Evolution of platelet functions in cirrhotic patients undergoing liver transplantation: A prospective exploration over a month.

This prospective observational study was designed to analyze platelet functions across time in 50 patients scheduled for liver transplantation (LT) secondary to decompensated cirrhosis or hepatocellular carcinoma. Platelet functions were assessed before LT (pre-LT), one week (D7) and 1 month (D28) after LT. Platelet count significantly increased from pre-LT time to day 28 as well as circulating CD34+hematopoietic stem cells. To avoid any influence of platelet count on assays, platelet function was evaluated on platelet-rich-plasma adjusted to pre-LT platelet count. Although platelet secretion potential did not differ between time-points, as evaluated by the expression of CD62P upon strong activation, platelet aggregation in response to various agonists significantly increased along time, however with no concomitant increase of circulating markers of platelet activation: platelet microvesicles, platelet-leukocyte complexes, soluble CD40L and soluble CD62P. In the multivariate analysis, hepatic function was associated with platelet count and function. A lower platelet aggregation recovery was correlated with Child C score. History of thrombosis or bleeding was associated with respective higher or lower values of platelet aggregation. This longitudinal analysis of platelet functions in LT patients showed an improvement of platelet functions along time together with platelet count increase, with no evidence of platelet hyperactivation at any time-point

Evolution of platelet functions in cirrhotic patients undergoing liver transplantation: A prospective exploration over a month - Fig 2

<p><b>(A) Boxplots for platelet count and (B) CD34+ hematopoietic progenitor stem cells at different time points.</b> Horizontal lines show median values and the 25–75 percentiles. Pre LT: pre liver transplantation.</p

Baseline characteristics of the study population at inclusion and quality of the liver graft.

<p>Baseline characteristics of the study population at inclusion and quality of the liver graft.</p

Baseline and evolution of the biological parameters of the 50 patients with the 3 time-point available data.

<p>Baseline and evolution of the biological parameters of the 50 patients with the 3 time-point available data.</p

Evolution of platelet functions in cirrhotic patients undergoing liver transplantation: A prospective exploration over a month - Fig 3

<p><b>Boxplots at different time points for (A) 10 μM ADP-induced platelet aggregation, (B) 1.5 mM arachidonic acid-induced platelet aggregation, (C) 20 μM TRAP-induced platelet aggregation, (D) 1 mg/mL ristocetin-induced platelet agglutination, (E) platelet microvesicles as a % of total platelet count, (F) soluble CD62P.</b> Horizontal lines show median values and the 25–75 percentiles. Pre LT: pre liver transplantation.</p

Flow chart.

<p>LT: Liver transplantation.</p

Venous thromboembolism risk and prophylaxis in hospitalised medically ill patients The ENDORSE Global Survey

Limited data are available regarding the risk for venous thromboembolism (VIE) and VIE prophylaxis use in hospitalised medically ill patients. We analysed data from the global ENDORSE survey to evaluate VTE risk and prophylaxis use in this population according to diagnosis, baseline characteristics, and country. Data on patient characteristics, VIE risk, and prophylaxis use were abstracted from hospital charts. VTE risk and prophylaxis use were evaluated according to the 2004 American College of Chest Physicians (ACCP) guidelines. Multivariable analysis was performed to identify factors associated with use of ACCP-recommended prophylaxis. Data were evaluated for 37,356 hospitalised medical patients across 32 countries. VIE risk varied according to medical diagnosis, from 31.2% of patients with gastrointestinal/hepatobiliary diseases to 100% of patients with acute heart failure, active noninfectious respiratory disease, or pulmonary infection (global rate, 41.5%). Among those at risk for VTE, ACCP-recommended prophylaxis was used in 24.4% haemorrhagic stroke patients and 40-45% of cardiopulmonary disease patients (global rate, 39.5%). Large differences in prophylaxis use were observed among countries. Markers of disease severity, including central venous catheters, mechanical ventilation, and admission to intensive care units, were strongly associated with use of ACCP-recommended prophylaxis. In conclusion, VIE risk varies according to medical diagnosis. Less than 40% of at-risk hospitalised medical patients receive ACCP-recommended prophylaxis. Prophylaxis use appears to be associated with disease severity rather than medical diagnosis. These data support the necessity to improve implementation of available guidelines for evaluating VIE risk and providing prophylaxis to hospitalised medical patients

Venous Thromboembolism Risk and Prophylaxis in the Acute Care Hospital Setting (ENDORSE Survey) Findings in Surgical Patients

Objective: To evaluate venous thromboembolism (VTE) risk in patients who underwent a major operation, including the use of, and factors influencing, American College of Chest Physicians-recommended types of VTE prophylaxis