Background: While there are multiple guidelines for the management of bleeding complications and hematoma if being treated with antithrombotic and anticoagulant drugs, these risks are not yet stratified for procedures with regional anesthesia. Materials and Methods: This study was an umbrella review of systematic studies and meta-analysis based on PRISMA guidelines in databases of Scopus, PubMed, Medline, Cochrane Library, and Web of Science databases. Due to heterogeneity in evaluated outcomes and methods of studies, only the qualitative evidence synthesis was performed. AMSTAR checklist was used to assess the risk of bias in included systematic reviews. Results: After an extensive search of relevant studies, 971 primary cases were identified. Following a thorough screening process, 5 systematic reviews were selected. The evidence suggests that head and neck punctures generally do not result in bleeding complications, except for rare cases of hematoma associated with Infraclavicular brachial plexus block. A deep cervical plexus block is not recommended. Interscalene blocks have varying findings, with some studies reporting hematoma incidence and spinal injury, while others consider them low risk. Supraclavicular brachial plexus block might be associated with hemothorax and infraclavicular blocks are not favored by reviews. Axillary brachial plexus blocks have a minor incidence of hematoma. Abdomen blocks, TAP blocks, ilioinguinal blocks, and rectus sheath blocks carry a higher risk of hematoma. Pectoral nerve (PECS) blocks have a relatively high risk, while paravertebral and intercostal blocks are considered high risk, but further research is needed regarding paravertebral blocks. Conclusion: The available evidence from systematic reviews and studies suggests varying levels of risk for different blocks and procedures that should be considered before decision-making.

Introduction: Mitral valve prolapse (MVP) is a known benign entity. However, in certain instances it may ensue cerebrovascular complication with ominous prognosis. This study was under taken in the past 9 years and 12 cases with mitral valve prolapse and cerebrovascular complications were diagnosed and their medical data were recorded. The main goals of this study were to try ana detect the possible risk factors and predisposing symptoms of stroke (including vertigo amorosis fugax faint and convulsion) in those patients, and to explore the possibility of prevention.Methods: MVP was diagnosed by physical examination and echocardiographic findings. The cases were divided clinically into two groups; group one which was hospitalized with cerebrovascular accident (CVA) as well paralysis. They include 6 cases aged between 18 and 42 years (average 33.5 years) with a male over female ratio was 2/4. Five out of 6 cases having had mitral regurgitation. Group 2 as the control group with 6 cases who were followed for 10-66 months at the cardiac clinic. Their age range was between 17 to 30 years (average age 22.5 years) one out of 6 had mitral regurgitation. The male to female ratio was 1/5. These cases with symptoms of risk factors as mentioned above were placed on Propranolol dipyridamol and aspirin with follow up of 10-66months (averaging 31 months).Results: In group 1 CT and MRI revealed embolic stroke in 4 cases and hemorrhage CVA in 2 cases, whereas in group 2 MRI and CT revealed ischemic changes without necrosis in 4 cases and normal pattern in 2 cases.Discussion: The conclusion of this study points to the fact that cases of MVP and true stroke as well as paralysis are older and patients with high risk symptoms such as faint, vertigo, convulsion, amorosis fugax, in combination with MVP which warrant the administration of anti thrombotic agents including aspirin dipyridamol while they are on Propranolol. The same is in cases with MVP associated with mitral insufficiency P.F.O. and migraine headache.

With an increasing incidence, diabetic kidney disease (DKD) has been the leading cause of chronic kidney disease and end-stage renal disease, and conventional therapies did not change this situation.This study intended to review and analyze the antioxidant and antithrombotic treatments of DKD for seeking novel therapeutic strategies. Relevant articles involved with antioxidant and antithrombotic treatments in DKD were retrieved and analyzed via systematic assessment. Meta-analysis showed that pancreatic kallikrein definitely reduced glycated hemoglobin in DKD patients (mean difference, 0.36%; 95% confidence interval, 0.08% to 0.63%; P=.01). Apart from the classic agents such as aspirin, novel drugs such as pancreatic kallikrein, sulodexide, and especially the traditional Chinese medicine includingTripterygium wilfordii and lumbrukinase, exert beneficial effects in DKD patients. Antioxidant and antithrombotic treatments are beneficial for DKD patients and represent promising therapeutic strategies in the future.

Introduction: Aqueous extract of Lagerstroemia speciosa (EALS) (Lythraceae) is widely used to treat diabetes. This plant has been shown an in vitro thrombolytic activity that indicates its potential to prevent the formation of blood clots in vivo. Thus, this study was undertaken to evaluate the antithrombotic and antihemolytic effects of EALS. Methods: Rats of both sexes (200 ±,5 g) were divided into five groups of six animals. Each group received orally distilled water, EALS (250, 500, 1000 mg/kg), and acetylsalicylic acid (100 mg/kg) for five days. After treatment, the FeCl3-induced arterial thrombus formation method was used to determine occlusion time. A coagulometer was used to detect activated partial thromboplastin time (aPTT) and prothrombin time (PT). Rabbit blood was used to determine clot lysis activity in vitro and antihemolytic activity using the 2, 2-azobis hydrochloride (2-methylpropionamidine) (AAPH) method. Results: EALS increased the occlusion time in a dose-dependent manner. At the dose of 1000 mg/kg, EALS increased the occlusion time significantly, from 4. 59 ±,2. 45 minutes to 15. 52 ±,2. 38 minutes (P < 0. 01). At high concentrations (1-4 mg/mL), EALS showed a significant increase in aPPT and PT (P < 0. 05). Streptokinase and EALS (4 mg/mL) induced significant clot lysis with percentage values of 78. 48 ±,2. 2 % and 49. 5 ±,1. 53 %, respectively (P < 0. 001). EALS inhibited AAPH-induced hemolysis. Conclusion: EALS exhibited antithrombotic and antihemolytic activities. The antithrombotic property of the plant could be attributed to its anticoagulant and thrombolytic activities. Regular consumption of L. speciosa leaves may prevent or treat thrombotic diseases.

Background: Hypercoagulopathy is one of the complications of thalassemia; high incidence of right sided heart failure (due to pulmonary hypertension) in some surveys indicates on the importance of this complication. In this research we evaluated a frequency of protein C and S, and antithrombin-III (AT-III) deficiency in thalassemia major patients in Isfahan.Methods: Serum level of protein C and S, and AT-III were measured in 41 thalassemia major patients (age 7-20 years), and the relation between serum level and age, sex, splenectomy, transfusion intervals, pre transfusion Hb, and serum ferritin level was detected. All of these patients were also evaluated for cardiac disease and pulmonary hypertension by doppler echocardiography.Findings: Overall, 43% of cases had protein C deficiency, 53% protein S deficiency, and 30% AT-III deficiency; 82% of all patients had at least one factor deficiency. The frequency of protein C, S and AT-III deficiency was higher in patient older than 10 years, with transfusion interval more than 21 days, and with less pre-transfusion Hb level. High ferritin level was also significantly related to protein C and S deficiency (p<0.05). With echocardiography, dilated heart was found in 8 (11.8% in non splenectomized, and 57% in splenectomized) (p<0.001); only 2 patients had evidences of pulmonary hypertension.Conclusion: Also hypercoagulopathy due to protein S, protein C and AT-III deficiency is common, but unlike some researches, we didn't find high incidence of pulmonary hypertension in our patients.  According to the high frequency of factor deficiency, more attention for hypercoagulable state is required in thalassemia major patients with risk factor.

Background and purpose: An aqueous extract from the root bark of Pseudocedrela kotschyi and aerial parts of Adenia cissampeloides has been proven in previous research to elicit significant anticoagulant property in vitro. This, therefore, indicates the potential usefulness of this extract in managing thromboembolic disease, a major global health risk. The aim of the present work was to establish the antithrombotic effect of a product made from extracts of the root bark of P. kotschyi and the aerial parts of A. cissampeloides (PAE). Experimental approach: The effect of PAE at 500-2000 mg/kg in inhibiting tail infarction and inflammation, as well as its effect on the microthrombi count, hematological, and coagulation profiles in a carrageenaninduced thrombosis model in Sprague-Dawley rats, was studied. Findings/Results: PAE significantly (P ≤ 0. 01-0. 001) reduced length of tail infarction and inflammation (redness, swelling, pain, and temperature). Histopathological studies revealed a significant reduction (P ≤ 0. 0001) in microthrombi count in the liver and the lungs with PAE treatment. PAE treatment caused a marginal (P ≤ 0. 01) increase in prothrombin time but resulted in a significant (P ≤ 0. 01-0. 0001) dosedependent increase in activated partial thromboplastin time, with the hematological profile being normal. Conclusion and implications: PAE showed anticoagulant and antithrombotic effects in vivo, indicative of its potential benefit as a natural product, and cost-effective therapeutic option, and hence could be helpful in thromboembolic therapies.