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  1. Article ; Online: A call to action: MTHFR polymorphisms should not be a part of inherited thrombophilia testing.

    Deloughery, Thomas G / Hunt, Beverley J / Barnes, Geoffrey D / Connors, Jean M

    Research and practice in thrombosis and haemostasis

    2022  Volume 6, Issue 4, Page(s) e12739

    Abstract: Testing for polymorphisms in the methylenetetrahydrofolate reductase (MTHFR) gene is still a standard part of thrombophilia testing in many laboratories. However, it is clear that these polymorphisms are not risk factors for arterial or venous thrombosis ...

    Abstract Testing for polymorphisms in the methylenetetrahydrofolate reductase (MTHFR) gene is still a standard part of thrombophilia testing in many laboratories. However, it is clear that these polymorphisms are not risk factors for arterial or venous thrombosis and therefore should not be part of thrombophilia testing. Eliminating MTHFR from thrombophilia testing will reduce patient concerns and health care costs.
    Language English
    Publishing date 2022-06-08
    Publishing country United States
    Document type Journal Article
    ISSN 2475-0379
    ISSN (online) 2475-0379
    DOI 10.1002/rth2.12739
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  2. Article ; Online: Clinical study applying machine learning to detect a rare disease: results and lessons learned.

    Hersh, William R / Cohen, Aaron M / Nguyen, Michelle M / Bensching, Katherine L / Deloughery, Thomas G

    JAMIA open

    2022  Volume 5, Issue 2, Page(s) ooac053

    Abstract: Machine learning has the potential to improve identification of patients for appropriate diagnostic testing and treatment, including those who have rare diseases for which effective treatments are available, such as acute hepatic porphyria (AHP). We ... ...

    Abstract Machine learning has the potential to improve identification of patients for appropriate diagnostic testing and treatment, including those who have rare diseases for which effective treatments are available, such as acute hepatic porphyria (AHP). We trained a machine learning model on 205 571 complete electronic health records from a single medical center based on 30 known cases to identify 22 patients with classic symptoms of AHP that had neither been diagnosed nor tested for AHP. We offered urine porphobilinogen testing to these patients via their clinicians. Of the 7 who agreed to testing, none were positive for AHP. We explore the reasons for this and provide lessons learned for further work evaluating machine learning to detect AHP and other rare diseases.
    Language English
    Publishing date 2022-06-30
    Publishing country United States
    Document type Journal Article
    ISSN 2574-2531
    ISSN (online) 2574-2531
    DOI 10.1093/jamiaopen/ooac053
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  3. Article: Direct oral anticoagulants in gastrointestinal malignancies: is the convenience worth the risk?

    Thapa, Namisha / Shatzel, Joseph / Deloughery, Thomas G / Olson, Sven R

    Journal of gastrointestinal oncology

    2019  Volume 10, Issue 4, Page(s) 807–809

    Language English
    Publishing date 2019-07-30
    Publishing country China
    Document type Journal Article
    ZDB-ID 2594644-4
    ISSN 2219-679X ; 2078-6891
    ISSN (online) 2219-679X
    ISSN 2078-6891
    DOI 10.21037/jgo.2019.02.07
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  4. Article ; Online: Thrombosis and Bleeding in Extracorporeal Membrane Oxygenation (ECMO) Without Anticoagulation: A Systematic Review.

    Olson, Sven R / Murphree, Catherine R / Zonies, David / Meyer, Andrew D / Mccarty, Owen J T / Deloughery, Thomas G / Shatzel, Joseph J

    ASAIO journal (American Society for Artificial Internal Organs : 1992)

    2021  Volume 67, Issue 3, Page(s) 290–296

    Abstract: Extracorporeal membrane oxygenation (ECMO) causes both thrombosis and bleeding. Major society guidelines recommend continuous, systemic anticoagulation to prevent thrombosis of the ECMO circuit, though this may be undesirable in those with active, or ... ...

    Abstract Extracorporeal membrane oxygenation (ECMO) causes both thrombosis and bleeding. Major society guidelines recommend continuous, systemic anticoagulation to prevent thrombosis of the ECMO circuit, though this may be undesirable in those with active, or high risk of, bleeding. We aimed to systematically review thrombosis and bleeding outcomes in published cases of adults treated with ECMO without continuous systemic anticoagulation. Ovid MEDLINE, Cochrane CENTRAL and CDSR, and hand search via SCOPUS were queried. Eligible studies were independently reviewed by two blinded authors if they reported adults (≥18 years) treated with either VV- or VA-ECMO without continuous systemic anticoagulation for ≥24 hours. Patient demographics, clinical data, and specifics of ECMO technology and treatment parameters were collected. Primary outcomes of interest included incidence of bleeding, thrombosis of the ECMO circuit requiring equipment exchange, patient venous or arterial thrombosis, ability to wean off of ECMO, and mortality. Of the 443 total publications identified, 34 describing 201 patients met our inclusion criteria. Most patients were treated for either acute respiratory distress syndrome or cardiogenic shock. The median duration of anticoagulant-free ECMO was 4.75 days. ECMO circuity thrombosis and patient thrombosis occurred in 27 (13.4%) and 19 (9.5%) patients, respectively. Any bleeding and major or "severe" bleeding was reported in 66 (32.8%) and 56 (27.9%) patients, respectively. Forty patients (19%) died. While limited by primarily retrospective data and inconsistent reporting of outcomes, our systematic review of anticoagulant-free ECMO reveals an incidence of circuity and patient thrombosis comparable to patients receiving continuous systemic anticoagulation while on ECMO.
    MeSH term(s) Adult ; Anticoagulants/therapeutic use ; Extracorporeal Membrane Oxygenation/adverse effects ; Female ; Hemorrhage/epidemiology ; Hemorrhage/etiology ; Humans ; Incidence ; Male ; Middle Aged ; Retrospective Studies ; Thrombosis/epidemiology ; Thrombosis/etiology ; Thrombosis/prevention & control
    Chemical Substances Anticoagulants
    Language English
    Publishing date 2021-02-21
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Systematic Review
    ZDB-ID 759982-1
    ISSN 1538-943X ; 0162-1432 ; 1058-2916
    ISSN (online) 1538-943X
    ISSN 0162-1432 ; 1058-2916
    DOI 10.1097/MAT.0000000000001230
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Non-vitamin K antagonist oral anticoagulants for heparin-induced thrombocytopenia. A systematic review of 54 reported cases.

    Shatzel, Joseph J / Crapster-Pregont, Meg / Deloughery, Thomas G

    Thrombosis and haemostasis

    2016  Volume 116, Issue 2, Page(s) 397–400

    Language English
    Publishing date 2016-08-01
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 518294-3
    ISSN 0340-6245
    ISSN 0340-6245
    DOI 10.1160/TH16-02-0101
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  6. Article ; Online: The efficacy and safety of direct oral anticoagulants vs traditional anticoagulants in cirrhosis.

    Hum, Justine / Shatzel, Joseph J / Jou, Janice H / Deloughery, Thomas G

    European journal of haematology

    2017  Volume 98, Issue 4, Page(s) 393–397

    Abstract: Introduction: The coagulopathy of cirrhosis is complex, placing patients at risk for both bleeding and thrombosis. Direct oral anticoagulants (DOACs) have equivalent or superior efficacy and safety as compared to vitamin K antagonists (VKAs); however, ... ...

    Abstract Introduction: The coagulopathy of cirrhosis is complex, placing patients at risk for both bleeding and thrombosis. Direct oral anticoagulants (DOACs) have equivalent or superior efficacy and safety as compared to vitamin K antagonists (VKAs); however, their efficacy and safety in liver cirrhosis has not been studied. To better define this, we evaluated outcomes of patients with cirrhosis prescribed DOACs compared to other anticoagulants at our center.
    Methods: Retrospective cohort study of patients with cirrhosis prescribed therapeutic anticoagulation over a 3-year period for thrombosis or prevention of stroke in patients with atrial fibrillation. The primary outcomes of interest were bleeding events and recurrent thrombosis or stroke.
    Results: During the study period, 27 patients with cirrhosis were prescribed a DOAC and 18 were prescribed VKA or low molecular weight heparin (LMWH). Both groups had similar total bleeding events (8 DOAC vs 10 other, P=.12). There were significantly less major bleeding episodes in the DOAC group (1 [4%] vs 5 [28%], P=.03). Recurrent thrombosis occurred in one patient receiving a DOAC (4%) and one patient (6%) receiving other anticoagulation (P=1.0).
    Conclusions: Direct oral anticoagulant use in patients with cirrhosis may be as safe as traditional anticoagulants. Patients with cirrhosis at our center prescribed DOACs had less major bleeding events, while maintaining efficacy at preventing stroke or thrombosis.
    MeSH term(s) Administration, Oral ; Adult ; Aged ; Aged, 80 and over ; Anticoagulants/administration & dosage ; Anticoagulants/adverse effects ; Female ; Hemorrhage/chemically induced ; Hemorrhage/epidemiology ; Humans ; Liver Cirrhosis/drug therapy ; Liver Cirrhosis/epidemiology ; Male ; Middle Aged ; Stroke/epidemiology ; Stroke/prevention & control ; Thrombosis/epidemiology ; Thrombosis/prevention & control ; Vitamin K/antagonists & inhibitors
    Chemical Substances Anticoagulants ; Vitamin K (12001-79-5)
    Language English
    Publishing date 2017-04
    Publishing country England
    Document type Clinical Trial ; Comparative Study ; Journal Article
    ZDB-ID 392482-8
    ISSN 1600-0609 ; 0902-4441
    ISSN (online) 1600-0609
    ISSN 0902-4441
    DOI 10.1111/ejh.12844
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    Zs.A 323: Show issues Location:
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  7. Article ; Online: Direct thrombin inhibitors for the treatment of venous thromboembolism: analysis of the Dabigatran versus Warfarin clinical trial.

    Liem, Timothy K / Deloughery, Thomas G

    Seminars in vascular surgery

    2011  Volume 24, Issue 3, Page(s) 157–161

    Abstract: Vitamin-K antagonists have played a dominant role in the long-term management of patients with venous thromboembolism, and large trials from the past decade reinforced warfarin's effectiveness as an intermediate-duration and extended-duration ... ...

    Abstract Vitamin-K antagonists have played a dominant role in the long-term management of patients with venous thromboembolism, and large trials from the past decade reinforced warfarin's effectiveness as an intermediate-duration and extended-duration anticoagulant. However, promising new oral direct thrombin inhibitors are proving to be at least as effective and as safe as the vitamin-K antagonists, without the associated hepatic toxicity that was seen with earlier orally administered direct thrombin inhibitors. This article reviews the recently published Dabigatran versus Warfarin in the Treatment of Acute Venous Thromboembolism clinical trial, and discusses the limitations and clinical applicability of the trial, especially in comparison with vitamin-K antagonists and the recently studied oral direct factor Xa inhibitors, rivaroxaban and apixaban.
    MeSH term(s) Anticoagulants/therapeutic use ; Antithrombins/therapeutic use ; Benzimidazoles/therapeutic use ; Dabigatran ; Humans ; Randomized Controlled Trials as Topic/methods ; Venous Thromboembolism/drug therapy ; Warfarin/therapeutic use ; beta-Alanine/analogs & derivatives ; beta-Alanine/therapeutic use
    Chemical Substances Anticoagulants ; Antithrombins ; Benzimidazoles ; beta-Alanine (11P2JDE17B) ; Warfarin (5Q7ZVV76EI) ; Dabigatran (I0VM4M70GC)
    Language English
    Publishing date 2011-09
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 645131-7
    ISSN 1558-4518 ; 0895-7967
    ISSN (online) 1558-4518
    ISSN 0895-7967
    DOI 10.1053/j.semvascsurg.2011.11.003
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  8. Article ; Online: The "platelet boilermaker": A treatment protocol to rapidly increase platelets in patients with immune-mediated thrombocytopenia.

    Olson, Sven R / Chu, Charles / Shatzel, Joseph J / Deloughery, Thomas G

    American journal of hematology

    2016  Volume 91, Issue 8, Page(s) E330–1

    Language English
    Publishing date 2016-08
    Publishing country United States
    Document type Letter
    ZDB-ID 196767-8
    ISSN 1096-8652 ; 0361-8609
    ISSN (online) 1096-8652
    ISSN 0361-8609
    DOI 10.1002/ajh.24409
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  9. Article: Non-vitamin K antagonist oral anticoagulants for heparin-induced thrombocytopenia. A systematic review of 54 reported cases

    Shatzel, Joseph J. / Crapster-Pregont, Meg / Deloughery, Thomas G.

    Thrombosis and Haemostasis

    2016  Volume 116, Issue 08, Page(s) 397–400

    Abstract: Supplementary Material to this article is available at www.thrombosis-online.com. ...

    Abstract Supplementary Material to this article is available at www.thrombosis-online.com.
    Language English
    Publishing date 2016-02-01
    Publisher Schattauer GmbH
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 518294-3
    ISSN 2567-689X ; 0340-6245
    ISSN (online) 2567-689X
    ISSN 0340-6245
    DOI 10.1160/TH16-02-0101
    Database Thieme publisher's database

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  10. Article ; Online: Prevalence and Clinical Significance of Incidental Vertebral Marrow Signal Abnormality in Thoracolumbar Spine MRI.

    Carlson, Hans L / Thompson, Austin R / Pettersson, David R / Goodwin, Brady / Deloughery, Thomas G / Carlson, Nels L / Marshall, Lynn M

    Spine

    2019  Volume 45, Issue 6, Page(s) 390–396

    Abstract: Study design: A cross-sectional study.: Objective: This study investigates the prevalence of incidental vertebral marrow signal abnormality (VMSA) in thoracolumbar spine magnetic resonance imaging (MRI) ordered for the evaluation of back and/or leg ... ...

    Abstract Study design: A cross-sectional study.
    Objective: This study investigates the prevalence of incidental vertebral marrow signal abnormality (VMSA) in thoracolumbar spine magnetic resonance imaging (MRI) ordered for the evaluation of back and/or leg pain and assess the clinical work-up for VMSAs.
    Summary of background data: Patients presenting with back pain are often referred for spine MRI for diagnostic evaluation. VMSA is most frequently found in the lumbar spine and is of clinical concern because it can represent malignancy. Standardized procedures for reporting and managing VMSAs do not exist.
    Methods: The radiology database at the Oregon Health & Science University health system was queried to identify patients with thoracolumbar spine MRI scans performed between January 2014 and June 2016. Patients 16 years or older with MRIs ordered by providers at a multidisciplinary spine specialty clinic for the diagnostic evaluation of back and/or leg pain were included. Radiology reports were searched for keywords pertaining to VMSAs, such as "malignancy." Medical records of these patients were further reviewed for the clinical work-up and final diagnoses pertaining to the VMSA.
    Results: The study sample included 1503 individual patients, of whom 65 (4%) had MRI radiology reports that described a VMSA. Thirty-one (48%) of the 65 patients with VMSAs had further evaluation recommended by radiology. Ten (32%) of these 31 patients were followed clinically without further diagnostic testing for the VMSA. Of the 65 patients with VMSAs, only one was diagnosed with malignancy (multiple myeloma).
    Conclusion: While VMSAs are not frequently found on thoracolumbar MRIs ordered to evaluate back and/or leg pain, there is a large amount of heterogeneity in how these abnormalities are documented and managed. This may indicate the need for clinical guidelines for the reporting and management of VMSAs detected on spine MRI and for improvement in communication between radiologists and ordering providers.
    Level of evidence: 3.
    MeSH term(s) Adult ; Aged ; Back Pain/diagnostic imaging ; Back Pain/etiology ; Bone Marrow/diagnostic imaging ; Connective Tissue Diseases/complications ; Connective Tissue Diseases/diagnostic imaging ; Connective Tissue Diseases/epidemiology ; Cross-Sectional Studies ; Female ; Follow-Up Studies ; Humans ; Incidental Findings ; Lumbar Vertebrae/diagnostic imaging ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Musculoskeletal Abnormalities/complications ; Musculoskeletal Abnormalities/diagnostic imaging ; Musculoskeletal Abnormalities/epidemiology ; Prevalence ; Thoracic Vertebrae/diagnostic imaging
    Language English
    Publishing date 2019-10-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 752024-4
    ISSN 1528-1159 ; 0362-2436
    ISSN (online) 1528-1159
    ISSN 0362-2436
    DOI 10.1097/BRS.0000000000003278
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