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Bhattacharya B, Kodadek L, Nichiporenko I, Morrissey S, Kirsch J, Choi J, Ladhani H, Kasotakis G, Mukherjee K, Narsule C, Sharma R, Ruangvoravat L, Grushka J, Rattan R, Bugaev N. Role of Vena Cava Filter in the Prophylaxis and Treatment of Venous Thromboembolism in Injured Adult Patients: A Systematic Review, Meta-Analysis, and Practice Management Guideline from the Eastern Association for the Surgery of Trauma [RETRACTED]. J Trauma Acute Care Surg 2024:01586154-990000000-00653. [PMID: 38454308 DOI: 10.1097/ta.0000000000004289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Injured patients are at an increased risk of developing deep vein thrombosis (DVT) and pulmonary embolism (PE). Inferior vena cava (IVC) filters have been used in injured patients to prevent venous thromboembolism (VTE), but current evidence-based guidelines are lacking. METHODS Questions regarding IVC filter use in injured patients with clearly defined Population(s), Intervention(s), Comparison(s), and appropriately selected Outcomes (PICO) were formulated. The study sought to understand the evidence behind use of ultra short term IVC filters and use of IVC filters in injured patients with and without known VTE who are unable to receive therapeutic anticoagulation and chemoprophylaxis, respectively. A literature search and review was conducted, followed by meta-analysis. The quality of evidence was assessed per Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. RESULTS There were twenty-one studies that were analyzed. Three studies were randomized controlled trials (RCTs), three were observational studies, and fifteen studies were retrospective studies. In injured patients without known acute VTE who cannot receive chemoprophylaxis, we recommend against placement of an IVC filter due to associated higher rate of mortality, DVT, PE, and length of stay. The quality of evidence was assessed to be low. In injured patients with known DVT who cannot receive chemoprophylaxis we conditionally recommend against placement of an IVC filter. The quality of evidence was assessed to be very low. No recommendations can be made with respect to placement of ultra short term IVC filters based upon available data. CONCLUSION IVC filters should not be placed routinely for prophylaxis in injured adult patients without known VTE who cannot receive chemoprophylaxis. The taskforce conditionally recommends against the placement of IVC filter in injured adult patients with known DVT who cannot receive chemoprophylaxis. LEVEL OF EVIDENCE Guideline; Systematic review/meta-analysis, level IV.
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Affiliation(s)
| | - Lisa Kodadek
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | | | | | - Jordan Kirsch
- Section of Trauma and Acute Care Surgery, Westchester Medical Center, Valhalla, NY
| | - Jeff Choi
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Husayn Ladhani
- Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO
| | - George Kasotakis
- Division of Trauma & Acute Care Surgery, Inova Fairfax Medical Campus, Falls Church, VA, University of Virginia
| | - Kaushik Mukherjee
- Division of Acute Care Surgery, Loma Linda University Health, Loma Linda, CA
| | - Chaitan Narsule
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA
| | - Rahul Sharma
- Section of Trauma and Acute Care Surgery, Mercy Hospital - St. Louis, St. Louis, MO
| | | | | | - Rishi Rattan
- Department of Surgery, Legacy Emanuel Medical Center, Portland, OR
| | - Nikolay Bugaev
- Associate Professor of Surgery, Emergency Surgical Services, Executive Director of Research, Department of Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington st, #4488, Boston, MA, 02111
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Kashkoush A, Petitt J, Ladhani H, Ho V, Kelly ML. 474 Predictors of Mortality, Withdrawal of Life-Sustaining Measures, and Discharge Disposition in Octogenarians With Subdural Hematomas. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kashkoush A, Petitt JC, Ladhani H, Ho VP, Kelly ML. Predictors of Mortality, Withdrawal of Life-Sustaining Measures, and Discharge Disposition in Octogenarians with Subdural Hematomas. World Neurosurg 2022; 157:e179-e187. [PMID: 34626845 PMCID: PMC8692425 DOI: 10.1016/j.wneu.2021.09.121] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Risk factors for mortality in patients with subdural hematoma (SDH) include poor Glasgow Coma Scale (GCS) score, pupil nonreactivity, and hemodynamic instability on presentation. Little is published regarding prognosticators of SDH in the elderly. This study aims to examine risk factors for hospital mortality and withdrawal of life-sustaining measures in an octogenarian population presenting with SDH. METHODS A prospectively collected multicenter database of 3279 traumatic brain injury admissions to 45 different U.S. trauma centers between 2017 and 2019 was queried to identify patients aged >79 years old presenting with SDH. Factors collected included baseline demographic data, past medical history, antiplatelet/anticoagulant use, and clinical presentation (GCS, pupil reactivity, injury severity scale [ISS]). Primary outcome data included hospital mortality/discharge to hospice care and withdrawal of life-sustaining measures. Multivariate logistic regression analyses were used to identify factors independently associated with primary outcome variables. RESULTS A total of 695 patients were isolated for analysis. Of the total cohort, the rate of hospital mortality or discharge to hospice care was 22% (n = 150) and the rate of withdrawal of life-sustaining measures was 10% (n = 66). A multivariate logistic regression model identified GCS <13, pupil nonreactivity, increasing ISS, intraventricular hemorrhage, and neurosurgical intervention as factors independently associated with hospital mortality/hospice. Congestive heart failure (CHF), hypotension, GCS <13, and neurosurgical intervention were independently associated with withdrawal of life-sustaining measures. CONCLUSIONS Poor GCS, pupil nonreactivity, ISS, and intraventricular hemorrhage are independently associated with hospital mortality or discharge to hospice care in patients >80 years with SDH. Pre-existing CHF may further predict withdrawal of life-sustaining measures.
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Affiliation(s)
- Ahmed Kashkoush
- Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, OH, United States of America. (9500 Euclid Ave, Cleveland, OH 44195)
| | - Jordan C. Petitt
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA. (2500 MetroHealth Drive Cleveland, Ohio 44109)
| | - Husayn Ladhani
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA. (2500 MetroHealth Drive Cleveland, Ohio 44109)
| | - Vanessa P. Ho
- Division of Trauma and Acute Care Surgery, Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA. (2500 MetroHealth Drive Cleveland, Ohio 44109)
| | - Michael L. Kelly
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA. (2500 MetroHealth Drive Cleveland, Ohio 44109)
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Nair DM, Virani A, Ladhani H. A study of the prevalence of hepatitis B in a rural population of India and the risk behaviors that lead to its spread. J Clin Epidemiol 1998. [DOI: 10.1016/s0895-4356(98)90081-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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