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Singh S, Kumar P, Padwad YS, Jaffer FA, Reed GL. Targeting Fibrinolytic Inhibition for Venous Thromboembolism Treatment: Overview of an Emerging Therapeutic Approach. Circulation 2024; 150:884-898. [PMID: 39250537 DOI: 10.1161/circulationaha.124.069728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Venous thrombosis and pulmonary embolism (venous thromboembolism) are important causes of morbidity and mortality worldwide. In patients with venous thromboembolism, thrombi obstruct blood vessels and resist physiological dissolution (fibrinolysis), which can be life threatening and cause chronic complications. Plasminogen activator therapy, which was developed >50 years ago, is effective in dissolving thrombi but has unacceptable bleeding risks. Safe dissolution of thrombi in patients with venous thromboembolism has been elusive despite multiple innovations in plasminogen activator design and catheter-based therapy. Evidence now suggests that fibrinolysis is rigidly controlled by endogenous fibrinolysis inhibitors, including α2-antiplasmin, plasminogen activator inhibitor-1, and thrombin-activable fibrinolysis inhibitor. Elevated levels of these fibrinolysis inhibitors are associated with an increased risk of venous thromboembolism in humans. New therapeutic paradigms suggest that accelerated and effective fibrinolysis may be achieved safely by therapeutically targeting these fibrinolytic inhibitors in venous thromboembolism. In this article, we discuss the role of fibrinolytic components in venous thromboembolism and the current status of research and development targeting fibrinolysis inhibitors.
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Affiliation(s)
- Satish Singh
- Protein Processing Center, Dietetics and Nutrition Technology Division, CSIR-Institute of Himalayan Bioresource Technology, Palampur, Himachal Pradesh, India (S.S., P.K., Y.S.P.)
- Translational Cardiovascular Research Center, Department of Medicine, University of Arizona, College of Medicine-Phoenix (G.L.R., S.S.)
| | - Pardeep Kumar
- Protein Processing Center, Dietetics and Nutrition Technology Division, CSIR-Institute of Himalayan Bioresource Technology, Palampur, Himachal Pradesh, India (S.S., P.K., Y.S.P.)
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India (P.K., Y.S.P.)
| | - Yogendra S Padwad
- Protein Processing Center, Dietetics and Nutrition Technology Division, CSIR-Institute of Himalayan Bioresource Technology, Palampur, Himachal Pradesh, India (S.S., P.K., Y.S.P.)
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India (P.K., Y.S.P.)
| | - Farouc A Jaffer
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (F.A.J.)
| | - Guy L Reed
- Translational Cardiovascular Research Center, Department of Medicine, University of Arizona, College of Medicine-Phoenix (G.L.R., S.S.)
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Li Y, Fan H, Wei W, Zhu H, Wang H, Lyu D, Zhang Z, Tan Y. A Silent Threat: Deep Vein Thrombosis in Early-Stage Parkinson's Disease. Risk Manag Healthc Policy 2024; 17:2169-2179. [PMID: 39263553 PMCID: PMC11389711 DOI: 10.2147/rmhp.s469725] [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: 03/19/2024] [Accepted: 08/22/2024] [Indexed: 09/13/2024] Open
Abstract
Introduction The primary clinical manifestation of venous thrombosis is discomfort in the lower extremities. Some early Parkinson's disease (PD) patients feel discomfort in the lower limbs. Venous thrombosis can risk lives by causing pulmonary embolism. This study examines the incidence of DVT in early PD patients and its correlation with different clinical and lab features. Methods A cross-sectional study was conducted on 117 patients with early-stage PD. Ultrasonography was employed to detect the presence of DVT. Factors such as age, gender, body mass index, lifestyle habits (smoking and drinking), medical history (hypertension, diabetes, atrial fibrillation, and tumor), and other lab tests linked to thrombosis were analyzed. Results In 117 patients, 11 (9.4%) had DVT, while 106 (90.6%) did not. There were no significant differences in gender, BMI, habits, medical history, or other thrombosis-related tests between both groups. However, DVT patients were older with higher d-dimer levels. They also showed an increased right substantia nigra ultrasound echo area, higher HY grades, higher UPDRS 3 scores, less improvement in UPDRS 3 scores and levodopa response. Discussion The primary risk factors for lower extremity venous thrombosis were found to be age, d-dimer levels, and low-dose levodopa. Therefore, for elderly patients with early-stage PD, it is crucial to conduct d-dimer and lower extremity vascular ultrasound tests. The prevention of venous thrombosis in the lower extremities of early PD patients is of utmost importance.
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Affiliation(s)
- Yang Li
- Department of Neurology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, People's Republic of China
| | - Huihui Fan
- Department of Ultrasound, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, People's Republic of China
| | - Wei Wei
- Department of Key Laboratory of Basic Research and Clinical Translation, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, People's Republic of China
| | - Hanyu Zhu
- Department of Neurology, Medical School of Huzhou University, Huzhou, People's Republic of China
| | - Haifeng Wang
- Department of Neurology, Medical School of Huzhou University, Huzhou, People's Republic of China
| | - Dayao Lyu
- Department of Neurology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, People's Republic of China
| | - Zengrui Zhang
- Department of Neurology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, People's Republic of China
| | - Ying Tan
- Department of Neurology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, People's Republic of China
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Barbati ME, Avgerinos ED, Baccellieri D, Doganci S, Lichtenberg M, Jalaie H. Interventional treatment for post-thrombotic chronic venous obstruction: Progress and challenges. J Vasc Surg Venous Lymphat Disord 2024; 12:101910. [PMID: 38777042 DOI: 10.1016/j.jvsv.2024.101910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/28/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
Chronic venous obstruction, including nonthrombotic iliac vein lesions and post-thrombotic syndrome, presents a significant burden on patients' quality of life and health care systems. Venous recanalization and stenting have emerged as promising minimally invasive approaches, yet challenges in patient selection, procedural techniques, and long-term outcomes persist. This review synthesizes current knowledge on the interventional treatment of post-thrombotic syndrome, focusing on the evolution of endovascular techniques and stenting. Patient selection criteria, procedural details, and the characteristics of dedicated venous stents are discussed. Particular emphasis is given to the role of inflow and other anatomical considerations, along with postoperative management protocols for an optimal long-term outcome.
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Affiliation(s)
- Mohammad E Barbati
- Clinic of Vascular and Endovascular Surgery, RWTH Aachen University Hospital, Aachen, Germany.
| | | | | | - Suat Doganci
- Department of Cardiovascular Surgery, University of Health Sciences, Ankara, Turkey
| | | | - Houman Jalaie
- Clinic of Vascular and Endovascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
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Stępień K, Siudut J, Zalewski J, Nowakowski T, Undas A. Elevated plasma factor XI is associated with postthrombotic syndrome. Thromb Res 2024; 241:109086. [PMID: 38968817 DOI: 10.1016/j.thromres.2024.109086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/12/2024] [Accepted: 07/02/2024] [Indexed: 07/07/2024]
Abstract
INTRODUCTION Postthrombotic syndrome (PTS), a common complication of deep vein thrombosis (DVT), is largely inflammatory by nature with contribution of prothrombotic mechanisms. The role of factor (F)XI in PTS has not been explored yet. We investigated whether elevated FXI is associated with PTS occurrence. MATERIALS AND METHODS We enrolled 180 consecutive patients (aged 43 ± 13 years) with first-ever DVT. After 3 months FXI levels were measured, along with inflammatory markers, thrombin generation, plasma clot permeability (Ks), clot lysis time (CLT), and fibrinolysis proteins. We assessed PTS using the Villalta score and recorded symptomatic venous thromboembolism (VTE) at a 1-year and venous ulcers at a median 53 months follow-up. RESULTS Baseline median FXI was 102 % [IQR 92-113 %] and showed positive association with Villalta score (R = 0.474, P < 0.001). Patients with PTS (n = 48, 26.7 %) had 16.1 % higher FXI (P < 0.001) and FXI ≥120 % occurred more often in PTS patients (odds ratio [OR] 5.55, 95 % confidence interval [CI] 2.28-13.47). There were associations of baseline FXI with Ks and CLT along with thrombin activatable fibrinolysis inhibitor (TAFI) activity, C-reactive protein, and interleukin-6, but not with fibrinogen, or thrombin generation. After age adjustment higher FXI was independently associated with PTS occurrence (OR per 1 % 1.06, 95 % CI 1.02-1.09) and VTE recurrence (OR 1.03, 95 % CI 1.01-1.06). At long-term follow-up, patients with venous ulcers had 13.6 % higher baseline FXI (P = 0.002). CONCLUSIONS Elevated FXI in association with inflammation and prothrombotic fibrin clot properties may contribute to the development of PTS following DVT.
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Affiliation(s)
- Konrad Stępień
- Department of Thromboembolic Disorders, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Department of Coronary Artery Disease and Heart Failure, St. John Paul II Hospital, Krakow, Poland
| | - Jakub Siudut
- Krakow Centre for Medical Research and Technologies, St. John Paul II Hospital, Krakow, Poland
| | - Jarosław Zalewski
- Department of Coronary Artery Disease and Heart Failure, St. John Paul II Hospital, Krakow, Poland; Department of Coronary Artery Disease and Heart Failure, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Nowakowski
- Department of Angiology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland; Clinical Department of Angiology, University Hospital in Krakow, Krakow, Poland
| | - Anetta Undas
- Department of Thromboembolic Disorders, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Krakow Centre for Medical Research and Technologies, St. John Paul II Hospital, Krakow, Poland.
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Brown C, Tokessy L, Delluc A, Carrier M. Risk of developing post thrombotic syndrome after deep vein thrombosis with different anticoagulant regimens: A systematic review and pooled analysis. Thromb Res 2024; 240:109057. [PMID: 38875846 DOI: 10.1016/j.thromres.2024.109057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Post-thrombotic syndrome (PTS) is common in patients with deep vein thrombosis (DVT). It is unclear if different types of anticoagulant therapies (e.g. vitamin K antagonists (VKA), direct oral anticoagulants (DOACs) or low molecular weight heparin (LMWH)) are associated with different risks of PTS. We sought to assess the incidence rates of PTS development following a proximal DVT of the lower extremity managed with different types of anticoagulation regimens. METHODS A systematic search of MEDLINE, EMBASE and PubMed, from inception to June 2023 was performed. The primary outcome was development of PTS. The secondary outcomes included severe PTS, venous ulcers, and major bleeding. Incidence rates were pooled using the random effects model and expressed as event per 100 patient-years with its associated 95 % confidence intervals (CI) using R software. RESULTS A total of 21 (4342 patients) articles were included in the analysis. The adjusted pooled incidence of PTS was 15.1 (95 % CI: 8.7 to 26.1), 18.2 (95 % CI: 9.4 to 35.1) and 24.6 (95 % CI: 9.2 to 65.5) per 100 patient-years patients managed with VKA, DOAC and LMWH, respectively. The adjusted pooled incidence of severe PTS was 5.1 (95 % CI: 2.6 to 10.0) and 0.2 (95 % CI: 0.01 to 2.7) per 100 patient-years for VKAs and DOACs, respectively. CONCLUSIONS The development of PTS is common in patients with proximal lower extremity DVT. The incidence rates of PTS seem to be similar across the different anticoagulation regimens, but severe PTS may be lower among patients receiving a DOAC.
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Affiliation(s)
- Cameron Brown
- Department of Medicine, The Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, Canada; Faculty of Arts and Science, Queen's University, Kingston, Canada
| | - Lauren Tokessy
- Department of Medicine, The Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, Canada; Faculty of Science, University of Ottawa, Ottawa, Canada
| | - Aurélien Delluc
- Department of Medicine, The Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, Canada
| | - Marc Carrier
- Department of Medicine, The Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, Canada.
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Bismuth J, Rotolo PD, Mathews SJ. Venous Thrombectomy: Are We Driving Procedures or Outcomes? J Endovasc Ther 2024; 31:503-504. [PMID: 36565274 DOI: 10.1177/15266028221144590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Jean Bismuth
- Division of Vascular and Endovascular Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Katy Heart and Vascular Institute, LLC, Katy, TX, USA
| | - Paul D Rotolo
- Department of Interventional Radiology, Health First, Melbourne, FL, USA
| | - S Jay Mathews
- Bradenton Cardiology Center, Manatee Memorial Hospital, Bradenton, FL, USA
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Morrison L, Smoody B, Woltjer R, Hinds MT, Loftis JM, Wyatt CW, Nguyen KP. Ferumoxytol-enhanced MRI assessment of venous Thrombus resolution and macrophage content in a murine deep vein thrombosis model. Thromb Res 2024; 240:109063. [PMID: 38878741 PMCID: PMC11239555 DOI: 10.1016/j.thromres.2024.109063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/29/2024] [Accepted: 06/11/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Imaging evaluation of acute deep vein thrombosis (DVT) or post-thrombotic syndrome (PTS) in animal or clinical models is limited to anatomical assessment of the location and extent of thrombi. We hypothesize that Fe-MRI, used to evaluate macrophage content in other inflammatory diseases, can be useful to evaluate the thromboinflammatory features after DVT over time. METHODS Nineteen wild-type CD-1 mice underwent surgical IVC ligation to induce DVT. Mice received either saline or 5 mg/kg of 14E11, a Factor XI inhibitor, before the procedure. Fe-MRI was performed on days 6-7 after ligation to evaluate thrombus volume, perfusion, and macrophage content via T2-weighted images. Mice were euthanized at days 3-15 after surgery. The thrombi and adjacent vein walls were excised, weighed, formalin-fixed, and paraffin-embedded for immunohistological analysis. Specimens were stained with specific antibodies to evaluate macrophage content, collagen deposition, neovascularization, and recanalization. Significance was determined using the Mann-Whitney U or Student's t-test. RESULTS After IVC-ligation in control mice, thrombus weights decreased by 59 % from day 3 to 15. Thrombus volumes peaked on day 5 before decreasing by 85 % by day 13. FXI inhibition led to reduced macrophage content in both thrombi (p = .008) and vein walls (p = .01), decreased thrombus volume (p = .03), and decreased thrombus mass (p = .01) compared to control mice. CCR2+ staining corroborated these findings, showing significantly reduced macrophage presence in the thrombi (p = .002) and vein wall (p = .002). CONCLUSIONS Fe-MRI T2 relaxation times can be used to characterize and quantify post-thrombotic changes of perfusion, macrophage content, and thrombus volume over time in a surgical mouse model of venous thrombosis. This approach could lead to better quantification of in vivo inflammation correlating monocyte and macrophage content within resolving thrombi and veins and may serve as a useful tool for research and clinically in the evaluation of the post-thrombotic environment.
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Affiliation(s)
- L Morrison
- Department of Surgery, Division of Vascular Surgery, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
| | - B Smoody
- Department of Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Advanced Imaging Research Center (AIRC), Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - R Woltjer
- Department of Pathology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - M T Hinds
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science Advanced Imaging Research Center (AIRC), Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - J M Loftis
- Research and Development, Portland VA Health Care System, 3710 SW US Veterans Highway Road, Portland, OR 97239, USA; Departments of Psychiatry and Behavioral Neuroscience, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - C W Wyatt
- Department of Pathology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - K P Nguyen
- Department of Surgery, Division of Vascular Surgery, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Department of Biomedical Engineering, School of Medicine, Oregon Health & Science Advanced Imaging Research Center (AIRC), Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Research and Development, Portland VA Health Care System, 3710 SW US Veterans Highway Road, Portland, OR 97239, USA
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Qi X, Wang M, Feng K, Ma Y, Zhang D, Guo Y, Fan Y, Jiao Y, Zhang X, Wang B, Shi Z, Sun Y. The effect of intraoperative intermittent pneumatic compression on deep venous thrombosis prophylaxis in patients undergoing elective craniotomy. Front Neurol 2024; 15:1421977. [PMID: 39045431 PMCID: PMC11263113 DOI: 10.3389/fneur.2024.1421977] [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: 04/23/2024] [Accepted: 06/20/2024] [Indexed: 07/25/2024] Open
Abstract
Objective Postoperative deep venous thrombosis (DVT) is commonly observed in patients undergoing craniotomy and is associated with a high incidence of pulmonary embolism and poor clinical outcomes. Herein, we investigated the prophylactic effect of DVT of intraoperative intermittent pneumatic compression (IPC) in patients undergoing craniotomy. Methods A total of 516 patients who underwent elective craniotomy between December 2021 and December 2022 were enrolled in this study. Patients were randomly assigned to the intervention group (received intraoperative IPC) or control group (without IPC). Lower extremity ultrasound was performed on both legs before and after surgery (1 h, 24 h, and 7 days post-intervention). DVT was defined as the visualization of a thrombus within the vein lumen of the leg. Coagulation and platelet function were measured at the start and end of the craniotomy. Results A total of 504 patients (251 in the intervention group and 253 in the control group) completed the study. Among these patients, 20.4% (103/504) developed postoperative DVT within the first week after surgery, with 16.7% occurring within 24 h. The incidence of postoperative DVT in the intervention group (9.6%, 24/251) was significantly lower than that in the control group (22.9%, 58/253, p < 0.001). Intraoperative IPC reduced the risk of DVT by 64.6% (0.354, 95% CI, 0.223-0.564, p < 0.001). There was no significant difference in coagulation and platelet function between the two groups (all p > 0.05). Conclusion DVT may develop within 24 h after the craniotomy. Intraoperative application of IPC reduces the incidence of postoperative DVT.
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Affiliation(s)
- Xiang Qi
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Mengrui Wang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Kang Feng
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yu Ma
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Dan Zhang
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yidi Guo
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yujie Fan
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yubing Jiao
- Department of Ultrasound, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Xiaoyu Zhang
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Baoguo Wang
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Zhonghua Shi
- Department of Intensive Care Medicine, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yongxing Sun
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
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Zhang H, Li XY, Li JS, Xia SB, Song C, Lu QS, Zhao W, Zhang L. Which one is the best in treating deep venous thrombosis -- percutaneous mechanical thrombectomy, catheter-directed thrombolysis or combination of them? J Cardiothorac Surg 2024; 19:423. [PMID: 38970107 PMCID: PMC11225378 DOI: 10.1186/s13019-024-02908-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/15/2024] [Indexed: 07/07/2024] Open
Abstract
OBJECTIVE To compare the treatment outcomes among percutaneous mechanical thrombectomy (PMT) with AngioJet, Catheter-directed thrombolysis (CDT), and a combination of both. METHODS One hundred forty nine patients with acute or sub-acute iliac-femoral vein thrombosis accepting CDT and/or PMT were divided into three groups respectively: PMT group, CDT group, PMT + CDT group (PMT followed by CDT). The severity of thrombosis was evaluated by venographic scoring system. Technical success was defined as restored patent deep venous blood flow after CDT and/or PMT. Clinical follow-up were assessed by ultrasound or venography imaging. The primary endpoints were recurrence of DVT, and severity level of post-thrombotic syndrome (PTS) during the follow-up. RESULTS Technical success and immediate clinical improvements were achieved on all patients. The proportion of sub-acute DVT and the venographic scoring in PMT + CDT group were significantly higher than that in CDT group and PMT group (proportion of sub-acute DVT: p = 0.032 and p = 0.005, respectively; venographic scoring: p < 0.001, respectively). The proportion of May-Thurner Syndrome was lower in PMT group than that in CDT and PMT + CDT group (p = 0.026 and p = 0.005, respectively). The proportion of DVT recurrence/stent thrombosis was significantly higher in CDT group than that in PMT + CDT group (p = 0.04). The severity of PTS was the highest in CDT group ( χ2 = 14.459, p = 0.006) compared to PMT group (p = 0.029) and PMT + CDT group (p = 0.006). CONCLUSION Patients with sub-acute DVT, high SVS scoring and combined May-Thurner Syndrome were recommended to take PMT + CDT treatment and might have lower rate of DVT recurrence/stent thrombosis and severe PTS. Our study provided evidence detailing of PMT + CDT therapy.
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Affiliation(s)
- Hao Zhang
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, 200433, China
| | - Xiao-Ye Li
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, 200433, China
| | - Jia-Si Li
- Department of Neurology, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Shi-Bo Xia
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, 200433, China
| | - Chao Song
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, 200433, China
| | - Qing-Sheng Lu
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, 200433, China
| | - Wei Zhao
- Department of General Surgery, The Fifth People's Hospital of Chengdu, Chengdu, Sichuan Province, China
| | - Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, 200433, China.
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Gámiz-Molina AB, Valenza-Peña G, Raya-Benítez J, Heredia-Ciuró A, Granados-Santiago M, López-López L, Valenza MC. Association between Mid-Term Functionality and Clinical Severity in Patients Hospitalized for Pulmonary Embolism. Healthcare (Basel) 2024; 12:1323. [PMID: 38998858 PMCID: PMC11241709 DOI: 10.3390/healthcare12131323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
The aim of this study is to evaluate the relationship between clinical severity and functionality, occupational performance, and health-related quality of life in patients hospitalized with pulmonary embolism. Pulmonary embolism patients were grouped by clinical severity using the Pulmonary Embolism Severity Index. Those scoring ≥160 were in the high-severity group (HSG); those scoring < 160 in the low-moderate group (LMSG). The main variables were functionality assessed by the World Health Organization Disability Assessment Schedule (WHODAS), self-perception of occupational performance assessed by the Canadian Occupational Performance Measure (COPM), pain and fatigue assessed by a Visual Analogue Scale (VAS), and health-related quality of life assessed by the EuroQol-5Dimensions (EQ-5D). Patients were evaluated at hospital admission and at 1-month and 3-month follow-up. At admission, there were significant differences between groups in the WHODAS and health-related quality of life in favor of the LMSG. At 1-month and at 3-month follow-up, there were significant differences between the LMSG and HSG in WHODAS, COMP, NRS pain, fatigue and EQ-5D scores in favor of the LMSG. An association exists between clinical severity and mid-term functionality, self-perception of occupational performance, pain, fatigue, and health-related quality of life in PE patients.
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Affiliation(s)
| | - Geraldine Valenza-Peña
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (G.V.-P.); (A.H.-C.); (M.C.V.)
| | - Julia Raya-Benítez
- Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (J.R.-B.); (M.G.-S.)
| | - Alejandro Heredia-Ciuró
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (G.V.-P.); (A.H.-C.); (M.C.V.)
| | - María Granados-Santiago
- Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (J.R.-B.); (M.G.-S.)
| | - Laura López-López
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (G.V.-P.); (A.H.-C.); (M.C.V.)
| | - Marie Carmen Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (G.V.-P.); (A.H.-C.); (M.C.V.)
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Xu N, Siriwardene M, Naidu N, Connor DE, Davies AH, Gloviczki P, Meissner MH, Parsi K. Diagnosis of post-thrombotic syndrome: International union of phlebology (UIP) survey of medical specialists. Phlebology 2024:2683555241259616. [PMID: 38863409 DOI: 10.1177/02683555241259616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
OBJECTIVE To review the current approaches to the diagnosis of Post-Thrombotic Syndrome (PTS) and to evaluate the potential need for a diagnostic tool. METHOD Medical specialists were invited to participate in an online survey of their current approaches to the diagnosis and management of PTS, including the use of scoring systems, diagnostic imaging techniques and the extent the practitioner reviews the patient's venous history. RESULTS 502 participants completed the survey. Over 80% obtained imaging reports to confirm a history of deep vein thrombosis (DVT). 72% of participants always obtained an up-to-date duplex ultrasound for PTS diagnosis. Over 50% did not use a scoring system for either PTS diagnosis or management. 65% of the participants agreed that a new system for PTS diagnosis should be devised. CONCLUSION Heterogeneity was observed in methods of diagnosing PTS by medical practitioners with frequent use of medical imaging studies and moderate use of scoring systems. Development of a new diagnostic tool for PTS should be considered for future studies.
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Affiliation(s)
- Nuo Xu
- Faculty of Medicine, The University of New South Wales, Kensington, NSW, Australia
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research (AMR), St Vincent's Hospital, Sydney, NSW, Australia
| | - Manisha Siriwardene
- Faculty of Medicine, The University of New South Wales, Kensington, NSW, Australia
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research (AMR), St Vincent's Hospital, Sydney, NSW, Australia
- Department of Dermatology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Nikita Naidu
- Faculty of Medicine, The University of New South Wales, Kensington, NSW, Australia
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research (AMR), St Vincent's Hospital, Sydney, NSW, Australia
- Department of Dermatology, St Vincent's Hospital, Sydney, NSW, Australia
| | - David E Connor
- Faculty of Medicine, The University of New South Wales, Kensington, NSW, Australia
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research (AMR), St Vincent's Hospital, Sydney, NSW, Australia
| | - Alun H Davies
- Department of Vascular Surgery, Imperial College & Imperial Healthcare NHS Trust, London, UK
| | - Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mark H Meissner
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Kurosh Parsi
- Faculty of Medicine, The University of New South Wales, Kensington, NSW, Australia
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research (AMR), St Vincent's Hospital, Sydney, NSW, Australia
- Department of Dermatology, St Vincent's Hospital, Sydney, NSW, Australia
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12
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Wang J, Ho P, Nandurkar H, Lim HY. Overall haemostatic potential assay for prediction of outcomes in venous and arterial thrombosis and thrombo-inflammatory diseases. J Thromb Thrombolysis 2024; 57:852-864. [PMID: 38649560 DOI: 10.1007/s11239-024-02975-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 04/25/2024]
Abstract
Thromboembolic diseases including arterial and venous thrombosis are common causes of morbidity and mortality globally. Thrombosis frequently recurs and can also complicate many inflammatory conditions through the process of 'thrombo-inflammation,' as evidenced during the COVID-19 pandemic. Current candidate biomarkers for thrombosis prediction, such as D-dimer, have poor predictive efficacy. This limits our capacity to tailor anticoagulation duration individually and may expose lower risk individuals to undue bleeding risk. Global coagulation assays, such as the Overall Haemostatic Potential (OHP) assay, that investigate fibrin generation and fibrinolysis, may provide a more accurate and functional assessment of hypercoagulability. We present a review of fibrin's critical role as a central modulator of thrombotic risk. The results of our studies demonstrating the OHP assay as a predictive biomarker in venous thromboembolism, chronic renal disease, diabetes mellitus, post-thrombotic syndrome, and COVID-19 are discussed. As a comprehensive and global measurement of fibrin generation and fibrinolytic capacity, the OHP assay may be a valuable addition to future multi-modal predictive tools in thrombosis.
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Affiliation(s)
- Julie Wang
- Northern Health, 185 Cooper St, Epping, VIC, 3076, Australia.
| | - Prahlad Ho
- Northern Health, 185 Cooper St, Epping, VIC, 3076, Australia
| | - Harshal Nandurkar
- Australian Centre for Blood Diseases, Monash Health, Melbourne, Australia
| | - Hui Yin Lim
- Northern Health, 185 Cooper St, Epping, VIC, 3076, Australia
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Patel RM, Pal K, Ahmed SH, Kuban JD, Patel M, Shah K, Habibollahi P, Metwalli Z, Gurusamy V, Gupta S, Rojas-Hernandez CM, Afshar-Kharghan V, Kroll MH, Sheth RA. Mechanical Venous Thrombectomy for Deep Venous Thrombosis in Cancer Patients: A Single-Center Retrospective Study. Cardiovasc Intervent Radiol 2024; 47:556-566. [PMID: 38548981 DOI: 10.1007/s00270-024-03691-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/20/2024] [Indexed: 04/01/2024]
Abstract
PURPOSE Venous thromboembolism (VTE) is a major contributor to the mortality of cancer patients. Mechanical thrombectomy (MT) is an endovascular technique that physically removes a thrombus without thrombolytics. The purpose of this study was to evaluate safety, efficacy, and clinical outcomes following MT for lower extremity DVT in cancer patients. METHODS This single-center, retrospective study evaluated outcomes following MT of lower extremity DVT in cancer patients from November 2019 to May 2023. The primary outcome measure was clinical success, defined as a decrease in Villalta score by at least 2 points following the intervention. Secondary outcomes included repeat intervention-free survival and overall survival. Technical success was defined as restoring venous flow with mild (< 10%) or no residual filling defect. RESULTS In total, 90 patients and 113 procedures were included. Technical and clinical success was achieved in 81% and 87% of procedures performed. Repeat intervention-free survival at 1 month, 3 months, and 6 months post-procedure was 92%, 82%, and 77%, respectively. The complication rate was 2.7%. Pathologic analysis of the extracted thrombus revealed tumor thrombus in 18.4% (18/98) samples. Overall survival for the study cohort was 87% at 1 month, 74% at 3 months, and 62% at 6 months. Patients who were found to have tumor thrombi were noted to have a decreased overall survival compared to patients with non-tumor thrombi (P = 0.012). CONCLUSION MT is safe and efficacious in reducing cancer patients' VTE-related symptoms. The high rate of tumor thrombus in thrombectomy specimens suggests this phenomenon is more common than suspected.
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Affiliation(s)
- Riya M Patel
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1471, Houston, TX, 77030-4009, USA
| | - Koustav Pal
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1471, Houston, TX, 77030-4009, USA
| | - Syed Hadi Ahmed
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1471, Houston, TX, 77030-4009, USA
| | - Joshua D Kuban
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1471, Houston, TX, 77030-4009, USA
| | - Milan Patel
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1471, Houston, TX, 77030-4009, USA
| | - Ketan Shah
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1471, Houston, TX, 77030-4009, USA
| | - Peiman Habibollahi
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1471, Houston, TX, 77030-4009, USA
| | - Zeyad Metwalli
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1471, Houston, TX, 77030-4009, USA
| | - Varshana Gurusamy
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1471, Houston, TX, 77030-4009, USA
| | - Sanjay Gupta
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1471, Houston, TX, 77030-4009, USA
| | | | - Vahid Afshar-Kharghan
- Section of Benign Hematology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael H Kroll
- Section of Benign Hematology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rahul A Sheth
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1471, Houston, TX, 77030-4009, USA.
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14
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Baastrup NN, Buch AK, Gundestrup AK, Olsen ASF, Kleif J, Al-Najami I, Deding U, Bertelsen CA. The incidence of venous thromboembolism after curative colon cancer surgery within an enhanced recovery after surgery programme. Thromb Res 2024; 237:46-51. [PMID: 38547694 DOI: 10.1016/j.thromres.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/29/2024]
Abstract
AIM Based on three randomised controlled trials performed more than a decade ago, several national guidelines recommend prolonged venous thromboprophylaxis for 28 days following elective surgery for colon cancer. None of these studies were conducted within enhanced recovery after surgery setting. Newer studies indicate that prolonged prophylaxis might not be necessary with enhanced recovery after surgery. We aimed to provide further evidence to this unresolved discussion. METHOD Retrospective study of patients undergoing elective surgery for colon cancer stage I-III with enhanced recovery after surgery in the Capital Region of Denmark from 2014 to 2017. Patients were excluded if discharged on postoperative day 28 or later, dying before discharge, undergoing concomitant rectum resection, or discharged with vitamin K antagonists, direct-oral anticoagulants, or low molecular weight heparin treatment. All patients received only low-dose low molecular weight heparin as prophylaxis during their admission. The primary endpoint was symptomatic lower limb deep venous thrombosis or pulmonary embolism diagnosed within 60 days postoperatively. RESULTS Out of the included population of 1806 patients, only three experienced a symptomatic venous thromboembolic event; none was fatal. Two had pulmonary embolism associated with pneumonia, while one patient was diagnosed with lower limb deep venous thrombosis at postoperative day 15 after an uncomplicated course with first discharge at postoperative day 2. CONCLUSION The risk of symptomatic venous thromboembolism after elective surgery for colon cancer with enhanced recovery after surgery seems negligible even without prolonged prophylaxis. The current guidelines need to be reconsidered.
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Affiliation(s)
- Niklas Nygaard Baastrup
- Department of Surgery, Copenhagen University Hospital - North Zealand, 3400 Hillerød, Denmark.
| | - Astrid Kerstine Buch
- Department of Surgery, Copenhagen University Hospital - North Zealand, 3400 Hillerød, Denmark
| | | | - Anna Sofie Friis Olsen
- Department of Surgery, Copenhagen University Hospital - North Zealand, 3400 Hillerød, Denmark
| | - Jakob Kleif
- Department of Surgery, Copenhagen University Hospital - North Zealand, 3400 Hillerød, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Issam Al-Najami
- Department of Surgery, Odense University Hospital, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Ulrik Deding
- Department of Surgery, Odense University Hospital, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Claus Anders Bertelsen
- Department of Surgery, Copenhagen University Hospital - North Zealand, 3400 Hillerød, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
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15
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Zhang Y, Wei H, Liu Y, Wang Q, He C. Clinical characteristics of lower extremity deep vein thrombosis in young vs. middle-aged adults: a single-center retrospective study. Front Cardiovasc Med 2024; 11:1381391. [PMID: 38737715 PMCID: PMC11082356 DOI: 10.3389/fcvm.2024.1381391] [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: 02/03/2024] [Accepted: 04/04/2024] [Indexed: 05/14/2024] Open
Abstract
Background The incidence of deep vein thrombosis (DVT) in the lower extremities is increasing in the younger population. However, there are fewer reported comparisons in the literature for lower extremity DVT. Methods Patients aged <40 years admitted with lower-extremity DVT between January 2018 and December 2023 were retrospectively analyzed and followed up for 1 year. Results A total of 61 patients were included in the study and divided into two groups: 33 patients over 30 years of age (middle-aged group) and 28 patients under 30 years of age (young group). A significant gender difference was observed, with a higher proportion of males in the young group compared to the middle-aged group (P < 0.001). Five patients in the young group were treated with anticoagulation alone, whereas all patients in the middle-aged group underwent endovascular therapy. A higher prevalence of inferior vena cava thrombosis in the young group compared to the middle-aged group (60.71% vs. 33.3%, P = 0.032). The proportion of iliac vein stenosis was significantly higher in the middle-aged groups than in the young group (P = 0.002). There was no statistically significant difference in venous function scores (Villalta and rVCSS) between the two groups during both the preoperative period and the postoperative follow-up (P > 0.05). The incidence of lower-extremity DVT post-thrombotic syndrome and thrombus recurrence was higher in the young group than in the middle-aged group at 1 year postoperatively (PTS: 78.57% vs. 33.3%, P < 0.001, and thrombus recurrence: 28.57% vs. 9.09%, P < 0.05). Univariate and multivariate analyses revealed that inferior vena cava thrombosis was an independent risk factor for severe DVT post-thrombotic syndrome and recurrent DVT (P < 0.05), whereas gender was an independent risk factor for recurrent DVT (P < 0.05). Conclusions This study suggests differences in the clinical characteristics and prognosis of lower-extremity DVT.
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Affiliation(s)
| | | | | | - Qiqi Wang
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chunshui He
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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16
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van den Berg JC. Will Getting Out the Thrombus Mechanically Keep the Deep Vein Thrombosis Patient Out of (Double) Trouble? Eur J Vasc Endovasc Surg 2024; 67:653. [PMID: 38061451 DOI: 10.1016/j.ejvs.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 01/11/2024]
Affiliation(s)
- Jos C van den Berg
- Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie, Inselspital, Bern, Switzerland; Clinica Luganese Moncucco, Lugano, Switzerland.
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17
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Cho LD, Bai H, Collins LC, Chen J, Cooke PV, Kang Y, Vasan V, Kim J, Gonzalez C, Dionne E, Kim SY, Ting W. Race differences in iliofemoral vein stenting for chronic venous insufficiency. Vascular 2024; 32:385-390. [PMID: 36395482 DOI: 10.1177/17085381221140612] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Major disparities in outcomes by race are present throughout vascular surgery, yet little has been published on iliac vein stent outcomes by race. This retrospective study assessed iliac vein stent outcomes by patient race. METHODS Patients who underwent iliac vein stenting at a single institution for chronic venous insufficiency (CVI) from 2011 to 2021 were reviewed. Demographic, preoperative, perioperative, and postoperative data were collected. Self-reported race groups included Asian, Black, Hispanic, and White. Univariate differences were analyzed using χ2 tests for categorical variables and 1-way ANOVA for continuous variables. Outcomes included change in Venous Clinical Severity Score (VCSS) at interval timepoints relative to a preoperative baseline and reinterventions. Logistic regression models were used to determine the unadjusted and adjusted odds ratio (OR) of any minor and major reintervention. Multivariate regression models controlled for demographic and comorbidity characteristics. RESULTS A total of 827 patients were included. Asian patients were younger and had a greater proportion of male patients, lower Body mass index (BMI), less smoking history, and fewer comorbidities. White patients were more likely to have a history of deep vein thrombosis (DVT). White patients presented with the most severe CVI symptoms as defined by both Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification and preoperative VCSS composite scores. There were no differences in acute DVT, number of stents deployed, and bilateral versus unilateral stent placement. Black patients had the longest average days of follow-up, followed sequentially by Hispanic, White, and Asian. Black patients had the most reinterventions, while Asian patients had the fewest. Asian patients were less likely to have a major reintervention. No differences in VCSS composite or change in VCSS were observed. CONCLUSIONS In patients with CVI, Asian patients presented younger and healthier, while White patients presented with the most severe symptoms. No differences were observed in VCSS outcomes, though Black patients had the most reinterventions.
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Affiliation(s)
- Logan D Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Halbert Bai
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Jenny Chen
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter V Cooke
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yeju Kang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vikram Vasan
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jinseo Kim
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Elyssa Dionne
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sung Yup Kim
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Windsor Ting
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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18
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Pasek J, Szajkowski S, Cieślar G. Comparison of the therapeutic efficacy of magneto-LED therapy and magnetostimulation applied as the adjuvant treatment of venous leg ulcers - preliminary study. Electromagn Biol Med 2024:1-12. [PMID: 38449355 DOI: 10.1080/15368378.2024.2325414] [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: 04/06/2023] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE Venous leg ulcers are chronic wounds that are difficult to cure. The aim of the study was to compare the therapeutic efficacy of two methods of physical medicine - magneto-LED therapy and magnetostimulation, applied as adjuvant treatment in the treatment of venous leg ulcers. METHODS The study included 81 patients, 37 male (45.6%) and 44 female (54.3%) ones, age range between 45 and 90 years, with venous leg ulcers. The patients were assigned to two study groups: magneto-LED therapy (group 1) or magnetostimulation (group 2). In both groups, a total of 40 daily procedures were performed. Wound healing was evaluated using computerized planimetry and the pain intensity on numeric rating scale. RESULTS After treatment, the decrease in healing rate in group 1 was statistically significantly higher in comparison to group 2 (p < 0.001), while a statistically significant reduction in the surface area of ulcers was obtained, amounting on the average from 6.34 ± 1.29 cm2 to 2.31 ± 1.25 cm2 in group 1 (p < 0.001), and from 6.52 ± 1.20 cm2 to 4.79 ± 1.17 cm2 in group 2 (p < 0.001). The percentage changes of ulcers area in group 1 (64.21 ± 17.94%) were statistically significantly greater as compared to group 2 (25.87 ± 14.07%) (p < 0.001). After treatment, the decrease in pain relief in group 1 was statistically significantly higher in comparison to group 2 (p = 0.006), while pain intensity after treatment decreased statistically significantly in both compared groups of patients (p < 0.001). CONCLUSIONS Magneto-LED therapy and magnetostimulation caused significant reduction of surface area of the treated venous leg ulcers and pain intensity, yet magneto-LED therapy was more efficient. Both evaluated methods also significantly reduced pain intensity.
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Affiliation(s)
- Jarosław Pasek
- Faculty of Health Sciences, Jan Długosz University in Częstochowa, Częstochowa, Poland
| | - Sebastian Szajkowski
- Faculty of Medical Sciences, Medical University of Mazovia in Warsaw, Warszawa, Poland
| | - Grzegorz Cieślar
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Bytom, Poland
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19
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Fard SS, Perkins TJ, Wells PS. Machine learning analysis of bleeding status in venous thromboembolism patients. Res Pract Thromb Haemost 2024; 8:102403. [PMID: 38706783 PMCID: PMC11066547 DOI: 10.1016/j.rpth.2024.102403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 05/07/2024] Open
Abstract
Background Anticoagulation therapy is the mainstay of therapy for patients with venous thromboembolism (VTE). However, continuing or stopping anticoagulants after the first 3 to 6 months is a difficult decision that requires ascertainment of the risk of bleeding and recurrent VTE. Despite the development of several statistical models to predict bleeding, the benefit of machine learning (ML) models has not been investigated in depth. Objectives To assess the benefits of ML algorithms in bleeding risk evaluation in VTE patients and gain insight into their baseline information. Methods The baseline clinical, demographic, and genotype information was collected for 2542 patients with VTE who were on extended anticoagulation therapy. Six unsupervised dimensionality reduction and clustering ML algorithms were used to visualize and cluster the data for patients with major bleeding (118 patients) and nonbleeders. Eight supervised ML algorithms were trained and compared with the previously derived clinical models using a 5-fold nested cross-validation scheme. Results The baseline dataset for bleeders and nonbleeders showed a high degree of similarity. Two novel clusters were discovered within the dataset for bleeders based on the presence of isolated pulmonary embolism or isolated deep vein thrombosis, though the difference in bleeding risks was not statistically significant (P = .32). The supervised analysis showed that the ML and clinical models have similar discrimination (c-statistics, ∼62%) and calibration performance (Brier score, ∼0.045). Conclusion The clinical variables recorded at baseline are not distinctive enough to improve bleeding prediction beyond the performance of the existing models, and other strategies or data modalities should be considered.
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Affiliation(s)
| | - Theodore J. Perkins
- The Ottawa Hospital Research Institute, the Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Philip S. Wells
- The Ottawa Hospital Research Institute, the Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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20
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Qamhawi Z, Kearns D, Wilton E, Wigham A. Thrombectomy of the Profunda Femoral Vein in Iliofemoral Deep Venous Thrombosis Using an Antegrade Popliteal Approach. Cardiovasc Intervent Radiol 2024; 47:379-385. [PMID: 38409560 DOI: 10.1007/s00270-024-03660-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 01/02/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Residual or undertreated inflow disease is a major cause of stent occlusion following endovascular thrombectomy for iliofemoral deep venous thrombosis (DVT). The profunda femoral vein (PFV) is an important inflow vessel alongside the femoral vein but is traditionally challenging to treat via an antegrade popliteal approach. This technical note describes a novel approach for PFV clearance in iliofemoral thrombectomy via the popliteal vein. MATERIALS AND METHODS Eight patients underwent PFV clearance as part of iliofemoral DVT thrombectomy via an antegrade popliteal approach. In seven patients, a popliteal-profunda communicating vessel was identified permitting PFV access and thrombectomy. In one patient, a popliteal-profunda communicator was not identified and an 'up and over' approach via the femoral bifurcation from the same popliteal access was utilised. Thrombectomy was performed using the Inari ClotTriever device or Penumbra's Indigo system. RESULTS Technical success in PFV thrombectomy was 100%. Six patients (75%) underwent stenting for an iliac stenotic lesion or May Thurner compression point. At the four-week ultrasound follow-up, the pelvic iliofemoral segment was patent in 7 patients (87.5%). The PFV was patent in 7 patients (87.5%) whereas the FV was only patent in 4 patients (50%). One patient underwent reintervention for iliofemoral stent occlusion. No PFV injury occurred and no post-procedure profunda reflux was identified. CONCLUSION PFV clearance can be achieved via an antegrade popliteal approach in iliofemoral thrombectomy to optimise inflow, negating the need for alternative or additional venous access. PFV may maintain upstream iliofemoral vein patency even with an occluded femoral vein. LEVEL OF EVIDENCE Level 4, Case Series.
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Affiliation(s)
- Zahi Qamhawi
- Department of Interventional Radiology, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
| | - Daniel Kearns
- Department of Interventional Radiology, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Emma Wilton
- Department of Vascular Surgery, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Andrew Wigham
- Department of Interventional Radiology, John Radcliffe Hospital, Oxford, OX3 9DU, UK
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Xie R, Han Z, Liu G, Chen L. Association between stroke and venous leg ulcers: A Mendelian randomization study. Int Wound J 2024; 21:e14785. [PMID: 38414343 PMCID: PMC10899862 DOI: 10.1111/iwj.14785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/22/2024] [Accepted: 02/02/2024] [Indexed: 02/29/2024] Open
Abstract
To investigate any potential bidirectional causal relationships between stroke and venous leg ulcers (VLUs), Mendelian randomization (MR) analyses were carried out in this study. The exposure factor was stroke, the outcome factor was VLUs. The two-sample MR study was carried out based on the online analysis platform (http://app.mrbase.org/). The association of stroke and VLUs was analysed via methods of Inverse Variance Weighted (IVW), Weighted Median, MR-Egger and weighted mode. IVW method suggested no association between stroke and VLUs ((β 1.06; SE 9.321; p = 0.9095)). Weighted median estimator (β 5.906; SE 11.99, p = 0.6223), MR-Egger (β -0.8677; SE 21.89; p = 0.9691) and weighted mode (β 9.336; SE 17.77; p = 0.6089) showed consistent results. Conversely, evidence indicating that the presence of VLUs increased the risk of stroke was lacking. According to this MR study, there is no causal connection between stroke and VLUs, which suggests that therapies targeting stroke may not be effective against VLUs.
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Affiliation(s)
- Ruiye Xie
- Science and Technology Innovation CenterGuangzhou University of Chinese MedicineGuangzhouChina
| | - Zhengyun Han
- Science and Technology Innovation CenterGuangzhou University of Chinese MedicineGuangzhouChina
| | - Guoqing Liu
- Science and Technology Innovation CenterGuangzhou University of Chinese MedicineGuangzhouChina
| | - Lei Chen
- Hainan Provincial Hospital of Traditional Chinese MedicineHaikouChina
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Watson C, Saaid H, Vedula V, Cardenas JC, Henke PK, Nicoud F, Xu XY, Hunt BJ, Manning KB. Venous Thromboembolism: Review of Clinical Challenges, Biology, Assessment, Treatment, and Modeling. Ann Biomed Eng 2024; 52:467-486. [PMID: 37914979 DOI: 10.1007/s10439-023-03390-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
Venous thromboembolism (VTE) is a massive clinical challenge, annually affecting millions of patients globally. VTE is a particularly consequential pathology, as incidence is correlated with extremely common risk factors, and a large cohort of patients experience recurrent VTE after initial intervention. Altered hemodynamics, hypercoagulability, and damaged vascular tissue cause deep-vein thrombosis and pulmonary embolism, the two permutations of VTE. Venous valves have been identified as likely locations for initial blood clot formation, but the exact pathway by which thrombosis occurs in this environment is not entirely clear. Several risk factors are known to increase the likelihood of VTE, particularly those that increase inflammation and coagulability, increase venous resistance, and damage the endothelial lining. While these risk factors are useful as predictive tools, VTE diagnosis prior to presentation of outward symptoms is difficult, chiefly due to challenges in successfully imaging deep-vein thrombi. Clinically, VTE can be managed by anticoagulants or mechanical intervention. Recently, direct oral anticoagulants and catheter-directed thrombolysis have emerged as leading tools in resolution of venous thrombosis. While a satisfactory VTE model has yet to be developed, recent strides have been made in advancing in silico models of venous hemodynamics, hemorheology, fluid-structure interaction, and clot growth. These models are often guided by imaging-informed boundary conditions or inspired by benchtop animal models. These gaps in knowledge are critical targets to address necessary improvements in prediction and diagnosis, clinical management, and VTE experimental and computational models.
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Affiliation(s)
- Connor Watson
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA
| | - Hicham Saaid
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA
| | - Vijay Vedula
- Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, New York, NY, USA
| | - Jessica C Cardenas
- Department of Surgery and the Center for Translational Injury Research, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Peter K Henke
- Section of Vascular Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Franck Nicoud
- CNRS, IMAG, Université de Montpellier, Montpellier, France
- Institut Universitaire de France, Paris, France
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, UK
| | - Beverley J Hunt
- Department of Thrombosis and Haemostasis, King's College, London, UK
- Thrombosis and Haemophilia Centre, Guy's & St Thomas' NHS Trust, London, UK
| | - Keefe B Manning
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA.
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA.
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23
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Rook B, van Rijn MJE, Jansma EP, van Montfrans C. Effect of exercise after a deep venous thrombosis: A systematic review. J Eur Acad Dermatol Venereol 2024; 38:289-301. [PMID: 37731155 DOI: 10.1111/jdv.19523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
Post-thrombotic syndrome (PTS) is a common complication after deep vein thrombosis (DVT) and has a major impact on physical symptoms, quality of life (QoL) and economic costs. Relatively simple lifestyle interventions as physical exercise might reduce PTS severity and increase QoL. To evaluate the direct and long-term effects of physical activity in patients with an acute or previous DVT. We conducted a systematic review through an additional search from 2007 up to March 2022, to complement the comprehensive systematic review of Kahn et al. Articles evaluating the effect of exercise after a DVT including symptoms, QoL and the incidence and severity of PTS, were included. Quality of the studies was assessed using a GRADE-like checklist and results were reported according to the PRISMA Statement. Ten studies were included, seven randomized controlled trials and three cohort studies. We identified three types of physical activity based on timing and duration; (1) early mobilisation in the acute phase of the DVT; (2) short duration exercise 1 year after DVT and (3) prolonged exercise during follow-up after a previous DVT. Early mobilisation showed improvement in QoL and pain reduction and after 2 years it resulted in a significant reduction of PTS severity. Prolonged supervised exercise resulted in improvement of QoL. In addition, positive effects on symptoms of venous insufficiency and muscle functions were observed. None of the included studies reported an increased risk of PTS or worsening of symptoms due to physical activity. Physical exercise after a DVT is safe, improves QoL, reduces pain and decreases PTS severity. Lifestyle intervention such as guided individualized training programs can be a useful supplementary therapy for patients after a DVT or for PTS patients. Optimal training programs may be identified by further studies that improve patient-oriented outcomes for both adults and children after a DVT.
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Affiliation(s)
- B Rook
- Emergency Department, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - M J E van Rijn
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - E P Jansma
- Head of Medical Information Specialists, Leiden University, Leiden, The Netherlands
| | - C van Montfrans
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
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24
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Xie Y, Huang Y, Stevenson HCS, Yin L, Zhang K, Islam ZH, Marcum WA, Johnston C, Hoyt N, Kent EW, Wang B, Hossack JA. A Quantitative Method for the Evaluation of Deep Vein Thrombosis in a Murine Model Using Three-Dimensional Ultrasound Imaging. Biomedicines 2024; 12:200. [PMID: 38255304 PMCID: PMC11154521 DOI: 10.3390/biomedicines12010200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Deep vein thrombosis (DVT) is a life-threatening condition that can lead to its sequelae pulmonary embolism (PE) or post-thrombotic syndrome (PTS). Murine models of DVT are frequently used in early-stage disease research and to assess potential therapies. This creates the need for the reliable and easy quantification of blood clots. In this paper, we present a novel high-frequency 3D ultrasound approach for the quantitative evaluation of the volume of DVT in an in vitro model and an in vivo murine model. The proposed method involves the use of a high-resolution ultrasound acquisition system and semiautomatic segmentation of the clot. The measured 3D volume of blood clots was validated to be correlated with in vitro blood clot weights with an R2 of 0.89. Additionally, the method was confirmed with an R2 of 0.91 in the in vivo mouse model with a cylindrical volume from macroscopic measurement. We anticipate that the proposed method will be useful in pharmacological or therapeutic studies in murine models of DVT.
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Affiliation(s)
- Yanjun Xie
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908, USA; (Y.X.); (Y.H.); (H.C.S.S.)
| | - Yi Huang
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908, USA; (Y.X.); (Y.H.); (H.C.S.S.)
| | - Hugo C. S. Stevenson
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908, USA; (Y.X.); (Y.H.); (H.C.S.S.)
| | - Li Yin
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA; (L.Y.); (K.Z.); (Z.H.I.); (W.A.M.); (C.J.); (N.H.); (E.W.K.); (B.W.)
| | - Kaijie Zhang
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA; (L.Y.); (K.Z.); (Z.H.I.); (W.A.M.); (C.J.); (N.H.); (E.W.K.); (B.W.)
| | - Zain Husain Islam
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA; (L.Y.); (K.Z.); (Z.H.I.); (W.A.M.); (C.J.); (N.H.); (E.W.K.); (B.W.)
| | - William Aaron Marcum
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA; (L.Y.); (K.Z.); (Z.H.I.); (W.A.M.); (C.J.); (N.H.); (E.W.K.); (B.W.)
| | - Campbell Johnston
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA; (L.Y.); (K.Z.); (Z.H.I.); (W.A.M.); (C.J.); (N.H.); (E.W.K.); (B.W.)
| | - Nicholas Hoyt
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA; (L.Y.); (K.Z.); (Z.H.I.); (W.A.M.); (C.J.); (N.H.); (E.W.K.); (B.W.)
| | - Eric William Kent
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA; (L.Y.); (K.Z.); (Z.H.I.); (W.A.M.); (C.J.); (N.H.); (E.W.K.); (B.W.)
| | - Bowen Wang
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA; (L.Y.); (K.Z.); (Z.H.I.); (W.A.M.); (C.J.); (N.H.); (E.W.K.); (B.W.)
| | - John A. Hossack
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908, USA; (Y.X.); (Y.H.); (H.C.S.S.)
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Carpenter C, O' Farrell A, Ní Áinle F, Ní Cheallaigh C, Kevane B. Retrospective cross-sectional analysis of concurrent VTE diagnosis in hospitalised socially excluded individuals in Ireland. BMJ Open 2024; 14:e073718. [PMID: 38216204 PMCID: PMC10806692 DOI: 10.1136/bmjopen-2023-073718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/17/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE Social exclusion (such as that experienced by people who are homeless, incarcerated or use drugs) increases morbidity across a range of diseases but is poorly captured in routine data sets. The aim of this study was to use a novel composite variable in a national-level hospital usage dataset to identify social exclusion and to determine whether social exclusion is associated with concurrent venous thromboembolism (VTE) in hospitalised patients in Ireland. Identifying and characterising this association in people who are socially excluded will inform VTE prevention and treatment strategies. DESIGN Retrospective cross-sectional study. SETTING Irish Hospital Inpatient Enquiry (HIPE) system, which collects diagnostic information by International Classification of Diseases Tenth Revision code on all hospital admission episodes in the Ireland. PARTICIPANTS All hospital admission episodes involving a VTE diagnosis (in a primary 'Dx 1' or secondary 'Dx 2-30' coding position) during a 12-month period in the Ireland were identified from consolidated, national-level datasets derived from the Irish HIPE system. Social exclusion was defined as the presence of one or more indicators of homelessness, drug use, incarceration, health hazards due to socioeconomic status or episodes of healthcare terminated prematurely. RESULTS Of 5701 admission episodes involving a VTE diagnosis (in a primary or secondary position) during the study period, 271 (4.8%) related to an individual affected by social exclusion. Among hospitalised individuals identified as being socially excluded based on the novel composite variable, the likelihood of having a concurrent VTE diagnosis was over twofold greater than that observed in the general population (OR 2.14, 95% CI 1.79 to 2.26; p<0.001). CONCLUSION These data suggest that VTE (primary and secondary) is over-represented in hospitalised socially excluded persons in Ireland and that the development of strategies to address this potentially life-threatening accompanying condition in this vulnerable patient group must be prioritised.
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Affiliation(s)
- Chloe Carpenter
- Irish Network for VTE Research, University College Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Anne O' Farrell
- Department of Statistics and Epidemiology, Health Intelligence Unit, HSE, Dublin, Ireland
| | - Fionnuala Ní Áinle
- Irish Network for VTE Research, University College Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Clíona Ní Cheallaigh
- School of Medicine, Trinity College, Dublin, Ireland
- Inclusion Health Service, St James's Hospital, Dublin, Ireland
| | - Barry Kevane
- Irish Network for VTE Research, University College Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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26
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Zhou K, Li N, Qi J, Tu P, Yang Y, Duan H. Diagnostic and prognostic potential of long non-coding RNA NORAD in patients with acute deep vein thrombosis and its role in endothelial cell function. Thromb J 2024; 22:3. [PMID: 38167080 PMCID: PMC10763087 DOI: 10.1186/s12959-023-00575-3] [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: 09/12/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Deep venous thrombosis (DVT) is the common clinical cardiovascular disease, and easily develops into post-thrombotic syndrome (PTS). The study aimed to examine the clinical value of long non-coding RNA NORAD gene in the development of DVT and PTS. In vitro, the underlying mechanism was explored. METHODS Serum levels of lncRNA NORAD gene in 85 DVT cases and 85 healthy individuals were tested. The role of lncRNA NORAD gene in human umbilical vein endothelial cells (HUVECs) proliferation, migration and inflammation was examined. The candidate downstream target gene was predicted via bioinformatic analysis. Gene ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were done for the function annotation and pathway enrichment. RESULTS LncRNA NORAD gene was at high expression in the serum of DVT patients, it can distinguish DVT patients from healthy controls with the area under the curve of 0.919. Elevated expression of lncRNA NORAD gene in PTS patients was detected, DVT cases with high expression of lncRNA NORAD gene were more susceptible to PTS. LncRNA NORAD gene knockdown promoted HUVECs' proliferation, migration while suppressing cell apoptosis and inflammation. MiR-93-5p served as a target of lncRNA NORAD gene, and its overexpression reversed the role of lncRNA NORAD gene in the biological function of HUVECs. The target genes of miR-93-5p were enriched in HIF-1 signaling, TGF-beta signaling and PI3K-Akt signaling, protein-protein interaction (PPI) network indicated STAT3, MAPK1 to be the key targets. CONCLUSIONS Upregulation of expression of lncRNA NORAD gene was a potential diagnostic biomarker for DVT and related to the development of PTS. LncRNA NORAD/miR-93-5p axis was involved in the progress of DVT through regulating endothelial cell function.
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Affiliation(s)
- Kun Zhou
- Department of Breast Thyroid Vascular Surgery, Taihe Hospital, Affiliated Hospital of Hubei University of Medicine, 442000, Shiyan, China
| | - Na Li
- Department of Hematology, Taihe Hospital, Affiliated Hospital of Hubei University of Medicine, 442000, Shiyan, China
| | - Jia Qi
- Department of Ophthalmology, Taihe Hospital, Affiliated Hospital of Hubei University of Medicine, 442000, Shiyan, China
| | - Pingping Tu
- Department of Ophthalmology, Taihe Hospital, Affiliated Hospital of Hubei University of Medicine, 442000, Shiyan, China
| | - Yan Yang
- Department of Breast Thyroid Vascular Surgery, Taihe Hospital, Affiliated Hospital of Hubei University of Medicine, 442000, Shiyan, China
| | - Hui Duan
- Department of Emergency, Taihe Hospital, Affiliated Hospital of Hubei University of Medicine, No.32, Renmin South Road, 442000, Shiyan, Huibei Province, China.
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Mohamad T, Kanaan E, Ogieuhi IJ, Mannaparambil AS, Ray R, Al-Nazer LWM, Ahmed HM, Hussain M, Kumar N, Kumari K, Nadeem M, Kumari S, Varrassi G. Thrombolysis vs Anticoagulation: Unveiling the Trade-Offs in Massive Pulmonary Embolism. Cureus 2024; 16:e52675. [PMID: 38380194 PMCID: PMC10877223 DOI: 10.7759/cureus.52675] [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: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 02/22/2024] Open
Abstract
Massive pulmonary embolism (MPE) is a severe form of venous thromboembolism (VTE) wherein enormous blood clots block the pulmonary arteries, resulting in substantial illness and death. Even with the progress made in diagnostic methods and treatments, the most effective approach for managing MPE is still a topic of considerable discussion. This study examines the delicate equilibrium between thrombolysis and anticoagulation in managing the problematic clinical situation posed by MPE, elucidating the compromises linked to each strategy. The genesis of MPE lies in the pathophysiology of VTE, when blood clots that originate from deep veins in the lower legs or pelvis move to the pulmonary vasculature, leading to an abrupt blockage. This obstruction leads to a series of hemodynamic alterations, such as elevated pulmonary vascular resistance, strain on the right ventricle, and compromised cardiac output, finally resulting in cardiovascular collapse. The seriousness of MPE is commonly categorized according to hemodynamic stability, with significant cases presenting immediate risks to patient survival. Traditionally, heparin has been the primary approach to managing MPE to prevent the spread of blood clots and their movement to other parts of the body. Nevertheless, there have been ongoing discussions regarding the effectiveness of thrombolysis, which entails the immediate delivery of fibrinolytic drugs to remove the blood clot. The use of thrombolysis in managing MPE is being reconsidered because of concerns over bleeding complications and long-term results despite its capacity to resolve the blocking clot quickly. This review rigorously analyzes the current body of evidence, exploring the intricacies of thrombolysis and anticoagulation in MPE. The focus is on evaluating the risk-benefit balance of each treatment option, considering aspects such as the patient's other medical conditions, hemodynamic stability, and potential long-term consequences. This review aims to clarify the complexities of the thrombolysis versus anticoagulation dilemma. It seeks to provide clinicians, researchers, and policymakers with a thorough understanding of the trade-offs in managing MPE. The goal is to facilitate informed decision-making and enhance patient outcomes.
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Affiliation(s)
- Tamam Mohamad
- Cardiovascular Medicine, Wayne State University, Detroit, USA
| | - Eyas Kanaan
- Internal Medicine, Corewell Health, Grand Rapids, USA
| | - Ikponmwosa J Ogieuhi
- Physiology, University of Benin, Benin City, NGA
- General Medicine, Siberian State Medical University, Tomsk, RUS
| | | | - Rubela Ray
- Internal Medicine, Bankura Sammilani Medical College and Hospital, Bankura, IND
| | | | | | | | | | - Komal Kumari
- Medicine, NMC Royal Family Medical Centre, Abu Dhabi, ARE
| | | | - Sanvi Kumari
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
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Zhang L, Jiang C, Chen Z, Song W, Zhao Y, Li F. Three-Year Outcomes, Risk Factors for Restenosis After Stenting for DVT Combined with Iliac Vein Compression Syndrome. Clin Appl Thromb Hemost 2024; 30:10760296241283821. [PMID: 39252512 DOI: 10.1177/10760296241283821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
This study aimed to evaluate the safety and efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) and stenting for treating acute iliofemoral deep venous thrombosis (DVT) combined with iliac vein compression syndrome (IVCS), and to identify the predictors of stent restenosis. Patients with acute proximal DVT combined with IVCS underwent PCDT and stenting from January 2017 to December 2022 were enrolled. Primary and secondary patency were assessed by duplex ultrasound (DUS). The morbidity of postthrombotic syndrome (PTS) was assessed by the Villalta score. Risk factors for stent restenosis were assessed using univariate and multivariate Cox regression models. Total of 254 patients were included. The mean follow-up time was 36.06 ± 17.66 months. The primary patency rates at 1 year, 3 years, and 5 years were 92.5%±1.7%, 85.4%±2.4%, and 82.4%±2.9%, respectively. The incidence of stent restenosis was 14.2%. Discontinuation of anticoagulants within one year [hazard ratio (HR) = 5.03; P = .048] was the factor associated with acute in-stent thrombosis. Previous DVT history (HR =2.29; P = .037) and stent placement across the inguinal ligament (HR =6.70; P < .001) were identified as independent risk factors significantly associated with stent restenosis. The overall PTS rate was 19.3%. PCDT with stenting is safe and effective for patients with iliofemoral DVT secondary to IVCS, leading to low rates of PTS. Previous DVT history and stents placed across the inguinal ligament may be predictors of stent restenosis. Furthermore, stent restenosis typically occurs within one year and is mainly caused by acute thrombosis due to discontinuation of anticoagulants.
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Affiliation(s)
- Lin Zhang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chuli Jiang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zheng Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Song
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Zhao
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fenghe Li
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Wang J, Smeath E, Lim HY, Nandurkar H, Kok HK, Ho P. Current challenges in the prevention and management of post-thrombotic syndrome-towards improved prevention. Int J Hematol 2023; 118:547-567. [PMID: 37651058 PMCID: PMC10615940 DOI: 10.1007/s12185-023-03651-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/15/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
Post-thrombotic syndrome (PTS) is a common and potentially debilitating complication of deep vein thrombosis (DVT), affecting up to 50% of DVT patients. The consequence of this chronic condition includes reduced quality of life, increased use of the healthcare system and decreased productivity. The societal impact of this condition is projected to increase, given our ageing population and increased burden of thrombotic diseases. Despite significant recent advances in our understanding of PTS, many unanswered questions remain. Currently, there are few effective and proven options for established PTS; hence, the emphasis should be on instituting effective prevention to reduce the progression to PTS. Effective anticoagulation lowers the risk of PTS, with direct oral anticoagulants appearing to outperform vitamin-K antagonists. However, the evidence for elastic compression stockings and endovascular thrombolysis or thrombectomy techniques remains unclear. Accurate identification of individuals at high risk of developing PTS may also improve the targeting of preventative interventions. This review will examine the current body of evidence regarding PTS, with a focus on preventative strategies as well as novel biomarkers.
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Affiliation(s)
- Julie Wang
- Northern Health, Epping, Melbourne, VIC, Australia.
- University of Melbourne, Melbourne, VIC, Australia.
- Department of Haematology, Northern Hospital, 185 Cooper St., Epping, Melbourne, 3076, VIC, Australia.
| | - Elise Smeath
- University of Melbourne, Melbourne, VIC, Australia
| | - Hui Yin Lim
- Northern Health, Epping, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | | | - Hong Kuan Kok
- Northern Health, Epping, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | - Prahlad Ho
- Northern Health, Epping, Melbourne, VIC, Australia
- Australian Centre for Blood Diseases, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
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30
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Wu YT, Chien CY, Matsushima K, Schellenberg M, Inaba K, Moore EE, Sauaia A, Knudson MM, Martin MJ. Early venous thromboembolism prophylaxis in patients with trauma intracranial hemorrhage: Analysis of the prospective multicenter Consortium of Leaders in Traumatic Thromboembolism study. J Trauma Acute Care Surg 2023; 95:649-656. [PMID: 37314427 DOI: 10.1097/ta.0000000000004007] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The optimal time to initiate venous thromboembolism prophylaxis (VTEp) for patients with intracranial hemorrhage (ICH) is controversial and must balance the risks of VTE with potential progression of ICH. We sought to evaluate the efficacy and safety of early VTEp initiation after traumatic ICH. METHODS This is a secondary analysis of the prospective multicenter Consortium of Leaders in the Study of Thromboembolism study. Patients with head Abbreviated Injury Scale score of > 2 and with immediate VTEp held because of ICH were included. Patients were divided into VTEp ≤ or >48 hours and compared. Outcome variables included overall VTE, deep vein thrombosis (DVT), pulmonary embolism, progression of intracranial hemorrhage (pICH), or other bleeding events. Univariate and multivariate logistic regressions were performed. RESULTS There were 881 patients in total; 378 (43%) started VTEp ≤48 hours (early). Patients starting VTEp >48 hours (late) had higher VTE (12.4% vs. 7.2%, p = 0.01) and DVT (11.0% vs. 6.1%, p = 0.01) rates than the early group. The incidence of pulmonary embolism (2.1% vs. 2.2%, p = 0.94), pICH (1.9% vs. 1.8%, p = 0.95), or any other bleeding event (1.9% vs. 3.0%, p = 0.28) was equivalent between early and late VTEp groups. On multivariate logistic regression analysis, VTEp >48 hours (odds ratio [OR], 1.86), ventilator days >3 (OR, 2.00), and risk assessment profile score of ≥5 (OR, 6.70) were independent risk factors for VTE (all p < 0.05), while VTEp with enoxaparin was associated with decreased VTE (OR, 0.54, p < 0.05). Importantly, VTEp ≤48 hours was not associated with pICH (OR, 0.75) or risk of other bleeding events (OR, 1.28) (both p = NS). CONCLUSION Early initiation of VTEp (≤48 hours) for patients with ICH was associated with decreased VTE/DVT rates without increased risk of pICH or other significant bleeding events. Enoxaparin is superior to unfractionated heparin as VTE prophylaxis in patients with severe TBI. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
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Affiliation(s)
- Yu-Tung Wu
- From the Division of Trauma, Emergency Surgery, and Surgical Critical Care (Y.-T.W., C.-Y.C., K.M., M.S., K.I., M.J.M.), LAC+USC Medical Center, University of Southern California, Los Angeles, California; Department of Trauma and Emergency Surgery (Y.-T.W.), Chang Gung Memorial Hospital, Linkou; Department of General Surgery (C.-Y.C.), Chang Gung Memorial Hospital, Keelung, Taiwan; Department of Surgery (E.E.M.), Ernest E Moore Shock Trauma Center at Denver Health Center; School of Public Health (A.S.), University of Colorado, Denver, Colorado; and Department of Surgery (M.M.K.), University of California San Francisco, San Francisco, California
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Shaikh A, Zybulewski A, Paulisin J, Bisharat M, Mouawad NJ, Raskin A, Ichinose E, Abramowitz S, Lindquist J, Azene E, Shah N, Nguyen J, Cockrell J, Khalsa B, Khetarpaul V, Murrey DA, Veerina K, Skripochnik E, Maldonado TS, Bunte MC, Annambhotla S, Schor J, Kado H, Mojibian H, Dexter D. Six-Month Outcomes of Mechanical Thrombectomy for Treating Deep Vein Thrombosis: Analysis from the 500-Patient CLOUT Registry. Cardiovasc Intervent Radiol 2023; 46:1571-1580. [PMID: 37580422 PMCID: PMC10615929 DOI: 10.1007/s00270-023-03509-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/28/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE Mechanical thrombectomy for the treatment of deep vein thrombosis (DVT) is being increasingly utilized to reduce symptoms and prevent postthrombotic syndrome (PTS), but more data on clinical outcomes are needed. Mechanical thrombectomy was studied in the ClotTriever Outcomes (CLOUT) registry with 6-month full analysis outcomes reported herein. MATERIALS AND METHODS The CLOUT registry is a prospective, all-comer study that enrolled 500 lower extremity DVT patients across 43 US sites treated with mechanical thrombectomy using the ClotTriever System. Core-lab assessed Marder scores and physician-assessed venous patency by duplex ultrasound, PTS assessment using Villalta score, venous symptom severity, pain, and quality of life scores through 6 months were analyzed. Adverse events were identified and independently adjudicated. RESULTS All-cause mortality at 30 days was 0.9%, and 8.6% of subjects experienced a serious adverse event (SAE) within the first 30 days, 1 of which (0.2%) was device related. SAE rethrombosis/residual thrombus incidence was 4.8% at 30 days and 8.0% at 6 months. Between baseline and 6 months, venous flow increased from 27.2% to 92.5% of limbs (P < 0.0001), and venous compressibility improved from 28.0% to 91.8% (P < 0.0001), while median Villalta scores improved from 9.0 at baseline to 1.0 at 6 months (P < 0.0001). Significant improvements in venous symptom severity, pain, and quality of life were also demonstrated. Outcomes from iliofemoral and isolated femoral-popliteal segments showed similar improvements. CONCLUSION Outcomes from the CLOUT study, a large prospective registry for DVT, indicate that mechanical thrombectomy is safe and demonstrates significant improvement in symptoms and health status through 6 months. Level of Evidence 3: Non-randomized controlled cohort/follow-up study.
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Affiliation(s)
- Abdullah Shaikh
- Allegheny Health Network Research Institute, 4 Allegheny Square East, Pittsburgh, PA, 15212, USA.
| | | | | | | | | | - Adam Raskin
- Mercy Health - The Heart Institute, Cincinnati, OH, USA
| | | | | | | | | | - Neil Shah
- Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | | | | | - Bhavraj Khalsa
- Heart and Vascular Center, Providence St. Joseph Hospital, Orange, CA, USA
| | | | - Douglas A Murrey
- Inland Imaging at Providence Sacred Heart Medical Center, Spokane, WA, USA
| | | | | | | | - Matthew C Bunte
- Saint Luke's Mid-America Heart Institute, Kansas City, MO, USA
| | | | - Jonathan Schor
- Northwell Health, Staten Island University Hospital, Staten Island, NY, USA
| | - Herman Kado
- William Beaumont Hospital, Royal Oak, MI, USA
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Shewarega A, Powell TM, Silin D. Protrieve sheath utilization for capturing supra-filter thrombus during a retrieval of thrombosed and embedded IVC filter. CVIR Endovasc 2023; 6:52. [PMID: 37882904 PMCID: PMC10602975 DOI: 10.1186/s42155-023-00397-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Inferior vena cava (IVC) filters, while effective in preventing pulmonary embolism, can increase the risk of IVC thrombosis. IVC filter (IVCF) thrombosis can result from emboli getting trapped within the filter, extension of deep vein thrombosis (DVT), or the device's inherent thrombogenicity causing in situ thrombosis. This condition can cause noticeable clinical symptoms and complicate the removal of the filter due to the potential for thromboembolism, often resulting in temporary filters remaining unextracted. This case report highlights a novel approach employed to mitigate the risk of thromboembolism during the procedure by capturing mobilized thrombus proximally to the entrapped IVCF. CASE PRESENTATION A 54-year-old woman with a complex medical history including cerebral palsy, Crohn's disease, and transfusion-dependent iron-deficiency anemia experienced a pulmonary embolism. Due to failed anticoagulation therapy resulting in gastrointestinal bleeding and high transfusion requirements, she underwent placement of an IVCF as a preventive measure against recurrent pulmonary embolism. Three years later, the patient presented with lower extremity swelling and a sudden decline in hemoglobin levels. Diagnostic imaging revealed adherent nonocclusive thrombus within and above the indwelling IVCF. Utilizing the novel Protrieve sheath with the self-expandable Nitinol funnel, successful endovascular removal of the embedded IVCF and adherent thrombus was performed, while mitigating the risk of intraprocedural pulmonary embolism. CONCLUSIONS The successful intraprocedural trapping and removal of mobilized thrombus from the IVCF removal was achieved using the Protrieve sheath and Nitinol funnel. This approach provides a promising solution to reduce the risk of embolization during the removal of thrombosed IVCFs, potentially outweighing the complications associated with filter removal.
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Affiliation(s)
- Annabella Shewarega
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen (AöR), Hufelandstreet 55, 45147, Essen, Germany.
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06510, USA.
| | - Taylor M Powell
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06510, USA
| | - Douglas Silin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06510, USA.
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Sassaki VS, Fukaya E. Varicose Veins: Approach, Assessment, and Management to the Patient with Chronic Venous Disease. Med Clin North Am 2023; 107:895-909. [PMID: 37541715 DOI: 10.1016/j.mcna.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
Varicose veins are tortuous and dilated veins commonly seen in chronic venous disease. This article will review chronic venous disease, including its differential diagnosis, workup, and treatment.
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Affiliation(s)
- Viviane Seki Sassaki
- Stanford Heart and Vascular Clinic- Vascular Laboratory, Stanford, CA 94305, USA
| | - Eri Fukaya
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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Della Corte V, Riolo R, Scaglione S, Pecoraro R, Tuttolomondo A. The Role of Biomarkers, Metabolomics, and COVID-19 in Venous Thromboembolism-A Review of Literature. Int J Mol Sci 2023; 24:13411. [PMID: 37686216 PMCID: PMC10488048 DOI: 10.3390/ijms241713411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
In recent years, the field of venous thromboembolism has undergone numerous innovations, starting from the recent discoveries on the role of biomarkers, passing through the role of metabolomics in expanding our knowledge on pathogenic mechanisms, which have opened up new therapeutic targets. A variety of studies have contributed to characterizing the metabolic phenotype that occurs in venous thromboembolism, identifying numerous pathways that are altered in this setting. Among these pathways are the metabolism of carnitine, tryptophan, purine, and fatty acids. Furthermore, new evidence has emerged with the recent COVID-19 pandemic. Hypercoagulability phenomena induced by this viral infection appear to be related to altered von Willebrand factor activity, alteration of the renin-angiotensin-aldosterone system, and dysregulation of both innate and adaptive immunity. This is the first literature review that brings together the most recent evidence regarding biomarkers, metabolomics, and COVID-19 in the field of venous thromboembolism, while also mentioning current therapeutic protocols.
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Affiliation(s)
- Vittoriano Della Corte
- Internal Medicine and Stroke Care Ward, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialities (PROMISE) “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy
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Tsiamita O, White K. Post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension: diagnosis and management. Br J Hosp Med (Lond) 2023; 84:1-10. [PMID: 37646549 DOI: 10.12968/hmed.2023.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension are two distinct clinical syndromes associated with adverse patient outcomes following a venous thromboembolism. Clinical manifestations of post-thrombotic syndrome include persistent pain, swelling and ultimately venous ulceration following a deep venous thrombosis. Patients experiencing chronic thromboembolic pulmonary hypertension may have symptoms ranging from exertional dyspnoea to overt right heart failure. From a physician's perspective, the most effective preventative strategy is good quality anticoagulation for prophylaxis of primary and secondary venous thromboembolism. The treatment of post-thrombotic syndrome mainly involves lifestyle modifications alongside the use of elastic compression stockings while patients with chronic thromboembolic pulmonary hypertension should be offered targeted surgical and medical treatment options available at expert centres. Further research is warranted for both conditions to determine the role of direct oral anticoagulants when used with a preventive or therapeutic intent.
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Affiliation(s)
- Olga Tsiamita
- Department of Clinical Haematology, Barts Health NHS Trust, London, UK
| | - Katie White
- Department of Clinical Haematology, Barts Health NHS Trust, London, UK
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Chen L, You G, Yang Z, Shen R, Zhang R, Zhu D, Wang L, Lin S, Lv L, Huang K. Leisure sedentary behaviour increases the risk of venous thromboembolism: a Mendelian randomisation study. BMC Cardiovasc Disord 2023; 23:362. [PMID: 37464328 DOI: 10.1186/s12872-023-03395-5] [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: 11/22/2022] [Accepted: 07/13/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a substantial contributor to the global burden of disease. Observational studies have suggested that leisure sedentary behaviours (LSB) are related to the risk of VTE; however, the causal role of LSB in VTE remains unclear. METHODS Using data obtained from genome-wide association studies in the UK Biobank (N = 422,218), we identified 84, 21, and 4 single nucleotide polymorphisms (SNPs) related to sedentary television (TV) watching, computer use, and driving, respectively. These SNPs were employed as instrumental variables. Summary statistics for SNP-VTE associations was obtained from the FinnGen study (5,403 cases and 130,235 controls). Two-sample Mendelian randomisation (MR) analyses were performed using inverse-variance weighted (IVW), MR-Egger,weighted median, and weighted mode approaches. Sensitivity analyses were conducted to ensure robustness of the results. RESULTS The main IVW approach demonstrated a positive association between the genetically predicted sedentary TV watching and the risk of VTE [odds ratio (OR):1.35, 95% confidence interval (CI):1.02-1.80, P = 0.039]. However, no significant association was observed for genetically predicted sedentary computer use or driving and VTE risk. The results from our series of sensitivity analyses, including Cochran's Q test, MR-Egger intercept test, and MR-Pleiotropy RESidual Sum and Outlier method, further supported these findings. CONCLUSION This study provides evidence of an association between genetically predicted sedentary TV watching and the risk of VTE. Further studies are required to elucidate the underlying causal mechanisms.
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Affiliation(s)
- Liang Chen
- Department of Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, P. R. China
| | - Guochang You
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong Province, P. R. China
| | - Zhenmei Yang
- Department of Breast Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, P. R. China
| | - Runnan Shen
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong Province, P. R. China
| | - Rong Zhang
- Department of Anesthesiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, P. R. China
| | - Dongxi Zhu
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong Province, P. R. China
| | - Linlu Wang
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong Province, P. R. China
| | - Shen Lin
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong Province, P. R. China
| | - Lin Lv
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong Province, P. R. China
| | - Kai Huang
- Department of Cardiovascular Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.33, Yingfeng Road, Haizhu District, Guangzhou, Guangdong Province, P. R. China.
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Mosquera MS, Diaz JA. Back To Basics: Theory of Thrombus Formation and Potential Implications for Therapies? Tech Vasc Interv Radiol 2023; 26:100894. [PMID: 37865449 DOI: 10.1016/j.tvir.2023.100894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and potentially fatal condition. Despite existing treatments, recurrence rates and complications remain high. Understanding the pathophysiology of thrombus formation is crucial for developing effective therapies. This narrative review provides an overview of the critical elements of acute and chronic DVT, presents a theoretical framework for understanding thrombus formation, and discusses potential implications for therapeutic interventions. In addition, a hypothesis of thrombus formation is formulated, encompassing all elements described in this work.
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Affiliation(s)
- M Silena Mosquera
- Department of Surgery, Center for Fetal Research, The Children's Hospital of Philadelphia Research Institute, Philadelphia, PA
| | - Jose A Diaz
- Division of Surgical Research, Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN.
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Dix C, Clements W, Gibbs H, So J, A Tran H, D McFadyen J. Venous anomalies and thromboembolism. Thromb J 2023; 21:45. [PMID: 37081466 PMCID: PMC10116765 DOI: 10.1186/s12959-023-00484-5] [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: 01/19/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023] Open
Abstract
Patients with venous anomalies are at increased risk of developing venous thromboembolism (VTE) and subsequent complications, but they are often under-recognised. While unprovoked VTE may trigger testing for inherited thrombophilias and malignancy screening, anatomic variants are considered less often. Venous anomalies increase the risk due to venous flow disturbance, resulting in hypertension, reduced flow velocity and turbulence. Recognition is important as endovascular or surgical intervention may be appropriate, these patients have a high rate of VTE recurrence if anticoagulation is ceased, and the anomalies can predispose to extensive VTE and severe post-thrombotic syndrome (PTS). In this case series, we present representative cases and radiological images of May-Thurner syndrome (MTS), inferior vena cava (IVC) variants and venous aneurysms, and review the available literature regarding optimal diagnosis and management in each condition.
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Affiliation(s)
- Caroline Dix
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, VIC, 3004, Australia.
| | - Warren Clements
- Department of Radiology, The Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Harry Gibbs
- Department of General Medicine, Alfred Health, Melbourne, VIC, 3004, Australia
| | - Joanne So
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Huyen A Tran
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, VIC, 3004, Australia
- Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Australia
| | - James D McFadyen
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, VIC, 3004, Australia
- Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Australia
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, 3004, Australia
- Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Australia
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Wang X, Ma Y, Hui X, Li M, Li J, Tian J, Wang Q, Yan P, Li J, Xie P, Yang K, Yao L. Oral direct thrombin inhibitors or oral factor Xa inhibitors versus conventional anticoagulants for the treatment of deep vein thrombosis. Cochrane Database Syst Rev 2023; 4:CD010956. [PMID: 37058421 PMCID: PMC10105633 DOI: 10.1002/14651858.cd010956.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
BACKGROUND Deep vein thrombosis (DVT) is a condition in which a clot forms in the deep veins, most commonly of the leg. It occurs in approximately one in 1000 people. If left untreated, the clot can travel up to the lungs and cause a potentially life-threatening pulmonary embolism (PE). Previously, a DVT was treated with the anticoagulants heparin and vitamin K antagonists. However, two forms of direct oral anticoagulants (DOACs) have been developed: oral direct thrombin inhibitors (DTIs) and oral factor Xa inhibitors, which have characteristics that may be favourable compared to conventional treatment, including oral administration, a predictable effect, lack of frequent monitoring or dose adjustment and few known drug interactions. DOACs are now commonly being used for treating DVT: recent guidelines recommended DOACs over conventional anticoagulants for both DVT and PE treatment. This Cochrane Review was first published in 2015. It was the first systematic review to measure the effectiveness and safety of these drugs in the treatment of DVT. This is an update of the 2015 review. OBJECTIVES: To assess the effectiveness and safety of oral DTIs and oral factor Xa inhibitors versus conventional anticoagulants for the long-term treatment of DVT. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 1 March 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) in which people with a DVT, confirmed by standard imaging techniques, were allocated to receive an oral DTI or an oral factor Xa inhibitor compared with conventional anticoagulation or compared with each other for the treatment of DVT. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were recurrent venous thromboembolism (VTE), recurrent DVT and PE. Secondary outcomes included all-cause mortality, major bleeding, post-thrombotic syndrome (PTS) and quality of life (QoL). We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS We identified 10 new studies with 2950 participants for this update. In total, we included 21 RCTs involving 30,895 participants. Three studies investigated oral DTIs (two dabigatran and one ximelagatran), 17 investigated oral factor Xa inhibitors (eight rivaroxaban, five apixaban and four edoxaban) and one three-arm trial investigated both a DTI (dabigatran) and factor Xa inhibitor (rivaroxaban). Overall, the studies were of good methodological quality. Meta-analysis comparing DTIs to conventional anticoagulation showed no clear difference in the rate of recurrent VTE (odds ratio (OR) 1.17, 95% confidence interval (CI) 0.83 to 1.65; 3 studies, 5994 participants; moderate-certainty evidence), recurrent DVT (OR 1.11, 95% CI 0.74 to 1.66; 3 studies, 5994 participants; moderate-certainty evidence), fatal PE (OR 1.32, 95% CI 0.29 to 6.02; 3 studies, 5994 participants; moderate-certainty evidence), non-fatal PE (OR 1.29, 95% CI 0.64 to 2.59; 3 studies, 5994 participants; moderate-certainty evidence) or all-cause mortality (OR 0.66, 95% CI 0.41 to 1.08; 1 study, 2489 participants; moderate-certainty evidence). DTIs reduced the rate of major bleeding (OR 0.58, 95% CI 0.38 to 0.89; 3 studies, 5994 participants; high-certainty evidence). For oral factor Xa inhibitors compared with conventional anticoagulation, meta-analysis demonstrated no clear difference in recurrent VTE (OR 0.85, 95% CI 0.71 to 1.01; 13 studies, 17,505 participants; moderate-certainty evidence), recurrent DVT (OR 0.70, 95% CI 0.49 to 1.01; 9 studies, 16,439 participants; moderate-certainty evidence), fatal PE (OR 1.18, 95% CI 0.69 to 2.02; 6 studies, 15,082 participants; moderate-certainty evidence), non-fatal PE (OR 0.93, 95% CI 0.68 to 1.27; 7 studies, 15,166 participants; moderate-certainty evidence) or all-cause mortality (OR 0.87, 95% CI 0.67 to 1.14; 9 studies, 10,770 participants; moderate-certainty evidence). Meta-analysis showed a reduced rate of major bleeding with oral factor Xa inhibitors compared with conventional anticoagulation (OR 0.63, 95% CI 0.45 to 0.89; 17 studies, 18,066 participants; high-certainty evidence). AUTHORS' CONCLUSIONS: The current review suggests that DOACs may be superior to conventional therapy in terms of safety (major bleeding), and are probably equivalent in terms of efficacy. There is probably little or no difference between DOACs and conventional anticoagulation in the prevention of recurrent VTE, recurrent DVT, pulmonary embolism and all-cause mortality. DOACs reduced the rate of major bleeding compared to conventional anticoagulation. The certainty of evidence was moderate or high.
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Affiliation(s)
- Xiaoqin Wang
- Michael G DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Canada
| | - Yanfang Ma
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong Special Administrative Region, China
| | - Xu Hui
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Meixuan Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jing Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Qi Wang
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Peijing Yan
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jianfeng Li
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou, China
| | - Ping Xie
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Liang Yao
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
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Ariyanti F, Sukrisman L, Antono D, Harimurti K. The risk for post-thrombotic syndrome of subjects with deep vein thrombosis in an Indonesian referral hospital: a retrospective cohort study. Thromb J 2023; 21:38. [PMID: 37020240 PMCID: PMC10074643 DOI: 10.1186/s12959-023-00482-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/29/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Post-thrombotic syndrome (PTS) is a complication of deep vein thrombosis (DVT) and affects 20-40% of DVT subjects. The risk factor of PTS after DVT is difficult to determine. We aimed to evaluate the incidence of PTS after 3 months of DVT diagnosis and to determine the risk of PTS. METHODS A retrospective cohort study of subjects who developed DVT confirmed by Doppler ultrasound in Cipto Mangunkusumo Hospital from April 2014 until June 2015. The presence of PTS was assessed after 3 months of completed DVT treatment using the Villalta score. Risk factors for PTS were evaluated from medical records. RESULTS There were 91 subjects with DVT with mean age of 58 years. 56% were female. It was dominated by subjects aged ≥ 60 years (45.1%). Hypertension (30.8%) and diabetes mellitus (26.4%) were the major comorbidities in this study. Deep vein thrombosis occurred commonly in unilateral side (79.1%), proximal localization (87.9%), and unprovoked DVT (47.3%). The cumulative incidence of PTS after DVT was 53.8%, 69% of subjects had mild PTS. Heaviness of the leg (63.2%) and edema (77.5%) were the most common symptoms. RESULTS There were 91 subjects with DVT with mean age of 58 years. 56% were female. It was dominated by subjects aged ≥ 60 years (45.1%). Hypertension (30.8%) and diabetes mellitus (26.4%) were the major comorbidities in this study. Deep vein thrombosis occurred commonly in unilateral side (79.1%), proximal localization (87.9%), and unprovoked DVT (47.3%). The cumulative incidence of PTS after DVT was 53.8%, 69% of subjects had mild PTS. Heaviness of the leg (63.2%) and edema (77.5%) were the most common symptoms. Significant risk factors for PTS were unprovoked DVT (adjusted RR 1.67; 95%CI: 1.17-2.04; p = 0.01) and female gender (adjusted RR 1.55; 95%CI: 1.03-1.94; p = 0.04). Age, body mass index, thrombus location, immobilization, malignancy and surgery was not associated with PTS. CONCLUSION We conclude that 53.8% of subjects suffered PTS after 3 months of DVT. Unprovoked DVT and female gender were significant risk factors for PTS.
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Affiliation(s)
- Farieda Ariyanti
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Lugyanti Sukrisman
- Division of Hematology - Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
| | - Dono Antono
- Cardiovascular Division- Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Kuntjoro Harimurti
- Clinical Epidemiology Unit, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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Pradier M, Rodger MA, Ghanima W, Kovacs MJ, Shivakumar S, Kahn SR, Sandset PM, Kearon C, Mallick R, Delluc A. Performance and Head-to-Head Comparison of Three Clinical Models to Predict Occurrence of Postthrombotic Syndrome: A Validation Study. Thromb Haemost 2023. [PMID: 36809776 DOI: 10.1055/a-2039-3388] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE The SOX-PTS, Amin, and Méan models are three different clinical prediction scores stratifying the risk for postthrombotic syndrome (PTS) development in patients with acute deep vein thrombosis (DVT) of the lower limbs. Herein, we aimed to assess and compare these scores in the same cohort of patients. METHODS We retrospectively applied the three scores in a cohort of 181 patients (196 limbs) who participated in the SAVER pilot trial for an acute DVT. Patients were stratified into PTS risk groups using positivity thresholds for high-risk patients as proposed in the derivation studies. All patients were assessed for PTS 6 months after index DVT using the Villalta scale. We calculated the predictive accuracy for PTS and area under receiver operating characteristic (AUROC) curve for each model. RESULTS The Méan model was the most sensitive (sensitivity 87.7%; 95% confidence interval [CI]: 77.2-94.5) with the highest negative predictive value (87.5%; 95% CI: 76.8-94.4) for PTS. The SOX-PTS was the most specific score (specificity 97.5%; 95% CI: 92.7-99.5) with the highest positive predictive value (72.7%; 95% CI: 39.0-94.0). The SOX-PTS and Méan models performed well for PTS prediction (AUROC: 0.72; 95% CI: 0.65-0.80 and 0.74; 95% CI: 0.67-0.82), whereas the Amin model did not (AUROC: 0.58; 95% CI: 0.49-0.67). CONCLUSION Our data support that the SOX-PTS and Méan models have good accuracy to stratify the risk for PTS.
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Affiliation(s)
- Michelle Pradier
- Department of Medicine (Division of Hematology) and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Marc A Rodger
- Department of Medicine, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
| | - Waleed Ghanima
- Department of Research, Ostfold Hospital Trust, Norway
- Department of Haematology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Michael J Kovacs
- Division of Hematology, Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Sudeep Shivakumar
- Division of Hematology, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Susan R Kahn
- Department of Medicine, McGill University and Division of Clinical Epidemiology, Lady Davis Institute, Montreal, Quebec, Canada
| | - Per Morten Sandset
- Department of Haematology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Clive Kearon
- Department of Medicine (Division of Hematology) and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ranjeeta Mallick
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Aurélien Delluc
- Department of Medicine (Division of Hematology) and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Morgovan C, Dobrea CM, Chis AA, Juncan AM, Arseniu AM, Rus LL, Gligor FG, Ardelean SA, Stoicescu L, Ghibu S, Frum A. A Descriptive Analysis of Direct Oral Anticoagulant Drugs Dosing Errors Based on Spontaneous Reports from the EudraVigilance Database. Pharmaceuticals (Basel) 2023; 16:ph16030455. [PMID: 36986554 PMCID: PMC10056464 DOI: 10.3390/ph16030455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Direct oral anticoagulant drugs (DOACs) interfere with the coagulation process, thus improving patient care for those who require anticoagulant treatment. This study presents a descriptive analysis of adverse reactions (ADRs) attributed to DOAC dosage errors (overdose, underdose, and improper dose). The analysis was performed based on the Individual Case Safety Reports from the EudraVigilance (EV) database. Results show that data reported for rivaroxaban, apixaban, edoxaban, and dabigatran are mostly regarding underdosing (51.56%) compared to overdosing (18.54%). The most dosage error reports were identified for rivaroxaban (54.02%), followed by apixaban (33.61%). Dabigatran and edoxaban had similar percentages (6.26% and 6.11%, respectively) regarding dosage error reports. Since coagulation issues can become life-threatening events, and factors such as advanced age and renal failure can influence the pharmacokinetics of drugs, the correct usage of DOACs is of utmost importance for the management and prevention of venous thromboembolism. Thus, the collaboration and the complementarity of knowledge of physicians and pharmacists may offer a reliable solution for DOAC dose management and improve patient care.
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Affiliation(s)
- Claudiu Morgovan
- Preclinical Department, Faculty of Medicine, "Lucian Blaga" University of Sibiu, 550169 Sibiu, Romania
| | - Carmen Maximiliana Dobrea
- Preclinical Department, Faculty of Medicine, "Lucian Blaga" University of Sibiu, 550169 Sibiu, Romania
| | - Adriana Aurelia Chis
- Preclinical Department, Faculty of Medicine, "Lucian Blaga" University of Sibiu, 550169 Sibiu, Romania
| | - Anca Maria Juncan
- Preclinical Department, Faculty of Medicine, "Lucian Blaga" University of Sibiu, 550169 Sibiu, Romania
| | - Anca Maria Arseniu
- Preclinical Department, Faculty of Medicine, "Lucian Blaga" University of Sibiu, 550169 Sibiu, Romania
| | - Luca Liviu Rus
- Preclinical Department, Faculty of Medicine, "Lucian Blaga" University of Sibiu, 550169 Sibiu, Romania
| | - Felicia Gabriela Gligor
- Preclinical Department, Faculty of Medicine, "Lucian Blaga" University of Sibiu, 550169 Sibiu, Romania
| | - Simona Alexandrina Ardelean
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, "Vasile Goldis" Western University of Arad, 310025 Arad, Romania
| | - Laurentiu Stoicescu
- Department of Cardiology, Vth Medical Clinic, Faculty of Medicine, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400139 Cluj-Napoca, Romania
| | - Steliana Ghibu
- Department of Pharmacology, Physiology and Pathophysiology, Faculty of Pharmacy, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Adina Frum
- Preclinical Department, Faculty of Medicine, "Lucian Blaga" University of Sibiu, 550169 Sibiu, Romania
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Ghouse J, Tragante V, Ahlberg G, Rand SA, Jespersen JB, Leinøe EB, Vissing CR, Trudsø L, Jonsdottir I, Banasik K, Brunak S, Ostrowski SR, Pedersen OB, Sørensen E, Erikstrup C, Bruun MT, Nielsen KR, Køber L, Christensen AH, Iversen K, Jones D, Knowlton KU, Nadauld L, Halldorsson GH, Ferkingstad E, Olafsson I, Gretarsdottir S, Onundarson PT, Sulem P, Thorsteinsdottir U, Thorgeirsson G, Gudbjartsson DF, Stefansson K, Holm H, Olesen MS, Bundgaard H. Genome-wide meta-analysis identifies 93 risk loci and enables risk prediction equivalent to monogenic forms of venous thromboembolism. Nat Genet 2023; 55:399-409. [PMID: 36658437 DOI: 10.1038/s41588-022-01286-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/13/2022] [Indexed: 01/21/2023]
Abstract
We report a genome-wide association study of venous thromboembolism (VTE) incorporating 81,190 cases and 1,419,671 controls sampled from six cohorts. We identify 93 risk loci, of which 62 are previously unreported. Many of the identified risk loci are at genes encoding proteins with functions converging on the coagulation cascade or platelet function. A VTE polygenic risk score (PRS) enabled effective identification of both high- and low-risk individuals. Individuals within the top 0.1% of PRS distribution had a VTE risk similar to homozygous or compound heterozygous carriers of the variants G20210A (c.*97 G > A) in F2 and p.R534Q in F5. We also document that F2 and F5 mutation carriers in the bottom 10% of the PRS distribution had a risk similar to that of the general population. We further show that PRS improved individual risk prediction beyond that of genetic and clinical risk factors. We investigated the extent to which venous and arterial thrombosis share clinical risk factors using Mendelian randomization, finding that some risk factors for arterial thrombosis were directionally concordant with VTE risk (for example, body mass index and smoking) whereas others were discordant (for example, systolic blood pressure and triglyceride levels).
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Affiliation(s)
- Jonas Ghouse
- Laboratory for Molecular Cardiology, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
- Laboratory for Molecular Cardiology, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | | | - Gustav Ahlberg
- Laboratory for Molecular Cardiology, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Laboratory for Molecular Cardiology, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren A Rand
- Laboratory for Molecular Cardiology, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Laboratory for Molecular Cardiology, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jakob B Jespersen
- Laboratory for Molecular Cardiology, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Laboratory for Molecular Cardiology, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Eva Birgitte Leinøe
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Linea Trudsø
- Laboratory for Molecular Cardiology, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Laboratory for Molecular Cardiology, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ingileif Jonsdottir
- deCODE genetics/Amgen, Inc., Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Iceland Department of Immunology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Karina Banasik
- Translational Disease Systems Biology, Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Brunak
- Translational Disease Systems Biology, Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sisse R Ostrowski
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ole B Pedersen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Næstved Hospital, Næstved, Denmark
| | - Erik Sørensen
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Mie Topholm Bruun
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Kaspar Rene Nielsen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Alex H Christensen
- Department of Cardiology, Copenhagen University Hospital, Herlev-Gentofte Hospital, Herlev, Denmark
| | - Kasper Iversen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital, Herlev-Gentofte Hospital, Herlev, Denmark
| | - David Jones
- Precision Genomics, Intermountain Healthcare, Saint George, UT, USA
| | - Kirk U Knowlton
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, UT, USA
- University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Lincoln Nadauld
- Precision Genomics, Intermountain Healthcare, Saint George, UT, USA
- Stanford University, School of Medicine, Stanford, CA, USA
| | | | | | | | | | - Pall T Onundarson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Laboratory Hematology, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Unnur Thorsteinsdottir
- deCODE genetics/Amgen, Inc., Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Gudmundur Thorgeirsson
- deCODE genetics/Amgen, Inc., Reykjavik, Iceland
- Department of Medicine, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Daniel F Gudbjartsson
- deCODE genetics/Amgen, Inc., Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | - Kari Stefansson
- deCODE genetics/Amgen, Inc., Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Hilma Holm
- deCODE genetics/Amgen, Inc., Reykjavik, Iceland
| | - Morten Salling Olesen
- Laboratory for Molecular Cardiology, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Laboratory for Molecular Cardiology, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Liu C, Zhou Y, Sun Y, Xu M, Wang G, Tang L. Effect of the timing of iliac vein stent implantation on catheter-directed thrombolysis in acute lower extremity deep venous thrombosis patients with severe iliac vein stenosis: a retrospective study. Phlebology 2023; 38:181-189. [PMID: 36803312 DOI: 10.1177/02683555231157566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE To investigate the effect of the timing of iliac vein stent implantation on catheter-directed thrombolysis (CDT) in acute lower extremity deep venous thrombosis (DVT) patients with severe iliac vein stenosis. METHODS The clinical data of 66 patients with acute lower extremity DVT complicated with severe iliac vein stenosis from May 2017 to May 2020 were retrospectively analyzed. Patients were divided into two groups by timing of iliac vein stent implantation: group A (iliac vein stent implantation before CDT treatment) for 34 and group B (iliac vein stent implantation after CDT treatment) for 32. The detumescence rate of affected limb, the thrombus clearance rate, the thrombolytic efficiency, the complication rate, the hospitalization cost, the stent patency rate within 1 year, and the scores (venous clinical severity score, Villalta, and chronic venous insufficiency questionnaire (CIVIQ) score) at 1 year postoperatively were compared between the two groups. RESULTS The thrombolytic efficiency of group A was higher than that of group B, while the incidence of complications and hospitalization expenses in group A were lower than those in group B. There was no statistical significance in the detumescence rate of affected limb, the thrombus clearance rate, the stent patency rate within 1 year, and the scores (VCSS, Villalta, and CIVIQ score) at 1 year postoperatively between the two groups. CONCLUSIONS For acute lower extremity DVT patients with severe iliac vein stenosis, iliac vein stent implantation before CDT treatment can improve the thrombolytic efficiency, and reduce the incidence of complications and hospitalization costs.
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Affiliation(s)
- Chunjiang Liu
- Department of Vascular Surgery, 74682Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, Zhejiang, China
| | - Yue Zhou
- Department of Vascular Surgery, 74682Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, Zhejiang, China
| | - Yifeng Sun
- Department of Vascular Surgery, 74682Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, Zhejiang, China
| | - Miaojun Xu
- Department of Vascular Surgery, 74682Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, Zhejiang, China
| | - Guohua Wang
- Department of Vascular Surgery, 74682Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, Zhejiang, China
| | - Liming Tang
- Department of Vascular Surgery, 74682Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, Zhejiang, China
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Li T, Li Y, Zhang L, Pang L, Tang X, Zhu J. Venous thromboembolism after arthroscopic shoulder surgery: a systematic review. J Orthop Surg Res 2023; 18:103. [PMID: 36788620 PMCID: PMC9927062 DOI: 10.1186/s13018-023-03592-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
PURPOSE To summarize the incidence, risk factors, diagnosis methods, prophylaxis methods, and treatment of venous thromboembolism (VTE) following arthroscopic shoulder surgery. METHODS Literature on VTE after arthroscopic shoulder surgeries was summarized, and all primary full-text articles reporting at least 1 case of deep vein thrombosis (DVT) or pulmonary embolism (PE) after arthroscopic shoulder surgeries were included. Articles were critically appraised and systematically analyzed to determine the incidence, risk factors, diagnosis, prophylaxis, and management of VTE following arthroscopic shoulder surgeries. RESULTS This study included 42 articles in which the incidence of VTE ranges from 0 to 5.71% and the overall incidence was 0.26%. Most VTE events took place between the operation day and the 14th day after the operation (35/51). Possible risk factors included advanced age (> 70 years), obesity (BMI ≥ 30 kg/m2), diabetes mellitus, thrombophilia, history of VTE, prolonged operation time, hormone use, and immobilization after surgery. The most common prophylaxis method was mechanical prophylaxis (13/15). No statistical difference was detected when chemoprophylaxis was applied. The management included heparinization followed by oral warfarin, warfarin alone and rivaroxaban, a direct oral anticoagulant. CONCLUSION Based on the included studies, the incidence rate of VTE after arthroscopic shoulder surgeries is relatively low. The risk factors for VTE are still unclear. CT/CTA and ultrasound were the mainstream diagnosis methods for PE and DVT, respectively. Current evidence shows that chemical prophylaxis did not deliver significant benefits, since none of the existing studies reported statistically different results. High-quality studies focusing on the prophylaxis and management of VTE population undergoing arthroscopic shoulder surgeries should be done in the future.
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Affiliation(s)
- Tao Li
- grid.13291.380000 0001 0807 1581Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Yinghao Li
- grid.13291.380000 0001 0807 1581Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Linmin Zhang
- grid.13291.380000 0001 0807 1581West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Long Pang
- grid.13291.380000 0001 0807 1581Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Xin Tang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan Province, People's Republic of China.
| | - Jing Zhu
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Nursing, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, Sichuan Province, People's Republic of China.
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Turner BRH, Thapar A, Jasionowska S, Javed A, Machin M, Lawton R, Gwozdz AM, Davies AH. Systematic Review and Meta-Analysis of the Pooled Rate of Post-Thrombotic Syndrome After Isolated Distal Deep Venous Thrombosis. Eur J Vasc Endovasc Surg 2023; 65:291-297. [PMID: 36257568 DOI: 10.1016/j.ejvs.2022.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/08/2022] [Accepted: 10/09/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To identify the rate of post-thrombotic syndrome (PTS) after isolated distal deep venous thrombosis (IDDVT) by performing a meta-analysis of the rate of PTS across randomised and observational studies. DATA SOURCES MEDLINE, Embase, the Cochrane Controlled Trials Register, Clinicaltrials.gov, European Union Clinical Trials, International Standard Randomised Controlled Trial Number, and the Australian and New-Zealand Trials Registries. REVIEW METHODS This review followed PRISMA guidelines using a registered protocol (CRD42021282136). Databases were searched up to December 2021 and prospective studies reporting the development of post-thrombotic syndrome were included; these were pooled with the meta-analysis. RESULTS The results showed a post-thrombotic rate of 17% (95% CI 11 - 26%) (seven studies, 217 cases, 1 105 participants). Heterogeneity was high (I2 = 89%). On meta-regression, the rate of post-thrombotic syndrome was not correlated with the length of follow up (p = .71). Three studies (302 participants) reported the severity of post-thrombotic syndrome: 78% were mild (Villalta score 5 - 9); 11% were moderate (Villalta score 10 - 14), and 11% were severe (Villalta score ≥ 15). CONCLUSION The risk of post-thrombotic syndrome after IDDVT was one in five and the risk of severe clinical manifestations, including ulceration, was one in 50. There was significant clinical, methodological, and statistical heterogeneity between studies and a substantial risk of bias from pooled studies. Randomised trials to support interventions for prevention of post-thrombotic syndrome are urgently needed.
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Affiliation(s)
- Benedict R H Turner
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ankur Thapar
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Centre for Circulatory Health, Anglia Ruskin University, Cambridge, UK
| | - Sara Jasionowska
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Azfar Javed
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Matthew Machin
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rebecca Lawton
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Adam M Gwozdz
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alun H Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.
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DeRoo E, Zhou T, Yang H, Stranz A, Henke P, Liu B. A vein wall cell atlas of murine venous thrombosis determined by single-cell RNA sequencing. Commun Biol 2023; 6:130. [PMID: 36721040 PMCID: PMC9889765 DOI: 10.1038/s42003-023-04492-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/16/2023] [Indexed: 02/02/2023] Open
Abstract
Deep vein thrombosis (DVT) is a common clinical problem, but its cellular and molecular mechanisms remain incompletely understood. In this study, we performed single-cell RNA sequencing on mouse inferior vena cava (IVC) 24 h after thrombus-inducing IVC ligation or sham operation. 9 cell types composed of multiple subpopulations were identified. Notable transcriptomic changes induced by DVT included a marked inflammatory response, elevated hypoxia, and globally reduced myogenesis. Analysis of individual cell populations revealed increased inflammation and reduced extracellular matrix production across smooth muscle cells and fibroblasts, juxtaposed against an early phenotypic shift in smooth muscle cell populations away from a contractile state. By characterizing the transcriptomic changes in the vein wall during acute venous thrombosis at the single-cell level, this work provides novel insights into early pathological events in the vein wall that may potentiate thrombus formation and result in long term adverse venous remodeling.
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Affiliation(s)
- Elise DeRoo
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Ting Zhou
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, 53705, USA.
| | - Huan Yang
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Amelia Stranz
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Peter Henke
- Department of Surgery, Division of Vascular Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Bo Liu
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, 53705, USA.
- Department of Cellular and Regenerative Biology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, 53705, USA.
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Yu F, Wu S, Chen C. Predictors of long-term outcomes after catheter-directed thrombolysis combined with stent implantation in acute deep vein thrombosis secondary to iliac vein compression. Medicine (Baltimore) 2023; 102:e32646. [PMID: 36705394 PMCID: PMC9875978 DOI: 10.1097/md.0000000000032646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The purpose of this study is to analyze predictive factors for long-term clinical outcomes after catheter-directed thrombolysis (CDT) combined with stent implantation for acute deep vein thrombosis (DVT) secondary to iliac vein compression (IVC). A retrospective analysis was performed to review clinical data and follow-up information on 52 patients who underwent CDT combined with stent implantation for acute DVT secondary to IVC from June 2015 to March 2020. Clinical outcomes including stent patency and incidence of postthrombotic syndrome (PTS) were investigated using Kaplan-Meier analysis. All included patients were categorized into 2 groups according to the presence of PTS. Potential risk factors, including age, gender, degree of iliac vein stenosis, time from onset to treatment, dosage of thrombolytic agent, stent extending below the inguinal ligament, and duration of anticoagulation for PTS were evaluated using multivariate logistic regression analysis. Over a median follow-up of 24 months, 4 individuals underwent reintervention due to in-stent stenosis or stent compression. Primary stent patency was 98.1% at 1 month, 94.2% at 6 months, 90.4% at 12 months, and 88.5% at 24 months. Freedom from PTS was 98.1% at 6 months, 84.6% at 12 months, and 75% at 24 months. No treatment-related mortality or morbidity was observed. Based on the development of PTS, 13 patients with PTS were classified into group A and 39 patients without PTS were regarded as group B. Upon multivariate logistic regression analysis, key prognostic factors for PTS were degree of iliac vein stenosis and time from onset to treatment. CDT combined with stent implantation is safe and effective for acute DVT secondary to IVC in the long-term perspective. Severe iliac vein stenosis and longer period from onset to treatment may be associated with a higher risk of PTS.
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Affiliation(s)
- Feng Yu
- Department of Vascular Surgery, Jiangyin Hospital of Traditional Chinese Medicine, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, Jiangyin, Jiangsu, China
| | - Shuai Wu
- Department of Vascular Surgery, Jiangyin Hospital of Traditional Chinese Medicine, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, Jiangyin, Jiangsu, China
| | - Cong Chen
- Department of Vascular Surgery, Jiangyin Hospital of Traditional Chinese Medicine, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, Jiangyin, Jiangsu, China
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Arokiaraj MC. Thrombolysis Through Punctured Coronary Balloon and 014 Wire Mediated Guitaring After IVC Filter Insertion in Iliofemoral Deep Vein Thrombosis. Eur J Case Rep Intern Med 2023; 10:003710. [PMID: 36819649 PMCID: PMC9930878 DOI: 10.12890/2023_003710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023] Open
Abstract
This is a report of a patient who presented with iliofemoral deep vein thrombosis, and was treated with pharmaco-invasive and pharmaco-mechanic methods using coronary balloon and mechanical disruption of clots with coronary 014 wire. A 65-year-old male presented with acute deep vein thrombosis extending from the left common iliac to the popliteal vein. The patient had significant swelling and pain. An inferior vena cava (IVC) filter was inserted, and catheter-directed thrombolysis was planned. A technical difficulty was encountered entering the proximal common iliac vein. Hence, a 014 balance middle weight (BMW) wire with coronary balloon support was introduced through a Cordis® 6 F. diagnostic catheter, and the 014 wire was advanced with guitaring technique up to the femoral vein. Thereafter, the coronary balloon was ruptured at high pressure, and thrombolysis using streptokinase was performed along the balloon tract up to the ostium of the common iliac vein. The patient symptomatically improved significantly and is currently on anticoagulants. Follow-up after one year showed minimal residual oedema, and less pain in the ankle region. Pharmaco-mechanical treatment is possible using coronary balloon dilatations and thrombolysis through a ruptured coronary balloon. Mechanical disruption of clots to some extent is feasible using 014 wire by a guitaring technique. LEARNING POINTS In difficult cases with deep vein thrombosis, coronary hardware could be used for balloon angioplasty, especially when the iliac bifurcation cannot be crossed.Even suboptimal results can lead to significant symptomatic improvement in deep venous thrombosis treatment.
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O'Shaugnessy F, Govindappagari S, Huang Y, Syeda SK, D'Alton ME, Wright JD, Friedman AM. Postthrombotic Syndrome and Chronic Pulmonary Embolism after Obstetric Venous Thromboembolism. Am J Perinatol 2023; 40:22-24. [PMID: 34808685 DOI: 10.1055/s-0041-1739471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE While the majority of venous thromboembolism (VTE) during pregnancy events resolve with anticoagulation, long-term complications may occur including (1) postthrombotic syndrome and (2) chronic pulmonary embolism. The objective of this study was to determine risk of these two complications. STUDY DESIGN A retrospective cohort study using the MarketScan databases was performed on deliveries from 2008 to 2014. We identified women aged 15 to 54 years diagnosed with acute VTE during pregnancy, the delivery hospitalization, or ≤60 days postpartum who received at least one prescription postpartum for anticoagulants. Risks of (1) chronic PE and (2) postthrombotic syndrome were evaluated for women at 6, 12, 24, and 60 months after delivery hospitalization through 2017 via the International Classification of Diseases, 9th/10th Revision, Clinical Modification codes. RESULTS Of 4,267 of 4,128,900 pregnancies complicated by VTE, the majority had DVT alone (61.8%, n = 2,637), while 25.8% had PE alone (n = 1,103) and 12.4% (n = 527) had both DVT and PE. Of the entire cohort, 3,328 retained insurance coverage at 6 months, 2,823 at 12 months, 2,161 at 24 months, and 831 at 60 months. Restricted to DVT, risk of postthrombotic syndrome was 0.7% at 6 months (n = 17), 1.1% at 12 months (n = 22), 1.7% at 24 months (n = 26), and 2.7% at 60 months (n = 16). Among women with PE diagnoses, the risk of chronic PE was 2.4% at 6 months (n = 30), 3.3% at 12 months (n = 36), 4.2% at 24 months (n = 36), and 7.2% at 60 months (n = 24). CONCLUSION In comparison to the general population, the risk of postthrombotic syndrome was lower. In comparison, the risk of chronic PE was similar to the estimates in the general population at comparable time points after PE events. For women with obstetric PE, it may be appropriate to be vigilant for findings and symptoms associated with chronic PE. KEY POINTS · Risk of postthrombotic syndrome after obstetric deep vein thrombosis is low.. · Risk of chronic pulmonary embolism may approximate that in the general population.. · Overall risk of chronic complications after obstetric VTE was relatively low..
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Affiliation(s)
- Fergal O'Shaugnessy
- Pharmacy Department, Rotunda Hospital, Dublin, Ireland.,Division of Population Health Sciences, Royal College of Surgeons, Dublin, Ireland
| | | | - Yongmei Huang
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Sbaa K Syeda
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
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