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Splenic and portal vein thrombosis (SPVT) is an alarming and potentially life-threatening complication of splenectomy. Prospective and retrospective studies have shown the incidence of symptomatic SPVT to be between 0% [...], Background: Splenic and portal vein thrombosis (SPVT) is a potentially life-threatening complication of splenectomy. There is a paucity of studies examining the role of prophylactic pre- and postoperative anticoagulation in the prevention of this complication. We designed a prospective randomized controlled trial (RCT) to more rigorously address the impact of prophylactic anticoagulation on the incidence of asymptomatic or symptomatic SPVT, detected on Doppler ultrasound, after laparoscopic splenectomy. Methods: This 2-centre, phase II, prospective, open-label, parallel-assignment RCT compared no postoperative anticoagulation to a regimen of 40 mg of enoxaparin subcutaneously once daily for 21 days. All patients underwent Doppler ultrasonography of the splenoportal system preoperatively and again 14-28 days after surgery to screen for nonocclusive or occlusive thrombosis. Results: From November 2006 to November 2008, 35 patients were enrolled in the RCT. Four patients withdrew, 1 required conversion to an open procedure and 1 died at 3 months (the cause of death was not related to the study). Of the 29 patients remaining, 15 were randomly assigned to the anticoagulation group and 14 to the nonanticoagulation group. One (3.4%) patient in the treatment group experienced portal thrombosis. Rates of postoperative bleeding were similar in both groups. Conclusion: This RCT of anticoagulation found a low overall risk of SPVT after laparoscopic splenectomy; however, this is an underpowered study, and further multicentred clinical trials are needed. Contexte : La thrombose de la veine splenique et porte (TVSP) est une complication de la splenectomie qui peut menacer la vie. Peu d'etudes se sont penchees sur le role de l'anticoagulation pre-operatoire et postoperatoire prophylactique dans la prevention de cette complication. Nous avons concu un essai controle randomise (ECR) prospectif afin d'analyser plus rigoureusement l'effet de l'anticoagulation prophylactique sur l'incidence de la TVSP asymptomatique ou symptomatique, detectee par echographie Doppler, apres une splenectomie par laparoscopie. Methodes : Au cours de cet ECR multicentrique de phase 2, prospectif, ouvert et a repartition en groupes paralleles, nous avons compare l'absence d'anticoagulation postoperatoire a un regime de 40 mg d'enoxaparine administree par voie sous-cutanee 1 fois par jour pendant 21 jours. Tous les patients ont subi une echographie Doppler du systeme splenoporte avant l'intervention et de nouveau de 14 a 28 jours apres l'intervention afin de depister la presence d'une thrombose non occlusive ou occlusive. Resultats : De novembre 2006 a novembre 2008, 35 patients ont ete inscrits a l'ECR. Quatre patients s'en sont retires, il a fallu dans 1 cas proceder a une intervention ouverte et 1 patient est decede a 3 mois (la cause du deces etant sans rapport avec l'etude). Sur les 29 patients restants, 15 ont ete affectes par randomisation au groupe de ceux qui ont recu une anticoagulation et 14, au groupe des patients qui n'en ont pas recu. Un patient (3,4 %) du groupe traite a subi une thrombose de la veine porte. Les taux de saignement postoperatoire etaient semblables dans les 2 cas. Conclusion : Cet ECR sur l'anticoagulation a revele un faible risque global de TVSP apres une splenectomie par laparoscopie, mais il s'agit d'une etude qui manque de puissance et d'autres essais randomises multicentriques s'imposent.

The presence of antiphospholipid antibodies associated with recurrent vascular thrombosis and/or pregnancy complications is characteristic for antiphospholipid syndrome. (1,2) Lupus anticoagulant (LA) is a heterogeneous group of antiphospholipid antibodies directed [...], * Context.--Lupus anticoagulant (LA) is a heterogeneous group of antiphospholipid antibodies. Among others, diluted prothrombin time (dPT) is a sensitive screening test for LA; however, the interpretation of LA tests is difficult in patients treated with anticoagulants. The effect of different types of anticoagulants on the result of LA tests, particularly on dPT, has not been studied extensively. Objective.--To determine whether the direct thrombin inhibitors lepirudin and argatroban and the predominantly factor Xa inhibitors enoxaparin, danaparoid, and fondaparinux could interfere with LA screening based on dPT. Design.--Each drug was added to normal and LApositive plasmas in clinically relevant concentrations. Each sample was tested for dPT. Samples with factor Xa inhibitors were investigated before and after addition of heparinase. Mixing and confirmatory tests for LA were not performed. Results.--In the presence of lepirudin or argatroban, dPT increased notably and the dPT ratio exceeded the cutoff value even at subtherapeutic concentrations resulting in false positivity. With increasing factor Xa inhibitor concentrations, a linear increase of dPT ratios and falsepositive results were also demonstrated. Although heparinase could almost completely neutralize the anti-Xa effect of all investigated factor Xa inhibitors, dPT ratio returned to the basal level only in case of enoxaparin. Conclusions.--Here we provide evidence that both the direct thrombin and indirect factor Xa inhibitors influence dPT assay for LA, causing false positivity. This should be considered when interpreting LA results during anticoagulant therapy. However, dPT seems to be a reliable test for LA screening under enoxaparin therapy after neutralization by heparinase. (Arch Pathol Lab Med. 2013;137:967-973; doi: 10.5858/arpa.2012-0236-OA)

Aims: The objective of this study was to elicit whether anticoagulant medication (aspirin, NSAIDS, and warfarin) can affect the false positive rate of faecal occult blood (FOB) testing. The data [...]