Antithrombin Deficiency: Frequency in Patients with Thrombosis and Thrombophilic Families.

PURPOSE: Antithrombin (AT) deficiency is a well-known inherited risk factor for venous thromboembolism (VTE). However, F V Leiden and F II20210a mutations have drawn much more attention in the recent years. Therefore, we have decided to analyze the frequency of antithrombin deficiency in different cohorts of patients and tried to formulate indications for its testing. RESULTS: Antithrombin deficiency was found in 4% of patients with recurrent VTE ≤ 50 years of age with, in 1% of patients with splanchnic vein thrombosis and in 2% of cases associated with combined oral contraceptives (COC) use or pregnancy. In patients with central venous thrombosis, antithrombin deficiency was not found. RECOMMENDATION: We consider antithrombin testing useful in patients with thrombosis occuring up to 45 years of age without any risk factors. Namely, females with VTE in pregnancy and puerperium should be tested as well as females with thrombosis on COC, if VTE occurred within the first year of their use. CONCLUSION: In spite of degressive interest in thrombophilia work up, we still consider antithrombin testing useful in defined clinical situations.

Quality of Life of Post-stroke Patients.

Introduction: Stroke is a disease whose consequences have a considerable impact on the quality of the patient's life. It is a widespread disease that has a disabling impact on life and, in addition to physical changes, brings about a number of psychological and cognitive processes. Goal: The goal of the study was to identify and describe the quality of life of post-stroke patients. Methodology: The study design was quantitative. A questionnaire of the authors' own design and the SF-36 questionnaire were used to obtain the data. Results: Significant differences in patient quality of life were identified in relation to patient gender. Moreover, the quality of life in all individual SF-36 dimensions, except for mental health, deteriorated with age. With regard to occupational placement, employed respondents gave the highest evaluation of quality of life according to SF-36 and old-age pensioners the lowest. The analysis shows that quality of life in individual dimensions is positively influenced by respondents' higher education. The evaluation in individual dimensions improves with the time that has passed since the stroke. Conclusion: The quality of life of post-stroke patients deteriorates with age. The deteriorating level of patient quality of life in older age requires programmes that include assessments and interventions that lead to the treatment of these patients.

General awareness of stroke in the Czech Republic.

OBJECTIVE: The main goal of the study was to find out the general public's awareness of stroke, the relations between the awareness of stroke and socio-demographic factors, and awareness of stroke and experience of stroke. METHODS: The combination of a non-standardized questionnaire on the stroke prevention and a standardized questionnaire on the identification of the general health literacy (HLSQ-16) was used. The sample was chosen using a quota choice. The sample structure corresponded with the composition of the Czech population with regard to regions, sex and age. These features were determined as representative. The sample consisted of 1,004 respondents. RESULTS: The general awareness of stroke is high in the Czech Republic. Most of the respondents (97.2%) stated that they had ever heard of stroke. This basic awareness is influenced by the sex and marital status of the respondents. Almost one half (42.2%) of the general public would welcome more information on stroke. Women showed significantly higher interest in the information than men. Significantly higher interest could be seen in elderly respondents while younger respondents said significantly more frequently that they were not interested in the information. Married respondents showed a significantly higher degree of awareness. Rural respondents expressed higher interest in the information. The interest in the information dropped with higher education. The interest was significantly influenced by the respondents' sex, place of residence, marital status, and education. Almost 1/4 (24.3%) of respondents mentioned stroke incidence in their families. Our study proved that this incidence significantly varied in dependence on the respondents' sex, age, marital status and education. Further questions were focused on the sources of information on stroke. The most important sources include internet, which was named by nearly one half (48.6%) of respondents, and it was found that women could use the sources of information more frequently than men. Women used all sources of information on stroke (internet, television, families, GPs) more than men. CONCLUSION: The Czech respondents' interest in stroke is significantly influenced by their sex, age, place of residence, marital status, and the respondents' education. The findings play a role in the focus on preventive activities in this area. It is necessary to implement the general public education not only in general practitioners' offices but also in mass media in order to improve the awareness of stroke.

Impact of Selected Geriatric Syndromes on the Quality of Life in the Population Aged 60 and Older.

BACKGROUND: Geriatric syndromes represent a critical domain in the population more than 60 years old. Basic syndromes include frailty, sarcopenia, loss of body mass, and a mild cognitive disorder. These are significant problems which can affect the quality of life. In our study, the Rapid Geriatric Assessment (RGA) tool was used to assess the geriatric syndromes, and the WHOQOL-BREF was used to assess the quality of life to survey 498 respondents from a population aged 60 and older. In all the assessments, the distribution of variables was tested, a nonnormal distribution of variables was identified, and subsequently, nonparametric tests were performed to identify the differences between groups. The study showed that the domain of physical health and the psychological domain were most affected. The results have shown that individual geriatric syndromes affect certain domains of the quality of life of the population above 60 with various intensity.

Pain Assessment: Benefits of Using Pain Scales for Surgical Patients in South Bohemian Hospitals.

Pain is a medical and nursing problem that is common in surgical departments. Inadequate pain management can lead to patient distress, as well as extending the period in which the patient's quality of life is reduced. The standardized SF-MPQ-2 questionnaire provides nurses with the opportunity to assess pain within a broader context. The aim of this descriptive and exploratory study was to describe the state of pain assessment in surgical patients in the South Bohemian Region and to highlight the benefits of using a standardized tool for proper pain assessment. The research was carried out using a quantitative survey within the South Bohemian Region (Czech Republic). The participants in the study were nurses working in surgical departments in hospitals in the region as well as hospitalized patients. The results show that nurses pay slightly more attention to pain assessments than doctors. We know that, generally, pain decreases with time after surgery. Nonetheless, returning pain, as well as continuous pain, can occur, both of which have an emotional component. The results of this study are directed at nurses and include a call for more effective pain management through improved assessment.

Heparin-induced thrombocytopenia treated with fondaparinux: single center experience.

BACKGROUND: Heparin-induced thrombocytopenia (HIT) is the most frequent drug-induced, immune-mediated thrombocytopenia. It is associated with significant morbidity and mortality. Anticoagulation with heparin must be stopped immediately and replaced by some suggested alternative - lepirudin, danaparoid or argatroban. Fondaparinux has been also successfully used in HIT. METHODS: We present a cohort of 10 patients diagnosed with HIT and treated in a university hospital in a period of four years. Diagnosis was based on Keeling´s scoring system, screening immunologic test for HIT (STic EXPERT® HIT) and sandwich ELISA (detection of IgG/heparin-PF4 antibodies). While other alternative anticoagulants are not readily available in our hospital, we used fondaparinux in all cases. RESULTS: From 2014 to 2018, eight males and two females (mean age 67 years, range 46-86 years) were diagnosed with HIT in our hospital. This complication developed in 9 cases after low-molecular-weight heparin and in one after heparin flushes in hemodialysis. A drop-in platelet count developed in all patients, thrombotic complications in 7 and skin necrosis in 2 cases. Fondaparinux was used in all patients, including two cases with severe renal impairment, the dose was chosen individually. We observed complete platelet recovery in all cases. One patient died because of advanced malignancy, others did not have any complication. In 6 cases we switched to oral anticoagulation after platelet recovery. CONCLUSIONS: In our group of 10 HIT patients fondaparinux was shown to be both safe and effective, even in those with severe renal impairment. Additional studies are warranted to confirm this observation.

Analysis of Risk Factors of Stroke and Venous Thromboembolism in Females With Oral Contraceptives Use.

Thrombotic diathesis has been a well-known complication of oral contraceptive use for more than 50 years. This is true not only for venous thrombosis but also for an arterial one. The etiology is usually multifactorial and depends on several additional risk factors. We analyzed the prevalence of inherited and acquired thrombophilia in a cohort of 770 females who had a thrombotic event in association with oral contraceptive use (700 women with venous thromboembolism [VTE], 70 with stroke). Moreover, we tried to identify additional risk factors. Inherited thrombophilia was found in 44.5% with higher frequency in the cohort with VTE (42%) than in females with stroke (24%). The most frequent finding was factor V Leiden. Cigarette smoking was significantly more frequent in the group with stroke (50% vs 25%). The prevalence of cigarette smoking in the group with VTE did not exceed the frequency in general population. Women on oral contraceptive pills have higher risk of venous as well as arterial thrombosis. The risk of venous thrombosis is increased in females with inherited thrombophilia, whereas those with some additional acquired risk factors (especially smoking) may be predisposed to arterial thrombosis. However, the absolute risk of thrombosis in healthy women is low, far less than the risk of unintended pregnancy. Moreover, the risk may be reduced by keeping some rules before the prescription of the pills, healthy life style, and a proper choice of contraception.

Diagnosis, etiology and management of the Budd-Chiari Syndrome: a bloodcoagulation and hepatological study on the course of the disease treated with TIPS.

BACKGROUND: Budd-Chiari Syndrome (BCS) is characterized by obstruction of blood flow in hepatic veins. The aim of the study was to analyze diagnosis, etiology and management of BCS. METHODS: We analyzed 44 patients (32 females, 12 males, the mean age <35y of age) treated with TIPS. Ascites was found in 35 patients as the most frequent symptom. The median of total follow-up was 52 months. Non-covered (bare) or covered stent was inserted to all patients. Diagnosis of myeloproliferative neoplasm (MPN) was based on WHO criteria. Other inherited or acquired thrombophilia were assessed as well. Therapy of BCS was with regard to the etiology. RESULTS: The etiology of BCS was identified in 38 cases. Ph- MPN was found as the most common risk factor (50%, N.=22), especially polycythemia vera. JAK2V617F mutation was detected in the most of 22 MPN cases (82.5%). The second most common etiologic factor was inherited thrombophilia (18%, N.=8). In the non-covered (bare) stent group, a primary patency rates 52.9% in 1 year and 20% in 5 years after TIPS (Portasystemic Shunt, Transjugular Intrahepatic) creation. In the covered stent group the 1-year and 5-year primary patency rates were was 80% and 33.3% respectively. The average 5-year re-intervention rate per patient was 1.65 procedures in the bare stent group and 0.67 in the covered stent group. Re-interventions were more frequent in MPN patients. All patients were anticoagulated with heparin at the beginning, switched to vitamin K antagonist. On top of TIPS, anticoagulant and a vigorous therapy of underlying disorder are necessary. CONCLUSION: BCS is a serious and life-threatening disorder in MPD is a major cause of morbidity and mortality. Therapy requires a multidisciplinary approach. Insertion of TIPS dedicated covered stent is a very effective treatment in cases resistant to conservative approach with lower dysfunction rate and the number of re-interventions.

Prothrombotic changes due to an increase in thyroid hormone levels.

OBJECTIVE: With increasing free thyroxine levels, a gradually rising risk of venous thromboembolism has been described in case-control studies. However, reports on the influence of thyroid hormones on haemostasis, while suggesting a hypercoagulable state in thyrotoxicosis, have often been inconclusive. This study evaluates multiple markers of haemostasis and fibrinolysis in a paired design, making it more sensitive to changes in thyroid hormone levels. DESIGN: We analysed multiple variables in patients who shifted from severe hypothyroidism to mild hyperthyroidism during thyroid cancer treatment. Those with possible residual disease were excluded. METHODS: Ninety patients following total thyroidectomy were tested on two occasions: i) before radioiodine remnant ablation and ii) 6 weeks later, on levothyroxine (lT4) suppression treatment, and the results were compared using the Wilcoxon's test for paired data. RESULTS: During lT4 treatment, significant increases (all P<0.001) in fibrinogen (from median 3.4 to 3.8 g/l), von Willebrand factor (from 85 to 127%), factor VIII (from 111 to 148%) and plasminogen activator inhibitor 1 (from 6.5 to 13.9 µg/l) were observed. In addition, the activation times of platelet adhesion and aggregation stimulated with collagen and epinephrine (EPI)/ADP, i.e. closure times in platelet function analyser (PFA-100), were significantly shortened (P<0.001): for EPI from median 148 to 117 s and for ADP from 95 to 80 s. Changes in other tests were less prominent or insignificant. CONCLUSIONS: An increase in thyroid hormone levels shifts the haemostatic balance towards a hypercoagulable, hypofibrinolytic state. This may contribute to the increased cardiovascular morbidity and mortality observed even in mild thyrotoxicosis.

Ultra high performance liquid chromatography tandem mass spectrometric detection in clinical analysis of simvastatin and atorvastatin.

Simvastatin and atorvastatin belong to the group of hypolipidemic drugs, more exactly to the second generation of inhibitors of microsomal 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase. They induce a significant reduction in total cholesterol, low-density lipoprotein cholesterol and plasma triglycerides, therefore they are widely used in the treatment of hypercholesterolemia even of its severe form-familiar hypercholesterolemia. Simvastatin and atorvastatin as the most widely used statins in clinical treatment and their hydroxy-acid/lactone forms were determined by means of UPLC in connection with triple quadrupole mass spectrometer. Deuterium labeled reference standard compounds were used as internal standards for the quantitation. Separation was performed on Acquity BEH C18 (100 mm x 2.1 mm, 1.7 microm) using gradient elution by mobile phase containing acetonitrile and ammonium acetate pH 4.0, which is convenient in order to prevent interconversion of analytes. ESI in positive mode was used for the ionization of all compounds. Two SRM (selected reaction monitoring) transitions were carefully optimized for each analyte in order to get high sensitivity and selectivity. SPE on Discovery DSC-18 was used as a sample preparation step. Intra-day precision was generally within 10% RSD, while inter-day precision within 15% RSD. Method accuracy expressed as recovery ranged from 75 to 100%. The method was validated with the sensitivity reaching LOQ 0.08-5.46 nmol/l and LOD 0.01-1.80 nmol/l in biological samples. Atorvastatin, simvastatin, its metabolites and hydroxy-acid/lactone forms were monitored in human serum and in lipoprotein fractions (LDL, HDL and VLDL) at patients with end stage renal diseases.