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Wang X, Wang J, Zhang X, Zhang X, Li Q, Li W, Jiang J, Jiao Y, Zhang T. Trends of Hospital-Acquired Lower Extremity Deep Venous Thrombosis in an Academic Medical Center in China from 2007 to 2021. Ann Vasc Surg 2025; 115:3-12. [PMID: 39894071 DOI: 10.1016/j.avsg.2024.12.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 11/18/2024] [Accepted: 12/20/2024] [Indexed: 02/04/2025]
Abstract
BACKGROUND This study aimed to evaluate the demographic characteristics and changing trends in the incidence of hospital-acquired lower extremity deep venous thrombosis (HA-LEDVT) in Chinese inpatients over the course of 15 years. METHODS We performed a retrospective analysis of the HA-LEDVT events in a medical center between January 1, 2007, and December 31, 2021. RESULTS A total of 846,347 eligible patients were analyzed. The overall incidence of HA-LEDVT was 2.53 per 1,000 admissions. The incidence was 0.22 and 4.20 per 1,000 admissions in 2007 and 2017, respectively (P < 0.01). Medical patients had a higher incidence of HA-LEDVT than surgical patients (3.19 vs. 2.14 per 1,000 admissions; P < 0.01). The incidence of HA-LEDVT increased from 0.28 to 11.90 per 1,000 admissions for those aged 17-29 years and 80-89 years, respectively (P < 0.01). The increase in HA-LEDVT incidence mainly occurred in patients aged ≥60 years. The median length of stay of HA-LEDVT patients was longer than that of other eligible patients (17 vs. 7 days; P < 0.01). Most of the HA-LEDVT events (77.8%) were diagnosed between hospital day 3 and 15, and the time from admission to HA-LEDVT diagnosis decreased by year. The rate of vascular surgery consultation for diagnosed or suspected HA-LEDVT and HA-LEDVT-related discharge instructions both decreased by half gradually over the 15 years of this study. Isolated distal deep vein thrombosis (DVT) accounted for 83.3% of all HA-LEDVT events, and the proportion increased significantly from 62.5% in 2007 to 88.7% in 2021 (P < 0.01). CONCLUSION The incidence of HA-LEDVT has been high in the Chinese population. More high-quality prospective studies are needed to guide prevention of HA-LEDVTs.
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Affiliation(s)
- Xiao Wang
- Department of Vascular Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Jing Wang
- Department of Vascular Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Xiaoming Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Xuemin Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Qingle Li
- Department of Vascular Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Wei Li
- Department of Vascular Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Jingjun Jiang
- Department of Vascular Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Yang Jiao
- Department of Vascular Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Tao Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Peking University, Beijing, China.
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Osagiede O, Aldhaleei W, Raimondo M, Wallace MB, Bi Y, Lukens FJ. An Analysis of the Clinical Burden and Economic Costs of Venous Thromboembolism During Inpatient Admissions for Pancreatic Cancer in the United States. Am J Hosp Palliat Care 2025:10499091251341453. [PMID: 40343960 DOI: 10.1177/10499091251341453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2025] Open
Abstract
Objectives: VTE is a frequent complication of pancreatic cancer, but it is often under-reported. VTE is associated with a shorter overall survival and poor quality of life in ambulatory settings. This study aims to examine the clinical burden and costs of newly diagnosed VTE during inpatient admissions for pancreatic cancer. Methods: We conducted a retrospective study of 108,690 pancreatic cancers using the National Inpatient Sample (NIS) database (January 2016 - December 2020). Patient and hospital characteristics, mortality, discharge disposition, length of stay (LOS), hospital costs and charges were compared between pancreatic cancer patients based on VTE occurrence. Multivariate regression was used to evaluate patient outcomes associated with VTE occurrence. Results: A total number of 4520 (4.2%) patients had VTE. Patients with VTE were more likely to have a high comorbidity index ≥3. Patients with VTE displayed higher odds of prolonged hospitalization, discharge to home hospice, and palliative care use, but no difference in in-hospital deaths. The adjusted additional mean hospital charge and cost were higher in patients with VTE by $10,293 (P < 0.001) and $2966 (P < 0.001), respectively. Conclusions: VTE occurrence during acute hospitalizations for pancreatic cancer is associated with significant morbidity, increased resource utilization and economic burden without additional risk for in-hospital mortality.
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Affiliation(s)
- Osayande Osagiede
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Wafa Aldhaleei
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Massimo Raimondo
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Michael B Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Yan Bi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Frank J Lukens
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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Lopes MS, Li HF, Sorensen RJD, Das S, Bradley SM, de Lemos JA, Roth GA, Wang T, Bohula EA, Gluckman TJ. Patterns of Prophylactic Anticoagulation Among Patients Hospitalized for COVID-19: An Analysis of the American Heart Association COVID-19 Cardiovascular Disease Registry. J Am Heart Assoc 2025; 14:e034186. [PMID: 40028842 DOI: 10.1161/jaha.123.034186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 06/12/2024] [Indexed: 03/05/2025]
Abstract
BACKGROUND Limited knowledge exists about prophylactic anticoagulation patterns in patients hospitalized for COVID-19. METHODS AND RESULTS We conducted a retrospective cohort study using American Heart Association COVID-19 Cardiovascular Disease Registry data from May 2020 to March 2022. We included patients without preexisting indications for or contraindications to anticoagulation, excluding those with missing anticoagulation data. Patients were categorized by the highest anticoagulation dose received. Multilevel logistic regression was used to assess the relationship between anticoagulation use/dose, patient demographics, clinical presentation, in-hospital course, institutional characteristics, and admission date, accounting for hospital clustering. Among 26 775 patients, 4157 (16%) received no anticoagulation, 15 617 (58%) low-dose, 3071 (11%) intermediate-dose, and 3930 (15%) full-dose anticoagulation. Significant hospital-level variability occurred for any anticoagulation use (range, 0%-98%; P<0.0001) and by dose (full anticoagulation range, 0%-85%; P<0.0001). Controlling for hospital variability, older age, male sex, non-White race, higher body mass index, higher platelets, corticosteroid use, and intensive care unit admission were positively associated with any anticoagulation use. Older age, male sex, higher body mass index, higher platelets, corticosteroid use, intensive care unit admission, mechanical ventilation, and admission before October 2020 were associated with higher anticoagulation dose (full versus low dose). Rates of no anticoagulation significantly increased in both intensive care unit and non-intensive care unit strata over time (P trend=0.01 and <0.0001, respectively). CONCLUSIONS In this large real-world analysis, nearly 1 in 6 patients hospitalized for COVID-19 received no prophylactic anticoagulation. Patient and disease characteristics associated with thrombotic risk and COVID-19 severity correlated with anticoagulation strategy. Importantly, substantial institutional differences emerged, highlighting gaps between clinical practice and guideline recommendations.
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Affiliation(s)
- Mathew S Lopes
- Division of Cardiovascular Medicine Brigham and Women's Hospital Boston MA USA
| | - Hsin-Fang Li
- Center for Cardiovascular Analytics, Research, and Data Science (CARDS) Providence Heart Institute Portland OR USA
| | - Reed J D Sorensen
- Institute for Health Metrics and Evaluation, University of Washington Seattle WA USA
| | - Sandeep Das
- UT Southwestern Medical Center Dallas TX USA
| | | | | | - Gregory A Roth
- Division of Cardiology, Department of Medicine University of Washington Seattle WA USA
| | - Tracy Wang
- Duke Clinical Research Institute Durham NC USA
| | - Erin A Bohula
- Division of Cardiovascular Medicine Brigham and Women's Hospital Boston MA USA
| | - Ty J Gluckman
- Center for Cardiovascular Analytics, Research, and Data Science (CARDS) Providence Heart Institute Portland OR USA
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Mitiku HZ, Assefa Addis B, Edmealem A, Tsegaye D, Biyazin Y, Abate A. Risk stratification and contributing factors of deep vein thrombosis among patients admitted at Debre Markos comprehensive specialized hospital, Ethiopia in 2024. Front Med (Lausanne) 2024; 11:1470212. [PMID: 39736980 PMCID: PMC11683679 DOI: 10.3389/fmed.2024.1470212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 11/22/2024] [Indexed: 01/01/2025] Open
Abstract
Introduction Deep vein thrombosis is a serious condition and a leading cause of morbidity and mortality in hospitalized patients. Studies conducted in various hospitals in Ethiopia have reported that the prevalence rates of deep vein thrombosis range from approximately 5-10% among hospitalized patients. The risk stratification of deep vein thrombosis and the identification of associated risk factors are critical for assessing deep vein thrombosis in hospital settings. Wells scoring provides a valuable framework for assessing individual risk. This study aims to assess the risk stratification of deep vein thrombosis and to identify the risk factors among patients admitted at Debre Markos Comprehensive Specialized Hospital. Method A facility-based cross-sectional study was conducted from December 2023 to February 2024. The study included 423 adult patients, and the data were collected using a structured questionnaire and chart review. Ordinal logistic regression analysis was conducted after performing the model test. Result The prevalence of deep vein thrombosis was found to be 7.9%, with 44.2% categorized as having no risk, 8.1% as moderate risk, and 47.7% as high risk for deep vein thrombosis stratification. Various risk factors, such as regular alcohol consumption (odd ratio 4.59, p = 0.032), a previous history of deep vein thrombosis (odd ratio 28.32, p = 0.000), the presence of a central catheter (odd ratio 12.92, p = 0.000), a severe lipid profile (odd ratio 3.8, p = 0.001), and a longer duration of stay in the ward (odd ratio 1.28, p = 0.000), were significantly associated with high risk for deep vein thrombosis stratification. Conclusion The prevalence of high-risk deep vein thrombosis stratification was found to be high, and the occurrence of deep vein thrombosis was also high within this risk group. Regular alcohol consumption, a previous history of deep vein thrombosis, the presence of a central catheter, a severe lipid profile, and a longer duration of stay in the ward were statistically significant for high-risk deep vein thrombosis stratification. This study highlights the importance of identifying patients who are at high risk for deep vein thrombosis stratification and addressing the risk factors for deep vein thrombosis stratification.
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Affiliation(s)
- Haymanot Zeleke Mitiku
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Birtukan Assefa Addis
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Afework Edmealem
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Dejen Tsegaye
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Yalemgeta Biyazin
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Abebe Abate
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Arya S, Khare R, Garg I, Srivastava S. Gene expression profiling in Venous thromboembolism: Insights from publicly available datasets. Comput Biol Chem 2024; 113:108246. [PMID: 39413445 DOI: 10.1016/j.compbiolchem.2024.108246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 09/03/2024] [Accepted: 10/09/2024] [Indexed: 10/18/2024]
Abstract
BACKGROUND Venous thromboembolism (VTE) is the third most common cardiovascular disease and is a major cause of mobility and mortality worldwide. VTE is a complex multifactorial disease and genetic mechanisms underlying its pathogenesis is yet to be completely elucidated. The aim of the present study was to identify hub genes and pathways involved in development and progression of blood clot during VTE using gene expression data from public repositories. METHODOLOGY Differential gene expression (DEG) data from two datasets, GSE48000 and GSE19151 were analysed using GEO2R tool. Gene expression data of VTE patients were compared to that of healthy controls using various bioinformatics tools. RESULTS When the differentially expressed genes of the two datasets were compared, it was found that 19 genes were up-regulated while 134 genes were down-regulated. Gene ontology (GO) and pathway analysis revealed that pathways such as complement and coagulation cascade and B-cell receptor signalling along with DNA methylation, DNA alkylation and inflammatory genes were significantly up-regulated in VTE patients. On the other hand, differentially down-regulated genes included mitochondrial translation elongation, termination and biosysthesis along with heme biosynthesis, erythrocyte differentiation and homeostasis. The top 5 up-regulated hub genes obtained by protein-protein interaction (PPI) network analysis included MYC, FOS, SGK1, CR2 and CXCR4, whereas the top 5 down-regulated hub genes included MRPL13, MRPL3, MRPL11, RPS29 and RPL9. The up-regulated hub genes are functionally involved in maintain vascular integrity and complementation cascade while the down-regulated hub genes were mostly mitochondrial ribosomal proteins. CONCLUSION Present study highlights significantly enriched pathways and genes associated with VTE development and prognosis. The data hereby obtained could be used for designing newer diagnostic and therapeutic tools for VTE management.
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Affiliation(s)
- Sunanda Arya
- Defence Institute of Physiology and Allied Sciences (DIPAS), Defence Research and Development Organization (DRDO), Lucknow Road, Timarpur, Delhi 110054, India
| | - Rashi Khare
- Defence Institute of Physiology and Allied Sciences (DIPAS), Defence Research and Development Organization (DRDO), Lucknow Road, Timarpur, Delhi 110054, India
| | - Iti Garg
- Defence Institute of Physiology and Allied Sciences (DIPAS), Defence Research and Development Organization (DRDO), Lucknow Road, Timarpur, Delhi 110054, India
| | - Swati Srivastava
- Defence Institute of Physiology and Allied Sciences (DIPAS), Defence Research and Development Organization (DRDO), Lucknow Road, Timarpur, Delhi 110054, India.
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Römer P, Krüger M, Al-Nawas B, Kämmerer PW, Heider J. Prevention of perioperative venous thromboembolic complications using pneumatic compression cuffs in oral cancer patients in maxillofacial surgery. Clin Oral Investig 2024; 28:589. [PMID: 39390275 PMCID: PMC11467114 DOI: 10.1007/s00784-024-05987-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Accepted: 10/01/2024] [Indexed: 10/12/2024]
Abstract
OBJECTIVES Venous thromboembolism (VTE) is still considered to be a significant medical issue. Physical measures to prevent perioperative venous thrombosis include early mobilization and intermittent pneumatic compression (IPC). The aim of this study was to evaluate whether IPC can reduce the incidence of postoperative thromboembolic events in patients with oral squamous cell carcinoma (OSCC) undergoing maxillofacial surgery. MATERIALS AND METHODS Between March 2020 and May 2021, 75 patients with OSCC who did not receive perioperative prophylaxis using IPC were retrospectively examined to determine the occurrence of postoperative thromboembolism. Accordingly, 79 patients who received perioperative thrombosis prophylaxis using an IPC system as part of surgical tumor therapy from May 2021 to September 2023 were included in the study. The primary outcome measure was the occurrence of postoperative thromboembolism. RESULTS In the control group without IPC, thromboembolic events were observed in five out of 75 patients during postoperative hospitalization. In the intervention group, no thromboembolic occurrences were identified among the 79 patients studied (p = 0.02). The mean Caprini score in the control group was 7.72, whereas in the intervention group it averaged 8.30 (p = 0.027). CONCLUSIONS The implementation of IPC-devices as supplementary perioperative thrombosis prophylaxis resulted in a notable decrease in postoperative venous thromboembolism (Number Needed to Treat = 15), which is why implementation of the system as a regular part of the clinical routine for perioperative management of OSCC patients can be considered a sensible approach. CLINICAL RELEVANCE The use of IPC enhances patient outcomes and may lead to improved postoperative care protocols in this high-risk patient population.
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Affiliation(s)
- P Römer
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany.
| | - M Krüger
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - B Al-Nawas
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - P W Kämmerer
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - J Heider
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
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Suryawanshi G, Jonason DE, Munigala S, Ghai M, Amateau S, Azeem N, Mallery S, Freeman ML, Trikudanathan G. Incidence and risk factors for deep vein thrombosis (DVT) and pulmonary embolism (PE) in acute necrotizing pancreatitis (ANP) - A single center experience. Pancreatology 2024; 24:856-862. [PMID: 39089978 DOI: 10.1016/j.pan.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 07/13/2024] [Accepted: 07/16/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION Inflammation-induced dysregulation of the coagulation cascade and vascular stasis in hospitalized patients with acute necrotizing pancreatitis (ANP) serve as a milieu for venous thromboembolism (VTE). Deep vein thrombosis (DVT) and pulmonary embolism (PE) are often underrecognized. We evaluated the incidence and risk factors for VTE in a cohort of patients with ANP. METHODS All adult patients with ANP at our center between 2009 and 2022 were followed for three months after index hospitalization and categorized into cases and controls based on development of VTE. Demographic, clinical, and radiologic characteristics during admission were compared. A multivariable analysis was done to identify independent predictors for VTE. A p value of <0.05 was taken as significant. RESULTS Among 643 ANP patients, 512 [males-350, median age-52 years] were eligible for inclusion. VTE developed in 64 (12.5 %) patients - 28 DVT (5 %), 22 PE (4 %) and both in 14 (3 %) after a median 16 days from the diagnosis of ANP. Significant independent predictors for VTE on multivariable analysis were age ≥60 years (OR 1.91; 95 % CI 1.04-3.53), peri-pancreatic extent of necrosis (OR 7.61; 95 % CI 3.94-14.70), infected necrosis (OR 2.26; 95 % CI 1.13-4.50) and total length of stay ≥14 days (OR 4.08; 95 % CI 1.75-9.50). CONCLUSIONS The overall incidence of VTE in our cohort of patients with ANP was 12.5 %, which was usually diagnosed within one month of hospitalization. High-risk patients can be stratified based on clinical and imaging characteristics and may benefit from intensive DVT screening and prophylaxis during hospitalization and following discharge.
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Affiliation(s)
- Gaurav Suryawanshi
- Department of Medicine, University of Minnesota Medical Center, Minnesota, USA
| | - David E Jonason
- Department of Medicine, University of Minnesota Medical Center, Minnesota, USA
| | - Satish Munigala
- St. Louis University Center for Health Outcomes Research, St. Louis, MO, USA
| | - Megan Ghai
- Department of Medicine, University of Arizona Medical Center, Arizona, USA
| | - Stuart Amateau
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota Medical Center, Minnesota, USA
| | - Nabeel Azeem
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota Medical Center, Minnesota, USA
| | - Shawn Mallery
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota Medical Center, Minnesota, USA
| | - Martin L Freeman
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota Medical Center, Minnesota, USA
| | - Guru Trikudanathan
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota Medical Center, Minnesota, USA.
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Gámiz-Molina AB, Valenza-Peña G, Raya-Benítez J, Heredia-Ciuró A, Granados-Santiago M, López-López L, Valenza MC. Association between Mid-Term Functionality and Clinical Severity in Patients Hospitalized for Pulmonary Embolism. Healthcare (Basel) 2024; 12:1323. [PMID: 38998858 PMCID: PMC11241709 DOI: 10.3390/healthcare12131323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
The aim of this study is to evaluate the relationship between clinical severity and functionality, occupational performance, and health-related quality of life in patients hospitalized with pulmonary embolism. Pulmonary embolism patients were grouped by clinical severity using the Pulmonary Embolism Severity Index. Those scoring ≥160 were in the high-severity group (HSG); those scoring < 160 in the low-moderate group (LMSG). The main variables were functionality assessed by the World Health Organization Disability Assessment Schedule (WHODAS), self-perception of occupational performance assessed by the Canadian Occupational Performance Measure (COPM), pain and fatigue assessed by a Visual Analogue Scale (VAS), and health-related quality of life assessed by the EuroQol-5Dimensions (EQ-5D). Patients were evaluated at hospital admission and at 1-month and 3-month follow-up. At admission, there were significant differences between groups in the WHODAS and health-related quality of life in favor of the LMSG. At 1-month and at 3-month follow-up, there were significant differences between the LMSG and HSG in WHODAS, COMP, NRS pain, fatigue and EQ-5D scores in favor of the LMSG. An association exists between clinical severity and mid-term functionality, self-perception of occupational performance, pain, fatigue, and health-related quality of life in PE patients.
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Affiliation(s)
| | - Geraldine Valenza-Peña
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (G.V.-P.); (A.H.-C.); (M.C.V.)
| | - Julia Raya-Benítez
- Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (J.R.-B.); (M.G.-S.)
| | - Alejandro Heredia-Ciuró
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (G.V.-P.); (A.H.-C.); (M.C.V.)
| | - María Granados-Santiago
- Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (J.R.-B.); (M.G.-S.)
| | - Laura López-López
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (G.V.-P.); (A.H.-C.); (M.C.V.)
| | - Marie Carmen Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (G.V.-P.); (A.H.-C.); (M.C.V.)
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Samanta J, Dhar J, Gupta P, Kochhar R. Venous Thrombosis in Acute Pancreatitis: What to and Not to Do? Dig Dis Sci 2024; 69:1537-1550. [PMID: 38600412 DOI: 10.1007/s10620-024-08418-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 03/26/2024] [Indexed: 04/12/2024]
Abstract
Acute pancreatitis is an acute inflammatory condition of the pancreas that has not only local but systemic effects as well. Venous thrombosis is one such complication which can give rise to thrombosis of the peripheral vasculature in the form of deep vein thrombosis, pulmonary embolism, and splanchnic vein thrombosis. The prevalence of these complications increases with the severity of the disease and adds to the adverse outcomes profile. With better imaging and awareness, more cases are being detected, although many at times it can be an incidental finding. However, it remains understudied and strangely, most of the guidelines on the management of acute pancreatitis are silent on this aspect. This review offers an overview of the incidence, pathophysiology, symptomatology, diagnostic work-up, and management of venous thrombosis that develops in AP.
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Affiliation(s)
- Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical College and Research, Chandigarh, India
| | - Jahnvi Dhar
- Department of Gastroenterology, Sohana Hospital, Mohali, Punjab, India
| | - Pankaj Gupta
- Department of Radiodiagnosis, Post Graduate Institute of Medical College and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Post Graduate Institute of Medical College and Research, Chandigarh, India.
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Kumar S, Azadi N, Emerson D, Santoso J. Randomized Trial of Sequential Compression Versus Ankle-Calf Movement to Increase Femoral Venous Velocity. Cureus 2023; 15:e48070. [PMID: 37927740 PMCID: PMC10620617 DOI: 10.7759/cureus.48070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 11/07/2023] Open
Abstract
Objective In postoperative patients with a high risk of bleeding, sequential compression devices (SCD) and ambulation are effective methods to reduce venous thromboembolic (VTE) risks. High leg venous flow decreases VTE risk. We postulated that ankle flexion and extension (AFE) while in bed increased leg venous flow velocity as well. We wished to compare the effectiveness of SCD versus AFE in increasing leg venous velocity. Methods Thirty-two healthy volunteers were recruited into the study. Each subject had two legs that were randomized into SCD or AFE. After 15 minutes of rest, SCD or AFE was applied, followed by 15 minutes of rest, and then an alternate treatment was given to the second leg. The sequence of leg and methodology was then reversed so the second treatment was applied to the first leg, and the first treatment to the second leg, and measurements were obtained. All treatments were separated by a rest period of 15 minutes. The venous velocity on each leg was measured by Doppler ultrasound at the superficial femoral vein. Venous velocity was measured initially (first cycle peak venous velocity) and during subsequent cycles. The alternate treatments on both legs with both treatments allowed for analysis in a manner where each subject could act as its control. Results Relative to baseline bed rest, SCD increased peak venous flow velocity by 112%, while AFE increased peak venous flow velocity by 161%. AFE resulted in 43% higher venous velocity on average than did SCDs (p<0.05). Conclusions AFE leads to significantly higher venous flow in the femoral veins of healthy subjects.
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Affiliation(s)
- Saurabh Kumar
- Obstetrics and Gynecology, University of California, Riverside, USA
| | - Negin Azadi
- Obstetrics and Gynecology, Meharry Medical College, Nashville, USA
| | - Donald Emerson
- Radiology, Methodist Le Bonheur Healthcare, Memphis, USA
| | - Joseph Santoso
- Obstetrics and Gynecology, Gynecologic Oncology, Baptist Medical Group, Memphis, USA
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Bikdeli B, Lo YC, Khairani CD, Bejjani A, Jimenez D, Barco S, Mahajan S, Caraballo C, Secemsky EA, Klok FA, Hunsaker AR, Aghayev A, Muriel A, Wang Y, Hussain MA, Appah-Sampong A, Lu Y, Lin Z, Aneja S, Khera R, Goldhaber SZ, Zhou L, Monreal M, Krumholz HM, Piazza G. Developing Validated Tools to Identify Pulmonary Embolism in Electronic Databases: Rationale and Design of the PE-EHR+ Study. Thromb Haemost 2023; 123:649-662. [PMID: 36809777 PMCID: PMC11200175 DOI: 10.1055/a-2039-3222] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Contemporary pulmonary embolism (PE) research, in many cases, relies on data from electronic health records (EHRs) and administrative databases that use International Classification of Diseases (ICD) codes. Natural language processing (NLP) tools can be used for automated chart review and patient identification. However, there remains uncertainty with the validity of ICD-10 codes or NLP algorithms for patient identification. METHODS The PE-EHR+ study has been designed to validate ICD-10 codes as Principal Discharge Diagnosis, or Secondary Discharge Diagnoses, as well as NLP tools set out in prior studies to identify patients with PE within EHRs. Manual chart review by two independent abstractors by predefined criteria will be the reference standard. Sensitivity, specificity, and positive and negative predictive values will be determined. We will assess the discriminatory function of code subgroups for intermediate- and high-risk PE. In addition, accuracy of NLP algorithms to identify PE from radiology reports will be assessed. RESULTS A total of 1,734 patients from the Mass General Brigham health system have been identified. These include 578 with ICD-10 Principal Discharge Diagnosis codes for PE, 578 with codes in the secondary position, and 578 without PE codes during the index hospitalization. Patients within each group were selected randomly from the entire pool of patients at the Mass General Brigham health system. A smaller subset of patients will also be identified from the Yale-New Haven Health System. Data validation and analyses will be forthcoming. CONCLUSIONS The PE-EHR+ study will help validate efficient tools for identification of patients with PE in EHRs, improving the reliability of efficient observational studies or randomized trials of patients with PE using electronic databases.
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Affiliation(s)
- Behnood Bikdeli
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States
- Cardiovascular Research Foundation (CRF), New York, New York, United States
| | - Ying-Chih Lo
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Candrika D Khairani
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Antoine Bejjani
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal and Medicine Department, Universidad de Alcalá (Instituto de Ramón y Cajal de Investigación Sanitaria), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Stefano Barco
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Shiwani Mahajan
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States
| | - César Caraballo
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States
| | - Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
| | - Andetta R Hunsaker
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Ayaz Aghayev
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Alfonso Muriel
- Clinical Biostatistics Unit. Hospital Universitario Ramón y Cajal. IRYCIS, CIBERESP: Universidad de Alcalá. Madrid, Spain
| | - Yun Wang
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Mohamad A Hussain
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Abena Appah-Sampong
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Yuan Lu
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States
| | - Zhenqiu Lin
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States
| | - Sanjay Aneja
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Rohan Khera
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States
| | - Samuel Z Goldhaber
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Li Zhou
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Manuel Monreal
- Cátedra de Enfermedad Tromboembólica, Universidad Católica de Murcia, Murcia, Spain
| | - Harlan M Krumholz
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, United States
| | - Gregory Piazza
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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12
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Dexter D, Kado H, Shaikh A, Schor J, Annambhotla S, Zybulewski A, Paulisin J, Bisharat M, Mouawad NJ, Bunte MC, Maldonado T, Skripochnik E, Raskin A, Gandhi S, Ichinose E, Beasley R, Mojibian H. Safety and Effectiveness of Mechanical Thrombectomy From the Fully Enrolled Multicenter, Prospective CLOUT Registry. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100585. [PMID: 39129803 PMCID: PMC11308834 DOI: 10.1016/j.jscai.2023.100585] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/15/2022] [Accepted: 01/03/2023] [Indexed: 08/13/2024]
Abstract
Background We report in-hospital outcomes from the multicenter, prospective, single-arm ClotTriever Outcomes (CLOUT) registry, which enrolled up to 500 patients with proximal lower extremity deep vein thrombosis (DVT) treated with percutaneous mechanical thrombectomy using the ClotTriever System (Inari Medical). Methods The CLOUT registry enrolled all-comer patients with DVT, irrespective of symptom duration, thrombus age, prior treatment of the current DVT, or bilateral thrombus. The primary effectiveness end point was defined as complete or near complete (≥75%) reduction in Marder score. Thrombus burden was assessed by an independent core laboratory. Mortality and serious adverse events, including device-relatedness, were adjudicated by an independent medical monitor. Here, safety and outcomes are evaluated through discharge. Results The median age was 61.9 years (IQR, 48.0-70.8), 50.5% were women, 24.9% had a history of DVT, and 23.2% had previously failed treatment of the current DVT. Nearly all procedures (99.4%) were performed in a single session with negligible procedural blood loss (median 40.0 mL; IQR, 20.0-50.0), and most patients (97.8%) required no subsequent intensive care unit monitoring. The primary effectiveness end point was achieved in 91.2% of limbs. Through discharge, 1 device-related serious adverse event (0.2%) occurred. Health status, as assessed by self-reported pain and circumferential measurements of limb edema, were significantly improved at discharge. Conclusions Thrombectomy with the ClotTriever System is a safe and effective treatment for proximal lower extremity DVT, while also avoiding the need of intensive care. Early patient improvements are demonstrated, and follow-up is ongoing to 2 years.
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Affiliation(s)
| | - Herman Kado
- Ascension Providence Hospital, Farmington Hills, Michigan
- William Beaumont Hospital, Royal Oak, Michigan
| | | | - Jonathan Schor
- Northwell Health, Staten Island University Hospital, Staten Island, New York
| | | | | | | | | | | | | | | | | | | | - Sagar Gandhi
- Prisma Health, University of South Carolina – School of Medicine, Greenville, South Carolina
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13
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Owodunni OP, Lau BD, Wang J, Shaffer DL, Kraus PS, Holzmueller CG, Aboagye JK, Hobson DB, Varasteh Kia M, Armocida S, Streiff MB, Haut ER. Effectiveness of a Patient Education Bundle on Venous Thromboembolism Prophylaxis Administration by Sex. J Surg Res 2022; 280:151-162. [PMID: 35969933 DOI: 10.1016/j.jss.2022.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/14/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Venous thromboembolism (VTE) is a frequent cause of preventable harm among hospitalized patients. Many prescribed prophylaxis doses are not administered despite supporting evidence. We previously demonstrated a patient-centered education bundle improved VTE prophylaxis administration broadly; however, patient-specific factors driving nonadministration are unclear. We examine the effects of the education bundle on missed doses of VTE prophylaxis by sex. METHODS We performed a post-hoc analysis of a nonrandomized controlled trial to evaluate the differences in missed doses by sex. Pre-intervention and intervention periods for patients admitted to 16 surgical and medical floors between 10/2014-03/2015 (pre-intervention) and 04/2015-12/2015 (intervention) were compared. We examined the conditional odds of (1) overall missed doses, (2) missed doses due to patient refusal, and (3) missed doses for other reasons. RESULTS Overall, 16,865 patients were included (pre-intervention 6853, intervention 10,012), with 2350 male and 2460 female patients (intervention), and 6373 male and 5682 female patients (control). Any missed dose significantly reduced on the intervention floors among male (odds ratio OR 0.55; 95% confidence interval CI, 0.44-0.70, P < 0.001) and female (OR 0.59; 95% CI, 0.47-0.73, P < 0.001) patients. Similar significant reductions ensued for missed doses due to patient refusal (P < 0.001). Overall, there were no sex-specific differences (P-interaction >0.05). CONCLUSIONS Our intervention increased VTE prophylaxis administration for both female and male patients, driven by decreased patient refusal. Patient education should be applicable to a wide range of patient demographics representative of the target group. To improve future interventions, quality improvement efforts should be evaluated based on patient demographics and drivers of differences in care.
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Affiliation(s)
- Oluwafemi P Owodunni
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brandyn D Lau
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Health Sciences Informatics, The Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medicine, Baltimore, Maryland; Department of Health Policy and Management, The Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Jiangxia Wang
- Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Dauryne L Shaffer
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland; Department of Nursing, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Peggy S Kraus
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Christine G Holzmueller
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medicine, Baltimore, Maryland
| | - Jonathan K Aboagye
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deborah B Hobson
- The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medicine, Baltimore, Maryland; Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Mujan Varasteh Kia
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephanie Armocida
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael B Streiff
- The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medicine, Baltimore, Maryland; Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elliott R Haut
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medicine, Baltimore, Maryland; Department of Health Policy and Management, The Johns Hopkins University School of Public Health, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland; The Johns Hopkins Surgery Center for Outcomes Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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14
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Sochet AA, Havlicek EE, Faustino EVS, Goldenberg NA. Mechanical Ventilation and Hospital-Acquired Venous Thromboembolism Among Critically Ill Children. Hosp Pediatr 2022; 12:1099-1109. [PMID: 36349533 DOI: 10.1542/hpeds.2022-006697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To estimate the occurrence of, and evaluate associations between, hospital-acquired venous thromboembolism (HA-VTE) and invasive mechanical ventilation (MV) among children hospitalized in the PICU. METHODS We performed a multicenter, retrospective cohort study comparing HA-VTE frequencies among subjects <18 years of age hospitalized in the PICU from January 2018 through December 2019 among 47 participating centers, via the Pediatric Health Information Systems registry. We excluded perinatal encounters, those with VTE present at admission, and those with observational status. The primary outcome was the proportion of HA-VTE events before hospital discharge, including extremity deep venous thrombosis, pulmonary embolism, and organ-specific deep venous thrombosis. The HA-VTE frequencies were compared using χ2 tests. The association between HA-VTE and MV was investigated via multivariable logistic regression, adjusting for previously described VTE risk factors. RESULTS Of the 205 231 PICU encounters identified for study, 70 829 (34.5%) underwent MV. The occurrence of HA-VTE was 2.2% and was greater among children who received, versus did not receive, MV (4.4% versus 1.1%, P < .001). Multivariable logistic regression revealed significant association between MV and HA-VTE (odds ratio 2.51, 95% confidence interval 2.33-2.69; P < .001). CONCLUSIONS In this multicenter, retrospective, registry-based cohort study, HA-VTE were diagnosed in 2.2% of critically-ill children, and after adjustment for central venous catheterization, MV independently increased the risk of HA-VTE 2.5-fold. These findings warrant prospective validation to inform the design of future risk-stratified clinical trials of thromboprophylaxis in critically-ill children.
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Affiliation(s)
- Anthony Alexander Sochet
- Divisions of Critical Care Medicine.,Department of Pediatrics, University of South Florida College of Medicine, Tampa, Florida.,Departments of Anesthesiology.,Critical Care Medicine, Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | | | | | - Neil Andrew Goldenberg
- Hematology, Department of Medicine, Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Critical Care Medicine, Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Departments of Medicine.,Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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15
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Kobo O, Raisi-Estabragh Z, Gevaert S, Rana JS, Van Spall HGC, Roguin A, Petersen SE, Ky B, Mamas MA. Impact of cancer diagnosis on distribution and trends of cardiovascular hospitalizations in the USA between 2004 and 2017. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:787-797. [PMID: 35913736 PMCID: PMC9603542 DOI: 10.1093/ehjqcco/qcac045] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIMS There is limited data on temporal trends of cardiovascular hospitalizations and outcomes amongst cancer patients. We describe the distribution, trends of admissions, and in-hospital mortality associated with key cardiovascular diseases among cancer patients in the USA between 2004 and 2017. METHODS Using the Nationwide Inpatient Sample we, identified admissions with five cardiovascular diseases of interest: acute myocardial infarction (AMI), pulmonary embolism (PE), ischaemic stroke, heart failure, atrial fibrillation (AF) or atrial flutter, and intracranial haemorrhage. Patients were stratified by cancer status and type. We estimated crude annual rates of hospitalizations and annual in-hospital all-cause mortality rates. RESULTS From >42.5 million hospitalizations with a primary cardiovascular diagnosis, 1.9 million (4.5%) had a concurrent record of cancer. Between 2004 and 2017, cardiovascular admission rates increased by 23.2% in patients with cancer, whilst decreasing by 10.9% in patients without cancer. The admission rate increased among cancer patients across all admission causes and cancer types except prostate cancer. Patients with haematological (9.7-13.5), lung (7.4-8.9), and GI cancer (4.6-6.3) had the highest crude rates of cardiovascular hospitalizations per 100 000 US population. Heart failure was the most common reason for cardiovascular admission in patients across all cancer types, except GI cancer (crude admission rates of 13.6-16.6 per 100 000 US population for patients with cancer). CONCLUSIONS In contrast to declining trends in patients without cancer, primary cardiovascular admissions in patients with cancer is increasing. The highest admission rates are in patients with haematological cancer, and the most common cause of admission is heart failure.
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Affiliation(s)
- Ofer Kobo
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, Newcastle ST5 5BG, UK
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera 38100, Israel
| | - Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Centre for Advanced Cardiovascular Imaging, Queen Mary University London, ondon E1 4NS, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Sofie Gevaert
- Department of Cardiology, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
| | - Jamal S Rana
- Department of Cardiology, Permanente Medical Group, Oakland, CA 94612, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Harriette G C Van Spall
- Department of Medicine, Department of Health Research Methods, Evidence, and Impact, Population Health Research Institute, Research Institute of St. Joe's, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera 38100, Israel
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Centre for Advanced Cardiovascular Imaging, Queen Mary University London, London E1 4NS, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- Health Data Research UK, London NW1 2BE, UK
- Alan Turing Institute, London NW1 2DB, UK
| | - Bonnie Ky
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, Newcastle ST5 5BG, UK
- Institute of Population Health, University of Manchester, Manchester M13 9PL, UK
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16
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Bergman ZR, Robbins AJ, Alwan FS, Bellin MD, Kirchner VA, Pruett TL, Mulier KE, Boucher AA, Lusczek ER, Beilman GJ. Perioperative Coagulation Changes in Total Pancreatectomy and Islet Autotransplantation. Pancreas 2022; 51:671-677. [PMID: 36099513 PMCID: PMC9547836 DOI: 10.1097/mpa.0000000000002085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Thrombotic complications after total pancreatectomy with islet autotransplantation (TPIAT) are common. However, the systemic changes to coagulation in the perioperative period have not been well studied. Our objective was to evaluate the derangements in coagulation in the perioperative period for this procedure. METHODS This was a prospective observational study of patients undergoing elective TPIAT for chronic pancreatitis. Multiple methods of evaluating coagulation, including 2 viscoelastic assays and standard laboratory assays were obtained at defined intraoperative and postoperative intervals. RESULTS Fifteen patients were enrolled. Laboratory values demonstrated initial intraoperative hypercoagulability before significant systemic anticoagulation after islet infusion with heparin. Hypercoagulability is again seen at postoperative days 3 and 7. Subgroup analysis did not identify any major coagulation parameters associated with portal vein thrombosis formation. CONCLUSIONS Apart from the immediate period after islet cell and heparin infusion, patients undergoing TPIAT are generally hypercoagulable leading to a high rate of thrombotic complications. Portal vein thrombosis development had minimal association with systemic derangements in coagulation as it is likely driven by localized inflammation at the time of islet cell infusion. This study may provide the groundwork for future studies to identify improvements in thrombotic complications.
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Affiliation(s)
| | | | | | | | | | | | | | - Alex A Boucher
- Pediatric Hematology and Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, MN
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17
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Jordan Bruno X, Koh I, Lutsey PL, Walker RF, Roetker NS, Wilkinson K, Smith NL, Plante T, Repp AB, Holmes CE, Cushman M, Zakai N. Venous thrombosis risk during and after medical and surgical hospitalizations: The medical inpatient thrombosis and hemostasis (MITH) study. J Thromb Haemost 2022; 20:1645-1652. [PMID: 35426248 PMCID: PMC9247009 DOI: 10.1111/jth.15729] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Thirty to seventy percent of all venous thromboembolism (VTE) events are associated with hospitalization. The absolute and relative risks during and after hospitalization are poorly characterized. OBJECTIVES Quantify the absolute rate and relative risk of VTE during and up to 3 months after medical and surgical hospitalizations. PATIENTS/METHODS We conducted an observational cohort study between 2010 and 2016 of patients cared for by the University of Vermont (UVM) Health Network's primary care population. Cox proportional hazard models with hospitalization modeled as a time-varying covariate were used to estimate VTE risk. RESULTS Over 4.3 years of follow-up, 55 220 hospitalizations (156 per 1000 person-years) and 713 first venous thromboembolism events (2.0 per 1000 person-years) occurred. Among individuals not recently hospitalized, the rate of venous thromboembolism was 1.4 per 1000 person-years and 71.8 per 1000 person-years during hospitalization. During the first, second, and third months after discharge, the rates of venous thromboembolism were 35.1, 11.3, and 5.2 per 1000 person-years, respectively. Relative to those not recently hospitalized, the age- and sex-adjusted HRs of venous thromboembolism were 38.0 (95% CI 28.0, 51.5) during hospitalization, and 18.4 (95% CI 15.0, 22.6), 6.3 (95% CI 4.3, 9.0), and 3.0 (95% CI 1.7, 5.4) during the first, second, and third months after discharge, respectively. Stratified by medical versus surgical services the rates were similar. CONCLUSION Hospitalization and up to 3 months after discharge were strongly associated with increased venous thromboembolism risk. These data quantify this risk for use in future studies.
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Affiliation(s)
- Ximena Jordan Bruno
- Hematology Oncology DivisionDepartment of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of MedicineLarner College of MedicineUniversity of VermontBurlingtonVermontUSA
- University of Vermont Medical CenterBurlingtonVermontUSA
| | - Insu Koh
- Department of Pathology & Laboratory MedicineLarner College of MedicineUniversity of VermontBurlingtonVermontUSA
| | - Pamela L. Lutsey
- Division of Epidemiology & Community HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Robert F. Walker
- Division of Epidemiology & Community HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Nicholas S. Roetker
- Chronic Disease Research GroupHennepin Healthcare Research InstituteMinneapolisMinnesotaUSA
| | - Katherine Wilkinson
- Department of Pathology & Laboratory MedicineLarner College of MedicineUniversity of VermontBurlingtonVermontUSA
| | - Nicolas L. Smith
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Kaiser Permanente WashingtonKaiser Permanente Washington Health Research InstituteSeattleWashingtonUSA
- Department of Veterans Affairs Office of Research and DevelopmentSeattle Epidemiologic Research and Information CenterSeattleWashingtonUSA
| | - Timothy B. Plante
- Department of MedicineLarner College of MedicineUniversity of VermontBurlingtonVermontUSA
- University of Vermont Medical CenterBurlingtonVermontUSA
| | - Allen B. Repp
- Department of MedicineLarner College of MedicineUniversity of VermontBurlingtonVermontUSA
- University of Vermont Medical CenterBurlingtonVermontUSA
| | - Chris E. Holmes
- Department of MedicineLarner College of MedicineUniversity of VermontBurlingtonVermontUSA
- University of Vermont Medical CenterBurlingtonVermontUSA
| | - Mary Cushman
- Department of MedicineLarner College of MedicineUniversity of VermontBurlingtonVermontUSA
- University of Vermont Medical CenterBurlingtonVermontUSA
- Department of Pathology & Laboratory MedicineLarner College of MedicineUniversity of VermontBurlingtonVermontUSA
| | - Neil A. Zakai
- Department of MedicineLarner College of MedicineUniversity of VermontBurlingtonVermontUSA
- University of Vermont Medical CenterBurlingtonVermontUSA
- Department of Pathology & Laboratory MedicineLarner College of MedicineUniversity of VermontBurlingtonVermontUSA
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18
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Su XF, Fan N, Yang XM, Song JM, Peng QH, Liu X. A Novel Electrocardiography Model for the Diagnosis of Acute Pulmonary Embolism. Front Cardiovasc Med 2022; 9:825561. [PMID: 35479265 PMCID: PMC9035687 DOI: 10.3389/fcvm.2022.825561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Acute pulmonary embolism (acPE) is a severe disease that is often misdiagnosed as it is difficult to detect quickly and accurately. In this study, a novel electrocardiogram (ECG) model was used to estimate the probability of acPE rapidly via analysis of ECG characteristics. A total of 327 patients with acPE who were diagnosed at the Sichuan Provincial People's Hospital (SPPH) between 2018 and 2021 were retrospectively studied. A total of 331 patients were randomly selected as the control group, which included patients hospitalized during the same time period. The control group included patients who presented with characteristic symptoms of acPE, but this diagnosis was ruled out following further diagnostic testing. This study compared the diagnostic value of the ECG model with those of another ECG scoring model (Daniel-ECG score) and the most common prediction models (Wells score and Geneva score). This study established an ECG-predictive model using analysis of the ECG abnormalities in patients with acPE. The final ECG model included certain novel ECG signs that had not been incorporated in the previous ECG score of the patients, and thus, compared to the previous ECG score, exhibited a more favorable area under the receiver operating characteristic curve (AUC) value (0.8741). The model developed in this study was named the SPPH-ECG model. Furthermore, this study compared the SPPH-ECG model with Daniel-ECG score, Wells score, and Geneva score, and the SPPH-ECG model was demonstrated to exhibit a superior AUC value (0.8741), sensitivity (79.08%), negative predictive value (79.52%), and test accuracy (79.42%), while the Geneva score presented superior specificity (100%) and positive predictive value (100%) compared with the SPPH-ECG model. In conclusion, the SPPH-ECG model may play a role in ruling out acPE in patients during diagnostic testing and diagnose acPE rapidly and accurately in combination with the Geneva scoring system.
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Affiliation(s)
- Xiao-Feng Su
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Na Fan
- Department of Echocardiography and Non-Invasive Cardiology Laboratory, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Xue-Mei Yang
- Sichuan Provincial People's Hospital, Chengdu, China
| | - Jun-Mei Song
- Sichuan Provincial People's Hospital, Chengdu, China
| | | | - Xin Liu
- Sichuan Provincial People's Hospital, Chengdu, China
- *Correspondence: Xin Liu
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19
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Akbik F, Pimentel-Farias C, Press DA, Foster NE, Luu K, Williams MG, Andea SG, Kyei RK, Wetsel GM, Grossberg JA, Howard BM, Tong F, Cawley CM, Samuels OB, Sadan O. Diffuse Angiogram-Negative Subarachnoid Hemorrhage is Associated with an Intermediate Clinical Course. Neurocrit Care 2021; 36:1002-1010. [PMID: 34932193 DOI: 10.1007/s12028-021-01413-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The cerebral angiography result is negative for an underlying vascular lesion in 15-20% of patients with nontraumatic subarachnoid hemorrhage (SAH). Patients with angiogram-negative SAH include those with perimesencephalic SAH and diffuse SAH. Consensus suggests that perimesencephalic SAH confers a more favorable prognosis than diffuse SAH. Limited data exist to contextualize the clinical course and prognosis of diffuse SAH in relation to aneurysmal SAH in terms of critical care complications, neurologic complications, and functional outcomes. Here we compare the clinical course and functional outcomes of patients with perimesencephalic SAH, diffuse SAH, and aneurysmal SAH to better characterize the prognostic implications of each SAH subtype. METHODS We conducted a retrospective cohort study that included all patients with nontraumatic SAH admitted to a tertiary care referral center between January 1, 2012, and December 31, 2017. Bleed patterns were radiographically adjudicated, and patients were assigned to three groups: perimesencephalic SAH, diffuse SAH, and aneurysmal SAH. Patient demographics, complications, and clinical outcomes were reported and compared. RESULTS Eighty-six patients with perimesencephalic SAH, 174 with diffuse SAH, and 998 with aneurysmal SAH presented during the study period. Patients with aneurysmal SAH were significantly more likely to be female, White, and active smokers. There were no significant differences between patients with diffuse SAH and perimesencephalic SAH patterns. Critical care complications were compared across all three groups, with significant between-group differences in hypotension and shock (3.5% vs. 16.1% vs. 38.4% for perimesencephalic SAH vs. diffuse SAH vs. aneurysmal SAH, respectively; p < 0.01) and endotracheal intubation (0% vs. 26.4% vs. 48.8% for perimesencephalic SAH vs. diffuse SAH vs. aneurysmal SAH, respectively; p < 0.01). Similar trends were noted with long-term supportive care with tracheostomy and gastrostomy tubes and length of stay. Cerebrospinal fluid diversion was increasingly required across bleed types (9.3% vs. 54.6% vs. 76.3% for perimesencephalic SAH vs. diffuse SAH vs. aneurysmal SAH, respectively, p < 0.001). Vasospasm and delayed cerebral ischemia were comparable between perimesencephalic SAH and diffuse SAH but significantly lower than aneurysmal SAH. Patients with diffuse SAH had intermediate functional outcomes, with significant rates of nonhome discharge (23.0%) and poor functional status on discharge (26.4%), significantly higher than patients with perimesencephalic SAH and lower than patients with aneurysmal SAH. Diffuse SAH similarly conferred an intermediate rate of good functional outcomes at 1-6 months post discharge (92.3% vs. 78.6% vs. 47.3% for perimesencephalic SAH vs. diffuse SAH vs. aneurysmal SAH, respectively; p < 0.016). CONCLUSIONS We confirm the consensus data that perimesencephalic SAH is associated with a more benign clinical course but demonstrate that diffuse SAH confers an intermediate prognosis, more malignant than perimesencephalic SAH but not as morbid as aneurysmal SAH. These results highlight the significant morbidity associated with diffuse SAH and emphasize need for vigilance in the acute care of these patients. These patients will likely benefit from continued high-acuity observation and potential support to avert significant risk of morbidity and neurologic compromise.
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Affiliation(s)
- Feras Akbik
- Division of Neurocritical Care, Departments of Neurology and Neurosurgery, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA, 30322, USA. .,Neuroscience Intensive Care Unit, Emory Healthcare, Atlanta, GA, USA.
| | - Cederic Pimentel-Farias
- Division of Neurocritical Care, Departments of Neurology and Neurosurgery, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA, 30322, USA.,Neuroscience Intensive Care Unit, Emory Healthcare, Atlanta, GA, USA
| | - Di'Jonai A Press
- Emory University, Atlanta, GA, USA.,Neuroscience Intensive Care Unit, Emory Healthcare, Atlanta, GA, USA
| | - Niara E Foster
- Emory University, Atlanta, GA, USA.,Neuroscience Intensive Care Unit, Emory Healthcare, Atlanta, GA, USA
| | - Kevin Luu
- Emory University, Atlanta, GA, USA.,Neuroscience Intensive Care Unit, Emory Healthcare, Atlanta, GA, USA
| | - Merin G Williams
- Emory University, Atlanta, GA, USA.,Neuroscience Intensive Care Unit, Emory Healthcare, Atlanta, GA, USA
| | - Sena G Andea
- Emory University, Atlanta, GA, USA.,Neuroscience Intensive Care Unit, Emory Healthcare, Atlanta, GA, USA
| | - Regina K Kyei
- Emory University, Atlanta, GA, USA.,Neuroscience Intensive Care Unit, Emory Healthcare, Atlanta, GA, USA
| | - Grace M Wetsel
- Emory University, Atlanta, GA, USA.,Neuroscience Intensive Care Unit, Emory Healthcare, Atlanta, GA, USA
| | - Jonathan A Grossberg
- Neuroscience Intensive Care Unit, Emory Healthcare, Atlanta, GA, USA.,Department of Neurosurgery, Emory University Hospital and Emory University School of Medicine, Atlanta, GA, USA
| | - Brian M Howard
- Neuroscience Intensive Care Unit, Emory Healthcare, Atlanta, GA, USA.,Department of Neurosurgery, Emory University Hospital and Emory University School of Medicine, Atlanta, GA, USA
| | - Frank Tong
- Neuroscience Intensive Care Unit, Emory Healthcare, Atlanta, GA, USA.,Department of Neurosurgery, Emory University Hospital and Emory University School of Medicine, Atlanta, GA, USA
| | - C Michael Cawley
- Neuroscience Intensive Care Unit, Emory Healthcare, Atlanta, GA, USA.,Department of Neurosurgery, Emory University Hospital and Emory University School of Medicine, Atlanta, GA, USA
| | - Owen B Samuels
- Division of Neurocritical Care, Departments of Neurology and Neurosurgery, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA, 30322, USA.,Neuroscience Intensive Care Unit, Emory Healthcare, Atlanta, GA, USA
| | - Ofer Sadan
- Division of Neurocritical Care, Departments of Neurology and Neurosurgery, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA, 30322, USA.,Neuroscience Intensive Care Unit, Emory Healthcare, Atlanta, GA, USA
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20
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Yang DJ, Li M, Yue C, Hu WM, Lu HM. Development and validation of a prediction model for deep vein thrombosis in older non-mild acute pancreatitis patients. World J Gastrointest Surg 2021. [DOI: 10.4240/wjgs.v13.i10.1257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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21
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Yang DJ, Li M, Yue C, Hu WM, Lu HM. Development and validation of a prediction model for deep vein thrombosis in older non-mild acute pancreatitis patients. World J Gastrointest Surg 2021; 13:1258-1266. [PMID: 34754393 PMCID: PMC8554725 DOI: 10.4240/wjgs.v13.i10.1258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/01/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Deep vein thrombosis (DVT) may cause pulmonary embolus, leading to late deaths. The systemic inflammatory and hypercoagulable state of moderate and severe acute pancreatitis (non-mild acute pancreatitis, NMAP) patients may contribute to the development of venous thromboembolism. Accurate prediction of DVT is conducive to clinical decisions.
AIM To develop and validate a potential new prediction nomogram model for the occurrence of DVT in NMAP.
METHODS NMAP patient admission between 2013.1.1 and 2018.12.31 at the West China Hospital of Sichuan University was collected. A total of 220 patients formed the training set for nomogram development, and a validation set was constructed using bootstrapping with 100 resamplings. Univariate and multivariate logistic regression analyses were used to estimate independent risk factors associated with DVT. The independent risk factors were included in the nomogram. The accuracy and utility of the nomogram were evaluated by calibration curve and decision curve analysis, respectively.
RESULTS A total of 220 NMAP patients over 60 years old were enrolled for this analysis. DVT was detected in 80 (36.4%) patients. The final nomogram included age, sex, surgery times, D-dimer, neutrophils, any organ failure, blood culture, and classification. This model achieved good concordance indexes of 0.827 (95%CI: 0.769-0.885) and 0.803 (95%CI: 0.743-0.860) in the training and validation sets, respectively.
CONCLUSION We developed and validated a prediction nomogram model for DVT in older patients with NMAP. This may help guide doctors in making sound decisions regarding the administration of DVT prophylaxis.
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Affiliation(s)
- Du-Jiang Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Mao Li
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Chao Yue
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wei-Ming Hu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hui-Min Lu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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22
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Lobastov K, Sautina E, Alencheva E, Bargandzhiya A, Schastlivtsev I, Barinov V, Laberko L, Rodoman G, Boyarintsev V. Intermittent Pneumatic Compression in Addition to Standard Prophylaxis of Postoperative Venous Thromboembolism in Extremely High-risk Patients (IPC SUPER): A Randomized Controlled Trial. Ann Surg 2021; 274:63-69. [PMID: 33201130 DOI: 10.1097/sla.0000000000004556] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To assess the efficacy of adjunctive IPC to standard prophylaxis of postoperative VTE in patients at extremely high-risk. SUMMARY OF BACKGROUND DATA The standard prophylaxis for postoperative VTE is insufficient in extremely high-risk patients. It is unclear whether an adjunctive use of IPC would result in a lower incidence of postoperative venous thrombosis. METHODS We randomly assigned patients who underwent major surgery and had a Caprini score of ≥11 to receive either IPC in addition to standard prophylaxis with anti-embolic stockings (pressure of 18-21 mm Hg at the ankle) and low-molecular-weight heparin (IPC group) or standard prophylaxis alone (control group). The primary outcome was an asymptomatic venous thrombosis of the lower limbs, as detected by duplex ultrasound scan performed before inclusion and every 3-5 days after surgery. RESULTS A total of 407 patients underwent randomization, of which 204 were assigned to the IPC group and 203 to the control group. The primary outcome occurred in 1 (0.5%) patient in the IPC group and 34 (16.7%) patients in the control group [relative risk, 0.03, 95% confidential interval (CI): 0.01-0.21]. Pulmonary embolism occurred in none of the 204 patients in the IPC group and in 5 (2.5%) patients in the control group (relative risk, 0.09; 95% CI, 0.01-1.63), and postoperative death occurred in 6 (2.9%) patients in the IPC group and 10 (4.9%) in the control group (relative risk, 0.50; 95% CI, 0.50-1.60). CONCLUSIONS Among patients with a Caprini score of ≥11 who received standard prophylaxis for VTE, adjunctive IPC resulted in a significantly lower incidence of asymptomatic venous thrombosis.
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Affiliation(s)
- Kirill Lobastov
- Department of General Surgery and Radiology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Ekaterina Sautina
- Department of General Surgery and Radiology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Eleanora Alencheva
- Department of Surgery and Endoscopy, Central State Medical Academy of the Presidents Administration of the Russian Federation, Moscow, Russian Federation
| | - Astanda Bargandzhiya
- Department of General Surgery and Radiology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Ilya Schastlivtsev
- Department of General Surgery and Radiology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Victor Barinov
- Department of Surgery and Endoscopy, Central State Medical Academy of the Presidents Administration of the Russian Federation, Moscow, Russian Federation
| | - Leonid Laberko
- Department of General Surgery and Radiology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Grigoriy Rodoman
- Department of General Surgery and Radiology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Valeriy Boyarintsev
- Department of Surgery and Endoscopy, Central State Medical Academy of the Presidents Administration of the Russian Federation, Moscow, Russian Federation
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23
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Ahmad DS, Mansoor E, Alikhan MM, Rana MN, Panhwar MS, Wong RCK, Smith ZL. Risk of Venous Thromboembolism in Acute Necrotizing Pancreatitis: A Large Database Study. Pancreas 2021; 50:71-76. [PMID: 33370025 DOI: 10.1097/mpa.0000000000001714] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Studies on the incidence of venous thromboembolism (VTE) in acute pancreatitis (AP) are scarce. We conducted a large database study to evaluate this relationship. METHODS Data were extracted from a large electronic health record (Explorys; IBM Watson Health, Armonk, NY). We identified patients with AP in 2018 and 2019, analyzing VTE incidence at 30 days after diagnosis of AP. Univariate and multivariate analyses were performed to identify risk factors associated with VTE. RESULTS A total of 25,620 cases of acute necrotizing pancreatitis (ANP) and 155,800 cases of acute nonnecrotizing pancreatitis (ANNP) were identified. The incidence of VTE was 7.1% for ANP, compared with 2.8% in ANNP (P < 0.001). On multivariate analysis, ANP conferred significantly greater odds of VTE (adjusted odds ratio, 2.78; 95% confidence interval, 2.73-2.84; P < 0.001), independent of other variables. In those with ANP, the presence of VTE was associated with a significantly higher mortality (23.5% vs 15.9%, P < 0.001). CONCLUSIONS Acute necrotizing pancreatitis carries near 2.5-fold risk of VTE, and a 3-fold risk of PE, compared with those with ANNP. Venous thromboembolism development in ANP is associated with higher mortality.
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Affiliation(s)
- Dina S Ahmad
- From the Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, TN
| | - Emad Mansoor
- Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Muhammed M Alikhan
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Mariam Nadeem Rana
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Muhammad Siyab Panhwar
- Department of Cardiology, Tulane University Heart and Vascular Institute, New Orleans, LA
| | - Richard C K Wong
- Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Zachary L Smith
- Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Cleveland, OH
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24
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Abstract
OBJECTIVES This study aimed to quantify the prevalence of venous thromboembolic (VTE) events in patients with pancreatitis requiring hospitalization and its impact on outcomes. METHODS Adult patients admitted from 2011 to 2018 for pancreatitis were identified. Every admission for pancreatitis in the first year after diagnosis was evaluated for a VTE (pulmonary embolism, deep vein thrombosis, or mesenteric vessel thrombosis) within 30 days of discharge. Characteristics of patients who developed a thromboembolic event were compared with those who did not. RESULTS There were 4613 patients with pancreatitis identified, 301 of whom developed a VTE (6.5%). Patients who developed a VTE were more likely to be male (P < 0.01), older (P = 0.03), and have an underlying coagulopathy (P < 0.01). Those with VTEs were more likely to die (27% vs 13%, P < 0.01), have more readmissions for pancreatitis (1.7 vs 1.3, P < 0.01), longer length of stay (16 vs 5.5 days, P < 0.01), and be discharged to acute or long-term rehabilitation rather than home (P < 0.01). CONCLUSIONS Acute pancreatitis requiring hospitalization is associated with high risk of VTE in the first year after diagnosis. Thromboembolic disease is associated with worse morbidity and mortality.
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25
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Bae DH, Lee WJ, Shin YM. Incidence of Major Bleeding in Patients with Pulmonary Thromboembolism Treated with Fixed Dose Alteplase 100 mg. J Korean Med Sci 2020; 35:e267. [PMID: 32830464 PMCID: PMC7445310 DOI: 10.3346/jkms.2020.35.e267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/30/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Acute pulmonary thromboembolism (PTE) is a critical cardiopulmonary condition associated with high mortality and morbidity. In massive PTE, recently referred to as high risk PTE, the routine protocol for thrombolysis with recombinant tissue plasminogen activator (alteplase) is 100 mg over 2 hours. However, there are concerns about bleeding in patients with low body weight (< 50 kg), elderly patients, and Asians. METHOD We performed a retrospective study in patients who were diagnosed with intermediate or high risk PTE, and who were treated with a fixed dose of alteplase (100 mg) in a single center at Chungbuk National University Hospital between July 2008 and April 2018. RESULTS A total of 42 patients were reviewed, 4 patients dropped out, and 38 patients were included in the analysis. There were 18 males (47.4%), and the average age of the patients was 70.68 years (± standard deviation 13.15). Major bleeding was seen in 10/38 patients (26.3%), and 30/38 patients (78.9%) were successfully discharged. CONCLUSION The major bleeding risk was higher in our study (26.3%) than in a previously published meta-analysis (9.24%). Therefore, we suggest reducing the dose of alteplase in patients who are elderly, Asian, or have cardiovascular disease. Further prospective studies of efficacy and bleeding rate after low dose alteplase should be considered.
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Affiliation(s)
- Dae Hwan Bae
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Won Jae Lee
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yoon Mi Shin
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
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26
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Ierardi AM, Coppola A, Fusco S, Stellato E, Aliberti S, Andrisani MC, Vespro V, Arrichiello A, Panigada M, Monzani V, Grasselli G, Venturini M, Rehani B, Peyvandi F, Pesenti A, Blasi F, Carrafiello G. Early detection of deep vein thrombosis in patients with coronavirus disease 2019: who to screen and who not to with Doppler ultrasound? J Ultrasound 2020; 24:165-173. [PMID: 32809207 PMCID: PMC7431752 DOI: 10.1007/s40477-020-00515-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Aim of the study is to evaluate the incidence of DVT in COVID-19 patients and its correlation with the severity of the disease and with clinical and laboratory findings. METHODS 234 symptomatic patients with COVID-19, diagnosed according to the World Health Organization guidelines, were included in the study. The severity of the disease was classified as moderate, severe and critical. Doppler ultrasound (DUS) was performed in all patients. DUS findings, clinical, laboratory's and therapeutic variables were investigated by contingency tables, Pearson chi square test and by Student t test and Fisher's exact test. ROC curve analysis was applied to study significant continuous variables. RESULTS Overall incidence of DVT was 10.7% (25/234): 1.6% (1/60) among moderate cases, 13.8% (24/174) in severely and critically ill patients. Prolonged bedrest and intensive care unit admission were significantly associated with the presence of DVT (19.7%). Fraction of inspired oxygen, P/F ratio, respiratory rate, heparin administration, D-dimer, IL-6, ferritin and CRP showed correlation with DVT. CONCLUSION DUS may be considered a useful and valid tool for early identification of DVT. In less severely affected patients, DUS as screening of DVT might be unnecessary. High rate of DVT found in severe patients and its correlation with respiratory parameters and some significant laboratory findings suggests that these can be used as a screening tool for patients who should be getting DUS.
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Affiliation(s)
- Anna Maria Ierardi
- Radiology Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
| | - Andrea Coppola
- Radiology Unit, Ospedale di Circolo e Fondazione Macchi, Insubria University, Varese, Italy
| | - Stefano Fusco
- Radiology Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Elvira Stellato
- Radiology Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Stefano Aliberti
- UOC Pneumologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy
| | - Maria Carmela Andrisani
- Radiology Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Valentina Vespro
- Radiology Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Antonio Arrichiello
- Radiology Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Mauro Panigada
- Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore, Milan, Italy
| | - Valter Monzani
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Grasselli
- Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy
| | - Massimo Venturini
- Radiology Unit, Ospedale di Circolo e Fondazione Macchi, Insubria University, Varese, Italy
| | - Bhavya Rehani
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Luigi Villa, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy
| | - Antonio Pesenti
- Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy
| | - Francesco Blasi
- UOC Pneumologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy
| | - Gianpaolo Carrafiello
- Radiology Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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27
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Dong F, Zhen K, Zhang Z, Si C, Xia J, Zhang T, Xia L, Wang W, Jia C, Shan G, Zhai Z, Wang C. Effect on thromboprophylaxis among hospitalized patients using a system-wide multifaceted quality improvement intervention: Rationale and design for a multicenter cluster randomized clinical trial in China. Am Heart J 2020; 225:44-54. [PMID: 32474204 PMCID: PMC7204686 DOI: 10.1016/j.ahj.2020.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/25/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a life-threatening disease that can affect each hospitalized patient. But the current in-hospital thromboprophylaxis remains suboptimal and there exists a large gap between clinical practice and guideline-recommended care in China. METHODS To facilitate implementation of guideline recommendations, we conduct a multicenter, adjudicator-blinded, cluster-randomized clinical trial, aiming to assess the effectiveness of a system-wide multifaceted quality improvement (QI) strategy on VTE prophylaxis improvement and thromboembolism reduction in clinical setting. Hospitals are randomized into intervention or control group. In intervention group, hospitals receive the concept of appropriate in-hospital thromboprophylaxis plus a multifaceted QI which encompasses four components: (1) an electronic alert combining computer-based clinical decision support system and electronic reminders, (2) appropriate prophylaxis based on dynamic VTE and bleeding risk assessments, (3) periodical audit and interactive feedback on performance, (4) strengthened training and patient education. In control, hospitals receive the concept of recommended prophylaxis alone without QI. Thromboprophylaxis will be at the discretion of hospitals and conducted as usual. With a final sample size of 5760 hospitalized patients in 32 hospitals on mainland China, this trial will examine the effect of QI on improvement in thromboprophylaxis and patient-centered outcomes. This is an open-label trial that patients and healthcare professionals will know group allocation after enrollment, but endpoint adjudicators and statisticians will be blinded. RCT# NCT04211181 CONCLUSIONS: The system-wide multifaceted QI intervention is expected to facilitate implementation of recommended VTE prophylaxis in hospital, thereafter reducing VTE incidence and relevant adverse events among hospitalized patients in China.
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Affiliation(s)
- Fen Dong
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Kaiyuan Zhen
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Zhu Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chaozeng Si
- Department of information management, China-Japan Friendship Hospital, Beijing, China
| | - Jiefeng Xia
- Department of information management, China-Japan Friendship Hospital, Beijing, China
| | - Tieshan Zhang
- Department of information management, China-Japan Friendship Hospital, Beijing, China
| | - Lei Xia
- Medical Affairs Department of China-Japan Friendship Hospital, Beijing, China
| | - Wei Wang
- Department of Nursing, China-Japan Friendship Hospital, Beijing, China
| | - Cunbo Jia
- China-Japan Friendship Hospital, Beijing, China
| | - Guangliang Shan
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Zhenguo Zhai
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China.
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kirchberger I, Ruile S, Linseisen J, Haberl S, Meisinger C, Berghaus TM. The lived experience with pulmonary embolism: A qualitative study using focus groups. Respir Med 2020; 167:105978. [DOI: 10.1016/j.rmed.2020.105978] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/25/2020] [Accepted: 04/13/2020] [Indexed: 12/24/2022]
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Shen C, Ge B, Liu X, Chen H, Qin Y, Shen H. Predicting the occurrence of venous thromboembolism: construction and verification of risk warning model. BMC Cardiovasc Disord 2020; 20:249. [PMID: 32460701 PMCID: PMC7251685 DOI: 10.1186/s12872-020-01519-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/10/2020] [Indexed: 12/12/2022] Open
Abstract
Background The onset of venous thromboembolism is insidious and the prognosis is poor. In this study, we aimed to construct a VTE risk warning model and testified its clinical application value. Methods Preliminary construction of the VTE risk warning model was carried out according to the independent risk warning indicators of VTE screened by Logistic regression analysis. The truncated value of screening VTE was obtained and the model was evaluated. ROC curve analysis was used to compare the test of Caprini risk assessment scale and VTE risk warning model. The cut-off value of the VTE risk warning model was used to evaluate the test effectiveness of the model for VTE patients with validation data set. Results The VTE risk warning model is p = ex / (1+ ex), x = − 4.840 + 2.557 • X10(1) + 1.432 • X14(1) + 2.977 • X15(1) + 3.445 • X18(1) + 1.086 • X25(1) + 0.249 • X34 + 0.282 • X41. ROC curve results show that: AUC (95%CI), cutoff value, sensitivity, specificity, accuracy, Youden index, Caprini risk assessment scale is 0.596 (0.552, 0.638), 5, 26.07, 96.50, 61.3%, 0.226, VTE risk warning model is 0.960 (0.940, 0.976), 0.438, 92.61, 91.83, 92.2%, 0.844, respectively, with statistically significant differences (Z = 14.521, P < 0.0001). The accuracy and Youden index of VTE screening using VTE risk warning model were 81.8 and 62.5%, respectively. Conclusions VTE risk warning model had high accuracy in predicting VTE occurrence in hospitalized patients. Its test performance was better than Caprini risk assessment scale. It also had high test performance in external population.
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Affiliation(s)
- Chen Shen
- Department of Nursing, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong City, 226000, Jiangsu, China
| | - Binqian Ge
- School of Nursing, Suzhou Vocational Health College, 28 Kehua Road, Suzhou City, 215009, Jiangsu, China
| | - Xiaoqin Liu
- Department of Nursing, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong City, 226000, Jiangsu, China
| | - Hao Chen
- Department of Information, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong City, 226000, Jiangsu, China
| | - Yi Qin
- Department of Nursing, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong City, 226000, Jiangsu, China
| | - Hongwu Shen
- Department of Nursing, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong City, 226000, Jiangsu, China.
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Hammons L, Filopei J, Steiger D, Bondarsky E. A narrative review of red blood cell distribution width as a marker for pulmonary embolism. J Thromb Thrombolysis 2020; 48:638-647. [PMID: 31228037 DOI: 10.1007/s11239-019-01906-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Red blood cell distribution width (RDW) is a marker of variability in red blood cell size, and is routinely reported as part of a patient's complete blood count. RDW has been shown to be associated with the prediction, severity and prognosis of pulmonary embolism (PE) in recent studies. The underlying biomolecular mechanism of the relationship of RDW to PE is largely unknown, but is thought to be due to the relationship of RDW with acute inflammatory markers and variations in blood viscosity. This review substantiates that a high RDW level, defined using either an arbitrary number or according to receiver operator curve statistics, is associated with a higher risk of acute PE, increased severity (massive vs. submassive) of PE and increased mortality in patients with PE. Nevertheless, the comparison of current studies is limited due to the definition of high RDW (each study uses a different RDW cutoff level), the broad range of exclusion criteria and the inclusion of differing modalities used to diagnose a PE (computed tomography angiogram, ventilation-perfusion study, or clinical diagnosis). Despite the above limitations, these studies provide a promising future clinical use for RDW as a marker of PE.
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Affiliation(s)
- Lindsay Hammons
- Department of Internal Medicine, Mount Sinai Beth Israel, New York City, USA.
| | - Jason Filopei
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Beth Israel, New York City, USA
| | - David Steiger
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Beth Israel, New York City, USA
| | - Eric Bondarsky
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University, New York City, USA
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Haque A, Minhaj A, Ahmed A, Khan O, Qasim P, Fareed H, Nazir F, Asghar A, Ali K, Mansoor S. A meta-analysis to estimate the incidence of thromboembolism in hospitalized COVID-19 patients. AIMS MEDICAL SCIENCE 2020. [DOI: 10.3934/medsci.2020020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Venous Thromboembolism in Necrotizing Pancreatitis: an Underappreciated Risk. J Gastrointest Surg 2019; 23:2430-2438. [PMID: 30734182 DOI: 10.1007/s11605-019-04124-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 01/14/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Necrotizing pancreatitis (NP) is a severe systemic inflammatory process. We have observed a high incidence of venous thromboembolism (VTE) in NP patients. However, remarkably few data exist to document the true incidence of VTE-including splanchnic vein thrombosis (SVT), extremity deep venous thrombosis (eDVT), and pulmonary embolism (PE)-in NP. Therefore, we sought to determine the incidence and risk factors for VTE in NP patients. METHODS Retrospective review of all NP patients treated at a single academic center between 2005 and 2015. VTE diagnosis was confirmed by ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and/or ventilation/perfusion (V/Q) scan. Descriptive statistics and univariate analysis were applied where appropriate; p value < 0.05 was considered statistically significant. RESULTS Five hundred and forty-five NP patients (median age 53 years; 65% males) were reviewed. VTE was diagnosed in 312 patients (57%). SVT was found in 50%, eDVT in 16%, and PE in 6%. VTE in multiple sites was found in 22% of patients. VTE was diagnosed a median of 37 days following pancreatitis diagnosis. Seventy-nine percent of patients required at least one surgical procedure over the course of their NP. Patients requiring surgery had a DVT incidence of 58%; however, VTE was diagnosed preoperatively in 63%. Male gender, history of previous DVT, infected necrosis, development of organ failure, and development of respiratory failure were identified as risk factors for VTE (p = 0.001-0.04) by univariate analysis. CONCLUSIONS Venous thromboembolism is extremely common in necrotizing pancreatitis. Regular ultrasound screening may be considered to facilitate early diagnosis in this extremely high-risk population.
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Meisinger C, Linseisen J, Kirchberger I, von Scheidt W, Berghaus TM. Long-term outcomes in patients with acute pulmonary embolism after in-hospital treatment: study protocol of the prospective Lungenembolie Augsburg Studie (LEA study). BMJ Open 2019; 9:e031411. [PMID: 31662388 PMCID: PMC6830593 DOI: 10.1136/bmjopen-2019-031411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/17/2019] [Accepted: 09/30/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Acute pulmonary embolism (PE) is a frequent life-threatening event and an important cause of hospitalisation, morbidity and mortality worldwide. Limited information on the long-term course of PE patients is available so far. The Lungenembolie Augsburg study will provide a view on the predisposing and PE-provoking factors, diagnostic procedures and short as well as long-term treatment options. Especially, the data on the long-term course of the disease-in combination with omics data obtained in biospecimens-will generate new knowledge regarding triggers, disease progression, treatment, long-term sequelae, prognosis and prevention of disease recurrence. METHODS AND ANALYSIS In this prospective study, we will include about 1000 patients admitted to the university hospital of Augsburg, aged 18 years and older with a confirmed diagnosis of acute PE. At baseline, demographic information, symptoms on presentation, delay in diagnosis, predisposing and PE-provoking factors, comorbidity, quality of life, symptoms of anxiety and depression, information on invasive and non-invasive treatment procedures, complications and laboratory parameters will be collected. During the hospital stay, 30 mL blood will be collected from the patients, processed, aliquoted and frozen at -80°C. In a subgroup of patients, an eight-channel polygraphy will be carried out to assess sleep-disordered breathing. All study participants will be followed up for 60 months via postal questionnaires or telephone interviews after hospital discharge. Long-term survival, bleeding complications and PE recurrence during the follow-up are the primary study outcomes. To identify risk factors and determinants associated with these outcomes, confounder-adjusted Cox-regressions will be used for modelling and to estimate relative risks. Effect modification by age and sex will be examined. ETHICS AND DISSEMINATION The study protocol was approved by the Ethics Committee of the Ludwig-Maximilians-Universität München (Date of approval: 1 August 2017, Reference number: 17-378). Study results will be presented at national and international conferences and published in peer-reviewed scientific journals.
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Affiliation(s)
- Christa Meisinger
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Chair of Epidemiology at UNIKA-T, Ludwig-Maximilians-Universitat Munchen, Augsburg, Germany
| | - Jakob Linseisen
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Chair of Epidemiology at UNIKA-T, Ludwig-Maximilians-Universitat Munchen, Augsburg, Germany
| | - Inge Kirchberger
- Chair of Epidemiology at UNIKA-T, Ludwig-Maximilians-Universitat Munchen, Augsburg, Germany
| | - Wolfgang von Scheidt
- Department of Cardiology, Respiratory Medicine and Intensive Care, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Thomas M Berghaus
- Department of Cardiology, Respiratory Medicine and Intensive Care, Universitätsklinikum Augsburg, Augsburg, Germany
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Abstract
Pulmonary embolism (PE) presents a spectrum of hemodynamic consequences, ranging from being asymptomatic to a life-threatening medical emergency. Management of submassive and massive PE often involves clinicians from multiple specialties, which can potentially delay the development of a unified treatment plan. In addition, patients with submassive PE can deteriorate after their presentation and require escalation of care. Underlying comorbidities such as chronic obstructive pulmonary disease, cancer, congestive heart failure, and interstitial lung disease can impact the patient's hemodynamic ability to tolerate submassive PE. In this review, we address the definitions, risk stratification (clinical, laboratory, and imaging), management approaches, and long-term outcomes of submassive PE. We also discuss the role of the PE response team in management of patients with PE.
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Affiliation(s)
- Parth M Rali
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
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Utilization of the Caprini score in conjunction with thrombodynamic testing reduces the number of unpredicted postoperative venous thromboembolism events in patients with colorectal cancer. J Vasc Surg Venous Lymphat Disord 2019; 8:31-41. [PMID: 31495765 DOI: 10.1016/j.jvsv.2019.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/09/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND The thrombodynamic test (TD) is a novel global test of hemostasis that allows to study the spatial-temporal characteristics of a clot formation in real time under conditions close to natural ones and demonstrates high sensitivity to detect the state of hypercoagulation. The main paraments of the test are the velocity of clot growth, clot's size, and clot density. The objective of this study was to compare the classic Caprini 2005 score and its modified version in association with the results of TD. The goal is to predict postoperative venous thromboembolism (VTE) in surgical patients undergoing surgery for colorectal cancer. METHODS This was a prospective observational clinical study involving 80 patients (33 men and 47 women; mean age, 73.9 ± 7.2 years) who underwent major (79 cases) or minor (1 case) surgery for colorectal cancer. Patients were at high risk for postoperative VTE (ie, a mean Caprini score of 9.9 ± 2.0) and received combined prophylaxis (ie, antiembolic compression stockings and enoxaparin 40 mg once daily) until discharge. Enoxaparin was administered at a fixed time of blood sampling for the TD test. Duplex ultrasound scan was performed to detect postoperative vein thrombosis before and 5 to 7 days after surgery. RESULTS Postoperative vein thrombosis was found in 21 of 80 patients (26.3%; 95% confidence interval, 17.9%-36.8%). Regression analysis and receiver operating characteristic (ROC) curve showed that Caprini scores significantly predicted VTE (P < .0001; area under the curve [AUC] = 0.839 ± 0.045). Analysis of ROC curve coordinates showed that a cutoff point of 11 scores had a sensitivity of 76.2% and a specificity of 74.6%. The results of the TD test showed significant hypercoagulation despite enoxaparin administration in patients with VTE. Regression analysis and ROC curves demonstrated that the following TD parameters had the greatest predictability for postoperative DVT: initial velocity of clot growth (Vin) and clot size (CS) measured at 12 hours after enoxaparin administration (AUC, 0.697 ± 0.063 and AUC, 0.790 ± 0.059, respectively), as well as Vin and CS measured 24 hours after the enoxaparin injection (S = 0.847 ± 0.059 and S = 0.803 ± 0.069, respectively). The cutoff points for VTE prediction at 12 and 24 hours seemed to be a Vin of greater than 62.5 and greater than 64.5 μm/minute (normal range, 35-56 μm/minute) as well as a CS of greater than 1351.5 and greater than 1333.5 μm (normal range, 800-1200 μm), respectively. Identified thresholds for TD parameters have been integrated into Caprini scores under the item "other congenital or acquired thrombophilia." The total Caprini scores were recalculated in patients where one or all TD parameters had exceeded the cutoff followed by reanalysis of the ROC curves. The best predictability was found for Caprini scores considering the elevation of all four TD parameters (AUC, 0.924 ± 0.029) with increased cutoff to a score of 12 with a sensitivity of 85.7% and a specificity of 81.4%. The use of cutoffs for the original and modified scores could be used to calculate the number of patients that were under cutoff but developed with VTE: 10.2% and 5.9%, respectively. CONCLUSIONS Integrating TD parameters into the Caprini score increases the ability to predict postoperative VTE.
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Schünemann HJ, Cushman M, Burnett AE, Kahn SR, Beyer-Westendorf J, Spencer FA, Rezende SM, Zakai NA, Bauer KA, Dentali F, Lansing J, Balduzzi S, Darzi A, Morgano GP, Neumann I, Nieuwlaat R, Yepes-Nuñez JJ, Zhang Y, Wiercioch W. American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv 2018; 2:3198-3225. [PMID: 30482763 PMCID: PMC6258910 DOI: 10.1182/bloodadvances.2018022954] [Citation(s) in RCA: 538] [Impact Index Per Article: 76.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/19/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is the third most common vascular disease. Medical inpatients, long-term care residents, persons with minor injuries, and long-distance travelers are at increased risk. OBJECTIVE These evidence-based guidelines from the American Society of Hematology (ASH) intend to support patients, clinicians, and others in decisions about preventing VTE in these groups. METHODS ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline-development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and adult patients. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess evidence and make recommendations, which were subject to public comment. RESULTS The panel agreed on 19 recommendations for acutely ill and critically ill medical inpatients, people in long-term care facilities, outpatients with minor injuries, and long-distance travelers. CONCLUSIONS Strong recommendations included provision of pharmacological VTE prophylaxis in acutely or critically ill inpatients at acceptable bleeding risk, use of mechanical prophylaxis when bleeding risk is unacceptable, against the use of direct oral anticoagulants during hospitalization, and against extending pharmacological prophylaxis after hospital discharge. Conditional recommendations included not to use VTE prophylaxis routinely in long-term care patients or outpatients with minor VTE risk factors. The panel conditionally recommended use of graduated compression stockings or low-molecular-weight heparin in long-distance travelers only if they are at high risk for VTE.
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Affiliation(s)
- Holger J Schünemann
- Department of Medicine and
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Mary Cushman
- Department of Medicine and
- Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine and University of Vermont Medical Center, Burlington, VT
| | - Allison E Burnett
- Inpatient Antithrombosis Service, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Susan R Kahn
- Department of Medicine, McGill University and Lady Davis Institute, Montreal, QC, Canada
| | - Jan Beyer-Westendorf
- Thrombosis Research Unit, Division of Hematology, Department of Medicine I, University Hospital "Carl Gustav Carus," Dresden, Germany
- Kings Thrombosis Service, Department of Hematology, Kings College London, United Kingdom
| | | | - Suely M Rezende
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Neil A Zakai
- Department of Medicine and
- Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine and University of Vermont Medical Center, Burlington, VT
| | - Kenneth A Bauer
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Francesco Dentali
- Department of Medicine and Surgery, Insubria University, Varese, Italy
| | | | - Sara Balduzzi
- Cochrane Italy, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy; and
| | - Andrea Darzi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Gian Paolo Morgano
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Ignacio Neumann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Internal Medicine, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Robby Nieuwlaat
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Juan J Yepes-Nuñez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Yuan Zhang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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National and Regional Trends in Deep Vein Thrombosis Hospitalization Rates, Discharge Disposition, and Outcomes for Medicare Beneficiaries. Am J Med 2018; 131:1200-1208. [PMID: 29753792 PMCID: PMC7040884 DOI: 10.1016/j.amjmed.2018.04.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Older adults are at increased risk of developing deep vein thrombosis. Little is known about national trends of deep vein thrombosis hospitalizations in the context of primary and secondary prevention efforts. METHODS Medicare standard analytic files were analyzed from 2015-2017 to identify Fee-For-Service patients aged ≥65 years who had a principal discharge diagnosis for deep vein thrombosis from 1999 to 2010. We reported the deep vein thrombosis hospitalization rates per 100,000 person-years as well as 30-day and 1-year mortality rates. We used mixed-effects models to calculate adjusted outcomes. RESULTS Overall, there were 726,423 deep vein thrombosis hospitalizations in Medicare Fee-for-Service from 1999 to 2010. Deep vein thrombosis hospitalization rate adjusted for age, sex, and race decreased from 264 per 100,000 person-years in 1999 to 167 per 100,000 person-years in 2010, a relative decline of 36.7% (P < .0001). Hospitalizations decreased for all subgroups by age, sex, and race with the exception of black patients (316 to 382 per 100,000 person-years, a relative increase of 20.8%) (P < .0001). Hospital length of stay decreased from 6.1 days in 1999 to 5.0 days in 2010, and the proportion of patients discharged to home decreased from 57.2% to 44.1%. Risk-adjusted 30-day, 6-month, and 1-year mortality and 30-day readmission rates remained relatively stable across the study period, but were highest among women in recent years. CONCLUSIONS The overall deep vein thrombosis hospitalization rate decreased from 1999 to 2010, except for black patients. Decreases in hospitalizations may reflect changes in clinical practice with increased outpatient rather than inpatient management, and faster transitions to outpatient care for management of deep vein thrombosis.
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Meel S, Peter A, Menezes C. The clinical features and management of pulmonary embolism at Chris Hani Baragwanath Academic Hospital. Afr J Thorac Crit Care Med 2018; 24:10.7196/AJTCCM.2018.v24i3.195. [PMID: 34541509 PMCID: PMC8424778 DOI: 10.7196/ajtccm.2018.v24i3.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Pulmonary embolism (PE) is the most common cause of preventable deaths in hospitalised patients. OBJECTIVES To determine the prevalence and associated features of PE at Chris Hani Baragwanath Academic Hospital (CHBAH) over a period of one year. METHODS A retrospective study was performed of patients with acute PE, as confirmed by computed tomography of the pulmonary arteries (CTPA). RESULTS A total of 498 CTPAs were requested during the study period. PE was confirmed in 147 (30%) of these cases. The mean age of the patients with PE was 46.8 (15.5) years. More than 40% of the patients with PE were HIV positive, of whom more than 60% had a CD4 count <200 cells/µL. Wells' and revised Geneva scores indicated comparable clinical probability of PE. Only 15% of the patients with highrisk PE were thrombolysed, with no documented complications. There were clear contraindications for thrombolysis in only two cases, but no reasons were stated for the other cases where thrombolysis was not utilised. None of the patients had a surgical or percutaneous embolectomy. A mortality rate of 24% was found among patients diagnosed with a PE; of these, 13 (46%) presented with high-risk PE and 2 were thrombolysed. Age >40 years was the only significant predictor of mortality, as indicated by both univariate and multivariate analyses. CONCLUSION PE is a common medical condition at CHBAH. The heavy infectious disease burden in the South African setting makes the diagnosis of PE challenging. Its management needs further optimisation to improve clinical outcomes.
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Affiliation(s)
- S Meel
- Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - A Peter
- Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - C Menezes
- Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
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Gao H, Liu H, Li Y. Value of D-dimer levels for the diagnosis of pulmonary embolism: An analysis of 32 cases with computed tomography pulmonary angiography. Exp Ther Med 2018; 16:1554-1560. [PMID: 30112074 DOI: 10.3892/etm.2018.6314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/06/2018] [Indexed: 12/15/2022] Open
Abstract
D-dimer levels correlate with the extent of pulmonary embolism (PE) on computed tomography pulmonary angiography (CTPA), but the use of D-dimer alone for screening and diagnosing PE remains controversial. This study compared the utility of plasma D-dimer levels for diagnosing PE with that of CTPA (gold standard). This was a retrospective analysis of 32 consecutive patients with suspected PE at the Affiliated Hospital of Yan'an University between OctoberC 2010 and March 2011. Blood was sampled before thrombolytic therapy was administered. D-dimer levels were measured using an automatic system. CTPA was used to diagnose PE and was performed within 48 h of blood sampling using a Siemens Somatom Sensation 64 computed tomography (CT) scanner. ROC curve analysis was performed to evaluate the diagnostic utility of D-dimer levels, with CTPA as the gold standard. Among the 32 patients, CTPA identified 26 patients with PE and 6 patients without obvious abnormality. Using a threshold value of 1.3 µg/ml for D-dimer level, the diagnosis of PE was achieved with a sensitivity of 96.2%, specificity of 50.0%, positive predictive value of 89.3%, negative predictive value of 75.0% and accuracy of 87.5%. D-dimer levels were significantly higher in patients positive for PE on CTPA than in those negative for PE on CTPA (9.85±7.14 vs. 2.82±2.65 µg/ml, P=0.001). Based on ROC curve analysis, the optimal threshold value for D-dimer level in the diagnosis of PE was 1.9 µg/ml. To conclude, D-dimer could be a simple, fast and inexpensive screening method for excluding a diagnosis of PE.
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Affiliation(s)
- Hui Gao
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.,Department of Radiology, The Affiliated Hospital of Yan'an University, Yan'an, Shaanxi 716000, P.R. China
| | - Hu Liu
- Cardiovascular Medicine Center, The Affiliated Hospital of Yan'an University, Yan'an, Shaanxi 716000, P.R. China
| | - Yanjing Li
- Department of Radiology, The Affiliated Hospital of Yan'an University, Yan'an, Shaanxi 716000, P.R. China
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Kahn SR, Morrison DR, Diendéré G, Piché A, Filion KB, Klil‐Drori AJ, Douketis JD, Emed J, Roussin A, Tagalakis V, Morris M, Geerts W, Cochrane Vascular Group. Interventions for implementation of thromboprophylaxis in hospitalized patients at risk for venous thromboembolism. Cochrane Database Syst Rev 2018; 4:CD008201. [PMID: 29687454 PMCID: PMC6747554 DOI: 10.1002/14651858.cd008201.pub3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in hospitalized patients. While numerous randomized controlled trials (RCTs) have shown that the appropriate use of thromboprophylaxis in hospitalized patients at risk for VTE is safe, effective, and cost-effective, thromboprophylaxis remains underused or inappropriately used. Our previous review suggested that system-wide interventions, such as education, alerts, and multifaceted interventions were more effective at improving the prescribing of thromboprophylaxis than relying on individual providers' behaviors. However, 47 of the 55 included studies in our previous review were observational in design. Thus, an update to our systematic review, focused on the higher level of evidence of RCTs only, was warranted. OBJECTIVES To assess the effects of system-wide interventions designed to increase the implementation of thromboprophylaxis and decrease the incidence of VTE in hospitalized adult medical and surgical patients at risk for VTE, focusing on RCTs only. SEARCH METHODS Our research librarian conducted a systematic literature search of MEDLINE Ovid, and subsequently translated it to CENTRAL, PubMed, Embase Ovid, BIOSIS Previews Ovid, CINAHL, Web of Science, the Database of Abstracts of Reviews of Effects (DARE; in the Cochrane Library), NHS Economic Evaluation Database (EED; in the Cochrane Library), LILACS, and clinicaltrials.gov from inception to 7 January 2017. We also screened reference lists of relevant review articles. We identified 12,920 potentially relevant records. SELECTION CRITERIA We included all types of RCTs, with random or quasi-random methods of allocation of interventions, which either randomized individuals (e.g. parallel group, cross-over, or factorial design RCTs), or groups of individuals (cluster RCTs (CRTs)), which aimed to increase the use of prophylaxis or appropriate prophylaxis, or decrease the occurrence of VTE in hospitalized adult patients. We excluded observational studies, studies in which the intervention was simply distribution of published guidelines, and studies whose interventions were not clearly described. Studies could be in any language. DATA COLLECTION AND ANALYSIS We collected data on the following outcomes: the number of participants who received prophylaxis or appropriate prophylaxis (as defined by study authors), the occurrence of any VTE (symptomatic or asymptomatic), mortality, and safety outcomes, such as bleeding. We categorized the interventions into alerts (computer or human alerts), multifaceted interventions (combination of interventions that could include an alert component), educational interventions (e.g. grand rounds, courses), and preprinted orders (written predefined orders completed by the physician on paper or electronically). We meta-analyzed data across RCTs using a random-effects model. For CRTs, we pooled effect estimates (risk difference (RD) and risk ratio (RR), with 95% confidence interval (CI), adjusted for clustering, when possible. We pooled results if three or more trials were available for a particular intervention. We assessed the certainty of the evidence according to the GRADE approach. MAIN RESULTS From the 12,920 records identified by our search, we included 13 RCTs (N = 35,997 participants) in our qualitative analysis and 11 RCTs (N = 33,207 participants) in our meta-analyses. PRIMARY OUTCOME Alerts were associated with an increase in the proportion of participants who received prophylaxis (RD 21%, 95% CI 15% to 27%; three studies; 5057 participants; I² = 75%; low-certainty evidence). The substantial statistical heterogeneity may be in part explained by patient types, type of hospital, and type of alert. Subgroup analyses were not feasible due to the small number of studies included in the meta-analysis.Multifaceted interventions were associated with a small increase in the proportion of participants who received prophylaxis (cluster-adjusted RD 4%, 95% CI 2% to 6%; five studies; 9198 participants; I² = 0%; moderate-certainty evidence). Multifaceted interventions with an alert component were found to be more effective than multifaceted interventions that did not include an alert, although there were not enough studies to conduct a pooled analysis. SECONDARY OUTCOMES Alerts were associated with an increase in the proportion of participants who received appropriate prophylaxis (RD 16%, 95% CI 12% to 20%; three studies; 1820 participants; I² = 0; moderate-certainty evidence). Alerts were also associated with a reduction in the rate of symptomatic VTE at three months (RR 64%, 95% CI 47% to 86%; three studies; 5353 participants; I² = 15%; low-certainty evidence). Computer alerts were associated with a reduction in the rate of symptomatic VTE, although there were not enough studies to pool computer alerts and human alerts results separately. AUTHORS' CONCLUSIONS We reviewed RCTs that implemented a variety of system-wide strategies aimed at improving thromboprophylaxis in hospitalized patients. We found increased prescription of prophylaxis associated with alerts and multifaceted interventions, and increased prescription of appropriate prophylaxis associated with alerts. While multifaceted interventions were found to be less effective than alerts, a multifaceted intervention with an alert was more effective than one without an alert. Alerts, particularly computer alerts, were associated with a reduction in symptomatic VTE at three months, although there were not enough studies to pool computer alerts and human alerts results separately.Our analysis was underpowered to assess the effect on mortality and safety outcomes, such as bleeding.The incomplete reporting of relevant study design features did not allow complete assessment of the certainty of the evidence. However, the certainty of the evidence for improvement in outcomes was judged to be better than for our previous review (low- to moderate-certainty evidence, compared to very low-certainty evidence for most outcomes). The results of our updated review will help physicians, hospital administrators, and policy makers make practical decisions about adopting specific system-wide measures to improve prescription of thromboprophylaxis, and ultimately prevent VTE in hospitalized patients.
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Affiliation(s)
- Susan R Kahn
- McGill UniversityDepartment of Epidemiology, Biostatistics and Occupational HealthMontrealCanada
- SMBD‐Jewish General Hospital, McGill UniversityCentre for Clinical Epidemiology and Community Studies3755 Cote Ste CatherineMontrealQCCanadaH3T 1E2
- McGill UniversityDivision of Internal Medicine and Department of MedicineMontrealQCCanadaH3T 1E2
| | - David R Morrison
- SMBD‐Jewish General Hospital, McGill UniversityCentre for Clinical Epidemiology and Community Studies3755 Cote Ste CatherineMontrealQCCanadaH3T 1E2
| | - Gisèle Diendéré
- SMBD‐Jewish General Hospital, McGill UniversityCentre for Clinical Epidemiology and Community Studies3755 Cote Ste CatherineMontrealQCCanadaH3T 1E2
| | - Alexandre Piché
- McGill UniversityDepartment of Mathematics and StatisticsMontrealCanada
| | - Kristian B Filion
- SMBD‐Jewish General Hospital, McGill UniversityCentre for Clinical Epidemiology and Community Studies3755 Cote Ste CatherineMontrealQCCanadaH3T 1E2
- McGill UniversityDepartments of Medicine and of Epidemiology, Biostatistics and Occupational HealthMontrealCanada
| | - Adi J Klil‐Drori
- SMBD‐Jewish General Hospital, McGill UniversityCentre for Clinical Epidemiology and Community Studies3755 Cote Ste CatherineMontrealQCCanadaH3T 1E2
| | - James D Douketis
- McMaster University and St. Josephs HospitalDepartment of MedicineRoom F‐53850 Carlton Avenue EastHamiltonONCanadaL8N 4A6
| | - Jessica Emed
- Jewish General HospitalDepartment of Nursing3755 Cote Ste CatherineMontrealQCCanadaH3T 1E2
| | - André Roussin
- University of Montreal and Thrombosis CanadaDepartment of Medicine1851 Sherbrooke St # 601MontrealQCCanadaH2K 4LS
| | - Vicky Tagalakis
- SMBD‐Jewish General Hospital, McGill UniversityCentre for Clinical Epidemiology and Community Studies3755 Cote Ste CatherineMontrealQCCanadaH3T 1E2
- McGill UniversityDivision of Internal Medicine and Department of MedicineMontrealQCCanadaH3T 1E2
| | - Martin Morris
- McGill UniversitySchulich Library of Physical Sciences, Life Sciences and EngineeringMontrealCanada
| | - William Geerts
- Sunnybrook Health Sciences Centre, University of TorontoDepartment of MedicineRoom D674, 2075 Bayview AvenueTorontoONCanadaM4N 3M5
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Park TY, Jung JW, Choi JC, Shin JW, Kim JY, Choi BW, Park IW. Epidemiological trend of pulmonary thromboembolism at a tertiary hospital in Korea. Korean J Intern Med 2017; 32:1037-1044. [PMID: 28286939 PMCID: PMC5668399 DOI: 10.3904/kjim.2016.248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 10/30/2016] [Accepted: 11/07/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND/AIMS Despite increasing interest in pulmonary thromboembolism (PTE), data on recent trends in PTE incidence are limited. This study evaluated the recent incidence rate of PTE. METHODS We performed a retrospective chart review of patients with PTE admitted to Chung-Ang University Hospital during the 10-year period from 2006 to 2015. Age-standardized incidence and mortality rates were calculated by the direct method per 100,000 populations. To analyze the trend of risk factor, we also calculated the proportions of cancer, major operation, and recent major fracture over that time. RESULTS Total crude incidence rate of PTE per 100,000 was 229.36 and the age-sex adjusted standardized incidence rate was 151.28 (95% confidence interval [CI], 127.88 to 177.10). The incidence rate have been significantly increased 1.083 times annually from 2006 (105.96 per 100,000) to 2015 (320.02 per 100,000) (95% CI, 1.049 to 1.118; p < 0.001). These incidences also increased annually in age group of 35 to 54, 55 to 74, and ≥ 75 years, and in both males (odds ratio [OR], 1.071; 95% CI, 1.019 to 1.127; p = 0.007) and females (OR, 1.091; 95% CI, 1.047 to 1.136; p < 0.001). Cancer accounted for most of the increase from 20.0% at 2006 to 2007 to 42.8% at 2014 to 2015 (OR, 1.154; 95% CI, 1.074 to 1.240; p < 0.001), while the proportions of recent fracture and major operation remained constant. CONCLUSIONS The incidence of pulmonary embolism has gradually increased over the 10 years. The increase of PTE incidence was mainly due to increased proportion of cancer patients.
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Affiliation(s)
| | | | | | | | | | | | - In Won Park
- Correspondence to In Won Park, M.D. Department of Internal Medicine, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Korea Tel: +82-2-6299-1401 Fax: +82-2-6299-2017 E-mail:
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Hong C, Luo FQ, Liu CL, Zhong NS, Li JY, Wang W. Clinical study of optical coherence tomography in the diagnosis of peripheral pulmonary artery thrombus. Thromb Res 2017; 161:52-59. [PMID: 29182940 DOI: 10.1016/j.thromres.2017.10.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/26/2017] [Accepted: 10/26/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Peripheral pulmonary artery thrombus (PPT) is common in the clinic. However, due to the lack of an ideal diagnostic tool, PPT cannot be quickly diagnosed and effectively treated at present. Optical coherence tomography (OCT) is a new intravascular imaging technique that is characterized by high image resolution. This technique is suitable for small vessel imaging and has the ability to distinguish red and white thrombi. OBJECTIVE This study aimed to evaluate the value of OCT in the diagnosis of PPT and in identifying the nature of thrombi by comparing the difference in sensitivity between OCT and selective pulmonary angiography (SPA). METHODS Highly suspected PPT patients were enrolled in this study. Pulmonary ventilation/perfusion (V/Q) mismatch pulmonary segments or peripheral pulmonary arteries were chosen. SPA was performed first, followed by OCT imaging. The diagnostic standard of thrombus with SPA was an intraluminal filling defect. The procedure and criteria for OCT diagnosis of thrombus were previously introduced in intracoronary OCT thrombus images. The diameter of the imaging vessels was measured, and they were grouped according to diameter. The diameter was <2mm in the distal segment group, 2-3mm in the middle segment group, and >3mm in the proximal segment group. The recognition abilities of intravascular thrombus with the different diameters of these two techniques were compared. Patients with obvious clinical symptoms and more red thromboses revealed by OCT were given standardized anticoagulant therapy for half a year. The clinical symptoms, 6-minute walking test and changes in the thrombus in the OCT images of these patients before and after treatment were observed. RESULTS A total of 22 patients with highly suspected PPT were suggested to undergo V/Q inspection. Finally, 12 patients were eligible for the study. SPA and OCT were performed in 61 peripheral pulmonary arteries in all 12 patients. The ideal SPA and OCT images obtained from a total of 76 blood vessel segments were suitable for comparative analysis. A total of 62 thrombi were found by SPA. Among these, eight thrombi were in the distal segment, 29 thrombi were in the middle segment, and 25 thrombi were in the proximal segment. A total of 81 thrombi were found by OCT, among which 22 thrombi were in the distal segment, 31 were in the middle segment, and 28 were in the proximal segment. There was a significant difference between two groups in the distal segment group (P=0.013), while there was no significant difference between two groups in the middle segment group or the proximal segment group (P>0.05). In addition to all the thrombi found by SPA, OCT found other thrombi that were missed by SPA. According to previous OCT images for determining the nature of thrombi, OCT revealed 81 thrombi, of which 48 (59%) were red thrombi and 33 (41%) were white thrombi. Then, seven patients who had obvious clinical symptoms and more red thrombi in the peripheral pulmonary artery were given anticoagulant therapy for six months. After treatment, these symptoms were improved, oxygenation indexes increased, and the six-minute walking test was extended in all these patients. After anticoagulation therapy, five patients underwent OCT review. These OCT images were matched and compared before and after anticoagulation therapy. The results revealed that most of the thrombi had disappeared, and a small amount of red thrombi turned white as the volume reduced. The mean lumen area before and after treatment was 2.05±1.03mm2 and 2.86±1.24mm2, respectively, and the difference was statistically significant (P=0.035). CONCLUSION OCT can clearly show the structure of the lumen and the wall of the peripheral pulmonary artery tube. The sensitivity of the diagnosis of PPT with a diameter of <2mm was higher than that of SPA. Moreover, OCT has the ability to distinguish between red and white thrombi, which is of guiding significance in anticoagulant therapy.
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Affiliation(s)
- Cheng Hong
- State Key Laboratory of Respiratory Diseases, First Affiliated Hospital of Guangzhou Medical University Department of Respiratory, Guangzhou Institute of Respiratory Diseases, Guangzhou, Guangdong 510120, China
| | - Fu-Quan Luo
- First Affiliated Hospital of Guangzhou Medical University Department of Cardiology, Guangzhou, Guangdong 510120, China
| | - Chun-Li Liu
- State Key Laboratory of Respiratory Diseases, First Affiliated Hospital of Guangzhou Medical University Department of Respiratory, Guangzhou Institute of Respiratory Diseases, Guangzhou, Guangdong 510120, China
| | - Nan-Shan Zhong
- State Key Laboratory of Respiratory Diseases, First Affiliated Hospital of Guangzhou Medical University Department of Respiratory, Guangzhou Institute of Respiratory Diseases, Guangzhou, Guangdong 510120, China
| | - Jie-Ying Li
- State Key Laboratory of Respiratory Diseases, First Affiliated Hospital of Guangzhou Medical University Department of Respiratory, Guangzhou Institute of Respiratory Diseases, Guangzhou, Guangdong 510120, China
| | - Wei Wang
- First Affiliated Hospital of Guangzhou Medical University Department of Cardiology, Guangzhou, Guangdong 510120, China.
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Trikudanathan G, Umapathy C, Munigala S, Gajendran M, Conwell DL, Freeman ML, Krishna SG. Venous Thromboembolism Is Associated With Adverse Outcomes in Hospitalized Patients With Acute Pancreatitis: A Population-Based Cohort Study. Pancreas 2017; 46:1165-1172. [PMID: 28902787 DOI: 10.1097/mpa.0000000000000906] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The systemic inflammatory cascade and vascular stasis in hospitalized patients with acute pancreatitis (AP) serve as a milieu for development of venous thromboembolism (VTE). Our aim was to estimate the prevalence and risk factors of VTE in AP and to evaluate its impact on clinical outcomes of AP. METHODS The Nationwide Inpatient Sample (2002-2011) was reviewed to identify all patients hospitalized with AP. Patients with a concomitant diagnosis of VTE were compared with those without. The primary clinical outcome (inpatient mortality) and secondary resources outcomes (length of stay and total hospital charges) were analyzed using univariate and multivariate comparisons. RESULTS Among 2,382,426 patients with AP, 22,205 (0.93%) had VTE. Multivariate analysis showed patients with greater comorbidity (odds ratio [OR], 1.47), white race (OR, 1.11), acute kidney injury (OR, 1.08), acute respiratory failure (OR, 1.40), pseudocyst (OR, 1.41), total parenteral nutrition (OR, 1.28), and central venous catheter placement (OR, 3.01) were associated with a diagnosis of VTE. Venous thromboembolism was also independently associated with increased mortality (OR, 1.31) and prolonged duration of hospitalization by 6.5 days (P < 0.001) and contributed to an excess $44,882 (P < 0.001) in hospitalization costs. CONCLUSIONS Venous thromboembolism is adversely associated with mortality and health care resource utilization in AP.
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Affiliation(s)
- Guru Trikudanathan
- From the *Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN; †Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA; ‡Saint Louis University Center for Outcomes Research, St Louis, MO; and §Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
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Venous thromboembolism in patients with pemphigus: A cohort study. J Am Acad Dermatol 2017; 77:256-260. [DOI: 10.1016/j.jaad.2017.01.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 01/01/2023]
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Bajaj NS, Kalra R, Arora P, Ather S, Guichard JL, Lancaster WJ, Patel N, Raman F, Arora G, Al Solaiman F, Clark DT, Dell'Italia LJ, Leesar MA, Davies JE, McGiffin DC, Ahmed MI. Catheter-directed treatment for acute pulmonary embolism: Systematic review and single-arm meta-analyses. Int J Cardiol 2016; 225:128-139. [DOI: 10.1016/j.ijcard.2016.09.036] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 09/05/2016] [Accepted: 09/15/2016] [Indexed: 12/19/2022]
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Olié V, Bonaldi C. Pulmonary embolism: Does the seasonal effect depend on age? A 12-year nationwide analysis of hospitalization and mortality. Thromb Res 2016; 150:96-100. [PMID: 27919419 DOI: 10.1016/j.thromres.2016.11.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/04/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Circannual variations in the incidence and mortality of pulmonary embolism (PE) have been previously described although conflicting observations have been reported. However, the association between age and seasonal variations of incidence and mortality rates is not established. This nationwide study aimed to assess the seasonal pattern in hospitalizations and mortality for PE along with the effect of age. METHODS Comprehensive records from the French hospital discharge databases between 2002 and 2013 and death certificates between 2000 and 2010 were used. For each outcome and separately for each sex, monthly event counts were analyzed using quasi-Poisson models with tensor-products of regression splines, including a seasonal component and controlling for the underlying time trend, age of patients and population size changes. RESULTS During the period studied, 599,432 patients with PE were hospitalized and 150,404 death certificates mentioned a PE. Compared with summer months, the winter peak was associated with 25% increasing rates in hospitalizations and mortality. The rates ratio of hospitalizations between the winter peak and the summer trough increased with age. The winter excess of incidence raised from 10%, IC 95% [5-16] in 30-year-old men to 33% [31-35] in 75year-old men. In the same way, the incidences at the peak time was 13% [9-18] and 34% [31-36] higher in 30 and 75-year-old women respectively. CONCLUSION Based on large nationwide study, our study showed a clear seasonal pattern both on PE incidence and mortality. In addition, our data supported an association of age on the PE seasonal variations.
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Affiliation(s)
- V Olié
- Non-communicable diseases and trauma direction, The French Public Health Agency, Saint-Maurice, France.
| | - C Bonaldi
- Non-communicable diseases and trauma direction, The French Public Health Agency, Saint-Maurice, France
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Shiue I. Increased health service use for pulmonary embolism in men: Northumbrian hospital episode statistics, 2013-2014. Int J Cardiol 2015; 201:176-8. [PMID: 26298372 DOI: 10.1016/j.ijcard.2015.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 08/01/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Ivy Shiue
- Department of Healthcare, Northumbria University, Newcastle upon Tyne, NE7 7XA England, UK; Northumbria Healthcare NHS Foundation Trust, UK.
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Increased health service use for hypotension in the very old: Northumbrian hospital episode statistics, 2013–2014. Int J Cardiol 2015; 201:185-7. [DOI: 10.1016/j.ijcard.2015.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 08/01/2015] [Indexed: 11/20/2022]
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Minges KE, Bikdeli B, Wang Y, Kim N, Curtis JP, Desai MM, Krumholz HM. National Trends in Pulmonary Embolism Hospitalization Rates and Outcomes for Adults Aged ≥65 Years in the United States (1999 to 2010). Am J Cardiol 2015; 116:1436-42. [PMID: 26409636 DOI: 10.1016/j.amjcard.2015.07.068] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/30/2015] [Accepted: 07/30/2015] [Indexed: 01/14/2023]
Abstract
Little is known about national trends of pulmonary embolism (PE) hospitalizations and outcomes in older adults in the context of recent diagnostic and therapeutic advances. Therefore, we conducted a retrospective cohort study of 100% Medicare fee-for-service beneficiaries hospitalized from 1999 to 2010 with a principal discharge diagnosis code for PE. The adjusted PE hospitalization rate increased from 129/100,000 person-years in 1999 to 302/100,000 person-years in 2010, a relative increase of 134% (p <0.001). Black patients had the highest rate of increase (174 to 548/100,000 person-years) among all age, gender, and race categories. The mean (standard deviation) length of hospital stay decreased from 7.6 (5.7) days in 1999 to 5.8 (4.4) days in 2010, and the proportion of patients discharged to home decreased from 51.1% (95% confidence interval [CI] 50.5 to 51.6) to 44.1% (95% CI 43.7 to 44.6), whereas more patients were discharged with home health care and to skilled nursing facilities. The in-hospital mortality rate decreased from 8.3% (95% CI 8.0 to 8.6) in 1999 to 4.4% (95% CI 4.2 to 4.5) in 2010, as did adjusted 30-day (from 12.3% [95% CI 11.9 to 12.6] to 9.1% [95% CI 8.5 to 9.7]) and 6-month mortality rates (from 23.0% [95% CI 22.5 to 23.4] to 19.6% [95% CI 18.8 to 20.5]). There were no significant racial differences in mortality rates by 2010. There was no change in the adjusted 30-day all-cause readmission rate from 1999 to 2010. In conclusion, PE hospitalization rates increased substantially from 1999 to 2010, with a higher rate for black patients. All mortality rates decreased but remained high. The increase in hospitalization rates and continued high mortality and readmission rates confirm the significant burden of PE for older adults.
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Affiliation(s)
- Karl E Minges
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Graduate School of Arts and Sciences, Yale University, New Haven, Connecticut
| | - Behnood Bikdeli
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yun Wang
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Nancy Kim
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jeptha P Curtis
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mayur M Desai
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut; Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
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Zhou W, Zhang K, Chen D, Gao P, Wang Q. Gene microarray analyses for potential biomarkers of single and recurrent venous thromboembolism. Mol Med Rep 2015; 12:7358-66. [PMID: 26397997 PMCID: PMC4626143 DOI: 10.3892/mmr.2015.4349] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 08/04/2015] [Indexed: 01/02/2023] Open
Abstract
Venous thromboembolism is a major cause of morbidity and mortality with a high recurrence rate. The present study aimed to explore the molecular mechanisms and potential biomarkers of single venous thromboembolism (SVTE) and recurrent venous thromboembolism (RVTE). The microarray dataset GSE19151 was downloaded from Gene Expression Omnibus, which contained data from whole blood samples from 63 healthy controls, 32 SVTE and 38 RVTE patients. Differentially expressed genes (DEGs) in the SVTE and RVTE groups compared with those in the controls were identified using the t-test, followed by clustering analysis of DEGs and samples. Functional and pathway enrichment analyses were performed for DEGs in patients with RVTE and SVTE, as well as specific DEGs in patients with RVTE. The identified 42 DEGs in RVTE were mainly enriched in biological processes of cellular protein metabolism, gene expression and translational elongation as well as in pathways associated with ribosomes, Parkinson's disease and oxidative phosphorylation. In SVTE, 20 DEGs were identified, which were mainly involved in biological processes of biopolymer biosynthesis, translational elongation and cellular protein metabolism as well as pathways associated with ribosomes and cardiac muscle contraction. In RVTE, 22 specific DEGs were mainly involved in translational elongation, negative regulation of the force of heart contraction by chemical signals, cell proliferation, ribosomal pathways and protein export. The identified DEGs of SVTE, including COX7C and UQCRQ, may be potential biomarkers for SVTE, and the specific DEGs of RVTE, including ADRBK1, NDUFA5 and ATP5O, may be potential biomarkers for RVTE.
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Affiliation(s)
- Wugang Zhou
- Emergency Department, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, P.R. China
| | - Ke Zhang
- Department of Hypertension, Ruijin Hospital, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Dongrui Chen
- Department of Hypertension, Ruijin Hospital, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Pingjin Gao
- Department of Hypertension, Ruijin Hospital, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Qiao Wang
- Emergency Department, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, P.R. China
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