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Wang L, Ma X, He H, Su L, Guo Y, Shan G, Wang Y, Zhou X, Liu D, Long Y. Association Between Different DVT Prevention Methods and Outcomes of Septic Shock Caused by Intestinal Perforation in China: A Cross-Sectional Study. Front Med (Lausanne) 2022; 9:878075. [PMID: 35572994 PMCID: PMC9092133 DOI: 10.3389/fmed.2022.878075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Septic shock, largely caused by intestinal perforation, is the most common critical illness in intensive care unit (ICU). As an important quality control strategy in ICU, deep vein thrombosis (DVT) prevention is routinely used in the treatment of septic shock. Nevertheless, the effects of DVT prevention on septic shock are not fully revealed. This study was thus designed to investigate the effects of DVT prevention on septic shock caused by intestinal perforation in China. Methods A total of 463 hospitals were enrolled in a survey, led by the China National Critical Care Quality Control Center (China NCCQC) from January 1, 2018 to December 31, 2018. The association between DVT prevention, including pharmacological prophylaxis and mechanical prophylaxis, and outcomes, such as prognosis, complications, hospital stays, and hospitalization costs, was determined in the present study. Main Results Notably, the increased rates of DVT prevention were not associated with the onset of complications in patients with septic shock caused by intestinal perforation (p > 0.05). In addition, even though increased DVT prevention did not affect hospital stays, it significantly decreased the discharge rates without doctor's order in patients with septic shock caused by intestinal perforation (p < 0.05). Nevertheless, it should be noted that the rates of pharmacological prophylaxis but not mechanical prophylaxis were significantly associated with the costs of septic shock caused by intestinal perforation (p < 0.05). Although increased total rates of DVT prevention and the rates of mechanical prophylaxis did not reduce the mortality in patients with septic shock caused by intestinal perforation, the higher frequent intervention using pharmacological prophylaxis indicated the lower mortality of these patients (p < 0.05). Conclusions DVT prevention by any means is a safe therapeutic strategy for treating septic shock caused by intestinal perforation, and pharmacological prophylaxis reduced the mortality of patients with septic shock caused by intestinal perforation.
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Affiliation(s)
- Lu Wang
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xudong Ma
- Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, China
| | - Huaiwu He
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Longxiang Su
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yanhong Guo
- Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, China
| | - Guangliang Shan
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences (CAMS), School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Ye Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences (CAMS), School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Xiang Zhou
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Dawei Liu
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yun Long
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Sih C, Mbatchou-Ngahane BH, Mboue-Djieka Y, Ngueng-Eke MC, Mbarga NT, Verla VS, Choukem SP. Incidence and impact of hospital-acquired complications in an internal medicine unit of a reference hospital in Cameroon: a prospective cohort study. Trans R Soc Trop Med Hyg 2021; 115:772-778. [PMID: 33210110 DOI: 10.1093/trstmh/traa116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/22/2020] [Accepted: 10/27/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hospital-acquired complications (HACs) contribute to increased morbidity, mortality and hospital costs. However, their burden is often overlooked in resource-limited settings. We sought to determine the incidence, risk factors and effects of HACs on direct medical costs. METHODS This was a prospective cohort study conducted in the Internal Medicine inpatient ward of Douala General Hospital over 3 mo. Patients were examined daily from admission to discharge, transfer or death. Incidence of HACs was calculated and risk factors of HACs were determined using univariate and multivariate regression models. RESULTS The cumulative incidence rate of HACs in 230 participants was 29.2/1000 patient-days. The incidence rate of infectious and non-infectious complications was 8.4/1000 and 20.9/1000 patient-days, respectively. The most common HAC was constipation (8.3/1000 patient-days). The most common infection was urinary tract infection (3.7/1000 patient-days). HIV infection and length of stay >8 d were significantly associated with the occurrence of HACs. Deep vein thrombosis was associated with the highest direct medical cost. CONCLUSION The incidence of HACs is high in our setting and leads to increased length of hospital stays as well as greater direct medical costs. Thus, there is a need for effective preventive strategies.
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Affiliation(s)
- Colette Sih
- Department of Internal Medicine, Faculty of Health Sciences, University of Buea, Cameroon.,Health and Human Development (2HD) Research Network, Douala, Cameroon
| | - Bertrand Hugo Mbatchou-Ngahane
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon.,Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | | | - Marie C Ngueng-Eke
- Department of Internal Medicine, Faculty of Health Sciences, University of Buea, Cameroon.,Health and Human Development (2HD) Research Network, Douala, Cameroon
| | - Nicole T Mbarga
- Health and Human Development (2HD) Research Network, Douala, Cameroon
| | - Vincent S Verla
- Department of Internal Medicine, Faculty of Health Sciences, University of Buea, Cameroon
| | - Simeon-Pierre Choukem
- Department of Internal Medicine, Faculty of Health Sciences, University of Buea, Cameroon.,Health and Human Development (2HD) Research Network, Douala, Cameroon.,Department of Internal Medicine, Douala General Hospital, Douala, Cameroon.,Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
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Tan TC, Goh CMY, Tan SSX, Tan LK, Yang Y, Lee LH. Epidemiology of pregnancy-associated pulmonary embolism in South Asian multi-ethnic country: Mortality trends over the last four decades. J Obstet Gynaecol Res 2020; 47:174-183. [PMID: 32840028 DOI: 10.1111/jog.14450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 07/14/2020] [Accepted: 08/08/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the cumulative incidence, time of occurrence and risk factors of pregnancy-associated pulmonary embolism (PE) in Singapore, and to review the maternal mortality ratio of PE over the last four decades. STUDY DESIGN AND SETTING In this retrospective epidemiology review, women with pregnancy-associated PE were identified via International Classification of Diseases codes and included if they had been objectively diagnosed on imaging with PE during pregnancy or within 6 weeks postpartum from 2004 to 2016 at KK Women's and Children's Hospital (KKH) and Singapore General Hospital (SGH) in Singapore. The medical records were reviewed and the time of occurrence of confirmed PE cases and risk factors for PE were noted. RESULTS There were 18 PE cases out of 174 708 deliveries, of which two were fatal, giving a cumulative incidence of PE at 1.03 per 10 000 deliveries and a mortality rate of 11.1%. The maternal mortality ratio is 1.14 per 100 000 deliveries, the lowest compared to that of the previous three decades (2.5-4.9 per 100 000 deliveries). Majority of PE (66.7%) occurred during the first 2 weeks postpartum. Cumulative incidence of postpartum PE was four times more in caesarean section compared to vaginal delivery at 1.58 per 10 000 deliveries and 0.40 per 10 000 deliveries, respectively. CONCLUSION Although the cumulative incidence of pregnancy-associated PE in Singapore is low, it is comparable to the United Kingdom (UK) and United States (US). Risk assessment and thromboprophylaxis have decreased PE mortality significantly during this period.
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Affiliation(s)
- Thiam Chye Tan
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | | | | | - Lay Kok Tan
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | - Yong Yang
- Department of Epidemiology, Singapore General Hospital, Singapore
| | - Lai Heng Lee
- Department of Haematology, Singapore General Hospital, Singapore
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Yang L, Wu J. Cost-effectiveness of rivaroxaban compared with enoxaparin plus warfarin for the treatment of hospitalised acute deep vein thrombosis in China. BMJ Open 2020; 10:e038433. [PMID: 32737096 PMCID: PMC7394175 DOI: 10.1136/bmjopen-2020-038433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Limited economic evaluation data for rivaroxaban compared with standard of care (SoC) exists in China. The objective of this analysis was to evaluate the cost-effectiveness of rivaroxaban compared with current SoC (enoxaparin overlapped with warfarin) for the treatment of acute deep vein thrombosis (DVT) in China. METHODS A Markov model was adapted from a payer's perspective to evaluate the costs and quality-adjusted life years (QALYs) of patients with DVT treated with rivaroxaban or enoxaparin/warfarin. Clinical data from the EINSTEIN-DVT trial were obtained to estimate the transition probabilities. Data on Chinese health resource use, unit costs and utility parameters were collected from previously published literature and used to estimate the total costs and QALYs. The time horizon was set at 5 years and a 3-month cycle length was used in the model. A 5% discount rate was applied to the projected costs. One-way sensitivity analyses and probabilistic sensitivity analyses were undertaken to assess the impact of uncertainty on results. RESULTS Rivaroxaban therapy resulted in an increase of 0.008 QALYs and was associated with lower total costs compared with enoxaparin/warfarin (US$4744.4 vs US$5572.4, respectively), demonstrating it to be a cost-saving treatment strategy. The results were mainly sensitive to length of hospitalisation due to DVT on enoxaparin/warfarin, cost per day of hospitalisation and the difference in length of stay of rivaroxaban-treated and enoxaparin/warfarin-treated patients. CONCLUSION Rivaroxaban therapy resulted in a cost saving compared with enoxaparin/warfarin for the anticoagulation treatment of patients with hospitalised acute DVT in China. TRIAL REGISTRATION NUMBER NCT00440193; Post-results.
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Affiliation(s)
- Li Yang
- School of Public Health, Peking University, Beijing, China
| | - Jingjing Wu
- Bayer Healthcare Company Ltd, Beijing, China
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Dagadaki O, Birbas K, Mariolis T, Baltopoulos G, Myrianthefs P. Necessity of the Periodical Ultrasound Assessment of the Peripheral Venous System in Intensive Care Unit Patients. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:367-373. [PMID: 30583820 DOI: 10.1016/j.ultrasmedbio.2018.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/27/2018] [Accepted: 10/05/2018] [Indexed: 06/09/2023]
Abstract
The utility of periodic sonographic assessment and monitoring for early diagnosis of deep vein thrombosis (DVT) in patients hospitalized in intensive care units (ICUs) was investigated. Of 314 patients hospitalized in an ICU over a 24-mo period, 248 were examined. The first examination of the patients was carried out within the first 48 h of ICU admission, and weekly examination followed until discharge. Peripheral veins were examined according to the general principles of the ultrasound study using the compression test in B-mode imaging (image to gray scale). The criterion for the absence or presence of a clot within the lumen was the presence or absence of full compressibility of the venous lumen, respectively. Intermittent compression was applied to multiple cross sections along the entire extent of the limbs. Three patients (1.2%) were diagnosed with sub-clinical DVT. The diagnoses were made on the third (sapheno-femoral junction), fourth (right internal jugular) and fifth (left gastrocnemius) weeks of hospitalization, respectively, although patients received full anticoagulation prophylaxis. DVT in a general-population ICU patient on anticoagulation prophylaxis did not seem to occur very frequently, and hence, regular ultrasound monitoring is not recommended. However, it may have value after the third week or in a selected population of ICU patients with very severe and/or multiple predisposing factors or who are not undergoing anticoagulant treatment because of contraindications.
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Affiliation(s)
- Ourania Dagadaki
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Intensive Care Unit at Agioi Anargyroi General Hospital, Nea Kifissia, Greece.
| | - Konstantinos Birbas
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Surgical Department at Agioi Anargyroi General Hospital, Nea Kifissia, Greece
| | - Theodoros Mariolis
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Surgical Department at Agioi Anargyroi General Hospital, Nea Kifissia, Greece
| | - George Baltopoulos
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Intensive Care Unit at Agioi Anargyroi General Hospital, Nea Kifissia, Greece
| | - Pavlos Myrianthefs
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Intensive Care Unit at Agioi Anargyroi General Hospital, Nea Kifissia, Greece
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Wu X, Li Z, Cao J, Jiao J, Wang Y, Liu G, Liu Y, Li F, Song B, Jin J, Liu Y, Wen X, Cheng S, Wan X. The association between major complications of immobility during hospitalization and quality of life among bedridden patients: A 3 month prospective multi-center study. PLoS One 2018; 13:e0205729. [PMID: 30312330 PMCID: PMC6185860 DOI: 10.1371/journal.pone.0205729] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/01/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose To describe the association between major complications of immobility (pressure ulcer, pneumonia, deep vein thrombosis and urinary tract infection) during hospitalization and the patients’ health-related quality of life after discharge. Methods The data were obtained from a multi-center study conducted in 2015. Complications of immobility during hospitalization was measured by case report form and quality of life after discharge was measured using the EQ-5D scale by telephone interview. Multilevel mixed-effects models were used to explore the association of complications and responses in the EQ-5D dimensions after controlling for important covariates. Results Among the 20,515 bedridden patients, 2,601(12.72%) patients experienced at least one of the major complications of immobility during hospitalization, including pressure ulcer (527, 2.57%), deep vein thrombosis (343, 1.67%), pneumonia (1647, 8.16%), and urinary tract infection (265, 1.29%). Patients with any of the four complications during hospitalization reported more problems in all EQ-5D dimensions except for pain/discomfort, and had lower mean EQ-VAS scores than those without any complications. The four complications all showed significant associations with the proportion of reported problems in certain dimensions after adjustment for confounding variables. Conclusions Major complications of immobility were significantly associated with reduced health related quality of life. Prevention of complications is critical to reduce the burden of decreased quality of life for bedridden patients.
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Affiliation(s)
- Xinjuan Wu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- * E-mail:
| | - Zhen Li
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing Cao
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing Jiao
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yingli Wang
- Operation center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ge Liu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ying Liu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fangfang Li
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Baoyun Song
- Department of Nursing, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yilan Liu
- Department of Nursing, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China
| | - Shouzhen Cheng
- Department of Nursing, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xia Wan
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China
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Li NX, Sun JW, Yu LM. Evaluation of the circulating MicroRNA-495 and Stat3 as prognostic and predictive biomarkers for lower extremity deep venous thrombosis. J Cell Biochem 2018; 119:5262-5273. [PMID: 29266445 DOI: 10.1002/jcb.26633] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/19/2017] [Indexed: 01/04/2023]
Abstract
This study aims to elucidate the prognostic and predictive biomarker of miR-495 and Stat3 in peripheral blood in relation to lower extremity deep venous thrombosis (DVT). Patients with lower limb fractures were assigned into case and control groups. Rats were allocated into blank (normal rats), sham (normal rats), DVT, miR-495 mimic, miR-495 inhibitor, over-Stat3, and si-Stat3 groups. ELISA was used to detect levels of prothrombin time (PT), endothelin-1 (ET-1), Human Fibrinogen (FIB), D-Dimer, blood coagulation factors V and VIII, tissue type plasminogen activator (t-PA), platelet activating factor (PAF), protein C and Stat3. qRT-PCR was employed for the evaluation of the expressions of miR-495 and Stat3, while receiver operating characteristic (ROC) curve was constructed to assess the predictive value of miR-495 and Stat3 as well as the treatment outcomes of patients with lower limb fractures. Logistic regression analyses were conducted in order to correlate indexes and lower extremity DVT. miR-495 overexpression, t-PA, PAF, and protein C were confirmed to be protective factors, while Stat3 overexpression, PT, ET-1, FIB, D-Dimer, blood coagulation factor V, and VIII were all ultimately considered to be risk factors of lower extremity DVT. Stat3 was confirmed to be the target gene of miR-495. Compared with the blank group, the length and weight of the thrombus as well as the ratio between length and weight, mRNA and protein expression of Stat3 were reduced in the miR-495 mimic and si-Stat3 groups. Our findings suggest that through the suppression of Stat3 expression, miR-495 prohibits lower extremity DVT in peripheral blood.
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Affiliation(s)
- Nai-Xuan Li
- Department of Interventional Medicine, The Affiliated Hospital of Binzhou Medical University, Binzhou, P.R. China
| | - Jing-Wu Sun
- Department of Vasculocardiology, The Affiliated Hospital of Binzhou Medical University, Binzhou, P.R. China
| | - La-Mei Yu
- Department of Physiology, Binzhou Medical University, Yantai, P.R. China
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Ramakrishnan N, Detect-Dvt Investigators. Prophylaxis and Incidence of Symptomatic Deep Vein Thrombosis in Indian Patients with Sepsis: DETECT-Deep Vein Thrombosis Registry. Indian J Crit Care Med 2017; 21:765-771. [PMID: 29279638 PMCID: PMC5699005 DOI: 10.4103/ijccm.ijccm_205_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To assess thromboprophylaxis rate and incidence of symptomatic deep vein thrombosis (DVT) in Indian patients with acute sepsis. MATERIALS AND METHODS Adult patients with sepsis, within 48 h of sepsis onset/hospital admission were included. DVT was assessed using Doppler ultrasonography if clinical signs were present. Data were collected at inclusion, discharge, and 30 ± 7 days (if discharged before 30 days). RESULTS The study included 278 patients (men: 69.4%; mean age: 56.3 ± 17.99 years). Out of 275 patients (data missing for 3 patients), 188 (68.4%; 95% confidence interval: 62.5-73.8) received DVT prophylaxis (185 at admission and 3 at discharge; pharmacological prophylaxis: n = 88, mechanical prophylaxis: n = 65, pharmacological + mechanical prophylaxis: n = 35) and 87 received no prophylaxis. In line with American College of Chest Physicians 2008 recommendations, among patients who received pharmacological prophylaxis (n = 123), low-molecular-weight heparin was given to 85.4% (n = 105) patients (duration: 9.1 ± 6.36 days), unfractionated heparin to 12.2% (n = 15) patients (duration: 9.2 ± 9.18 days), and fondaparinux to 5.7% (n = 7) patients (duration: 6.8 ± 3.30 days); 27/63 patients at high-risk of bleeding received mechanical prophylaxis; no patient received aspirin. Of 9 patients who developed DVT, 7 received no thromboprophylaxis (data missing for 2 patients). In total, 186/274 (67.9%) patients recovered from sepsis. CONCLUSIONS Two-third patients received thromboprophylaxis. The substantial role of thromboprophylaxis in DVT prevention mandates monitoring and control of thromboprophylaxis through internal audits in hospitals.
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Magetsari R, Dewo P, Nugroho AS, Lanodiyu Z. Deep Vein Thrombosis in Elderly Patients following Surgery for Fracture of the Proximal Femur. Malays Orthop J 2015; 8:7-10. [PMID: 26401228 DOI: 10.5704/moj.1411.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The incidence of Deep Vein Thrombosis (DVT) is high in orthopaedic cases, associated with morbidity and mortality. This study was done to evaluate the incidence of DVT and factors that contributed to DVT in elderly patients with proximal femur fracture who underwent surgery. Patients 60 years of age and older with proximal femur fracture who underwent surgery were enrolled into this study. Daily observation of the clinical signs of DVT was done post operatively until the subjects were discharged from the hospital. D-Dimer test and contrast venography were carried out on Day 2 and between Days 4 and 7 after surgery. Results were interpreted as normal and obstruction. There were 42 eligible patients, 18 of them (42.86 %) were diagnosed with DVT. We found that positive D-Dimer test (1.40), longer duration of surgery (1.86), and presence of clinical symptoms (1.09) increased the risk of the occurence of thrombosis although not statistically significant. There were four DVT patients who passed away within 4 months after surgery due to complication from DVT. The incidence of DVT in elderly with proximal femur fracture underwent surgery was relatively high (42.86 %) with the mortality rate was 22%.
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Affiliation(s)
- R Magetsari
- Department of Orthopaedics and Traumatology, Sardjito General Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - P Dewo
- Department of Orthopaedics and Traumatology, Sardjito General Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - A S Nugroho
- Department of Orthopaedics and Traumatology, Sardjito General Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Z Lanodiyu
- Department of Orthopaedics and Traumatology, Sardjito General Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia
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Lawall H, Oberacker R, Zemmrich C, Bramlage P, Diehm C, Schellong SM. Prevalence of deep vein thrombosis in acutely admitted ambulatory non-surgical intensive care unit patients. BMC Res Notes 2014; 7:431. [PMID: 24996222 PMCID: PMC4105515 DOI: 10.1186/1756-0500-7-431] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 06/20/2014] [Indexed: 11/10/2022] Open
Abstract
Background Data on prevalence rates of venous thromboembolism (VTE) in different patient populations are scarce. Most studies on this topic focus on older patients or patients with malignancies, immobilization or thrombophilia. Less is known about the VTE risk profile of non-surgical patients presenting with a variety of medical diseases of differing severity. Aim of the present study was to investigate VTE prevalence in a pospective cohort study of ambulatory medical intensive care unit patients within 24 h after acute admission. Methods Prospective cohort study of 102 consecutive patients after acute admission to medical intensive care unit. Ultrasound compression sonography, APACHE-II-Scoring and laboratory examination was performed within 24 hours after admission.Possible determinants of a high risk of VTE were examined. In all patients with a confirmed diagnosis of DVT or suspicion of PE thoracic computer tomography (CT) was performed. Results VTE was found in 7.8% out of 102 of patients, mean APACHE-II-Score was 14 (mortality risk of about 15%). Thrombus location was femoropopliteal in 5 patients, iliacal in 2 and peroneal in 1 patient. Five VTE patients had concomitant PE (62.5% of VTE, 4.9% of all patients). No predictors of prevalent VTE were identified from univariable regression analysis although relative risk was high in patients with a history of smoking (RR 3.40), immobility (RR 2.50), and elevated D-Dimer levels (RR 3.49). Conclusions Prevalent VTE and concomitant PE were frequent in acutely admitted ICU patients.
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Affiliation(s)
- Holger Lawall
- Department of Angiology, Asklepios Westklinikum Hamburg, Suurheid 20, 22559 Hamburg, Germany.
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Wang Y, Wang C, Chen Z, Zhang J, Liu Z, Jin B, Ying K, Liu C, Shao Y, Jing Z, Meng IL, Prins MH, Pap AF, Müller K, Lensing AW. Rivaroxaban for the treatment of symptomatic deep-vein thrombosis and pulmonary embolism in Chinese patients: a subgroup analysis of the EINSTEIN DVT and PE studies. Thromb J 2013; 11:25. [PMID: 24341332 PMCID: PMC3896794 DOI: 10.1186/1477-9560-11-25] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 11/08/2013] [Indexed: 11/30/2022] Open
Abstract
Background The worldwide EINSTEIN DVT and EINSTEIN PE studies randomized 8282 patients with acute symptomatic deep-vein thrombosis (DVT) and/or pulmonary embolism (PE) and, for the first time in trials in this setting, included patients in China. This analysis evaluates the results of these studies in this subgroup of patients. Methods A total of 439 Chinese patients who had acute symptomatic DVT (n=211), or PE with or without DVT (n=228), were randomized to receive rivaroxaban (15 mg twice daily for 21 days, followed by 20 mg once daily) or standard therapy of enoxaparin overlapping with and followed by an adjusted-dose vitamin K antagonist, for 3, 6, or 12 months. The primary efficacy outcome was symptomatic recurrent venous thromboembolism. The principal safety outcome was major or non-major clinically relevant bleeding. Results The primary efficacy outcome occurred in seven (3.2%) of the 220 patients in the rivaroxaban group and in seven (3.2%) of the 219 patients in the standard-therapy group (hazard ratio, 1.04; 95% confidence interval 0.36–3.0; p=0.94). The principal safety outcome occurred in 13 (5.9%) patients in the rivaroxaban group and in 20 (9.2%) patients in the standard-therapy group (hazard ratio, 0.63; 95% confidence interval 0.31–1.26; p=0.19). Major bleeding was observed in no patients in the rivaroxaban group and in five (2.3%) patients in the standard-therapy group. In fragile patients (defined as age >75 years, creatinine clearance <50 mL/min, and/or body weight ≤50 kg), the principal safety outcome occurred in four (8.9%) of the 45 patients who received rivaroxaban compared with seven (15.2%) of the 46 patients who received standard therapy. Conclusions In Chinese patients with acute symptomatic DVT and/or PE, rivaroxaban was as efficacious as enoxaparin followed by vitamin K antagonist therapy, with a similar safety profile. The relative efficacy and safety of rivaroxaban compared with enoxaparin/vitamin K antagonist were consistent with that found in the rest of the world. Trial registration number EINSTEIN PE, ClinicalTrials.gov
NCT00439777; EINSTEIN DVT, ClinicalTrials.gov
NCT00440193
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