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Park H, Kang H, Huang P, Lo‐Ciganic W, DeRemer CE, Wilson D, Dietrich EA. Comparative effectiveness and safety of extended anticoagulant therapy among Medicare beneficiaries with venous thromboembolism. Clin Transl Sci 2022; 16:128-139. [PMID: 36200137 PMCID: PMC9841301 DOI: 10.1111/cts.13433] [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: 06/06/2022] [Revised: 09/16/2022] [Accepted: 09/28/2022] [Indexed: 02/06/2023] Open
Abstract
Guidelines recommend an extended course of anticoagulation therapy for patients who experienced venous thromboembolism (VTE) without transient provocation, however, optimal duration remains uncertain. We assessed effectiveness and safety of extended use of apixaban and warfarin greater than 6 months of initial treatment in patients with VTE. We conducted a retrospective cohort study of Medicare beneficiaries aged greater than or equal to 18 years with deep vein thrombosis or pulmonary embolism. Patients were required to have initiated anticoagulants within 30 days of their first VTE diagnosis, completed 6 months of initial anticoagulant treatment, and received extended phase treatment with apixaban (the apixaban group) or warfarin (the warfarin group) or no extended therapy. Multivariable Cox proportional hazards modeling with inverse probability treatment weighting was used to compare recurrent VTE, mortality, and major bleeding risks among the three groups. Mean extended-treatment duration was up to 10 months and 14 months in apixaban and warfarin groups, respectively. Compared with no extended treatment, apixaban use was associated with decreased risks of recurrent VTE (hazard ratio [HR] = 0.08, [95% confidence interval [CI]: 0.01-0.41]) and mortality (HR = 0.37, [95% CI: 0.27-0.51]) without increased major bleeding risk (HR = 1.29, [95% CI: 0.68-2.45]); warfarin use was associated not with recurrent VTE risk change but with increased major bleeding risk (HR = 2.14, [95% CI: 1.26-3.65]) and decreased mortality risk (HR = 0.39, [95% CI: 0.29-0.51]). Compared with warfarin, apixaban use was associated with decreased recurrent VTE (HR = 0.13, [95% CI: 0.03-0.63]) and major bleeding (HR = 0.56, [95% CI: 0.32-0.98]) risks. Subgroup and sensitivity analyses (e.g., intention-to-treat) findings remained consistent. Compared with warfarin or no extended therapy, extended-apixaban use was associated with reduced risk of recurrent VTE without increased major bleeding risk. Continuing anticoagulant therapy with apixaban greater than 6 months may be effective and safe.
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Affiliation(s)
- Haesuk Park
- Department of Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of FloridaGainesvilleFloridaUSA,Center for Drug Evaluation and SafetyUniversity of FloridaGainesvilleFloridaUSA
| | - Hye‐Rim Kang
- Department of Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Pei‐Lin Huang
- Department of Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Wei‐Hsuan Lo‐Ciganic
- Department of Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of FloridaGainesvilleFloridaUSA,Center for Drug Evaluation and SafetyUniversity of FloridaGainesvilleFloridaUSA
| | - Christina E. DeRemer
- Department of Pharmacotherapy and Translational Research, College of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Debbie Wilson
- Department of Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Eric A. Dietrich
- Department of Pharmacotherapy and Translational Research, College of PharmacyUniversity of FloridaGainesvilleFloridaUSA
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Chou MY, Cheng CY, Long SJ, Yang KW, Hsu Y. Ileocolic Thrombophlebitis and Lymphadenitis Mimicking Acute Appendicitis as a Late Manifestation in a COVID-19 Patient: A Case Report. Cureus 2022; 14:e29019. [PMID: 36249632 PMCID: PMC9550207 DOI: 10.7759/cureus.29019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2022] [Indexed: 11/09/2022] Open
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Incidental pulmonary emboli are associated with a very high probability of progressive malignant disease on staging CT scans. Jpn J Radiol 2022; 40:914-918. [PMID: 35460065 DOI: 10.1007/s11604-022-01280-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/05/2022] [Indexed: 12/17/2022]
Abstract
PURPOSE The link between malignancy and venous thromboembolism (VTE) is well established; the risk has been shown to be higher in certain tumour types and in patients receiving platinum-based chemotherapy regimens. 'Active' cancer is often quoted as being a particular risk factor for VTE, but the definition varies widely and the supporting evidence is weak. This study was conceived to establish whether incidental pulmonary emboli are associated with an increased likelihood of progressive disease on a staging computed tomography (CT) scan. MATERIALS AND METHODS All CT scans containing incidental PEs over the course of a year in a large specialist cancer hospital were examined (n = 306). An age-matched control group was assembled. Multivariate logistic regression analysis was performed to establish the relationship of several independent variables, including progressive disease, with the dependent variable of the presence or absence of incidental pulmonary emboli. RESULTS Progressive disease was present in 144 of 306 (47.1%) of the patients in the PE group but only 63 of 306 (20.6%) of the control group patients. Progressive disease on the staging CT scan was found to have an odds ratio for incidental PE of 3.46, with a 95% CI of 2.38-5.01. Receiving platinum-based chemotherapy resulted in an odds ratio of 3.89 (2.41-6.28) for PE. Receiving non-platinum-based systemic anti-cancer therapy (SACT) resulted in an odds ratio for PE of 1.71 (1.16-2.50). CONCLUSION The detection of an incidental PE on a staging CT scan is associated with a very high risk of progressive malignant disease.
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Gazitt T, Pesachov J, Lavi I, Elias M, Haddad A, Feldhamer I, Cohen AD, Saliba W, Zisman D. The association between psoriatic arthritis and venous thromboembolism: a population-based cohort study. Arthritis Res Ther 2022; 24:16. [PMID: 34996505 PMCID: PMC8740055 DOI: 10.1186/s13075-021-02703-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although the risk of cardiovascular disease has been discussed extensively in both psoriasis (PsO) and psoriatic arthritis (PsA), very few studies have addressed the occurrence of venous thromboembolic (VTE) events among PsO patients, and even fewer in PsA. Thus, our goal was to assess the association between PsA and VTE events using a large population-based database. METHODS This retrospective cohort study includes all 5,275 patients with newly diagnosed PsA from the largest health care provider in Israel between January 2003 and December 2018. Identified PsA patients were matched by age, sex, ethnicity, and index date with 21,011 controls without PsA from the same database. Both groups were followed through June 30, 2019 for the occurrence of VTE event. Cox proportional hazard regression models were used to assess the association between PsA and VTE. RESULTS PsA cohort consisted of 53.2% females with mean age of 51.7±15.4 Sixty-two patients (1.2%) were diagnosed with VTE in the PsA group and 176 patients (0.8%) in the control group (p=0.023, HR=1.40, 95% CI 1.05-1.87). However, there was no increased risk of VTE among PsA patients on multivariable analysis (p=0.16, HR=1.27, 95% CI 0.91-1.80). Within the PsA group, patients with VTE were more often of older age and with history of VTE. CONCLUSIONS This study suggests that the increased risk of VTE in PsA patients appears to be related to the underlying comorbidities and not independently associated with PsA. Age and previous history of VTE were the only risk factors associated with increased risk of VTE in patients with PsA. Addressing VTE risk is recommended especially in the era of Janus kinase inhibitors.
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Affiliation(s)
- Tal Gazitt
- Rheumatology Unit, Carmel Medical Center, Michal 7 St, 3436212, Haifa, Israel.
- Department of Medicine, Division of Rheumatology, University of Washington Medical Center, Seattle, Washington, USA.
| | - Jacob Pesachov
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Idit Lavi
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Muna Elias
- Rheumatology Unit, Carmel Medical Center, Michal 7 St, 3436212, Haifa, Israel
| | - Amir Haddad
- Rheumatology Unit, Carmel Medical Center, Michal 7 St, 3436212, Haifa, Israel
| | - Ilan Feldhamer
- Central Headquarters, Clalit Health Services, Tel Aviv, Israel
| | - Arnon Dov Cohen
- Central Headquarters, Clalit Health Services, Tel Aviv, Israel
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Walid Saliba
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Devy Zisman
- Rheumatology Unit, Carmel Medical Center, Michal 7 St, 3436212, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Cramer P, Mensah C, DeSancho M, Malhotra A, Winokur R, Kesselman A. Prevalence of hypercoagulable states in stented thrombotic iliac vein compression syndrome with comparison of re-intervention and anticoagulation regimens. World J Radiol 2021; 13:371-379. [PMID: 35070117 PMCID: PMC8716936 DOI: 10.4329/wjr.v13.i12.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 11/25/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endovascular therapy is playing an increasing role in the treatment of iliofemoral venous disease. Iliac stent patency is multifactorial, and current management is based on best clinical practices, varying by institution.
AIM To evaluate how thrombophilia influences management and outcomes of patients who undergo venous stenting for thrombotic iliac vein compression syndromes.
METHODS A retrospective observational analysis was performed on 65 patients with thrombotic iliac vein compression syndrome that underwent common iliac vein (CIV) stenting between December 2013 and December 2019 at a large academic center. Search criteria included CIV stenting and iliac vein compression. Non-thrombotic lesions and iliocaval thrombosis and/or occlusions were excluded. A total of 65 patients were selected for final analysis. Demographic information, procedural data points, and post-procedural management and outcomes were collected. Statistical analyses included Fisher's exact and Chi-square tests to compare discrete variables and the Wilcoxon rank-sum test to compare continuous variables between thrombophilia positive and negative patients.
RESULTS 65 patients underwent successful balloon angioplasty and CIV stenting. Of these patients, 33 (50.8%) underwent thrombophilia testing, with 16 (48.5%) testing positive. Stent patency on ultrasound did not significantly differ between thrombophilia positive and negative patients at 1 mo (92.3% vs 81.3%, P = 0.6), 6 mo (83.3% vs 80%, P > 0.9), or 12 mo (77.8% vs 76.9%, P = 0.8). Immediately after stent placement, thrombophilia patients were more likely to be placed on dual therapy (aspirin and anticoagulation) or triple therapy (aspirin, clopidogrel, and anticoagulation) (50% vs 41.2%, P > 0.9), and remain on dual therapy at 6 mo (25% vs 12.5%, P = 0.5) and 12 mo (25% vs 6.7%, P = 0.6). There was no significant difference in re-intervention rates (25% vs 35.3%, P = 0.7) or number of re-interventions (average 2.3 vs 1.3 per patient, P = 0.4) between thrombophilia positive and negative patients.
CONCLUSION Half of patients with stented thrombotic iliac vein compression syndrome and thrombophilia testing were positive. The presence of thrombophilia did not significantly impact stent patency or re-intervention rates.
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Affiliation(s)
- Peyton Cramer
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY 10065, United States
| | - Cheryl Mensah
- Department of Medicine, Division of Hematology-Oncology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY 10065, United States
| | - Maria DeSancho
- Department of Medicine, Division of Hematology-Oncology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY 10065, United States
| | - Anuj Malhotra
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY 10065, United States
| | - Ronald Winokur
- Department of Radiology, Division of Interventional Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, United States
| | - Andrew Kesselman
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY 10065, United States
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Pillai A, Kathuria M, Bayona Molano MDP, Sutphin P, Kalva SP. An expert spotlight on inferior vena cava filters. Expert Rev Hematol 2021; 14:593-605. [PMID: 34139952 DOI: 10.1080/17474086.2021.1943350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction: Inferior vena cava (IVC) filters are mechanical filtration devices designed as an alternative to surgical ligation/plication of the IVC. Their use has been controversial, especially with the introduction of retrievable filters and expanded/prophylactic indications.Areas covered: Authors discuss the types of available IVC filters, indications for placement, evidence on their effectiveness in general and specific patient populations, procedural considerations, off-label use, complications, and filter retrieval. This review is based on manuscripts/abstracts published from 1960 to 2021 on venous thromboembolism and IVC filters.Expert opinion: Despite the limited data on their effectiveness and survival benefit, IVC filters continue to play an important role in the treatment of patients with venous thromboembolism (VTE) who cannot receive standard anticoagulation. There is no role of IVC filters in patients without VTE. While retrievable filters are desirable for short-term use, a dedicated team-based approach, and advanced training are required for their successful removal. Newer devices are promising in improving patient safety . The device manufacturers and regulatory agencies should consider specific approaches to track device-related adverse events. Population-based studies are required to establish optimal patient population who would benefit from these devices. .
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Affiliation(s)
- Anil Pillai
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Manoj Kathuria
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Patrick Sutphin
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sanjeeva P Kalva
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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Alidoost M, Conte GA, Gupta V, Patel S, Patel I, Shariff M, Gor S, Levitt MJ, Asif A, Hossain MA. Trends of Ordering Hypercoagulability Work-Up at an Academic Medical Center. J Blood Med 2021; 12:369-376. [PMID: 34093048 PMCID: PMC8169049 DOI: 10.2147/jbm.s271478] [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: 07/17/2020] [Accepted: 12/01/2020] [Indexed: 12/03/2022] Open
Abstract
Background Venous thromboembolism is a significant clinical event, with an annual incidence of 1–2 per 1000 population. Risk factors include recent surgery, prolonged immobility, oral contraceptive use, and active cancer. Inherited risks include protein C and S deficiencies, antithrombin deficiency, factor V Leiden mutation and prothrombin. These factors can be tested to guide therapy, but current evidence suggests that testing for inherited thrombophilia is not recommended in most inpatient settings. In the era of high value care, hypercoagulable testing for VTE creates a financial burden for the hospital and patients. We performed a retrospective chart review of hypercoagulable orders on VTE patients at our institution. Methods Institutional Review Board approval was obtained. A total of 287 adult patients admitted over a 3-month period with the diagnosis of VTE were included. Patients were identified via ICD-10 codes and data were collected from electronic medical records. Patient characteristics, provoked versus unprovoked VTE, and relative contraindications for hypercoagulability work-up were analyzed. Our primary outcome was to assess the appropriateness of thrombophilia testing in VTE patients based on screening guidelines. Our secondary outcome was to analyze the cost burden of ordering these tests. Results A total of 287 patients were included in our data analysis. Patient risk factors for VTE were malignancy, previous DVT, immobilization, surgery 3 months prior, and central line placement. Fifty-seven of 287 patients had at least one hypercoagulable test ordered during hospitalization which did not adhere to guidelines. Misuse of testing occurred during active thrombosis, active anticoagulation, presence of risk factors, first episode of VTE, and malignancy. The cost of ordering these 5 thrombophilia tests totaled over $40,000. Conclusion In our study, numerous patients were tested without compliance to standard recommendations, which created financial and value-based burdens on our health care system. Increased awareness among clinicians is thus warranted to ensure high value care.
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Affiliation(s)
- Marjan Alidoost
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, New Jersey, 07753, USA
| | - Gabriella A Conte
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, New Jersey, 07753, USA
| | - Varsha Gupta
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, New Jersey, 07753, USA
| | - Swapnil Patel
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, New Jersey, 07753, USA
| | - Ishan Patel
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, New Jersey, 07753, USA
| | - Mohammed Shariff
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, New Jersey, 07753, USA
| | - Shreya Gor
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, New Jersey, 07753, USA
| | - Michael J Levitt
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, New Jersey, 07753, USA
| | - Arif Asif
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, New Jersey, 07753, USA
| | - Mohammad A Hossain
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, New Jersey, 07753, USA
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Elenizi K, Alharthi R, Galinier M. Pulmonary embolism originating from germ cell tumor causes severe left ventricular dysfunction in a healthy young adult with full recovery: a case report. BMC Cardiovasc Disord 2021; 21:260. [PMID: 34039259 PMCID: PMC8157733 DOI: 10.1186/s12872-021-02066-7] [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: 01/26/2021] [Accepted: 05/17/2021] [Indexed: 11/28/2022] Open
Abstract
Background Cancer associated thrombosis is recognized. However, pulmonary embolism (PE) from testicular cancer is rarely reported. Right ventricular (RV) function and PE are closely related. The RV cannot cope with a sudden increase in afterload because of PE and this causes dysfunction, but isolated left ventricular dysfunction in this context is not reported in the literature. Case presentation We report an unusual association of pulmonary embolism and testicular germ cell tumor complicating severe left heart failure and full recovery at three months follow up in a 33-year-old patient with no prior medical history. The diagnosis was made after comprehensive history taking and physical examination with the help of different imaging modalities. Full recovery was achieved after optimal medical therapy. Conclusion This case raises our awareness of unusual clinical presentation as we report associated left-sided severe heart failure in cancer-related pulmonary embolism. Pulmonary embolism in healthy young adults warrant in-depth causative exploration.
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Affiliation(s)
- Khaled Elenizi
- Department of Cardiology, CHU-Toulouse, University Hospital of Toulouse, Hôpital Rangueil, 1 Avenue Jean Poulhès, 31059, Toulouse, France. .,Department of Internal Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Alkharj, 11942, Saudi Arabia.
| | - Rasha Alharthi
- Department of Cardiology, CHU-Toulouse, University Hospital of Toulouse, Hôpital Rangueil, 1 Avenue Jean Poulhès, 31059, Toulouse, France
| | - Michel Galinier
- Department of Cardiology, CHU-Toulouse, University Hospital of Toulouse, Hôpital Rangueil, 1 Avenue Jean Poulhès, 31059, Toulouse, France
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Song JC, Yang LK, Zhao W, Zhu F, Wang G, Chen YP, Li WQ. Chinese expert consensus on diagnosis and treatment of trauma-induced hypercoagulopathy. Mil Med Res 2021; 8:25. [PMID: 33840386 PMCID: PMC8040221 DOI: 10.1186/s40779-021-00317-4] [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: 02/03/2021] [Accepted: 03/25/2021] [Indexed: 11/29/2022] Open
Abstract
Trauma-induced coagulopathy (TIC) is caused by post-traumatic tissue injury and manifests as hypercoagulability that leads to thromboembolism or hypocoagulability that leads to uncontrollable massive hemorrhage. Previous studies on TIC have mainly focused on hemorrhagic coagulopathy caused by the hypocoagulable phenotype of TIC, while recent studies have found that trauma-induced hypercoagulopathy can occur in as many as 22.2-85.1% of trauma patients, in whom it can increase the risk of thrombotic events and mortality by 2- to 4-fold. Therefore, the Chinese People's Liberation Army Professional Committee of Critical Care Medicine and the Chinese Society of Thrombosis, Hemostasis and Critical Care, Chinese Medicine Education Association jointly formulated this Chinese Expert Consensus comprising 15 recommendations for the definition, pathophysiological mechanism, assessment, prevention, and treatment of trauma-induced hypercoagulopathy.
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Affiliation(s)
- Jing-Chun Song
- Department of Critical Care Medicine, the 908th Hospital of Joint Logistics Support Forces of Chinese PLA, Nanchang, 330002, China.
| | - Li-Kun Yang
- Department of Neurosurgery, the 904th Hospital of Joint Logistics Support Forces of Chinese PLA, Wuxi, 214044, Jiangsu, China
| | - Wei Zhao
- Division of Vascular and Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Feng Zhu
- Department of Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, 200120, China
| | - Gang Wang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710001, China
| | - Yao-Peng Chen
- Department of Blood Transfusion, the 923th Hospital of Joint Logistics Support Forces of Chinese PLA, Nanning, 530021, China
| | - Wei-Qin Li
- Department of Critical Care Medicine, General Hospital of Eastern Theater Command of Chinese PLA, Nanjing, 210002, China.
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Ganau M, Ligarotti GKI, Meloni M, Chibbaro S. Efficacy and safety profiles of mechanical and pharmacological thromboprophylaxis. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S224. [PMID: 31656803 PMCID: PMC6789350 DOI: 10.21037/atm.2019.08.44] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/08/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals, Oxford, UK
| | | | - Marco Meloni
- Department of Neurosurgery, Milano-Bicocca University, Milan, Italy
| | - Salvatore Chibbaro
- Department of Neurosurgery, University of Strasbourg, Strasbourg, France
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Abstract
INTRODUCTION Fifty-three years after the first description of an inherited prothrombotic condition (antithrombin deficiency), our knowledge on hereditary and acquired causes of hypercoagulability that can predispose carriers to venous thromboembolism (VTE) has greatly improved. Areas covered: Main causes of hereditary thrombophilia are summarized alongside new prothrombotic mutations recently discovered. The main causes of acquired thrombophilia, and namely, antiphospholipid antibody syndrome and hyperhomocysteinemia, are also discussed together with other common acquired prothrombotic states characterized by an increase of procoagulant factors and/or a decrease of natural anticoagulants. Finally, suggestions for thromboprophylaxis in carriers of hereditary thrombophilia according to current guidelines/evidence are made for the most challenging high-risk situations (i.e. surgery, pregnancy, contraception, cancer, economy class syndrome) as well as for the prevention of post-thrombotic syndrome. Expert opinion: A carrier of inherited thrombophilia should be evaluated in the framework of other (genetic and/or acquired) coexisting risk factors for first or recurrent VTE when assessing the need and duration of prevention (primary prophylaxis). Prevention strategies should be tailored to each patient and every situational risk factor. The knowledge of the carriership status of severe thrombophilia in the proband can be important to provide asymptomatic relatives with adequate counseling on thrombophilia screening or primary thromboprophylaxis.
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Affiliation(s)
- Elena Campello
- a Haemorrhagic and Thrombotic Diseases Unit, Department of Medicine (DIMED) , Padova University Hospital , Padova , Italy
| | - Luca Spiezia
- a Haemorrhagic and Thrombotic Diseases Unit, Department of Medicine (DIMED) , Padova University Hospital , Padova , Italy
| | - Angelo Adamo
- a Haemorrhagic and Thrombotic Diseases Unit, Department of Medicine (DIMED) , Padova University Hospital , Padova , Italy
| | - Paolo Simioni
- a Haemorrhagic and Thrombotic Diseases Unit, Department of Medicine (DIMED) , Padova University Hospital , Padova , Italy
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