360 research outputs found
Reproducibility of exhaled nitric oxide measurements in overweight and obese adults
Exhaled nitric oxide is a noninvasive measure of airway inflammation that can be detected by a handheld device. Obesity may influence the reproducibility of exhaled nitric oxide measurements, by - for instance - decreased expiratory reserve volume. We analyzed triple exhaled nitric oxide measurements from 553 participants (aged 45 to 65 years with a body mass index ≥27 kg/m2) of the Netherlands Epidemiology of Obesity Study. The interclass correlation coefficient (single measurement reliability) was 0.965 (95% CI: 0.960, 0.970). We conclude that for assessment of exhaled nitric oxide in large cohorts of overweight and obese adults a single measurement suffice
Progress of the ALIFE2 study : a dynamic road towards more evidence
Investigator-initiated studies are invaluable, especially in fields that are not particularly of interest for the pharmaceutical industry because they are either less profitable or concern special patient groups such as pregnant women. However, designing, conducting, and completing an investigator-initiated randomised controlled trial is challenging. Patients and physicians' preferences, ethics requirements, (international) legislation and funding are all areas where such challenges are encountered. The Anticoagulants for LIving FEtuses (ALIFE)2 study (NTR3361) is an example of an investigator initiated international multicenter trial that progresses slowly, at least initially, as many challenges had to be overcome. Here, we discuss the challenges we faced during the course of the ALIFE2 study up till now and we explain how some of these challenges can be tackled or even avoided
Addendum to “on the measurability of a function which occurs in a paper by A. C. Zaanen”
Current guidelines discourage combined oral contraceptive (COC) use in women with hereditary thrombophilic defects. However, qualifying all hereditary thrombophilic defects as similarly strong risk factors might be questioned. Recent studies indicate the risk of venous thromboembolism (VTE) of a factor V Leiden mutation as considerably lower than a deficiency of protein C, protein S, or antithrombin. In a retrospective family cohort, the VTE risk during COC use and pregnancy (including postpartum) was assessed in 798 female relatives with or without a heterozygous, double heterozygous, or homozygous factor V Leiden or prothrombin G20210A mutation. Overall, absolute VTE risk in women with no, single, or combined defects was 0.13 (95% confidence interval 0.08-0.21), 0.35 (0.22-0.53), and 0.94 (0.47-1.67) per 100 person-years, while these were 0.19 (0.07-0.41), 0.49 (0.18-1.07), and 0.86 (0.10-3.11) during COC use, and 0.73 (0.30-1.51), 1.97 (0.94-3.63), and 7.65 (3.08-15.76) during pregnancy. COC use and pregnancy were independent risk factors for VTE, with highest risk during pregnancy postpartum, as demonstrated by adjusted hazard ratios of 16.0 (8.0-32.2) versus 2.2 (1.1-4.0) during COC use. Rather than strictly contraindicating COC use, we advocate that detailed counseling on all contraceptive options, including COCs, addressing the associated risks of both VTE and unintended pregnancy, enabling these women to make an informed choice. (Blood. 2011;118(8):2055-2061
COVID-19-associated coagulopathy and antithrombotic agents—lessons after 1 year
COVID-19 is associated with a high incidence of thrombotic complications, which can be explained by the complex and
unique interplay between coronaviruses and endothelial cells, the local and systemic inflammatory response, and the
coagulation system. Empirically, an intensified dose of thrombosis prophylaxis is being used in patients admitted to
hospital with COVID-19 and several guidelines on this topic have been published, although the insufficiency of high
quality and direct evidence has led to weak recommendations. In this Viewpoint we summarise the pathophysiology of
COVID-19 coagulopathy in the context of patients who are ambulant, admitted to hospital, and critically ill or
non-critically ill, and those post-discharge from hospital. We also review data from randomised controlled trials in the
past year of antithrombotic therapy in patients who are critically ill. These data provide the first high-quality evidence on
optimal use of antithrombotic therapy in patients with COVID-19. Pharmacological thromboprophylaxis is not routinely
recommended for patients who are ambulant and post-discharge. A first ever trial in non-critically ill patients who were
admitted to hospital has shown that a therapeutic dose of low-molecular-weight heparin might improve clinical
outcomes in this population. In critically ill patients, this same treatment does not improve outcomes and prophylactic
dose anticoagulant thromboprophylaxis is recommended. In the upcoming months we expect numerous data from the
ongoing antithrombotic COVID-19 studies to guide clinicians at different stages of the disease.http://www.thelancet.com/haematologyam2022Medical Oncolog
The Absolute Risk of Venous Thrombosis after Air Travel: A Cohort Study of 8,755 Employees of International Organisations
In a cohort study of 8,755 employees of large international organizations followed for 38,910 person-years, Suzanne Cannegieter and colleagues find a risk of one thrombosis per 4,656 long-haul flights
Characterization of AIM2 DNA-Binding Properties and Filament Formation
High levels of thrombin-activatable fibrinolysis inhibitor (TAFI) are a supposed risk factor for thrombosis. However, results from previous studies are conflicting.We assessed the absolute risk of venous and arterial thromboembolism in subjects with high TAFI levels (> 126 U/dl) versus subjects with normal levels, and the contribution of other concomitant thrombophilic defects. Relatives from four identical cohort studies in families with either deficiencies of antithrombin, protein C or protein S, prothrombin 202 1 OA, high factorVIII levels, or hyperhomocysteinemia were pooled. Probands were excluded. Of 1,940 relatives, 187 had high TAR levels. Annual incidences of venous thromboembolism were 0.23% in relatives with highTAFI levels versus 0.26% in relatives with normal TAFI levels (adjusted relative risk [RR] 0.8; 95% confidence interval [0], 0.5-1.3). For arterial thrombosis these were 0.3 1 % versus 0.23% (adjusted RR 1.4; 95% Cl, 0.9-2.2). High levels of factor VIII, IX and XI were observed more frequently in relatives with high TAR levels. Only high factor VIII levels were associated with an increased risk of venous and arterial thrombosis, independently of TAR levels. None of these concomitant defects showed interaction with high TAR levels. High TAR levels were not associated with an increased risk of venous and arterial thromboembolism in thrombophilic families
Evidence-based approach to thrombophilia testing
Thrombophilia can be identified in about half of all patients presenting with VTE. Testing has increased tremendously for various indications, but whether the results of such tests help in the clinical management of patients has not been settled. I use evidence from observational studies to conclude that testing for hereditary thrombophilia generally does not alter the clinical management of patients with VTE, with occasional exceptions for women at fertile age. Because testing for thrombophilia only serves limited purpose this should not be performed on a routine basis
A Prospective Case-Control Study
Background: Few studies have assessed the effect of prothrombotic blood abnormalities on the risk of deep vein thrombosis (DVT) with hormone replacement therapy (HRT). Methods: We studied postmenopausal women with suspected DVT in whom HRT use and prothrombotic blood abnormalities were sought. Cases had unprovoked DVT and controls had no DVT and without DVT risk factors. The risk of DVT was determined in women with and without prothrombotic abnormalities. Results: A total of 510 postmenopausal women with suspected DVT were assessed; 57 cases and 283 controls were identified. Compared to HRT, nonusers without the factor V Leiden mutation, the risk of DVT was increased in estrogen-progestin HRT users (odds ratio [OR], 3.2; 95% confidence interval [CI]: 1.2-8.6) and in nonusers with the factor V Leiden mutation (OR, 5.3; 1.9-15.4) and appears multiplied in users of estrogen-progestin HRT with the factor V Leiden mutation (OR, 17.1; 3.7-78). Compared to HRT, nonusers with normal factor VIII, the risk of DVT was increased in estrogen-progestin HRT users with normal factor VIII (OR, 2.8; 1.0-7.9) and in HRT nonusers with the highest factor VIII quartile (OR, 6.0; 2.1-17), and appears to be multiplied in women who are users of estrogen-progestin HRT with the highest factor VIII quartile (OR, 17.0; 3.6-80). Conclusions: In postmenopausal women who are estrogen-progestin HRT users, the presence of the factor V Leiden mutation or an elevated factor VIII level appears to have a multiplicative effect on their overall risk of DVT, increasing it 17-fold compared to women without these blood abnormalities who are HRT nonusers
Association between weight or Body Mass Index and hand osteoarthritis: a systematic review
Objective:
To investigate the association between weight or Body Mass Index (BMI) and the
development of hand osteoarthritis (OA).
Methods:
Systematic review of observational studies. Medical databases were searched up to April
2008. Articles which presented data on the association between weight and hand OA
were selected. The qualities of these studies were then assessed by two independent
reviewers using a 19 criteria scoring syst
Outcome of intracranial bleeding managed with prothrombin complex concentrate in patients on direct factor Xa inhibitors or vitamin K antagonists
Intracranial hemorrhage (ICH) is the most feared complication of anticoagulation with a high mortality and morbidity. Before registration of a specific reversal agent
for factor Xa inhibitors (FXa-I), international guidelines recommended prothrombin complex concentrate (PCC), which also is the specific reversal agent for vitamin K
antagonists (VKA). In two contemporary cohorts, we compared clinical outcomes between patients with FXa-I and VKA related ICH treated with PCC between 2014
and 2018. Primary outcome was effective hemostasis after 24 h, according to the International Society of Thrombosis and Hemostasis definition. Safety outcomes
were defined as venous and arterial thromboembolic complications and death within 30 days. Thirty-six patients with FXa-I-ICH and 39 patients with VKA-ICH were
available for analysis. Baseline characteristics were comparable between both groups, except for time from start of symptoms to presentation at the hospital. In the
FXa-I-ICH cohort, 24 (73%) patients achieved effective hemostasis compared to 23 (62%) patients in the VKA-ICH cohort (crude odds ratio [OR] 1.62 [95%CI
0.59–4.48], adjusted OR 1.45 [95%CI 0.44–4.83]). Eight (24%) patients with FXa-I-ICH deceased compared to 17 (45%) patients with VKA-ICH (crude OR 0.38
[95%CI 0.14–1.24], adjusted OR 0.41 [95%CI 0.12–1.24]). In this observational cohort study, the outcome of ICH managed with PCC was similar in patients with
FXa-I-ICH and in patients with VKA-ICH
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