Title: Thrombosis and Haemostasis

Title: Thrombosis and Haemostasis

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? Akl, E.A., Terrenato, I., Barba, M., Sperati, F., Muti, P. and Schunemann, H.J. (2008), Extended perioperative thromboprophylaxis in patients with cancer. Thrombosis and Haemostasis, 100 (6), 1176-1180.

Abstract: We systematically reviewed the literature to compare the relative efficacy and safety of extended versus limited duration heparin for perioperative thromboprophylaxis in patients with cancer. We followed the Cochrane Collaboration systematic review methodology and searched MEDLINE, EMBASE, ISI the Web of Science, and CENTRAL. The outcomes of interest included mortality, symptomatic deep venous thrombosis (DVT), pulmonary embolism, and bleeding. We evaluated the quality of evidence by outcome using the GRADE approach. of 3,986 identified citations, we included three randomized clinical trials using low-molecular-weight heparin (LMWH). The quality of evidence for mortality, DVT, and major bleeding was low. There was no significant difference between extended (4 weeks) and limited duration thromboprophylaxis in terms of death at three months (relative risk [RR]=0.49; 95% confidence interval [CI] 0.12-1.94), or major bleeding at four weeks (RR=2.94; 95% CI 0.12-71.85). An extended regimen was associated with a significantly lower risk of asymptomatic DVT (RR=0.21; 95% Cl 0.05-0.94). No data was available for symptomatic DVT In conclusion, there is limited and low-quality evidence that extended duration LMWH for perioperative thromboprophylaxis reduces DVT in patients with cancer undergoing major abdominal or pelvic surgery. More and better quality evidence is needed to justify extended regimens.

Keywords: Cancer, Citations, Clinical Trials, Cochrane, Collaboration, Complications, Efficacy, Embase, Grade, Heparin, Heparins, Interest, ISI, Literature, Low-Molecular-Weight, Major Abdominal-Surgery, Malignancy, MEDLINE, Metaanalysis, Methodology, Mortality, Outcome, Outcomes, Patients, Prevention, Prolonged Thromboprophylaxis, Prophylaxis, Prophylaxis, Pulmonary Embolism, Randomized Clinical Trials, Recommendations, Relative Risk, Review, Risk, Safety, Science, Surgery, Systematic, Systematic Review, Thrombosis, Thrombosis, Venous Thromboembolism, Venous Thrombosis, Web of Science

? Sofi, F., Cesari, F., Abbate, R., Gensini, G.F., Broze, G. and Fedi, S. (2010), A meta-analysis of potential risks of low levels of protein Z for diseases related to vascular thrombosis. Thrombosis and Haemostasis, 103 (4), 749-756.

Abstract: the relationship between protein Z levels and thrombosis is controversial. We performed a systematic review and meta-analysis of the available studies to assess the association between protein Z and vascular thrombotic diseases. We conducted an electronic literature search through MEDLINE, EMBASE, Google Scholar, Web of Science, the Cochrane Library, bibliographies of retrieved articles and abstracts of congresses up to October, 2009. Studies were included if they analysed protein Z levels in patients with vascular thrombotic diseases. After the review process, 28 case-control studies (33 patient cohorts), including 4,218 patients with thrombotic diseases and 4,778 controls, were selected for analysis. The overall analysis using a random-effects model showed that low protein Z levels were associated with an increased risk of thrombosis (odds ratio [OR] 2.90, 95% confidence interval [CI] 2.05-4.12; p<0.00001). On subgroup analysis, a significant association was found between low protein Z levels and arterial vascular diseases (OR 2.67, 95%CI 1.60-4.48; p=0.0002), pregnancy complications (OR 4.17, 95%CI 2.31-7.52; p<0.00001), and venous thromboembolic diseases (OR 2.18, 95%CI 1.19-4.00; p=0.01). The results of this meta-analysis are consistent with a role for protein Z deficiency in thrombotic diseases, including arterial thrombosis, pregnancy complications and venous thromboembolism.

Keywords: Analysis, Atherosclerosis, Case-Control, Case-Control Studies, Coagulation, Cochrane, G79a Polymorphism, Google Scholar, Inhibitor, Ischemic-Stroke, Literature, Meta Analysis, Meta-Analysis, Model, Patients, Pregnancy, Pregnancy Complications, Protein Z, Prothrombotic Phenotype, Ratio, Review, Risk, Science, Systematic, Systematic Review, Thromboembolism, Thrombosis, Venous Thrombosis, Web of Science, Z Deficiency, Z Gene, Z Plasma-Levels

? Rabinovich, A., Cohen, J.M. and Kahn, S.R. (2014), The predictive value of markers of fibrinolysis and endothelial dysfunction in the post thrombotic syndrome: A systematic review. Thrombosis and Haemostasis, 111 (6), 1031-1040.

Full Text: 2014\Thr Hae111, 1031.pdf

Abstract: The post thrombotic syndrome (PTS) develops in 20-40% of deep venous thrombosis (DVT) patients. Risk factors for PTS have not been well elucidated. Identification of risk factors would facilitate individualised risk assessment for PTS. We conducted a systematic review to determine whether biomarkers of fibrinolysis or endothelial dysfunction can predict the risk for PIS among DVT patients. Studies were identified by searching the electronic databases PubMed, EMBASE, Scopus and Web of science. We included studies published between 1990 and 2013, measured biomarker levels in adult DVT patients, and reported rates of PTS development. Fourteen studies were included: 11 investigated the association between D-dimer and PTS; three examined fibrinogen; two measured von Willebrand factor; one measured plasminogen activator inhibitor-1; one assessed ADAMTS-13 (A Disintegrin and Metalloprotease with Thrombospondin type 1 repeats) and one measured factor XIII activity. Studies varied with regards to inclusion criteria, definition of PTS, time point and method of biomarker measurement. We were unable to meta-analyse results due to marked clinical heterogeneity. Descriptively, a significant association with PIS was found for D-dimer in four studies and factor XIII in one study. Further prospective research is needed to elucidate whether these markers might be useful to predict PTS development.

Keywords: Activator, Activity, Adult, Assessment, Association, Biomarker, Biomarkers, Clinical, Clinical-Course, Criteria, D-Dimer, D-Dimer, Databases, Deep Vein Thrombosis, Deep Venous Thrombosis, Development, Disease, Embase, Endothelial Dysfunction, Fibrinogen, Fibrinolysis, Follow-Up, Heterogeneity, Measurement, Patients, Population, Post Thrombotic Syndrome, Postthrombotic-Syndrome, Predictive, Predictive Value, Prospective, Pubmed, Rates, Research, Review, Risk, Risk Assessment, Risk Factors, Risk-Factors, Science, Scopus, Syndrome, Systematic, Systematic Review, Thromboembolism, Thrombosis, Value, Vein Thrombosis, Venous Thrombosis, Web Of Science