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Xu H, Xie JW, Yang JL, Huang ZY, Pei FX. Role of D-dimer and Fibrinogen in the Diagnosis of Periprosthetic Joint Infection: A Systematic Review and Meta-Analysis. Orthop Surg 2021; 13:692-700. [PMID: 33682337 PMCID: PMC8126916 DOI: 10.1111/os.12969] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/15/2021] [Accepted: 01/28/2021] [Indexed: 02/05/2023] Open
Abstract
The diagnostic potential of D-dimer and fibrinogen to detect periprosthetic joint infection (PJI) of the hip and knee is not well-understood. The aim of this study was to determine whether D-Dimer and fibrinogen can be used as effective biomarkers to screen PJI. A systematic review of the literature indexed in Web of Science, PubMed, Cochrane Library, Embase, and Google Scholar databases was performed. All studies using D-dimer levels in serum or plasma, or fibrinogen levels in plasma, for the diagnosis of PJI were included. Meta-analysis estimates, including sensitivity, specificity, diagnostic odds ratios (DOR), and the area under the summary receiver operating characteristic curve (AUSROC), were calculated using a random-effects model, and used to assess the diagnostic accuracy of these biomarkers. A total of nine studies were analyzed, and their quality was considered to be acceptable. D-dimer gave a limited diagnostic value if serum and plasma combined: sensitivity (0.77, 95% confidence interval [CI] [0.63 to 0.87]), specificity (0.67, 95% CI [0.54 to 0.78]), DOR (6.81, 95% CI [2.67 to 17.37]), and AUSROC (0.78, 95% CI [0.74 to 0.82]). Plasma D-dimer levels were associated with less satisfactory sensitivity (0.65, 95% CI 0.57 to 0.71), specificity (0.58, 95% CI 0.50 to 0.66), DOR (2.52, 95% CI 1.64 to 3.90), and AUSROC (0.65, 95% CI 0.61 to 0.69). Serum D-dimer levels showed higher corresponding values of 0.89 (95% CI 0.79 to 0.94), 0.76 (95% CI 0.55 to 0.89), 24.24 (95% CI 10.07 to 58.32), and 0.91 (95% CI 0.88 to 0.93). Plasma fibrinogen showed acceptable corresponding values of 0.79 (95% CI 0.70 to 0.85), 0.73 (95% CI 0.57 to 0.85), 10.14 (95% CI 6.16 to 16.70), and 0.83 (95% CI 0.79 to 0.86). Serum D-dimer may be an effective marker for the diagnosis of PJI in hip and knee arthroplasty patients, and it may show higher diagnostic potential than plasma fibrinogen. Plasma D-dimer may have limited diagnostic potential.
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Affiliation(s)
- Hong Xu
- Department of Orthopaedic Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jin-Wei Xie
- Department of Orthopaedic Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jing-Li Yang
- College of Earth and Environmental Sciences, School of Public Health, Lanzhou University, Lanzhou, China
| | - Ze-Yu Huang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Fu-Xing Pei
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Krychtiuk KA, Speidl WS, Giannitsis E, Gigante B, Gorog DA, Jaffe AS, Mair J, Möckel M, Mueller C, Storey RF, Vilahur G, Wojta J, Huber K, Halvorsen S, Geisler T, Morais J, Lindahl B, Thygesen K. Biomarkers of coagulation and fibrinolysis in acute myocardial infarction: a joint position paper of the Association for Acute CardioVascular Care and the European Society of Cardiology Working Group on Thrombosis. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 10:343-355. [PMID: 33620437 DOI: 10.1093/ehjacc/zuaa025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022]
Abstract
The formation of a thrombus in an epicardial artery may result in an acute myocardial infarction (AMI). Despite major advances in acute treatment using network approaches to allocate patients to timely reperfusion and optimal antithrombotic treatment, patients remain at high risk for thrombotic complications. Ongoing activation of the coagulation system as well as thrombin-mediated platelet activation may both play a crucial role in this context. Whether measurement of circulating biomarkers of coagulation and fibrinolysis could be useful for risk stratification in secondary prevention is currently not fully understood. In addition, measurement of such biomarkers could be helpful to identify thrombus formation as the leading mechanism for AMI. The introduction of biomarkers of myocardial injury such as high-sensitivity cardiac troponins made rule-out of AMI even more precise. However, elevated markers of myocardial injury cannot provide proof of a type 1 AMI, let alone thrombus formation. The combined measurement of markers of myocardial injury with biomarkers reflecting ongoing thrombus formation might be helpful for the fast and correct diagnosis of an atherothrombotic type 1 AMI. This position paper gives an overview of the current knowledge and possible role of biomarkers of coagulation and fibrinolysis for the diagnosis of AMI, risk stratification, and individualized treatment strategies in patients with AMI.
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Affiliation(s)
- Konstantin A Krychtiuk
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Walter S Speidl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Evangelos Giannitsis
- Department of Internal Medicine III, Cardiology, Angiology, Pulmonology, Medical University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Bruna Gigante
- Unit of Cardiovascular Medicine, Department of Medicine, Karolinska Institutet, Solnavägen 1, 171 77 Solna, Sweden.,Department of Clinical Science, Danderyds Hospital, Entrévägen 2, 182 57 Danderyd, Sweden
| | - Diana A Gorog
- Department of Medicine, National Heart & Lung Institute, Imperial College, Guy Scadding Building, Dovehouse St, Chelsea, London SW3 6LY, UK.,Postgraduate Medical School, University of Hertfordshire, Hatfield, UK
| | - Allan S Jaffe
- Department of Cardiology, Mayo Clinic, 1216 2nd St SW Rochester, MN 55902, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, 1216 2nd St SW Rochester, MN 55902, USA
| | - Johannes Mair
- Department of Internal Medicine III - Cardiology and Angiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Martin Möckel
- Division of Emergency and Acute Medicine and Chest Pain Units, Charite - Universitätsmedizin Berlin, Campus Mitte and Virchow, Augustenburger Pl. 1, 13353 Berlin, Germany
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Robert F Storey
- Cardiovascular Research Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Medical School, Beech Hill Rd, Sheffield S10 2RX, UK
| | - Gemma Vilahur
- Cardiovascular Program ICCC - Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Calle de Melchor Fernández Almagro, 3, 28029 Madrid, Spain
| | - Johann Wojta
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.,Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Kurt Huber
- Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria.,3rd Medical Department of Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstraße 37, 1160 Vienna, Austria
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
| | - Tobias Geisler
- University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Joao Morais
- Division of Cardiology, Santo Andre's Hospital, R. de Santo André, 2410-197 Leiria, Portugal
| | - Bertil Lindahl
- Department of Medical Sciences, Uppsala Clinical Research Center, Dag Hammarskjölds Väg 38, 751 85 Uppsala University, Uppsala, Sweden
| | - Kristian Thygesen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus N, Denmark
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Scherr C, Albuquerque DCD, Pozzan R, Ataide K, Ludmila T, Blanco F, Mangia CM. Papel da Interleucina 18 e da Proteína Precursora do Trombo na Doença Arterial Coronariana. Arq Bras Cardiol 2020; 114:692-698. [DOI: 10.36660/abc.20190176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/23/2019] [Indexed: 01/24/2023] Open
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Wei Y, Chen X, Shen H, Wu W, Cao G, Chen W, Wang Y, Shen H, Yu S, Zhang J. P-Selectin Level at First and Third Day After Portal Hypertensive Splenectomy for Early Prediction of Portal Vein Thrombosis in Patients With Cirrhosis. Clin Appl Thromb Hemost 2018; 24:76S-83S. [PMID: 30033741 PMCID: PMC6714827 DOI: 10.1177/1076029618788180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We aimed to investigate the changes in p-selectin (p-sel), thrombus precursor protein, and D-dimer (D-D) in patients with cirrhosis after portal hypertensive splenectomy and explore its values on the prediction of postoperative portal vein thrombosis (PVT) formation. A total of 144 patients with cirrhosis with portal hypertension who underwent portal hypertensive splenectomy from January 2009 to December 2016 were enrolled in this study and divided into the thrombus and nonthrombus groups. The levels of p-sel, thrombus precursor protein (TpP), and D-D were measured by flow cytometry, enzyme-linked immunosorbent assay, and immunoturbidimetry, respectively. Sensitivity, specificity, and other values for p-sel, TpP, and D-D were calculated. The linear discriminant, logistic regression, and decision tree methods were used to analyze the p-sel value on the prediction of PVT formation. Seventy-nine patients were confirmed having postoperative PVT, with the incidence rate of 54.86%. No significant differences were observed in the p-sel, TpP, and D-D between the thrombus and nonthrombus groups before surgery, but these 3 indexes were obviously elevated in the thrombus group after operation (P < .01). P-selectin level on first day showed the highest positive predictive value (91.0%) and diagnostic coincidence rate (83.3%), while negative expected value (76.6%) was lower than those of TpP and D-D. Multiple analyses showed the prediction accuracy of PVT was 61.1% (P = .023), 97.2% (P < .001), and 97.2% (P < .001), respectively. P-selectin has a significant value in predicting PVT. P-selectin level on first and third day is valuable and feasible for the early prediction of PVT.
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Affiliation(s)
- Yunhai Wei
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Xuedong Chen
- School of Science, Huzhou University, Huzhou, People's Republic of China
| | - Huaping Shen
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Wanbo Wu
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Guoliang Cao
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Wenxian Chen
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Yan Wang
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Hua Shen
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Sheng Yu
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
| | - Jinyu Zhang
- Surgical Department, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, People's Republic of China
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Camuglia AC, Waddell-Smith KE, Hammett CJ, Aylward PE. The potential role of anticoagulant therapy for the secondary prevention of ischemic events post-acute coronary syndrome. Curr Med Res Opin 2014; 30:2151-67. [PMID: 25140867 DOI: 10.1185/03007995.2014.949647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract The use of dual antiplatelet therapy has led to a substantial reduction in ischemic events post-acute coronary syndrome (ACS). Despite this, recurrent event rates remain high. Recent research has combined antiplatelet with anticoagulant therapy to reduce recurrent event rates further. Compared with standard medical therapy, rivaroxaban demonstrated improved efficacy outcomes and significantly reduced mortality after an ACS. Although clear benefits of novel oral anticoagulants post-ACS have been proven, concerns regarding bleeding are still a barrier to widespread use. This review explores key trials of dual antiplatelet therapy and examines the latest research in anticoagulation aiming to optimize clinical outcomes post-ACS.
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Affiliation(s)
- A C Camuglia
- Royal Brisbane and Women's Hospital and the University of Queensland , Queensland , Australia
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Challenges and limitations in the interpretation of systematic reviews: making sense of clopidogrel and CYP2C19 pharmacogenetics. Clin Pharmacol Ther 2013; 94:376-82. [PMID: 23670120 DOI: 10.1038/clpt.2013.100] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 05/03/2013] [Indexed: 11/08/2022]
Abstract
From 2010 to 2012, nine systematic reviews reported highly variable conclusions regarding the association between carriage of a cytochrome P450 2C19 loss-of-function allele and the risk of adverse cardiovascular (CV) events in individuals using clopidogrel. Possible contributors to the variable findings include differences in patient populations, CV end points, and statistical models utilized by the systematic reviews, as well as unexplained heterogeneity, inconsistent/incomplete reporting, and risk of publication bias with respect to the primary studies.
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Waks JW, Scirica BM. Established and novel biomarkers in ST-elevation myocardial infarction. Future Cardiol 2011; 7:523-46. [PMID: 21797748 DOI: 10.2217/fca.11.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cardiac biomarkers assist in the diagnosis of and risk stratification in acute coronary syndromes. In ST-elevation myocardial infarction (STEMI), rapid diagnosis and initiation of reperfusion via primary percutaneous coronary intervention or fibrinolysis is often based on the clinical history and presenting ECG, but measurement of biomarkers in the early and/or late phases of STEMI may allow the selection of patients who are at increased or decreased risk of subsequent complications. Although the measurement of only three biomarkers (troponin, natriuretic peptides and C-reactive protein) are currently included in practice guidelines, more than 20 other novel cardiac biomarkers have been proposed to provide improved risk stratification after a STEMI.
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Affiliation(s)
- Jonathan W Waks
- Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Ping P, Chan DW, Srinivas P. Advancing cardiovascular biology and medicine via proteomics: Opportunities and present challenges of cardiovascular proteomics. Circulation 2010; 121:2326-8. [PMID: 20516387 DOI: 10.1161/circulationaha.110.949230] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Peipei Ping
- Department of Physiology, University of California at Los Angeles, 90095, USA.
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9
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Momary KM, Dorsch MP, Bates ER. Genetic Causes of Clopidogrel Nonresponsiveness: Which Ones Really Count? Pharmacotherapy 2010; 30:265-74. [DOI: 10.1592/phco.30.3.265] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Momary KM, Dorsch MP. Factors associated with clopidogrel nonresponsiveness. Future Cardiol 2010; 6:195-210. [DOI: 10.2217/fca.10.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Clopiodgrel therapy is the standard of care in patients with acute coronary syndrome and in those undergoing percutaneous coronary intervention. However, there is a significant amount of interindividual variability in clopidogrel responsiveness. Clopidogrel is a prodrug and requires metabolism via several CYP450 enzymes in order to exert its antiplatelet effects. Interference in these activation steps is the primary cause of clopidogrel nonresponsiveness. This review focuses on genetic polymorphisms in, and drug interactions with, the CYP450 enzymes that are associated with clopidogrel nonresponsiveness. In addition, clinical factors that effect clopidogrel responsiveness are also reviewed. Particular emphasis is placed on those factors that are not only associated with a change in clopidogrel pharmacokinetics or pharmacodynamics, but are also associated with an increased risk of adverse cardiovascular events. Currently, the majority of data assessing clopidogrel nonresponsiveness focus on genetic variation in CYP2C19 and drug interactions with proton pump inhibitors. However, genetic variation in other CYP450 enzymes, other drug interactions and clinical causes have been studied and are also reviewed here. It is important for healthcare practitioners to recognize all of the causes of clopidogrel nonresponsiveness, especially as novel antiplatelet alternatives become available.
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Affiliation(s)
- Kathryn M Momary
- Mercer University College of Pharmacy and Health Sciences, Department of Pharmacy Practice, 3001 Mercer University Drive, Atlanta, GA 30341, USA
| | - Michael P Dorsch
- Department of Pharmacy Services, University of Michigan Health System and Department of Clinical, Social & Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
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Giugliano RP, Braunwald E. The Year in Non–ST-Segment Elevation Acute Coronary Syndrome. J Am Coll Cardiol 2009; 54:1544-55. [DOI: 10.1016/j.jacc.2009.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Accepted: 06/28/2009] [Indexed: 12/19/2022]
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Barrabés JA, Sanchís J, Sánchez PL, Bardají A. Actualización en cardiopatía isquémica. Rev Esp Cardiol (Engl Ed) 2009; 62 Suppl 1:80-91. [DOI: 10.1016/s0300-8932(09)70043-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Goetze JP. Markers of Activated Coagulation in Acute Coronary Syndromes⁎⁎Editorials published in the Journal of the American College of Cardiology reflect the views of the authors and do not necessarily represent the views of JACC or the American College of Cardiology. J Am Coll Cardiol 2008; 51:2430-1. [DOI: 10.1016/j.jacc.2008.02.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Accepted: 02/19/2008] [Indexed: 10/21/2022]
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