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Wang Z, Mao X, Guo Z, Che G, Xiang C, Xiang C. Establishment and validation of a nomogram predicting the risk of deep vein thrombosis before total knee arthroplasty. Thromb J 2024; 22:21. [PMID: 38365683 PMCID: PMC10873976 DOI: 10.1186/s12959-024-00588-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/29/2024] [Indexed: 02/18/2024] Open
Abstract
PURPOSE This study aimed to analyze the independent risk factors contributing to preoperative DVT in TKA and constructed a predictive nomogram to accurately evaluate its occurrence based on these factors. METHODS The study encompassed 496 patients who underwent total knee arthroplasty at our hospital between June 2022 and June 2023. The dataset was randomly divided into a training set (n = 348) and a validation set (n = 148) in a 7:3 ratio. The least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analysis were used to screen the predictors of preoperative DVT occurrence in TKA and construct a nomogram. The performance of the predictive models was evaluated using the concordance index (C-index), calibration curves, and the receiver operating characteristic (ROC) curves. Decision curve analysis was used to analyze the clinical applicability of nomogram. RESULTS A total of 496 patients who underwent TKA were included in this study, of which 28 patients were examined for lower extremity DVT preoperatively. Platelet crit, Platelet distribution width, Procalcitonin, prothrombin time, and D-dimer were predictors of preoperative occurrence of lower extremity DVT in the nomograms of the TKA patients. In addition, the areas under the curve of the ROC of the training and validation sets were 0.935 (95%CI: 0.880-0.990) and 0.854 (95%CI: 0.697-1.000), and the C-indices of the two sets were 0.919 (95%CI: 0.860-0.978) and 0.900 (95%CI: 0.791-1.009). The nomogram demonstrated precise risk prediction of preoperative DVT occurrence in TKA as confirmed by the calibration curve and decision curve analysis. CONCLUSIONS This Nomogram demonstrates great differentiation, calibration and clinical validity. By assessing individual risk, clinicians can promptly detect the onset of DVT, facilitating additional life monitoring and necessary medical interventions to prevent the progression of DVT effectively.
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Affiliation(s)
- Zehua Wang
- Department of Orthopedic, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xingjia Mao
- Department of Basic Medicine Sciences, and Department of Orthopaedics of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zijian Guo
- Department of Orthopedic, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Guoyu Che
- School of Health, Yuncheng Vocational and Technical University, Yuncheng, China
| | - Changxin Xiang
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, China
| | - Chuan Xiang
- Department of Orthopedic, The Second Hospital of Shanxi Medical University, Taiyuan, China.
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Wittig J, Drekolia MK, Kyselova A, Delgado Lagos F, Bochenek ML, Hu J, Schäfer K, Fleming I, Bibli SI. Endothelial-dependent S-Sulfhydration of tissue factor pathway inhibitor regulates blood coagulation. Redox Biol 2023; 62:102694. [PMID: 37030150 PMCID: PMC10119959 DOI: 10.1016/j.redox.2023.102694] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/19/2023] [Accepted: 04/02/2023] [Indexed: 04/05/2023] Open
Abstract
Tissue factor pathway inhibitor (TFPI) is an important regulator of coagulation and a link between inflammation and thrombosis. Here we investigated whether endothelial cell-driven oxidative post-translational modifications could have an impact on TFPI activity. We focused on S-sulfhydration, which is a hydrogen sulfide-dependent post-translational modification that, in endothelial cells, is regulated by the enzyme cystathionine γ-lyase (CSE). The study made use of human primary endothelial cells and blood from healthy individuals or subjects with atherosclerosis as well as from mice lacking endothelial CSE. TFPI was S-sulfhydrated in endothelial cells from healthy individuals and mice, while the loss of endothelial CSE expression/activity reduced its modification. Non-S-sulfhydrated TFPI was no longer able to interact with factor Xa, which facilitated the activation of tissue factor. Similarly, non-S-sulfhydratable TFPI mutants bound less protein S, while supplementation with hydrogen sulfide donors, preserved TFPI activity. Phenotypically, loss of TFPI S-sulfhydration increased clot retraction, suggesting that this post-translational modification is a new endothelial cell-dependent mechanism that contributes to the regulation of blood coagulation.
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Zang X, Su Y, Zhang W, Cao X, Li C, Lu S, Zhao H, Chen Y, Liang C, Wu J. Hepatocyte-derived Microparticles as Novel Biomarkers for the Diagnosis of Deep Venous Thrombosis in Trauma Patients. Clin Appl Thromb Hemost 2023; 29:10760296231153400. [PMID: 36749023 PMCID: PMC9909065 DOI: 10.1177/10760296231153400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Venous thromboembolism is a common complication following trauma. We investigated the dynamics of plasma microparticles (MPs) levels and explored their potential as biomarkers of deep vein thromboembolism (DVT) after trauma. A total of 775 patients with traumatic fractures were recruited in this nested study. About 106 trauma patients (53 DVT subjects and 53 age-, sex-, and fracture site-matched non-DVT subjects) and 53 healthy volunteers met the enrollment criteria. MPs were characterized by transmission electron microscope, nanoparticle tracking analysis, and western blotting. Circulating levels of MPs were measured using a flow cytometer. Meanwhile, routine laboratory parameters were examined in all patients. Compared to non-DVT patients, DVT patients had higher circulating phosphatidylserine (PS) + MPs, hepatocyte-derived MPs (HMPs), PS + HMPs, and platelet-derived MPs (PMPs). Notably, PS + HMPs had the best predictive value for DVT diagnosis in trauma patients (area under the curve [AUC] 0.8939, 95% CI 0.8326 to 0.9552), which was superior to d-dimer (AUC 0.5881). The Hepatic Procoagulant Index combined plasma levels of PS + HMPs and albumin, increasing the AUC to 0.8978 (95% CI 0.8396 to 0.9561). This is the first study that addressed circulating PS + HMPs are promising biomarkers with high performance in diagnosing DVT. The Hepatic Procoagulant Index is a potential predictor of DVT in trauma patients.
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Affiliation(s)
- Xinwei Zang
- Department of Clinical Laboratory, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Yu Su
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Beijing, China
| | - Wenjie Zhang
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Beijing, China
| | - Xiangyu Cao
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Beijing, China
| | - Chunyan Li
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Beijing, China
| | - Shan Lu
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Beijing, China
| | - Huiru Zhao
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Beijing, China
| | - Yuying Chen
- Department of Clinical Laboratory, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Cuiying Liang
- Department of Clinical Laboratory, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Jun Wu
- Department of Clinical Laboratory, Peking University Fourth School of Clinical Medicine, Beijing, China,Department of Clinical Laboratory, Beijing Jishuitan Hospital, Beijing, China,Jun Wu, Department of Clinical Laboratory, Peking University Fourth School of Clinical Medicine, Beijing, 100035, China.
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Haemostasis and Inflammatory Parameters as Potential Diagnostic Biomarkers for VTE in Trauma-Immobilized Patients. Diagnostics (Basel) 2023; 13:diagnostics13010150. [PMID: 36611442 PMCID: PMC9818770 DOI: 10.3390/diagnostics13010150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 01/03/2023] Open
Abstract
Venous thromboembolism (VTE), which encompasses deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major public health concern due to its high incidences of morbidity and mortality. Patients who have experienced trauma with prolonged immobilization are at an increased risk of developing VTE. Plasma D-dimer levels have been known to be elevated in trauma patients, and they were closely correlated with the number of fractures. In other words, plasma D-dimer levels cannot be used as the only indicator of VTE in trauma cases. Given the limitations, further study is needed to explore other potential biomarkers for diagnosing VTE. To date, various established and novel VTE biomarkers have been studied in terms of their potential for predicting VTE, diagnostic performance, and improving clinical therapy for VTE. Therefore, this review aims to provide information regarding classic and essential haemostasis (including prothrombin time (PT), activated partial thromboplastin time (aPTT), D-dimer, fibrinogen, thrombin generation, protein C, protein S, antithrombin, tissue factor pathway inhibitor, and platelet count) and inflammatory biomarkers (C-reactive protein, erythrocyte sedimentation rate, and soluble P-selectin) as potential diagnostic biomarkers that can predict the risk of VTE development among trauma patients with prolonged immobilization. Thus, further advancement in risk stratification using these biomarkers would allow for a better diagnosis of patients with VTE, especially in areas with limited resources.
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Bradshaw PG, Keegan SP, Droege ME, Dykes NJH, Ernst NE, Foertsch MJ, Makley AT, Mueller EW, Philpott CD, Srinivasan V, Winter JB, Goodman MD, Droege CA. Reversal of apixaban and rivaroxaban with andexanet alfa prior to invasive or surgical procedures. Pharmacotherapy 2022; 42:780-791. [PMID: 36073083 PMCID: PMC9826450 DOI: 10.1002/phar.2727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Outcomes following andexanet alfa reversal of factor Xa inhibitors in patients requiring urgent or emergent invasive procedures are lacking. This study aimed to describe efficacy and safety outcomes following andexanet alfa administration within 24 h of an invasive procedure. METHODS This single-center, observational, retrospective study included patients who received andexanet alfa within 24 h of an invasive or surgical procedure. The primary outcome was hemostatic efficacy graded as excellent, good, or poor using similar definitions to the ANNEXA-4 criteria. Secondary outcomes included hospital discharge disposition, intensive care unit (ICU) and hospital length of stay, 30-day mortality, 30-day thromboischemic event rates, and serum coagulation assay changes pre- and postreversal. RESULTS Forty-four patients met inclusion criteria; of these, 27 (62.8%) received apixaban and 16 (37.2%) were treated with rivaroxaban prior to admission. The indications for reversal were categorized as intracranial (n = 20 [45.5%]) or extracranial (n = 24 [54.5%]) sites. Majority of patients required emergent operative procedures (18 [40.9%]), followed by invasive device placement (10 [22.7%]) or arterial embolization (9 [20.5%]). Thirty-eight (86.4%) patients were able to be adequately graded for hemostatic efficacy. Overall, 30 (78.9%) patients achieved excellent or good hemostasis within 24 h after periprocedural administration of andexanet alfa (19 [82.6%] apixaban vs. 11 [78.6%] rivaroxaban; 12 [80.0%] intracranial events vs. 18 [78.3%] extracranial events). Discharge disposition was most often to a short- or long-term care facilities (27 [61.4%]). Thirty-day mortality and thromboischemic complications occurred in 15 (34.1%) and 12 (27.3%) patients, respectively. Prothrombin time and antifactor Xa assay results were significantly decreased after andexanet alfa administration (p < 0.05) while thromboelastogram assay values (reaction time, kinetic time, and activated clotting time) showed nonsignificant changes pre- versus postreversal. CONCLUSION Andexanet alfa may be used for urgent or emergent reversal of apixaban and rivaroxaban peri-procedurally with promising hemostatic outcomes. Further prospective, comparative clinical research is warranted.
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Affiliation(s)
- Paige Garber Bradshaw
- Department of PharmacyUC Health – University of Cincinnati Medical CenterCincinnatiOhioUSA,University of Cincinnati James L. Winkle College of PharmacyCincinnatiOhioUSA
| | - Shaun Patrick Keegan
- Department of PharmacyUC Health – University of Cincinnati Medical CenterCincinnatiOhioUSA,University of Cincinnati James L. Winkle College of PharmacyCincinnatiOhioUSA
| | - Molly Elizabeth Droege
- Department of PharmacyUC Health – University of Cincinnati Medical CenterCincinnatiOhioUSA,University of Cincinnati James L. Winkle College of PharmacyCincinnatiOhioUSA
| | - Nicole Jade Harger Dykes
- Department of PharmacyUC Health – University of Cincinnati Medical CenterCincinnatiOhioUSA,University of Cincinnati James L. Winkle College of PharmacyCincinnatiOhioUSA
| | - Neil Edward Ernst
- Department of PharmacyUC Health – University of Cincinnati Medical CenterCincinnatiOhioUSA,University of Cincinnati James L. Winkle College of PharmacyCincinnatiOhioUSA
| | - Madeline Jane Foertsch
- Department of PharmacyUC Health – University of Cincinnati Medical CenterCincinnatiOhioUSA,University of Cincinnati James L. Winkle College of PharmacyCincinnatiOhioUSA
| | - Amy Teres Makley
- Department of Surgery, Division of TraumaUniversity of CincinnatiCincinnatiOhioUSA
| | - Eric William Mueller
- Department of PharmacyUC Health – University of Cincinnati Medical CenterCincinnatiOhioUSA,University of Cincinnati James L. Winkle College of PharmacyCincinnatiOhioUSA
| | - Carolyn Dosen Philpott
- Department of PharmacyUC Health – University of Cincinnati Medical CenterCincinnatiOhioUSA,University of Cincinnati James L. Winkle College of PharmacyCincinnatiOhioUSA
| | - Vasisht Srinivasan
- Department of Emergency MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Jessica Brooke Winter
- Department of PharmacyUC Health – University of Cincinnati Medical CenterCincinnatiOhioUSA,University of Cincinnati James L. Winkle College of PharmacyCincinnatiOhioUSA
| | - Michael D. Goodman
- Department of Surgery, Division of TraumaUniversity of CincinnatiCincinnatiOhioUSA
| | - Christopher Allen Droege
- Department of PharmacyUC Health – University of Cincinnati Medical CenterCincinnatiOhioUSA,University of Cincinnati James L. Winkle College of PharmacyCincinnatiOhioUSA
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