Search Results (2,059)

Background: ABO blood type was reported to have a profound influence on hemostasis. This study aimed to determine the association between ABO blood type and the hemoglobin drop after total hip arthroplasty (THA). Methods: We retrospectively reviewed the changes in hemoglobin after elective primary THA. Demographic characteristics were analyzed for 794 eligible THAs. Changes in hemoglobin at postoperative days 1, 7, and 14 relative to the preoperative level were analyzed for 777 THAs that did not require allogenic blood transfusion (ABT). The effects of blood type were examined using a multivariate regression model and a propensity score matching model. Results: The hemoglobin drop was largest at 7 days, and the values differed significantly between type O cases and non-type O cases (2.68 ± 1.08 g/dL vs. 2.41 ± 1.02 g/dL; p = 0.0013). In the multivariate model, blood type O was identified as an independent factor for larger hemoglobin drop at 7 days (p = 0.015). Lower body mass index, non-hybrid THA, higher preoperative hemoglobin level, direct lateral approach, and prophylactic use of factor Xa inhibitor were also identified as independent risk factors for larger hemoglobin drop. After successful matching of 232 THAs in type O patients with 232 THAs in non-type O patients, hemoglobin drop at 7 days was significantly larger in type O patients (−2.44 ± 1.05 g/dL vs. −2.70 ± 1.05 g/dL, p = 0.0092). Conclusions: Blood type O was independently associated with a slightly greater postoperative hemoglobin decline after primary THA; however, the absolute between-group difference was small and was not accompanied by a higher allogenic transfusion rate. Therefore, ABO blood type may represent a minor risk marker and should be interpreted in the context of clinically more relevant bleeding- and hemodilution-related factors (e.g., perioperative anticoagulant/antiplatelet therapy and underlying coagulopathies). Full article

Background: Post-ERCP pancreatitis (PEP) remains the most common and clinically relevant adverse event following endoscopic retrograde cholangiopancreatography (ERCP). The impact of periampullary duodenal diverticulum and advanced cannulation techniques—particularly needle–knife precut sphincterotomy and transpancreatic septotomy (TPS)—on PEP risk remains debated. This study aimed to evaluate the association of these factors with PEP development in a large tertiary-center cohort. Methods: This retrospective study included 1226 patients who underwent ERCP between January 2018 and October 2022. Demographic, clinical, and procedural variables were recorded. Outcomes included PEP, hyperamylasemia, bleeding, and perforation. Univariable analyses were followed by multivariable logistic regression to identify independent predictors of PEP. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated. Results: PEP occurred in 17.3% of the cohort. Needle–knife precut sphincterotomy and transpancreatic septotomy were frequently used advanced cannulation techniques and were both associated with an increased prevalence of PEP, with PEP occurring in 30.3% of patients undergoing needle–knife precut sphincterotomy and 56.9% of those undergoing transpancreatic septotomy. In the multivariable model, needle–knife precut independently increased PEP risk by 2.45-fold (aOR 2.45; 95% CI 1.78–3.36; p < 0.001), whereas TPS demonstrated the strongest association, increasing the risk nearly fivefold (aOR 4.92; 95% CI 2.98–8.11; p < 0.001). Female sex showed a nonsignificant trend toward increased PEP risk (aOR 1.28; 95% CI 0.96–1.69; p = 0.08). Periampullary duodenal diverticulum, pancreatic duct stenting, comorbidities, and age were not independently associated with PEP development (p > 0.05 for all). Conclusions: Needle–knife precut sphincterotomy and transpancreatic septotomy were independent predictors of PEP, with the highest risk observed for transpancreatic septotomy, whereas periampullary diverticulum and pancreatic duct stenting were not associated with increased risk. Full article

Background: Coronary artery bypass grafting (CABG) is a well-established revascularization strategy for patients with multivessel coronary artery disease. The effectiveness of CABG is significantly influenced by antiplatelet therapy aimed at maintaining graft patency and reducing thrombotic complications. However, substantial inter-individual variability exists in platelet function responses to standard therapies such as aspirin and clopidogrel, leading to antiplatelet resistance. This variability has been linked to increased risks of myocardial infarction, stroke, and early graft failure. Platelet function testing (PFT) offers a potential strategy to identify resistance and guide more personalized antiplatelet therapy. This study aims to evaluate the association between perioperative platelet function test results and clinical outcomes following CABG. By assessing platelet responsiveness at multiple timepoints and correlating findings with postoperative events, the study seeks to determine whether PFT can stratify risk and improve patient management. Methods: This is a prospective, single-centre, observational cohort study conducted at a tertiary NHS cardiac surgery centre. Patients having elective or urgent isolated CABG will be enrolled and undergo perioperative PFT using the TEG6s system. Clinical outcomes will be monitored for 12 months postoperatively, with primary endpoints assessing the correlation between platelet function results and major adverse cardiovascular and cerebrovascular events (MACCE). Secondary endpoints will include the prevalence of antiplatelet resistance, demographic predictors, and the feasibility of integrating PFT into clinical workflows. Results: This study will report the prevalence of aspirin and clopidogrel resistance in CABG patients based on TEG6s PFT, as well as the correlation between platelet function results and MACCE, postoperative bleeding, and the need for surgical re-exploration. Additionally, it will examine the associations between demographic and clinical factors—such as diabetes status, renal function, BMI, and surgical technique—and variability in platelet responsiveness. The feasibility of incorporating PFT into perioperative workflows will also be evaluated, assessing whether results could support personalized antiplatelet management in future clinical trials. Conclusions: Findings from this study will provide real-world evidence regarding platelet function variability in CABG patients and suggest that PFT may identify those at increased risk of thrombotic complications. This exploratory analysis supports the need for larger interventional trials aimed at optimizing individualized postoperative antiplatelet therapy to improve surgical outcomes. Full article

Sepsis remains a leading cause of global mortality, and early management in the emergency department (ED) is a key determinant of clinical outcomes. Among the earliest physiological derangements in sepsis are abnormalities in coagulation, which represent not merely laboratory disturbances but fundamental reflections of dysregulated host response, endothelial injury, and evolving microvascular thrombosis. Sepsis-induced coagulopathy (SIC) and disseminated intravascular coagulation (DIC) form a dynamic continuum that frequently begins before shock is clinically apparent. Despite their prognostic value and pathophysiologic significance, these abnormalities are often underrecognized in the ED, where coagulation tests are still commonly interpreted through the narrow lens of bleeding risk rather than as markers of systemic thromboinflammation. This narrative review synthesizes current understanding of the mechanisms linking sepsis, endothelial dysfunction, and coagulation abnormalities; outlines the distinction between SIC and overt DIC; and highlights why early identification of coagulopathy in the ED is essential. We discuss practical bedside approaches, including recommended laboratory testing, pattern recognition, and application of validated scores such as the SIC and ISTH DIC criteria. System-level strategies, such as embedding coagulation testing into sepsis bundles, automating score calculation, and enhancing communication between the ED and ICU teams, are explored as avenues to improve early detection. Evidence suggests that ED recognition of SIC/DIC may refine risk stratification, guide triage decisions, and identify patients who may benefit from targeted anticoagulant strategies once stabilized. Ultimately, recognizing coagulation disorders in the ED reframes sepsis not solely as a hemodynamic crisis but as a complex, thromboinflammatory syndrome in which early intervention may alter trajectory and improve outcomes. Full article

Introduction: While extensive research has been conducted on specific factors affecting transplant outcomes in simultaneous pancreas-kidney recipients, less is known about outcomes following single pancreas transplantation (PTx). This study focuses on identifying factors related to early graft loss after PTx. Patients and Methods: A retrospective analysis was performed on a Eurotransplant (ET) registry database encompassing all consecutive solitary pancreas transplantations from 2000 to 2018. To address any missing values, multiple imputation techniques were employed. Uni and multivariable statistical analyses were performed. Results: The primary causes of early graft loss (<90 days) were thrombosis, bleeding, rejection, and infection. Using multivariable analysis, donor male gender (Hazard Ratio (HR) 0.62) was significantly associated with early graft survival. Of all recipient variables, recipient age (HR 0.96) and recipient cardiovascular history (HR 2.10) were associated with graft loss. A subgroup analysis PTx of female donors into female recipients showed an increased risk for early graft loss compared to male-to-male transplants (HR 2.14). The graft survival rates were 62.9% and 79.0%, respectively (p = 0.017). Discussion: This Eurotransplant registry analysis identifies various donor- and recipient-related risk factors after PTx, partly mirroring the SPK population but also identifying new factors. These findings identify PTx patients as a separate entity in pancreas transplantation and emphasize the need for tailor-made matching of donors and recipients. Full article

Background: Submacular hemorrhage (SMH) is a vision-threatening condition most associated with neovascular age-related macular degeneration (nAMD), although it may also arise from polypoidal choroidal vasculopathy, pathological myopia, retinal vascular diseases, trauma, and systemic factors. Rapid management is essential because subretinal blood induces photoreceptor toxicity, clot organization, and fibroglial scarring, leading to irreversible visual loss. The choice and urgency of treatment depend on hemorrhage size, duration, and underlying pathology, and the patient’s surgical risk category, which can influence the invasiveness of the selected procedure. This review aims to provide an updated synthesis of recent advances in the surgical and pharmacological management of SMH, focusing on evidence from the past five years and comparing outcomes across major interventional approaches. Methods: A narrative review of 27 recent clinical and multicentre studies was conducted. The included literature evaluated pneumatic displacement (PD), pars plana vitrectomy (PPV), subretinal or intravitreal recombinant tissue plasminogen activator (rtPA), anti-VEGF therapy, and hybrid techniques. Studies were analyzed about indications, surgical methods, timing of intervention, anatomical and functional outcomes, and complication and patient risk stratification. Results: Outcomes varied depending on the size and duration of hemorrhage, as well as the activity of underlying macular neovascularization. PD with intravitreal rtPA was reported as effective for small and recent SMH. PPV combined with subretinal rtPA, filtered air, and anti-VEGF therapy demonstrated favorable displacement and visual outcomes in medium to large hemorrhages or those associated with active nAMD. Hybrid techniques further improved clot mobilization in selected cases. Across studies, delayed intervention beyond 14 days correlated with reduced visual recovery due to blood organization and photoreceptor loss. Potential risks, including recurrent bleeding and rtPA-associated toxicity, were reported but varied across studies. Conclusions: Management should be individualized, considering hemorrhage characteristics and surgical risk. Laser therapy, including PDT, may serve as an adjunct in the perioperative or postoperative period, particularly in PCV patients. Early, tailored intervention typically yields the best functional outcomes. Full article

Background/Objectives: Multiple myeloma (MM) patients receiving immunomodulatory drugs (IMiDs) are at increased risk of venous thromboembolism (VTE). Standard prophylaxis typically involves aspirin or low-molecular-weight heparin (LMWH), guided by risk assessment tools such as SAVED and IMPEDE-VTE. However, these models have practical limitations, and real-world evidence supporting novel oral anticoagulants (NOACs) as primary prophylaxis remains limited. Methods: In this retrospective, single-center study, we analyzed 101 MM patients treated with IMiD-based therapy between January 2020 and December 2024. All patients received NOAC prophylaxis (apixaban 2.5 mg twice daily or rivaroxaban 10–20 mg once daily), irrespective of baseline thrombotic risk. Clinical characteristics, comorbidities, and treatment details were collected. The primary outcome was objectively confirmed VTE, while secondary outcomes included bleeding events and treatment feasibility, assessed by treatment continuation without clinically significant bleeding. Results: Median age was 63 years (range 35–89); 36.6% were female. Lenalidomide and pomalidomide were used in 86.1% and 13.9%, respectively. Twenty-eight patients (27.7%) had relapsed/refractory disease, while 72.3% were newly diagnosed. Over a median NOAC exposure of 6 months, two patients (2.0%) developed VTE (both deep vein thrombosis). One major bleeding event (1.0%) occurred. Conclusions: Universal NOAC prophylaxis in MM patients receiving IMiD-based therapy was associated with a low incidence of thromboembolic events and an acceptable safety profile. These real-world findings suggest that NOACs may represent a practical and effective alternative to aspirin or LMWH, potentially overcoming the limitations of score-based prophylaxis strategies. Full article

Background/Objectives: The most prevalent benign tumors in women are uterine fibroids. Most patients—more than half—do not exhibit any symptoms, but the most common clinical signs include irregular uterine bleeding, pelvic pain, gastrointestinal problems, increased frequency of urination, and, in some cases, infertility. Venous thromboembolism is a very rare consequence, especially when significant uterine fibroids are present. This syndrome usually develops because of pelvic vascular systems being compressed, which causes venous stasis. Pharmacological treatment, minimally invasive procedures, and surgical techniques are examples of therapy alternatives. The purpose of this study is to present, compare, and potentially elucidate the underlying mechanisms of VTE development in fibroids. Methods: we have synthesized findings from 24 documented instances of venous thromboembolism (VTE) linked to uterine fibroids. Results: the principal mechanism underlying thromboembolic events was identified as the mechanical compression of pelvic venous structures due to mass effect. Additionally, we recognized other pertinent risk factors, including oral contraceptive use, May-Thurner syndrome, myomatous erythrocytosis, and intravenous leiomyomatosis. None of the reviewed case reports provided evidence of confirmed inherited thrombophilia in the patients under investigation. The femoral and popliteal veins, primarily in the left leg, were most frequently impacted by thrombosis and the ensuing blockage. Imaging techniques confirmed that individuals suffered pulmonary embolisms in half of the cases. When the right treatment was given as soon as possible, most of VTEs had favorable outcome. In almost half of the cases examined, the patient had a hysterectomy. Since all symptoms were alleviated and the chance of additional thromboembolic consequences was reduced, this treatment strategy turned out to be the most successful. Conclusions: Clinicians should maintain a low threshold for venous imaging in women with large pelvic masses and unilateral limb symptoms. Despite being uncommon, VTE associated with UFs can cause serious morbidity. Mechanical venous compression is the main mechanism, which is often exacerbated by additional prothrombotic variables. Clinicians should maintain a low threshold for venous imaging in women with significant pelvic masses and unilateral limb symptoms, look for concurrent thrombophilia, and investigate early surgical consultation to address compressive etiologies when VTE is still unexplained. It would be simpler to ascertain the actual incidence and pinpoint risk variables that can be altered with standardized reporting of fibroid-associated VTE and prospective registries. Full article

Background/Objectives: Delayed sternal closure (DSC) is a useful management strategy for complex cardiac interventions. The aim of this study was to investigate the patients who had DSC in our clinic over a 12-year period and to evaluate the postoperative results. Methods: A total of 124 DSC patients from a total cardiac surgery practice during a 12-year period (n = 6532, 1.8%, between January 2014 and September 2025) were retrospectively analyzed. Preoperative and intraoperative patient characteristics, morbidities, and mortality rates were collected and compared with the group undergoing primary sternal closure (PSC), which were matched with the DSC group in terms of preoperative and intraoperative patient characteristics. Results: A total of 124 (1.8%) patients required DSC, and 33.1% of the patients were females. The indications were bleeding (n = 81, 65%) and hemodynamic instability (n = 43, 35%). Total bypass times, cross-clamp times, and CPB temperature were higher in patients with DSC. A higher rate of inotropic support, intra-aortic balloon pump, extracorporeal lung support, blood transfusion, and bleeding were found in the DSC group. There was no difference in terms of sternal infection rate (2.4%). Intensive care unit stay, hospital stay, and mortality rate were also significantly increased in patients with DSC. Mortality rate in the DSC group was 16.1%. Conclusions: Multiple sternum revisions due to bleeding and low cardiac output syndrome may lead to increased mortality in high-risk patients. Planned postponement of sternal closure in these high-risk cardiac surgery patients helps to reduce perioperative morbidity and mortality. Full article

Background: Nutritional deficiency anemias—including iron, vitamin B12, and folate deficiencies—are common worldwide and are increasingly recognized as potential contributors to venous thromboembolism (VTE). Mechanistic and epidemiologic data suggest that anemia may promote thrombosis through hypoxia, endothelial activation, reactive thrombocytosis, and hyperhomocysteinemia. However, a focused synthesis of clinical and genetic evidence specifically linking nutritional deficiency anemia to VTE has been lacking. Methods: We conducted a systematic search of PubMed and the Cochrane Library from inception to 30 September 2025 to identify studies assessing nutritional deficiency anemia in relation to VTE outcomes. Eligible studies included observational designs, case reports, case series, and Mendelian randomization (MR) analyses. Quality assessment followed the Newcastle–Ottawa Scale (NOS), Joanna Briggs Institute (JBI) checklists, and ROB-MR. The review was registered in PROSPERO (CRD420251235479). Results: Seven studies met the inclusion criteria. Observational analytical studies consistently showed that anemia was associated with adverse VTE-related outcomes. Lower hemoglobin predicted higher short-term mortality in acute pulmonary embolism (HR 1.16 per 1 g/dL decrease), increased symptomatic VTE among hospitalized patients (RR 1.94), and greater long-term bleeding and mortality risk in VTE cohorts (HRs 1.41–2.89). Iron-deficiency anemia increased the odds of VTE in population-based data (OR 1.43), and case reports described unprovoked DVT in young adults with moderate to severe anemia. The MR study indicated a potential causal association between anemia traits and thrombosis at unusual anatomical sites (OR 1.446). No study demonstrated a significant association with recurrent VTE. Most analytical studies were rated as good–high quality. Conclusion: Across multiple study designs, anemia—particularly iron-deficiency anemia and low baseline hemoglobin—appears to be an underrecognized factor associated with elevated VTE risk and adverse VTE-related outcomes. However, direct evidence for vitamin B12- and folate-deficiency anemia remains limited, and further well-designed prospective studies are required to confirm causality and clarify the contribution of specific nutritional deficiency subtypes, as well as to support integration of anemia assessment into VTE risk models. Full article

Background/Objectives: The novel wave electric toothbrush is considered potentially helpful in removing subgingival plaque to prevent the occurrence of periodontal diseases. This study aimed to assess the cleaning efficacy of a novel wave electric toothbrush on subgingival plaque and its safety profile for oral soft tissues. Methods: In vitro cleaning efficacy evaluations were conducted using oral dental models. The wave electric toothbrushes were divided into low-, medium-, and high-swing parameter groups, with manual brushing (Bass technique) as the control. Simulated plaque was applied to the buccal and gingival sulcus sites of the four first molars, and the plaque removal area and sulcus cleaning depth were measured. For safety evaluation, Sprague Dawley (SD) rats were brushed on their molars daily for 30 days, with bleeding incidents recorded. Oral soft tissues were analyzed through H&E staining and immunohistochemical analysis. Statistical analysis included ANOVA and Kruskal–Wallis (p < 0.05). Results: Medium- and high-swing groups demonstrated superior gingival sulcus cleaning efficacy, showing significant differences compared with the low-swing and control groups (p < 0.05). All swing parameters achieved complete plaque removal on buccal surfaces. No significant differences were observed between the low-swing and manual groups, or between the medium- and high-swing groups, regarding sulcus cleaning efficacy and maximum sulcus depth. During the 30-day in vivo experiment, medium- and high-swing groups showed low bleeding frequencies, primarily at the palatal gingiva and vestibule. Histological analyses indicated that higher swing parameters increased the likelihood of soft tissue injury. Conclusions: Wave electric toothbrushes enhance subgingival plaque removal, with higher swing parameters improving gingival sulcus cleaning. However, stronger parameters may increase the risk of soft tissue damage. Further clinical studies are required to establish optimal guidelines. Full article

Thromboprophylaxis in hospitalized patients is a critical component of care aimed at preventing venous thromboembolism (VTE), a common and potentially fatal complication during hospitalization. The risk of VTE varies substantially across patient populations, influenced by the type of illness, including both surgical procedures and medical comorbidities, and requires individualized assessment. At the same time, the implementation of pharmacological thromboprophylaxis must carefully balance the risk of thrombosis against the potential for bleeding. Commonly used risk assessment models, such as the Padua and IMPROVE scores, can help clinicians stratify patients according to their individual risk of VTE and bleeding complications. The aim of the present review is to provide a structured synthesis of the current evidence on thromboprophylaxis strategies in hospitalized patients, critically appraise the performance and applicability of existing VTE and bleeding risk models and highlight how these tools can guide a tailored illness-specific approach to prophylactic decision-making. Where relevant, the review also outlines practical, risk-adapted algorithms to optimize thromboprophylaxis across diverse clinical settings. Full article

The liver is the primary site of synthesis for most coagulation factors and the central organ responsible for maintaining hemostatic equilibrium. In individuals with advanced liver disease, significant disruptions in coagulation homeostasis occur and consequently predispose patients to both thrombotic and bleeding complications. This review summarizes the pathophysiologic basics of liver cirrhosis-associated coagulopathies and discusses the diagnosis and treatment of common procoagulant conditions such as portal vein thrombosis and post-transplant hepatic artery thrombosis. The review also systematically addresses the most common bleeding complications, including spontaneous, portal hypertension-related, and periprocedural bleeding. The proper pre-procedural assessment of the bleeding risk is often required due to the great number of invasive procedures to which these patients are frequently subjected. The viscoelastic testing (thromboelastogram and thromboelastometry) seems to emerge as the most appropriate diagnostic method. Specific treatment recommendations for the correction of coagulation abnormalities and the management of severe thrombocytopenia are hereby presented. Full article

Background/Objectives: Fever and pain are among the most common symptoms in pediatric infections and chronic diseases, causing significant discomfort for children and concern for caregivers. Effective management is essential to relieve distress while avoiding overtreatment or undertreatment. Paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs), particularly ibuprofen, are the primary antipyretic and analgesic agents in pediatric care, but their use in children with chronic conditions might be challenging. Methods: A narrative review and clinical expert judgment were used to synthesize current evidence on the use of paracetamol and NSAIDs (especially ibuprofen) in children with some common chronic diseases. Results: Paracetamol is often considered a first-line option in several chronic conditions. Caution is warranted in children with pre-existing malnutrition, obesity, and neuromuscular disorders as these factors might increase the risk of hepatotoxicity. NSAIDs provide additional anti-inflammatory effects and comparable analgesic efficacy but should be used cautiously in some high-risk populations due to potential gastrointestinal, renal, and bleeding complications. Their use is contraindicated in children with dehydration, renal impairment, nephrotic syndrome relapses, while careful risk-benefit assessment is required in small and vulnerable neonates. Some data also suggests NSAIDs may worsen outcomes in certain acute bacterial and viral infections. Data on chronic infections such as tuberculosis, HIV, and viral hepatitis are limited, highlighting the need for further research. Combination therapy with paracetamol and ibuprofen may enhance analgesia in postoperative settings without significantly increasing adverse events. Overall, available evidence is limited and largely observational. Conclusions: This narrative review synthesizes current evidence and clinical expertise to provide practical guidance on the rational use of paracetamol and NSAIDs in children, emphasizing individualized therapy according to comorbidities, risk factors, and clinical context, particularly in vulnerable populations. A risk-adapted, evidence-based approach ensures optimal symptom control while minimizing harm, supporting safer, more effective, and family-centered care for children with fever and pain. Full article

Background: Venous thromboembolism (VTE) is associated with high morbidity and mortality. The activation of multiple pathways of venous thrombosis occurs after an injury. A prophylaxis protocol is necessary to prevent early and late venous thrombotic complications. Methods: This study aimed to evaluate the outcomes of venous thromboembolism using the Greenfield risk assessment profile score and its association with bleeding complications. This was a retrospective cohort study conducted on trauma cases who were aged 15 years or older. The study was conducted from January 2020 through December 2022. Patients who were admitted to hospital for less than 24 h or those who died during resuscitation or treatment in an emergency room were excluded from this study. Results: We enrolled 580 cases. Among them, 46.6% were categorized as high-risk for developing venous thromboembolism, and 30.4% of these high-risk patients received pharmaco-mechanical thromboprophylaxis. All VTE cases were high risk according to the Greenfield risk assessment profile, accounting for 3% of the entire group and 1.4% of all enrolled cases. All major bleeding complications occurred with a previously diagnosed large subdural hematoma. Conclusions: Assessing VTE risk was crucial for optimal management of prophylaxis. Proper use of pharmacological prophylaxis had to be balanced against the risk of bleeding complications. Full article