Coagulation management of a patient with factor V Leiden mutation, lupus anticoagulant, and activated protein C resistance: a case report

Acute Myocardial Infarction in Patients with Hereditary Thrombophilia-A Focus on Factor V Leiden and Prothrombin G20210A

Factor V (FV) Leiden and prothrombin G20210A are the most common hereditary thrombophilias. While their role in venous thromboembolism is well known, there are still uncertainties regarding their relationship with arterial thrombotic events, especially coronary ones. Our research, based on an in-depth analysis of the available literature, provides up-to-date information on the relationship between FV Leiden and prothrombin G20210A and acute myocardial infarction. FV Leiden and prothrombin G20210A screening should be implemented only in select cases, such as acute coronary syndrome in young individuals and/or in the absence of traditional cardiovascular risk factors and/or in the absence of significant coronary artery stenosis at angiography. Their identification should be followed by the implementation of optimal control of modifiable traditional cardiovascular risk factors to reduce the risk of recurrent events and genotyping and genetic counseling of all family members of affected cases for proper prophylaxis. An extended dual antiplatelet therapy (DAPT) may be considered, given the lower risk of bleeding under DAPT conferred by FV Leiden.

Neuroprotective Effect of Halophyte Salicornia herbacea L. Is Mediated by Activation of Heme Oxygenase-1 in Mouse Hippocampal HT22 Cells

Salicornia herbacea L. (glasswort, tungtungmadi in Korean), a halophyte that grows in salt marshes and muddy seashores along the western coast of Korea, has been used as a seasoning vegetable and a folk medicine for intestinal ailments, nephropathy, and hepatitis. As the salt-tolerant herb was reported to contain antioxidants, including tungtungmadic acid, quercetin, and chlorogenic acid, we hypothesized that the ethanolic extract of S. herbacea L. (SH extract) enriched with antioxidative compounds will have neuroprotective activity. The herbal extract and its methylene chloride (MC) fraction showed a strong protective effect against glutamate-induced cell death in murine hippocampal HT22 cells. In addition, SH extract and MC fraction not only scavenged reactive oxygen species efficiently but also caused nuclear translocation of nuclear factor (erythroid-derived 2)-like 2 and subsequently significant induction of antioxidant enzymes such as NAD(P)H:quinone oxidoreductase, heme oxygenase 1 (HO-1), and glutathione reductase. Inhibition of the antioxidant enzyme HO-1 by tin protoporphyrin abolished the neuroprotective effect of the SH extract, suggesting an important role of HO-1 in protection against glutamate-induced neural damage. Metabolite profiling for ethanolic extract and solvent fractions of the herb suggested that diosmetin and a few unidentified compounds were responsible for the neuroprotective effect. Taken together, SH extract and its MC fraction exhibited a neuroprotective effect through Nrf2-mediated induction of antioxidant enzymes, such as HO-1, and warrant further in vivo and clinical studies to confirm its effects and potentially develop a neuroprotective salt substitute or dietary supplement.

Evidence-based patient safety advisory: blood dyscrasias

Rarely, patients with blood disorders may seek to undergo plastic surgery. Although plastic surgeons are not expected to diagnose or manage blood disorders, they should be able to recognize which patients are suitable for surgery and which should be referred to a hematologist before a procedure. This practice advisory provides an overview of the perioperative steps that should be completed to ensure appropriate care for patients with blood disorders.