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Aggarwal S, Patel S, Vashisht S, Kumar V, Sehgal IS, Chauhan R, Chaluvashetty DSB, Hemanth Kumar DK, Jindal DK. Guidelines for the prevention of venous thromboembolism in hospitalized patients with pelvi-acetabular trauma. J Clin Orthop Trauma 2020; 11:1002-1008. [PMID: 33192002 PMCID: PMC7656470 DOI: 10.1016/j.jcot.2020.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Venous thromboembolism is a dreaded complication leading to increased morbidity and mortality in patients having pelvi-acetabular fractures. OBJECTIVES These evidence based guidelines aim to provide the decision making ability in the prevention of venous thromboembolism in patients with pelvi-acetabular trauma planned for operative or non operative treatment. METHODS The patients were subclassified into 5 categories. The PICO framework was used to devise research questions in each category. The systematic reviews were performed for each research question. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess outcomes of critical interest. The guideline panel consisting of expert members of different subspecialties, analyzed the evidence and made recommendations. RESULTS The guideline panel proposed 21 recommendations. There are five recommendations in category 1 to 3, two recommendations in category 4 and four recommendations in category 5. CONCLUSION In pelvi-acetabular fractures there is strong evidence to suggest that thromboprophylaxis should be given. It should be initiated as early as possible after control of hemorrhage. The chemical prophylaxis is the preferred mode and LMWH is the preferred agent of choice. The mechanical methods can be used as an adjunct. The routine prophylactic use of IVC filters is not recommended. However, the use of retrievable IVC filters in high risk patients with established VTE in preoperative period can be considered. The use of newer directly acting oral anticoagulants is gaining importance.
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Affiliation(s)
| | - Sandeep Patel
- Department of Orthopaedics PGIMER, Chandigarh, India
| | | | - Vishal Kumar
- Department of Orthopaedics PGIMER, Chandigarh, India
| | | | - Rajeev Chauhan
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
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Li X, Haddadin I, McLennan G, Farivar B, Staub D, Beck A, Thompson D, Partovi S. Inferior vena cava filter – comprehensive overview of current indications, techniques, complications and retrieval rates. VASA 2020; 49:449-462. [DOI: 10.1024/0301-1526/a000887] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Summary: Inferior vena cava (IVC) filter has been used to manage patients with pulmonary embolism and deep venous thrombosis. Its ease of use and the expansion of relative indications have led to a dramatic increase in IVC filter placement. However, IVC filters have been associated with a platitude of complications. Therefore, there exists a need to examine the current indications and identify the patient population at risk. In this paper, we comprehensively reviewed the current indications and techniques of IVC filter placement. Further, we examined the various complications associated with either permanent or retrievable IVC filters. Lastly, we examined the current data on filter retrieval.
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Affiliation(s)
- Xin Li
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Ihab Haddadin
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Gordon McLennan
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Behzad Farivar
- Department of Vascular Surgery, Sydell and Arnold Miller Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniel Staub
- Department of Angiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Avi Beck
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Dustin Thompson
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Sasan Partovi
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
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ACR Appropriateness Criteria® Radiologic Management of Venous Thromboembolism-Inferior Vena Cava Filters. J Am Coll Radiol 2019; 16:S214-S226. [DOI: 10.1016/j.jacr.2019.02.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 02/02/2023]
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Guerado E, Bertrand ML, Cano JR, Cerván AM, Galán A. Damage control orthopaedics: State of the art. World J Orthop 2019; 10:1-13. [PMID: 30705836 PMCID: PMC6354106 DOI: 10.5312/wjo.v10.i1.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 02/06/2023] Open
Abstract
Damage control orthopaedics (DCO) originally consisted of the provisional immobilisation of long bone - mainly femur - fractures in order to achieve the advantages of early treatment and to minimise the risk of complications, such as major pain, fat embolism, clotting, pathological inflammatory response, severe haemorrhage triggering the lethal triad, and the traumatic effects of major surgery on a patient who is already traumatised (the “second hit” effect). In recent years, new locations have been added to the DCO concept, such as injuries to the pelvis, spine and upper limbs. Nonetheless, this concept has not yet been validated in well-designed prospective studies, and much controversy remains. Indeed, some researchers believe the indiscriminate application of DCO might be harmful and produce substantial and unnecessary expense. In this respect, too, normalised parameters associated with the acid-base system have been proposed, under a concept termed early appropriate care, in the view that this would enable patients to receive major surgical procedures in an approach offering the advantages of early total care together with the apparent safety of DCO. This paper discusses the diagnosis and treatment of severely traumatised patients managed in accordance with DCO and highlights the possible drawbacks of this treatment principle.
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Affiliation(s)
- Enrique Guerado
- Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, University of Malaga, Marbella 29603, Malaga, Spain
| | - Maria Luisa Bertrand
- Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, University of Malaga, Marbella 29603, Malaga, Spain
| | - Juan Ramon Cano
- Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, University of Malaga, Marbella 29603, Malaga, Spain
| | - Ana María Cerván
- Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, University of Malaga, Marbella 29603, Malaga, Spain
| | - Adolfo Galán
- Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, University of Malaga, Marbella 29603, Malaga, Spain
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Jones LM, Chu QD, Samra N, Hu B, Zhang WW, Tan TW. Evaluating the Utilization of Prophylactic Inferior Vena Cava Filters in Trauma Patients. Ann Vasc Surg 2018; 46:36-42. [DOI: 10.1016/j.avsg.2017.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 08/01/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
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Berber O, Vasireddy A, Nzeako O, Tavakkolizadeh A. The high-risk polytrauma patient and inferior vena cava filter use. Injury 2017; 48:1400-1404. [PMID: 28487103 DOI: 10.1016/j.injury.2017.04.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/28/2017] [Accepted: 04/17/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of this study was to assess the impact on practice of vena cava filter insertion guidelines (Eastern Association for the Surgery of Trauma: practice management guidelines). DESIGN The study was performed at a level 1 trauma centre with data from the 'Trauma Audit and Research Network' cross-referenced to hospital data. RESULTS A total of 1138 specific 'high-risk' major trauma patients were identified over a 6-year period. The mean age was 46 years (18-102) and the male to female ratio was 3.3:1. The average Injury Severity Score was 23.6 (4-75). The overall DVT rate was 2.6% and the PE rate was 1.8%. A retrievable IVC filter was inserted in 42 cases (3.8%). The filter retrieval rate was 23.8% at a mean of 68.5days (4-107). Only one complication was reported of a breakthrough PE despite filter. Applying the EAST guidelines to this cohort would have suggested filter insertion in 279 (24.6%) cases. The kappa concordance value between observed practice and the 'EAST filter group' was 0.103 (poor). The PE rate in the 'EAST filter group' was 2.2% vs 1.6% in the 'no filter group' (p=0.601, no statistical difference) and the observed odds ratio was 0.814 (95% CI 0.413, 1.602). CONCLUSION The EAST guidelines are useful but may be overestimating the need for filter insertion.
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Affiliation(s)
- Onur Berber
- Trauma and Orthopaedic Department, King's College Hospital NHS Foundation Trust, United Kingdom.
| | - Aswin Vasireddy
- Trauma and Orthopaedic Department, King's College Hospital NHS Foundation Trust, United Kingdom
| | - Obi Nzeako
- Trauma and Orthopaedic Department, King's College Hospital NHS Foundation Trust, United Kingdom
| | - Adel Tavakkolizadeh
- Trauma and Orthopaedic Department, King's College Hospital NHS Foundation Trust, United Kingdom
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Abstract
Optional vena cava filters can used to provide either short-term or permanent protection from pulmonary embolism. These devices have recently become available for clinical use in the United States. However, there remains a paucity of data about these devices and their outcomes. This article reviews current and future devices, the rationale behind non-permanent caval filtration, and the generally accepted guidelines for their clinical application.
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Affiliation(s)
- John A. Kaufman
- *Dotter Institute/Oregon Health & Science University, Portland, OR
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8
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Prevention of Venous Thromboembolism in Individuals with Spinal Cord Injury: Clinical Practice Guidelines for Health Care Providers, 3rd ed.: Consortium for Spinal Cord Medicine. Top Spinal Cord Inj Rehabil 2016; 22:209-240. [PMID: 29339863 PMCID: PMC4981016 DOI: 10.1310/sci2203-209] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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9
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Leeper WR, Murphy PB, Vogt KN, Leeper TJ, Kribs SW, Gray DK, Parry NG. Are retrievable vena cava filters placed in trauma patients really retrievable? Eur J Trauma Emerg Surg 2015. [PMID: 26201391 DOI: 10.1007/s00068-015-0553-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Concerns have arisen regarding the use of retrievable inferior vena cava filters (rIVCFs) in trauma patients due to increasing reports of low retrieval rates. We hypothesized that complete follow-up with a dedicated trauma nurse practitioner would be associated with a higher rate of retrievability. This study was undertaken to determine the rate of retrievability of rIVCFs placed in a Canadian Lead Trauma Centre, and to compare the rate of retrievability in our trauma population to our non-trauma patients. METHODS We performed a retrospective cohort study of all patients with rIVCF placed between Jan 1 2000 and June 30 2014. Data were collected on demographics, indication for filter placement, retrieval status, and reasons for non-retrieval. Comparison was made between trauma patients and non-trauma patients. RESULTS A total of 374 rIVCFs were placed (61 in trauma patients and 313 in non-trauma patients) and follow-up was complete for the entire cohort. Filter retrieval was achieved in 86.9 % of trauma patients. Reasons for non-retrieval were technical in two patients, and death before retrieval in six patients. Retrieval was successful in 48.9 % of non-trauma patients. CONCLUSIONS This study demonstrates that rIVCFs can be successfully retrieved amongst trauma patients. We demonstrated a higher rate of successful retrieval amongst trauma patients than non-trauma patients in our institution. Careful patient follow-up may play a role in successful retrieval of rIVCFs.
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Affiliation(s)
- W R Leeper
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada. .,Division of Critical Care, London Health Sciences Centre, London, ON, Canada.
| | - P B Murphy
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Division of General Surgery, London Health Sciences Centre, Room E2-217, Victoria Hospital, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - K N Vogt
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - T J Leeper
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - S W Kribs
- Department of Radiology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - D K Gray
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Trauma Program, London Health Sciences Centre, London, ON, Canada
| | - N G Parry
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Trauma Program, London Health Sciences Centre, London, ON, Canada.,Centre for Critical Illness Research, London, ON, Canada.,Division of Critical Care, London Health Sciences Centre, London, ON, Canada
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Jia W, Liu J, Tian X, Jiang P. Tempofilter II implantation in patients with lower extremity fractures and proximal deep vein thrombosis. Diagn Interv Radiol 2014; 20:245-50. [PMID: 24675164 DOI: 10.5152/dir.2013.13289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE We aimed to examine the efficacy and safety of Tempofilter II (B. Braun, Melsungen, Germany) implantation to prevent pulmonary embolism in patients with lower-extremity fractures and proximal deep vein thrombosis (DVT). MATERIALS AND METHODS The records of patients with lower limb fractures and proximal DVT who were implanted with Tempofilter II devices from May 2004 to August 2009 were reviewed. Data collected included success rate, occurrence of pulmonary embolism, retrieval rate, and complications. RESULTS A total of 176 eligible patients, including 129 males (73.3%) and 47 females (26.7%) with a median age of 42.0 years (interquartile range [IQR], 34.0-52.0 years) were included in the study. Filters were successfully implanted in 174 patients (98.9%). One patient experienced a pulmonary embolism after implantation and died. Filters were removed without complications in all other patients. Median filter implantation time was 27 days (IQR, 25.0-29.0 days). Visible organized thrombi were present on the surface of 144 (82.8%) of filters after removal, and the diameter of most thrombi (n=124) ranged from 0.5 to 1.0 cm. Filters migrated <2 cm in 104 patients (59.8%) and ≥ 2 cm in five patients (2.9%). In these five cases, three filters migrated into the right atrium and two migrated to the orifice of the renal veins. CONCLUSION Tempofilter II is safe and may be useful in cases of lower extremity fracture with proximal DVT for the prevention of pulmonary embolism. The filter is easily placed and retrieved, and associated with minimal complications.
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Affiliation(s)
- Wei Jia
- From the Department of Vascular Surgery Beijing Jishuitan Hospital, Beijing, China.
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Craig DG, Adam MG, Proffitt A, Parsons I, Tai NR, d'Arcy JL. Venous thromboembolism: reducing the risk in a Role 3 setting. J ROY ARMY MED CORPS 2014; 160:304-9. [PMID: 24429030 DOI: 10.1136/jramc-2013-000199] [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: 11/04/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) represents a significant preventable cause of hospital mortality. VTE assessment and prophylaxis rates are key patient safety and quality of care indicators. The aim of this study was to audit low molecular weight heparin (LMWH) and graduated elasticated compression stockings (GECS) prescriptions compared with the current Clinical Guidelines for Operations. METHODS Complete audit loop in the Role 3 Hospital, Camp Bastion, Afghanistan. A multifaceted intervention programme incorporating physician and nurse education and pre-printed medication charts was introduced to improve VTE assessment and prophylaxis rates. RESULTS Only 111/301 (36.9%) of patients in the pre-intervention cohort had a VTE risk assessment performed; this improved to 142/155 (91.6%, p<0.0001) post-intervention. A total of 57/88 (64.8%) patients prescribed LMWH pre-intervention had a documented assessment of bleeding risk performed; this rose to 65/66 (98.5%, p=0.0003) post-intervention. In pre-intervention, only 63/213 (29.6%) patients had a documented reassessment of VTE and bleeding risk at 24 h; reassessment rates rose to 68.8% (66/96 patients, p<0.0001) post-intervention. Of those patients at risk of VTE without ongoing bleeding risk, 62/96 (64.6%) had LMWH prescribed pre-intervention; this rose to 57/62 (91.9%) post-intervention (p<0.0001). Inappropriate LMWH prescription rates fell from 26/190 (13.7%) to 4/85 (4.7%, p=0.035) post-intervention. In those patients in whom GECS were not contraindicated, prescription rates rose from 23/95 (24.2%) to 42/62 (67.7%, p<0.0001) post-intervention. CONCLUSIONS Inclusion of pre-printed LMWH/GECS prescriptions and risk assessment stickers in the mediction chart significantly improved rates of VTE risk assessment and prophylaxis. These easily reproducible and low-cost interventions could improve patient safety on deployment.
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Affiliation(s)
- Darren G Craig
- Gastroenterology Department, The James Cook University Hospital, Middlesbrough, UK
| | - M G Adam
- Department of Infectious Diseases, Ealing Hospital NHS Trust, London, UK
| | - A Proffitt
- Department of Medicine, University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | - I Parsons
- 5 Medical Regiment, North Yorkshire, UK
| | - N R Tai
- Trauma Clinical Academic Unit, Royal London Hospital, London, UK
| | - J L d'Arcy
- Department of Cardiology, John Radcliffe Hospital, Oxford, UK
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Johnston WF, Jain A, Saad WE, Upchurch GR. Chest pain from excluded inferior vena cava filter after stent placement. J Vasc Surg Venous Lymphat Disord 2013; 2:70-3. [PMID: 26992972 DOI: 10.1016/j.jvsv.2013.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/12/2013] [Accepted: 06/16/2013] [Indexed: 10/26/2022]
Abstract
A 52-year-old patient presented with chronic substernal chest pain 18 months following exclusion of an inferior vena cava (IVC) filter with a self-expanding IVC stent. After a thorough work-up revealed no other possible cause of chest pain, the filter and stent were removed with subsequent resolution of chest pain. Intraoperatively, filter struts were found to have penetrated the posteromedial wall of the IVC and were abutting the periaortic neural plexus. Referred chest pain due to strut penetration of the caval wall is a novel complication of both IVC filters and IVC stents, demonstrating a need for continued surveillance.
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Affiliation(s)
- William F Johnston
- Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, Va
| | - Amit Jain
- Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, Va
| | - Wael E Saad
- Department of Radiology, University of Virginia, Charlottesville, Va
| | - Gilbert R Upchurch
- Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, Va.
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Baadh AS, Zikria JF, Rivoli S, Graham RE, Javit D, Ansell JE. Indications for Inferior Vena Cava Filter Placement: Do Physicians Comply with Guidelines? J Vasc Interv Radiol 2012; 23:989-95. [DOI: 10.1016/j.jvir.2012.04.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 04/09/2012] [Accepted: 04/12/2012] [Indexed: 10/28/2022] Open
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Three thousand seven hundred thirty-eight posttraumatic pulmonary emboli: a new look at an old disease. Ann Surg 2011; 254:625-32. [PMID: 21869675 DOI: 10.1097/sla.0b013e3182300209] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study was undertaken to determine the current incidence of pulmonary embolism (PE) and its attributable mortality after injury. BACKGROUND Despite compliance with prophylactic measures, PE remains a threat to postinjury recovery. We hypothesized that the liberal use of chest computed tomography after injury has resulted in an increased rate of detection of PE but that the mortality attributable to PE has decreased over the past decade. We also postulated that the risk factors for posttraumatic PE might be different from those for deep venous thrombosis (DVT). METHODS We examined demographics, injury data, risk factors, and outcomes from patients with DVT and PE compiled in the recent years (2007-2009) in the National Trauma Data Bank (NTDB). For comparison, we used patient data entered into NTDB from 1994 to 2001. Statistical models were created to examine the predictors of DVT and PE and PE-related mortality. RESULTS Among 888,652 patients in the current NTDB cohort, there were 9398 episodes of DVT (1.06%) and 3738 of PE (0.42%). Although many risk factors overlapped, a severe chest injury (Abbreviated Injury Score ≥ 3) conferred a much higher risk of PE than DVT. When comparing results from centers that had contributed to both data sets, there was a more than 2-fold increase in PE occurrence in the current cohort (0.49% vs 0.21%, P < 0.01) but with a significant reduction in PE-adjusted mortality (odds ratio, 4.08 vs 2.42). CONCLUSIONS The reported incidence of PE after trauma has more than doubled in recent years, while the PE-associated mortality has significantly decreased, suggesting that we are identifying a different disease entity or stage. Chest injuries convey a substantial risk for PE, a risk not likely to be diminished by leg compression devices or vena cava filters.
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Guryel E, Pearce R, Rickman M, Bircher M. Thrombo-prophylaxis in pelvic and acetabular trauma patients: a UK consensus? INTERNATIONAL ORTHOPAEDICS 2011; 36:165-9. [PMID: 21614603 DOI: 10.1007/s00264-011-1276-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 04/28/2011] [Indexed: 11/28/2022]
Abstract
AIMS The incidence of deep vein thrombosis, non-fatal pulmonary embolism and fatal pulmonary embolism may be as high as 61%, 10% and 2%, respectively, in patients with pelvic and acetabular injuries. A survey of the pelvic and acetabular units across the United Kingdom was performed to ascertain the thrombo-prophylaxis policy for these patients. In particular, questions were asked about different regimes on post-operative patients, conservatively managed patients and those simply discussed over the telephone. We enquired about their known rates of DVT and PE and their methods of data collection. METHODS Postal questionnaires were sent to 22 pelvic and acetabular trauma centres around the United Kingdom. RESULTS Replies from 18 units were received in which a total of 837 operations are performed per year. Forty-five percent of pelvic and acetabular units do not routinely prescribe chemical prophylaxis for post-operative patients and 56% do not prescribe prophylaxis for conservatively managed patients. The policy of the remaining units showed no consistency in duration or agent. Fifty-three percent of units use a database to collect information related to the numbers of patients operated up on. Forty-seven percent have no defined method for collecting DVT and PE numbers. For this reason, reported rates of proximal DVT, non-fatal PE and fatal PE were below that expected at 2.5%, 0.8% and 0.1%, respectively. CONCLUSIONS Despite high rates of thrombo-embolic complications in patients with pelvic and acetabular injuries there is no UK consensus on prescribing prophylaxis.
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Affiliation(s)
- Enis Guryel
- Department of Trauma and Orthopaedic Surgery, Pelvic and Acetabular Unit, St George's Healthcare NHS Trust, Blackshaw Road, London SW17 0QT, UK.
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Kiguchi M, McDonald KA, Govindarajan S, Makaroun MS, Chaer RA. Pharmacomechanical thrombolysis for renal salvage after filter migration and renal vein thrombosis. J Vasc Surg 2011; 53:1391-3. [DOI: 10.1016/j.jvs.2010.10.126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 10/28/2010] [Accepted: 10/28/2010] [Indexed: 10/18/2022]
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O'Keeffe T, Thekkumel JJ, Friese S, Shafi S, Josephs SC. A Policy of Dedicated Follow-Up Improves the Rate of Removal of Retrievable Inferior Vena Cava Filters in Trauma Patients. Am Surg 2011. [DOI: 10.1177/000313481107700131] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Retrievable Inferior Vena Cava Filters (IVCF) for prophylaxis against pulmonary embolus have been associated with low rates of removal. Strategies for improving the rates of retrieval have not been described. We hypothesized that a policy of dedicated follow-up would achieve a higher rate of filter removal. Trauma and Nontrauma patients who had a retrievable IVCF placed during 2006 were identified. A protocol existed for trauma patients with chart stickers, arm bracelets, and dedicated follow-up by nurse practitioners from three trauma teams. No protocol existed for nontrauma patients. Statistical analysis was performed using χ2 analysis or analysis of variance. One hundred sixty-seven retrievable IVCFs were placed over 12 months; 91 in trauma patients and 76 in nontrauma patients. Trauma patients were more likely to have their IVCF removed than nontrauma patients, 55 per cent versus 19 per cent, P < 0.001. There were differences between the three trauma teams, with removal rates of 44 per cent, 42 per cent, and 86 per cent respectively ( P < 0.05). On multivariate analysis young age and trauma patient status were independent predictors of filter removal. A policy of dedicated follow-up of patients with IVCFs can achieve significantly higher rates of filter removal than have been previously reported. Similar policies should be adopted by all centers placing retrievable IVCFs to maximize retrieval rates.
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Affiliation(s)
- Terence O'Keeffe
- Division of Trauma, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Joby J. Thekkumel
- Division of Trauma, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Susan Friese
- Division of Trauma, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | | | - Shellie C. Josephs
- Department of Radiology, University of Texas Southwestern Medical School, Dallas, Texas
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Bang SM, Jang MJ, Oh D, Kim YK, Kim IH, Yoon SS, Yoon HJ, Kim CS, Park S. Korean guidelines for the prevention of venous thromboembolism. J Korean Med Sci 2010; 25:1553-9. [PMID: 21060742 PMCID: PMC2966990 DOI: 10.3346/jkms.2010.25.11.1553] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 07/05/2010] [Indexed: 11/20/2022] Open
Abstract
This guideline focuses on the primary prevention of venous thromboembolism (VTE) in Korea. The guidelines should be individualized and aim at patients scheduled for major surgery, as well as patients with a history of trauma, high-risk pregnancy, cancer, or other severe medical illnesses. Currently, no nation-wide data on the incidence of VTE exist, and randomized controlled trials aiming at the prevention of VTE in Korea have yielded few results. Therefore, these guidelines were based on the second edition of the Japanese Guidelines for the Prevention of VTE and the eighth edition of the American College of Chest Physicians (ACCP) Evidenced-Based Clinical Practice Guidelines. These guidelines establish low-, moderate-, and high-risk groups, and recommend appropriate thromboprophylaxis for each group.
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Affiliation(s)
- Soo-Mee Bang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Moon Ju Jang
- Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea
| | - Doyeun Oh
- Department of Internal Medicine, School of Medicine, CHA University, Seongnam, Korea
| | - Yeo-Kyeoung Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - In Ho Kim
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Hwi-Joong Yoon
- Department of Hematology-Oncology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Chul-Soo Kim
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Seonyang Park
- Department of Internal Medicine, Seoul National University, Seoul, Korea
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Tiwari A, Saw C, Li M, Mohan I, Daly T, Swinnen J, Richardson A, So S, Young N, Vicaretti M, Fletcher J. Use of inferior vena cava filters in a tertiary referral centre in Australia. ANZ J Surg 2010; 80:364-7. [PMID: 20557513 DOI: 10.1111/j.1445-2197.2009.05082.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To investigate the use of inferior vena cava (IVC) filters in a tertiary referral centre, looking at indication, types of filters and, with temporary/optional filters, removal rates. METHODS Data was collected from a prospective database of all IVC filters inserted from January 2003 to January 2007. Patients' records and radiological imaging were all reviewed. RESULTS 66 patients (40 males) had IVC filters inserted during the study period. The median age of the male patients was 57.5 (21-79) years, and females 56 (24-81). There were 49 (74.2%) temporary/optional filters and 17 (25.8%) permanent filters. The most common indication for filter was a contraindication to anticoagulation for both permanent (64.7%) and temporary/optional filters (77.6%). In the temporary/optional filter group, 38 of 49 (77.6%) patients had documented venous thromboembolism, while in the permanent filter group, this was 14 of 17 (82.4%). Of the optional filters, 22 of 49 (45.8%) have been removed. CONCLUSION More than half (54.2%) of temporary/optional filters were not removed and with potential for long-term complications. A protocol has now being instituted for vascular surgeons to authorize the insertion of filters and to then be responsible for ensuring their removal.
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Affiliation(s)
- Alok Tiwari
- Department of Vascular Surgery, Westmead Hospital, University of Sydney, Westmead, NSW 2145, Australia
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Gargiulo NJ, O'Connor DJ, Veith FJ, Lipsitz EC, Vemulapalli P, Gibbs K, Suggs WD. Long-Term Outcome of Inferior Vena Cava Filter Placement in Patients Undergoing Gastric Bypass. Ann Vasc Surg 2010; 24:946-9. [DOI: 10.1016/j.avsg.2010.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 03/29/2010] [Accepted: 05/21/2010] [Indexed: 10/19/2022]
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Abstract
BACKGROUND The introduction of removable inferior vena cava filters (IVCF) has created new options for the prevention of pulmonary embolisms in surgical trauma patients. We have observed increasing use in trauma patients. PATIENTS AND METHODS A retrospective analysis was carried out of 49 trauma patients out of 85 who received IVCFs at our level 1 trauma centre in 2008. RESULTS The indications for IVCF placement were multiple trauma in 33 patients, severe head injury in 13 and spinal injury in 3 patients. Of the patients 34 underwent successful removal, 11 (22%) patients had had no retrieval attempt by December 2009 and attempts at removal were unsuccessful in 3 patients. The mean age of the patients was 33.3 years. CONCLUSION In 2008 the vast majority of IVCFs were inserted for prophylaxis in trauma patients. To increase the number of retrieved IVCFs, responsibility for the removal should be clarified in every hospital. The indications, advantages, safety and also the design of IVCFs are still under debate. A randomized controlled trial is needed to determine the appropriate use and indications for this potentially useful device in trauma patients.
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Affiliation(s)
- D Baschera
- Department of Orthopaedic and Trauma Surgery, Royal Perth Hospital, North Block, Level 5, Wellington Street, 6000, Perth, Australien.
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Rajasekhar A, Crowther M. Inferior vena caval filter insertion prior to bariatric surgery: a systematic review of the literature. J Thromb Haemost 2010; 8:1266-70. [PMID: 20345723 DOI: 10.1111/j.1538-7836.2010.03858.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Placement of inferior vena cava filters (IVCFs) is considered in many patients undergoing bariatric surgery. Their placement is driven by a high rate of pulmonary embolism (PE), uncertainty as to the effectiveness of pharmacologic prophylaxis, and a lack of alternate methods to prevent pulmonary embolism. We performed a systematic review of the literature to evaluate the evidence supporting placement of IVCFs in patients undergoing bariatric surgery. Eleven studies were identified; none were randomized trials. Descriptive analysis suggests that IVCFs reduced PE; however, the strength of this observation is tempered by the lack of use of effective forms of prophylaxis and the failure to account for complications of IVCF placement. We conclude, pending the results of controlled studies, that the use of IVCFs cannot be recommended for routine patients undergoing bariatric surgery.
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Affiliation(s)
- A Rajasekhar
- Department of Medicine, University of Florida, Gainesville, FL, USA
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Nazzal M, Chan E, Nazzal M, Abbas J, Erikson G, Sediqe S, Gohara S. Complications Related to Inferior Vena Cava Filters: A Single-Center Experience. Ann Vasc Surg 2010; 24:480-6. [DOI: 10.1016/j.avsg.2009.07.015] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 07/02/2009] [Accepted: 07/27/2009] [Indexed: 11/30/2022]
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Abstract
Acquired thrombotic risk factors include a variety of noninherited clinical conditions that can predispose an individual to an increased risk for venous thromboembolism. For patients in a critical care setting, certain acquired risk factors represent chronic conditions that the patients may have had before the current acute illness (e.g., malignancy, various cardiovascular risk factors, certain medications), whereas others may be directly related to the reason the patient is in an intensive care unit or the patient's management there (e.g., postoperative state, trauma, indwelling vascular access, certain medications). Optimal thromboprophylactic strategies depend on individual patient risk profiles including an assessment of the specific clinical setting. Treatment for patients with acquired thrombotic risk factors includes anticoagulant therapy and, if possible, resolution of the acquired risk factor(s). Heparin-induced thrombocytopenia represents a unique clinical situation in which all sources of heparin must be discontinued and the patient started on an alternative anticoagulant (e.g., a direct thrombin inhibitor) in the acute setting. The duration of anticoagulant therapy would vary depending on the specific clinical setting.
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Giannoudis PV. Editorial - Management of patients with multiple injuries: looking ahead to the future. Injury 2009; 40 Suppl 4:S1-4. [PMID: 19895946 DOI: 10.1016/j.injury.2009.10.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Intramedulläre Stabilisierung beidseitiger Femurfrakturen bei Polytrauma mit primärer Lungenembolie. Chirurg 2009; 80:969-73. [DOI: 10.1007/s00104-009-1753-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Contractor SG, Merkulov A, Bhatti W, Lee M, Gardner K. Penetration of Günther Tulip filter struts through an introducer sheath: case report and safety concerns. J Vasc Interv Radiol 2009; 20:1093-5. [PMID: 19560939 DOI: 10.1016/j.jvir.2009.04.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Revised: 04/23/2009] [Accepted: 04/26/2009] [Indexed: 10/20/2022] Open
Abstract
The authors present a patient who had a Günther-Tulip inferior vena cava filter placed under fluoroscopic guidance. The filter struts were seen to penetrate through the introducer sheath at deployment. This was believed to be secondary to a kink in the sheath at the site of venous entry and was due to the patient's nuchal obesity as well as his inability to turn his head to the opposite side. The introducer sheath was then placed through a long reinforced metal sheath through which the filter was then placed without complication.
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Affiliation(s)
- Sohail G Contractor
- Department of Radiology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, 150 Bergen Street, Newark, NJ 07101, USA.
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Papathanasopoulos A, Nikolaou V, Petsatodis G, Giannoudis PV. Multiple trauma: an ongoing evolution of treatment modalities? Injury 2009; 40:115-9. [PMID: 19128800 DOI: 10.1016/j.injury.2008.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 09/04/2008] [Indexed: 02/02/2023]
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Retrievable inferior vena cava filters in high-risk trauma and surgical patients: factors influencing successful removal. World J Surg 2008; 32:1444-9. [PMID: 18264826 DOI: 10.1007/s00268-007-9462-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND An Inferior vena cava filter (IVCF) provides prophylaxis against pulmonary embolism in patients that cannot be anticoagulated. A removable IVCF (R-IVCF) provides prophylaxis during a high-risk period while potentially eliminating long-term complications associated with a permanent IVCF. Factors influencing success of R-IVCF removal are ill-defined. METHODS The study was a retrospective review of a prospectively maintained patient registry comprising patients who received an R-IVCF (Bard Recovery and G2) at an academic level 1 trauma center. The influence of time in vivo, filter design, and filter head position on computed abdominal tomographic (CAT) scan (touching caval wall vs. free) on removal success was examined. RESULTS Ninety-two patients each received an R-IVCF. Thirty-nine patients underwent removal attempt and 30 R-IVCFs were removed. Time in vivo did not affect removal success (success: 228 +/- 104 days versus unsuccessful: 289 +/- 158 days, p = 0.18). Filter design impacted filter head position (Recovery: 43% touching versus G2: 6% touching, p = 0.023). Position of the filter head influenced removal success (touching: 50% success versus free: 88% success, p = 0.021). CONCLUSIONS Position of the filter head is the key determinant of removal success. Specific device designs may impact filter head position as was the case with the two designs in this analysis. Time in vivo does not affect removal success.
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Prophylactic Inferior Vena Cava Filters: Do They Make a Difference in Trauma Patients? ACTA ACUST UNITED AC 2008; 65:544-8. [DOI: 10.1097/ta.0b013e31817f980f] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Marquess JS, Burke CT, Beecham AH, Dixon RG, Stavas JM, Sag AA, Koch GG, Mauro MA. Factors Associated with Failed Retrieval of the Günther Tulip Inferior Vena Cava Filter. J Vasc Interv Radiol 2008; 19:1321-7. [DOI: 10.1016/j.jvir.2008.06.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Revised: 05/30/2008] [Accepted: 06/03/2008] [Indexed: 11/28/2022] Open
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Place des filtres caves dans le traitement de la maladie thromboembolique veineuse chez les patients cancéreux. ACTA ACUST UNITED AC 2008; 56:229-32. [DOI: 10.1016/j.patbio.2008.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Accepted: 03/05/2008] [Indexed: 11/21/2022]
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Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW. Prevention of Venous Thromboembolism. Chest 2008; 133:381S-453S. [PMID: 18574271 DOI: 10.1378/chest.08-0656] [Citation(s) in RCA: 2871] [Impact Index Per Article: 179.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- William H Geerts
- From Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - Graham F Pineo
- Foothills Hospital, University of Calgary, Calgary, AB, Canada
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Giannoudis PV, Stengel D. Clinical research in trauma and orthopaedic surgery--call for action. Injury 2008; 39:627-30. [PMID: 18508056 DOI: 10.1016/j.injury.2008.01.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Accepted: 01/24/2008] [Indexed: 02/02/2023]
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35
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Current World Literature. Curr Opin Anaesthesiol 2008; 21:85-8. [DOI: 10.1097/aco.0b013e3282f5415f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yunus TE, Tariq N, Callahan RE, Niemeyer DJ, Brown O, Zelenock GB, Shanley CJ. Changes in inferior vena cava filter placement over the past decade at a large community-based academic health center. J Vasc Surg 2008; 47:157-165. [DOI: 10.1016/j.jvs.2007.08.057] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Revised: 08/17/2007] [Accepted: 08/21/2007] [Indexed: 11/15/2022]
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