102 research outputs found
Women with congenital factor VII deficiency: clinical phenotype and treatment options from two international studies
A paucity of data exists on the incidence, diagnosis and treatment of bleeding in women with inherited factor VII (FVII) deficiency
Heterogeneous treatment effects of therapeutic-dose heparin in patients hospitalized for COVID-19
Importance Randomized clinical trials (RCTs) of therapeutic-dose heparin in patients hospitalized with COVID-19 produced conflicting results, possibly due to heterogeneity of treatment effect (HTE) across individuals. Better understanding of HTE could facilitate individualized clinical decision-making. Objective To evaluate HTE of therapeutic-dose heparin for patients hospitalized for COVID-19 and to compare approaches to assessing HTE. Design, Setting, and Participants Exploratory analysis of a multiplatform adaptive RCT of therapeutic-dose heparin vs usual care pharmacologic thromboprophylaxis in 3320 patients hospitalized for COVID-19 enrolled in North America, South America, Europe, Asia, and Australia between April 2020 and January 2021. Heterogeneity of treatment effect was assessed 3 ways: using (1) conventional subgroup analyses of baseline characteristics, (2) a multivariable outcome prediction model (risk-based approach), and (3) a multivariable causal forest model (effect-based approach). Analyses primarily used bayesian statistics, consistent with the original trial. Exposures Participants were randomized to therapeutic-dose heparin or usual care pharmacologic thromboprophylaxis. Main Outcomes and Measures Organ supportâfree days, assigning a value of â1 to those who died in the hospital and the number of days free of cardiovascular or respiratory organ support up to day 21 for those who survived to hospital discharge; and hospital survival. Results Baseline demographic characteristics were similar between patients randomized to therapeutic-dose heparin or usual care (median age, 60 years; 38% female; 32% known non-White race; 45% Hispanic). In the overall multiplatform RCT population, therapeutic-dose heparin was not associated with an increase in organ supportâfree days (median value for the posterior distribution of the OR, 1.05; 95% credible interval, 0.91-1.22). In conventional subgroup analyses, the effect of therapeutic-dose heparin on organ supportâfree days differed between patients requiring organ support at baseline or not (median OR, 0.85 vs 1.30; posterior probability of difference in OR, 99.8%), between females and males (median OR, 0.87 vs 1.16; posterior probability of difference in OR, 96.4%), and between patients with lower body mass index (BMI 90% for all comparisons). In risk-based analysis, patients at lowest risk of poor outcome had the highest propensity for benefit from heparin (lowest risk decile: posterior probability of OR >1, 92%) while those at highest risk were most likely to be harmed (highest risk decile: posterior probability of OR <1, 87%). In effect-based analysis, a subset of patients identified at high risk of harm (Pâ=â.05 for difference in treatment effect) tended to have high BMI and were more likely to require organ support at baseline. Conclusions and Relevance Among patients hospitalized for COVID-19, the effect of therapeutic-dose heparin was heterogeneous. In all 3 approaches to assessing HTE, heparin was more likely to be beneficial in those who were less severely ill at presentation or had lower BMI and more likely to be harmful in sicker patients and those with higher BMI. The findings illustrate the importance of considering HTE in the design and analysis of RCTs. Trial Registration ClinicalTrials.gov Identifiers: NCT02735707, NCT04505774, NCT04359277, NCT0437258
Vampires in the village Ćœrnovo on the island of KorÄula: following an archival document from the 18th century
SrediĆĄnja tema rada usmjerena je na raĆĄÄlambu spisa pohranjenog u DrĆŸavnom arhivu u Mlecima (fond: Capi del Consiglio deâ Dieci: Lettere di Rettori e di altre cariche) koji se odnosi na dogaÄaj iz 1748. godine u korÄulanskom selu Ćœrnovo, kada su mjeĆĄtani â vjerujuÄi da su se pojavili vampiri â oskvrnuli nekoliko mjesnih grobova. U radu se podrobno iznose osnovni podaci iz spisa te reÄeni dogaÄaj analizira u ĆĄirem druĆĄtvenom kontekstu i prate se lokalna vjerovanja.The main interest of this essay is the analysis of the document from the State Archive in Venice (file: Capi del Consiglio deâ Dieci: Lettere di Rettori e di altre cariche) which is connected with the episode from 1748 when the inhabitants of the village Ćœrnove on the island of KorÄula in Croatia opened tombs on the local cemetery in the fear of the vampires treating.
This essay try to show some social circumstances connected with this event as well as a local vernacular tradition concerning superstitions
Management of bleeding associated with dabigatran and rivaroxaban: a survey of current practices
University of Minnesota M.S. thesis. Major: Clinical Research. May 2013. Advisor: Mark T. Reding. 1 computer file (PDF); vi, 36 pages.Dabigatran and rivaroxaban are two new oral anticoagulants that have been recently approved as alternatives to warfarin. Clinical trials have shown non-inferiority of the new oral anticoagulants to warfarin for anti-thrombotic effects with equal to decreased bleeding risk. Unfortunately no standard method to assess the level of anticoagulation or reverse the effects of dabigatran or rivaroxaban is available. Current recommended management of bleeding patients taking dabigatran or rivaroxaban is based on expert opinion. To gain information from experience of physicians who have managed hemorrhaging patients, U.S. non-malignant hematologists were surveyed with a 31% response rate. In total, 43 cases of dabigatran associated hemorrhage and 5 cases of rivaroxaban associated bleeding were reported. Factor concentrates were used in 9 cases of dabigatran hemorrhage with perceived effectiveness ranging from 50-80%. A national registry is needed to track management of hemorrhages until antidotes become available
Management of incidental splanchnic vein thrombosis in cancer patients
A 75-year-old male with metastatic pancreatic cancer is undergoing chemotherapy with gemcitabine. A portal vein thrombosis was incidentally found on surveillance CT scan. He does not report any new abdominal pain or ascites. Should anticoagulation be used to treat asymptomatic portal vein thrombosis
Management of cancerâassociated thrombosis with thrombocytopenia: Impact of the ISTH guidance statement
Abstract Background Optimal management of cancerâassociated thrombosis (CAT) in patients with thrombocytopenia remains difficult given competing risks of recurrent thrombosis and increased bleeding. We determine the impact of the ISTH Scientific and Standardization Committee (SCC) guidance on CAT management and thrombocytopenia on platelet transfusion, bleeding, and recurrent thrombosis. Methods A retrospective review was performed of patients with CAT and thrombocytopenia who required anticoagulation for VTE for 11Â months before and after implementation of the ISTH SCC guidance. Medical records were reviewed to identify the type of VTE event, number of platelet transfusions, incidence of bleeding, and VTE recurrence within preâ and postintervention time periods. Results A total of 41 and 80 cases were included in the preintervention and postintervention periods, respectively. The preintervention group showed a trend toward less acute VTE events (39% vs 55%; PÂ =Â .05). The postintervention period had an increased perâpatient platelet transfusion (median, 2.5 vs 4; PÂ =Â .05). Nonmajor bleeding was increased in the postintervention group (2% vs 16%; PÂ =Â 0.03) and included all six (8%) major hemorrhages (PÂ =Â .09). There was numerically less recurrent thrombosis in the postintervention group (20% vs 8%; PÂ =Â .07), which was not significantly different when accounting for acuity of VTE. Management adherence was strong, at 91%, in the postintervention group. Conclusion The ISTH guidance on management of cancerâassociated thrombosis in patients with thrombocytopenia was successfully implemented in an academic medical center. There was no significant difference in bleeding or recurrent thrombosis outcomes after adjusting for acuity of VTE
Prise en charge dâune parturiente atteinte dâun dĂ©ficit sĂ©vĂšre en facteur VII (†5 %)
Lack of Efficacy of Pyridoxine (Vitamin B6) Treatment In Acquired Idiopathic Sideroblastic Anemia, Including Refractory Anemia with Ring Sideroblasts
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