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Yousef B, Abdalla M, Hassan A. Evaluation of Use and Outcomes of Heparins in Acute Deep Venous Thrombosis Treatment at Khartoum State Hospitals: A Descriptive Retrospective Study. MATRIX SCIENCE MEDICA 2021. [DOI: 10.4103/mtsm.mtsm_36_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Strandvik G, El-Menyar A, Asim M, Galwankar S, Al-Thani H. Clinical Characteristics, Management Practices, and In-hospital Outcomes among Trauma Patients with Venous Thromboembolism. J Emerg Trauma Shock 2020; 13:124-130. [PMID: 33013091 PMCID: PMC7472818 DOI: 10.4103/jets.jets_83_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 02/04/2020] [Accepted: 02/24/2020] [Indexed: 11/04/2022] Open
Abstract
Background We aimed to assess the clinical characteristics, management practices, and inhospital outcomes of venous thromboembolism (VTE) among trauma patients. Methods A retrospective analysis of all trauma patients with documented venous thromboembolic events in a level 1 trauma center was conducted. Patients were categorized into two groups based on the primary initial presentation postinjury (deep-vein thrombosis [DVT] or pulmonary embolism [PE]). Results Across the study period, a total of 662 patients were confirmed to have DVT and 258 patients were diagnosed with acute PE. Among them, 84 patients were identified to have trauma-associated VTE; 56 (8.5%) had DVT and 28 (10.9%) had PE. Two patients who initially presented with DVT developed PE on follow-up. There were 38 females and 46 males with a mean age of 46 ± 18 years. Abnormal coagulation profile was reported as 7 protein C deficiencies, 5 protein S deficiencies, 6 homocystinemia, 4 antithrombin III deficiency, 4 lupus anticoagulant, and 2 Factor V Leiden. Age, sex, obesity, D-dimer level, and treatment (except for heparin) were comparable between the two groups; whereas protein S deficiency, prior history of PE, bedridden status, congestive heart failure, and history of recent surgery, were more evident in the PE group. The incidence of postthrombotic syndrome was significantly higher in the DVT group. Overall mortality rate was 8.3% (DVT; 8.9% vs. PE; 7.1%, respectively = 0.78). Conclusion Coagulation profile plays an important role in posttraumatic thromboembolic disease. A thorough assessment for features of thromboembolic disorders is warranted in polytrauma patients to avoid missing this potentially life-threatening diagnosis. Larger studies are needed for better understanding and management of VTE in trauma.
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Affiliation(s)
- Gustav Strandvik
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma and Vascular Surgery Section, Department of Surgery, HGH, Doha, Qatar, Qatar.,Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Mohammad Asim
- Clinical Research, Trauma and Vascular Surgery Section, Department of Surgery, HGH, Doha, Qatar, Qatar
| | - Sagar Galwankar
- Department of Emergency Medicine, Sarasota Memorial Hospital and Florida State University, Sarasota, Florida, USA
| | - Hassan Al-Thani
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
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El-Menyar A, Asim M, Nabir S, Ahmed MN, Al-Thani H. Implications of elevated cardiac troponin in patients presenting with acute pulmonary embolism: an observational study. J Thorac Dis 2019; 11:3302-3314. [PMID: 31559033 DOI: 10.21037/jtd.2019.08.53] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To evaluate the implications of elevated cardiac troponin (cTn) in patients presenting with pulmonary embolism (PE). Methods We conducted a retrospective analysis for patients with PE between 2011 and 2015 with an average of 3 years follow-up. Patients were categorized into two groups based on the cTn status on admission (negative vs. positive) and RV/LV ratio (≤1.2 vs. >1.2). PE diagnosis was made by computed tomography pulmonary angiography (CTPA) examinations. Results Among 220 patients with PE, 52.7% had positive cTn and 31.7% had RV dysfunction. Protein S and C deficiency were significantly higher in patients with negative cTn. Patients with positive cTn were more likely to have high-risk simplified pulmonary embolism severity index (sPESI), RV dilation, RV/LV ratio >1.2, severe inferior vena cava reflux and high Qanadli score (QS >18 points). Thrombolytic therapy was used in 15 patients; 9 (60%) of them had elevated troponin. Combined cTn and sPESI had higher sensitivity, negative predictive value and negative likelihood ratio to predict in-hospital mortality. Overall 30-day and 3 years morality were 10.0% and 22.3%; that were significantly higher in patients with positive troponin. Cox regression analysis showed that mortality increased 2.5 times with positive cTn after adjusting for age, sex, and RV dysfunction (adjusted HR 2.5; 95% CI: 1.25-5.01), P=0.009. Conclusions Elevated cTn is independent predictor of short and long-term mortality. The predictive power of cTn increases when combined with the clinical probability score. Further, larger prospective studies are needed to confirm the findings of the present study.
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Affiliation(s)
- Ayman El-Menyar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.,Vascular Surgeryy, Hamad General Hospital (HGH), Doha, Qatar.,Clinical Research, Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Mohammad Asim
- Clinical Research, Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Syed Nabir
- Department of Radiology, Hamad General Hospital (HGH), Doha, Qatar
| | | | - Hassan Al-Thani
- Vascular Surgeryy, Hamad General Hospital (HGH), Doha, Qatar
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El-Menyar A, Asim M, Al-Thani H. Obesity Paradox in Patients With Deep Venous Thrombosis. Clin Appl Thromb Hemost 2017; 24:986-992. [PMID: 28877605 DOI: 10.1177/1076029617727858] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
We aimed to investigate the association between obesity and deep venous thrombosis (DVT) in a country with a high prevalence of obesity. This is a retrospective cohort study of patients who presented with DVT between 2008 and 2012. Data were analyzed and compared based on body mass index (BMI), and patients were classified into normal (<25), overweight (≥25 to <30), obese I (30 to <35), obese II (35 to <40), and obese III (≥40). Among 662 patients with DVT, 28% were overweight and 49% were obese. The mean age was 50.3 (16.5) years, and 51% were females. Diabetes mellitus and prior venous thromboembolism were significantly higher among obese patients. History of malignancy was more common in nonobese patients. Protein S and antithrombin III deficiency and hyperhomocysteinemia were more prevalent among morbid obese patients. Also, obese patients had higher incidence of thrombosis in the distal veins ( P = .03). Warfarin use and long-term therapy were more frequent in obese than nonobese. Postthrombotic syndrome was comparable in obese and nonobese groups. Recurrent DVT was higher in obese I ( P < .01), whereas mortality rates were greater in nonobese groups ( P = .001). Malignancy, diabetes mellitus, and common femoral vein involvement were predictors of mortality, whereas BMI ≥30 was the predictor of survival. Cox regression models showed that after adjusting for age, sex, pulmonary embolism, and duration of warfarin treatment, BMI ≥40 had better survival (hazard ratio: 0.177, 95% confidence interval: 0.045-0.691, P = .013). There is a significant association between obesity and DVT. Obese patients have characteristic risk factors and better survival. This obesity paradox needs further studies to assess its clinical and pharmacotherapeutic implications.
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Affiliation(s)
- Ayman El-Menyar
- 1 Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.,2 Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Mohammad Asim
- 1 Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- 3 Trauma and vascular Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
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El-Menyar A, Asim M, Jabbour G, Al-Thani H. Clinical implications of the anatomical variation of deep venous thrombosis. Phlebology 2017; 33:97-106. [DOI: 10.1177/0268355516687863] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Little is known about the anatomic variation and its implication in patients with lower limb deep venous thrombosis (DVT). We studied the clinical presentation, site of thrombosis and risk factors based on the anatomic distribution of lower limb DVT. Methods A retrospective analysis of clinically suspected DVT cases was conducted between 2008 and 2012. DVT was categorized by the location of the thrombosed segment and limb involved. The DVT anatomic segments were assessed according to left-to-right ratio, predisposing factors and clinical presentations. Results A total of 637 patients with DVT were included with a mean age of 50 ± 17 years (51%; females). The most frequently thrombosed segments were popliteal, posterior tibial and profunda femoris veins. DVT was more common at the left side, with a left-to-right ratio of 1.5:1. Bilateral DVT cases (38.5%) had more prior history of DVT as compared to left- (20.3%) and right-sided DVTs (22.6%); p = 0.01. Bilateral DVT was complicated more with post-thrombotic syndrome (leg ulcer) ( p = 0.02). The rates of pulmonary embolism (25%) and mortality (23.1%) were significantly higher for bilateral DVT in comparison to left- and right-sided DVT. Abnormal coagulation profile was significantly associated with posterior tibial DVT (81% vs. 71.4%; p = 0.01) as compared to patients with normal coagulation profile. Conclusion Lower limb DVTs are more common at the left side; however, patients with bilateral DVT have higher frequency of recurrence, post-thrombotic syndrome, pulmonary embolism and mortality. The anatomic segments of DVT show specific distribution depending on the predisposing factors. These findings could improve our understanding of the pathophysiology and management of DVT patients.
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Affiliation(s)
- Ayman El-Menyar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
- Clinical Research, Trauma Surgery, Hamad General Hospital, Doha, Qatar
- Cardiology Unit, Internal Medicine, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Mohammad Asim
- Clinical Research, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Gaby Jabbour
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar
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Abbasi OZ, Doan TT, Duggal S, Nair SU, Quinn SM. Utilization of bedside ultrasound in the diagnosis and management of massive pulmonary embolism: a case report. Radiol Case Rep 2016; 11:447-449. [PMID: 27920878 PMCID: PMC5128386 DOI: 10.1016/j.radcr.2016.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 11/18/2022] Open
Abstract
The prompt diagnosis and treatment of massive pulmonary embolism is a well-known challenge for physicians. We report a case of a 61-year-old hemodynamically unstable man who presented to the emergency department with complaints of acute dyspnea. After performing a focused history and physical, we used bedside ultrasound to diagnose significant right heart strain, which suggested massive bilateral pulmonary embolisms. This diagnosis was further supported by the visualization of deep venous thrombosis in the left lower extremity. The patient was treated with IV tissue plasminogen activator in the emergency department and survived to discharge in his usual state of health.
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Affiliation(s)
- Osman Z. Abbasi
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network/USF MCOM, CC & I-78, Allentown, PA 18103
| | - Thanhnga T. Doan
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network/USF MCOM, CC & I-78, Allentown, PA 18103
| | - Sumit Duggal
- Division of Cardiology, Department of Medicine, Lehigh Valley Hospital and Health Network/USF MCOM, Allentown, PA
| | - Sanjeev U. Nair
- Division of Cardiology, Department of Medicine, Lehigh Valley Hospital and Health Network/USF MCOM, Allentown, PA
| | - Shawn M. Quinn
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network/USF MCOM, CC & I-78, Allentown, PA 18103
- Corresponding author.
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El-Menyar A, Nabir S, Ahmed N, Asim M, Jabbour G, Al-Thani H. Diagnostic implications of computed tomography pulmonary angiography in patients with pulmonary embolism. Ann Thorac Med 2016; 11:269-276. [PMID: 27803753 PMCID: PMC5070436 DOI: 10.4103/1817-1737.191868] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION: Pulmonary embolism (PE) is a serious cardiovascular and pulmonary complication worldwide. We aimed to assess the implications of different computed tomography pulmonary angiography (CTPA) parameters in patients with acute PE. METHODS: A retrospective observational study to include patients presented with clinical suspicious of PE who underwent CTPA was conducted. Patients' demographics, clinical presentation, risk factors, laboratory investigations, management, and outcome were analyzed. Computed tomography findings included clot burden (Qanadli score [QS]) and right ventricular dysfunction (RVD) parameters. RESULTS: A total of 45 patients with radiologically confirmed diagnosis of PE were included in the study; of these patients, 8 (17.8%) died during the hospital course. Patients who died were 13 years older than those who survived, and the mortality rate was significantly higher in patients with cancer. The two groups were comparable for cardiovascular parameters. The mean clot burden (QS) was 19.5 ± 11.3 points and 53% of patients had QS >18 points. Obesity (52.4% vs. 12.5%; P = 0.01), hypertension (54.4% vs. 23.8%; P = 0.03), and median D-dimer levels (7.8 vs. 3.4; P = 0.03) were significantly higher in patients with QS >18. Among right ventricular (RV) dysfunction parameters, only higher RV/left ventricular (LV) ratio (P = 0.001) and bowing of interventricular septum (P = 0.001) were associated with higher QS. A significant positive correlation was found between RV short axis (r = 0.499, P = 0.001), RV/LV ratio (r = 0.592, P = 0.001), and pulmonary artery (PA) diameter (r = 0.301, P = 0.04) with the PA clot burden. Receiver operating characteristic curve for clot burden showed a cutoff value of 17.5 points to accurately predict RV dysfunction. CONCLUSIONS: Clot burden >18 is associated with RV dysfunction in patients with acute PE. Echocardiography and RVD parameters showed no correlation with in-hospital deaths. CTPA has clinicoradiological implications for risk stratification in PE patients. As the sample size is small, our findings warrant further larger prospective studies.
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Affiliation(s)
- Ayman El-Menyar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar; Department of Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Syed Nabir
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Nadeem Ahmed
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Mohammad Asim
- Department of Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Gaby Jabbour
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Vascular Surgery, Hamad General Hospital, Doha, Qatar
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