Thrombosis and Haemostasis 

About: Thrombosis and Haemostasis is an academic journal published by Thieme Medical Publishers (Germany). The journal publishes majorly in the area(s): Platelet & Platelet activation. It has an ISSN identifier of 0340-6245. Over the lifetime, 14902 publications have been published receiving 577612 citations. The journal is also known as: Journal of the International Society on Thrombosis and Haemostasis & Thrombosis and haemostasis (Print).

A Method to Determine the Optimal Intensity of Oral Anticoagulant Therapy

Abstract: Oral anticoagulant therapy has been shown to be effective for several indications. The optimal intensity of anticoagulation for each indication, however, is largely unknown. To determine this optimal intensity, randomised clinical trials are conducted in which two target levels of anticoagulation are compared. This approach is inefficient, since the choice of the target levels will be arbitrary. Moreover, the achieved intensity is not taken into account. We propose a method to determine the optimal achieved intensity of anticoagulation. This method can be applied within a clinical trial as an “efficacy-analysis”, but also on data gathered in day-to-day patient care. In this method, INR-specific incidence rates of events, either thromboembolic or hemorrhagic, are calculated. The numerator of the incidence rate is based on data on the INR at the time of the event. The denominator consists of the person-time at each INR value, summed over all patients, and is calculated from all INR measurements of all patients during the follow-up interval. This INR-specific person-time is calculated with the assumption of a linear increase or decrease between two consecutive INR determinations. Since the incidence rates may be substratified on covariates, efficient assessment of the effects of other factors (e.g. age, sex, comedication) by multivariate regression analysis becomes possible. This method allows the determination of the optimal pharmacological effects of anticoagulation, which can form a rational starting point for choosing the target levels in subsequent clinical trials.

Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation.

Abstract: 1. Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 2. Department of Haematology, Royal Liverpool University Hospital, Liverpool, UK 3. University of Texas Medical School, Gulf States Hemophilia Center, Houston, TX 4. 2nd Department of Internal Medicine, Mie University School of Medicine, Tsu-city Mieken, Japan 5. Dept. of Vascular Medicine and Internal Medicine, Academic Medical Center, University of Amsterdam, the Netherlands

Derivation of a Simple Clinical Model to Categorize Patients Probability of Pulmonary Embolism: Increasing the Models Utility with the SimpliRED D-dimer

Abstract: We have previously demonstrated that a clinical model can be safely used in a management strategy in patients with suspected pulmonary embolism (PE). We sought to simplify the clinical model and determine a scoring system, that when combined with D-dimer results, would safely exclude PE without the need for other tests, in a large proportion of patients. We used a randomly selected sample of 80% of the patients that participated in a prospective cohort study of patients with suspected PE to perform a logistic regression analysis on 40 clinical variables to create a simple clinical prediction rule. Cut points on the new rule were determined to create two scoring systems. In the first scoring system patients were classified as having low, moderate and high probability of PE with the proportions being similar to those determined in our original study. The second system was designed to create two categories, PE likely and unlikely. The goal in the latter was that PE unlikely patients with a negative D-dimer result would have PE in less than 2% of cases. The proportion of patients with PE in each category was determined overall and according to a positive or negative SimpliRED D-dimer result. After these determinations we applied the models to the remaining 20% of patients as a validation of the results. The following seven variables and assigned scores (in brackets) were included in the clinical prediction rule: Clinical symptoms of DVT (3.0), no alternative diagnosis (3.0), heart rate >100 (1.5), immobilization or surgery in the previous four weeks (1.5), previous DVT/PE (1.5), hemoptysis (1.0) and malignancy (1.0). Patients were considered low probability if the score was 4.0. 7.8% of patients with scores of less than or equal to 4 had PE but if the D-dimer was negative in these patients the rate of PE was only 2.2% (95% CI = 1.0% to 4.0%) in the derivation set and 1.7% in the validation set. Importantly this combination occurred in 46% of our study patients. A score of

Autologous platelets as a source of proteins for healing and tissue regeneration

Abstract: Platelets are known for their role in haemostasis where they help prevent blood loss at sites of vascular injury. To do this, they adhere, aggregate and form a procoagulant surface leading to thrombin generation and fibrin formation. Platelets also release substances that promote tissue repair and influence the reactivity of vascular and other blood cells in angiogenesis and inflammation. They contain storage pools of growth factors including PDGF, TGF-β and VEGF as well as cytokines including proteins such as PF4 and CD40L. Chemokines and newly synthesised active metabolites are also released. The fact that platelets secrete growth factors and active metabolites means that their applied use can have a positive influence in clinical situations requiring rapid healing and tissue regeneration.Their administration in fibrin clot or fibrin glue provides an adhesive support that can confine secretion to a chosen site. Additionally, the presentation of growth factors attached to platelets and/or fibrin may result in enhanced activity over recombinant proteins. Dental implant surgery with guided bone regeneration is one situation where an autologous platelet-rich clot clearly accelerates ossification after tooth extraction and/or around titanium implants. The end result is both marked reductions in the time required for implant stabilisation and an improved success rate. Orthopaedic surgery, muscle and/or tendon repair, reversal of skin ulcers, hole repair in eye surgery and cosmetic surgery are other situations where autologous platelets accelerate healing. Our aim is to review these advances and discuss the ways in which platelets may provide such unexpected beneficial therapeutic effects.

Towards Definition, Clinical and Laboratory Criteria, and a Scoring System for Disseminated Intravascular Coagulation* On behalf of the Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the ISTH

Abstract: Already in the 19th century some of the first clinical and pathological observations related to DIC were made. A more precise description of DIC and its underlying pathogenesis had to wait until the 20th century, when more insight in the mechanism of blood coagulation was attained and better laboratory tests had become available. Although the general picture of DIC is known to most clinicians, a precise description of the syndrome, a good working definition and a useful scoring system are not available. The SSC subcommittee on DIC has worked over the last years to come closer to achieve these goals. Traditionally DIC is diagnosed in association with the following