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Bosio G, Destrempes F, Roy Cardinal MH, Cloutier G. Effect of rt-PA on Shear Wave Mechanical Assessment and Quantitative Ultrasound Properties of Blood Clot Kinetics In Vitro. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:829-840. [PMID: 38205972 DOI: 10.1002/jum.16411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE The consequences associated with blood clots are numerous and are responsible for many deaths worldwide. The assessment of treatment efficacy is necessary for patient follow-up and to detect treatment-resistant patients. The aim of this study was to characterize the effect of treatment on blood clots in vitro using quantitative ultrasound parameters. METHODS Blood from 10 pigs was collected to form three clots per pig in gelatin phantoms. Clots were subjected to 1) no treatment, 2) rt-PA (recombinant tissue plasminogen activator) treatment after 20 minutes of clotting, and 3) rt-PA treatment after 60 minutes of clotting. Clots were weighted before and after the experiment to assess the treatment effect by the mass loss. The clot kinetics was studied over 100 minutes using elastography (Young's modulus, shear wave dispersion, and shear wave attenuation). Homodyne K-distribution (HKD) parameters derived from speckle statistics were also studied during clot formation and dissolving (diffuse-to-total signal power ratio and intensity parameters). RESULTS Treated clots loosed significantly more mass than non-treated ones (P < .005). A significant increase in Young's modulus was observed over time (P < .001), and significant reductions were seen for treated clots at 20 or 60 minutes compared with untreated ones (P < .001). The shear wave dispersion differed for treated clots at 60 minutes versus no treatments (P < .001). The shear wave attenuation decreased over time (P < .001), and was different for clots treated at 20 minutes versus no treatments (P < .031). The HKD intensity parameter varied over time (P < .032), and was lower for clots treated at 20 and 60 minutes than those untreated (P < .001 and P < .02). CONCLUSION The effect of rt-PA treatment could be confirmed by a decrease in Young's modulus and HKD intensity parameter. The shear wave dispersion and shear wave attenuation were sensitive to late and early treatments, respectively. The Young's modulus, shear wave attenuation, and HKD intensity parameter varied over time despite treatment.
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Affiliation(s)
- Guillaume Bosio
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
- Institute of Biomedical Engineering, University of Montreal, Montreal, Quebec, Canada
| | - François Destrempes
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Marie-Hélène Roy Cardinal
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Guy Cloutier
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
- Institute of Biomedical Engineering, University of Montreal, Montreal, Quebec, Canada
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Montreal, Quebec, Canada
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Spiezia L, Forestan C, Campello E, Simion C, Simioni P. Persistently High Levels of Coagulation Factor XI as a Risk Factor for Venous Thrombosis. J Clin Med 2023; 12:4890. [PMID: 37568292 PMCID: PMC10420025 DOI: 10.3390/jcm12154890] [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: 06/06/2023] [Revised: 07/12/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Coagulation factor XI (FXI) promotes fibrin formation and inhibits fibrinolysis. Elevated plasma FXI levels, limited to a single measurement, are associated with a higher thrombotic risk. Our case-control study aimed to identify the effect of persistently increased plasma FXI levels on the risk of deep vein thrombosis (DVT). All patients evaluated between January 2016 and January 2018 for a first episode of proximal DVT of the lower extremity were considered for enrolment. Plasma FXI levels were measured at least 1 month after the discontinuation of anticoagulant treatment (T1). The patients with increased plasma FXI levels (>90th percentile of controls) were tested again 3 months later (T2). Among the 200 enrolled patients (M/F 114/86, age range 26-87 years), 47 patients had increased plasma FXI levels at T1 and16 patients had persistently increased plasma FXI levels at T2. The adjusted odds ratio for DVT was 2.4 (95% CI, 1.3 to 5.5, p < 0.001) for patients with increased FXI levels at T1 and 5.2 (95% CI, 2.3 to 13.2, p < 0.001) for patients with persistently high FXI levels at T2. Elevated FXI levels constitute a risk factor for deep vein thrombosis, and this risk nearly doubled in patients with persistently increased plasma FXI levels. Larger prospective studies are needed to confirm our findings.
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Affiliation(s)
- Luca Spiezia
- General Medicine and Thrombotic and Haemorrhagic Diseases Unit, Department of Medicine, University of Padova, 35138 Padova, Italy; (C.F.); (E.C.); (C.S.); (P.S.)
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Akinbo DB, Ajayi OI. Thrombotic Pathogenesis and Laboratory Diagnosis in Cancer Patients, An Update. Int J Gen Med 2023; 16:259-272. [PMID: 36711430 PMCID: PMC9879027 DOI: 10.2147/ijgm.s385772] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/04/2023] [Indexed: 01/23/2023] Open
Abstract
Cancer-associated thrombosis (CAT) is a leading cause of mortality in cancer patients and its incidence varies in different parts of the world. Venous thromboembolism (VTE) is a prominent manifestation of CAT, and significantly impacts morbidity and survival compared to arterial thrombosis in cancer patients. Several risk factors for developing VTE such as chemotherapy and immobilization have also been found co-existing with cancer patients and contributing to the increased risk of VTE in cancer patients than in non-cancer patients. This review highlights recent mechanisms in the pathogenesis of hypercoagulable syndromes associated with cancer, multiple mechanisms implicated in promoting cancer-associated thrombosis and their diagnostic approaches. Cancer cells interact with every part of the hemostatic system; generating their own procoagulant factors, through stimulation of the prothrombotic properties of other blood cell components or the initiation of clotting by cancer therapies which can all directly activate the coagulation cascade and contribute to the VTE experienced in CAT. It is our hope that the multiple interconnections between the hemostatic system and cancer biology and the improved biomarkers reported in this study can be relevant in establishing a predictive model for VTE, optimize early detection of asymptomatic microthrombosis for more personalized prophylactic strategies and incorporate effective therapeutic options and patient management to reduce mortality and morbidity, and improve the quality of life of affected cancer patients.
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Affiliation(s)
- David Bolaji Akinbo
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Afe Babalola University, Ado – Ekiti, Ekiti State, Nigeria,Department of Food, Nutrition, Dietetics and Health, College of Health and Human Sciences, Kansas State University, Manhattan, KS, USA,Correspondence: David Bolaji Akinbo, Email
| | - Olutayo Ifedayo Ajayi
- Department of Physiology, School of Basic Medical Sciences, College of Medical Sciences, University of Benin, Benin City, Edo State, Nigeria
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Haemostasis and Inflammatory Parameters as Potential Diagnostic Biomarkers for VTE in Trauma-Immobilized Patients. Diagnostics (Basel) 2023; 13:diagnostics13010150. [PMID: 36611442 PMCID: PMC9818770 DOI: 10.3390/diagnostics13010150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 01/03/2023] Open
Abstract
Venous thromboembolism (VTE), which encompasses deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major public health concern due to its high incidences of morbidity and mortality. Patients who have experienced trauma with prolonged immobilization are at an increased risk of developing VTE. Plasma D-dimer levels have been known to be elevated in trauma patients, and they were closely correlated with the number of fractures. In other words, plasma D-dimer levels cannot be used as the only indicator of VTE in trauma cases. Given the limitations, further study is needed to explore other potential biomarkers for diagnosing VTE. To date, various established and novel VTE biomarkers have been studied in terms of their potential for predicting VTE, diagnostic performance, and improving clinical therapy for VTE. Therefore, this review aims to provide information regarding classic and essential haemostasis (including prothrombin time (PT), activated partial thromboplastin time (aPTT), D-dimer, fibrinogen, thrombin generation, protein C, protein S, antithrombin, tissue factor pathway inhibitor, and platelet count) and inflammatory biomarkers (C-reactive protein, erythrocyte sedimentation rate, and soluble P-selectin) as potential diagnostic biomarkers that can predict the risk of VTE development among trauma patients with prolonged immobilization. Thus, further advancement in risk stratification using these biomarkers would allow for a better diagnosis of patients with VTE, especially in areas with limited resources.
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Bosio G, Zenati N, Destrempes F, Chayer B, Pernod G, Cloutier G. Shear Wave Elastography and Quantitative Ultrasound as Biomarkers to Characterize Deep Vein Thrombosis In Vivo. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1807-1816. [PMID: 34713918 DOI: 10.1002/jum.15863] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/02/2021] [Accepted: 10/11/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Investigate shear wave elastography (SWE) and quantitative ultrasound (QUS) parameters in patients hospitalized for lower limb deep vein thrombosis (DVT). METHOD Sixteen patients with DVT were recruited and underwent SWE and radiofrequency data acquisitions for QUS on day 0, day 7, and day 30 after the beginning of symptoms, in both proximal and distal zones of the clot identified on B-mode scan. SWE and QUS features were computed to differentiate between thrombi at day 0, day 7, and day 30 following treatment with heparin or oral anticoagulant. The Young's modulus from SWE was computed, as well as QUS homodyned K-distribution (HKD) parameters reflecting blood clot structure. Median and interquartile range of SWE and QUS parameters within clot were taken as features. RESULTS In the proximal zone of the clot, the HKD ratio of coherent-to-diffuse backscatter median showed a significant decrease from day 7 to day 30 (P = .036), while the HKD ratio of diffuse-to-total backscatter median presented a significant increase from day 7 to day 30 (P = .0491). In the distal zone of the clot, the HKD normalized intensity of the echo envelope median showed a significant increase from day 0 to day 30 (P = .0062). No SWE features showed statistically significant differences over time. Nonetheless, a trend of lower median of Young's modulus within clot for patients who developed a pulmonary embolism was observed. CONCLUSION QUS features may be relevant to characterize clot's evolution over time. Further analysis of their clinical interpretation and validation on a larger dataset would deserve to be studied.
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Affiliation(s)
- Guillaume Bosio
- Institute of Biomedical Engineering, University of Montreal, Montréal, Québec, Canada
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montréal, Québec, Canada
| | - Nora Zenati
- UGA UFRM-Université Grenoble Alpes-UFR Médecine, Grenoble, France
| | - François Destrempes
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montréal, Québec, Canada
| | - Boris Chayer
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montréal, Québec, Canada
| | - Gilles Pernod
- UGA UFRM-Université Grenoble Alpes-UFR Médecine, Grenoble, France
- Centre Hospitalier Universitaire de Grenoble, Grenoble, France
- F-CRIN INNOVTE Network, Saint Etienne, France
| | - Guy Cloutier
- Institute of Biomedical Engineering, University of Montreal, Montréal, Québec, Canada
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montréal, Québec, Canada
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Montréal, Québec, Canada
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Venous Thromboembolism. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ajmal F, Haroon M, Kaleem U, Gul A, Khan J. Comparison of Chemical and Mechanical Prophylaxis of Venous Thromboembolism in Non-surgical Mechanically Ventilated Patients. Cureus 2021; 13:e19548. [PMID: 34917432 PMCID: PMC8668419 DOI: 10.7759/cureus.19548] [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] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
To compare the efficacy of mechanical and chemical prophylaxis in non-surgically mechanically ventilated patients in terms of reduction in mortality and length of hospital stay. A total of 200 patients admitted to intensive care units (ICUs) were recruited retrospectively. Half participants received mechanical prophylaxis and half received chemical prophylaxis. Patients with medical diseases with age 18 years or above, both genders, Pakistani nationals, receiving mechanical ventilation for more than 48 hours or receiving subcutaneous low molecular weight (LMW) heparin or subcutaneous unfractionated heparin were included. Cases who undergone surgery and were then admitted to ICU, those who received both mechanical and chemical therapies, and patients who received anticoagulant treatment before admission to ICU were excluded from the study. The patient’s age, gender, length of stay in ICU, and mortality were recorded in each group. Chi-square test was used to compare categorical data and Student t-test for continuous variables. The mean age was 55.51±8.37 years. The males were 108(54%) and females were 92(46%). The mortality rate was higher in the mechanical prophylaxis group (49%) than chemical (31%) statistically significantly (P=0.014). Similarly, the length of hospital stay was also higher in the mechanical prophylaxis group (7.27±0.897 days) than chemical (6.67±1.045) statistically (P<0.001). Chemical prophylaxis can reduce mortality and length of hospital stay more effectively than mechanical prophylaxis in ICUs admitted patients.
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Affiliation(s)
- Fahad Ajmal
- Critical Care Medicine, Bahria International Hospital, Rawalpindi, Rawalpindi, PAK
| | - Mohammad Haroon
- Internal Medicine, Bahria International Hospital, Rawalpindi, Rawalpindi, PAK
| | - Umar Kaleem
- Critical Care Medicine, Bahria International Hospital, Rawalpindi, Rawalpindi, PAK
| | - Aisha Gul
- Critical Care Medicine, Bahria International Hospital, Rawalpindi, Rawalpindi, PAK
| | - Jawad Khan
- Critical Care Medicine, Bahria International Hospital, Rawalpindi, Rawalpindi, PAK
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Rinaldi I, Hamonangan R, Azizi MS, Cahyanur R, Wirawan F, Fatya AI, Budiananti A, Winston K. Diagnostic Value of Neutrophil Lymphocyte Ratio and D-Dimer as Biological Markers of Deep Vein Thrombosis in Patients Presenting with Unilateral Limb Edema. J Blood Med 2021; 12:313-325. [PMID: 34295202 PMCID: PMC8290850 DOI: 10.2147/jbm.s291226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/26/2021] [Indexed: 01/25/2023] Open
Abstract
Introduction Patients with deep vein thrombosis (DVT) pose high morbidity and mortality risk thus needing fast and accurate diagnosis. Wells clinical prediction scores with D-dimer testing are traditionally used to rule out patients with low probability of DVT. However, D-dimer testing has a few limitations regarding its relatively low specificity. Neutrophil-lymphocyte ratio (NLR), a marker of inflammation, was found to increase in DVT. Hence, we aimed to evaluate the role of NLR for DVT diagnosis. Methods Data were collected from medical records of patients with suspected DVT at Cipto Mangunkusumo National General Hospital during January–December 2014. Diagnosis of DVT was conducted using lower limb ultrasonography. Diagnostic values for NLR, D-dimer, and NLR + D-dimer were determined by receiver operating characteristic (ROC) analysis to obtain area under the curve (AUC), sensitivity, specificity, negative predictive value, and positive predictive values. Sensitivity and specificity analyses of NLR and D-dimer were also conducted based on Wells score and divided into groups of low and high probability of DVT. Results The AUC values for NLR, D-dimer, and NLR + D-dimer were 72.6%, 70.4%, and 76.1%, respectively. The optimal cut-off value determined for NLR was 5.12 with sensitivity of 67.7%, specificity of 67.9%, PPV of 68.85%, and NPV of 64.91% in differentiating subjects with and without DVT. This study also found that D-dimer had sensitivity of 69.4%, specificity of 71.4%, PPV of 72.88%, and NPV of 67.8%. Meanwhile, the NLR + D-dimer combination had sensitivity of 66.1% and specificity of 72.6%. Multivariate analysis showed that NLR (OR: 2.636; 95% CI: 1.144–6.076; p: 0.023) and D-dimer (OR: 4.175; 95% CI: 1.810–9.633; p: 0.001) were associated with DVT. Conclusion NLR value has wider AUC than D-Dimer and is relatively easier to obtain and does not require specific assay, thus enabling rapid evaluation of symptomatic patients suspected of having DVT. Adding NLR to D-dimer increased AUC to detect DVT. Therefore, NLR could serve as a complementary diagnostic tool for D-dimer to exclude DVT, especially in low clinical probability patients.
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Affiliation(s)
- Ikhwan Rinaldi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Rachmat Hamonangan
- Department of Internal Medicine, PGI Cikini Hospital, Jakarta, Indonesia
| | - Mohamad Syahrir Azizi
- Division of Cardiology, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Rahmat Cahyanur
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Fadila Wirawan
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Atikah Isna Fatya
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ageng Budiananti
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Kevin Winston
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Venous Thromboembolism. Fam Med 2021. [DOI: 10.1007/978-1-4939-0779-3_88-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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10
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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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Campello E, Spiezia L, Simion C, Tormene D, Camporese G, Dalla Valle F, Poretto A, Bulato C, Gavasso S, Radu CM, Simioni P. Direct Oral Anticoagulants in Patients With Inherited Thrombophilia and Venous Thromboembolism: A Prospective Cohort Study. J Am Heart Assoc 2020; 9:e018917. [PMID: 33222589 PMCID: PMC7763770 DOI: 10.1161/jaha.120.018917] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background In this prospective cohort study, we aimed to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) versus heparin/vitamin K antagonists for the treatment of venous thromboembolism (VTE) in patients with inherited thrombophilia. Methods and Results We enrolled consecutive patients with acute VTE and inherited thrombophilia treated with DOACs (cases) or heparin/vitamin K antagonists (controls), matched for age, sex, ethnicity, and thrombophilia type. End points were VTE recurrence and bleeding complications; residual vein thrombosis and post‐thrombotic syndrome; VTE recurrence after anticoagulant discontinuation. Two hundred fifty‐five cases (age 52.4±17.3 years, Female 44.3%, severe thrombophilia 33.1%) and 322 controls (age 49.7±18.1 years, Female 50.3%, severe thrombophilia 35.1%) were included. The cumulative incidence of VTE recurrence during anticoagulation was 1.09% in cases versus 1.83%, adjusted hazard ratio (HR) 0.67 (95% CI, 0.16–2.77). The cumulative incidence of bleeding was 10.2% in cases versus 4.97%, HR 2.24 (95% CI 1.10–4.58). No major bleedings occurred in cases (versus 3 in controls). No significant differences regarding residual vein thrombosis and post‐thrombotic syndrome. After anticoagulant discontinuation, DOACs yielded a significantly lower 2‐year VTE recurrence risk versus traditional anticoagulants (HR, 0.61 [95% CI, 0.47–0.82]). Conclusions DOACs and heparin/vitamin K antagonists showed a similar efficacy in treating VTE in patients with thrombophilia. Although major bleeding episodes were recorded solely with heparin/vitamin K antagonists, we noted an overall increased bleeding rate with DOACs. The use of DOACs was associated with a lower 2‐year risk of VTE recurrence after anticoagulant discontinuation.
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Affiliation(s)
- Elena Campello
- Thrombotic and Hemorrhagic Diseases Unit Department of Medicine Padova University Hospital Padova Italy
| | - Luca Spiezia
- Thrombotic and Hemorrhagic Diseases Unit Department of Medicine Padova University Hospital Padova Italy
| | - Chiara Simion
- Thrombotic and Hemorrhagic Diseases Unit Department of Medicine Padova University Hospital Padova Italy
| | - Daniela Tormene
- Thrombotic and Hemorrhagic Diseases Unit Department of Medicine Padova University Hospital Padova Italy
| | | | - Fabio Dalla Valle
- Thrombotic and Hemorrhagic Diseases Unit Department of Medicine Padova University Hospital Padova Italy
| | - Anna Poretto
- Thrombotic and Hemorrhagic Diseases Unit Department of Medicine Padova University Hospital Padova Italy
| | - Cristiana Bulato
- Thrombotic and Hemorrhagic Diseases Unit Department of Medicine Padova University Hospital Padova Italy
| | - Sabrina Gavasso
- Thrombotic and Hemorrhagic Diseases Unit Department of Medicine Padova University Hospital Padova Italy
| | - Claudia Maria Radu
- Thrombotic and Hemorrhagic Diseases Unit Department of Medicine Padova University Hospital Padova Italy
| | - Paolo Simioni
- Thrombotic and Hemorrhagic Diseases Unit Department of Medicine Padova University Hospital Padova Italy
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Wu B, Chen S, Zhuang L, Zeng J. The expression level of COX7C associates with venous thromboembolism in colon cancer patients. Clin Exp Med 2020; 20:527-533. [PMID: 32653968 DOI: 10.1007/s10238-020-00644-1] [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: 05/19/2020] [Accepted: 07/02/2020] [Indexed: 12/13/2022]
Abstract
Venous thromboembolism (VTE) is a common complication of colon cancer. In the present study, we aimed to explore the association of the oncogene COX7C to VTE in colon cancer patients. Samples from 580 patients were examined histologically for VTE and pathological characteristic of cancer. Gene mutation and expression analysis were performed using polymerase chain reaction-based assays to evaluate genes related to VTE, including COX7C. Univariate analysis between clinical pathological factors and VTE was conducted. Logistic regression analysis was performed for the prediction of VTE by pathological factors and gene expressions. Among patients investigated, a total of 56 patients had VTE. COX7C had a significant correlation with VTE (p < 0.001). Despite a correlation between tumor size, invasion depth of tumor, lymph node metastasis, lymph node metastasis, distant metastasis, lymphovascular invasion, histologic type and pathology type, Ki-67, and some other genes, to VTE (p > 0.05), only COX7C expression demonstrated significance in its ability to predict VTE. Here, we show that COX7C upregulation strongly correlates with VTE in colon cancer, which implicates its role as a biomarker and therapeutic target of VTE in colon cancer.
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Affiliation(s)
- Biyu Wu
- Department of Nursing, Quanzhou First Hospital Affiliated To Fujian Medical University, No.250 East Street, Licheng District, Quanzhou, 362000, Fujian, China
| | - Shurong Chen
- Department of Geriatric, Quanzhou First Hospital Affiliated To Fujian Medical University, No.250 East Street, Licheng District, Quanzhou, 362000, Fujian, China
| | - Lihong Zhuang
- Second Department of Gastrointestinal Surgery, Quanzhou First Hospital Affiliated To Fujian Medical University, No.250 East Street, Licheng District, Quanzhou, 362000, Fujian, China
| | - Jingyang Zeng
- Department of Anesthesiology, Quanzhou First Hospital Affiliated To Fujian Medical University, No.250 East Street, Licheng District, Quanzhou, 362000, Fujian, China.
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Gibbs L, Moulton J, Tichenor V. Venous Thromboembolism. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_88-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Analysis of the Association Between MicroRNA Biogenesis Gene Polymorphisms and Venous Thromboembolism in Koreans. Int J Mol Sci 2019; 20:ijms20153771. [PMID: 31374978 PMCID: PMC6695971 DOI: 10.3390/ijms20153771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 07/26/2019] [Accepted: 07/31/2019] [Indexed: 12/15/2022] Open
Abstract
Venous thromboembolism (VTE) involves the formation of a blood clot, typically in the deep veins of the leg or arm (deep vein thrombosis), which then travels via the circulatory system and ultimately lodges in the lungs, resulting in pulmonary embolism. A number of microRNAs (miRNAs) are well-known regulators of thrombosis and thrombolysis, and mutations in miRNA biogenesis genes, such as DICER1, DROSHA have been implicated in miRNA synthesis and function. We investigated the genetic association between polymorphisms in four miRNA biogenesis genes, DICER1 rs3742330A > G, DROSHA rs10719T > C, RAN rs14035C > T and XPO5 rs11077A > C, and VTE in 503 Koreans: 300 controls and 203 patients. Genotyping was assessed with polymerase chain reaction-restriction fragment length polymorphism assays. We detected associations between polymorphisms in RAN and XPO5 and VTE prevalence (RAN rs14035CC + CT versus TT: p = 0.018; XPO5 rs11077AA + AC versus CC: p < 0.001). Analysis of allele combinations of all four polymorphisms (DICER1, DROSHA, RAN, XPO5) revealed that A-T-T-A was associated with decreased VTE prevalence (p = 0.0002), and A-T-C-C was associated with increased VTE prevalence (p = 0.027). Moreover, in subjects with provoked VTE, the DROSHA rs10719T > C, polymorphism was associated with increased disease prevalence (TT versus TC + CC: p < 0.039). Our study demonstrates that RAN and XPO5 polymorphisms are associated with risk for VTE in Korean subjects.
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Ramacciotti E, Aguiar VCR, Júnior VC, Casella IB, Zerati AE, Fareed J. Edoxaban for Venous Thromboembolism Treatment-The New Kid on The Block for Latin America. A Practical Guide. Clin Appl Thromb Hemost 2018; 24:340S-349S. [PMID: 30486661 PMCID: PMC6714848 DOI: 10.1177/1076029618812955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Edoxaban, a direct factor Xa inhibitor (FXa), is the fourth direct oral anticoagulant
(DOAC) approved for clinical use in the treatment of venous thromboembolism (VTE) in Latin
America, following global approvals for this indication. Edoxaban features some particular
characteristics when compared to the previously approved DOACs. This review summarizes the
main properties of edoxaban, the outcomes results of its pivotal global clinical trials
and the peculiar clinical features of this compound. This practical guide aims to help
Latin America clinicians understand edoxaban, its proper indication and its use for the
appropriate patients with VTE.
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Affiliation(s)
- Eduardo Ramacciotti
- Vascular Surgery, Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, Brazil.,Vascular Surgery, Hospital e Maternidade Dr. Christóvão da Gama, Santo André, São Paulo, Brazil.,Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
| | | | | | | | | | - Jawed Fareed
- Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
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16
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Stevens H, Tran H. Update on diagnosis and anticoagulant therapy for venous thromboembolism. Intern Med J 2018; 48:1175-1184. [DOI: 10.1111/imj.14063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 07/06/2018] [Accepted: 07/08/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Hannah Stevens
- Department of Haematology; Alfred Hospital; Melbourne Victoria Australia
- Haemostasis and Thrombosis Unit; Alfred Hospital; Melbourne Victoria Australia
- Australian Centre for Blood Diseases; Monash University; Melbourne Victoria Australia
| | - Huyen Tran
- Department of Haematology; Alfred Hospital; Melbourne Victoria Australia
- Haemostasis and Thrombosis Unit; Alfred Hospital; Melbourne Victoria Australia
- Australian Centre for Blood Diseases; Monash University; Melbourne Victoria Australia
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17
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Antipsychotic drugs may increase the risk of venous thromboembolism. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-018-0535-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Shabani Varaki E, Gargiulo GD, Penkala S, Breen PP. Peripheral vascular disease assessment in the lower limb: a review of current and emerging non-invasive diagnostic methods. Biomed Eng Online 2018; 17:61. [PMID: 29751811 PMCID: PMC5948740 DOI: 10.1186/s12938-018-0494-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/02/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Worldwide, at least 200 million people are affected by peripheral vascular diseases (PVDs), including peripheral arterial disease (PAD), chronic venous insufficiency (CVI) and deep vein thrombosis (DVT). The high prevalence and serious consequences of PVDs have led to the development of several diagnostic tools and clinical guidelines to assist timely diagnosis and patient management. Given the increasing number of diagnostic methods available, a comprehensive review of available technologies is timely in order to understand their limitations and direct future development effort. MAIN BODY This paper reviews the available diagnostic methods for PAD, CVI, and DVT with a focus on non-invasive modalities. Each method is critically evaluated in terms of sensitivity, specificity, accuracy, ease of use, procedure time duration, and training requirements where applicable. CONCLUSION This review emphasizes the limitations of existing methods, highlighting a latent need for the development of new non-invasive, efficient diagnostic methods. Some newly emerging technologies are identified, in particular wearable sensors, which demonstrate considerable potential to address the need for simple, cost-effective, accurate and timely diagnosis of PVDs.
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Affiliation(s)
- Elham Shabani Varaki
- The MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Penrith, NSW, 2750, Australia.
| | - Gaetano D Gargiulo
- The MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Penrith, NSW, 2750, Australia
| | - Stefania Penkala
- School of Science and Health, Western Sydney University, Penrith, NSW, 2750, Australia
| | - Paul P Breen
- The MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Penrith, NSW, 2750, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, NSW, 2750, Australia
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19
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O'Brien A, Redley B, Wood B, Botti M, Hutchinson AF. STOPDVTs: Development and testing of a clinical assessment tool to guide nursing assessment of postoperative patients for Deep Vein Thrombosis. J Clin Nurs 2018; 27:1803-1811. [DOI: 10.1111/jocn.14329] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Alanna O'Brien
- Centre for Quality and Patient Safety Research-Epworth HealthCare Partnership; Deakin University; Geelong Vic. Australia
| | - Bernice Redley
- School of Nursing and Midwifery; Deakin University; Geelong Vic. Australia
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Monash Health; Deakin University; Clayton Vic. Australia
| | - Beverley Wood
- Centre for Quality and Patient Safety Research-Epworth HealthCare Partnership; Deakin University; Geelong Vic. Australia
- School of Nursing and Midwifery; Deakin University; Geelong Vic. Australia
| | - Mari Botti
- Centre for Quality and Patient Safety Research-Epworth HealthCare Partnership; Deakin University; Geelong Vic. Australia
- School of Nursing and Midwifery; Deakin University; Geelong Vic. Australia
| | - Anastasia F Hutchinson
- Centre for Quality and Patient Safety Research-Epworth HealthCare Partnership; Deakin University; Geelong Vic. Australia
- School of Nursing and Midwifery; Deakin University; Geelong Vic. Australia
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20
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Wang KL, Yap ES, Goto S, Zhang S, Siu CW, Chiang CE. The diagnosis and treatment of venous thromboembolism in asian patients. Thromb J 2018; 16:4. [PMID: 29375274 PMCID: PMC5774147 DOI: 10.1186/s12959-017-0155-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/20/2017] [Indexed: 02/07/2023] Open
Abstract
Although the incidence of venous thromboembolism (VTE) in Asian populations is lower than in Western countries, the overall burden of VTE in Asia has been considerably underestimated. Factors that may explain the lower prevalence of VTE in Asian populations relative to Western populations include the limited availability of epidemiological data in Asia, ethnic differences in the genetic predisposition to VTE, underdiagnoses, low awareness toward thrombotic disease, and possibly less symptomatic VTE in Asian patients. The clinical assessment, diagnostic testing, and therapeutic considerations for VTE are, in general, the same in Asian populations as they are in Western populations. The management of VTE is based upon balancing the treatment benefits against the risk of bleeding. This is an especially important consideration for Asian populations because of increased risk of intracranial hemorrhage with vitamin K antagonists. Non-vitamin K antagonist oral anticoagulants have shown advantages over current treatment modalities with respect to bleeding outcomes in major phase 3 clinical trials, including in Asian populations. Although anticoagulant therapy has been shown to reduce the risk of postoperative VTE in Western populations, VTE prophylaxis is not administered routinely in Asian countries. Despite advances in the management of VTE, data in Asian populations on the incidence, prevalence, recurrence, risk factors, and management of bleeding complications are limited and there is need for increased awareness. To that end, this review summarizes the available data on the epidemiology, risk stratification, diagnosis, and treatment considerations in the management of VTE in Asia.
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Affiliation(s)
- Kang-Ling Wang
- 1General Clinical Research Center, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., 11217 Taipei, Taiwan.,2School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Eng Soo Yap
- 3Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.,4Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Shinya Goto
- 5Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Shu Zhang
- 6Arrhythmia Center, National Center for Cardiovascular Diseases and Beijing Fuwai Hospital, Chinese Academy of Medical Sciences and Pekin Union Medical College, Beijing, China
| | - Chung-Wah Siu
- Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chern-En Chiang
- 1General Clinical Research Center, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., 11217 Taipei, Taiwan.,2School of Medicine, National Yang-Ming University, Taipei, Taiwan
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21
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Kovács S, Csiki Z, Zsóri KS, Bereczky Z, Shemirani AH. Characteristics of platelet count and size and diagnostic accuracy of mean platelet volume in patients with venous thromboembolism. A systematic review and meta-analysis. Platelets 2017; 30:139-147. [DOI: 10.1080/09537104.2017.1414175] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Sándor Kovács
- Department of Research Methodology and Statistics, Institute of Sectorial Economics and Methodology, Faculty of Economics and Business, Debrecen University, Debrecen, Hungary, Hungary
| | - Zoltán Csiki
- Department of Medicine, Debrecen University, Debrecen, Hungary, Hungary
| | - Katalin S Zsóri
- Central Pharmacy, Erzsébet hospital, Sátoraljaújhely, Hungary, Hungary
| | - Zsuzsanna Bereczky
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary Hungary
| | - Amir H. Shemirani
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary Hungary
- Central Laboratory, Erzsébet hospital, Sátoraljaújhely, Hungary, Hungary
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22
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Morphological Signs of Intravital Contraction (Retraction) of Pulmonary Thrombotic Emboli. BIONANOSCIENCE 2017. [DOI: 10.1007/s12668-017-0476-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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23
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Thiruganasambandamoorthy V, Stiell IG, Sivilotti MLA, Rowe BH, Mukarram M, Arcot K, Kwong K, McRae AD, Wells GA, Taljaard M. Predicting Short-term Risk of Arrhythmia among Patients With Syncope: The Canadian Syncope Arrhythmia Risk Score. Acad Emerg Med 2017; 24:1315-1326. [PMID: 28791782 DOI: 10.1111/acem.13275] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/31/2017] [Accepted: 08/04/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Syncope can be caused by serious occult arrhythmias not evident during initial emergency department (ED) evaluation. We sought to develop a risk tool for predicting 30-day arrhythmia or death after ED disposition. METHODS We conducted a multicenter prospective cohort study at six tertiary care EDs and included adults (≥16 years) with syncope. We collected standardized variables from clinical evaluation and investigations including electrocardiogram and troponin at index presentation. Adjudicated outcomes included death or arrhythmias including procedural interventions for arrhythmia within 30 days. We used multivariable logistic regression to derive the prediction model and bootstrapping for interval validation to estimate shrinkage and optimism. RESULTS A total of 5,010 patients (mean ± SD age = 53.4 ± 23.0 years, 54.8% females, and 9.5% hospitalized) were enrolled with 106 (2.1%) patients suffering 30-day arrhythmia/death after ED disposition. We examined 39 variables and eight were included in the final model: lack of vasovagal predisposition, heart disease, any ED systolic blood pressure < 90 or > 180 mm Hg, troponin (>99th percentile), QRS duration > 130 msec, QTc interval > 480 msec, and ED diagnosis of cardiac/vasovagal syncope (optimism corrected C-statistic 0.90 [95% CI = 0.87-0.93]; Hosmer-Lemeshow p = 0.08). The Canadian Syncope Arrhythmia Risk Score had a risk ranging from 0.2% to 74.5% for scores of -2 to 8. At a threshold score of ≥0, the sensitivity was 97.1% (95% CI = 91.6%-99.4%) and specificity was 53.4% (95% CI = 52.0%-54.9%). CONCLUSIONS The Canadian Syncope Arrhythmia Risk Score can improve patient safety by identification of those at risk for arrhythmias and aid in acute management decisions. Once validated, the score can identify low-risk patients who will require no further investigations.
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Affiliation(s)
- Venkatesh Thiruganasambandamoorthy
- Department of Emergency Medicine; University of Ottawa; Ottawa ON
- Department of Epidemiology and Community Medicine; University of Ottawa; Ottawa ON
- Ottawa Hospital Research Institute; The Ottawa Hospital; Ottawa ON
| | - Ian G. Stiell
- Department of Emergency Medicine; University of Ottawa; Ottawa ON
- Department of Epidemiology and Community Medicine; University of Ottawa; Ottawa ON
- Ottawa Hospital Research Institute; The Ottawa Hospital; Ottawa ON
| | - Marco L. A. Sivilotti
- Department of Emergency Medicine; Queen's University; Kingston ON
- Department of Biomedical and Molecular Sciences; Queen's University; Kingston ON
| | - Brian H. Rowe
- Department of Emergency Medicine and School of Public Health; Edmonton AB
| | | | - Kirtana Arcot
- Ottawa Hospital Research Institute; The Ottawa Hospital; Ottawa ON
| | - Kenneth Kwong
- Department of Epidemiology and Community Medicine; University of Ottawa; Ottawa ON
- Ottawa Hospital Research Institute; The Ottawa Hospital; Ottawa ON
| | - Andrew D. McRae
- Department of Emergency Medicine; University of Calgary; Calgary AB Canada
| | - George A. Wells
- Department of Epidemiology and Community Medicine; University of Ottawa; Ottawa ON
| | - Monica Taljaard
- Department of Epidemiology and Community Medicine; University of Ottawa; Ottawa ON
- Ottawa Hospital Research Institute; The Ottawa Hospital; Ottawa ON
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24
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Bruel S, Ginzarly M, Bertoletti L, Fayard P, Chapelier E, Seffert B, Simon-Momège B, Frappé P. Practical issues in suspected venous thrombosis in general practice: A multicentre prospective cohort in primary care. Thromb Res 2017; 158:19-21. [PMID: 28800412 DOI: 10.1016/j.thromres.2017.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/31/2017] [Accepted: 08/04/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Sébastien Bruel
- Department of General Practice, University of Saint-Etienne, Saint-Etienne, France; INSERM U1059, Sainbiose-Dysfonction Vasculaire et Hémostase, Saint-Etienne, France.
| | - Mouzayan Ginzarly
- Department of General Practice, University of Saint-Etienne, Saint-Etienne, France; INSERM U1059, Sainbiose-Dysfonction Vasculaire et Hémostase, Saint-Etienne, France
| | - Laurent Bertoletti
- INSERM U1059, Sainbiose-Dysfonction Vasculaire et Hémostase, Saint-Etienne, France; Department of Vascular and Therapeutic Medicine, University Hospital of Saint-Etienne, Saint-Etienne, France; INSERM CIC1408, Saint-Etienne, France
| | | | | | - Benjamin Seffert
- Department of Vascular and Therapeutic Medicine, University Hospital of Saint-Etienne, Saint-Etienne, France
| | | | - Paul Frappé
- Department of General Practice, University of Saint-Etienne, Saint-Etienne, France; INSERM U1059, Sainbiose-Dysfonction Vasculaire et Hémostase, Saint-Etienne, France; INSERM CIC1408, Saint-Etienne, France
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25
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Verma K, Legnani C, Palareti G. Cost-minimization analysis of venous thromboembolism diagnosis: Comparison of standalone imaging with a strategy incorporating D-dimer for exclusion of venous thromboembolism. Res Pract Thromb Haemost 2017; 1:57-61. [PMID: 30046674 PMCID: PMC6058208 DOI: 10.1002/rth2.12008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/02/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The burden of healthcare costs has substantially risen in the last few decades. One possible contributing factor to this increase are the diagnostic approaches for venous thromboembolism (VTE) using only imaging to exclude a diagnosis of VTE. OBJECTIVE To demonstrate cost minimization in the diagnosis of VTE by comparing standalone imaging (computed tomography pulmonary angiography and compression ultrasonography) to a published VTE diagnostic strategy incorporating assessment of pre-test probability and D-dimer testing. METHODS We retrospectively reviewed data from a multicenter diagnostic accuracy study of a D-dimer reagent where consecutive outpatients (n=747) with suspected VTE, including both pulmonary embolism (n=346) and deep venous thrombosis (n=401) were evaluated. By applying a VTE diagnostic strategy and using the proportion of patients that were diagnosed as VTE-negative (n=137 for PE; n=120 for DVT), we developed a cost calculator to compare the average diagnostic test cost per suspected VTE patient, both before and after the implementation of the VTE diagnostic strategy. RESULTS Implementation of the VTE diagnostic strategy reduced the average diagnostic test cost for a suspected PE patient by 38% and for a suspected DVT patient by 24%. Assuming the proportion of VTE suspected patients to be 30% PE and 70% DVT, the weighted average reduction in the diagnostic test cost per suspected VTE patient was 32%. CONCLUSION Implementation of a VTE diagnostic strategy can allow hospitals to reduce costs without compromising patient safety.
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Affiliation(s)
| | - Cristina Legnani
- Angiology and Blood CoagulationUniversity Hospital of BolognaBolganaItaly
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26
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Venous Thromboembolism. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Kim JY, Im S, Choi YM, Jang YJ, Chae CS, Park GY. Relationship Between Deep Vein Thrombosis and Lower Limb Swelling in Patients with Brain Lesions. BRAIN & NEUROREHABILITATION 2017. [DOI: 10.12786/bn.2017.10.e17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ju Yong Kim
- Medical Corps of 21st Division, Republic of Korea Army, Yanggu, Korea
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Yong Min Choi
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong Jun Jang
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Choong Sik Chae
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Geun-Young Park
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
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28
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Amin A, Marrs JC. Direct Oral Anticoagulants for the Management of Thromboembolic Disorders. Clin Appl Thromb Hemost 2016; 22:605-16. [DOI: 10.1177/1076029615601492] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Anticoagulation therapy is central to the management of thromboembolic disorders, and the use of direct oral anticoagulants offers several advantages over standard therapy with parenteral heparins and vitamin K antagonists. In phase III clinical trials, the direct oral anticoagulants (given once or twice daily) all demonstrated favorable benefit–risk profiles compared with conventional standard therapy for the treatment and secondary prevention of venous thromboembolism and for stroke prevention in patients with nonvalvular atrial fibrillation. In clinical practice, many factors may influence overall clinical outcomes in patients receiving anticoagulant therapy, including adherence and persistence to the prescribed therapy, which becomes particularly important during long-term therapy. When choosing an anticoagulant for an individual patient, the pharmacological and clinical profile of the anticoagulant, its dosing regimen, and the patient’s clinical characteristics (eg, renal function and comorbidities) and preferences should be considered. This review examines the rationale for and clinical evidence of the selected dosing regimens of the direct oral anticoagulants for the treatment of venous thromboembolism and stroke prevention in nonvalvular atrial fibrillation. The potential influence of dosing strategies (eg, once- or twice-daily dosing) and other factors on patient adherence and therapy persistence are also discussed.
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Affiliation(s)
- Alpesh Amin
- Anticoagulation Services, Department of Medicine, Irvine School of Medicine, University of California, Orange, CA, USA
| | - Joel C. Marrs
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
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29
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Thiruganasambandamoorthy V, Kwong K, Wells GA, Sivilotti MLA, Mukarram M, Rowe BH, Lang E, Perry JJ, Sheldon R, Stiell IG, Taljaard M. Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope. CMAJ 2016; 188:E289-E298. [PMID: 27378464 DOI: 10.1503/cmaj.151469] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 03/16/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Syncope can be caused by serious conditions not evident during initial evaluation, which can lead to serious adverse events, including death, after disposition from the emergency department. We sought to develop a clinical decision tool to identify adult patients with syncope who are at risk of a serious adverse event within 30 days after disposition from the emergency department. METHODS We prospectively enrolled adults (age ≥ 16 yr) with syncope who presented within 24 hours after the event to 1 of 6 large emergency departments from Sept. 29, 2010, to Feb. 27, 2014. We collected standardized variables at index presentation from clinical evaluation and investigations. Adjudicated serious adverse events included death, myocardial infarction, arrhythmia, structural heart disease, pulmonary embolism, serious hemorrhage and procedural interventions within 30 days. RESULTS We enrolled 4030 patients with syncope; the mean age was 53.6 years, 55.5% were women, and 9.5% were admitted to hospital. Serious adverse events occurred in 147 (3.6%) of the patients within 30 days after disposition from the emergency department. Of 43 candidate predictors examined, we included 9 in the final model: predisposition to vasovagal syncope, heart disease, any systolic pressure reading in the emergency department < 90 or > 180 mm Hg, troponin level above 99th percentile for the normal population, abnormal QRS axis (< -30° or > 100°), QRS duration longer than 130 ms, QTc interval longer than 480 ms, emergency department diagnosis of cardiac syncope and emergency department diagnosis of vasovagal syncope (C statistic 0.88, 95% confidence interval [CI] 0.85-0.90; optimism 0.015; goodness-of-fit p = 0.11). The risk of a serious adverse event within 30 days ranged from 0.4% for a score of -3 to 83.6% for a score of 11. The sensitivity was 99.2% (95% CI 95.9%-100%) for a threshold score of -2 or higher and 97.7% (95% CI 93.5%-99.5%) for a threshold score of -1 or higher. INTERPRETATION The Canadian Syncope Risk Score showed good discrimination and calibration for 30-day risk of serious adverse events after disposition from the emergency department. Once validated, the tool will be able to accurately stratify the risk of serious adverse events among patients presenting with syncope, including those at low risk who can be discharged home quickly.
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Affiliation(s)
- Venkatesh Thiruganasambandamoorthy
- Departments of Emergency Medicine (Thiruganasambandamoorthy, Perry, Stiell) and of Epidemiology and Community Medicine (Thiruganasambandamoorthy, Kwong, Wells, Perry, Stiell, Taljaard), University of Ottawa; Ottawa Hospital Research Institute (Thiruganasambandamoorthy, Kwong, Mukarram, Perry, Stiell, Taljaard), The Ottawa Hospital, Ottawa, Ont.; Departments of Emergency Medicine (Sivilotti) and of Biomedical and Molecular Sciences (Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Departments of Emergency Medicine (Lang) and Medicine (Sheldon), University of Calgary, Calgary, Alta.
| | - Kenneth Kwong
- Departments of Emergency Medicine (Thiruganasambandamoorthy, Perry, Stiell) and of Epidemiology and Community Medicine (Thiruganasambandamoorthy, Kwong, Wells, Perry, Stiell, Taljaard), University of Ottawa; Ottawa Hospital Research Institute (Thiruganasambandamoorthy, Kwong, Mukarram, Perry, Stiell, Taljaard), The Ottawa Hospital, Ottawa, Ont.; Departments of Emergency Medicine (Sivilotti) and of Biomedical and Molecular Sciences (Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Departments of Emergency Medicine (Lang) and Medicine (Sheldon), University of Calgary, Calgary, Alta
| | - George A Wells
- Departments of Emergency Medicine (Thiruganasambandamoorthy, Perry, Stiell) and of Epidemiology and Community Medicine (Thiruganasambandamoorthy, Kwong, Wells, Perry, Stiell, Taljaard), University of Ottawa; Ottawa Hospital Research Institute (Thiruganasambandamoorthy, Kwong, Mukarram, Perry, Stiell, Taljaard), The Ottawa Hospital, Ottawa, Ont.; Departments of Emergency Medicine (Sivilotti) and of Biomedical and Molecular Sciences (Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Departments of Emergency Medicine (Lang) and Medicine (Sheldon), University of Calgary, Calgary, Alta
| | - Marco L A Sivilotti
- Departments of Emergency Medicine (Thiruganasambandamoorthy, Perry, Stiell) and of Epidemiology and Community Medicine (Thiruganasambandamoorthy, Kwong, Wells, Perry, Stiell, Taljaard), University of Ottawa; Ottawa Hospital Research Institute (Thiruganasambandamoorthy, Kwong, Mukarram, Perry, Stiell, Taljaard), The Ottawa Hospital, Ottawa, Ont.; Departments of Emergency Medicine (Sivilotti) and of Biomedical and Molecular Sciences (Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Departments of Emergency Medicine (Lang) and Medicine (Sheldon), University of Calgary, Calgary, Alta
| | - Muhammad Mukarram
- Departments of Emergency Medicine (Thiruganasambandamoorthy, Perry, Stiell) and of Epidemiology and Community Medicine (Thiruganasambandamoorthy, Kwong, Wells, Perry, Stiell, Taljaard), University of Ottawa; Ottawa Hospital Research Institute (Thiruganasambandamoorthy, Kwong, Mukarram, Perry, Stiell, Taljaard), The Ottawa Hospital, Ottawa, Ont.; Departments of Emergency Medicine (Sivilotti) and of Biomedical and Molecular Sciences (Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Departments of Emergency Medicine (Lang) and Medicine (Sheldon), University of Calgary, Calgary, Alta
| | - Brian H Rowe
- Departments of Emergency Medicine (Thiruganasambandamoorthy, Perry, Stiell) and of Epidemiology and Community Medicine (Thiruganasambandamoorthy, Kwong, Wells, Perry, Stiell, Taljaard), University of Ottawa; Ottawa Hospital Research Institute (Thiruganasambandamoorthy, Kwong, Mukarram, Perry, Stiell, Taljaard), The Ottawa Hospital, Ottawa, Ont.; Departments of Emergency Medicine (Sivilotti) and of Biomedical and Molecular Sciences (Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Departments of Emergency Medicine (Lang) and Medicine (Sheldon), University of Calgary, Calgary, Alta
| | - Eddy Lang
- Departments of Emergency Medicine (Thiruganasambandamoorthy, Perry, Stiell) and of Epidemiology and Community Medicine (Thiruganasambandamoorthy, Kwong, Wells, Perry, Stiell, Taljaard), University of Ottawa; Ottawa Hospital Research Institute (Thiruganasambandamoorthy, Kwong, Mukarram, Perry, Stiell, Taljaard), The Ottawa Hospital, Ottawa, Ont.; Departments of Emergency Medicine (Sivilotti) and of Biomedical and Molecular Sciences (Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Departments of Emergency Medicine (Lang) and Medicine (Sheldon), University of Calgary, Calgary, Alta
| | - Jeffrey J Perry
- Departments of Emergency Medicine (Thiruganasambandamoorthy, Perry, Stiell) and of Epidemiology and Community Medicine (Thiruganasambandamoorthy, Kwong, Wells, Perry, Stiell, Taljaard), University of Ottawa; Ottawa Hospital Research Institute (Thiruganasambandamoorthy, Kwong, Mukarram, Perry, Stiell, Taljaard), The Ottawa Hospital, Ottawa, Ont.; Departments of Emergency Medicine (Sivilotti) and of Biomedical and Molecular Sciences (Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Departments of Emergency Medicine (Lang) and Medicine (Sheldon), University of Calgary, Calgary, Alta
| | - Robert Sheldon
- Departments of Emergency Medicine (Thiruganasambandamoorthy, Perry, Stiell) and of Epidemiology and Community Medicine (Thiruganasambandamoorthy, Kwong, Wells, Perry, Stiell, Taljaard), University of Ottawa; Ottawa Hospital Research Institute (Thiruganasambandamoorthy, Kwong, Mukarram, Perry, Stiell, Taljaard), The Ottawa Hospital, Ottawa, Ont.; Departments of Emergency Medicine (Sivilotti) and of Biomedical and Molecular Sciences (Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Departments of Emergency Medicine (Lang) and Medicine (Sheldon), University of Calgary, Calgary, Alta
| | - Ian G Stiell
- Departments of Emergency Medicine (Thiruganasambandamoorthy, Perry, Stiell) and of Epidemiology and Community Medicine (Thiruganasambandamoorthy, Kwong, Wells, Perry, Stiell, Taljaard), University of Ottawa; Ottawa Hospital Research Institute (Thiruganasambandamoorthy, Kwong, Mukarram, Perry, Stiell, Taljaard), The Ottawa Hospital, Ottawa, Ont.; Departments of Emergency Medicine (Sivilotti) and of Biomedical and Molecular Sciences (Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Departments of Emergency Medicine (Lang) and Medicine (Sheldon), University of Calgary, Calgary, Alta
| | - Monica Taljaard
- Departments of Emergency Medicine (Thiruganasambandamoorthy, Perry, Stiell) and of Epidemiology and Community Medicine (Thiruganasambandamoorthy, Kwong, Wells, Perry, Stiell, Taljaard), University of Ottawa; Ottawa Hospital Research Institute (Thiruganasambandamoorthy, Kwong, Mukarram, Perry, Stiell, Taljaard), The Ottawa Hospital, Ottawa, Ont.; Departments of Emergency Medicine (Sivilotti) and of Biomedical and Molecular Sciences (Sivilotti), Queen's University, Kingston, Ont.; Department of Emergency Medicine and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Departments of Emergency Medicine (Lang) and Medicine (Sheldon), University of Calgary, Calgary, Alta
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30
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Feng YX, Yang LJ, Li T, Dong HW, Yao HC, Liu FZ. Association between elevated D-dimer levels and adverse outcome in patients with acute heart failure. Int J Cardiol 2016; 214:415-6. [DOI: 10.1016/j.ijcard.2016.03.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 03/29/2016] [Indexed: 10/22/2022]
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Yamada SM, Tomita Y, Murakami H, Nakane M. Deep Vein Thrombosis in the Lower Extremities in Comatose Elderly Patients with Acute Neurological Diseases. Yonsei Med J 2016; 57:388-92. [PMID: 26847291 PMCID: PMC4740531 DOI: 10.3349/ymj.2016.57.2.388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 07/16/2015] [Accepted: 07/28/2015] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Comatose elderly patients with acute neurological illness have a great risk of deep vein thrombosis (DVT). In this study, the incidence of DVT and the effectiveness of early initiation of treatment were evaluated in those patients. MATERIALS AND METHODS Total 323 patients were admitted to our ward due to neurological diseases in one year, and 43 patients, whose Glasgow Coma Scale was ≤ 11 and who was older than ≥ 60 years, were included in this study. D-dimer was measured on admission and day 7, and lower-extremity ultrasonography was performed on day 7. When DVT was positive, heparin treatment was initiated, and further evaluation of pulmonary embolism (PE) was conducted. Vena cava filter protection was inserted in PE-positive patients. Incidence of DVT and PE, alteration of D-dimer value, and effect of heparin treatment were analyzed. RESULTS DVT was positive in 19 (44.2%) patients, and PE was in 4 (9.3%). D-dimer was significantly higher in DVT-positive group on day 7 (p<0.01). No DVT were identified in patients with ischemic disease, while 66.7% of intracerebral hemorrhage and 53.3% of brain contusion patients were DVT positive. Surgery was a definite risk factor for DVT, with an odds ratio of 5.25. DVT and PE disappeared by treatment in all cases, and no patients were succumbed to the thrombosis. CONCLUSION Patients with hemorrhagic diseases or who undergo operation possess high risk of DVT, and initiation of heparin treatment in 7 days after admission is an effective prophylaxis for DVT in comatose elderly patients without causing bleeding.
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Affiliation(s)
- Shoko Merrit Yamada
- Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan.
| | - Yusuke Tomita
- Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Hideki Murakami
- Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Makoto Nakane
- Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
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32
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Karakaya B, Tombak A, Serin MS, Tiftik N. Change in plasma a disintegrin and metalloprotease with thrombospondin type-1 repeats-13 and von Willebrand factor levels in venous thromboembolic patients. Hematology 2016; 21:295-9. [DOI: 10.1080/10245332.2015.1125079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Bulent Karakaya
- Internal Medicine Department, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Anil Tombak
- Hematology Department, Mersin University Faculty of Medicine, Mersin, Turkey
| | | | - Naci Tiftik
- Hematology Department, Mersin University Faculty of Medicine, Mersin, Turkey
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33
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Analysis of an algorithm incorporating limited and whole-leg assessment of the deep venous system in symptomatic outpatients with suspected deep-vein thrombosis (PALLADIO): a prospective, multicentre, cohort study. LANCET HAEMATOLOGY 2015; 2:e474-80. [DOI: 10.1016/s2352-3026(15)00190-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/20/2015] [Accepted: 08/25/2015] [Indexed: 11/21/2022]
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Soomro AY, Guerchicoff A, Nichols DJ, Suleman J, Dangas GD. The current role and future prospects of D-dimer biomarker. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2015; 2:175-84. [PMID: 27533759 DOI: 10.1093/ehjcvp/pvv039] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 09/23/2015] [Indexed: 11/14/2022]
Abstract
D-dimers have been discovered as by-products of fibrinolysis. In situations where the fundamental pathology is associated with increased thrombolytic activity, D-dimer assays could serve an integral role in the clinical workup, and have an already established role in the diagnosis of clinical disorders of venous thromboembolism, and disseminated intravascular coagulation. However, there is growing literature suggesting that this is not the only clinical scenario where D-dimers may be of significance. They may also become an important biomarker in coronary and carotid artery atherosclerosis and aortic diseases. Being a non-invasive and quick means of diagnosis, D-dimers are a cost-effective tool used for diagnosing diseases. With the future being steered in the direction of preventive cardiology, it is imperative for clinicians to understand how to effectively utilize biomarkers in order to diagnose disorders. In this context, we review D-dimer's origin, current clinical utility, and potential future applications.
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Affiliation(s)
- Armaghan Y Soomro
- Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA
| | - Alejandra Guerchicoff
- Cardiac Research Foundation, NY111 East 59th Street, 12th Floor, New York, NY 10022, USA
| | - Dru J Nichols
- Cardiac Research Foundation, NY111 East 59th Street, 12th Floor, New York, NY 10022, USA
| | - Javed Suleman
- Mount Sinai Hospital, 1 Gustave L. Levy Place # 504, New York, NY 10029, USA
| | - George D Dangas
- Cardiac Research Foundation, NY111 East 59th Street, 12th Floor, New York, NY 10022, USA Mount Sinai Hospital, 1 Gustave L. Levy Place # 504, New York, NY 10029, USA
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Han L, Jensen JT. Does the Progestogen Used in Combined Hormonal Contraception Affect Venous Thrombosis Risk? Obstet Gynecol Clin North Am 2015; 42:683-98. [PMID: 26598309 DOI: 10.1016/j.ogc.2015.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Combined hormonal contraceptives (CHCs) use a combination of estrogen and progestogen to provide contraception. The most important risk of using CHCs is venous thromboembolism (VTE). It is unclear whether the type of progestogen used in a method augments that risk. Although the evidence supporting an increase in thrombosis risk is not conclusive, neither is the evidence supporting the benefit of newer progestogens in terms of tolerability or continuation. The benefits of CHCs outweigh the risks and the absolute risk of VTE remains small. A balanced discussion of potential risks and benefits of particular CHC formulations is warranted during contraception counseling.
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Affiliation(s)
- Leo Han
- Department of Obstetrics and Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Jeffrey T Jensen
- Department of Obstetrics and Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
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36
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Muñoz-Figueroa GP, Ojo O. Venous thromboembolism: use of graduated compression stockings. ACTA ACUST UNITED AC 2015; 24:680, 682-5. [DOI: 10.12968/bjon.2015.24.13.680] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
| | - Omorogieva Ojo
- Senior Lecturer in Primary Care, Faculty of Education and Health, University of Greenwich, London
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37
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Frank B, Ariza L, Lamparter H, Grossmann V, Prochaska JH, Ullmann A, Kindler F, Weisser G, Walter U, Lackner KJ, Espinola-Klein C, Münzel T, Konstantinides SV, Wild PS. Rationale and design of three observational, prospective cohort studies including biobanking to evaluate and improve diagnostics, management strategies and risk stratification in venous thromboembolism: the VTEval Project. BMJ Open 2015; 5:e008157. [PMID: 26133379 PMCID: PMC4499722 DOI: 10.1136/bmjopen-2015-008157] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Venous thromboembolism (VTE) with its two manifestations deep vein thrombosis (DVT) and pulmonary embolism (PE) is a major public health problem. The VTEval Project aims to investigate numerous research questions on diagnosis, clinical management, treatment and prognosis of VTE, which have remained uncertain to date. METHODS AND ANALYSIS The VTEval Project consists of three observational, prospective cohort studies on VTE comprising cohorts of individuals with a clinical suspicion of acute PE (with or without DVT), with a clinical suspicion of acute DVT (without symptomatic PE) and with an incidental diagnosis of VTE (PE or DVT). The VTEval Project expects to enrol a total of approximately 2000 individuals with subsequent active and passive follow-up investigations over a time period of 5 years per participant. Time points for active follow-up investigations are at months 3, 6, 12, 24 and 36 after diagnosis (depending on the disease cohort); passive follow-up investigations via registry offices and the cancer registry are performed 48 and 60 months after diagnosis for all participants. Primary short-term outcome is defined by overall mortality (PE-related death and all other causes of death), primary long-term outcome by symptomatic VTE (PE-related death, recurrence of non-fatal PE or DVT). The VTEval Project includes three 'all-comer' studies and involves the standardised acquisition of high-quality data, covering the systematic assessment of VTE including symptoms, risk profile, psychosocial, environmental and lifestyle factors as well as clinical and subclinical disease, and it builds up a large state-of-the-art biorepository containing various materials from serial blood samplings. ETHICS AND DISSEMINATION The VTEval Project has been approved by the local data safety commissioner and the responsible ethics committee (reference no. 837.320.12 (8421-F)). Trial results will be published in peer-reviewed journals and presented at national and international scientific meetings. TRIAL REGISTRATION NUMBER NCT02156401.
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Affiliation(s)
- Bernd Frank
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Liana Ariza
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Heidrun Lamparter
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Vera Grossmann
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Jürgen H Prochaska
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
- Department of Medicine 2, University Medical Center Mainz, Mainz, Germany
| | - Alexander Ullmann
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Florentina Kindler
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Gerhard Weisser
- Department of Medicine 2, University Medical Center Mainz, Mainz, Germany
| | - Ulrich Walter
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany
| | | | - Thomas Münzel
- Department of Medicine 2, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site RhineMain, Mainz, Germany
| | | | - Philipp S Wild
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany
- Preventive Cardiology and Preventive Medicine, Department of Medicine 2, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site RhineMain, Mainz, Germany
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38
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Thrombophilia diagnosis: a retrospective analysis of a single-center experience. Blood Coagul Fibrinolysis 2015; 26:649-54. [PMID: 26083989 DOI: 10.1097/mbc.0000000000000332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
It is estimated that 30-50% of patients suffering from deep vein thrombosis (DVT) could be diagnosed with congenital or acquired thrombophilia. Its diagnosis, however, rarely changes the clinical management, but is associated with significant costs and negative psychological and social aspects. The aim of this study was to perform a retrospective analysis of the causes and clinical consequences of diagnostics for thrombophilia. A retrospective review of the medical records of 5600 patients was performed, 62 of whom had, at the time, been diagnosed for thrombophilia because of a thromboembolic event. A review of the current literature on the validity of diagnostic tests for hypercoagulability in certain clinical conditions was also performed. The most common reason for thrombophilia testing was episodes of lower limb DVT (56%). The most frequently diagnosed abnormalities were the heterozygous form of the V Leiden gene (18%), protein S deficiency (11%), and the anti cardiolipin antibody IgG (11%). In 45% of the patients, laboratory results did not confirm the presence of any congenital thrombophilia. After receiving the results, 11% of the respondents completed oral anticoagulation therapy after 3 months, and 28% of patients qualified for indefinite use of oral anticoagulant therapy. In most of the cases examined, the diagnosis of thrombophilia did not significantly affect the treatment. A common aberration identified in patients with a history of thromboembolic incidents was the coexistence of risk factors for atherosclerosis.
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39
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Huang W, Goldberg RJ, Cohen AT, Anderson FA, Kiefe CI, Gore JM, Spencer FA. Declining Long-term Risk of Adverse Events after First-time Community-presenting Venous Thromboembolism: The Population-based Worcester VTE Study (1999 to 2009). Thromb Res 2015; 135:1100-6. [PMID: 25921936 DOI: 10.1016/j.thromres.2015.04.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/02/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Contemporary trends in health-care delivery are shifting the management of venous thromboembolism (VTE) events (deep vein thrombosis [DVT] and/or pulmonary embolism [PE]) from the hospital to the community, which may have implications for its prevention, treatment, and outcomes. MATERIALS AND METHODS Population-based surveillance study monitoring trends in clinical epidemiology among residents of the Worcester, Massachusetts, metropolitan statistical area (WMSA) diagnosed with an acute VTE in all 12 WMSA hospitals. Patients were followed for up to 3 years after their index event. Total of 2334 WMSA residents diagnosed with first-time community-presenting VTE (occurring in an ambulatory setting or diagnosed within 24 hours of hospitalization) from 1999 through 2009. RESULTS While PE patients were consistently admitted to the hospital for treatment over time, the proportion diagnosed with DVT-alone admitted to the hospital decreased from 67% in 1999 to 37% in 2009 (p value for trend <0.001). Among hospitalized patients, the mean length of stay decreased from 5.6 to 4.8 days (p value for trend <0.001). Between 1999 and 2009, treatment of VTE shifted from warfarin and unfractionated heparin towards use of low-molecular-weight heparins and newer anticoagulants; also, 3-year cumulative event rates decreased for all-cause mortality (41-26%), major bleeding (12-6%), and recurrent VTE (17-9%). CONCLUSIONS A decade of change in VTE management was accompanied by improved long-term outcomes. However, rates of adverse events remained fairly high in our population-based surveillance study, implying that new risk-assessment tools to identify individuals at increased risk for developing major adverse outcomes over the long term are needed.
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Affiliation(s)
- W Huang
- Center for Outcomes Research, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
| | - R J Goldberg
- Department of Quantitative Health Science, University of Massachusetts Medical School, Worcester, MA, USA
| | - A T Cohen
- Haematological Medicine, Guy's and St Thomas' Hospitals, King's College, London, UK
| | - F A Anderson
- Center for Outcomes Research, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - C I Kiefe
- Department of Quantitative Health Science, University of Massachusetts Medical School, Worcester, MA, USA
| | - J M Gore
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - F A Spencer
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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40
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Venous Thromboembolism. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_88-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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41
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Blann A. Prevention and treatment of venous thromboembolism: the nurse's role in management. ACTA ACUST UNITED AC 2014. [DOI: 10.12968/bjca.2014.9.11.534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Andrew Blann
- Senior Lecturer and Consultant in Medicine, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham
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42
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Zwicker JI, Bauer KA. How long is long enough? Extended anticoagulation for the treatment of cancer-associated deep vein thrombosis. J Clin Oncol 2014; 32:3596-9. [PMID: 25267753 DOI: 10.1200/jco.2014.56.5184] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A previously healthy 41-year-old man presents with left leg pain and shortness of breath. He has a 20–packyear history of smoking but quit 2 years ago. An ultrasound of the left leg shows thrombosis of the superficial femoral and popliteal veins.Onchest computed tomography (CT) angiogram, there is a large right hilar mass and enlarged mediastinal lymph nodes but no pulmonary emboli. He is treated with therapeutic doses of low–molecular weight heparin (LMWH), with brief interruptions for invasive procedures and surgery. Transbronchial biopsy is performed, and pathology yields a diagnosis of poorly differentiated non–small cell lung cancer (NSCLC; EGFR/KRAS wild type and ALK and ROS1 negative by fluorescent in situ hybridization). After additional tests, the patient is determined to have stage IIIA NSCLC. Subsequently, he receives concurrent chemotherapy consisting of cisplatin/etoposide and chest radiotherapy, resulting in a marked decrease in the size of the right hilar mass and mediastinal lymph nodes. He then undergoes right upper lobectomy and mediastinal lymph node dissection, which demonstrate no clinical or pathologic evidence of cancer. The patient returns to clinic, having been treated for >6 months with LMWH. He reports both mild shortness of breath with exertion and minimal chronic swelling of the left lower extremity. A follow-up ultrasound shows nonocclusive intraluminal thrombus in the left superficial femoral and popliteal veins; follow-up chest CT angiogram shows no evidence of pulmonary emboli.
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Affiliation(s)
- Jeffrey I Zwicker
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Kenneth A Bauer
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Vázquez FJ, Posadas-Martínez ML, Sevilla SG, Giunta DH, Gándara E. The role compression ultrasound in hospitalized patients with suspected pulmonary embolism. Thromb Res 2014; 134:1162-3. [PMID: 25220940 DOI: 10.1016/j.thromres.2014.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/18/2014] [Accepted: 08/19/2014] [Indexed: 11/24/2022]
Affiliation(s)
- F J Vázquez
- Internal Medicine Research Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - M L Posadas-Martínez
- Internal Medicine Research Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - S G Sevilla
- Department of Medicine, Austral University, Pilar Buenos Argentina.
| | - D H Giunta
- Internal Medicine Research Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - E Gándara
- Divison of Hematology-Department of Medicine. University of Ottawa-Ottawa Hospital. Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada
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44
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Pollack CV. The use of oral anticoagulants for the treatment of venous thromboembolic events in an ED. Am J Emerg Med 2014; 32:1526-33. [PMID: 25315880 DOI: 10.1016/j.ajem.2014.08.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 08/26/2014] [Accepted: 08/28/2014] [Indexed: 12/01/2022] Open
Abstract
Venous thromboembolism (VTE) is a disease spectrum that ranges from deep vein thrombosis (DVT) to pulmonary embolism (PE). Rapid diagnosis and treatment of VTE by emergency care providers are critical for decreasing patient mortality, morbidity, and the incidence of recurrent events. Recent American College of Chest Physicians guidelines recommend initial treatment with unfractionated heparin, low-molecular weight heparin, or fondaparinux overlapped with warfarin for a minimum of 5 days for the treatment of VTE in most cases. Warfarin monotherapy is thereafter continued for 3, 6, or 12 months. These guidelines were published before the approval of target-specific oral anticoagulants (TSOACs), and they have yet to be updated to reflect these new treatment options. For some patients, TSOACs, which act by directly inhibiting factor IIa or factor Xa, may provide safer, more convenient alternatives to warfarin. Their advantages include ease of use, reduced monitoring requirements, and lower bleeding risk than traditional therapy. Additionally, clinical trials have established noninferiority of TSOACs to warfarin for the prevention of recurrent VTE. These trials have demonstrated that TSOACs exhibit similar or lower bleeding rates, particularly intracranial bleeding rates compared with warfarin. Anticoagulation therapy with TSOACs may allow early discharge or outpatient management options for low-risk patients with DVT and PE. This review addresses the importance of early diagnosis and treatment of VTE, outcomes of VTE risk assessment, key efficacy and safety data from phase 3 clinical trials for the various TSOACs for the treatment of DVT and PE, and the corresponding considerations for clinical practice.
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Affiliation(s)
- Charles V Pollack
- Department of Emergency Medicine, Pennsylvania Hospital, University of Pennsylvania
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45
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Khademvatani K, Seyyed-Mohammadzad MH, Akbari M, Rezaei Y, Eskandari R, Rostamzadeh A. The relationship between vitamin D status and idiopathic lower-extremity deep vein thrombosis. Int J Gen Med 2014; 7:303-9. [PMID: 24971035 PMCID: PMC4069050 DOI: 10.2147/ijgm.s64812] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Vitamin D has been shown to have an anticoagulant effect. A decrease in 25-hydroxyvitamin D [25(OH)D] concentration has also been associated with an increased risk of venous thromboembolism. Hence, we sought to determine the relationship between 25(OH) D levels and idiopathic lower-extremity deep vein thrombosis (DVT). Methods In a case control study, a total of 82 participants with idiopathic lower-extremity DVT were enrolled along with 85 sex- and age-matched healthy participants as controls. The plasma 25(OH)D levels were measured in all the studied samples. Results The participants’ mean age was 47.1±12.3 years. Baseline characteristics were not significantly different between the groups. The concentration of 25(OH)D was significantly lower in the DVT group compared to that of the control group (17.9±10.3 versus 23.1±12.5 ng/mL, P=0.004). The prevalence of participants with deficient 25(OH)D levels was significantly higher in the both DVT and control groups than those with sufficient 25(OH)D levels (68.3% versus 13.4%, and 49.4% versus 28.2%, respectively, P=0.027). In a multivariate analysis, 25(OH)D levels and sex were found to be the only independent predictors of DVT (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02–1.08, P=0.001 and OR 0.51, 95% CI 0.26–1.00, P=0.049, respectively). Conclusion Low levels of 25(OH)D are associated with idiopathic lower-extremity DVT. Further investigation is needed to establish determinants and probable causative role of 25(OH)D.
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Affiliation(s)
- Kamal Khademvatani
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Mohammad Akbari
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Yousef Rezaei
- Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Ramin Eskandari
- Department of Cardiology, Firoozgar Hospital, Iran University of Medial Sciences, Tehran, Iran
| | - Alireza Rostamzadeh
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
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