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Limandal HK, Kayğın MA, Özkaya AL, Özkara T, Diler MS, Çüçen HI, Yıldız Z, Ergün S, Dağ Ö. The role of alpha-1-antitrypsin in the etiopathogenesis of chronic venous disease: A prospective clinical trial. Phlebology 2023; 38:16-21. [PMID: 36413267 DOI: 10.1177/02683555221141818] [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: 11/24/2022]
Abstract
OBJECTIVE The study aimed to examine whether alpha-1-antitrypsin (AAT), an inhibitor of leukocyte esterase(LE), which damages the venous vessel wall, has a protective effect against chronic venous disease(CVD), and to examine the relationship between AAT levels and disease severity. METHODS Patients admitted with varicose vein disease and having reflux flow lasting longer than 0.5 s as determined by Doppler ultrasound were included. The informed consents were taken, and blood samples were obtained for complete blood count, C-reactive protein (CRP) level, and AAT level following anamnesis and physical examination. Clinical Etiologic Anatomic Pathologic (CEAP) classification was used to assess disease severity, and patients were divided into CEAP 1-5 groups accordingly. RESULTS A total of 87 patients were included in the study. There was no statistically significant difference between the groups in body weight, red blood cell counts, platelet counts, or neutrophil counts (p = 0.117, p = 0.932, p = 0.177, and p = 0.177, respectively).CRP and AAT levels were higher in patients with a CEAP clinical score of 5 compared to the other groups (p = 0.018, and p = 0.020, respectively). AAT levels were similar in the CEAP 1-3 group and decreased in the CEAP-4 group but increased again in the CEAP-5 group. The AAT level was 1.62 ± 0.3 g/L in the CEAP-1 group, 1.61 ± 0.21 g/L in the CEAP-2 group, 1.61 ± 0.27 g/L in the CEAP-3 group, 1.48 ± 0.28 g/L in the CEAP-4 group, and 1.94 ± 0.39 g/L in the CEAP-5 group. CRP levels and platelet counts were observed to affect AAT levels (p = 0.10, p = 0.017, respectively). CONCLUSION We believe that our hypothesis that low AAT levels play a role in the etiopathogenesis of CVD has been partially validated, at least in the CEAP-4 group. However, we believe that increased AAT levels in the CEAP-5 group may be a reactive increase in increased LE levels due to higher CRP levels of this group.
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Affiliation(s)
- Hüsnü Kamil Limandal
- Department of Cardiovascular Surgery, 215289Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Mehmet Ali Kayğın
- Department of Cardiovascular Surgery, 215289Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Alev Lazoğlu Özkaya
- Department of Medical Biochemistry, 215289Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Taha Özkara
- Department of Cardiovascular Surgery, 215289Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Mevriye Serpil Diler
- Department of Cardiovascular Surgery, 215289Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Hatice Işıl Çüçen
- Department of Cardiovascular Surgery, 215289Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Ziya Yıldız
- Department of Cardiovascular Surgery, 215289Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Servet Ergün
- Department of Pediatric Cardiovacscular Surgery, 215289Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Özgür Dağ
- Department of Cardiovascular Surgery, 215289Erzurum Regional Education and Research Hospital, Erzurum, Turkey
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Huang J, Liu XY, Wu ZP, Ma YK. Quality of Life Status and Influencing Factors Among Patients with Deep Vein Thrombosis. Patient Prefer Adherence 2022; 16:949-956. [PMID: 35422616 PMCID: PMC9005138 DOI: 10.2147/ppa.s353128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/18/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The objective of the study was to describe the quality of life (QoL) status and investigate the influencing factors of QoL among patients with deep vein thrombosis (DVT). METHODS A retrospective analysis at a single center was performed, and the clinical data of 161 patients with DVT admitted to West China Hospital of Sichuan University from June 2019 to June 2020 were collected with the Villalta scale, Hospital Anxiety and Depression Scale (HADS), and Chronic Venous Insufficiency Questionnaire (CIVIQ). The relationship between QoL and influencing factors, including characteristics, course of DVT, postthrombotic syndrome (PTS), psychological status, and behaviors, was analyzed by Student's t-test, analysis of variance and multiple linear regression. RESULTS A total of 161 patients who completed all the questionnaires between 2019 and 2020 were included, and 110 patients (68%) were male. The mean QoL score acquired by the CIVIQ scale was 74.18±8.44, and the results showed significant differences between patients of different ages, genders, behaviors and psychological statuses (P < 0.05). Multiple regression analysis showed that age (P = 0.024), negative mood (P < 0.001), CCI index (P < 0.001), PTS (P < 0.001) and regular exercise (P = 0.002) influenced the CIVIQ scale evaluation model, in which exercise regularly was a protective factor for QoL, and age, negative mood, CCI index and PTS were risk factors for QoL. CONCLUSION The QoL of DVT patients was impaired and associated with age, mood, CCI index and PTS. Regular exercise is beneficial for improving the quality of life of DVT patients.
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Affiliation(s)
- Jing Huang
- Department of Vascular Surgery, West China Hospital, Sichuan University, West China School of Nursing, Sichuan University, Chengdu, People’s Republic of China
- Department of Orthopedics, Orthopedic Reaserch Institute, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Xiao-yan Liu
- Department of Vascular Surgery, West China Hospital, Sichuan University, West China School of Nursing, Sichuan University, Chengdu, People’s Republic of China
- Department of Orthopedics, Orthopedic Reaserch Institute, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Zhou-peng Wu
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Correspondence: Zhou-peng Wu, Department of Vascular Surgery, West China Hospital, Sichuan University, No. 37 Guoxuexiang Wuhou District, Chengdu, Sichuan, People’s Republic of China, Email
| | - Yu-kui Ma
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
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Sinabulya H, Silveira A, Blomgren L, Roy J. Plasma levels of leucocyte elastase-generated cross linked fibrin degradation products (E-XDP) are elevated in chronic venous disease. PLoS One 2021; 16:e0261073. [PMID: 34905581 PMCID: PMC8670697 DOI: 10.1371/journal.pone.0261073] [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: 05/21/2021] [Accepted: 11/23/2021] [Indexed: 11/19/2022] Open
Abstract
Patients with chronic venous disease (CVD) have elevated levels of leucocyte elastase (LE) released from the activation of leucocytes. In acute deep venous thrombosis (DVT), LE can degrade fibrin from the thrombus resulting in cross-linked fibrin degradation products (E-XDP) being released into the bloodstream. In patients with CVD the levels and significance of circulating E-XDP are unknown. We aimed to investigate the association between plasma E-XDP concentration and severity of CVD. Levels of E-XDP were quantified with a specific enzyme-linked immunosorbent assay (ELISA) in plasma from 142 consecutively recruited CVD patients (mean age 64 years, (range 23–89), 81 were females and 61 males). Patients were also divided into three groups based on CVD severity using the C-class of the Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification, with C 0–1 class as the reference group, C 2–3 as the second group and C 4–6 as the third group with the most severely affected patients. We found significantly elevated levels of E-XDP in patients with C 4–6 compared with patients with C 0–1 (p = 0.007) and increased with increasing disease severity across the groups (p = 0.02). Significant independent association was observed between levels of E-XDP and the classes C 4–6 after adjustment for age and sex (p < 0.05), but the association was no longer significant after further adjustment for use of statins, use of anticoagulants and history of DVT (p = 0.247). This exploratory study shows that E-XDP levels are elevated in patients with CVD, encouraging further studies on the role of E-XDP in CVD.
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Affiliation(s)
- Helen Sinabulya
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Angela Silveira
- Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Lena Blomgren
- Department of Cardiovascular Surgery, Karlskoga Vein Centre, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden
| | - Joy Roy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Asady E, Ghanima W, Jelsness‐Jorgensen L, Klok FA, Kahn SR, Stromme H, Wik HS. Health-related quality-of-life questionnaires for deep vein thrombosis and pulmonary embolism: A systematic review on questionnaire development and methodology. Res Pract Thromb Haemost 2021; 5:e12556. [PMID: 34278190 PMCID: PMC8279125 DOI: 10.1002/rth2.12556] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/19/2021] [Accepted: 05/04/2021] [Indexed: 12/25/2022] Open
Abstract
To improve the quality and accuracy of the patient-reported outcome measures that assess health-related quality of life (HRQoL), guidelines have been developed to standardize the development and validation process. Considering the increasing importance of HRQoL questionnaires in research, we set out to review the literature and evaluate whether existing questionnaires developed for deep vein thrombosis (DVT) and pulmonary embolism (PE) fulfill state-of-the-art requirements. The literature search was conducted in March 2019 and updated in September 2020. Seven databases were searched. No time limit was set for the search to include all available questionnaires. The inclusion criteria were original publications describing the development of disease-specific HRQoL questionnaires specific to DVT or PE in adults and available in English. The questionnaires were assessed to determine whether they fulfill the requirements in the latest guidelines. A total of 3826 references were identified. After the exclusion process, 15 papers were reviewed in full, of which 7 were included. Four questionnaires were developed for chronic venous disease, two were specific to DVT, and one was specific to PE. Most questionnaires we found in this review, fulfilled some but none fulfilled all recommendations in existing guidelines. Because the development of current available HRQoL questionnaires specific to DVT or PE do not fulfil all recommendations of existing guidelines, there is room for improvements within this field. Such improvements could likely enhance the quality associated with the use of these end points in clinical trials and practice.
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Affiliation(s)
- Elia Asady
- Department of ResearchØstfold Hospital TrustGrålumNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Waleed Ghanima
- Department of ResearchØstfold Hospital TrustGrålumNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
- Department of HaematologyOslo University HospitalOsloNorway
| | - Lars‐Petter Jelsness‐Jorgensen
- Department of ResearchØstfold Hospital TrustGrålumNorway
- Department of Health SciencesØstfold University CollegeHaldenNorway
| | - F. A. Klok
- Department of Medicine – Thrombosis and HemostasisLeiden University Medical CenterLeidenThe Netherlands
| | - Susan R. Kahn
- McGill UniversityMontrealQCCanada
- Jewish General HospitalMontrealQCCanada
| | - Hilde Stromme
- Library of Medicine and ScienceUniversity of OsloNorway
| | - Hilde S. Wik
- Department of HaematologyOslo University HospitalOsloNorway
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The Most Severe Stage of Chronic Venous Disease: An Update on the Management of Patients with Venous Leg Ulcers. Adv Ther 2020; 37:19-24. [PMID: 31970660 PMCID: PMC7004438 DOI: 10.1007/s12325-020-01219-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Indexed: 12/14/2022]
Abstract
Venous leg ulcers (VLUs) are the most severe manifestation of chronic venous disease (CVD). Due to their chronic nature, high recurrence rate and slow healing time, VLUs account for 80% of all leg ulcers seen in patients with CVD. VLUs impose a heavy burden on patients that reduces their quality of life; VLUs also represent a major socioeconomic impact due to the cost and duration of care. The primary medical approach to treating VLUs is local compression therapy in combination with venoactive drug (VAD) pharmacotherapy to promote the reduction of the inflammatory reaction initiated by venous hypertension. Micronized purified flavonoid fraction (MPFF; Daflon®) is the most widely prescribed VAD. MPFF counteracts the pathophysiologic mechanisms of CVD and ulceration and has proven to be an effective adjunct to compression therapy in patients with large and chronic VLUs. Two other non-VAD drugs, pentoxifylline and sulodexide, have also been shown to improve VLU healing and are also recommended in addition to compression therapy. However, MPFF is the only VAD with the highest strength of recommendations in the 2018 guidelines for the healing of VLUs.
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Meulendijks A, de Vries F, van Dooren A, Schuurmans M, Neumann H. A systematic review on risk factors in developing a first‐time Venous Leg Ulcer. J Eur Acad Dermatol Venereol 2019; 33:1241-1248. [DOI: 10.1111/jdv.15343] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/16/2018] [Indexed: 11/30/2022]
Affiliation(s)
- A.M. Meulendijks
- Julius Center of Health Care Sciences Nursing Science University Medical Centre Utrecht Utrecht The Netherlands
- Research Centre for Healthy and Sustainable Living University of Applied Sciences Utrecht Utrecht The Netherlands
| | - F.M.C. de Vries
- Research Centre for Healthy and Sustainable Living University of Applied Sciences Utrecht Utrecht The Netherlands
- Raboud University Nijmegen The Netherlands
| | - A.A. van Dooren
- Research Centre for Healthy and Sustainable Living University of Applied Sciences Utrecht Utrecht The Netherlands
| | - M.J. Schuurmans
- Julius Center of Health Care Sciences Nursing Science University Medical Centre Utrecht Utrecht The Netherlands
- Research Centre for Healthy and Sustainable Living University of Applied Sciences Utrecht Utrecht The Netherlands
| | - H.A.M. Neumann
- Department of Dermatology Erasmus Medical Center Rotterdam The Netherlands
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Ghanima W, Wik HS, Tavoly M, Enden T, Jelsness-Jørgensen LP. Late consequences of venous thromboembolism: Measuring quality of life after deep vein thrombosis and pulmonary embolism. Thromb Res 2017; 164:170-176. [PMID: 28760416 DOI: 10.1016/j.thromres.2017.07.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 07/14/2017] [Accepted: 07/21/2017] [Indexed: 01/07/2023]
Abstract
The identification of specific post-thrombotic complications as well as an increased appreciation of the importance of patient-reported outcome measures have triggered an interest in studying health-related quality of life (HRQoL) in patients with a history of venous thromboembolism (VTE). In order to enable a comprehensive assessment of HRQoL in clinical trials it is recommended that both generic and disease-specific questionnaires be used. SF-36 and EQ-5D are the most widely used generic questionnaires in VTE studies, whereas several disease-specific questionnaires have been developed to evaluate HRQoL following deep vein thrombosis (DVT) and in chronic venous disease (CVD). The most widely used of these is the VEINES-QOL/Sym, which was developed for CVD. VT-QOL and DVTQOL are both questionnaires developed to evaluate HRQoL after DVT, while PEmb-QoL is currently the only available disease-specific questionnaire developed specifically for pulmonary embolism (PE). Although studies show inconsistent results, patients who sustain DVT seem in general to report similar HRQoL compared to the general population. However, patients who develop PTS after DVT report poorer HRQoL using both generic and disease-specific questionnaires. HRQoL appears to be impaired in patients who sustain PE compared to the general population. In these patients, persistent dyspnea after PE has been shown to be a predictor of reduced HRQoL. Further work is needed to develop practical, patient-derived, valid, reliable and responsive disease-specific HRQoL instruments covering the specific aspects of these diseases.
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Affiliation(s)
- Waleed Ghanima
- Departments of Medicine, Østfold Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway; Department of Haematology, Oslo University Hospital, Norway.
| | | | - Mazdak Tavoly
- Departments of Medicine, Østfold Hospital, Norway; Department of Medicine, Sahlgrenska University Hospital, Sweden
| | - Tone Enden
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
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