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Kim S, Kim M, Kodra A. Risks and Benefits of Device-Assisted Treatment of Pulmonary Embolism. Int J Angiol 2024; 33:101-106. [PMID: 38846990 PMCID: PMC11152619 DOI: 10.1055/s-0044-1782535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Pulmonary embolism (PE) is a common disease associated with significant morbidity and mortality. Despite the familiarity with this disease, the best treatment remains undefined. Traditionally, treatment of PE has involved a choice of anticoagulation, thrombolysis, or surgery. However, the debate over pharmacologic versus mechanical treatment of acute PE reared up again with the advent of user-friendly mechanical and aspiration thrombectomy technologies. This is especially true for submassive PE, which is an area for potential growth both for understanding the pathophysiology of the disease process and management. Multiple devices are available for treatment of PE. Understanding the risks and benefits of each device is paramount in the complex management of PE.
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Affiliation(s)
- Sofia Kim
- Department of Cardiology, Northwell Health Lenox Hill Hospital, New York
| | - Michael Kim
- Department of Cardiology, Northwell Health Lenox Hill Hospital, New York
| | - Arber Kodra
- Department of Cardiology, Northwell Health Lenox Hill Hospital, New York
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2
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Zheng Z, Pandit K, Chang AR, Shin JI, Charytan DM, Grams ME, Surapaneni A. Association of eGFR and Albuminuria with Venous Thromboembolism. Clin J Am Soc Nephrol 2024; 19:301-308. [PMID: 37971889 PMCID: PMC10937012 DOI: 10.2215/cjn.0000000000000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND CKD has been implicated as a risk factor of venous thromboembolism, but the evidence is limited to relatively healthy populations. The objective of this study was to discern whether parameters of kidney function and damage are associated with the occurrence of venous thromboembolism after hospitalization. METHODS We conducted a retrospective study including 23,899 and 11,552 adult individuals hospitalized within Geisinger Health System and New York University (NYU) Langone Health from 2004 to 2019 and 2012 to 2022, respectively. A Poisson model was used to evaluate adjusted incidence rates of venous thromboembolism according to eGFR and albuminuria categories in each cohort. Cox proportional hazards models were used to analyze associations of eGFR and urinary albumin-to-creatinine ratio (UACR) with venous thromboembolism, and hazard ratios (HRs) were meta-analyzed across cohorts. RESULTS Both lower eGFR and higher UACR were associated with higher risks of venous thromboembolism. In the Geisinger cohort, the incidence of venous thromboembolism after hospital discharge ranged from 10.7 (95% confidence interval [CI], 9.2 to 12.6) events per 1000 person-years in individuals in G1A1 (eGFR >90 ml/min per 1.73 m 2 and UACR <30 mg/g) to 27.7 (95% CI, 20.6 to 37.2) events per 1000 person-years in individuals with G4-5A3 (eGFR <30 ml/min per 1.73 m 2 and UACR >300 mg/g). A similar pattern was observed in the NYU cohort. Meta-analyses of the two cohorts showed that every 10 ml/min per 1.73 m 2 reduction in eGFR below 60 ml/min per 1.73 m 2 was associated with a 6% higher risk of venous thromboembolism (HR 1.06 [95% CI, 1.02 to 1.11], P = 0.01), and each two-fold higher UACR was associated with a 5% higher risk of venous thromboembolism (HR 1.05 [95% CI, 1.03 to 1.07], P < 0.001). CONCLUSIONS Both eGFR and UACR were independently associated with higher risk of venous thromboembolism after hospitalization. The incidence rate was higher with greater severity of CKD. PODCAST This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_12_14_CJN0000000000000352.mp3.
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Affiliation(s)
- Zhong Zheng
- Nephrology Division, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Krutika Pandit
- Division of Precision Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Alex R. Chang
- Kidney Health Research Institute, Geisinger, Danville, Pennsylvania
| | - Jung-Im Shin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David M. Charytan
- Nephrology Division, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Morgan E. Grams
- Nephrology Division, Department of Medicine, New York University Grossman School of Medicine, New York, New York
- Division of Precision Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Aditya Surapaneni
- Division of Precision Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, New York
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Edwards MA, Brennan E, Rutt AL, Muraleedharan D, Casler JD, Spaulding A, Colibaseanu D. Venous Thromboembolism Prophylaxis in Otolaryngologic Patients Using Caprini Assessment. Laryngoscope 2024; 134:1169-1182. [PMID: 37740910 DOI: 10.1002/lary.31041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 08/13/2023] [Accepted: 08/28/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE The aim was to determine the utilization of Caprini guideline-indicated venous thromboembolism (VTE) prophylaxis and impact on VTE and bleeding outcomes in otolaryngology (ORL) surgery patients. METHODS Elective ORL surgeries performed between 2016 and 2021 were retrospectively identified. Logistic regression models were used to examine the association between patient characteristics and receiving appropriate prophylaxis, inpatient, 30- and 90-day VTE and bleeding events. RESULTS A total of 4955 elective ORL surgeries were analyzed. Thirty percent of the inpatient cohort and 2% of the discharged cohort received appropriate risk-stratified VTE prophylaxis. In those who did not receive appropriate prophylaxis, overall inpatient VTE was 3.5-fold higher (0.73% vs. 0.20%, p = 0.015), and all PE occurred in this cohort (0.47% vs. 0.00%, p = 0.005). All 30- and 90-day discharged VTE events occurred in those not receiving appropriate prophylaxis. Inpatient, 30- and 90-day discharged bleeding rates were 2.10%, 0.13%, and 0.33%, respectively. Although inpatient bleeding was significantly higher in those receiving appropriate prophylaxis, all 30- and 90-day post-discharge bleeding events occurred in patients not receiving appropriate prophylaxis. On regression analysis, Caprini score was significantly positively associated with likelihood of receiving appropriate inpatient prophylaxis (odds ratio [OR] 1.05, confidence interval [CI] 1.03-1.07) but was negatively associated in the discharge cohort (OR 0.43, CI 0.36-0.51). Receipt of appropriate prophylaxis was associated with reduced odds of inpatient VTE (OR 0.24, CI 0.06-0.69), but not with risk of bleeding. CONCLUSION Although Caprini VTE risk-stratified prophylaxis has a positive impact in reducing inpatient and post-discharge VTE, it must be balanced against the risk of inpatient postoperative bleeding. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1169-1182, 2024.
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Affiliation(s)
- Michael A Edwards
- Advanced GI and Bariatric Surgery Division, Department of Surgery, Mayo Clinic, Jacksonville, Florida, U.S.A
| | - Emily Brennan
- Division of Health Care Delivery Research, Mayo Clinic, Robert D. and Patricia E. Kern Center, Jacksonville, Florida, U.S.A
| | - Amy L Rutt
- Mayo Clinic, Department of Otolaryngology/Head and Neck Surgery, Jacksonville, Florida, U.S.A
| | - Divya Muraleedharan
- Advanced GI and Bariatric Surgery Division, Department of Surgery, Mayo Clinic, Jacksonville, Florida, U.S.A
| | - John D Casler
- Mayo Clinic, Department of Otolaryngology/Head and Neck Surgery, Jacksonville, Florida, U.S.A
| | - Aaron Spaulding
- Division of Health Care Delivery Research, Mayo Clinic, Robert D. and Patricia E. Kern Center, Jacksonville, Florida, U.S.A
| | - Dorin Colibaseanu
- Colon and Rectal Surgery Division, Mayo Clinic, Jacksonville, Florida, U.S.A
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4
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Zhang X, Yang Y, Wu F. A bibliometric analysis in venous thromboembolism nursing (1999-2022): Current status and future prospects. Heliyon 2024; 10:e23770. [PMID: 38192823 PMCID: PMC10772189 DOI: 10.1016/j.heliyon.2023.e23770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/13/2023] [Accepted: 12/13/2023] [Indexed: 01/10/2024] Open
Abstract
Research on venous thromboembolism (VTE) in nursing has garnered significant attention. This study aimed to examine the characteristics of VTE nursing publications, offering valuable insights into the current state of the field and forecasting future trends. A comprehensive screening of global publications up to 2022 was conducted using the Web of Science Core Collection database to investigate VTE nursing. The search incorporated keywords such as 'venous thromboembolism', 'deep vein thrombosis', and 'pulmonary embolism' to identify relevant studies. A bibliometric analysis of these publications was performed using various visualisation tools such as VOSviewer and R software. A total of 675 papers on VTE nursing were identified, with the earliest publication dating back to 1999. The research involved 971 institutions from 43 countries, with the United States leading by contributing to 261 articles. Harvard University emerged as the most productive institution, and Heit, with 17 publications, was the most cited author. The journal Thrombosis Research published the highest number of papers (11). The frontiers of VTE nursing research are anticipated to continue focusing on topics such as epidemiology, risk factors, and VTE prevention and management.
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Affiliation(s)
- Xuan Zhang
- Department of Stomatology, The First Affiliated Hospital of the University of South China, Hengyang, 421001, Hunan Province, China
| | - Yuehui Yang
- Department of Stomatology, The First Affiliated Hospital of the University of South China, Hengyang, 421001, Hunan Province, China
| | - Fang Wu
- Department of Stomatology, The First Affiliated Hospital of the University of South China, Hengyang, 421001, Hunan Province, China
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Kammath V, Gupta A, Bald A, Hope G, Kansal N, Al Samaraee A, Bhattacharya V. A Three-year Retrospective Study Looking at Preventing Hospital Acquired Thrombosis. Cardiovasc Hematol Agents Med Chem 2024; 22:212-222. [PMID: 38288832 DOI: 10.2174/0118715257269027231228114930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/13/2023] [Accepted: 12/06/2023] [Indexed: 07/09/2024]
Abstract
BACKGROUND Hospital-acquired venous thromboembolism (HA-VTE) is defined as cases of venous thromboembolism (VTE) that occur in a hospital and within ninety days of a hospital admission. Deep vein thromboses (DVTs) most commonly occur within the deep veins of the pelvis and legs. If the thrombus dislodges and travels to the lungs, it can result in a pulmonary embolus (PE). VTE is associated with significant morbidity and mortality, accounting for almost 10% of all hospital deaths. If risk factors are correctly identified and VTE prophylaxis is prescribed, VTE can be a preventable condition. In 2010, NHS England launched The National Venous Thromboembolism Prevention Programme. This included NICE guidance, and a VTE risk assessment tool, which must be completed for at least 95% of patients on admission. The National Thrombosis Survey, published by Thrombosis UK, studied how this program was implemented locally, and audited HA-VTE prevention strategies nationally. OBJECTIVES Using the Thrombosis Survey and NICE guidance as an aide, this study collects data about hospital-acquired DVT (HA-DVT) at the Queen Elizabeth Hospital in Gateshead (QEH) and aims to: 1. Identify cases of HA-DVT and understand the clinical circumstances surrounding these cases 2. Assess the quality of VTE preventative measures at QEH 3. Outline potential improvement in reducing the incidence of HA-VTE at this hospital Methods: This retrospective cohort study used electronic records to identify all cases of DVT between April 2019 and April 2022 at QEH. Cases of HA-DVT were defined as: a positive ultrasound doppler report and either the case occurring in the 90 days following an inpatient stay, or beyond two days into an admission. For these cases of HA-DVT, we recorded the: reason for admission; admitting specialty; presence of an underlying active cancer and deaths occurring within 90 days of diagnosis. We assessed the quality of VTE preventative measures, by recording the: completion of VTE risk assessments; prescription of weight-adjusted pharmacological VTE prophylaxis and provision of VTE prophylaxis on discharge. For HA-DVT cases occurring within 90 days of an inpatient stay, the preventative measures were assessed on the original admission. Electronic records were used to record the completion rate of the National VTE risk assessment tool for all inpatients during this time frame. RESULTS The VTE risk assessment tool was completed for 98.5% of all admissions. One hundred and thirty-five cases of HA-DVT were identified between April 2019 and April 2022. Sixteen patients with HA-DVT did not have VTE prophylaxis prescribed on admission. Eleven of these patients had a clearly documented reason why anticoagulation was avoided. In HA-DVT cases where pharmacological VTE prophylaxis was prescribed, 23% were prescribed an inappropriate dose for their weight. If anticoagulation was required on discharge, this was prescribed appropriately in 94% of cases. About 31% of the patients with HA-DVT had an underlying active malignancy. Thirty-nine patients died within 90 days of the DVT being diagnosed; in only 1 case was VTE thought to be a contributing factor to death. CONCLUSION The hospital exceeded the national standard of VTE risk assessment completion on admission (greater than 95%). For almost a quarter of patients with HA-DVT, the dose of thromboprophylaxis prescribed was not appropriate for weight. In five cases of HA-DVT, thromboprophylaxis was omitted with no clear justification. HA-DVT often affects the most clinically vulnerable patients and is associated with a high mortality.
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Affiliation(s)
- Vipin Kammath
- Department of Surgery, Queen Elizabeth Hospital NHS Foundation Trust, Gateshead, UK
| | - Anuj Gupta
- Newcastle University Medical School, Newcastle, UK
| | - Alexander Bald
- Department of Surgery, Queen Elizabeth Hospital NHS Foundation Trust, Gateshead, UK
| | - Gavin Hope
- Department of Surgery, Queen Elizabeth Hospital NHS Foundation Trust, Gateshead, UK
| | - Nisheeth Kansal
- Department of Surgery, Queen Elizabeth Hospital NHS Foundation Trust, Gateshead, UK
| | - Ahmad Al Samaraee
- Department of Surgery, Queen Elizabeth Hospital NHS Foundation Trust, Gateshead, UK
| | - Vish Bhattacharya
- Department of Surgery, Queen Elizabeth Hospital NHS Foundation Trust, Gateshead, UK
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6
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Mosquera MS, Diaz JA. Back To Basics: Theory of Thrombus Formation and Potential Implications for Therapies? Tech Vasc Interv Radiol 2023; 26:100894. [PMID: 37865449 DOI: 10.1016/j.tvir.2023.100894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and potentially fatal condition. Despite existing treatments, recurrence rates and complications remain high. Understanding the pathophysiology of thrombus formation is crucial for developing effective therapies. This narrative review provides an overview of the critical elements of acute and chronic DVT, presents a theoretical framework for understanding thrombus formation, and discusses potential implications for therapeutic interventions. In addition, a hypothesis of thrombus formation is formulated, encompassing all elements described in this work.
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Affiliation(s)
- M Silena Mosquera
- Department of Surgery, Center for Fetal Research, The Children's Hospital of Philadelphia Research Institute, Philadelphia, PA
| | - Jose A Diaz
- Division of Surgical Research, Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN.
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7
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Yin Q, Zhang X, Liao S, Huang X, Wan CC, Wang Y. Potential anticoagulant of traditional chinese medicine and novel targets for anticoagulant drugs. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 116:154880. [PMID: 37267694 DOI: 10.1016/j.phymed.2023.154880] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 05/04/2023] [Accepted: 05/12/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Anticoagulants are the main drugs used for the prevention and treatment of thrombosis. Currently, anticoagulant drugs are primarily multitarget heparin drugs, single-target FXa inhibitors and FIIa inhibitors. In addition, some traditional Chinese drugs also have anticoagulant effects, but they are not the main direction of treatment at present. But the anticoagulant drugs mentioned above, all have a common side effect is bleeding. Many other anticoagulation targets are under investigation. With further exploration of coagulation mechanism, how to further determine new anticoagulant targets and how to make traditional Chinese medicine play anticoagulant role have become a new field of exploration. PURPOSE The purpose of the study was to summarize the recent research progress on coagulation mechanisms, new anticoagulant targets and traditional Chinese medicine. METHODS A comprehensive literature search was conducted using four electronic databases, including PubMed, Embase, CNKI, Wanfang database and ClinicalTrials.gov, from the inception of the study to 28 Feb 2023. Key words used in the literature search were "anticoagulation", "anticoagulant targets", "new targets", "coagulation mechanisms", "potential anticoagulant", "herb medicine", "botanical medicine", "Chinese medicine", "traditional Chinese medicine", "blood coagulation factor", keywords are linked with AND/OR. Recent findings on coagulation mechanisms, potential anticoagulant targets and traditional Chinese medicine were studied. RESULTS The active components extracted from the Chinese medicinal herbs, Salvia miltiorrhiza, Chuanxiong rhizoma, safflower and Panax notoginseng have obvious anticoagulant effects and can be used as potential anticoagulant drugs, but the risk of bleeding is unclear. TF/FVIIa, FVIII, FIX, FXI, FXII, and FXIII have all been evaluated as targets in animal studies or clinical trials. FIX and FXI are the most studied anticoagulant targets, but FXI inhibitors have shown stronger advantages. CONCLUSION This review of potential anticoagulants provides a comprehensive resource. Literature analysis suggests that FXI inhibitors can be used as potential anticoagulant candidates. In addition, we should not ignore the anticoagulant effect of traditional Chinese medicine, and look forward to more research and the emergence of new drugs.
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Affiliation(s)
- Qinan Yin
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, PR. China; Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, PR. China
| | - Xiaoqin Zhang
- Department of Critical Care Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, PR. China
| | - Suqing Liao
- Department of Critical Care Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, PR. China
| | - Xiaobo Huang
- Department of Critical Care Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, PR. China
| | - Chunpeng Craig Wan
- College of Agronomy, Jiangxi Agricultural University, Jiangxi Key Laboratory for Post-Harvest Technology and Nondestructive Testing of Fruits & Vegetables, Nanchang 330045, PR. China.
| | - Yi Wang
- Department of Critical Care Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, PR. China.
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Harris KM, Arya R, Elias A, Weber T, Green DA, Greaves DK, Petersen LG, Roberts L, Kamine TH, Mazzolai L, Bergauer A, Kim DS, Olde Engberink RH, zu Eulenberg P, Grassi B, Zuccarelli L, Baldassarre G, Tabury K, Baatout S, Jordan J, Blaber AP, Choukér A, Russomano T, Goswami N. Pathophysiology, risk, diagnosis, and management of venous thrombosis in space: where are we now? NPJ Microgravity 2023; 9:17. [PMID: 36797288 PMCID: PMC9935502 DOI: 10.1038/s41526-023-00260-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/20/2023] [Indexed: 02/18/2023] Open
Abstract
The recent incidental discovery of an asymptomatic venous thrombosis (VT) in the internal jugular vein of an astronaut on the International Space Station prompted a necessary, immediate response from the space medicine community. The European Space Agency formed a topical team to review the pathophysiology, risk and clinical presentation of venous thrombosis and the evaluation of its prevention, diagnosis, mitigation, and management strategies in spaceflight. In this article, we discuss the findings of the ESA VT Topical Team over its 2-year term, report the key gaps as we see them in the above areas which are hindering understanding VT in space. We provide research recommendations in a stepwise manner that build upon existing resources, and highlight the initial steps required to enable further evaluation of this newly identified pertinent medical risk.
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Affiliation(s)
- Katie M. Harris
- grid.25055.370000 0000 9130 6822Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Canada
| | - Roopen Arya
- grid.429705.d0000 0004 0489 4320Kings College Hospital, NHS Foundation Trust, London, UK
| | - Antoine Elias
- Vascular Medicine, Toulon Hospital Centre, Toulon, France
| | - Tobias Weber
- Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany. .,KBR, Cologne, Germany.
| | - David A. Green
- grid.461733.40000 0001 2375 6474Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany ,KBR, Cologne, Germany ,grid.13097.3c0000 0001 2322 6764Centre for Human and Applied Physiological Sciences, King’s College London, London, UK
| | - Danielle K. Greaves
- grid.46078.3d0000 0000 8644 1405Faculty of Health, University of Waterloo, Waterloo, Canada
| | - Lonnie G. Petersen
- grid.5254.60000 0001 0674 042XDepartment of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark ,grid.116068.80000 0001 2341 2786Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, Cambridge, USA
| | - Lara Roberts
- grid.429705.d0000 0004 0489 4320Kings College Hospital, NHS Foundation Trust, London, UK
| | - Tovy Haber Kamine
- grid.281162.e0000 0004 0433 813XDivision of Trauma, Acute Care Surgery, and Surgical Critical Care, Baystate Medical Center, Springfield, MA USA
| | - Lucia Mazzolai
- grid.9851.50000 0001 2165 4204Department of Angiology, Lausanne University, Lausanne, Switzerland
| | | | - David S. Kim
- grid.461733.40000 0001 2375 6474Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany ,grid.17091.3e0000 0001 2288 9830Department Emergency Medicine, University British Columbia, Vancouver, Canada
| | - Rik H. Olde Engberink
- grid.509540.d0000 0004 6880 3010Amsterdam UMC location University of Amsterdam, Department of Internal Medicine, Section of Nephrology, Amsterdam, The Netherlands ,Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | - Peter zu Eulenberg
- grid.5252.00000 0004 1936 973XInstitute for Neuroradiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Bruno Grassi
- grid.5390.f0000 0001 2113 062XDepartment of Medicine, University of Udine, Udine, Italy
| | - Lucrezia Zuccarelli
- grid.5390.f0000 0001 2113 062XDepartment of Medicine, University of Udine, Udine, Italy
| | - Giovanni Baldassarre
- grid.5390.f0000 0001 2113 062XDepartment of Medicine, University of Udine, Udine, Italy
| | - Kevin Tabury
- grid.8953.70000 0000 9332 3503Radiobiology Unit, Belgian Nuclear Research Centre, SCK CEN, Mol, Belgium
| | - Sarah Baatout
- grid.8953.70000 0000 9332 3503Radiobiology Unit, Belgian Nuclear Research Centre, SCK CEN, Mol, Belgium
| | - Jens Jordan
- grid.7551.60000 0000 8983 7915Institute of Aerospace Medicine, German Aerospace Center and University of Cologne, Köln, Germany
| | - Andrew P. Blaber
- grid.61971.380000 0004 1936 7494Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC Canada
| | - Alexander Choukér
- grid.411095.80000 0004 0477 2585Translational Research Stress & Immunity, Klinik für Anästhesiologie/Forschungslabors, LMU Klinikum, München, Germany
| | - Thais Russomano
- grid.411095.80000 0004 0477 2585Translational Research Stress & Immunity, Klinik für Anästhesiologie/Forschungslabors, LMU Klinikum, München, Germany ,InnovaSpace UK, London, UK
| | - Nandu Goswami
- grid.11598.340000 0000 8988 2476Division of Physiology, Otto Löwi Research Center for Vascular Biology, Immunity and Inflammation, Medical University of Graz, Graz, Austria ,Mohammed Bin Rashid University of Medicine and Applied Health Sciences, Dubai, United Arab Emirates
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Fu AZ, Feng X, Ashton V, Kharat A. Risk factors for recurrent venous thromboembolism: a real-world analysis. Blood Coagul Fibrinolysis 2022; 33:301-309. [PMID: 35834716 DOI: 10.1097/mbc.0000000000001140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study was conducted in patients treated for initial venous thromboembolism (VTE) for approximately 6 months to enhance understanding of the risk factors to inform clinical decision-making about long-term anticoagulation therapy. This retrospective cohort study was conducted using a large administrative claims database in the United States. A Cox proportional hazards model was used to examine demographic and clinical characteristics associated with recurrent VTE. A total of 13 831 patients had an index VTE event, and recurrent VTE occurred in 844 (6.1%) of these patients over a median follow-up of 22.8 months. Baseline comorbidities of arrhythmia, congestive heart failure, and chronic kidney disease were significantly associated with recurrent VTE. During the period of anticoagulation treatment after the index VTE, use of antidepressants was associated with an increased risk of recurrent VTE, whereas use of antibiotics and major surgery were associated with a decreased risk. In the 6 months prior to index VTE, anti-inflammatory agents and major surgery were associated with a decreased risk of recurrent VTE. The type of index VTE was also significantly associated with recurrent VTE, with an increased risk observed in patients with pulmonary embolism (PE) alone or PE with deep vein thrombosis (DVT) versus DVT alone. This real-world analysis identified baseline comorbidities, medications, and index VTE type to be factors predictive of recurrent VTE among patients treated for index VTE for approximately 6 months. Consideration of these factors may assist in the identification of patients who may benefit from extended anticoagulant therapy.
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Affiliation(s)
- Alex Z Fu
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
- Georgetown University Medical Center, Washington, DC, USA
| | - Xue Feng
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | | | - Akshay Kharat
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
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Okoye HC, Ezekekwu C, Nwagha TU, Korubo K, Omunakwe HE, Nnachi OC, Madu AJ, Nwogoh B, Efobi CC, Muoghalu EA, Nonyelu C, Okoye AE, Obodo OI, Ugwu CS, Egolum MC, Nnachi OA, Okpala I. Prevalence of venous thromboembolism and its associations in a large racially homogenous population of sickle cell disease patients. Eur J Haematol Suppl 2022; 109:321-326. [PMID: 35687045 DOI: 10.1111/ejh.13811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Abstract
To determine the prevalence of venous thromboembolism (VTE) among adult sickle cell disease (SCD) patients in Nigeria. METHODS This was a multicentre retrospective study in which the medical records of adult SCD patients were reviewed. Information on demographics, steady-state haemogram, clinical phenotypes, duration of follow-up, history of VTE including risk factors and management was collected. RESULTS Of the 509 SCD patients with a median (IQR) duration of follow-up of 2 years, 10 (2.0%) had VTE (9 DVT and 1 PE). Their median (IQR) age was 27 (22.8-30.3) years. Identifiable risk factors for VTE included positive family history (2, 20%) surgery, splenectomy, paraplegia and cancer (1, 10% each). No risk factor was identifiable in four persons. VTE had no significant association with age and gender. VTE was significantly associated with the following events: acute chest syndrome [p = .002, odds ratio (OR) 8, 95% CI 2.2-28.9], osteonecrosis [p = .012, OR 5.24, 95% CI, 1.45-18.91] and vaso-occlusive crisis [p = .035]. Also significantly associated with VTE were pulmonary hypertension [p = .001, OR 23.3, 95%CI 5.18-105.06] and stroke [p = .032, OR 9.35, 95%CI 0.87-53.25]. CONCLUSION The prevalence of VTE among SCD patients in Nigeria is low. It is significantly associated with vaso-occlusive crisis, pulmonary hypertension and stroke.
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Affiliation(s)
- Helen Chioma Okoye
- Department of Haematology and Immunology, College of Medicine, University of Nigeria, Enugu, Nigeria.,Department of Haematology and Immunology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Chinedu Ezekekwu
- Department of Haematology and Immunology, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Theresa Ukamaka Nwagha
- Department of Haematology and Immunology, College of Medicine, University of Nigeria, Enugu, Nigeria.,Department of Haematology and Immunology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Kaladada Korubo
- Department of Haematology and Blood Transfusion, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Hannah E Omunakwe
- Department of Haematology, Rivers State University Teaching Hospital, Port Harcourt, Nigeria
| | - Oluomachi Charity Nnachi
- Department of Haematology and Blood Transfusion, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Anazoeze Jude Madu
- Department of Haematology and Immunology, College of Medicine, University of Nigeria, Enugu, Nigeria.,Department of Haematology and Immunology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Benedict Nwogoh
- Department of Haematology, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Chilota Chibuife Efobi
- Department of Haematology and Blood Transfusion, College of Health Sciences, Nnamdi Azikiwe University, Nnewi, Nigeria
| | - Ebele Adaobi Muoghalu
- Department of Haematology and Immunology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Charles Nonyelu
- Department of Haematology and Immunology, College of Medicine, University of Nigeria, Enugu, Nigeria.,Department of Haematology and Immunology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Augustine E Okoye
- Department of Haematology and Blood Transfusion, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Onochie Ikenna Obodo
- Department of Haematology and Immunology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Chioma Sandra Ugwu
- Department of Haematology and Immunology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Michael C Egolum
- Department of Haematology and Immunology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Oji Anya Nnachi
- Department of Haematology and Blood Transfusion, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Iheanyi Okpala
- Department of Haematology and Immunology, College of Medicine, University of Nigeria, Enugu, Nigeria.,Department of Haematology and Immunology, University of Nigeria Teaching Hospital, Enugu, Nigeria
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11
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Ultrasound-assisted catheter-directed thrombolysis versus anticoagulation alone for management of submassive pulmonary embolism. J Cardiol 2022; 80:441-448. [DOI: 10.1016/j.jjcc.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/31/2022] [Accepted: 04/25/2022] [Indexed: 10/31/2022]
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12
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Dou C, Li T, Yang S, Geng Q, Lu Q, Zhang Y, Yu J, Hu F, Ding J. Epidemiological status and risk factors of deep vein thrombosis in patients with femoral neck fracture. J Orthop Surg Res 2022; 17:41. [PMID: 35065681 PMCID: PMC8783407 DOI: 10.1186/s13018-022-02926-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 01/06/2022] [Indexed: 01/17/2023] Open
Abstract
Abstract
Objectives
The purpose of this study was to investigate the incidence of deep vein thrombosis (DVT) and clarify the risk factors of DVT in patients with femoral neck fracture.
Methods
A self-designed questionnaire was used to collect the clinical data of 1209 patients with femoral neck fracture in our hospital from January 2019 to December 2019. The content of the questionnaire mainly includes general information, past medical history, history of present illness, operation related information, occurrence of DVT. The collected data were entered into Excel to analyze the incidence and risk factors of DVT in patients with femoral neck fracture. Chi square test and binary logistic regression model was used to screen the risk factors of DVT.
Results
1209 cases of femoral neck fracture were included in this study. The incidence of DVT was 28.0% (339 patients). Among them, 71.7% (243 patients) were preoperative DVT and 28.3% (96 patients) were postoperative DVT. For the risk-factor analysis, gender, age, time from injury to hospitalization, operative method, anesthesia method and intraoperative blood loss were independent risk factors for DVT.
Conclusion
The incidence of DVT in patients with femoral neck fracture is relatively high, and there are many related risk factors.
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13
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Escobar MQ, Tasic L, da Costa TBBC, Stanisic D, Montalvão S, Huber S, Annichino-Bizzacchi JM. Serum Metabolic Profiles Based on Nuclear Magnetic Resonance Spectroscopy among Patients with Deep Vein Thrombosis and Healthy Controls. Metabolites 2021; 11:874. [PMID: 34940632 PMCID: PMC8704499 DOI: 10.3390/metabo11120874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
Deep venous thrombosis (DVT) is associated with significant morbidity and mortality. Studies on changes in the level of metabolites could have the potential to reveal biomarkers that can assist in the early detection, diagnosis, monitoring of DVT progression, response to treatment, or recurrence of DVT. In this scenario, the metabolomic analysis can provide a better understanding of the biochemical dysregulations of thrombosis. Using an untargeted metabolomic approach through magnetic resonance spectroscopy and multi- and univariate statistical analysis, we compared 40 patients with previous venous thrombosis and 40 healthy individuals, and we showed important serum differences between patients and controls, especially in the spectral regions that correspond to glucose, lipids, unsaturated lipids, and glycoprotein A. Considering the groups depending on risk factors and the local of the previous episode (lower limbs or cerebral system), we also noticed differences in metabolites linked to lipids and lactate. Comparative analyses pointed to altered ratios of glucose/lactate and branched-chain amino acids (BCAAs)/alanine, which might be associated with the fingerprints of thrombosis. Although samples for metabolomic analysis were collected months after the acute episode, these results highlighted that, alterations can still remain and may contribute to a better understanding of the complications of the disease.
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Affiliation(s)
- Melissa Quintero Escobar
- Hematology and Hemotherapy Center, Hemocentro, University of Campinas (UNICAMP), Campinas 13083-878, SP, Brazil; (S.M.); (S.H.)
- Chemical Biology Laboratory, Department of Organic Chemistry, Institute of Chemistry, University of Campinas (UNICAMP), Campinas 13083-970, SP, Brazil; (T.B.B.C.d.C.); (D.S.)
| | - Ljubica Tasic
- Chemical Biology Laboratory, Department of Organic Chemistry, Institute of Chemistry, University of Campinas (UNICAMP), Campinas 13083-970, SP, Brazil; (T.B.B.C.d.C.); (D.S.)
| | - Tassia Brena Barroso Carneiro da Costa
- Chemical Biology Laboratory, Department of Organic Chemistry, Institute of Chemistry, University of Campinas (UNICAMP), Campinas 13083-970, SP, Brazil; (T.B.B.C.d.C.); (D.S.)
| | - Danijela Stanisic
- Chemical Biology Laboratory, Department of Organic Chemistry, Institute of Chemistry, University of Campinas (UNICAMP), Campinas 13083-970, SP, Brazil; (T.B.B.C.d.C.); (D.S.)
| | - Silmara Montalvão
- Hematology and Hemotherapy Center, Hemocentro, University of Campinas (UNICAMP), Campinas 13083-878, SP, Brazil; (S.M.); (S.H.)
| | - Stephany Huber
- Hematology and Hemotherapy Center, Hemocentro, University of Campinas (UNICAMP), Campinas 13083-878, SP, Brazil; (S.M.); (S.H.)
| | - Joyce Maria Annichino-Bizzacchi
- Hematology and Hemotherapy Center, Hemocentro, University of Campinas (UNICAMP), Campinas 13083-878, SP, Brazil; (S.M.); (S.H.)
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14
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Zengin A, Karataş MB, Çanga Y, Güzelburç Ö, Yelgeç NS, Emre A. Terapia Trombolítica em Octogenários com Embolia Pulmonar Aguda. Arq Bras Cardiol 2021; 118:68-74. [PMID: 35195211 PMCID: PMC8959058 DOI: 10.36660/abc.20201060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/24/2021] [Indexed: 11/25/2022] Open
Abstract
Fundamento Apesar da grande proporção de octogenários com embolia pulmonar aguda, há pouca informação indicando a estratégia de manejo ideal, especialmente medidas terapêuticas, como a terapia lítica. Objetivos O número de pacientes idosos diagnosticados com embolia pulmonar aguda aumenta constantemente. Porém, o papel do tratamento trombolítico não está claramente definido entre os octogenários. Nosso objetivo é avaliar a efetividade da terapia lítica em pacientes octogenários diagnosticados com embolia pulmonar. Métodos Cento e quarenta e oito indivíduos (70,3% de mulheres, n=104) com mais de 80 anos foram incluídos no estudo. Os pacientes foram divididos em dois grupos: tratamento trombolítico versus não-trombolítico. As taxas de mortalidade hospitalar e episódios de sangramento foram definidos como desfechos do estudo. Valor de p <0,05 foi considerado como estatisticamente significativo. Resultados A mortalidade hospitalar reduziu significativamente no grupo trombolítico em comparação ao não-trombolítico (10,5% vs. 24,2%; p=0,03). Episódios de sangramento menores foram mais comuns no braço que recebeu o tratamento trombolítico, mas grandes hemorragias não diferiram entre os grupos (35,1% vs. 13,2%, p<0,01; 7% vs. 5,5% p=0,71, respectivamente). O escore de PESI alto (OR: 1,03 IC95%; 1,01-1,04 p<0,01), a terapia trombolítica (OR: 0,15 IC95%; 0,01-0,25, p< 0,01) e níveis altos de troponina (OR: 1,20 IC95%; 1,01-1,43, p=0,03) estiveram independentemente associados a taxas de mortalidade hospitalar na análise de regressão multivariada. Conclusão A terapia trombolítica esteve associada à mortalidade hospitalar reduzida em detrimento do aumento geral das complicações de sangramento em octogenários.
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15
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Badescu MC, Ciocoiu M, Badulescu OV, Vladeanu MC, Bojan IB, Vlad CE, Rezus C. Prediction of bleeding events using the VTE-BLEED risk score in patients with venous thromboembolism receiving anticoagulant therapy (Review). Exp Ther Med 2021; 22:1344. [PMID: 34630698 DOI: 10.3892/etm.2021.10779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/03/2021] [Indexed: 12/15/2022] Open
Abstract
Venous thromboembolism (VTE) is a major healthcare problem due to its high incidence, significant mortality rate from pulmonary embolism, high recurrence rate and morbidity from long-term complications. After a first episode of VTE all patients must receive anticoagulant treatment for 3 months. Further anticoagulation is recommended in patients without transient risk factors for VTE or patients with active cancer, if they are not at a high risk for bleeding. The VTE-BLEED risk score was created with the purpose of enabling a better stratification of the bleeding risk during stable anticoagulation after a first VTE. Currently, it is the most validated risk score in VTE settings (selected and non-selected cohorts). It has a good prediction power for major bleeding events in patients receiving any of the currently available classes of oral anticoagulants, and it can identify patients at risk of intracranial and fatal bleeding events. The aim of our review was to highlight the strengths of the VTE-BLEED risk score, to acknowledge its weak points and to properly position its use in current medical practice.
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Affiliation(s)
- Minerva Codruta Badescu
- Department of Internal Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Manuela Ciocoiu
- Department of Pathophysiology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Oana Viola Badulescu
- Department of Pathophysiology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Maria-Cristina Vladeanu
- Department of Pathophysiology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Iris Bararu Bojan
- Department of Pathophysiology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cristiana Elena Vlad
- Department of Nephrology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
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16
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Maasdorp SD. Venous thromboembolism and infection. Afr J Thorac Crit Care Med 2021; 27:10.7196/AJTCCM.2021.v27i3.171. [PMID: 34734175 PMCID: PMC8547340 DOI: 10.7196/ajtccm.2021.v27i3.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- S D Maasdorp
- Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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17
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Mazzolai L, Ageno W, Alatri A, Bauersachs R, Becattini C, Brodmann M, Emmerich J, Konstantinides S, Meyer G, Middeldorp S, Monreal M, Righini M, Aboyans V. Second consensus document on diagnosis and management of acute deep vein thrombosis: updated document elaborated by the ESC Working Group on aorta and peripheral vascular diseases and the ESC Working Group on pulmonary circulation and right ventricular function. Eur J Prev Cardiol 2021; 29:1248-1263. [PMID: 34254133 DOI: 10.1093/eurjpc/zwab088] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/25/2021] [Accepted: 05/07/2021] [Indexed: 12/14/2022]
Abstract
This consensus document is proposed to clinicians to provide the whole spectrum of deep vein thrombosis management as an update to the 2017 consensus document. New data guiding clinicians in indicating extended anticoagulation, management of patients with cancer, and prevention and management of post-thrombotic syndrome are presented. More data on benefit and safety of non-vitamin K antagonists oral anticoagulants are highlighted, along with the arrival of new antidotes for severe bleeding management.
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Affiliation(s)
- Lucia Mazzolai
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Chemin de Mont-Paisible 18, CH-1011 Lausanne, Switzerland
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Via Ravasi 2, 21100 Varese, Italy
| | - Adriano Alatri
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Chemin de Mont-Paisible 18, CH-1011 Lausanne, Switzerland
| | - Rupert Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt GmbH, Grafenstraße 9, 64283 Darmstadt, Germany.,Departement of Vascular Medicine, Center for Thrombosis and Hemostasis, University Medical Center Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Cecilia Becattini
- Departement of Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Marianne Brodmann
- Département of Internal Medicine, Division of Angiology, Medical University Graz, Graz, Austria
| | - Joseph Emmerich
- Department of Vascular Medicine, Groupe Hospitalier Paris Saint-Joseph and University of Paris, Paris, France
| | - Stavros Konstantinides
- Departement of Vascular Medicine, Center for Thrombosis and Hemostasis, University Medical Center Mainz, Langenbeckstr. 1, 55131 Mainz, Germany.,Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Saskia Middeldorp
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, Spain
| | - Marc Righini
- Division of Angiology and Hemostasis, Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital and Inserm 1094, Tropical Neuroepidemiology, School of Medicine, 2 avenue martin Luther-King 87042 Limoges, France
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18
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Rubio-Jurado B, Albores-Arguijo RC, Guerra-Soto A, Plasencia-Ortiz T, Tavarez-Macías G, Huerta-Hernández J, Riebeling-Navarro C, Nava-Zavala AH. Concordance between clinical diagnosis of pulmonary thromboembolism at hospital discharge and anatomopathological diagnosis. Int J Immunopathol Pharmacol 2021; 34:2058738420942390. [PMID: 32838596 PMCID: PMC7450291 DOI: 10.1177/2058738420942390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Half of the cases of pulmonary thromboembolism (PTE) are not diagnosed because of
its unspecific clinical presentation; in Mexico, autopsy data reveal a similar
incidence to that of developed countries. The objective of this work was to know
the concordance between the clinical diagnosis of PTE at hospital discharge and
its autopsy diagnosis. The method used was a retrospective cohort study of cases
with PTE diagnosis who attended from January 2005 to December 2013. Information
was obtained from the autopsies registry and clinical charts. From 177,368
hospital discharges, there were 412 (6.74%) with PTE diagnosis. There were
13,559 deaths, with PTE diagnosis in 139 (1%) patients. There were 479
autopsies, and in 66 (14%) of whom PTE diagnosis was documented, the mean age
was 55 years (range, 18–89 years). The premortem diagnosis of PTE at discharge
was confirmed in 412 cases. Postmortem diagnosis of principal disease was
medical in 49 (74%) and medical-surgical in 17 (26%) patients. We found that
nine patients had the clinical diagnosis of PTE, unlike the postmortem
diagnosis, which was reported in 66 autopsies. The above allows establishing a
1:7 ratio that represents 14%. D-dimer was determined in 11 cases (16%) and was
positive in 8 (73%). Thromboprophylaxis was applied in 15 cases (23%). The study
of necropsies and identification of discrepancies is needed to improve the
diagnostic accuracy and healthcare quality. The evaluation of hemostasis
biomarkers besides D-dimer can better describe the pro-thrombotic state, the
risk of thrombosis, and its association with morbidity and mortality.
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Affiliation(s)
- Benjamín Rubio-Jurado
- Servicio de Hematología UMAE, HE, CMNO, Instituto Mexicano del Seguro Social, Guadalajara, México.,Unidad de Investigación Biomédica 02, UMAE, HE, CMNO, Instituto Mexicano del Seguro Social, Guadalajara, México.,Extensión, Consulting and Research Division, Universidad de Monterrey, San Pedro Garza García, México
| | | | - Antonio Guerra-Soto
- Unidad de Investigación Biomédica 02, UMAE, HE, CMNO, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Teresita Plasencia-Ortiz
- Departamento de Patología, UMAE, HE, CMNO, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Gerónimo Tavarez-Macías
- Departamento de Patología, UMAE, HE, CMNO, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Jennifer Huerta-Hernández
- Departamento de Patología, UMAE, HE, CMNO, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Carlos Riebeling-Navarro
- Unidad de Investigación en Epidemiología Clínica, UMAE, Hospital de Pediatría CMNS-XXI, Instituto Mexicano del Seguro Social/UNAM, México City, México
| | - Arnulfo Hernán Nava-Zavala
- Unidad de Investigación Biomédica 02, UMAE, HE, CMNO, Instituto Mexicano del Seguro Social, Guadalajara, México.,Programa Internacional de la Facultad de Medicina, Universidad Autónoma de Guadalajara, Zapopan, México.,División de Medicina Interna, Servicio de Inmunología y Reumatología, Hospital General de Occidente, Secretaria de Salud Jalisco, Zapopan, México
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19
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Hassan FM, Alsultan A, Alzehrani F, Albuali W, Bubshait D, Abass E, Elbasheer M, Alkhanbashi A. Genetic Variants of RPL5 and RPL9 Genes among Saudi Patients Diagnosed with Thrombosis. Med Arch 2021; 75:188-193. [PMID: 34483448 PMCID: PMC8385736 DOI: 10.5455/medarh.2021.75.188-193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/20/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Thrombosis directly affects the quality of life with increased mortality. The RPL5 (L5) gene on intron 6 on chromosome 1p22, rs6604026 is associated with multiple sclerosis risk, whereas RPL9 (L9) on 8 exons on chromosome 4p14 has been documented so far as being an essential involvement in the proliferation of protein synthesized cells mostly by gene products. OBJECTIVE The aim of this work was to assess genetic variants of RPL5 and RPL9 and thrombosis to characterize their role in the diagnosis of thrombosis among the Saudi population. METHODS The cross-sectional study involved 100 Saudi patients diagnosed with thrombosis (arterial or venous) in 50 healthy individuals as controls in the same age and sex groups. Primers were designed RPL5 and RPL9 for molecular analysis. The Sanger System ABI-3730xL (Hong Kong) automatic sequencing was used for DNA sequencing. Statistical analysis was performed using the Prism 5 and SPSS version-21 programs. RESULTS The male / female age ratio was 66.7 / 57.4, and the mean age was 61.2 years. Most of the patients were self-identifiable and without a previous history of thrombosis (61.0%). Most of the patients had just been diagnosed, that is, in the last five years (74.0%), about 43% of the patients underwent treatment using combination therapy (Aspirin and oral anticoagulants). New gene variants of RPL5 (5 SNPs) and RPL9 (9 SNPs) were detected in Saudi thrombotic patients. CONCLUSION Mutations in RPL5 and RPL9 were reported in all thrombotic patients, represented by a new variant of the ribosomal protein gene and correlated with thrombosis in the Saudi population. These results may reflect an association between the ribosomal protein SNP gene and the incidence and progression of thrombosis in the Saudi population.
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Affiliation(s)
- Fathelrahman Mahdi Hassan
- Department of Clinical Laboratory Sciences, College of Applied Medical Science. Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Afnan Alsultan
- Department of Clinical Laboratory Sciences, College of Applied Medical Science. Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faisal Alzehrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Science. Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Waleed Albuali
- Department of Pediatrics, College of Medicine. Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Dalal Bubshait
- Department of Pediatrics, College of Medicine. Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Elfadil Abass
- Department of Clinical Laboratory Sciences, College of Applied Medical Science. Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mudathir Elbasheer
- Department of Clinical Laboratory Sciences, College of Applied Medical Science. Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulmohsen Alkhanbashi
- Department of Clinical Laboratory Sciences, College of Applied Medical Science. Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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20
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Liu W, He L, Zeng W, Yue L, Wei J, Zeng S, Wang X, Gong Z. Peripherally inserted central venous catheter in upper extremities leads to an increase in D-dimer and deep vein thrombosis in lower extremities. Thromb J 2021; 19:24. [PMID: 33836784 PMCID: PMC8035721 DOI: 10.1186/s12959-021-00275-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/22/2021] [Indexed: 11/15/2022] Open
Abstract
Background The purpose of this study is to elucidate the association between peripherally inserted central venous catheter (PICC) in upper extremities and lower extremity deep venous thrombosis (LEDVT) by observing the changes in D-dimer. Methods This was a retrospective cohort study with 3452 patients (104 inserted with PICCs and 3348 without PICC) enrolled at the neurology department from April 1, 2017 to April 1, 2020. The patients underwent color Doppler ultrasound (CDU) and D-dimer examinations. LEDVT-related factors and D-dimer value were analyzed before and after PICC insertion. The predictive value of D-dimer for LEDVT was also evaluated. Results Univariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 9 times and promoted the increase of D-dimer by 5 times. After risk adjustment, multivariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 4 times and tripled the risk of D-dimer increase. The concentration of D-dimer was significantly increased after PICC insertion. D-dimer was unsuitable for excluding venous thrombosis in patients inserted with PICCs. Conclusions PICC insertion increases the level of D-dimer and the risk of LEDVT. The risks of venous thrombosis need to be assessed in patients inserted with PICCs to ensure the expected clinical outcomes.
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Affiliation(s)
- Wanli Liu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Lianxiang He
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Wenjing Zeng
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Pharmacy, Xiangya Hospital, National Clinical Research Center for Geriatric Disorders, Central South University, Hunan, 410008, Changsha, People's Republic of China
| | - Liqing Yue
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Jie Wei
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Pharmacy, Xiangya Hospital, National Clinical Research Center for Geriatric Disorders, Central South University, Hunan, 410008, Changsha, People's Republic of China
| | - Shuangshuang Zeng
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Pharmacy, Xiangya Hospital, National Clinical Research Center for Geriatric Disorders, Central South University, Hunan, 410008, Changsha, People's Republic of China
| | - Xiang Wang
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Pharmacy, Xiangya Hospital, National Clinical Research Center for Geriatric Disorders, Central South University, Hunan, 410008, Changsha, People's Republic of China
| | - Zhicheng Gong
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China. .,Department of Pharmacy, Xiangya Hospital, National Clinical Research Center for Geriatric Disorders, Central South University, Hunan, 410008, Changsha, People's Republic of China.
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21
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Yuan X, Tong X, Wang Y, Wang H, Wang L, Xu X. Coagulopathy in elderly patients with coronavirus disease 2019. Aging Med (Milton) 2020; 3:260-265. [PMID: 33392432 PMCID: PMC7771561 DOI: 10.1002/agm2.12133] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/15/2020] [Accepted: 10/15/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Since the outbreak of coronavirus disease 2019 (COVID-19), clinical features have been analyzed in detail. However, coagulopathy in elderly COVID-19 patients has been scarcely reported. METHODS Coagulation parameters of 189 patients with COVID-19 in Tongji hospital were retrospectively analyzed among age groups. RESULTS Patients were divided into 2 groups: older group (≥65 years, n = 87) and younger group (<65 years, n = 102). The proportion of patients with elevated fibrinogen (79.0% vs 59.6%, p = .005) and D-dimer (78.0% vs 55.2%, p = .001) shows the significant difference between the groups. The elderly patients revealed significantly longer prothrombin time (14.0 [13.4-14.4]s vs 13.6 [13.2-14.1]s, p = .026), higher D-dimer (1.00 [0.5-1.9] μg/mL vs 0.6 [0.3-1.6] μg/mL, p = .013) and fibrinogen (5.2 [4.1-6.2] g/L vs 4.4 [3.4-5.7] g/L, p = .004) levels, compared to the younger group. A positive correlation was observed between the coagulation parameters and inflammatory markers including high-sensitivity C-reactive protein and interleukin-6 (p < .05). CONCLUSIONS The hypercoagulable state is more common in elderly COVID-19 patients, and coagulopathy is associated with excessive systemic inflammation.
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Affiliation(s)
- Xueting Yuan
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission; Institute of Geriatric Medicine, Chinese Academy of Medical SciencesP. R. China
| | - Xunliang Tong
- Department of Pulmonary and Critical Care MedicineBeijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical SciencesP. R. China
| | - Yan Wang
- Department of Pulmonary and Critical Care MedicineBeijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical SciencesP. R. China
| | - He Wang
- Department of Pulmonary and Critical Care MedicineBeijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical SciencesP. R. China
| | - Liuming Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyHubeiChina
| | - Xiaomao Xu
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission; Institute of Geriatric Medicine, Chinese Academy of Medical SciencesP. R. China
- Department of Pulmonary and Critical Care MedicineBeijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical SciencesP. R. China
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22
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Quintero M, Tasic L, Annichino-Bizzacchi J. Thrombosis: Current knowledge based on metabolomics by nuclear magnetic resonance (NMR) spectroscopy and mass spectrometry (MS). THROMBOSIS UPDATE 2020. [DOI: 10.1016/j.tru.2020.100011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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23
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Sbeit W, Kadah A, Shafrir A, Kalisky I, Mahamid M, Hazou W, Katz L, Mari A, Khoury T. Unawareness of thromboprophylaxis is associated with low venous thromboembolism occurrence in hospitalized patients with acute inflammatory bowel disease flare. Minerva Med 2020; 111. [DOI: 10.23736/s0026-4806.20.06885-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
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24
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Schofield Z, Baksamawi HA, Campos J, Alexiadis A, Nash GB, Brill A, Vigolo D. The role of valve stiffness in the insurgence of deep vein thrombosis. COMMUNICATIONS MATERIALS 2020; 1:65. [PMID: 32999999 PMCID: PMC7497694 DOI: 10.1038/s43246-020-00066-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/18/2020] [Indexed: 05/28/2023]
Abstract
Deep vein thrombosis is a life-threatening development of blood clots in deep veins. Immobility and blood flow stagnancy are typical risk factors indicating that fluid dynamics play an important role in the initiation of venous clots. However, the roles of physical parameters of the valves and flow conditions in deep vein thrombosis initiation have not been fully understood. Here, we describe a microfluidics in vitro method that enabled us to explore the role of valve elasticity using in situ fabrication and characterisation. In our experimental model the stiffness of each valve leaflet can be controlled independently, and various flow conditions were tested. The resulting complex flow patterns were detected using ghost particle velocimetry and linked to localised thrombus formation using whole blood and an aqueous suspension of polystyrene particles. In particular, valves with leaflets of similar stiffness had clot formation on the valve tips whereas valves with leaflets of different stiffness had clot formation in the valve pocket.
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Affiliation(s)
- Zoe Schofield
- School of Chemical Engineering, University of Birmingham, Birmingham, B15 2TT UK
- Physical Sciences for Health, University of Birmingham, Birmingham, B15 2TT UK
| | | | - Joana Campos
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Alessio Alexiadis
- School of Chemical Engineering, University of Birmingham, Birmingham, B15 2TT UK
| | - Gerard B. Nash
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Alexander Brill
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, B15 2TT UK
- Department of Pathophysiology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Centre of Membrane Proteins and Receptors, University of Birmingham and Nottingham, The Midlands, UK
| | - Daniele Vigolo
- School of Chemical Engineering, University of Birmingham, Birmingham, B15 2TT UK
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25
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Coelho J, Divernet-Queriaud M, Roy PM, Penaloza A, Le Gal G, Trinh-Duc A. Comparison of the Wells score and the revised Geneva score as a tool to predict pulmonary embolism in outpatients over age 65. Thromb Res 2020; 196:120-126. [PMID: 32862033 DOI: 10.1016/j.thromres.2020.07.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 12/14/2022]
Abstract
TITLE Comparison of the Wells score and the revised Geneva score as a tool to predict pulmonary embolism in outpatients over 65 years of age. INTRODUCTION The incidence and mortality of pulmonary embolism (PE) is high in the elderly. The Wells score (SW) and the revised Geneva score (RGS) have been validated in patient populations with a large age range. The aim of this study was to compare the predictive accuracy of these two scores in diagnosis of PE in patients over 65 years of age. METHOD A prospective multicentre study (nine French and three Belgian centres) was conducted at the same time as the PERCEPIC study. A total of 1757 patients admitted with suspected PE were included and divided into two groups according to age (≥65 years or <65 years). The pre-test probability of PE was assessed prospectively for the RGS. The SW was calculated retrospectively. The predictive accuracy of the two scores was compared by the area under the curve (AUC) of the ROC curves. RESULTS The overall prevalence of PE was 11.3%. The prevalence among patients aged ≥65 in the low, moderate and high pre-test probability groups, evaluated using the WS and was respectively 13.5% (CI 95%: CI 9.9-17.3), 28.2% (CI 22.1-34.3), 50% (CI 26-74) and 8.1% (CI 3.2-12.9), 22.3% (CI 18.2-26.3), 43.7% (CI 25.6-61.9) using the RGS. The AUC for the WS and RGS for patients aged ≥65 was 0.632 (CI 0.574-0.691) and 0.610 (CI 0.555-0.666). The difference between the AUCs was not statistically significant (p = .441). CONCLUSION In the population for this study, the WS and RGS have the same PE diagnostic accuracy in patients over age 65. This result should be validated in a prospective study that directly compares these scores.
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Affiliation(s)
- Julien Coelho
- Centre Hospitalier d'Agen-Nérac, Site St Esprit, 21 route de Villeneuve, 47923 Agen, France.
| | | | - Pierre-Marie Roy
- Emergency Department, Centre Hospitalier Universitaire Angers, Institut Mitovasc, Université d'Angers, Angers, France
| | - Andréa Penaloza
- Emergency Department, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Grégoire Le Gal
- Division of Hematology-Thrombosis Program, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Albert Trinh-Duc
- Centre Hospitalier d'Agen-Nérac, Site St Esprit, 21 route de Villeneuve, 47923 Agen, France
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26
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Mansella G, Keil C, Nickel CH, Eken C, Wirth C, Tzankov A, Peterson CJ, Aujesky D, Bingisser R. Delayed Diagnosis in Pulmonary Embolism: Frequency, Patient Characteristics, and Outcome. Respiration 2020; 99:589-597. [PMID: 32694258 DOI: 10.1159/000508396] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/02/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The incidence and the outcomes of pulmonary embolism (PE) missed during emergency department (ED) workup are largely unknown. OBJECTIVES To describe the frequency, demographics, and outcomes of patients with delayed diagnosis of PE. METHODS We retrospectively compared patients diagnosed with PE during ED workup (early diagnosis) with patients diagnosed with PE thereafter (delayed diagnosis). Electronic health records (EHR) of 123,560 consecutive patients who attended a tertiary hospital ED were screened. Data were matched with radiology and pathology results from the EHR. RESULTS Of 1,119 patients presenting to the ED with early workup for PE, PE was diagnosed in 182 patients (80.5%) as early diagnosis. Delayed diagnosis was established in 44 cases (19.5%) using radiology and/or autopsy data. Median age of patients with early diagnosis was significantly lower as compared to delayed diagnosis (67 vs. 77.5 years). Main symptoms were dyspnea (109 patients [59.9%] in early, 20 patients [45.5%] in delayed diagnosis), chest pain (90 patients [49.5%] in early, 8 patients [18.2%] in delayed diagnosis), and nonspecific complaints (16 patients [8.8%] in early, 13 patients [29.5%] in delayed diagnosis). In-hospital mortality was 1.6% in early diagnosis and 43.2% in delayed diagnosis. CONCLUSIONS Delayed diagnosis of PE carries a worse prognosis than early diagnosis. This discrepancy may arise from either delayed therapy, confounding variables (e.g., older age), or both. Possible reasons for delayed diagnoses are nonspecific presentations and symptoms overlapping with preexisting conditions.
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Affiliation(s)
- Gregory Mansella
- Department of Emergency Medicine, University Hospital of Basel, University of Basel, Basel, Switzerland,
| | - Christoph Keil
- Department of Cardiology, Vienna North Hospital, Vienna, Austria
| | - Christian H Nickel
- Department of Emergency Medicine, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Ceylan Eken
- Department of Emergency Medicine, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Christian Wirth
- Department of Emergency Medicine, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Alexandar Tzankov
- Department of Pathology, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Caspar Joyce Peterson
- Department of Emergency Medicine, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Bingisser
- Department of Emergency Medicine, University Hospital of Basel, University of Basel, Basel, Switzerland
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27
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Trimaille A, Curtiaud A, Marchandot B, Matsushita K, Sato C, Leonard-Lorant I, Sattler L, Grunebaum L, Ohana M, Von Hunolstein JJ, Andres E, Goichot B, Danion F, Kaeuffer C, Poindron V, Ohlmann P, Jesel L, Morel O. Venous thromboembolism in non-critically ill patients with COVID-19 infection. Thromb Res 2020; 193:166-169. [PMID: 32707275 PMCID: PMC7367026 DOI: 10.1016/j.thromres.2020.07.033] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/11/2020] [Accepted: 07/15/2020] [Indexed: 01/30/2023]
Abstract
Venous thromboembolism (VTE) is a frequent complication in COVID-19 patients. Single-center study of COVID-19 patients admitted to general ward. 17.0% of patients with VTE Lack of thromboprophylaxis and leukocytosis were independent risk factors of VTE. VTE is independently associated with worse in-hospital outcomes.
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Affiliation(s)
- Antonin Trimaille
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France; INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Anaïs Curtiaud
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Benjamin Marchandot
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Kensuke Matsushita
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France; INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Chisato Sato
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France; INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Ian Leonard-Lorant
- Radiology Department, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Laurent Sattler
- Department Laboratory Haematology, Center for Thrombosis and Haemostasis, Nouvel Hôpital Civil Strasbourg University Hospital, Strasbourg, France
| | - Lelia Grunebaum
- Department Laboratory Haematology, Center for Thrombosis and Haemostasis, Nouvel Hôpital Civil Strasbourg University Hospital, Strasbourg, France
| | - Mickaël Ohana
- Radiology Department, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Jean-Jacques Von Hunolstein
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Emmanuel Andres
- Department of Internal Medicine, Médicale B, Strasbourg University Hospital, Strasbourg, France
| | - Bernard Goichot
- Department of Internal Medicine, Diabetes and Metabolic Disorders, Strasbourg University Hospital, Strasbourg, France
| | - François Danion
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | - Charlotte Kaeuffer
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | - Vincent Poindron
- National Referral Center for Systemic Autoimmune Diseases, Clinical Immunology Department, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Patrick Ohlmann
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Laurence Jesel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France; INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France
| | - Olivier Morel
- Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France; INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, Strasbourg, France.
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28
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Abdel-Hafez O, Salih M, Aloka F, Patel K. Intravascular ultrasound-guided mechanical thrombectomy using the INARI ClotTriever device of an iatrogenic deep venous thrombosis. BMJ Case Rep 2020; 13:13/7/e235464. [PMID: 32675124 DOI: 10.1136/bcr-2020-235464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Deep vein thrombosis (DVT) is a common disorder affecting 1 to 2 per 1000 Americans annually, resulting in significant morbidity and mortality. Anticoagulation is the mainstay management strategy for DVT. However, this could prove insufficient in cases where a mechanical obstruction is responsible for the DVT. We are presenting an interesting case of iatrogenic DVT incurred after Prolene suturing of lacerated iliac vein and the management employed for this challenging case with a successful and significant improvement in the clinical outcome.
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Affiliation(s)
- Osama Abdel-Hafez
- Cardiovascular Department, Saint Joseph Mercy Oakland Hospital, Pontiac, Michigan, USA
| | - Mohammed Salih
- Cardiovascular Department, Saint Joseph Mercy Oakland Hospital, Pontiac, Michigan, USA
| | - Feras Aloka
- Cardiovascular Department, Saint Joseph Mercy Oakland Hospital, Pontiac, Michigan, USA
| | - Kirit Patel
- Cardiovascular Department, Saint Joseph Mercy Oakland Hospital, Pontiac, Michigan, USA
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29
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Duanmu Y, Goldsmith AJ, Henwood PC, Platz E, Hoyler JE, Kimberly HH. Visual Estimation of Tricuspid Annular Plane Systolic Excursion by Emergency Medicine Clinicians. West J Emerg Med 2020; 21:1022-1028. [PMID: 32726278 PMCID: PMC7390579 DOI: 10.5811/westjem.2020.5.46714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 05/12/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Tricuspid annular plane systolic excursion (TAPSE) is an established echocardiographic marker of right ventricular (RV) systolic function. The objective of this study was to evaluate whether emergency clinicians can visually estimate RV function using TAPSE in a set of video clips compared to a reference standard M-mode measurement. METHODS Emergency clinicians were shown a five-minute educational video on TAPSE. Participants then viewed 20 apical four-chamber point-of-care ultrasound (POCUS) echocardiography clips and recorded their estimate of TAPSE distance in centimeters (cm), as well as whether TAPSE was normal (>1.9 cm), borderline (1.5-1.9 cm), or abnormal (<1.5 cm). We calculated sensitivity, specificity, and overall accuracy of visual TAPSE categorization using M-mode measurement as the criterion standard. Participants also reported their comfort with assessing TAPSE on a five-point Likert scale before and after participation in the study. RESULTS Among 70 emergency clinicians, including 20 postgraduate year 1-4 residents, 22 attending physicians, and 28 physician assistants (PA), the pooled sensitivity and specificity for visual assessment of TAPSE was 88.6% (95% confidence interval, 85.4-91.7%) and 81.6% (95% CI, 78.2-84.4%), respectively. The sensitivity and specificity for the clips in which the measured TAPSE was <1.5 cm or >1.9 cm was 91.4% (95% CI, 88.4-94.3%) and 90.8% (95% CI, 87.7-93.9%), respectively. There was no significant difference in sensitivity (p = 0.27) or specificity (p = 0.55) between resident and attending physicians or between physicians and PAs (p = 0.17 and p = 0.81). Median self-reported comfort with TAPSE assessment increased from 1 (interquartile range [IQR] 1-2) to 3 (IQR 3-4) points after participation in the study. CONCLUSION A wide range of emergency clinicians demonstrated fair accuracy for visual estimation of TAPSE on previously recorded POCUS echocardiography video clips. These findings should be considered hypothesis generating and warrant validation in larger, prospective studies.
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Affiliation(s)
- Youyou Duanmu
- Stanford University School of Medicine, Department of Emergency Medicine, Palo Alto, California
| | - Andrew J Goldsmith
- Harvard Medical School, Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Patricia C Henwood
- Thomas Jefferson University, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Elke Platz
- Harvard Medical School, Brigham and Women's Hospital, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Heidi H Kimberly
- Newton Wellesley Hospital, Department of Emergency Medicine, Newton, Massachusetts
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30
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Catella J, Bertoletti L, Mismetti P, Ollier E, Samperiz A, Soler S, Suriñach JM, Mahé I, Lorente MA, Braester A, Monreal M. Severe renal impairment and risk of bleeding during anticoagulation for venous thromboembolism. J Thromb Haemost 2020; 18:1728-1737. [PMID: 32299150 DOI: 10.1111/jth.14837] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 08/31/2023]
Abstract
BACKGROUND Detection of severe renal impairment in patients with venous thromboembolism (VTE) is mandatory both for selecting anticoagulant therapy and for evaluating major bleeding risk, increased by severe renal impairment. OBJECTIVES To determine whether the Cockcroft and Gault (CG) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas identify severe renal impairment in the same VTE patients presenting the same risk of major bleeding. PATIENTS/METHODS We compared clinical characteristics and outcomes during the first 3 months of anticoagulation between VTE patients in the RIETE registry with severe renal impairment according to the CG and/or CKD-EPI formula (estimated glomerular filtration rate <30 mL/min and <30 mL/min/1.73 m2 , respectively). The primary outcome was major bleeding. RESULTS Up to October 2017, 41 796 patients were included in RIETE. Among the 4676 patients with severe renal impairment according to at least one of the formulas, this was not confirmed by the other formula in 1904 (40.7%). Major bleeding risk was increased in every patient subgroup with severe renal impairment vs patients without this condition (CG or CKD-EPI < 30: odds ratio [OR] = 2.26, 95% confidence interval [CI 2.01-2.53], only CG < 30: OR = 1.72, 95% CI [1.37-2.13], only CKD-EPI < 30: OR = 2.34, 95% CI [1.77-3.05], CG+CKD-EPI < 30: OR = 2.47, 95% CI [2.16-2.83], all vs CG+CKD-EPI > 30). CONCLUSION The CG and CKD-EPI formulas identify different subgroups of patients with severe renal impairment, leading to discordant results in 40.7% of these patients. Irrespective of the formula used for their identification, patients with severe renal impairment have a higher risk of major bleeding under anticoagulant therapy.
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Affiliation(s)
- Judith Catella
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
- INSERM, CIC-1408, CHU Saint-Etienne, Saint-Etienne, France
- F-CRIN INNOVTE network, Saint-Etienne, France
| | - Patrick Mismetti
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
- INSERM, CIC-1408, CHU Saint-Etienne, Saint-Etienne, France
- F-CRIN INNOVTE network, Saint-Etienne, France
| | - Edouard Ollier
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
- URCIP, CHU de St-Etienne, Saint-Etienne, France
| | - Angel Samperiz
- Department of Internal Medicine, Hospital Reina Sofía, Tudela, Spain
| | - Silvia Soler
- Department of Internal Medicine, Hospital Olot i Comarcal de la Garrotxa, Gerona, Spain
| | - José Maria Suriñach
- Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Isabelle Mahé
- F-CRIN INNOVTE network, Saint-Etienne, France
- Department of Internal Medicine, Hôpital Louis Mourier (APHP), University Paris 7, Colombes, France
| | | | - Andrei Braester
- Department of Haematology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Spain
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31
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Yu R, Nansubuga F, Yang J, Ding W, Li K, Weng D, Wu P, Chen G, Ma D, Wei J. Efficiency and safety evaluation of prophylaxes for venous thrombosis after gynecological surgery. Medicine (Baltimore) 2020; 99:e20928. [PMID: 32569239 PMCID: PMC7310966 DOI: 10.1097/md.0000000000020928] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/04/2020] [Accepted: 05/25/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In this study, we investigate the incidence of venous thrombosis (VT), and evaluate the effectiveness and safety of 3 major thromboprophylaxes and the potential risk factors for VT in women undergoing surgery for a gynecological malignancy. METHODS We performed a randomized controlled trial of 307 patients undergoing laparoscopic surgery for gynecological malignancies at a single institution from January 2016 to October 2017. Patients were divided into 3 groups: one receiving a half dose of low-molecular-weight heparin sodium injection (FLUXUM, Alfa Wassermann, Italy) delivered by injection, one receiving a full dose of FLUXUM, and a third group receiving an Argatroban injection. RESULTS None of the patients in our study developed a pulmonary embolism, bleeding, or infectious complications. There were no statistical differences in the rate of deep venous thrombosis (DVT) (0%, 0%, and 2.38%) and the superficial venous thromboembolism (SVT) (15.66%, 8.97%, and 18.6%) among the 3 groups. None of the patients developed symptomatic VT. The effect of treatment on alanine aminotransferase and aspartate aminotransferase differed between the groups, with a minimal effect in the Argatroban group, and all 3 methods resulted in minimal impairment of renal function. Decreased hemoglobin, elevated levels of D-dimer, and prothrombin time were closely related to thrombogenesis. CONCLUSION In conclusion, the incidence of postoperative thrombosis in gynecological malignancy among these Chinese people is not as low as we had originally presumed. Argatroban is not more effective than Parnaparin as a direct thrombin inhibitor, but it has less influence on liver function, which is beneficial for patients undergoing chemotherapy. Hemoglobin, D-dimer, and prothrombin time may be used to predict or detect thrombogenesis.
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Affiliation(s)
- Ruidi Yu
- Department of Obstetrics and Gynecology
| | | | - Jun Yang
- Division of Vascular Surgery, Hepatic Surgery Center, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | | | - Kezhen Li
- Department of Obstetrics and Gynecology
| | | | - Peng Wu
- Department of Obstetrics and Gynecology
| | - Gang Chen
- Department of Obstetrics and Gynecology
| | - Ding Ma
- Department of Obstetrics and Gynecology
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Kim MH, Jun KW, Hwang JK, Park SC, Yun SS, Moon IS, Kim JI. Incidence and outcome of isolated distal deep vein thrombosis in kidney transplant recipients. Ann Surg Treat Res 2020; 98:324-331. [PMID: 32528912 PMCID: PMC7263890 DOI: 10.4174/astr.2020.98.6.324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/02/2020] [Accepted: 04/07/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Isolated distal deep vein thrombosis (IDDVT) is a localized lesion; nonetheless, the risk of proximal vein propagation makes it difficult to decide on the treatment protocol—that is, whether immediate anticoagulation after diagnosis or surveillance via serial imaging should be employed. This study aimed to investigate the appropriate treatment protocol for IDDVT in kidney transplant recipient (KTR). Methods Surveillance for venous thromboembolism (VTE) was performed using duplex ultrasonography (DUS) before transplant surgery and at 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year after transplant surgery. Dual mechanical prophylaxis was administered to prevent VTE. Results In total, 60 out of 829 patients (7.2%) developed VTE, with 49 cases (81.6%) of IDDVT. Among IDDVT patients, 15 patients were treated using anticoagulation-first strategy, whereas the remaining 34 patients were treated using surveillance-first strategy. No patient in either group exhibited thrombus extension into the proximal vein or recurrence within 1 year from transplant surgery. Conclusion In Korean KTR, extension of IDDVT into the proximal vein could be prevented safely and effectively by serial DUS surveillance along with the maintenance of mechanical prophylaxis. However, the patients who have high thrombus burden or are difficult to get repeated DUS require the use of anticoagulation in early stages.
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Affiliation(s)
- Mi-Hyeong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kang-Woong Jun
- Division of Vascular and Transplant Surgery, Department of Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Jeong-Kye Hwang
- Division of Vascular and Transplant Surgery, Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun-Cheol Park
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Seop Yun
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In-Sung Moon
- Division of Vascular and Transplant Surgery, Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Il Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
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Culbert MH, Hamidi M, Zeeshan M, Hanna K, Romero A, Joseph B, O'Keeffe T. Retrospective Analysis of Low-Molecular-Weight Heparin and Unfractionated Heparin in Pediatric Trauma Patients: A Comparative Analysis. J Surg Res 2020; 249:121-129. [DOI: 10.1016/j.jss.2019.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/28/2019] [Accepted: 11/03/2019] [Indexed: 11/28/2022]
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Xu J, Zhou Y, Nie H, Xiong Z, OuYang H, Huang L, Fang H, Jiang H, Huang F, Yang Y, Ding X, Wang X, Zhou W. Hyperthermia-triggered UK release nanovectors for deep venous thrombosis therapy. J Mater Chem B 2020; 8:787-793. [PMID: 31899460 DOI: 10.1039/c9tb01851d] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Deep vein thrombosis (DVT) is a common and lethal complication of surgery.
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Affiliation(s)
- Jiasheng Xu
- Department of Vascular Surgery
- The Second Affliated Hospital of Nanchang University
- China
| | - Yu Zhou
- Department of Vascular Surgery
- The Second Affliated Hospital of Nanchang University
- China
| | - Han Nie
- Department of Vascular Surgery
- The Second Affliated Hospital of Nanchang University
- China
| | | | - Huan OuYang
- Department of Vascular Surgery
- The Second Affliated Hospital of Nanchang University
- China
| | - Li Huang
- Department of Vascular Surgery
- The Second Affliated Hospital of Nanchang University
- China
| | - Huaqiang Fang
- Department of Vascular Surgery
- The Second Affliated Hospital of Nanchang University
- China
| | - Huixia Jiang
- Department of Vascular Surgery
- The Second Affliated Hospital of Nanchang University
- China
| | - Feng Huang
- Department of Medicine
- Nanchang University
- China
| | - Yalan Yang
- Department of Medicine
- Nanchang University
- China
| | - Xingwei Ding
- The National Engineering Research Center for Bioengineering Drugs and the Technologies of Translational Medicine Nanchang University
- China
| | - Xiaolei Wang
- The National Engineering Research Center for Bioengineering Drugs and the Technologies of Translational Medicine Nanchang University
- China
| | - Weimin Zhou
- Department of Vascular Surgery
- The Second Affliated Hospital of Nanchang University
- China
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Higher Imaging Yield When Clinical Decision Support Is Used. J Am Coll Radiol 2019; 17:496-503. [PMID: 31899178 DOI: 10.1016/j.jacr.2019.11.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/05/2019] [Accepted: 11/20/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Increased utilization of CT pulmonary angiography (CTPA) for the evaluation of pulmonary embolism has been associated with decreasing diagnostic yields and rising concerns about the harms of unnecessary testing. The objective of this study was to determine whether clinical decision support (CDS) use would be associated with increased imaging yields after controlling for selection bias. METHODS We performed a retrospective cohort study in the emergency departments of two tertiary care hospitals of all CTPAs performed between August 2015 and September 2018. Providers ordering a CTPA are routed to an optional CDS tool, which allows them to use Wells' Criteria for pulmonary embolism. After propensity score matching, CTPA yield was calculated for the CDS-use and CDS-dismissal groups and stratified by provider type. RESULTS A total of 7,367 CTPAs were ordered during the study period. Of those, providers used the CDS tool in 2,568 (35%) cases and did not use the tool in 4,799 (65%) of cases. After propensity score matching, CTPA yield was 11.99% in the CDS-use group and 8.70% in the CDS-dismissal group (P < .001). Attending physicians, residents, and physician assistant CDS users demonstrated a 56.5% (P = .006), 38.7% (P = .01), and 16.7% (P = .03) increased yield compared with those who dismissed the tool, respectively. DISCUSSION Diagnostic yield was 38% higher for CTPAs when the provider used the CDS tool, after controlling for selection bias. Yields were higher for every provider type. Further research is needed to discover successful strategies to increase provider use of these important tools.
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Rawal A, Ardeshna D, Hesterberg K, Cave B, Ibebuogu UN, Khouzam RN. Is there an optimal "door to cath time" in the treatment of acute pulmonary embolism with catheter-directed thrombolysis? ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:419. [PMID: 31660318 DOI: 10.21037/atm.2019.07.89] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ultrasound assisted catheter-directed thrombolysis (UACT) is a relatively novel approach to treating acute pulmonary embolism (PE). It is an alternative to systemic thrombolysis with good success rates and low reported in-hospital mortality, and low rates of procedure-related major and minor bleeding. Since UACT received FDA approval for the treatment of PE in 2014, there is paucity of data regarding the optimal timing of initiation of the procedure after the initial diagnosis is made. We reviewed the available literature regarding UACT for acute PE and found six studies that included time to procedure. Based on our review, patients may benefit from early (<24-48 h after presentation) rather than delayed (>48 h) initiation. Early initiation of therapy has shown to improve pulmonary arterial pressures, right ventricular (RV) to left ventricular (LV) ratios, with low rates of bleeding and low post procedural and in hospital mortality. However, further studies are required to confirm these findings and establish the appropriate timeline for initiation of UACT.
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Affiliation(s)
- Aranyak Rawal
- Department of Internal Medicine-Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Devarshi Ardeshna
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kirstin Hesterberg
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Brandon Cave
- Department of Pharmacy, Methodist University Hospital, Memphis, TN, USA
| | - Uzoma N Ibebuogu
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rami N Khouzam
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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Abstract
OBJECTIVES Recent evidence suggests that half-dose thrombolysis for pulmonary embolism may provide similar efficacy with reduced bleeding risk compared with full-dose therapy, but comparative studies are lacking. We aimed to evaluate the effectiveness and safety of half-dose versus full-dose alteplase for treatment of pulmonary embolism. DESIGN A retrospective cohort study comparing outcomes in patients receiving half-dose (50 mg) versus full-dose (100 mg) alteplase for pulmonary embolism. We used propensity score matching and sensitivity analyses to address confounding and hospital-level clustering. SETTING Data from 420 hospitals obtained from the Premier Healthcare Database between January 2010 and December 2014. SUBJECTS Adult critically ill patients with acute pulmonary embolism treated with IV alteplase therapy. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS This study included 3,768 patients: 699 (18.6%) in the half-dose and 3,069 (81.4%) in the full-dose group. At baseline, patients receiving half-dose alteplase required vasopressor therapy (23.3% vs 39.4%; p < 0.01) and invasive ventilation (14.3% vs 28.5%; p < 0.01) less often, compared with full dose. After propensity matching (n = 548 per group), half-dose alteplase was associated with increased treatment escalation (53.8% vs 41.4%; p < 0.01), driven mostly by secondary thrombolysis (25.9% vs 7.3%; p < 0.01) and catheter thrombus fragmentation (14.2% vs 3.8%; p < 0.01). Hospital mortality was similar (13% vs 15%; p = 0.3). There was no difference in cerebral hemorrhage (0.5% vs 0.4%; p = 0.67), gastrointestinal bleeding (1.6% vs 1.6%; p = 0.99), acute blood loss anemia (6.9% vs 4.6%; p = 0.11), use of blood products (p > 0.05 for all), or documented fibrinolytic adverse events (2.6% vs 2.8%; p = 0.82). CONCLUSIONS Compared with full-dose alteplase, half-dose was associated with similar mortality and rates of major bleeding. Treatment escalation occurred more often in half-dose-treated patients. These results question whether half-dose alteplase provides similar efficacy with improved safety, and highlights the need for further study before use of half-dose alteplase therapy can be routinely recommended in patients with pulmonary embolism.
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Kim MH, Jun KW, Hwang JK, Kim SD, Kim JY, Park SC, Won YS, Yun SS, Moon IS, Kim JI. Venous Thromboembolism Following Abdominal Cancer Surgery in the Korean Population: Incidence and Validation of a Risk Assessment Model. Ann Surg Oncol 2019; 26:4037-4044. [DOI: 10.1245/s10434-019-07633-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Indexed: 11/18/2022]
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Taylor BA, Parducci PM, Zaleski AL, Panza GA, Pescatello LS, Thompson PD. Venous thromboemboli associated with acute aerobic exercise: A review of case report commonalities. Scand J Med Sci Sports 2019; 29:1749-1754. [PMID: 31241786 DOI: 10.1111/sms.13505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 06/03/2019] [Accepted: 06/18/2019] [Indexed: 12/31/2022]
Abstract
Venous thromboembolic (VTE) events such as deep vein thrombosis (DVT) and pulmonary embolism (PE) have been reported in otherwise low-risk healthy athletes following acute bouts of aerobic exercise. PURPOSE To review case reports and assess the commonalities of athletic individuals with VTE, as well as return-to-play (RTP) recommendations. METHODS We reviewed 47 reports (20 DVTs, 15 PEs, and 12 DVTs/PEs, 19 women) of trained individuals who were diagnosed with DVT and/or PE following aerobic exercise. We assessed frequency of VTE risk factors, presenting symptoms, and RTP recommendations. RESULTS The age of women (24.6 ± 7.0 years) was lower (P < .01) than of men (40.6 ± 13.6 years). Of the 19 women, 14 (73.7%) used oral contraceptives. Thirteen cases (27.7%) reported a recent period of prolonged inactivity (>1 hour), and another 12 cases were found to have an antithrombin disorder following testing after diagnosis. The most frequently reported symptoms were muscle pain in 26 of 32 (81.3%) DVT or DVT/PE cases, and dyspnea in 21 of 27 (77.8%) PE or DVT/PE cases. Despite these common symptoms, the estimated time from first report of symptoms to confirmed diagnosis was 56.3 ± 118.7 days and 25 cases (53.2%) were initially misdiagnosed. Twenty-three cases (48.9%) did not report RTP recommendations, and those which did varied widely. CONCLUSIONS Thirty-two cases (~70%) had at least one of three major risk factors, suggesting that many cases of VTE in athletes may be preventable with better education and awareness. The wide variety of RTP recommendations highlights the need for standardized guidelines in this population.
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Affiliation(s)
- Beth A Taylor
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut.,Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Paul M Parducci
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
| | - Amanda L Zaleski
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut.,Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Gregory A Panza
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut.,Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Linda S Pescatello
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
| | - Paul D Thompson
- Department of Preventive Cardiology, Hartford Hospital, Hartford, Connecticut
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Risk of Recurrent Venous Thromboembolism After an Initial Episode: Risk Stratification and Implications for Long-term Treatment. Curr Cardiol Rep 2019; 21:24. [PMID: 30828779 DOI: 10.1007/s11886-019-1111-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW Venous thromboembolism (VTE) is a common condition with significant associated morbidity and mortality. Recurrent VTE after an initial episode is a preventable medical condition. The following review discusses data supporting recurrence risk estimates after an initial VTE episode as well as treatment strategies to mitigate risk of recurrent VTE. RECENT FINDINGS This review particularly highlights methods for stratifying the risk of recurrent VTE and recent studies that have evaluated direct oral anticoagulants for the prevention of recurrent VTE. Risk assessment for VTE recurrence should guide anticoagulation duration. In patients who present with unprovoked VTE events, there remains a high risk of recurrence that is significantly mitigated with extended duration anticoagulation with either a vitamin K antagonist or direct oral anticoagulant.
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Raymundo SRDO, Lobo SMA, Hussain KMK, Hussein KG, Secches IT. What has changed in venous thromboembolism prophylaxis for hospitalized patients over recent decades: review article. J Vasc Bras 2019; 18:e20180021. [PMID: 31191626 PMCID: PMC6542320 DOI: 10.1590/1677-5449.002118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 11/13/2018] [Indexed: 11/21/2022] Open
Abstract
Venous thromboembolism (VTE) is a common disease with high rates of morbidity and mortality and is considered the number one cause of avoidable mortality among hospitalized patients. Although VTE incidence is extremely high in all countries and there is ample evidence that thromboprophylaxis inexpensively reduces the rate of thromboembolic complications in both clinical and surgical patients, a great deal of doubt remains with respect to patient safety with this type of intervention and in relation to the ideal thromboprophylaxis methods. Countless studies and evidence-based recommendations confirm the efficacy of prophylaxis for prevention of VTE and/or patient deaths, but it remains underutilized to this day. This article presents a wide-ranging review of existing prophylaxis methods up to the present, from guidelines and national and international studies of thromboprophylaxis.
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Affiliation(s)
- Selma Regina de Oliveira Raymundo
- Faculdade Regional de Medicina de São José do Rio Preto – FAMERP, Hospital de Base, São José do Rio Preto, SP, Brasil.
- Hospital Austa, São José do Rio Preto, SP, Brasil.
| | - Suzana Margareth Ajeje Lobo
- Faculdade Regional de Medicina de São José do Rio Preto – FAMERP, Hospital de Base, São José do Rio Preto, SP, Brasil.
| | | | - Kassim Guzzon Hussein
- Faculdade de Medicina em São José do Rio Preto – FACERES, São José do Rio Preto, SP, Brasil.
| | - Isabela Tobal Secches
- Faculdade de Medicina em São José do Rio Preto – FACERES, São José do Rio Preto, SP, Brasil.
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Pannucci CJ. Venous Thromboembolism in Aesthetic Surgery: Risk Optimization in the Preoperative, Intraoperative, and Postoperative Settings. Aesthet Surg J 2019; 39:209-219. [PMID: 29846505 DOI: 10.1093/asj/sjy138] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The purpose of this Continuing Medical Education (CME) article is to provide a framework for practicing surgeons to conceptualize and quantify venous thromboembolism risk among the aesthetic and ambulatory surgery population. The article provides a practical approach to identify and minimize venous thromboembolism risk in the preoperative, intraoperative, and postoperative settings.
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Affiliation(s)
- Christopher J Pannucci
- Division of Plastic Surgery, Division of Health Services Research, at the University of Utah, Salt Lake City, UT
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Rastogi P, Kumar N, Ahluwalia J, Das R, Varma N, Suri V, Senee H. Thrombophilic risk factors are laterally associated with Apolipoprotein E gene polymorphisms in deep vein thrombosis patients: An Indian study. Phlebology 2018; 34:324-335. [PMID: 30282515 DOI: 10.1177/0268355518802693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Deep vein thrombosis is a multifactorial disease with many acquired and genetic risk factors. Polymorphism in the APOE gene is an upcoming potential pathogenic factor whose role is unclear in deep vein thrombosis. METHODS An equal number of deep vein thrombosis cases and controls (N = 100, each) were investigated for APOE gene polymorphisms along with known acquired and hereditable thrombophilic risk factors. APOE genotyping was done by polymerase chain reaction. RESULTS The ε3/ε4 and ε2/ε3 APOE genotypes were commoner in deep vein thrombosis cases than controls but not statistically significant ( ε3/ε4 → 18% versus 11%, OR = 1.776, CI = 0.792-3.984, p = 0.16; ε2/ε3 →10% versus 9%, OR = 1.123, CI = 0.436-2.895, p = 0.809). However, the following risk factors were found to be laterally associated with APOE genotypes in cases of deep vein thrombosis: pregnancy with ε2/ε3 genotype positivity (N = 29; p = 0.019), recurrent pregnancy loss with ε3/ε3 genotype (N = 29; p = 0.016), normal antithrombin levels with ε3/ε3 genotype (N = 62; p = 0.03) and non-O blood group with ε3/ε4 genotype (N = 100; p = 0.023). CONCLUSION APOE genotypes have shown only a modest association with deep vein thrombosis and were not statistically significant. A lateral association of these genotypes with thrombophilic risk factors was observed which may be investigated further for the possible pathogenetic mechanisms and their therapeutic implications.
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Affiliation(s)
- Pulkit Rastogi
- 1 Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narender Kumar
- 2 Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jasmina Ahluwalia
- 2 Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reena Das
- 2 Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- 2 Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Suri
- 3 Department of Internal Medicine, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harikishan Senee
- 2 Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Rapid Systematic Review: Age-Adjusted D-Dimer for Ruling Out Pulmonary Embolism. J Emerg Med 2018; 55:586-592. [DOI: 10.1016/j.jemermed.2018.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 07/02/2018] [Indexed: 11/24/2022]
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Yue Y, Sun Q, Man C, Fu Y. Association of the CYP4V2 polymorphism rs13146272 with venous thromboembolism in a Chinese population. Clin Exp Med 2018; 19:159-166. [PMID: 30276487 PMCID: PMC6394589 DOI: 10.1007/s10238-018-0529-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 09/22/2018] [Indexed: 12/28/2022]
Abstract
Genome-wide association studies have identified the CYP4V2 polymorphism (rs13146272) as a risk factor associated with venous thromboembolism (VTE). However, due to the small sample size and variance in genetic analysis models, the relationship between VTE and rs13146272 remains unclear. Here, we performed a case-control study to analyse the associations between rs13146272 and VTE in a Chinese population and to compare the differences among various ethnicities. In this study, 226 VTE patients and 205 healthy controls were recruited, and the allele frequency of variant rs13146272 was analysed by a MassARRAY SNP genotyping assay. In addition, 9 case-control cohorts from 5 studies involving 6667 VTE-affected individuals and 8716 control subjects were included in this meta-analysis. Pooled ORs and 95% CIs were calculated to assess the association between rs13146272 and VTE by using different genetic models. Our case-control study results showed that there was no significant association between VTE and rs13146272 under the additive model (OR = 0.92, 95% CIs: 0.70-1.21, p = 0.55) in this Chinese population. However, the results of the meta-analysis performed by merging all cohorts showed that rs13146272 was significantly associated with VTE under the additive model, recessive model and dominant model. In the additive and recessive models, the association reached the threshold for genome-wide significance (p < 5.0e-08). In conclusion, our pooled systematic study results indicated that individuals with the A allele had a higher risk of developing VTE than those with the C allele of the rs13146272 variant, but the risk was inconsistent among different ethnicities. Further validation of this association with larger sample sizes and multiple ethnicities is warranted.
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Affiliation(s)
- Yongjian Yue
- Institute of Shenzhen Respiratory Diseases, Department of Respiratory and Critical Medicine, The Second Clinical Medical College (Shenzhen People's Hospital) of Jinan University, No. 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China
| | - Qing Sun
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, China
| | - Chiwai Man
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Yingyun Fu
- Institute of Shenzhen Respiratory Diseases, Department of Respiratory and Critical Medicine, The Second Clinical Medical College (Shenzhen People's Hospital) of Jinan University, No. 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China.
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Egini O, Dufresne A, Khalid M, Egini C, Jaffe E. Case Report: Diffuse T wave inversions as initial electrocardiographic evidence in acute pulmonary embolism. F1000Res 2018; 7:738. [PMID: 30356445 PMCID: PMC6178910 DOI: 10.12688/f1000research.14927.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2018] [Indexed: 12/01/2022] Open
Abstract
Acute pulmonary embolism (PE) is a life-threatening condition and is typically diagnosed by a combination of symptoms, clinical signs and imaging. Electrocardiogram may be helpful in diagnosis, and the most widely described pattern of occurrence is the so-called S
1Q
3T
3 pattern. Here, we describe the case of an African-American male who presented with typical chest pain, diffuse T wave inversions with serial troponin elevation. There was initial concern for Wellen's syndrome but was finally diagnosed as acute PE. This case underscores the necessity of vigilance and a lower threshold for PE work up even in patients presenting as acute coronary syndrome.
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Affiliation(s)
- Ogechukwu Egini
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, 11213, USA
| | - Alix Dufresne
- Division of Cardiology, Interfaith Medical Center, Brooklyn, NY, 11213, USA
| | - Mazin Khalid
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, 11213, USA
| | | | - Eric Jaffe
- Internal Medicine Residency Program, Interfaith Medical Center, Brooklyn, NY, 11213, USA
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Comorbidity assessment as predictor of short and long-term mortality in elderly patients with hemodynamically stable acute pulmonary embolism. J Thromb Thrombolysis 2018; 44:316-323. [PMID: 28852931 DOI: 10.1007/s11239-017-1540-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Elderly patients presenting with acute pulmonary embolism (PE) frequently have significant underlying comorbidities which may condition the prognosis. The current study aimed to determine the ability of Charlson comorbidity index (CCI) score to predict short and long-term mortality in elderly patients with hemodynamically stable acute PE. All hemodynamically stable patients aged >65 years with acute PE, evaluated in the Emergency Department since 2010 through 2014, were included in this retrospective cohort study. CCI, simplified pulmonary embolism severity index (sPESI) scores and vital status were recorded. Were included 162 patients with confirmed PE, out of 657 suspected cases (24.7%). Median age: 79.2 years, 74.1% presented an sPESI > 1 and 61.1% a CCI > 1. The overall 30, 90-day and 2-year mortality was 11.7% (95%CI 6.6-16.6), 19.8% (95%CI 13.4-25.7) and 31.8% (95%CI 24.1-38.8). For 30-day mortality sPESI showed an AUC 0.642 (95%CI 0.511-0.772) and adding CCI as covariate did not increase its prognostic performance. For 90-day mortality, in an adjusted model including sPESI and CCI, CCI showed a HR 1.282 (95%CI 1.151-1.429, p-value < 0.001), and sPESI a HR = NS(p-value = 0.267). For 2-year mortality, in an adjusted model including sPESI and CCI, CCI showed a HR 1.295 (95%CI 1.180-1.421, p-value < 0.001) and sPESI a HR = NS(p-value = 0.353). In elderly patients with hemodynamically stable PE, the CCI score was found to be an independent predictor of mortality. CCI shows a significantly better ability to predict 90-day and 2-year mortality than sPESI. The assessment of comorbidity burden by using the CCI score may be proposed as an useful tool to predict mortality in these patients.
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Ando K, Fujiya M, Nomura Y, Inaba Y, Sugiyama Y, Iwama T, Ijiri M, Takahashi K, Tanaka K, Sakatani A, Ueno N, Kashima S, Moriichi K, Mizukami Y, Okumura T. The incidence and risk factors of venous thromboembolism in Japanese inpatients with inflammatory bowel disease: a retrospective cohort study. Intest Res 2018; 16:416-425. [PMID: 30090041 PMCID: PMC6077312 DOI: 10.5217/ir.2018.16.3.416] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 12/25/2022] Open
Abstract
Background/Aims Venous thromboembolism (VTE) is a major extraintestinal manifestation in inflammatory bowel disease (IBD), regarded as an independent risk factor for VTE according to reports from Western countries. However, the incidence and risk factors of VTE in Asian IBD patients are not fully understood. We aimed to reveal the incidence and risk factors of VTE in Japanese IBD inpatients. Methods The incidence of VTE in inpatients with IBD (n=340), gastrointestinal cancers (n=557), and other gastrointestinal diseases (n=569) treated at our hospital from 2009 to 2013 was retrospectively investigated. The characteristics and laboratory data of IBD inpatients with and without VTE were compared in univariate and multivariate analyses. Clinical courses of VTE in IBD were surveyed. Results VTE was detected in 7.1% of IBD inpatients, significantly higher than in gastrointestinal cancer inpatients (2.5%) and inpatients with other gastrointestinal diseases (0.88%). The incidence of VTE in ulcerative colitis (UC) patients (16.7%) was much higher than that in those with Crohn's disease (3.6%). In the univariate analysis, the risk factors were an older age, central venous catheter, prednisolone, surgery, low serum albumin, high serum C-reactive protein and D-dimer. According to a multivariate analysis, >50 years of age and surgery were the only risk factors. The in-hospital mortality rate of IBD inpatients with VTE was 4.2%. Conclusions The incidence of VTE with IBD, especially UC, was found to be high compared with other digestive disease, which was almost equivalent to that of Western countries. The efficacy of prophylaxis needs to be investigated in Asian IBD patients.
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Affiliation(s)
- Katsuyoshi Ando
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Mikihiro Fujiya
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Yoshiki Nomura
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Yuhei Inaba
- Department of Gastroenterology, Asahikawa City Hospital, Asahikawa, Japan
| | - Yuuya Sugiyama
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Takuya Iwama
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Masami Ijiri
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Keitaro Takahashi
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Kazuyuki Tanaka
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Aki Sakatani
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Nobuhiro Ueno
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Shin Kashima
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Kentaro Moriichi
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Yusuke Mizukami
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Toshikatsu Okumura
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
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Turner TE, Saeed MJ, Novak E, Brown DL. Association of Inferior Vena Cava Filter Placement for Venous Thromboembolic Disease and a Contraindication to Anticoagulation With 30-Day Mortality. JAMA Netw Open 2018; 1:e180452. [PMID: 30646021 PMCID: PMC6324296 DOI: 10.1001/jamanetworkopen.2018.0452] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE Despite the absence of data from randomized clinical trials, professional societies recommend inferior vena cava (IVC) filters for patients with venous thromboembolic disease (VTE) and a contraindication to anticoagulation therapy. Prior observational studies of IVC filters have suggested a mortality benefit associated with IVC filter insertion but have often failed to adjust for immortal time bias, which is the time before IVC filter insertion, during which death can only occur in the control group. OBJECTIVE To determine the association of IVC filter placement with 30-day mortality after adjustment for immortal time bias. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness, retrospective cohort study used a population-based sample of hospitalized patients with VTE and a contraindication to anticoagulation using the State Inpatient Database and the State Emergency Department Database, part of the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality, from hospitals in California (January 1, 2005, to December 31, 2011), Florida (January 1, 2005, to December 31, 2013), and New York (January 1, 2005, to December 31, 2012). Data analysis was conducted from September 15, 2015, to March 14, 2018. EXPOSURE Inferior vena cava filter placement. MAIN OUTCOMES AND MEASURES Multivariable Cox proportional hazard models were constructed with IVC filters as a time-dependent variable that adjusts for immortal time bias. The Cox model was further adjusted using the propensity score as an adjustment variable. RESULTS Of 126 030 patients with VTE, 61 281 (48.6%) were male and the mean (SD) age was 66.9 (16.6) years. In this cohort, 45 771 (36.3%) were treated with an IVC filter, whereas 80 259 (63.7%) did not receive a filter. In the Cox model with IVC filter status analyzed as a time-dependent variable to account for immortal time bias, IVC filter placement was associated with a significantly increased hazard ratio of 30-day mortality (1.18; 95% CI, 1.13-1.22; P < .001). When the propensity score was included in the Cox model, IVC filter placement remained associated with an increased hazard ratio of 30-day mortality (1.18; 95% CI, 1.13-1.22; P < .001). CONCLUSIONS AND RELEVANCE After adjustment for immortal time bias, IVC filter placement was associated with increased 30-day mortality in patients with VTE and a contraindication to anticoagulation. Randomized clinical trials are needed to determine the efficacy of IVC filter placement in patients with VTE and a contraindication to anticoagulation.
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Affiliation(s)
- Tyson E. Turner
- Division of Cardiology, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Mohammed J. Saeed
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Eric Novak
- Division of Cardiology, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - David L. Brown
- Division of Cardiology, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
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Effects of intermittent pneumatic compression treatment on clinical outcomes and biochemical markers in patients at low mobility with lower limb edema. J Vasc Surg Venous Lymphat Disord 2018; 6:500-510. [DOI: 10.1016/j.jvsv.2018.01.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/27/2018] [Indexed: 01/22/2023]
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