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García-Núñez J, D Vera D, Ortiz AF, Rodríguez A, Lara JJ, Gomez MJ, Serrano-Gómez S, Reyes A, Ferreira-Prada C, Galvis-Méndez M, Vargas-Pérez O, Mantilla-García DE. A Study on the Efficacy and Safety of Pipeline Shield Stents and Nonmodified Surface Flow-Diverting Stents in Patients with Intracranial Aneurysms. World Neurosurg 2024; 183:e781-e786. [PMID: 38216035 DOI: 10.1016/j.wneu.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Few studies have compared the Pipeline Shield stents with previous generations of flow-diverting stents (FDSs) for the treatment of unruptured intracranial aneurysms. This study aimed to evaluate the efficacy and safety of Pipeline Shield stents and FDSs without modified surfaces. METHODS The present evaluation is a retrospective cohort study of patients endovascularly treated with Pipeline Shield stents or FDSs without modified surfaces for unruptured intracranial aneurysms between January 2014 and June 2022. The data analyzed were obtained from the anonymized database of our institution's interventional radiology service. RESULTS A total of 147 patients with 155 unruptured intracranial aneurysms were included. Of the 155 aneurysms, 96 were treated with Pipeline Shield stents and 59 with FDSs without modified surfaces. The aneurysms treated with Pipeline Shield stents had higher 6-month (O'Kelly-Marotta [OKM] D; 87.5% vs. 71.4%; P = 0.025) and 1-year (OKM D; 82.5% vs. 63.0%; P = 0.047) occlusion rates than the aneurysms treated using FDSs without modified surfaces. No differences between the devices were found at the 1-year follow-up in the incidence of ischemic stroke (P = 0.939) or hemorrhagic complications (P = 0.559). CONCLUSIONS Pipeline Shield stents demonstrated superior complete occlusion rates (OKM D) at both the 6-month and the 1-year follow-up assessments compared with nonmodified surface FDSs. No significant differences were found in the safety profiles between the 2 types of stents with regard to thromboembolic complications and ischemic events. Further research with larger study populations is necessary to validate these findings.
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Affiliation(s)
- Julio García-Núñez
- Interventional Radiology Department, Fundación Oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia; Interventional Radiology Department, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Daniela D Vera
- Interventional Radiology Department, Fundación Oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia.
| | - Andrés F Ortiz
- Interventional Radiology Department, Fundación Oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia
| | - Adriana Rodríguez
- Interventional Radiology Department, Fundación Oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia
| | - Juan José Lara
- Radiology Department, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - María José Gomez
- Radiology Department, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | | | - Adriana Reyes
- Research Group-UNAB, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Carlos Ferreira-Prada
- Interventional Radiology Department, Fundación Oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia
| | - Melquizidel Galvis-Méndez
- Interventional Radiology Department, Fundación Oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia
| | - Oliverio Vargas-Pérez
- Interventional Radiology Department, Fundación Oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia; Interventional Radiology Department, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Daniel E Mantilla-García
- Interventional Radiology Department, Fundación Oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia; Interventional Radiology Department, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
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Kanazawa R, Yoshihara T, Uchida T, Higashida T, Arai N, Ohbuchi H, Takahashi Y. Thromboembolic complications during and after embolization of unruptured aneurysms: A chronological outcome in periprocedural thromboembolic events. Surg Neurol Int 2023; 14:362. [PMID: 37941641 PMCID: PMC10629294 DOI: 10.25259/sni_625_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/13/2023] [Indexed: 11/10/2023] Open
Abstract
Background Ischemic complications develop after elective coil embolization procedures at a certain rate. The prevention of these events has been a longstanding issue for many interventional neuroradiologists. This study aimed to clarify whether procedural ischemic events after unruptured aneurysm embolization decrease over time with perioperative anti-thromboembolic treatment or surgical experience. Methods This study included patients with cerebral aneurysms in our institution between July 2012 and June 2020. Dual-antiplatelet therapy (DAPT) was performed (Phase 1). Thromboembolic events developed at a certain rate; thus, rivaroxaban was administered with single-antiplatelet therapy (SAPT) to improve thromboembolic results (Phase 2), showing better outcomes than in Phase 1. Subsequently, DAPT was administered again (Phase 3). Ischemic complications were evaluated in each phase or compared between the DAPT group and the direct oral anticoagulant (DOAC) with the clopidogrel (DOAC+SAPT) group. Results Relatively, fewer symptomatic ischemic events were noted in Phase 2 or the DOAC+SAPT group, but the outcome was not better in Phase 3 than in Phase 2. Symptomatic complications were more common in Phase 3 than in Phases 1 and 2. Conclusion Ischemic complications occurred at a certain rate after endovascular procedures for unruptured aneurysms. The incidence did not decrease over time; particularly, standard DAPT plus postoperative anti-thromboembolic medication did not adequately decrease complications in Phase 3 compared to Phases 1 and 2. Therefore, accumulated experience or a learning curve could not explain the results. DOAC administration might decrease the risk of these events, but further accumulation of evidence or prospective investigation is warranted.
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Affiliation(s)
| | - Tomoyuki Yoshihara
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, Osaka, Japan
| | - Takanori Uchida
- Department of Neurosurgery, Nagareyama Central Hospital, Chiba, Japan
| | | | - Naoyuki Arai
- Department of Neurosurgery, Medical Center Adachi, Tokyo Women’s Medical University, Tokyo, Japan
| | - Hidenori Ohbuchi
- Department of Neurosurgery, Medical Center Adachi, Tokyo Women’s Medical University, Tokyo, Japan
| | - Yuichi Takahashi
- Department of Neurosurgery, Sassa General Hospital, Nishitokyo, Japan
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Khan BA, Khalid A, Saeed Z, Ihsan-Ul-Haq, Khan MY, Rashid S, Naveed A, Dar FS. Exploring safety and efficacy of rivaroxaban after living donor liver transplantation: a retrospective study. Langenbecks Arch Surg 2023; 408:308. [PMID: 37578661 DOI: 10.1007/s00423-023-03042-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE Thromboembolic complications remain a significant concern in postoperative patients, particularly those who have undergone liver transplantation. Warfarin has been the standard oral anticoagulant. Direct oral anticoagulants (DOACs) have several advantages over warfarin, including rapid onset of action and standardized dose guidelines. We aimed to assess the safety of rivaroxaban in living donor liver transplantation (LDLT) recipients. METHODS This study was a single-center, retrospective descriptive analysis of LDLT recipients who received rivaroxaban between December 2020 and April 2022. A total of 27 recipients received rivaroxaban postoperatively. Liver function tests, immunosuppression levels, serum creatinine, and INR were recorded before the initiation of rivaroxaban and then on post-therapy days 1, 7, 14, 28, 90, and 180. RESULTS Among the 27 recipients receiving rivaroxaban postoperatively, portal venous thrombosis was the most prevalent indication for anticoagulation (44.4%), followed by Budd-Chiari syndrome (29.6%). Nine patients had a twofold increase in either ALT or AST values, two of whom were treated for biliary strictures and the others for rejection. Eighteen patients were given tacrolimus, and eight were on cyclosporine, with one patient switched from tacrolimus to cyclosporine due to insufficient therapeutic levels. There were no incidents of bleeding or re-thrombosis during the 180-day follow-up period. CONCLUSION Rivaroxaban may be a safe and effective alternative in LDLT recipients with no significant adverse incidents. Further studies with larger sample sizes are needed to confirm these findings and determine this population's optimal dose and duration of rivaroxaban therapy.
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Affiliation(s)
- Bilal Ahmed Khan
- Department of Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan.
| | - Abdullah Khalid
- Department of Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan
| | - Zubair Saeed
- Department of Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan
| | - Ihsan-Ul-Haq
- Department of Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan
| | - Muhammad Yasir Khan
- Department of Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan
| | - Sohail Rashid
- Department of Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan
| | - Ammara Naveed
- Gastroenterology and Hepatology Department, PKLI&RC, Lahore, Pakistan
| | - Faisal Saud Dar
- Department of Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan
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Uematsu H, Shinoda K, Saito A, Sakai K. Deep venous thrombosis in a kidney transplant recipient with COVID-19: a case report. CEN Case Rep 2023; 12:98-103. [PMID: 35972687 PMCID: PMC9379217 DOI: 10.1007/s13730-022-00724-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/21/2022] [Indexed: 02/04/2023] Open
Abstract
The outcomes of COVID-19 in kidney transplant recipients have shown high mortality. In addition to their immunocompromised states, kidney transplant recipients frequently have certain exacerbation risk comorbidities of COVID-19, such as diabetes mellitus, hypertension, and chronic kidney disease. Several concomitant diseases develop during the course of COVID-19, one of which is thromboembolism, which can potentially lead to a critical condition. However, thromboembolic complications in kidney transplant recipients with COVID-19 have not been fully addressed in previous studies. A 62-year-old man, who underwent kidney transplantation 17 years ago, was diagnosed with COVID-19 and was admitted to our hospital. Although the patient was in remission at the start of the hospitalization, his condition became severe on day 7 after admission, with fever, elevated white blood cell counts (10,000/μL) and a high C-reactive protein level (6.9 mg/dL). Although the patient was not under forced bed rest, an ultrasound study on day 10 detected deep venous thrombosis (DVT), with an elevated D-dimer level (6.2 µg/dL). We withdrew the mycophenolate mofetyl and the tacrolimus dosage but did not administer any specific treatment for COVID-19. The patient achieved successful clearance of SARS-CoV-2 on day 16. The DVT disappeared after systematic heparin treatment and oral rivaroxaban for 2 months. DVT occurred in a kidney transplant recipient with COVID-19 who was not bedridden and might manifest when the clinical status was exacerbated during hospitalization.
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Affiliation(s)
- Hikaru Uematsu
- Department of Nephrology, Faculty of Medicine, Toho University, 6-11-1 Omorinishi, Tokyo, 143-8541, Japan
| | - Kazunobu Shinoda
- Department of Nephrology, Faculty of Medicine, Toho University, 6-11-1 Omorinishi, Tokyo, 143-8541, Japan.
| | - Akinobu Saito
- Department of Nephrology, Faculty of Medicine, Toho University, 6-11-1 Omorinishi, Tokyo, 143-8541, Japan
| | - Ken Sakai
- Department of Nephrology, Faculty of Medicine, Toho University, 6-11-1 Omorinishi, Tokyo, 143-8541, Japan
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Sánchez-Medina FF, Valenzuela-Antelo O, Valenzuela-Molina LC, Arias-Martínez J, López-Morales CM, Ornelas-Aguirre JM. Thromboembolic and hemorrhagic complications in patients with prosthetic heart valves cared for in a tertiary care center. What have we learned? GAC MED MEX 2023; 159:210-218. [PMID: 37494706 DOI: 10.24875/gmm.m23000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/17/2022] [Accepted: 03/28/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Heart valve replacement surgery with mechanical or biological prostheses entails a risk of thromboembolism and bleeding complications. OBJECTIVE To determine the complications related to complementary anticoagulation therapy and the probability of risk. METHODS One-hundred and sixty-three patients who underwent heart valve replacement between 2002 and 2016 with either mechanical or biological prostheses, and who received vitamin K antagonists after hospital discharge, were studied. Anticoagulation therapy was categorized into optimal and non-optimal according to INR values prior to the development of complications. Patients with comorbidities and other risk factors for thrombosis and/or bleeding were excluded. RESULTS In total, 68.7 % of patients received mechanical prostheses, and 31.3 %, biological prostheses (p ≤ 0.001); 25.2 % experienced the complications that motivated the study (p ≤ 0.001), which were hemorrhagic in 48.8 %, thromboembolic in 26.8 %, and of both types in 24.4 % (relative risk = 4.229). Among the patients with complications, 95.1 % received mechanical prostheses, and 4.9 %, biological (p = 0.005); non-optimal INR was identified in 49.7 % (p ≤ 0.001). CONCLUSIONS Given the high risk of thromboembolic and hemorrhagic complications, valve prostheses must be carefully chosen, and care priorities should include prevention and follow-up, especially in those patients who require anticoagulation therapy.
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Affiliation(s)
- Fernando F Sánchez-Medina
- Department of Cardiothoracic Surgery, Centro Médico Nacional del Noroeste, Instituto Mexicano del Seguro Social, Ciudad Obregón, Sonora
| | | | - Lucía C Valenzuela-Molina
- Intensive Care Unit, Centro Médico Nacional del Noroeste, Instituto Mexicano del Seguro Social, Ciudad Obregón, Sonora
| | - Joel Arias-Martínez
- Department of Health Sciences, Universidad de Sonora, Ciudad Obregón, Sonora
| | - Cruz M López-Morales
- Department of Family Medicine, Delegación Estatal del Instituto Mexicano del Seguro Social, Mexicali, Baja California. Mexico
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Søgaard M, Skjøth F, Nielsen PB, Beyer-Westendorf J, Larsen TB. First Trimester Anticoagulant Exposure and Adverse Pregnancy Outcomes in Women with Preconception Venous Thromboembolism: A Nationwide Cohort Study. Am J Med 2022; 135:493-502.e5. [PMID: 34798098 DOI: 10.1016/j.amjmed.2021.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate first trimester anticoagulant exposure and risks of adverse pregnancy-related and fetal outcomes. METHODS Using Danish nationwide registries, we identified all pregnant women with preconception venous thromboembolism, 2000-2017, and linked data on exposure to low-molecular-weight heparin (LMWH), vitamin K antagonist (VKA), or non-VKA oral anticoagulant (NOAC) during pregnancy. We assessed pregnancy-related and fetal outcomes associated with first trimester anticoagulant exposure. RESULTS Among 4490 pregnancies in women with preconception venous thromboembolism (mean age 31 years, 40% nulliparous) during the first trimester, 63.1% were unexposed, 25.9% were exposed to LMWH, 10.4% VKA, and 0.6% NOAC. Adverse outcomes were lowest in unexposed and LMWH exposed. Compared with unexposed, VKA was associated with higher risks of preterm (adjusted odds ratio [OR] 2.26; 95% confidence interval [CI], 1.70-2.99) and very preterm birth (adjusted OR 3.78; 95% CI, 1.91-7.49), shorter mean gestational age was associated with VKA (-7.5 days; 95% CI, -9.1 to -5.9 days) or NOAC (-2.3 days; 95% CI, -8.4-3.8), and lower mean birthweight with VKA (-55 g; 95% CI, -103.1 to -8.5) or NOAC (-190 g; 95% CI, -364.1 to -16.4). Adjusted ORs for small-for-gestational-age infants were 1.07 (95% CI, 0.77-1.50) with VKA, and 3.29 (95% CI, 1.26-7.95) with NOAC. Mean 5-minute Apgar score (9.8) and congenital defect prevalence (8.4%-10%) varied little across exposure groups. CONCLUSIONS Fetal risk was lowest in unexposed and LMWH-exposed pregnancies, supporting the recommendation of LMWH during pregnancy. NOAC safety during pregnancy is unclear due to the rarity of NOAC exposure.
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Affiliation(s)
- Mette Søgaard
- Department of Cardiology, Aalborg University Hospital, Denmark; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Denmark.
| | - Flemming Skjøth
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Denmark; Unit for Clinical Biostatistics, Aalborg University Hospital, Denmark
| | - Peter Brønnum Nielsen
- Department of Cardiology, Aalborg University Hospital, Denmark; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Denmark
| | - Jan Beyer-Westendorf
- Thrombosis Research Unit, Department of Medicine I, Division Hematology, University Hospital "Carl Gustav Carus", Dresden, Germany
| | - Torben Bjerregaard Larsen
- Department of Cardiology, Aalborg University Hospital, Denmark; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Denmark
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Schmoch T, Brenner T, Becker-Pennrich A, Hinske LC, Weigand MA, Briegel J, Möhnle P. [Practice of pharmaceutical thrombosis prophylaxis and anticoagulation in patients with sepsis and pre-existing anticoagulation or heparin-induced type II thrombocytopenia-Results of a nationwide survey in German intensive care units]. Anaesthesist 2022; 71:193-200. [PMID: 34351433 PMCID: PMC8340811 DOI: 10.1007/s00101-021-01011-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/04/2021] [Accepted: 06/20/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND A pre-existing anticoagulation treatment and predisposing diseases for thromboembolic events represent common problems in patients with sepsis or septic shock; however, these conditions are not addressed in current national guidelines for sepsis and septic shock. One of the aims of this nationwide survey in Germany was therefore to determine how intensive care physicians deal with these problems. METHODS From October 2019 to May 2020, we conducted a nationwide survey among German medical directors of intensive care units (ICU) addressing anticoagulation and drug-based prophylaxis of venous thromboembolism (VTE) in patients with sepsis and sepsis-induced coagulopathy. One focus was the procedure for patients with a pre-existing anticoagulation treatment or a previously known heparin-induced thrombocytopenia (HIT) type 2 (acute symptomatic vs. dating back years). RESULTS In most of the participating ICUs pre-existing anticoagulation is largely continued with low molecular weight heparin preparations or unfractionated heparin. In patients with pre-existing HIT type 2 both acute symptomatic and dating back years, argatroban represents the drug of choice. There is a high degree of variability in the definition of the target values, usually being well above the range for pure VTE prophylaxis. CONCLUSION Data on the continuation of anticoagulation beyond VTE prophylaxis with a subsequently increased risk of bleeding in patients with sepsis and septic shock is limited and treatment decisions are in many cases subject to individual consideration by the practitioner. The results of our survey imply the need for a systematic work-up of this topic in order to support daily practice in many ICUs with the required evidence.
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Affiliation(s)
- Thomas Schmoch
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - Thorsten Brenner
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Andrea Becker-Pennrich
- Klinik für Anästhesiologie und Abteilung für Transfusionsmedizin, Zelltherapeutika und Hämostaseologie (ATMZH), LMU Klinikum München, München, Deutschland
| | - Ludwig Christian Hinske
- Klinik für Anästhesiologie und Abteilung für Transfusionsmedizin, Zelltherapeutika und Hämostaseologie (ATMZH), LMU Klinikum München, München, Deutschland
- Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, LMU München, München, Deutschland
| | - Markus A Weigand
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Josef Briegel
- Klinik für Anästhesiologie und Abteilung für Transfusionsmedizin, Zelltherapeutika und Hämostaseologie (ATMZH), LMU Klinikum München, München, Deutschland
| | - Patrick Möhnle
- Klinik für Anästhesiologie und Abteilung für Transfusionsmedizin, Zelltherapeutika und Hämostaseologie (ATMZH), LMU Klinikum München, München, Deutschland
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Asmar S, Nelson A, Anand T, Hammad A, Obaid O, Ditillo M, Saljuqi T, Tang A, Joseph B. Marijuana and thromboembolic events in geriatric trauma patients: The cannabinoids clots correlation! Am J Surg 2021; 223:798-803. [PMID: 34334193 DOI: 10.1016/j.amjsurg.2021.07.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/12/2021] [Accepted: 07/20/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Tetrahydrocannabinol (THC) can alter the coagulation cascade resulting in hypercoagulability. The aim of our study is to evaluate the impact of THC use on thromboembolic complications (TEC) in geriatric trauma patients (GTP). METHODS This is a 2017 analysis of the TQIP database including all GTP (age ≥65 years). Patients were stratified based on THC use. Propensity score matching (1:2 ratio) was performed. RESULTS A total of 2,835 patients were matched (THC+: 945 and THC-: 1,890). Mean age was 70 ± 6 years, 94% sustained blunt injuries, and median ISS was 22[12-27]. Sixty-two percent of patients received thromboprophylaxis, with median time to initiation of 27 h from admission. Overall, the rate of TEC was 2.1% and mortality was 6.0%. THC + patients had significantly higher rates of TEC compared to THC- patients (3.0% vs. 1.7%; p = 0.01). Rates of DVT (2.2% vs 0.6%, p < 0.01) and PE (1.4% vs 0.4%, p < 0.01) were higher in the THC + group. CONCLUSION THC exposure increases the risk of TEC in GTP. Incorporation of THC use into risk assessment protocols merits serious consideration in GTP.
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Affiliation(s)
- Samer Asmar
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Adam Nelson
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Tanya Anand
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Ahmad Hammad
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Omar Obaid
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Michael Ditillo
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Tawab Saljuqi
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Andrew Tang
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
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Dawra S, Shrivastava S, Kumar D, Asturkar V, Kumar A, Ahmad F, Nanda S. Clinical complications seen in patients after recovery from coronavirus disease 2019: Experience from a COVID care center. Med J Armed Forces India 2021; 77:S475-S478. [PMID: 34334914 PMCID: PMC8313073 DOI: 10.1016/j.mjafi.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/02/2021] [Indexed: 10/25/2022] Open
Abstract
We have had recent experience that patients who have recovered from coronavirus disease 2019 (COVID-19) infection are being readmitted with thromboembolic complications, and some have had sudden cardiac death. There is paucity of literature on such presentations after clinical and microbiological recovery. In the present case series, we present five such patients recently managed at our COVID-19 care facility. All the patients described were elderly (mean age: 66 years) with multiple comorbidities (mean Charlson Comorbidity Index score: 3.5). Two were initially managed at another COVID care facility and discharged. They were admitted at our center within one week of discharge. One patient who was managed at our center was discharged and then readmitted. The other two had recovered from their illness and were planned for discharge (mean duration of hospital stay in initial admission: 14.4 days). All presented within one week of clinical and microbiological recovery (mean: 4.2 days). All were on adequate anticoagulation during initial presentation. All these patients had raised D-dimer levels (three suffered sudden cardiac arrest, one had a confirmed pulmonary thromboembolism, and one had acute ST-elevation myocardial infarction). Thromboembolic complications should be considered an important differential diagnosis in all patients who present with any complication in the immediate follow-up period of recovery from COVID-19 disease. Repeat analysis of D-dimer levels at follow-up may be considered in those who recovered from severe disease. Extended period of anticoagulation and close follow-up may be considered in all patients with COVID-19 who are at high risk of developing thromboembolic complications.
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Affiliation(s)
- Saurabh Dawra
- Classified Specialist (Medicine) & Gastroenterologist, Command Hospital (SC), Pune, India
| | - Sharad Shrivastava
- Senior Adviser (Medicine) & Gastroenterologist, Command Hospital (SC), Pune, India
| | - Dharmendra Kumar
- Senior Adviser (Medicine) & Gastroenterologist, Command Hospital (SC), Pune, India
| | - Vikram Asturkar
- Classified Specialist (Medicine) & Neurologist, Command Hospital (SC), Pune, India
| | - Ankit Kumar
- Resident, Department of Internal Medicine, Armed Forces Medical College, Pune, India
| | - Faiz Ahmad
- Senior Adviser (Medicine) & Neurologist, Command Hospital (SC), Pune, India
| | - Subrat Nanda
- Senior Adviser (Medicine) & Neurologist, Command Hospital (SC), Pune, India
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Osei-OWusu W, Ntiamoah DO, Akuffo GA, Mintaah S, Owusu M, Sackey B, Antwi-Boateng L, Abdul G, Annani-Akollor M, Owiredu EW, Debrah AY, Addai-Mensah O. Coagulation abnormalities in childhood acute lymphoblastic leukemia: assessing the impact of L-asparaginase therapy in Ghana. Thromb J 2021; 19:44. [PMID: 34174899 PMCID: PMC8235643 DOI: 10.1186/s12959-021-00297-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the rate of childhood acute lymphoblastic leukemia (ALL) is increasing in Africa, there is a dearth of information on the disease and the dynamics of hemostatic parameters with therapy. METHODS In this case-control study, we evaluated variations in the level/activity of selected coagulation parameters among cALL in Ghana and healthy controls stratified by stage of therapeutic management. RESULTS In all, the research recruited 104 participants comprising 26 cALL cases and 78 healthy controls. The cALL group had significantly higher prothrombin time (PT) (p = 0.001), activated partial thromboplastin time (APTT) (p < 0.0001) and D-dimers (p = 0.001) but lower platelet (PLT) count, protein C (PC) (p < 0.0001), protein S (PS) (p < 0.0001) and antithrombin III (ATIII) (p < 0.0001) compared to controls. Compared to the healthy controls, activity of PC was lower during induction (p < 0.0001), consolidation (p = 0.005) and maintenance phases of chemotherapy (p = 0.012) while activities of PS and ATIII were lower at both induction (p < 0.0001, p = 0.006) and consolidation (p < 0.0001, p = 0.018) phases of chemotherapy. CONCLUSION Our findings provide evidence in the context of Africa and corroborates previous reports that cALL could result in a state of hypercoagulability, possibly leading to a high risk of thrombosis and thromboembolic complications. This possibly increased risk is not limited to the induction phase but also the consolidation phase.
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Affiliation(s)
- William Osei-OWusu
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - David Ofosu Ntiamoah
- Department of Basic and Applied Biology, University of Energy and Natural Resources, Sunyani, Ghana
| | - Gordon Asare Akuffo
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Selina Mintaah
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Owusu
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Benedict Sackey
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lilian Antwi-Boateng
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ganiwu Abdul
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Max Annani-Akollor
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eddie-Williams Owiredu
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Alexander Yaw Debrah
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Otchere Addai-Mensah
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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11
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Abstract
Neurological symptoms occur in approximately one-third of hospitalized patients with coronavirus disease 2019 (COVID-19). Among these symptoms, hypoxic encephalopathy develops in one-fifth of severe cases, while ischemic strokes due to thrombotic complications are common in one-third of COVID-19 intensive care patients. Brain involvement of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is eventuated by several routes, including hematogenous spread, transsynaptic entry through infected neurons, olfactory nerve, ocular epithelium, vascular endothelium, and impaired blood–brain barrier. Besides the high angiotensin-converting enzyme-2 (ACE2) binding affinity, and FURIN preactivation, SARS-CoV-2 maintains efficient neuronal entry while evading immune surveillance by using basigin and neuropilin-1 receptors. However, the neurological manifestations and their pathogenic mechanisms are still debated in COVID-19 patients.
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Affiliation(s)
- Ayse Basak Engin
- Gazi University, Faculty of Pharmacy, Department of Toxicology, Ankara, Turkey
| | - Evren Doruk Engin
- Ankara University, Biotechnology Institute, Gumusdere Campus, Kecioren, Ankara, Turkey
| | - Atilla Engin
- Gazi University, Faculty of Medicine, Department of General Surgery, Ankara, Turkey
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12
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Zerwes S, Steinbauer M, Gosslau Y, Warm T, Hyhlik-Dürr A. [COVID-19 infection-Risk of thromboembolic complications]. Gefasschirurgie 2020; 25:397-402. [PMID: 32905019 PMCID: PMC7462439 DOI: 10.1007/s00772-020-00687-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 08/16/2020] [Indexed: 12/21/2022]
Abstract
Während das durch das SARS-CoV-2-Virus ausgelöste COVID-19-Syndrom zunächst hauptsächlich als Lungenerkrankung angesehen wurde, ist die Zahl der Berichte über vaskuläre Komplikationen zuletzt angestiegen. Ziel der vorliegenden Übersichtsarbeit ist es, die relevantesten vaskulären Beteiligungen bei COVID-19 zusammenzufassen. Hierzu zählen venöse und arterielle thrombembolische Ereignisse sowie lokale Thrombosen, die sich im Rahmen der Zytokinausschüttung direkt am Endothel bilden können. Eine generalisierte Koagulopathie scheint ebenfalls den thrombogenen Zustand zu begünstigen. Mit einer Rate von etwa 20 % zählen tiefe Beinvenenthrombosen (TVT) bei intensivpflichtigen COVID-19-Patienten zu den häufigsten thrombembolischen Ereignissen. Zudem konnten auch bei vaskulär vorerkrankten Patienten arterielle Ereignisse wie Schlaganfälle oder akute Koronarsyndrome beobachtet werden. Kinder weisen selten vaskuläre Komplikationen auf. Hier wird von einer Systemreaktion berichtet, die dem Kawasaki-Syndrom und Toxic-shock-Syndrom ähnlich ist. Nach aktueller Datenlage ist das Risiko für thrombembolische Ereignisse bei stationären COVID-19-Patienten deutlich erhöht, sodass eine Thromboseprophylaxe mit niedermolekularem bzw. unfraktioniertem Heparin notwendig ist. Bei Kontraindikationen gegen eine medikamentöse Thromboseprophylaxe sollte die intermittierende pneumatische Kompression erfolgen. Zudem empfiehlt sich bei der stationären Aufnahme von Patienten mit SARS-CoV-2-Verdacht oder -Nachweis die Bestimmung der D‑Dimere und bei positivem Befund die großzügige Indikationsstellung zur Kompressionssonographie der tiefen Beinvenen. So können TVT frühzeitig erkannt und therapiert werden. Die Behandlung der Thrombosen erfolgt leitliniengerecht mittels therapeutischer Antikoagulation. Weitere Studien und Register sind notwendig, um den Zusammenhang zwischen einer COVID-19-Infektion und dem Auftreten von thrombembolischen Ereignissen besser zu verstehen.
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Affiliation(s)
- S Zerwes
- Gefäßchirurgie und endovaskuläre Chirurgie, Medizinische Fakultät, Universität Augsburg, Stenglinstraße 2, 86156 Augsburg, Deutschland
| | - M Steinbauer
- Klinik für Gefäßchirurgie, Krankenhaus Barmherzige Brüder, Regensburg, Deutschland
| | - Y Gosslau
- Gefäßchirurgie und endovaskuläre Chirurgie, Medizinische Fakultät, Universität Augsburg, Stenglinstraße 2, 86156 Augsburg, Deutschland
| | - T Warm
- Gefäßchirurgie und endovaskuläre Chirurgie, Medizinische Fakultät, Universität Augsburg, Stenglinstraße 2, 86156 Augsburg, Deutschland
| | - A Hyhlik-Dürr
- Gefäßchirurgie und endovaskuläre Chirurgie, Medizinische Fakultät, Universität Augsburg, Stenglinstraße 2, 86156 Augsburg, Deutschland
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13
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Haroon KH, Muhammad A, Hussain S, Patro SN. COVID-19 Related Cerebrovascular Thromboembolic Complications in Three Young Patients. Case Rep Neurol 2020; 12:321-328. [PMID: 33173491 PMCID: PMC7573918 DOI: 10.1159/000511179] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/18/2020] [Indexed: 11/19/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a viral illness, caused by the novel severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). It is currently affecting millions of people worldwide and is associated with coagulopathy, both in the venous and arterial systems. The proposed mechanism being excessive inflammation, platelet activation, endothelial dysfunction, and stasis. As an ongoing pandemic declared by WHO in March 2020, health systems worldwide are experiencing significant challenges with COVID-19-related complications. It has been noticed that patients with COVID-19 are at greater risk of thrombosis.
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Affiliation(s)
- Khawaja Hassan Haroon
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Ahmad Muhammad
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Suhail Hussain
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Satya Narayana Patro
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
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14
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Nojima J, Kaneshige R, Motoki Y, Ieko M. Increased oxidative stress may be a risk factor for thromboembolic complications in patients with antiphospholipid syndrome. Thromb Res 2020; 196:52-53. [PMID: 32841920 DOI: 10.1016/j.thromres.2020.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/29/2020] [Accepted: 08/04/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Junzo Nojima
- Department of Laboratory Science, Faculty of Health Science, Yamaguchi University Graduate School of Medicine, Japan.
| | - Risa Kaneshige
- Department of Laboratory Science, Faculty of Health Science, Yamaguchi University Graduate School of Medicine, Japan.
| | - Yukari Motoki
- Department of Laboratory Science, Faculty of Health Science, Yamaguchi University Graduate School of Medicine, Japan.
| | - Masahiro Ieko
- Department of Internal Medicine, School of Dentistry, Health Sciences University of Hokkaido, Japan
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15
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Kishikawa R, Tanaka T, Hashimoto M, Honda K, Omori Y, Ishihara A, Kamoi Y. Percutaneous Catheter Thrombus Aspiration of Right Renal Infarction Caused by Left Ventricular Thrombi due to Takotsubo Cardiomyopathy. Int Heart J 2020; 61:400-403. [PMID: 32173705 DOI: 10.1536/ihj.19-447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Takotsubo cardiomyopathy (TC) is a temporal dysfunction of the left ventricle (LV) due to psychological or physiological stress; however, it rarely causes LV thrombus. We report a case of a 49-year-old woman who developed LV thrombi due to TC despite anticoagulation therapy. The thrombi caused acute systemic infarction, with the most severe occlusion being in the right renal artery. The patient underwent percutaneous catheter aspiration thrombectomy of the right renal artery and her renal function recovered shortly after. The results of this case suggest that catheter aspiration thrombectomy is effective in the treatment of thromboembolism in TC.
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Affiliation(s)
| | | | | | - Kei Honda
- Department of Cardiology, Showa General Hospital
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16
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Abstract
Excluding the left atrial appendage in patients with nonvalvular atrial fibrillation is a mechanical way to decrease stroke risk. During endothelialization, the closure device is exposed to circulating blood, which might activate the coagulation cascade. In excessive proportions, possibly resulting in the development of device-related thrombus, requiring a bridging period with optimal antithrombotic treatment. Initial protocol treatment is less suitable for patients with contraindications to anticoagulation. Less intensive antithrombotic regimens investigated suggest safety and efficacy, however further research is required. A tailored treatment, considering bleeding and thromboembolic risk based on patient/procedural characteristics in every patient, is probably the best approach.
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Affiliation(s)
- Moniek Maarse
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435CM Nieuwegein, The Netherlands.
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435CM Nieuwegein, The Netherlands
| | - Lucas V A Boersma
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435CM Nieuwegein, The Netherlands; Department of Cardiology, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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17
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Gmeiner M, Wagner H, van Ouwerkerk WJR, Sardi G, Thomae W, Senker W, Holl K, Gruber A. Long-Term Outcomes in Ventriculoatrial Shunt Surgery in Patients with Pediatric Hydrocephalus: Retrospective Single-Center Study. World Neurosurg 2020; 138:e112-8. [PMID: 32061956 DOI: 10.1016/j.wneu.2020.02.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Long-term outcomes are rarely reported for patients with pediatric hydrocephalus. Ventriculoperitoneal shunting is the surgical standard; nevertheless, in selected patients, a ventriculoatrial shunt (VAS) remains an important alternative. This study aimed to analyze the causes of VAS revisions and complications. METHODS Pediatric patients who underwent their first shunt operation between 1982 and 1992 were included. The timing, cause, and modality of VAS revisions were retrospectively determined. RESULTS Overall, 138 patients were treated for hydrocephalus and 61 patients received a VAS during the follow-up period. A primary VAS was the first shunt type in 42 (68.85%) patients. In 19 (31.15%) patients, conversions to second-line VAS were carried out. The rates of VAS revisions performed for dysfunction or elective lengthening of a short atrial catheter were 52.2% and 22.9%, respectively. There was no difference in the number of VAS revisions between patients with primary VASs and second-line VASs. Age at VAS and etiology of hydrocephalus had no effect on the number of revisions. Specific VAS complications were observed in 2 patients. Deep positioning of the distal catheter led to asymptomatic tricuspid regurgitation that was reversible after shortening of the atrial catheter. Another patient presented with shunt nephritis and completely recovered after the atrial catheter was replaced with a peritoneal catheter. CONCLUSIONS VAS remains an appropriate second-line alternative in selected patients. Specific VAS complications were rarely observed and completely reversible after treatment. However, regular and specific follow-up examinations are strongly recommended to avoid cardiopulmonary or renal complications.
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18
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Zou H, Li Y, Xu G. Management of anticoagulation and antiplatelet therapy in patients with primary membranous nephropathy. BMC Nephrol 2019; 20:442. [PMID: 31791286 PMCID: PMC6889582 DOI: 10.1186/s12882-019-1637-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/21/2019] [Indexed: 02/07/2023] Open
Abstract
Background It has been recognized that primary membranous nephropathy (MN) is related to an increased risk for thromboembolic complications. However, the current evidence supporting prophylactic and therapeutic anticoagulation is too weak to better meet the clinical needs of this patient population. The present review provides some suggestions to guide the decision on anticoagulant management in primary MN patients with a high risk of thrombosis or with thromboembolic complication. Materials and methods We extracted relevant studies by searching the published literature using the Cochrane Library, Medline, PubMed and Web of Science from March 1968 to March 2018. Eligible publications included guidelines, reviews, case reports, and clinical trial studies that concerned the rational management of anticoagulation therapy in the primary MN population. The evidence was thematically synthesized to contextualize implementation issues. Results It was helpful for clinicians to make a decision for personalized prophylactic aspirin or warfarin in primary MN patients when serum albumin was < 3.2 g/dl to prevent arterial and venous thromboembolic events (VTEs). The treatment regimen for thromboembolic complications (VTEs, acute coronary syndrome and ischemic stroke) in primary MN was almost similar to that for the general population with thromboembolic events. It is noteworthy that patients should continue the previous primary MN treatment protocol during the entire treatment period until they achieve remission, the protocol is complete and the underlying diseases resolve. Conclusion The utility of prophylactic aspirin or warfarin may have clinical benefits for the primary prevention of thromboembolic events in primary MN with hypoalbuminemia. It is necessary to perform large randomized controlled trials and to formulate relevant guidelines to support the present review.
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Affiliation(s)
- Honghong Zou
- Department of Nephrology, the Second Affiliated Hospital of Nanchang University, 330006; No. 1, Minde Road, Donghu District,, Nanchang, People's Republic of China
| | - Yebei Li
- Department of Nephrology, the Second Affiliated Hospital of Nanchang University, 330006; No. 1, Minde Road, Donghu District,, Nanchang, People's Republic of China
| | - Gaosi Xu
- Department of Nephrology, the Second Affiliated Hospital of Nanchang University, 330006; No. 1, Minde Road, Donghu District,, Nanchang, People's Republic of China.
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19
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Yoshimoto Y, Fujikawa T, Tanaka A, Hayashi H, Shimoike N, Kawamoto H, Nakasuga C, Yamamoto T. Optimal use of antiplatelet agents, especially aspirin, in the perioperative management of colorectal cancer patients undergoing laparoscopic colorectal resection. World J Surg Oncol 2019; 17:92. [PMID: 31153382 PMCID: PMC6545215 DOI: 10.1186/s12957-019-1634-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/22/2019] [Indexed: 01/09/2023] Open
Abstract
Background Laparoscopic abdominal surgery is considered superior to open surgery. However, efficacy and safety outcomes of laparoscopic surgery in colorectal cancer (CRC) are unclear, particularly in patients undergoing antiplatelet therapy (APT). The aim of this study was to evaluate safety of antiplatelet agents, especially aspirin, in peri-operative management of patients undergoing laparoscopic colorectal resection for CRC. Methods A total of 578 radical laparoscopic colorectal surgeries in CRC patients performed between January 2005 and December 2015 at the Kokura Memorial Hospital were retrospectively reviewed. Patients were divided into three groups based on the risk for thromboembolism: a high-risk group receiving APT (APT-HR), a low-risk group receiving APT (APT-LR), and a low-risk group not receiving APT (non-APT). Bleeding complications (BC) and thromboembolic complications (TC) were assessed. Perioperative and outcome variables in groups receiving APT were compared with those in the non-APT group. Results APT-HR, APT-LR, and non-APT groups included 54 (9.3%), 114 (19.7%), and 410 (70.9%) patients, respectively. Blood loss during operation (p = 0.304), operative time (p = 0.956), hospitalisation after surgery (p = 0.307), and Clavien–Dindo classification of surgery-related complications (p = 0.467) were not significantly different in the three groups. Occurrence of intra-operative BC (blood loss ≥ 200 ml) (p = 0.864), post-operative BC (p = 0.630), and TC (p = 0.287) were also not significantly different in the three groups. Results of our analysis indicated that APT and non-interrupted APT were not associated with BC or TC. Conclusions Analysis of laparoscopic colorectal resection in CRC showed that APT was not a major factor for fatal BC or TC. In patients with high thromboembolic risk, continuing aspirin may inhibit the increase in TC without increasing BC in the peri-operative period.
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Affiliation(s)
- Yasunori Yoshimoto
- Department of Surgery, Kokura Memorial Hospital, 3-2-1, Asano, Kokura-kita, Kitakyushu, Fukuoka, 802-8555, Japan.
| | - Takahisa Fujikawa
- Department of Surgery, Kokura Memorial Hospital, 3-2-1, Asano, Kokura-kita, Kitakyushu, Fukuoka, 802-8555, Japan
| | - Akira Tanaka
- Department of Surgery, Kokura Memorial Hospital, 3-2-1, Asano, Kokura-kita, Kitakyushu, Fukuoka, 802-8555, Japan
| | - Hideto Hayashi
- Department of Surgery, Kokura Memorial Hospital, 3-2-1, Asano, Kokura-kita, Kitakyushu, Fukuoka, 802-8555, Japan
| | - Norihiro Shimoike
- Department of Surgery, Kokura Memorial Hospital, 3-2-1, Asano, Kokura-kita, Kitakyushu, Fukuoka, 802-8555, Japan
| | - Hiroshi Kawamoto
- Department of Surgery, Kokura Memorial Hospital, 3-2-1, Asano, Kokura-kita, Kitakyushu, Fukuoka, 802-8555, Japan
| | - Chiyo Nakasuga
- Department of Surgery, Kokura Memorial Hospital, 3-2-1, Asano, Kokura-kita, Kitakyushu, Fukuoka, 802-8555, Japan
| | - Tsunenori Yamamoto
- Department of Surgery, Kokura Memorial Hospital, 3-2-1, Asano, Kokura-kita, Kitakyushu, Fukuoka, 802-8555, Japan
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Yamaguchi J, Kinoshita K, Hirabayashi M, Hori S, Furukawa M, Sakurai A. Thromboembolic Complications Following Tissue Plasminogen Activator Therapy in Patients of Acute Ischemic Stroke - Case Report and Possibility for Detection of Cardiac Thrombi. Open Med (Wars) 2018; 13:551-555. [PMID: 30519632 PMCID: PMC6272048 DOI: 10.1515/med-2018-0081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/23/2018] [Indexed: 01/20/2023] Open
Abstract
Many reports focus on the probability of intracranial hemorrhage as a complication after recombinant tissue plasminogen activator (rt-PA) therapy. However, thromboembolic complications are not well discussed. We experienced a case in which severe thromboembolic complications occurred in the right radial and right ulnar artery. Arterial fibrillation was observed in this case. If multiple thrombi exist in the atrium or ventricle, multiple small embolic particles may appear following thrombolytic therapy, and that may be a potential risk of secondary thromboembolic complications due to incomplete dissolution of thrombi. Transesophageal echocardiography is a standard method to detect intracardiac sources of emboli in the case of arterial fibrillation. Transesophageal echocardiography is, however, an invasive method for patients with ischemic stroke during rt-PA therapy. High resolution enhanced CT could be a useful tool and may be a reliable alternative to transthoracic echocardiography. Careful assessment of thromboembolic complications following rt-PA therapy in patients with arterial fibrillation is needed. In this case report and mini review, we would like to discuss about the accurate diagnostic methods to detect cardiac or undetermined embolic sources and provide expedited stroke care. These embolic sources may be more readily discovered during rt-PA therapy within the limited therapeutic time window.
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Affiliation(s)
- Junko Yamaguchi
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo Japan
| | | | - Marina Hirabayashi
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo Japan
| | - Satoshi Hori
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo Japan
| | - Makoto Furukawa
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo Japan
| | - Atsushi Sakurai
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo Japan
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Barbieri L, Verdoia M, Schaffer A, Suryapranata H, De Luca G. Risk and Benefits of Triple Therapy in Patients Undergoing Coronary Stent Implantation Requiring Oral Anticoagulation: A Meta-Analysis of 16 Studies. Cardiovasc Drugs Ther 2017; 30:611-622. [PMID: 27757726 DOI: 10.1007/s10557-016-6692-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with coronary artery disease who undergo stent implantation and have concomitant indication for long-term oral anticoagulation represent a considerable proportion of the overall population. To date there is still no consensus about the optimal antithrombotic strategy to choose in this kind of patients, due to the difficult balance between an increased risk of bleeding and thromboembolic complications. Therefore, the aim of this study was to perform a meta-analysis to evaluate the risk and benefits of triple antithrombotic therapy versus dual antithrombotic therapy in patients undergoing coronary stent implantation, requiring long-term oral anticoagulation. METHODS We performed formal searches of PubMed, EMBASE, Cochrane central register of controlled trials and major international scientific session abstracts from January 1990 to September 2015 regarding the use of triple antithrombotic therapy (TT) versus dual therapy (DT) in patients undergoing percutaneous coronary stent implantation that required chronic oral anticoagulation. Data regarding study design, inclusion/exclusion criteria, number of patients, and selected endpoints was extracted by 2 investigators. Disagreements were resolved by consensus. RESULTS Sixteen trials with a total of 21716 patients undergoing coronary stent implantation with indication to long term oral anticoagulation, were finally included. A total of 6950 received TT, whereas 14766 received DT alone. The follow-up period ranged from 180 to 730 days. Data regarding mortality were available in 21658 patients (99.7 %). All cause mortality was observed in 10.4 % patients in TT versus 16.3 % in DT (OR [95 % CI] =0.73 [0.66-0.80], p <0.001; p het <0.001). In addition, TT was associated with a reduced incidence of MI (6.4 versus 9.8 %, OR [95 % CI] = 0.74 [0.65-0.84], p < 0.001; phet < 0.001) and ischemic stroke (1.8 versus 3.9 %, OR [95 % CI] = 0.55 [0.45-0.68], p < 0.001; p het = 0.07). As expected, TT was associated with a significant increase in major bleeding events (10.8 versus 8.5 %, OR [95 % CI] = 1.38 [1.25-1.53], p < 0.001; p het = 0.02). By meta regression analysis we found that benefits in mortality with TT were inversely related with the risk of bleedings (beta [95 % CI] = 2.25 (1.55; 2.95), p < 0.00001). The benefits with TT regarding overall mortality, recurrent MI and ischemic stroke were also confirmed in a pre-specified analysis versus DAPT or oral anticoagulation in association with a single antiplatelet agent. CONCLUSION This meta-analysis showed that among patients undergoing coronary stent implantation, requiring chronic OAC, the use of a TT is associated with a significant reduction in overall mortality, recurrent MI and ischemic stroke. As expected, we found a higher incidence of bleedings in patients treated with triple therapy. The benefits in mortality were lost in patients at high-risk for bleedings.
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Affiliation(s)
- Lucia Barbieri
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, C.so Mazzini, 18, 28100, Novara, Italy
| | - Monica Verdoia
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, C.so Mazzini, 18, 28100, Novara, Italy
| | - Alon Schaffer
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, C.so Mazzini, 18, 28100, Novara, Italy
| | | | - Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, C.so Mazzini, 18, 28100, Novara, Italy.
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Castro-Menéndez M, Pena-Paz S, Rocha-García F, Rodríguez-Casas N, Huici-Izco R, Montero-Viéites A. Efficacy of 2 grammes of intravenous transexamic acid in the reduction of post-surgical bleeding after total hip and knee replacement. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 60:315-24. [PMID: 27342383 DOI: 10.1016/j.recot.2016.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/23/2016] [Accepted: 05/05/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There is currently sufficient clinical evidence to recommend tranexamic acid (TXA) for reducing post-operative blood loss in total knee and hip arthroplasty, however, its optimal dose and administration regimes are unknown. OBJECTIVE Analyse effectiveness and safety of TXA in total hip and knee arthroplasty using 2 grammes (g) intravenously in two different regimes. MATERIAL AND METHODS A prospective randomised intervention study was conducted on a total of 240 patients. The patients were divided into 3 groups: 1) control; 2) 1g of TXA intraoperative, followed by another postoperative; and 3): 2g preoperative. Each group consisted of 40 patients undergoing total knee arthroplasty, and 40 total hip arthroplasty. Postoperative blood loss, transfusion rate, and thromboembolic complications were studied. RESULTS There were significant differences (p<.005) when comparing mean total blood loss and transfusion between group 1 and 2, and between group 1 and 3, but not between the two TXA groups (2 and 3). The authors only recorded one complication in group 1 (deep vein thrombosis). DISCUSION This study was not performed to investigate the already well established effectiveness of TXA, but to confirm if 2 empirical intravenous g is safe, and what is most beneficial regimen. In conclusion, according to the literature, both proven patterns of 2g intravenous of TXA are effective in reducing blood loss and transfusion requirements, without increasing the complication rate.
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Affiliation(s)
- M Castro-Menéndez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Monforte de Lemos, Lugo, España.
| | - S Pena-Paz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Lucus Augusta, Lugo, España
| | - F Rocha-García
- Servicio de Anestesia y Reanimación, Hospital de Monforte de Lemos, Lugo, España
| | - N Rodríguez-Casas
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Monforte de Lemos, Lugo, España
| | - R Huici-Izco
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Monforte de Lemos, Lugo, España
| | - A Montero-Viéites
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Monforte de Lemos, Lugo, España
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Abstract
Splenectomy is attended by medical complications, principally infectious and thromboembolic; the frequency of complications varies with the conditions that led to splenectomy (hematologic splenectomy, trauma, presence of portal hypertension). Most infectious complications are caused by encapsulated bacteria (Meningococcus, Pneumococcus, Hemophilus). These occur mainly in children and somewhat less commonly in adults within the first two years following splenectomy. Post-splenectomy infections are potentially severe with overwhelming post-splenectomy infection (OPSI) and this justifies preventive measures (prophylactic antibiotics, appropriate immunizations, patient education) and demands prompt antibiotic management with third-generation cephalosporins for any post-splenectomy fever. Thromboembolic complications can involve both the caval system (deep-vein thrombophlebitis, pulmonary embolism) and the portal system. Portal vein thrombosis occurs more commonly in patients with myeloproliferative disease and cirrhosis. No thromboembolic prophylaxis is recommended apart from perioperative low molecular weight heparin. However, some authors choose to prescribe a short course of anti-platelet medication if the post-splenectomy patient develops significant thrombocytosis. Thrombosis of the portal or caval venous system requires prolonged warfarin anticoagulation for 3 to 6 months. Finally, some studies have suggested an increase in the long-term incidence of cancer in splenectomized patients.
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Affiliation(s)
- R Buzelé
- Université Paris Diderot-Paris 7, Hôpital Beaujon, Service de Médecine Interne, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - L Barbier
- Université Paris Diderot-Paris 7, Hôpital Beaujon, Service de Chirurgie Hépato-Bilio-Pancréatique, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - A Sauvanet
- Université Paris Diderot-Paris 7, Hôpital Beaujon, Service de Chirurgie Hépato-Bilio-Pancréatique, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - B Fantin
- Université Paris Diderot-Paris 7, Hôpital Beaujon, Service de Médecine Interne, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
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Singh H, Ish P, Dewan R, Anuradha S, Singla S. Combined Arterial and Venous Thrombosis in Ulcerative Colitis- A Rare Vascular Manifestation. J Clin Diagn Res 2016; 10:OD12-3. [PMID: 27190869 DOI: 10.7860/jcdr/2016/17906.7608] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/19/2015] [Accepted: 02/10/2016] [Indexed: 11/24/2022]
Abstract
Combined arterial and venous thrombosis in patients with ulcerative colitis is a rare extra vascular manifestation, which motivated the current report. Increased coagulability is a recognised feature of ulcerative colitis with frequency increasing during flares. We report the case of a 42-year-old lady who was a diagnosed case of ulcerative colitis, currently in remission. She presented with swelling followed by discolouration of left lower limb which later was diagnosed as deep venous thrombosis combined with femoral and popliteal artery thrombosis. This led to wet gangrene of the limb, sepsis, septic shock and death despite aggressive management with heparin infusion, ionotropes, and parenteral antibiotics therapy.
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Affiliation(s)
- Harpreet Singh
- Senior Resident, Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital , New Delhi, India
| | - Pranav Ish
- Post Graduate Resident, Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital , New Delhi, India
| | - Richa Dewan
- Director Professor, Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital , New Delhi, India
| | - S Anuradha
- Professor, Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital , New Delhi, India
| | - Sumeet Singla
- Assistant Professor, Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital , New Delhi, India
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Fochtmann A, Forstner C, Hagmann M, Keck M, Muschitz G, Presterl E, Ihra G, Rath T. Predisposing factors for candidemia in patients with major burns. Burns 2014; 41:326-32. [PMID: 25239850 DOI: 10.1016/j.burns.2014.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 02/18/2014] [Revised: 07/03/2014] [Accepted: 07/05/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite advances in surgery and critical care, candidemia remains a significant cause of morbidity and mortality in patients with extensive burns. METHODS A retrospective single-center cohort study was performed on 174 patients admitted to the Burn Intensive Care Unit of the General Hospital of Vienna (2007-2013). An AIC based model selection procedure for logistic regression models was utilized to identify factors associated with the presence of candidemia. RESULTS Twenty (11%) patients developed candidemia on median day 16 after ICU admission associated with an increased overall mortality (30% versus 10%). Statistical analysis identified the following factors associated with proven candidemia: younger age (years) odds ratio (OR):0.96, 95% confidence interval (95% CI):0.92-1.0, female gender (reference male) OR:5.03, 95% CI:1.25-24.9, gastrointestinal (GI) complications requiring surgery (reference no GI complication) OR:20.37, 95% CI:4.25-125.8, non-gastrointestinal thromboembolic complications (reference no thromboembolic complication) OR:17.3, 95% CI:2.57-170.4 and inhalation trauma (reference no inhalation trauma) OR:7.96, 95% CI:1.4-48.4. CONCLUSIONS Above-mentioned patient groups are at considerably high risk for candidemia and might benefit from a prophylactic antifungal therapy. Younger age as associated risk factor is likely to be the result of the fact that older patients with a great extent of burn body surface have a lower chance of survival compared to younger patients with a comparable TBSA.
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Affiliation(s)
- Alexandra Fochtmann
- Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria.
| | - Christina Forstner
- Medical University of Vienna, Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Vienna, Austria.
| | - Michael Hagmann
- Medical University of Vienna, Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Vienna, Austria.
| | - Maike Keck
- Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria.
| | - Gabriela Muschitz
- Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria.
| | - Elisabeth Presterl
- Medical University of Vienna, Clinical Institute of Infection Control and Hospital Epidemiology, Vienna, Austria.
| | - Gerald Ihra
- Medical University of Vienna, Department of Anesthesiology and General Intensive Care, Vienna, Austria.
| | - Thomas Rath
- Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria.
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van Rijsingen IAW, Bakker A, Azim D, Hermans-van Ast JF, van der Kooi AJ, van Tintelen JP, van den Berg MP, Christiaans I, Lekanne Dit Deprez RH, Wilde AAM, Zwinderman AH, Meijers JCM, Grootemaat AE, Nieuwland R, Pinto YM, Pinto-Sietsma SJ. Lamin A/C mutation is independently associated with an increased risk of arterial and venous thromboembolic complications. Int J Cardiol 2012; 168:472-7. [PMID: 23073275 DOI: 10.1016/j.ijcard.2012.09.118] [Citation(s) in RCA: 24] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 09/10/2012] [Accepted: 09/22/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Lamin A/C (LMNA) mutation carriers suffer from a variety of clinical phenotypes, including dilated cardiomyopathy (DCM). Although it has been suggested that carriers are at risk for thromboembolic complications, it is unknown whether this risk is higher than can be expected from the underlying cardiac abnormalities. The purpose of this study was to determine whether a LMNA mutation is associated with an increased risk of thromboembolic complications. METHODS We compared a cohort of 76 LMNA mutation carriers with a cohort of 224 idiopathic DCM patients without a LMNA mutation, with respect to the prevalence of arterial and venous thromboembolic complications. Furthermore, we carried out a case-control study to explore whether a prothrombotic phenotype was present in LMNA mutation carriers without DCM or atrial tachyarrhythmias (n=14) and compared this with mutation negative relatives (n=13). RESULTS The prevalence of thromboembolic complications was higher in the cohort of LMNA mutation carriers than in DCM patients (22 vs 11%; p<0.05), after respectively mean follow-up of 42 ± 12 and 49 ± 12 years. After adjustment for possible confounders, including atrial tachyarrhythmias and left ventricular ejection fraction, LMNA mutation carriership was independently associated with an increased risk of thromboembolic complications (HR 4.8, 95% CI: 2.2-10.6). The results of the case-control study suggested a prothrombotic phenotype in LMNA mutation carriers, as reflected by an altered platelet function and increased thrombin generation. CONCLUSIONS LMNA mutation is independently associated with an increased risk of arterial and venous thromboembolic complications. Laboratory research in LMNA mutation carriers without severe cardiac abnormalities suggests a prothrombotic phenotype.
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