L. Salmaso

Whole blood coagulation assessment using rotation thrombelastogram thromboelastometry in patients with acute deep vein thrombosis

Common tests for the assessment of blood coagulation in the acute phase of deep vein thrombosis are of limited value for the evaluation of the associated hypercoagulability. The new rotation thromboelastometry by rotation thrombelastogram has the potential to provide information on whole blood clot formation and prothrombotic state in patients with acute deep vein thrombosis. Rotation thrombelastogram parameters were evaluated in whole blood of 30 patients with a first episode of acute deep vein thrombosis and 40 healthy controls. The effect of factor VIII and fibrinogen levels on rotation thrombelastogram assays was also assessed in the study population and in a model of blood supplemented by increasing amounts of fibrinogen. All assays performed were consistent with a remarkable hypercoagulable profile in deep vein thrombosis patients as compared with controls. In particular, maximum clot firmness and the area under curve values, which are expected to better correlate with the hypercoagulable state in the acute phase of deep vein thrombosis, were significantly higher in patients than in controls. As expected, fibrinogen was shown to be one of the main determinants of the hypercoagulability in rotation thrombelastogram assays. In a small subset of acute deep vein thrombosis patients, inherited thrombophilia had no influence on rotation thrombelastogram parameters. The new rotation thrombelastogram thromboelastometry is a useful tool to detect acute deep vein thrombosis-related hypercoagulability. Prospective studies are needed to define the potential applications of rotation thrombelastogram in the management of deep vein thrombosis patients.

Thrombophilia as a predictor of persistent residual vein thrombosis

To compare the probability of leg vein recanalization between carriers and non-carriers of thrombophilia after an episode of deep vein thrombosis (DVT) of the lower extremities, we reviewed the clinical records of 472 patients with proximal DVT who were diagnosed with thrombophilia, and had long-term ultrasound scanning. One hundred and thirty-seven patients (29.0%) were carriers of thrombophilia. After adjusting for age, sex, DVT localization and modality of presentation, the hazard ratio of vein recanalization in thrombophilic compared with non-thrombophilic patients was 0.49 (95% CI, 0.38 to 0.63). These findings suggest that thrombophilia is an independent predictor of persistent residual vein thrombosis.

The role of antiphospholipid antibodies toward the protein C/protein S system in venous thromboembolic disease

The association between venous thromboembolism (VTE) and antibodies anti-Protein C (PC)/Protein S (PS) is still uncertain. We performed a case-control study to determine the risk of VTE related to the presence of these auto-antibodies considered independently of the presence of lupus anticoagulant (LAC) or anti-cardiolipin antibodies (ACA). One hundred thirty-five patients with idiopathic VTE and 164 healthy subjects were enrolled. Anti-PC and anti-PS antibodies (both IgG and IgM) were assessed using commercially available ELISA kits. Among cases there was a higher prevalence of elevated anti-PC IgM antibodies than in controls (OR 2.44, 95%CI 1.00-5.94). The presence of anti-PC IgG and anti-PS IgG and IgM antibodies was also higher in cases than in controls, but the difference was not statistically significant. Only five patients had both anti-PC or anti-PS antibodies and LAC or ACA. We performed a stepwise multivariate logistic regression analysis showing that anti-PC IgM>958 percentile was a significant predictor of VTE after adjustment for LAC or ACA (OR 2.52, 95%CI 1.01-6.24)). Larger prospective studies are needed to confirm this finding.

Italian experience of pediatric liver transplantation.

Abstract:  The SIGENP Group has created an Italian Liver Transplantation database. The study considers all patients under 18 yr of age on the waiting list or transplanted between 1984 and 2005. Demographic and clinical data were collected and a descriptive analysis was conducted. Kaplan–Meier survival curves were calculated and Cox’s proportional‐hazards regression analysis were performed to identify predictors of death after transplantation. Twenty‐two Italian centers took part and data were collected on 622 cases: only 53.8% of the transplants performed up until 1998 were carried out in Italy, while this was true of 97.7% of the operations performed between 1999 and 2005. Recipient survival curve analysis revealed one‐, two‐ and five‐yr survival rates of 88, 87 and 84%, respectively, and a significant improvement in survival after 1998 (p = 0.0322). Cox’s analysis identified the following risk factors for death after liver transplantation, i.e. transplantation before 1998, neoplasms or fulminant hepatic failure as indications, being in intensive care at the time of transplantation and retransplantation. The center where the transplant is performed also revealed an influence on patient survival. Thanks to a better patient follow‐up and more cooperation between specialists, the mean survival after liver transplantation is improving and Italian children can be transplanted in Italy.

Optimal allocation of urban nuclei to hospital birth centres in a geographical region

We consider a geographical region with a three-tiered neonatal care network, which includes birth centres for supplying basic assistance for delivery, neonatal care and neonatal intensive care, with a design such that all higher-level centres also provide the lower levels of assistance. The region’s population is distributed in urban nuclei, the needs of which — in terms of assistance related to birth and newborn — are established on the basis of statistical analyses. Every mother-to-be is admitted to a birth centre serving the level corresponding to the needs of her pregnancy. Newborn transfers from a lower- to a higher-level centre are feasible in the event of unforeseen health issues. In this chapter we allocate urban nuclei to birth centres for what concerns all-level admissions, also allocating lower-level centres to suitable upper-level centres for any transfers, with a view to minimising the inconvenience due to the distances involved without overloading any centres; we use the results obtained for suitably resizing the network to further improve its efficiency. The allocation model is a linear program solved using GAMS algebraic language and Cplex solver. An actual application was considered.