Pulmonary arterial hypertension patients display normal kinetics of clot formation using thrombelastography.

Pulmonary arterial hypertension is characterized by endothelial dysfunction and microthrombi formation. The role of anticoagulation remains controversial, with studies demonstrating inconsistent effects on pulmonary arterial hypertension mortality. Clinical anticoagulation practices are currently heterogeneous, reflecting physician preference. This study uses thrombelastography and hematology markers to evaluate whether clot formation and fibrinolysis are abnormal in pulmonary arterial hypertension patients. Venous blood was collected from healthy volunteers (n = 20) and patients with pulmonary arterial hypertension (n = 20) on stable medical therapy for thrombelastography analysis. Individual thrombelastography parameters and a calculated coagulation index were used for comparison. In addition, hematologic markers, including fibrinogen, factor VIII activity, von Willebrand factor activity, von Willebrand factor antigen, and alpha2-antiplasmin, were measured in pulmonary arterial hypertension patients and compared to healthy volunteers. Between group differences were analyzed using t tests and linear mixed models, accounting for repeated measures when applicable. Although the degree of fibrinolysis (LY30) was significantly lower in pulmonary arterial hypertension patients compared to healthy volunteers (0.3% ± 0.6 versus 1.3% ± 1.1, p = 0.04), all values were within the normal reference range (0-8%). All other thrombelastography parameters were not significantly different between pulmonary arterial hypertension patients and healthy volunteers (p ≥ 0.15 for all). Similarly, alpha2-antiplasmin activity levels were higher in pulmonary arterial hypertension patients compared to healthy volunteers (103.7% ± 13.6 versus 82.6% ± 9.5, p < 0.0001), but all individual values were within the normal range (75-132%). There were no other significant differences in hematologic markers between pulmonary arterial hypertension patients and healthy volunteers (p ≥ 0.07 for all). Sub-group analysis comparing thrombelastography results in patients treated with or without prostacyclin pathway targeted therapies were also non-significant. In conclusion, treated pulmonary arterial hypertension patients do not demonstrate abnormal clotting kinetics or fibrinolysis by thrombelastography.

Distribution of Preventive Dental Care during Pregnancy in Rhode Island, 2012 to 2015.

AIMS: To examine the distribution of preventive dental care for pregnant women in Rhode Island. METHODS: The data used were obtained from the 2012 to 2015 Rhode Island Pregnancy Risk Assessment Monitoring System (RIPRAMS). Statistical analyses were conducted for respondents who had valid information for both preventive dental care receipt and race/ethnicity to examine population differences in the receipt of preventive dental care. RESULTS: Respondents who identified as Hispanic and had more than 12 years of education had higher odds for preventive dental care receipt in Rhode Island between 2012 to 2015 compared to non-Hispanic whites. Furthermore, respondents with lower household income were the least likely to have received preventive dental care. This was especially true for black and non-Hispanic women who reported being neither black nor white. CONCLUSION: Preventive dental care in Rhode Island between 2012 and 2015 did not meet the perinatal and Infant Oral Health Quality Improvement (PIOHQI) target of 60% in minority populations.