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Zhou X, Zhang L, Cai J, Mei A, Pan Y, Wang M, Guo C, Sun J, Shi R. Application Areas of Intermittent Pneumatic Compression in the Prevention of Deep Vein Thrombosis During Dixon Surgery: A Randomized, Controlled Trial. Clin Ther 2023; 45:977-982. [PMID: 37626001 DOI: 10.1016/j.clinthera.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/22/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023]
Abstract
PURPOSE Deep vein thrombosis (DVT) is common in the lithotomy position after laparoscopic surgery. Intermittent pneumatic compression (IPC) plays an important role in DVT prevention. However, few studies have compared the different compression areas of IPC application. It was hypothesized that the location of the compression sleeves could have an impact on the effects of thromboprophylaxis. METHODS In this randomized, controlled trial performed from August 2020 to March 2021, 164 patients scheduled to undergo laparoscopic Dixon surgery were randomly assigned to one of four groups, based on the bilateral placement of compression sleeves during surgery: feet, calves, thighs, or control (no IPC). Both lower extremities were monitored for DVT on days 1 and 7 after surgery, using ultrasonographic assessment of mean blood velocity, blood flow volume, and diameter of the common femoral veins. Thrombosis-related hematologic analysis was performed. FINDINGS On day 1 after surgery, IPC of the feet or calves was associated with a reduced prevalence of DVT compared with controls (both: P = 0.024; OR = 0.09; 95% CI, 0.01-0.72), while IPC of the thighs had no significant benefit (P = 0.781; OR = 0.86; 95% CI, 0.29-2.55). The prevalence of DVT in the left extremity was lower with IPC of the feet and calves compared with controls (both, P = 0.048). The mean blood velocity in the common femoral vein was significantly increased after surgery with IPC of the left and right feet (P = 0.006 and 0.007, respectively) and calves (P = 0.011 and P = 0.026, respectively) compared with controls. Similarly, the volume of blood flow in the left common femoral vein was greater with IPC of the feet and calves (P = 0.03 and 0.027, respectively). However, on day 7 after surgery, the between-group differences in the prevalences of DVT and hematologic indicators of thrombosis were not significant. IMPLICATIONS On day 1 after surgery, IPC application at the feet or calves facilitated venous return and, hence, reduced the prevalence of DVT, especially in the left extremities. However, there were no significant differences in the prevalences of DVT or thrombosis-related hematologic indicators among the four groups on the day 7 after surgery. Chinese Clinical Trial Registration identifier: ChiCTR2000035325.
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Affiliation(s)
- Xiaotian Zhou
- Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Wenzhou
| | - Liqing Zhang
- Operative Room Nursing, First Affiliated Hospital, Wenzhou Medical University, Wenzhou
| | - Jinxia Cai
- Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Wenzhou
| | - Aishuang Mei
- Operative Room Nursing, First Affiliated Hospital, Wenzhou Medical University, Wenzhou
| | - Yifei Pan
- Department of Colorectal Surgery, First Affiliated Hospital, Wenzhou Medical University, Wenzhou
| | - Mingshan Wang
- Clinical Laboratory, First Affiliated Hospital, Wenzhou Medical University, Wenzhou
| | - Chengnan Guo
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Jiehao Sun
- Department of Anesthesiology, First Affiliated Hospital, Wenzhou Medical University, Wenzhou.
| | - Ruolin Shi
- Operative Room Nursing, First Affiliated Hospital, Wenzhou Medical University, Wenzhou.
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Dhanesha N, Ansari J, Pandey N, Kaur H, Virk C, Stokes KY. Poststroke venous thromboembolism and neutrophil activation: an illustrated review. Res Pract Thromb Haemost 2023; 7:100170. [PMID: 37274177 PMCID: PMC10236222 DOI: 10.1016/j.rpth.2023.100170] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 06/06/2023] Open
Abstract
Patients with acute ischemic stroke are at a high risk of venous thromboembolism (VTE), such as deep vein thrombosis (DVT), estimated to affect approximately 80,000 patients with stroke each year in the United States. The prevalence of symptomatic DVT after acute stroke is approximately 10%. VTE is associated with increased rates of in-hospital death and disability, with higher prevalence of in-hospital complications and increased 1-year mortality in patients with stroke. Current guidelines recommend the use of pharmacologic VTE prophylaxis in patients with acute ischemic stroke. However, thromboprophylaxis prevents only half of expected VTE events and is associated with high risk of bleeding, suggesting the need for targeted alternative treatments to reduce VTE risk in these patients. Neutrophils are among the first cells in blood to respond after ischemic stroke. Importantly, coordinated interactions among neutrophils, platelets, and endothelial cells contribute to the development of DVT. In case of stroke and other related immune disorders, such as antiphospholipid syndrome, neutrophils potentiate thrombus propagation through the formation of neutrophil-platelet aggregates, secreting inflammatory mediators, complement activation, releasing tissue factor, and producing neutrophil extracellular traps. In this illustrated review article, we present epidemiology and management of poststroke VTE, preclinical and clinical evidence of neutrophil hyperactivation in stroke, and mechanisms for neutrophil-mediated VTE in the context of stroke. Given the hyperactivation of circulating neutrophils in patients with stroke, we propose that a better understanding of molecular mechanisms leading to neutrophil activation may result in the development of novel therapeutics to reduce the risk of VTE in this patient population.
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Affiliation(s)
- Nirav Dhanesha
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
| | - Junaid Ansari
- Department of Neurology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
| | - Nilesh Pandey
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
| | - Harpreet Kaur
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
| | - Chiranjiv Virk
- Division of Vascular Surgery and Endovascular Surgery, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
| | - Karen Y Stokes
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
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Systematic Review of Existing Stroke Guidelines: Case for a Change. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5514793. [PMID: 35722461 PMCID: PMC9199531 DOI: 10.1155/2022/5514793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/07/2022] [Indexed: 11/30/2022]
Abstract
Methods We systematically searched for guideline recommendation on the day-to-day use of peripheral inflammatory markers such as NLR published in the English language between January 1, 2005, and October 2020. Any other evidence of system biology-based approach or recommendation was explored within the selected guidelines for this scoping review. Only the latest guideline per writing group was selected. Each guideline was analyzed independently by 2 to 4 authors to determine clinical scenarios explained/given, scientific evidence used, and recommendations presented in the context of system biology. Results The scoping review found 2,911 titles at the beginning of the search. Final review included with 15 guidelines. Stroke-related organizations wrote sixty-five percent of the guidelines while national ministries wrote a fewer number of guidelines. We were primarily interested in recommendations for acute management in AIS published in the English language. Fifteen eligible guidelines were identified from 15 different countries/regions. None of the guidelines recommended the routine use of peripheral markers of inflammation, such as NLR, among their acute assessment and management recommendations. None of the existing guidelines explored the system biology approach to one of the most complex diseases affecting the human brain, stroke. Conclusions This systematic review has identified a significant evidence-practice gap in all existing national stroke guidelines published in English medium as of October 2020. These guidelines included the only current “living stroke guidelines,” stroke guidelines from Australia with a real opportunity to modernize the living stroke guidelines with systems biology approach, and provide 2020 vision towards better stroke care globally. Investigation of complex disease such as stroke is best served through a systems biology approach. One of the easiest places to start is simple blood tests such as total white cell count and NLR. Systems biology approach point us towards simple tools such immune-inflammatory index (SII) and serial systemic immune inflammatory indices (SSIIi) which should pave the way for the stroke physician community address the challenges in systems biology approach in stroke care. These challenges include translating bench research to the bedside, managing big data (continuous pulse, blood pressure, sleep, oxygen saturation, progressive changes in NLR, SII, SSIIi, etc.). Working with an interdisciplinary team also provides a distinct advantage. Recent adoption of historic WHO-IGAP calls for immediate action. The 2022 World Brain Day campaign on Brain Health for All is the perfect opportunity to raise awareness and start the process.
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Diwu W, Hu G, Zhou M, Bi L, Yan M, Wei H, Fan J. Effects of different intensities of intermittent pneumatic soft-tissue compression on bone defect repair. BMC Musculoskelet Disord 2022; 23:403. [PMID: 35490215 PMCID: PMC9055722 DOI: 10.1186/s12891-022-05341-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background To estimate the effects of different intensities of intermittent pneumatic soft-tissue compression on bone defect repair in an animal model. Methods Five mm radial bone defect in length was made in 64 mature New Zealand rabbits and all animals randomly assigned into four groups: Group A (control group without compression), Group B (5–7 kPa intensity), Group C (8–10 kPa intensity) and Group D (11–13 kPa intensity). On the fourth day after surgery, their legs were intermittently pneumatic compressed for 4 weeks. The stimulation lasted 30 min every day and the frequency of compression was 15 Hz. New bone formation in 4 groups was evaluated by gross observation, X-ray, Micro-CT, and histological staining at 2 and 4 weeks after surgery. Result There was more new bony callus in the bone defect in group C than in other groups by gross observation and X-ray radiography at 2 and 4 weeks. The Micro-CT results showed more new bony callus, bone trabecula and higher bone mineral density in group C. Fluorescent labeling results showed the speed of new bone formation in Group C was faster than that in other groups, among which the control group had the slowest speed of new bone formation. The result of histology had shown that the trabeculae in bone callus in group C had a regular form, the trabeculae were wide and had a more become osteoblast around them. Conclusion The intermittent pneumatic soft-tissue compression can accelerate new bone formation of bone defects and the optimal intensity is 8–10 kPa for repairing the rabbit radial bone defect.
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Affiliation(s)
- Weilong Diwu
- Department of Orthopedics, The First Affiliated Hospital, The Fourth Military Medical University, Xi'an, China
| | - Gang Hu
- Department of Orthopedics, The First Affiliated Hospital, The Fourth Military Medical University, Xi'an, China
| | - Minghao Zhou
- Department of Oral Implants, School of Stomatology, State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, The Fourth Military Medical University, Xi'an, China
| | - Long Bi
- Department of Orthopedics, The First Affiliated Hospital, The Fourth Military Medical University, Xi'an, China
| | - Ming Yan
- Department of Orthopedics, The First Affiliated Hospital, The Fourth Military Medical University, Xi'an, China
| | - Hongbo Wei
- Department of Oral Implants, School of Stomatology, State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases & Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, The Fourth Military Medical University, Xi'an, China.
| | - Junjun Fan
- Department of Orthopedics, The First Affiliated Hospital, The Fourth Military Medical University, Xi'an, China.
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Chiu CC, Lin HF, Lin CH, Chang HT, Hsien HH, Hung KW, Tung SL, Shi HY. Multidisciplinary Care after Acute Care for Stroke: A Prospective Comparison between a Multidisciplinary Post-Acute Care Group and a Standard Group Matched by Propensity Score. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147696. [PMID: 34300144 PMCID: PMC8303420 DOI: 10.3390/ijerph18147696] [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] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/15/2021] [Accepted: 07/18/2021] [Indexed: 02/07/2023]
Abstract
In this large-scale prospective cohort study, a propensity score matching method was applied in a natural experimental design to investigate how post-acute care (PAC) after stroke affects functional status and to identify predictors of functional status. The main objective of this study was to examine longitudinal changes in various measures of functional status in stroke patients and predictors of scores for these measures before and after PAC. A group of patients who had received PAC for stroke at one of two medical centers (PAC group, n = 273) was compared with a group who had received standard care for stroke at one of four hospitals (three regional hospital and one district hospital; non-PAC group, n = 273) in Taiwan from March, 2014, to October, 2018. The patients completed the functional status measures before rehabilitation, the 12th week and the 1st year after rehabilitation. Generalized estimating equations were used to estimate differences-in-differences models for examining the effects of PAC. The average age was 68.0 (SD = 8.1) years, and males accounted for 57.9%. During the follow-up period, significant risk factors for poor functional outcomes were advanced age, hemorrhagic stroke, and poor function scores before rehabilitation (p < 0.05). Between-group comparisons at subsequent time points revealed significantly higher functional status scores in the PAC group versus the non-PAC group (p < 0.001). Notably, for all functional status measures, between-group differences in total scores significantly increased over time from baseline to 1 year post-rehabilitation (p < 0.001). The contribution of this study is its further elucidation of the clinical implications and health policy implications of rehabilitative care after stroke. Specifically, it improves understanding of the effects of PAC in stroke patients at different follow-up times. Therefore, a policy implication of this study is that standard care for stroke should include intensive rehabilitative PAC to maximize recovery of overall function.
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Affiliation(s)
- Chong-Chi Chiu
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
- Department of General Surgery, E-Da Cancer Hospital, Kaohsiung 82445, Taiwan
| | - Hsiu-Fen Lin
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan;
- Department of Neurology, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Ching-Huang Lin
- Division of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan;
| | - Hong-Tai Chang
- Department of Surgery, Kaohsiung Municipal United Hospital, Kaohsiung 80457, Taiwan;
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
| | - Hong-Hsi Hsien
- Department of Internal Medicine, St. Joseph Hospital, Kaohsiung 80288, Taiwan;
| | - Kuo-Wei Hung
- Division of Neurology, Department of Internal Medicine, Yuan’s General Hospital, Kaohsiung 80249, Taiwan;
| | - Sheng-Li Tung
- Department of Medical Research, Chiayi Chang Gung Hospital, Chiayi 61301, Taiwan;
| | - Hon-Yi Shi
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 08708, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- Correspondence: ; Tel.: +886-7-3211101 (ext. 2648); Fax: +886-7-3137487
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Huang Y, Guo C, Song K, Li C, Ding N. Association of clinical and laboratory variables with in-hospital incidence of deep vein thrombosis in patients after acute ischemic stroke: A retrospective study. Medicine (Baltimore) 2021; 100:e24601. [PMID: 33578563 PMCID: PMC7886450 DOI: 10.1097/md.0000000000024601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/12/2021] [Indexed: 01/05/2023] Open
Abstract
Deep vein thrombosis (DVT) is a serious complication in patients with acute ischemic stroke (AIS). Early prediction of DVT could enable physicians to perform a proper prevention strategy. We analyzed the association of clinical and laboratory variables with DVT to evaluate the risk of DVT in patients after AIS.AIS patients admitted to the Changsha Central Hospital between January 2017 and December 2019 with length of stay in hospital ≥7 days were included. Clinical and laboratory variables for DVT at baseline were collected, and the diagnosis of DVT was confirmed by ultrasonography. Independent factors were developed by Multivariate logistic regression analysis.A total of 101 patients were included in the study. The in-hospital incidence of DVT after AIS was 19.8%(20/101). The average level of D-dimer when DVT detected was significant increased around 4-fold than that on admission (P < .001). Pulmonary infection (odds ratio [OR] = 5.4, 95%CI:1.10-26.65, P = .037)) and increased muscle tone (OR = 0.11, 95%CI:0.02-0.58, P = .010) as independent relevant factors for DVT were confirmed.Pulmonary infection as a risk factor and increased muscle tone as a protective factor for DVT were identified in patients after AIS. The level of D-dimer which increased around 4-fold compared to the initial level could be an indicator for DVT occurrence.
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Yogendrakumar V, Lun R, Khan F, Salottolo K, Lacut K, Graham C, Dennis M, Hutton B, Wells PS, Fergusson D, Dowlatshahi D. Venous thromboembolism prevention in intracerebral hemorrhage: A systematic review and network meta-analysis. PLoS One 2020; 15:e0234957. [PMID: 32579570 PMCID: PMC7314010 DOI: 10.1371/journal.pone.0234957] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/02/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION To summarize and compare the effectiveness of pharmacological thromboprophylaxis to pneumatic compression devices (PCD) for the prevention of venous thromboembolism in patients with acute intracerebral hemorrhage. METHODS MEDLINE, PUBMED, EMBASE, and CENTRAL were systematically searched to identify randomized and non-randomized studies that compared each intervention directly to each other or against a common control (hydration, anti-platelet agents, stockings) in adults with acute spontaneous intracerebral hemorrhage. Two investigators independently screened the studies, extracted data, and appraised risk of bias. Studies with a high risk of bias were excluded from our final analysis. The primary outcome was the occurrence of venous thromboembolism (proximal deep vein thrombosis or pulmonary embolism) in the first 30 days. RESULTS 8,739 articles were screened; four articles, all randomized control trials, met eligibility criteria. Bayesian network meta-analysis was performed to calculate risk estimates using both fixed and random effects analyses. 607 patients were included in the network analysis. PCD were associated with a significant decrease in venous thromboembolism compared to control (OR: 0.43, 95% Credible Limits [CrI]: 0.23-0.80). We did not find evidence of statistically significant differences between pharmacological thromboprophylaxis and control (OR: 0.93, 95% CrI: 0.19-4.37) or between PCD and pharmacological thromboprophylaxis (OR: 0.47, 95% CrI: 0.09-2.54). CONCLUSION PCDs are superior to control interventions, but meaningful comparisons with pharmacotherapy are not possible due to a lack of data. This requires further exploration via large pragmatic clinical trials. TRIAL REGISTRATION PROSPERO: CRD42018090960.
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Affiliation(s)
- Vignan Yogendrakumar
- Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Ronda Lun
- Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Faizan Khan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kristin Salottolo
- Trauma Research Department, St. Anthony Hospital, Lakewood, Colorado, United States of America
| | - Karine Lacut
- EA3878, Université de Bretagne Occidentale, Brest, France
| | - Catriona Graham
- Wellcome Trust Clinical Research Facility, Western General Hospital, Edinburgh, Scotland, United Kingdom
| | - Martin Dennis
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Philip S. Wells
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Dar Dowlatshahi
- Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, Canada
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