Association of coagulation dysfunction with thrombosis, bleeding and mortality in patients supported by veno-venous extracorporeal membrane oxygenation for viral pneumonia.

Background: Bleeding and thrombosis remain leading causes of morbidity and mortality in patients supported by extracorporeal membrane oxygenation (ECMO).

Aims: Assess haemostatic changes during veno-venous (VV)-ECMO support after respiratory failure due to viral pneumonia and their association with major bleeding, thrombosis and mortality.

Methods: Coagulation factors (II, V, VII, VIII, IX, X, XI, XII), von-Willebrand profile and thrombin generation (TG) were measured at cannulation, during VV-ECMO (every 5 day), 1hr and 24hrs-post decannulation in 50 patients (Aug 2018-Jan 2020).

Machine Learning in Venous Thromboembolism - Why and What Next?

Venous thromboembolism (VTE) remains a leading cause of cardiovascular morbidity and mortality, despite advances in imaging and anticoagulation. VTE arises from diverse and overlapping risk factors, such as inherited thrombophilia, immobility, malignancy, surgery or trauma, pregnancy, hormonal therapy, obesity, chronic medical conditions (e.g.

Thrombocytosis and bleeding in myeloproliferative neoplasms: exploring clinical diversity and risk of acquired von Willebrand syndrome-insights from a UK center.

Background: Myeloproliferative neoplasms (MPNs) represent a group of blood disorders characterized by myeloid cell proliferation and an associated increased risk of thrombosis and bleeding. Platelet count may have a direct link to these complications.

Objectives: To share our MPN clinic's experience with hemostatic testing and bleeding outcomes in patients with platelets ≥ 800 × 10/L.

Anti-PF4 disorders: Pathogenesis, diagnosis and treatment.

Platelet factor 4 (PF4) is a cationic protein, able to form complexes with negatively charged molecules upon its self-assembly into PF4 tetramers. The targeting of these PF4 complexes by immunoglobulin G (IgG) antibodies underlies anti-PF4 disorders such as heparin-induced thrombocytopenia (HIT) and Vaccine-Induced Immune Thrombocytopenia and Thrombosis (VITT)/VITT-like disorders. The formation of IgG/PF4 immune complexes facilitates uncontrolled activation of platelets, neutrophils and monocytes, via IgG-mediated Fcγ receptor binding.

Unresolved issues in the diagnosis and management of thrombotic antiphospholipid syndrome.

Antiphospholipid syndrome (APS) is a highly prothrombotic autoimmune disease characterized by the persistent presence of antiphospholipid autoantibodies (aPL) in association with thrombotic or nonthrombotic macro- and microvascular manifestations and/or pregnancy complications. This review is restricted to thrombotic APS. Since the publication of the American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for APS, several authors have emphasized the difference between "classification" and "diagnosis" as a potential pitfall for clinicians.

Comparison of 7 artificial intelligence models in predicting venous thromboembolism in COVID-19 patients.

Background: An artificial intelligence (AI) approach can be used to predict venous thromboembolism (VTE).

Objectives: To compare different AI models in predicting VTE using data from patients with COVID-19.

Methods: We used feature ranking through recursive feature elimination with AI algorithms (logistic regression and random forest classifier) and standard statistical methods to identify the significant factors that contribute to developing VTE in COVID-19 patients using a large dataset from "Coagulopathy associated with COVID-19," a multicenter observational study.

Guidance-Based Appropriateness of Hemostasis Testing in the Acute Setting.

In this review, we aim to highlight the extent of inappropriate hemostasis testing and provide practical guidance on how to prevent it. We will focus on the acute setting, including but not limited to the emergency department and intensive care unit. To this end, we will first discuss the significance of inappropriateness, in the general context of laboratory medicine.

A cell-based model to study mechanisms of endothelial-dependent thrombin generation in response to inflammation and its modulation by hydroxychloroquine.

Background: Inflammation is a driver of thrombosis, but the phenomenon of thromboinflammation has been defined only recently, bringing together the multiple pathways involved. models can support the development of new therapeutics targeting the endothelium and also assess the existing immunomodulatory drugs, such as hydroxychloroquine, in modulating the inflammation-driven endothelial prothrombotic phenotype.

Objectives: To develop a model for thrombin generation (TG) on the surface of human endothelial cells (ECs) to assess pro/antithrombotic properties in response to inflammation.

Lupus anticoagulant and valvular cardiac surgery.

Despite its name, lupus anticoagulant (LAC) neither exclusively occurs in lupus nor induces anticoagulation. It is an antiphospholipid antibody found in 2%-4% of the population that promotes clot formation by targeting phospholipid-protein complexes in cell membranes. However, in vitro, LAC exhibits paradoxical effects, prolonging clotting times in phospholipid-dependent assays such as Activated Partial Thromboplastin Time (APTT).

Rivaroxaban for stroke patients with antiphospholipid syndrome (RISAPS): protocol for a randomized controlled, phase IIb proof-of-principle trial.

Background: Optimal secondary prevention antithrombotic therapy for patients with antiphospholipid syndrome (APS)-associated ischemic stroke, transient ischemic attack, or other ischemic brain injury is undefined. The standard of care, warfarin or other vitamin K antagonists at standard or high intensity (international normalized ratio (INR) target range 2.0-3.

Pleiotropic Effects of Heparin and its Monitoring in the Clinical Practice.

Unfractionated heparin (UFH) was uncovered in 1916, has been used as an anticoagulant since 1935, and has been listed in the World Health Organization's Model List of Essential Medicines. Despite the availability of many other anticoagulants, the use of heparin (either low molecular weight heparin [LMWH] or UFH) is still substantial. Heparin has pleotropic effects including anticoagulant and several nonanticoagulant properties such as antiproliferative, anti-inflammatory activity, and anticomplement effects.

Dilemmas in the diagnosis and management of antiphospholipid syndrome.

Antiphospholipid syndrome (APS) is characterized by thrombosis (which may be venous, arterial, or microvascular) and/or pregnancy morbidity in association with persistently positive antiphospholipid antibodies. Although thrombosis and pregnancy morbidity are the main clinical criteria for a diagnosis of APS in the revised Sapporo (Sydney) criteria, recently published American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for APS have significantly refined the diagnostic algorithm to include a scoring system clustered into 6 clinical domains (macrovascular venous thromboembolism, macrovascular arterial thrombosis, microvascular thrombosis, obstetric, cardiac valve, and hematologic). Diagnosis of APS is complicated by the fact that significant heterogeneity exists in patients' clinical presentation, underlying vascular risk factors, and methods of detecting antiphospholipid antibodies.

Impact of very low dose rivaroxaban in addition to dual antiplatelet therapy on endogenous fibrinolysis in acute coronary syndrome: The VaLiDate-R study.

Background: Impaired endogenous fibrinolysis is adverse cardiovascular risk factor in acute coronary syndrome (ACS) patients. Addition of very low dose rivaroxaban (VLDR) to dual antiplatelet therapy (DAPT) reduces cardiovascular events but increases bleeding.

Objective: We aimed to assess whether addition of VLDR to DAPT can enhance endogenous fibrinolysis.

Adult Highlights From the Extracorporeal Life Support Organization Registry: 2017-2022.

The Extracorporeal Life Support Organization (ELSO) registry captures clinical data and outcomes on patients receiving extracorporeal membrane oxygenation (ECMO) support across the globe at participating centers. It provides a very unique opportunity to benchmark outcomes and analyze the clinical course to help identify ways of improving patient outcomes. In this review, we summarize select adult ECMO articles published using the ELSO registry over the past 5 years.

The immunology of long COVID.

Long COVID is the patient-coined term for the disease entity whereby persistent symptoms ensue in a significant proportion of those who have had COVID-19, whether asymptomatic, mild or severe. Estimated numbers vary but the assumption is that, of all those who had COVID-19 globally, at least 10% have long COVID. The disease burden spans from mild symptoms to profound disability, the scale making this a huge, new health-care challenge.

Thombosis, major bleeding, and survival in COVID-19 supported by veno-venous extracorporeal membrane oxygenation in the first vs second wave: a multicenter observational study in the United Kingdom.

Background: Bleeding and thrombosis are major complications of veno-venous (VV) extracorporeal membrane oxygenation (ECMO).

Objectives: To assess thrombosis, major bleeding (MB), and 180-day survival in patients supported by VV-ECMO between the first (March 1 to May 31, 2020) and second (June 1, 2020, to June 30, 2021) waves of the COVID-19 pandemic.

Methods: An observational study of 309 consecutive patients (aged ≥18years) with severe COVID-19 supported by VV-ECMO was performed in 4 nationally commissioned ECMO centers in the United Kingdom.

Mechanisms regulating heterogeneity of hemostatic gene expression in endothelial cells.

The hemostatic system involves an array of circulating coagulation factors that work in concert with platelets and the vascular endothelium to promote clotting in a space- and time-defined manner. Despite equal systemic exposure to circulating factors, bleeding and thrombotic diseases tend to prefer specific sites, suggesting an important role for local factors. This may be provided by endothelial heterogeneity.

A Comparison of Long-Term Outcomes in Patients Managed With Venovenous Extracorporeal Membrane Oxygenation in the First and Second Waves of the COVID-19 Pandemic in the United Kingdom.

Objectives: Early studies of venovenous extracorporeal membrane oxygenation (ECMO) in COVID-19 have revealed similar outcomes to historical cohorts. Changes in the disease and treatments have led to differences in the patients supported on venovenous ECMO in the first and second waves. We aimed to compare these two groups in both the acute and follow-up phase.