Participants with self-reported thrombosis were older and more likely to be female. FVL A allele carriage (GA + AA vs. GG) was significantly higher in thrombosis cases (OR 3.6, p = 0.0002). In addition, individuals carrying FVL AA and GA genotypes had a lower mean platelet volume on average than those with the GG genotype (p = 0.03). MTHFR C677T did not show a similar association, and the F2 G20210A variant was too rare for analysis. Conclusions: There were significant differences in FVL A allele carriage between individuals with a history of thrombosis and the control group. Future research should explore the complex interplay between genetics and environment in thrombosis risk within this population.

Bilateral Adrenal Hemorrhage in a Patient Anticoagulated with Apixaban for Antiphospholipid Syndrome (APS): A Rare Case Report

Context: Adrenal hemorrhage is a recognized yet rare complication associated with antiphospholipid syndrome (APS), an autoimmune disorder characterized by the presence of antiphospholipid antibodies that increase the risk of thrombosis. The incidence of adrenal hemorrhage in patients with APS has a diagnostic yield of approximately one-third, indicating that it may often go unrecognized in clinical practice. Traditionally, the management of APS has relied on anti-vitamin K therapy, such as warfarin. However, the advent of direct oral anticoagulants (DOACs) has prompted discussions about their use as an alternative. Recent clinical guidelines, however, strongly advise against the use of DOACs in patients with APS due to concerns over their safety and efficacy in preventing thromboembolic events. Case Presentation: This case study describes a 53-year-old woman with a history of venous thromboembolism who was treated with apixaban, a direct oral anticoagulant. She presented with acute abdominal pain and symptoms suggestive of adrenal insufficiency. Initial evaluations revealed significant changes in her clinical condition, leading to further diagnostic imaging. A CT scan demonstrated bilateral adrenal hemorrhage, which was a surprising finding given her anticoagulation therapy. Subsequent laboratory tests indicated a positive triple antibody profile, confirming a diagnosis of primary antiphospholipid syndrome. This case is particularly noteworthy as there have been limited documented instances of adrenal hemorrhage in patients receiving chronic anticoagulation with apixaban. The presentation of bilateral adrenal hemorrhage in the context of APS adds a crucial dimension to the understanding of the disease and its management. Conclusion: This case highlights the potential for serious complications, such as adrenal hemorrhage, in patients with antiphospholipid syndrome, particularly those treated with direct oral anticoagulants. It underscores the necessity for clinicians to remain vigilant for such rare yet significant events in the management of APS. Additionally, this case raises important questions regarding the appropriateness of DOACs in this patient population, especially given the latest recommendations against their use. Increased awareness and further investigation into the implications of anticoagulation strategies in APS patients are warranted to improve patient outcomes and safety.