Thrombolysis Research Articles

Epidemiology of pulmonary embolism diagnosis and management among United States emergency departments over an eight-year period

IntroductionPulmonary embolism (PE) is a major cause of morbidity and mortality in the United States. However, as diagnostic imaging, risk stratification tools, and treatment have evolved over time, there is a critical need for current data on the incidence, testing, admission rates, and medical management of PE in the ED setting. MethodsThis was a cross-sectional study of ED patients with PE diagnoses from 1/1/2016 to 12/31/2023 using the Epic Cosmos national database. ED visits were identified using ICD-10 codes corresponding to acute PE. Chronic PEs were excluded. Outcomes included total ED visits, admission rates, anticoagulant treatment prescribed from the ED, and thrombolytic therapy. Anticoagulant prescriptions included warfarin, enoxaparin, dabigatran, apixaban, rivaroxaban, edoxaban, and betrixaban. Thrombolytic agents included alteplase, tenecteplase, and urokinase. We also assessed changes in the overall rate of CT pulmonary angiograms (CTPA) performed. ResultsOut of 186,138,130 total ED encounters, PE represented 531,968 (0.29 %). The overall rate of PE diagnosis rose slowly from 0.20 % in 2016 to a peak of 0.35 % in 2021. Among those with PE, 363,584 (68.3 %) were admitted. The rate of admission declined over time from 75.6 % to 66.1 %. Among those prescribed anticoagulation, the most common medication was apixaban (40.0 %), followed by rivaroxaban (17.3 %), enoxaparin (6.1 %), warfarin (2.6 %), and dabigatran (0.4 %). Thrombolytics were administered in 4.5 % of cases, with the rate of thrombolytics peaking at 5.3 % in 2018 before lowering to 3.5 % in 2023. The overall rate of CTPA increased from 2.4 % to 5.0 %, while the rate of proportion of PEs diagnosed declined from 8.7 % to 6.4 %. ConclusionThis study highlights significant shifts in the epidemiology and management of PE within the ED setting. Overall rates of PE rose, while a larger proportion were discharged. Direct oral anticoagulants have become the predominant therapy with the majority of patients receiving apixaban. Thrombolytic use occurs in a small subset and has been declining over time. CTPA rates have risen, while the overall diagnostic yield has declined.

Study on Optimal Production Conditions of Fibrinolytic Kinase Derived from the Nereid Worm, Perinereis aibuhitensis Grub

The fibrinolytic kinase identified in the nereid worm (Perinereis aibuhitensis Grub) displays exceptional kinase activity, stability, and specificity, suggesting its potential as a promising candidate for the advancement of new thrombolytic drugs. In this study, a process was optimized for the production of fibrinolytic kinase using Escherichia coli, and the effects of factors such as inoculum, pH, OD, temperature, inducer concentration, and time on the protein yield were investigated. The optimum points of key parameters were determined by single-factor experiments, and the initial pH, OD, and time were determined to be significant by PB (Plackett–Burman design) with six factors at two levels of experiments. The response surface experiments highlighted the key roles of initial pH and induced OD values, and the convergence of the model and experimental data confirmed the optimal conditions and reasonable fluctuation intervals, which proved the reliability of the model.

Study on the public awareness of stroke risk factors, symptoms, treatment and rehabilitation: A community based cross sectional survey from a tertiary referral centre in South India

Background: The incidence of Non communicable diseases (NCDs) including stroke is increasing in India over the past few years. Thrombolysis therapy has revolutionized management of acute ischemic stroke. In spite of such recent advances in stroke therapy, the public remains uninformed about stroke symptoms and management. Objective: To assess the public awareness of stroke risk factors, symptoms, treatment and rehabilitation measures. Methods: The study was a community-based cross-sectional study, designed as an online survey. The tool used for the survey was a semi-structured online questionnaire. Results: Regarding the risk factors of stroke, of the participants, 41 (14.8%) were aware of valvular heart diseases, 18 (6.5%) of lack of exercise, 238 (85.9%) of dyslipedemia, 236 (85.2%) of hypertension, 222 (80.1%) of smoking, and 154 (55.6%) of diabetes. Regarding symptoms of stroke, of the participants, 209 (75.5%) were aware of loss of balance, 240 (86.6%) of speech abnormalities, 261 (94.2%) of facial weakness, and 234 (84.5%) of weakness. Conclusion: Efforts should be made to educate the public regarding uncommon symptoms of stroke, thrombolysis treatment and rehabilitation measures, so that people make beneficial health care decisions in stroke management.

Machine learning-based prediction of early neurological deterioration after intravenous thrombolysis for stroke: insights from a large multicenter study.

This investigation seeks to ascertain the efficacy of various machine learning models in forecasting early neurological deterioration (END) following thrombolysis in patients with acute ischemic stroke (AIS). Employing data from the Shenyang Stroke Emergency Map database, this multicenter study compiled information on 7,570 AIS patients from 29 comprehensive hospitals who received thrombolytic therapy between January 2019 and December 2021. An independent testing cohort was constituted from 2,046 patients at the First People's Hospital of Shenyang. The dataset incorporated 15 pertinent clinical and therapeutic variables. The principal outcome assessed was the occurrence of END post-thrombolysis. Model development was executed using an 80/20 split for training and internal validation, employing classifiers like logistic regression with lasso regularization (lasso regression), support vector machine (SVM), random forest (RF), gradient-boosted decision tree (GBDT), and multi-layer perceptron (MLP). The model with the highest area under the curve (AUC) was utilized to delineate feature significance. Baseline characteristics showed variability in END incidence between the training (n = 7,570; END incidence 22%) and external validation cohorts (n = 2,046; END incidence 10%; p < 0.001). Notably, all machine learning models demonstrated superior AUC values compared to the reference model, indicating their enhanced predictive capacity. The lasso regression model achieved the highest AUC at 0.829 (95% CI: 0.799-0.86; p < 0.001), closely followed by the MLP model with an AUC of 0.828 (95% CI: 0.799-0.858; p < 0.001). The SVM, RF, and GBDT models also showed commendable AUCs of 0.753, 0.797, and 0.774, respectively. Decision curve analysis revealed that the SVM and MLP models demonstrated a high net benefit. Feature importance analysis emphasized "Onset To Needle Time" and "Admission NIHSS Score" as significant predictors. Our research establishes the MLP and lasso regression as robust tools for predicting early neurological deterioration in acute ischemic stroke patients following thrombolysis. Their superior predictive accuracy, compared to traditional models, highlights the significant potential of machine learning approaches in refining prognosis and enhancing clinical decisions in stroke care management. This advancement paves the way for more tailored therapeutic strategies, ultimately aiming to improve patient outcomes in clinical practice.

Possibilities of thrombolytic therapy of acute myocardial infarction with ST

Possibilities of thrombolytic therapy of acute myocardial infarction with ST

Coronary thrombosis and myocardial ischemia in Kawasaki disease: a case report

BackgroundCoronary artery thrombosis and myocardial ischemia caused by giant coronary aneurysms are the main causes of death in children with Kawasaki disease. The use of thrombolytic therapy in children with Kawasaki disease who have coronary thrombosis is a controversial topic, especially with respect to the timing of treatment.Case presentationIn this article, we report a case of a child aged two years and nine months with Kawasaki disease whose coronary arteries had no involvement in the acute phase. However, by only one week after discharge, the patient returned because we found giant coronary aneurysms complicated by thrombosis via echocardiography. Despite aggressive thrombolytic therapy, the child developed myocardial ischemia during thrombolytic therapy. Fortunately, because of timely treatment, the child’s thrombus has dissolved, and the myocardial ischemia has resolved.ConclusionsThis case suggests that for patients at high risk of coronary artery aneurysms, echocardiography may need to be reviewed earlier. Low-molecular-weight heparin should be added to antagonize the early procoagulant effects of warfarin when warfarin therapy is initiated. In the case of first-detected coronary thrombosis, aggressive thrombolytic therapy may be justified, particularly during the acute and subacute phases of the disease course.

Laparoscopic ureteroplasty of a transplanted kidney using a healthy native ureter

Introduction. Ureteral strictures are a common urological complication of kidney transplantation. For short narrowings of the ureter, endoscopic operations are used; for extended defects the Boari operation is often performed. An alternative method may be to use a native ureter.Purpose of the study. To study the results of such operations in four patients.Materials &amp; methods. We observed four patients with extended ureteral strictures of a transplanted kidney. Among them were three women and one man. Previously, all patients had undergone a cadaveric kidney transplant; the time from the operation itself to the development of stricture ranged from 3 months to 13 years. Initially, all patients underwent percutaneous drainage of the pyelocaliceal system of the transplanted kidney. After stabilization of creatinine values, the pelvis or pyeloureteral segment of the transplanted kidney was isolated using a transperitoneal approach. Further, the lower third of the ipsilateral native ureter was crossed at the level of the iliac vessels. Its upper end was clipped and anastomosis with the pelvis or ureteropelvic junction of the graft was performed.Results. The procedures were successful in all patients. In three patients the operation was completed using a laparoscopic approach. In one patient in whom extensive ureteral obliteration developed 3 months after transplantation against the background of incompetent ureterocystoneoastomosis and urinary leakage, when the pelvis was isolated, which was covered by the external iliac vein, the latter was injured with bleeding. This required conversion to open access, suturing of the iliac vein defect, further excision of the pelvis and anastomosis with the native ureter. In the post-operative period, the patient developed thrombosis of the iliac and femoral veins below the suturing area, and successful thrombolytic therapy was performed. Nephrostomy drain was removed before discharge and the stent was removed on an outpatient visit 4 to 6 weeks after surgery. Currently the condition of all patients is stable, the graft is functioning, and their diuresis is unchanged, serum creatinine ranges from 106 to 180 μmol/l.Conclusion. The use of a healthy native ureter is an adequate method of replacement of extended ureteral strictures of the transplanted kidney.

Clinical characteristics and management of functional neurological disorders (FND) mimicking stroke in emergency settings: a functional stroke mimic cases.

FNDs mimicking a stroke represent a growing challenge in the emergency department (ED). A comprehensive diagnostic approach involving clinical evaluation and neuroimaging is essential to differentiate stroke from mimics. The safety profile of thrombolysis justifies its use where FNDs cannot be ruled out. This approach highlights the need for more precise diagnostic tools and protocols to improve patient care and reduce unnecessary treatments. Distinguishing FNDs from actual cerebrovascular events is critical yet difficult, particularly under time constraints. Given the urgency and potential severity of strokes, intravenous thrombolysis is frequently administered even when FNDs cannot be definitively excluded. This retrospective study analyzed data of participants admitted to the Trieste University Hospital Stroke Unit between January 2018 and December 2022, focusing on those presenting with sudden-onset focal neurological deficits mimicking a stroke, with some presenting within the reperfusion treatment window (<4.5 h from symptoms onset). We obtained detailed clinical evaluations and neuroimaging, and administered thrombolytic therapy in selected cases. We included 84 participants presenting with stroke mimics (average age of 45 yo) predominantly female (65.5%). Most common presentations: hemiparesis or hemisensory loss (75%), speech disorder (10.7%), vertigo/gait disorders (4.8%). History of psychiatric disorders was found in 32.1% of cases, and 48.8% had prior neurological disease or stroke risk factors. Advanced neuroimaging was performed in 43 cases yielding normal or non-specific results. Thrombolysis was safely administered in 31%. Patients mostly recovered within the first 24 h from admission (44.7%). We compared this FND's sample with 291 patients with mild ischemic stroke (NIHSS ≤7).

P008 COMPARISON OF CLINICAL OUTCOME OF ELDERLY (AGED &gt;65 YEARS) VS NON-ELDERLY HYPERTENSIVE STEMI PATIENTS: RESULTS FROM NAMI REGISTRY

Background and Objective: Elderly hypertensive ST-segment elevation myocardial infarction (STEMI) patients had increased morbidity and mortality. Little is known regarding clinical outcome of elderly hypertensive STEMI patients worldwide. This study aimed to compare clinical outcome of elderly and non-elderly hypertensive STEMI Bangladeshi patients. Methods: This prospective observational study- National Heart Foundation Hospital Acute Myocardial Infarction (NAMI) Registry was carried out in our hospital over eight years (2015-2022). All hypertensive STEMI patients were included in this study. Clinical outcome of elderly (aged &gt;65 years) and non-elderly (aged ≤65 years) patients were compared. Results: NAMI registry enrolled 10488 STEMI patients. Among them 6890 (65.69%) patients were hypertensive and included in this study. Of them 1127 (16.4%) patients were elderly, and 5763 (83.6%) patients were non-elderly. The mean age of the elderly patients was 72.93 ± 5.5 years and non-elderly patients 52.54 ± 8.69 years. Although male were predominant in both groups (79.3% vs 85.0%; p=0.001), significantly more female were in elderly group (20.7% vs 15.0%; p=0.001). Most of the elderly patients had chronic kidney disease (85.1% vs 41.3%; p=0.001). Most of the non-elderly patients were smokers (52.8% vs 41.3%; p=0.001), dyslipidemic (81.1% vs 76.0%; p=0.001), and obese (38.8% 31.4%; p=0.001). Elderly patients received less invasive therapy (thrombolytic therapy- 14.3% vs 19.0%, p=0.002; primary percutaneous coronary intervention- 10.6% vs 11.6%; pharmaco-invasive therapy-5.9% vs 11.4%, p=0.001; only percutaneous coronary intervention- 18.4% vs 20.0%) and more medical therapy (50.9% vs 38.1%; p=0.001). Elderly patients were more prone to complications (cardiogenic shock- 14.8% vs 10.8%, p=0.001; acute left ventricular failure- 33.9% vs 22.7%, p=0.001; conduction disturbance- 15.2% vs 9.7%, p=0.001; arrhythmias- 13.1% vs 8.2%, p=0.001; cardiac arrest-7.5% vs 4.7%, p=0.001; in-hospital death- 7.9% vs 4.2%, p=0.001). Conclusions: Most of the elderly hypertensive STEMI patients had chronic kidney disease, less risk factor, received less invasive therapy but more medical therapy and were more prone to complications in comparison to younger counterpart.

Patency and reflux in relation to postthrombotic syndrome: a subanalysis of the Ultrasound-Accelerated Catheter-Directed Thrombolysis Versus Anticoagulation for the Prevention of Post-Thrombotic Syndrome trial

BackgroundAdjunctive catheter-directed thrombolysis shows variable efficacy in preventing postthrombotic syndrome (PTS), despite restored patency. ObjectivesThis Ultrasound-Accelerated Catheter-Directed Thrombolysis Versus Anticoagulation for the Prevention of Post-Thrombotic Syndrome (CAVA) trial subanalysis investigated the effect of ultrasound-accelerated catheter-directed thrombolysis (UACDT) on patency, reflux, and their relevance in PTS development. MethodsThis multicenter, randomized, single-blind trial enrolled patients (aged 18-85 years) with a first iliofemoral deep vein thrombosis and symptom duration ≤14 days. Patency and reflux were assessed by duplex ultrasound at 12 months (T12) and long-term (LT) follow-up (median, 39.5 months; IQR, 24.0-63.0 months). PTS was diagnosed using the Villalta score. ResultsUACDT significantly improved patency in all vein segments at T12 (60.3% UACDT vs 25.9% standard treatment [ST]; P = .002) and LT (45.2% UACDT vs 11.9% ST; P < .001). Popliteal patency, however, was similar between groups (87.9% UACDT vs 83.3% ST; P = .487). Reflux was similar between groups at T12 and LT; only popliteal reflux was significantly reduced in the UACDT group at LT (22.6% UACDT vs 44.8% ST; P = .010). Absent iliac patency at T12 was associated with increased PTS risk in the ST group only (odds ratio [OR], 10.84; 95% CI, 1.93-60.78; P = .007). In the UACDT group, popliteal reflux at T12 was associated with moderate-to-severe PTS at T12 (OR, 4.88; 95% CI, 1.10-21.57; P = .041) and LT (OR, 5.83; 95% CI, 1.44-23.63; P = .009). Combined popliteal reflux and absent iliac patency significantly amplified PTS risk (OR, 10.79; 95% CI, 2.41-48.42; P < .001). ConclusionUACDT improved patency and reduced popliteal reflux. Iliac patency and popliteal reflux are independently associated with moderate-to-severe PTS and contribute synergistically to its development. However, a proportion of moderate-to-severe PTS cases lacks an evident underlying cause.

Low Dose Aspirin Initiation 18 Hours After Thrombolytic Therapy in Acute Ischemic Stroke.

To investigate the safety of administering low-dose aspirin (81mg) 18 hours after intravenous thrombolytic therapy. This is a retrospective cohort investigation. Individuals received either alteplase or tenecteplase for acute ischemic stroke followed by aspirin 81mg (after follow-up imaging). An institutional change moved follow-up post-thrombolytic CT scans to 18 hours, and qualifying patients were grouped based on whether they received aspirin ≤24 hours or >24 hours. Chart reviews were conducted to assess the primary outcome of new or worsening intracranial hemorrhage, as well as secondary outcomes of change in stroke scale scores at discharge and 3 months, lengths of stay, favorable outcomes at 3 months, hospital readmission, and mortality. Out of 350 patients screened, 130 qualified for inclusion-50 of whom received aspirin ≤24 hours (mean 21.1 hours, SD±6.2), and 80 who received aspirin >24 hours (mean 34 hours, SD±8.2). Only 1 new intracranial bleed occurred following aspirin administration in the >24-hour group. No statistically significant differences were observed in any of the secondary outcomes, although there was higher mortality (3/50 vs. 2/80, P =0.372) and shorter hospital length of stay (median difference -1.0 day, P =0.0336) in the <24 hours group. Low-dose aspirin administration sooner than 24 hours following thrombolytic therapy did not increase bleeding events. Sooner aspirin administration after ischemic stroke can potentially enhance the prevention of secondary embolization and did not demonstrate worse clinical outcomes; however, further randomized controlled trials are needed.

Management of Thoracic Empyema in Children: A Survey of Indian Pediatricians, Pediatric Surgeons, Pulmonologists, and Intensivists.

Empyema thoracis poses a clinical conundrum due to its diverse clinical presentations and management options. The study aimed to investigate the variability in clinical practice across centres and disciplines in the management of empyema in children. An online questionnaire focusing on paediatric empyema management was circulated among clinicians in India. Data on demographics, clinical experience, treatment modalities, and intervention indications were collected, and responses were analysed. The survey amongst 252 participants uncovered notable discrepancies in the viewpoints of pediatricians and pediatric surgeons on the use of fibrinolytic and the indication for video assisted thoracoscopic surgery in pediatric thoracic empyema. While surgeons tended to favour surgical interventions, paediatricians leaned towards conservative management and fibrinolytic therapy. This study highlights substantial differences in clinical practice and underscores the need for standardized guidelines and interdisciplinary collaboration to optimize patient care and outcomes.

Intervención dirigida por catéter en la embolia aguda de pulmón. Posicionamiento SEC-Asociación de Cardiología Intervencionista/SEC-Asociación de Cardiopatía Isquémica y Cuidados Agudos Cardiovasculares/SEC-GT Hipertensión Pulmonar

Pulmonary embolism (PE) is the leading cause of hospital death and the third most frequent cause of cardiovascular mortality. Traditionally, treatment options have included anticoagulation, thrombolysis, or surgery; however, catheter-directed interventions (CDI), including catheter-directed thrombolysis and aspiration thrombectomy, have been developed for patients with intermediate- or high-risk PE. These techniques can rapidly improve right ventricular function, hemodynamic status, and mortality in some patients, although there is a lack of evidence from randomized controlled trials. This document, prepared by the Interventional Cardiology Association, the Association of Ischemic Heart Disease and Acute Cardiovascular Care, and the Working Group on Pulmonary Hypertension of the Spanish Society of Cardiology (SEC), reviews the current recommendations and available evidence on the management of PE. It emphasizes the importance of rapid response teams, risk stratification, and early patient monitoring in identifying candidates for reperfusion. Based on existing clinical evidence on CDI, the document discusses various clinical scenarios and provides guidance on patient selection, particularly in situations of uncertainty due to insufficient evidence. Lastly, it describes periprocedural support, highlighting the necessary multidisciplinary approach to improve outcomes and reduce morbidity and mortality in patients with PE.

Catheter-Directed Thrombolysis for Superficial Femoral Artery Thrombosis via the Ipsilateral Dorsalis Pedis Artery.

Catheter-Directed Thrombolysis for Superficial Femoral Artery Thrombosis via the Ipsilateral Dorsalis Pedis Artery.

Influence of Socioeconomic Status on Patients' Choice of Thrombolytic Agent and its Outcome in Acute Ischemic Stroke.

Alteplase, a recombinant tissue-type plasminogen activator (rtPA) is the only FDA-approved thrombolytic drug in acute ischemic stroke (AIS). Tenecteplase is a modified rtPA, which is cheaper. We aimed to study influence of socioeconomic status (SES) in patients' preference of thrombolytic agent and its outcome. This prospective observational study conducted in PGIMER, a tertiary care center in India, recruited AIS patients thrombolyzed between July 2017 and September 2018. We studied variables including SES, thrombolytic agent chosen, and outcomes like National Institutes of Health Stroke Scale (NIHSS) scores at 24-h and at discharge; and modified Rankin Scale (mRS) after 3 months. Thirty-nine patients received tenecteplase and 39 patients received alteplase. Seven patients belonged to upper class, all of whom (100%) chose alteplase. Thirty patients belonged to upper middle class, of whom 25 (83.3%) and five (16.7%) patients chose alteplase and tenecteplase, respectively. Twenty-five patients belonged to lower middle class in which seven (28%) and 15 (72%) chose alteplase and Tenecteplase, respectively. Twenty patients were in upper lower class, of whom 4 (20%) and 16 (80%) chose alteplase and Tenecteplase, respectively. The difference in distribution of SES in tenecteplase and alteplase groups was significant (P = 0.000). Median 3 month-mRS scores were 3 and 3.5 in alteplase and tenecteplase groups, respectively (P = 0.608). There were no significant differences in NIHSS score improvement at 24 h postthrombolysis (P = 0.537) or at discharge (P = 0.429) among different SES categories. No correlation between SES and 3 month-mRS score was found (Spearman's ρ = 0.101, P = 0.398). Majority of patients in upper and lower SES chose alteplase and Tenecteplase, respectively. However, there were no significant differences in outcomes among various SES categories.

Ultraslow low-dose thrombolytic therapy in patients with acute mechanical prosthetic heart valve thrombosis – A prospective cohort study

BackgroundWhile surgery still remains the gold standard treatment for mechanical prosthetic valve thrombosis (MPVT) by many guidelines, the ultraslow low-dose thrombolytic regimen has been reported as a promising alternative. MethodsIn this prospective single-center cohort, patients with acute MPVT were treated with an ultraslow low-dose thrombolytic regimen consisting of 25 mg infusion of recombinant tissue-type plasminogen activator (rtPA) over 25 h. The regimen could be repeated in case of failure until resolution/occurrence of adverse events or a maximum cumulative dose of 150 mg. The primary outcome was the complete MPVT resolution rate; other outcomes included first-dose success rate, major bleeding, thromboembolic events, mortality, and total thrombolytic dose/duration. ResultsBetween April 2018 to January 2024, 135 episodes of acute MPVT were treated with an ultraslow low-dose thrombolytic regimen in 118 patients. In 118/135 (87.4 %) episodes, right-sided prosthetic valve was involved. Complete success was achieved in 88.1 % of cases, with 39.5 % responding after the first dose. The median total dose was 50 mg over a median of 30 h. Only one fatal intracranial hemorrhage occurred (0.7 %), with no other bleeding or thromboembolic complications. ConclusionThe ultraslow low-dose thrombolytic regimen appears to exhibit high efficacy and acceptable safety in treating acute MPVT. Further large clinical trials are essential for validating these preliminary findings.

Salvaging intraluminal peritoneal dialysis catheter obstruction from blood clot with a targeted thrombolytic agent: an innovation.

Peritoneal dialysis (PD) catheter malfunction commonly leads to the removal of the catheter and eventually to a transfer to hemodialysis. The most common cause is intraluminal obstruction caused by blood and fibrin clots. Recommended interventions include irrigation of the catheter with heparinized saline; if this method fails, thrombolytic agents may be used. Mechanical methods such as intraluminal brushing are also utilized, typically after medical treatment fails. Here, we present a case of a patient who developed an intraluminal blood clot that persisted despite attempts with intraluminal thrombolytic drugs and intraluminal brushing. To salvage the catheter, targeted thrombolysis was performed using an endoscopic retrograde cholangiopancreatography (ERCP) guidewire to reinforce the coiled PD catheter and puncture the clots. Additionally, a Swing Tip cannula was employed for direct injection of the thrombolytic agent. These interventions successfully preserved the catheter, resolving the clot and ensuring continued functionality.

Analysis of Deep Vein Thrombosis: A Prospective Observational Study.

Objective This prospective observational study aimed to investigate the prevalence, acquired risk factors, and treatment outcomes of deep vein thrombosis (DVT) at a tertiary care center in India. Materials and methods Conducted from 2022 to 2024, the study included 100 patients diagnosed with lower extremity DVT. The study subjects included patients visiting the general surgery, vascular surgery, surgical gastroenterology, general medicine, emergency medicine, and obstetrics and gynecology departments with symptoms suggestive of DVT. The primary objectives were to evaluate the effectiveness of conventional anticoagulation and thrombolytic therapy as well as to assess the various acquired risk factors for DVT. Patients underwent comprehensive clinical and biochemical evaluations, including venous Doppler ultrasound, and were treated based on their clinical presentations. The study's primary end outcome was early recanalization rates on day 14 post-initiation of treatment and occurrence of post-thrombotic syndrome (PTS). Secondary outcome measures included duration of hospital stay, time taken to return to workand early complications. Results The highest incidence of DVT was in individuals in their forties, with a mean age of 44.84+/-11.71 years and a female preponderance of 58% (n=58). Key acquired risk factors identified included hypertension (25%; n=25), diabetes mellitus (20%; n=20), obesity (16%; n=16), and smoking (34%; n=34). Obesity (16%; n=16), a history of DVT (25%; n=25), trauma/immobilization (9%; n=9), pregnancy (10%; n=10), smoking (34%; n=34), and cancer (20%; n=20) were also identified as important acquired risk factors contributing to the occurrence of DVT. Amongst the study participants, 28% (n=28) had femoro-popliteal segment involvement, 36% (n=36) had calf vein thrombosis, and the remaining 36% (n=36) showed femoro-iliac segment thrombosis. Conventional anticoagulation was administered to 69% (n=69) of patients, while 31% (n=31) received thrombolytic therapy. Both treatments showed similar recanalization rates, but thrombolytic therapy was associated with a longer hospital stay (8.61+/-1.65 days; p=0.024; p<0.05) and return to work period (14.65+/-2.31 days; p=0.012; p<0.05). Post-thrombotic syndrome was less common in the thrombolytic therapy group (3%; n=3). Three patients died in the study, with the cause being pulmonary embolism. The descriptive statistics were computed to delineate the study sample. After completion of data collection, data analysis was achieved using SPSS for Windows, Version 16 (Released 2007; SPSS Inc., Chicago, United States), and the correlations sought after were achieved using the chi-square test of significance. Conclusion The study underscores the importance of recognizing and managing acquired risk factors for DVT, thereby facilitating early diagnosis and ultimately reducing morbidity and mortality. Understanding these factors and employing effective treatment strategies are crucial for better management and prevention of DVT, enhancing patient outcomes.

The choice of a method for restoring coronary blood flow in myocardial infarction with ST segment elevation (literature review)

In the structure of total mortality, cardiovascular diseases are in the first place in the world. The main and most common reason for this is the incidence of myocardial infarction (MI). The basis of the pathogenesis of MI with ST elevation is persistent and complete thrombotic occlusion of the large epicardial branch of the coronary artery, leading to extensive necrosis of the heart muscle with the development of life-threatening complications, including death, the frequency of which is 8–10 %. The prognosis for MI is influenced by the presence of risk factors, complications, hemodynamic status, polymorbidity, as well as tactics for restoring coronary blood flow. To eliminate acute coronary artery occlusion, conservative treatment is used – thrombolytic therapy, surgical – primary percutaneous intervention, thromboextraction, coronary bypass surgery, as well as their combination. Today, there are scattered and isolated studies characterizing the approach to treatment in patients with MI with ST elevation in various diseases and with polymorbid pathology, the relationship with risk factors and laboratory and instrumental data has not been established, among which predictors of rapid response and death in patients with polymorbid pathology for emergency physicians have not been determined. It can be assumed that the chosen optimal patient management tactics in a specific clinical situation, taking into account the above-mentioned factors, will reduce the development of complications and increase the survival rate of patients with MI.

Characteristics, management, and major adverse cardiac events of ST-elevation myocardial infarction (STEMI) patients in rural area: a Jember acute coronary syndrome medical records study

The mortality and morbidity of ST-elevation myocardial infarction (STEMI) remain high, and it is still the leading cause of death worldwide. Timely reperfusion lowers the risk of MACE and improves survival. However, reperfusion delay is still a significant issue in developing countries, particularly rural area. This study aimed to determine the characteristics, management, and major adverse cardiac events of STEMI patients in Jember Distric to enhance reperfusion therapy in rural areas. It was an analytical observational cross-sectional study with a quantitative method. A total of 108 medical records of STEMI patients of the Dr. Soebandi District Hospital, Jember in period of 2019 to 2020 were included using the consecutive sampling technique. As much as 78 (62%) of the patients did not receive reperfusion therapy while the remaining patients (41 or 38%) received the therapy, namely percutaneous coronary intervention (20 or 18.5%), fibrinolytic therapy (19 or 17.6%), and both (2 or 1.9%). Multivariate analysis for reperfusion was statistically significant (p=0.016; OR 3.688 95% CI: 1.274-10.679). The level of education, health funding, and distance to the hospital did not affect the delay of the reperfusion therapy. Reperfusion was highly associated with the incidence of MACE and this study discovered a threefold benefit of reperfusion in lowering the occurrence of MACE (p=0.016). In conclusion, the majority of STEMI patients does not get reperfusion therapy. Delays in reperfusion treatment are not related to the patient's level of education, health funding, or distance to the hospital. Nonetheless, the delay my be attributed to the Jember community's lack of awareness of STEMI symptoms.