Risk Of Deep Vein Thrombosis Research Articles

A Comparison between Enoxaparin and Aspirin in Preventing Deep Vein Thrombosis after Spine Surgery: A Randomized Clinical Trial.

Deep Vein Thrombosis (DVT) is a significant medical concern characterized by the formation of blood clots within the venous system. Surgical procedures are known to increase the risk of DVT. While enoxaparin has proven to be highly effective in treating DVT, concerns about bleeding and accurate dosage regulation may restrict its application. Recent research has focused on aspirin's potential in preventing DVT after various surgeries. This study aimed to determine whether aspirin was as effective as enoxaparin in preventing DVT after spine surgery. This randomized controlled trial enrolled study patients who underwent spine surgery at Shahid Kamyab Emergency Hospital in Mashhad, and had a Caprini score > 5, indicating a higher risk of DVT. In the control group, patients received subcutaneous injections of enoxaparin at a dosage of 40 mg, while the intervention group received oral aspirin tablets with a daily dosage of 81 mg. An experienced radiologist performed a Doppler ultrasound of the lower limbs' veins seven days after surgery to diagnose DVT. The outcomes of the two groups were then compared. A total of 100 patients participated in the clinical trial and were equally assigned to the aspirin and enoxaparin groups. Both groups were homogeneous regarding the basic and clinical characteristics. The incidence of postoperative DVT was 4.0% in the aspirin group and 10.0% in the enoxaparin group (p=0.092). The incidence of hemorrhage was 2.0% in the aspirin group and 4.0% in the enoxaparin group (p=0.610). These findings indicate that aspirin may be a promising alternative to enoxaparin for DVT prevention after surgery, but additional research is essential to validate these results and further assess the benefits and risks associated with aspirin usage in this context.

Embolic Risk of Deep Vein Thrombosis is not Related to the Nature of Proximal Clot

Embolic Risk of Deep Vein Thrombosis is not Related to the Nature of Proximal Clot

Use of antifibrinolytic therapy in orthopedic surgery: a review

Total joint arthroplasties, trauma, and spine surgery are correlated with a significant amount of bleeding. The severity of the bleeding might be substantial enough to require a blood transfusion to treat the resulting anemia. Antifibrinolytic therapy is used to reduce blood loss in orthopedic surgery. This review aimed to assess the recent research supporting the use of antifibrinolytic therapy to reduce blood loss in orthopedic surgery. In the last 10 years, the published studies determining antifibrinolytic therapy's effect on orthopedic surgery were searched in Google Scholar and PubMed. Antifibrinolytic agents are used in most surgical operations, including orthopedic surgery. It causes a significant reduction in blood loss and blood transfusion. In addition, antifibrinolytic therapy did not increase the risk of deep vein thrombosis in patients undergoing total joint arthroplasty. Tranexamic acid, epsilon aminocaproic acid, and aprotinin are the most popular fibrinolytic agents. Tranexamic acid is more frequently used in patients undergoing joint replacement, spine and trauma surgery. . Although aminocaproic acid has a more limited history of usage in orthopedic surgery than tranexamic acid, it has a more significant antifibrinolytic effect.

Deep venous thrombosis in autosomal dominant polycystic kidney

ABSTRACT Autosomal dominant polycystic kidney disease (ADPKD) is a prevalent genetic cystic condition that results in progressive loss of renal function. The disease is associated with various complications, including compression of adjacent structures like the inferior vena cava (IVC), which can lead to deep vein thrombosis (DVT) and ultimately, pulmonary embolism. This report details a case of a 41-year-old patient with ADPKD who presented with left leg DVT. Imaging revealed IVC compression due to enlarged kidneys, and blood tests indicated low levels of coagulation proteins C and S. The patient is hypertensive and has advanced renal failure (glomerular filtration rate [GFR] 12.6 mL/min) but has not yet initiated dialysis. The patient was initiated on treatment with the novel oral anticoagulant, apixaban, and exhibited favorable outcomes. His DVT is believed to be the result of multiple factors acting in concert. IVC compression, a significant precipitant doctor of DVT, is frequently observed in ADPKD patients, with rates as high as 15% in severe cases and 15% in mild cases, according to a study by Yin et al. The incidence of venous thromboembolism (VTE) in patients with chronic kidney disease increases as GFR decreases, with rates 2.5–5.5-fold higher in moderate-to-severe end-stage renal disease than in the general population. VTE is a multifactorial disease with both acquired and inherited thrombophilia factors. This particular case presents a unique event within our medical practice, as it is relatively uncommon to witness such a correlation between DVT and polycystic kidney disease. It serves as an exemplification of a case that necessitates diligent monitoring due to the heightened risk of recurrent DVT.

Precision nursing and intermittent pneumatic compression significantly reduce perioperative deep vein thrombosis in post-surgical ovarian cancer patients.

This study investigated the efficacy of precision nursing combined with intermittent pneumatic compression (IPC) devices in preventing perioperative deep vein thrombosis (DVT) in patients with ovarian cancer. A retrospective analysis was conducted on 136 ovarian cancer surgery patients at Xi'an People's Hospital from February 2019 to April 2023. The patients were divided into two groups: 71 patients received precision nursing with IPC intervention (study group), while the remaining received standard nursing care (control group). Key variables analyzed included operation duration, intraoperative blood loss, postoperative blood transfusion requirements, changes in limb circumference, and variations in coagulation parameters activated partial thromboplastin time (APTT), D-Dimer (D-D), Fibrinogen (FIB), and Prothrombin Time (PT) before and after surgery. The incidence of DVT was recorded in both groups to determine risk factors for deep vein thrombosis. No significant differences were observed between the groups regarding operation duration, intraoperative blood loss, and postoperative blood transfusion rates (P > 0.05). Post-intervention, significant improvements were noted in the study group, with reduced FIB and D-D levels and increased PT and APTT levels compared to the control group (P < 0.05). Furthermore, the study group exhibited a significantly smaller post-intervention difference in limb circumference and a lower incidence of DVT (P=0.003). Precision nursing combined with IPC, pre-intervention D-D < 498.5, and FIGO stages III+IV were identified as independent factors against DVT development. Precision nursing paired with an IPC device significantly reduces the risk of perioperative DVT in ovarian cancer patients compared to conventional care.

Risperidone Associated With Acute Pulmonary Thromboembolism: A Case Report

Antipsychotic drugs (APs) are widely used drugs for schizophrenia. For decades, these agents are frequently associated with some side-effects, including increased the risk of Venous Thromboembolism (VTE). A case of a man (53 years old) with schizophrenia was reported in this study. The man with no identified risk factor for thromboembolism, and developed Pulmonary Embolism (PE) and Deep Vein Thrombosis (DVT) after treatment with risperidone 2 years. The current case indicates that use of risperidone for long time can be associated with the risk of PTE and DVT. Risperidone is a Second-Generation Antipsychotic medication (SGA), as a mixed serotonin 5HT2 and dopamine D2 receptor antagonist possibly implicated in this adverse event. As suggested by this observation, VTE and PTE risk not just appears to new users, so they should be vigilant monitored to ensure early detection and prompt treatment of VET and PTE during medication.

Serum VEGF, P-Selectin, HDL-C, Platelet Index, and Coagulation Function Index in Deep Vein Thrombosis after Traumatic Fracture.

The goal was to investigate the relationship between serum vascular endothelial growth factor (VEGF), P-selectin, high-density lipoprotein cholesterol (HDL-C), platelet parameters, and coagulation function indexes and postoperative deep vein thrombosis (DVT) in patients with traumatic fracture. A total of 150 patients with traumatic fractures after DVT were selected as the DVT group, and 150 patients with traumatic fractures without DVT during the same period were selected as the non-DVT group. Serum VEGF, P-selectin, HDL-C, platelet parameters including platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), platelet large cell ratio (P-LCR), and plasma coagulation function indexes including thrombin time (TT), prothrombin time (PT), activated partial thrombin time (APTT), fibrinogen (FIB), and D-dimer (D-D) were measured. Pearson's correlation was performed to analyze the correlation between serum VEGF, P-selectin, and coagulation function indexes, and binary logistic regression was used to analyze the risk factors of DVT. Serum VEGF and P-selectin in the DVT group were higher while HDL-C was lower than those in the non-DVT group (p < 0.05). Serum VEGF and P-selectin were negatively correlated with plasma D-D and FIB (p < 0.05), and serum HDL-C was negatively correlated (p < 0.05). Compared with the non-DVT group, MPV, PDW, and P-LCR in the DVT group were decreased (p < 0.05). Multivariate logistic regression analysis showed that P-LCR was a risk factor for postoperative DVT in patients with traumatic fractures (p < 0.05). Serum VEGF and P-selectin are higher and HDL-C is lower in patients with DVT after postoperative traumatic fracture than in patients without DVT. Combined detection of serum VEGF, P-selectin, HDL-C, and coagulation function indexes may help to reduce the risk of DVT. Platelet parameters (MPV, PDW, P-LCR) have certain reference values for the clinical diagnosis and disease evaluation of DVT.

A Bidirectional two-Sample Mendelian Randomization Study of the Association Between Venous Thromboembolism and Ischaemic Stroke.

Previous clinical and epidemiological studies have shown that patients with venous thromboembolism (VTE) are comorbid with symptoms of ischaemic stroke (IS). Current understanding about increased risk of IS after VTE remain inconclusive. This study use a bidirectional two-sample Mendelian randomization (MR) study to explore the causality of VTE, pulmonary embolism (PE), deep vein thrombosis (DVT), and IS. This study used pooled data from published genome-wide association studies (GWAS). GWAS statisics of IS (from EBI database, n = 484 121), VTE (from Finngen database, n = 218 792), PE (from Finngen database, n = 218 413), and DVT (from UK biobank database, n = 337 159) were assessed. Forward and reverse MR analysis were conducted to explore the causal relationship between three type of the exposure (VTE, PE, and DVT) and the outcome (IS). Our primary causal inference method was Inverse Variance Weighted (IVW). Secondary inference methods were Weighted Median and MR-Egger. For the sensitive analysis, MR-PRESSO, MR-Egger intercept, Cochran's Q, leave-one method were used to consolidate our findings. In the foward MR analysis, VTE increased the risk of IS (ORIVW = 1.034, PIVW = 0.021) and PE was also a risk factor for IS (OR = 1.055, PIVW = 0.009). There was no causality that DVT influenced on IS (PIVW > 0.05). In the reverse MR analysis, IS came to be a risk factor for DVT (OR = 1.003, PIVW = 0.046). Meanwhile, IS took not any causal effect on VTE and PE. All the results passed the reasonable sensitive analysis. Our findings provided genetic evidence that PE and VTE can lead to an increased risk of IS, whereas increased IS promoted the risk of DVT further. Our findings provided novel insights about the risk factors and management for IS.

Prevalence of symptomatic deep vein thrombosis (DVT) in patients with temporary double lumen dialysis femoral catheterization-Experience from Multan institute of kidney diseases Multan (MIKD).

Objective: The study was conducted in Multan institute of kidney diseases to explore the DVT prevalence after double lumen dialysis femoral catheterization for haemodialysis.&#x0D; Methodology: Retrospective cross sectional study was conducted in Multan Institute of Kidney Diseases, all double lumen dialysis femoral catheters passed over a period of five years (sep-2017 to sep-2022) were included in study, identified from electronic system of hospital. Except for those with temporary femoral catheters, all patients met the exclusion criteria. SPSS version 25 was used for data analysis and prevalence of DVT was calculated.&#x0D; RESULTS: Total 6628 patients with a mean age of 48(range 14 -90 years) were catheterized, 4105(61.9%) males and 2523(38.1%) were females, right sided catheters were 1826(27.5%) and 4802(72.5%) patients underwent left sided insertions. Duplex ultrasound was done of all symptomatic 252(3.8%) patients and femoral DVT was confirmed in 174(2.6%) that is 69% of symptomatic patients. The incidence of DVT significantly (3.7 fold) increase at day six and onward. Prevalence of DVT is 2.6% in all catheterized and 69% of symptomatic patients.&#x0D; Conclusion: Femoral vein remains an important emergency haemodialysis access route. Physicians inserting femoral venous catheters should be aware of the risk of lower extremity DVT from day three and consider performing duplex ultrasound examinations at day five and onwards if it is extremely necessary to be kept in situ for this duration, otherwise attention should be paid gaining access elsewhere at earliest possible opportunity.

Predictive value of three kinds of thrombosis risk assessment scale for lower extremity deep vein thrombosis after hip fracture in elderly patients

To explore predictive value of Caprini score, Wells score and Autar score for lower extremity deep vein thrombosis (DVT) after hip fracture in elderly patients. A total of 310 elderly patients with hip fracture were selected from January 2018 to September 2022. According to the lower extremity color ultrasound examination results, 155 patients with DVT were divided into thrombosis group, included 42 males and 113 females, aged from 60 to 101 years old with an average of (80.58±8.84) years old; and 155 patients without DVT were divided into control group, included 58 males and 97 females, aged from 60 to 94 years old with an average of (79.01±8.99) years old. Caprini score, Wells score and Autar score immediately after admission were collected and compared between two groups. Receiver operating characteristic (ROC) curve was used to evaluate predictive value of three thrombus risk assessment tables for DVT after hip fracture in elderly patients. Caprini score, Wells score and Autar score in thrombus group were significantly higher than those in control group (P<0.001). ROC curve analysis results showed that the best cut-off value of Caprini score was 8.5 points, the sensitivity was 46.5%, the specificity was 99.4%, and area under the curve(AUC) was 0.763. The best cut-off value of Wells score was 1.5, the sensitivity was 100%, the specificity was 99.4%, and AUC was 0.998. The best cut-off value of Autar score was 10.5 points, the sensitivity was 58.1%, the specificity was 84.5%, and AUC was 0.717. Caprini scale, Wells scale and Autar scale all have good predictive efficacy for the risk of DVT in elderly patients with hip fracture, and could provide an important reference for clinical guidance for prevention, management and treatment of DVT after hip fracture in elderly patients, among which Wells scale has a higher predictive value.

Non-Vitamin K Antagonist Oral Anticoagulants versus Low Molecular Weight Heparin for Cancer-Related Venous Thromboembolic Events: Individual Patient Data Meta-Analysis.

Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in cancer patients. Low molecular weight heparin (LMWH) has been the standard of care but new guidelines have approved the use of non-vitamin K antagonist oral anticoagulants (NOAC). By conducting an individual patient data (IPD) meta-analysis of randomised controlled trials (RCTs) comparing the outcomes of NOAC versus LMWH in cancer patients, we aim to determine an ideal strategy for the prophylaxis of VTE and prevention of VTE recurrence. Three databases were searched from inception until 19 October 2022. IPD was reconstructed from Kaplan-Meier curves. Shared frailty, stratified Cox and Royston-Parmar models were fit to compare the outcomes of venous thromboembolism recurrence and major bleeding. For studies without Kaplan-Meier curves, aggregate data meta-analysis was conducted using random-effects models. Eleven RCTs involving 4844 patients were included. Aggregate data meta-analysis showed that administering NOACs led to a significantly lower risk of recurrent VTE (RR = 0.65; 95%CI: 0.50-0.84) and deep vein thrombosis (DVT) (RR = 0.60; 95%CI: 0.40-0.90). In the IPD meta-analysis, NOAC when compared with LMWH has an HR of 0.65 (95%CI: 0.49-0.86) for VTE recurrence. Stratified Cox and Royston-Parmar models demonstrated similar results. In reducing risks of recurrent VTE and DVT among cancer patients, NOACs are superior to LMWHs without increased major bleeding.

Muscle specific declines in oxygen saturation during acute ambulation with hands-free and conventional mobility devices.

Disuse is associated with reduced muscle oxygen saturation (SmO2). Improving oxygen delivery to tissues is important for healing, preventing muscle atrophy, and reducing the risk of deep vein thrombosis. Mobility devices are used during disuse periods to ambulate and protect the injured limb. This study examined SmO2 in walking and ambulation with various mobility devices. Thirty-eight participants randomly completed four, ten-minute trials which included: (1) walking, (2) medical kneeling scooter (MKS), (3) hands-free crutch (HFC), and (4) axillary crutch (AC). During each trial, near infrared spectroscopy sensors were placed on the vastus lateralis (VL), biceps femoris (BF), and lateral gastrocnemius (LG) of the right limb. Compared to walking, all mobility devices showed a decline in SmO2 in the VL of ∼10% (mean ± SD; 75% ± 12%-65% ± 17%, P < 0.05). In the BF, SmO2 declined ∼9% in AC compared to walking (76% ± 12%-67% ± 17%, P = 0.025). In the LG, SmO2 declined in AC (64% ± 16%) compared to MKS (70% ± 15%, P = 0.005). There were no differences in LG SmO2 compared to walking (69% ± 13%) in MKS (P > 0.05) or HFC (65% ± 15%, P > 0.05). In young, healthy volunteers, the use of mobility devices altered muscle oxygenation in several muscles. AC reduced muscle oxygenation in the VL, BF, and LG; while MKS and HFC maintained BF and LG muscle oxygenation at a level consistent with ambulatory walking.

Risk assessment scales to predict risk of lower extremity deep vein thrombosis among multiple trauma patients: a prospective cohort study

BackgroundDeep vein thrombosis (DVT) is a common complication in orthopedic patients. Previous studies have focused on major orthopedic surgery.There are few studies with multiple trauma. We aimed to describe the prevalence of DVT and compare the predictive power of the different risk assessment scales in patients with multiple trauma.MethodsThis prospective cohort study involved multiple trauma patients admitted to our hospital between October 2021 and December 2022. Data were prospectively collected for thrombotic risk assessments using the Risk Assessment Profile for thromboembolism(RAPT), the DVT risk assessment score (DRAS), and the Trauma Embolic Scoring System (TESS), respectively. The receiver operation characteristic (ROC) curve and the area under the curve (AUC) were evaluated to compare the predictive power. The whole leg duplex ultrasound of both lower extremities Doppler ultrasound was used to determine DVT incidence.ResultsA total of 210 patients were included, and the incidence of DVT was 26.19%. Distal DVT accounted for 87.27%; postoperative DVT, 72.73%; and bilateral lower extremity thrombosis, 30.91%. There were significant differences in age, education degree, pelvic fracture, surgery, ISS, D-dimer level, length of hospital stay and ICU stay between the thrombosis group and the non-thrombosis group. The AUCs for RAPT, DRAS, and TESS were 0.737, 0.710, and 0.683, respectively. There were no significant differences between the three ROC curves.ConclusionsThe incidence of DVT was relatively high during hospitalization. We prospectively validated the tests to predict risk of DVT among patients with multiple trauma to help trauma surgeons in the clinical administration of DVT prophylaxis.

Analysis of Inferior Vena Cava Filter Indications and Retrieval Rates at an Academic Medical Center in Appalachia

Introduction: Inferior vena cava (IVC) filters are placed for prevention of pulmonary embolism in patients with venous thromboembolism (VTE) and a contraindication to anticoagulation. Additional clinical indications for IVC filters, such as pre-operative prophylaxis for VTE and extensive VTE, are controversial and vary across clinical guidelines. Current guidelines recommend that IVC filters be retrieved after resolution of their clinical indication. A common problem is failure to retrieve IVC filters when indicated, resulting in prolonged or indefinite placement of these devices. Failure to remove IVC filters contributes to an increased risk of filter-associated complications such as device migration, embolization to the cardiopulmonary circulation, perforation and increased risk of deep vein thrombosis (DVT). The goal of this study is to identify IVC filter indications and retrieval statistics at our academic medical center in Appalachia. We seek to compare our performance to national averages, identify the reasons for failure of retrieval in our patient population and develop quality improvement initiatives to improve our performance. Methods: An IRB-approved, single-institution, retrospective chart review was conducted for all patients who had an IVC filter placed between January 2020 and December 2022 at West Virginia University Hospital. Patient demographics, comorbidities, placement indications, retrieval statistics and filter-associated complications were obtained from the electronic medical record (EMR). Patients who had a permanent IVC filter placed were excluded from the final analysis. Statistical analysis was performed using Mann-Whitney U and Chi squared tests where appropriate to compare the retrieval and failure of retrieval groups. Results: The study sample (n=450) had a mean age of 65.3±15.4 years and was comprised of 54.2% males and 45.8% females. West Virginia residents comprised 82.4% of the study sample. The most common reported clinical indications for placement included VTE with a contraindication to anticoagulation (62.4%), preoperative prophylaxis for VTE (15.8%), extensive VTE (15.3%), pharmacomechanical thrombectomy (15.0%) or other (3.1%). The rate of IVC filter retrieval was 25.4% (n=114). The most common reasons for failure of retrieval were loss to follow-up (31.8%), other reasons including provider or patient preference (31.5%), patient death (28.3%), clinical indication remains present (5.7%) and unsuccessful retrieval (2.7%). Patients in the failure of retrieval group (n=114) were significantly older (69 vs 61 years, p&amp;lt;0.001) and had a higher frequency of clinical indications for history of VTE with a contraindication to anticoagulation (231 vs 50 patients, p&amp;lt;0.0001) and extensive VTE (49 vs 20 patients, p&amp;lt;0.0001) compared to retrieval group (n=336). There was a nonsignificant trend toward greater frequency of chronic conditions in the failure of retrieval group including cancer history (101 vs 26 patients, p=0.15), heart failure (44 vs 11, p=0.41) and hypercoagulable disease (16 vs 2 patients, p=0.26). Conclusions: Our institution had a lower IVC filter retrieval rate than the estimated average of 34% reported in a systematic review by Angel et al. Patients with comorbid conditions tended to not undergo retrieval, predisposing them to a higher risk of filter-associated complications. A history of VTE with a contraindication to anticoagulation was the most common clinical indication for placement, but the other most common indications are not universally guideline recommended which identified an area of opportunity for multidisciplinary provider education. Patient loss to follow-up is the predominant reason for failure of retrieval at our institution, which is consistent with the healthcare disparity faced by our predominantly rural, Appalachian patient population of travelling long distances to our tertiary center to obtain specialty care. Quality improvement strategies to mitigate this limitation in the context of IVC filter placement through close local follow-up for timely reassessment, retrieval evaluation and removal will be developed.

Sickle Cell Trait Is Associated with Adverse Clinical Outcomes in a Matched Case-Control Study at a Tertiary Care Center

Background: Sickle cell trait (SCT) is a common condition affecting more than 300 million individuals worldwide and 3 million in the United States. Although generally believed to be an asymptomatic condition, there is growing data to suggest potential associations with morbidity, including risk for venous-thromboembolic events and chronic kidney disease. Methods: We conducted this retrospective cohort study using electronic health record data from the University of Colorado Health Data Compass data warehouse. Patients with a coded diagnosis of SCT were analyzed for SCT-related clinical outcomes compared against a 1:1 randomized matched sample of controls without a history of SCT (matched on age, race, sex). Individuals with sickle cell disease, Sickle-cell/Hb-C disease, sickle-thalassemia, other sickle cell disorders, and hemolytic anemias were excluded from both case and control groups. Outcomes included chronic kidney disease (CKD), deep vein thrombosis (DVT), pulmonary embolism (PE), hematuria, rhabdomyolysis, and splenic infarction. Multivariate logistic regression was used to examine the association of each condition based on SCT carrier status, adjusting for age, sex, and race. Results: We included 1447 SCT patients with complete demographic data, along with 1447 matched controls (n = 2894). There were 1019 (70.4%) women and 428 (29.6%) men in each case and control group. A majority (72.7%) were black or African American. The median age of the cohort was 36 years (IQR = 28 - 47). We found significant associations for CKD (OR = 2.95, 95% CI: 2.03 - 4.30), DVT (2.54, 95% CI: 1.42 - 4.54), PE (OR=4.25, 95% CI: 2.43 - 7.45), and hematuria (OR= 2.28, 95% CI: 1.57 - 3.31). (Table) Despite few overall events and wide confidence intervals, association remained significant for rhabdomyolysis (OR=3.32, 95% CI 1.07 - 10.24) and splenic infarction (OR=44.9, 95% CI 6.15 - 328.00). Male sex was strongly associated with splenic infarction (OR = 8.70, 95% CI 4.11 - 18.41) and rhabdomyolysis (OR = 19.14, 95% CI 4.35 - 84.18). Conclusion: In this case-control cohort study we found significantly increased risk for CKD, DVT, PE, hematuria, rhabdomyolysis, and splenic infarction for patients with sickle cell trait with odds ratios similar to those seen in other study cohorts. The significant morbidity associated with this common genotype warrants further research into primary prevention of SCT associated adverse outcomes.

Association between Hereditary Angioedema and Venous Thromboembolism in a Large Population-Based Case-Control Study

Introduction: Hereditary Angioedema (HAE) is a rare congenital disorder primarily caused by mutations in the SERPING1 gene that results in C1 inhibitor (C1INH) deficiency or dysfunction. C1INH is a multifunctional serine protease inhibitor that functions as a major endogenous negative regulator of the kallikrein-kinin, contact pathway of coagulation and complement systems. HAE typically presents with episodes of unpredictable subcutaneous and submucosal swelling. However, HAE patients also have evidence of systemic activation of coagulation including elevated plasma prothrombin fragments, thrombin antithrombin complexes and D-dimers. Further, patients with HAE have recently been reported to have an increased risk of venous thromboembolism (VTE). Methods: To evaluate the risk of VTE in patients with HAE we conducted a large population-based case-control study leveraging data from the United Kingdom Clinical Practice Research Datalink (CPRD). The CPRD Aurum dataset used here maintains anonymized electronic medical records of over 40 million individuals from over 1600 primary care practices in the United Kingdom. SNOMED CT medical codes were used to identify a cohort of 2,198 patients diagnosed with HAE between 1992 and 2022 in the CPRD Aurum dataset with a matched (age, gender, family practice, and index date for HAE) cohort of 4,376 controls selected. VTE events including deep vein thrombosis (DVT) and pulmonary embolism in the HAE case and control cohorts were identified using SNOMED CT medical codes. The Cox proportional hazards model was used to determine hazard ratios (HR) for VTE events in HAE cases versus controls adjusting for covariates age, sex, body mass index, blood pressure, smoking status and a number of co-morbidities specifically; neoplasm, type 2 diabetes, ischemic heart disease, chronic obstructive pulmonary disease, chronic kidney disease, autoimmune disorders and depression. Results: A greater proportion of the HAE cases were female (62%) with a mean age at HAE diagnosis of 37 years. The median follow-up period for both cases and controls was 17 years (interquartile range (IQR):8-28 years). The overall incidence of VTE in HAE cases was 1.1/1000 patient years versus 0.6/1000 patient years in the control cohort. In unadjusted analyses HAE was associated with a significantly increased risk of VTE (HR 1.70, 95% CI 1.37-2.22, P&amp;lt;0.0001). Importantly, in adjusted analyses HAE remained significantly associated with an increased risk of VTE (HR 1.44, 95% CI 1.12-1.83, P=0.004, Figure 1). Of note, this association is similar in magnitude to that previously reported for heterozygous carriers of FV Leiden, the prothrombin gene mutation and high confidence loss of function mutations in Protein C and Protein S in comparable population-based case-control studies. In adjusted sub-analyses HAE was associated with a significantly increased risk of DVT (HR: 1.42, 95% CI 1.09-1.87, P=0.01) with a trend towards an increased risk of PE (HR 1.37, 95% CI 0.84-2.27, P=0.2). Conclusions: The results of this population-based case-control study, roughly an order of magnitude larger in size than prior reports, demonstrate that HAE is associated with a significantly increased risk of VTE similar to that reported for common hereditary thrombophilias. These findings reinforce the important role of endogenous C1INH as a negative regulator of prothrombotic processes involved in VTE in the setting of HAE.

Hip Fracture and Its Complications in Elderly: A Literature Review

Hip fractures, a common injury among the elderly, are associated with a range of significant complications. This literature review provides a comprehensive overview of the epidemiology, types of hip fractures, and their complications. These complications encompass high mortality rates, mobility and functional impairment, delirium, pressure ulcers, infections, and an increased risk of deep vein thrombosis and pulmonary embolism. Surgical management and rehabilitation are critical components of treatment. Understanding the complexities of hip fractures and their associated complications is essential for healthcare professionals to improve patient care and outcomes in this population. Further research is needed to develop effective preventive and therapeutic strategies to minimize the impact of these fractures on individuals' lives.&#x0D; &#x0D; Received: 14 October 2023 / Accepted: 16 November 2023 / Published: 23 November 2023

Risk of deep vein thrombosis (DVT) in lower extremity after total knee arthroplasty (TKA) in patients over 60 years old

PurposeThere is a significant risk of DVT after TKA. We aim to evaluate the potential risk factors for postoperative DVT in the lower extremities in TKA patients over 60 years of age and provide a reference for the effective prevention of DVT.MethodsThis retrospective study included patients older than 60 who underwent TKA surgery in our hospital from May 2015 to May 2022 and compared and analyzed patients' personal characteristics and clinical data with or without postoperative DVT. Logistic regression analysis was performed to determine the potential risk factors for DVT after TKA. The sensitivity and specificity of each risk factor in the diagnosis of DVT were compared by the ROC curve, and the value of this model in the diagnosis of DVT was further investigated using a multivariable combined diagnosis ROC curve model.ResultsA total of 661 patients over 60 who underwent TKA were included. Preoperative Hematocrit (HCT), platelet count, anesthesia mode, postoperative D-dimer, ESR, diabetes mellitus, and other aspects of the DVT group and non-DVT group were statistically significant after TKA (P < 0.05). Multivariate logistics regression analysis showed that preoperative HCT, anesthesia mode, and diabetes were independent risk factors for DVT in patients over 60 years old after TKA. Compared with the univariate ROC model, the multivariable combined ROC curve analysis model has a higher diagnostic value for the diagnosis of DVT.ConclusionDVT is common in patients over 60 years of age after TKA, and there is a multivariable influence on its pathogenesis. For patients over 60 with diabetes, neuraxial anesthesia is recommended for patients with high preoperative HCT levels, which may reduce the incidence of postoperative DVT.

A phenome-wide approach to identify causal risk factors for deep vein thrombosis

Deep vein thrombosis (DVT) is the formation of a blood clot in a deep vein. DVT can lead to a venous thromboembolism (VTE), the combined term for DVT and pulmonary embolism, a leading cause of death and disability worldwide. Despite the prevalence and associated morbidity of DVT, the underlying causes are not well understood. Our aim was to leverage publicly available genetic summary association statistics to identify causal risk factors for DVT. We conducted a Mendelian randomization phenome-wide association study (MR-PheWAS) using genetic summary association statistics for 973 exposures and DVT (6,767 cases and 330,392 controls in UK Biobank). There was evidence for a causal effect of 57 exposures on DVT risk, including previously reported risk factors (e.g. body mass index—BMI and height) and novel risk factors (e.g. hyperthyroidism and varicose veins). As the majority of identified risk factors were adiposity-related, we explored the molecular link with DVT by undertaking a two-sample MR mediation analysis of BMI-associated circulating proteins on DVT risk. Our results indicate that circulating neurogenic locus notch homolog protein 1 (NOTCH1), inhibin beta C chain (INHBC) and plasminogen activator inhibitor 1 (PAI-1) influence DVT risk, with PAI-1 mediating the BMI-DVT relationship. Using a phenome-wide approach, we provide putative causal evidence that hyperthyroidism, varicose veins and BMI enhance the risk of DVT. Furthermore, the circulating protein PAI-1 has a causal role in DVT aetiology and is involved in mediating the BMI-DVT relationship.

Prospective validation of a unique pretest probability score for preoperative deep vein thrombosis

Abstract Background Venous thromboembolism is a crucial perioperative complication. We developed a pretest probability score (KAGOSHIMA DVT score) for predicting deep vein thrombosis (DVT) before surgery. The purpose of our study was to validate KAGOSHIMA DVT score prospectively. Methods KAGOSHIMA DVT score was assigned 2 points to D-dimer ≥ 1.5 μg/mL and 1 point each to age ≥ 60 years, female, ongoing glucocorticoid therapy, cancer with high risk of DVT and prolonged immobility. KAGOSHIMA DVT score of 3 points or higher was defined as intermediate group, 5 or higher as high group. We included a total of 4051 patients planned surgery under general anesthesia between May 2022 and February 2023. 452 patients were performed whole leg ultrasonography suspected DVT using a cutoff point of D-dimer ≥ 1μg/ml, KAGOSHIMA DVT score of 3 points or higher. We excluded aneurysm, pregnancy, ongoing anticoagulant therapy, and other thrombosis. We validated 253 patients of the presence of DVT. Results DVT was detected in 93/253 (36.8%) patients, 64/200 (32%) in the intermediate probability group, and 29/53 (54.7%) in the high group, respectively. The prevalence of DVT increased with each increase in KAGOSHIMA DVT score. D-dimer ≥ 1.5 μg/mL (92% vs 100%, p=0.033), age ≥ 60 years (86.5% vs 96.2%, p=0.048), female (53% vs 96.2%, p&amp;lt;0.001), glucocorticoids (6.5% vs 22.6%, p=0.001), active cancer with high risk of DVT (23% vs 64.2%, p&amp;lt;0.001), and prolonged immobility (4.5% vs 22.6%, p&amp;lt;0.001) were significantly higher in the high probability group than the intermediate group. The number of whole-leg ultrasonography decreased from 461 to 253(54.7%) during the same period. In the intermediate group, the detection rate of DVT was a significantly higher in the prospective study than in the retrospective study (21.4% vs 32%, p=0.012). In the high probability group, there was no significant difference (48.2% vs 54.7%, p=0.49). Conclusion KAGOSHIMA DVT score stratified perioperative DVT probability and was useful to detect DVT prospectively.rate of DVT