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Mruthunjaya AKV, Torriero AAJ. Electrochemical Monitoring in Anticoagulation Therapy. Molecules 2024; 29:1453. [PMID: 38611733 PMCID: PMC11012951 DOI: 10.3390/molecules29071453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/16/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
The process of blood coagulation, wherein circulating blood transforms into a clot in response to an internal or external injury, is a critical physiological mechanism. Monitoring this coagulation process is vital to ensure that blood clotting neither occurs too rapidly nor too slowly. Anticoagulants, a category of medications designed to prevent and treat blood clots, require meticulous monitoring to optimise dosage, enhance clinical outcomes, and minimise adverse effects. This review article delves into the various stages of blood coagulation, explores commonly used anticoagulants and their targets within the coagulation enzyme system, and emphasises the electrochemical methods employed in anticoagulant testing. Electrochemical sensors for anticoagulant monitoring are categorised into two types. The first type focuses on assays measuring thrombin activity via electrochemical techniques. The second type involves modified electrode surfaces that either directly measure the redox behaviours of anticoagulants or monitor the responses of standard redox probes in the presence of these drugs. This review comprehensively lists different electrode compositions and their detection and quantification limits. Additionally, it discusses the potential of employing a universal calibration plot to replace individual drug-specific calibrations. The presented insights are anticipated to significantly contribute to the sensor community's efforts in this field.
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Affiliation(s)
| | - Angel A. J. Torriero
- School of Life and Environmental Sciences, Deakin University, Burwood 3125, Australia
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Chen F, Sun W, Sun S, Li Z, Wang Z, Yu L. Clinical characteristics and risk factors for mortality among inpatients with COVID-19 in Wuhan, China. Clin Transl Med 2020; 10:e40. [PMID: 32508024 PMCID: PMC7300688 DOI: 10.1002/ctm2.40] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/27/2020] [Indexed: 01/22/2023] Open
Affiliation(s)
- Fuyang Chen
- Intensive Care UnitCentral Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Wenwu Sun
- Intensive Care UnitCentral Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Shengrong Sun
- Department of Breast and Thyroid SurgeryRenmin Hospital of Wuhan UniversityWuhanChina
| | - Zhiyu Li
- Department of Breast and Thyroid SurgeryRenmin Hospital of Wuhan UniversityWuhanChina
| | - Zhong Wang
- Department of Breast and Thyroid SurgeryRenmin Hospital of Wuhan UniversityWuhanChina
| | - Li Yu
- Intensive Care UnitCentral Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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Mohammadi Aria M, Erten A, Yalcin O. Technology Advancements in Blood Coagulation Measurements for Point-of-Care Diagnostic Testing. Front Bioeng Biotechnol 2019; 7:395. [PMID: 31921804 PMCID: PMC6917661 DOI: 10.3389/fbioe.2019.00395] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/21/2019] [Indexed: 12/24/2022] Open
Abstract
In recent years, blood coagulation monitoring has become crucial to diagnosing causes of hemorrhages, developing anticoagulant drugs, assessing bleeding risk in extensive surgery procedures and dialysis, and investigating the efficacy of hemostatic therapies. In this regard, advanced technologies such as microfluidics, fluorescent microscopy, electrochemical sensing, photoacoustic detection, and micro/nano electromechanical systems (MEMS/NEMS) have been employed to develop highly accurate, robust, and cost-effective point of care (POC) devices. These devices measure electrochemical, optical, and mechanical parameters of clotting blood. Which can be correlated to light transmission/scattering, electrical impedance, and viscoelastic properties. In this regard, this paper discusses the working principles of blood coagulation monitoring, physical and sensing parameters in different technologies. In addition, we discussed the recent progress in developing nanomaterials for blood coagulation detection and treatments which opens up new area of controlling and monitoring of coagulation at the same time in the future. Moreover, commercial products, future trends/challenges in blood coagulation monitoring including novel anticoagulant therapies, multiplexed sensing platforms, and the application of artificial intelligence in diagnosis and monitoring have been included.
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Affiliation(s)
| | - Ahmet Erten
- Department of Electronics and Communication Engineering, Istanbul Technical University, Istanbul, Turkey
| | - Ozlem Yalcin
- Graduate School of Biomedical Sciences and Engineering, Koc University, Sariyer, Turkey
- Department of Physiology, Koc University School of Medicine, Koc University, Sariyer, Turkey
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Kim TJ, Yu YD, Park DS, Rha KH, Hong SJ, Cho KS, Chung BH, Koo KC. Impact of Cerebrovascular Disease on Survival Benefits from Local Treatment in Patients with De Novo Metastatic Hormone-Sensitive Prostate Cancer. Yonsei Med J 2019; 60:1129-1137. [PMID: 31769243 PMCID: PMC6881707 DOI: 10.3349/ymj.2019.60.12.1129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/09/2019] [Accepted: 10/08/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Local treatment has become a treatment option for patients with de novo metastatic hormone-sensitive prostate cancer (mHSPC). Subgroup analyses based on a history of cerebrovascular disease (CVD) were performed to evaluate the impact thereof on overall survival (OS) after local treatment. MATERIALS AND METHODS A retrospective analysis was performed for 879 patients with de novo mHSPC between August 2003 and November 2016. Patients were stratified according to prior CVD history and the type of initial treatment: androgen-deprivation therapy (ADT) alone versus local treatment consisting of radical prostatectomy (RP) or radiation therapy (RT) with ADT, with or without metastasis-directed therapy. The primary outcome was OS assessed by Kaplan-Meier analysis and Cox-regression models. RESULTS Of 879 patients, 660 (75.1%) men underwent ADT alone, and 219 (24.9%) men underwent RP or RT with ADT, with or without metastasis-directed therapy. The median follow-up was 38 months. Multivariable analysis showed CVD history to be associated with a higher risk of overall mortality (p=0.001). In the overall cohort and in patients without a history of CVD, patients who underwent local treatment exhibited higher OS than men who received ADT alone (all p<0.001). However, the survival benefit conferred by local treatment was not seen in patients with a history of CVD (p=0.324). OS was comparable between patients who received RP and RT (p=0.521). CONCLUSION Local treatment with or without metastasis-directed therapy may provide OS advantages for mHSPC patients without a history of CVD. Further prospective studies are needed to address these important concerns.
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Affiliation(s)
- Tae Jin Kim
- Department of Urology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Young Dong Yu
- Department of Urology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Dong Soo Park
- Department of Urology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Koon Ho Rha
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Joon Hong
- Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Ha Chung
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyo Chul Koo
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Wu YM, Zhai YD, Zhou YT, Tang SM, Li XY, Jia LF, Meng XB, Zhang H, Sun GB, Sun XB. Protection of Shuxuetong combined with aspirin against cerebral ischemia/reperfusion injury through ameliorating coagulation and fibrinolysis system. CHINESE HERBAL MEDICINES 2018. [DOI: 10.1016/j.chmed.2018.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Blood Coagulation Following an Acute Ischemic Stroke. CURRENT HEALTH SCIENCES JOURNAL 2018; 44:118-121. [PMID: 30687528 PMCID: PMC6320462 DOI: 10.12865/chsj.44.02.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/27/2018] [Indexed: 01/01/2023]
Abstract
Objective. Hemostasis is a complex physiological process that stops bleeding at the site of a vascular injury. Although the majority of vascular accidents are ischemic, the role of hypercoagulable state and stroke needs further investigation. Materials and Methods. Fresh whole blood was taken from 61 acute ischemic stroke patients and compared to 18 healthy subjects and investigated with optical coherence tomography imaging after initiating coagulation. We used an OCT1300SS system (Thorlabs) and did 3D scans. We then processed the images with ImageJ. For each image mean, integrated density, skewness and kurtosis of gray values were analyzed. Results. Mean gray value and integrated intensity of sampled data showed an intrinsic difference detected with OCT. This difference was further confirmed by the data distribution analysis. Conclusions. Results suggest, that normal blood coagulation, is not a random reaction while in the case of stroke patients, the relatively symmetrical distribution of gray values brings coagulation closer randomized process.
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Zhao Y, Li X, Zhang K, Tong T, Cui R. The Progress of Epilepsy after Stroke. Curr Neuropharmacol 2018; 16:71-78. [PMID: 28606039 PMCID: PMC5771387 DOI: 10.2174/1570159x15666170613083253] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/14/2017] [Accepted: 05/02/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Epilepsy is the second most common disease caused by multiple factors and characterized by an excessive discharge of certain neurons in the nervous system. Cerebrovascular disease, including stroke, is viewed as the most common cause of epilepsy in the elderly population, accounting for 30%-50% of the newly diagnosed cases of epilepsy cases in this age group. METHODS Data were collected from Web of Science, Medline, Pubmed, Scopus, through searching of these keywords: "Stroke" and "epilepsy". RESULTS Depending on the underlying cerebrovascular disease, 3%-30% of patients after stroke may develop post-stroke epilepsy (PSE), which has a negative effect on stroke prognosis and the quality of life. CONCLUSION In this review, we summarized new aspects emerging from research into PSE, including definition, epidemiology, risk factors, mechanism, accessory examination and treatment strategies for post-stroke epilepsy, which will enrich our knowledge of this disorder.
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Affiliation(s)
- Yinghao Zhao
- Department of Thoracic Surgery, the Second Hospital of Jilin University; Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, Changchun, Jilin, P.R. China
| | - Xiangyan Li
- Center of Chinese Medicine and Bio-Engineering Research and Development, Changchun University of Chinese Medicine, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, P.R. China
| | - Kun Zhang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, the Second Hospital of Jilin University, 218 Ziqiang Street, Changchun130041, P.R. China
| | - Ti Tong
- Department of Thoracic Surgery, the Second Hospital of Jilin University; Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, Changchun, Jilin, P.R. China
| | - Ranji Cui
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, the Second Hospital of Jilin University, 218 Ziqiang Street, Changchun130041, P.R. China
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Zhou F, Zhou L, Guo T, Wang N, Hao H, Zhou Y, Yu D. Plasma proteomics reveals coagulation, inflammation, and metabolic shifts in H-type hypertension patients with and without acute ischemic stroke. Oncotarget 2017; 8:100384-100395. [PMID: 29245986 PMCID: PMC5725028 DOI: 10.18632/oncotarget.22233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/03/2017] [Indexed: 12/26/2022] Open
Abstract
Systematic profiling of a larger portion of circulating plasma proteome provide opportunities for unbiased discovery of novel markers to improve diagnostic, therapeutic, or predictive accuracy. This study aimed to identify differentially expressed proteins (DEPs) in plasma that could provide overall insight into the molecular changes of both H- type hypertension (HH) and HH-related acute ischemic stroke (AIS). This study used an iTRAQ-based LC-MS/MS proteomics approach to screen for plasma DEPs in HH patients with and without AIS, and controls. After excluding highly abundant plasma proteins, more than 600 proteins, and their relative levels, were identified. Of these, 26 DEPs, each showing > 1.2-fold change, were identified in HH and HH-related AIS patients compared with controls. Bioinformatics analysis revealed that these DEPs were enriched in 21 functional gene ontology items; “blood coagulation” was the most predominant pathway showing enrichment. Of these, eight DEPs were located in the hub position of networks involved with protein-protein interactions. AT-3, CRP, ApoB, and AHSG were further validated in each group by enzyme-linked immune sorbent assays. Comparing HH-related AIS with HH, the areas under the curve for AT-3, CRP, ApoB, and AHSG were 0.698, 0.892, 0.626, and 0.847, respectively. This proteomic profiling study provided enhanced pathophysiological understanding of the regulatory processes involved in coagulation, inflammation, and metabolism, and identified a panel of novel biomarkers for detecting HH-related AIS during its pre-stroke stage.
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Affiliation(s)
- Feng Zhou
- Department of Neurology, Affiliated Haikou Hospital at Xiangya Medical School of Central South University, Haikou 570208, Hainan, China
| | - Lv Zhou
- Department of Neurology, Affiliated Haikou Hospital at Xiangya Medical School of Central South University, Haikou 570208, Hainan, China
| | - Tie Guo
- Department of Neurology, Affiliated Haikou Hospital at Xiangya Medical School of Central South University, Haikou 570208, Hainan, China
| | - Nianzhen Wang
- Department of Neurology, Affiliated Haikou Hospital at Xiangya Medical School of Central South University, Haikou 570208, Hainan, China
| | - Haizhen Hao
- Department of Neurology, Affiliated Haikou Hospital at Xiangya Medical School of Central South University, Haikou 570208, Hainan, China
| | - Yanhui Zhou
- Department of Neurology, Affiliated Haikou Hospital at Xiangya Medical School of Central South University, Haikou 570208, Hainan, China
| | - Dan Yu
- Department of Neurology, Affiliated Haikou Hospital at Xiangya Medical School of Central South University, Haikou 570208, Hainan, China
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Tutwiler V, Peshkova AD, Andrianova IA, Khasanova DR, Weisel JW, Litvinov RI. Contraction of Blood Clots Is Impaired in Acute Ischemic Stroke. Arterioscler Thromb Vasc Biol 2016; 37:271-279. [PMID: 27908894 DOI: 10.1161/atvbaha.116.308622] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 11/17/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Obstructive thrombi or thrombotic emboli are the pathogenic basis of ischemic stroke. In vitro blood clots and in vivo thrombi can undergo platelet-driven contraction (retraction), resulting in volume shrinkage. Clot contraction can potentially reduce vessel occlusion and improve blood flow past emboli or thrombi. The aim of this work was to examine a potential pathogenic role of clot contraction in ischemic stroke. APPROACH AND RESULTS We used a novel automated method that enabled us to quantify time of initiation and extent and rate of clot contraction in vitro. The main finding is that clot contraction from the blood of stroke patients was reduced compared with healthy subjects. Reduced clot contraction correlated with a lower platelet count and their dysfunction, higher levels of fibrinogen and hematocrit, leukocytosis, and other changes in blood composition that may affect platelet function and properties of blood clots. Platelets from stroke patents were spontaneously activated and displayed reduced responsiveness to additional stimulation. Clinical correlations with respect to severity and stroke pathogenesis suggest that the impaired clot contraction has the potential to be a pathogenic factor in ischemic stroke. CONCLUSIONS The changeable ability of clots and thrombi to shrink in volume may be a novel unappreciated mechanism that aggravates or alleviates the course and outcomes of ischemic stroke. The clinical importance of clot or thrombus transformations in vivo and the diagnostic and prognostic value of this blood test for clot contraction need further exploration.
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Affiliation(s)
- Valerie Tutwiler
- From the Department of Cell and Developmental Biology, University of Pennsylvania School of Medicine, Philadelphia (V.T., J.W.W., R.I.L.); School of Biomedical Engineering, Sciences, and Health Systems, Drexel University, Philadelphia, PA (V.T.); Institute of Fundamental Medicine and Biology, Kazan Federal University, Russia (A.D.P., I.A.A., R.I.L.); and Neurology Department, Interregional Clinical Diagnostic Center, Kazan, Russia (D.R.K.)
| | - Alina D Peshkova
- From the Department of Cell and Developmental Biology, University of Pennsylvania School of Medicine, Philadelphia (V.T., J.W.W., R.I.L.); School of Biomedical Engineering, Sciences, and Health Systems, Drexel University, Philadelphia, PA (V.T.); Institute of Fundamental Medicine and Biology, Kazan Federal University, Russia (A.D.P., I.A.A., R.I.L.); and Neurology Department, Interregional Clinical Diagnostic Center, Kazan, Russia (D.R.K.)
| | - Izabella A Andrianova
- From the Department of Cell and Developmental Biology, University of Pennsylvania School of Medicine, Philadelphia (V.T., J.W.W., R.I.L.); School of Biomedical Engineering, Sciences, and Health Systems, Drexel University, Philadelphia, PA (V.T.); Institute of Fundamental Medicine and Biology, Kazan Federal University, Russia (A.D.P., I.A.A., R.I.L.); and Neurology Department, Interregional Clinical Diagnostic Center, Kazan, Russia (D.R.K.)
| | - Dina R Khasanova
- From the Department of Cell and Developmental Biology, University of Pennsylvania School of Medicine, Philadelphia (V.T., J.W.W., R.I.L.); School of Biomedical Engineering, Sciences, and Health Systems, Drexel University, Philadelphia, PA (V.T.); Institute of Fundamental Medicine and Biology, Kazan Federal University, Russia (A.D.P., I.A.A., R.I.L.); and Neurology Department, Interregional Clinical Diagnostic Center, Kazan, Russia (D.R.K.)
| | - John W Weisel
- From the Department of Cell and Developmental Biology, University of Pennsylvania School of Medicine, Philadelphia (V.T., J.W.W., R.I.L.); School of Biomedical Engineering, Sciences, and Health Systems, Drexel University, Philadelphia, PA (V.T.); Institute of Fundamental Medicine and Biology, Kazan Federal University, Russia (A.D.P., I.A.A., R.I.L.); and Neurology Department, Interregional Clinical Diagnostic Center, Kazan, Russia (D.R.K.)
| | - Rustem I Litvinov
- From the Department of Cell and Developmental Biology, University of Pennsylvania School of Medicine, Philadelphia (V.T., J.W.W., R.I.L.); School of Biomedical Engineering, Sciences, and Health Systems, Drexel University, Philadelphia, PA (V.T.); Institute of Fundamental Medicine and Biology, Kazan Federal University, Russia (A.D.P., I.A.A., R.I.L.); and Neurology Department, Interregional Clinical Diagnostic Center, Kazan, Russia (D.R.K.).
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Pertinence des prescriptions d’anticoagulants oraux à la sortie d’un service de médecine interne d’un hôpital régional suisse. Rev Med Interne 2016; 37:579-86. [DOI: 10.1016/j.revmed.2015.10.355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/21/2015] [Accepted: 10/27/2015] [Indexed: 11/20/2022]
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Hung TY, Lee YK, Huang MY, Hsu CY, Su YC. Increased risk of ischemic stroke in patients with burn injury: a nationwide cohort study in Taiwan. Scand J Trauma Resusc Emerg Med 2016; 24:44. [PMID: 27052491 PMCID: PMC4823901 DOI: 10.1186/s13049-016-0236-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 04/04/2016] [Indexed: 02/01/2023] Open
Abstract
Background Conflicting results have been obtained by studies attempting to assess the risks of ischemic stroke in patients with burn injury, while the long-term risk of stroke in survivors of burn injury remains unexplored. We evaluated whether the risk of ischemic stroke in patients hospitalized with burn injury in Taiwan is higher when compared to the general population. Methods The data from one million National Health Insurance (NHI) adult beneficiaries were evaluated from January 1, 2005 until December 31, 2012 to identify those who developed ischemic stroke. Each identified patient with burn injury was matched with one hundred unexposed patients based on a high-dimensional propensity score. Cox regression models were applied to compare the risks of the development of ischemic stroke in the matched cohorts. Results A total of 743,237 patients were enrolled. After matching, 1,763 burn injury patients and 176,300 unexposed patients were selected and compared. The adjusted hazard ratio of ischemic stroke was significantly increased in burn injury patients (1.84; 95 % CI, 1.43–2.36). A subgroup analysis based on patients who survived longer than 12 months in the matched cohort also revealed higher hazard ratio in the burn injury patients (1.54; 95 % CI, 1.11–2.13). Conclusion The risk of ischemic stroke is significantly higher in patients hospitalized with burn injury than in the general population, and these risks may extend longer than expected.
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Affiliation(s)
- Tzu-Yao Hung
- Emergency Department, Zhongxing Branch of Taipei City Hospital, Taipei, Taiwan
| | - Yi-Kung Lee
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Rd., Dalin Township, Chiayi County 622, Taiwan, R.O.C
| | - Ming-Yuan Huang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chen-Yang Hsu
- Department of Public Heath, National Taiwan University, Taipei, Taiwan
| | - Yung-Cheng Su
- School of Medicine, Tzu Chi University, Hualien, Taiwan. .,Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Rd., Dalin Township, Chiayi County 622, Taiwan, R.O.C.
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Van Nostrand WE. The influence of the amyloid ß-protein and its precursor in modulating cerebral hemostasis. Biochim Biophys Acta Mol Basis Dis 2015; 1862:1018-26. [PMID: 26519139 DOI: 10.1016/j.bbadis.2015.10.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 02/07/2023]
Abstract
Ischemic and hemorrhagic strokes are a significant cause of brain injury leading to vascular cognitive impairment and dementia (VCID). These deleterious events largely result from disruption of cerebral hemostasis, a well-controlled and delicate balance between thrombotic and fibrinolytic pathways in cerebral blood vessels and surrounding brain tissue. Ischemia and hemorrhage are both commonly associated with cerebrovascular deposition of amyloid ß-protein (Aß). In this regard, Aß directly and indirectly modulates cerebral thrombosis and fibrinolysis. Further, major isoforms of the Aß precursor protein (AßPP) function as a potent inhibitor of pro-thrombotic proteinases. The purpose of this review article is to summarize recent research on how cerebral vascular Aß and AßPP influence cerebral hemostasis. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia, edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock.
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Affiliation(s)
- William E Van Nostrand
- Department of Neurosurgery, HSC-T12/086, Stony Brook University, Stony Brook, NY 11794-8122, USA; Department of Medicine, HSC-T12/086, Stony Brook University, Stony Brook, NY 11794-8122, USA.
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Kell DB, Pretorius E. The simultaneous occurrence of both hypercoagulability and hypofibrinolysis in blood and serum during systemic inflammation, and the roles of iron and fibrin(ogen). Integr Biol (Camb) 2015; 7:24-52. [PMID: 25335120 DOI: 10.1039/c4ib00173g] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although the two phenomena are usually studied separately, we summarise a considerable body of literature to the effect that a great many diseases involve (or are accompanied by) both an increased tendency for blood to clot (hypercoagulability) and the resistance of the clots so formed (hypofibrinolysis) to the typical, 'healthy' or physiological lysis. We concentrate here on the terminal stages of fibrin formation from fibrinogen, as catalysed by thrombin. Hypercoagulability goes hand in hand with inflammation, and is strongly influenced by the fibrinogen concentration (and vice versa); this can be mediated via interleukin-6. Poorly liganded iron is a significant feature of inflammatory diseases, and hypofibrinolysis may change as a result of changes in the structure and morphology of the clot, which may be mimicked in vitro, and may be caused in vivo, by the presence of unliganded iron interacting with fibrin(ogen) during clot formation. Many of these phenomena are probably caused by electrostatic changes in the iron-fibrinogen system, though hydroxyl radical (OH˙) formation can also contribute under both acute and (more especially) chronic conditions. Many substances are known to affect the nature of fibrin polymerised from fibrinogen, such that this might be seen as a kind of bellwether for human or plasma health. Overall, our analysis demonstrates the commonalities underpinning a variety of pathologies as seen in both hypercoagulability and hypofibrinolysis, and offers opportunities for both diagnostics and therapies.
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Affiliation(s)
- Douglas B Kell
- School of Chemistry and The Manchester Institute of Biotechnology, The University of Manchester, 131, Princess St, Manchester M1 7DN, Lancs, UK.
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Hurtarte Sandoval AR, Flores Robles BJ, Andrus RF, Yaxcal Chon DA. Transient ischaemic attack secondary to paraneoplastic erythrocytosis. BMJ Case Rep 2014; 2014:bcr-2013-202572. [PMID: 25336545 DOI: 10.1136/bcr-2013-202572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
A 67-year-old woman with a history of hypertension and type 2 diabetes mellitus was admitted to the hospital due to aphasia and left-sided hemiparesis during the past 5 h with resolution of symptoms within 24 h. On admission laboratory analysis showed haemoglobin 19.2 g/dL and haematocrit 55.1%. Cerebral CT scan was also performed on admission revealing periventricular leucoaraiosis. Studies to investigate the cause of erythrocytosis were started and elevated erythropoietin levels were found. In order to investigate a secondary cause of erythrocytosis an abdominal ultrasound was conducted revealing a left renal mass. CT scans of thorax, abdomen and pelvis confirmed renal mass 8 × 8 cm of diameter, suggestive of neoplasm without associated lymphadenopathy or metastases. Radical nephrectomy was performed and a pathological diagnosis demonstrated clear cell renal cell carcinoma and was staged as T2aN0M0.
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Prior Cancer in Patients with Ischemic Stroke: The Bergen NORSTROKE Study. J Stroke Cerebrovasc Dis 2014; 23:919-25. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.07.041] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 06/18/2013] [Accepted: 07/28/2013] [Indexed: 12/20/2022] Open
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Jiang B, Ryan KA, Hamedani A, Cheng Y, Sparks MJ, Koontz D, Bean CJ, Gallagher M, Hooper WC, McArdle PF, O'Connell JR, Stine OC, Wozniak MA, Stern BJ, Mitchell BD, Kittner SJ, Cole JW. Prothrombin G20210A mutation is associated with young-onset stroke: the genetics of early-onset stroke study and meta-analysis. Stroke 2014; 45:961-7. [PMID: 24619398 DOI: 10.1161/strokeaha.113.004063] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Although the prothrombin G20210A mutation has been implicated as a risk factor for venous thrombosis, its role in arterial ischemic stroke is unclear, particularly among young adults. To address this issue, we examined the association between prothrombin G20210A and ischemic stroke in a white case-control population and additionally performed a meta-analysis. METHODS From the population-based Genetics of Early Onset Stroke (GEOS) study, we identified 397 individuals of European ancestry aged 15 to 49 years with first-ever ischemic stroke and 426 matched controls. Logistic regression was used to calculate odds ratios (ORs) in the entire population and for subgroups stratified by sex, age, oral contraceptive use, migraine, and smoking status. A meta-analysis of 17 case-control studies (n=2305 cases <55 years) was also performed with and without GEOS data. RESULTS Within GEOS, the association of the prothrombin G20210A mutation with ischemic stroke did not achieve statistical significance (OR=2.5; 95% confidence interval [CI]=0.9-6.5; P=0.07). However, among adults aged 15 to 42 years (younger than median age), cases were significantly more likely than controls to have the mutation (OR=5.9; 95% CI=1.2-28.1; P=0.03), whereas adults aged 42 to 49 years were not (OR=1.4; 95% CI=0.4-5.1; P=0.94). In our meta-analysis, the mutation was associated with significantly increased stroke risk in adults ≤55 years (OR=1.4; 95% CI=1.1-1.9; P=0.02), with significance increasing with addition of the GEOS results (OR=1.5; 95% CI=1.1-2.0; P=0.005). CONCLUSIONS The prothrombin G20210A mutation is associated with ischemic stroke in young adults and may have an even stronger association among those with earlier onset strokes. Our finding of a stronger association in the younger young adult population requires replication.
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Affiliation(s)
- Baijia Jiang
- From the Departments of Neurology (B.J., A.H., M.J.S., M.A.W., B.J.S., S.J.K., J.W.C.), Medicine (K.A.R., Y.C., P.F.M., J.R.O., B.D.M.), and Epidemiology and Public Health (O.C.S.), University of Maryland School of Medicine, Baltimore; Centers for Disease Control and Prevention, Atlanta, GA (D.K., C.J.B., M.G., W.C.H.); Department of Veterans Affairs, Veterans Affairs Medical Center Baltimore, MD (Y.C., M.A.W., B.J.S., S.J.K., J.W.C.); and Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore, Geriatric Research, Education and Clinical Center, MD (B.D.M., S.J.K.)
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Abstract
Complex multiorgan failure may require simultaneous transplantation of several organs, including heart-lung, kidney-pancreas, or multivisceral transplantation. Solid organ transplantation can also be combined with hematopoietic stem cell transplantation to modulate immunologic response to a solid organ allograft. Combined multiorgan transplantation may offer a lower rate of allograft rejection and lower immunosuppression needs. In recent years, intestinal and multivisceral transplantations became viable as a rescue treatment for patients with irreversible intestinal failure who can no longer tolerate total parenteral nutrition with 70% survival after 5 years which is comparable to other types of solid organ allografts. Post-transplant neurologic complications were reported in up to 86% of allograft recipients and greatly overlap in intestinal and multivisceral allograft recipients, without a significant effect on the outcome of transplantation. Other common organ combinations in multiorgan transplantation include kidney-pancreas, which is mostly used for patients with renal failure and uncontrolled diabetes, and heart-lung for patients with congenital heart disease and idiopathic pulmonary arterial hypertension. Kidney-pancreas transplantation frequently results in an improvement of diabetic complications, including diabetic neuropathy. Heart-lung allograft recipients have very similar clinical course and spectrum of neurologic complications to lung transplant recipients. At this time there are no reports of an increased risk of graft-versus-host disease with combined transplantation of solid organ allograft and hematopoietic stem cells. Chronic immunosuppression and complex toxic-metabolic disturbances after multiorgan transplantation create a permissive environment for development of a wide spectrum of neurologic complications which largely resemble complications after transplantations of individual components of complex multiorgan allografts.
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Affiliation(s)
- Saša A Zivković
- Neurology Service, Department of Veterans Affairs and Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Ng KWP, Loh PK, Sharma VK. Role of investigating thrombophilic disorders in young stroke. Stroke Res Treat 2011; 2011:670138. [PMID: 21331344 PMCID: PMC3038796 DOI: 10.4061/2011/670138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 12/22/2010] [Accepted: 01/05/2011] [Indexed: 11/20/2022] Open
Abstract
Our knowledge about various inherited and acquired causes of thrombophilic disorders has increased significantly during the past decade. Technology for various diagnostic tests for these rare disorders has matched the rapid advances in our understanding about the thrombophilic disorders. Inherited thrombophilic disorders predispose young patients for various venous or arterial thrombotic and thromboembolic episodes. Our understanding has also improved about various gene-gene and gene-environment interactions and their impact on the resultant heterogenous clinical manifestations. We describe various thrombophilic disorders, their diagnostic tests, pathogenic potential in isolation or with other concurrent inherited/acquired defects and possible therapeutic and prophylactic strategies. Better understanding, optimal diagnostic and screening protocols are expected to improve the diagnostic yield and help to reduce morbidity, disability, and mortality in relatively younger patients harbouring these inherited and acquired thrombophilic disorders.
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Affiliation(s)
- Kay W P Ng
- Division of Neurology, Department of Medicine, National University Hospital, 1E, Kent Ridge Road, Singapore 119228
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Sairanen T, Kanerva M, Valanne L, Lyytinen J, Pekkonen E. Churg-strauss syndrome as an unusual aetiology of stroke with haemorrhagic transformation in a patient with no cardiovascular risk factors. Case Rep Neurol 2011; 3:32-8. [PMID: 21468361 PMCID: PMC3064863 DOI: 10.1159/000323214] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background We present here a case of haemorrhagic brain infarction in a middle-aged and physically active male, who had never smoked. This case report aims to remind the internist and neurologist to bear in mind unusual aetiologies of brain infarcts in patients without classical cardiovascular risk factors. Case Description A 49-year-old male with pulmonary asthma and a prior history of nasal polyps had a wake-up stroke with left-sided symptoms and speech disturbance. A head MRI and MR angiography revealed a recent haemorrhagic infarct in the right putamen and corona radiata. The left hemiparesis progressed to sensory-motor hemiplegia on the 4th day. In the head CT, it was shown that the haemorrhagic infarct had progressed to a large haematoma. A pansinusitis was also diagnosed. The aetiological investigations revealed a minor atrial septal defect (ASD) with shunting and a heterozygotic clotting factor V R506Q mutation. A remarkable blood eosinophilia of 9.80 E9/l (42%) together with fever, sinusitis, wide-spread bilateral nodular pulmonary infiltrates that did not respond to wide-spectrum antimicrobial treatment, positive anti-neutrophilic cytoplasmic antibodies, a high myeloperoxidase antibody level and slightly positive anti-proteinase 3 antibodies suggested the diagnosis of Churg-Strauss syndrome. These inflammatory symptoms and findings promptly responded to treatment with corticosteroids and cyclophosphamide. Conclusions Even after the concomitant findings of the low risk factors, i.e. small ASD and heterozygotic clotting factor mutation, continued search for the final aetiology of stroke revealed Churg-Strauss syndrome, which was the key to the treatment.
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Affiliation(s)
- Tiina Sairanen
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
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Martínez-Martínez M, Cazorla-García R, Rodríguez de Antonio L, Martínez-Sánchez P, Fuentes B, Diez-Tejedor E. Estados de hipercoagulabilidad e ictus isquémico en pacientes jóvenes. Neurologia 2010. [DOI: 10.1016/j.nrl.2009.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Martínez-Martínez M, Cazorla-García R, Rodríguez de Antonio L, Martínez-Sánchez P, Fuentes B, Diez-Tejedor E. Hypercoagulability and ischemic stroke in young patients. NEUROLOGÍA (ENGLISH EDITION) 2010. [DOI: 10.1016/s2173-5808(10)70065-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Linnemann B, Schindewolf M, Zgouras D, Erbe M, Jarosch-Preusche M, Lindhoff-Last E. Are patients with thrombophilia and previous venous thromboembolism at higher risk to arterial thrombosis? Thromb Res 2008; 121:743-50. [PMID: 17804043 DOI: 10.1016/j.thromres.2007.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Revised: 07/14/2007] [Accepted: 07/18/2007] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Whether thrombophilic disorders, which are established risk factors for venous thromboembolism (VTE), also increase the risk of arterial thrombosis is still unknown. MATERIALS AND METHODS We analyzed data from 1081 consecutive patients (649 F/432 M, 16-93 years of age) with previous VTE registered in the MAISTHRO (MAin-ISar-THROmbosis) database with regard to arterial thrombotic events and contributing risk factors. Screening for thrombophilia included testing for factor V Leiden and prothrombin G20210A mutation, antiphospholipid antibodies and activities of factor VIII, protein C, protein S and antithrombin. RESULTS Of the entire study cohort, 40 patients (3.7%) had a prior myocardial infarction (MI), and 41 (3.8%) suffered a stroke. Other arterial thrombotic events were rare. Elevated factor VIII levels were more prevalent in MI patients than in controls (44.4 vs. 25.9%, p=0.044), but after adjusting for the traditional cardiovascular risk factors, this relationship was no longer significant. We observed a higher rate of lupus anticoagulant in MI patients with an adjusted odds ratio of 3.3 (95%CI 0.84-12.8, p=0.090). No difference in any other tested thrombophilia was observed in patients with MI or stroke relative to those without. CONCLUSION The cumulative incidence of arterial thrombotic events in VTE patients is low, and the inherited thrombophilias do not seem to substantially increase the risk of arterial thrombosis.
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Affiliation(s)
- Birgit Linnemann
- Division of Vascular Medicine, Department of Internal Medicine, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7 D-60590 Frankfurt/Main, Germany.
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Chapter 12 Blood coagulation and fibrinolysis: mechanisms of thrombosis. Stroke 2008. [DOI: 10.1016/s0072-9752(08)01912-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Nelson SM, Greer IA. Thromboembolic events in pregnancy: pharmacological prophylaxis and treatment. Expert Opin Pharmacother 2007; 8:2917-31. [DOI: 10.1517/14656566.8.17.2917] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Perkins SL, Reddy VBV, Reichard KK, Thompsen MA, Dunphy CH. Recommended curriculum for teaching hematopathology to subspecialty hematopathology fellows. Am J Clin Pathol 2007; 127:962-76. [PMID: 17509994 DOI: 10.1309/6c41q30m5rm83qmh] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The performance and interpretation of clinical hematology and hematopathology laboratory tests and diagnosis of benign or malignant hematolymphoid disorders present unique challenges to hematopathology fellow trainees. To assist hematopathology fellowship program directors in preparing trainees to meet these challenges, a task force of pathologists with expertise in hematopathology developed a suggested training curriculum that includes a comprehensive list of topics in the areas of analytic hematology, bone marrow pathology, lymph node pathology, splenic pathology, lymphoma diagnostics, cytogenetics, and molecular diagnostics. This report also includes recommendations for training experiences that will facilitate the transition of subspecialty residents to practicing consultants in hematopathology.
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Affiliation(s)
- Sherrie L Perkins
- Department of Pathology, University of Utah, Salt Lake City , UT 84132, USA
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