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Bassett E, Broadbent J, Gill D, Burgess S, Mason AM. Inconsistency in UK Biobank Event Definitions From Different Data Sources and Its Impact on Bias and Generalizability: A Case Study of Venous Thromboembolism. Am J Epidemiol 2024; 193:787-797. [PMID: 37981722 PMCID: PMC11074710 DOI: 10.1093/aje/kwad232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/21/2023] Open
Abstract
The UK Biobank study contains several sources of diagnostic data, including hospital inpatient data and data on self-reported conditions for approximately 500,000 participants and primary-care data for approximately 177,000 participants (35%). Epidemiologic investigations require a primary disease definition, but whether to combine data sources to maximize statistical power or focus on only 1 source to ensure a consistent outcome is not clear. The consistency of disease definitions was investigated for venous thromboembolism (VTE) by evaluating overlap when defining cases from 3 sources: hospital inpatient data, primary-care reports, and self-reported questionnaires. VTE cases showed little overlap between data sources, with only 6% of reported events for persons with primary-care data being identified by all 3 sources (hospital, primary-care, and self-reports), while 71% appeared in only 1 source. Deep vein thrombosis-only events represented 68% of self-reported VTE cases and 36% of hospital-reported VTE cases, while pulmonary embolism-only events represented 20% of self-reported VTE cases and 50% of hospital-reported VTE cases. Additionally, different distributions of sociodemographic characteristics were observed; for example, patients in 46% of hospital-reported VTE cases were female, compared with 58% of self-reported VTE cases. These results illustrate how seemingly neutral decisions taken to improve data quality can affect the representativeness of a data set.
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Affiliation(s)
| | | | | | | | - Amy M Mason
- Correspondence to Dr. Amy M. Mason, Victor Phillip Dahdaleh Heart and Lung Research Institute, Biomedical Campus, Papworth Road, Trumpington, Cambridge CB2 0BB, United Kingdom (e-mail: )
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Ballas C, Lakkas L, Kardakari O, Papaioannou E, Siaravas KC, Naka KK, Michalis LK, Katsouras CS. In-Hospital versus Out-of-Hospital Pulmonary Embolism: Clinical Characteristics, Biochemical Markers and Echocardiographic Indices. J Cardiovasc Dev Dis 2024; 11:103. [PMID: 38667721 PMCID: PMC11050175 DOI: 10.3390/jcdd11040103] [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: 02/22/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND A significant proportion of pulmonary embolisms (PEs) occurs in patients during hospitalisation for another reason. However, limited data regarding differences between out-of-hospital PE (OHPE) and in-hospital PE (IHPE) is available. We aimed to compare these groups regarding their clinical characteristics, biochemical markers, and echocardiographic indices. METHODS This was a prospective, single-arm, single-centre study. Adult consecutive patients with non-COVID-related PE from September 2019 to March 2022 were included and followed up for 12 months. RESULTS The study included 180 (84 women) patients, with 89 (49.4%) suffering from IHPE. IHPE patients were older, they more often had cancer, were diagnosed earlier after the onset of symptoms, they had less frequent pain and higher values of high sensitivity troponin I and brain natriuretic peptide levels compared to OHPE patients. Echocardiographic right ventricular (RV) dysfunction was detected in similar proportions in the 2 groups. IHPE had increased in-hospital mortality (14.6% vs. 3.3%, p = 0.008) and similar post-discharge to 12-month mortality with OHPE patients. CONCLUSIONS In this prospective cohort study, IHPE differed from OHPE patients regarding age, comorbidities, symptoms, and levels of biomarkers associated with RV dysfunction. IHPE patients had higher in-hospital mortality compared to OHPE patients and a similar risk of death after discharge.
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Affiliation(s)
| | | | | | | | | | | | | | - Christos S. Katsouras
- Second Department of Cardiology, University Hospital of Ioannina, 45500 Ioannina, Greece (L.L.); (O.K.); (E.P.); (K.C.S.); (K.K.N.); (L.K.M.)
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3
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Barp M, Carneiro VSM, Malaquias SG, Pagotto V. Temporal trend in venous thromboembolism hospitalization rates in Brazilian older adults, 2010-2020. J Thromb Thrombolysis 2023; 55:156-165. [PMID: 36335519 DOI: 10.1007/s11239-022-02724-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/08/2022]
Abstract
Aging is one of the main risk factors for venous thromboembolism (VTE). Changes in prevention, diagnosis, and treatment strategies for this condition in recent years require an analysis of its rates in health services. The objective of this study was to analyze a temporal trend of hospitalizations for VTE in Brazilian older adults. This ecological time series study used data from the Hospital Information System (HIS) on VTE hospitalizations from 2010 to 2020, selecting admissions with the main diagnosis of pulmonary thromboembolism (PTE) (I.26.0, I.26.9) and deep vein thrombosis (DVT) (I.80.0, I80.1, I80.2, I80.3, I80.8, I80.9). Hospitalization rates were calculated for each year and the Prais-Winsten. In Brazil, the trend of hospitalizations for VTE decreased, with an annual percentage change of - 40.71 (confidence interval [CI] - 50.46; - 29.04). DVT decreased, with an annual percentage change of - 43.14 (95% confidence interval [CI] - 51.36; - 33.54). All Brazilian regions showed a downward trend in hospitalizations for VTE and DVT, except for the Northeast region, which remained stable. Conversely, the trend of hospitalizations for PTE showed an upward in Brazil, with an annual percentage change of 4.33 (95% CI 1.26; 7.48). An upward trend was observed in hospitalizations for PTE in the Northeast region, and a stationary trend was observed in the other regions. The results showed a downward trend in hospitalization rates for DVT and an upward trend for PTE. The study indicates regional differences in rates and trends.
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Affiliation(s)
- Milara Barp
- Graduate Program in Nursing, Faculty of Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil.
| | | | | | - Valéria Pagotto
- Faculty of Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil
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Mokgokong R, Khachatryan A, Quignot N, Chaves J, Moniot A, Gusto G. Comparative Analysis of All-Cause Health Care Resource Utilization and Costs Among Venous Thrombosis Patients Without Cancer Prescribed Apixaban or VKAs in France. Adv Ther 2022; 39:3766-3776. [PMID: 35767124 PMCID: PMC9309117 DOI: 10.1007/s12325-022-02200-7] [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: 04/12/2022] [Accepted: 05/19/2022] [Indexed: 11/27/2022]
Abstract
Introduction The direct oral anticoagulant (DOAC) apixaban has shown to have non-inferior efficacy and better safety than vitamin K antagonists (VKAs) in patients with venous thromboembolism (VTE). We determined whether healthcare resource use (HCRU) and direct all-cause medical and non-medical costs in patients with VTE in France differed between VKAs and apixaban. Methods A retrospective cohort study was conducted using French national health data from January 2013–June 2018 for anticoagulant-naïve adults hospitalized with VTE. All-cause costs and HCRU per patient per month (PPPM) were compared between apixaban and VKA cohorts created by 1:1 propensity score matching. Two-part models with bootstrapping were used to calculate marginal effects for costs and HCRU. Results The matched VKA and apixaban cohorts each comprised 7503 patients. Compared to VKAs, patients prescribed apixaban had significantly lower (P < 0.0001) mean all-cause costs PPPM for outpatient visits (€438.54 vs. €455.58), overall laboratory tests (€21.26 vs. €83.73), and hospitalizations (€249.48 vs. €343.82), but significantly higher (P < 0.0001) mean all-cause costs PPPM for overall drugs (€97.06 vs. €69.56) and medical procedures (€42.12 vs. €35.50). Mean total all-cause direct medical costs (€687.93 vs. €798.70) and total all-cause direct medical and non-medical costs (€771.60 vs. €883.66) were significantly lower (P < 0.0001) for apixaban. Mean HCRU PPPM showed similar trends. Subgroup analyses showed that, among patients with recurrent VTE, patients prescribed apixaban had significantly lower (P < 0.0001) all-cause costs PPPM for total medical costs (€17.26 vs. €18.12) and total all-cause direct medical and non-medical costs (€18.37 vs. €19.20) than patients prescribed VKAs. Similarly, among patients with bleeding, patients prescribed apixaban had significantly lower (P < 0.0001) all-cause costs PPPM for total medical costs (€15.34 vs. €32.61) and total all-cause direct medical and non-medical costs (€16.23 vs. €34.63) than patients prescribed VKAs. Conclusion Compared to VKAs, apixaban may be cost-saving in the treatment of patients hospitalized for acute VTE. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02200-7.
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Affiliation(s)
- Ruth Mokgokong
- Health Economics & Outcomes Research, Pfizer Ltd, Walton Oaks, Tadworth, KT20 7NS, UK.
| | | | | | - Jose Chaves
- Global Medical Affairs, Pfizer SLU, Internal Medicine, Madrid, Spain
| | - Audrey Moniot
- Medical Affairs, Pfizer SAS, Internal Medicine, Paris, France
| | - Gaelle Gusto
- Evidence and Access, Certara France, Paris, France
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Jiménez-García R, Albaladejo-Vicente R, Hernandez-Barrera V, Villanueva-Orbaiz R, Carabantes-Alarcon D, de-Miguel-Diez J, Zamorano-Leon JJ, Lopez-de-Andres A. Type 2 Diabetes Is a Risk Factor for Suffering and for in-Hospital Mortality with Pulmonary Embolism. A Population-Based Study in Spain (2016-2018). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228347. [PMID: 33187341 PMCID: PMC7698274 DOI: 10.3390/ijerph17228347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/29/2020] [Accepted: 11/10/2020] [Indexed: 12/19/2022]
Abstract
(1) Background: The relationship between type 2 diabetes (T2DM) and pulmonary embolism (PE) has not been well stablished so far. We aim to analyze incidence, clinical conditions and in-hospital mortality (IHM) according to the presence of T2DM among patients hospitalized for suffering from PE. The factors associated with IHM were identified. (2) Methods: Patients aged ≥40 years hospitalized for PE from 2016 to 2018 included in the Spanish National Health System Hospital Discharge Database were analyzed. Dependent variables included incidence, IHM and length of hospital stay. Independent variables were age, sex, diagnosed comorbidities, thrombolytic therapy and inferior vena cava filter placement. Poisson and logistic regression models were constructed for multivariable analysis. (3) Results: Of the 47,190 hospitalizations for PE recorded, 16.52% had T2DM. Adjusted incidence of PE was higher among T2DM women (IRR 1.83; 95% CI: 1.58-1.96) and men (IRR 1.22; 95% CI: 1.18-1.27) than among non-diabetic subjects. Crude IHM in T2DM patients with PE was similar in both sexes but higher than in non-diabetic patients. Among T2DM patients with PE, risk factors for IHM included older age, comorbidity, atrial fibrillation and massive PE. Obesity was associated with lower IHM. Suffering T2DM was a risk of IHM (OR 1.15; 95% CI 1.05-1.26) after PE. (4) Conclusions: The incidence of PE is higher in T2DM men and women than in non-diabetic patients. T2DM was a risk factor for IHM after PE.
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Affiliation(s)
- Rodrigo Jiménez-García
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (R.V.-O.); (D.C.-A.); (J.J.Z.-L.)
| | - Romana Albaladejo-Vicente
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (R.V.-O.); (D.C.-A.); (J.J.Z.-L.)
- Correspondence:
| | - Valentin Hernandez-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, 28922 Madrid, Spain; (V.H.-B.); (A.L.-d.-A.)
| | - Rosa Villanueva-Orbaiz
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (R.V.-O.); (D.C.-A.); (J.J.Z.-L.)
| | - David Carabantes-Alarcon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (R.V.-O.); (D.C.-A.); (J.J.Z.-L.)
| | - Javier de-Miguel-Diez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009 Madrid, Spain;
| | - José Javier Zamorano-Leon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (R.V.-O.); (D.C.-A.); (J.J.Z.-L.)
| | - Ana Lopez-de-Andres
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, 28922 Madrid, Spain; (V.H.-B.); (A.L.-d.-A.)
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Labianca A, Bosetti T, Indini A, Negrini G, Labianca RF. Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer. Cancers (Basel) 2020; 12:E2070. [PMID: 32726933 PMCID: PMC7466093 DOI: 10.3390/cancers12082070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 12/21/2022] Open
Abstract
In the general population, the incidence of thromboembolic events is 117 cases/100,000 inhabitants/year, while in cancer patient incidence, it is four-fold higher, especially in patients who receive chemotherapy and who are affected by pancreatic, lung or gastric cancer. At the basis of venous thromboembolism (VTE) there is the so-called Virchow triad, but tumor cells can activate coagulation pathway by various direct and indirect mechanisms, and chemotherapy can contribute to VTE onset. For these reasons, several studies were conducted in order to assess efficacy and safety of the use of anticoagulant therapy in cancer patients, both in prophylaxis setting and in therapy setting. With this review, we aim to record principal findings and current guidelines about thromboprophylaxis in cancer patients, with particular attention to subjects with additional risk factors such as patients receiving chemotherapy or undergoing surgery, hospitalized patients for acute medical intercurrent event and patients with central venous catheters. Nonetheless we added a brief insight about acute and maintenance therapy of manifested venous thromboembolism in cancer patients.
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Affiliation(s)
- Alice Labianca
- Medical Oncology Unit, Department of Oncology and Haematology, ASST Papa Giovanni XXIII, 24121 Bergamo, Italy; (A.L.); (T.B.); (G.N.)
| | - Tommaso Bosetti
- Medical Oncology Unit, Department of Oncology and Haematology, ASST Papa Giovanni XXIII, 24121 Bergamo, Italy; (A.L.); (T.B.); (G.N.)
| | - Alice Indini
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20019 Milano, Italy;
| | - Giorgia Negrini
- Medical Oncology Unit, Department of Oncology and Haematology, ASST Papa Giovanni XXIII, 24121 Bergamo, Italy; (A.L.); (T.B.); (G.N.)
| | - Roberto Francesco Labianca
- Medical Oncology Unit, Department of Oncology and Haematology, ASST Papa Giovanni XXIII, 24121 Bergamo, Italy; (A.L.); (T.B.); (G.N.)
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Howlett J, Benzenine E, Cottenet J, Foucher P, Fagnoni P, Quantin C. Could venous thromboembolism and major bleeding be indicators of lung cancer mortality? A nationwide database study. BMC Cancer 2020; 20:461. [PMID: 32448219 PMCID: PMC7245783 DOI: 10.1186/s12885-020-06930-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/05/2020] [Indexed: 02/06/2023] Open
Abstract
Background Venous thromboembolism (VTE) is highly prevalent in cancer patients and can cause severe morbidity. VTE treatment is essential, but anticoagulation increases the risk of major bleeding. The purpose was to evaluate the impact of VTE and major bleeding on survival and to identify significant risk factors for these events in lung cancer patients. Methods Data were extracted from a permanent sample of the French national health information system (including hospital and out-of-hospital care) from 2009 to 2016. All episodes of VTE and major bleeding events within one year after cancer diagnosis were identified. A Cox model was used to analyse the effect of VTE and major bleeding on the patients’ one-year survival. VTE and major bleeding risk factors were analysed with a Fine and Gray survival model. Results Among the 2553 included patients with lung cancer, 208 (8%) had a VTE episode in the year following diagnosis and 341 (13%) had major bleeding. Almost half of the patients died during follow-up. Fifty-six (60%) of the patients presenting with pulmonary embolism (PE) died, 48 (42%) of the patients presenting with deep vein thrombosis (DVT) alone died and 186 (55%) of those presenting with a major bleeding event died. The risk of death was significantly increased following PE and major bleeding events. VTE concomitant with cancer diagnosis was associated with an increased risk of VTE recurrence beyond 6 months after the first VTE event (sHR = 4.07 95% CI: 1.57–10.52). Most major bleeding events did not appear to be related to treatment. Conclusion VTE is frequent after a diagnosis of lung cancer, but so are major bleeding events. Both PE and major bleeding are associated with an increased risk of death and could be indicators of lung cancer mortality.
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Affiliation(s)
- Jennifer Howlett
- CHRU Dijon, Pharmacy, F-21000, Dijon, France.,Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Eric Benzenine
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France.,INSERM, CIC 1432, Clinical Investigation Center, clinical epidemiology/ clinical trials unit, Dijon University Hospital, Dijon, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France.,INSERM, CIC 1432, Clinical Investigation Center, clinical epidemiology/ clinical trials unit, Dijon University Hospital, Dijon, France
| | | | - Philippe Fagnoni
- CHRU Dijon, Pharmacy, F-21000, Dijon, France.,Unité INSERM U866, Dijon University Hospital, Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France. .,INSERM, CIC 1432, Clinical Investigation Center, clinical epidemiology/ clinical trials unit, Dijon University Hospital, Dijon, France. .,Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France.
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Maitre T, Cottenet J, Beltramo G, Georges M, Blot M, Piroth L, Bonniaud P, Quantin C. Increasing burden of noninfectious lung disease in persons living with HIV: a 7-year study using the French nationwide hospital administrative database. Eur Respir J 2018; 52:13993003.00359-2018. [PMID: 30139778 DOI: 10.1183/13993003.00359-2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/28/2018] [Indexed: 01/03/2023]
Abstract
An overall reduction in the incidence of AIDS and a change in the spectrum of lung disease have been noticed in persons living with HIV (PLHIV). Our aim was to provide an epidemiological update regarding the prevalence of lung diseases in PLHIV hospitalised in France.We analysed the prevalence of lung disease in PLHIV hospitalised in France from 2007 to 2013, from the French nationwide hospital medical information database, and assessed the association between HIV and incident noninfectious disease over 4 years of follow-up.A total of 52 091 PLHIV were hospitalised in France between 2007 and 2013. Among PLHIV hospitalised with lung disease, noninfectious lung diseases increased significantly from 45.6% to 54.7% between 2007 and 2013, whereas the proportion of patients with at least one infectious lung disease decreased significantly. In 2010, 10 067 prevalent hospitalised PLHIV were compared with 8 244 682 hospitalised non-PLHIV. In 30-49-year-old patients, HIV infection was associated with chronic obstructive pulmonary disease (COPD), chronic respiratory failure, emphysema, lung fibrosis and pulmonary arterial hypertension (PAH) even after adjustment for smoking.The emergence of noninfectious lung disease, in particular COPD, emphysema, lung fibrosis, PAH and chronic respiratory disease, in PLHIV would justify mass screening in this population.
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Affiliation(s)
- Thomas Maitre
- Dept of Pulmonary Medicine and Intensive Care Unit, University Hospital, Dijon, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France.,INSERM, CIC 1432, Clinical Investigation Centre, Clinical Epidemiology/Clinical Trials Unit Dijon, Dijon, France
| | - Guillaume Beltramo
- Dept of Pulmonary Medicine and Intensive Care Unit, University Hospital, Dijon, France.,INSERM, LNC UMR866, LipSTIC LabEx Team, Dijon, France.,Bourgogne Franche-Comté University, Dijon, France
| | - Marjolaine Georges
- Dept of Pulmonary Medicine and Intensive Care Unit, University Hospital, Dijon, France.,Bourgogne Franche-Comté University, Dijon, France
| | - Mathieu Blot
- Bourgogne Franche-Comté University, Dijon, France.,Dept of Infectious Disease, University Hospital, Dijon, France
| | - Lionel Piroth
- INSERM, CIC 1432, Clinical Investigation Centre, Clinical Epidemiology/Clinical Trials Unit Dijon, Dijon, France.,Bourgogne Franche-Comté University, Dijon, France.,Dept of Infectious Disease, University Hospital, Dijon, France
| | - Philippe Bonniaud
- Dept of Pulmonary Medicine and Intensive Care Unit, University Hospital, Dijon, France.,INSERM, LNC UMR866, LipSTIC LabEx Team, Dijon, France.,Bourgogne Franche-Comté University, Dijon, France.,These two authors contributed equally to this work
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France.,INSERM, CIC 1432, Clinical Investigation Centre, Clinical Epidemiology/Clinical Trials Unit Dijon, Dijon, France.,Bourgogne Franche-Comté University, Dijon, France.,Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France.,These two authors contributed equally to this work
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9
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Ahmad J, Lynch MK, Maltenfort M. Incidence and Risk Factors of Venous Thromboembolism After Orthopaedic Foot and Ankle Surgery. Foot Ankle Spec 2017; 10:449-454. [PMID: 28413884 DOI: 10.1177/1938640017704944] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study examines the incidence and risk of postoperative symptomatic venous thromboembolism (VTE) after orthopaedic foot/ankle surgery. MATERIALS Patients that received foot/ankle surgery between 2006 and 2016 were reviewed. Inclusion criteria were surgical patients that were without coagulopathy, previous VTE, and/or using anticoagulation medications including aspirin. Age, sex, body mass index, medical comorbidities, and surgical diagnosis and procedure(s) were noted. Records were reviewed to see who developed a symptomatic VTE within 90 days from surgery. RESULTS This study involved 2774 patients that received foot/ankle surgery between 2006 and 2016. Of them, 22 (0.79%) developed a VTE within 90 days from surgery. The mean age of these patients was 49.5 years. Twelve patients were male and 10 were female. Sixteen patients were obese and 6 were nonobese. Postoperative VTEs were 14 infrapopliteal deep vein thrombosis (DVT), 1 suprapopliteal DVT, and 7 pulmonary emboli. The most common surgeries involved were ankle fracture repair in 8 (0.29%), Achilles tendon repair in 2 (0.07%), ankle ligament reconstruction in 2, and hammer-toe correction in 2 patients. Obesity was predictive of a postoperative VTE to a statistically significant degree (P = .04). Age, sex, medical comorbidities, diagnosis, and type of surgery were not significantly prognostic for a postsurgical VTE (P ≥ .05). DISCUSSION The incidence of VTE after foot/ankle surgery is low. However, obese patients are at significantly higher risk for VTE after such procedures. CLINICAL RELEVANCE These findings are important when educating patients as to their risks of developing a VTE after orthopaedic foot/ankle surgery. LEVELS OF EVIDENCE Level III: Retrospective cohort study.
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Affiliation(s)
- Jamal Ahmad
- Orthopaedic Foot and Ankle Surgery, NorthShore Orthopaedic Institute, NorthShore University Health System, Lincolnshire, Illinois (JA).,Rothman Institute Orthopaedics, Philadelphia, Pennsylvania (MKL, MM)
| | - Mary-Katherine Lynch
- Orthopaedic Foot and Ankle Surgery, NorthShore Orthopaedic Institute, NorthShore University Health System, Lincolnshire, Illinois (JA).,Rothman Institute Orthopaedics, Philadelphia, Pennsylvania (MKL, MM)
| | - Mitchell Maltenfort
- Orthopaedic Foot and Ankle Surgery, NorthShore Orthopaedic Institute, NorthShore University Health System, Lincolnshire, Illinois (JA).,Rothman Institute Orthopaedics, Philadelphia, Pennsylvania (MKL, MM)
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10
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Deguchi H, Elias DJ, Griffin JH. Minor Plasma Lipids Modulate Clotting Factor Activities and May Affect Thrombosis Risk. Res Pract Thromb Haemost 2017; 1:93-102. [PMID: 29082360 PMCID: PMC5658053 DOI: 10.1002/rth2.12017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Essentials Circulating blood contains hundreds of lipids, many of which might influence blood coagulation. Recent discoveries about circulating lipids that can affect blood coagulation are reviewed. Minor abundance plasma lipids can modulate thrombin generation via direct effects on factor Xa. Variations in minor abundance plasma lipids can influence thrombin generation and thrombosis risk.
Abstract Different minor abundance plasma lipids significantly influence thrombin generation in vitro and significant differences in such lipids are linked to risk for venous thrombosis. Some plasma sphingolipids including glucosylceramide, lyso‐sulfatide and sphingosine have anticoagulant properties whereas, conversely, some plasma phospholipid derivatives, including certain lyso‐phospholipids and ethanolamides, have procoagulant properties. Plasma metabolite profiling of venous thrombosis patients showed association of venous thrombosis with decreased plasma long‐chain acylcarntines, leading to discovery of their anticoagulant activity as inhibitors of factor Xa. Inhibition of factor Xa by acylcarnitines does not require the protein's Gla‐domain, emphasizing an expanded framework for the paradigm for lipid‐clotting factor interactions. Overall, whether by genetics or environment, alterations in the dynamics of lipid metabolism linked to an altered lipidome may contribute to regulation of blood coagulation because imbalances between physiologic procoagulant and anticoagulant lipids may contribute to excessive thrombin generation that augments risk for thrombosis.
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Affiliation(s)
- Hiroshi Deguchi
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - Darlene J Elias
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA.,Scripps Clinic and Scripps Green Hospital, La Jolla, CA, USA
| | - John H Griffin
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA.,Department of Medicine, University of California San Diego, La Jolla, CA, USA
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