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A Seeming Paradox: Ischemic Stroke in the Context of Idiopathic Thrombocytopenic Purpura
Nowadays, we have a relatively sophisticated standard approach to a patient with acute ischemic stroke, including the sequence of diagnostic methods and treatment modalities. In practice, however, we are occasionally confronted with a patient whose medical history or comorbidities force us to make a decision without the support of guidelines. One such situation is the occurrence of acute ischemic stroke in a patient with known idiopathic thrombocytopenic purpura, where a tendency to use thrombolysis, anticoagulants, or antiplatelet agents collides with the fear of life-threatening bleeding. In this review, we try to outlin...
Source: Clinical and Applied Thrombosis/Hemostasis - February 2, 2016 Category: Hematology Authors: Mihalov, J., Timarova, G. Tags: Reviews Source Type: research

Over 50 Years of Fibrinogen Concentrate
March 2013 represented the 50th anniversary of the first license granted for a fibrinogen concentrate. In this review, we look at the history of bleeding management that led to the development of fibrinogen concentrate, discuss its current use, and consider future developments for this product. (Source: Clinical and Applied Thrombosis/Hemostasis)
Source: Clinical and Applied Thrombosis/Hemostasis - February 2, 2016 Category: Hematology Authors: Costa-Filho, R., Hochleitner, G., Wendt, M., Teruya, A., Spahn, D. R. Tags: Reviews Source Type: research

Outcome of Medically Versus Surgically Treated Patients With Chronic Thromboembolic Pulmonary Hypertension
Chronic thromboembolic pulmonary hypertension (CTEPH) is an ominous disease leading to progressive right heart failure. Selected patients can be treated by pulmonary endarterectomy (PEA). We assessed long-term clinical outcome of patients with CTEPH who underwent PEA and patients who remained on medical treatment alone. A total of 112 consecutive patients with CTEPH referred between 1998 and 2008 to one center were followed for a mean of 35 (range 0-128) months after diagnosis. All the patients had advanced pulmonary hypertension at baseline. The operated group had higher World Health Organization functional class compared...
Source: Clinical and Applied Thrombosis/Hemostasis - December 9, 2015 Category: Hematology Authors: Wieteska, M., Biederman, A., Kurzyna, M., Dyk, W., Burakowski, J., Wawrzynska, L., Szturmowicz, M., Fijałkowska, A., Szatkowski, P., Torbicki, A. Tags: Original Articles Source Type: research

Restoration of Normal Prothrombin Time/International Normalized Ratio With Fresh Frozen Plasma in Hypocoagulable Patients
Fresh frozen plasma (FFP) is an effective reversal agent for hypocoagulable patients. Its proven efficacy continues to prompt its usage as both a prophylactic and a therapeutic therapy. Although published guidelines encouraging the appropriate administration of FFP exist, overutilization continues. The purpose of these ex vivo studies was to determine the effects of succeeding volumes of FFP supplementation on hypocoagulable plasma prothrombin time/international normalized ratio (PT/INR). By analyzing the decline in PT/INR with varying volumes of FFP, a minimal required volume of FFP could be identified representing the op...
Source: Clinical and Applied Thrombosis/Hemostasis - December 9, 2015 Category: Hematology Authors: Only, A. J., DeChristopher, P. J., Iqal, O., Fareed, J. Tags: Original Articles Source Type: research

Relative Risk of Deep Vein Thrombosis in Very Elderly Patients Compared With Elderly Patients
This study analyzes the relative risk of DVT in very elderly patients older than 90 years of age compared with elderly patients aged 80 to 89 years. The study was performed at the Department of Internal Medicine, University Hospital of Saarland, Homburg/Saar, Germany, between 2004 and 2012. After completing ultrasound examinations, 20 (64.52%, 12 [60%] female patients, mean age 91.8 ± 1.83 years) of the 31 patients in the study group and 132 (62.26%, 87 [65.91%] female patients, mean age 83.84 ± 2.66 years) of the 212 patients in the control group were diagnosed with DVT. An increased relative risk of DVT was...
Source: Clinical and Applied Thrombosis/Hemostasis - December 9, 2015 Category: Hematology Authors: Yayan, J., Bals, R. Tags: Original Articles Source Type: research

N-Terminal Pro-Brain Natriuretic Peptide Level is Associated With Severity and Complexity of Coronary Atherosclerosis in Patients With Acute Coronary Syndrome
N-terminal pro-brain natriuretic peptide (NT-proBNP) levels are associated with short- and long-term mortality in acute coronary syndrome (ACS). We investigated whether baseline NT-proBNP levels are associated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore). We enrolled 509 patients with ACS who underwent coronary angiography. The patients were divided into tertiles according to the SXScore: low SXScore (≤22), intermediate SXScore (23-32), and high SXScore (≥33). The NT-proBNP levels demonstrated an increase from low SXScore tertile to high SXScore tertile. The NT-proBNP levels according to...
Source: Clinical and Applied Thrombosis/Hemostasis - December 9, 2015 Category: Hematology Authors: Kurtul, A., Yarlioglues, M., Murat, S. N., Duran, M., Acikgoz, S. K., Sensoy, B., Ergun, G., Cetin, M., Ornek, E. Tags: Original Articles Source Type: research

Relationship Between Hematologic Indices and Global Registry of Acute Coronary Events Risk Score in Patients With ST-Segment Elevation Myocardial Infarction
The aim of this study was to evaluate the relationship between hematologic indices and the Global Registry of Acute Coronary Events (GRACE) score in patients with ST-segment elevation myocardial infarction (STEMI). A total of 800 patients who consecutively and retrospectively presented with STEMI within 12 hours of symptom onset. After accounting for exclusion criteria, a total of 379 patients remained in the study. We enrolled 379 patients with STEMI (mean age 61.7 ± 13.6 years; men 73%). Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), red cell distribution width (RDW), and monocyte count ...
Source: Clinical and Applied Thrombosis/Hemostasis - December 9, 2015 Category: Hematology Authors: Acet, H., Ertas, F., Akıl, M. A., Özyurtlu, F., Polat, N., Bilik, M. Z., Aydın, M., Oylumlu, M., Yüksel, M., Yıldız, A., Kaya, H., Akyüz, A., Özbek, M. Tags: Original Articles Source Type: research

Assessment of Silent Neuronal Injury Following Coronary Angiography and Intervention in Patients With Acute Coronary Syndrome
The aim of this study is to evaluate the incidence and predictors of silent neuronal injury (SNI) after coronary angiography (CAG) and intervention by serial measurement of serum neuron-specific enolase (NSE) in patients presented with acute coronary syndrome (ACS). Ninety-eight consecutive patients presented with ACS and underwent CAG and intervention were included in the study. The NSE levels significantly increased after CAG and intervention compared to baseline levels (22.03 ± 27.70 and 10.08 ± 3.15 consecutively). Left ventricular ejection fraction in the SNI+ group was significantly lower than that in t...
Source: Clinical and Applied Thrombosis/Hemostasis - December 9, 2015 Category: Hematology Authors: Aykan, A. C., Gökdeniz, T., Bektas, H., Boyacı, F., Gül, I., Hatem, E., Kalaycıoglu, E., Turan, T., Cevirme, D., Celik, S. Tags: Original Articles Source Type: research

Flow Augmentation in Acute Ischemic Stroke
There is an urgent need for additional therapeutic options for acute ischemic stroke considering the major pitfalls of the options available. Herein, we briefly review the role of cerebral blood flow, collaterals, vasoreactivity, and reperfusion injury in acute ischemic stroke. Then, we reviewed pharmacological and interventional measures such as volume expansion and induced hypertension, intra-aortic balloon counterpulsation, partial aortic occlusion, extracranial–intracranial carotid bypass surgery, sphenopalatine ganglion stimulation, and transcranial laser therapy with regard to their effects on flow augmentation...
Source: Clinical and Applied Thrombosis/Hemostasis - December 9, 2015 Category: Hematology Authors: Yadollahikhales, G., Borhani-Haghighi, A., Torabi-Nami, M., Edgell, R., Cruz-Flores, S. Tags: Original Articles Source Type: research

Early Identification of Asymptomatic Pulmonary Embolism Proximal to the Subsegmental Arteries After Gynecologic Surgery
In this study, we investigated whether asymptomatic PE occurring just after gynecologic surgery was subsegmental, and we examined the background characteristics of patients who experienced PE within 2 months postoperatively. All hospital records were reviewed, yielding a total of 2052 women who had undergone surgeries performed by the gynecologic oncology team between 2003 and 2013 in the National Kyushu Cancer Center. Asymptomatic and symptomatic postoperative PE cases diagnosed by multidetector computed tomography angiography or lung scan were identified; after excluding 2 cases of preoperative PE, there were 15 (0.73%) ...
Source: Clinical and Applied Thrombosis/Hemostasis - December 9, 2015 Category: Hematology Authors: Okadome, M., Saito, T., Shimamoto, K., Ogahara, R., Akiyoshi, H., Fujimoto, M., Shinozaki, K. Tags: Original Articles Source Type: research

Plasma Levels of Plasminogen Activator Inhibitor Type 1 and Vitronectin in Children With Cancer
Conclusions: This is a preliminary study done in children with malignancies, investigating PAI-1 and vitronectin. Further study is needed, including larger trials and tumor tissue with histopathological examination as in adults. (Source: Clinical and Applied Thrombosis/Hemostasis)
Source: Clinical and Applied Thrombosis/Hemostasis - December 9, 2015 Category: Hematology Authors: Tugcu, D., Devecioglu, O., Unuvar, A., Ekmekci, H., Ekmekci, O. B., Anak, S., Ozturk, G., Akcay, A., Aydogan, G. Tags: Original Articles Source Type: research

Recent Change in Treatment of Disseminated Intravascular Coagulation in Japan: An Epidemiological Study Based on a National Administrative Database
This study investigated the time trends and hospital factors affecting the use of drugs for infectious disease-associated disseminated intravascular coagulation (DIC) based on a national administrative database. A total of 14 324 patients with infectious disease-associated DIC were referred to 1041 hospitals from 2010 to 2012 in Japan. Patients’ data were collected from the administrative database to determine time trends and hospital factors affecting the use of drugs for DIC. Three study periods were established, namely, the fiscal years 2010 (n = 3308), 2011 (n = 5403), and 2012 (n = 5613). The use of antithrombin...
Source: Clinical and Applied Thrombosis/Hemostasis - December 9, 2015 Category: Hematology Authors: Murata, A., Okamoto, K., Mayumi, T., Muramatsu, K., Matsuda, S. Tags: Original Articles Source Type: research

Hematopoietic Stem Cell Transplant-Associated Thrombotic Microangiopathy
Hematopoietic stem cell transplant-associated thrombotic microangiopathy (TA-TMA) is a fatal, multifactorial disorder, which may present with thrombocytopenia, hemolysis, acute renal failure, mental status changes and involvement of other organs. The pathogenesis of TA-TMA is complex and includes multiple risk factors such as certain conditioning regimens, calcineurin inhibitors (CNIs), graft-versus-host disease (GVHD), human leukocyte antigen mismatch, and opportunistic infections. The end result of these insults is endothelial injury in the kidney and other organs. Recent studies also indicate a role of complement activa...
Source: Clinical and Applied Thrombosis/Hemostasis - December 9, 2015 Category: Hematology Authors: Elsallabi, O., Bhatt, V. R., Dhakal, P., Foster, K. W., Tendulkar, K. K. Tags: Original Articles Source Type: research

Real-World Medical Cost Avoidance When New Oral Anticoagulants are Used Versus Warfarin for Venous Thromboembolism in the United States
Conclusion: Based on real-world data, when any of the evaluated NOACs are used instead of warfarin for treatment of patients with acute VTE, annual medical costs are reduced. Of the NOACs, apixaban has the greatest real-world medical cost avoidance, as its use is associated with substantial reductions in both VTE and MB event rates. (Source: Clinical and Applied Thrombosis/Hemostasis)
Source: Clinical and Applied Thrombosis/Hemostasis - December 9, 2015 Category: Hematology Authors: Amin, A., Bruno, A., Trocio, J., Lin, J., Lingohr-Smith, M. Tags: Review Source Type: research

The Safety and Efficacy of 12 Versus 24 Hours of Tirofiban Infusion in Patients Undergoing Primary Percutaneous Coronary Intervention
Conclusion: Our study revealed that 12-hour tirofiban administration versus 24-hour tirofiban administration in STEMI who underwent primary PCI was similar with respect to in-hospital efficacy and safety and major adverse cardiac events during 6-month follow-up. (Source: Clinical and Applied Thrombosis/Hemostasis)
Source: Clinical and Applied Thrombosis/Hemostasis - October 5, 2015 Category: Hematology Authors: Topcu, S., Karal, H., Kaya, A., Bakirci, E. M., Tanboga, I. H., Kurt, M., Aksakal, E., Acikel, M., Sevimli, S. Tags: Original Articles Source Type: research