Does venous thromboembolism prophylaxis affect the risk of venous thromboembolism and adverse events following primary hip and knee replacement? A retrospective cohort study

Background

The optimum chemical venous thromboembolism (VTE) prophylactic agents following total hip and knee replacement (THR and TKR) remain unknown. NICE recommends multiple agents, including direct oral anticoagulants (DOACs), low-molecular weight heparin (LMWH), and aspirin. We assessed whether VTE prophylaxis affected the risk of VTE and adverse events following primary THR and TKR.

Materials and methods

We reviewed 982 elective primary THRs (59%) and TKRs (41%) at a large tertiary centre during 2018. The primary outcome was any VTE (DVT and/or PE) within 90-days. Secondary outcomes were adverse events within 90-days (major bleeding and wound complications). The association between VTE prophylaxis and outcomes was assessed.

Results

The overall prevalence of VTE and adverse events were 2.7% (n = 27) and 15.2% (n = 136) respectively. The most common agents used were DOAC ± LMWH (50.7%, n = 498), followed by aspirin ± LMWH (35.5%, n = 349) and LMWH alone (4.7%, n = 46). The risk of VTE (aspirin ± LMWH = 3.7%, DOAC = 2.0%, LMWH = 2.2%) was not significantly different between agents (p = 0.294). The risk of any adverse event was significantly higher (p < 0.001) with aspirin ± LMWH (16.1%; n = 56) and LMWH (28.3%; n = 13) compared with DOACs ± LMWH (7.0%; n = 35) in TKRs only, there was no differences between agents for adverse events in THRs (p = 0.644).

Conclusions

Choice of thromboprophylaxis did not influence the risk of VTE following primary THR and TKR. DOACs (+/- LMWH) were associated with the lowest risk of adverse events. Large multicentre trials are still needed to assess the efficacy and safety of these agents following THR and TKR.

A well-being programme in severe mental illness. Baseline findings in a UK cohort

INTRODUCTION

Patients with severe mental illness (SMI) have higher rates of cardiovascular disease (CVD) morbidity and mortality than the general population. In the UK, data were limited regarding the known prevalence of physical health screening of SMI patients.

AIMS

A total of 966 patients with SMI from seven geographically varied regions in the UK agreed to participate in a 2-year nurse-led intervention (Well-being Support Programme), designed to improve their overall physical health by providing basic physical health checks, health promotion advice, weight management and physical activity groups in secondary care.

RESULTS

At baseline, only 31% of participants had undergone a recent physical health check. There were high rates of obesity (BMI > 30 in 49%), glucose abnormalities (12.4%), hypertension/prehypertension (50%), hyperlipidaemia (71%), poor diet (32%), low exercise levels (37.4%) and smoking (50%).

CONCLUSIONS

Patients with SMI where healthcare professionals have concerns regarding their physical health, have potentially modifiable risk factors for CVD, which remain undiagnosed. Programmes designed to address the physical health problems in SMI need to be implemented and evaluated in this already marginalised group of people.

The rubble-pile asteroid Itokawa as observed by Hayabusa

During the interval from September through early December 2005, the Hayabusa spacecraft was in close proximity to near-Earth asteroid 25143 Itokawa, and a variety of data were taken on its shape, mass, and surface topography as well as its mineralogic and elemental abundances. The asteroid's orthogonal axes are 535, 294, and 209 meters, the mass is 3.51 x 10(10) kilograms, and the estimated bulk density is 1.9 +/- 0.13 grams per cubic centimeter. The correspondence between the smooth areas on the surface (Muses Sea and Sagamihara) and the gravitationally low regions suggests mass movement and an effective resurfacing process by impact jolting. Itokawa is considered to be a rubble-pile body because of its low bulk density, high porosity, boulder-rich appearance, and shape. The existence of very large boulders and pillars suggests an early collisional breakup of a preexisting parent asteroid followed by a re-agglomeration into a rubble-pile object.

Exposed Water Ice Deposits on the Surface of Comet 9P/Tempel 1

We report the direct detection of solid water ice deposits exposed on the surface of comet 9P/Tempel 1, as observed by the Deep Impact mission. Three anomalously colored areas are shown to include water ice on the basis of their near-infrared spectra, which include diagnostic water ice absorptions at wavelengths of 1.5 and 2.0 micrometers. These absorptions are well modeled as a mixture of nearby non-ice regions and 3 to 6% water ice particles 10 to 50 micrometers in diameter. These particle sizes are larger than those ejected during the impact experiment, which suggests that the surface deposits are loose aggregates. The total area of exposed water ice is substantially less than that required to support the observed ambient outgassing from the comet, which likely has additional source regions below the surface.

Deep Impact: Excavating Comet Tempel 1

Deep Impact collided with comet Tempel 1, excavating a crater controlled by gravity. The comet's outer layer is composed of 1- to 100-micrometer fine particles with negligible strength (<65 pascals). Local gravitational field and average nucleus density (600 kilograms per cubic meter) are estimated from ejecta fallback. Initial ejecta were hot (>1000 kelvins). A large increase in organic material occurred during and after the event, with smaller changes in carbon dioxide relative to water. On approach, the spacecraft observed frequent natural outbursts, a mean radius of 3.0 +/- 0.1 kilometers, smooth and rough terrain, scarps, and impact craters. A thermal map indicates a surface in equilibrium with sunlight.

Asteroid 1950 DA's encounter with Earth in 2880: physical limits of collision probability prediction

Integration of the orbit of asteroid (29075) 1950 DA, which is based on radar and optical measurements spanning 51 years, reveals a 20-minute interval in March 2880 when there could be a nonnegligible probability of the 1-kilometer object colliding with Earth. Trajectory knowledge remains accurate until then because of extensive astrometric data, an inclined orbit geometry that reduces in-plane perturbations, and an orbit uncertainty space modulated by gravitational resonance. The approach distance uncertainty in 2880 is determined primarily by uncertainty in the accelerations arising from thermal re-radiation of solar energy absorbed by the asteroid. Those accelerations depend on the spin axis, composition, and surface properties of the asteroid, so that refining the collision probability may require direct inspection by a spacecraft.

The landing of the NEAR-Shoemaker spacecraft on asteroid 433 Eros

The NEAR-Shoemaker spacecraft was designed to provide a comprehensive characterization of the S-type asteroid 433 Eros (refs 1,2,3), an irregularly shaped body with approximate dimensions of 34 x 13 x 13 km. Following the completion of its year-long investigation, the mission was terminated with a controlled descent to its surface, in order to provide extremely high resolution images. Here we report the results of the descent on 12 February 2001, during which 70 images were obtained. The landing area is marked by a paucity of small craters and an abundance of 'ejecta blocks'. The properties and distribution of ejecta blocks are discussed in a companion paper. The last sequence of images reveals a transition from the blocky surface to a smooth area, which we interpret as a 'pond'. Properties of the 'ponds' are discussed in a second companion paper. The closest image, from an altitude of 129 m, shows the interior of a 100-m-diameter crater at 1-cm resolution.

Imaging of small-scale features on 433 Eros from NEAR: evidence for a complex regolith

On 25 October 2000, the Near Earth Asteroid Rendevous (NEAR)-Shoemaker spacecraft executed a low-altitude flyover of asteroid 433 Eros, making it possible to image the surface at a resolution of about 1 meter per pixel. The images reveal an evolved surface distinguished by an abundance of ejecta blocks, a dearth of small craters, and smooth material infilling some topographic lows. The subdued appearance of craters of different diameters and the variety of blocks and different degrees of their burial suggest that ejecta from several impact events blanketed the region imaged at closest approach and led to the building up of a substantial and complex regolith consisting of fine materials and abundant meter-sized blocks.

The neurochemical basis for the applications of the greater omentum in neurosurgery

The omentum has been utilized in neurosurgery for over 30 years. However, the anatomical and physiological bases for its applications have not been described in great detail. In this paper, we will review the current status of the omentum applications for the management of central nervous system disorders.

Radio science results during the NEAR-shoemaker spacecraft rendezvous with eros

We determined the mass of asteroid 433 Eros, its lower order gravitational harmonics, and rotation state, using ground-based Doppler and range tracking of the Near Earth Asteroid Rendezvous (NEAR)-Shoemaker spacecraft and images of the asteroid's surface landmarks. The mass of Eros is (6.687 +/- 0.003) x 10(18) grams, which, coupled with our volume estimate, implies a bulk density of 2. 67 +/- 0.03 grams per cubic centimeter. The asteroid appears to have a uniform density distribution. The right ascension and declination of the rotation pole are 11.37 +/- 0.05 and 17.22 +/- 0.05 degrees, respectively, and at least over the short term, the rotation state of Eros is stable with no measurable free precession of the spin pole. Escape velocities on the surface vary from 3.1 to 17.2 meters per second. The dynamical environment of Eros suggests that it is covered with regolith and that one might expect material transport toward the deepest potential wells in the saddle and 5.5-kilometer crater regions.

Radar observations of asteroid 216 kleopatra

Radar observations of the main-belt, M-class asteroid 216 Kleopatra reveal a dumbbell-shaped object with overall dimensions of 217 kilometers by 94 kilometers by 81 kilometers (+/-25%). The asteroid's surface properties are consistent with a regolith having a metallic composition and a porosity comparable to that of lunar soil. Kleopatra's shape is probably the outcome of an exotic sequence of collisional events, and much of its interior may have an unconsolidated rubble-pile structure.

Estimating the mass of asteroid 433 eros during the NEAR spacecraft flyby

The Near Earth Asteroid Rendezvous (NEAR) spacecraft flew within 3830 kilometers of asteroid 433 Eros on 23 December 1998. The gravitational perturbation on NEAR was evident in the spacecraft tracking data. Ground-based Doppler and range tracking of the spacecraft as well as spacecraft images of the asteroid's center of figure and surface features were used to determine the mass and rotation pole of Eros. The mass of Eros is (7.2 +/- 1.8) x 10(18) grams and, coupled with a volume estimate provided by the NEAR imaging team, this mass suggests a bulk density of 2.5 +/- 0.8 grams per cubic centimeter. The rotation pole position is 15.6 (+/-3.7) degrees in right ascension and 16.4 (+/-1.8) degrees in declination, which is consistent with ground-based and NEAR imaging team observations.

Radar and optical observations of asteroid 1998 KY26

Observations of near-Earth asteroid 1998 KY26 shortly after its discovery reveal a slightly elongated spheroid with a diameter of about 30 meters, a composition analogous to carbonaceous chondritic meteorites, and a rotation period of 10.7 minutes, which is an order of magnitude shorter than that measured for any other solar system object. The rotation is too rapid for 1998 KY26 to consist of multiple components bound together just by their mutual gravitational attraction. This monolithic object probably is a fragment derived from cratering or collisional destruction of a much larger asteroid.

Imaging of asteroid 433 eros during NEAR's flyby reconnaissance

During the 23 December 1998 flyby of asteroid 433 Eros, the Near-Earth Asteroid Rendezvous (NEAR) spacecraft obtained 222 images of Eros, as well as supporting spectral observations. The images cover slightly more than two-thirds of Eros (best resolution is approximately 400 meters per pixel) and reveal an elongated, cratered body with a linear feature extending for at least 20 kilometers. Our observations show that Eros has dimensions of 33 x 13 x 13 kilometers. The volume, combined with the mass determined by the NEAR radio science experiment, leads to a density of 2.5 +/- 0.8 grams per cubic centimeter. This relatively high density, and the presence of an extensive linear feature, suggest that Eros may be a structurally coherent body.

Estimating the mass of asteroid 253 mathilde from tracking data during the NEAR flyby

The terminal navigation of the Near Earth Asteroid Rendezvous (NEAR) spacecraft during its close flyby of asteroid 253 Mathilde involved coordinated efforts to determine the heliocentric orbits of the spacecraft and Mathilde and then to determine the relative trajectory of the spacecraft with respect to Mathilde. The gravitational perturbation of Mathilde on the passing spacecraft was apparent in the spacecraft tracking data. As a result of the accurate targeting achieved, these data could be used to determine Mathilde's mass as 1.033 (+/- 0.044) x 10(20) grams. Coupled with a volume estimate provided by the NEAR imaging team, this mass suggests a low bulk density for Mathilde of 1.3 grams per cubic centimeter.

Radar detection of the nucleus and coma of comet hyakutake

Radar observations of comet Hyakutake (C/1996 B2) made at the Goldstone Deep Space Communications Complex in California have detected echoes from the nucleus and from large grains in the inner coma. The nucleus of this bright comet was estimated to be only 2 to 3 kilometers in diameter. Models of the coma echo indicate backscatter from porous, centimeter-size grains ejected anisotropically at velocities of tens of meters per second. The radar observations suggest that a comet's activity may be a poor indicator of its size and provide evidence that large grains constitute an important component of the mass loss from a typical active comet.

Detection of soft X-rays and a sensitive search for noble gases in comet Hale-Bopp

An image of comet Hale-Bopp (C/1995 O1) in soft x-rays reveals a central emission offset from the nucleus, as well as an extended emission feature that does not correlate with the dust jets seen at optical wavelengths. Neon was found to be depleted in the cometary ice by more than a factor of 25 relative to solar abundance, which suggests that ices in Hale-Bopp formed at (or later experienced) temperatures higher than 25 kelvin. A helium line emission at a wavelength of 584 angstroms was detected and may be attributable to charge transfer of solar wind alpha particles in the cometary coma. Ionized oxygen and another helium line contribute to an emission observed at 538 angstroms.

Pass the Royal College examinations. MCQ technique

Trainee doctors can fail Royal College exams as a result of poor multiple choice question technique. On a negatively marked exam it is possible for candidate to know a subject well, answer 72% of the questions correctly, and yet still only obtain a mark of 44%. As a result, even some very good clinicians fail these exams.

The Royal College examinations: preparation and practice

Membership examinations are complex and difficult. Important practical issues must be considered at an early stage, and you can improve upon your chance of success by addressing your learning style, revision strategy and examination technique.

MRCPsych examination technique: the short answer question paper

Many candidates expect to pass the short answer question paper of the MRCPsych Part II examination using a straightforward regurgitation of facts. They are surprised by the need for good technique in order to do well in this paper.

Hubble Space Telescope Observations of Comet P/Shoemaker-Levy 9 (1993e)

The Hubble Space Telescope observed the fragmented comet P/Shoemaker-Levy 9 (1993e) (P indicates that it is a periodic comet) on 1 July 1993. Approximately 20 individual nuclei and their comae were observed in images taken with the Planetary Camera. After subtraction of the comae light, the 11 brightest nuclei have magnitudes between approximately 23.7 and 24.8. Assuming that the geometric albedo is 0.04, these magnitudes imply that the nuclear diameters are in the range approximately 2.5 to 4.3 kilometers. If the density of each nucleus is 1 gram per cubic centimeter, the total energy deposited by the impact of these 11 nuclei into Jupiter's atmosphere next July will be approximately 4 x 10(30) ergs ( approximately 10(8) megatons of TNT). This latter number should be regarded as an upper limit because the nuclear magnitudes probably contain a small residual coma contribution. The Faint Object Spectrograph was used to search for fluorescence from OH, which is usually an excellent indicator of cometary activity. No OH emission was detected, and this can be translated into an upper limit on the water production rate of approximately 2 x 10(27) molecules per second.

Radar Images of Asteroid 1989 PB

Radar observations of the near-Earth asteroid 1989 PB, made shortly after its optical discovery, yield a sequence of delay-Doppler images that reveal it to consist of two distinct lobes that appear to be in contact. It seems likely that the two lobes once were separate and that they collided to produce the current "contact-binary" configuration.

Radar Detection of Phobos

Radar echoes from the martian satellite Phobos provide information about that object's surface properties at scales near the 3.5-cm observing wavelength. Phobos appears less rough than the moon at centimeter-to-decimeter scales. The uppermost few decimeters of the satellite's regolith have a mean bulk density within 20% of 2.0 g cm(-3). The radar signature of Phobos (albedo, polarization ratio, and echo spectral shape) differs from signatures measured for small, Earth-approaching objects, but resembles those of large (>/=100-km), C-class, mainbelt asteroids.