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Yang Y, Zhan J, Li X, Hua J, Lei H, Chen X. A nomogram to predict the risk of venous thromboembolism in patients with colon cancer in China. Cancer Med 2024; 13:e7231. [PMID: 38698697 PMCID: PMC11066491 DOI: 10.1002/cam4.7231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/22/2024] [Accepted: 04/18/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVE To create a nomogram for predicting the likelihood of venous thromboembolism (VTE) in colon cancer patients from China. METHODS The data of colon cancer patients from Chongqing University Cancer Hospital between 2019 and 2022 were analyzed. Patients were divided into training set and internal validation set by random split-sample method in a split ratio of 7:3. The univariable and multivariable logistic analysis gradually identified the independent risk factors for VTE. A nomogram was created using all the variables that had a significance level of p < 0.05 in the multivariable logistic analysis and those with clinical significance. Calibration curves and clinical decision curve analysis (DCA) were used to assess model's fitting performance and clinical value. Harrell's C-index (concordance statistic) and the area under the receiver operating characteristic curves (AUC) were used to evaluate the predictive effectiveness of models. RESULTS A total of 1996 patients were ultimately included. There were 1398 patients in the training set and 598 patients in the internal validation set. The nomogram included age, chemotherapy, targeted therapy, hypertension, activated partial thromboplastin time, prothrombin time, platelet, absolute lymphocyte count, and D-dimer. The C-index of nomogram and Khorana score were 0.754 (95% CI 0.711-0.798), 0.520 (95% CI 0.477-0.563) in the training cohort and 0.713 (95% CI 0.643-0.784), 0.542 (95% CI 0.473-0.612) in the internal validation cohort. CONCLUSIONS We have established and validated a nomogram to predict the VTE risk of colon cancer patients in China, which encompasses a diverse age range, a significant population size, and various clinical factors. It facilitates the identification of high-risk groups and may enable the implementation of targeted preventive measures.
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Affiliation(s)
- Yuanyuan Yang
- Department of Nuclear MedicineChongqing University Cancer HospitalChongqingChina
| | - Jiayi Zhan
- Department of Traditional Chinese MedicineChongqing University Cancer HospitalChongqingChina
| | - Xiaosheng Li
- Chongqing Cancer Multi‐omics Big Data Application Engineering Research CenterChongqing University Cancer HospitalChongqingChina
| | - Jun Hua
- Department of Nuclear MedicineChongqing University Cancer HospitalChongqingChina
| | - Haike Lei
- Chongqing Cancer Multi‐omics Big Data Application Engineering Research CenterChongqing University Cancer HospitalChongqingChina
| | - Xiaoliang Chen
- Department of Nuclear MedicineChongqing University Cancer HospitalChongqingChina
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Laganà A, Assanto GM, Masucci C, Passucci M, Donzelli L, Serrao A, Baldacci E, Santoro C, Chistolini A. Secondary Prophylaxis of Venous Thromboembolism (VTE) with Low Dose Apixaban or Rivaroxaban: Results from a Patient Population with More than 2 Years of Median Follow-up. Mediterr J Hematol Infect Dis 2024; 16:e2024020. [PMID: 38468835 PMCID: PMC10927198 DOI: 10.4084/mjhid.2024.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/08/2024] [Indexed: 03/13/2024] Open
Abstract
Background Direct oral anticoagulants (DOACs) are widely used for the treatment and secondary prophylaxis of venous thromboembolism (VTE). Nowadays, DOACs represent the gold standard for long-term anticoagulation, with low-intensity DOACs administration becoming increasingly used worldwide in such scenario. Albeit low-intensity apixaban and rivaroxaban are approved for clinical usage as secondary VTE prophylaxis, there are few literature data regarding their efficacy and safety with a long follow-up. Objectives The aim of our study was to evaluate the efficacy and safety of low-dose DOACs for VTE secondary prophylaxis in patients at high risk of VTE recurrence. Methods We retrospectively evaluated patients who required long-term anticoagulant secondary prophylaxis to prevent recurrent VTE, treated with apixaban 2.5 mg BID or rivaroxaban 10 mg daily with a follow-up ≥ 12 months. Results The examined patients were 323. The median low-dose DOAC administration time was 25.40 months (IQR 13.93-45.90). Twelve (3.7%) VTE recurrences were observed; 21 bleeding events were registered (6.5%), including one episode of Major bleeding (MB) (0.3%), 8 Clinically relevant nonmajor bleeding (CRNMB) (2.5%) and 12 minor bleeding (3.7%). No statistically significant difference in the rate of VTE recurrence and/or bleeding events emerged between the rivaroxaban and apixaban groups. Patients included in the study for multiple episodes of VTE presented a significantly higher risk of a new VTE recurrence during low-intensity DOAC. Conclusions Our data suggest that low-dose DOACs may be effective and safe in secondary VTE prophylaxis in patients at high risk of VTE recurrence; however, attention might be needed in their choice in such a scenario for patients who experienced multiple episodes of VTE.
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Affiliation(s)
- Alessandro Laganà
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | | | - Chiara Masucci
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Mauro Passucci
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Livia Donzelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Alessandra Serrao
- Haematology and Stem Cell Transplant Unit, A. O. San Camillo Forlanini (LR), Rome, Italy
| | - Erminia Baldacci
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Cristina Santoro
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Antonio Chistolini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
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Lonnberg F, Roos A, Farm M, Heurlin A, Okas M, Gigante B, Siddiqui AJ. Causes of death after first time venous thromboembolism. Thromb J 2024; 22:16. [PMID: 38303070 PMCID: PMC10832181 DOI: 10.1186/s12959-024-00586-8] [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: 10/18/2023] [Accepted: 01/23/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Causes of death after first time community-acquired venous thromboembolism (VTE) diagnosed in unselected patients at the emergency department (ED) was investigated. MATERIALS AND METHODS The study consists of all patients > 18 years of age who had a visit for any medical reason to any of 5 different ED in Stockholm County, Sweden from 1st January 2016 to 31st December 2017. We have identified all patients with a first registered incident VTE; deep vein thrombosis (DVT) and/or pulmonary embolism (PE) during the study period. Cox regression models were used to estimate hazards ratios (HR) with 95% confidence intervals (CIs) for all-cause mortality and cause-specific death in patients with DVT or PE using all other patients as the reference group. RESULTS In total, 359,884 patients had an ED visit during the study period of whom about 2.1% were diagnosed with VTE (DVT = 4,384, PE = 3,212). The patients with VTE were older compared to the control group. During a mean follow up of 2.1 years, 1567 (21%) and 23,741(6.7%) patients died within the VTE and reference group, respectively. The adjusted risk of all-cause mortality was nearly double in patients with DVT (HR 1.7; 95% CI, 1.5-1.8) and more than 3-fold in patients with PE (HR 3.4; 95% CI, 3.1-3.6). While the risk of cancer related death was nearly 3-fold in patient with DVT (HR 2.7; 95% CI, 2.4-3.1), and 5-fold in PE (HR 5.4; 95% CI, 4.9-6.0 respectively). The diagnosis of PE during the ED visit was associated with a significantly higher risk of cardiovascular death (HR 2.2; 95% CI, 1.9-2.6). CONCLUSION Patients with VTE have an elevated risk of all-cause mortality, including cardiovascular death.
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Affiliation(s)
- Frida Lonnberg
- Department of Medicine, Karolinska Institute, Solna, Sweden
- Acute and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Roos
- Department of Medicine, Karolinska Institute, Solna, Sweden
- Acute and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Farm
- Karolinska University, Solna, Sweden
- Karolinska University Hospital, Solna, Sweden
| | - André Heurlin
- Acute Medicine, Capio. St. Görans Hospital, Stockholm, Sweden
| | - Mantas Okas
- Acute Medicine, Capio. St. Görans Hospital, Stockholm, Sweden
| | - Bruna Gigante
- Department of Medicine, Karolinska Institute, Solna, Sweden
- Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
| | - Anwar J Siddiqui
- Department of Medicine, Karolinska Institute, Solna, Sweden.
- Acute and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden.
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Tischler EH, Tsai SHL, Wolfert AJ, von Keudell A, Roudnitsky V, Gross J, Suneja N. Is There a Role for Anti-factor Xa Activity Assay in Venous Thromboembolism Prophylaxis Management Among Orthopaedic Trauma Patients? Systematic Review and Meta-analysis. J Orthop Trauma 2023; 37:e368-e376. [PMID: 37053117 DOI: 10.1097/bot.0000000000002611] [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] [Accepted: 04/06/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To determine the effect of anti-factor Xa assay dosing of low-molecular-weight heparin (LMWH) on rates of venous thromboembolism (VTE), deep vein thrombosis (DVT), pulmonary embolism (PE), bleeding, and mortality among orthopaedic trauma patients. DATA SOURCES PubMed/MEDLINE, Embase, Ovid, Cochrane Central Register of Controlled Trials (CENTRAL), clinicaltrials.gov , and Scopus were systematically searched from inception of the database to 2021. STUDY SELECTION Prospective, retrospective, and randomized controlled trial studies were included if they compared rates of VTE, DVT, PE, bleeding, and/or mortality between orthopaedic trauma patients receiving anti-factor Xa-based LMWH dosing and those receiving standard dosing. DATA EXTRACTION Two independent reviewers screened titles and abstracts for eligibility. Study characteristics including study design, inclusion criteria, and intervention were extracted. DATA SYNTHESIS Meta-analysis was performed using pooled proportion of events (effect size) with 95% confidence intervals. A random-effects model was used. Heterogeneity was quantified by Higgins I 2 . Heterogeneity and variability between subgroups indicated differences in the pooled estimate represented by a P -value. RESULTS Six hundred eighty-five studies were identified, and 10 studies including 2870 patients were included. In total, 30.3% and 69.7% received an adjusted and nonadjusted dose of LMWH, respectively. The rate of VTE and DVT were significantly lower in the anti-factor Xa-adjusted cohort, whereas there was no statistically significant difference in rates of PE, bleeding, or mortality between the cohorts. CONCLUSIONS This systematic review and meta-analysis demonstrates that anti-factor Xa activity assay dosing of LMWH among orthopaedic trauma patients leads to a reduction in overall DVT rates, although not PE rates, without an increased risk of bleeding events. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Eric H Tischler
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Sung Huang Laurent Tsai
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Adam J Wolfert
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Arvind von Keudell
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Valery Roudnitsky
- Department of General Surgery, The State University of New York Downstate Health Sciences University, Brooklyn, NY; and
| | - Jonathan Gross
- Department of Orthopaedic Surgery, Staten Island University Hospital, Northwell Health Staten Island, Staten Island, NY
| | - Nishant Suneja
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, NY
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA
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Ni X, Su H, Lv Y, Li R, Liu L, Zhu Y, Yang Z, Hu C. Modifiable pathways for longevity: A Mendelian randomization analysis. Clin Nutr 2023; 42:1041-1047. [PMID: 37172463 DOI: 10.1016/j.clnu.2023.04.026] [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: 03/28/2022] [Revised: 03/28/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND A variety of factors, including diet and lifestyle, obesity, physiology, metabolism, hormone levels, psychology, and inflammation, have been associated with longevity. The specific influences of these factors, however, are poorly understood. Here, possible causal relationships between putative modifiable risk factors and longevity are investigated. METHODS A random effects model was used to investigate the association between 25 putative risk factors and longevity. The study population comprised 11,262 long-lived subjects (≥90 years old, including 3484 individuals ≥99 years old) and 25,483 controls (≤60 years old), all of European ancestry. The data were obtained from the UK Biobank database. Genetic variations were used as instruments in two-sample Mendelian randomization to reduce bias. The odds ratios for genetically predicted SD unit increases were calculated for each putative risk factor. Egger regression was used to determine possible violations of the Mendelian randomization model. RESULTS Thirteen potential risk factors showed significant associations with longevity (≥90th) after correction for multiple testing. These included smoking initiation (OR:1.606; CI: 1.112-2.319) and educational attainment (OR:2.538, CI: 1.685-3.823) in the diet and lifestyle category, systolic and diastolic blood pressure (OR per SD increase: 0.518; CI: 0.438-0.614 for SBP and 0.620; CI 0.514-0.748 for DBP) and venous thromboembolism (OR:0.002; CI: 0.000-0.047) in the physiology category, obesity (OR: 0.874; CI: 0.796-0.960), BMI (OR per 1-SD increase: 0.691; CI: 0.628-0.760), and body size at age 10 (OR per 1-SD increase:0.728; CI: 0.595-0.890) in the obesity category, type 2 diabetes (T2D) (OR:0.854; CI: 0.816-0.894), LDL cholesterol (OR per 1-SD increase: 0.743; CI: 0.668-0.826), HDL cholesterol (OR per 1-SD increase: 1.243; CI: 1.112-1.390), total cholesterol (TC) (OR per 1-SD increase: 0.786; CI: 0.702-0.881), and triglycerides (TG) (OR per 1-SD increase: 0.865; CI: 0.749-0.998) in the metabolism category. Both longevity (≥90th) and super-longevity (≥99th), smoking initiation, body size at age 10, BMI, obesity, DBP, SBP, T2D, HDL, LDL, and TC were consistently associated with outcomes. The examination of underlying pathways found that BMI indirectly affected longevity through three pathways, namely, SBP, plasma lipids (HDL/TC/LDL), and T2D (p < 0.05). CONCLUSION BMI was found to significantly affect longevity through SBP, plasma lipid (HDL/TC/LDL), and T2D. Future strategies should focus on modifying BMI to improve health and longevity.
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Affiliation(s)
- Xiaolin Ni
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, 100730, PR China.
| | - Huabin Su
- Jiangbin Hospital, Guangxi Zhuang Autonomous Region, 530021, PR China
| | - Yuan Lv
- Jiangbin Hospital, Guangxi Zhuang Autonomous Region, 530021, PR China
| | - Rongqiao Li
- Jiangbin Hospital, Guangxi Zhuang Autonomous Region, 530021, PR China
| | - Lei Liu
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Yan Zhu
- Center for Health Statistics and Information, National Health Commission of Peoples Republic of China, Beijing 100044, PR China
| | - Ze Yang
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, 100730, PR China
| | - Caiyou Hu
- Jiangbin Hospital, Guangxi Zhuang Autonomous Region, 530021, PR China
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Djulbegovic B, Hozo I, Lizarraga D, Guyatt G. Decomposing clinical practice guidelines panels' deliberation into decision theoretical constructs. J Eval Clin Pract 2023; 29:459-471. [PMID: 36694469 DOI: 10.1111/jep.13809] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/26/2023]
Abstract
UNLABELLED RATIONALE, AIMS AND OBJECTIVES: The development of clinical practice guidelines (CPG) suffers from the lack of an explicit and transparent framework for synthesising the key elements necessary to formulate practice recommendations. We matched deliberations of the American Society of Haematology (ASH) CPG panel for the management of pulmonary embolism (PE) with the corresponding decision-theoretical constructs to assess agreement of the panel recommendations with explicit decision modelling. METHODS Five constructs were identified of which three were used to reformulate the panel's recommendations: (1) standard, expected utility threshold (EUT) decision model; (2) acceptable regret threshold model (ARg) to determine the frequency of tolerable false negative (FN) or false positive (FP) recommendations, and (3) fast-and-frugal tree (FFT) decision trees to formulate the entire strategy for management of PE. We compared four management strategies: withhold testing versus d-dimer → computerized pulmonary angiography (CTPA) ('ASH-Low') versus CTPA→ d-dimer ('ASH-High') versus treat without testing. RESULTS Different models generated different recommendations. For example, according to EUT, testing should be withheld for prior probability PE < 0.13%, a clinically untenable threshold which is up to 15 times (2/0.13) below the ASH guidelines threshold of ruling out PE (at post probability of PE ≤ 2%). Three models only agreed that the 'ASH low' strategy should be used for the range of pretest probabilities of PE between 0.13% and 13.27% and that the 'ASH high' management should be employed in a narrow range of the prior PE probabilities between 90.85% and 93.07%. For all other prior probabilities of PE, choosing one model did not ensure coherence with other models. CONCLUSIONS CPG panels rely on various decision-theoretical strategies to develop its recommendations. Decomposing CPG panels' deliberation can provide insights if the panels' deliberation retains a necessary coherence in developing guidelines. CPG recommendations often do not agree with the EUT decision analysis, widely used in medical decision-making modelling.
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Affiliation(s)
- Benjamin Djulbegovic
- Department of Computational & Quantitative Medicine, Beckman Research Institute, Duarte, California, USA.,Division of Health Analytics, Duarte, California, USA.,Evidence-based Medicine & Comparative Effectiveness Research, Duarte, California, USA
| | - Iztok Hozo
- Department of Mathematics, Indiana University, Gary, Indiana, USA
| | - David Lizarraga
- Department of Computational & Quantitative Medicine, Beckman Research Institute, Duarte, California, USA.,Division of Health Analytics, Duarte, California, USA.,Evidence-based Medicine & Comparative Effectiveness Research, Duarte, California, USA
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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A Comprehensive Review of Risk Factors for Venous Thromboembolism: From Epidemiology to Pathophysiology. Int J Mol Sci 2023; 24:ijms24043169. [PMID: 36834580 PMCID: PMC9964264 DOI: 10.3390/ijms24043169] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/29/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
Venous thromboembolism (VTE) is the third most common cause of death worldwide. The incidence of VTE varies according to different countries, ranging from 1-2 per 1000 person-years in Western Countries, while it is lower in Eastern Countries (<1 per 1000 person-years). Many risk factors have been identified in patients developing VTE, but the relative contribution of each risk factor to thrombotic risk, as well as pathogenetic mechanisms, have not been fully described. Herewith, we provide a comprehensive review of the most common risk factors for VTE, including male sex, diabetes, obesity, smoking, Factor V Leiden, Prothrombin G20210A Gene Mutation, Plasminogen Activator Inhibitor-1, oral contraceptives and hormonal replacement, long-haul flight, residual venous thrombosis, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, trauma and fractures, pregnancy, immobilization, antiphospholipid syndrome, surgery and cancer. Regarding the latter, the incidence of VTE seems highest in pancreatic, liver and non-small cells lung cancer (>70 per 1000 person-years) and lowest in breast, melanoma and prostate cancer (<20 per 1000 person-years). In this comprehensive review, we summarized the prevalence of different risk factors for VTE and the potential molecular mechanisms/pathogenetic mediators leading to VTE.
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Bluvshtein V, Catz A, Mahamid A, Elkayam K, Michaeli D, Front L, Kfir A, Gelernter I, Aidinoff E. Venous thromboembolism and anticoagulation in spinal cord lesion rehabilitation inpatients: A 10-year retrospective study. NeuroRehabilitation 2023; 53:143-153. [PMID: 37424485 PMCID: PMC10473086 DOI: 10.3233/nre-230063] [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: 04/05/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a concern following the onset of spinal cord lesions (SCL). OBJECTIVES To assess the current efficacy and risks of anticoagulation after SCL and consider changes in thromboprophylaxis. METHODS This retrospective cohort study included individuals admitted to inpatient rehabilitation within 3 months of SCL onset. Main outcome measures were the incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), bleeding, thrombocytopenia, or death, which occurred within 1 year of the SCL onset. RESULTS VTE occurred in 37 of the 685 patients included in the study (5.4%, 95% CI 3.7-7.1%, 2.8% PE), and in 16 of 526 patients who received prophylactic anticoagulation at rehabilitation (3%, 95% CI 1.6-4.5%, 1.1% PE, with at least 1 fatality). Of these 526, 1.3% developed clinically significant bleeding and 0.8% thrombocytopenia. Prophylactic anticoagulation, most commonly 40 mg/day, continued until a median period of 6.4 weeks after SCL onset (25% -75% percentiles 5.8-9.7), but in 29.7%, VTE occurred more than 3 months after SCL onset. CONCLUSION The VTE prophylaxis used for the present cohort contributed to a considerable but limited reduction of VTE incidence. The authors recommend conducting a prospective study to assess the efficacy and safety of an updated preventive anticoagulation regimen.
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Affiliation(s)
- Vadim Bluvshtein
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amiram Catz
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ala Mahamid
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Keren Elkayam
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Dianne Michaeli
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Lilach Front
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Adi Kfir
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Ilana Gelernter
- School of Mathematical Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Elena Aidinoff
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Intensive Care for Consciousness Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
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Djulbegovic B, Hozo I. Decision-Making When Diagnostic Testing is Available. Cancer Treat Res 2023; 189:53-65. [PMID: 37789160 DOI: 10.1007/978-3-031-37993-2_4] [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: 10/05/2023]
Abstract
When a decision-maker has the option of diagnostic testing, they face a typical dilemma: (1) do not administer treatment and do not test, (2) test and decide to administer treatment based on the test result, and (3) administer treatment without testing. In this chapter, we will discuss the theory behind threshold modeling when diagnostic testing is available; we will illustrate the approach by presenting a case vignette.
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Affiliation(s)
- Benjamin Djulbegovic
- Hematology Stewardship Program, Division of Hematology/Oncology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Iztok Hozo
- Department of Mathematics, Indiana University Northwest, Gary, IN, USA
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10
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Halvorsen S, Mehilli J, Cassese S, Hall TS, Abdelhamid M, Barbato E, De Hert S, de Laval I, Geisler T, Hinterbuchner L, Ibanez B, Lenarczyk R, Mansmann UR, McGreavy P, Mueller C, Muneretto C, Niessner A, Potpara TS, Ristić A, Sade LE, Schirmer H, Schüpke S, Sillesen H, Skulstad H, Torracca L, Tutarel O, Van Der Meer P, Wojakowski W, Zacharowski K. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J 2022; 43:3826-3924. [PMID: 36017553 DOI: 10.1093/eurheartj/ehac270] [Citation(s) in RCA: 246] [Impact Index Per Article: 123.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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11
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Kondreddy V, Keshava S, Das K, Magisetty J, Rao LVM, Pendurthi UR. The Gab2-MALT1 axis regulates thromboinflammation and deep vein thrombosis. Blood 2022; 140:1549-1564. [PMID: 35895897 PMCID: PMC9523376 DOI: 10.1182/blood.2022016424] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/20/2022] [Indexed: 11/20/2022] Open
Abstract
Deep vein thrombosis (DVT) is the third most common cause of cardiovascular mortality. Several studies suggest that DVT occurs at the intersection of dysregulated inflammation and coagulation upon activation of inflammasome and secretion of interleukin 1β (IL-1β) in restricted venous flow conditions. Our recent studies showed a signaling adapter protein, Gab2 (Grb2-associated binder 2), plays a crucial role in propagating inflammatory signaling triggered by IL-1β and other inflammatory mediators in endothelial cells. The present study shows that Gab2 facilitates the assembly of the CBM (CARMA3 [CARD recruited membrane-associated guanylate kinase protein 3]-BCL-10 [B-cell lymphoma 10]-MALT1 [mucosa-associated lymphoid tissue lymphoma translocation protein 1]) signalosome, which mediates the activation of Rho and NF-κB in endothelial cells. Gene silencing of Gab2 or MALT1, the effector signaling molecule in the CBM signalosome, or pharmacological inhibition of MALT1 with a specific inhibitor, mepazine, significantly reduced IL-1β-induced Rho-dependent exocytosis of P-selectin and von Willebrand factor (VWF) and the subsequent adhesion of neutrophils to endothelial cells. MALT1 inhibition also reduced IL-1β-induced NF-κB-dependent expression of tissue factor and vascular cell adhesion molecule 1. Consistent with the in vitro data, Gab2 deficiency or pharmacological inhibition of MALT1 suppressed the accumulation of monocytes and neutrophils at the injury site and attenuated venous thrombosis induced by the inferior vena cava ligation-induced stenosis or stasis in mice. Overall, our data reveal a previously unrecognized role of the Gab2-MALT1 axis in thromboinflammation. Targeting the Gab2-MALT1 axis with MALT1 inhibitors may become an effective strategy to treat DVT by suppressing thromboinflammation without inducing bleeding complications.
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Affiliation(s)
- Vijay Kondreddy
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX
| | - Shiva Keshava
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX
| | - Kaushik Das
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX
| | - Jhansi Magisetty
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX
| | - L Vijaya Mohan Rao
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX
| | - Usha R Pendurthi
- Department of Cellular and Molecular Biology, The University of Texas Health Science Center at Tyler, Tyler, TX
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12
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Cai YS, Dong HH, Li XY, Ye X, Chen S, Hu B, Li H, Miao JB, Chen QR. Incidence of venous thromboembolism after surgery for adenocarcinoma in situ and the validity of the modified Caprini score: A propensity score-matched study. Front Oncol 2022; 12:976988. [PMID: 36119540 PMCID: PMC9478866 DOI: 10.3389/fonc.2022.976988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/12/2022] [Indexed: 12/05/2022] Open
Abstract
Background Recently, the new World Health Organization (WHO) tumor classification removed adenocarcinoma in situ (AIS) from the diagnosis of lung cancer. However, it remains unclear whether the “malignancy” item should be assessed when the modified Caprini Risk Assessment Model (RAM) is used to assess venous thromboembolism (VTE) risk in AIS. The purpose of our study is to assess differences between AIS and stage IA adenocarcinoma (AD) from a VTE perspective. Methods A retrospective study was performed on AIS and IA adenocarcinoma in our hospital from January 2018 to December 2021, and divided into AIS group and AD group. Propensity score matching (PSM) was used to compare the incidence of VTE and coagulation function, and to analyze whether the RAM is more effective when the “malignancy” item is not evaluated in AIS. Results 491 patients were included after screening, including 104 patients in the AIS group and 387 patients in the AD group. After PSM, 83 patients were matched. The incidence of VTE and D-dimer in the AIS group was significantly lower than that in the AD group (P<0.05).When using the RAM to score AIS, compared with retaining the “malignancy” item, the incidence of VTE in the intermediate-high-risk group was significantly higher after removing the item (7.9% vs. 36.4%, P=0.018), which significantly improved the stratification effect of the model. Conclusions The incidence of postoperative VTE in AIS was significantly lower than that in stage IA adenocarcinoma. The stratification effect was more favorable when the “malignancy” item was not evaluated in AIS using the RAM.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Qi-rui Chen
- *Correspondence: Jin-bai Miao, ; Qi-rui Chen,
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13
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Wang M, Wang W, Jia X, He Q, Zhu S, Kang Y, Zhang R, Ren Y, Li L, Zou K, Zong Z, Sun X. Associations Between Antithrombosis and Ventilator-Associated Events, ICU Stays, and Mortality Among Mechanically Ventilated Patients: A Registry-Based Cohort Study. Front Pharmacol 2022; 13:891178. [PMID: 35924051 PMCID: PMC9339989 DOI: 10.3389/fphar.2022.891178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The effect of thromboembolism prophylaxis on clinical outcomes, such as ventilator-associated events (VAEs), ICU stays, and mortality, remains controversial. This study was conducted to evaluate the effect of pharmacological thromboprophylaxis on VAEs, ICU stays, and ICU mortality among patients receiving mechanical ventilation (MV). Materials and Methods: A retrospective cohort study was conducted based on a well-established registry of healthcare-associated infections at ICUs in the West China Hospital system. Patients who consistently received MV for at least 4 days from 1 April 2015 to 31 December 2018 were included. Hazard ratios (HRs) were compared for three tiers of VAEs, ICU stays, and ICU mortality among patients receiving pharmacological thromboprophylaxis versus those without using the time-dependent Cox model. For the analyses of ICU stays and ICU mortality, we also used Fine-Gray models to disentangle the competing risks and outcomes of interest. Results: Overall, 6,140 patients were included. Of these, 3,805 received at least one prescription of antithrombosis agents. Treatments with antithrombosis agents were associated with lower risk of VAEs (HR: 0.87, 95% CI: 0.77, 0.98) and ICU mortality (HR: 0.72, 95% CI: 0.61, 0.86) than those without. Anticoagulants but not antiplatelet agents were associated with decreased risk of VAEs (HR: 0.86, 95% CI: 0.75, 0.98), ICU mortality (HR: 0.62, 95% CI: 0.51, 0.76), and less time to ICU discharge (HR: 1.15, 95% CI: 1.04, 1.28). Antithrombosis may be associated with decreased risk of VAEs in patients with D-dimer >5 mg/LFEU (HR: 0.84, 95%CI: 0.72, 0.98). Conclusions: Pharmacological thromboprophylaxis was associated with lower risk of VAEs and ICU mortality. Similar effects were observed between unfractionated heparins versus low-molecular-weight heparins.
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Affiliation(s)
- Mingqi Wang
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Wen Wang
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Xue Jia
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Postgraduate, West China Hospital of Sichuan University, Chengdu, China
| | - Qiao He
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Shichao Zhu
- Department of Infection Control, West China Hospital of Sichuan University, Chengdu, China
| | - Yan Kang
- Intensive Care Unit, West China Hospital of Sichuan University, Chengdu, China
| | - Rui Zhang
- Information Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Ren
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Ling Li
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Kang Zou
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Zhiyong Zong
- Department of Infection Control, West China Hospital of Sichuan University, Chengdu, China
- Center of Infection Diseases, West China Hospital of Sichuan University, Chengdu, China
- *Correspondence: Xin Sun, ; Zhiyong Zong,
| | - Xin Sun
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
- *Correspondence: Xin Sun, ; Zhiyong Zong,
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14
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Mansory EM, Abu-Farhaneh M, Iansavitchene A, Lazo-Langner A. Venous and Arterial Thrombosis in Ambulatory and Discharged COVID-19 Patients: A Systematic Review and Meta-analysis. TH OPEN 2022; 6:e276-e282. [PMID: 36299810 PMCID: PMC9484870 DOI: 10.1055/a-1913-4377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/25/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction
Venous and arterial thromboses are frequently observed complications in patients with severe novel coronavirus disease 2019 (COVID-19) infection who require hospital admission. In this study, we evaluate the epidemiology of venous and arterial thrombosis events in ambulatory and postdischarge patients with COVID-19 infection.
Materials and Method
EMBASE and MEDLINE were searched up to July 21, 2021, in addition to other sources. We included studies that assessed the epidemiology of venous and arterial thrombosis events in ambulatory and postdischarge COVID-19 patients.
Results
A total of 16 studies (102,779 patients) were identified. The overall proportion of venous thromboembolic events in all patients, that is, ambulatory and postdischarge, was 0.80% (95% confidence interval [CI]: 0.44–1.28), 0.28% (95% CI: 0.07–0.64), and 1.16% (95% CI: 0.69–1.74), respectively. Arterial events occurred in 0.75% (95% CI: 0.27–1.47) of all patients, 1.45% (95% CI: 1.10–1.86) of postdischarge patients, and 0.23% (95% CI: 0.019–0.66) of ambulatory patients. The pooled incidence rate estimates per 1,000 patient-days for VTE events were 0.06 (95% CI: 0.03–0.08) and 0.12 (95% CI: 0.07–0.19) for outpatients and postdischarge, respectively, whereas for arterial events were 0.10 (95% CI: 0–0.30) and 0.26 (95% CI: 0.16–0.37).
Conclusion
This study found a low risk of venous and arterial thrombi in ambulatory and postdischarge COVID-19 patients, with a higher risk in postdischarge patients compared with ambulatory patients. This suggests that regular universal thromboprophylaxis in these patient populations is probably not necessary.
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Affiliation(s)
- Eman M. Mansory
- Department of Medicine, Division of Hematology, Western University, London, Ontario, Canada
- Department of Hematology, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Alla Iansavitchene
- Health Sciences Library, London Health Sciences Centre, London, Ontario, Canada
| | - Alejandro Lazo-Langner
- Department of Medicine, Division of Hematology, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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15
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Cai Y, Dong H, Li X, Liu Y, Hu B, Li H, Miao J, Chen Q. Development and validation of a nomogram to assess postoperative venous thromboembolism risk in patients with stage IA non-small cell lung cancer. Cancer Med 2022; 12:1217-1227. [PMID: 35758614 PMCID: PMC9883570 DOI: 10.1002/cam4.4982] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a common postoperative complication in patients with lung cancer that seriously affects prognosis and quality of life. At present, the detection rate of patients with early-stage lung cancer is increasing, but there are few studies on the risk factors for postoperative venous thromboembolism (VTE) in patients with stage IA non-small cell lung cancer (NSCLC). This study aimed to establish a nomogram for predicting the probability of postoperative VTE risk in patients with stage IA NSCLC. METHODS The clinical data of 452 patients with stage IA NSCLC from January 2017 to January 2022 in our center were retrospectively analyzed and randomly divided into a training set and a validation set at a ratio of 7:3. Independent risk factors were identified by univariate and multivariate logistic regression analyses, and a nomogram was established based on the results and internally validated. The predictive power of the nomogram was evaluated by receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA). RESULTS The nomogram prediction model included three risk factors: age, preoperative D-dimer, and intermuscular vein dilatation. The areas under the ROC curve of this predictive model were 0.832 (95% CI: 0.732-0.924) and 0.791 (95% CI: 0.668-0.930) in the training and validation sets, respectively, showing good discriminative power. In addition, the probability of postoperative VTE occurrence predicted by the nomogram was consistent with the actual occurrence probability. In the decision curve, the nomogram model had a better net clinical benefit at a threshold probability of 5%-90%. CONCLUSION This study is the first to develop a nomogram for predicting the risk of postoperative VTE in patients with stage IA NSCLC; this nomogram can accurately and intuitively evaluate the probability of VTE in these patients and help clinicians make decisions on prevention and treatment.
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Affiliation(s)
- Yongsheng Cai
- Department of Thoracic SurgeryBeijing Institute of Respiratory Medicine and Beijing Chao‐Yang Hospital, Capital Medical UniversityBeijingChina
| | - Honghong Dong
- Department of Thoracic SurgeryBeijing Institute of Respiratory Medicine and Beijing Chao‐Yang Hospital, Capital Medical UniversityBeijingChina
| | - Xinyang Li
- Department of Thoracic SurgeryBeijing Institute of Respiratory Medicine and Beijing Chao‐Yang Hospital, Capital Medical UniversityBeijingChina
| | - Yi Liu
- Department of Thoracic SurgeryBeijing Institute of Respiratory Medicine and Beijing Chao‐Yang Hospital, Capital Medical UniversityBeijingChina
| | - Bin Hu
- Department of Thoracic SurgeryBeijing Institute of Respiratory Medicine and Beijing Chao‐Yang Hospital, Capital Medical UniversityBeijingChina
| | - Hui Li
- Department of Thoracic SurgeryBeijing Institute of Respiratory Medicine and Beijing Chao‐Yang Hospital, Capital Medical UniversityBeijingChina
| | - Jinbai Miao
- Department of Thoracic SurgeryBeijing Institute of Respiratory Medicine and Beijing Chao‐Yang Hospital, Capital Medical UniversityBeijingChina
| | - Qirui Chen
- Department of Thoracic SurgeryBeijing Institute of Respiratory Medicine and Beijing Chao‐Yang Hospital, Capital Medical UniversityBeijingChina
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16
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Klemen ND, Feingold PL, Hashimoto B. Reply to R.A. Snyder et al. J Clin Oncol 2022; 40:2512-2513. [PMID: 35580286 PMCID: PMC9467674 DOI: 10.1200/jco.22.00320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nicholas D Klemen
- Nicholas D. Klemen, MD, Surgery Branch, National Cancer Institute, Bethesda, MD; Paul L. Feingold, MD, Department of Surgery, Brigham and Women's Hospital, Harvard University, Boston, MA; and Barry Hashimoto, PhD, Division of Social Science, New York University Abu Dhabi, Saadiyat Island, United Arab Emirates
| | - Paul L Feingold
- Nicholas D. Klemen, MD, Surgery Branch, National Cancer Institute, Bethesda, MD; Paul L. Feingold, MD, Department of Surgery, Brigham and Women's Hospital, Harvard University, Boston, MA; and Barry Hashimoto, PhD, Division of Social Science, New York University Abu Dhabi, Saadiyat Island, United Arab Emirates
| | - Barry Hashimoto
- Nicholas D. Klemen, MD, Surgery Branch, National Cancer Institute, Bethesda, MD; Paul L. Feingold, MD, Department of Surgery, Brigham and Women's Hospital, Harvard University, Boston, MA; and Barry Hashimoto, PhD, Division of Social Science, New York University Abu Dhabi, Saadiyat Island, United Arab Emirates
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17
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Zuke WA, Chughtai M, Emara AK, Zhou G, Koroukian SM, Molloy RM, Piuzzi NS. What Are Drivers of Readmission for Readmission-Requiring Venous Thromboembolic Events After Primary Total Hip Arthroplasty? An Analysis of 544,443 Cases. J Arthroplasty 2022; 37:958-965.e3. [PMID: 35065217 DOI: 10.1016/j.arth.2022.01.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a potential postoperative complication after total hip arthroplasty (THA). These events present with a range of severity, and some require readmission. The present study aimed to identify unexplored risk factors for severe VTE that lead to hospital readmission. METHODS The Agency of Healthcare Research and Quality's National Readmissions Database was retrospectively queried for all patients who underwent primary THA (January 2016 to December 2018). Study population included patients who were readmitted for VTE within 90 days after an elective THA. Bivariate and multivariate regression analyses were performed using patient demographics, insurance status, elective nature of the surgery, healthcare institution characteristics, and baseline comorbidities. RESULTS Higher risk of readmission for VTE was evident among elderly (71-80 years vs <40 years: odds ratio [OR] 1.7, 95% confidence interval [CI] 1.3-2.2, P = .0002), male patients (OR 1.2, 95% CI 1.2-1.3). Nonelective THAs were associated with markedly higher odds of readmission for VTE (OR 20.5, 95% CI 18.9-22.2), peripheral vascular disease (OR 1.2, 95% CI 1.1-1.4), lymphoma (OR 1.5, 95% CI 1.1-2.1), metastatic cancer (OR 1.8, 95% CI 1.4-2.2), obesity (OR 1.5, 95% CI 1.4-1.6), and fluid-electrolyte imbalance (OR 1.1, 95% CI 1.0-1.2). Home health care (OR 0.8, 95% CI 0.7-0.8) and discharge to skilled nursing facility (OR 0.7, 95% CI 0.7-0.8) had lower odds of readmission for VTE vs unsupervised home discharge, while insurance type was not a significant driver(P > .05). CONCLUSION One in 135 THA patients is likely to experience a VTE requiring readmission after THA. Male patients, age >70 years, and specific baseline comorbidities increase such risk. Furthermore, discharge to a supervised setting mitigated the risk of VTE requiring readmission compared to unsupervised discharge. As VTE prophylaxis protocols continue to evolve, these patients may require optimized perioperative care pathways to mitigate VTE complications.
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Affiliation(s)
- William A Zuke
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Guangjin Zhou
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | | | - Robert M Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
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18
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Karasavvidis T, Bouris V, Xiang W, Tzavellas G, Charisis N, Palaiodimos L, Kigka V, Bourantas C, Gkiatas I. Prophylaxis for Venous Thromboembolic Events in Elective Total Hip and Total Knee Arthroplasty. Curr Pharm Des 2022; 28:771-777. [PMID: 35440299 DOI: 10.2174/1381612828666220418090928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/09/2022] [Indexed: 11/22/2022]
Abstract
Venous thromboembolism (VTE) is a serious complication after major orthopaedic operations, such as a total hip (THA) and knee (TKA) arthroplasty. Therefore, perioperative VTE prophylaxis is recommended; a multitude of modern options are available, including both pharmacologic (aspirin, unfractionated and lowmolecular-weight heparin, vitamin K antagonists, and novel oral anticoagulants) and/or mechanical interventions (early mobilization, graduated compression stockings, intermittent pneumatic compression devices, and venous foot pumps). However, because of the abundance of these possibilities, it is crucial to understand the benefits and drawbacks of each VTE prophylaxis option to ensure that the optimal treatment plan is developed for each patient. The American College of Chest Physicians (AACP) and the American Academy of Orthopaedic Surgeons (AAOS) have both published individual guidelines on VTE prophylaxis regimens, alongside numerous studies evaluating the efficacy and outcomes of the different prophylaxis modalities. The purpose of this review is to provide a summary of the evidence on VTE prophylaxis after elective total hip and knee arthroplasty based on current guidelines and highlight the major concerns and potential complications.
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Affiliation(s)
| | - Vasileios Bouris
- Department of Vascular Surgery, General Hospital of Athens G. Genimatas, Athens, Greece
| | - William Xiang
- Hospital for Special Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, New York, NY, USA
| | | | - Nektarios Charisis
- Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | | | - Vassiliki Kigka
- School of Medicine, University of Ioannina, Ioannina, Greece
| | | | - Ioannis Gkiatas
- Hospital for Special Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, New York, NY, USA
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19
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Klemen ND, Feingold PL, Hashimoto B. How Strong Is the Evidence Supporting Thromboprophylaxis in Surgical Oncology? J Clin Oncol 2022; 40:320-323. [PMID: 34871037 PMCID: PMC9851687 DOI: 10.1200/jco.21.01934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Nicholas D. Klemen
- Surgery Branch, National Cancer Institute, Bethesda, MD,Nicholas D. Klemen, MD, Surgery Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr, CRC, Building 10, Bethesda, MD 20892; e-mail:
| | - Paul L. Feingold
- Department of Surgery, Brigham and Women's Hospital, Harvard University, Boston, MA
| | - Barry Hashimoto
- Division of Social Science, New York University Abu Dhabi, Saadiyat Island, United Arab Emirates
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20
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Transverse myelitis as a first event of multiple sclerosis precipitated by Pfizer-BioNTech COVID-19 vaccination. NEUROIMMUNOLOGY REPORTS 2022. [PMCID: PMC8813198 DOI: 10.1016/j.nerep.2022.100074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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21
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Crosstalk between Venous Thromboembolism and Periodontal Diseases: A Bioinformatics Analysis. DISEASE MARKERS 2021; 2021:1776567. [PMID: 34925639 PMCID: PMC8683231 DOI: 10.1155/2021/1776567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 12/12/2022]
Abstract
Background This current study applied bioinformatics analysis to reveal the crosstalk between venous thromboembolism (VTE) and periodontitis, as well as the potential role of immune-related genes in this context. Methods Expression data were downloaded from the GEO database. Blood samples from venous thromboembolism (VTE) were used (GSE19151), while for periodontal disease, we used gingival tissue samples (GSE10334, GSE16134, and GSE23586). After batch correction, we used “limma” packages of R language for differential expression analysis (p value < 0.05, ∣logFC | ≥0.5). We used Venn diagrams to extract the differentially expressed genes common to VTE and periodontitis as potential crosstalk genes and applied functional enrichment analysis (GO biological process and KEGG pathway). The protein-protein interaction (PPI) network of crosstalk genes was constructed by Cytoscape software. The immune-related genes were downloaded from the literature. The Wilcoxon test was used to test the scores of immune infiltrating cells. The crosstalk genes were further screened by LASSO Logistic Regression. Results For periodontitis, 427 case and 136 control samples, and for VTE, 70 case and 63 control samples were included. The obtained PPI network had 1879 nodes and 2257 edges. Moreover, 782 immune genes and 28 cell types were included in the analysis. Over 90% of immune cells had different expressions in VTE and periodontitis. We obtained 12 significant pathways corresponding to crosstalk genes. CD3D, CSF3R, and CXCR4 acted as an immune gene and a crosstalk gene. We obtained a total of 12 shared biomarker crosstalk genes. Among those 12 biomarker crosstalk genes, 4 were immune genes (LGALS1, LSP1, SAMSN1, and WIPF1). Conclusion Four biomarker crosstalk genes between periodontitis and VTE were also immune genes, i.e., LGALS1, LSP1, SAMSN1, and WIPF1. The findings of the current study need further validation and are a basis for development of biomarkers.
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22
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Lavikainen LI, Guyatt GH, Lee Y, Couban RJ, Luomaranta AL, Sallinen VJ, Kalliala IEJ, Karanicolas PJ, Cartwright R, Aaltonen RL, Ahopelto K, Aro KM, Beilmann-Lehtonen I, Blanker MH, Cárdenas JL, Craigie S, Galambosi PJ, Garcia-Perdomo HA, Ge FZ, Gomaa HA, Huang L, Izett-Kay ML, Joronen KM, Karjalainen PK, Khamani N, Kilpeläinen TP, Kivelä AJ, Korhonen T, Lampela H, Mattila AK, Najafabadi BT, Nykänen TP, Nystén C, Oksjoki SM, Pandanaboyana S, Pourjamal N, Ratnayake CBB, Raudasoja AR, Singh T, Tähtinen RM, Vernooij RWM, Wang Y, Xiao Y, Yao L, Haukka J, Tikkinen KAO. Systematic reviews of observational studies of Risk of Thrombosis and Bleeding in General and Gynecologic Surgery (ROTBIGGS): introduction and methodology. Syst Rev 2021; 10:264. [PMID: 34625092 PMCID: PMC8499502 DOI: 10.1186/s13643-021-01814-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/12/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) and bleeding are serious and potentially fatal complications of surgical procedures. Pharmacological thromboprophylaxis decreases the risk of VTE but increases the risk of major post-operative bleeding. The decision to use pharmacologic prophylaxis therefore represents a trade-off that critically depends on the incidence of VTE and bleeding in the absence of prophylaxis. These baseline risks vary widely between procedures, but their magnitude is uncertain. Systematic reviews addressing baseline risks are scarce, needed, and require innovations in methodology. Indeed, systematic summaries of these baseline risk estimates exist neither in general nor gynecologic surgery. We will fill this knowledge gap by performing a series of systematic reviews and meta-analyses of the procedure-specific and patient risk factor stratified risk estimates in general and gynecologic surgeries. METHODS We will perform comprehensive literature searches for observational studies in general and gynecologic surgery reporting symptomatic VTE or bleeding estimates. Pairs of methodologically trained reviewers will independently assess the studies for eligibility, evaluate the risk of bias by using an instrument developed for this review, and extract data. We will perform meta-analyses and modeling studies to adjust the reported risk estimates for the use of thromboprophylaxis and length of follow up. We will derive the estimates of risk from the median estimates of studies rated at the lowest risk of bias. The primary outcomes are the risk estimates of symptomatic VTE and major bleeding at 4 weeks post-operatively for each procedure stratified by patient risk factors. We will apply the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate evidence certainty. DISCUSSION This series of systematic reviews, modeling studies, and meta-analyses will inform clinicians and patients regarding the trade-off between VTE prevention and bleeding in general and gynecologic surgeries. Our work advances the standards in systematic reviews of surgical complications, including assessment of risk of bias, criteria for arriving at the best estimates of risk (including modeling of the timing of events and dealing with suboptimal data reporting), dealing with subgroups at higher and lower risk of bias, and use of the GRADE approach. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021234119.
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Affiliation(s)
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Yung Lee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Rachel J Couban
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Anna L Luomaranta
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ville J Sallinen
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilkka E J Kalliala
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Paul J Karanicolas
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Rufus Cartwright
- Department of Obstetrics and Gynaecology, LNWH NHS Trust, London, UK
| | - Riikka L Aaltonen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Kaisa Ahopelto
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Karoliina M Aro
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ines Beilmann-Lehtonen
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marco H Blanker
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jovita L Cárdenas
- National Center for Health Technology Excellence (CENETEC) Direction of Health Technologies assessment, Mexico City, Mexico
| | - Samantha Craigie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Päivi J Galambosi
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Herney A Garcia-Perdomo
- Division of Urology, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia
| | - Fang Zhou Ge
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Huda A Gomaa
- High Institute of Public Health, Alexandria University, Alexandria, Egypt
- Tanta Chest Hospital, Ministry of Health and Population, Tanta, Egypt
| | - Linglong Huang
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Matthew L Izett-Kay
- Urogynaecology Department, The John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Kirsi M Joronen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Päivi K Karjalainen
- Department of Obstetrics and Gynecology, Central Finland Central Hospital, Jyväskylä, Finland
- Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Nadina Khamani
- Department of Obstetrics and Gynecology, Institute of Childrens' Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas P Kilpeläinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti J Kivelä
- Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tapio Korhonen
- Experts by Experience, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Hanna Lampela
- Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anne K Mattila
- Central Finland Central Hospital, Department of Surgery, Jyväskylä, Finland
| | - Borna Tadayon Najafabadi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Carolina Nystén
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Sanjay Pandanaboyana
- Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Negar Pourjamal
- Laboratory of Molecular Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Chathura B B Ratnayake
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Auckland City Hospital, Auckland, New Zealand
| | | | - Tino Singh
- Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Riikka M Tähtinen
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Robin W M Vernooij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yuting Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Yingqi Xiao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- West China School of Nursing/Department of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Yao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Jari Haukka
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Clinicum/Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland.
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23
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Liu Y, Wang M, Dong X, He J, Zhang L, Zhou Y, Xia X, Dou G, Wu CT, Jin J. A phase I, single and continuous dose administration study on the safety, tolerability, and pharmacokinetics of neorudin, a novel recombinant anticoagulant protein, in healthy subjects. Pharmacol Res Perspect 2021; 9:e00785. [PMID: 33957018 PMCID: PMC8101608 DOI: 10.1002/prp2.785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 11/11/2022] Open
Abstract
The aim of this study was to evaluate the tolerability, safety, and pharmacokinetics of single and continuous dose administration of recombinant neorudin (EPR-hirudin, EH) by intravenous administration in healthy subjects, and to provide a safe dosage range for phase II clinical research. Forty-four subjects received EH as a single dose of between 0.2 and 2.0 mg/kg by intravenous bolus and drip infusion. In addition, 18 healthy subjects were randomly divided into three dose groups (0.15, 0.30, and 0.45 mg/kg/h) with 6 subjects in each group for the continuous administration trial. Single or continuous doses of neorudin were generally well tolerated by healthy adult subjects. There were no serious adverse events (SAEs), and all adverse events (AEs) were mild to moderate. Moreover, no subjects withdrew from the trial because of AEs. There were no clinically relevant changes in physical examination results, clinical chemistry, urinalysis, or vital signs. The incidence of adverse events was not significantly related to drug dose or systemic exposure. After single-dose and continuous administration, the serum EH concentration reached its peak at 5 min, and the exposure increased with the increase in the administered dose. The mean half-life (T1/2 ), clearance (Cl), and apparent volume of distribution (Vd) of EH ranged from 1.7 to 2.5 h, 123.9 to 179.7 ml/h/kg, and 402.7 to 615.2 ml/kg, respectively. The demonstrated safety, tolerability, and pharmacokinetic characteristics of EH can be used to guide rational drug dosing and choose therapeutic regimens in subsequent clinical studies. Clinical trial registration: Chinadrugtrials.org identifier: CTR20160444.
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Affiliation(s)
- Yubin Liu
- Beijing Institute of Radiation Medicine, Beijing, China
| | - Meixia Wang
- Phase 1 Clinical Research Center, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Xiaona Dong
- Beijing Institute of Radiation Medicine, Beijing, China
| | - Jia He
- Beijing SH Biotechnology Co., Ltd., Beijing, China
| | - Lin Zhang
- Beijing Institute of Radiation Medicine, Beijing, China
| | - Ying Zhou
- Beijing Institute of Radiation Medicine, Beijing, China
| | - Xia Xia
- Beijing SH Biotechnology Co., Ltd., Beijing, China
| | - Guifang Dou
- Beijing Institute of Radiation Medicine, Beijing, China
| | - Chu-Tse Wu
- Beijing Institute of Radiation Medicine, Beijing, China
| | - Jide Jin
- Beijing Institute of Radiation Medicine, Beijing, China
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24
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Moonla C, Sosothikul D, Chiasakul T, Rojnuckarin P, Uaprasert N. Anticoagulation and In-Hospital Mortality From Coronavirus Disease 2019: A Systematic Review and Meta-Analysis. Clin Appl Thromb Hemost 2021; 27:10760296211008999. [PMID: 33874753 PMCID: PMC8060743 DOI: 10.1177/10760296211008999] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Hypercoagulability in coronavirus disease 2019 (COVID-19) may aggravate disease severity during hospitalization but the reported survival benefits from anticoagulation (AC) vary among studies. We performed a literature research to estimate pooled odds ratios (ORs) of in-hospital mortality and major bleeding comparing among intermediate-to-therapeutic dose AC, prophylactic dose AC, and no AC. Until October 22, 2020, PubMed, EMBASE, and Cochrane Library Database were searched for studies reporting AC utilization and mortality in COVID-19. Studies with suspected risk of bias were excluded before the synthesis of pooled ORs with 95% confidence intervals (CIs) using random-effects models. Of 37 identified studies (N = 19,510), 17 (N = 17,833) were aggregated in the meta-analysis. The overall mortality rate was 23.1% (95% CI 18.7-28.2). The pooled odds of mortality comparing anticoagulated to non-anticoagulated patients were similar, but lower in prophylactic dose AC group (OR 0.83; 95% CI 0.73-0.95). Notably, intermediate-to-therapeutic dose AC increased mortality (OR 1.60; 95% CI 1.11-2.31) and major bleeding compared to prophylactic dose AC (OR 3.33; 95% CI 2.34-4.72). Our findings support the optimal efficacy and safety profiles of prophylactic dose AC in hospitalized COVID-19 patients.
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Affiliation(s)
- Chatphatai Moonla
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Research Unit in Translational Hematology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Darintr Sosothikul
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Clinical Research for Holistic Management in Pediatric Hematology and Oncology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Thita Chiasakul
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Research Unit in Translational Hematology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Ponlapat Rojnuckarin
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Research Unit in Translational Hematology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Noppacharn Uaprasert
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Research Unit in Translational Hematology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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25
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Santana DC, Hadad MJ, Emara A, Klika AK, Barsoum W, Molloy RM, Krebs VE, Bloomfield MR, Piuzzi NS. Perioperative Management of Chronic Antithrombotic Agents in Elective Hip and Knee Arthroplasty. ACTA ACUST UNITED AC 2021; 57:medicina57020188. [PMID: 33672130 PMCID: PMC7927106 DOI: 10.3390/medicina57020188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 11/30/2022]
Abstract
Total hip and knee arthroplasty are common major orthopedic operations being performed on an increasing number of patients. Many patients undergoing total joint arthroplasty (TJA) are on chronic antithrombotic agents due to other medical conditions, such as atrial fibrillation or acute coronary syndrome. Given the risk of bleeding associated with TJAs, as well as the risk of thromboembolic events in the post-operative period, the management of chronic antithrombotic agents perioperatively is critical to achieving successful outcomes in arthroplasty. In this review, we provide a concise overview of society guidelines regarding the perioperative management of chronic antithrombotic agents in the setting of elective TJAs and summarize the recent literature that may inform future guidelines. Ultimately, antithrombotic regimen management should be patient-specific, in consultation with cardiology, internal medicine, hematology, and other physicians who play an essential role in perioperative care.
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Affiliation(s)
- Daniel C. Santana
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA; (D.C.S.); (M.J.H.); (A.E.); (A.K.K.); (R.M.M.); (V.E.K.); (M.R.B.)
| | - Matthew J. Hadad
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA; (D.C.S.); (M.J.H.); (A.E.); (A.K.K.); (R.M.M.); (V.E.K.); (M.R.B.)
| | - Ahmed Emara
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA; (D.C.S.); (M.J.H.); (A.E.); (A.K.K.); (R.M.M.); (V.E.K.); (M.R.B.)
| | - Alison K. Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA; (D.C.S.); (M.J.H.); (A.E.); (A.K.K.); (R.M.M.); (V.E.K.); (M.R.B.)
| | - Wael Barsoum
- Healthcare Outcomes Performance Company (HOPCo), Phoenix, AZ 85023, USA;
| | - Robert M. Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA; (D.C.S.); (M.J.H.); (A.E.); (A.K.K.); (R.M.M.); (V.E.K.); (M.R.B.)
| | - Viktor E. Krebs
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA; (D.C.S.); (M.J.H.); (A.E.); (A.K.K.); (R.M.M.); (V.E.K.); (M.R.B.)
| | - Michael R. Bloomfield
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA; (D.C.S.); (M.J.H.); (A.E.); (A.K.K.); (R.M.M.); (V.E.K.); (M.R.B.)
| | - Nicolas S. Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA; (D.C.S.); (M.J.H.); (A.E.); (A.K.K.); (R.M.M.); (V.E.K.); (M.R.B.)
- Correspondence:
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26
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Eikelboom J. Mortality benefits of thromboprophylaxis. Lancet Haematol 2020; 7:e783. [PMID: 33091348 DOI: 10.1016/s2352-3026(20)30285-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/24/2020] [Indexed: 06/11/2023]
Affiliation(s)
- John Eikelboom
- Department of Medicine, McMaster University, Hamilton, ON L9K 1H8, Canada.
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27
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Klemen ND, Feingold PL, Hashimoto B, Gross CP, Pei KY. Mortality benefits of thromboprophylaxis - Authors' reply. LANCET HAEMATOLOGY 2020; 7:e783-e784. [PMID: 33091349 DOI: 10.1016/s2352-3026(20)30322-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Nicholas D Klemen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Paul L Feingold
- Department of Surgery, Brigham and Women's Hospital, Harvard University, Boston MA, USA
| | - Barry Hashimoto
- Division of Social Science, New York University Abu Dhabi, Saadiyat Island, United Arab Emirates
| | - Cary P Gross
- Department of Internal Medicine and Yale COPPER Center, Yale University School of Medicine, New Haven, CT, USA
| | - Kevin Y Pei
- Department of Surgery, Indiana University School of Medicine, Fort Wayne, IN, USA
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28
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Schulman S. Is venous thromboembolism a preventable cause of death? LANCET HAEMATOLOGY 2020; 7:e555-e556. [PMID: 32735828 DOI: 10.1016/s2352-3026(20)30219-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Sam Schulman
- Thrombosis and Atherosclerosis Research Institute, and Department of Medicine, McMaster University, Hamilton, ON L8L 2X2, Canada; Department of Obstetrics and Gynaecology, The First I M Sechenov Moscow State Medical University, Russia.
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29
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Landi A, De Servi S. The burden of thrombotic complications in critically ill patients with COVID-19: charting the uncharted. Intern Emerg Med 2020; 15:893-895. [PMID: 32504198 PMCID: PMC7274268 DOI: 10.1007/s11739-020-02393-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/29/2020] [Indexed: 11/02/2022]
Affiliation(s)
- Antonio Landi
- Cardiology Unit, Cardiovascular Department, IRCCS MultiMedica, Milan, Italy.
| | - Stefano De Servi
- Cardiovascular Department, University of Pavia Medical School, Pavia, Italy
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