The Sepsis Coagulopathy Asahi Recombinant LE Thrombomodulin (SCARLET) trial has many defects, and thus cannot be the terminator of recombinant thrombomodulin (rTM). On the contrary, it provides sufficient evidence for further research. Based on analysis focusing on the failure of SCARLET and several previous anticoagulant studies, it is most important for new studies to grasp the following two points: (1) The enrolled cases should have sufficient disease severity and a clear standard for disseminated intravascular coagulation; (2) Heparin should not be used in combination with the investigated drugs. Multiple post-hoc analyses show that no combination of heparin will not increase the risk of thromboembolism. In fact, the combination of heparin can mask the true efficacy of the investigated drug. Due to the complexity of sepsis treatment and the limitations of clinical studies, the results of all treatment studies should be repeatedly verified, rather than be determined at one stroke. Some research conclusions contrary to disease physiology, pharmacology and clinical practice may be deceptive, and should be cautious rather than be simply accepted. On the other hand, the dissenting voices in the "consensus" scene are often well discussed by the authors and should be highly valued.
Humans ; Anticoagulants/therapeutic use* ; Thrombomodulin/therapeutic use* ; Blood Coagulation Disorders ; Disseminated Intravascular Coagulation/drug therapy* ; Sepsis/drug therapy* ; Heparin/therapeutic use* ; Recombinant Proteins

Atrial fibrillation (AF), the most common sustained arrhythmia, is associated with a range of symptoms, including palpitations, cognitive impairment, systemic embolism, and increased mortality. It places a significant burden on healthcare systems worldwide. Despite decades of research, the precise mechanisms underlying AF remain elusive. Current understanding suggests that factors like stretch-induced fibrosis, epicardial adipose tissue (EAT), chronic inflammation, autonomic nervous system (ANS) imbalances, and genetic mutations all play significant roles in its development. In recent years, the advent of wearable devices has revolutionized AF diagnosis, enabling timely detection and monitoring. However, balancing early diagnosis with efficient resource utilization presents new challenges for healthcare providers. AF management primarily focuses on stroke prevention and symptom alleviation. Patients at high risk of thromboembolism require anticoagulation therapy, and emerging pipeline drugs, particularly factor XI inhibitors, hold promise for achieving effective anticoagulation with reduced bleeding risks. The scope of indications for catheter ablation in AF has expanded significantly. Pulsed field ablation, as a novel energy source, shows potential for improving success rates while ensuring safety. This review integrates existing knowledge and ongoing research on AF pathophysiology and clinical management, with emphasis on diagnostic devices, next-generation anticoagulants, drugs targeting underlying mechanisms, and interventional therapies. It offers a comprehensive mosaic of AF, providing insights into its complexities.
Humans ; Atrial Fibrillation/drug therapy* ; Stroke ; Risk Factors ; Anticoagulants/therapeutic use* ; Blood Coagulation ; Catheter Ablation ; Treatment Outcome

Acute Kidney Injury/therapy* ; Anticoagulants/therapeutic use* ; Blood Coagulation ; Child ; Citrates ; Citric Acid/therapeutic use* ; Continuous Renal Replacement Therapy ; Humans ; Renal Replacement Therapy

Thalassemia is the most common human hereditary hemolytic anemia. Due to splenomegaly and hypersp-lenism, splenectomy can be used as a means of treatment for thalassemia. Various complications following splenectomy, however, especially thromboembolic complications are remarkable. This review summarizes the incidence, clinical manifestations and development time of thromboembolism. The pathogenesis of thromboembolism after splenectomy in thalassemia, such as abnormal platelet number and function, changes in red cell membrane, endothelial cell damage, dysfunction of other procoagulant and anticoagulant factors, and local factors associated with splenectomy are elaborated and the trategies to prevent and treat the thromboembolic events in thalassemia after splenectomy, including the attention to risk factors associated with splenectomy, a reassessment of splenectomy, regular blood transfusion to reduce the ratio of abnormal red blood cells, treatment with anticoagulant and antiplatelet drugs, application of hydroxyurea and stem cell transplantation are discussed.
Anticoagulants ; therapeutic use ; Blood Transfusion ; Humans ; Risk Factors ; Splenectomy ; Thalassemia ; pathology ; Thromboembolism ; pathology ; prevention & control ; therapy

Deep venous thrombosis (DVT) is one of the most common complications after total joint replacement, which is also one of the most concerned problems for clinicians. Domestic research data shows that the incidence of DVT in patients without thrombotic prophylaxis after joint replacement surgery are 20.6%-40.0%. The occurrence mechanism of DVT is explained by the Virchow theory, that is blood stasis, the blood vessel wall damage and blood coagulation state. The diagnostic rate of DVT is not satisfactory. The diagnosis of symptomatic DVT depends mainly on clinical symptoms and auxiliary examination. The diagnosis of asymptomatic DVT is mainly based on the auxiliary examination. The prevention and treatment of DVT after artificial joint replacement is currently mainly concentrated in the aspects of new oral anticoagulant agents, drug prevention method, and time limit.
Anticoagulants ; therapeutic use ; Arthroplasty, Replacement ; adverse effects ; Blood Coagulation ; Humans ; Incidence ; Venous Thrombosis ; diagnosis ; therapy

To evaluate the safety and efficiency of citrate anticoagulant-based continuous blood purification in patients at high risk of bleeding. 
 Methods: One hundred and fifty-two patients at high risk of bleeding were divided into local citrate group (group A, n=68) and heparin group (group B, n=84). Clotting function, change of pH, ionized sodium, bicarbonate ion, ionized calcium, activated clotting time (ACT) and complications were monitored before and during treatment. 
 Results: Compared to the group A, the incidence of clotting in filter and chamber, the degree of bleeding or fresh bleeding were significantly reduced in the group B (P<0.05). ACT of post-filter at 4, 8 and 12 h during the treatment in the group A was significantly extended compared with that without treatment (P<0.05), while there was no significant change in group B (P>0.05). The pH value, the levels of ionized sodium, bicarbonate ion and ionized calcium during the treatment were maintained in normal range in both group A and group B.
 Conclusion: Local citrate-based continuous blood purification can achieve effective anticoagulation and decrease the incidence of bleeding. It is an ideal choice for patients at high risk of bleeding.
Anticoagulants ; pharmacology ; Bicarbonates ; blood ; Blood Coagulation ; drug effects ; Blood Coagulation Tests ; Calcium ; blood ; Citrates ; Citric Acid ; therapeutic use ; Female ; Hemodiafiltration ; adverse effects ; methods ; Hemofiltration ; Hemorrhage ; etiology ; prevention & control ; Heparin ; therapeutic use ; Humans ; Intensive Care Units ; Male ; Reference Values ; Renal Dialysis ; Sodium ; blood ; Treatment Outcome

No abstract available.
Aged ; Antibodies, Antiphospholipid/blood ; Anticoagulants/therapeutic use ; Antiphospholipid Syndrome/blood/*complications/diagnosis/drug therapy ; Biomarkers/blood ; Female ; Fluorodeoxyglucose F18 ; Glucocorticoids/therapeutic use ; Humans ; Multimodal Imaging/methods ; Positron-Emission Tomography ; Radiopharmaceuticals ; Takayasu Arteritis/*complications/diagnosis/drug therapy ; Tomography, X-Ray Computed ; Treatment Outcome

Adolescent ; Adult ; Anticoagulants ; therapeutic use ; Blood Coagulation Disorders ; diagnosis ; drug therapy ; Female ; Humans ; Male ; Middle Aged ; Vascular Malformations ; diagnosis ; drug therapy ; Veins ; pathology ; Young Adult

OBJECTIVETo investigate the influence of divalent cation chelator EDTA and heparin sodium on the detection of ITP platelet-specific autoantibodies by the modified monoclonal antibody immobilization of platelet antigen assay (MAIPA) and to explore the relationship between types of platelet specific autoantibodies and glucocorticoid efficacy.

METHODSThe samples were obtained from EDTA- and heparin- anticoagulant ITP patients, respectively, so as to detect the platelet-specific autoantibodies (GPIIb/IIIa and GPIbα) in 140 ITP samples by modified MAIPA, then the differences between these two methods were compared.

RESULTSOut of 140 cases in EDTA group, 55 cases were positive for GPIIb/IIIa, while 76 cases in heparin group were positive for GPIIb/IIIa, 42 cases in both group were repeatable; among them 13 cases were positive in EDTA group and negative in heparin group, while 34 cases were positive in heparin group and negative in EDTA group, there was significant difference between them (x (2) = 9.38, P < 0.05), 62 cases in 140 cases of EDTA group were positive for GPIba, while 51 cases in heparin group were positive for GPIba, 42 cases in both group were repeatabe; among them 20 cases were positive in EDTA group and negative in heparin group, while 9 cases were positive in heparin group and negative in EDTA group, there was no significant difference between them (x (2) = 3.44, P > 0.05). A total of 320 cases received a standard glucocorticoid treatment, out of them 143 cases were positive for GPIbα with effective rate 39.9%, 177 cases were negative for GPIbα with effective rate 79.7%, there was statisticalty significant difference between them (x (2) = 53.115, P < 0.05).

CONCLUSIONEDTA anticoagulant (a divalent cation chelator) has a significant influence on detection of ITP platelet-specific autoantibodies (GPIIb/IIIa) by a modified MAIPA method and the GPIbα antibody positive may be one of the important factors that results in un-sensitivity of ITP patients to glucocorticoid treatment.

Antibodies, Monoclonal ; Anticoagulants ; therapeutic use ; Antigens, Human Platelet ; Autoantibodies ; blood ; Blood Platelets ; immunology ; Fibrinolytic Agents ; Glucocorticoids ; therapeutic use ; Heparin ; Humans ; Platelet Glycoprotein GPIIb-IIIa Complex ; Purpura, Thrombocytopenic, Idiopathic ; blood ; immunology

We herein report the use of endoscopic n-butyl-2-cyanoacrylate injections to obliterate a gastric varix, which led to cyanoacrylate embolisation in the splenic and portal veins in a single patient. Cyanoacrylate embolisation is a known but uncommonly reported complication of endoscopic sclerotherapy. This case report illustrates the successful management of this complication (i.e. cyanoacrylate embolisation in the splenic and portal veins) with anticoagulation and analyses the presentation and management of other cases of cyanoacrylate embolisation reported in the literature.
Aged ; Anticoagulants ; chemistry ; therapeutic use ; Blood Pressure ; Cyanoacrylates ; chemistry ; Embolism ; chemically induced ; diagnostic imaging ; therapy ; Esophageal and Gastric Varices ; drug therapy ; Humans ; Injections ; Male ; Portal Vein ; pathology ; Sclerotherapy ; Splenic Vein ; pathology ; Tomography, X-Ray Computed ; Ultrasonography, Doppler