Andrea Lobos Sierra

🧠

[Andrea Lobos Sierra @andrelobos821]

"You're mad, bonkers, completely off your head. But I'll tell you a secret. All the best people are”

[Sara Moscatelli @saramoscatelli7]

🫀 Apixaban in children: not just safe—biologically active

We now have more than clinical outcomes.
We have mechanistic data.
:
📊 What did this study actually do?

Substudy of SAXOPHONE trial
182 children with heart disease
Apixaban vs standard of care (VKA/LMWH)
Serial hemostatic biomarkers + thrombin generation assays
➡️ Not just “does it work”

👉 but how it works
⚠️ Key finding
👉 Apixaban reduces hypercoagulability
↓ D-dimer
↑ Lag time & time to peak
↓ Peak thrombin
➡️ A clear shift toward less thrombin generation

💡 But here’s the nuance (and it matters)
👉 Apixaban does NOT suppress everything
Preserves endogenous thrombin potential (ETP)
No major effect on protein C / protein S
➡️ Not a “blunt anticoagulant”
➡️ More like a modulator of coagulation dynamics
🧬 Mechanistic insight

Factor Xa inhibition leads to:
Slower thrombin initiation
Delayed amplification
But ongoing, controlled thrombin generation
➡️ A shift in timing, not just magnitude

⚠️ The hidden variable: prior VKA exposure
Strong carryover effect at baseline
Suppressed d-dimer and thrombin parameters
👉 Interpretation without this = wrong conclusions
💡 Clinical pearl
Transitioning from VKA → apixaban:
👉 Stable d-dimer levels
👉 No rebound hypercoagulability
➡️ Supports safe switching strategy

🧠 What’s really important here
This is pediatric haemostasis—NOT adult haemostasis.
Developmental coagulation system
Variable protein levels
Complex congenital heart disease physiology
👉 And yet:
➡️ Apixaban shows predictable, consistent effects across ages

🔥 Take-home
Apixaban is not just “easier to use” in children.
👉 It produces a controlled, physiologically coherent anticoagulation profile
Not suppression.
Regulation.

#PediatricCardiology #Thrombosis #Apixaban #CongenitalHeartDisease #CardioGenetics #ClinicalResearch 🫀

https://t.co/Uct6n613lx

[Patricio Sandoval @neuropuc]

Ha fallecido uno de mis maestros, el Dr Jorge Tapia Illanes. Profesor Titular de @FacmedicinaUC, Discípulo de Miller Fisher, Jay Mohr, Louis Caplan y EP Richardson. Pionero de la neuropatología y neurología vascular en Chile. Maestro de la neurología chilena @sonepsyn 2018, destacado por su aporte a la especialidad como gran docente formador de decenas de generaciones de médicos y neurólogos. QEPD 🕊️, muchas gracias por todo lo que aprendí de él y a seguir el legado de enseñar neurología “stroke by stroke” 🧠

[International Journal of Stroke @IntJStroke]

💊Low-dose rivaroxaban + antiplatelet therapy for symptomatic intracranial atherosclerotic stenosis

Dual pathway inhibition may be associated with ⬇️ lower risk of recurrent stroke compared to antiplatelet therapy alone

Read more here!👇
https://t.co/R3zsAwN3is

[Andrea Lobos Sierra @andrelobos821]

@Dam_Grindelwal @_arielmayo Hola, eres un ser humano real?
Porque con esa foto y ese comentario se asume que quieres matar a otros seres humanos. Asumo que si es así, eres medianamente inteligente y algo de conocimiento tienes?

[Andrea Lobos Sierra @andrelobos821]

@_arielmayo Hola. Con humildad, me parece impresentable desde cualquier punto d vista aceptar como mínimamente verídico un argumento q las tiene todas d sensacionalista (e incluso pésimo en eso) y nada d verídico. Creo q si el movimiento anti judío debiese tener vergüenza d esta publicación.

[Andrea Lobos Sierra @andrelobos821]

@KastTeCago Hola, no te gusta que alguien que es de derecha diga algo humano y bondadoso a otros seres humanos? Por último alega cuando se dice algo que atente en contra de otro ser humano. Me dio mucha pena un comentario con tanta maldad como este post.

[Neurology Journal @GreenJournal]

Published in Neurology Neuroimmunology & Neuroinflammaton: Sjögren Syndrome Candidate Autoantigen AQP5 Triggers AQP4 CNS Autoimmunity Through Self-Antigen Mimicry https://t.co/XHuq2br93l

@jsabatino37

[Neurology Journal @GreenJournal]

Ribbon-Like Cortical Calcifications in Hereditary Cerebral Hemorrhage With Amyloidosis-Dutch Type: https://t.co/kDwV7mdS6i

[Practical Neurology @PracticalNeurol]

🧠 New in Practical Neurology:
Paraneoplastic KLHL11 antibody encephalitis presenting with progressive tinnitus, hearing loss, and cerebellar ataxia.
KLHL11-IgG - strongly linked to testicular germ cell tumours - shows a distinctive “sparkles” pattern on immunofluorescence 🔬
Early recognition is key to prevent irreversible neuronal injury.
📄 Mahmoud et al., Pract Neurol 2025;25:443–447
🔗 https://t.co/s0W40TEIDf
#Neuroimmunology #AutoimmuneEncephalitis #Paraneoplastic #KLHL11 #Neurology #MedTwitter

[Doc Navarrow @DocNavarrow]

The “insular knife-cut” sign: a sharp FLAIR demarcation between insular hyperintensity and spared basal ganglia.

Found in 70% of HSV encephalitis cases and highly specific (99%).
Its presence strongly predicts HSVE even when PCR is pending or negative.

https://t.co/xUbeUl7WjO

[Andrea Lobos Sierra @andrelobos821]

@NeuroinmunUC @EthelScl I had the privilege of being taught - thou shortly- by Dr Ciampi. Her hunger for knowledge with -always- emphasis in patient care is mind blowing !

[NeuroinmunologiaUC @NeuroinmunUC]

🎉👏 Congratulations to Dra. Ethel Ciampi @EthelScl on her outstanding presentation at #ECTRIMS2025!
We are proud to see her representing our Neuroimmunology UC team on the international stage, sharing knowledge and advancing MS research. 🌍🧠✨

#ECTRIMS2025 #NeuroUC

[EthelCiampiSCL @EthelScl]

https://t.co/vDwwiRFi5Z Now available online! @TheMOGProject @TheSumairaFDN @NeuroinmunUC

[International Journal of Stroke @IntJStroke]

#FlashbackFriday!
⬆️📈Elevated CRP levels at admission and 24h predict atrial fibrilliation post-stroke after mechanical thrombectomy for LVO stroke

https://t.co/5UKMfj0sxM
@luciodanna2 @giovmerl @Simona_Sacco_ @mattfos89 @SomaBanerjee73

[Andrea Lobos Sierra @andrelobos821]

En éstas fiestas patrias no olvidar diferenciar entre la borrachera y síntomas de ACV!!!!!

Y si hay dudas… mejor consultar! Para eso estamos.

[INTERNEURONA @interneurona]

📊Nuestra encuesta refleja que aún hay un tramo largo de mejoría en #Latam con respecto a #protocolos y adaptación de recomendaciones basadas en #evidencia

🧠Hacer equipo, redes, educar, protocolizar, medir, mejorar 💪🏼

@WorldStrokeOrg @ALATACV
@sheilambrasil @georgeinstitute

[Andrea Lobos Sierra @andrelobos821]

There’s no such a thing as “a long time ago”. There’s only memories that mean something and memories that don’t.

[Andrea Lobos Sierra @andrelobos821]

@TitoPadronso Por favor cámbialo de colegio!!!

[Andrea Lobos Sierra @andrelobos821]

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occupation and exposure to everything our curious minds may dare to ask.
And as we endure the responsibility that is taking care, we MUST, always, be grateful. Because in the end, we ought to give everything and more to the one that gave us everything and even more.

[Andrea Lobos Sierra @andrelobos821]

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Being a physician is a privilege, a vocation and we must practice with gratefulness.
Grateful to the patient, a human being with nothing that separates their naked body to our eyes, their darkest secrets to our ears, their entire being, hopes and dreams,