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Snyder DJ, Zilinyi RS, Cohen DJ, Parikh SA, Sethi SS. Patient-Reported Outcomes in Venous Thromboembolism: A Systematic Review of the Literature, Current Challenges, and Ways Forward. J Am Heart Assoc 2023; 12:e032146. [PMID: 38014656 DOI: 10.1161/jaha.123.032146] [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: 08/08/2023] [Accepted: 10/04/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) affects >1.2 million Americans annually. Although the clinical outcomes and economic burdens of VTE have been well described, the impact of VTE on patients' health status has yet to be summarized. This systematic review summarizes how patient-reported outcome measures (PROMs) have been used in VTE to date. METHODS AND RESULTS PubMed/MEDLINE was queried for literature published through March 2023 using PROMs in a population of patients with VTE. Studies were excluded if the reference was an editorial, review, or case report, or if the study included patients with conditions other than VTE. Qualitative analyses were performed. After screening and exclusion, 136 references were identified; 5 described PROM development, 20 focused on PROM validation, and 111 used PROMs in outcomes research. The most used generic PROMs were the 36-item Short-Form Health Survey and EuroQol 5-dimensional questionnaire, and the most common disease-specific PROMs were the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms and the Pulmonary Embolism Quality of Life Questionnaire. PROMs were used to quantify the changes in health status after diagnosis, characterize the trajectory of subsequent improvement, and identify drivers of continued impairments in health status like postthrombotic syndrome and postpulmonary embolism syndrome. PROMs were also used to investigate the impact of novel treatment modalities on quality of life. CONCLUSIONS This review demonstrates the many benefits of PROM use, including quantifying changes in health status with treatment, capturing patients' experiences with the treatment itself, and identifying complications of VTE. Incorporating PROMs into VTE care will be an essential component of evaluating the effectiveness of novel therapies and should lead to improved shared decision-making for patients with VTE.
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Affiliation(s)
- Daniel J Snyder
- Department of Medicine, New York Presbyterian Columbia University Irving Medical Center New York NY USA
| | - Robert S Zilinyi
- Division of Cardiology, Department of Medicine Columbia University Irving Medical Center New York NY USA
| | - David J Cohen
- Cardiovascular Research Foundation New York NY USA
- Saint Francis Hospital Roslyn NY USA
| | - Sahil A Parikh
- Division of Cardiology, Department of Medicine Columbia University Irving Medical Center New York NY USA
| | - Sanjum S Sethi
- Division of Cardiology, Department of Medicine Columbia University Irving Medical Center New York NY USA
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2
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Villalba L, Vaddavalli VV, Tripathi RK. Iliac vein stenting and pregnancy. J Vasc Surg Venous Lymphat Disord 2023; 11:1276-1284. [PMID: 37572777 DOI: 10.1016/j.jvsv.2023.08.003] [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: 05/21/2023] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023]
Abstract
Venous stenting is the mainstay treatment of symptomatic iliofemoral venous outflow obstruction. However, because pregnancy and the postpartum period are hypercoagulable, concerns exist regarding stent placement in women of childbearing age. We performed a systematic review up to April 2023 of studies reporting on the performance of venous stents in women who subsequently became pregnant. The data collected included demographics, indication for stenting, stent characteristics, stent-related complications, incidence of venous thromboembolism, medical management during pregnancy, and follow-up. The indications for stenting included acute iliofemoral deep vein thrombosis in 39 patients (51%), nonthrombotic iliac vein lesions in 35 (46%), and post-thrombotic lesions in 2 patients. A total of 76 women with 87 subsequent pregnancies after stenting were included. Of the 76 women, 1 (1.14%) experienced stent occlusion, 2 (2.29%) developed asymptomatic nonocclusive in-stent thrombus, and 2 (2.29%) experienced permanent stent compression. The only patency loss occurred because of inadequate anticoagulation therapy in a patient with antiphospholipid antibodies. The two cases of permanent compression occurred in an arterial stent and a balloon-fenestrated Vici stent (Boston Scientific). Venous stents performed well through pregnancy and can be safely used in women of childbearing age. Given the increased risk of venous thromboembolism and the low bleeding risk, it is prudent to recommend anticoagulation therapy for all stented patients until more data are available.
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Affiliation(s)
- Laurencia Villalba
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia; Department of Vascular Surgery, The Wollongong Hospital, Wollongong, NSW, Australia; Vascular Care Centre, Wollongong, NSW, Australia.
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Liu Q, Chen L, Wang Z, Peng Z, Chen W, Pan Y, Wang Y, Sha Y. The role of D-dimer and fibrinogen testing in catheter-directed thrombolysis with urokinase for deep venous thrombosis. Phlebology 2023:2683555231176911. [PMID: 37207999 DOI: 10.1177/02683555231176911] [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: 05/21/2023]
Abstract
BACKGROUND During catheter-directed thrombolysis (CDT), D-dimer (D-D) are generated in large quantities and fibrinogen (FIB) is continuously consumed. Reduction of FIB increases the risk of bleeding. However, there are currently few studies on the relationship between D-D and FIB concentrations during CDT. OBJECTIVES To evaluate the relationship of D-D and FIB concentrations during CDT with urokinase for deep venous thrombosis (DVT). METHOD 17 patients with lower limb DVT were enrolled and treated with CDT. The concentrations of plasma D-D and FIB were measured every 8 h during thrombolysis. The degree of thrombolysis was evaluated, the change rules of D-D and FIB concentrations were analyzed, and the change curve graphs were drawn. The "thrombus volume," "thrombolysis time," "thrombolysis ratio," "D-D peak," "D-D rising speed," "FIB falling speed," and "duration of D-D elevation" were calculated in each patient. The mixed model was used to simulate the time change trend of the plasma D-D and FIB concentrations. Pearson method and linear regression were used to analyze the correlation and linear relationship, respectively. RESULTS The D-D concentration first increased rapidly and then decreased gradually, and the FIB concentration continued to decrease during thrombolysis. The rate of the decline of FIB varies with the urokinase dose. The thrombus volume is positively correlated with D-D rising speed, duration of D-D elevation, D-D peak, and FIB falling speed; the D-D rising speed is positively correlated with the D-D peak and FIB falling speed; and the D-D peak is positively correlated with the FIB falling speed. The correlation coefficients were all statistically significant (p < 0.05). Efficacy reached level I-II in 76.5% patients. No major bleeding occurred in any of the patients. CONCLUSION During CDT with urokinase for DVT, the concentrations of D-D and FIB show specific changes, and there are some specific relationships between each other. Understanding these changes and relationships may be helpful to adjust the thrombolysis time and urokinase dose more rationally.
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Affiliation(s)
- Qiang Liu
- Department of Radiology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Liang Chen
- Department of Interventional Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
| | - Zhengyu Wang
- Department of Interventional Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
| | - Zhiqing Peng
- Department of Interventional Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
| | - Wei Chen
- Department of Radiology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Yucheng Pan
- Department of Radiology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Yongli Wang
- Department of Interventional Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
| | - Yan Sha
- Department of Radiology, Eye and ENT Hospital, Fudan University, Shanghai, China
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4
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Guo J, Li C, Yu P, Xu T, Zhou H, Chen H. The effect of low molecular weight heparin combined with air pressure in the prevention of lower extremity venous thrombosis after cesarean section: A single-center retrospective study. Medicine (Baltimore) 2023; 102:e33475. [PMID: 37058024 PMCID: PMC10101301 DOI: 10.1097/md.0000000000033475] [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: 11/24/2022] [Accepted: 03/17/2023] [Indexed: 04/15/2023] Open
Abstract
In this study, we investigated the effect of low-molecular-weight heparin combined with pneumatic pressure in preventing lower extremity deep vein thrombosis after cesarean section, as well as on the visual analog scale (VAS) score. 120 women who underwent cesarean sections at full term in our hospital from January 2019 to January 2022 were included and divided into a control group (55 cases) and an observation group (65 cases) based on the different treatment methods: the control group was treated with low-molecular-weight heparin and the observation group was treated with pneumatic compression therapy based on the control group. The 2 groups were analyzed for thrombosis, clinical efficacy of the treatment methods, and VAS scores. The incidence of deep vein thrombosis in the observation group were significantly lower than in the control group (4.62% vs 21.82%, P < .05). There were no statistically significant differences in activated partial thromboplastin time, prothrombin time, and thrombin time between the 2 groups (P > .05) before treatment; however, after treatment, activated partial thromboplastin time, prothrombin time, and thrombin time in the observation group were significantly higher than those in the control group (P < .05). The clinical efficacy was significantly higher in the observation group compared with the control group (95.38% vs 78.18%, respectively). The VAS scores in the observation group were significantly lower than those in the control group (P < .05). Hence, low-molecular-weight heparin combined with pneumatic pressure therapy significantly reduces the incidence of lower limb deep vein thrombosis after cesarean section. It also improves the coagulation index and reduces post-operative pain. Therefore, it should be considered for use in clinical practice.
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Affiliation(s)
- Jian Guo
- Department of Vascular Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chenhao Li
- Department of Vascular Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Peidong Yu
- Department of Vascular Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Tongjie Xu
- Department of Vascular Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Haoge Zhou
- Department of Vascular Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hao Chen
- Department of Vascular Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
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Cheng X, Wang W, Du R, Zhang M, Xie Y, Sun W, Ji J, Sun B, Zhang Y. Impact of repeated intravenous infusions of umbilical cord-derived versus bone marrow-derived mesenchymal stem cells on angiogenesis in a pregnant experimentally induced deep venous thrombosis rat model. In Vitro Cell Dev Biol Anim 2022; 58:957-969. [PMID: 36469244 DOI: 10.1007/s11626-022-00733-3] [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: 09/14/2022] [Accepted: 10/22/2022] [Indexed: 12/12/2022]
Abstract
Deep venous thrombosis (DVT) therapy during pregnancy warrants special consideration for the woman and the fetus. This study aimed to evaluate the impact of umbilical cord-derived mesenchymal stem cells (UC-MSCs) and bone marrow-derived mesenchymal stem cells (BM-MSCs) in terms of pro-angiogenic capacity and amelioration of pregnancy outcomes. The pregnant DVT rat model was successfully established by the "stenosis" method. Three consecutive injections of both UC-MSCs and BM-MSCs improved angiogenesis and ameliorated the embryo absorption rate in pregnant SD rats with DVT, in which UC-MSCs promoted angiogenesis more significantly. Furthermore, the levels of serum vascular endothelial growth factor-A (VEGF-A) and epidermal growth factor (EGF) were significantly higher in the UC-MSC group compared to those of the BM-MSC group. Thereafter, differentially expressed genes (DEGs) in thrombosed inferior vena cava tissues in the UC-MSC and BM-MSC groups were identified using transcriptome sequencing and further assessed by RT-qPCR and western blotting. The bioinformatics analysis indicated that the enriched DEG terms occurred in the cytokine activity, and the DEG pathways were significantly enriched in the cytokine-cytokine receptor interaction. In addition, both the mRNA and protein levels of angiogenic genes and their receptors, including VEGF-A, VEGF receptor-1, EGF, and EGF receptor, were significantly higher in the UC-MSC group. In conclusion, the BM-MSCs and UC-MSCs both significantly stimulate angiogenesis and ameliorate the embryo absorption rate in pregnant SD rats with DVT, but the difference in cytokine secretion causes UC-MSCs to have more potent angiogenic effects than BM-MSCs.
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Affiliation(s)
- Xi Cheng
- Department of Gynecology and Obstetrics, Affiliated Hospital of Nantong University, Medical School of Nantong University, No. 20 Xi-Si Road, Nantong, 226001, Jiangsu, China
| | - Weina Wang
- Department of Gynecology and Obstetrics, Affiliated Hospital of Nantong University, Medical School of Nantong University, No. 20 Xi-Si Road, Nantong, 226001, Jiangsu, China
| | - Rong Du
- Department of Gynecology and Obstetrics, Affiliated Hospital of Nantong University, Medical School of Nantong University, No. 20 Xi-Si Road, Nantong, 226001, Jiangsu, China
| | - Mu Zhang
- Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China
| | - Yuanyuan Xie
- Department of Gynecology and Obstetrics, Affiliated Hospital of Nantong University, Medical School of Nantong University, No. 20 Xi-Si Road, Nantong, 226001, Jiangsu, China
| | - Weiwei Sun
- Department of Orthopedics, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, 226001, Jiangsu, China
| | - Jingjing Ji
- Department of Gynecology and Obstetrics, Affiliated Hospital of Nantong University, Medical School of Nantong University, No. 20 Xi-Si Road, Nantong, 226001, Jiangsu, China
| | - Baolan Sun
- Department of Laboratory, Affiliated Hospital of Nantong University, No. 20 Xi-Si Road, Nantong, 226001, Jiangsu, China.
| | - Yuquan Zhang
- Department of Gynecology and Obstetrics, Affiliated Hospital of Nantong University, Medical School of Nantong University, No. 20 Xi-Si Road, Nantong, 226001, Jiangsu, China.
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Schrufer-Poland TL, Florio K, Grodzinsky A, Borsa JJ, Schmidt L. Management of May Thurner Syndrome in Pregnant Patients. J Cardiovasc Dev Dis 2022; 9:jcdd9120410. [PMID: 36547407 PMCID: PMC9784684 DOI: 10.3390/jcdd9120410] [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: 09/29/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022] Open
Abstract
May Thurner Syndrome contributes to thromboembolic disease and can cause significant morbidity in pregnant patients secondary to exaggerated anatomic relationships and physiologic changes in the hematologic system favoring thrombogenesis. Because this condition is both underrecognized and underreported, management in pregnant and postpartum patients is based on expert opinion without any formal evidence-based guidance. Herein, we review five pregnancies in four patients with May Thurner Syndrome and general management strategies. Through collaborative and multidisciplinary care, patients with May Thurner Syndrome can be safely and successfully managed during pregnancy and the postpartum period with appropriate anticoagulation.
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Affiliation(s)
- Tabitha L. Schrufer-Poland
- Maternal and Fetal Medicine, Saint Luke’s Health System, Kansas City, MO 64111, USA
- Cardiovascular Outcomes Research Department, Saint Luke’s Health System, Kansas City, MO 64111, USA
- Correspondence:
| | - Karen Florio
- Maternal and Fetal Medicine, Saint Luke’s Health System, Kansas City, MO 64111, USA
- Cardiovascular Outcomes Research Department, Saint Luke’s Health System, Kansas City, MO 64111, USA
| | - Anna Grodzinsky
- Cardiovascular Outcomes Research Department, Saint Luke’s Health System, Kansas City, MO 64111, USA
| | - John J. Borsa
- Department of Radiology, Saint Luke’s Health System, Kansas City, MO 64111, USA
- Department of Radiology, University of Missouri Kansas City, Kansas City, MO 64108, USA
| | - Laura Schmidt
- Cardiovascular Outcomes Research Department, Saint Luke’s Health System, Kansas City, MO 64111, USA
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Liu Q, Chen W, Wang YL, Wang ZY, Peng ZQ, Xiang JF, Chen L, Pan YC, Sha Y. A new method of monitoring catheter-directed thrombolysis for deep venous thrombosis-application of D-dimer and fibrinogen testing. Phlebology 2022; 37:216-222. [PMID: 35236191 DOI: 10.1177/02683555211064026] [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: 11/15/2022]
Abstract
BACKGROUND Catheter-directed thrombolysis (CDT) is one of the main treatment methods for acute deep venous thrombosis (DVT), which has the characteristics of long treatment time and large dosage of thrombolytic drugs. In the absence of good monitoring methods, problems such as low thrombolytic efficiency and high risk of bleeding are easy to occur. OBJECTIVE To evaluate the value of D-dimer (D-D) and fibrinogen (FIB) testing as a thrombolysis-monitoring method during CDT for acute DVT. METHODS Twenty patients with acute DVT were divided into group A and group B. During CDT, the D-D and FIB testing every 8 h were used in group A, and the venography and FIB testing every 24 h in group B. The thrombolysis rate, thrombolysis time, urokinase dosage, and X-ray radiation dose were compared. RESULTS The thrombolysis rate in group A was significantly higher than that in group B (p < 0.05), but the number of venography and radiation dose were significantly lower than those in group B (p < 0.05). CONCLUSION D-D and FIB testing can improve the thrombolysis rate, reduce the risk of bleeding, and decrease the number of angiograms and X-ray radiation dose during CDT.
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Affiliation(s)
- Qiang Liu
- Department of Radiology, Eye & ENT Hospital, 12478Fudan University, Shanghai, China
| | - Wei Chen
- Department of Radiology, Eye & ENT Hospital, 12478Fudan University, Shanghai, China
| | - Yong-Li Wang
- Department of Interventional Radiology, 12474Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
| | - Zheng-Yu Wang
- Department of Interventional Radiology, 12474Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
| | - Zhi-Qing Peng
- Department of Interventional Radiology, 12474Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
| | - Jian-Feng Xiang
- Department of Interventional Radiology, 12474Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
| | - Liang Chen
- Department of Interventional Radiology, 12474Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
| | - Yu-Cheng Pan
- Department of Radiology, Eye & ENT Hospital, 12478Fudan University, Shanghai, China
| | - Yan Sha
- Department of Radiology, Eye & ENT Hospital, 12478Fudan University, Shanghai, China
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Lu ZX, Wei HL, Shi Y, Huang H, Su H, Chen L. Safety and Efficacy of Endovascular Treatment on Pregnancy-Related Iliofemoral Deep Vein Thrombosis. Clin Appl Thromb Hemost 2022; 28:10760296221124903. [PMID: 36083157 PMCID: PMC9465584 DOI: 10.1177/10760296221124903] [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] [Indexed: 11/15/2022] Open
Abstract
Objective: This study investigates the safety and efficacy of
endovascular treatments on pregnancy-related iliofemoral deep vein thrombosis
(DVT). Methods: We retrospectively reviewed data of 46 patients
who had symptomatic pregnancy-related iliofemoral DVT and underwent endovascular
treatment. The patients treated with catheter-directed thrombolysis (CDT) were
classified as the CDT group. In contrast, those treated with CDT combined with
pharmacomechanical thrombectomy (PMT) or angioplasty/stenting were classified as
the pharmacomechanical catheter-directed thrombolysis (PCDT) group.
Results: Based on the immediate post-operative clot burden
reduction rate analysis of 46 patients: 22 cases were completely dissolved
(lysis grades III), 12 were partially dissolved (lysis grades II), and 12 failed
(lysis grades I). There was a statistically significant difference in the rate
of clot burden reduction between the CDT group (n = 19) and the PCDT group
(n = 27) (p = 0.001). There was no statistically significant
difference in the number of bleeding events between the two groups
(p = 0.989). At 24 months, cumulative venous patency in the
CDT group was 50.0%, compared to 78.2% in the PCDT group. Furthermore, there was
a statistically significant difference in Villalta score
(p = 0.001) and venous severity scoring (VCSS score)
(p = 0.005) between the two groups.
Conclusions: CDT treatment combined with PMT or
angioplasty/stenting is comparatively safe and effective for pregnant-related
DVT patients. PCDT outperforms CDT in terms of immediate efficacy and reduces
the incidence of post-thrombotic syndrome with better midterm outcomes.
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Affiliation(s)
- Zhao-Xuan Lu
- Department of Vascular and Interventional Radiology, 385685Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Heng-Le Wei
- Department of Radiology, 579164The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
| | - Yadong Shi
- Department of Vascular and Interventional Radiology, 385685Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hao Huang
- Department of Vascular and Interventional Radiology, 385685Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Haobo Su
- Department of Vascular and Interventional Radiology, 385685Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Liang Chen
- Department of Vascular and Interventional Radiology, 385685Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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