Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Dec 2024
ReviewNovel factors affecting fibrin clot formation and their clinical implications.
Fibrin formation is pivotal in hemostasis, serving as a temporary barrier to blood loss following vascular injury, while in thrombosis this process is involved in thrombus progression, stability, and recurrence. Growing evidence shows exceptional complexity of processes that determine fibrin clot structure and function, especially lysability, both in health and disease, which might be relevant in the pathogenesis of arterial and venous thromboembolic diseases. ⋯ These factors have been shown to be not only associated with ischemic stroke, myocardial infarction, pulmonary embolism, and cardiovascular death, but also with unfavorably altered fibrin clot characteristics, which underscores clinical relevance of fibrin clot properties. Given preclinical or ongoing studies aimed at modifying some of these factors, in particular FXI/FXIa inhibitors, recent findings might expand our knowledge on fibrin‑related mechanisms of emerging therapeutic agents tested and stimulate further research into new targets for future therapeutic interventions to prevent thromboembolic events.
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Pol. Arch. Med. Wewn. · Dec 2024
ReviewDiagnosis of sepsis: which clinical and laboratory biomarkers are useful?
The quest for a definitive diagnostic tool for sepsis has spanned decades, yet it remains elusive. The diagnostic workup of sepsis is inherently complex, involving dozens of biochemical, hematologic, and immunologic parameters, alongside complex microbiological diagnostics. Over the past decade, the integration of omics technologies has further complicated this diagnostic landscape. ⋯ This work provides an overview of selected diagnostic biomarkers that are deemed readily applicable in routine clinical practice, extending applicability beyond highly specialized university hospitals. Verifying the reliability and clinical utility of diagnostic parameters generally takes several years, and often is more challenging in patients with sepsis, as compared with other cohorts, because of the complexity of this condition. Nevertheless, the integration of new technologies, the expanded use of bedside diagnostics, and advancements in omics technologies are propelling us toward the realization of personalized medicine and theranostics.