Journal of thrombosis and haemostasis : JTH
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J. Thromb. Haemost. · Aug 2012
ReviewSymptomatic subsegmental pulmonary embolism: what is the next step?
The introduction of computed tomography pulmonary angiography (CTPA) has led to an increase in the incidence of pulmonary embolism (PE) diagnosis. However, the case fatality rate is lower and the mortality rates of PE have remained unchanged, suggesting a lower severity of illness. Specifically, the multiple-detector CTPA increased the rate of subsegmental filling defect reported in patients with suspected PE. ⋯ Only a small number of patients with SSPE diagnosed by CTPA and without DVT who did not receive anticoagulation treatment have been reported in the literature. None of these patients suffered recurrent symptomatic VTE (PE or DVT) during the 3-month follow-up period (0%; 95% CI, 0-7.4%), suggesting that SSPE might be clinically unimportant. These conclusions are only hypothesis generating and need to be confirmed in prospective clinical management studies before changing clinical practice.
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J. Thromb. Haemost. · Aug 2012
ReviewEpidemiology and prevention of catheter-related thrombosis in patients with cancer.
Central venous catheters are extensively used in patients with cancer to secure delivery of chemotherapy and facilitate phlebotomy. Unfortunately, considerable morbidity can result from early complications or late sequelae, ranging from arterial puncture, pneumothorax and bloodstream infections to catheter-related thrombosis (CRT). ⋯ Efforts to reduce thrombotic complications, involving flushing the catheter with heparinized solutions, the use of heparin-bonded catheters, and systemic anticoagulant prophylaxis, have been largely ineffective. More studies are needed to understand the pathophysiology of thrombotic complications, to help identify effective interventions to reduce this adverse outcome.
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J. Thromb. Haemost. · Aug 2012
A genome-wide association study of venous thromboembolism identifies risk variants in chromosomes 1q24.2 and 9q.
To identify venous thromboembolism (VTE) disease-susceptibility genes. ⋯ Apart from F5 rs6025, ABO rs8176719, rs2519093 and F2 rs1799963, additional common and high VTE-risk SNPs among whites are unlikely.
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J. Thromb. Haemost. · Jul 2012
Platelet- and erythrocyte-derived microparticles trigger thrombin generation via factor XIIa.
The procoagulant properties of microparticles (MPs) are due to the of the presence of phosphatidylserine (PS) and tissue factor (TF) on their surface. The latter has been demonstrated especially on MPs derived from monocytes. ⋯ MPs from platelets and erythrocytes not only propagate coagulation by exposing PS but also initiate thrombin generation independently of TF in a FXII-dependent manner. In contrast, monocyte-derived MPs trigger coagulation predominantly via TF.
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J. Thromb. Haemost. · Jul 2012
Review Meta AnalysisPrognostic clinical prediction rules to identify a low-risk pulmonary embolism: a systematic review and meta-analysis.
Prognostic assessment is important for the management of patients with a pulmonary embolism (PE). A number of clinical prediction rules (CPRs) have been proposed for stratifying PE mortality risk. The aim of this systematic review was to assess the performance of prognostic CPRs in identifying a low-risk PE. ⋯ Prognostic CPRs efficiently identify PE patients at a low risk of mortality. Before implementing prognostic CPRs in the routine care of PE patients, well-designed management studies are warranted.