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Pradhyumnan H, Perez GG, Patel SH, Blaya MO, Bramlett HM, Raval AP. A Perspective on Hormonal Contraception Usage in Central Nervous System Injury. J Neurotrauma 2024; 41:541-551. [PMID: 37975282 DOI: 10.1089/neu.2023.0219] [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: 11/19/2023] Open
Abstract
Naturally occurring life stages in women are associated with changes in the milieu of endogenous ovarian hormones. Women of childbearing age may be exposed to exogenous ovarian hormone(s) because of their use of varying combinations of estrogen and progesterone hormones-containing oral contraceptives (OC; also known as "the pill"). If women have central nervous system (CNS) injury such as spinal cord injury (SCI) and traumatic brain injury (TBI) during their childbearing age, they are likely to retain their reproductive capabilities and may use OC. Many deleterious side effects of long-term OC use have been reported, such as aberrant blood clotting and endothelial dysfunction that consequently increase the risk of myocardial infarction, venous thromboembolism, and ischemic brain injury. Although controversial, studies have suggested that OC use is associated with neuropsychiatric ramifications, including uncontrollable mood swings and poorer cognitive performance. Our understanding about how the combination of endogenous hormones and OC-conferred exogenous hormones affect outcomes after CNS injuries remains limited. Therefore, understanding the impact of OC use on CNS injury outcomes needs further investigation to reveal underlying mechanisms, promote reporting in clinical or epidemiological studies, and raise awareness of possible compounded consequences. The goal of the current review is to discuss the impacts of CNS injury on endogenous ovarian hormones and vice-versa, as well as the putative consequences of exogenous ovarian hormones (OC) on the CNS to identify potential gaps in our knowledge to consider for future laboratory, epidemiological, and clinical studies.
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Affiliation(s)
- Hari Pradhyumnan
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratory (CVDRL), Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Gina G Perez
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratory (CVDRL), Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Shahil H Patel
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratory (CVDRL), Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Meghan O Blaya
- Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
- The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Helen M Bramlett
- Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
- The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
- Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
| | - Ami P Raval
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratory (CVDRL), Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
- Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
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2
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Fazzone B, Anderson EM, Krebs J, Ueland W, Viscardi C, Jacobs C, Spratt JR, Scali ST, Jeng E, Upchurch GR, Weaver ML, Cooper MA. Perioperative Cerebrospinal Fluid Drain Placement Does Not Increase Venous Thromboembolism Risk After Thoracic and Fenestrated Endovascular Aortic Repair. Ann Vasc Surg 2024; 99:58-64. [PMID: 37972728 DOI: 10.1016/j.avsg.2023.09.079] [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: 04/03/2023] [Revised: 09/04/2023] [Accepted: 09/26/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) incidence after thoracic and fenestrated endovascular aortic repair (TEVAR/FEVAR) is high (up to 6-7%) relative to other vascular procedures; however, the etiology for this discrepancy remains unknown. Notably, patients undergoing TEVAR/FEVAR commonly receive cerebrospinal fluid drains (CSFDs) for neuroprotection, requiring interruption of perioperative anticoagulation and prolonged immobility. We hypothesized that CSFDs are a risk factor for VTE after TEVAR/FEVAR. METHODS Consecutive TEVAR/FEVAR patients at a single center were reviewed (2011-2020). Cerebrospinal fluid drains (CSFDs) were placed based on surgeon preference preoperatively or for spinal cord ischemia (SCI) rescue therapy postoperatively. The primary end-point was VTE occurrence, defined as any new deep venous thrombosis (DVT) or pulmonary embolism (PE) confirmed on imaging within 30 days postoperatively. Routine postoperative VTE screening was not performed. Patients with and without VTE, and subjects with and without CSFDs were compared. Logistic regression was used to explore associations between VTE incidence and CSFD exposure. RESULTS Eight hundred ninety-seven patients underwent TEVAR/FEVAR and 43% (n = 387) received a CSFD at some point during their care (preoperative: 94% [n = 365/387]; postoperative SCI rescue therapy: 6% [n = 22/387]). CSFD patients were more likely to have previous aortic surgery (44% vs. 37%; P = 0.028) and received more postoperative blood products (780 vs. 405 mL; P = 0.005). The overall VTE incidence was 2.2% (n = 20). 70% (14) patients with VTE had DVT, 50% (10) had PE, and 20% (4) had DVT and PE. Among TEVAR/FEVAR patients with VTE, 65% (n = 13) were symptomatic. Most VTEs (90%, n = 18) were identified inhospital and the median time to diagnosis was 12.5 (interquartile range 7.5-18) days postoperatively. Patients with VTE were more likely to have nonelective surgery (95% vs. 41%; P < 0.001), had higher American Society of Anesthesiologists classification (4.1 vs. 3.7; P < 0.001), required longer intensive care unit admission (24 vs. 12 days; P < 0.001), and received more blood products (1,386 vs. 559 mL; P < 0.001). Venous thromboembolism (VTE) incidence was 1.8% in CSFD patients compared to 3.5% in non-CSFD patients (odds ratio 0.70 [95% confidence interval 0.28-1.78, P = 0.300). However, patients receiving CSFDs postoperatively for SCI rescue therapy had significantly greater VTE incidence (9.1% vs. 1.1%; P = 0.044). CONCLUSIONS CSFD placement was not associated with an increased risk of VTE in patients undergoing TEVAR/FEVAR. Venous thromboembolism (VTE) risk was greater in patients undergoing nonelective surgery and those with complicated perioperative courses. Venous thromboembolism (VTE) risk was greater in patients receiving therapeutic CSFDs compared to prophylactic CSFDs, highlighting the importance of careful patient selection for prophylactic CSFD placement.
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Affiliation(s)
- Brian Fazzone
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL
| | - Erik M Anderson
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL
| | - Jonathan Krebs
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL
| | - Walker Ueland
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL
| | - Chelsea Viscardi
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL
| | - Chris Jacobs
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL
| | - John R Spratt
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL
| | - Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL
| | - Eric Jeng
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL
| | - Gilbert R Upchurch
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL
| | - M Libby Weaver
- Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, VA
| | - Michol A Cooper
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL.
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Haim A, Avnery O, Rubin-Asher D, Amir H, Hashem K, Zvi HB, Ratmansky M. Enoxaparin for VTE thromboprophylaxis during inpatient rehabilitation care: assessment of the standard fixed dosing regimen. BMC Pharmacol Toxicol 2024; 25:8. [PMID: 38200581 PMCID: PMC10782744 DOI: 10.1186/s40360-023-00728-0] [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: 02/19/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND We aimed to examine the efficiency of fixed daily dose enoxaparin (40 mg) thromboprophylaxis strategy for patients undergoing inpatient rehabilitation. METHODS This was an observational, prospective, cohort study that included 63 hospitalized patients undergoing rehabilitative treatment following sub-acute ischemic stroke (SAIS) or spinal cord injury (SCI), with an indication for thromboprophylaxis. Anti-Xa level measured three hours post-drug administration (following three consecutive days of enoxaparin treatment or more) was utilised to assess in vivo enoxaparin activity. An anti-Xa level between 0.2-0.5 U/ml was considered evidence of effective antithrombotic activity. RESULTS We found sub-prophylactic levels of anti-Xa (<0.2 U/ml) in 19% (12/63). Results were within the recommended prophylactic range (0.2-0.5 U/ml) in 73% (46/63) and were supra-prophylactic (>0.5 U/ml) in 7.9% (5/63) of patients. Anti-Xa levels were found to inversely correlate with patients' weight and renal function as defined by creatinine clearance (CrCl) (p<0.05). CONCLUSIONS Our study confirmed that a one-size-fits-all approach for venous thromboembolism (VTE) prophylaxis may be inadequate for rehabilitation patient populations. The efficacy of fixed-dose enoxaparin prophylaxis is limited and may be influenced by renal function and weight. This study suggests that anti-Xa studies and prophylactic enoxaparin dose adjustments should be considered in certain patients, such as those who are underweight, overweight and or have suboptimal renal function. TRIAL REGISTRATION No. NCT103593291, registered August 2018.
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Affiliation(s)
- Amir Haim
- Loewenstein Rehabilitation Medical Center, 278 Achuza St, Raanana, POB 3, 43100, Israel.
- School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Orli Avnery
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Hematology Institute, Meir Medical Center, Kfar Saba, Israel
| | - Deborah Rubin-Asher
- Loewenstein Rehabilitation Medical Center, 278 Achuza St, Raanana, POB 3, 43100, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagay Amir
- Loewenstein Rehabilitation Medical Center, 278 Achuza St, Raanana, POB 3, 43100, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kaifa Hashem
- Loewenstein Rehabilitation Medical Center, 278 Achuza St, Raanana, POB 3, 43100, Israel
| | - Harel Ben Zvi
- Loewenstein Rehabilitation Medical Center, 278 Achuza St, Raanana, POB 3, 43100, Israel
| | - Motti Ratmansky
- Loewenstein Rehabilitation Medical Center, 278 Achuza St, Raanana, POB 3, 43100, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Peng S, Zhang M, Jin J, MacCormick AD. The effectiveness of venous thromboembolism prophylaxis interventions in trauma patients: A systematic review and network meta-analysis. Injury 2023; 54:111078. [PMID: 37865011 DOI: 10.1016/j.injury.2023.111078] [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: 08/19/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a major complication of trauma. Currently, there are few studies summarising the evidence for prophylaxis in trauma settings. This review provides evidence for the use of VTE prophylactic interventions in trauma patients to produce evidence-based guidelines. METHODS A PRISMA-compliant review was conducted from Sep 2021 to June 2023, using Embase, Medline and Google Scholar. The inclusion criteria were: randomized-controlled trials (RCTs) in English published after 2000 of adult trauma patients comparing VTE prophylaxis interventions, with a sample size higher than 20. The network analysis was conducted using RStudio. The results of the pairwise comparisons were presented in the form of a league table. The quality of evidence and heterogeneity sensitivity were assessed. The primary outcome focused on venous thromboembolism (VTE), and examined deep vein thrombosis (DVT) and pulmonary embolism (PE) as separate entities. The secondary outcomes included assessments of bleeding and mortality. PROSPERO registration: CRD42021266393. RESULTS Of the 7,948 search results, 23 studies with a total of 21,312 participants fulfilled screening criteria, which included orthopaedic, spine, solid organ, brain, spinal cord, and multi-region trauma. Of the eight papers comparing chemical prophylaxis medications in patients with hip or lower limb injuries, fondaparinux and enoxaparin were found to be significantly superior to placebo in respect of prevention of DVT, with no increased risk of bleeding. Regarding mechanical prophylaxis, meta-analysis of two studies of inferior vena cava filters failed to provide significant benefits to major trauma patients. CONCLUSION Enoxaparin and fondaparinux are safe and effective options for VTE prevention in trauma patients, with fondaparinux being a cheaper and easier administration option between the two. Inconclusive results were found in mechanical prophylaxis, requiring more larger-scale RCTs.
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Affiliation(s)
- Serena Peng
- School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland Te Waipapa Taumata Rau, Auckland, New Zealand.
| | - Mandy Zhang
- School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland Te Waipapa Taumata Rau, Auckland, New Zealand
| | - James Jin
- School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland Te Waipapa Taumata Rau, Auckland, New Zealand; Department of Surgery, Te Whatu Ora - Counties Manukau, Auckland, New Zealand
| | - Andrew D MacCormick
- School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland Te Waipapa Taumata Rau, Auckland, New Zealand; Department of Surgery, Te Whatu Ora - Counties Manukau, Auckland, New Zealand
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Draganich C, Park A, Sevigny M, Charlifue S, Coons D, Makley M, Fenton J, Alvarez R, Berliner J. Venous thromboembolism: Exploring incidence and utility of screening in spinal cord injury. J Spinal Cord Med 2023:1-8. [PMID: 37162305 DOI: 10.1080/10790268.2023.2207063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE To assess the incidence and possible risk factors for venous thromboembolism (VTE) in patients admitted to a SCI rehabilitation center. DESIGN Retrospective review. SETTING Acute neurorehabilitation hospital specializing in SCI. METHODS Records of 228 consecutive admissions were reviewed. All patients received screening four limb ultrasounds on admission. Charts were reviewed to determine whether VTE was diagnosed at the acute care hospital or in the rehabilitation center; either on admission screening or later in the rehabilitation stay. Charts were reviewed to identify potential risk factors for VTE as well as the incidence of bleeding complications in patients on full anticoagulation. RESULTS In this cohort, 115 deep venous thromboses (DVTs) were identified in the following settings: 27% in acute care [n = 31], 70% on admission to rehabilitation [n = 80], and 24% during the rehabilitation stay [n = 28]. Of those on therapeutic anticoagulation due to admission diagnosis of VTE [n = 63], 12.7% developed recurrent DVT and 9.5% had bleeding complications. Of those who were initiated and continued on therapeutic anticoagulation, there was zero incidence of PE. Risk factors for the development of VTE included age, body mass index (BMI), rehabilitation length of stay, injury etiology, spinal cord-related surgery, and history of inferior vena cava filter. CONCLUSIONS DVT was identified in 70% of this cohort with screening ultrasound on admission to rehabilitation and of those initiated and continued on therapeutic anticoagulation, none developed PE, while 9.5% had bleeding complications. Given the findings of this study, prospective research in noninvasive vascular ultrasound screening for VTE should be considered.
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Affiliation(s)
- Christina Draganich
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Andrew Park
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
- Craig Hospital, Englewood, CO, USA
| | | | | | - David Coons
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
- VHA Spinal Cord Injury & Disorders, Aurora, CO, USA
| | - Michael Makley
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
- Craig Hospital, Englewood, CO, USA
| | | | - Raul Alvarez
- Colorado Blood and Cancer Care, LLC, Denver, CO, USA
| | - Jeffrey Berliner
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
- Craig Hospital, Englewood, CO, USA
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Bluvshtein V, Catz A, Mahamid A, Elkayam K, Michaeli D, Front L, Kfir A, Gelernter I, Aidinoff E. Venous thromboembolism and anticoagulation in spinal cord lesion rehabilitation inpatients: A 10-year retrospective study. NeuroRehabilitation 2023; 53:143-153. [PMID: 37424485 PMCID: PMC10473086 DOI: 10.3233/nre-230063] [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: 04/05/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a concern following the onset of spinal cord lesions (SCL). OBJECTIVES To assess the current efficacy and risks of anticoagulation after SCL and consider changes in thromboprophylaxis. METHODS This retrospective cohort study included individuals admitted to inpatient rehabilitation within 3 months of SCL onset. Main outcome measures were the incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), bleeding, thrombocytopenia, or death, which occurred within 1 year of the SCL onset. RESULTS VTE occurred in 37 of the 685 patients included in the study (5.4%, 95% CI 3.7-7.1%, 2.8% PE), and in 16 of 526 patients who received prophylactic anticoagulation at rehabilitation (3%, 95% CI 1.6-4.5%, 1.1% PE, with at least 1 fatality). Of these 526, 1.3% developed clinically significant bleeding and 0.8% thrombocytopenia. Prophylactic anticoagulation, most commonly 40 mg/day, continued until a median period of 6.4 weeks after SCL onset (25% -75% percentiles 5.8-9.7), but in 29.7%, VTE occurred more than 3 months after SCL onset. CONCLUSION The VTE prophylaxis used for the present cohort contributed to a considerable but limited reduction of VTE incidence. The authors recommend conducting a prospective study to assess the efficacy and safety of an updated preventive anticoagulation regimen.
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Affiliation(s)
- Vadim Bluvshtein
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amiram Catz
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ala Mahamid
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Keren Elkayam
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Dianne Michaeli
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Lilach Front
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Adi Kfir
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Ilana Gelernter
- School of Mathematical Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Elena Aidinoff
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Intensive Care for Consciousness Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
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Keller K, Wöllner J, Schmitt VH, Ostad MA, Sagoschen I, Münzel T, Espinola-Klein C, Hobohm L. Risk Factors for Pulmonary Embolism in Patients with Paralysis and Deep Venous Thrombosis. J Clin Med 2021; 10:jcm10225412. [PMID: 34830695 PMCID: PMC8618323 DOI: 10.3390/jcm10225412] [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: 10/05/2021] [Revised: 11/04/2021] [Accepted: 11/15/2021] [Indexed: 01/10/2023] Open
Abstract
Background. Venous thromboembolism is a frequent complication and an important cause of death in patients with paralysis. We aimed to investigate predictors of pulmonary embolism (PE) and the impact of PE on the survival of patients with paralysis in comparison to those with deep venous thrombosis or thrombophlebitis (DVT). Methods: Patients were selected by screening the German nationwide inpatient sample (2005–2017) for paralysis, and were stratified for venous thromboembolism (VTE) and the VTE-sub-entity PE (ICD-code I26). Impact of PE on mortality and predictors for PE were analyzed. Results: Overall, 7,873,769 hospitalizations of patients with paralysis were recorded in Germany 2005–2017, of whom 1.6% had VTE and 7.0% died. While annual hospitalizations increased (2005: 520,357 to 2017: 663,998) (β 12,421 (95% CI 10,807 to 14,034), p < 0.001), in-hospital mortality decreased from 7.5% to 6.7% (β −0.08% (95% CI −0.10% to −0.06%), p < 0.001). When focusing on 82,558 patients with paralysis hospitalized due to VTE (51.8% females; 58.3% aged ≥ 70 years) in 2005–2017, in-hospital mortality was significantly higher in patients with paralysis and PE than in those with DVT only (23.8% vs. 6.3%, p < 0.001). Cancer (OR 2.18 (95% CI 2.09–2.27), p < 0.001), heart failure (OR 1.83 (95% CI 1.76–1.91), p < 0.001), COPD (OR 1.63 (95% CI 1.53–1.72), p < 0.001) and obesity (OR 1.42 (95% CI 1.35–1.50), p < 0.001) were associated with PE. PE (OR 4.28 (95% CI 4.07–4.50), p < 0.001) was a strong predictor of in-hospital mortality. Conclusions: In Germany, annual hospitalizations of patients with paralysis increased in 2005–2017, in whom VTE and especially PE substantially affected in-hospital mortality. Cancer, heart failure, COPD, obesity and acute paraplegia were risk factors of PE.
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Affiliation(s)
- Karsten Keller
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany; (V.H.S.); (M.A.O.); (I.S.); (T.M.); (C.E.-K.); (L.H.)
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany
- Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Correspondence:
| | - Jens Wöllner
- Swiss Paraplegic Center Nottwil, Department of Neuro-Urology, 6207 Nottwil, Switzerland;
- Department of Urology and Pediatric Urology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany
| | - Volker H. Schmitt
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany; (V.H.S.); (M.A.O.); (I.S.); (T.M.); (C.E.-K.); (L.H.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, 55131 Mainz, Germany
| | - Mir A. Ostad
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany; (V.H.S.); (M.A.O.); (I.S.); (T.M.); (C.E.-K.); (L.H.)
| | - Ingo Sagoschen
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany; (V.H.S.); (M.A.O.); (I.S.); (T.M.); (C.E.-K.); (L.H.)
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany; (V.H.S.); (M.A.O.); (I.S.); (T.M.); (C.E.-K.); (L.H.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, 55131 Mainz, Germany
| | - Christine Espinola-Klein
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany; (V.H.S.); (M.A.O.); (I.S.); (T.M.); (C.E.-K.); (L.H.)
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany
| | - Lukas Hobohm
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany; (V.H.S.); (M.A.O.); (I.S.); (T.M.); (C.E.-K.); (L.H.)
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany
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8
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Xie H, Xu G, Huo C, Li W, Zhao H, Lv Z, Li Z. Brain Function Changes Induced by Intermittent Sequential Pneumatic Compression in Patients With Stroke as Assessed by Functional Near-Infrared Spectroscopy. Phys Ther 2021; 101:6290099. [PMID: 34061206 DOI: 10.1093/ptj/pzab140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 02/08/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Intermittent sequential pneumatic compression (ISPC) can effectively promote cerebral perfusion and collateral blood supply in patients with stroke. However, the effects of ISPC on cerebral oscillations are still unclear. METHODS The tissue concentration of oxyhemoglobin and deoxyhemoglobin oscillations were measured by functional near-infrared spectroscopy under resting and ISPC conditions in 27 right-handed adult patients with stroke. Five characteristic frequency signals (I, 0.6-2 Hz; II, 0.145-0.6 Hz; III, 0.052-0.145 Hz; IV, 0.021-0.052 Hz; and V, 0.0095-0.021 Hz) were identified using the wavelet method. The wavelet amplitude (WA) and laterality index (LI) were calculated to describe the frequency-specific cortical activities. RESULTS The ISPC state of patients with ischemic stroke showed significantly increased WA values of the ipsilesional motor cortex (MC) in the frequency intervals III (F37 = 8.017), IV (F37 = 6.347), and V (F37 = 5.538). There was no significant difference in the WA values in the ISPC state compared with the resting state in patients with hemorrhagic stroke. Also, the LI values of the prefrontal cortex and MC in patients decreased more obviously in the ISPC state than in the resting state despite no significant difference. CONCLUSION The significantly increased WA values in the frequency intervals III, IV, and V in the MC of patients with ischemic stroke might be related to cortical activity in the MC in addition to increased cerebral perfusion. The decreased LI values in the prefrontal cortex and MC indicated that the ISPC may have had a positive effect on the functional rehabilitation of these regions. IMPACT This study provides a method for assessing the effects of ISPC on cerebral oscillations, and the results benefit the optimization of ISPC parameters in personalized treatment for the functional recovery of patients with stroke.
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Affiliation(s)
- Hui Xie
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China.,Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids Beijing, China
| | - Gongcheng Xu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China.,Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids Beijing, China
| | - Congcong Huo
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China.,Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids Beijing, China
| | - Wenhao Li
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China.,Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids Beijing, China
| | - Haihong Zhao
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids Beijing, China
| | - Zeping Lv
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids Beijing, China
| | - Zengyong Li
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids Beijing, China.,Key Laboratory of Neuro-functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Beijing, China
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