Uric acid played a role in the association between gender and deep vein thrombosis in patients with stroke

Differences in Incidence of Preoperative Deep Vein Thrombosis and Coagulation Function at Admission in Younger and Older Adults With Hip Fracture

BACKGROUND

The objectives of this study were to analyze differences in deep vein thrombosis (DVT) incidence in both lower extremities before operation and blood coagulation function at admission in younger and older adults with hip fracture and to guide DVT prevention in these patients.

MATERIALS AND METHODS

The 505 hip fracture patients enrolled in this research were sorted into an older adult (≥60 years) group (424 cases) and a younger adult group (81 cases) based on age. Preoperative DVT incidence in both lower extremities was analyzed. Differences in demographic characteristics, comorbidities, and preoperative DVT incidence in both lower extremities, blood coagulation function, and platelet count at admission were compared.

RESULTS

Preoperative DVT incidence in both lower extremities in hip fracture patients increased with age. Compared with the younger adult group, preoperative DVT incidence in both lower extremities was higher, the ratio of women was higher, the ratio of patients with comorbidities (eg, hypertension, diabetes) was higher, fibrinogen was higher, and antithrombin III was lower in the older adult group.

CONCLUSION

Preoperative DVT incidence in both lower extremities in these patients increased with age. Compared with the younger adult group, preoperative DVT incidence was higher, hypercoagulable state was more obvious, and anticoagulant activity was weaker in the older adult group. This may be related to more patients of advanced age, a higher ratio of female patients, and more comorbidities. Advanced age (≥60 years) is the independent risk factor for preoperative DVT. [Orthopedics. 2025;48(3):139-145.].

Predictors and outcomes of deep venous thrombosis in patients with acute ischemic stroke: results from the Chinese Stroke Center Alliance

BACKGROUND

No large-scale, multicenter studies have explored the incidence rate and predictors of deep vein thrombosis (DVT) in patients with acute ischemic stroke (AIS). We aimed to determine the risk factors of DVT, and assess the association between DVT and clinical outcomes in AIS patients.

METHODS

In total, 106,612 patients with AIS enrolled in the Chinese Stroke Center Alliance between August 2015 and July 2019 were included. The predictors of DVT in AIS patients were screened based on the logistic regression analysis for the comparison of the characteristics and clinical outcomes of patients with and without DVT.

RESULTS

The overall incidence of DVT after AIS was 4.7%. Factors associated with increased incidence of DVT included advanced age, female sex, high admission National Institutes of Health Stroke Scale score, history of cerebral hemorrhage, transient ischemic attack (TIA), dyslipidemia, atrial fibrillation, and peripheral vascular disease, International Normalized Ratio (INR) <0.8 or >1.5, and blood uric acid >420 μmol/L. Ambulation and early antithrombotic therapy were associated with a lower incidence of DVT. Patients with DVT was associated with longer hospital stay (OR=1.44, 95% CI: 1.35-1.54), and higher in-hospital mortality (OR=1.68, 95% CI: 1.25-2.27).

CONCLUSIONS

This large-scale, multi-center study showed that the occurrence of DVT in AIS patients is associated with various modifiable and objective indicators, such as abnormal INR and uric acid >420 μmol/L. Ambulatory status and early antithrombotic therapy can reduce the occurrence of DVT in AIS patients. In AIS patients, DVT may prolong the hospital stay and increase the risk of in-hospital mortality. Future research should focus on the clinical implementation of existing evidence on DVT prevention in AIS patients.

TMEM16F mediated phosphatidylserine exposure and microparticle release on erythrocyte contribute to hypercoagulable state in hyperuricemia

The link between hyperuricemia (HUA) and the risk of venous thromboembolism (VTE) has been well established. However, the mechanisms of thrombus generation and the effect of HUA on procoagulant activity (PCA) of erythrocytes remain unclear no matter in uremia or hyperuricemia. Here, phosphatidylserine (PS) exposure, microparticles (MPs) release, cytosolic Ca2+, TMEM16F expression, reactive oxygen species (ROS) and lipid peroxidation of erythrocyte were detected by flow cytometer. PCA was assessed by coagulation time, purified coagulation complex and fibrin production assays. The fibrin formation was observed by scanning electron microscopy (SEM). We found that PS exposure, MPs generation, TMEM16F expression and consequent PCA of erythrocyte in HUA patients significantly increased compared to those in healthy volunteers. Furthermore, high UA induced PS exposure, and MPs release of erythrocyte in concentration and time-dependent manners in vitro, which enhanced the PCA of erythrocyte and was inhibited by lactadherin, a PS inhibitor. Additionally, using SEM, we also observed compact fibrin clots with highly-branched networks and thin fibers supported by red blood cells (RBCs) and RBC-derived MPs (RMPs). Importantly, we demonstrated UA enhanced the production of ROS and lipid peroxidation and reduced the generation of glutathione (GSH) of erythrocyte, which enhanced TMEM16F activity and followed PS externalization and RMPs formation. Collectively, these results suggest that Ca2+-dependent TMEM16F activation may be responsible for UA-induced PS exposure and MPs release of RBC, which thereby contribute to the prothrombotic risk in HUA.