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Seminars in Thrombosis and Hemostasis

Giuseppe Lippi, Elisa Danese, Emmanuel J Favaloro
Aspirin is one of the most often used drugs for prevention and treatment of a variety of thrombotic disorders. This narrative review aims to provide an overview of evidence highlighting potential benefits and relative harms of aspirin in primary prevention of cardiovascular disease. The authors summarize key findings of the ASPirin in Reducing Events in the Elderly (ASPREE) Investigator Group randomized trial and also provide a comparative overview of recent meta-analyses. Overall, all-cause mortality was largely heterogeneous, with some meta-analyses showing a modestly decreased risk in patients taking aspirin, with others reporting no effects, but the ASPREE Investigator Group trial evidencing 14% higher risk...
October 22, 2018: Seminars in Thrombosis and Hemostasis
Job Harenberg, Rupert Schreiner, Svetlana Hetjens, Christel Weiss
The assessment of the anticoagulant effect of direct oral anticoagulants (DOACs) can be important for rapid medical decision-making, especially in patients needing immediate management. An assay that screens for the absence or presence of a DOAC would help accelerate treatment in these situations. Chromogenic and coagulation methods have several limitations, including limited accuracy, long turnaround time, and their need of specialized laboratories. Oral factor Xa and thrombin inhibitors are also eliminated by the kidneys and can be detected in patient urine samples using a single, rapid, sensitive, and patient-specific qualitative assay...
August 22, 2018: Seminars in Thrombosis and Hemostasis
Emmanuel J Favaloro
Although the landscape of anticoagulation therapy is evolving, vitamin K antagonists (VKAs) such as warfarin remain an anticoagulant of choice for many clinicians and their patients. Nevertheless, management of VKA therapy remains challenging, largely because of patient variability and drug and food interactions; thus, VKA dosing has to be personalized. This is achieved by regular monitoring using a test called the prothrombin time (PT) , mathematically converted to an international normalized ratio (INR). The INR system is meant to harmonize laboratory test results by taking into account reagent and instrumentation variability that is otherwise expected to give rise to variable PT values, but which should accordingly lead to less variable INR values...
August 22, 2018: Seminars in Thrombosis and Hemostasis
Vincenzo Russo, Roberta Bottino, Anna Rago, Pierpaolo Di Micco, Antonio D' Onofrio, Biagio Liccardo, Paolo Golino, Gerardo Nigro
Atrial fibrillation (AF) is commonly diagnosed in the setting of active cancer. Because of an increased risk of either thromboembolic events or bleeding, the decision to initiate therapeutic anticoagulation in patients with active cancer can be challenging. Moreover, little is still known about the optimal anticoagulation therapy in the setting of AF and cancer, and no guidelines are as yet available. Considering that nonvitamin K antagonist oral anticoagulants (NOACs) are recommended as alternatives to vitamin K antagonists for stroke prevention in AF patients with CHA2 DS2- VASc score ≥2, the authors performed a systematic review of the current literature to describe the efficacy and safety of NOACs in AF patients with malignancy...
August 17, 2018: Seminars in Thrombosis and Hemostasis
Adam Cuker, Joseph E Marturano, Maria E Carinato, Thomas J Lowery, Douglas B Cines
There is a clinical need for pragmatic approaches to measure integrated hemostatic reactions in whole blood rapidly, using small volumes of blood. The authors have applied T2 magnetic resonance (T2MR) to assess coagulation reactions based on partitioning of red blood cells and proteins that occurs during fibrin formation and platelet-mediated clot contraction. T2MR is amenable to measuring clotting times, individual coagulation factors, and platelet function. T2MR also revealed a novel "hypercoagulable" signature characterized by fibrin clots almost insusceptible to fibrinolysis that surround tessellated arrays of polyhedral erythrocytes ("third peak")...
August 17, 2018: Seminars in Thrombosis and Hemostasis
Murray J Adams, James W Fell
No abstract text is available yet for this article.
November 2018: Seminars in Thrombosis and Hemostasis
Eva Zetterberg, Marcus Ljungkvist, Maryem Salim
Sports and strenuous exercise have traditionally been discouraged for people with hemophilia (PWH) because of the perceived risk of bleeding. In this review, studies investigating the pros and cons of exercise are presented, and although most studies are of low validity, the randomized trials that do exist tell us that PWH benefit from exercise in terms of improved muscular function, endurance, and quality of life and that increased bleeding does not seem to be an issue. The authors also review the studies that have analyzed the current physical status of PWH compared with the general population in different countries...
November 2018: Seminars in Thrombosis and Hemostasis
Bassel Nazha, Bhavi Pandya, Alex C Spyropoulos, Craig M Kessler
Venous thromboembolism (VTE) is a leading cause of morbidity with potentially detrimental career consequences in elite athletes. Their unique predisposing factors entail a higher-than-expected VTE incidence. Anticoagulation treatment is challenging, especially among those athletes wishing to resume their competitive activities. The authors review the current VTE treatment guidelines from the perspective of treating elite athletes. They then provide an expert opinion individualized treatment approach based on the pharmacokinetic properties of direct oral anticoagulants that permits tailoring the drug's timing to the athlete's competitive endeavors...
November 2018: Seminars in Thrombosis and Hemostasis
Lisa N van der Vorm, Dana Huskens, Cécile H Kicken, Jasper A Remijn, Mark Roest, Bas de Laat, Adam Miszta
Physical activity is beneficial for health, for example, by lowering the risk of cardiovascular events. However, vigorous exercise is associated with the occurrence of thromboembolic events and sudden cardiac death, in particular in untrained individuals. Whereas acute exercise is known to cause a hypercoagulable state, repeated exposure to (strenuous) exercise by means of training may actually condition the hemostatic response to exercise. To date, the effects of exercise training on blood coagulability and the underlying mechanisms have yet to be fully discerned...
November 2018: Seminars in Thrombosis and Hemostasis
Emma Kate Zadow, Murray John Adams, Cecilia M Kitic, Sam Shi Xuan Wu, James William Fell
While athletes are often considered the epitome of health due to their physique and lowered potential for metabolic and cardiovascular diseases, they may also be at risk for the onset and development of venous thromboembolism (VTE). In an attempt to achieve and remain competitive, athletes are frequently exposed to numerous athlete-specific risk factors, which may predispose them to VTE through the disruption of factors associated with Virchow's triad (i.e., hypercoagulability, venous stasis, and vessel wall injury)...
November 2018: Seminars in Thrombosis and Hemostasis
Massimo Franchini, Silvia Fasoli, Giorgio Gandini, Anna Chiara Giuffrida
Physical activity provides many benefits in patients with congenital bleeding disorders. Patients with hemophilia are encouraged to participate in exercise and sports, especially those patients receiving prophylaxis. Several publications and guidelines have explored this issue in hemophilia patients, evaluating in particular the impact of physical activity on patients' well-being and quality of life. The other rare congenital bleeding disorders are less studied; they are heterogeneous in terms of clinical bleeding phenotype, incidence of hemarthrosis, and arthropathy...
November 2018: Seminars in Thrombosis and Hemostasis
Line H Evensen, Sigrid K Brækkan, John-Bjarne Hansen
Venous thromboembolism (VTE) is a complex multifactorial disease that represents a growing public health concern. Identification of modifiable risk factors at the population level may provide a measure to reduce the burden of VTE. In this review, we summarize current knowledge of the role of physical activity on the risk of VTE and VTE-related complications. We also discuss methodological challenges related to research on physical activity, and put forward plausible mechanisms for an association between physical activity and VTE...
November 2018: Seminars in Thrombosis and Hemostasis
Brian R Kupchak
Hemostasis is the ability of the body to control blood loss following vascular injury. The process is composed of a complex array of pathways made up of the coagulation and fibrinolytic systems that allow the fluid blood to clot after injury and then the subsequent breakdown of the clot, permitting repair of the injured tissue. Studies to date have shown exercise to be a stimulating factor in both the coagulation and fibrinolytic pathways. Additionally, air travel has been shown to be a risk factor for thrombosis...
November 2018: Seminars in Thrombosis and Hemostasis
Anne-Mette Hvas, Søs Neergaard-Petersen
Regular exercise may reduce the risk of major cardiovascular thrombotic events. However, previous studies suggest that the risk of myocardial infarction or primary cardiac arrest is transiently increased during exercise. Thus, on the one hand, exercise seems to be able to protect against cardiovascular disease, but on the other hand, it seems to provoke sudden cardiac death. As platelets play a key role in arterial thromboembolic disease, the effect of exercise on platelet function is of special interest. This systematic review summarizes the evidence of the influence of exercise on platelet function in patients with coronary artery disease, angina pectoris, hypertension, or peripheral arterial disease...
November 2018: Seminars in Thrombosis and Hemostasis
Simon Chang, Anna-Marie B Münster, Jørgen Gram, Johannes J Sidelmann
Anabolic androgenic steroid (AAS) abuse surged during the 1980s and is seen in approximately 1 in 20 of all males today. A wide spectrum of AAS compounds and abuse regimens are applied and AAS abuse has been associated with an unfavorable cardiovascular profile. The aim of this review is to critique the collected data concerning effects of AAS abuse on thrombosis risk through presentation of condensed evidence from studies investigating AAS-induced changes in coagulation, fibrinolysis, and cardiovascular risk markers...
November 2018: Seminars in Thrombosis and Hemostasis
Giuseppe Lippi, Gian Luca Salvagno, Cantor Tarperi, Matteo Gelati, Martina Montagnana, Elisa Danese, Luca Festa, Fabian Sanchis-Gomar, Emmanuel J Favaloro, Federico Schena
Since the impact of possible prothrombotic factors on blood coagulation resulting from exercise remains elusive, this study investigated the acute effects of middle-distance endurance running on blood coagulation parameters in middle-aged athletes. The study population consisted of 33 male endurance runners who were engaged in a 21.1 km run under competitive conditions. Blood samples were collected before the run, immediately after the run, and 3 hours after run completion. Samples were assessed for activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen, D-dimer, factor VIII (FVIII), von Willebrand factor antigen (VWF:Ag), endogenous thrombin potential (area under the curve of thrombin generation [TGA-AUC]), and peak thrombin generation (TGA-PK)...
November 2018: Seminars in Thrombosis and Hemostasis
Giuseppe Lippi, Emmanuel J Favaloro, Fabian Sanchis-Gomar
Although few doubts remain that physical exercise should be widely promoted for maintenance of health and fitness, the risk of adverse events such as sudden death (especially due to cardiac causes, i.e., sudden cardiac death [SCD]) during exercise remains tangible. The overall risk of sudden death in athletes is relatively low (i.e., usually comprised between 0.1 and 38/100,000 person-years), and globally comparable to that of the general population. However, up to 20% of all sudden death cases are still recorded while exercising...
November 2018: Seminars in Thrombosis and Hemostasis
Benjamin Brenner, Ton Lisman
No abstract text is available yet for this article.
October 2018: Seminars in Thrombosis and Hemostasis
Laura P B Elbers, Alessandro Squizzato, Victor E A Gerdes
Lower levels of free thyroxine (whether this is endogenous or exogenous) lead to a hypocoagulable state, and higher levels of free thyroxine lead to a hypercoagulable state. In this narrative review, the effects of different levels of thyroid hormones on clinical end points are described. Hypothyroidism is associated with an increased bleeding risk, whereas hyperthyroidism leads to an increased risk of venous thrombosis. Besides, effects of thyroid hormone on the heart may indirectly influence hemostasis. Hyperthyroidism leads to a higher incidence of atrial fibrillation and atrial flutter, and, at least partly by that mechanism, a higher risk of cerebral arterial thrombosis...
October 2018: Seminars in Thrombosis and Hemostasis
Beverley J Hunt
Extremes of body weight are not uncommon in the modern world and include anorexia nervosa (AN) and obesity. Both conditions are associated with increased morbidity and mortality: AN has the highest mortality rate of all mental illnesses and unfortunately obesity has reached epidemic proportions and is a well-recognized risk factor for cardiovascular disease including venous thromboembolism (VTE). This article summarizes the current understanding of hemostatic changes of these extremes of body weight. The hemostatic changes of AN have not been well described...
October 2018: Seminars in Thrombosis and Hemostasis
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