Background: Cirrhotic patients have higher rates of hypercoagulable disorders. We hypothesized that orthotopic liver transplant (OLT) recipients with pre-operative portal vein thrombosis (PVT) have more post-operative...Background: Cirrhotic patients have higher rates of hypercoagulable disorders. We hypothesized that orthotopic liver transplant (OLT) recipients with pre-operative portal vein thrombosis (PVT) have more post-operative thrombotic events than those without PVT. Aims: To compare rates of post-op thrombotic events and outcomes between those with and without pre-op PVT. Methods: All OLT recipients between 1/02-4/09 were retrospectively reviewed. Outcome measures included survival, deep venous thrombosis, pulmonary embolism, hepatic artery thrombosis, and recurrent PVT. Minimum follow up was 6 months. Results: In 363 OLTs performed, mean recipient age was 53.1 yrs (±9.2);268 patients were male. Mean MELD at transplant was 22.1 (±6.2). The prevalence of pre-op PVT was 11.2% (41/350). There was no difference in the % of post-op thrombotic events between those with and without PVT (p = 0.77). MELD, recipient and donor age, and gender were similar in both groups. Mean survival in those with pre-op PVT was 85.2 months vs. 78.7 in those without PVT (p = 0.19). Conclusions: The rate of post-op thrombotic events was equivalent in OLT recipients with and without pre-op PVT. The presence of PVT did not adversely impact patient survival and should not be a contraindication to OLT.展开更多
BACKGROUND The hereditary antithrombin(AT)deficiency caused by SERPINC1 gene mutation is an autosomal dominant thrombotic disorder.An increasing number of studies have shown that mutations in the SERPINC1 rs2227589 po...BACKGROUND The hereditary antithrombin(AT)deficiency caused by SERPINC1 gene mutation is an autosomal dominant thrombotic disorder.An increasing number of studies have shown that mutations in the SERPINC1 rs2227589 polymorphic site are correlated with a risk of venous thromboembolism(VTE)at common sites,such as lower extremity deep venous thrombosis and pulmonary thromboembolism.Currently,there are no reports of cerebral venous sinus thrombosis(CVST),a VTE site with a low incidence rate and rs2227589 polymorphism.CASE SUMMARY Here,we report a Chinese CVST case with a mutation of the SERPINC1 rs2227589 polymorphic site,which did not cause significant AT deficiency.In a 50-year-old male patient presenting with multiple cerebral venous sinus thromboses no predisposing factors were detected,although a relative had a history of lower extremity deep venous thrombosis.We performed sequencing of the SERPINC1 gene for the patient and his daughter,which revealed the same heterozygous mutation at the rs2227589 polymorphic site:c.41+141G>A.CONCLUSION The results showed that more studies should be conducted to assess the correlation between rs2227589 polymorphism and CVST.展开更多
Dear Editor,I am Dr. Jungyul Park from the Division of Oculoplasty, Department of Ophthalmology, Pusan National University Hospital, Busan, Korea. I am writing to present a case of direct approach to thrombosed superi...Dear Editor,I am Dr. Jungyul Park from the Division of Oculoplasty, Department of Ophthalmology, Pusan National University Hospital, Busan, Korea. I am writing to present a case of direct approach to thrombosed superior ophthalmic vein of recalcitrant indirect carotid cavernous fistula which was failed to treat with multiple conventional embolization treatment. To our knowledge this is very challenging procedure to the ophthalmologist, and not well described in literatures, especially in thrombocythemia patient with thrombosed superior ophthalmic vein.展开更多
BACKGROUND The validation of various risk scores in elderly patients with comorbid atrial fibrillation(AF)and acute coron-ary syndrome(ACS)has not been reported.The present study compared the predictive performance of...BACKGROUND The validation of various risk scores in elderly patients with comorbid atrial fibrillation(AF)and acute coron-ary syndrome(ACS)has not been reported.The present study compared the predictive performance of existing risk scores in patients.these METHODS A total of 1252 elderly patients with AF and ACS comorbidities(≥65 years old)were consecutively enrolled from January 2015 to December 2019.All patients were followed up for one year.The predictive performance of risk scores in predict-bleeding and thromboembolic events was calculated and compared.ing RESULTS During the 1-year follow-up,183(14.6%)patients had thromboembolic events,198(15.8%)patients had BARC class≥2 bleeding events,and 61(4.9%)patients had BARC class≥3 bleeding events.For the BARC class≥3 bleeding events,discrimina-tion of the existing risk scores was low to moderate,PRECISE-DAPT(C-statistic:0.638,95%CI:0.611-0.665),ATRIA(C-statistic:0.615,95%CI:0.587-0.642),PARIS-MB(C-statistic:0.612,95%CI:0.584-0.639),HAS-BLED(C-statistic:0.597,95%CI:0.569-0.624)and CRUSADE(C-statistic:0.595,95%CI:0.567-0.622).However,the calibration was good.PRECISE-DAPT showed a higher in-tegrated discrimination improvement(IDI)than PARIS-MB,HAS-BLED,ATRIA,and CRUSADE(P<0.05)and the best decision curve analysis(DCA).For thromboembolic events,the discrimination of GRACE(C-statistic:0.636,95%CI:0.608-0.662)was higher than CHA2DS2-VASc(C-statistic:0.612,95%CI:0.584-0.639),OPT-CAD(C-statistic:0.602,95%CI:0.574-0.629)and PARIS-CTE(C-statistic:0.595,95%CI:0.567-0.622).The calibration was good.Compared to OPT-CAD and PARIS-CTE,the IDI of the GRACE score slightly improved(P<0.05).However,NRI analysis showed no significant difference.DCA showed that the clinical practic-of thromboembolic risk scores was similar.ability CONCLUSIONS The discrimination and calibration of existing risk scores in predicting 1-year thromboembolic and bleeding events were unsatisfactory in elderly patients with comorbid AF and ACS.PRECISE-DAPT showed higher IDI and DCA than other risk scores in predicting BARC class≥3 bleeding events.The GRACE score showed a slight advantage in predicting throm-botic events.展开更多
文摘Background: Cirrhotic patients have higher rates of hypercoagulable disorders. We hypothesized that orthotopic liver transplant (OLT) recipients with pre-operative portal vein thrombosis (PVT) have more post-operative thrombotic events than those without PVT. Aims: To compare rates of post-op thrombotic events and outcomes between those with and without pre-op PVT. Methods: All OLT recipients between 1/02-4/09 were retrospectively reviewed. Outcome measures included survival, deep venous thrombosis, pulmonary embolism, hepatic artery thrombosis, and recurrent PVT. Minimum follow up was 6 months. Results: In 363 OLTs performed, mean recipient age was 53.1 yrs (±9.2);268 patients were male. Mean MELD at transplant was 22.1 (±6.2). The prevalence of pre-op PVT was 11.2% (41/350). There was no difference in the % of post-op thrombotic events between those with and without PVT (p = 0.77). MELD, recipient and donor age, and gender were similar in both groups. Mean survival in those with pre-op PVT was 85.2 months vs. 78.7 in those without PVT (p = 0.19). Conclusions: The rate of post-op thrombotic events was equivalent in OLT recipients with and without pre-op PVT. The presence of PVT did not adversely impact patient survival and should not be a contraindication to OLT.
基金Supported by the Affiliated Hospital of Guangdong Medical University,No.LCYJ2018C009.
文摘BACKGROUND The hereditary antithrombin(AT)deficiency caused by SERPINC1 gene mutation is an autosomal dominant thrombotic disorder.An increasing number of studies have shown that mutations in the SERPINC1 rs2227589 polymorphic site are correlated with a risk of venous thromboembolism(VTE)at common sites,such as lower extremity deep venous thrombosis and pulmonary thromboembolism.Currently,there are no reports of cerebral venous sinus thrombosis(CVST),a VTE site with a low incidence rate and rs2227589 polymorphism.CASE SUMMARY Here,we report a Chinese CVST case with a mutation of the SERPINC1 rs2227589 polymorphic site,which did not cause significant AT deficiency.In a 50-year-old male patient presenting with multiple cerebral venous sinus thromboses no predisposing factors were detected,although a relative had a history of lower extremity deep venous thrombosis.We performed sequencing of the SERPINC1 gene for the patient and his daughter,which revealed the same heterozygous mutation at the rs2227589 polymorphic site:c.41+141G>A.CONCLUSION The results showed that more studies should be conducted to assess the correlation between rs2227589 polymorphism and CVST.
文摘Dear Editor,I am Dr. Jungyul Park from the Division of Oculoplasty, Department of Ophthalmology, Pusan National University Hospital, Busan, Korea. I am writing to present a case of direct approach to thrombosed superior ophthalmic vein of recalcitrant indirect carotid cavernous fistula which was failed to treat with multiple conventional embolization treatment. To our knowledge this is very challenging procedure to the ophthalmologist, and not well described in literatures, especially in thrombocythemia patient with thrombosed superior ophthalmic vein.
基金supported by the National Clinical Research Center for Geriatric Diseases(No.NCRCGPLAGH-20190003)the Chinese Cardiovascular Health Alliance-Advanced Fund(No.2019-CCAACCESS-054).
文摘BACKGROUND The validation of various risk scores in elderly patients with comorbid atrial fibrillation(AF)and acute coron-ary syndrome(ACS)has not been reported.The present study compared the predictive performance of existing risk scores in patients.these METHODS A total of 1252 elderly patients with AF and ACS comorbidities(≥65 years old)were consecutively enrolled from January 2015 to December 2019.All patients were followed up for one year.The predictive performance of risk scores in predict-bleeding and thromboembolic events was calculated and compared.ing RESULTS During the 1-year follow-up,183(14.6%)patients had thromboembolic events,198(15.8%)patients had BARC class≥2 bleeding events,and 61(4.9%)patients had BARC class≥3 bleeding events.For the BARC class≥3 bleeding events,discrimina-tion of the existing risk scores was low to moderate,PRECISE-DAPT(C-statistic:0.638,95%CI:0.611-0.665),ATRIA(C-statistic:0.615,95%CI:0.587-0.642),PARIS-MB(C-statistic:0.612,95%CI:0.584-0.639),HAS-BLED(C-statistic:0.597,95%CI:0.569-0.624)and CRUSADE(C-statistic:0.595,95%CI:0.567-0.622).However,the calibration was good.PRECISE-DAPT showed a higher in-tegrated discrimination improvement(IDI)than PARIS-MB,HAS-BLED,ATRIA,and CRUSADE(P<0.05)and the best decision curve analysis(DCA).For thromboembolic events,the discrimination of GRACE(C-statistic:0.636,95%CI:0.608-0.662)was higher than CHA2DS2-VASc(C-statistic:0.612,95%CI:0.584-0.639),OPT-CAD(C-statistic:0.602,95%CI:0.574-0.629)and PARIS-CTE(C-statistic:0.595,95%CI:0.567-0.622).The calibration was good.Compared to OPT-CAD and PARIS-CTE,the IDI of the GRACE score slightly improved(P<0.05).However,NRI analysis showed no significant difference.DCA showed that the clinical practic-of thromboembolic risk scores was similar.ability CONCLUSIONS The discrimination and calibration of existing risk scores in predicting 1-year thromboembolic and bleeding events were unsatisfactory in elderly patients with comorbid AF and ACS.PRECISE-DAPT showed higher IDI and DCA than other risk scores in predicting BARC class≥3 bleeding events.The GRACE score showed a slight advantage in predicting throm-botic events.
