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Othman S, Bertolaccini CM, Pannucci CJ. Unfractionated Heparins, Low-Molecular-Weight Heparins, and Indirect Factor Xa Inhibitors in Plastic and Reconstructive Surgery: An Evidence-Based Review. Plast Reconstr Surg 2024; 153:1224e-1231e. [PMID: 37189249 DOI: 10.1097/prs.0000000000010695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
SUMMARY Venous thromboembolism can present with devastating complications and sequalae, particularly in the surgical patient. Current data support prophylactic anticoagulant use in high-risk hospitalized patients, defined as those with a Caprini Risk Assessment Model score of 7 or greater. The most frequently used chemoprophylaxis agents include unfractionated heparin, low-molecular-weight heparin, and indirect factor Xa inhibitors. The authors review the mechanisms of action, metabolism, reversal agents, indications, contraindications, advantages, and disadvantages of these medications in plastic and reconstructive surgery.
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Affiliation(s)
- Sammy Othman
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwell Health
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2
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Zuin M, Rigatelli G, Temporelli P, Bilato C. Trends in mortality related to venous thromboembolism in the European Union, 2012-2020. Intern Emerg Med 2024; 19:941-949. [PMID: 38448688 DOI: 10.1007/s11739-024-03550-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/18/2024] [Indexed: 03/08/2024]
Abstract
We sought to assess the sex- and age-specific trends in venous thromboembolism (VTE) mortality in the 27 European Union Member States (EU-27) between years 2012 and 2020. Data on cause-specific deaths and population numbers by sex for each country of the EU-27 were retrieved through the publicly available European Statistical Office (EUROSTAT) dataset for the years 2012-2020. VTE-related deaths were ascertained when ICD-10 codes I26, I80, and I82.9 were listed as the primary cause of death in the medical death certificate. To calculate annual trends, we assessed the average annual percent change (AAPC) with relative 95% confidence intervals (CIs) using Joinpoint regression. During the study period, 96,037 (55,278 males and 40,759 females) died for VTE. The age-adjusted mortality rate (AAMR) linearly declined from 2.86 (95% CI 2.84-2.90) deaths per 100,000 individuals in 2012 to 2.53 (95% CI 2.50-2.56) deaths per 100,000 population in 2020 [AAPC: - 2.1% (95% CI - 3.6 to - 0.6), p = 0.001] without differences between sexes (p = 0.60). The higher AAMR was observed in some eastern European countries such as Bulgaria, Czech Republic, and Lithuania. On the contrary, the lower AAMR was mainly clustered in the Mediterranean area (Italy, Spain, and Cyprus). Over the last decade, the age-adjusted VTE-related mortality has been continuously declining in most of the in EU-27 Member States. However, some disparities still exist between western and eastern European countries.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy.
| | - Gianluca Rigatelli
- Department of Cardiology, Ospedali Riuniti Padova Sud, Schiavonia, Padua, Italy
| | - Pierluigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Italy
| | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano, Italy
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3
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Mathews R, Hinds MT, Nguyen KP. Venous thromboembolism: diagnostic advances and unaddressed challenges in management. Curr Opin Hematol 2024; 31:122-129. [PMID: 38359323 PMCID: PMC10977858 DOI: 10.1097/moh.0000000000000809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE OF REVIEW This review summarizes recent advances in developing targeted diagnostics for venous thromboembolism (VTE) and unaddressed knowledge gaps in patient management. Without addressing these critical data needs, the morbidity in VTE patients will persist. RECENT FINDINGS Recent studies investigating plasma protein profiles in VTE patients have identified key diagnostic targets to address the currently unmet need for low-cost, confirmatory, point-of-care VTE diagnostics. These studies and a growing body of evidence from animal model studies have revealed the importance of inflammatory and vascular pathology in driving VTE, which are currently unaddressed targets for VTE therapy. To enhance the translation of preclinical animal studies, clinical quantification of thrombus burden and comparative component analyses between modeled VTE and clinical VTE are necessary. SUMMARY Lead candidates from protein profiling of VTE patients' plasma offer a promising outlook in developing low cost, confirmatory, point-of-care testing for VTE. Additionally, addressing the critical knowledge gap of quantitatively measuring clinical thrombi will allow for an array of benefits in VTE management and informing the translatability of experimental therapeutics.
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Affiliation(s)
- Rick Mathews
- Department of Biomedical Engineering, Oregon Health and Science University
| | - Monica T Hinds
- Department of Biomedical Engineering, Oregon Health and Science University
| | - Khanh P Nguyen
- Department of Biomedical Engineering, Oregon Health and Science University
- Research & Development Service, VA Portland Healthcare System
- Division of Vascular Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
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4
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Dix C, Moloney M, Tran HA, McFadyen JD. Venous Thromboembolism and Estrogen-Containing Gender-Affirming Hormone Therapy. Thromb Haemost 2024; 124:387-398. [PMID: 37816389 DOI: 10.1055/a-2188-8898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
Gender-affirming therapy involves the use of hormones to develop the physical characteristics of the identified gender and suppressing endogenous sex hormone production. Venous thromboembolism (VTE) is a known risk of exogenous estrogen therapy, and while evidence of VTE risk among transgender women using modern gender-affirming hormone therapy (GAHT) is still emerging, it is thought to affect up to 5% of transgender women. Historically, GAHT was associated with a high risk of VTE; however, modern preparations are less thrombogenic mainly due to significantly lower doses used as well as different preparations. This review presents the available literature regarding the following four topics: (1) risk of VTE among transgender women receiving estradiol GAHT, (2) how the route of administration of estradiol affects the VTE risk, (3) perioperative management of GAHT, (4) VTE risk among adolescents on GAHT. There is a need for large, longitudinal studies of transgender women using GAHT to further characterize VTE risk and how this is affected by factors such as patient age, duration of GAHT use, tobacco use, body mass index, and comorbidities. Future studies in these areas could inform the development of clinical guidelines to improve the care of transgender people.
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Affiliation(s)
- Caroline Dix
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, Australia
| | - Mollie Moloney
- Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Australia
| | - Huyen A Tran
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, Australia
- Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Australia
| | - James D McFadyen
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, Australia
- Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Australia
- Atherothrombosis and Vascular Biology Program, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Hopper H, Adsit M, Reiter CR, Satalich JR, Schmidt RC, Peri MI, Cyrus JW, Vap AR. Female Sex, Older Age, Earlier Surgery, Anticoagulant Use, and Meniscal Repair Are Associated With Increased Risk of Manipulation Under Anesthesia or Lysis of Adhesions for Arthrofibrosis After Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy 2024; 40:1687-1699. [PMID: 38000486 DOI: 10.1016/j.arthro.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
PURPOSE To determine what patient or surgical factors are associated with an increased risk of arthrofibrosis requiring manipulation under anesthesia (MUA) or lysis of adhesions (LOA) after anterior cruciate ligament reconstruction (ACLR). METHODS A systematic review was performed in adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Cochrane, Embase, and Medline databases were searched for studies published through February 2023. Inclusion criteria were studies that identified risk factors for MUA and/or LOA after ACLR. Studies investigating arthrofibrosis after multiligamentous knee injuries or ACL repair were excluded. RESULTS Eleven studies including a total of 333,876 ACLRs with 4,842 subsequent MUA or LOA (1.45%) were analyzed. Increasing age was associated with an increased risk in 3 studies (P < .001, P < .05, P < .01) but was found to have no association another two. Other factors that were identified by multiple studies as risk factors for MUA/LOA were female sex (4 studies), earlier surgery (5 studies), use of anticoagulants other than aspirin (2 studies), and concomitant meniscal repair (4 studies). CONCLUSIONS In total, 1.45% of the patients who underwent ACLR and were included in this systematic review had to undergo a subsequent MUA/LOA to treat arthrofibrosis. Female sex, older age, earlier surgery, use of anticoagulants other than aspirin, and concomitant meniscal repair were associated with increased risk of MUA/LOA. The modifiable risks, including use of anticoagulants and time between injury and surgery, can be considered when making treatment decisions. LEVEL OF EVIDENCE Level IV, systematic review of Level III-IV studies.
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Affiliation(s)
- Haleigh Hopper
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A..
| | - Matthew Adsit
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - Charles R Reiter
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, U.S.A
| | - James R Satalich
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - R Cole Schmidt
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - Maria I Peri
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - John W Cyrus
- Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Alexander R Vap
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
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Peseski AM, Kapoor S, Kuchibhatla M, Adamski A, Abe K, Beckman MG, Reyes NL, Richardson LC, Saber I, Schulteis R, Singh BP, Sitlinger A, Thames EH, Ortel TL. An epidemiologic study comparing cancer- and noncancer-associated venous thromboembolism in a racially diverse Southeastern United States county. Res Pract Thromb Haemost 2024; 8:102420. [PMID: 38817950 PMCID: PMC11137544 DOI: 10.1016/j.rpth.2024.102420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 06/01/2024] Open
Abstract
Background Cancer-associated venous thromboembolism (CA-VTE) represents a major cause of morbidity and mortality in patients with cancer. Despite poor outcomes, there is an ongoing knowledge gap in epidemiologic data related to this association. Objectives To compare venous thromboembolism (VTE) characteristics, risk factors, and outcomes between patients with and without active cancer in a racially diverse population. Methods Our surveillance project occurred at the 3 hospitals in Durham County, North Carolina, from April 2012 through March 2014. Electronic and manual methods were used to identify unique Durham County residents with VTE. Results We identified 987 patients with VTE during the surveillance period. Of these, 189 patients had active cancer at the time of their VTE event. Patients with CA-VTE were older (median age: 69 years vs 60 years, P < .0001) and had a lower body mass index (median body mass index: 26.0 kg/m2 vs 28.4 kg/m2, P = .0001) than noncancer patients. The most common cancers in our cohort were gastrointestinal, breast, genitourinary, and lung. The proportion of VTE cases with pulmonary embolism (PE) was greater in the cancer cohort compared with that in the noncancer cohort (58.2% vs 44.0%, P = .0004). Overall survival was lower in the CA-VTE group than in patients without cancer (P < .0001). Black patients with CA-VTE had lower proportion of PE (52.3% vs 67.1%, P = .05) but had decreased survival (P < .0003) in comparison with White patients. Conclusion Future studies may be needed to continue to evaluate local and national VTE data to improve VTE prevention strategies and CA-VTE outcomes.
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Affiliation(s)
- Andrew M. Peseski
- Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Sargam Kapoor
- Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Alys Adamski
- Division of Blood Disorders and Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karon Abe
- Division of Blood Disorders and Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michele G. Beckman
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nimia L. Reyes
- Division of Blood Disorders and Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa C. Richardson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Ryan Schulteis
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Bhavana Pendurthi Singh
- Division of Hematology Oncology, Lehigh Valley Hospital Pocono, East Stroudsburg, Pennsylvania, USA
| | - Andrea Sitlinger
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina, USA
| | - Elizabeth H. Thames
- Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Thomas L. Ortel
- Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina, USA
- Department of Pathology, Duke University, Durham, North Carolina, USA
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Chen IW, Wang WT, Lai YC, Lin CM, Liu PH, Wu SZ, Hung KC. Association between systemic sclerosis and risk of cerebrovascular and cardiovascular disease: a meta-analysis. Sci Rep 2024; 14:6445. [PMID: 38499699 PMCID: PMC10948904 DOI: 10.1038/s41598-024-57275-9] [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: 11/30/2023] [Accepted: 03/15/2024] [Indexed: 03/20/2024] Open
Abstract
We aimed to evaluate the association between systemic sclerosis (SSc) and major cerebrovascular/cardiovascular risks through a systematic approach. Databases were systematically searched from their inception to October 10, 2023 for studies comparing cerebrovascular/cardiovascular event rates between patients with SSc and controls. The primary outcome was the stroke risk in patients with SSc. Secondary outcomes included risk of myocardial infarction (MI), cardiovascular disease (CVD), peripheral vascular disease (PVD), and venous thromboembolism (VTE). Seventeen studies with 6,642,297 participants were included. SSc was associated with a significantly increased risk of stroke (HR, 1.64; 95% confidence interval [CI], 1.35-2.01), CVD (HR, 2.12; 95% CI, 1.36-3.3), MI (HR, 2.15; 95% CI, 1.23-3.77), VTE (HR, 2.75; 95% CI, 1.77-4.28), and PVD (HR, 5.23; 95% CI, 4.25-6.45). Subgroup analysis revealed a significantly increased stroke risk in the non-Asian group (HR, 1.55; 95% CI, 1.26-1.9), while the Asian group displayed a higher but not statistically significant risk (HR, 1.86; 95% CI, 0.97-3.55). The study found that SSc is associated with a significantly increased risk of cerebrovascular/cardiovascular events. These findings highlight the importance of vasculopathy in SSc and suggest the need for enhanced clinical monitoring and preventive measures in this high-risk population.
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Affiliation(s)
- I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Wei-Ting Wang
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yi-Chen Lai
- Department of Anesthesiology, Chi Mei Medical Center, No. 901, ChungHwa Road, YungKung Dist, Tainan, 71004, Taiwan
| | - Chien-Ming Lin
- Department of Anesthesiology, Chi Mei Medical Center, No. 901, ChungHwa Road, YungKung Dist, Tainan, 71004, Taiwan
| | - Ping-Hsin Liu
- Department of Anesthesiology, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Su-Zhen Wu
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
- Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, No. 901, ChungHwa Road, YungKung Dist, Tainan, 71004, Taiwan.
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Rahmani R, Eaddy S, Stegelmann SD, Skrobot G, Andreshak T. Chemical prophylaxis and venous thromboembolism following elective spinal surgery: A systematic review and meta-analysis. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 17:100295. [PMID: 38204918 PMCID: PMC10777073 DOI: 10.1016/j.xnsj.2023.100295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 01/12/2024]
Abstract
Background Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a potentially devastating complication after surgery. Spine surgery is associated with an increased risk of postoperative bleeding, such as spinal epidural hematomas (SEH), which complicates the use of anticoagulation. Despite this dilemma, there is a lack of consensus around perioperative VTE prophylaxis. This systematic review investigates the relationship between chemoprophylaxis and the incidence rates of VTE and SEH in the elective spine surgical population. Methods A comprehensive literature search was performed using PubMed, Embase, and Cochrane databases to identify studies published after 2,000 that compared VTE chemoprophylaxis use in elective spine surgery. Studies involving patients aged < 18 years or with known trauma, cancer, or spinal cord injuries were excluded. Pooled incidence rates of VTE and SEH were calculated for all eligible studies, and meta-analyses were performed to assess the relationship between chemoprophylaxis and the incidences of VTE and SEH. Results Nineteen studies met our eligibility criteria, comprising a total of 220,932 patients. The overall pooled incidence of VTE was 3.2%, including 3.3% for DVT and 0.4% for PE. A comparison of VTE incidence between patients that did and did not receive chemoprophylaxis was not statistically significant (OR 0.97, p=.95, 95% CI 0.43-2.19). The overall pooled incidence of SEH was 0.4%, and there was also no significant difference between patients that did and did not receive chemoprophylaxis (OR 1.57, p=.06, 95% CI 0.99-2.50). Conclusions The use of perioperative chemoprophylaxis may not significantly alter rates of VTE or SEH in the elective spine surgery population. This review highlights the need for additional randomized controlled trials to better define the risks and benefits of specific chemoprophylactic protocols in various subpopulations of elective spine surgery.
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Affiliation(s)
- Roman Rahmani
- Mercy Health St. Vincent Medical Center, Department of Orthopedics, 2409 Cherry St, Suite #10, Toledo, OH 43608, United States
| | - Samuel Eaddy
- Mercy Health St. Vincent Medical Center, Department of Orthopedics, 2409 Cherry St, Suite #10, Toledo, OH 43608, United States
| | - Samuel D. Stegelmann
- HCA Medical City Healthcare UNT-TCU GME (Denton), 3535 S Interstate 35, Denton, TX 76210, United States
| | - Gabriel Skrobot
- Mercy Health St. Vincent Medical Center, Department of Orthopedics, 2409 Cherry St, Suite #10, Toledo, OH 43608, United States
| | - Thomas Andreshak
- Mercy Health St. Vincent Medical Center, Department of Orthopedics, 2409 Cherry St, Suite #10, Toledo, OH 43608, United States
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Hashimoto H, Imai S, Yamashita R, Kiyomi A, Sugiura M. Association of Antipsychotic Drugs with the Risk of Recurrent Venous Thromboembolism: A Retrospective Study of Data from a Japanese Inpatient Database. Drugs Real World Outcomes 2024; 11:109-116. [PMID: 38015358 DOI: 10.1007/s40801-023-00401-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Approximately a decade has passed since the addition of venous thromboembolism to the list of significant adverse reactions of antipsychotic drugs. However, only a few studies have investigated the relationship between antipsychotic use and venous thromboembolism in the Japanese population. PURPOSE We aimed to evaluate the risk of recurrent venous thromboembolism in users of antipsychotic drugs and update the evidence on venous thromboembolism in the Japanese population. METHODS A cross-sectional retrospective analysis of data from a large Japanese claims database, managed by Medical Data Vision Co. Ltd., was conducted. Adult patients who experienced venous thromboembolism between October 2014 and September 2018 in acute care hospitals were identified. The risk of recurrent venous thromboembolism was evaluated with logistic regression using demographic variables. The data of patients using antipsychotic drugs within specific therapeutic classes were also evaluated. RESULTS We included 8960 patients (mean age, 69 years; 59.2% female). Recurrent venous thromboembolism was observed in 686 patients (7.7%). The risk of recurrent venous thromboembolism was significantly higher in younger patients [< 65 years: reference; 65-74 years: odds ratio (OR) 0.81, 95% confidence interval (CI) 0.66-0.99, p = 0.04; ≥ 75 years: OR 0.77, 95% CI 0.64-0.94, p = 0.01], those with history of surgery (OR 1.39, 95% CI 1.18-1.65, p = 0.01), and anticoagulant users (OR 2.25, 95% CI 1.46-3.48, p = 0.01) and was significantly lower in the presence of comorbidities (OR 0.68, 95% CI 0.58-0.81, p< 0.01) and fractures (OR 0.49, 95% CI 0.26-0.94, p = 0.03). Long-term antipsychotic drug prescriptions (> 14 days) were associated with a higher risk of venous thromboembolism than short-term prescriptions (≤ 14 days) (OR 1.56, 95% CI 1.04-2.34, p = 0.03). CONCLUSIONS In patients with a history of venous thromboembolism, particular attention should be paid to recurrence in younger patients. If antipsychotic drugs are prescribed for > 14 days to patients with a history of venous thromboembolism, they should be administered carefully, guided by reported findings. Further evaluations using different databases or populations are required to generalize the findings of this study.
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Affiliation(s)
- Hiroyuki Hashimoto
- Department of Drug Safety and Risk Management, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1, Horinouchi, Hachioji, Tokyo, 192-0392, Japan
| | - Shinobu Imai
- Division of Pharmacoepidemiology, Department of Healthcare and Regulatory Sciences, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Ryoka Yamashita
- Department of Drug Safety and Risk Management, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1, Horinouchi, Hachioji, Tokyo, 192-0392, Japan
| | - Anna Kiyomi
- Department of Drug Safety and Risk Management, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1, Horinouchi, Hachioji, Tokyo, 192-0392, Japan
| | - Munetoshi Sugiura
- Department of Drug Safety and Risk Management, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1, Horinouchi, Hachioji, Tokyo, 192-0392, Japan.
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10
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Arnold MJ. Thromboembolic Disease. Prim Care 2024; 51:65-82. [PMID: 38278574 DOI: 10.1016/j.pop.2023.07.004] [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: 01/28/2024]
Abstract
Venous thromboembolism (VTE) encompasses deep vein thrombosis and pulmonary embolism, both of which can present on a spectrum from subtle symptoms to life- and limb-threatening emergencies. Some risk factors for VTE overlap cardiovascular risk factors and statin therapy can somewhat reduce the VTE risk. When presentations are not life-threatening, clinical prediction scores using the Well's criteria are best used to determine diagnostic testing. The mainstay of VTE treatment is anticoagulant therapy, although life- and limb-threatening presentations can also require thrombolytic therapy.
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Affiliation(s)
- Michael J Arnold
- Department of Family Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 40814, USA.
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11
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Crane HM, Nance RM, Ruderman SA, Haidar L, Tenforde MW, Heckbert SR, Budoff MJ, Hahn AW, Drumright LN, Ma J, Mixson LS, Lober WB, Barnes GS, McReynolds J, Attia EF, Peter I, Moges T, Bamford L, Cachay E, Mathews WC, Christopolous K, Hunt PW, Napravnik S, Keruly J, Moore RD, Burkholder G, Willig AL, Lindstrom S, Whitney BM, Saag MS, Kitahata MM, Crothers KA, Delaney JAC. Venous Thromboembolism Among People With HIV: Design, Implementation, and Findings of a Centralized Adjudication System in Clinical Care Sites Across the United States. J Acquir Immune Defic Syndr 2024; 95:207-214. [PMID: 37988634 PMCID: PMC11151789 DOI: 10.1097/qai.0000000000003339] [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: 02/09/2023] [Accepted: 08/30/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND People with HIV (PWH) are at increased risk for venous thromboembolism (VTE). We conducted this study to characterize VTE including provoking factors among PWH in the current treatment era. METHODS We included PWH with VTE between 2010 and 2020 at 6 sites in the CFAR Network of Integrated Clinical Systems cohort. We ascertained for possible VTE using diagnosis, VTE-related imaging, and VTE-related procedure codes, followed by centralized adjudication of primary data by expert physician reviewers. We evaluated sensitivity and positive predictive value of VTE ascertainment approaches. VTEs were classified by type and anatomic location. Reviewers identified provoking factors such as hospitalizations, infections, and other potential predisposing factors such as smoking. RESULTS We identified 557 PWH with adjudicated VTE: 239 (43%) had pulmonary embolism with or without deep venous thrombosis, and 318 (57%) had deep venous thrombosis alone. Ascertainment with clinical diagnoses alone missed 6% of VTEs identified with multiple ascertainment approaches. DVTs not associated with intravenous lines were most often in the proximal lower extremities. Among PWH with VTE, common provoking factors included recent hospitalization (n = 134, 42%), infection (n = 133, 42%), and immobilization/bed rest (n = 78, 25%). Only 57 (10%) PWH had no provoking factor identified. Smoking (46%), HIV viremia (27%), and injection drug use (22%) were also common. CONCLUSIONS We conducted a robust adjudication process that demonstrated the benefits of multiple ascertainment approaches followed by adjudication. Provoked VTEs were more common than unprovoked events. Nontraditional and modifiable potential predisposing factors such as viremia and smoking were common.
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Affiliation(s)
- Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA
| | - Robin M Nance
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Lara Haidar
- Department of Pharmacy, University of Manitoba, Manitoba, CA
| | - Mark W Tenforde
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, CA
| | - Andrew W Hahn
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Jimmy Ma
- Department of Medicine, University of Washington, Seattle, WA
| | - L S Mixson
- Department of Medicine, University of Washington, Seattle, WA
| | - William B Lober
- Department of Medicine and Clinical Informatics Research Group, University of Washington, Seattle, WA
| | - Gregory S Barnes
- Clinical Informatics Research Group, University of Washington, Seattle, WA
| | - Justin McReynolds
- Clinical Informatics Research Group, University of Washington, Seattle, WA
| | - Engi F Attia
- Department of Medicine, University of Washington, Seattle, WA
| | - Inga Peter
- Department of Genetics, Mount Sinai University, New York NY
| | - Tesfaye Moges
- Department of Medicine, University of California, San Diego, CA
| | - Laura Bamford
- Department of Medicine, University of California, San Diego, CA
| | - Edward Cachay
- Department of Medicine, University of California, San Diego, CA
| | | | | | - Peter W Hunt
- Department of Medicine, University of California, San Francisco, CA
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Jeanne Keruly
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Greer Burkholder
- Department of Medicine, University of Alabama Birmingham, Birmingham, AL
| | - Amanda L Willig
- Department of Medicine, University of Alabama Birmingham, Birmingham, AL
| | - Sara Lindstrom
- Department of Genetics, University of Washington, Seattle, WA; and
| | | | - Michael S Saag
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Joseph A C Delaney
- Department of Medicine, University of Washington, Seattle, WA
- Department of Medicine, University of Manitoba, Manitoba, CA
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Løchen Arnesen CA, Evensen LH, Hveem K, Gabrielsen ME, Hansen JB, Brækkan SK. Proportion of venous thromboembolism attributed to recognized prothrombotic genotypes in men and women. Res Pract Thromb Haemost 2024; 8:102343. [PMID: 38476459 PMCID: PMC10926210 DOI: 10.1016/j.rpth.2024.102343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 03/14/2024] Open
Abstract
Background Data on the proportion of venous thromboembolism (VTE) risk attributed to prothrombotic genotypes in men and women are limited. Objectives We aimed to estimate the population attributable fraction (PAF) of VTE for recognized, common prothrombotic genotypes in men and women using a population-based case cohort. Methods Cases with incident VTE (n = 1493) and a randomly sampled subcohort (n = 13,069) were derived from the Tromsø study (1994-2012) and the Trøndelag Health Study (1995-2008) cohorts. DNA samples were genotyped for 17 single-nucleotide polymorphisms (SNPs) previously associated with VTE. PAFs with 95% bias-corrected CIs (based on 10,000 bootstrap samples) were estimated for SNPs significantly associated with VTE, and a 6-SNP cumulative model was constructed for both sexes. Results In women, the individual PAFs for SNPs included in the cumulative model were 16.9% for ABO (rs8176719), 17.6% for F11 (rs2036914), 15.1% for F11 (rs2289252), 8.7% for FVL (rs6025), 6.0% for FGG (rs2066865), and 0.2% for F2 (rs1799963). The cumulative PAF for this 6-SNP model was 37.8%. In men, the individual PAFs for SNPs included in the cumulative model were 21.3% for ABO, 12.2% for F11 (rs2036914), 10.4% for F11 (rs2289252), 7.5% for FVL, 7.8% for FGG, and 1.1% for F2. This resulted in a cumulative PAF in men of 51.9%. Conclusion Our findings in a Norwegian population suggest that 52% and 38% of the VTEs can be attributed to known prothrombotic genotypes in men and women, respectively.
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Affiliation(s)
- Carl Arne Løchen Arnesen
- Thrombosis Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
- Thrombosis Research Center, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Line H Evensen
- Thrombosis Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Kristian Hveem
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- HUNT Research Center, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Maiken E Gabrielsen
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - John-Bjarne Hansen
- Thrombosis Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
- Thrombosis Research Center, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Sigrid K Brækkan
- Thrombosis Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
- Thrombosis Research Center, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
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Hansen ES, Edvardsen MS, Aukrust P, Ueland T, Hansen JB, Brækkan SK, Morelli VM. Galectin-3-binding protein and future venous thromboembolism. Res Pract Thromb Haemost 2024; 8:102311. [PMID: 38327613 PMCID: PMC10847771 DOI: 10.1016/j.rpth.2023.102311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/18/2023] [Accepted: 12/23/2023] [Indexed: 02/09/2024] Open
Affiliation(s)
- Ellen-Sofie Hansen
- Thrombosis Research Group, Department of Clinical Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
| | - Magnus S. Edvardsen
- Thrombosis Research Group, Department of Clinical Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
| | - Pål Aukrust
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Oslo, Norway
- Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Thor Ueland
- Thrombosis Research Group, Department of Clinical Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Oslo, Norway
| | - John-Bjarne Hansen
- Thrombosis Research Group, Department of Clinical Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
- Thrombosis Research Center, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Sigrid K. Brækkan
- Thrombosis Research Group, Department of Clinical Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
- Thrombosis Research Center, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Vânia M. Morelli
- Thrombosis Research Group, Department of Clinical Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
- Thrombosis Research Center, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
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Anand P, Zhang Y, Merola D, Jin Y, Wang SV, Lii J, Liu J, Lin KJ. Comparison of EHR Data-Completeness in Patients with Different Types of Medical Insurance Coverage in the United States. Clin Pharmacol Ther 2023; 114:1116-1125. [PMID: 37597260 PMCID: PMC10919452 DOI: 10.1002/cpt.3027] [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: 06/07/2023] [Accepted: 08/12/2023] [Indexed: 08/21/2023]
Abstract
Prior studies have demonstrated that misclassification of study variables due to electronic health record (EHR)-discontinuity can be mitigated by restricting EHR-based analyses to subjects with high predicted EHR-continuity based on a simple algorithm. In this study, we compared EHR continuity in populations covered by Medicare, Medicaid, or commercial insurance. Using claims-linked EHRs from a multicenter network in Massachusetts, including Medicare (MA EHR-Medicare cohort) and Medicaid (MA EHR-Medicaid cohort) claims data; and TriNetX (TriNetX cohort) claims-linked EHR data from 11 US-based healthcare organizations, we assessed (1) EHR-continuity quantified by proportion of encounters captured by EHR (capture proportion (CP)); (2) area under receiver operating curve (AUROC) of previously validated model to identify patients with high EHR-continuity (CP ≥ 0.6); (3) misclassification of 40 patient characteristics, quantified by average standardized absolute mean difference (ASAMD). Study participants were ≥ 65 years (Medicare) or ≥ 18 years (Medicaid, TriNetX) with ≥ 365 days of continuous insurance enrollment overlapping with an EHR encounter. We found that the mean CP was 0.30, 0.18, and 0.19 and AUROC of the prediction model to identify patients with high EHR-continuity was 0.92, 0.89, and 0.77 in the MA EHR-Medicare, MA EHR-Medicaid, and TriNetX cohorts, respectively. Restricting to patients with predicted EHR-continuity percentile of top 20%, 50%, and 50% in MA EHR-Medicare, MA EHR-Medicaid, and TriNetX cohorts resulted in acceptable levels of misclassification (ASAMD < 0.1). Using a prediction model to identify cohorts with high EHR-continuity can improve validity, but cutoffs to achieve this goal vary by population.
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Affiliation(s)
- Priyanka Anand
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Yichi Zhang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Yinzhu Jin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Shirley V. Wang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Joyce Lii
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jun Liu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Arora P, Muehrcke M, Russell M, Ghanekar S. Utilization outcomes of direct oral anticoagulants in Medicare patients. Res Social Adm Pharm 2023; 19:1424-1431. [PMID: 37429747 DOI: 10.1016/j.sapharm.2023.07.002] [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: 12/19/2022] [Revised: 04/19/2023] [Accepted: 07/02/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE To compare the adherence, persistence, discontinuation and switching rates of direct oral anticoagulants (DOACs) for Medicare patients with non-valvular atrial fibrillation (NVAF) or venous thromboembolism (VTE). METHODS This was retrospective observational cohort study design. Medicare Part D claims files were used for the study duration (2015-2018). Inclusion-exclusion criteria were applied to identify the NVAF and VTE sample using dabigatran, rivaroxaban, apixaban, edoxaban and warfarin during the identification period (2016-2017). Outcomes of adherence, persistence, time to non-persistence and time to discontinuation were assessed in those who did not switch the index drug in the follow-up period (365 days from the index date). Switching rates were assessed in those who switched the index drug at least once in the aforementioned follow-up period. Descriptive statistics were conducted for all the outcomes, and comparisons were made using t-tests, chi-square, and ANOVA. Logistic regression was conducted to compare the odds of being adherent and the odds of switching in NVAF and VTE patient cohorts. RESULTS Of all the DOACs, patients with NVAF or VTE were most adherent to apixaban (PDC = 76.88). Among all the DOACs, non-persistence and discontinuation rates were highest for warfarin. Majority of the switches were reported from dabigatran to other DOAC and to apixaban from other DOAC. Despite the better utilization outcomes reported for apixaban users, Medicare plans covered rivaroxaban favorably. It was associated with the lowest mean amount paid by the patient (NVAF: $76; VTE: $59), and the highest mean amount paid by the plans (NVAF: $359; VTE: $326). CONCLUSION Medicare plans need to consider adherence, persistence, discontinuation and switching rates of DOACs to make the coverage decisions.
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Affiliation(s)
- Prachi Arora
- College of Pharmacy and Health Sciences, Butler University, 4600 Sunset Ave, Indianapolis, IN, 46208, USA.
| | - Maria Muehrcke
- College of Pharmacy and Health Sciences, Butler University, 4600 Sunset Ave, Indianapolis, IN, 46208, USA.
| | - Molly Russell
- College of Pharmacy and Health Sciences, Butler University, 4600 Sunset Ave, Indianapolis, IN, 46208, USA.
| | - Saurabh Ghanekar
- Resultant, 111 Monument Circle, Suite 202, Indianapolis, IN, 46204, USA.
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Hansen ES, Edvardsen MS, Aukrust P, Ueland T, Hansen JB, Brækkan SK, Morelli VM. Combined effect of high factor VIII levels and high mean platelet volume on the risk of future incident venous thromboembolism. J Thromb Haemost 2023; 21:2844-2853. [PMID: 37393000 DOI: 10.1016/j.jtha.2023.06.022] [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: 04/03/2023] [Revised: 06/10/2023] [Accepted: 06/22/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND High factor VIII (FVIII) levels and large platelets, as reflected by a high mean platelet volume (MPV), are separately associated with increased risk of venous thromboembolism (VTE). Whether the combination of high FVIII levels and large platelets has a supra-additive effect on VTE risk is unknown. OBJECTIVES We aimed to investigate the joint effect of high FVIII levels and large platelets, as reflected by high MPV, on the risk of future incident VTE. METHODS A population-based nested case-control study with 365 incident VTE cases and 710 controls was derived from the Tromsø study. FVIII antigen levels and MPV were measured in blood samples drawn at baseline. Odds ratios with 95% CIs were estimated across FVIII tertiles (<85%, 85%-108%, and ≥108%) and within predefined MPV strata (<8.5, 8.5-9.5, and ≥9.5 fL). RESULTS VTE risk increased linearly across FVIII tertiles (Ptrend < .001) in models adjusted for age, sex, body mass index, and C-reactive protein. In the combined analysis, participants with FVIII levels in the highest tertile and an MPV of ≥9.5 fL (ie, joint exposure) had an odds ratio for VTE of 2.71 (95% CI, 1.44-5.11) compared with those with FVIII levels in the lowest tertile and an MPV of <8.5 fL (reference). In the joint exposure group, 52% (95% CI, 17%-88%) of VTEs were attributable to the biological interaction between FVIII and MPV. CONCLUSION Our results suggest that large platelets, as reflected by high MPV, might play a role in the mechanism by which high FVIII level increases the risk of incident VTE.
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Affiliation(s)
- Ellen-Sofie Hansen
- Thrombosis Research Group, Department of Clinical Medicine, UiT-the Arctic University of Norway, Tromsø, Norway.
| | - Magnus S Edvardsen
- Thrombosis Research Group, Department of Clinical Medicine, UiT-the Arctic University of Norway, Tromsø, Norway
| | - Pål Aukrust
- Faculty of Medicine, University of Oslo, Oslo, Norway; Research Institute of Internal Medicine, Oslo, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Thor Ueland
- Thrombosis Research Group, Department of Clinical Medicine, UiT-the Arctic University of Norway, Tromsø, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway; Research Institute of Internal Medicine, Oslo, Norway
| | - John-Bjarne Hansen
- Thrombosis Research Group, Department of Clinical Medicine, UiT-the Arctic University of Norway, Tromsø, Norway; Thrombosis Research Center, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Sigrid K Brækkan
- Thrombosis Research Group, Department of Clinical Medicine, UiT-the Arctic University of Norway, Tromsø, Norway; Thrombosis Research Center, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Vânia M Morelli
- Thrombosis Research Group, Department of Clinical Medicine, UiT-the Arctic University of Norway, Tromsø, Norway; Thrombosis Research Center, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
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Alsulami SS, El-Ghammaz A. Cardiovascular risk factors and venous thromboembolism in Kingdom of Saudi Arabia: A meta-analysis and systemic review. Niger J Clin Pract 2023; 26:1399-1409. [PMID: 37929514 DOI: 10.4103/njcp.njcp_229_23] [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: 11/07/2023]
Abstract
Over the years, the literature dealt with venous thromboembolism (VTE) and atherosclerosis as two distinct pathologic processes but recently this theory has been challenged. This research aims to determine the relationship between cardiovascular risk factors and VTE. This meta-analysis and systemic review included case-control and non-case-control studies. We searched Google Scholar, Web of Science, MEDLINE, and EMBASE for studies conducted in Saudi Arabia, addressing the relationship between VTE and cardiovascular risk factors, and published during the period from January 2001 to December 2021. Quality assessment was done for included studies and pooled odds and prevalence ratios were reported. Evidence of bias was assessed using funnel plots and the Egger regression test. A total of 3291 patients with VTE and 3393 controls from 24 studies were enrolled. The pooled odds ratios were 1.33 (95% confidence interval (95% CI) = 1.01-1.77), 1.2 (95% CI = 0.88-1.64), 0.881 (95% CI = 0.55-1.41), 0.676 (95% CI = 0.04-11.25), 1.15 (95% CI = 0.75-1.75), 0.925 (95% CI = 0.55-1.56), 1.45 (95% CI = 0.89-2.35), and 1.49 (95% CI = 0.24-5.23) for age >60 years, female gender, hypertension, dyslipidemia, diabetes, cardiovascular disease, obesity, and smoking, respectively. The pooled prevalence ratios were 42.6%, 55.7%, 51.6%, 48%, 44%, 32.8%, 30.9%, and 46.6%, respectively, for the same factors. Few studies reported dyslipidemia and smoking. In conclusion, old Old age, female gender, diabetes, obesity, and smoking are associated with increased risk of VTE with the highest risks seen with obesity and smoking. Additionally, female gender was the most prevalent risk factor among VTE patients.
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Affiliation(s)
- S S Alsulami
- Department of Medicine, Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - A El-Ghammaz
- Department of Medicine, Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Internal Medicine, Clinical Hematology and Bone Marrow Transplantation Unit, Faculty of Medicine, Ain Shams University, Egypt
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Giorgio K, Walker RF, MacLehose RF, Herrera DA, Wang W, Alonso A, Zakai NA, Lutsey PL. Venous thromboembolism mortality and trends in older US adults, 2011-2019. Am J Hematol 2023; 98:1364-1373. [PMID: 37366276 PMCID: PMC10529371 DOI: 10.1002/ajh.26996] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/18/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023]
Abstract
Venous thromboembolism (VTE) affects 1.2 million people per year in the United States. With several clinical changes in diagnosis and treatment approaches in the past decade, we evaluated contemporary post-VTE mortality risk profiles and trends. Incident VTE cases were identified from the 2011-2019 Medicare 20% Sample, which is representative of nearly all Americans aged 65 and older. The social deprivation index was linked from public data; race/ethnicity and sex were self-reported. The all-cause mortality risk 30 days and 1 year after incident VTE was calculated in demographic subgroups and by prevalent cancer diagnosis status using model-based standardization. Risks for major cancer types, risk differences by age, sex, race/ethnicity, and socio-economic status (SES), and trends over time are also reported. The all-cause mortality risk among older US adults following incident VTE was 3.1% (95% CI 3.0-3.2) at 30 days and 19.6% (95% CI 19.2-20.1) at 1 year. For cancer-related VTE events, the age-sex-race-standardized risk was 6.0% at 30 days and 34.7% at 1 year. The standardized 30-day and 1-year risks were higher among non-White beneficiaries and among those with low SES. One-year mortality risk decreased 0.28 percentage points per year (95% CI 0.16-0.40) on average across the study period, with no trend observed for 30-day mortality risk. In sum, all-cause mortality risk following incident VTE has decreased slightly in the last decade, but racial and socio-economic disparities persist. Understanding patterns of mortality among demographic subgroups and in cancer-associated events is important for targeting efforts to improve VTE management.
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Affiliation(s)
- Katherine Giorgio
- Division of Epidemiology & Community Health; School of Public Health, University of Minnesota, Minneapolis, MN
| | - Rob F. Walker
- Division of Epidemiology & Community Health; School of Public Health, University of Minnesota, Minneapolis, MN
| | - Richard F. MacLehose
- Division of Epidemiology & Community Health; School of Public Health, University of Minnesota, Minneapolis, MN
| | - Diego Adrianzen Herrera
- Division of Hematology/Oncology, Department of Medicine & Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT
| | - Wendy Wang
- Division of Epidemiology & Community Health; School of Public Health, University of Minnesota, Minneapolis, MN
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Neil A. Zakai
- Division of Hematology/Oncology, Department of Medicine & Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT
| | - Pamela L. Lutsey
- Division of Epidemiology & Community Health; School of Public Health, University of Minnesota, Minneapolis, MN
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Merli GJ, Yenser H, Orapallo D. Approach to the Patient with Non-cardiac Leg Swelling. Med Clin North Am 2023; 107:945-961. [PMID: 37541718 DOI: 10.1016/j.mcna.2023.05.009] [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: 08/06/2023]
Abstract
One of the most common reasons for patient visits in the outpatient practice is lower extremity swelling. Non-cardiac etiologies are the most frequent reason for these encounters. The approach to this patient population will focus on the 7 key questions to initiate the gathering of historical information on the etiology of leg swelling. Figures and tables will complement the text for diagnosing lower extremity swelling. In this article, the common non-cardiac etiologies will be reviewed which include medications, chronic venous insufficiency, lymphatic disease, lipedema, venous thrombosis, and musculoskeletal etiologies.
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Affiliation(s)
- Geno J Merli
- Division Vascular Medicine, Jefferson Vascular Center, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Suite 6210, Gibbon Building, 111 South 11th Street, Philadelphia, PA 19107, USA.
| | - Heather Yenser
- Division of Vascular Medicine, Department of Surgery, Jefferson Vascular Center, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Suite 6210, Gibbon Building, 111 South 11th Street, Philadelphia, PA 19107, USA
| | - Dina Orapallo
- Division of Vascular Medicine, Department of Surgery, Jefferson Vascular Center, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Suite 6210, Gibbon Building, 111 South 11th Street, Philadelphia, PA 19107, USA
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George P, Jagun O, Liu Q, Wentworth C, Napatalung L, Wolk R, Anway S, Zwillich SH. Incidence Rates of Infections, Malignancies, Thromboembolism, and Cardiovascular Events in an Alopecia Areata Cohort from a US Claims Database. Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00937-9. [PMID: 37296372 PMCID: PMC10366041 DOI: 10.1007/s13555-023-00937-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION Alopecia areata (AA) is an autoimmune disease with an underlying immuno-inflammatory pathogenesis. Treatments can include systemic corticosteroids and immunomodulators (such as Janus kinase inhibitors); these medications may be associated with a risk of some adverse events. However, large-scale observational studies of baseline incidence rates (IRs) of infection, cardiovascular disease, malignancy, and thromboembolism in US patients with AA, including those with alopecia totalis or alopecia universalis (AT/AU), are limited. This real-world, US claims-based study aimed to estimate the incidence of events in patients with AA compared with matched patients without AA. METHODS Patients aged ≥ 12 years enrolled in the Optum Clinformatics Data Mart database from 1 October 2016 to 30 September 2020, with ≥ 2 AA diagnosis codes were included in the AA cohort. Patients without AA were age-, sex-, and race-matched 3:1 to patients with AA. Baseline comorbidities were evaluated during the 12-month period pre-index date. Incident cases of serious/herpes infections, malignancies, major adverse cardiovascular events (MACE), and thromboembolic events were evaluated post-index date. Data are presented using descriptive statistics, proportional percentages, frequencies, and IRs (calculated with 95% CI). RESULTS Overall, 8784 patients with AA, 599 of whom had AT/AU, were matched to 26,352 patients without AA. IRs per 1000 person-years among the AA and non-AA cohorts, respectively, were 18.5 and 20.6 for serious infections, 19.5 and 9.7 for herpes simplex infections, 7.8 and 7.6 for herpes zoster infections, 12.5 and 11.6 for primary malignancies, 16.0 and 18.1 for MACE, and 4.9 and 6.1 for venous thromboembolisms. Compared with patients with non-AT/AU AA, patients with AT/AU largely had higher IRs for most baseline comorbidities and outcome events evaluated. CONCLUSION Patients with AA had a higher IR of herpes simplex infection than the matched non-AA cohort. Patients with AT/AU generally had higher rates of outcome events than patients without AT/AU.
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Affiliation(s)
| | - Oladayo Jagun
- Pfizer Inc., 66 Hudson Blvd. East, New York, NY, 10001, USA.
| | - Qing Liu
- Pfizer Inc., 66 Hudson Blvd. East, New York, NY, 10001, USA
| | | | - Lynne Napatalung
- Pfizer Inc., 66 Hudson Blvd. East, New York, NY, 10001, USA
- Mount Sinai Hospital, New York, NY, USA
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Abstract
Venous thromboembolism, that consists of the interrelated conditions deep-vein thrombosis and pulmonary embolism, is an under-appreciated vascular disease. In Western regions, approximately 1 in 12 individuals will be diagnosed with venous thromboembolism in their lifetime. Rates of venous thromboembolism are lower in Asia, but data from other regions are sparse. Numerous risk factors for venous thromboembolism have been identified, which can be classified as acute or subacute triggers (provoking factors that increase the risk of venous thromboembolism) and basal or acquired risk factors (which can be modifiable or static). Approximately 20% of individuals who have a venous thromboembolism event die within 1 year (although often from the provoking condition), and complications are common among survivors. Fortunately, opportunities exist for primordial prevention (prevention of the development of underlying risk factors), primary prevention (management of risk factors among individuals at high risk of the condition) and secondary prevention (prevention of recurrent events) of venous thromboembolism. In this Review, we describe the epidemiology of venous thromboembolism, including the incidence, risk factors, outcomes and opportunities for prevention. Meaningful health disparities exist in both the incidence and outcomes of venous thromboembolism. We also discuss these disparities as well as opportunities to reduce them.
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Affiliation(s)
- Pamela L Lutsey
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - Neil A Zakai
- Division of Hematology/Oncology, Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
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22
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Seyerle AA, Laurie CA, Coombes BJ, Jain D, Conomos MP, Brody J, Chen MH, Gogarten SM, Beutel KM, Gupta N, Heckbert SR, Jackson RD, Johnson AD, Ko D, Manson JE, McKnight B, Metcalf GA, Morrison AC, Reiner AP, Sofer T, Tang W, Wiggins KL, Boerwinkle E, de Andrade M, Gabriel SB, Gibbs RA, Laurie CC, Psaty BM, Vasan RS, Rice K, Kooperberg C, Pankow JS, Smith NL, Pankratz N. Whole Genome Analysis of Venous Thromboembolism: the Trans-Omics for Precision Medicine Program. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2023; 16:e003532. [PMID: 36960714 PMCID: PMC10151032 DOI: 10.1161/circgen.121.003532] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/04/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Risk for venous thromboembolism has a strong genetic component. Whole genome sequencing from the TOPMed program (Trans-Omics for Precision Medicine) allowed us to look for new associations, particularly rare variants missed by standard genome-wide association studies. METHODS The 3793 cases and 7834 controls (11.6% of cases were individuals of African, Hispanic/Latino, or Asian ancestry) were analyzed using a single variant approach and an aggregate gene-based approach using our primary filter (included only loss-of-function and missense variants predicted to be deleterious) and our secondary filter (included all missense variants). RESULTS Single variant analyses identified associations at 5 known loci. Aggregate gene-based analyses identified only PROC (odds ratio, 6.2 for carriers of rare variants; P=7.4×10-14) when using our primary filter. Employing our secondary variant filter led to a smaller effect size at PROC (odds ratio, 3.8; P=1.6×10-14), while excluding variants found only in rare isoforms led to a larger one (odds ratio, 7.5). Different filtering strategies improved the signal for 2 other known genes: PROS1 became significant (minimum P=1.8×10-6 with the secondary filter), while SERPINC1 did not (minimum P=4.4×10-5 with minor allele frequency <0.0005). Results were largely the same when restricting the analyses to include only unprovoked cases; however, one novel gene, MS4A1, became significant (P=4.4×10-7 using all missense variants with minor allele frequency <0.0005). CONCLUSIONS Here, we have demonstrated the importance of using multiple variant filtering strategies, as we detected additional genes when filtering variants based on their predicted deleteriousness, frequency, and presence on the most expressed isoforms. Our primary analyses did not identify new candidate loci; thus larger follow-up studies are needed to replicate the novel MS4A1 locus and to identify additional rare variation associated with venous thromboembolism.
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Affiliation(s)
- Amanda A. Seyerle
- Division of Pharmaceutical Outcomes & Policy, Eshelman School of Pharmacy, Univ of North Carolina at Chapel Hill, Chapel Hill, NC
- Carolina Health Informatics Program, Univ of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Deepti Jain
- Dept of Biostatistics, Univ of Washington, Seattle, WA
| | | | - Jennifer Brody
- Cardiovascular Health Rsrch Unit, Univ of Washington, Seattle, WA
| | - Ming-Huei Chen
- NHLB’s The Framingham Heart Study, Population Sciences Branch, Division of Intramural Rsrch, National Heart, Lung, and Blood Inst, Framingham, MA
| | | | - Kathleen M. Beutel
- Dept of Laboratory Medicine & Pathology, School of Medicine, Univ of Minnesota, Minneapolis, MN
| | | | - Susan R. Heckbert
- Cardiovascular Health Rsrch Unit, Univ of Washington, Seattle, WA
- Dept of Epidemiology, Univ of Washington, Seattle, WA
| | - Rebecca D. Jackson
- Division of Endocrinology, Diabetes & Metabolism, Ohio State Univ, Columbus, OH
| | - Andrew D. Johnson
- NHLB’s The Framingham Heart Study, Population Sciences Branch, Division of Intramural Rsrch, National Heart, Lung, and Blood Inst, Framingham, MA
| | - Darae Ko
- Cardiovascular Medicine Section, Boston Univ School of Medicine
| | - JoAnn E. Manson
- Dept of Epidemiology, TH Chan School of Public Health, Harvard Univ, Boston, MA
| | | | | | - Alanna C. Morrison
- Human Genetics Ctr, Dept of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, Univ of Texas Health Science Ctr at Houston, Houston, TX
| | | | - Tamar Sofer
- Division of Sleep & Circadian Disorders, Brigham and Women’s Hospital
- Dept of Medicine, Harvard Medical School, Boston, MA
| | - Weihong Tang
- Division of Epidemiology & Community Health, Univ of Minnesota, Minneapolis, MN
| | - Kerri L. Wiggins
- Cardiovascular Health Rsrch Unit, Univ of Washington, Seattle, WA
| | | | - Eric Boerwinkle
- Human Genetics Ctr, Dept of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, Univ of Texas Health Science Ctr at Houston, Houston, TX
| | | | | | | | | | - Bruce M. Psaty
- Cardiovascular Health Rsrch Unit, Univ of Washington, Seattle, WA
- Dept of Epidemiology, Univ of Washington, Seattle, WA
- Depts of Medicine & Health Services, Univ of Washington, Seattle, WA
- Kaiser Permanente Washington Health Rsrch Inst, Seattle, WA
| | | | - Ken Rice
- Dept of Biostatistics, Univ of Washington, Seattle, WA
| | | | - James S. Pankow
- Division of Epidemiology & Community Health, Univ of Minnesota, Minneapolis, MN
| | - Nicholas L. Smith
- Cardiovascular Health Rsrch Unit, Univ of Washington, Seattle, WA
- Dept of Epidemiology, Univ of Washington, Seattle, WA
- Seattle Epidemiologic Rsrch & Information Ctr, VA Office of Rsrch & Development, Seattle, WA
| | - Nathan Pankratz
- Dept of Laboratory Medicine & Pathology, School of Medicine, Univ of Minnesota, Minneapolis, MN
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23
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Ružičić DP, Dzudovic B, Matijasevic J, Benic M, Salinger S, Kos L, Kovacevic-Preradovic T, Mitevska I, Neskovic A, Bozovic B, Bulatovic N, Miloradovic V, Djuric I, Obradovic S. Signs and symptoms of acute pulmonary embolism and their predictive value for all-cause hospital death in respect of severity of the disease, age, sex and body mass index: retrospective analysis of the Regional PE Registry (REPER). BMJ Open Respir Res 2023; 10:10/1/e001559. [PMID: 37076250 PMCID: PMC10124252 DOI: 10.1136/bmjresp-2022-001559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/31/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND The incidence of the signs and symptoms of acute pulmonary embolism (PE) according to mortality risk, age and sex has been partly explored. PATIENTS AND METHODS A total of 1242 patients diagnosed with acute PE and included in the Regional Pulmonary Embolism Registry were enrolled in the study. Patients were classified as low risk, intermediate risk or high risk according to the European Society of Cardiology mortality risk model. The incidence of the signs and symptoms of acute PE at presentation with respect to sex, age, and PE severity was investigated. RESULTS The incidence of haemoptysis was higher in younger men with intermediate-risk (11.7% vs 7.5% vs 5.9% vs 2.3%; p=0.01) and high-risk PE (13.8% vs 2.5% vs 0.0% vs 3.1%; p=0.031) than in older men and women. The frequency of symptomatic deep vein thrombosis was not significantly different between subgroups. Older women with low-risk PE presented with chest pain less commonly (35.8% vs 55.8% vs 48.8% vs 51.9%, respectively; p=0.023) than men and younger women. However, younger women had a higher incidence of chest pain in the lower-risk PE group than in the intermediate-risk and high-risk PE subgroups (51.9%, 31.4% and 27.8%, respectively; p=0.001). The incidence of dyspnoea (except in older men), syncope and tachycardia increased with the risk of PE in all subgroups (p<0.01). In the low-risk PE group, syncope was present more often in older men and women than in younger patients (15.5% vs 11.3% vs 4.5% vs 4.5%; p=0.009). The incidence of pneumonia was higher in younger men with low-risk PE (31.8% vs<16% in the other subgroups, p<0.001). CONCLUSION Haemoptysis and pneumonia are prominent features of acute PE in younger men, whereas older patients more frequently have syncope with low-risk PE. Dyspnoea, syncope and tachycardia are symptoms of high-risk PE irrespective of sex and age.
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Affiliation(s)
- Dušan Predrag Ružičić
- Department of Internal Medicine and Invasive Cardiology, General Hospital Valjevo, Valjevo, Serbia
| | - Boris Dzudovic
- Clinic Of Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
- School of Medicine, University of Defense, Belgrade, Serbia
| | - Jovan Matijasevic
- Institute of Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
- School of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Marija Benic
- Institute of Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
| | - Sonja Salinger
- Clinic of Cardiology, Clinical Center Nis, Nis, Serbia
- School of Medicine, University of Nis, Nis, Serbia
| | - Ljiljana Kos
- Clinic of Cardiology, Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Tamara Kovacevic-Preradovic
- Clinic of Cardiology, Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina
- School of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Irena Mitevska
- Clinic of Cardiology, Intensive Care Unit, School of Medicine Skopje, University of Skopje, Skopje, North Republic of Macedonia
| | - Aleksandar Neskovic
- Clinic of Cardiology, Clinical Center Zemun, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bjanka Bozovic
- Clinic of Cardiology, Clinical Center Podgorica, Podgorica, Montenegro
| | - Nebojsa Bulatovic
- Clinic of Cardiology, Clinical Center Podgorica, Podgorica, Montenegro
- School of Medicine, University of Podgorica, Podgorica, Montenegro
| | - Vladimir Miloradovic
- Clinic of Cardiology, Clinical Center Kragujevac, Kragujevac, Serbia
- School of Medicine, University of Kragujevac, Kragujevac, Serbia
| | - Ivica Djuric
- Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia
| | - Slobodan Obradovic
- School of Medicine, University of Defense, Belgrade, Serbia
- Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia
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24
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Oleksiuk-Bójko M, Lisowska A. Venous thromboembolism: Why is it still a significant health problem? Adv Med Sci 2023; 68:10-20. [PMID: 36368288 DOI: 10.1016/j.advms.2022.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/08/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) remains the third leading cause of acute cardiovascular syndrome following myocardial infarction and ischemic stroke. The global burden of disease worldwide is high and shows a steady upward trend in recent years with an incidence of 1-2 per 1000 adults per year. The overarching goal of the initial management of VTE is to prevent early and late adverse outcomes. Rapid evaluation and therapeutic intervention is vital to improving prognosis. METHODS We searched PubMed, Science Direct and Scopus databases for articles published in the last 10 years. Additionally, some earlier articles were analyzed. RESULTS For the purposes of this review, we discussed how understanding the epidemiology of VTE and the current knowledge of early and late complications of this disease have shaped the current approach to VTE prevention. We also analyzed the current knowledge and the most up-to-date information about VTE in COVID-19 infection. Contemporary perspective presented in this article on mortality in VTE, the incidence of recurrences, the risk of major bleeding during therapy and the chronic complications indicate why this is a major challenge for today's medicine and a current target for further research. CONCLUSIONS Understanding the interaction between environmental and genetic factors appears to be crucial in the diagnostic process. It can provide insight into the pathophysiology of VTE, potentially identifying options for targeted prevention and treatment. However, due to differences in clinical presentation, diagnosing pulmonary embolism may not be an easy task which perfectly illustrates the scale and complexity of the disease.
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Affiliation(s)
- Monika Oleksiuk-Bójko
- Department of Cardiology, University Clinical Hospital in Bialystok, Bialystok, Poland
| | - Anna Lisowska
- Department of Cardiology, University Clinical Hospital in Bialystok, Bialystok, Poland.
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25
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Patel R, Stokes WA, Roberts C, Chung J, Fancy T, Wen S, Gao S. Preoperative low-molecular weight heparin chemoprophylaxis in head and neck free flap reconstruction. Am J Otolaryngol 2023; 44:103722. [PMID: 36527816 DOI: 10.1016/j.amjoto.2022.103722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The safety of presurgical thromboprophylaxis using low molecular weight heparin (LMWH) has not been well described in head and neck oncologic surgery with free tissue transfer (HNS-FTT). METHODS Retrospective chart review of HNS-FTT patients receiving versus not receiving presurgical subcutaneous enoxaparin (Px-LMWH) was performed. Outcomes included estimated blood loss (EBL), hematoma, flap compromise, DVT or pulmonary embolus (PE). Fisher's exact test and Wilcoxon Rank Sum test were performed to compare groups. Odds ratios and associated 95 % confidence intervals were provided as appropriate. RESULTS 43 of 128 patients (34 %) received Px-LMWH. There was no significant difference in EBL, hematoma, or flap complications between groups. Patients without Px-LMWH had higher rates of DVT and PE, although the difference did not reach statistical significance (p = 1.00, 0.095, respectively). CONCLUSION Presurgical Px-LMWH can be used in major head and neck reconstructive surgery without increased intraoperative blood loss or postoperative complications. Larger studies will need to be done to determine the impact of Px-LMWH on DVT and PE in this patient population. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Rusha Patel
- University of Oklahoma Health Sciences Center, United States of America.
| | | | | | | | - Tanya Fancy
- West Virginia University, United States of America
| | - Sijin Wen
- West Virginia University, United States of America
| | - Si Gao
- West Virginia University, United States of America
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26
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Comparison of Adverse Events between Isolated Left Atrial Appendage Closure and Combined Catheter Ablation. J Clin Med 2023; 12:jcm12051824. [PMID: 36902610 PMCID: PMC10003199 DOI: 10.3390/jcm12051824] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 02/26/2023] Open
Abstract
(1) Background: This study aimed to investigate the effect of an additional catheter ablation (CA) procedure on the risk of post-procedure adverse events during CA combined with left atrial appendage closure (LAAC). (2) Methods: From July 2017 to February 2022, data from 361 patients with atrial fibrillation who underwent LAAC at our center were analyzed retrospectively. The adverse events were compared between CA + LAAC and LAAC-only groups. (3) Results: The incidence of device-related thrombus (DRT) and embolic events was significantly lower in the CA + LAAC group than in the LAAC-only group (p = 0.01 and 0.04, respectively). A logistic regression analysis revealed that the combined procedure served as a protective factor for DRT (OR = 0.09; 95% confidence interval: 0.01-0.89; p = 0.04). Based on a Cox regression analysis, the risk of embolism marginally increased in patients aged ≥65 years (HR = 7.49, 95% CI: 0.85-66.22 p = 0.07), whereas the combined procedure was found to be a protective factor (HR = 0.25, 95% CI: 0.07-0.87 p = 0.03). Further subgroup and interaction analyses revealed similar results. (4) Conclusions: The combined procedure may be associated with a lower rate of post-procedure DRT and embolization without a higher occurrence of other adverse events after LAAC. A risk-score-based prediction model was conducted, showing a good prediction performance.
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27
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Brækkan SK, Hansen JB. VTE epidemiology and challenges for VTE prevention at the population level. THROMBOSIS UPDATE 2023. [DOI: 10.1016/j.tru.2023.100132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
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28
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Folsom AR, Tang W, Hong CP, Rosamond WD, Lane JA, Cushman M, Pankratz N. Prediction of venous thromboembolism incidence in the general adult population using two published genetic risk scores. PLoS One 2023; 18:e0280657. [PMID: 36716319 PMCID: PMC9886242 DOI: 10.1371/journal.pone.0280657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/05/2023] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Most strategies for prevention of venous thromboembolism focus on preventing recurrent events. Yet, primary prevention might be possible through approaches targeting the whole population or high-risk patients. To inform possible prevention strategies, population-based information on the ability of genetic risk scores to identify risk of incident venous thromboembolism is needed. MATERIALS AND METHODS We used proportional hazards regression to relate two published genetic risk scores (273-variants versus 5-variants) with venous thromboembolism incidence in the Atherosclerosis Risk in Communities Study (ARIC) cohort (n = 11,292), aged 45-64 at baseline, drawn from 4 US communities. RESULTS Over a median of 28 years, ARIC identified 788 incident venous thromboembolism events. Incidence rates rose more than two-fold across quartiles of the 273-variant genetic risk score: 1.7, 2.7, 3.4 and 4.0 per 1,000 person-years. For White participants, age, sex, and ancestry-adjusted hazard ratios (95% confidence intervals) across quartiles were strong [1 (reference), 1.30 (0.99,1.70), 1.85 (1.43,2.40), and 2.58 (2.04,3.28)] but weaker for Black participants [1, 1.05 (0.63,1.75), 1.37 (0.84,2.22), and 1.32 (0.80,2.20)]. The 5-variant genetic risk score showed a less steep gradient, with hazard ratios in Whites of 1, 1.17 (0.89,1.54), 1.48 (1.14,1.92), and 2.18 (1.71,2.79). Models including the 273-variant genetic risk score plus lifestyle and clinical factors had a c-statistic of 0.67. CONCLUSIONS In the general population, middle-aged adults in the highest quartile of either genetic risk score studied have approximately two-fold higher risk of an incident venous thromboembolism compared with the lowest quartile. The genetic risk scores show a weaker association with venous thromboembolism for Black people.
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Affiliation(s)
- Aaron R. Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Weihong Tang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Ching-Ping Hong
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Wayne D. Rosamond
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - John A. Lane
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Mary Cushman
- Department of Medicine and Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, VT, United States of America
| | - Nathan Pankratz
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, United States of America
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Hu M, Wang X, Yang Y. Causal relationship between moderate to vigorous physical activity and venous thromboembolism. J Thromb Thrombolysis 2023; 55:576-583. [PMID: 36595107 DOI: 10.1007/s11239-022-02754-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 01/04/2023]
Abstract
Previous studies have shown conflicting results about the impact of moderate to vigorous physical activity on the risk of venous thromboembolism (VTE). Using Mendelian randomization, we assessed whether moderate to vigorous physical activity causally affects VTE from genetic level. Genetic instruments associated with moderate to vigorous physical activity at the genome-wide significance level (P < 5×10- 8) were selected from the UK Biobank. Summary-level data for VTE were obtained from the FinnGen consortium. Univariable and multivariable Mendelian randomization analyses were conducted. Genetically predicted moderate to vigorous physical activity had no effect on VTE [odds ratio (OR) = 1.08; 95% confidence interval (CI) 0.66-1.78; P = 0.75] under a multiplicative random-effects inverse-variance weighted model. MR-Egger (OR = 0.20; 95% CI 0.01-4.70; P = 0.33), weighted median (OR = 1.08; 95% CI 0.52-2.25; P = 0.84), simple mode (OR = 2.53; 95% CI 0.59-10.92; P = 0.23), weighted mode (OR = 2.21; 95% CI 0.50-9.74; P = 0.31), and multivariable Mendelian randomization (OR = 0.74; 95% CI 0.46-1.19; P = 0.22) also yielded no significant association. The overall estimate was not influenced by individual single nucleotide polymorphism. No evidence of heterogeneity or horizontal pleiotropy was observed. Therefore, moderate to vigorous physical activity had no causal association with VTE in the general population.
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Affiliation(s)
- Mengjin Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100037, China
| | - Xiaoning Wang
- School of Medicine, Shandong University, Jinan, 250012, China
| | - Yuejin Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100037, China.
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Ram S, Shalev-Ram H, Neuhof B, Shlezinger R, Shalev-Rosental Y, Chodick G, Yogev Y. Air travel during pregnancy and the risk of venous thrombosis. Am J Obstet Gynecol MFM 2023; 5:100751. [PMID: 36115570 DOI: 10.1016/j.ajogmf.2022.100751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/06/2022] [Accepted: 09/11/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Pregnancy and air travel independently increase the risk of venous thrombosis. However, there is a lack of data regarding the added risk, if at all, of thrombosis after air travel during pregnancy. OBJECTIVE This study aimed to determine the potential added risk of venous thromboembolism among pregnant women who traveled by air. STUDY DESIGN This was an observational retrospective study using data from 452,663 live births between the years 2010 to 2019. The study group consisted of women who flew during pregnancy. Data of pregnant women who flew during pregnancy were compared with that of pregnant women who did not fly during pregnancy. The primary outcome was venous thromboembolism during pregnancy and in the postpartum period. A case of venous thromboembolism was deemed related to air travel only if it occurred up to 8 weeks after the return flight (exposure time). Propensity score weighting Poisson regression was calculated to assess the effect and to control selection biases. Risk per day was calculated. RESULTS Overall, 421,125 live births were included. Of those cases, 33,674 (8%) had traveled by air during pregnancy (study group), and 387,451 (92%) did not (control group). There were 6 cases of venous thromboembolism after a flight that occurred during the exposure time of 8 weeks and 285 cases of venous thromboembolism in the control group (0.05% vs 0.07%; P=.158). When the propensity weighting Poisson regression was calculated as risk per day, there was a significantly increased risk between the study and control groups (0.00031% vs 0.00022%; hazard ratio, 1.406; P=.005). CONCLUSION The overall risk of venous thromboembolism after air travel is low; however, our study found that the risk of venous thromboembolism during pregnancy is increased by air traveling.
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Affiliation(s)
- Shai Ram
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Drs Ram and Yogev); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Ram, Shalev-Ram, Shalev-Rosenthal, Chodick, and Yogev).
| | - Hila Shalev-Ram
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Ram, Shalev-Ram, Shalev-Rosenthal, Chodick, and Yogev); Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel (Dr Shalev-Ram)
| | - Bitya Neuhof
- Department of Statistics and Data Science, Hebrew University of Jerusalem, Jerusalem, Israel (Ms Neuhof and Ms Shlezinger)
| | - Roei Shlezinger
- Department of Statistics and Data Science, Hebrew University of Jerusalem, Jerusalem, Israel (Ms Neuhof and Ms Shlezinger)
| | - Yael Shalev-Rosental
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Ram, Shalev-Ram, Shalev-Rosenthal, Chodick, and Yogev)
| | - Gabriel Chodick
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Ram, Shalev-Ram, Shalev-Rosenthal, Chodick, and Yogev); Maccabi Healthcare Services, Tel Aviv, Israel (Dr Chodick)
| | - Yariv Yogev
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Drs Ram and Yogev); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Ram, Shalev-Ram, Shalev-Rosenthal, Chodick, and Yogev)
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Takahashi S, Imura M, Katada J. Epidemiology and Treatment Patterns of Venous Thromboembolism: an Observational Study of Nationwide Time-Series Trends in Japan. Cardiol Ther 2022; 11:589-609. [PMID: 36318364 PMCID: PMC9652174 DOI: 10.1007/s40119-022-00284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Previous studies on anticoagulation treatment trends have mostly focused on hospitalized patients. This study aimed to clarify the treatment status of patients with venous thromboembolism (VTE) in Japan from 2011 to 2018, including outpatients, and to assess adherence with current guidelines. METHODS Data of inpatients and outpatients who were treated for VTE were extracted from a nationwide claims database (Medical Data Vision Co., Ltd., Tokyo, Japan) and analyzed. RESULTS The study included 79,330 patients with VTE; half were diagnosed during hospitalization for diseases other than VTE. The proportion of outpatient treatment increased significantly from 2015 to 2018 (Cochran-Armitage trend test, P < 0.0001), while 80% were anticoagulated in hospital after pulmonary embolism (PE) diagnosis. The proportion of patients with VTE treated as outpatients was no lower than the proportion of inpatients, even in the presence of active cancer, and there were no clear differences in anticoagulant choices. Treatment with direct oral anticoagulants (DOACs) did not always include the recommended initial intensification therapy. There was wide variation in the duration of DOAC treatment and the median duration of use was shorter than that recommended in VTE treatment guidelines. CONCLUSION While the gradual increase in VTE outpatient treatment appears to be in line with guideline recommendations, PE outpatient treatment could be further facilitated. The large proportion of patients diagnosed with VTE during hospitalization for other conditions suggests the importance of further utilizing in-hospital manuals for thrombosis prevention. The presence or absence of cancer did not appear to affect the basic treatment strategy of anticoagulation for VTE. Future studies are expected to better define the characteristics of patients who can be safely and effectively treated in an outpatient setting, and to examine whether anticoagulation for a shorter treatment period than recommended by the guidelines or DOAC therapy without initial intensification would improve patient outcomes.
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Affiliation(s)
- Shoko Takahashi
- Medical Affairs, Internal Medicine, Pfizer Biopharmaceuticals Group, Pfizer Japan Inc., 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan.
| | - Miki Imura
- Medical Affairs, Internal Medicine, Pfizer Biopharmaceuticals Group, Pfizer Japan Inc., 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan
| | - Jun Katada
- Medical Affairs, Internal Medicine, Pfizer Biopharmaceuticals Group, Pfizer Japan Inc., 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan
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Owodunni OP, Lau BD, Wang J, Shaffer DL, Kraus PS, Holzmueller CG, Aboagye JK, Hobson DB, Varasteh Kia M, Armocida S, Streiff MB, Haut ER. Effectiveness of a Patient Education Bundle on Venous Thromboembolism Prophylaxis Administration by Sex. J Surg Res 2022; 280:151-162. [PMID: 35969933 DOI: 10.1016/j.jss.2022.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/14/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Venous thromboembolism (VTE) is a frequent cause of preventable harm among hospitalized patients. Many prescribed prophylaxis doses are not administered despite supporting evidence. We previously demonstrated a patient-centered education bundle improved VTE prophylaxis administration broadly; however, patient-specific factors driving nonadministration are unclear. We examine the effects of the education bundle on missed doses of VTE prophylaxis by sex. METHODS We performed a post-hoc analysis of a nonrandomized controlled trial to evaluate the differences in missed doses by sex. Pre-intervention and intervention periods for patients admitted to 16 surgical and medical floors between 10/2014-03/2015 (pre-intervention) and 04/2015-12/2015 (intervention) were compared. We examined the conditional odds of (1) overall missed doses, (2) missed doses due to patient refusal, and (3) missed doses for other reasons. RESULTS Overall, 16,865 patients were included (pre-intervention 6853, intervention 10,012), with 2350 male and 2460 female patients (intervention), and 6373 male and 5682 female patients (control). Any missed dose significantly reduced on the intervention floors among male (odds ratio OR 0.55; 95% confidence interval CI, 0.44-0.70, P < 0.001) and female (OR 0.59; 95% CI, 0.47-0.73, P < 0.001) patients. Similar significant reductions ensued for missed doses due to patient refusal (P < 0.001). Overall, there were no sex-specific differences (P-interaction >0.05). CONCLUSIONS Our intervention increased VTE prophylaxis administration for both female and male patients, driven by decreased patient refusal. Patient education should be applicable to a wide range of patient demographics representative of the target group. To improve future interventions, quality improvement efforts should be evaluated based on patient demographics and drivers of differences in care.
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Affiliation(s)
- Oluwafemi P Owodunni
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brandyn D Lau
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Health Sciences Informatics, The Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medicine, Baltimore, Maryland; Department of Health Policy and Management, The Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Jiangxia Wang
- Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Dauryne L Shaffer
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland; Department of Nursing, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Peggy S Kraus
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Christine G Holzmueller
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medicine, Baltimore, Maryland
| | - Jonathan K Aboagye
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deborah B Hobson
- The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medicine, Baltimore, Maryland; Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Mujan Varasteh Kia
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephanie Armocida
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael B Streiff
- The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medicine, Baltimore, Maryland; Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elliott R Haut
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medicine, Baltimore, Maryland; Department of Health Policy and Management, The Johns Hopkins University School of Public Health, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland; The Johns Hopkins Surgery Center for Outcomes Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Hedderson MM, Asgari MM, Xu F, Quesenberry CP, Sridhar S, Geier J, Lemeshow AR. Rates of cardiovascular events among patients with moderate-to-severe atopic dermatitis in an integrated health care system: A retrospective cohort study. PLoS One 2022; 17:e0277469. [PMID: 36395164 PMCID: PMC9671329 DOI: 10.1371/journal.pone.0277469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022] Open
Abstract
Patients with versus without atopic dermatitis may have a greater risk of cardiovascular events, and the risk increases with severity of atopic dermatitis. The incidence of cardiovascular events in the population of patients with moderate-to-severe atopic dermatitis is largely unknown. This retrospective study evaluates incidence rates of cardiovascular events in patients aged ≥12 years with moderate-to-severe atopic dermatitis in a cohort of Kaiser Permanente Northern California health care system members without recognized risk factors for adverse events. Patients with moderate-to-severe atopic dermatitis, as defined by dermatologist-rendered code and prescription history between 2007 and 2018, were included. Major adverse cardiovascular events, venous thrombotic events, deep vein thrombosis, and pulmonary embolisms were identified via International Classification of Diseases codes. Stratification variables included age, sex, race, smoking history, and diabetes. Incidence rates per 1000 person-years were calculated by the number of patients with an incident event divided by the total person-years of observation. Among 8197 patients with moderate-to-severe atopic dermatitis, incidence rates per 1000 person-years (95% confidence interval) for major adverse cardiovascular events, venous thrombotic events, deep vein thrombosis, and pulmonary embolism were: 2.6 (2.1-3.2), 2.0 (1.5-2.5), 1.6 (1.2-2.1), and 0.7 (0.5-1.0), respectively. Incidence rates for all events were higher for older versus younger patients, patients with versus without diabetes, former smokers versus patients who had never smoked, and men versus women, except for pulmonary embolisms, which were higher in women. This study estimated the incidence of cardiovascular events in patients with moderate-to-severe atopic dermatitis and provides valuable information for clinicians.
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Affiliation(s)
- Monique M. Hedderson
- Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Maryam M. Asgari
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Fei Xu
- Kaiser Permanente Northern California, Oakland, California, United States of America
| | | | - Sneha Sridhar
- Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Jamie Geier
- Pfizer, Inc., New York, New York, United States of America
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Anticoagulant Usage After Anterior Cruciate Ligament Reconstruction Is Associated With Increased Rate of Manipulation Under Anesthesia. J Am Acad Orthop Surg 2022; 31:574-580. [PMID: 36368041 DOI: 10.5435/jaaos-d-20-01358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/18/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Arthrofibrosis after anterior cruciate ligament reconstruction (ACLR) is a notable but uncommon complication of ACLR. To improve range of motion after ACLR, aggressive physical therapy, arthroscopic/open lysis of adhesions, and revision surgery are currently used. Manipulation under anesthesia (MUA) is also a reasonable choice for an appropriate subset of patients with inadequate range of motion after ACLR. Recently, the correlation between anticoagulant usage and arthrofibrosis after total knee arthroplasty has become an area of interest. The purpose of this study was to determine whether anticoagulant use has a similar effect on the incidence of MUA after ACLR. METHODS The Mariner data set of the PearlDiver database was used to conduct this retrospective cohort study. Patients with an isolated ACLR were identified by using Current Procedural Terminology codes. Patients were then stratified by MUA within 2 years of ACLR, and the use of postoperative anticoagulation was identified. In addition, patient demographics, medical comorbidities, and timing of ACLR were recorded. Univariate and multivariable analyses were used to model independent risk factors for MUA. RESULTS We identified 216,147 patients who underwent isolated ACLR. Of these patients, 3,494 (1.62%) underwent MUA within 2 years. Patients who were on anticoagulants after ACLR were more likely to require an MUA (odds ratio [OR]: 2.181; P < 0.001), specifically low-molecular-weight heparin (OR: 2.651; P < 0.001), warfarin (OR: 1.529; P < 0.001), and direct factor Xa inhibitors (OR: 1.957; P < 0.001). DISCUSSION In conclusion, arthrofibrosis after ACLR is associated with the use of preoperative or postoperative thromboprophylaxis. Healthcare providers should be aware of increased stiffness among these patients and treat them aggressively.
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Gollamudi J, Sartain SE, Navaei AH, Aneja S, Kaur Dhawan P, Tran D, Joshi J, Gidudu J, Gollamudi J, Chiappini E, Varricchio F, Law B, Munoz FM. Thrombosis and thromboembolism: Brighton collaboration case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2022; 40:6431-6444. [PMID: 36150973 DOI: 10.1016/j.vaccine.2022.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 01/27/2023]
Abstract
This is a Brighton Collaboration case definition of thrombosis and thromboembolism to be used in the evaluation of adverse events following immunization, and for epidemiologic studies for the assessment of background incidence or hypothesis testing. The case definition was developed by a group of experts convened by the Coalition for Epidemic Preparedness Innovations (CEPI) in the context of active development of SARS-CoV-2 vaccines. The case definition format of the Brighton Collaboration was followed to develop a consensus definition and defined levels of certainty, after an exhaustive review of the literature and expert consultation. The document underwent peer review by the Brighton Collaboration Network and by selected expert reviewers prior to submission.
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Affiliation(s)
- Jahnavi Gollamudi
- Department of Medicine, Section of Hematology, Baylor College of Medicine, Houston, TX, USA
| | - Sarah E Sartain
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Amir Hassan Navaei
- Pediatric Critical Care, Transfusion Medicine & Coagulation, Pediatrics and Pathology & Immunology Departments, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St, Suite WB110, Houston 77021, TX, USA
| | - Satinder Aneja
- Department of Pediatrics, School of Medical Sciences & Research, Sharda University, Gr Noida, India
| | | | - Dat Tran
- Oregon Health Authority, Public Health Division, Acute and Communicable Disease Prevention Section, Portland, OR, USA
| | - Jyoti Joshi
- International Centre for Antimicrobial Resistance Solutions (ICARS), Orestads Boulevard 5, 2300 Copenhagen, Denmark
| | - Jane Gidudu
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Elena Chiappini
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | | | - Barbara Law
- SPEAC, Brighton Collaboration, Independent Consultant, Vancouver, BC, Canada
| | - Flor M Munoz
- Department of Pediatrics, Section of Infectious Diseases, and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA.
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Tøndel BG, Morelli VM, Hansen J, Brækkan SK. Risk factors and predictors for venous thromboembolism in people with ischemic stroke: A systematic review. J Thromb Haemost 2022; 20:2173-2186. [PMID: 35815351 PMCID: PMC9796787 DOI: 10.1111/jth.15813] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/15/2022] [Accepted: 07/01/2022] [Indexed: 01/07/2023]
Abstract
Identification of individuals with ischemic stroke at particularly high risk of venous thromboembolism (VTE) is crucial for targeted thromboprophylaxis. To guide clinical decision-making and development of risk prediction models, increased knowledge on risk factors and biomarkers is needed. Therefore, we set out to identify risk factors and predictors for VTE in people with ischemic stroke by conducting a systematic review of the literature. Medline and Embase were searched from January 1990 and onwards. Studies investigating demographic, clinical, and/or laboratory factors for stroke-related VTE were considered. Two reviewers screened all retrieved records, independently and in duplicate. Risk of bias assessments were guided by a structured framework (PROSPERO-ID: CRD42020176361). Of 4674 identified records, 26 studies were included. Twenty-six demographic, clinical, and laboratory factors associated with increased risk of stroke-related VTE after multivariable adjustments were identified. The following factors were reported by ≥2 studies: prior VTE, cancer, prestroke disability, leg weakness, increasing lesion volume of the brain infarct, infection, low Barthel Index, increasing length of hospital stay, biochemical indices of dehydration, as well as elevated levels of D-dimer, C-reactive protein, and homocysteine. The majority of the studies were of poor quality with moderate or high risk of bias. In conclusion, this systematic review informs on several potential risk factors and predictors for VTE in people with ischemic stroke. To improve risk stratification and guide development of risk prediction models, further confirmation is needed because there were few high-quality studies on each factor.
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Affiliation(s)
- Birgitte G. Tøndel
- Thrombosis Research Center (TREC), Department of Clinical MedicineUiT – the Arctic University of NorwayTromsøNorway
| | - Vânia M. Morelli
- Thrombosis Research Center (TREC), Department of Clinical MedicineUiT – the Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| | - John‐Bjarne Hansen
- Thrombosis Research Center (TREC), Department of Clinical MedicineUiT – the Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| | - Sigrid K. Brækkan
- Thrombosis Research Center (TREC), Department of Clinical MedicineUiT – the Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
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Zheng D, Qi G, Adu IK, Wu H, Zhu M. Efficacy of traditional Chinese medicine combined with rivaroxaban in the treatment of lower extremity deep vein thrombosis: A meta-analysis. Medicine (Baltimore) 2022; 101:e29483. [PMID: 36181038 PMCID: PMC9524882 DOI: 10.1097/md.0000000000029483] [Citation(s) in RCA: 4] [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] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Despite the usefulness of traditional Chinese medicine (TCM) in the treatment of lower deep vein thrombosis (DVT), there is no consensus on safety and efficacy. We aim to systematically evaluate the safety and efficacy of TCM combined with Rivaroxaban in the treatment of lower limb DVT. METHODS An online search of databases such as Cochrane Library, Embase, Pubmed, and Web of science, as well as CBM, China Science and Technology Journal Database, China Knowledge Network (CNKI) and Wanfang Data (from inception to July, 2021) was performed. All published clinical randomized controlled trials (RCTs) were screened manually, evaluated for quality and considered for meta-analysis using RevMan 5.3. RESULTS Nine RCTs with a total of 730 cases were included, 368 cases in the trial group were treated with TCM combined with Rivaroxaban, and 362 cases in the control group were treated with Rivaroxaban alone after surgery. Clinical efficiency was significantly higher in the test group [OR = 3.33, 95% CI (2.01, 5.53), P < .00001], the circumference of the affected limb was significantly lower in the thigh and calf, respectively [MD = -1.48, 95% CI (-1.88, -1.09), P < .00001], [MD = -0.54, 95% CI (-0.62, -0.46), P < .00001], pain scores were significantly lower [MD = -0.97, 95% CI (-1.58, -0.36), P = .002], coagulation index plasma fibrinogen (FIB) was significantly lower [MD = -0.85, 95% CI (-1.18, -0.52), P < .00001], coagulation function index D-2 aggregates were significantly reduced [MD = -0.69, 95% CI (-1.13, -0.24), P = .002], serum hypersensitive C-reactive protein (hs-CRP) measurements were significantly reduced [MD = -5.37, 95% CI (-9.20, -1.55), P = .006], complications measurement was significantly lower [OR = 0.60, 95% CI (0.27, 1.30), P = .20], activated partial thrombin time (ATPP) measurement was significantly lower [MD = 5.70, 95% CI (4.28, 7.12), P < .00001] and prothrombin time (PT) measurement was significantly lower [MD = 1.64, 95% CI (0.70, 2.57), P = .0006]. CONCLUSION Based on the available evidence, TCM combined with Rivaroxaban for treating lower extremity DVT have better clinical efficacy and safety profile, reducing the risk of bleeding complications and adverse effects. Further improved studies are needed to support this inference.
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Affiliation(s)
- Dandan Zheng
- Health Science Center, Yangtze University, Jingzhou, Hubei, China
| | - Gui Qi
- Health Science Center, Yangtze University, Jingzhou, Hubei, China
- *Correspondence: Gui Qi, Health Science Center, Yangtze University, No. 1 Nanhuan Road, Jingzhou, Hubei 434023, China (e-mail: )
| | - Isaac Kumi Adu
- Health Science Center, Yangtze University, Jingzhou, Hubei, China
- Department of Medicine, the Second Hospital of Jingzhou & the Affiliated Hospital of Hubei College of Chinese Medicine, Jingzhou, Hubei, China
| | - Haichao Wu
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Mingyuan Zhu
- Health Science Center, Yangtze University, Jingzhou, Hubei, China
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Pankratz N, Wei P, Brody JA, Chen MH, de Vries PS, Huffman JE, Stimson MR, Auer PL, Boerwinkle E, Cushman M, de Maat MPM, Folsom AR, Franco OH, Gibbs RA, Haagenson KK, Hofman A, Johnsen JM, Kovar CL, Kraaij R, McKnight B, Metcalf GA, Muzny D, Psaty BM, Tang W, Uitterlinden AG, van Rooij JGJ, Dehghan A, O'Donnell CJ, Reiner AP, Morrison AC, Smith NL. Whole-exome sequencing of 14 389 individuals from the ESP and CHARGE consortia identifies novel rare variation associated with hemostatic factors. Hum Mol Genet 2022; 31:3120-3132. [PMID: 35552711 PMCID: PMC9476613 DOI: 10.1093/hmg/ddac100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/07/2022] [Accepted: 04/27/2022] [Indexed: 11/12/2022] Open
Abstract
Plasma levels of fibrinogen, coagulation factors VII and VIII and von Willebrand factor (vWF) are four intermediate phenotypes that are heritable and have been associated with the risk of clinical thrombotic events. To identify rare and low-frequency variants associated with these hemostatic factors, we conducted whole-exome sequencing in 10 860 individuals of European ancestry (EA) and 3529 African Americans (AAs) from the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium and the National Heart, Lung and Blood Institute's Exome Sequencing Project. Gene-based tests demonstrated significant associations with rare variation (minor allele frequency < 5%) in fibrinogen gamma chain (FGG) (with fibrinogen, P = 9.1 × 10-13), coagulation factor VII (F7) (with factor VII, P = 1.3 × 10-72; seven novel variants) and VWF (with factor VIII and vWF; P = 3.2 × 10-14; one novel variant). These eight novel rare variant associations were independent of the known common variants at these loci and tended to have much larger effect sizes. In addition, one of the rare novel variants in F7 was significantly associated with an increased risk of venous thromboembolism in AAs (Ile200Ser; rs141219108; P = 4.2 × 10-5). After restricting gene-based analyses to only loss-of-function variants, a novel significant association was detected and replicated between factor VIII levels and a stop-gain mutation exclusive to AAs (rs3211938) in CD36 molecule (CD36). This variant has previously been linked to dyslipidemia but not with the levels of a hemostatic factor. These efforts represent the largest integration of whole-exome sequence data from two national projects to identify genetic variation associated with plasma hemostatic factors.
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Affiliation(s)
- Nathan Pankratz
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Peng Wei
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jennifer A Brody
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ming-Huei Chen
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Framingham Heart Study, National Heart, Lung and Blood Institute, Framingham, MA, USA
- Population Sciences Branch, National Heart, Lung and Blood Institute, Framingham, MA, USA
| | - Paul S de Vries
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jennifer E Huffman
- Framingham Heart Study, National Heart, Lung and Blood Institute, Framingham, MA, USA
- Population Sciences Branch, National Heart, Lung and Blood Institute, Framingham, MA, USA
- Center for Population Genomics, MAVERIC, VA Boston Healthcare System, Boston, MA, USA
| | - Mary Rachel Stimson
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Paul L Auer
- Division of Biostatistics, Institute for Health and Equity, and Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Mary Cushman
- Departments of Medicine and Pathology, University of Vermont, Colchester, VT, USA
| | - Moniek P M de Maat
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Richard A Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Kelly K Haagenson
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jill M Johnsen
- Research Institute Bloodworks, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Christie L Kovar
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Robert Kraaij
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Barbara McKnight
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Ginger A Metcalf
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Donna Muzny
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Weihong Tang
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - André G Uitterlinden
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Abbas Dehghan
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Biostatistics and Epidemiology, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Christopher J O'Donnell
- Framingham Heart Study, National Heart, Lung and Blood Institute, Framingham, MA, USA
- Cardiology Section, Department of Medicine, Boston Veterans Administration Healthcare, Harvard Medical School, Boston, MA, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Alex P Reiner
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Alanna C Morrison
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nicholas L Smith
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle WA, USA
- Seattle Epidemiologic Research and Information Center, Veterans Administration Office of Research and Development, Seattle, WA, USA
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Mok Y, Ishigami J, Sang Y, Kucharska-Newton AM, Salameh M, Schrack JA, Palta P, Coresh J, Windham BG, Lutsey PL, Folsom AR, Matsushita K. Clinically Recognized Varicose Veins and Physical Function in Older Individuals: The ARIC Study. J Gerontol A Biol Sci Med Sci 2022; 77:1637-1643. [PMID: 34606610 PMCID: PMC9373961 DOI: 10.1093/gerona/glab287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although a few studies reported an association between varicose veins and physical function, this potentially bidirectional association has not been systematically evaluated in the general population. METHOD In 5 580 participants (aged 71-90 years) from the Atherosclerosis Risk in Communities study, varicose veins were identified in outpatient and inpatient administrative data prior to (prevalent cases) and after (incident cases) visit 5 (2011-2013). Physical function was evaluated by the Short Physical Performance Battery (SPPB, score ranging from 0 to 12). We evaluated (i) cross-sectional association between prevalent varicose veins and physical function, (ii) association of prevalent varicose veins with subsequent changes in physical function from visit 5 to visits 6 (2016-2017) and 7 (2018-2019), and (iii) association of physical function at visit 5 with incident varicose veins during a median follow-up of 3.6 years (105 incident varicose veins among 5 350 participants without prevalent cases at baseline). RESULTS At baseline, varicose veins were recognized in 230 (4.1%) participants and cross-sectionally associated with reduced physical function. Longitudinally, prevalent varicose veins were not significantly associated with a decline in SPPB over time. In contrast, a low SPPB ≤6 was associated with a greater incidence of varicose veins compared to SPPB ≥10 (adjusted hazard ratio 2.13 [95% confidence interval = 1.19, 3.81]). CONCLUSION In community-dwelling older adults, varicose veins and low physical function were associated cross-sectionally. Longitudinally, low physical function was a risk factor for incident varicose veins, but not vice versa. Our findings suggest an etiological contribution of low physical function to incident varicose veins.
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Affiliation(s)
- Yejin Mok
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, ,Baltimore, Maryland, USA
| | - Junichi Ishigami
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, ,Baltimore, Maryland, USA
| | - Yingying Sang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, ,Baltimore, Maryland, USA
| | - Anna M Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, ,North Carolina, USA
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Maya Salameh
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer A Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, ,Baltimore, Maryland, USA
| | - Priya Palta
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, ,Baltimore, Maryland, USA
| | - B Gwen Windham
- Department of Medicine, The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, ,Baltimore, Maryland, USA
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Akrivou D, Perlepe G, Kirgou P, Gourgoulianis KI, Malli F. Pathophysiological Aspects of Aging in Venous Thromboembolism: An Update. Medicina (B Aires) 2022; 58:medicina58081078. [PMID: 36013544 PMCID: PMC9415158 DOI: 10.3390/medicina58081078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/03/2022] [Accepted: 08/07/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this review is to highlight all the factors that associate venous thromboembolism (VTE) with aging. Elderly people are characterized by a higher incidence of thrombosis taking into account the co-existing comorbidities, complications and fatality that arise. Based on the Virchow triad, pathophysiological aspects of venous stasis, endothelium injury and hypercoagulability in elderly people (≥65 years) are described in detail. More precisely, venous wall structure, nitric oxide (NO) and endothelin-1 expression are impaired in this age group. Furthermore, an increase in high-molecular-weight kininogen (HMWK), prekallikrein, factors V, VII, VIII, IX and XI, clot lysis time (CLT) and von Willebrand factor (vWF) is observed. Age-dependent platelet dysfunction and changes in anticoagulant factors are also illustrated. A “low-grade inflammation stage” is delineated as a possible risk factor for thrombosis in the elderly. Consequently, clinical implications for frail elderly people related to diagnosis, treatment, bleeding danger and VTE recurrence emerge. We conclude that aging is an acquired thrombotic factor closely related to pathophysiological changes.
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Affiliation(s)
- Dimitra Akrivou
- Respiratory Medicine Department, Faculty of Medicine, University of Thessaly, 41300 Larissa, Greece
| | - Garifallia Perlepe
- Respiratory Medicine Department, Faculty of Medicine, University of Thessaly, 41300 Larissa, Greece
| | - Paraskevi Kirgou
- Respiratory Medicine Department, Faculty of Medicine, University of Thessaly, 41300 Larissa, Greece
| | | | - Foteini Malli
- Respiratory Medicine Department, Faculty of Medicine, University of Thessaly, 41300 Larissa, Greece
- Respiratory Disorders Lab, Faculty of Nursing, University of Thessaly, 41300 Larissa, Greece
- Respiratory Medicine Department, University Hospital of Larissa, 41223 Larissa, Greece
- Correspondence: ; Tel.: +30-2410684612
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Hashimoto H, Imai S, Kiyomi A, Sugiura M. Effectiveness and safety of extended treatment with direct oral anticoagulants for venous thromboembolism in Japan: A retrospective cohort study using claims data. THROMBOSIS UPDATE 2022. [DOI: 10.1016/j.tru.2022.100113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Montez-Rath ME, Lubwama R, Kapphahn K, Ling AY, LoCasale R, Robinson L, Chandross KJ, Desai M. Characterizing real world safety profile of oral Janus kinase inhibitors among adult atopic dermatitis patients: evidence transporting from the rheumatoid arthritis population. Curr Med Res Opin 2022; 38:1431-1437. [PMID: 35699028 DOI: 10.1080/03007995.2022.2088715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To address potential safety concerns of Janus Kinase Inhibitors (JAK-Is), we characterized their safety profile in the atopic dermatitis (AD) patient population. METHODS In this retrospective observational study, we used propensity score-based methods and a Poisson modeling framework to estimate the incidence of health outcomes of interest (HOI) for the AD patient. To that end, two mutually exclusive cohorts were created using a real world data resource: a rheumatoid arthritis (RA) cohort, where we directly quantify the safety risk of JAK-Is on HOIs, and an AD cohort, that comprises the target population of interest and to whom we transport the results obtained from the RA cohort. The RA cohort included all adults who filled at least one prescription for a JAK-I (tofacitinib, baricitinib, or upadacitinib) between 1 January 2017 and 31 January 2020. The AD cohort consisted of all adults diagnosed with AD during the same period. We first estimated the incidence rate of each HOI in the RA cohort, and then transported the results to the AD population. RESULTS The RA and AD cohorts included 5,296 and 261,855 patients, respectively. On average, patients in the AD cohort were younger, more often male, more likely to be Asian, and had higher household income. They also had a lower prevalence of several comorbid conditions including hypertension, chronic kidney disease, obesity, and depression. Overall, the transported incidence rates of the HOIs to the AD cohort were lower than those obtained in the RA cohort by 13-50%. CONCLUSION We applied transportability methods to characterize the risk of the HOIs in the AD population and found absolute risks higher than that of the general population. Future work is needed to validate these conclusions in comparable populations.
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Affiliation(s)
- Maria E Montez-Rath
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Kris Kapphahn
- Department of Medicine, Division of Biomedical Informatics Research, Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Albee Y Ling
- Department of Medicine, Division of Biomedical Informatics Research, Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | | | - Manisha Desai
- Department of Medicine, Division of Biomedical Informatics Research, Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, USA
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Thachil R, Nagraj S, Kharawala A, Sokol SI. Pulmonary Embolism in Women: A Systematic Review of the Current Literature. J Cardiovasc Dev Dis 2022; 9:jcdd9080234. [PMID: 35893223 PMCID: PMC9330775 DOI: 10.3390/jcdd9080234] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 01/27/2023] Open
Abstract
Cardiovascular disease is the leading cause of death in women. Pulmonary embolism (PE) is the third most-common cause of cardiovascular death, after myocardial infarction (MI) and stroke. We aimed to evaluate the attributes and outcomes of PE specifically in women and explore sex-based differences. We conducted a systematic review of the literature using electronic databases PubMed and Embase up to 1 April 2022 to identify studies investigating PE in women. Of the studies found, 93 studies met the eligibility criteria and were included. The risk of PE in older women (especially >40 years of age) superseded that of age-matched men, although the overall age- and sex-adjusted incidence of PE was found to be lower in women. Risk factors for PE in women included age, rheumatologic disorders, hormone replacement therapy or oral contraceptive pills, pregnancy and postpartum period, recent surgery, immobilization, trauma, increased body mass index, obesity, and heart failure. Regarding pregnancy, a relatively higher incidence of PE has been observed in the immediate postpartum period compared to the antenatal period. Women with PE tended to be older, presented more often with dyspnea, and were found to have higher NT-proBNP levels compared to men. No sex-based differences in in-hospital mortality and 30-day all-cause mortality were found. However, PE-related mortality was higher in women, particularly in hemodynamically stable patients. These differences form the basis of future research and outlets for reducing the incidence, morbidity, and mortality of PE in women.
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Affiliation(s)
- Rosy Thachil
- Correspondence: ; Tel.: +718-918-5937; Fax: +(571)-376-6710
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44
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In-hospital prognosis of malignancy-related pulmonary embolism: an analysis of the national inpatient sample 2016–2018. J Thromb Thrombolysis 2022; 54:630-638. [DOI: 10.1007/s11239-022-02684-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 11/26/2022]
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Danford NC, Mehta S, Boddapati V, Hellwinkel JE, Jobin CM, Greisberg JK. Venous thromboembolism prophylaxis with low molecular weight heparin versus unfractionated heparin for patients undergoing operative treatment of closed femoral shaft fractures. J Clin Orthop Trauma 2022; 31:101949. [PMID: 35874319 PMCID: PMC9304763 DOI: 10.1016/j.jcot.2022.101949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The objective of this study was to compare inpatient mortality rates for patients with operatively treated closed femoral shaft fractures (AO/OTA 32 A-C) who received venous thromboembolism (VTE) prophylaxis with either low molecular weight heparin (LMWH) or unfractionated heparin. METHODS This was a retrospective cohort study of a national database of patients presenting to Level I through IV trauma centers in the United States. All patients ≥18 years of age who sustained an operatively treated closed femoral shaft fracture were included. The primary outcome of inpatient mortality was compared between two groups: those who received LMWH or unfractionated heparin for VTE prophylaxis. Secondary outcomes were complications including VTE and bleeding events. Groups were compared using a multivariate regression model. RESULTS There were 2058 patients included in the study. Patients who received VTE prophylaxis with LMWH had lower odds of inpatient mortality compared to patients who received VTE prophylaxis with unfractionated heparin (OR 0.19; 95% CI 0.05 to 0.68, p = 0.011). CONCLUSIONS VTE prophylaxis with LMWH is associated with lower inpatient mortality compared to VTE prophylaxis with unfractionated heparin for patients undergoing operative treatment of closed femoral shaft fractures. To our knowledge this is the first study to report these associations for a specific subset of orthopedic trauma patients.
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Affiliation(s)
- Nicholas C. Danford
- Corresponding author. Columbia University Irving Medical Center, 622 W, 168th St. PH-11, New York, NY, 10032, USA.
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Saber I, Adamski A, Kuchibhatla M, Abe K, Beckman M, Reyes N, Schulteis R, Pendurthi Singh B, Sitlinger A, Thames EH, Ortel TL. Racial differences in venous thromboembolism: A surveillance program in Durham County, North Carolina. Res Pract Thromb Haemost 2022; 6:e12769. [PMID: 35873215 PMCID: PMC9301530 DOI: 10.1002/rth2.12769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 06/15/2022] [Accepted: 06/24/2022] [Indexed: 11/06/2022] Open
Abstract
Background Venous thromboembolism (VTE) affects approximately 1-2 individuals per 1000 annually and is associated with an increased risk for pulmonary hypertension, postthrombotic syndrome, and recurrent VTE. Objective To determine risk factors, incidence, treatments, and outcomes of VTE through a 2-year surveillance program initiated in Durham County, North Carolina (population approximately 280,000 at time of study). Patients/Methods We performed a retrospective analysis of data actively collected from three hospitals in Durham County during the surveillance period. Results A total of 987 patients were diagnosed with VTE, for an annual rate of 1.76 per 1000 individuals. Hospital-associated VTE occurred in 167 hospitalized patients (16.9%) and 271 outpatients who were hospitalized within 90 days of diagnosis (27.5%). Annual incidence was 1.98 per 1000 Black individuals compared to 1.25 per 1000 White individuals (p < 0.0001), and Black individuals with VTE were younger than White individuals (p < 0.0001). Common risk factors included active cancer, prolonged immobility, and obesity, and approximately half were still taking anticoagulant therapy 1 year later. A total of 224 patients died by 1 year (28.5% of patients for whom outcomes could be confirmed), and Black patients were more likely to have recurrent VTE than White patients during the first 6 months following initial presentation (9.4% vs. 4.1%, p = 0.01). Conclusions Ongoing surveillance provides an effective strategy to identify patients with VTE and monitor treatment and outcomes. We demonstrated that hospital-associated VTE continues to be a major contributor to the burden of VTE and confirmed the higher incidence of VTE in Black compared to White individuals.
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Affiliation(s)
- Ibrahim Saber
- Division of Hematology, Department of Medicine Duke University Medical Center Durham North Carolina USA
| | - Alys Adamski
- Centers for Disease Control and Prevention Atlanta Georgia USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics Duke University Durham North Carolina USA
| | - Karon Abe
- Centers for Disease Control and Prevention Atlanta Georgia USA
| | - Michele Beckman
- Centers for Disease Control and Prevention Atlanta Georgia USA
| | - Nimia Reyes
- Centers for Disease Control and Prevention Atlanta Georgia USA
| | - Ryan Schulteis
- Durham Veterans' Administration Medical Center Durham North Carolina USA
| | | | - Andrea Sitlinger
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine Duke University Medical Center Durham North Carolina USA
| | - Elizabeth H Thames
- Division of Hematology, Department of Medicine Duke University Medical Center Durham North Carolina USA
| | - Thomas L Ortel
- Division of Hematology, Department of Medicine Duke University Medical Center Durham North Carolina USA.,Department of Pathology Duke University Medical Center Durham North Carolina USA
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Wojta J. Commentary on "Elevated plasma levels of plasminogen activator inhibitor-1 are associated with risk of future incident venous thromboembolism": A new role for plasminogen activator inhibitor-1-An inhibitor of fibrinolysis predicts future venous thromboembolic events and links them to obesity. J Thromb Haemost 2022; 20:1559-1561. [PMID: 35754015 PMCID: PMC9328391 DOI: 10.1111/jth.15728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Johann Wojta
- Department of Internal Medicine IIMedical University of ViennaViennaAustria
- Ludwig Boltzmann Institute for Cardiovascular ResearchViennaAustria
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Jørgensen CT, Tavoly M, Pettersen HH, Førsund E, Roaldsnes C, Olsen MK, Tjønnfjord E, Gleditsch J, Galovic AG, Vikum SF, Brækkan SK, Ghanima W. The venous thrombosis registry in Østfold Hospital (TROLL registry) - design and cohort description. Res Pract Thromb Haemost 2022; 6:S2475-0379(22)00161-3. [PMID: 35949883 PMCID: PMC9351429 DOI: 10.1002/rth2.12770] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/31/2022] [Accepted: 06/14/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose The incidence of venous thromboembolism (VTE) is expected to increase over the next decades, further increasing its substantial impact on patients and health care resources. Registries have the benefit of reporting real‐world data without excluding clinically important subgroups. Our aim was to describe a Norwegian VTE registry and to provide descriptive data on the population and management. Registry Population The Venous Thrombosis Registry in Østfold Hospital (TROLL) is an ongoing registry of consecutive patients diagnosed with, treated, and/or followed up for VTE at Østfold Hospital, Norway, since 2005. Baseline and follow‐up data, including demographics, clinical features, risk factors, diagnostic procedures, classification of VTE, and treatment were collected during hospitalization, and at scheduled outpatient visits. Findings to Date From January 2005 to June 2021, 5037 patients were eligible for research in TROLL. Median age was 67 years (interquartile range, 55–77), and 2622 (52.1%) were male. Of these, 2736 (54.3%) had pulmonary embolism (PE), 2034 (40.4%) had deep vein thrombosis (DVT), and 265 (5.3%) had upper‐extremity DVT or splanchnic or cerebral sinus vein thrombosis. In total, 2330 (46.3%) were classified as unprovoked VTE, and 1131 (22.5%) had cancer. Direct oral anticoagulants were the most frequent therapeutic agents (39.3%) followed by low‐molecular‐weight heparins (30.4%) and vitamin K antagonists (30.3%). Outpatient treatment for PE increased from 4% in 2005 to 23% in 2019. Future Plans TROLL is a population‐based ongoing registry that represents a valuable source of real‐world data that will be used for future research on the management and outcomes of VTE.
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Affiliation(s)
- Camilla Tøvik Jørgensen
- Department of Emergency Medicine Østfold Hospital Sarpsborg Norway.,Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Mazdak Tavoly
- Department of Medicine Sahlgrenska University Hospital Gothenburg Sweden
| | | | - Eli Førsund
- Department of Emergency Medicine Østfold Hospital Sarpsborg Norway
| | | | | | - Eirik Tjønnfjord
- Department of Emergency Medicine Østfold Hospital Sarpsborg Norway
| | - Jostein Gleditsch
- Institute of Clinical Medicine University of Oslo Oslo Norway.,Department of Radiology Østfold Hospital Sarpsborg Norway
| | | | | | - Sigrid Kufaas Brækkan
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway Tromsø Norway.,Division of Internal Medicine University Hospital of North Norway Tromsø Norway
| | - Waleed Ghanima
- Department of Research Østfold Hospital Sarpsborg Norway.,Clinic of Internal Medicine Østfold Hospital Sarpsborg Norway.,Department of Hematology, Oslo University Hospital and Institute of Clinical Medicine University of Oslo Oslo Norway
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Jordan Bruno X, Koh I, Lutsey PL, Walker RF, Roetker NS, Wilkinson K, Smith NL, Plante T, Repp AB, Holmes CE, Cushman M, Zakai N. Venous thrombosis risk during and after medical and surgical hospitalizations: The medical inpatient thrombosis and hemostasis (MITH) study. J Thromb Haemost 2022; 20:1645-1652. [PMID: 35426248 PMCID: PMC9247009 DOI: 10.1111/jth.15729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Thirty to seventy percent of all venous thromboembolism (VTE) events are associated with hospitalization. The absolute and relative risks during and after hospitalization are poorly characterized. OBJECTIVES Quantify the absolute rate and relative risk of VTE during and up to 3 months after medical and surgical hospitalizations. PATIENTS/METHODS We conducted an observational cohort study between 2010 and 2016 of patients cared for by the University of Vermont (UVM) Health Network's primary care population. Cox proportional hazard models with hospitalization modeled as a time-varying covariate were used to estimate VTE risk. RESULTS Over 4.3 years of follow-up, 55 220 hospitalizations (156 per 1000 person-years) and 713 first venous thromboembolism events (2.0 per 1000 person-years) occurred. Among individuals not recently hospitalized, the rate of venous thromboembolism was 1.4 per 1000 person-years and 71.8 per 1000 person-years during hospitalization. During the first, second, and third months after discharge, the rates of venous thromboembolism were 35.1, 11.3, and 5.2 per 1000 person-years, respectively. Relative to those not recently hospitalized, the age- and sex-adjusted HRs of venous thromboembolism were 38.0 (95% CI 28.0, 51.5) during hospitalization, and 18.4 (95% CI 15.0, 22.6), 6.3 (95% CI 4.3, 9.0), and 3.0 (95% CI 1.7, 5.4) during the first, second, and third months after discharge, respectively. Stratified by medical versus surgical services the rates were similar. CONCLUSION Hospitalization and up to 3 months after discharge were strongly associated with increased venous thromboembolism risk. These data quantify this risk for use in future studies.
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Affiliation(s)
- Ximena Jordan Bruno
- Hematology Oncology DivisionDepartment of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of MedicineLarner College of MedicineUniversity of VermontBurlingtonVermontUSA
- University of Vermont Medical CenterBurlingtonVermontUSA
| | - Insu Koh
- Department of Pathology & Laboratory MedicineLarner College of MedicineUniversity of VermontBurlingtonVermontUSA
| | - Pamela L. Lutsey
- Division of Epidemiology & Community HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Robert F. Walker
- Division of Epidemiology & Community HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Nicholas S. Roetker
- Chronic Disease Research GroupHennepin Healthcare Research InstituteMinneapolisMinnesotaUSA
| | - Katherine Wilkinson
- Department of Pathology & Laboratory MedicineLarner College of MedicineUniversity of VermontBurlingtonVermontUSA
| | - Nicolas L. Smith
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Kaiser Permanente WashingtonKaiser Permanente Washington Health Research InstituteSeattleWashingtonUSA
- Department of Veterans Affairs Office of Research and DevelopmentSeattle Epidemiologic Research and Information CenterSeattleWashingtonUSA
| | - Timothy B. Plante
- Department of MedicineLarner College of MedicineUniversity of VermontBurlingtonVermontUSA
- University of Vermont Medical CenterBurlingtonVermontUSA
| | - Allen B. Repp
- Department of MedicineLarner College of MedicineUniversity of VermontBurlingtonVermontUSA
- University of Vermont Medical CenterBurlingtonVermontUSA
| | - Chris E. Holmes
- Department of MedicineLarner College of MedicineUniversity of VermontBurlingtonVermontUSA
- University of Vermont Medical CenterBurlingtonVermontUSA
| | - Mary Cushman
- Department of MedicineLarner College of MedicineUniversity of VermontBurlingtonVermontUSA
- University of Vermont Medical CenterBurlingtonVermontUSA
- Department of Pathology & Laboratory MedicineLarner College of MedicineUniversity of VermontBurlingtonVermontUSA
| | - Neil A. Zakai
- Department of MedicineLarner College of MedicineUniversity of VermontBurlingtonVermontUSA
- University of Vermont Medical CenterBurlingtonVermontUSA
- Department of Pathology & Laboratory MedicineLarner College of MedicineUniversity of VermontBurlingtonVermontUSA
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Glise Sandblad K, Rosengren A, Sörbo J, Jern S, Hansson P. Pulmonary embolism and deep vein thrombosis—comorbidities and temporary provoking factors in a register‐based study of 1.48 million people. Res Pract Thromb Haemost 2022; 6:e12714. [PMID: 35677029 PMCID: PMC9166387 DOI: 10.1002/rth2.12714] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/28/2022] [Accepted: 04/10/2022] [Indexed: 12/03/2022] Open
Abstract
Background Knowledge on differences in patients who present with deep vein thrombosis (DVT) and those with pulmonary embolism (PE) is incomplete. Objective To determine comorbidities and temporary provoking factors in patients with a first‐time PE or DVT. Methods This was a nationwide Swedish registry‐based, retrospective, case‐control study including 298 172 patients with first‐time venous thromboembolism (VTE) and 1 185 079 controls matched for age, sex, and county of residence, free of VTE at the time of matching. Results Patients with PE were older than those with DVT (mean age, 69 vs 66 years) and included slightly more women (PE, 53.4% vs DVT, 52.1%). After multivariable adjustment for comorbidities (within 7 years) and temporary provoking factors (within 3 months), heart failure (PE: adjusted odds ratio [aOR], 2.64 [99% confidence interval [CI], 2.55‐2.73]; DVT: aOR, 1.66 [99% CI, 1.60‐1.72]), ischemic heart disease (PE: aOR, 1.51 [99% CI, 1.47‐1.56]; DVT: aOR, 1.01 [99% CI, 0.98‐1.04]), and chronic obstructive pulmonary disease (PE: aOR, 2.51 [99% CI, 2.40‐2.63]; DVT, 1.54 [99% CI, 1.47‐1.62]) were among diseases that showed higher odds ratios in patients with PE than in those with DVT, compared with controls. Comorbidities registered within 6 months were associated with higher aORs than those within 7 years. The highest population attributable risks for PE were for cancer (13.0%) and heart failure (11.7%). Conclusion Cardiopulmonary diseases, particularly with recent onset, imply a higher risk for PE, whereas orthopedic surgery and lower‐extremity fractures carry a higher risk of DVT.
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Affiliation(s)
- Katarina Glise Sandblad
- Department of Medicine, Geriatrics and Emergency Medicine Östra Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Annika Rosengren
- Department of Medicine, Geriatrics and Emergency Medicine Östra Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Jan Sörbo
- Department of Clinical Physiology Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
| | - Sverker Jern
- The Wallenberg Laboratory for Cardiovascular Research Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Per‐Olof Hansson
- Department of Medicine, Geriatrics and Emergency Medicine Östra Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
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