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Life
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Coagulation and Its Disorders: From Molecular Mechanisms to Clinical Management
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Coagulation and Its Disorders: From Molecular Mechanisms to Clinical Management

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Physiology and Pathology".

Deadline for manuscript submissions: closed (30 July 2024) | Viewed by 3678

Special Issue Editor

Dr. Anna Lisa Montemari

E-Mail Website
Guest Editor
Clinical Laboratory Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
Interests: coagulation; inflammation; diabetes; laboratory medicine

Special Issue Information

Dear Colleagues,

Coagulation is a dynamic process triggered by controlled proteolytic activation through the intrinsic and extrinsic pathways that include a set of coagulation proteins. Any genetic mutation or functional defect involving coagulation factors modifies thrombin generation, resulting in bleeding or thrombosis. Several infectious and inflammatory diseases, organ failures, genetic mutations, and syndromes may impact coagulation mechanisms, with consequences ranging from minor alterations to severe disseminated intravascular coagulation (DIC). Also, pharmacological treatments may have repercussions in the coagulation system.

Understanding the molecular mechanisms of diseases is the basis of supervising coagulative impairments and may help to develop new therapeutic approaches to rescue or control the proteolytic cascade. New-drug development and experimentation may help to modulate them and to prevent bleeding or clot formation, resulting in clinical features and prognosis enhancement when translated in animal models or in humans.

Laboratory diagnostics plays a crucial role in diagnosis and treatment paths. Special attention must be paid to the choice of laboratory method, and its execution and dedicated personnel, space, and equipment are indispensable.

This Special Issue aims to collect the most recent knowledge in the field, accepting original research articles and reviews related to coagulation disorders, their molecular mechanisms, diagnostic tests, and novel treatment strategies. 

Dr. Anna Lisa Montemari
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Life is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • coagulation
  • bleeding disorders
  • thrombotic mechanisms
  • animal models
  • molecular mechanisms
  • disseminated intravascular coagulation
  • fibrinolysis
  • new diagnostic tools and treatment
  • inflammatory response
  • thrombin generation
  • coagulation alterations induced by hepatic and metabolic disorders
  • drug-induced coagulation alterations

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Published Papers (4 papers)

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12 pages, 1114 KiB  
Article
Bleeding Symptoms in Pediatric Patients with Congenital FVII Deficiency and Correlation to Thrombin Generation Assay Parameters: A Single-Center Retrospective Analysis
by Giovina Di Felice, Sonia Iavarone, Anna Lisa Montemari, Costanza Tripiciano, Michela Massoud, Simona Pezzi, Chiara Giorni, Ottavia Porzio and Matteo Luciani
Life 2024, 14(12), 1559; https://doi.org/10.3390/life14121559 - 27 Nov 2024
Viewed by 275
Abstract
Inherited factor VII deficiency is the most common rare bleeding disorder, affecting about 1/500,000 individuals without gender predilection. Most of the patients with FVII 20–50% are asymptomatic, but post-traumatic or post-surgical bleeding may often occur since there is not an exact correlation between [...] Read more.
Inherited factor VII deficiency is the most common rare bleeding disorder, affecting about 1/500,000 individuals without gender predilection. Most of the patients with FVII 20–50% are asymptomatic, but post-traumatic or post-surgical bleeding may often occur since there is not an exact correlation between FVII plasma levels and the bleeding phenotype. We enrolled 19 children and adolescents with FVII levels of 20–35% and 33 controls. Laboratory data collected included thrombin generation, prothrombin time, activated partial thromboplastin time, fibrinogen, and FVII levels. In our study, we found a statistical difference in the lag time ratio (p < 0.01) and tt-peak ratio (p < 0.05) between patients and controls but no difference in the other parameters, such as the endogenous thrombin potential (ETP). However, when we categorized patients, regardless of their bleeding scores, as presenting symptoms and having no symptoms, both the lag time ratio (p = 0.01) and tt-peak ratio (p < 0.05) were significantly different, and the vel. index % showed increased levels in patients without symptoms (p < 0.05). This study shows that thrombin generation may be a useful tool in assessing the risk of bleeding symptoms in children with an FVII deficiency categorized in the mild category (20–35%), although we cannot predict the severity of the bleeding. Full article
(This article belongs to the Special Issue Coagulation and Its Disorders: From Molecular Mechanisms to Clinical Management)
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14 pages, 446 KiB  
Article
Optimizing Continuous Renal Replacement Therapy with Regional Citrate Anticoagulation: Insights from the ORCA Trial—A Retrospective Study on 10 Years of Practice
by Rita Jacobs, Walter Verbrugghe, Jason Bouziotis, Ingrid Baar, Karolien Dams, Annick De Weerdt and Philippe G. Jorens
Life 2024, 14(10), 1304; https://doi.org/10.3390/life14101304 - 14 Oct 2024
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Abstract
(1) Background: Citrate is preferred in continuous renal replacement therapy (CRRT) for critically ill patients because it prolongs filter life and reduces bleeding risks compared to unfractionated heparin (UFH). However, regional citrate anticoagulation (RCA) can lead to acid–base disturbances, citrate accumulation, and overload. [...] Read more.
(1) Background: Citrate is preferred in continuous renal replacement therapy (CRRT) for critically ill patients because it prolongs filter life and reduces bleeding risks compared to unfractionated heparin (UFH). However, regional citrate anticoagulation (RCA) can lead to acid–base disturbances, citrate accumulation, and overload. This study compares the safety and efficacy of citrate-based CRRT with UFH and no anticoagulation (NA) in acute kidney injury (AKI) patients. (2) Methods: A retrospective analysis was conducted on adult patients (≥18 years) who underwent CRRT from July 2010 to June 2021 in an intensive care unit. (3) Results: Among 829 AKI patients on CRRT: 552 received RCA, 232 UFH, and 45 NA. The RCA group had a longer filter lifespan compared to UFH and NA (56 h [IQR, 24–110] vs. 36.0 h [IQR, 17–63.5] vs. 22 h [IQR, 12–48]; all Padj < 0.001). Bleeding complications were fewer in the RCA group than in the UFH group (median 3 units [IQR, 2–7 units] vs. median 5 units [IQR, 2–12 units]; Padj < 0.001) and fewer in the NA group than in the UFH group (median 3 units [IQR, 1–5 units] vs. 5 units [IQR, 2–12 units]; Padj = 0.03). Metabolic alkalosis was more common in the RCA group (32.5%) compared to the UFH (16.2%) and NA (13.5%) groups, while metabolic acidosis persisted more in the UFH group and NA group (29.1% and 34.6%) by the end of therapy vs. the citrate group (16.8%). ICU mortality was lower in the RCA group (52.7%) compared to the UFH group (63.4%; Padj = 0.02) and NA group (77.8%; Padj = 0.003). (4) Conclusions: Citrate anticoagulation outperforms heparin-based and no anticoagulation in filter patency, potentially leading to better outcomes through improved therapy effectiveness and reduced transfusion needs. However, careful monitoring is crucial to limit potential complications attributable to its use. Full article
(This article belongs to the Special Issue Coagulation and Its Disorders: From Molecular Mechanisms to Clinical Management)
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12 pages, 3317 KiB  
Case Report
Postoperative Thrombocytopenia after Revision Arthroplasty: Features, Diagnostic and Therapeutic Considerations
by Carmen Saguna, Nicoleta Mariana Berbec, Marian Platon, Alexandra Marcoci, Andreea Jercan, Andrei Colita, Mihai Emanuel Gherghe, Dana-Georgiana Nedelea, Romica Cergan, Cristian Scheau and Serban Dragosloveanu
Life 2024, 14(9), 1124; https://doi.org/10.3390/life14091124 - 6 Sep 2024
Cited by 1 | Viewed by 615
Abstract
We present the case of a 66 year-old male patient who developed severe postoperative thrombocytopenia after revision total hip arthroplasty. The patient underwent surgery in a dedicated orthopedics hospital and was initially managed in the intensive care unit. Upon the development of thrombocytopenia, [...] Read more.
We present the case of a 66 year-old male patient who developed severe postoperative thrombocytopenia after revision total hip arthroplasty. The patient underwent surgery in a dedicated orthopedics hospital and was initially managed in the intensive care unit. Upon the development of thrombocytopenia, he was referred to a dedicated hematology clinic for investigation and advanced management. A thorough diagnostic algorithm was employed in order to rule out the main causes of thrombocytopenia. By exclusion, we diagnosed the patient as suffering from a rare and severe form of postoperative thrombocytopenia through an immune mechanism. Although postoperative thrombocytopenia is relatively frequent but transitory and no treatment is required, this condition was refractory to corticosteroids and substitution therapy; however, it quickly responded to treatment with thrombopoietin receptor agonists. The patient recovered and was successfully discharged with normal platelet values. While rare occurrences, alternative causes of thrombocytopenia such as infection, drug-induced, or immune should be considered in patients developing postoperative thrombocytopenia. Full article
(This article belongs to the Special Issue Coagulation and Its Disorders: From Molecular Mechanisms to Clinical Management)
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9 pages, 1187 KiB  
Brief Report
Are Gamers Prone to eThrombosis during Long Gaming Sessions?
by Kasper B. Krarup, Henrik B. Krarup, Morten Mørk, Søren Lundbye-Christensen, Aase Handberg, Hien T. T. Nguyen, Inge S. Pedersen and Søren R. Kristensen
Life 2024, 14(4), 525; https://doi.org/10.3390/life14040525 - 18 Apr 2024
Viewed by 1308
Abstract
During the last two decades, several cases of venous thrombosis (VTE) after a prolonged period at a computer have been described, denominated as “eThrombosis”. Video gaming on a computer has become very popular and can be a social activity where several players gather [...] Read more.
During the last two decades, several cases of venous thrombosis (VTE) after a prolonged period at a computer have been described, denominated as “eThrombosis”. Video gaming on a computer has become very popular and can be a social activity where several players gather to play against each other or in a virtual environment for several days (“LAN (i.e., Local Area Network) parties”) where the participants are sedentary and consuming calorie-rich food items. The aim of this study was to investigate potential coagulation activation during a 42 h LAN party. Nine male gamers volunteered for the LAN party. Citrated blood was sampled before and every 6 h, and plasma was analyzed for thrombin generation, thrombin–antithrombin complexes (TAT), prothrombin fragment 1 + 2 (F1 + 2), and D-dimer. Thrombin generation increased slightly but not significantly during the LAN party, whereas the coagulation activation markers were unchanged. These results do not indicate that the coagulation system is activated significantly during 42 h of gaming with minimal physical activity. Although increased activity cannot be excluded, it does not directly indicate a risk of VTE in general. Full article
(This article belongs to the Special Issue Coagulation and Its Disorders: From Molecular Mechanisms to Clinical Management)
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