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Papadakis E, Gavriilaki E, Kotsiou N, Tufano A, Brenner B. Fright of Long-Haul Flights: Focus on Travel-Associated Thrombosis. Semin Thromb Hemost 2025; 51:438-447. [PMID: 40015328 DOI: 10.1055/s-0045-1805038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2025]
Abstract
Travel-related thrombosis (TRT), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), poses a significant health risk associated with long-haul travel. Prolonged immobility, dehydration, and cabin pressure changes during flights contribute to venous stasis, hypoxia, and hypercoagulability, collectively increasing the risk of venous thromboembolism (VTE). While the absolute risk of TRT is relatively low in the population overall, it rises significantly among high-risk groups, including individuals with a history of VTE, thrombophilia, pregnancy, or recent surgery. This review explores the epidemiology, pathophysiology, clinical presentation, and diagnostic evaluation of TRT while highlighting the importance of early recognition and prevention. Risk assessment models can provide guidance for identifying at-risk travelers. Preventive strategies include pharmacological prophylaxis with low-molecular-weight heparin (LMWH) for high-risk individuals and nonpharmacological measures such as compression stockings, intermittent pneumatic compression, mobility exercises, and hydration. Guidelines from international societies recommend tailored interventions based on individual risk profiles, as randomized controlled trials are scarce. Given that long-haul travel dramatically expands, this review critically analyzes the available TRT management strategies in various clinical settings, aiming to increase awareness of this global health issue.
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Affiliation(s)
- Emmanuel Papadakis
- Ob/Gyn Hematology, Thrombosis and Hemostasis Clinic, Genesis Hospital, Thessaloniki, Greece
| | - Eleni Gavriilaki
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Kotsiou
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Benjamin Brenner
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
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Zhang L, Hu WP, Zhang H, Xia SB, Wang HF, Song C, Lu QS. Retrievable Inferior Vena Cava Filter Trapped Embolus: A Risk Factor of Detachment of Thrombus Analysis Based on a Multicenter Prospective Observational Study. J Endovasc Ther 2025; 32:774-783. [PMID: 37882181 DOI: 10.1177/15266028231205718] [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] [Indexed: 10/27/2023]
Abstract
PURPOSE Up to now, the indications of inferior vena cava filter placement still remain controversial in the academic field. The aim of this study was to determine the risk factors of detachment of thrombus and to evaluate the necessity of inferior vena cava filter placement to prevent fatal pulmonary embolism. MATERIALS AND METHODS A total of 2892 patients participated in the multicenter prospective observational study from January 1, 2018, to December 31, 2018, and underwent retrievable inferior vena cava filter (RIVCF) placement in 103 centers in China. The primary endpoint of the study was RIVCF trapped embolus detected by inferior vena cava venography/ultrasound/computed tomography scanning or visible macroscopic thrombus before or during RIVCF retrieval. The relative factors of RIVCF trapped embolus were analyzed accordingly. RESULTS The average age of the patients was 61.0 (50.0-71.0) years. Retrievable inferior vena cava filter trapped embolus occurred in 308 patients (10.65%). The fracture location, surgery location, and endovascular intervention differed between RIVCF trapped embolus and non-RIVCF trapped embolus groups (p<0.001, respectively). By multivariate analysis, RIVCF trapped embolus were less common in older patients (odds ratio [OR]=0.998; p<0.001) and more common in patients with below-the-knee fracture (OR=1.093, p=0.038), thigh fracture (OR=1.118, p=0.007), and pelvis surgery (OR=1.067, p=0.016). In addition, compared with patients without endovascular intervention, patients with percutaneous mechanical thrombectomy (PMT) + catheter-directed thrombolysis (CDT) were more prone to develop RIVCF trapped embolus (OR=1.060, p=0.010). However, RIVCF trapped embolus was less common in patients with CDT (OR=0.961, p=0.004). CONCLUSIONS Lower limb fracture, pelvis surgery, and PMT + CDT are prone to cause trapped embolus. As a trapped embolus often represents the possibility of severe pulmonary embolism, lower limb fracture, pelvis surgery, and PMT + CDT could be risk factors of fatal pulmonary embolism. Due to the low incidence of trapped embolus, it is not necessary to place filters in elderly patients and CDT-only patients.Clinical ImpactThe purpose of this paper is to standardize the use of inferior vena cava filter and avoid unnecessary filter implantation through the summary and analysis of a large number of clinical data. At the same time, more attention should be paid to and active treatment should be given to high-risk groups of pulmonary embolism.
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Affiliation(s)
- Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Wen-Ping Hu
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
- Department of Vascular Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hao Zhang
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Shi-Bo Xia
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Hong-Fei Wang
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Chao Song
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Qing-Sheng Lu
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
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Bailey AJM, Luo OD, Zhou SQ, Wells PS. The incidence and risk of venous thromboembolism in patients with active malignancy and isolated superficial venous thrombosis: a systematic review and meta-analysis (the IROVAM-iSVT review). J Thromb Haemost 2025; 23:1824-1837. [PMID: 40154793 DOI: 10.1016/j.jtha.2025.03.019] [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: 09/27/2024] [Revised: 02/13/2025] [Accepted: 03/13/2025] [Indexed: 04/01/2025]
Abstract
BACKGROUND The management of cancer-associated isolated superficial venous thrombosis (iSVT) remains controversial as cancer patients are at higher risk of bleeding and venous thromboembolism (VTE). OBJECTIVES We performed a systematic review and meta-analysis to determine the incidence and risk of VTE in patients with iSVT and active malignancy. METHODS Medline, Embase, Web of Science, and the Cochrane Library were searched from inception to December 2, 2024, to identify studies investigating VTE rates in adult patients with iSVT and active malignancy. The incidence of VTE in patients with active malignancy and iSVT was pooled by meta-analysis and compared to patients with iSVT without active malignancy. Secondary outcomes included the incidence of major bleeding, clinically relevant nonmajor bleeding, hospitalization, and all-cause death. RESULTS Eight full-text studies were included, comprising 5998 iSVT patients and 448 with active malignancy. Patients with cancer-associated iSVT had an overall incidence of VTE of 18.2 events per 100 patient years (95% CI, 5.2-31.2; I2 = 76%) and a higher rate of VTE compared to patients with iSVT without active malignancy (risk ratio, 2.57; 95% CI, 1.78-3.71; I2 = 0%; P < .001). There were 2 major bleeding events per 100 patient years (95% CI, 0-6.7; I2 = 59%) and 22.8 deaths per 100 patient years (95% CI, 0-58.7; I2 = 73%) for cancer-associated iSVT. Only 1 study reported on clinically relevant nonmajor bleeding and hospitalization rates, respectively. CONCLUSION Patients with iSVT and active malignancy have high rates of VTE despite treatment. Future studies should investigate the role of extended duration anticoagulation on VTE rates in this population.
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Affiliation(s)
| | - Owen Dan Luo
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada.
| | - Shi Qi Zhou
- Faculty of Science, McGill University, Montréal, Quebec, Canada
| | - Philip Steven Wells
- Department of Medicine, University of Ottawa, and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Willems SPE, Cnossen MH, van Es N, den Exter PL, Kruis IC, Maas DPMSM, Meijer K, Nieuwenhuizen L, Rijpma S, Saes JL, Simons A, Schutgens REG, Weiss M, Blijlevens NMA, van Heerde WL, Schols SEM. Bleeding symptoms in persons with rare bleeding disorders and a heterozygous genotype: data from the Rare Bleeding Disorders in the Netherlands study. J Thromb Haemost 2025; 23:1787-1799. [PMID: 40056984 DOI: 10.1016/j.jtha.2025.02.030] [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: 09/24/2024] [Revised: 01/23/2025] [Accepted: 02/25/2025] [Indexed: 04/07/2025]
Abstract
BACKGROUND Limited data exist on persons with rare bleeding disorders possessing a heterozygous genotype, as most studies focus on biallelic genotypes and more severe coagulation factor deficiencies. A growing body of evidence suggests that persons with a heterozygous genotype experience clinically relevant bleeding symptoms. OBJECTIVES This study aimed to explore the incidence of bleeding symptoms and postoperative bleeding in persons with a heterozygous genotype. METHODS This cross-sectional substudy of the Rare Bleeding Disorders in the Netherlands study (2017-2019) included persons with rare coagulation factor deficiencies and disorders of fibrinolysis with a heterozygous or biallelic genotype. Clinical data and laboratory samples were collected during a single study visit along with questionnaires. RESULTS In total, 86 persons with a heterozygous genotype and 55 with a biallelic genotype were included. Median factor activity levels in persons with a heterozygous genotype approached 50% with considerable heterogeneity (range, 11%-93%). In 75%, persons with a heterozygous genotype reported bleeding severity of grade II or III. Female-specific bleeding was common. In total, 425 surgical procedures were performed. Persons with a heterozygous genotype were less likely to receive periprocedural treatment, and omission of periprocedural treatment was associated with postoperative bleeding in procedures with intermediate-high bleeding risk. Postoperative bleeding was comparable for persons with a heterozygous genotype (35%; 59/171) and a biallelic genotype (35%; 86/247; P = .926). CONCLUSION In our population with rare bleeding disorders, the majority of persons possessing a heterozygous genotype exhibited spontaneous bleeding symptoms. Especially in intermediate-high risk procedures, a proactive approach to periprocedural hemostatic treatment in persons with a heterozygous genotype seems beneficial.
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Affiliation(s)
- Sterre P E Willems
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands; Hemophilia Treatment Center, Nijmegen-Eindhoven-Maastricht, the Netherlands
| | - Marjon H Cnossen
- Department of Pediatric Hematology and Oncology, Erasmus University Medical Center, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Nick van Es
- Department of Vascular Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, Netherlands
| | - Paul L den Exter
- Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Ilmar C Kruis
- Netherlands Hemophilia Society, Nijkerk, the Netherlands
| | - Dominique P M S M Maas
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands; Hemophilia Treatment Center, Nijmegen-Eindhoven-Maastricht, the Netherlands
| | - Karina Meijer
- Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands
| | - Laurens Nieuwenhuizen
- Hemophilia Treatment Center, Nijmegen-Eindhoven-Maastricht, the Netherlands; Department of Hematology, Máxima Medical Center Eindhoven, Eindhoven, the Netherlands
| | - Sanna Rijpma
- Department of Laboratory Medicine, Laboratory of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joline L Saes
- Center for Benign Haematology, Thrombosis and Haemostasis, van Creveldkliniek, University Medical Center Utrecht and University Utrecht, Utrecht, the Netherlands
| | - Annet Simons
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Roger E G Schutgens
- Center for Benign Haematology, Thrombosis and Haemostasis, van Creveldkliniek, University Medical Center Utrecht and University Utrecht, Utrecht, the Netherlands
| | - Marjan Weiss
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nicole M A Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Waander L van Heerde
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands; Enzyre BV, Novio Tech Campus, Nijmegen, the Netherlands
| | - Saskia E M Schols
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands; Hemophilia Treatment Center, Nijmegen-Eindhoven-Maastricht, the Netherlands.
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Mittman BG, Rothberg MB. Estimated Impact of Model-Guided Venous Thromboembolism Prophylaxis versus Physician Practice. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2025:2025.05.29.25328593. [PMID: 40492076 PMCID: PMC12148274 DOI: 10.1101/2025.05.29.25328593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/11/2025]
Abstract
Background The American Society of Hematology (ASH) recommends assessing venous thromboembolism (VTE) and major bleeding risk to optimize pharmacological VTE prophylaxis for medical inpatients. However, the clinical utility of model-guided approaches remains unknown. Methods Our objective was to estimate differences in VTE and major bleeding event rates and efficiency with prophylaxis guided by risk models versus prophylaxis based on physician judgment. Patients were adults admitted to one of 10 Cleveland Clinic hospitals between December 2017 and January 2020. We compared physician practice with hypothetical prophylaxis recommended by model- based prophylaxis strategies, including ASH-recommended risk scores (Padua and IMPROVE) and locally derived Cleveland Clinic risk prediction models. For each strategy we quantified the prophylaxis rate, VTE and major bleeding rates, and the incremental number-needed-to-treat (NNT) to prevent one event (VTE or bleeding). Results Physicians prescribed prophylaxis to 62% of patients whereas model-based strategies recommended prophylaxis for 17-87%. Model-guided prophylaxis produced more VTEs and fewer major bleeds than physicians, but total events varied among strategies. Overall, per 1,000 patients, model- based strategies produced 14.0-16.1 events compared with 14.3 for physicians. The Padua/IMPROVE models recommended prophylaxis for the fewest patients but caused the most total events. The most efficient model-based strategy recommended prophylaxis to 28% of patients with an incremental NNT (relative to no prophylaxis) of 80. Compared to physicians, it reduced prophylaxis by 55% and total events by 0.14%. Conclusions Physicians often prescribed inappropriate prophylaxis, highlighting the need for decision support. A model-based strategy maximized efficiency, reducing both events and prophylaxis relative to physicians.
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Lavrenova A, Klychnikov O, Ioutsi V, Rodin I, Luneva O, Nefedova L. Effect of Warfarin on Lifespan and Oxidative Stress Tolerance of Drosophila melanogaster. Int J Mol Sci 2025; 26:4808. [PMID: 40429949 PMCID: PMC12112360 DOI: 10.3390/ijms26104808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2025] [Revised: 05/09/2025] [Accepted: 05/15/2025] [Indexed: 05/29/2025] Open
Abstract
In vertebrates, vitamin K is a cofactor for the gamma-glutamyl carboxylase (GGCX) involved in the carboxylation of glutamic acid residues. During the vitamin K cycle, vitamin K is oxidised by GGCX, and then reduced by vitamin K epoxide reductase (VKOR), which is inhibited by the synthetic coumarin warfarin. GGCX and VKOR are present in Drosophila melanogaster, but the existence of a vitamin K cycle remains unproven. Semi-lethal concentrations (LC50) of K3, menadione sodium bisulfite (MSB), and warfarin to neutralise the negative effect of MSB were selected for the Drosophila cultivation medium. LC-MS analysis was used for vitamin K measurement in flies' extracts. The EPR method and RT-PCR were used for ROS level measurement and gene transcription assessment, respectively. The LC50 of MSB in the medium resulted in a more than 20-fold increase in endogenous K2 in flies, demonstrating the mechanism of K3-to-K2 conversion. Administration of 1 mM warfarin in the medium with MSB completely neutralised its negative effect on viability. Developed flies had decreased K2 level, confirming the existence of a vitamin K cycle, and both reduced ROS level and hsp22 gene transcription. The biochemical pathways affected by elevated K2 concentrations involves both elements of the vitamin K cycle and the adaptive mitochondrial antioxidant system.
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Affiliation(s)
- Anna Lavrenova
- Department of Genetics, Faculty of Biology, M. V. Lomonosov Moscow State University, 119234 Moscow, Russia;
| | - Oleg Klychnikov
- Department of Biochemistry, Faculty of Biology, M. V. Lomonosov Moscow State University, 119234 Moscow, Russia;
| | - Vitaliy Ioutsi
- The National Medical Research Center for Endocrinology, 117292 Moscow, Russia;
| | - Igor Rodin
- Department of Analytical Chemistry, Faculty of Chemistry, M. V. Lomonosov Moscow State University, 119991 Moscow, Russia;
- Lomonosov Institute of Fine Chemical Technologies, Russian Technological University, 119571 Moscow, Russia
| | - Oksana Luneva
- Department of Biophysics, Faculty of Biology, M. V. Lomonosov Moscow State University, 119234 Moscow, Russia;
| | - Lidia Nefedova
- Department of Genetics, Faculty of Biology, M. V. Lomonosov Moscow State University, 119234 Moscow, Russia;
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Lu BW, Li JC, Wen MT, Luo D, Guo YQ, Li G. Safety comparisons among different subcutaneous anticoagulants for venous thromboembolism using FDA adverse event reporting system. Sci Rep 2025; 15:17070. [PMID: 40379814 PMCID: PMC12084613 DOI: 10.1038/s41598-025-01527-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Accepted: 05/06/2025] [Indexed: 05/19/2025] Open
Abstract
Venous thromboembolism (VTE) remains a significant global health burden, particularly in older adults. While fondaparinux sodium, enoxaparin sodium, and dalteparin sodium are commonly used anticoagulants, their safety profiles require further evaluation. This study analyzes their adverse drug events (ADEs) using data from the FDA Adverse Event Reporting System (FAERS). A retrospective pharmacovigilance study was conducted using FAERS data from Q1 2004 to Q2 2024. Reports identifying fondaparinux sodium, enoxaparin sodium, or dalteparin sodium as the primary suspect drug were extracted. ADEs were classified using MedDRA 23.0 at the System Organ Class (SOC) and Preferred Term (PT) levels. Disproportionality analysis was performed with Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-item Gamma Poisson Shrinker (MGPS). FAERS contained 470 reports for fondaparinux sodium, 1,375 for enoxaparin sodium, and 344 for dalteparin sodium. Most cases involved patients aged ≥ 60, with a female predominance. Hospitalization was the most frequent outcome. Fondaparinux showed the strongest signals for intra-abdominal haematoma (ROR = 374.14, PRR = 371.14), muscle haemorrhage (ROR = 354.91, PRR = 347.04), and retroperitoneal haematoma (ROR = 214.97, PRR = 213.25). Enoxaparin demonstrated notable signals for heparin-induced thrombocytopenia (HIT) (ROR = 149.42, PRR = 147.53) and retroperitoneal haemorrhage (ROR = 287.68, PRR = 284.03). Dalteparin showed notable signals for HIT (ROR = 127.88, PRR = 126.49) and retroperitoneal haemorrhage (ROR = 103.23, PRR = 102.75). Distinct ADE profiles were identified among the three anticoagulants, underscoring the need for individualized risk assessment. These findings highlight the importance of close monitoring, particularly in high-risk patients, to optimize anticoagulation safety.
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Affiliation(s)
- Bo-Wen Lu
- The First Clinical Medical School, Shandong University of Traditional Chinese Medicine, Jinan, 250014, Shandong, China
| | - Jia-Cheng Li
- The First Clinical Medical School, Shandong University of Traditional Chinese Medicine, Jinan, 250014, Shandong, China
- Orthopaedic, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China
| | - Ming-Tao Wen
- Orthopaedic, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China
| | - Di Luo
- Orthopaedic, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China
| | - Yu-Qi Guo
- The First Clinical Medical School, Shandong University of Traditional Chinese Medicine, Jinan, 250014, Shandong, China
| | - Gang Li
- Orthopaedic, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China.
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Wu B, Wang H, Li Y, Sun J, Zhang L, Wang H. Age-related risk factors and manifestations in deep venous thrombosis. Phlebology 2025:2683555251341760. [PMID: 40338151 DOI: 10.1177/02683555251341760] [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: 05/09/2025]
Abstract
ObjectiveThe incidence, risk factors, and clinical presentation of deep venous thrombosis (DVT) vary with age. This study aimed to evaluate the differences in clinical characteristics of DVT among patients of different ages.MethodsWe retrospectively analyzed 938 patients with symptomatic lower extremity DVT admitted to our hospital between January 2020 and January 2024. Patients were categorized into youth (<40 years), middle-aged (40-64 years), and elderly (>65 years) groups. Demographic data, comorbidities, risk factors, clinical presentations, and management approaches were collected and analyzed.ResultsMost participants were middle-aged or elderly, with young patients constituting only 11.19% of the study population. The youth group had a slight female predominance, while the middle-aged and elderly group had a balanced gender distribution. The elderly group were more likely to have comorbidities such as diabetes and malignancies, though they had a lower prevalence of autoimmune diseases compared to younger patients. Congenital risk factors were relatively rare in the overall population, yet were present in 22.86% of young patients, a significantly higher proportion than in the middle-aged and elderly groups. Most patients with DVT were provoked, especially in the elderly group. The prevalence of concurrent congenital and acquired factors was 13.33% in the youth group, compared to only 4.97% in the middle-aged group and 2.88% in the elderly group. Proximal DVT was most frequent in middle-aged patients, while young patients were more likely to seek treatment in the acute phase and undergo surgical intervention. Anticoagulation noncompliance was noted in nearly 40% of elderly patients but only 6.67% of young patients.ConclusionRisk factors and clinical characteristics of DVT vary significantly with age, particularly between young and elderly patients. Young patients were more inclined to seek prompt and effective treatment and demonstrated better adherence to anticoagulation therapy.
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Affiliation(s)
- Bo Wu
- Department of Abdominal Wall, Hernia and Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Haoyuan Wang
- Department of Abdominal Wall, Hernia and Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yujia Li
- Department of Abdominal Wall, Hernia and Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Jianming Sun
- Department of Abdominal Wall, Hernia and Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Lili Zhang
- Department of General Practice, Chongqing University Fuling Hospital, Chongqing, China
| | - Haiyang Wang
- Department of Abdominal Wall, Hernia and Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Cortese F, Stolfi L, Luzi G, Tarsia G, D'Addeo G, De Francesco M, Tondi P, Costantino MF. Superficial vein thrombosis: State of art. A review. Phlebology 2025:2683555251338747. [PMID: 40317195 DOI: 10.1177/02683555251338747] [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: 05/07/2025]
Abstract
ObjectivesSuperficial venous thrombosis (SVT) is an acute thrombosis affecting the superficial venous system, characterized by inflammation of the venous wall. While much research has focused on deep vein thrombosis (DVT), SVT has historically been neglected due to its reputation as a benign and self-limiting condition.MethodsA literature search was conducted using PubMed and Google Scholar from January 2000 to December 2023, focusing on English-language publications and including original articles, systematic reviews, and randomized controlled trials. The following keywords were used in various combinations: "superficial venous thrombosis," "superficial thrombophlebitis," "phlebitis," and "thrombophlebitis." The review aimed to analyze SVT, discuss its key features, treatment approaches, and prognosis. We identified 133 potentially relevant records, of which 98 were screened in full text; 39 met our inclusion criteria (i.e., adult populations, clinical data on SVT incidence, risk factors, and treatment outcomes). A PRISMA-style flowchart illustrates the selection process and reasons for exclusion (e.g., duplication, lack of relevant endpoints).ResultsSVT is a common but often underestimated condition that can lead to complications, including pulmonary embolism. The mainstay treatment consists of anticoagulant therapy, starting with low-dose unfractionated heparin or fondaparinux as the first-line drug, progressing to oral anticoagulants at therapeutic doses in more extensive cases. The diagnosis is primarily clinical but should be confirmed by color Doppler ultrasound. Furthermore, SVT may be indicative of serious underlying conditions.ConclusionsWhile often considered benign, SVT is a deceptive pathology. If not properly diagnosed and treated, it can progress to DVT and associated complications. Additionally, SVT may signal significant systemic conditions such as malignancies, hereditary thrombophilia, and cardiovascular diseases, warranting further investigation by clinicians.
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Affiliation(s)
| | - Luisiana Stolfi
- Cardiovascular Department, Institute of Cardiology, San Carlo Hospital, Potenza, Italy
| | - Giampaolo Luzi
- Division of Cardiac Surgery, Cardiovascular Department, San Carlo Regional Hospital, Potenza, Italy
| | | | - Gianpaolo D'Addeo
- Cardiovascular Department, Institute of Cardiology, San Carlo Hospital, Potenza, Italy
| | | | - Paolo Tondi
- Department of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Ciampi-Dopazo JJ, Guirola-Ortiz JA, Garcia-Flores P. Current state of the interventional approach to acute pulmonary embolism. RADIOLOGIA 2025; 67:370-377. [PMID: 40412850 DOI: 10.1016/j.rxeng.2024.01.008] [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: 11/11/2023] [Accepted: 01/20/2024] [Indexed: 05/27/2025]
Abstract
Massive pulmonary embolism (PE) is a disease with high mortality, therefore early diagnosis and treatment is essential to save lives. In the absence of contraindications, patients with massive PE (high risk) should be treated immediately with full-dose intravenous systemic thrombolysis. The subset of patients for whom systemic thrombolysis is not successful and who continue to present with haemodynamic compromise or those with contraindications may be candidates for various catheter-directed or surgical therapies. The decision algorithm in intermediate-high/submassive risk patients is complex and must be employed by a multidisciplinary team and success may depend on the experience of the medical specialists involved.
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Affiliation(s)
- J J Ciampi-Dopazo
- Unidad de Radiología Intervencionista, Servicio de Radiodiagnóstico, Hospital Universitario Virgen de la Nieves, Granada, Spain.
| | - J A Guirola-Ortiz
- Unidad de Radiología Intervencionista, Servicio Radiodiagnóstico, Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - P Garcia-Flores
- Servicio de Neumología, Hospital Universitario Virgen de las Nieves, Granada, Spain
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Binko MA, Andraska EA, Reitz KM, Handzel RM, Singh MJ, Sridharan ND, Chaer RA, Hager ES. The natural history of portal venous system aneurysms. J Vasc Surg Venous Lymphat Disord 2025; 13:102163. [PMID: 39733830 DOI: 10.1016/j.jvsv.2024.102163] [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: 08/25/2024] [Revised: 12/03/2024] [Accepted: 12/13/2024] [Indexed: 12/31/2024]
Abstract
BACKGROUND Portal venous system aneurysms (PVAs) are increasingly diagnosed on cross-sectional computed tomography imaging. However, the natural history of these aneurysms is poorly understood, and reports are limited to small case series. METHODS Terms relevant to PVAs were searched in radiology reports (2010-2022), with PVA presence confirmed by manual review. PVA were defined as a diameter greater than 1.5 cm in patients without cirrhosis and 1.9 cm in those with cirrhosis. Aneurysm growth was defined as greater than 20% increase in size, whereas aneurysm regression was defined as greater than 20% decrease in size. Patient demographics, comorbid conditions, and PVA outcomes were abstracted. Univariate statistics were used to compare groups. RESULTS Thirty-eight aneurysms with radiographic follow up were identified in 35 patients, involving the portal vein (n = 18; 47.4%), splenic vein (n = 10; 26.3%), superior mesenteric vein (n = 3; 7.9%), and portal confluence (n = 7; 18.4%). Although 12 (31.6%) were idiopathic, the remaining 26 (68.4%) were associated with portal hypertension (n = 20; 52.6%) and prior liver transplant (n = 4; 10.5%). The median growth was 0.2 cm (range, -2.6 to 2.4 cm) over median follow up over 5.0 years (range, 0.3-16.6 years). Five PVAs (13.2%) regressed and were largely idiopathic (80.0%; P = .03). Thirteen PVAs (34.2%) grew and were associated with portal hypertension (n = 11; 84.6%; P = .003) and thrombosis (n = 6; 46.2%; P = .05). Nine PVAs (23.7%) thrombosed, predominantly in males (n =7; 77.8%). The median growth was 1.0 cm (range, -0.7 to 1.9 cm). Three patients (33.3%) were symptomatic from PVA thrombosis including abdominal pain (n = 2; 22.2%), intestinal ischemia (n = 1; 11.1%), and variceal bleeding (n = 2; 22.2%). Four patients (44.4%) were treated with anticoagulation. No aneurysms ruptured. Of the 58 PVAs initially identified with and without radiographic follow up, five (8.6%) underwent intervention with a median diameter of 4.0 cm (range, 3.4-5 cm). Intervention included vein ligation (n = 1; 20.0%), aneurysmorrhaphy (n = 1; 20.0%), and aneurysmectomy (n = 3; 60.0%). There was one case of aneurysm recurrence 20 years following resection and one postoperative mortality. CONCLUSIONS Two-thirds of PVAs, including those with size greater than 3 cm, remain stable on surveillance. Although annual surveillance is initially recommended to confirm PVA stability, interval imaging can be subsequently extended given low growth rates. Over 20% of PVAs thrombosed, but none ruptured. Although we did not observe any cases of rupture, the devastating consequences of rupture necessitate consideration of surgical intervention for large symptomatic PVAs.
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Affiliation(s)
- Mary A Binko
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Elizabeth A Andraska
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Katherine M Reitz
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | | | - Michael J Singh
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Natalie D Sridharan
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Rabih A Chaer
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Eric S Hager
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
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12
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Li HL, Zhang H, Chan YC, Cheng SW. Prevalence and risk factors of hospital acquired venous thromboembolism. Phlebology 2025; 40:266-274. [PMID: 39499060 DOI: 10.1177/02683555241297566] [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] [Indexed: 11/07/2024]
Abstract
ObjectivesTo investigate the prevalence, clinical characteristics and risk factors of hospital acquired venous thromboembolism (HA-VTE) in a Chinese Hospital.MethodsRetrospective analysis of patients diagnosed as HA-VTE in a single institution from January 2016 to December 2022 was performed. Patients with VTE prior to admission or within 48 h after admission were excluded. Demographic data of patients was retrieved from the electronic medical database, and parameters affecting the occurrence of HA-VTE were analyzed.Results4,022 patients from 321,997 episodes of medical admissions were diagnosed as VTE. Among these, 952 (23.7%) fulfilled the criteria of HA-VTE, corresponding to an incidence of 0.296%. 76% of patients presented with HA-deep vein thrombosis (DVT) alone, 13% presented with isolated HA-pulmonary embolism (PE), and 11% presented with concomitant HA- DVT and PE. Risk factor analyses showed statistically higher incidence in patients with elder age (67.5 ± 15.5 vs 48.3 ± 17.2 years, p < .001), male gender (0.346% vs 0.262%, p < .001), malignancy (0.513% vs 0.252%, p < .001), trauma (0.659% vs 0.28%, p < .001), emergency admission (0.664% vs 0.186%, p < .001), ICU stay (2.981% vs 0.226%, p < .001), and patients undergoing major surgery (0.702% vs 0.176%, p < .001). Patients with HA-VTE had longer hospital stay (22.5 ± 26.6 vs 7.21 ± 9.23 days, p < .001) and higher mortality rate (8.51% vs 1.01%, p < .001). The crude incidence rate of HA-VTE increased annually from 0.75 per 1,000 patients in 2016 to 5.89 per 1,000 patients in 2022. The subspecialties with the highest incidence rate of HA-VTE were cardiovascular surgery (1.40%), neurosurgery (1.10%), and respiratory medicine (0.72%).ConclusionThis is one of the few large scale studies to show that HA-VTE, accounting for nearly one quarter of all VTE events, occurs in 0.296% of adult hospitalizations. Patients with elder age, malignancy, ICU stay, and undergoing major surgery require more intensive HA-VTE surveillance and prevention.
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Affiliation(s)
- Hai-Lei Li
- Division of Vascular Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - He Zhang
- Division of Vascular Surgery, Department of Surgery, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Yiu Che Chan
- Division of Vascular Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
- Division of Vascular Surgery, Department of Surgery, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Stephen W Cheng
- Division of Vascular Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
- Division of Vascular Surgery, Department of Surgery, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
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13
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Lei Y, Guo W, Zhang Y, Fan Y, Xu H. Knowledge, attitude, and practice of orthopedic, vascular surgery, and anesthesiology doctors regarding postoperative deep vein thrombosis prevention in surgical patients. Sci Rep 2025; 15:13317. [PMID: 40247045 PMCID: PMC12006420 DOI: 10.1038/s41598-025-98441-x] [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: 07/22/2024] [Accepted: 04/11/2025] [Indexed: 04/19/2025] Open
Abstract
Orthopedic and vascular surgeries carry a high risk of postoperative deep vein thrombosis (DVT). This cross-sectional study assessed the knowledge, attitude, and practice (KAP) of orthopedists, vascular surgeons, and anesthesiologists regarding postoperative DVT prevention in surgical patients. The study was performed at two hospitals in China from November 22 to December 13, 2023. Demographic information and KAP data were collected using a self-administered questionnaire. Among 294 doctors, 187 (63.61%) were male, and 248 (84.35%) had prior experience in orthopedic surgeries. Mean scores for knowledge, attitude, and practice were 9.94 ± 1.91, 37.12 ± 2.94, and 23.02 ± 3.64, respectively. Knowledge was correlated to attitude (r = 0.182, P = 0.002), knowledge to practice (r = 0.234, P < 0.001), and attitude to practice (r = 0.281, P < 0.001). Attitude score (OR = 1.249, 95% CI: [1.127-1.385], P < 0.001) and anesthesiology work (OR = 0.309, 95% CI: [0.158-0.603], P = 0.001) were independently associated with proactive practice. Structural equation modeling confirmed direct impacts of knowledge on attitude (β = 0.894, P < 0.001) and practice (β = 1.786, P < 0.001) and of attitude on practice (β = 0.338, P = 0.017). In conclusion, orthopedists, vascular surgeons, and anesthesiologists showed good knowledge, attitude, and practice toward DVT prevention in surgical patients in two hospitals in China.
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Affiliation(s)
- Yajuan Lei
- Department of Anesthesiology, Shanxi Academy of Medical Sciences, Shanxi Bethune Hospital, Taiyuan, 030032, China.
| | - Wenzhi Guo
- Department of Anesthesiology, The Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Yannan Zhang
- Department of Orthopedics, Shanxi Academy of Medical Sciences, Shanxi Bethune Hospital, Taiyuan, 030032, China
| | - Yong Fan
- Department of Anesthesiology, Taiyuan Microhand Surgery Hospital, Taiyuan, 030006, China
| | - Huimin Xu
- Department of Vascular Surgery, Shanxi Academy of Medical Sciences, Shanxi Bethune Hospital, Taiyuan, 030032, China
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Neri G, Ielapi J, Bosco V, Mastrangelo H, Mellace F, Salerno N, Mazza GA, Serraino GF, Caracciolo D, Venturella R, Torella D, Mastroroberto P, Chiappetta M, Russo A, Tagliaferri P, Tassone P, Zullo F, Bruni A, Longhini F, Garofalo E. Severe Hemodynamic Instability in a Young Pregnant Woman with Massive Pericardial Effusion and Pulmonary Embolism Secondary to Primary Mediastinal Non-Hodgkin's Lymphoma. J Clin Med 2025; 14:2670. [PMID: 40283500 PMCID: PMC12027832 DOI: 10.3390/jcm14082670] [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: 03/16/2025] [Revised: 04/09/2025] [Accepted: 04/11/2025] [Indexed: 04/29/2025] Open
Abstract
Background: Lymphomas account for approximately 10% of cancers diagnosed during pregnancy, with Hodgkin's lymphoma being the most common. However, non-Hodgkin lymphomas, including primary mediastinal large B-cell lymphoma (PMBCL), also represent a significant proportion. Both mediastinal lymphomas and pregnancy develop a hypercoagulable state, increasing the risk of venous thromboembolism and massive pulmonary embolism (PE), requiring extracorporeal membrane oxygenation (ECMO). Methods: Clinical data, blood test and imagings have been collected by the medical records of the patient. Results: We present a 25-year-old woman, at 32 weeks of gestation, who presented to the emergency department with progressive dyspnea and asthenia. Echocardiography revealed a hemodynamically significant pericardial effusion and severe right ventricular dysfunction. Given the severity of her condition, she underwent an emergency caesarean section and subsequently a pericardial drainage. A chest computed tomography scan revealed an incidental mediastinal mass along with a massive PE. Despite pericardial drainage, she remained hemodynamically unstable. Since thrombolysis was contraindicated for the recent cesarean section, venoarterial ECMO was initiated. Systemic anticoagulation was guaranteed by heparin, which shifted to argatroban for heparin resistance. The mediastinal mass was also biopsied, and the diagnosis of PMBCL carried out. Cytoreductive chemotherapy was initiated with the COMP-R regimen (i.e., cyclophosphamide, vincristine, methotrexate, prednisone, and rituximab), and the patient progressively improved up to ICU and hospital discharge. Conclusions: This case highlights the challenges in managing a complicated patient requiring early multidisciplinary intervention, which was crucial for stabilizing the patient and optimizing fetal and maternal prognosis.
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Affiliation(s)
- Giuseppe Neri
- Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (G.N.); (V.B.); (H.M.); (F.M.); (A.R.); (F.L.); (E.G.)
| | - Jessica Ielapi
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (J.I.); (N.S.); (G.A.M.); (G.F.S.); (D.C.); (R.V.); (D.T.); (P.M.); (P.T.); (P.T.); (F.Z.)
| | - Vincenzo Bosco
- Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (G.N.); (V.B.); (H.M.); (F.M.); (A.R.); (F.L.); (E.G.)
| | - Helenia Mastrangelo
- Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (G.N.); (V.B.); (H.M.); (F.M.); (A.R.); (F.L.); (E.G.)
| | - Federica Mellace
- Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (G.N.); (V.B.); (H.M.); (F.M.); (A.R.); (F.L.); (E.G.)
| | - Nadia Salerno
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (J.I.); (N.S.); (G.A.M.); (G.F.S.); (D.C.); (R.V.); (D.T.); (P.M.); (P.T.); (P.T.); (F.Z.)
| | - Giuseppe Antonio Mazza
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (J.I.); (N.S.); (G.A.M.); (G.F.S.); (D.C.); (R.V.); (D.T.); (P.M.); (P.T.); (P.T.); (F.Z.)
| | - Giuseppe Filiberto Serraino
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (J.I.); (N.S.); (G.A.M.); (G.F.S.); (D.C.); (R.V.); (D.T.); (P.M.); (P.T.); (P.T.); (F.Z.)
| | - Daniele Caracciolo
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (J.I.); (N.S.); (G.A.M.); (G.F.S.); (D.C.); (R.V.); (D.T.); (P.M.); (P.T.); (P.T.); (F.Z.)
| | - Roberta Venturella
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (J.I.); (N.S.); (G.A.M.); (G.F.S.); (D.C.); (R.V.); (D.T.); (P.M.); (P.T.); (P.T.); (F.Z.)
| | - Daniele Torella
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (J.I.); (N.S.); (G.A.M.); (G.F.S.); (D.C.); (R.V.); (D.T.); (P.M.); (P.T.); (P.T.); (F.Z.)
| | - Pasquale Mastroroberto
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (J.I.); (N.S.); (G.A.M.); (G.F.S.); (D.C.); (R.V.); (D.T.); (P.M.); (P.T.); (P.T.); (F.Z.)
| | - Marco Chiappetta
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Alessandro Russo
- Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (G.N.); (V.B.); (H.M.); (F.M.); (A.R.); (F.L.); (E.G.)
| | - Pierosandro Tagliaferri
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (J.I.); (N.S.); (G.A.M.); (G.F.S.); (D.C.); (R.V.); (D.T.); (P.M.); (P.T.); (P.T.); (F.Z.)
| | - Pierfrancesco Tassone
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (J.I.); (N.S.); (G.A.M.); (G.F.S.); (D.C.); (R.V.); (D.T.); (P.M.); (P.T.); (P.T.); (F.Z.)
| | - Fulvio Zullo
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (J.I.); (N.S.); (G.A.M.); (G.F.S.); (D.C.); (R.V.); (D.T.); (P.M.); (P.T.); (P.T.); (F.Z.)
| | - Andrea Bruni
- Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (G.N.); (V.B.); (H.M.); (F.M.); (A.R.); (F.L.); (E.G.)
| | - Federico Longhini
- Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (G.N.); (V.B.); (H.M.); (F.M.); (A.R.); (F.L.); (E.G.)
| | - Eugenio Garofalo
- Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (G.N.); (V.B.); (H.M.); (F.M.); (A.R.); (F.L.); (E.G.)
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15
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Wang H, Shen J. Clinical effect of catheter-directed thrombolysis combined with intermittent pneumatic compression on lower extremity deep venous thrombosis. Clin Radiol 2025; 86:106929. [PMID: 40378417 DOI: 10.1016/j.crad.2025.106929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Revised: 03/21/2025] [Accepted: 04/08/2025] [Indexed: 05/18/2025]
Abstract
AIM This study investigated the effectiveness of catheter-directed thrombolysis (CDT) combined with intermittent pneumatic compression (IPC) in patients with lower extremity deep venous thrombosis (LEDVT). MATERIALS AND METHODS A retrospective analysis was conducted on 68 LEDVT patients. Those who received CDT with IPC were assigned to the IPC group, while those who underwent CDT alone were designated as the control group. Both groups were further divided into early and late subgroups based on the time from symptom onset to CDT. Data collected included the cumulative urokinase dosage, CDT duration, and other relevant clinical indicators. RESULTS The cumulative urokinase dosage was lower in the IPC group than in the control group (P<0.05). CDT duration was shorter in the IPC group than in the control group and was also shorter in the early subgroup compared with the late subgroup (all P<0.05). The peak D-dimer occurred earlier in the IPC group than in the control group (P<0.05). The incidence of grade II-III thrombolysis was higher in the IPC group than in the control group on days 2 and 3 of CDT (all P<0.05). The IPC group showed a greater reduction in thigh and calf circumference than the control group on days 3 and 4 of CDT (all P<0.05). CONCLUSIONS In LEDVT patients, CDT combined with IPC reduced the cumulative urokinase dosage, shortened CDT duration, promoted earlier deep vein patency, and accelerated the relief of lower extremity swelling.
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Affiliation(s)
- H Wang
- Department of Outpatient, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - J Shen
- Department of Oncology and Vascular Interventional Therapy, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China.
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16
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Jiang X, Li M, Tang Y, Hu J, Gai X, Zhang C, Li T, Wang Y, Wang H. Research progress on the mechanism of transcutaneous electrical acupoint stimulation in the perioperative period. Front Neurol 2025; 16:1563681. [PMID: 40291842 PMCID: PMC12021628 DOI: 10.3389/fneur.2025.1563681] [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: 01/20/2025] [Accepted: 03/27/2025] [Indexed: 04/30/2025] Open
Abstract
Transcutaneous Electrical Acupoint Stimulation (TEAS) is a non-invasive therapeutic approach that combines modern electrophysiological technology with traditional Chinese medicine principles. Over the past few decades, TEAS has become a significant medical intervention during the perioperative period and its mechanisms have seen a continuous development. These mechanisms span across multiple aspects, including the regulation of the neuroendocrine network system, inhibition of oxidative stress, alleviation of immune suppression, regulation of endothelial function, and inhibition of coagulation and fibrinolysis system activation. This article aims to summarize and elaborate the mechanisms of TEAS in the perioperative period and to discuss current research challenges. Future studies should strive to optimize treatment protocols to promote the research on the mechanisms of TEAS in the perioperative period, subsequently offering patients safer and more effective treatment alternatives.
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Affiliation(s)
- Xiaobo Jiang
- College of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Mengqi Li
- College of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Yuanjian Tang
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Jing Hu
- Department of Paediatric Endocrinology, The First Hospital of Jilin University, Changchun, China
| | - Xiangmu Gai
- College of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Chenfeng Zhang
- College of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Tie Li
- College of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, China
| | - Yanxin Wang
- Department of Cardiovascular Rehabilitation, The Third Clinical Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Hongfeng Wang
- Northeast Asia Institute of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
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17
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Zhang D, He L, Ouyang C, Wang Y, Ning Q, Liao D. A comparative analysis of three risk assessment scales for predicting venous thromboembolism in traumatic brain injury patients. Sci Rep 2025; 15:11623. [PMID: 40185781 PMCID: PMC11971365 DOI: 10.1038/s41598-025-91290-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2024] [Accepted: 02/19/2025] [Indexed: 04/07/2025] Open
Abstract
Venous thromboembolism (VTE) is a common complication in patients with traumatic brain injury (TBI). This study aimed to assess the predictive ability of the Caprini score, Risk Assessment Profile for Thromboembolism (RAPT), and Trauma Embolic Scoring System(TESS) for VTE risk assessments in TBI patients. A retrospective analysis of 460 TBI patients was conducted, categorizing them into VTE and non-VTE groups based on imaging results. The three scales were applied to assess VTE risk, and their performance was compared using receiver operating characteristic(ROC) curves and area under the curve(AUC) values. The VTE incidence was 31.7%. The RAPT scale demonstrated the highest AUC (0.826) and optimal cutoff (9.5) with balanced sensitivity (0.753) and specificity (0.771). The Caprini and TESS scales also showed moderate to high predictive value but had lower AUCs. All three scoring scales showed medium to high predictive value for the risk of VTE in patients with TBI. Among them, the RAPT scoring scale offered the highest predictive value for VTE risk in TBI patients, with fewer items, making it easier for clinical implementation. It stands as the most appropriate VTE risk assessment scale for TBI patients at present.
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Affiliation(s)
- Dandan Zhang
- Department of Orthopedics, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
- Trauma center of West China Hospital/West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Lingxiao He
- Department of Orthopedics, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
- Trauma center of West China Hospital/West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Chaowei Ouyang
- Department of Orthopedics, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
- Trauma center of West China Hospital/West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yiyan Wang
- Department of Orthopedics, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
- Trauma center of West China Hospital/West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Qian Ning
- Department of Orthopedics, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
- Trauma center of West China Hospital/West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Dengbin Liao
- Department of Orthopedics, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China.
- Trauma center of West China Hospital/West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China.
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18
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Zaman MA, Sohail MO, Sbeitan I, Aldergash SM. Prolonged Antibiotics Versus Prolonged Anticoagulation: A Case Report of Libman-Sacks Endocarditis. Cureus 2025; 17:e83203. [PMID: 40443610 PMCID: PMC12122049 DOI: 10.7759/cureus.83203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2025] [Indexed: 06/02/2025] Open
Abstract
Marantic endocarditis, also known as nonbacterial thrombotic endocarditis (NBTE), Libman-Sacks endocarditis, or verrucous endocarditis, is a rare, non-infectious endocarditis (IE) that primarily affects the aortic and mitral valves. It is often underreported due to its subtle nonspecific presentation and close echocardiographic resemblance to infective endocarditis (IE). Substantial NBTE differentials include cardiac tumors, IE, and prior residual lesions. Echocardiography, clinical evaluation, and other alternative imaging modalities, such as cardiac CT or PET/CT, are essential for comprehensive assessment. Treatment options primarily focus on managing the underlying condition and preventing thromboembolic events. As NBTE is characterized by sterile vegetations on cardiac valves and is not caused by an infectious agent, antibiotics have no role in treating NBTE. Anticoagulation is a critical component of treatment in patients with NBTE. However, the recommended duration of anticoagulation is not known and is a case-based decision. The American College of Chest Physicians guidelines suggest that patients with NBTE and systemic or pulmonary emboli should be treated with full-dose intravenous unfractionated heparin or subcutaneous low molecular weight heparin. It is suggested that anticoagulation should continue until the vegetation resolves (median of 11 months) or for at least one to two years to mitigate the systemic embolic risks.
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Affiliation(s)
- Muhammad A Zaman
- Internal Medicine, Conemaugh Memorial Medical Center, Johnstown, USA
| | | | - Ibrahim Sbeitan
- Oncology, University of Pittsburgh Medical Center, Johnstown, USA
| | - Salah M Aldergash
- Internal Medicine, Conemaugh Memorial Medical Center, Johnstown, USA
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19
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Okoye G, Ben-Umeh KC, Avanceña ALV, Onukwugha E. Healthcare resource utilization and costs after initiating direct-acting oral anticoagulants or low molecular weight heparins in patients with venous thromboembolism. Vasc Med 2025; 30:197-204. [PMID: 39760434 PMCID: PMC12014951 DOI: 10.1177/1358863x241305097] [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] [Indexed: 01/07/2025]
Abstract
BACKGROUND Venous thromboembolism (VTE) can lead to significant healthcare resource utilization (HcRU) and costs. First-line treatments such as direct-acting oral anticoagulants (DOAC) and low molecular weight heparin (LMWH) are utilized for VTE management. There are limited observational studies to determine which first-line drug for VTE is associated with lower HcRU and cost. Therefore, we sought to compare HcRU and costs of commercially insured patients with VTE who initiated DOAC or LMWH in the US. METHODS We utilized Merative MarketScan Research Database (2016-2021) to identify adults initiating DOAC or LMWH for VTE. Baseline measures were assessed 12 months prior to the index date of drug initiation. Inverse probability of treatment weighting was used to control confounding. For HcRU, logistic regression was used to model emergency room and inpatient visits and the negative binomial count model was used for outpatient visits. The average marginal effect for total healthcare cost comparing DOAC with LMWH users was estimated using a generalized linear model. HcRU and costs were evaluated for 12 months posttreatment initiation. RESULTS DOAC users had lower odds of inpatient visits (adjusted odds ratio [aOR] 0.53, 95% CI 0.46 to 0.59), emergency room visits (aOR 0.86, 95% CI 0.73 to 0.99), and outpatient visits (adjusted incident rate ratio 0.52, 95% CI 0.50 to 0.54) in comparison to LMWH users. DOAC users had lower total healthcare costs of -$9573 (95% CI -$11,149 to -$7997) (US dollars). CONCLUSION This cohort study suggests that DOAC use is associated with fewer inpatient, outpatient, and emergency room visits, and lower healthcare costs compared to LMWH use for VTE management.
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Affiliation(s)
- Godwin Okoye
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Kenechukwu C Ben-Umeh
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Anton LV Avanceña
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Eberechukwu Onukwugha
- Department of Practice, Sciences, and Health Outcomes Research, School of Pharmacy, University of Maryland, Baltimore, MD, USA
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20
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Cao P, Luo X, Gao R, Li Y, Li L, Zhang Y, Liu X. Endovascular Stenting and Factor Xa Inhibitors for Filter-Associated Chronic IVC Occlusion: A Case Series. AMERICAN JOURNAL OF CASE REPORTS 2025; 26:e946402. [PMID: 40159665 PMCID: PMC11970536 DOI: 10.12659/ajcr.946402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 02/11/2025] [Accepted: 01/29/2025] [Indexed: 04/02/2025]
Abstract
BACKGROUND Chronic inferior vena cava (IVC) occlusion is a serious long-term complication of inferior vena cava filters (IVCFs) placement, which can lead to severe post-thrombotic syndrome (PTS). Endovascular management associated with anticoagulation may be one of limited options. Here, we present 3 patients with chronic filter-associated IVC occlusion managed with endovascular stenting and Factor Xa inhibitor infusion. CASE REPORT Case 1: A 48-year-old man who presented bilateral lower-extremity swelling, hyperpigmentation, and refractory venous ulcerations with a permanent IVCFs placements 16 years before admission was diagnosed as having filter-associated chronic IVC occlusions. Recanalization was performed through endovascular therapy, and factor Xa inhibitor was selected for antithrombotic therapy. Although in-stent occlusion was discovered on the left limb during 1-year follow-up, relief of symptoms was achieved at 36-month follow-up. Case 2: A 75-year-old man with a 6-year history of bilateral lower-extremity swelling, hyperpigmentation, and refractory venous ulcerations was found to have chronic IVC occlusions due to permanent IVCFs. Endovascular therapy and factor Xa inhibitor were chosen for revascularization, and symptomatic relief and stents patency were maintained until the last follow-up (30 months). Case 3: A 46-year-old man diagnosed with filter-associated chronic IVC occlusions underwent endovascular stenting and factor Xa inhibitor infusion. Improvement was shown during the first-year follow-up, but recurrence of symptoms and in-stent occlusions were discovered at 18-month follow-up for anticoagulation withdrawal. CONCLUSIONS Despite risks of in-stent occlusions, factor Xa inhibition associated with endovascular may be a safe and feasible management of filter-associated chronic IVC occlusion.
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Affiliation(s)
- Pengkai Cao
- Department of Vascular Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Xintong Luo
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, PR China
| | - Ruijiao Gao
- Department of Vascular Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Yunsong Li
- Department of Vascular Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Liang Li
- Department of Vascular Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Yanrong Zhang
- Department of Vascular Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Xiangdong Liu
- Department of Vascular Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
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21
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Phyo WW, Deodhar K, Chang A, Blair M, Boyd AN, Geik C. Prophylactic Enoxaparin Dosing and Anti-Xa Levels in Medicine Patients With Obesity. J Pharm Technol 2025:87551225251328255. [PMID: 40170754 PMCID: PMC11955971 DOI: 10.1177/87551225251328255] [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: 04/03/2025] Open
Abstract
Introduction: Previous studies have shown that the manufacturer's standard fixed dosing of enoxaparin for venous thromboembolism (VTE) prophylaxis leads to sub-prophylactic anti-Xa levels in medicine patients with obesity. Yet, there is limited literature describing higher dosing strategies in this patient population, and an optimal dosing regimen has not been well-established. Objective: The primary objective was to evaluate mean doses (mg/kg/d) of prophylactic enoxaparin that are associated with goal anti-Xa levels in medicine patients with obesity across 3 body mass index (BMI) groups (40-49 kg/m2, 50-59 kg/m2, ≥60 kg/m2). Methods: This is a single-center, retrospective cohort study of adult patients (age ≥18 years) with BMI ≥40 kg/m2 admitted to a medicine team with at least 1 appropriately drawn anti-Xa level between January 2018 and July 2023. The institution's goal anti-Xa level for VTE prophylaxis was 0.2 to 0.4 units/mL. The primary outcome was the comparison of mean dose between those within anti-Xa at goal and not at goal. Secondary outcomes included the percentages of initial anti-Xa levels below, within, or above goal range and the incidence of new VTE and major bleeding events during hospitalization while on enoxaparin. All outcomes were stratified into 3 BMI groups: 40-49 kg/m2, 50-59 kg/m2, and ≥60 kg/m2. Results: Median dose of those with final anti-Xa level at goal was significantly higher than that of those not in goal anti-Xa range across all 3 BMI groups (0.57 vs 0.50 mg/kg/d; P < 0.05). The majority of the initial anti-Xa levels were subprophylactic, with only 35.7% of patients (or 75 of 210 patients) had initial anti-Xa within the goal range. There were no statistically significant differences in the number of blood transfusions or VTE events between the groups. Conclusion: Findings suggest that medicine patients with BMI ≥40 kg/m2 may require enoxaparin doses higher than 0.5 mg/kg/d to reach goal prophylactic anti-Xa level. However, more robust data are necessary to further validate these results and the clinical implications.
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Affiliation(s)
- Wint War Phyo
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN, USA
| | | | - Amy Chang
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN, USA
| | - Mary Blair
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN, USA
| | - Allison N. Boyd
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN, USA
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22
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Scerrati A, Scanferla G, Sgarbanti L, Mantovani G, Angelini C, Flacco ME, Maugeri R, Bonosi L, Iacopino DG, Tumbiolo S, Adorno A, Brunasso L, Lofrese G, Rosetti V, Tosatto L, Somma T, Cavallo LM, Lombardi S, Sturiale CL, Signorelli F, Auricchio AM, Menna G, Ricciardi L, Montemurro N, Raneri F, Rustemi O, Zambon G, Cavallo MA, De Bonis P. Clinical outcomes and hemorrhagic or thromboembolic risks in decompressive craniectomy for patients taking antiplatelet or anticoagulant therapy. Neurosurg Rev 2025; 48:328. [PMID: 40140119 PMCID: PMC11947026 DOI: 10.1007/s10143-025-03491-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Revised: 02/20/2025] [Accepted: 03/20/2025] [Indexed: 03/28/2025]
Abstract
Decompressive craniectomy (DC) is a critical surgical intervention for elevated intracranial pressure. However, the impact of preoperative antiplatelet or anticoagulant therapy on outcomes and complications remains unclear. A retrospective-prospective study was conducted on 145 patients undergoing DC between November 2021 and May 2023. Patients were categorized into two groups: those with (n = 48) and without (n = 97) preoperative antithrombotic therapy. Demographic data, comorbidities, antithrombotic therapy type and duration, clinical outcomes, and pre-operative risk factors (CHA2DS2-VASc and HAS-BLED scores) were analyzed. While there was a trend towards higher hemorrhagic complications in the antithrombotic therapy group (20.0% vs. 11.3%), this difference was not statistically significant. However, thromboembolic events, primarily stroke (27.7% vs. 9.3%) and acute myocardial infarction (10.6% vs. 0.0%), were significantly more frequent in the antithrombotic therapy group. Multivariate analysis revealed that ischemic stroke as a primary diagnosis, rather than antithrombotic therapy itself, was a significant predictor of thromboembolic complications (adjusted OR 3.49, 95%CI 1.47-8.28, p = 0.005). Pre-operative GCS was associated with improved outcomes (adjusted OR 0.81, 95%CI 0.67-0.97, p = 0.025). While antithrombotic therapy does not appear to increase the risk of hemorrhagic complications after DC, it is associated with a higher risk of thromboembolic events, especially in patients with ischemic stroke. Individualized assessment and tailored management of antithrombotic therapy are crucial to optimize outcomes in DC patients. Further studies are needed to refine strategies for bridging anticoagulation and managing antithrombotic therapy in this population, considering factors such as CHA2DS2-VASc and HAS-BLED scores, as well as patient-specific risk profiles.
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Affiliation(s)
- Alba Scerrati
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Giovanni Scanferla
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Lorenzo Sgarbanti
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Giorgio Mantovani
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Chiara Angelini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Maria Elena Flacco
- Environmental and Preventive Sciences, University of Ferrara, Ferrara, Italy
| | - Rosario Maugeri
- Unit of Neurosurgery, AOUP "Paolo Giaccone", Department of Biomedicine Neurosciences and Advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
| | - Lapo Bonosi
- Unit of Neurosurgery, AOUP "Paolo Giaccone", Department of Biomedicine Neurosciences and Advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
| | - Domenico Gerardo Iacopino
- Unit of Neurosurgery, AOUP "Paolo Giaccone", Department of Biomedicine Neurosciences and Advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
| | | | | | - Lara Brunasso
- Unit of Neurosurgery Hospital "Villa Sofia", Palermo, Italy
| | | | | | | | - Teresa Somma
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II University of Naples, 80131, Naples, Italy
| | - Luigi Maria Cavallo
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II University of Naples, 80131, Naples, Italy
| | - Sara Lombardi
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, Federico II University of Naples, 80131, Naples, Italy
| | - Carmelo Lucio Sturiale
- Department of Neurosurgery, Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.Go A. Gemelli 8, 00168, Rome, Italy.
| | - Francesco Signorelli
- Department of Neurosurgery, Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.Go A. Gemelli 8, 00168, Rome, Italy
| | - Anna Maria Auricchio
- Department of Neurosurgery, Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.Go A. Gemelli 8, 00168, Rome, Italy
| | - Grazia Menna
- Department of Neurosurgery, Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.Go A. Gemelli 8, 00168, Rome, Italy
| | - Luca Ricciardi
- Neurosurgical Unit, Department of Neuroscience, Mental Health, and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Fabio Raneri
- Department of Neurosurgery, ULSS8 Berica, Vicenza, Italy
| | - Oriela Rustemi
- Department of Neurosurgery, ULSS8 Berica, Vicenza, Italy
| | | | - Michele Alessandro Cavallo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Pasquale De Bonis
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant'Anna University Hospital of Ferrara, Ferrara, Italy
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23
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Chen X, Sui Z, Ting J, Qi M, Yin Y, He F. Analysis of the current status and influencing factors of LEDVT in patients with acute hemorrhagic stroke. Medicine (Baltimore) 2025; 104:e41759. [PMID: 40128074 PMCID: PMC11936670 DOI: 10.1097/md.0000000000041759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Accepted: 02/16/2025] [Indexed: 03/26/2025] Open
Abstract
Lower extremity deep venous thrombosis (LEDVT) is a common complication in patients with acute hemorrhagic stroke, leading to increased risk of pulmonary embolism, disability, and mortality. Despite its importance, LEDVT often goes undetected in clinical practice, and early preventive strategies remain insufficient. This study aimed to explore the incidence of LEDVT in acute hemorrhagic stroke patients, identify key risk factors, and discuss potential preventive measures to reduce its occurrence and improve patient outcomes. A retrospective analysis was conducted on 431 acute hemorrhagic stroke patients admitted to The First Affiliated Hospital of Chengdu Medical College between January 2022 and December 2023. Relevant clinical data, including patient demographics, comorbidities, NIHSS score, and treatment history, were collected. LEDVT was diagnosed using standardized ultrasound criteria. Statistical analyses, including univariate and multivariate logistic regression, were performed using SPSS 17.0 to identify independent risk factors associated with LEDVT. The incidence of LEDVT among the 431 acute hemorrhagic stroke patients was 12.1%, with 52 cases identified. Significant risk factors for LEDVT included advanced age, diabetes, infection, prolonged bed rest, high-dose diuretic use, NIHSS score ≥16, and hyperlipidemia (P < .05). Gender, smoking history, and alcohol consumption were not found to be statistically significant. Multivariate logistic regression revealed that advanced age, diabetes, infection, prolonged bed rest, high-dose diuretic use, NIHSS score ≥16, and hyperlipidemia were independent risk factors for LEDVT. LEDVT in acute hemorrhagic stroke patients is influenced by multiple factors, including comorbidities, severity of neurological impairment, and treatment regimens. Dehydration therapy used for managing brain edema and intracranial pressure was also found to be an independent risk factor. Given the significant impact of LEDVT on patient prognosis, early identification of at-risk patients and the implementation of proactive preventive measures-such as pharmacological treatments and physical interventions-are critical in reducing the occurrence of LEDVT, alleviating patient suffering, and improving long-term outcomes. Future studies should focus on refining preventive strategies and exploring more individualized interventions to further reduce the incidence of LEDVT in these patients.
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Affiliation(s)
- Xuemei Chen
- Department of Neurosurgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Zhao Sui
- Department of Neurosurgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Jing Ting
- Department of Neurosurgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Minjin Qi
- Department of Neurosurgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Yijing Yin
- Department of Neurosurgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Furong He
- Department of Neurosurgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
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24
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Jimenez Tejero E, Lopez-Alcalde J, Correa-Pérez A, Stallings E, Gaetano Gil A, Del Campo Albendea L, Mateos-Haro M, Fernandez-Felix BM, Stallings R, Alvarez-Diaz N, García Laredo E, Solier A, Fernández-Martínez E, Morillo Guerrero R, de Miguel M, Perez R, Antequera A, Muriel A, Jimenez D, Zamora J. Sex as a prognostic factor for mortality in adults with acute symptomatic pulmonary embolism. Cochrane Database Syst Rev 2025; 3:CD013835. [PMID: 40110896 PMCID: PMC12043200 DOI: 10.1002/14651858.cd013835.pub2] [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] [Indexed: 03/22/2025]
Abstract
BACKGROUND Pulmonary embolism (PE) is relatively common worldwide. It is a serious condition that can be life-threatening. Studies on the relationship between adverse outcomes of this condition and whether a patient is male or female have yielded inconsistent results. Determining whether there is an association between sex and short-term mortality in patients with acute PE is important as this information may help guide different approaches to PE monitoring and treatment. OBJECTIVES To determine whether sex (i.e. being a male or a female patient) is an independent prognostic factor for predicting mortality in adults with acute symptomatic pulmonary embolism. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases, and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials register up to 17 February 2023. We scanned conference abstracts and reference lists of included studies and systematic reviews. We also contacted experts to identify additional studies. There were no restrictions with respect to language or date of publication. SELECTION CRITERIA We included phase 2-confirmatory prognostic studies, that is, any longitudinal study (prospective or retrospective) evaluating the independent association between sex (male or female) and mortality in adults with acute PE. DATA COLLECTION AND ANALYSIS We followed the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of prognostic factor studies (CHARMS-PF) and the Cochrane Prognosis Methods Group template for prognosis reviews. Two review authors independently screened the studies, extracted data, assessed the risk of bias according to the Quality in Prognosis Studies (QUIPS) tool, and assessed the certainty of the evidence (GRADE). Meta-analyses were performed by pooling adjusted estimates. When meta-analysis was not possible, we reported the main results narratively. MAIN RESULTS We included seven studies (726,293 participants), all of which were retrospective cohort studies with participants recruited and managed in hospitals between 2000 and 2018. Studies took place in the USA, Spain, and Japan. Most studies were multicentre. None were conducted in low- or middle-income countries. The participants' mean age ranged from 62 to 69 years, and the proportion of females was higher in six of the seven studies, ranging from 46% to 60%. Sex and gender terms were used inconsistently. Participants received different PE treatments: reperfusion, inferior vena cava filter, anticoagulation, and haemodynamic/respiratory support. The prognostication time (the point from which the outcome was predicted) was frequently omitted. The included studies provided data for three of our outcomes of interest. We did not consider any of the studies to be at an overall low risk of bias for any of the outcomes analysed. We judged the certainty of the evidence as moderate to low due to imprecision and risk of bias. We found moderate-certainty evidence (due to imprecision) that for female patients there is likely a small but clinically important reduction in all-cause mortality at 30 days (odds ratio (OR) 0.81, 95% confidence interval (CI) 0.72 to 0.92; I2 = 0%; absolute risk difference (ARD) 24 fewer deaths in women per 1000 participants, 95% CI 35 to 10 fewer; 2 studies, 17,627 participants). However, the remaining review outcomes do not indicate lower mortality in female patients. There is low-certainty evidence (due to serious risk of bias and imprecision) indicating that for females with PE, there may be a small but clinically important increase in all-cause hospital mortality (OR 1.11, 95% CI 1.00 to 1.22; I2 = 21.7%; 95% prediction interval (PI) 0.76 to 1.61; ARD 13 more deaths in women per 1000 participants, 95% CI 0 to 26 more; 3 studies, 611,210 participants). There is also low-certainty evidence (due to very serious imprecision) indicating that there may be little to no difference between males and females in PE-related mortality at 30 days (OR 1.08, 95% CI 0.55 to 2.12; I2 = 0%; ARD 4 more deaths in women per 1000 participants, 95% CI 22 fewer to 50 more; 2 studies, 3524 participants). No study data was found for the other outcomes, including sex-specific mortality data at one year. Moreover, due to insufficient studies, many of our planned methods were not implemented. In particular, we were unable to conduct assessments of heterogeneity or publication bias or subgroup and sensitivity analyses. AUTHORS' CONCLUSIONS The evidence is uncertain about sex (being male or female) as an independent prognostic factor for predicting mortality in adults with PE. We found that, for female patients with PE, there is likely a small but clinically important reduction in all-cause mortality at 30 days relative to male patients. However, this result should be interpreted cautiously, as the remaining review outcomes do not point to an association between being female and having a lower risk of death. In fact, the evidence in the review also suggested that, in female patients, there may be a small but clinically important increase in all-cause hospital mortality. It also showed that there may be little to no difference in PE-related mortality at 30 days between male and female patients. There is currently no study evidence from longitudinal studies for our other review outcomes. Although the available evidence is conflicting and therefore cannot support a recommendation for or against routinely considering sex to quantify prognosis or to guide personalised therapeutic approaches for patients with PE, this Cochrane review offers information to guide future primary research and systematic reviews.
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Affiliation(s)
- Elena Jimenez Tejero
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
- Cochrane Associate Centre of Madrid, Madrid, Spain
| | - Jesús Lopez-Alcalde
- Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
- Cochrane Associate Centre of Madrid, Madrid, Spain
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS); CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Institute for Complementary and Integrative Medicine, University Hospital Zurich; University of Zurich, Zurich, Switzerland
| | - Andrea Correa-Pérez
- Hospital Pharmacy and Medical Devices Department, Hospital Central de la Defensa "Gomez Ulla", Madrid, Spain
| | - Elena Stallings
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS); CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Andrea Gaetano Gil
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Laura Del Campo Albendea
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS); CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Miriam Mateos-Haro
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Borja Manuel Fernandez-Felix
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS); CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Raymond Stallings
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Eduardo García Laredo
- Faculty of Health Sciences, Universidad Internacional de La Rioja (UNIR), Logroño, Spain
- Comet Global Innovation SL, Barcelona, Spain
| | - Aurora Solier
- Respiratory Department, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | - Raquel Morillo Guerrero
- Department of Pneumology, Hospital Universitario Ramón y Cajal (IRYCIS); CIBER Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Marcos de Miguel
- Department of Anesthesiology and Intensive Care, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Raquel Perez
- Respiratory Department, Hospital Universitario 12 de Octubre, Universidad Complutense Madrid, Madrid, Spain
| | - Alba Antequera
- International Health Department, ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Alfonso Muriel
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS); CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Nursing and Physiotherapy, Universidad de Alcalá, Alcalá De Henares, Spain
| | - David Jimenez
- Respiratory Department, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- Medicine Department, Universidad de Alcalá (IRYCIS), Madrid, Spain
- CIBER Enfermedades Respiratorias, CIBERES, Madrid, Spain
| | - Javier Zamora
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS); CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
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25
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Patel K, Beyda R. Fixed-dose subcutaneous low-molecular-weight heparin versus adjusted-dose unfractionated heparin for venous thromboembolism treatment. Acad Emerg Med 2025. [PMID: 40098582 DOI: 10.1111/acem.70021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Revised: 02/25/2025] [Accepted: 02/26/2025] [Indexed: 03/19/2025]
Affiliation(s)
- Krishna Patel
- Department of Emergency Medicine, Brookdale University Hospital Medical Center, Brooklyn, New York, USA
| | - Raymond Beyda
- Department of Emergency Medicine, Brookdale University Hospital Medical Center, Brooklyn, New York, USA
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26
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Szymanski K, Weber C, Daugherty K, Cohen DA. A review of venous thromboembolism for the hospitalist. Postgrad Med 2025; 137:131-138. [PMID: 39804968 DOI: 10.1080/00325481.2025.2452155] [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: 05/20/2024] [Revised: 12/10/2024] [Accepted: 01/07/2025] [Indexed: 01/16/2025]
Abstract
Venous thromboembolism (VTE), consisting of both deep vein thrombosis (DVT) and pulmonary embolism (PE), is an extremely common condition both in the United States and worldwide. Not only is the diagnosis associated with significant morbidity and mortality for patients but it also imposes a deleterious financial burden on the US healthcare system. Diagnosis may be challenging due to variability in clinical presentation and requires a sequential workup including assessment of clinical pretest probability for VTE, D-dimer testing, and imaging. Following diagnosis, proper risk stratification is necessary to determine the appropriate treatment as well as the need for inpatient care. Elucidation of underlying major or minor risk factors at the time of diagnosis is essential as the presence of which may influence the duration of therapy. First-line treatment for most patients is anticoagulation with a direct oral anticoagulant (DOAC) for a minimum of 3-6 months. In multiple clinical trials, DOACs have proven to be non-inferior to vitamin K antagonists for the treatment of VTE with a lower risk of bleeding. Special consideration should be taken in the choice of agent and duration of treatment for patients who have underlying thrombophilias or malignancy and who are pregnant.
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Affiliation(s)
- Kelly Szymanski
- Department of Internal Medicine, Lankenau Medical Center, Wynnewood, PA, USA
| | - Carly Weber
- Department of Internal Medicine, Lankenau Medical Center, Wynnewood, PA, USA
| | - Kaitlin Daugherty
- Department of Internal Medicine, Lankenau Medical Center, Wynnewood, PA, USA
| | - David A Cohen
- Department of Internal Medicine, Lankenau Medical Center, Wynnewood, PA, USA
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Vinson DR, Somers MJ, Qiao E, Campbell AR, Heringer GV, Florio CJ, Zekar L, Middleton CE, Woldemariam ST, Gupta N, Poth LS, Reed ME, Roubinian NH, Raja AS, Sperling JD. Consent to advanced imaging in antenatal pulmonary embolism diagnostics: Prevalence, outcomes of nonconsent and opportunities to mitigate delayed diagnosis risk. Acad Emerg Med 2025; 32:260-273. [PMID: 39552252 DOI: 10.1111/acem.15045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Revised: 10/15/2024] [Accepted: 10/18/2024] [Indexed: 11/19/2024]
Abstract
BACKGROUND Nonconsent to pulmonary vascular (or advanced) imaging for suspected pulmonary embolism (PE) in pregnancy can delay diagnosis and treatment, increasing risk of adverse outcomes. We sought to understand factors associated with consent and understand outcomes after nonconsent. METHODS This retrospective cohort study was undertaken across 21 community hospitals from October 1, 2021, through March 31, 2023. We included gravid patients undergoing diagnostics for suspected PE who were recommended advanced imaging. The primary outcome was verbal consent to advanced imaging. Diagnostic settings were nonobstetric (99% emergency departments [EDs]) and obstetrics (labor and delivery and outpatient clinics). Using quasi-Poisson regression, we calculated adjusted relative risks (aRRs) of consenting with 95% confidence intervals (CIs). We also reported symptom resolution and delayed imaging at follow-up and 90-day PE outcomes. RESULTS Imaging was recommended for 405 outpatients: median age was 30.5 years; 50% were in the third trimester. Evaluation was more common in nonobstetric (83%) than obstetric settings (17%). Overall, 314 (78%) agreed to imaging and 91 (22%) declined imaging. Consenting was more prevalent in obstetric settings compared with nonobstetric settings: 99% versus 73% (p < 0.001). When adjusted for demographic and clinical variables, including pretest probability, only obstetric setting was independently associated with consenting: aRR 1.26 (95% CI 1.09-1.44). Seventy-nine (87%) patients declining imaging had 30-day follow-up. Eight of 12 who reported persistent or worsening symptoms on follow-up were again recommended advanced imaging and consented. Imaging was negative. None who initially declined imaging were diagnosed with PE or died within 90 days. CONCLUSIONS One in five gravid patients suspected of PE declined advanced imaging, more commonly in nonobstetric (principally ED) settings than obstetric settings. Patients symptomatic on follow-up responded favorably to subsequent imaging recommendations without 90-day outcomes. Improving the communication and documentation of informed consent and securing close follow-up for nonconsenters may mitigate risks of missed and delayed PE diagnosis.
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Affiliation(s)
- David R Vinson
- The Permanente Medical Group, Pleasanton, California, USA
- Kaiser Permanente Northern California Division of Research, Pleasanton, California, USA
- Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center, Roseville, California, USA
| | - Madeline J Somers
- Kaiser Permanente Northern California Division of Research, Pleasanton, California, USA
| | - Edward Qiao
- California Northstate University College of Medicine, Elk Grove, California, USA
| | - Aidan R Campbell
- Department of Biology, New York University, New York, New York, USA
| | - Grace V Heringer
- Department of Neurobiology, Physiology and Behavior, University of California, Davis, California, USA
| | - Cole J Florio
- Department of Microbiology and Molecular Genetics, University of California, Davis, California, USA
| | - Lara Zekar
- Department of Emergency Medicine, UC Davis Health, Sacramento, California, USA
| | - Cydney E Middleton
- Department of Emergency Medicine, UC Davis Health, Sacramento, California, USA
| | - Sara T Woldemariam
- Department of Obstetrics and Gynecology, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Nachiketa Gupta
- The Permanente Medical Group, Pleasanton, California, USA
- Department of Emergency Medicine, Kaiser Permanente Redwood City Medical Center, Redwood City, California, USA
| | - Luke S Poth
- The Permanente Medical Group, Pleasanton, California, USA
- Department of Emergency Medicine, Kaiser Permanente South San Francisco Medical Center, San Francisco, California, USA
| | - Mary E Reed
- Kaiser Permanente Northern California Division of Research, Pleasanton, California, USA
| | - Nareg H Roubinian
- The Permanente Medical Group, Pleasanton, California, USA
- Kaiser Permanente Northern California Division of Research, Pleasanton, California, USA
- Department of Pulmonary and Critical Care Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Ali S Raja
- Departments of Emergency Medicine and Radiology, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Jeffrey D Sperling
- The Permanente Medical Group, Pleasanton, California, USA
- Department of Maternal and Fetal Medicine, Kaiser Permanente Modesto Medical Center, Modesto, California, USA
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King HL, Padilla-Lazos T, Chitkara A, Tan V, Benedetti GB, Agha A, Martens KL, Shatzel JJ. Unveiling the complexities of catheter-related thrombosis: risk factors, preventive strategies, and management. J Thromb Thrombolysis 2025; 58:443-457. [PMID: 40042718 DOI: 10.1007/s11239-025-03073-7] [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] [Accepted: 01/31/2025] [Indexed: 04/20/2025]
Abstract
Catheter-related deep venous thrombosis (CR-DVT) is a common complication of central venous catheters, however optimal prophylactic and treatment strategies have yet to be fully defined. While the use of anticoagulation for CR-DVT prophylaxis is not routinely recommended, current available data offer heterogeneous results due to small sample size, non-uniform study design, and varying comorbid conditions. Available guidelines for the treatment of CR-DVT generally recommend a limited duration of anticoagulation after catheter removal. If ongoing use is required and the device remains functional, guidelines support anticoagulation throughout the time the catheter remains in place. It is worth acknowledging that data guiding these recommendations is largely derived from observational studies of upper extremity CR-DVT, along with randomized trials of anticoagulation in patients with lower extremity DVT. Therefore, large, randomized controlled trials are desperately needed to define optimal management, especially in patients who are at high risk for bleeding. This review explores the epidemiology and risk factors of CR-DVT, diagnostic, prophylactic and treatment strategies, guideline recommendations, and future advances in the field, including the introduction of novel anticoagulants. With current available evidence, we also conclude with an individualized approach to preventing and managing CR-DVT to assist clinicians who are faced with this common clinical scenario.
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Affiliation(s)
- Hannah L King
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
| | | | - Akshit Chitkara
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Virginia Tan
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - Aya Agha
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kylee L Martens
- Division of Hematology and Medical Oncology, Oregon Health & Science University, Portland, OR, USA
| | - Joseph J Shatzel
- Division of Hematology and Medical Oncology, Oregon Health & Science University, Portland, OR, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
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Kazemi R, Jandaghi FS, Jannesari A, Montazeri F. Pseudoaneurysm of the lower pole segmental artery of the kidney following open nephrolithotomy using an avascular approach: a case report. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2025; 13:51-56. [PMID: 40124575 PMCID: PMC11928827 DOI: 10.62347/xyva5477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Accepted: 02/13/2025] [Indexed: 03/25/2025]
Abstract
Aneurysms are abnormalities in blood vessels that can be categorized as true aneurysms or pseudoaneurysms. Pseudoaneurysms occur when one or more layers of the blood vessel wall rupture, often as a result of trauma or medical procedures, such as nephrolithotomy. This case study discusses a pseudoaneurysm of the lower pole segmental artery of the kidney that developed after an open nephrolithotomy despite an avascular surgical plan. The patient experienced intermittent gross hematuria, highlighting the potential complications associated with renal surgeries. The diagnosis was challenging, necessitating a high suspicion index and imaging modalities such as ultrasound, CT scans, and angiography. Treatment options varied from conservative management to angioembolization, which is preferred for its minimally invasive nature and ability to preserve renal parenchyma. This study aims to demonstrate that the risk of pseudoaneurysm should be considered even in an atrophic nephrolithotomy performed without vascular invasion.
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Affiliation(s)
- Reza Kazemi
- Department of Urology, Isfahan University of Medical SciencesIsfahan, Iran
| | - Faezeh Sadat Jandaghi
- Department of Urology, School of Medicine, Al-Zahra Hospital, Isfahan University of Medical SciencesIsfahan, Iran
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30
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Merz LE, Bassa B, Ní Áinle F, Fogerty AE. Thrombotic complications in pregnancy: a case-based review of the evidence. J Thromb Haemost 2025; 23:417-428. [PMID: 39395543 DOI: 10.1016/j.jtha.2024.09.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 08/27/2024] [Accepted: 09/25/2024] [Indexed: 10/14/2024]
Abstract
Pregnancy is a prothrombotic state due to an estrogen-driven shift in the coagulation system, increased venous stasis, and external restriction of blood flow caused by the gravid uterus. Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in pregnancy. Preventing, recognizing, and treating thrombosis in pregnancy, as well as the postpartum period, often challenges decision making in the clinical setting. In early pregnancy, guidance with respects to thrombophilia testing and anticoagulation in increasing the likelihood of live birth among patients with recurrent miscarriages is evolving. This review explores emerging data that support clinical decision making in thrombosis care in women with common thrombotic complications in pregnancy. The first case outlines VTE diagnosis in pregnancy, initial anticoagulation management, management around delivery and postpartum, and subsequent long-term anticoagulation treatment. The second case examines testing for inherited and acquired thrombophilia in the setting of recurrent miscarriage and the management of obstetric antiphospholipid syndrome. Lastly, the third case reviews VTE risk assessment and prevention in pregnancy and the postpartum period, as well as duration and dose of postpartum thromboprophylaxis. Review of these common clinical scenarios surrounding thrombotic complications in pregnancy demonstrates recent advances in high-quality data, current gaps in knowledge, and variation in expert opinion. Ultimately, multidisciplinary discussion and teamwork remain key to optimal, safe care. Clinicians must prioritize collaborative, high-quality trials and prospective clinical management studies to better understand and define best practice in this population.
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Affiliation(s)
- Lauren E Merz
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Hematology/Oncology, Department of Medicine, Mass General Brigham, Boston, Massachusetts, USA.
| | - Bibi Bassa
- Royal College of Surgeons in Ireland, Dublin, Ireland; Division of Trauma and Emergency Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Fionnuala Ní Áinle
- Royal College of Surgeons in Ireland, Dublin, Ireland; Rotunda Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
| | - Annemarie E Fogerty
- Division of Hematology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Mojaddedi S, Jamil J, Abraham A, Jamil D, Mansoor H, Elgendy IY. Venous thromboembolism during pregnancy and postpartum period: an updated review. Minerva Med 2025; 116:62-74. [PMID: 39392291 DOI: 10.23736/s0026-4806.24.09242-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
Venous thromboembolism (VTE) is a leading cause of maternal mortality. The risk of VTE in pregnant and postpartum women is ~ five times higher compared with non-pregnant women. There is a physiological tendency to a hypercoagulable state, from conception to the postpartum period. Several non-obstetric risk factors independently increase the risk of VTE. Since most signs and symptoms of VTE might mimic those of a normal pregnancy, a high index of suspicion is warranted to establish the diagnosis. D-dimer, ultrasonography and computed tomography pulmonary angiography are the primary tools for VTE diagnosis. Management mainly revolves around systemic anticoagulation with heparin. Advanced therapy options exist, but these can be considered for selected high-risk cases.
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Affiliation(s)
- Sanaullah Mojaddedi
- Graduate Medical Education, University of Central Florida College of Medicine, Orlando, FL, USA
- Internal Medicine Residency Program, HCA Florida North Florida Hospital, Gainesville, FL, USA
| | - Javairia Jamil
- College of Medicine, Gulf Medical University, Ajman, United Arab Emirates
| | - Andrew Abraham
- Graduate Medical Education, University of Central Florida College of Medicine, Orlando, FL, USA
- Internal Medicine Residency Program, HCA Florida North Florida Hospital, Gainesville, FL, USA
| | - Dawood Jamil
- Internal Medicine Residency Program, Henry Ford Hospital, Detroit, MI, USA
| | - Hend Mansoor
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA -
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32
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Huang X, Song J, Zhang X, Wang M, Ding Y, Ji X, Zhou D, Meng R. Understanding Drug Interactions in Antiplatelet Therapy for Atherosclerotic Vascular Disease: A Systematic Review. CNS Neurosci Ther 2025; 31:e70258. [PMID: 39924343 PMCID: PMC11807728 DOI: 10.1111/cns.70258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 01/16/2025] [Accepted: 01/23/2025] [Indexed: 02/11/2025] Open
Abstract
BACKGROUND Antiplatelet drugs are a cornerstone in managing atherosclerotic vascular disease (ASVD). However, their interactions with other medications present significant challenges to treatment efficacy and safety. Patients with ASVD often require multiple treatment regimens due to complex comorbidities, which increases the risk of drug-drug interactions (DDIs). These interactions can lead to drug resistance, reduced therapeutic outcomes, or adverse effects. A thorough understanding of DDIs is crucial for optimizing patient care. AIMS This review aims to explore the clinical significance. mechanisms, and implications of DDIs in antiplatelet therapy Additionally, it seeks to identify future research directions to advance personalized treatment strategies and improve therapeutic outcomes. MATERIALS AND METHODS A systematic literature review was conducted using key databases, focusing on clinical studies, mechanistic research, and guidelines related to antiplatelet therapy and DDIs. Findings were analyzed to identify common interaction patterns, associated risks, and management strategies. RESULTS The review identifies common DDIs involving antiplatelet drugs, particularly with anticoagulants, nonsteroidal anti-inflammatory drugs, and proton pump inhibitors. These interactions primarily occur through pharmacokinetic mechanisms, such as alterations in drug metabolism via cytochrome P450 enzymes, and pharmacodynamic mechanisms, including synergistic or antagonistic effects on platelet inhibition. Clinically, DDIs can increase bleeding risk, reduce antiplatelet efficacy, and contribute to adverse cardiovascular outcomes. Strategies to mitigate these risks include individualized drug selection, dose adjustments, genetic testing, and therapeutic drug monitoring. DISCUSSION Effective management of DDIs in antiplatelet therapy is essential to improve clinical outcomes. A patient-specific approach, considering comorbidities, genetic predispositions, and concurrent medications, is crucial. The review categorizes DDIs based on clinical settings and underscores the need for further research on predictive biomarkers, pharmacogenomics, and advanced monitoring techniques. CONCLUSION DDIs significantly impact the effectiveness and safety of antiplatelet therapy, necessitating a comprehensive understanding of their mechanisms and clinical implications. Future research should focus on developing personalized treatment approaches, integrating genetic testing, and optimizing pharmacological monitoring to minimize risks and improve therapeutic outcomes. This review provides a foundation for advancing clinical practice and enhancing the management of patients with ASVD.
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Affiliation(s)
- Xiangqian Huang
- Department of NeurologyXuanwu Hospital, Capital Medical UniversityBeijingChina
- Advanced Center of StrokeBeijing Institute for Brain DisordersBeijingChina
| | - Jiahao Song
- Department of NeurologyXuanwu Hospital, Capital Medical UniversityBeijingChina
- Advanced Center of StrokeBeijing Institute for Brain DisordersBeijingChina
| | - Xiaoming Zhang
- Department of NeurologyXuanwu Hospital, Capital Medical UniversityBeijingChina
- Advanced Center of StrokeBeijing Institute for Brain DisordersBeijingChina
| | - Mengqi Wang
- Department of NeurologyXuanwu Hospital, Capital Medical UniversityBeijingChina
- Advanced Center of StrokeBeijing Institute for Brain DisordersBeijingChina
| | - Yuchuan Ding
- Department of NeurosurgeryWayne State University School of MedicineDetroitMichiganUSA
| | - Xunming Ji
- Department of NeurologyXuanwu Hospital, Capital Medical UniversityBeijingChina
- Advanced Center of StrokeBeijing Institute for Brain DisordersBeijingChina
| | - Da Zhou
- Department of NeurologyXuanwu Hospital, Capital Medical UniversityBeijingChina
- Advanced Center of StrokeBeijing Institute for Brain DisordersBeijingChina
| | - Ran Meng
- Department of NeurologyXuanwu Hospital, Capital Medical UniversityBeijingChina
- Advanced Center of StrokeBeijing Institute for Brain DisordersBeijingChina
- Department of NeurosurgeryWayne State University School of MedicineDetroitMichiganUSA
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Ogihara Y, Yamashita Y, Morimoto T, Muraoka N, Umetsu M, Nishimoto Y, Takada T, Nishikawa T, Ikeda N, Otsui K, Sueta D, Tsubata Y, Shoji M, Shikama A, Hosoi Y, Tanabe Y, Chatani R, Tsukahara K, Nakanishi N, Kim K, Ikeda S, Sato T, Kimura T, Dohi K, ONCO DVT Study Investigators. Clinical outcomes of cancer-associated isolated distal deep vein thrombosis: a comparison between asymptomatic and symptomatic thrombosis-findings from the ONCO DVT Study. Res Pract Thromb Haemost 2025; 9:102722. [PMID: 40224278 PMCID: PMC11992421 DOI: 10.1016/j.rpth.2025.102722] [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: 01/19/2025] [Revised: 02/23/2025] [Accepted: 02/26/2025] [Indexed: 04/15/2025] Open
Abstract
Background The risk of recurrent venous thromboembolism (VTE) in patients with isolated distal deep vein thrombosis (IDDVT) is generally low, particularly when IDDVT is asymptomatic. However, cancer patients with IDDVT, even asymptomatic IDDVT, may be at a higher risk of recurrent VTE. Objectives To compare the clinical outcomes of cancer patients with asymptomatic and symptomatic IDDVT. Methods The ONCO DVT trial is a randomized clinical trial that compared 12-month versus 3-month edoxaban treatment regimens in cancer patients with IDDVT. In this post hoc analysis, 601 patients were categorized into the asymptomatic (n = 479) and symptomatic (n = 122) groups based on IDDVT-related symptoms at diagnosis. The primary outcome was the composite of symptomatic recurrent VTE or VTE-related death at 12 months, while the major secondary outcome was major bleeding at 12 months. Results The cumulative 12-month incidence of the primary outcome was lower in the asymptomatic group than that in the symptomatic group (2.9% vs 13.4%; P < .001; hazard ratio, 0.21; 95% CI, 0.10-0.47). Among the 12 patients with symptomatic recurrent VTE in the asymptomatic group, 8 (67%) had recurrent IDDVT, and 11 (92%) experienced recurrence after discontinuing anticoagulation therapy. The cumulative 12-month incidence of major bleeding was lower in the asymptomatic group than that in the symptomatic group (7.8% and 13.2%; P = .048). Conclusion The risk of recurrent symptomatic VTE was lower in cancer patients with asymptomatic IDDVT than in those with symptomatic IDDVT. Most recurrent VTE events were recurrent IDDVT, with the majority occurring after discontinuing anticoagulation therapy.
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Affiliation(s)
- Yoshito Ogihara
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yugo Yamashita
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | - Nao Muraoka
- Division of Cardiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Michihisa Umetsu
- Division of Vascular Surgery, Department of Surgery, Tohoku University Hospital, Sendai, Japan
| | - Yuji Nishimoto
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Takuma Takada
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Tatsuya Nishikawa
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
| | - Nobutaka Ikeda
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kazunori Otsui
- Department of General Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yukari Tsubata
- Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine, Izumo, Japan
| | - Masaaki Shoji
- Department of Cardiovascular Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Ayumi Shikama
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yutaka Hosoi
- Department of Cardiovascular Surgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yasuhiro Tanabe
- Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ryuki Chatani
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kengo Tsukahara
- Division of Cardiology, Fujisawa City Hospital, Fujisawa, Japan
| | - Naohiko Nakanishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kitae Kim
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Satoshi Ikeda
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toru Sato
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Takeshi Kimura
- Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - ONCO DVT Study Investigators
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
- Division of Cardiology, Shizuoka Cancer Center, Shizuoka, Japan
- Division of Vascular Surgery, Department of Surgery, Tohoku University Hospital, Sendai, Japan
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
- Department of Onco-Cardiology, Osaka International Cancer Institute, Osaka, Japan
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
- Department of General Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine, Izumo, Japan
- Department of Cardiovascular Medicine, National Cancer Center Hospital, Tokyo, Japan
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Cardiovascular Surgery, Kyorin University Faculty of Medicine, Tokyo, Japan
- Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
- Division of Cardiology, Fujisawa City Hospital, Fujisawa, Japan
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan
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Babadagli HE, Ye J, Chen J, Turgeon R, Wang EH. Efficacy and safety of anti-thrombotic therapy after surgical mitral valve repair: a scoping review. Open Heart 2025; 12:e003158. [PMID: 39884742 PMCID: PMC11784107 DOI: 10.1136/openhrt-2024-003158] [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: 12/28/2024] [Accepted: 01/15/2025] [Indexed: 02/01/2025] Open
Abstract
BACKGROUND Mitral valve repair (MVr) is the gold standard treatment for degenerative mitral regurgitation, yet there is ongoing controversy regarding optimal anti-thrombotic therapy post-MVr. This scoping review aimed to summarise current evidence on the safety and efficacy of anti-thrombotic therapy after MVr, identify knowledge gaps and propose a future study design. METHODS We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, the WHO International Clinical Trials Registry Platform and bibliographies of included trials, guidelines and other reviews from inception to 17 September 2024. Randomised controlled trials (RCT) and cohort and case-control studies assessing any anti-thrombotic therapy with any outcomes after MVr were included. Using a predefined collection form, two authors independently extracted data on study characteristics and results were summarised narratively into themes based on the PICO elements. RESULTS Of 1296 screened references, we included 11 studies (10 cohort and one non-inferiority RCT). All studies compared vitamin K antagonist (VKA) to an anti-platelet, direct oral anti-coagulant or no anti-thrombotic therapy for median duration of 90 days. Thromboembolic and bleeding event incidences ranged from 0% to 14.3% and 0% to 9.1%, respectively. Seven studies reported no difference in thromboembolic events, and three reported reduced rates with VKA compared with control, while results for bleeding events varied widely. The RCT found edoxaban was non-inferior to warfarin for thromboembolic outcomes, but not for bleeding. Substantial methodological and clinical heterogeneity, high risk of bias and insufficient mitigation of confounders, such as concomitant atrial fibrillation, were prevalent across studies. CONCLUSION Based on this scoping review, existing literature on anti-thrombotic therapy after MVr is inconclusive due to design limitations. We proposed a study design for a pragmatic RCT that addresses prior study limitations and that could provide definitive evidence to guide anti-thrombotic management in MVr patients.
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Affiliation(s)
- Hazal Ece Babadagli
- Department of Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, British Columbia, Canada
- The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada
| | - Jian Ye
- Cardiac Surgery, St Paul's Hospital, Vancouver, British Columbia, Canada
- Department of Surgery, The University of British Columbia - Vancouver Campus, Vancouver, British Columbia, Canada
| | - Jenny Chen
- Pharmacy, Surrey Memorial Hospital, Surrey, British Columbia, Canada
| | - Ricky Turgeon
- The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada
- Department of Pharmaceutical Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Erica Hz Wang
- The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada
- Department of Pharmaceutical Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada
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Sun J, Liu Y, Chen J, Zhou Y, Fan H, Zhao Q. Catheter replacement combined with antiplatelet therapy in hemodialysis catheter-related right atrial thrombus: a potential treatment approach. BMC Cardiovasc Disord 2025; 25:26. [PMID: 39815167 PMCID: PMC11736923 DOI: 10.1186/s12872-025-04485-2] [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: 07/19/2024] [Accepted: 01/08/2025] [Indexed: 01/18/2025] Open
Abstract
BACKGROUND Catheter-related right atrial thrombus (CRAT) is a severe complication in hemodialysis patients that can lead to catheter dysfunction and pulmonary embolism (PE). However, no standardized treatment strategy currently exists for hemodialysis-related CRAT. This study aims to investigate the efficacy of catheter replacement and antiplatelet therapy in managing hemodialysis CRAT. METHODS We conducted a retrospective cohort study on patients at West China Hospital diagnosed with catheter dysfunction caused by right atrial thrombosis between May 2019 and March 2022. All CRAT were asymptomatic and underwent catheter replacement (either guidewire exchange or insertion at a new site), with the new catheter tip repositioned away from the original location and closer to the right atrium. Antiplatelet therapy with dipyridamole was initiated post-procedure. We analyzed the efficacy of catheter replacements and antiplatelet therapy in hemodialysis-related CRAT. RESULTS Among the 178 patients with CRAT who underwent catheter replacement, the success rate was 98.9%. Preoperative examinations detected asymptomatic PE in 10 patients (5.6%). During follow-up, 3 patients (1.9%) developed new asymptomatic PE post-operation, and no fatal PE occurred. The catheter primary patency rates at 3, 6, and 12 months were 87.0%, 62.6%, and 36.7%, respectively. The secondary patency rates were 91.7%, 75.7%, and 52.3% at 3, 6, and 12 months, respectively. No patients died due to PE or other thrombotic complications. CONCLUSIONS Catheter replacement combined with antiplatelet therapy may be a potential treatment approach for patients with hemodialysis-related CRAT < 6 cm, without other complications except from catheter dysfunction.
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Affiliation(s)
- Jibo Sun
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Chengdu, 610041, China
| | - Yu Liu
- Department of Medical Administration, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jiehao Chen
- Animal Laboratory Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yaojia Zhou
- Animal Laboratory Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hong Fan
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China.
- State Key Laboratory of Respiratory Health and Multimorbidity, Chengdu, 610041, China.
| | - Qiuyan Zhao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China.
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Stubblefield WB, Helderman R, Strokes N, Greineder CF, Barnes GD, Vinson DR, Westafer LM. Factors in Initial Anticoagulation Choice in Hospitalized Patients With Pulmonary Embolism. JAMA Netw Open 2025; 8:e2452877. [PMID: 39752158 PMCID: PMC11699532 DOI: 10.1001/jamanetworkopen.2024.52877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 10/28/2024] [Indexed: 01/04/2025] Open
Abstract
Importance Despite guideline recommendations to use low-molecular-weight heparins (LMWHs) or direct oral anticoagulants in the treatment of most patients with acute pulmonary embolism (PE), US-based studies have found increasing use of unfractionated heparin (UFH) in hospitalized patients. Objective To identify barriers and facilitators of guideline-concordant anticoagulation in patients hospitalized with acute PE. Design, Setting, and Participants This qualitative study conducted semistructured interviews from February 1 to June 3, 2024, that were recorded, transcribed, and analyzed in an iterative process using reflexive thematic analysis. Interview participants were physicians in emergency medicine, hospital medicine (hospitalist), interventional cardiology, and interventional radiology. Participants were recruited using maximum variation sampling targeting UFH-dominant vs LMWH-dominant approaches in hospitalized patients with acute PE. We triangulated results with a group of interventional cardiologists and radiologists (interventionalists). Main Outcomes and Measures Common themes and factors associated with anticoagulant selection for hospitalized patients with acute PE. Reflexive thematic analysis was used to identify these themes and factors. Results Of the 46 interviewees (median [IQR] age, 43 [36-50] years; 33 who identified as men [71.7%]), 25 (54.3%) were emergency physicians, 17 (37.0%) were hospitalists, and 4 (8.7%) were interventionalists. Each interview lasted a median (IQR) of 29 (25-32) minutes. Prominent themes associated with anticoagulant selection included agnosticism regarding choice of anticoagulant, the inertia of learned practice, and therapeutic momentum after anticoagulation initiation. Institutional culture and support were factors associated with choice of the dominant anticoagulation strategy. Additionally, factors associated with UFH use were fear of decompensation and misperceptions regarding the pharmacology of anticoagulants and catheter-directed treatments. Conclusions and Relevance In this qualitative study, physicians across a spectrum of specialties and geographical settings reported common barriers and facilitators to the use of guideline-concordant anticoagulation in patients hospitalized with acute PE, particularly agnosticism regarding choice of anticoagulant, inertia of learned practice, therapeutic momentum after anticoagulation initiation, and institutional culture and support. Future implementation efforts may consider targeting these domains.
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Affiliation(s)
- William B. Stubblefield
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ron Helderman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas
| | - Natalie Strokes
- Department of Emergency Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield
| | | | - Geoffrey D. Barnes
- Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - David R. Vinson
- Division of Research, Kaiser Permanente Northern California, Pleasanton
- Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center, Roseville, California
| | - Lauren M. Westafer
- Department of Emergency Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield
- Department of Healthcare Delivery and Population Science, University of Massachusetts Chan Medical School-Baystate, Springfield
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Campbell AR, Florio CJ, Heringer GV, Woldemariam ST, Casey SD, Stubblefield WB, Westafer LM, Qiao E, Middleton CE, Zekar L, Gupta N, Somers MJ, Reed ME, Roubinian NH, Pai AP, Sperling JD, Vinson DR. Preemptive anticoagulation during antenatal pulmonary embolism diagnostics in a community setting: retrospective cohort study. Res Pract Thromb Haemost 2025; 9:102695. [PMID: 40104811 PMCID: PMC11914514 DOI: 10.1016/j.rpth.2025.102695] [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: 10/14/2024] [Revised: 12/27/2024] [Accepted: 01/24/2025] [Indexed: 03/20/2025] Open
Abstract
Background Society recommendations for preemptive (or empiric) anticoagulation during antenatal pulmonary embolism (PE) diagnostics rely on expert opinion, which varies widely across guidelines. The American College of Chest Physicians (CHEST), for example, recommends preemptive anticoagulation when PE is highly suspected or when a delay in imaging is anticipated. The American College of Obstetricians and Gynecologists, however, makes no mention of preemptive anticoagulation for suspected PE in their practice bulletin on thromboembolism in pregnancy. Patterns of preemptive anticoagulation in pregnancy are unknown. Objectives To describe the prevalence of and CHEST-based eligibility for preemptive anticoagulation in pregnancy. Methods This retrospective cohort study was undertaken across 21 United States community hospitals from October 1, 2021 through March 30, 2023. We included pregnant adults without COVID-19 undergoing definitive diagnostic PE imaging. We used pregnancy-adapted Geneva scores to calculate pretest probability as a proxy for suspicion. Results We included 326 patients: median age, 31.0 years; 51% were in the third trimester. Diagnostic settings included emergency departments (n = 254; 78%), Labor & Delivery (n = 65; 20%), and outpatient clinics (n = 7; 2%). Median time from emergency department computed tomography order to results was 1.40 hours (IQR: 0.78, 2.06). Prevalence of confirmed or presumed PE was low (n = 8; 2.5%). Only 2 patients (0.6%) received preemptive anticoagulation, whereas by CHEST criteria, 34 patients (10.4%) were eligible. Conclusion We found rare use of preemptive anticoagulation during antenatal PE diagnostics in this imaged cohort with low PE prevalence and rapid access to diagnostic imaging. More research is needed to explore setting-specific variation in preemptive anticoagulation use.
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Affiliation(s)
| | - Cole J Florio
- Kaiser Permanente CREST Network, Pleasanton, California, USA
- Department of Microbiology and Molecular Genetics, University of California, Davis, California, USA
| | - Grace V Heringer
- Kaiser Permanente CREST Network, Pleasanton, California, USA
- Department of Neurobiology, Physiology and Behavior, University of California, Davis, California, USA
| | - Sara T Woldemariam
- Department of Obstetrics and Gynecology, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Scott D Casey
- Kaiser Permanente CREST Network, Pleasanton, California, USA
- Kaiser Permanente Northern California Division of Research, Pleasanton, California, USA
- Department of Emergency Medicine, Kaiser Permanente Vallejo Medical Center, Vallejo, California, USA
- The Permanente Medical Group, Pleasanton, California, USA
| | - William B Stubblefield
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lauren M Westafer
- Department of Emergency Medicine and Department of Healthcare Delivery and Population Science, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA
| | - Edward Qiao
- Kaiser Permanente CREST Network, Pleasanton, California, USA
- California Northstate University College of Medicine, Elk Grove, California, USA
| | - Cydney E Middleton
- Department of Emergency Medicine, UC Davis Health, Sacramento, California, USA
| | - Lara Zekar
- Department of Emergency Medicine, UC Davis Health, Sacramento, California, USA
| | - Nachiketa Gupta
- The Permanente Medical Group, Pleasanton, California, USA
- Department of Emergency Medicine, Kaiser Permanente Redwood City Medical Center, Redwood City, California, USA
| | - Madeline J Somers
- Kaiser Permanente CREST Network, Pleasanton, California, USA
- Kaiser Permanente Northern California Division of Research, Pleasanton, California, USA
| | - Mary E Reed
- Kaiser Permanente CREST Network, Pleasanton, California, USA
- Kaiser Permanente Northern California Division of Research, Pleasanton, California, USA
| | - Nareg H Roubinian
- Kaiser Permanente Northern California Division of Research, Pleasanton, California, USA
- The Permanente Medical Group, Pleasanton, California, USA
- Department of Pulmonary and Critical Care Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Ashok P Pai
- The Permanente Medical Group, Pleasanton, California, USA
- Department of Hematology and Oncology, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Jeffrey D Sperling
- The Permanente Medical Group, Pleasanton, California, USA
- Department of Maternal and Fetal Medicine, Kaiser Permanente Modesto Medical Center, Modesto, California, USA
| | - David R Vinson
- Kaiser Permanente CREST Network, Pleasanton, California, USA
- Kaiser Permanente Northern California Division of Research, Pleasanton, California, USA
- The Permanente Medical Group, Pleasanton, California, USA
- Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center, Roseville, California, USA
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Akhlaghpasand M, Mohammadi I, Hajnorouzali A, Firouzabadi SR, Hosseinpour M, Hajikarimloo B, Yazdani KO, Zeraatian-Nejad S, Eghbali F. Salvage pulmonary embolectomy following cardiac arrest: a 10-year experience. Ann Med Surg (Lond) 2025; 87:70-75. [PMID: 40109648 PMCID: PMC11918630 DOI: 10.1097/ms9.0000000000002827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Accepted: 11/21/2024] [Indexed: 03/22/2025] Open
Abstract
Introduction Acute pulmonary embolism (PE), particularly massive PE, presents significant mortality risk, often necessitating emergency intervention such as surgical embolectomy. The prognosis for patients undergoing such interventions, especially after cardiac arrest, remains poor due to hemodynamic complications. This study aims to evaluate the efficacy of salvage pulmonary embolectomy in patients experiencing cardiac arrest due to massive PE, focusing on survival outcomes and influential risk factors. Methods Conducted at a single center over 10 years, this retrospective study involved 21 patients who underwent surgical embolectomy post-cardiac arrest due to massive PE. Data were collected on patient demographics, clinical presentation, and outcomes, analyzing factors such as age, hospital stay, and operative details. Results Out of 21 patients, 13 survived 1 year post-operation, translating to a 1-year survival rate of 61.90%. Intra-hospital survival was 76.19% (16 patients). Notable findings included a significant association between increased age and higher mortality (hazard ratio = 1.14, P = 0.024), and a longer hospital stay post-procedure in non-survivors (hazard ratio = 1.52, P = 0.03). Conclusion Salvage pulmonary embolectomy can improve survival in patients with massive PE following cardiac arrest. However, outcomes heavily depend on the patient's age and the length of the hospital stay. Future studies should focus on refining surgical techniques and improving pre- and postoperative care to enhance survival rates further.
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Affiliation(s)
- Mohammadhosein Akhlaghpasand
- Cardiovascular Surgery Research and Development Committee, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Ida Mohammadi
- Cardiovascular Surgery Research and Development Committee, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Amir Hajnorouzali
- Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sharyar Rajai Firouzabadi
- Cardiovascular Surgery Research and Development Committee, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Melika Hosseinpour
- Cardiovascular Surgery Research and Development Committee, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Bardia Hajikarimloo
- Cardiovascular Surgery Research and Development Committee, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Kaveh Oraii Yazdani
- Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sam Zeraatian-Nejad
- Cardiovascular Surgery Research and Development Committee, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Department of Cardiovascular Diseases, Zahedan University of Medical Science, Zahedan, Iran
| | - Foolad Eghbali
- Department of Cardiovascular Diseases, Zahedan University of Medical Science, Zahedan, Iran
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Izawa-Ishizawa Y, Ikeyama S, Miyatake A, Masuda S, Tobiume M, Miyamoto Y, Nakai Y, Yoshioka K, Taoka T. Resuscitated patient after simultaneous intravascular thrombolytic therapy for massive pulmonary embolism and embolization of an injured hepatic artery : a case report. THE JOURNAL OF MEDICAL INVESTIGATION 2025; 72:177-181. [PMID: 40268442 DOI: 10.2152/jmi.72.177] [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] [Indexed: 04/25/2025]
Abstract
We report a case of successful management of a massive pulmonary embolism (PE) with simultaneous hepatic arterial injury using anticoagulation and interventional radiology (IVR). The patient, with pre-existing muscle atrophy, decreased lower extremity mobility, and spinal stenosis, developed bilateral PE during rehabilitation. Following cardiopulmonary arrest, chest compressions for resuscitation resulted in hepatic hemorrhage. The patient was treated with intravenous heparin, transcatheter arterial embolization, thrombectomy, and blood transfusion, leading to full recovery without neurological complications. This case highlights the importance of assessing PE risk in hospitalized patients and highlights the efficacy of IVR in complex cases. J. Med. Invest. 72 : 177-181, February, 2025.
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Affiliation(s)
- Yuki Izawa-Ishizawa
- Department of General Medicine, Taoka Hospital, Tokushima, Japan
- Department of Clinical Pharmacology and Therapeutics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Shizuo Ikeyama
- Department of Interventional Radiology, Taoka Hospital, Tokushima, Japan
| | - Akiko Miyatake
- Department of General Medicine, Taoka Hospital, Tokushima, Japan
| | - Shiho Masuda
- Department of Internal Medicine, Taoka Hospital, Tokushima, Japan
- Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Michiko Tobiume
- Department of Internal Medicine, Taoka Hospital, Tokushima, Japan
| | | | - Yoh Nakai
- Department of Internal Medicine, Taoka Hospital, Tokushima, Japan
| | | | - Takashige Taoka
- Department of General Medicine, Taoka Hospital, Tokushima, Japan
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OIiveira-Mendes S, Lopes Freitas R, Simões J, Guedes C. Multiple Therapeutic Modalities in Intermediate-High-Risk Pulmonary Embolism: A Case Report. Cureus 2025; 17:e77543. [PMID: 39958122 PMCID: PMC11829714 DOI: 10.7759/cureus.77543] [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] [Accepted: 01/15/2025] [Indexed: 02/18/2025] Open
Abstract
Pulmonary embolism (PE) is a significant cardiovascular condition requiring stratified management, particularly in intermediate-high-risk cases where hemodynamic instability is absent but markers of severity are present. This report presents the case of a 54-year-old female with malignancy-associated intermediate-high-risk PE complicated by severe hypoxemic respiratory failure and high bleeding risk. The patient underwent multiple advanced interventions, including percutaneous thrombectomy, catheter-directed thrombolysis, and reduced-dose systemic thrombolysis, due to persistent thrombotic burden and respiratory insufficiency. The case underscores the challenges of managing PE in the context of advanced malignancy and comorbidities, necessitating a balance between thrombosis resolution and minimizing hemorrhagic risk. The therapeutic approach was partially guided by the "MOPETT trial" findings, demonstrating the efficacy and safety of reduced-dose thrombolysis in moderate PE cases. Despite achieving significant improvements in respiratory function, the patient's advanced-stage malignancy and declining functional status ultimately limited oncological treatment options, transitioning care to a palliative focus. This case emphasizes the critical role of individualized therapeutic strategies that address both the acute thrombotic event and the broader oncological context, aiming to optimize patient outcomes while considering quality of life and palliative care needs. It also highlights the importance of multidisciplinary collaboration in managing complex PE cases.
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Affiliation(s)
| | | | - Joana Simões
- Internal Medicine, Hospital Pedro Hispano, Matosinhos, PRT
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Dharmavaram N, Esmaeeli A, Jacobson K, Brailovsky Y, Raza F. Cardiopulmonary Exercise Testing, Rehabilitation, and Exercise Training in Postpulmonary Embolism. Heart Fail Clin 2025; 21:119-135. [PMID: 39550075 DOI: 10.1016/j.hfc.2024.08.001] [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] [Indexed: 11/18/2024]
Abstract
Long-term exercise intolerance and functional limitations are common after an episode of acute pulmonary embolism (PE), despite 3 to 6 months of anticoagulation. These persistent symptoms are reported in more than half of the patients with acute PE and are referred as "post-PE syndrome." Although these functional limitations can occur from persistent pulmonary vascular occlusion or pulmonary vascular remodeling, significant deconditioning can be a major contributing factor. Herein, the authors review the role of exercise testing to elucidate the mechanisms of exercise limitations to guide next steps in management and exercise training for musculoskeletal deconditioning.
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Affiliation(s)
- Naga Dharmavaram
- Division of Cardiology, Department of Medicine, University of Wisconsin-Madison, Hospitals and Clinics, 600 Highland Avenue CSC-E5/582B, Madison, WI 53792, USA
| | - Amir Esmaeeli
- Division of Cardiology, Department of Medicine, University of Wisconsin-Madison, Hospitals and Clinics, 600 Highland Avenue CSC-E5/582B, Madison, WI 53792, USA
| | - Kurt Jacobson
- Division of Cardiology, Department of Medicine, University of Wisconsin-Madison, Hospitals and Clinics, 600 Highland Avenue CSC-E5/582B, Madison, WI 53792, USA
| | - Yevgeniy Brailovsky
- Division of Cardiology, Department of Medicine, Jefferson Heart Institute-Sidney Kimmel School of Medicine, Thomas Jefferson University, 111 South 11th Street, Philadelphia, PA 19107, USA
| | - Farhan Raza
- Division of Cardiology, Department of Medicine, University of Wisconsin-Madison, Hospitals and Clinics, 600 Highland Avenue CSC-E5/582B, Madison, WI 53792, USA.
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Boutros M, Nham FH, Corsi MP, Aoun M, Lopez J, Kassis E, Daher M, El-Othmani MM. Bibliometric Analysis of Outpatient Hip and Knee Arthroplasty Research Evolution. THE ARCHIVES OF BONE AND JOINT SURGERY 2025; 13:87-99. [PMID: 39980799 PMCID: PMC11836798 DOI: 10.22038/abjs.2024.80590.3681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 10/21/2024] [Indexed: 02/22/2025]
Abstract
Objectives Total joint arthroplasty is an effective treatment for end stage osteoarthritis. As perioperative protocols are developed, outpatient arthroplasty has been gaining traction to facilitate earlier recovery and same day discharge. The aim of this manuscript is to analyze the trends in outpatient arthroplasty over a 17-year duration. This analysis seeks to predict emerging themes in the literature on patient optimization and outcomes in outpatient arthroplasty. Methods This study conducted a literature review on outpatient arthroplasty with the Web of Science Core Collection over a 17-year period between 2005 and 2022. Bibliometric data was imported and analyzed with Bibliometrix and VOSviewer. Results 198 articles were identified demonstrating an annual growth of 19.61% with notable bursts in 2017 and 2021. United States was the top global contributor followed by Canada and European nations. There were significant contributions across 219 institutions and 758 authors, with the Journal of Arthroplasty being the most productive and influential journals. Key themes identified include the feasibility of outpatient surgery, pain management, and perioperative complications and costs. Conclusion This bibliometric analysis highlights the ongoing growth and development within outpatient arthroplasty since 2005. The United States remain the global leader within outpatient related arthroplasty research. Previous, current, and ongoing trends are highlighted within this field for further development as hotspots.
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Affiliation(s)
- Marc Boutros
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Fong H. Nham
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, MI, USA
| | - Matthew P. Corsi
- School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Maroun Aoun
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Jhonny Lopez
- School of Medicine, Wayne State University, Detroit, Michigan, USA
| | | | - Mohammad Daher
- Department of Orthopaedic Surgery, Brown University, Providence, RI, USA
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Richardson JS, Clark CL, Bastani A, Shams AH, Fermann GJ, Hiestand BC, Kea B, Mace SE, Peacock WF, Yang A, Welker JA. D-dimer Levels in Acute, Medically Ill, Hospitalized Patients: A Large, Prospective, Multicenter Study in the United States. Clin Appl Thromb Hemost 2025; 31:10760296251320406. [PMID: 39943869 PMCID: PMC11822829 DOI: 10.1177/10760296251320406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Revised: 01/16/2025] [Accepted: 01/28/2025] [Indexed: 02/16/2025] Open
Abstract
BACKGROUND The study's main aim was to determine the prevalence of elevated D-dimer levels in adult patients hospitalized for acute medical illnesses not suspected to have venous thromboembolism (VTE). The secondary aims were to determine VTE prophylaxis rates and VTE events. METHODS This multicenter, prospective, observational study included patients who were admitted across nine US hospitals. Patients who were ≥60 years of age, admitted for an acute medical illness (nonsurgical/nontraumatic), and not suspected to have VTE (deep vein thrombosis [DVT]/pulmonary embolism [PE]) were enrolled. Current use of anticoagulation and recent major surgery were exclusion criteria. D-dimers were measured at hospital admission, and the analysis was performed at a central laboratory using the STA-Liatest D-Di test kit (Diagnostica Stago, Asnières sur Seine, France). The upper limit of normal (ULN) for D-dimer was defined as ≥500 ng/mL. Age-adjusted thresholds were calculated as age × 10 ng/mL. VTE events included symptomatic DVT (distal or proximal) or PE occurring during admission. RESULTS Among 995 patients (50.7% female; mean age, 70 ± 8 years), 74.4% (n = 740) had a D-dimer ≥ ULN, 62.2% (n = 619) had elevated age-adjusted levels, and 48.8% (n = 486) had D-dimers at least two times the ULN. The rate of VTE prophylaxis was 66.5% (n = 662); in this cohort, 1.8% (n = 18) developed a VTE. CONCLUSION Most hospitalized acute medically ill patients ≥60 years of age had elevated D-dimer levels on admission. Although an elevated D-dimer may be associated with VTE risk, its poor specificity indicates that it should not guide prophylaxis management without a multifactor risk assessment.
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Affiliation(s)
- Jordan S. Richardson
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Carol L. Clark
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Aveh Bastani
- Department of Emergency Medicine, Corewell Health Beaumont Hospital-Troy, Troy, MI, USA
| | - Ali H. Shams
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Gregory J. Fermann
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Brian C. Hiestand
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Bory Kea
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Sharon E. Mace
- Department of Emergency Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - W. Frank Peacock
- Department of Emergency Medicine, Ben Taub General Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Alex Yang
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - James A. Welker
- Department of Medicine, Anne Arundel Medical Center, Annapolis, MD, USA
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Villalobos A, Valle R, Pagán-Escribano J, Ortiz M, Demelo-Rodríguez P, Font C. 2024 Spanish Society of Internal Medicine (SEMI) recommendations for the management of cancer-associated venous thromboembolism. Rev Clin Esp 2025; 225:35-44. [PMID: 39490527 DOI: 10.1016/j.rceng.2024.10.007] [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: 04/24/2024] [Accepted: 09/02/2024] [Indexed: 11/05/2024]
Abstract
Vennous thromboembolism (VTE) is a common complication associated to greater mortality in patients with cancer. Its etiology is multifactorial and depends on the characteristics and co-morbidities of the patient, the tumor type and extension, and the oncological treatment. The management of VTE is more complex in patients with cancer due to an increased risk of recurrence and major bleeding complications during anticoagulation compared to the general non-oncological population. The above differences have led to the development of specific clinical trials to assess the efficacy and safety of anticoagulant therapy in patients with cancer. The present clinical guidelines are intended to provide general recommendations on the management of cancer-associated VTE according to updated according to the most recent scientific evidence.
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Affiliation(s)
- A Villalobos
- Servicio de Medicina Interna, Hospital Universitario Regional de Málaga, Málaga, Spain
| | - R Valle
- Servicio de Medicina Interna, Hospital Sierrallana, Torrelavega, Cantabria, Spain
| | - J Pagán-Escribano
- Unidad de Enfermedad Tromboembólica Venosa, Medicina Interna, Hospital General Universitario José María Morales Meseguer, Murcia, Spain; Centro Regional de Hemodonación, Servicio Murciano de Salud, Murcia, Spain
| | - M Ortiz
- Servicio de Medicina Interna, Hospital Clinic de Barcelona, Barcelona, Spain
| | - P Demelo-Rodríguez
- Unidad de Enfermedad Tromboembólica Venosa, Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - C Font
- Servicio de Oncología Médica, Hospital Clinic de Barcelona, Barcelona, Spain.
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Sultana F, Rayan R, Brishti TJ, Mizan I, Sifat S, Ifatujjahan F, Sequeira Gross JC, Francis Morel GA. Clinical Outcomes and Healthcare Utilization in Pulmonary Embolism Patients With and Without Prothrombin G20210A Mutation: A National Retrospective Cohort Study. Cureus 2025; 17:e76921. [PMID: 39906432 PMCID: PMC11790415 DOI: 10.7759/cureus.76921] [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] [Accepted: 01/04/2025] [Indexed: 02/06/2025] Open
Abstract
BACKGROUND Pulmonary embolism (PE) is a severe condition often linked to thromboembolic risk factors, such as the prothrombin gene (PGM) G20210A mutation. Although this mutation is a recognized risk factor for venous thromboembolism, little is known about how it affects the clinical course and healthcare utilization of PE patients. OBJECTIVE This new study will reveal the complete effect of PGM on clinical outcomes in patients treated for PE, such as hospital stay length, in-hospital death rates, healthcare costs, and associated health conditions. It will also examine how socioeconomic status and demographics impact these outcomes. METHODS This retrospective cohort study was conducted using data from the National Inpatient Sample (NIS) from 2016 to 2020. It included adults admitted with a primary diagnosis of PE aged 18 and older. The patients were divided into two groups: those with the PGM mutation and those without. There were two groups where the patients was divided based on their PGM use: those with and those without. Multivariate logistic regression assessed in-hospital mortality, while linear regression models evaluated length of stay (LOS) and healthcare charges. The models were adjusted for demographics, comorbidities (Charlson Comorbidity Index), and hospital characteristics. RESULTS Among the 903,230 PE patients, 2,065 (0.2%) had PGM. Patients with the mutation had a significantly lower in-hospital mortality than those without the mutation (adjusted OR 0.13, 95% CI 0.02-0.92, p = 0.041). PGM carriers also had lower rates of atrial fibrillation (5.1% vs. 11.8%, p < 0.001), congestive heart failure (CHF) (5.9% vs. 16.0%, p < 0.001), and chronic obstructive pulmonary disease (COPD) (8.6% vs. 15.5%, p < 0.001), but higher rates of obesity (32.5% vs. 26.1%, p = 0.004) and hyperlipidemia (30.7% vs. 36.0%, p = 0.031). Despite a longer hospital stay in PGM patients (mean difference: 0.52 days, p = 0.005), the difference in total hospital charges was not statistically significant (mean difference: $6,295, p = 0.090). CONCLUSIONS Patients with PE and the PGM had lower mortality rates in this national retrospective cohort than those without the mutation. Patients without the PGM presented with more serious comorbidities, including higher rates of atrial fibrillation, CHF, and COPD, which may have contributed to their worse outcomes.
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Affiliation(s)
- Fahmida Sultana
- Medicine, Washington University of Health and Sciences, San Pedro, BLZ
| | - Ribaba Rayan
- Internal Medicine, Shaheed Suhrawardy Medical College and Hospital, Dhaka, BGD
| | | | - Iffath Mizan
- Medicine, El Camino Hospital, Mountain View, USA
| | - Sabrina Sifat
- Medicine, Kumudini Women's Medical College, Tangail, BGD
| | | | | | - Garry Aliosha Francis Morel
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Saint Louis University Hospital, St. Louis, USA
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Ngo D, Chen J, Nguyen C, Choi K, Pullarkat V. Patterns of interventions for central venous catheter-associated deep vein thrombosis and outcomes in cancer patients. J Oncol Pharm Pract 2025; 31:12-16. [PMID: 38166462 DOI: 10.1177/10781552231219995] [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] [Indexed: 01/04/2024]
Abstract
PURPOSE This letter evaluated the impact of different management strategies, specifically the presence or absence of therapeutic anticoagulation, on clinical outcomes for central venous catheter (CVC)-associated deep vein thrombosis (DVT) in cancer patients. METHODS One-hundred ninety-eight adult cancer patients with a confirmed CVC-associated DVT diagnosis from February 2013 and February 2021 were included. RESULTS Incidence of symptomatic recurrent venous thromboembolism (VTE) was similar between patients who received therapeutic anticoagulation and those who did not (14% vs 16%, p = 0.807). In addition, therapeutic anticoagulation did not significantly alter the incidence of grade 3 and above bleeding events despite most patients having hematologic malignancies (9% vs 8%, p = 0.826). CONCLUSION AND RELEVANCE Therapeutic anticoagulation was not associated with a reduction in the incidence of recurrent VTE or increase the incidence of bleeding in adult cancer patients following a CVC-associated DVT diagnosis.
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Affiliation(s)
- Dat Ngo
- Department of Pharmacy, City of Hope, Duarte, CA, USA
| | - Jason Chen
- Department of Pharmacy, City of Hope, Duarte, CA, USA
| | - Chris Nguyen
- Department of Pharmacy, City of Hope, Duarte, CA, USA
| | - Kathy Choi
- Department of Pharmacy, City of Hope, Duarte, CA, USA
| | - Vinod Pullarkat
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
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Li Y, Gu J, Ge J, Kong J, Shang L. HSYA ameliorates venous thromboembolism by depleting the formation of TLR4/NF-κB pathway-dependent neutrophil extracellular traps. Int Immunopharmacol 2024; 143:113534. [PMID: 39504860 DOI: 10.1016/j.intimp.2024.113534] [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: 08/04/2024] [Revised: 10/11/2024] [Accepted: 10/27/2024] [Indexed: 11/08/2024]
Abstract
Neutrophil extracellular traps (NETs), released by activated neutrophils, are implicated in various medical conditions, including venous thromboembolism (VTE). To develop effective therapeutic strategies for VTE, it is crucial to elucidate the mechanisms involved. In this study, we explored the role of NETs in VTE pathogenesis and assessed the impact of hydroxyl safflower yellow pigment A (HSYA) treatment on VTE pathogenesis. Various biochemical, pharmacological, and functional assessments were performed in human samples and VTE mouse models. Our findings revealed that NETs formation was enhanced in VTE patients and mouse model. NETs were shown to reduce the viability and integrity of endothelial cells and facilitated ferroptosis in human umbilical vein endothelial cells (HUVECs) in a concentration-dependent manner. Depletion of NETs using the NE inhibitor Alvelestat significantly alleviated ferroptosis in VTE mice. Similarly, NETs depletion markedly attenuated thrombus formation and vein wall thickness in VTE mice. Notably, NETs treatment induced a significant elevation in total N6-Methyladenosine (m6A) RNA methylation level in HUVECs, with the most significant increase observed in methyltransferase-like 3 (METTL3). Mechanistically, the TLR4/NF-κB pathway was activated, and silencing METTL3 reversed the NETs-induced activation of this pathway in HUVECs. Rescue assays illustrated that METTL3 regulated the viability and ferroptosis of NETs-stimulated HUVECs by mediating TLR4 mRNA stability. Additionally, we found that HSYA exerted protective effects against ferroptosis in NETs-induced HUVECs and VTE mice. In summary, HSYA ameliorates VTE by depleting neutrophil extracellular traps through the inhibition of the TLR4/NF-κB pathway, thus providing a novel therapeutic strategy for treating VTE.
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Affiliation(s)
- Yan Li
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No.68 Changle Road, Nanjing, Jiangsu 210006, China
| | - Jianping Gu
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No.68 Changle Road, Nanjing, Jiangsu 210006, China
| | - Jingping Ge
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No.68 Changle Road, Nanjing, Jiangsu 210006, China
| | - Jie Kong
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No.68 Changle Road, Nanjing, Jiangsu 210006, China
| | - Longcheng Shang
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, No.68 Changle Road, Nanjing, Jiangsu 210006, China.
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Omura A, Mori H, Sasai M, Tezuka T, Wada D, Sone H, Takei Y, Tashiro K, Sato T, Ebato M, Suzuki H. Use of Direct Oral Anticoagulation for Isolated Distal Deep Vein Thrombosis in Japanese Orthopedic Patients. Ann Vasc Dis 2024; 17:371-377. [PMID: 39726555 PMCID: PMC11669022 DOI: 10.3400/avd.oa.24-00061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 09/01/2024] [Indexed: 12/28/2024] Open
Abstract
Objectives: Although direct oral anticoagulants (DOAC) have become widely used, little is known about the efficacy of DOAC for isolated distal deep vein thrombosis (DVT). Methods: In-hospitalized orthopedic patients with isolated distal DVT who were diagnosed from 2016 to 2018 were enrolled and were followed for 1 year. Embolic events included symptomatic pulmonary embolism (PE) and DVT extension above the knee. Bleeding events were determined in the presence of bleeding academic research consortium (BARC) 2, 3 or 5 bleeding. Results: Of 196 orthopedic patients, 84% of patients (n = 164) received DOAC (DOAC+ group), whereas 16% of patients (n = 32) did not (DOAC- group). Cumulative incidence of embolic events was observed in 1.5% of the DOAC+ group and none of the DOAC- group (p = 0.443). Cumulative incidence of bleeding events was observed in 5.1% of the DOAC+ group and none of the DOAC- group (p = 0.157). The majority of bleeding events (80%) occurred in patients with HAS-BLED scores of 3 or greater. Conclusions: There were no significant differences in embolic events and bleeding events in retrospective data. Balancing thrombotic risk and bleeding risk remains to be key for isolated distal DVT.
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Affiliation(s)
- Ayumi Omura
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Hiroyoshi Mori
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Masahiro Sasai
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Takahiro Tezuka
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Daisuke Wada
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Hiromoto Sone
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Yosuke Takei
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Kazuma Tashiro
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Tokutada Sato
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Mio Ebato
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
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Zou ZJ, Song HX, Wang T, Ma HY, Cao LP, Wu T. The effects of common peroneal nerve electrical stimulation on lower extremity deep venous hemodynamics: A randomized, crossover and controlled study. Medicine (Baltimore) 2024; 103:e40847. [PMID: 39686451 PMCID: PMC11651443 DOI: 10.1097/md.0000000000040847] [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] [Received: 11/23/2023] [Accepted: 11/19/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND Intermittent pneumatic compression (IPC) and neuromuscular electrical stimulation can improve deep vein hemodynamics in the lower limbs. We developed a new, small and convenient, and easy to wear common peroneal nerve electrical stimulator (CPNES) and to investigate the effectiveness and safety of CPNES intervention on deep venous hemodynamics. METHODS Thirty healthy volunteers were recruited and randomly divided into group A and B. In group A, the hemodynamics of the left superficial femoral artery and the superficial femoral vein were measured after IPC compression, and then the CPNES was activated and the hemodynamics was measured again. In group B, the order of intervention was reversed. RESULTS In group A, the peak velocity, time average blood flow velocity (TAMV), and flow velocity of femoral vein after IPC and CPNES intervention were higher than these of the baseline (P < .05, respectively). No significant differences of these blood flow parameters were found between IPC and CPNES intervention (P > .05, respectively). In group B, these blood flow parameters of femoral vein after IPC and CPNES intervention were higher than these of the baseline (P < .05, respectively). No significant difference of these blood flow parameters (P > .05, respectively) were noted between IPC and CPNES intervention as well. No differential change of these flow velocity of femoral artery after IPC and CPNES intervention in group A or group B. The hemodynamics of superficial femoral arteries and veins after intervention in group A and B were similar (P > .05, respectively). CONCLUSION The effectiveness of CPNES intervention on the hemodynamics of the lower extremity is similar with that of IPC, increasing blood flow and may prevent venous thrombosis without adverse reaction.
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Affiliation(s)
- Zhao-Jun Zou
- Nursing Department, Shaw Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hai-Xin Song
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ting Wang
- Nursing Department, Shaw Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hai-Yun Ma
- Nursing Department, Shaw Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Li-Ping Cao
- Nursing Department, Shaw Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Tao Wu
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Chalidis B, Davitis V, Papadopoulos P, Pitsilos C. Subclavian vessels injury: An underestimated complication of clavicular fractures. World J Crit Care Med 2024; 13:98579. [PMID: 39655299 PMCID: PMC11577540 DOI: 10.5492/wjccm.v13.i4.98579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 09/04/2024] [Accepted: 09/09/2024] [Indexed: 10/31/2024] Open
Abstract
Clavicle fractures are frequent orthopedic injuries, often resulting from direct trauma or a fall. Most clavicle fractures are treated conservatively without any complications or adverse effects. Concomitant injuries of the subclavian vein or artery are rarely encountered and most commonly associated with high-energy trauma or comminuted clavicle fractures. They are potentially life-threatening conditions leading to hemorrhage, hematoma, pseudoaneurysm or upper limb ischemia. However, the clinical presentation might be obscure and easily missed, particularly in closed and minimally displaced clavicular fractures, and timely diagnosis relies on early clinical suspicion. Currently, computed tomography angiography has largely replaced conventional angiography for the assessment of subclavian vessel patency, as it demonstrates high accuracy and temporal resolution, acute turnaround time, and capability of multiplanar reconstruction. Depending on the hemodynamic stability of the patient and the severity of the injury, subclavian vessel lesions can be treated conservatively with observation and serial evaluation or operatively. Interventional vascular techniques should be considered in patients with serious hemorrhage and limb ischemia, followed by stabilization of the displaced clavicle fracture. This review aims to provide a comprehensive overview of the incidence, clinical presentation, diagnostic approaches, and current management strategies of clavicle fractures associated with subclavian vessel injuries.
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Affiliation(s)
- Byron Chalidis
- First Orthopaedic Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Vasileios Davitis
- Second Orthopaedic Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54635, Greece
| | - Pericles Papadopoulos
- Second Orthopaedic Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54635, Greece
| | - Charalampos Pitsilos
- Second Orthopaedic Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54635, Greece
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