1,720,970 research outputs found
Evaluation of Covid-19-Associated Hypercoagulability with Functional Coagulation Assays and Extracellular Vesicles
Full text linkCritical Review of International Clinical Practice Guidelines Recommendations for Prevention, Diagnosis, and Management of Central Venous Catheter Thrombosis
No full textCentral venous catheters (CVCs) are widely used in clinical practice for the administration of medications, parenteral nutrition, and hemodynamic monitoring. However, their use is associated with a significant risk of thrombosis, which can lead to serious complications, including catheter dysfunction, infection, and embolism. Numerous international clinical practice guidelines (CPGs) have been developed to address the prevention, diagnosis, and management of CVC-related thrombosis. This critical review aims to evaluate and compare the recommendations provided by these guidelines, highlighting areas of consensus, variation, and potential gaps. We systematically analyzed CPGs from major healthcare organizations, focusing on key aspects such as risk stratification, prophylactic strategies, diagnostic algorithms, and therapeutic interventions. Although most guidelines emphasize the importance of risk assessment and early intervention, there are notable discrepancies in recommendations regarding the use of anticoagulant prophylaxis, imaging modalities for diagnosis, and the duration of anticoagulation therapy. Additionally, the review explores the evidence underpinning these recommendations and identifies areas where robust clinical data are lacking. Our analysis underscores the need for harmonization across guidelines to ensure consistent and evidence-based care. Furthermore, we advocate for the development of multidisciplinary approaches to enhance decision-making and optimize clinical outcomes in this domain. By addressing the gaps and inconsistencies in current CPGs, this review seeks to provide a framework for improving the prevention, diagnosis, and management of CVC-related thrombosis, ultimately enhancing patient outcomes and reducing the healthcare burden
Long-term hypercoagulability, endotheliopathy and inflammation following acute SARS-CoV-2 infection
No full textIntroduction: both symptomatic and asymptomatic SARS-CoV-2 infections - coined Coronavirus disease 2019 (COVID-19) - have been linked to a higher risk of cardiovascular events after recovery. Areas covered: our review aims to summarize the latest evidence on the increased thrombotic and cardiovascular risk in recovered COVID-19 patients and to examine the pathophysiological mechanisms underlying the interplay among endothelial dysfunction, inflammatory response and coagulation in long-COVID. We performed a systematic search of studies on hypercoagulability, endothelial dysfunction and inflammation after SARS-CoV-2 infection. Expert opinion: endothelial dysfunction is a major pathophysiological mechanism responsible for most clinical manifestations in COVID-19. The pathological activation of endothelial cells by a virus infection results in a pro-adhesive and chemokine-secreting phenotype, which in turn promotes the recruitment of circulating leukocytes. Cardiovascular events after COVID-19 appear to be related to persistent immune dysregulation. Patients with long-lasting symptoms display higher amounts of proinflammatory molecules such as tumor necrosis factor-α, interferon γ and interleukins 2 and 6. Immune dysregulation can trigger the activation of the coagulation pathway. The formation of extensive microclots in vivo, both during acute COVID-19 and in long-COVID-19, appears to be a relevant mechanism responsible for persistent symptoms and cardiovascular events
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Use of Glucocorticoids and Risk of Venous Thromboembolism: A Narrative Review
No full textGlucocorticoids are potent anti-inflammatory agents that are widely used for the treatment of many inflammatory, autoimmune, and neoplastic disorders. However, their beneficial effect is associated with several side effects, including an increased risk of cardiovascular complications, such as myocardial infarction and stroke. Whether their use also contributes to a procoagulant state, and therefore increases the risk of venous thromboembolism (VTE), is still a matter of debate. As an increased risk of venous thrombotic events is described in patients with Cushing's syndrome, which is characterized by endogenous hypercortisolism, it is reasonable to speculate that the chronic administration of glucocorticoids may induce a hypercoagulable state. However, it seems virtually impossible to separate the role of the drug from the underlying condition, which itself predisposes to the development of VTE. Actually, some evidence suggests that the use of exogenous glucocorticoids for the treatment of underlying disease and its exacerbations may further amplify the risk of VTE. Moreover, a procoagulant state has also been reported in healthy participants receiving oral glucocorticoids versus placebo. We have performed a concise narrative review on available data on the influence of exogenous glucocorticoids on hemostasis and their clinical impact on the risk of VTE
Efficacy and safety of anticoagulant treatment in elderly patients with venous thromboembolism beyond the first 3 to 6 months of therapy: A narrative review
No full textExtended anticoagulation remains a crucial consideration in patients with venous thromboembolism (VTE), especially in older adults. In this population, the two main challenges are the increased risk of bleeding and the underrepresentation in clinical trials. Current guidelines recommend indefinite anticoagulation for unprovoked VTE, except in patients at high bleeding risk, where the benefits and risks must be carefully balanced. In contrast, VTE triggered by a transient risk factor typically does not require prolonged treatment once the factor has resolved. For patients with chronic risk factors, indefinite anticoagulation is often recommended, but decisions should be individualized based on patient preference, risk of recurrence, and bleeding risk. Emerging data highlight the potential role of D-dimer testing in guiding extended therapy. However, in older adults, D-dimer levels may be frequently elevated for reasons unrelated to VTE, limiting its specificity. Real-world studies show wide variability in practice, with many clinicians opting for anticoagulation beyond six months regardless of whether the VTE was provoked. Recent observational data indicate that extended therapy beyond two years may significantly lower recurrence rates, especially following pulmonary embolism, with acceptable bleeding risks. New tools, such as the VTE-PREDICT risk score, aim to support personalized decision-making by estimating both recurrence and bleeding risks over 5 years. Nevertheless, validated bleeding risk scores in older patients remain suboptimal, demonstrating limited predictive power. Alternative strategies, including low-dose DOACs and adjunctive measures such as proton pump inhibitors, may reduce bleeding risk. Balancing recurrence prevention against bleeding complications remains central to optimizing extended-phase VTE treatment, particularly in elderly or comorbid populations
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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