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Zheng H, Han Y, Zhao G, Wang R, Wu J, Chen X, Zhao Q, Ren F, Huang J. Topical Use of Low-dose Tranexamic Acid Has no Effect on Drainage Volume after Medial Open Wedge High Tibial Osteotomy: A Case Control Study. Orthop Surg 2024; 16:894-901. [PMID: 38444379 PMCID: PMC10984820 DOI: 10.1111/os.14014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE Many studies reported that tranexamic acid (TXA) was effective in reducing surgical blood loss in the perioperative period of medial open wedge high tibial osteotomy (MOWHTO). However, few studies focused on the simple topical use of TXA in MOWHTO, and the modality and dosage of topical use of TXA varied. The purpose of this study was to observe the effect of topical use of low-dose TXA on drainage volume after MOWHTO, and to analyze the related influencing factors. METHODS Data of patients who underwent MOWHTO combined with arthroscopic knee surgery in our department from January 2019 to September 2021 were retrospectively analyzed. A total of 105 patients (38 males and 67 females, aged 57.7 ± 7.5 years) were included in this study who received topical TXA or no TXA. The patients were divided into three groups: control group (39 cases), 0.5 g TXA group (40 cases), 1 g TXA group (26 cases). Postoperative drainage volume, wound healing, incidence of hematoma and deep venous thrombosis (DVT) were observed and analyzed in the three groups. The effects of gender, hypertension and diabetes on postoperative drainage volume were analyzed using a t-test. The correlation between age, body mass index (BMI), osteotomy gap and postoperative drainage volume were analyzed using the Pearson correlation coefficient. RESULTS The average postoperative drainage volume of the control group was 259.54 ± 226.33 mL, that of the 0.5 g TXA group was 277.18 ± 177.68 mL, and that of the 1 g TXA group was 229.15 ± 219.93 mL. There was no statistically significant difference in postoperative drainage volume among the three groups (F = 0.423, p = 0.656). There was no local hematoma and wound infection in the three groups. The wound fat liquefaction was found in one patient of the control group. The incidence of DVT was 38.9% (7/18) and 57.1% (8/14) in the control group and 0.5 TXA group, respectively. There was no significant difference in the incidence of DVT between the above two groups (p = 0.476). The average postoperative drainage volume of male patients in the three groups was higher than that of female patients, and the differences were statistically significant (p < 0.05). There was no correlation between age, BMI, osteotomy gap and postoperative drainage volume in the three groups (p > 0.05). CONCLUSION Topical use of low-dose TXA has no significant effect on drainage volume after MOWHTO. The drainage volume after MOWHTO in male patients was more than that in female patients. Topical administration of low-dose TXA does not increase postoperative complications, such as DVT and hematoma.
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Affiliation(s)
- Huifeng Zheng
- Department of Sports Injury and ArthroscopyTianjin HospitalTianjinChina
| | - Yuqin Han
- Department of Sports Injury and ArthroscopyTianjin HospitalTianjinChina
| | - Guangjuan Zhao
- Department of Sports Injury and ArthroscopyTianjin HospitalTianjinChina
| | - Rui Wang
- Department of Sports Injury and ArthroscopyTianjin HospitalTianjinChina
| | - Jiang Wu
- Department of Sports Injury and ArthroscopyTianjin HospitalTianjinChina
| | - Xiao Chen
- Department of Sports Injury and ArthroscopyTianjin HospitalTianjinChina
| | - Qian Zhao
- Department of Sports Injury and ArthroscopyTianjin HospitalTianjinChina
| | - Fuji Ren
- Department of Sports Injury and ArthroscopyTianjin HospitalTianjinChina
| | - Jingmin Huang
- Department of Sports Injury and ArthroscopyTianjin HospitalTianjinChina
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Baranoski JF, White AC, Chung CY, Catapano JS, De Oliveira Sillero R, Hui FK, Huisman TA, Lawton MT, Abruzzo T. Mechanical disorders of the cervicocerebral circulation in children and young adults. J Neurointerv Surg 2023:jnis-2022-019577. [PMID: 37696598 DOI: 10.1136/jnis-2022-019577] [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: 06/22/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023]
Abstract
Mechanical disorders of the cervicocerebral circulation (MDCC) are conditions in which neurological symptoms result from a disturbance of cerebral blood flow attributable to external mechanical forces exerted on extracranial blood vessels by adjacent musculoskeletal structures during head movement that is presumably within a physiological range. The disease spectrum includes bow hunter's syndrome, carotid-type Eagle syndrome, and various dynamic venous compression syndromes. These conditions have distinct phenotypes in children which differ from those expressed in older adults. In contemporary practice, recognition and diagnostic evaluation is the domain of the neuroendovascular specialist. The diagnostic evaluation of MDCC involves significant technical nuance that can be critical to directing appropriate management, particularly in children. This report aims to provide a comprehensive overview of the pathophysiology, anatomical patterns, diagnosis, and treatment for the full spectrum of MDCC that is commonly encountered in clinical practice.
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Affiliation(s)
| | - Andrew C White
- Radiology, Neurosurgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Neurosurgery, University of Colorado Denver, Aurora, Colorado, USA
| | - Charlotte Y Chung
- Radiology, New York University Langone Medical Center, New York, New York, USA
| | | | | | - Ferdinand K Hui
- Neuroscience Institute, Queen's Medical Center, Honolulu, Hawaii, USA
| | | | - Michael T Lawton
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Todd Abruzzo
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
- Radiology, Phoenix Children's Hospital, Phoenix, Arizona, USA
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Kelmer P, Sioutas GS, Salem MM, Srinivasan VM, Burkhardt JK. Surgical Burr Hole Access for Direct Sinus Puncture and Transvenous Coil Embolization of a Complex Superior Sagittal Sinus Dural Arteriovenous Fistula. J Neurointerv Surg 2023:jnis-2023-020774. [PMID: 37611939 DOI: 10.1136/jnis-2023-020774] [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: 07/03/2023] [Accepted: 07/27/2023] [Indexed: 08/25/2023]
Abstract
Dural arteriovenous fistulas (dAVFs) account for 10-15% of all cerebral vascular malformations,1 and their location around the superior sagittal sinus is rare with an incidence of 4-11% of all dAVFs.2 Endovascular transarterial or transvenous embolization are the treatment routes of choice for dAVFs,3 but in rare cases direct sinus access may be favorable.4 5 We present an unusual case of a complex superior sagittal sinus dAVF with multiple arterial feeders and an occluded posterior superior sagittal sinus segment which was challenging for classic embolization routes. A combined surgical and endovascular approach in the hybrid biplane operating room was performed and is shown in video 1 By using a direct surgical burr hole for sinus access anterior to the dAVF and the thrombosed sinus portion followed by transvenous coil embolization, the dAVF was cured in a minimally invasive and safe fashion.neurintsurg;jnis-2023-020774v1/V1F1V1Video 1Treatment of a complex superior sagittal sinus dural arteriovenous fistula by surgical burr hole access for direct sinus puncture and transvenous coil embolization.
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Affiliation(s)
| | - Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jan Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Al-Maisary S, Kremer J, Romano G, Karck M, Simone RD. Symptomatic Upper Extremity Deep Venous Thrombosis After Laser Lead Extraction. Braz J Cardiovasc Surg 2023; 38:e20220361. [PMID: 37540103 PMCID: PMC10399234 DOI: 10.21470/1678-9741-2022-0361] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION Laser lead extraction is a well-established method for removing unwanted leads with low morbidity and mortality. In this small series of cases, we documented our experience with venous thrombosis after laser lead extraction. METHODS Retrospective data of patients who underwent laser lead extraction with postoperative axillo-subclavian vein thrombosis between May 2010 and January 2020 were analyzed. Demographic, operative, clinical, and follow-up characteristics of those patients were collected from our medical database. RESULTS Six patients underwent percutaneous laser lead extraction. Mean age of the patients was 64±7 years. And four of them were male. A total of 11 leads with a mean age of 92±43.8 months were extracted. Patients presented with painful arm swelling postoperatively. CONCLUSION Laser lead extraction may lead to symptomatic upper extremity deep venous occlusion.
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Affiliation(s)
- Sameer Al-Maisary
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jamila Kremer
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Gabrielle Romano
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Raffaele De Simone
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Choi S, Kim KY, Hwang HP, Han YM. Denali Inferior Vena Cava Filter Retrieval: Complications and Success Rates. J Korean Soc Radiol 2023; 84:879-888. [PMID: 37559819 PMCID: PMC10407073 DOI: 10.3348/jksr.2022.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/12/2022] [Accepted: 11/13/2022] [Indexed: 08/11/2023]
Abstract
PURPOSE The present study was to evaluate the outcomes of Denali filter retrieval. MATERIALS AND METHODS We retrospectively reviewed 143 patients who received Denali filter insertion from September 2015 to April 2020. Ninety-seven patients who required removal of the filters were include in this study. Filters were retrieved with either standard or advanced techniques. Venography before and after retrieval was obtained to evaluate technical success, complications and duration of filter insertion. RESULTS All 97 filters were retrieved successfully without complications. Ninety-two (94.8%) were retrieved with standard technique and 5 filters (5.2%) required the advanced technique. There were two cases with a filter angle greater than 15 degrees. Inferior vena cava penetration was shown in 17 patients (17.5%) on venography but was not associated with contrast media extravasation after filter removal. CONCLUSION The Denali filter showed a high rate of successful retrieval without complications. This study adds value to previous studies and trials showing that the Denali filter is a reliable and safe filter that can potentially improve retrieval rates, with increasing use of this device.
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García-Gómez MA, García-Pérez J, Colorado-Cruz MF, López-Burgos CP, López-Zamora B, León-Pérez KM, Solano-Cruz HA, Cruz-Domínguez MDP, Vera-Lastra OL, Medina-García G. [Ethiology, risk factors and Whole blood viscosity index in thromboembolic venous disease]. Rev Med Inst Mex Seguro Soc 2023; 61:140-146. [PMID: 37200530 PMCID: PMC10399765] [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] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/07/2022] [Indexed: 05/20/2023]
Abstract
Backround Venous thromboembolic disease (VTED) is a frequent cause of hospitalization and mortality. Whole blood viscosity (WBV) participates in the pathogenesis of thrombosis. Objective To identify the most frequent etiologies and their association with WBV index (WBVI) in hospitalized patients with VTED. Material and methods Observational, cross-sectional, retrospective, analytical study, Group 1: cases (patients diagnosed with VTED) and Group 2: controls without thrombosis. Risk factors for VTED were described and WBVI was calculated from total proteins and hematocrit. Descriptive and inferential statistics were used with Chi-squared test, Fisher's exact test, Mann Whitney U test, bivariate and multivariate logistic regression analysis. Results We included 146 patients and 148 controls, age 46.3 ±17.7 vs. 58 ± 18.2 years, of both sexes (female, 65.1%). The most frequent etiology was neoplastic (23.3%), followed by diseases with cardiovascular risk (17.8%). Independent risk factors for VTED were age, chronic kidney disease, presence of liver disease or solid neoplasia. WBVI was similar in patients with VTED as in those without thrombosis. We found an association of the presence of deep vein thrombosis and diseases with cardiovascular risk (p = 0.040). Conclusions The presence of chronic kidney disease, liver disease, and solid neoplasia are independent risk factors for VTED. The WBVI is a simple and rapid diagnostic tool in the evaluation of patients with VTED.
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Affiliation(s)
- Miguel Alejandro García-Gómez
- Instituto Mexicano del Seguro Social, Hospital de Especialidades "Dr. Antonio Fraga Mouret" Centro Médico Nacional La Raza, Departamento de Medicina Interna. Ciudad de México, México
| | - Joaquín García-Pérez
- Instituto Mexicano del Seguro Social, Hospital de Especialidades "Dr. Antonio Fraga Mouret" Centro Médico Nacional La Raza, Departamento de Medicina Interna. Ciudad de México, México
| | | | | | - Berenice López-Zamora
- Universidad Juárez Autónoma de Tabasco, Facultad de Medicina. Villahermosa, Tabasco, México
| | | | | | - María Del Pilar Cruz-Domínguez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Dirección de Educación e Investigación en Salud. Ciudad de México, México
| | - Olga Lidia Vera-Lastra
- Instituto Mexicano del Seguro Social, Hospital de Especialidades "Dr. Antonio Fraga Mouret" Centro Médico Nacional La Raza, Departamento de Medicina Interna. Ciudad de México, México
| | - Gabriela Medina-García
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Unidad de Investigación en Medicina Traslacional en enfermedades hemato-oncológicas. Ciudad de México, México
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GARCIA JOÃOVITORDACRUZ, TAKATA VINICIUS, DIAZ LUISEDUARDOPLUMACHER, DADA NETO FRANCISCO, SANTANA MARCOSVINICIUSFELIX, DOBASHI EIFFELTSUYOSHI. EFFICIENCY OF DEEP VENOUS THROMBOSIS PREVENTION IN PROXIMAL FEMUR FRACTURES. Acta Ortop Bras 2022; 30:e256947. [PMID: 36561477 PMCID: PMC9757728 DOI: 10.1590/1413-785220223006e256947] [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] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/03/2021] [Indexed: 12/23/2022]
Abstract
Objective To determine the efficiency of the deep venous thrombosis (DVT) prophylaxis protocol in postoperative patients due to proximal femoral fractures and to assess any statistical difference between the types of fractures. Methods A retrospective observational study based on the analysis of patients' medical records who underwent to a surgical intervention due to proximal femoral fractures in 2017 and 2021 at Hospital IFOR - Rede D'Or São Luiz. These patients were selected according to previously determined inclusion and exclusion criteria. A total of 99 patients were included divided by sex, age, laterality, length of stay, and death. According to the institutional protocol, was used chemoprophylaxis with low-molecular-weight heparin, associated use of pneumatic compression with compression stockings, and early gait. The DVT diagnosis was determined by clinical evaluation and imaging tests such as venous Doppler ultrasonography and laboratory tests. Results The protocol was effective in our study. Only one (1.01%) patient developed DVT. Due to the lack of samples, we could not achieve our secondary objective. Conclusion The institutional protocol is efficient for DVT prophylaxis and essential in these cases. Level of Evidence II, Prognostic Study.
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Affiliation(s)
| | - VINICIUS TAKATA
- Rede D’Or São Luiz, Hospital IFOR, São Bernardo do Campo, SP, Brazil
| | | | | | - MARCOS VINICIUS FELIX SANTANA
- Rede D’Or São Luiz, Hospital IFOR, São Bernardo do Campo, SP, Brazil.,Universidade Federal de São Paulo, Paulista School of Medicine, São Paulo, SP, Brazil
| | - EIFFEL TSUYOSHI DOBASHI
- Rede D’Or São Luiz, Hospital IFOR, São Bernardo do Campo, SP, Brazil.,Universidade Federal de São Paulo, Paulista School of Medicine, São Paulo, SP, Brazil
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8
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Darley L, Drouet C, Cochet A. [Internal jugular venous thrombosis and esophageal adenocarcinoma]. Rev Prat 2022; 72:419. [PMID: 35638988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Affiliation(s)
| | | | - Alexandre Cochet
- "Service de médecine nucléaire, CGFL, Dijon, France Université de Bourgogne Franche-Comté, UFR sciences médicales et pharmaceutiques, Dijon, France"
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9
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Espitia O. [Catheter thrombosis and upper extremity thrombosis in oncology]. Rev Prat 2022; 72:277-280. [PMID: 35638951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Olivier Espitia
- "Service de médecine interne et vasculaire, Nantes université, CHU Nantes, France"
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10
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Théreaux J. [Venous thromboembolic risk after bariatric surgery]. Rev Prat 2022; 72:176-177. [PMID: 35289527] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
VENOUS THROMBOEMBOLIC RISK AFTER BARIATRIC surgeryvenous thromboembolism is widely considered as the first medical postoperative complication after bariatric surgery with a rate around 0.5% during the first 90 postoperative days. Pulmonary embolism is often associated With septic complication, increasing the risk of postoperative death. Chemoprophylaxis with a minimum lenght of 10 days remains the corner stone of preventive treatment.
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Affiliation(s)
- Jérémie Théreaux
- Service de chirurgie viscérale et digestive, centre hospitalier universitaire de Brest, site Cavale-Blanche, Brest, France ; EA 3878. Groupe d'étude de la thrombose de Bretagne occidentale (GETBO) ; université de Bretagne occidentale, UFR médecine et sciences de lasanté, Brest, France
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11
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Feldman PA. Proposed mechanism for rare thrombotic events after use of some Covid-19 vaccines. Med Hypotheses 2022;:110756. [PMID: 35002021 DOI: 10.1016/j.mehy.2021.110756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/09/2021] [Accepted: 11/19/2021] [Indexed: 11/20/2022]
Abstract
Administration of AstraZeneca/Oxford and Johnson & Johnson/Janssen Covid-19 vaccines which use an adenovirus vector for DNA delivery has been associated with very rare thromboembolic complications coupled with an immune response to platelet factor 4 protein. The cause of this has not yet been identified. It is known that binding of coagulation factor proteins to the surface of some adenoviruses can protect their function. Here I propose that the thromboembolic events are caused by impairment of coagulation factor X binding to the virus capsid. The unprotected capsid then stimulates an immune response leading to platelet activation, increased thrombogenicity and formation of an antibody complex with platelet factor 4. Impaired binding of factor X may be due to an undiagnosed mutation in affected individuals. Options to test this mechanism experimentally and potential remedial actions to resolve the hazard are described. This mechanism offers a remedial route to address concerns about the safety of these vaccines, which are otherwise well-positioned to deliver global Covid-19 immunity across diverse healthcare economies.
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Manfredi VM, Machado MB, Barbato NG, Takata ET, Dobashi ET. EFFECTIVENESS OF DEEP VENOUS THROMBOSIS PREVENTION IN TOTAL HIP ARTHROPLASTY. Acta Ortop Bras 2021; 29:293-296. [PMID: 34849092 PMCID: PMC8601383 DOI: 10.1590/1413-785220212906243045] [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] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/05/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the efficacy of Deep Venous Thrombosis (DVT) prophylaxis protocol in patients undergoing total hip arthroplasty (THA), and to verify differences in the rates of this complication when comparing primary replacement surgeries with revision surgeries. METHODS We conducted a retrospective study of patients operated between 2012 and 2018, with inclusion and non-inclusion criteria determined by the researchers. A protocol was created to compile data including 92 patients, amounting to 110 operated hips, divided by gender, age, laterality, among other criteria. For THA cases, low molecular weight heparin chemoprophylaxis was used, associated with the use of pneumatic and elastic compression, concomitant to deambulation as soon as possible. The detection of DVT was determined by clinical evaluation and imaging exams such as: simple radiographs, ultrasound, arterial and venous color doppler, and laboratory tests. RESULTS The use of the protocol was very effective in our study. Only one (1.09%) case of deep venous thrombosis was found. CONCLUSION The use of thromboprophylaxis for DVT is indispensable, as was clearly demonstrated by these cases. We observed only one (1.09%) case of DVT in our series. Level of Evidence III, Retrospective Study.
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Affiliation(s)
- Victor Martins Manfredi
- Ifor Hospital, Institute of Fractures, Orthopedics and Rehabilitation, São Bernardo do Campo, SP, Brazil
| | | | - Nícolas Giorgini Barbato
- Ifor Hospital, Institute of Fractures, Orthopedics and Rehabilitation, São Bernardo do Campo, SP, Brazil
| | - Edmilson Takehiro Takata
- Ifor Hospital, Institute of Fractures, Orthopedics and Rehabilitation, São Bernardo do Campo, SP, Brazil
- Federal University of São Paulo, São Paulo School of Medicine, São Paulo, SP, Brazil
| | - Eiffel Tsuyoshi Dobashi
- Ifor Hospital, Institute of Fractures, Orthopedics and Rehabilitation, São Bernardo do Campo, SP, Brazil
- Federal University of São Paulo, São Paulo School of Medicine, São Paulo, SP, Brazil
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Roffé A, Guedon A, Lallmahomed E. [Actual use of direct oral anticoagulants in venous thromboembolic disease]. Rev Med Interne 2021; 43:82-88. [PMID: 34176700 DOI: 10.1016/j.revmed.2021.06.005] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 12/29/2022]
Abstract
Direct oral anticoagulants recently became the first-line choice for anticoagulation in venous thromboembolic disease. Many studies have shown its non-inferiority regarding the risk of thromboembolic recurrence compared to anti-vitamin K without increasing the risk of bleeding in the general population. However, specific populations such as patients with cancer, patients with kidney failure, patients with constitutional thrombophilia, elderly patients, or patients with extreme weight are at risk of intolerance to the use of direct oral anticoagulants. Precautions in use may be necessary as discussed in recently published guidelines about antiphospholipid syndrome. This review aims to list the main clinical trials investigating direct oral anticoagulants in venous thromboembolic disease in the general population and populations at risk, as well as to provide an update on current international and French guidelines.
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Affiliation(s)
- A Roffé
- Service de médecine vasculaire, hôpital Européen Georges-Pompidou, Paris, France.
| | - A Guedon
- Service de médecine vasculaire, hôpital Européen Georges-Pompidou, Paris, France
| | - E Lallmahomed
- Service de cardiologie, Centre hospitalier intercommunal Robert-Ballanger, Aulnay-sous-Bois, France
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Picón-Jaimes YA, Echeverry-Lenis LE, Orozco-Chinome JE. [May-Thurner syndrome as a cause of abdominal pain: Case report]. Rev Med Inst Mex Seguro Soc 2021; 59:163-169. [PMID: 34232410] [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] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/18/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The May-Thurner syndrome consists of an anatomical anomaly of the iliac veins that predisposes the person presenting it to the appearance of venous insufficiency and recurrent thrombotic episodes of the lower limbs. The aim of this article was to present a case of this pathology, highlighting a rare symptom that led to its diagnosis. CASE REPORT 46-year-old woman with severe abdominal pain in the right iliac fossa not associated with other gastrointestinal symptoms or fever. Contrast tomography of the abdomen and pelvis reported bilateral common iliac vein thrombosis. After ruling out acute surgical abdomen or immunological pathologies, an abdominal-pelvic angiography was performed, which led to the diagnosis of May-Thurner syndrome. It was performed endovascularly, pharmaco-mechanical thrombolysis, balloon plasty, and stent installation. CONCLUSIONS This type of abdominal vascular compression syndromes are rare and require a high index of suspicion to be diagnosed, which is why publications of this type of pathology take on relevance since they teach readers about the pathology.
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Ahmad AS. May-Thurner Syndrome, an Often Overlooked Cause of Deep Vein Thrombosis: A Case Report. Oman Med J 2021; 36:e269. [PMID: 34234962 PMCID: PMC8223584 DOI: 10.5001/omj.2021.33] [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: 11/09/2019] [Accepted: 05/07/2020] [Indexed: 11/18/2022] Open
Abstract
Deep vein thrombosis (DVT) is a common medical condition, but the predisposing anatomical factors, which may be amenable to definitive treatment, are usually overlooked. Therefore, a high index of clinical suspicion is the key to early diagnosis. We report here one such case of May-Thurner syndrome (MTS) to raise awareness. MTS (also known as iliac vein compression syndrome) should be suspected in cases of extensive DVT of the leg, particularly involving the iliac vein on the left side. The prognosis is improved with thrombolysis followed by angioplasty and stent to address the venous stenosis.
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Abstract
Venous aneurysm of the head and neck is a rare clinical entity due to its asymptomatic nature and tendency of clinicians to report only surgical results. Whereas the primary aneurysm of internal jugular vein (IJV) in children is being increasingly recognized, secondary aneurysms of veins of the head and neck in adults, notably the external jugular vein (EJV) aneurysm remains only in anecdotal case reports. We present the case of a 63-year-old previously healthy woman who presented with a gradually progressive right lateral neck swelling over the last 18 months. Following the evaluation, she was diagnosed as a case of isolated spontaneous right-sided EJV aneurysm and was managed by surgical excision of the aneurysm.
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Affiliation(s)
| | - Nilanjan Roy
- Armed Forces Medical College, Department of Surgery, Pune, Maharashtra, India
| | | | | | - Divya Shelly
- Indian Navy Hospital Ship Asvini, Mumbai, Maharashtra, India
| | - Basil Badarudeen
- Armed Forces Medical College, Department of Surgery, Pune, Maharashtra, India
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17
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Abstract
Cardiovascular diseases, including peripheral arterial and venous disease, myocardial infarction, and stroke, are the number one cause of death worldwide annually. In the last 20 years, the role of necroptosis, a newly identified form of regulated necrotic cell death, in cardiovascular disease has come to light. Specifically, the damaging role of two kinase proteins pivotal in the necroptosis pathway, Receptor Interacting Protein Kinase 1 (RIPK1) and Receptor Interacting Protein Kinase 3 (RIPK3), in cardiovascular disease has become a subject of great interest and importance. In this review, we provide an overview of the current evidence supporting a pathologic role of RIPK1 and RIPK3 in cardiovascular disease. Moreover, we highlight the evidence behind the efficacy of targeted RIPK1 and RIPK3 inhibitors in the prevention and treatment of cardiovascular disease.
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Affiliation(s)
| | | | - Bo Liu
- Department of Surgery, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA; (E.D.); (T.Z.)
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18
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Ahmed SA, Hameed SA, Hussen BM, Salihi A. Prevalence of the prothrombin G20210A mutation among ischemic stroke patients. J Cardiovasc Thorac Res 2020; 12:227-230. [PMID: 33123330 PMCID: PMC7581837 DOI: 10.34172/jcvtr.2020.39] [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: 01/31/2020] [Accepted: 08/11/2020] [Indexed: 11/09/2022] Open
Abstract
Introduction: Ischemic stroke is characterized as a sudden neurological deficit attributed to an acute focal injury of the central nervous system by a vascular cause. This study was performed to determine the frequency of G20210A mutation in the prothrombin gene and its effectiveness on the incidence of ischemic stroke in the Erbil city of Kurdistan region, Iraq. Methods: A total of 50 patients with ischemic stroke was analyzed for the detection of prothrombin gene mutation (G20210A), using polymerase chain reaction (PCR), Restriction fragment length polymorphism (RFLP) with Hind III restriction enzyme. Results: We observed no evidence of an association between ischemic stroke and G20210A mutation in the prothrombin gene in this region. Conclusion: Our finding demonstrates that prothrombotic gene variant seems not to be linked to the incidence of ischemic stroke in Erbil region.
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Affiliation(s)
- Salar A Ahmed
- Department of Clinical Biochemistry, College of Medicine, Hawler Medical University, Erbil, Iraq
| | | | - Bashdar M Hussen
- Department of Pharmacognocy, College of Pharmacy, Hawler Medical University, Iraq
| | - Abbas Salihi
- Department of Biology, College of Science, Salahaddin University-Erbil, Erbil, Iraq.,Department of Medical Analysis, Faculty of Science, Tishk International University, Erbil, Iraq
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19
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Kim J, Kim HJ, Park S, Kim DK, Kim TH. Predictive Factors of Deep Vein Thrombosis in Gynecologic Cancer Survivors with Lower Extremity Edema: A Single-Center and Retrospective Study. Healthcare (Basel) 2020; 8:healthcare8010048. [PMID: 32120824 PMCID: PMC7151164 DOI: 10.3390/healthcare8010048] [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: 01/17/2020] [Revised: 02/15/2020] [Accepted: 02/25/2020] [Indexed: 11/25/2022] Open
Abstract
This study was conducted to examine predictive factors of deep vein thrombosis (DVT) in gynecologic cancer survivors with lower extremity edema (LEE). In the current single-center, retrospective study, there was a total of 315 eligible patients, including 80 patients with DVT and 235 without DVT. They were therefore divided into two groups: the DVT group (n = 80) and the non-DVT group (n = 235). Then, baseline and clinical characteristics of the patients were compared between the two groups. In our study, distant organ metastasis, advanced stage, lymphadectomy, and amount of intraoperative blood loss had a positive predictive value for the occurrence of DVT in gynecologic cancer survivors presenting LEE. In conclusion, our results indicate that it is necessary to consider the possibility of LEE arising from DVT in gynecologic cancer survivors with advanced-stage cancer, distant organ metastasis, lymphadectomy, and intraoperative blood loss over 1500 mL.
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Affiliation(s)
- Jungin Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju 27478, Korea; (J.K.); (S.P.); (D.K.K.)
| | - Hyun-Jun Kim
- Department of Obstetrics & Gynecology, School of Medicine, Konkuk University, Chungju 27478, Korea;
- Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05029, Korea
| | - Seunghun Park
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju 27478, Korea; (J.K.); (S.P.); (D.K.K.)
| | - Dong Kyu Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju 27478, Korea; (J.K.); (S.P.); (D.K.K.)
| | - Tae Hee Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju 27478, Korea; (J.K.); (S.P.); (D.K.K.)
- Correspondence: ; Tel.: +82-43-840-8890; Fax: +82-43-840-8968
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20
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Ghiasian M, Mansour M, Moradian N. Prognosis of fasting in patients with cerebral venous thrombosis using oral contraceptives. Iran J Neurol 2019; 18:82-84. [PMID: 31565205 PMCID: PMC6755507] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: There have been studies that showed a higher incidence of cerebral venous thrombosis (CVT) in Ramadan, a month in which people fast in Muslim countries, which was associated with increasing use of oral contraceptives (OCPs) in women. We aimed to evaluate the effect and prognosis of fasting in patients with CVT using OCPs. Methods: Consecutive patients with diagnosis of CVT in Sina hospital, Hamadan, West of Iran, from May of 2009 to June of 2016 were evaluated, and women using OCPs were included. Other risk factors except fasting were excluded. Clinical presentation and outcomes of CVT was assessed. Patients were followed up for 12 months. Results: 58 patients were included in this study. 31 of these patients had fasting simultaneously. Fasting in patients using OCPs caused significantly higher focal neurological deficit (64.5%, P = 0.018), and higher hemorrhage (66.7%, P = 0.042). At discharge, 51.6% and after three months, 25.8% of patients with fasting had disability [6 > modified Rankin Scale (mRS) >1]. In patients who used OCPs as sole risk factor, 25.9% at discharge and 11.1% after three months had disability. Conclusion: Fasting in patients with CVT using OCPs causes significant increase in focal neurological deficit and hemorrhage, which also increases the hospital stay and lengthens recovery. However, long-term prognosis and mortality of CVT is similar between the two groups.
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Affiliation(s)
- Masoud Ghiasian
- Department of Neurology, Sina Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Mansour
- Department of Neurology, Sina Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Nasrin Moradian
- Department of Neurology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
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21
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Shakibajahromi B, Ashjazadeh N, Safari A, Borhani-Haghighi A. Changes in trend of cerebral venous sinus thrombosis. Iran J Neurol 2019; 18:33-34. [PMID: 31316734 PMCID: PMC6626603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Nahid Ashjazadeh
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Anahid Safari
- Stem Cells Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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22
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Lal D, Gujjar AR, Ramachandiran N, Obaidi A, Kumar S, El-Tigani M, Al-Azri F, Al-Asmi AR. Spectrum of Cerebral Venous Thrombosis in Oman. Sultan Qaboos Univ Med J 2018; 18:e329-e337. [PMID: 30607274 DOI: 10.18295/squmj.2018.18.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 12/18/2017] [Revised: 03/07/2018] [Accepted: 04/12/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives Cerebral venous thrombosis (CVT) can have varied and life-threatening manifestations. This study aimed to examine the spectrum of its clinical presentations and outcomes in a tertiary hospital in Oman. Methods This retrospective study was conducted at the Sultan Qaboos University Hospital, Muscat, Oman, between January 2009 and December 2017. The medical records of all patients with CVT were reviewed to determine demographic characteristics, clinical features and patient outcomes. Results A total of 30 patients had CVT. The mean age was 36.8 ± 11 years and the male-to-female ratio was 2:3. Common manifestations included headache (83%), altered sensorium (50%), seizures (43%) and hemiparesis (33%). Underlying risk factors were present in 16 patients (53%). Computed tomography or magnetic resonance imaging of the brain was abnormal in all patients, with indications of infarcts (40%) and major sinus thrombosis (100%). There were five cases (20%) of deep CVT. The patients were treated with low-molecular-weight heparin, mannitol and anticonvulsants. The majority (77%) had no residual neurological deficits at follow-up. Conclusion These findings indicate that CVT is a relatively uncommon yet treatable disorder in Oman. A high index of suspicion, early diagnosis, prompt anticoagulation treatment and critical care may enhance favourable patient outcomes.
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Affiliation(s)
- Darshan Lal
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Arunodaya R Gujjar
- Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Nandagopal Ramachandiran
- Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ammar Obaidi
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Sunil Kumar
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Mortada El-Tigani
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Faizal Al-Azri
- Department of Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Abdullah R Al-Asmi
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
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23
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Andrade JV, Magalhães J, Resende C, Gomes D, Laranjo G, Campos J, Santos E, Faria C. [Venous Thromboembolism in Pediatric Age: A 15 Year Retrospective Review]. ACTA MEDICA PORT 2018; 31:489-495. [PMID: 30332373 DOI: 10.20344/amp.9639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/03/2017] [Revised: 07/23/2018] [Accepted: 07/02/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Pulmonary thromboembolism and deep venous thrombosis occur in pediatric age, with unknown incidence, morbidity and mortality. Our aim is to review the epidemiology, clinical presentation, complementary diagnostic tests and prognosis of patients with pulmonary thromboembolism and deep venous thrombosis. MATERIAL AND METHODS Retrospective, descriptive and analytical study of pediatric patients admitted to a Level II hospital for pulmonary thromboembolism and deep venous thrombosis, between 2000 and 2014. Demographic characteristics, clinical history, comorbidities and risk factors were studied. RESULTS Eleven patients (n = 7 pulmonary thromboembolism, n = 5 deep venous thrombosis, n = 1 both), 64% females and with 16 years old average, were admitted. All patients with pulmonary thromboembolism presented symptoms of chest pain and/or dyspnea, 25% syncope/palpitations and 25% fever. All patients with deep venous thrombosis reported localized pain at the site of obstruction, 83% edema/cyanosis of the affected limb and 17% fever. The study of positive thrombophilia was the most frequent risk factor in both entities. The mean value of D-dimers was 3252 ug/dL and 2660 ug/dL in pulmonary thromboembolism and deep venous thrombosis, respectively. All patients started anticoagulation, three required intensive care, two had sequelae and one died. DISCUSSION All patients had at least one risk factor, and hereditary hypercoagulability was most commonly established. CONCLUSIONS The increased incidence in the pediatric population described in some studies can be attributed to an increased awareness of this pathology, medical advances and increasing survival of chronic diseases. There is a lack of evidence-based recommendations identifying patients at risk of thrombosis so that decisions can be made carefully, balancing the risk and benefit in each case.
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Affiliation(s)
| | - Joana Magalhães
- Serviço de Pediatria. Centro Hospitalar Tondela-Viseu. Viseu, Portugal
| | - Catarina Resende
- Serviço de Pediatria. Centro Hospitalar Tondela-Viseu. Viseu, Portugal
| | - Dora Gomes
- Serviço de Pediatria. Centro Hospitalar Tondela-Viseu. Viseu, Portugal
| | - Gabriela Laranjo
- Serviço de Pediatria. Centro Hospitalar Tondela-Viseu. Viseu, Portugal
| | - Joana Campos
- Serviço de Pediatria. Centro Hospitalar Tondela-Viseu. Viseu, Portugal
| | - Elisabete Santos
- Serviço de Pediatria. Centro Hospitalar Tondela-Viseu. Viseu, Portugal
| | - Cristina Faria
- Serviço de Pediatria. Centro Hospitalar Tondela-Viseu. Viseu, Portugal
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24
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Abstract
Oral anticoagulants are commonly used drugs in patients with CKD and patients with ESKD to treat atrial fibrillation to reduce stroke and systemic embolism. Some of these drugs are used to treat or prevent deep venous thrombosis and pulmonary embolism in patients with CKD who undergo knee and hip replacement surgeries. Warfarin is the only anticoagulant that is approved for use by the Food and Drug Administration in individuals with mechanical heart valves. Each oral anticoagulant affects the coagulation profile in the laboratory uniquely. Warfarin and apixaban are the only anticoagulants that are Food and Drug Administration approved for use in patients with CKD and patients with ESKD. However, other oral anticoagulants are commonly used off label in this patient population. Given the acquired risk of bleeding from uremia, these drugs are known to cause increased bleeding events, hospitalization, and overall morbidity. Each anticoagulant has unique pharmacologic properties of which nephrologists need to be aware to optimally manage patients. In addition, nephrologists are increasingly asked to aid in the management of adverse bleeding events related to oral anticoagulant use in patients with CKD and patients with ESKD. This article summarizes the clinical pharmacology of these drugs and identifies knowledge gaps in the literature related to their use.
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Affiliation(s)
- Nishank Jain
- Division of Nephrology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Medicine Service, Central Arkansas Veterans Affairs Health Care System, Little Rock, Arkansas
| | - Robert F Reilly
- Division of Nephrology, Department of Internal Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama; and .,Division of Nephrology, Department of Medicine, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
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25
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Langer F, Dos Santos D, Suertegaray G, Haygert C. Bilateral Deep Vein Thrombosis Associated with Inferior Vena Cava Agenesis in a Young Patient Manifesting as Low Back Pain. ACTA MEDICA PORT 2017; 30:333-337. [PMID: 28555560 DOI: 10.20344/amp.7744] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 04/14/2016] [Accepted: 12/19/2016] [Indexed: 11/20/2022]
Abstract
Congenital absence of the inferior vena cava is a rare vascular anomaly, and most cases are asymptomatic. Nevertheless, patients with inferior vena cava malformations may have increased risk of deep venous thrombosis. Particularly, cases of bilateral deep venous thrombosis may arise owing to an insufficient collateral venous drainage from the lower limbs. We hereby describe a case of a previously healthy young male patient presenting with bilateral lower limb deep venous thrombosis as the initial clinical manifestation of congenital inferior vena cava agenesis. We conclude that in young patients presenting with deep venous thrombosis, especially when thrombosis occurs spontaneously, bilaterally, or recurrently, inferior vena cava anomalies should be thoroughly investigated and ruled out as appropriate.
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Affiliation(s)
- Felipe Langer
- Radiology and Imaging Diagnosis. University Hospital of Santa Maria. Rio Grande do Sul. Brazil
| | - Daiane Dos Santos
- Radiology and Imaging Diagnosis. University Hospital of Santa Maria. Rio Grande do Sul. Brazil
| | - Gustavo Suertegaray
- Radiology and Imaging Diagnosis. University Hospital of Santa Maria. Rio Grande do Sul. Brazil
| | - Carlos Haygert
- Radiology and Imaging Diagnosis. University Hospital of Santa Maria. Rio Grande do Sul. Brazil
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26
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Roy S, Bhatt S, Rawal R, Tandon A, Meena N. Splenic Vein Thrombosis as a Rare Complication of Disseminated Tuberculosis - Imaging Diagnosis and Case Report. Pol J Radiol 2017; 82:106-109. [PMID: 28344684 PMCID: PMC5335783 DOI: 10.12659/pjr.900198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 06/21/2016] [Accepted: 07/18/2016] [Indexed: 11/27/2022] Open
Abstract
Background Venous thromboembolism is a known but rare complication associated with Mycobacterium tuberculosis infection. The reported incidence of venous thromboembolism is 1.5–3.4% of infected patients, and it occurs due to a hypercoagulable state induced by the associated inflammation. Case Report A young woman with pulmonary tuberculosis was found to have disseminated tuberculosis and a clinically unsuspected partial thrombus in the splenic vein on imaging. Ultrasound demonstrated hepato-splenomegaly with multiple granulomas as well as ascites and a left-sided pleural effusion. An increased calibre of the splenic vein with a hyperechogenicity within it raised the suspicion of a thrombus, which was confirmed on a contrast-enhanced CT examination. CECT of the abdomen also showed a small peripheral splenic infarct, while CECT of the chest revealed bilateral miliary lesions in the lungs along with necrotic mediastinal lymphadenopathy. The final imaging diagnosis was disseminated tuberculosis complicated by splenic vein thrombosis. A timely institution of anti-coagulant and anti-tubercular treatment led to a complete resolution of the splenic vein thrombosis. Conclusions Contrast-enhanced CT serves as a useful imaging tool for the detection of venous thrombosis and for the estimation of a complete burden of the disease. This condition should be kept in mind by both clinicians and radiologists and looked for in order to prevent life-threatening complications.
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Affiliation(s)
- Satarupa Roy
- Department of Radiology, University College of Medical Sciences (Delhi University) and Guru Teg Bahadur Hospital, Dilshad Gardens, India
| | - Shuchi Bhatt
- Department of Radiology, University College of Medical Sciences (Delhi University) and Guru Teg Bahadur Hospital, Dilshad Gardens, India
| | - Rajesh Rawal
- Department of Radiology, University College of Medical Sciences (Delhi University) and Guru Teg Bahadur Hospital, Dilshad Gardens, India
| | - Anupama Tandon
- Department of Radiology, University College of Medical Sciences (Delhi University) and Guru Teg Bahadur Hospital, Dilshad Gardens, India
| | - Neha Meena
- Department of Radiology, University College of Medical Sciences (Delhi University) and Guru Teg Bahadur Hospital, Dilshad Gardens, India
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27
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Batur A, Polat V, Ozgokce M, Alpaslan M, Yavuz A, Arslan H, Bora A, Sakarya ME. Pulsatility Index of Popliteal Artery in Patients with Isolated Calf Vein Thrombosis: A Novel Technique for Detecting Thrombosis. Pol J Radiol 2017; 82:161-164. [PMID: 28392853 PMCID: PMC5375175 DOI: 10.12659/pjr.899949] [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: 06/07/2016] [Accepted: 08/09/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To investigate the usefulness of popliteal artery spectral doppler findings as a complimentary approach to isolated calf vein thrombosis (DVT). MATERIAL/METHODS We included consecutive patients presenting with symptomatic and sonographically proven acute isolated calf DVT. Patients with thrombosis of any other vein were excluded. We classified calf vein into into four main types. We investigated how many of these four vessels had DVT and compared them with respect to the pulsatility index (PI) value of the popliteal artery. RESULTS We evaluated spectral doppler characteristics of the popliteal artery on the same side as the isolated calf vein thrombosis as well as on the opposite side. The relationship between PI values of the popliteal artery and the number of thrombosed calf veins was investigated. In patients with 1 and/or 2 thrombosed veins, the mean PI was 6.03±0.54 on the side of cDVT and 5.68±0.39 on the opposite side (p=0.008), respectively. Inpatients with 3 and/or 4 thrombosed veins, the mean PI was 8.05±0.61 on the side of cDVT and 6.34±0.47 on the opposite side (p=0.001), respectively. CONCLUSIONS Venous doppler sonography for the evaluation of calf DVT may be limited by patient characteristics such as obesity, edema, and tenderness., Arterial PI can be used as a complimentary technique for the detection of venous thrombosis in such of cases.
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Affiliation(s)
- Abdussamet Batur
- Department of Radiology, Yuzuncuyil University, Dursun Odabas Medical Center, Van, Turkey
| | - Vural Polat
- Department of Cardiovascular Surgery, Yuzuncuyil University, Dursun Odabas Medical Center, Van, Turkey
| | - Mesut Ozgokce
- Department of Radiology, Yuzuncuyil University, Dursun Odabas Medical Center, Van, Turkey
| | - Muhammed Alpaslan
- Department of Radiology, Yuzuncuyil University, Dursun Odabas Medical Center, Van, Turkey
| | - Alpaslan Yavuz
- Department of Radiology, Yuzuncuyil University, Dursun Odabas Medical Center, Van, Turkey
| | - Harun Arslan
- Department of Radiology, Yuzuncuyil University, Dursun Odabas Medical Center, Van, Turkey
| | - Aydin Bora
- Department of Radiology, Yuzuncuyil University, Dursun Odabas Medical Center, Van, Turkey
| | - Mehmet Emin Sakarya
- Department of Radiology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
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28
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Kim IS, Jo WM. The Role of Pharmacomechanical Endovascular Intervention for Iliofemoral Vein Thrombosis Compared to Conventional Anticoagulation Therapy. J Korean Med Sci 2017; 32:47-53. [PMID: 27914131 PMCID: PMC5143298 DOI: 10.3346/jkms.2017.32.1.47] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 09/14/2016] [Indexed: 12/25/2022] Open
Abstract
Although anticoagulation therapy is the primary treatment for deep vein thrombosis (DVT), it has not been associated with the rapid recanalization of the venous occlusion. Moreover, it is associated with long-term disability due to post-thrombotic syndrome (PTS). In contrast, pharmacomechanical endovascular intervention (PMI) results in more rapid clinical improvement in DVT patients, but there are few reports on its long-term outcomes. This retrospective study evaluated the clinical effectiveness of PMI compared to conventional anticoagulation therapy (ACA) for acute and subacute iliofemoral DVT. We reviewed the medical records of 102 patients with iliofemoral DVT. A total of 46 patients for ACA and 56 patients for PMI were enrolled. We analyzed the clinical differences between the PMI and ACA groups by comparing the clinical signs, residual DVT free-rate, and PTS-free rate. There were no statistically significant differences in the demographic characteristics and risk factors except age between the groups (age: ACA, 52.0 ± 18.0 years; PMI, 59.0 ± 17.0 years; P = 0.035). The 1-, 3-, and 5-year residual DVT-free rate (ACA = 84.7%, 71.6%, and 46.0%; PMI = 82.1%, 76.8%, and 76.8%, respectively; P = 0.235) was not significantly different. However, the 1-, 3-, and 5-year PTS-free rate was significantly different (ACA = 93.5%, 74.0%, and 55.7%; PMI = 92.9%, 90.0%, and 90.0%, respectively; P = 0.019). There was no significant difference in the rate of other complications. PMI showed a lower incidence of PTS during the follow-up period. Therefore, PMI should be considered as an effective therapeutic modality for patients with iliofemoral DVT.
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Affiliation(s)
- In Sub Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Won Min Jo
- Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Ansan, Korea.
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29
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Park J, Lee JM, Lee JS, Cho YJ. Pharmacological and Mechanical Thromboprophylaxis in Critically Ill Patients: a Network Meta-Analysis of 12 Trials. J Korean Med Sci 2016; 31:1828-1837. [PMID: 27709864 PMCID: PMC5056218 DOI: 10.3346/jkms.2016.31.11.1828] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 08/12/2016] [Indexed: 01/23/2023] Open
Abstract
Thromboprophylaxis for venous thromboembolism is widely used in critically ill patients. However, only limited evidence exists regarding the efficacy and safety of the various thromboprophylaxis techniques, especially mechanical thromboprophylaxis. Therefore, we performed meta-analysis of randomized controlled trials (RCTs) that compared the overall incidence of deep vein thrombosis (DVT) for between unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), and intermittent pneumatic compression (IPC) in critically ill patients. A Bayesian random effects model for multiple treatment comparisons was constructed. The primary outcome measure was the overall incidence of DVT at the longest follow-up. The secondary outcome measure was the incidence of major bleeding, as defined by the original trials. Our analysis included 8,622 patients from 12 RCTs. The incidence of DVT was significantly lower in patients treated with UFH (OR, 0.45; 95% CrI, 0.22-0.83) or LMWH (OR, 0.38; 95% CrI, 0.18-0.72) than in patients in the control group. IPC was associated with a reduced incidence of DVT compared to the control group, but the effect was not statistically significant (OR, 0.50; 95% CrI, 0.20-1.23). The risk of DVT was similar for patients treated with UFH and LMWH (OR, 1.16; 95% CrI, 0.68-2.11). The risk of major bleeding was similar between the treatment groups in medical critically ill patients and also in critically ill patients with a high risk of bleeding. In critically ill patients, the efficacy of mechanical thromboprophylaxis in reducing the risk of DVT is not as robust as those of pharmacological thromboprophylaxis.
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Affiliation(s)
- Jonghanne Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea
| | - Jeong Seok Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. ,
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Soleimani M, Mohammadi R, Masoumi N, Safarinejad MR. Supradiaphragmatic Inferior Vena Caval Thrombectomy Without Cardiopulmonary Bypass: A Case Series at a Single Center. Nephrourol Mon 2016; 8:e39726. [PMID: 27878115 PMCID: PMC5111170 DOI: 10.5812/numonthly.39726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/05/2016] [Accepted: 06/18/2016] [Indexed: 12/24/2022] Open
Abstract
Introduction Inferior vena cava tumor thrombectomy in renal cell carcinoma patients is a challenging procedure, frequently requiring the vascular bypass technique for high-level thrombi with additional complications. Adopting a technique such as intrapericardial control in selected cases will circumvent these problems. Here, we present the results of our intrapericardial control technique during supradiaphragmatic inferior vena caval tumor thrombectomy. Case Presentation The records of six patients with supradiaphragmatic tumor thrombi, who underwent radical nephrectomy and thrombectomy at our center with intrapericardial control between the years 2008 and 2015, were retrospectively reviewed. The patients’ characteristics, intra- and postoperative data, histology, and follow-up records were gathered and compared. There were no immediate or 30-day postoperative deaths. The mean age of the patients was 61.3 years (range 46 - 75). The total mean duration of surgery was 315 minutes and the mean amount of transfused red blood cells was 4.33 units during surgery and 0.8 units in the postoperative period. The average hospitalization duration was 8 days (range 5 - 17). Tumor stage was T3 in four patients and T4 in two, due to ipsilateral adrenal involvement. The mean duration of follow-up was 33.5 months. Only one of the patients developed recurrences, first in the tumor bed and then at the site of the skin incision; these were excised with no apparent complications. Conclusions Radical nephrectomy and tumor thrombectomy by intrapericardial control without cardiopulmonary bypass and hypothermic circulatory arrest is a safe and effective procedure that can avoid serious intra- and postoperative complications while providing acceptable cancer-control and mortality results.
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Affiliation(s)
- Mohammad Soleimani
- Department of Urology, Shahid Modarres Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Reza Mohammadi
- Department of Urology, Shahid Modarres Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Navid Masoumi
- Department of Urology, Shahid Modarres Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Navid Masoumi, Department of Urology, Shahid Modarres Hospital, Shahid Beheshti Medical University, Postal Code: 1998734383, Tehran, IR Iran. Tel: +98-2122074087-98, Fax: +98-2122074101, E-mail:
| | - Mohammad Reza Safarinejad
- Clinical Center for Urological Disease Diagnosis and Private Clinic Specializing in Urological and Andrological Genetics, Tehran, IR Iran
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Marcy PY, Thariat J, Chevenet C, Lacout A. Jugular Vein Invasion Diagnosis and Prognosis in Thyroid Carcinomas. Pol J Radiol 2016; 81:268-9. [PMID: 27354880 PMCID: PMC4907401 DOI: 10.12659/pjr.896757] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 11/25/2015] [Indexed: 01/05/2023] Open
Abstract
Diagnosis of venous jugular invasion by means of traditional imaging is very rarely reported in the literature. Doppler ultrasound definitively helps to diagnose the tumor thrombus, the extent, and helps in redefining the TNM stage of such an aggressive thyroid tumor.
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Affiliation(s)
- Pierre Yves Marcy
- Department of Radiodiagnostics, PolyClinique Les Fleurs, Ollioules, France
| | - Juliette Thariat
- Department of Oncology & Radiation Therapy, Antoine Lacassagne Cancer Research Institute, Nice, France
| | - Carole Chevenet
- Department of Histopathology, Centre de Pathologie, Aurillac, France
| | - Alexis Lacout
- Department of Radiodiagnostics, Surgical Medical Center de Tronquières (CMC) Aurillac, Aurillac, France
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Placci A, Mattioli M, Notarangelo MF, Gonzi G, Zardini M. Internal Jugular Vein Complete Thrombosis After Dual Chamber Pacemaker Implant. J Atr Fibrillation 2016; 9:1406. [PMID: 27909511 PMCID: PMC5089505 DOI: 10.4022/jafib.1406] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 04/28/2016] [Accepted: 05/30/2016] [Indexed: 06/06/2023]
Abstract
Venous thrombosis after pacemaker implant is a known, although often underrecognized condition that can challenge system revision or upgrading, leading occasionally to thromboembolic complications. Several factors are considered to promote thrombus formation. Among them, alteration of blood flow mechanics due to the presence of catheters in the vessel lumen may itself play a pivotal role. Hereby we present the case of a 65-year old men who underwent a dual-chamber pacemaker implant in another institute for sick sinus syndrome by means of left cephalic venous access. About two months later he started experiencing neck swelling, pain and dysphagia. Six months later, ultrasonography and CT-scan revealed complete jugular vein thrombosis caused by a lead loop at the level of the left subclavian vein. Of note, thrombosis occurred despite proper oral anticoagulation with warfarin undertaken for coexisting atrial fibrillation. It's important to keep in mind this possible complication of pacemaker implant to allow for early diagnosis and better treatment chances. This case report is an example of how proximal catheter displacement may promote thrombus formation, probably by affecting blood flow mechanics, even in spite of proper oral anticoagulation.
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Krzesiek E, Zaleska-Dorobisz U, Iwańczak B, Dorobisz AT. Deep Vein Thrombosis of the Left Lower Limb in a 12 Year-Old Female Child with Ulcerative Colitis - Case Report. Pol J Radiol 2016; 81:65-8. [PMID: 26966473 PMCID: PMC4763799 DOI: 10.12659/pjr.894529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/03/2015] [Accepted: 07/15/2015] [Indexed: 12/26/2022] Open
Abstract
Background Inflammatory bowel disease includes ulcerative colitis and Crohn’s disease. Case Report This case report presents a patient with ulcerative colitis, with thrombotic complication of the left common iliac vein that occurred at the age of 11, two years after diagnosis. After a year of anticoagulation and compression therapy, although exacerbations of underlying disease occurred in the first 6 months of treatment, there was no recurrence of deep venous thrombosis, partial recanalization within affected venous system has been achieved and the patient is remission of ulcerative colitis for the last six months. Conclusions In children, thromboembolic complications occur about 7 times less often than in adults, but increases in the case of hospitalized children. In children with IBD this complication can occur independently og disease activity even in patients with any other risk factors.
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Affiliation(s)
- Elżbieta Krzesiek
- Department of Pediatrics, Gastroenterologu and Nutrition, Medical University, Wrocław, Poland
| | | | | | - Andrzej T Dorobisz
- Department of Vascular, General and Transplant Surggery, Medical University, Wrocław, Poland
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Na YG, Fang R, Kim YH, Cho KJ, Kim TK. Clinical Performance of the 1st American Academy of Orthopaedic Surgeons Clinical Guideline on Prevention of Symptomatic Pulmonary Embolism after Total Knee Arthroplasty in Korean Patients. J Korean Med Sci 2015; 30:1865-73. [PMID: 26713064 PMCID: PMC4689833 DOI: 10.3346/jkms.2015.30.12.1865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 09/01/2015] [Indexed: 11/20/2022] Open
Abstract
We sought to document the clinical performance of the 1st American Academy of Orthopaedic Surgeons (AAOS) guideline on the prevention of symptomatic pulmonary embolism (PE) after total knee arthroplasty (TKA) in Korean patients, in terms of the proportions of the each risk-stratified group, efficacy and safety. Consecutive 328 patients underwent TKA were preoperatively assessed for the risks of PE and bleeding and categorized into 4 groups: 1) standard risk, 2) high risk for PE, 3) high risk for bleeding, and 4) high risks both for PE and bleeding. One of three options was administered according to the groups (aspirin in group 1 or 4; enoxaparin and following aspirin in group 2; antithrombotic stocking in group 3). Incidences of symptomatic deep vein thrombosis (DVT) and PE, and major or minor bleeding complications were evaluated. Majority of the patients (86%) were assessed to be with standard risks both for PE and bleeding. No patient experienced symptomatic DVT or PE and major bleeding. Eleven percent of the patients discontinued chemoprophylaxis because of bleeding-related wound complication. In conclusion, the 1st AAOS guideline functions successfully in Korean patients undergoing TKA in terms of prevention of symptomatic DVT and PE while avoiding major bleeding complications.
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Affiliation(s)
- Young Gon Na
- Joint Reconstruction Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Rui Fang
- Department of Orthopedic Surgery, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yeon Ho Kim
- Joint Reconstruction Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kwan Jae Cho
- Joint Reconstruction Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae Kyun Kim
- Joint Reconstruction Center, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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Walecki J, Mruk B, Nawrocka-Laskus E, Piliszek A, Przelaskowski A, Sklinda K. Neuroimaging of Cerebral Venous Thrombosis (CVT) - Old Dilemma and the New Diagnostic Methods. Pol J Radiol 2015; 80:368-73. [PMID: 26251677 PMCID: PMC4518840 DOI: 10.12659/pjr.894386] [Citation(s) in RCA: 18] [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: 04/15/2015] [Accepted: 04/26/2015] [Indexed: 02/02/2023] Open
Abstract
Background Cerebral venous thrombosis is a relatively uncommon neurologic disorder that is potentially reversible with prompt diagnosis and appropriate medical care. The pathogenesis is multifactorial and the disease may occur at any age. CVT is often associated with nonspecific symptoms. Radiologists play a crucial role in patient care by providing early diagnosis through interpretation of imaging studies. Underdiagnosis or misdiagnosis can increase the risk of severe complications, including hemorrhagic stroke or death. The purpose of this study is to investigate radiological and clinical characteristics of cerebral venous thrombosis (CVT) based on material from 34 patients under care of our hospital. Material/Methods A total of 34 patients were diagnosed with CVT from August 2009 until March 2015. A clinical and radiological database of patients with final diagnosis of CVT was analyzed. Results Patient group included 22 women and 12 men at a mean age of 48.7 years (ranging from 27 to 77 years). In the study group 8 patients (23.5%) suffered from hemorrhagic infarction, whereas 16 patients (47%) were diagnosed with venous infarction without hemorrhage. Thirty patients (88%) had transverse sinus thrombosis. Conclusions According to our study, CVT was more prevalent in women. Transverse sinus was the most common location. Among all age groups, the highest prevalence was seen in the fifth decade (n=14). Contrast-enhanced CT and MR venography were the most sensitive imaging modalities.
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Affiliation(s)
- Jerzy Walecki
- Department of Radiology and Diagnostic Imaging, Medical Center of Postgraduate Education, Warsaw, Poland
| | - Bartosz Mruk
- Department of Radiology and Diagnostic Imaging, Medical Center of Postgraduate Education, Warsaw, Poland
| | - Ewa Nawrocka-Laskus
- Department of Radiology and Diagnostic Imaging, Medical Center of Postgraduate Education, Warsaw, Poland
| | - Agnieszka Piliszek
- Department of Radiology and Diagnostic Imaging, Medical Center of Postgraduate Education, Warsaw, Poland
| | - Artur Przelaskowski
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Katarzyna Sklinda
- Department of Radiology and Diagnostic Imaging, Medical Center of Postgraduate Education, Warsaw, Poland
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Ashrani AA, Barsoum MK, Crusan DJ, Petterson TM, Bailey KR, Heit JA. Is lipid lowering therapy an independent risk factor for venous thromboembolism? A population-based case-control study. Thromb Res 2015; 135:1110-6. [PMID: 25891841 DOI: 10.1016/j.thromres.2015.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 04/01/2015] [Accepted: 04/06/2015] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The independent effect of lipid lowering therapy (LLT) on venous thromboembolism (VTE) risk is uncertain. OBJECTIVE To test statin and non-statin LLT as potential VTE risk factors. METHODS Using Rochester Epidemiology Project resources, we identified all Olmsted County, MN residents with objectively diagnosed incident VTE (cases) over the 13-year period, 1988-2000 (n=1340), and one to two matched controls (n=1538). We reviewed their complete medical records for baseline characteristics previously identified as independent VTE risk factors, and for statin and non-statin LLT. Using conditional logistic regression, we tested the overall effect of LLT on VTE risk and also separately explored the role of statin versus that of non-statin LLT, adjusting for other baseline characteristics. RESULTS Among cases and controls, 74 and 111 received statin LLT, and 32 and 50 received non-statin LLT, respectively. Univariately, and after individually controlling for other potential VTE risk factors (i.e., BMI, trauma/fracture, leg paresis, hospitalization for surgery or medical illness, nursing home residence, active cancer, central venous catheter, varicose veins, prior superficial vein thrombosis, diabetes, congestive heart failure, angina/myocardial infarction, stroke, peripheral vascular disease, smoking, anticoagulation), LLT was associated with decreased odds of VTE (unadjusted OR=0.73; p=0.03). When considered separately, statin and non-statin LLT were each associated with moderate, non-significant lower odds of VTE. After adjusting for angina/myocardial infarction, each was significantly associated with decreased odds of VTE (OR=0.63, p<0.01 and OR=0.61, p=0.04, respectively). CONCLUSIONS LLT is associated with decreased VTE risk after adjusting for known risk factors.
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Affiliation(s)
- Aneel A Ashrani
- Division of Hematology, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, United States.
| | - Michel K Barsoum
- Division of Cardiovascular Diseases, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Daniel J Crusan
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Tanya M Petterson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Kent R Bailey
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, United States
| | - John A Heit
- Division of Hematology, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, United States; Division of Cardiovascular Diseases, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, United States; Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, United States
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Gu KM, Shin JW, Park IW. A case of antiphospholipid syndrome refractory to secondary anticoagulating prophylaxis after deep vein thrombosis-pulmonary embolism. Tuberc Respir Dis (Seoul) 2015; 77:274-8. [PMID: 25580146 PMCID: PMC4286787 DOI: 10.4046/trd.2014.77.6.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/03/2014] [Revised: 12/10/2014] [Accepted: 12/10/2014] [Indexed: 12/05/2022] Open
Abstract
Antiphospholipid syndrome (APS) is an acquired systemic autoimmune disorder characterized by a combination of clinical criteria, including vascular thrombosis or pregnancy morbidity and elevated antiphospholipid antibody titers. It is one of the causes of deep vein thrombosis and pulmonary embolism that can be critical due to the mortality risk. Overall recurrence of thromboembolism is very low with adequate anticoagulation prophylaxis. The most effective treatment to prevent recurrent thrombosis is long-term anticoagulation. We report on a 17-year-old male with APS, who manifested blue toe syndrome, deep vein thrombosis, pulmonary thromboembolism, and cerebral infarction despite adequate long-term anticoagulation therapy.
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Affiliation(s)
- Kang Mo Gu
- Division of Allergy and Pulmonary Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jong Wook Shin
- Division of Allergy and Pulmonary Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - In Won Park
- Division of Allergy and Pulmonary Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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38
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Roepke RML, de Campos FPF, Lovisolo SM, Santos EHS. Septic pelvic thrombophlebitis of unknown origin: an ever threatening entity. Autops Case Rep 2014; 4:39-46. [PMID: 28573117 PMCID: PMC5444397 DOI: 10.4322/acr.2014.027] [Citation(s) in RCA: 3] [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: 07/16/2014] [Accepted: 09/10/2014] [Indexed: 11/23/2022] Open
Abstract
Septic pelvic thrombophlebitis (SPT) is a rare and severe entity, which may occur after abortion, delivery, gynecological diseases, or surgeries. Diagnosis is challenging when no risk factor is clearly present, since clinically, symptoms are non-specific. Nowadays, with the aid of imaging methods, diagnosis has become more achievable, but the treatment still bears some uncertainties. The authors present a fatal case of SPT in a young woman who sought medical care already presenting signs of septic shock, referring fever and non-characteristic abdominal pain. The patient evolved rapidly to multiple organ failure and respiratory distress, which was also due to septic pulmonary embolism. The autopsy confirmed the computed tomographic findings of a right ovarian vein septic thrombophlebitis and multiple septic pulmonary embolization foci. The patient did not present any of the recognized risk factors; neither did she present signs of pelvic inflammatory disease on admission or at autopsy. However, an intrauterine device was present. The authors call attention to this entity in the differential diagnosis of a woman with fever and abdominal pain, as well as for an empiric broad-spectrum antibiotic regimen in these cases.
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Affiliation(s)
- Roberta Muriel Longo Roepke
- Department of Internal Medicine - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | | | - Silvana Maria Lovisolo
- Anatomic Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
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Lee JM, Lim JH, Kim JS, Park JS, Memon A, Lee SK, Nam HS, Cho JH, Kwak SM, Lee HL, Kim HJ, Hong GJ, Ryu JS. Multiple hypercoagulability disorders at presentation of non-small-cell lung cancer. Tuberc Respir Dis (Seoul) 2014; 77:34-7. [PMID: 25114702 PMCID: PMC4127411 DOI: 10.4046/trd.2014.77.1.34] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 12/18/2013] [Revised: 03/18/2014] [Accepted: 04/18/2014] [Indexed: 11/24/2022] Open
Abstract
Hypercoagulability disorders are commonly encountered in clinical situations in patients with a variety of cancers. However, several hypercoagulability disorders presenting as first symptoms or signs in cancer patients have rarely been reported. We herein described a case of a woman with adenocarcinoma of the lung presenting with deep vein thrombosis, nonbacterial thrombotic endocarditis, recurrent cerebral embolic infarction, and heart failure.
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Affiliation(s)
- Jeong Min Lee
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Jun Hyeok Lim
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Jung-Soo Kim
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Ji Sun Park
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Azra Memon
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Seul-Ki Lee
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Hae-Seong Nam
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Jae-Hwa Cho
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Seung-Min Kwak
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Hong Lyeol Lee
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Hyun-Jung Kim
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Geun-Jeong Hong
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Jeong-Seon Ryu
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
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Lim SY, Jeon K, Kim HJ, Kim SM, Song J, Ha JM, Um SW, Koh WJ, Chung MP, Kim H, Kwon OJ, Suh GY. Antifactor Xa levels in critically ill Korean patients receiving enoxaparin for thromboprophylaxis: a prospective observational study. J Korean Med Sci 2013; 28:466-71. [PMID: 23487580 PMCID: PMC3594613 DOI: 10.3346/jkms.2013.28.3.466] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 01/04/2013] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to investigate antifactor Xa (aFXa) levels after once daily dose of 40 mg of enoxaparin and to evaluate factors influencing aFXa levels among Korean intensive care unit (ICU) patients. This prospective observational study was conducted between August and December 2011 in medical ICUs at Samsung Medical Center. AFXa levels between 0.1 and 0.3 U/mL were considered to be effective for antithrombotic activity. Fifty-five patients were included. The median aFXa levels were 0.22 (IQR 0.17-0.26) at 4 hr, 0.06 (IQR 0.02-0.1) at 12 hr, and 0 U/mL (IQR 0-0.03) at 24 hr. The numbers of patients showing effective antithrombotic aFXa levels were 48 (87.3%), 18 (32.7%), and 0 (0%) at 4, 12 and 24 hr, respectively. At 12 hr, higher sequential organ failure assessment (SOFA) scores and hyperbilirubinemia were significantly associated with low aFXa levels (OR, 0.58; 95% CI, 0.36-0.93; P = 0.02 and 0.06; 0.003-0.87; 0.04, respectively). Once daily dose of 40 mg of enoxaparin is inadequate for maintaining effective antithrombotic aFXa levels, and the inadequacy is more salient for patients with high SOFA scores and hyperbilirubinemia.
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Affiliation(s)
- So Yeon Lim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee-Jin Kim
- Department of Laboratory Medicine & Genetics, Seoul, Korea
| | - Seon Mi Kim
- Medical Intensive Care Unit, Samsung Medical Center, Seoul, Korea
| | - Junwhi Song
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jung Min Ha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Man Pyo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - O Jung Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gee Young Suh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Manafi Rasi A, Kazemian G, Emami Moghadam M, Tavakoli Larestani R, Fallahi A, Nemati A, Nazari M, Fallahi F, Safari S. Deep vein thrombosis following below knee immobilization: the need for chemoprophylaxis. Trauma Mon 2013; 17:367-9. [PMID: 24350128 PMCID: PMC3860667 DOI: 10.5812/traumamon.9158] [Citation(s) in RCA: 11] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 12/29/2012] [Accepted: 12/29/2012] [Indexed: 11/29/2022] Open
Abstract
Background There is controversy regarding routine prophylaxis for deep vein thrombosis (DVT) in patients treated via a short leg cast or splint following lower extremity trauma. Objectives The main aim of this study is to evaluate the incidence of DVT and need for chemoprophylaxis in these patients. Materials and Methods Patients with ankle sprains or stable foot/ankle fractures were entered in this cross-sectional study. Serum D-dimer levels were measured 2 weeks following fixation. If the D-dimer levels were above 0.2 micrograms/ml the test was considered positive and the patient was referred for Doppler ultrasound examination (DUE) to confirm or rule out the diagnosis of DVT. Finally, the incidence of DVT was calculated and the role of predisposing factors was investigated. Results There were 95 patients with an average age of 38 ± 13.7 (77.9% males); 46 patients had at least one risk factor for DVT. The D-dimer test was positive in 21(22.1%) patients. DVT was confirmed by DUE in 3 patients (3.1%). The incidence of DVT significantly increased in the presence of 3 or more risk factors (P = 0.01). Conclusions It seems that DVT is not a common complication of below knee fixation and chemoprophylaxis is not necessary when the patient has less than 3 predisposing factors. With 3 or more risk factors chemoprophylaxis and periodic follow-ups must be considered.
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Affiliation(s)
- Alireza Manafi Rasi
- Department of Orthopedic and Trauma Surgery, Shahid Beheshti University of Medical Sciences, Imam Hossein Hospital, Tehran, IR Iran
| | - Gholamhossein Kazemian
- Department of Orthopedic and Trauma Surgery, Shahid Beheshti University of Medical Sciences, Imam Hossein Hospital, Tehran, IR Iran
| | - Mohammad Emami Moghadam
- Department of Orthopedic and Trauma Surgery, Shahid Beheshti University of Medical Sciences, Imam Hossein Hospital, Tehran, IR Iran
| | - Reza Tavakoli Larestani
- Department of Orthopedic and Trauma Surgery, Shahid Beheshti University of Medical Sciences, Imam Hossein Hospital, Tehran, IR Iran
| | - Amirhossein Fallahi
- Department of Orthopedic and Trauma Surgery, Shahid Beheshti University of Medical Sciences, Imam Hossein Hospital, Tehran, IR Iran
- Corresponding author: Amirhossein Fallahi, Department of Orthopedic and Trauma Surgery, Shahid Beheshti University of Medical Sciences, Imam Hossein Hospital, Shahid Madani Avenue, P.O. box: 1617763141, Tehran, IR Iran. Tel.: +98-9102122979, Fax: +98-2177583625, E-mail:
| | - Ali Nemati
- Department of Orthopedic and Trauma Surgery, Shahid Beheshti University of Medical Sciences, Imam Hossein Hospital, Tehran, IR Iran
| | - Maryam Nazari
- Department of Physical Medicine and Rehabilitation, Tehran University of Medical Sciences, Firuzgar Hospital, Tehran, IR Iran
| | - Fateme Fallahi
- Kashan Nursing and Midwifery College, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Saeed Safari
- Department of Emergency Medicine, Shahid Beheshti University of Medical Sciences, Imam Hossein Hospital, Tehran, IR Iran
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Abstract
Since the late 1980s, low dose aspirin has been used to prevent stroke and ischemic heart disease. However, prophylactic effect of antiplatelets against venous thromboembolism (VTE), in patients who undergo hip fracture surgery (HFS) is controversial. Our purpose was to determine the incidence of symptomatic VTE after HFS and to evaluate whether antiplatelets reduce the development of symptomatic VTE following HFS. We retrospectively reviewed 858 HFS in 824 consecutive patients which were performed from May 2003 to April 2010 at an East Asian institute. We compared the incidence of symptomatic VTE in antiplatelet users and non-users using multivariate logistic regression analyses. Overall incidences of symptomatic pulmonary embolism including fatal pulmonary embolism, and symptomatic deep vein thrombosis in this study were 2.4% (21/858), and 3.5% (30/858), respectively. The incidence of symptomatic VTE was 4.8% (12/250) in antiplatelet users and 4.3% (26/608) in non-users (P = 0.718). It is suggested that antiplatelet agents are not effective in prevention of symptomatic VTE after HFS.
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Affiliation(s)
- Hyung-Min Ji
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ki-Choul Kim
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Vyas S, Das PJ, Gupta SK, Kakkar N, Khandelwal N. Superior and inferior ophthalmic veins thrombosis with cavernous sinus meningioma. Middle East Afr J Ophthalmol 2011; 18:256-8. [PMID: 21887086 PMCID: PMC3162743 DOI: 10.4103/0974-9233.84066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ophthalmic vein thrombosis is an extremely rare entity. We present a case of middle-aged female who presented with proptosis. Contrast-enhanced computed tomography and magnetic resonance imaging showed cavernous sinus meningioma with ipsilateral superior and inferior vein thrombosis. A brief review of the vascular involvement of the meningioma and ophthalmic vein thrombosis is presented along with the case.
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Affiliation(s)
- Sameer Vyas
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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44
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Sadeghi R, Safi M. Systemic thrombolysis in the upper extremity deep vein thrombosis. ARYA Atheroscler 2011; 7:40-6. [PMID: 22577443 PMCID: PMC3347843] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 05/03/2011] [Indexed: 11/04/2022]
Abstract
Almost 4% of all patients with venous thrombosis have upper extremity deep vein thrombosis (UEDVT) and the incidence of UEDVT increases over time. The frequency of post-thrombotic syndrome (PTS) after UEDVT is not low and upper extremity PTS is a potentially major morbidity that adversely affects quality of life, particularly if the dominant arm is involved. We discuss briefly the role of thrombolytic therapy in the treatment of upper extremity deep vein thrombosis and also the role of systemic thrombolysis in selected patients.
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Affiliation(s)
- Roxana Sadeghi
- Assistant Professor of Cardiology, Cardiovascular Research Center, Department of Internal Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences (SUMS), Tehran, Iran
| | - Morteza Safi
- Assistant Professor of Cardiology, Cardiovascular Research Center, Department of Internal Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences (SUMS), Tehran, Iran
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