Thrombogenic Risk Factors Research Articles

Diagnosis and treatment of venous thrombosis

The subject of this guideline from the Institute of Family Medicine at the University of Zurich (IHAMZ) is the management of venous thrombosis. The review summarizes the current evidence and recommendations from international guidelines (1-6). The IHAMZ-guidelines focus on primary care, they also provide guidance on the coordination of general and specialist medical care as well as on the transition between outpatient and hospital care taking into account the special features of the Swiss healthcare system. The guideline is devided in two parts. Part 1 discusses the diagnosis and treatment of deep vein thrombosis (DVT). A validated algorithm is recommended for the diagnostic process, which begins with the assessment of the clinical probability. With the inclusion of the D-dimer test, the need for subsequent imaging diagnostics can be reduced. The differences between the evaluation of an initial and recurrent DVT are shown and the indications and scope of evidence-based environmental diagnostics (thrombophilia and tumor search) are presented. All patients with DVT should receive anticoagulation (AC) for 3-6 months, as there is a high risk of recurrence with AC 3 months. The duration of the subsequent secondary prophylaxis depends on the presumed risk of recurrence on the one hand and the risk of bleeding on the other. Part 2 is dedicated to special thrombosis situations such as shoulder-arm vein thrombosis (SAVT), cancer-associated thrombosis (CAT) and superficial vein thrombosis (SVT). The article on hormone- and pregnancy-associated DVT, developed together with the Department of Gynecology at the University Hospital of Zurich, discusses the importance of hormonal contraception and menopausal hormone replacement therapy (HRT) as a thrombogenic risk factor as well as special features in the diagnosis and treatment of thrombosis in pregnancy.

Assessment of the physical development of children with and without high thrombogenic risk factors in the Health Center for Children

BACKGROUND: Up to 65% diseases associated with pathological thrombus have been described; more than 100 thrombogenic risk factors leading to vascular accidents have been studied. It is known that physical development is an important indicator of health in children. The relationship between the presence of thrombogenic risk factors in various disorders of physical development in children has been studied.
 AIM: To determine the relationship between physical development disorders in children and the presence of thrombogenic risk factors.
 MATERIALS AND METHODS: The study included 396 children aged 14–18 years, who underwent physical growth assessment using the sigma deviation method and genetic testing to determine polymorphisms of folate cycle genes and polymorphisms of thrombophilia genes. Statistical processing was carried out using the application package Statistica 10.0 (StatSoft, Inc., USA).
 RESULTS: The analysis of anthropometric indicators in children showed that in the group of the patients with thrombogenic risk factors, height and body weight values with average physical disharmonious development due to excess weight were statistically significantly higher than age-reference indicators.
 CONCLUSIONS: Based on the results of the study, it has been shown that disharmony in physical development in children with high thrombogenic risk factors may be one of the risk factors for the development of thrombotic conditions.

Investigation of thrombogenic risk factors in young adult male sportsmen

Abstract The study aimed to check the impact of sportsmen’s physical activity on blood coagulation processes and myocardial micro injuries in young adult male sportsmen. Comparing the results of athletes before and after 6 months of the training season, a statistically significant increase in the following parameters: PT (12.03±0.76 vs. 13.51±0.72 s; p<0.01), INR (1.03±0.07 vs. 1.14±0.06; p<0.01), APPT (28.73±3.27 vs. 33.31±5.63 s; p<0.01) and TT (20.62±0.97 vs. 22.49 ±1.41 s; p<0.01) was observed. Analyzing the results between the control group and the study group before training, the following changes were observed: APTT (35.26±6.74 vs. 28.73±3.27 s; p<0.01), HGMCR (750.17±59.23 vs. 569.38±51.24 ng/L; p <0.01) and L-FABP (329.16±92.04 vs. 151.80±70.10 ng/L; p=0.02) and an increase in H-FABP level (2.75±1.32 vs. 4.14±1.30 ng/mL; p<0.01). Comparing the values between the control group and the study group, but after training, an increase in the value for PT (12.88±1.41 vs. 13.51±0.72 s; p = 0.02), INR (1.09±0.13 vs. 1.14±0.06; p=0.02), TT (20.64±1.43 vs. 22.49±1.41 s; p<0.01) and H-FABP (2.75±1.32 vs. 3.94±1.47 ng/L; p<0.01) and decrease in HGMCR activity (750.17±59.23 vs. 581.47±51.25 ng/L; p<0.01) were observed. There was also a strong positive correlation between HGMCR and H-FABP (r = 0.77) and a strong negative correlation between TT and Fb (r = -0.808) and between TT and APTT (r = -0.424). Summarizing our study, we confirm that physical activity in sportsmen, especially overtraining, may have an impact on blood coagulation processes and may also lead to microdamage of the heart muscle.

Screening of thrombogenic risk factors in children in the Altai krai

Introduction. One of the urgent problems of modern pediatrics is the risk of developing vascular complications in children, among which thrombosis is not uncommon. For early diagnosis and thromboprophylaxis of strokes and other vascular complications, the identification of thrombogenic risk factors is indicated.
 The purpose of the study. Based on the screening, to establish predictors of thrombogenic risk in children living in urban and rural areas of the Altai Territory for the timely prevention of vascular complications.
 Materials and methods. The results of a screening study of two hundred seventeen aged 12–17 years children living in the city of Barnaul, Zarinsk and Klyuchevsk districts of the Altai Territory, were analyzed. Screening examination of children without signs of thrombosis and bleeding was carried out at an outpatient appointment with a pediatrician in random sampling. The questionnaire included questions to clarify the family thrombotic history, personal thrombotic history, background somatic diseases. Clinical examination was performed for all interviewed patients.
 Results. According to the results of the study, it was revealed that in 65 (30%) of the 217 children surveyed, the closest relatives had thrombogenic risk factors, such as heart attacks, strokes, hypertension, coronary heart disease (CHD). After analyzing the personal thrombotic history, it was found that in the general group of patients, myocardial infarction was observed in 2 (0.9%) children. Strokes were noted in 5 (2.3%) respondents, and thrombosis and TIA in 2 (0.9%) subjects. When analyzing the results, it was found that a significant proportion of children had the following conditions, such as vegetative-vascular dystonia (VVD) of the hypertensive type, the presence of signs of undifferentiated connective tissue dysplasia (UCTD), smoking, obesity.
 Conclusion. According to screening data in children, the main predisposing factors in the development of thrombosis, strokes and heart attacks are a burdened family, thrombotic history, the presence of some somatic diseases. The combination of these factors justifies the need for additional examination for the prevention of vascular thrombosis.

Antifosfolipidni sindrom kod dece

Antiphospholipid syndrome is a multisystemic autoimmune disease characterized by the appearance of arterial and/or venous thrombosis, often in multiple locations, thrombocytopenia and repeated spontaneous abortions in affected pregnant women, due to the permanent presence of antiphospholipid antibodies. It can also occur in children and manifest itself in any period of childhood, from infancy, due to transplacental transfer of maternal antibodies, or de novo production of autoantibodies, to adolescence. Clinical manifestations described in adults can also occur in children but are modified by age characteristics, such as the immaturity of the immune or other organ systems, greater exposure to viral and bacterial infections, implementation of routine immunization, absence of thrombogenic risk factors common to adults (hypertension, arteriosclerosis, consumption of cigarettes, alcohol and/or oral contraceptives), as well as the absence of pregnancy. Antiphospholipid antibodies most often used in daily clinical work are anticardiolipin antibodies, anti-b2 glycoprotein I antibodies, and lupus anticoagulants. Pathogenic mechanisms have not been investigated in detail - it is assumed that they are similar to the adult form of the disease. However, there is rare evidence of the existence of specific patterns of immune response to individual antigenic components, which may lead to specific production of antiphospholipid antibodies during childhood. It is also important to note that these antibodies can be found in about 25% of healthy children. The Sapporo criteria are used to diagnose antiphospholipid syndrome in adults. They include clinical (vascular thrombosis, repeated fetal losses) and laboratory parameters (persistent presence of one of the antiphospholipid antibodies) in the IgG and/or IgM class, in medium or high titer. The updated Sapporo criteria also apply to children. They include the same laboratory and clinical criteria, except for pregnancy pathology. The differential diagnosis is very broad and requires extensive diagnostics. Considering the specificity of the disease in childhood, the recommendations valid for adults, modified to a certain degree, apply to the treatment of diseases in children.

Pulmonary Embolism at High Altitude: Analysis of Risk Factors

Objective: To analyze the risk factors for pulmonary embolism stationed at high altitudes with high altitude as one of the determinants.
 Study Design: Retrospective longitudinal study.
 Place and Duration of Study: Combined Military Hospital Skardu Pakistan, from Jan 2016 to Jan 2020.
 Methodology: A total of 25 consecutive cases with pulmonary embolism reported to this hospital during the study period were enrolled. Medical records of all patients were retrospectively analyzed to determine the risk factors. In addition, patient demographic data, clinical features, and laboratory and radiological findings were recorded.
 Results: Mean age of the patient was 30.68±5.37 years with a range from 23 to 40 years, the mean height of deployment was 17223.00±3577.00 feet, while the mean duration of stay was 53.92±44.76 days. Dyspnoea (84%) was the commonest clinical presentation followed by palpitation, chest pain, headache and haemoptysis. Most patients (88%) were non-smokers, while no patient had known significant risk factors. Thrombophilia and vascultitic screening were negative for all patients. In the absence of any significant hereditary or acquired risk factor, high altitude remains the only thrombogenic risk factor patients deployed at heights.
 Conclusion: Stay at a high altitude is a major risk factor for pulmonary embolism in young patients without any other known risk factor.

Clinical case of thrombosis in a newborn child with congenital heart disease against the background of hereditary thrombophilia

Introduction. The problem of neonatal thrombosis is becoming increasingly urgent in clinical practice due to its importance in the development of a complicated course of the neonatal period in children with hereditary and acquired thrombogenic risk factors. The aim of the investigation is to present a clinical case of multiple thromboses in a premature newborn infant with congenital heart disease on the background of multigenic thrombophilia, complicated by neonatal sepsis. Materials and methods. Materials for the investigation were the primary medical records: history of the newborn, medical history of the patient-newborn child with the established diagnosis of great-vessel thrombosis, with the congenital heart disease and the presence of genetic thrombophilia, who was under observation for 2 months. The findings of objective, laboratory (clinical blood tests, investigation of hemostasis parameters, homocysteine concentration, molecular-genetic study of hemostasis enzymes genes, folate cycle enzymes genes) and instrumental (CT angiography, ultrasonic examination of abdominal cavity and retroperitoneal organs, ECHO cardiography, ultrasonic Dopplerography) research methods were evaluated. Results and Discussion. In the clinical observation under consideration, there was a burdened molecular genetic background consisting of carriage of plasminogen activator inhibitor gene polymorphisms and folate cycle enzyme genes: MTHFR 677 – C/T, MTHFR 2756 – A/G, MTRR 66 – G/G, and hyperhomocysteinemia were the factors responsible for multiple thrombosis in a patient born with critical congenital heart disease (CHD), contributed to generalization of the infection process with the development of multiple organ failure, and exacerbated the postoperative period after correction of heart disease. Conclusion. The clinical case demonstrates the development of multiple thrombosis and septic process in a child born with CHD. The results of molecular genetic study proved the presence of hereditary thrombophilia in the child, which was a predictor of thrombosis development and probably a risk factor aggravating the severity of generalized infectious process, which complicated pre- and postoperative periods of the main disease, CHD.

Determination of the prevalence of thrombogenic risk factors on the examination of children in the Health Centre

Introduction. Thrombosis in children and adults is believed to be always multifactorial and caused by a combination of permanent and temporary thrombogenic risk factors. Carriage of hereditary or life-long thrombogenic risk factors accompanying a person, causing a tendency to occur arterial and venous thrombosis is a critical problem, but little studied in paediatrics. Materials and methods. A genetic study of twelve prothrombotic polymorphic variants of candidate genes was carried out at the Health Centre. Three hundred 96 children were examined; 177 (43.3%) were boys, and 219 (56.7%) were girls. The average age of the patients was 15.6 ± 1.8 years. The main group of children with thrombogenic risk factors consisted of 27 cases, including ten boys and 17 girls. The comparison group consisted of 396 adolescents, including 167 boys and 202 girls. Results. The study of genetic polymorphisms of the genes of blood clotting factors and genes of folate metabolism in the work of the Health Centre revealed the prevalence of the A2756G allele of the MTR gene (p = 0.032) and the C1565 allele of the ITGB3 gene (p = 0.012) in the population of girls to be statistically significantly higher than in boys. The proportion of the 4G allele (-675) of the PAI-1 gene (p = 0.028) was also determined to be significantly more often detected in boys, while the proportion of the 5G allele of the PAI-1 gene (p = 0.032) was found with a higher frequency in girls. The distribution of allele and genotype frequencies in the studied genes of blood coagulation factors and folate metabolism were checked for compliance with the Hardy-Weinberg equilibrium. The group of children with thrombogenic risk factors included 27 patients. In children of this group, in 64.3% of cases, a mutation of the GA genotype of the factor V Leiden gene was detected, and 37.5% of children were with compounds from the homozygous TT allele of the C677T MTHFR genotype and the homozygous AA allele of the G(-455)A genotype of the fibrinogen FBG gene. Conclusion. With the introduction of personalized prophylaxis in the thrombogenic risk group based on the children’s health centre, thrombogenic complications can be successfully prevented.

КЛИНИКО-ЛАБОРАТОРНЫЕ ОСОБЕННОСТИ ТЕЧЕНИЯ ТРОМБОЭМБОЛИИ ЛЕГОЧНОЙ АРТЕРИИ У ПАЦИЕНТОВ С COVID-19 И ПОВЫШЕННЫМ УРОВНЕМ D-ДИМЕРА НА МОМЕНТ ГОСПИТАЛИЗАЦИИ

Elevated levels of D­dimer are not uncommon in patients with SARS­CoV­2 infection, and interpretation of this phenomenon is challenging for clinicians. Pulmonary embolism (PE) is an extremely severe complication and frequent event among patients with COVID­19. Objective: to establish the clinical and laboratory features of the course of PE verified by computed tomography angiography (CTA) of the pulmonary arteries in a group of individuals with confirmed SARS­CoV­2 infection and elevated D­dimer levels at the time of admission. Мaterials and methods. Analysis of medical records of 3664 in patients with confirmed SARS­CoV­2 coronavirus infection, hospitalized at “4th Сity Clinical Hospital named after N. E. Savchenko” of Minsk in the period from 01.01.2021 to 31.12.2021 was performed, the prevalence of patients with PE and COVID­19 was 3.1 % (n = 113). Two groups of patients with confirmed COVID­19 with elevated D­dimer level (>500 ng/ml) at the time of admission were defined: the study group (“PE+”) included COVID­19 patients with verified PE by CTA (n = 15), the comparison group (“PE–”) included those with PE excluded by CTA (n = 22). Results. The findings showed that individuals with COVID­19, elevated D­dimer level and developed PE at the time of admission had a more marked respiratory insufficiency, higher leukocytosis and neutrophil levels; the proportion of patients with increased prothrombin time (PT) was higher in the “PE+” group compared to the “PE–” group. A moderately strong association between outcome (PE) and elevated PT levels (ϕ = 0.43, p < 0.05), elevated leukocyte levels (ϕ = 0.34, p < 0.05), direct correlations between a number of inflammatory and hemostasis indicators were found. Conclusion. The findings indicate the presence of COVID­19­associated coagulopathy in patients with confirmed SARS­CoV­2 infection and elevated D­dimer level at the time of hospitalization. The pathogenetic basis and thrombogenic risk factors in patients with COVID­19 require further clarification.

Deep Venous Thrombosis and Pulmonary Thromboembolism in a Physically Nonprepared Trekker in the Himalayas: An Autopsy Report

Deep Venous Thrombosis (DVT) and Subsequent Pulmonary Thromboembolism (PTE) in high altitude climbers is a well-known concept. The acclimatization process at high altitude is itself a thrombogenic event. Accordingly, when a physically nonprepared individual with preexisting thrombogenic risk factors attempts trekking at high altitude, they may end up with fatal thromboembolic events. Here, we report a case of a low-lander with multiple thrombogenic risk factors who developed DVT and PTE when he went for a trekking trip in the Himalayas. The risk factors, autopsy findings, and possible mechanism of developing fatal pulmonary embolism, in this case, are discussed here.

Deep Venous Thrombosis And Pulmonary Thromboembolism In A Physically Nonprepared Trekker In The Himalayas – An Autopsy Report.

Deep venous thrombosis (DVT) and subsequent pulmonary thromboembolism (PTE) in high altitude climbers is a well-known concept. The acclimatization process at high altitude is itself a thrombogenic event. Having said that, when a physically nonprepared individual with preexisting thrombogenic risk factors attempts trekking at high altitude, he may end up with fatal thromboembolic events. Here we report a case of a low lander with multiple thrombogenic risk factors who developed DVT and PTE when he went for a trekking trip in the Himalayas. The risk factors, autopsy findings and possible mechanism of developing fatal pulmonary embolism, in this case, are discussed here.

Obesity as a Thrombogenic and Cardiovascular Risk Factor in Children

Background/Aims: Obesity leads to increased risk of thromboembolic events in adults, but few studies have addressed the relationship between obesity and thrombogenic risk during childhood. The aim of this study was to evaluate the prothrombotic state of obese children in comparison with healthy children. Methods: Thrombin generation, fibrinogen, and D-dimer levels, along with metabolic parameters, were measured in 72 prepubertal children, of which 47 were obese and 25 eutrophic. Results: A significant increase in thrombin generation, fibrinogen, and dyslipidemia was found among obese patients. Conclusion: A prothrombotic state develops in childhood obesity during the prepubertal phase.

Endothelial dysfunction and thromboembolism in children, adolescents, and young adults with acute lymphoblastic leukemia

Endothelial dysfunction has not previously been investigated as a thrombogenic risk factor among patients with acute lymphoblastic leukemia (ALL), known to be at high risk of thromboembolism. We retrospectively explored the association between three circulating biomarkers of endothelial dysfunction (thrombomodulin, syndecan-1, VEGFR-1) measured in prospectively collected blood samples and risk of thromboembolism in 55 cases and 165 time-matched controls, treated according to the NOPHO ALL2008 protocol. In age-, sex-, and risk group-adjusted analysis, increasing levels of thrombomodulin and VEGFR-1 were independently associated with increased odds of developing thromboembolism (OR 1.37 per 1 ng/mL [95% CI 1.20‒1.56, P < 0.0001] and OR 1.21 per 100 pg/mL [95% CI 1.02‒1.21, P = 0.005], respectively). These associations remained significant when including only samples drawn >30 days before thromboembolic diagnosis. Thrombomodulin levels were on average 3.2 ng/mL (95% CI 2.6-8.2 ng/mL) higher in samples with measurable asparaginase activity (P < 0.0001). Among single nucleotide variants located in or neighboring coding genes for the three biomarkers, none were significantly associated with odds of thromboembolism. If results are validated in another cohort, thrombomodulin and VEGFR-1 could serve as predictive biomarkers, identifying patients in need of preemptive antithrombotic prophylaxis.

Factor V Leiden mutation, prothrombin gene mutation, and deficiencies in coagulation inhibitors associated with Budd-Chiari syndrome and portal vein thrombosis: results of a case-control study

AbstractIn a collaborative multicenter case-control study, we investigated the effect of factor V Leiden mutation, prothrombin gene mutation, and inherited deficiencies of protein C, protein S, and antithrombin on the risk of Budd-Chiari syndrome (BCS) and portal vein thrombosis (PVT). We compared 43 BCS patients and 92 PVT patients with 474 population-based controls. The relative risk of BCS was 11.3 (95% CI 4.8-26.5) for individuals with factor V Leiden mutation, 2.1(95% CI 0.4-9.6) for those with prothrombin gene mutation, and 6.8 (95% CI 1.9-24.4) for those with protein C deficiency. The relative risk of PVT was 2.7 (95% CI 1.1-6.9) for individuals with factor V Leiden mutation, 1.4 (95% CI 0.4-5.2) for those with prothrombin gene mutation, and 4.6 (95% CI 1.5-14.1) for those with protein C deficiency. The relative risk of BCS or PVT was not increased in the presence of inherited protein S or antithrombin deficiency. Concurrence of either acquired or inherited thrombotic risk factors was observed in 26% of the BCS patients and 37% of the PVT patients. We conclude that factor V Leiden mutation and hereditary protein C deficiency appear to be important risk factors for BCS and PVT. Although the prevalence of the prothrombin gene mutation was increased, it was not found to be a significant risk factor for BCS and PVT. The coexistence of thrombogenic risk factors in many patients indicates that BCS and PVT can be the result of a combined effect of different pathogenetic mechanisms.

Prevalence of definite antiphospholipid syndrome in carriers of the JAK2V617F mutation

IntroductionPatients with Philadelphia-negative myeloproliferative neoplasms (MPNs), particularly those carrying the JAK2V617F mutation, are at increased risk of thrombosis. While an association of MPNs with autoimmune disorders has been established, the prevalence of inherited or acquired thrombophilias in JAK2V617F-positive patients remains obscure. We therefore investigated the coincidence of the JAK2V617F mutation with additional thrombogenic risk factors. MethodsIn a retrospective study, we analyzed all patients referred for thrombophilia work-up between 01/2011 and 08/2019, in whom additional JAK2V617F mutation analysis was performed because of thromboembolic events that were recurrent, atypically located and/or associated with abnormal blood counts. ResultsOf 472 tested patients, 49 (10.4%) were JAK2V617F-positive. While the frequency of inherited thrombophilias (factor V Leiden and prothrombin G20210A mutation, deficiency of antithrombin, protein C, protein S) was not different between the two groups, the prevalence of definite antiphospholipid syndrome (APS), mostly associated with a moderate- or high-risk antibody profile, was significantly higher in patients with (22.4%) than in those without (8.4%) JAK2V617F mutation (p < 0.01). All evaluable JAK2V617F-positive patients with APS were subsequently diagnosed with MPN. In patients with JAK2V617F mutation, presence of concomitant APS was associated with a significantly younger age (49 ± 14 vs. 60 ± 15 years) at the time of thrombophilia work-up (p < 0.05). ConclusionWe found a significant association between JAK2V617F-positive MPN and definite APS. The presence of concomitant APS in patients carrying the JAK2V617F mutation may lead to earlier manifestation of thromboembolic events and may warrant more aggressive antithrombotic treatment strategies to prevent recurrence.

Essential thrombocythemia: a hemostatic view of thrombogenic risk factors and prognosis.

Essential thrombocythemia (ET) is a classical myeloproliferative neoplasm that is susceptible to hypercoagulable state due to impaired hemostatic system, so that thrombotic complications are the leading cause of mortality in ET patients. The content used in this article has been obtained by the PubMed database and Google Scholar search engine from English-language articles (2000-2019) using the following keywords: "Essential thrombocythemia," "Thrombosis," "Risk factors" and "Hemostasis. In this neoplasm, the count and activity of cells such as platelets, leukocytes, endothelial cells, as well as erythrocytes are increased, which can increase the risk of thrombosis through rising intercellular interactions, expression of surface markers, and stimulation of platelet aggregation. In addition to these factors, genetic polymorphisms in hematopoietic stem cells (HSCs), including mutations in JAK2, CALR, MPL, or genetic abnormalities in other genes associated with the hemostatic system may be associated with increased risk of thrombotic events. Moreover, disruption of coagulant factors can pave the way for thrombogeneration. Therefore, the identification of markers related to cell activation, genetic abnormalities, or alternation in the coagulant system can be used together as diagnostic and prognostic markers for the occurrence of thrombosis among ET patients. Thus, because thrombotic complications are the main factors of mortality in ET patients, a hemostatic viewpoint and risk assessment of cellular, genetic, and coagulation factors can have prognostic value and contribute to the choice of effective treatment and prevention of thrombosis.

The role of inflammation mechanisms in the development of predisposition to thrombosis and thromboembolism in patients with chronic obstructive pulmonary disease and concurrent obstructive sleep apnea

The objective: to study the effect of sleep-related breathing disorders on the activation of blood coagulation reactions associated with systemic inflammation in patients with chronic obstructive pulmonary disease and concurrent obstructive sleep apnea.Subjects and methods. An open prospective comparative study analyzed thrombogenic risk factors, markers of inflammation and insulin resistance in 65 patients with chronic obstructive pulmonary disease and concurrent obstructive sleep apnea, 26 of them received non-invasive ventilation as a part of their therapy (main group).Results. The blood levels of homocysteine and prothrombin fragments 1+2 are closely associated with the duration of nocturnal hypoxemia, concentrations of C-reactive protein, C-peptide, and endothelial vascular growth factor and can be managed with CPAP therapy.The authors state that they have no conflict of interests.

Continuous-flow left ventricular assist device implantation in patients with preexisting mechanical mitral valves: a systematic review

ABSTRACTIntroduction: A preexisting mechanical mitral valve (MMV) is thought to be a thrombogenic risk factor after continuous-flow left ventricular assist device (CF-LVAD) implantation. We sought to evaluate the management and outcomes of preexisting MMVs in patients following CF-LVAD implantation.Areas covered: An electronic search was performed to identify the presence of an MMV at the time of CF-LVAD implantation. Of the 1,168 studies identified, only five studies consisting of seven CF-LVAD patients met the inclusion criteria. Patient-level data were extracted and analyzed.Expert opinion: The median patient age was 54 (IQR: 42–61) years and 71.4% (5/7) were male. Non-ischemic cardiomyopathy was the predominant etiology (83.3%, 5/6) of heart failure, and bridge-to-transplant the predominant indication (85.7%, 6/7) for CF-LVAD. Aortic valve prosthesis was present in 42.9% (3/7) of patients. Median time from MMV to CF-LVAD placement was 6.0 years (IQR: 1.3–15.0). The median lower limit of the INR range was 2.8 (IQR: 2.1–3.0) and upper limit of the INR range was 3.5 (IQR: 3.1–3.5). During a median follow-up time of 120 (IQR: 70–201) days, there were no major GI bleeds or clinically significant thromboembolic complications. With adequate anticoagulation, preexisting MMVs in CF-LVAD patients did not result in clinically significant thromboembolic events.

Is it safe and effective to reduce the target anticoagulation range for patients with mechanical prosthetic aortic valves?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Is it safe and effective to reduce the target anticoagulation range for patients with mechanical aortic valves?' Altogether 922 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question. Only studies that compared high (target international normalized ratio 2-3) versus low (target international normalized ratio <2-3) intensity anticoagulation were included. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that there is growing evidence for the reduction of the target anticoagulation range for patients with mechanical prosthetic aortic valves, especially bileaflet valves with presumed better haemodynamic properties. Several large randomized controlled trials and a meta-analysis have concluded that reducing the target international normalized ratio range (below the conventional range of 2-3) for mechanical aortic valves in patients with no thrombogenic risk factors produces less bleeding and does not increase thromboembolic events.

Сочетанная тромбофилия по данным гематологического консультирования

Введение. Диагностическая значимость гомозиготной мутации генов факторов свертывания крови FV Leiden и FII, а также их гетерозиготного полиморфизма в сочетании с маркерами первичного антифосфолипидного синдрома как предикторов тромбоза остается неоднозначной. Цель исследования: представить клинические случаи сочетанных тромбофилий, выявленных в процессе амбулаторного гематологического консультирования. Материалы и методы. В базе данных приема гематолога с января 2012 г. по апрель 2017 г. выявлен 891 пациент (837 женщин и 54 мужчины), которым было проведено обследование и консультирование на предмет тромбофилии и/или наличия активных факторов тромбогенного риска. Результаты. Сочетанная тромбофилия выявлена у 7 (0,8%) из 891 обследованного или у 7 (2,8%) из 246 пациентов с факторами тромбогенного риска. В 4 случаях у 2 мужчин (44 и 28 лет) и у 2 женщин (29 и 33 лет) диагноз установлен в связи с тяжелой и/или рецидивирующей венозной и артериальной тромбоэмболией и у 3 женщин (27, 36 и 39 лет) в связи с синдромом потери плода. Заключение. Анализ наблюдений подтверждает целесообразность поиска сочетанной тромбофилии в случае рецидивирующего тромбоза для выбора оптимальной антикоагулянтной терапии. Introduction. The diagnostic signifi cance of homozygous mutation of FV Leiden and FII clotting factor genes, as well as their heterozygous polymorphism in combination with the markers of the primary antiphospholipid syndrome as predictors of thrombosis remains ambiguous. Aim: to present clinical cases of combined thrombophilia revealed during outpatient hematology counseling. Materials and methods. In hematologist database from January 2012 to April 2017 we found 891 patients (837 women and 54 men) who were examined and consulted for thrombophilia and/or presence of active factors of thrombogenic risk. Results. Combined thrombophilia was identifi ed in 7 (0.8%) of 891 patients or in 7 (2.8%) of 246 patients with thrombogenic risk factors. In 4 cases — 2 men (44 and 28 years) and 2 women (29 and 33 years old) had a diagnosis due to severe and/or recurrent venous and arterial thromboembolism and 3 women (27, 36 and 39 years) had a diagnosis due to fetal loss syndrome. Conclusion. The observations confi rm the practicability of researching for combined thrombophilia in case of recurrent thrombosis for the choice of optimal anticoagulant therapy.