Editor's Note: From June 22 to June 26, 2024, the 32nd International Society on Thrombosis and Haemostasis (ISTH 2024) conference was successfully held in Bangkok, Thailand. At this prestigious event, the research achievements of Dr. Litao Zhang's team from Wuhan Asia General Hospital shone brightly. Several studies on anticoagulation management were selected, showcasing their significant contributions and expertise in the field of thrombosis and hemostasis. "Oncology Frontier - Hematology Frontier" invited Dr. Litao Zhang to comprehensively interpret the research content of his team. Here, we have compiled and invite you to join us in sharing this academic breeze.Empowering Healthcare with Social Media: Exploring Warfarin Anticoagulation Management via Mini-Programs
At this ISTH conference, an oral presentation focused on warfarin anticoagulation management. Despite a decrease in its use in recent years, warfarin remains an indispensable treatment option for patients with heart valve diseases. Managing anticoagulation in this large patient group has long been a critical challenge.
In evaluating the quality of anticoagulation control, both domestic and international studies and guidelines commonly use the percentage of time in therapeutic range (TTR) of the International Normalized Ratio (INR) as a key indicator. However, existing data show that the TTR in the Chinese population is not ideal, with an anticoagulation target rate below 40%, far from the desired level of over 70%.
To address this issue, our team proposed a research plan to manage warfarin anticoagulation based on WeChat mini-programs, considering the widespread use of social media among the Chinese population. Through this mini-program, patients can conveniently record their warfarin monitoring results (i.e., INR values) and receive timely medication reminders and abnormal result alerts. Patients can also communicate their health information with the research team in real-time via the mini-program. The research team can access patients’ basic medication and medical information in real-time and notify relevant researchers through WeChat in case of abnormal results.
To verify the effectiveness of this management plan, we conducted a randomized clinical controlled trial. The control group used a conventional management model, where patients visited local medical institutions through outpatient services and used standardized anticoagulation record cards to record their results. After approximately one and a half years of follow-up, results showed that the experimental group managed via social media had significantly reduced coagulation events, with an anticoagulation quality target rate of over 70%, far exceeding the control group’s 50%.
A critical measure of anticoagulation quality is the variability of INR during anticoagulation. The experimental group showed remarkable stability, with rare occurrences of extreme high INR values, indicating that patients maintained a relatively stable anticoagulation range over time. When patients’ INR values exceed 5 or further rise above 10, timely interventions are necessary. In contrast, the control group had a significantly higher proportion of such extreme values.
Through this study, we confirmed that managing patients via social media is not only feasible but also highly effective in reducing bleeding risks and significantly improving the anticoagulation quality of warfarin patients in China. In the future, we will continue to expand the research scope, incorporating advanced technologies like machine learning and artificial intelligence to further enhance patient services. We believe these strategies will provide effective avenues for managing anticoagulation patients.
New Solution for VA-ECMO Anticoagulation Challenges: A Single-Center Study Reveals Flexible Low-Dose Anticoagulation Strategy Monitored by D-Dimer
At ISTH 2024, our team presented three research posters, and we will now focus on a single-center study on venous-arterial extracorporeal membrane oxygenation (VA-ECMO) anticoagulation management. Given the prevalent risks of bleeding and thrombosis during VA-ECMO anticoagulation, often exceeding half of the cases, our team has long collaborated closely with various hospital departments to explore more ideal anticoagulation strategies for this group.
Through this single-center retrospective study, we observed that monitoring laboratory D-dimer changes can be an effective way to achieve individualized anticoagulation adjustments for patients. Based on our clinical experience, VA-ECMO patients initially receive low-dose and low-intensity anticoagulation. If no thrombosis occurs and D-dimer does not significantly increase or remains stable, the low-intensity treatment continues. However, if D-dimer levels continuously rise, with the second result more than 1.5 times higher than the first and D-dimer values increasing fourfold or more, the anticoagulation intensity should be gradually increased. Additionally, if thrombosis forms during ECMO anticoagulation management, the anticoagulation intensity should also be increased.
This strategy differs from traditional ECMO anticoagulation guidelines, which do not apply a uniform standard of anticoagulation intensity to all patients. Over approximately 4-5 years, data from more than 130 ECMO patients showed that using this new anticoagulation strategy, bleeding events were nearly halved compared to the control group, without a significant increase in thrombosis events. Therefore, for Chinese ECMO patients, this anticoagulation strategy is undoubtedly a promising approach.
However, there are still several key details that need to be clarified and refined for this strategy, such as the specific multiples of D-dimer increase and the optimal timing for monitoring. Looking ahead, we will continue to seek better anticoagulation strategies to ensure that ECMO patients, even in critical conditions, can effectively reduce bleeding risks and thrombosis incidence, thereby smoothly navigating through dangerous periods.
Leaders in the Wave of Intelligence: Wuhan Asia General Hospital’s Innovations in Artificial Intelligence
Wuhan Asia General Hospital’s coagulation team has long been dedicated to research and practice in cardiovascular-related coagulation management, anticoagulation management, and critical coagulation management. Artificial intelligence, as a research focus that has garnered much attention in recent years, is increasingly demonstrating its practical applications and contributions to medical development. To fully harness its unique value, it is necessary to further identify and focus on specific niche scenarios as breakthroughs to promote the in-depth application and development of artificial intelligence in the medical field.
Taking warfarin treatment management as an example, although it does not pose a significant challenge for experienced medical experts, the process involves more than simple drug adjustments. The treatment process requires rigorous and meticulous medical decisions to ensure effectiveness and safety. Managing patients accumulates a wealth of successful and failed treatment data. By using machine learning or artificial intelligence technology to deeply process and learn from this data, corresponding medical models can be constructed. These models can address most of the issues encountered in warfarin treatment management, such as dosage adjustment strategies, monitoring timing, and interpretation of monitoring results. This innovative initiative is expected to significantly reduce the heavy clinical burden on healthcare workers and effectively increase the number of patients served, thereby improving the efficiency and quality of medical services. Currently, our hospital has achieved some results in this area, successfully constructing and implementing several models that have shown promising effects and clinical value.
Furthermore, we can explore innovative coagulation-related automated scoring systems based on artificial intelligence to further promote the intelligent development of the medical field. Currently, there are numerous clinical scoring systems related to coagulation, such as disseminated intravascular coagulation (DIC) scoring, heparin-induced thrombocytopenia (HIT) scoring, and liver function-related scoring. These scoring systems usually require a lot of information to be filled in, making the process complex and cumbersome, which can be problematic for clinical staff and negatively affect scoring accuracy. By using artificial intelligence for natural language processing and learning from medical records and laboratory results, clinicians can update and track patient scores in real-time and with precision, providing strong support for diagnosis and treatment in coagulation disease management. Wuhan Asia General Hospital’s multidisciplinary team is actively exploring and researching this field, making it a core focus for breakthroughs.
Litao Zhang
Associate Professor, Associate Chief Technician, Director of the Laboratory Department at Wuhan Asia General Hospital. In 2019, he was a visiting scholar at the Hematology Department of the Royal Liverpool Hospital, University of Liverpool, UK. He specializes in clinical communication, laboratory management, and clinical research of complex thrombosis and hemostasis. He has led nine provincial natural science foundation projects and published 29 papers as the first author in the past five years, with 22 indexed by SCI. He has been awarded certificates for “Most Cited Paper” and “Most Popular Paper” from JTH and ISLH for three consecutive years. He has drafted three Chinese expert consensuses in the field of coagulation and was selected for the “Young and Middle-aged Medical Talents Program” in Wuhan in 2020.
Social Positions:
- Editorial Board Member of “Laboratory Medicine” and “Journal of Thrombosis and Hemostasis”
- Standing Committee Member of the Inspection Branch of the Chinese Non-governmental Medical Institutions Association
- Deputy Chairman of the Medical Laboratory Committee of Wuhan Non-governmental Medical Institutions
- Youth Committee Member of the Laboratory Branch of the Hubei Medical Association
- Youth Committee Member of the Laboratory Branch of the Wuhan Medical Association
