12th Congress of the European Hematology ... - Haematologica

symptoms of DVT, 3 (7.89%) previous DVT, 6 (15.73%) surgery within
4 weeks before, 7 (18.42%) active cancer, 1 (2.63%) refered OA intake.
5 patients (13.15%) died. Group B characteristics: 29 patients (7 male/22
female). Median age: 69 years (30-92). Median D-dimer at diagnosis
2096 µg/L (237-7198). 14 patients (48.27%) showed signs or symptoms
of DVT, 7 (24.13%) required immobilization in the previous 4 weeks, 2
(6.89%) surgery within 4 weeks before, 5 (17.24%) active cancer, 1
(3.44%) was pregnant. 2 patients (6.89%) died due to complications of
acute event. In group A we found a statistically significant between score
of clinical assessment and OS. We found a positive correlation coefficient
(r 0.508) statistically significant (p=0.005) between clinical score and troponin
levels in group B. There were no differences between the two Ddimer
assays with regard of severity of PE, PaO2, troponin, pulmonary
hypertension and other features. Conclusions. a) The score of clinical
assessment employed in our series may be useful as a right ventricular
dysfunction marker; neverthless the prognostic value of this score need
to be evaluated in properly designed pospective studies. b) Results of the
two D-dimer assays are not related to the severity of PE assessed by
various markers in our serie.
0828
ORAL ANTICOAGULATION REVERSAL: FRESH FROZEN PLASMA OR PROTHROMBIN
COMPLEX CONCENTRATE?
B. Soria Santabarbara, N. Fernandez-Mosteirin, F. Sevil, C. Salvador-
Osuna, A. Godoy, N. Padron, M. Torres, J.F. Lucia, M. Giralt
Hospital Universitario Miguel Servet, ZARAGOZA, Spain
Background. Oral anticoagulation (OA) reversal may be required due to
bleeding, asymptomatic over anticoagulation or surgical procedures. The
anticoagulant effect may be reversed by a variety of Methods. vitamin K,
fresh frozen plasma (FFP) and prothrombin complex concentrates (PCCs).
Aims. To analize the characteristics of patients that have required rapid
OA reversal and to evaluate the results of the aplication of an OA reversal
guidelines. Patients and Methods. We reviewed the clinical files, demographic
and clinical parameters, and complications of patientes who
requiered OA reversal during a period of twelve months in our center.
According to our guidelines all patients received vitamin K and FFP (rapid
but no immediate reversal required) or PCC (immediate reversal).
Results. 73277 samples from 6464 anticoagulated patients were processed.
75 pacientes (1.16%) (33 male / 42 female), median age 76 years (range
38-86) received PCC; 40 patients (0.63%) (14 male / 26 female), median
age 79 years (range 49-92) received FFP. All patients were under
acenocumarol treatment but 3 (2 in PCC group and 1 in FFP taking warfarin).
OA indications in PCC patients: atrial fibrillation (FA) 45 (60%),
prosthetic heart valve (PV) 19 (25.3%), deep venous thrombosis
(DVT)/pulmonary embolism (PE) 8 (10.6%), myocardiopathy 3 (4%),
stroke 1 (1.3%), acute arterial ischemia (AAI) 1 (1.3%). OA indications in
FFP patients: FA 22 (55%), PV 9 (22.5%), DVT/PE 5 (12.5%), stroke 2
(5%) and mitral stenosis (MS) 2 (5%). In PCC group 8 (10.6%) patients
pressented a time from starting OA to PCC administration less than 4
weeks, in the remaining 67 patients median of OA treatment was 37.5
months (range 2-168). In FFP median time of OA was 47 months (0-168).
Median INR at the moment of PCC administration 3.18 (range 1.44-9.8)
and 3.93 (range 1.55-12) in FFP group. 22 patients in FFP group and 29 in
PCC group were over therapeutic anticoagulation levels.
Table 1.
FFP PCC
Indication/Number OA Indication/Number OA
Gastrointestinal Bleeding/16 10 AF, 4 PV, Intracraneal Bleeding/19 11 FA, 7 PV
1 DVT, 1 MS 1 DVT
Urgent surgery/11 4 FA, 3 DVT, Gastrointestinal 10 FA, 5 PV,
1 PE, 1 MS Bleeding/17 1 DVT,
1 AAI
Mucous Bleeding/6 3 AF, 2 Stroke, Urgent 16 FA, 7 PV,
1 PV surgery/28 2 DVT, 1 PE
2 DM
Hemoptysis/2 1 AF, 1 PV Hemoptysis/2 2 FA
Intestinal obstruction 1 PV Hematuria/2 1 FA, 1 PV
Intracraneal Bleeding/1 1 FA Invasive procedure 7 4 FA, 2 PV,
1 DVT
Retroperitoneal Bleeding/1 1 FA
DIC/1 1 PV
Thigh hematoma/1 1 FA
12 th Congress of the European Hematology Association
38 (50.6%) patients received PCC and 18 (45%) received FFP due to
major bleeding. Incidence of major bleeding in our serie 0.86%. After
PCC all patients normalized INR whereas 7 (17%) patients treated
with FFP pressented INR over 1.5 after administration. Thrombotic
complications after PCC administration were not observed. 3 (7.5%)
patiens treated with FFP presented complications due to volume overload
(cardiogenic shock, congestive heart failure and pulmonary edema).
In the group of PCC 6 (8%) patients died due to complications of
the acute event and 4 (10%) in the group of FFP. Conclusions. a) Anual
incidence of major bleeding in OA patients in our serie is slightly less
than described in literature. b) Administration of PCC is a safety and
effective treatment, able to achieve immediate reversal of OA. c)
According our results FFP takes more time to correct anticoagulation;
at the same time we must consider volume overload complications
due FFP administration.
0829
ELUSIVE ASSOCIATION BETWEEN THE ANTICARDIOLIPIN ANTIBODIES AND THE VENOUS
THROMBOEMBOLISM
J. Gonzalez-Ordonez, 1 C. Fernández-Canal, 2 M.E. Gonzalez, 2
M. Moran-Alcala, 1 D. Macias, 1 M.A. Arias1 1 Hospital San Agustin, AVILES; 2 Hospital de Cabueñes, GIJON, Spain
Background. The association of some antiphospholipid antibodies and
the venous thromboembolism (VTE) seems categorically established for
the lupus anticoagulant but is less conclusive for the other related autoantibodies.
Among them, the possible thrombogenic role attributed to
the anticardiolipin antibodies (ACA) is one of the most controversial
mainly due to methodological issues. In fact, the available clinical data
are influenced by the absence of reference material for calibration and
by discrepancies about the cut-off values used for the interpretation of
Results. We aim to know any possible association between anticardiolipin
antibodies (using methods for IgG and IgM isotypes) and the VTE
with regards to the influence of different cut-off levels. Population and
methods. We studied 574 subjects, 297 consecutive patients suffering an
episode of VTE objectively diagnosed (105 with pulmonary embolism
and 192 with deep venous thrombosis) and 277 healthy controls of similar
gender and age [in overall 61.9(13.9) y, 50.8% males]. The 21.5% of
the thrombotic episodes were recurrences. The blood sample of patients
was obtained several weeks after the oral anticoagulation withdraw
(around seven months after the acute thrombotic episode). We performed
a commercial enzyme-linked immunoabsorbant assay (ELISA)
for both isotypes (IgG and IgM) of the anticardiolipin antibodies (ACA)
in serum and a molecular identification of the main thrombophilic mutations
(FV Leiden or prothrombin 20210A). Results. ACA of IgG isotype.
Using the manufacturer criteria the 5% of samples (19 patients and 10
controls) were considered as positives (>15 U/mL) (non-significant difference).
We tested several arbitraries and statistical cut-off values (90th,
95th, 97.5th, 99th percentiles) obtaining a non-significant association
with the exception of a very weak one using the value of 20 U/mL [OR=
3.1 (1.1-9.2) (p