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C0084 The effect of CME educational programs on VTE morality & morbidity in King Fahad hospital - Jeddah - KSA
Abstracts / Thrombosis Research 130 (2012) S100–S202
Comment: These data indicate that MPTP formation stringently controls mitochondrial (ΔΨm depolarization), cytoplasmic (caspase-3 activation) and cellular (platelet shrinkage and microparticle formation) apoptotic events in A23187-stimulated platelets but is much less involved in phosphatidylserine externalization on the platelet plasma membrane, which is mostly MPTP-independent. CsA may rescue platelets from apoptosis, preventing caspase-3 activation and inhibiting the terminal manifestations of platelet apoptosis, such as platelet shrinkage and degradation to microparticles. Furthermore, this study suggests a novel potentially useful application of CsA as an inhibitor of platelet demise via apoptosis in thrombocytopenias associated with enhanced platelet apoptosis.
S199
- Mortality rate has dropped denoting better adherence to guidelines. - Both medical and surgical departments has improved in prophylactic usage and mortality rate however, relatively more efforts is needed with medical departments. - Risk assessment model and VTE prophylaxis sheet should be implemented immediately. VTE awareness programs should take place among all Medical Staff. Also, adherence to International Guidelines in VTE prophylaxis is mandatory. doi:10.1016/j.thromres.2012.08.257
doi:10.1016/j.thromres.2012.08.256
C0084 The effect of CME educational programs on VTE morality & morbidity in King Fahad hospital - Jeddah - KSA Essam Aboelnazar1, Fahd Alhameed2 1 Surgery, UMQ University - Jeddah, Saudi Arabia; 2National Gurad, ICU - Jeddah, Saudi Arabia Background: Thromboprophylaxis was inadequate and corrective measures to improve VTE prophylaxis has been identified including VTE awareness. The objective of this 2nd wave VTE registry is to evaluate the impact of CME including VTE SZ on incidence of VTE Morbidity and Mortality Methods: - The study is a retrospective observational registry. It comprised a stage of collecting all VTE events and deaths in the hospital from 1 July 2009 till 30 June 2010 “1st wave 1 July 2008 till 30 June 2009” - Identifying all patients with clinical diagnosis of VTE during the same period. In the next stage, to identify all patients with confirmed VTE diagnosis. - Only patients with confirmed VTE diagnosis were included in the analysis. - VTE awareness and educational programs were conducted during the 2nd wave including 2 VTE SZ - Comparison between the results of the two registries to evaluate changes in VTE Morbidity & Mortality Results: - 147 cases have been confirmed to have VTE (age range: 40– 79 years old) during the registry period. - Confirmed VTE mortality accounts for 1.9% and 1.1% of total hospital mortality in 1st wave and 2nd wave respectively (P b 0.05) - VTE prophylaxis was associated with significant reduction of Mortality 2% versus 26% of patients without prophylaxis (P b 0.001) - Reduction of the percentage of DVT cases progressed to PE, with absence of developed PE cases after the 2nd wave. (P b 0.001) - PE reduction is significant in both medical P b 0.001) & surgical (P b 0.05) ward after the 2nd wave. - Use of prophylactic anti-coagulation therapy has increased from 37% at 1st wave to 64% at 2nd wave (P b 0.001) - Medical Prophylaxis increased from 22% to 57% (P b 0.001) - Surgical Prophylaxis increased from 44% to 82% (P b 0.001
C0400 Relation between thrombotic symptoms and fibrin generation kinetics in patients with dysfibrinogenemia Virtudes Vila1, Elena Mesa2, Saturnino Haya2, Ana Cid2, Jose Antonio Aznar2 1 Hospital Universitario La Fe, Investigación - Av Campanar, 21, 46009 Valencia, Spain; 2Hospital Universitario La Fe, Unidad de hemostasia y trombosis - Av Campanar, 21, 46009 Valencia, Spain Background: Congenital dysfibrinogenemia is a functional disorder of fibrinogen (FG) that represents a rare cause of thrombophilia. Although this cause of thrombophilia is rare must not be misdiagnosed. Our aim was to analyse molecular functionality of congenital dysfibrinogens (DisFG) to try to establish a difference between those with thrombotic or hemorrhagic clinica. Methods: 30 cases of 18 families were included. Evaluated parameters were: 1) Kinetic of fibrin (Fn) generation in plasma by spectrophotometric measurements at 350 nm with thrombin (Th) in presence or absence of calcium; data obtained from kinetics curve were maximum optical density (Max OD), maximum generation slope (Max G slope) and delay in the onset of fibrin generation (Lag time); 2) Kinetics of generation and degradation of fibrin with thrombin, calcium and tPA; data derived from curve were maximum optical density (Max OD), maximum generation and degradation slope (Max G slope and Max D slope) and delay in the onset of fibrin generation and degradation (Lag time); 3) Thrombin generation (TG nM) by calibrated automated thrombogram assay (CAT). Results: Seven cases with DisFG had thrombotic symptoms and 9 cases had bleeding symptoms, whereas 13 DisFG were asymptomatic. All patients showed a decrease in the Max slope of fibrin generation (20-60%) and an increased lag time (≈ 200%) respect to normal FG. However, DisFG with thrombotic symptoms compared with bleeding symptoms, showed that the ratio between generation and degradation kinetics of Fn was increased (p b 0.05), as well as the ratio of Fn generation with and without calcium (p b 0.05). TG was more elevated in patients with thrombotic symptoms (296 ± 113 vs 132 ± 109 nM). Comment: DisFg patients had thrombotic (23%) and hemorrhagic (30%) clinical manifestations. All patients had abnormal Fn generation. However, the effect of calcium on fibrin formation and the ratio generation/degradation helps to distinguish the phenotype thrombotic and hemorrhagic. Alterations in the calcium binding site are related with thrombotic dysfibrinogenemia. TG can be useful to differentiate the risk of having these symptoms. Project supported by Pfizer and CSL Berhing
Comment: - Usage of prophylactic anti-coagulation measures has improved however, still more improvements is needed.
doi:10.1016/j.thromres.2012.08.258
Comment: These data indicate that MPTP formation stringently controls mitochondrial (ΔΨm depolarization), cytoplasmic (caspase-3 activation) and cellular (platelet shrinkage and microparticle formation) apoptotic events in A23187-stimulated platelets but is much less involved in phosphatidylserine externalization on the platelet plasma membrane, which is mostly MPTP-independent. CsA may rescue platelets from apoptosis, preventing caspase-3 activation and inhibiting the terminal manifestations of platelet apoptosis, such as platelet shrinkage and degradation to microparticles. Furthermore, this study suggests a novel potentially useful application of CsA as an inhibitor of platelet demise via apoptosis in thrombocytopenias associated with enhanced platelet apoptosis.
S199
- Mortality rate has dropped denoting better adherence to guidelines. - Both medical and surgical departments has improved in prophylactic usage and mortality rate however, relatively more efforts is needed with medical departments. - Risk assessment model and VTE prophylaxis sheet should be implemented immediately. VTE awareness programs should take place among all Medical Staff. Also, adherence to International Guidelines in VTE prophylaxis is mandatory. doi:10.1016/j.thromres.2012.08.257
doi:10.1016/j.thromres.2012.08.256
C0084 The effect of CME educational programs on VTE morality & morbidity in King Fahad hospital - Jeddah - KSA Essam Aboelnazar1, Fahd Alhameed2 1 Surgery, UMQ University - Jeddah, Saudi Arabia; 2National Gurad, ICU - Jeddah, Saudi Arabia Background: Thromboprophylaxis was inadequate and corrective measures to improve VTE prophylaxis has been identified including VTE awareness. The objective of this 2nd wave VTE registry is to evaluate the impact of CME including VTE SZ on incidence of VTE Morbidity and Mortality Methods: - The study is a retrospective observational registry. It comprised a stage of collecting all VTE events and deaths in the hospital from 1 July 2009 till 30 June 2010 “1st wave 1 July 2008 till 30 June 2009” - Identifying all patients with clinical diagnosis of VTE during the same period. In the next stage, to identify all patients with confirmed VTE diagnosis. - Only patients with confirmed VTE diagnosis were included in the analysis. - VTE awareness and educational programs were conducted during the 2nd wave including 2 VTE SZ - Comparison between the results of the two registries to evaluate changes in VTE Morbidity & Mortality Results: - 147 cases have been confirmed to have VTE (age range: 40– 79 years old) during the registry period. - Confirmed VTE mortality accounts for 1.9% and 1.1% of total hospital mortality in 1st wave and 2nd wave respectively (P b 0.05) - VTE prophylaxis was associated with significant reduction of Mortality 2% versus 26% of patients without prophylaxis (P b 0.001) - Reduction of the percentage of DVT cases progressed to PE, with absence of developed PE cases after the 2nd wave. (P b 0.001) - PE reduction is significant in both medical P b 0.001) & surgical (P b 0.05) ward after the 2nd wave. - Use of prophylactic anti-coagulation therapy has increased from 37% at 1st wave to 64% at 2nd wave (P b 0.001) - Medical Prophylaxis increased from 22% to 57% (P b 0.001) - Surgical Prophylaxis increased from 44% to 82% (P b 0.001
C0400 Relation between thrombotic symptoms and fibrin generation kinetics in patients with dysfibrinogenemia Virtudes Vila1, Elena Mesa2, Saturnino Haya2, Ana Cid2, Jose Antonio Aznar2 1 Hospital Universitario La Fe, Investigación - Av Campanar, 21, 46009 Valencia, Spain; 2Hospital Universitario La Fe, Unidad de hemostasia y trombosis - Av Campanar, 21, 46009 Valencia, Spain Background: Congenital dysfibrinogenemia is a functional disorder of fibrinogen (FG) that represents a rare cause of thrombophilia. Although this cause of thrombophilia is rare must not be misdiagnosed. Our aim was to analyse molecular functionality of congenital dysfibrinogens (DisFG) to try to establish a difference between those with thrombotic or hemorrhagic clinica. Methods: 30 cases of 18 families were included. Evaluated parameters were: 1) Kinetic of fibrin (Fn) generation in plasma by spectrophotometric measurements at 350 nm with thrombin (Th) in presence or absence of calcium; data obtained from kinetics curve were maximum optical density (Max OD), maximum generation slope (Max G slope) and delay in the onset of fibrin generation (Lag time); 2) Kinetics of generation and degradation of fibrin with thrombin, calcium and tPA; data derived from curve were maximum optical density (Max OD), maximum generation and degradation slope (Max G slope and Max D slope) and delay in the onset of fibrin generation and degradation (Lag time); 3) Thrombin generation (TG nM) by calibrated automated thrombogram assay (CAT). Results: Seven cases with DisFG had thrombotic symptoms and 9 cases had bleeding symptoms, whereas 13 DisFG were asymptomatic. All patients showed a decrease in the Max slope of fibrin generation (20-60%) and an increased lag time (≈ 200%) respect to normal FG. However, DisFG with thrombotic symptoms compared with bleeding symptoms, showed that the ratio between generation and degradation kinetics of Fn was increased (p b 0.05), as well as the ratio of Fn generation with and without calcium (p b 0.05). TG was more elevated in patients with thrombotic symptoms (296 ± 113 vs 132 ± 109 nM). Comment: DisFg patients had thrombotic (23%) and hemorrhagic (30%) clinical manifestations. All patients had abnormal Fn generation. However, the effect of calcium on fibrin formation and the ratio generation/degradation helps to distinguish the phenotype thrombotic and hemorrhagic. Alterations in the calcium binding site are related with thrombotic dysfibrinogenemia. TG can be useful to differentiate the risk of having these symptoms. Project supported by Pfizer and CSL Berhing
Comment: - Usage of prophylactic anti-coagulation measures has improved however, still more improvements is needed.
doi:10.1016/j.thromres.2012.08.258